Spontaneous humeral torsion deformity correction after displaced supracondylar fractures in children

Background After displaced supracondylar humerus fractures (SCHF) in children, residual deformities are common with cubitus varus (CV) being the clinically most visible. Distal fragment malrotation may lead to instability, fragment tilt and subsequent CV. Detection and assessment of malrotation is difficult and the fate of post-traumatic humeral torsion deformity is unknown. The aim of this study was to evaluate the incidence of humeral torsion differences in children with surgically treated SCHF and to observe spontaneous changes over time. Methods A cohort of 27 children with displaced and surgically treated SCHF were followed prospectively from the diagnosis until twelve months after trauma. Clinical, photographic, sonographic and radiological data were obtained regularly. Differences in shoulder and elbow motion, elbow axis, sonographic humeral torsion measurement and radiological evaluation focusing on rotational spur were administered. Results Six weeks after trauma, 67% of SCHF children had a sonographically detected humeral torsion difference of > 5° (average 14.0 ± 7.6°). Of those, 44% showed a rotational spur, slight valgus or varus on radiographs. During follow-up, an average decrease of the difference from 14° (six weeks) to 7.8° (four months) to 6.5° (six months) and to 4.9° (twelve months) was observed. The most significant correction of posttraumatic humeral torsion occurred in children < 5 years and with internal malrotation > 20°. Conclusion After displaced and surgically treated SCHF, most children had humeral torsion differences of both arms. This difference decreased within one year after trauma due to changes on the healthy side or correction in younger children with severe deformity. Level of Evidence/Clinical relevance Therapeutic Level IV

Relationship Differences in Pre-season Isometric Shoulder Strength, Humeral Torsion and Shoulder Range of Motion in Collegiate Baseball Players (218)

Objectives: Muscle strength, humeral torsion (HT) and shoulder range of motion (ROM) have been linked to throwing performance and injury risk in baseball players. Research suggests that players who demonstrate an isometric shoulder external rotation (ER)/internal rotation (IR) strength ratio of <0.75 are at a higher risk for developing a throwing-related upper extremity injury. While the relationships between HT and shoulder ROM have been examined in the literature, few studies have examined the potential relationships between these variables and isometric shoulder strength. The purpose of this study was to examine the relationships between isometric shoulder strength, HT and shoulder ROM at the start of each baseball season in a cohort of healthy junior college baseball players. Methods: Ninety-two healthy junior college baseball players (mean age=19.9±0.8 years) were prospectively assessed at the start of 2 consecutive spring seasons. Variables measured included HT, shoulder ROM and isometric shoulder strength. Both the dominant (D) and non-dominant (ND) shoulders of each player were assessed throughout the study. Chi square tests and bivariate Pearson correlation coefficients were calculated to examine between group differences and the relationships between variables. Statistical significance was set a priori at α=0.05. Results: 33.7% of junior college players demonstrated a D shoulder ER/IR strength ratio of <0.75 at the start of baseball season. Pitchers and position players demonstrated no significant differences in D shoulder ER/IR strength ratios at the start of the season (P=.40). Additionally, moderate positive relationships were observed between D HT and D IR ROM (r=0.35; P=.001) as well as D horizontal adduction (HA) ROM (r=0.43; P<.001). A moderate relationship was also observed between ND HT and ND IR ROM (r=0.56, P<.001), however ND ER and HA ROM demonstrated weaker relationships respectively (ER: r=-0.27; P=.01; HA: r=0.26; P=.01). Inverse relationships were observed between HT and ER strength in both the D and ND shoulders (D: r=-0.27, P=.01; ND: r=-0.28, P=.007). Internal rotation ROM was also inversely correlated with ER strength (r=-0.29, P=0.005) and ER/IR strength ratios (r=-0.31, P=.003), but only in the D shoulder. No significant correlations were observed between ROM and strength in the ND shoulder. Conclusions: One third of the junior college baseball players in this study began the season with marked deficits in D shoulder strength, irrespective of their position. We then examined the relationships between HT, shoulder ROM and isometric shoulder strength and confirmed the previously established correlation between HT and shoulder ROM. Moreover, there appeared to be inverse relationships between HT and ER strength in both the D and ND shoulders as well as IR ROM and ER strength in the D shoulder. This study emphasizes the importance of pre-season rotator cuff strength training, with an emphasis on improving ER strength, to potentially aid in the prevention of throwing-related upper extremity injuries in collegiate baseball players. Humeral torsion and shoulder ROM may influence isometric shoulder strength, however more research is needed to better understand these relationships in the throwing shoulder.

A STUDY OF MORPHOMETRIC ANALYSIS AND MEASUREMENT OF ANGLE OF TORSION OF THE HEAD OF HUMERUS AND SHOULDER ARTHROPLASTY

Back ground: Humerus is the longest of the long bones of superior extremity.It”s head articulates with scapular glenoid cavity to form the gleno-humeral/Shoulder joint.The rounded head of Humerus is too weakly supported in the scapular glenoid cavity lined by glenoid labrum which makes it the most mobile and most unstable nd joint and so most commonly dislocated joint of the human body.Also the humeral head part is the 2 most important part of shoulder arthroplasty. Aim of the study is to make a clinical evaluation of parameters used in prosthesis design for the humeral component applied in arthroplasty of the proximal upper extremity. Methods: A total of 100 (Rt -58,Lt –42 ) dry human Humerus available in the Department of Anatomy of Calcutta National Medical College,Kolkata,West Bengal and Nilratan Sircar Medical College,Kolkata,West Bengal were taken for the study.The Humeral heads are measured in supero-inferior(SI) diameter, and antero-posterior diameter(AP), The width of Humeral head (Wdth),and angle of Humeral Torsion were measured. At the very beginning the both sided Humerus taken for the study are properly numbered using permanent marker pen.The width of the Humeral head(Wdth) is measured 1stly by pressing the head in modelling dough and when the mould is prepared,semisolid plaster of paris is lled into the mould. After drying the replica of humeral head is smoothened upto the mark of anatomical neck of humerus thus proper width can be measured. The superoinferior(SI) diameter, and antero-posterior diameter(AP) were measured by digital slide callipers by placing it directly onto the surface of consequently numbered humeral heads. The width of Humeral head (Wdth ) were measured from these replica(properly numbered) humeral heads, made of plaster of paris at the middle, the highest thickness was measured. The measurements are taken via spreading slide calipers in milimeters. For measuring the angle of humeral angle of torsion ,we xedly placed the humerus on to a area over the smooth part of the vertical wall which was meeting another horizontal wall at 90 degrees angle thus the line joining the two epicondyles of humerus lies parallel to the vertical wall.Now placing the straight edge of the protractor onto the upper end of humerus the angle of humeral torsion is measured. Results: Both sided Humerae were analysed separately for Morphological measurement, and angle of Humeral torsion.Mean values for SI were 41.31+3.46mm (Right side) and 40.91+3.27mm(Left side). Mean values for AP were 38.27+3.05mm (Right side) and 37.91+2.70mm(Left side). Conclusion: This study will contribute some relevant data and help the orthopaeditians in dealing with cases of shoulder pathology and shoulder arthroplasty cases.

The Relationship Between Humeral Torsion and Arm Injury in Baseball Players: A Systematic Review and Meta-analysis

Context: Humeral torsion (HT) has been linked to various injuries and benefits. However, the exact interplay between HT, shoulder range of motion (ROM), competition level differences, and injury risk is unclear. Objective: To determine the relationship between HT, ROM, and injury risk in baseball players. Secondarily, to determine HT based on competition level. Data Sources: PubMed, Embase, Web of Science, CINAHL, and Cochrane databases were searched from inception until November 4, 2018. Study Selection: Inclusion criteria consisted of (1) HT measurements and (2) arm injury or shoulder ROM. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: Two reviewers recorded patient demographics, competition level, HT, shoulder ROM, and injury data. Results: A total of 32 studies were included. There was no difference between baseball players with shoulder and elbow injuries and noninjured players (side-to-side HT difference: mean difference [MD], 1.75 [95% CI, –1.83 to 2.18]; dominant arm: MD, 0.17 [95% CI, –1.83 to 2.18]). Meta-regression determined that for every 1° increase in shoulder internal rotation (IR), there was a subsequent increase of 0.65° in HT (95% CI, 0.28 to 1.02). HT did not explain external rotation (ER ROM: 0.19 [95% CI, –0.24 to 0.61]) or horizontal adduction (HA ROM: 0.18 [95% CI, –0.46 to 0.82]). There were no differences between HT at the high school, college, or professional levels. Conclusion: No relationship was found between HT and injury risk. However, HT explained 65% of IR ROM but did not explain ER ROM or HA ROM. There were no differences in HT pertaining to competition level. The majority of IR may be nonmodifiable. Treatment to restore and maintain clinical IR may be important, especially in players with naturally greater torsion. HT adaptation may occur prior to high school, which can assist in decisions regarding adolescent baseball participation.

Evaluation of Bilateral Asymmetry in the Humerus of Human Skeletal Specimen

Several studies have established a relationship between morphological and behavioral asymmetry making investigations of bilateral bone asymmetry an attractive and important research area. The purpose of this study was to investigate bilateral asymmetry patterns of skeletal specimen from five geographical locations (Rwanda, Burundi, Congo, Kenya, and Uganda) at Galloway Osteological Collection, Department of Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences. The angle of torsion and retroversion, mid-shaft circumference, length, and weight of 232 pairs of humeri were determined. A Torsiometer was used to measure the angle of torsion in degrees according to Krahl and Evans 1945, a tape was used to measure the mid-shaft circumference at the level of the apex of the deltoid V, and the length in cm was determined. An osteometric board was used to measure the length of the humerus in centimeters. A weighing balance was used to measure the weight of the humerus in grams. The analysis of humeral asymmetry with respect to parameters of the human skeletal specimen at the Galloway Osteological Collection Mulago revealed bilateral asymmetrical status observed in the angle of torsion, length, weight, and mid-shaft circumference. Our result mostly showed lateralization to the right in all the parameters investigated except the torsion angle which is to the left. Our investigation revealed that humeral torsion is inversely proportional to weight, length, and mid-shaft circumference of the humerus. This study established the existence of bilateral asymmetries in the humeri of all the geographical regions investigated with more asymmetry observed in the male compared with the female.