Three-dimensional characterization of trabecular bone mineral density of the proximal ulna using quantitative computed tomography

Background: Although previous studies have measured general proximal forearm bone mineral density (BMD), no study has systematically mapped the 3-dimensional trabecular BMD of the proximal ulna. The aim of this study was to describe the 3-dimensional distribution of the trabecular bone density of the proximal ulna. We hypothesize a variable distribution of proximal ulna trabecular BMD depending on the region of interest (ROI). Methods: Computed tomographic (CT) scans of 9 fresh-frozen cadaveric proximal ulna specimens with a mean age of 59.3 +/- 8.1 years were studied. Each CT file was converted from DICOM to a QCT file that could be analyzed using QCT software (QCT Pro Version 6.1, Model 4 CT Calibration Phantom; MindWays Software Inc, Austin, TX, USA). The ROIs were defined as spheres of trabecular bone 3 mm in diameter located throughout the proximal ulna. Results: ROIs proximal to the trochlear notch demonstrated higher BMD than ROIs distal to the trochlear notch. Furthermore, volar ROIs adjacent to the ulnohumeral joint tended to have higher BMD than dorsal ROIs. The highest BMD was found in the tip of the olecranon. Conclusion: Hardware in fixation constructs for proximal ulnar fractures should be directed toward ROIs with the highest BMD to maximize purchase. Hardware should approach the ulnohumeral joint without penetrating the joint to capture trabecular bone with the highest BMD. The most important fixation in such a construct will be that which captures trabecular bone with maximum BMD proximal to the trochlear notch (eg, the tip of the olecranon). (C) 2019 Published by Elsevier Inc. on behalf of Journal of Shoulder and Elbow Surgery Board of Trustees.