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. 2017 Nov;6(4):307-315.
doi: 10.1055/s-0037-1602849. Epub 2017 May 10.

Microstructure of the Distal Radius and Its Relevance to Distal Radius Fractures

Gregory Ian Bain  1 , Simon Bruce Murdoch MacLean  1 , Tom McNaughton  2 , Ruth Williams  3
Affiliations

Microstructure of the Distal Radius and Its Relevance to Distal Radius Fractures

Gregory Ian Bain et al. J Wrist Surg. 2017 Nov.

Erratum in

Abstract

Background There is a paucity of information on the microstructure of the distal radius, and how this relates to its morphology and function. Purpose This study aims to assess the microanatomical structure of the distal radius, and relate this to its morphology, function, and modes of failure. Methods Six dry adult skeletal distal radii were examined with microcomputed tomography scan and analyzed with specialist computer software. From 3D and 2D images, the subchondral, cortical, and medullary trabecular were assessed and interpreted based on the overall morphology of the radius. Results The expanded distal radial metaphysis provides a wide articular surface for distributing the articular load. The extrinsic wrist ligaments are positioned around the articular perimeter, except on the dorsal radial corner. The subchondral bone plate is a 2 mm multilaminar lattice structure, which is thicker below the areas of the maximal articular load. There are spherical voids distally, which become ovoid proximally, which assist in absorbing articular impact. It does not have Haversian canals. From the volar aspect of the lunate facet, there are thick trabecular columns that insert into the volar cortex of the radius at the metaphyseal-diaphyseal junction. For the remainder of the subchondral bone plate, there is an intermediate trabecular network, which transmits the load to the intermediate trabeculae and then to the trabecular arches. The arches pass proximally and coalesce with the ridges of the diaphyseal cortex. Conclusion The distal radius morphology is similar to an arch bridge. The subchondral bone plate resembles the smooth deck of the bridge that interacts with the mobile load. The load is transmitted to the rim, intermediate struts, and arches. The metaphyseal arches allow the joint loading forces to be transmitted proximally and laterally, providing compression at all levels and avoiding tension. The arches have a natural ability to absorb the impact which protects the articular surface. The distal radius absorbs and transmits the articular impact to the medullary cortex and intermediate trabeculae. The medullary arches are positioned to transmit the load from the intermediate trabeculae to the diaphysis. Clinical Relevance The microstructure of the distal radius is likely to be important for physiological loading of the radius. The subchondral bone plate is a unique structure that is different to the cancellous and cortical bone. All three bone types have different functions. The unique morphology and microstructure of the distal radius allow it to transmit load and protect the articular cartilage.

Keywords: distal radius; fracture; micro-CT; microarchitecture; ultrastructure.

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Conflict of interest statement

Conflict of Interest None.

Figures

Fig. 1
Fig. 1
A sequence of axial images was calibrated using ImageJ. A point at the most prominent aspect of Lister's tubercle was identified. A further point 1 cm proximal to this was used to represent the metadiaphyseal junction of the radius. ( A ) “Cortex-cortex” measurements were taken from the furthest point of each cortex. ( B ) “Intramedullary” distance represents the distance between from the inner cortices. This process was repeated for each of the six radii.
Fig. 2
Fig. 2
Sagittal section of the distal radius showing the subchondral bone plate.
Fig. 3
Fig. 3
( A–B ) Axial section of the distal radius. Ultrastructure shows trabecular struts arising perpendicular and between the laminae within this plate. A sphere-shaped void is present between the laminae and struts.
Fig. 4
Fig. 4
Axial section through the distal radius illustrating braces reinforcing thickened zones in the cortical pillars. Rods, sheets, and ridges are shown.
Fig. 5
Fig. 5
Sagittal section through the lunate fossa of the distal radius.
Fig. 6
Fig. 6
A sagittal section through the scaphoid facet of the distal radius showing the relationship between the subchondral bone plate, trabecular arches, and voids.
Fig. 7
Fig. 7
An illustration of a Gothic arch merging to form a Gothic vault. Source: Image received with permission from Dr. Gregory Ian Bain.
Fig. 8
Fig. 8
A sagittal section through the distal radius showing the relationship between trabeculae and coalescence to the adjacent cortex.
Fig. 9
Fig. 9
An axial section through the distal radius illustrating grooves and ridges in the cortical bone. Source: Image received with permission from Dr. Gregory Ian Bain.
Fig. 10
Fig. 10
Axial section of the cortical pillars with a radiodensity color scale (Hounsfield units).The relative radiodensity is greater at the dorsal, radiopalmar, and ulnopalmar corners. These are the three pillars of the distal radius.
Fig. 11
Fig. 11
The subchondral bone plate has a unique biological structure with a multilayer osseus lattice. It functions both as a sandwich panel and a leaf spring.
Fig. 12
Fig. 12
Illustration of an aircraft's fuselage demonstrating longeerons and comparison with the microarchitecture of the distal radius. Source: Image received with permission from Dr. Gregory Ian Bain.
Fig. 13
Fig. 13
A sagittal view of the distal radius through the scaphoid facet. The distal radius comprises a thin metaphyseal cortex and a thicker diaphyseal cortex. The metaphyseal region contains a concentration of cancellous bone arranged in a series of arches and is called the trabecular vault. The physeal scar abuts the apex of the trabecular vault. There is a subchondral bone plate underlying the articular surface, and this structure is called the subchondral multilaminar plate. The architectural structure resembles that of a bridge.
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