PMID- 28060814 OWN - NLM STAT- MEDLINE DCOM- 20170814 LR - 20181113 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 12 IP - 1 DP - 2017 TI - Glenohumeral Joint Kinematics following Clavicular Fracture and Repairs. PG - e0164549 LID - 10.1371/journal.pone.0164549 [doi] LID - e0164549 AB - BACKGROUND: The purpose of this biomechanical study was to determine the effect of shortened clavicle malunion on the center of rotation of the glenohumeral (GH) joint, and the capacity of repair to restore baseline kinematics. METHODS: Six shoulders underwent automated abduction (ABD) and abbreviated throwing motion (ATM) using a 7-DoF automated upper extremity testing system in combination with an infrared motion capture system to measure the center of rotation of the GH joint. ATM was defined as pure lateral abduction and late cocking phase to the end of acceleration. Torsos with intact clavicle underwent testing to establish baseline kinematics. Then, the clavicles were subjected to midshaft fracture followed by kinematics testing. The fractured clavicles underwent repairs first by clavicle length restoration with plate fixation, and then by wiring of fragments with a 2-cm overlap to simulate shortened malunion. Kinematic testing was conducted after each repair technique. Center of rotation of the GH joint was plotted across all axes to outline 3D motion trajectory and area under the curve. RESULTS: Throughout ABD, malunion resulted in increased posterior and superior translation compared to baseline. Plate fixation restored posterior and superior translations at lower abduction angles but resulted in excess anterior and inferior translation at overhead angles. Throughout ATM, all conditions were significantly anterior and superior to baseline. Translation with malunion was situated anterior to the fractured and ORIF conditions at lower angles of external rotation. Plate fixation did not restore baseline anteroposterior or superoinferior translation at any angle measured. CONCLUSIONS: This study illustrates the complex interplay of the clavicle and the GH joint. While abnormal clavicle alignment alters shoulder motion, restoration of clavicle length does not necessarily restore GH kinematics to baseline. Rehabilitation of the injured shoulder must address the osseous injury and the dynamic forces of the shoulder girdle. FAU - Rosso, Claudio AU - Rosso C AD - Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America. FAU - Nasr, Michael AU - Nasr M AD - Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America. FAU - Walley, Kempland C AU - Walley KC AD - Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America. FAU - Harlow, Ethan R AU - Harlow ER AD - Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America. FAU - Haghpanah, Babak AU - Haghpanah B AD - Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America. AD - Department of Mechanical and Industrial Engineering, Northeastern University, Boston, Massachusetts, United States of America. FAU - Vaziri, Ashkan AU - Vaziri A AD - Department of Mechanical and Industrial Engineering, Northeastern University, Boston, Massachusetts, United States of America. FAU - Ramappa, Arun J AU - Ramappa AJ AD - Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America. FAU - Nazarian, Ara AU - Nazarian A AUID- ORCID: 0000-0003-3992-3489 AD - Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America. AD - Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America. FAU - DeAngelis, Joseph P AU - DeAngelis JP AD - Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20170106 PL - United States TA - PLoS One JT - PloS one JID - 101285081 SB - IM MH - Biomechanical Phenomena MH - Clavicle/*injuries/surgery MH - Computer Simulation MH - *Fractures, Bone/pathology/surgery MH - Humans MH - Male MH - Middle Aged MH - *Models, Theoretical MH - Range of Motion, Articular MH - Recovery of Function MH - Shoulder Joint/*physiopathology MH - *Wound Healing PMC - PMC5218560 COIS- Funding from all sources, including the Medical Advisory Committee of the Major League Baseball, does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. EDAT- 2017/01/07 06:00 MHDA- 2017/08/15 06:00 PMCR- 2017/01/06 CRDT- 2017/01/07 06:00 PHST- 2016/06/27 00:00 [received] PHST- 2016/09/07 00:00 [accepted] PHST- 2017/01/07 06:00 [entrez] PHST- 2017/01/07 06:00 [pubmed] PHST- 2017/08/15 06:00 [medline] PHST- 2017/01/06 00:00 [pmc-release] AID - PONE-D-16-25722 [pii] AID - 10.1371/journal.pone.0164549 [doi] PST - epublish SO - PLoS One. 2017 Jan 6;12(1):e0164549. doi: 10.1371/journal.pone.0164549. eCollection 2017.