Three-dimensional distribution of trabecular bone density and cortical thickness in the distal humerus

Background: One major barrier to osteosynthesis in distal humeral fractures is poor bone quality. This study was an attempt to measure the bone quality in the distal humerus. Methods: We measured the distribution of total bone mineral density (BMD), trabecular BMD (tBMD), and cortical thickness (CTh) in the distal humerus using peripheral quantitive computed tomography. Four slices in the infracondylar, Supracondylar, and distal disphyseal regions of 25 human cadaver humeri were investigated. Results: Total BMD decreased continuously from the distal diaphysis to the trochlea. Within the infracondylar region, the capitellum was the region of lowest tBMD and CTh (P < .001). Measurements in anterior regions were higher than in most others (P < .001). The tBMD of the medial column in the infracondylar and supracondylar regions was 31% and 36% higher vs the lateral Column (P < .001). The medial column had an average 22% higher CTh in the supracondylar and 38% higher CTh in distal diaphyseal regions vs the lateral sides (P < .001). Conclusions: Distal humeral bone properties vary widely, providing stronger bone stock on the medial side. This may improve understanding of implant failure and techniques in surgical treatment. Level of evidence: Basic science study (C) 2009 Journal of Shoulder and Elbow Surgery Board of Trustees.