Predicting the deltoid tuberosity index in proximal humerus fractures using fracture characteristics and patient age: development of the LBQ-PHF score
Abstract Background The 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 methods A retrospective...
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-023-06883-z |
| _version_ | 1797454142302584832 |
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| author | Sam Razaeian Okba Al Marhi Birgitt Wiese Dafang Zhang Panagiotis Bouklas Christian Krettek Nael Hawi |
| author_facet | Sam Razaeian Okba Al Marhi Birgitt Wiese Dafang Zhang Panagiotis Bouklas Christian Krettek Nael Hawi |
| author_sort | Sam Razaeian |
| collection | DOAJ |
| description | Abstract Background The 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 methods A 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. Results Only 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%. Conclusion Age 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. |
| first_indexed | 2024-03-09T15:33:00Z |
| format | Article |
| id | doaj.art-40bb21a0d6cd4f8b993df6796489c315 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-03-09T15:33:00Z |
| publishDate | 2023-09-01 |
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| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-40bb21a0d6cd4f8b993df6796489c3152023-11-26T12:07:10ZengBMCBMC Musculoskeletal Disorders1471-24742023-09-0124111010.1186/s12891-023-06883-zPredicting the deltoid tuberosity index in proximal humerus fractures using fracture characteristics and patient age: development of the LBQ-PHF scoreSam Razaeian0Okba Al Marhi1Birgitt Wiese2Dafang Zhang3Panagiotis Bouklas4Christian Krettek5Nael Hawi6Department of Trauma Surgery, Hannover Medical SchoolDepartment of Trauma Surgery and Orthopaedic Surgery, Helios St. Marienberg Klinik Helmstedt GmbHHannover Medical School, MHH Information Technology (MIT)Department of Orthopaedic Surgery, Brigham and Women’s HospitalDepartment of Trauma Surgery and Orthopaedic Surgery, Helios St. Marienberg Klinik Helmstedt GmbHHannover Humerus Registry (HHR)Hannover Humerus Registry (HHR)Abstract Background The 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 methods A 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. Results Only 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%. Conclusion Age 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.https://doi.org/10.1186/s12891-023-06883-zProximal humerus fractureLocal bone qualityDeltoid tuberosity indexFracture morphologyFracture patternValgus |
| spellingShingle | Sam Razaeian Okba Al Marhi Birgitt Wiese Dafang Zhang Panagiotis Bouklas Christian Krettek Nael Hawi Predicting the deltoid tuberosity index in proximal humerus fractures using fracture characteristics and patient age: development of the LBQ-PHF score BMC Musculoskeletal Disorders Proximal humerus fracture Local bone quality Deltoid tuberosity index Fracture morphology Fracture pattern Valgus |
| title | Predicting the deltoid tuberosity index in proximal humerus fractures using fracture characteristics and patient age: development of the LBQ-PHF score |
| title_full | Predicting the deltoid tuberosity index in proximal humerus fractures using fracture characteristics and patient age: development of the LBQ-PHF score |
| title_fullStr | Predicting the deltoid tuberosity index in proximal humerus fractures using fracture characteristics and patient age: development of the LBQ-PHF score |
| title_full_unstemmed | Predicting the deltoid tuberosity index in proximal humerus fractures using fracture characteristics and patient age: development of the LBQ-PHF score |
| title_short | Predicting the deltoid tuberosity index in proximal humerus fractures using fracture characteristics and patient age: development of the LBQ-PHF score |
| title_sort | predicting the deltoid tuberosity index in proximal humerus fractures using fracture characteristics and patient age development of the lbq phf score |
| topic | Proximal humerus fracture Local bone quality Deltoid tuberosity index Fracture morphology Fracture pattern Valgus |
| url | https://doi.org/10.1186/s12891-023-06883-z |
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