Orthopaedic Traumatology, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, 650# Xinsongjiang RD, Songjiang Area, Shanghai, 201620, China.
Experimental Trauma and Orthopedics, Frankfurt Initiative for Regenerative Medicine, J.W. Goethe University, Frankfurt am Main, Germany.
Int Orthop. 2019 Jun;43(6):1429-1434. doi: 10.1007/s00264-019-04294-1. Epub 2019 Jan 21.
To radiographically characterize the relationship between inferior displacement of great tuberosity (GT) fracture and associated occult or minor displaced humeral neck fracture.
Thirty patients with inferior displacement of the GT on the initial anterior-posterior (AP) view X-ray were included in this study. Twenty-four patients received further computed tomography (CT) scans. One patient with negative CT scans underwent MRI. Radiographic indexes included the cervico-diaphyseal angle, the distance of the inferior displacement of the GT fracture, the apex-tuberosity distance, and the direction of the GT shift on the 3D-CT scan. The measurement reliability was analyzed by calculating intra-class correlation (ICC) coefficients. The relationships between the parameters were revealed using Pearson correlation analysis.
In the 30 cases, humeral neck fractures were detected by AP view X-ray (6 cases), CT (23 cases), and MRI (1 case). The mean cervico-diaphyseal angle was 146.7° ± 8.9°. The mean inferior displacement of the GT fracture was 13.4 ± 5.9 mm. The mean apex-tuberosity distance was 11.8 ± 2.8 mm. Posterior/inferior displacement of the GT fractures was observed in 24 patients via CT scan. All the evaluated parameters presented correlations among methods, indicating intra-rater and inter-rater reliability. The Pearson correlation analysis revealed that inferior displacement of GT fracture was correlated with the cervico-diaphyseal angle (P < 0.05).
The inferior displacement of GT fracture on AP view X-ray is a useful diagnostic clue for the early recognition of occult humeral neck fracture and may indicate the need for further CT/MRI examination.
通过影像学特征来描述大结节下移位骨折与隐匿性或轻微移位肱骨干骨折之间的关系。
本研究纳入了 30 例初始前后位（AP）X 线片显示大结节下移位的患者。其中 24 例患者进一步接受了计算机断层扫描（CT）检查，1 例 CT 扫描阴性的患者接受了 MRI 检查。影像学指标包括颈干角、大结节下移位骨折的距离、结节顶点距离和 3D-CT 扫描中大结节移位的方向。通过计算组内相关系数（ICC）评估测量可靠性。使用 Pearson 相关分析揭示参数之间的关系。
在 30 例病例中，通过 AP 位 X 线片（6 例）、CT（23 例）和 MRI（1 例）检测到肱骨干骨折。颈干角的平均值为 146.7°±8.9°。大结节下移位骨折的平均距离为 13.4±5.9mm。结节顶点距离的平均值为 11.8±2.8mm。通过 CT 扫描观察到 24 例患者的大结节后下移位。所有评估参数在各种方法之间均存在相关性，表明了观察者内和观察者间的可靠性。Pearson 相关分析表明，大结节下移位骨折与颈干角呈相关性（P<0.05）。
AP 位 X 线片上大结节下移位骨折是早期识别隐匿性肱骨干骨折的有用诊断线索，并可能提示需要进一步进行 CT/MRI 检查。
