The Waterfall Fascia Lata Interposition Arthroplasty "Grika Technique" as Treatment of Posttraumatic Osteoarthritis of the Elbow in a High-Demand Adult Patient: Validity and Reliability

Interpositional elbow arthroplasty using fascia lata autograft in stiff elbow: Case series of 8 patients

INTRODUCTION

Constrain of a total elbow replacement and elbow arthrodesis are too much for the working population to bear. As such interpositional elbow arthroplasty using fascia lata autologous graft to reconstruct the elbow joint is a viable option in this age group.

MATERIALS AND METHOD

8 patients were operated for arthritic stiff elbow, and joint reconstruction was done using fascia lata autologous graft, with out the use of any hinged external fixator. Pre-operative and post-operative functional assessment was done using Mayo Elbow Performance Score (MEPS) and statistically measured using a paired t-test. Result There was significant improvement in range of motion in coronal (flexion-extension) and axial (supination-protonation) with p-value of <0.001. The mean pre-operative MEPI increased from 40.6 points to 91.9 points (p < 0.0001). All parameters of MEPI had statistically significant improvement with exception of stability (p-value = 0.0824).

Early outcome after the use of the triceps fascia flap in interposition elbow arthroplasty: a novel method in the treatment of post-traumatic elbow stiffness

Background: Post-traumatic elbow stiffness (PTES) results in severe interference with the activities of daily living (ADL), affecting mainly young people. Total elbow arthroplasty (TEA) is relatively contraindicated in the young patient and arthrodesis is poorly tolerated. Interposition elbow arthroplasty (IEA) improves the range of motion (ROM) buying time for future reconstructive surgery. While the fascia lata remains the most common material used in IEA, the triceps fascia is a native vascularized tissue, and it does not require a separate incision to harvest. To our knowledge, there are no published studies on the use of this technique of IEA. Method: Sixteen patients with post-traumatic elbow stiffness had IEA with the triceps fascia between January 2009 and January 2017. The ROM was assessed pre-operatively and post-operatively at the 6th and the 24th week. The researchers also evaluated the functional outcome with the Mayo Elbow Performance Score (MEPS) at the 24th week. The data were analysed with the software IBM SPSS Version 20. Results: Nine males and seven females had IEA with the triceps fascia. The mean age of the subjects was 22.8 years (SD = 6.39). The median duration of the stiffness was eight months (range: 2–168 months). Fall was the most frequent cause of post-traumatic elbow stiffness, and the non-dominant side was more frequently involved. Fourteen patients had an intervention at the native bone setters before presentation to the hospital. The mean elbow ROM increased from 16.4° pre-operatively to 97.2° at the 24th week (p < 0.001), while the mean MEPS improved from 42.5° pre-operatively to 81.2° post-operatively (p < 0.001). Conclusion: The triceps fascia flap provides an excellent alternative to the fascia lata for IEA without the complications of the donor site morbidity.

Plate-and-bone-strut fixation of distal third humeral shaft aseptic non-unions: A consecutive case series

INTRODUCTION

Non-union after humeral shaft fractures are seen frequently in clinical practice. The incidence is 2-10% after conservative management and up to 30% after surgical treatment. The purpose of this study is to evaluate the outcomes of plate-and-bone-strut-allograft technique with bone chip augmentation for aseptic non-unions of the distal third of the humerus.

MATERIALS AND METHODS

26 consecutive cases were treated using a trans-triceps approach. The non-union was fixed with a 4.5 mm Locking Compression Plate combined with a strut bone allograft at the anterior part of the humerus and bone chips. All patients underwent the same rehabilitation protocol of 12 weeks. Clinical evaluation took place 12 months after surgery with the Mayo elbow score and Oxford elbow score.

RESULTS

Complete bone healing without complications was achieved in all 26 patients. The average period of radiographic union was 106 days. The average range of flexion-extension was 108° (94°-180°) and pro-supination was 159° (102°-180°). Twelve months after surgery, average Mayo elbow score was 86 (68-100) and the Oxford elbow score was 83 (52-100).

CONCLUSION

The plate-and-bone-strut-allograft technique with bone chip augmentation in distal humeral shaft for aseptic non-unions resulted in union of all cases. No adverse events related to the surgery or the materials used were documented.

Pediatric Radioulnar Synostosis after Olecranon Fracture: A Case Report

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.