title: Indications for computed tomography (CT-) diagnostics in proximal humeral fractures: a comparative study of plain radiography and computed tomography.
abstract: BACKGROUND
  Precise indications for computed tomography (CT) in proximal humeral fractures are not established. The purpose of this study was a comparison of conventional radiographic views with different CT reconstructions with 2 D and 3 D imaging to establish indications for additional CT diagnostics depending on the fractured parts.
  
  
  METHODS
  In a prospective diagnostic study in two level 1 trauma centers, 44 patients with proximal humeral fractures were diagnosed with conventional X-rays (22 AP + axillary views, 22 AP + scapular Y-views) and CT (multi-planar reconstruction (MPR) and maximum intensity projection (MIP)) with 2 D and 3 D imaging. 3 observers assessed the technical image quality, the assessment of the relevant anatomical structures (2-sample-t-test) and the percentage of the osseous overlap of the proximal humerus (Welch-test) using a scoring system. The quality of the different diagnostic methods was assessed according to the number of fractured parts (Bonferroni-Holm adjustment).
  
  
  RESULTS
  There was significantly more overlap of the fractured region on the scapular Y-views (mean 71.5%, range 45-90%) than on axillary views (mean 56.2%, range 10.5-100%). CT-diagnostics allowed a significantly better assessment of the relevant structures than conventional diagnostics (p < 0.05) independently of the fracture severity (two-, three-, and four-part fractures).
  
  
  CONCLUSIONS
  Conventional X-rays with AP view and a high-quality axillary view are useful for primary diagnostics of the fracture and often but not always show a clear presentation of the relevant bony structures such as both tuberosities, the glenoid and humeral head. CT with thin slices technology and additional 3 D imaging provides always a clear presentation of the fractured region. Clinically, a CT should be performed--independently of the number of fractured parts--when the proximal humerus and the shoulder joint are not presented with sufficient X-ray-quality to establish a treatment plan.
authors.affiliation: Klinik für Unfall- und Wiederherstellungschirurgie, BG-Unfallklinik Tübingen, Eberhard-Karls-Universität Tübingen, Tübingen, Germany. C.Bahrs@gmx.de
authors.forename: Christian
authors.initials: C
authors.lastname: Bahrs
authors.forename: Bernd
authors.initials: B
authors.lastname: Rolauffs
authors.forename: Norbert P
authors.initials: NP
authors.lastname: Südkamp
authors.forename: Hagen
authors.initials: H
authors.lastname: Schmal
authors.forename: Christoph
authors.initials: C
authors.lastname: Eingartner
authors.forename: Klaus
authors.initials: K
authors.lastname: Dietz
authors.forename: Philippe L
authors.initials: PL
authors.lastname: Pereira
authors.forename: Kuno
authors.initials: K
authors.lastname: Weise
authors.forename: Erich
authors.initials: E
authors.lastname: Lingenfelter
authors.forename: Peter
authors.initials: P
authors.lastname: Helwig