Biomechanical study of isolated radial head dislocation

Abstract Background Isolated radial head dislocation is a rare injury with an unclear pathomechanism, and the treatment is controversial. The purpose of the present study was to investigate the biomechanical contributions of the annular ligament, quadrate ligament, interosseous membrane, and annular...

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Main Authors: Naoki Hayami, Shohei Omokawa, Akio Iida, Jirachart Kraisarin, Hisao Moritomo, Pasuk Mahakkanukrauh, Takamasa Shimizu, Kenji Kawamura, Yasuhito Tanaka
Format: Article
Language:English
Published: BMC 2017-11-01
Series:BMC Musculoskeletal Disorders
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12891-017-1829-1
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author Naoki Hayami
Shohei Omokawa
Akio Iida
Jirachart Kraisarin
Hisao Moritomo
Pasuk Mahakkanukrauh
Takamasa Shimizu
Kenji Kawamura
Yasuhito Tanaka
author_facet Naoki Hayami
Shohei Omokawa
Akio Iida
Jirachart Kraisarin
Hisao Moritomo
Pasuk Mahakkanukrauh
Takamasa Shimizu
Kenji Kawamura
Yasuhito Tanaka
author_sort Naoki Hayami
collection DOAJ
description Abstract Background Isolated radial head dislocation is a rare injury with an unclear pathomechanism, and the treatment is controversial. The purpose of the present study was to investigate the biomechanical contributions of the annular ligament, quadrate ligament, interosseous membrane, and annular ligament reconstructions to proximal radioulnar joint stability. Methods Five fresh frozen cadaveric upper extremities were amputated above the elbow and solidly fixed on a customized jig. Radial head dislocation was reproduced by sequential sectioning of ligamentous structures and passive mobility testing. Radial head displacement during mobility testing was measured with an electromagnetic tracking device in three forearm rotation positions. The data were compared among different sectioning stages and between two types of simulated ligamentous reconstruction. Results Lateral displacement of the radial head significantly increased in the neutral forearm rotation after annular ligament sectioning (46 ± 10%, p < 0.05). After quadrate ligament sectioning, we found significant posterior (67 ± 36%, p < 0.05) and lateral (74 ± 24%, p < 0.01) displacement in neutral forearm rotation and pronation. Significant radial head displacement was found in all directions and in all forearm positions after sequential sectioning of the proximal half of the interosseous membrane. Anatomical annular ligament reconstruction stabilized the proximal radioulnar joint except for anterior laxity in neutral forearm rotation (15 ± 6%, p < 0.05). The radial head with Bell Tawse procedure was significantly displaced in all directions. Conclusion The direction of radial head instability varied depending on the degree of soft tissue sectioning and specific forearm rotation. Anterior radial head dislocation may involve more severe ligament damage than other types of dislocation. Anatomical annular ligament reconstruction provided multidirectional radial head stability.
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spelling doaj.art-61632738d485499cbfaf3b71758172c22022-12-21T19:26:58ZengBMCBMC Musculoskeletal Disorders1471-24742017-11-011811710.1186/s12891-017-1829-1Biomechanical study of isolated radial head dislocationNaoki Hayami0Shohei Omokawa1Akio Iida2Jirachart Kraisarin3Hisao Moritomo4Pasuk Mahakkanukrauh5Takamasa Shimizu6Kenji Kawamura7Yasuhito Tanaka8Department of Orthopedic Surgery, Nara Medical UniversityDepartment of Hand Surgery, Nara Medical UniversityDepartment of Orthopedic Surgery, Nara Medical UniversityDepartment of Orthopedic Surgery, Faculty of Medicine, Chiang Mai UniversityDepartment of Physiotherapy, Osaka Yukioka College of Health ScienceDepartment of Anatomy, Faculty of Medicine, Chiang Mai UniversityDepartment of Orthopedic Surgery, Nara Medical UniversityDepartment of Orthopedic Surgery, Nara Medical UniversityDepartment of Orthopedic Surgery, Nara Medical UniversityAbstract Background Isolated radial head dislocation is a rare injury with an unclear pathomechanism, and the treatment is controversial. The purpose of the present study was to investigate the biomechanical contributions of the annular ligament, quadrate ligament, interosseous membrane, and annular ligament reconstructions to proximal radioulnar joint stability. Methods Five fresh frozen cadaveric upper extremities were amputated above the elbow and solidly fixed on a customized jig. Radial head dislocation was reproduced by sequential sectioning of ligamentous structures and passive mobility testing. Radial head displacement during mobility testing was measured with an electromagnetic tracking device in three forearm rotation positions. The data were compared among different sectioning stages and between two types of simulated ligamentous reconstruction. Results Lateral displacement of the radial head significantly increased in the neutral forearm rotation after annular ligament sectioning (46 ± 10%, p < 0.05). After quadrate ligament sectioning, we found significant posterior (67 ± 36%, p < 0.05) and lateral (74 ± 24%, p < 0.01) displacement in neutral forearm rotation and pronation. Significant radial head displacement was found in all directions and in all forearm positions after sequential sectioning of the proximal half of the interosseous membrane. Anatomical annular ligament reconstruction stabilized the proximal radioulnar joint except for anterior laxity in neutral forearm rotation (15 ± 6%, p < 0.05). The radial head with Bell Tawse procedure was significantly displaced in all directions. Conclusion The direction of radial head instability varied depending on the degree of soft tissue sectioning and specific forearm rotation. Anterior radial head dislocation may involve more severe ligament damage than other types of dislocation. Anatomical annular ligament reconstruction provided multidirectional radial head stability.http://link.springer.com/article/10.1186/s12891-017-1829-1Radial head dislocationBiomechanical studyAnnular ligamentQuadrate ligamentInterosseous membraneLigament reconstruction
spellingShingle Naoki Hayami
Shohei Omokawa
Akio Iida
Jirachart Kraisarin
Hisao Moritomo
Pasuk Mahakkanukrauh
Takamasa Shimizu
Kenji Kawamura
Yasuhito Tanaka
Biomechanical study of isolated radial head dislocation
BMC Musculoskeletal Disorders
Radial head dislocation
Biomechanical study
Annular ligament
Quadrate ligament
Interosseous membrane
Ligament reconstruction
title Biomechanical study of isolated radial head dislocation
title_full Biomechanical study of isolated radial head dislocation
title_fullStr Biomechanical study of isolated radial head dislocation
title_full_unstemmed Biomechanical study of isolated radial head dislocation
title_short Biomechanical study of isolated radial head dislocation
title_sort biomechanical study of isolated radial head dislocation
topic Radial head dislocation
Biomechanical study
Annular ligament
Quadrate ligament
Interosseous membrane
Ligament reconstruction
url http://link.springer.com/article/10.1186/s12891-017-1829-1
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