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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 14  |  Issue : 4  |  Page : 360-364

A morphological and morphometric study of distal end of ulna with its clinical implications


1 Department of Anatomy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
2 Department of Forensic Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India

Date of Submission10-May-2018
Date of Decision22-Sep-2019
Date of Acceptance10-Nov-2019
Date of Web Publication16-Jul-2020

Correspondence Address:
Dr. Chandni Gupta
Department of Anatomy, Kasturba Medical College, Manipal - 576 104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_38_18

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  Abstract 


Background and Aim: The distal end of the ulna is of utmost anatomical importance for normal hand functioning. It can get damaged in various injuries such as avulsion of the ulnar styloid process or ulnar styloid triquetral impaction syndrome. Hence, the aim of this study is to measure the various dimensions of distal end of ulna and to look for its various morphological features. Materials and Methods: The study was conducted on fifty dry ulnae of unknown sex. Length of styloid process, width of fovea, and pole and height of seat were measured. Various morphological features of the distal end of ulna were also noted down. Results: The mean length of styloid process, width of fovea, and pole were 0.55, 0.47, and 0.56 cm, respectively. The mean height of seat was 0.72 cm. In 59.57% of cases, the styloid process was straight and in 78.7% of cases, the tip of the styloid process was blunt. The most common shape of pole was kidney shape in 48% of cases. Conclusion: The results of this study will be useful for hand surgeons in dealing with distal ulnar injuries and even for reconstruction of the distal radioulnar joint with prosthesis of distal end of ulna.

Keywords: Distal radioulnar joint, pole, seat, styloid process, ulna


How to cite this article:
Gupta C, Naik S, Kurian P, Kalthur S, Palimar V, D'Souza A. A morphological and morphometric study of distal end of ulna with its clinical implications. J Datta Meghe Inst Med Sci Univ 2019;14:360-4

How to cite this URL:
Gupta C, Naik S, Kurian P, Kalthur S, Palimar V, D'Souza A. A morphological and morphometric study of distal end of ulna with its clinical implications. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2020 Aug 11];14:360-4. Available from: http://www.journaldmims.com/text.asp?2019/14/4/360/289857




  Introduction Top


The distal end of the ulna comprises the head, styloid process, and fovea. The fovea is a roughened depression at the base of the styloid process on its lateral aspect. The head of ulna constitutes two parts “pole” and “seat,” which are used while describing the structure and function of the bones and joints of the wrist and hand in the context of kinesiology. The “pole” articulates with the triangular fibrocartilaginous complex of the wrist and the “seat” articulates with the radius. The seat occupies more than two-thirds of the perimeter of the head of ulna and is covered by articular cartilage.[1]

When there is ulnar dorsal dislocation of the distal radioulnar joint, the mechanism of injury is hyperpronation, whereas in ulnar volar dislocation, the mechanism of injury is hypersupination. Galeazzi fracture-dislocations can also be associated with fracture of the ulnar shaft and styloid process in high-energy trauma. While playing sports, powerful impact on the thenar side of the hand causes the wrist to go into hyperextension, with ulnar deviation and intercarpal supination.[2]

Traumatic injuries around the ulnar head generally disturb the distal radioulnar joint. The dislocations of the ulnar head with associated fracture of the radius (Galeazzi lesion) had been treated by implantation of prosthesis such as the Herbert ulnar head instead of arthrodesis.[3] Moreover, before putting the prosthesis of the lower end of the ulna, the orthopedician should know the detailed anatomy of the distal end of ulna.

Hence, the aim of our study is to measure the various dimensions of the distal end of ulna and its various morphologic features which would help the orthopedician in selecting an accurate size prosthesis of the lower end of ulna in cases of distal radioulnar joint injuries.


  Materials and Methods Top


The study was done on fifty (26 right sided and 24 left sided) dry ulnae without any deformity. Institutional ethics committee approval was not taken as the study was done on dry bones of unknown sex. The parameters which were measured at the distal end of ulna are as follows:

  1. Maximum height of seat
  2. Maximum width of pole along the transverse axis
  3. Maximum width of fovea along the transverse axis
  4. Length of styloid process.


All the measurements were measured using the divider and scale [Figure 1].
Figure 1: Various measurement done on distal end of ulna. (a) Length of styloid process. (b) Width of pole. (c) Height of seat. (d) Width of fovea

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Various morphological parameters were also looked for such as shape of pole, presence or absence of vascular foramina in the fovea, and presence or absence of groove for extensor carpi ulnaris (ECU).

Statistical analysis of the results was done using SPSS software (IBM SPSS, USA). Moreover, Student's t-test was done to correlate various parameters of the right and left sides.

Ethical clearance

Ethical clearance was obtained from the Institutional Ethical Committee of Manipal Academy of Higher Education, Manipal on 22nd April 2018. With ethical clearance no MAHE/ECMAN/2018-19/12


  Results Top


The mean and range of all parameters measured on the ulna on the right and left sides is shown in [Table 1].
Table 1: Various measurements done on ulna on the right and left sides

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The mean length of styloid process, width of fovea, and pole were 0.55, 0.47, and 0.56 cm, respectively. The mean height of seat was 0.72 cm.

Various morphologic features seen in styloid process and in the ulna on the right and left sides are shown in [Table 2] and [Table 3].
Table 2: Various morphologic features seen in styloid process on the right and left sides

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Table 3: Various morphologic features seen on ulna on the right and left sides

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In 59.57% of cases, the styloid process was straight, whereas in 40.4% of cases, it was curved. In 78.7% of cases, the tip of styloid process was blunt and in 21.2% of cases, it was sharp [Figure 2].
Figure 2: Different types of styloid process. (a) Straight styloid process. (b) Curved styloid process. (c) Blunt and sharp styloid process

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In 80% of cases, vascular foramina were present in the fovea, whereas in 20% of cases, there were no vascular foramina. The seat was sloping in 64% of cases and nonsloping in 36% of cases. Groove for ECU was seen in 98% of cases and in 2% of cases, it was absent [Figure 3].
Figure 3: Showing presence or absence of vascular foramina in the fovea, seat sloping and non sloping and presence or absence of styloid process and groove for Extensor carpi ulnaris. (a) Absence of vascular foramina in the fovea, absent styloid process and non sloping seat. (b) Presence of vascular foramina in the fovea, present styloid process and sloping seat (c) Absence of groove for extensor carpi ulnaris (d) Presence of groove for extensor carpi ulnaris

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The most common shape of pole was kidney shape in 48% of cases, and it was coma shaped and semicircular in 20% each, whereas it was semilunar in 12% of cases [Figure 4].
Figure 4: Different shapes of poles. (a) Semilunar. (b) Semicircular. (c) Comma shaped. (d) Kidney shaped

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  Discussion Top


Traumatic injuries around the ulnar head generally involve both the joint compartments: the distal radioulnar and ulnar-carpal joints. Hence, the goal must be to reestablish the normal anatomy in serious circumstances whenever possible.[4]

Joshi et al., Sharma et al., and Ashiyani et al. observed the average maximum width of pole as 0.52, 0.54, and 0.56 cm in right-sided ulnae and 0.47, 0.61, and 0.57 cm in left-sided ulnae.[5],[6],[7] While in our study, we got the width of pole as 0.55 cm on the right side and 0.57 cm on the left side. Our results were almost similar to those of Ashiyani et al.

Joshi et al., Sharma et al., and Ashiyani et al. observed the average maximum height of seat as 0.63, 0.59, and 0.60 cm on the right side and 0.52, 0.69, and 0.64 cm on the left side, respectively.[5],[6],[7] While in our study, we got the height of seat as 0.69 cm on the right side and 0.75 cm on the left side.

Sharma et al. found sloping seat in 60% of cases and nonsloping in 40% of cases on the right as well as on the left side.[6] Joshi et al. found that seat was sloping in 66.6% and 61.6% of cases on the right and left sides, respectively, whereas nonsloping in 33.3% and 38.3% of cases on the right and left sides, respectively. Our results were almost similar to those of their study. We also got sloping seat in 65.3% and 62.5% of cases on the right and left sides and nonsloping in 34.6% and 37.5% of cases on the right and left sides, respectively.[5]

Joshi et al., Sharma et al., and Ashiyani et al. recorded the average maximum width of fovea as 0.52, 0.45, and 0.47 cm on right-sided and 0.51, 0.49, and 0l. 41 cm on left-sided ulnae.[5],[6],[7] While in our study, we got the height of seat as 0.46 cm on the right side and 0.48 cm on the left side, respectively. Our results were almost similar to those of Sharma et al.

Sharma et al. and Ashiyani et al. found the average length of styloid process as 0.52 and 0.42 cm on the right side and 0.50 and 0.52 cm on the left side.[6],[7] While in our study, we got the length of styloid process as 0.56 cm on the right side and 0.55 cm on the left side. Giachino et al. gave the importance of length of ulnar styloid process as a causative factor in ulnar styloid triquetral impaction (USTI) producing ulnar-sided wrist pain.[8]

Sharma et al. found that styloid process was present in all cases in their study.[6] Joshi et al. found that it was present in 95.7% and 95% of cases on the right and left sides and absent in 4.3% and 5% of cases on the right and left sides, respectively, whereas, in our study, it was present in 96.1% and 91.6% of cases on the right and left sides and absent in 3.84% and 8.33% of cases on the right and left sides, respectively.[5] Sharma et al. and Joshi et al. found that styloid process was curved in 10% and 13.64% of cases and straight in 90% and 83.36% of cases on the right side and it was 100% straight on the left side in Sharma et al.'s study, whereas in Joshi et al.'s study, it was curved in 14.03% and straight in 85.97% of cases on the left side. Whereas, in our study, we found that it was curved in 36% of cases and straight in 64% of cases on the right side and on the left side, it was curved in 45.4% of cases and straight in 54.5% of cases. Sharma et al. and Joshi et al. also found that the tip of the styloid process was blunt in 60%, 77.27% and 70%, 63.15% of cases and pointed in 40%, 22.72% and 30%, 36.85% of cases on the right and left sides,[5],[6] whereas in our study, the tip was blunt in 80% and 77.2% of cases and pointed in 20% and 22.7% of cases on the right and left sides, respectively.

Ashiyani et al., Joshi et al., and Sharma et al. found that in 5%, 15.61%, and 20% of ulna, we also found absence of vascular foramina in 20% of our cases,[5],[6],[7] similar to that of the results by Sharma et al.'s study.

Ashiyani et al. found the most common shape of the pole as semilunar (55%), followed by coma shaped (25%), semicircular (15%), and kidney (5%) shaped.[7] Sharma et al. and Joshi et al. found the most common shape of the pole as semilunar (60% and 63.76%), followed by coma shaped (10% and 23.18%), semicircular (20% and 13.04%), and kidney (10% and 0%) shaped on the right side and on the left side the most common shape of the pole as semilunar (40% and 63.33%), followed by coma shaped (30% and 20%), semicircular (20% and 6.66%), and kidney (10% and 9.99%) shaped, whereas in our study, we found that the pole was most commonly kidney shaped in 48% of cases, coma shaped and semicircular in 20% of cases each, and semilunar in 12% of cases.[5],[6] We found that on the right side, the most common shape of the pole was kidney shaped (34.6%), followed by semicircular (26.9%), semilunar (19.2%), and coma shaped (19.2%), and on the left side, the most common shape of the pole was kidney shaped (62.5%), followed by coma shaped (45.4%), semicircular (20.8%), and semilunar (4%) shaped.

Ashiyani et al. observed a groove for ECU in all right- and left-sided ulnae.[7] Sharma et al. observed the groove in all left-sided ulnae and in 80% of right-sided ulnae.[6] Joshi et al. have classified the groove for ECU tendon in shallow (found in 48.1%) and deep (found in 24.38%) and they observed no groove in 27.21% ulnae,[5] whereas in our study, we found the groove in 98% of cases and it was absent in 2% of cases.


  Conclusion Top


The connection of distal end of ulna with radius and ulnar carpus is significant from the functional point of view. If a slight alteration occurs in this region, it can lead to major load alterations and result in various pain syndromes (ulnar styloid impaction, USTI, ulnar carpal abutment, etc.)[4] Hence, thorough anatomical information and morphometric data are vital for treatment modality of this region. Even the results of this study will also help the orthopedician to choose a correct size of prosthesis in cases of distal radioulnar joint injuries as well as dislocation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Oatis CA. Kinesiology in Structure and Function of the Bones and Joints of the Wrist and Hand. 2nd ed. Baltimore: Williams and Wilkins, Lippincott; 2003. p. 243-54.  Back to cited text no. 1
    
2.
Tulley E. Sports Physiotherapy Applied Science and Practice in the Wrist and Hand. 1st ed. Melbourne: Churchill Livingstone; 1995. p. 439-42.  Back to cited text no. 2
    
3.
Grechenig W, Peicha G, Fellinger M. Primary ulnar head prosthesis for the treatment of an irreparable ulnar head fracture dislocation. J Hand Surg Br 2001;26:269-71.  Back to cited text no. 3
    
4.
Berger RA, Weiss AP. Hand Surgery. 1st ed., Vol. 1. Philadelphia, USA: Williams and Wilkins, Lippincott; 2004. p. 297.  Back to cited text no. 4
    
5.
Joshi SD, Joshi SS, Athavale SA, Kishve PS, Jadhav SD. Metrical and non-metrical study of lower end of ulna. J Anat Soc India 2009;5:156-60.  Back to cited text no. 5
    
6.
Sharma A, Kumar A, Singh P. Anatomical study of the distal end of cadaveric human ulnae: A clinical consideration for the management of distal radioulnar joint injuries. Singapore Med J 2011;52:673-6.  Back to cited text no. 6
    
7.
Ashiyani ZA, Meghatar NK, Jadav HR. Morphometrical study of lower end of ulna. Int J Sci Res 2014;3:326-7.  Back to cited text no. 7
    
8.
Giachino AA, Mclntyre AI, Guy KJ, Conway AF. Ulnar styloid t triquetral impaction. Hand Surg 2007;12:123-34.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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