Clinics in Shoulder and Elbow

대한견·주관절의학회 (Korean Shoulder and Elbow Society)
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Biomechanical investigation of arm position on deforming muscular forces in proximal humerus fractures

  • Christen E. Chalmers (Department of Orthopedic Surgery, University of California Irvine) ;
  • David J. Wright (Department of Orthopedic Surgery, University of California Irvine) ;
  • Nilay A. Patel (Department of Orthopedic Surgery, University of California Irvine) ;
  • Hunter Hitchens (Cornell University) ;
  • Michelle McGarry (Orthopaedic Biomechanics Laboratory, Congress Medical Foundation) ;
  • Thay Q. Lee (Orthopaedic Biomechanics Laboratory, Congress Medical Foundation) ;
  • John A. Scolaro (Department of Orthopedic Surgery, University of California Irvine)
  • 투고 : 2022.02.22
  • 심사 : 2022.04.28
  • 발행 : 2022.12.01
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초록

Background: Muscular forces drive proximal humeral fracture deformity, yet it is unknown if arm position can help mitigate such forces. Our hypothesis was that glenohumeral abduction and humeral internal rotation decrease the pull of the supraspinatus and subscapularis muscles, minimizing varus fracture deformity. Methods: A medial wedge osteotomy was performed in eight cadaveric shoulders to simulate a two-part fracture. The specimens were tested on a custom shoulder testing system. Humeral head varus was measured following physiologic muscle loading at neutral and 20° humeral internal rotation at both 0° and 20° glenohumeral abduction. Results: There was a significant decrease in varus deformity caused by the subscapularis (p<0.05) at 20° abduction. Significantly increasing humeral internal rotation decreased varus deformity caused by the subscapularis (p<0.05) at both abduction angles and that caused by the supraspinatus (p<0.05) and infraspinatus (p<0.05) at 0° abduction only. Conclusions: Postoperative shoulder abduction and internal rotation can be protective against varus failure following proximal humeral fracture fixation as these positions decrease tension on the supraspinatus and subscapularis muscles. Use of a resting sling that places the shoulder in this position should be considered.

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참고문헌

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