{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:12:54Z","timestamp":1790997174855,"version":"4.1.0"},"reference-count":33,"publisher":"Elsevier BV","issue":"4","license":[{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jshoulderelbow.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Shoulder and Elbow Surgery"],"published-print":{"date-parts":[[2022,4]]},"DOI":"10.1016\/j.jse.2021.08.033","type":"journal-article","created":{"date-parts":[[2021,10,5]],"date-time":"2021-10-05T18:28:15Z","timestamp":1633458495000},"page":"782-791","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":6,"title":["How can medial support for proximal humeral fractures be achieved when positioning of regular calcar screws is challenging? Slotting and off-axis fixation strategies"],"prefix":"10.1016","volume":"31","author":[{"given":"Jian","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi","family":"Zhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Ling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dajun","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiagen","family":"Sheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.jse.2021.08.033_bib1","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1097\/BOT.0000000000000057","article-title":"Effect of calcar screw use in surgical neck fractures of the proximal humerus with unstable medial support: a biomechanical study","volume":"28","author":"Bai","year":"2014","journal-title":"J Orthop Trauma"},{"key":"10.1016\/j.jse.2021.08.033_bib2","doi-asserted-by":"crossref","first-page":"105295","DOI":"10.1016\/j.clinbiomech.2021.105295","article-title":"Biomechanical evaluation of different types of lateral hinge fractures in medial opening wedge high tibial osteotomy","volume":"83","author":"Chen","year":"2021","journal-title":"Clin Biomech (Bristol, Avon)"},{"key":"10.1016\/j.jse.2021.08.033_bib3","doi-asserted-by":"crossref","first-page":"2625","DOI":"10.1002\/jor.24429","article-title":"Secondary perforation risk in plate osteosynthesis of unstable proximal humerus fractures: a biomechanical investigation of the effect of screw length","volume":"37","author":"Ciric","year":"2019","journal-title":"J Orthop Res"},{"key":"10.1016\/j.jse.2021.08.033_bib4","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","article-title":"Epidemiology of adult fractures: A review","volume":"37","author":"Court-Brown","year":"2006","journal-title":"Injury"},{"key":"10.1016\/j.jse.2021.08.033_bib5","doi-asserted-by":"crossref","first-page":"2161","DOI":"10.1016\/j.injury.2018.11.009","article-title":"Fractures in older adults. A view of the future?","volume":"49","author":"Court-Brown","year":"2018","journal-title":"Injury"},{"key":"10.1016\/j.jse.2021.08.033_bib6","article-title":"PHILOS and PHILOS Long","year":"2016","journal-title":"Surgical Technique"},{"issue":"430","key":"10.1016\/j.jse.2021.08.033_bib7","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1097\/01.blo.0000137554.91189.a9","article-title":"A new locking plate for unstable fractures of the proximal humerus","author":"Fankhauser","year":"2005","journal-title":"Clin Orthop Relat Res"},{"key":"10.1016\/j.jse.2021.08.033_bib8","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1007\/s00402-019-03175-x","article-title":"The influence of screw length on predicted cut-out failures for proximal humeral fracture fixations predicted by finite element simulations","volume":"139","author":"Fletcher","year":"2019","journal-title":"Arch Orthop Trauma Surg"},{"key":"10.1016\/j.jse.2021.08.033_bib9","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1002\/jor.24235","article-title":"Importance of locking plate positioning in proximal humeral fractures as predicted by computer simulations","volume":"37","author":"Fletcher","year":"2019","journal-title":"J Orthop Res"},{"key":"10.1016\/j.jse.2021.08.033_bib10","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1097\/BOT.0000000000000042","article-title":"Effect of off-axis screw insertion, insertion torque, and plate contouring on locked screw strength","volume":"28","author":"Gallagher","year":"2014","journal-title":"J Orthop Trauma"},{"key":"10.1016\/j.jse.2021.08.033_bib11","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1097\/BOT.0b013e3180333094","article-title":"The importance of medial support in locked plating of proximal humerus fractures","volume":"21","author":"Gardner","year":"2007","journal-title":"J Orthop Trauma"},{"key":"10.1016\/j.jse.2021.08.033_bib12","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1097\/BOT.0000000000000229","article-title":"Surgical management of complex proximal humerus fractures\u2014a systematic review of 92 studies including 4500 patients","volume":"29","author":"Gupta","year":"2015","journal-title":"J Orthop Trauma"},{"key":"10.1016\/j.jse.2021.08.033_bib13","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.jse.2004.01.034","article-title":"Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus","volume":"13","author":"Hertel","year":"2004","journal-title":"J Shoulder Elbow Surg"},{"key":"10.1016\/j.jse.2021.08.033_bib14","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1002\/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L","article-title":"Development of an upper extremity outcome measure: the DASH (Disabilities of the Arm, Shoulder and Hand) [corrected]. The Upper Extremity Collaborative Group (UECG)","volume":"29","author":"Hudak","year":"1996","journal-title":"Am J Ind Med"},{"key":"10.1016\/j.jse.2021.08.033_bib15","doi-asserted-by":"crossref","first-page":"1669","DOI":"10.1002\/jor.24881","article-title":"Biomechanical comparison of five cannulated screw fixation strategies for young vertical femoral neck fractures","volume":"39","author":"Jiang","year":"2021","journal-title":"J Orthop Res"},{"key":"10.1016\/j.jse.2021.08.033_bib16","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1186\/1471-2474-14-102","article-title":"Does medial support decrease major complications of unstable proximal humerus fractures treated with locking plate?","volume":"14","author":"Jung","year":"2013","journal-title":"BMC Musculoskelet Disord"},{"key":"10.1016\/j.jse.2021.08.033_bib17","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/j.clinbiomech.2014.06.008","article-title":"Biomechanical effects of calcar screws and bone block augmentation on medial support in locked plating of proximal humeral fractures","volume":"29","author":"Katthagen","year":"2014","journal-title":"Clin Biomech (Bristol, Avon)"},{"key":"10.1016\/j.jse.2021.08.033_bib18","first-page":"1235","article-title":"The biomechanics of locked plating for repairing proximal humerus fractures with or without medial cortical support","volume":"69","author":"Lescheid","year":"2010","journal-title":"J Trauma"},{"key":"10.1016\/j.jse.2021.08.033_bib19","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1016\/j.injury.2018.02.007","article-title":"Calcar screw position in proximal humerus fracture fixation: Don't miss high!","volume":"49","author":"Mehta","year":"2018","journal-title":"Injury"},{"key":"10.1016\/j.jse.2021.08.033_bib20","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","article-title":"Fracture and dislocation classification compendium\u20142018","volume":"32","author":"Meinberg","year":"2018","journal-title":"J Orthop Trauma"},{"key":"10.1016\/j.jse.2021.08.033_bib21","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1007\/s00276-005-0318-7","article-title":"The arteries of the humeral head and their relevance in fracture treatment","volume":"27","author":"Meyer","year":"2005","journal-title":"Surg Radiol Anat"},{"key":"10.1016\/j.jse.2021.08.033_bib22","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1097\/01.blo.0000198718.91223.ca","article-title":"Displaced proximal humeral fractures: part I. Classification and evaluation","volume":"442","author":"Neer","year":"2006","journal-title":"Clin Orthop Relat Res"},{"key":"10.1016\/j.jse.2021.08.033_bib23","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.jse.2019.06.014","article-title":"Failure to restore the calcar and locking screw cross-threading predicts varus collapse in proximal humerus fracture fixation","volume":"29","author":"Padegimas","year":"2020","journal-title":"J Shoulder Elbow Surg"},{"key":"10.1016\/j.jse.2021.08.033_bib24","doi-asserted-by":"crossref","first-page":"1931","DOI":"10.1016\/j.jse.2017.05.003","article-title":"Defining optimal calcar screw positioning in proximal humerus fracture fixation","volume":"26","author":"Padegimas","year":"2017","journal-title":"J Shoulder Elbow Surg"},{"key":"10.1016\/j.jse.2021.08.033_bib25","doi-asserted-by":"crossref","first-page":"e113","DOI":"10.2106\/JBJS.K.00202","article-title":"The role of medial comminution and calcar restoration in varus collapse of proximal humeral fractures treated with locking plates","volume":"95","author":"Ponce","year":"2013","journal-title":"J Bone Joint Surg Am"},{"key":"10.1016\/j.jse.2021.08.033_bib26","doi-asserted-by":"crossref","first-page":"S56","DOI":"10.1016\/S0020-1383(13)70200-6","article-title":"Comparative study of three models of extra-articular distal humerus fracture osteosynthesis using the finite element method on an osteoporotic computational model","volume":"44","author":"Sabalic","year":"2013","journal-title":"Injury"},{"key":"10.1016\/j.jse.2021.08.033_bib27","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.2106\/JBJS.16.00112","article-title":"Quality of reduction influences outcome after locked-plate fixation of proximal humeral type-C fractures","volume":"98","author":"Schnetzke","year":"2016","journal-title":"J Bone Joint Surg Am"},{"key":"10.1016\/j.jse.2021.08.033_bib28","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1302\/0301-620X.85B4.12843","article-title":"The cortical thickness of the proximal humeral diaphysis predicts bone mineral density of the proximal humerus","volume":"85","author":"Tingart","year":"2003","journal-title":"J Bone Joint Surg Br"},{"key":"10.1016\/j.jse.2021.08.033_bib29","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.jmbbm.2017.07.004","article-title":"Fatigue failure of plated osteoporotic proximal humerus fractures is predicted by the strain around the proximal screws","volume":"75","author":"Varga","year":"2017","journal-title":"J Mech Behav Biomed Mater"},{"key":"10.1016\/j.jse.2021.08.033_bib30","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1016\/j.clinbiomech.2006.06.005","article-title":"Biomechanical comparison of a unique locking plate versus a standard plate for internal fixation of proximal humerus fractures in a cadaveric model","volume":"21","author":"Walsh","year":"2006","journal-title":"Clin Biomech (Bristol, Avon)"},{"key":"10.1016\/j.jse.2021.08.033_bib31","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1016\/j.injury.2020.04.018","article-title":"Where should the pins be placed to decrease the failure rate after fixation of a Mayo IIA olecranon fracture? A biomechanical analysis","volume":"51","author":"Wang","year":"2020","journal-title":"Injury"},{"key":"10.1016\/j.jse.2021.08.033_bib32","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1007\/s00264-011-1227-5","article-title":"The clinical benefit of medial support screws in locking plating of proximal humerus fractures: a prospective randomized study","volume":"35","author":"Zhang","year":"2011","journal-title":"Int Orthop"},{"key":"10.1016\/j.jse.2021.08.033_bib33","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.2106\/JBJS.15.01232","article-title":"Distinct proximal humeral geometry in Chinese population and clinical relevance","volume":"98","author":"Zhang","year":"2016","journal-title":"J Bone Joint Surg Am"}],"container-title":["Journal of Shoulder and Elbow Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1058274621007059?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1058274621007059?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:54:22Z","timestamp":1761008062000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1058274621007059"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4]]},"references-count":33,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,4]]}},"alternative-id":["S1058274621007059"],"URL":"https:\/\/doi.org\/10.1016\/j.jse.2021.08.033","relation":{},"ISSN":["1058-2746"],"issn-type":[{"value":"1058-2746","type":"print"}],"subject":[],"published":{"date-parts":[[2022,4]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"How can medial support for proximal humeral fractures be achieved when positioning of regular calcar screws is challenging? Slotting and off-axis fixation strategies","name":"articletitle","label":"Article Title"},{"value":"Journal of Shoulder and Elbow Surgery","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jse.2021.08.033","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2021 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.","name":"copyright","label":"Copyright"}]}}