ReviewJSES international2026
Evaluation of proximal ulna morphology: a systematic review of varus angulation of the proximal ulna.
Review in JSES international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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5 authors.
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Abstract
Background: Varus angulation (VA) of the proximal ulna is a key morphological feature influencing fracture reduction, implant design, and elbow biomechanics. Despite its clinical significance, reported values and measurement techniques vary widely. The aim of this study was to systematically review and synthesize the existing literature on proximal ulnar VA in adults, establish normative values, evaluate methodological variation, and recommend standardized assessment approaches and values for the VA. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, electronic databases (MEDLINE, Embase, and Cochrane Library) were searched from January 2000 to November 2024. Eligible studies reported quantitative measurements of VA in adults without pathology. Data on study design, measurement technique, imaging modality, and risk of bias (assessed with the Anatomical Quality Assessment Tool) were extracted and analyzed. Results: Seventeen studies were included. Imaging modalities used to measure VA were computed tomography (CT) (n = 7), X-ray (n = 1), and cadaveric analysis (n = 9). Reported VA means ranged from 6.6° to 17.7°, with a pooled mean of 12.4° ± 2.9°. Tip-to-varus apex distance ranged from 47.8 mm to 99.7 mm (pooled mean 77.6 mm ± 4.2 mm). Significant methodological heterogeneity was observed, particularly in anatomical landmarks (eg, olecranon tip, posterior cortex, triceps insertion) and measurement lines (axis-based vs. vertical). Analysis of variance comparing VA across CT, X-ray, and cadaveric studies demonstrated no statistically significant difference between modalities (F ≈ 0.83, Conclusion: Reported proximal ulnar varus angulation and apex position demonstrate a reproducible central tendency despite substantial between-study heterogeneity driven primarily by landmark and axis definition rather than imaging modality. For clinical reconstruction, restoring approximately 10-15° of varus with the apex located 70-90 mm distal to the olecranon tip is a pragmatic target range. CT-based, axis-defined methods offer the most consistent and reproducible estimates and should be adopted as the preferred reference standard for research reporting and pre-operative planning.
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