Radiographic patterns of osteoporotic proximal humerus fractures

Carbone, Stefano; Mezzoprete, R; Papalia, Matteo; Arceri, Valerio; Carbone, Andrea; Gumina, Stefano

doi:10.1016/j.ejrad.2017.12.025

Cited by 13 publications

(12 citation statements)

References 30 publications

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“…In fact, traumas, in both periods, occurred in the home environment and acted on an osteoporotic bone. The data seem to be in line with the results of Carbone et al, 7 who observed that 72% of patients with humeral head fractures were markedly osteoporotic and that most of these patients were elderly women sustaining low-energy trauma. Postacchini et al 20 in an epidemiologic study observed that clavicle fractures represent 2.6% of all fractures and that traffic accidents, falls, and sports injury were the most common causes responsible for the fracture.…”

Section: Discussionsupporting

confidence: 91%

The impact of COVID-19 on shoulder and elbow trauma: an Italian survey

Gumina

Proietti

Porcellini

et al. 2020

Journal of Shoulder and Elbow Surgery

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Background: Because of the rapid spread of COVID-19, on March 8, 2020 Italy became a ''protected area'': people were told not to leave their homes unless it was essential. The aim of this study was to evaluate the activity of our trauma center, relative to shoulder and elbow, in the 30 days starting from March 8, 2020, the first day of restrictions in Italy, and to compare it with the same days of 2019 to weigh the impact of COVID-19 on shoulder and elbow trauma. Materials and methods: Patients managed in our trauma center between March 8, 2020, and April 8, 2020 (COVID period), for shoulder and elbow trauma were retrospectively included and compared to patients admitted in the same period of 2019 (no-COVID period). Clinical records of all participants were examined to obtain information regarding age, sex, mechanism of injury, and diagnosis. Results: During the no-COVID period, 133 patients were admitted for a shoulder or elbow trauma; in the COVID period, there were 47 patients (65% less first aid). In the no-COVID and COVID period, patients with shoulder contusion totaled 60 (14.78% of all; male [M]: 34; female [F]: 26; mean age 51.8 years, range 18-88) and 11 (12.09% of all contusions; M: 7, F: 4; mean age 43 years, range 24-60), respectively. In the no-COVID period, 27 fractures (9.34% of all fractures) involved the shoulder, whereas 18 fractures (8.69%) were registered in the COVID period. In the no-COVID period, 14 elbow fractures were treated (4.8% of all fractures), compared with 4 in the COVID period. In the no-COVID and COVID periods, 6 patients (M: 5, F: 1; mean age 42 years, range 21-64) and 2 patients (M: 1, F: 1; mean age 29.5 years, range 24-35) reported having a feeling of momentary post-traumatic shoulder instability, and 0 and 1 patients (M: 1, F: 0; age 56 years), respectively, reported similar symptoms at the elbow. Finally, first or recurrent dislocations in the no-COVID period were 10, and in the COVID period, 7; elbow dislocations in the no-COVID period were 2, and in the COVID period, there were 3. Conclusions: During the COVID period, we provided a reduced number of health services, especially for patients with low-energy trauma and for those who underwent sports and traffic accidents. However, during the COVID period, elderly subjects remain exposed to shoulder and elbow trauma due to low-energy (domestic) falls. The subsequent hospitalization of these patients has contributed to making it more difficult to manage the hospital wards that are partly occupied by COVID-19 patients.

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Section: Discussionsupporting

confidence: 91%

The impact of COVID-19 on shoulder and elbow trauma: an Italian survey

Gumina

Proietti

Porcellini

et al. 2020

Journal of Shoulder and Elbow Surgery

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“…New approaches will therefore be necessary in the future when it comes to osteoporotic patients. 4,5…”

Section: Introductionmentioning

confidence: 99%

“…New approaches will therefore be necessary in the future when it comes to osteoporotic patients. 4,5 PHF are more commonly observed in older women following low-energy trauma, and exhibit a specific radiological pattern. They manifest with metaphyseal and tubercle fragmentation, impacted fragments, and inferior subluxation of the humeral head.…”

Section: Introductionmentioning

confidence: 99%

Effect of Osteoporosis on Proximal Humerus Fractures

Taşkesen

Göçer

Uzel

et al. 2020

Geriatr Orthop Surg Rehabil

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Introduction: Proximal humerus fractures (PHF) constitute the majority of the most common osteoporotic fractures. Bone density measurements can affect treatment methods and outcomes. This study was aimed to investigate the effect of osteoporosis values, measured from direct radiographs, on fracture type, surgical outcomes. Methods: 248 patients over 50 years of age who presented to Mersin City Hospital between 2017 and 2020 with proximal humeral fractures were retrospectively evaluated. The age and gender of the patients and the fracture types were evaluated according to the AO classification system from the direct radiographs obtained at the time of admission were recorded. The Tingart cortical thickness and deltoid tuberosity index (DTI) measurements were used to assess osteoporosis status in all patients. Postoperative and follow-up radiographs of 45 patients, treated with fixed-angle proximal humeral locking plate, were evaluated for radiographic results and their correlations with osteoporosis measurements were examined. Results: According to the demographic characteristics of the patients, 171 patients were female and 77 patients were male (F/M: 3/1), and mean age was 69.2 ± 11.66 (50-95). Considering the bone quality parameters in all patients, the mean Tingart value was 5.8 ± 1.6 mm and the mean DTI was 1.43 ± 0.17, where there was a correlation between the Tingart value and DTI (r = 0.810 and p < 0.001). Although there was a statistically significant relationship between the osteoporosis parameters and age and gender (p < 0.001 and p = 0.023, respectively), main AO fracture types were not related to osteoporosis (p < 0.05). In the operated group (n = 48, 19%), 19 patients (42%) showed poor outcomes, which were not associated with age and osteoporosis parameters. Conclusion: This study was concluded that osteoporosis parameters differ between genders and age groups in patients with PHF, however osteoporosis is not the main factor affecting the fracture type and surgical outcomes.

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“…This, in turn, should yield stronger correlations with fracture load, which will help develop advanced algorithms for proximal humerus fracture fixation and arthroplasty. 8,20,21…”

Section: Discussionmentioning

confidence: 99%

“…Determining whether these variables scale proportionally with bone length is important because the measurements of CI and MCCT could be made at the same percentage of total HL regardless of the size of the bone, which is an important step in advancing algorithms that guide treatment in proximal humerus fractures. 8,20,21 Accordingly, we asked: (1) Does HHD (from the CFM), Tingart distance, and Mather distance correlate with humerus length? (2) And if they do correlate, then what is the location of HHD, Tingart distance, and Mather distance as a percentage of humerus length?…”

Section: Introductionmentioning

confidence: 99%

The Circle-Fit Method Helps Make Reliable Cortical Thickness Measurements Regardless of Humeral Length

Shelton

Steele

Saiz

et al. 2018

Geriatr Orthop Surg Rehabil

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Background:Although proximal humerus strength/quality can be assessed using cortical thickness measurements (eg, cortical index), there is no agreement where to make them. Tingart and coworkers used measurements where the proximal endosteum becomes parallel, while Mather and coworkers used measurements where the periosteum becomes parallel. The new circle-fit method (CFM) makes 2 metaphyseal (M1-M2) and 6 diaphyseal (D1-D6) measurements referenced from humeral head diameter (HHD). However, it is unknown whether these locations correlate to humeral length (HL). Accordingly, we asked: (1) Does HHD, Tingart distance, and Mather distance correlate with HL? (2) What is the location of HHD, Tingart distance, and Mather distance as a percentage of HL? and (3) Which CFM D1-D6 locations correlate with Tingart and Mather distances?Materials and Methods:Measurements made on cortical thickness (CT) scout views of 19 humeri (ages: 16-73 years) included HHD, distances from the superior aspect of the humerus to proximal Tingart and Mather locations, and HL.Results:Intraclass correlation was excellent for CFM-HHD, poor for Tingart, and moderate for Mather. The CFM-HHD had a stronger correlation to HL than Tingart and Mather. Mean HHD was 15.5% (0.9%) of HL while Tingart was 27.0% (4.1%) and Mather was 23.2% (3.8%). Tingart distance corresponded to D2/D3 CFM locations while the Mather distance was similar to D1/D2.Discussion:The CFM reliably correlates with HL and provides a stronger correlation and less variance between specimens than the Tingart or Mather Methods.Conclusions:Because the CFM produces reliable percent of HL locations, it should be used to define locations for obtaining biomechanically relevant CT measurements such as cortical index. Stronger correlations of these CFM-based measurements with proximal humerus strength will be important for developing advanced algorithms for fracture treatment.

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Radiographic patterns of osteoporotic proximal humerus fractures

Cited by 13 publications

References 30 publications

The impact of COVID-19 on shoulder and elbow trauma: an Italian survey

The impact of COVID-19 on shoulder and elbow trauma: an Italian survey

Effect of Osteoporosis on Proximal Humerus Fractures

The Circle-Fit Method Helps Make Reliable Cortical Thickness Measurements Regardless of Humeral Length

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