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Original article
Submitted: 2021-08-24
Accepted: 2021-09-10
Published online: 2021-09-28
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The morphological and morphometric analysis of the variant patterns of the tricipital aponeurosis: A new anatomical classification with possible clinical implications

A. Patra1, A. Asghar2, K. S. Ravi3, F. Duparc4, S. Arora5
DOI: 10.5603/FM.a2021.0097
·
Pubmed: 34590297
Affiliations
  1. All India Institute of Medical Sciences, Bathinda, Department of Anatomy, AIIMS, BATHINDA-INDIA, 151001 Bathinda, India
  2. All India Institute of Medical Sciences,Patna, Patna, India
  3. All India Institute of Medical Sciences, Rishikesh, Rishikesh, India
  4. Universite_de_Rouen, France
  5. Maulana Azad Medical College, Department of Anatomy, Bahadur Shah Zafar Marg,, 110002 New Delhi, India

open access

Ahead of Print
ORIGINAL ARTICLES
Submitted: 2021-08-24
Accepted: 2021-09-10
Published online: 2021-09-28

Abstract

Background: Tricipital aponeurosis (TA) has gained attraction as a constant and reliable landmark to identify the location of radial nerve in the setting of fracture distal humeri. The aponeurosis itself shows variant anatomical patterns. In this study, we intend to provide a comprehensive description and functional classification of observed anatomical variations with possible clinical implications.

Materials and methods: Sixty arms belonging to 30 adult cadavers were studied. TA was examined grossly to document variations in its shape and classified accordingly. Subsequently, length and breadth of TA were measured. The distance of the radial nerve (RN) from the point of confluence and from the lateral border of TA was also measured (tricepso-radial distance, TRD). These distances were correlated with the different patterns of TA obtained.

Results: Based on the shape of the proximal apex of TA or point of confluence and frequency of their occurrence, we propose a new classification of four patterns for the TA anatomy. Pattern I: classically seen as the triangular proximal apex (76.67%); Pattern II: tongue shaped or blunt proximal apex (18.33%); Pattern III: bifurcated or dual proximal apex (3.33%); Pattern IV: as the absence of TA (1.67%). The mean of length and breadth of TA was 16.58±2.05 cm and 3.61±0.61 cm respectively. The mean distance of RN from point of confluence and lateral border of TA was 3.57±0.19 cm and 2.04±0.56 cm respectively. The length, breadth of TA and tricepso-radial distance (TRD) differs amongst the different patterns of TA.

Conclusions: Anatomical variations in the shape and size of TA are frequently encountered. The proposed, hitherto undescribed, classification may make operating surgeon aware of these morphological variations and help prevent iatrogenic injury to RN. Such classification is simple and unique, however, its success relies upon universal acceptance.

Abstract

Background: Tricipital aponeurosis (TA) has gained attraction as a constant and reliable landmark to identify the location of radial nerve in the setting of fracture distal humeri. The aponeurosis itself shows variant anatomical patterns. In this study, we intend to provide a comprehensive description and functional classification of observed anatomical variations with possible clinical implications.

Materials and methods: Sixty arms belonging to 30 adult cadavers were studied. TA was examined grossly to document variations in its shape and classified accordingly. Subsequently, length and breadth of TA were measured. The distance of the radial nerve (RN) from the point of confluence and from the lateral border of TA was also measured (tricepso-radial distance, TRD). These distances were correlated with the different patterns of TA obtained.

Results: Based on the shape of the proximal apex of TA or point of confluence and frequency of their occurrence, we propose a new classification of four patterns for the TA anatomy. Pattern I: classically seen as the triangular proximal apex (76.67%); Pattern II: tongue shaped or blunt proximal apex (18.33%); Pattern III: bifurcated or dual proximal apex (3.33%); Pattern IV: as the absence of TA (1.67%). The mean of length and breadth of TA was 16.58±2.05 cm and 3.61±0.61 cm respectively. The mean distance of RN from point of confluence and lateral border of TA was 3.57±0.19 cm and 2.04±0.56 cm respectively. The length, breadth of TA and tricepso-radial distance (TRD) differs amongst the different patterns of TA.

Conclusions: Anatomical variations in the shape and size of TA are frequently encountered. The proposed, hitherto undescribed, classification may make operating surgeon aware of these morphological variations and help prevent iatrogenic injury to RN. Such classification is simple and unique, however, its success relies upon universal acceptance.

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Keywords

triceps brachii, aponeurosis, classification, humerus, fracture, landmark

About this article
Title

The morphological and morphometric analysis of the variant patterns of the tricipital aponeurosis: A new anatomical classification with possible clinical implications

Journal

Folia Morphologica

Issue

Ahead of Print

Article type

Original article

Published online

2021-09-28

DOI

10.5603/FM.a2021.0097

Pubmed

34590297

Keywords

triceps brachii
aponeurosis
classification
humerus
fracture
landmark

Authors

A. Patra
A. Asghar
K. S. Ravi
F. Duparc
S. Arora

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