Deltoid tuberosity index obtained by computed tomography versus radiography for measuring bone quality in proximal humeral fractures: a retrospective observational study

Abstract

Abstract Background In cases of proximal humeral fractures, fracture severity and the patient’s osteoporotic condition should be assessed to achieve the best possible treatment outcomes. The Tingart measurement is commonly used to assess bone quality, but it can be problematic if the measurement area is affected by the fracture. Recently, the deltoid tuberosity index (DTI) has been developed as another index to evaluate bone quality. The aim of this study was to compare the efficacy of the DTI obtained by X-ray imaging with computed tomography (CT) in assessing bone quality for proximal humeral fractures. Methods Fifteen patients with proximal humeral fractures were included, and the images were assessed twice by two independent evaluators with an interval of 1 month between each assessment. According to DTI values measured by X-ray, values greater than 1.4 were considered positive for osteoporosis, while values less than or equal to 1.4 were considered negative. The inclusion criteria were patients over 18 years old with a proximal humeral fracture who underwent anteroposterior radiography and CT. Pathological fractures, pre-existing humeral fractures, and metabolic diseases were excluded. Results There was good agreement between the CT and X-ray measurements. However, there were significant differences between them, with the CT measure being higher than the X-ray measure in 46.7% of the evaluations. The best cut-off points for diagnosing osteoporosis were found to be the same for CT and DTI: 1.4. CT diagnosis had an accuracy of 73.3%, a sensitivity of 65.2%, and a specificity of 78.4% when compared to X-ray diagnosis. False-positive diagnoses were 14.3%, and false-negative diagnoses were 13.3%. Conclusions CT can be considered a good method for diagnosing osteoporosis in proximal humeral fractures. The findings of this study allow the surgeon to use the CT as a new tool to make the diagnosis of osteoporosis and to define the patient under risk for surgical procedure.