Advanced CT visualization improves the accuracy of orthopaedic trauma surgeons and residents in classifying proximal humeral fractures: a feasibility study

Dauwe, Jan; Mys, Karen; Putzeys, Guy; Schader, Jana Felicitas; Richards, R. Geoff; Gueorguiev, Boyko; Варга, П.; Nijs, Stefaan

doi:10.1007/s00068-020-01457-3

Cited by 5 publications

(6 citation statements)

References 18 publications

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“…The main one was to show that none of Hertel prognostic criteria evaluated in this study present interobserver agreement, regardless of whether the assessment is performed by using radiographs, CT, or both. Other authors have already observed the same, including employing more modern imaging methods than those used in this study [ 11 , 25 , 39 , 41 ]. The main limitation of the study by Hertel et al [ 7 ] was the assessment of the fracture pattern by a single observer, which obviously lacks objectivity and reproducibility.…”

Section: Discussionsupporting

confidence: 77%

“…In the current study, we showed some usefulness for both the 2D and 3D tomography to help surgeons in the primary interpretation of Hertel prognostic criteria, with moderate intraobserver agreement, without, however, statistical difference when compared to the radiographic examination. Recent studies have shown that the use of other imaging modalities, such as segmented 3D CT [ 39 ] and 3D printed models [ 40 , 41 ], adds value to the understanding of the morphology of the proximal humerus fracture, which was not evaluated in the current study.…”

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: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

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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“…However, because of the high complexity of these fractures and the limited resolution of clinical CT scans, small fragments can be and were sometimes missed. Although a previously developed tool [ 12 ] was utilized here to assist this procedure, the segmentation technique is also influenced by the skill of the observer. Future work should evaluate the accuracy of clinical CT image-based fracture fragment segmentation against reliable ground truth data, e.g., based on high-resolution (micro-)CT imaging in an in vitro study.…”

Section: Discussionmentioning

confidence: 99%

“…The cortical compartments of the fracture fragments were identified and isolated on the zoom-in CT images using a custom image processing tool and graphical user interface (GUI) implemented in Matlab R2021b (The Mathworks Ltd., Natick, MA, USA) and C++, established in a previous study [ 12 ]. The procedure automatically pre-segmented the cortical shell utilizing an adaptive thresholding technique [ 26 ] combined with an edge-detection segmentation algorithm.…”

Section: Methodsmentioning

confidence: 99%

“…A preoperative radiograph or 2D slice-wise view of computed tomography (CT) scan may not be sufficient for a complete comprehension of complex PHF. The added value of advanced visualization of segmented 3D CT images is positively associated with a better ability of both less and more experienced surgeons to categorize complex fractures [ 12 , 13 , 14 ]. Having appreciated the complexity of the PHF, the subsequent challenge is to define the premorbid intact anatomic morphology so that accurate reduction tactics and endpoints can be planned and achieved.…”

Section: Introductionmentioning

confidence: 99%

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Statistical Morphology and Fragment Mapping of Complex Proximal Humeral Fractures

et al. 2023

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Background and Objectives: Proximal humerus fractures (PHFs) are common in the elderly, but the treatment results are often poor. A clear understanding of fracture morphology and distribution of cortical bone loss is important for improved surgical decision making, operative considerations, and new implant designs. The aim of this study was to develop a 3D segmentation fracture mapping technique to create a statistical description of the spatial pattern and cortical bone loss of complex PHFs. Materials and Methods: Fifty clinical computed tomography (CT) scans of complex PHFs and their contralateral intact shoulders were collected. In-house software was developed for semi-automated segmentation and fracture line detection and was combined with manual fracture reduction to the contralateral template in a commercial software. A statistical mean model of these cases was built and used to describe probability maps of the fracture lines and cortical fragments. Results: The fracture lines predominantly passed through the surgical neck and between the tuberosities and tendon insertions. The superior aspects of the tuberosities were constant fragments where comminution was less likely. Some fracture lines passed through the bicipital sulcus, but predominantly at its edges and curving around the tuberosities proximally and distally. Conclusion: A comprehensive and systematic approach was developed for processing clinical CT images of complex fractures into fracture morphology and fragment probability maps and applied on PHFs. This information creates an important basis for better understanding of fracture morphology that could be utilized in future studies for surgical training and implant design.

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An automatic segmentation algorithm for conglutinated bone fragments in 3D CT images of lower limb fractures based on morphology

Miao,

Zheng,

Han

et al. 2024

Multimed Tools Appl

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Advanced CT visualization improves the accuracy of orthopaedic trauma surgeons and residents in classifying proximal humeral fractures: a feasibility study

Cited by 5 publications

References 18 publications

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

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

Statistical Morphology and Fragment Mapping of Complex Proximal Humeral Fractures

An automatic segmentation algorithm for conglutinated bone fragments in 3D CT images of lower limb fractures based on morphology

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