Morphological and Morphometric Examination of the Proximal and Distal Ends of the Radius

Abstract

Aim: The radius, located on the lateral forearm, plays a key role in pronation and supination. Its proximal and distal ends contribute to the stability and motion of the elbow and wrist joints, making them susceptible to trauma, with fractures common, especially in the geriatric population. Understanding the morphological and morphometric features of these ends is crucial for surgical interventions, such as screwing techniques for complex fractures. This study aims to examine the morphological and morphometric characteristics of the proximal and distal ends of the human radius and provide clinically relevant data. Material and Method: 70 radii (34 right and 36 left) from the collections of Necmettin Erbakan University and Acıbadem Mehmet Ali Aydınlar University were analyzed. Measurements were taken using digital calipers, an osteometric board, a tape measure, and the Image J program. Morphological classifications of the articular fovea and radial tuberosity were recorded. Morphometric analysis of the proximal and distal extremities was conducted, and data, analyzed using SPSS 21, were found to be normally distributed. Right-left comparisons were made using paired Student's t-tests, type differences with one-way ANOVA, and relationships with correlation tests. Results: Among all radii, 97.1% of articular foveae were elliptical, while 54.3% of radial tuberosities were single roughened (Type b). No significant differences were found in the morphology of the articular fovea or radial tuberosity between the right and left sides (p>0.05). The medial thickness of the radial head (RH-mt) and the anterior lenght of the ulnar notch (UN-al) were significantly larger on the right side (p<0.05). Larger circumferences, diameters, and inclination angles were observed in double roughened (Type c) radial tuberosities (p<0.05). This was observed for the medial and lateral sides, as well as for the neck and head regions. Conclusion: The data obtained from our study might be useful as a reference in post-traumatic reconstruction, prosthesis design and orthopaedic surgical procedures in adults.

Keywords

• Radius
• radial tuberosity
• the articular fovea of the radius
• inclination angle

Kaynakça

1. Bair MM, Zafar Gondal A. Anatomy, shoulder and upper limb, forearm radius. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
2. Törnvall AH, Ekenstam Fa, Hagert C-G, Irstam L. Radiologic examination and measurement of the wrist and distal radio-ulnar joint. Acta Radiol Diagn (Stockh). 1986;27:581-8.
3. Gogoi P, Dutta A, Daolagupu AK, et al. A rare case of fracture of radius associated with dislocation of both distal and proximal radio-ulnar joint. Case Reports in Clinical Medicine. 2014;3:367-72.
4. Uslu M, Arıcan M, Işık C, et al. The outcome of conservative treatment of adult distal radius fractures compared with the other wrist: radiological and functional evaluation. J Clin Exp Invest. 2014;5:403-9.
5. Cooper A, Wood TR, Scholten DJ, Carroll EA. Nonsurgical management of distal radius fractures in the elderly: approaches, risks and limitations. Orthop Res Rev. 2022;14:287-92.
6. Jones CW, Lawson RD. One size does not fit all: distal radioulnar joint dysfunction after volar locking plate fixation. J Wrist Surg. 2014;3:42-5.
7. Duckworth AD, Clement ND, Jenkins PJ, et al. The epidemiology of radial head and neck fractures. J Hand Surg Am. 2012;37:112-9.
8. Biewener A, Bischoff F, Rischke T, et al. Instability of the proximal radioulnar joint in Monteggia fractures—an experimental study. J Orthop Surg Res. 2019;14:392.

9. Captier G, Canovas F, Mercier N, et al. Biometry of the radial head: biomechanical implications in pronation and supination. Surg Radiol Anat. 2002;24:295-301.
10. Mazzocca AD, Burton KJ, Romeo AA, et al. Biomechanical evaluation of 4 techniques of distal biceps brachii tendon repair. Am J Sports Med. 2007;35:252-8.
11. Hopkins KD, Weeks DL. Tests for normality and measures of skewness and kurtosis: their place in research reporting. Educational and Psychological Measurement. 1990;50:717-29.
12. Samokhina AO, Shemyakov SE, Semchuk IP, et al. Automated determination of morphometric parameters of the human radius based on the results of its computed tomography. Bulletin of Experimental Biology and Medicine. 2024;176:820-3.
13. Eerten P, Lindeboom R, Oosterkamp AE, Goslings J. An X-ray template assessment for distal radial fractures. Arch Orthop Trauma Surg. 2008;128:217-21.
14. Rayna A, Maria Francis Y, Baskaran S, et al. Morphometric study of proximal and distal end of radius and its clinical significance. Journal of Clinical and Diagnostic Research. 2018;12:AC09-12.
15. Avnioğlu S, Yılmaz S, Ünalmış Aykar D. Morphometic examination of radius. Journal of US-China Medical Science. 2020;17:172-6.
16. Kadel M, Thapa TP. Study of the head of human dry radii in a medical college of nepal: a descriptive cross-sectional study. JNMA J Nepal Med Assoc. 2020;58:141-3.
17. Puchwein P, Heidari N, Dorr K, et al. Computer-aided analysis of radial head morphometry. Orthopedics. 2013;36:e51-7.
18. Singh A, Singh A. A Morphometric study of head of radius and its clinical implication in radial head prosthesis. 2019;8:AO20-3.
19. King GJ, Zarzour ZD, Patterson SD, Johnson JA. An anthropometric study of the radial head: implications in the design of a prosthesis. J Arthroplasty. 2001;16:112-6.
20. Gupta C, Kalthur SG, Malsawmzuali JC, D'Souza AS. A morphological and morphometric study of proximal and distal ends of dry radii with its clinical implications. Biomed J. 2015;38:323-8.
21. Ajit Singh V, Chan CYW, Wh L, Kanthan RS. Distal radius morphometry in the malaysian population. Malaysian Orthopaedic Journal. 2008;22:27-30.
22. Mazzocca AD, Cohen M, Berkson E, et al. The anatomy of the bicipital tuberosity and distal biceps tendon. J Shoulder Elbow Surg. 2007;16:122-7.
23. Sun W, Jiang X, Zha Y, et al. Relationship between measurements of ipsilateral capitellum and prosthetic radial head size. J Orthop Surg Res. 2022;17:496.
24. Miró JI, Bensi AG, Rodríguez GLG, Clembosky G. Minimally invasive fixation with dorsal suspension button and volar plate in distal radius fractures with dorsal die punch fragments: a preliminary study. J Wrist Surg. 2022;12:161-9.
25. Luenam S, Vongvanichvathana A, Kosiyatrakul A, et al. Matching precision of the reverse contralateral radial head in generating of the individualized prosthesis from the surface registration in tuberosity-neck and in tuberosity-diaphysis. J Orthop Surg (Hong Kong). 2019;27:2309499018821774.
26. Akshaya AA. Morphometric analysis of radial head and its clinical implications. Biosc Biotech Res Comm. 2020;13:283-7.
27. Ethiraj S, C JK, Shetty S. A study of morphology and morphometry of proximal end of dry radius bones with its clinical implications. International Journal of Anatomy and Research. 2019;7:6712-6.
28. Berkmortel C, Gladwell M, Ng J, et al. Effect of radial neck length on joint loading. Journal of Shoulder and Elbow Arthroplasty. 2019;3:1-7.
29. Hilgersom NFJ, Nagel M, Janssen SJ, et al. Greater radial tuberosity size is associated with distal biceps tendon rupture: a quantitative 3-D CT case-control study. Knee Surg Sports Traumatol Arthrosc. 2021;29:4075-81.
30. Prithishkumar I, Francis D, Nithyanand M, et al. Morphometry of the distal radius – an osteometric study in the Indian population. Indian Journal of Basic & Applied Medical Research. 2012;1:166-71.
31. Garapati S, Santhi C, Pentyala S. The syloid process: morphometry and its clinical implications in Costal region of Andrapradesh, India. Int J Anat Res. 2017;5:3796-9.
32. af Ekenstam F. Anatomy of the distal radioulnar joint. Clin Orthop Relat Res. 1992;14-8.
33. Kitamura T, Moritomo H, Arimitsu S, et al. The biomechanical effect of the distal interosseous membrane on distal radioulnar joint stability: a preliminary anatomic study. J Hand Surg Am. 2011;36:1626-30.
34. Nalbant A. Radiological evaluation of forearm bones in Anatolian population. EJMI. 2023;7:384-93.
35. Kamal AH, Zakaria OM, Majzoub RA, et al. Distal radius extra-articular fractures: the impact of anatomical alignment on patient's perceived outcome (a single center experience). Cureus. 2023;15:e36541.
36. Bronstein A, Heaton D, Tencer AF, Trumble TE. Distal radius malunion and forearm rotation: a cadaveric study. J Wrist Surg. 2014;3:7-11.
37. Finsen V, Rod O, Rød K, et al. The relationship between displacement and clinical outcome after distal radius (colles’) fracture. J Hand Surg Eur Vol. 2012;38:116-26.
38. Nakamura T, Iwamoto T, Matsumura N, et al. Radiographic and arthroscopic assessment of DRUJ instability due to foveal avulsion of the radioulnar ligament in distal radius fractures. J Wrist Surg. 2014;03:12-7.
39. Agarwala V, Vetri D. Morphometric study of distal end of the radius in the southern Assam population. IJOS. 2019;5:187-90.
40. Bilgin Y, Ekinci M, Ozmen Z, Birisik F. Radiological measurement parameters of distal radius and wrist measured on X-rays in the Turkish population. North Clin Istanb. 2023;10:484-9.