Beruflich Dokumente
Kultur Dokumente
This information is current as of November 20, 2008 Reprints and Permissions Click here to order reprints or request permission to use material from this article, or locate the article citation on jbjs.org and click on the [Reprints and Permissions] link. The Journal of Bone and Joint Surgery 20 Pickering Street, Needham, MA 02492-3157 www.jbjs.org
Publisher Information
TRANSVERSE
ROTATION EXTREMITY
OF
THE IN
SEGMENTS LOCOMOTION
T. INMAN, M.D.,
OF
*
THE
LOWER
BY
A.
S.
LEVENS,
M.S.,
C.E.,
VERNE BERKELEY,
SAN
FRANCISCO,
AND
CALIFORNIA
College
of Engineering,
and
Division
of Orlhopaedic
Surgery,
,lfedical
Scho3l
A complete
analysis
of human
locomotion
is difficult.
The
fact
that
persons
walk
and
apparent ease, and without conscious effort, does are simple or readily understood. A comprehensive analysis of the movements of the various segments
of these movements with force studies and muscle
not. imply that. the mechanisms study of locomotion includes of the body, but also the conaction. Consideration of a prob-
of such to
suggests one
that component.
delimitations in the
are
necessary,
and pattern
the
present
endeavors
tremity.
of the
investigators
segments
the motions
findings upon
plane.
regard to parasagittal
is doubtful
previous
have attempted to measure the of the low-er extremity, as projected attention has been given to transverse plane
indications
transverse rotatory upon a horizontal rotatory motions, regarded rotations as a more of the
motions of the various segplane. It is conceivable that possibly because motion in significant various act-ion in human of the
lowcr
parasagittal
Present
has
are
usually that
been transverse
propulsion.
segments
extremity In order
at
are an important factor in the ease to improve function, reduce fatigue, points on the stump of the amputee,
of walking of normal individuals. more or less continual abrasion in the prosthesis for
be
critical
allow-ing
a major
transverse rotations of the same order of magnitude contribution toward the improvement of artificial Transverse rotations, as discussed herein,
various study of
as those in normal legs may legs. refer to angular d!isplaccments axes. Results
twelve
of
provided
the of a
bone
these
segments
movements
of the
in
leg about
twenty-six
their
longitudinal
individuals,
are
of
presented
thom
normal
completely
satisfactory
data. study were: of transverse rotations with regard rotations with respect to artificial of the limbs. segments other. of the lowcn
The primary objectives in this 1. To determine the magnitude extremity, 2. To and their relative ideas for transverse design formulate
to each
TECHNIQUES
Placenient
of Pins threaded bony pins, 2.5 millimeters prominences adjacent in diameter, to the hip were drilled firmly into the and knee joints, sterile pre-
various
cautions and local anaesthesia being used. Targets, each consisting of a light w-ooden rod wit.h spheres attached! at tw-o points, were fastened to the pins. Figure 1 shows pins No. 1, No. &, and No. 3, placed in the iliac crest of the pelvis, in the adductor tuberele of the femur, an(! in the upper portion of the tibia (tibial tubercle), respectively. The insertion
*
In
Soptember
1945,
a research
project
on
prosthetic
devices
was
undertakon
at.
the
Univorsity
of
supervised
the National is directed
NO. 4,
by Professor H. D. Eberhart of the Civil Engineering Division. The work was initiResearch Council, at. the reQuest of the Surgeon General of tho Army. The national by the Committee on Artificial Limbs of the National Research Council.
194$
OCTOBFR
85
S6()
A.
5.
LEVENS,
V.
T.
INMAN,
AND
J.
A.
BLOSSER
of pin
fmom knee
tile
No.
-as
of
tile
femur
as
movement
that
motion
placement.
at the
( OlleCtiofl
A (11 ronizc(l second, the oli(ular
of Data photographic
35-millimeter with a shutter The cameras ncfcrcn(c tccoro! o1 the motion-picture
movement.
cameras,
of
orientc(l
tile
was at to
by -eight
synper from
speed
were
of 1, 96 second!,
so located planes as
.
of twenty-five
siibjO(t.
to
refer
targets
mutually
and side
penpenviews
(o-o)r(!inate
( Fig.
2 ) Iti this
top,
of
Fmu.
2 data. (ReMonthly,
1 simultaneously. we ii studied
Fig. 1: Subject with limls and targets attached. Fig. 2: Arramigemiient for recording pin-study produoed, liv J)crn)issiomi, fromu Populer Scien.ce page 82, July 1947.)
obtaine(l \Vhi(ll
from
A clock enlarged!
made images.
it possible
to identify
Reduction
The co-ordinates
perspective
of I)ata
first method
employed
targets. This
in
-as
the felt
reduction necessary
of data to
made for
use
of computed errors
space due to
of the
correct
possible
between
obtained
UOI1
amid parallax. Later it was found that. in certain cases the values of the angles pins, ol)tamed from orthogonal projections, compared quite favorably with values from measurements taken directly from the photographs, showing the projections
the
pins read
isene
set
or within photographs
of
directly
of the true values for the between values obtained Phase relationships The differences the were between
computed values and those obtained directly from not significant, since the variations were less t.han the
tested.
TilE
JOURNAL
(IF
BONE
AND
JOINT
SUR(;ERY
THE
SEGMENTS
OF
THE
LOWER
EXTREMITY
IN
LOCOMOTION
861
TABLE
DATA ON AlA,
I
FROM
SUBJECTS*
PIN STUDIES
Subject
Age (Years) 24
Weight (Pounds) 185 150 180 168 160 150 160 162 165 175 152 165 175 170 152 180
(Feet)
Itniarks
6 6 5 5 6 5 .5 6 5 6 5 5 6 5 5 6
difficulties;
110
olata
2 3 4 6 7 8 9 10 ii
12
27 40 21 19 26 20 25 21 21 27 24 23 23 27 21
One
Pins
pin only;
miot
no data
properly; ono Pill bemit
set pin
pin
Excessive
Excessive
vibration
vibration
Excessive Excessive
Satisfactory
pin pin
vibration vibration
data
Gait
affected loosened;
by
pins;
no made
data
Pin
110 runs
Satisfactory Satisfactory
data
(lata
13 14 15 16 17 18 19 20 21 22 23 24 25 26
Satisfactory
Satisfactory
no
piis
145
140 175 200 145 180 182 160 135 160 sul)jects and three
5
5 5 6 5 6 6 5 5 5 aliih)utces.
28 28
23 26 23
932 6 8 7 83 0 1 11 10 7
25
19
looso oyoio
27
28 29 *Tii.o,Iit.,_5ix
27
21 mio)rnial
comriploto
110)1 reduce:1
Test
Results
Twenty-six normal subjects, varying in age from nineteen to Of shown forty, iere
No
data
were
obtained single
from data
from pin
seven
the
iere
first and
not
seven
used
subjects
for the
because difficulties.
reasons
of excessive the
in Table
pin
I.
bending
subjects,
of pins,
the
settings,
the
subjects
were
considered
satisfactory
and
analysis.
The
photographs w-ere plotted on a rectangular axis represented time in seconds and t.he only with
system, represented
notation in degrees. Complete analysis has been made straight. and level walking. Data dealing walking, Discu-snion
Curves
of the data dealing with the top front and lateral views, in straight
will
be
presented
in subsequent
publications.
of Curves
obtained from motion-picture records of twelve normal subjects performing
straight, although
cases.
same general pattern rotation varied in curves of all subjects changes occurred
had
VOL.
Detailed study and analysis of individual and composite to he based on the action of both legs, since the significant.
30-A, NO. 4. OCTOBER 1948
862
A.
S.
LEVENS,
V.
T.
INMAN,
AND
J.
A.
BLOSSEII
a-s
Zr.
THE
Jt)tRNAL
OF
HONE
AND
JOINT
SURGERY
THE
sE(;MENTs
OF
THE
LOWER
EXTREMITY
IN LoCOMoTIoN
563
bL
a.
-I;
I,
%OI,,
30-A,
NO.
4,
OCTOBER
194
864
A.
5.
IJEVENS,
I.
T. INMAN,
TABLE II
AND
J.
A.
BLOSSER
RANGE
OF
TRANSVERSE
HTArmoN
Polvis-Pin Subject 8 11 12 13
-
No.
lmniir-Pin
( I)egrees)
No.
Tibia-Pili
(I)egrees)
No,
14 16 21
23 24 25 26 27
10.0 7.2
Notin 8.4 3.0 7.4 9.4 13.3
17.2 9.8
24.8 18.0 14.0 8.6 Loose 23.3
19.6 13.4
22.8 15.0 17.0 17.4 21.4 24.1
Maximum
Minimum Average
tion
to positions
of each
leg.
The
following
proved
to he of salient
importance:
4. Foot
floor;
5. Foot flat and abreast of other 6. Heel (of extremity with pins) rrh time during ivhich the foot
w-hich
heel
is the floor
the These
time two
any
From
part.
of the
foot cycle
is the
a w-alking
the time the foot of the pin-loaded it comes abreast of the other foot, rotation. At rate of rotation the time of the
leaves femur,
As
move floor,
there is considerable increase in inward rotation a rapid increase until the other foot leaves the extremity leaves the
notation
the heel strikes the At the peaks of the This period then, is on the foot, is
the distal pants
receives the full weight of the body. floor until the full weight of the body
of all segment-s (pelvis, femur, and tibia),
the
this extremity
foot
of increased rotate
acceleration
rotation starts with a wheneas outwand Rotation while just This on the
SURGERY
weight-bearing
of the tibia is momentarily suppressed the pelvis and femur continue inward before the heel-rising is show-n in Figure The magnitude
position, while the pelvis and femur continue outward notation. 5-A for a single subject. and time of occurrence of the transverse rotation of the femur
THE JOURNAL OF BONE AND JOINT
THE
SEGMENTS
OF
THE
LOWER
EXTREMITY
IN
LOCOMOTION
865
TABLE
RELATIVE TRANSVERSE ROTATION
III
AT
Hm
AND
1NEE
JOINTS
DURING
STANCE
PHASE
Subject
Fommmr
with
to
Pelvis
Tibia
with
to
Feniur
1 out
8.8 6.4 9.0 13.3 Pin No). 4.1 8.6 2.7 2 loose
2 loose
tibia
are
of particular
interest
to
the
clinician,
for
they
are
no
doubt
related
to the
locking and!,
mechanism in unlocking
twice in a-n
of the the
average
knee. knee,
When outward
the
knee
is locked, takes
inward place.
notation the
of the knee
femur locks
occurs; and
notation
Normally
unlocks
again
pictures
near
the
end
the last portion of the swing phase and isas cleanly show-n in high-speed motion alt-ens locking
and
of a number
the
the to in the
doubleremain fast-er
locking ext-ended
cadences.
action during
occurs, the
in entire
that stance
notation
during phase.
of the
rates double
femur,
of walking
tends
Ranges
of transverse
as well
maximum,
minimum,
and
average
values
in each
case,
are
shown
in
Table
II.
These
values
were
Curves
The
general
however,
pattern the
IV
OF THE
is similar knee-locking
to that effect
of the
curves
in
Figure
3. As
previously
is shown
TABLE
MAGNITUDES OF TRANSVERSE ROTATION
PELVIS,
FEMUR,
AND
TIBIA
Transverse
Rotation
Relative
Transverse
Rotation
Member
Range (Degrees)
Average (Degrees)
Members
Rango (Degrees)
Average (Degrees)
to to to
7.7 15.3
Tibia
with
respect
4.1
to
13.3
8.7
to femur Femur 19.3 in Tables II and III. with respect 4.9 to 11 .4 8.4
to pelvis
data
are
VOL.
4, OCTOBER
866
A.
5.
LEENS,
V.
T.
INMAN,
AND
J. A. BLOSSE1(
I-
-f.
NOIiV1Od
THE
JOURNAl.
OF
BONE
AND
JOIINT
SURGERY
THE
SEOMENT5
OF
THE
LOWER
EXTREMITY
IN
LOCOMOTION
867
I-
V0)I.
30-A,
NO.
4,
O(TOHER
1948
868
A.
S.
LEVENS,
V. T. INMAN,
AND
J. A. BLOSSER
:z
Li 1 IZr biN.
WcV
iiiiiii-iiiii
cE 0 In
TIBIATO
#{231}FEMUR
-Z\-g. b-a
-
r;lj-
--
u_T
LiJO
0 RELATIVE
Relation of rotation,
891011 iN
6
12
13
$4
ROTATION
FIG.
DEGREES
rank (during stance phase).
in degrees,
to percentile
THE
JOURNAL
OF
BONE
AND
JOINT
SURGERY
THE
SEGMENTS
OF
THE
LOWER
EXTREMITY
IN
LOCOMOTION
869 near
plvis,
tinctly striking
in While
the
the
tibia!
curve.
to
Note
positions know
particularly
of the the ranges
the
stance
flattening
phase.
of the
rotation
curve of the
the
heelfemur,
an(!
heel-rising
it is important
of transverse
a bearing
of the with
joints
Composite
from to the
a clinical
curves for
point
all
of view-.
relative transverse
subjects,
respect
femur
(knee
joint)
and
of the
with
respect
to the
pelvis
(hip)
instance position
approximately
is practically locked-knee
3.5 degrees
inward
locked-knee
position
and
the
full
weight-bearing
posit-ion.
Beyond
this
point
there
is a
slight outward relative transverse t-erval from the full weight-bearing followed by a very slight mw-and
relative outward rotation of
rotation of approximately 1.5 degrees, during the inposition to the time flexing at- the knee occurs. This is rotation of about 0.5 degree, after which there is a marked
approximately
3.5 with
minimal
degrees
as
the pelvis
foot
reaches
the
toe-off
position. The
interest.
relative
Throughout
rotation
the
of the
period
femur
from
respect
load
to the
to full
is also
of considerable
inward notation
weight-hearing,
7 degrees rotation
results
occurs. of about
deals only
transverse
low-en extremity, as projected upon covering straight and level walking. In all subjects, the average relative notation
the foot is fixed on the floor-that is, during the
a horizontal of the
major
plane, with
tibia
portion
respect
of the
to the
stance
phase-may
be obtained from the tibia! pin matelv 7 degrees mw-and, during cycle per femur
individual relative
magnitude of the relative from 7 per cent. to 17 per outward of the in the tibia with interval respect from
; and cent.
Ranges
it is approximately of the
of
cent. and
to 43 of the
to the
wit-h
respect
cases,
pelvis,
transverse
as well as maximum, in Table IV. Here again, for the individual cases. to both designer for the
minimum, and average values for the variations exist in the magnitudes of A knowledge of the possible ranges and clinician, since such information limbs joints and of one improvement at the knee of artificial and hip
and
average
values
is of significance
will he helpful both in developing mechanisms in a bet-ten understanding of locomotion. Figure subject.
feet-abreast takes place
5-B During
(about
shows the
the stance
relative
transverse
rotations
position,
phase, in the interval from the heel-striking position to the very little transverse rotation of the tibia with respect to the femur 1 to 1 .5 degrees) As the knee locks, relative rotation increases inw-ardly
.
about knee
stance about
outward
relative position
of the interval rotation
rotation to
femur
the
the
from
the
heel-striking
rotation by the a shorter relative
from is about
feet--abreast
action from
outwand
out-w-ard. This by mw-and relative rotation of about 2 degrees, during the interval position to the heel-rising position. From this point- on, fairly rapid
of approximately
10 degrees
occurs
as
the
toe-off
position
is
reached.
VOL. 30-A, NO. 4, OCTOBER 1948
870
A.
5.
LEVENS,
V.
T.
INMAN,
AND
J.
A.
BLOSSER
IZ
.-JZ
Zr.
c:btZ
,J:
1HI
JOURNAL
OF
BONE
AND
JOINl
sURo;ERY
THE
SEGMENTS
OF
THE
LOWER
EXTREMITY
IN
LOCOMOTION
871
Arm klo-motat
ion
mechanism
oluring
vitl
king.
relation
a.I1d
to of the
percentile
of the
rotations is shown
of Iotation
of the
less lines, between
iemui
with
the
tespect
values shown
to
tibia
to the points
in Figure
than
6. ( )molinate
values
represent
percentages
of SuI)jects
having
magnitudes
corresponding
with respect
abscissae.
to femur
The
lie of relative
both
on
cases-femur
straight
with
respect.
to
pelvis
-eny
dist
pattern.
demonstration notation
A stiiking
at the knee joint is shown in Figures 7-A and 7-B. change from the flexed position of the leg to the the angular change between the targets.
SUMMARY AND
The fully
angular extended
dhsplacement position
caused is cleally
by the seen in
CONCLUSIONS
rotations and!
of
the
pelvis, rotations
femur, of the
and
tibia segment-s
occur
in
all
normal
Outward!
are
relate(l
to weight-hearing.
place rotation
during the phase from minimal occurs (luring the phase from
ro(ations of the low-er extremity appear their related ligamentous structures. upon the an(! rhythm
articulations
will,
the
mechanisms
present time no prosthesis to provide for transverse rotation prevents and thus requires
1948
OCTOBER
872 joints to torque occur stump. the-knee the by knee fixed the proximal is the This foot side amputees between amputee, position, hinge bars who to the least. the
A.
5.
LEVENS,
v.
T.
INMAN,
AND
J.
A.
BLOSSER
will stance
take phase,
place this
the
stump
is particularly in addition
above-the-knee
suction-socket of rotatory
is further the
produced
sockets
connecting adequate
shank. the
In the
use
case
have
stump
of suction
an ankle mechanism may make it possible not only to provide for transverse also to do away with side hinge bars and lacers, w-hich tend to restrict the of the knee. The incorporation of a simple mechanism which provides for transverse sufficient magnitude, together may well constitute a major improvement of function and used on this project. All the very marked from high-speed nism. The the stance frames phase.
with a unit for the return of the foot to the normal contribution to both the comfort of the amputee synchrony in walking. An experimental mechanism
who
amputees
have
employed
this
mechanism
have
the width of the gap shows The ultimate incorporation become standard practice,
the amount of rotation occurring of this device, or modifications and may be advantageous in leg
CWdPLETE
BY WENDELL
ERNEST
DISLOCATION
J.
A.
oF
PENSACOLA,
THE
TALUS
FLORIDA, AND
NEWCOMB,
BRAY, M.D.,
M.D.,
LOUISVILLE,
KENTUCKY
This
case
is reported
because
of
its
rarity
and
because
the
need
for
reduction,
the
possibility
of revasculanization,
of preserving
years ankle
jumped
from
a moving
vehicle
and about
the
of his of the
skull
the ground.
of his Physical
He suffered
a mild
He
cerebral
arrived at of over vertical portion
concussion
the the the axes. hospital right prominence. The
and,
therefore,
had
mecha-
nism
after
treatment to the
wa-s rendered
lateral malleolus. 90 degrees axis
foot-
with The
prominence revealed
was
very
of the
talus
-zontal <Figs.
was transverse
fibula. No
of the
was lateral
under before the spinal pressure
1 and 2). The treatment, wire through tibia. Considerable forced rotated plane. Kirschner split 90
the
patient and
anaesthesia, on a Steinmann
calcaneus, bone
countertraction anteroposterior
necessary into
vertical
pin week
axis, while
were removed,
travelling and
the
a toe-to-groin
90 degrees
plaster
of displacement
was applied. This
in
the was
the plaster
was
changed;
THE
necrotic
JOINT
area was
SURGERY