Is there a relationship between the lengths of the ipsilateral clavicle and the ulna? An anthropometric and statistical study

Abstract

Aim: Mathematical relationships between bones in close proximity are useful for determining the proper length of comminuted or severely displaced bones during surgical reconstruction. This study examined the relationship between the lengths of the clavicle and ulna to develop a length propotion formula that can facilitate obtaining the proper length of the clavicle during surgery for displaced and comminuted fractures.

Methods: The study enrolled 130 individuals (76 males, 54 females)who were healty for their upper extremities and was seen in our orthopedics outpatient clinic during April 2019 to June 2019. The right and left clavicles and ulnas of each individual were measured. All measurements were peformed by two of the authors in an blinded fashion.

 Results. Mean overall age was 32.2 years. There were significant correlations between the clavicle and ipsilateral ulnar lengths (p=0.001). However, there was a length difference between the right and left clavicles. The left clavicle was 9.00 ± 2.16 mm longer than the right in males and 7.13 ± 2.03 mm longer in females (p=0.001). There was no significant length difference between the right and left ulnas in either sex (0.84 ± 1.033 mm in males and 0.52 ± 0.818 mm in females).

Conclusion. There is a significant ratio between the clavicle and ulna lengths on both the right and left sides in both sexes, but it isn’t the same for males and females. We propose that these length proportion formula can be used for determining the clavicle length for the surgical treatment of comminuted fractures with plates and particularly with nails.

Keywords

• Comminuted fracture,clavicle,ulna,length ratio

Klavikula ve ulna boyları arasında anlamlı bir oran varmı? Antropometrik ve istatistiksel bir çalışma

Öz

Amaç: Parçalı ve deplase kırıkların cerrahi rekonstrüksiyonu sırasında opere edilen kemiğin uygun boyunun tahmin edilebilmesi için bu kemik boyu ile komşu diğer bir kemiğin matematiksel olarak boy oranının kullanılması oldukça  kullanışlıdır. Bu çalışmada parçalı klavikula kırıkları cerrahi tedavisi sırasında kullanılmak üzere, klavikula ve ulna kemikleri arasında matematiksel olarak anlamlı bir boy oranı olup olmadığının araştırılması amaçlanmıştır.

Yöntemler: Nisan-Haziran 2019 dönemi içerisinde, ortopedi ve travmatoloji polikliniğimizde görülen üst ekstremiteleri sağlıklı 130 hasta (76 erkek, 54 kadın) çalışmaya dahil edildi. Bütün hastaların sağ ve sol ulna ve klavikulaları birbirinin ölçümlerine kör 2 yazar tarafından, aynı yöntemler kullanılarak ölçüldü.

Bulgular: Toplamda ortalama yaş 32.2 yıl idi. Aynı taraf ulna ve klavikula boyları arasında anlamlı bir oran olduğu saptandı (p=0.001).  Aynı zamanda sağ ve sol klavikula boyları arasında anlamlı uzunluk farkı bulunduğu görüldü. Sol klavikula, erkeklerde 9.00 ± 2.16 mm ve kadınlarda 7.13 ± 2.03 mm sağ klavikuladan daha uzun idi (p=0.001). Ancak her iki grupta da sağ ve sol ulna boyları arasında anlamlı bir fark saptanmadı (0.84 ± 1.033 mm erkeklerde ve 0.52 ± 0.818 mm kadınlarda).

Sonuçlar: Hem kadın, hem de erkeklerde her iki tarafta klavikula ve ulna kemikleri arasında matematiksel olarak anlamlı bir oran var olduğu ortaya kondu. Ancak bu oran her iki cinsiyet için farklı idi. Biz bu çalışmanın sonucuna dayanarak, parçalı klavikula kırıklarının plak ve özellikle çivi ile cerrahi tedavisi sırasında, ortaya konan bu orantısal formüllerin uygun kemik boyunun hesaplanarak sağlanması için kullanılabileceğini düşünmekteyiz.

Anahtar Kelimeler

• Parçalı kırık,klavikula,ulna,boy oranı

Kaynakça

1. 1. Pietak A, Ma S, Beck CW, Stringer MD. Fundamental ratios and logarithmic periodicity in human limb bones. J Anat. 2013;222:526-37.
2. 2. Resnick D. The rebirth of rational morphology: process structuralism’s philosophy of biology. Acta Biotheor. 1994;42:1–14.
3. 3. Aydinlioglu A, Akpinar F, Tosun N. Mathematical relations between the lengths of the metacarpal bones and phalanges: surgical significance. Tohoku J Exp Med. 1998;185:209-16.
4. 4. Dogan A, Uslu M, Aydinlioglu A, Harman M, Akpinar F. Morphometric study of the human metatarsals and phalanges. Clin Anat. 2007;20:209–14.
5. 5. Hillen RJ, Bolsterlee B, Veeger DHEJ. The biomechanical effect of clavicular shortening on shoulder muscle function, a simulation study. Clin Biomech (Bristol, Avon). 2016;37:141-6.
6. 6. Bachoura A, Deane AS, Kamineni S. Clavicle anatomy and the applicabil-ity of intramedullary midshaft fracture fixation. J Shoulder Elbow Surg. 2012;21:1384–90.
7. 7. Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br. 1997;79:537-9.
8. 8. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. Evidence-based Orthopaedic Trauma Working Group. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma. 2005;9:504-7.

9. 9. McKee MD. Clavicle fractures in 2010: sling/swathe or open reduction and internal fixation? Orthop Clin North Am. 2010; 41:225-31.
10. 10. VanBeek C, Boselli KJ, Cadet ER, Ahmad CS, Levine WN. Precontoured plating of clavicle fractures: decreased hardware-related complications? Clin Orthop Relat Res. 2011;469:3337–43.
11. 11. Wang XH, Cheng L, Guo WJ, Li AB, Cheng GJ, Lei T, et al. Plate Versus Intramedullary Fixation Care of Displaced Midshaft Clavicular Fractures: A Meta-Analysis of Prospective Randomized Controlled Trials. Medicine (Baltimore). 2015;94:e1792.
12. 12. Kadakia AP, Rambani R, Qamar F, McCoy S, Koch L, Venkateswaran B. Titanium elastic stable intramedullary nailing of displaced midshaft clavicle fractures: A review of 38 cases. Int J Shoulder Surg. 2012;6:82-5.
13. 13. Chung HJ, Hong KJ, Kim DS. Biomechanical properties of titanium elastic nail applied toa cadaveric clavicle model. Orthop Traumatol Surg Res. 2015;101:823-6.
14. 14. Smekal V, Irenberger A, Struve P, Wambacher M, Krappinger D, Kralinger FS. Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized, controlled, clinical trial. J Orthop Trauma. 2009;23:106-12.
15. 15. Smekal V, Irenberger A, Attal RE, Oberladstaetter J, Krappinger D, Kralinger F. Elastic stable intramedullary nailing is best for mid-shaft clavicular fractures without comminution: results in 60 patients. Injury. 2011;42:324-9.
16. 16. Cunningham BP, McLaren A, Richardson M, McLemore R. Clavicular length: the assumption of symmetry. Orthopedics. 2013;36:343-7.
17. 17. Sehrawat JS, Pathak RK. Variability in anatomical features of human clavicle: Its forensic anthropological and clinical significance. Translational Res Anat. 2016;3:5-14.
18. 18. Huang JI, Toogood P, Chen MR, Wilber JH, Cooperman DR. Clavicular anatomy and the applicability of precontoured plates. J Bone Joint Surg Am. 2007;89:2260-5.
19. 19. Bachoura A, Deane AS, Wise JN, Kamineni S. Clavicle morphometry revisited: a 3 dimensional study with relevance to operative fixation. J Shoulder Elbow Surg. 2013;22:e15-21.
20. 20. Daruwalla ZJ, Courtis P, Fitzpatrick C, Fitzpatrick D, Mullett H. Anatomic variation of the clavicle: A novel three-dimensional study. Clin Anat. 2010;23:199-209.
21. 21. Daruwalla ZJ, Courtis P, Fitzpatrick C, Fitzpatrick D, Mullett H. An application of principal component analysis to the clavicle and clavicle fixation devices. J Orthop Surg Res. 2010;5:21.