Sequence of the Essex-Lopresti lesion--a high-speed video documentation and kinematic analysis.

BACKGROUND AND PURPOSE: The pathomechanics of the Essex-Lopresti lesion are not fully understood. We used human cadavers and documented the genesis of the injury with high-speed cameras. METHODS: 4 formalin-fixed cadaveric specimens of human upper extremities were tested in a prototype, custom-made, drop-weight test bench. An axial high-energy impulse was applied and the development of the lesion was documented with 3 high-speed cameras. RESULTS: The high-speed images showed a transversal movement of the radius and ulna, which moved away from each other in the transversal plane during the impact. This resulted into a transversal rupture of the interosseous membrane, starting in its central portion, and only then did the radius migrate proximally and fracture. The lesion proceeded to the dislocation of the distal radio-ulnar joint and then to a full-blown Essex-Lopresti lesion. INTERPRETATION: Our findings indicate that fracture of the radial head may be preceded by at least partial lesions of the interosseous membrane in the course of high-energy axial trauma.

Glass -polyalkenoate cement: An alternative material for kyphoplasty in osteoporotic vertebral compression fractures - An ex vivo study.

Adjacent vertebral body fracture is described as a risk after vertebroplasty and kyphoplasty. It may be true that this phenomenon is caused precisely because of the frequently used polymethylmethacrylate cement (PMMA), which shows a higher level of stiffness than bone material and may ultimately lead to shifting stress levels within the entire spine. The goal of the present study was to evaluate and compare the pressure distribution in the endplate of human vertebrae after kyphoplasty with PMMA and aluminum-free glass-polyalkenoate cement (gpc). For the present study, 8 fresh frozen human cadaveric vertebral bodies from the thoracolumbar junction were used. All vertebrae were augmented transpedicularly on one side with gpc and on the other side with PMMA. A loading of 600 N, 800 N and 1000 N was applied. In the data processing an individual region of interest (roi) was generated for each vertebra. The following parameters were determined for each roi: maximum force [N], maximum pressure [kPa], mean pressure [kPa], roi area [cm2]. We found significantly higher mean pressure values in the areas of the vertebrae augmented with PMMA, compared to the ones after augmentation with gpc (p = 0.012) when applying 1000 N. In the groups with lower forces there were no statistical relevant differences. The pressure distribution shows an advantage for gpc. A material, which does not create load concentration onto the cranial and caudal vertebral surface, could have major advantages concerning the risk of adjacent vertebral fractures. Thus the results of the 1000 N loading protocol suggest gpc being a possible alternative to ordinary PMMA cement, regarding its influence on stiffness in kyphoplasty. These and other general aspects like incorporation should be addressed and elaborated more detailed in further studies.

Influence of calibration method and material on the accuracy of stress distribution measurement systems.

Biomechanical analyses of the stress distribution and the force transfer in the human knee are essential to better understand the aetiology of joint diseases. Accuracy studies of commonly used capacitive or resistive-based stress distribution measurement systems have led to severe problems caused by an inaccurate experimental setup. For instance, in one study, overestimations of the measured forces in the sensor's centre were reported. Therefore, the primary aim of this study was to investigate the ability of capacitive and resistive-based sensors to measure forces in a homogenous pressure environment and the secondary goal was to analyse the influence of different calibration materials on the measurement accuracy. A Novel pressure vessel and metal indenters covered with different rubber materials were used in combination with a material testing machine to load the sensors. Four different linearly increasing nominal forces (925-3670 N) were applied and the deviations between the nominal and the measured forces were calculated. The capacitive measurement system showed errors between 1% and 7% in the homogenous pressure environment, whereas the errors of the resistive system were found to vary between 4% and 17%. The influence of the calibration material was observed to be greater for the resistive sensors (1-179%) than for the capacitive sensors (0.5-25%). In conclusion, it can be stated that - for the pressure measurement systems compared in this article - the capacitive one is less sensitive to the calibration method and the calibration material than the resistive system.

Do counteracting external frontal plane moments alter the intraarticular contact force distribution in the loaded human tibiofemoral joint?

BACKGROUND: There are strong indications that asymmetric medio-lateral load distribution in the knee joint is a risk factor for osteoarthritis. Externally applied frontal plane moments (adduction and abduction) might affect the distribution of knee joint compartment loading. However, this is not confirmed through intraarticular measurements in loaded human knee joints. The purpose of the study was to determine the force distribution and the movement of the centre of pressure in the loaded tibiofemoral joint as a function of varied externally applied counteracting frontal plane moments and in dependence of the knee flexion angle. METHODS: Adduction and abduction moments of 2.5 Nm and 5 Nm were applied to six cadaveric knees exhibiting varus, valgus and normal alignments. The joints were mounted in a knee joint loading simulator. During simulated muscle-driven extension-flexion cycles, intraarticular forces were determined using capacitive pressure sensors inserted into the medial and lateral knee joint compartments. Motion of femur and tibia were assessed by a motion analysis system. RESULTS: Externally applied frontal plane moments altered the intraarticular force distribution and caused shifts in the centre of pressure up to 4.3mm in all knee joints. Larger redistribution effects were found in higher knee flexion angles. The medial compartment load increased during the flexion in all investigated knee joints. CONCLUSIONS: The application of counteracting frontal plane moments for the conservative treatment of osteoarthritis can redistribute the forces and might slow down the progression of the disease. CLINICAL RELEVANCE: The findings of this study offer novel insights to guide the development and optimization of mechanical aids for the treatment of osteoarthritic knees.