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Huddleston HP, Connors K, Levy KH, Kurtzman JS, Hayes WT, Koehler SM. Proximal Row Carpectomy Does Not Alter Contact Pressures of the Lunate Fossa: A Cadaveric Study. Hand (N Y) 2024; 19:82-89. [PMID: 35815611 PMCID: PMC10786110 DOI: 10.1177/15589447221105542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Previous studies have suggested that proximal row carpectomy (PRC) results in increased contact pressures and decreased contact areas in the radiocarpal joint. Such experiments, however, used older technologies that may be associated with considerable measurement errors. The purpose of this study was to determine whether there was a significant difference in contact pressure and contact area before and after PRC using Tekscan, a newer pressure sensing technology. METHODS Ten nonpaired cadaveric specimens were dissected proximal to the carpal row and potted. An ultra-thin Tekscan sensor was secured in the lunate fossa of the radius. The wrists were loaded with 200 N of force for 60 seconds to simulate clenched-fist grip; contact pressure and area was assessed before and after PRC. RESULTS Performing a PRC did not significantly increase mean contact pressure at the lunate fossa compared to the native state (mean increase of 17.4 ± 43.2 N/cm2, P = .184). Similarly, the PRC did not significantly alter peak contact pressures at the lunate fossa (intact: 617.2 ± 233.46 N/cm2, median = 637.5 N/cm2; PRC: 707.8 ± 156.6 N/cm2, median = 728.5 N/cm2; P = .169). In addition, the PRC (0.46 ± 0.15 cm2, median = 0.48 cm2) and intact states (0.49 ± 0.25 cm2, median = 0.44 cm2) demonstrated similar contact areas (P = .681). CONCLUSIONS In contrast to prior studies that demonstrated significant increases in contact pressure and decreases in contact area after PRC, our findings propose that performing a PRC does not significantly alter the contact pressures or area of the lunate fossa of the radiocarpal joint.
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Mena A, Wollstein R, Baus J, Yang J. Finite Element Modeling of the Human Wrist: A Review. J Wrist Surg 2023; 12:478-487. [PMID: 38213568 PMCID: PMC10781520 DOI: 10.1055/s-0043-1768930] [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: 12/28/2022] [Accepted: 04/13/2023] [Indexed: 01/13/2024]
Abstract
Background Understanding wrist biomechanics is important to appreciate and treat the wrist joint. Numerical methods, specifically, finite element method (FEM), have been used to overcome experimental methods' limitations. Due to the complexity of the wrist and difficulty in modeling, there is heterogeneity and lack of consistent methodology in the published studies, challenging our ability to incorporate information gleaned from the various studies. Questions/Purposes This study summarizes the use of FEM to study the wrist in the last decade. Methods We included studies published from 2012 to 2022 from databases: EBSCO, Research4Life, ScienceDirect, and Scopus. Twenty-two studies were included. Results FEM used to study wrist in general, pathology, and treatment include diverse topics and are difficult to compare directly. Most studies evaluate normal wrist mechanics, all modeling the bones, with fewer studies including cartilage and ligamentous structures in the model. The dynamic effect of the tendons on wrist mechanics is rarely accounted for. Conclusion Due to the complexity of wrist mechanics, the current literature remains incomplete. Considering published strategies and modeling techniques may aid in the development of more comprehensive and improved wrist model fidelity.
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Affiliation(s)
- Andres Mena
- Human-Centric Design Research Laboratory, Department of Mechanical Engineering, Texas Tech University, Lubbock, Texas
| | - Ronit Wollstein
- Department of Orthopedic Surgery, School of Medicine, New York University, New York, New York
| | - Juan Baus
- Human-Centric Design Research Laboratory, Department of Mechanical Engineering, Texas Tech University, Lubbock, Texas
| | - James Yang
- Human-Centric Design Research Laboratory, Department of Mechanical Engineering, Texas Tech University, Lubbock, Texas
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Heifner JJ, Orbay JL. Assessment and Management of Acute Volar Rim Fractures. J Wrist Surg 2022; 11:214-218. [PMID: 35837594 PMCID: PMC9276059 DOI: 10.1055/s-0041-1732338] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022]
Abstract
The volar rim of the distal radius is the only bony restraint to volar carpal subluxation. Higher loads across the volar rim require stable and rigid fixation to maintain reduction and allow healing while rehabilitation begins. Volar marginal fragments are not amenable to buttressing by fixed angle volar locking plates. Appropriate management of volar marginal fragments comprises two steps-recognition of their presence and rigid anatomical repair. The best opportunity for success in the presence of a volar marginal fragment is its adequate initial treatment. The purpose of this review is to reinforce the importance of a complete preoperative and intraoperative evaluation of distal radius fractures. Volar marginal fragments can easily be overlooked even following initial reduction and fixation. Understanding the relevant anatomy and loading parameters can facilitate intraoperative decisions on approach and fixation, which are integral to achieving optimal clinical outcomes.
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Affiliation(s)
- John J. Heifner
- St. George's University School of Medicine, Great River, New York, New York
| | - Jorge L. Orbay
- The Miami Hand and Upper Extremity Institute, Miami, Florida
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Huddleston HP, Kurtzman JS, Levy KH, Connors KM, Hayes WT, Koehler SM. Radiocarpal Contact Pressures Are Not Altered after Scapholunate Ligament Tears. J Wrist Surg 2022; 11:250-256. [PMID: 35845237 PMCID: PMC9276067 DOI: 10.1055/s-0041-1731817] [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: 12/06/2020] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
Background The scapholunate interosseous ligament (SLIL) couples the scaphoid and lunate, preventing motion and instability. Prior studies suggest that damage to the SLIL may significantly alter contact pressures of the radiocarpal joint. Questions/Purposes The purpose of this study was to investigate the contact pressure and contact area in the scaphoid and lunate fossae of the radius prior to and after sectioning the SLIL. Methods Ten cadaveric forearms were dissected distal to 1-cm proximal to the radiocarpal joint and a Tekscan sensor was placed in the radiocarpal joint. The potted specimen was mounted and an axial load of 200 N was applied over 60 seconds. Results Sectioning of the SLIL did neither significantly alter mean contact pressure at the lunate fossa ( p = 0.842) nor scaphoid fossa ( p = 0.760). Peak pressures were similar between both states at the lunate and scaphoid fossae ( p = 0.301-0.959). Contact areas were similar at the lunate fossa ( p = 0.508) but trended toward an increase in the SLIL sectioned state in the scaphoid fossa ( p = 0.055). No significant differences in the distribution of contact pressure ( p = 0.799), peak pressure ( p = 0.445), and contact area ( p = 0.203) between the scaphoid and lunate fossae after sectioning were observed. Conclusion Complete sectioning of the SLIL in isolation may not be sufficient to alter the contact pressures of the wrist. Clinical Relevance Injury to the secondary stabilizers of the SL joint, in addition to complete sectioning of the SLIL, may be needed to induce altered biomechanics and ultimately degenerative changes of the radiocarpal joint.
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Affiliation(s)
- Hailey P. Huddleston
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Joey S. Kurtzman
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Kenneth H. Levy
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Katherine M. Connors
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Westley T. Hayes
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Steven M. Koehler
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
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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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Mechanical performance comparison of two surgical constructs for wrist four-corner arthrodesis via dorsal and radial approaches. Clin Biomech (Bristol, Avon) 2021; 82:105274. [PMID: 33508561 DOI: 10.1016/j.clinbiomech.2021.105274] [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] [Received: 10/21/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Four-corner arthrodesis, which involves fusing four carpal bones while removing the scaphoid bone, is a standard surgery for the treatment of advanced stages of wrist arthritis. Nowadays, it can be performed using a dorsal approach by fixing a plate to the bones and a new radial approach is in development. To date, there is no consensus on the biomechanically optimal and most reliable surgical construct for four-corner arthrodesis. METHODS To evaluate them biomechanically and thus assist the surgeon in choosing the best implant orientation, radial or dorsal, the two different four-corner arthrodesis surgical constructs were virtually simulated on a 3D finite element model representing all major structures of the wrist. Two different realistic load sets were applied to the model, representing common tasks for the elderly. FINDINGS Results consistency was assessed by comparing with the literature the force magnitude computed on the carpal bones. The Von Mises stress distribution in the radial and dorsal plates were calculated. Stress concentration was located at the plate-screw interface for both surgical constructs, with a maximum stress value of 413 MPa for the dorsal plate compared to 326 MPa for the radial plate, meaning that the stress levels are more unfavourable in the dorsal approach. INTERPRETATION Although some bending stress was found in one load case, the radial plate was mechanically more robust in the other load case. Despite some limitations, this study provides, for the first time, quantified evidence that the newly developed radial surgical construct is mechanically as efficient as the dorsal surgical construct.
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Liu W, Wang B, Zhang S, Li Y, Hu B, Shao Z. Wrist Reconstruction after En bloc Resection of Bone Tumors of the Distal Radius. Orthop Surg 2021; 13:376-383. [PMID: 33480185 PMCID: PMC7957383 DOI: 10.1111/os.12737] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/04/2020] [Accepted: 06/03/2020] [Indexed: 12/02/2022] Open
Abstract
Wrist reconstruction after en bloc resection of bone tumors of the distal radius has been a great challenge. Although many techniques have been used for the reconstruction of long bone defects following en bloc resection of the distal radius, the optimal reconstruction method remains controversial. This is the first review to systematically describe various reconstruction techniques. We not only discuss the indications, functional outcomes, and complications of these reconstruction techniques but also review the technical refinement strategies for improving the stability of the wrist joint. En bloc resection should be performed for Campanacci grade III giant cell tumors (GCT) as well as malignant tumors of the distal radius. However, wrist reconstruction after en bloc resection of the distal radius represents a great challenge. Although several surgical techniques, either achieving a stable wrist by arthrodesis or reconstructing a flexible wrist by arthroplasty, have been reported, the optimal reconstruction procedure remains controversial. The purpose of this review was to investigate which reconstruction methods might be the best option by analyzing the indications, techniques, limitations, and problems of different reconstruction methods. With the advancement of imaging, surgical techniques and materials, some reconstruction techniques have been further refined. Each of the techniques discussed in this review has its advantages and disadvantages. Wrist arthrodesis seems to be preferred over wrist arthroplasty in terms of grip strength and long‐term complications, while wrist arthroplasty seems to be superior to wrist arthrodesis in terms of wrist motion. All things considered, wrist arthroplasty with a vascularized fibular head autograft might be a good option because of better wrist function, acceptable grip strength, and a relatively lower complication rate. Moreover, wrist arthrodesis is still an option if the fibular head autograft reconstruction fails. Orthopaedic oncologists should familiarize themselves with the characteristics of each technique to select the most appropriate reconstruction method depending on each patient's situation.
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Affiliation(s)
- Weijian Liu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Baichuan Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuo Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yubin Li
- Department of Orthopaedics, Linqing City People's Hospital, Linqing, China
| | - Binwu Hu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zengwu Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Camus EJ, Aimar A, Van Overstraeten L, Schuind F, Innocenti B. Lunate loads following different osteotomies used to treat Kienböck's disease: A 3D finite element analysis. Clin Biomech (Bristol, Avon) 2020; 78:105090. [PMID: 32562880 DOI: 10.1016/j.clinbiomech.2020.105090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/08/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND One of most accepted principles for treating Kienböck's disease before wrist degeneration settles in is to decompress the lunate by an osteotomy. Several osteotomies have been proposed since 1935. However, they are based on biomechanical hypotheses that are sometimes conflicting: This study compares the decompression effect of radius transverse shortening, radius lateral closing and medial closing wedge osteotomies, capitate shortening - with and without hamate shortening - and a Camembert-type radius wedge osteotomy with and without ulnar head shortening according to Sennwald. METHODS We built a 3D wrist model using finite elements that included the metacarpal, carpal and forearm bones. All wrist ligaments and Triangular Fibrocartilage Complex were incorporated in the simulation. Load was applied on the metacarpals with the forearm bones fixed. We then applied the different osteotomies to the model. FINDINGS When load was applied to the wrist, the osteotomies that best unloaded the lunate were the capitate shortening osteotomy combined with hamate shortening and the Camembert osteotomy combined with ulna shortening; the latter was the only osteotomy that completely unloaded the lunate. INTERPRETATION We think the association of the radius Camembert osteotomy and ulna Sennwald's shortening osteotomy is the most effective procedure to propose in Kienböck's disease.
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Affiliation(s)
- Emmanuel J Camus
- SELARL Chirurgie de la main et du pied, 94bis rue Gustave Delory, 59810, Lesquin, France; ULB Brussels Free University, Erasme Hospital, Lennik road No 808, Brussels, Belgium.
| | - Anna Aimar
- ULB Brussels Free University-Ecole Polytechnique de Bruxelles, Beams (Bio, Electro And Mechanical Systems) Dept., Avenue Franklin Roosevelt No 50, Brussels, Belgium
| | - Luc Van Overstraeten
- ULB Brussels Free University, Erasme Hospital, Lennik road No 808, Brussels, Belgium; HFSU rue Pierre Caille No 9, 7500 Tournai, Belgium
| | - Frédéric Schuind
- ULB Brussels Free University, Erasme Hospital, Lennik road No 808, Brussels, Belgium
| | - Bernardo Innocenti
- ULB Brussels Free University-Ecole Polytechnique de Bruxelles, Beams (Bio, Electro And Mechanical Systems) Dept., Avenue Franklin Roosevelt No 50, Brussels, Belgium
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Schmidt I. Functional Outcomes After Salvage Procedures for Wrist Trauma and Arthritis (Four-Corner Fusion, Proximal Row Carpectomy, Total Wrist Arthroplasty, Total Wrist Fusion, Wrist Denervation): A Review of Literature. Open Orthop J 2019. [DOI: 10.2174/1874325001913010217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Background:
Several salvage procedures for the arthritically destroyed wrist exist. Each of these has advantages as well as disadvantages.
Aims:
The aim of this article is to give practical insights for the clinician on: (1) biomechanical and clinical fundamentals of normal and impaired wrist motion; (2) difficulties in assessment of postoperative outcome between measured motion by the surgeon and self-reported outcome by the patient; (3) indications for each procedure; and (4) differences in functional outcome between partial and complete motion-preserving as well as complete motion-restricting salvage procedures.
Methods:
In trend, Proximal Row Carpectomy (PRC) is slightly superior over four-corner fusion (4CF) in terms of functional outcome, but the methodology-related postoperative motion is decreased for both procedures. Furthermore, PRC is easier to perform, needs lower costs, and has fewer complications than 4CF. Total Wrist Arthroplasty (TWA) has the advantage compared to PRC and 4CF that the preoperative motion values are preserved, but it is limited by decreased load-bearing capacity for the wrist. Total Wrist Fusion (TWF) is associated with a higher load-bearing capacity for the wrist than TWA, but it is limited for carrying out essential activities of daily living. Both PRC and 4CF can be combined primarily by wrist denervation. Wrist denervation alone does not impair the movement of the wrist.
Results and Conclusion:
Salvage procedures for the arthritically destroyed wrist should be detected regarding patients age- and gender-related claims in work and leisure. Not all of them can be successfully re-employed in their original occupations associated with high load-bearing conditions.
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Oflaz H, Gunal I. Maximum loading of carpal bones during movements: a finite element study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:47-50. [DOI: 10.1007/s00590-018-2287-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/01/2018] [Indexed: 10/28/2022]
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11
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Koehler SM, Beck CM, Nasser P, Gluck M, Hausman MR. The effect of screw trajectory for the reduction and association of the scaphoid and lunate (RASL) procedure: a biomechanical analysis. J Hand Surg Eur Vol 2018; 43:635-641. [PMID: 28886667 DOI: 10.1177/1753193417729257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to determine if screw placement in the reduction and association of the scaphoid and the lunate (RASL) procedure affected the ability of the scapholunate joint to withstand force. After completely disrupting of the scapholunate ligament in 29 fresh-frozen cadaveric wrists, we placed the RASL screw either distal or proximal to the lateral aspect of the dorsal ridge of the scaphoid and into the dorsal or volar aspect of the lunate. Specimens were subjected to repeated cycles of transcarpal axial force, mimicking clenched-fist loading, until failure. Screw placement distal to the lateral aspect of the dorsal scaphoid ridge was significantly associated with failure when examined manually, radiographically (1.8 vs. 0.5 mm) and using real-time motion capture (diastasis: 1.6 vs. 0.4 mm; Euler angle: 4.5 ° vs. 0.8 °). The lateral aspect of the dorsal ridge is a reliable radiographic landmark on the scaphoid and provides surgeons with a convenient starting point to achieve the most biomechanically stable RASL construct, and, therefore, enhances the potential for an optimal clinical outcome.
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Affiliation(s)
- Steven M Koehler
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Mount Sinai Health System, New York, New York, USA
| | - Christina M Beck
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Mount Sinai Health System, New York, New York, USA
| | - Philip Nasser
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Mount Sinai Health System, New York, New York, USA
| | - Matthew Gluck
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Mount Sinai Health System, New York, New York, USA
| | - Michael R Hausman
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Mount Sinai Health System, New York, New York, USA
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Gislason MK, Foster E, Bransby-Zachary M, Nash DH. Biomechanical analysis of the Universal 2 implant in total wrist arthroplasty: a finite element study. Comput Methods Biomech Biomed Engin 2017; 20:1113-1121. [PMID: 28580792 DOI: 10.1080/10255842.2017.1336548] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Little is known about the mechanics of in vivo loading on total wrist prostheses where many studies have looked at the mechanics of other types of arthroplasty such as for the hip and the knee which has contributed to the overall success of these types of procedures. Currently surgeons would prefer to carry out arthrodesis on the wrist rather than consider arthroplasty as clinical data have shown that the outcome of total wrist arthroplasty is poorer than compared to the hip and knee. More research is needed on the loading mechanisms of the implants in order to enhance the design of future generation implants. This study looks at the load transfer characteristics of the Universal 2 implant using a finite element model of a virtually implanted prosthesis during gripping. The results showed that the loading on the implant is higher on the dorsal and ulnar aspect than on the volar and radial aspect of the implant. The whole load is transmitted through the radius and none through the ulna.
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Affiliation(s)
- M K Gislason
- a Institute for Biomedical and Neural Engineering, School of Science and Engineering , University of Reykjavik , Reykjavik , Iceland.,b Faculty of Engineering, Department of Mechanical and Aerospace Engineering , University of Strathclyde , Glasgow , UK
| | - E Foster
- b Faculty of Engineering, Department of Mechanical and Aerospace Engineering , University of Strathclyde , Glasgow , UK
| | | | - D H Nash
- b Faculty of Engineering, Department of Mechanical and Aerospace Engineering , University of Strathclyde , Glasgow , UK
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Functional Morphology of the Primate Hand: Recent Approaches Using Biomedical Imaging, Computer Modeling, and Engineering Methods. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/978-1-4939-3646-5_9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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Load transmission characteristics of limited carpal fusions: a two-dimensional finite element study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:305-8. [PMID: 24974194 DOI: 10.1007/s00590-014-1495-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 06/08/2014] [Indexed: 10/25/2022]
Abstract
Although limited carpal fusion is a choice of treatment in several wrist disorders, little is known about the biomechanics of these procedures, especially the loads carried by the ligaments. In a finite element study, four types of limited carpal fusions (scaphotrapeziotrapezoid, capitohamate, four corner fusion with and without scaphoid excision) were simulated and the loads carried by the ligaments were recorded. Measurements were repeated with and without implantation. The load transmission through the ligaments varied by the type of the fusion but, radioscaphoid and long radiolunate ligaments carried significantly more loads if not excised during the operation. Implantation did not affect the results in most cases. The model of the present study may be useful in preoperative planning.
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Quantification of the transverse carpal ligament elastic properties by sex and region. Clin Biomech (Bristol, Avon) 2014; 29:601-6. [PMID: 24933659 DOI: 10.1016/j.clinbiomech.2014.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 05/13/2014] [Accepted: 05/13/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The transverse carpal ligament is an integral factor in the etiology of carpal tunnel syndrome. The purpose of this study was to report the biomechanical properties of this ligament and quantify sex-based differences and regional variation in tissue response. We hypothesized that the mechanical response would not be uniform across the surface, and that female ligament properties would have higher strain profiles and lower mechanical properties. METHODS Uniaxial testing of twelve (six males, six females) human fresh frozen cadaveric transverse carpal ligaments was carried out using an Instron Materials Testing Machine. Strain was measured via a non-contact optical method. FINDINGS The following biomechanical properties of the transverse carpal ligament were reported in this work: failure strain (male: 9.2 (SD 5.0), female: 15.5 (SD 7.1)%), strength (male: 4.9 (SD 1.5), female: 4.5 (SD 1.6) MPa), and modulus of elasticity (male: 52.9 (SD 19.6), female: 38.2 (SD 21.9) MPa). The radial side displayed significantly more strain at failure compared to ulnar (P<0.0001). INTERPRETATION The results of this study provide evidence that manipulative treatments should focus stretching on the radial half of the tissue, which experiences larger strains under uniform loading conditions. In addition, this work suggests possible sex-based differences in mechanical properties of the transverse carpal ligament, which could provide a basis for the development of improved non-surgical treatment methods for carpal tunnel syndrome. The results can also be applied to generate more accurate computational models of the wrist.
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Zhu Z, Zhang C, Zhao S, Dong Y, Zeng B. Partial wrist arthrodesis versus arthroplasty for distal radius giant cell tumours. INTERNATIONAL ORTHOPAEDICS 2013; 37:2217-23. [PMID: 23925879 DOI: 10.1007/s00264-013-2040-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 07/17/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical efficacy of using the proximal fibular graft for partial wrist arthrodesis or arthroplasty after the resection of giant cell tumours of the distal radius. METHODS Between February 2006 and August 2010, 14 patients (seven males, seven females; average age, 35.7 years) with grade II and III giant cell tumours of the distal radius were treated by tumour resection and autologous proximal fibular grafts to reconstruct the wrist in our hospital. Seven patients each were treated by wrist arthroplasty and partial wrist arthrodesis, and were followed up for 2.2-6.8 years (average, 3.9 years). RESULTS All patients achieved primary healing. No tumour recurrence was observed during follow-up in any of the patients. No statistically significant difference in forearm rotation was observed between patients undergoing the two different treatments. However, wrist flexion-extension activities were significantly better and the wrist grip strengths were significantly worse in the arthroplasty group than in the arthrodesis group. The Musculoskeletal Tumour Society score did not significantly differ between the groups. CONCLUSIONS Overall, joint arthroplasty remains a favourable treatment with regard to the functional outcome for giant cell tumours of the distal radius; however, some of these patients may have a weaker grip strength. In comparison, partial wrist fusion appears to provide a durable and stable wrist with good long-term functional outcome.
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Affiliation(s)
- Zhongsheng Zhu
- Department of Orthopaedic Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, 301 YanChang Zhong Road, Shanghai, China, 200072
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Werber KD, Schmelz R, Peimer CA, Wagenpfeil S, Machens HG, Lohmeyer JA. Biomechanical effect of isolated capitate shortening in Kienbock's disease: an anatomical study. J Hand Surg Eur Vol 2013; 38:500-7. [PMID: 22918882 DOI: 10.1177/1753193412458996] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Multiple operations have been proposed to slow the progression of osteonecrosis and secondary carpal damage in Kienböck's disease. To assess the biomechanical changes after capitate shorting, we inserted pressure-testing devices into the carpal and radiocarpal joints in an anatomical study. Pressure sensors were placed into eight thawed non-fixated human cadaver arms to measure the forces transmitted in physiological loading. Longitudinal 9.8 N and 19.6 N forces were applied before and after capitate shortening. After capitate shortening, significant load reduction on the lunate was evident in all specimens. An average decrease of 49% was seen under a 9.8 N load and 56% under a 19.6 N load. The load was transferred to the radial and ulnar intercarpal joints. More relief of pressure on the lunate after isolated capitate shortening is achieved with a shallow angle between the scaphoid and capitate in the posteroanterior radiograph.
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Affiliation(s)
- K-D Werber
- Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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