Finite element evaluation of the stability of the elbow joint in the “terrible triad injury” by two surgical methods

doi:10.3969/j.issn.2095-4344.1293

Abstract

Abstract:

BACKGROUND: The ‘terrible triad injury” of the elbow joint is a serious complex fracture and dislocation. It is worthwhile to study on stability of the elbow joint by repairing the medial collateral ligament structure instead of the fixation of the coronal process.

OBJECTIVE: To compare the mechanical value of different flexion angles of the elbow joint under two modes of fixing ulnar coronoid process and repairing medial collateral ligament based on the stability reconstruction of the lateral column of the elbow joint and to evaluate the effect of two surgical methods on the stability of the elbow joint by establishing a finite element model of the “terrible triad injury” of the elbow joint.

METHODS: Using data of the elbow joint CT and MRI, command stream files were generated from the computer. The elbow joint solid model was established and meshed. To compare the elbow joint stability, by simulating whether the medial collateral ligament was repaired or not after fracture, and the coronoid process was fixed or not, longitudinal load was applied to analyze the stress distribution on the elbow joint surface under various working conditions.

RESULTS AND CONCLUSION: (1) The maximum stress of the normal elbow joint surface was 0.78 MPa when the elbow joint was extended to 0°. If the 1/3 coronoid process fracture was fixed, and the medial collateral ligament was not repaired, the maximum stress of the articular surface of the model was 0.84 MPa. If the coronoid process fracture was not fixed, the medial collateral ligament was repaired, the maximum stress of the articular surface was also 0.84 MPa. (2) When the elbow joint was flexed 30°, the maximum stress of the articular surface of the normal elbow joint model was 2.02 MPa. If the 1/3 coronoid process fracture was fixed, and the medial collateral ligament was not repaired; the maximum stress of the joint surface was 2.02 MPa. If the coronoid process fracture was not fixed, the medial collateral ligament was repaired, and the maximum stress was 2.07 MPa. (3) The maximum displacement of the normal elbow joint surface was 0.14 mm when the elbow joint was straight. If the 1/3 coronoid process fracture was fixed, and the medial collateral ligament was not repaired, the maximum displacement of the articular surface of the model was 0.15 mm. If the coronoid process fracture was not fixed, the medial collateral ligament was repaired, the maximum displacement of the articular surface of the elbow joint model was 0.16 mm. (4) When the elbow joint was flexed 30°, and the maximum displacement of the articular surface of the normal elbow joint model was 0.52 mm. If the 1/3 coronoid process fracture was fixed, and the medial collateral ligament was not repaired, and the maximum displacement was 0.52 mm. If the coronoid process fracture was not fixed, the medial collateral ligament was repaired, and the maximum displacement was 0.51 mm. (5) The above results show that the experiment has successfully established the finite element model of the “terrible triad injury” of the elbow joint. If the 1/3 coronoid process fracture is fixed, the medial collateral ligament is not repaired, and the maximum stress and displacement of the articular surface of the model were slightly smaller than those of the normal model. If the coronoid process fracture is not fixed, only the medial collateral ligament is repaired, and the maximum stress and displacement of the articular surface of the elbow joint model are greater or substantially equal to the values of the normal model. Biomechanical studies suggest that the medial collateral ligament can replace the fixation of the coronoid process fracture and reconstruct the stability of the elbow joint on the basis of the stability reconstruction of the lateral column of the elbow joint.

Key words: elbow joint, terrible triad injury, finite element, coronoid process, bone fractures, medial collateral ligament, stability, stress, displacement

CLC Number:

R459.9|R605|R683

','1');return false;" target="_blank">

R459.9|R605|R683

Song Chao, Ding Zhihong, Yin Tao, Li Zhenshi, Wu Liang, Zhou Wenchao, Xu Bo, Liu Yue, Kong Dece, Yang Tieyi, Zhang Yan .

Finite element evaluation of the stability of the elbow joint in the “terrible triad injury” by two surgical methods

[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(24): 3834-3839.

Figures/Tables 4

References

[1]Hotchkiss RN. Fractures and dislocations of the elbow. In: Rockwood CA Jr, Green DP, Bucholz RW, Heckman JD, eds. Rockwood and Green’s Fractures in Adults. 4th ed, Vol 1. Philadelphia, PA, USA: Lippincott-Raven. 1996;929-1024.

[2]Chen NC, Ring D. Terrible triad injuries of the elbow. J Hand Surg Am. 2015;40(11):2297-2303.

[3]Giannicola G, Calella P, Piccioli A et al. Terrible triad of the elbow: is it still a troublesome injury? Injury. 2015;46 (Suppl 8): S68-S76.

[4]Mazhar FN, Ebrahimi H, Jafari D et al. Radial head resection versus prosthetic arthroplasty in terrible triad injury: a retrospective comparative cohort study. Bone Joint J. 2018; 100-B(11):1499-1505.

[5]Pugh DMW, Wild LM, Schemitsch EH, et al. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg Am. 2004;86(6): 1122-1130.

[6]McKee MD, Pugh DM, Wild LM, et al. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures: surgical technique. J Bone Joint Surg Am. 2005;87(s1):22-32.

[7]Mellema JJ, Doornberg JN, Dyer GS, et al. Distribution of coronoid fracture lines by specific patterns of traumatic elbow instability. J Hand Surg Am. 2014;39(10):2041-2046.

[8]Feng D, Zhang X, Jiang Y et al. Plate fixation through an anterior approach for coronoid process fractures: a retrospective case series and a literature review. Medicine (Baltimore). 2018;97(36):e12041.

[9]刘仁浩,周楠,毕郑刚.尺骨冠状突骨折的修复策略及生物力学分析[J].中国组织工程研究,2013,21(43):7610-7617.

[10]Sard A, Dutto E, Rotini R, et al. The posterior bundle of the elbow medial collateral ligament: biomechanical study and proposal for a new reconstruction surgical technique. Musculoskelet Surg. 2017;101(Suppl 2):181-186.

[11]Kovacevic D, Vogel LA, Levine WN. Complex elbow instability: radial head and coronoid. Hand Clin. 2015;31(4):547-556.

[12]Hartzler RU, Llusa-Perez M, Steinmann SP et al. Transverse coronoid fracture: when does it have to be fixed? Clin Orthop Relat Res. 2014;472(7):2068-2074.

[13]Morry BF, An KN. Stability of the elbow: osseous constraints. J Shoulder Elbow Surg. 2005;1:174-178．

[14]Callaway GH, Field LD, Deng XH. Biomechanical evaluation of the medial collateral ligament of the elbow. J Bone Joint Surg Am. 1997;8:1223-1231．

[15]Maloney MD, Mohr KJ, Attrache NS. Elbow injuries in the throwing athlete. Difficult diagnosis and surgical complications. Clin Sport Med. 1999;4:795-809.

[16]Poelert S, Valstar E, Weinans H, et al. Patient-specific finite element modeling of bones. Proc Inst Mech Eng H. 2013; 227(4):464-478.

[17]Burkhart TA, Andrews DM, Dunning CE. Finite element modeling mesh quality, energy balance and validation methods: a review with recommendations associated with the modeling of bone tissue. J Biomech. 2013;46(9):1477-1488.

[18]Doornberg JN, Ring D. Coronoid fracture patterns. J Hand Surg Am. 2006; 31(1):45-52.

[19]Jeon IH, Sanchez-Sotelo J, Zhao K, et al. The contribution of the coronoid and radial head to the stability of the elbow. J Bone Joint Surg Br. 2012;94:86-92.

[20]Pugh DMW, Wild LM, Schemitsch EH, et al. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg Am. 2004;86(6): 1122-1130.

[21]McKee MD, Pugh DM, Wild LM, et al. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures: surgical technique. J Bone Joint Surg Am. 2005;87(s1):22-32.

[22]Mathew PK, Athwal GS, King GJW. Terrible triad injury of the elbow: current concepts. J Am Acad Orthop Surg. 2009;17(7): 137-151.

[23]Labott JR, Aibinder WR, Dines JS, et al. Understanding the medial ulnar collateral ligament of the elbow: review of native ligament anatomy and function. World J Orthop. 2018;9(6): 78-84.

[24]Dodds SD, Fishler T. Terrible triad of the elbow. Orthop Clin North Am. 2013;44(1):47-58.

[25]Hrubina M, Horak Z, Skotak M et al. Assessment of complications depending on the sliding screw position-finite element method analysis. Bratisl Lek Listy. 2015;116(5): 302-310.

[26]Aquilina P, Parr WC, Chamoli U, et al. Finite element analysis of patient-specific condyle fracture plates: a preliminary study. Craniomaxillofac Trauma Reconstr. 2015;8(2):111-116.

[27]倪鹏辉,张鹰,杨晶,等.临床骨科中应用的有限元分析法:新理论与新进展[J].中国组织工程研究,2016,20(31):4693-4699.