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Bone Anatomy

Elbow osseous anatomy: humerus, ulna, radius—critical landmarks for fracture classification & surgical approaches.

Overview

The management of forearm pathology requires precise anatomical understanding and tailored surgical strategies. For hypertrophic non-unions of pathological forearm fractures, stabilization of the entire bone combined with early mobilization is the standard of care [1]. In cases of Trevor’s disease (dysplasia epiphysealis hemimelica), complete resection and correction osteotomy can restore normal anatomy and yield good function without local recurrence in patients with functional impairment or remarkable deformity [4]. The one-bone forearm procedure is indicated only when instability and bone loss are irreparable by bone-grafting or other reconstructive procedures, and there is no chance of restoring rotation of the forearm [21].

Pediatric upper extremity interventions present distinct challenges. Bone lengthening in this population is associated with a high complication rate [9]. Success in pediatric upper extremity bone lengthening is commonly defined by radiographic lengthening, joint motion, and patient satisfaction rather than validated outcome measures [9]. Anterior Monteggia lesions in children with no major intra-articular injury or damage to epiphyseal centers can be treated with procedures allowing for anatomical reduction, complete bone remodeling, and good range of motion [27].

Preoperative planning relies on detailed imaging and an appreciation of anatomical variability. Standard and specialized radiographic views of the elbow provide valuable clinical information during patient evaluation [8]. CT-based measurements of distal humerus morphology provide a basis for the design of distal humeral orthopaedic implants to ensure greater alignment with anatomical structure and improved surgical outcomes [24]. Preoperative humeral computed tomography may serve as an indicator of low bone mineral density, with lower HU values at anchor insertion sites suggesting a risk of bone fragility during surgical planning for rotator cuff repair [60]. The proximal radius exhibits a wide range in size and intraindividual parameter variations that must be considered in the design of anatomically precontoured plates [62]. Furthermore, the ulnar greater sigmoid notch "coverage angle" comprises both bone and cartilage contributions [2]. Data concerning the mechanical properties of bone tissue are often difficult to interpret due to the absence of standardization or unification of experimental methods, approaches, and goals [5].

Anatomy & Pathophysiology

Osseous Morphology and Variability

The ulnar greater sigmoid notch coverage angle involves contributions from both bone and cartilage [2]. Lateral ulnar morphology is more variable than previously defined, though side-to-side variability is minimal [50]. A portion of the lateral trochlear ridge (aLTR) is covered with articular cartilage but remains non-articulating throughout the normal elbow range of motion [48]. The valgus angulation of available elbow implant designs is discordant with the mean native valgus angulation found in demographic studies, and the valgus laxity of the implants does not cover the variability in the studied population [51]. Consequently, variable ulnar anatomy may necessitate modular or custom implant designs to achieve accurate alignment with the ulnar flexion axis and central positioning of the stem [52].

Kinematics and Biomechanics

The valgus carrying angle decreases during elbow flexion, with most varus angle changes occurring between 30 and 90 degrees of flexion [34]. The carrying angle cannot be estimated independently by the flexion angle [42]. Three-dimensional analysis of elbow soft tissue footprints and anatomy aids in restoring elbow biomechanics and preserving range of motion [29]. Torsion fractures of the radius or ulna cause a lack of full forearm rotation due to mechanical block and loss of synchrony between the paired radio-ulnar joints [58]. Elbows with a fracture involving more than 50 percent of the coronoid process displace more readily than those with 50 percent or less, especially when flexed 60 degrees and beyond [54]. Fixation of olecranon fractures must be secure enough to permit early motion to avoid significant stiffness of the elbow joint [57]. A biomechanical model successfully created a reproducible and clinically relevant palmar beak fracture in Bennett fractures [61].

Ligamentous, Muscular, and Neurovascular Structures

The anatomy of the shoulder, arm, and elbow includes ossification patterns, joint mechanics, ligamentous stabilizers, musculature, neurovascular structures, and surgical approaches [20]. The relative position of the median nerve with respect to the ulnar insertion of the brachialis muscle changes with elbow and forearm movements [45]. A thorough understanding of biomechanical principles and neurological pathways is necessary for managing upper limb spasticity [47].

Clinical Evaluation and Reconstruction Priorities

Standard and specialized radiographic views of the elbow provide valuable clinical information during patient evaluation [8]. Severe osseous, soft tissue, and neural trauma affect the functional results of the elbow region in unusual patterns of Monteggia fracture-dislocation [49]. Restoration of elbow flexion is the first priority in surgical reconstructions for adult brachial plexus injuries involving combined C5 and C6 injuries, followed by shoulder motor function and stability, and then elbow, wrist, and finger extension if C7 root is involved [44]. The Discovery Elbow System resulted in improved function, reduced pain, and high patient satisfaction with a 4-year mean follow-up [16].

Classification

Pathological Non-Union: Hypertrophic non-union of a pathological forearm fracture secondary to multiple myeloma is managed with stabilization of the entire bone and early mobilization [1].

Ulnar Anatomy: The ulnar greater sigmoid notch "coverage angle" involves both bone and cartilage contributions [2]. Recognition of anatomical details and variations of the ulnar nerve is essential for accurate diagnosis and surgical decompression to avoid iatrogenic injury [6].

Coxa Vara: Evaluation of coxa vara should include a search for family history, trauma, infection, and associated skeletal abnormalities to classify the condition and select optimal treatment [3].

Bone Tissue Mechanics: Data concerning the mechanical properties of bone tissue are often difficult to interpret due to the absence of standardization or unification of experimental methods, approaches, and goals [5].

Ossification: The bones of the human skeleton develop via two distinct processes: intramembranous and endochondral ossification [7].

Elbow Radiography: Most commonly utilized radiographic measures of elbow anatomy are consistent between sexes, across the adolescent age group, and between adolescents and young adults [10].

Bone Pathology: A rational approach to studying pathological changes in bone involves analyzing factors influencing bone deposition and demineralization, leading to a classification of diseases based on sclerosis and lysis [15].

Shoulder, Arm, and Elbow Anatomy: The chapter on anatomy of the shoulder, arm, and elbow provides a comprehensive review including ossification patterns, joint mechanics, ligamentous stabilizers, musculature, neurovascular structures, and surgical approaches [20].

Scaphoid Vascularity: The laterovolar and dorsal blood supply systems share the supply of the proximal two thirds of the scaphoid bone [25]. The distal blood supply group of the scaphoid bone is circumscribed to the tuberosity [25].

Elbow Osteoarthritis: A bony landmarks classification system effectively delineates osteophyte distribution in elbow osteoarthritis patients [30].

Angiomatous Lesions: A general classification of angiomatous lesions of the extremities is established based on clinical and pathological features, noting that transitional features exist between groups [40].

Monteggia Fractures: Subgroups in Bado's classification of Monteggia fracture-dislocations (Type IV-A through IV-D) are proposed based on the direction of angulation and dislocation [43].

Other Considerations: The evidence base includes general methodological challenges in interpreting bone tissue mechanics [5] and comprehensive anatomical reviews covering ossification, mechanics, and surgical approaches [20].

Clinical Presentation

History and Etiology: Evaluation of coxa vara requires a search for family history, trauma, infection, and associated skeletal abnormalities [3]. Pathological forearm fractures secondary to multiple myeloma can present as hypertrophic non-union [1]. Pediatric Monteggia fracture-dislocations may be associated with ipsilateral distal radius fractures, requiring heightened suspicion for associated injuries [19]. Pseudarthrosis of the radius associated with neurofibromatosis is characterized by a cystic bone lesion and the presence of neural tissue within the pseudarthrosis [32].

Inspection and Radiographic Evaluation: Standard and specialized radiographic views of the elbow provide valuable clinical information during patient evaluation [8]. Most commonly utilized radiographic measures of the elbow are consistent between sexes, across the adolescent age group, and between adolescents and young adults [10]. Accurate identification of partial avulsion patterns in the pediatric humeral medial epicondyle is important for understanding the natural history of these injuries [11]. Roentgenographic recognition of minute fractures of the supracondylar process of the humerus, along with reactive bone formation in surrounding muscle, guides conservative management [12]. New bone formation during limb lengthening in children can be reliably evaluated using ultrasound combined with radiological findings [13]. Awareness of the normal characteristics of ossification of the lateral epicondylar epiphysis may reduce the need for comparison roentgenograms [33].

Anatomical Variations and Congenital Anomalies: Anatomic variations in the ulnar greater sigmoid notch coverage angle exist, involving both bone and cartilage contributions [2]. Recognition of ulnar nerve anatomical details and variations is essential for accurate diagnosis and surgical decompression to avoid iatrogenic injury [6]. Trevor's disease (dysplasia epiphysealis hemimelica) can present as a rare case in the elbow [4]. Bilateral congenital pseudarthrosis of the olecranon can present in an adult, highlighting the significance of a detailed history and cautious radiographic interpretation [35].

Special Tests and Regional Characteristics: Impinging exostoses of the proximal radius can present with distinct clinical features and atypical symptoms arising from impingement on soft-tissue structures [17]. Regional characteristics of cortical bone quality vary in the proximal humerus of postmenopausal women, with similar conditions seen in the medial column in the metaphyseal region [18]. The bones of the human skeleton develop via two distinct processes: intramembranous and endochondral ossification [7].

Investigations

Plain radiography: Elbow anatomy: Standard radiographic measures of elbow anatomy are consistent between sexes, across the adolescent age group, and between adolescents and young adults [10]. Supracondylar process: Roentgenographic recognition of minute fractures of the supracondylar process of the humerus, along with the reparative nature of reactive bone formation in the surrounding muscle, should guide conservative management [12]. Pathological fractures: Diagnosis of textilomas causing pathologic fracture of the distal humerus is challenging, as MRI and CT scans often lead to false conclusions, making medical history the most important diagnostic tool [72]. Pediatric Monteggia: Maintaining heightened suspicion for associated injuries and implementing accurate radiography with frequent follow-up are essential in cases of pediatric Monteggia fracture–dislocation with ipsilateral distal radius fracture [19]. Osteochondritis dissecans (OCD): Loose bodies in OCD of the capitellum are often missed, especially on standard X-rays and MRIs [41].

MRI: Nerve localization: MRI determination of posterior interosseus nerve (PIN) position is reliable and consistent with prior cadaveric study [55]. Recognition of anatomical details and variations of the ulnar nerve is essential for accurate diagnosis and surgical decompression to avoid iatrogenic injury [6]. Bone density assessment: Average cortical bone thickness measurements obtained from shoulder MRI are correlated with DXA and appear effective in differentiating patients with normal and abnormal bone mineral density, potentially guiding further diagnostic assessments [56]. UTE MRI can reliably and accurately measure humeral cortical thickness, but cannot accurately measure cancellous density or accurately and reliably measure glenoid cortical thickness [70]. Soft tissue findings: Increased MRI signal in the extensor carpi radialis brevis origin is common in both symptomatic and asymptomatic elbows and increases with age [67]. Post-operative evaluation: Magnetic resonance imaging indicates that donor sites after autologous osteochondral mosaicplasty for cartilaginous lesions of the elbow joint are resurfaced with fibrous tissue [73]. Advanced processing: Further developments in deep learning processing of MRI bone shape models have the potential to allow surgeons to obtain all clinically relevant information from MRI scans and reduce the need for multiple imaging studies for patients with shoulder pathology [69]. Median nerve compression: Imaging and nerve conduction studies may fail to provide a definitive answer for median nerve compression secondary to a high insertion of pronator teres, emphasizing the importance of clinical findings [74].

CT: Bone density correlation: There is a high correlation with low errors between subchondral bone density measurements taken from conventional CT images and those from magnetic resonance imaging around osteochondritis dissecans lesions of the capitellum, suggesting both modalities are useful in clinical decision making [68]. Bone quality assessment: CT osteoabsorptiometry can be indirectly used to give information about bone quality in vivo by correlating mineralization with mechanical strength of the subchondral bone plate of the humeral head [71].

Other Considerations: Paediatric limb lengthening: The formation of new bone in paediatric patients undergoing limb lengthening can be reliably evaluated using ultrasound when combined with radiological findings [13]. Pathological non-union: Stabilisation of the entire bone and early mobilisation are appropriate management principles for hypertrophic non-union of a pathological forearm fracture secondary to multiple myeloma [1]. Proximal radius exostoses: Anatomic considerations of impinging exostoses of the proximal radius provide guidance in assessing atypical symptoms arising from impingement on soft-tissue structures and aid in planning for surgical resection [17]. Proximal humerus bone quality: Similar cortical bone quality conditions are seen in the medial column in the metaphyseal region of the proximal humerus in postmenopausal women [18]. Scaphoid blood supply: The laterovolar and dorsal blood supply systems share the supply of the proximal two thirds of the scaphoid bone, while the distal group is circumscribed to the tuberosity [25].

Treatment

Non-Operative

Conservative management is appropriate for fractures of the supracondylar process of the humerus, guided by roentgenographic recognition of the minute fracture and the reparative nature of reactive bone formation [12]. Spontaneous recovery without specific treatment is relatively good for most instances, although permanent epiphyseal growth changes may occasionally occur [14]. Conservative management of Galeazzi fracture-dislocations was successful only in children, resulting in failure in 80 per cent of adults [75]. Initial management of symptomatic distal radioulnar joint (DRUJ) arthritis is nonsurgical, with surgery reserved for patients with refractory pain [66].

Operative

Indications: Stabilization of the entire bone and early mobilization are appropriate management principles for hypertrophic non-union of a pathological forearm fracture secondary to multiple myeloma [1]. The one-bone forearm procedure is indicated only if instability and bone loss are irreparable by bone-grafting or other reconstructive procedures and there is no chance of restoring rotation of the forearm [21]. Modified Nicoll-graft treatment is the treatment of choice for gap non-unions of the upper extremity [59]. Complete resection and correction osteotomy can lead to restoration of normal anatomy and good function without local recurrence in patients with Trevor's disease who have functional impairment or remarkable deformity [4]. Surgical management of congenital radioulnar synostosis most commonly involves one or more derotational osteotomies, as resection of the synostosis has been shown to have high-complication rates and lead to subpar outcomes [76].

Surgical Approach / Technique: Open anatomical reduction with stabilization of all injured structures, followed by six to eight weeks of immobilization, is probably the optimum treatment for fracture-dislocation of the radiocarpal joint [28]. The procedure for anterior Monteggia lesions in children can be recommended for patients with no major intra-articular injury or damage to epiphyseal centers, allowing for anatomical reduction and complete bone remodeling with a good range of motion [27]. A novel technique for forearm reconstruction in ulnar dysplasia with dislocation of the radial head achieved better functional outcomes, with the elbow and wrist functioning well at 3-year follow-up, compared with previously reported treatment options [23]. Functional reconstruction of complex arm defects using a modified Capanna technique and latissimus dorsi muscle transfer can result in good healing, complete bone consolidation, and reasonable mobility of the dominant limb, preserving independence [77].

Implant Selection: CT-based measurement and analysis of distal humerus morphology provide a basis for the design of distal humeral orthopaedic implants to ensure greater alignment with anatomical structure and improved surgical outcomes [24]. Safe insert points for screw fixation on the bony-en-face view of the humeral greater tuberosity are zones 1a, 3a, 2a, or 7, while neurovascular dangerous zones 8, 11, 10, and 9 should be avoided for plate fixation [26]. Improved histology at the tendon-to-bone interface is correlated with improved final construct strength at the 12-week time point when using an interposition bioresorbable scaffold with a vented anchor for primary rotator cuff repair [22]. Recombinant human BMP-2 and allograft is safe and as effective as traditional autogenous bone-grafting for the treatment of tibial fractures associated with extensive traumatic diaphyseal bone loss [36].

Adjuncts: The Ilizarov technique has demonstrated efficacy in achieving expected clinical outcomes in the treatment of bone defects of the radius and ulna [39]. Distraction osteogenesis using monolateral external fixation can obtain impressive gains in femoral and tibial length, but the cost is increased treatment time and complications [37]. Bone lengthening in the pediatric upper extremity is associated with a high complication rate, and success is commonly defined by radiographic lengthening, joint motion, and patient satisfaction rather than validated outcome measures [9].

Other Considerations: Evaluation for coxa vara should include a search for family history, trauma, infection, and associated skeletal abnormalities to classify the condition and select optimal treatment [3]. Standard and specialized views of the elbow provide valuable clinical information during patient evaluation when used appropriately [8]. Targeting the proximal ulna's narrowest segment provides an effective approach for olecranon osteotomy when precise morphology is unknown [38]. Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors [64].

Complications

Other Considerations: Hypertrophic non-union can occur in pathological forearm fractures secondary to multiple myeloma [1]. Traumatic bowing of the forearm in children is a distinct clinical entity caused by plastic deformation from longitudinal forces, often occurring with a fracture of the other bone [79]. Coxa vara requires evaluation for family history, trauma, infection, and associated skeletal abnormalities to classify the condition and select optimal treatment [3]. Trevor's disease (dysplasia epiphysealis hemimelica) can cause functional impairment and remarkable deformity in the elbow [4]. Limb lengthening in the pediatric upper extremity is associated with a high complication rate [9]. Spontaneous recovery is common for certain pediatric injuries, but permanent epiphyseal growth changes may occur occasionally [14]. Osteoid-oma can produce premature fusion of the epiphysis of the distal phalanx of the big toe due to local damage to the epiphyseal plate and secondary effects of increased vascularity and regional osteoporosis [53].

Recovery

Light activity (weeks): Open anatomical reduction with stabilization of all injured structures, followed by six to eight weeks of immobilization, is probably the optimum treatment for fracture-dislocation of the radiocarpal joint [28].

Full activity (months): Total elbow arthroplasty with the Discovery Elbow System resulted in improved function, reduced pain, and high patient satisfaction at a 4-year mean follow-up [16]. Forearm reconstruction in ulnar dysplasia with dislocation of the radial head achieved better functional outcomes, with the elbow and wrist functioning well at 3-year follow-up, compared with previously reported treatment options [23].

Complete recovery / outcome plateau (months): Double semitendinosus anterior cruciate ligament reconstruction is efficient in restoring satisfactory stability for most patients and stabilizes the evolution of degenerative lesions as shown by standing X-ray at 10-year follow-up [81]. Patients with a preoperative symptom duration of two years or greater for symptomatic medial knee overload/arthritis do not experience inferior patient-reported outcomes or clinical outcomes than patients with a symptom duration of less than 2 years at mid-term follow-up after high tibial osteotomy [65].

Rehabilitation protocol: Stabilization of the entire bone and early mobilization are appropriate management principles for hypertrophic non-union of a pathological forearm fracture secondary to multiple myeloma [1]. Complete resection and correction osteotomy in patients with functional impairment or remarkable deformity from Trevor's disease (dysplasia epiphysealis hemimelica) can lead to restoration of normal anatomy and good function without local recurrence [4].

Functional milestones: Bone lengthening in the pediatric upper extremity is associated with a high complication rate, and success is commonly defined by radiographic lengthening, joint motion, and patient satisfaction rather than validated outcome measures [9]. The prognosis for spontaneous recovery without specific treatment is relatively good in most instances of pediatric humeral medial epicondyle injuries, although permanent epiphyseal growth changes may occur occasionally [14]. Accurate identification of partial avulsion patterns in the pediatric humeral medial epicondyle and their underlying pathology is likely important for understanding the natural history of these injuries and the outcomes of different treatment strategies [11].

Other Considerations: Improved histology at the tendon-to-bone interface is correlated with improved final construct strength at the 12-week time point following primary rotator cuff repair using an interposition bioresorbable scaffold with a vented anchor in sheep [22]. Bone mineral in the calcanei in men decreased more than the expected age-dependent decline during a 5-year study period following arthroscopic shoulder surgery [80].

Key Evidence

  • [Case_report] Management principles remain the same with stabilisation of the entire bone and early mobilisation being appropriate. (10.1186/1749-799x-5-26)
  • [L5] Biomechanical and clinical studies are needed to understand the true clinical relevance of these anatomic variations. (10.1016/j.jse.2015.06.006)
  • [L5] Evaluation should include a search for family history, trauma, infection, and associated skeletal abnormalities to classify coxa vara and select optimal treatment. (10.5435/00124635-199803000-00003)
  • [L4] Complete resection and correction osteotomy in patients with functional impairment or remarkable deformity can lead to restoration of normal anatomy and result in good function without local recurrence. (10.1016/j.jse.2012.10.031)
  • [L4] Data from the literature concerning the mechanical properties of bone tissue can be extracted to support or contradict many hypotheses, not because of any inherent ambiguities in the data but rather because of the absence of standardization or unification of experimental methods, approaches, and goals. (10.2106/00004623-197456050-00012)
  • [L5] Recognition of these anatomical details and variations is essential for accurate diagnosis and surgical decompression to avoid iatrogenic injury. (10.1016/j.hcl.2007.05.001)
  • [L5] Standard and specialized views of the elbow can be very beneficial and, when used appropriately, will provide valuable clinical information during the evaluation of patients. (10.1016/j.jhsa.2014.04.035)
  • [L5] The procedure is associated with a high complication rate, and success is commonly defined by radiographic lengthening, joint motion, and patient satisfaction rather than validated outcome measures. (10.2106/jbjs.16.00007)
  • [L4] Most commonly utilized radiographic measures were consistent between sexes, across the adolescent age group, and between adolescents and young adults. (10.1016/j.jse.2011.10.026)
  • [L4] Accurate identification of these injury patterns and their underlying pathology is likely important for understanding the natural history of these injuries and the outcomes of different treatment strategies. (10.1177/03635465241310407)
  • [L4] Roentgenographic recognition of the minute fracture of the process, together with the reparative nature of the reactive bone formation in the muscle about it, should guide one to conservative management. (10.2106/00004623-196749030-00014)
  • [L4] The formation of new bone in paediatric patients undergoing limb lengthening could be reliably evaluated using ultrasound when combined with radiological findings. (10.1302/0301-620x.106b7.bjj-2023-1019.r2)
  • [L4] The Discovery Elbow System resulted in improved function, reduced pain, and high patient satisfaction. (10.1016/j.jse.2014.08.013)
  • [L4] The anatomic considerations illustrated by these two cases may provide guidance in assessment of atypical symptoms arising from impingement on soft-tissue structures and aid in planning for surgical resection. (10.1016/j.xrrt.2021.01.001)
  • [L4] Similar conditions were seen in the medial column in the metaphyseal region. (10.1016/j.jse.2018.09.001)
  • [Case_report] Maintaining heightened suspicion for associated injuries and implementing accurate radiography with frequent follow-up are essential. (10.1016/j.xrrt.2024.06.002)
  • [L5] Improved histology was correlated with improved final construct strength at the 12-week time point. (10.1016/j.jse.2019.05.024)
  • [L4] Compared with previously reported treatment options, this surgery achieved better functional outcomes, with the elbow and wrist functioning well at 3-year follow-up. (10.1177/17531934221095919)
  • [L4] The findings provide a basis for the design of distal humeral orthopaedic implants, ensuring greater alignment with the anatomical structure of the distal humerus and improved surgical outcomes. (10.1186/s12891-024-07858-4)
  • [L4] The laterovolar and dorsal systems share the supply of the proximal two thirds of the bone, while the distal group is circumscribed to the tuberosity. (10.2106/00004623-196648060-00010)
  • [L5] The authors recommend selecting safe insert points from zones 1a, 3a, 2a, or 7 for screw fixation and avoiding neurovascular dangerous zones 8, 11, 10, and 9 for plate fixation. (10.1016/j.jse.2025.02.061)
  • [L4] The procedure can be recommended for children with anterior Monteggia lesions who have no major intra-articular injury or damage to epiphyseal centers, as it allows for anatomical reduction and complete bone remodeling with a good range of motion. (10.2106/00004623-198668040-00022)
  • [L4] Open anatomical reduction with stabilization of all injured structures, followed by six to eight weeks of immobilization, is probably optimum treatment. (10.2106/00004623-197759020-00011)
  • [L5] This study provides the upper extremity surgeon with information that may aid in restoring elbow biomechanics and preserving range of motion in these patients. (10.1016/j.jse.2014.05.003)
  • [L3] The bony landmarks classification system effectively delineated osteophyte distribution in elbow patients. (10.1186/s13018-025-06145-9)
  • [Case_report] The condition is characterized by a cystic bone lesion and the presence of neural tissue within the pseudarthrosis. (10.2106/00004623-197759070-00027)
  • [L5] Awareness of the normal characteristics of ossification of the lateral epicondylar epiphysis may reduce the need for comparison roentgenograms, although these should be made if there is any doubt whatever about the diagnosis. (10.2106/00004623-198264030-00016)
  • [L5] The dynamic elbow testing apparatus characterized a decrease of valgus carrying angle during elbow flexion and found that most varus angle changes occurred between 30 and 90 degrees of flexion. (10.1016/j.jhsa.2023.07.010)
  • [L4] This case represents bilateral congenital pseudarthrosis of the olecranon presenting in an adult, highlighting the significance of a detailed history and cautious radiographic interpretation. (10.1016/j.jse.2010.01.002)
  • [L2] The present study suggests that rhBMP-2/allograft is safe and as effective as traditional autogenous bone-grafting for the treatment of tibial fractures associated with extensive traumatic diaphyseal bone loss. (10.2106/jbjs.e.00381)
  • [L4] Distraction osteogenesis can obtain impressive gains in femoral and tibial length, but the cost is increased treatment time and complications. (10.2106/00004623-199806000-00003)
  • [L5] Targeting the proximal ulna's narrowest segment provides an effective approach for osteotomy when precise morphology is unknown. (10.1016/j.jse.2024.12.012)
  • [L1] This method has demonstrated efficacy in achieving expected clinical outcomes. (10.1186/s13018-023-04126-4)
  • [L4] The study establishes a general classification of angiomatous lesions of the extremities based on clinical and pathological features, noting that while each group has distinctive characteristics, transitional features exist between groups. (10.2106/00004623-196244050-00001)
  • [L4] Loose bodies are often missed, especially on standard X-rays and MRIs. (10.1177/1758573218756866)
  • [L4] The study suggests that the carrying angle cannot be estimated independently by the flexion angle and could be useful in elbow disorders. (10.1016/j.jse.2007.03.028)
  • [Paper] Restoration of elbow flexion is the first priority, followed by shoulder motor function and stability, and then elbow, wrist, and finger extension if C7 root is involved. (10.1016/j.injury.2020.02.076)
  • [L5] This study confirms that the relative position of the median nerve with respect to the ulnar insertion of the brachialis muscle changes with elbow and forearm movements. (10.1016/j.jse.2021.03.022)
  • [L5] A thorough understanding of biomechanical principles and neurological pathways is necessary for the hand surgeon. (10.1177/17531934261434453)
  • [L5] Our results suggest that there is a portion of the aLTR that, despite being covered with articular cartilage, is non-articulating throughout normal elbow range of motion. (10.2106/jbjs.18.01270)
  • [L4] Severe osseous, soft tissue, and neural trauma affect the functional results of the elbow region. (10.1186/1749-799x-1-12)
  • [L5] This demonstrates lateral ulnar morphology to be more variable than previously defined with minimal side-to-side variability, which are important considerations for fracture fixation and elbow arthroplasty. (10.1016/j.jse.2019.10.016)
  • [L4] The valgus angulation of the available elbow designs is discordant with the mean native valgus angulation found in this study, and the valgus laxity of the implants does not cover the variability in the studied population. (10.1016/j.jse.2023.04.017)
  • [L5] Because of the variable ulnar anatomy, modular or custom designs may be needed to achieve accurate alignment with the ulnar flexion axis and central positioning of the stem. (10.1016/j.jse.2008.03.008)
  • [Case_report] The premature closure likely occurred due to local damage to the epiphyseal plate by the lesion directly, in conjunction with secondary effects of increased vascularity and regional osteoporosis. (10.2106/00004623-197557010-00024)
  • [L5] In response to axial load, elbows with a fracture involving more than 50 percent of the coronoid process displace more readily than elbows with a fracture involving 50 percent or less of the coronoid process, especially when the elbow is flexed 60 degrees and beyond. (10.2106/00004623-200012000-00009)
  • [L4] MRI determination of PIN position is reliable and consistent with prior cadaveric study. (10.1016/j.arthro.2020.12.118)
  • [L3] Average cortical bone thickness measurements obtained from shoulder MRI are correlated with DXA and appear effective in differentiating patients with normal and abnormal BMD, potentially guiding further diagnostic assessments. (10.1177/17585732241279090)
  • [L5] Fixation must be secure enough to permit early motion to avoid significant stiffness of the elbow joint. (10.5435/00124635-200007000-00007)
  • [L5] The ultimate effect of such torsion is a lack of full forearm rotation due to mechanical block and loss of synchrony between the paired radio-ulnar joints. (10.2106/00004623-195335030-00013)
  • [L4] The authors state this method is their treatment of choice for gap non-unions of the upper extremity. (10.2106/00004623-198163020-00007)
  • [L3] Clinicians should consider the risk of bone fragility during surgical planning given the lower HU values observed at anchor insertion sites. (10.1016/j.xrrt.2025.100624)
  • [L5] This model successfully created a reproducible and clinically relevant palmar beak fracture in a biomechanical setting. (10.1016/j.jhsa.2018.04.024)
  • [L5] Besides the wide range in size, intraindividual parameter variations have to be taken into account in the design of anatomically precontoured plates. (10.1016/j.jse.2011.11.008)
  • [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
  • [L4] Patients with a preoperative duration of symptomatic medial knee overload/arthritis of two years or greater do not experience inferior PRO or clinical outcomes than patients with a symptom duration of less than 2 years at mid-term follow-up. (10.1016/j.jisako.2022.03.003)
  • [L5] Initial management of symptomatic DRUJ arthritis is nonsurgical, with surgery reserved for patients with refractory pain. (10.5435/00124635-201210000-00002)
  • [L4] Increased MRI signal in the ECRB origin is common in symptomatic and in asymptomatic elbows. (10.1016/j.jse.2016.01.033)
  • [L4] We observed a high correlation with low errors between the measurements taken from conventional CT images and the measurements from magnetic resonance imaging, suggesting that both modalities are useful in clinical decision making. (10.1016/j.jhsa.2021.06.020)
  • [L3] Further developments of this technology have the potential to allow for surgeons to obtain all clinically relevant information from MRI scans and reduce the need for multiple imaging studies for patients with shoulder pathology. (10.1016/j.jseint.2023.05.008)
  • [L5] UTE MRI can reliably and accurately measure humeral cortical thickness, but cannot accurately measure cancellous density or accurately and reliably measure glenoid cortical thickness. (10.1016/j.jseint.2021.10.010)
  • [L5] CT osteoabsorptiometry can be indirectly used to give information about bone quality in vivo. (10.1016/j.jse.2011.05.018)
  • [L4] Diagnosis of textilomas can be very challenging as MRI and CT scans often lead to false conclusions; the medical history is the most important diagnostic tool. (10.1016/j.jse.2016.07.024)
  • [L4] However, magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue. (10.1177/0363546507306465)
  • [L4] It also emphasizes the importance of clinical findings because imaging and nerve conduction studies failed to provide a definitive answer. (10.1111/j.1758-5740.2010.00051.x)
  • [L4] Conservative management was successful only in children, resulting in failure in 80 per cent of adults. (10.2106/00004623-197557080-00006)
  • [L5] Currently, surgical management most commonly involves one or more derotational osteotomies, as resection of the synostosis has been shown to have high-complication rates and lead to subpar outcomes. (10.5435/jaaos-d-20-01133)
  • [Case_report] The patient presented with good healing, complete bone consolidation, and reasonable mobility of the dominant limb, preserving independence. (10.1016/j.xrrt.2025.100656)
  • [L4] Traumatic bowing of the forearm is a distinct clinical entity caused by plastic deformation from longitudinal forces, often occurring with a fracture of the other bone. (10.2106/00004623-197456030-00019)
  • [L3] The bone mineral in the calcanei in men during the 5-year study period decreased more than the expected age-dependent decline after arthroscopic shoulder surgery. (10.1007/s00167-015-3760-z)
  • [L4] The study shows that the procedure is efficient in restoring a satisfactory stability for most patients and stabilises the evolution of the degenerative lesions as shown by standing X-ray. (10.1007/s001670050076)

See Also

References

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