title: Proximal humeral fractures: an understanding of the ideal plate positioning.
abstract: OBJECTIVE
  The present study aims to evaluate if the bicipital groove can be used as a parameter for ideal plate positioning in proximal humeral fixation applying locking compression plate.
  
  
  METHODS
  The authors questioned whether the bicipital groove can be used as a parameter for ideal plate positioning applying locking compression plate for proximal humeral fractures. A method using the bicipital groove as the main parameter was developed using computed tomography scan (CT-scan). Seventy shoulders presenting fracture absence were used to calculate proper plate positioning, allowing the largest area for locked screw placement into the humeral head. Intraclass correlation coefficient and Bland and Altman graphics calculated intra-observer reliability for CT-scan evaluation.
  
  
  RESULTS
  All observers presented satisfactory plate positioning using this method. The mean differences for observers were close to zero, suggesting high interobserver reproducibility. A significant (p <0.0001) intra-observer agreement existed for the three evaluators. Observer 2 agreement was the strongest (ICC = 0.98), showing almost perfect reproducibility measurement, followed by observer 3 (ICC = 0.84) with good reproducibility, and lastly observer 1 demonstrated moderate degree agreement (ICC = 0.47).
  
  
  CONCLUSIONS
  Considering the CT-scan analysis, the bicipital groove can be used as a parameter for ideal plate positioning in proximal humeral fractures. This method demonstrated satisfactory intra-observer reproducibility. Adopting this method, longer and better distributed screw placement provides more stable fixation for proximal humeral fractures.
authors.affiliation: Department of Orthopaedic Surgery, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil.
authors.forename: Pedro José
authors.initials: PJ
authors.lastname: Labronici
authors.forename: Rodrigo Pires
authors.initials: RP
authors.lastname: e Albuquerque
authors.forename: Vinícius
authors.initials: V
authors.lastname: Schott
authors.forename: Robinson Esteves Santos
authors.initials: RE
authors.lastname: Pires
authors.forename: Willian Dias
authors.initials: WD
authors.lastname: Belangero
authors.forename: José Sérgio
authors.initials: JS
authors.lastname: Franco
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed