The greater tuberosity version angle: a novel method of acquiring humeral alignment during intramedullary nailing

J. M. Gutierrez-Naranjo, L. M. Salazar, V. A. Kanawade, E. E. Abdel Fatah, M. Mahfouz, N. W. Brady, A. K. Dutta

Research output: Contribution to journalArticlepeer-review

Abstract

Aims This study aims to describe a new method that may be used as a supplement to evaluate humeral rotational alignment during intramedullary nail (IMN) insertion using the profile of the perpendicular peak of the greater tuberosity and its relation to the transepicondylar axis. We called this angle the greater tuberosity version angle (GTVA). Methods This study analyzed 506 cadaveric humeri of adult patients. All humeri were CT scanned using 0.625 × 0.625 × 0.625 mm cubic voxels. The images acquired were used to generate 3D surface models of the humerus. Next, 3D landmarks were automatically calculated on each 3D bone using custom-written C++ software. The anatomical landmarks analyzed were the transepicondylar axis, the humerus anatomical axis, and the peak of the perpendicular axis of the greater tuberosity. Lastly, the angle between the transepicondylar axis and the greater tuberosity axis was calculated and defined as the GTVA. Results The value of GTVA was 20.9° (SD 4.7°) (95% CI 20.47° to 21.3°). Results of analysis of variance revealed that females had a statistically significant larger angle of 21.95° (SD 4.49°) compared to males, which were found to be 20.49° (SD 4.8°) (p = 0.001). Conclusion This study identified a consistent relationship between palpable anatomical landmarks, enhancing IMN accuracy by utilizing 3D CT scans and replicating a 20.9° angle from the greater tuberosity to the transepicondylar axis. Using this angle as a secondary reference may help mitigate the complications associated with malrotation of the humerus following IMN. However, future trials are needed for clinical validation.

Original languageEnglish (US)
Pages (from-to)929-936
Number of pages8
JournalBone and Joint Open
Volume5
Issue number10
DOIs
StatePublished - Oct 2024

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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