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Fouché R, El Amiri L, Bestandji N, Uzel AP. Articular fracture of the distal humerus classified Dubberley 2b: Case report of two patients and review of the literature. Trauma Case Rep 2024; 51:101032. [PMID: 38655250 PMCID: PMC11036088 DOI: 10.1016/j.tcr.2024.101032] [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: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
Articular fractures of the distal humerus are rare, and even rarer are fractures involving the trochlea and capitellum in a single fragment, with no associated comminution. These fractures are classified as 2a according to the Dubberley classification and are rarely described in the literature. Two cases of Dubberley 2a fractures were treated at our hospital. The first case, involving a 68-year-old patient, was treated with a medial and a lateral approach, combined with posteroanterior fixation using 3 Herbert screws. In the 2nd case, a 16-year-old male was treated with a single lateral approach, permitting fixation with two Herbert screws. One of the two screws is inserted into the bone at the edge of the cartilage, with an anteroposterior trajectory that leaves the cartilage intact. We opted mainly for posteroanterior screw fixation in subchondral bone, which is less damaging to articular cartilage and soft tissues and has already demonstrated its reliability. No associated lesions were found, and no complications were encountered. Results were excellent, with Mayo Elbow Performance Index (MEPI) scores of 95 and 100 respectively. Herbert screw fixation therefore appears to be an option of choice for these fractures, although comparative studies are needed to evaluate the different treatments available.
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Affiliation(s)
- Raphaël Fouché
- University of the French Antilles, Department of Orthopedic Surgery, University Hospital of Guadeloupe, Route de Chauvel, 97139 Les Abymes, Guadeloupe
| | - Laela El Amiri
- Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, University of Strasbourg, 10 Avenue Baumann, 67400 Illkirch, France
| | - Nassim Bestandji
- Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, University of Strasbourg, 10 Avenue Baumann, 67400 Illkirch, France
| | - André-Pierre Uzel
- Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, University of Strasbourg, 10 Avenue Baumann, 67400 Illkirch, France
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Jenkins CW, Edwards GAD, Chalk N, McCann PA, Amirfeyz R. Does preservation of columns affect the medium-term outcome in distal humerus hemiarthroplasty for acute unreconstructable fractures? Shoulder Elbow 2022; 14:85-94. [PMID: 35154409 PMCID: PMC8832714 DOI: 10.1177/1758573220977768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/09/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND We assessed distal humeral column preservation effects on clinical, radiographic and patient reported outcomes following distal humerus hemiarthroplasty for acute unreconstructable fractures. METHODS Thirty-seven consecutive patients (mean age, 75; range, 29-93 years) with an average follow-up of 61 months (range, 24-105 months) after distal humerus hemiarthroplasty using a triceps preserving approach were studied. QuickDASH and Oxford Elbow Score assessed patient reported outcomes. Clinical and radiographic assessments comprised range of motion, grip strength, instability, implant loosening, chondral wear, heterotopic ossification and condylar union. RESULTS Average QuickDASH was 14.9 (range, 0-63) and Oxford Elbow Score 40.35 (range, 25-48). Mean flexion arc was 108°, extension deficit 17° and pronosupination arc 155°. Average operative sided grip strength was 31.05 kg versus 31.13 kg contralaterally. Column preservation had no statistically significant effect on QuickDASH (p = 0.75), Oxford Elbow Score (p = 0.78), flexion-extension (p = 0.87), pronosupination (p = 0.78) or grip strength (p = 0.87). No progressive radiographic loosening or symptomatic chondral wear occurred. All fixed columns united. Three cases of immediate post-operative laxity fully resolved on elbow mobilisation. Four post-operative complications required further surgery: one ulnar neuropathy, one heterotopic ossification, one wound breakdown and one traumatic dislocation. CONCLUSION Medium-term outcome of distal humerus hemiarthroplasty for acute unreconstructable distal humeral fractures is reliable irrespective of condylar preservation.
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Affiliation(s)
| | | | | | | | - Rouin Amirfeyz
- Rouin Amirfeyz, Department of Orthopaedic Surgery, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK.
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Nakao R, Shen W, Shimajiri Y, Kainou K, Sato Y, Ulla A, Ohnishi K, Ninomiya M, Ohno A, Uchida T, Tanaka M, Akama K, Matsui T, Nikawa T. Oral intake of rice overexpressing ubiquitin ligase inhibitory pentapeptide prevents atrophy in denervated skeletal muscle. NPJ Sci Food 2021; 5:25. [PMID: 34504092 PMCID: PMC8429733 DOI: 10.1038/s41538-021-00108-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/12/2021] [Indexed: 02/07/2023] Open
Abstract
We previously reported that intramuscular injections of ubiquitin ligase CBLB inhibitory pentapeptide (Cblin; Asp-Gly-pTyr-Met-Pro) restored lost muscle mass caused by sciatic denervation. Here, we detected Cblin on the basolateral side of Caco-2 cells after being placed on the apical side, and found that cytochalasin D, a tight junction opener, enhanced Cblin transport. Orally administered Cblin was found in rat plasma, indicating that intact Cblin was absorbed in vitro and in vivo. Furthermore, transgenic Cblin peptide-enriched rice (CbR) prevented the denervation-induced loss of muscle mass and the upregulation of muscle atrophy-related ubiquitin ligases in mice. These findings indicated that CbR could serve as an alternative treatment for muscle atrophy.
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Affiliation(s)
- Reiko Nakao
- grid.267335.60000 0001 1092 3579Department of Nutritional Physiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Weilin Shen
- grid.177174.30000 0001 2242 4849Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School, Kyushu University, Fukuoka, Japan
| | - Yasuka Shimajiri
- grid.411621.10000 0000 8661 1590Faculty of Life and Environmental Science, Shimane University, Matsue, Shimane Japan ,EditForce, Fukuoka, Japan
| | - Kumiko Kainou
- grid.411621.10000 0000 8661 1590Faculty of Life and Environmental Science, Shimane University, Matsue, Shimane Japan
| | - Yuki Sato
- grid.267335.60000 0001 1092 3579Department of Nutritional Physiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Anayt Ulla
- grid.267335.60000 0001 1092 3579Department of Nutritional Physiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kohta Ohnishi
- grid.267335.60000 0001 1092 3579Department of Clinical Nutrition and Food Management, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Miyuki Ninomiya
- grid.267335.60000 0001 1092 3579Department of Nutritional Physiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Ayako Ohno
- grid.267335.60000 0001 1092 3579Department of Nutritional Physiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Takayuki Uchida
- grid.267335.60000 0001 1092 3579Department of Nutritional Physiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Mitsuru Tanaka
- grid.177174.30000 0001 2242 4849Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School, Kyushu University, Fukuoka, Japan
| | - Kazuhito Akama
- grid.411621.10000 0000 8661 1590Faculty of Life and Environmental Science, Shimane University, Matsue, Shimane Japan
| | - Toshiro Matsui
- grid.177174.30000 0001 2242 4849Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School, Kyushu University, Fukuoka, Japan
| | - Takeshi Nikawa
- grid.267335.60000 0001 1092 3579Department of Nutritional Physiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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Fram BR, Seigerman DA, Ilyas AM. Coronal Shear Fractures of the Distal Humerus: A Review of Diagnosis, Treatment, and Outcomes. Hand (N Y) 2021; 16:577-585. [PMID: 31625402 PMCID: PMC8461205 DOI: 10.1177/1558944719878817] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Fractures of the capitellum and trochlea are uncommon fractures of the elbow and can be challenging to treat due to their size, location, and articular nature. Because of their intra-articular nature and predilection toward displacement, these fractures are typically treated operatively. Furthermore, capitellum fractures have high rates of associated injuries, including radial head fractures or lateral collateral ligament injury in ~30% to 60% of patients. In addition to open reduction internal fixation, operative options include fragment excision, arthroscopic assisted reduction and fixation, and elbow arthroplasty. In this article, we undertake a comprehensive literature review of capitellum fractures of the distal humerus, in an attempt to summarize the existing body of evidence and propose areas of future study.
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Affiliation(s)
| | | | - Asif M. Ilyas
- Thomas Jefferson University Hospital, Philadelphia, PA, USA,Asif M. Ilyas, Rothman Institute of Orthopedics, Thomas Jefferson University Hospital, 925 Chestnut Street, 5 Floor, Philadelphia PA 19107, USA.
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Abstract
Distal humerus hemiarthroplasty is a good surgical option for nonreconstructable intraarticular distal humerus fractures in selected lower-demand patients. The lifetime activity restrictions have not been determined, but are likely less than a total elbow arthroplasty. From a technical standpoint, distal humeral prostheses should be implanted at the correct depth and rotation. The collateral ligaments, condyles, and epicondyles should be preserved and/or repaired to maintain joint stability. Short- to midterm retrospective studies have shown promising results.
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Abstract
Posttraumatic elbow stiffness is a disabling condition that remains challenging to treat despite improvement of our understanding of the pathogenesis of posttraumatic contractures and new treatment regimens. This review provides an update and overview of the etiology of posttraumatic elbow stiffness, its classification, evaluation, nonoperative and operative treatment, and postoperative management.
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Gonçalves LBJ, Ring DC. Fractures of the humeral trochlea: case presentations and review. J Shoulder Elbow Surg 2016; 25:e151-5. [PMID: 27083581 DOI: 10.1016/j.jse.2016.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/28/2016] [Accepted: 02/12/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Lucas B J Gonçalves
- Department of Orthopedic Surgery, Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
| | - David C Ring
- Department of Surgery and Perioperative Care, Dell Medical School, Austin, TX, USA
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