The Effect of Radioscapholunate Fusion With and Without Distal Scaphoid and Triquetrum Excision on Capitolunate Contact Pressures.

PURPOSE: To determine the effects of motion-increasing modifications to radioscapholunate (RSL) arthrodesis on capitolunate contact pressure in cadaveric wrist specimens. METHODS: Ten fresh-frozen cadaveric wrists were dissected of all superficial soft tissue, potted in polymethyl-methacrylate, and the carpus exposed via a ligament-sparing capsulotomy. An RSL arthrodesis was simulated using 2 2.4-mm distal radius plates with locking screws. The distal scaphoid pole and triquetrum were removed with an osteotome and rongeur, respectively. Contact area, pressure, and force were measured in the capitolunate joint during the application of a 35-N uniaxial load using pressure-sensitive film. Measurements were obtained before and after simulated RSL fusion, following distal scaphoidectomy and after triquetrectomy. RESULTS: The combination of RSL fusion with distal scaphoid excision (DSE) increased contact forces in the capitolunate joint by 50% over controls. An RSL fusion, and RSL fusion with DSE and triquetrum excision (TE), exhibited intermediate levels of contact force between controls and RSL fusion with DSE. Capitolunate contact pressures were similar between all experimental groups. Contact area in the capitolunate joint increased by 43% after RSL fusion with DSE over intact specimen controls. Lastly, contact area in wrists with RSL fusion, and RSL fusion with DSE and TE, were elevated, but not significantly different from intact controls. CONCLUSIONS: A DSE performed at the time of RSL fusion results in increased midcarpal joint contact force and area, with resultant contact pressures unchanged. Triquetrectomy, which has been previously shown to improve range of motion, did not increase contact forces in the capitolunate joint. CLINICAL RELEVANCE: If a surgeon is contemplating performing an RSL arthrodesis with DSE, we recommend adding a triquetrectomy to improve motion because this does not add to the potentially deleterious effects of increased midcarpal contact force.

Three-dimensional kinematics of the lunate, hamate, capitate and triquetrum with type 1 or 2 lunate morphology.

The purpose of this study was to investigate the differences in three-dimensional carpal kinematics between type 1 and 2 lunates. We studied 15 instances of wrist flexion to extension (nine type 1, six type 2), 13 of radial to ulnar deviation (seven type 1, six type 2), and 12 of dart-throwing motion (six each of type 1 and 2) in 25 normal participants based on imaging with computerized tomography. Mean proximal translation of the distal articular midpoint of the triquetrum relative to type 2 lunates during wrist radioulnar deviation was 2.9 mm (standard deviation (SD) 0.7), which was significantly greater than for type 1 lunates, 1.6 mm (SD 0.6). The hamate contacted the lunate in ulnar deviation and ulnar flexion of wrists with type 2 lunates but not with type 1. We conclude that the four-corner kinematics of the wrist joint are different between type 1 and 2 lunates.

Effect of capitate morphology on contact biomechanics after proximal row carpectomy.

PURPOSE: Proximal row carpectomy (PRC) is used as a treatment for a variety of wrist pathologies to maintain motion and to improve strength and decrease pain. Several studies have looked at how PRC alters wrist characteristics, although they did not provide an explanation for the variability observed in outcomes. Studies have classified the capitate into 3 unique types: round, V-shaped, or flat. We hypothesized that these differences in morphology could affect the contact biomechanics between the radius and the capitate after PRC. METHODS: A total of 14 cadaveric wrists underwent PRC. They were classified by capitate morphology and then loaded to 200 N in a neutral position, flexion, and extension. We measured contact area, contact pressure, and location using pressure-sensitive film in all 3 positions and compared their morphology types. RESULTS: Nine wrists had a round-type capitate, 4 had a V-shaped capitate, and 1 had a flat capitate, which we excluded from statistical analysis. Comparing round and V-shaped types, we found no differences in contact area, pressure, or location in any wrist position For the V-shaped capitates, there was increased contact pressure in flexion and extension compared with the wrist in neutral. Center of pressure translated dorsal and radial in flexion to volar and ulnar in extension for all types. CONCLUSIONS: When we compared V-shaped and round-type capitates, we found no significant differences in contact characteristics of the wrist after PRC. There were some differences in contact pressure for V-shaped capitates in various wrist positions. CLINICAL RELEVANCE: Differences between round and V-shaped capitates do not appear to affect contact biomechanics after PRC. Thus, these 2 capitate shapes may not necessarily be a factor in the decision-making process to perform PRC.

Exploring third metacarpal capitate facet shape in early hominins.

The joint between the capitate and third metacarpal plays an important role in stabilizing the manus during hand use in great apes and humans. Researchers have examined the morphology of this region in humans, our fossil relatives, and other extant primates to try to understand the importance of this joint in human evolution. The first goal of our research was to explore shape variation of the third metacarpal capitate facet across extant anthropoids, including hominoids, cercopithecoids, and platyrrhines. This analysis allowed us to examine the range of variation in the capitate facet and the degree to which locomotor behavior, phylogeny, and size explained shape variation. We also examined capitate facet shape in the early hominin fossil record in order to explore how the shape of this articular surface has changed during early hominin evolution. We captured six landmark coordinates on the edge of the capitate facet in extant anthropoids and fossil specimens to quantify and visualize shape variation in this region. We used principal components analysis, Procrustes distances, and multivariate regression analysis to investigate different possible influences on shape variation. We found that shape variation corresponded to function, phylogeny, and size. With the exception of brachiation, shape variation did not clearly correspond with any specific locomotor behavior. However, we identified a shift in the relative mediolateral breadth of the capitate facet during early hominin evolution, which is most likely one of several adaptations for a more stable joint surface.

In vivo kinematics of the scaphoid, lunate, capitate, and third metacarpal in extreme wrist flexion and extension.

PURPOSE: Insights into the complexity of active in vivo carpal motion have recently been gained using 3-dimensional imaging; however, kinematics during extremes of motion has not been elucidated. The purpose of this study was to determine motion of the carpus during extremes of wrist flexion and extension. METHODS: We obtained computed tomography scans of 12 healthy wrists in neutral grip, extreme loaded flexion, and extreme loaded extension. We obtained 3-dimensional bone surfaces and 6-degree-of-freedom kinematics for the radius and carpals. The flexion and extension rotation from neutral grip to extreme flexion and extreme extension of the scaphoid and lunate was expressed as a percentage of capitate flexion and extension and then compared with previous studies of active wrist flexion and extension. We also tested the hypothesis that the capitate and third metacarpal function as a single rigid body. Finally, we used joint space metrics at the radiocarpal and midcarpal joints to describe arthrokinematics. RESULTS: In extreme flexion, the scaphoid and lunate flexed 70% and 46% of the amount the capitate flexed, respectively. In extreme extension, the scaphoid extended 74% and the lunate extended 42% of the amount the capitates extended, respectively. The third metacarpal extended 4° farther than the capitate in extreme extension. The joint contact area decreased at the radiocarpal joint during extreme flexion. The radioscaphoid joint contact center moved onto the radial styloid and volar ridge of the radius in extreme flexion from a more proximal and ulnar location in neutral. CONCLUSIONS: The contributions of the scaphoid and lunate to capitate rotation were approximately 25% less in extreme extension compared with wrist motion through an active range of motion. More than half the motion of the carpus when the wrist was loaded in extension occurred at the midcarpal joint. CLINICAL RELEVANCE: These findings highlight the difference in kinematics of the carpus at the extremes of wrist motion, which occur during activities and injuries, and give insight into the possible etiologies of the scaphoid fractures, interosseous ligament injuries, and carpometacarpal bossing.

Knuckle-walking in Sivapithecus? The combined effects of homology and homoplasy with possible implications for pongine dispersals.

Sivapithecus is a Miocene great ape from South Asia that is orangutan-like cranially but is distinctive postcranially. Work by others shows that the humerus resembles large terrestrial cercopithecoids proximally and suspensory hominoids distally, but most functional interpretations nevertheless situate Sivapithecus in an arboreal setting. We present a new quantitative analysis of the Sivapithecus capitate and hamate. Though the functional morphology of both bones suggests some degree of arboreality, the overall morphology is most similar to knuckle-walking African apes. Other features of the Sivapithecus humerus and hind limb are also functionally consistent with knuckle-walking, and we suggest that this locomotor behavior is a valid alternative functional interpretation of the postcranial morphology. We speculate that knuckle-walking in Sivapithecus would have evolved independently from African apes, perhaps for similar ecological reasons. The discovery of a possible pongine knuckle-walker challenges the hypotheses that (1) knuckle-walking evolved only once in hominoids and (2) knuckle-walking is too highly specialized to be the positional behavior from which human bipedalism evolved. The possibility of knuckle-walking in Sivapithecus may help to explain not only the curious combination of characters that typify the postcranium but also the unique postcranial morphology of extant Pongo. Furthermore, it may clarify the distribution of fossil pongines across many ecological zones in Eurasia in the Miocene and Pleistocene, as well as, independently, the spread of African apes across a diversity of environments in equatorial Africa.

Conformational changes in the carpus during finger trap distraction.

PURPOSE: Wrist distraction is a common treatment maneuver used clinically for the reduction of distal radial fractures and midcarpal dislocations. Wrist distraction is also required during wrist arthroscopy to access the radiocarpal joint and has been used as a test for scapholunate ligament injury. However, the effect of a distraction load on the normal wrist has not been well studied. The purpose of this study was to measure the three-dimensional conformational changes of the carpal bones in the normal wrist as a result of a static distractive load. METHODS: Using computed tomography, the dominant wrists of 14 healthy volunteers were scanned at rest and during application of 98 N of distraction. Load was applied using finger traps, and volunteers were encouraged to relax their forearm muscles and to allow distraction of the wrist. The motions of the bones in the wrist were tracked between the unloaded and loaded trial using markerless bone registration. The average displacement vector of each bone relative to the radius was calculated, as were the interbone distances for 20 bone-bone interactions. Joint separation was estimated at the radiocarpal, midcarpal, and carpometacarpal joints in the direction of loading using the radius, lunate, capitate, and third metacarpal. RESULTS: With loading, the distance between the radius and third metacarpal increased an average of 3.3 mm +/- 3.1 in the direction of loading. This separation was primarily in the axial direction at the radiocarpal (1.0 mm +/- 1.0) and midcarpal (2.0 mm +/- 1.7) joints. There were minimal changes in the transverse direction within the distal row, although the proximal row narrowed by 0.98 mm +/- 0.7. Distraction between the radius and scaphoid (2.5 mm +/- 2.2) was 2.4 times greater than that between the radius and lunate (1.0 mm +/- 1.0). CONCLUSIONS: Carpal distraction has a significant (p < .01) effect on the conformation of the carpus, especially at the radiocarpal and midcarpal joints. In the normal wrist, external traction causes twice as much distraction at the lunocapitate joint than at the radiolunate joint.

New primate carpal bones from Rudabánya (late Miocene, Hungary): taxonomic and functional implications.

We describe a scaphoid and two capitates from the late Miocene site of Rudabánya, Hungary using qualitative and quantitative comparisons to a large sample of hominoid, cercopithecoid, and platyrrhine primates. The scaphoid (RUD 202) is not fused to the os centrale and in this way is like most primates other than African apes and humans (hominines). Qualitatively, its morphology is most similar to Pongo, and univariate analyses generally confirm an ape-like morphology with an increased range of mobility. One capitate (RUD 167) is compatible in size to the scaphoid, and its morphology suggests a combination of monkey-like generalized arboreality and ape-like enhanced mobility. RUD 203 is a smaller, fragmentary capitate, about half the size of RUD 167, and preserves only the distal portion of the body with the third metacarpal articular surface. Its morphology is virtually identical to that of RUD 167, and an exact randomization test revealed that it is statistically likely to find two carpal bones of such disparate sizes within one taxon. However, due to morphological similarities with other Miocene hominoids as well as implications for size variation within one taxon and sex, we consider the taxonomic affiliation of RUD 203 to be unresolved. We attribute the scaphoid and RUD 167 capitate to the hominine Rudapithecus hungaricus (formerly Dryopithecus brancoi; see Begun et al., 2008) based on overall morphological similarity to extant apes, particularly Pongo, and not to the pliopithecoid Anapithecus hernyaki, the only other primate known from Rudabánya. The similarities in carpal morphology to suspensory taxa are consistent with previous interpretations of Rudapithecus positional behavior. The scaphoid and the RUD 167 capitate are consistent in size with a partial skeleton including associated postcranial and craniodental specimens from the same level at the locality and may be from the same individual. These are the first carpal bones described from Rudabánya and from this taxon, and they add to our understanding of the evolution of arboreal locomotion in late Miocene apes.

In vivo radiocarpal kinematics and the dart thrower's motion.

BACKGROUND: Wrist motion is dependent on the complex articulations of the scaphoid and lunate at the radiocarpal joint. However, much of what is known about the radiocarpal joint is limited to the anatomically defined motions of flexion, extension, radial deviation, and ulnar deviation. The purpose of the present study was to determine the three-dimensional in vivo kinematics of the scaphoid and lunate throughout the entire range of wrist motion, with special focus on the dart thrower's wrist motion, from radial extension to ulnar flexion. METHODS: The three-dimensional kinematics of the capitate, scaphoid, and lunate were calculated from serial computed tomography scans of both wrists of fourteen healthy male subjects (average age, 25.6 years; range, twenty-two to thirty-four years) and fourteen healthy female subjects (average age, 23.6 years; range, twenty-one to twenty-eight years), which yielded data on a total of 504 distinct wrist positions. RESULTS: The scaphoid and lunate primarily flexed or extended in all directions of wrist motion, and their rotation varied linearly with the direction of wrist motion (R2= 0.90 and 0.82, respectively). Scaphoid and lunate motion was significantly less along the path of the dart thrower's motion than in any other direction of wrist motion (p < 0.01 for both carpal bones). The scaphoid and lunate translated radially (2 to 4 mm) when extended, but they did not translate appreciably when flexed. CONCLUSIONS: The dart thrower's path defined the transition between flexion and extension rotation of the scaphoid and lunate, and it identified wrist positions at which scaphoid and lunate motion approached zero. These findings indicate that this path of wrist motion confers a unique degree of radiocarpal stability and suggests that this direction, rather than the anatomical directions of wrist flexion-extension and radioulnar deviation, is the primary functional direction of the radiocarpal joint.