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Kamal RN, Bronenberg P, Shapiro LM. Volar Intra-articular Extended Window Approach for Intra-articular Distal Radius Fractures. Tech Hand Up Extrem Surg 2024; 28:115-121. [PMID: 37994780 PMCID: PMC11105992 DOI: 10.1097/bth.0000000000000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Distal radius fractures are one of the most common injuries seen globally with increasing use of use of volar plating for surgical treatment. Although it is common to directly visualize the articular surface for most other periarticular fractures, during volar plating of the distal radius the joint is typically not visualized. This is due to concern for carpal instability from disruption of the volar carpal ligaments. When direct visualization of the articular surface is deemed necessary, either to reduce articular fragments or to confirm the quality of reduction, current options include a separate dorsal arthrotomy or arthroscopic assistance. However, biomechanical evidence supports safely performing a volar capsulotomy to visualize the articular surface. We describe the Volar Intra-Articular Extended Window approach, which allows direct visualization of the articular surface through the volar approach to treat distal radius fractures.
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Affiliation(s)
- Robin N. Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
| | - Pedro Bronenberg
- Hand and Upper Extremity Surgery Department, Prof. Dr. “Carlos Ottolenghi Institute”, Hospital Italiano de Buenos Aires
| | - Lauren M. Shapiro
- UC San Francisco Department of Orthopaedic Surgery, San Francisco, CA
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2
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Asseln M, Quack V, Michalik R, Rath B, Hildebrand F, Migliorini F, Eschweiler J. Sex-Specific Size Analysis of Carpal Bones: Implications for Orthopedic Biomedical Device Design and Therapy Planning. Life (Basel) 2024; 14:140. [PMID: 38255755 PMCID: PMC10820598 DOI: 10.3390/life14010140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/21/2023] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Consideration of the individual carpal bone characteristics of the wrist plays a key role in well-functioning biomedical devices and successful surgical procedures. Although geometric differences and individual bone sizes have been analyzed in the literature, detailed morphologic descriptions and correlations covering the entire wrist reported in a clinical context are lacking. This study aimed to perform a comprehensive and automatic analysis of the wrist morphology using the freely available "Open Source Carpal Database" (OSCD). We quantified the size of each of the individual carpal bones and their combination. These sizes were extracted in n = 117 datasets of the wrist of the OSCD in anatomical directions and analyzed using descriptive statics and correlation analysis to investigate the morphological characteristics under sex-specific aspects and to provide regression plots and equations to predict individual carpal bone sizes from the proximal and distal row dimensions. The correlations in the proximal row were higher compared to the distal row. We established comprehensive size correlations and size rations and found that there exist statistical differences between sex, particularly of the scaphoid. The regression plots and equations we provided will assist surgeons in a more accurate preoperative morphological evaluation for therapy planning and may be used for future anatomically inspired orthopedic biomedical device designs.
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Affiliation(s)
- Malte Asseln
- Department of Biomechanical Engineering, University of Twente, 7522 NB Enschede, The Netherlands
| | - Valentin Quack
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Roman Michalik
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Björn Rath
- Department of Orthopaedic Surgery, Klinikum Wels-Grieskirchen, 4600 Wels, Austria
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano, 39100 Bolzano, Italy
| | - Jörg Eschweiler
- Department of Trauma and Reconstructive Surgery, BG Hospital Bergmannstrost, 06112 Halle (Saale), Germany;
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Mack ZE, Kamal RN, Best GM, Wolfe SW, Pichora DR, Rainbow MJ. The Intercalated Segment: Does the Triquetrum Move in Synchrony With the Lunate? J Hand Surg Am 2022; 47:762-771. [PMID: 34627631 DOI: 10.1016/j.jhsa.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 06/20/2021] [Accepted: 08/20/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify the relative motion between the lunate and triquetrum during functional wrist movements and to examine the impact of wrist laxity on triquetral motion. METHODS A digital database of wrist bone anatomy and carpal kinematics for 10 healthy volunteers in 10 different positions was used to study triquetral kinematics. The orientation of radiotriquetral (RT) and radiolunate rotation axes was compared during a variety of functional wrist movements, including radioulnar deviation (RUD) and flexion-extension (FE), and during a hammering task. The motion of the triquetrum relative to the radius during wrist RUD was compared with passive FE range of motion measurements (used as a surrogate measure for wrist laxity). RESULTS The difference in the orientation of the radiolunate and RT rotation axes was less than 20° during most of the motions studied, except for radial deviation and for the first stage of the hammering task. During wrist RUD, the orientation of the RT rotation axis varied as a function of passive FE wrist range of motion. CONCLUSIONS The suggestion that the lunate and triquetrum move together as an intercalated segment may be an oversimplification. We observed synchronous movement during some motions, but as the wrist entered RUD, the lunate and triquetrum no longer moved synchronously. These findings challenge the assumptions behind models describing the mechanical function of the carpals. CLINICAL RELEVANCE Individual-specific differences in the amount of relative motion between the triquetrum and lunate may contribute to the variability in outcomes following lunotriquetral arthrodesis. Variation in triquetral motion patterns may also have an impact on the ability of the triquetrum to extend the lunate, affecting the development of carpal instability.
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Affiliation(s)
- Zoe E Mack
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada
| | - Robin N Kamal
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Gordon M Best
- Department of General Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Scott W Wolfe
- Department of Orthopaedic Surgery, Hospital for Special Surgery and Weill Cornell Medical Centre, New York, NY
| | - David R Pichora
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada; Division of Orthopaedic Surgery, Queen's University, Kingston, ON, Canada
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada.
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4
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Bird EE, Kivell TL, Skinner MM. Patterns of internal bone structure and functional adaptation in the hominoid scaphoid, lunate, and triquetrum. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2021. [DOI: 10.1002/ajpa.24449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Emma E. Bird
- Skeletal Biology Research Centre, School of Anthropology and Conservation University of Kent Canterbury UK
| | - Tracy L. Kivell
- Skeletal Biology Research Centre, School of Anthropology and Conservation University of Kent Canterbury UK
- Department of Human Evolution Max Planck Institute for Evolutionary Anthropology Leipzig Germany
| | - Matthew M. Skinner
- Skeletal Biology Research Centre, School of Anthropology and Conservation University of Kent Canterbury UK
- Department of Human Evolution Max Planck Institute for Evolutionary Anthropology Leipzig Germany
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Azad A, Choi JT, Fisch R, Gipsman A, Nicholson LT, Ghiassi A. Wrist-Spanning Fixation of Radiocarpal Dislocation: A Cadaveric Assessment of Ulnar Translation. Hand (N Y) 2021; 16:482-490. [PMID: 31517519 PMCID: PMC8283113 DOI: 10.1177/1558944719873148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Radiocarpal dislocations represent a high-energy wrist injury that can occur with or without concomitant fractures about the wrist. Poor outcomes are often due to radiocarpal instability and secondary ulnar translation. The purpose of this cadaveric study is to determine if there is any difference in the radiographic parameters in a wrist dislocation model given the different location of distal fixation. Methods: Ten paired fresh cadaver upper extremities were fluoroscopically evaluated with posterior-anterior (PA) and lateral views. We created a radiocarpal dislocation model and applied a dorsal bridge plate to either the second or third metacarpal. Repeat PA and lateral fluoroscopic views were obtained for evaluation of radial inclination, radial height, volar tilt, ulnar variance, radiolunate angle, radioscaphoid angle, scapholunate angle, radial rotation index, and four indices for ulnar translation (Taleisnik, Gilula, McMurtry, and Chamay). Results: Bridge plate application to the second metacarpal resulted in a significantly greater incidence of ulnar translation compared to the third metacarpal. Application to either metacarpal resulted in extension of the carpus relative to the radius. Conclusions: A more anatomic radiocarpal relationship was restored more often when distal fixation of the dorsal wrist-spanning bridge plate was applied to the third metacarpal. Further investigation is warranted to determine clinical relevance of these findings in conjunction with clinical and radiographic outcomes.
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Affiliation(s)
- Ali Azad
- Keck Medical Center of University of Southern California, Los Angeles, USA,Ali Azad, Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, 1200 N. State Street, GNH 3900, Los Angeles, CA 90033, USA.
| | - Jihoon Tony Choi
- Keck Medical Center of University of Southern California, Los Angeles, USA
| | - Robert Fisch
- Keck Medical Center of University of Southern California, Los Angeles, USA
| | - Aaron Gipsman
- Keck Medical Center of University of Southern California, Los Angeles, USA
| | | | - Alidad Ghiassi
- Keck Medical Center of University of Southern California, Los Angeles, USA
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6
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Sandow M, Fisher T. Anatomical anterior and posterior reconstruction for scapholunate dissociation: preliminary outcome in ten patients. J Hand Surg Eur Vol 2020; 45:389-395. [PMID: 31718405 DOI: 10.1177/1753193419886536] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study reviews the efficacy of a reconstruction to address scapholunate dissociation using an anterior and posterior approach with a hybrid synthetic tape/tendon weave between the trapezium, scaphoid, lunate and radius: an anatomical front and back (ANAFAB) repair. This repair is a compilation of the components of a number of previously reported repair techniques, and based on published kinematic evidence. It aims to restore the anatomical mechanical constraints on both anterior and posterior aspects of the carpus. Patients were immobilized in a cast for 6 weeks, but no stabilizing wires were used. Ten patients have undergone the reconstruction and were assessed at a minimum 24-month follow-up. They achieved excellent realignment of the carpus, a postoperative median scapholunate gap of 3 mm and a recovery of more than 75% of grip strength and range of motion. No patient required secondary surgery or treatment related to the carpal stabilization. Level of evidence: IV.
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Affiliation(s)
- Michael Sandow
- Wakefield Orthopaedic Clinic, Adelaide, South Australia.,Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia
| | - Thomas Fisher
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia
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7
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Wolff A. Clinical relevance commentary in response to: Force transmission through the wrist during performance of push-ups on a hyperextended and a neutral wrist. J Hand Ther 2020; 31:331-332. [PMID: 30077388 DOI: 10.1016/j.jht.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Aviva Wolff
- Clinician Investigator, Upper Extremity Research, Department of Rehabilitation, Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA.
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Akhbari B, Moore DC, Laidlaw DH, Weiss APC, Akelman E, Wolfe SW, Crisco JJ. Predicting Carpal Bone Kinematics Using an Expanded Digital Database of Wrist Carpal Bone Anatomy and Kinematics. J Orthop Res 2019; 37:2661-2670. [PMID: 31378991 PMCID: PMC7376386 DOI: 10.1002/jor.24435] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/24/2019] [Indexed: 02/04/2023]
Abstract
The wrist can be considered a 2 degrees-of-freedom joint with all movements reflecting the combination of flexion-extension and radial-ulnar deviation. Wrist motions are accomplished by the kinematic reduction of the 42 degrees-of-freedom of the individual carpal bones. While previous studies have demonstrated the minimal motion of the scaphoid and lunate as the wrist moves along the dart-thrower's path or small relative motion between hamate-capitate-trapezoid, an understanding of the kinematics of the complete carpus across all wrist motions remains lacking. To address this, we assembled an open-source database of in vivo carpal motions and developed mathematical models of the carpal kinematics as a function of wrist motion. Quadratic surfaces were trained for each of the 42-carpal bone degrees-of-freedom and the goodness of fits were evaluated. Using the models, paths of wrist motion that generated minimal carpal rotations or translations were determined. Model predictions were best for flexion-extension, radial-ulnar deviation, and volar-dorsal translations for all carpal bones with R 2 > 0.8, while the estimates were least effective for supination-pronation with R 2 < 0.6. The wrist path of motion's analysis indicated that the distal row of carpal bones moves rigidly together (<3° motion), along the anatomical axis of wrist motion, while the bones in the proximal row undergo minimal motion when the wrist moves in a path oblique to the main axes. The open-source dataset along with its graphical user interface and mathematical models should facilitate clinical visualization and enable new studies of carpal kinematics and function. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2661-2670, 2019.
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Affiliation(s)
- Bardiya Akhbari
- Center for Biomedical Engineering and School of Engineering, Brown University, Providence, RI 02912
| | - Douglas C. Moore
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903
| | - David H. Laidlaw
- Department of Computer Science, Brown University, Providence, RI 02912
| | - Arnold-Peter C. Weiss
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903
| | - Edward Akelman
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903
| | - Scott W. Wolfe
- Hand and Upper Extremity Center, Hospital for Special Surgery, New York, NY 10021
| | - Joseph J. Crisco
- Center for Biomedical Engineering and School of Engineering, Brown University, Providence, RI 02912,Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903
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9
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Stephens NB, Kivell TL, Pahr DH, Hublin JJ, Skinner MM. Trabecular bone patterning across the human hand. J Hum Evol 2018; 123:1-23. [PMID: 30072187 DOI: 10.1016/j.jhevol.2018.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 02/06/2023]
Abstract
Hand bone morphology is regularly used to link particular hominin species with behaviors relevant to cognitive/technological progress. Debates about the functional significance of differing hominin hand bone morphologies tend to rely on establishing phylogenetic relationships and/or inferring behavior from epigenetic variation arising from mechanical loading and adaptive bone modeling. Most research focuses on variation in cortical bone structure, but additional information about hand function may be provided through the analysis of internal trabecular structure. While primate hand bone trabecular structure is known to vary in ways that are consistent with expected joint loading differences during manipulation and locomotion, no study exists that has documented this variation across the numerous bones of the hand. We quantify the trabecular structure in 22 bones of the human hand (early/extant modern Homo sapiens) and compare structural variation between two groups associated with post-agricultural/industrial (post-Neolithic) and foraging/hunter-gatherer (forager) subsistence strategies. We (1) establish trabecular bone volume fraction (BV/TV), modulus (E), degree of anisotropy (DA), mean trabecular thickness (Tb.Th) and spacing (Tb.Sp); (2) visualize the average distribution of site-specific BV/TV for each bone; and (3) examine if the variation in trabecular structure is consistent with expected joint loading differences among the regions of the hand and between the groups. Results indicate similar distributions of trabecular bone in both groups, with those of the forager sample presenting higher BV/TV, E, and lower DA, suggesting greater and more variable loading during manipulation. We find indications of higher loading along the ulnar side of the forager sample hand, with high site-specific BV/TV distributions among the carpals that are suggestive of high loading while the wrist moves through the 'dart-thrower's' motion. These results support the use of trabecular structure to infer behavior and have direct implications for refining our understanding of human hand evolution and fossil hominin hand use.
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Affiliation(s)
- Nicholas B Stephens
- Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, 04103 Leipzig, Germany.
| | - Tracy L Kivell
- Skeletal Biology Research Centre, School of Anthropology and Conservation, University of Kent, Canterbury CT2 7NZ, United Kingdom; Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, 04103 Leipzig, Germany
| | - Dieter H Pahr
- Institute for Lightweight Design and Structural Biomechanics, Vienna University of Technology, Getreidemarkt 9, A-1060 Vienna, Austria
| | - Jean-Jacques Hublin
- Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, 04103 Leipzig, Germany
| | - Matthew M Skinner
- Skeletal Biology Research Centre, School of Anthropology and Conservation, University of Kent, Canterbury CT2 7NZ, United Kingdom; Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, 04103 Leipzig, Germany
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10
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Best GM, Zec ML, Pichora DR, Kamal RN, Rainbow MJ. Does Wrist Laxity Influence Three-Dimensional Carpal Bone Motion? J Biomech Eng 2018; 140:2668582. [PMID: 29305609 DOI: 10.1115/1.4038897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Indexed: 11/08/2022]
Abstract
Previous two-dimensional (2D) studies have shown that there is a spectrum of carpal mechanics that varies between row-type motion and column-type motion as a function of wrist laxity. More recent three-dimensional (3D) studies have suggested instead that carpal bone motion is consistent across individuals. The purpose of this study was to use 3D methods to determine whether carpal kinematics differ between stiffer wrists and wrists with higher laxity. Wrist laxity was quantified using a goniometer in ten subjects by measuring passive wrist flexion-extension (FE) range of motion (ROM). In vivo kinematics of subjects' scaphoid and lunate with respect to the radius were computed from computed tomography (CT) volume images in wrist radial and ulnar deviation positions. Scaphoid and lunate motion was defined as "column-type" if the bones flexed and extended during wrist radial-ulnar deviation (RUD), and "row-type" if the bones radial-ulnar deviated during wrist RUD. We found that through wrist RUD, the scaphoid primarily flexed and extended, but the scaphoids of subjects with decreased laxity had a larger component of RUD (R2 = 0.48, P < 0.05). We also determined that the posture of the scaphoid in the neutral wrist position predicts wrist radial deviation (RD) ROM (R2 = 0.46, P < 0.05). These results suggest that ligament laxity plays a role in affecting carpal bone motion of the proximal row throughout radial and ulnar deviation motions; however, other factors such as bone position may also affect motion. By developing a better understanding of normal carpal kinematics and how they are affected, this will help physicians provide patient-specific approaches to different wrist pathologies.
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Affiliation(s)
- Gordon M Best
- Department of Mechanical and Materials Engineering, Human Mobility Research Centre, Queen's University, 130 Stuart Street, Kingston K7 L 3N6, ON, Canada e-mail:
| | - Michelle L Zec
- Department of Surgery, Human Mobility Research Centre, Queen's University, , Kingston K7 L 3N6, ON, Canada e-mail:
| | - David R Pichora
- Department of Mechanical and Materials Engineering, Human Mobility Research Centre, Queen's University, 130 Stuart Street, Kingston K7 L 3N6, ON, Canada e-mail:
| | - Robin N Kamal
- Department of Orthopaedic Surgery, Robert A. Chase Hand & Upper Limb Center, Stanford University, 450 Broadway Street, Redwood City, CA 94063 e-mail:
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Human Mobility Research Centre, Queen's University, 130 Stuart Street, Kingston K7 L 3N6, ON, Canada e-mail:
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11
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Feehan L, Fraser T. Early controlled mobilization using dart-throwing motion with a twist for the conservative management of an intra-articular distal radius fracture and scapholunate ligament injury: A case report. J Hand Ther 2017; 29:191-8. [PMID: 27264904 DOI: 10.1016/j.jht.2016.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 02/22/2016] [Accepted: 02/25/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED This case describes an early controlled mobilization (ECM) approach that uses dart-throwing motion (DTM) with a twist orthoses as an alternative to immobilization for conservative management of a minimally displaced and intra-articular distal radius styloid fracture with an associated scapholunate ligament injury in a 47-year-old female health care administrator (JP). Pain-free active DTM began at day 10 (5 times/d) with a dynamic DTM with a twist orthosis worn during the day from weeks 3 to 6. At 6 weeks, JP had pain-free functional mobility and strength with minimal limitation in household and occupational activities, returning to her normal sporting activities by 3 months. ECM led to rapid return of normal functioning in the short term with no apparent impact on intermediate outcomes at 8 months. This case allows hand therapists to consider a similar ECM approach for the management of similar injuries in their patients. LEVEL OF EVIDENCE Level 5 and case report.
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Affiliation(s)
- Lynne Feehan
- Clinical Research, Rehabilitation Program, Fraser Health Authority, Surrey, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Trevor Fraser
- HealthOne Physiotherapy & Hand Clinic, Surrey, British Columbia, Canada
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12
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Feehan L, Fraser T. Dart-throwing motion with a twist orthoses: Design, fabrication, and clinical tips. J Hand Ther 2017; 29:205-12. [PMID: 27264905 DOI: 10.1016/j.jht.2015.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/01/2015] [Accepted: 12/21/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Lynne Feehan
- Lead, Clinical Research, Rehabilitation Program, Fraser Health Authority, Surrey, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Trevor Fraser
- HealthOne Physiotherapy & Hand Clinic, Surrey, British Columbia, Canada
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Abstract
The complex interaction of the carpal bones, their intrinsic and extrinsic ligaments, and the forces in the normal wrist continue to be studied. Factors that influence kinematics, such as carpal bone morphology and clinical laxity, continue to be identified. As imaging technology improves, so does our ability to better understand and identify these factors. In this review, we describe advances in our understanding of carpal kinematics and kinetics. We use scapholunate ligament tears as an example of the disconnect that exists between our knowledge of carpal instability and limitations in current reconstruction techniques.
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Affiliation(s)
- Robin N Kamal
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
| | - Adam Starr
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI
| | - Edward Akelman
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI
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14
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Rainbow MJ, Wolff AL, Crisco JJ, Wolfe SW. Functional kinematics of the wrist. J Hand Surg Eur Vol 2016; 41:7-21. [PMID: 26568538 DOI: 10.1177/1753193415616939] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 10/22/2015] [Indexed: 02/03/2023]
Abstract
The purpose of this article is to review past and present concepts concerning functional kinematics of the healthy and injured wrist. To provide a context for students of the wrist, we describe the progression of techniques for measuring carpal kinematics over the past century and discuss how this has influenced today's understanding of functional kinematics. Next, we provide an overview of recent developments and highlight the clinical relevance of these findings. We use these findings and recent evidence that supports the importance of coupled motion in early rehabilitation of radiocarpal injuries to develop the argument that coupled motion during functional activities is a clinically relevant outcome; therefore, clinicians should develop a framework for its dynamic assessment. This should enable a tailored and individualized approach to the treatment of carpal injuries.
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Affiliation(s)
- M J Rainbow
- Department of Mechanical and Materials Engineering & Human Mobility Research Centre, Queen's University Kingston, ON, Canada
| | - A L Wolff
- Leon Root Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - J J Crisco
- Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
| | - S W Wolfe
- The Hand and Upper Extremity Center, Weill Medical College of Cornell University, New York, NY, USA
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