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The relevance of neutral arm positioning for true ap-view X-ray to provide true projection of the humeral head shaft angle

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Textbooks commonly recommend using the true anterior–posterior (ap)-view with the patient’s arm in a sling and therefore in internal rotation (IR) for radiologic diagnostic assessment of the proximal humerus after trauma. However, IR or external rotation (ER) may affect the projection of the head shaft angle (HSA) and therefore bias the diagnostic conclusion significantly. We hypothesized that neutral rotation (NR) of the arm is mandatory for true ap-view to provide true projection of the HSA.

Materials and methods

A simplified geometrical model of the proximal humerus was used to examine the influence of different arm positions and angulations of the central ray in relation to the projection of the HSA.

Results

Both ER and IR misleadingly suggested an increased valgus angle. Simulating the true ap-view with the central ray in cranio-caudal direction, IR changed the projection of the HSA substantially.

Conclusion

In conclusion, standard fixation of the patient’s arm in a shoulder sling in IR for true ap-view may result in an oblique projection, potentially leading to incorrect surgical implications. To prevent misdiagnosed valgus or varus angulation, NR of the arm should be obeyed when performing true ap-view X-ray. We, therefore, highly recommend to overcome the traditionally arm position, ensuring the true amount of dislocation to assure correct surgical implications and comparable follow-up examinations.

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Acknowledgments

The first author wants to thank Mag. Manfred Dopler for sharing his geometrical knowledge and for the discussion that led to this manuscript.

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Authors and Affiliations

  1. Department of Trauma Surgery and Sports Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Clemens Hengg, Simon Euler, Markus Wambacher, Michael Blauth & Franz Kralinger

  2. Unit Geometry and CAD, University of Innsbruck, Technikerstrasse 13, 6020, Innsbruck, Austria

    Peter Mayrhofer

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  1. Clemens Hengg
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  2. Peter Mayrhofer
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  3. Simon Euler
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  4. Markus Wambacher
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Correspondence to Clemens Hengg.

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Hengg, C., Mayrhofer, P., Euler, S. et al. The relevance of neutral arm positioning for true ap-view X-ray to provide true projection of the humeral head shaft angle. Arch Orthop Trauma Surg 136, 213–221 (2016). https://doi.org/10.1007/s00402-015-2368-6

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  • DOI: https://doi.org/10.1007/s00402-015-2368-6

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