Pectoralis major tendon reference (PMT): A new method for accurate restoration of humeral length with hemiarthroplasty for fracture

For hemiarthroplasty reconstruction of a proximal humeral fracture, accurate restoration of humeral head position is challenging, and incorrect prosthetic placement is associated with a poor outcome of surgical treatment. The purpose of this study was to validate the pectoralis major tendon as a reproducible landmark for accurate restoration of humeral length with hemiarthroplasty reconstruction. We dissected 20 cadavers (40 shoulders), and the distance between the upper border of the pectoralis major tendon insertion on the humerus and the top of the humeral head was measured (PMT). The PMT averaged 5.6 ± 0.5 cm (with a confidence level of 95%). In only 4 of 40 shoulders did this distance exceed 6.0 cm, and there was no correlation between the size of the patient and this measurement. The PMT is a useful landmark that will aid in accurate restoration of humeral length when reconstructing complex proximal humeral fractures where landmarks are otherwise lost because of fracture comminution.