Three-dimensional morphometry of the proximal ulna: a comparison to currently used anatomically preshaped ulna plates.
BACKGROUND
Anatomically preshaped plates are increasingly used for stabilization of comminuted olecranon and Monteggia fractures. The purposes of this study were to investigate the morphology of the proximal ulna and to compare morphologic findings with geometry of 4 preshaped ulna plates.


METHODS
Forty human elbows (mean age, 68 years; range, 21-98 years) were measured by 2 independent observers using 64-slice computed tomography scans and 3-dimensional measuring software.


RESULTS
Measurements showed a mean dorsal hook angle of 95.3° ± 9.0° (range, 74.7°-110.8°) with gender-specific differences (mean, 92.2° ± 8.1° in men and 98.3° ± 8.9° in women; P = .029); a mean distance from the tip of the olecranon to the proximal edge of the ulna of 24.7 ± 2.7 mm (range, 20-30.5 mm) with gender-specific differences (P = .00068); a mean varus angulation of 14.3° ± 3.6° (range, 5.8°-21.2°); and a mean anterior angulation (proximal ulna dorsal angulation) of 6.2° ± 2.7° (range, 1.0°-11.2°). The investigated plates offered a tolerable (± standard deviation) hook angle in 25% to 68%, an appropriate varus angulation in 0% to 20%, and an adequate anterior angulation in 23% to 88%. The intraclass correlation coefficient was between 0.74 and 0.91.


CONCLUSIONS
The proximal ulna has a gender-specific and variable morphology. Some currently used anatomically preshaped proximal ulna plates differ significantly from these morphologic findings. In cases where reduction is not exactly possible, application of an "anatomically preshaped" plate may result in poor reduction. Especially in case of Monteggia fractures with instability of the radiocapitellar joint, surgeons could be misguided by plates that do not incorporate anterior angulation, resulting in subluxation of the radial head on the capitellum.
Universitätsklinik für Unfallchirurgie, Medizinische Universität Graz, Graz, Austria. paul.puchwein@medunigraz.at
Paul
P
Puchwein
Thomas Armin
TA
Schildhauer
Sylvia
S
Schöffmann
Nima
N
Heidari
Gunter
G
Windisch
Wolfgang
W
Pichler
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D002102:Cadaver; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D009011:Monteggia's Fracture / Q000000981:diagnostic imaging / Q000601:surgery; D015588:Observer Variation; D056740:Olecranon Process / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D011856:Radiographic Image Enhancement; D015203:Reproducibility of Results; D012494:Sampling Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D014457:Ulna / Q000033:anatomy & histology* / Q000000981:diagnostic imaging* / Q000601:surgery; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D055815:Young Adult