Modified axillary radiograph of the shoulder: a new position

Senna, Luís Filipe; Albuquerque, Rodrigo Pires e

doi:10.1016/j.rboe.2016.12.001

Cited by 3 publications

(2 citation statements)

References 3 publications

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“…It is known that posttraumatic osteonecrosis of the proximal humerus is the most common complication after fractures in this anatomic region, occurring in up to 16% of patients, and represents a problem for both the patient and the surgeon [ 6 , 8 , 20 ]. In this context, surgeons must be able to assess the risk factors for AVN of the humeral head to influence not only decision-making, but also to guide them regarding the prognosis in relation to this complication [ 13 , 14 , 21 ]. Hertel et al [ 7 ] described some predictors of humeral head ischemia after fracture; however, little is discussed about the difficulty of interpreting these criteria in the presence of numerous factors that potentially make it difficult to evaluate the radiographic examination.…”

Section: Discussionmentioning

confidence: 99%

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Computed Tomography Does Not Improve Intra- and Interobserver Agreement of Hertel Radiographic Prognostic Criteria

Tullio

Giordano²,

Belangero³

et al. 2022

Medicina

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Background and Objectives: Proximal humerus fractures are the second most frequent site of avascular necrosis (AVN), occurring in up to 16% of cases. The Hertel criteria have been used as a reference for the prediction of humerus head ischemia. However, these are based solely on the use of radiographs, which can make interpretation extremely difficult due to several reasons, such as the overlapping fragments, severity of the injury, and noncompliant acute pain patients. The objectives of the study were to evaluate the role of computed tomography (CT) in the interpretation of the Hertel criteria and to evaluate the intra- and interobserver agreement of orthopedic surgeons, comparing their area of expertise. Materials and Methods: The radiographs and CT scans of 20 skeletally mature patients who had fractures of the proximal humerus were converted to jpeg and mov, respectively. All images were evaluated by eight orthopedic surgeons (four trauma surgeons and four shoulder surgeons) in two different occasions. The intra- and interobserver agreement was assessed by using the Kappa coefficient. The level of significance was 5%. Results: There was a weak-to-moderate intraobserver agreement (κ < 0.59) for all examiners. Only the medial metaphyseal hinge greater than 2 mm was identified by 87.5% of evaluators both in the radiographic and CT examinations in the two rounds of the study (p < 0.05). There was no significant interobserver agreement (κ < 0.19), as it occurred only in some moments of the second round of evaluation. Conclusions: The prognostic criteria for humeral head ischemia evaluated in this study showed weak intra- and interobserver agreement in both the radiographic and tomographic evaluation. CT did not help surgeons in the primary interpretation of Hertel prognostic criteria used in this study when compared to the radiographic examination.

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Section: Discussionmentioning

confidence: 99%

“…The imaging evaluation comprised a true AP (Grashey), scapular Y, and axillary view [ 12 ]. In patients with limited abduction of the glenohumeral joint due to pain or joint incongruity, the modified axillary view was performed [ 13 ]. The CT evaluation comprised 5 mm axial, coronal, and sagittal slices and a 3D reconstruction.…”

Section: Methodsmentioning

confidence: 99%

Computed Tomography Does Not Improve Intra- and Interobserver Agreement of Hertel Radiographic Prognostic Criteria

Tullio

Giordano²,

Belangero³

et al. 2022

Medicina

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The Clinical Utility of Additional Axillary and Velpeau Radiographs in the Evaluation of Suspected Shoulder Trauma

Cruz

Castillo

Chintapalli

et al. 2020

Journal of Orthopaedic Trauma

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Objectives: To investigate the clinical utility of additional axillary or Velpeau views in evaluating potential shoulder trauma after a standard radiograph series of anteroposterior, Grashey, and/or trans-scapular views. Design: Retrospective study. Setting: Level I academic medical center. Patients: All patients in a 10-year span who received an initial shoulder radiograph series followed by additional axillary/Velpeau views within 24 hours. Main Outcome Measurements: The clinical utility of the additional axillary/Velpeau views, including the final diagnosis and treatment plan, as ascertained through examination of radiology reports, progress notes, and radiograph images. Results: A total of 271 cases were reviewed, with 35 patients being excluded from the final cohort because they received post-treatment radiographs to confirm a successful therapeutic outcome. The additional axillary/Velpeau views did not affect clinical decision making in 230 (97.5%) of the remaining 236 cases. All 6 patients whose care benefitted from the additional views carried the diagnosis of shoulder instability, accounting for 40% of this diagnostic group. The additional views confirmed an equivocal finding in 5 of these 6 cases and changed the diagnosis (demonstrating a posterior dislocation that was not evident on initial radiographs) and treatment plan (leading to a closed glenohumeral reduction procedure) in the other case. Conclusions: Additional axillary/Velpeau views of suspected shoulder trauma rarely led to a change in the final treatment plan, except in patients in which a definitive diagnosis of stability or instability could not be made based on initial radiographs. A cost/benefit analysis is required to weigh the cost of additional radiographs with the benefit of capturing infrequent yet serious dislocations (usually posterior). Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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