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Al-Hamdani A, Rasmussen JV, Al-Hamdani MA, Sørensen AKB, Eschen J, Olsen BS. The Copenhagen Classification System for Distal Humeral Fractures is useful to identify patients who may require treatment with hemi- or total elbow arthroplasty. JSES Int 2024; 8:915-920. [PMID: 39035674 PMCID: PMC11258849 DOI: 10.1016/j.jseint.2024.03.016] [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: 07/23/2024] Open
Abstract
Background Classification systems are only useful if there is agreement among observers. The purpose of this study is to introduce a simple and clinically applicable classification system - The Copenhagen Classification System for Distal Humeral Fractures (CCDHF) and to compare the interobserver and intraobserver agreement for this classification with the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA), and the Sheffield classification systems. The primary objective of the new classification system is to distinguish fractures that may not be suitable for open reduction and internal fixation, necessitating treatment options such as elbow hemiarthroplasty or total elbow arthroplasty (TEA). Methods Five consultant elbow surgeons assessed a consecutive series of 105 sets X-rays of distal humeral fractures on 2 occasions with at least 10 weeks interval. All X-rays were classified according to AO/OTA, Sheffield, and the CCDHF systems. The CCDHF system has been developed collaboratively by a panel of five experienced elbow surgeons. Based on consensus, the surgeons identified specific fracture characteristics where elbow hemiarthroplasty or TEA might be needed. Results The mean interobserver agreement was fair for AO/OTA and moderate for Sheffield and the CCDHF. The mean intraobserver agreement was moderate for AO/OTA and substantial for Sheffield and the CCDHF. The observers were uncertain about the classification in 29% of the cases with the AO/OTA classification, 15% with the Sheffield classification, and 12% with CCDHF. Conclusion The CCDHF demonstrated validity and clinical applicability and can assist surgeons in identifying fractures that may require hemiarthroplasty or TEA treatment.
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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
| | - Jacob Eschen
- Department of Orthopaedic Surgery, Privathospitalet Danmark, Copenhagen, Denmark
| | - Bo S. Olsen
- Department of Orthopaedic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Sandoval LA, Reiter CR, Wyatt PB, Satalich JR, Ernst BS, O’Neill CN, Vanderbeck JL. Total Elbow Arthroplasty Versus Open Reduction and Internal Fixation for Distal Humerus Fractures: A Propensity Score Matched Analysis of 30-Day Postoperative Complications. Geriatr Orthop Surg Rehabil 2024; 15:21514593241260097. [PMID: 38855405 PMCID: PMC11159534 DOI: 10.1177/21514593241260097] [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: 10/06/2023] [Revised: 03/25/2024] [Accepted: 05/15/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Open reduction and internal fixation (ORIF) is an established surgical procedure for distal humeral fractures; however, total elbow arthroplasty (TEA) has become an increasingly popular alternative for elderly patients with these injuries. Using a large sample of recent patient data, this study compares the rates of short-term complications between ORIF and TEA and evaluates complication risk factors. Methods Patients who underwent primary TEA or ORIF from 2012 to 2021 were identified by Current Procedural Terminology codes in the American College of Surgeons National Surgical Quality Improvement Program database. Propensity score matching controlled for demographic and comorbid differences. The rates of 30-day postoperative complications were compared. Results A total of 1539 patients were identified, with 1365 (88.7%) and 174 (11.3%) undergoing ORIF and TEA, respectively. Patients undergoing TEA were older on average (ORIF: 56.2 ± 19.8 years, TEA: 74.3 ± 11.0 years, P < .001). 348 patients were included in the matched analysis, with 174 patients in each group. TEA was associated with an increased risk for postoperative transfusion (OR = 6.808, 95% CI = 1.355 - 34.199, P = .020). There were no significant differences in any adverse event (AAE) between procedures (P = .259). A multivariate analysis indicated age was the only independent risk factor for the development of AAE across both groups (OR = 1.068, 95% CI = 1.011 - 1.128, P = .018). Conclusion The risk of short-term complications within 30-days of ORIF or TEA procedures are similar when patient characteristics are controlled. TEA, however, was found to increase the risk of postoperative transfusions. Risks associated with increasing patient age should be considered prior to either procedure. These findings suggest that long-term functional outcomes can be prioritized in the management of distal humerus fractures.
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Affiliation(s)
- Luke A. Sandoval
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Charles R. Reiter
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Phillip B. Wyatt
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - James R. Satalich
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Brady S. Ernst
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Conor N. O’Neill
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jennifer L. Vanderbeck
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
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West W, Moore A, Gerhardt C, Webb P, Binitie O, Lazarides A, Letson D, Joyce D. Dual plating in the metastatic distal humerus: Benefits may outweigh the risks. J Orthop 2024; 51:103-108. [PMID: 38361983 PMCID: PMC10864758 DOI: 10.1016/j.jor.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
Background Impending and complete pathologic fractures of the distal humerus are rare complications of metastatic cancer. Surgical treatment aims to quickly restore function and minimize pain. Plate and screw fixation (PSF) is a common method for addressing these lesions, but unlike in orthopaedic trauma, there are no clear guidelines for best management. While dual PSF theoretically provides better support and reduces the chance of reoperation due to tumor progression, single PSF is currently the more common choice. Materials and methods Between March 2008 and September 2021, 35 consecutive patients who underwent PSF for distal humerus metastasis or multiple myeloma were retrospectively reviewed. The proportion of patients who developed various postoperative complications, including infection, nonunion, deep vein thrombosis, tumor progression, and radial nerve palsy, as well as those requiring reoperation, was calculated. Mann-Whitney U test, Pearson's chi-squared, and Fisher's exact test were used to investigate differences between the single and dual PSF groups with statistical significance defined as p ≤ 0.05. Results There was no significant difference (p = 0.259) in revision rate, although 3 of 21 (14.3 %) single PSF patients required reoperation compared to 0 of 14 (0.0 %) dual PSF patients. The revisions were performed in one patient due to refracture and in two patients due to tumor progression. Although not statistically significant, a larger percentage of single PSF patients developed a postoperative complication compared to dual PSF patients [odds ratio 0.42 (95 % confidence interval 0.071 to 2.5); p = 0.431]. Single PSF did lead to shorter operative time compared to dual PSF [p < 0.001]. Conclusion Dual PSF is non-inferior to single PSF and potentially results in fewer reoperations and postoperative complications in distal humerus pathologic lesions, although it leads to longer operative time. The current study is limited by small sample size due to the rarity of distal humerus metastatic lesions.
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Affiliation(s)
- William West
- University of South Florida Morsani College of Medicine, USA
| | | | | | - Paul Webb
- University of South Florida Morsani College of Medicine, USA
| | | | | | | | - David Joyce
- Sarcoma Department, Moffitt Cancer Center, USA
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Stoddart MT, Panagopoulos GN, Craig RS, Falworth M, Butt D, Rudge W, Higgs D, Majed A. A systematic review of the treatment of distal humerus fractures in older adults: A comparison of surgical and non-surgical options. Shoulder Elbow 2024; 16:175-185. [PMID: 38655404 PMCID: PMC11034469 DOI: 10.1177/17585732221099845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 04/26/2024]
Abstract
Background Fractures of the distal humerus are a common fragility fracture in older adults. The purpose of this study was to systematically review the literature to produce pooled estimates of the outcomes of treatment using total elbow arthroplasty (TEA), open reduction and locking plate fixation (ORIF), hemiarthroplasty or with conservative management. Methods A systematic review of PUBMED and EMBASE databases was conducted for studies reporting outcomes of intra-articular fractures in older adults. Data extracted included patient-reported outcome measures as well as clinical outcomes including ROM, adverse events and all-cause reoperation rates. Results Forty-eight studies met the inclusion criteria and included 1838 acute, intra-articular distal humeral fractures. There was no clinically important difference in patient-reported pain and function measured on the Mayo Elbow Performance Score (TEA = 89.3 (SD 20.0), Hemi = 88.4 (SD 10.6), internal fixation = 85.0 (SD 14.7), non-operative = 85.1 (SD 11.0)). Discussion Each of the treatment modalities studies resulted in a reasonable level of elbow function. The included studies were largely non-comparative and at considerable risk of bias. As elbow replacement surgery becomes centralised in the UK, there is a real need for high-quality comparative research studies to inform practice.
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Affiliation(s)
| | | | - Richard S. Craig
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, UK
| | - Mark Falworth
- Shoulder & Elbow Service, Royal National Orthopaedic Hospital, Stanmore, UK
| | - David Butt
- Shoulder & Elbow Service, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Will Rudge
- Shoulder & Elbow Service, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Deborah Higgs
- Shoulder & Elbow Service, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Addie Majed
- Shoulder & Elbow Service, Royal National Orthopaedic Hospital, Stanmore, UK
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LaGreca M, Chaudhry YP, Falconiero T, Muzzonigro T, Lippe D, Shah M. Nail-plate Combination Treatment of Ipsilateral Humeral Shaft and Distal Humerus Fractures - A Case Report. J Orthop Case Rep 2024; 14:100-104. [PMID: 38560314 PMCID: PMC10976525 DOI: 10.13107/jocr.2024.v14.i03.4304] [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] [Received: 12/14/2023] [Revised: 01/05/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Humeral shaft and distal humerus fractures have several different treatment options, including plate fixation and intramedullary nailing. Each has its own benefits, but typically, they are not used in conjunction. While nail-plate combinations (NPCs) have become more common in the lower extremity, literature on their use in upper extremity fractures remains scarce. Case Report A 74-year-old right-hand dominant male presented after a fall with a closed left transverse midshaft humerus fracture and an associated supracondylar distal humerus fracture with intercondylar extension through a medial column. Due to the segmental nature of his injury, medial column plating was used in conjunction with a retrograde intramedullary nail to obtain anatomic reduction and fixation of the articular injury while stabilizing the midshaft humerus fracture with minimal soft tissue disruption. The patient was recommended non-weight bearing through his left arm for 6 weeks, at which point he returned to weight bearing as tolerated. He was allowed to range his left elbow after 2 weeks. His left elbow range of motion at the 4-month follow-up was 20-135 degrees, and he reported minimal pain. Conclusion The retrograde NPC should be considered in segmental humeral fractures involving the distal articular surface and midshaft humerus fractures as it limits violation of the soft tissue while avoiding iatrogenic disruption of the articular surface at the shoulder or elbow.
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Affiliation(s)
- Mark LaGreca
- Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Yash P Chaudhry
- Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Thomas Falconiero
- Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Thomas Muzzonigro
- Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Daniel Lippe
- Department of Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Mitesh Shah
- Main Line Health Orthopedics and Spine, Lankenau Medical Center, Wynewood, Pennsylvania
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Kruszewski A, Piszczatowski S, Piekarczyk P, Cieślik P, Kwiatkowski K. Weak Points of Double-Plate Stabilization Used in the Treatment of Distal Humerus Fracture through Finite Element Analysis. J Clin Med 2024; 13:1034. [PMID: 38398347 PMCID: PMC10888649 DOI: 10.3390/jcm13041034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Multi-comminuted, intra-articular fractures of the distal humerus still pose a challenge to modern orthopedics due to unsatisfactory treatment results and a high percentage (over 50%) of postoperative complications. When surgical treatment is chosen, such fractures are fixed using two plates with locking screws, which can be used in three spatial configurations: either parallel or one of two perpendicular variants (posterolateral and posteromedial). The evaluation of the fracture healing conditions for these plate configurations is unambiguous. The contradictions between the conclusions of biomechanical studies and clinical observations were the motivation to undertake a more in-depth biomechanical analysis aiming to indicate the weak points of two-plate fracture stabilization. METHODS Research was conducted using the finite element method based on an experimentally validated model. Three variants of distal humerus fracture (Y, λ, and H) were fixed using three different plate configurations (parallel, posterolateral, and posteromedial), and they were analyzed under six loading conditions, covering the whole range of flexion in the elbow joint (0-145°). A joint reaction force equal to 150 N was assumed, which corresponds with holding a weight of 1 kg in the hand. The biomechanical conditions of bone union were assessed based on the interfragmentary movement (IFM) and using criteria formulated by Steiner et al. Results: The IFMs were established for particular regions of all of the analyzed types of fracture, with distinction to the normal and tangential components. In general, the tangential component of IFM was greater than normal. A strong influence of the elbow joint's angular position on the IFM was observed, with excessive values occurring for flexion angles greater than 90°. In most cases, the smallest IFM values were obtained for the parallel plaiting, while the greatest values were obtained for the posteromedial plating. Based on IFM values, fracture healing conditions in particular cases (fracture type, plate configuration, loading condition, and fracture gap localization) were classified into one of four groups: optimal bone union (OPT), probable union (PU), probable non-union (PNU), and non-union (NU). CONCLUSIONS No plating configuration is able to ensure distal humerus fracture union when the full elbow flexion is allowed while holding a weight of 1 kg in the hand. However, flexion in the range of 0-90° with such loadings is acceptable when using parallel plating, which is a positive finding in the context of the early rehabilitation process. In general, parallel plating ensures better conditions for fracture healing than perpendicular plate configurations, especially the posteromedial version.
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Affiliation(s)
- Artur Kruszewski
- Faculty of Mechanical Engineering, Institute of Biomedical Engineering, Bialystok University of Technology, 45A Wiejska Street, 15-351 Bialystok, Poland;
| | - Szczepan Piszczatowski
- Faculty of Mechanical Engineering, Institute of Biomedical Engineering, Bialystok University of Technology, 45A Wiejska Street, 15-351 Bialystok, Poland;
| | - Piotr Piekarczyk
- Department of Traumatology and Orthopedics, Military Institute of Medicine—National Research Institute, 128 Szaserów Street, 04-141 Warsaw, Poland; (P.P.); (P.C.); (K.K.)
| | - Piotr Cieślik
- Department of Traumatology and Orthopedics, Military Institute of Medicine—National Research Institute, 128 Szaserów Street, 04-141 Warsaw, Poland; (P.P.); (P.C.); (K.K.)
| | - Krzysztof Kwiatkowski
- Department of Traumatology and Orthopedics, Military Institute of Medicine—National Research Institute, 128 Szaserów Street, 04-141 Warsaw, Poland; (P.P.); (P.C.); (K.K.)
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Evan TYZ, Yen JWR, Seow D, Jiali CC, Kumar L, Baskar S, Liang S, Kumar N. Single-Level Cervical Artificial Disc Replacement Compared with Cage Screw Implants: 2-Year Clinical and Radiological Outcomes Especially Adjacent Level Ossification. Asian Spine J 2023; 17:729-738. [PMID: 37408294 PMCID: PMC10460666 DOI: 10.31616/asj.2022.0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/31/2022] [Accepted: 11/24/2022] [Indexed: 07/07/2023] Open
Abstract
STUDY DESIGN Retrospective single-center, single-surgeon cohort study. PURPOSE Our goal was to compare the 2-year clinical and radiological results of artificial disc replacement (ADR) and cage screw (CS) implants in patients with cervical degenerative disc disease (DDD). OVERVIEW OF LITERATURE Anterior cervical discectomy and fusion with CS implants are an acceptable alternative to traditional cageplate construct due to perceived decreased complications of dysphagia. However, patients may experience adjacent segment disease because of increased motion and intradiscal pressure. ADR is an alternative to restore the physiological kinematics of the operated disc. Few studies directly compare ADR and CS construct for their efficacy. METHODS Patients who received single-level ADR or CS between January 2008 and December 2018 were included. Data collected was preoperatively, intraoperatively, and postoperatively (6, 12, 24 months). Demographic information, surgical information, complications, follow-up surgery, and outcome ratings (Japanese Orthopaedic Association [JOA], Neck Disability Index [NDI], Visual Analog Scale [VAS] neck and arm, 36-item Short Form Health Survey [SF-36], EuroQoL-5 Dimension [EQ-5D]) were gathered. The radiological assessment included motion segment height, adjacent disc height, lordosis, cervical lordosis, T1 slope, the sagittal vertical axis C2-7, and adjacent level ossification development (ALOD). RESULTS Fifty-eight patients were included (ADR: 37 and CS: 21). At 6 months, both groups' JOA, VAS, NDI, SF-36, and EQ-5D scores significantly improved, and the positive trends persisted at 2 years. Noted no significant difference in the enhancement of clinical scores except for the VAS arm (ADR: 5.95 vs. CS: 3.43, p =0.001). Radiological parameters were comparable except for the progression of ALOD of the subjacent disc (ADR: 29.7% vs. CS: 66.9%, p =0.02). No significant difference in adverse events or severe complications seen. CONCLUSIONS ADR and CS obtain good clinical results for symptomatic single-level cervical DDD. ADR demonstrated a significant advantage over CS in the improvement of VAS arm and reduced progression of ALOD of the adjacent lower disc. No statistically significant difference of dysphonia or dysphagia between the two groups were seen, attributed to their comparable zero profile.
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Affiliation(s)
- Teo Yu Ze Evan
- Department of Orthopaedic Surgery, National University Health System,
Singapore
| | - Joshua Wong Rui Yen
- Department of Orthopaedic Surgery, National University Health System,
Singapore
| | - Dexter Seow
- Department of Orthopaedic Surgery, National University Health System,
Singapore
| | - Corin Chen Jiali
- Department of Orthopaedic Surgery, National University Health System,
Singapore
| | - Laranya Kumar
- Department of Orthopaedic Surgery, National University Health System,
Singapore
| | - Sangeetha Baskar
- Department of Orthopaedic Surgery, National University Health System,
Singapore
| | - Shen Liang
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore,
Singapore
| | - Naresh Kumar
- Department of Orthopaedic Surgery, National University Health System,
Singapore
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Al-Gburi M, Al-Hamdani A, Rasmussen JV, Olsen BS. Low risk of postoperative ulnar nerve affection in surgically treated distal humeral fractures when the nerve is released in situ. World J Orthop 2023; 14:526-532. [PMID: 37485432 PMCID: PMC10359752 DOI: 10.5312/wjo.v14.i7.526] [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: 02/23/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 07/17/2023] Open
Abstract
BACKGROUND Adult distal humeral fractures (DHF) comprise 2%-5% of all fractures and 30% of all elbow fractures. Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular structures. Open reduction and internal fixation (ORIF) are often the treatment of choice, but arthroplasty is considered in case of severe comminution or in elderly patients with poor bone quality. Ulnar nerve affection following surgical treatment of distal humerus fractures is a well-recognized complication.
AIM To report the risk of ulnar nerve affection after surgery for acute DHFs.
METHODS We retrospectively identified 239 consecutive adult patients with acute DHFs who underwent surgery with ORIF, elbow hemiarthroplasty (EHA) or total elbow arthroplasty (TEA) between January 2011 and December 2019. In all cases, the ulnar nerve was released in situ without anterior transposition. We used our institutional database to review patients’ medical records for demographics, fracture morphology, type of surgery and ulnar nerve affection immediately; records were reviewed after surgery and at 2 wk and 12 wk of routine clinical outpatient follow-up. Twenty-nine percent patients were excluded due to pre- or postoperative conditions. Final follow-up examination was a telephone interview in which ulnar nerve affection was reported according to the McGowen Classification Score. A total of 210 patients were eligible for interview, but 13 patients declined participation and 17 patients failed to respond. Thus, 180 patients were included.
RESULTS Mean age at surgery was 64 years (range 18-88 years); 121 (67.3%) patients were women; 59 (32.7%) were men. According to the AO/OTA classification system, we recorded 47 patients with type A3, 55 patients with type B and 78 patients with type C fractures. According to the McGowen Classification Score, mild ulnar nerve affection was reported in nine patients; severe affection, in two. A total of 69 patients were treated with ORIF of whom three had mild temporary ulnar nerve affection and one had severe ulnar nerve affection. In all, 111 patients were treated with arthroplasty (67 EHA, 44 TEA) of whom seven had mild ulnar nerve affection and one had severe persistent ulnar nerve affection. No further treatment was provided.
CONCLUSION The risk of ulnar nerve affection after surgical treatment for acute DHF is low when the ulnar nerve is released in situ without nerve transposition, independently of the treatment provided.
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Affiliation(s)
- Mustafa Al-Gburi
- Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital, Hellerup 2900, Gentofte, Denmark
| | - Ali Al-Hamdani
- Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital, Hellerup 2900, Gentofte, Denmark
| | - Jeppe Vejlgaard Rasmussen
- Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital, Hellerup 2900, Gentofte, Denmark
| | - Bo Sanderhoff Olsen
- Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital, Hellerup 2900, Gentofte, Denmark
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Yoshii Y, Iwabuchi S, Ikumi A, Kohyama S, Ogawa T, Ishii T. Correlations between 3D preoperative planning and postoperative reduction in the osteosynthesis of distal humeral fractures. J Orthop Surg Res 2023; 18:283. [PMID: 37031170 PMCID: PMC10082491 DOI: 10.1186/s13018-023-03772-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/01/2023] [Indexed: 04/10/2023] Open
Abstract
BACKGROUND Three-dimensional preoperative planning has been applied to the osteosynthesis of distal humerus fractures. The present study investigated the correlations between 3D preoperative planning and postoperative reduction for the osteosynthesis of distal humerus fractures using 3D parameters. METHODS Twenty-three elbows of 23 distal humerus fracture patients who underwent osteosynthesis with three-dimensional preoperative planning were evaluated. 3D images of the distal humerus were created after taking preoperative CT scans of the injured elbow. Fracture reduction, implant selection, and placement simulations were performed based on 3D images. Postoperative CT images were taken 1 month after surgery. Correlations were evaluated with preoperative plans and postoperative 3D images. The longitudinal axis and coordinates of the humerus were defined on the 3D images. The coronal angle (CA) was defined as the angle formed by the long axis and the line connecting the medial and lateral margins of the trochlea of the humerus on a coronal plane image. The sagittal angle (SA) was defined as the angle formed by the long axis and the line connecting the top of the lateral epicondyle and the center of the humeral capitellum on a sagittal plane image. The axial angle (AA) was defined as the angle between the sagittal plane and the line connecting the medial and lateral margins behind the trochlea of the humerus. The intraclass correlation coefficients (ICC) of each measurement value were assessed between preoperative planning and postoperative images. RESULTS Preoperative planning and postoperative measurement values were CA: 85.6 ± 5.9°/85.8 ± 5.9°, SA: 140.9 ± 8.5°/139.4 ± 7.9°, and AA: 84.0 ± 3.1°/82.6 ± 4.9°, respectively. ICCs were CA: 0.75 (P < 0.01), SA: 0.78 (P < 0.01), and AA: 0.34 (P < 0.05), respectively. CONCLUSIONS The 3D preoperative planning of distal humeral fractures achieved the good correlations of coronal and sagittal angles, but the relatively poor correlation of the axial angle. This may be attributed to an inability to assess the rotation angle during surgery. We propose the measurement indices shown in the present study as a three-dimensional evaluation index for distal humerus fractures. TRIAL REGISTRATION Registered as NCT04349319 at ClinicalTrials.gov.
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Affiliation(s)
- Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan.
| | - Sho Iwabuchi
- Department of Orthopaedic Surgery, University of Tsukuba Hospital, Tsukuba, Ibaraki, 305-8576, Japan
| | - Akira Ikumi
- Department of Orthopaedic Surgery, University of Tsukuba Hospital, Tsukuba, Ibaraki, 305-8576, Japan
| | - Sho Kohyama
- Department of Orthopaedic Surgery, Kikkoman General Hospital, Noda, Chiba, 278-0005, Japan
| | - Takeshi Ogawa
- Department of Orthopaedic Surgery, Mito Medical Center Hospital, Ibaraki, Ibaraki, 311-3193, Japan
| | - Tomoo Ishii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
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Sivagurunathan G, Shirodkar K, Hegde G, Shamshuddin S, Proctor R, Naqvi J, Knowles D, Ali I. Musculoskeletal Computed Tomography: How to Add Value When Reporting Adult Upper Limb Trauma. J Comput Assist Tomogr 2023; 47:264-276. [PMID: 36877776 DOI: 10.1097/rct.0000000000001417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
ABSTRACT There is increasing reliance on computed tomography to evaluate fractures and dislocations following routine evaluation with plain radiography, critical in preoperative planning; computed tomography can provide multiplanar reformats and 3-dimensional volume-rendered imaging, providing a better global assessment for the orthopedic surgeon. The radiologist plays a critical role in appropriately reformatting the raw axial images to illustrate best the findings that will help determine further management. In addition, the radiologist must succinctly report the pertinent findings that will have the most significant bearing on treatment, assisting the surgeon in deciding between nonoperative and operative management. The radiologist should also carefully review imaging to look for ancillary findings in the setting of trauma beyond the bones and joints, including the lungs and rib cage when visualized.In this review article, we will systematically describe key features for fractures of the scapula, proximal humerus, distal humerus, radial head and neck, olecranon, coronoid process through a case-based approach, and distal radius. Although there are numerous detailed classification systems for each of these fractures, we aim to focus on the core descriptors that underpin these classification systems. The goal is to provide the radiologist with a checklist of critical structures they must assess and findings that they should mention in their report, emphasizing those descriptors that influence patient management.
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Zha Y, Hua K, Huan Y, Chen C, Sun W, Ji S, Xiao D, Gong M, Jiang X. Biomechanical comparison of three internal fixation configurations for low transcondylar fractures of the distal humerus. Injury 2023; 54:362-369. [PMID: 36509562 DOI: 10.1016/j.injury.2022.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND We aimed to evaluate the biomechanical stiffness and strength of different internal fixation configurations and find suitable treatment strategies for low transcondylar fractures of the distal humerus. METHODS AND MATERIALS Thirty 4th generation composite humeri were used to create low transcondylar fracture models that were fixed by orthogonal and parallel double plates as well as posterolateral plate and medial screw (PPMS) configurations (n=10 in each group) using an anatomical locking compression plate-screw system and fully threaded medial cortical screws. Posterior bending (maximum 50 N), axial loading (maximum 200 N) and internal rotation (maximum 10 N·m) were tested, in that order, for each specimen. Stiffness under different biomechanical settings among different configurations were compared. Another 18 sets of fracture models were created using these three configurations (n=6 in each group) and the load to failure under axial loading among different configurations was compared. RESULTS Under posterior bending, the stiffness of parallel group was higher than orthogonal group (P<0.001), and orthogonal group was higher than PPMS group (P<0.001). Under axial loading, the stiffness of parallel group was higher than orthogonal group (P=0.001) and PPMS group (P<0.001); however, the difference between orthogonal and PPMS group was not statistically significant (P>0.05). Under internal rotation, the stiffness of parallel group was higher than orthogonal group (P=0.044), and orthogonal group was higher than PPMS group (P=0.029). In failure test under axial loading, the load to failure in the orthogonal group was lower than parallel group (P=0.009) and PPMS group (P=0.021), but the difference between parallel group and PPMS group was not statistically significant (P>0.05). All specimens in orthogonal group demonstrated "distal medial failure"; most specimens had "distal medial and trochlear failure" in the parallel group; most specimens exhibited "contact failure" in the PPMS group. CONCLUSION For treating low transcondylar fractures, the overall stiffness and strength of the parallel configuration were superior to those of the orthogonal and PPMS configurations. Nevertheless, the PPMS configuration can provide adequate stability and stiffness comparable to double-plate configurations under axial loading. Therefore, the PPMS construct may have certain clinical value.
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Affiliation(s)
- Yejun Zha
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Kehan Hua
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Yong Huan
- State Key Laboratory of Nonlinear Mechanics (LNM), Institute of Mechanics, Chinese Academy of Sciences, Beijing, China
| | - Chen Chen
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Weitong Sun
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Shangwei Ji
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Dan Xiao
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Maoqi Gong
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Xieyuan Jiang
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing 100035, China.
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Muacevic A, Adler JR, Shanthappa AH. Functional Outcome of Distal Humerus Fractures Treated With Open Reduction and Internal Fixation With Bicolumnar Plating in a Tertiary Care Setting. Cureus 2023; 15:e33540. [PMID: 36779108 PMCID: PMC9907393 DOI: 10.7759/cureus.33540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
Introduction Fractures of the distal humerus in the adult comprise approximately one-third of all humeral fractures. Over the past 20 years, nonoperative treatment for these fractures has been substituted by anatomic reduction and internal fixation based on the Association for Osteosynthesis (AO)/Association for the Study of Internal Fixation (ASIF) philosophy of plate fixation which resulted in early mobilization and superior performance. Pre-contoured, anatomically designed locking plates are anticipated to offer sufficient stability, permit early elbow range of motion, and safeguard the soft tissue. In comparison to any other joint, the elbow's good anatomical alignment, perfect stability, and early mobilization principles are of utmost significance. Methodology A hospital-based consecutive case series of distal humerus fracture patients managed surgically with bicolumnar plating at R.L. Jalappa Hospital Centre, from June 2021 to June 2022 was chosen. Patients were clinically assessed by measuring the range of motion of the elbow with a goniometer. A six-week post-operative review was the first one. Routine checkups were scheduled every four weeks up until there was evidence of fracture consolidation radiologically. Clinically Mayo Elbow Performance score (MEPS) was analyzed at the end of six-month follow-up and tabulated. Institutional Ethical committee permission was taken prior to the study. Results In the study, 47% of cases had an Excellent MEPS followed by 33% of patients having a good MEPS and 13% having a Fair MEPS rating. Only 7% of patients had poor MEPS. Among the patients, 33.3% had 90 MEPS followed by 16.6% cases had 85 MEPS. Only 2 patients had 55 MEPS in the study. The fracture pattern configuration based on AO classification in our study was C2>C1>C3>A2.3=A3.3. Conclusion Due to an increase in road traffic accidents, complicated distal humeral fractures are becoming more common among younger people. In terms of stability and arc of motion, excellent to good functional outcomes were attained in around 80% of the study group. Because of the extremely stable build system produced by parallel plating, there have been no reported instances of implant failure or non-union.
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Komijani M, Shamabadi A, Oryadi Zanjani L, Nabian MH, Panjavi B, Shahriar Kamrani R. Outcomes of the Pin and Plate Technique in Complex Fractures and Nonunions of Distal Humerus. THE ARCHIVES OF BONE AND JOINT SURGERY 2023; 11:503-509. [PMID: 37674697 PMCID: PMC10479823 DOI: 10.22038/abjs.2023.69446.3268] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 06/10/2023] [Indexed: 09/08/2023]
Abstract
Objectives This study investigates outcomes and complications of the pin and plate fixation technique, which was suggested for distal humerus fractures. It also reports the results of its application in nonunions for the first time. Methods Forty-nine fracture and 17 nonunion cases who underwent surgery using the technique and were followed for at least 18 months were assessed through the range of motion (ROM), Quick Disabilities of the Arm, Shoulder, and Hand Score (Quick-DASH), Mayo Elbow Performance Score (MEPS), four-category verbal rating scale (VRS-4), and complications. Results At the last follow-up, the mean scores of flexion, extension deficit, supination, and pronation ranges in fracture cases were 116.7, 22.9, 90.0, and 90.0 degrees, respectively. These values in nonunion cases were 112.2, 26.4, 86.7, and 85.5 degrees, respectively. The average ROM in fracture cases was 93.8, while it was 85.8 degrees in nonunion cases. The mean Quick-DASH in fracture and nonunion patients were 25.2 and 31.1, respectively. According to the MEPS, 77.5% of fracture and 64.7% of nonunion patients had excellent and good results. In fracture cases, the mean scores of VRS-4 at rest, light activity, and hard activity were 1.3, 1.8, and 2.3, respectively. These values in nonunion cases were 1.8, 2.2, and 2.5, respectively. The most common complications were device prominence and ulnar neuropathy. Conclusion An acceptable union rate and proper elbow function can be expected by using this technique. Owing to the promising results of this study, further high-quality studies are recommended. Hereby this technique is called Persian Fixation.
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Affiliation(s)
- Mehdi Komijani
- Department of Orthopedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- These two authors have participated as first author equally
| | - Ahmad Shamabadi
- Department of Orthopedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- These two authors have participated as first author equally
| | - Leila Oryadi Zanjani
- Department of Orthopedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Nabian
- Department of Orthopedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Panjavi
- Department of Orthopedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shahriar Kamrani
- Department of Orthopedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Stone A, Chan G, Sinclair L, Phadnis J. Elbow arthroplasty in trauma-current concepts review. J Orthop 2023; 35:126-133. [PMID: 36471696 PMCID: PMC9718957 DOI: 10.1016/j.jor.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Despite advancements in modern locking plate technology, distal humerus fractures in the elderly remain difficult to treat. A subset of fractures in this osteoporotic bone includes multiple, shallow articular fragments that renders fixation unreliable, precluding early motion and acceptable functional outcomes. Arthroplasty, in the form of either Total Elbow Arthroplasty (TEA) or Distal Humeral Hemiarthroplasty (DHH) are alternative treatment options in this cohort and are being increasingly used. Methods This article reviews the use of TEA or DHH for acute distal humerus fracture, including patient selection, pre-operative planning, surgical approach, implant positioning, rehabilitation, outcomes and complications. Results Arthroplasties are being increasingly used for acute distal humerus fractures, however they introduce potential complications not seen with fixation. Due care must be employed to correct implant positioning which is a function of implant rotation, implant length and implant sizing. We describe a robust technique for epicondyle repair in DHH and unlinked TEA to avoid instability. Outcomes of DHH and TEA for acute distal humerus fracture are encouraging, however further long-term outcome and comparative data regarding arthroplasty is required. Conclusions Short to medium term outcomes demonstrate that both DHH and TEA are valuable options for selected patients, although attention to technique is required to minimise potential complications.
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Affiliation(s)
- A. Stone
- Shoulder & Elbow Post-CCT Fellow, University Hospitals Sussex NHS Foundation Trust, UK
| | - G. Chan
- Specialty Registrar, University Hospitals Sussex NHS Foundation Trust, Honorary Clinical Lecturer, Brighton & Sussex Medical School, UK
| | - L. Sinclair
- Clinical Librarian, University Hospitals Sussex NHS Foundation Trust, UK
| | - J. Phadnis
- Consultant Trauma & Orthopaedic Surgeon, University Hospitals Sussex NHS Foundation Trust, Honorary Clinical Reader, Brighton & Sussex Medical School, UK
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Yokoyama H, Takegami Y, Tokutake K, Oshika Y, Iwase K, Tanaka K, Kanemura T, Imagama S. Clinical comparison of double-plate fixation by the perpendicular plate method versus parallel plate method for distal humeral fracture: a multicenter (TRON group) study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03462-1. [PMID: 36527504 DOI: 10.1007/s00590-022-03462-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Double-plating methods are popular, with perpendicular and parallel plate methods being widely used surgical method for the rigid fixation of distal humeral fracture (DHF). However, which plate method is better for DHF remains controversial. The aim of this study was to compare patient outcomes including the incidences of complications and reoperation between the two plate methods. METHODS We extracted 383 patients with DHF undergoing surgery between 2011 and 2020 from our multicenter database, which is named TRON. We divided the subjects into two groups: perpendicular plating group (Group A) and parallel plating group (Group B). To adjust for baseline differences between the groups, patients were matched for age, sex, olecranon osteotomy, AO type, and type of injury. We assessed the Mayo Elbow Performance Score (MEPS) at 3 and 6 months and the last follow-up month as the clinical outcome. We investigated the incidences of complications and reoperations in both groups. RESULTS After matching, each group comprised 50 patients. There was no significant difference between Group A versus Group B in MEPS score at each time point. The incidence of implant removal in Group B was higher than that in Group A (26.5% vs 50%, p = 0.023). DISCUSSION Although there were no significant differences in clinical outcomes or complications between the two groups, the incidence of implant removal was higher in Group B than in Group A. In the parallel plate technique, where the plates have to be placed in areas with thin subcutaneous soft tissue, the incidence of implant removal might be high due to the discomfort caused by the implant.
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Affiliation(s)
- Hiroki Yokoyama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasutaka Oshika
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kenya Iwase
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kohei Tanaka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Pappu R, Vavilalaa AR, Reddy AVG, Boddeda S, Reddy K. A New Technique of Fixing Intra-articular Fractures of the Distal Humerus without Exposing the Ulnar Nerve by Posterior Approach. J Orthop Case Rep 2022; 12:14-18. [PMID: 36687496 PMCID: PMC9831224 DOI: 10.13107/jocr.2022.v12.i08.2946] [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] [Received: 03/01/2022] [Revised: 05/22/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Distal humerus fractures constitute around 0.2 to 7% of all fractures, 30% of all humerus fractures, most common in young adults, are due to high energy trauma and in old age due to osteoporosis. A common step in all currently available approaches is to identify the ulnar nerve, expose, mobilise, and retract this from its surrounding bed or in situ release. Ulnar neuropathy is either observed immediately after surgery or delayed up to one year after surgery. We are describing a new posterior approach for intra-articular distal humerus fractures, where identification and retraction of the ulnar nerve are not required to fix the intra-articular fractures of the distal humerus, thereby avoiding injury to the ulnar nerve. Material and Methods Seven patients with AO type B and C were treated using our new ulnar nerve-sparing approach between January 2017 and December 2019. Postoperatively, all the patients have been examined for ulnar neuropathy symptoms. Results We have no ulnar nerve neuropathy either in the post-operative period or at 2 years follow-up (five cases were followed up for 2 years and two patients lost to follow-up after 6 months). At the end of 2 years, the mean range of motion achieved at elbow was 134°. The mean oxford elbow score was 45.2 (42-47). Heterotopic ossification and infection were not found in our cases. Conclusion Our ulnar nerve-sparing approach for intra-articular fractures of distal third humerus by posterior approach helps in fixing articular fractures of distal humerus without exposing ulnar nerve during surgery without compromising on the exposure of fracture for fixation, thus reducing the chances of ulnar nerve injury and post-operative neuropathy.
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Affiliation(s)
- Rajasekhar Pappu
- Department of Orthopaedic Surgery, Sunshine Bone and Joint Institute, Secunderabad, Telangana, India
| | - Abhilash Rao Vavilalaa
- Department of Orthopaedic Surgery, Pratima institute of medical sciences, Karimnagar, Telangana, India
| | - A V Gurava Reddy
- Department of Orthopaedic Surgery, Sunshine Bone and Joint Institute, Secunderabad, Telangana, India
| | - Sandeep Boddeda
- Department of Orthopaedic Surgery, Sunshine Bone and Joint Institute, Secunderabad, Telangana, India,Address of Correspondence: Dr. Sandeep Boddeda, Department of Orthopaedic Surgery, Sunshine Bone and Joint Institute, Secunderabad, Telangana, India. E-mail:
| | - Kishan Reddy
- Department of Orthopaedic Surgery, Pratima institute of medical sciences, Karimnagar, Telangana, India
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Schultzel M, Rangarajan R, Blout C, Manuputy I, Lee BK, Itamura JM. Hemiarthroplasty for the treatment of distal humerus fractures: long-term clinical results. J Shoulder Elbow Surg 2022; 31:1510-1514. [PMID: 35063642 DOI: 10.1016/j.jse.2021.12.027] [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: 10/09/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total elbow arthroplasty is a treatment for unreconstructable distal humerus fractures; implant longevity remains a concern, especially in younger patients. However, distal humeral hemiarthroplasty (DHH) offers an alternative with potential long-term advantages. METHODS This is a retrospective study of 10 patients who underwent DHH for distal humerus fractures over a 4-year period (2008-2012) by a single surgeon. Patients underwent testing of range of motion, Mayo Elbow Performance Scores (MEPS), Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), visual analog scale (VAS), Single Assessment Numeric Evaluation (SANE), Simple Shoulder Test, Charlson Comorbidity Index (CCI), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores. Average patient age at surgery was 71.9 years (range 56-81 years); average follow-up was 115.2 months (range 96-144 months). RESULTS Patients maintained improvements in MEPS (mean 88, range 75-100) and DASH scores (mean 37.1, range 11.21-55.09), along with no statistically significant decrease in range of motion or scores in comparison to either short- or midterm results. Mean VAS score was 2.2 (range 0-7), SANE 69 (range 55-85), ASES 76.66 (range 51.67-100), and CCI 4.3 (range 1-7). Participants had an average flexion of 126° (range: 90°-140°), extension of 36° (range: 30°-45°), supination of 66° (range: 60°-70°), and pronation of 64° (range: 45°-80°). No elbow dislocations, subluxations, or heterotopic ossification were observed. Complications included 1 fracture and 1 complaint of prominent hardware. Four patients were deceased, and 1 patient was lost to follow-up. CONCLUSION This long-term review suggests that DHH may be an effective treatment for certain distal humerus fractures. The data suggest that elbow range of motion and functional use are maintained from comparison with short- and midterm studies, with no appreciable change in radiographic cartilage wear along the radius or ulna.
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Affiliation(s)
| | - Rajesh Rangarajan
- Marshfield Medical Center-Beaver Dam-Institute for Movement and Orthopedics, Beaver Dam, WI, USA
| | - Collin Blout
- Cedars-Sinai Kerlan-Jobe Institute at White Memorial Medical Center, Los Angeles, CA, USA
| | - Isaac Manuputy
- Cedars-Sinai Kerlan-Jobe Institute at White Memorial Medical Center, Los Angeles, CA, USA
| | - Brian K Lee
- Cedars-Sinai Kerlan-Jobe Institute at White Memorial Medical Center, Los Angeles, CA, USA
| | - John M Itamura
- Cedars-Sinai Kerlan-Jobe Institute at White Memorial Medical Center, Los Angeles, CA, USA
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Nandi R, Ghosh S, Maiti A, Mandal A, Maiti G. Outcome of fixation of distal humerus fracture via paratricipital approach – A prospective study. JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2022. [DOI: 10.4103/jodp.jodp_10_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Good functional outcomes after open reduction and internal fixation for AO/OTA type 13-C2 and -C3 acute distal humeral fractures in patients aged over 45 years. J Shoulder Elbow Surg 2022; 31:143-150. [PMID: 34474137 DOI: 10.1016/j.jse.2021.07.024] [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: 04/22/2021] [Revised: 07/13/2021] [Accepted: 07/26/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to report the functional outcomes and complications after open reduction and internal fixation (ORIF) for Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) type 13-C2 and -C3 acute distal humeral fractures with minimum 2-year follow-up. Our hypothesis was that ORIF would provide functional outcomes that are comparable to those of total elbow arthroplasty and elbow hemiarthroplasty reported in the literature. MATERIALS AND METHODS During a 6-year period, 23 patients aged > 45 years were treated with double plating for AO/OTA type 13-C2 or -C3 fractures. The mean age was 62 years (range, 46-80 years). The Oxford Elbow Score was used as the primary outcome; the Mayo Elbow Performance Score, pain severity score (on a visual analog scale), range of motion, reoperations, and complications were used as secondary outcomes. RESULTS The median Oxford Elbow Score was 42 (range, 25-48), where a score of 48 represents a normal elbow; 20 patients achieved good to excellent outcomes, and 3 achieved fair outcomes. The median Mayo Elbow Performance Score was 85 (range, 60-100), where a score of 100 represents a normal elbow; 18 patients achieved good to excellent outcomes, and 5 achieved fair outcomes. The median visual analog scale score was 2 (range, 0-5). The median flexion-extension and supination-pronation arcs were 120° (range, 70°-155°) and 160° (range, 75°-170°), respectively. Eight complications were recorded in 7 patients; 4 of them required reoperation because of fracture pseudarthrosis or elbow stiffness. Ten patients were working at the time of trauma, and nine of them returned to the same occupation. Our results are comparable to the results of previously published studies regarding the outcome of ORIF, elbow hemiarthroplasty, or total elbow arthroplasty for AO/OTA type 13-C fractures. CONCLUSION ORIF is a reliable treatment option for AO/OTA type 13-C2 and -C3 acute distal humeral fractures in middle-aged and elderly patients, despite the considerable rate of complications. Good to excellent results can be obtained in most patients.
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20
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Alidina S, Alidina J, Souza F, Kalandiak S, Subhawong TK. Radiographic Evaluation of Elbow Fractures. Semin Musculoskelet Radiol 2021; 25:529-537. [PMID: 34706382 DOI: 10.1055/s-0041-1731083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Fractures and dislocations of the elbow are a common cause of emergency department visits each year. Radiography remains the bedrock of an initial injury assessment, and recognition of distinctive injury patterns based on fracture location, morphology, and severity, guides optimal clinical decision-making. This article reviews basic elbow anatomy, frequently seen fractures and injury patterns, and highlights how these findings influence surgical planning and patient management.
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Affiliation(s)
- Sameer Alidina
- University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Jasim Alidina
- Department of Radiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Felipe Souza
- Department of Radiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Steven Kalandiak
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ty K Subhawong
- Department of Radiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
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21
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Moharram AN, Mahmoud M, Lymona A, Afifi A, Ezzat M, Abdel-Wahed M. Temporary spanning plate across the elbow for complex fractures of the distal humerus. BMC Musculoskelet Disord 2021; 22:875. [PMID: 34645437 PMCID: PMC8515665 DOI: 10.1186/s12891-021-04764-x] [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: 08/07/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Open reduction internal fixation (ORIF) is the gold standard management of fractures of the distal humerus. Stable fixation to allow early mobilization is not always possible in cases with comminuted fracture patterns and bone loss, with a high failure rate. We propose augmentation of internal fixation in these unstable situations with a spanning plate across the elbow to protect the fixation construct temporarily until bone union. METHODS Eighteen patients with complex distal humeral fractures were managed with standard ORIF technique augmented with a temporary plate spanning across the elbow as an internal fixator. Cases included were either very distal, comminuted (6 cases) or insufficiency fractures (4 cases) or revision fixation cases (8 cases). The temporary spanning plate was removed as soon as signs of early radiographic union were detected. RESULTS Seventeen patients were available for final follow up at a mean 28.3 months. The spanning plate was removed after 3.4 months on average. At the final follow-up, the mean elbow total arc of motion was 86.3°. The mean Mayo Elbow Performance Score (MEPS) was 80, and the mean Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score was 27. CONCLUSION Spanning the elbow temporarily with a plate in adjunct to standard ORIF technique is both simple and effective in achieving fracture stability and union and minimizes failure rates after fixation of comminuted, very distal fractures, osteoporotic cases, or revision fixation cases with bone loss. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
| | - Mostafa Mahmoud
- Kasr El-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Lymona
- Kasr El-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Afifi
- Kasr El-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mostafa Ezzat
- Kasr El-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Russo R, Guastafierro A, Della Rotonda G, Viglione S, Ciccarelli M, Fiorentino F, Minopoli P, Mortellaro M, Pietroluongo LR, Langella F. Osteochondral allograft transplantation for complex distal humeral fractures assisted by 3D computer planning and printing technology: technical note. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1443-1450. [PMID: 34524509 DOI: 10.1007/s00590-021-03118-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The surgical treatment of comminuted distal humeral articular fractures (DHF) is challenging and is jeopardized by the high rate of complications. The study aims to describe the application of osteochondral allograft (OCA) transplantation for the treatment of complex DHF assisted with a 3D printed specific instrumentation. METHODS Retrospective study. Inclusion criteria were the presence of an articular multi-fragmented DHF treated with frozen OCA. Clinical, self-reported and radiographic outcomes were collected every 6 months. CT were performed at 2 years FU. RESULTS Four patients were included. At a mean follow-up of 37.3 months (24-49) MEPS, DASH and VAS were 90 (80-100), 11.8 (0-25) and 1 (0-3) points, respectively. Not significant complication or reoperation was recorded. Graft healing was observed in 3 cases. In all cases, we observed arthritic progression after 2 years of follow-up. CONCLUSION OCA transplantation can be considered a reliable and safe procedure in patients affected by a complex DHF. LEVEL OF EVIDENCE Level V. Technical Notes.
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Affiliation(s)
- Raffaele Russo
- Second Orthopaedic and Traumatology Unit, Pineta Grande Hospital, Caserta, Italy
| | - Antonio Guastafierro
- Second Orthopaedic and Traumatology Unit, Pineta Grande Hospital, Caserta, Italy
| | | | - Stefano Viglione
- Second Orthopaedic and Traumatology Unit, Pineta Grande Hospital, Caserta, Italy
| | - Michele Ciccarelli
- Second Orthopaedic and Traumatology Unit, Pineta Grande Hospital, Caserta, Italy
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Surgical Elbow Dislocation Approach to the Distal Humerus for Apparent Capitellar and Lateral Condyle Fractures in Adults. J Orthop Trauma 2021; 35:e77-e81. [PMID: 33105453 DOI: 10.1097/bot.0000000000001923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Access to fractures of the distal humeral capitellum, trochlea, and lateral condyle is difficult through traditional approaches due to limited anterior articular exposure for direct reduction and fixation. The purpose of this study is to evaluate the relative articular exposure of a surgical dislocation (SD) approach to the distal humerus compared with olecranon osteotomy (OO). METHODS Eight paired elbows from 4 cadavers underwent either SD or OO approach. Methylene blue staining demarcated visualized articular surface before disarticulation of the elbows. The main outcome measures were average visualized total distal humeral articular surface and anterior and posterior surface, and capitellar surface relative to the total surfaces was compared for each surgical approach using unpaired parametric t-tests. RESULTS Intraclass correlation between raters was 0.995. The median exposed articular surface for SD and OO approaches was 90.0% and 62.8%, respectively. The overall exposure was significantly greater for the dislocation technique (P = 0.0003). With respect to specific regions of the distal humeral articular surface, SD allowed significantly greater visualization of the anterior surface (95.9% vs. 48.9%, P < 0.0001) and capitellum (100% vs. 40.4%, P < 0.0001). CONCLUSION The surgical elbow dislocation approach to the distal humerus permits near total exposure of the anterior articular surface and the entire capitellum. Our data support this approach for anterior articular fractures of the distal humerus, to include those fractures that extend to the medial surface of the trochlea.
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Abstract
Background Distal humerus fracture open reduction and internal fixation (ORIF) represents a substantial cost burden to the health care system. The purpose of this study was to describe surgical encounter cost variation for distal humerus ORIF, and to determine demographic-, injury-, and treatment-specific factors that influence cost. Methods We retrospectively identified adult patients (≥18 years) treated for isolated distal humerus fractures between July 2014 and July 2019 at a single tertiary academic referral center. For each case, surgical encounter total direct costs (SETDCs) were obtained via our institution's information technology value tools, which prospectively record granular direct cost data for every health care encounter. Costs were converted to 2019 dollars using the personal consumption expenditure indices for health and summarized with descriptive statistics. Univariate and multivariate linear regression models were used to identify factors influencing SETDC. Results Surgical costs varied widely for the 47 included patients, with a standard deviation (SD) of 33% and interquartile range of 76%-124% relative to the mean SETDC. Implant and facility costs were responsible for 46.2% and 32.6% of the SETDC, respectively. Implant costs also varied considerably, with an SD of 21% and range from 13%-36% relative to the mean SETDC. Multivariate analysis demonstrated that SETDC increased 24% (P < .001) on performing an olecranon osteotomy, and by 15% for each additional 1 hour of surgical time (P < .001). These findings were independent of age, sex, body mass index, open fracture, need for an additional small plate construct as a reduction aid, and fracture pattern (all insignificant in the multivariate analysis, with P >.05 for each factor). Conclusion Substantial variations in surgical encounter total direct costs for distal humerus ORIF exist, as do wide variations in associated implant costs that comprise nearly half of the entire surgical cost. Performing an olecranon osteotomy, and increased surgical time, significantly increased surgical costs. Although use of an olecranon osteotomy may not be a completely controllable factor as it is confounded by fracture severity and operative time, this may suggest that surgeons should try to use an olecranon osteotomy judiciously. Although complexity of the fracture pattern was statistically insignificant, it is confounded by the need for an olecranon osteotomy and increased surgical time and likely is a clinically relevant and nonmodifiable driver of surgical cost. These findings highlight opportunities to reduce cost variation, and potentially improve the value of care, for distal humerus ORIF patients.
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Lemsanni M, Chafik R, Madhar M, Elhaoury H, Najeb Y. [Sub- and intercondylar fractures of the distal humerus in adults]. Pan Afr Med J 2020; 36:346. [PMID: 33224412 PMCID: PMC7664147 DOI: 10.11604/pamj.2020.36.346.24516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction les fractures articulaires complètes de l’extrémité inférieure de l’humérus de l’adulte sont des lésions rares et graves. Les options thérapeutiques sont nombreuses mais le traitement chirurgical par ostéosynthèse est ardemment défendu. L’objectif de notre travail a été de décrire les caractéristiques épidémiologiques, clinico-radiologiques et thérapeutiques de ces fractures, ainsi que d’évaluer les résultats fonctionnels obtenus chez nos patients. Méthodes nous avons mené une étude prospective sur une période de 3 ans, portant sur 38 patients admis pour fracture articulaire complète sus et inter-condylienne de l’humérus distal (classée type C selon la classification de l’AO), traités chirurgicalement par voie postérieure trans-olécranienne avec un recul moyen de 34 mois. Résultats nous avons remarqué une distribution bimodale avec une atteinte du sujet jeune de sexe masculin d’une part, et une survenue chez les femmes âgées d’autre part. Les étiologies étaient dominées par les accidents de la voie publique chez 78%. Lors du suivi, nous avons noté un seul cas d’infection superficielle du site opératoire et il n’y a eu aucun cas de démontage du matériel ni de pseudarthrose. De surcroit, aucune complication de l’ostéosynthèse de l’olécrane n’a été enregistrée. Les résultats fonctionnels ont été très satisfaisants avec un score de Mayo-Clinic Elbow Performance Score (MEPS) moyen de 86. Conclusion nous considérons que la voie postérieure trans-olécranienne semble être la meilleure voie d’abord de ces fractures puisqu’elle permet une bonne exposition articulaire, condition sine qua non pour une restitution anatomique parfaite et une ostéosynthèse stable afin d’entreprendre une rééducation précoce et adaptée.
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Affiliation(s)
- Meryem Lemsanni
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Ibn Tofail, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Maroc
| | - Rachid Chafik
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Ibn Tofail, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Maroc
| | - Mohamed Madhar
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Ibn Tofail, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Maroc
| | - Hanane Elhaoury
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Ibn Tofail, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Maroc
| | - Youssef Najeb
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Ibn Tofail, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Maroc
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Shah NV, Hayes WT, Wang H, Hordines JC, Karakostas JE, Paxinos O, Koehler SM. A pilot biomechanical study comparing a novel, intramedullary Nail/Plate construct to standard Dual-Plate fixation of intra-articular C2.3 distal humerus fractures. Injury 2020; 51:2148-2157. [PMID: 32605784 DOI: 10.1016/j.injury.2020.06.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The gold-standard treatment for intra-articular distal humerus fractures (DHFs) is dual-plate/dual-column fixation, though optimal orientation is not yet established. With a superior method not yet identified, we propose a load-sharing construct, combining absolute stability (extramedullary plate fixation) for distal articular fragments and relative stability (load-sharing intramedullary nail) for the metaphyseal segment. The purpose of this pilot study was to evaluate the biomechanical performance of a novel implant compared to orthogonal dual-plating. MATERIALS AND METHODS Ten fresh-frozen matched-pairs of human cadaveric upper extremities with no prior elbow pathology/surgery were used. Pairs were randomized into two groups: Dual-Plate (medial and posterolateral) or novel Nail/Plate (cross-locked medial nail and posterolateral plate). AO/ASIF type 13-C2.3 multifragmentary fractures with simulated metaphyseal comminution. Biomechanical testing included stiffness (MPa) and load to failure (Newtons) in axial (100 cycles at 3 Hz at 20 N increments from 20 to 100 N) and coronal (varus/valgus; 4,000 cycles from 50N-100 N at 3 Hz) planes. Failed specimens were not analyzed and mechanisms were identified. For all failures, mechanisms were identified and reviewed by three consultant surgeons for revision vs. immobilization, to attempt to recreate a real-world scenario. All outcomes were compared between groups. RESULTS During stiffness testing, zero Nail/Plate specimens failed, but two (20%) Dual-Plate specimens failed (mechanisms: fracture diastasis; bone collapse and intussusception into osteotomy, yielding articular congruency loss). For remaining samples, Nail/Plate (n = 10) coronal (varus/valgus) stiffness was comparable to Dual-Plate (n = 8) constructs (41.5 vs. 39.0 MPa, p = 0.440). Remaining Dual-Plate constructs had greater axial overall stiffness than Nail/Plate (118.3 ± 48.3 vs. 95.6 ± 34.7 MPa, p = 0.020). Failure loads were comparable between Nail/Plate and Dual-Plate constructs (1,327.8 vs. 1,032.4 N, p = 0.170). Individual nail yield strength ranged from 1,101.1-1,124.4 N (n = 2). In review of all failures, the most common overall mechanism was fracture/osteotomy site posterolateral plate bending. Revision recommendation rate was comparable between constructs (Nail/Plate, 22.2% vs. Dual-Plate, 44.4%, p>0.05). CONCLUSIONS The novel Nail/Plate construct demonstrated non-inferior coronal (varus/valgus) stiffness, despite producing lower axial stiffness than orthogonal dual-plating, potentially due to the load-sharing cross-locked design. Considering comparable biomechanical performance, with no failures and comparable recommendations for revision, this novel construct warrants further evaluation as an alternative to the gold-standard, dual-plate fixation method for intra-articular distal humerus fractures. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY 11203, USA
| | - Westley T Hayes
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY 11203, USA
| | - Hanbin Wang
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY 11203, USA
| | - John C Hordines
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY 11203, USA
| | - Jonathan E Karakostas
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY 11203, USA
| | - Odysseas Paxinos
- Orthopaedic Department, 251 Hellenic Air Force Hospital, Athens, Greece
| | - Steven M Koehler
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY 11203, 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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Wang X, Liu G. A comparison between perpendicular and parallel plating methods for distal humerus fractures: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e19602. [PMID: 32501964 PMCID: PMC7306383 DOI: 10.1097/md.0000000000019602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To compare the clinical outcomes of perpendicular and parallel plating for the treatment of distal humerus fractures. METHODS Two investigators independently searched PubMed, OVID, and ScienceDirect databases prior to April 2019, without any limitations on language or publication status. The outcomes were union time, range of motion of elbow, Mayo Elbow Performance Score, and postoperative complications. Two authors independently performed a methodological quality and risk of bias assessment using Cochrane collaboration's tool. Data analysis was performed with STATA version 13.0. RESULTS Six randomized controlled trials with 305 participants were included. The present meta-analysis indicated that orthogonal plating was associated with a longer union time compared with parallel plating. There were no significant differences between the 2 groups regarding Elbow function, Mayo Elbow Performance Score, operation time, reduction quality, or postoperative complications. CONCLUSION Both parallel plating and orthogonal plating are considered to be effective methods when treating distal humerus fractures. The results of this study found that parallel plating is superior to orthogonal plating in humerus fracture healing.
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Affiliation(s)
- Xiaohan Wang
- Department of Orthopedics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing
| | - Guoyan Liu
- Department of Orthopedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong, China
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Veeresh V, Bansal H, Dhiman A, Trikha V. Radial Nerve Palsy After Intercondylar Distal Humerus Fracture: A Case Report. JBJS Case Connect 2020; 10:e2000429. [PMID: 34047539 DOI: 10.2106/jbjs.cc.20.00429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 30-year-old man sustained an injury to the right elbow after a fall from a bike. On clinical examination, he had preoperative radial nerve palsy with radiological diagnosis of the intercondylar distal humerus fracture. Intraoperatively, the patient had the radial nerve entrapped between the proximal metaphyseal fragment and distal lateral condyle of the humerus. CONCLUSION Preoperative radial nerve palsy associated with the intercondylar distal humerus fracture is very rare. Fractures with the significant anterolateral displacement of the proximal metaphyseal fracture segment may entrap the course of the radial nerve in the anterior compartment of the distal humerus and thus manifest as radial nerve palsy.
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Affiliation(s)
- Vivek Veeresh
- 1Department of Orthopedics, JPNATC, AIIMS, New Delhi, India
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Hanlon DP, Mavrophilipos V. The Emergent Evaluation and Treatment of Elbow and Forearm Injuries. Emerg Med Clin North Am 2019; 38:81-102. [PMID: 31757256 DOI: 10.1016/j.emc.2019.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article provides an updated review of the emergent evalution and treatment of elbow and forearm injuries in the emergency department. Clinically necessary imaging is discussed. Common and uncommon injuries of the elbow and forearm are reviewed with an emphasis on early recognition, efficient management, and avoidance of complications. The astute emergency physician will rely on a focused history and precise examination, applied anatomic knowledge, and strong radiographic interpretative skills to avoid missed injuries and complications.
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Affiliation(s)
- Dennis P Hanlon
- Department of Emergency Medicine, Allegheny General Hospital, 320 E. North Avenue, Pittsburgh, PA 15212, USA.
| | - Vasilios Mavrophilipos
- Department of Emergency Medicine, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
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Phen HM, Schenker ML. Minimizing Posttraumatic Osteoarthritis After High-Energy Intra-Articular Fracture. Orthop Clin North Am 2019; 50:433-443. [PMID: 31466660 DOI: 10.1016/j.ocl.2019.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article serves to provide an overview of molecular and surgical interventions to minimize the progression of posttraumatic arthritis following high-energy intra-articular fractures. The roles of cartilage and the microcellular environment are discussed, as well as the response of the joint and cartilage to injury. Molecular therapies, such as glucocorticoids, mesenchymal stem cells, and bisphosphonates, are presented as potential treatments to prevent progression to posttraumatic arthritis. High-energy intra-articular fractures of the elbow, hip, knee, and ankle are discussed, with emphasis on restoring anatomic alignment, articular reduction, and stability of the joint.
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Affiliation(s)
- Huai Ming Phen
- Emory Orthopaedic Trauma & Fracture, 49 Jesse Hill Jr. Drive South East, 3rd Floor, Atlanta, GA 30303, USA.
| | - Mara L Schenker
- Emory Orthopaedic Trauma & Fracture, 49 Jesse Hill Jr. Drive South East, 3rd Floor, Atlanta, GA 30303, USA
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Plate-and-bone-strut fixation of distal third humeral shaft aseptic non-unions: A consecutive case series. J Clin Orthop Trauma 2019; 10:S127-S132. [PMID: 31695271 PMCID: PMC6823753 DOI: 10.1016/j.jcot.2019.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Non-union after humeral shaft fractures are seen frequently in clinical practice. The incidence is 2-10% after conservative management and up to 30% after surgical treatment. The purpose of this study is to evaluate the outcomes of plate-and-bone-strut-allograft technique with bone chip augmentation for aseptic non-unions of the distal third of the humerus. MATERIALS AND METHODS 26 consecutive cases were treated using a trans-triceps approach. The non-union was fixed with a 4.5 mm Locking Compression Plate combined with a strut bone allograft at the anterior part of the humerus and bone chips. All patients underwent the same rehabilitation protocol of 12 weeks. Clinical evaluation took place 12 months after surgery with the Mayo elbow score and Oxford elbow score. RESULTS Complete bone healing without complications was achieved in all 26 patients. The average period of radiographic union was 106 days. The average range of flexion-extension was 108° (94°-180°) and pro-supination was 159° (102°-180°). Twelve months after surgery, average Mayo elbow score was 86 (68-100) and the Oxford elbow score was 83 (52-100). CONCLUSION The plate-and-bone-strut-allograft technique with bone chip augmentation in distal humeral shaft for aseptic non-unions resulted in union of all cases. No adverse events related to the surgery or the materials used were documented.
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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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Zarezadeh A, Mamelson K, Thomas WC, Schoch BS, Wright TW, King JJ. Outcomes of distal humerus fractures: What are we measuring? Orthop Traumatol Surg Res 2018; 104:1253-1258. [PMID: 30352777 DOI: 10.1016/j.otsr.2018.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 08/03/2018] [Accepted: 08/23/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We evaluate the most common outcome measures used in distal humerus fracture studies in order to suggest standardization for future research. MATERIALS AND METHODS A systematic review identified articles assessing the outcomes of acute distal humerus fractures from 2006 to 2016 from PubMed and Web of Science databases. The inclusion criterion was studies reporting on the outcomes of treatment of acute distal humerus fractures. Review articles, meta-analyses, studies with<5 patients, technique articles, biomechanical studies, and those focusing on one complication/outcome were excluded. Patient demographics and all outcome measures were reviewed. Journal and demographic factors were then compared. RESULTS One-hundred-nine of 2158 articles met inclusion criteria. The median number of fractures per study was 35. Mean patient age was 55.0 years. Average follow-up was 35 months. Range-of-motion and strength measurements were reported in 90% and 17% of studies, respectively. Twenty patient-reported outcome instruments were used. The most commonly reported measures were MEPS, DASH, VAS pain, and Quick DASH scores. An average of 1.9 outcome measures were reported per study. A journal impact factor of≥1.5 was associated with more reported outcome measures. Articles including elbow arthroplasty were associated with higher impact factor journals, more outcome measures, and longer follow-up. Level of evidence was not associated with the number of reported outcome measures. DISCUSSION The current distal humerus fracture literature inconsistently reports outcome measures. More outcome measures were reported in higher impact journals. Future distal humerus fracture studies should include MEPS, DASH or Quick DASH, and VAS Pain scores to allow for appropriate cross-study comparison. LEVEL OF EVIDENCE IV, Systematic review.
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Affiliation(s)
- Ali Zarezadeh
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Kelly Mamelson
- College of Medicine, Florida State University, Tallahassee, FL, USA
| | - W Christian Thomas
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Bradley S Schoch
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.
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Faqih AI, Bedekar N, Shyam A, Sancheti P. Effects of muscle energy technique on pain, range of motion and function in patients with post-surgical elbow stiffness: A randomized controlled trial. Hong Kong Physiother J 2018; 39:25-33. [PMID: 31156315 PMCID: PMC6467834 DOI: 10.1142/s1013702519500033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 11/13/2017] [Indexed: 11/21/2022] Open
Abstract
Background: Elbow is a very functional joint. Elbow stiffness is a significant cause of disability hampering the function of the upper extremity as a whole. Muscle Energy Techniques (METs) are relatively pain-free techniques used in clinical practice for restricted range of motion (ROM). Objective: To study the effects of MET on pain, ROM and function given early in the rehabilitation in post-surgical elbow stiffness. Methods: An RCT was conducted on 30 patients post elbow fracture fixation. Group 1 was given MET immediately post removal of immobilization while Group 2 received MET 1 week later along with the rehabilitation protocol. Pain (Visual Analogue Scale), ROM (goniometry) and function (Disability of Arm, Shoulder and Hand questionnaire) were assessed pre and post 3 weeks. Results: Group 1 showed greater improvement than Group 2, mean flexion and extension change between groups being 11.7±2.8, 95%CI(5.9,17.4) and 8.5±2.0, 95%CI(4.4,12.7), respectively. VAS and DASH scores improved better in Group 1, mean change being 1.2±0.2, 95%CI(0.6,1.8) and 18.2±2.2, 95%CI(13.5,22.8) for VAS and DASH scores, respectively. Conclusion: MET can be used as an adjunct to the rehabilitation protocol to treat elbow stiffness and can be given safely in the early stages of post elbow fracture rehabilitation managed surgically with open reduction and rigid internal fixation.
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Affiliation(s)
- Anood I Faqih
- Sancheti Institute College of Physiotherapy Shivajinagar, Pune, India
| | - Nilima Bedekar
- Department of Musculoskeletal Physiotherapy Sancheti Institute College of Physiotherapy Shivajinagar, Pune, India
| | - Ashok Shyam
- Department of Academic Research Sancheti Institute for Orthopaedics and Rehabilitation Pune, India
| | - Parag Sancheti
- Sancheti Institute for Orthopaedics and Rehabilitation Pune, India
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Rollo G, Rotini R, Eygendaal D, Pichierri P, Bisaccia M, Prkic A, Stasi A, Meccariello L. Effect of trochleocapitellar index on adult patient-reported outcomes after noncomminuted intra-articular distal humeral fractures. J Shoulder Elbow Surg 2018; 27:1326-1332. [PMID: 29907373 DOI: 10.1016/j.jse.2018.02.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anatomic surgical reduction of intra-articular fractures of the distal humerus is important to achieve the best long-term outcomes and prevent post-traumatic arthritis. In this study we compared the radiographic reduction using the trochleocapitellar index. We also correlated the trochleocapitellar index to the functional outcomes next to the comparison of the triceps brachii lifting approach and olecranon osteotomy approach, 2 common approaches for distal humeral fractures. METHODS From January 2006 to June 2016, patients with elbow fractures were registered in 4 centers. The trochleocapitellar index, a ratio between the angle of the capitellum and the trochlea to the midline of the distal humerus on anterior-posterior radiographs, was calculated for included patients. Functional outcomes were measured using the Oxford Elbow Score and the Mayo Elbow Performance Score. Bone healing was measured using radiographic union scoring. RESULTS There were 86 patients enrolled: 46 in the olecranon osteotomy group and 40 in the triceps lifting group. Functional outcomes and bone healing did not differ between the approaches. Functional results had a medium correlation with the trochleocapitellar index, which did not differ between the 2 approaches (olecranon osteotomy group, κ = 0.56; triceps lifting group, κ = 0.57; P = .7932). CONCLUSIONS The trochleocapitellar index has a moderate predictive value on the functional results after 12 months after open reduction and internal fixation of intra-articular distal humeral factures. There is no difference in reduction, as measured by trochlear index and functional outcome scores, between the olecranon osteotomy approach and the triceps brachii lifting approach groups.
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Affiliation(s)
- Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Roberto Rotini
- Shoulder and Elbow Unit, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Denise Eygendaal
- Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands; Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Paolo Pichierri
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Michele Bisaccia
- Orthopaedics and Traumatology Unit, Department of Surgical and Biomedical Science, S.M. Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Ante Prkic
- Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Alessandro Stasi
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Luigi Meccariello
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
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Crönlein M, Lucke M, Beirer M, Pförringer D, Kirchhoff C, Biberthaler P, Braun KF, Siebenlist S. Polyaxial locking plates in treating distal humeral fractures: a comparative randomized trial for clinical outcome. BMC Musculoskelet Disord 2017; 18:547. [PMID: 29282027 PMCID: PMC5745613 DOI: 10.1186/s12891-017-1910-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 12/13/2017] [Indexed: 12/30/2022] Open
Abstract
Background Management of distal humeral fractures remains to be one of the most challenging aspects in trauma surgery. Low profile plating systems with variable angle screw fixation represent a crucial advancement to the established angular stable locking plates with considerable attention in current research. The aim of the prospective randomized trial was to review the preliminary results and patients’ outcome following treatment with these newly developed implants and to rule out potential differences in fracture treatment of two different plating systems. Methods Twenty patients with distal humeral fractures (AO 13-A1 – AO 13-C3) were included in the current study since 2014. After completing the randomization plan, patients were distributed into two groups for different variable angle locking plates (DePuy Synthes® VA-LCP vs. Medartis® Aptus Elbow). Functional elbow scoring (ROM, MEPS, QuickDASH) served as primary outcome parameter, while radiological fracture consolidation served as secondary outcome parameter. Follow-ups were conducted 6 weeks, 12 weeks, 6 months and 12 months after the operation. Results Seventeen of 20 patients (85%) concluded all follow-up examinations. Postoperative elbow extension deficiencies showed significant differences between the two groups in all follow-up examinations with a mean of Ø 18 +/− 7.4 degrees in the DePuy Synthes® VA-LCP group compared to a mean of Ø 6.5 +/− 7.5 degrees in the Medartis® Aptus Elbow group (p = 0.002) 12 months postoperatively. Functional scoring showed a disparate pattern. The Medartis® Aptus Elbow group achieved significantly better MEP scores during follow-up. However, the analysis of the QuickDash revealed better results of the DePuy Synthes® VA-LCP group in the first half and better results of the Medartis® Aptus Elbow group in the second half of the follow-up examination instead. Conclusions Considering the complexity of distal humeral fractures, the usage of anatomically preshaped low profile variable angle locking plates for operative treatment leads to good clinical results. Even though there might be some advances of the Medartis® Aptus Elbow plating system concerning postoperative ROM and elbow function, a consistent difference in the overall clinical outcome between the two plating systems could not be detected. Trial registration https://clinicaltrials.gov/ct2/show/NCT03272490 Retrospectively Registered 1. September 2017.
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Affiliation(s)
- Moritz Crönlein
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Martin Lucke
- Department of Trauma Surgery, Chirurgisches Klinikum München Süd, Am Isarkanal 30, 81379, Munich, Germany
| | - Marc Beirer
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Dominik Pförringer
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Karl F Braun
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany. .,Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
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Zhang J, Lin X, Zhong Z, Wu C, Tan L. [Effectiveness comparison of suspension fixation plus hinged external fixator and double plate internal fixation in treatment of type C humeral intercondylar fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:778-784. [PMID: 29798519 DOI: 10.7507/1002-1892.201612123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the effectiveness of suspension fixation plus hinged external fixator with double plate internal fixation in the treatment of type C humeral intercondylar fractures. Methods Between January 2014 and April 2016, 30 patients with type C (Association for the Study of Internal Fixation, AO/ASIF) humeral intercondylar fractures were treated. Kirschner wire suspension fixation plus hinged external fixator was used in 14 cases (group A), and double plate internal fixation in 16 cases (group B). There was no significant difference in gender, age, injury cause, disease duration, injury side, and type of fracture between 2 groups ( P>0.05). Results There was no significant difference in operation time and hospitalization stay between 2 groups ( P>0.05). But the intraoperative blood loss in group A was significantly less than that in group B ( P<0.05); the visual analogue scale (VAS) score at 1 day and 3 days after operation in group A were significantly less than those in group B ( P<0.05). Primary healing of incision was obtained in all patients of 2 groups, and no surgery-related complications occurred. The patients were followed up 6-24 months (mean, 12.3 months) in group A and 6-24 months (mean, 12.8 months) in group B. The self-evaluation satisfaction rate was 85.7% (12/14) in group A and was 81.2% (13/16) in group B at 3 months after operation, showing no significant difference ( χ2=0.055, P=0.990). Based on the improved Gassebaum elbow performance score at 6 months after operation, excellent and good rate of the elbow function was 78.6% (excellent in 5 cases, good in 6 cases, fair in 2 cases, and poor in 1 case) in group A and was 81.2% (excellent in 6 cases, good in 7 cases, fair in 2 cases, and poor in 1 case) in group B, showing no significant difference between 2 groups ( χ2=0.056, P=0.990). Heterotopic ossification occurred at 3 months after operation in 1 case of each group respectively. The X-ray films showed bony union in all cases; no loosening or breakage of screw was observed. The bone union time showed no significant difference between 2 groups ( t=-0.028, P=0.978). The time of internal fixation removal, the intraoperative blood loss, and VAS score at 1 day and 3 days after operation in group A were significant better than those in group B ( P<0.05). Conclusion The suspension fixation plus hinged external fixator and double plate internal fixation for the treatment of type C humeral intercondylar fractures have ideal outcome in elbow function. But the suspension fixation plus hinged external fixator is better than double plate internal fixation in intraoperative blood loss, postoperative VAS score, and time of internal fixation removal.
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Affiliation(s)
- Jian Zhang
- NO.1 Department of Orthopaedics, the Fourth People's Hospital of Zigong, Zigong Sichuan, 643000, P.R.China
| | - Xu Lin
- NO.1 Department of Orthopaedics, the Fourth People's Hospital of Zigong, Zigong Sichuan, 643000,
| | - Zeli Zhong
- NO.1 Department of Orthopaedics, the Fourth People's Hospital of Zigong, Zigong Sichuan, 643000, P.R.China
| | - Chao Wu
- NO.1 Department of Orthopaedics, the Fourth People's Hospital of Zigong, Zigong Sichuan, 643000, P.R.China
| | - Lun Tan
- NO.1 Department of Orthopaedics, the Fourth People's Hospital of Zigong, Zigong Sichuan, 643000, P.R.China
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Rangarajan R, Papandrea RF, Cil A. Distal Humeral Hemiarthroplasty Versus Total Elbow Arthroplasty for Acute Distal Humeral Fractures. Orthopedics 2017; 40:13-23. [PMID: 28375524 DOI: 10.3928/01477447-20161227-02] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
For acute distal humeral fractures not amenable to open reduction and internal fixation, total elbow arthroplasty has become an established alternative. However, lifelong activity restrictions designed to prevent early mechanical failure make this a poor option for some patients. This has led to a renewed interest in distal humeral hemiarthroplasty. Using modern implants and techniques, distal humeral hemiarthroplasty has shown outcomes comparable to those of total elbow arthroplasty at short- to mid-term follow-up, with an overall higher but different complication rate. Long-term data are needed, but the available literature suggests that distal humeral hemiarthroplasty be considered as another option on the treatment spectrum in select patient populations. [Orthopedics. 2017; 40(1):13-23.].
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