Objective: To establish an optimal single hinge axis position for applicati
on of hinged external fixation to the elbow joint.
Design: Cadaveric biomechanical investigation.
Setting: A customized motion transducer applied passive elbow motion to six
cadaveric upper extremities. The instant rotation axis of the humero-ulnar
articulation was determined from three-dimensional kinematic data acquired
by an electromagnetic motion tracking system. For each specimen, an optima
l fixator hinge position was calculated from these motion data. Interventio
n: A prototype articulated external fixator was applied to the elbow, first
with its hinge aligned along the computed optimal position. Then the fixat
or was mounted in sixteen distinct off-axis positions.
Main Outcome Measure: Additional resistance to joint motion (in terms of en
ergy) corresponding to deliberately introduced amounts of relative malalign
ment between the optimal elbow axis and the actual fixator hinge axis.
Results: Aligning the fixator hinge along the optimized axis position resul
ted in a minimal amount of energy (0.15 joules) needed to rotate the elbow
through a prescribed range of motion. Malpositioning the hinge by ten milli
meters caused up to ten times that amount of motion resistance.
Conclusions: An optimal fixator hinge position can be determined to minimiz
e the increase in motion resistance due to fixator application. The severel
y increased motion resistance associated with small amounts of malalignment
between the fixator hinge and the anatomic elbow axis suggests the need fo
r highly accurate fixator hinge application.