Kim, Eugene
(Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
,
Park, Se-Jin
(Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
,
Jeong, Haw-Jae
(Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
,
Ahn, Jin Whan
(Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
,
Shin, Hun-Kyu
(Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
,
Park, Jai Hyung
(Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
,
Lee, Mi Yeon
(Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
,
Tsuyoshi, Murase
(Department of Orthopedic Surgery, Osaka University Graduate School of Medicine)
,
Sumika, Ikemototo
(Department of Orthopedic Surgery, Osaka University Graduate School of Medicine)
,
Kazuomi, Sugamoto
(Department of Orthopedic Surgery, Osaka University Graduate School of Medicine)
,
Choi, Young-Min
(Department of Orthoped)
Background: Normal elbow joint kinematics has been widely studied in cadaver, whilst in vivo study, especially of the forearm, is rare. Our study analyses, in vivo, the kinematics of normal forearm and of malunited forearm using a three-dimensional computerized simulation system. Methods: We examine...
Background: Normal elbow joint kinematics has been widely studied in cadaver, whilst in vivo study, especially of the forearm, is rare. Our study analyses, in vivo, the kinematics of normal forearm and of malunited forearm using a three-dimensional computerized simulation system. Methods: We examined 8 patients with malunited Monteggia fracture and 4 controls with normal elbow joint. The ulna and radius were reconstructed from CT data placing the forearm in three different positions; full pronation, neutral, and full supination using computer bone models. We analyzed the axis of rotation 3-dimentionally based on the axes during forearm rotation from full pronation to full supination. Results: Axis of rotation of normal forearm was pitch line, with a mean range of 2 mm, from full pronation to full supination, connecting the radial head center proximally and ulnar fovea distally. In normal forearm, the mean range was 1.32 mm at the proximal radioulnar joint and 1.51 mm at the distal radioulnar joint. However in Monteggia fracture patients, this range changed to 7.65 mm at proximal and 4.99 mm at distal radoulnar joint. Conclusions: During forearm rotation, the axis of rotation was constant in normal elbow joint but unstable in malunited Monteggia fracture patients as seen with radial head instability. Therefore, consideration should be given not only to correcting deformity but also to restoring AOR by 3D kinematics analysis before surgical treatment of such fractures.
Background: Normal elbow joint kinematics has been widely studied in cadaver, whilst in vivo study, especially of the forearm, is rare. Our study analyses, in vivo, the kinematics of normal forearm and of malunited forearm using a three-dimensional computerized simulation system. Methods: We examined 8 patients with malunited Monteggia fracture and 4 controls with normal elbow joint. The ulna and radius were reconstructed from CT data placing the forearm in three different positions; full pronation, neutral, and full supination using computer bone models. We analyzed the axis of rotation 3-dimentionally based on the axes during forearm rotation from full pronation to full supination. Results: Axis of rotation of normal forearm was pitch line, with a mean range of 2 mm, from full pronation to full supination, connecting the radial head center proximally and ulnar fovea distally. In normal forearm, the mean range was 1.32 mm at the proximal radioulnar joint and 1.51 mm at the distal radioulnar joint. However in Monteggia fracture patients, this range changed to 7.65 mm at proximal and 4.99 mm at distal radoulnar joint. Conclusions: During forearm rotation, the axis of rotation was constant in normal elbow joint but unstable in malunited Monteggia fracture patients as seen with radial head instability. Therefore, consideration should be given not only to correcting deformity but also to restoring AOR by 3D kinematics analysis before surgical treatment of such fractures.
* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.
제안 방법
The construction of 3-dimensional (3D) bone surface models. (A) The test subjects were scanned whilst in a prone position with the shoulders at full elevation, the elbow at full extension, and the forearm at 3 different positions (full pronation, neutral, and full supination). The image was scanned to include the wrist and elbow joints.
The subjects had to actively maintain the above positions, and the image was taken to include the elbow and wrist joints. The recorded images were converted into Digital Imaging and Communications in Medicine (DICOM) data, which were made into 3D surface models using a commercial software programme (Bone viewer; Orthree, Osaka, Japan) (Fig. 1). These 3D surface models made from the above 3 positions underwent a markerless surface registration matching technique using a different program (Bone simulator; Orthree, Osaka, Japan),21,22) which superimposed based on the ulna.
When the AOR is physically damaged, the restoration of its normal state is paramount. The restoration should involve not only the 2-dimensional assessments such as radiography prior to corrective osteotomy, but also a 3-dimensional kinematic analysis which identifies the instability of AOR in the PRUJ and DRUJ. When this instability is restored to normal, it appears to aid surgical prognosis.
The study was composed of a normal group and malunited Monteggia fracture group, with patients having both radial head dislocation and malunited Monteggia fracture. Noraml group was comprised four patients (2 male and 2 female) who agreed to opposite side normal forearm CT scan.
19) have used this method to research forearm AOR with an emphasis on distal radioulnar joints (DRUJ), and as a consequence research on proximal radioulnar joints (PRUJ) is limited. Therefore, our research analyzes AOR change in forearm pronation and supination in normal and malunited forearms comparing the DRUJl and PRUJ.
후속연구
The limitations listed above mean that our study results fall short to be used as evidence for change of specific clinical standards or medical procedure. But importantly, we believe that this new methodology involving the analysis of kinematics will help improve the understanding of forearm motion and mechanism in future research.
참고문헌 (34)
Bell Tawse AJ. The treatment of malunited anterior Monteggia fractures in children. J Bone Joint Surg Br. 1965;47(4):718-23.
Horii E, Nakamura R, Koh S, Inagaki H, Yajima H, Nakao E. Surgical treatment for chronic radial head dislocation. J Bone Joint Surg Am. 2002;84(7):1183-8.
Holst-Nielsen F, Jensen V. Tardy posterior interosseous nerve palsy as a result of an unreduced radial head dislocation in Monteggia fractures: a report of two cases. J Hand Surg Am. 1984;9(4):572-5.
Lloyd-Roberts GC, Bucknill TM. Anterior dislocation of the radial head in children: aetiology, natural history and management. J Bone Joint Surg Br. 1977;59(4):402-7.
Oner FC, Diepstraten AF. Treatment of chronic post-traumatic dislocation of the radial head in children. J Bone Joint Surg Br. 1993;75(4):577-81.
Seel MJ, Peterson HA. Management of chronic posttraumatic radial head dislocation in children. J Pediatr Orthop. 1999;19(3):306-12.
Hirayama T, Takemitsu Y, Yagihara K, Mikita A. Operation for chronic dislocation of the radial head in children. Reduction by osteotomy of the ulna. J Bone Joint Surg Br. 1987;69(4):639-42.
Inoue G, Shionoya K. Corrective ulnar osteotomy for malunited anterior Monteggia lesions in children. 12 patients followed for 1-12 years. Acta Orthop Scand. 1998;69(1):73-6.
Cappellino A, Wolfe SW, Marsh JS. Use of a modified Bell Tawse procedure for chronic acquired dislocation of the radial head. J Pediatr Orthop. 1998;18(3):410-4.
Hollister AM, Gellman H, Waters RL. The relationship of the interosseous membrane to the axis of rotation of the forearm. Clin Orthop Relat Res. 1994;(298):272-6.
Youm Y, Dryer RF, Thambyrajah K, Flatt AE, Sprague BL. Biomechanical analyses of forearm pronation-supination and elbow flexion-extension. J Biomech. 1979;12(4):245-55.
Nakamura T, Yabe Y, Horiuchi Y, Yamazaki N. In vivo motion analysis of forearm rotation utilizing magnetic resonance imaging. Clin Biomech. 1999;14(5):315-20.
Hagert CG. The distal radioulnar joint in relation to the whole forearm. Clin Orthop Relat Res. 1992;(275):56-64.
Christensen JB, Adams JP, Cho KO, Miller L. A study of the interosseous distance between the radius and ulna during rotation of the forearm. Anat Rec. 1968;160(2):261-71.
Fischer KJ, Manson TT, Pfaeffle HJ, Tomaino MM, Woo SL. A method for measuring joint kinematics designed for accurate registration of kinematic data to models constructed from CT data. J Biomech. 2001;34(3):377-83.
Oka K, Murase T, Moritomo H, Goto A, Sugamoto K, Yoshikawa H. Accuracy analysis of three-dimensional bone surface models of the forearm constructed from multidetector computed tomography data. Int J Med Robot. 2009;5(4):452-7.
Murase T, Oka K, Moritomo H, Goto A, Yoshikawa H, Sugamoto K. Three-dimensional corrective osteotomy of malunited fractures of the upper extremity with use of a computer simulation system. J Bone Joint Surg Am. 2008;90(11):2375-89.
Heo YM, Kim WS, Kim SH, Jeon TS, Kim SB, Oh BH. Isolated anterior dislocation of the radial head in adult: a case report. J Korean Shoulder Elbow Soc. 2007;10(1):131-5.
Exner GU. Missed chronic anterior Monteggia lesion. Closed reduction by gradual lengthening and angulation of the ulna. J Bone Joint Surg Br. 2001;83(4):547-50.
Hasler CC, Von Laer L, Hell AK. Open reduction, ulnar osteotomy and external fixation for chronic anterior dislocation of the head of the radius. J Bone Joint Surg Br. 2005;87(1):88-94.
Shon HC, Kim WY, Park SE, Kim YY, Yoon JS, Ji JH. Surgical treatment of neglected adult Monteggia fracture. J Korean Shoulder Elb Soc. 2006;9(2):235-41.
Shen J, Papadonikolakis A, Garrett JP, Davis SM, Ruch DS. Ulnar-positive variance as a predictor of distal radioulnar joint ligament disruption. J Hand Surg Am. 2005;30(6):1172-7.
Miyake J, Moritomo H, Kataoka T, Murase T, Sugamoto K. In vivo three-dimensional motion analysis of chronic radial head dislocations. Clin Orthop Relat Res. 2012;470(10):2746-55.
Kim E, Moritomo H, Murase T, Masatomi T, Miyake J, Sugamoto K. Three-dimensional analysis of acute plastic bowing deformity of ulna in radial head dislocation or radial shaft fracture using a computerized simulation system. J Shoulder Elbow Surg. 2012;21(12):1644-50.
Moojen TM, Snel JG, Ritt MJ, Venema HW, Kauer JM, Bos KE. In vivo analysis of carpal kinematics and comparative review of the literature. J Hand Surg Am. 2003;28(1):81-7.
Foumani M, Strackee SD, Jonges R, et al. In-vivo threedimensional carpal bone kinematics during flexion-extension and radio-ulnar deviation of the wrist: Dynamic motion versus step-wise static wrist positions. J Biomech. 2009;42(16):2664-71.
※ AI-Helper는 부적절한 답변을 할 수 있습니다.