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Analysis of the Concentric Distraction and Distraction Loss of the Bridged Elbow by a Dynamic Fixator

Published online by Cambridge University Press:  05 May 2011

K.-S. Shih ,
W.-S. Lee ,
C.-S. Tseng ,
T.-W. Lu ,
S.-M. Hou  and
S.-C. Lin
K.-S. Shih
Affiliation:
Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan 10617, R.O.C. Division of Orthopedic Surgery, Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan 22060, R.O.C.
W.-S. Lee
Affiliation:
Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan 10607, R.O.C.
C.-S. Tseng
Affiliation:
Institute of Biomedical Engineering, National Central University, Taoyuan, Taiwan 32001, R.O.C. Department of Mechanical Engineering, National Central University, Taoyuan, Taiwan 32001, R.O.C.
T.-W. Lu
Affiliation:
Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan 10617, R.O.C.
S.-M. Hou
Affiliation:
Department of Orthopedic Surgery, National Taiwan University, Taipei, Taiwan 10617, R.O.C.
S.-C. Lin
Affiliation:
Institute of Biomedical Engineering, Department of Mechanical Engineering, National Central University, Taoyuan, Taiwan 32001, R.O.C.
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Abstract

The mechanisms of concentric distraction and distraction loss within the elbow-fixator-pin construct remains unclear. Furthermore, the literature reports are inconsistent regarding the correct distraction distance between the articulating surfaces of a bridged elbow. This study investigated the mechanism of the distraction loss in terms of the relevant fixator design and elbow angle. Four elbow joints flexed at 90°, 120°, 150°, and 180° were developed in this study. The contribution of each humeral and ulnar distractor to the concentric distraction at the elbow center was evaluated by the finite-element method. The distraction loss within the elbow-fixator-pin construct was studied along the specific load-transferring paths on both elbow sides. Among four elbow models, both concentric and eccentric distractions simultaneously occur at the elbow center. The distraction loss always exists in the joint distraction of the bridged elbow. Comparatively, the 120° elbow model showed the more effectively concentric distraction. For the 180° elbow model, the distraction loss was the highest. This distraction loss was mainly attributed to the lateral deflection of the fixing pins and the vectorial transformation of the distracted length of the distractors. The lateral deflection of the fixing pins is a function of the stiffness of both pins and periarticular tissues. The spatial relationship of the elbow anatomy, elbow angle, and fixator frame plays a significant role in the vectorial transformation of the effective distraction between the elbow articulating surfaces.

Keywords

Joint distractionArthrodiatasisDynamic fixatorFinite element analysis
Type
Articles
Information
Journal of Mechanics , Volume 26 , Issue 1 , March 2010 , pp. 105 - 112
Copyright
Copyright © The Society of Theoretical and Applied Mechanics, R.O.C. 2010

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References

1.Cheng, S. L. and Morrey, B. F., “Treatment of the Mobile, Painful Arthritic Elbow by Distraction Interposition Arthroplasty,” Journal of Bone and Joint Surgery, British Volume, 82, pp. 233–238 (2000).CrossRefGoogle ScholarPubMed
2.King, G. J. and Faber, K. J., “Posttraumatic Elbow Stiffness,” Orthopedic Clinics of North America, 31, pp. 129–143 (2000).CrossRefGoogle ScholarPubMed
3.Morrey, B. F., “The Posttraumatic Stiff Elbow,” Clinical Orthopaedics and Related Research, 431, pp. 26–35 (2005).Google Scholar
4.Morrey, B. F., “Distraction Arthroplasty: Clinical Applications.” Clinical Orthopaedics and Related Research, 293, pp. 46–54 (1993).CrossRefGoogle Scholar
5.van Roermund, P. M., van Valburg, A. A., Duivemann, E., van Melkebeek, J., Lafeber, F. P., Bijlsma, J. W. and Verbout, A. J., “Function of Stiff Joints May Be Restored by Ilizarov Joint Distraction,” Clinical Orthopaedics and Related Research, 348, pp. 220–227 (1998).CrossRefGoogle Scholar
6.Ruch, D. S. and Triepel, C. R., “Hinged Elbow Fixation for Recurrent Instability Following Fracture Dislocation,” Injury, 32, pp. SD70–78 (2001).CrossRefGoogle ScholarPubMed
7.Hausman, M. R. and Birnbaum, P. S., “Interposition Elbow Arthroplasty,” Techniques in Hand and Upper Extremity Surgery, 8, pp. 181–188 (2004).CrossRefGoogle ScholarPubMed
8.Stavlas, P., Gliatis, J., Polyzois, V. and Polyzois, D., “Unilateral Hinged External Fixator of the Elbow in Complex Elbow Injuries,” Injury, 35, pp. 1158–1166 (2004).CrossRefGoogle ScholarPubMed
9.Gausepohl, T., Mader, K. and Pennig, D., “Mechanical Distraction for the Treatment of Posttraumatic Stiffness of the Elbow in Children and Adolescents,” Journal of Bone and Joint Surgery, American Volume, 88, pp. 1011–1021 (2006).Google ScholarPubMed
10.Howard, C. B., Simkin, A., Tiran, Y., Porat, S., Segal, D. and Mattan, Y., “Do Axial Dynamic Fixators Really Produce Axial Dynamization?” Injury, 30, pp. 25–30 (1999).CrossRefGoogle ScholarPubMed
11.Jupiter, J. B. and Ring, D., “Treatment of Unreduced Elbow Dislocations with Hinged External Fixation,” Journal of Bone and Joint Surgery, American Volume, 84, pp. 1630–1965 (2002).Google ScholarPubMed
12.Madey, S. M., Bottlang, M., Steyers, C. M., Marsh, J. L. and Brown, T. D., “Hinged External Fixation of the Elbow: Optimal Axis Alignment to Minimize Motion Resistance,” Journal of Orthopaedic Trauma, 14, pp. 41–47 (2000).CrossRefGoogle ScholarPubMed
13.Lee, D. H., “Posttraumatic Elbow Arthritis and Arthroplasty.” Orthopedic Clinics of North America, 30, pp. 141–162(1999).CrossRefGoogle ScholarPubMed
14.Fox, R. J., Varitimidis, S. E., Plakseychuk, A., Vardakas, D. G., Tomaino, M. M. and Sotereanos, D. G., “The Compass Elbow Hinge: Indications and Initial Results,” Journal of Hand Surgery (Br-Eu). 25B, pp. 568–572 (2000).CrossRefGoogle Scholar
15.Regan, W. D., Korinek, S. L., Morrey, B. F. and An, K. N., “Biomechanical Study of Ligaments Around the Elbow Joint,” Clinical Orthopaedics and Related Research, 271, pp. 170–179(1991).CrossRefGoogle Scholar
16.Safran, M. R. and Baillargeon, D., “Soft-Tissue Stabilizers of the Elbow,” Journal of Shoulder Elbow Surg., 14, pp. 179S–185S (2005).CrossRefGoogle ScholarPubMed
17.Shih, K. S., Lu, T. W., Fu, Y. C., Hou, S. M., Sun, J. S. and Cheng, C. Y., “Biomechanical Analysis of Nonconstrained and Semiconstrained Total Elbow Replacement: A Preliminary Report,” Journal of Mechanics, 24, pp. 103–110(2008).CrossRefGoogle Scholar
18.Mader, K., Pennig, D., Gausepohl, T., Koslowsky, T. C. and Wulke, A. P., “Post-Traumatic Stiffness of the Elbow: Arthrodiatasis Using Unilateral Hinged External Fixation,” Scientific Exhibit at the 71th AAOS Annual Meeting (2004).Google Scholar