CARPAL ANATOMY. 2 carpal rows:
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- Corey Timothy Crawford
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1 biomechanics
2 CARPAL ANATOMY 2 carpal rows: 1. Distal Trapezium, trapezoid, capitate, hamate bound together by strong interosseous (intrinsic) ligaments to form distal row, which moves together as a single unit 2. Proximal Scaphoid, lunate, triquetrum and pisoform form the proximal row. It has no muscle attachments and is inherently unstable in compression without its ligamentous attachments. Acts as a link between the relatively rigid distal row and the radioulnar articulations.
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6 FLEXION-EXTENSION Normal wrist range is: - 85 to 90 degrees of flexion, and - 75 to 80 degrees of extension
7 RADIAL-ULNAR DEVIATION Total arc of radial-ulnar deviation is approximately 50 degrees: 15 to 20 degrees radially and 35 to 37 degrees ulnarly (Youm et al, 1978; Volz et al, 1980).
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9 ARTHRITIC HAND/WRIST
10 WRIST ARTHRODESIS Plate Fixation
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12 TOTAL WRIST ARTHROPLASTY Themistocles Cluck performed the first total wrist arthroplasty is 1890, using an ivory prosthesis in a wrist joint affected by tuberculosis.
13 General Indications Disabling pain Combined radiocarpal / midcarpal arthritis Relatively low demand patient Preferably elderly Patient recognizes lifetime limitations
14 Specific to Rheumatoid Arthrodesis of opposite wrist Autofusion, severe stiffness Deformity that impairs function Multiple joints involved by arthritis Progressive deformity
15 Specific to Osteoarthritis SLAC wrist with capitate involvement An alternative for SLAC wrist in elderly Other global wrist degenerative patterns
16 Specific to Post-Traumatic Arthritis Low demand patient SNAC wrist Diffuse arthritic changes
17 General Contra-indications High demand patient Regular dependence on walking aides Previous wrist sepsis Absent motor control of wrist Poor bone stock Previous surgical fusion?
18 SWANSON
19 VOLZ
20 MEULI
21 TRISPHERICAL
22 BIAX
23 MWPIII
24 Design characteristics of prostheses as of 1998 (Costi J, et al. J Rheumatology 25:3, 1998) Normal Wrist Swanson Volz Meuli Trispherical Biaxial MWPIII Year of Design 5,000,000 BC Material: stems, bearing Bone, artivcular cartilage, HP silicone elastomer Co-Cr, PE Ti-Al-Nb, PE Ti, HDPE Co-Cr, PE Ti-Al-Nb, P cup, Ti nitrid ball synovial fluid No. of components 10* F/E (degrees) 73/71 30/ /80 85 N/A 50/80 R/U (degrees) 19/ /70 10 N/A 70/70 Axial (degrees) 0 5** 0 >10 N/A N/A Radial Component Radius 1 stem 1 stem 2 stems 1 stem 1 stem 2 stems MC components Carpus 3 rd 3 rd 2 nd, 3 rd Long 3 rd short Long 3 rd, short 2 nd, 3 rd 2 nd trapezoid Cemented - No Yes Yes Yes Yes Either * Eight carpal bones and radius and ulna ** Estimate only: the design of the Swanson implies that there can be some axial rotation or torsional twist
25 Summary of clinical results for all prostheses (Costi J, et al. J Rheumatology 25:3, 1998) Swanson Volz Meuli Trispherical Biaxial MWPIII No. studies Average FU range No. prostheses Range of average F/E (degrees) Range of average R/U (degrees) Fracture (%) Revision (%)
26 UNIVERSAL TOTAL WRIST (UTW)
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29 EXPERIMENTAL TESTING
30 Experimental Test Fixture Neutral and offset positions permitted The radial fixture resides on a x-y stage
31 UTW Medium Implant: 30N compression Resisting Moment (Nmm) N (1) N (2) N (3) 30N (4) N (5) Rotation (degrees) 30N (6)
32 THEORETICAL FE Model
33 FE MODEL ~ 1 element/mm 2 ~215 elements/mm 2
34 FE MODEL DEFINITIONS CAD (Pro E) models were imported into PATRAN (version 8.5) Each metallic component was modeled as a rigid body E CoCr >> E PE. Carpal Component: 6,710 quadrilateral elements Radial Component: 1,366 triangular elements The polymeric component was modeled via 20, noded brick elements (E PE = MPa, v = 0.45). 3D FE non-linear contact analysis was performed with ABAQUS v5.8.
35 Point Contacts Arise within 1 degree of rotation 50 N Compressive load maintained Von Mises (MPa)
36 CONTACT AREA: FE Predictions Contact Area (mm 2 ) 0 Rotation (deg) Load (N)
37 Neutral on Mises Contour lot through 10 egrees of flexion 2 degrees 4 degrees 6 degrees 8 degrees 10 degrees
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40 10 degree Neutral 2 degrees 4 degrees 6 degrees 8 degrees
41 Resisting Moment (N-mm) Ellipsoid 100 Toroid Rotation (degrees) Toroid (Universal) Ellipsoid (Modified Implant)
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43 FATIGUE TESTING: lb, 15Hz, 5,000,000 Cycles
44 FATIGUE TESTING: Testing Configuration
45 SINGLE-SNAP 0.25 mm/s & 5 mm/s
46 COMPONENT-SNAP 0.25 mm/s & 5 mm/s
47 BENDING Sagittal & Coronal
48 ROTATION
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