Validation of a Practical Forearm Supination Strength Measurement Technique in the Large Sample Cohort

Distal biceps tendon repair: outcome and complications with single incision anchor fixation

PURPOSE

The purpose of this study is to evaluate the functional outcome and quality of life in distal biceps tendon repair with single incision technique and anchor fixation method.

METHODS

A retrospective cohort study was made of patients with complete distal biceps tendon rupture. The chosen repair method was single incision technique with anchor fixation. The outcome was assessed with functional testing of the elbow with strength and ROM. Additionally Mayo elbow performance index, Oxford elbow score, Disability arm hand shoulder questionnaire and patient rated elbow evaluation scores were used to evaluate quality of life.

RESULTS

Of the 28 patients, the average strength in flexion and supination was decreased with 91% and 89% of the strength compared to the non-injured arm. ROM was preserved in flexion, extension, supination and pronation. The mean scores for quality of life evaluation were MEPS = 96 ± 7.8, OES = 46.8 ± 1.9, DASH = 1.0 ± 1.9 and PREE = 2.0 ± 3.6. LABCN injury was the most common temporary complication with 30% followed by pain with 23%. Two patients were identified with HO and 1 patient was identified with median nerve injury. There were no cases of radioulnar synostosis and PIN injury.

CONCLUSION

Overall strength in flexion and supination were slightly decreased with preserved ROM. Patients reported nearly perfect quality of life as demonstrated with the scores. The complications rate was high with mainly minor complications. Distal biceps tendon repair with single incision technique and anchor fixation overall leads to a very satisfying outcome.

Novel Radiographic Indexes for Elbow Stability Assessment: Part A-Cadaveric Validation

INTRODUCTION

Elbow bony stability relies primarily on the high anatomic congruency between the humeral trochlea and the ulnar greater sigmoid notch. No practical tools are available to distinguish different morphotypes of the proximal ulna and herewith predict elbow stability. The aim of this study was to assess inter-observer reproducibility, evaluate diagnostic performance and determine responsiveness to change after simulated coronoid process fracture for three novel elbow radiographic indexes.

METHODS

Ten fresh-frozen cadaver specimens of upper limbs from human donors were available for this study. Three primary indexes were defined, as well as two derived angles: Trochlear Depth Index (TDI); Posterior Coverage Index (PCI); Anterior Coverage Index (ACI); radiographic coverage angle (RCA); olecranon-diaphisary angle (ODA). Each index was first measured on standardized lateral radiographs and subsequently by direct measurement after open dissection. Finally, a type II coronoid fracture (Regan and Morrey classification) was created on each specimen and both radiographic and open measurements were repeated. All measurements were conducted by two orthopaedic surgeons and two dedicated musculoskeletal radiologists.

RESULTS

All three indexes showed good or moderate inter-observer reliability and moderate accuracy and precision when compared to the gold standard (open measurement). A significant change between the radiographic TDI and ACI before and after simulated coronoid fracture was observed [TDI: decrease from 0.45 ± 0.03 to 0.39 ± 0.08 (p = 0.035); ACI: decrease from 1.90 ± 0.17 to 1.58 ± 0.21 (p = 0.001)]. As expected, no significant changes were documented for the PCI. Based on these data, a predictive model was generated, able to identify coronoid fractures with a sensitivity of 80% and a specificity of 100%.

CONCLUSION

New, simple and easily reproducible radiological indexes to describe the congruency of the greater sigmoid notch have been proposed. TDI and ACI change significantly after a simulated coronoid fracture, indicating a good responsiveness of these parameters to a pathological condition. Furthermore, combining TDI and ACI in a regression model equation allowed to identify simulated fractures with high sensitivity and specificity. The newly proposed indexes are, therefore, promising tools to improve diagnostic accuracy of coronoid fractures and show potential to enhance perioperative diagnostic also in cases of elbow instability and stiffness.

LEVEL OF EVIDENCE

Basic science study.

CLINICAL RELEVANCE

The newly proposed indexes are promising tools to improve diagnostic accuracy of coronoid fractures as well as to enhance perioperative diagnostic for elbow instability and stiffness.

Novel Radiographic Indexes for Elbow Stability Assessment: Part B-Preliminary Clinical Study

INTRODUCTION

The coronoid process plays a key-role in preserving elbow stability. Currently, there are no radiographic indexes conceived to assess the intrinsic elbow stability and the joint congruency. The aim of this study is to present new radiological parameters, which will help assess the intrinsic stability of the ulnohumeral joint and to define normal values of these indexes in a normal, healthy population.

METHODS

Four independent observers (two orthopaedic surgeons and two radiologists) selected lateral view X-rays of subjects with no history of upper limb disease or surgery. The following radiographic indexes were defined: trochlear depth index (TDI); anterior coverage index (ACI); posterior coverage index (PCI); olecranon-coronoid angle (OCA); radiographic coverage angle (RCA). Inter-observer and intra-observer reproducibility were assessed for each index.

RESULTS

126 subjects were included. Standardized lateral elbow radiographs (62 left and 64 right elbows) were obtained and analysed. The mean TDI was 0.46 ± 0.06 (0.3-1.6), the mean ACI was 2.0 ± 0.2 (1.6-3.1) and the mean PCI was 1.3 ± 0.1 (1.0-1.9). The mean RCA was 179.6 ± 8.3° (normalized RCA: 49.9 ± 2.3%) and the mean OCA was 24.6 ± 3.7°. The indexes had a high-grade of inter-observer and intra-observer reliability for each of the four observers. Significantly higher values were found for males for TDI, ACI, PCI and RCA.

CONCLUSION

The novel radiological parameters described are simple, reliable and easily reproducible. These features make them a promising tool for radiographic evaluation both for orthopaedic surgeons and for radiologists in the emergency department setting or during outpatient services.

LEVEL OF EVIDENCE

Basic Science Study (Case Series).

CLINICAL RELEVANCE

The novel radiological parameters described are reliable, easily reproducible and become handy for orthopaedic surgeons as well as radiologists in daily clinical practice.