AccScience Publishing / JCTR / Online First / DOI: 10.36922/JCTR025490091
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ORIGINAL ARTICLE

Humeral shaft coverage: A preliminary radiographic measurement of displacement in surgical neck humerus fractures

Ahmed Nageeb Mahmoud1,2* ,  Yagiz Ozdag1 ,  Juan David Bernate1 ,  Mahmoud AH Mahmoud1,3 ,  William Mack Malarkey1 ,  Mostafa Aly Elabd2 ,  Louis Christopher Grandizio1 ,  Daniel S. Horwitz1
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1 Department of Orthopedic Surgery, Geisinger Medical Center, Danville, Pennsylvania, United States of America
2 Department of Orthopedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
3 Department of Orthopedic Surgery, Faculty of Medicine, South Valley University, Qena, Egypt
JCTR, 025490091 https://doi.org/10.36922/JCTR025490091
Received: 1 December 2025 | Revised: 19 February 2026 | Accepted: 11 May 2026 | Published online: 5 June 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Background: Fracture displacement and bony contact in proximal humeral fractures can affect healing and patient outcomes. The eccentric head index, currently used to measure displacement, is relatively complex and not ideal for all fracture types. Aim: This study proposes and evaluates the reproducibility of an exploratory measurement, the humeral shaft coverage, to quantify the degree of bony contact between fracture ends in surgical neck humeral fractures. Methods: All patients with surgical neck humeral fractures who had undergone closed reduction in our electronic medical records were identified using the diagnostic terms, and their full series of follow-up radiographs were reviewed for measurement by two observers. The estimated total humeral shaft coverage (THSC) was calculated by multiplying the proportion of metaphyseal width covered by the humeral head on both anteroposterior (AP) and scapular Y views. Total uncoverage was determined using the formula: 1 – THSC. Results: Two observers evaluated 22 shoulder AP and Y radiographs, resulting in 44 measurements, and each repeated their measurements to assess intra-observer reliability. The mean HSC values for observers 1 and 2 were 0.36 ± 0.32 and 0.44 ± 0.31, with no significant difference (p = 0.098). Inter-observer reliability was good to excellent (intraclass correlation coefficient [ICC] = 0.88, 95% confidence interval: 0.67–0.97). Intra-observer reliability was excellent for both observers (ICC = 0.99). Conclusion: Humeral shaft coverage is a consistent measurement that may help quantify fracture displacement in surgical neck humeral fractures. Relevance for patients: A simple method for quantifying fracture displacement may help predict prognosis and guide management of proximal humeral fractures.

Keywords
Humeral fractures
Radiography
Fracture displacement
Shoulder joint
Prognosis
Emergency treatment
Funding
None.
Conflict of interest
The authors declare no conflict of interest.
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