title: How to determine the bone mineral density of the distal humerus with radiographic tools?
abstract: BACKGROUND
  The aim of this study was to investigate three methods of prediction of the bone quality of the distal humerus: dual-energy X-ray absorptiometry (DEXA), Ct-Scan and plain radiographs.
  
  
  METHODS
  The bone mineral density (BMD) of 21 cadaveric distal humerus was determined using DEXA at two levels. Then a CT-scan and anteroposterior radiographs were taken. The cancellous density was estimated with the CT-scan. The cortico-medullar index (CMI) was calculated as cortical thickness divided by total bone thickness on AP views.
  
  
  RESULTS
  A significant positive correlation was found between the BMD of the epiphysis and the CMI of r = 0.61. The mean BMD of the distal humerus was 0.559 g/cm(2). Male specimens showed a significantly higher BMD than females. The mean CMI of diaphysis was 1.431 and the mean BMD of the metaphysis region was 0.444 g/cm(2).
  
  
  CONCLUSIONS
  More than a direct evaluation of the bone density with a CT-scan, the CMI of the distal humerus diaphysis is a predictor of the bone quality of the distal humerus. This should be of great help for the surgeon's decision making in case of fracture of the distal humerus, as open Reduction and Internal Fixation (ORIF) of fractures of the distal humerus can lead to failure due to poor bone quality.
  
  
  METHODS
  Basic Science Study, Anatomic Cadaver Study.
authors.affiliation: Shoulder and Elbow Service CCOM-Chu Strasbourg, 10, Avenue Baumann, 67400, Illkirch, France. pclavert@unistra.fr.|Institute of Normal Anatomy, Faculté de Médecine, 4 rue Kirschleger, 67085, Strasbourg Cedex, France. pclavert@unistra.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Clavert
authors.affiliation: Rheumatology Unit, Department of Rheumatology, Hôpital de Hautepierre, University Hospital, 1 Avenue Molière, 67098, Strasbourg, France.
authors.forename: R-M
authors.initials: RM
authors.lastname: Javier
authors.affiliation: Département d'Orthopédie-Traumatologie, CHU Dupuytren, 2Avenue Martin Luther King, 87042, Limoges Cedex, France.
authors.forename: J L
authors.initials: JL
authors.lastname: Charrissoux
authors.affiliation: Chirurgie Orthopédique, Traumatologique et Plastique, Centre Hospitalier de Besançon, 2 Bd Fleming, 25030, Besançon, France.
authors.forename: L
authors.initials: L
authors.lastname: Obert
authors.affiliation: Service de Traumatologie, Chirurgie Orthopédique, Centre Hospitalier, 194 Av Rubillard, 72037, Le Mans, France.
authors.forename: L
authors.initials: L
authors.lastname: Pidhorz
authors.affiliation: Service d'Orthopédie- Traumatologie, Centre Chirurgical E. Galle, 49 rue Hermite, 54000, Nancy, France.
authors.forename: F
authors.initials: F
authors.lastname: Sirveaux
authors.affiliation: Centre Hospitalier Universitaire de Toulouse, Institut de l'Appareil Locomoteur, Place du Dr Baylac, 31059, Toulouse, France.
authors.forename: P
authors.initials: P
authors.lastname: Mansat
authors.affiliation: Service d'Orthopédie- Traumatologie, Place Amélie Raba-Leon, 33076, Bordeaux Cedex, France.
authors.forename: T
authors.initials: T
authors.lastname: Fabre
mesh_terms: D015502:Absorptiometry, Photon; D015519:Bone Density; D005260:Female; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging*; D008297:Male; D014057:Tomography, X-Ray Computed
keywords: Bone mineral density; Distal humerus; Dual energy X-ray absorptiometry; Osteoporosis; Quantitative CT