Reliability of humeral head measurements performed using two- and three-dimensional computed tomography in patients with
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ORIGINAL PAPER
Reliability of humeral head measurements performed using two- and three-dimensional computed tomography in patients with shoulder instability Jakub Stefaniak 1,2
&
A. M. Kubicka 3 & A. Wawrzyniak 2 & L. Romanowski 1 & P. Lubiatowski 1,2
Received: 16 September 2019 / Accepted: 6 July 2020 # The Author(s) 2020
Abstract Purpose The aim of the study was to compare two measurement methods of humeral head defects in patients with shoulder instability. Intra- and inter-observer reliability of humeral head parameters were performed with the use of 2D and 3D computed tomography. Methods The study group was composed of one hundred humeral heads measured with the use of preoperative 2D and 3D computed tomography by three independent observers (two experienced and one inexperienced). All observers repeated measurements after 1 week. The intra-class correlation coefficient (ICC) and the minimal detectable change with 95% confidence (MDC95%) were used for statistical analysis of diagnostic agreement. Results For 3D inter-observer reliability, ICC values were “excellent” for all parameters and MDC95% values were “excellent” or “reasonable.” All intra-observer ICC and MDC95% values for 3D were “excellent” for experienced and inexperienced observers. For 2D-CT, ICC values were usually “good” or “moderate” with MDC95% values higher than 10 or 30%. Conclusions Three-dimensional CT measurements are more reliable than 2D for humeral head and Hill-Sachs lesion assessment. This study showed that 2D measurements, even performed by experienced observers (orthopaedic surgeons), are burdened with errors. The 3D reconstruction decreased the risk of error by eliminating inaccuracy in setting the plane of the measurements. Keywords Shoulder instability . Measurement reliability . Bone defects . 2D-CT . 3D-CT
Introduction Shoulder instability is a common condition affecting 25 in every 100.000 people a year. It affects mainly young people, especially men (3:1) [1]. In people under 20 years of age, the risk of recurrent instability after the first dislocation can be up to 90% [2]. During anterior shoulder dislocation, the humeral head is displaced in front of the glenoid and its posterior surface is
* Jakub Stefaniak [email protected] 1
Sport Trauma and Biomechanics Unit, Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
2
Rehasport Clinic, Poznań, Poland
3
Institute of Zoology, Poznań University of Life Sciences, Poznań, Poland
wedged into the anterior edge of the glenoid. The resulting bone impression, called Hill-Sachs defect, is the common diagnosis in patients with recurrent shoulder instability. The presence of a Hill-Sachs defect may predispose to a conflict between the humeral head and glenoid, and consequently to the dislocation of the shoulder joint [3]. Diagnosis of the defects of the anterior glenoid rim and the Hill-Sachs defect is important in treatment and facilitates the selection of an appropriate treatment method [4, 5]. Recentl
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