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Zhang X, Tham S, Ek ET, McCombe D, Ackland DC. Scaphoid, lunate and capitate kinematics in the normal and ligament deficient wrist: A bi-plane X-ray fluoroscopy study. J Biomech 2023; 158:111685. [PMID: 37573806 DOI: 10.1016/j.jbiomech.2023.111685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 08/15/2023]
Abstract
The ligamentous structures of the wrist stabilise and constrain the interactions of the carpal bones during active wrist motion; however, the three-dimensional translations and rotations of the scaphoid, lunate and capitate in the normal and ligament deficient wrist during planar and oblique wrist motions remain poorly understood. This study employed a computer-controlled simulator to replicate physiological wrist motion by dynamic muscle force application, while carpal kinematics were simultaneously measured using bi-plane x-ray fluoroscopy. The aim was to quantify carpal kinematics in the native wrist and after sequential sectioning of the scapholunate interosseous ligament (SLIL) and secondary scapholunate ligament structures. Seven fresh-frozen cadaveric wrist specimens were harvested, and cycles of flexion-extension, radial-ulnar deviation and dart-thrower's motion were simulated. The results showed significant rotational and translational changes to these carpal bones in all stages of disruptions to the supporting ligaments (p < 0.05). Specifically, following the disruption of the dorsal SLIL (Stage II), the scaphoid became significantly more flexed, ulnarly deviated, and pronated relative to the radius, whereas the lunate became more extended, supinated and volarly translated (p < 0.05). Sectioning of the dorsal intercarpal (DIC), dorsal radiocarpal (DRC), and scaphotrapeziotrapezoid (STT) ligaments (Stage IV) caused the scaphoid to collapse further into flexion, ulnar deviation, and pronation. These findings highlight the importance of all the ligamentous attachments that relate to the stability of the scapholunate joint, but more importantly, the dorsal SLIL in maintaining scapholunate stability, and the preservation of the attachments of the DIC and DRC ligaments during dorsal surgical approaches. The findings will be useful in diagnosing wrist pathology and in surgical planning.
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Affiliation(s)
- X Zhang
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - S Tham
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia; Department of Plastic and Hand Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia; Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia
| | - E T Ek
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia
| | - D McCombe
- Department of Plastic and Hand Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia; Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia
| | - D C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia.
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Li J, Rath B, Hildebrand F, Eschweiler J. Wrist Bone Motion during Flexion-Extension and Radial-Ulnar Deviation: An MRI Study. Life (Basel) 2022; 12:life12101458. [PMID: 36294894 PMCID: PMC9605103 DOI: 10.3390/life12101458] [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: 08/24/2022] [Revised: 09/10/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
The wrist joint plays a vital role in activities of daily living. Clinical applications, e.g., therapeutic planning, prosthesis design, and wrist biomechanical analysis, require a detailed understanding of wrist maneuvers and motion. The lack of soft tissue information, motion analysis on limited carpal bones, etc., restrain the investigation of wrist kinematics. In this study, we established 3D models of carpal bones with their cartilages, and revealed the helical axes (HA) of all eight carpal bones for the first time. Both left and right hands at different positions of flexion-extension (FE) and radial-ulnar deviation (RUD) from five subjects were in-vivo imaged through a magnetic resonance imaging device. We segmented all of the bones, including cartilage information in the wrist joint, after which we explored the kinematics of all carpal bones with the HA method. The results showed that the HA of all carpal bones for FE bounded tightly and was mainly located slightly above the radius. During the RUD, carpal bones in the distal row rotated along with wrist movement while the scaphoid, lunate, and triquetrum primarily flexed and extended. Further results reported that the carpal bones translated greater in RUD than in FE. With the generation of more delicate wrist models and thorough investigations of carpal motion, a better understanding of wrist kinematics was obtained for further pathologic assessment and surgical treatment.
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Affiliation(s)
- Jianzhang Li
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany
- Correspondence: ; Tel.: +49-(0)-241-80-88386
| | - 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
| | - Jörg Eschweiler
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany
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Eschweiler J, Migliorini F. Reply to Nikolaidis, P.T.; Afonso, J. Comment on "Eschweiler et al. Anatomy, Biomechanics, and Loads of the Wrist Joint. Life 2022, 12, 188". Life (Basel) 2022; 12:1174. [PMID: 36013353 PMCID: PMC9410372 DOI: 10.3390/life12081174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023] Open
Abstract
Pantelis Nikolaidis and Jose Afonso published a letter [...].
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Affiliation(s)
- Jörg Eschweiler
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany;
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Musculoskeletal Modeling of the Wrist via a Multi Body Simulation. Life (Basel) 2022; 12:life12040581. [PMID: 35455073 PMCID: PMC9031395 DOI: 10.3390/life12040581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 12/23/2022] Open
Abstract
In this study, three different musculoskeletal modeling approaches were compared to each other. The objective was to show the possibilities in the case of a simple mechanical model of the wrist, using a simple multi-body-simulation (MBS) model, and using a more complex and patient-specific adaptable wrist joint MBS model. Musculoskeletal modeling could be a useful alternative, which can be practiced as a non-invasive approach to investigate body motion and internal loads in a wide range of conditions. The goal of this study was the introduction of computer-based modelling of the physiological wrist with (MBS-) models focused on the muscle and joint forces acting on the wrist.
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Li J, Nebelung S, Schock J, Rath B, Tingart M, Liu Y, Siroros N, Eschweiler J. A Novel Combined Level Set Model for Carpus Segmentation from Magnetic Resonance Images with Prior Knowledge aligned in Polar Coordinate System. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 208:106245. [PMID: 34247119 DOI: 10.1016/j.cmpb.2021.106245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Segmentation on carpus provides essential information for clinical applications including pathological evaluations, therapy planning, wrist biomechanical analysis, etc. Along with the acquisition procedure of magnetic resonance (MR) technique, poor quality of wrist images (e.g., occlusion, low signal-to-noise ratio, and contrast) often causes segmentation failure. METHODS In this work, to address such problems, a shape prior enhanced level set model was proposed. By transferring a shape contour in Cartesian Coordinate System (COS) into a curve in Polar Coordinate System (POS), parameters describing conventional shape invariance, i.e., translations, rotation, and scale were simplified into a single parameter for phase shift, which strongly improved algorithm efficiency. Given a training set in COS, a confidence interval representing the corresponding curves in POS was utilized as the shape prior set term in the model. Integrated with an edge detector, a local intensity descriptor, and a regularization term, the proposed method further possessed abilities against noise, intensity inhomogeneity as well as re-initialization problem. Images from 15 in-vivo acquired MR-datasets of the human wrist were used for validation. The performance of the proposed method has been compared with three state-of-the-art methods. RESULTS We reported a Dice Similarity Coefficient of 96.88±1.20%, a Relative Volume Difference of -1.53±3.01%, a Volume Overlap Error of 6.03±2.23%, a 95% Hausdorff Distance of 1.43±0.66 mm, an Average Symmetric Surface Distance of 0.50±0.17 mm, and a Root Mean Square Distance of 0.71±0.25 mm for the proposed method. The time consumption was 36.03±19.98 s. CONCLUSIONS Experimental results indicated that, compared with three other methods, the proposed method achieved significant improvement in terms of accuracy and efficiency.
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Affiliation(s)
- Jianzhang Li
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Aachen, Germany.
| | - Sven Nebelung
- Institute of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Justus Schock
- Institute of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Björn Rath
- Department of Orthopaedic Surgery, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Markus Tingart
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Aachen, Germany
| | - Yu Liu
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Aachen, Germany
| | - Nad Siroros
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Aachen, Germany
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Loisel F, Durand S, Persohn S, Aubry S, Lepage D, Bonnet X, Skalli W. Scapholunate kinematics after flexible anchor repair. Med Eng Phys 2019; 75:59-64. [PMID: 31734015 DOI: 10.1016/j.medengphy.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/09/2019] [Accepted: 11/03/2019] [Indexed: 01/07/2023]
Abstract
The scapholunate joint is one of the keystones of the wrist kinematics, and its study is difficult due to the carpal bones size and the richness of surrounding ligaments. We propose a new method of quantitative assessment of scapholunate kinematics through bone motion tracking in order to investigate scapholunate ligament lesion as well as repair techniques. On 6 intact wrists, steel beads were inserted into the bones of interest to track their motions. Experimental set up allowed wrist flexion extension and radio-ulnar deviation motions. Low-dose bi-planar radiographs were performed each 10° of movement for different configurations: 1) intact wrist, 2) scapholunate ligament division, 3) repair by soft anchors at the posterior then 4) anterior part. Beads' 3D coordinates were computed at each position from biplanar X-Rays, allowing accurate registration of each wrist bone. The Monte Carlo sensitivity study showed accuracy between 0.2° and 1.6 ° for the scaphoid and the lunate in motions studied. The maximum flexion-extension range of motion of the scaphoid significantly decreased after anterior repair from 73° in injured wrist to 62.7°. The proposed protocol appears robust, and the tracking allowed to quantify the anchor's influence on the wrist kinematics.
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Affiliation(s)
- François Loisel
- ENSAM, Institut de Biomécanique Humaine G. Charpark, 151, Boulevard de l'Hôpital, 75013 Paris, France; Service de Chirurgie Orthopédique, Traumatologique, Plastique et Reconstructrice, SOS Main, CHU J. Minjoz, 3 Bd A. Fleming, 25000 Besançon, France.
| | - Stan Durand
- ENSAM, Institut de Biomécanique Humaine G. Charpark, 151, Boulevard de l'Hôpital, 75013 Paris, France.
| | - Sylvain Persohn
- ENSAM, Institut de Biomécanique Humaine G. Charpark, 151, Boulevard de l'Hôpital, 75013 Paris, France.
| | - Sébastien Aubry
- Service de Radiologie Ostéoarticulaire, CHU J. Minjoz, 3 Bd A. Fleming, 25000 Besançon, France.
| | - Daniel Lepage
- Service de Chirurgie Orthopédique, Traumatologique, Plastique et Reconstructrice, SOS Main, CHU J. Minjoz, 3 Bd A. Fleming, 25000 Besançon, France.
| | - Xavier Bonnet
- ENSAM, Institut de Biomécanique Humaine G. Charpark, 151, Boulevard de l'Hôpital, 75013 Paris, France.
| | - Wafa Skalli
- ENSAM, Institut de Biomécanique Humaine G. Charpark, 151, Boulevard de l'Hôpital, 75013 Paris, France.
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Degeorge B, Coulomb R, Kouyoumdjian P, Mares O. Arthroscopic Dorsal Capsuloplasty in Scapholunate Tears EWAS 3: Preliminary Results after a Minimum Follow-up of 1 Year. J Wrist Surg 2018; 7:324-330. [PMID: 30174990 PMCID: PMC6117177 DOI: 10.1055/s-0038-1660446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 04/23/2018] [Indexed: 12/21/2022]
Abstract
Purpose We retrospectively evaluated the results of all arthroscopic dorsal scapholunate (SL) capsuloplasty without pinning in patients presenting predynamic instability and dorsal capsuloscapholunate septum lesions on arthro-computed tomography scan after failed medical treatment. Materials and Methods Fifteen patients, mean age 34.3 years, underwent all arthroscopically assisted dorsal capsuloplasty. Patients were assessed preoperatively and postoperatively by a clinical (pain, Watson's test, range of motion, and strength), functional (quick disabilities of the arm, shoulder, and hand), patient-rated wrist evaluation, and Mayo wrist score scores), and radiological (SL gap and dorsal intercalated segmental instability [DISI]) examination. SL tears were evaluated during surgery by European Wrist Arthroscopy Society (EWAS) classification. Results The mean follow-up period was 20.2 months (range, 12-41). Preoperatively, positive Watson's test was noted in all cases. DISI deformity was noted in three cases without any SL gap. The SL instability was graded EWAS IIIB ( n = 8) or EWAS IIIC ( n = 7). Postoperatively, positive Watson's test was noted in only one case. Activity pain decreased from 7.8 preoperatively to 2.4 postoperatively. Range of motion in flexion-extension increased from 92.9 degrees preoperatively to 126.2 degrees postoperatively. Grip strength increased from 24.2 preoperatively to 38.2 postoperatively. At final follow-up, range of motion in flexion-extension and grip strength were estimated at 87 and 91% compared with contralateral side, respectively. All functional scores were significantly improved at the last follow-up. No radiographic SL gapping in grip views or DISI deformity was noted. Discussion Cadaveric studies demonstrated that the dorsal portion of SL ligament is critical for the stability of the SL complex. The entire arthroscopic SL capsuloplasty technique provides reliable results for pain relief, avoiding postoperative stiffness associated with open procedures. It is an alternative technique for patients with predynamic SL instability after failure of medical management and shall not prelude the resort to any further open procedure. Level of Evidence This is a level IV, case series.
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Affiliation(s)
- Benjamin Degeorge
- Département de Chirurgie Orthopédique et Traumatologique, Chirurgie du Rachis, CHU Carémeau, Nîmes, France
| | - Rémy Coulomb
- Département de Chirurgie Orthopédique et Traumatologique, Chirurgie du Rachis, CHU Carémeau, Nîmes, France
| | - Pascal Kouyoumdjian
- Département de Chirurgie Orthopédique et Traumatologique, Chirurgie du Rachis, CHU Carémeau, Nîmes, France
| | - Olivier Mares
- Département de Chirurgie Orthopédique et Traumatologique, Chirurgie du Rachis, CHU Carémeau, Nîmes, France
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Impact of Simulated Knee Injuries on the Patellofemoral and Tibiofemoral Kinematics Investigated with an Electromagnetic Tracking Approach: A Cadaver Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7189714. [PMID: 29850554 PMCID: PMC5937613 DOI: 10.1155/2018/7189714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/13/2018] [Accepted: 03/12/2018] [Indexed: 01/01/2023]
Abstract
Purpose The purpose of this study was to evaluate the approach of using an electromagnetic tracking (EMT) system for measuring the effects of stepwise, simulated knee injuries on patellofemoral (PF) and tibiofemoral (TF) kinematics. Methods Three cadaver knees were placed in a motion rig. EMT sensors were mounted on the patella, the medial/lateral femoral epicondyles, the tibial condyle, and the tibial tuberosity (TT). After determining the motion of an intact knee, three injuries were simulated and the resulting bony motion was tracked. Results Starting with the intact knee fully extended (0° flexion) and bending it to approximately 20°, the patella shifted slightly in the medial direction. Then, while bending the knee to the flexed position (90° flexion), the patella shifted progressively more laterally. After transecting the anterior cruciate ligament (ACL), the base of the medial menisci (MM) at the pars intermedia, and the medial collateral ligament (MCL), individual changes were observed. For example, the medial femoral epicondyle displayed a medial lift-off in all knees. Conclusion We demonstrated that our EMT approach is an acceptable method to accurately measure PF joint motion. This method could also enable visualization and in-depth analysis of in vivo patellar function in total knee arthroplasty, if it is established for routine clinical use.
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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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Eschweiler J, Stromps JP, Fischer M, Schick F, Rath B, Pallua N, Radermacher K. Development of a biomechanical model of the wrist joint for patient-specific model guided surgical therapy planning: Part 1. Proc Inst Mech Eng H 2017; 230:310-25. [PMID: 26994117 DOI: 10.1177/0954411916632791] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An enhanced musculoskeletal biomechanical model of the wrist joint is presented in this article. The developed computational model features the two forearm bones radius and ulna, the eight wrist bones, the five metacarpal bones, and a soft tissue apparatus. Validation of the model was based on information taken from the literature as well as own experimental passive in vitro motion analysis of eight cadaver specimens. The computational model is based on the multi-body simulation software AnyBody. A comprehensive ligamentous apparatus was implemented allowing the investigation of ligament function. The model can easily patient specific personalized on the basis of image information. The model enables simulation of individual wrist motion and predicts trends correctly in the case of changing kinematics. Therefore, patient-specific multi-body simulation models are potentially valuable tools for surgeons in pre- and intraoperative planning of implant placement and orientation.
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Affiliation(s)
- Jörg Eschweiler
- Helmholtz-Institute for Biomedical Engineering, Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany Department of Orthopaedic, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Jan-Philipp Stromps
- Department of Plastic Surgery, Hand and Burns Surgery, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Maximilian Fischer
- Helmholtz-Institute for Biomedical Engineering, Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany
| | - Fabian Schick
- Helmholtz-Institute for Biomedical Engineering, Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany
| | - Björn Rath
- Department of Orthopaedic, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Norbert Pallua
- Department of Plastic Surgery, Hand and Burns Surgery, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Klaus Radermacher
- Helmholtz-Institute for Biomedical Engineering, Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany
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Eschweiler J, Stromps JP, Fischer M, Schick F, Rath B, Pallua N, Radermacher K. A biomechanical model of the wrist joint for patient-specific model guided surgical therapy: Part 2. Proc Inst Mech Eng H 2016; 230:326-34. [DOI: 10.1177/0954411916635443] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An enhanced musculoskeletal biomechanical model of the wrist joint is presented in this article. The computational model is based on the multi-body simulation software AnyBody. Multi body dynamic musculoskeletal models capable of predicting muscle forces and joint contact pressures simultaneously would be valuable for studying clinical issues related to wrist joint degeneration and restoration. In this study, the simulation model of the wrist joint was used for investigating deeper the biomechanical function of the wrist joint. In representative physiological scenarios, the joint behavior and muscle forces were computed. Furthermore, the load transmission of the proximal wrist joint was investigated. The model was able to calculate the parameters of interest that are not easily obtainable experimentally, such as muscle forces and proximal wrist joint forces. In the case of muscle force investigation, the computational model was able to accurately predict the computational outcome for flexion and extension motion. In the case of force distribution of the proximal wrist joint, the model was able to predict accurately the computational outcome for an axial load of 140 N. The presented model and approach of using a multi-body simulation model are anticipated to have value as a predictive clinical tool including effect of injuries or anatomical variations and initial outcome of surgical procedures for patient-specific planning and custom implant design. Therefore, patient-specific multi-body simulation models are potentially valuable tools for surgeons in pre- and intraoperative planning of implant placement and orientation.
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Affiliation(s)
- Jörg Eschweiler
- Helmholtz-Institute for Biomedical Engineering, Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany
- Department of Orthopaedic, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Jan-Philipp Stromps
- Department of Plastic Surgery, Hand and Burns Surgery, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Maximilian Fischer
- Helmholtz-Institute for Biomedical Engineering, Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany
| | - Fabian Schick
- Helmholtz-Institute for Biomedical Engineering, Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany
| | - Björn Rath
- Department of Orthopaedic, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Norbert Pallua
- Department of Plastic Surgery, Hand and Burns Surgery, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Klaus Radermacher
- Helmholtz-Institute for Biomedical Engineering, Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany
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