Advanced SearchSearch Tips
Evaluation of Focal Bone Mineral Density Using Three-dimensional Measurement of Hounsfield Units in the Proximal Humerus
facebook(new window)  Pirnt(new window) E-mail(new window) Excel Download
  • Journal title : Clinics in Shoulder and Elbow
  • Volume 18, Issue 2,  2015, pp.86-90
  • Publisher : Korean Shoulder and Elbow Society
  • DOI : 10.5397/cise.2015.18.2.86
 Title & Authors
Evaluation of Focal Bone Mineral Density Using Three-dimensional Measurement of Hounsfield Units in the Proximal Humerus
Moon, Young Lae; Jung, Sung; Park, Sang Ha; Choi, Gwi Youn;
  PDF(new window)
Background: Although there are several methods for evaluating bone quality, Hounsfield units (HU), a standardized computed tomography (CT) attenuation coefficient, provide a useful tool for estimating focal bone mineral density (BMD). The aim of this study is to investigate the HU for evaluating the degree of osteoporosis in greater tuberosity with regard to anchor positioning. Methods: Forty patients diagnosed as normal on shoulder CT were included and categorized according to age and gender. Axially sectioned CT images were processed to 3-dimensional models containing information about bone quality using Mimics (14.11 platform v14.1.1.1 Materialise). Three-dimensional anchors were simulated and positioned according to 6 regions of interest (ROI) in the greater tuberosity classified using Tingart's system. Mean HU of intra-anchor volumes in the 6 regions was measured. Results: A significant decrease in HU was observed with increasing age (p=0.0001) and menopause (p<0.001). A significant difference in HU was found between male and female groups with males showing the higher values (p=0.0001). HU of proximal areas of ROI was higher than those of distal areas (p<0.005). However, although mean HU of distal posterior ROI showed the lowest values, no statistically significant difference was found between anterior, middle, and posterior regions (p=0.087). Conclusions: Mean HU of ROIs provides a tool for preoperative assessment of focal BMD, which is a factor of suture anchor stability and can be used to aid decision-making regarding secure anchor positioning for rotator cuff repair. Our data support that the most secure point is the proximal regions of ROI.
Shoulder;Hounsfield units;Three-dimensional;Bone density;Anchor stability;
 Cited by
Aktay SA, Kowaleski MP. Analysis of suture anchor eyelet position on suture failure load. Vet Surg. 2011;40(4):418-22. crossref(new window)

Barber FA, Cawley P, Prudich JF. Suture anchor failure strength--an in vivo study. Arthroscopy. 1993;9(6):647-52. crossref(new window)

Cummins CA, Appleyard RC, Strickland S, Haen PS, Chen S, Murrell GA. Rotator cuff repair: an ex vivo analysis of suture anchor repair techniques on initial load to failure. Arthroscopy. 2005;21(10):1236-41. crossref(new window)

Ma R, Chow R, Choi L, Diduch D. Arthroscopic rotator cuff repair: suture anchor properties, modes of failure and technical considerations. Expert Rev Med Devices. 2011;8(3):377-87. crossref(new window)

Strauss E, Frank D, Kubiak E, Kummer F, Rokito A. The effect of the angle of suture anchor insertion on fixation failure at the tendon-suture interface after rotator cuff repair: deadman's angle revisited. Arthroscopy. 2009;25(6):597-602. crossref(new window)

Tingart MJ, Lehtinen J, Zurakowski D, Warner JJ, Apreleva M. Proximal humeral fractures: regional differences in bone mineral density of the humeral head affect the fixation strength of cancellous screws. J Shoulder Elbow Surg. 2006;15(5):620-4. crossref(new window)

Poukalova M, Yakacki CM, Guldberg RE, et al. Pullout strength of suture anchors: effect of mechanical properties of trabecular bone. J Biomech. 2010;43(6):1138-45. crossref(new window)

Tingart MJ, Apreleva M, Lehtinen J, Zurakowski D, Warner JJ. Anchor design and bone mineral density affect the pull-out strength of suture anchors in rotator cuff repair: which anchors are best to use in patients with low bone quality? Am J Sports Med. 2004;32(6):1466-73. crossref(new window)

Oh JH, Song BW, Kim SH, et al. The measurement of bone mineral density of bilateral proximal humeri using DXA in patients with unilateral rotator cuff tear. Osteoporos Int. 2014;25(11):2639-48. crossref(new window)

Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am. 2011;93(11):1057-63. crossref(new window)

Silva MJ, Keaveny TM, Hayes WC. Computed tomographybased finite element analysis predicts failure loads and fracture patterns for vertebral sections. J Orthop Res. 1998;16(3):300-8. crossref(new window)

McBroom RJ, Hayes WC, Edwards WT, Goldberg RP, White AA 3rd. Prediction of vertebral body compressive fracture using quantitative computed tomography. J Bone Joint Surg Am. 1985;67(8):1206-14.

Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312(7041):1254-9. crossref(new window)

Rho JY, Hobatho MC, Ashman RB. Relations of mechanical properties to density and CT numbers in human bone. Med Eng Phys. 1995;17(5):347-55. crossref(new window)

Wirth AJ, Goldhahn J, Flaig C, Arbenz P, Muller R, van Lenthe GH. Implant stability is affected by local bone microstructural quality. Bone. 2011;49(3):473-8. crossref(new window)

Ciarelli MJ, Goldstein SA, Kuhn JL, Cody DD, Brown MB. Evaluation of orthogonal mechanical properties and density of human trabecular bone from the major metaphyseal regions with materials testing and computed tomography. J Orthop Res. 1991;9(5):674-82. crossref(new window)

Mahar A, Bynum CK, Lee S, Tasto J, Pedowitz R. Failure mode of suture anchors as a function of insertion depth. Am J Sports Med. 2005;33:1030-4. crossref(new window)