Kinematics of the ligamentous unstable elbow joint after application of a hinged external fixation device: a cadaveric study.

We studied the kinematics of 8 ligamentous unstable elbow joint preparations after application of the Orthofix elbow external fixation device. Valgus, varus, external rotatory, and internal rotatory load tests were performed in lateral collateral ligament (LCL)-deficient and LCL/medial collateral ligament (MCL)-deficient joints. After placement of the fixator, the mean extension decreased significantly to 19.5 degrees +/- 7.2 degrees in the LCL-deficient joint and to 19.1 degrees +/- 6.6 degrees in the LCL/MCL-deficient joint compared with the mean extension of the intact joint, which was 10.5 degrees +/- 4.2 degrees. After application of the fixator, valgus displacement was significantly decreased by 4.0 degrees +/- 3.4 degrees in the LCL-deficient joint and by 3.6 degrees +/- 3.3 degrees in the LCL/MCL-deficient joint compared with the intact joint. External rotatory displacement was significantly decreased in the LCL-deficient joint by 4.9 degrees +/- 3.7 degrees and in the LCL/MCL-deficient joint by 5.0 degrees +/- 4.7 degrees. Internal rotatory displacement was significantly decreased by 3.3 degrees +/- 2.7 degrees in the LCL-deficient joint, but it was not significantly changed in the LCL/MCL-deficient joint. The Orthofix elbow external fixator guided elbow motion to a more varus position compared with the intact elbow and decreased the range of motion of the joint, constraining mainly extension. We conclude that the fixator stabilized the ligamentous unstable elbow joint efficiently but at the expense of changes in the normal motion pattern.

[1]  T D Brown,et al.  Hinged external fixation of the elbow: optimal axis alignment to minimize motion resistance. , 2000, Journal of orthopaedic trauma.

[2]  A. Weiland,et al.  Valgus stability of the elbow , 1987, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[3]  H. B. Bamberger,et al.  Indications, alternatives, and complications of external fixation about the elbow. , 2002, Hand clinics.

[4]  D. Ring,et al.  Treatment of Unreduced Elbow Dislocations with Hinged External Fixation , 2002, The Journal of bone and joint surgery. American volume.

[5]  T. Brown,et al.  Assessment of elbow joint kinematics in passive motion by electromagnetic motion tracking , 2000, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[6]  E. Chao,et al.  A biomechanical study of normal functional elbow motion. , 1981, The Journal of bone and joint surgery. American volume.

[7]  A. Lundberg,et al.  Variation in the position and orientation of the elbow flexion axis. , 2003, The Journal of bone and joint surgery. British volume.

[8]  M. McKee,et al.  Management of recurrent, complex instability of the elbow with a hinged external fixator , 1998 .

[9]  J. O. Søjbjerg,et al.  Kinematics of the lateral ligamentous constraints of the elbow joint. , 1996, Journal of shoulder and elbow surgery.

[10]  J. O. Søjbjerg,et al.  Laxity of the elbow after experimental excision of the radial head and division of the medial collateral ligament. Efficacy of ligament repair and radial head prosthetic replacement: a cadaver study. , 2003, Journal of Bone and Joint Surgery-british Volume.

[11]  K. An,et al.  Elbow subluxation and dislocation. A spectrum of instability. , 1992, Clinical orthopaedics and related research.

[12]  K. Mader,et al.  Transarticular fixation with the capacity for motion in fracture dislocations of the elbow. , 2000, Injury.

[13]  M. McKee,et al.  Management of recurrent, complex instability of the elbow with a hinged external fixator. , 1998, The Journal of bone and joint surgery. British volume.

[14]  A. Plakseychuk,et al.  The Compass Elbow Hinge: Indications and Initial Results , 2000, Journal of hand surgery.

[15]  S. L. Jensen,et al.  Elbow joint stability following experimental osteoligamentous injury and reconstruction. , 2003, Journal of shoulder and elbow surgery.

[16]  B F Morrey,et al.  Valgus stability of the elbow. A definition of primary and secondary constraints. , 1991, Clinical orthopaedics and related research.

[17]  James A. Johnson,et al.  Variability and repeatability of the flexion axis at the ulnohumeral joint , 2003, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[18]  M. V. Volkov,et al.  Restoration of function in the knee and elbow with a hinge-distractor apparatus. , 1975, The Journal of bone and joint surgery. American volume.

[19]  K. An,et al.  An in vitro biomechanical study of a hinged external fixator applied to an unstable elbow. , 2005, Journal of shoulder and elbow surgery.

[20]  J. O. Søjbjerg,et al.  Lateral collateral ligament of the elbow joint: anatomy and kinematics. , 1996, Journal of shoulder and elbow surgery.

[21]  J. Gliatis,et al.  Unilateral hinged external fixator of the elbow in complex elbow injuries. , 2004, Injury.

[22]  J. London.  Kinematics of the elbow. , 1981, The Journal of bone and joint surgery. American volume.

[23]  B. Adams,et al.  Articulated external fixation of the elbow , 2001 .