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Ge X, Ge X, Wang C, Liu Q, Wang B, Chen L, Cheng K, Qin M. Application of ultrasound in avoiding radial nerve injury during elbow arthroscopy: a retrospective follow-up study. BMC Musculoskelet Disord 2022; 23:1126. [PMID: 36566206 PMCID: PMC9789568 DOI: 10.1186/s12891-022-06109-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/21/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A safe and effective technique for anterolateral portal placement in elbow arthroscopy is significant. We compared the outcomes of patients who underwent elbow arthroscopy using different ultrasound-assisted techniques. METHODS From May 2016 to June 2021 a retrospective analysis on all patients who underwent elbow arthroscopy in our department was performed. Patients were separated into three groups: non-ultrasound; preoperative ultrasound; and intraoperative ultrasound. The minimum follow-up period was 1 year. Nerve injuries, visual analog scale (VAS), Mayo elbow-performance score (MEPS), Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), and range of motion (ROM) of the elbow were evaluated for comparison among the three groups pre- and post-operatively. RESULTS All 55 patients completed a 1-year follow-up: non-ultrasound (n = 20); preoperative ultrasound (n = 17); and intraoperative ultrasound (n = 18). There were 3 cases (15.0%) of transient radial nerve palsy in the non-ultrasound group. No nerve complications occurred in preoperative ultrasound and intraoperative ultrasound groups. The probability of postoperative radial nerve injury in the three groups was statistically different (P < 0.05). There was no significant difference in the VAS score, MEPS, DASH score, and ROM among the three groups at the follow-up evaluation (P > 0.05). CONCLUSION Performing anterolateral portal placement during elbow arthroscopy with ultrasound-assisted techniques successfully avoided radial nerve injury.
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Affiliation(s)
- Xingtao Ge
- grid.452710.5Department of Orthopedics, Rizhao People’s Hospital, 276800 Rizhao, Shandong P.R. China
| | - Xinghua Ge
- grid.452710.5Department of Neurosurgery, Rizhao People’s Hospital, 276800 Rizhao, Shandong P.R. China
| | - Chen Wang
- grid.452710.5Department of Orthopedics, Rizhao People’s Hospital, 276800 Rizhao, Shandong P.R. China
| | - Qinghua Liu
- grid.452710.5Department of Ultrasonography, Rizhao People’s Hospital, 276800 Rizhao, Shandong P.R. China
| | - Bin Wang
- grid.452710.5Department of Orthopedics, Rizhao People’s Hospital, 276800 Rizhao, Shandong P.R. China
| | - Longgang Chen
- grid.452710.5Department of Orthopedics, Rizhao People’s Hospital, 276800 Rizhao, Shandong P.R. China
| | - Kai Cheng
- grid.452710.5Department of Orthopedics, Rizhao People’s Hospital, 276800 Rizhao, Shandong P.R. China
| | - Ming Qin
- grid.452710.5Department of Orthopedics, Rizhao People’s Hospital, 276800 Rizhao, Shandong P.R. China
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Substantiation of safe and effective arthroscopic approaches to the elbow joint in case of enthesopathy of the distal humerus. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2022. [DOI: 10.17816/2311-2905-1977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: With the development of arthroscopic surgical techniques, diagnostic and therapeutic possibilities have significantly expanded, but they have not become widely used in everyday clinical practice in the treatment of elbow joint pathology. This is due to the small volume of the joint, the close location of the neurovascular formation and the complexity of manipulation. Elbow arthroscopy is a dynamic procedure with a change in the ratio of neurovascular structures and portals in different elbow positions. The risk of damage to neurovascular formations during arthroscopy of the elbow joint is up to 14%.
Purpose: determination of the safest areas promising for the formation of arthroscopic approaches to the elbow joint in the treatment of patients with enthesopathy of the distal humerus..
Methods: To achieve this goal, a complex topographic- anatomical and clinical study was performed on 30 non-fixed anatomical preparations of the upper limb, which included 4 stages, where the topographic and anatomical features of the tendon-muscular and neurovascular structures forming the elbow joint were studied, depending on the angle of flexion of the elbow joint at 3 different levels: level I - 5 cm above the joint space, level II - joint space, level III - the neck of the radius, additionally the above structures were studied using MRI studies in 30 patients.
Results: When the elbow joint is flexed to 90, the brachial artery at level I moves away from the bone and is located at a distance from 27,8 (27.7-28,1) mm to 28,6 (28,4-28,7). The radial nerve at the II level from СMEL is located at 16,4 (16,5-18,8) mm. Median nerve from СMEL by 17,5 (16,6-18,1) mm. The brachial artery is 23,7 (20,522,8) mm distant from the СMEL. The anterior bundle of the MCL has: an average proximal width of 6,2 1,4 mm, an average width of the middle part of 6,5 1,5 mm, an average distal width of 9,3 1,4 mm. The average area of attachment on the medial epicondyle of the humerus is 45,5 9,3 mm, it has a rounded shape. The radial collateral ligament has an average length of 20,5 1.9 mm and a bundle width of 5,2 0,8mm. The average area of attachment on the humerus is 13,6 mm. The average area of ECRB on the lateral epicondyle of the humerus was 53,1 3,7mm. The mean area of the FCR on the medial epicondyle was 58,3 6.3mm. The distance from the entrance of the deep branch of the radial nerve to the canalis sapinatorius to the joint space is 28 (25,529,6) mm.
Conclusion: The results of this study allow the operating surgeon to decide on the choice and placement of arthroscopic access to the elbow joint, which in turn helps to minimize the risk of damage to neurovascular structures.
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Lung B, MacGillis K, Iyer H, Karasavvidis T, Wang E. Anatomic study of an anterior portal for percutaneous internal fixation of capitellum fractures. J Shoulder Elbow Surg 2022; 31:2043-2048. [PMID: 35472575 DOI: 10.1016/j.jse.2022.03.012] [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: 12/17/2021] [Revised: 03/05/2022] [Accepted: 03/14/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fractures of the capitellum are uncommon and difficult to treat surgically. Capitellar open reduction-internal fixation uses a lateral open approach with posterior-to-anterior or anterior-to-posterior screw fixation. We investigated the use of an anterior portal for placement of anterior-to-posterior screw fixation through cadaveric measurement of the anatomic relationships from an anteriorly to posteriorly placed Kirschner wire (K-wire) to anterior elbow structures and calculated the percentage of articular surface accessed from the anterior portal. METHODS Eight fresh-frozen cadaveric elbows without radiographic or cutaneous evidence of prior trauma or surgery were used for this study. An arthroscopic proximal anteromedial portal was cannulized, and the radiocapitellar joint was evaluated. A single 1-cm portal was placed 1 cm distal to the elbow flexion crease and based lateral to the biceps tendon. The location of the portal was confirmed with a spinal needle, and blunt dissection with a hemostat was performed down to capsular tissue and for arthrotomy. A spinal needle sheath was threaded over a blunt switching stick and served as a cannula for placement of a 0.062 K-wire. Articular mapping was performed with cartilage scraping by the K-wire; the K-wire was then placed at the perceived center along the proximal-to-distal and radial-to-ulnar axis of the capitellum. Fluoroscopic confirmation of the wire's location was performed. Under loupe magnification, anatomic dissection was performed and the shortest distance measurements were recorded with digital calipers from the K-wire to the dissected structures. Capitellar articular measurements were recorded, in addition to the articular area defined by the K-wire. Data analysis was performed, and the average distance and standard deviation (in millimeters) were calculated. For structures that were pierced by or touching the K-wire, the distance was recorded as 0.1 mm. RESULTS The average distance from the K-wire to the radial, lateral antebrachial cutaneous, and median nerves was 1.8 mm, 11.5 mm, and 28.0 mm, respectively. The average distance from the median cubital vein and biceps tendon was 3.7 mm and 13.4 mm, respectively. The pin track pierced the brachioradialis and supinator muscles in all but 1 specimen. The average capitellar articular surface marked was 39.1% of the calculated articular footprint of the capitellum. CONCLUSIONS The anterior portal to the capitellum is directly adjacent to the radial nerve and lateral antebrachial cutaneous nerve, where each is susceptible to injury. We recommend blunt dissection and insertion of a cannula to allow drilling and placement of internal fixation in a relatively safe manner with respect to neurovascular structures.
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Affiliation(s)
- Brandon Lung
- Department of Orthopaedic Surgery, University of California Irvine Health, Orange, CA, USA.
| | - Kyle MacGillis
- Department of Orthopaedics, Stony Brook University College of Medicine, Stony Brook, NY, USA
| | - Hari Iyer
- Department of Orthopaedics, Stony Brook University College of Medicine, Stony Brook, NY, USA
| | - Theofilos Karasavvidis
- Department of Orthopaedic Surgery, University of California Irvine Health, Orange, CA, USA
| | - Edward Wang
- Department of Orthopaedics, Stony Brook University College of Medicine, Stony Brook, NY, USA
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Contreras JJ, Meissner A, Valenzuela A, Liendo R, de Marinis R, Calvo C, Soza F. Establishing safe zones to avoid nerve injury in the posterior minimally invasive plate osteosynthesis for humerus fractures: an MRI study. JSES Int 2022; 6:1015-1022. [DOI: 10.1016/j.jseint.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Cucchi D, Luceri F, Menon A, Müller LP, Kabir K, Randelli PS, Arrigoni P, Wegmann K. Anatomic relations of the median nerve to the ulnar insertion of the brachialis muscle: safety issues and implications for medial approaches to the elbow joint. Arch Orthop Trauma Surg 2022; 142:813-821. [PMID: 33484309 PMCID: PMC8994731 DOI: 10.1007/s00402-021-03753-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/01/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Preventing nerve injury is critical in elbow surgery. Distal extension of medial approaches, required for coronoid fracture fixation and graft-replacement, may endanger the median nerve. This study aims to describe an easily identifiable and reproducible anatomical landmark to localize the median nerve distal to the joint line and to delineate how its relative position changes with elbow flexion and forearm rotation. MATERIALS AND METHODS The median nerve and the ulnar insertion of the brachialis muscle were identified in eleven fresh-frozen cadaveric specimens after dissection over an extended medial approach. The elbow was brought first in full extension and then in 90° flexion, and the shortest distance between the two structures was measured while rotating the forearm in full pronation, neutral position and full supination. RESULTS The distance between the median nerve and the brachialis insertion was highest with the elbow flexed and the forearm in neutral position. All distances measured in flexion were larger than those in extension, and all distances measured from the most proximal point of the brachialis insertion were larger than those from the most distal point. Distances in pronation and in supination were smaller than to those in neutral forearm position. CONCLUSIONS The ulnar insertion of the brachialis is a reliable landmark to localize and protect the median nerve at the level of the coronoid base. Elbow flexion and neutral forearm position increase significantly the safety margins between the two structures; this information suggests some modifications to the previously described medial elbow approaches. LEVEL OF EVIDENCE Basic Science Study.
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Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Francesco Luceri
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, Milan, 20122, Italy
| | - Alessandra Menon
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, Milan, 20122, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Lars Peter Müller
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Faculty of Medicine and University Hospital, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Koroush Kabir
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Pietro Simone Randelli
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, Milan, 20122, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Paolo Arrigoni
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, Milan, 20122, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Kilian Wegmann
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Faculty of Medicine and University Hospital, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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Kamble P, Prabhakar A, Wankhade AM, Mohanty SS, Rathod T. A Rare Case of Lateral Displacement of Median Nerve in a Dislocated Elbow and its Management. J Orthop Case Rep 2021; 11:80-83. [PMID: 35415152 PMCID: PMC8930389 DOI: 10.13107/jocr.2021.v11.i12.2578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/15/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Elbow dislocation usually presents with a deformity and swelling, yet it can also present with neurological complication. Nerve injury with dislocation is common in the pediatric age group and is reported infrequently among adults. The most common nerve involved with dislocation is the ulnar nerve followed by the median nerve. The median nerve usually slips medially during dislocation and gets entrapped posterior to the medial epicondyle or it can get entrapped between the fractured medial epicondyle. Here, we describe a unique case of posterolateral elbow dislocation in a 30-year-old female patient with having lateral displacement of the median nerve and the mechanism probably by which the nerve got displaced laterally. Case Presentation A 30-years-old female patient of right hand dominant came to us with a left elbow injury after a road traffic accident. Clinical and Radiological examination revealed a posterior-lateral dislocated elbow with a fracture of the radial head and lateral condyle avulsion. Clinically, there was a weakness and sensory hypoesthesia along the median nerve distribution over the left hand and forearm. Initially, closed reduction and splinting done. Later, a planned surgery with a lateral approach avulsed lateral condyle and radial head fixation done with relocation of the median nerve, which was displaced laterally. Conclusion There are numerous cases of elbow dislocation with nerve involvement and their complications have been previously described throughout literature. Here, we present a rare case of lateral displacement of the median nerve in a dislocated elbow and the possible mechanism with its management.
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Affiliation(s)
- Prashant Kamble
- Department of Orthopedics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Akil Prabhakar
- Department of Orthopedics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India,Address of Correspondence: Dr. Akil Prabhakar, Department of Orthopedics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India. E-mail:
| | - Ajay M Wankhade
- Department of Orthopedics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - S S Mohanty
- Department of Orthopedics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Tushar Rathod
- Department of Orthopedics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
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Abstract
The objective of this review is to summarize the surgical options for primary osteoarthritis of the elbow, reported clinical outcomes, and suggested indications in previous literatures. The surgical management of primary elbow arthritis has evolved because of an improved understanding of pathologic mechanisms and manifestations as well as the development of novel surgical techniques and devices. Osteocapsular arthroplasty (OCA), elbow debridement, distraction arthroplasty, and total elbow arthroplasty (TEA) have been employed for managing elbow osteoarthritis. Elbow debridement and OCA can be helpful in most cases of symptomatic elbow arthritis. TEA is usually recommended for end-stage arthritis in elderly patients after prosthetic implants have been in place for long periods or after complications. Distraction arthroplasty might find a place in the treatment of younger, active patients with end-stage arthritis.
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Affiliation(s)
- Jae-Man Kwak
- 65526Department of Orthopedic Surgery, Eulji Medical Center, College of Medicine, Eulji University, Uijeongbu, South Korea
| | - In-Ho Jeon
- 65526Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea
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Hilgersom NFJ, Viveen J, Tuijthof GJM, Bleys RLAW, van den Bekerom MPJ, Eygendaal D. Arthroscopic localization of the ulnar nerve behind the medial capsule is unreliable. JSES Int 2020; 4:1031-1036. [PMID: 33345253 PMCID: PMC7738441 DOI: 10.1016/j.jseint.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose Ulnar nerve injury is the most common neurologic complication of elbow arthroscopy. The purpose of this cadaveric study was to quantify the ability of surgeons to locate the ulnar nerve behind the posteromedial capsule during elbow arthroscopy using sole arthroscopic vision. Methods Twenty-one surgeons were asked to pin the ulnar nerve at the medial gutter and the posteromedial compartment using arthroscopic visualization of the medial capsule only. Pinning of the ulnar nerve was performed from extra-articular. Then, the cadaveric specimens were dissected and the shortest distances between the pins and ulnar nerve measured. Results Median pin-to-nerve distances at the medial gutter and posteromedial compartment were 0 mm (interquartile range [IQR], 0-3 mm) and 2 mm (IQR, 0-6 mm), respectively. The ulnar nerve was pinned by 11/21 surgeons (52%) at the medial gutter, and 7/21 surgeons (33%) at the posteromedial compartment. Three of 21 surgeons (14%) pinned the ulnar nerve at both the medial gutter and the posteromedial compartment. Surgeon's experience and operation volume did not affect these outcomes (P > .05). Conclusions Surgeons' ability to locate the ulnar nerve behind the posteromedial capsule using sole arthroscopic visualization, without external palpation, is poor. We recommend to proceed carefully when performing arthroscopic procedures in the posteromedial elbow, and identify and mobilize the ulnar nerve prior to any posteromedial capsular procedures.
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Affiliation(s)
- Nick F J Hilgersom
- Department of Orthopaedic Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands
| | - Jetske Viveen
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, the Netherlands
| | - Gabriëlle J M Tuijthof
- Department of Orthopaedic Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands.,Department of Instrument Development, Engineering and Evaluation, Maastricht University, Maastricht, the Netherlands
| | - Ronald L A W Bleys
- Department of Anatomy, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, Amphia Hospital, Breda, the Netherlands
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O'Shea R, Panwar J, Chu Kwan W, Stimec J, Camp MW, Gargan M. Establishing Safe Zones to Avoid Nerve Injury in the Approach to the Humerus in Pediatric Patients: A Magnetic Resonance Imaging Study. J Bone Joint Surg Am 2019; 101:2101-2110. [PMID: 31800423 DOI: 10.2106/jbjs.19.00019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The surgical anatomy of upper-extremity peripheral nerves in adults has been well described as "safe zones" or specific distances from osseous landmarks. In pediatrics, relationships between nerves and osseous landmarks remain ambiguous. The goal of our study was to develop a model to accurately predict the location of the radial and axillary nerves in children to avoid iatrogenic injury when approaching the humerus in this population. METHODS We conducted a retrospective review of 116 magnetic resonance imaging (MRI) scans of entire humeri of skeletally immature patients; 53 of these studies met our inclusion criteria. Two independent observers reviewed all scans. Arm length was measured as the distance between the lateral aspect of the acromion and the lateral epicondyle. We then calculated the distances (defined as the percentage of arm length) between the radial nerve and distal osseous landmarks (the medial epicondyle, transepicondylar line, and lateral epicondyle) as well between the axillary nerve and the most lateral aspect of the acromion. RESULTS The axillary nerve was identified at a distance equaling 18.6% (95% confidence interval [CI], ±0.62%) of arm length inferior to the lateral edge of the acromion. The radial nerve crossed (1) the medial cortex of the posterior part of the humerus at a distance equaling 63.19% (95% CI: ±0.942%) of arm length proximal to the medial epicondyle, (2) the middle of the posterior part of the humerus at a distance equaling 53.9% (95% CI: ±1.08%) of arm length proximal to the transepicondylar line, (3) the lateral cortex of the posterior part of the humerus at a distance equaling 45% (95% CI: ±0.99%) of arm length proximal to the lateral epicondyle, and (4) from the posterior to the anterior compartment at a distance equaling 35.3% (95% CI: ±0.92%) of arm length proximal to the lateral epicondyle. A strong linear relationship between these distances and arm length was observed, with an intraclass correlation coefficient of >0.9 across all measurements. CONCLUSIONS The positions of the radial and axillary nerves maintain linear relationships with arm lengths in growing children. The locations of these nerves in relation to palpable osseous landmarks are predictable. CLINICAL RELEVANCE Knowing the locations of upper-extremity peripheral nerves as a proportion of arm length in skeletally immature patients may help to avoid iatrogenic injuries during surgical approaches to the humerus.
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Affiliation(s)
| | - Jyoti Panwar
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Radiology, Christian Medical College, Vellore, India
| | | | | | - Mark W Camp
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Grim C, Engelhardt M, Hoppe MW, Seil R, Hotfiel T. Lösungen für häufige Komplikationen der Ellenbogenarthroskopie. ARTHROSKOPIE 2019. [DOI: 10.1007/s00142-019-00299-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Willinger L, Lacheta L, Imhoff AB, Siebenlist S. Der steife Ellenbogen – Teil 1. ARTHROSKOPIE 2019. [DOI: 10.1007/s00142-019-0271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Thaveepunsan S, Shields MN, O'Driscoll SW. The Needle-and-Knife Technique: A Safe Technique for Anterolateral Portal Placement in Elbow Arthroscopy. Orthop J Sports Med 2019; 7:2325967118817232. [PMID: 30729140 PMCID: PMC6350134 DOI: 10.1177/2325967118817232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Safe and effective portal placement is crucial for successful elbow
arthroscopy. Various techniques for anterolateral portal placement in elbow
arthroscopy have been described, yet radial nerve injuries are commonly
reported. Purpose: To report on the technique and safety of anterolateral portal placement by
the needle-and-knife method and its clinical applications. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was completed of patients who underwent an
arthroscopic procedure in the anterior compartment of the elbow and
anterolateral portal placement. Patients were evaluated immediately
postoperatively and at subsequent visits and were monitored for signs of
radial nerve injury. Results: A total of 460 patients met the inclusion criteria, of which 309 (67%)
underwent the needle-and-knife technique. There was 1 case (0.3%) of
temporary radial nerve palsy. For the remaining 151 patients who underwent
anterolateral portal placement by other techniques, there were 2 cases of
temporary radial nerve palsy (1.3%). There were no cases of the
needle-and-knife technique being unsuccessful or abandoned in lieu of a
different technique. Use of the needle-and-knife technique increased over
time with experience and practice. Initially, contraindications to this
technique included impaired view of the lateral side of the anterior
compartment of the elbow caused by severe intra-articular scar (65%),
extensive synovitis (10%), or large osteophytes or loose bodies (10%). For
the remaining patients (15%) who did not have portals placed via the
needle-and-knife technique, alternate techniques were used for teaching
purposes. Conclusion: The needle-and-knife technique is reproducible and easy to perform by a
clinician instructed in its use and trained in elbow arthroscopy. Its main
advantage is that it permits the surgeon to safely slide the knife along the
lateral supracondylar ridge, releasing the scarred capsule and thereby
increasing the available space in which to work. Enlarging the working space
inside scarred and contracted elbows cannot be accomplished by distending
the capsule.
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Affiliation(s)
- Sutee Thaveepunsan
- Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Maegan N Shields
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Shawn W O'Driscoll
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Kowalski JM, Monica JT. A Novel Method of Patient Positioning Using Shoulder Arthroscopy Equipment for Elbow Arthroscopy. Orthopedics 2018; 41:e158-e160. [PMID: 29120003 DOI: 10.3928/01477447-20171102-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/06/2017] [Indexed: 02/03/2023]
Abstract
Indications for elbow arthroscopy are expanding; however, it is uncommon compared with shoulder arthroscopy. Elbow arthroscopy can be complicated by positioning, including the need to obtain specific arm holders required by most operating rooms. Surgery can be performed in the supine, prone, or lateral position. Arm traction allows for distraction of the joint space, full insufflation, and therefore visualization of intra-articular anatomy. This article outlines a new technique using previously available shoulder arthroscopy equipment to avoid increased cost incurred by procuring new, elbow-specific equipment. This technique is performed in the supine position using a hydraulic system and a shoulder 3-point distractor. [Orthopedics. 2018; 41(1):e158-e160.].
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Hilgersom NFJ, van Deurzen DFP, Gerritsma CLE, van der Heide HJL, Malessy MJA, Eygendaal D, van den Bekerom MPJ. Nerve injuries do occur in elbow arthroscopy. Knee Surg Sports Traumatol Arthrosc 2018; 26:318-324. [PMID: 28932881 DOI: 10.1007/s00167-017-4719-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 09/14/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose is to create more awareness as well as emphasize the risk of permanent nerve injury as a complication of elbow arthroscopy. METHODS Patients who underwent elbow arthroscopy complicated by permanent nerve injury were retrospectively collected. Patients were collected using two strategies: (1) by word-of-mouth throughout the Dutch Society of Shoulder and Elbow Surgery, and the Leiden University Nerve Centre, and (2) approaching two medical liability insurance companies. Medical records were reviewed to determine patient characteristics, disease history and postoperative course. Surgical records were reviewed to determine surgical details. RESULTS A total of eight patients were collected, four men and four women, ageing 21-54 years. In five out of eight patients (62.5%), the ulnar nerve was affected; in the remaining three patients (37.5%), the radial nerve was involved. Possible causes for nerve injury varied among patients, such as portal placement and the use of motorized instruments. CONCLUSIONS A case series on permanent nerve injury as a complication of elbow arthroscopy is presented. Reporting on this sequel in the literature is little, however, its risk is not to be underestimated. This study emphasizes that permanent nerve injury is a complication of elbow arthroscopy, concurrently increasing awareness and thereby possibly aiding to prevention. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Nick F J Hilgersom
- Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Derek F P van Deurzen
- Department of Orthopaedic Surgery, Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - Carina L E Gerritsma
- Department of Orthopaedic Surgery, Martini Hospital, Van Swietenplein 1, 9728 NT, Groningen, The Netherlands
| | - Huub J L van der Heide
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Martijn J A Malessy
- Department of Neurosurgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Upper Limb Unit, Amphia Hospital, Langendijk 75, 4819 EV, Breda, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopaedic Surgery, Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
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Camp CL, Degen RM, Dines JS, Altchek DW, Sanchez-Sotelo J. Basics of Elbow Arthroscopy Part III: Positioning and Diagnostic Arthroscopy in the Lateral Decubitus Position. Arthrosc Tech 2016; 5:e1351-e1355. [PMID: 28560136 PMCID: PMC5439271 DOI: 10.1016/j.eats.2016.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/25/2016] [Indexed: 02/03/2023] Open
Abstract
In recent years, arthroscopy has gained popularity as a preferred treatment of a multitude of pathologies affecting the elbow. Since its initial description in 1985, many modifications have been made as our knowledge and technology have advanced. Currently, the majority of arthroscopic procedures are performed in either the lateral decubitus or supine suspended position. In this work, we discuss the history, patient positioning, and key steps for performing elbow arthroscopy in the lateral decubitus position. In addition to key steps, a number of strengths and limitations of this set up are discussed in detail. When properly executed, elbow arthroscopy can be performed in a safe and efficient manner with minimal risk to patients.
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Affiliation(s)
- Christopher L. Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Address correspondence to Christopher L. Camp, M.D., Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021, U.S.A.Department of Orthopaedic SurgerySports Medicine and Shoulder Service Hospital for Special Surgery535 E. 70 StreetNew YorkNY10021U.S.A.
| | - Ryan M. Degen
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - Joshua S. Dines
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - David W. Altchek
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
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Annular ligament reconstruction with the superficial head of the brachialis: surgical technique and biomechanical evaluation. Surg Radiol Anat 2016; 39:585-591. [PMID: 27822697 DOI: 10.1007/s00276-016-1774-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to perform biomechanical testing of annular ligament (AL) reconstruction using the superficial head of the brachialis tendon (SHBT) as a distally based tendon graft. We hypothesized that posterior translation of the radial head following AL reconstruction with an SHBT graft does not significantly differ from intact specimens. METHODS Six fresh-frozen elbow specimens were used. The stability of the radial head against posterior translation forces (30 N) was evaluated in 0°, 45°, 90° and 120° of elbow flexion. Posterior translation was obtained for the intact AL, the sectioned AL and the reconstructed AL. Cyclic loading (100 cycles) in 90° of elbow flexion was performed for the intact and the reconstructed AL. RESULTS Posterior translation of the radial head decreased during elbow flexion in native specimens. Sectioning of the AL significantly increased instability over the full range of motion. AL reconstruction with the SHBT restored the stability of the proximal radius but-other than the native AL-was not influenced by elbow flexion. In 120° of flexion the native AL provided significantly more stability when compared to the reconstructed AL. Cyclic loading did not provide significant differences between native and reconstructed specimens. CONCLUSIONS We provide a feasible technique for AL reconstruction using the SHBT. The biomechanical results obtained in this study confirm the efficacy of the procedure. AL reconstruction restores the stability of the proximal radius, yet it cannot fully mimic the complex features of the intact AL.
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