Artikel
CT-based prediction of the straight antegrade humeral nail's entrypoint and exposure of "critical types": truth or fiction?
Suche in Medline nach
Autoren
-
Simon Euler
- Medizinische Universität Innsbruck, Klinik für Unfallchirurgie und Sporttraumatologie, Innsbruck, Austria
-
Clemens Hengg
- Medizinische Universität Innsbruck, Klinik für Unfallchirurgie und Sporttraumatologie, Innsbruck, Austria
-
Matthias Boos
- Medizinische Universität Innsbruck, Innsbruck, Austria
-
Grant J. Dornan
- Steadman Philippon Research Institute, Vail, CO, United States
-
Travis L Turnbull
- Steadman Philippon Research Institute, Vail, CO, United States
-
Peter J. Millett
- The Steadman Clinic, Director of Shoulder Surgery, Vail, United States
-
Maximilian Petri
- Medizinische Hochschule Hannover, Hannover, Germany
| Veröffentlicht: | 10. Oktober 2016 |
|---|
Gliederung
Text
Objectives: Straight antegrade intramedullary nailing of proximal humerus fractures has shown promising clinical results. However, up to 36% of all humeri seem to be "critical types" in terms of the potential violation of the supraspinatus (SSP) tendon footprint by the ideal nail's insertion zone. The aims of this study were to evaluate if a CT scan could reliably predict the nail's entrypoint on the humeral head and if it would be possible to preoperatively estimate the individual risk of iatrogenic violation of the SSP tendon footprint by evaluating the uninjured contralateral humerus.
Methods: Twenty matched pairs of human cadaveric shoulders underwent CT scans. The entrypoint for an antegrade nail as well as measurements regarding critical distances between the entrypoint and the rotator cuff were determined. Next, gross anatomic measurements of the same data were performed, and compared to the CT data. Furthermore, specimens were scanned for "critical types".
Results and Conclusion: 40% of all specimens were found to be "critical types". The CT measurements exhibited excellent intra- and interrater reliability (ICCs > 0.90). Similarly, excellent agreement between the CT scan and gross anatomic measurements (ICCs > 0.88) was found. All anatomic measurements were found to correlate strongly between left and right paired specimens.
Computed tomography can reliably predict the entry point in antegrade humeral nailing and therefore preoperatively identify "critical types" of humeral heads at risk of iatrogenic implantation damage to the SSP tendon footprint.
