In Vivo Three-dimensional Motion Analysis of Chronic Radial Head Dislocations

Abstract

Background Forearm kinematics and interosseous membrane function in chronic radial head dislocations sustained in childhood are unknown. Several procedures have been performed to reduce the radial head on the basis of static preoperative assessment in only one forearm position, but clinical results are not always favorable. Questions/purposes We investigated the in vivo threedimensional (3D) kinematics and length changes of interosseous membrane ligaments during forearm rotation in chronic radial head dislocations using 3D CT registration techniques. Methods We examined 10 patients with chronic radial head dislocations (seven Type 1 and three Type 4 Monteggia lesions). To quantify kinematics, the axis of rotation (AOR) and radial head motion were investigated using computer bone models constructed from CT data placing the forearm in three positions. We also created six interosseous membrane ligaments and calculated their 3D lengths during forearm rotation.

Korrekturosteotomie des distalen Humerus und Unterarms – eine praktische Übersicht

“…Nonunion of the radial or ulnar condyle leads to severe arthrosis of the affected elbow joint, resulting in pain, loss of motion, and handicap in daily life and professional activities [8]. Chronic missed Monteggia deformity inevitably results in loss of flexion, forearm rotation, and arthritic deformity of the radiocapitellar joint [9][10][11][12][13][14]. In all cases, clinical history may reveal pain, stiffness, loss of motion, loss of strength, disability, and visible cosmetic changes.…”

“…Fig. 2; [2,3,9]). It may also occur due to abnormal joint kinematics following radioulnar joint malalignment secondary to axial malunion.…”

“…In the last 5 years, in cases of complex deformities in more than one plane at the distal humerus, as well as in cases with rotational deformity in the forearm (e.g., after malunion), the authors perform computerized three-dimensional (3D) planning with/without patient-specific templates, since rotational deformities cannot consistently and accurately be calculated by traditional planning techniques [1,9,16,19].…”

“…6). In the last 7 years, all multiplanar deformities of the distal humerus treated by the senior author (KM) were preoperatively planned using computed tomography (CT)-based three-dimensonial (3D) planning and 3D prototyping [4,9,16,19]. Although these planning procedures have become more and more expensive in recent years (as medical companies in this sector have started to reimburse their development costs), the authors are aware that multidimensional deformities in the modern era should not be planned two-dimensionally and, as such, challenge the medical insurance companies to cover the costs in all cases (which are on average € 3500 per planning/rapid prototyping of templates) [1,16].…”

In vivo 3D Kinematics of Axis of Rotation in Malunited Monteggia Fracture Dislocation

“…Other factors to consider in chronic dislocation of the radial head are interosseous membrane and rotational deformity of the ulna. Miyake et al 30) argue that the interosseous membrane maintains isometric during normal forearm rotation and that this provides stability when the radial heads are exercised. Further, in quaternary Monteggia fracture patients, the loss of function of the interosseous membrane means that ligament reconstruction should be considered as well as ulnar correction.…”