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Morphometric feature description of the proximal ulna based on quantitative measurement: a key consideration for implant design

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A Correction to this article was published on 29 December 2022

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Abstract

Purpose

To perform quantitative measurements of the anatomic morphology of the proximal ulna and establish the morphologic references based on Chinese for the surgical protocol and implant design.

Methods

The computed tomography data of 156 upper extremities were involved in this study. The ulna model was reconstructed in Mimics. Ten distance and 6 angle parameters were measured by 4 independent investigators with a new quantitative measurement method. The intraclass correlation coefficient was used to evaluate the measuring reliability. Gender and side differences of measured parameters were evaluated.

Results

Measurements showed a mean coronoid height of 15 mm, which was 42% of ulnar height with gender-specific differences (mean 16 mm in men and 14 mm in women, P < 0.001). A mean unsupported anteromedial facet width of 8 mm was 61% of the coronoid anteromedial facet. A larger opening angle correlates to a larger olecranon-diaphysis angle (P < 0.001) and larger coronoid height (P = 0.001). A mean proximal ulna dorsal angulation of 4.7° is present in 80% of models at an average of 52 mm distal to olecranon tip. The average proximal ulna varus angulation was 16° at a mean of 74 mm distal to the olecranon tip. Morphological features between the left and right sides were highly consistent. The ICC was between 0.789 and 0.978 for inter-observer and between 0.696 and 0.997 for intra-observer reliability.

Conclusions

The proximal ulna features variable morphology but minor side differences among individuals. Over half of the anteromedial facet was not supported by the proximal ulnar diaphysis, making the coronoid vulnerable to elbow trauma. Preconditioning or customized design of the ulnar plate in the clinical setting with the help of contralateral morphology may be a good choice.

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Availability of data and materials

This work was performed in the Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China. The upper extremity DICOM data of 114 subjects between 2016 and 2020 were collected from our institution.

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Funding

This work was supported by the Special Projection on the Health Care of the Chinese Military Foundation (Grant 14BJZ09) and the Special Research Project of Prevention and Treatment of Military Training Injuries (20XLS27). We declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Author notes

  1. Daofeng Wang, Jiantao Li, and Gaoxiang Xu have contributed equally to this manuscript.

Authors and Affiliations

  1. Medical School of Chinese PLA, Beijing, China

    Daofeng Wang, Gaoxiang Xu & Wupeng Zhang

  2. Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Beijing, 100048, China

    Daofeng Wang, Jiantao Li, Gaoxiang Xu, Hao Zhang, Cheng Xu, Wupeng Zhang, Hua Li, Licheng Zhang, Li Li & Peifu Tang

  3. National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China

    Daofeng Wang, Jiantao Li, Gaoxiang Xu, Hao Zhang, Cheng Xu, Wupeng Zhang, Hua Li, Licheng Zhang & Peifu Tang

  4. Department of Orthopedics, School of Medicine, Nankai University, Tianjin, China

    Wupeng Zhang

  5. Department of Orthopedics, Kunming Medical University, Yanan Hospital, Kunming, China

    Xuewen Gan & Ying Xiong

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  1. Daofeng Wang
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Contributions

All authors contributed to the study’s conception and design. Project development and protocol were designed by PT, LZ, and LL. Material preparation, data collection, and analysis were performed by DW, JL, and GX. The first draft of the manuscript was written by DW. HZ, CX, WZ, HL, XG, and YX commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Li Li or Peifu Tang.

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Conflict of interest

The authors and their immediate family have no relevant financial or non-financial interests to disclose.

Ethical approval

This approval is to certify that the study “Morphometric Feature Description of the Proximal Ulna Based on Quantitative Measurement: A Key Consideration for Implant Design” has been approved by the ethics committee of Chinese PLA General Hospital (S2020-114-01).

Consent to participate

This is an observational study based on the CT data. Informed consent in the study is not applicable.

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This is an observational study based on the CT data. Informed consent to publish in the study is not applicable.

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Wang, D., Li, J., Xu, G. et al. Morphometric feature description of the proximal ulna based on quantitative measurement: a key consideration for implant design. Surg Radiol Anat 45, 215–224 (2023). https://doi.org/10.1007/s00276-022-03058-8

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