Effect of distal humeral varus deformity on strain in the lateral ulnar collateral ligament and ulnohumeral joint stability.
BACKGROUND
Recent reports have implicated cubitus varus deformity as a risk factor for the development of late posterolateral rotatory instability of the elbow. The purpose of this study was to determine the biomechanical relationship between cubitus varus and strain in the lateral ulnar collateral ligament and subluxation of the ulnohumeral joint as it relates to posterolateral rotatory instability.


METHODS
Eleven fresh-frozen cadaveric elbow joints were mounted in an apparatus that allowed active elbow motion. Supracondylar osteotomies were performed to create cubitus varus deformities of 0 degrees to 30 degrees in 5 degrees increments. Each elbow was loaded with a supination moment of 1.2 Nm and a resistive triceps extension force. Strain in the lateral ulnar collateral ligament and widening of the ulnohumeral joint were measured at each position of varus, and the resulting strain and joint-widening values were averaged.


RESULTS
Strain in the lateral ulnar collateral ligament was found to increase as the cubitus varus deformity increased. Likewise, the ulnohumeral joint space was seen to progressively widen with increasing cubitus varus. Strain was significantly increased at 30 degrees of varus deformity (p = 0.03), and widening of the ulnohumeral joint space was significantly increased at 25 degrees of varus deformity (p = 0.004). When differences in the size of the cadaveric specimens were accounted for in an analysis of covariance, ligament strain was significantly increased at 25 degrees of varus (p = 0.005) and widening of the ulnohumeral joint space, at 20 degrees (p = 0.01).


CONCLUSIONS
Cubitus varus deformity of the elbow increases strain in the lateral ulnar collateral ligament, with a corresponding increase in ulnohumeral joint-opening consistent with the posterolateral rotatory instability of the elbow seen clinically.
Upper Extremity Reconstructive Service, St. Michael's Hospital and the University of Toronto, 55 Queen Street East, Suite 800, Toronto, ON M5C 1R6, Canada.
Murray J
MJ
Beuerlein
Jeffrey T
JT
Reid
Emil H
EH
Schemitsch
Michael D
MD
McKee
D000368:Aged; D001696:Biomechanical Phenomena; D002102:Cadaver; D017885:Collateral Ligaments / Q000503:physiopathology*; D004551:Elbow Joint; D005260:Female; D006801:Humans; D006811:Humerus / Q000503:physiopathology*; D016916:Joint Deformities, Acquired / Q000150:complications* / Q000503:physiopathology; D007593:Joint Instability / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D012399:Rotation; D014457:Ulna