Novel Radiographic Indexes for Elbow Stability Assessment: Part B—Preliminary Clinical Study

Abstract

Introduction The coronoid process plays a key-role in preserving elbow stability. Currently, there are no radiographic indexes conceived to assess the intrinsic elbow stability and the joint congruency. The aim of this study is to present new radiological parameters, which will help assess the intrinsic stability of the ulnohumeral joint and to define normal values of these indexes in a normal, healthy population. Methods Four independent observers (two orthopaedic surgeons and two radiologists) selected lateral view X-rays of subjects with no history of upper limb disease or surgery. The following radiographic indexes were defined: trochlear depth index (TDI); anterior coverage index (ACI); posterior coverage index (PCI); olecranon–coronoid angle (OCA); radiographic coverage angle (RCA). Inter-observer and intra-observer reproducibility were assessed for each index. Results 126 subjects were included. Standardized lateral elbow radiographs (62 left and 64 right elbows) were obtained and analysed. The mean TDI was 0.46 ± 0.06 (0.3–1.6), the mean ACI was 2.0 ± 0.2 (1.6–3.1) and the mean PCI was 1.3 ± 0.1 (1.0–1.9). The mean RCA was 179.6 ± 8.3° (normalized RCA: 49.9 ± 2.3%) and the mean OCA was 24.6 ± 3.7°. The indexes had a high-grade of inter-observer and intra-observer reliability for each of the four observers. Significantly higher values were found for males for TDI, ACI, PCI and RCA. Conclusion The novel radiological parameters described are simple, reliable and easily reproducible. These features make them a promising tool for radiographic evaluation both for orthopaedic surgeons and for radiologists in the emergency department setting or during outpatient services. Level of evidence Basic Science Study (Case Series). Clinical relevance The novel radiological parameters described are reliable, easily reproducible and become handy for orthopaedic surgeons as well as radiologists in daily clinical practice.

Novel Radiographic Indexes for Elbow Stability Assessment: Part A—Cadaveric Validation

“…Though, plain films are still unable to guarantee the benefits of dynamic investigation, several dynamic stress while performing X-rays were performed without clinically relevant results [47,48]. Thank to the rigorous ex vivo anatomical validation, this study paves the way to the application of the described indexes and angles in vivo (Part B, [49]) and in the clinical setting, anticipating also a possible future description on CT and MRI images reconstructed in a sagittal trochlear plane.…”

A 70° Arthroscope Provides Better Visualization of the Medial Side of the Elbow Than a 30° Arthroscope

“… 13 In these cases, the surgeon is often more focused on the repair of the bony components, and this could lead to an underestimation of the ligamentous injuries. 14 , 15 Moreover, ultrasound and/or magnetic resonance imaging (MRI) evaluation of the ligaments could be challenging, especially right after a traumatic event. 16 , 17 Arthro-MRI or arthro–computed tomography has higher sensitivity but is less readily available in case of ligamentous injury after acute instability.…”

Humeral trochlear morphology does not influence coronoid fractures in elbow dislocation

“…While the role of the ulnar greater sigmoid notch congruence has already been studied [8, 9], the relationship between individual anatomical joint congruence and simple (SED) or complex (CED) elbow dislocation remains unclear. The role of distal humeral morphology in humeroulnar instability has not been extensively analyzed.…”