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Koukos C, Kotsapas M, Sidiropoulos K, Traverso A, Bilsel K, Montoya F, Arrigoni P. A Novel Surgical Treatment Management Algorithm for Elbow Posterolateral Rotatory Instability (PLRI) Based on the Common Extensor Origin Integrity. J Clin Med 2024; 13:2411. [PMID: 38673685 PMCID: PMC11051432 DOI: 10.3390/jcm13082411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Here, we introduce a comprehensive treatment algorithm for posterolateral rotatory instability (PLRI) of the elbow, a condition affecting elbow mobility. We outline a diagnostic approach and a novel surgical management plan through the arthroscopic surgeon's point of view. Methods: The central focus of this management approach is the integrity of common extensor origin (CEO). High clinical suspicion must be evident to diagnose PLRI. Special clinical and imaging tests can confirm PLRI but sometimes the final confirmation is established during the arthroscopic treatment. The most appropriate treatment is determined by the degree of CEO integrity. Results: The treatment strategy varies with the CEO's condition: intact or minor tears require arthroscopic lateral collateral ligament imbrication, while extensive tears may need plication reinforced with imbrication or, in cases of retraction, a triceps tendon autograft reconstruction of the lateral ulnar collateral ligament alongside CEO repair. These approaches aim to manage residual instability and are complemented using a tailored rehabilitation protocol to optimize functional outcomes. Conclusion: PLRI is a unique clinical condition and should be treated likewise. This algorithm offers valuable insights for diagnosing and treating PLRI, enhancing therapeutic decision-making.
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Affiliation(s)
- Christos Koukos
- Medical Center Wuppertal, 42329 Wuppertal, Germany;
- Sports Trauma and Pain Ιnstitute, 54655 Thessaloniki, Greece
| | - Michail Kotsapas
- Orthopaedic Department, General Hospital of Naousa, 59200 Naousa, Greece
| | - Konstantinos Sidiropoulos
- Medical School of Patras, University of Patras, 26504 Patras, Greece
- Emergency Department, Papageorgiou General Hospital of Thessaloniki, 54635 Thessaloniki, Greece
| | - Aurélien Traverso
- Orthopaedic Department, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland
- ASST Pini-CTO, 20122 Milan, Italy
| | - Kerem Bilsel
- Faculty of Medicine, Acibadem Mehmet Ali Aydınlar University, 34752 Instanbul, Turkey;
- Orthopaedics and Traumatology Department, FulyaAcibadem Hospital, 34349 Instanbul, Turkey
| | - Fredy Montoya
- Sanatorio Aleman Clinic, Universidad de Concepcion, Concepcion 4070386, Chile;
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Weng L, Zhang G, Zhou H, Liu X, Cao Y, Zhang Y. Arthroscopically assisted closed reduction for displaced lateral humeral condyle fractures over 4 mm in children. Injury 2024; 55:111309. [PMID: 38199074 DOI: 10.1016/j.injury.2023.111309] [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: 10/25/2023] [Revised: 12/30/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Lateral humeral condyle fractures (LHCFs) are the most common intra-articular fracture occurring at the elbow in children. Conventional treatment for displaced pediatric LHCFs is open reduction and percutaneous pinning, and few studies have regarded the efficacy of arthroscopic-assisted techniques. We aimed to evaluate the efficacy of anatomic reduction via elbow arthroscopy for pediatric humeral lateral condyle fractures with displacements >4 mm. METHODS A total of 32 children with LHCFs featuring displacements >4 mm were enrolled in this retrospective study. Arthroscopically assisted reduction was performed as the primary treatment approach. For simple displaced fractures, arthroscopically assisted reduction was directly employed with intermittent intra-articular irrigation. For fractures with distal fragment rotation, the rotated fragments were firstly realigned into a simple displaced position under fluoroscopy before proceeding with arthroscopy. The success rate of arthroscopically assisted reduction and clinical outcomes at the latest follow-up were assessed, and complications related to the procedure were monitored. RESULTS Twenty-nine of 32 (90.62 %) enrolled cases were successfully treated with arthroscopically assisted reduction. Failure cases were attributed to soft tissue swelling, which hindered the manipulation of the fracture fragments for reduction or fixation. We subsequently adapted the surgical procedure, resulting in a significant increase in the success of arthroscopically assisted reduction, rising from 71.43 % to 96 %. Among the 29 successfully treated cases, excellent functional outcomes were observed in 18 cases, and 11 cases showed good outcomes. Regarding the carrying angle outcomes, 28 patients achieved excellent results, with one patient having a good outcome. The most frequent radiographic finding after surgery was lateral spur formation without further negative effects. Only one case of superficial infection occurred, promptly healing with topical management. No significant complications such as neurovascular injury or compartment syndrome were observed. CONCLUSION Arthroscopically assisted anatomic reduction provides a promising alternative to open reduction for LHCFs with displacements exceeding 4 mm, offering direct visualization of the articular surface and minimizing soft tissue dissection.
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Affiliation(s)
- Liuqi Weng
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China
| | - Ge Zhang
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China
| | - Hai Zhou
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China
| | - Xing Liu
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China
| | - Yujiang Cao
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China
| | - Yuan Zhang
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China.
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Pierreux P, Caekebeke P, van Riet R. The role of arthroscopy in instability of the elbow. JSES Int 2023; 7:2594-2599. [PMID: 37969538 PMCID: PMC10638551 DOI: 10.1016/j.jseint.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Pieter Pierreux
- Department of Orthopaedics and Traumatology, Orthoclinic Brugge, AZ Sint-Jan AV, Brugge, Belgium
| | - Pieter Caekebeke
- Department of Orthopedic Surgery and Traumatology, Genk, Belgium
| | - Roger van Riet
- Department of Orthopedic Surgery, AZ Monica and University of Antwerp, Antwerp, Belgium
- Orthopedic Specialists, Harley Street Specialist Hospital, London, United Kingdom
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Moreno-Castillo C, Echeverría JT, Martinez FT, Reinares F. Evaluation of Surgical Approaches to Management of Traumatic Posteromedial Elbow Instability Syndrome: A Systematic Literature Review Protocol. Cureus 2023; 15:e47880. [PMID: 38021946 PMCID: PMC10681372 DOI: 10.7759/cureus.47880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Posteromedial Instability Syndrome of the Elbow (PMIE) is a condition that arises from injuries to the stabilizing structures of the elbow joint, such as the coronoid process or ulnar lateral collateral ligament. Surgical treatment is commonly performed, but there is uncertainty regarding its results. This systematic review will synthesise the available evidence regarding the efficacy of surgical approaches to PMIE. Published and unpublished primary studies that regard outcomes of patients treated for PMIE, irrespective of approach, will be considered for inclusion. Iterative searches will be performed in the PubMed/MEDLINE, EMBASE, and Cochrane CENTRAL repositories from their inception to May 2023. Grey literature repositories will also be searched. The Cochrane risk of bias tool will be used to assess the quality of eligible interventional studies, while the MINORS tool will be employed for observational studies. If possible, a meta-analysis based on the random-effects model will be conducted. Heterogeneity will be assessed using Cochrane's Q and I2 statistics, and explored through subgroup analyses and sensitivity analyses. Relevant outcomes will include elbow joint functionality as assessed by validated scales, the proportion of patients returning to usual daily life activities, the development of recurrent joint instability in the postoperative period, quality of life and the development of postoperative arthritis. This protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) at the University of York. Its registration number is CRD42023451516.
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Affiliation(s)
| | | | - Felipe T Martinez
- Investigación Clínica, Concentra Educación e Investigación Biomédica, Viña del Mar, CHL
- Medicina Interna, Escuela de Medicina, Universidad Andrés Bello, Viña del Mar, CHL
| | - Felipe Reinares
- Traumatology, Hospital Clínico Mutual de Seguridad, Santiago, CHL
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Longo UG, Papalia R, De Salvatore S, Piccioni V, Tancioni A, Piergentili I, Denaro V. Have Elbow Arthroscopy Hospitalizations Decreased over the Years? An Epidemiological Italian Study from 2001 to 2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3638. [PMID: 36834331 PMCID: PMC9959056 DOI: 10.3390/ijerph20043638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
This study describes the trends of elbow arthroscopy in Italy and other countries in order to evaluate the yearly rates of EA. Its purpose is for future epidemiological studies to be able to compare their data between countries in order to understand the reasons for the increasing and decreasing trends. Data for this study were obtained from National Hospital Discharge records (SDO) at the Italian Ministry of Health (INHS). Data regarding sex, age, region of residence, region of surgery, length of hospitalization, and procedure codes were included. In total, 2414 elbow arthroscopies were performed in Italy from 2001 to 2016 in the adult population. The highest number of procedures was found in the 40-44 and 45-49 years age groups. Males represented the majority of patients undergoing EA both in total and over the years. An increase from 2001 to 2010 and a decrease from 2010 to 2016 were reported in the present analysis. According to other studies, males of 40-44 and 45-49 years age groups represent the most treated patients. Further epidemiological studies would provide data that could be compared between countries, reaching a general consensus on the best indications for this procedure.
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Affiliation(s)
- Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Rocco Papalia
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Valentina Piccioni
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Alessandro Tancioni
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Ilaria Piergentili
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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Danilov MA, Ershov DS, Liadova MV, Badriev DA, Ershov NS. TREATMENT OF SIMPLE CHRONIC INSTABILITY OF THE ELBOW JOINT. SURGICAL PRACTICE 2022. [DOI: 10.38181/2223-2427-2022-1-14-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Simple chronic instability of the elbow joint is one of the urgent problems in modern traumatology due to the fact that the standard tactics of managing patients with traumatic injuries of the elbow joint due to dislocation, which amounts to its elimination, immobilization of the upper limb and subsequent development of movements in the joint, most often does not take into account damage to specific soft tissue structures. With untimely treatment for qualified help, with late or unsuccessful attempts to eliminate dislocation of the bones of the forearm, less often with chronic traumatization of the ligamentous apparatus of the elbow joint during some types of occupation, one of the most unpleasant complications may form, namely, chronic instability. This article discusses the main types of chronic instability of the elbow joint, analyzes approaches to the management of patients with simple chronic instability. Despite the not very high occurrence of this pathology, the effectiveness of modern surgical treatment options aimed at reconstruction of the ligamentous apparatus of the elbow joint, the percentage of unsatisfactory results of treatment of simple chronic recurrent and persistent instability of the elbow joint remains high.
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Affiliation(s)
- M. A. Danilov
- Pirogov Russian National Research Medical University
| | - D. S. Ershov
- Pirogov Russian National Research Medical University
| | - M. V. Liadova
- Pirogov Russian National Research Medical University
| | - D. A. Badriev
- Pirogov Russian National Research Medical University
| | - N. S. Ershov
- Pirogov Russian National Research Medical University
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