{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T20:49:00Z","timestamp":1782074940135,"version":"3.54.5"},"reference-count":16,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Allegheny Health Network Orthopedic Institute Research Committee"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Shoulder & Elbow"],"abstract":"\n Background<\/jats:title>\n Cementless reverse shoulder arthroplasty (RSA) with percutaneous locking screw fixation is an increasingly utilized option for treatment of proximal humerus fractures. The safety of percutaneous screw placement in the humerus has not been well established. This study aims to evaluate the proximity of the axillary and radial nerves to percutaneous screw trajectories in RSA.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A humeral fracture stem with percutaneous locking screws was implanted into six male cadaveric specimens. Screw holes were over-drilled, and distances from trocars and drill bits to the axillary and radial nerves were measured using precise calipers.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The drill bit was an average of 5.43\u2005mm from the axillary nerve exiting the proximal cross-lock hole, with direct nerve penetration in one specimen. At the distal cross-lock hole, the drill bit was 1.45\u2005mm from the radial nerve and pierced it in two specimens. The middle cross-lock hole showed no proximity to either nerve. Arm rotation did not affect these distances.<\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n The axillary and radial nerves are near the proximal and distal locking screws in RSA fracture stems with cross-locking options. Surgeons should exercise caution when placing these screws to reduce nerve injury risk. Further clinical studies are needed to validate these findings.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/17585732261457640","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:34:43Z","timestamp":1781613283000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The safety of percutaneous screw placement in reverse shoulder arthroplasty for fracture: A cadaveric study"],"prefix":"10.1177","author":[{"given":"Ryan P","family":"Tantone","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3235-8709","authenticated-orcid":false,"given":"Alyssa","family":"Dobyns","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8276-4252","authenticated-orcid":false,"given":"Steven","family":"Regal","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-021-02551-x"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jseint.2024.06.006"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12178-020-09597-0"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2020.04.052"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.98B1.36336"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00590-022-03400-1"},{"key":"e_1_3_3_8_2","unstructured":"Tornier Perform Humeral Stem. www.stryker.com. Available from: https:\/\/www.stryker.com\/us\/en\/trauma-and-extremities\/products\/tornier-perform-humeral-fracture.html (2024 accessed 12 October 2025)."},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-022-05444-8"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2021.105283"},{"key":"e_1_3_3_11_2","first-page":"535","article-title":"Surgical fixation of periprosthetic humeral shaft fracture about a short-stem anatomic total shoulder arthroplasty with a proximal humeral locking plate: surgical technique and report of 3 cases","volume":"3","author":"Oeding JF","year":"2023","unstructured":"Oeding JF, Lawler SM, Lazarus MD, et al. Surgical fixation of periprosthetic humeral shaft fracture about a short-stem anatomic total shoulder arthroplasty with a proximal humeral locking plate: surgical technique and report of 3 cases. JSES Rev Rep Tech 2023; 3: 535\u2013540.","journal-title":"JSES Rev Rep Tech"},{"key":"e_1_3_3_12_2","first-page":"297","article-title":"Periprosthetic fractures in reverse total shoulder arthroplasty: current concepts and advances in management","volume":"9","author":"Garcia-Fernandez C","year":"2015","unstructured":"Garcia-Fernandez C, L\u00f3piz-Morales Y, L\u00f3pez A, et al. Periprosthetic fractures in reverse total shoulder arthroplasty: current concepts and advances in management. Open Orthop J 2015; 9: 297\u2013304.","journal-title":"Open Orthop J"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2006.07.001"},{"key":"e_1_3_3_14_2","article-title":"Anatomy of axillary nerve and its clinical importance: a cadaveric study","volume":"9","author":"Gurushantappa PK","year":"2015","unstructured":"Gurushantappa PK, Kuppasad S. Anatomy of axillary nerve and its clinical importance: a cadaveric study. J Clin Diagn Res 2015; 9: AC13\u2013AC17.","journal-title":"J Clin Diagn Res"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12178-019-09585-z"},{"key":"e_1_3_3_16_2","article-title":"Determination of gender from various measurements of the humerus","volume":"12","author":"Khan MA","year":"2020","unstructured":"Khan MA, Gul H, Mansor Nizami S. Determination of gender from various measurements of the humerus. Cureus 2020; 12: e6598.","journal-title":"Cureus"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.5115\/acb.2017.50.3.180"}],"container-title":["Shoulder & Elbow"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17585732261457640","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/17585732261457640","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17585732261457640","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T20:25:15Z","timestamp":1782073515000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/17585732261457640"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,16]]},"references-count":16,"alternative-id":["10.1177\/17585732261457640"],"URL":"https:\/\/doi.org\/10.1177\/17585732261457640","relation":{},"ISSN":["1758-5732","1758-5740"],"issn-type":[{"value":"1758-5732","type":"print"},{"value":"1758-5740","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,16]]},"article-number":"17585732261457640"}}