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Regional differences in the three-dimensional bone microstructure of the radial head: implications for observed fracture patterns

  • Trauma Surgery
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Abstract

Introduction

A characterization of the internal bone microstructure of the radial head could provide a better understanding of commonly occurring fracture patterns frequently involving the (antero)lateral quadrant, for which a clear explanation is still lacking. The aim of this study is to describe the radial head bone microstructure using micro-computed tomography (micro-CT) and to relate it to gross morphology, function and possible fracture patterns.

Materials and methods

Dry cadaveric human radii were scanned by micro-CT (17 μm/pixel, isotropic). The trabecular bone microstructure was quantified on axial image stacks in four quadrants: the anterolateral (AL), posterolateral (PL), posteromedial (PM) and anteromedial (AM) quadrant.

Results

The AL and PL quadrants displayed the significantly lowest bone volume fraction and trabecular number (BV/TV range 12.3–25.1%, Tb.N range 0.73–1.16 mm−1) and highest trabecular separation (Tb.Sp range 0.59–0.82 mm), compared to the PM and AM quadrants (BV/TV range 19.9–36.9%, Tb.N range 0.96–1.61 mm−1, Tb.Sp range 0.45–0.74 mm) (p = 0.03).

Conclusions

Our microstructural results suggest that the lateral side is the “weaker side”, exhibiting lower bone volume faction, less trabeculae and higher trabecular separation, compared to the medial side. As the forearm is pronated during most falls, the underlying bone microstructure could explain commonly observed fracture patterns of the radial head, particularly more often involving the AL quadrant. If screw fixation in radial head fractures is considered, surgeons should take advantage of the “stronger” bone microstructure of the medial side of the radial head, should the fracture line allow this.

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Acknowledgements

We thank the Ray Last Anatomy Laboratory at The University of Adelaide for the provision of cadaveric bone specimens, Adelaide Microscopy for providing access to the micro-CT system, Dr. Marco Palanca for valuable suggestions, The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) for covering the costs of micro-CT imaging.

Funding

This study was funded by the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) to cover the costs of micro-CT imaging.

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Authors and Affiliations

  1. Department of Orthopedic and Trauma Surgery, College of Medicine and Public Health Flinders University and Flinders Medical Centre, Adelaide, SA, 5042, Australia

    Jetske Viveen, Ruurd L. Jaarsma, Job N. Doornberg & Gregory I. Bain

  2. Department of Orthopedic Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands

    Jetske Viveen, Job N. Doornberg & Denise Eygengaal

  3. Medical Device Research Institute, College of Science and Engineering, Flinders University, Tonsley, SA, 5042, Australia

    Egon Perilli

  4. Groningen University, Groningen University Medical Centre, Groningen, The Netherlands

    Job N. Doornberg

  5. Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands

    Denise Eygengaal

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Correspondence to Jetske Viveen.

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Conflict of Interest

Author #1 received an unrestricted Research Grant from the Marti-Keuning-Eckhardt Foundation, Jo Kolk Foundation and Michael-van Vloten Foundation. Author #4 received an unrestricted Postdoc Research Grant from the Marti-Keuning-Eckhardt Foundation. Other authors declare that they have no conflict of interest.

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Viveen, J., Perilli, E., Jaarsma, R.L. et al. Regional differences in the three-dimensional bone microstructure of the radial head: implications for observed fracture patterns. Arch Orthop Trauma Surg 142, 165–174 (2022). https://doi.org/10.1007/s00402-020-03665-3

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