Universität zu Köln

Kahmann, Stephanie L. ORCID: 0000-0001-7919-0510 (2024). Investigating the Terrible Triad Injury of the Elbow: Expanding Knowledge using Advanced Computational Methods. PhD thesis, Universität zu Köln.

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Abstract

The terrible triad injury of the elbow consists of a dislocation, and fractures of the radius and the coronoid [1]. It is commonly accompanied by pain, instability of the joint and limited range of motion [2]. The outcome of the treatment of these injuries has improved with research over the last years and, in some publications, is considered not so terrible anymore [3]. Despite that, meta analyses showed that even with the research in the specific field, the outcome has not improved sufficiently and that, apart from good and excellent results, still moderate to poor outcomes are reported [4]. Therefore, this work aims to contribute to improving this situation by deepening the knowledge about the injury and by promoting research that may improve the clinical approaches in the treatment of the terrible triad injury. There is still no consensus regarding the exact fracture mechanism of terrible triad injuries. In order to achieve deeper understanding of it, we designed a Finite Element Analysis [5]. Since no validated model of the entire elbow has been made available yet, we provide this groundwork: a validated simulation of the physiological elbow. The simulation parameters were adjusted to best match the experiment of its subject-specific biomechanical counterpart. These optimized parameters were then applied to the remaining 7 samples and compared to their experimental results. We found that the stiffness and the pressure distribution in the joint were predicted with moderate correlation on average. Further, the joint in which peak pressure was measured was predicted correctly in all 7 test cases. In future research, the fracture model can be based on this simulation Apart from that, it is not yet well understood if the radial head fracture and the coronoid fracture reflect specific fracture patterns when they occur in the context of terrible triad injuries. In order to explore that, we automated parts of the formerly manual process in creating fracture heat maps with an algorithm [6]. We hypothesized that the algorithm performs the same task faster than the manual execution and that it shows no large deviation (< 5.0 mm) from the manually detected edges. The hypotheses were confirmed, as the algorithm was 23-times faster and showed a deviation of 2.5 ± 2.4 mm compared to the manual execution in proximal humerus fractures. Furthermore, fractures of the distal humerus, tibia plateau, scaphoid and acetabulum could be processed. Further research has to demonstrate applicability to the terrible triad injury. With these two research studies, the basis is created to gather clinically relevant data in the future, deepening the understanding of the terrible triad injury and, in the long term, improving the situation for patients.

Item Type:	Thesis (PhD thesis)
Creators:	Creators Email ORCID ORCID Put Code Kahmann, Stephanie L. stephanielucina.kahmann@gmail.com orcid.org/0000-0001-7919-0510 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-732917
Date:	2024
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Orthopädie > Klinik und Poliklinik für Orthopädie und Unfallchirurgie
Subjects:	Natural sciences and mathematics Technology (Applied sciences) Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language Biomechanics UNSPECIFIED Morphing UNSPECIFIED Finite Element Analysis UNSPECIFIED
Date of oral exam:	29 July 2024
Referee:	Name Academic Title van Lenthe, Harry Prof. Grüll, Holger Prof. Balke, Maurice Prof.
Related URLs:	Publication Publication
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/73291