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Gunsoy Z, Sayer G, Dinc M, Soydemir OC, Oguzkaya S. The effect of plate location on radial nerve palsy recovery time associated with humeral shaft fractures. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02524-9. [PMID: 39008113 DOI: 10.1007/s00068-024-02524-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/04/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND This study aims to investigate the influence of plate placement on nerve regeneration in humerus fractures accompanied by radial nerve injury. METHODS A retrospective analysis was conducted on a cohort of 94 patients with humerus fractures and concomitant radial nerve injury treated between January 2018 and November 2022. After applying exclusion criteria, 31 patients were included in the study. Clinical outcomes were assessed by comparing demographic data, surgical duration, radial nerve recovery time, the Mayo Elbow Performance Score (MEPS), Disabilities of the Arm Shoulder and Hand (DASH), and the Medical Research Council (MRC) scale. RESULTS Two distinct groups were established: lateral plating and anteromedial (AM) plating. These groups demonstrated comparability regarding age, gender, and body mass index (BMI). No statistically significant differences were observed between the groups concerning MEPS and MRC. The AM plating group notably exhibited shorter surgical durations, faster recovery times, and lower DASH scores. CONCLUSION According to the findings of this investigation, in cases of humerus fractures accompanied by radial nerve injury, AM plating may be preferable over lateral plating due to its association with reduced surgical durations and expedited nerve recovery.
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Affiliation(s)
- Zeki Gunsoy
- Department of Hand Surgery, Bursa City Hospital, Bursa, Turkey.
| | - Gokhan Sayer
- Department of Orthopedics and Traumatology, Bursa City Hospital, Bursa, Turkey
| | - Mustafa Dinc
- Department of Orthopedics and Traumatology, Bursa City Hospital, Bursa, Turkey
| | | | - Sinan Oguzkaya
- Department of Orthopedics and Traumatology, Bursa City Hospital, Bursa, Turkey
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Birinci T, Altun S, Ziroğlu N, Kaya Mutlu E. The Shanghai Elbow Dysfunction Score: Psychometric Properties, Reliability and Validity Study of the Turkish Version. Eval Health Prof 2024; 47:111-118. [PMID: 37312232 DOI: 10.1177/01632787231183089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The Shanghai Elbow Dysfunction Score (SHEDS) is a self-reported assessment of post-traumatic elbow stiffness that measures elbow-related symptoms and elbow motion capacities. This study aimed to (1) translate and cross-culturally adapt the SHEDS into Turkish and (2) investigate the psychometric properties of the Turkish version in patients with post-traumatic elbow stiffness. The psychometric properties of the Turkish version of the SHEDS (SHEDS-T) were tested in 108 patients (72 male; mean age, 43.2 ± 11.2 years) with post-traumatic elbow stiffness. Cronbach's alpha was used to assess internal consistency. The intraclass correlation coefficients were used to estimate test-retest. Construct validity was analyzed with the Turkish version of the Disabilities Arm, Shoulder and Hand (DASH), the Mayo Elbow Performance Score (MEPS), and the Short Form-12 (PCS-12 and MCS-12). The SHEDS-T showed sufficient internal consistency (Cronbach's α coefficient = 0.83) and test-retest reliability (ICC = .96). The correlation coefficients between the SHEDS-T, the DASH, and the MEPS were .75 and .54, respectively (p < .001). There was a moderate correlation between the SHEDS-T and PCS-12 (r = .65, p = .01) and a weak positive correlation between the SHEDS and the MCS-12 (r = .40, p = .03). The SHEDS-T has sufficient reliability and validity to measure elbow-related symptoms and elbow motion capacities for Turkish-speaking individuals with post-traumatic elbow stiffness.
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Affiliation(s)
- Tansu Birinci
- Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul Medeniyet University, Istanbul, Turkey
| | - Suleyman Altun
- Clinic of Orthopaedics and Traumatology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Nezih Ziroğlu
- Clinic of Orthopaedics, Traumatology and Sports Surgery, Acıbadem Atakent Hospital, Istanbul, Turkey
| | - Ebru Kaya Mutlu
- Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Bandırma Onyedi Eylul University, Balikesir, Turkey
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Zhou SC, Jin SY, Wang QY, Ren GK, Peng CG, Wang YB, Wu DK. Surgical flip-dislocation of the bicolumnar approach without olecranon osteotomy versus olecranon osteotomy in type AO 13C3 distal humeral fracture: a matched-cohort study. J Orthop Surg Res 2023; 18:913. [PMID: 38031095 PMCID: PMC10688126 DOI: 10.1186/s13018-023-04405-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/24/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Our experience with the surgical flip-dislocation of the bicolumnar (SFDB) approach for type AO 13C3 humeral fractures indicates that this surgical approach can be performed safely and effectively in appropriately selected patients. We aimed to evaluate the clinical outcomes of the SFDB approach without olecranon osteotomy (OO) for type AO 13C3 distal humeral fractures. METHODS We retrospectively reviewed 65 cases of type AO 13C3 distal humeral fractures treated between April 2008 and July 2018; 33 patients were treated with the SFDB approach, and the remaining were treated with OO. Propensity score matching was used to control for sex, age, and the American Society of Anesthesiology score. Elbow pain, range of motion, stability, and function were assessed using the Mayo Elbow Performance Index (MEPI) and the Disabilities of the Arm, Shoulder, and Hand questionnaire. Clinical complications, reoperation rates, and radiographic results were compared between the groups. RESULTS Operative time and blood loss were significantly lower in the SFDB group than in the OO group (P = 0.001, P = 0.002, respectively). At the final follow-up, the mean postoperative MEPI did not significantly differ between the groups (P = 0.628). According to Morrey's criteria, a typical functional range of elbow motion was achieved in 12 and 15 patients in the SFDB and OO groups, respectively. CONCLUSIONS The SFDB approach achieves superior exposure of the articular surface without injury to the extensor mechanism in type 13C3 articular surface fracture treatment. This approach also results in good early functional recovery and clinical outcomes, with a low risk of complications.
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Affiliation(s)
- Shi-Cheng Zhou
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Changchun, Jilin, People's Republic of China
| | - Sheng-Yu Jin
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Changchun, Jilin, People's Republic of China
| | - Qing-Yu Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Changchun, Jilin, People's Republic of China
| | - Guang-Kai Ren
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Changchun, Jilin, People's Republic of China
| | - Chuan-Gang Peng
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Changchun, Jilin, People's Republic of China
| | - Yan-Bing Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Changchun, Jilin, People's Republic of China.
| | - Dan-Kai Wu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Changchun, Jilin, People's Republic of China.
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Aliyev AG, Tikhilov RM, Shubnyakov II, Ambrosenkov AV, Zhabin GI, Boyarov AA, Cherkasov MA, Antipov AP. Coonrad-Morrey total elbow arthroplasty implications in young patients with post-traumatic sequelae. J Shoulder Elbow Surg 2022; 31:1874-1883. [PMID: 35533979 DOI: 10.1016/j.jse.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 03/24/2022] [Accepted: 03/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND We aimed to evaluate the clinical and radiological results of total elbow arthroplasty (TEA) performed for trauma sequelae in patients <45 years of age. METHODS This retrospective study included 63 patients aged <45 years who underwent TEA between 2005 and 2017 for previous elbow injuries. The average follow-up period was 5.23 years (range, 2-13 years). The clinical analysis included limb function according to the Mayo Elbow Performance Score, Oxford Elbow Score, and range of motion. The degree of radiolucency was determined using plain radiographic images. RESULTS The average amplitude of elbow flexion/extension increased from 49.1 ± 36.7 to 98.7 ± 28.2 (P < .01), and the average amplitude of elbow pronation/supination increased from 87.2 ± 52.3 to 118.7 ± 26.3 (P = .02). Functional results improved from 21.4 ± 13.1 to 67.3 ± 14.5 (P < .01) on the Mayo scale, and those measured according to the Oxford scale improved from 15.4% ± 7.0% to 28.0% ± 10.6% (P < .01). Complications were observed in 16 (32.7%) patients. Among them, 10 patients (20.4%) required revision elbow arthroplasty with replacement of implant components. The overall 5-year implant survival rate was 79.4% (95% confidence interval: 63.4-91.2), and the 10-year survival rate was 77.5% (95% confidence interval: 59.3-88.2). CONCLUSION TEA allows restoration of the full range of motion in the elbow joint and significantly improves limb function in most cases. However, the low survival rate of implants and high incidence of complications do not permit TEA to become a routine intervention for treating post-traumatic consequences in young patients.
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Affiliation(s)
- Alimurad G Aliyev
- Vreden' National Medical Research Centre for Traumatology and Orthopedics, St. Petersburg, Russia.
| | - Rashid M Tikhilov
- Vreden' National Medical Research Centre for Traumatology and Orthopedics, St. Petersburg, Russia
| | - Igor' I Shubnyakov
- Vreden' National Medical Research Centre for Traumatology and Orthopedics, St. Petersburg, Russia
| | - Andrey V Ambrosenkov
- Vreden' National Medical Research Centre for Traumatology and Orthopedics, St. Petersburg, Russia
| | - Georgiy I Zhabin
- Vreden' National Medical Research Centre for Traumatology and Orthopedics, St. Petersburg, Russia
| | - Andrey A Boyarov
- Vreden' National Medical Research Centre for Traumatology and Orthopedics, St. Petersburg, Russia
| | - Magomed A Cherkasov
- Vreden' National Medical Research Centre for Traumatology and Orthopedics, St. Petersburg, Russia
| | - Alexander P Antipov
- Vreden' National Medical Research Centre for Traumatology and Orthopedics, St. Petersburg, Russia
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Papen A, Schöttker-Königer T, Schäfer A, Morrison F, Hollinger B, Burkhart KJ, Nietschke R, Zimmerer A, Maffulli N, Migliorini F, Schneider MM. Reliability, validity and critical appraisal of the cross-cultural adapted German version of the Mayo Elbow Performance Score (MEPS-G). J Orthop Surg Res 2022; 17:328. [PMID: 35752835 PMCID: PMC9233775 DOI: 10.1186/s13018-022-03210-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Background The Mayo Elbow Performance Score (MEPS) is a rating system consisting of four dimensions to evaluate elbow performance. It is a common tool for assessment of elbow impairments worldwide. We determined the validity and reliability of its German version (MEPS-G) after cross-cultural adaptation.
Methods Six investigators examined 57 patients with elbow pathologies. The MEPS-G was compared to validated elbow scores such as the German versions of DASH, the Oxford Elbow Score, pain level and subjective elbow performance on a VAS. Inter-rater reliability (IRR) and validity of the score and its dimensions were also reviewed. Verification was performed using the intraclass correlation coefficient (ICC), the prevalence and bias with adjusted Kappa (PABAK) and the Spearman correlation.
Results The IRR of the MEPS-G score was moderate (ICC (2.1) = 0.65). The IRR of the four individual dimensions was moderate to high (KPABAK = 0.55 -0.81). Validity for the sum score (r = 0.52–0.65) and the dimensions pain (r = 0.53–0.62), range of motion (r = 0.7) and stability (r = − 0.61) was verified. The function subscale reached insufficient validity (r = 0.15–0.39). Conclusion The MEPS-G is not sufficiently valid, which is consistent with its English version. The patient-based dimensions were a weakness, demonstrating high risk of bias. There is no general recommendation for the utilization of the MEPS-G as outcome measurement for patients with elbow pathologies.
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Affiliation(s)
- A Papen
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Hildesheim, Germany
| | - T Schöttker-Königer
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Hildesheim, Germany
| | - A Schäfer
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Hildesheim, Germany
| | - F Morrison
- German Association for Manual Therapy (DVMT e.V.), Dresden, Germany
| | - B Hollinger
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany
| | - K J Burkhart
- Arcus Sportklinik, Pforzheim, Germany.,University of Cologne, Cologne, Germany
| | | | | | - N Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, UK.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - F Migliorini
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Marco M Schneider
- Arcus Sportklinik, Pforzheim, Germany. .,University of Witten/Herdecke, Witten, Germany.
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Giannaka M, Andrigiannakis A, Dimitriadis Z, Fandridis E, Kapreli E, Strimpakos N. Cross-cultural validation of the Oxford Elbow Score and Mayo Elbow Performance Score in Greek. Musculoskelet Sci Pract 2022; 57:102499. [PMID: 34999382 DOI: 10.1016/j.msksp.2021.102499] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/21/2021] [Accepted: 12/25/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Oxford Elbow Score (OES) and Mayo Elbow Performance Score (MEPS) are two of the most commonly used instruments for the functional assessment of elbow joint. The aim of this study was to cross-culturally validate the OES and MEPS into Greek language and examine their convergent validity, internal consistency, test-retest reliability and floor and ceiling effects. METHODS The two instruments were translated into Greek with the back translation method. Their final Greek versions (OES-GR and MEPS-GR) were completed by 40 patients with elbow disorders. The patients completed also the Greek version of the Disabilities of the Arm Shoulder and Hand (DASH-GR). The patients re-completed the OES-GR after 24 h. RESULTS The OES-GR was found to have good internal consistency (Cronbach's α = 0.85, 95%CI = 0.74-0.92), in contrast to the MEPS-GR (Cronbach's α = 0.47, 95%CI = 0.15-0.70). Both instruments were found to have good convergent validity with the DASH-GR (for MEPS-GR rs = -0.64, 95% CI -0.79 to -0.41; for OES-GR rs = -0.84, 95%CI = -0.91 to -0.72). Good was also the convergent validity of the OES-GR with the MEPS-GR (rs = 0.71, 95%CI = 0.51 to 0.84). The test-retest reliability for each domain of the OES-GR was found good to excellent (total score ICC = 0.91, 95%CI = 0.83-0.95; pain ICC = 0.90, 95%CI = 0.81-0.95; function ICC = 0.81, 95%CI = 0.68-0.90; social-psychological ICC = 0.91, 95%CI = 0.84-0.95). CONCLUSION The findings about the internal consistency, test-retest reliability, convergent validity and ceiling/floor effects of the OES-GR suggest that it is a quite valid and reliable instrument which can be used with confidence in Greek patients with elbow disorders. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Magdalene Giannaka
- Quality of Life and Health Assessment Research Lab, Physiotherapy Department, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Andreas Andrigiannakis
- Quality of Life and Health Assessment Research Lab, Physiotherapy Department, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Zacharias Dimitriadis
- Quality of Life and Health Assessment Research Lab, Physiotherapy Department, School of Health Sciences, University of Thessaly, Lamia, Greece
| | | | - Eleni Kapreli
- Clinical Exercise Physiology and Rehabilitation Research Lab, Physiotherapy Department, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Nikolaos Strimpakos
- Quality of Life and Health Assessment Research Lab, Physiotherapy Department, School of Health Sciences, University of Thessaly, Lamia, Greece.
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Huang GH, Tang JA, Yang TY, Liu Y. Floating elbow combining ipsilateral distal multiple segmental forearm fractures: A case report. World J Clin Cases 2021; 9:3372-3378. [PMID: 34002147 PMCID: PMC8107907 DOI: 10.12998/wjcc.v9.i14.3372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/04/2021] [Accepted: 02/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Floating elbow along with ipsilateral multiple segmental forearm fracture is a rare and high-energy injury, although elbow dislocation or fracture of the ulna and radius may occur separately.
CASE SUMMARY We report the case of a 37-year-old woman with open (IIIA) fracture of the right distal humerus with multiple shaft fractures of the ipsilateral radius and ulna with a history of falling from a height of almost 20 m from a balcony. After providing advanced trauma life support, damage control surgery was performed to debride the arm wound and temporarily stabilize the right upper limb with external fixators in the emergency operating room. Subsequently, one-stage internal fixation of multiple fractures was performed with normal values of biochemical indicators and reduction in limb swelling. The patient achieved good outcome at the 7 mo follow-up.
CONCLUSION One- or two-stage treatment must be performed according to the type of injury; we efficiently used the “damage control principle.”
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Affiliation(s)
- Guo-Hua Huang
- Department of Orthopedics, Shanghai Pudong New Area Gongli Hospital, Affiliated to the Second Military Medical University, Shanghai 200135, China
| | - Jiang-An Tang
- Department of Orthopedics, Shanghai Pudong New Area Gongli Hospital, Affiliated to the Second Military Medical University, Shanghai 200135, China
| | - Tie-Yi Yang
- Department of Orthopedics, Shanghai Pudong New Area Gongli Hospital, Affiliated to the Second Military Medical University, Shanghai 200135, China
| | - Yue Liu
- Department of Orthopedics, Shanghai Pudong New Area Gongli Hospital, Affiliated to the Second Military Medical University, Shanghai 200135, China
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Yang YP, Yuan S, Cui GQ, An N, Ao YF. Extracapsular subcutaneous endoscopic treatment for refractory lateral epicondylalgia: technique, retrospective results, and prognostic factors. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:782. [PMID: 34268395 PMCID: PMC8246197 DOI: 10.21037/atm-20-6799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/26/2021] [Indexed: 12/03/2022]
Abstract
Background The extracapsular subcutaneous endoscopic treatment is a new and under-researched approach to the endoscopic treatment of refractory lateral epicondylalgia. We aimed to introduce the techniques of the method and the mid-long term clinical effects. Furthermore, we intended to identify demographic and surgical-related factors correlated with prognosis of extracapsular subcutaneous method. Methods Patients with a minimum of 6 months of conservative treatment for lateral epicondylalgia were recruited from March 2012 to July 2018. Key surgical techniques including microfracture and endoscopic suture were used. Visual analog scale (VAS), Mayo Elbow Performance Score (MEPS), and Disability of Arm (Shoulder and Hand, DASH) scores were used to evaluate clinical results. Univariable analysis and multivariable logistic regression were used to analyze effects of demographic characteristics and treatment techniques on prognosis. Results Seventy-eight patients were treated with modified subcutaneous extracapsular surgery. No serious complications such as neurovascular injury or infection occurred. Postoperative VAS, MEPS, and DASH scores significantly improved (P<0.001). Age was associated with prognosis regarding VAS score (P=0.023). Older age was an independent relevant factor for poor prognosis regarding VAS score (OR =0.914, 95% CI: 0.842–0.993, P=0.033), and microfracture during surgery related to poor prognosis for DASH score (OR =0.056, 95% CI: 0.004–0.783, P=0.032). Plaster fixation was an independent factor related to good prognosis regarding DASH score (OR =11.156, 95% CI: 1.009–123.363, P=0.049). Conclusions Extracapsular subcutaneous method of refractory lateral epicondylalgia has satisfactory and stable clinical results with high safety. Techniques of extracapsular method include debridement, microfracture, and tendon suture under endoscope. Young age, no microfracture, and postoperative plaster fixation were associated with good long-term prognosis.
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Affiliation(s)
- Yu-Ping Yang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Shuo Yuan
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Guo-Qing Cui
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Ning An
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Ying-Fang Ao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
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Schemitsch C, Seeto B, Rubinger L, Vicente M, Schemitsch E, McKee M. Functional outcome following elbow release and hardware removal after bicolumnar fixation of distal humeral fractures. Injury 2020; 51:1592-1596. [PMID: 32451145 DOI: 10.1016/j.injury.2020.04.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/20/2020] [Accepted: 04/25/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Intra-articular fractures of the distal humerus are typically treated with bicolumnar plate fixation. Despite prompt and accurate reduction and fixation, there is a high rate of complications post-surgical fixation. The purpose of this study was to determine the indications, technique, and outcomes of patients who had undergone an elbow release and hardware removal following bicolumnar plate fixation for an intra-articular fracture of the distal humerus. METHODS Patients who had undergone an elbow release and hardware removal by a single surgeon following bicolumnar fixation of an intra-articular fracture of the distal humerus were identified. Patients were contacted to participate in a chart review and to return to clinic for a follow-up visit. Patients who returned for a follow-up visit completed the DASH (Disabilities of the Arm, Shoulder and Hand), the MEPS (Mayo Elbow Performance Score), and the SF-36. RESULTS Forty-two patients were included in the final analysis. The average time from the original injury to the elbow release procedure was 17.5 months. There was an improvement of 33° in the mean flexion-extension arc following the procedure (p<0.001). The mean DASH score was 21 (SD=19) and the mean MEPS score was 82 (SD=16). There was a high rate of post-traumatic osteoarthritis (n=30). Two patients underwent a total elbow arthroplasty (TEA). One patient sustained a re-fracture of the distal humerus, and subsequently underwent repeat bicolumnar fixation. There were four reoperations (10%): two patients had a revision release of contracture and two patients underwent a closed manipulation. CONCLUSIONS It appears safe to remove both plates and to re-intervene relatively early. There is a modest but consistent improvement in flexion-extension arc, and the re-operation rate is low. Although there is a high rate of post-traumatic arthritic change radiographically, TEA was rare, and elbow-based outcome scores were good, although not normal.
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Affiliation(s)
- Christine Schemitsch
- Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Brian Seeto
- Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Luc Rubinger
- Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Milena Vicente
- Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Emil Schemitsch
- Department of Surgery, Western University, London, Ontario, Canada
| | - Michael McKee
- Department of Orthopaedic Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA.
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Al-Hamdani A, Rasmussen JV, Holtz K, Olsen BS. Elbow hemiarthroplasty versus open reduction and internal fixation for AO/OTA type 13 C2 and C3 fractures of distal humerus in patients aged 50 years or above: a randomized controlled trial. Trials 2020; 21:497. [PMID: 32513252 PMCID: PMC7278155 DOI: 10.1186/s13063-020-04418-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/14/2020] [Indexed: 11/25/2022] Open
Abstract
Background Intraarticular distal humeral fractures of AO/OTA type 13 C2 and C3 pose a surgical challenge despite the evolution of surgical implants and techniques. Open reduction and internal fixation (ORIF) is often preferred as the first choice of treatment, but the results vary and are sometimes disappointing. Total elbow arthroplasty (TEA) has been widely used for fractures that are not amenable to ORIF in elderly patients, but the mechanical complications remain a challenge, especially in active patients. Elbow hemiarthroplasty (EHA) provides a modern alternative that might avoid the mechanical complications and weight bearing restrictions related to the linked articulation in semi-constrained TEA. No studies have compared the results of EHA to that of ORIF, but case series have reported promising results. Methods/design This is a study protocol describing an investigator-initiated, non-blinded randomized controlled trial comparing the outcome of EHA with ORIF for AO/OTA type 13 C2 and C3 fractures of the distal humerus in patients who are 50 years or older. Forty-four patients with AO/OTA type 13 C2 and C3 fractures of distal humerus will be randomized to either EHA or ORIF. The Oxford Elbow Score (OES) will be used as primary outcome. Mayo Elbow Performance Score (MEPS), pain severity score (VAS), range of motion, and patient satisfaction will be used as secondary outcomes. Reoperations, complications, and the length of sick leave will be recorded. The patients will be examined after the operation and at 3 months and 1, 2, 5, and 10 years. Discussion The main objective of this study is to investigate the best treatment option for AO/OTA type 13 C2 and C3 fractures of distal humerus in patients aged 50 years or above. We hypothesize that EHA results in fewer complications and superior functional outcome compared with ORIF and that the mechanical complications related to the linked articulation of TEA can be avoided. Trial registration ClinicalTrials.gov, PRS, NCT04163172. Registered November 13, 2019. https://clinicaltrials.gov/ct2/results?cond=&term=evori&cntry=&state=&city=&dist= (Table 2). The protocol has been approved by The Scientific Ethics Committee of the Capital Region of Denmark (Jr. no.: H− 19,035,590). The processing of personal data has been approved by the Danish Data Protection Agency (Jr. no. P-2019-246). Inclusion started on February 1, 2020.
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Affiliation(s)
- Ali Al-Hamdani
- Department of Orthopaedic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Jeppe V Rasmussen
- Department of Orthopaedic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kenneth Holtz
- Department of Orthopaedic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bo S Olsen
- Department of Orthopaedic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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BÜKER N, ŞAVKIN R, ALTINDAL F, TONAK HA. Lateral epikondilit tedavisinde derin transvers friksiyon masajı ve ekstrakorporeal şok dalga tedavisinin kısa dönem etkilerinin karşılaştırılması. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.640715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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12
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Meena MK, Singh K, Meena S, Kumbhare C, Chouhan D. Lateral Approach Versus Combined Lateral and Anteromedial Approach for Surgical Treatment of Terrible Triad of Elbow: A Meta-Analysis. Bull Emerg Trauma 2020; 8:4-9. [PMID: 32201696 PMCID: PMC7071937 DOI: 10.29252/beat-080102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Objective To find out which surgical approach, optimize the functional outcomes and reduce the risk of complications in terrible triad of elbow". Methods Medline, EMBASE, Cochrane Library, and Google Scholar were searched to identify relevant studies, which were included if they were retrospective or prospective in design, involved participants who had terrible triad of elbow (TTIE) that compared lateral approach (LA) with combined lateral and anteromedial approach (CML), and were published in English. Outcomes of interest were functional outcomes, complications, and operative time. Results Four studies, involving 470 patients were included in the systematic review. Mean follow up after surgery was typically 24 to 30 months. We found significant more range of motion (ROM) of elbow in CML as compared to LA group (MD: -14.21, 95% CI: -21.13 to-7.29, p<0.00001). There was significant more forearm rotation in CML as compared to LA group (MD: -18.88, 95% CI: -32.35 to -5.40, p<0.00001). Mayo elbow performance score (MEPS) was significantly more in CML (MD: -3.31, 95% CI: -7.23 to 0.62, p=0.00001). Blood loss, operative time, VAS and complications were more in CML group; however, the difference was not significant. The heterogeneity of the study and synthesizing retrospective data were the primary limitations. Conclusion Our analysis demonstrated that combined lateral and medial approach had significantly more elbow ROM and forearm rotation. The combined approach also had significantly more MEPS. However, using combined approach significantly increased the operative time.
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Affiliation(s)
- Mukesh Kumar Meena
- Department of Orthopedics, Lady Hardinge Medical College(LHMC) and Associated Hospitals, New Delhi, India
| | - Karmbeer Singh
- Department of Orthopedics, Lady Hardinge Medical College(LHMC) and Associated Hospitals, New Delhi, India
| | - Sanjay Meena
- Department of Orthopedics, Lady Hardinge Medical College(LHMC) and Associated Hospitals, New Delhi, India
| | - Chetan Kumbhare
- Department of Orthopedics, Lady Hardinge Medical College(LHMC) and Associated Hospitals, New Delhi, India
| | - Dushyant Chouhan
- Department of Orthopedics, Lady Hardinge Medical College(LHMC) and Associated Hospitals, New Delhi, India
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Vaichinger AM, Shields MN, Morrey ME, O'Driscoll SW. Prospective Blinded Evaluation of Patient-Physician Agreement Using the Summary Outcome Determination (SOD) Score. Mayo Clin Proc 2019; 94:1231-1241. [PMID: 31248694 DOI: 10.1016/j.mayocp.2018.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/20/2018] [Accepted: 10/03/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine whether the Summary Outcome Determination (SOD) score demonstrates a high level of physician-patient agreement in a prospective setting with multiple raters. PATIENTS AND METHODS For this study, 100 patients who were being evaluated at various intervals following shoulder or elbow surgery were prospectively enrolled from May 30, 2017, through August 31, 2017. The patients' attending physicians and a member of their team (physician assistant, resident, fellow, medical student) assigned categorical and numerical SOD scores while blinded to the scores given by each other. All scores were analyzed among raters, assessing internal consistencies, agreement, and reliability. RESULTS The mean follow-up (interval between surgery and completion of the survey) was 31 months, with a range of 1 to 220 months. The intraclass correlation coefficient for patient and physician numerical scores was excellent at 0.82. The weighted κ value for categorical scores was 0.64. Bland-Altman analysis revealed low average discrepancy at 0.6 with a 95% CI of -3.3 to 4.5. The Cronbach α value was 0.94, indicating strong internal validity. The categorical physician-patient agreement occurred within one category 96% of the time. CONCLUSION This study found that the SOD score has strong agreement with excellent intraclass correlation coefficient and weighted κ values, indicating substantial agreement, reproducibility (shown by low average error), and strong internal validity. With promising results in the prospective setting, the SOD score was found to be an easy to use outcome measure with reliable agreement between patient and physician. This score has potential to be a metric revealing the "value" of a specific surgical intervention.
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Affiliation(s)
| | | | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Al-Hamdani A, Rasmussen JV, Sørensen AKB, Ovesen J, Holtz K, Brorson S, Olsen BS. Good outcome after elbow hemiarthroplasty in active patients with an acute intra-articular distal humeral fracture. J Shoulder Elbow Surg 2019; 28:925-930. [PMID: 30630712 DOI: 10.1016/j.jse.2018.10.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 10/03/2018] [Accepted: 10/19/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study reported the clinical outcomes and complications after elbow hemiarthroplasty (EHA) for acute distal humeral fractures Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) type C2 and C3. METHOD During a 6-year period, 24 active patients with acute intra-articular and multifragmentary distal humeral fractures were treated with an EHA by 1 of 4 experienced elbow surgeons. Mean age was 65 years (range, 47-80 years). Median follow-up time was 20 months (range, 12-70 months). RESULTS The median Oxford Elbow Score was 40 points (range, 17-48 points), where 48 points represents a normal elbow. Outcomes were "good to excellent results" in 21 patients, "fair" in 2 patients, and "poor" in 1 patient. The median Mayo Elbow Performance Score was 85 points (range, 50-100 points), where 100 points represents a normal elbow. Outcomes were "good to excellent" in 19 patients, "fair" in 4 patients, and "poor" in 1 patient. The median pain severity score was 2 (range, 0-7) in a scale from 0 to 10 where 0 represents a pain-free elbow. The median flexion/extension and supination/pronation arcs were 110° (range, 60°-140°) and 160° (range, 115°-180°), respectively. Complications were recorded in 7 patients, and 3 of them underwent reoperation because of stiffness, which was treated with open release. CONCLUSIONS EHA provides a good and reliable option in the treatment of an acute intra-articular distal humeral fracture unsuitable for open reduction and internal fixation, especially in active patients.
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Affiliation(s)
- Ali Al-Hamdani
- Department of Orthopaedic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Jeppe V Rasmussen
- Department of Orthopaedic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anne Kathrine B Sørensen
- Department of Orthopaedic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Janne Ovesen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Kenneth Holtz
- Department of Orthopaedic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Stig Brorson
- Department of Orthopaedic Surgery, Zealand University Hospital, Koge, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bo S Olsen
- Department of Orthopaedic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Celik D, Anaforoglu Kulunkoglu B. Photobiomodulation Therapy Versus Extracorporeal Shock Wave Therapy in the Treatment of Lateral Epicondylitis. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 37:269-275. [DOI: 10.1089/photob.2018.4533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Derya Celik
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University, Istanbul, Turkey
| | - Bahar Anaforoglu Kulunkoglu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
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Effect of Radial Nerve Release on Lateral Epicondylitis Outcomes: A Prospective, Randomized, Double-Blinded Trial. J Hand Surg Am 2019; 44:216-221. [PMID: 30057223 DOI: 10.1016/j.jhsa.2018.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 05/29/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of our study was to examine the result of lateral epicondylitis surgery with and without posterior interosseous nerve release. METHODS We conducted a prospective, randomized, double-blind single-center clinical trial in 54 patients treated surgically for lateral epicondylitis, without any EMG or imaging sign of compression of the posterior interosseous nerve at the arcade of Frohse. The patients were equally divided into intervention (supplemental radial nerve release) and control groups (no radial nerve release). Clinical symptoms and disability related to the upper extremity were assessed by a blinded assessor prior to surgery, using both the Quick Disabilities of the Arm, Shoulder, and hand (QuickDASH) and Mayo Elbow Performance Score (MEPS) and again at 1-, 3-, and 6-month intervals after surgery. RESULTS Significant improvement was observed in both groups from the first month after surgery and for the whole evaluation period for both the MEPS and the QuickDASH scores. CONCLUSIONS Radial nerve release, in association with surgical treatment for lateral epicondylitis, was not associated with greater improvement. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
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Zhao X, Yu L, Tao S, Deng L, Wei C, Wang B, Zhu S. [Treatment of severe distal humeral bone defects with three-dimensional printing technology]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1534-1539. [PMID: 30569679 PMCID: PMC8414236 DOI: 10.7507/1002-1892.201803008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 10/22/2018] [Indexed: 02/04/2023]
Abstract
Objective To explore the application of three-dimensional (3D) printing technology in precise and individualized surgical treatment of severe distal humeral bone defect. Methods Five patients with severe distal humeral bone defects were treated with customized 3D printing prostheses between December 2010 and December 2015. There were 4 males and 1 female, with an age of 23-57 years (mean, 35 years); and the length of the bone defect was 5-12 cm (mean, 8 cm). The cause of injury was mechanical injury in 2 cases and strangulation in 3 cases. All of them were the open fracture of Gustilo type Ⅲ. There were 2 cases of radial fracture, 1 case of cubital nerve injury, and 3 cases of radial nerve injury. The time from injury to one-stage operation was 6-18 hours (mean, 10 hours). The operation time, intraoperative blood loss, and intraoperative fluoroscopy were recorded. During follow-up, the anteroposterior and lateral X-ray films of the elbow joints were performed to identify whether there was prosthesis loosening; Mayo Elbow Performance Score (MEPS) and upper extremity Enneking score were used to evaluate limb function. Results The operation time was 140-190 minutes (mean, 165 minutes). The intraoperative blood loss was 310-490 mL (mean, 415 mL). The intraoperative fluoroscopy was 1-3 times (mean, 1.6 times). Five patients were followed up 14-38 months (mean, 21 months). The wound exudate occurred in 1 case and cured after anti-inflammatory local dressing change; the subcutaneous hematoma occurred in 1 case, and improved after color Doppler ultrasound guided puncture and drainage. The MEPS scores and the Enneking scores were all significantly improved when compared with preoperative ones ( P<0.05). Except MEPS score between 6 and 12 months after operation had no significant difference ( P>0.05), there were significant differences in MEPS scores and Enneking scores between the other time points ( P<0.05). During the follow-up, no prosthetic loosening or joint dislocation occurred. Conclusion 3D printing technology can achieve personalized treatment of severe distal humeral bone defects, obtain relatively good elbow joint function, and has less postoperative complications and satisfactory effectiveness.
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Affiliation(s)
- Xing Zhao
- Department of Orthopedics, Taihe Hospital of Shiyan, Shiyan Hubei, 442000, P.R.China;Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Li Yu
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Shengxiang Tao
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Linglong Deng
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Chi Wei
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Bing Wang
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Shaobo Zhu
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071,
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Chen YP, Lan YS, Hu WL, Hung YC. Nonoperative manipulative reduction with Chinese herbs for the treatment of a displaced olecranon fracture: A case report. Medicine (Baltimore) 2018; 97:e10818. [PMID: 29794769 PMCID: PMC6392946 DOI: 10.1097/md.0000000000010818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Displaced olecranon fracture is a common injury following a fall or direct trauma to the elbow. There have been no reports of patients with a displaced olecranon fracture who have only received nonoperative manipulative reduction with Chinese herbs. PATIENT CONCERNS The patient was a 64-year-old woman with a complex elbow injury that occurred in a traffic accident. The patient complained of severe, painful limitation of motion on straightening or bending. DIAGNOSES The patient was diagnosed with a displaced fracture of the left olecranon (type IIA olecranon fracture according to the Mayo classification system). INTERVENTIONS The patient underwent nonoperative manipulation with Chinese herbs. OUTCOMES The fracture was successfully reduced. After 3 to 4 months of follow-up, severe pain and disability in the elbow were improved following reduction of the left olecranon fracture in which there was no longer a displacement. LESSONS Nonoperative manipulative reduction performed by a well-trained physician with Chinese herbs may be a treatment option for displaced olecranon fractures.
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Affiliation(s)
- Yu-Pei Chen
- Department of Chinese Medicine, Tainan Hospital, Ministry of Health and Welfare
- School of Medicine
- School of Law, National Cheng Kung University, Tainan
| | - Yi-Shan Lan
- Department of Chinese Medicine, Tainan Hospital, Ministry of Health and Welfare
| | - Wen-Long Hu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and School of Traditional Chinese Medicine, Chang Gung University College of Medicine
- Kaohsiung Medical University College of Medicine
- Fooyin University College of Nursing
| | - Yu-Chiang Hung
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and School of Traditional Chinese Medicine, Chang Gung University College of Medicine
- School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan
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Li T, Li XL, Hu SX, Sun W, Wu J. Evaluation of effect and safety of arthroscopic surgery with three different operative approaches in patients with terrible triad of the elbow: A comparative study. Medicine (Baltimore) 2018; 97:e0398. [PMID: 29642203 PMCID: PMC5908638 DOI: 10.1097/md.0000000000010398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The terrible triad of the elbow (TTE) is a difficult injury, and the usual TTE consists of posterior dislocation of the elbow, radial head fracture, and coronoid fracture. The target of this retrospective study is to explore the effect, postoperative complications, and prognostic factors in patients with TTE undergoing arthroscopic surgery with three different operative approaches. METHODS Patients with TTE underwent arthroscopic surgery were treated using lateral, anterior medial, or combined lateral and anterior medial approaches, respectively. In order to analyze the postoperative complications and the effect of arthroscopic surgery for patients with TTE, the function of elbow joint before and after the surgery was evaluated and the flexion-extension of elbow joint and rotation of elbow joint and forearm were measured. RESULTS The evaluation results obtained from patients underwent 3 different operative approaches revealed that after surgery, patients receiving arthroscopic surgery using combined lateral and anterior medial approach had superior flexion-extension of elbow joint, rotation of elbow joint and forearm, higher Mayo Elbow Performance Score (MEPS) and more cases of Broberg-Morrey grade 0, and lower complication rate, compared with those using lateral or anterior medial approach. A key finding in the study demonstrated that fracture type, operative approach, and postoperative complications were factors related with the effect of arthroscopic surgery for patients with TTE. CONCLUSION Collectively, the key findings obtained from the present study supported the notion that the effect of arthroscopic surgery in combined lateral and anterior medial approach is much better than in lateral approach or anterior medial approach, and is related with fracture type, operative approach, and postoperative complications.
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Affiliation(s)
- Tao Li
- Department of Emergency and Trauma Surgery, Jining No.1 People's Hospital, Jining
| | - Xing-Long Li
- Department of Orthopedics, Yankuang Group Genaral Hospital, Zoucheng
| | - Shi-Xiang Hu
- Department of Surgery, Xizou Health Center of Qufu, Qufu
| | - Wei Sun
- Department of Surgery, Taiping Town Health Center of Zoucheng, Zoucheng, P.R. China
| | - Jing Wu
- Department of Emergency and Trauma Surgery, Jining No.1 People's Hospital, Jining
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Evans JP, Smith CD, Fine NF, Porter I, Gangannagaripalli J, Goodwin VA, Valderas JM. Clinical rating systems in elbow research-a systematic review exploring trends and distributions of use. J Shoulder Elbow Surg 2018; 27:e98-e106. [PMID: 29444754 DOI: 10.1016/j.jse.2017.12.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/21/2017] [Accepted: 12/26/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clinical rating systems are used as outcome measures in clinical trials and attempt to gauge the patient's view of his or her own health. The choice of clinical rating system should be supported by its performance against established quality standards. METHODS A search strategy was developed to identify all studies that reported the use of clinical rating systems in the elbow literature. The strategy was run from inception in Medline Embase and CINHAL. Data extraction identified the date of publication, country of data collection, pathology assessed, and the outcome measure used. RESULTS We identified 980 studies that reported clinical rating system use. Seventy-two separate rating systems were identified. Forty-one percent of studies used ≥2 separate measures. Overall, 54% of studies used the Mayo Elbow Performance Score (MEPS). For arthroplasty, 82% used MEPS, 17% used Disabilities of Arm, Shoulder and Hand (DASH), and 7% used QuickDASH. For trauma, 66.7% used MEPS, 32% used DASH, and 23% used the Morrey Score. For tendinopathy, 31% used DASH, 23% used Patient-Rated Tennis Elbow Evaluation (PRTEE), and 13% used MEPS. Over time, there was an increased proportional use of the MEPS, DASH, QuickDASH, PRTEE, and the Oxford Elbow Score. CONCLUSIONS This study identified a wide choice and usage of clinical rating systems in the elbow literature. Numerous studies reported measures without a history of either a specific pathology or cross-cultural validation. Interpretability and comparison of outcomes is dependent on the unification of outcome measure choice. This was not demonstrated currently.
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Affiliation(s)
- Jonathan P Evans
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK; Health Services and Policy Research Group, University of Exeter, Exeter, UK; National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, University of Exeter Medical School, Exeter, UK.
| | - Chris D Smith
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Nicola F Fine
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Ian Porter
- Health Services and Policy Research Group, University of Exeter, Exeter, UK
| | | | - Victoria A Goodwin
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Jose M Valderas
- Health Services and Policy Research Group, University of Exeter, Exeter, UK
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Sochacki KR, Jack RA, Hirase T, McCulloch PC, Lintner DM, Liberman SR, Harris JD. Arthroscopic Debridement for Primary Degenerative Osteoarthritis of the Elbow Leads to Significant Improvement in Range of Motion and Clinical Outcomes: A Systematic Review. Arthroscopy 2017; 33:2255-2262. [PMID: 29100769 DOI: 10.1016/j.arthro.2017.08.247] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 08/09/2017] [Accepted: 08/09/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this investigation was to determine whether arthroscopic debridement of primary elbow osteoarthritis results in statistically significant and clinically relevant improvement in (1) elbow range of motion and (2) clinical outcomes with (3) low complication and reoperation rates. METHODS A systematic review was registered with PROSPERO and performed using PRISMA guidelines. Databases were searched for studies that investigated the outcomes of arthroscopic debridement for the treatment of primary osteoarthritis of the elbow in adult human patients. Study methodological quality was analyzed. Studies that included post-traumatic arthritis were excluded. Elbow motion and all elbow-specific patient-reported outcome scores were eligible for analysis. Comparisons between preoperative and postoperative values from each study were made using 2-sample Z-tests (http://in-silico.net/tools/statistics/ztest) using a P value < .05. RESULTS Nine articles (209 subjects, 213 elbows, 187 males, 22 females, mean age 45.7 ± 7.1 years, mean follow-up 41.7 ± 16.3. months; 75% right, 25% left; 79% dominant elbow, 21% nondominant) were analyzed. Elbow extension (23.4°-10.7°, Δ 12.7°), flexion (115.9°-128.7°, Δ 12.8°), and global arc of motion (94.5°-117.6°, Δ 23.1°) had statistically significant and clinically relevant improvement following arthroscopic debridement (P < .0001 for all). There was also a statistically significant (P < .0001) and clinically relevant improvement in the Mayo Elbow Performance Score (60.7-84.6, Δ 23.9) postoperatively. Six patients (2.8%) had postoperative complications. Nine (4.2%) underwent reoperation. CONCLUSIONS Elbow arthroscopic debridement for primary degenerative osteoarthritis results in statistically significant and clinically relevant improvement in elbow range of motion and clinical outcomes with low complication and reoperation rates. LEVEL OF EVIDENCE Systematic review of level IV studies.
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Affiliation(s)
- Kyle R Sochacki
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Robert A Jack
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Takashi Hirase
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | | | - David M Lintner
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Shari R Liberman
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Joshua D Harris
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A..
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