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The effect of radial head fracture size on elbow kinematics and stability
Author(s) -
Beingessner Daphne M.,
Dunning Cynthia E.,
Gordon Karen D.,
Johnson James A.,
King Graham J. W.
Publication year - 2005
Publication title -
journal of orthopaedic research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.041
H-Index - 155
eISSN - 1554-527X
pISSN - 0736-0266
DOI - 10.1016/j.orthres.2004.06.001
Subject(s) - valgus , elbow , ligament , medial collateral ligament , cadaveric spasm , kinematics , humerus , anatomy , radial head fracture , radial head , fracture (geology) , ulna , medicine , orthodontics , materials science , physics , composite material , classical mechanics
This study determined the effect of radial head fracture size and ligament injury on elbow kinematics. Eight cadaveric upper extremities were studied in an in vitro elbow simulator. Testing was performed with ligaments intact, with the medial collateral (MCL) or lateral collateral (LCL) ligament detached, and with both the MCL and LCL detached. Thirty degree wedges were sequentially removed from the anterolateral radial head up to 120°. Valgus angulation and external rotation of the ulna relative to the humerus were determined for passive motion, active motion, and pivot shift testing with the arm in a vertical (dependent) orientation. Maximum varus–valgus laxity was calculated from measurements of varus and valgus angulation with the arm in horizontal gravity‐loaded positions. No effect of increasing radial head fracture size was observed on valgus angulation during passive and active motion in the dependent position. In supination, external rotation increased with increasing fracture size during passive motion with LCL deficiency and both MCL and LCL deficiency. With intact ligaments, maximum varus–valgus laxity increased with increasing radial head fracture size. With ligament disruption, elbows were grossly unstable, and no effect of increasing radial head fracture size occurred. During pivot shift testing, performed with the ligaments intact, subtle instability was noted after resection of one‐third of the radial head. In this in vitro biomechanical study, small subtle effects of radial head fracture size on elbow kinematics and stability were seen in both the ligament intact and ligament deficient elbows. These data suggest that fixation of displaced radial head fractures less than or equal to one‐third of the articular diameter may have some biomechanical advantages; however, clinical correlation is required. © 2004 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved.