The treatment for the humeral shaft fractures in adults usually presents two possibilities of management: conservative treatment and surgical treatment. The conservative treatment is administered through the use of cast and the surgical treatment can be provided with the use of plates and screws or with the use of rigid intramedullary nails. Flexible intramedullary nails are widely used in the treatment of long bone fractures in children. We aim to use flexible intramedullary nails in the treatment for humeral shaft fractures in adults and assess the consolidation time, pain and the rehabilitation results. The research was conducted through the selection of twenty cases of humeral shaft fractures in adults in which the treatment was provided with the use of flexible intramedullary nails. The results were satisfactory, with good signs of approval regarding the management of the fractures. From the positive results that were obtained, we expect to increase the number of cases treated with flexible intramedullary nails and to compare them with control groups that have undergone other forms of treatment for these fractures. / O tratamento das fraturas da diáfise do úmero em adulto apresenta habitualmente duas possibilidades de condução: tratamento conservador e tratamento cirúrgico. O tratamento conservador é realizado com uso de aparelho gessado. O tratamento cirúrgico apresenta duas modalidades: uso de placas e parafusos e uso de hastes intramedulares rígidas. As hastes intramedulares flexíveis têm seu uso bem estabelecido no tratamento das fraturas de ossos longos em crianças. O objetivo desse trabalho foi utilizar as hastes intramedulares flexíveis na condução do tratamento das fraturas da diáfise do úmero em adultos e avaliar tempo de consolidação, dor e resultados de reabilitação. O presente estudo é ensaio clínico aberto, não randomizado, com um braço, com seleção sequencial de 20 casos de fraturas de diáfise de úmero em adultos nos quais o tratamento foi conduzido com o uso das hastes intramedulares flexíveis. O emprego de hastes intramedulares flexíveis resultou em índice de consolidação de 95%. A média de tempo entre a fratura e o retorno ao trabalho foi de 72,68 dias, e a média de tempo entre a cirurgia e o retorno ao trabalho foi de 60,89 dias. As médias dos ângulos de abdução do ombro, aos 21, 60 e 180 dias foram de 25,75º, 97,63º e 174,74º, respectivamente. Com base nesses resultados positivos obtidos, espera-se ampliar o número de casos tratados com as hastes intramedulares flexíveis e realizar um comparativo com grupos controles que sigam outras formas de tratamento destas fraturas.

O tratamento de fraturas umerais distais em aves impõe grande dificuldade, devido a córtices muito finas dos ossos A artrodese com fixador externo da articulação úmero-rádio-ulnar é inviável para aves que se pretende reintroduzir ao meio ambiente. Doze animais foram divididos em dois grupos: cirurgias bilaterais com anquilose de uma asa (asa estática) e manutenção da articulação da outra (asa dinâmica) (grupo 1), e cirurgia unilateral, com manutenção da função da articulação (asa dinâmica), sendo a outra controle (asa intacta) (grupo 2). Foram feitas avaliações clínicas, radiológicas, morfológicas do osso, histomorfométricas (de ambos os grupos) e de capacidade de vôo (grupo 2). A 6 semanas, todos os animais apresentavam fraturas consolidadas, com excessão de dois animais do grupo 1, que somente apresentaram consolidação das asas dinâmicas às 9 semanas e das estáticas às 12 semanas. Todos os animais do grupo 2 apresentaram capacidade de vôo adequada, antes de 13 semanas após a cirurgia. No grupo 1 o úmero da asa dinâmica representava 99,1% do comprimento do da asa estática, e no grupo 2, estes eram 99,5% em relação à asa intacta. A amplitude da asa, no grupo 2, demonstrou que a relação da asa dinâmica/intacta foi de 93%, e no grupo 1 a relação asa dinâmica/estática foi de 105%. O volume do osso intacto foi de aproximadamente 29% da área estudada, enquanto o da asa estática foi de 19% e das asas dinâmicas, de 22%. Houve diferença entre o número de osteoblástos das asas intactas e dinâmicas, porém não houve diferença entre as asas estáticas e intactas e entre as dinâmicas e as estáticas, e também não houve diferença do número de osteoclástos entre nenhum tipo de asa. A razão da superfície óssea pelo volume ósseo indica a quantidade de áreas de reabsorção. Não houve diferença entre as asas estática e dinâmica, porém houve diferença entre estas e os controles. O método proposto de técnica para fixação de fraturas umerais distais, sem a anquilose da articulação úmero-rádio-ulnar, demonstrou ser efetivo em manter o comprimento ósseo, a amplitude da asa e assim, garantindo a capacidade de vôo das aves tratadas, além de demonstrar ser equivalente histológicamente à técnica tradicional e mais estável de anquilose da articulação, para este tipo de fratura, e até mesmo, no período estudado, ser equivalente ao osso são, sendo um método adequado para a reparação de fraturas distais de úmero em aves quando se pretende a reabilitação destes animais. / The treatment of humeral distal fractures in birds is very difficult, because these bones are very brittle. Ankylosis of the humeral-radio-ulnar joint with an external fixator is unviable for birds intended for re-habilitation and reintroduction. Twelve animals were used and they were divided in two groups: bilateral surgeries, with ankylosis of one wing (static wing) and maintenance of the joint function of the other wing (dynamic wing) (group 1), and unilateral surgery, with maintenance of the joint function of the wing (dynamic wing), and the other was used as control group (intact wing) (group 2). Clinical, radiographic, morphologic and histomorphometric evaluations of the wings and bones (of both groups) and of evaluations of flight capacity (in group 2) were made. At 6 weeks, all animals had healed fractures, except two animals in group 1, that only presented consolidation of the dynamic wing at 9 weeks and the static wings at 12 weeks. All animals in group 2 were capable of flying before 13 weeks after surgery. In group 1, the humerus of the dynamic wing was 99.1% the length of that of the static wing, and in group 2, these were 99.5% compared to the intact wing. Wing amplitude, in group 2, showed a dynamic/ intact ratio of 93%, and in group 1 the dynamic/ static wing ratio was 105%. The volume of the intact bone was approximately 29% of the studied area, while in the static wing it was of 19% and in the dynamic wing, 22%. There was a difference in the number of osteoblasts of the intact and dynamic wings, but there was no difference between static and intact, and between dynamic and static wings, and also, there was no difference in the numbers of osteoclasts between any wings. The bone surface/ volume ratio indicates the amount of resorption areas. There was no significant difference between static and dynamic wings, but there was a difference between static and intact wings. The proposed method of distal humeral fracture fixation technique, without ankylosis of the humerus-radius-ulna joint, demonstrated being effective in keeping bone length, wing amplitude e therefore, guaranteeing flight capacity of the birds treated, as well as being histologically equivalent to the tradicional, more stable, joint ankylosis technique, for thise kind of fracture, and even, for the studied period, being equivalent to healthy bone, being an adequate method for fracture repair for this kind of fracture in birds, when one intends rehabilitation of these animals.

L'existence d'une lésion transfixiante de la coiffe des rotateurs est très fréquente dans la population générale avec une prévalence de près de 20%. Cette prévalence augmente avec l'âge tout comme l'existence de lésions asymptomatiques. Comment explique-t-on l'existence de lésions tendineuses qui ne provoquent pas de symptômes ?Le rôle essentiel de la coiffe des rotateurs est de center la tête humérale en face de la glène pour permettre une action optimale du deltoïde. Cette action de centrage est toujours possible en cas de lésion du supra-spinatus et l'épaule peut conserver une fonction satisfaisante à condition que l'équilibre soit conservé entre la coiffe antérieure (Sub-Scapularis) et la coiffe postérieure (Infra-Spinatus et Teres Minor). Comment expliquer alors que des lésions, même petites du supra-épineux peuvent-être à l'origine d'une impotence fonctionnelle de l'épaule ?Il existe une réelle dissociation anatomo-clinique des ruptures de la coiffe des rotateurs et l'expression clinique des lésions de la coiffe est multifactorielle et inconstante. Elle dépend de la taille de la lésion et de son évolutivité, de l'existence d'une bursite sous-acromiale et de l'existence d'une tendinopathie du long biceps.La comparaison de sujets symptomatiques et de sujets asymptomatiques présentant une rupture de coiffe a permis de pointer du doigt l'importance des muscles péri-scapulaires dans la compréhension du retentissement des lésions de coiffe des rotateurs. En effet, ces muscles péri-scapulaires ont pour fonction d'orienter la scapula et la glène lors des mouvements du bras. Lorsque ceux-ci sont altérés, les anomalies d'orientation de la scapula sont appelés dyskinésies scapulaires.Lors de précédents travaux, nous avons étudié la faisabilité d'étude pseudo-cinématique de la scapula par rapport au thorax lors d'un mouvement d'élévation du bras à l'aide de stéréoradiographies basse-dose EOS®. Cependant cette technique basée sur la localisation de points précis de la scapula sur les différentes vues radiographiques s'est montrée peu reproductible et difficile à utiliser en routine clinique.L'objectif de ce travail de Thèse était tout d'abord d'optimiser cette technique d'analyse prometteuse et peu-irradiante afin d'obtenir une analyse fonctionnelle quantitative fiable et reproductible de la scapula. Ensuite, nous avons souhaité utiliser cette technique in-vivo, sur une cohorte de sujets pour évaluer le comportement de la scapula dans différentes situations pathologiques. / Existence of a full thickness rotator cuff tear is really common in the general population with prevalence near 20%. This prevalence increases with age as the existence of asymptomatic cuff tear. How can we explain that tendinous injuries do not cause symptoms?The essential action of the rotator cuff is to center the humeral head in front of the glenoid cavity in order to enable a maximal action of the deltoid muscle. This centering action is still possible in case of supra-spinatus tendon tear and the shoulder can keep a satisfying function if equilibrium is conserved between the anterior cuff (Sub-scapularis muscle) and the posterior cuff (Infra-spinatus and Teres Minor muscles). How can we explain that supra-spinatus tears, even small, can induce functional impairment of the shoulder?There is a real dissociation between anatomy and clinic for the rotator cuff tears and the clinical expression of cuff tears is multifactorial and variable. It depends of the size of the tear and its evolution, of the existence of a sub-acromial bursitis and of the existence of a long head biceps tendinopathy.Comparison between symptomatic and asymptomatic subjects which present a rotator cuff tear permitted to show the importance of the periscapular muscles for the understanding of the rotator cuff tears. Indeed, the function of the periscapular muscles is to orientate the scapula and the glenoid during arm movements. When periscapular muscles are altered, there are anomalies in the scapular orientation which are called scapular dyskinesis.In previous works, we studied the feasibility of pseudo-kinematic studies of the scapula during arm elevation according to the thorax coordinate system derived from low-dose EOS® stereoradiographs. However, this method which was based on the location of specific scapular bony landmarks on each stereoradiographs, presented a low reproducibility and was difficult to use in clinical conditions.The aim of this Thesis was first to optimize this promising method In order to obtain a functional quantitative analysis of the scapula reliable and reproducible. Then, we would like to use this method in-vivo in order to assess the orientation of the scapula during arm elevation on pathologic subjects.

Abstract Although nonoperative treatment is recognized as an effective treatment method for humeral shaft fractures, it is associated with an approximately 10% risk of nonunion and long-term impairments of the shoulder joint. There is a growing interest to treat even simple humeral shaft fractures operatively to avoid these problems. Intramedullary (IM) nailing has proven to be very effective in the treatment of femoral and tibial shaft fractures and the same method has been adopted for humeral shaft fractures. However, the results regarding union rate and shoulder joint function after antegrade insertion of an IM nail have been very controversial. The purpose of this study was to investigate fracture union, shoulder joint function and symptoms after antegrade IM nailing of humeral shaft fractures, to assess safety and results of IM nailing in pathological fractures, to evaluate the efficacy of exchange nailing and Ilizarov's technique in the treatment of nonunion after IM nailing and to find out, by comparing shoulder joint symptoms and function after antegrade IM nailing and dynamic compression (DC) plate fixation, whether antegrade access to the medullary cavity is the main reason behind shoulder joint problems. During the years 1987-1997, 126 humeral shaft fractures were operated upon in Oulu University Hospital using antegrade IM nailing. The nonunion rate was 22% and distraction of the fracture fragments was the most important risk factor associated with nonunion. The reoperation rate, for various reasons, was 25%. Shoulder joint pain and impairment of function was present in 37% of the patients. In the treatment of 18 pathological fractures IM nailing was a rapid and safe operation, associated with good pain relief. Exchange nailing of 13 cases of nonunion after IM nailing resulted in a union rate of 47% and this method is not useful in the humerus in contrast to tibial and femoral fractures. Permanent nonunion leaves the patient with severe impairment of the shoulder joint and a loose nail may lead to severe osteolysis of cortical bone. In complicated nonunion with poor bone quality, Ilizarov's technique, although associated with a high rate of minor complications and reoperations, worked well. When IM nailing was compared with DC plating it was found that there were no significant differences in shoulder pain, function scores, range-of-motion and strength. Antegrade insertion of the nail, if carried out properly, is probably not the main reason for shoulder joint impairment after IM nailing. Antegrade IM nailing of humeral shaft fractures is associated with several problems, e.g. shoulder joint impairment and difficulties in reconstruction after nonunion, and indications for this method may be exceptional, such as comminuted and pathological fractures.

[EN] Shoulder pain is one of the most common conditions, affecting approximately 16% to 25% of the general population over the age of 50. Individualized treatment plans and preventative strategies are required using objective, reliable and accurate tools to detect minimal changes in patients' functional ability. However, the most commonly used tools for the functional assessment of shoulder pain patients have been shown to have limitations. The use of functional questionnaires may lead to subjective scoring and the reliability of goniometers is low. Human movement analysis using photogrammetry provides great accuracy and reliability. Although there is some evidence for the usefulness of this technique in the assessment of shoulder pain, the complexity of the technology and the measurement protocols have been an obstacle to its implantation within the clinical context. The purpose of this study is to develop a methodology for functional assessment of the shoulder joint based on kinematic analysis. The measurement procedures should meet the main requirements of the clinical setting and provide a differential value in comparison with the most commonly used clinical tools. With this aim, a simplified measurement procedure has been defined in order to measure the humeral elevation in the scapular plane executed with two different weights: 250 g and 1 kg. To assess shoulder functionality three types of variables were calculated: (i) descriptive movement variables; (ii) execution rhythm variables and iii) variability variables. A comparison of reliability in the description of humerothoracic motion during elevation in the scapular plane was made using the YX¿Y¿¿ and XZ¿Y¿¿ sequences and the attitude vector. A reproducibility study was performed in order to determine the reliability and agreement of the measurement procedure. The effect of age, gender, dominance and the magnitude of the weight handled in the motion of the healthy group was analyzed. Normal patterns were obtained to be used as a reference to evaluate the performance of subjects with shoulder pain. Finally, the sample of patients was divided into two levels of functionality (based on the DASH score) and, in a second study, the same sample was classified by diagnosis (tendinitis of the rotator cuff and rotator cuff tears). In both cases, we assessed the capacity of the kinematic variables to discriminate between groups, comparing the results with the outcomes of functional questionnaires, goniometry and dynamometry. The XZ¿Y¿¿ sequence presented the best results in the description of the humerothoracic elevation in the scapular plane. The measurement procedures presented high reliability and agreement in all the variables studied. The weight handled was the only factor that affected the motion of the healthy group, as no significant effect of gender, dominance and age was found. The comparison between healthy people and people with shoulder injuries showed differences in all the kinematic variables. Moreover, patients presented higher sensitivity to the increment of the weight handled. A larger effect was observed in the kinematic variables compared with the clinical variables when the pathologic group was divided according to level of functionality and diagnosis. The variability variables and the descriptive movement variables presented the best ability to differentiate between the two levels of functionality. In the analysis of the two diagnosis groups none of the clinical variables showed differences. In contrast, some of the kinematic variables were able to discriminate between the two groups. In particular, the execution rhythm variables presented the best results. The results of this study show promising progress in the development of objective methods of functional assessment of the shoulder with the aim of providing the clinical community with more precise and sensitive measures that enhance the management of rehabilitation treatments. / [ES] El dolor de hombro es una de las patologías que con más frecuencia afecta a la población ya que se estima que entre el 16% y 25% de los mayores de 50 años lo padecen. La eficacia de los planes de prevención y tratamiento depende de la existencia de herramientas objetivas, válidas y reproducibles y que sean capaces de detectar mínimos cambios en el estado funcional del paciente. Sin embargo, los instrumentos utilizados habitualmente presentan ciertas limitaciones. Los cuestionarios tienen la desventaja de la subjetividad en cuanto a la puntuación del paciente. Por otra parte, los goniómetros presentan una baja reproducibilidad. El análisis de movimientos humanos mediante fotogrametría tiene una alta precisión y fiabilidad y, existen evidencias de su utilidad para la valoración del hombro doloroso, pero la complejidad de la técnica y de los protocolos de medida ha sido un obstáculo para su implantación en el ámbito clínico. El objetivo del presente trabajo es desarrollar una metodología de valoración funcional de la articulación del hombro, basada en técnicas de análisis cinemático, que se adapte a los requerimientos fundamentales del ámbito clínico y que aporte un valor diferencial en comparación con las herramientas clínicas habituales. Con este fin se ha definido un procedimiento de medida simplificado, para medir la elevación humeral en el plano de la escápula, ejecutada con dos pesos distintos, de 250 g y 1 kg. Para valorar la funcionalidad del hombro se calcularon tres tipos de variables: (i) las descriptivas del movimiento; (ii) las de ritmo de ejecución del gesto y (iii) las variables de variabilidad. Se ha realizado una comparación de la fiabilidad en la descripción del movimiento usando las secuencias de Euler YX¿Y¿¿ y XZ¿Y¿¿ y el vector orientación. Se ha llevado a cabo un estudio de reproducibilidad del procedimiento de medida. Se ha analizado el efecto de la edad, el sexo, la dominancia y la magnitud de la carga levantada en sujetos sanos. Se ha comparado el movimiento de los pacientes con lesión del hombro, con los valores de referencia de sujetos sanos. Por último, se realizaron dos subgrupos de la muestra de sujetos con patología de hombro: (i) según el nivel de funcionalidad y (ii) según el diagnóstico. En cada caso, se analizó la capacidad de las variables cinemáticas para discriminar entre los subgrupos definidos, contrastando los resultados con las variables obtenidas de la valoración mediante cuestionarios, goniometría y dinamometría. Se seleccionó la secuencia de Euler XZ¿Y¿¿ para representar el movimiento, por presentar los errores más bajos. El procedimiento de medida demostró una elevada reproducibilidad en todas las variables. El análisis en personas sanas, indicó que no existe una influencia del sexo, la dominancia y la edad en el gesto estudiado. Sí se encontró un efecto significativo del peso levantado. La comparación entre personas sanas y con lesión del hombro mostró diferencias en todas las variables cinemáticas. Además, los pacientes mostraron mayor sensibilidad al peso manejado. Al dividir el grupo patológico, se observó un mayor efecto en las variables cinemáticas que en las variables clínicas, tanto del nivel de funcionalidad como del diagnóstico. Las variables de variabilidad y las descriptivas del movimiento fueron las que mejor discriminaron entre ambos niveles de funcionalidad. Al estudiar los dos subgrupos de diagnóstico no se encontró ninguna diferencia en las variables clínicas. Por el contrario, la valoración cinemática sí mostró resultados distintos, siendo las variables del ritmo de ejecución del movimiento las que mostraron mayores diferencias entre los dos grupos. Los resultados de este trabajo resultan prometedores para progresar en el desarrollo de métodos objetivos de valoración funcional del hombro que proporcionen a la comunidad clínica medidas más precisas y sensibles que permitan mejorar la / [CAT] El dolor de muscle és una de les patologies que amb més freqüència afecta la població ja que s'estima que entre el 16% i 25% dels majors de 50 anys el patixen. Este fet fa necessari que s'establisquen plans de prevenció i tractament individualitzats, per a la qual cosa és imprescindible disposar de ferramentes objectives, vàlides i reproduïbles i que siguen capaços de detectar mínims canvis en l'estat funcional del pacient. Els instruments utilitzats habitualment en l¿avaluació funcional del pacient amb dolor de muscle presenten certes limitacions. Els qüestionaris tenen el principal desavantatge de la subjectivitat en la puntuació del pacient. D'altra banda, els goniòmetres permeten una mesura objectiva del rang articular, encara que presenten una baixa reproduïbilitat. L'anàlisi de moviments humans amb fotogrametria té una alta precisió i fiabilitat i, a més, permet estudiar alteracions en el moviment del pacient al llarg de tot el gest i no únicament valorar el resultat final del mateix (i.e. rang articular). Hi ha evidències de la seua utilitat per a la valoració del muscle dolorós, però la complexitat de la tècnica i dels protocols de mesura han sigut un obstacle per a la seua implantació en l'àmbit clínic. L'objectiu del treball és desenvolupar una metodologia de valoració funcional de l'articulació del muscle, basada en tècniques d'anàlisi cinemàtic, que s'adapte als requeriments de l'àmbit clínic i que aporte un valor diferencial en comparació amb les ferramentes clíniques habituals. Amb aquesta finalitat s'ha definit un procediment de mesura de l¿elevació humeral en el plànol de l¿escàpula simplificat, executat amb dos pesos, 250 g i 1 kg. Per valorar-lo es van calcular tres tipus de variables: (i) descriptives del moviment; (ii) de ritme d'execució del gest i (iii) de variabilitat. S'ha realitzat una comparació de la fiabilitat en la descripció del moviment emprant les seqüències d'Euler YX¿Y¿¿ i XZ¿Y¿¿ i el vector orientació. S¿ha portat a terme un estudi de reproduïbilitat. S¿ ha analitzat el efecte dels factors edat, sexe, dominància i càrrega en subjectes sans. S¿han definit uns valors de referència en subjectes sans usats per avaluar el moviment d¿elevació humeral en el plànol escapular en pacients amb lesió de muscle. Per últim, s¿ha classificat la mostra amb patologia de muscle segons: (i) el nivell de funcionalitat i (ii) el diagnòstic, (tendinitis o trencament del maneguet rotador), amb dos categories cadascuna. En ambdues classificacions s¿ analitzà la capacitat de les variables cinemàtiques per discriminar entre categories. Els resultats es contrastaren amb les variables clíniques (qüestionaris, goniometria i dinamometria). Es va seleccionar la seqüència d'Euler XZ¿Y¿¿ per presentar uns errors més baixos. El procediment de mesura demostrà una elevada fiabilitat a totes les variables. L¿anàlisi amb persones sanes indicà que no existeix una influència significativa del sexe, la dominància i l¿edat en el gest però sí del pes. La comparació entre persones sanes i amb lesió de muscle mostrà diferències en totes les variables cinemàtiques. A més, els pacients presentaren una major sensibilitat al pes suportat. Quan es dividí el grup patològic, es va observar un major efecte en les variables cinemàtiques que en les clíniques, en ambdues classificacions (nivell de funcionalitat i diagnòstic). Les variables de variabilitat i descriptives del moviment foren les que millor discriminaren entre els nivells de funcionalitat. En estudiar els dos subgrups de diagnòstic no es va trobar cap diferència en les variables clíniques però sí amb la valoració cinemàtica, sent les variables del ritme d¿execució les més discriminants. Els resultats d¿aquest treball esdevenen prometedors per progressar en el desenvolupament de mètodes objectius de valoració funcional del muscle que proporcionen a la comunitat clínica / Lopez Pascual, J. (2015). Caracterización cinemática de la elevación humeral en el plano escapular. Definición de patrones de normalidad y análisis del gesto patológico [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/48880 / TESIS

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The thesis describes the anatomical study, which has been taken place at Orthopedic Clinic of the 1st Faculty of Medicine, Motol University Hospital and at Institute of Anatomy 1st Faculty of Medicine, Charles University in Prague from 2002 till 2009. The study was focused on the area of the upper part of the humerus in order to measure spatial relationships among anatomical structures, especially attachments of rotator cuff muscles to optimize implantation arthroplasty of shoulder joint. Clinico-anatomical study, which results were published in 2010, was also based at measuring angular relations of structures proximal humerus. The proximal humerus was marked by 29 points on the cortical bone, which defined the position of the medial margin of the greater tubercle, the lateral margin of the lesser tubercle, bicipital groove, the crest of greater tubercle and to define position of the proximal humeral metaphyseal axis and anatomical neck. Measurements were carried out in the transversal planes and the measurement method was developed on the reconstruction and the spatial definition of basic axes (axis of humeral head and axis of proximal humeral shaft) with the optimized number of reference points of anatomical neck and cortical bone of proximal humeral shaft. Angles between the axis of the head...

The thesis describes the anatomical study, which has been taken place at Orthopedic Clinic of the 1st Faculty of Medicine, Motol University Hospital and at Institute of Anatomy 1st Faculty of Medicine, Charles University in Prague from 2002 till 2009. The study was focused on the area of the upper part of the humerus in order to measure spatial relationships among anatomical structures, especially attachments of rotator cuff muscles to optimize implantation arthroplasty of shoulder joint. Clinico-anatomical study, which results were published in 2010, was also based at measuring angular relations of structures proximal humerus. The proximal humerus was marked by 29 points on the cortical bone, which defined the position of the medial margin of the greater tubercle, the lateral margin of the lesser tubercle, bicipital groove, the crest of greater tubercle and to define position of the proximal humeral metaphyseal axis and anatomical neck. Measurements were carried out in the transversal planes and the measurement method was developed on the reconstruction and the spatial definition of basic axes (axis of humeral head and axis of proximal humeral shaft) with the optimized number of reference points of anatomical neck and cortical bone of proximal humeral shaft. Angles between the axis of the head...

La masse corporelle et la direction des charges sont des facteurs qui peuvent modifier la morphologie des surfaces articulaires qui sont généralement orientées et de taille suffisante pour résister aux charges chroniques. Chez les hominoïdes, les forces de tension et compression, générées par la locomotion, sont transmises à travers l’articulation du coude. Ces espèces ont une morphologie similaire de l’extrémité distale de l’humérus, mais qui présente certaines différences selon la taille des individus et leurs modes de locomotion. Ce projet tente de caractériser plus exhaustivement cette variation en analysant la largeur des surfaces articulaires ainsi que leur position et orientation par rapport à l’axe long de la diaphyse. La prémisse de ce mémoire est que, chez les espèces plus arboricoles, la morphologie de l’articulation distale de l’humérus répond aux stress transverses générés par les puissants muscles fléchisseurs du poignet et des doigts qui traversent le coude obliquement. En revanche, les espèces plus terrestres présentent une morphologie permettant de résister aux forces axiales provenant du contact avec le sol. Des coordonnées tridimensionnelles et des mesures linéaires ont été recueillies sur un échantillon squelettique d’individus des genres Homo, Pan, Gorilla et Pongo. Les résultats obtenus révèlent que l’orientation et la position des surfaces articulaires de la trochlée correspondent aux types de locomotion, or leur taille et celle et du capitulum semblent être influencées par la taille des individus. L’hypothèse suggérant que les stress reliés aux divers modes de locomotion des hominoïdes influencent la morphologie de l’articulation distale de l’humérus est donc supportée. / In hominoids, tensile and compressive forces generated by locomotion and upper-limb use are transmitted through the elbow joint. It has been noticed that the distal humerus of hominoid is morphologically very similar across species. However, some studies have suggested that articular shape varies in relation to size and locomotor modes. This project is an attempt to characterize more thoroughly distal humeral variation in hominoids. It considers the humeral trochlea not only as a structure by itself, as it has been done before, but as an articulation that varies in orientation relative to the diaphysis. Indeed, there is evidence that articulations have a minimum size and are generally oriented to better resist habitual loads. This project tested the hypothesis that predominantly arboreal species are expected to present joints that have a size, position and orientation of articular surfaces to better resist shear loads generated by the strong finger and wrist flexor muscles crossing the elbow obliquely. Consequently, predominantly terrestrial species should present articulations shape and orientation that are better to resist axial load generated by ground reaction forces. Ten landmarks and two linear measurements were taken from a skeletal sample including specimens from the Homo, Pan, Gorilla and Pongo genus. Results show that orientation and position of humeral trochlea joint surfaces correlate with locomotor modes and that length of the articular surfaces seems to be better correlated with size. The main hypothesis suggesting that stress related to locomotion in hominoids should influence the morphology of distal humeral joints is therefore supported.

La masse corporelle et la direction des charges sont des facteurs qui peuvent modifier la morphologie des surfaces articulaires qui sont généralement orientées et de taille suffisante pour résister aux charges chroniques. Chez les hominoïdes, les forces de tension et compression, générées par la locomotion, sont transmises à travers l’articulation du coude. Ces espèces ont une morphologie similaire de l’extrémité distale de l’humérus, mais qui présente certaines différences selon la taille des individus et leurs modes de locomotion. Ce projet tente de caractériser plus exhaustivement cette variation en analysant la largeur des surfaces articulaires ainsi que leur position et orientation par rapport à l’axe long de la diaphyse. La prémisse de ce mémoire est que, chez les espèces plus arboricoles, la morphologie de l’articulation distale de l’humérus répond aux stress transverses générés par les puissants muscles fléchisseurs du poignet et des doigts qui traversent le coude obliquement. En revanche, les espèces plus terrestres présentent une morphologie permettant de résister aux forces axiales provenant du contact avec le sol. Des coordonnées tridimensionnelles et des mesures linéaires ont été recueillies sur un échantillon squelettique d’individus des genres Homo, Pan, Gorilla et Pongo. Les résultats obtenus révèlent que l’orientation et la position des surfaces articulaires de la trochlée correspondent aux types de locomotion, or leur taille et celle et du capitulum semblent être influencées par la taille des individus. L’hypothèse suggérant que les stress reliés aux divers modes de locomotion des hominoïdes influencent la morphologie de l’articulation distale de l’humérus est donc supportée. / In hominoids, tensile and compressive forces generated by locomotion and upper-limb use are transmitted through the elbow joint. It has been noticed that the distal humerus of hominoid is morphologically very similar across species. However, some studies have suggested that articular shape varies in relation to size and locomotor modes. This project is an attempt to characterize more thoroughly distal humeral variation in hominoids. It considers the humeral trochlea not only as a structure by itself, as it has been done before, but as an articulation that varies in orientation relative to the diaphysis. Indeed, there is evidence that articulations have a minimum size and are generally oriented to better resist habitual loads. This project tested the hypothesis that predominantly arboreal species are expected to present joints that have a size, position and orientation of articular surfaces to better resist shear loads generated by the strong finger and wrist flexor muscles crossing the elbow obliquely. Consequently, predominantly terrestrial species should present articulations shape and orientation that are better to resist axial load generated by ground reaction forces. Ten landmarks and two linear measurements were taken from a skeletal sample including specimens from the Homo, Pan, Gorilla and Pongo genus. Results show that orientation and position of humeral trochlea joint surfaces correlate with locomotor modes and that length of the articular surfaces seems to be better correlated with size. The main hypothesis suggesting that stress related to locomotion in hominoids should influence the morphology of distal humeral joints is therefore supported.