Post-operative morphometric analysis of proximal humeral internal locking system fixation using three-dimensional computed tomography

Chirurgia Narządów Ruchu i Ortopedia Polska · Published 2026-06-29 · DOI 10.31139/chnriop.2026.91.2.8

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Authors (5)

Ganesh Anantharamakrishnan, Silambarasi Nagasamy, Arun Kumar, Pradeep Elangovan, Haemanath Pandian

Abstract

<p>Introduction. Proximal humeral fractures often require surgical fixation, with post-operative assessment&nbsp;traditionally relying on conventional radiography despite its limitations. This exploratory study utilizes&nbsp;subtraction CT and 3D reconstruction to evaluate new morphometric parameters for assessing fixation.<br />Materials and methods. This prospective observational study included 30 patients with proximal humerus&nbsp;fractures who underwent PHILOS fixation at a tertiary care hospital from October 2022 to March 2023.&nbsp;Postoperative morphometric analysis was performed using 3D reconstruction and subtraction CT. The&nbsp;quality of anatomical reduction, alignment, implant positioning, and screw placement was systematically&nbsp;assessed, including critical parameters such as the neck-shaft angle and inferomedial screws.<br />Results. The study analyzed 30 proximal humerus fractures, with a mean age of 48.1 years (26 to 72 years)&nbsp;and a female predominance (60%). Neck-shaft angles ranged from 97.3 to 140.7 (mean 129.9), with&nbsp;varus collapse (&lt;110) observed in 13.3% of cases, predominantly in three-part fractures with ineffective<br />inferomedial screw placement. Screw penetration was documented in 26.7% of patients. Subgroup analysis&nbsp;showed a non-significant trend toward higher neck-shaft angles in patients with shaft-plate angles ≤10&nbsp;(132.0 5.1 vs. 133.2 4.3, p = 0.525).<br />Conclusion. This study highlights the importance of advanced imaging in assessing PHILOS fixation.&nbsp;3D CT provides critical insights into screw placement, construct stability, and novel parameters like&nbsp;shaft-plate angles. Post-operative CT evaluation may facilitate earlier detection of suboptimal implant&nbsp;positioning, though prospective studies with clinical outcome data are needed to confirm its impact on&nbsp;complication rates.</p>

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Publication details

Year
2026

Citation

Anantharamakrishnan, G., Nagasamy, S., Kumar, A., et al. (2026). Post-operative morphometric analysis of proximal humeral internal locking system fixation using three-dimensional computed tomography. Chirurgia Narządów Ruchu i Ortopedia Polska. https://doi.org/10.31139/chnriop.2026.91.2.8

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