Comparison of Anteroposterior Vs. Axial X-rays for Assessing Bone Loss in Recurrent Shoulder Dislocation

Muhammad Shoaib; Muhammad Nadeem; Ahmed Mushtaq Khan; Muhammad Nauman Iqbal; Azhar Yasin

doi:10.70749/ijbr.v2i02.345

Authors

Muhammad Shoaib Department of Orthopaedics, Combined Military Hospital, Rawalpindi, Punjab, Pakistan.
Muhammad Nadeem Department of Orthopaedics, Combined Military Hospital, Rawalpindi, Punjab, Pakistan.
Ahmed Mushtaq Khan Department of Orthopaedics, Combined Military Hospital, Rawalpindi, Punjab, Pakistan.
Muhammad Nauman Iqbal Department of Orthopaedics, Combined Military Hospital, Rawalpindi, Punjab, Pakistan.
Azhar Yasin Department of Orthopaedics, Combined Military Hospital, Rawalpindi, Punjab, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v2i02.345

Keywords:

AP X-rays, Axial X-rays, Recurrent Shoulder Dislocation, Glenohumeral Joint Instability, Hill-sachs Lesion, Bankart Lesion.

Abstract

Background: Recurrent shoulder dislocation frequently causes the glenoid and humeral head to gradually lose bone, which decreases joint stability and raises the risk of another dislocation. Treating bone loss accurately is crucial, especially when it comes to surgical procedures. The diagnostic precision of axial and anteroposterior (AP) X-rays in identifying and measuring bone loss in patients with repeated shoulder dislocations was examined in this study. Methods: 30 individuals who experienced recurrent shoulder dislocations had axial and anteroposterior (AP) radiography. The humeral head bone loss was measured in millimeters, whereas the glenoid bone loss was expressed as a percentage of the total glenoid surface area. The images were evaluated by two separate radiologists who determined the images' sensitivity, specificity, and accuracy for both modalities. The Intraclass Correlation Coefficient (ICC) was utilized to assess inter-observer reliability, and Receiver Operating Characteristic (ROC) curve analysis was employed to assess overall diagnostic performance. Results: The sensitivity of axial X-rays was found to be much higher (85%) than that of AP X-rays (70%; p < 0.05). Additionally, axial X-rays demonstrated higher accuracy (83% vs.68%) and specificity (80% vs. 65%). Using Axial X-rays, the mean glenoid bone loss was 16.5%, whereas using AP X-rays, it was 14.2%. For axial X-rays, the humeral head bone loss was 5.6 mm, but for AP X-rays, it was 4.8 mm. Compared to AP X-rays, the ICC for inter-observer reliability was greater for axial X-rays (0.88 and 0.85). Axial X-rays performed better diagnostically than AP X-rays (AUC = 0.71), according to ROC analysis. However, Gold standard investigation for bone loss in recurrent sholder dislocation is always a CT scan. Conclusion: When it comes to identifying and measuring bone loss in repeated shoulder dislocations, axial X-rays provide better diagnostic accuracy than AP X-rays, which is why they are the preferred imaging modality for preoperative evaluation.

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