Posterolateral rotatory laxity following surgery to the head of the radius: biomechanical comparison of two surgical approaches

Outcomes using the extensor digitorum communis splitting approach for the treatment of radial head fractures

BACKGROUND

Surgery on the radial head is usually performed via the Kocher interval. Iatrogenic injury to the posterior interosseous nerve (PIN) and lateral ligamentous complex are known complications of lateral elbow approaches. The extensor digitorum communis (EDC) splitting approach for lateral elbow exposure is known to provide better access to the anterior half of the radial head while reducing the risk of injury to the lateral ligaments. The aim of this study was to provide clinical outcome data for the EDC splitting approach.

METHODS

Thirteen patients with closed radial head fractures underwent internal fixation or replacement via the EDC splitting approach. Patients were evaluated using the Mayo Elbow Performance, American Shoulder and Elbow Surgeons (ASES), and Disabilities of Arm, Shoulder and Hand scores. Clinical assessments of the elbows were also performed.

RESULTS

Ten patients underwent open reduction and internal fixation of their radial heads, and 3 underwent radial head replacements. At final follow-up, all patients achieved good to excellent Mayo Elbow Performance scores, with a mean score of 90 (range 80-100). They had a mean ASES elbow score of 89.6 (range 77-97) and a mean Disabilities of Arm, Shoulder and Hand score of 12.8 (range 6.67-25.8). Patients reported a mean overall ASES satisfaction score of 8.5 (range 6-10). There were no significant surgical complications, including iatrogenic damage to the PIN or the lateral ligaments.

CONCLUSION

The EDC splitting approach is a feasible method of exposing the lateral elbow, providing safe and reliable access to the radial head.

Complications of Elbow Trauma

The elbow is a highly congruent trochoginglymoid joint allowing motion in both flexion-extension and pronosupination across 3 articulations. Therefore, treatment of fractures of the elbow can be technically challenging to manage, even after initial surgery. The posttraumatic elbow is prone to complications such as stiffness associated with heterotopic ossification, instability or subluxation (posterolateral rotatory instability and varus posteromedial instability patterns), and wound complications. This article discusses the pathoanatomy, prevention, and treatment of these complications.

An extensive posterior approach of the elbow with osteotomy of the medial epicondyle

BACKGROUND

This study describes a posterior approach to the elbow for placement of a total elbow prosthesis.

METHODS

Release of the medial collateral ligament is achieved by performing an osteotomy of the medial epicondyle. This allows anatomic refixation of the origin of the medial collateral ligament. A description of the posterior approach is given. Standard radiographs were used to analyze the bone-to-bone refixation of the osteotomy of the medial epicondyle in 13 elbows.

RESULTS

Radiographs showed proper bone healing in all elbows, with restoration of the anatomic origin of the medial collateral ligament.

DISCUSSION

The described approach provides a good exposure of the elbow necessary for the placement of modern total elbow prostheses, without compromising the stability of the elbow. Refixation of stabilizing structures is relatively easy and results in an anatomic position of the ligaments.

Anatomical parameters in the lateral ulnar collateral ligament reconstruction: a cadaver study

Introduction

The purpose of this study was to indentify the ulnar insertion of the LUCL using the olecranon tip and the radial head as parameters to guide the ligament reconstruction surgery.

Methods

Thirteen elbows of eight fresh cadavers were dissected for the study of the LUCL. The distances between the proximal and distal insertion of the LUCL (footprint), between the radial head and the footprint and between the olecranon tip and the footprint were measure with a digital pachimeter.

Results

The average distance from the radial head to the proximal and distal ulnar insertion of the LUCL was 13.6 and 22.99 mm, respectively. The average distance between the olecranon tip and the proximal and distal ulnar insertion of the LUCL was 38.25 and 47.6 respectively. The mean length of the LUCL footprint was 9.35 mm.

Conclusions

The LUCL insertion has a wide footprint with average 9.3 mm (7.5-11 mm). Ulnar insertion half point be located at 18.2 mm of the radial head and at 42.9 mm of olecranon tip.

Ultrasound assessment of the lateral collateral ligamentous complex of the elbow: imaging aspects in cadavers and normal volunteers

OBJECTIVE

The Lateral Collateral Ligamentous complex (LCL) is an important stabiliser of the elbow. It has a Y-shaped structure with three components. In this study, we sought to describe the ultrasound aspect of the individual components of this ligamentous complex and to evaluate the performance of ultrasound in both cadavers and in normal subjects.

METHODS

Ten cadaveric elbow specimens underwent high-frequency ultrasound. Two specimens were sliced and two were dissected for anatomical correlation. Ten elbows of normal subjects were also evaluated by ultrasound. The findings were compared.

RESULTS

The three components of the LCL could be visualised in all specimens and normal subjects with the exception of the proximal portion of one specimen. In 80% of the specimens and 100% of the healthy volunteers the proximal portion of the LCL could be separated from the extensor tendons.

CONCLUSION

High-resolution ultrasound can assess all components of the LCL of the elbow and can distinguish them from surrounding structures.