Development and Validation of a Computed Tomography-Based Methodology to Measure Carpal Kinematics

2005 ◽  
Vol 127 (3) ◽  
pp. 541-548 ◽  
Author(s):  
Jamie Pfaeffle ◽  
Brad Blankenhorn ◽  
Kathryne Stabile ◽  
Joseph Imbriglia ◽  
Robert Goitz ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Distal Radius ◽  
Three Dimensions ◽  
Surface Matching ◽  
Helical Axis ◽  
Wrist Flexion ◽  
Commercial Software ◽  
Flexion Extension ◽  
Surface Models ◽  
Carpal Kinematics

Motion of the wrist bones is complicated and difficult to measure. Noninvasive measurement of carpal kinematics using medical images has become popular. This technique is difficult and most investigators employ custom software. The objective of this paper is to describe a validated methodology for measuring carpal kinematics from computed tomography (CT) scans using commercial software. Four cadaveric wrists were CT imaged in neutral, full flexion, and full extension. A registration block was attached to the distal radius and used to align the data sets from each position. From the CT data, triangulated surface models of the radius, lunate, and capitate bones were generated using commercial software. The surface models from each wrist position were read into engineering design software that was used to calculate the centroid (position) and principal mass moments of inertia (orientation) of (1) the capitate and lunate relative to the fixed radius and (2) the capitate relative to the lunate. These data were used to calculate the helical axis kinematics for the motions from neutral to extension and neutral to flexion. The kinematics were plotted in three dimensions using a data visualization software package. The accuracy of the method was quantified in a separate set of experiments in which an isolated capitate bone was subjected to two different known rotation/translation motions for ten trials each. For comparison to in vivo techniques, the error in distal radius surface matching was determined using the block technique as a gold standard. The motion that the lunate and capitate underwent was half that of the overall wrist flexion-extension range of motion. Individually, the capitate relative to the lunate and the lunate relative to the radius generally flexed or extended about 30 deg, while the entire wrist (capitate relative to radius) typically flexed or extended about 60 deg. Helical axis translations were small, ranging from 0.6 mm to 1.8 mm across all motions. The accuracy of the method was found to be within 1.4 mm and 0.5 deg (95% confidence intervals). The mean error in distal radius surface matching was 2.4 mm and 1.2 deg compared to the use of a registration block. Carpal kinematics measured using the described methodology were accurate, reproducible, and similar to findings of previous investigators. The use of commercially available software should broaden the access of researchers interested in measuring carpal kinematics using medical imaging.

Outcomes of Supplementary Spring Wire Fixation With Volar Plating for Volar Lunate Facet Fragments in Distal Radius Fractures

Hand ◽  
2020 ◽  
pp. 155894472097640
Author(s):  
Nathaniel Fogel ◽  
Lauren M. Shapiro ◽  
Allison Roe ◽  
Sahitya Denduluri ◽  
Marc J. Richard ◽  
...  
Keyword(s):  
Distal Radius ◽  
Distal Radius Fractures ◽  
Wrist Flexion ◽  
Volar Plating ◽  
Radius Fractures ◽  
Locked Plating ◽  
Spring Wire ◽  
Flexion Extension ◽  
Wire Fixation ◽  
The Mean

Background Intra-articular distal radius fractures with small volar lunate facet fragments can be challenging to address with volar plate fixation alone. Volar locked plating with supplementary spring wire fixation has been previously described in a small series but has not been further described in the literature. We hypothesized that this technique can provide adequate fixation for volar lunate facet fragments smaller than 15 mm in length, which are at risk of displacement. Methods We completed a retrospective chart review (2015-2019) of patients who underwent volar locked plating with the addition of supplementary spring wire fixation for intra-articular distal radius fractures with a volar lunate facet fragment (<15 mm). Postoperative radiographs were assessed to evaluate union, evidence of hardware failure, escape of the volar lunate facet fragment, and postoperative volar tilt. Clinical outcome was assessed with wrist flexion/extension, arc of pronosupination, and Quick Disabilities of the Arm, Shoulder, and Hand Score ( QuickDASH) scores. Results Fifteen patients were identified, of which all went on to fracture union. There were no hardware failures or escape of the volar lunate facet fragment at final follow-up. One patient underwent hardware removal for symptoms of flexor tendon irritation. The mean wrist flexion was 59°, wrist extension was 70°, pronation was 81°, and supination was 76°. The mean QuickDASH score was 18.5. The mean postoperative volar tilt was 3.6°. Conclusions Supplementary spring wire fixation with standard volar plating provides stable fixation for lunate facet fragments less than 15 mm. This technique is a safe and reliable alternative to commercially available fragment-specific implants.

How Much Scaphoid Can be Safely Resected? A Biomechanical Analysis of the Effects of Distal Scaphoid Resection

Hand ◽  
2020 ◽  
pp. 155894472096671
Author(s):  
Assaf Kadar ◽  
Ruby Grewal ◽  
Clare E. Padmore ◽  
Stacy Fan ◽  
Daniel G. Langohr ◽  
...  
Keyword(s):  
Biomechanical Analysis ◽  
Wrist Flexion ◽  
Extended Position ◽  
Flexion Extension ◽  
Simple Alternative ◽  
Carpal Kinematics ◽  
Wrist Fusion ◽  
Clinically Significant ◽  
Dorsal Intercalated Segment Instability ◽  
Potentially Clinically Significant

Background: Resection of the distal pole of the scaphoid has been advocated as a simple alternative to other wrist salvage procedures for scaphoid nonunion advanced collapse and scaphotrapezio-trapezoid arthritis. However, the extent of scaphoid that may be resected without adversely affecting carpal kinematics has never been clearly defined. Methods: Seven cadaveric upper extremities were tested in a custom motion wrist simulator. A 3-stage sequential sectioning of the distal scaphoid protocol was performed in 25% increments then cyclic active wrist flexion-extension and dart thrower’s motion trials were recorded. Results: The extent of distal scaphoid resection had no effect on overall wrist range of motion. The lunate assumed a more extended position following resection of the distal scaphoid compared to intact. At 25%, 50%, and 75% of distal scaphoid resection, the lunate extended to 13.32° ± 9.4°, 23.43° ± 7.5°, and 15.81° ± 16.9°, respectively. The capitate migrated proximally with 25% and 50% distal scaphoidectomy, and proximally and radially with 75% of the scaphoid resected. Resection of 75% of the scaphoid resulted in unstable wrist kinematics. Conclusions: Resection of up to 25% of the distal scaphoid did not significantly influence carpal kinematics and induced mild lunate extension deformity. Resection of 50% of the scaphoid induced further and potentially clinically significant lunate extension and dorsal intercalated segment instability. Further removal of 75% of the distal scaphoid induced capitate migration radially and unpredictable wrist kinematics. Consequently, removal of over 25% of the scaphoid should be avoided or supplemented with partial wrist fusion.

scholarly journals The Effect of Proximal Hamate Osteotomy on Carpal Kinematics for Reconstruction of Proximal Pole Scaphoid Nonunion With Avascular Necrosis

Hand ◽  
2018 ◽  
Vol 15 (3) ◽  
pp. 371-377 ◽  
Author(s):  
Sanjeev Kakar ◽  
Ryan M. Greene ◽  
Timothy Hewett ◽  
Andrew R. Thoreson ◽  
Alexander W. Hooke ◽  
...  
Keyword(s):  
Motion Tracking ◽  
Wrist Flexion ◽  
Proximal Pole ◽  
Phase Tracking ◽  
3 Dimensional ◽  
Flexor Carpi Ulnaris ◽  
Flexion Extension ◽  
Carpal Kinematics ◽  
Fresh Frozen ◽  
Scaphoid Reconstruction

Background: The purpose of this study is to determine the effects of proximal hamate transfer for proximal pole scaphoid reconstruction upon carpal kinematics. Methods: Eight fresh-frozen cadaveric wrists underwent evaluation of their radiocarpal and midcarpal motion after proximal hamate osteotomy. A wrist simulator was used to apply cyclical tension to the flexor carpi ulnaris (FCU), flexor carpi radialis (FCR), extensor carpi ulnaris (ECU), and extensor carpi radialis longus and brevis stitched together (ECR). Kinematic motion was captured using Moiré Phase Tracking 3-dimensional motion-tracking sensors (MPT, Metria Innovation, Inc, Milwaukee, Wisconsin) to evaluate the lunocapitate and scapholunate angles for each condition. Results: During wrist flexion-extension and radial-ulnar deviation, there were no statistically significant differences about the lunocapitate or scapholunate axis between the intact and post-hamate osteotomy conditions. Conclusions: The harvest of the proximal hamate for proximal pole scaphoid reconstruction does not appear to adversely affect wrist kinematics.

Primary excision of the ulnar head for fractures of the distal ulna associated with fractures of the distal radius in severe osteoporotic patients

2013 ◽  
Vol 39 (3) ◽  
pp. 293-299 ◽  
Author(s):  
H. Yoneda ◽  
K. Watanabe
Keyword(s):  
Distal Radius ◽  
Contralateral Side ◽  
Fracture Site ◽  
Wrist Flexion ◽  
Distal Radial Fractures ◽  
Ulnar Head ◽  
Flexion Extension ◽  
Ulna Fractures ◽  
The Mean ◽  
Short Time

We performed primary excision of the ulnar head on 23 patients over 70 years of age with severe comminuted fractures of both the distal radius and ulna. The distal radius fracture was fixed rigidly with a volar locking plate, and the ulnar head was resected at the fracture site. All the distal radial fractures united without major complications. The mean wrist flexion/extension arc was 122°, the mean pronation/supination arc was 164°, and grip strength was 69% of that on the contralateral side. All patients returned to their daily activities within a short time without any additional surgical treatment. For elderly patients, primary excision of the ulnar head is an effective treatment for comminuted distal radius and ulna fractures.

scholarly journals Studying Primate Carpal Kinematics in Three Dimensions Using a Computed-Tomography-Based Markerless Registration Method

2010 ◽  
Vol 293 (4) ◽  
pp. 692-709 ◽  
Author(s):  
Caley M. Orr ◽  
Evan L. Leventhal ◽  
Spencer F. Chivers ◽  
Mary W. Marzke ◽  
Scott W. Wolfe ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Three Dimensions ◽  
Registration Method ◽  
Carpal Kinematics

Does Wrist Laxity Influence Three-Dimensional Carpal Bone Motion?

2018 ◽  
Vol 140 (4) ◽  
Author(s):  
Gordon M. Best ◽  
Michelle L. Zec ◽  
David R. Pichora ◽  
Robin N. Kamal ◽  
Michael J. Rainbow
Keyword(s):  
Three Dimensional ◽  
Carpal Bone ◽  
Patient Specific ◽  
Wrist Flexion ◽  
Ulnar Deviation ◽  
Column Type ◽  
Flexion Extension ◽  
Carpal Kinematics ◽  
Carpal Mechanics

Previous two-dimensional (2D) studies have shown that there is a spectrum of carpal mechanics that varies between row-type motion and column-type motion as a function of wrist laxity. More recent three-dimensional (3D) studies have suggested instead that carpal bone motion is consistent across individuals. The purpose of this study was to use 3D methods to determine whether carpal kinematics differ between stiffer wrists and wrists with higher laxity. Wrist laxity was quantified using a goniometer in ten subjects by measuring passive wrist flexion–extension (FE) range of motion (ROM). In vivo kinematics of subjects' scaphoid and lunate with respect to the radius were computed from computed tomography (CT) volume images in wrist radial and ulnar deviation positions. Scaphoid and lunate motion was defined as “column-type” if the bones flexed and extended during wrist radial–ulnar deviation (RUD), and “row-type” if the bones radial–ulnar deviated during wrist RUD. We found that through wrist RUD, the scaphoid primarily flexed and extended, but the scaphoids of subjects with decreased laxity had a larger component of RUD (R2 = 0.48, P < 0.05). We also determined that the posture of the scaphoid in the neutral wrist position predicts wrist radial deviation (RD) ROM (R2 = 0.46, P < 0.05). These results suggest that ligament laxity plays a role in affecting carpal bone motion of the proximal row throughout radial and ulnar deviation motions; however, other factors such as bone position may also affect motion. By developing a better understanding of normal carpal kinematics and how they are affected, this will help physicians provide patient-specific approaches to different wrist pathologies.

Long-Term Outcomes of Corrective Osteotomy for the Treatment of Distal Radius Malunion

2010 ◽  
Vol 35 (5) ◽  
pp. 370-380 ◽  
Author(s):  
S.A. Lozano-Calderón ◽  
K.M. Brouwer ◽  
J.N. Doornberg ◽  
J. Carel Goslings ◽  
P. Kloen ◽  
...  
Keyword(s):  
Distal Radius ◽  
Corrective Osteotomy ◽  
Long Term Results ◽  
Dash Score ◽  
Wrist Flexion ◽  
Perceived Disability ◽  
Flexion Extension ◽  
Distal Radius Malunion ◽  
Radius Malunion

Corrective osteotomy is an established but challenging treatment for distal radius malunion. Short- and intermediate-term results have been previously published while long-term results have not. The long-term results of 22 patients treated with corrective osteotomy for symptomatic distal radius malunion are presented (range 6—24 years, mean 13 years). All patients completed the DASH questionnaire and the modified Gartland and Werley, and Green and O’Brien scores postoperatively. Wrist alignment was assessed through standard wrist radiographs. Average wrist flexion—extension was 72.5% of the contralateral limb. Grip strength averaged 71%. The DASH score averaged 16 points corresponding to mild perceived disability. Results were categorized as fair on both the Gartland and Werley score (average 9 points) and the modified Green and O’Brien score (average 67 points). Wrist alignment was maintained over time but 13 patients presented mild to moderate symptomatic wrist arthritis. The outcome presented may be a reflection of the use of stricter evaluation instruments or reflect the development of post-traumatic arthritis.

The Primary Sauve–Kapandji Procedure—For Treatment of Comminuted Distal Radius and Ulnar Fractures

2005 ◽  
Vol 30 (1) ◽  
pp. 60-66 ◽  
Author(s):  
E. HORII ◽  
T. OHMACHI ◽  
R. NAKAMURA
Keyword(s):  
Distal Radius ◽  
Contralateral Side ◽  
Wrist Flexion ◽  
Distal Radial Fractures ◽  
Distal Ulna ◽  
Time Period ◽  
Flexion Extension ◽  
Comminuted Fractures ◽  
The Mean ◽  
Short Time

We have performed primary Sauve–Kapandji procedures on four patients with severe open comminuted fractures of both the distal radius and ulna. The fragmented distal ulna was fixed to the sigmoid notch in order to stabilize the ulnar side of the carpus, and a proximal pseudoarthrosis was maintained for forearm rotation. All the distal radial fractures united without major complications. The mean wrist flexion/extension arc was 76°, the mean pronation/supination arc was 135°, and grip strength was 64% of the contralateral side. All patients returned to their work or daily activities within short time period without any additional surgical treatment, except for removal of implants in three patients. The primary Sauve–Kapandji procedure is effective for the reconstruction of severely combined distal radius and ulnar fractures.

Scaphoid Motion of the Wrist with Scapho-trapezio-trapezoidal Osteoarthritis-A Pilot Study

2020 ◽  
Vol 16 (3) ◽  
pp. 206-209
Author(s):  
Ronit Wollstein ◽  
Hisao Moritomo ◽  
Iida Akio ◽  
Shohei Omokawa
Keyword(s):  
Neutral Position ◽  
Wrist Flexion ◽  
Wrist Movement ◽  
Ulnar Deviation ◽  
Wrist Motion ◽  
3 Dimensional ◽  
Active Flexion ◽  
Extended Position ◽  
Flexion Extension ◽  
Surface Models

Background: The purpose of this study was to investigate scaphoid motion within the scapho-trapezio-trapezoidal (STT) joint during wrist motion in the presence of STT joint osteoarthritis (OA). Methods: We studied 11 wrists with STT OA and 5 normal wrists. Computed tomography (CT) images were acquired in five wrist positions (maximum active flexion, extension, radial deviation, ulnar deviation, and neutral position). The 3-dimensional surface models of the radius and scaphoid were constructed and the motion of scaphoid relative to the radius was calculated. Results and Conclusion: During wrist flexion/extension motion, the scaphoid rotated mostly in the flexion/extension plane. The angle tended to be smaller in STT OA than in normal. During wrist radioulnar deviation, the scaphoid was in an extended position in neutral wrist in STT OA. The motion of scaphoid in STT OA was divided into two types: a rigid type and mobile type. The mobile type rotated closer to the flexion/extension plane than the rigid type. Taking into account scaphoid motion during wrist movement before surgery may provide better results in the treatment of STT OA.

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