Effect of humeral rotation on the reliability of radiographic measurements for proximal humerus fractures.

Intra-class correlation Proximal humerus fracture Radiograph Reliability Rotation Shoulder Surgery

Journal

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
ISSN: 1436-2023
Titre abrégé: J Orthop Sci
Pays: Japan
ID NLM: 9604934

Informations de publication

Date de publication:
30 Jun 2023
Historique:
received: 29 12 2022
revised: 18 05 2023
accepted: 14 06 2023
medline: 2 7 2023
pubmed: 2 7 2023
entrez: 1 7 2023
Statut: aheadofprint

Résumé

There are concerns as to the reliability of proximal humerus radiographic measurements, particularly regarding the rotational position of the humerus when obtaining radiographs. 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. 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). 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 IV.

Sections du résumé

BACKGROUND 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 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 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 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 METHODS
Level IV.

Identifiants

DOI: 10.1016/j.jos.2023.06.006 PMID: 37393111
pubmed: 37393111
pii: S0949-2658(23)00179-3
doi: 10.1016/j.jos.2023.06.006
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest None.

Auteurs

Aresh Sepehri (A)

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 (DJ)

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. Electronic address: david.stockton@vch.ca.

Darren M Roffey (DM)

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 (KA)

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 (JM)

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 (P)

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.

Classifications MeSH