The pectoralis major tendon as a reference for restoring humeral length and retroversion with hemiarthroplasty for fracture

The success of anatomic reattachment of the tuberosities in proximal humeral fractures, treated with hemiarthroplasty, correlates with functional results. The purpose of this study was to determine the value of the upper edge of the pectoralis major insertion (PMI) as a landmark to establish the proper height and version of hemiarthroplasty implanted for proximal humeral fractures. Twenty cadaveric humeri were studied by CT scan to analyze the relationship between the PMI and humeral height and retroversion. The mean distance from the PMI to the tangent to the humeral head was 5.64 cm. The mean distance of the PMI to the posterior fin of the prosthesis was 1.06 cm. The mean angle between the PMI and the posterior fin of the prosthesis was 24.65°. The upper edge of the pectoralis major insertion constitutes a reproducible reference point to restore proper humeral height and retroversion in hemiarthroplasty for proximal humeral fracture.