Advertisement

Der Unfallchirurg

, Volume 121, Issue 3, pp 199–205 | Cite as

Torsionsfehlstellungen am Humerus

  • N. HawiEmail author
  • S. Razaeian
  • C. Krettek
  • R. Meller
  • E. Liodakis
Leitthema

Zusammenfassung

Die Torsion des Humerus beschreibt die physiologische Verdrehung des Humerus in seiner Längsachse. Zur Torsionsbestimmung sind verschiedene klinische und radiologische Messverfahren beschrieben. Die computertomographische Messung stellt derzeit die standardmäßige Methode dar. Hierbei orientiert sich der Winkel zum einen an der Humeruskopf- und an der transepikondylären Achse und wird als Retroversion beschrieben. Die Retroversion des Humerus wird in der Literatur mit Werten zwischen 10° und 40° angegeben. Bei der Behandlung einer Vielzahl von Pathologien am Humerus bedarf es des genauen Verständnisses der humeralen Retroversion. Die Retroversion des Humerus ist v. a. in der Prothetik, aber auch in der Fraktursituation und der Korrektur posttraumatischer Deformitäten zu berücksichtigen. Ist eine Orientierung an den originären anatomischen Landmarken des Humerus nicht mehr möglich, ist diese an der kontralateralen Seite zu empfehlen.

Schlüsselwörter

Retroversion Fraktur Osteotomie Prothese Schulter 

Torsional malalignment of the humerus

Abstract

The torsion of the humerus describes the physiological rotation of the humerus around its longitudinal axis. Various clinical and radiological methods for measurement have been described. The computed tomography method is currently the gold standard. The angle between the humeral head axis and the transepicondylar axis is measured. This angle is called retroversion. Values of retroversion vary between 10° and 40°. For the treatment of many humeral pathologies, a precise reconstruction of the anatomical retroversion is required. The retroversion of the humerus has to be considered in shoulder arthroplasty, in fracture situations and also in planning correction of posttraumatic deformities. If an orientation to the original anatomical landmarks of the humerus is no longer possible, an orientation to the contralateral side is recommended.

Keywords

Retroversion Fracture Osteotomy Arthroplasty Shoulder 

Notes

Danksagung

Die Autoren bedanken sich bei Harun Hawi für die Bearbeitung des Videomaterials.

Einhaltung ethischer Richtlinien

Interessenkonflikt

N. Hawi, S. Razaeian, C. Krettek, R. Meller und E. Liodakis geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Supplementary material

Video 1: Intraoperatives Video der Korrekturosteotomie des im Beitrag dargestellten Falls

Literatur

  1. 1.
    Bernageau J (1990) Imaging of the shoulder in orthopedic pathology [in French]. Rev Prat 40:983–92PubMedGoogle Scholar
  2. 2.
    Bichat X (1801) Traité d’anatomie descriptive, t. I, Paris, an. X (18U1)Google Scholar
  3. 3.
    Bigliani LU, Codd TP, Connor PM, Levine WN, Littlefield MA, Hershon SJ (1997) Shoulder motion and laxity in the professional baseball player. Am J Sports Med 25:609–613.  https://doi.org/10.1177/036354659702500504 CrossRefPubMedGoogle Scholar
  4. 4.
    Boileau P, Bicknell RT, Mazzoleni N, Walch G, Urien JP (2008) CT scan method accurately assesses humeral head retroversion. Clin Orthop Relat Res 466:661–669.  https://doi.org/10.1007/s11999-007-0089-z CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Boileau P, Walch G (1997) The three-dimensional geometry of the proximal humerus. Implications for surgical technique and prosthetic design. J Bone Joint Surg Br 79:857–865CrossRefPubMedGoogle Scholar
  6. 6.
    Boileau P, Walch G, Liotard JP (1992) Radio-cinematographic study of active elevation of the prosthetic shoulder. Rev Chir Orthop Reparatrice Appar Mot 78:355–364PubMedGoogle Scholar
  7. 7.
    Broca P (1881) Le torsion de l’humerus et le tropometre. Rev Anthropol 4:193–210 (385–423)Google Scholar
  8. 8.
    Cassagnaud X, Maynou C, Petroff E, Dujardin C, Mestdagh H (2003) A study of reproducibility of an original method of CT measurement of the lateralization of the intertubercular groove and humeral retroversion. Surg Radiol Anat 25:145–151.  https://doi.org/10.1007/s00276-003-0101-6 CrossRefPubMedGoogle Scholar
  9. 9.
    Chandler TJ, Kibler WB, Uhl TL, Wooten B, Kiser A, Stone E (1990) Flexibility comparisons of junior elite tennis players to other athletes. Am J Sports Med 18:134–136.  https://doi.org/10.1177/036354659001800204 CrossRefPubMedGoogle Scholar
  10. 10.
    Compito CA, Self EB, Bigliani LU (1994) Arthroplasty and acute shoulder trauma. Reasons for success and failure. Clin Orthop Relat Res 307:27–36Google Scholar
  11. 11.
    Cowgill LW (2007) Humeral torsion revisited: a functional and ontogenetic model for populational variation. Am J Phys Anthropol 134:472–480.  https://doi.org/10.1002/ajpa.20689 CrossRefPubMedGoogle Scholar
  12. 12.
    Cyprien JM, Vasey HM, Burdet A, Bonvin JC, Kritsikis N, Vuagnat P (1983) Humeral retrotorsion and glenohumeral relationship in the normal shoulder and in recurrent anterior dislocation (scapulometry). Clin Orthop Relat Res (Section II):8–17Google Scholar
  13. 13.
    Dahnert W, Bernd W (1986) Computer tomography determination of the torsion angle of the humerus. Z Orthop Ihre Grenzgeb 124:46–49.  https://doi.org/10.1055/s-2008-1044522 CrossRefPubMedGoogle Scholar
  14. 14.
    Doyle AJ, Burks RT (1998) Comparison of humeral head retroversion with the humeral axis/biceps groove relationship: a study in live subjects and cadavers. J Shoulder Elbow Surg 7:453–457CrossRefPubMedGoogle Scholar
  15. 15.
    Edelson G (1999) Variations in the retroversion of the humeral head. J Shoulder Elbow Surg 8:142–145CrossRefPubMedGoogle Scholar
  16. 16.
    Edelson G (2000) The development of humeral head retroversion. J Shoulder Elbow Surg 9:316–318.  https://doi.org/10.1067/mse.2000.106085 CrossRefPubMedGoogle Scholar
  17. 17.
    Evans FG, Krahl VE (1945) The torsion of the humerus: a phylogenetic study from fish to man. Am J Anat 76:303–307CrossRefGoogle Scholar
  18. 18.
    Fuchs CC, Schmid P, Engelhardt P (1991) Computerized tomography measurement of humerus torsion. Z Orthop Ihre Grenzgeb 129:423–425.  https://doi.org/10.1055/s-2008-1040267 CrossRefPubMedGoogle Scholar
  19. 19.
    Gegenbaur C (1968) Über die Drehung des Humerus. Jena Z Med Naturwiss 4:50–64Google Scholar
  20. 20.
    Guenoun D, Le Corroller T, Lagier A, Pauly V, Champsaur P (2015) Correlation between the retroversion of the humeral head and the orientation of the intertubercular sulcus: a CT scan anatomical study. Surg Radiol Anat 37:357–361.  https://doi.org/10.1007/s00276-014-1354-y CrossRefPubMedGoogle Scholar
  21. 21.
    Habermeyer P, Brunner U, Mayr B, Schiller K (1986) Computertomographie versus konventionelle Röntgentechnik bei der Diagnostik der Schulterluxation. Hefte Unfallheilkd 181:384–387Google Scholar
  22. 22.
    Harland U, Huber C, Larem K, Hunold J (1987) Sonographische Bestimmung des Retrotorsionswinkels am Humerus. Orthop Prax 23:626–631Google Scholar
  23. 23.
    Hernigou P, Duparc F, Hernigou A (2002) Determining humeral retroversion with computed tomography. J Bone Joint Surg Am 84–A:1753–1762CrossRefPubMedGoogle Scholar
  24. 24.
    Ito N, Eto M, Maeda K, Rabbi ME, Iwasaki K (1995) Ultrasonographic measurement of humeral torsion. J Shoulder Elbow Surg 4:157–161CrossRefPubMedGoogle Scholar
  25. 25.
    Kibler WB, Chandler TJ, Livingston BP, Roetert EP (1996) Shoulder range of motion in elite tennis players. Effect of age and years of tournament play. Am J Sports Med 24:279–285.  https://doi.org/10.1177/036354659602400306 CrossRefPubMedGoogle Scholar
  26. 26.
    Krahl VE (1947) The torsion of the humerus; its localization, cause and duration in man. Am J Anat 80:275–319CrossRefPubMedGoogle Scholar
  27. 27.
    Krahl VE, Evans FG (1945) Humeral torsion in man. Am J Phys Anthropol 3:229–253CrossRefGoogle Scholar
  28. 28.
    Kronberg M, Brostrom LA, Soderlund V (1990) Retroversion of the humeral head in the normal shoulder and its relationship to the normal range of motion. Clin Orthop Relat Res 253:113–117Google Scholar
  29. 29.
    Laumann U, Kramps H (1984) Computer tomography on recurrent shoulder dislocation. Surgery of the shoulder. Decker, PhiladelphiaGoogle Scholar
  30. 30.
    Martin CP (1933) The cause of torsion of the humerus and of the notch on the anterior edge of the glenoid cavity of the scapula. J Anat 67:573–582PubMedPubMedCentralGoogle Scholar
  31. 31.
    Martins C (1857) Nouvelle comparaison des membres pelviens et thoraciques chez l’homme et chez les mammifères: déduites de la torsion de l’humérus: BoehmGoogle Scholar
  32. 32.
    McKern TW, Stewart TD (1957) Skeletal age changes in young American males analysed from the standpoint of age identification. Headquarters, Quartermaster Research & Development Command, Quartermaster Research & Development Center, Environmental Protection Research Division, NatickCrossRefGoogle Scholar
  33. 33.
    Moeckel BH, Altchek DW, Warren RF, Wickiewicz TL, Dines DM (1993) Instability of the shoulder after arthroplasty. J Bone Joint Surg Am 75:492–497CrossRefPubMedGoogle Scholar
  34. 34.
    Myers JB, Oyama S, Clarke JP (2012) Ultrasonographic assessment of humeral retrotorsion in baseball players: a validation study. Am J Sports Med 40:1155–1160.  https://doi.org/10.1177/0363546512436801 CrossRefPubMedGoogle Scholar
  35. 35.
    Myers JB, Oyama S, Goerger BM, Rucinski TJ, Blackburn JT, Creighton RA (2009) Influence of humeral torsion on interpretation of posterior shoulder tightness measures in overhead athletes. Clin J Sport Med 19(f6):366–371.  https://doi.org/10.1097/JSM.0b013e3181b544 CrossRefPubMedGoogle Scholar
  36. 36.
    Neer CS 2nd (1955) Articular replacement for the humeral head. J Bone Joint Surg Am 37–A:215–228CrossRefPubMedGoogle Scholar
  37. 37.
    Oh JH, Kim W, Cayetano AA Jr. (2017) Measurement methods for humeral retroversion using two-dimensional computed tomography scans: which is most concordant with the standard method? Clin Orthop Surg 9:223–231.  https://doi.org/10.4055/cios.2017.9.2.223 CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Pieper H‑G (1996) Torsional adaptation of the humeral shaft to unilateral strain in handball players. J Shoulder Elbow Surg 5:S48CrossRefGoogle Scholar
  39. 39.
    Pieper HG (1998) Humeral torsion in the throwing arm of handball players. Am J Sports Med 26:247–253.  https://doi.org/10.1177/03635465980260021501 CrossRefPubMedGoogle Scholar
  40. 40.
    Randelli M, Gambrioli PL (1986) Glenohumeral osteometry by computed tomography in normal and unstable shoulders. Clin Orthop Relat Res 208:151–156Google Scholar
  41. 41.
    Roach NT, Lieberman DE, Gill TJt PWE, Gill TJ 3rd (2012) The effect of humeral torsion on rotational range of motion in the shoulder and throwing performance. J Anat 220:293–301.  https://doi.org/10.1111/j.1469-7580.2011.01464.x CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Saha AK (1971) Dynamic stability of the glenohumeral joint. Acta Orthop Scand 42:491–505CrossRefPubMedGoogle Scholar
  43. 43.
    Saha AK (1978) Rezidivierende Schulterluxation. ISBN 978-3432901510Google Scholar
  44. 44.
    Scheuer L, Blck S (2000) Development juvenile osteology. Elsevier, New YorkGoogle Scholar
  45. 45.
    Tillett E, Smith M, Fulcher M, Shanklin J (1993) Anatomic determination of humeral head retroversion: the relationship of the central axis of the humeral head to the bicipital groove. J Shoulder Elbow Surg 2:255–256.  https://doi.org/10.1016/S1058-2746(09)80085-2 CrossRefPubMedGoogle Scholar
  46. 46.
    Whiteley R, Ginn K, Nicholson L, Adams R (2006) Indirect ultrasound measurement of humeral torsion in adolescent baseball players and non-athletic adults: reliability and significance. J Sci Med Sport 9:310–318.  https://doi.org/10.1016/j.jsams.2006.05.012 CrossRefPubMedGoogle Scholar
  47. 47.
    Yamamoto N, Itoi E, Minagawa H, Urayama M, Saito H, Seki N et al (2006) Why is the humeral retroversion of throwing athletes greater in dominant shoulders than in nondominant shoulders? J Shoulder Elbow Surg 15:571–575.  https://doi.org/10.1016/j.jse.2005.06.009 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • N. Hawi
    • 1
    Email author
  • S. Razaeian
    • 1
  • C. Krettek
    • 1
  • R. Meller
    • 1
  • E. Liodakis
    • 1
  1. 1.Unfallchirurgische KlinikMedizinische Hochschule HannoverHannoverDeutschland

Personalised recommendations