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Wintges K, Cramer C, Mader K. Missed Monteggia Injuries in Children and Adolescents: A Treatment Algorithm. CHILDREN (BASEL, SWITZERLAND) 2024; 11:391. [PMID: 38671608 PMCID: PMC11049118 DOI: 10.3390/children11040391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
Monteggia injuries are rare childhood injuries. In 25-50% of cases, however, they continue to be overlooked, leading to a chronic Monteggia injury. Initially, the chronic Monteggia injury is only characterized by a moderate motion deficit, which is often masked by compensatory movements. Later, however, there is a progressive valgus deformity, neuropathy of the ulnar nerve and a progressive deformity of the radial head ("mushroom deformity") with ultimately painful radiocapitellar arthrosis. In the early stages, when the radial head is not yet deformed and there is no osteoarthritis in the humeroradial joint, these injuries can be treated with reconstruction procedures. This can be achieved either by an osteotomy of the proximal ulna with or without gradual lengthening. If there is already a severe deformity of the radial head and painful osteoarthritis, only rescue procedures such as functional radial head resection or radial head resection with or without hemi-interposition arthroplasty can be used to improve mobility and, above all, to eliminate pain. In this review article, we provide an overview of the current treatment options of chronic Monteggia injury in children and adolescents and present a structured treatment algorithm depending on the chronicity and dysplastic changes.
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Affiliation(s)
- Kristofer Wintges
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christopher Cramer
- Division Hand, Forearm and Elbow Surgery, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Konrad Mader
- Division Hand, Forearm and Elbow Surgery, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
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Javadi A, Ahmadi Z, Kachooei AR. Short- to Mid-term Results of Patient-Specific Polymethylmethacrylate Radial Head Prosthesis in Complex Radial Head Fractures Using 3-Dimensional Mold System. J Hand Surg Asian Pac Vol 2023; 28:398-408. [PMID: 37501547 DOI: 10.1142/s2424835523500431] [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: 07/29/2023]
Abstract
Background: We used antibiotic-impregnated polymethylmethacrylate (PMMA) bone cement to make a patient-specific radial head prosthesis (RHP) by applying the 3-dimensional (3D) designing technique in patients with Mason types 3 and 4 radial head fractures. The aim of this study is to report the short- to mid-term outcomes of this procedure. Methods: This is a prospective study of all patients who underwent a patient-specific PMMA bone cement RHP at our institute over a 1-year period from May 2017 to June 2018. The outcome measures included range of motion, grip strength, visual analogue scale (VAS) for pain at rest and at activity, disabilities of arm, shoulder and hand (DASH) score and Mayo elbow performance index (MEPI). Radiographs of the elbow ere obtained at final follow-up and any complications were also recorded. Results: Our study included eight patients with a mean follow-up of 18 months (13-20 months). The mean arc of extension-flexion and supination-pronation of the operated side was 86% and 96% of the unaffected side, respectively. Mean grip strength was 86% of the unaffected side. The mean VAS for pain at rest was 0 and during activity was 2 out of 10. The mean DASH score was 8 out of 100 (0-22), showing minimal disability and ability to cope with most living activities. MEPI showed four excellent, three good and one fair result. One patient complained of proximal forearm pain that appeared 1 year after surgery. No patient complained of ulnar nerve symptoms requiring intervention. No RHP was removed during the follow-up. Conclusions: PMMA RHP can be used safely as an alternative to metal prostheses to restore valgus and axial stability of the forearm. The use of 3D printing optimised the design and surgical technique of radial head arthroplasty, and we need further studies to assess the long-term follow-ups. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Aidin Javadi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Ahmadi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir R Kachooei
- Rothman Orthopaedics Florida at AdventHealth, Orlando, FL, USA
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Kwak JM, Lee KW, Jung GH, Kholinne E, Hwang SJ, Koh KH, Jeon IH. Biomechanical impact of elbow motion in elbow stiffness. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05781-2. [PMID: 37010561 DOI: 10.1007/s00264-023-05781-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/13/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND A mechanical block in the elbow due to osteophytes in the olecranon fossa is a common clinical symptom for elbow stiffness. PURPOSE/HYPOTHESIS This study aims to understand the biomechanical characteristics or changes in the stiff elbow in the resting (or neutral) and swing position of the arm using a cadaveric model. The hypotheses included the following: (1) a difference exists in the articular contact pressure of the elbow by comparing the non-stiff and stiff models in in vivo studies; (2) the degree of stiffness would affect the increase of the joint loading of the elbow. STUDY DESIGN Controlled laboratory study, cadaveric study. METHODS Eight fresh-frozen specimens from individuals of both sexes were included in the biomechanical study. The specimen was mounted on a custom-designed jig system with gravity-assisted muscle contracture to mimic the elbow in a standing position. The elbow was tested in two conditions (the resting and passive swing). Contact pressure was recorded for three seconds in the resting position, which was the neutral position of the humerus. By dropping the forearm from 90° of the elbow flexion, the passive swing was performed. The specimens were tested sequentially in three stages of stiffness (stage 0, no stiffness; stage 1, 30° of extension limitation; and stage 2, 60° of extension limitation). After data collection was completed in stage 0, a stiff model was sequentially created for each stage. The stiff model of the elbow was created by blocking the olecranon by inserting a 2.0 K-wire into the olecranon fossa horizontally with the intercondylar axis. RESULTS The mean contact pressures were 279 ± 23, 302 ± 6, and 349 ± 23 kPa in stages 0, 1, and 2, respectively. The increases in the mean contact pressure in stages 2 versus 0 were significant (P < 0.0001). The mean contact pressures were 297 ± 19, 310 ± 14, and 326 ± 13 kPa in stages 0, 1, and 2, respectively. The peak contact pressures were 420 ± 54, 448 ± 84, and 500 ± 67 kPa in stages 0, 1, and 2, respectively. The increases in mean contact pressure in stage 2 versus 0 were significant (P = 0.039). The increases in peak contact pressure in stages 0 versus 2 were significant (P = 0.007). CONCLUSIONS The elbow bears the load created by gravity and muscle contracture in the resting and swing motion. Moreover, extension limitation of stiff elbow increases the load bearing in the resting position and swing motion. Careful surgical management should be considered for meticulous clearance of bony spur around olecranon fossa to resolve the extension limitation of the elbow.
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Affiliation(s)
- Jae-Man Kwak
- Department of Orthopedic Surgery, College of Medicine, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, South Korea
| | - Kwang Won Lee
- Shoulder and Elbow Clinic, Daejeon Woori Hospital, Daejeon, South Korea
| | - Gu-Hee Jung
- Department of Orthopedic Surgery, College of Medicine, Gyeongsang National University, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, Faculty of Medicine, Universitas Trisakti, St Carolus Hospital, Jakarta, Indonesia
| | - Seung Jun Hwang
- Department of Anatomy, College of Medicine, Ulsan University, Seoul, Korea
| | - Kyoung Hwan Koh
- Department of Orthopedic Surgery, College of Medicine, Asan Medical Center, Ulsan University, Seoul, South Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, College of Medicine, Asan Medical Center, Ulsan University, Seoul, South Korea.
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Kwak JM, Rotman D, Lievano JR, Xue M, O'Driscoll SW. The role of the lateral part of the distal triceps and the anconeus in varus stability of the elbow: a biomechanical study. J Shoulder Elbow Surg 2023; 32:159-167. [PMID: 36167289 DOI: 10.1016/j.jse.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/26/2022] [Accepted: 08/11/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The role of the lateral part of the distal triceps as a stabilizer in the lateral collateral ligament-deficient elbow and whether its effect in improving the stability is independent of that of the anconeus are unclear. METHODS Seven cadaveric elbows were tested under gravity varus stress using a custom-made machine designed to simulate muscle loads while allowing passive flexion of the elbow. An injury model was created by sectioning the lateral collateral ligament and sparing the common extensor origin. The lateral part of the distal triceps tendon was loaded sequentially with 0 N, 10 N, 25 N, and 40 N. Each stage of the lateral part of the distal triceps loading was tested with the anconeus unloaded (inactive) or with a 25-N load applied (active). Articular contact pressures on the coronoid, the medial facet, and the lateral facet were collected and processed using Tekscan sensors and software. RESULTS A significant decrease in the mean coronoid contact pressure was seen with sequential loading of the lateral part of the distal triceps (P < .001). The ratio of medial to lateral facet contact pressures significantly decreased with sequential loading of the lateral part of the distal triceps (P < .001), indicating a better distribution of the contact pressure between the medial and lateral facets as the lateral part of the distal triceps was loaded. These effects were statistically significant, both with and without anconeus loading. There was no significant modification of the effect of the lateral part of the distal triceps loading on the contact pressure by the anconeus loading (P = .47). However, with active anconeus loading, the contact pressure and the ratio of medial to lateral facet contact pressures were significantly lower for any stage of lateral triceps loading (P < .001), indicating a synergistic effect of the anconeus. CONCLUSIONS In a lateral collateral ligament-deficient elbow, the lateral part of the distal triceps loading prevents the increased contact pressure on the coronoid under varus stress and improves the distribution of contact pressures on the coronoid. Anconeus loading further decreases and improves the distribution of the contact pressures; however, its effect is independent of that of the lateral part of the distal triceps. These results substantiate a role of the lateral part of the distal triceps as a dynamic constraint against elbow varus and have clinical implications for prevention and rehabilitation of elbow instability.
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Affiliation(s)
- Jae-Man Kwak
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, College of Medicine, Eulji University, Uijeongbu, Republic of Korea
| | - Dani Rotman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Mingqiang Xue
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Qingxiu District of Nanning City, Guangxi, China
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Kwak JM, Rotman D, Lievano JR, Fitzsimmons JS, O'Driscoll SW. The role of the lateral collateral ligament-capsule complex of the elbow under gravity varus. J Shoulder Elbow Surg 2023; 32:150-158. [PMID: 36167291 DOI: 10.1016/j.jse.2022.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/26/2022] [Accepted: 08/11/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The lateral collateral ligament complex along with the capsule is likely to be at risk during arthroscopic extensor carpi radialis brevis release for lateral epicondylitis. We hypothesized that disruption of the lateral collateral ligament-capsule complex (LCL-cc) would increase the mean contact pressure on the coronoid under gravity varus. MATERIALS AND METHODS Eight cadaveric elbows were tested via gravity varus and weighted varus (2 Nm) stress tests using a custom-made machine designed to simulate muscle loads while allowing passive flexion of the elbow. Mean articular surface contact pressure data were collected and processed using intra-articular thin-film sensors and software. Sequential testing was performed on each specimen from stage 0 to stage 3 (stage 0, intact; stage 1, release of anterior one-third of LCL-cc; stage 2; release of anterior two-thirds of LCL-cc; and stage 3, release of entire LCL-cc). The mean contact pressure on the coronoid and the mean ratio of contact pressure on the medial coronoid to that on the lateral coronoid (M/L ratio) were used for comparisons among the stages and the intact elbow. RESULTS The overall mean contact pressure significantly increased in stage 2 (P = .0004 in gravity varus and P = .0001 in weighted varus) and stage 3 (P < .0001 in gravity varus and P < .0001 in weighted varus) compared with that in stage 0. In contrast, release of the anterior one-third of the LCL-cc (stage 1) did not significantly increase the mean contact pressure on the coronoid in any degree of flexion under gravity varus (P = .09) or weighted varus loading (P = .6). The M/L ratio difference between stage 0 and stage 1 was 1.1 ± 1.1 under gravity varus (P = .8) and 2.1 ± 1.0 under weighted varus (P = .2). The overall M/L ratios in stage 2 and stage 3 were significantly higher than those seen in stage 0 under gravity varus (P = .04 in stage 2 and P = .02 in stage 3) and weighted varus (P = .006 in stage 2 and P < .0001 in stage 3). CONCLUSIONS Loss of the anterior two-thirds or more of the LCL-cc significantly increases the overall mean contact pressure on the coronoid, especially the medial coronoid, under both gravity varus and weighted varus. The LCL-cc also plays a role in the distribution of coronoid contact pressure against gravity varus loads.
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Affiliation(s)
- Jae-Man Kwak
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, College of Medicine, Eulji University, Uijeongbu, Republic of Korea
| | - Dani Rotman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ramazanian T, Müller-Lebschi JA, Merlet MCH, Lee H, Vaichinger AM, Fitzsimmons JS, O'Driscoll SW. Effect of Radiocapitellar Joint Over/Under Stuffing on Elbow Joint Contact Pressure. J Hand Surg Am 2022; 48:403.e1-403.e9. [PMID: 36229309 DOI: 10.1016/j.jhsa.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 10/08/2021] [Accepted: 11/17/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE Comminuted radial head fractures are commonly treated by surgical resection or replacement with a prosthesis. A potential problem with radial head replacement is overlengthening of the radial neck ("overstuffing" of the radial head), which has been shown to affect both ulnohumeral kinematics and radiocapitellar pressures. We hypothesized that an overstuffed radial head prosthesis increases capitellar pressure and reduces coronoid pressure. METHODS Seven human cadaveric elbows were prepared on a custom-designed apparatus simulating stabilizing muscle loads, and passively flexed from 0° to 90° under gravity valgus torque while joint contact pressures were measured. Each elbow was tested sequentially with different neck lengths, starting with the intact specimen followed by insertion of understuffed (-2 mm), standard-height (0 mm), and overstuffed (+2 mm) radial head prostheses in neutral forearm rotation, 40° pronation, and 40° supination positions, respectively. RESULTS Capitellar mean contact pressures significantly increased after insertion of an overstuffed radial head prosthesis. In valgus position with neutral forearm rotation, capitellar mean contact pressure on the joint with an intact radial head averaged 227 ± 70 kPa. Insertion of understuffed, standard-height, and overstuffed radial head prostheses changed the mean contact pressures to 152 ± 76 kPa, 212 ± 68 kPa, and 491 ± 168 kPa, respectively. The overstuffed radial head group had significantly lower whole coronoid mean contact pressures (153 ± 56 kPa) compared with the intact (390 ± 138 kPa) and standard-height (376 ± 191 kPa) radial head groups. CONCLUSIONS An increase in radial prosthesis height significantly increases capitellar contact pressures and reduces coronoid contact pressures. CLINICAL RELEVANCE Restoration of the anatomic radial head height is critical when performing radial head arthroplasty to maintain normal joint biomechanics. Elevated capitellar contact pressures can potentially lead to pain and early degenerative changes.
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Affiliation(s)
- Taghi Ramazanian
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | | | - HoMin Lee
- Department of Orthopedics, College of Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Anthony M Vaichinger
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - James S Fitzsimmons
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Shawn W O'Driscoll
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
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Ramazanian T, Müller-Lebschi JA, Yao Chuang M, Vaichinger AM, Fitzsimmons JS, O’Driscoll SW. Effect of incremental increase in radial neck height on coronoid and capitellar contact pressures. Shoulder Elbow 2021; 13:445-450. [PMID: 34394742 PMCID: PMC8355654 DOI: 10.1177/1758573219881772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/28/2019] [Accepted: 09/13/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Over-lengthening of the radial neck has been shown to affect ulnohumeral kinematics and has been proposed to affect radiocapitellar pressures. We hypothesized that an incremental increase in radial neck height increases the capitellar contact pressure and reduces the coronoid contact pressure. Knowledge of the effects of over-lengthening is clinically important in preventing pain and degenerative changes due to overstuffing. METHODS Six human cadaveric elbows were prepared on a custom-designed apparatus simulating muscle loads and passive flexion from 0° to 90° under gravity valgus torque while measuring joint contact pressures in this biomechanical study. Each elbow was tested sequentially starting with the intact specimen followed by insertion of a radial head prosthesis with 0, +2, and +4 mm of radial neck height, respectively. RESULTS Capitellar mean contact pressures significantly increased after insertion of +2 and +4 mm radial head prostheses (p < 0.03). The capitellar mean contact pressure with a 0 mm radial head prosthesis was 97 KPa. Insertion of +2 mm and +4 mm radial heads increased mean contact pressures to 391 KPa (p = 0.001) and 619 KPa (p = 0.001), respectively, with 90° of elbow flexion. DISCUSSION Increasing radial prosthesis height by 2 mm significantly increases capitellar contact pressures and reduces coronoid contact pressures.
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Affiliation(s)
- Taghi Ramazanian
- Department of Orthopedics, Biomechanics
Laboratory, Mayo Clinic, Rochester, MN, USA
| | | | - Min Yao Chuang
- Department of Orthopedics, MacKay Memorial
Hospital, Taipei
| | - Anthony M Vaichinger
- Department of Orthopedics, Biomechanics
Laboratory, Mayo Clinic, Rochester, MN, USA
| | - James S Fitzsimmons
- Department of Orthopedics, Biomechanics
Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Shawn W O’Driscoll
- Department of Orthopedics, Biomechanics
Laboratory, Mayo Clinic, Rochester, MN, USA,Shawn W O’Driscoll, Mayo Clinic, 200 First St, SW
Rochester, MN 55905, USA.
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Degenerative changes in the elbow joint after radial head excision for fracture: quantitative 3-dimensional analysis of bone density, stress distribution, and bone morphology. J Shoulder Elbow Surg 2021; 30:e199-e211. [PMID: 33152499 DOI: 10.1016/j.jse.2020.09.035] [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: 02/28/2020] [Revised: 09/21/2020] [Accepted: 09/29/2020] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS AND BACKGROUND Some investigators speculate that excision may lead to elbow arthritis and associated problems; however, evidence supporting this theory is limited. It is hypothesized that radial head excision causes bone density changes as a result of asymmetrical stress distributions, consequently leading to osteophyte formation. In this study, we sought to quantitatively compare the 3-dimensional (3D) bone density and stress distributions between operative and nonoperative elbows in patients who underwent radial head excision. Furthermore, we aimed to quantify the bone morphologic changes using 3D models in the same cohort. METHODS After retrospective identification, this study enrolled 6 patients who had undergone radial head excision for radial head fractures. We created 3D bone models using computed tomography data obtained from the injured and uninjured elbows. Humerus and ulna models were divided into anatomic regions, and the bone density of each region was assessed and described by its percentage of high-density volume (%HDV). We also constructed finite element models and measured the stress values in each region. Furthermore, we compared the bone morphology by superimposing the operative elbow onto the mirror image of the nonoperative elbow. RESULTS The mean interval from radial head excision to examination was 8.4 ± 3.3 years. The %HDV on the operative side was higher than that of the nonoperative side at the anterolateral trochlea (77.5% ± 6.5% vs. 64.6% ± 4.0%, P = .028) and posterolateral trochlea (70.7% ± 7.8% vs. 63.1% ± 3.8%, P = .034) regions of the distal humerus. Reciprocal changes were observed in the proximal ulna, as %HDV was higher in the lateral coronoid (52.6% ± 9.6% vs. 34.2% ± 6.6%, P = .007). The stress distributions paralleled the bone density measurements. The operative elbows demonstrated an enlarged capitellum and a widened and deepened trochlea with osteophyte formation compared with the nonoperative side. DISCUSSION AND CONCLUSION In elbows treated with radial head excision, we identified asymmetrical bone density and stress alterations on the lateral side of the ulnohumeral joint and bone morphologic changes across the joint. These data support the theory that radial head excision contributes to ulnohumeral arthritis over the long term.
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Factor S, Rotman D, Pritsch T, Allon R, Tordjman D, Atlan F, Rosenblatt Y. Radial head excision and Achilles allograft interposition arthroplasty for the treatment of chronic pediatric radiocapitellar pathologies: A report of four cases. Shoulder Elbow 2021; 13:213-222. [PMID: 33897853 PMCID: PMC8039757 DOI: 10.1177/1758573219897859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/29/2019] [Accepted: 10/09/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Severe radiocapitellar pathologies represent a unique problem in the pediatric population, as radial head excision can lead to substantial long-term complications. We present a case series of four pediatric patients treated by a novel technique-radial head excision followed by Achilles allograft interposition arthroplasty. METHODS Four children (ages 12-15 years) are described. Their clinical and radiographic outcomes were assessed by a visual analog scale, the Mayo Elbow Performance Score, the Disabilities of the Arm, Shoulder and Hand questionnaire, grip strength, and range of motion. RESULTS At a mean follow-up of two years, the average flexion-extension arc of motion improved from 107° to 131°, and the rotation arc improved from 100° to 154°. The average visual analog scale, Mayo Elbow Performance Score, and Disabilities of the Arm, Shoulder and Hand scores were 2, 92.5, and 11.5, respectively. Two patients required subsequent additional procedures-manipulation under anesthesia and ulnar shortening osteotomy. Proximal migration of the radius was observed in three out of the four patients. DISCUSSION Combined radial head excision and Achilles allograft interposition arthroplasty represents a viable option for the treatment of chronic pediatric radiocapitellar pathologies, with good results in terms of clinical and functional outcomes as well as patient satisfaction in the short-medium term.
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Affiliation(s)
- Shai Factor
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Shai Factor, Orthopedic Division, Tel Aviv Medical Center, 6 Weitzman St., Tel Aviv 6423906, Israel.
| | - Dani Rotman
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Pritsch
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raviv Allon
- Rappaport Faculty of Medicine, The Technion—Israel Institute of Technology, Haifa, Israel
| | - Daniel Tordjman
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Franck Atlan
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishai Rosenblatt
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hosseini-Farid M, Ramzanpour M, McLean J, Ziejewski M, Karami G. Rate-dependent constitutive modeling of brain tissue. Biomech Model Mechanobiol 2019; 19:621-632. [PMID: 31612343 DOI: 10.1007/s10237-019-01236-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022]
Abstract
In this paper, the dynamic behavior of bovine brain tissue, measured from a set of in vitro experiments, is investigated and represented through a nonlinear viscoelastic constitutive model. The brain samples were tested by employing unconfined compression tests at three different deformation rates of 10, 100, and 1000 mm/s. The tissue exhibited a significant rate-dependent behavior with different compression speeds. Based on the parallel rheological framework approach, a nonlinear viscoelastic model that captures the key aspects of the rate dependency in large-strain behavior was introduced. The proposed model was numerically calibrated to the tissue test data from three different deformation rates. The determined material parameters provided an excellent constitutive representation of tissue response in comparison with the test results. The obtained material parameters were employed in finite element simulations of tissue under compression loadings and successfully verified by the experimental results, thus demonstrating the computational compatibility of the proposed material model. The results of this paper provide groundwork in developing a characterization framework for large-strain and rate-dependent behavior of brain tissue at moderate to high strain rates which is of the highest importance in biomechanical analysis of the traumatic brain injury.
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Affiliation(s)
| | | | - Jayse McLean
- Department of Mechanical Engineering, North Dakota State University, Fargo, ND, 58104, USA
| | - Mariusz Ziejewski
- Department of Mechanical Engineering, North Dakota State University, Fargo, ND, 58104, USA
| | - Ghodrat Karami
- Department of Mechanical Engineering, North Dakota State University, Fargo, ND, 58104, USA.
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