Novel Radiographic Indexes for Elbow Stability Assessment: Part B—Preliminary Clinical Study (original) (raw)
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Novel Radiographic Indexes for Elbow Stability Assessment: Part A—Cadaveric Validation
Indian Journal of Orthopaedics, 2021
Introduction Elbow bony stability relies primarily on the high anatomic congruency between the humeral trochlea and the ulnar greater sigmoid notch. No practical tools are available to distinguish different morphotypes of the proximal ulna and herewith predict elbow stability. The aim of this study was to assess inter-observer reproducibility, evaluate diagnostic performance and determine responsiveness to change after simulated coronoid process fracture for three novel elbow radiographic indexes. Methods Ten fresh-frozen cadaver specimens of upper limbs from human donors were available for this study. Three primary indexes were defined, as well as two derived angles: Trochlear Depth Index (TDI); Posterior Coverage Index (PCI); Anterior Coverage Index (ACI); radiographic coverage angle (RCA); olecranon–diaphisary angle (ODA). Each index was first measured on standardized lateral radiographs and subsequently by direct measurement after open dissection. Finally, a type II coronoid fra...
A protocol for clinical evaluation of the carrying angle of the elbow by anatomic landmarks
Journal of Shoulder and Elbow Surgery, 2008
The aim of this work was to present an in vivo protocol to estimate the carrying angle of the elbow in full extension. Forty-four arms were measured by using an electrogoniometer to acquire 3-dimensional coordinates of the landmarks. An algorithm based on the Cardan decomposition method was used to compute the carrying angle and the flexion and pronation angles of the elbow. The mean carrying angle was 12.42 6 4.06 , in agreement with the literature and with values obtained by a standard goniometer (r ¼ 0.46; P ¼ .000). Our protocol provided excellent repeatability (interclass correlation coefficient [ICC] ¼ 0.85), greater than a goniometer (ICC ¼ 0.76), and a standard error of measurement of only 1.62 . Flexion was a significant factor (P ¼ .01) in carrying angle estimation. This study suggests that the carrying angle cannot be estimated independently by the flexion angle, even when measured in apparently full extension, and it could be useful in elbow disorders, such as fractures or epicondylar disease management and evaluation of elbow reconstruction. (J Shoulder Elbow Surg 2008;17:106-112.)
Elbow radiographic anatomy: measurement techniques and normative data
Journal of Shoulder and Elbow Surgery, 2012
Background: An increase in elbow pathology in adolescents has paralleled an increase in sports participation. Evaluation and classification of these injuries is challenging because of limited information regarding normal anatomy. The purpose of this study was to evaluate normal radiographic anatomy in adolescents to establish parameters for diagnosing abnormal development. Established and new measurements were evaluated for reliability and variance based on age and sex. Methods: Three orthopaedic surgeons independently, and in a standardized fashion, evaluated the normal anteroposterior and lateral elbow radiographs of 178 adolescent and young adult subjects. Fourteen measurements were performed including radial neck-shaft angle, articular surface angle, articular surface morphologic assessment (subjective and objective evaluation of the patterns of ridges and sulci), among others. We performed a statistical analysis by age and sex for each measure and assessed for inter-and intraobserver reliability. Results: The distal humerus articular surface was relatively flat in adolescence and became more contoured with age, as objectively demonstrated by increasing depth of the trochlear and trochleocapitellar sulci, and decreasing trochlear notch angle. Overall measurements were similar between males and females, with an increased carrying angle in females. There were several statistically significant differences based on age and sex; but these were small and unlikely to be clinically significant. Inter and intraobserver reliability were variable; some commonly utilized tools had poor reliability. Conclusion: Most commonly utilized radiographic measures were consistent between sexes, across the adolescent age group, and between adolescents and young adults. Several commonly used assessment tools show poor reliability.
Biomechanical Evaluation of the Elbow Using Roentgen Stereophotogrammetric Analysis
Clinical Orthopaedics and Related Research, 2002
The medial collateral ligament complex is the primary constraint of the elbow to valgus forces and is composed of the anterior bundle, the posterior bundle, and a transverse part. Total and partial ruptures have been described. Clinical and radiologic examinations of medial or valgus instability of the elbow are difficult. The effect of different stages of medial collateral ligament ruptures on ulnohumeral movement in cadavers was determined to rationalize the use of physical and radiologic examinations in different stages of valgus instability in vivo. Using roentgen stereophotogrammetric analysis, motion is determined between the humerus and ulna under valgus load and between the humerus and radius during maximal pronation of the forearm after various dimensions of medial collateral ligament lesions. The increase in distance between the humerus and ulna under a 15 N valgus load varied from 2.7 mm to 9.8 mm. The increase in distance between the humerus and proximal radius with the forearm in pronation in an intact specimen and after transsection of the anterior medial collateral ligament and posterior medial collateral ligament in the anterior direction was 9.7 mm. These results suggest that detection of partial ruptures with clinical and radiologic examinations is difficult. Anterior movement of the radial head can be used as an additional parameter of valgus instability.
BMC Musculoskeletal Disorders, 2014
The current research is a retrospective study that involves the description of a new trochleocapitellar index (TCI), on basis of anteroposterior (AP) radiographs of normal and fractured paediatric elbows. This index may be useful in assessing the alignment of the elbow with a supracondylar fracture. Methods: The index was evaluated to define its normal and pathological range in children between the ages of 1-13 years. A total of 212 elbows in 141 children were radiographically evaluated. 70 children without fracture elbows were evaluated by radiographs taken at the time of trauma. 35 children with unilateral fractures that healed in a normal alignment were compared to 33 patients that had a mal-union and three patients with bilateral elbow fractures. The patients were radiographically assessed at the time of fracture as well as after fracture healing as part of a routine clinical assessment. Treatment included observation, cast or internal fixation as needed.
The drop sign, a radiographic warning sign of elbow instability
Journal of Shoulder and Elbow Surgery, 2005
Persistent instability or redislocation is uncommon but of significant concern in treating elbow dislocations. Finding an objective, static radiographic sign that might correlate with the presence of instability was the purpose of this study. Pre-and post-reduction radiographs of 10 consecutive simple and complete adult elbow dislocations were reviewed and compared with radiographs of 20 consecutive adult elbows without any trauma history. A statistically significant measured increase in static ulnohumeral distance was noted on the routine unstressed post-reduction lateral radiographs of patients sustaining dislocation. We have termed this increased distance the drop sign. It differs from the radiographic ulnohumeral separation noted during O'Driscoll's test for posterolateral rotary instability, which is present only with axial compression. The drop sign becomes concerning only if persistent after the first reduction radiograph and may be a warning sign of the presence of instability. (J Shoulder Elbow Surg 2005;14:312-317.)
Computer Aided Surgery, 2012
A CT-based imaging technique to investigate ulnohumeral joint congruency of elbows undergoing physiologic flexion is introduced. This technique, which employed landmark registration and a previously developed inter-bone distance algorithm, was validated experimentally. Results obtained with this imaging technique were validated in a single specimen by comparing the resulting joint congruency maps to results obtained with experimental casting in a static position. Additionally, the accuracy of the registration technique was assessed in four specimens using fiducial and target registration error to evaluate the positional and angular accuracy. Preliminary data from an intact cadaveric elbow was shown to demonstrate the utility of this technique. The overall accuracy of the registration was better than 1 mm, and the congruency maps showed excellent correspondence with the casting, validating the use of a CT-based imaging technique to examine the congruency of joints undergoing quasi-static flexion.
Development and validation of an elbow score
Rheumatology, 2004
Objectives. Few of the questionnaires available for evaluating the function and clinical state of the elbow have been validated. An ideal score would be consistent, sensitive, reliable and elbow-specific, incorporating both patient perception and clinician assessment. This was our aim. Methods. Items were generated using 25 patients and expert opinion, and reduced using 25 new patients to yield a nine-item patient questionnaire and a six-item clinical evaluation (of strength, motion and ulnar nerve involvement). This was validated using 63 new patients (of whom 28 were studied twice without therapy and 18 were studied again after appropriate surgery).
Validity of Goniometric Elbow Measurements: Comparative Study with a Radiographic Method
Clinical Orthopaedics & Related Research, 2011
Background A universal goniometer is commonly used to measure the elbow's ROM and carrying angle; however, some authors question its poor intertester reliability. Questions/purposes We (1) assessed the validity of goniometric measurements as compared with radiographic measurements in the evaluation of ROM of the elbow and (2) determined the reliability of both. Methods The ROM and carrying angle of 51 healthy subjects (102 elbows) were measured using two methods: with a universal goniometer by one observer three times and on radiographs by two independent examiners. Paired t-test and Pearson's correlation were used to compare and detect the relationship between mean ROM. The maximal error was calculated according to the Bland and Altman method. Results The intraclass correlation coefficients (ICC) ranged from 0.945 to 0.973 for the goniometric measurements and from 0.980 to 0.991 for the radiographic measurements. The two methods correlated when measuring the total ROM in flexion and extension. The maximal errors of the goniometric measurement were 10.3°f or extension, 7.0°for flexion, and 6.5°for carrying angle 95% of the time. We observed differences for maximum flexion, maximal extension, and carrying angle between the methods. Conclusion Both measurement methods differ but they correlate. When measured with a goniometer, the elbow ROM shows a maximal error of approximately 10°. Clinical Relevance The goniometer is a reasonable and simple clinical tool, but for research protocols, we suggest using the radiographic method because of the higher level of precision required. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
Overuse-related instability of the elbow: the role of CT-arthrography
Insights into Imaging
The elbow is a complex joint whose biomechanical function is granted by the interplay and synergy of various anatomical structures. Articular stability is achieved by both static and dynamic constraints, which consist of osseous as well as soft-tissue components. Injuries determining instability frequently involve several of these structures. Therefore, accurate knowledge of regional anatomy and imaging findings is fundamental for a precise diagnosis and an appropriate clinical management of elbow instability. This review focuses particularly on the varied appearance of overuse-related elbow injuries at CT-arthrography.