Evidence map›Paper›PMID 34080060›Full record

ArticleArchives of orthopaedic and trauma surgery2022

Analysis of the subcapital two-part humerus fracture by fluoroscopy: objective criteria for classification and decision making.

Nicolas Bless, Nicola Keller, Amir Steinitz, Thibaut Klein, Daniel Rikli

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Article in Archives of orthopaedic and trauma surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

5 authors.

Nicolas Bless *Department of Orthopedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland. Nicolas.Bless@usb.ch.
Nicola Keller *University of Basel, Basel, Switzerland.
Amir SteinitzClinic for Orthopedics and Surgery, Merian Iselin, Basel, Switzerland.
Thibaut KleinDepartment of Biomedicine, University of Basel, Basel, Switzerland.
Daniel RikliDepartment of Orthopedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSurgical decision making in the treatment of proximal humerus fractures (PHFx) is primarily based on fracture classification using standard radiographs. Due to the lack of objective criteria, this classification process is associated with high interobserver variation. In this study, we investigate the fluoroscopic analysis of humerus fractures through the surgical neck using a semi-quantitative determination of distinct angulation patterns of the proximal humerus as they appear in the image intensifier.

methodsUsing a saw bone model, defined subcapital 2-part fracture configurations were generated and assessed radiographically. Anatomical landmarks-including the greater and lesser tuberosity as well as anatomical neck-were identified using an image converter, and the exact degree of fracture displacement with 10° up to 70° (in 10° increments) of posterior, varus or combined posterior-varus angulation was compared to nondisplaced controls. From the resultant series of radiographs, the appearance of these angulations in anteroposterior (AP) and scapular Y-views were also visualized and defined.

resultsAn angulation of 50° or more of any given 2-part fracture through the surgical neck is present when the greater tuberosity becomes the most proximal point in AP view (varus and combined posterior-varus angulation) or a bimodal form is found for the superior contour of the head with the lesser tuberosity being the most proximal point in the Y-view (posterior angulation).

conclusionThe radiological appearance of various PHFx constellations can be well visualized using the saw bone shoulder model. The presence of angulation in accordance with the Neer classification for group III fractures can be adequately determined by analyzing the relative position of the greater or lesser tuberosity to the humeral head calotte. This can assist the surgeon's decision on whether to operate or opt for a conservative approach. LEVEL OF EVIDENCE: Basic Science, Anatomy Study, Imaging.

Indexed as

Humeral FracturesShoulder FracturesDecision MakingFluoroscopyFracture Fixation, InternalHumansHumerusAngulationClassificationFluoroscopyProximal humerus fractureShoulderSurgical neck

Identifiers

PMID34080060
PMCPMC9381626

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