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Zou D, Hu X, An KN, Dai K, Yu X, Gong W, Tsai TY. Distal Humeral Trochlear Geometry Associated With the Spatial Variation of the Dynamic Elbow Flexion Axis. Front Bioeng Biotechnol 2022; 10:850198. [PMID: 35814006 PMCID: PMC9263270 DOI: 10.3389/fbioe.2022.850198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022] Open
Abstract
Background: The complexity of the spatial dynamic flexion axis (DFA) of the elbow joint makes the elbow prosthesis design and humeral component alignment challenging. This study aimed to 1) investigate the variations of the spatial DFA during elbow flexion and 2) investigate the relationship between the distal humeral trochlear geometry and the in vivo spatial variation of the DFA. Methods: Ten healthy subjects participated in this study. Each subject performed a full elbow extension to maximum flexion with hand supination under dual fluoroscopic imaging system (DFIS) surveillance. The 2D fluoroscopic images and the 3D bone models were registered to analyze the in vivo elbow kinematics and DFAs. The spatial DFA positions were defined as inclination with the medial and lateral epicondyle axes (MLA) in the transverse and coronal planes. The range of the DFA positions was also investigated during different flexion phases. The Spearman correlation method was used to analyze the relationship between the distal humeral trochlear’s morphological parameters and the position of DFAs during different flexion phases. Results: The pathway of the DFAs showed an irregular pattern and presented individual features. The medial trochlear depth (MTD) (r = 0.68, p = 0.03) was positively correlated with the range of the DFA position (2.8° ± 1.9°) in the coronal plane from full extension to 30° of flexion. Lateral trochlear height (LTH) (r = −0.64, p = 0.04) was negatively correlated with the DFA position (−1.4° ± 3.3°) in the transverse plane from 30° to 60° of flexion. A significant correlation was found between LTH with the DFA position in the coronal (r = −0.77, p = 0.01) and transverse planes (r = −0.76, p = 0.01) from 60° to 90° of flexion. Conclusion: This study showed that the pathway of the dynamic flexion axis has an individual pattern. The medial and lateral trochlear sizes were the key parameters that might affect the elbow joint flexion function. When recovering complex distal humeral fractures or considering the implant design of total elbow arthroplasty, surgeons should pay more attention to the medial and lateral trochlea’s geometry, which may help restore normal elbow kinematics.
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Affiliation(s)
- Diyang Zou
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
| | - Xiangjun Hu
- Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kai-Nan An
- Department of Biomechanics, Mayo Clinic, Rochester, MN, United States
| | - Kerong Dai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopaedic Surgery, Shanghai Ninth People s Hospital, Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
| | - Xiaowei Yu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Weihua Gong
- Department of Orthopaedic Surgery, Shanghai Ninth People s Hospital, Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Weihua Gong, ; Tsung-Yuan Tsai,
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopaedic Surgery, Shanghai Ninth People s Hospital, Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- *Correspondence: Weihua Gong, ; Tsung-Yuan Tsai,
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