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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 8  |  Issue : 1  |  Page : 28-30

Anthropometric characterisation of elbow angles and lines among Tibetan children (3–13 years) seeking refugee in India: A comparison survey


1 Department of Orthopedics, Dr. RPGMC, Kangra, Himachal Pradesh, India
2 Department of Community Medicine, Dr. RPGMC, Kangra, Himachal Pradesh, India
3 Department of Radiodiagnosis, Dr. RPGMC, Kangra, Himachal Pradesh, India

Date of Web Publication5-Jan-2018

Correspondence Address:
Dr. Sunil Kumar Raina
Department of Community Medicine, Dr. RPGMC, Tanda, Kangra, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AIHB.AIHB_18_17

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  Abstract 

Background: Various radiological criteria based on anthropometric parameters are used to understand injuries on paediatric elbow and for checking the degree of reduction after manipulation. The anthropometric parameters of Caucasians are different from European and mongoloids, their parameters cannot be applied across different population groups living in India. Hence, there is a need to characterise anthropometric parameters of elbow among children of different ethnicity living in Indian. Materials and Methods: The study population comprised of all cases of injury to the elbow joint between 3 and 13 years of age reporting to the Department of Orthopaedics during the study and belonging to Tibetan population seeking refuge in India. The X-rays films were preserved and the angles and lines (as anthropometric parameters) were drawn on the radiographs. Results: The mean value for Baumann angle in males was 72° with standard deviation (SD) of 2.75 and in girls was 73° with SD of 1.41. The mean lateral capitellohumeral angle in children from 3 to 13 years of age was 45.33° ± 3.97°. The anterior humeral line passed through middle one-third of capitellum in 86.6%. The radiocapitellar intersection occurred in 100% of the cases with radiocapitellar bisection reported on 86.6% of the X-rays films. Conclusion: As the values of two population; Indian and Tibetan differ, establishing comparisons can significantly affect the outcome while managing elbow injuries.

Keywords: Angles, anthropometric, characterisation, elbow, lines, Tibetan


How to cite this article:
Sehgal M, Awasthi B, Raina SK, Chauhan N, Sharma V, Thakur L. Anthropometric characterisation of elbow angles and lines among Tibetan children (3–13 years) seeking refugee in India: A comparison survey. Adv Hum Biol 2018;8:28-30

How to cite this URL:
Sehgal M, Awasthi B, Raina SK, Chauhan N, Sharma V, Thakur L. Anthropometric characterisation of elbow angles and lines among Tibetan children (3–13 years) seeking refugee in India: A comparison survey. Adv Hum Biol [serial online] 2018 [cited 2020 Jul 7];8:28-30. Available from: http://www.aihbonline.com/text.asp?2018/8/1/28/222243




  Introduction Top


Injury to child's elbow results in break to forearm bones like older individuals as they instinctively tend to protect themselves during a fall with their arms outstretched. However, paediatric elbow fractures have both a higher incidence and greater variability in fracture patterns in contrast to older individuals.[1] A large majority (65%–75%) of fractures in children occur in the upper extremity with supracondylar fractures accounting for the maximum (60%) because of its relative weakness.[2],[3],[4]

Paediatric elbow injuries are evaluated using radiological criteria and include a measurement of Baumann's angle in anteroposterior view, humerocondylar angle in lateral view, anterior humeral line and radiocapitellar line. An extensive search on PubMed reveals that the studies regarding angles and lines around elbow are limited to European and some Mongoloid populations. We previously reported on the anthropometric Characterisation of Elbow Angles and Lines among Indian Children.[5] The current study was aimed at characterisation of Elbow Angles, and Lines among Tibetan Children settled in India. The modern Tibetan populations are genetically most similar to other modern East Asian populations.[6]


  Materials and Methods Top


The Tibetan settlement of Dharamshala in India began in 1959 when His Holiness the Dalai Lama had to flee Tibet and the Government of India allowed him and his followers to settle in McLeodGanj (in Upper Dharamshala) where they established their “government-in-exile.” Since then the Tibetan Welfare Office is situated at Mcleodganj in Dharamsala of Kangra District, Himachal Pradesh about 8 km from the main town Dharamsala. The total Tibetan population at McLeodGanj is 10,470.[7]

The study was conducted on all consenting patients aged 3–13 years from ethnic Tibetan population seeking refuge in India and presenting to the Department of Orthopaedics of medical college with injuries around the elbow joint. Patients with injury to bilateral elbow (old or new) and with congenital deformities around bilateral elbow joint were excluded from the study. Further children < 3 years of age and above 13 years of age were also excluded from the study.

The study was approved by the Institution Ethics Committee. The methodology for the conduct of the study was the same as was used in Indian children. The details are provided elsewhere.[5]

Statistical analysis

The angles were analysed using mean and standard deviation (SD) and expressed with Confidence Interval. The lines were expressed as percentage using already defined criteria.


  Results Top


A total of 20 Tibetan children in the age group 3–13 years were enlisted for the study. The mean value for the Baumann angle among study participants was 72 with SD of 2.75 [Table 1]. The mean value for Baumann angle in males was 72° with SD of 2.75 and in girls were 73° with SD of 1.41. The mean lateral capitellohumeral angle in children from 3 to 13 years of age was 45.33° ±3.97°. The mean value for lateral capitellohumeral angle in males is 45.53° ±3.92° and females are 44 ± 5.65. The difference in males and females is not statistically significant. We observed that anterior humeral line passed through middle one-third of capitellum in 86.6%. It was also observed that the radiocapitellar intersection occurred in 100% of the cases with radiocapitellar bisection reported on 86.6% of the X-rays films observed.
Table 1: Elbow lines and angles in Indian and Tibetan children (3-13 years)

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  Discussion Top


An extensive search on PubMed reveals that studies conducted across the world have given different values for the Baumann angle. An Asian study conducted in this context in Hong Kong, China on 105 radiographs concluded that the mean Baumann angle in boys was 70.1° with SD of 5.8 and in girls to be 69.9 with SD of 5.7°.[8] Williamson et al.[9] in their study proposed a mean value of 70° with an SD of 4°. In this study conducted on 20 Tibetan children, the mean value in males was 72° with SD of 2.75 and in girls were 73° with SD of 1.41. The age group in this study was 3–13 years of age and average mean value for Baumann angle was 72 with SD of 2.75. In an earlier study conducted on Indian children, the mean ± (SD) for Baumann angle in children was much higher at 75° ± 4.70°.[5] Mean ± (SD) of Baumann angle in males was 76° ± 4.44° and females was 74° ±5.37° in this study. From our analysis, it seems that the mean value of Tibetan children lesser than Indian children. Further, it is higher than children from the western world but similar to the Chinese population.

A study conducted by Shank et al.[10] shows that in normal elbows, the mean Lateral capitellohumeral angle is 51° ±6° and does not vary with age, side or sex. Simanosky et al.[11] found that mean value for a lateral capitellohumeral angle for all ages was 41.6° (30°–70°). In our study on Tibetan children, mean lateral capitellohumeral angle in children from 3 to 13 years of age is 45.33° ±3.97°. While the mean value for lateral capitellohumeral angle in males is 45.53° ±3.92°, it is 44 ± 5.65 for females. The difference in males and females is statistically not significant. Our results are intermediate of the results of the 2 western studies placing lateral capitellohumeral angle between 40° and 55°. The SD in our study is also almost the same as western literature. The lateral capitellohumeral angle for Indian children is higher than their Tibetan counterparts. In a study performed on 120 radiographs by Herman et al.[12] the anterior humeral line passed through the anterior third of the capitellum in 31% of the elbows, the middle third in 52% and the posterior third in 18%. We observed that anterior humeral line passed through middle one-third of capitellum in 86.6% of the cases which is almost similar to our study on the Indian population. In 6.6% of the cases, it passed through the anterior one-third, and 6.6% of the cases, it passed through the posterior one-third.

The results of our study further support that anterior humeral line can be used as an important marker to quantify anterior-posterior displacement of the distal part of the humerus after a supracondylar elbow fracture and the adequacy of fracture reduction after treatment in local population. Our study aimed at calculating the radiocapitellar intersection and bisection on lateral radiographs of elbow using the line passing through the radial neck as a reference. In our study radiocapitellar intersection occurred in 100% of the cases. Further radiocapitellar bisection was seen in 86.6%of the X-rays. Till date, only 2 studies have been conducted in western population regarding this parmeter. No study could be found on Tibetan population. A study published in 2014 by Ramirez et al. which according to them is the largest study done on 116 radiographs found radiocapitellar intersection to be 98.2% and radiocapitellar bisection to be 77.8% on the lateral radiographs.[13] The results of this study seem to strongly correlate with our study.

In a study conducted by Kunkel et al. in 2011, the radiocapitellar instersection was 95% and radiocapitellar bissection was present in 63% cases.[14] They suggested that subtle malalignment of the radiocapitellar joint may not be best assessed by the radiocapitellar line and when such malalignment is suspected investigations such as ultrasonography and magnetic resonance imaging should be done. Our study and the study conducted by Ramirez et al., however, refutes this statement and advocates radiocapitellar (RCL) intersection to be a strong predictor for detecting subtle malalignment in Monteggia fracture dislocations.


  Conclusion Top


The anthropometric values for elbow angles and lines between Indian and Tibetan differ. Therefore, identifying these differences can significantly affect the outcome in elbow injuries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Woods GW, Tullos HS. Elbow instability and medial epicondyle fractures. Am J Sports Med 1977;5:23-30.  Back to cited text no. 1
    
2.
Rogers LF. Radiology of Skeletal Trauma. 2nd ed. New York: Churchill Livingstone; 1992. p. 749-836.  Back to cited text no. 2
    
3.
Crombie A, Duncan R. Closed reduction and percutaneous fixation of displaced paediatric supracondylar fractures of the elbow. Curr Orthop 2004;18:147-53.  Back to cited text no. 3
    
4.
Steenbrugge FM. Guidelines and pitfalls in the management of supracondylar humerus fractures in children. Curr Orthop 2001;15:214-9.  Back to cited text no. 4
    
5.
Awasthi B, Raina SK, Chauhan N, Sehgal M, Sharma V, Thakur L. Anthropometric characterisation of elbow angles and lines among Indian children. Adv Hum Biol 2017;7:71-4.  Back to cited text no. 5
  [Full text]  
6.
Majumder PP. The human genetic history of South Asia. Curr Biol 2010;20:R184-7.  Back to cited text no. 6
    
7.
Tibetan Settlement Office, Mcleodganj, Dharamsala. Available from: http://www.centraltibetanreliefcommittee.org/doh/settlements/india. [Last accessed on 2017 Mar 07].  Back to cited text no. 7
    
8.
Yeung SH, Lam CY, Ho HM, Ko PP, Ng JK, Lam JJ. Characterstics of Baumann's angle in Hong Kong Chinese children. HKMJ 1996;2:363-5.  Back to cited text no. 8
    
9.
Williamson DM, Coates CJ, Miller RK, Cole WG. Normal characteristics of the Baumann (Humerocapitellar) angle: An aid in assessment of supracondylar fractures. J Pediatr Orthop 1992;12:636-9.  Back to cited text no. 9
    
10.
Shank CF, Wiater BP, Pace JL, Jinguji TM, Schmale GA, Bittner RC, et al. The lateral capitellohumeral angle in normal children: Mean, variation, and reliability in comparison to Baumann's angle. J Pediatr Orthop 2011;31:266-71.  Back to cited text no. 10
    
11.
Simanosky N, Lamdan R, Mosheiff R, Simanovsky N. Underreduced supracondylar fracture of the humerus in children. J Pediatr Orthop 2007;27:733-8.  Back to cited text no. 11
    
12.
Herman MJ, Boardman MJ, Hoover JR, Chafetz RS. Relationship of the anterior humeral line to the capitellar ossific nucleus: Variability with age. J Bone Joint Surg Am 2009;91:2188-93.  Back to cited text no. 12
    
13.
Ramirez RN, Ryan DD, Williams J, Wren TA, Ibrahim D, Weiss JM, et al. A line drawn along the radial shaft misses the capitellum in 16% of radiographs of normal elbows. J Pediatr Orthop 2014;34:763-7.  Back to cited text no. 13
    
14.
Kunkel S, Cornwall R, Little K, Jain V, Mehlman C, Tamai J, et al. Limitations of the radiocapitellar line for assessment of pediatric elbow radiographs. J Pediatr Orthop 2011;31:628-32.  Back to cited text no. 14
    



 
 
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