The Impact of Scaphoid Malunion on Radioscaphoid Joint Contact: A Computational Analysis.

Autor:	Chambers SB; Department of Plastic and Reconstructive Surgery, Western University, St. Joseph's Health Care, London, Ontario, Canada., Padmore CE; Department of Biomedical Engineering, Lawson Health Research Institute, St. Joseph's Health Care, London, Ontario, Canada., Grewal R; Department of Surgery, Western University, the Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada., Suh N; Department of Surgery, Western University, the Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada. Electronic address: nina.suh@sjhc.london.on.ca.
Jazyk:	angličtina
Zdroj:	The Journal of hand surgery [J Hand Surg Am] 2020 Jul; Vol. 45 (7), pp. 610-618.e1. Date of Electronic Publication: 2020 Mar 25.
DOI:	10.1016/j.jhsa.2020.01.009
Abstrakt:	Purpose: The clinical relevance of scaphoid malunion is controversial because the biomechanical sequelae remain poorly understood. In this computational study, the effect of increasing scaphoid malunion on radioscaphoid joint contact was assessed. Methods: Six computational wrist models of active wrist flexion-extension were used to examine 6 scaphoid malunions of varying severities. The malunions were computationally created using 3-dimensional imaging software. Each scaphoid was shortened at the waist by 2 mm to simulate fracture comminution and the distal pole was angulated volarly from 15° to 55° in 10° intervals to create a total of 6 scaphoid malunion models per specimen. Each malunion model was then assessed at 3 wrist positions: neutral, 40° flexion, and 40° extension. The radioscaphoid contact area, as well as the contact centroid, was calculated. Results: There was a statistically significant association between malunion severity and a wider area of contact at the radiocar: pal joint. The centroid of this radioscaphoid contact area also moved in an ulnar direction for all tested wrist positions. In the extended wrist position, the centroid also moved volarly. Conclusions: In this computational model, the amount of radioscaphoid joint contact was significantly increased with progressive scaphoid malunion severity. Furthermore, the position of the contact centroid had a significant change in position in the ulnar direction in all wrist positions with increasing scaphoid malunion. The clinical importance of this contact is yet to be elucidated, but this computational model serves as a basis for understanding the biomechanical consequences of scaphoid humpback deformities. Clinical Relevance: This study provides a computational analysis examining changes at the radioscaphoid joint that may occur within the wrist with the scaphoid malunited. (Copyright © 2020 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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