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The Journal of Bone and Joint Surgery (American) 84:1753-1762 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Determining Humeral Retroversion with Computed Tomography

P. Hernigou, MD, F. Duparc, MD and A. Hernigou, MD

Investigation performed at Hôpital Henri Mondor, Creteil, France

P. Hernigou, MD
Service d'Orthopédie et de Traumatologie, Université Paris XII, Hôpital Henri Mondor, 51, avenue du Mal. de Lattre de Tassigny, 94010 Creteil, France

F. Duparc, MD
Service d'Orthopédie, Hôpital Charles Nicolle, 1, rue de Germont, 76031 Rouen, France

A. Hernigou, MD
Service d'Imagerie, Hôpital Europeen Georges Pompidou, 20, rue Leblanc, 75908 Paris, Cedex 15, France

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The purpose of this study was to develop and standardize a technique in which computed tomography images are used to determine the humeral torsion angle with landmarks that can be used during surgery.

Methods: One hundred and twenty cadaveric humeri were studied. The retroversion of these anatomical specimens was measured on a computed tomography scan and compared with the direct measurements of the specimens. The retroversion of the humerus was measured by determining the orientation of the proximal articular surface of the humerus with respect to the transepicondylar line of the distal part of the humerus and the forearm axis. To evaluate this method of measuring retroversion, the protocol was tested in patients before and after shoulder arthroplasty.

Results: The degree of reproducibility of the measurements made on the computed tomography scan was evaluated by determining the interclass correlation coefficient. The interclass correlation coefficient was considered good (between 0.85 and 0.90) for the measurements of the normal humeri when the orientation of the articular surface measured in the distal part of the humeral head, the epicondylar axis, and the ulnar axis were used as references. There was a significant difference (p < 0.01) between the mean angular orientation of the proximal articular surface with respect to the epicondylar axis (17.6°) and the mean angular orientation of the proximal articular surface with respect to a line perpendicular to the forearm axis (28.8°). Despite a wide variation in the humeral torsion angle among the specimens from the different cadavera, the angle varied little between the two normal humeri of the same individual (mean side-to-side difference, 2.1°).

Conclusion: This study demonstrated that retroversion of the proximal part of the humerus can be reliably measured with computed tomography.

Clinical Relevance: Determining retroversion with computed tomography is more accurate than palpating the epicondylar axis or using the forearm as a goniometer during surgery. Computed tomography is useful for measuring the amount of rotation of humeri with a malunited fracture or severe arthritic deformity.


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