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Zhao W, Yuan H, Zhang Y, Guo Y, Basnet S, Li S, Li T, Liang B, Pei G. A novel configuration for the fixation of intra-articular C2.3 distal humerus fractures with the potential for minimally invasive surgery: a biomechanical evaluation and finite element analysis. J Shoulder Elbow Surg 2024; 33:1138-1149. [PMID: 37944743 DOI: 10.1016/j.jse.2023.09.034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/15/2023] [Accepted: 09/24/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Distal humerus fractures are a challenge to treat, and the current standard of care, open reduction internal fixation with a double-plate, has a high rate of complications. We proposed a novel internal fixation configuration, lateral intramedullary nail and medial plate (LINMP) and verified its rigidity through biomechanical tests and finite element analysis. METHODS The study involved biomechanical testing of 30 synthetic humerus models to compare 2 different fixation systems for an AO 13C-2.3 type fracture. The orthogonal double-plate (ODP) group and the LINMP group were compared through biomechanical testing to measure stiffness and failure load fewer than 3 working conditions. Based on the results, we optimized the intramedullary nail by eliminating the holes at the distal end of the nail and incorporating a 2-hole external locking plate. The Finite element analysis was also conducted to further compare the modified LINMP configuration with the previous 2 fixation configurations. RESULTS In biomechanical tests, the ODP group exhibited lower stiffness under bending and compression forces compared to the LINMP group, but higher stiffness and failure loads under torsion force. In finite element analysis, the modified LINMP reduces the maximum stress of the fixation structure without significantly reducing the stiffness under bending stress and axial compression conditions. In torsion stress conditions, the modified LINMP enhances both the maximum stress and the stiffness, although it remains marginally inferior to the ODP structure. CONCLUSION Our study demonstrates that the innovative LINMP presents comparable or slightly superior concerning bending and axial loading compared to orthogonal double-plate osteosynthesis for distal humeral intra-articular fractures, which might become a minimally invasive option for these fractures.
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Affiliation(s)
- Wei Zhao
- School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Haiyang Yuan
- BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yunwei Zhang
- Xiamen Humanity Hospital, Fujian Medical University, Xiamen, Fujian, China
| | - Yao Guo
- School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Shiva Basnet
- School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Sijing Li
- School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Tengbo Li
- School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Binjie Liang
- Xiamen Humanity Hospital, Fujian Medical University, Xiamen, Fujian, China.
| | - Guoxian Pei
- School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China; Medical Intelligence and Innovation Academy, Southern University of Science and Technology Hospital, Shenzhen, Guangdong, China.
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Zhang W, Wu X, Chen H, Bai J, Long L, Xue D. Regional distribution prevalence of heterotopic ossification in the elbow joint: a 3D study of patients after surgery for traumatic elbow injury. J Shoulder Elbow Surg 2024; 33:948-958. [PMID: 38182024 DOI: 10.1016/j.jse.2023.11.015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Heterotopic ossification (HO) is a common complication after elbow fracture surgery and can lead to severe upper extremity disability. The radiographic localization of postoperative HO has been reported previously. However, there is no literature examining the distribution of postoperative HO at the three-dimensional (3D) level. This study aimed to investigate 1) the distribution characteristics of postoperative HO and 2) the possible risk factors affecting the severity of postoperative HO at a 3D level. METHODS A retrospective review was conducted of patients who presented to our institution with HO secondary to elbow fracture between 13 January 2020 and 16 February 2023. Computed tomography scans of 56 elbows before elbow release surgery were reconstructed in 3D. HO was identified using density thresholds combined with manual identification and segmentation. The elbow joint and HO were divided into six regions according to three planes: the transepicondylar plane, the lateral ridge of the trochlear plane, and the radiocapitellar joint and coronoid facet plane. The differences in the volume of regional HO associated with different initial injuries were analyzed. RESULTS Postoperative HO was predominantly present in the medial aspect of the capsule in 52 patients (93%), in the lateral aspect of the capsule in 45 patients (80%), in the medial supracondylar in 32 patients (57%), and in the lateral supracondylar, radial head, and ulnar region in the same number of 28 patients (50%). The median and interquartile range volume of total postoperative HO was 1683 (777-4894) mm3. The median and interquartile range volume of regional postoperative HO were: 584 (121-1454) mm3 at medial aspect of capsule, 207 (5-568) mm3 at lateral aspect of capsule, 25 (0-449) mm3 at medial supracondylar, 1 (0-288) at lateral supracondylar, 2 (0-478) at proximal radius and 7 (0-203) mm3 at the proximal ulna. In the subgroups with Injury Severity Score > or = 16, Gustilo-Anderson II, normal uric acid levels, elevated alkaline phosphatase, and body mass index > or = 24, the median HO volume exceeds that of the respective control groups. CONCLUSION The medial aspect of the capsule was the area with the highest frequency and median volume of postoperative HO among all initial elbow injury types. Patients with higher Gustilo-Anderson grade, Injury Severity Score, alkaline phosphatase or Body Mass Index had higher median volume of postoperative HO.
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Affiliation(s)
- Weijun Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, PR China
| | - Xiaoyong Wu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, PR China
| | - Hongyu Chen
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, PR China
| | - Jinwu Bai
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, PR China
| | - Long Long
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, PR China
| | - Deting Xue
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, PR China.
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Yadav S. Tuberculosis of the Elbow Joint in an Indian Boy: A Rare Entity With a Diagnostic Challenge. Cureus 2024; 16:e58184. [PMID: 38741885 PMCID: PMC11089490 DOI: 10.7759/cureus.58184] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
Tuberculosis of the bones and joints is an infrequently reported entity. Isolated involvement of the elbow joint is exceedingly rare, even in endemic countries. The diagnosis is an arduous task, especially if it presents in younger age groups. Herein, a case of tuberculosis of the right elbow joint in a seven-year-old Indian child is presented. The diagnosis was challenging due to the vague clinical features and rarity of the disease, but he was diagnosed after a detailed clinical examination along with a radiometric assessment. He was initiated on the appropriate chemotherapy.
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Affiliation(s)
- Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
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Taylor F, Page R, Wheeler J, Lorimer M, Corfield S, Peng Y, Burnton J. Distal humeral hemiarthroplasty compared to total elbow replacement for distal humeral fractures: a registry analysis of 906 procedures. J Shoulder Elbow Surg 2024; 33:356-365. [PMID: 37689104 DOI: 10.1016/j.jse.2023.08.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/01/2023] [Accepted: 08/06/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Total elbow replacement (TER) is an accepted treatment for complex intra-articular distal humerus fractures in elderly patients. Distal humeral hemiarthroplasty (HA) is also a potential surgical option for unreconstructable fractures and avoids the concerns regarding mechanical wear and functional restrictions associated with TER. In the current literature, there are limited data available to compare the revision rates of HA and TER for the treatment of fracture. We used data from a large national arthroplasty registry to compare the outcome of HA and TER undertaken for fracture/dislocation and to assess the impact of demographics and implant choice on revision rates. METHODS Data obtained from the Australian Orthopaedic Association National Joint Replacement Registry from May 2, 2005, to December 31, 2021, included all procedures for primary elbow replacement with primary diagnosis of fracture or dislocation. The analyses were performed using Kaplan-Meier estimates of survivorship and hazard ratios (HRs) from Cox proportional hazards models. RESULTS There were 293 primary HA and 631 primary TER procedures included. The cumulative percentage revision (CPR) rate at 9 years was 9.7% for HA (95% confidence interval [CI] 6.0, 15.7), and 11.9% (95% CI 8.5, 16.6) for TER. When adjusted for age and gender, there was a significantly higher risk of revision after 3 months for TER compared to HA (HR 2.47, 95% CI 1.22, 5.03, P = .012). There was no difference in the rate of revision for patients aged <55 years or ≥75 years when HA and TER procedures were compared. In primary TER procedures, loosening was the most common cause of revision (3.6% of primary TER procedures), and the most common type of revision in primary TER involved revision of the humeral component only (2.6% of TER procedures). TER has a higher rate of first revision for loosening compared to HA (HR 4.21, 95% CI 1.29, 13.73; P = .017). In HA procedures, instability (1.7%) was the most common cause for revision. The addition of an ulna component was the most common type of revision (2.4% of all HA procedures). CONCLUSION For the treatment of distal humerus fractures, HA had a lower revision rate than TER after 3 months when adjusted for age and gender. Age <55 or ≥75 years was not a risk factor for revision when HA was compared to TER. Loosening leading to revision is more prevalent in TER and increases with time. In HA, the most common type of revision involved addition of an ulna component with preservation of the humeral component.
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Affiliation(s)
- Fraser Taylor
- Gold Coast University Hospital, Southport, QLD, Australia.
| | - Richard Page
- Barwon Centre of Orthopaedic Research and Education, Deakin University, Geelong, VIC, Australia; Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia
| | - James Wheeler
- Gold Coast University Hospital, Southport, QLD, Australia
| | - Michelle Lorimer
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia
| | - Sophie Corfield
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia
| | - Yi Peng
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia
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Jelti O, Barzouq A, El Alaoui O, Abdeljaouad N, Yacoubi H. Concurrent Palmar Lunate Dislocation and Posterior Elbow Dislocation With a Distal Radius Fracture: A Rare Case Report. Cureus 2024; 16:e52609. [PMID: 38374856 PMCID: PMC10875395 DOI: 10.7759/cureus.52609] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2024] [Indexed: 02/21/2024] Open
Abstract
We present an unusual case involving the simultaneous dislocation of the trans-scapho-retro-lunate in the right wrist and a posterolateral dislocation in the right elbow joint with a distal radius fracture in a 23-year-old male with no notable medical history. These injuries occurred when he fell from a height of around 12 meters onto his outstretched right hand. The patient presented to the hospital in a normal upper limb trauma position with no discomfort to critical functions. Predominant symptoms at the emergency department were discomfort in the right wrist, hand, and ipsilateral elbow, as well as the entire upper limb functional impairment. Both the wrist and the elbow seemed distorted on examination, with considerable edema and loss of bone landmarks. Passive mobilization was hampered by pain, but peripheral pulses were detectable. The radial, ulnar, and median nerves' autonomous sensory-motor domains were intact, with a cutaneous opening classified as stage 2 by the Cauchoix-Duparc classification. The elbow dislocation was successfully treated using a closed reduction method. External manipulation was employed to reduce the trans-scaphoid perilunate dislocation, which was subsequently stabilized through percutaneous screw fixation of the scaphoid using a triquetrum-lunate pin. Additionally, a styloid pin was utilized to address and manage a distal radius fracture, followed by the implementation of a radiometacarpal external fixator. After one year and three months, the patient reported no pain in his elbow and minimal wrist discomfort during heavy lifting.
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Affiliation(s)
- Ousama Jelti
- Department of Orthopedics and Traumatology, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Mohammed First University, Oujda, MAR
| | - Abdelilah Barzouq
- Department of Orthopedics and Traumatology, Faculty of Medicine and Pharmacy, Centre Hospitalier Universitaire (CHU) Mohammed VI, Oujda, MAR
| | - Oussama El Alaoui
- Department of Orthopedics and Traumatology, Faculty of Medicine and Pharmacy, Centre Hospitalier Universitaire (CHU) Mohammed VI, Mohammed First University, Oujda, MAR
| | - Najib Abdeljaouad
- Department of Orthopedics and Traumatology, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Mohammed First University, Oujda, MAR
| | - Hicham Yacoubi
- Department of Orthopedics and Traumatology, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Mohammed First University, Oujda, MAR
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Rezende RF, Gajo MDM, Costa SMD, Lazarini RF, Carvalho Junior AERD, Almeida Filho IAD. Total Arthroplasty in Complex Elbow Injury. Rev Bras Ortop 2023; 58:e813-e817. [PMID: 37908517 PMCID: PMC10615598 DOI: 10.1055/s-0040-1722574] [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: 07/06/2020] [Accepted: 10/14/2020] [Indexed: 10/21/2022] Open
Abstract
The authors present an atypical case of a left elbow complex fracture with extensive loss of bone and muscle tissue. The patient was submitted to several surgical procedures, which resulted in a total arthroplasty of the left elbow with triceps reconstruction using a semitendinosus muscle tendon graft.
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Affiliation(s)
| | - Marcela de Melo Gajo
- Médico ortopedista e traumatologista, Hospital Felício Rocho, Belo Horizonte, MG, Brasil
| | | | - Rafael Fuchs Lazarini
- Médico ortopedista e traumatologista, Hospital Felício Rocho, Belo Horizonte, MG, Brasil
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Reddy S, Jain D, Pradyumna K, R P. The Morphology and Morphometric Analysis of the Radius Bone: A Study on Freshly Frozen Cadavers in the Indian Population. Cureus 2023; 15:e41170. [PMID: 37525770 PMCID: PMC10387188 DOI: 10.7759/cureus.41170] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/02/2023] Open
Abstract
Introduction The radial bone and the radioulnar joint are vital for the physiological and physical stability of the elbow. The prostheses and plates used in cases of radius fracture are designed based on the morphology of the Western population. This could result in a bone-implant mismatch when applied to the Indian population, resulting in complications. Hence, the study aimed to record the normal values of radius morphology in the Indian population. Methods A total of 30 (eight male and seven female) freshly frozen cadaveric bilateral upper limbs were chosen. Cadavers with previous surgical scars, deformities, and congenital defects of the upper limb were excluded. The radius was excised, and morphometric parameters were measured with a non-elastic measuring tape and a digital caliper and recorded using GeoGebra software. Results All measuring parameters exhibited no significant difference between the right and left side of the bone (p > 0.05), whereas the difference between males and females for most parameters was statistically significant (p < 0.05). The mean difference between the anteroposterior (AP) diameter and transverse diameter of the radial head for the study sample was 0.89 ± 0.06 mm. Thus, the AP diameter was 4% greater than the transverse diameter. The head of the radius was observed to be almost round. The degree of extent of the safe zone was 124.64°, with an average safe arc length of 3.27 ± 0.55 cm. Conclusion The morphometric measurements of the radius in the Indian population are different from the Western population.
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Affiliation(s)
- Sandeep Reddy
- Orthopaedics, Ramaiah Medical College, Bangalore, IND
| | | | | | - Prajwal R
- Orthopaedics, Aster CMI Hospital, Bangalore, IND
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Tamura A, Saito M. Muscle Activity Characteristics of the Pronator Teres during Throwing in Baseball Pitchers: A Pilot Study. Healthcare (Basel) 2023; 11:healthcare11040618. [PMID: 36833152 PMCID: PMC9957271 DOI: 10.3390/healthcare11040618] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/08/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
The pronator teres muscle is a major dynamic stabilizer of elbow valgus stress during throwing. This study aims to investigate pronator teres muscle activation during breaking ball pitching in baseball pitchers. Twelve male college baseball players with more than eight years of baseball experience were included in this study. A wireless surface electromyography (EMG) system was used to measure the activation of the forearm muscles and record EMG data during fastball and curveball pitching. Peak pronator teres muscle activation during curveball pitching was greater than that during fastball pitching (p = 0.03). There was no difference in the muscle activation of the other forearm muscles (p > 0.05). These results indicate that increased muscle activity in the pronator teres may contribute to stiffness and induce pronator teres syndrome or medial elbow injuries related to the overuse of the pronator teres, especially during curveball pitching. Controlling curveball throws contributes to player coaching and conditioning for the prevention of elbow joint disorders and pronator teres syndrome.
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Niu X, Huang X, Xu Y, Yi J, Hu J, Xiao L. Surgical management of acute combined injuries of the ipsilateral wrist and elbow joints. Ann Transl Med 2023; 11:154. [PMID: 36846016 PMCID: PMC9951007 DOI: 10.21037/atm-22-6598] [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] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023]
Abstract
Background Combined injuries of ipsilateral wrist and elbow joints are rare in clinical practice, characterized by multiple joint dislocations or/and fractures and varying manifestations. As there are still no clinical guidelines and no consensus on the standard treatment, this study aimed to explore the surgical intervention and complications of this kind of combined injuries. Methods This retrospective study was conducted in a single center. A total of 13 patients with acute combined injuries of the ipsilateral wrist and elbow joints receiving surgical treatment from August 2013 to May 2016 were retrospectively analyzed. The fracture and joint instability and structural damages were repaired and reconstructed. Results All 13 patients were followed up for a mean duration of 17 months (range: 14 to 22 months). The X-ray films showed good fracture reduction and joint alignment, no fixation failure, re-displacement, bone nonunion, or ischemic necrosis in all cases. According to the Mayo Elbow Performance Score (MEPS), the excellent and good rate of joint function was 84.6%. According to the Mayo Modified Wrist Score (MMWS), the excellent and good rate of joint function was 76.9%. There were no significant restrictions on elbow and wrist movements. The disabilities of the arm, shoulder, and hand (DASH) score was excellent, with an average of 18.5 points. Conclusions The key to intervention of combined injuries of the wrist and elbow is to identify the types of injuries and conduct an overall assessment to determine the appropriate surgical methods. Early surgical intervention and rehabilitation exercise are the main principles for the treatment.
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Affiliation(s)
- Xiaofeng Niu
- Department of Upper Extremity Orthopedics, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xijun Huang
- Department of Upper Extremity Orthopedics, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yinfeng Xu
- Department of Upper Extremity Orthopedics, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianhua Yi
- Department of Upper Extremity Orthopedics, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Hu
- Department of Upper Extremity Orthopedics, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liangbao Xiao
- Department of Upper Extremity Orthopedics, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Figueirido B, Pérez-Ramos A, Hotchner A, Lovelace D, Pastor FJ, Martín-Serra A. Elbow-joint morphology in the North American 'cheetah-like' cat Miracinonyx trumani. Biol Lett 2023; 19:20220483. [PMID: 36693427 PMCID: PMC9873470 DOI: 10.1098/rsbl.2022.0483] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The North American cheetah-like cat Miracinonyx trumani is an extinct species that roamed the Pleistocene prairies 13 000 years ago. Although M. trumani is more closely related to the cougar (Puma concolor) than to the living cheetah (Acinonyx jubatus), it is believed that both A. jubatus and M. trumani possess a highly specialized skeleton for fast-running, including limbs adapted for speed at the expense of restricting the ability of prey grappling. However, forelimb dexterity of M. trumani has not been yet investigated. Here, we quantify the 3D-shape of the humerus distal epiphysis as a proxy for elbow-joint morphology in a sample of living cats to determine whether the extinct M. trumani was specialized to kill open-country prey using predatory behaviour based on fast running across the prairies and steppe terrains of the North American Pleistocene. We show that M. trumani had an elbow morphology intermediate to that of P. concolor and A. jubatus, suggesting that M. trumani had a less specialized pursuit predatory behaviour than A. jubatus. We propose that M. trumani probably deployed a unique predatory behaviour without modern analogues. Our results bring into question the degree of ecomorphological convergence between M. trumani and its Old World vicar A. jubatus.
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Affiliation(s)
- Borja Figueirido
- Departamento de Ecología y Geología, Facultad de Ciencias, Universidad de Málaga, Málaga 29071 Spain
| | - Alejandro Pérez-Ramos
- Departamento de Ecología y Geología, Facultad de Ciencias, Universidad de Málaga, Málaga 29071 Spain
| | - Anthony Hotchner
- Department of Geoscience, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - David Lovelace
- Department of Geoscience, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Francisco J. Pastor
- Departamento de Anatomía y Radiología, Museo de Anatomía, Universidad de Valladolid, Valladolid 47005, Spain
| | - Alberto Martín-Serra
- Departamento de Ecología y Geología, Facultad de Ciencias, Universidad de Málaga, Málaga 29071 Spain
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Laidig D, Weygers I, Seel T. Self-Calibrating Magnetometer-Free Inertial Motion Tracking of 2-DoF Joints. Sensors (Basel) 2022; 22:9850. [PMID: 36560219 PMCID: PMC9785932 DOI: 10.3390/s22249850] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Human motion analysis using inertial measurement units (IMUs) has recently been shown to provide accuracy similar to the gold standard, optical motion capture, but at lower costs and while being less restrictive and time-consuming. However, IMU-based motion analysis requires precise knowledge of the orientations in which the sensors are attached to the body segments. This knowledge is commonly obtained via time-consuming and error-prone anatomical calibration based on precisely defined poses or motions. In the present work, we propose a self-calibrating approach for magnetometer-free joint angle tracking that is suitable for joints with two degrees of freedom (DoF), such as the elbow, ankle, and metacarpophalangeal finger joints. The proposed methods exploit kinematic constraints in the angular rates and the relative orientations to simultaneously identify the joint axes and the heading offset. The experimental evaluation shows that the proposed methods are able to estimate plausible and consistent joint axes from just ten seconds of arbitrary elbow joint motion. Comparison with optical motion capture shows that the proposed methods yield joint angles with similar accuracy as a conventional IMU-based method while being much less restrictive. Therefore, the proposed methods improve the practical usability of IMU-based motion tracking in many clinical and biomedical applications.
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Affiliation(s)
- Daniel Laidig
- Control Systems Group, Technische Universität Berlin, 10623 Berlin, Germany
| | - Ive Weygers
- Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91052 Erlangen, Germany
| | - Thomas Seel
- Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91052 Erlangen, Germany
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Matsuo K, Masuma H, Kawabata M, Miyata T, Miida K, Watanabe H. Medial elbow joint space gapping associated with repetitive baseball pitching in preadolescent baseball players. J Shoulder Elbow Surg 2022; 31:1035-41. [PMID: 34968691 DOI: 10.1016/j.jse.2021.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The baseball pitching motion creates valgus stress to the medial elbow, which contributes to increased medial elbow joint space gapping. The musculoskeletal systems of preadolescent baseball players are immature compared with those of adults, but it is unclear whether the repetitive pitching action causes an increase in medial elbow joint space gapping. This study aimed to examine differences in medial elbow joint space gapping based on the pitch count of preadolescent baseball players compared with those of adult players. METHODS The participants were 11 healthy preadolescent baseball players and 12 college students with baseball experience. They threw 60 maximal-effort pitches arranged into 4 sets of 15 pitches. The medial elbow joint space was measured ultrasonographically with the forearm weight before pitching and following every set of 15 pitches. Repeated-measures analysis of variance and the Bonferroni post hoc test were used to compare the medial elbow joint space among the 5 pitching sets (before pitching and after 15, 30, 45, and 60 pitches) and between the groups of preadolescent baseball players and college students. RESULTS There was no significant change in the medial elbow joint space gapping of the dominant elbow based on age/pitch count (F = 0.42, P = .796). There was a significant effect of pitch count (F = 30.28, P < .001) and between-group effects (F = 4.56, P = .045). The medial elbow joint space gapping increased significantly after 60 pitches in preadolescent baseball players (P = .023) and college students (P = .021). The medial elbow joint space gapping in preadolescent baseball players was significantly wider than that in college students (P = .007 before pitching, P = .027 at 15 pitches). CONCLUSION Sixty repetitive pitches contributed to an increase in the medial elbow joint space gapping, regardless of age. The results of this study provide further evidence when considering pitching limitations.
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Walch A, Garcia-Maya B, Knowles NK, Athwal GS, King GJW. Computed tomography analysis of the relationship between the coronoid and the radial head. J Shoulder Elbow Surg 2021; 30:2824-2831. [PMID: 34216785 DOI: 10.1016/j.jse.2021.05.025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/17/2021] [Accepted: 05/23/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The coronoid process is an important stabilizer of the elbow, and its anatomy has been extensively studied. However, data documenting the relationship of the coronoid relative to the radial head (RH) are limited. The latter is a good landmark for the surgeon when débriding or reconstructing the coronoid. This imaging-based study quantified the anatomic relationship between the coronoid and the proximal radius and ulna. METHODS We investigated 80 cadaveric upper extremities (18 paired elbows) by 3-dimensional digital analysis of computed tomography data. After construction of a standardized coordinate system, the relationships between the coronoid, the anterior-most point of the RH, the deepest point of the articular surface of the RH, the top of the lesser sigmoid notch, and the deepest point of the guiding ridge of the trochlear notch were analyzed. RESULTS The mean height of the tip of the coronoid was 36 ± 4 mm (range, 26-43 mm). The mean height of the anterior-most point of the RH was 40 ± 4 mm (range, 28-47 mm). The mean distance between the tip of the coronoid and the anterior-most point of the RH was 4.5 ± 1 mm (range, 2-10 mm). For paired elbows, the heights of the tip of the coronoid and the anterior-most point of the RH were similar between sides. CONCLUSION This study described the relationship between the coronoid and RH. This information should prove useful when reconstructing a coronoid from a medial approach in the case of an intact RH. The difference in radiographic height between the tip of the coronoid and anterior RH in the normal elbow averages 5 mm. However, when we account for the normal cartilage thickness of the RH and coronoid, a 3- to 6-mm difference in height would be seen at surgery depending on whether the cartilage of the coronoid process is intact or removed. The distance between the tip of the coronoid and the anterior-most point of the RH is similar to the size of shavers used when débriding osteophytes during arthroscopy.
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Affiliation(s)
- Arnaud Walch
- Service de Chirurgie de la Main et du Membre Superieur, Hopital Edouard Herriot, Lyon, France.
| | | | - Nikolas K Knowles
- Roth/McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, University of Western Ontario, London, ON, Canada
| | - Georges S Athwal
- Roth/McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, University of Western Ontario, London, ON, Canada
| | - Graham J W King
- Roth/McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, University of Western Ontario, London, ON, Canada
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14
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Das SK, Bohara S, Bhandari R, Sinha R, Das B, Karki S. A missed medial humeral epicondyle fracture with incarcerated fragment in the elbow joint and ulnar nerve palsy: A rare case report. Clin Case Rep 2021; 9:e04982. [PMID: 34721854 PMCID: PMC8543049 DOI: 10.1002/ccr3.4982] [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: 06/30/2021] [Revised: 09/15/2021] [Accepted: 09/23/2021] [Indexed: 11/08/2022] Open
Abstract
Medial epicondyle fracture associated with incarcerated intra-articular fragment and ulnar nerve palsy is uncommon and frequently missed. We report a case of 13-year-old boy with incarcerated medial epicondyle fracture fragment in ulnohumeral joint and ulnar nerve palsy, which was managed successfully by open reduction internal fixation and ulnar nerve transposition.
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Affiliation(s)
- Subhash Kumar Das
- Department of OrthopedicsNepalese Army Institute of Health SciencesShree Birendra HospitalKathmanduNepal
| | - Sujan Bohara
- Nepalese Army Institute of Health SciencesShree Birendra HospitalKathmanduNepal
| | - Ravi Bhandari
- Department of OrthopedicsNepalese Army Institute of Health SciencesShree Birendra HospitalKathmanduNepal
| | - Ritesh Sinha
- Department of OrthopedicsNepalese Army Institute of Health SciencesShree Birendra HospitalKathmanduNepal
| | - Bikash Das
- National Medical College and Teaching HospitalBirgunjNepal
| | - Samikshya Karki
- Nepalese Army Institute of Health SciencesShree Birendra HospitalKathmanduNepal
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15
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Kirschbaum S, Plachel F, Kerschbaum M, Gerhard C, Thiele K. Does sonography allow an objective and reproducible distinction between stable, hypermobile, and unstable elbow joints? J Shoulder Elbow Surg 2021; 30:1142-1151. [PMID: 33482368 DOI: 10.1016/j.jse.2020.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 04/22/2020] [Revised: 11/15/2020] [Accepted: 11/19/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The diagnosis of residual or chronic elbow instability is often challenging. Sonography allows a dynamic examination of the elbow joint without any radiation exposure. The purpose of this prospective single-center study was to investigate the application of sonography for the evaluation of ligamentous instabilities of the elbow joint. Therefore, asymptomatic (stable) and acute dislocated (unstable) elbows were examined by sonography. METHODS A total of 72 elbows in 36 participants (23 women and 13 men; mean age, 40 ± 17 years [range, 18-82 years]) were examined. Group 1 (G1 [normal]) included 40 unaffected, asymptomatic elbow joints; 28 elbows belonged to 14 voluntary participants (bilateral), whereas 12 asymptomatic elbows belonged to patients who had an acute elbow dislocation (contralateral elbow). Group 2 (G2 [hypermobile]) included 20 hypermobile elbow joints in 10 participants (bilateral), and group 3 (G3 [unstable]) included 12 acute unstable elbow joints without bony lesions. Radiographic assessment included sonography of both elbow joints with standardized measurements of the neutral and stressed radiocapitellar and ulnohumeral distances (calculated as Δ values). Two investigators independently performed all measurements. Additionally, plain radiographs and magnetic resonance imaging of the affected elbow joints were obtained in G3. RESULTS On the radial side, the mean radiocapitellar Δ was statistically higher in G3 (2.2 ± 1.6 mm) than in G1 (0.5 ± 0.4 mm, P < .01) or G2 (0.8 ± 0.6 mm, P < .01). G3 also showed an increased ulnohumeral Δ (2.7 ± 0.7 mm) compared with G1 (1.0 ± 0.7 mm, P < .01) or G2 (0.9 ± 0.3 mm, P < .01). No significant differences in the mean radiocapitellar Δ (P = .06) and ulnohumeral Δ (P = .26) were found between G1 and G2. Within G3, Δ was significantly higher at the affected elbow joint than at the contralateral, unaffected elbow joint (P = .04 for the radial side and P = .04 for the ulnar side). The inter-rater correlation coefficient was 0.82 for the radial side and 0.74 for the ulnar side. Patients with collateral ligament injuries, diagnosed on magnetic resonance imaging, showed higher Δ values than those with intact collateral ligaments, although no significant difference was found. CONCLUSION Sonography of the elbow joint is a valuable imaging tool for the assessment of ligamentous instability. Nevertheless, a distinction between healthy and hypermobile elbow joints is not possible, and therefore, obtaining a complete clinical history and examination is vital. We further recommend comparing the affected elbow joint with the contralateral side to access intraindividual differences.
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Affiliation(s)
- Stephanie Kirschbaum
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin, Berlin, Germany.
| | - Fabian Plachel
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | | | - Christian Gerhard
- Department for Trauma, Hand and Sports Surgery, St. Vincentius-Kliniken, ViDia Christliche Kliniken Karlsruhe, Karlsruhe, Germany
| | - Kathi Thiele
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin, Berlin, Germany
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16
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Barik S, Singh G, Maji S, Azam MQ, Singh V. Preoperative Prediction of Gartland IV Supracondylar Fractures of Humerus: Is it Possible? Rev Bras Ortop 2021; 56:230-234. [PMID: 33935319 PMCID: PMC8075635 DOI: 10.1055/s-0040-1722578] [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: 04/28/2020] [Accepted: 09/17/2020] [Indexed: 11/06/2022] Open
Abstract
Objectives
The present study aims to identify preoperative characteristics of the patient, of the injury, as well as of imaging, which would point towards a type IV fracture. The present study shall help the operating team to predict more accurately the type IV pattern preoperatively, leading to improved counselling of the caregivers, planning of surgery, as well as preparedness regarding open reduction, if such situation arises.
Methods
A retrospective study was conducted, including patients that met the following criteria: 1) age < 16 years old; 2) Gartland type-III and type-IV supracondylar fractures; and 3) with complete records. Demographic data like age, gender, laterality, mode of injury, hospital duration of the injury, history of previous attempts of closed reduction, open/closed fracture, distal neurovascular status, and radiographic data like angulation, translation, osseous apposition and fracture comminution were collected.
Results
Hospital duration of the injury and previous attempts of closed reduction were the factors that had a statistically significant difference among types III and IV fractures (
p
< 0.05). A diagnosis of type IV supracondylar fractures was significantly more likely in the presence of valgus angulation of the distal fragment ≥ 17° (odds ratio [OR] = 20.22; 95% confidence interval [CI] = 3.45–118.65). Flexion angulation ≥ 10° (OR = 5.32; 95% CI = 0.24–119.88) of the distal fragment predicted Gartland type IV with a sensitivity of 41% and a specificity of 100%.
Conclusion
The preoperative evaluation of suspected Gartland IV fractures can help the operating surgeon in predicting such injuries. Nonradiographic factors like increased hospital duration of the injury, attempts at previously closed reduction, and radiographic parameters like valgus and flexion angulation were more likely to be associated with type IV fractures. Level of evidence III.
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Affiliation(s)
- Sitanshu Barik
- Departamento de Ortopedia, All India Institute of Medical Sciences, Rishikesh, Índia
| | - Gobinder Singh
- Departamento de Ortopedia, All India Institute of Medical Sciences, Rishikesh, Índia
| | - Subhajit Maji
- Departamento de Ortopedia, All India Institute of Medical Sciences, Rishikesh, Índia
| | - Md Quamar Azam
- Departamento de Cirurgia de Trauma, All India Institute of Medical Sciences, Rishikesh, Índia
| | - Vivek Singh
- Departamento de Ortopedia, All India Institute of Medical Sciences, Rishikesh, Índia
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17
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Tat AM, Can F, Tat NM, Sasmaz HI, Antmen AB. The effects of manual therapy and exercises on pain, muscle strength, joint health, functionality and quality of life in haemophilic arthropathy of the elbow joint: A randomized controlled pilot study. Haemophilia 2021; 27:e376-e384. [PMID: 33626198 DOI: 10.1111/hae.14281] [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] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Effective physiotherapy interventions are required for haemophilic arthropathy (HA) of the elbow due to its biomechanical differences and contribution to upper limb functionality. AIM To investigate the effects of manual therapy & exercises on bleeding frequency, pain, range of motion (ROM), strength, joint health, functionality and quality of life (QoL) in HA of the elbow. METHODS Seventeen participants with HA of the elbow were randomized as Manual Therapy & Exercises Group (MTEG = 9) and Home Exercises Group (HEG = 8). Soft tissue mobilization, joint traction (grade I-II) and Mulligan's mobilization with movement as manual therapy, and stretching/strengthening exercises were applied to MTEG, while HEG had only same exercises as home programme. The interventions lasted 3 days/weekly for 5 weeks. Bleeding frequency was evaluated with patients' records; pain with Numeric Pain Scale; ROM with goniometer; strength with digital dynamometer; joint health with HJHS; functionality with Quick-Disability of Arm, Shoulder and Hand questionnaire; and QoL with Oxford Elbow Score. RESULTS Bleeding frequency and activity pain were decreased, while elbow ROMs and flexor strength were increased in MTEG (P ˂ 0.05). Also significantly improvements were seen in joint health, functionality and QoL in MTEG. HEG showed improvements in activity pain, QoL and some ROMs. MTEG had better results in ROMs, joint health and functionality (P ˂ 0.05). CONCLUSION Manual therapy & exercises may be used without causing bleeding and pain to increase the functionality, joint health and QoL, and is superior to home exercise for joint health and functionality. Home exercises may be ameliorated in pain, QoL and some ROMs.
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Affiliation(s)
- Ayse Merve Tat
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Necmettin Erbakan University, Konya, Turkey
| | - Filiz Can
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Necati Muhammed Tat
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Necmettin Erbakan University, Konya, Turkey
| | - Hatice Ilgen Sasmaz
- Faculty of Medicine, Department of Pediatric Hematology and Oncology, Cukurova University, Adana, Turkey
| | - Ali Bulent Antmen
- Department of Pediatric Hematology and Oncology, Acıbadem Hospital, Adana, Turkey
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18
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Padovani S, Capuzzo M, Massari L, Caruso G, Arrigoni P, Zaolino C, Cucchi D, Valpiani G, Colozza A. Validation of the cross-cultural adapted Italian version of the Oxford Elbow Score. JSES Int 2021; 5:328-333. [PMID: 33681858 PMCID: PMC7910718 DOI: 10.1016/j.jseint.2020.10.025] [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] [Indexed: 12/02/2022] Open
Abstract
Background The Oxford Elbow Score (OES) is an English-language questionnaire specifically designed to evaluate surgical elbow outcomes. This scoring system has been translated into other languages. Given the lack of an Italian version of the OES, the present study was designed to establish, culturally adapt, and validate the Italian version. Methods The OES questionnaire was culturally adapted to Italian patients in accordance with the literature guidelines with a pilot phase including seven patients with elbow problems and seven healthy subjects. The study includes 110 participants from three hospitals, who underwent elbow surgery for acute (70%) or chronic diseases. At least one month after elbow surgery, at the “index visit”, the physician completed the Mayo Elbow Performance Index and patients completed the following questionnaires: the Italian OES, the shortened version of the Disability of Arm, Shoulder and Hand Questionnaire (QuickDASH) and the Short-Form 36 Health Survey. Internal consistency was evaluated using Cronbach's alpha. Reproducibility was assessed using the intraclass correlation coefficient in ten patients who completed the OES again two-three days after the index visit. Construct validity was assessed using Spearman correlation coefficients. Responsiveness was evaluated in 68 patients who answered the questionnaires four months after the index visit, using the Wilcoxon signed-rank test, the effect size and the standardized response mean calculation. Results Cronbach's alpha was excellent: 0.86 (0.82-0.90) for OES pain, 0.92 (0.90-0.94) for OES function, and 0.90 (0.87-0.93) for OES social/psychological. The intraclass correlation coefficient was 0.94 (0.78-0.98) for OES pain, 0.91 (0.71-0.97) for OES function, 0.95 (0.83-0.98) for OES social-psychological and 0.93 (0.76-0.98) for OES total. The Spearman ρ was >0.7 for OES pain and QuickDASH, for OES function and both QuickDASH and Mayo Elbow Performance Index, and for OES social-psychological and QuickDASH. Regarding responsiveness, the mean of the changes between the two visits ranged from 33.9 for OES pain, to 44 points for OES function and OES social/psychological. The effect size and the standardized response mean were >0.8 for all OES domains. Conclusion This study demonstrates that the Italian version of the OES, translated in accordance with the international standardized guidelines, is reliable, valid, and responsive in patients who have undergone elbow surgery.
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Affiliation(s)
- Sara Padovani
- Department of Orthopedics and Traumatology, Ospedale degli Infermi di Faenza, Faenza (RA), Italy.,Orthopedics and Traumatology Unit, Sant Anna University Hospital of Ferrara, Ferrara, Italy
| | - Maurizia Capuzzo
- Department of Morphology, Experimental Medicine and Surgery, Section of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - Leo Massari
- Orthopedics and Traumatology Unit, Sant Anna University Hospital of Ferrara, Ferrara, Italy
| | - Gaetano Caruso
- Orthopedics and Traumatology Unit, Sant Anna University Hospital of Ferrara, Ferrara, Italy
| | - Paolo Arrigoni
- U.O.C. 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Carlo Zaolino
- U.O.C. 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | - Giorgia Valpiani
- Research Innovation Quality and Accreditation Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Alessandra Colozza
- Department of Orthopedics and Traumatology, Ospedale degli Infermi di Faenza, Faenza (RA), Italy
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19
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Huels N, Harms O, Keim D, Rohn K, Fehr M. Treatment of the Clinical Symptoms of Osteoarthritis in the Elbow Joints of Dogs Using Nuclear Magnetic Resonance Therapy: A Randomized, Double-Blinded Trial. Front Vet Sci 2020; 7:500278. [PMID: 33282923 PMCID: PMC7691575 DOI: 10.3389/fvets.2020.500278] [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: 02/26/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives: To evaluate the effects of nuclear magnetic resonance therapy (MBST®) on the clinical symptoms of osteoarthritis (OA) in the elbow joints of dogs. Methods: In this double-blind study, 28 dogs with lameness caused by OA in the elbow joint were randomly allocated to two groups: 14 dogs received nuclear magnetic resonance (NMR) therapy [treatment group (TG)], and 14 dogs received a placebo [placebo group (PG)] over a period of 7 consecutive days. Visual and objective gait analyses were performed before treatment (M1) and at 3 (M2) and 6 months (M3) after treatment. At M2 and M3 Symmetry indices (SI) of the peak vertical force (PVFz) and the vertical impulse (IFz), lameness scores, and pain scores were compared with their values at M1 to calculate the overall treatment effectiveness (OTE) score. We also documented additional pain medication and medical physiotherapy during the time of study. Finally, we measured the range of motion (ROM) in order to evaluate the functional development of the joint. Results: The median OTE score of dogs in the TG indicates no change after 3 month and was improved after 6 months of treatment. There was an improvement of the median OTE score of dogs in the PG after 3 months of treatment. Further, the OTE scores of dogs in the PG were actually worse after 6 months. Nevertheless, there were no significance differences in SIPVFz, SIIFz, ROM, and lameness- and pain scores between the TG and PG at M1, M2, and M3. When considering all collected parameters (excluding the ROM) to calculate the OTE, no significant difference between groups was measurable for the OTE. Conclusion: There was a positive effect of NMR therapy (MBST®) on the treatment of OA in dogs. However, future studies should investigate the mechanisms underlying NMR therapy and the pathophysiology of OA to provide optimal treatments for patients. Clinical Significance: Our results demonstrated that the response to NMR treatment was individualized for each dog. As an integral way of treating dogs with chronic OA, NMR therapy may be an alternative therapeutic approach to support traditional medications.
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Affiliation(s)
- Nikolaus Huels
- Clinic for Small Animals, University of Veterinary Medicine Hannover Foundation, Hanover, Germany
| | - Oliver Harms
- Clinic for Small Animals, University of Veterinary Medicine Hannover Foundation, Hanover, Germany
| | - Dana Keim
- Clinic for Small Animals, University of Veterinary Medicine Hannover Foundation, Hanover, Germany
| | - Karl Rohn
- Institute for Biometry, Epidemiology and Information Processing, University of Veterinary Medicine, Hanover, Germany
| | - Michael Fehr
- Clinic for Small Animals, University of Veterinary Medicine Hannover Foundation, Hanover, Germany
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20
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Touloupakis G, Biancardi E, Theodorakis E, Ghirardelli S, Ferrara F, Gherlinzoni F, Antonini G. The Influence of Medial Comminution in the Treatment Choice of Radial Head Fracture. Malays Orthop J 2020; 14:124-128. [PMID: 33403072 PMCID: PMC7752005 DOI: 10.5704/moj.2011.019] [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] [Indexed: 11/14/2022] Open
Abstract
Introduction: The aim of our retrospective study was to investigate the role of the medial side involvement in the treatment choice of radial head fractures. Materials and Methods: We searched the databases of our institutions for the surgical procedures diagnosed as "fracture of the radial head" and for the procedures related to "prosthesis of the radial head" and "osteosynthesis of the radial head" in the period from May 2014 to October 2017. The fractures were first classified according to the Mason classification . We then allocated the patients into three study groups according to the site of the fracture, either the medial or lateral side of the radial head : Group A, with an isolated lateral fracture of the radius head; Group B1, with a medial fracture of the radius head with two medial fragments; and Group B2, with a medial fracture of the radius head with multiple medial fragments. We performed a multivariate analysis to identify statistically significant correlation between the pre-operative classifications of Mason and our study, the type of surgical procedure, and the clinical outcome. Results: Mayo Elbow Performance (MEP) scores determined at the final follow-up of the study (mean 16.6 months, range 12-26 months) was excellent in 17 patients (4 in Group A, 6 in Group B1 and 7 in Group B2), and good in 12 patients (3 in Group A, 7 in Group B1, and 2 in Group B2). One patient showed a poor result in MEP score probably because of an infection and implant removal. Conclusion: Regarding medial fractures of the radial head, our study showed satisfactory results with a radial head prosthesis for comminuted or multifragmentary radial head fractures. For surgeons with advanced elbow fracture expertise, osteosynthesis could be attempted in a fracture pattern that involved only two medial fragments.
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Affiliation(s)
- G Touloupakis
- Department of Orthopaedics and Traumatology, San Carlo Borromeo Hospital, Milan, Italy
| | - E Biancardi
- Department of Orthopaedics and Traumatology, San Carlo Borromeo Hospital, Milan, Italy
| | - E Theodorakis
- Department of Orthopaedics and Traumatology, AAS 2 Bassa Friulana-Isontina, Gorizia, Italy
| | - S Ghirardelli
- Department of Orthopaedics and Traumatology, San Carlo Borromeo Hospital, Milan, Italy
| | - F Ferrara
- Department of Orthopaedics and Traumatology, Fatebenefratelli Hospital, Milan, Italy
| | - F Gherlinzoni
- Department of Orthopaedics and Traumatology, AAS 2 Bassa Friulana-Isontina, Gorizia, Italy
| | - G Antonini
- Department of Orthopaedics and Traumatology, San Carlo Borromeo Hospital, Milan, Italy
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21
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Gracitelli MEC, Guglielmetti CLB, Botelho CAS, Malavolta EA, Assunção JH, Ferreira Neto AA. Surgical Treatment of Post-traumatic Elbow Stiffness by Wide Posterior Approach. Rev Bras Ortop 2020; 55:570-578. [PMID: 33093721 PMCID: PMC7575365 DOI: 10.1055/s-0039-1700827] [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: 03/31/2019] [Accepted: 07/23/2019] [Indexed: 11/25/2022] Open
Abstract
Objective
To demonstrate the clinical outcomes and complication rates of the surgical release with a single posterior approach in the treatment of post-traumatic elbow stiffness.
Methods
A prospective study with patients submitted to surgery between May 2013 and June 2018 in a single center. The access to the elbow was made through the posterior approach. The patients were followed up by an occupational therapy team, and were submitted to a standardized rehabilitation protocol, with static progressive orthoses and dynamic orthoses. The primary outcome was the range of flexion-extension of the elbow after 6 months.
Results
A total of 26 patients completed the minimum follow-up of 6-months. The mean range of flexion-extension of the elbow at the end of 6 months was of 98.3 ± 22.0°, with an amplitude gain of 40.0 ± 14.0° in relation to the pre-operative period (
p
< 0.001). The average flexion-extension gain at the end of 6 months was of 51.7% ± 17.1% (
p
< 0.001). The mean pronosupination at the end of 6 months was of 129.0 ± 42.7° (
p
< 0.001). Half of the cases had moderate and severe stiffness in the pre-operative period, compared with 7.7% at 6 months post-operatively (
p
< 0.001). The mean score for the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) instruments was 74.4 ± 16.8 points and 31.7 ± 21.9 points respectively (
p
< 0.001 for both). The visual analogue scale (VAS) score presented no statistically significant difference compared to the pre-operative period (
p
= 0.096). Complications were observed in 6 (23%) patients, and no new surgical procedures were necessary.
Conclusions
The surgical release of the elbow associated with a rehabilitation protocol is a safe technique, with satisfactory results and low rate of complications.
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Affiliation(s)
- Mauro E C Gracitelli
- Shoulder and Elbow Group, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - César L B Guglielmetti
- Shoulder and Elbow Group, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Caio A S Botelho
- Shoulder and Elbow Group, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eduardo A Malavolta
- Shoulder and Elbow Group, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jorge H Assunção
- Shoulder and Elbow Group, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Arnaldo A Ferreira Neto
- Shoulder and Elbow Group, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
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22
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PÉRez-Llanes R, Donoso-ÚBeda E, MeroÑO-Gallut J, Lopez-Pina JA, Cuesta-Barriuso R. Manual Therapy Effectively Decreases the Frequency of Joint Bleeding Improves Joint Health and Reduces Pain in Hemophilic Elbow Arthropathy: A Prospective Cohort Study. J Rehabil Med Clin Commun 2020; 3:1000035. [PMID: 33884137 PMCID: PMC8008725 DOI: 10.2340/20030711-1000035] [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] [Subscribe] [Scholar Register] [Accepted: 04/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To verify the safety and effectiveness of manual therapy intervention using fascial therapy in adult patients with haemophilic elbow arthropathy. METHODS Prospective cohort study. A total of 28 patients with haemophilic elbow arthropathy was recruited in 3 cities in Spain. Patients received one-fascial therapy session per week for 3 weeks. The dependent variables were: frequency of joint bleeding, joint pain (visual analogue score) and joint status (Hemophilia Joint Health Score). Outcomes were measured at baseline (T0), post-treatment (T1) and after 3 months' follow-up (T2). Using Student's t-test, the means obtained in the evaluations were compared. The analysis of variance (ANOVA) test of repeated measures provided the intra-subject effect. The chosen level of significance was p < 0.05. RESULTS A total of 28 patients were recruited according to the selection criteria. No joint bleeding occurred during or after the intervention. The primary outcome, frequency of bleeding, improved after intervention (p <0.001). The secondary variables joint status and joint pain improved after the experimental period (p <0.001). There were significant changes in the repeated measures factor in the frequency of haemarthrosis (F = 20.61; p = 0.00), joint status (F = 64.11; p = 0.00) and perceived pain (F = 33.15; p = 0.00). CONCLUSION Manual therapy using fascial therapy did not produce haemarthrosis in patients with haemophilic elbow arthropathy. Fascial therapy can improve the perception of pain and joint state,maintaining this improvement after a follow-up period of 3 months.
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Affiliation(s)
- Raúl PÉRez-Llanes
- Department of Physiotherapy, Faculty of Health Sciences, Catholic University San Antonio-UCAM, Murcia, Spain
| | | | | | - Jose Antonio Lopez-Pina
- Department of Basic Psycology and Methodology, Faculty of Psycology, University of Murcia, Murcia, Spain
| | - Rubén Cuesta-Barriuso
- Department of Physiotherapy, European University of Madrid, Madrid, Spain
- Real Fundaciόn Victoria Eugenia, Madrid, Spain
- Fishemo CEE, Spanish Federation of Hemophilia, Madrid, Spain
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Encinoso M, Orós J, Ramírez G, Jaber JR, Artiles A, Arencibia A. Anatomic Study of the Elbow Joint in a Bengal Tiger ( Panthera tigris tigris) Using Magnetic Resonance Imaging and Gross Dissections. Animals (Basel) 2019; 9:E1058. [PMID: 31805734 PMCID: PMC6940883 DOI: 10.3390/ani9121058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/04/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 12/29/2022] Open
Abstract
The objective of our research was to describe the normal appearance of the bony and soft tissue structures of the elbow joint in a cadaver of a male mature Bengal tiger (Panthera tigris tigris) scanned via MRI. Using a 0.2 Tesla magnet, Spin-echo (SE) T1-weighting, and Gradient-echo short tau inversion recovery (GE-STIR), T2-weighting pulse sequences were selected to generate sagittal, transverse, and dorsal planes. In addition, gross dissections of the forelimb and its elbow joint were made. On anatomic dissections, all bony, articular, and muscular structures could be identified. The MRI images allowed us to observe the bony and many soft tissues of the tiger elbow joint. The SE T1-weighted MR images provided good anatomic detail of this joint, whereas the GE-STIR T2-weighted MR pulse sequence was best for synovial cavities. Detailed information is provided that may be used as initial anatomic reference for interpretation of MR images of the Bengal tiger (Panthera tigris tigris) elbow joint and in the diagnosis of disorders of this region.
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Affiliation(s)
- Mario Encinoso
- Hospital Veterinario Los Tarahales, Recta de Los Tarahales 15, 35013 Las Palmas de Gran Canaria, Spain; (M.E.); (A.A.)
| | - Jorge Orós
- Departamento de Morfología, Facultad de Veterinaria, Universidad de Las Palmas de Gran Canaria, Trasmontaña, Arucas, 35416 Las Palmas, Spain; (J.O.); (J.R.J.)
| | - Gregorio Ramírez
- Departamento de Anatomía y Anatomía Patológica, Universidad de Murcia, 30100 Murcia, Spain;
| | - José Raduan Jaber
- Departamento de Morfología, Facultad de Veterinaria, Universidad de Las Palmas de Gran Canaria, Trasmontaña, Arucas, 35416 Las Palmas, Spain; (J.O.); (J.R.J.)
| | - Alejandro Artiles
- Hospital Veterinario Los Tarahales, Recta de Los Tarahales 15, 35013 Las Palmas de Gran Canaria, Spain; (M.E.); (A.A.)
| | - Alberto Arencibia
- Departamento de Morfología, Facultad de Veterinaria, Universidad de Las Palmas de Gran Canaria, Trasmontaña, Arucas, 35416 Las Palmas, Spain; (J.O.); (J.R.J.)
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Li F, Mao D, Pan X, Zhang X, Mi J, Rui Y. Celecoxib cannot inhibit the progression of initiated traumatic heterotopic ossification. J Shoulder Elbow Surg 2019; 28:2379-2385. [PMID: 31757369 DOI: 10.1016/j.jse.2019.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 02/03/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Heterotopic ossification (HO) is a recognized sequela after trauma and arthroplasty. The purpose of this study was to evaluate the therapeutic effect of celecoxib on HO. We hypothesized that celecoxib may inhibit the progression of initiated HO. METHODS We performed a retrospective review of 37 patients who underwent elbow joint surgery between January 2014 and June 2018. Seventeen patients were prescribed orally administered celecoxib (200 mg/dose, twice daily) for 2 months after the diagnosis of HO, whereas the remaining 20 patients were administered celecoxib for 1 month starting immediately after surgery. HO progression was evaluated by plain radiographs. By use of an Achilles tendon puncture-induced HO mouse model, the curative effect of celecoxib was illustrated at different HO progression stages. The mice were assigned to 1 of 4 groups: sham group, vehicle group, group receiving celecoxib on day 1, and group receiving celecoxib in week 6. Achilles tendons were analyzed by micro-computed tomography and histochemistry after 12 weeks. RESULTS Celecoxib did not inhibit the progression of initiated HO in the patients in whom HO was diagnosed, whereas those who received celecoxib after surgery had lower morbidity. Achilles tendon puncture effectively induced typical HO in mice. The ectopic bone volume was significantly reduced in the day 1 celecoxib group compared with the vehicle group; however, the difference was not statistically significant in the week 6 celecoxib group. CONCLUSIONS Administration of celecoxib starting immediately after surgery can significantly inhibit the formation of HO. Once HO is visible on plain radiographs or micro-computed tomography, celecoxib cannot effectively attenuate further progression of HO in humans and mice.
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Affiliation(s)
- Fengfeng Li
- Department of Orthopedics, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Dong Mao
- Research Institute of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Xiaoyun Pan
- Research Institute of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Xin Zhang
- Research Institute of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Jingyi Mi
- Department of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Yongjun Rui
- Department of Orthopedics, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China.
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Ślusarczyk A, Piechocki K, Symonides B. Dyspnoe, cough and fever in 80-year old patient with chronic heart failure. Pol Merkur Lekarski 2019; 47:187-189. [PMID: 31812973] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
UNLABELLED The prevalence of heart failure (HF) in developed countries exceeds 10% in adults over 70 year old. At the following report we aim to present a case of HF worsening complicated by gout attack. CASE REPORT 80-year old patient was admitted to the hospital, with the suspicion of pneumonia, because of 3-day history of dyspnoe, cough and fever. Patient reported redness, swelling and pain in the area of left elbow. Prior to admission patient was diagnosed with bursitis and treated with antibiotic without symptoms resolution. There was past medical history of atrial fibrillation, hypertension, intermittent claudication, COPD. One month before, patient was hospitalized due to HF worsening. Diuretics' dosage was increased at that time and symptoms resolved. On admission: blood pressure 145/88 mm Hg, HR 96/min irregular, saturation O2 88% without oxygen therapy. On physical examination, bilateral pulmonary crackles, redness, tenderness of left elbow were found. Laboratory tests demonstrated elevated parameters of inflammation - leukocytosis 13.4G/L, neutrophilia 11G/L, CRP 142.5 mg/L, but normal procalcitonin 0.27 ng/ml. Moreover, high NTproBNP 8573 pg/ml and hyperuricemia 13.1 mg/dl were detected. Chest X-ray indicated pulmonary venous congestion. ECG revealed atrial fibrillation with QRS rate of 100/min, left axis deviation. Therefore, gout attack was diagnosed and after colchicine administration symptoms resolved quickly. CONCLUSIONS Clinical signs including fever, elevated parameters of inflammation and dyspnoe justify pneumonia consideration in differential diagnosis. Importantly, non-infectious causes of inflammatory conditions, like gout must be also considered. Patients with HF often develop hyperuricemia due to diuretic treatment, aggravated catabolism and often co-prevalent chronic kidney disease.
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Affiliation(s)
- Aleksander Ślusarczyk
- Medical University of Warsaw: Student Scientific Group "Pressor", Department of Internal Medicine, Hypertension and Angiology
| | - Kacper Piechocki
- Medical University of Warsaw: 2Department of Internal Medicine, Hypertension and Angiology
| | - Bartosz Symonides
- Medical University of Warsaw: 2Department of Internal Medicine, Hypertension and Angiology
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Veksins A, Kozinda O, Sandersen C. Computed tomographic morphometry of the biceps brachii muscle tendon of dogs affected by the medial coronoid disease. Anat Histol Embryol 2019; 49:196-202. [PMID: 31709577 DOI: 10.1111/ahe.12513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/26/2019] [Revised: 09/30/2019] [Accepted: 10/21/2019] [Indexed: 12/01/2022]
Abstract
The objective of this study was to measure the biceps brachii muscle (BBM) attachment to the medial coronoid process (MCP) using computed tomography images and to compare these data between clinically healthy and dogs affected by medial coronoid disease (MCD). Computed tomography was performed in MCD-affected and healthy dogs. Multiplanar reconstruction views were obtained to measure distance (cm) of the BBM attachment point to the MCP. Results showed that the mean BBM attachment point-to-MCP was 1.42 ± 0.23 cm in MCD-affected and 1.27 ± 0.20 cm in healthy dogs, respectively. In dogs with MCD, the BBM attachment point-to-MCP was significantly more abaxial than in clinically healthy dogs (p < .001). The results of this study support the hypothesis that the BBM attachment site is more abaxial to the MCP and therefore may contribute to supraphysiological overload leading to MCD. Albeit more research is necessary, this study proves a relationship between the BBM attachment point and the development of MCD.
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Affiliation(s)
- Armands Veksins
- Latvia University Life Sciences and Technologies, Jelgava, Latvia
| | - Oskars Kozinda
- Latvia University Life Sciences and Technologies, Jelgava, Latvia
| | - Charlotte Sandersen
- Latvia University Life Sciences and Technologies, Jelgava, Latvia.,The University of Liege, Liege, Belgium
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Matsuura T, Hashimoto Y, Kinoshita T, Nishino K, Nishida Y, Takigami J, Katsuda H, Shimada N. Donor Site Evaluation After Osteochondral Autograft Transplantation for Capitellar Osteochondritis Dissecans. Am J Sports Med 2019; 47:2836-2843. [PMID: 31503508 DOI: 10.1177/0363546519871064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 01/31/2023]
Abstract
BACKGROUND Osteochondral autograft transplantation (OAT) for capitellar osteochondritis dissecans (OCD) requires harvesting of tissue from the asymptomatic knee joint. However, donor site morbidity (DSM) in such cases remains unclear. PURPOSE To evaluate DSM and postoperative radiographic findings in patients undergoing OAT for advanced capitellar OCD. STUDY DESIGN Case series; Level of evidence, 4. METHODS Eighty-six juvenile athletes underwent OAT for advanced capitellar OCD. The 2000 International Knee Documentation Committee subjective score, rate of return to sports, and symptoms in the donor knee were assessed at a mean follow-up of 86 months (range, 28-185 months). Additionally, 49 of the 86 patients were assessed by radiographic and magnetic resonance imaging (MRI) findings of the knee donor site. DSM was defined according to the usual criterion (persistent symptoms for >1 year or the need for subsequent intervention) and a stricter criterion (the presence of any symptoms, such as effusion, patellofemoral complaints, crepitation, unspecified disturbance, stiffness, pain/instability during activities, and osteoarthritic change). The stricter criterion was also used to allocate patients into a DSM group and a no-DSM group. RESULTS Two and 11 patients were determined to have DSM according to the usual and stricter criteria, respectively. All patients returned to the competitive level of their sports. The mean International Knee Documentation Committee score was 99.0. MRI findings showed abnormal signal intensity in 17 patients (35%) and hypertrophic changes in 11 patients (22%) at the donor harvest sites. The MOCART (magnetic resonance observation of cartilage repair tissue) score was higher in the no-DSM group (mean, 68.2) than in the DSM group (mean, 52.9) (P = .027). CONCLUSION OAT for juvenile athletes with advanced capitellar OCD provided good clinical outcomes. The DSM rate was relatively low (2.3%) with the usual criterion but high (12.8%) with the stricter criterion. MRI showed an abnormal signal intensity and hypertrophy in some cases.
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Affiliation(s)
- Takeshi Matsuura
- Department of Orthopaedic Surgery, Shimada Hospital, Shimada, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takuya Kinoshita
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yohei Nishida
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Junsei Takigami
- Department of Orthopaedic Surgery, Shimada Hospital, Shimada, Japan
| | - Hiroshi Katsuda
- Department of Orthopaedic Surgery, Shimada Hospital, Shimada, Japan
| | - Nagakazu Shimada
- Department of Orthopaedic Surgery, Shimada Hospital, Shimada, Japan
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Tang G, Chen Z, Li Y. [Development and Testing of Multi-mode Elbow Joint Muscle Strength Training Device]. Zhongguo Yi Liao Qi Xie Za Zhi 2019; 43:322-325. [PMID: 31625326 DOI: 10.3969/j.issn.1671-7104.2019.05.003] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Muscle strength training plays an important role in improving limb movement function, preventing muscle atrophy and promoting muscle function recovery in patients with various bone and joint diseases. The sports function of elbow joint is closely related to people's daily life activity ability. At present, Chinese muscle strength training devices are depended on import. Therefore, it is of great significance to develop muscle strength training devices. Based on the concepts and characteristics of isometric training, isotonic training, passive training and isokinetic training, in the upper computer, the servo driver and servo motor are controlled through the LabView interface, and the real-time torque is detected by the torque sensor, realizing four training modes. The main parameters of the multi-mode elbow joint muscle strength training device meet the requirements, and the trainers have a good experience.
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Affiliation(s)
- Geng Tang
- College of Electrical Engineering and Automation, Fuzhou University, Fuzhou, 350108
- Fujian Key Lab of Medical Institute and Pharmaceutical Technology, Fuzhou, 350108
| | - Zihan Chen
- College of Electrical Engineering and Automation, Fuzhou University, Fuzhou, 350108
- Fujian Key Lab of Medical Institute and Pharmaceutical Technology, Fuzhou, 350108
| | - Yurong Li
- College of Electrical Engineering and Automation, Fuzhou University, Fuzhou, 350108
- Fujian Key Lab of Medical Institute and Pharmaceutical Technology, Fuzhou, 350108
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29
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Liu X, Li P, Wang Z, Lu Y, Li N, Xiao L, Duan H, Wang Z, Li J, Shan C, Wu W. Evaluation of isokinetic muscle strength of upper limb and the relationship with pulmonary function and respiratory muscle strength in stable COPD patients. Int J Chron Obstruct Pulmon Dis 2019; 14:2027-2036. [PMID: 31564850 PMCID: PMC6733348 DOI: 10.2147/copd.s214737] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/15/2019] [Indexed: 11/23/2022] Open
Abstract
Background Upper limb muscle strength plays an important role in respiratory and pulmonary function, and limited research focuses on the role of strength and endurance of the elbow extensor and flexor. This study was conducted to accurately assess upper limb muscle function and quantified associations with pulmonary function and respiratory muscle strength in patients with stable chronic obstructive pulmonary disease (COPD). Methods In this cross-sectional study, patients with stable COPD treated in Yue-Yang Integrative Medicine Hospital from March 2014 to March 2016 were recruited. All participants underwent a pulmonary function test (forced expiratory volume in first second/forced vital capacity, FEV1/FVC; percentage value of predicted FEV1, FEV1%pred), a respiratory muscle strength test (maximal inspiratory pressure, MIP; maximal expiratory pressure, MEP), and an isokinetic test of dominant upper limb after a 24-hr interval (peak torque, PT; PT/body weight, PT/BW; total work, TW; endurance ratio, ER). Results A total of 88 patients with stable COPD (age: 65.5±8.7 years) were recruited, of which 73% (64 patients) were male. In the multiple stepwise regression analysis, sex remained as significant impactors in the final model for FEV1%pred (adjusted R2=0.243, P<0.001). Elbow flexor PT/BW and ER, sex, and BMI remained as significant impactors in the final model for FEV1/FVC (adjusted R2=0.255, P<0.01). Elbow flexor TW remained as significant impactors for MIP (adjusted R2=0.112, P=0.001), while elbow extensor PT and PT/BW and sex remained as significant impactors for MEP (adjusted R =0.385, P<0.01). Conclusion In stable COPD, pulmonary function and respiratory muscle strength are associated with upper limb muscle strength. In particular, elbow flexor endurance is likely an important impactor for pulmonary function and inspiratory muscle strength, while elbow extensor strength is of importance for expiratory muscle strength.
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Affiliation(s)
- Xiaodan Liu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China.,Institute of Rehabilitation Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Peijun Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Zhenwei Wang
- Department of Respiratory Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, People's Republic of China
| | - Yufan Lu
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Ning Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Lu Xiao
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Hongxia Duan
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Zhengrong Wang
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Jian Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Chunlei Shan
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China.,Institute of Rehabilitation Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Weibing Wu
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, People's Republic of China
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Wegmann K, Knowles N, Lalone E, Müller LP, Athwal GS, King GJW. Computed Tomography Analysis of the Radial Notch of the Ulna. J Hand Surg Am 2019; 44:794.e1-794.e8. [PMID: 30502012 DOI: 10.1016/j.jhsa.2018.10.010] [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: 12/09/2017] [Revised: 08/19/2018] [Accepted: 10/09/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The anatomy of the radial head and capitellum has been extensively studied; however, the anatomy of the radial notch of the ulna (RNU) has received little attention. This imaging-based anatomic study characterizes the morphology of the RNU. METHODS Ninety-eight cadaveric arms (57 male, 72 ± 14 y) were imaged with computed tomography, and 3-dimensional reconstructions of the proximal ulna were constructed. The anteroposterior and proximal-distal dimensions of the RNU as well as the radius of curvature at standardized levels were measured in 2-mm increments. The orientation of the RNU was also determined. RESULTS The proximal-distal and anteroposterior dimensions of the RNU were 12 ± 2 mm (range, 7-16 mm) and 18 ± 3 mm (range, 12-24 mm), respectively. The average radius of curvature of the RNU was 15 ± 0 mm (range, 15-16 mm). The radius of curvature did not change significantly when comparing the proximal and distal aspect of the RNU. The RNU was rotated 33° ± 2° (range, 31° to 38°) externally relative to the transverse plane of the ulna. The average depth of the RNU at its deepest point was 2.2 ± 0.4 mm (range, 1.5-2.7 mm). The depth decreased from proximal to distal, being most shallow distally. The depth changed by an increase of the radius of curvature, as well as by rotation in the frontal plane. CONCLUSIONS The RNU anatomy was variable, generally extending laterally from proximal to distal. This suggests that a radial head implant should taper from proximal to distal to optimize contact at the RNU. CLINICAL RELEVANCE The present study investigates the detailed anatomy of the radial notch of the ulna using computed tomography scans. The data might help improve the design of prosthetic components.
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Affiliation(s)
- Kilian Wegmann
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany.
| | - Nikolas Knowles
- Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
| | - Emily Lalone
- Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
| | - Lars P Müller
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany
| | - George S Athwal
- Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
| | - Graham J W King
- Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
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31
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Yang XH, Wei C, Li GP, Wang JJ, Zhao HT, Shi LT, Cao XY, Zhang YZ. Anatomical study of the anterior neurovascular interval approach to the elbow: observation of the neurovascular interval and relevant branches. Folia Morphol (Warsz) 2019; 79:387-394. [PMID: 31448401 DOI: 10.5603/fm.a2019.0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/31/2019] [Revised: 07/09/2019] [Accepted: 07/11/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of the study was to investigate the anatomy of the anterior nerve and artery of the elbow joint to provide reference on the relevant surgical approach to the elbow joint, and determine a simple better surgical approach for the treatment of part of the fractures of the elbow joint. MATERIALS AND METHODS The upper extremities of 10 adult cadavers fixed by formaldehyde and perfused with red latex in the artery were observed to investigate the anatomic structure of the anterior approach to the elbow joint. From the clearance of the brachioradialis and pronator teres muscle to the approach of the neurovascular interval, we observed the states of the median nerve, the brachial, radial and ulnar arteries, and its branches through anatomical layers and measurement methods. RESULTS Through the anterior neurovascular interval approach to the elbow, nerve and artery can be protected, and the anterior structures of the elbow, such as the ulna coronoid process, humeroulnar joint and trochlea of the humerus, can be exposed. CONCLUSIONS This study demonstrates that the anterior anatomical structure of the elbow joint including the trochlea of the humerus, coronoid process of the ulna and the front capsule of the elbow can be exposed through the anterior neurovascular approach to the elbow.
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Affiliation(s)
- X-H Yang
- Second Department of Orthopaedics, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - C Wei
- Emergency Centre of Trauma, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - G-P Li
- Second Department of Orthopaedics, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - J-J Wang
- Second Department of Orthopaedics, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - H-T Zhao
- Second Department of Orthopaedics, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - L-T Shi
- Second Department of Orthopaedics, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - X-Y Cao
- Second Department of Orthopaedics, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Y-Z Zhang
- Emergency Centre of Trauma, Third Hospital of Hebei Medical University, Shijiazhuang, China.
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Pan K, Wang F, Zhang J, Li M, Shi P, Cao Z, Zhou J. [Finite element analysis on biomechanical properties of medial collateral ligament of elbow joint under different flexion angles]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2019; 36:401-406. [PMID: 31232542 DOI: 10.7507/1001-5515.201709018] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Three-dimensional finite element model of elbow was established to study the effect of medial collateral ligament (MCL) in maintaining the stability of elbow joint. In the present study a three-dimensional geometric model of elbow joint was established by reverse engineering method based on the computed tomography (CT) image of healthy human elbow. In the finite element pre-processing software, the ligament and articular cartilage were constructed according to the anatomical structure, and the materials and contacts properties were given to the model. In the neutral forearm rotation position and 0° flexion angle, by comparing the simulation data of the elbow joint with the experimental data, the validity of the model is verified. The stress value and stress distribution of medial collateral ligaments were calculated at the flexion angles of elbow position in 15°, 30°, 45°, 60°, 75°, 90°, 105°, 120°, 135°, respectively. The result shows that when the elbow joint loaded at different flexion angles, the anterior bundle has the largest stress, followed by the posterior bundle, transverse bundle has the least, and the stress value of transverse bundle is trending to 0. Therefore, the anterior bundle plays leading role in maintaining the stability of the elbow, the posterior bundle plays supplementary role, and the transverse bundle does little. Furthermore, the present study will provide theoretical basis for clinical recognizing and therapy of elbow instability caused by medial collateral ligament injury.
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Affiliation(s)
- Kui Pan
- College of Mechanical Engineering, Tianjin University of Science and Technolog, Tianjin 300222, P.R.China;The Key Laboratory of Integrated Design and On-Line Monitoring of Light Industrial and Food Engineering Machinery and Equipment in Tianjin, Tianjin 300222, P.R.China
| | - Fang Wang
- College of Mechanical Engineering, Tianjin University of Science and Technolog, Tianjin 300222, P.R.China;The Key Laboratory of Integrated Design and On-Line Monitoring of Light Industrial and Food Engineering Machinery and Equipment in Tianjin, Tianjin 300222,
| | - Jianguo Zhang
- College of Mechanical Engineering, Tianjin University of Science and Technolog, Tianjin 300222, P.R.China;The Key Laboratory of Integrated Design and On-Line Monitoring of Light Industrial and Food Engineering Machinery and Equipment in Tianjin, Tianjin 300222,
| | - Mingxin Li
- Traumatology Department, Hospital of Tianjin, Tianjin 300211, P.R.China
| | - Peizhen Shi
- College of Mechanical Engineering, Tianjin University of Science and Technolog, Tianjin 300222, P.R.China;The Key Laboratory of Integrated Design and On-Line Monitoring of Light Industrial and Food Engineering Machinery and Equipment in Tianjin, Tianjin 300222, P.R.China
| | - Zijun Cao
- College of Mechanical Engineering, Tianjin University of Science and Technolog, Tianjin 300222, P.R.China;The Key Laboratory of Integrated Design and On-Line Monitoring of Light Industrial and Food Engineering Machinery and Equipment in Tianjin, Tianjin 300222, P.R.China
| | - Jingsong Zhou
- College of Mechanical Engineering, Tianjin University of Science and Technolog, Tianjin 300222, P.R.China;The Key Laboratory of Integrated Design and On-Line Monitoring of Light Industrial and Food Engineering Machinery and Equipment in Tianjin, Tianjin 300222, P.R.China
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Ohta S, Ikeguchi R, Yurie H, Takeuchi H, Mitsuzawa S, Matsuda S. Keyhole resection of intra-articular osteoid osteoma in the ulnar trochlear notch using 3-dimensional computed tomography-based navigation. J Shoulder Elbow Surg 2019; 28:e57-e61. [PMID: 30658777 DOI: 10.1016/j.jse.2018.10.020] [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: 09/27/2018] [Accepted: 10/20/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Souichi Ohta
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan.
| | - Ryosuke Ikeguchi
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Hirofumi Yurie
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | | | - Sadaki Mitsuzawa
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
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He SK, Zhao SC, Guo JH, Qin TW, Huang FG. Combined use of Kirschner wires and hinged external fixator for capitellar and trochlear fractures: a minimum 24-month follow-up. ANZ J Surg 2018; 89:196-200. [PMID: 30484942 DOI: 10.1111/ans.14924] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 09/19/2018] [Accepted: 09/22/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Open reduction and internal fixation is the adequate treatment for capitellar and trochlear fractures. Given the low incidence of this type of fractures, it is difficult to constitute a universally accepted method for fixation. Thus, we hypothesised that combined use of Kirschner wires (K-wires), absorbable rods and sutures for fixation and post-operative hinged external fixator for early rehabilitation exercise can restore elbow joint function well. METHODS This retrospective study included 20 patients with a mean age of 48.3 (range 16-76) years. According to the Dubberley classification, fractures were classified on plain radiographs, computed tomography images and intra-operative findings. All patients were evaluated by the range of motion of the elbow and the Broberg-Morrey score. RESULTS All fractures had healed without non-union, and the average time was 13.6 (range 8-17) weeks. The mean follow-up was 42.5 (range 24-80) months. The mean flexion was 117.1° (range 90°-135°), and the mean extension was 17.5° (range 0°-45°). The mean pronation was 74.4° (range 45°-85°), and the mean supination was 84.3° (range 60°-90°). The average Broberg-Morrey score was 86.2 (range 68-98) points with 10 excellent, 7 good and 3 fair results. CONCLUSION K-wires, absorbable rods and sutures combined with hinged external fixator are feasible for fixation of capitellar and trochlear fractures. However, due to the absence of a control group (such as Herbert screw fixation), comparative studies are still needed to demonstrate the safety and reliability of K-wires for fixation.
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Affiliation(s)
- Shu-Kun He
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Si-Chun Zhao
- Department of Orthopedics, The Third People's Hospital of Mianyang, Mianyang, China
| | - Jin-Hai Guo
- Department of Orthopedics, The First People's Hospital of Jintang County (The Jintang Hospital of West China Hospital, Sichuan University), Chengdu, China
| | - Ting-Wu Qin
- Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Fu-Guo Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
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Rahman M, Cil A, Stylianou AP. Medial Collateral Ligament Deficiency of the Elbow Joint: A Computational Approach. Bioengineering (Basel) 2018; 5:bioengineering5040084. [PMID: 30308994 PMCID: PMC6316890 DOI: 10.3390/bioengineering5040084] [Citation(s) in RCA: 6] [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: 08/04/2018] [Revised: 10/02/2018] [Accepted: 10/08/2018] [Indexed: 11/16/2022] Open
Abstract
Computational elbow joint models, capable of simulating medial collateral ligament deficiency, can be extremely valuable tools for surgical planning and refinement of therapeutic strategies. The objective of this study was to investigate the effects of varying levels of medial collateral ligament deficiency on elbow joint stability using subject-specific computational models. Two elbow joint models were placed at the pronated forearm position and passively flexed by applying a vertical downward motion on humeral head. The models included three-dimensional bone geometries, multiple ligament bundles wrapped around the joint, and the discretized cartilage representation. Four different ligament conditions were simulated: All intact ligaments, isolated medial collateral ligament (MCL) anterior bundle deficiency, isolated MCL posterior bundle deficiency, and complete MCL deficiency. Minimal kinematic differences were observed for isolated anterior and posterior bundle deficient elbows. However, sectioning the entire MCL resulted in significant kinematic differences and induced substantial elbow instability. Joint contact areas were nearly similar for the intact and isolated posterior bundle deficiency. Minor differences were observed for the isolated anterior bundle deficiency, and major differences were observed for the entire MCL deficiency. Complete elbow dislocations were not observed for any ligament deficiency level. As expected, during isolated anterior bundle deficiency, the remaining posterior bundle experiences higher load and vice versa. Overall, the results indicate that either MCL anterior or posterior bundle can provide anterior elbow stability, but the anterior bundle has a somewhat bigger influence on joint kinematics and contact characteristics than posterior one. A study with a larger sample size could help to strengthen the conclusion and statistical significant.
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Affiliation(s)
- Munsur Rahman
- Department of Civil and Mechanical Engineering, University of Missouri-Kansas City, 5110 Rockhill Road, Kansas City, MO 64110, USA.
| | - Akin Cil
- Department of Civil and Mechanical Engineering, University of Missouri-Kansas City, 5110 Rockhill Road, Kansas City, MO 64110, USA.
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, USA.
- Department of Orthopaedics, Truman Medical Centers, 2301 Holmes Street, Kansas City, MO 64108, USA.
| | - Antonis P Stylianou
- Department of Civil and Mechanical Engineering, University of Missouri-Kansas City, 5110 Rockhill Road, Kansas City, MO 64110, USA.
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Abstract
We present an unusual case of five months old neglected anterior dislocation of the right elbow joint in a 19-year old man. The patient had been initially treated by a traditional bone setter, but the elbow remained unreduced. He presented to us with pain, deformity and limited range of motion of his right elbow joint. Radiographs revealed an unreduced anterior dislocation of the right elbow joint. We describe the problems encountered during open reduction and rehabilitation and result one year after the operation with the patient having a stable elbow and a functional range of motion.
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Affiliation(s)
- S K Nema
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research
| | - G Behera
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research
| | - M Poduval
- Department of Orthopaedics, SME Tata Consultancy Services, Mumbai, India
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Malesa K, Urban M, Michalik D, Pomianowski S. KPS Bipolar Radial Head Arthroplasty - Polyethylene Head Replacement with a Metal-covered Head. Case Study. Ortop Traumatol Rehabil 2018; 20:229-237. [PMID: 30152772 DOI: 10.5604/01.3001.0012.2133] [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] [Indexed: 11/13/2022]
Abstract
Radial head replacement should be indicated in all cases of radial head fractures when open reduction and internal fixation is anticipated to be difficult or impossible. Although excellent therapeutic results have been ob-tained, this procedure, like any other surgical procedures, may be associated with severe complications, includ-ing contractures, ossification or aseptic synovitis. In these cases, removal of the prosthetic radial head has al-ways been a safe and popular solution producing a satisfactory clinical outcome. However, we present the case of a patient in whom the prosthesis was left in place, but the polyethylene head was replaced with a metal-covered head. The decision to perform this procedure was taken intraoperatively.
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Affiliation(s)
- Kamila Malesa
- Samodzielny Publiczny Szpital Kliniczny im. Prof. A. Grucy w Otwocku, Otwock, Polska / Gruca Orthopaedic and Trauma Teaching Hospital in Otwock, Poland Klinika Chirurgii Urazowej Narządu Ruchu i Ortopedii CMKP / Department of Traumatology and Orthopaedics, Centre of Postgraduate Medical Education
| | - Mariusz Urban
- Samodzielny Publiczny Szpital Kliniczny im. Prof. A. Grucy w Otwocku, Otwock, Polska / Gruca Orthopaedic and Trauma Teaching Hospital in Otwock, Poland Klinika Chirurgii Urazowej Narządu Ruchu i Ortopedii CMKP / Department of Traumatology and Orthopaedics, Centre of Postgraduate Medical Education
| | - Dariusz Michalik
- Samodzielny Publiczny Szpital Kliniczny im. Prof. A. Grucy w Otwocku, Otwock, Polska / Gruca Orthopaedic and Trauma Teaching Hospital in Otwock, Poland Klinika Chirurgii Urazowej Narządu Ruchu i Ortopedii CMKP / Department of Traumatology and Orthopaedics, Centre of Postgraduate Medical Education
| | - Stanisław Pomianowski
- Samodzielny Publiczny Szpital Kliniczny im. Prof. A. Grucy w Otwocku, Otwock, Polska / Gruca Orthopaedic and Trauma Teaching Hospital in Otwock, Poland Klinika Chirurgii Urazowej Narządu Ruchu i Ortopedii CMKP / Department of Traumatology and Orthopaedics, Centre of Postgraduate Medical Education
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Figueirido B. Phenotypic disparity of the elbow joint in domestic dogs and wild carnivores. Evolution 2018; 72:1600-1613. [PMID: 29766489 DOI: 10.1111/evo.13503] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 04/29/2018] [Accepted: 05/01/2018] [Indexed: 11/27/2022]
Abstract
In this article, I use geometric morphometrics in 2D from a sample of 366 elbow joints to quantify phenotypic disparity in domestic dog breeds, in wild canids, and across the order Carnivora. The elbow joint is a well-established morphological indicator of forearm motion and, by extension, of functional adaptations toward locomotor or predatory behavior in living carnivores. The study of the elbow joint in domestic dogs allows the exploration of potential convergences between (i) pursuit predators and fast-running dogs, and (ii) ambush predators and fighting breeds. The results indicate that elbow shape disparity among domestic dogs exceeds than in wolves; it is comparable to the disparity of wild Caninae, but is significantly lower than the one observed throughout Canidae and Carnivora. Moreover, fast-running and fighting breeds are not convergent in elbow joint shape with extreme pursuit and ambush wild carnivores, respectively. The role of artificial selection and developmental constraints in shaping limb phenotypic disparity through the extremely fast evolution of the domestic dog is discussed in the light of this new evidence.
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Affiliation(s)
- Borja Figueirido
- Departamento de Ecología y Geología, Área de Paleontología, Facultad de Ciencias, Universidad de Málaga, 29071 Málaga, Spain
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Rahman M, Sharifi Renani M, Cil A, Stylianou AP. Musculoskeletal Model Development of the Elbow Joint with an Experimental Evaluation. Bioengineering (Basel) 2018; 5:E31. [PMID: 29677139 DOI: 10.3390/bioengineering5020031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 11/17/2022] Open
Abstract
A dynamic musculoskeletal model of the elbow joint in which muscle, ligament, and articular surface contact forces are predicted concurrently would be an ideal tool for patient-specific preoperative planning, computer-aided surgery, and rehabilitation. Existing musculoskeletal elbow joint models have limited clinical applicability because of idealizing the elbow as a mechanical hinge joint or ignoring important soft tissue (e.g., cartilage) contributions. The purpose of this study was to develop a subject-specific anatomically correct musculoskeletal elbow joint model and evaluate it based on experimental kinematics and muscle electromyography measurements. The model included three-dimensional bone geometries, a joint constrained by multiple ligament bundles, deformable contacts, and the natural oblique wrapping of ligaments. The musculoskeletal model predicted the bone kinematics reasonably accurately in three different velocity conditions. The model predicted timing and number of muscle excitations, and the normalized muscle forces were also in agreement with the experiment. The model was able to predict important in vivo parameters that are not possible to measure experimentally, such as muscle and ligament forces, and cartilage contact pressure. In addition, the developed musculoskeletal model was computationally efficient for body-level dynamic simulation. The maximum computation time was less than 30 min for our 35 s simulation. As a predictive clinical tool, the potential medical applications for this model and modeling approach are significant.
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Park JY, Seo BH, Hong KH, Lee JH, Oh KS, Chung SW, Noh YM. Prevalence and clinical outcomes of heterotopic ossification after ulnar collateral ligament reconstruction. J Shoulder Elbow Surg 2018; 27:427-434. [PMID: 29433643 DOI: 10.1016/j.jse.2017.11.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/28/2017] [Revised: 11/04/2017] [Accepted: 11/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ulnar collateral ligament (UCL) reconstruction has become increasingly popular in elite athletes. However, the prevalence of heterotopic ossification (HO) formation after UCL reconstruction has not yet been reported. We sought to determine the prevalence of HO formation after UCL reconstruction and the clinical outcomes following HO treatment. MATERIALS AND METHODS From October 2005 to April 2014, 179 patients underwent primary UCL reconstruction. Of the 179 patients, 161 with a minimum of 2 years of follow-up were retrospectively reviewed to evaluate HO formation and clinical outcomes. RESULTS Among 161 patients, HO was detected in 8 cases (5%). Of these 8 patients, 2 were asymptomatic and another 2 complained about transient ulnar neuropathy. The remaining 4 patients had pain; 2 were treated with open excision, and 1 underwent arthroscopic excision. The odds of HO in patients in whom transient ulnar neuropathy develops after UCL reconstruction are 6 times higher than those without transient ulnar neuropathy (odds ratio, 5.957; 95% confidence level, P = .04). Of the 8 patients, 7 returned to the same level or a higher level of competition. HO was found, on average, 5 months (range, 3-9 months) after UCL reconstruction. CONCLUSION The prevalence of HO formation was approximately 5% after UCL reconstruction and increased with transient ulnar neuropathy. After UCL reconstruction, the surgeon should carefully observe HO formation, especially in the early stages after the operation. With appropriate treatment, the clinical outcomes of HO treatment after UCL reconstruction are favorable.
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Affiliation(s)
- Jin-Young Park
- Center for Shoulder, Elbow and Sports Medicine, Neon Orthopaedic Clinic, Seoul, Republic of Korea
| | - Beom Ho Seo
- Center for Shoulder, Elbow and Sports Medicine, Neon Orthopaedic Clinic, Seoul, Republic of Korea.
| | - Kyung-Ho Hong
- Center for Shoulder, Elbow and Sports Medicine, Neon Orthopaedic Clinic, Seoul, Republic of Korea; Department of Orthopedic Surgery, SeoulChuk Hospital, Seoul, Republic of Korea
| | - Jae-Hyung Lee
- Center for Shoulder, Elbow and Sports Medicine, Neon Orthopaedic Clinic, Seoul, Republic of Korea
| | - Kyung-Soo Oh
- Department of Orthopedic Surgery, Konkuk University Hospital, Seoul, Republic of Korea
| | - Seok Won Chung
- Department of Orthopedic Surgery, Konkuk University Hospital, Seoul, Republic of Korea
| | - Young-Min Noh
- Department of Orthopedic Surgery, Dong-A University Hospital, Busan, Republic of Korea
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Zhang J, Wang J, Mao X, Li Z. Multiple extra-articular synovial cysts accompanied by rheumatoid arthritis in the bilateral elbow joints: A case report. Medicine (Baltimore) 2018; 97:e9879. [PMID: 29443754 PMCID: PMC5839867 DOI: 10.1097/md.0000000000009879] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Synovial cysts are well known in rheumatoid arthritis (RA), and most common in the popliteal fossa. They may produce lots of local symptoms and complaints, which may present initially as an unrelated clinical condition. Few studies have reported multiple extra-articular synovial cysts (MESCs) in the RA patients. Early diagnosis is crucial for patient treatment. PATIENT CONCERNS A 50-year-old man without any special clinical histories found a soya bean size bump at the left elbow medially, then multiple lumps were found at bilateral elbows and gradually increasing. No pain, no activity, no redness, and swelling. Magnetic resonance imaging (MRI) showed multiple cystic lesions in the bursa and surrounding soft tissue of bilateral elbow joints. In addition, the elbow joint bursa was swollen and the synovial membrane was significantly thickened. DIAGNOSES The man was diagnosed as RA with multiple extra-articular synovial cysts formation. INTERVENTIONS The patient was performed tylectomy of the right elbow. Other lumps were punctured and injected with compound betamethasone injection. OUTCOMES The bumps were reduced in size and the swelling relieved, and the patient was sent to the department of rheumatology and immunology for further treatment. LESSONS In this case, it is difficult for the diagnosis of RA because of no relative histories and simultaneously multiple cystic lesions in multiple joints. Imaging examinations can show the characteristics of such kind of disease and be very helpful for the diagnosis and differentiate diagnosis.
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Affiliation(s)
- Jingfeng Zhang
- Department of Radiology, the First Affiliated Hospital, School of Medicine, Zhejiang University
| | - Junli Wang
- Department of Radiology, the First Affiliated Hospital, School of Medicine, Zhejiang University
| | - Xiongwei Mao
- Department of Radiology, Hospital of Zhejiang University, Hangzhou, China
| | - Zhengang Li
- Department of Radiology, the First Affiliated Hospital, School of Medicine, Zhejiang University
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Abstract
BACKGROUND Sideswipe injuries of elbow often poses significant functional loss resulting from devastating injuries involving osseoligamentous structures as well as multilevel soft tissue injuries around the elbow. Inspite of treatment, no conscientious treatment opinion is available in the literature to provide optimum functional outcome. The objective of this study is to evaluate the results of prosthetic replacement of old healed sideswipe injuries of elbow with gross dysfunctional disabilities resulting from loss of bones and muscles around the joint. MATERIALS AND METHODS Fourteen patients of 2-3 years old healed sideswipe injuries of the elbow, treated by Baksi sloppy hinge (original version in seven and recent version in seven) prosthetic replacement were evaluated. All had normal neurovascular status except two; one having ulnar nerve deficit the other median nerve in another. The mean age was 42.7 years (range 32-61 years). RESULTS The average followup period was 13.5 years (range 5.11-23.11 years). Ten patients regained stable 0° to 130° elbow flexion, and four had restricted terminal flexion with arc 10°-115° following V-Y plasty of contracted triceps. Mean supination was 22° and mean pronation was 35°. According to Mayo Elbow Performance Score (MEPS), excellent results were in five (35.7%), good in six (42.8%), and fair in one (7.1%). Two patients (14.2%) needed removal of prosthesis due to intractable delayed infection and considered failure. Following removal, the resected elbow retained relatively stable motions due to mature fibrous tissues connecting the adjacent bone ends and reorientation of muscle balance. Postoperative improvement of MEPS (mean 84) was significant (P = 0.0037) compared to preoperative value (mean 41.7). Two patients had superficial wound infection and five aseptic loosening of which one was symptomatic. CONCLUSION Prosthetic replacement of elbow is an effective salvage procedure in old healed sideswipe injuries.
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Affiliation(s)
- Debadyuti Baksi
- Department of Orthopaedics, MGM Medical College, Kishanganj, Bihar, India,Address for correspondence: Dr. Debadyuti D Baksi, DA-3, Sector – I, Salt Lake City, Kolkata - 700 064, West Bengal, India. E-mail:
| | - A K Pal
- Department of Orthopaedics, IPGME and R, Kolkata, West Bengal, India
| | - D P Baksi
- Department of Orthopaedics, Medical College and Hospital, Kolkata, West Bengal, India
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Kamrani RS, Moradi A, Sharafat Vaziri A, Nabian MH, Ghane B. Arthroscopic ablation of an osteoid osteoma of the elbow: a case series with a minimum of 18 months' follow-up. J Shoulder Elbow Surg 2017; 26:e122-7. [PMID: 28236570 DOI: 10.1016/j.jse.2017.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 01/04/2017] [Accepted: 01/19/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthroscopic excision of an osteoid osteoma was first reported in the knee joint; since then, there have been several reports of arthroscopic excisions in the knee, shoulder, and elbow, with inconclusive outcomes because of a limited number of cases. The aim of this prospective study was to evaluate the medium-term functional effects of arthroscopic ablation in cases of an osteoid osteoma around the elbow. METHODS We treated osteoid osteoma of the elbow through arthroscopic ablation in 10 patients. The arthroscopic resection procedure was performed 23 ± 9 months (range, 12-36 months) after initial symptoms. At the preoperative examination and last follow-up examination, the elbow flexion-extension and forearm supination-pronation ranges of motion were measured. The patients were assessed by the Mayo Elbow Performance Score, the visual analog scale for the elbow and wrist, and the Quick Disabilities of the Arm, Shoulder, and Hand score. Finally, the patients' general satisfaction was assessed. RESULTS The postoperative elbow flexion-extension range of motion was significantly higher compared with range of motion before surgery (P = .001; r = 0.86). According to the Mayo Elbow Performance Score, the average score increased significantly at the final follow-up examination. The mean preoperative and final Quick Disabilities of the Arm, Shoulder, and Hand scores were 47 ± 14 and 1.6 ± 2.8, respectively (P < .001). All patients were satisfied with the operation result. CONCLUSION According to the results of our study, arthroscopic ablation is a safe and efficient method of treatment for osteoid osteoma of the elbow, with a fast rehabilitation time.
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Sandeep KN, Suresh G, Gopisankar B, Abhishek N, Sujiv A. Does Excision of Heterotopic Ossification of the Elbow Result in Satisfactory Patient-Rated Outcomes? Malays Orthop J 2017; 11:35-40. [PMID: 28435572 PMCID: PMC5393112 DOI: 10.5704/moj.1703.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Indexed: 11/28/2022] Open
Abstract
Introduction Treatment of heterotopic ossification (HO) of the elbow is challenging and fraught with complications. Patients who sustain direct trauma to the elbow joint, the central nervous system, and thermal burns are at increased risk for development of HO. There is a paucity of studies and reports on patient’s self-evaluation after the excision of the heterotopic ossification. Materials and Methods This retrospective study assessed outcomes after excision of heterotopic ossification around the elbow in a cohort of ten patients operated from 2012 to 2015. The outcome assessment was done by the Mayo Elbow Performance index (MEPI) and the American Shoulder and Elbow Surgeons-Elbow score (ASES-E scores). Results The mean follow-up was 18.11 months after the operation. The Mayo Elbow Performance Score was excellent in two elbows, good in six and fair in two. The mean gain in flexion-extension arc after excision of HO was 80 degrees. All of the patients had residual flexion deformity postoperatively. Eight of the nine patients were able to do activities requiring flexion at final follow-up. Conclusion Excision of HO around the elbow is associated with satisfactory patient-rated outcomes in spite of failure to regain full range of motion.
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Affiliation(s)
- K N Sandeep
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - G Suresh
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - B Gopisankar
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - N Abhishek
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - A Sujiv
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Abstract
The incidence of primary total elbow arthroplasty (TEA) in young patients is increasing. The indications for revision surgery are also rising. Here, we report a rare case of pseudotumor detected in a patient 16 years after TEA. Intraoperative findings revealed a necrotic mass characterized by a conspicuous metallosis in the soft tissues around the prosthesis, which caused ulnar nerve dislocation. Due to this anatomical change, a lesion of the nerve was accidentally produced during revision surgery. The case report emphasizes that the indications for elbow replacement, as well as the patient education about the permanent physical limitations, should be carefully considered. Moreover, the high risks of complications related to the revision procedure and pseudotumor removal need to be addressed before surgery. The technique should be done carefully and a preliminary thorough imaging should be performed, since a newly formed mass can cause significant distortion of the anatomy.
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Affiliation(s)
- Roberto Rotini
- Department of Shoulder and Elbow Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Graziano Bettelli
- Department of Shoulder and Elbow Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Michele Cavaciocchi
- Department of Shoulder and Elbow Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Lucia Savarino
- Department of Complex Orthopedic-Trauma Pathology, Laboratory for Orthopaedic Pathophysiology and Regenerative Medicine, Rizzoli Orthopaedic Institute, Bologna, Italy,Address for correspondence: Dr. Lucia Savarino, Department of Complex Orthopedic-Trauma Pathology, Laboratory for Orthopaedic Pathophysiology and Regenerative Medicine, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy. E-mail:
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Abstract
Fracture of bilateral capitulum humeri is a very rare injury. We present a case of a 38-year-old woman, affected by a shear fracture of bilateral capitellum after a motorcycle accident. Intervention was carried out through a lateral approach on both sides and direct fixation of the fragment with headless screws. Consolidation was achieved and no signs of avascular necrosis occurred at 24 months of follow-up. The patient returned to her previous activities with no functional limitations. To the best of our knowledge, only four cases are reported describing different types of treatment and postoperative period of cast immobilization. According to our review of the literature regarding capitellar fractures, we preferred an immediate postoperative rehabilitation of the elbow, following the stable osteosynthesis.
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Affiliation(s)
- Alessandro Are
- Department of Orthopedics, Policlinico Casilino Hospital, Rome, Italy
| | - Ignazio Tornatore
- Department of Orthopedics, Policlinico Casilino Hospital, Rome, Italy
| | - Emmanouil Theodorakis
- Department of Orthopedics, Aurelia Hospital, Rome, Italy,Corresponding author. Tel.: +39 3407444861.
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47
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Puri A, Gulia A, Byregowda S, Ramanujan V. Reconstruction of the elbow and forearm for Ewing sarcoma of ulna: A new biological technique. Int J Shoulder Surg 2016; 10:85-8. [PMID: 27186061 PMCID: PMC4857536 DOI: 10.4103/0973-6042.180721] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Primary bone tumors around the elbow represent <1% of all the skeletal tumors. Surgery with or without adjuvant therapy (radiotherapy, chemotherapy) is the treatment of choice for malignant tumors. Reconstruction of the elbow and forearm in malignant tumors is challenging as it involves a complex interplay between multiple joints which need to be stabilized for the optimal functional outcome. We describe a new technique for the reconstruction of the elbow after resection of a proximal ulna tumor with articular radio-ulnar synostosis with the creation of a single bone forearm. We attempted to achieve a mobile elbow and stable wrist joint with the radio-ulnar union at the proximal articular surface of the ulna resulting in a single bone forearm. The procedure involves an oblique osteotomy preserving the olecranon process (after taking adequate margins based on oncological principles) and its articular cartilage along with the attachment of the triceps tendon. Then the radial head was partially denuded of its cartilage using a burr, leaving cartilage only on the volar side, and then fused to the remnant olecranon. Osteosynthesis was done using compression screw and tension band wiring. The advantages of this procedure are that the mobility at wrist and elbow are retained, it requires minimal hardware and allows for primary closure of the wound.
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Affiliation(s)
- Ajay Puri
- Orthopaedic Oncology Services, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ashish Gulia
- Orthopaedic Oncology Services, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Suman Byregowda
- Orthopaedic Oncology Services, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vishnu Ramanujan
- Orthopaedic Oncology Services, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Abstract
Myositis ossificans circumscripta (MOC) is a kind of self-localized, benign and tumor-like lesions often seen in adults, with approximately 75% of cases caused by trauma. We reported a case of non-traumatic MOC occurred at the elbow joint in a 9-year old child and it has been excised by surgery. After 18 months follow-up, a favorable outcome has been achieved with the Broberg-Morrey score of 100. We suggest that surgical resection should be done as soon as the diagnosis is confirmed.
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Affiliation(s)
- Peng-Fei Li
- First Clinic Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Zi-Ling Lin
- Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China,Corresponding author. Tel.: +86 13600460045.
| | - Zhi-Hui Pang
- Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
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49
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Lake SP, Castile RM, Borinsky S, Dunham CL, Havlioglu N, Galatz LM. Development and use of an animal model to study post-traumatic stiffness and contracture of the elbow. J Orthop Res 2016; 34:354-64. [PMID: 26177969 DOI: 10.1002/jor.22981] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 08/04/2014] [Accepted: 07/08/2015] [Indexed: 02/04/2023]
Abstract
Post-traumatic joint stiffness (PTJS) of the elbow is a debilitating condition that poses unique treatment challenges. While previous research has implicated capsular tissue in PTJS, much regarding the development and progression of this condition remains unknown. The objective of this study was to develop an animal model of post-traumatic elbow contracture and evaluate its potential for studying the etiology of PTJS. The Long-Evans rat was identified as the most appropriate species/breed for development due to anatomical and functional similarities to the human elbow joint. Two surgical protocols of varying severity were utilized to replicate soft tissue damage seen in elbow subluxation/dislocation injuries, including anterior capsulotomy and lateral collateral ligament transection, followed by 6 weeks of unilateral joint immobilization. Following sacrifice, flexion-extension mechanical joint testing demonstrated decreased range-of-motion and increased stiffness for injured-immobilized limbs compared to control and sham animals, where functional impact correlated with severity of injury. Histological evaluation showed increased cellularity, adhesion, and thickness of capsule tissue in injured limbs, consistent with clinical evidence. To our knowledge, this is the first animal model capable of examining challenges unique to the anatomically and biomechanically complex elbow joint. Future studies will use this animal model to investigate mechanisms responsible for PTJS.
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Affiliation(s)
- Spencer P Lake
- Department of Mechanical Engineering & Materials Science, Washington University, 1 Brookings Hall, Campus Box 1185, St. Louis, 63130, Missouri.,Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri.,Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Ryan M Castile
- Department of Mechanical Engineering & Materials Science, Washington University, 1 Brookings Hall, Campus Box 1185, St. Louis, 63130, Missouri
| | - Stephanie Borinsky
- Department of Mechanical Engineering & Materials Science, Washington University, 1 Brookings Hall, Campus Box 1185, St. Louis, 63130, Missouri.,Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Chelsey L Dunham
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Necat Havlioglu
- Department of Pathology, John Cochran VA Medical Center, St Louis, Missouri
| | - Leesa M Galatz
- Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
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50
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Yazıcı A, Kayan G, Yaylacı S, Demir MV, Karakeçe E, Tamer A, Karabay O. Tuberculous arthritis of the elbow joint: A case report. Eur J Rheumatol 2016; 3:142-143. [PMID: 27733947 DOI: 10.5152/eurjrheum.2015.0062] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/18/2015] [Indexed: 11/22/2022] Open
Abstract
Tuberculous arthritis of the elbow joint is rare. A 57-year-old male patient presented with swelling, pain, and redness of the elbow. The symptoms first appeared one month ago; he was given antibiotic treatment after the diagnosis of septic arthritis at another center. The patient who did not improve with treatment was diagnosed with tuberculous arthritis according to the culture and was started on antituberculosis treatment. Tuberculous arthritis usually presents with chronic arthritis. However, it can also present in patients with septic arthritis.
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Affiliation(s)
- Ayten Yazıcı
- Department of Internal Medicine, Division of Rheumatology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Gökçen Kayan
- Clinic of Infection Diseases, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Selçuk Yaylacı
- Department of Internal Medicine, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Mustafa Volkan Demir
- Department of Internal Medicine, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Engin Karakeçe
- Department of Clinic Microbiology, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Ali Tamer
- Department of Internal Medicine, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Oğuz Karabay
- Clinic of Infection Diseases, Sakarya Training and Research Hospital, Sakarya, Turkey
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