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A radiographic investigation of the relationships between humeral cortical bone thickness, medullary canal width and the supratrochlear aperture (STA)

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Abstract

The supratrochlear aperture (STA) is a perforation of the septum between the olecranon and coronoid fossae of the humerus. Bones with STA are prone to supracondylar fractures and are thought to have narrower medullary canals. Our aim was to explore the relationship of the STA with medullary canal width and humeral size. The study employed a case–control research design with approximately equal numbers of individuals with and without STA from South African Whites, Blacks, and the Mixed ethnic group. Radiographs were taken anteroposteriorly using a Lodox Statscan and Image J® software was used to acquire measurements from the radiographs. In the proximal diaphysis, the mean medullary canal width was significantly smaller for STA humeri (13.59 vs. 14.72 mm). The same was true for the midshaft (10.21 vs. 10.84 mm) and the distal portion (10.05 vs. 10.63 mm). While STA humeri appeared to have narrower medullary canal dimensions, this was not the case after standardizing for bone size. The smaller medullary canal width reported in the literature for STA-bearing humeri is, therefore, due to bone size differences and not STA presence. This is supported by the strong positive correlation between bone size and medullary canal width irrespective of STA status. Thus, the medullary canal width increases with bone size independent of STA status. We, therefore, propose that bone size, and not STA presence, is the major factor to consider when choosing rods for intramedullary fixation.

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Acknowledgments

We thank Nafeesah Karriem for permission to use the Lodox scanner and providing technical assistance at the University of Cape Town and Professor Wadee for permission to use the Lodox facility at the Department of Forensic Pathology, Stellenbosch University. We are very grateful to the following people for access to skeletal material: Brendon Billings for access to the Raymond A Dart Collection of Human Skeletons, Mandi Alblas for use of the University of Stellenbosch Bone Collection, Professor Alan Morris for use the University of Cape Town Bone Collection, and Professor Ericka L’Abbé and Marius Loots for use of the Pretoria Bone Collection. We thank Dr. T Esan for advice on statistical methods. Funding for the project came from the National Research Foundation (South Africa).

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Authors and Affiliations

  1. Faculty of Health Sciences, School of Anatomical Sciences, University of the Witwatersrand, Johannesburg, 7 York Road, Parktown, 2193, South Africa

    Robert Ndou, Sovana Maharaj & Lynne Alison Schepartz

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  1. Robert Ndou
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  2. Sovana Maharaj
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  3. Lynne Alison Schepartz
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Correspondence to Robert Ndou.

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Ethics

Ethical clearance (W-CJ-140604-1) under the South African Human Tissue Act No. 65 of 1983 and the National Health Act No. 61 of 2003 applies for use of the skeletal elements in the present study.

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All the authors declare no financial relationship with the sponsor.

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Ndou, R., Maharaj, S. & Schepartz, L.A. A radiographic investigation of the relationships between humeral cortical bone thickness, medullary canal width and the supratrochlear aperture (STA). Surg Radiol Anat 39, 57–68 (2017). https://doi.org/10.1007/s00276-016-1701-2

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