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Distal Radius Bony Architecture
Theresa Wyrick, MD
University of Arkansas for Medical Sciences, Little Rock, AR

Peripheral quantitative computed tomography (pQCT) as well as micro-computed tomography (microCT) have been proven to accurately evaluate the bone density, volume and structure of the distal radius. Data has been used to diagnose osteopenia and osteoporosis. Current literature contains analyses of the effects of hormonal and pharmacologic agents on osteoporotic bone using these imaging modalities. No available studies exist describing the regional microarchitecture of the distal radius. This article describes the regional microarchitecture of the distal radius in terms of density and orientation using pQCT and micoCT imaging. Ten cadaveric distal radius specimens were exmained using pQCT and five were further examined using microCT. Data gathered from the pQCT images was used to measure total bone density (TOT_DEN) and trabecular bone density (TRAB_DEN) and was collected in 2mm axial cuts including the distal 30 mm of the radius. The information was grouped into three 10mm sections and referred to as the styloid, sigmoid notch and shaft sections. Data collected from microCT amalysis was used to measure trabecular number (TbN), trabecular spacing (TbSp) and trabecular thickness (TbTh). The information was grouped to examine all regions of the distal radius including the subchondral and metaphyseal regions and comparing volar bone mesaurements to those of dorsal bone. The pQCT data showed the mean TOT_DEN was highest in the shaft section at 420.7 (+/-76) mm/cub cm (p<0.05). The TRAB_DEN was highest in the styloid segment at 319.7 (+/-152.2) mm/cub cm (p<0.05). The TOT_DEN and TRAB_DEN were lowest in the signoid notch segment at 238.8 (+/-58.3) mm/cub cm and 178 (+/-58.6) mm/cub cm respectively (p<0.05). The microCT data revealed no statistical difference in trabecular thickness between the subchondral and metaphyseal regions(p<0.05). The trabeculae were significantly more numerous and closer together in the subchondral region (p<0.05). There was no significant difference found in the trabecular spacing, number or thickness when comparing dorsal to volar bone located in the subchondral region. The microarchitecture of the distal radius is not uniform. The least dense bone according to pQCT is located in the sigmoid notch section of the distal radius encompassing the metaphyseal region where most low energy fractures occur. The highest density of trabecular bone is found in the distal third section identified by the radial styloid making this area advanageous for screw piurchase. Fixation in the dense bone found in the radial styloid is helpful in adding overall stability to the construct and is always recommended.


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