Clin Orthop Surg.  2017 Jun;9(2):223-231. 10.4055/cios.2017.9.2.223.

Measurement Methods for Humeral Retroversion Using Two-Dimensional Computed Tomography Scans: Which Is Most Concordant with the Standard Method?

• Oh JH
• Kim W
• Cayetano A

• KMID: 2412293
• DOI: http://doi.org/10.4055/cios.2017.9.2.223

Abstract

BACKGROUND
Humeral retroversion is variable among individuals, and there are several measurement methods. This study was conducted to compare the concordance and reliability between the standard method and 5 other measurement methods on two-dimensional (2D) computed tomography (CT) scans.
METHODS
CT scans from 21 patients who underwent shoulder arthroplasty (19 women and 2 men; mean age, 70.1 years [range, 42 to 81 years]) were analyzed. The elbow transepicondylar axis was used as a distal reference. Proximal reference points included the central humeral head axis (standard method), the axis of the humeral center to 9 mm posterior to the posterior margin of the bicipital groove (method 1), the central axis of the bicipital groove -30° (method 2), the base axis of the triangular shaped metaphysis +2.5° (method 3), the distal humeral head central axis +2.4° (method 4), and contralateral humeral head retroversion (method 5). Measurements were conducted independently by two orthopedic surgeons.
RESULTS
The mean humeral retroversion was 31.42°± 12.10° using the standard method, and 29.70°± 11.66° (method 1), 30.64°± 11.24° (method 2), 30.41°± 11.17° (method 3), 32.14°± 11.70° (method 4), and 34.15°± 11.47° (method 5) for the other methods. Interobserver reliability and intraobserver reliability exceeded 0.75 for all methods. On the test to evaluate the equality of the standard method to the other methods, the intraclass correlation coefficients (ICCs) of method 2 and method 4 were different from the ICC of the standard method in surgeon A (p < 0.05), and the ICCs of method 2 and method 3 were different form the ICC of the standard method in surgeon B (p < 0.05).
CONCLUSIONS
Humeral version measurement using the posterior margin of the bicipital groove (method 1) would be most concordant with the standard method even though all 5 methods showed excellent agreements.

Keyword

Humerus; Version; Computed tomography

MeSH Terms

Adult
Aged
Aged, 80 and over
Bone Retroversion/*diagnostic imaging
Female
Humans
Humerus/*diagnostic imaging
Male
Middle Aged
Retrospective Studies
Tomography, X-Ray Computed/*methods/*standards

Figure

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  Fig. 1 (A) Schematic drawing of the standard method. (B) The transepicondylar axis is defined as a line between the most medial and most lateral extension of the distal humerus. (C) The angle between the central axis of the humeral head and the elbow transepicondylar axis (asterisk) is shown. The central axis is a perpendicular axis of the boundaries of the articular surface determined by using the limits of the subchondral bone in the largest circle of the humeral head.

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  Fig. 2 (A) Schematic drawing of method 1. (B) The angle between the 9 mm posterior margin of the bicipital groove axis and the elbow transepicondylar axis (asterisk) is shown.

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  Fig. 3 (A) Schematic drawing of method 2. (B) The angle between the bicipital groove center axis and the elbow transepicondylar axis (asterisk) –30° is shown.

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  Fig. 4 Method 3 measures the angle between the metaphyseal axis and the elbow transepicondylar axis (asterisk) +2.5°.

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  Fig. 5 (A) Schematic drawing of method 4. (B) The angle between the axis through the distal humeral head central axis and the elbow transepicondylar axis (asterisk) +2.4° is shown. The distal humeral head central axis is the axis perpendicular to the boundaries of the articular surface determined by using the limits of the subchondral bone on 2 slices (6 mm) below the largest circle of the humeral head on axial slices.

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