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Biomechanical comparison of elbow stability constructs.

James F Stenson1, Jeffrey C Lynch2, Quincy T Cheesman2

  • 1Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.

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|March 5, 2022
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Summary

Static external fixators (SEF), hinged external fixators (HEF), and internal joint stabilizers (IJS) equally maintain elbow joint stability. Hinged elbow orthoses (HEO) failed to provide stability in complex elbow trauma cases.

Keywords:
Elbow instabilitybiomechanical stabilitybiomechanical strengthcomplex elbow injuryhinged elbow bracehinged external fixatorinternal joint stabilizerstatic external fixator

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Area of Science:

  • Orthopedic surgery
  • Biomechanical engineering
  • Trauma care

Background:

  • Complex elbow trauma often requires additional fixation beyond surgical stabilization to ensure joint congruity and stability.
  • Various biomechanical constructs, including static external fixators (SEF), hinged external fixators (HEF), internal joint stabilizers (IJS), and hinged elbow orthoses (HEO), are available.
  • The optimal choice for adjunct fixation in elbow trauma remains undetermined.

Purpose of the Study:

  • To biomechanically compare the effectiveness of SEF, HEF, IJS, and HEO in maintaining elbow joint stability after soft-tissue release.
  • To evaluate the impact of varying varus stress on the performance of each construct.

Main Methods:

  • Eight matched cadaveric upper extremities underwent a 360° capsuloligamentous soft-tissue release.
  • Anteroposterior stress radiographs were taken at 0° and 45° flexion under baseline conditions (hand weight).
  • SEF, HEF, IJS, and HEO were sequentially applied, and radiographs were obtained with 0 kg and 2.3 kg of applied weight to assess displacement, congruence, and ulnohumeral opening angle.

Main Results:

  • No significant differences in ulnohumeral joint space or opening angle were observed between SEF, HEF, and IJS under varus stress (0 kg and 2.3 kg) at 0° and 45° flexion.
  • The HEO demonstrated catastrophic failure in all tested positions, even without applied weight.
  • No construct showed superiority in maintaining elbow congruity compared to the others (excluding HEO).

Conclusions:

  • SEF, HEF, and IJS provide comparable stability for the elbow against arm weight and moderate varus stress.
  • HEO is ineffective in providing additional stability to an unstable elbow.
  • The choice between SEF, HEF, and IJS may depend on factors beyond biomechanical stability under these specific tested conditions.