Objective To explore the radiologic anatomical characteristics of the relative position between acromion and humerus head, as well as the clinical application in the treatment of proximal humerus fractures with intramedullary nailing. Methods A total of 105 standard shoulder joint images under X-ray were selected. The supraglenoid tubercles was defined as point A, the subglenoid tubercles as point B, the apex of the superior lateral aspect of anatomical neck of humerus as point C, the anteroinferior aspect of anatomical neck of humerus as point D, and the outermost edge of the acromion as point E, the intersection of the axis of the humerus shaft and the cortex of the humerus head as point F, and the outermost edge of the greater tuberosity of humerus as point H. The line was drawn parallel to the axis of the humerus shaft through point E and point H respectively. The line perpendicular to the axis of the humerus shaft was drawn through point F. The two points of intersection were point G and I. Lines AB, CD, EF, EG, FG, GI, HI, EI were measured respectively. The humeral neck shaft angle (∠α) and the angle between line EF and line FG (∠β) were measured respectively. And the acromial projection index (API, FG/FI×100%) was calculated. The morphology of acromion and its relative position with the axis of the humerus shaft in the sagittal plane were observed. The correlation among the above measurements were analyzed by Spearman correlation. The gender difference was analyzed by t-test. The difference in anatomical parameters among three types of the morphology of acromion was analyzed by ANOVA test. Results The age was negatively related with HI, AB was positively related with CD, GI and HI, CD was positively related with AB, EG, GI and HI, ∠β was positively related with EG, GI, and negatively related with EF, FG and API, API was positively related with EF, FG and negatively related with EG, GI, HI and ∠β. The AB, CD, GI and HI of the male were longer than those of the female, the ∠β of the male was larger than that of the female, and the API of the male was smaller than that of the female, with statistical difference (P≤0.05). Except for the type I, acromion generally crossed the axis of the humerus shaft in type II and III. There was no significant difference in anatomical parameters among the three types of acromion (P>0.05). Conclusions The difficulty of intramedullary nailing placement in the humerus is closely related to the API. The larger the humerus head, the smaller the acromion projection index, and the easier it is to insert the nail. The male have a larger humeral head size than female, so it may be easier to insert intramedullary nail in male. Compared to the type I acromion, it may be more difficult in inserting the nail for the type II and III.
Key words
Acromion /
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Proximal humerus /
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Radiologic anatomy /
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Intramedullary nail /
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Acromial projection index
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