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Arthrokinematics of the Distal Radioulnar Joint in the Normal Wrist and Following Distal Radius Malunion

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Arthrokinematics of the Distal Radioulnar Joint in the Normal Wrist and Following Distal Radius Malunion Western University Scholarship@Western Electronic Thesis and Dissertation Repository 4-14-2016 12:00 AM Arthrokinematics of the Distal Radioulnar Joint in the Normal Wrist and Following Distal Radius Malunion Braden M. Gammon The University of Western Ontario Supervisor Dr. Graham King The University of Western Ontario Joint Supervisor Dr. James Johnson The University of Western Ontario Graduate Program in Medical Biophysics A thesis submitted in partial fulfillment of the equirr ements for the degree in Master of Science © Braden M. Gammon 2016 Follow this and additional works at: https://ir.lib.uwo.ca/etd Part of the Medical Biophysics Commons Recommended Citation Gammon, Braden M., "Arthrokinematics of the Distal Radioulnar Joint in the Normal Wrist and Following Distal Radius Malunion" (2016). Electronic Thesis and Dissertation Repository. 3713. https://ir.lib.uwo.ca/etd/3713 This Dissertation/Thesis is brought to you for free and open access by Scholarship@Western. It has been accepted for inclusion in Electronic Thesis and Dissertation Repository by an authorized administrator of Scholarship@Western. For more information, please contact [email protected]. Abstract Contact patterns in the distal radioulnar joint (DRUJ) are not well understood for normal anatomy or with distal radius deformity. This thesis presents three studies which investigate the arthrokinematics of the DRUJ for these conditions. The first study compared casting and Tekscan, two standard methods for contact measurement, with a novel technique of proximity mapping termed Inter-cartilage Distance (ICD). The relative benefits, limitations and role for ICD in DRUJ contact assessment were examined and discussed. The second study used ICD to characterize contact patterns in the native DRUJ. Contact was found to be maximal in 10° of supination and the contact centroid moved volar and proximal with supination. The third and final study evaluated the effect of dorsal angulation deformity on DRUJ arthrokinematics. The contact centroid moved volarly, while simulated triangular fibrocartilage complex (TFCC) rupture reduced DRUJ contact area and caused the centroid position to become more variable in its pathway. Keywords: Arthrokinematics, distal radioulnar joint, DRUJ, triangular fibrocartilage complex, TFCC, ulnar head, sigmoid notch, distal radius malunion, fracture, deformity, wrist, forearm, kinematics, biomechanics, Tekscan, casting, Inter-cartilage Distance, ICD, proximity mapping, in vitro, simulator Co-Authorship Statement Chapter One Sole author – Braden Gammon Manuscript Review – Graham King, Jim Johnson Chapter Two Study Design – Braden Gammon, Emily Lalone, Graham King, Jim Johnson Specimen Preparation – Braden Gammon Data Collection – Braden Gammon, Mark Welsh Data Analysis – Braden Gammon, Emily Lalone, Ryan Willing Statistical Analysis – Braden Gammon Manuscript Preparation – Braden Gammon Manuscript Review – Emily Lalone, Graham King, Jim Johnson Chapter Three Study Design – Braden Gammon, Emily Lalone, Graham King, Jim Johnson Specimen Preparation – Braden Gammon, Masao Nishiwaki Data Collection – Braden Gammon, Mark Welsh, Masao Nishiwaki Data Analysis – Braden Gammon, Emily Lalone, Ryan Willing Statistical Analysis – Braden Gammon Manuscript Preparation – Braden Gammon Manuscript Review – Emily Lalone, Graham King, Jim Johnson A version of this manuscript will be submitted to the Journal of Hand Surgery (American) entitled: In Vitro Arthrokinematics of the Intact DRUJ Authors: Gammon B, Lalone E, Willing R, Nishiwaki M, Johnson J, King GJW Chapter Four Study Design – Braden Gammon, Emily Lalone, Graham King, Jim Johnson Specimen Preparation – Braden Gammon, Masao Nishiwaki Data Collection – Braden Gammon, Mark Welsh, Masao Nishiwaki Data Analysis – Braden Gammon, Emily Lalone, Ryan Willing Statistical Analysis – Braden Gammon Manuscript Preparation – Braden Gammon Manuscript Review – Emily Lalone, Graham King, Jim Johnson A version of this manuscript will be submitted to the Journal of Hand Surgery (American) entitled: The effect of Dorsal Angulation Deformities on In Vitro Arthrokinematics of the DRUJ Authors: Gammon B, Lalone E, Willing R, Nishiwaki M, Johnson J, King GJW Chapter Five Sole author – Braden Gammon Manuscript Review – Graham King, Jim Johnson ii Acknowledgments It is with a deep sense of admiration and gratitude that I acknowledge the support of my supervisors, Dr. Graham King and Dr. Jim Johnson. Together they have created a space and vehicle for students from all over the globe to gather and hone their skills in the field of biomechanical research. It is this type of environment that facilitates the cross-pollination of techniques and ideas, and breeds new thought leaders and researchers. I am humbled to have worked with some of the best in this field, and am grateful for the opportunities this has afforded me. I will fondly remember my two lab testing partners, Mark Welsh and Masao Nishiwaki. Both are immensely talented individuals who co-developed the novel wrist simulator this testing took place upon. I am grateful to Masao for exposing me to the nuances of specimen preparation, wrist anatomy and of course, Japanese culture. Both Mark and I would like to think we lightened the otherwise lengthy testing days he organized with our music, companionship and revelry. I am indebted to Emily Lalone, who tirelessly introduced me to the budding scientific realm of Arthrokinematics. Her energy and unfailingly upbeat attitude was motivating, particularly when concepts and data analysis techniques seemed daunting. I have an entirely new appreciation for how kinematics and 3-D modeling can come together to generate great science when the right person is steering the ship. I also owe thanks to Ryan Willing, who developed key programs for our data analysis which added a layer of completeness and polish to the work. Of course, I must express some of my deepest appreciation for the efforts of our summer students: Stephanie Gurr, Sarah DeDecker and Erica Yang. Their assistance in extracting and compiling the data has made construction of this manuscript teneable. iii Dedication This manuscript is dedicated to my beautiful, loving, patient wife Jessica and our sons Liam and Kai, who are the pride and centre of our lives. I have “refined” this thesis over the course of 3+ years and it has diverted my attention on many evenings and weekends. Throughout this time they have remained sympathetic, encouraging and supportive. Its completion is a combined achievement that we will all celebrate with pride. I would also like to pay a sincere tribute to the late Dr. Jim Roth. I was fortunate to train under Dr. Roth during one of the final rotations he supervised at the Roth | McFarlane Hand and Upper Limb Center. His teaching was crafted through experience from a distinguished career in hand surgery and carried an immense amount of practical importance. I owe Dr. Roth a debt of personal gratitude for admitting me to the fellowship program and facilitating my combined Master’s Degree. Without this training, I would not have had the privilege or opportunity to embark upon an academic career. Of all the lessons he taught, the most profound was that it is possible to have a great impact on both the field of surgery and a loving family. iv Table of Contents Abstract ................................................................................................................................ i Co-Authorship Statement.................................................................................................... ii Acknowledgments.............................................................................................................. iii Dedication .......................................................................................................................... iv Table of Contents ................................................................................................................ v List of Figures .................................................................................................................. viii List of Appendices ............................................................................................................. xi Chapter 1 ............................................................................................................................. 1 1 General Introduction ...................................................................................................... 1 1.1 Bony and Soft Tissue Anatomy of the DRUJ ......................................................... 1 1.2 Stabilizers of the DRUJ ........................................................................................ 10 1.3 DRUJ and Forearm Biomechanics........................................................................ 13 1.4 Distal Radius Malunion and its Influence on the DRUJ ....................................... 15 1.5 Joint Contact at the DRUJ in Normal and Malunited Conditions ........................ 17 1.6 Methods for Assessing Joint Contact .................................................................... 18 1.6.1 Direct Methods.......................................................................................... 18 1.6.2 Indirect Methods ....................................................................................... 19 1.7 Rationale ............................................................................................................... 22 1.8 Objectives and Hypotheses ..................................................................................
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