title: Virtual morphological comparison of three intramedullary nailing systems for the treatment of proximal humeral fractures.
abstract: Proximal humerus fractures treated with intramedullary nails show good results. However, the correct anatomical reconstruction of four-part fractures is demanding especially when using intramedullary nails. We therefore compared different intramedullary nail designs for the proximal humerus in a virtual morphological manner. Three commercially available nailing systems where virtually implanted in virtually generated reproducible four-part fractures of 25 digitised humeri. The objective of this study was to quantify and characterise the anatomical position of the proximal screws in the most vulnerable case of a four-part fracture. Taking into account a minimum distance of 5mm between the screw head and the fracture line, osteosynthesis was possible in 54 out of 75 cases. Difficulties placing the proximal screws could be observed at the localisation of the lower lesser tubercle or/and at the sulcus intertubercularis. This morphological analysis could be the basis for choosing the most sufficient implant intra operatively or even improving the nail design.
authors.affiliation: St. Vinzenz Clinic Pfronten, Department for Surgery and Orthopedics, Kirchenweg 15, 87459 Pfronten, Germany. Electronic address: T.Harnoss@googlemail.com.
authors.forename: Tobias
authors.initials: T
authors.lastname: Harnoss
authors.affiliation: Munich University of Applied Sciences, Lothstr. 34, 80335 Munich, Germany. Electronic address: berndfelkel@yahoo.de.
authors.forename: Bernd
authors.initials: B
authors.lastname: Felkel
authors.affiliation: Department of Traumatology and Reconstructive Surgery, BG Unfallklinik, Eberhard Karls Universität Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany. Electronic address: sdoebele@bgu-tuebingen.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Döbele
authors.affiliation: Munich University of Applied Sciences, Lothstr. 34, 80335 Munich, Germany. Electronic address: u.schreiber@tum.de.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schreiber
authors.affiliation: Clinic of Orthopedics and Traumatology, Department for Sport Orthopedics, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675 Munich, Germany. Electronic address: papandi@gmx.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Lenich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D006811:Humerus / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014584:User-Computer Interface
keywords: Fracture; Intramedullary nailing; Proximal humerus; Virtual comparison