Al Saffar, Radi Ali
Quantification of the variable radiocarpal ligaments pattern.
MSc(R) thesis, University of Glasgow.
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Background: The connections between the radius and the forearm, supporting the radiocarpal joint are poorly understood. They are also of high clinical importance as they are easily damaged through trauma and involved in the mechanical/functional decline of wrists with various degenerative joint diseases. This area has been a source of debate and inconsistency for decades due to the lack of reproducible, quantitative studies, and the recurrent use of different descriptions and terminology. The current study aims to accurately define the key ligaments supporting the radiocarpal joint by quantifying the size, shape and attachment area of the ligamentous structures around the distal radius.
Materials and Methods: The various attachments of each radiocarpal ligament were analysed in 10 anatomic preparations using gross, histological and 3D morphometric approaches. Each ligament fascicular pattern was traced from one attachment to another; diversions into non-fascicular (disorganised) tissue were excised. The dimensions of each ligament were measured three different ways: manual with callipers, from a digital photograph using ImageJ and with a 3D digitizer to create and measure a virtual 3D model of each structure. Two parameters were analysed in three different levels: the radial, middle and ulnar length as well as the proximal, middle and distal width. The area of ligamentous attachment (enthesis) of each radiocarpal ligament was measured with the microscribe digitiser and confirmed histologically.
Results: The ligamentous attachments of the distal radius are highly variable. Unlike the manual and digital measurements, microscribe measurements provide more reproducible data as there was no significant difference between the rounds of measurement for all structures (p>0.05). Histological analysis confirmed the gross findings with more quantitative details about each attachment.
Conclusions: These results provide an important insight towards a better understanding of the complex radiocarpal ligament anatomy with a morphometric description. The microscribe method gave more consistent results than the manual and digital methods and it is probably more accurate. The current study may suggest a special consideration in relation to the carpal instability aetiology and management. Further studies are required to determine the causative factors of these variations besides the study approaches and individual variability.
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