Predicting the deltoid tuberosity index in proximal humerus fractures using fracture characteristics and patient age: development of the LBQ-PHF score

BMC Musculoskeletal Disorders

Research

Dafang Zhang¹  Panagiotis Bouklas²  Okba Al Marhi²  Sam Razaeian³  Christian Krettek⁴  Nael Hawi⁵  Birgitt Wiese⁶ 

[1] Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 75 Francis St, 02115, Boston, MA, USA;Department of Trauma Surgery and Orthopaedic Surgery, Helios St. Marienberg Klinik Helmstedt GmbH, Conringstraße 26, 38350, Helmstedt, Germany;Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany;Hannover Humerus Registry (HHR), Traumastiftung gGmbH Carl-Neuberg-Str. 1, 30625, Hannover, Germany;Hannover Humerus Registry (HHR), Traumastiftung gGmbH Carl-Neuberg-Str. 1, 30625, Hannover, Germany;Orthopaedic and Surgical Clinic Braunschweig (OCP), Mauernstraße 35, 38100, Braunschweig, Germany;Hannover Medical School, MHH Information Technology (MIT), Carl-Neuberg-Str. 1, 30625, Hannover, Germany;

关键词: Proximal humerus fracture;    Local bone quality;    Deltoid tuberosity index;    Fracture morphology;    Fracture pattern;    Valgus;    Score;   

DOI  :  10.1186/s12891-023-06883-z

 received in 2023-04-11, accepted in 2023-09-14,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe aim of this study was to investigate (1) whether fracture pattern and age are associated with local bone quality (LBQ), and (2) whether a scoring system based on these variables is able to predict LBQ in proximal humerus fractures (PHF).Materials and methodsA retrospective study was performed of all acute PHF at a Level 2 trauma center with plain radiographs and CT between June 2009 and March 2022. Local bone quality was measured by using the deltoid tuberosity index (DTI). In addition to age and gender, fracture morphology was categorized using the following classification systems: Neer, Resch, AO Foundation/Orthopaedic Trauma Association (AO/OTA), and Hertel/LEGO. Additionally, coronal head alignment was calculated by measuring the head-shaft angle.ResultsOnly the Resch classification system revealed a significant relationship between fracture type and bone quality, as there was a significant association between coronal head alignment and DTI (p = 0.001). Valgus head alignment was observed significantly more frequent in patients with low bone quality (p = 0.002). Multinomial logistic regression analysis revealed a significant relative risk ratio for age (RRR = 0.97, [95% CI, 0.94-1], p = 0.039) and a non-significant trend for DTI (RRR = 1.26, [95% CI, 0.96–1.64], p = 0.092) for occurrence of anatomic relative to valgus head alignment. Using a DTI cut-off value of 1.3 instead of 1.4, age and also varus head alignment were identified as significant predictors of LBQ (OR = 1.12, [95% CI, 1.1–1.15], p < 0.001; OR = 0.54, [95% CI, 0.3–0.96], p = 0.037). A scoring system called the LBQ-PHF score (local bone quality in proximal humerus fractures), developed based on these two variables was able to predict LBQ with a sensitivity of 79.2% and a specificity of 86.7%.ConclusionAge and coronal humeral head alignment are independent predictors of LBQ in PHF. A simple scoring system developed based on these variables is able to assess BQ with solid predictive characteristics.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

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