Elbow Instability: Anatomy, Biomechanics, Diagnostic Maneuvers, and Testing

Karbach, Lauren E.; Elfar, John C.

doi:10.1016/j.jhsa.2016.11.025

Cited by 101 publications

(61 citation statements)

References 24 publications

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“…While compared with isolated radial head fractures, the TTI involves more structural damage of the elbow, including ligaments and coronoid process. Damage to these structures increases the valgus stress on the radial head [ 23 , 24 ]. We also found that Mason III fractures were accompanied by more severe damage to the capsuloligamentous structures, reflecting higher energy damage to the elbow structures compared to Mason I or II fractures.…”

Section: Discussionmentioning

confidence: 99%

Prediction and Potential Preventions for the Development of Posttraumatic Osteoarthritis after the Terrible Triad Injury: A Multicenter Risk Factors Study

Lin

et al. 2020

BioMed Research International

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Objective. A multicenter study to evaluate risk factors for the development of moderate or severe posttraumatic osteoarthritis (PTOA) and to find potential preventions. Methods. We conducted a retrospective multicenter study including the terrible triad injury (TTI) patients with surgical treatment from January 2007 to November 2014. Demographics, injury information, and treatment history were obtained retrospectively. According to the Broberg and Morrey criterion, 198 included patients were sorted into two groups: the mild or no PTOA and moderate or severe PTOA. Uni- and multivariate logistic regression analyses were used to identify risk factors for moderate or severe PTOA. Results. Moderate or severe PTOA was present in 64 patients (32.3%). Significant risk factors were Mason III radial head fracture (OR 4.049, 95% CI 1.877-8.736, p<0.001), medial collateral ligament injury (OR 5.120, 95% CI 1.261-20.790, p=0.022), and heavy use of elbow (OR 2.333, 95% CI 1.060-5.136, p=0.035). Besides, patients suffered subluxation (p=0.007) and those with more risk factors had a higher risk to develop moderate or severe PTOA. Conclusions. Moderate or severe PTOA was common after the TTI. Patients need to be counseled about avoiding heavy use of the elbow, especially for those with Mason III radial head fractures. Surgeons should be aware of the recurrent instability of the elbow.

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Section: Discussionmentioning

confidence: 99%

Prediction and Potential Preventions for the Development of Posttraumatic Osteoarthritis after the Terrible Triad Injury: A Multicenter Risk Factors Study

Lin

et al. 2020

BioMed Research International

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“…Compared to the shoulder, the elbow allows a more constrained range of motion. Indeed, it is commonly approximated as a hinge joint with one principal rotational degree of freedom (DOF), corresponding to the flexion–extension motion (0–140°) [1,2]. A second DOF consisting in pronation–supination is commonly referred to the wrist joint, even if the elbow partially cooperates during the motion.…”

Section: Introductionmentioning

confidence: 99%

“…Elbow muscles are dynamic stabilizers. Among them, the lateral extensor musculature (extensor carpi ulnaris, extensor digitorum communis, extensor carpi radialis brevis, extensor carpi radialis longus, anconeus) resists varus forces, while the medial flexor musculature (the flexor carpi ulnaris, flexor carpi radialis, flexor digitorum superficialis, pronator teres) resists valgus forces [2].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Role and Motion Contribution of Ligaments and Bony Constraints in the Elbow Stability: A Preliminary Study

et al. 2019

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In flexion–extension motion, the interaction of several ligaments and bones characterizes the elbow joint stability. The aim of this preliminary study was to quantify the relative motion of the ulna with respect to the humerus in two human upper limbs specimens and to investigate the constraints role for maintaining the elbow joint stability in different section conditions. Two clusters of four markers were fixed respectively to the ulna and humerus, and their trajectory was recorded by a motion capture system during functional orthopedic maneuver. Considering the posterior bundle of medial collateral complex (pMUCL) and the coronoid, two section sequences were executed. The orthopedic maneuver of compression, pronation and varus force was repeated at 30°, 60° and 90° flexion for the functional investigation of constraints. Ulna deflection was compared to a baseline elbow flexion condition. With respect to the intact elbow, the coronoid osteotomy influences the elbow stability at 90° (deflection = 11.49 ± 17.39 mm), while small differences occur at 30° and 60°, due to ligaments constraint. The contemporary pMUCL section and coronoid osteotomy causes elbow instability, with large deflection at 30° (deflection = 34.40 ± 9.10 mm), 60° (deflection = 45.41 ± 18.47 mm) and 90° (deflection = 52.16 ± 21.92 mm). Surgeons may consider the pMUCL reconstruction in case of unfixable coronoid fracture.

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“…The elbow joint comprises ligamentous and bony stabilizers that furnish both primary and secondary stability during flexion. The ulnohumeral articulation, the anterior bundle of the medial collateral ligament (AM-CL) and the lateral collateral ligament (LCL) complex are the 3 primary static constraints, while the radiocapitellar articulation, the common flexor tendons, the common extensor tendons and the joint capsule are the secondary static constraints 1 . The muscles which cross the elbow joint represent the dynamic stabilizers, and their role has already been investigated in 2,3 .…”

Section: Introductionmentioning

confidence: 99%

Multibody modelling of ligamentous and bony stabilizers in the human elbow

Terzini

Zanetti

Audenino

et al. 2019

Muscle Ligaments and Tendons J

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The elbow ligamentous and bony structures play essential roles in the joint stability. Nevertheless, the contribution of different structures to joint stability is not yet clear and a comprehensive experimental investigation into the ligament and osseous constraints changes in relation to joint motions would be uphill and somehow unattainable, due to the impossibility of obtaining all the possible configurations on the same specimen. Therefore, a predictive tool of the joint behavior after the loss of retentive structures would be helpful in designing reconstructive surgeries and in pre-operative planning. In this work, a multibody model consisting of bones and non-linear ligamentous structures is presented and validated through comparison with experimental data. An accurate geometrical model was equipped with non-linear ligaments bundles between optimized origin and insertion points. The joint function was simulated according to maneuvers accomplished in published experimental studies which explored the posteromedial rotatory in-stability (PMRI) in coronoid and posterior medial collateral ligament (PB) deficient elbows. Moreover, a complete design of experiments (DOE) was explored, investigating the influence of the elbow flexion degree, of the coronoid process and of the medial collateral ligaments (MCL) structures (anterior and posterior bundles) in the elbow joint opening. The implemented computational model accurately predicted the joint behavior with intact and deficient stabilizing structures at each flexion degree, and highlighted the statistically significant influence of the MCL structures (P<0.05) on the elbow stability. The predictive ability of this multibody elbow joint model let foresee that future investigations under different loading scenarios and injured or surgically reconstructed states could be effectively simulated, helping the ligaments reconstruction optimization in terms of bone tunnel localizations and grafts pre-loading. Level of evidence: V.

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Elbow Instability: Anatomy, Biomechanics, Diagnostic Maneuvers, and Testing

Cited by 101 publications

References 24 publications

Prediction and Potential Preventions for the Development of Posttraumatic Osteoarthritis after the Terrible Triad Injury: A Multicenter Risk Factors Study

Prediction and Potential Preventions for the Development of Posttraumatic Osteoarthritis after the Terrible Triad Injury: A Multicenter Risk Factors Study

Biomechanical Role and Motion Contribution of Ligaments and Bony Constraints in the Elbow Stability: A Preliminary Study

Multibody modelling of ligamentous and bony stabilizers in the human elbow

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