Three-dimensional analysis of acute plastic bowing deformity of ulna in radial head dislocation or radial shaft fracture using a computerized simulation system

Background: Little 3-dimensional biomechanical investigation of plastic bowing deformity of the ulna has been reported, and the purpose of this study was to conduct such an investigation to elucidate mechanisms of injury and appropriate treatments. Methods: Ten cases of traumatic plastic deformity of the ulna in pediatric patients, 4 with chronic radial head dislocations (Monteggia equivalent) and 6 with malunited radial shaft fractures, were analyzed for rotational deformities in the axial plane and bending deformities in the sagittal and coronal planes in Euler angle space by use of a 3-dimensional computerized simulation system with a markerless registration technique. Results: Deformed ulnae with radial head dislocations had 18.7 degrees +/- 17.4 degrees of external rotation in the axial plane and 10.4 degrees +/- 7.0 degrees of extension in the sagittal plane whereas those with malunited radial shaft fractures had 12.5 degrees +/- 12.7 degrees of internal rotation and 6.3 degrees +/- 5.6 degrees of flexion displacement compared with mirror images of the opposite ulnae. Absolute values of rotational deformities in both groups were larger than those of sagittal and coronal bending deformities. Discussion: Most major traumatic plastic bowing deformities of the ulna involved rotation rather than bending. External rotational stress on the ulna is suspected to cause radial head dislocation, and internal rotational stress results in radial shaft fracture during falls onto outstretched arms. Therefore the correction of rotational deformities of the ulna should be considered in the treatment of chronic radial head dislocations and malunited radial shaft fractures. Level of evidence: Basic Science, Anatomic Study, Imaging. (C) 2012 Journal of Shoulder and Elbow Surgery Board of Trustees.