The role of biceps loading and muscle activation on radial head stability in anterior Monteggia injuries: An in vitro biomechanical study |
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| Institution: | 1. Western Upper Limb Facility, Sturgeon Hospital, St. Albert, Alberta, Canada;2. Division of Orthopaedic Surgery, Department of Surgery, Edmonton, Alberta, Canada;3. Roth-McFarlane Hand & Upper Limb Centre, St. Joseph''s Health Care, London, Ontario, Canada;4. Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada;5. Division of Orthopaedic Surgery, Department of Surgery, London, Ontario, Canada;1. School of Physical Therapy, Western University, London, ON, Canada;2. Roth-McFarlane Hand and Upper Limb Centre, St. Joseph''s Hospital, London, ON, Canada;3. Department of Surgery, University of Western Ontario, London, ON, Canada;4. Department of Surgery, Western University, London, ON, Canada;1. Orthoklinik Hand Center, Santa Cruz do Sul, Rio Grande do Sul, Brazil;2. Titular Member and Board Member of The Brazilian Society of Hand Therapy and Upper Limb, SBTM, Brazil;3. Hand and Microsurgery Department, Santa Cruz Hospital, Santa Cruz do Sul, Rio Grande do Sul, Brazil;4. Pazin Clinic, Brazil;1. Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia;2. Faculty of Economics, University of Novi Sad, Subotica, Serbia;3. Department of Physical and Sports Education, PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Faculty of Sport Sciences, University of Granada, Granada, Spain;1. School of Rehabilitation, University of Ottawa, Ottawa, Ontario, Canada;2. Bruyère Research Institute, Ottawa, Ontario, Canada;3. Centre for Hip Health and Mobility Robert H.N. Ho Research Centre, School of Kinesiology, University of British Columbia, Vancouver, Canada;4. Evidence-Based Health Department, Federal University of Sao Paulo, Sao Paulo, Brazil;5. Department of Physical Education and Sport, University of Cadiz, Cadiz, Spain;6. Mary Pack Arthritis Program, Vancouver Coastal Health and Centre for Hip Health and Mobility and Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada |
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| Abstract: | IntroductionLittle evidence-based information is available to direct the optimal rehabilitation of patients with anterior Monteggia injuries.Purpose of the StudyThe aims of this biomechanical investigation were to (1) quantify the effect of biceps loading and (2) to compare the effect of simulated active and passive elbow flexion on radial head stability in anterior Monteggia injuries.Study DesignIn vitro biomechanical study.MethodsSix cadaveric arms were mounted in an elbow motion simulator. The effect of biceps loading, simulated active and passive elbow flexion motions was examined with application of 0N, 20N, 40N, 60N, 80N, and 100N of load. Simulated active and passive elbow flexion motions were then performed with the forearm supinated. Radial head translation relative to the capitellum was measured using an optical tracking system. After testing the intact elbows, the proximal ulna was osteotomized and realigned using a custom jig to simulate an anatomical reduction. We then sequentially sectioned the anterior radiocapitellar joint capsule, annular ligament, quadrate ligament, and the proximal and middle interosseous membrane to simulate soft tissue injuries commonly associated with anterior Monteggia fractures.ResultsGreater magnitudes of biceps loading significantly increased anterior radial head translation. However, there was no significant difference in radial head translation between simulated active and passive elbow flexion except in the final stage of soft tissue sectioning. There was a significant increase in anterior radial head translation with progressive injury states with both isometric biceps loading and simulated active and passive motion.ConclusionsOur results demonstrate that anatomic reduction of the ulna may not be sufficient to restore radial head alignment in anterior Monteggia injuries with a greater magnitude of soft tissue injury. In cases with significant soft tissue injury, the elbow should be immobilized in a flexed and supinated position to allow relaxation of the biceps and avoid movement of the elbow in the early postoperative period. |
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| Keywords: | Monteggia Biceps loading Active motion Passive motion Annular ligament Interosseous membrane |
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