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      The Importance of the Supratrochlear Foramen of the Humerus in Humans: An Anatomical Study

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          Abstract

          Background

          The supratrochlear foramen (STF) is an important and relatively common anatomic variation in the lower end of the humerus in humans. Its structure has received increased attention in recent years. Anatomical knowledge of STF is useful for anatomists, anthropologists, orthopedic surgeons, and radiologists. This aperture is of great interest to anthropologists who claim it as one of the points in establishing a relationship between humans and lower animals. The goal of this study was to describe the features of STF of the humerus in the Turkish population.

          Material/Methods

          All bones were obtained from the Department of Anatomy, Faculty of Medicine and Department of Antrophology, University of Mustafa Kemal, Hatay. A total of 166 dried humeri (83 right side and 83 left side), of which 78 belonged to males and 88 to females, were examined to determine the presence of supratrochlear foramen. Digital vernier calipers were used to measure the maximum width (transverse) and height (vertical) of the STF.

          Results

          Out of 166 bones, the foramen was present in 18 humeri (4 right side and 14 left side), showing the incidence as 10.8% with unpaired humeri. We observed 4 types of shape: oval, round, triangular, and sieve-like. The average diameter of the long (transverse) axis was 5.93±1.68 mm and the short (vertical) axis was 4.06±0.89 mm. Some of the bones showed translucency of the bony septum, found in 17 (20.5%) on both sides of the humeri.

          Conclusions

          There are few studies about STF in the Turkish population. Knowledge of supratrochlear foramen in the distal humerus in humans is important in diagnostic orthopedics, in intramedullary nailing of the humerus, and in possibly increasing the risk of future low-energy fractures. In addition, STF is a radiolucent area in radiographs and may be misinterpreted as an osteolytic or cystic lesion.

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          Most cited references50

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          A systematic review of medial and lateral entry pinning versus lateral entry pinning for supracondylar fractures of the humerus.

          The supracondylar fracture of the distal humerus is the most common pediatric fracture in the elbow. This systematic review summarizes the existing data about the effect of medial and lateral (medial/lateral) entry pins versus only lateral entry pin fixation on the risk of iatrogenic nerve injury and deformity or loss of reduction. A literature search identified clinical trials and observational studies presenting the probability of nerve injury and/or deformity or loss of reduction associated with closed reduction and either medial/lateral entry or lateral entry pinning of supracondylar fractures in pediatric patients. Data from 2054 children were identified from 35 studies; 2 randomized trials, 6 cohort studies, and 25 case series. For operative fixation with medial/lateral entry pins, the probability of ulnar nerve injury is 5.04 times higher than with lateral entry pins. When all documented operative nerve injuries are included, the probability of iatrogenic nerve injury is 1.84 times higher with medial/lateral entry pins than with isolated lateral pins. Medial/lateral pin entry provides a more stable configuration, and the probability of deformity or loss of reduction is 0.58 times lower than with isolated lateral pin entry. When the prospective studies alone were analyzed, there were no significant difference in the probability of iatrogenic nerve injury or deformity and displacement, although the confidence intervals were wide. This systematic review indicates that medial/lateral entry pinning, of pediatric supracondylar fractures, remains the most stable configuration and that care needs to be taken regardless of technique to avoid iatrogenic nerve injury and loss of reduction.
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            Septal aperture of the humerus in a mediaeval human skeletal population.

            Simon Mays (2008)
            Humeral septal aperture is studied in a large Mediaeval skeletal series from England. The aims are to investigate associations between septal aperture and sex, age, side and humeral robusticity; and to evaluate any associations with relative projection of ulna coronoid and olecranon processes. In this way, it is hoped to shed light on age at occurrence and the causation of the trait. Results showed a paucity of cases in juveniles. In adults, the trait was more common in left bones and in females. No association was found with humeral robusticity or humero-ulnar conformation. Detailed morphological study of humeral septa of individuals with and without apertures suggested that septal aperture forms via resorption from the anterior surface of the septum. In this group, apertures appear generally to form in early adult life. It is suggested that in the study group septal aperture generally arises from impingement on the humeral septum by the coronoid and olecranon processes, chiefly the former. It is tentatively suggested that frequency of septal aperture may be an index of joint hypermobility in earlier populations. Copyright 2008 Wiley-Liss, Inc.
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              Normal osseous variants presenting as cystic or lucent areas on radiography and CT imaging: a pictorial overview.

              We present a number of commonly encountered pseudolesions. These represent areas of the skeleton that are relatively radiolucent simulating an osteolytic or cystic lesion. Such areas discussed in this article include the superolateral humeral head, rhomboid fossa of the clavicle, scapular defect, supratrochlear foramen, biceps tendon insertion, vascular channel of the ulna, distal condylar area of the knee, 'bone in bone' disturbance, dorsal defect of the patella, metadiaphyseal area, 'Wards' triangle', inframalleolar fossa of the fibula, and anterior lytic defect of the calcaneus. We provide an overview of commonly encountered pseudolesions, that may lead to false positive diagnosis of an osteolytic or cystic lesion.
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                Author and article information

                Journal
                Med Sci Monit
                Med. Sci. Monit
                Medical Science Monitor
                Medical Science Monitor : International Medical Journal of Experimental and Clinical Research
                International Scientific Literature, Inc.
                1234-1010
                1643-3750
                2014
                13 December 2014
                : 20
                : 2643-2650
                Affiliations
                [1 ]Department of Anatomy, Mustafa Kemal University, Tayfur Ata Sokmen Medical Faculty, Hatay, Turkey
                [2 ]Department of Anthropology, Mustafa Kemal University, Hatay, Turkey
                [3 ]Department of Microbiology, Mustafa Kemal University, Tayfur Ata Sokmen Medical Faculty, Hatay, Turkey
                Author notes
                Corresponding Author: Nizami Duran, e-mail: nizamduran@ 123456hotmail.com
                [A]

                Study Design

                [B]

                Data Collection

                [C]

                Statistical Analysis

                [D]

                Data Interpretation

                [E]

                Manuscript Preparation

                [F]

                Literature Search

                [G]

                Funds Collection

                Article
                892074
                10.12659/MSM.892074
                4267125
                25515544
                245e50f8-0a32-413e-bd4e-66912a1bdd14
                © Med Sci Monit, 2014

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License

                History
                : 24 July 2014
                : 05 August 2014
                Categories
                Human Anatomy

                anatomy,humerus,observer variation,supratrochlear foramen

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