Development of an in-vivo method of wrist joint motion analysis.

BACKGROUND: A clinically applicable method of plotting wrist joint motion in three-dimensions has not been described. Computer modelling has been used to improve joint arthroplasty elsewhere in the body. We aimed to develop a method of measuring, and modelling, wrist joint motion that could potentially be used to improve the kinematic performance of wrist arthroplasty designs. METHODS: An electromagnetic system was used to record wrist motion in three-dimensions. A small pilot study attempted to assess repeatability. A larger group of volunteers with normal wrists was also studied. An iterative computer model, using a two-axis hinge, was developed. One output from this model, the offset of the two axes of motion, is presented as an example of the possible applications of this method of analysis. FINDINGS: For any one individual, in the pilot study, the offset of the axes calculated was relatively reproducible. Between individuals the difference in the offset of the axes was more marked. In 99 normal sets of data the mean axis offset was 6.8mm (range 28 mm to -21 mm) A positive value represented the radio-ulnar deviation axis placed distal to the flexion-extension axis. INTERPRETATION: The three-dimensional motion plots generated using this method could be used clinically to follow disease progression or recovery following surgery. The computer modelling method described has potential applications, if further refined, to wrist joint arthroplasty design.

A kinematic model of the wrist based on maximization of joint contact area.

The wrist is a complex joint and the factors governing its behaviour are poorly understood. A hypothesis that the movement of the carpal bones could be predicted using a minimum energy principle was tested. Carpal bones were dissected from a cadaveric forearm and their shapes were laser-digitized to obtain three-dimensional computer models. A computer program was created to measure contact area between neighbouring articular surfaces and to maximize this quantity by adjusting the six degrees of freedom of the bone models. This procedure was performed for 1.0 degree increments of rotation applied to the capitate bone up to 20 degrees of ulnar and 10 degrees of radial deviation. The model correctly predicted certain aspects of the complex behaviour of the carpal bones. The results for the scaphoid in particular displayed characteristics in common with known behaviour of this bone. During 20 degrees of unlar deviation and 10 degrees of radial deviation, the bone demonstrated 11.3 degrees of extension and 9.4 degrees of flexion respectively. The novelty of the study lay in the fact that the model did not rely upon ligamentous constraints. The results are encouraging, considering the only information used by the algorithm was the shape of the articular surfaces.