Morphometric Evaluation of Rarely Seen Supratrochlear Foramen and Supracondylar Process in the Humerus in Turkish Population

Öz

Abstract

Background: Sometimes seen distal to humerus foramen supratrochleare and supracondylar process are rare variations. Supracondylar process is a variations observed on the distal side of humerus. The supracondylar process is a variant located 1/3 distal side of the humerus. The supratrochlear foramen may appear between the coronoid fossa and olecra-non fossa. Since the foramen may appear in a semi-transparent form, it may be misdiagnosed as an osteolytic lesion. The aim of the present study was to identify the prevalence and morphology of supratrochlear foramen and the supracondylar process of the humerus inTurkish population . Furthermore, we believe considering these variations by looking at this variation in the previously taken radiological images of the people, help identification of that person in any forensic case.
Materials and Methods: The present study was conducted on 460 humerus samples (237 right; 223 left) with unclear age and gender in the Anatomy Laboratories of Necmettin Erbakan Meram, KTO Karatay, Yozgat Bozok, Kayseri Erciyes Faculties of Medicine. Morphometric measurements of such formations on the humerus were performed through a digital calliper and osteometric board. Furthermore, along with supratrochlear typing, the prevalence in the process and humerus was also detected.
Results: In the present study, the supracondylar process was detected in 11 (2.4%) individuals (4 right; 7 left); however, it was not detected in 449 (97.6%) humerus samples. The supratrochlear foramen was detected in 63 (13.7%) of 460 humeri. The foramen supratrochlear was seen in 10.8% of the humerus on the right side in 16.5% (29) and in 16.5% of the left humerus. The prevalence of both process and foramen on the humerus was 0.7% (3). The average lengths of right supracondylar process and left supracondylar process were 9.47±1.94 mm and 16.24±14.06 mm, respectively. The verti-cal diameter was 3.45±1.07 mm on the right supratrochlear foramen, and 3.57±1.17 mm on the left supratrochlear foramen; mean transverse diameter of the right foramen was 4.73±2.81 mm, and mean transverse diameter was detect-ed 4.41± 2.49 mm on the left.
Conclusions: The prevalence of supratrochlear foramen and the supracondylar process was higher on the left side; howev-er, both are detected on the right side. We believe that the data obtained would be helpful for an orthopaedic surgeon during intramedullary nailing, and for differential diagnosis of some osteolytic lessons for a radiologist. In addition, these variations can be an important indicator in the differentiation of different races.

Key Words: Humerus, Supracondylar process, Supratrochlear foramen, Morphometry, Variation

Anahtar Kelimeler

• Humerus
• Supracondylar process
• Supratrochlear foramen
• Morphometry
• Variation
• Humerus, Supracondylar process, Supratrochlear foramen, Morphometry, Variation

Türk Populasyonunda Humerus'da Nadir Görülen Foramen supratrochleare ve Processus supracondylaris'in Morfometrik Değerlendirilmesi

Öz

Amaç: Humerus’un extremitas distalde bulunma ihtimali olan processus supracondylaris ve foramen supratrochlearis varyasyonel durumlardır. Foramen supratrochlearis; fossa coronoid ve fossa olecranon arasında görülebilir. Bazen de foramen yarı saydam olarak görüldüğü için osteolitik bir lezyon olarak tanımlanır ve yanlış teşhise neden olabilir. Bu çalışmanın amacı humerus’taki foramen supratrochlearis ve processus supracondylaris’in Orta Anadoludaki Türk populasyonuna ait prevelansını ve morfolojisini tanımlamaktır. Materyal ve metod: Çalışmamız KTO Karatay, Yozgat Bozok, Kayseri Erciyes Üniveristesi Tıp Fakülteleri ve Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Anatomi Laboratuvar’ında bulunan kemik koleksiyonlarındaki yaşı ve cinsiyetti belli olmayan 460 humerus (237 sol, 223 sağ) üzerinde gerçekleştirilmiştir. Humerus kemiğindeki bu oluşumların morfometrik ölçümleri digital kumpas ve osteometrik tahta ile gerçekleştirildi. Ayrıca çalışmamızda foramen supratrohlearis’in tiplendirmesi yanı sıra hem foramen hem de processus humerus’da görülme yüzdesi belirlendi. Bulgular: Çalışmamızda processus supracondylaris 11 bireyde %2,4 oranında (sağ 4, sol 7 ) görülürken 446 humerus’da (%97,6) görülmedi. 460 humerus’un 63 tanesinde (%13,7) de foramen supratrochlearis görüldü. Humerus’un %10,8’inde sağ tarafta %16,5 (29), sol humerus’ların ise %16,5’inde foramen supratrochlearis görüldü. Humerus’da hem processus hemde foramen görülme sıklığı % 0,7 (3) olarak belirlenmiştir. Sağ processus supracondylaris uzunluğu ortalama 9,47±1,94 mm, sol tarafta ise ortalama 16,24±14,06 mm olarak belirlenmiştir. Sağ foramen supratrochlearis vertikal çapı ortalama 3,45±1,07 mm, sol taraf çapı ise 3,57±1,17 mm; sağ foramen supratrochlearis tranvers çapı ortalama 4,73±2,81 mm sol taraf çapı ise 4,41± 2,49 mm olarak tespit edildi. Sonuç: Elde edilen verilerin ortopedik cerrahlar için intramedüller çivileme yaparken ve radyolog için o bölgedeki bazı osteolitik lezyonların ayırıcı tanısından yardımcı olacağı kanısındayız ve farklı ırkların önemli bir göstergesi olduğu düşünülebilir.

Anahtar Kelimeler

• Humerus
• supracondylar processus
• supratrochlear foramen
• morphometry
• variation
• Humerus, supracondylar processus, supratrochlear foramen, morphometry, variation

Kaynakça

1. 1. Standring S, Ellis H, Healy JC, Johnson D, Williams A. Implantation, placentation, pregnancy and parturition. Gray’s anatomy. Philadelphia: Churchill Livingstone. 2008;1250-1355.
2. 2. Paraskevas GK, Natsis K, Anastasopoulos N, Ioannidis O, Kitsoulis P. Humeral septal aperture associated with supracondylar process: a case report and review of the literature. Humeral Septal Aperture Associated with Supracondylar Process: a Case Report and Review of the Literature. 2012;135-141.
3. 3. Shivaleela C, Suresh B. S, Kumar GV, Lakshmiprabha S. Morphological study of the supracondylar process of the humerus and its clinical implications. Journal of clinical and diagnostic research: JCDR. 2014;8(1):1.
4. 4. Bain G, Gupta P, Phadnis J, Singhi PK. Endoscopic excision of supracondylar humeral spur for decompression of the median nerve and brachial artery. Arthroscopy techniques. 2016;5(1):67-70.
5. 5. Tzaveas AP, Dimitriadis AG, Antoniou KI, Pazis IG, Paraskevas GK, Vrettakos AN. Supracondylar process of the humerus: a rare case with compression of the ulnar nerve. Journal of plastic surgery and hand surgery. 2010;44(6):325-326.
6. 6. Das S. Supratrochlear foramen of the humerus. Anatomical science international. 2008;2(83):120-120.
7. 7. Roaf R. Foramen in the humerus caused by the median nerve. The Journal of bone and joint surgery. British volume. 1957;39(4):748-749.
8. 8. De Wilde V, De Maeseneer M, Lenchik L, Van Roy P, Beeckman P, Osteaux M. Normal osseous variants presenting as cystic or lucent areas on radiography and CT imaging: a pictorial overview. European journal of radiology. 2004;51(1):77-84.

9. 9. Hirsh IS. The supratrochlear foramen: clinical and anthropological considerations. The American Journal of Surgery. 1927;2(5):500-505.
10. 10. Emery KH, Zingula SN, Anton CG, Salisbury SR, Tamai J. Pediatric elbow fractures: a new angle on an old topic. Pediatric radiology. 2016;46(1):61-66.
11. 11. Peeters FLM. Radiological manifestations of the Cornelia de Lange syndrome. Pediatric radiology.1975;3(1):41-46.
12. 12. Akpinar F, Aydinlioglu A, Tosun N, Dogan A, Tuncay I, Ünal Ö. A morphometric study on the humerus for intramedullary fixation. The Tohoku journal of experimental medicine. 2003;199(1):35-42.
13. 13. Kumar RJ, Anaberu P, Shringeri AS, Rakshith A, Hullatti P. Supracondylar Process, an Institutional Experience of a Rare Case Series. Orthop Muscular Syst. 2020;9(278):2161-0533.
14. 14. Thompson JK, Edwards JD. Supracondylar process of the humerus causing brachial artery compression and digital embolization in a fast-pitch softball player: A case report. Vascular and endovascular surgery. 2005;39(5):445-448.
15. 15. Bilge T, Yalaman O, Bilge S, Çokneşeli B, Barut Ş. Entrapment Neuropathy of the Meidan Nerve at the Level of the Ligament of Struthers. Neurosurgery. 1990;27(5):787-789.
16. 16. Aydinlioglu A, Cirak B, Akpinar F, Tosun N, Dogan A. Bilateral median nerve compression at the level of Struthers' ligament: Case report. Journal of neurosurgery. 2000;92(4):693-696.
17. 17. Martin-Schütz GO, Arcoverde M, Barros GDR, Babinski MA, Manaia JHM, Silva CRCM., Pires LAS. A meta-analysis of the supracondylar process of the humerus with clinical and surgical applications to orthopedics. Int J Morphol. 2019;37:43-48.
18. 18. Soni S, Verma M, Ghulyani T, Saxena A. Supratrochlear foramen: An incidental finding in the foothills of Himalayas. OA Case Reports. 2013;2(8):75.
19. 19. Hima BA, Narasinga RB. Supratrochlear foramen-a phylogenıc remnant. International Journal of Basic and applied medical sciences. 2013;3(2):130-32.
20. 20. Krishnamurthy A, Yelicharla AR, Takkalapalli A, Munishamappa V, Bovinndala B, Chandramohan M. Supratrochlear foramen of humerus–a morphometric study. Int J Biol Med Res. 2011;2(3):829-31.
21. 21. Kaur J. Zorasingh. Supratrochlear foramen of humerus-A morphometric study. Indian J. Basic Appl. Med. Res. 2013;2(7):651-4.
22. 22. Ozturk A. The supratrochlear foramen in the humerus (Anatomical Study) st Tıp Fak. Mecmuas.2000;63:72-76.
23. 23. Joshi MM, Kishve PS, Wabale, RNA. morphometric study of supratrochlear foramen of the humerus in western indian dry bone sample. Int J Anat Res. 2016;4(3):2609-13.
24. 24. Naqshi BF, Shah AB, Gupta S, Raina S, Khan HA, Gupta N, et al. Supratrochlear foramen: an anatomic and clinico-radiological assessment. Int J Health Sci Res.2015;5(1):146-150.
25. 25. Kumarasamy SA., Subramanian M, Gnanasundaram V, Subramanian A, Ramalingam R. Study of Intercondyloid Foramen of Humerus. Estudio del foramen intercondíleo del húmero. Revista Argentina de Anatomía Clínica. 2011;3(1):32-36.
26. 26. Arunkumar KR, Manoranjitham R, Raviraj K, Dhanalakshmi V. Morphological study of supratrochlear foramen of humerus and its clinical implications. 2015.
27. 27. Nayak SR, Das S, Krishnamurthy A, Prabhu LV, Potu BK. Supratrochlear foramen of the humerus: An anatomico-radiological study with clinical implications. Upsala journal of medical sciences. 2009;114(2):90-94.
28. 28. Bahşi İ. An anatomic study of the supratrochlear foramen of the humerus and review of the literature. Eur J Ther. 2019;25(4):295-303.
29. 29. Kumar U, Sukumar CD, Sirisha V, Rajesh V, Kalpana T. Morphologic and morphometric study of supra trochlear foramen of dried human humeri of telangana region. International Journal of Current Research and Review. 2015;7(9):95.
30. 30. Erdogmus S, Guler M, Eroglu S, Duran N. The importance of the supratrochlear foramen of the humerus in humans: an anatomical study. Medical science monitor: international medical journal of experimental and clinical research. 2014;20:2643.
31. 31. Veerappan V, Ananthi S, Kannan NG, Prabhu K. Anatomical and radiological study of supratrochlear foramen of humerus. World J Pharm Pharm Sci. 2013;2(1):313-20.
32. 32. Singhal S, Rao V. Supratrochlear foramen of the humerus. Anatomical science international. 2007;82(2):105-107.
33. 33. Oluyemi KA, Okwuonu UC, Adesanya OA, Akinola OB, Ofusori DA, Ukwenya VO, et al. Supracondylar and infratubercular processes observed in the humeri of Nigerians. African Journal of Biotechnology. 2007;6(21).
34. 34. Kumar GR, Mehta CD. A study of the incidence of supracondylar process of the humerus. Journal of the Anatomical Society of India. 2008;57(2):111-115.
35. 35. Prabahita B, Pradipta RC, Talukdar KL. A study of supracondylar process of humerus. Journal of Evolution of Medical and Dental Sciences. 2012;1(5):822.
36. 36. Vandana R, Patil S. Study of supracondylar process of humerus. International Journal of Health & Allied Sciences. 2014;3(2):134-134.
37. 37. Nikumbh R, Nikumbh DB, Doshi MA, Ugadhe MN. Morphometric study of the supracondylar process of the humerus with its clinical utility. Int J Anat Res. 2016;4(1):1941-1944.
38. 38. Mathew AJ, Gopidas GS, Sukumaran TT. A study of the supratrochlear foramen of the humerus: anatomical and clinical perspective. Journal of clinical and diagnostic research: JCDR. 2016;10(2):AC05.
39. 39. Bhanu PS, Sankar KD. Anatomical note of supratrochlear foramen of humerus in south costal population of Andhra Pradesh. Narayana Medical Journal, 2012;1(2):28-34.
40. 40. Diwan RK, Rani A, Rani A, Chopra J, Srivastava AK., Sharma PK, etal. Incidence of supratrochlear foramen of humerus in North Indian population. Biomedical research. 2013;24(1):142-45.