Ulna Research Articles

Effects of Dietary Pattern on Average Cortical Bone Density and Estimated Thickness of the Proximal Ulna

There is an established relationship between diet and phenotype in various human body systems. Vegetarian diets may contain lower quantities of calcium and protein compared to other diets, causing speculation that this dietary pattern may contribute to lower bone mineral density (BMD) or osteoporosis. Nutritional intake is a major element in a person’s overall Bone Mineral Density (BMD), but little is known about how the upper extremity responds to changes in dietary pattern. There is also conflicting evidence for the effects of a vegetarian diet on bone, with some studies suggesting that lower quantities of calcium and protein compared to other diets contributes to lower bone mineral density (BMD), while others find that the lower acidic load found in the vegetarian diet combined with a higher intake of potassium have a calcium‐sparing effect with positive effects on bone health. This study tests how vegetarian and convenience diets affect Cortical Bone Thickness (CBT) and Average Cortical Density (ACD) of the olecranon process in humans, a site of fracture in the upper limb.Computed tomography (CT) scans with varying dietary pattern were obtained from the New Mexico Decedent Image Database and segmented in 3D Slicer. Cortical thickness was measured by calculating the difference between periosteal and endosteal section contours. Density was approximated by comparing the average radiodensity after applying a threshold of 500 HU to isolate cortical bone. MANOVA and post‐hoc ANOVA testing were conducted in R Studio to test differences between dietary groups. There was a statistically significant effect of bone length (p = 0.001) and diet (p = 0.014) on both proximal ulnar bone properties measured (approximated cortical thickness and density). Post‐hoc testing found that only bone length had a significant effect on cortical thickness (p = 0.003) while diet, but not bone length or sex, had a significant effect on average cortical density (p = 0.008).These results provide evidence of detrimental effects of a convenience diet on bone density, and possible evidence for beneficial effects of a vegetarian diet. Convenience foods are high in saturated fats, sodium, and refined sugars, which have been shown to have negative effects on bone mass and bone microarchitecture in rodents. Our results suggest that similar effects may be seen in the cortical bone of humans, providing additional evidence for the negative effects of convenience food on health. Previous studies have found that nutritional acidic load, which may be lowered by a vegetarian diet, is positively correlated with fracture risk and negatively correlated with BMD. Our results support these findings and add to the growing evidence for the benefits of a vegetarian diet.

Paper 12: Biomechanical Comparison of Anatomic Restoration of the Ulnar Footprint Versus Traditional Ulnar Tunnels in Ulnar Collateral Ligament Reconstruction

Objectives:Current techniques for ulnar collateral ligament (UCL) do not reproduce the anatomic ulnar footprint of the UCL. The purpose of this study was to describe a novel UCL reconstruction technique that utilizes proximal-to-distal ulnar bone tunnels to better recreate the anatomy of the UCL and compare the biomechanical profile at time zero between this technique, the native UCL, and the traditional docking technique. Our hypothesis was that the biomechanical profile of the anatomic technique is similar to the native UCL and traditional docking technique.Methods:Ten matched cadaveric elbows were potted with the forearm in neutral rotation. The palmaris longus tendon graft was harvested, and bones were sectioned 14 cm proximal and distal to the elbow joint. Specimen testing included: (1) native UCL testing performed at 90° flexion with 0.5 Nm valgus moment preload, (2) cyclic loading from 0.5-to-5 Nm valgus moment for 1000 cycles at 1 Hz, and (3) load to failure at 0.2 mm/s. Elbows then underwent UCL reconstruction with one elbow of each pair receiving the classic docking technique using either anatomic (proximal-to-distal) or traditional (anterior-to-posterior) tunnel locations. Specimen testing was then repeated, as described above.Results:There was no difference between maximum load at failure or valgus angle between the anatomic or traditional tunnel location techniques (34.90 ± 10.65 Nm vs. 37.28 ± 14.26 Nm, P = 0.644) or the native UCL (45.83 ± 17.03 Nm, P = 0.099). Additionally, there was no difference in valgus angle after 1000 cycles across the anatomic (4.58 ± 1.47°), traditional (4.08 ± 1.28°), or native UCL (4.07 ± 1.99°). Anatomic group and the native UCL had similar valgus angles at failure (24.13 ± 5.86° vs. 20.13 ± 5.70°, P = 0.083), while the traditional group had a higher valgus angle at failure compared to the native UCL (24.88 ± 6.18° vs. 19.44 ± 5.86°, P = 0.015).Conclusions:UCL reconstruction with the docking technique utilizing proximal-to-distal ulnar tunnels to restore the anatomic ulnar footprint better recreates the anatomy of the UCL while providing valgus stability comparable to reconstruction with docking technique using traditional anterior-to-posterior ulnar tunnel locations. These results suggest that utilization of the anatomic tunnel location in UCL reconstruction has similar biomechanical properties compared to the traditional method at the time of initial fixation (i.e., not accounting for healing following reconstruction in vivo) while keeping the ulnar tunnels further from the ulnar nerve. Further studies are warranted to determine if an anatomically based UCL reconstruction results in differing outcomes compared to traditional reconstruction techniques.

Nanohydroxyapatite-Protein Interface in Composite Sintered Scaffold Influences Bone Regeneration in Rabbit Ulnar Segmental Defect

The healing physiology of bone repair and remodeling that occurs after normal fracture is well orchestrated. However, it fails in complex clinical conditions and hence requires augmentation by grafts. In this study, composite nanohydroxyapatite (nHA), poly(hydroxybutyrate) (PHB) and poly(ɛ-caprolactone) (PCL) constituted microspheres sintered three-dimensional scaffold were evaluated in rabbit ulnar segmental defect. A composite scaffold using PHB-PCL-nHA microspheres was developed with protein interface by solvent/non-solvent sintering to provide multiple cues such as biocomposition, cancellous bone equivalent meso-micro multi-scale porosity, and compressive strength. In vitro DNA quantification and alkaline phosphatase (ALP) assays revealed that the protein interfaced composite scaffolds supported osteoblast proliferation and mineralization significantly higher than scaffolds without protein and TCPS (p < 0.05). Scanning electron micrographs of osteoblasts cultured scaffolds demonstrated cell-matrix interaction, cell spreading, colonization and filopodial extension across the porous voids. Cylindrical scaffolds (5 × 10 mm) were implanted following segmental defect (10 mm) in rabbit ulnar bone and compared with untreated control. Radiography (4, 8 and 12 weeks) and µ-computed tomography (12 weeks) analysis showed directional bone tissue formation by bridging defective site in both scaffolds with and without protein interface. Whereas, undesired sclerotic-like tissue formation was observed in control groups from 8 weeks. Histology by hot Stevenel’s blue and van Gieson’s picrofuchsin staining has confirmed enhanced bone maturation in scaffold groups while presence of osteoids was observed in control after 12 weeks. Thus, the developed composite matrices exhibits osteoinductive, osteoconductive properties and demonstrates its bone regenerative potential owing to its compositional, micro & macro structural and mechanical properties.Graphical abstract

Simulated Analysis Ti-6Al-4V Plate and Screw as Transverse Diaphyseal Fracture Implant for Ulna Bone

Transverse diaphyseal fracture is one of the most common fractures caused by accidents. The fracture treatment needs surgery to apply the fixations that matched the bone geometry. This paper aims to reverse engineering of a published bone plate and screw criteria into a three-dimensional (3D) model and analyze them using the finite element method (FEM) in several factors, the bone, the plate, the screw, the unification of plate and screw, and combination all components. This paper conducts two main activities of designing plate and screw based on literature for ulna bone implant and running the FEM to achieve the von Misses stress in the plate, screw, and bone by placing load and constrained area based on the actual use of the implant in the patient. The maximum number in von Misses stress are 5.01855 MPa for bone only, 0.00918 MPa for plate only, 193.304 MPa for screws only, 6.28160 MPa for the assembly screws and a plate, and 761.07 MPa for all unification. All simulation results meet the expectation that the bone analysis is less than the compressive strength of the ulnar bone. Moreover, when applied to the bone, the plate and screw analysis and the assembly also demonstrate a lower number than the yield strength of the properties of the Ti6Al4V materials. All this biomechanical assessment confirms that designs could withstand ulnar bone’s ultimate flexural load and pressure. The finite element analysis (FEA) on the proposed recreated dimension on ulnar plate and screw is expected to accelerate the rehabilitation process of radius ulnar fracture, particularly in the transverse diaphyseal fracture in ulna bone.

Classification of Distal Growth Plate Ossification States of the Radius Bone Using a Dedicated Ultrasound Device and Machine Learning Techniques for Bone Age Assessments

X-ray imaging, based on ionizing radiation, can be used to determine bone age by examining distal growth plate fusion in the ulna and radius bones. Legal age determination approaches based on ultrasound signals exist but are unsuitable to reliably determine bone age. We present a low-cost, mobile system that uses one-dimensional ultrasound radio frequency signals to obtain a robust binary classifier enabling the determination of bone age from data of girls and women aged 9 to 24 years. These data were acquired as part of a clinical study conducted with 148 subjects. Our system detects the presence or absence of the epiphyseal plate by moving ultrasound array transducers along the forearm, measuring reflection and transmission signals. Even though classical digital signal processing methods did not achieve a robust classifier, we achieved an F1 score of approximately 87% for binary classification of completed bone growth with machine learning approaches, such as the gradient boosting machine method CatBoost. We demonstrate that our ultrasound system can classify the fusion of the distal growth plate of the radius bone and the completion of bone growth with high accuracy. We propose a non-ionizing alternative to established X-ray imaging methods for this purpose.

Application of WALANT in Diaphyseal Plating of Forearm Fractures: An Observational Study

Wide-Awake Local Anesthesia No Tourniquet (WALANT) is a novel anesthesia technique in distal radius and ankle fracture fixation. However, to date, there are limited studies in diaphyseal plating of forearm fractures under WALANT. This research is to study the feasibility of the use of WALANT technique in plating of diaphyseal fractures of the forearm as well as peri-operative outcomes. Sixty-one adult patients who underwent diaphyseal plating of the forearm under WALANT between the period of January 2019 and January 2021. It consists of 31 radius fractures, 15 ulna fractures and 15 ipsilateral radius and ulna fractures. Outcomes evaluated were duration of stay, peri-operative numerical pain rating scale, peri-operative blood pressure and heart rate, visual analogue scale for anxiety, blood loss, surgery duration, adverse effect, patient's satisfaction and any complications at 6 months follow up. Fifty-four patients (88.5%) were male and 7 patients (11.5%) were female with a mean age of 31.7 years (SD = 13.564). Thirty-eight out of 61 patients were totally pain free throughout the surgery. Ten (13%) patients reported pain during muscle dissection, 14 (18%) patients reported pain during bone manipulation and 12 (16%) patients reported pain during bone drilling. There was no significant difference in pain score between radius and ulna bones (P > .05). There was a significant change in blood pressure after LA infiltration (P < .01). The mean estimated blood loss was 27.39 ml (SD = 11.44) and the mean duration of post-surgery hospital stay was 1 day (SD = 1.026). Fifty-six patients (92%) recommended diaphyseal plating of the forearm under WALANT. None of the patients required conversion to general anesthesia and had any adverse events or infection during 6 months follow up. Diaphyseal plating of the forearm under WALANT is a feasible alternative anesthesia technique and is well tolerated by patients. Therapeutic III.

Vascularized bone flaps for trauma induced bone defects of the upper extremity in young adults: Presentation of two cases

Nonunions after complex upper extremity injury in young adults may result in diminished function, pain and decreased quality of life. The use of vascularized bone flaps is challenging. However, it offers the most bone healing stimulating properties in revision surgery. First, we describe the case of a young man with complex open wrist injury. He developed an osteoarthritis of the wrist, with abundant bone loss of the distal radius, ulna and carpal bones. He underwent wrist arthrodesis with the use of a vascularized iliac crest bone flap. Secondly, the case of a young woman is presented following a 4-part luxation fracture of the proximal humerus. She developed a nonunion with concomitant avascular necrosis. A reconstruction with plate fixation and a vascularized fibula flap was performed. In our cases, the use of vascularized autologous bone flaps resulted in union and a good clinical outcome. In literature, scarce evidence is present on the indications, procedure specifics, complications, clinical outcome, and patient related outcome measurements of the use of vascularized bone flaps for posttraumatic bone defects of the upper limb. This is likely due to the heterogeneity and scarcity of the patient population. The use of vascularized bone flaps is a viable treatment option for patients with complex nonunions of the upper extremity. • Impaired fracture healing of the upper extremity results in diminished functional outcome. • The use of vascularized bone flaps is an important option in revision surgery. • Vascularized fibula flaps and iliac crest flaps have good bone healing properties. • Osteoconductivity, osteoinductivity, osteogenicity and structural support determine the effectiveness of the graft.

Medial Ulnar Collateral Ligament Reconstruction: A Dual Docking, 4-Ply Reconstructive Technique

Background: Ulnar collateral ligament injuries are common in the overhead-throwing athlete as the anterior band of this ligament is the primary soft tissue static stabilizer to valgus stress during a throwing motion. Various surgical techniques have been described over the past 30 years to address these injuries including Jobe, modified Jobe, docking, 3-stranded docking, Graftlink, and anatomic repairs with good to excellent results. Nevertheless, modifications to these techniques may increase the strength and survival of the reconstruction, which may expedite and optimize postoperative rehabilitation and return to play. Indications: This is a reproducible technique that provides excellent outcomes. We believe a 4-ply construct, with the addition of a high tensile strength suture tape, may provide superior biomechanical properties compared to other reconstructive techniques. Biomechanical testing for this technique is currently underway. Technique Description: Medial ulnar collateral ligament reconstruction using a gracilis autograft passed from proximal to distal, secured at the ulna with a cortical button tension loop construct, and then repassed from distal to proximal with the addition of a high strength suture in parallel to function as an internal brace. Together, this creates a reinforced, 4-ply, ulnar collateral ligament reconstruction with excellent tensile strength. Other advantages of this technique are that it avoids bony bridge fracture between ulnar tunnels, it preserves ulnar bone stock, creates a more anatomic insertion at the sublime tubercle and provides a simple method to tension the entire graft construct. Results: The expected outcomes from this procedure are consistently positive with recent literature reporting greater than 90% of patients having an excellent outcome and over 80% of overhead athletes returning to sport at or above previous level. Conclusion: This specific technique provides a rigid, high-tensile strength reconstruction with excellent outcomes and a high percentage of return to play. Additionally, this technique avoids various technical pitfalls by utilizing cortical button suspensory fixation at the ulna which minimizes complications such as ulnar tunnel conversion and iatrogenic injury to the ulnar nerve when drilling posterior to the sublime tubercle as is necessary with other techniques.

Artificial Intelligence-Assisted Bone Age Assessment to Improve the Accuracy and Consistency of Physicians With Different Levels of Experience.

BackgroundThe accuracy and consistency of bone age assessments (BAA) using standard methods can vary with physicians' level of experience.MethodsTo assess the impact of information from an artificial intelligence (AI) deep learning convolutional neural network (CNN) model on BAA, specialists with different levels of experience (junior, mid-level, and senior) assessed radiographs from 316 children aged 4–18 years that had been randomly divided into two equal sets-group A and group B. Bone age (BA) was assessed independently by each specialist without additional information (group A) and with information from the model (group B). With the mean assessment of four experts as the reference standard, mean absolute error (MAE), and intraclass correlation coefficient (ICC) were calculated to evaluate accuracy and consistency. Individual assessments of 13 bones (radius, ulna, and short bones) were also compared between group A and group B with the rank-sum test.ResultsThe accuracies of senior, mid-level, and junior physicians were significantly better (all P < 0.001) with AI assistance (MAEs 0.325, 0.344, and 0.370, respectively) than without AI assistance (MAEs 0.403, 0.469, and 0.755, respectively). Moreover, for senior, mid-level, and junior physicians, consistency was significantly higher (all P < 0.001) with AI assistance (ICCs 0.996, 0.996, and 0.992, respectively) than without AI assistance (ICCs 0.987, 0.989, and 0.941, respectively). For all levels of experience, accuracy with AI assistance was significantly better than accuracy without AI assistance for assessments of the first and fifth proximal phalanges.ConclusionsInformation from an AI model improves both the accuracy and the consistency of bone age assessments for physicians of all levels of experience. The first and fifth proximal phalanges are difficult to assess, and they should be paid more attention.

Retrospective analysis: risk factors predicting failure of closed reduction in pediatric diaphyseal forearm fractures treated with elastic stable intramedullary nails (ESINs).

Level IV.

Case report: Congenital pseudoarthrosis ulna with radial head extrusion

Isolated congenital pseudoarthrosis of the ulna bone is not a common entity. We present such a case of a 13year teenager, she visited us with a deformity of her right forearm (since birth), and extruded forearm bone from the lateral aspect of the elbow joint. The examination and investigation confirmed the diagnosis of congenital pseudoarthrosis of the ulna bone with extrusion of the radial head and we treated her condition by the creation of a single bone forearm as a salvage procedure.

Upper Extremities Injuries in Children Attending Pediatric Emergency Department-SFH, Riyadh-Saudi

Trauma is a physical injury caused by violence or other forces; in serious trauma, the patient will be at risk of death or loss of function. Trauma is a leading cause of morbidity and mortality among all age groups. Objective: To study the pattern and outcome of upper limbs trauma in children attending the pediatric emergency department. Methodology: This was a retrospective cross-sectional study conducted in the Department of Pediatrics at Security Forces Hospital-Al-Riyadh. Result: Total number of patients seen during the study period was 343 patients, their age range between 6 months and 13 years old with a mean age of 5.473 (±3.8572); also, results showed boys were 187 (54.5%) patients and girls were 156 (45.5%) patients. Based on the site of trauma in the upper limbs, lacerations were in 114 (33.2%), Hand and/or wrist fracture in 67 (19.5%), Nursemaid Elbow in 43 (12.5%), both Radius and Ulnar bones fracture in 33 (9.6%), Radius bone fracture in 29 (8.5%), supracondylar fracture in 22 (6.4%), Clavicle bone fracture in 20 (5.8%), Humorous bone fracture in 7 (2%), Condylar bone fracture 6 (1.7%), and there was 1 (0.3%) patient with Scapulae and Ulna fracture.

A rare case of bilateral retinoblastoma metastasizing into the forearm

We present a case of an 8-year-old boy who had undergone chemotherapy with transpupillary thermotherapy for bilateral retinoblastoma (RB) at the age of 6 months. The patient had left forearm pain at the present visit. Bilateral ocular examination did not reveal any signs of RB reactivation. However, bone scan with technetium 99m-methyl diphosphonate (99mTc–MDP) and magnetic resonance imaging (MRI) showed the presence of metastasis in the proximal end of the ulnar bone, which was confirmed on bone marrow biopsy. Based on PCR study and molecular analysis, Ewing's sarcoma was ruled out and the patient was confirmed to have metastatic RB. Subsequently, he underwent chemotherapy along with wide excision of left proximal ulna + extracorporeal radiation therapy (ECRT) + plate reconstruction. At 15-month follow-up, the patient was stable with absence of recurrence of RB. This case highlights the need for long-term follow-up of patients with RB and the need for timely detection and management of metastasis.

Comparative anatomy of selected bones of forelimb of local Mongrelian Dog (Canis lupus familiaris) in Sokoto, Nigeria

This research was conducted over period of 3 months with the aim of studying Age related changes of selected bones of forelimb (Scapula, Humerus, Radius and Ulna) in Local Mongrelian Dog (Canis lupus familiaris). The study entails biometrical and gross observations on the bones. The sample bones were acquired from the experimental animals of comparative anatomy in the department. The bones were categorized into various age groups for the research. The length, width, diameter and circumference of the samples (scapula, humerus, radius and ulna bones) were determined for all the groups. The shape, size, color, location, position and relation of each segment of the samples at various stages of development were determined. The differences across the age groups of different samples were observed and recorded. Based on the research result, it was concluded that, the biometric and morphometry data was found to be increasing with advancement of age. A baseline data was established with the view to enhance learning.

Biomechanical Comparison of Anatomic Restoration of the Ulnar Footprint vs Traditional Ulnar Tunnels in Ulnar Collateral Ligament Reconstruction

Background: Current techniques for ulnar collateral ligament (UCL) reconstruction do not reproduce the anatomic ulnar footprint of the UCL. The purpose of this study was to describe a novel UCL reconstruction technique that utilizes proximal-to-distal ulnar bone tunnels to better re-create the anatomy of the UCL and to compare the biomechanical profile at time zero among this technique, the native UCL, and the traditional docking technique. Hypothesis: The biomechanical profile of the anatomic technique is similar to the native UCL and traditional docking technique. Study Design: Controlled laboratory study. Methods: Ten matched cadaveric elbows were potted with the forearm in neutral rotation. The palmaris longus tendon graft was harvested, and bones were sectioned 14 cm proximal and distal to the elbow joint. Specimen testing included (1) native UCL testing performed at 90° of flexion with 0.5 N·m of valgus moment preload, (2) cyclic loading from 0.5 to 5 N·m of valgus moment for 1000 cycles at 1 Hz, and (3) load to failure at 0.2 mm/s. Elbows then underwent UCL reconstruction with 1 elbow of each pair receiving the classic docking technique using either anatomic (proximal to distal) or traditional (anterior to posterior) tunnel locations. Specimen testing was then repeated as described. Results: There were no differences in maximum load at failure between the anatomic and traditional tunnel location techniques (mean ± SD, 34.90 ± 10.65 vs 37.28 ± 14.26 N·m; P = .644) or when including the native UCL (45.83 ± 17.03 N·m; P = .099). Additionally, there were no differences in valgus angle after 1000 cycles across the anatomic technique (4.58°± 1.47°), traditional technique (4.08°± 1.28°), and native UCL (4.07°± 1.99°). The anatomic group and the native UCL had similar valgus angles at failure (24.13°± 5.86° vs 20.13°± 5.70°; P = .083), while the traditional group had a higher valgus angle at failure when compared with the native UCL (24.88°± 6.18° vs 19.44°± 5.86°; P = .015). Conclusion: In this cadaveric model, UCL reconstruction with the docking technique utilizing proximal-to-distal ulnar tunnels better restored the ulnar footprint while providing valgus stability comparable with reconstruction with the docking technique using traditional anterior-to-posterior ulnar tunnel locations. These results suggest that utilization of the anatomic tunnel location in UCL reconstruction has similar biomechanical properties to the traditional method at the time of initial fixation (ie, not accounting for healing after reconstruction in vivo) while keeping the ulnar tunnels farther from the ulnar nerve. Further studies are warranted to determine if an anatomically based UCL reconstruction results in differing outcomes than traditional reconstruction techniques. Clinical Relevance: Current UCL reconstruction techniques do not accurately re-create the ulnar UCL footprint. The UCL is a dynamic constraint to valgus loads at the elbow, and a more anatomic reconstruction may afford more natural joint kinematics. This more anatomic technique performs similarly to the traditional docking technique at time zero, and the results of this study may offer a starting point for future in vivo studies.

The Relationship Between Anaerobic Power and Arm Volume and Service Shot Speed in Volleyball Players

Aim: The aim of this study is to examine the relationship between upper extremity anaerobic power and arm volume with the correct service shooting rate of athletes interested in volleyball. A total of 13 male athletes playing elite level volleyball participated in the study. Method: Arm volumes were measured while the athlete was standing and legs were shoulder width apart. The distance between the acromion bone and the olecranon bone was measured with ± 1 mm accuracy at 10% intervals. Forearm volumes were measured while the athlete was standing and legs were shoulder-width apart. The distance between the olecranon bone and the ulnar styloid bone was measured with ± 1 mm accuracy at 10% intervals. To determine their anaerobic performance, Wingate anaerobic power and capacity test (AP) was performed on a pan arm ergometer, which was connected to a computer modified for this arm and operated with compatible software. The service speed (SS) of the athletes was used in Pocket Radar. Data evaluation was carried out using a statistical program in computer environment. "Shapiro-Wilk Test" was used for normal distribution of data. In statistical analysis, minimum and maximum values, arithmetic mean, standard deviation values were calculated. "Pearson" correlation analysis was used for the normally distributed data in the relationship of arm volume (AV) with anaerobic power. The data were evaluated according to the "0.05" significance level. Results: When the findings are examined, the AP and SS values of the athletes (r =, 843 **; p &lt;, 001), RightAV values with SS (r = .857 **; p &lt;, 000), LeftAV and SS values (r = .924 **; p &lt;, 000) and significant relationship was found between Total AV and SS values (r =, 894 **; p &lt;, 000). Conclusions: As a result, the findings of our study showed that men who do elite volleyball sports both have high upper extremity anaerobic power characteristics and have a high percentage of muscles around the arm, and play a decisive role in the correct service shooting speed. Keywords: Volleyball, Power, Volume, Service

Association between body mass index, bone bending strength, and BMD in young sedentary women.

The purpose of this study was to determine whether body mass index (BMI) is a predictor of tibial or ulnar bending strength and bone mineral density (BMD) in sedentary women. Sedentary women (n = 34), age 19-27years, with low BMI (LBMI < 18.5kg/m2, n = 16), and normal or high BMI (NHBMI between 18.5 and 29.9kg/m2, n = 18) participated as study subjects. Study outcomes included tibial and ulnar bending strength (EI in Nm2) using a non-invasive mechanical response tissue analyzer (MRTA); BMD and bone mineral content (BMC) of the whole body (WB), femoral neck (FN), total hip (TH), lumbar spine 1-4 (LS1-4), and ulna; and bone turnover biomarkers. The LBMI group have lower (p < 0.01) body weight [group difference (Δ) = 32.0%], lean mass (LM) (Δ = 23.1%), fat mass (FM) (Δ = 77.2%), and tibial bending strength (Δ = 22.0%), compared to the NHBMI. The LBMI group also have lower (all p < 0.025) BMC in WB (Δ = 19.9%), FN (Δ = 20.1%) and TH (Δ = 19.0%), compared to the NHMBI, not in BMD results. Multivariate regression analysis shows that significant predictors of tibial bending strength are tibia length (adjusted R2 = .341), age (adjusted R2 = .489), ulna BMD (adjusted R2 = .536), and LM (adjusted R2 = .580). BMI was positively correlated with tibial EI (p < 0.05), height, weight, FM, LM, body fat% (all p < 0.01), and BMD of WB, FN, TH, and LS 1-4 (p < 0.05 or < 0.01). Our results show that BMI is not a significant predictor of tibial or ulnar bending strength in young sedentary women.

Kinematic Analysis During Straight Line Free Swimming in Horses: Part 1 - Forelimbs.

Background: Swimming is used for rehabilitation and conditioning purposes in equine sports medicine despite the lack of understanding of equine swimming kinematics. The aim of this study was to assess forelimb joints kinematics (elbow, carpus, and fetlock) in swimming horses. The specific objectives were 1- to calculate and compare joint angles in swimming vs. passive mobilizations (PM), 2- to determine joint angular velocities during a swimming stride cycle.Methods: Eleven elite endurance horses swam in a 100-m straight pool. Underwater (swimming) and overground (PM) videos were recorded from the horses' left side. Joint markers were applied on the lateral hoof wall, lateral metacarpal epicondyle, ulnar carpal bone, lateral humeral epicondyle, and the greater tubercle of humerus, from which elbow, carpus and fetlock angles, and angular velocities were obtained. As a reference, maximal fetlock, carpus, and elbow flexion/extension angles were determined during PM overground. Differences between angle extrema, angular velocities and range of motion (ROM) were compared.Results: Carpus and fetlock ROM were significantly smaller (p < 0.001) during swimming when compared with PM, while there was no difference in elbow ROM between both situations. The carpus had the greatest ROM of all joints during swimming. Absolute angular velocities values of all joints during swimming were greater during retraction than protraction (p < 0.001). When compared to other joints during protraction, the carpus joint reached the highest angular velocity.Conclusion: Swimming, as a rehabilitation exercise, has the potential to benefit horses where great elbow ROM with a moderate carpus and fetlock extension are wanted.

194 Challenging the Dogma of Radiographs a Joint Above and Below a Suspected Fracture: Quantification of Waste in Wrist Fracture Evaluation

The dogmatic teaching and practice to obtain X-ray imaging of the joint above and below every suspected wrist fracture is ingrained in emergency medicine and orthopedics. Originally recommended in a 1975 abstract, based on no data, this idea has been perpetuated to the present. In the interest of patient cost, resource management, and throughput we questioned the utility of this knee jerk radiographic exploration. We assessed the probability of identifying fractures outside of the wrist x-ray when no tenderness to palpation was elicited beyond the wrist. We performed a retrospective medical record review of patients diagnosed with wrist fractures at an urban public aid academic hospital. Inclusion criteria: was ICD diagnosis of distal radius, distal ulna, or carpal bone fractures at discharge between April 2019 and April 2020. Patients were excluded if they were <18 years of age, GCS <15, documented tenderness to the hand, proximal forearm, elbow, or humerus, or follow up visits. The documented physical exams performed by ED providers and Orthopedic consults were reviewed to identify location of tenderness both at the wrist and elsewhere. Undocumented tenderness was assumed to be negative. Analysis was performed with descriptive statistics including 95% confidence intervals. 716 patient encounters were identified. After exclusions, the cohort included 345 unique patients who presented with only wrist tenderness. Of the 345 patients, 113 were between the ages 18-40, 193 were between 40-65, and 39 patients were over 65. 177 (51%) were female. Based on our exclusion criteria, this sample had no tenderness outside of the wrist. Still, there were 268 hand x-rays, 284 forearm x- rays, 77 elbow x-rays, and 21 humerus x-rays performed. There were zero additional fractures identified in this imaging beyond the wrist. Analysing the frequency and outcome of these additional x-rays allowed estimation of the upper limit of the 95% CI as a way of estimating the probability of identifying an additional fracture. Forearm radiographs identified 0 % additional fractures, (95% CI (0.0 to 1.3%)). Hand x-rays 0% (95% CI (0.0 to 1.4%). Wrist x-rays alone identified 345 distal radial fractures, 184 distal ulna fractures, 14 carpal bone fracture/dislocations, and 1 proximal metacarpal fracture. The proportion of patients with additional radiographs that identified a fracture not identified on wrist x-ray in this sample was zero. Based on sample size the potential miss rate is likely less than 2%. This argues against default image ordering above and below tenderness and may provide savings on time, radiation, and cost.

Arthroscopic Triangular Fibrocartilage Complex Reconstruction Using a Palmaris Longus Tendon Graft.

Patients suffer from persistent ulnar wrist pain and distal radioulnar joint instability because of chronic triangular fibrocartilage complex (TFCC) foveal tear are treated with TFCC reconstruction. We performed an arthroscopic TFCC reconstruction using a palmaris longus tendon graft that provided a minimally invasive procedure. After confirming the TFCC foveal tear and stability between the TFCC remnant and radius, the bone tunnel was made in the ulna from the ulnar shaft to ulnar fovea. The position of the bone tunnel was checked by fluorography and arthroscopy. Curved bendable 18-gauge needles into which 3-0 nylon sutures were inserted in a loop shape were passed through the tunnel from the ulnar side, and both volar-side and dorsal-side TFCC remnants were penetrated. The nylon suture was extracted from the arthroscopic 4/5 portal, and the palmaris longus tendon graft was introduced into the joint. The graft was passed through the TFCC remnant and ulnar bone tunnel from the arthroscopic portal and fixed to the ulna using an interference screw. This procedure was indicated for TFCC foveal tears with intact radial-side TFCC remnants. If the radial-side tear and instability between the TFCC and radius coexist, this technique is contraindicated, and stabilization of both the radial and ulnar sides of the TFCC should be considered. This arthroscopic technique does not violate the distal radioulnar joint capsule, extensor carpi ulnaris tendon, or tendon sheath. In addition, it helps to stabilize the ulnar carpal complex.