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Zhang C, Ma JT, Wang WS. Arthroscopic Medial Bi-portal Extra-articular Debridement for Recalcitrant Medial Epicondylitis. Arthrosc Tech 2024; 13:102876. [PMID: 38584625 PMCID: PMC10995642 DOI: 10.1016/j.eats.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/01/2023] [Indexed: 04/09/2024] Open
Abstract
Medial epicondylitis, or golfer's elbow, is characterized by pain and tenderness at the tendon insertion points of the pronator teres and flexor carpi radialis. Conservative treatment is sufficient for most patients, whereas surgical treatment is the best choice for intractable medial epicondylitis. With open surgery or arthroscopic surgery, good clinical results have been reported. However, there is still no consensus on which surgical technique is more ideal. We describe our technique of arthroscopic medial bi-portal extra-articular debridement, which is a safe and effective technique that allows more accurate debridement and maximum protection of the ulnar nerve while reducing surgical scars, relieving postoperative pain, reducing the probability of elbow infection and ankylosis, and shortening the recovery time.
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Affiliation(s)
- Chuan Zhang
- Shoulder and Elbow Surgery Center, Luoyang Orthopedic Hospital of Henan Province & Orthopedic Hospital of Henan Province, Zhengzhou, China
| | - Jiang-Tao Ma
- Shoulder and Elbow Surgery Center, Luoyang Orthopedic Hospital of Henan Province & Orthopedic Hospital of Henan Province, Zhengzhou, China
| | - Wen-Sheng Wang
- Shoulder and Elbow Surgery Center, Luoyang Orthopedic Hospital of Henan Province & Orthopedic Hospital of Henan Province, Zhengzhou, China
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Kwak JM, Kholinne E, Hwang SJ, Jeon IH. Arthroscopic assessment for lateral collateral ligament complex deficiency of the elbow: a cadaveric study. INTERNATIONAL ORTHOPAEDICS 2024; 48:143-150. [PMID: 38091075 DOI: 10.1007/s00264-023-06046-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 11/15/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE To evaluate whether elbow instability due to lateral collateral ligament complex injury can be assessed reliably through arthroscopy. METHODS Eight fresh human cadaveric elbows were placed in a simulated lateral decubitus position. The radiocapitellar joint (RCJ) gap and ulnohumeral joint (UHJ) gap (mm) were measured with different sizes of probes from the posterolateral viewing portal. The elbow was 90 degrees flexed with neutral forearm rotation for RCJ gap measurement and 30 degrees flexed with full supination for UHJ gap measurement. Sequential testing was performed from Stage 0 to Stage 3 (Stage 0: intact; Stage 1: the release of the anterior 1/3 LCL complex; Stage 2: the release of the anterior two thirds of the LCL complex; and Stage 3: the release of the entire LCL complex) on each specimen. The mean gap of RCJ and lateral UHJ was used for the comparison between stages with the intact elbow. RESULTS The mean RCJ gap distance in Stage 2 and Stage 3 was significantly increased compared to that in Stage 0 (Stage 0 vs. Stage 2: P = .008; Stage 0 vs. Stage 3: P = .010). The mean UHJ gap distance of Stage 1, Stage 2, and Stage 3 was significantly increased compared to that in Stage 0 (Stage 0 vs. Stage 1: P = 0.025; Stage 0 vs. Stage 2: P = .010; Stage 0 vs. Stage 3: P = .011). In contrast, the release of the anterior 1/3 of the LCL complex (Stage 1) was not significantly increased compared to the mean joint gap distance of RCJ (P = .157). CONCLUSION Arthroscopic measurement of joint gap widening in RCJ and UHJ is a reliable assessment method to detect LCL complex deficiency that involves the anterior two thirds or more.
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Affiliation(s)
- Jae-Man Kwak
- Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, College of Medicine, Eulji University, Uijeongbu, South Korea
| | - Erica Kholinne
- Faculty of Medicine, Universitas Trisakti, Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia
| | - Seung Jun Hwang
- Department of Anatomy, College of Medicine, Ulsan University, Seoul, Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, 88 Olympic-Ro 43 Gil Pungnap 2(I)-Dong, Songpa-Gu, Seoul, 05505, South Korea.
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Bhashyam AR, Chen N. Arthroscopic-Assisted Fracture Fixation About the Elbow. Hand Clin 2023; 39:587-595. [PMID: 37827611 DOI: 10.1016/j.hcl.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Arthroscopic-assisted fracture fixation can be used for some adult elbow fractures. In particular, for articular fractures of the anterior elbow (coronoid/capitellum), elbow arthroscopy can provide excellent visualization of fracture fragments using a less invasive surgical exposure. Meticulous adherence to safe techniques and utilization of specialized equipment can help maximize safety and facilitate reproducible surgical results.
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Affiliation(s)
- Abhiram R Bhashyam
- Department of Orthopaedic Surgery, Hand & Arm Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Neal Chen
- Department of Orthopaedic Surgery, Hand & Arm Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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de Klerk HH, Doornberg JN, Eygendaal D, Jupiter JB. The management of elbow trauma from a historical perspective. JSES Int 2023; 7:2553-2559. [PMID: 37969509 PMCID: PMC10638554 DOI: 10.1016/j.jseint.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The origins of contemporary orthopedics can be traced all the way back to antiquity. Despite the absence of modern imaging techniques, a few bright minds were able to lay the groundwork for understanding these fractures. This historical review will cover the process behind the various treatments for elbow fractures, such as splinting and casting, mobilization, amputation, fracture fixation, arthroplasty, and arthroscopy.
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Affiliation(s)
- Huub H. de Klerk
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands
| | - Job N. Doornberg
- Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Jesse B. Jupiter
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Haasters F, Helfen T, Böcker W, Mayr HO, Prall WC, Lenich A. The value of elbow arthroscopy in diagnosing and treatment of radial head fractures. BMC Musculoskelet Disord 2019; 20:343. [PMID: 31351457 PMCID: PMC6661091 DOI: 10.1186/s12891-019-2726-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 07/17/2019] [Indexed: 12/04/2022] Open
Abstract
Background Surgical treatment of radial head fractures is increasingly performed arthroscopically. These fractures often feature concomitant injuries to the elbow joint, which may be under-diagnosed in the radiological examinations. Little is known about the diagnostic value of arthroscopy, the treatment options that arise from arthroscopically assisted fracture fixation and clinical results. We hypothesized that arthroscopy can detect additional concomitant injuries and simultaneously expands the therapeutic options. Therefore aim of this study was to compare arthroscopic and radiologic findings, to assess the distinct arthroscopic procedures and to follow up on the clinical outcomes. Methods Twenty patients with radial head fractures were retrospectively included in two study centers. All patients underwent elbow arthroscopy due to at least one of the following suspected concomitant injuries: osteochondral lesions of the humeral capitellum, injuries of the collateral ligaments or loose joint bodies. Preoperative radiological findings were compared to arthroscopic findings. Afterwards, arthroscopic treatment options and clinical outcomes were assessed. Results Arthroscopic findings led to revision of the classified fracture type in 70% (p = 0.001) when compared to preoperative conventional radiographs (CR) and in 9% (p = 0.598) when compared to computed tomography (CT) or magnetic resonance imaging (MRI). Diagnosis of loose bodies was missed in 60% (p < 0.001) of the CR and in 18% (p = 0.269) of the CT/MRI scans. Osteochondral lesions were not identified in 94% (p < 0.001) of the CR and in 27% (p = 0.17) of the CT/MRI scans. Percutaneous screw fixation was performed in 65% and partial radial head resection in 10%. Arthroscopy revealed elbow instability in 35%, leading to lateral collateral ligament reconstruction. After a mean follow up of 41.4 ± 3.4 months functional outcome was excellent in all cases (DASH-Score 0.6 ± 0.8; MEPI-Score 98.5 ± 2.4; OES-Score 47.3 ± 1.1). Conclusions Elbow arthroscopy has a significant diagnostic value in radial head fractures when compared to standard radiological imaging. Although statistically not significant, arthroscopy also revealed concomitant injuries in patients that presented with an uneventful MRI/CT. Furthermore, all intraarticular findings could be treated arthroscopically allowing for excellent functional outcomes. Trial registration Institutional Review Board University of Munich (LMU), Trial Number 507–14.
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Affiliation(s)
- Florian Haasters
- Hospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU), Nussbaumstr. 20, 80336, Munich, Germany. .,Department of Knee, Hip and Shoulder Surgery, Schön Klinik Munich-Harlaching, Academic Teaching Hospital of the Paracelsus Private Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria.
| | - Tobias Helfen
- Hospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU), Nussbaumstr. 20, 80336, Munich, Germany
| | - Wolfgang Böcker
- Hospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU), Nussbaumstr. 20, 80336, Munich, Germany
| | - Hermann O Mayr
- Department of Orthopaedics and Traumatology, Freiburg University Hospital, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg im Breisgau, Germany
| | - Wolf Christian Prall
- Hospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU), Nussbaumstr. 20, 80336, Munich, Germany.,Department of Knee, Hip and Shoulder Surgery, Schön Klinik Munich-Harlaching, Academic Teaching Hospital of the Paracelsus Private Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria
| | - Andreas Lenich
- Department of Orthopedic Sports Medicine, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Heffernan JT, O'Brien MJ, Savoie FH. Arthroscopic Management of Elbow Fractures and Dislocations. OPER TECHN SPORT MED 2017. [DOI: 10.1053/j.otsm.2017.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Dei Giudici L, Faini A, Garro L, Tucciarone A, Gigante A. Arthroscopic management of articular and peri-articular fractures of the upper limb. EFORT Open Rev 2017; 1:325-331. [PMID: 28461964 PMCID: PMC5367527 DOI: 10.1302/2058-5241.1.160016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The management of articular fractures is always a matter of concern. Each articular fracture is different from the other, whatever the classification system used and the surgical or non-surgical indications employed by the surgeon. The main goals remain anatomical reduction, stable fixation, loose body removal and minimal invasiveness. Open procedures are a compromise. Unfortunately, it is not always possible to meet every treatment goal perfectly, since associated lesions can pass unnoticed or delay treatment, and even in a ‘best-case’ scenario there can be complications in the long term. In the last few decades, arthroscopic joint surgery has undergone an exponential evolution, expanding its application in the trauma field with the development of arthroscopic and arthroscopically-assisted reduction and internal fixation (ARIF) techniques. The main advantages are an accurate diagnosis of the fracture and associated soft-tissue involvement, the potential for concomitant treatments, anatomical reduction and minimal invasiveness. ARIF techniques have been applied to treat fractures affecting several joints: shoulder, elbow, wrist, hip, knee and ankle. The purpose of this paper is to provide a review of the most recent literature concerning arthroscopic and arthroscopically-assisted reduction and internal fixation for articular and peri-articular fractures of the upper limb, to analyse the results and suggest the best clinical applications. ARIF is an approach with excellent results in treating upper-limb articular and peri-articular fractures; it can be used in every joint and allows treatment of both the bony structure and soft-tissues. Post-operative outcomes are generally good or excellent. While under some circumstances ARIF is better than a conventional approach, the results are still beneficial due to the consistent range of movement recovery and shorter rehabilitation time. The main limitation of this technique is the steep learning curve, but investing in ARIF reduces intra-operative morbidity, surgical errors, operative times and costs.
Cite this article: Dei Giudici L, Faini A, Garro L, Tucciarone A, Gigante A. Arthroscopic management of articular and peri-articular fractures of the upper limb. EFORT Open Rev 2016;1:325-331. DOI: 10.1302/2058-5241.1.160016.
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Affiliation(s)
- Luca Dei Giudici
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Faini
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Garro
- II Orthopaedic Division, Istituto Chirurgico Ortopedico Traumatologico, ICOT, Latina, Italy
| | - Agostino Tucciarone
- II Orthopaedic Division, Istituto Chirurgico Ortopedico Traumatologico, ICOT, Latina, Italy
| | - Antonio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
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Abstract
Several types of elbow fractures are amenable to arthroscopic or arthroscopic-assisted fracture fixation, including fractures of the coronoid, radial head, lateral condyle, and capitellum. Other posttraumatic conditions may be treated arthroscopically, such as arthrofibrosis or delayed radial head excision. Arthroscopy can be used for assessment of stability or intra-articular fracture displacement. The safest portals are the midlateral (soft spot portal), proximal anteromedial, and proximal anterolateral. Although circumstances may vary according to the injury pattern, a proximal anteromedial portal is usually established first. Arthroscopy enables a less invasive surgical exposure that facilitates visualization of the fracture fragments in select scenarios.
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Affiliation(s)
- Leslie A Fink Barnes
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai Medical Center, 5 East 98th Street, Box 1188, New York, NY 10029, USA
| | - Bradford O Parsons
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai Medical Center, 5 East 98th Street, Box 1188, New York, NY 10029, USA.
| | - Michael Hausman
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai Medical Center, 5 East 98th Street, Box 1188, New York, NY 10029, USA
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Wegmann K, Burkhart KJ, Bingoel AS, Ries C, Neiss WF, Müller LP. Anatomic relations between the lateral collateral ligament and the radial head: implications for arthroscopic resection of the synovial fold of the elbow. Knee Surg Sports Traumatol Arthrosc 2015; 23:3421-5. [PMID: 25026927 DOI: 10.1007/s00167-014-3091-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 05/22/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to determine the anatomic relationship between the radial head and the lateral collateral ligament (LCL) and when the LCL would be at risk of iatrogenic injury during arthroscopic resection of the synovial fold. METHODS Thirty-four formalin-fixed upper extremities were dissected. A projection of the LCL onto the radial head was marked with a needle. The percentage of the posterior border of the radial head overlaid by the LCL was digitally measured. A portion of the projection of the LCL was statistically correlated with the overall diameter of the radial head. RESULTS The overall diameter of the radial head was 21.2 mm ± 2.3. The proportionate projection of the medial border of the LCL onto the radial head was 5.3 ± 1.6 mm on average. The lateral 25 % of the radial head was overlaid by the LCL with a maximum value of 40 % on average. The inter- and intraobserver reliability showed very good accordance with the digital measurements (r > 0.8). CONCLUSION Care must be taken when performing a resection in the lateral 40 % of the radial head, whereas resection in the medial 60 % of the radial head appears to be safe. The LCL is an important stabiliser of the elbow joint, a lesion of which by undeliberate arthroscopic dissection may lead to joint instability. Iatrogenic injury to the LCL presumably can be prevented when respecting the given data. LEVEL OF EVIDENCE Experimental study.
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Affiliation(s)
- Kilian Wegmann
- Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany.
| | - Klaus Josef Burkhart
- Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany.,Department for Shoulder Surgery, Rhön-Klinikum, Bad Neustadt, Germany
| | - Alperen Sabri Bingoel
- Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany
| | - Christian Ries
- Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany
| | | | - Lars Peter Müller
- Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany
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Inner Synovial Membrane Footprint of the Anterior Elbow Capsule: An Arthroscopic Boundary. ANATOMY RESEARCH INTERNATIONAL 2015; 2015:426974. [PMID: 26380112 PMCID: PMC4561978 DOI: 10.1155/2015/426974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 08/06/2015] [Indexed: 11/27/2022]
Abstract
Introduction. The purpose of this study is to describe the inner synovial membrane (SM) of the anterior elbow capsule, both qualitatively and quantitatively. Materials and Methods. Twenty-two cadaveric human elbows were dissected and the distal humerus and SM attachments were digitized using a digitizer. The transepicondylar line (TEL) was used as the primary descriptor of various landmarks. The distance between the medial epicondyle and medial SM edge, SM apex overlying the coronoid fossa, the central SM nadir, and the apex of the SM insertion overlying the radial fossa and distance from the lateral epicondyle to lateral SM edge along the TEL were measured and further analyzed. Gender and side-to-side statistical comparisons were calculated. Results. The mean age of the subjects was 80.4 years, with six male and five female cadavers. The SM had a distinctive double arched attachment overlying the radial and coronoid fossae. No gender-based or side-to-side quantitative differences were noted. In 18 out of 22 specimens (81.8%), an infolding extension of the SM was observed overlying the medial aspect of the trochlea. The SM did not coincide with the outer fibrous attachment in any specimen. Conclusion. The humeral footprint of the synovial membrane of the anterior elbow capsule is more complex and not as capacious as commonly understood from the current literature. The synovial membrane nadir between the two anterior fossae may help to explain and hence preempt technical difficulties, a reduction in working arthroscopic volume in inflammatory and posttraumatic pathologies. This knowledge should allow the surgeon to approach this aspect of the anterior elbow compartment space with the confidence that detachment of this synovial attachment, to create working space, does not equate to breaching the capsule. Alternatively, stripping the synovial attachment from the anterior humerus does not constitute an anterior capsular release.
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Simon P, Unterhauser F, von Roth P, Schmidmaier G, Winkler T. [Treatment of Mason type II radial head fractures by percutaneous reduction]. Unfallchirurg 2015; 117:341-7. [PMID: 23494162 DOI: 10.1007/s00113-012-2340-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The therapeutic algorithm for the treatment of Mason type II radial head fractures is still controversially discussed. This study describes the technique of percutaneous fracture reduction without additional internal fixation of the radial head as an alternative to open reduction and presents the results of the method. MATERIAL AND METHODS The data from 26 out of 30 patients with a Mason type II radial head fracture who had been consecutively treated with percutaneous fracture reduction were evaluated retrospectively. The analysis comprised the disabilities of shoulder and hand (DASH) score, the Mayo elbow performance score (MEPS) and data from the radiological examinations. RESULTS The average follow-up time was 21 months (range 6-47 months). In 22 cases (85 %) an anatomical reduction could be achieved, 2 cases (8 %) showed a complete redislocation of the fragment and 2 cases (8 %) a partial redislocation. The average DASH score was 5.6 points (range 0-56) and the average MEPS was 93.8 (range 60-100). Only 4 patients (15 %) reported persisting functional impairment with a DASH score >10. CONCLUSIONS The method of percutaneous reduction of radial head fractures without additional internal fixation in Mason type II fractures has been demonstrated to be a good alternative to open reduction.
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Affiliation(s)
- P Simon
- Centrum für Muskuloskeletale Chirurgie, Charité Universitätsmedizin Berlin, Freie und Humboldt-Universität Berlin, Charitéplatz 1, 10117, Berlin, Deutschland,
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13
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Abstract
Elbow arthroscopy is a tool useful for the treatment of a variety of pathologies about the elbow. The major indications for elbow arthroscopy include débridement for septic elbow arthritis, synovectomy for inflammatory arthritis, débridement for osteoarthritis, loose body extraction, contracture release, treatment of osteochondral defects and selected fractures or instability, and tennis elbow release. Contraindications, technical considerations, and favorable outcomes following treatment with elbow arthroscopy require careful patient evaluation, a thorough understanding of anatomic principles, and proper patient positioning and portal selection to guide preoperative planning and overall patient care. Elbow arthroscopy is an effective procedure for the treatment of inflammatory arthritis, osteoarthritis, and lateral epicondylitis.
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Goodwin D, Dynin M, Macdonnell JR, Kessler MW. The role of arthroscopy in chronic elbow instability. Arthroscopy 2013; 29:2029-36. [PMID: 24113650 DOI: 10.1016/j.arthro.2013.08.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 08/01/2013] [Accepted: 08/15/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE Elbow arthroscopy has had an emerging role in the management of many disorders of the elbow. In patients with chronic elbow instability, several arthroscopic techniques have been described in the diagnosis and management of posterolateral rotatory instability and valgus instability. METHODS We performed a systematic review investigating the role of arthroscopy in posterolateral rotatory instability and valgus instability in the elbow using the PubMed and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases, and the Cochrane Database of Systematic Reviews, consisting of articles from peer-reviewed journals published in the English language after January 1, 1991. RESULTS Search criteria initially identified 249 articles. Twenty-five articles met criteria for inclusion. This included 17 review articles, 4 cadaveric studies, 3 retrospective studies, and 1 prospective study. Two of the retrospective studies compared arthroscopic and open techniques. Articles included in this systematic review concluded that arthroscopy is an accurate adjunct to physical examination and imaging in the diagnosis of chronic elbow instability and affords an exceptional view of the joint with the ability to address intra-articular pathologic conditions. Arthroscopic surgical techniques have shown equivalent clinical outcomes in a comparison of arthroscopic and open techniques. CONCLUSIONS Elbow arthroscopy is a valuable tool in the diagnosis and management of chronic elbow instability. Patients treated arthroscopically benefit from additional diagnostic techniques, improved visualization of the elbow joint, the ability to address coexisting intra-articular pathologic conditions, and minimal soft tissue injury with no clinical consequences in outcomes. With such significant advantages, the use of elbow arthroscopy is likely to expand in the management of chronic elbow instability. LEVEL OF EVIDENCE Level IV, systematic review.
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Affiliation(s)
- David Goodwin
- Department of Orthopaedic Surgery, Georgetown University Hospital, Washington, D.C., U.S.A..
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15
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Byram IR, Kim HM, Levine WN, Ahmad CS. Elbow arthroscopic surgery update for sports medicine conditions. Am J Sports Med 2013; 41:2191-202. [PMID: 23572098 DOI: 10.1177/0363546513482106] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Elbow arthroscopic surgery can now effectively treat a variety of conditions that affect athletes. Advances in instrumentation, increased surgeon familiarity, and expanded indications have led to significant growth in elbow arthroscopic surgery in the past few decades. While positioning, portal placement, and specific instruments may vary among surgeons, anatomic considerations guide surgical approaches to minimize neurovascular compromise. Arthroscopic procedures vary in difficulty, and surgeons should follow stepwise advancement with experience. Removal of loose bodies, debridement of synovial plicae, and debridement of the extensor carpi radialis brevis for lateral epicondylitis are considered simple procedures for novice elbow arthroscopic surgeons. More advanced procedures include management of osteochondritis dissecans, valgus extension overload in the throwing athlete, and capsular release. With proper technique, a variety of athletic elbow conditions can be treated arthroscopically with predictable results and minimal morbidity.
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Affiliation(s)
- Ian R Byram
- Center for Shoulder, Elbow and Sports Medicine, New York Presbyterian/Columbia University Medical Center, New York, NY, USA
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Desai VN, Cheung EV. Postoperative pain associated with orthopedic shoulder and elbow surgery: a prospective study. J Shoulder Elbow Surg 2012; 21:441-50. [PMID: 22192767 DOI: 10.1016/j.jse.2011.09.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 09/20/2011] [Accepted: 09/24/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND In the last 2 decades, extensive research in postoperative pain management has been undertaken to decrease morbidity. Orthopedic procedures tend to have increased pain compared with other procedures, but further research must be done to manage pain more efficiently. Postoperative pain morbidities and analgesic dependence continue to adversely affect health care. MATERIALS AND METHODS The study assessed the pain of 78 elbow and shoulder surgery patients preoperatively and postoperatively using the Short-Form McGill Pain Questionnaire (SF-MPQ). Preoperatively, each patient scored their preoperative pain (PP) and anticipated postoperative pain (APP). Postoperatively, they scored their 3-day (3dpp) and 6-week postoperative pain (6wpp). The pain intensities at these 4 intervals were then compared and analyzed using Pearson coefficients. RESULTS APP and PP were strong predictors of postoperative pain. The average APP was higher than the average postoperative pain. The 6wpp was significantly lower than the 3dpp. Sex, chronicity, and type of surgery were not significant factors; however, the group aged 18 to 39 years had a significant correlation with postoperative pain. CONCLUSION PP and APP were both independent predictors of increased postoperative pain. PP was also predictive of APP. Although, overall postoperative pain was lower than APP or PP due to pain management techniques, postoperative pain was still significantly higher in patients with increased APP or PP than their counterparts. Therefore, surgeons should factor patient's APP and PP to better manage their patient's postoperative pain to decrease comorbidities.
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Affiliation(s)
- Vimal N Desai
- Department of Orthopedic Surgery, Stanford University Medical Center, Redwood City, CA 94063, USA
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17
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Arthroscopy-assisted fracture fixation. Knee Surg Sports Traumatol Arthrosc 2011; 19:320-9. [PMID: 21082166 DOI: 10.1007/s00167-010-1298-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Accepted: 10/12/2010] [Indexed: 02/06/2023]
Abstract
PURPOSE the purpose of this article was to systematically analyze the results of published studies in the literature which evaluated the use of arthroscopically assisted techniques in intra-articular fracture fixation. METHODS published investigations to date were analyzed by classifying them according to joints that were involved with intra-articular fractures including: knee, ankle, hip, shoulder, elbow, and wrist joints. The results were studied to assess the feasibility, efficiency, and outcomes of arthroscopy-assisted fracture fixation. RESULTS arthroscopy-assisted techniques have been used successfully for the treatment of fractures of the tibial plateau, tibial eminence, malleoli, pilon, calcaneus, femoral head, glenoid, greater tuberosity, distal clavicle, radial head, coronoid, distal radius, and scaphoid. The major advantages of arthroscopic fracture fixation over open methods are direct visualization of the intra-articular space, decreased invasiveness, and the possibility for multitask interventions through which fixation of the fracture, and repair of the soft tissues and the cartilage can be performed simultaneously. The time-consuming and technically demanding nature of the procedures with a prolonged learning curve and limited fixation alternatives are the main disadvantages of this technique. CONCLUSION arthroscopic fixation is increasingly utilized for certain intra-articular fracture types due to the minimally invasive nature of the procedures and high accuracy. Randomized controlled trials are needed to justify wider use of arthroscopy-assisted techniques for treatment of intra-articular fractures.
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