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The Transverse Sigmoid Notch Morphology Unravelled.

Simon B Kramer1, Frederike Raad1, Alexander Hauser2

  • 1Department of Trauma Surgery, Maasstad Hospital, Maasstadweg, Rotterdam, The Netherlands.

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|October 8, 2024
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Summary

The sigmoid notch shape classification may not accurately describe wrist anatomy, as 47% of wrists showed different shapes at varying CT scan levels. This suggests limitations in using the Tolat classification for pathology assessment.

Keywords:
Distal radiusFlat faceListers tubercleSigmoid notchSki slopeTolat classification

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Area of Science:

  • Orthopedics
  • Radiology
  • Anatomy

Background:

  • Pathology is often linked to transverse sigmoid notch morphology using the Tolat classification.
  • The Tolat classification assumes a consistent sigmoid notch shape across different anatomical views.

Purpose of the Study:

  • To investigate if sigmoid notch shape (SNS) determination is influenced by the transverse computed tomography (CT) plane level on the distal radius's axial axis.
  • To compare transverse SNS at different axial CT levels within the same wrist.

Main Methods:

  • The transverse SNS of 53 participants were classified by two researchers using Tolat's four morphologies.
  • SNS was assessed at two distinct axial CT levels: Lister tubercle and the smallest distance between the ulnar head and sigmoid notch (SDUS).

Main Results:

  • Forty-seven percent of wrists exhibited different SNS types based on the CT scan's axial level.
  • Excellent interobserver agreement was achieved (87% at Lister tubercle, 85% at SDUS).

Conclusions:

  • Significant variability (47%) in transverse sigmoid notch types was observed within the same wrist across different CT levels.
  • The Tolat transverse sigmoid classification may have limited utility for describing pathology related to sigmoid notch morphology due to this variability.