Weinberg Douglas S, Park Paul J, Boden Kaeleen A, Malone Kevin J, Cooperman Daniel R, Liu Raymond W
Department of Orthopaedic Surgery (D.S.W., K.J.M., and R.W.L.), School of Medicine (P.J.P. and K.A.B.), Case Western Reserve University, Cleveland, Ohio.
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut.
J Bone Joint Surg Am. 2016 Jul 6;98(13):1103-12. doi: 10.2106/JBJS.15.00845.
Evaluating rotation during open reduction and internal fixation of a forearm fracture is of paramount importance. In challenging cases, surgeons may utilize radiographic relationships between proximal and distal radial and ulnar landmarks to assess rotational position. However, to our knowledge, limited anatomic data are available to confirm these relationships.
Six hundred cadaveric radii and ulnae were obtained. Digital representations of the bicipital tuberosity, the radial styloid, the coronoid process, and the ulnar styloid were acquired, and the rotational profiles between respective landmarks were calculated. In order to validate the results and investigate the ability to differentiate rotated osseous positions, each bone was imaged in increments of 10° of rotation and the profile of each landmark was measured.
The radial styloid was at a mean of 158° ± 14° of supination relative to the bicipital tuberosity. The ulnar styloid was at a mean of 185° ± 14° of supination relative to the coronoid process. Imaging of the bones in increments of 10° of rotation supported the relationships above. It was also found that a 1-mm difference in profile size corresponded to up to 60° of rotation for the average ulna, compared with 10° for the average radius.
Our findings suggest that using the bicipital tuberosity and the radial styloid to assess intraoperative rotation of the radius on anteroposterior radiographs may be of limited value; the landmarks were not generally 180° apart. Although the rotational positions of the coronoid process and the ulnar styloid were, on average, closer to 180°, surgeons should be aware of the wide range of normal anatomy as well as the inability to judge rotation by as much as 60°, even for an "ideal" ulna.
This study, to our knowledge, represents the first anatomic investigation of the rotational profiles between the osseous landmarks used to assess forearm rotation after fracture. We recommend that surgeons first image the bicipital tuberosity at its largest profile, supinate the arm 20°, and confirm that the radial styloid is at its largest profile. The ulna can then be assessed to support the lack of rotational deformity in the forearm.
评估前臂骨折切开复位内固定术中的旋转情况至关重要。在具有挑战性的病例中，外科医生可能会利用桡骨和尺骨近端与远端标志点之间的影像学关系来评估旋转位置。然而，据我们所知，可用于证实这些关系的解剖学数据有限。
获取600根尸体桡骨和尺骨。获取肱二头肌结节、桡骨茎突、冠突和尺骨茎突的数字图像，并计算各标志点之间的旋转轮廓。为了验证结果并研究区分旋转骨位置的能力，对每根骨头以10°的旋转增量进行成像，并测量每个标志点的轮廓。
桡骨茎突相对于肱二头肌结节的平均旋后角度为158°±14°。尺骨茎突相对于冠突的平均旋后角度为185°±14°。以10°的旋转增量对骨头进行成像支持上述关系。还发现，对于平均尺骨，轮廓尺寸相差1毫米相当于旋转多达60°，而对于平均桡骨则为10°。
我们的研究结果表明，使用肱二头肌结节和桡骨茎突在前后位X线片上评估桡骨的术中旋转可能价值有限；这些标志点通常并非相隔180°。尽管冠突和尺骨茎突的旋转位置平均更接近180°，但外科医生应意识到正常解剖结构的广泛差异，以及即使对于“理想”尺骨也无法判断多达60°的旋转情况。
据我们所知，本研究是对用于评估骨折后前臂旋转的骨标志点之间旋转轮廓的首次解剖学研究。我们建议外科医生首先在肱二头肌结节最大轮廓处进行成像，将手臂旋后20°，并确认桡骨茎突处于其最大轮廓处。然后可以评估尺骨以支持前臂无旋转畸形。
