|Year : 2021 | Volume
| Issue : 2 | Page : 70-74
Morphometric study of the distal end of dry adult humerus of the South Indian population with its clinical applications
G Vinay1, W Benjamin2, Aditya K Das3, KH Raviprasanna4, D Sunil Kumar5
1 Associate Professor, Department of Anatomy, All India Institute of Medical Sciences, Guwahati, Assam, India
2 Associate Professor, Department of Anatomy, PK Das Institute of Medical Sciences, Vaniyakulam, Palakkad, Kerala, India
3 Professor, Department of Anatomy, Sree Narayana Institute of Medical Sciences, Chalakka, Ernakulam, Kerala, India
4 Associate Professor, Department of Anatomy, Mamata Medical College, Khammam, Telangana, India
5 Associate Professor, Department of Community Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
|Date of Submission||07-Oct-2020|
|Date of Decision||04-Jan-2021|
|Date of Acceptance||17-Feb-2021|
|Date of Web Publication||09-Apr-2021|
K H Raviprasanna
Associate Professor, Department of Anatomy, Mamata Medical College, Khammam, Telangana
Source of Support: None, Conflict of Interest: None
Background: The arm bone is the largest and strongest bone of the superior extremity. Movement of the arm bone helps in essential activities like writing. lifting objects and throwing. Use of implants in communited cracks in the lower end of the humerus of an aged person may be needed to retain the mobility at the elbow joint. The present study was aimed at providing morphometry of the distal end of the arm bone for comparison with different populations. Methodology: Eight morphometric parameters were evaluated from 200 dry adult humeral bones using the osteometric board and digital vernier calipers. Results: The average value of the maximal length of the arm bone in the present study was 306.3 ± 21.19 mm in the right humerus and 301.1 ± 22.4 mm in the left humerus. The transverse distance between the medial and lateral epicondyles was 57.4 ± 4.8 mm and 56.0 ± 4.7 mm in right and left humerus, respectively. The average distance between the capitulum and medial end of trochlea horizontally was 39.6 ± 3.4 and 39.5 ± 4.3 mm in right and left humerus, respectively. The average maximum transverse diameter of the trochlea was 24.4 ± 2.6 and 23.5 ± 2.6 mm in right and left humerus, respectively. The average anteroposterior diameter of the trochlea was 17.0 ± 3.9 and 16.3 ± 3.7 mm in right and left humerus, respectively. Conclusion: Eight morphometric parameters of 200 humeri presented. This information can be useful for surgeons in preparing implants and reconstruction of fractures of the distal end of the arm bone.
Keywords: Capitulum, distal end, fractures, Humerus, trochlea
|How to cite this article:|
Vinay G, Benjamin W, Das AK, Raviprasanna K H, Kumar D S. Morphometric study of the distal end of dry adult humerus of the South Indian population with its clinical applications. Natl J Clin Anat 2021;10:70-4
|How to cite this URL:|
Vinay G, Benjamin W, Das AK, Raviprasanna K H, Kumar D S. Morphometric study of the distal end of dry adult humerus of the South Indian population with its clinical applications. Natl J Clin Anat [serial online] 2021 [cited 2021 May 12];10:70-4. Available from: http://www.njca.info/text.asp?2021/10/2/70/313539
| Introduction|| |
The humerus is the largest and sturdiest bone of the superior extremity. It has proximal end, shaft and the distal end. The lateral epicondyle, capitulum, trochlea, and medial epicondyle are the features of the distal end of the arm bone. The medial and lateral epicondyles of the arm bone give attachment to muscles for the flexor and extensor compartments of the forearm, respectively. The trochlea of the distal end of the arm bone joins with the trochlear indent of the ulna and the capitulum joins with the radial head to form the elbow joint. The medial flange of the trochlea is sharp and at lower level than the capitulum. This acts as a factor for the carrying angle at the elbow. Morphometry of the long bones is important for the identification of unknown bodies, estimation of height, age, gender in forensic science. Anthropological scientists, health experts, and anatomists have used anthropometric techniques for estimation of the height of an individual and bone length from unknown skeletal remains. Munoz et al. used remains of humerus segments to estimate the total length of humerus and gender. Orthopedic surgeons face difficulty in fixing the complex fractures involving the distal end of arm bone with damage to the nerve and blood vessels. The availability of precontoured implants helps in fracture reduction. The information of the morphometry of the distal end of the arm bone can assist in reconstructive surgeries through implants. Burkhart et al. reported that the postoperative mobilization was immediate in elderly patients who underwent total elbow arthroplasty and they could do routine activities. The present study was aimed at providing morphometry of the distal end of the arm bone for comparison with different populations.
| Materials and Methods|| |
Two-hundred dry human adult humerii obtained from the bone banks of the department of anatomy of private medical colleges in south India. They were segregated as 93 belonged to the right side and 107 to the left side. The bones included in this study were nonpathological and free from damage. Bones with poor condition and partly damaged were excluded from the study. After obtaining the clearance from the Institutional Ethics Committee (IEC/IRB No.8, dated 14-5-2019), the following morphometric measurements of the eight parameters planned for this study were measured. P1 – the maximal length of arm bone was measured from the tip of the head of the humerus to the transverse line passing at the apex of the trochlea with the help of the osteometric board with the precision of 1 mm [Figure 1]. P2 The transverse distance between the medial and lateral epicondyles. P3 The transverse distance from the medial flange of the trochlea to the capitulum. P4 The horizontal distance from the medial epicondyle to the capitulum, P5 – the maximal horizontal diameter of the trochlea. P6 – Anteroposterior diameter of the trochlea at the middle part of the trochlea. P7 – Maximal length of the medial flange of the trochlea. P8 – Maximal length of the lateral flange of the trochlea. The measurements of the distal end of humerus were measured using digital vernier caliper in millimeters as shown in [Figure 2] and [Figure 3].
|Figure 1: Image shows how the Parameter 1 was measured using osteometric board|
Click here to view
|Figure 2: The parameters (P2–P5) used for measuring the distal end of humerus. P2 – The transverse distance between the medial and lateral epicondyles. P3 – The transverse distance from the medial flange of the trochlea to the capitulum. P4 – The transverse distance from the medial epicondyle to the capitulum. P5 – The maximal horizontal diameter of the trochlea|
Click here to view
|Figure 3: How parameter 7 (maximal length of medial flange of trochlea) was measured|
Click here to view
The data were entered into Microsoft Excel (Office 2010, Microsoft Inc., USA) and followed by analysis using SPSS 23.0 software version (Statistical Package for Social Sciences, IBM, SPSS Statisticsfor windows, Armonk, NY, USA). The mean, standard deviation, and level of significance were calculated for each parameter. Independent samples t-test was applied to each of these parameters for assessing statistical significance. The P < 0.05 was taken as statistically significant.
| Results|| |
Two hundred bones used in this study included 93 right and 107 left humeral bones. Each bone was measured for eight parameters as described in the materials and methods. The average value of the maximal length of the 200 arm bones (P1) was 303.7 ± 22.1 mm. The average transverse distance between the medial epicondyle and lateral epicondyle (P2) was 56.7 ± 4.7 mm and the average transverse distance from the medial flange of the trochlea to the capitulum (P3) was 39.5 ± 3.8 mm. The average transverse distance from the medial epicondyle to the capitulum (P4) was 53.5 ± 5.5 mm. The mean horizontal diameter of the trochlea (P5) was 23.9 ± 2.6 mm. The average anteroposterior diameter of the trochlea (P6) was 16.6 ± 3.8 mm. Trochlea's medial flange average length (P7) was 22.7 ± 2.7 mm and lateral flange average length (P8) was 18.5 ± 2.9 mm. The average values and standard deviation for the measurements obtained from the eight parameters were categorized under the right and left humerus and the respective values are depicted in [Table 1]. The P value obtained from the independent samples t-test to show the statistical significance is shown in [Table 1].
|Table 1: Data analysis of the parameters used for morphometry of distal end of humerus in millimeters|
Click here to view
| Discussion|| |
Several parameters of the arm bone help orthopedic surgeons, anthropological scientists, forensic experts, and morphologists. Distal humeral arthroplasty is a reasonable treatment option for older patients with unreconstructable intraarticular fractures of the distal humerus as well as in younger patients with rheumatoid arthritis, orthopedic tumor with significant bone loss, malunion, or osteomyelitis. The regression equations are formulated for estimation of total length of humerus from its proximal segment measurements on 150 humeral bones by Lakshmi Kantha BM et al. These parameters can be utilized for estimating the height of the individual, age, gender and race. Above measurements can also help orthopedic surgeons in the procurement of prosthetic implants for reconstructive surgeries and arthroplasty.
The average value of the maximal length of arm bone provides proof to demonstrate the typical features of a group of people. The average maximal length of arm bone of the present study is compared with different authors in [Table 2]. The maximal length of arm bone considered in the present study was lower than the Turkish and Brazilian population., The subtle difference between the population can be accredited to heredity and acclimatization. The occurrence of asymmetry of the right and left superior extremity is an innate feature. It can likewise be disclosed because of the control of the contralateral hemisphere of the brain, the left half of the cerebral hemisphere will be bigger than the right one and shows functional superiority and prevailing influence on the right extremity., [Table 3] shows the comparison of the values obtained after measuring parameters two to parameter six related to the distal end of the arm bone. Lokanadham et al. reported the gender differences in the maximum horizontal diameter of the trochlea (20.34 ± 0.022 and 20.09 ± 0.034 mm in males and females, respectively).
|Table 2: Comparison between the different studies for the parameter of maximal length of arm bone (P1)|
Click here to view
The length of the medial flange of the trochlea was observed to be more when compared to the lateral flange of the trochlea which creates an angulation called the trochlear angle. The difference in the length of medial and lateral flanges of the trochlea and the presence of trochlear angle results in the formation of carrying angle during extension of the elbow joint. Any alterations related to carrying angle can cause cubitus valgus and cubitus varus.
Even though the overall occurrence of distal humeral fractures in adults has been reported 5.7 cases/1,00,000 cases. However, these can be challenging to treat as they can result in considerable long-term impairment. Distal humeral fractures can range from mere extraarticular to complicated. The communited distal humeral fractures with split in trochlea and capitulum make fracture reduction and stabilization challenging. Complex fractures can be managed with the help of open reduction and fixing the fracture internally. Total elbow arthroplasty has a best success rate for patients with inflammatory arthritis, aged patients with acute distal humeral fractures. The excision of humeral condyles had minimal aftereffects on the strength of the forearm, the wrist, and the hand. There were no consequences on the Mayo Elbow Performance Score following total elbow arthroplasty. The existing study elaborates the morphometry of adult humerus, the outcomes of the study may not have huge clinical implications as distal humeral fractures (including supracondylar fractures) are most common in children. In distal humeral fractures in elderly patients, total elbow replacement can be considered and outcomes of the present study (distal humeral morphometry) are of less value in such situations. The outcomes of the present study are important during distal humeral hemiarthroplasty. However, this surgical procedure is relatively rare. The other limitations of this study are smaller and unequal (right and left) sample size when compared to the actual population in the area and gender inequality.
The purpose of the present study was to compare with right and left arm bones. The average values of the different measurements of the distal end of the humerus are almost similar to the different authors with little variations. The difference observed in the distal humeral morphometry can be endorsed to genetic factors, race, environment and even continuous change in the mode of living of a human being. The morphometry of distal humerus can help in improving the designs of prosthetic implants which are used for reconstruction of complex fractures either by partial or total elbow arthroplasty other than helping in the estimation of height and age of an individual.
| Conclusion|| |
Eight morphometric parameters of 200 humeri presented. The average maximal length was 303.7 ± 22.1 mm, the average distance between medial and lateral epicondyle was 56.7 ± 4.7 mm. The difference observed in the distal humeral morphometry can be endorsed to genetic factors, race, environment and even continuous change in the mode of living of a human being. The morphometry of distal humerus can help in improving the designs of prosthetic implants which are used for reconstruction of complex fractures either by partial or total elbow arthroplasty other than helping in estimation of height and age of an individual.
We thank with due respect and deep gratitude to the other teaching faculty and nonteaching staff from the Anatomy Department for suggestions and advice that helped us largely.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sinnatamby CS. Upper limb. Osteology of the upper limb. In: Last's Anatomy: Regional and Applied. Part 12. 12th
ed., Ch. 2. Philadelphia: Churchill Livingstone Elsevier Ltd.; 2011. p. 171-2.
Akman SD, Karkas P, Bozkir MG. The morphometric measurements of humerus segments. Turk J Med Sci 2006;36:81-5.
Munoz JI, Linares Iglesias M, Suarez Penaranda JM, Mayo M, Miguens X, Rodríguez Calvo MS, et al
. Stature estimation from radiographically determined long bone length in a Spanish population sample. Forensic Sci Int 2001;46:363-6.
Siva Narayana A, Himabindu A. The morphometric study of distal end of humerus. Paripex Indian J Res 2018;7:136-7.
Burkhart KJ, Müller LP, Schwarz C, Mattyasovszky SG, Rommens PM. Treatment of the complex intraarticular fracture of the distal humerus with the latitude elbow prosthesis. Oper Orthop Traumatol 2010;22:279-98.
Salles AD, Carvalho CR, Silva DM, Santana LA. Reconstruction of humeral length from measurements of its proximal and distal fragments. Braz J Morphol Sci 2009;26:55-61.
Dunn J, Kusnezov N, Pirela-Cruz M. Distal humeral hemiarthroplasty: Indications, results, and complications. A systematic review. Hand (N Y) 2014;9:406-12.
Lakshmi Kantha BM, Naveen NS, Kulkarni R, Veena V. Regression equation for estimation of total humeral length using measurements of its proximal segments among Indian population. Natl J Clin Anat 2016;5:15-21. [Full text]
Ashiyani ZA, Solanki S, Mehta CD. The morphometric measurement of segments of humerus. J Res Med Den Sci 2016;4:38-40.
Hiramoto Y. Right-left differences in the lengths of human arm and leg bones. Kaibogaku Zasshi 1993;68:536-43.
Singh A, Nagar M, Kumar A. An anthropometric study of the humerus in adults. Res Rev J Med Health Sci2014;3:77-82.
Lokanadham S, Khaleel N, Raj PA. Morphometric analysis of humerus bone in Indian population. Sch J App Med Sci 2013;1:288-90.
Purkait R, Chandran H. An anthropometric investigation into the probable cause of formation of 'carrying angle': A sex indicator. J Indian Acad Forensic Med 2004;26:14-19.
Robinson CM, Hill RM, Jacobs N, Dall G, Court-Brown CM. Adult distal humeral metaphyseal fractures: Epidemiology and results of treatment. J Orthop Trauma 2003;17:38-47.
Sanchez-Sotelo J. Total elbow arthroplasty. Open Orthop J 2011;5:115-23.
McKee MD, Pugh DM, Richards RR, Pedersen E, Jones C, Schemitsch EH. Effect of humeral condylar resection on strength and functional outcome after semiconstrained total elbow arthroplasty. J Bone Joint Surg Am 2003;85:802-7.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]