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Eckers F, Hochreiter B, Forsyth S, Ek ET. Proximal humerus reconstruction in reverse total shoulder arthroplasty with proximal humeral bone loss using a lower trapezius tendon transfer with Achilles tendon-bone allograft: surgical technique and report of 2 cases. JSES Int 2024; 8:508-514. [PMID: 38707582 PMCID: PMC11064716 DOI: 10.1016/j.jseint.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Affiliation(s)
- Franziska Eckers
- Melbourne Orthopaedic Group, Melbourne, Australia
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Bettina Hochreiter
- Melbourne Orthopaedic Group, Melbourne, Australia
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Sarah Forsyth
- Melbourne Orthopaedic Group, Melbourne, Australia
- Melbourne Shoulder Group, Melbourne, Australia
| | - Eugene T. Ek
- Melbourne Orthopaedic Group, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
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Hochreiter B, Eckers F, Calek AK, Cassidy TJ, Amaranath JE, Leung M, Ek ET. Distal Biceps Tendon Repair Using a Double Intracortical Button Anatomical Footprint Repair Technique. J Shoulder Elbow Surg 2024:S1058-2746(24)00308-2. [PMID: 38688419 DOI: 10.1016/j.jse.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Distal biceps tendon repair is usually performed via a double-incision or single-incision bicortical drilling technique. However, these techniques are associated with specific complications and usually do not allow for anatomical footprint restoration. It was the aim of this study to report the clinical results of a double intracortical button anatomical footprint repair technique for distal biceps tendon tears. We hypothesized that this technique would result in supination strength comparable to the uninjured side with a low re-rupture rate and minimal bony or neurological complications. MATERIAL AND METHODS This was a retrospective, single-surgeon cohort study of a consecutive series of 22 patients with a mean (SD) age of 50.7 (9.4) years and at least 1-year follow-up after distal biceps tendon repair. At final follow-up, complications, range of motion (ROM), the Patient-rated Elbow Evaluation (PREE), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, visual analog scale (VAS) for pain, patient satisfaction and supination strength in neutral as well as 60° of supination were analyzed. Radiographic evaluation was performed on a CT scan. RESULTS One patient (4.5%) experienced slight paresthesia in the area of the lateral antebrachial cutaneous nerve. Heterotopic ossification was seen in one patient (4.5%). All patients recovered full ROM except for one who had 10° of loss of flexion and extension. Median PREE score was 4.6 (0-39.6), median MEP was 100 (70-100) and median DASH was 1.4 (0-16.7). All but one patient were very satisfied with the outcome. The affected arm had a mean of 98% (± 13) of neutral supination strength (p=0.633) and 94% (± 12) of supination strength in 60° (p=0.054) compared to the contralateral, unaffected side. There were four cases (18.2%) of cortical thinning due to at least one button and one case of button pull-out (4.5%). CONCLUSIONS The double intracortical button anatomical footprint repair technique seems to provide reliable restoration of supination strength, excellent patient satisfaction while minimizing complications, particularly nerve damage and heterotopic ossification.
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Affiliation(s)
- Bettina Hochreiter
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC, Australia; Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Franziska Eckers
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC, Australia; Department of Orthopedics, University Hospital Basel, Basel, Switzerland
| | - Anna-Katharina Calek
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC, Australia; Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | | | - Megan Leung
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC, Australia; Department of Surgery, Monash University, Melbourne, VIC, Australia
| | - Eugene T Ek
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC, Australia; Department of Surgery, Monash University, Melbourne, VIC, Australia
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Hochreiter B, Germann C, Feuerriegel GC, Sutter R, Selman F, Gressl M, Ek ET, Wieser K. Natural History of Quantitative Fatty Infiltration and 3D Muscle Volume After Nonoperative Treatment of Symptomatic Rotator Cuff Tears: A Prospective MRI Study of 79 Patients. J Bone Joint Surg Am 2024; 106:690-699. [PMID: 38386719 DOI: 10.2106/jbjs.23.01083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
BACKGROUND The severity of fatty infiltration (FI) predicts the treatment outcome of rotator cuff tears. The purpose of this investigation was to quantitatively analyze supraspinatus (SSP) muscle FI and volume at the initial presentation and after a 3-month minimum of conservative management. We hypothesized that progression of FI could be predicted with initial tear size, FI, and muscle volume. METHODS Seventy-nine shoulders with rotator cuff tears were prospectively enrolled, and 2 magnetic resonance imaging (MRI) scans with 6-point Dixon sequences were acquired. The fat fraction within the SSP muscle was measured on 3 sagittal slices, and the arithmetic mean was calculated (FI SSP ). Advanced FI SSP was defined as ≥8%, pathological FI SSP was defined as ≥13.5%, and relevant progression was defined as a ≥4.5% increase in FI SSP . Furthermore, muscle volume, tear location, size, and Goutallier grade were evaluated. RESULTS Fifty-seven shoulders (72.2%) had normal FI SSP , 13 (16.5%) had advanced FI SSP , and 9 (11.4%) had pathological FI SSP at the initial MRI scan. Eleven shoulders (13.9%) showed a ≥4.5% increase in FI SSP at 19.5 ± 14.7 months, and 17 shoulders (21.5%) showed a ≥5-mm 3 loss of volume at 17.8 ± 15.3 months. Five tears (7.1%) with initially normal or advanced FI SSP turned pathological. These tears, compared with tears that were not pathological, had significantly higher initial mediolateral tear size (24.8 compared with 14.3 mm; p = 0.05), less volume (23.5 compared with 34.2 mm 3 ; p = 0.024), more FI SSP (9.6% compared with 5.6%; p = 0.026), and increased progression of FI SSP (8.6% compared with 0.5%; p < 0.001). An initial mediolateral tear size of ≥20 mm yielded a relevant FI SSP progression rate of 81.8% (odds ratio [OR], 19.0; p < 0.001). Progression rates of 72.7% were found for both initial FI SSP of ≥9.9% (OR, 17.5; p < 0.001) and an initial anteroposterior tear size of ≥17 mm (OR, 8.0; p = 0.003). Combining these parameters in a logistic regression analysis led to an area under the receiver operating characteristic curve (AUC) of 0.913. The correlation between FI SSP progression and the time between MRI scans was weak positive (ρ = 0.31). CONCLUSIONS Three risk factors for relevant FI progression, quantifiable on the initial MRI, were identified: ≥20-mm mediolateral tear size, ≥9.9% FI SSP , and ≥17-mm anteroposterior tear size. These thresholds were associated with a higher risk of tear progression: 19 times higher for ≥20-mm mediolateral tear size, 17.5 times higher for ≥9.9% FI SSP , and 8 times higher for ≥17-mm anteroposterior tear size. The presence of all 3 yielded a 91% chance of ≥4.5% progression of FI SSP within a mean of 19.5 months. LEVEL OF EVIDENCE Diagnostic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bettina Hochreiter
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christoph Germann
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Georg C Feuerriegel
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Farah Selman
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Maximilian Gressl
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Eugene T Ek
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
- Department of Surgery, Monash Medical Center, Monash University, Melbourne, Victoria, Australia
| | - Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Onggo JR, Chua NSH, Onggo JD, Wang KK, Ek ET. Clinical Outcomes Following Surgical Management of Post-Traumatic Elbow Contractures in the Pediatric Age Group: A Meta-Analysis and Systematic Review. J Hand Surg Am 2024:S0363-5023(24)00026-1. [PMID: 38416094 DOI: 10.1016/j.jhsa.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 12/15/2023] [Accepted: 01/03/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Post-traumatic elbow stiffness is a common occurrence resulting in potentially substantial functional limitations in both daily activities and recreational endeavors. In children, this can be particularly difficult given the early stages of childhood and development and the challenges of rehabilitation. Several studies have reported favorable results of elbow contracture releases in children, resulting in improvements in outcomes. This meta-analysis aimed to determine the efficacy and safety of elbow contracture releases in the pediatric population (<18 years), along with subgroup analyses comparing age groups, operative approach, and post-traumatic versus nontraumatic etiologies. METHODS Meta-analysis was performed with a multidatabase search (PubMed, OVID, EMBASE, and Medline) according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines on September 25, 2020. Data from all published literature meeting inclusion criteria were extracted and analyzed. RESULTS Seven studies were included, comprising 114 post-traumatic elbow contractures. Mean age was 13.7 years. Contracture releases of the elbow led to improvements in flexion-extension arc of motion by 48º, and pronosupination arc of motion by 22º. Subgroup analysis comparing age groups of <10, 10-14 and 15-18 years showed greater improvements in flexion-extension arc in the older age group, whereas subgroup analysis comparing injury patterns revealed a larger improvement in pronosupination motion for radial head fractures. Comparing open and arthroscopic procedures, open releases had greater improvement in both flexion-extension and pronosupination motion by 18º and 21º, respectively, although there were limited patients in the arthroscopy group. CONCLUSION Operative management of pediatric elbow contractures is effective. Older children, children with radial head fractures, and those receiving open contracture releases may be more likely to have greater improvements. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- James R Onggo
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, VIC, Australia; Department of Orthopaedic Surgery, Box Hill Hospital, Victoria, Australia
| | - Nina S H Chua
- Department of Orthopaedic Surgery, Box Hill Hospital, Victoria, Australia
| | - Jason D Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Victoria, Australia
| | - Kemble K Wang
- Department of Orthopaedic Surgery, Box Hill Hospital, Victoria, Australia; Department of Orthopaedic Surgery, Royal Children's Hospital, Victoria, Australia
| | - Eugene T Ek
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, VIC, Australia; Melbourne Orthopaedic Group, Melbourne, VIC, Australia.
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Rawal A, Eckers F, Lee OSH, Hochreiter B, Wang KK, Ek ET. Current Evidence Regarding Shoulder Instability in the Paediatric and Adolescent Population. J Clin Med 2024; 13:724. [PMID: 38337418 PMCID: PMC10856087 DOI: 10.3390/jcm13030724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Paediatric and adolescent shoulder instability is caused by a unique combination of traumatic factors, ligamentous laxity, and pattern of muscle contractility. The multifactorial nature of its aetiology makes interpretation of the literature difficult as nomenclature is also highly variable. The purpose of this review is to summarize the existing literature and shed light on the nuances of paediatric and adolescent shoulder instability. The epidemiology, clinical features, imaging, and management of all forms of paediatric shoulder instability are presented. The main findings of this review are that structural abnormalities following a dislocation are uncommon in pre-pubertal paediatric patients. Young post-pubertal adolescents are at the highest risk of failure of non-operative management in the setting of traumatic instability with structural abnormality, and early stabilisation should be considered for these patients. Remplissage and the Latarjet procedure are safe treatment options for adolescents at high risk of recurrence, but the side-effect profile should be carefully considered. Patients who suffer from instability due to generalized ligamentous laxity benefit from a structured, long-term physiotherapy regimen, with surgery in the form of arthroscopic plication as a viable last resort. Those who suffer from a predominantly muscle patterning pathology do not benefit from surgery and require focus on regaining neuromuscular control.
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Affiliation(s)
- Aziz Rawal
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia; (A.R.); (F.E.)
| | - Franziska Eckers
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia; (A.R.); (F.E.)
- Orthopädie und Traumatologie, Universitätsspital Basel, 4031 Basel, Switzerland
| | - Olivia S. H. Lee
- Victorian Paediatric Rehabilitation Service, The Royal Children’s Hospital, Melbourne, VIC 3052, Australia;
| | - Bettina Hochreiter
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia; (A.R.); (F.E.)
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8006 Zürich, Switzerland
| | - Kemble K. Wang
- Department of Orthopaedic Surgery, The Royal Children’s Hospital, Melbourne, VIC 3052, Australia;
| | - Eugene T. Ek
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia; (A.R.); (F.E.)
- Department of Surgery, Monash University, Melbourne, VIC 3800, Australia
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Zhang X, Tham S, Ek ET, McCombe D, Ackland DC. Scaphoid, lunate and capitate kinematics in the normal and ligament deficient wrist: A bi-plane X-ray fluoroscopy study. J Biomech 2023; 158:111685. [PMID: 37573806 DOI: 10.1016/j.jbiomech.2023.111685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 08/15/2023]
Abstract
The ligamentous structures of the wrist stabilise and constrain the interactions of the carpal bones during active wrist motion; however, the three-dimensional translations and rotations of the scaphoid, lunate and capitate in the normal and ligament deficient wrist during planar and oblique wrist motions remain poorly understood. This study employed a computer-controlled simulator to replicate physiological wrist motion by dynamic muscle force application, while carpal kinematics were simultaneously measured using bi-plane x-ray fluoroscopy. The aim was to quantify carpal kinematics in the native wrist and after sequential sectioning of the scapholunate interosseous ligament (SLIL) and secondary scapholunate ligament structures. Seven fresh-frozen cadaveric wrist specimens were harvested, and cycles of flexion-extension, radial-ulnar deviation and dart-thrower's motion were simulated. The results showed significant rotational and translational changes to these carpal bones in all stages of disruptions to the supporting ligaments (p < 0.05). Specifically, following the disruption of the dorsal SLIL (Stage II), the scaphoid became significantly more flexed, ulnarly deviated, and pronated relative to the radius, whereas the lunate became more extended, supinated and volarly translated (p < 0.05). Sectioning of the dorsal intercarpal (DIC), dorsal radiocarpal (DRC), and scaphotrapeziotrapezoid (STT) ligaments (Stage IV) caused the scaphoid to collapse further into flexion, ulnar deviation, and pronation. These findings highlight the importance of all the ligamentous attachments that relate to the stability of the scapholunate joint, but more importantly, the dorsal SLIL in maintaining scapholunate stability, and the preservation of the attachments of the DIC and DRC ligaments during dorsal surgical approaches. The findings will be useful in diagnosing wrist pathology and in surgical planning.
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Affiliation(s)
- X Zhang
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - S Tham
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia; Department of Plastic and Hand Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia; Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia
| | - E T Ek
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia
| | - D McCombe
- Department of Plastic and Hand Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia; Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia
| | - D C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia.
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Tee R, Harvey JN, Tham SK, Ek ET. Medial Femoral Condyle Corticoperiosteal Flap for Failed Total Wrist Fusions. J Wrist Surg 2023; 12:288-294. [PMID: 37564622 PMCID: PMC10411124 DOI: 10.1055/s-0043-1760737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 12/03/2022] [Indexed: 01/22/2023]
Abstract
Background Recalcitrant nonunion following total wrist arthrodesis is a rare but challenging problem. Most commonly, in the setting of failed fusion after multiple attempts of refixation and cancellous bone grafting, the underlying cause for the failure is invariably multifactorial and is often associated with a range of host issues in addition to poor local soft-tissue and bony vascularity. The vascularized medial femoral condyle corticoperiosteal (MFC-CP) flap has been shown to be a viable option in a variety of similar settings, which provides vascularity and rich osteogenic progenitor cells to a nonunion site, with relatively low morbidity. While its utility has been described for many other anatomical locations throughout the body, its use for the treatment of failed total wrist fusions has not been previously described in detail in the literature. Methods In this article, we outline in detail the surgical technique for MFC-CP flap for the management of recalcitrant aseptic nonunions following failed total wrist arthrodesis. We discuss indications and contraindications, pearls and pitfalls, and potential complications of this technique. Results Two illustrative cases are presented of patients with recalcitrant nonunions following multiple failed total wrist fusions. Conclusion When all avenues have been exhausted, a free vascularized corticoperiosteal flap from the MFC is a sound alternative solution to achieve union, especially when biological healing has been compromised. We have been able to achieve good clinical outcomes and reliable fusion in this difficult patient population.
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Affiliation(s)
- Richard Tee
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Jason N. Harvey
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
- Orthosport Victoria, Richmond, Melbourne, Victoria, Australia
| | - Stephen K. Tham
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
- Victorian Hand Surgery Associates, Fitzroy, Melbourne, Victoria, Australia
| | - Eugene T. Ek
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
- Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia
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Ernstbrunner L, Robinson DL, Huang Y, Wieser K, Hoy G, Ek ET, Ackland DC. The Influence of Glenoid Bone Loss and Graft Positioning on Graft and Cartilage Contact Pressures After the Latarjet Procedure. Am J Sports Med 2023; 51:2454-2464. [PMID: 37724693 DOI: 10.1177/03635465231179711] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Glenohumeral joint contact loading before and after glenoid bone grafting for recurrent anterior instability remains poorly understood. PURPOSE To develop a computational model to evaluate the influence of glenoid bone loss and graft positioning on graft and cartilage contact pressures after the Latarjet procedure. STUDY DESIGN Controlled laboratory study. METHODS A finite element model of the shoulder was developed using kinematics, muscle and glenohumeral joint loading of 6 male participants. Muscle and joint forces at 90° of abduction and external rotation were calculated and employed in simulations of the native shoulder, as well as the shoulder with a Bankart lesion, 10% and 25% glenoid bone loss, and after the Latarjet procedure. RESULTS A Bankart lesion as well as glenoid bone loss of 10% and 25% significantly increased glenoid and humeral cartilage contact pressures compared with the native shoulder (P < .05). The Latarjet procedure did not significantly increase glenoid cartilage contact pressure. With 25% glenoid bone loss, the Latarjet procedure with a graft flush with the glenoid and the humerus positioned at the glenoid half-width resulted in significantly increased humeral cartilage contact pressure compared with that preoperatively (P = .023). Under the same condition, medializing the graft by 1 mm resulted in humeral cartilage contact pressure comparable with that preoperatively (P = .097). Graft lateralization by 1 mm resulted in significantly increased humeral cartilage contact pressure in both glenoid bone loss conditions (P < .05). CONCLUSION This modeling study showed that labral damage and greater glenoid bone loss significantly increased glenoid and humeral cartilage contact pressures in the shoulder. The Latarjet procedure may mitigate this to an extent, although glenoid and humeral contact loading was sensitive to graft placement. CLINICAL RELEVANCE The Latarjet procedure with a correctly positioned graft should not lead to increased glenohumeral joint contact loading. The present study suggests that lateral graft overhang should be avoided, and in the situation of large glenoid bone defects, slight medialization (ie, 1 mm) of the graft may help to mitigate glenohumeral joint contact overloading.
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Affiliation(s)
- Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - Dale L Robinson
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Yichen Huang
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Greg Hoy
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - Eugene T Ek
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
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Ernstbrunner L, Almond M, Rupasinghe HS, Jo OI, Zbeda RM, Ackland DC, Ek ET. Biomechanical Comparison of Distal Biceps Tendon Repair Techniques: Extracortical Single-Button Inlay Fixation Versus Intracortical Double-Button Onlay Anatomic Footprint Fixation. Am J Sports Med 2023:3635465231171131. [PMID: 37184036 DOI: 10.1177/03635465231171131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Extracortical single-button (SB) inlay repair is a commonly used distal biceps tendon technique. However, complications (eg, neurovascular injury) and nonanatomic repairs have led to the development of intracortical fixation techniques. PURPOSE To compare the biomechanical stability of extracortical SB repair with an anatomic intracortical double-button (DB) repair technique. STUDY DESIGN Controlled laboratory study. METHODS The distal biceps tendon was transected in 18 cadaveric elbows from 9 donors. One elbow of each donor was randomly assigned to the extracortical SB or anatomic DB group. Both groups were cyclically loaded with 60 N over 1000 cycles between 90° of flexion and full extension. The elbow was then fixed in 90° of flexion and the repair construct loaded to failure. Gap formation and construct stiffness during cyclic loading and ultimate load to failure were analyzed. RESULTS When compared with the extracortical SB technique after 1000 cycles, the anatomic DB technique showed significantly less gap formation (mean ± SD, 2.7 ± 0.8 vs 1.5 ± 0.9 mm; P = .017) and significantly more construct stiffness (87.4 ± 32.7 vs 119.9 ± 31.6 N/mm; P = .023). Ultimate load to failure was not significantly different between the groups (277 ± 93 vs 285 ± 135 N; P = .859). The failure mode in the anatomic DB group was significantly different from that of the extracortical SB technique (P = .002) and was due to fracture avulsion of the cortical button in 7 of 9 specimens (vs none in the SB group). CONCLUSION Our study shows that the intracortical DB technique produces equivalent or superior biomechanical performance to that of the SB technique. The DB technique may offer a clinically viable alternative to the SB repair technique. CLINICAL RELEVANCE This study suggests, at worst, an equivalent and, at best, a superior biomechanical performance of intracortical anatomic DB footprint repair at the time of surgery. However, the mode of failure suggests that this technique should not be used in patients with poor bone quality.
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Affiliation(s)
- Lukas Ernstbrunner
- Melbourne Orthopaedic Group, Melbourne, Australia
- Hand and Wrist Biomechanics Laboratory, O'Brien Institute / St Vincent's Institute, Fitzroy, Australia
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Australia
| | - Mitchell Almond
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
| | - Harshi S Rupasinghe
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
| | - Olivia I Jo
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Australia
| | | | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
| | - Eugene T Ek
- Melbourne Orthopaedic Group, Melbourne, Australia
- Hand and Wrist Biomechanics Laboratory, O'Brien Institute / St Vincent's Institute, Fitzroy, Australia
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Australia
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Jo OI, Almond M, Rupansinghe HS, Ackland DC, Ernstbrunner L, Ek ET. Biomechanical analysis of plating techniques for unstable lateral clavicle fractures with coracoclavicular ligament disruption (Neer type IIB). J Shoulder Elbow Surg 2023; 32:695-702. [PMID: 36535559 DOI: 10.1016/j.jse.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/01/2022] [Accepted: 11/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Neer type IIB lateral clavicle fractures are inherently unstable fractures with associated disruption of the coracoclavicular (CC) ligaments. Because of the high rate of nonunion and malunion, surgical fixation is recommended; however, no consensus has been reached regarding the optimal fixation method. A new plating technique using a superior lateral locking plate with anteroposterior (AP) locking screws, resulting in orthogonal fixation in the lateral fragment, has been designed to enhance stability and reduce implant failure. The purpose of this study was to biomechanically compare 3 different clavicle plating constructs within a fresh frozen human cadaveric shoulder model. METHODS Twenty-four fresh frozen cadaveric shoulders were randomized into 3 groups (n = 8 specimens): group 1, lateral locking plate only (Medartis Aptus Superior Lateral Plate); group 2, lateral locking plate with CC stabilization (No. 2 FiberWire); and group 3, lateral locking plate with 2 AP locking screws stabilizing the lateral fragment. All specimens were subject to cyclic loading of 70 N for 500 cycles. Data were analyzed for gap formation after cyclic loading, construct stiffness, and ultimate load to failure, defined by a marked decrease in the load displacement curve. RESULTS After 500 cycles, there was no statistically significant difference between the 3 groups in gap formation (P = .179). No specimen (0/24) failed during cyclic loading. Ultimate load to failure was significantly higher in group 3 compared to group 1 (286 N vs. 167 N; P = .022), but not to group 2 (286 N vs. 246 N; P = .604). There were no statistically significant differences in stiffness (group 1: 504 N/mm; group 2: 564 N/mm; group 3: 512 N/mm; P = .712). Peri-implant fracture was the primary mode of failure for all 3 groups, with group 3 demonstrating the lowest rate of peri-implant fractures (group 1: 6/8; group 2: 7/8; group 3: 4/8; P = .243). CONCLUSION Biomechanical evaluation of the clavicle plating techniques showed effective fixation across all specimens at 500 cycles. The lateral locking plate with orthogonal AP locking screw fixation in the lateral fragment demonstrated the greatest ultimate failure load, followed by the lateral locking plate with CC stabilization. This new plating technique showed compatible stiffness and gap formation when compared to conventional lateral locking plates as well as plates with CC fixation. The use of orthogonal screw fixation in the distal fragment may negate against the need for CC stabilization in these types of fractures, thus minimizing surgical dissection around the coracoid and potential complications.
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Affiliation(s)
- Olivia I Jo
- Melbourne Orthopaedic Group, Melbourne, VIC, Australia; Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Mitchell Almond
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Harshi S Rupansinghe
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Lukas Ernstbrunner
- Melbourne Orthopaedic Group, Melbourne, VIC, Australia; Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Eugene T Ek
- Melbourne Orthopaedic Group, Melbourne, VIC, Australia; Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute, Fitzroy, VIC, Australia; Department of Surgery, Monash Medical Centre, Monash University, Melbourne, VIC, Australia.
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Cassidy JT, Paszicsnyek A, Ernstbrunner L, Ek ET. Acromial and Scapular Spine Fractures following Reverse Total Shoulder Arthroplasty-A Systematic Review of Fixation Constructs and Techniques. J Clin Med 2022; 11:jcm11237025. [PMID: 36498600 PMCID: PMC9736861 DOI: 10.3390/jcm11237025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 11/29/2022] Open
Abstract
Fractures of the acromion and the scapular spine are established complications of reverse shoulder arthroplasty (RSA), and when they occur, the continuous strain by the deltoid along the bony fragments makes healing difficult. Evidence on treatment specific outcomes is poor, making the definition of a gold standard fixation technique difficult. The purpose of this systematic review is to assess whether any particular fixation construct offers improved clinical and/or radiographic outcomes. A systematic review of the literature on fixation of acromial and scapular spine fractures following RSA was carried out based on the guidelines of PRISMA. The search was conducted on PubMed, Embase, OVID Medline, and CENTRAL databases with strict inclusion and exclusion criteria applied. Methodological quality assessment of each included study was done using the modified Coleman methodology score to asses MQOE. Selection of the studies, data extraction and methodological quality assessment was carried out by two of the authors independently. Only clinical studies reporting on fixation of the aforementioned fractures were considered. Fixation construct, fracture union and time to union, shoulder function and complications were investigated. Nine studies reported on fixation strategies for acromial and scapular spine fractures and were therefore included. The 18 reported results related to fractures in 17 patients; 1 was classified as a Levy Type I fracture, 10 as a Levy Type II fracture and the remaining 7 fractures were defined as Levy Type III. The most frequent fixation construct in type II scapular spine fractures was a single plate (used in 6 of the 10 cases), whereas dual platin was the most used fixation for Levy Type III fractures (5 out of 7). Radiographic union was reported in 15 out of 18 fractures, whereas 1 patient (6.7%) had a confirmed non-union of a Levy Type III scapular spine fracture, requiring revision fixation. There were 5 complications reported, with 2 patients undergoing removal of metal and 1 patient undergoing revision fixation. The Subjective Shoulder Value and Visual Analogue Scale pain score averaged 75% and 2.6 points, respectively. The absolute Constant Score and the ASES score averaged 48.2 and 78.3 points, respectively. With the available data, it is not possible to define a gold standard surgical fixation but it seems that even when fracture union can be achieved, functional outcomes are moderate and there is an increased complication rate. Future studies are required to establish a gold standard fixation technique.
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Affiliation(s)
- J. Tristan Cassidy
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Melbourne, VIC 3181, Australia
| | - Alexander Paszicsnyek
- Department of Orthopaedic Surgery and Traumatology, General Hospital Oberndorf, Paracelsusstraße 37, 5110 Oberndorf, Austria
| | - Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, VIC 3050, Australia
- Department of Biomedical Engineering, University of Melbourne, Parkville, Melbourne, VIC 3010, Australia
| | - Eugene T. Ek
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Melbourne, VIC 3181, Australia
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, VIC 3181, Australia
- Correspondence: ; Tel.: +61-(3)-9573-9678; Fax: +61-(3)-9573-9688
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Cosic F, Ernstbrunner L, Hoy GA, Ooi KS, Ek ET. Case Report: Midshaft clavicle fracture with concomitant high grade (Type V) acromioclavicular joint dislocation. Front Surg 2022; 9:885378. [PMID: 36017522 PMCID: PMC9395734 DOI: 10.3389/fsurg.2022.885378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Concomitant acromioclavicular joint dislocation and midshaft clavicle fracture are rare injuries, generally resulting from high energy trauma, with limited previous experience in management. Case A 30 year old male presented following a pushbike accident. He had suffered a head on collision with another cyclist. Radiographic examination demonstrated a displaced midshaft clavicle fracture with a Rockwood Type V acromioclavicular joint dislocation. Operative management was undertaken using a dual plating technique. At six month follow up the patient demonstrated full range of motion and had no pain. Conclusion Appropriate radiographic evaluation and careful intraoperative assessment are required using the principles of management for acromioclavicular joint injuries, along with stabilization of the mid-clavicular fracture to reduce the risk of non-union.
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Affiliation(s)
- Filip Cosic
- Department of Orthopaedic Surgery, Austin Health, Heidelberg, VIC, Australia
- Correspondence: Filip Cosic
| | - Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Austin Health, Heidelberg, VIC, Australia
- Melbourne Orthopaedic Group, Windsor, VIC, Australia
| | - Greg A. Hoy
- Department of Orthopaedic Surgery, Austin Health, Heidelberg, VIC, Australia
- Melbourne Orthopaedic Group, Windsor, VIC, Australia
| | - Keat S. Ooi
- Department of Orthopaedic Surgery, Austin Health, Heidelberg, VIC, Australia
| | - Eugene T. Ek
- Department of Orthopaedic Surgery, Austin Health, Heidelberg, VIC, Australia
- Melbourne Orthopaedic Group, Windsor, VIC, Australia
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13
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Ernstbrunner L, Rupasinghe HS, Almond M, Jo OI, Zbeda RM, Oppy A, Treseder T, Pullen C, Ek ET, Ackland DC. A new all-suture tension band tape fixation technique for simple olecranon fractures versus conventional tension band wire fixation: a comparative biomechanics study. J Shoulder Elbow Surg 2022; 31:1376-1384. [PMID: 35167913 DOI: 10.1016/j.jse.2022.01.130] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/12/2022] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Simple transverse or short oblique olecranon fractures without articular comminution are classified as Mayo type IIA fractures and are typically treated with a tension band wire construct. Because of the high reoperation rates, frequently because of prominent hardware, all-suture tension band constructs have been introduced. It was the purpose to compare the biomechanical performance of conventional tension band wire fixation with a new all-suture tension band tape fixation for simple olecranon fractures. METHODS Mayo type IIA olecranon fractures were created in 20 cadaveric elbows from 10 donors. One elbow of each donor was randomly assigned to the tension band wire technique (group TBW) or tension band tape (Arthrex, 1.3-mm SutureTape) technique (group TBT). Both groups were cyclically loaded with 500 N over 500 cycles, after which a uniaxial displacement was performed to evaluate load to failure. Data were analyzed for gap formation after cyclic loading, construct stiffness, and ultimate load to failure, where failure was defined as fracture gap formation greater than 4.0 mm. RESULTS There was no significant difference in gap formation after 500 cycles between the TBW (1.8 mm ± 1.3 mm) and the TBT (1.9 mm ± 1.1 mm) groups (P = .854). The TBT showed a tendency toward greater construct stiffness compared with the TBW construct (mean difference: 142 N/mm; P = .053). Ultimate load to failure was not significantly different comparing both groups (TBW: 1138 N ± 286 N vs. TBT: 1126 N ± 272 N; P = .928). In both groups, all repairs failed because of >4.0-mm gap formation at the fracture site and none because of tension band construct breakage. CONCLUSIONS Our study shows that the TBT technique produces equivalent or superior biomechanical performance to the TBW for simple olecranon fractures. The TBT approach reduces the risk of hardware prominence and as a result mitigates against the need for hardware removal. The TBT technique offers a clinically viable alternative to TBW.
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Affiliation(s)
- Lukas Ernstbrunner
- Upper Limb Surgery, Melbourne Orthopaedic Group, Windsor, VIC, Australia; Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute, Melbourne, VIC, Australia; Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, Australia.
| | | | - Mitchell Almond
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, Australia
| | - Olivia I Jo
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Robert M Zbeda
- Upper Limb Surgery, Melbourne Orthopaedic Group, Windsor, VIC, Australia
| | - Andrew Oppy
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Thomas Treseder
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Christopher Pullen
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Eugene T Ek
- Upper Limb Surgery, Melbourne Orthopaedic Group, Windsor, VIC, Australia; Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute, Melbourne, VIC, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, Australia
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14
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Ek ET, Flynn JN, Boyce GN, Padmasekara G. The role of elbow positioning on arthroscopic assessment of the long head of biceps tendon in the beach chair position. ANZ J Surg 2022; 92:1820-1825. [PMID: 35557483 PMCID: PMC9541622 DOI: 10.1111/ans.17764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/03/2022] [Accepted: 04/23/2022] [Indexed: 11/27/2022]
Abstract
Background Tendinopathy of the long head of biceps (LHB) tendon is a common cause of anterior shoulder pain and dysfunction. The extra‐articular portion within the bicipital groove undergoes frequent load and friction during shoulder movements and pathology within this area is frequently missed during arthroscopic assessment. Methods We quantified the arthroscopically assessable length of tendon within the shoulder in 14 consecutive patients undergoing subpectoral biceps tenodesis. After biceps tenotomy at the superior labrum, the tagged tendon was maximally tensioned and marked at the biceps outlet with the elbow in extension and flexion. The distance in distance between the two were measured. Results Mean distance from the superior labral insertion of the biceps to the outlet was 16.4 ± 4.1 mm (range, 11–25). With tension on the biceps with elbow extension, the mean measurable distance was 31.3 ± 6.7 mm (range, 19–45). With elbow flexion, this increased to 39.5 ± 5.9 mm (range, 25–52). Mean increase in visible tendon length was 8.2 ± 4.3 mm (range, 5–21) (p = 0.002). Conclusion Elbow flexion results in an average increase of 26.2% more extra‐articular tendon visualized at arthroscopy. Therefore, we believe that elbow flexion is a useful adjunct, especially when performed in conjunction with techniques that pull the tendon into the joint, thus allowing for more complete arthroscopic assessment of the LHB, increasing detection of symptomatic biceps tendonitis. Level of evidence: Level IV.
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Affiliation(s)
- Eugene T Ek
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.,Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | | | - Glenn N Boyce
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
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15
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Ek ET, Wang KK, Bohan CM, Goulding NJ, Jamieson RP. Role of Tranexamic Acid in Arthroscopic Osteocapsular Release of the Elbow for Degenerative Arthritis. Orthop J Sports Med 2022; 10:23259671221089608. [PMID: 35464902 PMCID: PMC9019345 DOI: 10.1177/23259671221089608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Minimizing intra-articular bleeding and swelling is crucial in preventing the development of stiffness around the elbow. Tranexamic acid (TXA) has been shown to be an effective adjunct in reducing perioperative bleeding after surgery. Purpose: To determine the effect of intravenous (IV) TXA on postoperative drain tube output in arthroscopic osteocapsular release of the elbow for primary degenerative arthritis. Study Design: Cohort study; Level of evidence, 3. Methods: The authors performed a retrospective cohort study of 83 consecutive patients with primary degenerative elbow arthritis who underwent an arthroscopic osteocapsular release between 2015 and 2018. They organized patients into a no-TXA group (control) and a group that was given 1.0 g of IV TXA before tourniquet release. The primary outcome measure was drain tube output, and secondary outcome measures included postoperative day 1 pain levels on a visual analog scale and early range of motion at 8 weeks. Differences between groups were analyzed using 1-way analysis of variance, the Mann-Whitney U test, or the Fisher exact test. Results: There were 43 patients in the no-TXA group and 40 patients in the TXA group. Administration of IV TXA resulted in a 51% decrease in mean intra-articular bleeding for the TXA group, as measured via drain tube output (88.8 ± 80.5 mL [no-TXA] vs 43.4 ± 52.4 mL [TXA]; P = .0016). In both groups, there were significant increases in elbow arc of motion when compared with preoperative measurements. There were no between-group differences in early range of motion (129.7° ± 12.4° [no-TXA] vs 131.7° ± 9.2° [TXA]; P = .549) or postoperative pain (1.9 ± 2.2 [no-TXA] vs 1.5 ± 1.7 [TXA]; P = .89). Conclusion: In this study, IV TXA significantly reduced postoperative intra-articular bleeding in patients who underwent arthroscopic osteocapsular release of the elbow for primary degenerative arthritis. However, there were no differences in postoperative range of motion or pain between patients who received TXA and controls.
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Affiliation(s)
- Eugene T. Ek
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | - Kemble K. Wang
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
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Boekel P, Ek ET. Contamination Associated With Glove Changing Techniques in the Operating Theatre. Front Surg 2022; 9:839040. [PMID: 35392064 PMCID: PMC8980212 DOI: 10.3389/fsurg.2022.839040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background Sterility of the operative field during surgery is imperative in reducing the risk of infection. Most commonly, double gloves are worn by surgeons. When contamination occurs, the top gloves are changed intra-operatively. No studies have investigated which glove changing technique is best. Therefore, in this study, we aim to identify which top glove changing technique causes the least surface contamination. Methods Glitterbug™ (UV fluorescent powder) was applied to the top gloves of 3 individuals who changed their top gloves according to a randomised method – Method 1: 3 pairs worn, remove the outer pair; Method 2: 2 pairs worn, remove the top glove, replace unassisted; and Method 3: 2 pairs worn, remove the top glove, and replace assisted by a scrub nurse. A blinded investigator inspected for Glitterbug™ contamination under UV light. Results Two hundred and ten trials were performed and two types of contamination were identified, namely, direct contact and airborne spread. For absolute contamination, Method 1 had 59/64 (92%) contaminated trials, Method 2 had 49/65 (75%) contaminated trials, and Method 3 had 64/81 (79%) contaminated trials. This was statistically significant (p = 0.031). For direct contamination only, Method 1 had 38/64 (59%) contaminated trials, Method 2 had 24/65 (37%) contaminated trials, and Method 3 had 20/81 (25%) contaminated trials. This was statistically significant (p < 0.0001). Conclusions Method 2 had a statistically significant lower contamination rate overall, with Method 3 having the lowest direct contamination rate. We believe that wearing 2 gloves, removing the top glove and replacing it, either assisted or unassisted, could decrease surface contamination of the sterile field.
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Affiliation(s)
- Pamela Boekel
- Department of Orthopaedic Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
- *Correspondence: Pamela Boekel
| | - Eugene T. Ek
- Department of Orthopaedic Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
- Melbourne Orthopaedic Group, Melbourne, VIC, Australia
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, VIC, Australia
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17
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Ye X, Ek ET, Wang KK. Arthroscopic Ulnohumeral Joint Debridement and Transolecranon Microfracture for Osteochondritis Dissecans of the Humeral Trochlea. Arthrosc Tech 2022; 11:e285-e290. [PMID: 35256965 PMCID: PMC8897482 DOI: 10.1016/j.eats.2021.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/24/2021] [Indexed: 02/03/2023] Open
Abstract
Osteochondritis dissecans of the humeral trochlea is a rare cause of elbow pain adolescents. Despite being a juvenile form of osteochondritis dissecans, spontaneous resolution is not uniform, and more than one-half of patients experience ongoing pain, crepitus and loss of motion. Traditionally, nonsurgical management has been favoured as distal trochlea articular lesions were only accessible via olecranon osteotomy. Consequently, the threshold for intervention is high as the recovery prolonged. We present our technique of accessing the trochlear osteochondritis dissecans via ulnohumeral joint arthroscopy with transolecranon microfracture, which enables these lesions to be managed with reduced morbidity.
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Affiliation(s)
- Xuan Ye
- Department of Orthopaedic Surgery, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Eugene T. Ek
- Department of Orthopaedic Surgery, Royal Children’s Hospital, Parkville, Victoria, Australia,Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia,Department of Surgery, Monash University, Clayton, Victoria, Australia
| | - Kemble K. Wang
- Department of Orthopaedic Surgery, Royal Children’s Hospital, Parkville, Victoria, Australia,Melbourne Orthopaedic Surgeons, East Melbourne, Victoria, Australia,Department of Surgery, Monash University, Clayton, Victoria, Australia,Address correspondence to Kemble K. Wang, Melbourne Orthopaedic Surgeons, 170 Gipps St., East Melbourne, Victoria, Australia.
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18
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Galbraith JG, Huntington LS, Borbas P, Ackland DC, Tham SK, Ek ET. Biomechanical comparison of intramedullary screw fixation, dorsal plating and K-wire fixation for stable metacarpal shaft fractures. J Hand Surg Eur Vol 2022; 47:172-178. [PMID: 34018870 DOI: 10.1177/17531934211017705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We compared four methods of metacarpal shaft fixation: 2.2 mm intramedullary headless compression screw; 3.0 mm intramedullary headless compression screw; intramedullary K-wire fixation; and dorsal plate fixation. Transverse mid-diaphyseal fractures were created in 64 metacarpal sawbones and were assigned into four groups. Peak load to failure and stiffness were measured in cantilever bending and torsion. We found that dorsal plating had the highest peak load to failure. However, initial bending stiffness of the 3.0 mm intramedullary headless compression screw was higher than that of the dorsal plates. In torsion testing, dorsal plating had the highest peak torque, but there was no significant difference in torsional stiffness between the plate and intramedullary headless compression screw constructs. We concluded that intramedullary headless compression screw fixation is biomechanically superior to K-wires in cantilever bending and torsion; however, it is less stable than dorsal plating. In our study, the initial stability provided by K-wire fixation was sufficient to cope with expected loads in the early rehabilitation period, whereas dorsal plates and IHCS constructs provided stability far in excess of what is required.
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Affiliation(s)
- John G Galbraith
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, VIC, Australia
| | - Lachlan S Huntington
- Department of Biomechanical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Paul Borbas
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, VIC, Australia
| | - David C Ackland
- Department of Biomechanical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen K Tham
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, VIC, Australia.,Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute, Melbourne, VIC, Australia.,Department of Surgery, Monash University, Clayton, VIC, Australia This study was performed at the Department of Biomechanical Engineering, University of Melbourne, Australia, and the Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute
| | - Eugene T Ek
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, VIC, Australia.,Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute, Melbourne, VIC, Australia.,Department of Surgery, Monash University, Clayton, VIC, Australia This study was performed at the Department of Biomechanical Engineering, University of Melbourne, Australia, and the Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute
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Affiliation(s)
- Stephen K. Tham
- Hand Surgery Unit, St Vincent's Public Hospital and Dandenong Hospital, Melbourne, Australia
| | - Eugene T. Ek
- Department of Orthopaedic Surgery, University of Melbourne and at Dandenong Hospital, Monash University, Austin Hospital, Melbourne, Australia
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Jo O, Borbas P, Grubhofer F, Ek ET, Pullen C, Treseder T, Ernstbrunner L. Prosthesis Designs and Tuberosity Fixation Techniques in Reverse Total Shoulder Arthroplasty: Influence on Tuberosity Healing in Proximal Humerus Fractures. J Clin Med 2021; 10:jcm10184146. [PMID: 34575254 PMCID: PMC8468418 DOI: 10.3390/jcm10184146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 12/04/2022] Open
Abstract
Reverse total shoulder arthroplasty (RTSA) is increasingly used for the treatment of complex proximal humerus fractures and fracture sequelae. In 2021, half a dozen models of fracture stems are commercially available, reflecting its growing utility for fracture management. Prosthesis designs, bone grafting and tuberosity fixation techniques have evolved to allow better and more reliable fixation of tuberosities and bony ingrowth. Patients with anatomical tuberosity healing not only have an increased range of active anterior elevation and external rotation, but also experience fewer complications and longer prosthesis survival. This review provides an overview of recent evidence on basic and fracture-specific RTSA design features as well as tuberosity fixation techniques that can influence tuberosity healing.
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Affiliation(s)
- Olivia Jo
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (C.P.); (T.T.)
| | - Paul Borbas
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (P.B.); (F.G.)
| | - Florian Grubhofer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (P.B.); (F.G.)
| | - Eugene T. Ek
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia;
| | - Christopher Pullen
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (C.P.); (T.T.)
| | - Thomas Treseder
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (C.P.); (T.T.)
| | - Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (C.P.); (T.T.)
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (P.B.); (F.G.)
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia;
- Department of Biomedical Engineering, University of Melbourne, Parkville, Melbourne, VIC 3010, Australia
- Correspondence: ; Tel.: +41-44386-1111
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Keating C, McCombe D, Powell CA, Maloney P, Ek ET, Tham SK. Reconstruction of the Proximal Scaphoid With a Medial Femoral Trochlea Osteochondral Graft: Minimum 2-Year Results. J Hand Surg Am 2021; 46:248.e1-248.e9. [PMID: 33257054 DOI: 10.1016/j.jhsa.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 07/26/2020] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To report the clinical and radiological outcomes after medial femoral trochlear (MFT) osteochondral graft for the salvage of proximal scaphoid fractures with a minimum 2-year follow-up. METHODS A retrospective review was performed of patients with comminuted fractures of the proximal scaphoid treated by excision of the proximal pole and replacement with free vascularized MFT osteochondral graft. Demographic data, objective and radiographic measurements, and patient-reported outcome measures of the upper limb and knee were collected. Pain was assessed by completion of a visual analog scale (VAS). RESULTS Between February 2014 and May 2015, 12 MFT osteochondral grafts were performed. Eight patients were available for follow-up at a mean of 34 months (range, 28-39 months). The mean range of wrist flexion was 31° (range, 15°-60°), extension was 34° (range, 5°-60°), radial deviation was 9° (range, 0°-20°), ulnar deviation was 28° (range, 10°-45°) and grip strength was 42 kg (range, 25-53 kg). The median wrist pain, as measured by VAS, was 0.7 (mean, 1.3; range, 0-6). The average follow-up scapholunate, radiolunate, and radioscaphoid angles were 58.9° (range, 44°-93°), 12.9° (range, 0°-30°), and 46.0° (range, 35°-63°), respectively. The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 13.9 (range, 3-43) and Patient Rated Wrist Evaluation (PRWE) score was 22.4 (range, 2-68). The mean postoperative Oxford Knee Score was 42 (range, 14-48). One patient suffered notable knee pain at 37-month follow-up. One patient suffered notable pain on the radial side of the wrist and underwent scaphoid excision and 4-corner arthrodesis. CONCLUSIONS Replacement of the fragmented proximal scaphoid by MFT graft is an alternative to other salvage options and most patients can expect pain relief and acceptable wrist motion. These results need to be balanced against the potential for donor-site morbidity. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Cameron Keating
- Hand Surgery Unit, Department of Plastic Surgery, St. Vincent's Hospital, Melbourne, Australia
| | - David McCombe
- Hand Surgery Unit, Department of Plastic Surgery, St. Vincent's Hospital, Melbourne, Australia; Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, St. Vincent Institute, Melbourne, Australia
| | - Christopher A Powell
- Hand Surgery Unit, Department of Plastic Surgery, St. Vincent's Hospital, Melbourne, Australia
| | - Peter Maloney
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, Australia
| | - Eugene T Ek
- Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, St. Vincent Institute, Melbourne, Australia; Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, Australia
| | - Stephen K Tham
- Hand Surgery Unit, Department of Plastic Surgery, St. Vincent's Hospital, Melbourne, Australia; Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, St. Vincent Institute, Melbourne, Australia; Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, Australia.
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Ek ET, Philpott AJ, Flynn JN, Richards N, Hardidge AJ, Rotstein AH, Wood AD. Characterization of the Proximal Long Head of Biceps Tendon Anatomy Using Magnetic Resonance Imaging: Implications for Biceps Tenodesis. Am J Sports Med 2021; 49:346-352. [PMID: 33315467 DOI: 10.1177/0363546520976630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biceps tenodesis is a common treatment for proximal long head of biceps (LHB) tendon pathology. To maintain biceps strength and contour and minimize cramping, restoration of muscle-length tension and appropriate positioning of the tenodesis is key. Little is known about the biceps musculotendinous junction (MTJ) anatomy, especially in relation to the overlying pectoralis major tendon (PMT), which is a commonly used landmark for tenodesis positioning. PURPOSE To characterize the in vivo topographic anatomy of the LHB tendon, in particular the MTJ relative to the PMT, using a novel axial proton-density magnetic resonance imaging (MRI) sequence. STUDY DESIGN Descriptive laboratory study. METHODS In total, 45 patients having a shoulder MRI for symptoms unrelated to their biceps tendon or rotator cuff were prospectively recruited. There were 33 men and 12 women, with a mean age of 37 ± 13 years (range, 18-59 years). All patients underwent routine shoulder MRI scans with an additional axial proton density sequence examining the LHB tendon and its MTJ. Three independent observers reviewed each MRI scan, and measurements were obtained for (1) MTJ length, (2) the distance between the proximal MTJ and the superior border of the PMT (MTJ-S), (3) the distance between the distal MTJ to the inferior border of the PMT, and (4) the width of the PMT. RESULTS The average position of the MTJ-S was 5.9 ± 10.8 mm distal to the superior border of the PMT. The mean MTJ length was 32.5 ± 8.3 mm and the width of the PMT was 28.0 ± 7.3 mm. We found no significant correlation between patient age, height, sex, or body mass index and any of the biceps measurements. We observed wide variability of the MTJ-S position and identified 3 distinct types of biceps MTJ: type 1, MTJ-S above the PMT; type 2, MTJ-S between 0 and 10 mm below the superior border of the PMT; and type 3, MTJ-S >10 mm distal to the superior PMT. CONCLUSION In this study, the in vivo anatomy of the LHB tendon is characterized relative to the PMT using a novel MRI sequence. The results demonstrate wide variability in the position of the MTJ relative to the PMT, which can be classified into 3 distinct subtypes or zones relative to the superior border of the PMT. Understanding this potentially allows for accurate and anatomic placement of the biceps tendon for tenodesis. CLINICAL RELEVANCE To our knowledge, this is the first study to radiologically analyze the in vivo topographic anatomy of the LHB tendon and its MTJ. The results of this study provide more detailed understanding of the variability of the biceps MTJ, thus allowing for more accurate placement of the biceps tendon during tenodesis.
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Affiliation(s)
- Eugene T Ek
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | - Andrew J Philpott
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Nada Richards
- Victoria House Medical Imaging, Melbourne, Victoria, Australia
| | - Andrew J Hardidge
- Department of Orthopaedic Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Ayla D Wood
- Department of Orthopaedic Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Abstract
Objective This study systematically reviews the outcomes of surgical repair of triangular fibrocartilage complex (TFCC) tears. Existing surgical techniques include capsular sutures, suture anchors, and transosseous sutures. However, there is still no consensus as to which is the most reliable method for ulnar-sided peripheral and foveal TFCC tears. Methods A systematic review of MEDLINE and EMBASE was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The focus was on traumatic Palmer 1B ulna-sided tears. Twenty-seven studies were included, including three comparative cohort studies. Results There was improvement in all functional outcome measures after repair of TFCC tears. The outcomes following peripheral and foveal repairs were good overall: Mayo Modified Wrist Evaluation (MMWE) score of 80.1 and 85.1, Disabilities of the Arm, Shoulder and Hand (DASH) score of 15.7 and 15.8, grip strength of 80.3 and 92.7% (of the nonoperated hand), and pain intensity score of 2.1 and 1.7, respectively. For peripheral tears, transosseous suture technique achieved better outcomes compared with capsular sutures in terms of grip strength, pain, Patient-Rated Wrist Evaluation (PRWE), and DASH scores (grip 85.8 vs. 77.7%; pain 1.5 vs. 2.2; PRWE 11.6 vs. 15.8; DASH 14.4 vs. 16.1). For foveal tears, transosseous sutures achieved overall better functional outcomes compared with suture anchors (MMWE 85.4 vs. 84.9, DASH 10.9 vs. 20.6, pain score 1.3 vs. 2.1), but did report slightly lower grip strength than the group with suture anchors (90.2 vs. 96.2%). Arthroscopic techniques achieved overall better outcomes compared with open repair technique. Conclusion Current evidence demonstrates that TFCC repair achieves good clinical outcomes, with low complication rates. Level of Evidence This is a Level IV, therapeutic study.
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Affiliation(s)
- Edward H. Liu
- Department of Orthopaedic Surgery, Division of Hand Surgery, Monash University, Dandenong Hospital, Melbourne, Victoria, Australia
| | - Kary Suen
- Department of Orthopaedic Surgery, Division of Hand Surgery, Monash University, Dandenong Hospital, Melbourne, Victoria, Australia
| | - Stephen K. Tham
- Department of Orthopaedic Surgery, Division of Hand Surgery, Monash University, Dandenong Hospital, Melbourne, Victoria, Australia
- Victorian Hand Surgery Associates, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Monash Medical Centre, Melbourne, Victoria, Australia
- Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute Fitzroy, Melbourne, Victoria, Australia
| | - Eugene T. Ek
- Department of Orthopaedic Surgery, Division of Hand Surgery, Monash University, Dandenong Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Monash Medical Centre, Melbourne, Victoria, Australia
- Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute Fitzroy, Melbourne, Victoria, Australia
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
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Ek ET, Johnson PR, Bohan CM, Padmasekara G. Clinical Outcomes of Double-Screw Fixation with Autologous Bone Grafting for Unstable Scaphoid Delayed or Nonunions with Cavitary Bone Loss. J Wrist Surg 2021; 10:9-16. [PMID: 33552688 PMCID: PMC7850798 DOI: 10.1055/s-0040-1714252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/03/2020] [Indexed: 10/23/2022]
Abstract
Objective This study reports on the clinical outcomes of double screw fixation with autologous cancellous bone grafting and early active range of motion for delayed and nonunited scaphoid waist fractures with cavitary segmental bone loss. Patients and Methods Twenty-one consecutive patients underwent fixation using two 2.2 mm antegrade headless compression screws with autologous distal radius cancellous bone graft. Postoperatively, patients were allowed early active motion with a resting splint until union was achieved. Patients were reviewed radiologically and clinically to assess for fracture union, complications, residual pain, wrist function, and return to work and recreational activities. Results All but one patient was male, and the mean age was 23 years (range, 15-38 years). The average time from initial injury was 16 months (range, 3-144 months). Nineteen of 21 (90.5%) patients achieved union at a mean of 2.8 months (range, 1.4-9.2 months). Of the patients who failed, one underwent revision surgery with vascularized bone grafting at 10.6 months. The other patient refused further intervention as he was asymptomatic. Conclusion Double-screw fixation with bone grafting and early active range of motion is a safe and effective technique for management of delayed and nonunited unstable scaphoid fractures with cavitary bone loss. This potentially allows for earlier return to function, without compromise to union rates. Level of Evidence This is a Level IV, retrospective case series study.
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Affiliation(s)
- Eugene T. Ek
- Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Monash Medical Centre, Clayton, Melbourne, Victoria, Australia
| | - Paul R. Johnson
- Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia
| | - Carmel M. Bohan
- Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia
| | - Gayan Padmasekara
- Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia
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Ek ET, Johnson PR, Bohan CM, Padmasekara G. Autologous bone grafting and double screw fixation for unstable scaphoid nonunions with cavitary bone loss. J Hand Surg Eur Vol 2021; 46:205-206. [PMID: 32746686 DOI: 10.1177/1753193420946656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Eugene T Ek
- Melbourne Orthopaedic Group, Windsor, VIC, Australia.,Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, VIC, Australia.,Department of Surgery, Monash Medical Centre, Monash University, Melbourne, VIC, Australia
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26
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Liu EH, Schulz PD, Ek ET. Periprosthetic fracture of the scaphoid after successful headless compression screw fixation: report of two cases. J Hand Surg Eur Vol 2020; 45:1093-1095. [PMID: 32536297 DOI: 10.1177/1753193420930593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Edward H Liu
- Division of Hand Surgery, Monash University, Melbourne, VIC, Australia
| | | | - Eugene T Ek
- Division of Hand Surgery, Monash University, Melbourne, VIC, Australia.,Department of Surgery, Monash University, Melbourne, VIC, Australia.,Melbourne Orthopaedic Group, Melbourne, VIC, Australia
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Borbas P, Eid K, Ek ET, Ricks M, Feigl G, Jeserschek JM. A cadaveric study of the three different palpation-guided techniques for glenohumeral joint injections. Shoulder Elbow 2020; 12:399-403. [PMID: 33281944 PMCID: PMC7689608 DOI: 10.1177/1758573219869332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/10/2019] [Accepted: 07/12/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND It is not known whether an anterior, posterior or superior approach using the Neviaser portal is more accurate for glenohumeral joint injections. The aim of this study was to evaluate the accuracy of the palpation-guided technique and compare the three different approaches. METHODS Palpation-guided glenohumeral joint injections were performed in 48 shoulders (24 cadavers) by two operators. Each shoulder was injected by three different approaches with a different coloured latex solution. The three approaches included the anterior, posterior and superior methods. The accuracy and location of unsuccessful injections were assessed through dissection of the shoulders. RESULTS Posterior injections were the most successful with an accuracy rate of 89.6%, followed by anterior injections (75%) and superior injections (54.2%). Both posterior (p = 0.0001) and anterior injections (p = 0.03) were statistically significantly more accurate than superior injections. The most common failure mode was an intratendinous or intramuscular injection, which occurred most frequently with a superior approach. CONCLUSIONS Use of a superior approach through the Neviaser portal for the palpation-guided technique for glenohumeral joint injections showed a statistically significant inferior accuracy when compared to both the posterior and anterior approaches and is therefore not recommended. Posterior approached injections were the most accurate.
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Affiliation(s)
- Paul Borbas
- Department of Orthopaedics, Cantonal Hospital Baden, Baden, Switzerland,Melbourne Orthopaedic Group and Department of Surgery, Monash University, Melbourne, Australia,Paul Borbas, Kantonsspital Baden, Im Ergel 1, Baden 5404, Switzerland.
| | - Karim Eid
- Department of Orthopaedics, Cantonal Hospital Baden, Baden, Switzerland
| | - Eugene T Ek
- Melbourne Orthopaedic Group and Department of Surgery, Monash University, Melbourne, Australia
| | - Matthew Ricks
- Melbourne Orthopaedic Group and Department of Surgery, Monash University, Melbourne, Australia
| | - Georg Feigl
- Institute of Macroscopical and Clinical Anatomy, Medical University of Graz, Graz, Austria
| | - Julian M Jeserschek
- Institute of Macroscopical and Clinical Anatomy, Medical University of Graz, Graz, Austria
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McBride AP, Brais G, Wood T, Ek ET, Hoy G. Stress reactions and fractures around the elbow in athletes. J Sci Med Sport 2020; 24:425-429. [PMID: 33223454 DOI: 10.1016/j.jsams.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/15/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
Stress fractures of the upper limb affect athletes from a wide range of sports. Athletes involved in throwing sports are particularly susceptible along with athletes from sports involving high repetitive and compressive loads such as gymnastics. Diagnosis can be made from clinical history, examination and radiography in some cases however MRI imaging is often required for definitive diagnosis. The mainstay of management is rest and activity modification however advanced pathology often requires surgical management for successful resolution and return to play. In the elbow, the bones susceptible to excessive stress in sport are the distal humerus, the olecranon process of the ulna, the coronoid process of the ulna, the sublime tubercle and the radial head. In immature patients, medial epicondyle apophysis is the most common location. The article presents a narrative review of the literature.
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Affiliation(s)
| | | | - Tim Wood
- Melbourne Orthopaedic Group, Australia
| | | | - Greg Hoy
- Melbourne Orthopaedic Group, Australia
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Boyce GN, Philpott AJ, Ackland DC, Ek ET. Single versus dual orthogonal plating for comminuted midshaft clavicle fractures: a biomechanics study. J Orthop Surg Res 2020; 15:248. [PMID: 32646450 PMCID: PMC7346347 DOI: 10.1186/s13018-020-01771-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Dual orthogonal plating of clavicle fractures may provide greater stiffness and strength than unilateral plate constructs and allow the use of lower-profile plates. We aim to biomechanically compare three clavicle plating constructs in a comminuted clavicle fracture model. METHOD Fifteen clavicle sawbones were osteotomised, simulating a comminuted midshaft fracture and allocated to either: group 1, single superior plate (3.5 mm superior plate); group 2, combination plating (3.5 mm superior plate, 2.8 mm anterior plate) and group 3, dual mini-plates (two 2.8-mm orthogonal mini-plates). Specimens were biomechanically tested under torsion and cantilever bending. Construct stiffness (Nm/degree) and load to failure (Nm) were measured. RESULTS Group 2 had higher torsional (0.70 vs. 0.60 Nm/deg, p = 0.017) and cantilever bending stiffness (0.61 vs. 0.51 Nm/deg, p = 0.025) than group 1. Group 3 had lower cantilever bending stiffness (0.39 vs. 0.51 Nm/deg, p < 0.004) and load to failure (40.87 vs. 54.84 Nm, p < 0.01) than group 1. All dual plate constructs that catastrophically failed did so from fracture at the lateral ends of the plates. Single plate constructs failed due to plate bending. CONCLUSION Dual orthogonal fixation with mini-plates demonstrated lower stiffness and strength than traditional superior plating. The addition of an anterior mini-plate to a traditional superior plating improved construct stiffness and may have a role in patients seeking early return to activity. LEVEL OF EVIDENCE Basic science biomechanical study.
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Affiliation(s)
- Glenn N Boyce
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Melbourne, VIC, 3181, Australia
- Department of Orthopaedic Surgery, Bendigo Health, Bendigo, VIC, Australia
| | - Andrew J Philpott
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Melbourne, VIC, 3181, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Eugene T Ek
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Melbourne, VIC, 3181, Australia.
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, VIC, Australia.
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Abstract
Isolated proximal radioulnar joint instability is an uncommon and often challenging problem that may manifest as recurrent instability of the proximal aspect of the radius, usually during forearm pronation and supination. Instability is due to deficiency of the stabilizing structures around the proximal aspect of the radius, and biomechanical studies have highlighted the importance of the annular ligament and the interosseous membrane in both transverse and longitudinal plane stability. Reconstruction of the stabilizing structures around the radial head often is indicated in cases of recurrent instability and includes joint-preserving procedures such as annular ligament reconstruction, proximal ulnar osteotomy, and interosseous membrane reconstruction. Rarely, salvage procedures such as interpositional arthroplasty or 1-bone forearm reconstruction are necessary. A thorough understanding of the anatomic structures that stabilize the proximal aspect of the radius and the complexities of forearm biomechanics is required in order to successfully diagnose and manage this condition.
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Affiliation(s)
| | - Eugene T Ek
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.,Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
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Borbas P, Eid K, Ek ET, Feigl G. Innervation of the acromioclavicular joint by the suprascapular nerve. Shoulder Elbow 2020; 12:178-183. [PMID: 32565919 PMCID: PMC7285973 DOI: 10.1177/1758573219851005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/29/2019] [Accepted: 04/24/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND The suprascapular nerve is largely responsible for the majority of the sensory innervation of the acromioclavicular joint. In this anatomical study, we describe, in detail, the anatomy of the sensory innervation of the acromioclavicular joint by the branches of the suprascapular nerve. METHODS Twenty-seven shoulders from 17 cadaveric specimens were carefully dissected to identify the course of the suprascapular nerve, with the main focus being on the sensory innervation of the acromioclavicular joint. Nine specific measurements of the acromioclavicular joint sensory nerves were made of each shoulder in relation to distinct anatomical landmarks to determine the mean location and course of these nerves. RESULTS In all 27 shoulders (100%), a sensory branch to the acromioclavicular joint with a proximal origin from the suprascapular nerve could be depicted ("first sensory branch"). The mean length of this branch was 4.3 cm (range: 3.3-5.3 cm). In 14 shoulders (52%), a further sensory branch of the suprascapular nerve innervating the posterior acromioclavicular joint capsule could be identified ("second sensory branch"). DISCUSSION A detailed anatomical description of the sensory innervation of the acromioclavicular joint from suprascapular nerve branches was performed, which can potentially aid in the development of more focused anesthetic blockades and acromioclavicular joint denervation procedures.
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Affiliation(s)
- Paul Borbas
- Center for Orthopedic Surgery, State Hospitals Aarau and Baden, Baden, Switzerland,Institute of Macroscopical and Clinical Anatomy, Medical University of Graz, Graz, Austria *Current affiliation: Department of Orthopaedics, Cantonal Hospital Baden, Baden, Switzerland,Paul Borbas, Kantonsspital Baden, Im Ergel 1, 5404 Baden, Switzerland.
| | - Karim Eid
- Center for Orthopedic Surgery, State Hospitals Aarau and Baden, Baden, Switzerland,Institute of Macroscopical and Clinical Anatomy, Medical University of Graz, Graz, Austria *Current affiliation: Department of Orthopaedics, Cantonal Hospital Baden, Baden, Switzerland
| | - Eugene T Ek
- Melbourne Orthopaedic Group and Department of Surgery, Monash University, Melbourne, Australia
| | - Georg Feigl
- Institute of Macroscopical and Clinical Anatomy, Medical University of Graz, Graz, Austria *Current affiliation: Department of Orthopaedics, Cantonal Hospital Baden, Baden, Switzerland
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Crepaldi BE, Keating C, Ek ET, Tham SKY. Medial Femoral Trochlea Graft for Scaphoid Waist Nonunion: A Case Report and Review of the Literature. J Wrist Surg 2020; 9:186-189. [PMID: 32509420 PMCID: PMC7263860 DOI: 10.1055/s-0039-3401015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 11/01/2019] [Indexed: 10/25/2022]
Abstract
The medial femoral trochlea (MFT) of the knee is a donor site for convex osteochondral vascularized bone that has been used for the salvage of fractures of the proximal pole of the scaphoid. Chronic nonunited fractures of the scaphoid may lead to a sequence of degenerative change often referred to as scaphoid nonunion advance collapse. The vascularized MFT osteochondral graft has been reported as a salvage procedure for fractures of the proximal pole of the scaphoid, in situations where fixation is not an option. In this "Special review," we describe the technique of free vascularized MFT graft in a case in which the nonunited scaphoid fracture was associated with segmental loss of the articular surface of the scaphoid waist. Given the likely progression of arthritis, if left untreated, we elected to treat this by replacing the lost articular surface using a vascularized intercalary osteochondral MFT graft between the nonunited scaphoid segments.
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Affiliation(s)
- Bruno E. Crepaldi
- St. Vincent's Hand Surgery Unit, Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia
| | - Cameron Keating
- St. Vincent's Hand Surgery Unit, Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia
| | - Eugene T. Ek
- Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia
- Dandenong Hospital Hand Unit, Dandenong, Victoria, Australia
| | - Stephen K. Y. Tham
- St. Vincent's Hand Surgery Unit, Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia
- Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia
- Dandenong Hospital Hand Unit, Dandenong, Victoria, Australia
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Ek ET, Perret MC, Borbas P. Arthroscopic Knotless Repair of Complete Full-Thickness Tears of the Subscapularis Tendon Through a Single Portal. Arthrosc Tech 2020; 9:e439-e443. [PMID: 32368462 PMCID: PMC7188956 DOI: 10.1016/j.eats.2019.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/19/2019] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic repair of subscapularis tendon tears has shown to be a reliable and reproducible technique and is now considered the gold standard method over open repair. However, most arthroscopic techniques use several working portals and the procedure can be technically challenging and time-consuming, especially when knot-tying is required and when multiple anchors are used. Recently, single-portal knotless techniques have been popularized for upper-third lesions (e.g. Lafosse type 1 or 2 tears). Here, we describe a technique of repairing complete tears of the subscapularis tendon (Lafosse type 3 and 4) using knotless suture anchors through a single portal. This technique is quick and allows a safe anatomic footprint repair to the lesser tuberosity.
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Affiliation(s)
- Eugene T. Ek
- Melbourne Orthopaedic Group, Windsor, Melbourne,Department of Surgery, Monash Medical Centre, Monash University, Clayton, Victoria, Australia,Address correspondence to A/Prof. Eugene T. Ek, M.B.B.S., Ph.D., F.R.A.C.S., Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Melbourne, 3181, VIC, Australia.
| | | | - Paul Borbas
- Melbourne Orthopaedic Group, Windsor, Melbourne
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Borbas P, Churchill J, Ek ET. Surgical management of chronic high-grade acromioclavicular joint dislocations: a systematic review. J Shoulder Elbow Surg 2019; 28:2031-2038. [PMID: 31350107 DOI: 10.1016/j.jse.2019.03.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/10/2019] [Accepted: 03/13/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND To date, no gold-standard technique exists for the treatment of chronic acromioclavicular joint (ACJ) instability. We systematically reviewed the clinical results of 3 main categories of ACJ reconstruction for high-grade chronic instability. METHODS A literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The inclusion criteria were clinical studies involving patients with ACJ instability (Rockwood grades III-VI) for at least 6 weeks, managed with ACJ stabilization, with a minimum 1-year follow-up. Depending on the surgical technique, patients were divided into 1 of 3 groups: nonbiological fixation between the coracoid and clavicle, for example, suture loops and synthetic ligaments (group 1); biological reconstruction of the coracoclavicular ligaments, for example, allograft or autograft ligament reconstruction (group 2); and ligament and/or tendon transfer, for example, the Weaver-Dunn procedure (group 3). Patient demographic characteristics, functional scores, radiographic outcomes, and complications were compared. RESULTS Two independent investigators reviewed 960 articles. A total of 27 studies met the inclusion criteria, comprising 590 patients divided into 1 of 3 groups. The complication rates were similar among the 3 groups: 15% for nonbiological fixation, 15% for biological reconstruction, and 17% for ligament and/or tendon transfer, with failure rates of 8%, 7%, and 5%, respectively. In terms of functional results, the mean Constant score was 87.2 points for nonbiological fixation (n = 89), 92.4 points for biological reconstruction (n = 86), and 87.4 points for ligament and/or tendon transfer (n = 49). CONCLUSION On comparison of the results of 3 different ACJ reconstruction methods, all techniques showed similar complication rates. Among the level II studies, ACJ reconstruction with a tendon graft showed superior results.
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Affiliation(s)
- Paul Borbas
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
| | | | - Eugene T Ek
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia; Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia.
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Sikora SK, Tham SK, Harvey JN, Garcia-Elias M, Goldring T, Rotstein AH, Ek ET. The Twist X-Ray: A Novel Test for Dynamic Scapholunate Instability. J Wrist Surg 2019; 8:61-65. [PMID: 30723604 PMCID: PMC6358452 DOI: 10.1055/s-0038-1673344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
Background Scapholunate instability (SLI) is the most common form of carpal instability. Early detection of SLI is imperative as early reconstructive procedures can potentially prevent the natural history of progressive degenerative arthritis. After wrist arthroscopy, magnetic resonance imaging (MRI) remains the next best noninvasive diagnostic option; however, access still remains costly and is often limited in many health care systems worldwide. In this article, we describe a novel device that allows for dynamic X-rays to be taken, accentuating the scapholunate (SL) widening. Description of Technique Twist X-ray views are generated by the patient clenching a device that combines the standard clenched fist views with ulnar deviation and supination. The test is easy to perform and functions by combining a higher grip force with the ulnar deviation and pronation effects of the extensor carpi ulnaris tendon, thus accentuating the SL gap in dynamic instability. Patients and Methods We present a series of four patients with dynamic SLI and compare the findings of the Twist X-rays with conventional wrist X-rays series, including standard anteroposterior, lateral, radial, and ulna deviation, clenched fist, and pencil grip views. Results In all the four patients, there was substantial dynamic SL widening. The SL interval increased from a mean of 1.8 mm (range: 1.5-2.8) on posteroanterior X-rays to 6.3 mm (range: 4.6-8.2) with the Twist views. Interestingly, on the pencil grip view, the mean widening was only 1.5 mm (range: 1-2.8 mm). Conclusion The authors describe a novel device that allows for improved detection of dynamic SL ligament instability when performing stress X-ray views of the wrist. Level of Evidence This is a Level IV study.
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Affiliation(s)
- Sheena K. Sikora
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, Australia
| | - Stephen K. Tham
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, Australia
- Victorian Hand Surgery Associates, Melbourne, Victoria, Australia
| | - Jason N. Harvey
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, Australia
- Orthosports Victoria, Epworth Hospital, Melbourne, Victoria, Australia
| | | | - Tony Goldring
- Victoria House Medical Imaging, Melbourne, Victoria, Australia
| | | | - Eugene T. Ek
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, Australia
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
- Department of Surgery, Monash Medical Centre, Monash University, Australia
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Jamieson RP, Harvey JN, Ek ET. Bipolar osteoarticular reconstruction of the radioscaphoid joint. J Hand Surg Eur Vol 2019; 44:211-213. [PMID: 30282503 DOI: 10.1177/1753193418802559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Richard P Jamieson
- 1 Division of Hand Surgery, Dandenong Hospital, Monash University, Melbourne, Australia.,2 Melbourne Orthopaedic Group, Melbourne, Australia
| | - Jason N Harvey
- 1 Division of Hand Surgery, Dandenong Hospital, Monash University, Melbourne, Australia.,3 Orthosports Victoria, Melbourne, Australia
| | - Eugene T Ek
- 1 Division of Hand Surgery, Dandenong Hospital, Monash University, Melbourne, Australia.,2 Melbourne Orthopaedic Group, Melbourne, Australia
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Wang KK, Zhang X, McCombe D, Ackland DC, Ek ET, Tham SK. Quantitative analysis of in-vivo thumb carpometacarpal joint kinematics using four-dimensional computed tomography. J Hand Surg Eur Vol 2018; 43:1088-1097. [PMID: 30068246 DOI: 10.1177/1753193418789828] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to define the normal thumb carpometacarpal joint kinematics in-vivo during opposition and abduction using four-dimensional computed-tomography in four volunteers. Movement of the metacarpal relative to the trapezium was quantified using both Euler and helical axis representations. Articular surface contact patterns were also analysed. The overall axis of rotation for the movement of opposition and abduction passes through the trapezium and the base of the proximal phalanx, respectively. An abrupt change in instantaneous axis of rotation at terminal opposition was found. Ligament modelling shows dorsoradial ligament becomes tauter towards terminal opposition, whereas anterior oblique ligament becomes more slack. These results support the existence of the 'screw-home' pivot at terminal opposition and the importance of the dorsoradial ligament for stability in this position. The normal reference set in this study can help establish a diagnostic tool for subtle carpometacarpal instability, or for evaluating efficacy of surgery.
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Affiliation(s)
- Kemble K Wang
- 1 Hand Surgery Unit, Dandenong Hospital, Monash University, Melbourne, Australia.,2 Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, Melbourne, Australia
| | - Xin Zhang
- 2 Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, Melbourne, Australia.,3 Department of Biomechanical Engineering, University of Melbourne, Melbourne, Australia
| | - David McCombe
- 2 Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, Melbourne, Australia.,4 Hand Surgery Unit, St Vincent's Hospital, Melbourne, Australia
| | - David C Ackland
- 2 Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, Melbourne, Australia.,3 Department of Biomechanical Engineering, University of Melbourne, Melbourne, Australia
| | - Eugene T Ek
- 1 Hand Surgery Unit, Dandenong Hospital, Monash University, Melbourne, Australia.,2 Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, Melbourne, Australia
| | - Stephen K Tham
- 1 Hand Surgery Unit, Dandenong Hospital, Monash University, Melbourne, Australia.,2 Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, Melbourne, Australia.,4 Hand Surgery Unit, St Vincent's Hospital, Melbourne, Australia
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Smith ML, Gotmaker R, Hoy GA, Ek ET, Carr A, Flynn JN, Evans MC. Minimizing Propionibacterium acnes
contamination in shoulder arthroplasty: use of a wound protector. ANZ J Surg 2018; 88:1178-1181. [DOI: 10.1111/ans.14821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/16/2018] [Accepted: 07/24/2018] [Indexed: 01/05/2023]
Affiliation(s)
- Mitchell L. Smith
- Department of Orthopaedics; Melbourne Orthopaedic Group; Melbourne Victoria Australia
| | - Robert Gotmaker
- Department of Anaesthetics; St Vincent's Hospital; Melbourne Victoria Australia
| | - Greg A. Hoy
- Department of Upper Limb; Melbourne Orthopaedic Group; Melbourne Victoria Australia
| | - Eugene T. Ek
- Department of Upper Limb; Melbourne Orthopaedic Group; Melbourne Victoria Australia
- Department of Surgery; Monash University; Melbourne Victoria Australia
| | - Ashley Carr
- Department of Upper Limb; Melbourne Orthopaedic Group; Melbourne Victoria Australia
- Department of Surgery; Monash University; Melbourne Victoria Australia
| | - Jennifer N. Flynn
- Department of Orthopaedics; Epworth Hospital; Melbourne Victoria Australia
| | - Matthew C. Evans
- Department of Upper Limb; Melbourne Orthopaedic Group; Melbourne Victoria Australia
- Department of Surgery; Monash University; Melbourne Victoria Australia
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Rancy SK, Ek ET, Paul S, Hotchkiss RN, Wolfe SW. Nonspanning Total Wrist Arthrodesis with a Low-Profile Locking Plate. J Wrist Surg 2018; 7:127-132. [PMID: 29576918 PMCID: PMC5864497 DOI: 10.1055/s-0037-1606257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
Purpose This study aims to compare the outcomes and complications of our technique for nonspanning total wrist arthrodesis using a locking plate with the standard carpometacarpal spanning technique. Methods A retrospective review of charts was performed to identify patients who underwent total wrist arthrodesis by the senior author (S.W.W.). We compared the outcomes of 15 cases of nonspanning wrist fusion with a 2.4/2.7 mm locking T plate to 11 cases of spanning wrist fusion with a 2.7/3.5 mm locking compression plate. Minimum follow-up was 3 months. Indications for fusion included rheumatoid arthritis, posttraumatic arthritis, Kienböck's disease, primary osteoarthritis, juvenile inflammatory arthropathy, psoriasis, brachial plexopathy, failed hemi or total wrist arthroplasty, failed four-corner fusion, and failed proximal row carpectomy. The primary outcome was fusion. Secondary outcomes included time to union, patient-rated wrist evaluation score, numerical rating scale pain score, grip strength, and complications. Results All the wrists got fused. There were no significant differences in objective and subjective outcomes between cohorts. There were three complications (27%) in the spanning group, including tendon rupture and peri-implant fracture at the third metacarpal. This was compared with three complications (20%) in the nonspanning group, consisting of hardware removal. Discussion We achieved similar fusion rates employing both spanning and nonspanning total wrist arthrodesis techniques, without necessitating carpometacarpal arthrodesis in the latter. Complications associated with our method were comparably less severe than those reported in the literature. We advocate nonspanning arthrodesis as an alternative method for total wrist fusion with a high union rate and minimal risk of complications at the carpometacarpal joint. Level of Evidence Therapeutic level IV.
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Affiliation(s)
- Schneider K. Rancy
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Eugene T. Ek
- Department of Surgery, Melbourne Orthopaedic Group, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | - Sophia Paul
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Robert N. Hotchkiss
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
- Weill Medical College of Cornell University, New York, New York
| | - Scott W. Wolfe
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
- Weill Medical College of Cornell University, New York, New York
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Mandaleson A, Tham SK, Lewis C, Ackland DC, Ek ET. Scaphoid Fracture Fixation in a Nonunion Model: A Biomechanical Study Comparing 3 Types of Fixation. J Hand Surg Am 2018; 43:221-228. [PMID: 29132789 DOI: 10.1016/j.jhsa.2017.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 08/15/2017] [Accepted: 10/03/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Union of a scaphoid fracture after fixation is influenced by various factors, one of which is fracture stability. This study aims to compare the biomechanical stability of 3 different types of scaphoid fracture fixation in a scaphoid nonunion model. METHODS Thirty cadaveric scaphoid specimens were assigned to one of 3 different fixation groups: (1) single 3.0-mm compression screw, (2) two 2.2-mm screws, and (3) scaphoid plate. A 3-mm volar wedge osteotomy was created at the scaphoid waist to simulate a nonunion model. The primary outcome measure was load to failure, whereas secondary outcome measures were load to 2-mm displacement, energy absorbed, stiffness, and mode of failure, recorded by video and retrieval analysis. RESULTS There was a significantly lower load to failure in the single screw construct compared with that in the double screw (mean difference 187.2 N) and plate fixation constructs (mean difference 150.7 N). The mean load to 2-mm displacement in the single screw construct (91.5 N) was also significantly lower than that in the double screw (181.8 N) and plate fixation constructs (197.2 N). There was a significantly lower stiffness with the single screw fixation compared with that of the double screws (mean difference 85.4 N/mm), and lower energy absorbed with single screws when compared with that of double screws (mean difference 386.5 mJ) and when compared with plate fixation (mean difference 270.8 mJ). CONCLUSIONS In this biomechanical study comparing fixation methods using a model of scaphoid nonunion with bone loss, we found that double screws or plate fixation demonstrated significantly greater stability, stiffness, and energy absorption when compared with a single compression screw. We found no discernible differences between double screw fixation and the plate groups. CLINICAL RELEVANCE The use of double screws or plate fixation in a nonunion setting may allow accelerated rehabilitation without compromise to fracture stability.
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Affiliation(s)
- Avanthi Mandaleson
- Division of Hand Surgery, Department of Orthopaedics, Monash University, Dandenong Hospital, Dandenong, Australia; Department of Mechanical Engineering, University of Melbourne, Parkville, Australia
| | - Stephen K Tham
- Division of Hand Surgery, Department of Orthopaedics, Monash University, Dandenong Hospital, Dandenong, Australia; Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, St Vincent's Institute, Melbourne, Victoria, Australia; Victorian Hand Surgery Associates, Fitzroy, Australia; Department of Surgery, Monash Medical Centre, Monash University, Clayton, Australia
| | - Craig Lewis
- Department of Mechanical Engineering, University of Melbourne, Parkville, Australia
| | - David C Ackland
- Department of Mechanical Engineering, University of Melbourne, Parkville, Australia
| | - Eugene T Ek
- Division of Hand Surgery, Department of Orthopaedics, Monash University, Dandenong Hospital, Dandenong, Australia; Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, St Vincent's Institute, Melbourne, Victoria, Australia; Department of Surgery, Monash Medical Centre, Monash University, Clayton, Australia; Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia.
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Ek ET, Wang KK. Arthroscopic Repair of the Lateral Ulnar Collateral Ligament of the Elbow Using a Knotless Suture Anchor. Arthrosc Tech 2018; 7:e77-e81. [PMID: 29552473 PMCID: PMC5850883 DOI: 10.1016/j.eats.2017.08.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 08/10/2017] [Indexed: 02/03/2023] Open
Abstract
The lateral collateral ligament (LCL) complex of the elbow plays a crucial role in the stability of the elbow joint, especially to varus loads. Deficiency of particularly the lateral ulnar collateral component of the LCL can lead to chronic posterolateral rotatory instability, which can be functionally debilitating and can lead to a rapid onset of early degenerative arthritis. Commonly, in the setting of acute rupture of the LCL, the ligament is repaired using an open technique with suture anchor fixation to the lateral epicondyle insertion point. However, with advancing arthroscopic techniques, it has become possible to repair the LCL arthroscopically. We present a relatively simple method for an all-arthroscopic repair of the LCL to the humerus using a knotless suture anchor technique.
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Affiliation(s)
- Eugene T. Ek
- Melbourne Orthopaedic Group, Windsor, Melbourne, Australia,Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Australia,Address correspondence to Eugene T. Ek, M.B.B.S., Ph.D., F.R.A.C.S., Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Melbourne, VIC 3181, Australia.Melbourne Orthopaedic Group33 The Avenue, WindsorMelbourneVIC3181Australia
| | - Kemble K. Wang
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Australia
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42
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Holder NG, Schneider AK, Ek ET. Protuberant heterotopic ossification following distal biceps tendon repair. ANZ J Surg 2017; 89:E208-E209. [PMID: 29124838 DOI: 10.1111/ans.14232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/07/2017] [Accepted: 08/08/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Nicholas G Holder
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.,Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Adrian K Schneider
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery and Traumatology, Kantonsspital, St. Gallen, Switzerland
| | - Eugene T Ek
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.,Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
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43
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Ek ET, Wang K. Fixation of Ultrasmall Proximal Pole Scaphoid Fractures Using Bioabsorbable Osteochondral Fixation Nails. J Hand Surg Am 2017; 42:758.e1-758.e4. [PMID: 28709792 DOI: 10.1016/j.jhsa.2017.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 06/12/2017] [Indexed: 02/02/2023]
Abstract
Surgical treatment of ultrasmall proximal pole scaphoid fractures poses a number of challenges. The fragment may be too small to fix with conventional headless screw fixation owing to the high risk of fragmentation upon insertion. However, excision of the fragment risks compromising the scapholunate ligament complex and also exposes the radioscaphoid joint to potential degenerative changes. Under these circumstances, we describe the use of bioabsorbable osteochondral fixation nails that allows stable low-profile fixation while minimizing the risk of fracturing the proximal pole.
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Affiliation(s)
- Eugene T Ek
- Division of Hand Surgery, Department of Orthopaedics, Dandenong Hospital, Melbourne, Victoria, Australia; Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia; Melbourne Orthopaedic Group, Windsor, Victoria, Australia.
| | - Kemble Wang
- Division of Hand Surgery, Department of Orthopaedics, Dandenong Hospital, Melbourne, Victoria, Australia; Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia; Melbourne Orthopaedic Group, Windsor, Victoria, Australia
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Schneider AK, Ek ET. Isolated avascular necrosis of the olecranon. J Shoulder Elbow Surg 2017; 26:e198-e202. [PMID: 28410955 DOI: 10.1016/j.jse.2017.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/08/2017] [Accepted: 02/13/2017] [Indexed: 02/01/2023]
Affiliation(s)
- Adrian K Schneider
- Melbourne Orthopaedic Group, Windsor, VIC, Australia; Department of Orthopedic Surgery and Traumatology, Kantonsspital, St. Gallen, Switzerland.
| | - Eugene T Ek
- Melbourne Orthopaedic Group, Windsor, VIC, Australia; Department of Orthopaedic Surgery, University of Melbourne, Austin Hospital, Melbourne, VIC, Australia
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Schneider AK, Hoy GA, Ek ET, Rotstein AH, Tate J, Taylor DM, Evans MC. Interobserver and intraobserver variability of glenoid track measurements. J Shoulder Elbow Surg 2017; 26:573-579. [PMID: 27989718 DOI: 10.1016/j.jse.2016.09.058] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/21/2016] [Accepted: 09/27/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND A method of assessing combined glenoid and humeral bone loss in traumatic shoulder instability with an associated treatment protocol was recently published. The aim of this study was to investigate its reliability and reproducibility. METHODS Seventy-one patients with unilateral anteroinferior shoulder instability underwent computed tomography scans, from which 3-dimensional images were derived. En face views of both glenoid fossae and with 3 views of the humeral head were provided to 4 assessors to determine interobserver reliability. From these measurements, the shoulder was assigned a treatment classification. Two observers repeated their assessments 1 month later to determine intraobserver reliability. For each measurement, the mean coefficient of variability was calculated. RESULTS Assessment of glenoid bone loss showed good interobserver (4 observers agreeing in 90.1% of cases) and also good intraobserver agreement (94% and 96%). There was a poor level of interobserver reliability regarding the on-track or off-track classification (72%). Intraobserver reliability for this measurement was less variable (90% and 80%). There was a poor level of agreement between observers (65%) regarding treatment classification. The coefficient of variability for the Hill-Sachs lesion measured 19.2%, indicating a high level of variability for this measurement compared with <4% for all other measures. CONCLUSION Linear bone loss on the glenoid can be measured reliably and reproducibly; however, evaluation of Hill-Sachs lesions demonstrates a high level of variability, and poor interobserver reliability.
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Affiliation(s)
- Adrian K Schneider
- Upper Limb Unit, Melbourne Orthopaedic Group, Windsor, Victoria, Australia; Department of Orthopaedic Surgery and Traumatology, Kantonsspital, St. Gallen, Switzerland
| | - Gregory A Hoy
- Upper Limb Unit, Melbourne Orthopaedic Group, Windsor, Victoria, Australia; Department of Surgery, Monash University, Clayton, Victoria, Australia
| | - Eugene T Ek
- Upper Limb Unit, Melbourne Orthopaedic Group, Windsor, Victoria, Australia; Department of Surgery, Monash University, Clayton, Victoria, Australia
| | | | - Julie Tate
- Victoria House Medical Imaging, Prahran, Victoria, Australia
| | - David McD Taylor
- Austin Health Emergency Department, Heidelberg, Victoria, Australia
| | - Matthew C Evans
- Upper Limb Unit, Melbourne Orthopaedic Group, Windsor, Victoria, Australia; Department of Surgery, Monash University, Clayton, Victoria, Australia.
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Wijeratna MD, Ek ET, Hoy GA, Chehata A. Use of a Bone Graft Drill Harvester to Create the Fenestration During Arthroscopic Ulnohumeral Arthroplasty. Arthrosc Tech 2015; 4:e503-5. [PMID: 26697312 PMCID: PMC4662236 DOI: 10.1016/j.eats.2015.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 05/19/2015] [Indexed: 02/03/2023] Open
Abstract
The Outerbridge-Kashiwagi procedure, or ulnohumeral arthroplasty, was described in 1978 as a method of treating elbow arthritis by creating a fenestration in the olecranon fossa. This fenestration diminishes the likelihood of recurrent spurs in the olecranon fossa and coronoid fossa, without loss of structural bony strength. Arthroscopic techniques have now been developed to perform this procedure. We describe an efficient method of creating the fenestration between the olecranon fossa and coronoid fossa during an arthroscopic ulnohumeral arthroplasty, or Outerbridge-Kashiwagi procedure, that also reduces the amount of residual bone debris produced during the resection.
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Affiliation(s)
- Malin D. Wijeratna
- Melbourne Orthopaedic Group, Windsor, Australia
- Austin Hospital, Heidelberg, Australia
- Address correspondence to Malin D. Wijeratna, B.Sc.(Hons), M.B.B.S., F.R.C.S.(Tr&Orth), 231 Queen Ediths Way, Cambridge, CB1 8NJ, England.
| | - Eugene T. Ek
- Melbourne Orthopaedic Group, Windsor, Australia
- Austin Hospital, Heidelberg, Australia
| | - Gregory A. Hoy
- Melbourne Orthopaedic Group, Windsor, Australia
- Austin Hospital, Heidelberg, Australia
| | - Ash Chehata
- Cabrini Hospital Brighton, Brighton, Australia
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Kang L, Ek ET, Wei MT, Meyers KN, Hearns KA, Carlson MG. Biomechanical Analysis of Scapholunate Ligament Repair Techniques. J Hand Surg Am 2015; 40:1534-9. [PMID: 25986650 DOI: 10.1016/j.jhsa.2015.03.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 03/26/2015] [Accepted: 03/26/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the biomechanical properties of 3 scapholunate repair techniques. METHODS In 51 cadavers, the scapholunate ligament was exposed through a dorsal approach, incised at its scaphoid insertion, and repaired using 1 of 3 techniques: 2 single-loaded suture anchors, 2 double-loaded suture anchors, or 2 transosseous sutures. Twenty-four repaired specimens underwent load to failure (LTF) testing using tensile distraction on a servo-hydraulic machine. Twenty-seven specimens underwent cyclical testing to measure gap formation at the scapholunate joint. RESULTS The mode of failure was suture pullout through the substance of the ligament in 22 specimens, failure at the bone suture interface in 1, and anchor pullout in 1. Double-loaded anchor repairs demonstrated a significantly higher mean ultimate LTF compared with single-loaded anchor (91 N vs 35 N) and transosseous (91 N vs 60 N) repairs. Transosseous repairs demonstrated a higher mean ultimate LTF compared with single-loaded suture repairs (60 N vs 35 N). After 300 cycles, the average gap for the transosseous repair group was double that for the single- and double-loaded repairs, although not statistically significant. CONCLUSIONS Primary scapholunate ligament repairs using double-loaded suture anchors demonstrated significantly higher strength compared with single-loaded anchors and transosseous repairs. On cyclic loading, transosseous repairs demonstrated the greatest gap formation with no measurable difference between single- and double-loaded repairs. CLINICAL RELEVANCE In a cadaveric model for primary repairs, double-loaded suture anchors demonstrated the highest LTF and offer a similar but unproven performance in vivo.
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Affiliation(s)
- Lana Kang
- Division of Hand and Upper Extremity Surgery and the Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Eugene T Ek
- Division of Hand and Upper Extremity Surgery and the Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Mike T Wei
- Division of Hand and Upper Extremity Surgery and the Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Kathleen N Meyers
- Division of Hand and Upper Extremity Surgery and the Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Krystle A Hearns
- Division of Hand and Upper Extremity Surgery and the Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Michelle G Carlson
- Division of Hand and Upper Extremity Surgery and the Department of Biomechanics, Hospital for Special Surgery, New York, NY.
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48
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Shi LL, Jiang JJ, Ek ET, Higgins LD. Failure of the lesser tuberosity osteotomy after total shoulder arthroplasty. J Shoulder Elbow Surg 2015; 24:203-9. [PMID: 25107599 DOI: 10.1016/j.jse.2014.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/28/2014] [Accepted: 05/04/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lesser tuberosity osteotomy (LTO) as an approach during total shoulder arthroplasty (TSA) is a reliable technique with strong biomechanical fixation and a low failure rate. Complications have been infrequently reported in the literature. METHODS We report a case series of 5 patients who sustained failure of the LTO repair after primary TSA. The data on the patient demographic characteristics, surgical technique, postoperative care, revision surgery, and clinical outcomes are reported. RESULTS The mean age of the 5 patients was 52 years, all patients were men, and the mean body mass index was 28 kg/m(2). They were followed up for a mean of 29 months (range, 24-38 months). The mean time from initial TSA to diagnosis of LTO failure was 9 weeks (range, 5-12 weeks). Two patients reported no trauma, 2 had minor trauma (using a pulley, rolling over in bed), and 1 sustained a fall. At the latest follow-up, the mean visual analog scale; Single Assessment Numeric Evaluation; University of California, Los Angeles; and American Shoulder and Elbow Surgeons scores were 4 (range, 0-6), 48 (range, 20-70), 19 (range, 11-22), and 63 (range, 48-83), respectively. Only 1 patient required no additional procedures beyond the revision LTO repair. Another patient required a second revision LTO repair. The remaining 3 patients either underwent or were recommended to undergo reverse arthroplasty. CONCLUSION Failure of the LTO repair after TSA may possibly be an under-reported complication that is associated with poor clinical outcomes and limited options for revision surgery. In patients with a high risk of LTO failure, considerations should be made to augment the LTO repair during the index TSA procedure.
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Affiliation(s)
- Lewis L Shi
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Hospitals, Chicago, IL, USA.
| | - Jimmy J Jiang
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Hospitals, Chicago, IL, USA
| | - Eugene T Ek
- Melbourne Orthopaedic Group and Department of Orthopaedic Surgery, University of Melbourne, Austin Hospital, Melbourne, VIC, Australia
| | - Laurence D Higgins
- Sports Medicine and Shoulder Service, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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49
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Hassani H, Cherix S, Ek ET, Rüdiger HA. Comparisons of preoperative three-dimensional planning and surgical reconstruction in primary cementless total hip arthroplasty. J Arthroplasty 2014; 29:1273-7. [PMID: 24502952 DOI: 10.1016/j.arth.2013.12.033] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/15/2013] [Accepted: 12/30/2013] [Indexed: 02/01/2023] Open
Abstract
Reconstruction of important parameters such as femoral offset and torsion is inaccurate, when templating is based on plain x-rays. We evaluate intraoperative reproducibility of pre-operative CT-based 3D-templating in a consecutive series of 50 patients undergoing primary cementless THA through an anterior approach. Pre-operative planning was compared to a postoperative CT scan by image fusion. The implant size was correctly predicted in 100% of the stems, 94% of the cups and 88% of the heads (length). The difference between the planned and the postoperative leg length was 0.3 + 2.3 mm. Values for overall offset, femoral anteversion, cup inclination and anteversion were 1.4 mm ± 3.1, 0.6° ± 3.3°, -0.4° ± 5° and 6.9° ± 11.4°, respectively. This planning allows accurate implant size prediction. Stem position and cup inclination are accurately reproducible.
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Affiliation(s)
- Hassen Hassani
- Department of Orthopaedics Hôpital Orthopédique-Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland
| | - Stéphane Cherix
- Department of Orthopaedics Hôpital Orthopédique-Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland
| | - Eugene T Ek
- Melbourne Orthopaedic Group and Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Melbourne, Australia
| | - Hannes A Rüdiger
- Department of Orthopaedics Hôpital Orthopédique-Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland.
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50
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Abstract
Carpal fractures are exceedingly rare clinical entities and are often associated with concomitant injuries. In this review, we focus on fractures of the carpus, excluding the scaphoid, and provide an update on the current consensus as to mechanism, diagnosis, management, outcomes, and complications after such injuries.
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Affiliation(s)
- Nina Suh
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY; Melbourne Orthopaedic Group and Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Melbourne, Australia
| | - Eugene T Ek
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY; Melbourne Orthopaedic Group and Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Melbourne, Australia
| | - Scott W Wolfe
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY; Melbourne Orthopaedic Group and Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Melbourne, Australia.
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