An in-vitro biomechanical comparison of annular ligament repair and reconstructions to restore radial head stability in anterior Monteggia fractures
Bibliographic record
Abstract
Background: Persistent or recurrent instability of the radial head (RH) remains a challenge in treating anterior Monteggia fractures despite anatomic restoration of the ulna. RH instability may be caused by the pull of the biceps muscle with rupture of the annular ligament and other soft tissue stabilizers of the proximal radius. Currently, the optimal method to stabilize the proximal radius is unknown. The purpose of this study was to compare annular ligament repair with three different ligament reconstructions in restoring anterior RH stability. Methods: Eight cadaveric upper extremities were mounted on an elbow simulator in 90 degrees of flexion with the forearm in neutral rotation. Simulated sequential biceps loading was applied in 10 N increments up to a maximum biceps load of 150 N to generate an anteriorly directed force to the RH. Testing was first conducted in the native state with all soft tissue intact, followed by sectioning the central interosseous membrane, the proximal interosseous membrane, and annular and quadrate ligaments. This was followed by the randomized evaluation of an annular ligament repair and three different ligament reconstructions, including a Bell Tawse reconstruction with triceps fascia (Bell Tawse reconstruction), a free tendon annular ligament reconstruction (Itadera reconstruction), and a free tendon anatomic annular ligament reconstruction (anatomic reconstruction). An optical tracking system was used to determine RH kinematics relative to the humerus. For all test states, the anterior translation of the RH relative to the capitellum was quantified as a measure of subluxation. Results: = .015), respectively. Conclusion: Annular ligament repair was most effective in restoring normal RH stability; however, repair of this structure may not always be feasible as the tissues are often compromised by the injury and may not be reparable. The Itadera reconstruction was the most effective reconstruction technique at restoring RH stability and should be considered over alternative procedures when annular ligament repair is not feasible. These data also suggest that careful rehabilitation will be important postoperatively as residual RH instability can occur even with an anatomic reduction of the ulna and annular ligament repair or reconstruction.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".