Ultimate fracture load of cadaver proximal humeri correlates more strongly with mean combined cortical thickness than with areal cortical index, DEXA density, or canal-to-calcar ratio

Skedros, John G.; Mears, Chad S.; Burkhead, Wayne Z.

doi:10.1302/2046-3758.61.bjr-2016-0145.r1

Cited by 14 publications

(16 citation statements)

References 25 publications

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“…Our results are in line with previous reports affirming that simple-to-measure radiographic parameters of the proximal humerus are more useful in predicting ultimate fracture load than sophisticated exams and evaluations such as DEXA density. [23] Combining our results with those of this article, we speculate that DEXA evaluations are not necessary for the diagnosis of osteoporosis of proximal humerus fractures.…”

Section: Accepted Manuscriptsupporting

confidence: 72%

Radiographic patterns of osteoporotic proximal humerus fractures

Carbone

Mezzoprete

Papalia

et al. 2018

European Journal of Radiology

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Osteoporosis of the proximal humerus was identified in 72% of patients during a two year period; most of these patients were elderly females sustaining low energy trauma. These fractures showed to have specific radiographic patterns, as comminution of metaphysis and tuberosities, impaction of fragments, and inferior subluxation of the humeral head. These patterns can be assessed with the simple observation of a 2-plan view of a radiograph, without the use of specific software.

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Section: Accepted Manuscriptsupporting

confidence: 72%

Radiographic patterns of osteoporotic proximal humerus fractures

Carbone

Mezzoprete

Papalia

et al. 2018

European Journal of Radiology

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“…These factors were also shown to be superior to other simple-to-measure radiographic parameters (areal cortical index, canal-to-calcar ratio, and medial cortical ratio) in determining bone strength. 13 Limitations of this study included the small sample size, which was due to the high costs associated with preparing cadaveric shoulder specimens, imaging preand post-fracture, and the process of cortical thickness mapping. A larger sample size would have increased the power of the study and reduced the risk of a type two error.…”

Section: Discussionmentioning

confidence: 99%

The biomechanics of proximal humeral fractures: Injury mechanism and cortical morphology

et al. 2018

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Background The aim of this study was to examine the effect of arm position on proximal humerus fracture configuration and to determine whether cortical thinning would predispose to fracture propagation and more complex patterns of injury. Methods A drop test rig was designed to simulate falls onto an outstretched arm (‘parachute reflex’). Thirty-one cadaveric specimens underwent computer tomography scanning and cortical thicknesses mapping. Humeri were fractured according to one of the two injury mechanisms and filmed using a high-speed camera. Anatomical descriptions of the injuries were made. Areas of thinning were measured and correlated with zones of fracture propagation. Results Direct impact simulation resulted in undisplaced humeral head split fractures in 53% of cases, with the remainder involving disruption to the articular margin and valgus impaction. Alternatively, the ‘parachute reflex’ predominantly produced shield-type injuries (38%) and displaced greater tuberosity fractures (19%). A strong correlation was demonstrated between cortical thinning and the occurrence of fracture (odds ratio = 7.766, 95% confidence interval from 4.760 to 12.669, p<0.0001). Conclusion This study has shown that arm position during a fall influences fracture configuration of the proximal humerus. Correlating fracture pattern and mechanism of injury will allow more appropriate fracture reduction techniques to be devised.

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“…Previously, only one type of parameter was used in most studies, either a numerical value or an index. 11 , 13 , 15 - 21 We found that the radiographic parameters of the distal femur, CBTavg and DFCI, correlated well with BMD and the T-score. Thus, these parameters could be used for identifying both osteoporosis and osteopenia.…”

Section: Discussionmentioning

confidence: 62%

“… 23 , 36 - 40 However, the relationship between the radiographic parameters and BMD have not been reappraised. 11 , 13 , 15 - 21 , 41 To our knowledge, this is the first study to propose new radiographic parameters focusing on the distal femur, where a fragility fracture has a high morbidity, 42 and compare these parameters with the BMD from DXA.…”

Section: Discussionmentioning

confidence: 99%

“…However, the diagnosis of osteoporosis can be overlooked, as DXA studies may not be routinely undertaken in patients who suffer trauma. 10 Various radiographic parameters have focused on the frequently fractured metaphyseal regions, such as the proximal humerus, 11 - 15 proximal femur, 16 , 17 femoral shaft, 18 proximal tibia, 19 , 20 and the distal tibia, 21 in an attempt to predict osteoporosis. The validity of all of these parameters has been verified, except for those at the distal femur.…”

Section: Introductionmentioning

confidence: 99%

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Radiographic predictors for bone mineral loss

Sun

et al. 2018

Bone & Joint Research

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ObjectivesResearchers continue to seek easier ways to evaluate the quality of bone and screen for osteoporosis and osteopenia. Until recently, radiographic images of various parts of the body, except the distal femur, have been reappraised in the light of dual-energy X-ray absorptiometry (DXA) findings. The incidence of osteoporotic fractures around the knee joint in the elderly continues to increase. The aim of this study was to propose two new radiographic parameters of the distal femur for the assessment of bone quality.MethodsAnteroposterior radiographs of the knee and bone mineral density (BMD) and T-scores from DXA scans of 361 healthy patients were prospectively analyzed. The mean cortical bone thickness (CBTavg) and the distal femoral cortex index (DFCI) were the two parameters that were proposed and measured. Intra- and interobserver reliabilities were assessed. Correlations between the BMD and T-score and these parameters were investigated and their value in the diagnosis of osteoporosis and osteopenia was evaluated.ResultsThe DFCI, as a ratio, had higher reliability than the CBTavg. Both showed significant correlation with BMD and T-score. When compared with DFCI, CBTavg showed better correlation and was better for predicting osteoporosis and osteopenia.ConclusionThe CBTavg and DFCI are simple and reliable screening tools for the prediction of osteoporosis and osteopenia. The CBTavg is more accurate but the DFCI is easier to use in clinical practice.Cite this article: Q-F. He, H. Sun, L-Y. Shu, Y. Zhu, X-T. Xie, Y. Zhan, C-F. Luo. Radiographic predictors for bone mineral loss: Cortical thickness and index of the distal femur. Bone Joint Res 2018;7:468–475. DOI: 10.1302/2046-3758.77.BJR-2017-0332.R1.

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Ultimate fracture load of cadaver proximal humeri correlates more strongly with mean combined cortical thickness than with areal cortical index, DEXA density, or canal-to-calcar ratio

Cited by 14 publications

References 25 publications

Radiographic patterns of osteoporotic proximal humerus fractures

Radiographic patterns of osteoporotic proximal humerus fractures

The biomechanics of proximal humeral fractures: Injury mechanism and cortical morphology

Radiographic predictors for bone mineral loss

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