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Daneshvar P, Gee A, Brzozowski P, Schemitsch EH, Rasoulinejad P, Zdero R. Biomechanics of plate fixation following traditional olecranon osteotomy versus novel proximal ulna osteotomy for visualizing a distal humerus injury. Proc Inst Mech Eng H 2023; 237:1052-1060. [PMID: 37485996 DOI: 10.1177/09544119231189108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
After a distal humeral injury, olecranon osteotomy (OO) is a traditional way to visualize the distal humerus for performing fracture fixation. In contrast, the current authors previously showed that novel proximal ulna osteotomy (PUO) allows better access to the distal humerus without ligamentous compromise. Therefore, this study biomechanically compared plating repair following OO versus PUO. The left or right ulna from eight matched pairs of human cadaveric elbows were randomly assigned to receive OO or PUO and repaired using pre-contoured titanium plates. Destructive and non-destructive mechanical tests were performed to assess stability. Mechanical tests on OO versus PUO groups yielded average results for ulna cantilever bending stiffness at a 90° elbow angle (29.6 vs 30.5 N/mm, p = 0.742), triceps tendon pull stiffness at a 90° elbow angle (28.2 vs 24.4 N/mm, p = 0.051), triceps tendon pull stiffness at a 110° elbow angle (61.9 vs 59.5 N/mm, p = 0.640), and triceps tendon pull failure load at a 110° elbow angle (1070.1 vs 1359.7 N, p = 0.078). OO and PUO elbows had similar failure mechanisms, namely, tendon tear or avulsion from the ulna with or without some fracture of the proximal bone fragment, or complete avulsion of the proximal bone fragment from the plate. The similar biomechanical stability (i.e., no statistical difference for 4 of 4 mechanical measurements) and failure mechanisms of OO and PUO plated elbows support the clinical use of PUO as a possible alternative to OO for visualizing the distal humerus.
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Affiliation(s)
- Parham Daneshvar
- Department of Surgery, Division of Orthopaedic Surgery, Queen's University, Kingston, Canada
| | - Aaron Gee
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, Canada
| | | | - Emil H Schemitsch
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, Canada
- Department of Surgery, Division of Orthopaedic Surgery, Western University, London, Canada
| | - Parham Rasoulinejad
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, Canada
- Department of Surgery, Division of Orthopaedic Surgery, Western University, London, Canada
| | - Radovan Zdero
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, Canada
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Giordano V, Glória RC, Dos Santos TA, Koch HA, Giannoudis PV. Extra-articular Olecranon Osteotomy for Reconstruction of Distal Humerus Fractures: Technique and Clinical Results. Orthopedics 2022; 45:e220-e225. [PMID: 35245137 DOI: 10.3928/01477447-20220225-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Articular fractures of the distal humerus in adults are challenging fractures requiring adequate surgical exposure for optimum reconstruction. Most commonly, an articular osteotomy of the olecranon is performed, but complications have been reported related to both creating and repairing the articular osteotomy. We describe the use of an extra-articular olecranon osteotomy for approaching articular fractures of the distal humerus. We highlight the surgical steps required to obtain adequate exposure facilitating anatomical reduction, stable fixation, and early range of motion of the elbow joint. This technique can be added to the surgeon's armamentarium for the management of these complex injuries. [Orthopedics. 2022;45(4):e220-e225.].
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Daneshvar P, Gee A, Schemitsch EH, Pike J, Huang A, Jarvie G, Zdero R, Rasoulinejad P. Proximal Ulna Osteotomy for Complex Fractures of the Distal Humerus: A 3-Dimensional Laser Analysis and Comparison With Olecranon Osteotomy. J Hand Surg Am 2022; 47:320-328. [PMID: 35082086 DOI: 10.1016/j.jhsa.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/21/2021] [Accepted: 11/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The current methods of distal humerus (DH) articular surface visualization only allow a limited view of the joint. This study describes an osteotomy procedure that increases the visualization of and access to the DH articular surface for fixation without compromising ligaments. METHODS Eighteen fresh-frozen human elbows (9 matched pairs) underwent proximal ulna osteotomy (PUO) or transverse olecranon osteotomy (OO) contralaterally. The visualized articular surface of the DH was demarcated, and the surface areas of the DH, capitellum, and trochlea were measured using 3-dimensional scanning. The angular arc of the articular surface of the capitellum and trochlea was measured using a goniometer. RESULTS The 3-dimensional scans showed that 87.6% of the total DH surface area was visualized using PUO versus 65.6% using OO. When the trochlea and capitellum surface areas were separated, 94.0% versus 75.9% of the trochlea and 74.8% versus 44.7% of the capitellum were visualized using PUO and OO, respectively. The goniometric angles demonstrated that 98.2% versus 70.9% of the trochlea and 75.1% versus 43.5% of the capitellum articular surface arc angles were visualized using PUO and OO, respectively. After PUO with further release of the flexor-pronator mass was performed, 100% of the DH articular surface was visualized. CONCLUSIONS Proximal ulnar osteotomy improves the visualization of the DH articular surface. CLINICAL RELEVANCE Proximal ulna osteotomy spares ligaments, avoids osteotomizing the greater sigmoid notch, involves more robust metaphyseal bone for potentially better fixation, and may permit DH arthroplasty without compromising primary ligamentous elbow stabilizers. Further clinical studies are needed to assess the utility of this type of osteotomy.
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Affiliation(s)
- Parham Daneshvar
- Kingston Health Sciences Centre, Kingston General Hospital Site, Kingston, Canada; Department of Surgery, Queen's University, Kingston, Canada; St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
| | - Aaron Gee
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, Canada
| | - Emil H Schemitsch
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, Canada; Department of Surgery, Division of Orthopaedic Surgery, Western University, London, Canada
| | - Jeff Pike
- St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Adrian Huang
- St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Geoff Jarvie
- St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Radovan Zdero
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, Canada; Department of Surgery, Division of Orthopaedic Surgery, Western University, London, Canada; Department of Mechanical and Materials Engineering, Western University, London, Canada
| | - Parham Rasoulinejad
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, Canada; Department of Surgery, Division of Orthopaedic Surgery, Western University, London, Canada
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Hess S, Bürki A, Moor BK, Bolliger L, Zysset P, Zumstein MA. A biomechanical study comparing the mean load to failure of two different osteosynthesis techniques for step-cut olecranon osteotomy. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:414-420. [PMID: 37588712 PMCID: PMC10426472 DOI: 10.1016/j.xrrt.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Olecranon osteotomies are frequently used to expose distal humeral intraarticular fractures. The step-cut olecranon osteotomy (SCOOT) is an augmented version of the oblique olecranon osteotomy, which has recently been evaluated biomechanically with tension band wiring (TBW) fixation. However, complications with TBW are common. In this study, we, therefore, compared the mean load to failure of TBW with compression screws for SCOOT fixation. We hypothesized a higher load to failure for the compression screw group. Methods We performed a SCOOT on 36 Sawbones. Eighteen were fixed with TBW, and another 18 with two compression screws. The humeroulnar joint was simulated using an established test setup, which allows the application of triceps traction force through a tendon model to the ulna, while the humeroulnar joint is in a fixed position. Eight models of each fixation group were tested at 20°, and eight at 70° of flexion by isometrical loading until failure, which was defined as either a complete fracture or gap formation of more than 2 mm at the osteotomy site. Results At 20° of flexion, mean load to failure was similar between the TBW group (1360 ± 238 N) and the compression screw group (1401 ± 261 N) (P = .88). Also, at 70° of flexion, the mean load to failure was similar between the TBW group (1398 ± 215 N) and the compression screw group (1614 ± 427 N) (P = .28). Conclusions SCOOTs fixed with TBW and compression screws showed similar loads to failure. A SCOOT fixed with compression screws might be a valuable alternative for surgeons when treating intraarticular distal humeral fractures. However, future in vivo studies are necessary to confirm our results in a clinical setting.
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Affiliation(s)
- Silvan Hess
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern Switzerland
| | | | - Beat K. Moor
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern Switzerland
| | - Lilianna Bolliger
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern Switzerland
| | | | - Matthias A. Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopaedics Sonnenhof, Bern, Switzerland
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Shahriar Kamrani R, Nezameslami A, Shamabadi A, Oryadi Zanjani L. Outcomes of olecranon osteotomy for treatment of distal humerus fractures and nonunions: A report of the 15-year experience. Sci Sports 2021. [DOI: 10.1016/j.scispo.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hoelscher-Doht S, Kladny AM, Paul MM, Eden L, Buesse M, Meffert RH. Low-profile double plating versus dorsal LCP in stabilization of the olecranon fractures. Arch Orthop Trauma Surg 2021; 141:245-251. [PMID: 32417960 PMCID: PMC7886832 DOI: 10.1007/s00402-020-03473-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Proximal ulna fractures are common in orthopaedic surgery. Comminuted fractures require a high primary stability by the osteosynthesis, to allow an early functional rehabilitation as fast as possible, to reduce long-term limitations of range of motion. Classical dorsal plating is related to wound healing problems due to the prominence of the implant. New low-profile double plates are available addressing the soft tissue problems by positioning the plates at the medial and lateral side. This study analysed whether, under high loading conditions, these new double plates provide an equivalent stability as compared to the rigid olecranon locking compression plate (LCP). MATERIALS AND METHODS In Sawbones, Mayo Type IIB fractures were simulated and stabilized by plate osteosyntheses: In group one, two low-profile plates were placed. In group two, a single dorsal plate (LCP) was used. The bones was than cyclically loaded simulating flexion grades of 0°, 30°, 60° and 90° of the elbow joint with increasing tension forces (150 , 150 , 300 and 500 N). The displacement and fracture gap movement were recorded. In the end, in load-to-failure tests, load at failure and mode of failure were determined. RESULTS No significant differences were found for the displacement and fracture gap widening during cyclic loading. Under maximum loading, the double plates revealed a comparable load at failure like the single dorsal plate (LCP). The double plates failed with a proximal screw pull-out of the plate, whereas in the LCP group, in 10 out of 12 specimens the mode of failure was a diaphyseal shaft fracture at the distal plate peak. CONCLUSION Biomechanically, the double plates are a good alternative to the dorsal LCP providing a high stability under high loading conditions and, at the same, time reducing the soft tissue irritation by a lateral plate position.
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Affiliation(s)
- Stefanie Hoelscher-Doht
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany.
| | - A-M Kladny
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany
| | - M M Paul
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany
| | - L Eden
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany
| | - M Buesse
- Institut Straumann AG, Peter-Merian-Weg 12, 4052, Basel, Switzerland
| | - R H Meffert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany
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Zumstein MA, Raniga S, Flueckiger R, Campana L, Moor BK. Triceps-sparing extra-articular step-cut olecranon osteotomy for distal humeral fractures: an anatomic study. J Shoulder Elbow Surg 2017; 26:1620-1628. [PMID: 28479258 DOI: 10.1016/j.jse.2017.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/14/2017] [Accepted: 03/01/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND This anatomic study investigated the distal humeral articular surface exposure achievable through a triceps-sparing oblique extra-articular osteotomy of the olecranon with a step-cut modification compared with the anconeus flap transolecranon apex distal chevron osteotomy. In addition, the bone contact surface areas of the osteotomized surfaces after transolecranon and extra-articular osteotomies were compared. METHODS Seven pairs of fresh adult cadaveric elbow joints were examined. Each of the right elbows underwent triceps-sparing extra-articular step-cut olecranon osteotomy (SCOOT) with an anconeus flap, and the left elbows underwent the anconeus flap transolecranon apex distal chevron osteotomies (CO). The articular surface exposed by each of the osteotomy techniques was then digitally analyzed using a 3-dimensional measurement system. The bone contact surface area of the osteotomized surfaces was also assessed. RESULTS The percentage of total joint exposed by the SCOOT group was less than the CO group (SCOOT: 64% ± 3% vs. CO: 73% ± 3%; P = .002). There was significantly greater bone contact surface area of the osteotomized surfaces in the SCOOT group compared with the CO group (SCOOT: 1172 ± 251 mm2 vs. CO: 457 ± 133 mm2; P = .002). CONCLUSION The triceps SCOOT procedure with an anconeus flap provides excellent distal humeral articular surface exposure with the added benefit of a substantially increased (2.6-times) bone contact surface area of the osteotomized surfaces.
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Affiliation(s)
- Matthias A Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland.
| | - Sumit Raniga
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Remy Flueckiger
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Lorenzo Campana
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Beat K Moor
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland
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