Type II coronoid fracture in a terrible triad elbow: An experimental study of the elbow kinematics using dynamic radiostereometric analysis

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-05-11 DOI:10.1016/j.clinbiomech.2025.106557

Johanne Frost Teilmann , Josephine Olsen Kipp , Emil Toft Petersen , Chalotte Krabbe Hemmingsen , Maiken Stilling , Theis Muncholm Thillemann

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引用次数: 0

Abstract

Background

The aim of this study was to evaluate the elbow kinematics with and without a Regan-Morrey type II coronoid fracture in an experimental setting of terrible triad injury with intact collateral ligaments and radial head arthroplasty.

Methods

Eight human donor arms were examined following radial head arthroplasty with and without a 1/3 coronoid fracture by CT and dynamic radiostereometry during elbow flexion with the forearm in unloaded neutral position, and in supinated- and pronated position without and with 10 N either varus or valgus load, respectively. The elbow kinematics were described using anatomical coordinate systems.

Findings

The coronoid fracture changed the elbow kinematics. In the valgus loaded pronated forearm position, the radius shifted mean 1.7 mm (95 %CI 0.2; 3.2) posterior, and the ulna shifted mean 0.6 mm (95 %CI 0.0; 1.2) in the radial direction. In the unloaded supinated position, the radius shifted 0.8 mm (95 %CI 0.0; 1.5) posterior and 1.0 mm (95 %CI 0.4; 1.6) in the ulnar direction, while the ulna shifted 0.7 mm (95 %CI 0.1; 1.4) posterior. In the varus loaded supinated position, the radius shifted 1.4 mm (95 %CI 0.2; 2.6) in the ulnar direction.

Interpretation

The Regan-Morrey type II coronoid fracture imposed slight kinematic changes to the elbow joint, which may not be clinically relevant. This indicates that a type II coronoid fracture may not need fixation in the setting of optimal radial head arthroplasty with intact collateral ligaments. However, elbow stability should be evaluated intraoperatively in every terrible triad case.

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可怕的三联性肘关节II型冠状骨骨折：使用动态放射立体分析肘关节运动学的实验研究

本研究的目的是评估Regan-Morrey II型冠状面骨折伴和不伴的肘关节运动学，这是一个伴有完整副韧带和桡骨头置换术的可怕三联性损伤的实验环境。方法采用CT和动态放射立体测量技术，分别对8例桡骨头置换术后1/3冠状面骨折患者在肘关节屈曲、前臂无负荷中立位、旋后位和旋前位、无10 N内翻或外翻载荷情况下进行CT和动态放射立体测量。用解剖坐标系描述肘关节的运动学。结果：冠状面骨折改变了肘关节的运动学。在外翻载荷下前臂旋前位，桡骨平均移位1.7 mm (95% CI 0.2；3.2)，尺骨平均移位0.6 mm (95% CI 0.0；1.2)径向。卸车后旋位时，桡骨移位0.8 mm (95% CI 0.0；1.5 mm后侧和1.0 mm (95% CI 0.4；尺侧移位0.7 mm (95% CI 0.1；1.4)后。内翻载荷旋后位时，桡骨移位1.4 mm (95% CI 0.2；2.6)尺侧。Regan-Morrey II型冠状面骨折对肘关节造成轻微的运动学改变，这可能与临床无关。这表明II型冠状突骨折可能不需要固定在最佳的桡骨头置换术与完整的副韧带。然而，在每一个可怕的三联征病例中，术中都应该评估肘关节的稳定性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.