|Year : 2022 | Volume
| Issue : 2 | Page : 128-132
Morphometric scrutiny of the radial head: A foundation for prosthesis crafting
Shilpi Shrivastava, Shilpa M Bhimalli, Sheetal Vishwanath Pattanshetti
Department of Anatomy, J. N. Medical College, KAHER, Belagavi, Karnataka, India
|Date of Submission||19-Feb-2022|
|Date of Acceptance||12-May-2022|
|Date of Web Publication||23-Aug-2022|
Shilpa M Bhimalli
Department of Anatomy, J. N. Medical College, KAHER, Belagavi - 590 010, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Radius is one of the two constituent bones of the forearm. It is frequently fractured or dislocated due to trauma, pathology, etc. Prosthetic radial head may be indicated in the management of comminuted fractures of the radial head. Aims and Objectives: This study was undertaken with the aim to measure various dimensions of the head of the radius bone and to collate these dimensions between right-sided and left-sided bones. Materials and Methods: Three hundred bones, collected from the Department of Anatomy of Jawaharlal Nehru Medical College, Belagavi, Karnataka, were systematically investigated using digital Vernier caliper, normal ruler, and inelastic thread. The data recorded were then analyzed to obtain the results. Results: The mean length, diameter, and circumference of the head of the radius bones were 9.47 ± 1.49 mm, 19.92 ± 2.03 mm, and 6.42 ± 0.63 cm, respectively (irrespective of the side). For only one aspect, the length of the radial head, a statistically significant difference was obtained between the values of bones of both sides. Conclusion: Numerous studies have shown an extensively varied range of values for several parameters. Utmost care and precision are required by the orthopedic surgeons, prosthetists, etc. while treating patients or prosthesis making, to avoid untoward outcomes like soreness, etc. This study strives to underline this need for precision by highlighting the varied range of parameters in the regional population.
Keywords: Digital Vernier caliper, fracture, prosthesis, radial head, radius
|How to cite this article:|
Shrivastava S, Bhimalli SM, Pattanshetti SV. Morphometric scrutiny of the radial head: A foundation for prosthesis crafting. J Sci Soc 2022;49:128-32
| Introduction|| |
The radius is a long bone of the forearm situated lateral to the ulna. The proximal end of the radius includes the head, neck, and tuberosity.
The radial head is usually discoid in shape. Shallow cup at its proximal surface links it with the humeral capitulum. A smooth peripheral surface associates it with the ulnar notch. It contributes for the establishment of some noteworthy joints of upper limb like, proximal radio-ulnar joint, and humeroradial joint, which help in various movements of the elbow and forearm, necessitated by human life.,,,
In-depth comprehension of these dimensions and anatomy is indispensable to attain the greatest positive outcomes for reconstruction, patient's rehabilitation or prosthesis creation and to abate after-effects of any surgical procedure done (orthopedic/oncologic).,
The aim of the present study was to appraise the morphometric measurements of dry adult human radius bone and collate them between both sides.
| Materials and Methods|| |
All bones (anonymous sex, age, and race) were collected from the bone bank of the Department of Anatomy of Jawaharlal Nehru Medical College, Belagavi. It is a cross-sectional study, done from January 1, 2020 to June 30, 2021. The study protocol was approved by the institutional ethical committee. It was performed on 300 dry adult human radius bones, 155 left sided and 145 right sided. All adult, normal, dried, human radius bones, irrespective of the sides, sex, age, and race, without any obvious pathology or deformity and completely intact were counted in the study sample. Pediatric bones, bones with any deformity/destruction or healed fractures, broken radius and with any pathology or abnormality were not included in this study.
Steps for measurement
Measurements taken are shown in [Figure 1]. They were measured as shown in [Table 1].
|Figure 1: Measurements at proximal part of radius bone. LRH: Length of the radial head (A to B), DRH: Diameter of the radial head (C to D), CRH: Circumference of the radial head (Along Point E)|
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Recording of the parameters
For an individual parameter, the dimensions were procured for three counts and the mean was documented as the ultimate value.
Length of the radial head
It was measured with the help of digital Vernier caliper, from the upper border of radial head (A) to the lower border of it (B) [Figure 1]. It was recorded in millimeters.
Diameter of the radial head (C to D)
It was measured in millimeters as the maximum reading when the jaws of the digital Vernier caliper were kept in the middle of the head of the radius bone [Figure 1].
Circumference of the radial head
It was measured using an inelastic thread and a normal ruler. The head of the radius was encircled using the inelastic thread along point E as shown in [Figure 1] and the end was marked. This marked length was then measured (in centimeters) by the help of normal ruler.
Data obtained were then compiled and structured using MS Excel. Statistical analysis was executed by applying unpaired t-test to compute the range, mean value, standard deviation, 95% confidence interval and P value data for both right- and left-sided radius bones. Results were considered statistically significant whenever P ≤ 0.05. Mean values of the individual parameters were calculated (for each side as well as the overall mean).
| Results|| |
The length of the head of the left-sided radius bone ranged from 5.95 mm to 13.93 mm and the mean was 9.65 ± 1.53 mm. For the right-sided radius bone, it ranged from 4.85 mm to 12.66 mm and the mean was 9.28 ± 1.44 mm. The mean length of the head of the radius bone (irrespective of its side) was 9.47 ± 1.49 mm. The range of the length was from 4.85 mm to 13.93 mm.
The diameter of the head of the left-sided radius bone ranged from 15.17 mm to 24.93 mm and the mean was 19.92 ± 1.96 mm. For the right-sided radius bone, it ranged from 15.07 mm to 24.66 mm and the mean was 19.92 ± 2.09 mm. The average diameter of the head of the radius bones (irrespective of its side) was 19.92 ± 2.03 mm. The range of the diameter was from 15.07 mm to 24.93 mm.
Radial head circumference for the left-sided bone ranged from 4.9 cm to 8.2 cm and the mean was 6.44 ± 0.61 cm. For the right-sided radius bone, it ranged from 4.5 cm to 7.9 cm and the mean was 6.39 ± 0.64 cm. The mean circumference of the head of the radius bones, irrespective of its side, was 6.42 ± 0.63 cm. The range of the circumference was from 4.5 cm to 8.2 cm [Table 2].
|Table 2: The mean value of parameters with standard deviation for both right sided and left sided radius bones and overall mean. Also, 95% confidence interval and P value is shown|
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Only for 1 parameter-length of the radial head (LRH), a statistically significant difference was found between the values of both sides bones as the P value obtained was statistically significant (*0.0315). For the rest of the parameters, P values are statistically insignificant [Graph 1].
| Discussion|| |
Fracture is a complete or partial disruption in the continuity of a bone, produced due to trauma, overuse, or ailments that weaken bones. Bones accompanied by ligaments and muscles are the factors which sustain the stability of a joint. Insufficient backing by ligaments and muscles or the substandard shape of articular surfaces leads to the dislocation of a joint. Factors restricting the span of movements are the shape of articulating bones, tension of the ligaments, tension of antagonistic muscles, and the approximation of the soft parts. Fracture healing is an indispensably significant clinical experience for fracture – patients and for concerned clinicians. The medical appraisal of fracture – healing is centered on both clinical as well as radiographic findings. Risk considerations for tardy union and nonunion comprise “patient-dependent” aspects such as progressive age, health comorbidities, nonsteroidal anti-inflammatory drugs usage, several inherited conditions, ailments of metabolism, smoking, and dietary deficits. “Patient-independent” aspects take account of fracture-pattern, site and dislodgment, gravity of soft-tissue damage, extent of bony damage, quality of invasive treatment, and infection incidence.,,
Fractures or dislocation of the bones is quite common Now-a-days due to road traffic accidents, direct injury, fall, pathology (osteoporosis, malignancy, etc.), sports injury, and so on.
Sex determination, age estimation, stature reconstruction, and the identification of anonymous bodily remains or bodies or skeletal remains can also be achieved by various anthropometric techniques using a bone as the probe. The standards of anthropometry vary with population. Dimensions of anthropometric elements of elongated bones can be employed for the determination of sex and prediction of height.,
The radius is the lateral and petite bone of the ante-brachium. The forearm entity is formed by two parallel bones; hence, supination-pronation movements of the forearm are achievable as radius can pivot about the ulna during the elbow flexion. Proximally, the superior aspect of the radial head connects to the humeral-capitulum providing movements at the elbow joint.
Fracture and dislocation of the radius bone, both isolated or in conjunction with that of the ulna bone, is quite common. It can occur due to various reasons such as fall on outstretched hand, sports-related injuries, road traffic accidents, industrial accidents, pathological fractures due to osteoporosis and malignancies. If these fractures are comminuted or the malignancy requires excision of the bone segment, then prosthesis is a necessity., Many important muscles, tendons, vessels, and nerves pass along the radius bone which can be damaged in the injuries, are crucial for the normal functioning of the upper limb. Severe pain, loss of strength, decreased range of motion, joint instability, malunion, nonunion, shortening of the limb, loosening/tightening of the bicipital tendon, etc. are the recorded after-effects. These can then lead to physical, mental as well as a financial burden to the individual.
Gupta C et al. found the mean length of the head of the radius to be 0.91 ± 0.10 cm for right-sided radius, 0.90 ± 0.13 cm for the left-sided radius and the overall range as 0.70–1.10 cm. Singh A and Singh A observed the values of 7.99 ± 1.39 mm for right sided, 9.57 ± 1.40 mm for left sided and 8.65 ± 1.55 mm as the overall mean length. Ethiraj S and Jyothi KC observed the mean length of the head of the radius as 0.86 ± 0.10 cm for right-sided and 0.95 ± 0.12 cm for the left-sided radius bone. Rayna et al. noticed it as 0.6 ± 0.07 cm on right-sided and 0.6 ± 0.06 cm on left-sided radius. Shastry A et al. observed the values, 9.88 mm and 9.71 mm for right-sided and left-sided radius, respectively. Rajasree G and Hema L observed this measurement to be 13.67 mm for right-sided and 13.47 mm for the left-sided radius bone. In the current study, the average length of radial head at right-sided bone was 9.28 ± 1.44 mm and for left-sided radius, bone was obtained as 9.65 ± 1.53 mm. The overall mean LRH was found to be 9.47 ± 1.49 mm. The span of the length of the head of the radius was 4.85 mm to 13.93 mm. Results of the present study are nearest to those of Gupta C et al. and Shastry A et al., but we have found the length to be more on the left-sided radius, which is in contrast. Furthermore, here one can notice a varied range of values in different studies and within the samples of the same study. On analyzing the result of our study, the difference between the values of right- and left-sided radius was found to be statistically significant.
Shastry A et al. observed the diameter of the radial head to be 19.04 mm and 18.81 mm in right-sided and left-sided radius, respectively. Gupta C et al. obtained the value of 1.91 cm as the overall mean, irrespective of the sides. Rajasree G and Hema L observed this measurement as 15.41 mm for right-sided and 15.45 mm for the left-sided radius bone. Ethiraj S and Jyothi KC observed the mean diameter of the radius as 1.98 ± 0.24 cm for right-sided and 01.98 ± 00.18 cm for the left. Singh A and Singh A (2019) observed the mean values of 19.43 ± 2.39 mm. In the present study, the mean diameter of the head of right-sided radius bone was 19.92 ± 2.09 mm and for left-sided radius, bone was obtained as 19.92 ± 1.96 mm. The overall mean diameter of the radial head was found to be 19.92 ± 2.03 mm. The span of the diameter of the head of the radius was 15.07 mm to 24.93 mm. The results of the present study are similar to those of Ethiraj S, Jyothi KC (2019) and Singh A and Singh A (2019). Rajasree G and Hema L found a significantly less value. On comparing these results statistically, no significant difference was found between the values of both sides, but the range of values is varying from study to study.
Rayna et al. observed that the mean circumference of the radial head was 6.3 ± 0.60 cm on the right-sided and 6.1 ± 0.58 cm on the left-sided radius. Rajasree G and Hema L obtained the mean value of 49.10 mm on the right side and 48.31 mm on the left. Van Riet et al. observed the average circumference of the head of the radius as 77.5 ± 6.7 mm overall. In the present study, the mean circumference of the head of the right-sided radius bone was 6.39 ± 0.64 cm and for the left-sided radius bone was 6.44 ± 0.61 cm. The overall mean circumference of the head of the radius bone was found to be 6.42 ± 0.63 cm. The span of the circumference of the radial head ranged from 4.5 cm to 8.2 cm. The results of the present study were similar to those of Rayna et al. except for the fact that the left-sided value is higher than the right-sided in the present study. Notably, low values were obtained by Rajasree G and Hema L while higher values by Van Riet et al. On comparing these results statistically, no significant difference was found between the values of both sides, but the range of values is varying from study to study.
| Conclusion|| |
Wide range of values of various parameters is found on comparison with other studies of different regions and populations. Furthermore, for certain parameters, namely, LRH, a statistically significant difference was found in between the values of the right-sided and left-sided radius bones. Thus, care must be taken by the treating surgeon or prosthetists, etc. while treating or prosthesis making, so that minimum unwanted outcomes such as soreness and inadequate range of motion are faced and maximum functionality is achieved by the patient.
Nonunion of the fractured segments is challenging to resolve and develop tremendous physical, mental, and financial pressure. All approaches that aid to lessen healing-time with quicker recommencement to work and routine not only upgrade medical aftermath but they also support to cut the monetary load for patients with fracture and its nonunion as well. Surgical treatment intends to inhibit the cross-union between the two forearm bones, in order to preserve the actions of pronation-supination.
Utmost care should be taken during the treatment and rehabilitation in such cases as a significant difference is present between the values for the bones of both sides. It is crucial to restoring the normal anatomy of the bone and related structures for the hassle-free functioning of an individual and for this, thorough knowledge of the relevant anatomical parameters is essential. It will also help other specialties in better outcomes. A detailed study of various parameters would be of use to orthopedic surgeons, onco-surgeons, physiotherapists, prosthetists, clinicians, radiologists, and also medicolegal experts in the diagnosis, treatment, management, and identification of the case.
The study protocol was approved by the Institutional ethical committee of Jawaharlal Nehru Medical College, Belagavi.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]