Ewha Med J.  2024 Apr;47(2):e25. 10.12771/emj.2024.e25.

The use of the bicipital groove as an intraoperative landmark for proximal humeral rotation during fracture fixation

• Lee HJ
• Joung S
• Kholinne E
• Lee SJ
• Yoon JP
• Tan J
• Jeon IH

• KMID: 2556314
• DOI: http://doi.org/10.12771/emj.2024.e25

Abstract

Objectives
This study aimed to quantify the relationship between proximal humeral rotation and the lateral border of the bicipital groove on fluoroscopic imaging.
Methods
A composite normal humerus with a marker placed on the lateral border of the bicipital groove was affixed to a custom rotation device at the proximal cut segment. Consecutive fluoroscopic images were captured from −60° to 60° in 5° increments and from −15° to 15° in 1° increments. The index value was calculated by taking the ratio of the distance from the medial boundary of the proximal humerus to the lateral border of the bicipital groove to the distance between the medial and lateral boundaries of the proximal humerus. The correlation between the humeral rotation and the index value was determined.
Results
The index value showed a strong positive linear correlation position during internal rotation of the humerus across the entire range (r=0.998, P<0.001), as well as when the humerus was externally rotated, ranging from 15° of internal rotation to 15° of external rotation (r=0.991, P<0.001).
Conclusion
The lateral border of the bicipital groove may serve as a useful intraoperative landmark for assessing proximal humeral rotation. This could potentially enhance the outcomes of humeral fracture repair and upper arm arthroplasty.

Keyword

Humerus; Anatomic models; Anatomic landmarks; Rotation

Figure

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  Fig. 1. Experimental setting. The motor–humerus complex was positioned on a radiolucent table under a C-arm. Using the rotation device, the proximal part was rotated, while the cut distal part was fixed. A fluoroscopic image was taken at each consecutive rotational position.

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  Fig. 2. A custom program. After making a block, two lines (green lines) are automatically generated. Lines from the medial and lateral boundary of the humeral head to the lateral border of the bicipital groove can be drawn perpendicularly to the green lines. The program calculated the index value.

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  Fig. 3. Linear correlation between the index value and humeral rotation. A strongly positive correlation was observed within the range from 15° of internal rotation to 15° of external rotation.

Reference

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