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      Stability of the Elbow Joint: Relevant Anatomy and Clinical Implications of In Vitro Biomechanical Studies

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          The aim of this literature review is to describe the clinical anatomy of the elbow joint based on information from in vitro biomechanical studies. The clinical consequences of this literature review are described and recommendations are given for the treatment of elbow joint dislocation.

          The PubMed and EMBASE electronic databases and the Cochrane Central Register of Controlled Trials were searched. Studies were eligible for inclusion if they included observations of the anatomy and biomechanics of the elbow joint in human anatomic specimens.

          Numerous studies of the kinematics, kinesiology and anatomy of the elbow joint in human anatomic specimens yielded important and interesting implications for trauma and orthopaedic surgeons.

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          Most cited references63

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          A biomechanical study of normal functional elbow motion.

          Maegan Askew, Chi-Yang Chao, B Morrey (1981)
          We studied thirty-three normal patients, eighteen women and fifteen men, for normal motion and the amount of elbow motion required for fifteen activities of daily living. The amounts of elbow flexion and forearm rotation (pronation and supination) were measured simultaneously by means of an electrogoniometer. Activities of dressing and hygiene require elbow positioning from about 140 degrees of flexion needed to reach the occiput to 15 degrees of flexion required to tie a shoe. Most of these activities are performed with the forearm in zero to 50 degrees of supination. Other activities of daily living (such as eating, using a telephone, or opening a door) are accomplished with arcs of motion of varying magnitudes. Most of the activities of daily living that were studied in this project can be accomplished with 100 degrees of elbow flexion (from 30 to 130 degrees) and 100 degrees of forearm rotation (50 degrees of pronation and 50 degrees of supination). These data, not previously recorded, may be used to provide an objective basis for the determination of disability impairment, to determine the optimum position for elbow splinting or arthrodesis, and to assist in the design of elbow prostheses. The motion needed to perform essential daily activities is obtainable with a successful total elbow arthroplasty.
          Article 0 comments Cited 158 times – based on 0 reviews     Review now
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            Posterolateral rotatory instability of the elbow.

            Jimmy Bell, Shawn O'Driscoll, B Morrey (1991)
            Recurrent posterolateral rotatory instability of the elbow is an apparently undescribed clinical condition that is difficult to diagnose. We treated five patients, ranging in age from five to forty years, who had such a lesion and in whom the instability could be demonstrated only by what we call the posterolateral rotatory-instability test. This test involves supination of the forearm and application of a valgus moment and an axial compression force to the elbow while it is flexed from full extension. The elbow is reduced in full extension and must be subluxated as it is flexed in order to obtain a positive test result (a sudden reduction of the subluxation). Flexion of more than about 40 degrees produces a sudden palpable and visible reduction of the radiohumeral joint. The elbow does not subluxate without provocation. The cause for this condition, we think, is laxity of the ulnar part of the lateral collateral ligament, which allows a transient rotatory subluxation of the ulnohumeral joint and a secondary dislocation of the radiohumeral joint. The annular ligament remains intact, so the radio-ulnar joint does not dislocate. Operative repair of the lax ulnar part of the lateral collateral ligament eliminated the posterolateral rotatory instability, as revealed intraoperatively in our five patients.
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              Fractures of the coronoid process of the ulna.

              B Morrey, W Regan (1989)
              A review of thirty-five patients who had a fracture of the coronoid process of the ulna revealed three types of fracture: Type I--avulsion of the tip of the process; Type II--a fragment involving 50 per cent of the process, or less; and Type III--a fragment involving more than 50 per cent of the process. A concurrent dislocation or associated fracture was present in 14, 56, and 80 per cent of these patients, respectively. The outcome correlated well with the type of fracture. According to an objective elbow-performance index used to assess the results for the thirty-two patients who had at least one year of follow-up (mean, fifty months), 92 per cent of the patients who had a Type-I fracture, 73 per cent who had a Type-II fracture, and 20 per cent who had a Type-III fracture had a satisfactory result. Residual stiffness of the joint was most often present in patients who had a Type-III fracture. We recommend early motion within three weeks after injury for patients who have a Type-I or Type-II fracture. Reduction and fixation, followed by early motion when possible, may be the preferred treatment for patients who have a Type-III fracture.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Orthop J
                Journal ID (publisher-id): TOORTHJ
                Title: The Open Orthopaedics Journal
                Publisher: Bentham Open
                ISSN (Electronic): 1874-3250
                Publication date (Electronic): 11 May 2011
                Publication date Collection: 2011
                Volume: 5
                Pages: 168-176
                Affiliations
                [1 ]Department of Surgery-Traumatology, Westfriesgasthuis, P.O. Box 600, 1620 AR Hoorn, The Netherlands
                [2 ]Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
                [3 ]Department of Orthopaedics, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands
                [4 ]Department of Neuroscience, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
                Author notes
                [* ]Address correspondence to this author at the Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; Tel: +31 10 7032395; Fax: +31 10 7032396; E-mail: d.denhartog@ 123456erasmusmc.nl
                Article
                Publisher ID: TOORTHJ-5-168
                DOI: 10.2174/1874325001105010168
                PMC ID: 3104563
                PubMed ID: 21633722
                SO-VID: 528cd0fd-4028-41a3-8f88-dc70fb45e86d
                Copyright © © de Haan et al.; Licensee Bentham Open.
                License:

                This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

                History
                Date received : 13 March 2011
                Date revision received : 26 March 2011
                Date accepted : 1 April 2011
                Categories
                Subject: Article

                ScienceOpen disciplines: Orthopedics
                Keywords: elbow joint,biomechanics,review literature.,anatomy,joint instability
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: elbow joint, biomechanics, review literature., anatomy, joint instability

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