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Therefore, our goal was to investigate the fluoroscopic analysis of humerus fractures through the surgical neck using a semiquantitative determination of distinct angulation patterns of the proximal humerus. įluoroscopy provides an immediate sequence of radiographic images, which allows the surgeon to intraoperatively evaluate static or dynamic pictures of the structure of interest. Furthermore, most surgery indications are based on the physician’s opinion regarding fracture severity, which adds to the lack of objectivity in planning the right treatment for PHFx. Interobserver reliability for the classification of PHFx is generally low and was demonstrated as only “fair” especially for the assessment of head-shaft angulation in the coronal and sagittal plane. In contrast, fractures through the surgical neck are classified as displaced either by the displacement of the shaft by more than 1 cm or an angulation of the head of more than 45° without further guidelines the degree of angulation is difficult to recognize on a standard radiograph. The latter system distinguishes all minimal displaced fractures as ‘1-part fractures' because they are viewed as a stable unit and therefore, can be conservatively treated. ĭue to the extensive fracture combinations that can occur, PHFx classification can be challenging, even with the availability of the well-established AO and Neer systems. The decision for surgery, on the other hand, is influenced not only by patient age but by the presence of associated orthopedic injuries, fracture severity and the presence of associated glenohumeral dislocation. Nonoperative treatment of PHFx is considered routine regardless of patient age. With the marked rise in incidence due to the aging population, PHFx plays a prominent role in trauma surgery. Proximal humerus fractures (PHFx) are the third most common bone fractures worldwide, accounting for 6% of all fractures. This can assist the surgeon’s decision on whether to operate or opt for a conservative approach. The presence of angulation in accordance with the Neer classification for group III fractures can be adequately determined by analyzing the relative position of the greater or lesser tuberosity to the humeral head calotte.
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The radiological appearance of various PHFx constellations can be well visualized using the saw bone shoulder model.
#Fluoroscopy gif machine series#
From the resultant series of radiographs, the appearance of these angulations in anteroposterior (AP) and scapular Y-views were also visualized and defined.Īn angulation of 50° or more of any given 2-part fracture through the surgical neck is present when the greater tuberosity becomes the most proximal point in AP view (varus and combined posterior-varus angulation) or a bimodal form is found for the superior contour of the head with the lesser tuberosity being the most proximal point in the Y-view (posterior angulation). Anatomical landmarks-including the greater and lesser tuberosity as well as anatomical neck-were identified using an image converter, and the exact degree of fracture displacement with 10° up to 70° (in 10° increments) of posterior, varus or combined posterior-varus angulation was compared to nondisplaced controls. Using a saw bone model, defined subcapital 2-part fracture configurations were generated and assessed radiographically. In this study, we investigate the fluoroscopic analysis of humerus fractures through the surgical neck using a semi-quantitative determination of distinct angulation patterns of the proximal humerus as they appear in the image intensifier. Due to the lack of objective criteria, this classification process is associated with high interobserver variation. Surgical decision making in the treatment of proximal humerus fractures (PHFx) is primarily based on fracture classification using standard radiographs.