Rotational Anatomy of the Radius and Ulna: Surgical Implications

Daneshvar, Parham; Willing, Ryan; Lapner, Michael; Pahuta, Markian; King, Graham J.W.

doi:10.1016/j.jhsa.2020.04.018

Cited by 7 publications

(11 citation statements)

References 25 publications

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“…The entire volar cortex of the distal third of the radius presents a gradual external rotational angle from proximal to distal (from 14˚ to ‒2) relative to the central axis. Recently, Daneshvar et al[ 9 ] performed a similar study and found a mean of 3° rotational difference between such principal radial axes, at the level of 15 mm proximal to the joint. However, the difference in our series was 8°.…”

Section: Discussionmentioning

confidence: 93%

“…The volar cortical axis of the distal radius was the perpendicular to the line along the volar flat surface of the radius at the level of 15 mm proximal to the lunate facet. [ 9 ] The medial cortical axis was the line along the medial surface of the distal radius at the level of immediately proximal to the sigmoid notch. The central axis was the perpendicular to the line connecting the styloid tip and the midpoint between the volar and dorsal margins of the sigmoid notch at the radiocarpal joint level.…”

Section: Methodsmentioning

confidence: 99%

“…Several different anatomical locations have been used as a principal axis of the distal radius in the past; the central (mediolateral radiocarpal joint) axis, volar cortical axis (at distal metaphyseal level), and sigmoid notch axis. [ 5 , 8 , 9 ] Moreover, a comparative analysis of these axes was performed only in one study partly,[ 9 ] to the best of our knowledge.…”

Section: Introductionmentioning

confidence: 99%

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A radiographic study of dorsovolar wrist axes and a database of angular measurements on axial computed tomography images

et al. 2022

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Objectives This study aims to identify the most accurate dorsovolar principal axis of the distal radius and carpus identified on axial computed tomography (CT) sections and to establish normative data for angular measurements among these axes. Patients and methods Between December 2019 and December 2021, normal axial CT images of wrists of a total of 42 individuals (25 males, 17 females; mean age: 31±8.4 years; range, 18 to 45 years) were retrospectively analyzed. Eight axes were identified on axial CT images: four distal radial axes (the volar cortical, medial cortical, central, and sigmoid notch axes) and four carpal axes (the scapholunate, lunotriquetral, capitohamate, and pisotrapezial axes). Twenty-two angular parameters were measured with reference to four principal axes (the volar cortical, medial cortical, central, and pisotrapezial axes). Results The mean sigmoid notch rotation (version) angles relative to the four principal axes were 8±5° (range, –2° to 18°), 6±5° (range, –2° to 13°), 1±5° (range, –8° to 14°), and 4±4° (range, –3° to 15°), respectively. The mean scapholunate rotation angles were –13±5° (range, –27° to –6°), –15±6° (range, –29° to –8°), –21±5° (range, –30° to –11°), and –8±5° (range, –28° to –6°), respectively. Among four principal axes, the volar cortical and medial cortical axes were nearly collinear with both of relatively fixed carpal axes. The four principal axes showed angular differences between 2° and 8° with each other. There was no significant difference between men and women for all measurements. Conclusion The axial CT sections can be used to describe the various angulations between the normal wrist axes such as the sigmoid notch and scapholunate joint rotation angles. Despite slight differences among the four principal axes, the volar cortical and medial cortical axes are more consistent with the relatively fixed carpal axes.

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Section: Discussionmentioning

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A radiographic study of dorsovolar wrist axes and a database of angular measurements on axial computed tomography images

et al. 2022

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“…A similar study, made with regards to general surgical implications, focused on the rotation of the radius and the ulnae, which is very helpful as an addition to our study, yet it was not sufficient for a prosthesis design, since no information about the head and shaft sizing is given [ 15 ]. Interestingly, where our study found a rather supinated rotation of the ulnae, their sample had an average pronation of 8.4° in their ulna.…”

Section: Discussionmentioning

confidence: 99%

3D analysis of the distal ulna with regard to the design of a new ulnar head prosthesis

Furrer

Nagy

Reissner

et al. 2022

BMC Musculoskelet Disord

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Study design A retrospective, single center, data analysis. Objective Persistent pain and instability are common complications after distal ulnar head arthroplasty. One main reason may be the insufficient representation of the anatomical structures with the prosthesis. Some anatomical structures are neglected such as the ulnar head offset and the ulnar torsion which consequently influences the wrist biomechanics. Methods CT scans of the ulnae of forty healthy and asymptomatic patients were analyzed in a three-dimensional surface calculation program. In the best fit principle, cylinders were fitted into the medullary canal of the distal ulna and the ulnar head to determine their size. The distance between the central axes of the two cylinders was measured, which corresponds to the ulnar offset, and also their rotational orientation was measured, which corresponds to the ulnar torsion. Results The mean medullary canal diameter was 5.8 mm (±0.8), and the ulnar head diameter was 15.8 mm (±1.5). The distance between the two cylinder axes was 3.89 mm (±0.78). The orientation of this offset was at an average of 8.63° (±15.28) of supination, reaching from 23° pronation to 32° supination. Conclusion With these findings, a novel ulnar head prosthesis should have different available stem and head sizes but also have an existing but variable offset between these two elements. A preoperative three-dimensional analysis is due to the high variation of offset orientation highly recommended. These findings might help to better represent the patients natural wrist anatomy in the case of an ulnar head arthroplasty. Level of Evidence III.

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“…Length, volume, bowing and twisting differences of the bilateral forearm bones were investigated first, then regional shape differences were analyzed. In particular, many researchers have reported that the radius and ulna have characteristic natural bowing and twisting [28,[32][33][34][35][36]. Several studies reported that deformities of the forearm bone diaphysis can cause 50% to 60% restriction of forearm bone rotation [31,37].…”

Section: Discussionmentioning

confidence: 99%

Morphological symmetry of the radius and ulna—Can contralateral forearm bones utilize as a reliable template for the opposite side?

2021

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The most important precondition for correction of the affected forearm using data from the contralateral side is that the left and right bone features must be similar, in order to develop patient-specific instruments (PSIs) and/or utilize computer-assisted orthopedic surgery (CAOS). The forearm has complex anatomical structure, and most people use their dominant hand more than their less dominant hand, sometimes resulting in asymmetry of the upper limbs. The aim of this study is to investigate differences of the bilateral forearm bones through a quantitative comparison of whole bone parameters including length, volume, bowing, and twisting parameters, and regional shape differences of the forearm bones. In total, 132 bilateral 3D radii and ulnae 3D models were obtained from CT images, whole bone parameters and regional shape were analyzed. Statistically significant differences in whole bone parameters were not shown. Regionally, the radius shows asymmetry in the upper section of the central part to the upper section of the distal part. The ulna shows asymmetry in the lower section of the proximal part to the lower section of the central part. Utilizing contralateral side forearm bones to correct the affected side may be feasible despite regional differences in the forearm bones of around 0.5 mm.

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Rotational Anatomy of the Radius and Ulna: Surgical Implications

Cited by 7 publications

References 25 publications

A radiographic study of dorsovolar wrist axes and a database of angular measurements on axial computed tomography images

A radiographic study of dorsovolar wrist axes and a database of angular measurements on axial computed tomography images

3D analysis of the distal ulna with regard to the design of a new ulnar head prosthesis

Morphological symmetry of the radius and ulna—Can contralateral forearm bones utilize as a reliable template for the opposite side?

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