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Finding Lister's Tubercle: A Morphometric Analysis
Daniel A London, MD, MS
1, Calvin Luu, DO
2, Faith Korpus, BA
1, William Sells, BHS
1; Andre Ivy, MD, MS
3(1)University of Missouri, Columbia, MO, (2)Advocate Health, Aurora, IL, (3)Dupage Medical Group, Lombard, IL
Introduction: Lister's Tubercle is an important palpable landmark for distal radius anatomy. Palpation of this prominence plays a role in multiple clinical scenarios, including identifying the third dorsal compartment, determining wrist arthroscopy portal placement, and closed reduction and splinting of distal radius fractures. In some instances, this anatomy cannot be easily palpated due to excessive soft tissue, trauma, or being obscured by splint material. Therefore, we sought to determine if there is a relationship between visible hand anatomy and the location of Lister's tubercle, making its identification easier when it cannot be directly palpated.
Materials & Methods: Patients who presented to two hand and upper extremity practices with non-traumatic pathology were enrolled. Patient's sex, height, and the distance from each fingertip to the metacarpal head and Lister's Tubercle, as well as the distance from each metacarpal head to Lister's Tubercle were recorded. A ratio comparing the distance from the fingertip to Lister's tubercle divided by the distance from the fingertip to the metacarpal head was calculated. Descriptive statistics were calculated. A Kruskal-Wallis analysis comparing the calculated ratios and gender was performed. Pearson's correlation values were calculated for the ratios and patients' height. Ratios for the various digits were compared by Wilcoxon signed-rank tests.
Results: 144 patients (52 male, 92 female) were enrolled. The data were not normal; therefore, non-parametric results are presented. Table 1 shows the median and IQR values for each measurement. The median ratios for the index and ring fingers were the most practically useful: 2.0 and 2.0. There was a significant association between the calculated ratio for the index finger and gender, although this is not clinically significant (male: 2.00, female: 2.03, p=0.03). There were no significant correlations between each finger's ratio and patients' height (p>0.05). There were significant differences between the ratios for each digit (p<0.001) except between the index and ring finger (p>0.05).
Conclusions: From our morphometric analysis, clinicians can predictably use double the distance from the index and ring fingertips to the respective metacarpal heads as a surrogate to determine the position of Lister's Tubercle when it is not palpable or visible. Such information can be useful when determining wrist arthroscopy portal placement, as well as hand and mold position when performing a closed reduction of a distal radius fracture.
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