Humerus yüzey anatomisi ve perkütan plak uygulaması: Kadavra çalışması

Abstract

Amaç: Humerus kırıklarının minimal invaziv plak osteosentezi sırasında mekanik engel oluşturabilecek kasların yerleşim yerlerinin belirlenmesi amaçlandı.

Çalışma planı: Çalışma, 6 erkek kadavranın 12 üst ekstremitesi üzerinde yapıldı. Kadavraların ortalama yaşı 61.8 (45-72)’di. Tüm piyeslerde büyük tuberkül ile lateral epikondil arasındaki mesafe olarak tanımlanan humerus uzunluğu ölçüldü. 4.5 mm’lik bir plak subbrakiyel olarak açılan bir tünelden yerleştirilirken karşılaşılan mekanik engeller değerlendirildi ve anatomik engellerin lateral epikondile olan mesafeleri ölçüldü.

Bulgular: Kadavraların ortalama humerus uzunluğu 271.8 mm olarak ölçüldü. Uygulamalarda, başta deltoid kasının anterior insersiyosu ile brakialis kasının proksimal kısmı olmak üzere çeşitli anatomik engeller tanımlandı. Lateral epikondil ile deltoid insersiyosunun en proksimal ve distali arasındaki mesafe sırasıyla 188.9 mm ve 138.7 mm; lateral epikondil ile brakialis kasının origosu arasındaki mesafe ise 147.4 mm olarak ölçüldü. Lateral epikondil ile anterior deltoid insersiyosunun proksimali, lateral epikondil ile anterior deltoid insersiyosunun distali ve lateral epikondil ile brakialis kasının origosunun proksimali arasındaki mesafelerin, humerus uzunluğuna oranları ise sırasıyla %69.4, %51 ve %54.2 olarak bulundu. Ölçümler yüksek gözlemciler arası güvenilirlik göstermekteydi (p<0.001).

Çıkarımlar: Humerus anterior yüzüne minimal invaziv plak osteosentez tekniği ile plak yerleştirilebilmesi sırasında deltoid insersiyosu ve brakialis kası origosunun proksimal kısmı gibi mekanik engellerin göz önünde bulundurulması gereklidir.

Keywords

• Humerus; Minimal invazif plak osteosentezi; kadavra; kırık.

Humeral surface anatomy and percutaneous plate advancement: a cadaveric study

Abstract

Objective: The aim of this study was to identify the anatomical obstacles on the humeral surface which can complicate subcutaneous plate advancement during surgical treatment of humeral fractures.

Methods: We dissected twelve upper extremities of six male cadavers, and measured the humeral length, which was defined as the distance between the greater tubercle and the lateral epicondyle. We performed a retrograde advancement of a 4.5 mm plate through the subbrachial tunnel and noted the mechanical obstacles during the procedure. In addition, we recorded the distances between the anatomic obstacles and lateral epicondyle.

Results: The average humeral length was 271.8 mm. We identified anterior insertion of the deltoid muscle and the proximal part of the brachialis muscle as the main anatomic obstacles on the anterior surface of the humerus. The average distances between the lateral epicondyle and the most proximal and distal insertion of anterior deltoid were 188.9 mm and 138.7 mm, respectively. The average distance between the lateral epicondyle and the brachialis origin was 147.4 mm. Proportions of the distances between the lateral epicondyle and proximal of anterior deltoid insertion, the lateral epicondyle and distal of anterior deltoid insertion and the lateral epicondyle and proximal of brachialis origin to humeral length were 69.4%, 51%, and 54.2%, respectively. There was a high interobserver reliability (p<0.001).

Conclusion: The deltoid insertion and proximal attachment of the brachialis muscles were identified as mechanical obstacles when performing the percutaneous plating. These sites caused difficulties with the procedure during the retrograde plate advancement through submuscular tunnel on the anterior surface of humerus. It was also noted that for successful plate advancement, it was necessary to release the anterior part of the deltoid insertion.

Keywords

• Humerus
• minimal invasive plate osteosynthesis
• cadaver
• fracture

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