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

Francesco Luceri; Davide Cucchi; Enrico Rosagrata; Carlo Eugenio Zaolino; Alessandra Menon; Mattia Radici; Andrea Zagarella; Michele Catapano; Mauro Battista Gallazzi; Paolo Angelo Arrigoni; Pietro Simone Randelli

doi:10.1007/s43465-021-00399-1

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

Indian J Orthop. 2021 Apr 28;55(Suppl 2):347-358. doi: 10.1007/s43465-021-00399-1. eCollection 2021 Jul.

Authors

Francesco Luceri^#¹, Davide Cucchi^#², Enrico Rosagrata^{1

3}, Carlo Eugenio Zaolino¹, Alessandra Menon^{4

5}, Mattia Radici^{1

3}, Andrea Zagarella⁶, Michele Catapano⁶, Mauro Battista Gallazzi⁶, Paolo Angelo Arrigoni^#^{1

5}, Pietro Simone Randelli^#^{4

5

7}

Affiliations

¹ U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy.
² Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Venurberg-Campus 1, 53127 Bonn, Germany.
³ Residency Program, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy.
⁴ U.O.C. 1° Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy.
⁵ Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy.
⁶ Servizio di Radiologia, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.
⁷ REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy.

^# Contributed equally.

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.

Keywords: Congruency; Coronoid process; Elbow instability; Olecranon; Opening angle; Proximal ulna; Radiographic study.