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Luceri F, Cucchi D, Rosagrata E, Zaolino CE, Viganò M, de Girolamo L, Zagarella A, Catapano M, Gallazzi MB, Arrigoni PA, Randelli PS. Novel Radiographic Indexes for Elbow Stability Assessment: Part A-Cadaveric Validation. Indian J Orthop 2021; 55:336-346. [PMID: 34306546 PMCID: PMC8275710 DOI: 10.1007/s43465-021-00407-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/16/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Elbow bony stability relies primarily on the high anatomic congruency between the humeral trochlea and the ulnar greater sigmoid notch. No practical tools are available to distinguish different morphotypes of the proximal ulna and herewith predict elbow stability. The aim of this study was to assess inter-observer reproducibility, evaluate diagnostic performance and determine responsiveness to change after simulated coronoid process fracture for three novel elbow radiographic indexes. METHODS Ten fresh-frozen cadaver specimens of upper limbs from human donors were available for this study. Three primary indexes were defined, as well as two derived angles: Trochlear Depth Index (TDI); Posterior Coverage Index (PCI); Anterior Coverage Index (ACI); radiographic coverage angle (RCA); olecranon-diaphisary angle (ODA). Each index was first measured on standardized lateral radiographs and subsequently by direct measurement after open dissection. Finally, a type II coronoid fracture (Regan and Morrey classification) was created on each specimen and both radiographic and open measurements were repeated. All measurements were conducted by two orthopaedic surgeons and two dedicated musculoskeletal radiologists. RESULTS All three indexes showed good or moderate inter-observer reliability and moderate accuracy and precision when compared to the gold standard (open measurement). A significant change between the radiographic TDI and ACI before and after simulated coronoid fracture was observed [TDI: decrease from 0.45 ± 0.03 to 0.39 ± 0.08 (p = 0.035); ACI: decrease from 1.90 ± 0.17 to 1.58 ± 0.21 (p = 0.001)]. As expected, no significant changes were documented for the PCI. Based on these data, a predictive model was generated, able to identify coronoid fractures with a sensitivity of 80% and a specificity of 100%. CONCLUSION New, simple and easily reproducible radiological indexes to describe the congruency of the greater sigmoid notch have been proposed. TDI and ACI change significantly after a simulated coronoid fracture, indicating a good responsiveness of these parameters to a pathological condition. Furthermore, combining TDI and ACI in a regression model equation allowed to identify simulated fractures with high sensitivity and specificity. The newly proposed indexes are, therefore, promising tools to improve diagnostic accuracy of coronoid fractures and show potential to enhance perioperative diagnostic also in cases of elbow instability and stiffness. LEVEL OF EVIDENCE Basic science study. CLINICAL RELEVANCE The newly proposed indexes are promising tools to improve diagnostic accuracy of coronoid fractures as well as to enhance perioperative diagnostic for elbow instability and stiffness.
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Affiliation(s)
- Francesco Luceri
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Venurberg-Campus 1, 53127 Bonn, Germany
| | - Enrico Rosagrata
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Residency Program, Università Degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Carlo Eugenio Zaolino
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Marco Viganò
- Laboratorio di Biotecnologie Applicate All’Ortopedia, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Laura de Girolamo
- Laboratorio di Biotecnologie Applicate All’Ortopedia, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Andrea Zagarella
- Servizio di Radiologia, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Michele Catapano
- Servizio di Radiologia, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Mauro Battista Gallazzi
- Servizio di Radiologia, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Paolo Angelo Arrigoni
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Pietro Simone Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
- U.O.C. 1° Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
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Luceri F, Arrigoni P, Barco R, Cucchi D, Raj N, Frassoni S, Randelli PS. Does Sawbone-Based Arthroscopy Module (SBAM) Can Help Elbow Surgeons? Indian J Orthop 2021; 55:182-188. [PMID: 34113427 PMCID: PMC8149533 DOI: 10.1007/s43465-020-00133-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/30/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The use of elbow arthroscopy is becoming increasingly common in orthopaedic practice; nevertheless, it is still considered a difficult procedure with a long learning curve. The aim of the study is to evaluate the role of a new elbow Sawbone-Based Arthroscopy Module (e-SBAM) in the training of elbow surgeons. METHODS Fourteen surgeons were classified as "Expert" (n: 7; more than 10 years of experience in arthroscopic surgery) and "Not-expert" surgeons (n: 7; less than 10 years of experience). During a dedicated arthroscopic session, using the Sawbones Elbow model (Sawbones Europe AB®), all participants were asked to perform an arthroscopic round and to touch three specific landmarks. An independent observer measured the time that each participant needed to perform this task (Performance 1). The same measurement was repeated after two weeks of eSBAM training (Performance 2). RESULTS "Not-expert" surgeons needed significantly more time (41 s; range 26-120) than "Expert" ones (13 s; range 8-36) to complete Performance 1. One "Not-expert" surgeon did not complete Performance 1 and needed more than 120 s for Performance 2. The whole study group required a median of 5 s less to complete Performance 2. A tendency towards an improvement was observed in the group of the non-experienced surgeons as compared with the experienced ones. CONCLUSIONS The simulation training can be advantageous in the learning curve of young elbow surgeons and helpful for experienced surgeons. E-SBAM can be used as an effective tool for the current stepwise arthroscopic elbow training programs with the aim of improving arthroscopic elbow skills. LEVEL OF EVIDENCE Basic Science Study.
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Affiliation(s)
- Francesco Luceri
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy
| | - Paolo Arrigoni
- U.O. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Raul Barco
- Shoulder and Elbow Unit, Hospital Universitario la Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Davide Cucchi
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Nishant Raj
- Krishna Hospital and Trauma Centre, Patel Nagar Ghaziabad, Uttar Pradesh 201001 India
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy
| | - Pietro Simone Randelli
- U.O. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
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Luceri F, Cucchi D, Pichierri I, Zaolino CE, Menon A, Nikhil JM, Arrigoni PA, Randelli PS. Validation of a Practical Forearm Supination Strength Measurement Technique in the Large Sample Cohort. Indian J Orthop 2020; 54:292-296. [PMID: 33194104 PMCID: PMC7609524 DOI: 10.1007/s43465-020-00239-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/17/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The strength of forearm in pronation and supination (P/S) is an important clinical assessment during pre-operative examination as well as in post-operative evaluation. Many clinical trials concerning the measurement of forearm P/S strength were performed using a dynamometer fixed on the wall. The aim of this study was to bring out a simple and reliable technique for the measurement of P/S strength using a dynamometer manually supported and stabilized by an examiner. We hypothesized that there are no differences in evaluation of elbow P/S strength using the dynamometer fixed or the dynamometer stabilized by an operator in healthy people. METHODS The study was performed on a cross-sectional cohort of 100 healthy subjects without any history of injuries or previous surgery of the upper limbs. Isometric forearm P/S strengths were measured on the dominant and non-dominant forearms, using the dynamometer fixed on a table, and using the same dynamometer kept by an operator. The measurements were repeated in triplicate at 45°, 90° and 120° of elbow flexion in both upper limbs for all patients. RESULTS A total of 100 subjects (50 females, 50 males) were included in the study group. The mean age was 46.5 years (range 25-52 years). Female and male subjects showed no significant differences concerning the mean age (F/M ratio 0.50/0.50). The mean body mass index of all participants was 24.34 ± 3.66 kg/m2.No significant statistics difference was reported between the P/S strength measured using the two detection methods in our study group (45°, 90° and 120° of elbow flexion and both upper limbs). CONCLUSION The manually stabilized technique is a valid and reliable technique to assess the P/S strength of the forearm. This is a simple and effective method that may be reproduced in our daily clinical practice as well as in sportive practice.
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Affiliation(s)
- Francesco Luceri
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Sigmund- Freud-Str. 25, 53127 Bonn, Germany
| | - Ivan Pichierri
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Carlo Eugenio Zaolino
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Alessandra Menon
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Laboratorio di Biomeccanica Applicata, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | | | - Paolo Angelo Arrigoni
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Pietro Simone Randelli
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Laboratorio di Biomeccanica Applicata, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
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