Elbow position affects distal radioulnar joint kinematics.
OBJECTIVE
Previous in vivo and in vitro studies of forearm supination-pronation suggest that distal radioulnar joint kinematics may be affected by elbow flexion. The primary hypotheses tested by this study were that, in vivo, ulnar variance changes with elbow flexion and forearm rotation, and the arc of forearm rotation changes in relationship to elbow flexion.


METHODS
Changes in radioulnar kinematics during forearm supination-pronation and elbow flexion (0 degrees to 90 degrees ) were studied in 5 uninjured subjects using computed tomography, dual-orthogonal fluoroscopy, and 3-dimensional modeling. Analysis of variance and post-hoc testing was performed.


RESULTS
Proximal translation of the radius was greatest with the elbow flexed to 90 degrees with the arm in midpronation. With the arm in midpronation, the translation of the radius was significantly greater at 0 degrees versus 45 degrees of elbow flexion (0.82 +/- 0.59 mm vs 0.65 +/- 0.80 mm, F: 4.49, post hoc: 0.055; p = .05) and significantly smaller at 45 degrees versus 90 degrees of elbow flexion (0.65 +/- 0.80 mm vs 0.97 +/- 0.35 mm, F: 4.49, post hoc: 0.048; p = .05). Proximal translation of the radius in midpronation was significantly greater than when the forearm was in a supinated position when the elbow was at 0 degrees or 90 degrees flexion (F: 14.90, post hoc: <0.01; p < .01, F: 19.11, post hoc: <0.01, p < .01). The arc of forearm rotation was significantly decreased at 0 degrees compared with 90 degrees of elbow flexion (129.3 degrees +/- 22.2 degrees vs 152.8 degrees +/- 14.4 degrees , F: 3.29, post hoc: 0.79; p = .09). The center of rotation shifted volarly and ulnarly with increasing elbow extension.


CONCLUSIONS
Elbow position affects the kinematics of the distal radioulnar joint. The kinematics of the distal radioulnar joint are primarily affected by forearm rotation and secondarily by elbow flexion. These findings have clinical relevance to our understanding of ulnar impaction, and how elbow position affects the proximal-distal translation of the radius. These findings have implications for the treatment of ulna impaction, radiographic evaluation of the distal ulna, and future biomechanical studies.
Fu
Eric
E
Hand and Upper Extremity Service and the Bioengineering Laboratory, Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA.
Li
Guoan
G
Souer
J Sebastiaan
JS
Lozano-Calderon
Santiago
S
Herndon
James H
JH
Jupiter
Jesse B
JB
Chen
Neal C
NC
D000328:Adult; D001696:Biomechanical Phenomena; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000502:physiology*; D005471:Fluoroscopy; D005542:Forearm / Q000000981:diagnostic imaging / Q000502:physiology; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D011403:Pronation / Q000502:physiology*; D011884:Radius / Q000000981:diagnostic imaging / Q000502:physiology*; D016059:Range of Motion, Articular / Q000502:physiology*; D012016:Reference Values; D013484:Supination / Q000502:physiology*; D014057:Tomography, X-Ray Computed; D014457:Ulna / Q000000981:diagnostic imaging / Q000502:physiology*; D055815:Young Adult