Garkisch Angelina, Fischer Dagmar-C, Mittlmeier Thomas, Märdian Sven, Klaan Bastian, Weber Marc-André, Erbersdobler Andreas, Pauly Stephan, Gahr Patrick
Department of Traumatology, Hand and Reconstructive Surgery, Rostock University Medical Center, Schillingallee 35, 18057, Rostock, Germany.
Department of Pediatrics, Rostock University Medical Center, Rostock, Germany.
J Orthop Surg Res. 2025 Jun 3;20(1):560. doi: 10.1186/s13018-025-05964-0.
There are no clear criteria for decision-making after proximal humeral fractures, and the choice of surgical strategy and, in particular, timing is controversial. Vascular disruption can lead to delayed avascular necrosis of the humeral head, which may result in failure of the fixation procedure and the need for revision surgery. MRI pulse sequences with zero echo time (ZTE) provide "CT-like" images of the bone, while dynamic contrast-enhanced MRI (DCE MRI) allows for visualization and quantification of vascular permeability, blood flow, and clearance rates within the bone. We hypothesize that MRI with a ZTE sequence is non-inferior to CT in terms of fracture morphology specification and that DCE MRI is suitable for quantifying perfusion of the humeral head after a proximal humeral fracture.
This study is designed to investigate the value of modern MRI diagnostics in proximal humeral fractures. 30 patients with an acute unilateral proximal humeral fracture and an indication for ORIF with a locking plate will receive routine diagnostics (conventional X-rays and CT), supplemented by ZTE and DCE 3 Tesla MRI protocols and clinical scores. Two follow-up examinations will be performed at 3 and 6 months after surgery.
As the optimal treatment method and timing of proximal humeral fractures are still controversial, the results of this study might help surgeons decide on the optimal treatment. The first aim is to evaluate the ZTE MRI sequence for its ability to assess fracture morphology compared to CT imaging. In this way, it can be decided whether or not the ZTE sequences can be considered as an alternative to CT imaging in proximal humeral fractures. The second aim of the study is to investigate the feasibility of DCE MRI for quantifying perfusion of the humeral head over a six-month period after proximal humeral fracture and ORIF with a locking plate. If the initial DCE MRI shows restricted perfusion of the humeral head, the risk of avascular necrosis may be increased, so it may be beneficial for the patient to proceed directly to reverse shoulder arthroplasty (RSA) instead of osteosynthesis with the risk of later revision. The data obtained from this study are required for the planning of a randomized trial.
DRKS-ID: DRKS00031380, MRI for acute proximal humeral fractures / - Assessment of fracture geometry with an MRI application for imaging cortical bone surfaces (Part I) / - Quantification of humeral head perfusion with Dynamic Contrast-Enhanced MRI (Part II). Acronym: Rostock MRI Study. Date of Registration 2023-06-14. Recruitment is scheduled from 1st July 2023 to 31st December 2024. The final follow-up is scheduled for June 2025. https://drks.de/search/de/trial/DRKS00031380/details;jsessionid=D961FF527EB81204EB9F211810A89B73 .
肱骨近端骨折后尚无明确的决策标准，手术策略的选择，尤其是手术时机存在争议。血管损伤可导致肱骨头延迟性缺血性坏死，这可能导致固定手术失败以及需要进行翻修手术。零回波时间（ZTE）的MRI脉冲序列可提供骨骼的“类CT”图像，而动态对比增强MRI（DCE MRI）则能够可视化并量化骨骼内的血管通透性、血流和清除率。我们假设，就骨折形态学特征而言，采用ZTE序列的MRI并不逊色于CT，且DCE MRI适用于量化肱骨近端骨折后肱骨头的灌注情况。
本研究旨在探讨现代MRI诊断在肱骨近端骨折中的价值。30例急性单侧肱骨近端骨折且有使用锁定钢板进行切开复位内固定指征的患者将接受常规诊断（传统X线和CT），并辅以3特斯拉ZTE和DCE MRI检查方案以及临床评分。术后3个月和6个月将进行两次随访检查。
由于肱骨近端骨折的最佳治疗方法和时机仍存在争议，本研究结果可能有助于外科医生确定最佳治疗方案。首要目的是评估ZTE MRI序列与CT成像相比评估骨折形态的能力。通过这种方式，可以确定ZTE序列是否可被视为肱骨近端骨折中CT成像的替代方法。本研究的第二个目的是探讨DCE MRI在量化肱骨近端骨折及使用锁定钢板进行切开复位内固定术后六个月内肱骨头灌注情况的可行性。如果初始DCE MRI显示肱骨头灌注受限，则缺血性坏死的风险可能会增加，因此对于患者来说，直接进行反肩置换术（RSA）而非存在后期翻修风险的骨合成术可能更为有益。本研究获得的数据是一项随机试验规划所必需的。
DRKS编号：DRKS00031380，急性肱骨近端骨折的MRI / - 使用用于成像皮质骨表面的MRI应用评估骨折几何形状（第一部分） / - 使用动态对比增强MRI量化肱骨头灌注（第二部分）。首字母缩写：罗斯托克MRI研究。注册日期2023年6月14日。招募计划于2023年7月1日至2024年12月31日进行。最终随访定于2025年6月。https://drks.de/search/de/trial/DRKS00031380/details;jsessionid=D961FF527EB81204EB9F211810A89B73 。
