Risk Factors for Severe Proximal Humerus Fracture and Correlation Between Deltoid Tuberosity Index and Bone Mineral Density

Kim, Dong-Min; Park, Dongjun; Kim, Hyojune; Lee, Jun Young; Shin, Myung Jin; Jeon, In-Ho; Koh, Kyoung Hwan

doi:10.1177/2151459320938571

Cited by 11 publications

(4 citation statements)

References 39 publications

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“…Similar findings were also revealed in the present study. The present study found that, as age increases by one year, the incidence of severe PHF increases by 1.064 times, this result is comparable to the results (1.044 times) of Kim et al[ 38 ], additionally, they indicated that gender was the independent risk factor of severe PHFs considering that females were 3.763 times more likely to suffer from severe PHF than males, without a clear cause. This study only included patients greater than or equal to 60 years old, here we did not find a similar result.…”

Section: Discussionsupporting

confidence: 90%

Hounsfield units predicts the occurrence but not the patterns of proximal humerus fracture in the elderly patients

Liu

Yang

et al. 2023

BMC Musculoskelet Disord

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Background Increased incidence of fragility fractures of the proximal humerus has been reported. Proximal humerus Hounsfield unit (HU) measurements based on computed tomography (CT) scans of the shoulder can be used to evaluate bone mineral density (BMD). It is unknown whether HU values can predict the risk of proximal humerus osteoporotic fracture and /or fracture patterns. Therefore, the objectives of this study were to identify whether the HU value is associated with proximal humeral osteoporotic fracture risk, and whether or not it has an impact on the complexity of the fracture. Methods We identified 60 + years old patients’ CT scans between 2019 and 2021 according to the inclusion and exclusion criteria. All patients were divided into two groups based on the presence or lack of a fracture in the proximal humerus, meanwhile, patients with fractures were stratified into simple and comminuted fractures based on the Neer classification. HU values were calculated within the proximal humerus and compared between groups using the Student t-test, and receiver operating characteristic (ROC) curve analysis was used to determine the ability of HU values to predict fracture. Results A total of 138 patients with proximal humerus fracture (PHF) including 62 simple PHFs and 76 complex PHFs and 138 non-fracture patients were enrolled in the study. The HU values decreased as age increased among all patients. Both male and female patients with PHF had significantly lower HU values compared with non-fracture patients, the area under the curve (AUC) of the ROC curve for males and females was 0.8 and 0.723 respectively. Nevertheless, no significant differences were found between simple and complex fractures of the proximal humerus in the HU values. Conclusion Decreasing HU values on CT may be an early warning sign of fracture potential, however, it was not a predictive factor for comminuted fracture of the proximal humerus.

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Section: Discussionsupporting

confidence: 90%

Hounsfield units predicts the occurrence but not the patterns of proximal humerus fracture in the elderly patients

Liu

Yang

et al. 2023

BMC Musculoskelet Disord

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“…The Tingart index ( 7 ) and the deltoid tuberosity index ( 8 ) assess cortical bone thickness measurements on anteroposterior views of the shoulder using a 2-dimensional technique. These two methods of measuring cortical bone thickness have been widely investigated in proximal humerus fracture ( 8 , 9 ); however, it has not been determined whether the trabecular thickness (Tb.th) of the humeral trabecular bones change in the process of aging ( 10 ). Dual-energy X-ray absorptiometry (DXA) method remains the gold standard for the diagnosis of osteoporosis, but there is not yet a defined threshold value for the proximal humerus ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Quantification of bone quality and distribution of the proximal humerus with dual-energy computed tomography

Yu,

Yang,

Zhou

et al. 2023

Quant Imaging Med Surg

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Background The proximal humerus is a common site of osteoporotic fractures, and bone quality is a predictor of surgical reduction quality. Dual-energy computed tomography (DECT) is assuming an increasingly important role in the quantification of bone mineral density (BMD) due it is ability to perform three-material decomposition. We aimed to analyze the bone quality and distribution of the proximal humerus with DECT quantitatively. Methods Sixty-five consecutive patients (average age 49.5±15.2 years; male: female ratio 32:33) without proximal humerus fractures who had undergone DECT were retrospectively selected. The humeral head was divided into 4 regions on a cross section in the medial plane between the greater tuberosity and the surgical neck. The quantitative parameters, including virtual noncalcium (VNCa) value, computed tomography value of calcium (CaCT), computed tomography value of mixed-energy images (regular CT value) (rCT), and relative calcium density (rCaD), were measured. The correlations between the quantitative parameters and age and body mass index (BMI) were analyzed, and the correlations of age, sex, BMI, region of the humeral head, and VNCa value on CaCT were evaluated. Results The differences in CaCT, rCT, and rCaD between the 4 regions of proximal humerus were statistically significant (P<0.001), while the difference in VNCa values was not (P=0.688). The calcium concentration (CaCT and rCaD) was the densest in the posteromedial zone. The differences of CaCT, rCT, and rCaD between males and females in the 4 regions of proximal humerus were statistically significant (P<0.05), while those of the posterolateral zone were not (rCT; P>0.05). The differences in VNCa values between males and females were also not significant (P>0.05). Multivariable linear regression analysis indicated that sex, age, BMI, regions, and VNCa were significant (P<0.05) predictors of the CaCT value. Conclusions The concentration of calcium was the densest in the posteromedial region of proximal humerus, and the VNCa value of DECT may be used for quantifying the BMD of the proximal humerus.

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“…26,27 The DTI value was lower in women in the plate group, which is related to poorer bone quality and predisposition to fractures. The study of Kim et al,28 in 2020, showed a strong correlation between the deltoid tuberosity index (DTI) and the T score value in bone densitometry. Values < 1.4 correlate with low bone mineral density in patients with proximal humerus fracture, and female sex and advanced age were considered independent risk factors for severe proximal humerus fracture.…”

Section: Discussionmentioning

confidence: 99%

Antegrade Nailing Versus Locking Plate of 2-and 3-Part Proximal Humerus Fractures

et al. 2022

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Objective: To evaluate and compare the proportions of complications and radiographic findings of osteosynthesis of 2- and 3-part proximal humerus fractures with two methods of treatment: third-generation antegrade nailing and locking plate. Methods: 46 patients with a mean age of 58.9 ± 16.6 years between January 2020 and January 2021 were evaluated. In sixteen cases (34.8%), antegrade nailing was used, and in thirty cases (65, 2%), a locking proximal humerus plate. The method used included the rate of complications with a minimum follow-up of 6 months after surgery and radiographic evaluation. Results: There was no difference between the groups regarding the proportion of complications (nail group 18.8%, plate group 13.3%; p = 0.681). The nail group had less residual varus loss (cervicodiaphyseal angle nail group with 132.1º ± 2.3º, plate group 123.8º ± 10.1º; p < 0.001). In the plate group, women had the lowest value (1.43 ± 0.22) of the deltoid tuberosity index (DTI) compared to men (1.58 ± 0.11) (p = 0.022). Conclusion: Osteosynthesis, with a locking plate and antegrade nailing, did not show differences in the proportion of complications. The nail group had less change in the postoperative cervicodiaphyseal angle, however, there were two serious complications with screw cut-out and varus deviation, requiring surgical reapproach. Level of Evidence II, Retrospective Observational Study.

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Risk Factors for Severe Proximal Humerus Fracture and Correlation Between Deltoid Tuberosity Index and Bone Mineral Density

Cited by 11 publications

References 39 publications

Hounsfield units predicts the occurrence but not the patterns of proximal humerus fracture in the elderly patients

Hounsfield units predicts the occurrence but not the patterns of proximal humerus fracture in the elderly patients

Quantification of bone quality and distribution of the proximal humerus with dual-energy computed tomography

Antegrade Nailing Versus Locking Plate of 2-and 3-Part Proximal Humerus Fractures

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