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Head-shaft angle changes during internal and external shoulder rotations: 2-D angulation in 3-D space - 30/03/17

Doi : 10.1016/j.otsr.2016.11.015 
A. Adikrishna a, H. Hong a, M.F. Deslivia b, c, B. Zhu d, J. Tan e, I.-H. Jeon a,
a Department of Orthopaedics Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea 
b Department of HCI and Robotics, University of Science and Technology, Daejon, Republic of Korea 
c Center of Robotics, Korea Institute of Science and Technology, Seoul, Republic of Korea 
d Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, Zhejiang, China 
e Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China 

Corresponding author at: Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Republic of Korea.Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan86 Asanbyeongwon-gil, Songpa-guSeoul 138-736Republic of Korea

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Abstract

Introduction

Restoration of native head-shaft angle (HSA) is critical for treatment of proximal humerus fracture. However, HSA has not been properly investigated according to the humeral rotation. This study was designed to analyze the relationship between the humeral rotation and the HSA at 1° increments, and clarify its serial changing pattern according to the humeral rotation.

Hypothesis

The angulation of HSA would be undervalued when the humerus is being rotated externally and it would be overvalued when it is being rotated internally.

Materials and methods

Eight dried cadaveric normal humeri were CT scanned. They were analyzed using computer-aided design with a standardized neutral position. HSA was the angle between the humeral shaft axis (SA) and the humeral head axis (HA). SA and HA were the best-fit lines through center of all the best-fitting circles in every cross section along the humeral shaft and within the humeral head, respectively. Each 3D model was rotated 30° internally and 45° externally relatives to the SA at 1° increments with the camera was fixed at antero-posterior view of neutral position. Angulation of HSA in every rotational degree was documented as ratio relatives to the angulation of HSA in neutral position.

Results

The average HSA at neutral position was 133±1.93°. HSA was underestimated by 8±1.9% and it was overestimated by 20±5.1% at the maximum external rotation (ER) and internal rotation (IR), respectively. HSA was underestimated by 1% in every 5.8° of ER and overestimated by 1% in every 1.5° of IR. Rotational misalignments within 10° of IR and 18° of ER could be tolerated (P>.05).

Conclusions

HSA was underestimated at ER and was overestimated at IR. This information could be useful for surgeons in restoring the native HSA for treatment of proximal humerus fracture.

Type of study

Basic research study.

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Keywords : Proximal humerus fracture, Head-shaft angle, Proximal humerus, Humeral internal rotation, Humeral external rotation, CAD, 3D analysis


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Vol 103 - N° 2

P. 159-163 - avril 2017 Retour au numéro
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