Elbow disorders are common as a consequence of both traumatic and degenerative conditions. Relative to disorders of the lower limb, there is comparatively little evidence to direct the treatment of many elbow disorders. Biomechanical studies are required to develop and validate the optimal treatment of elbow disorders prior to their application in patients. Clinically relevant simulation of elbow motion in the laboratory can be a powerful tool to advance our knowledge of elbow disorders.
This work was undertaken with the rationale that simulation and quantification of elbow motion could be improved significantly. This treatise includes the development and evaluation of an in-vitro elbow motion simulator which, with the humerus horizontally positioned, is the first to achieve active flexion and extension in a vertical plane. Additionally, it is capable of operating in the vertical, varus and valgus positions, and while maintaining full forearm pronation or supination.
The simulator controller employs a Cascade PID configuration with feedforward transfer functions, which achieves unified control of flexion angle and muscle tension for multiple muscles. Feedback of the elbow joint angle and muscle tension is utilized to achieve closed-loop control. A performance evaluation in a full series of specimens clearly demonstrated that the actual joint angle is not more than 5˚ removed from the desired setpoint during flexion or extension in any position.
Also, a new method for creating upper extremity bone segment coordinate systems which are derived from elbow flexion and forearm rotation was developed and tested. This produced joint kinematics with significantly less inter-subject variability than traditional anatomy-derived coordinate systems. This minimally-invasive method also provides increased statistical power for laboratory based studies and may prove useful for clinical applications.
The new simulation techniques developed herein were applied to an in-vitro investigation of olecranon fracture repair with clinical significance. This study revealed valuable insights into a common repair procedure. This was made possible by the previously unattainable measurements that these new techniques now provide.
These developments will assist surgeons and other investigators in the design and evaluation of treatments for elbow disorders, and contribute to the betterment of patient care.
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