Geometrical analysis for assessing torsional alignment of humerus

doi:10.1186/s12891-020-3118-7

. 2020 Feb 10;21(1):92.

doi: 10.1186/s12891-020-3118-7.

Geometrical analysis for assessing torsional alignment of humerus

Yo-Lun Chu^{1

2

3}, Cheng-Kuang Chen³, Yu-Chia Liu³, Tung-Wu Lu¹, Chen-Kun Liaw^{4

5

6}

Affiliations

¹ Institute of Biomedical Engineering, National Taiwan University, Taipei, 100, Taiwan.
² Department of Orthopaedics, Taipei Municipal Wanfang Hospital, Taipei, 11696, Taiwan.
³ Department of Orthopedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, 11101, Taiwan.
⁴ Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan. u9301013@cmu.edu.tw.
⁵ Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, 11031, Taiwan. u9301013@cmu.edu.tw.
⁶ Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering, Research Center of Biomedical Device, Taipei Medical University, Taipei City, 11301, Taiwan. u9301013@cmu.edu.tw.

PMID: 32041587
PMCID: PMC7011366
DOI: 10.1186/s12891-020-3118-7

Geometrical analysis for assessing torsional alignment of humerus

Yo-Lun Chu et al. BMC Musculoskelet Disord. 2020.

. 2020 Feb 10;21(1):92.

doi: 10.1186/s12891-020-3118-7.

Authors

Yo-Lun Chu^{1

2

3}, Cheng-Kuang Chen³, Yu-Chia Liu³, Tung-Wu Lu¹, Chen-Kun Liaw^{4

5

6}

Affiliations

¹ Institute of Biomedical Engineering, National Taiwan University, Taipei, 100, Taiwan.
² Department of Orthopaedics, Taipei Municipal Wanfang Hospital, Taipei, 11696, Taiwan.
³ Department of Orthopedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, 11101, Taiwan.
⁴ Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan. u9301013@cmu.edu.tw.
⁵ Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, 11031, Taiwan. u9301013@cmu.edu.tw.
⁶ Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering, Research Center of Biomedical Device, Taipei Medical University, Taipei City, 11301, Taiwan. u9301013@cmu.edu.tw.

PMID: 32041587
PMCID: PMC7011366
DOI: 10.1186/s12891-020-3118-7

Abstract

Background: Compared to other types of surgeries, minimally invasive surgeries (MISs) of humeral shaft fractures are associated with less radial nerve injury, less soft tissue injury and higher union rate. However, malrotation often occurs in MISs when closed reduction methods are used. This study aims to define specific palpable landmarks to help surgeons determine the correct torsional angle and reduce the incidence of malrotation.

Methods: Twenty-eight normal humeral computed tomography scans were retrieved from our image database. One line was drawn through the vertices of the intertubercular sulcus of the humeral head in the coronal view, and another line was drawn through the longest axis between the medial and lateral condyles in the coronal view. The angle between these two lines was measured at least 3 times for each scan.

Results: The profile of the intertubercular sulcus tangent line of the humeral head and the axis of the distal humerus was identified as the most accurate method for assessing the precision of torsion during MIS for humeral shaft fractures. The transepicondylar axis line is more internally rotated than the intertubercular sulcus tangent line. The mean angle was measured to be 41.1 degrees.

Conclusions: The axis of the distal humeral condyles is internally rotated by approximately 41.1 degrees compared with the intertubercular sulcus tangent line of the humeral head. Minimally invasive surgeries can be performed by using these palpable landmarks. The torsional deformities can be reduced with the proper angle adjustment without the need for fluoroscopy. It can also be used to treat unstable comminuted humeral fractures.

Level of evidence: Retrospective Study, Diagnostic study, Level III.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Two reference axis lines: OA line is the tangent line of the intertubercular sulcus; OB line is the transepicondylar axis line

**Fig. 2**
Points x and y are the vertices of biceps groove. The two points are connected in a tangent line of the deepest intertubercular sulcus

See this image and copyright information in PMC

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References

1. Sarmiento A, Zagorski JB, Zych GA, Latta LL, Capps CA. Functional bracing for the treatment of fractures of the humeral diaphysis. JBJS. 2000;82:478–486. doi: 10.2106/00004623-200004000-00003. - DOI - PubMed
1. Walker M, Palumbo B, Badman B, Brooks J, Gelderen JV, Mighell M. Humeral shaft fractures: a review. J Shoulder Elb Surg. 2011;20:833–844. doi: 10.1016/j.jse.2010.11.030. - DOI - PubMed
1. Hoang-Kim Amy, Goldhahn Jörg, Hak David J. Evidence-Based Orthopedics. Oxford, UK: Wiley-Blackwell; 2011. Humeral Shaft Fractures; pp. 366–373.
1. Schoch BS, Padegimas EM, Maltenfort M, Krieg J, Namdari S. Humeral shaft fractures: national trends in management. J Orthop Traumatol. 2017;18:259–263. doi: 10.1007/s10195-017-0459-6. - DOI - PMC - PubMed
1. Tytherleigh-Strong G, Walls N, McQueen MM. The epidemiology of humeral shaft fractures. J Bone Joint Surg Br Vol. 1998;80:249–253. doi: 10.1302/0301-620X.80B2.0800249. - DOI - PubMed

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[1] Sarmiento A, Zagorski JB, Zych GA, Latta LL, Capps CA. Functional bracing for the treatment of fractures of the humeral diaphysis. JBJS. 2000;82:478–486. doi: 10.2106/00004623-200004000-00003. - DOI - PubMed

[2] Sarmiento A, Zagorski JB, Zych GA, Latta LL, Capps CA. Functional bracing for the treatment of fractures of the humeral diaphysis. JBJS. 2000;82:478–486. doi: 10.2106/00004623-200004000-00003. - DOI - PubMed

[3] Walker M, Palumbo B, Badman B, Brooks J, Gelderen JV, Mighell M. Humeral shaft fractures: a review. J Shoulder Elb Surg. 2011;20:833–844. doi: 10.1016/j.jse.2010.11.030. - DOI - PubMed

[4] Walker M, Palumbo B, Badman B, Brooks J, Gelderen JV, Mighell M. Humeral shaft fractures: a review. J Shoulder Elb Surg. 2011;20:833–844. doi: 10.1016/j.jse.2010.11.030. - DOI - PubMed

[5] Hoang-Kim Amy, Goldhahn Jörg, Hak David J. Evidence-Based Orthopedics. Oxford, UK: Wiley-Blackwell; 2011. Humeral Shaft Fractures; pp. 366–373.

[6] Hoang-Kim Amy, Goldhahn Jörg, Hak David J. Evidence-Based Orthopedics. Oxford, UK: Wiley-Blackwell; 2011. Humeral Shaft Fractures; pp. 366–373.

[7] Schoch BS, Padegimas EM, Maltenfort M, Krieg J, Namdari S. Humeral shaft fractures: national trends in management. J Orthop Traumatol. 2017;18:259–263. doi: 10.1007/s10195-017-0459-6. - DOI - PMC - PubMed

[8] Schoch BS, Padegimas EM, Maltenfort M, Krieg J, Namdari S. Humeral shaft fractures: national trends in management. J Orthop Traumatol. 2017;18:259–263. doi: 10.1007/s10195-017-0459-6. - DOI - PMC - PubMed

[9] Tytherleigh-Strong G, Walls N, McQueen MM. The epidemiology of humeral shaft fractures. J Bone Joint Surg Br Vol. 1998;80:249–253. doi: 10.1302/0301-620X.80B2.0800249. - DOI - PubMed

[10] Tytherleigh-Strong G, Walls N, McQueen MM. The epidemiology of humeral shaft fractures. J Bone Joint Surg Br Vol. 1998;80:249–253. doi: 10.1302/0301-620X.80B2.0800249. - DOI - PubMed

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Geometrical analysis for assessing torsional alignment of humerus

Affiliations

Geometrical analysis for assessing torsional alignment of humerus

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Affiliations

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Conflict of interest statement

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