Radiological and biomechanical assessment of displaced greater tuberosity fractures
| Autor: | Richard W. Nyffeler, Angela Seidel, Mathias Bergmann, Stefan Werlen |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
Shoulder medicine.medical_specialty Rotation Shoulders Movement medicine.medical_treatment Radiography 610 Medicine & health Subacromial 03 medical and health sciences 0302 clinical medicine Cadaver Impingement medicine Humans Orthopedics and Sports Medicine Displacement (orthopedic surgery) Acromion Reduction (orthopedic surgery) 030203 arthritis & rheumatology Orthodontics Original Paper 030222 orthopedics Shoulder Joint business.industry Index Radius Greater tuberosity Fracture medicine.anatomical_structure Shoulder Impingement Syndrome Orthopedic surgery Shoulder Fractures Female Surgery business Greater Tuberosity |
| Zdroj: | Nyffeler, Richard W.; Seidel, Angela; Werlen, Stefan; Bergman, Manfred Max (2019). Radiological and biomechanical assessment of displaced greater tuberosity fractures. International orthopaedics, 43(6), pp. 1479-1486. Springer 10.1007/s00264-018-4170-x International Orthopaedics |
| DOI: | 10.1007/s00264-018-4170-x |
| Popis: | Purpose Greater tuberosity fractures are challenging lesions concerning decision-making. In order to improve our treatment algorithm, we developed a new method, which allows predicting a possible subacromial conflict on standard anteroposterior radiographs, considering not only the displacement of the fragment but also the width of the subacromial space. Methods The measurement technique consisted of drawing three concentric circles on true anteroposterior radiographs. The inner circle (radius Rh) perfectly matched the humeral head surface. The medial circle (radius Rt) was tangent to the greater tuberosity, and the outer circle (radius Ra) touched the undersurface of the acromion. The ratio Rt/Rh, which describes how much the greater tuberosity projects above the articular surface, and the relationship (Rt-Rh)/(Ra-Rh), which quantifies the space occupied by the greater tuberosity under the acromion, were calculated and called Greater Tuberosity Index and Impingement Index, respectively. Five dry humeri were used to assess the influence of rotation and abduction on the Greater Tuberosity Index. The radiographs of 80 shoulders without any osseous pathology were analyzed to obtain reference values for both indices. Finally, greater tuberosity fractures with different displacements were created in five cadaver specimens, and subacromial impingement was correlated with these parameters. Results On anteroposterior radiographs, the greater tuberosity was most prominent in neutral rotation, regardless of abduction. In shoulders without osseous pathology, the Greater Tuberosity Index and the Impingement Index averaged 1.15 (range 1.06–1.28) and 0.46 (range 0.21–0.67). In the biomechanical experiments, the Impingement Index was a better discriminator for subacromial impingement than the Greater Tuberosity Index. A fracture with a displacement corresponding to an Impingement Index of 0.71 or greater was associated with subacromial impingement. Conclusions Reduction of a displaced greater tuberosity fragment should be considered if the Impingement Index is 0.7 or greater. The measurement method is simple and reliable and has the potential to be used for the assessment of subacromial impingement in other conditions. |
| Databáze: | OpenAIRE |
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