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Sepehri A, Stockton DJ, Roffey DM, Lefaivre KA, Potter JM, Guy P. Effect of humeral rotation on the reliability of radiographic measurements for proximal humerus fractures. J Orthop Sci 2023:S0949-2658(23)00179-3. [PMID: 37393111 DOI: 10.1016/j.jos.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/18/2023] [Accepted: 06/14/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND There are concerns as to the reliability of proximal humerus radiographic measurements, particularly regarding the rotational position of the humerus when obtaining radiographs. METHODS Twenty-four patients with proximal humerus fractures fixed surgically with locked plates received postoperative anteroposterior radiographs with the humerus in neutral rotation and in 30° of internal and external rotation. Radiographic measurements for head shaft angle, humeral offset and humeral head height were performed in each humeral rotation position. Intra-class correlation coefficient was used to assess inter-rater and intra-rater reliability. Mean differences (md) in measurements between humeral positions was evaluated using one-way ANOVA. RESULTS Head shaft angle demonstrated good-to-excellent reliability; the highest estimates for inter-rater reliability (ICC: 0.85; 95% CI: 0.76, 0.94) and intra-rater reliability (ICC: 0.96; 95% CI: 0.93, 0.98) were achieved in neutral rotation. There were significant differences in measurement values between each rotational position, with mean head shaft angle of 133.1° in external rotation, and increasingly valgus measurements in neutral (md: 7.6°; 95% CI: 5.0, 10.3°; p < 0.001) and internal rotation (md: 26.4°; 95% CI: 21.8, 30.9°; p < 0.001). Humeral head height and humeral offset showed good-to-excellent reliability in neutral and external rotation, but poor inter-rater reliability in internal rotation. Humeral head height was significantly greater using internal compared to external rotation (md: 4.5 mm; 95% CI: 1.7, 7.3 mm; p = 0.002). Humeral offset was significantly greater in external compared to internal rotation (md: 4.6 mm; 95% CI: 2.6, 6.6 mm; p < 0.001). CONCLUSIONS Views of the humerus in neutral rotation and 30° of external rotation displayed superior reliability. Differences in radiographic measurement values, depending on humeral rotation views, can make for problematic correlations with patient outcome measures. Studies assessing radiographic outcomes following proximal humerus fractures should ensure standardized humeral rotation for obtaining anteroposterior shoulder radiographs, with neutral rotation and external rotation views likely yielding the most reliable results. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Aresh Sepehri
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 11th Floor - Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - David J Stockton
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 11th Floor - Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, 3rd Floor - Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, V5Z 1M9, Canada.
| | - Darren M Roffey
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 11th Floor - Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, 3rd Floor - Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, V5Z 1M9, Canada
| | - Kelly A Lefaivre
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 11th Floor - Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, 3rd Floor - Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, V5Z 1M9, Canada
| | - Jeffrey M Potter
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 11th Floor - Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, 3rd Floor - Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, V5Z 1M9, Canada
| | - Pierre Guy
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 11th Floor - Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, 3rd Floor - Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, V5Z 1M9, Canada
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Lukas J, Menduri H, Christian S, Bernhard J, Matthijs J. Impact of aberrant beam paths on antero-posterior shoulder radiographs in proximal humeral fractures. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04901-2. [PMID: 37169933 DOI: 10.1007/s00402-023-04901-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/19/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Accurate radiographic assessment of proximal humeral fractures (PHF) is important as it influences clinical decision-making and predicts clinical outcome. Since aberrant radiographic views might influence the assessment of fracture displacement, it was the goal of this study to investigate the impact of aberrant beam paths on radiographic assessment of PHF. MATERIALS AND METHODS Ten consecutive patients with a displaced PHF, bilateral computed tomography (CT) scan, and a true clinical AP radiograph were included. Digitally reconstructed radiographs (DRRs) were generated and aberrant beam paths were simulated by rotation of ± 30° around the horizontal (flexion and extension) and vertical axis (internal and external rotation) by increments of 10°. Measurement of the neck-shaft-angle (NSA) and eccentric head index (EHI) addressed humeral angulation and offset, respectively. Paired comparisons determined the influence of aberrant beam paths on both measurements between incremental altered views, and between clinical and digital true AP views. Descriptive statistics assessed the change in Neer classification and recommended treatment. RESULTS True AP DRRs approximated the clinical true AP view by a mean difference of 2° for NSA, and a mean difference of 0.12 for EHI. NSA in injured shoulders was most susceptible to malrotation around the vertical axis (p < 0.03), with largest differences seen for internal rotation. Aberrant projections in extension had no influence on NSA (p > 0.70), whereas flexion of ≥ 20° and 30° demonstrated differences in injured and uninjured shoulders, respectively (p < 0.05). EHI was only influenced by malrotation in internal rotation in uninjured shoulders (p < 0.03). Alterations in Neer type occurred at 30° of malrotation in 5 cases, with a change in recommended treatment in 2. CONCLUSIONS Humeral angulation and offset measurements on AP radiographs are more susceptible to aberrant beam paths in fractured humeri. Altered radiographic beam paths around the vertical axis showed the most substantial influence on the assessment of PHF, with angular measurements demonstrating larger differences then offset measurements. Beam path alterations of 30° can influence the Neer classification, and might influence fracture displacement-based decisions.
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Affiliation(s)
- Jud Lukas
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Hoessly Menduri
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Spross Christian
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Jost Bernhard
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Jacxsens Matthijs
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
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Yoshida Y, Matsumura N, Yamada Y, Hiraga S, Ishii K, Oki S, Yokoyama Y, Yamada M, Nakamura M, Nagura T, Jinzaki M. Three-dimensional alignment of the upper extremity in the standing neutral position in healthy subjects. J Orthop Surg Res 2022; 17:239. [PMID: 35428333 PMCID: PMC9013055 DOI: 10.1186/s13018-022-03113-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/31/2022] [Indexed: 11/23/2022] Open
Abstract
Background Though alignment of the spine and lower extremities in the standing neutral position has been evaluated, a few studies evaluating the alignment of the upper extremities have also been made. This study assessed the normal alignment of the upper extremities in the standing neutral position and clarified the three-dimensional angular rotations of the upper extremity joints. Methods Computed tomography (CT) images of 158 upper extremities from 79 healthy volunteers were prospectively acquired in the standing neutral position using an upright CT scanner. Three-dimensional coordinate systems of the thorax, scapula, humerus, and forearm were designated, and three-dimensional angular rotations of the scapulothoracic, glenohumeral, and elbow joints were calculated. Results The median angle of the scapulothoracic joint was 9.2° (interquartile range [IQR], 5.2°–12.5°) of upward rotation, 29.0° (IQR, 24.9°–33.3°) of internal rotation, and 7.9° (IQR, 4.3°–11.8°) of anterior tilt. The median angle of the glenohumeral joint was 4.5° (IQR, 0.9°–7.8°) of abduction, 9.0° (IQR, 2.2°–19.0°) of internal rotation, and 0.3° (IQR, − 2.6°–3.1°) of extension. The median angle of the elbow joint was 9.8° (IQR, 6.9°–12.4°) of valgus, 90.2° (IQR, 79.6°–99.4°) of pronation, and 15.5° (IQR, 13.2°–18.1°) of flexion. Correlations in angular rotation values were found between the right and left upper extremities and between joints. Conclusions This study clarified the three-dimensional angular rotation of upper extremity joints in the standing neutral position using an upright CT scanner. Our results may provide important insights for the functional evaluation of upper extremity alignment.
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Short stem humeral components in reverse shoulder arthroplasty: stem alignment influences the neck-shaft angle. Arch Orthop Trauma Surg 2021; 141:183-188. [PMID: 32221702 DOI: 10.1007/s00402-020-03424-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Shorter humeral reverse total shoulder arthroplasty (RTSA) stems may reduce stress shielding, however, potentially carry the risk of varus/valgus malalignment. This radiographic study's purpose was to measure the incidence of stem malalignment and thus the realized neck-shaft angle (NSA). The hypothesis was that malalignment of the stem is a frequent postoperative radiographic finding. METHODS Radiographs of an uncemented curved short stem RTSA with a 145° NSA were reviewed. The study group included 124 cases at a mean age of 74 (range 48-91) years. The humeral stem axis was measured and defined as neutral if the value fell within ± 5° of the longitudinal humeral axis. Angular values > 5° were defined as malaligned in valgus or varus. The filling ratio of the implant within the humeral shaft was measured at the level of the metaphysis (FRmet) and diaphysis (FRdia). RESULTS The average humeral stem axis angle was 4 ± 3° valgus, corresponding to a true mean NSA of 149 ± 3°. Stem axis was neutral in 73% (n = 90) of implants. Of the 34 malaligned implants, 82% (n = 28) were in valgus (NSA = 153 ± 2°) and 18% (n = 6) in varus (NSA = 139 ± 1°). The average FRmet and FRdia were 0.68 ± 0.11 and 0.72 ± 0.11, respectively. A low positive association was found between stem diameter and filling ratios (r = 0.39; p < 0.001); indicating smaller stem sizes were more likely to be misaligned. CONCLUSION Uncemented short stem implants may decrease stress shielding; however, approximately one quarter were implanted > 5° malaligned. The majority of malaligned components (86%) were implanted in valgus, corresponding to an NSA of > 150°. As such, surgeons must be aware that shorter and smaller stems may lead to axial malalignment influencing the true SA. LEVEL OF EVIDENCE Level IV, retrospective study.
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Measuring Lateral Screw Protuberance Is a Clinically Accurate Method for Quantifying Femoral Neck Shortening. J Orthop Trauma 2020; 34:600-605. [PMID: 33065661 DOI: 10.1097/bot.0000000000001806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this study is to compare the reliability and accuracy of the screw protuberance method (SPM) and overlay method (OM) for measuring femoral neck shortening on anterior-posterior (AP) radiographs. The secondary aim is to investigate the changes in reliability and accuracy with varying femoral rotation. METHODS Radio-opaque femur sawbone models were fitted with either 3 cancellous screws or a sliding hip screw implant. Anterior-posterior radiographs were obtained using C-arm fluoroscopy with femoral neck shortening up to 15 mm and with the femoral shaft in 30 degrees of internal rotation to 30 degrees of external rotation (ER). Four observers measured femoral neck shortening at 2 time points. Intraobserver and interobserver reliability were calculated using the intraclass coefficient. Accuracy was analyzed through a Bland-Altman agreement statistic stratified by femoral rotation. RESULTS Both measurement techniques displayed excellent reliability, regardless of femoral rotation or implant. There was a significant difference in femoral neck shortening measurements with rotation for both the OM (P < 0.001) and SPM (P < 0.001). Both methods are accurate within 1 mm of the actual magnitude of shortening from 30-degree internal rotation to 15-degree ER. At 30-degree ER, shortening was underestimated by -2.10 mm using the OM (95% confidence interval, -2.43 to -1.76; P < 0.01) and by -1.64 mm using the SPM (95% confidence interval, -1.83 to -1.45; P < 0.01). CONCLUSION This study demonstrates that both the OM and SPM are accurate and reliable assessments for femoral neck shortening; however, both methods are sensitive to extreme ER. Given the simplicity of the SPM technique, it may have increased utility for pragmatic research studies.
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Knierzinger D, Crepaz-Eger U, Hengg C, Kralinger F. Does cement augmentation of the screws in angular stable plating for proximal humerus fractures influence the radiological outcome: a retrospective assessment. Arch Orthop Trauma Surg 2020; 140:1413-1421. [PMID: 32130479 PMCID: PMC7505823 DOI: 10.1007/s00402-020-03362-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Screw-tip augmentation in angular stable plating offers new possibilities for the treatment of complex proximal humerus fractures. This retrospective analysis was performed to evaluate the radiological outcome of proximal humerus fractures treated with angular stable plates and additional screw-tip cement augmentation in patients over the age of 60. MATERIALS AND METHODS A retrospective single centre analysis was conducted from June 2013 to December 2016. The minimum follow-up time was set to 6 months after surgery. Anatomical reduction and fixation were evaluated in respect to reattached tuberosities to the head fragment and the adequate restoration of the calcar area not showing any valgus or varus malalignment. Complete fracture healing was determined 3 months after surgery. Any failures such as secondary displacement, primary screw perforation, intraarticular cement leakage and avascular necrosis of the humeral head with concomitant screw cut-out were assessed. RESULTS In total, 24 patients (21 females; 3 males) at a median age of 77.5 (62-96) years were included. Five 2-part, twelve 3-part and seven 4-part fractures were detected. The measured median BMD value of 23 patients was 78.4 mg/cm3 (38.8-136.9 mg/cm3). Anatomical reduction was achieved in 50% of the patients. In most cases, the A level screws and the B1 screw were augmented with bone cement by a median of 7 (5-9) head screws used. Postoperative varus displacement was not detected in any of the patients. One patient (4.2%) sustained an early secondary displacement. Intraarticular cement leakage was detected in 3 patients (2 head-split fractures). Avascular necrosis of the humeral head was observed in 4 patients (16.7%). Revision surgery was necessary in four cases, using hemiarthroplasty twice and reverse shoulder arthroplasty the other two times. CONCLUSION Screw-tip augmentation in angular stable plating for proximal humerus fracture treatment showed a low secondary displacement rate of 4.2% in patients suffering from poor bone quality. Nevertheless, the occurrence of avascular necrosis of the humeral head with mainly severe fracture patterns observed in this study was higher compared to previously reported results in the literature. Cement augmentation in head-split fractures is not recommended, considering the high risk of an intraarticular cement leakage.
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Affiliation(s)
- Dominik Knierzinger
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Ulrich Crepaz-Eger
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Clemens Hengg
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Franz Kralinger
- Department of Trauma Surgery, Wilhelminenspital Wien, Montleartstraße 37, 1160, Vienna, Austria
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Impact of shoulder rotation on neck-shaft angle: A clinical study. Orthop Traumatol Surg Res 2017; 103:865-868. [PMID: 28576698 DOI: 10.1016/j.otsr.2017.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/21/2017] [Accepted: 04/26/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Two recent experimental studies evaluated the influence of shoulder rotation on neck-shaft angle, with conflicting results. However, there have been no clinical studies of whether this angle varies in different shoulder positions. The present study aimed to determine whether shoulder rotation affects neck-shaft angle on standard radiographs in patients with complaints of shoulder pain. HYPOTHESIS Shoulder rotation does not affect neck-shaft angle. MATERIALS AND METHODS A prospective study was conducted in selected patients with shoulder pain. Three true anterior-posterior radiographic views were obtained: in neutral rotation, 30° external rotation, and internal rotation with patient's arm in a sling. The X-rays were evaluated by three shoulder and elbow surgeons. Inter- and intra-observer reliability was evaluated by intraclass correlation coefficient (ICC). RESULTS Neck-shaft angle on true AP view did not differ between neutral rotation and 30° external rotation: 132±6° and 130±9°, respectively (P>0.999). In internal rotation with the hand resting on the abdomen, neck-shaft angle was 145±6°: i.e., significantly different (P<0.001) to the other two positions. Intra- and inter-observer correlation demonstrated excellent reliability. CONCLUSIONS Radiographic neck-shaft angle was significantly different in internal rotation with the patient's arm in a sling, compared with views in neutral or 30° external rotation. Intra- and inter-observer correlation showed excellent reliability. LEVEL OF EVIDENCE II, comparative prospective study.
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Laux CJ, Grubhofer F, Werner CML, Simmen HP, Osterhoff G. Current concepts in locking plate fixation of proximal humerus fractures. J Orthop Surg Res 2017; 12:137. [PMID: 28946902 PMCID: PMC5613450 DOI: 10.1186/s13018-017-0639-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 09/17/2017] [Indexed: 12/27/2022] Open
Abstract
Despite numerous available treatment strategies, the management of complex proximal humeral fractures remains demanding. Impaired bone quality and considerable comorbidities pose special challenges in the growing aging population. Complications after operative treatment are frequent, in particular loss of reduction with varus malalignment and subsequent screw cutout. Locking plate fixation has become a standard in stabilizing these fractures, but surgical revision rates of up to 25% stagnate at high levels. Therefore, it seems of utmost importance to select the right treatment for the right patient. This article provides an overview of available classification systems, indications for operative treatment, important pathoanatomic principles, and latest surgical strategies in locking plate fixation. The importance of correct reduction of the medial cortices, the use of calcar screws, augmentation with bone cement, double-plate fixation, and auxiliary intramedullary bone graft stabilization are discussed in detail.
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Affiliation(s)
- Christoph J Laux
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Florian Grubhofer
- Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Clément M L Werner
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Hans-Peter Simmen
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Georg Osterhoff
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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Adikrishna A, Hong H, Deslivia MF, Zhu B, Tan J, Jeon IH. Head-shaft angle changes during internal and external shoulder rotations: 2-D angulation in 3-D space. Orthop Traumatol Surg Res 2017; 103:159-163. [PMID: 28082108 DOI: 10.1016/j.otsr.2016.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 11/20/2016] [Accepted: 11/25/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Restoration of native head-shaft angle (HSA) is critical for treatment of proximal humerus fracture. However, HSA has not been properly investigated according to the humeral rotation. This study was designed to analyze the relationship between the humeral rotation and the HSA at 1° increments, and clarify its serial changing pattern according to the humeral rotation. HYPOTHESIS The angulation of HSA would be undervalued when the humerus is being rotated externally and it would be overvalued when it is being rotated internally. MATERIALS AND METHODS Eight dried cadaveric normal humeri were CT scanned. They were analyzed using computer-aided design with a standardized neutral position. HSA was the angle between the humeral shaft axis (SA) and the humeral head axis (HA). SA and HA were the best-fit lines through center of all the best-fitting circles in every cross section along the humeral shaft and within the humeral head, respectively. Each 3D model was rotated 30° internally and 45° externally relatives to the SA at 1° increments with the camera was fixed at antero-posterior view of neutral position. Angulation of HSA in every rotational degree was documented as ratio relatives to the angulation of HSA in neutral position. RESULTS The average HSA at neutral position was 133±1.93°. HSA was underestimated by 8±1.9% and it was overestimated by 20±5.1% at the maximum external rotation (ER) and internal rotation (IR), respectively. HSA was underestimated by 1% in every 5.8° of ER and overestimated by 1% in every 1.5° of IR. Rotational misalignments within 10° of IR and 18° of ER could be tolerated (P>.05). CONCLUSIONS HSA was underestimated at ER and was overestimated at IR. This information could be useful for surgeons in restoring the native HSA for treatment of proximal humerus fracture. TYPE OF STUDY Basic research study.
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Affiliation(s)
- A Adikrishna
- Department of Orthopaedics Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - H Hong
- Department of Orthopaedics Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - M F Deslivia
- Department of HCI and Robotics, University of Science and Technology, Daejon, Republic of Korea; Center of Robotics, Korea Institute of Science and Technology, Seoul, Republic of Korea
| | - B Zhu
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, Zhejiang, China
| | - J Tan
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - I-H Jeon
- Department of Orthopaedics Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
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Response to letter to the editor concerning "The rotation of the humeral head does not alter radiographic evaluation of the head-shaft angle". J Shoulder Elbow Surg 2016; 25:e367. [PMID: 27742252 DOI: 10.1016/j.jse.2016.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 07/20/2016] [Indexed: 02/01/2023]
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Hengg C, Euler S, Wambacher M, Blauth M, Kralinger F. Regarding "The rotation of the humeral head does not alter radiographic evaluation of the head-shaft angle". J Shoulder Elbow Surg 2016; 25:e365-e366. [PMID: 27742251 DOI: 10.1016/j.jse.2016.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/20/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Clemens Hengg
- Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck (MUI), Innsbruck, Austria.
| | - Simon Euler
- Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck (MUI), Innsbruck, Austria
| | - Markus Wambacher
- Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck (MUI), Innsbruck, Austria
| | - Michael Blauth
- Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck (MUI), Innsbruck, Austria
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