1
|
Gallusser N, Goetti P, Lallemand G, Terrier A, Vauclair F. Surgical approaches to the capitellum: a comparative anatomic study. J Shoulder Elbow Surg 2024; 33:798-803. [PMID: 37890766 DOI: 10.1016/j.jse.2023.09.022] [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] [Received: 04/16/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Osteochondritis dissecans (OCD) of the humeral capitellum is an important cause of elbow disability in young athletes. Large and unstable lesions sometimes require joint reconstruction with osteochondral autograft. Several approaches have been described to expose the capitellum for the purpose of treating OCD. The posterior anconeus-splitting approach and the lateral approach with or without release of the lateral ligamentous complex are the most frequently used for this indication. The surface accessible by these approaches has not been widely studied. This study compared the extent of the articular surface of the capitellum that could be exposed with the Kocher approach (without ligament release) vs. the posterior anconeus-splitting approach. A secondary outcome was the measurement of any additional area that could be reached with lateral ulnar collateral ligament release (Wrightington approach). METHODS The 3 approaches were performed on 8 adult cadaveric elbows: first, the Kocher approach; then, the anconeus-splitting approach; and finally, the Wrightington approach. The visible articular surface was marked out after completion of each approach. RESULTS The mean articular surface of the capitellum was 708 mm2 (range, 573-830 mm2). The mean visible articular surface was 49% (range, 43%-60%) of the total surface with the Kocher approach, 74% (range, 61%-90%) with the posterior anconeus-splitting approach, and 93% (range, 91%-97%) with the Wrightington approach. Although the Kocher approach provided access to the anterior part of the capitellum, the anconeus-splitting approach showed adequate exposure to the posterior three-quarters of the articular surface and overlapped the most posterior part of the Kocher approach. A combination of the 2 lateral ulnar collateral ligament-preserving approaches allowed access to 100% of the joint surface. CONCLUSION Most OCD lesions are located in the posterior area of the capitellum and can therefore be reached with the anconeus-splitting approach. When OCD lesions are located anteriorly, the Kocher approach without ligament release is efficient. A combination of these 2 approaches enabled the entirety of the joint surface to be viewed.
Collapse
Affiliation(s)
- Nicolas Gallusser
- Department of Orthopaedic and Trauma Surgery, Valais Hospital, Sion, Switzerland
| | - Patrick Goetti
- Department of Orthopaedic and Trauma Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Geoffroi Lallemand
- Department of Orthopaedic and Trauma Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alexandre Terrier
- Department of Orthopaedic and Trauma Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Frédéric Vauclair
- Department of Orthopaedic and Trauma Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Bone and Motion Center, Hirslanden Clinique Bois-Cerf, Lausanne, Switzerland.
| |
Collapse
|
2
|
Liu S, Peng L, Liu J, OuYang L, Wang Z, Rai S, Lin W, Tang X. Possible Mechanism and Treatment Results of Combined Pediatric Fractures of the Humeral Lateral Condyle and Ipsilateral Ulnar Olecranon. Orthop Surg 2024; 16:104-110. [PMID: 38018315 PMCID: PMC10782239 DOI: 10.1111/os.13945] [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] [Received: 07/15/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE Combined fractures of the lateral condyle of the humerus and the ipsilateral ulnar olecranon are rarely seen in children. Therefore, the mechanism and suitable treatments remain debatable. This study describes the possible mechanism of combined humeral lateral condyle and ipsilateral ulnar olecranon fractures and presents the treatment results. METHODS Children diagnosed with combined fractures of the humeral lateral condyle and ipsilateralulnar olecranon from July 2010 to July 2020 were retrospectively analyzed. Humeral lateral condyle fractures were treated with open reduction and internal fixation with bioabsorbable pins. Ulnar olecranon fractures were treated with closed reduction and percutaneous pinning with K-wires for Mayo type IA fractures and with tension-band wiring or a locking plate for Mayo type IIA fractures. The postoperative function and appearance of the elbow were evaluated using the Flynn criteria and Mayo Elbow Performance Score (MEPS) at follow-up. RESULTS The cohort comprised 19 patients aged from 4 to 11 years. Bony compression and avulsion by attached muscles and ligaments may be the leading factors causing the combined injuries, as the children fell with an outstretched and supinated elbow. The average follow-up time was 33 months. High MEPS of >90 indicated that good to excellent results were obtained without complications. CONCLUSIONS This study proposed a reasonable hypothesis for the mechanism of combined humeral lateral condyle and ipsilateral ulnar olecranon fractures in children. Satisfactory outcomes were achieved with bioabsorbable pins for lateral condyle fractures and closed reduction and percutaneous pinning with K-wires, tension-band wiring, or locking plate for olecranon fractures.
Collapse
Affiliation(s)
- Shuai Liu
- Pediatric Orthopedics DepartmentWuxi 9th People's Hospital Affiliated to Soochow UniversityWuxiChina
| | - LianQi Peng
- Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - JiaTong Liu
- Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - LiZhi OuYang
- Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - ZeZheng Wang
- Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Saroj Rai
- Department of OrthopaedicsAl Ahalia HospitalAbu DhabiUnited Arab Emirates
| | - WeiFeng Lin
- Pediatric Orthopedics DepartmentWuxi 9th People's Hospital Affiliated to Soochow UniversityWuxiChina
| | - Xin Tang
- Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| |
Collapse
|
3
|
Feinstein SD, Paterno AV, Allen AD, Jewell E, Wright ST, Draeger RW. Techniques and Fixation of Olecranon Osteotomy: A Systematic Review. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:643-649. [PMID: 37790831 PMCID: PMC10543770 DOI: 10.1016/j.jhsg.2023.04.001] [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: 11/08/2022] [Accepted: 04/12/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose We aimed to characterize the incidence of complications regarding olecranon osteotomy, looking more specifically at the type of osteotomy and the fixation construct used to repair the osteotomy. Methods In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search was performed. A study was included if it was an adult clinical study, a transverse or chevron olecranon osteotomy was performed, and the study explicitly states the fixation construct used to repair the osteotomy. A quality assessment was performed in each study prior to data extraction. Results We included 39 studies with a total of 1,445 patients. Most studies included patients who were being treated primarily for a distal humerus fracture. The overall incidence of delayed union was 27/643 (4.2%), with a higher rate in transverse osteotomy than in chevron osteotomy (5/49 (10.2%) vs 22/595 (3.7%)). Nonunion occurred in 43/811 (5.4%) of patients, with a higher rate in transverse osteotomy (6/73 (8.2%) vs. 37/712 (5.2%)). Implant failure or loss of reduction occurred in 44/746 (5.9%) of patients, with a higher rate in transverse osteotomy (11/49 (22.4%) vs 33/688 (4.8%)). The removal of implants occurred in 236/1078 (21.9%) of all patients, with the highest rate in those studies that used plate fixation 44/99 (44.4%). Conclusions Compared with chevron osteotomy, patients who underwent transverse osteotomy had a higher incidence of delayed union, nonunion, and implant failure or loss of reduction requiring revision surgery. The incidence of implant removal indicates that patients should be informed that nearly half of the osteotomy fixed with a plate was removed after implantation. Type of study/level of evidence Therapeutic III.
Collapse
Affiliation(s)
- Shawn D. Feinstein
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| | - Anthony V. Paterno
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| | - Andrew D. Allen
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| | - Emily Jewell
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| | - Sarah T. Wright
- University Libraries, University of North Carolina, Chapel Hill, NC
| | - Reid W. Draeger
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| |
Collapse
|
4
|
Zhou X, Wang B, Liu Y, Wang Z, Zhao X, Liu F, Lu S, Xu W, Li L, Dong J. Comparative Study Between the Mini-Open (≤2.5 Cm) Approach and Conventional Open Lateral Approach in the Surgical Treatment of Radial Head Fractures. J Pain Res 2022; 15:3413-3422. [PMID: 36320225 PMCID: PMC9618242 DOI: 10.2147/jpr.s374599] [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: 05/24/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose The conventional lateral approach is widely used to treat radial head fractures with screws. However, the traditional incision may have shortcomings, including excessive exposure and significant scarring. We propose an innovative method – a mini-open lateral approach of less than 2.5 cm for surgical treatment of radial head fractures with screws. Methods From Jan 2017 to Dec 2020, 34 patients diagnosed with closed radial head fracture were treated with open reduction and internal fixation (ORIF) in this study. The novel group (mini-open group) included 15 patients, and the other 19 patients were in the traditional group. The time of operation and the blood loss during operation were recorded. Postoperative clinical outcomes and radiographic results were recorded and compared between the two groups. The range of motion (ROM) in the elbow, the Visual Analogue Scale (VAS), the Mayo Elbow Performance Score (MEPS), Rating Scale of the American Shoulder and Elbow Surgeons (ASES), and the Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire (Q-DASH) score and complications, such as wound infection, vascular and nerve damage, and fragment redisplacement were observed in the two groups. Results In the comparison between the two groups, there was no significant difference in age, sex, cause of radial head fracture, or other basic information. The operation time, intraoperative blood loss, and VAS score at 3 days postoperation were significantly reduced in the novel group (p < 0.05). The follow-up results showed that there was no significant difference in MEPS, ASES, or Q-DASH scores between the two groups. Conclusion The mini-open approach reduced intraoperative blood loss, shortened operation time, relieved patient pain, and achieved a satisfactory postoperative clinical result, which demonstrates that the novel approach is a safe and effective option for treating radial head fractures.
Collapse
Affiliation(s)
- Xiaofeng Zhou
- Department of Orthopaedics Surgery, Shandong Provincial Hospital, Shandong University, Jinan, People’s Republic of China
| | - Bingzhi Wang
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Yu Liu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital, Shandong University, Jinan, People’s Republic of China
| | - Zicheng Wang
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Xuehui Zhao
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Fanxiao Liu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Shun Lu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Weicheng Xu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Lianxin Li
- Department of Orthopaedics Surgery, Shandong Provincial Hospital, Shandong University, Jinan, People’s Republic of China,Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China,Correspondence: Lianxin Li, Department of Orthopaedics, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, 250021, People’s Republic of China, Tel +8613505312449, Email
| | - Jinlei Dong
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China,Jinlei Dong, Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China, Tel +861509874540, Email
| |
Collapse
|
5
|
Meccariello L, Caiaffa V, Mader K, Prkic A, Eygendaal D, Bisaccia M, Pica G, Utrilla-Hernando S, Pica R, Rollo G. Treatment of Unstable Elbow Injuries with a Hinged Elbow Fixator: Subjective and Objective Results. Strategies Trauma Limb Reconstr 2022; 17:68-73. [PMID: 35990180 PMCID: PMC9357797 DOI: 10.5005/jp-journals-10080-1553] [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] [Indexed: 12/03/2022] Open
Abstract
Introduction Injuries around the elbow pose a challenging problem for orthopaedic surgeons. The complex bony architecture of the joint should be restored and the thin soft tissue envelope needs to be handled with meticulous care. Elbow instability is a complication seen after dislocations and fractures of the elbow and remains a treatment challenge. The purpose of this study was to provide subjective and objective results following the surgical treatment of unstable elbow dislocations with an external hinged fixation technique. Methods Forty-six consecutive patients with complex trauma of the elbow with instability after ligament reconstruction were enrolled between January 2017 and December 2019. The parameters used to quantify the subjective and objective functional results were the Mayo Elbow Score (MES, objective) and Oxford Elbow Score (OES, subjective), and clinical stability of the elbow joint. We also performed a radiological follow-up of the fractures. Results The mean MES and OES scores were good at the 12-month follow-up. We had 38 patients with stable joints and 8 patients with minor instability. Using the stress test, we saw a significant difference in the affected joint under varus stress (6.7 ± 1.8 mm) compared to the healthy joint (5.8 ± 1.2 mm) laterally. Furthermore, medially the gap was significantly larger (5.8 ± 0.8 mm, treated elbow) than the contralateral gap under valgus stress (4.3 ± 0.8 mm) (p <0.001). Twenty-one complications occurred in 46 patients (46%): Seven patients had a clinical change of elbow axis: Three valgus (6%), four varus (9%); Superficial wound infection occurred in one case (2%) and ulnar nerve dysfunction in two (4%). The most common medium-term complication was post-traumatic osteoarthritis in eight cases (17%). Heterotopic ossification occurred in five patients (11%) and elbow stiffness in five cases (11%). Conclusion The use of the hinged elbow external fixator in the treatment of complex elbow trauma is a valid therapeutic adjunct to ligamentous reconstruction showing encouraging results with acceptable complications. How to cite this article Meccariello L, Caiaffa V, Mader K, et al. Treatment of Unstable Elbow Injuries with a Hinged Elbow Fixator: Subjective and Objective Results. Strategies Trauma Limb Reconstr 2022;17(2):68–73.
Collapse
Affiliation(s)
- Luigi Meccariello
- Department of Orthopaedics and Traumatology, AORN San Pio Hospital, Benevento, Italy
- Luigi Meccariello, Department of Orthopaedics and Traumatology, AORN San Pio Hospital, Benevento, Italy, Phone: +393299419574, e-mail:
| | - Vincenzo Caiaffa
- Department of Orthopaedics and Traumatology, AORN San Pio Hospital, Benevento, Italy; Department of Orthopaedics and Traumatology, Di Venere Hospital, Bari, Italy
| | - Konrad Mader
- Division Hand, Forearm and Elbow Surgery, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ante Prkic
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics, Erasmus MC, Rotterdam, The Netherlands
| | - Michele Bisaccia
- Department of Orthopedics and Traumatology, Azienda Ospedaliera “Santa Maria della Misericordia”, Perugia, Italy
| | - Giuseppe Pica
- Department of Orthopaedics and Traumatology, AORN San Pio Hospital, Benevento, Italy
| | | | - Roberta Pica
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences University “La Sapienza”, Piazzale Aldo Moro, Rome, Italy
| | - Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| |
Collapse
|
6
|
Rollo G, Vicenti G, Rotini R, Prkic A, Eygendaal D, Meccariello L. Open Reduction and Internal Fixation Using Double Plating with Biological and Artificial Bone Grafting of Aseptic Non-unions of the Distal Humerus: Clinical Results. Strategies Trauma Limb Reconstr 2022; 16:144-151. [PMID: 35111253 PMCID: PMC8778730 DOI: 10.5005/jp-journals-10080-1533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim Intra-articular non-union of fractures is an uncommon but complex problem because in general, it is characterised by marked instability, pain, strength loss and significant functional limitation. The aim of this study is to report our prospective medium-term outcomes of the treatment of intra-articular, distal humeral aseptic non-unions using open reduction and internal fixation, augmented with artificial bone. Materials and methods A retrospective case series of 16 patients with intra-articular, aseptic non-unions of the distal humerus was analysed for range of motion, pain, Mayo Elbow Performance Scores (MEPS) and Oxford Elbow Scores (OES) after 12 months. Mean age was 44 years (range, 18–84 years) and mean total follow-up was 43 months (range, 24–62 months). Results All subjective and objective scores were significantly higher 12 months after treatment with internal fixation and artificial bone augmentation; the mean improvement on the MEPS was 18 points and 17 points on the OES. All patients returned to work, most without limitations. Autografts had worse outcomes compared to allografts regarding post-operative pain and time to return to work. No adverse events related to the artificial bone augmentation were seen and all fractures consolidated. Conclusion The use of two locking plates and bone graft augmentation with autografts or allografts with artificial bone grafts is a successful treatment of intra-articular distal humeral non-unions after hardware failure or biological limitations. Clinical significance The use of artificial bone in the treatment of septic non-unions of the upper limb is safe. When no autograft is possible because of concurrent morbidity, it can be used alone or combined with an allograft to reconstruct the affected bone without leading to extra morbidity or complications. How to cite this article Rollo G, Vicenti G, Rotini R, et al. Open Reduction and Internal Fixation Using Double Plating with Biological and Artificial Bone Grafting of Aseptic Non-unions of the Distal Humerus: Clinical Results. Strategies Trauma Limb Reconstr 2021;16(3):144–151.
Collapse
Affiliation(s)
- Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Giovanni Vicenti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari “Aldo Moro”–AOU Policlinico Consorziale, Bari, Italy; Orthopaedic and Trauma Unit, Bari, Italy
| | - Roberto Rotini
- Shoulder and Elbow Unit, “Rizzoli” Orthopaedic Institute, Bologna, Italy
| | - Ante Prkic
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
- Ante Prkic, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands, Phone: +31648340436; e-mail:
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands; Department of Orthopedic Surgery, AUMC, Amsterdam, The Netherlands
| | - Luigi Meccariello
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| |
Collapse
|
7
|
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.
Collapse
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
| | | |
Collapse
|
8
|
Hua K, Ji S, Li T, Chen C, Zha Y, Gong M, Sun W, Lu S, Jiang X. Correlation between modified trochleocapitellar index and post-traumatic elbow stiffness in type C2-3 distal humeral fractures among adults. J Shoulder Elbow Surg 2020; 29:1876-1883. [PMID: 32446760 DOI: 10.1016/j.jse.2020.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/16/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to propose the modified trochleocapitellar index (mTCI), assess its reliability, and evaluate its correlation with post-traumatic elbow stiffness in type C2-3 distal humeral fractures among adults. METHODS From January 2013 to June 2017, a total of 141 patients with type C2-3 distal humeral fractures were included. The mTCI was calculated as the ratio between the modified trochlear and capitellar angles relative to the humeral axis (mTCI-HA), lateral humeral line (mTCI-LHL), and medial humeral line (mTCI-MHL) from anteroposterior radiographs taken immediately after the operation. The patients were divided into group A (with elbow stiffness) and group B (without elbow stiffness) based on follow-up results. To determine risk factors for elbow stiffness, univariate and logistic regression analyses were performed on each radiographic parameter separately, together with other clinical variables. Interrater reliability was assessed for all measurements. RESULTS Specific optimal ranges of value were identified for mTCI-HA (0.750-0.875), mTCI-LHL (0.640-1.060), and mTCI-MHL (0.740-0.900), beyond which the likelihood of elbow stiffness significantly increased (P < .001). By multivariate analysis, mTCI-HA (odds ratio [OR] 26.22, 95% confidence interval [CI] 3.39-203.07, P = .002), mTCI-LHL (OR 5.37, 95% CI 2.17-13.28, P < .001), and mTCI-MHL (OR 5.95, 95% CI 1.91-18.56, P = .002) values beyond the optimal ranges were identified as the independent risk factors for elbow stiffness. The interrater reliability of mTCI-HA, mTCI-LHL, and mTCI-MHL was 0.986, 0.983, and 0.987, respectively. CONCLUSION The mTCI measurement method is reliable. Either too small or too large mTCI values were associated with post-traumatic elbow stiffness among adult patients with type C2-3 distal humeral fractures. The mTCI-HA showed a better predictive value than mTCI-LHL and mTCI-MHL.
Collapse
Affiliation(s)
- Kehan Hua
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Shangwei Ji
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Ting Li
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Chen Chen
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Yejun Zha
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Maoqi Gong
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Weitong Sun
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Shuai Lu
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Xieyuan Jiang
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China.
| |
Collapse
|
9
|
Understanding the Radiographic Anatomy of the Proximal Ulna and Avoiding Inadvertent Intraarticular Screw Placement. J Orthop Trauma 2020; 34:102-107. [PMID: 31809415 DOI: 10.1097/bot.0000000000001638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To map the proximal ulnar articular margins and ensure safe extraarticular placement of implants. METHODS Ten fresh frozen adult elbow cadaver specimens were obtained. Radiopaque wire was applied to the articular margin of the articular facets and the central trochlear ridge of the proximal ulna. Fluoroscopic images were obtained demonstrating the articular facet margins. Radiographic measurements were performed and used to identify relative safe screw zones. RESULTS All specimens demonstrated marked extension of the ulnar and radial facets dorsal to the central trochlear ridge. The dorsal extent of the ulnar facets from the central trochlear ridge averaged 9.7 mm (range, 7.9-13 mm; SD, 1.5 mm) and 6.2 mm (range, 3.4-9.4 mm; SD, 1.9 mm), respectively. The average footprint of the posterior ulnar facet occupied 44% (±4.9%) of the total ulnar height from the dorsal cortex to the trochlear ridge. CONCLUSIONS The articular margins of the anterior and posterior facets of the proximal ulna are challenging to identify radiographically. A surgical "at-risk zone" exists within 9.7 mm from the radiographic margin of the central trochlear ridge. Implants placed within this zone have the potential to violate the articular surface.
Collapse
|
10
|
Ripani U, Manzarbeitia-Arroba P, Guijarro-Leo S, Urrutia-Graña J, De Masi-De Luca A. Vitamin C May Help to Reduce the Knee's Arthritic Symptoms. Outcomes Assessment of Nutriceutical Therapy. Med Arch 2020; 73:173-177. [PMID: 31404121 PMCID: PMC6643354 DOI: 10.5455/medarh.2019.73.173-177] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction Osteoarthritis (OA) is a chronic joint disease characterized by degeneration of the articular cartilage, changes in the physico-chemical properties of the synovial fluid and macroscopical modifications of the joint. Patients with Classes I and II of Knee OA can be treated with pharmacologic therapy. Vitamin C is key for both preventing inflammatory arthritis and maintaining healthy joints with OA. Aim The aim of our paper is to verify the effectiveness of the addition of vitamin c in nutriceutical drugs for the therapy of the knee arthritis in the young adult. Results Group B has a lower VAS score at 6 and 12 months with p<0.05. Not statistical difference we found in KSS during all follow up. A better quality of life was founded in Group B at 12 months in group B(p<0.05) and less use of pain killers/monthly(p<0.05). Conclusion There is no denying that vitamin C benefits everybody, whether they have arthritis or not. Therefore, it is a good idea to maintain a healthy balance of vitamin C. Without a doubt, vitamin C benefits most people with early OA.
Collapse
Affiliation(s)
- Umberto Ripani
- Pain Therapy Center, Division of Anesthesia, Analgesia and Intensive Care, Department of Emergency, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Paloma Manzarbeitia-Arroba
- Department of Orthopedics and Traumatology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Sandra Guijarro-Leo
- Department of Orthopedics and Traumatology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Javier Urrutia-Graña
- Department of Orthopedics and Traumatology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | | |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Oguzkaya S, Cakar B, Argun M. Pediatric Radioulnar Synostosis after Olecranon Fracture: A Case Report. CASE REPORTS IN ORTHOPEDIC RESEARCH 2019. [DOI: 10.1159/000502410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Radioulnar synostosis which develops after treatment of isolated olecranon fracture is a rare complication. The aim of this study was to determine the clinical findings and postoperative outcomes of radioulnar synostosis after isolated olecranon fracture in a child patient. A 14-year-old girl was evaluated after falling on her left elbow. She had pain, edema, and motion limitation in her left elbow. After radiologic examinations, diagnosis of olecranon fracture was made. Olecranon fracture was fixated by open reduction and internal fixation with tension band wiring method via the posterior approach. When the patient came to the control to remove the implants 9 months after the first operation, there was a limitation in the supination and pronation movements. In the radiographs, synostosis was observed in the proximal region between the radius and ulna. The patient was reoperated to remove the implants. In the same session, synostosis was excised by using the posterior approach, and a barrier between the bones was constituted with bone wax and early elbow range of motion exercises started. In the postoperative first month, the patient had full flexion and extension but with 30 degrees of supination deficit. Radioulnar synostosis is rare but can be seen after isolated olecranon fractures. Early elbow motion after radioulnar synostosis surgery helps the patient to increase joint movement.
Collapse
|