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van der Windt AE, Colaris JW, den Hartog D, The B, Eygendaal D. Persistent elbow dislocation. JSES Int 2023; 7:2605-2611. [PMID: 37969499 PMCID: PMC10638553 DOI: 10.1016/j.jseint.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Acute elbow dislocation is a common injury with an incidence in the general population estimated at around 5/100,000. Persistent (or static) elbow dislocation is a relatively rare problem but might occur due to inappropriate assessment or treatment of acute simple or complex elbow dislocations. Persistent elbow dislocation can be an invalidating and painful condition with a more ominous prognosis than an acute elbow dislocation with appropriate treatment. Surgical treatment of persistent elbow dislocation is a complex intervention that requires extended surgical exposure and arthrolysis in combination with circumferential ligamentous and osseous stabilization. Satisfactory results are described, but complication and reintervention rates are high. After-treatment with a dynamic external fixator is often necessary.
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Affiliation(s)
- Anna E. van der Windt
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joost W. Colaris
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dennis den Hartog
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bertram The
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Pierreux P, Caekebeke P, van Riet R. The role of arthroscopy in instability of the elbow. JSES Int 2023; 7:2594-2599. [PMID: 37969538 PMCID: PMC10638551 DOI: 10.1016/j.jseint.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Pieter Pierreux
- Department of Orthopaedics and Traumatology, Orthoclinic Brugge, AZ Sint-Jan AV, Brugge, Belgium
| | - Pieter Caekebeke
- Department of Orthopedic Surgery and Traumatology, Genk, Belgium
| | - Roger van Riet
- Department of Orthopedic Surgery, AZ Monica and University of Antwerp, Antwerp, Belgium
- Orthopedic Specialists, Harley Street Specialist Hospital, London, United Kingdom
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Stringfellow TD, Matheron G, Subramanian P, Domos P. Predicting the need for collateral ligament repair in transolecranon fractures of the elbow: a traffic light model. J Shoulder Elbow Surg 2023; 32:2333-2339. [PMID: 37423464 DOI: 10.1016/j.jse.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/18/2023] [Accepted: 06/03/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Biomechanical studies have shown that translation of the proximal radius relative to the capitellum in the sagittal plane can predict integrity of the collateral ligaments in a transolecranon fracture model; no studies have examined this in clinical practice. METHODS AND MATERIALS Nineteen consecutive transolecranon fracture dislocations were retrospectively reviewed. Data collection included patient demographics, fracture classifications, surgical management, and failure with instability. Distance between the center of the radial head and the center of the capitellum was measured on initial radiographs by 2 independent raters on 3 separate occasions. Statistical analysis was used to compare the median displacement between patients who required collateral ligament repair for stability and those who did not. RESULTS Sixteen cases with a mean age of 57 years (range 32-85) were analyzed with an inter-rater Pearson coefficient of 0.89 for displacement measurement. Median displacement where collateral ligament repair was needed and performed was 17.13 mm (interquartile range [IQR] = 10.43-23.88) compared with 4.63 mm (IQR = 2.68-6.58) where collateral ligament repair was not performed and not required (P = .002). In 4 cases, ligament repair was not performed initially but deemed necessary based on clinical outcome and postoperative and intraoperative images. Of these, the median displacement was 15.59 mm (IQR = 10.09-21.20), and 2 of these required revision fixation. DISCUSSION Where displacement on initial radiographs exceeded 10 mm, lateral ulnar collateral ligament (LUCL) repair was required in all cases (red group). If less than 5 mm, ligament repair was not required in any case (green group). Between 5 and 10 mm, following fracture fixation, the elbow must be screened carefully to assess for any instability and a low threshold set for LUCL repair to prevent posterolateral rotatory instability (amber group). Using these findings, we propose a traffic light model to predict the need for collateral ligament repair in transolecranon fractures and dislocation.
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Affiliation(s)
| | - George Matheron
- Barnet and Chase Farm Hospitals, Royal Free London NHS Foundation Trust, London, UK
| | | | - Peter Domos
- Barnet and Chase Farm Hospitals, Royal Free London NHS Foundation Trust, London, UK.
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Rotman D, Lievano JR, O'Driscoll SW. Prosthetic resurfacing of engaging posterior capitellar defects in recurrent posterolateral rotatory instability of the elbow. Clin Shoulder Elb 2023; 26:287-295. [PMID: 37652744 PMCID: PMC10497932 DOI: 10.5397/cise.2022.01424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/15/2023] [Accepted: 06/28/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Posterolateral rotatory instability (PLRI) is a common mechanism of recurrent elbow instability. While the essential lesion is a deficiency in the lateral ulnar collateral ligament (LUCL), there are often associated concomitant bony lesions, such as an Osborne-Cotterill lesions (posterior capitellar fractures) and marginal radial head fractures, that compromise stability. Currently, there is no standard treatment for posterior capitellar deficiency associated with recurrent PLRI. METHODS We conducted a retrospective review of five patients with recurrent PLRI of the elbow associated with a posterior capitellar impaction fracture engaging with the radial head during normal range of motion. The patients were treated surgically with LUCL reconstruction or repair and off-label reconstruction of the capitellar joint surface using a small metal prosthesis designed for metatarsal head resurfacing (HemiCAP toe classic). RESULTS Five patients (three adolescent males, two adult females) were treated between 2007 and 2018. At a median follow-up of 5 years, all patients had complete relief of their symptomatic instability. No patients had pain at rest, but two patients had mild pain (visual analog scale 1-3) during physical activity. Three patients rated their elbow as normal, one as almost normal, and one as greatly improved. On short-term radiographic follow-up there were no signs of implant loosening. None of the patients needed reoperation. CONCLUSIONS Recurrent PLRI of the elbow associated with an engaging posterior capitellar lesion can be treated successfully by LUCL reconstruction and repair and filling of the capitellar defect with a metal prosthesis. This treatment option has excellent clinical results in the short-medium term. Level of evidence: IV.
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Affiliation(s)
- Dani Rotman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jorge Rojas Lievano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
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Zhang B, Liu L, Liu J, Wang G, Han L, Tian X, Dong J. Surgical Treatment of Adams Type IV Anterolateral Fracture of the Ulna Coronoid Process. Orthop Surg 2023; 15:2033-2041. [PMID: 36636909 PMCID: PMC10432438 DOI: 10.1111/os.13634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/09/2022] [Accepted: 11/23/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Anterolateral coronal fractures are so rare that the mechanism of injury, the type of combined fracture and ligament injury, and the optimal treatment are unknown. To study the outcome of surgical treatments for anterolateral (AL) fracture of the ulna coronoid process (Adams Type IV) and summarize the characteristics of this type of fracture and to guide clinical applications. METHODS From February 2015 to April 2021, 32 patients were included in the study. All patients had standard radiography with anteroposterior and lateral views, computed tomography, and intraoperative fluoroscopy. All patients were treated surgically. Surgery-related information, including surgical approach, operation duration, blood loss, and repairing the lateral collateral ligament and the medial collateral ligament integrity, were recorded. The patient's clinical details, such as the final range of motion (ROM), the Broberg-Morrey scores and the visual analogue scale (VAS) at the last follow-up, were described. The chi-square test or Fisher's exact test was used for statistical analysis. RESULTS We divided patients into two groups according to the anterolateral coronoid fracture morphology. In the intact group, 20 patients with an intact anterolateral coronoid fracture fragment. In the comminuted group, 12 patients with comminuted anterolateral coronoid fracture fragments extended the less sigmoid notch of the ulna. There was no difference in age, sex, total incision length, follow-up duration, and recovery with rehabilitation among the two groups (all Ps >0.05). The other follow-up outcomes, such as elbow ROM (Flexion, Extension, Posterior rotation, Anterior rotation), VAS score, or Broberg-Morrey scores, were not different between the two groups (all Ps >0.05). Both groups achieved relatively satisfactory clinical outcomes, and the Broberg-Morrey score and index excellence rate reached 84.38%. There is a statistical difference in the history of elbow dislocation (P = 0.017), radial head fracture type (P = 0.041), operation duration (P = 0.014) and blood loss at operation (P = 0.029) between the two groups. Cannulated screws, anchors, and sutures were used as point fixation in the coronoid process of the ulna. There was a statistical difference between the two groups in the choice of internal fixation (P = 0.020). CONCLUSIONS For anterolateral ulnar coronoid fractures with different degrees of comminution, effective and reliable surgical treatment can achieve better results and fewer complications.
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Affiliation(s)
- Bo Zhang
- Department of No. 2 Upper Extremity TraumatologyTianjin HospitalTianjinChina
| | - Lintao Liu
- Department of No. 2 Upper Extremity TraumatologyTianjin HospitalTianjinChina
| | - Junyang Liu
- Department of No. 2 Upper Extremity TraumatologyTianjin HospitalTianjinChina
| | - Guangyu Wang
- Department of No. 2 Upper Extremity TraumatologyTianjin HospitalTianjinChina
| | - Lei Han
- Department of No. 2 Upper Extremity TraumatologyTianjin HospitalTianjinChina
| | - Xu Tian
- Department of No. 2 Upper Extremity TraumatologyTianjin HospitalTianjinChina
| | - Jingming Dong
- Department of No. 2 Upper Extremity TraumatologyTianjin HospitalTianjinChina
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Sachinis NP, Yiannakopoulos CK, Beitzel K, Koukos C. Arthroscopic Modified Elbow Lateral Collateral Ligament Imbrication: An Operative Technique. Arthrosc Tech 2023; 12:e709-e714. [PMID: 37323785 PMCID: PMC10265613 DOI: 10.1016/j.eats.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/19/2023] [Indexed: 06/17/2023] Open
Abstract
When the lateral collateral ligament (LCL) complex fails to support the radiocapitellar and ulnohumeral joints in advanced stages of insufficiency, the patient experiences posterolateral rotatory instability (PLRI). Open lateral ulnar collateral ligament repair with a ligamentous graft has been the standard treatment for PLRI. Despite producing good clinical stability rates, this method is associated with significant lateral soft-tissue dissection and a lengthy recovery period. By fastening the LCL to its humeral insertion, arthroscopic imbrication of the LCL can increase stability. The senior author modified this technique. With the aid of a passer, the LCL complex, lateral capsule, and anconeus may be weaved with a single (doubled) suture, secured with a Nice knot. LCL complex imbrication may be used to restore stability and improve pain and function in patients with grade I and II PLRI.
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Affiliation(s)
- Nikolaos Platon Sachinis
- First Orthopaedic Department of Aristotle University of Thessaloniki, “Georgios Papanikolaou” Hospital, Thessaloniki, Greece
| | - Christos K. Yiannakopoulos
- Iaso Hospital, Athens, Greece
- School of Physical Education and Sports Science, National & Kapodistrian University of Athens, Athens, Greece
| | - Knut Beitzel
- Shoulder Institute, ATOS Orthoparc Klinik, Cologne, Germany
| | - Christos Koukos
- Special Sports Surgery Department, St. Josef Krankenhaus, Wuppertal, Germany
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Tranier M, Bacle G, Marteau E, Sos C, Laulan J, Roulet S. Lateral elbow ligament reconstruction for posterolateral rotatory instability: 10 years follow-up in 32 patients. JSES Int 2023; 7:357-363. [PMID: 36911761 PMCID: PMC9998886 DOI: 10.1016/j.jseint.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Posterolateral rotatory instability (PLRI) is the most frequent form of both acute and chronic elbow instability. It is due to mechanical incompetence of the lateral collateral ligament. O'Driscoll et al described treatment of this instability by autologous reconstruction of the lateral ulnar collateral ligament. The aim of our study was to evaluate the medium and long-term clinical, functional and radiological results of patients who were surgically treated for PLRI by this technique. We hypothesized that such ligament reconstruction restores a functional joint complex and durably stabilizes the elbow and limits the long-term risk of osteoarthritis. Methods All patients treated for symptomatic PLRI by ligament reconstruction since January 1995 and who had a minimum follow-up of 36 months were retrospectively included. Results Thirty-two patients (32 elbows) underwent clinical and radiological evaluation with a mean follow-up of 112 months (range, 36-265 months). The success rate of the procedure was 97% with one patient requiring revision reconstruction. Twenty-four patients (75%) were free from pain. Pain was significantly greater in patients with associated lesions (P = .03) and those with morbid obesity (body mass index ≥40) (P = .03). Twenty-nine (91%) patients had resumed their previous activities. Twenty-eight patients (87%) were satisfied or very satisfied. The mean Mayo Clinic score was 96/100 and the QuickDash 14.7/100. Two patients (6%) with accompanying lesions developed severe osteoarthritis. Conclusion Elbow ligament reconstruction by the technique of O'Driscoll et al effectively restores stability and limits progression to osteoarthritis in the long term. The only failure in our series was due to several technical errors. Patients who had dislocation with associated lesions or morbid obesity are at risk of poorer functional results.
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Affiliation(s)
- Manon Tranier
- Department of Orthopedic Surgery, Hand and Peripheral Nerve Surgery Unit, Trousseau University Hospital of Tours, Medical University François Rabelais of Tours, Tours, France
| | - Guillaume Bacle
- Department of Orthopedic Surgery, Hand and Peripheral Nerve Surgery Unit, Trousseau University Hospital of Tours, Medical University François Rabelais of Tours, Tours, France
| | - Emilie Marteau
- Department of Orthopedic Surgery, Hand and Peripheral Nerve Surgery Unit, Trousseau University Hospital of Tours, Medical University François Rabelais of Tours, Tours, France
| | - Clara Sos
- Department of Orthopedic Surgery, Hand and Peripheral Nerve Surgery Unit, Trousseau University Hospital of Tours, Medical University François Rabelais of Tours, Tours, France
| | - Jacky Laulan
- Department of Orthopedic Surgery, Hand and Peripheral Nerve Surgery Unit, Trousseau University Hospital of Tours, Medical University François Rabelais of Tours, Tours, France
| | - Steven Roulet
- ELSAN, Clinique Belledonne, France.,Centre de l'Épaule et de la Main du Dauphiné - Groupe Chirurgical Verdun, Grenoble, France
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Guerra E, Marinelli A, Tortorella F, Flöter MDS, Ritali A, Sessa A, Carbone G, Cavallo M. Elbow Arthroscopy for the Treatment of Radial Head Fractures: Surgical Technique and 10 Years of Follow Up Results Compared to Open Surgery. J Clin Med 2023; 12:jcm12041558. [PMID: 36836092 PMCID: PMC9960197 DOI: 10.3390/jcm12041558] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND This study aimed to describe the ARIF (Arthroscopic Reduction Internal Fixation) technique for radial head fractures and to compare the results with ORIF (Open Reduction Internal Fixation) at mean 10 years. METHODS A total of 32 patients affected by Mason II or III fractures of the radial head who underwent ARIF or ORIF by screws fixation were retrospectively selected and evaluated. A total of 13 patients were treated (40.6%) by ARIF and 19 patients (59.4%) by ORIF. Mean follow-up was 10 years (7-15 years). All patients underwent MEPI and BMRS scores at follow-up, and statistical analysis was performed. RESULTS No statistical significance was reported in Surgical Time (p = 0.805) or BMRS (p = 0.181) values. Significative improvement was recorded in MEPI score (p = 0.036), and between ARIF (98.07, SD ± 4.34) and ORIF (91.57, SD ± 11.67). The ARIF group showed lower incidence of postoperative complications, especially regarding stiffness (15.4% with ORIF at 21.1%). CONCLUSIONS The radial head ARIF surgical technique represents a reproducible and safe procedure. A long learning curve is required, but with proper experience, it represents a tool that might be beneficial for patients, as it allows a radial head fracture to be treated with minimal tissue damage, evaluation and treatment of the concomitant lesions, and with no limitation of the positioning of screws.
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Affiliation(s)
- Enrico Guerra
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alessandro Marinelli
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Fabio Tortorella
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | | | - Alice Ritali
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Andrea Sessa
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giuseppe Carbone
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Cavallo
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Correspondence: ; Tel.: +39-051-636-6927
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Ott N, Harland A, Lanzerath F, Leschinger T, Hackl M, Wegmann K, Müller LP. Locking suture repair versus ligament augmentation-a biomechanical study regarding the treatment of acute lateral collateral ligament injuries of the elbow. Arch Orthop Trauma Surg 2023; 143:857-863. [PMID: 35064826 PMCID: PMC9925465 DOI: 10.1007/s00402-022-04337-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 01/01/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Lateral collateral ligament (LCL) tears are frequently observed in fractures and dislocations of the elbow. Recent biomechanical evidence suggests that additional ligament augmentation may improve repair stability. The aim of this biomechanical in-vitro study was to compare the resistance of a locking suture repair of the LCL with a ligament augmentation technique. MATERIAL AND METHODS Eight fresh frozen cadaveric elbows were evaluated for stability against varus/posterolateral rotatory forces (3 Nm). A strain gauge (µm/m; negative values) was placed at the origin and insertion of the lateral ulnar collateral ligament (LUCL) and cyclic loading was performed for 1000 cycles. We analyzed three distinct scenarios: (A) native LCL, (B) locking transosseou suture repair of the LCL, (C) simple LCL repair with additional ligament augmentation of the LUCL. RESULTS The mean measured strain was - 416.1 µm/m (A), - 618 µm/m (B) and - 288.5 µm/m (C) with the elbow flexion at 90°; the strain was significantly higher in scenario B compared to C (p = .01). During the cyclic load (1000) the mean measured strain was - 523.1 µm/m (B) and - 226.3 µm/m (C) with the elbow flexion at 60°; the strain was significantly higher in scenario B compared to C (p = .01). No significant difference between the first and the last cycles was observed (p = .09; p = .07). One failure of the LCL repair was observed after 1000 cycles; none of the ligament augmentations failed. CONCLUSION Ligament augmentation (C) provides higher resistance compared to the native LCL (A) and to the locking suture repair technique (B). Both techniques, however, hold up during 1000 cycles. While ligament augmentation might enhance the primary stability of the repair, future clinical studies have to show whether this increase in resistance leads to negative effects like higher rates of posttraumatic elbow stiffness. LEVEL OF EVIDENCE Basic science study, biomechanics.
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Affiliation(s)
- Nadine Ott
- Department of Trauma and Orthopedic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany.
| | - Arne Harland
- Department of Trauma and Orthopedic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Street 62, 50937 Cologne, Germany
| | - Fabian Lanzerath
- Department of Trauma and Orthopedic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Street 62, 50937 Cologne, Germany
| | - Tim Leschinger
- Department of Trauma and Orthopedic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Street 62, 50937 Cologne, Germany
| | - Michael Hackl
- Department of Trauma and Orthopedic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Street 62, 50937 Cologne, Germany
| | - Kilian Wegmann
- Department of Trauma and Orthopedic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Street 62, 50937 Cologne, Germany
| | - Lars Peter Müller
- Department of Trauma and Orthopedic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Street 62, 50937 Cologne, Germany
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Arthroscopic lateral collateral ligament imbrication of the elbow: short-term clinical results. J Shoulder Elbow Surg 2022; 31:2316-2321. [PMID: 35872170 DOI: 10.1016/j.jse.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/21/2022] [Accepted: 06/05/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Chronic posterolateral rotatory instability (PLRI) of the elbow results from an insufficient lateral collateral ligament (LCL) complex. Arthroscopic LCL imbrication may prove a minimally invasive alternative to open lateral ulnar collateral ligament (LUCL) reconstruction with a quicker rehabilitation. The purpose of this study is to analyze the validity of a modified arthroscopic imbrication technique. We hypothesized that arthroscopic LUCL imbrication would yield stable elbows in patients with grade 1 or 2 chronic PLRI at a minimum of 2 year of follow-up. METHODS We retrospectively assessed data of all PLRI patients who underwent arthroscopic LUCL imbrication from 2010 to 2013 (n = 20). Stage 3 PLRIs (frank ulnohumeral dislocations) were excluded from this treatment. After confirmation of PLRI during standard elbow arthroscopy, a doubled absorbable suture is shuttled through as much LCL tissue as possible (from the lateral ulnar border to the area proximal to the lateral epicondyle) and the sutures are tied. This results in a plication of the entire LCL complex. Objective elbow stability was assessed using a combination of the pivot shift, table top, and posterior drawer tests. RESULT Of 20 included patients, 18 were stable subjectively and objectively at a minimum of 2 year of follow-up. Mean Mayo Elbow Performance Score improved from 48 preoperatively to 88.9 at final follow-up (P < .001). Mean Quick-Disabilities of the Arm, Shoulder, and Hand score improved from 53 preoperatively to 10.3 at final follow-up (P < .001). One patient developed elbow stiffness. Two patients reported tenderness of the subcutaneous PDS knots. CONCLUSION As a less invasive alternative to open LCL reconstruction using a graft, arthroscopic LCL imbrication has demonstrated acceptable rates of perceived elbow stability among patients with stage 1 or 2 PLRI.
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Postoperative MR Imaging of the Elbow. Magn Reson Imaging Clin N Am 2022; 30:629-643. [DOI: 10.1016/j.mric.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Colozza A, Menozzi M, Perna L, Cavaciocchi M, Martini I, Galavotti C, Padovani S. Results of arthroscopically assisted reduction and fixation of anteromedial facet coronoid fractures at short-term follow-up. J Shoulder Elbow Surg 2022; 31:1890-1897. [PMID: 35550430 DOI: 10.1016/j.jse.2022.03.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/20/2022] [Accepted: 03/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Varus posteromedial rotatory instability is a typical pattern of elbow injury that involves fracture of the anteromedial facet (AMF) of the coronoid, as well as injuries to the lateral ligament complex and the posterior bundle of the medial collateral ligament. Some authors support the idea that subtype II AMF coronoid fractures require fixation to restore elbow stability, but this topic is still an issue in the literature. The purpose of this study was to assess the clinical and radiologic outcomes of arthroscopically assisted reduction and internal fixation (ARIF) of AMF fractures. METHODS This retrospective single-center trial evaluated consecutive patients who underwent ARIF of isolated subtype II AMF coronoid fractures between 2014 and 2020. At the final follow-up, the patients were examined for elbow range of motion, stability, and pain. Injury and post-treatment radiographs were reviewed to assess fracture healing and heterotopic ossification. RESULTS A total of 32 patients (21 male and 11 female patients) with a median age of 47 ± 16 years were included. The average follow-up period was 28 ± 12.4 months. Coronoid process fractures were fixed by cannulated screws in 26 cases (81.25%); in 2 of these cases, additional Kirschner wires were used. Two Kirschner wires were used in 1 case (3.12%), and in the remaining 5 cases (15.62%), osteosuture was used. The lateral ulnar collateral ligament was injured in 27 cases (84.4%) and was always repaired. Other associated lesions were medial collateral ligament injury, osteochondral lesion, and radial head fracture. There were no surgical complications. At the final follow-up, the average Mayo Elbow Performance Score was 98.4 ± 2.7 and the mean Oxford Elbow Score was 47.3 ± 1.4. No cases of nonunion were detected on radiographic assessment. CONCLUSIONS Although technically demanding, ARIF has several potential advantages in comparison to open surgery: less scarring, a decreased risk of infection, and less postoperative pain.
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Affiliation(s)
- Alessandra Colozza
- Osteoarticular Department, Orthopaedic and Traumatology Unit, Azienda Ospedaliera of Faenza, Faenza, Italy.
| | - Margherita Menozzi
- Orthopaedic and Traumatology Unit, Civil Hospital of Guastalla, Guastalla, Italy
| | - Luigi Perna
- Osteoarticular Department, Orthopaedic and Traumatology Unit, Azienda Ospedaliera of Faenza, Faenza, Italy
| | - Michele Cavaciocchi
- Osteoarticular Department, Orthopaedic and Traumatology Unit, Azienda Ospedaliera of Faenza, Faenza, Italy
| | - Ilaria Martini
- Osteoarticular Department, Orthopaedic and Traumatology Unit, Azienda Ospedaliera of Faenza, Faenza, Italy
| | | | - Sara Padovani
- Osteoarticular Department, Orthopaedic and Traumatology Unit, Azienda Ospedaliera of Faenza, Faenza, Italy
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Chanlalit C, Mahasupachai N, Sakdapanichkul C. Arthroscopic lateral collateral ligament imbrication for treatment of atraumatic posterolateral rotatory instability. J Orthop Surg (Hong Kong) 2022; 30:10225536221113243. [PMID: 35790113 DOI: 10.1177/10225536221113243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Among the causative lesions of lateral elbow pain, atraumatic posterolateral rotatory instability (PLRI) is a rare condition, but it produces pain and disability to the elbow. It still lacks published specific treatment literature. According to the development of arthroscopy, the arthroscopic lateral collateral ligament (LCL) imbrication can possibly be an alternative minimal invasive procedure that can eradicate the atraumatic PLRI. Hypothesis/Purpose: To report clinical results of arthroscopic LCL imbrication for the treatment on atraumatic PLRI elbow. Methods: Thirty-three patients with chronic atraumatic lateral elbow pain were presented to our institution between July 2015 and December 2021. Eight patients were diagnosed with atraumatic PLRI and underwent arthroscopic LCL imbrication. Comparison between the pre- and post-operative scores were recorded, which were The Quick-Disabilities of Arm, Shoulder, and Hand (Quick-DASH) score, Mayo Elbow Performance Index (MEPI) and Visual Analog Scale for pain (VAS). Results: Mean follow-up was 16 months (9-24 months). Comparing between pre-operation and post-operation, all of eight patients had significant improved Quick-DASH score (mean 55.62 vs 7.62, p = .004), MEPI (mean 50.00 vs 96.87, p = .000) and VAS for pain (mean 8.14 vs 1.28, p = .000). Conclusion: Atraumatic PLRI is a concerning lesion in patients with lateral elbow pain. Arthroscopic LCL imbrication can be simultaneously performed with other lateral elbow pain causations, such as tennis elbow and pathological plica, and provide painless, stable, and functional elbow. LEVEL OF EVIDENCE Case Series (Level of evidence: 4).
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Affiliation(s)
- Cholawish Chanlalit
- Center of Excellent in Upper Extremity Reconstruction and Sports Medicine, Department of Orthopaedics, HRH Princess Maha Chakri Sirindhorn Medical Center, 37692Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Nattakorn Mahasupachai
- Center of Excellent in Upper Extremity Reconstruction and Sports Medicine, Department of Orthopaedics, HRH Princess Maha Chakri Sirindhorn Medical Center, 37692Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Chidchanok Sakdapanichkul
- Center of Excellent in Upper Extremity Reconstruction and Sports Medicine, Department of Orthopaedics, HRH Princess Maha Chakri Sirindhorn Medical Center, 37692Srinakharinwirot University, Nakhon Nayok, Thailand
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14
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Danilov MA, Ershov DS, Liadova MV, Badriev DA, Ershov NS. TREATMENT OF SIMPLE CHRONIC INSTABILITY OF THE ELBOW JOINT. SURGICAL PRACTICE 2022. [DOI: 10.38181/2223-2427-2022-1-14-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Simple chronic instability of the elbow joint is one of the urgent problems in modern traumatology due to the fact that the standard tactics of managing patients with traumatic injuries of the elbow joint due to dislocation, which amounts to its elimination, immobilization of the upper limb and subsequent development of movements in the joint, most often does not take into account damage to specific soft tissue structures. With untimely treatment for qualified help, with late or unsuccessful attempts to eliminate dislocation of the bones of the forearm, less often with chronic traumatization of the ligamentous apparatus of the elbow joint during some types of occupation, one of the most unpleasant complications may form, namely, chronic instability. This article discusses the main types of chronic instability of the elbow joint, analyzes approaches to the management of patients with simple chronic instability. Despite the not very high occurrence of this pathology, the effectiveness of modern surgical treatment options aimed at reconstruction of the ligamentous apparatus of the elbow joint, the percentage of unsatisfactory results of treatment of simple chronic recurrent and persistent instability of the elbow joint remains high.
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Affiliation(s)
- M. A. Danilov
- Pirogov Russian National Research Medical University
| | - D. S. Ershov
- Pirogov Russian National Research Medical University
| | - M. V. Liadova
- Pirogov Russian National Research Medical University
| | - D. A. Badriev
- Pirogov Russian National Research Medical University
| | - N. S. Ershov
- Pirogov Russian National Research Medical University
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15
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De Giorgi S, Vicenti G, Bizzoca D, Carrozzo M, Baglioni M, Virgilio A, Moretti L, Moretti B. Lateral collateral ulnar ligament reconstruction techniques in posterolateral rotatory instability of the elbow: A systematic review. Injury 2022; 53 Suppl 1:S8-S12. [PMID: 33187675 DOI: 10.1016/j.injury.2020.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/28/2020] [Accepted: 11/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Elbow chronic instability is a disable complication, presenting as recurrent joint subluxations or dislocations. This systematic review aims to assess (1) the clinical outcome and (2) the complication rates of the surgical techniques currently used in the management of posterolateral rotatory elbow instability. METHODS OVID-MEDLINE®, SCOPUS, and PubMed were searched from January 2009 to February 2019 to identify relevant studies. The search terms used were "LUCL", "Posterolateral dislocation", "Elbow Docking technique", "Elbow Jobe technique" and "Elbow single strand technique". The methodological qualities of the studies were evaluated, relevant data were extracted. RESULTS Three studies, published between 2012 and 2015, were included in this review. No studies concerning the single strand technique met the inclusion criteria. The included studies had a level of evidence IV and recruited 33 patients undergoing a Jobe technique reconstruction and 8 patients undergoing a Docking technique. Jobe procedure registered better clinical and functional outcome, assessed using the Mayo Clinic Elbow Performance Scale (MEPS), compared with patients managed with Docking technique. Nonetheless, this difference is not significant. There was not a significantly different complication rate (p = 0.57) between patients treated with these two different techniques. CONCLUSION This systematic review showed that both Jobe and Docking techniques are safe and effective in the treatment of posterolateral elbow instability. However, future studies with larger sample size and a longer follow-up interval are needed to draw stronger conclusions on the efficacy of the different LUCL surgical reconstruction techniques.
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Affiliation(s)
- Silvana De Giorgi
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
| | - Giovanni Vicenti
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy.
| | - Davide Bizzoca
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
| | - Massimiliano Carrozzo
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
| | - Marco Baglioni
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
| | - Antonio Virgilio
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
| | - Lorenzo Moretti
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
| | - Biagio Moretti
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
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16
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Jimenez IA, Spector DI, Chaney SB, Moore R, Paré JA. Surgical stabilization of traumatic elbow joint luxation and proximal ulnar fracture in a silvery langur (Trachypithecus cristatus). J Am Vet Med Assoc 2021; 259:1466-1470. [PMID: 34757936 DOI: 10.2460/javma.20.08.0458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 3-year-old 5-kg sexually intact female silvery langur housed in a single-species group at a zoological institution was presented because of acute trauma to the left forelimb. CLINICAL FINDINGS Radiography of the left forelimb revealed a type II Monteggia fracture (proximal ulnar fracture with cranial displacement and caudal luxation of the radial head). During surgery, disruption of the annular ligament and rupture of the lateral collateral ligament were noted. TREATMENT AND OUTCOME The langur underwent open reduction and internal fixation of the ulnar fracture and placement of a radioulnar positional screw, a prosthetic lateral collateral ligament, and a temporary hinged type 1A external skeletal fixator. The langur was returned to group housing, underwent behavioral training, and was periodically anesthetized for physical therapy sessions to improve range of motion of the left elbow joint. The external skeletal fixator was removed 4 weeks after surgery, and the radioulnar positional screw was removed 6 weeks after surgery. Three months after surgery, the range of motion of the langur's left elbow joint was considered normal, and the animal returned to normal activity. CLINICAL RELEVANCE For the captive silvery langur of the present report, surgical stabilization and postoperative management of a type II Monteggia fracture of the left forelimb were successful with recovery of elbow joint function. These techniques may be applied to other captive nonhuman primates, including those that brachiate or are members of social species that must be housed with conspecifics in the postoperative period to maintain group dynamics.
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Affiliation(s)
| | | | - Sarah B Chaney
- From the Wildlife Conservation Society, Zoological Health Program, Bronx, NY 10460
| | - Robert Moore
- From the Animal Medical Center, New York, NY 10065.,From the Wildlife Conservation Society, Zoological Health Program, Bronx, NY 10460
| | - Jean A Paré
- From the Wildlife Conservation Society, Zoological Health Program, Bronx, NY 10460
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17
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Seah RB, Mak WK, Bryant K, Korlaet M, Dwyer A, Bain GI. Four-dimensional computed tomography scan for dynamic elbow disorders: recommendations for clinical utility. JSES Int 2021; 6:182-186. [PMID: 35141694 PMCID: PMC8811401 DOI: 10.1016/j.jseint.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Four-dimensional computed tomography (4D CT) is rapidly emerging as a diagnostic tool for the investigation of dynamic upper limb disorders. Dynamic elbow pathologies are challenging to diagnose, and at present, limitations exist in current imaging modalities Objective We aimed to assess the clinical utility of 4D CT in detecting potential dynamic elbow disorders. Methods Twenty-eight elbow joints from 26 patients with symptoms of dynamic elbow pathology were included in this study. They were first assessed by a senior orthopedic surgeon with subsequent qualitative data obtained via a Siemens Force Dual Source CT scanner (Erlangen, Germany), producing two- and three-dimensional “static” images and 4D dynamic “movie” images for assessment in each clinical scenario. Clinical assessment before and after scan was compared. Results Use of 4D CT scan resulted in a change of diagnosis in 16 cases (57.14%). This included a change in primary diagnosis in 2 cases (7.14%) and secondary diagnosis in 14 cases (50%). In 25 cases (89.29%), the 4D CT scan allowed us to understand the pathological anatomy in greater detail which led to a change in the management plan of 15 cases (53.57%). Conclusion 4D CT is a promising diagnostic tool in the management of dynamic elbow disorders and may be considered in clinical practice. Future studies need to compare it with other diagnostic modalities such as three-dimensional CT.
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Affiliation(s)
| | - Wai-Keong Mak
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
- Corresponding author: Wai-Keong Mak, MRCS, MBBS, 110 Sengkang E Way, Singapore 544886.
| | - Kimberley Bryant
- Clinical and Research Imaging Centre, SAHMRI, Adelaide, SA, Australia
| | - Mishelle Korlaet
- Department of Orthopaedic Surgery and Trauma, Flinders University, Bedford Park, SA, Australia
| | - Andrew Dwyer
- Department of Orthopaedic Surgery and Trauma, Flinders University, Bedford Park, SA, Australia
| | - Gregory I. Bain
- Department of Orthopaedic Surgery and Trauma, Flinders University, Bedford Park, SA, Australia
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18
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Intractable lateral epicondilytis: A differential diagnosis algorithm for a correct clinical interpretation. APUNTS SPORTS MEDICINE 2021. [DOI: 10.1016/j.apunsm.2021.100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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19
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Gilotra MN, Fridman J, Enobun B, Kuntz AF, Glaser DL, Huffman GR. Risk factors associated with atraumatic posterolateral rotatory instability. JSES Int 2021; 5:827-833. [PMID: 34223438 PMCID: PMC8245999 DOI: 10.1016/j.jseint.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Traumatic posterolateral rotatory instability after elbow dislocation or fracture dislocation has been well described. However, few reports cover atraumatic posterolateral rotatory instability as a cause of lateral-sided elbow pain. We assessed the risk factors and epidemiology of atraumatic posterolateral rotatory instability in a case-control study. Methods A retrospective review of all patients treated operatively for atraumatic posterolateral rotatory instability during a 6-year period was compared with a group of patients with extensor carpi radialis brevis tendinopathy without instability treated during the same time period. Bivariate and multiple logistic regression statistical analyses were used to investigate the following risk factors: gender, age, hand dominance, diabetes, smoking, body mass index, corticosteroid injection history, and duration of symptoms. Disabilities of the Arm, Shoulder, and Hand and pain scores were obtained preoperatively and postoperatively. Results Thirteen patients with atraumatic posterolateral rotatory instability were compared with 12 patients with extensor carpi radialis brevis tendinopathy. Multivariate analysis revealed patients with atraumatic posterolateral rotatory instability were more likely to have multiple corticosteroid injections (P = .05) and present with a longer duration of symptoms (P = .03). Postoperative pain scores improved in both groups. Conclusions Atraumatic posterolateral rotatory instability should be considered in the differential diagnosis of lateral elbow when patients present with a protracted clinical course. Statistically, posterolateral rotatory instability patients more often present with a history of multiple corticosteroid injections.
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Affiliation(s)
- Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jake Fridman
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Blessing Enobun
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew F Kuntz
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - David L Glaser
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - G Russell Huffman
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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20
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Abstract
Primary radial head arthroplasty (RHA) produces good or excellent results in approximately 85% of patients. However, complications are not uncommon and have been described in up to 23% of cases. The number of RHA is increasing, and consequently the absolute number of complications is expected to rise as well. The decision on whether to revise or remove the prosthesis seems more likely to depend on the preference of the surgeon or the hospital, rather than on objectifying problems with the prosthesis. The current article presents an algorithm for the work-up and treatment of most complications that can occur following RHA. Five subgroups of problems were identified: osteoarthritis, stiffness, instability, infection and implant-related issues. In short, the preferred treatment depends mainly on the chondral condition and stability of the elbow joint.
Cite this article: EFORT Open Rev 2020;5:398-407. DOI: 10.1302/2058-5241.5.190055
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Affiliation(s)
- Izaäk F Kodde
- Orthopedic Center Antwerp, AZ Monica Hospital, Antwerp, Belgium.,Department of Orthopedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | - Jetske Viveen
- Department of Orthopedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, The Netherlands
| | - Bertram The
- Department of Orthopedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, The Netherlands
| | | | - Denise Eygendaal
- Department of Orthopedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, The Netherlands.,Department of Orthopedic Surgery, Amsterdam UMC, Amsterdam, The Netherlands
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21
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Liu JY, Zhang JZ, Wang YM, Tian X, Dong JM. Difference Between Posterior Monteggia Fractures and Posterior Fracture-Dislocation of Proximal Ulna in Adults. Orthop Surg 2020; 12:1448-1455. [PMID: 32790243 PMCID: PMC7670164 DOI: 10.1111/os.12784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To figure out the difference between patients with posterior Monteggia fractures which were concomitant with proximal radioulnar joint (PRUJ) dislocation and posterior fracture-dislocation of the proximal ulna that were not concomitant with PRUJ. METHODS From January 2016 to January 2019, 37 consecutive adult patients who had posterior fracture-dislocation of proximal ulna (no PRUJ dislocation, n = 16) and posterior Monteggia fractures (PRUJ dislocation, n = 21) were included. All patients had intraoperative fluoroscopy, computed tomography (CT) scans, and standard radiography (anteroposterior view and lateral view). The mechanism of injury, the cases with open fracture, sustained multiple injuries and classification of fracture was recorded. The clinical details of the patients such as the final range of motion (ROM) and the Broberg-Morrey scores were described. RESULTS Patients with PRUJ dislocation (ten type A, five type B, and six type D) and those without concomitant PRUJ dislocation (fifteen type A and one type C) exhibited an obvious difference according to the classifications of Jupiter et al. (P = 0.010). Ninety-five percent of patients who had PRUJ dislocation were accompanied by a metaphyseal fracture, while only 50% of the patients who did not have PRUJ dislocation were accompanied by a metaphyseal fracture (P = 0.002). Meanwhile, 16 of 20 metaphyseal fractures had more than one fragment in the group of dislocations, but five of eight metaphyseal fractures were comminuted in the control group. The two groups exhibited an obvious difference (P = 0.009). The 21 patients who sustained a radioulnar dislocation had less mean arc of flexion, pronation, and Broberg-Morrey scores were significantly less than the patients of the control group (flexion: 117.38 ± 14.46 vs 127.50 ± 13.416, P = 0.035; pronation: 59.76 ± 11.88 vs 67.50 ± 6.58, P = 0.017; Broberg-Morrey: 80.48 ± 12.17 vs 88.19 ± 10.28, P = 0.040). CONCLUSIONS Patients suffering posterior Monteggia fractures had more metaphyseal fractures, more comminuted fractures of the metaphysis, and worse ultimate ulnohumeral motion than patients of posterior fracture-dislocation of proximal ulna.
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Affiliation(s)
- Jun-Yang Liu
- Department of Orthopedic Trauma, Tianjin Hospital, Tianjin, China
| | - Ji-Zheng Zhang
- Department of Anesthesiology, Tianjin Hospital, Tianjin, China
| | - Ye-Ming Wang
- Department of Orthopedic Trauma, Tianjin Hospital, Tianjin, China
| | - Xu Tian
- Department of Orthopedic Trauma, Tianjin Hospital, Tianjin, China
| | - Jing-Ming Dong
- Department of Orthopedic Trauma, Tianjin Hospital, Tianjin, China
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22
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van Riet RP, van den Bekerom MPJ, Van Tongel A, Spross C, Barco R, Watts AC. Radial head fractures. Shoulder Elbow 2020; 12:212-223. [PMID: 32565923 PMCID: PMC7285971 DOI: 10.1177/1758573219876921] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 06/16/2019] [Accepted: 08/06/2019] [Indexed: 11/16/2022]
Abstract
The shape and size of the radial head is highly variable but correlates to the contralateral side. The radial head is a secondary stabilizer to valgus stress and provides lateral stability. The modified Mason-Hotchkiss classification is the most commonly used and describes three types, depending on the number of fragments and their displacement. Type 1 fractures are typically treated conservatively. Surgical reduction and fixation are recommended for type 2 fractures, if there is a mechanical block to motion. This can be done arthroscopically or open. Controversy exists for two-part fractures with >2 mm and <5 mm displacement, without a mechanical bloc as good results have been published with conservative treatment. Type 3 fractures are often treated with radial head replacement. Although radial head resection is also an option as long-term results have been shown to be favourable. Radial head arthroplasty is recommended in type 3 fractures with ligamentous injury or proximal ulna fractures. Failure of primary radial head replacement may be due to several factors. Identification of the cause of failure is essential. Failed radial head arthroplasty can be treated by implant removal alone, interposition arthroplasty, revision radial head replacement either as a single stage or two-stage procedure.
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Affiliation(s)
- RP van Riet
- Department of Orthopedic Surgery, Monica Hospital, Antwerp, Belgium,MoRe Foundation, Antwerp, Belgium,Department of Orthopedic Surgery and Traumatology, University Hospital Antwerp, Antwerp, Belgium,RP van Riet, Department of Orthopedic Surgery, Monica Hospital, Stevenslei 20, 2100 Antwerp, Belgium.
| | - MPJ van den Bekerom
- Shoulder and Elbow Unit, Joint Research, Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands
| | - A Van Tongel
- Department of Orthopaedics and Traumatology, UZ Gent, Ghent, Belgium
| | - C Spross
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - R Barco
- Upper Limb Unit, Hospital Universitario La Paz, Madrid, Spain
| | - AC Watts
- Upper Limb Unit, Wrightington Hospital, UK
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23
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LUCL internal bracing restores posterolateral rotatory stability of the elbow. Knee Surg Sports Traumatol Arthrosc 2020; 28:1195-1201. [PMID: 31352495 DOI: 10.1007/s00167-019-05632-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Posterolateral rotatory instability (PLRI) of the elbow occurs from an insufficient lateral collateral ligament complex (LCLC). For subacute LCLC injuries, lateral ulnar collateral ligament (LUCL) internal bracing rather than reconstruction may be a viable option. The purpose of the study was to compare the stabilizing effects of LUCL internal bracing to triceps tendon graft reconstruction in simulated PLRI. METHODS Sixteen cadaveric elbows were assigned for either LUCL internal bracing (n = 8) or reconstruction with triceps tendon graft (n = 8). Specimen were mounted and a valgus rotational torque was applied to the ulna to test posterolateral rotatory stability. Posterolateral rotation was measured at 0°, 30°, 60°, 90° and 120° of elbow flexion. Cyclic loading was performed for 1000 cycles at 90° of elbow flexion. Three conditions were compared in each specimen: intact elbow, LUCL and radial collateral ligament (RCL) transected, and then either LUCL internal bracing or reconstruction with triceps tendon graft. RESULTS Transection of the LUCL and RCL significantly increased posterolateral rotation in all degrees of elbow flexion compared to the intact condition (P < 0.05). Both LUCL internal bracing and reconstruction restored posterolateral rotatory stability to the native state between 0° and 120° of elbow flexion, with no significant difference in improvement between groups. Similarly, LUCL internal bracing and reconstruction groups showed no significant difference in posterolateral rotation compared to the intact condition during cyclic loading. CONCLUSIONS At time zero, both LUCL internal bracing and reconstruction with triceps tendon graft restored posterolateral rotatory stability. As such, this study supports the use of internal bracing as an adjunct to primary ligament repair in subacute PLRI.
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24
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Molenaars RJ, Schoolmeesters BJA, Viveen J, The B, Eygendaal D. There is a role for allografts in reconstructive surgery of the elbow and forearm. Knee Surg Sports Traumatol Arthrosc 2019; 27:1840-1846. [PMID: 30341449 DOI: 10.1007/s00167-018-5221-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/15/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Allografts play an important role in tendon, ligament, and bone reconstruction surgery, particularly when suitable available autologous tissue is limited. Enthusiasm for the use of allografts in reconstructive orthopedic surgery has increased over the past decade, with an increase in allograft use in a variety of procedures. The purpose of this review is to provide an overview of the various applications and indications for the use of allografts in reconstructive surgical procedures of the elbow and forearm. METHODS MEDLINE/PubMed was searched from 1990 through October 2018 for studies on tendon and bony allografts in elbow and forearm reconstructive surgery. RESULTS The Achilles tendon allograft is the most frequently used tendinous allograft, predominantly used in distal biceps and triceps reconstruction. Although reconstruction of the ulnar collateral ligament of the elbow is generally performed using autografts, it has been shown that semitendinosus and gracilis allografts may be equally effective. Extensor hallucis longus allografts are recommended for reconstruction of the lateral collateral ligaments in patients with posterolateral rotatory instability, and there may be a role for osteochondral allograft transplantation in capitellar osteochondral defects. In addition, the use of allografts in reconstruction of the interosseous membrane and various bone pathologies (fractures, bone tumors, forearm nonunions) has been described in current literature. CONCLUSION There is a large variety of pathology and procedures involving the use of various types of allografts in orthopedic reconstructive surgery of the elbow and forearm.
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Affiliation(s)
- R J Molenaars
- Sports Medicine Center, Harvard Medical School at Massachusetts General Hospital, 175 Cambridge St, 4th Floor, Boston, MA, 02114, USA. .,Department of Orthopaedic Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - J Viveen
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - B The
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - D Eygendaal
- Department of Orthopaedic Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
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25
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Complex Case of Open Fracture-Dislocation of the Elbow. Case Rep Orthop 2019; 2019:3495742. [PMID: 31214371 PMCID: PMC6535853 DOI: 10.1155/2019/3495742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/28/2019] [Indexed: 11/17/2022] Open
Abstract
Complex elbow instability is difficult to surgically address. Careful consideration of the fractures and soft tissue injuries is required. We present the case of a patient who sustained an open fracture-dislocation of the elbow with significant loss of the external humeral condyle and partial loss of the olecranon. He was surgically treated with an iliac crest tricortical autograft fixed with a buttress plate and a lag screw. His lateral ulnar collateral ligament was reconstructed with tendinous autograft collected from his third and fourth extensor digitorum longus tendons. While the procedure complicated with a Nocardia infection and wound breakdown, the patient almost had full range of motion without instability at 11 months of follow-up.
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Karthik K, Kasilingam V, Othieno-P'otonya K. Elbow instability following lateral collateral ligament complex avulsion fracture and joint interposition: an uncommon presentation. BMJ Case Rep 2018; 2018:bcr-2018-225551. [PMID: 30173132 DOI: 10.1136/bcr-2018-225551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The lateral collateral ligament (LCL) complex of the elbow is a capsuloligamentous structure, critical for elbow stability. Though isolated ligamentous injuries have been reported in literature, there are no studies reporting avulsion fractures of the lateral ligamentous complex of the elbow with joint incarceration in a child. An 11-year-old boy presented to the emergency department after a fall from height, with pain and swelling to the lateral side of his left elbow. Radiographs established a fracture of the lateral condyle and CT imaging confirmed an avulsion of the lateral ligamentous complex, with fragments in the inferior radiocapitellar joint. Examination under anaesthesia revealed an unstable elbow with restricted extension, and the child underwent joint debridement and open reduction internal fixation of LCL complex with cannulated screws. At the final follow-up at 15 months, the child regained preinjury level of function.
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Affiliation(s)
- Karuppaiah Karthik
- Department of Orthopaedics, King's College Hospital NHS Foundation Trust, London, UK
| | - Vidhya Kasilingam
- Department of Orthopaedics, King's College Hospital NHS Foundation Trust, London, UK
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Janßen R, Falkowski AL, Hirschmann A. [Assessment of ligament and tendon injuries of the elbow using magnetic resonance imaging]. Radiologe 2018; 58:996-1003. [PMID: 30105535 DOI: 10.1007/s00117-018-0441-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
An overview about the normal anatomy and frequent pathologies of tendons and ligaments of the elbow using MRI will be provided. The unique joint configuration and articulation, as well as passive ligamentous and active muscle structures as well as the unique configuration of the articulating components of the elbow contribute to joint stabilization. MRI is an essential imaging modality in patients with ligamentous injuries including the sequelae of joint dislocation as well as chronic pathologies such as long-standing and refractory tendinopathies. Ideally, when reporting MRI of the elbow, the joint is separated into its four compartments, anterior, posterior, medial and lateral, allowing precise, comprehensive and structured reporting.
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Affiliation(s)
- R Janßen
- Muskuloskelettale Radiologie, Klinik für Radiologie und Nuklearmedizin, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz.
| | - A L Falkowski
- Muskuloskelettale Radiologie, Klinik für Radiologie und Nuklearmedizin, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz
| | - A Hirschmann
- Muskuloskelettale Radiologie, Klinik für Radiologie und Nuklearmedizin, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz
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