Surgical importance of radiographically aided morphometry of the proximal ulna / Importancia quirúrgica de la morfometría de la ulna proximal con examen radiográfico

This study was conducted to define the proximal ulnar morphometry with respect to dorsal and intramedullary implant design. Eighty two dry Anatolian ulnae were evaluated by both the traditional and digital morphometric analysis methods. Also the medullary cavities and cortical bone thicknesses were measured from radiographic images. The mean value of ulnar length (UL) was 25.06 cm; distance between the most prominent anterior point of the superior surface of the olecranon (MAPO) and the most posterior point of the olecranon (MPPO), distance between the MPPO and maximum anterior angulation (MAA), distance between the MPPO and the maximum varus angulation (MVA) were; 1.67 cm, 5.36 cm and 7.56 cm, respectively. The average antero-posterior diameters at midolecranon plane (MOP), MAA plane (MAAP) and MVA plane (MVAP) were; 1.78 cm, 1.68 cm and 1.41 cm; transverse diameters of same planes were; 1.96 cm, 1.65 cm and 1.51 cm, respectively. The mean olecranon angle (OA), MAA and MVA were: 113.35°, 9.12° and 13.82°; also the mean circumferences at same planes were 6.48 cm, 6.37 cm and 5.16 cm, respectively. The mean antero-posterior medullary diameter at MAAP and mean transverse medullary diameter at MVAP were; 6.83 mm and 7.22 mm, respectively. Mean anterior and posterior cortical bone thicknesses at MAAP were: 3.61 mm and 4.25 mm; the mean medial and lateral cortical bone thicknesses at MVAP were: 4.06 mm and 4.13 mm, respectively. Dorsal angulation and medullary angulation of the proximal ulna presents different architecture. Unique morphological architecture of the proximal ulna should be taken into consideration in means of surgical operations and examination of radiographic images. It can be inferred that standardized bony landmarks may helpful during the process of designing and manufacturing precurved dorsal plates and as well as variable proximal ulnar implants.

Este estudio se realizó para definir la morfometría ulnar proximal con respecto al diseño de implante dorsal e intramedular. Ochenta y dos ulnas de Anatolia secas fueron evaluadas por los métodos de análisis morfométrico tradicional y digital. También se midieron las cavidades medulares y el grosor del hueso cortical a partir de imágenes radiográficas. El valor medio de la longitud ulnar (LU) fue de 25,06 cm; distancia entre el punto anterior más prominente de la superficie superior del olécranon (SSO) y el punto más posterior (PPO), la distancia entre el PPO y la angulación anterior máxima (AAM), la distancia entre el PPO y la angulación máxima en varo (AMV) fueron; 1,67 cm, 5,36 cm y 7,56 cm, respectivamente. Los diámetros anteroposteriores medios en el plano medio del olécranon (PMO), el plano AAM (AAP) y el plano AMV fueron; 1,78 cm, 1,68 cm y 1,41 cm; los diámetros transversales de los mismos planos eran; 1,96 cm, 1,65 cm y 1.51 cm, respectivamente. El ángulo medio del olécranon (AMO), AAM y MVA fueron: 113,35 °, 9,12 ° y 13,82 °; También las circunferencias medias en los mismos planos fueron 6,48 cm, 6,37 cm y 5,16 cm, respectivamente. El diámetro medular anteroposterior medio en AMV y el diámetro medular transversal medio en AMV fueron; 6,83 mm y 7,22 mm, respectivamente. Los grosores óseos corticales anteriores y posteriores medios en AMV fueron: 3,61 mm y 4,25 mm; Los espesores medios de los huesos corticales medial y lateral en AMV fueron: 4,06 mm y 4,13 mm, respectivamente. La angulación dorsal y la angulación medular de la ulna proximal presentan una arquitectura diferente. La arquitectura morfológica única de la ulna proximal debe tenerse en cuenta en las operaciones quirúrgicas con el examen de imágenes radiográficas. Se puede inferir que los puntos de referencia óseos estandarizados pueden ser útiles durante el proceso de diseño y fabricación de placas dorsales precurvadas y también de implantes ulnares proximales variables.

Chronic recurrent multifocal osteomyelitis exhibiting predominance of periosteal reaction / Osteomielite crônica multifocal recorrente exibindo predomínio de reação periosteal

Summary Chronic recurrent multifocal osteomyelitis is an idiopathic nonpyogenic autoinflammatory bone disorder involving multiple sites, with clinical progression persisting for more than 6 months and which may have episodes of remission and exacerbation in the long term. It represents up to 2-5% of the cases of osteomyelitis, with an approximate incidence of up to 4/1,000,000 individuals, and average age of disease onset estimated between 8-11 years, predominantly in females. The legs are the most affected, with a predilection for metaphyseal regions along the growth plate. We describe the case of a female patient, aged 2 years and 5 months, with involvement of the left ulna, right jaw and left tibia, showing a predominance of periosteal reaction as main finding.

Resumo Osteomielite crônica multifocal recorrente é uma desordem autoinflamatória óssea idiopática não piogênica, envolvendo vários sítios e com evolução clínica persistindo por mais de 6 meses, podendo apresentar episódios de remissão e exacerbação em longo prazo. Representa de 2 a 5% das osteomielites, com incidência aproximada de até 4/1.000.000, com idade média de apresentação estimada entre 8 e 11 anos, predominando no gênero feminino. Os membros inferiores são os mais afetados, com predileção para regiões metafisárias junto à fise. Descrevemos um caso da doença em uma menina de 2 anos e 5 meses de idade, com acometimento de ulna esquerda, mandíbula à direita e tíbia esquerda, exibindo predomínio de reação periosteal como achado principal.

Gradual Lengthening of the Ulna in Patients with Multiple Hereditary Exostoses with a Dislocated Radial Head

PURPOSE: Multiple hereditary exostoses of the forearm typically form in the distal ulna, causing disturbances in the growth of the ulna and functional disability. Multiple hereditary exostoses inhibit the growth of the ulna, leading to an acquisition of a varus deformity in the radius, which sometimes leads to dislocation of the radial head, the development of limitations in the pronation-supination of the forearm, and cosmetic problems. MATERIALS AND METHODS: We retrospectively reviewed the cases of four patients who had deformities of the forearm with radial head dislocation associated with multiple hereditary exostoses, and evaluated the radiologic and clinical results of excision of the osteochondromas from the distal ulna and gradual ulnar lengthening with an Ilizarov external fixator. RESULTS: Good clinical and radiological results were obtained after a mean follow-up of 25 months. At the most recent follow-up, radial bowing, ulnar shortening, carpal slip, and the pronation/supination arch of the forearm had improved. There was little change in terms of preoperative radial articular angle and the flexion/extension arch of the elbow by the most recent follow-up. CONCLUSION: Treatment of four forearms from four patients by excision of osteochondromas and gradual lengthening of the ulna with an Ilizarov external fixator spontaneously reduced dislocations of the radial heads without the need for any additional operative intervention. All patients were satisfied with the final results.

Positive or Negative Ulnar Variance after Ulnar Shortening for Ulnar Impaction Syndrome: A Retrospective Study

BACKGROUND: The goal of this study was to compare simple radiographic findings and clinical results according to residual ulnar variance following ulnar shortening for ulnar impaction syndrome. METHODS: Forty-five cases of ulnar impaction syndrome, which were treated with ulnar shortening from 2005 to 2008, were studied retrospectively. Group I included 13 cases with positive residual variance after ulnar shortening and group II included 32 cases with negative variance after shortening. The presence of a lunate cystic lesion both preoperatively and at final follow-up and assessments of wrist function based on the modified Mayo wrist score, the disabilities of the arm, shoulder, and hand (DASH) score, as well as the Chun and Palmer score were evaluated. RESULTS: A cystic lesion of the lunate was present in 4 cases preoperatively and the size decreased in 2 cases at final follow-up in group I, and in 10 and 5 cases, respectively, in group II. No statistical difference was observed between the groups. The modified Mayo wrist score, DASH score, as well as the Chun and Palmer score improved significantly in both groups. No significant differences were observed between the two groups in terms of the proportion of positive cystic lesions at final follow-up or the functional scores. CONCLUSIONS: After ulnar shortening, the degree of radiological change in the cystic lunate lesions and clinical improvement did not differ significantly between the groups with unintended residual positive and negative variance after shortening.

Stature estimation from upper extremity long bones by digital radiography / 法医学杂志

OBJECTIVE@#To obtain regression formula for estimation of stature in Han population in Sichuan Province from length of the upper extremity long bones by digital radiography.@*METHODS@#The statures of 365 healthy adults and digital radiographs of their right upper extremity long bones were measured. All statistical dispositions were done in SPSS including description and regression analysis.@*RESULTS@#Twenty-seven simple regression and 3 multiple regression formulae with statistic significance in estimation of the stature from the sum of the length of the upper extremity long bones were established. Regression coefficient was higher in ulna than in radius, in male than in female, and was more accurate in multiple regression formulae than in simple regression formulae.@*CONCLUSION@#Digital radiograph measurement of the length of the upper extremity long bones seems to be a simple and practical method to estimate human stature in forensic practice.

Age estimation by skeletal maturation of the bones of the wrist and hand in the Egyptian boys and girls

The hand with its numerous secondary centers in phalanges and metacarpals and the wrist with its tightly packed primary centers are useful for the purpose of recording progress of skeletal maturation and in identification. This study aimed to establish both a chronological sequence of postnatal skeletal maturation in the Egyptian children and the intersexual differences. In this study, 156 radiographic plates of the hand and wrist in posteroanterior projection of the Egyptian children between 1-13 years of age. All cases were free from any pathological conditions that could alter the normal skeletal development. The ossification centers studied in each case, corresponded to the distal epiphysis of ulna and radius, the campus, the metacarpals and the phalanges. It was found that there was a significant differences in mean [Ba] between girls and boys at 9 and 11 years where girls showed significantly higher mean [Ba] than boys. The difference between [Ba] and [Ca] was a negative value in more males than females. A detailed and ordered study of ossification center of each bone of the hand and wrist was made and the intersexual differences were demonstrated. The [Ba] and [Ca] was related statistically and the results was represented graphically. A high statistical correlation between the two variables was found. Standards representing the length of metacarpal bones and phalanges were obtained. Girls have significantly longer second metacarpal bone than boys in all age groups except at 1 and 9 years of age. Males have significally higher mean total diameter of second metacarpal than females in all age groups from 1 to 10 years except at the age of 5 years

Giant cell tumour of the lower end of the radius--a new treatment modality.

Excision of the lower end of the radius with centralisation of ulna was done in 3 patients with histology proved diagnosis of giant cell tumour, as secondary procedure in 2 cases following recurrence of tumour in the fibular graft, and as a primary procedure in one, where the segment of fibula required was more than 15.2 cm. After an average follow-up of 2.3 years, the results were assessed both subjectively and objectively. The patients were happy with their hand functions and were able to have more than 80% of the grip strength. They could return to their former occupation. There was no recurrence of tumour and no pain at the wrist.