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Related Concept Videos

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The upper limb consists of the arm, forearm, wrist, and hand bones. The humerus is the single bone of the upper arm region. Proximally, it has a large, spherical, smooth head that articulates with the glenoid cavity of the scapula to form the glenohumeral or shoulder joint. The margin of the head is the anatomical neck, a residual epiphyseal plate. Laterally it extends to form bony projections called the greater tubercle and the lesser tubercle. Next to the tubercles is the surgical neck, a...
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Functional Classification of Joints
The functional classification of joints is determined by the amount of mobility between the adjacent bones. Joints are functionally classified as a synarthrosis or immobile joint, an amphiarthrosis or slightly moveable joint, or as a diarthrosis, a freely moveable joint. Fibrous and cartilaginous joints can be functionally classified as either synarthroses  or amphiarthroses, whereas all synovial joints are classified as diarthroses.
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The radius is longer of the two bones that make up the human antebrachium or forearm. At the proximal end, the radius articulates with the capitulum of the humerus and the radial notch of the ulna to form the elbow joint. At the distal end, the radius articulates with the ulna via the ulnar notch, forming the distal radioulnar joint. Distally, the radius also attaches to the carpal wrist bones (scaphoid and lunate) to form the radiocarpal joint.
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Internal Rotation and Transthoracic Lateral Radiographs Frequently Disagree on Sagittal Angulation in Humeral Shaft

Douglas Zhang1, Jacob Brooks1, Gregory Schimizzi2

  • 1University of Chicago Pritzker School of Medicine (Chicago, Illinois).

Journal of Orthopaedic Trauma
|April 17, 2026
PubMed
Summary

Internal rotation views often conflict with transthoracic views for humeral shaft fracture alignment. This discrepancy in sagittal angulation should be considered during treatment planning for these fractures.

Keywords:
Humeral shaft fractureclinical decision-makingnon-operative treatmentoperative treatmentsagittal alignment

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Area of Science:

  • Orthopedic surgery
  • Radiology
  • Trauma care

Background:

  • Humeral shaft fractures require accurate assessment of sagittal angulation for proper treatment.
  • Radiographic views, including transthoracic and internal rotation, are used to evaluate fracture alignment.

Purpose of the Study:

  • To compare sagittal angulation measurements of humeral shaft fractures between transthoracic and internal rotation radiographs.
  • To identify fracture characteristics associated with discrepancies in alignment measurements between these two radiographic views.

Main Methods:

  • Retrospective cohort study at a Level 1 trauma center.
  • Included adult patients with closed humeral shaft fractures (AO/OTA 12A-C) with both transthoracic and internal rotation views.
  • Compared sagittal angulation and analyzed differences >10 degrees using paired t-tests and Fisher's Exact Test.

Main Results:

  • Thirty-one patients were analyzed; 35% showed disagreement in acceptable alignment between views.
  • Transthoracic views (19.3±13.2°) showed significantly greater mean sagittal angulation than internal rotation views (12.8±11.7°, p=0.02).
  • Over half of patients (54%) had angulation differences greater than 10 degrees between views, with no correlation to fracture type or location.

Conclusions:

  • Internal rotation views frequently provide conflicting sagittal alignment information compared to transthoracic views for humeral shaft fractures.
  • These discrepancies should be carefully considered when making treatment decisions for humeral shaft fractures.