Altered Glenohumeral Biomechanics in Proximal Humeral Fracture Malunion

Melissa A. Wright, Mario H. Lobao, Pooyan Abbasi, Brent G. Parks, Katherine L. Mistretta, Anand M. Murthi

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Introduction:There is little biomechanical evidence to support the traditional guideline that 45° represents acceptable proximal humerus deformity. We evaluated glenohumeral contact pressure (GP) and area, subacromial contact pressure, and joint abduction to assess biomechanical changes with different proximal humerus deformities.Methods:Fifteen fresh-frozen cadaver shoulders were used. Intact specimens were tested on a custom dynamic shoulder frame. Subsequently, a surgical neck fracture was made in each specimen and fixed using a custom dual hinge plate for fixation of 15°, 30°, and 45° deformities in varus, valgus, antecurvatum, retrocurvatum, and combined varus-antecurvatum and valgus-retrocurvatum. Specimens were then retested.Results:Compared with the intact state, GP was markedly lower with all levels of varus and varus-antecurvatum deformity. Valgus and combined valgus-retrocurvatum deformity of 45° led to notable increases in GP compared with the intact state. Varus deformities of 30° and 45° caused significant increases in subacromial pressures and limited abduction markedly from 60° to 54.2° and 44.6° (P < 0.001).Discussion:Varus and antecurvatum proximal humerus deformities as small as 15° were associated with notable alterations in glenohumeral joint mechanics. With valgus and retrocurvatum deformity, statistically significant joint alterations occurred only at higher deformity levels.

Original languageEnglish
Pages (from-to)E1167-E1175
JournalJournal of the American Academy of Orthopaedic Surgeons
Issue number23
StatePublished - Dec 1 2021


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