ABSTRACT
PURPOSE: To create a biomechanical model of palmar midcarpal instability by selective ligament sectioning and to analyze treatment by simulated partial wrist arthrodesis. METHODS: Nine fresh-frozen cadaver arms were moved through 3 servohydraulic actuated motions and 2 passive wrist mobilizations. The dorsal radiocarpal, triquetrohamate, scaphocapitate, and scaphotrapeziotrapezoid ligaments were sectioned to replicate palmar midcarpal instability. Kinematic data for the scaphoid, lunate, and triquetrum were recorded before and after ligament sectioning and again after simulated triquetrohamate arthrodesis (TqHA) and radiolunate arthrodesis (RLA). RESULTS: Following ligament sectioning, the model we created for palmar midcarpal instability was characterized by significant increases in (1) lunate angular velocity, (2) lunate flexion-extension, and (3) dorsal/volar motion of the capitate during dorsal/volar mobilizations. Simulated TqHA caused significantly more scaphoid flexion and less extension during the wrist radioulnar deviation motion. It also increased the amount of lunate and triquetral extension during wrist flexion-extension. Simulated RLA significantly reduced scaphoid flexion during both wrist radioulnar deviation and flexion-extension. CONCLUSIONS: Both simulated arthrodeses eliminate wrist clunking and may be of value in treating palmar midcarpal instability. However, simulated RLA reduces proximal row motion whereas simulated TqHA alters how the proximal row moves. Long-term clinical studies are needed to determine if these changes are detrimental. CLINICAL RELEVANCE: Palmar midcarpal instability is poorly understood, with most treatments based on pathomechanical assumptions. This study provides information that clinicians can use to design better treatment strategies for this unsolved condition.
Subject(s)
Arthrodesis , Biomechanical Phenomena/physiology , Carpal Joints/surgery , Joint Instability/surgery , Wrist Joint/surgery , Aged , Aged, 80 and over , Cadaver , Carpal Joints/physiopathology , Female , Hamate Bone/physiopathology , Hamate Bone/surgery , Humans , Joint Instability/physiopathology , Ligaments, Articular/injuries , Male , Middle Aged , Triquetrum Bone/physiopathology , Triquetrum Bone/surgery , Wrist Joint/physiopathologyABSTRACT
The adult retina is organized into three cellular layers--an outer photoreceptor, a middle interneuron and an inner retinal ganglion cell (RGC) layer. Although the retinal pigment epithelium (RPE) and Müller cells are important in the establishment and maintenance of this organization, the signals involved are unknown. Here we show that Sonic hedgehog signaling from RGCs is required for the normal laminar organization in the vertebrate retina.
