Morphometric analysis of the proximal ulna using three-dimensional computed tomography and computer-aided design: varus, dorsal, and torsion angulation

Abstract

The proximal ulna, particularly the course of the posterior border, has a complex three-dimensional (3D) morphology which has been highlighted recently due to its clinical relevance in relation to surgical treatments. 3D computed tomography (CT) reconstruction and computer-aided design (CAD) based software can help to visualize the complex anatomy and thus aid the investigation of the more detailed morphology of the proximal ulna. In our current study, 3D CT reconstruction images of 20 cadavers were imported into the 3D CAD program. Three morphologic angle parameters of the proximal ulna were measured including the dorsal, varus and torsion angulation. The torsion angulation was measured using the flat spot of olecranon dorsal aspect. We measured the total length of the ulna and the distance between the olecranon tip and the apex of dorsal and varus angulation. Furthermore, the thickness of olecranon was also measured for all the specimens. The results showed that the mean dorsal, varus, and torsion angulation was 4.3A degrees (range 2.6A degrees-5.9A degrees), 12.1A degrees (range 7.9A degrees-17.6A degrees), and 22.5A degrees (range 16.6A degrees-30.5A degrees), respectively. The average length ratio of the dorsal and varus angulation apex to the total ulnar length was 26.4 % (range 19.8-30.7 %) and 32.7 % (range 27.5-37.5 %), respectively. The average of olecranon thickness at the proximal tip, mid-olecranon fossa, and at coronoid tip level was 17.8 mm (range 14.1-22.8 mm), 19.7 mm (range 15.8-23.1 mm), and 35.1 mm (range 27.9-41.8 mm), respectively. In conclusion, variations in the proximal ulna have to be considered when anatomically contoured dorsal plates are applied. Knowledge of the 3D morphologic anatomy of the proximal ulna would provide important information on fracture reductions, and the design of a precontoured dorsal plate or a prosthetic ulnar stem.