Eighteen osteoligamentous elbow joint specimens were included in a study of the medial collateral ligament complex (MCL). The morphologic characteristics of the MCL were examined, and three-dimensional kinematic measurements were taken after selective ligament dissections were performed. On morphologic evaluation the MCL is divided into the anterior bundle and the posterior bundle. The anterior bundle can be divided into anterior and posterior bands. The maximum valgus and internal rotatory instability after transection of the anterior band, 11.7 degrees and 11.2 degrees, respectively, were found at elbow flexions of 30 degrees and 40 degrees. Severance of the entire anterior bundle produced major valgus and internal rotatory laxity through the complete flexion arc of maximal 14.2 degrees and 18.5 degrees, respectively, at 70 degrees and 60 degrees of elbow flexion. Cutting both the posterior band and the posterior bundle resulted in only internal rotatory laxity of maximal 7.2 degrees at 130 degrees of elbow flexion. This study defines the anterior band as the primary constraint to valgus and internal rotatory forces, the posterior band as the secondary, and the posterior bundle as the tertiary constraint. The MCL was observed to be a complex of ligamentous fibers rather than individual bands that stabilizes the joint against valgus and internal rotatory forces.

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Fifty-one patients with fracture of the body of the talus were seen at follow-up examination an average of 23 months after treatment. Osteonecrosis had developed in 8 out of 17 patients with displaced shearing or crush fractures of the trochlea. Malunion as well as subluxation predisposed to osteoarthrosis in the subtalar and talocrural joints. Thus, osteoarthrosis was present in 9 out of 21 patients without malunion, in 8 out of 16 patients with malunion, and in 11 out of 14 with malunion as well as subluxation. Judging from the nature of the complaints, the difficulties in rehabilitation, and the disability assessment, the prognosis was fairly grave, also after the small, usually non-displaced fractures of the posterior and lateral tubercles. Out of 20 patients with fractures of this type only 6 obtained almost complete relief from their symptoms, only 8 could go back to their previous work on a full-time basis, and 11 were assessed to be 10 per cent or more disabled. Fractures in the posterior and lateral tubercles must therefore be interpreted as links in more extensive injuries involving the subtalar joint and possibly the talocrural joint with associated injuries to articular cartilage, joint capsules, and ligaments.

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