Radial shortening osteotomy reduces radiocapitellar contact pressures while preserving valgus stability of the elbow.

PURPOSE: Shortening osteotomy of the proximal radius might represent a potential salvage procedure in symptomatic radiocapitellar osteoarthritis, which could decrease radiocapitellar load while preserving the native radial head. In an in-vitro biomechanical investigation, we sought to determine whether shortening osteotomy of the proximal radius (1) decreases the radiocapitellar joint pressure upon axial loading and (2) retains valgus stability of the elbow. In addition, the anatomic configuration of the lesser sigmoid notch was evaluated to assess possible contraindications. METHODS: Axial loading (0-400 N) and valgus torque (7.5 N m) over the full range of motion were applied to 14 fresh-frozen specimens before and after shortening osteotomy of the proximal radius by 2.5 mm. Radiocapitellar and ulnohumeral load distribution during axial compression was evaluated using a digital pressure mapping sensor. Valgus displacement was analyzed with a 3D camera system. The inclination angle (α) of the lesser sigmoid notch was assessed via 50 CT scans. RESULTS: Up to axial loading of 250 N, shortening osteotomy caused a significant decrease in radiocapitellar contact pressures (p < 0.041). Valgus stability of specimens did not differ before and after shortening osteotomy (n.s.). The mean inclination angle (α) of the lesser sigmoid notch was 11.3° ± 6.3°. 46% had an inclination angle of ≤ 10° (type I). 46% had an inclination angle of 11°-20° (type II). In 8%, the inclination angle was >20° (type III). CONCLUSION: Shortening osteotomy of the proximal radius can decrease radiocapitellar contact pressures during axial loading of up to 250 N. Primary valgus stability is not relevantly influenced by this procedure. In few patients, shortening osteotomy may cause radioulnar impingement of the radial head at the distal edge of the lesser sigmoid notch due to an inclination angle of >20°. Shortening osteotomy might be a promising treatment option to decrease pain levels in case of isolated radiocapitellar osteoarthritis.

Extracting duration information in a picture category decoding task using hidden Markov Models.

OBJECTIVE: Adapting classifiers for the purpose of brain signal decoding is a major challenge in brain-computer-interface (BCI) research. In a previous study we showed in principle that hidden Markov models (HMM) are a suitable alternative to the well-studied static classifiers. However, since we investigated a rather straightforward task, advantages from modeling of the signal could not be assessed. APPROACH: Here, we investigate a more complex data set in order to find out to what extent HMMs, as a dynamic classifier, can provide useful additional information. We show for a visual decoding problem that besides category information, HMMs can simultaneously decode picture duration without an additional training required. This decoding is based on a strong correlation that we found between picture duration and the behavior of the Viterbi paths. MAIN RESULTS: Decoding accuracies of up to 80% could be obtained for category and duration decoding with a single classifier trained on category information only. SIGNIFICANCE: The extraction of multiple types of information using a single classifier enables the processing of more complex problems, while preserving good training results even on small databases. Therefore, it provides a convenient framework for online real-life BCI utilizations.

The circumferential graft technique for treatment of multidirectional elbow instability: a comparative biomechanical evaluation.

BACKGROUND: Ligament reconstruction with a circumferential graft represents an innovative technique for treatment of multidirectional elbow instability. This biomechanical study compared the stability of the intact elbow joint with the circumferential graft technique and the conventional technique. METHODS: Seven fresh frozen cadaveric elbows were evaluated for stability against valgus and varus/posterolateral rotatory forces (3 Nm) over the full range of motion. Primary stability was determined for intact specimens, after sectioning of the collateral ligaments, after applying the circumferential graft technique (box-loop), and after conventional collateral ligament reconstruction. Cyclic loading (1000 cycles) was performed to assess joint stability and stiffness of the native ligaments and the tendon grafts. RESULTS: Primary stability of both reconstruction techniques was equal to the native specimens (P = .17-.91). Sectioning of the collateral ligaments significantly increased joint instability (P < .001). The reconstruction techniques provided equal stability after 1000 cycles (P = .78). Both were inferior to the intact specimens (P = .02). Cyclic loading caused a significantly lower increase in stiffness of the native ligaments compared with the tendon grafts of either reconstruction technique (P = .001-.008). Significantly better graft stiffness was retained with the circumferential graft technique compared with conventional reconstruction (P = .04). CONCLUSION: Neither reconstruction technique fully reproduces the biomechanical profile of the native collateral ligaments. The circumferential graft technique seems to resist cyclic loading slightly better than the conventional reconstruction technique, yet both reconstruction techniques provide comparable stability.