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IJCRR - 7(9), May, 2015

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MORPHOLOGIC AND MORPHOMETRIC STUDY OF SUPRA TROCHLEAR FORAMEN OF DRIED HUMAN HUMERI OF TELANGANA REGION

Author: Udaya Kumar P., Sukumar C. D., Sirisha V., Rajesh V., Murali Krishna S., Kalpana T.

Category: Healthcare

Abstract:Introduction: Olecranon fossa and coronoid fossa of lower end of humerus are separated by a thin plate of bone called supratrochlear septum. In some cases this septum is perforated, named as supratrochlear foramen. Materials and Methods: The present study is carried out with 270 (119 left sided + 151 right sided) dried humeri of unknown sex and age. Bones were examined for the presence of supratrochlear foramen, their shape and measured vertical and horizontal diameters. Translucency of septum was identified by keeping the bone against a light source. Results: Observation of 270 humeri showed the presence of Supra trochlear foramen in 57(26%) bones. 26% left sided bones and 17.21% of right sided bones were found to have STF. Oval shaped foramen dominated the other shapes. The mean transverse diameter of foramen was observed to be 6.36 \? 2.88 mm on left side and 5.76 \? 2.22 mm on right side, where as the vertical diameter was found to be 4.76 \? 2.64 mm mm on left side and 4.64 \? 2.45 mm on right side. Out of 213 bones, transluscency of septum was observed in 130 (61.03%) humeri.
Conclusion: The present study suggests left preponderance with majority of oval shape of supra trochlear foramen in similaritywith most other studies done in India. The knowledge of STF is important to Orthopedicians, radiologists and Anthropologists

Keywords: Supra trochlear septum, Supra trochlear foramen, Humerus, Translucency of septum

Full Text:

INTRODUCTION

Olecranon fossa and coronoid fossa of lower end of humerus are separated by a thin plate of bone called supratrochlear septum. It is lined by synovial membrane in life1 . In some cases this septum is perforated, called supratrochlear foramen. Supra trochlear foramen was also called as epitrochlear foramen, intercondylar foramen or septal aperture in various anthropometric studies. It was first described by Merckel in 18252 . Supratrochlear foramen has been described in dogs, rats and cattle by various animal studies3, 4. Paraskevas et al.5 reported that the medullary canal is shorter in bones with supratrochlear foramen. With the increase in intramedullary nailing as a means of supracondylar fracture repair of humerus, it is of clinical significance to orthopedicians, as is also of great interest to anthropologists in establishing evolutionary relationship between lower animals and humans.

MATERIALS AND METHODS

Aim of the study is to analyze the morphology and morphometry of supratrochlear foramen and to calculate its incidence in Telangana region of South India. The present study is carried out in with 270 (119+151) dried humeri of unknown sex and age. Bones were obtained from the department of Anatomy, Mamata Medical College. One hundred and nineteen left sided and One hundred and fifty one right sided bones, free from pathological changes, were examined for the presence of supratrochlear foramen and their shape. Vertical and horizontal diameters were measured using vernier caliper. Translucency of septum was identified by light source from behind.

RESULTS

Two hundred and seventy dry humeri were observed for the presence of supra trochlear foramen. Out of 119 left sided bones, 31 bones (26%) and out of 151 bones, 26 (17.21%) bones were found to have supra trochlear foramen. Twenty six (21.9 %) left sided bones and nineteen (12.6%) bones on the right showed oval shaped foramen. rounded foramen was observed in five bones both on right side (3.3%) as well as on the left side (4.2%). A Triangular shaped foramen and a semi lunar foramen were observed in two individual right sided bones (Figure No.1). The mean transverse diameter of foramen was observed to be 6.36 mm on left side and 5.76 mm on right side with a standard deviation of 2.88 mm and 2.22 mm respectively, where as the vertical diameter was found to be 4.76 mm on left side and 4.64 mm on right side with a standard deviation of 2.64 mm and 2.45 mm respectively. Out of 213 bones, transluscency of septum was observed in 130 (61.03%) humeri with 63.07% (82) on left side and 36.92% (48) on right side. Comparative data on incidence of various shapes, mean and standard deviation of vertical and horizontal diameters of supra trochlear foramina are shown in tabular form (Table No: I and II).

DISCUSSSION

Various mechanisms have been postulated, explaining the reasons for existence of supratrochlear foramen. Tyllianakis, et al.6 considered this foramen as atavistic, in contradiction to the popular theory of mechanical pressure causing this foramen in the distal end of humerus during hyper extension or due to larger olecranon process. Brauer, et al.7 suggested that the Joint hyper mobility on left side and in females is the reason for high prevalence of the same. Hirsh et al.8 proposed that the pressure of olecrenon process reduces the blood flow to the septum, leading to the formation of foramen. Benfer9 and Sahajpal et al. 10 attributed this formation of foramen to disturbance of calcium metabolism and excessive bone resorption during child growth respectively. According to Blakely et al. 11, supra trochlear foramen is a phylogenetic character found in primates, which is expressed in weaker limbs and suppressed in the stronger limbs. Statistics show that the incidence of STF in Indian population ranges from 19.17% (Veerappan et al. 12) to 40.78% (Jadhav Maryuri et al. 13). Incidence of STF in various studies in India are tabulated (Table no. III). 26% of bones showed the presence of supra trochlear foramen in the present study. The frequency of supra trochlear foramen is higher on left side than on the right, in almost all the studies as was observed in the present study also. In contrast Nayak et al.14 and Kumarasamy S A15, observed the frequency of supra trochlear foramen to be higher on right ( 44.5% and 36.6% respectively) side than on left (26.8% and 22.8% respectively) side. Singhal S.16 found that the frequency was similar on both sides. In seperate studies by Bhanu PS et al. 17 and Krishna Murthy et al. 18, anupama et al.19 and Manjappa20, translucency of septum was found in 82.14% and 66.6%, 62% and 48.4% of humeri respectively. vasantha bhai21 and veerappan12 reported an incidence of 66.6%, 545.8% respectively, chiefly on right side in contrast to the above said studies. In the present study the translucency was found to be in 61.03% with 63.07% (82) on left side and 36.92% (48) on right side. As De Wilde V et al. 22 pointed out, Radiological misinterpretation of STF can avoided with the knowledge of STF, as it may be mistaken with osteolytic or cystic lesion of distal end of humerus. In the present study the average transverse diameter was found to be 6.36 ± 2.88 mm on left side and 5.76 ± 2.22mm on right side, and vertical diameter was found to be 4.76±2.64 on left side and 4.64 ± 2.45 on right side, which was observed to be in close proximity to all the other studies. The knowledge of STF is a necessity to orthopedicians as the presence of STF poses difficulty in fixation of supra condylar fracture by intra medullary nailing. Akpinar et al23, observed that the humeri with septal aperture have very narrow medullary canal. Paraskevas5 advised that the antegrade route is better for intramedullary nailing, than retrograde method, in people with STF.

CONCLUSION

The present study suggests left preponderance with majority of oval shape of supra trochlear foramen in similarity with most other studies done in India. But in view of smaller sample size in many studies, the statistics need to be carefully considered before radiological diagnosis or undertaking surgical interventions.

ETHICAL COMMITTEE CLEARANCE:

As the study included only dry human bones from the bone bank of department of Anatomy, ethical committee clearance was not taken into consideration. Authors will take the responsibility of any further allegations regarding ethical clearance that arise from the study.

ACKNOWLEDGEMENTS

Authors would like to thank Dr Suseelamma D., Professor and Head of the Depatment of Anatomy and their colleagues for their precious suggestions and support during the study. Authors would like to extend their gratitude to all the scholars / authors / editors / publishers whose articles; journals are reviewed, cited and included in the references of this manuscript.

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A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR.
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award

A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award

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MORPHOLOGIC AND MORPHOMETRIC STUDY OF SUPRA TROCHLEAR FORAMEN OF DRIED HUMAN HUMERI OF TELANGANA REGION

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