Distal Humeral Trochlear Geometry Associated With the Spatial Variation of the Dynamic Elbow Flexion Axis

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Abstract

Background: The complexity of the spatial dynamic flexion axis (DFA) of the elbow joint makes the elbow prosthesis design and humeral component alignment challenging. This study aimed to 1) investigate the variations of the spatial DFA during elbow flexion and 2) investigate the relationship between the distal humeral trochlear geometry and the in vivo spatial variation of the DFA.

Methods: Ten healthy subjects participated in this study. Each subject performed a full elbow extension to maximum flexion with hand supination under dual fluoroscopic imaging system (DFIS) surveillance. The 2D fluoroscopic images and the 3D bone models were registered to analyze the in vivo elbow kinematics and DFAs. The spatial DFA positions were defined as inclination with the medial and lateral epicondyle axes (MLA) in the transverse and coronal planes. The range of the DFA positions was also investigated during different flexion phases. The Spearman correlation method was used to analyze the relationship between the distal humeral trochlear’s morphological parameters and the position of DFAs during different flexion phases.

Results: The pathway of the DFAs showed an irregular pattern and presented individual features. The medial trochlear depth (MTD) ( r = 0.68, p = 0.03) was positively correlated with the range of the DFA position (2.8° ± 1.9°) in the coronal plane from full extension to 30° of flexion. Lateral trochlear height (LTH) ( r = −0.64, p = 0.04) was negatively correlated with the DFA position (−1.4° ± 3.3°) in the transverse plane from 30° to 60° of flexion. A significant correlation was found between LTH with the DFA position in the coronal ( r = −0.77, p = 0.01) and transverse planes ( r = −0.76, p = 0.01) from 60° to 90° of flexion.

Conclusion: This study showed that the pathway of the dynamic flexion axis has an individual pattern. The medial and lateral trochlear sizes were the key parameters that might affect the elbow joint flexion function. When recovering complex distal humeral fractures or considering the implant design of total elbow arthroplasty, surgeons should pay more attention to the medial and lateral trochlea’s geometry, which may help restore normal elbow kinematics.

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Author and article information

Contributors

Tsung-Yuan Tsai: URI : https://loop.frontiersin.org/people/1178441/overview

Journal

Journal ID (nlm-ta): Front Bioeng Biotechnol

Journal ID (iso-abbrev): Front Bioeng Biotechnol

Journal ID (publisher-id): Front. Bioeng. Biotechnol.

Title: Frontiers in Bioengineering and Biotechnology

Publisher: Frontiers Media S.A.

ISSN (Electronic): 2296-4185

Publication date (Electronic): 24 June 2022

Publication date Collection: 2022

Volume: 10

Electronic Location Identifier: 850198

Affiliations

[1] ¹ School of Biomedical Engineering & Med-X Research Institute , Shanghai Jiao Tong University , Shanghai, China

[2] ² Department of Orthopaedic Surgery, Shanghai Ninth People s Hospital, Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology , Shanghai Jiao Tong University School of Medicine , Shanghai, China

[3] ³ Department of Biomechanics , Mayo Clinic , Rochester, MN, United States

[4] ⁴ Department of Orthopaedic Surgery , Shanghai Jiao Tong University Affiliated Sixth People’s Hospital , Shanghai, China

[5] ⁵ Department of Rehabilitation Medicine , Zhongshan Hospital , Fudan University , Shanghai, China

[6] ⁶ Engineering Research Center of Digital Medicine and Clinical Translation , Ministry of Education , Shanghai, China

Author notes

Edited by: Jun Pan, Chongqing University, China

Reviewed by: Ding Jian, Shanghai Jiao Tong University, China

Jay Trivedi, Rhode Island Hospital, United States

*Correspondence: Weihua Gong, gwh1124@ 123456sina.com ; Tsung-Yuan Tsai, tytsai@ 123456sjtu.edu.cn

[ † ]

These authors have contributed equally to this work

This article was submitted to Biomechanics, a section of the journal Frontiers in Bioengineering and Biotechnology

Article

Publisher ID: 850198

DOI: 10.3389/fbioe.2022.850198

PMC ID: 9263270

PubMed ID: 35814006

SO-VID: 48cd304c-b6ab-4f5b-b4e6-6f00f3fcc6a6

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 07 January 2022

Date accepted : 13 May 2022

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