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Papageorgiou P, Giannatos V, Batis A, Kokkalis Z. Neglected Bicondylar Fracture of the Distal Humerus Treated With Total Elbow Arthroplasty. Cureus 2024; 16:e61818. [PMID: 38975387 PMCID: PMC11227293 DOI: 10.7759/cureus.61818] [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: 06/06/2024] [Indexed: 07/09/2024] Open
Abstract
A 69-year-old woman suffered a distal humerus fracture including the medial and lateral condyles. She received conservative treatment with a posterior arm splint at a local healthcare center where she was evaluated by a non-specialist physician. Eight months later, she presented to our department complaining about severe instability. An upper limb specialist examined the patient at the time, and after thoroughly explaining the condition, he suggested a surgical approach with total elbow arthroplasty (TEA), which was then performed. At the one-year follow-up, the patient had a full range of motion without any complications or pain complaints. TEA in neglected fractures of the distal humerus is a poorly researched topic in the field of upper limb surgery with only scarce literature available. In this case report, we present the excellent outcomes of the procedure performed on an elderly patient after non-union regaining her quality of life and suggest that TEA can be a viable solution in elderly patients with complicated or non-united elbow fractures.
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Affiliation(s)
| | | | - Antonios Batis
- Orthopaedics and Traumatology, University of Patras, Patras, GRC
| | - Zinon Kokkalis
- Orthopaedic Surgery, Medical School, University of Patras, Patras, GRC
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Sivagurunathan G, Shirodkar K, Hegde G, Shamshuddin S, Proctor R, Naqvi J, Knowles D, Ali I. Musculoskeletal Computed Tomography: How to Add Value When Reporting Adult Upper Limb Trauma. J Comput Assist Tomogr 2023; 47:264-276. [PMID: 36877776 DOI: 10.1097/rct.0000000000001417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
ABSTRACT There is increasing reliance on computed tomography to evaluate fractures and dislocations following routine evaluation with plain radiography, critical in preoperative planning; computed tomography can provide multiplanar reformats and 3-dimensional volume-rendered imaging, providing a better global assessment for the orthopedic surgeon. The radiologist plays a critical role in appropriately reformatting the raw axial images to illustrate best the findings that will help determine further management. In addition, the radiologist must succinctly report the pertinent findings that will have the most significant bearing on treatment, assisting the surgeon in deciding between nonoperative and operative management. The radiologist should also carefully review imaging to look for ancillary findings in the setting of trauma beyond the bones and joints, including the lungs and rib cage when visualized.In this review article, we will systematically describe key features for fractures of the scapula, proximal humerus, distal humerus, radial head and neck, olecranon, coronoid process through a case-based approach, and distal radius. Although there are numerous detailed classification systems for each of these fractures, we aim to focus on the core descriptors that underpin these classification systems. The goal is to provide the radiologist with a checklist of critical structures they must assess and findings that they should mention in their report, emphasizing those descriptors that influence patient management.
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Li T, Yan J, Ren Q, Hu J, Wang F, Xiao C, Liu X. Efficacy and safety of anterior transposition of the ulnar nerve for distal humerus fractures: A systematic review and meta-analysis. Front Surg 2023; 9:1005200. [PMID: 36684340 PMCID: PMC9853443 DOI: 10.3389/fsurg.2022.1005200] [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] [Received: 08/16/2022] [Accepted: 12/14/2022] [Indexed: 01/08/2023] Open
Abstract
Background This systematic review and meta-analysis was performed to summarize available evidence of anterior transposition of the ulnar nerve for patients with distal humerus fractures. Materials and Methods The databases were searched from PubMed, Cochrane, Embase, Scopus, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP Database (VIP), and Wan Fang Database up to June 2022. The clinical outcome included operation time, fracture healing time, hospital stays, elbow joint function, and ulnar neuritis rate. Statistical analysis was performed with Review Manager 5.3 (Cochrane Collaboration). Results A total of 17 studies were included (8 RCTs and 9 retrospective studies), and 1280 patients were analyzed. The results of this meta-analysis showed anterior transposition group had longer operation time (MD = 20.35 min, 95%CI: 12.56-28.14, P < 0.00001). There was no significant difference in fracture healing time (SMD = -0.50, 95%CI: -1.50-0.50, P = 0.33), hospital stays (MD = -1.23 days, 95%CI: -2.72--0.27, P = 0.11), blood loss (MD = 2.66 ml, 95%CI: -2.45-7.76, P = 0.31), and ulnar neuritis rate (OR = 1.23, 95%CI: 0.63-2.42, P = 0.54) between two groups. Finally, elbow joint motion, elbow joint function, fracture nonunion, and post-operative infection (P > 0.05) between two groups were not significantly statistic difference. Conclusion This meta-analysis showed that anterior transposition group is not superior to non-transposition group for patients with distal humerus fractures without ulnar nerve injury. On the contrary, non-transposition group have shorter operation time than that of anterior transposition group. Non-transposition group did not increase the post-operative ulnar neuritis rate. Therefore, both anterior transposition group and non- transposition group are the treatment options for patients with distal humerus fractures without ulnar nerve injury. Besides, these findings need to be further verified by multi-center, double-blind, and large sample RCTs.
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Affiliation(s)
- Ting Li
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, China,Department of Postgraduate, Chengdu Medical College, Chengdu, China
| | - Jingxin Yan
- Department of Interventional Therapy, Affiliated Hospital of Qinghai University, Xining, China,Department of Postgraduate, Qinghai University, Xining, China
| | - Qiuyu Ren
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, China,Department of Postgraduate, Chengdu Medical College, Chengdu, China
| | - Jiang Hu
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, China
| | - Fei Wang
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, China
| | - Chengwei Xiao
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, China,Correspondence: Xilin Liu Chengwei Xiao
| | - Xilin Liu
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, China,Correspondence: Xilin Liu Chengwei Xiao
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Athanaselis ED, Komnos G, Deligeorgis D, Hantes M, Karachalios T, Malizos KN, Varitimidis S. Double Plating in Type C Distal Humerus Fractures: Current Treatment Options and Factors that Affect the Outcome. Strategies Trauma Limb Reconstr 2022; 17:7-13. [PMID: 35734034 PMCID: PMC9166263 DOI: 10.5005/jp-journals-10080-1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose This is a retrospective cohort study of type C distal humeral fractures (AO classification system) aimed at evaluating the effectiveness of current operative treatment options. Materials and methods Thirty-seven patients with type C distal humeral fractures, treated operatively from January 2002 to September 2016, were retrospectively studied. Thirty-two were eligible for inclusion. Patients were treated by open reduction using the posterior approach, olecranon osteotomy and parallel-plate two-column internal fixation. Patients were evaluated for fracture healing, functional outcomes and complications (infection, ulnar neuropathy, heterotopic ossification and need for implant removal). Restoration of the normal anatomy was defined by measuring carrying angle, posterior angulation and intercondylar distance of distal humerus. Results The mean follow-up time was 8.7 years [range 2–15.5 years, standard deviation (SD) = 3.96]. Mean time to fracture union was 8 weeks for 29 patients (90.6%) (range, 6–10 weeks). In nine cases, there was malunion of varied importance (28.1%). There was one case with postoperative ulnar neuropathy and one case with deep infection. The mean Disabilities of the Arm, Shoulder and Hand (DASH) score and mean Mayo Elbow Performance Score (MEPS) were 20 (range 0–49) and 83.3 (range 25–100), respectively. Conclusion In complex distal humerus fractures, the posterior approach with olecranon osteotomy and parallel plating of two columns, after anatomic reconstruction of the articular segment, is a prerequisite for successful elbow function. How to cite this article Athanaselis ED, Komnos G, Deligeorgis D, et al. Double Plating in Type C Distal Humerus Fractures: Current Treatment Options and Factors that Affect the Outcome. Strategies Trauma Limb Reconstr 2022;17(1):7–13.
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Affiliation(s)
- Efstratios D Athanaselis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Georgios Komnos
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Dimitrios Deligeorgis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Michael Hantes
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Theofilos Karachalios
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Konstantinos N Malizos
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Sokratis Varitimidis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
- Sokratis Varitimidis, Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece, e-mail:
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Moharram AN, Mahmoud M, Lymona A, Afifi A, Ezzat M, Abdel-Wahed M. Temporary spanning plate across the elbow for complex fractures of the distal humerus. BMC Musculoskelet Disord 2021; 22:875. [PMID: 34645437 PMCID: PMC8515665 DOI: 10.1186/s12891-021-04764-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Open reduction internal fixation (ORIF) is the gold standard management of fractures of the distal humerus. Stable fixation to allow early mobilization is not always possible in cases with comminuted fracture patterns and bone loss, with a high failure rate. We propose augmentation of internal fixation in these unstable situations with a spanning plate across the elbow to protect the fixation construct temporarily until bone union. METHODS Eighteen patients with complex distal humeral fractures were managed with standard ORIF technique augmented with a temporary plate spanning across the elbow as an internal fixator. Cases included were either very distal, comminuted (6 cases) or insufficiency fractures (4 cases) or revision fixation cases (8 cases). The temporary spanning plate was removed as soon as signs of early radiographic union were detected. RESULTS Seventeen patients were available for final follow up at a mean 28.3 months. The spanning plate was removed after 3.4 months on average. At the final follow-up, the mean elbow total arc of motion was 86.3°. The mean Mayo Elbow Performance Score (MEPS) was 80, and the mean Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score was 27. CONCLUSION Spanning the elbow temporarily with a plate in adjunct to standard ORIF technique is both simple and effective in achieving fracture stability and union and minimizes failure rates after fixation of comminuted, very distal fractures, osteoporotic cases, or revision fixation cases with bone loss. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
| | - Mostafa Mahmoud
- Kasr El-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Lymona
- Kasr El-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Afifi
- Kasr El-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mostafa Ezzat
- Kasr El-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Nasreen S, Bansal A, Rela R, Rai G, Sah RP, Gupta AR. Inter Maxillary Fixation Versus Open Reduction for the Treatment of Mandibular Condyle Fractures: A Comparative Evaluation. J Pharm Bioallied Sci 2021; 13:S268-S271. [PMID: 34447090 PMCID: PMC8375891 DOI: 10.4103/jpbs.jpbs_729_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022] Open
Abstract
Background: The treatment for fractured mandibular condyles aims at restoring the masticatory ability, occlusion, symmetry, and function as the bit were before the trauma. The treatment of the mandibular condylar fracture can be done based on the two protocols. Aims: The present clinical trial was conducted to collate aftertreatment upshot of closed treatment and open surgical treatment for mandibular condyle fractures. Materials and Methods: Forty-two patients were divided into two groups (n = 12) which were treated with either the closed reduction using intermaxillary fixation or open reduction and internal fixation. The following clinical parameters were assessed at 1st and 3rd day and at 1, 3, and 6 weeks: lateral excursion and protrusion, occlusion; interincisal opening, mandibular ramus height, deviation/deflection during jaw opening, and pain assessment using visual analog score. The collected data were subjected to statistical evaluation. Results: Interincisal opening was found to be 8.125 ± 0.3467 mm and 6.016 ± 0.1528 mm, respectively, for Group I and Group II which was statistically significant (P < 0.00001). At the 3 months and 6th week postoperatively, it was increased in the surgical groups to 17.433 ± 0.3822 mm and 19.175 ± 0.3696 mm, respectively. Conclusion: The present trial suggests surgical open reduction and internal fixation treatment of the mandibular condylar fracture is better than the nonsurgical closed reduction in terms of interincisal opening, lateral excursion, and protrusive mandibular movement range.
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Affiliation(s)
- Saba Nasreen
- Department of Dentistry, SKMCH, Muzaffarpur, Bihar, India
| | - Anupam Bansal
- Department of Oral and Maxillofacial Surgery, Darshan Dental College, Udaipur, Rajasthan, India
| | - Rathi Rela
- Department of Oral Medicine and Radiology, Nalanda Medical College and Hospital, Patna, Bihar, India
| | - Gaurav Rai
- Department of Oral and Maxillofacial Surgery, Buddha Institute of Dental Science, Patna, Bihar, India
| | - Ram Prasad Sah
- Department of Dentistry, Sri Krishna Medical College and Hospital. Muzaffarpur, Bihar, India
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Results of Linked Convertible Total Elbow Arthroplasty for the Management of Distal Humeral Fractures in the Elderly. J Hand Surg Am 2021; 46:396-402. [PMID: 33423847 DOI: 10.1016/j.jhsa.2020.10.034] [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: 08/29/2020] [Accepted: 10/30/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Total elbow arthroplasty (TEA) is increasingly used for the management of comminuted distal humeral fractures in elderly patients. There are limited data on the outcome of modern elbow arthroplasty designs in larger patient cohorts. The aim of the current study was to review the outcomes and complications using a cemented convertible TEA system in a linked configuration in patients with distal humeral fractures. METHODS Patients with distal humeral fractures treated with TEA and a minimum of 2 years' follow-up were reviewed. Demographic information, patient-reported outcome, functional and radiographic outcome assessments, and complications were reported. RESULTS Forty patients met inclusion criteria; 35 were female. Median follow-up was 4 years (range, 2-13 years). Average age of patients at the index procedure was 79 ± 9 years. All implants were linked. Range of motion was: extension 16° ± 13°, flexion 127° ± 14°, supination 79° ± 11°, and pronation 73° ± 20°. Patient-reported outcome scores were: Patient-Rated Elbow Evaluation 37 ± 35, Quick-Disabilities of the Arm, Shoulder, and Hand 31 ± 31, and Mayo Elbow Performance Index 90 ± 18. Seven patients had heterotopic ossification. Lucent lines were noted predominantly in humeral implant zone V. No lucent lines were noted around the ulnar component in any radiographic zone. Complications occurred in 9 patients (22%) and 2 revisions were performed: one for infection and one for a late periprosthetic fracture. CONCLUSIONS Total elbow arthroplasty for fracture in elderly patients provides pain relief, functional range of motion, and good patient-reported outcome scores. No implant-related complications of this convertible implant system were encountered, but longer-term follow-up is needed. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Zhong H, Ma L, Wang M, Huang Y, Zhou Y, Chen L, Chen G, Li J, Chen J, Zhang Y. Comparison of biomechanical characteristics in treatment of distal humerus fracture using different fixation plates: A finite element study. Microsc Res Tech 2019; 82:199-205. [PMID: 30629776 DOI: 10.1002/jemt.23156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/26/2018] [Accepted: 09/21/2018] [Indexed: 11/11/2022]
Abstract
With the development of digital technology of orthopedics, personalized plate has been applied to treat different kinds of fractures. However, no studies of personalized implants in the treatment of distal humeral fractures have been reported. Therefore, we design a personalized anatomical locking plate (DPALP) to treat distal humerus fracture of adult. The model of humerus and personalized plate and traditional Y-shaped compression plate (YCP) was built and analyzed by finite element method. We found that peak value of stress of humerus fixed by YCP is higher than that of DPALP, and the peak value of stress of screws used in DPALP group is higher than that of YCP. Meanwhile, peak of displacement of YCP is higher than that of DPALP, and the peak value of displacement of humerus bone is higher than that of YCP. The patient with DPALP had a good clinical outcome (83) evaluated with Broberg and Morrey Score. Our results show that DPALP and YCP could get similar mechanical and clinical results for distal humorous intra-articular fractures, and stress distribution of DPALP group is more balanced, and it takes less time in the operation. Furthermore, DPALP can perfectly fit the humeri and achieve the anatomical reduction. In general, DPALP is more suitable for patients with intra-articular complicated fractures. Our findings will benefit clinicians treating distal humeral fractures and provide an alternative option.
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Affiliation(s)
- Hua Zhong
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Orthopedics, The Zhanjiang Central People's Hospital, Zhanjiang, China
| | - Limin Ma
- Department of Orthopedics, Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China
| | - Ming Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yan Huang
- Department of Orthopedics, The Zhanjiang Central People's Hospital, Zhanjiang, China
| | - Ye Zhou
- Department of Orthopedics, Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China
| | - Lingling Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Guangmou Chen
- Department of Orthopedics, The Zhanjiang Central People's Hospital, Zhanjiang, China
| | - Jianwei Li
- Department of Orthopedics, The Zhanjiang Central People's Hospital, Zhanjiang, China
| | - Jin Chen
- Department of Orthopedics, The Zhanjiang Central People's Hospital, Zhanjiang, China
| | - Yu Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Orthopedics, The Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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