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De Crescenzo A, Garofalo R, Celli A. Internal joint stabilizer covered by an anconeus flap for elbow instability: surgical technique and preliminary results. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:476-484. [PMID: 39157257 PMCID: PMC11329043 DOI: 10.1016/j.xrrt.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Affiliation(s)
- Angelo De Crescenzo
- Department of Orthopaedic and Traumatology Surgery, Shoulder and Elbow Unit, Ente Ecclesiastico Ospedale “F. Miulli”, Acquaviva delle Fonti, Bari, Italy
| | - Raffaele Garofalo
- Department of Orthopaedic and Traumatology Surgery, Shoulder and Elbow Unit, Ente Ecclesiastico Ospedale “F. Miulli”, Acquaviva delle Fonti, Bari, Italy
| | - Andrea Celli
- Department of Orthopaedic Surgery, Shoulder and Elbow Unit, Hesperia Hospital, Modena, Italy
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Brule N, Ozdag Y, Koshinski JL, Luciani AM, Grandizio LC. Ulnohumeral Cross-Pinning in the Management of Traumatic Elbow Instability. J Hand Surg Am 2024:S0363-5023(24)00262-4. [PMID: 39001767 DOI: 10.1016/j.jhsa.2024.06.003] [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: 02/19/2024] [Revised: 05/31/2024] [Accepted: 06/12/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE Traumatic elbow instability (subluxation and dislocation) represents a challenging clinical entity that can be complicated by persistent intraoperative instability after attempted stabilization or recurrent postoperative instability. Both static and dynamic supplemental stabilization procedures have been described for cases where fracture fixation and ligament repair fail to restore stability. There is a paucity of prior studies involving ulnohumeral cross-pinning (UCP), which is a type of static supplemental stabilization. Our purpose was to assess complications and outcomes after UCP. METHODS We reviewed all surgical cases involving primary and revision UCP for traumatic elbow instability at a single center from 2017-2023. Baseline demographics were recorded. Outcomes including radiographs, range of motion, patient-reported outcome measures, and surgical complications were analyzed. RESULTS Fourteen patients undergoing UCP were included with a mean follow-up of 27 months. Five cross-pinnings (36%) were performed during revision procedures. Mean visual analog scale (VAS) pain, Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and the Single Assessment Numeric Evaluation (SANE) scores were 2.4, 34, and 69, respectively. The mean flexion-extension and pronation-supination arcs were 114° and 140°, with 85% achieving at least a 100° arc for flexion and forearm rotation. Five patients (36%) had complications, all of which required reoperation. Two complications involved postoperative instability: one radial head subluxation and one radial head dislocation. Both occurred in revision UCP cases indicated for recurrent postoperative instability. CONCLUSIONS Ulnohumeral cross-pinning for persistent and recurrent elbow instability results in maintained ulnohumeral joint alignment, functional arcs of elbow range of motion, and acceptable patient-reported outcome measures, particularly in the setting of a primary procedure indicated for persistent intraoperative instability. Ulnohumeral cross-pinning is a reasonable supplemental stabilization procedure for complex elbow instability. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Nick Brule
- Division of Hand and Upper-Extremity Surgery, Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger MSKI, Scranton, PA
| | - Yagiz Ozdag
- Division of Hand and Upper-Extremity Surgery, Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger MSKI, Scranton, PA
| | - Jessica L Koshinski
- Division of Hand and Upper-Extremity Surgery, Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger MSKI, Scranton, PA
| | - A Michael Luciani
- Division of Hand and Upper-Extremity Surgery, Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger MSKI, Scranton, PA
| | - Louis C Grandizio
- Division of Hand and Upper-Extremity Surgery, Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger MSKI, Scranton, PA.
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De Crescenzo A, Garofalo R, Pederzini LA, Celli A. The internal joint stabilizer for elbow instability: current concepts. J ISAKOS 2024; 9:482-489. [PMID: 38462216 DOI: 10.1016/j.jisako.2024.03.003] [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] [Received: 12/31/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/12/2024]
Abstract
The management of residual elbow instability is challenging in both acute and chronic injuries. Among the available devices, the hinged external fixator provides an additional joint stabilization while allowing an early motion, but it is clumsy and associated to high rate of pin track complications. To address these issues, an internal joint stabilizer (IJS) has been recently developed. An easier recreation of the axis of rotation coupled to the reduced lever arm of the hinge is the root of the consistent and satisfactory results thus far observed. In addition, the device is more comfortable for the patients being an internal stabilizer. Nonetheless, a second surgery for the device removal is necessary, of which the timing is still not standardized. This current concepts paper describes literature regarding outcomes of the IJS focusing on the rate of maintained radiographic joint reduction, the resultant range of motion, and the associated complication profile.
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Affiliation(s)
- Angelo De Crescenzo
- Ente Ecclesiastico Ospedale "F. Miulli", Department of Orthopaedic and Traumatology Surgery, Shoulder and Elbow Unit, Acquaviva delle Fonti, Bari, 70021, Italy.
| | - Raffaele Garofalo
- Ente Ecclesiastico Ospedale "F. Miulli", Department of Orthopaedic and Traumatology Surgery, Shoulder and Elbow Unit, Acquaviva delle Fonti, Bari, 70021, Italy
| | - Luigi Adriano Pederzini
- Nuovo Ospedale di Sassuolo, Department of Orthopaedic, Traumatology and Arthroscopic Surgeries, Modena, 41049, Italy
| | - Andrea Celli
- Hesperia Hospital, Department of Orthopaedic and Traumatology Surgery, Shoulder and Elbow Unit, Modena, 41125, Italy
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Ma CH, Wu CH, Chiu YC, Tsai KL, Jou IM, Tu YK. Using External Joint Stabilizer - Elbow (EJS-E) for treating elbow instability-biomechanical assessment and clinical outcomes. BMC Musculoskelet Disord 2022; 23:1137. [PMID: 36581852 PMCID: PMC9798638 DOI: 10.1186/s12891-022-06103-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the outcome of using an External Joint Stabilizer - Elbow (EJS-E) for persistent elbow instability based on biomechanical experiments and analysis of clinical results. METHODS An EJS-E was used in 17 elbow instability patients. The median follow-up was 26 months (range, 12-42 months). We evaluated the flexion-extension and pronation-supination movement arcs, visual analog scale (VAS) score, Mayo Elbow Performance Score (MEPS), Broberg and Morrey classification system, and occurrence of complications in these patients. Moreover, construct stiffness and maximum strength tests were performed to evaluate the strength of the fixation techniques. RESULTS The final median range of the extension-to-flexion and pronation-to-supination arc of the elbow was 135° (range, 110°-150°) and 165° (range, 125°-180°), respectively. The VAS pain scores were > 3 in two patients. The median MEPS was 90 (range, 80-100 points). Five patients showed signs of grade I post-traumatic osteoarthritis according to the Broberg and Morrey radiographic classification system, while grade II changes were observed in three patients. Complications included axis pin loosening with pin-tract infection in two patients, transient ulnar nerve symptoms in two patients, heterotopic ossification in two patients, and suture anchors infection in one patient. Based on the biomechanical testing results, the EJS-E exhibited higher stiffness and resisting force in varus loading. It was 0.5 (N/mm) stiffer and 1.8 (N·m) stronger than the internal joint stabilizer (IJS) by difference of medians (p < 0.05). CONCLUSIONS Biomechanical and clinical outcomes show that EJS-E via the posterior approach can restore mobility and stability in all patients, thus serving as a valuable alternative option for the treatment of persistent instability of the elbow.
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Affiliation(s)
- Ching-Hou Ma
- grid.411447.30000 0004 0637 1806Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, 1, E-Da Road, Kaohsiung City, Taiwan 824 Taiwan ,grid.411447.30000 0004 0637 1806School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chin-Hsien Wu
- grid.411447.30000 0004 0637 1806Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, 1, E-Da Road, Kaohsiung City, Taiwan 824 Taiwan ,grid.411447.30000 0004 0637 1806School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yen-Chun Chiu
- grid.411447.30000 0004 0637 1806Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, 1, E-Da Road, Kaohsiung City, Taiwan 824 Taiwan
| | - Kun-Ling Tsai
- grid.64523.360000 0004 0532 3255Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-Ming Jou
- grid.411447.30000 0004 0637 1806Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, 1, E-Da Road, Kaohsiung City, Taiwan 824 Taiwan
| | - Yuan-Kun Tu
- grid.411447.30000 0004 0637 1806Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, 1, E-Da Road, Kaohsiung City, Taiwan 824 Taiwan ,grid.411447.30000 0004 0637 1806School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
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Li XY, Wang YL, Yang S, Han PF. Radial head arthroplasty vs. open reduction and internal fixation for the treatment of terrible triad injury of the elbow: A systematic review and meta‑analysis update. Exp Ther Med 2022; 24:592. [PMID: 35949335 PMCID: PMC9353546 DOI: 10.3892/etm.2022.11529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/01/2022] [Indexed: 11/06/2022] Open
Abstract
Terrible triad injury of the elbow (TTIE) is a severe high-energy injury to the elbow, mainly including elbow dislocation, coronoid fracture and radial head fracture. It is difficult to maintain the stability of the elbow joint using traditional conservative treatment, and there is a high risk of redislocation and various complications. Therefore, surgical treatment is currently advocated, mainly for repairing damaged ligaments and reconstructing bony structures, but there is still controversy about the treatment plan for the radial head. The current meta-analysis was conducted to compare the differences in efficacy of radial head arthroplasty (RHA) and open reduction internal fixation (ORIF) in the treatment of TTIE. Published literature related to the treatment (either ORIF or RHA) of TTIE was searched for in Embase, PubMed, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, ProQuest Dissertations and Theses, Cochrane Library and Chinese Biomedical Literature Database. According to the search strategy, a total of 1,928 related publications were retrieved. The patient must have been diagnosed with TTIE and required surgery on the radial head. The interventions were RHA and ORIF. Non-case-control studies, case reports, review articles, letters, duplicate reports and literature without sufficient relevant data were excluded. The quality of the literature was evaluated according to the Cochrane systematic review methodology and the Jadad scale. After data extraction, meta-analysis was performed using ReviewManager 5.4 software (Cochrane). A total of 15 studies involving 455 patients (189 who underwent RHA and 266 who underwent ORIF) were included. Range of motion (ROM) of the forearm (pronation-supination arc) after surgery in the RHA group [95% CI (0.28, 9.59); P=0.04] was found to be significantly superior to the ORIF group, with a lower incidence of complications [95% CI (0.22, 0.84); P=0.01]. However, there was no statistically significant difference for the Mayo Elbow Performance Score, Disabilities of the Arm, Shoulder and Hand Score nor for ROM of the elbow (flexion-extension arc). Overall, compared with the ORIF group, the RHA group had better forearm rotational ROM and fewer complications after surgery. Therefore, RHA was found to be superior to ORIF in the treatment of TTIE.
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Affiliation(s)
- Xi-Yong Li
- Graduate School, Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Yun-Lu Wang
- Graduate School, Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Su Yang
- Graduate School, Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Peng-Fei Han
- Department of Orthopedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
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