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Palmar cortical angle of the distal radius: a radiological study
PALMAR CORTICAL ANGLE OF THE DISTAL RADIUS: A RADIOLOGICAL STUDY R. S. BASSI, K. M. KRISHNAN, S. S. DHILLON and S. C. DESHMUKH From the Department of Trauma and Orthopaedics, City Hospital NHS Trust, Dudley Road, Birmingham, England, UK
Fifty lateral radiographs of normal wrists were viewed to determine the palmar cortical angle of the distal radius. The palmar cortical angle is different to its previously described palmar tilt or angulation. The mean value for the palmar cortical angle was 371 (range, 26–501). This may be clinically important in the design of palmar plates for the distal radius. Journal of Hand Surgery (British and European Volume, 2003) 28B: 2: 163–164
between observations was also calculated together with the 95% limits of agreement.
INTRODUCTION There is no information and no reference values for the angle between the palmar surface of the distal radius and the shaft of the radius. This study set out to determine this value, the palmar cortical angle of the distal radius.
RESULTS The palmar cortical angle had a mean value of 371 (SD,61) for the first observer and 381 (SD,61) for the second observer. The mean of the difference was 11 (SD,4) and the 95% limits of agreement were 71 to 81.
MATERIALS AND METHODS DISCUSSION
Normal wrist radiographs were randomly selected from the radiology department. Fifty with good-quality lateral views of the wrist joint were chosen. This quality was confirmed by the overlapping of the ulnar head and distal radius. In each case, a line was drawn along the palmar surface of the shaft of the distal radius. A second line was drawn parallel to the palmar cortex of the distal radius (palmar cortical line). The angle between these two lines was measured and represented the palmar cortical angle (Fig 1). Two observers made the measurements independently to reduce the likelihood of bias. For each observer, the mean angle and standard deviation were calculated. The mean of the difference
Fig 1
Radiological and anatomical measurements of the distal radius have been extensively studied in the past (Friberg and Lundstrom, 1976; Johnson and Szabo, 1993; Solgaard, 1984). Parameters such as radial height, radial inclination and palmar tilt have been assessed. To our knowledge, no radiological or anatomical study has looked at the palmar cortical angle of the distal radius. This is different to the palmar angulation of the articular surface of the distal radius. The mean palmar cortical angle was 371 and the result of our two independent observers indicated good reproducibility. In our experience of palmar plating of the distal radius, pre-bent palmar buttress plates, such
Measurement of the palmar cortical angle: A, line drawn along palmar surface of shaft of distal radius; B, palmar cortical line; a, palmar cortical angle. 163
164
as the AO (Stratec, Overdorf, Switzerland) palmar tension band plate which is pre-bent to 201, have to be contoured a further 151 or so to reproduce the normal palmar anatomy of the distal radius. This is in keeping with our measurements of the palmar cortical angle. At the time of surgery, contouring of the plate is determined by measuring the palmar cortical angle of the unaffected wrist, which it is assumed is similar to that of the injured wrist. References Friberg S, Lundstrom B (1976). Radiographic measurements on the radio-carpal joint in distal radius fractures. Acta Radiologica Diagnosis, 17: 869–876.
THE JOURNAL OF HAND SURGERY VOL. 28B No. 2 APRIL 2003 Johnson PG, Szabo RM (1993). Angle measurement of the distal radius: a cadaver study. Skeletal Radiology, 22(4): 243–246. Solgaard S (1984). Angle of inclination of the articular surface of the distal radius. Radiologe, 24(7): 346–348.
Received: 4 July 2002 Accepted after revision: 22 October 2002 Dr Rashpal Singh Bassi, 44 Beaudesert Road, Handsworth, Birmingham B20 3TG, UK. Tel.: +44-121-551-3237; E-mail: [email protected]. r 2003 The British Society for Surgery of the Hand. Published by Elsevier Science Ltd. All rights reserved. doi:10.1016/S0266-7681(02)00305-4/jhsb.2003.0878, available online at http://www.sciencedirect. com
Fifty lateral radiographs of normal wrists were viewed to determine the palmar cortical angle of the distal radius. The palmar cortical angle is different to its previously described palmar tilt or angulation. The mean value for the palmar cortical angle was 371 (range, 26–501). This may be clinically important in the design of palmar plates for the distal radius. Journal of Hand Surgery (British and European Volume, 2003) 28B: 2: 163–164
between observations was also calculated together with the 95% limits of agreement.
INTRODUCTION There is no information and no reference values for the angle between the palmar surface of the distal radius and the shaft of the radius. This study set out to determine this value, the palmar cortical angle of the distal radius.
RESULTS The palmar cortical angle had a mean value of 371 (SD,61) for the first observer and 381 (SD,61) for the second observer. The mean of the difference was 11 (SD,4) and the 95% limits of agreement were 71 to 81.
MATERIALS AND METHODS DISCUSSION
Normal wrist radiographs were randomly selected from the radiology department. Fifty with good-quality lateral views of the wrist joint were chosen. This quality was confirmed by the overlapping of the ulnar head and distal radius. In each case, a line was drawn along the palmar surface of the shaft of the distal radius. A second line was drawn parallel to the palmar cortex of the distal radius (palmar cortical line). The angle between these two lines was measured and represented the palmar cortical angle (Fig 1). Two observers made the measurements independently to reduce the likelihood of bias. For each observer, the mean angle and standard deviation were calculated. The mean of the difference
Fig 1
Radiological and anatomical measurements of the distal radius have been extensively studied in the past (Friberg and Lundstrom, 1976; Johnson and Szabo, 1993; Solgaard, 1984). Parameters such as radial height, radial inclination and palmar tilt have been assessed. To our knowledge, no radiological or anatomical study has looked at the palmar cortical angle of the distal radius. This is different to the palmar angulation of the articular surface of the distal radius. The mean palmar cortical angle was 371 and the result of our two independent observers indicated good reproducibility. In our experience of palmar plating of the distal radius, pre-bent palmar buttress plates, such
Measurement of the palmar cortical angle: A, line drawn along palmar surface of shaft of distal radius; B, palmar cortical line; a, palmar cortical angle. 163
164
as the AO (Stratec, Overdorf, Switzerland) palmar tension band plate which is pre-bent to 201, have to be contoured a further 151 or so to reproduce the normal palmar anatomy of the distal radius. This is in keeping with our measurements of the palmar cortical angle. At the time of surgery, contouring of the plate is determined by measuring the palmar cortical angle of the unaffected wrist, which it is assumed is similar to that of the injured wrist. References Friberg S, Lundstrom B (1976). Radiographic measurements on the radio-carpal joint in distal radius fractures. Acta Radiologica Diagnosis, 17: 869–876.
THE JOURNAL OF HAND SURGERY VOL. 28B No. 2 APRIL 2003 Johnson PG, Szabo RM (1993). Angle measurement of the distal radius: a cadaver study. Skeletal Radiology, 22(4): 243–246. Solgaard S (1984). Angle of inclination of the articular surface of the distal radius. Radiologe, 24(7): 346–348.
Received: 4 July 2002 Accepted after revision: 22 October 2002 Dr Rashpal Singh Bassi, 44 Beaudesert Road, Handsworth, Birmingham B20 3TG, UK. Tel.: +44-121-551-3237; E-mail: [email protected]. r 2003 The British Society for Surgery of the Hand. Published by Elsevier Science Ltd. All rights reserved. doi:10.1016/S0266-7681(02)00305-4/jhsb.2003.0878, available online at http://www.sciencedirect. com