1
|
Mendez-Daza CH, Arce-Eslava PA. Reconstruction of a Distal Humeral Fracture with Articular Bone Loss Using Osteochondral Allograft: A Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00008. [PMID: 37053361 DOI: 10.2106/jbjs.cc.22.00749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
CASE A 31-year-old right-hand-dominant man sustained an open left distal humerus fracture resulting in a complete loss of the lateral column involving 30% of the articular surface and the lateral collateral ligament complex. Reconstructive surgery was conducted in 2 stages, beginning with articulated external elbow fixation followed by reconstruction with a fresh osteochondral allograft. Outcomes were satisfactory with no elbow pain or instability, and osseointegration was demonstrated in radiographs. CONCLUSION The technique described in this report can be a viable option for treating young patients with a severe distal humerus fracture complicated and can provide favorable clinical and radiological outcomes.
Collapse
|
2
|
Complications and Survivorship of Distal Humeral Allograft Reconstruction After Tumor Resection: Literature Review and Case Series. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:e20.00256-8. [PMID: 33591127 PMCID: PMC7886443 DOI: 10.5435/jaaosglobal-d-20-00256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 12/05/2022]
Abstract
Primary bone sarcomas of the proximal humerus represent most bone sarcomas in the upper extremity. However, limited literature exists on the survival and complications of distal humeral allograft reconstruction because of the relative rarity of disease at the distal end.
Collapse
|
3
|
D'Ambrosi R, Formiconi F, Ursino N, Rubino M. Treatment of complete ankylosed elbow with total arthroplasty. BMJ Case Rep 2019; 12:12/7/e231123. [PMID: 31331932 DOI: 10.1136/bcr-2019-231123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We reported the case of a 38-year-old patient who in 2017 presented to our institution after post-traumatic complete ankylosis of the elbow. He complained of stiffness and pain, and the radiographs revealed complete fusion of the humeroulnar joint. The Mayo Elbow Performance Score (MEPS) on admission was 31, and the elbow was fused at 90° flexed position. The patient underwent semiconstrained total elbow arthroplasty with Bryan-Morrey approach; after a 2.1 years follow-up, active arc of movement was 120°. The MEPS was excellent with a 100 points score, the patient was able to complete all activities of daily living. We did not report any complications. Total elbow arthroplasty has shown to be a good therapeutic option that make it possible to restore adequate functional range of motion and relieve pain in young patients with post-traumatic stiffness/arthritis of the elbow.
Collapse
|
4
|
Tang J, Zhu H, Luo X, Li Q, Levin LS, Tintle SM. A vascularized elbow allotransplantation model in the rat. J Shoulder Elbow Surg 2015; 24:779-86. [PMID: 25799921 DOI: 10.1016/j.jse.2015.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 01/01/2015] [Accepted: 01/03/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this research was to develop a rat model for vascularized composite allotransplantation (VCA) of the elbow. METHODS We developed an animal model for VCA of the elbow in rats. Microvascular VCA was performed in 9 rats across a major histocompatibility barrier. Three different immunosuppressive regimens were provided. Joint mobility and weight-bearing capability were assessed throughout 90 days of life. Pedicle patency, bone blood flow, and histologic analyses were performed. RESULTS In the cyclosporine group, forelimb activity was recovered during the postoperative 90 days. The extremity that was operated on was used in daily activities. There was minimal motion or use of the limb in the cyclosporine taper and control groups. The vascular pedicles were patent at the time of death in the cyclosporine-treated group but not in the remaining groups. Micro-computed tomography scan performed 3 months after transplantation revealed union at the bone junctions, and the elbow joint appeared grossly normal on death in the cyclosporine treatment group only. Incomplete healing was observed in the other 2 groups, and the elbow joints were grossly destroyed. Histologic examination revealed normal cartilage and bone cells in the cyclosporine-treated group, whereas the nontreated groups demonstrated lymphocytic infiltration and loss of normal histologic features. Flow cytometry of blood samples obtained on days 14, 30, 60, and 90 showed no recipient cell chimerism in any of the groups. CONCLUSIONS We developed an animal model for elbow VCA. Immunosuppressed animals regained nearly normal function of forelimbs and maintained grossly normal elbow cartilage. Without cyclosporine treatment, the elbow transplants were rejected.
Collapse
Affiliation(s)
- Juyu Tang
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, China
| | - Hainan Zhu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University Medical College, Shanghai, China
| | - Xusong Luo
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University Medical College, Shanghai, China
| | - Qinfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University Medical College, Shanghai, China
| | - L Scott Levin
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Scott M Tintle
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.
| |
Collapse
|
5
|
Barthel PY, Mansat P, Sirveaux F, Dap F, Molé D, Dautel G. Is total elbow arthroplasty indicated in the treatment of traumatic sequelae? 19 cases of Coonrad-Morrey(®) reviewed at a mean follow-up of 5.2 years. Orthop Traumatol Surg Res 2014; 100:113-8. [PMID: 24370486 DOI: 10.1016/j.otsr.2013.10.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 06/20/2013] [Accepted: 10/04/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Traumatic sequelae of the elbow are difficult to manage because of bone deformities, changes in joint congruency and bone defects. MATERIALS AND METHODS Total elbow arthroplasty is a therapeutic option when the joint space has disappeared. Nineteen patients underwent semi-constrained Coonrad-Morrey(®) total elbow arthroplasty in 12 cases for post-traumatic elbow arthritis (group 1) and in seven cases for 7 non-union of the distal humerus (group 2). The mean age at surgery was 60 years old (56 in group 1 and 67 in group 2). The mean delay between the initial trauma and arthroplasty was 16 years (group 1) and 22 months (group 2). RESULTS At a mean follow-up of 5.5 years (24-156 months) in group 1, the Quick-DASH score was 34 points with outcomes that were considered to be good to excellent in 75% of the cases according to the Mayo Elbow Performance Score (MEPS). A progressive radiolucency was identified on X-ray in 33% of the cases, and moderate wear of the polyethylene insert in 17%. There were 7 complications (58%) requiring revision in 3 cases (25%). At a mean follow-up of 4.6 years (24-108 months) in group 2, the Quick-DASH score was 39 points with good and excellent results in 86% according to the MEPS. A radiolucency was noted in 28% and moderate wear of the inserts in 14%. There were 2 complications (28%) requiring revision in 1 case (14%). CONCLUSION Semi-constrained total elbow arthroplasties provide recovery of functional range of motion with a stable and pain-free elbow for post-traumatic conditions. The age at surgery is a risk factor for complications. The indication for total elbow arthroplasty in patients under 60 should be carefully considered in relation to alternative treatment options. LEVEL OF EVIDENCE Level IV Retrospective study.
Collapse
Affiliation(s)
- P Y Barthel
- Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, Centre chirurgical Emile-Gallé, CHU de Nancy, 54000 Nancy, France.
| | - P Mansat
- Service de Chirurgie orthopédique et traumatologique, CHU Purpan, 31000 Toulouse, France
| | - F Sirveaux
- Service de chirurgie orthopédique et traumatologique, Centre chirurgical Emile-Gallé, 54000 Nancy, France
| | - F Dap
- Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, Centre chirurgical Emile-Gallé, CHU de Nancy, 54000 Nancy, France
| | - D Molé
- Service de chirurgie orthopédique et traumatologique, Centre chirurgical Emile-Gallé, 54000 Nancy, France
| | - G Dautel
- Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, Centre chirurgical Emile-Gallé, CHU de Nancy, 54000 Nancy, France
| |
Collapse
|
6
|
Abstract
Destructive changes of the elbow joint represent a challenge for both patient and surgeon. Resection arthroplasty is associated with postoperative instability and loss of power and is a rarely performed procedure. Interpositional arthroplasty remains a useful option for healthy active patients with severe post-traumatic elbow arthrosis and is one of the oldest methods used to reconstruct the elbow. The principle of interpositional arthroplasty is based on a sparing resection of the destroyed joint surface and on creating a congruent elbow joint with human tissue. Nowadays, autogenous dermis, fascia lata or Achilles allograft are used. A preoperatively stable elbow is required to prevent instability following interpositional arthroplasty. The use of total elbow arthroplasty is limited due to the contraindications and in such cases the only remaining options are salvage procedures of the elbow. In general, arthrodesis should be performed in patients with painful osteoarthritis of the elbow with high demands on the upper extremities. Historically, tuberculosis was the most common indication for elbow arthrodesis and various methods of elbow arthrodesis have been described. However, most attention has been given to the position in which the elbow joint should be fixed and should be decided depending on the individual characteristics of the patient. Sufficient bone stock is crucial for a successful elbow arthrodesis and in cases with massive bone loss reconstruction of the elbow using an allograft can be performed to restore bone quality. However, the high complication rate of this procedure limits the scope of its use. Nevertheless, allograft procedures can restore pain-free joint function for several years.
Collapse
|
7
|
Hossein EM, Ashraf H, Peivandi L. Total allograft transplantation of the elbow joint after wide resection of synovial cell sarcoma: a case series. Transplant Proc 2011; 43:652-4. [PMID: 21440786 DOI: 10.1016/j.transproceed.2011.01.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Total elbow allograft transplantation is an option for patients who have extensive joint defects secondary to tumor surgery, trauma, or failed total elbow arthroplasty. This salvage procedure provides patients with a useful, painless range of motion of the elbow. We report our experience with two complete elbow allograft reconstructions after tumor resection surgery with 5 and 6 years of follow-up.
Collapse
Affiliation(s)
- E M Hossein
- Department of Orthopedics, School of Medicine, Mashhad University of Medical Sciences, Ghaem University Hospital, Mashhad Orthopedics Research Center.
| | | | | |
Collapse
|
8
|
Total elbow allografts with collateral ligament reconstruction for posttraumatic elbow injuries. J Orthop Sci 2010; 15:795-803. [PMID: 21116898 DOI: 10.1007/s00776-010-1540-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 07/30/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND The use of total osteoarticular elbow allografts as a salvage procedure for reconstruction of posttraumatic elbow periarticular defects and bone loss has been previously described. Although the procedure restores bone stock and provides a painless functional joint, it is associated with multiple complications, including infection, nonunion, and instability. METHODS We report a consecutive series of eight patients with posttraumatic elbow injuries and extensive bone loss treated with massive osteoarticular elbow allografts augmented by collateral ligament reconstruction using hamstring allograft. To improve union rates, bone morphogenetic protein-II was applied to the host-graft junctions of the reconstructed elbow. Patients were evaluated clinically and radiographically. The average age of patients was 43 years (range 30-69 years). RESULTS At a mean follow up of 32 months (range 18-44 months), the average Mayo Elbow Performance Score was 81. All patients reported no or only minimal pain in the elbow. The average arc of motion was 102°, and the mean rotational arc of motion was 100°. Four of the eight elbows developed a complication. CONCLUSIONS This procedure may serve as a viable salvage option in selected patients with the potential to provide pain relief and improve function, but it is associated with a high complication rate.
Collapse
|
9
|
Kharrazi FD, Busfield BT, Khorshad DS, Hornicek FJ, Mankin HJ. Osteoarticular and total elbow allograft reconstruction with severe bone loss. Clin Orthop Relat Res 2008; 466:205-9. [PMID: 18196394 PMCID: PMC2505305 DOI: 10.1007/s11999-007-0011-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Accepted: 10/02/2007] [Indexed: 01/31/2023]
Abstract
UNLABELLED Osteoarticular allograft reconstruction is an option in patients with massive periarticular elbow bone loss secondary to tumor surgery or trauma. Our consecutive series consisted of 18 patients with tumors and one patient with trauma. Reconstruction consisted of 16 hemiarticular allografts and three total elbow osteoarticular allografts; patients had a minimum followup of 2 years (mean, 9.9 years; range, 2-12 years). For patients who had hemiarticular allografts, 14 of 16 were able to return to their preoperative level of occupational function, with one patient experiencing failure of the allograft from infection. For the three patients who had total elbow allograft reconstructions, all had degenerative changes develop after surgery and two of the allografts failed. Complications occurred in six of 19 patients. Hemiarticular elbow allograft reconstruction is useful for limb salvage with massive bone loss. Total elbow allograft reconstructions have a high failure rate in the mid-term. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
Affiliation(s)
- F. Daniel Kharrazi
- Kerlan-Jobe Orthopaedic Clinic, 6801 Park Terrace Dr, Los Angeles, CA 90045 USA
| | | | - Daniel S. Khorshad
- Kerlan-Jobe Orthopaedic Clinic, 6801 Park Terrace Dr, Los Angeles, CA 90045 USA
| | - Francis J. Hornicek
- Department of Orthopedic Surgery, Orthopedic Oncology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Henry J. Mankin
- Department of Orthopedic Surgery, Orthopedic Oncology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| |
Collapse
|
10
|
Delloye C, Cornu O, Druez V, Barbier O. Bone allografts: What they can offer and what they cannot. ACTA ACUST UNITED AC 2007; 89:574-9. [PMID: 17540738 DOI: 10.1302/0301-620x.89b5.19039] [Citation(s) in RCA: 261] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Bone allografts can be used in any kind of surgery involving bone from minor defects to major bone loss after tumour resection. This review describes the various types of bone grafts and the current knowledge on bone allografts, from procurement and preparation to implantation. The surgical conditions for optimising the incorporation of bone are outlined, and surgeon expectations from a bone allograft discussed.
Collapse
Affiliation(s)
- C Delloye
- Department of Orthopaedic Surgery, Cliniques Universitaires St-Luc, 10, Avenue Hippocrate, B1200, Bruxelles, Belgium.
| | | | | | | |
Collapse
|