Effectiveness of the lateral unilateral dynamic external fixator after elbow ligament injury.

BACKGROUND: The optimum management of ligamentous injuries of the elbow is not known. Use of dynamic external fixators has been advocated to stabilize the joint while maintaining motion, but there are no published data to corroborate their efficacy. The purpose of this study was to test the hypothesis that a laterally applied unilateral dynamic external fixator is capable of stabilizing and restoring normal kinematics to elbows with varying degrees of soft-tissue injury. METHODS: Six fresh-frozen cadaveric upper extremities, from donors who were an average of seventy-six years of age at the time of death, were tested in a custom apparatus with an electromagnetic tracking device to analyze the kinematic behavior. Testing began with an injury of either the lateral or the medial collateral ligament, which was followed by a second test with an injury to the ligament on the contralateral side of the joint. In each test, the varus-valgus displacement and the forearm rotatory displacement were measured through the arc of elbow flexion under three loading conditions (hand weight alone, hand weight plus 3.5 N, and hand weight plus 7 N). After each test (with each injury), a unilateral external fixator was applied from the lateral aspect of the elbow, and the same measurements were conducted under the three loading conditions across the elbow joint. RESULTS: With varus stress testing, both after injury of the medial collateral ligament alone and after injury of the lateral collateral ligament and extensor mass alone, the laterally applied unilateral dynamic external fixator was capable of maintaining the displacements within the laxity envelope of an uninjured elbow. With valgus stress testing, after either lateral or medial ligamentous injury, the fixator was unable to maintain displacements within the normal laxity envelope when a 7-N load was applied to the elbow. When both medial and lateral injuries were present, the lateral fixator maintained varus displacement within normal limits, but valgus displacement was consistently maintained within normal limits only when no additional load was applied to the forearm. CONCLUSIONS: A lateral dynamic elbow external fixator is capable of maintaining varus displacements within normal limits in the presence of medial and lateral collateral ligament injuries and with a 7-N load added to the limb. However, valgus displacement is only consistently maintained within normal limits if no additional displacement force is added to the weight of the hand and forearm. The maintenance of valgus displacement is more sensitive to additional load and specifically to the extent of medial soft-tissue injury.

Kinematic and torque-related effects of dorsally angulated distal radius fractures and the distal radial ulnar joint.

PURPOSE: The purpose of this study was to examine the torque required to achieve a full range of motion of the distal radioulnar joint (DRUJ) as a result of increasing dorsal angulation from simulated fractures of the distal radius. Based on this study the accepted amount of dorsal angulation of the distal radius can be determined. METHODS: In 9 fresh cadaver limbs motion of the DRUJ was simulated by a custom motion and loading forearm device. The malunion model of the distal radius was controlled by a specially designed external fixation frame that provided control in 6 degrees of dorsal angulations (N, 0 degrees, 10 degrees, 20 degrees, 30 degrees, and 40 degrees ). The study included an intact and nonintact triangular fibrocartilage complex. RESULTS: This study showed that torque across the DRUJ was affected by the degree of simulated malunion of the distal radius. With more than 30 degrees dorsal angulation the torque across the DRUJ was increased in both muscle loading and unloading conditions. Although significance was not noted, with resistive loading this study showed torque changes with as little as 10 degrees malunion of the distal radius. CONCLUSIONS: We conclude that reduction of distal radius fractures to within 10 degrees of dorsal angulation is needed to allow patients to maintain full forearm and wrist rotation.