ArticleThe bone & joint journal2020
The neck-shaft angle is the key factor for the positioning of calcar screw when treating proximal humeral fractures with a locking plate.
Article in The bone & joint journal, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 26 citations in OpenAlex.
- Locking plates versus intramedullary nails for the treatment of two- and three-part proximal humerus fractures in patients older than 60 years: a meta-analysis.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Pooled it
- Kirschner wire-assisted positioning technique reduces operative time and fluoroscopy exposure in proximal humeral PHILOS plate placement: a retrospective comparative study.Journal of orthopaedic surgery and research · 2026Article
- What is the postoperative prognosis of proximal humeral fractures in China? Protocol for a multicentre prospective cohort study (CAST).BMJ open · 2025Article
- Correlation of Radiological Parameters with Functional Outcomes in Proximal Humeral Fractures Treated with PHILOS Plates: A Retrospective Analysis.Journal of orthopaedic case reports · 2024Article
- Review
- The relationship between humeral head angulation and bone void within the humeral head in proximal humerus fractures.Heliyon · 2024Article
- Clinical and radiographic results of locking plate with medial support screw in Proximal Humerus fracture - the more, the better?BMC musculoskeletal disorders · 2024Article
- Pre-operative virtual three-dimensional planning for proximal humerus fractures: A proof-of-concept study.Shoulder & elbow · 2024Article
- Novel Use of a Fibular Strut Allograft with Fibular Head in an Elderly Patient with Proximal Humeral Fracture and Severe Metaphyseal Comminution: An Alternative to Shoulder Arthroplasty.Journal of clinical medicine · 2024Article
- Application of Intramedullary Calcar Support Plate and Lateral Locking Plate in Elderly Patients with Neer 3 and 4-Part Fractures of Proximal Humerus Through a Deltoid Splitting Approach.Indian journal of orthopaedics · 2024Article
- [Comparison of locking plate and intramedullary nail in treatment of Neer two- and three-part fractures of the proximal humerus in the elderly].Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsThe aim of this study was to explore why some calcar screws are malpositioned when a proximal humeral fracture is treated by internal fixation with a locking plate, and to identify risk factors for this phenomenon. Some suggestions can be made of ways to avoid this error.
methodsWe retrospectively identified all proximal humeral fractures treated in our institution between October 2016 and October 2018 using the hospital information system. The patients' medical and radiological data were collected, and we divided potential risk factors into two groups: preoperative factors and intraoperative factors. Preoperative factors included age, sex, height, weight, body mass index, proximal humeral bone mineral density, type of fracture, the condition of the medial hinge, and medial metaphyseal head extension. Intraoperative factors included the grade of surgeon, neck-shaft angle after reduction, humeral head height, restoration of medial support, and quality of reduction. Adjusted binary logistic regression and multivariate logistic regression models were used to identify pre- and intraoperative risk factors. Area under the curve (AUC) analysis was used to evaluate the discriminative ability of the multivariable model.
resultsData from 203 patients (63 males and 140 females) with a mean age of 62 years (22 to 89) were analyzed. In 49 fractures, the calcar screw was considered to be malpositioned; in 154 it was in the optimal position. The rate of malpositioning was therefore 24% (49/203). No preoperative risk factor was found for malpositioning of the calcar screws. Only the neck-shaft angle was found to be related to the risk of screw malpositioning in a multivariate model (with an AUC of 0.72). For the fractures in which the neck-shaft angle was reduced to between 130° and 150°, 91% (133/46) of calcar screws were in the optimal position.
conclusionThe neck-shaft angle is the key factor for the appropriate positioning of calcar screws when treating a proximal humeral fracture with a locking plate. We recommend reducing the angle to between 130° and 150°. Cite this article:
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.