Which parameters are more reliable in proximal humerus surgery in terms of the axillary nerve?
Merve Önder1, İbrahim Etli2, Cengiz Aldemir2
1Department of Anatomy, Akdeniz University Faculty of Medicine, Antalya, Türkiye
2Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Türkiye
Keywords: Axillary nerve, morphometric evaluation, proximal humeral surgery, safe surgical area.
Objectives: This study aims to examine the reliability of the old and new parameters in determining the axillary nerve safe area for surgical interventions in the proximal humerus by measuring the distances between the top of the humeral head, the top of the greater tuberosity, the base of the greater tuberosity, and the acromion and axillary nerve.
Materials and methods: Between 2020 and 2022, a total of 52 shoulders of 26 fresh frozen male human cadavers (mean age: 46±25.5 years; range, 28 to 64 years), 26 right and 26 left were included. The deltopectoral approach was used. The intersection distances of the anterolateral end of the acromion, the top of the humeral head, the top of the tuberculum majus, and the base of the tuberculum majus with the N. axillaries were determined. All measurements were performed using the Microscribe® G2X.
Results: The mean distance from the top of the tuberculum majus to the axillary nerve (shown as "A") was measured as 4.36±0.17 cm and 4±0.21 cm on the right and left, respectively. The mean distance from the center of the base of the tuberculum majus to the axillary nerve (shown as "B") was measured as 1.27±0.18 cm and 1.24±0.11 cm on the right and left, respectively. The mean distance from the apex of the humeral head to the axillary nerve (shown as "C") was measured as 6.15±0.39 cm and 5.89±0.34 cm on the right and left, respectively. The mean distance between the anterolateral end of the acromion (shown as "D") was measured as 6.15±0.39 cm and 5.89±0.34 cm on the right and left, respectively. There was a moderate positive correlation between distances A and B measured on the right and left side, respectively (r=0,484; p=0,012) (r=0,454; p=0,020).
Conclusion: A strong positive correlation was found between the distances A and B. The A, B, and C parameters had a weak correlation with parameter D. The anatomical parameters A and B was found to be less variable and more reliable than parameter D.
Citation: Önder M, Etli İ, Aldemir C. Which parameters are more reliable in proximal humerus surgery in terms of the axillary nerve?. Jt Dis Relat Surg 2023;34(1):190-195. doi: 10.52312/jdrs.2023.882
The study protocol was approved by the Clinical Research Ethics Committee of the University of Health Sciences Türkiye, (date: 08.09.2022, no: 2022-274). The study was conducted by the principles of the Declaration of Helsinki.
Data Sharing Statement:
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Provided input into the concept and design of the study, and provided the materials: M.Ö., İ.E., C.A.; Collected and assembled the data: M.Ö., İ.E.; Analyzed the data: M.Ö., İ.E., C.A.; Carried out literature review: M.Ö.., C.A.; Wrote the article: M.Ö., İ.E., C.A.; All authors have critically revised the article, read and approved the final version at the time of submission.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.