Plain Radiograph Analysis of the Distal Humerus Posterior Bowing That May Affect Interlocking Intramedullary Nailing for Humerus Shaft Fracture

Jaekwang Yum; Kyunghwan Boo; Minkyu Sung; Jiseok Jang

doi:10.4055/jkoa.2015.50.1.31

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Yum, Boo, Sung, and Jang: Plain Radiograph Analysis of the Distal Humerus Posterior Bowing That May Affect Interlocking Intramedullary Nailing for Humerus Shaft Fracture

Original Article

Journal of the Korean Orthopaedic Association 2015; 50(1): 31-36.

Published online: 28 February 2015

DOI: https://doi.org/10.4055/jkoa.2015.50.1.31

Plain Radiograph Analysis of the Distal Humerus Posterior Bowing That May Affect Interlocking Intramedullary Nailing for Humerus Shaft Fracture

Jaekwang Yum, M.D., Ph.D., Kyunghwan Boo, M.D., Minkyu Sung, M.D., Jiseok Jang, M.D.

Department of Orthopaedic Surgery, Sanggye Paik Hospital, Inje University of College of Medicine, Seoul, Korea.

Correspondence to: Kyunghwan Boo, M.D. Department of Orthopaedic Surgery, Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul 139-707, Korea. TEL: +82-2-950-1114, FAX: +82-2-950-1429, bkh26@hanmail.net

Received 18 July 2014 Revised 15 September 2014 Accepted 18 December 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

No research on posterior bowing of the distal humerus in the sagittal plane requiring evaluation during performance of intramedullary nailing has been reported in Korea. This study is designed to evaluate the location and angle of distal humeral posterior bowing in the sagittal plane through analysis of true lateral radiographs of humerus and discusses key points when performing intramedullary nailing.

Materials and Methods

A retrospective study was conducted on 99 people with a simple lateral radiograph of the humerus and the authors analyzed total length of humerus, the angle and location of maximum posterior bowing in the distal shaft of the humerus.

Results

The mean length of the humerus was 319.7 mm, and the mean angle of the distal posterior bowing was 8.8 degrees. The mean point of posterior bowing was 221.6 mm from the proximal end, which was 69.3% of the total length of the humerus.

Conclusion

The average posterior angulation of humerus existed at the point of 69.3% from the proximal humerus. Careful assessment is needed during intramedullary nailing in order to prevent complications.

Keywords: humeral fracture, posterior bowing of humerus, intramedullary nailing

Figures and Tables

Figure 1

Measurement of posterior angulation of the distal humerus.

Figure 2

Measurement of the distance between the tip of the proximal humerus and the maximal point of posterior angulation of the distal humerus.

Figure 3

(A) True lateral radiograph of elbow before surgery shows 10 degrees of posterior angulation and 16 mm width of intramedullary canal. The fracture occurred approximately 70 mm proximally from the point of maximal posterior angulation. (B) Postoperative radiograph shows anterior angulation and displacement of the fracture site (arrow).

Figure 4

(A) Insertion of an intramedullary nail should be done with caution when site of fracture (imaginary dashed line) is at the distal humeral shaft. Lateral view of the humeral shaft shows that the intramedullary nail impinges with the posterior cortex of the distal humeral shaft. (B) Immediate postoperative radiograph shows posterior cortical breakage (arrow) resulting from impingement of the intramedullary nail with the distal humeral shaft due to posterior angulation of the humeral shaft.

Table 1

Results of Measurement according to True Lateral Radiograph of Humerus

^*Distance between posterior angulation and proximal humerus/length of humeral shaft×100.

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