OBJECTIVE: To obtain three-dimensional intraosseous artery of the hamate and to provide the vascular anatomy basis of hamate fracture fixation. METHODS: PbO (lead monoxide, Sinopharm Chemical Reagent Beijing Co. Ltd) was ground into particles less than 40 μm and suspended in turpentine oil (Chemical Reagent Beijing Co. Ltd) at ratios of 1 g : 1.5 mL, 1 g : 1 mL and 1 g : 0.5 mL. Three specimens were investigated. Brachial arteries were cannulated and perfused with lead-based contrast agent. Hamates were harvested and scanned using micro-computed tomography (microCT). The acquisition protocols were as follows: CT scan setup: total rotation [Degrees], 360; rotation steps, 360; X-ray detector setup: transaxial, 2048; axial, 2048; exposure time, 1 500 ms, Binning, 1; system magnification: high-med. X-ray tube setup: 80 kV, 500 mA current. The down-sampling factor used in the reconstruction was 2. The effective voxel size of the final image was 27.30 μm. The three-dimensional model of the hamate was generated and the distribution and pattern of vessels were evaluated. RESULTS: There were abundant extraosseous vessels around the hamate. They were mainly running in the tendons and ligaments around the hamate. Four vascular zones were identified on the hamate surface. They were on the palmar platform of the hamate body, on the dorsal side, on the ulnar side and on the tip of hamulus, namely. There were anastomoses among 4 vascular zones. We did not observe any vessels penetrating through the articular cartilage. The extraosseous vessels of the vascular zones gave a number of intraosseous branches into the hamate. The hamate body received intraosseous blood supply from the dorsal, palmar and ulnar while the hamulus from the palmar, ulnar and hamulus tip. There were some intraosseous branches anastomosing with each other. CONCLUSION The extraosseous and intraosseous vessels of the hamate were more than what used to be considered. The hamate body and hamulus received blood supply from multiple directions and arteries anastomosed extensively both outside and inside the hamate, making it possible that the intraosseous perfusion survived after fracture. It is likely that the nonunion after the hamate fracture is not caused by the vascular damage but the malalignment of the fragments.
Beijing ; Brachial Artery ; Fluoroscopy ; Fractures, Bone/diagnostic imaging* ; Hamate Bone/injuries* ; Humans ; Ulna ; Wrist Injuries/diagnostic imaging* ; X-Ray Microtomography

OBJECTIVESTo establish a clinical method for measuring the displacement of the distal radioulnar joint (DRUJ) precisely irrespective of ulnar variance, and to derive normal population translation references with palmar and dorsal stress.

METHODSThirty-seven normal distal forearms were scanned with computed tomography using an apparatus designed by Pirela-Cruz. Each extremity was scanned in two positions: maximal ulnar palmar and dorsal stress. The digital imaging and communications in medicine (DICOM) CT images were then imported into Mimics 10.0 for three-dimensional reconstruction. On the DRUJs 3D images, choose the most prominent point of the palmar and dorsal margins of the sigmoid notch and the excavate ulna fovea as the reference points A, B and C. A perpendicular line was then drawn from the point C to a line connecting points A and B with the intersection D. Calculate the ratio of AD/AB and DB/AB. Two observers measured all the DRUJs independently and one repeated the measurements one month later to determine the interobserver and intraobserver reliability.

RESULTSThe mean ratio values of palmar (AD/AB) and dorsal (DB/AB) translation were 0.39 ± 0.07 and 0.37 ± 0.07, and the normal references (x(-) ± 2 s) were from 0.25 to 0.50 and from 0.23 to 0.50, respectively. No significant differences were observed in terms of positions, genders and dominant hands. The intraclass correlation coefficient (ICC) values for interobserver and intraobserver reliability (DB/AB, AD/AB) were 0.84, 0.80, 0.93 and 0.92, respectively.

CONCLUSIONSThis new method could accurately measure the displacement of DRUJs with acceptable reliability, even with ulna positive or negative variance. Instability of DRUJ may be indicated when AD/AB is less than 0.25 or BD/AB is less than 0.23.

Adult ; Aged ; Female ; Humans ; Imaging, Three-Dimensional ; Joint Dislocations ; diagnostic imaging ; Joint Instability ; diagnostic imaging ; Male ; Middle Aged ; Radius ; diagnostic imaging ; Tomography, X-Ray Computed ; Ulna ; diagnostic imaging ; Wrist Joint ; diagnostic imaging ; Young Adult

OBJECTIVETo investigate three-dimensional kinematics of the superficial and deep portion of triangular fibrocartilage complex (TFCC) in different parts of the forearm rotation.

METHODSSix wrists of 6 volunteers were used to obtain CT scans at different positions of the wrist. The wrists were scanned from 90 degrees of pronation to 90 degrees of supination at an interval of 30 degrees. The 3-dimensional radius and ulna were reconstructed with customized software and changes in length of the superficial and deep portion of TFCC during forearm rotation.

RESULTSIn forearm pronation, the superficial dorsal portion and the deep palmar portion of the TFCC were tight. While the superficial palmar portion and the deep dorsal potion of the TFCC were lax. In supination, the changes in length of all these fibers were reverse.

CONCLUSIONSIn forearm rotation one portion fibers of dorsal TFCC and one portion fibers of palmar TFCC are tight, and this mechanism controls stability during DRUJ rotation.

Adult ; Biomechanical Phenomena ; Female ; Forearm ; physiology ; Humans ; Imaging, Three-Dimensional ; Male ; Pronation ; Radiography ; Radius ; diagnostic imaging ; Supination ; Triangular Fibrocartilage ; diagnostic imaging ; Ulna ; diagnostic imaging ; Wrist Joint ; diagnostic imaging ; Young Adult

Adolescent ; Child ; Child, Preschool ; Combined Modality Therapy ; External Fixators ; Female ; Humans ; Male ; Manipulation, Orthopedic ; methods ; Radiography ; Radius Fractures ; diagnostic imaging ; therapy ; Splints ; Ulna Fractures ; diagnostic imaging ; therapy

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.
Adult ; Aged ; Anthropometry ; Asian People ; Body Height ; Female ; Forensic Anthropology/methods* ; Humans ; Humerus/diagnostic imaging* ; Male ; Middle Aged ; Radiography ; Radius/diagnostic imaging* ; Regression Analysis ; Sex Characteristics ; Ulna/diagnostic imaging* ; Young Adult

OBJECTIVETo evaluate the clinical results of ulnar osteotomy and internal fixation in treating old anterior dislocation of radial head in children.

METHODSFrom Jan.2004 to Jan.2010, 18 patients with old anterior dislocation of radial head were treated with open reduction for radial head and ulnar osteotomy and internal fixation, including 12 males and 6 females with an average age of (6.9 +/- 1.3) years (3 to 15 years). Among them, 15 cases had history of external injury, from injury to operation was for 5-65 months with an average of (24.0 +/- 5.5) months. Limitation of activity occurred in all patients including flexion and extension of elbow joint and rotation of forearm, without radial nerve injury and obviously radial head deformation.

RESULTSAll incisions obtained primary healing and no nonunion, re-dislocation of radial head and nerve injury were found. All patients were followed up from 9 to 38 months with an average of (17.0 +/- 4.5) months. Union time of fracture was from 2.3 to 3.9 months with an average of (2.8 +/- 0.5) months. Postoperative activity in flexion and extension of elbow joint and rotation of forearm improved significantly compared with preoperative. The clinical effects were evaluated according to Zhuyukui criteria, 14 patients got excellent results, 3 good, 1 fair.

CONCLUSIONUlnar osteotomy and internal fixation in treating old anterior dislocation of radial head in children can obtain satisfactory results and effectively improve the activities in flexion and extension of elbow joint and rotation of forearm and prevent re-dislocation of radial head.

Adolescent ; Bone Plates ; Child ; Child, Preschool ; Female ; Humans ; Humerus ; diagnostic imaging ; surgery ; Joint Dislocations ; surgery ; Male ; Osteotomy ; methods ; Tomography, X-Ray Computed ; Ulna ; surgery

INTRODUCTIONThe purpose of this study was to examine the differing curves of the volar distal radius of healthy Malaysian Malays, so as to obtain detailed morphological information that will further the understanding of volar plate osteosynthesis in Malaysian Malays.

METHODSComputed tomography with three-dimensional reconstruction was performed on the wrists of 16 healthy Malaysian Malay volunteers. Profile measurements were made using a software program. A novel parameter, the pronator quadratus curve angle, was explored and introduced in this study. Interclass correlation coefficients were calculated to assess the level of agreement between the data collected by the principal investigator and that collected by an independent radiologist.

RESULTSThe mean ± standard deviation of the arc radii on the radial aspect was 17.50° ± 5.40°, while the median (interquartile range [IQR]) of the arc radii on the ulnar aspect was 25.27° (IQR 5.80°). The mean ± standard deviation of the curvature of the pronator quadratus line was 40.52° ± 2.48°. The arc radii on the radial aspect was significantly lower than the arc radii on the ulnar aspect (p = 0.001). Different radial and ulnar arcs were observed in 56.25% of the radii; the arc was deeper on the ulnar aspect in 93.75% of the radii.

CONCLUSIONBased on the findings of this study, the likelihood of achieving anatomical reduction with uniformly curved, fixed-angle volar plates is questionable. Changes in the design of these implants may be needed to optimise their usage in the Malaysian Malay population.

Adult ; Bone Plates ; Cross-Sectional Studies ; Female ; Fracture Fixation, Internal ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Malaysia ; Male ; Radius ; anatomy & histology ; diagnostic imaging ; Radius Fractures ; diagnostic imaging ; Reproducibility of Results ; Software ; Tomography, X-Ray Computed ; Ulna ; anatomy & histology ; diagnostic imaging ; Young Adult

Ulnar nerve injury in closed fracture of forearm in children is uncommon.Commonly, neurapraxia is the reason for this palsy but other severe injuries or nerve entrapment has been reported in some cases. The importance of diagnosis concerning the types of the nerve injury lies in the fact that they have totally different management.We present a case of ulnar nerve deficit in a child following a closed fracture of the forearm bones. It is imperative to diagnose exact cause of palsy as it forms the basis for treatment. MRI scan can help diagnosis and accordingly guide the management. Simple nerve contusion should be treated conservatively, and exploration with fixation of the fracture should be done in lacerations and entrapments of the nerve. Surgery is not the treatment of choice in cases that could be managed conservatively.
Accidental Falls ; Child ; Diagnostic Errors ; Fractures, Closed ; complications ; diagnosis ; therapy ; Humans ; Magnetic Resonance Imaging ; Radius Fractures ; complications ; diagnosis ; therapy ; Ulna Fractures ; complications ; diagnosis ; therapy ; Ulnar Nerve ; injuries ; Ulnar Neuropathies ; diagnosis ; etiology