Radiographic measurements of normal elbows: Clinical relevance to olecranon fractures

Abstract

This study aims to calculate a clinically relevant and intra-operatively accessible measure of olecranon length that could be reliably applied by the operating surgeon to optimise fixation of comminuted olecranon fractures. One hundred normal adult antero-posterior and lateral radiographs of the elbow were studied with respect to the proximal olecranon height (OH), trochlear notch width (TW) on lateral views, and trans-epicondylar distance (TED) and trochlear width distance (TWD) on AP views. Three mean ratios were then derived: TWD/TW, TED/TW and OH/TW. The average OH was 26.2 mm (range 21-29), TW was 24.7 mm (range 21-32), TED was 58.7 mm (range 49-74), and the TWD was 27.0 mm (range 22-32). The average ratio of TWD: TW was 1.08 (SD = 0.08), that of TED: TW was 2.38 (SD = 0.18) and OH/TW was 1.06 (SD = 0.08). Comminuted fractures of the olecranon are a surgical challenge since it is often impossible to gauge the correct length to achieve in reconstruction of the olecranon process. Our data can be easily applied to the clinical situation, by taking intra-operative radiographs, and calculating the ratios as demonstrated above. These will guide the surgeon to obtain a more reliable length of the olecranon intra-operatively.

Redefining the proximal ulna anatomy

“…Wadia et al [20] reported that the mean olecranon height (POH) was 26.2 ± 2.01 mm (range 21-29 mm) and trochlear notch width (TW) was 24.7 ± 1.21 mm (range 21-32 mm) in 100 anteroposterior and lateral elbow radiographs. In our study, the average POH was 24.6 ± 2.6 mm (range 19.4-29 mm) and the average TW was 22.3 ± 1.9 mm (range 17.4-26.4 mm).…”

“…As a result, the mean RTW was found 24.4 ± 2.4 mm (range 19-30.4 mm) and UTW was found 29.4 ± 2.7 mm (range 23.6-35.2 mm). According to the study of Wadia et al [20] TW was the mostly affected and the most important parameter for reconstruction in olecranon fractures. Restriction of TW may occur during the compression of the comminuted fractures with intramedullary screws.…”

“…Several studies have described the anatomic patterns of the proximal ulna, but with limited parameters such as the varus angulation, notch length, olecranon width, height of coronoid process, radial notch height, ulnar length, or proximal ulna dorsal angulation (PUDA) [20][21][22].…”

Radial head translation measurement in healthy individuals: the radiocapitellar ratio

“…Other radiographic parameters have been described around the elbow, including the anterior humeral line, as described by Herman et al, 8 and measurements specific to the olecranon, as described by Wadia et al 22 The carrying angle of the elbow has also been examined, and Kumar et al 10 reported good correlations for carrying angles measured on radiographs compared with cadaveric bones.…”

Complex fracture-dislocations of the proximal ulna and radius in adults: a comprehensive classification

“…6,7,11,16 Furthermore, because most of these classifications were reported a few years ago, they cannot exploit recent knowledge about the functional anatomy of the elbow, including the complex interaction between bone and soft-tissue constraints of the joint. 20,32,34,38,48 The purpose of this study was to report a new comprehensive classification of complex fracture-dislocations of the proximal ulna and radius that may provide a guide for operative management and be useful in determining the prognosis of these conditions.…”