Cortical thickness analysis of the proximal humerus

Shoulder Elbow. 2019 Apr;11(2):87-93. doi: 10.1177/1758573217736744. Epub 2017 Nov 5.


Background: Structural changes within the proximal humerus influence the mechanical properties of the entire bone and predispose to low-energy fractures with complex patterns. The aim of the present study was to measure the cortical thickness in different regions of the proximal humerus.

Methods: Thirty-seven proximal humeri were analyzed using novel engineering software to determine cortical thickness in 10 distinct anatomical zones.

Results: The cortical thickness values ranged from 0.33 mm to 3.5 mm. Fifteen specimens demonstrated a consistent pattern of progressive cortical thinning that increased between the bicipital groove (thickest), the lesser tuberosity and the greater tuberosity (thinnest). Fifteen humeri were characterized by a progressive increase in cortical thickness between the greater tuberosity (thinnest), the bicipital groove and lesser tuberosity (thickest). The diaphysis exhibited the thickest cortical zone in 27 specimens, whereas the articular surface possessed the thinnest cortex in 18 cases.

Conclusions: In conclusion, this is the first study to comprehensively assess cortical thickness of the humeral head. Our findings suggest that proximal humeral fractures occur along lines of cortical thinning and are displaced by the hard glenoid bone. The identification of specific areas of thick cortices may improve pre-operative planning and optimize fracture fixation.

Keywords: biomechanical modelling; cortical thickness; fracture patterns; proximal humeral fracture.