Morphometric feature description of the proximal ulna based on quantitative measurement: a key consideration for implant design.

PURPOSE: To perform quantitative measurements of the anatomic morphology of the proximal ulna and establish the morphologic references based on Chinese for the surgical protocol and implant design. METHODS: The computed tomography data of 156 upper extremities were involved in this study. The ulna model was reconstructed in Mimics. Ten distance and 6 angle parameters were measured by 4 independent investigators with a new quantitative measurement method. The intraclass correlation coefficient was used to evaluate the measuring reliability. Gender and side differences of measured parameters were evaluated. RESULTS: Measurements showed a mean coronoid height of 15 mm, which was 42% of ulnar height with gender-specific differences (mean 16 mm in men and 14 mm in women, P < 0.001). A mean unsupported anteromedial facet width of 8 mm was 61% of the coronoid anteromedial facet. A larger opening angle correlates to a larger olecranon-diaphysis angle (P < 0.001) and larger coronoid height (P = 0.001). A mean proximal ulna dorsal angulation of 4.7° is present in 80% of models at an average of 52 mm distal to olecranon tip. The average proximal ulna varus angulation was 16° at a mean of 74 mm distal to the olecranon tip. Morphological features between the left and right sides were highly consistent. The ICC was between 0.789 and 0.978 for inter-observer and between 0.696 and 0.997 for intra-observer reliability. CONCLUSIONS: The proximal ulna features variable morphology but minor side differences among individuals. Over half of the anteromedial facet was not supported by the proximal ulnar diaphysis, making the coronoid vulnerable to elbow trauma. Preconditioning or customized design of the ulnar plate in the clinical setting with the help of contralateral morphology may be a good choice.

Sex estimation using ulna in a Thai population / Estimación del sexo utilizando la ulna en una población tailandesa

SUMMARY: Sex estimation from fragmentary bone remain is still challenge for forensic pathologist. Ulna has been reported useful for sex estimation by metric analysis. This study generated sex estimation function for fragment and complete of ulnar bone in a Thai population. The function was generated from 200 pairs of ulnar bone, and others 20 pair of ulnar bone were used for test the accuracy of the functions. Olecranon width was the best single variable for sex predicting of proximal part of ulna, which right olecranon width could be classified the sex 90.5 %. While distal end width of ulna was the variable for predicting the sex of distal part, which left distal end width could be classified the sex with 83.0 %. Stepwise discriminant function analysis was applied to proximal part. For proximal part of right ulna 4 measurements were selected (inferior-medial trochlear notch length, olecranon width, olecranon-coronoid process length, and maximum proximal ulnar width), while the left side, superior trochlear notch width, olecranon width, and maximum proximal ulnar width were chosen, and their functions could be predicted the sex with 91.0 % and 90.0 %, respectively. Our results indicated the ulnar bone had high ability for estimating the sex in a Thai population.

RESUMEN: La estimación del sexo a partir de restos óseos fragmentarios sigue siendo un desafío para el patólogo forense. Se ha informado de la utilidad de la ulna para la estimación del sexo mediante análisis métrico. En este estudio se analizó la estimación del sexo para un fragmento y de la ulna completa en una población tailandesa. La función se generó a partir de 200 pares de ulnas y se utilizaron otras 20 pares de ulnas estimando la precisión de las funciones. El ancho del olécranon fue la mejor variable individual para predecir el sexo en la parte proximal de la ulna (90, 5 %). Si bien el ancho del extremo distal de la ulna fue la variable para predecir el sexo, el ancho del extremo distal izquierdo podría clasificarse por sexo con un 83,0 % de certeza. Se aplicó un análisis de función discriminante escalonada a la parte proximal. Para la parte proximal de la ulna derecha se seleccionaron 4 medidas (longitud de la incisura troclear inferior-medial, ancho del olécranon, longitud del proceso olecraneano-proceso coronoides y ancho ulnar proximal máximo), mientras que en el lado izquierdo, fue determinado el ancho de la incisura superior troclear, ancho del olécranon y ancho ulnar proximal máximo. Se eligió el ancho, y se pudo predecir el sexo en el 91,0 % y 90,0 % de los casos, respectivamente. Nuestros resultados indicaron que la ulna tenía una alta capacidad para estimar el sexo en una población tailandesa.

Estimation of sex based on postcranial elements in European American and Latin American populations.

This study assesses the use of postcranial elements for sex estimation taking population variability into account. European American and Latin American populations are independently analyzed. Nine measurements from postcranial elements were collected from 72 European American individuals, and 59 Latin American individuals. Statistical analyses were performed using the Statistical Package for Social Science (SPSS) version 15. Statistical analyses were conducted to corroborate that there were no intra- or interobserver errors. In both populations, significant differences were found on all measured traits between males and females, except Scapular Breadth in Latin Americans. According to Discriminant Function Analysis (DFA) in the European American population the Ulna Minimum Breadth of the Olecranon (UMBO) correctly classified 91.3% of individuals. When this parameter was combined with the Diameter of Humeral Head (HHD), the two correctly classified 98% of individuals. In Latin Americans, the UMBO correctly classified 82.4% of the individuals. When combined with HHD, the measurements correctly classified 79.4% individuals. UMBO is the most useful trait to correctly assign the sex of the remains in both populations. Including the HHD improved accuracy rates in the European American sample. These results are in agreement with previous studies, which named the humerus as one of the potentially useful bones to consider for sex estimation based on its accuracy. Thus, these two anatomical regions could be used alone or in combination with other methodologies for sex estimation, which is particularly important in situations of fragmentary remains and incomplete skeletons.

Validity of computed tomographic measurements and morphological comparison of cubital tunnel in idiopathic cubital tunnel syndrome.

BACKGROUND: Ulnar neuropathy is a common reason for referral to hand surgeons, and 10 to 30% of cubital tunnel syndrome (CuTS) is idiopathic. We hypothesized that the cause of idiopathic CuTS is in the bony structure. METHODS: We analyzed 79 elbows (39 idiopathic CuTS and 40 without CuTS symptom) using computed tomography and Materialize Mimics software to compare the differences between the two groups. We proposed a new bony cubital tunnel with a new boundary that could play a role in ulnar nerve compression symptom. RESULTS: The mean cubital tunnel volume was 1245.6 mm3 in all patients, 1180.6 mm3 in CuTS patients, and 1282.3 mm3 in the control group. A significant difference (p = 0.015) between two groups was found. Bony cubital tunnel cross-sectional area, cubital tunnel depth, and cubital tunnel angle also showed significant differences. CONCLUSION: The shape of the bony cubital tunnel is an important cause of CuTS, and the normal variation of the volume and cross-sectional area of the cubital tunnel and cubital tunnel angle could influence the occurrence of idiopathic CuTS.

The olecranon aperture of the humerus: a meta-analysis with anthropological and clinical discussion.

The olecranon aperture is an anatomical variant of the humerus that communicates the olecranon fossa with the coronoid fossa. It is also known as the supratrochlear foramen. Older anatomical textbooks refer to it as a rare variation caused by the perforation of the thin bony plate which separates both fossae. This anatomical variant may be confused as an osteolytic lesion of the humerus in radiographic images. The present work aims to perform a meta-analysis of the olecranon aperture. Heterogeneity between studies was evaluated using I2 estimation and the Cochran Q statistic test. A random effect model was used for all analyses. A total of sixty-one studies (20,338 humeri) were included in this meta-analysis. The pooled prevalence of the olecranon aperture was 21.9% (95% confidence interval: 18.6% to 25.3%). This variant was more commonly found in female than in male bones (statistically significant difference). The olecranon aperture is a common anatomical variant among the general population, although individuals from Africa possess a higher predisposition to develop it. The name supratrochlear foramen is incorrect, as foramina are conduit to vessels or nerves, as such, we propose the term olecranon aperture.

The shape match of the olecranon tip for reconstruction of the coronoid process: influence of side and osteotomy angle.

BACKGROUND: The integrity of the coronoid process is critical to maintaining elbow stability. Unreconstructible fractures and chronic coronoid deficiency are challenging clinical problems with no clear solution. The purposes of this study were to investigate the shape match of the ipsilateral and contralateral olecranon tips as graft options and to determine the influence of the osteotomy angle on fitment. METHODS: Nineteen paired cadaveric elbow joints were investigated by 3-dimensional digital analysis of computed tomography DICOM (Digital Imaging and Communications in Medicine) data. After construction of an ulnar coordinate system, the ipsilateral and contralateral olecranon tips were digitally harvested at 10°, 20°, 30°, 40°, 50°, and 60° osteotomy angles. In an overlay analysis, we compared the shape match of the ipsilateral and contralateral grafts and the different angles. RESULTS: The ipsilateral grafts showed an average mismatch of 1.8 mm (standard deviation, 1.38 mm), whereas the contralateral grafts had a significantly lower (P < .001) mean mismatch of 1.3 mm (standard deviation, 0.95 mm). The 50° osteotomy plane showed the best shape match in comparison with the native coronoid-in both the ipsilateral and contralateral grafts. Evaluation of the intraclass correlation coefficient was calculated at r = 0.944, showing high repeatability of the measurements. CONCLUSIONS: The contralateral olecranon tip graft showed significantly better shape matching to the native coronoid than the ipsilateral olecranon graft. Specifically, the contralateral graft more closely matched the biomechanically critical anteromedial coronoid facet. Finally, both the contralateral and ipsilateral olecranon grafts had better shape matching with the native coronoid when osteotomy was performed at higher angles, specifically 50°.

Characterization of the tissue crossing the supratrochlear aperture of the humerus using histochemical techniques.

INTRODUCTION: The supratrochlear aperture (STA) is the opening observed in the septum that separates the olecranon from the coronoid fossae. Numerous studies have shown that there is considerable variation in the occurrence of this feature within and among populations. MATERIALS AND METHODS: Cadavers (n = 43) were assessed for the presence of the STA by means of X-ray. Ten samples of STA-bearing bones and an equal number of controls without STA were obtained from cadavers using a hole saw. These samples were decalcified, fixed in formalin and processed for histological assessment in differing (ascending) grades of alcohol before being embedded in paraffin wax. Sections (10 µm thick) were stained with haematoxylin and eosin (H&E) for general architecture as well as the rapid one-step Mallory-Heidenhain stain for bone and connective tissue. RESULTS: The STA samples exhibited an abundance of connective tissue arranged in regular bundles of fibers across the STA. In contrast, the controls showed only bone tissue in the septum. DISCUSSION AND CONCLUSION: The arrangement of connective tissue fibers organized in regular bundles is a characteristic of strength, which may indicate that the STA is under sustained stress or pressure from the olecranon and coronoid processes of the ulna. It remains debatable whether the STA should continue to be considered as a foramen in life as we demonstrate that it is obliterated by connective tissue. It contains no neurovascular structures, making it unlike other structures defined as foramina.

Correlation between the length from the elbow to the distal interphalangeal joint of the little finger and the length of the intramedullary nail selected for femoral fracture fixation.

AIM: To determine whether there is a correlation between the length of forearm to the distal interphalangeal joint (DIPJ) of the little finger and length of antegrade intramedullary (IM) femoral nails in adults. STUDY DESIGN AND METHODS: Measurements from the tip of the olecranon to the DIPJ of the ipsilateral upper limb was taken in 30 patients undergoing antegrade IM femoral nails. The length of the IM nails inserted was determined by intra-operative measurements using a guide wire. The two measurements were analysed for correlation and mean difference. RESULTS: The mean forearm to DIP of little finger length was 38.86 with a standard deviation of 2.83. The mean IM length and standard deviation were 38.56 and 2.77 respectively. The difference between the two means 0.3 (95% CI). Correlation testing between the two variables shows a positive relationship (Pearson Correlation factor of 1). The scatter plot shows a positive linear relationship. CONCLUSIONS: Length of the forearm from the tip of the olecranon to the DIP joint of the little finger represents the ideal length of IM nail for the femur. It can be readily performed with the use of a tape measure and can serve as a useful adjunct to determining ideal length in cases where the contralateral femur cannot be used.

Triceps-sparing extra-articular step-cut olecranon osteotomy for distal humeral fractures: an anatomic study.

BACKGROUND: This anatomic study investigated the distal humeral articular surface exposure achievable through a triceps-sparing oblique extra-articular osteotomy of the olecranon with a step-cut modification compared with the anconeus flap transolecranon apex distal chevron osteotomy. In addition, the bone contact surface areas of the osteotomized surfaces after transolecranon and extra-articular osteotomies were compared. METHODS: Seven pairs of fresh adult cadaveric elbow joints were examined. Each of the right elbows underwent triceps-sparing extra-articular step-cut olecranon osteotomy (SCOOT) with an anconeus flap, and the left elbows underwent the anconeus flap transolecranon apex distal chevron osteotomies (CO). The articular surface exposed by each of the osteotomy techniques was then digitally analyzed using a 3-dimensional measurement system. The bone contact surface area of the osteotomized surfaces was also assessed. RESULTS: The percentage of total joint exposed by the SCOOT group was less than the CO group (SCOOT: 64% ± 3% vs. CO: 73% ± 3%; P = .002). There was significantly greater bone contact surface area of the osteotomized surfaces in the SCOOT group compared with the CO group (SCOOT: 1172 ± 251 mm2 vs. CO: 457 ± 133 mm2; P = .002). CONCLUSION: The triceps SCOOT procedure with an anconeus flap provides excellent distal humeral articular surface exposure with the added benefit of a substantially increased (2.6-times) bone contact surface area of the osteotomized surfaces.

[The bare area of the proximal ulna : An anatomical study on optimizing olecranon osteotomy]. / Die Bare Area der proximalen Ulna : Eine anatomische Studie zur Optimierung der Olekranonosteotomie.

BACKGROUND: Olecranon osteotomy is an established approach for the treatment of distal humerus fractures. It should be performed through the bare area of the proximal ulna to avoid iatrogenic cartilage lesions. OBJECTIVES: The goal of this study was to analyze the anatomy of the proximal ulna with regard to the bare area and, thereby, to optimize the hitting area of the bare area when performing olecranon osteotomy. MATERIALS AND METHODS: The bare areas of 30 embalmed forearm specimens were marked with a radiopaque wire and visualized three-dimensionally with a mobile C­arm. By means of 3D reconstructions of the data sets, the following measurements were obtained: height of the bare area; span of the bare area-hitting area in transverse osteotomy; ideal angle for olecranon osteotomy to maximize the hitting area of the bare area; distance of the posterior olecranon tip to the entry point of the transverse osteotomy and the ideal osteotomy. RESULTS: The height of the bare area was 4.92 ± 0.81 mm. The hitting area of the transverse osteotomy averaged 3.73 ± 0.89 mm. The "ideal" angle for olecranon osteotomy was 30.7° ± 4.19°. The distance of the posterior olecranon tip to the entry point was 14.08 ± 2.75 mm for the transverse osteotomy and 24.21 ± 3.15 mm for the ideal osteotomy. The hitting area of the bare area in the ideal osteotomy was enhanced significantly when compared to the transverse osteotomy (p < 0.0001). CONCLUSIONS: This study provides guide values for correct osteotomy of the olecranon. Moreover, a 30° angulation of the osteotomy can significantly increase the hitting area of the bare area.

Intermuscular aponeuroses between the flexor muscles of the forearm and their relationships with the ulnar nerve.

INTRODUCTION: The aim of this study was to clarify the morphological characteristics of the intermuscular aponeurosis between the flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS; IMAS), and that between the FCU and flexor digitorum profundus (FDP; IMAP), and their topographic relationships with the ulnar nerve. MATERIALS AND METHODS: Fifty limbs of 38 adult cadavers were studied. RESULTS: The IMAS extended along the deep surface of the FCU adjoining the FDS, having the appearance of a ladder, giving off "steps" that decreased in width from superficial to deep around the middle of the forearm. Its proximal part divided into two bands connected by a thin membrane, and was attached to the medial epicondyle and the tubercle (the most medial prominent part of the coronoid process of the ulna), respectively. The IMAP extended deep between the FCU and FDP from the antebrachial fascia, and its distal end was located on the posterior border of the FCU. The IMAP became broader toward its proximal part, and its proximal end was attached anterior and posterior to the tubercle and the olecranon, respectively. The ulnar nerve passed posterior to the medial epicondyle and then medial to the tubercle, and was crossed by the deep border of the IMAS at 58.3 ± 14.1 mm below the medial epicondyle. CONCLUSION: The deep border of the IMAS and aberrant tendinous structure passing across the ulnar nerve, or the parts of the IMAS and IMAP passing posterior to the ulnar nerve are potential causes of ulnar nerve compression.

The ulnar greater sigmoid notch "coverage angle": bone and cartilage contribution. Magnetic resonance imaging anatomic study on 78 elbows.

BACKGROUND: To study the degree of coverage provided by the greater sigmoid notch (GSN) to the humeral trochlea, as well as the contribution of the olecranon and coronoid process cartilage tips to this angle, and its variations. METHODS: We recruited 39 healthy volunteers, comprising 19 women and 20 men, with a mean age of 28 years (range, 21-32 years). High-definition magnetic resonance images were obtained for the right and left elbows. Four angles were measured on the sagittal plane passing through the coronoid and olecranon tips: angle A, identified by 2 lines from the trochlea center to the olecranon bone-cartilage junction and olecranon cartilage tip; angle B, identified by 2 lines from the trochlea center to the olecranon and coronoid bone-cartilage junction; angle C, identified by 2 lines from the trochlea center to the coronoid bone-cartilage junction and coronoid cartilage tip; and GSN coverage angle (GSN-ca), defined as the sum of angles A, B, and C. Pearson correlation tests, t tests, and intraclass correlation coefficients were used for statistical analyses. RESULTS: The mean angle A, angle B, and angle C values were 6° (range, 2°-12°), 182° (range, 153°-204°), and 9° (range, 2°-16°), respectively. No correlations were found between these 3 angles. The mean GSN-ca was 198° (range, 167°-222°), and the GSN-ca was less than 180° in 8% of the cases. No significant differences emerged for side or gender or for total length of the ulna. CONCLUSION: The GSN showed significantly different shapes on the sagittal plane that we defined as closed type when the GSN-ca was greater than 180° (92%) and as open type when the GSA-ca was less than 180° (8%). The cartilage tip contribution varied and was not correlated with that of bone.

Applied anatomical study of the modified anconeus flap approach.

PURPOSE: Conventional surgical therapy for an intercondylar humerus fracture might result in multiple potential complications. Our study was conducted to evaluate the modified anconeus flap approach by adequately exposing the distal humeral articular surface, avoiding osteotomy of the olecranon and transection of the main part of the triceps brachial tendon from the olecranon. METHODS: Preparations of 20 upper limb specimens from adult cadavers were used in this study. We investigated the anatomical features of the distal tendon of the triceps brachii. Then, we designed a modified anconeus flap approach in cadaver specimens combined with the medial paratricipital approach, and we compared the extent of exposure of the distal humeral articular surface between the triceps-reflecting anconeus pedicle approach and this modified approach. RESULTS: The downward neurovascular bundles supplying the anconeus were located far from the intramuscular tendon of the triceps brachii. In addition, the medial head of the triceps was continuous with the anconeus near the lateral epicondyle of the humerus. These anatomical properties could assist in reducing adverse events in surgery. The percentage of the exposed humerus distal articular surface was 42.7% by applying the modified anconeus flap approach combined with the medial paratricipital approach. The modified anconeus flap approach can overcome the shortcomings of osteotomy or triceps transverse and fulfill reduction and internal fixation of most distal humerus intercondylar fractures. CONCLUSIONS: The present study has demonstrated a new approach for adequately exposing the distal humeral articular surface during surgery for an intercondylar humerus fracture. With this modified approach, osteotomy of the olecranon and the separation or transection of the main part of the triceps brachial tendon from the olecranon are not necessarily required. Therefore, we suggest that this novel approach could be applied as the primary surgical approach in intercondylar humerus fracture surgeries if the surgeons are familiar with the regional features of distal tendon of the triceps brachii and anconeus.

Influence of muscle hypertrophy on the moment arm of the triceps brachii muscle.

Although the moment arm of the triceps brachii muscle has been shown to be associated with the muscle's anatomical cross-sectional area, whether training-induced muscle hypertrophy alters the moment arm of the muscle remains unexplored. Therefore, the current study aimed to examine this. Eleven men underwent a 12-week resistance training program for the triceps brachii muscle. The maximum muscle anatomical cross-sectional area (ACSAmax), the moment arm of the triceps brachii muscle, and the anterior-posterior dimension of the olecranon were measured using a magnetic resonance imaging system before and after intervention. The ACSAmax (33.6 ± 11.9%, P < .001) and moment arm (5.5 ± 4.0%, P = .001) significantly increased after training, whereas the anterior-posterior dimension of the olecranon did not change (P > .05). The change in moment arm was smaller than that expected from the relationship between the ACSAmax and the moment arm before the intervention. The present results indicate that training-induced triceps brachii muscle hypertrophy could increase the muscle moment arm, but its impact can be small or negligible.

Determination of equine deep digital flexor muscle volume based on distances between anatomical landmarks.

In equine medicine the use of Botox® is experimental. Dosages are determined from human treatment-protocols and limited numbers of equine studies. Determination of target-muscle volume can be helpful to extrapolate human dosages. The aim of the study was to calculate a formula enabling the estimation of the deep digital flexor muscle (DDFM) volume based on distances between anatomical landmarks. Nineteen cadaveric limbs were collected and distance A (top of olecranon to Os carpi accessorium) and B (circumference of limb) were measured. Converting mathematical formulas, C was calculated: π × (((0.5B)/π)(2)) × A. DDFM volume was determined by water displacement. Linear Regression Analysis was used to analyse data. The line best fitting the observed points was: Ln(volume[ml]) = -1.89 + 0.98 × Ln(value C[cm(3)]). Correlation was highest when natural logarithm was applied to both variables and was 0.97. The calculated formula enables estimating DDFM volume of a living horse. This estimated volume can be useful to apply human Botox® treatment-protocols.

Surgical techniques of olecranon fractures.

Olecranon fractures are common upper extremity injuries. The vast majority are treated with operative fixation. Many treatment techniques have been described including tension band and plating. This review covers the most commonly used fixation techniques in detail, including pearls and pitfalls with case examples of both successful treatments and potential complications.

Proximal ulna morphometry: which are the "true" anatomical preshaped olecranon plates?

PURPOSE: To define the optimum design of the anatomical preshaped olecranon plate. METHODS: The geometry of the proximal ulna was studied in 200 paired Caucasian ulnae, using a digital caliper and goniometer. Gender and side differences were analyzed. Results were compared with the corresponding geometrical parameters of three olecranon plates with different contour. All three plates were placed on the dorsal surface of a "model" ulna, i.e., a right dried ulna having osteometric parameters similar to the averages of our sample, and plate-to-bone fit was examined in two planes. RESULTS: The proximal ulna had an 8.48° (2.1°-15.7°) mean varus angulation and an 8.49° (1.70°-14.10°) mean anterior angulation, located on average 8.19 cm (5.68-11.66 cm) and 8.63 cm (5.28-11.92 cm) distal to the bone's most proximal point, respectively. The mean olecranon angle was 110.34° (98.70°-125.80°) and the olecranon length was 1.58 cm on average (1.20-2.12 cm). Only the plate having both varus and anterior angulation presented a good plate-to-bone fit in both planes. CONCLUSIONS: A "true" anatomical preshaped olecranon plate should have both varus and anterior angulation close to the average angulations of the normal ulna and located in a certain distance from its proximal edge. The olecranon part of the plate should primarily not exceed the olecranon length and secondarily be close to the average olecranon angle. We believe that such a plate may facilitate intraoperative restoration of the proximal ulna complex anatomy, when dealing with comminuted or Monteggia fractures, thus leading to better postoperative results.

Bursite cotovelar aguda em filhote: Relato De Caso / Elbow acute bursitis in a puppy: Case Report / Bursitis aguda de codo en cachorro de perro: Relato De Caso

Bursite cotovelar é uma cavidade preenchida por fluido, circundada por tecido conjuntivo fibroso denso, que surge na face lateral do olécrano. Normalmente, essa condição clínica é causada por traumatismo crônico. Relata-se um caso de bursite cotovelar aguda bilateral em um cão da raça dálmata, macho, de 35 dias de idade. Clinicamente, o animal apresentava aumento de volume flutuante e indolor, na região do olécrano, bilateral, de um dia de evolução. Na punção aspirativa foi observado um líquido de aspecto seroso e vermelho, e no exame citológico apenas leucócitos e hemácias. Devido ao histórico e tempo de evolução, o diagnóstico presuntivo foi de bursite cotovelar traumática aguda. O tratamento preconizado foi à base de anti-inflamatório, tratamento tópico, bandagem ao redor da lesão e repouso. O cão retornou com sete dias totalmente recuperado. Apesar da bursite em pequenos animais ocorrer devido a traumas repetidos, apresentando uma característica de cronicidade, a bursite pode ser aguda e se originar de um único trauma...

Elbow bursitis is a cavity filled with fluid and surrounded by dense fibrous connective tissue, which appears on the lateral side of the olecranon. Typically, this medical condition is caused by chronic trauma. This paper reports a case of bilateral acute bursitis in the elbow in a Dalmatian dog, male, with 35 days of age. Clinically, the animal presented painless swelling of the floating volume in the olecranon region, bilateral, with a one-day evolution. In aspiration, serous red fluid could be observed, and upon cytological examination, only leukocytes and erythrocytes were observed. Due to the history and evolution time, the presumptive diagnosis was that of acute traumatic bursitis in the elbow. The treatment was based on anti-inflammatory medication, topical treatment, bandage around the lesion and rest. The dog returned after 7 days fully recovered. Although bursitis occurs in small animals due to repeated trauma, presenting a chronicity characteristic, it can also be acute and originated from a single trauma...

La bursitis de codo es una cavidad llena de fluido y rodeada por tejido conectivo fibroso denso, que surge en el lado lateral del olécranon. Por lo general, esa condición clínica es causada por un trauma crónico. Se presenta un caso de bursitis aguda bilateral en el codo de un perro de la raza dálmata, macho, de 35 días de edad. Clínicamente, el animal presentaba aumento de volumen flotante y sin dolor, en la región del olécranon, bilateral, un día de evolución. En una aspiración se ha observado un líquido de aspecto seroso y rojo, y en el examen citológico sólo leucocitos y eritrocitos. Debido al histórico y tiempo de evolución, el diagnóstico presuntivo fue bursitis de codo traumática aguda. El tratamiento preconizado fue a base de antiinflamatorio, tratamiento tópico, vendaje alrededor de la lesión y reposo. El perro volvió con siete días totalmente recuperado. Aunque la bursitis se produce en animales pequeños debido a traumas repetidos, presentando una característica de cronicidad, la bursitis puede ser aguda y originarse a partir de un único trauma...

Application of a navigation system for contouring anatomical plasty of the distal end of the humerus.

The effectiveness of navigation systems in performing accurate orthopaedic surgery has been reported previously, but there have been no reports on the application of navigation in surgeries involving bone resection around the elbow joint. In this study, anatomical plasty or bone resection was performed to restore anatomical morphology in 10 cases of osteoarthritis of the elbow and deformity of the distal end of the humerus. Bone resection was performed on the distal end of the humerus using navigation and on the proximal end of the ulna via freehand surgery. Postoperatively, the elbow function was evaluated and pre- and postoperative CT images were used to measure the bone resection. There were no complications arising from the use of navigation, and elbow function was improved in all cases. By evaluating the CT images, it was found that navigated resection of the fossae of the distal humerus was more effective than freehand resection of the processes of the proximal ulna, thus confirming the usefulness of navigation. In future, to fully confirm this finding, it will be necessary to conduct prospective controlled studies of cases in which navigation is used to perform arthroplasty, including those that involve the proximal end of the ulna.

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. MATERIALS AND 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. CONCLUSION: 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.