Elbow Function Score Research Articles

Case-control study on a new Kirschner wire tension band with hole in the treatment of adult olecranon fractures in adults

To compare the efficacy of Kirschner wire tension band with hole and common Kirschner wire tension band in the treatment of olecranon fractures in adults, so as to guide the selection of clinical surgical procedures. From July 2011 to October 2015, a total of 49 patients with olecranon fractures underwent open reduction and fixation with Kirschner wire tension band, which were retrospectively analyzed. Of the 49 patients, 21 patients(group A) were treated with Kirschner wire tension band with hole, including 12 males and 9 females, with an average age of(37.6 ±8.2) years old;28 patients(group B) were treated with common Kirschner wire, including 18 males and 10 females, with an average age of(38.9±7.3) years old. There were no statistically significant differences between the two groups in general data. The differences of operative duration, frequency of radiation, fracture healing time, complications and postoperative elbow function scores between the two groups were observed and analyzed by parallel statistical analysis. In group A, the operative duration was(60.4±10.7) min, the average number of radiation times was (12.5±2.9); in group B, the operative duration was (62.3±11.8) min, and the average radiation times was(13.7±3.8); there was no significant difference in operative time and radiation times between the two groups (P >0.05). In group A, the fracture healing time was (13.2±2.6) weeks without K-wire migration, skin irritation and other complications; and fracture healing time in group B was(14.6±1.8) weeks with complications(K-wire migration in 6 cases, skin irritation in 7 cases, internal fixation failure in 2 cases);the fracture healing time of group A was shorter than that in group B. Evaluation of elbow joint function in two groups of patients after operation showed that in group A, pain score was 41.0±3.5, movement function score was 18.0±2.1, stability score was 9.0±0.8, daily activities score was 18.0±4.3, the total average score was 87.0±7.8; and in group B, the pain score was 39.0±5.6, movement function score was 17.0±3.2, the stability score was 8.0±2.4, daily activities score was 16.0±5.2, the total average score was 83.0±10.7. There were no statistically significant in the scores between the two groups. Compared with ordinary Kirschner wire, the treatment of olecranon fracture with Kirschner tension band with hole can shorten the time of fracture healing, significantly reduce the occurrence of complications, and do not affect the recovery of postoperative function, which is suitable for clinical use.

Late Reconstruction of the Interosseous Membrane with Bone-Patellar Tendon-Bone Graft for Chronic Essex-Lopresti Injuries: Outcomes with a Mean Follow-up of Over 10 Years.

The purpose of this study was to report our long-term outcomes following reconstruction of the forearm interosseous membrane (IOM) with bone-patellar tendon-bone (BPTB) graft for treatment of chronic Essex-Lopresti injuries. We identified 33 patients who underwent IOM reconstruction with BPTB graft for chronic Essex-Lopresti injuries over a 20-year treatment interval. Twenty male and 13 female patients, with a mean age of 42.1 years (range, 19 to 73 years) and a minimum follow-up interval of 5 years, were included. Preinjury clinical examination and radiographic measurements were obtained from records for comparison with prospectively collected data. Additional functional outcome data collected postoperatively included QuickDASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH]), modified Mayo wrist (MMW), and Broberg-Morrey elbow function scores. IOM reconstruction was performed at a mean interval (and standard deviation) of 44.9 ± 60.0 months (range, 6.4 to 208 months) from the time of the initial injury. At a mean follow-up of 10.9 ± 4.4 years (range, 5.5 to 24.2 years), significant improvements were observed in mean elbow flexion-extension arc (+13° [95% confidence interval (CI), 4° to 22°]; p = 0.005), wrist flexion-extension arc (+19° [95% CI, 4° to 34°]; p = 0.016), forearm pronation-supination (+23° [95% CI, 8° to 39°]; p = 0.004), and grip strength (+25% of that of the contralateral side [95% CI, 18% to 32% of contralateral side]; p < 0.001). Improvements in ulnar variance were sustained over the long term from +3.9 mm (95% CI, 3.2 to 4.6 mm) preoperatively to -1.6 mm (95% CI, -2.3 to -0.9 mm) immediately postoperatively and -1.1 mm (95% CI, -1.8 to -0.4 mm) at the time of the final follow-up (p < 0.001). The mean QuickDASH, MMW, and Broberg-Morrey scores were 29.8 (range, 5 to 61), 82.7 (range, 60 to 100), and 91.6 (range, 64 to 100), respectively. IOM reconstruction with a BPTB graft is an effective treatment option for chronic Essex-Lopresti injuries, with satisfactory clinical and functional outcomes over the long term. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Radial head replacement with metal prosthesis and reduction with stabilization of the distal radio-ulnar joint as a treatment of established Essex-Lopresti injury

Objective To investigate the effect of radial head replacement with metal prosthesis and reduction with stabilization of the distal radio-ulnar joint as a treatment of established Essex-Lopresti injury. Methods From March 2012 to December 2015, 5 patients with established Essex-Lopresti injury, whose radiuses had moved proximally since radial head had been resected in the earlier operation, were operated in our department, including 4 males and 1 female, aged from 25 to 50 years (average, 38.8 years). The interval from the radial head resection to the operation in our department was 2 to 7 months (average, 4.6 months). All the 5 patients were operated with radial head replacement with metal prosthesis under no longitudinal stress, and 4 of them got distal ulnar shortening for reduction of the distal radio-ulnar joint. 2 of the 5 cases acquired distal radial-ulnar joint stability after reduction, and the other 3 could not acquired stability and needed open reduction and repairing ligament structure of the wrist and pinning fixation for 4-6 weeks. The Mayo elbow and wrist function score were used to evaluate pre- and post-operative function, with recording the range of motion of the elbow, forearm and wrist. Results All the 5 patients were followed-up for 24 to 60 months (average 45 months). The Mayo elbow function score was improved from preoperative 62 (range, 45-75) to 96 (range, 80-100) at the latest follow-up. The Mayo wrist functional score was improved from 54 (range, 15-65) to 81 (range, 55-90) at the latest follow-up. All patients got significant improvement of involved upper extremity function, without proximal shifting of radius, radial head prosthesis failure or instability of the distal radio-ulnar joint. Conclusion It is effective for treatment of established Essex-Lopresti injury to replace radial head with metal prosthesis and to reduce and stabilize the distal radio-ulnar joint with distal ulnar shortening while necessary. Key words: Radius fractures; Dislocations; Arthroplasty, replacement; Osteotomy

Application of 3D printing osteotomy plate in osteotomy for correction of cubitus varus in children

Objective To study the application value of 3D printing osteotomy plate technique in the correction of cubitus varus deformity in children. Methods From July 2014 to December 2015, 7 patients with cubitus varus deformity were treated with wedge-shaped osteotomy of lateral humeral supracondylar. Before surgery thin-section CT scan and elbow joint three-dimensional reconstruction were performed. According to the cubitus varus situation, the best osteotomy angle was designed and then a guide plate was established which was anatomically consistent with the osteotomy range. Three-dimensional data model of the guide plate were input into 3D printer for producing guide plate. During the operation, the established guide plate of osteotomy was matched with the part of humeral osteotomy. After osteotomy along the plate, the osteotomy gap was slowly closed and fixed by plate. Results The osteotomy angle was satisfactory in 7 cases after operation. Postoperative follow-up time ranged from 3 to 6 months with an average of 4 months. The elbow function was evaluated according to the Mayo elbow function score. The results were excellent in 5 cases, good in 1 case and fair in 1 case. Conclusion The osteotomy plate which is 3D printed can provide a personalized and accurate osteotomy for correction of cubitus varus deformity in children. Key words: Elbow joint; Osteotomy; Cubitus varus; 3D printing

Treatment of intercondylar fracture of the humerus through internal and external elbow approach or elbow posterior olecranon osteotomy approach

To investigate the efficacy, advantages and disadvantages of internal and external elbow joint approach and olecranon osteotomy approach for the treatment of intercondylar fracture of humerus. From October 2012 to May 2016, 18 cases of intercondylar fracture of humerus were treated by operation including 12 males and 6 females with a mean age of 33.5 years old (ranged from 4 to 56 years old); 8 cases were operated by internal and external elbow joint approach, 10 cases were operated by olecranon osteotomy approach. According to AO classification, 3 cases were type C1, 8 cases were type C2, 7 cases were type C3. All patients were excluded from neurologic and vascular injuries. All patients were followed up from 12 to 26 months with an average of 15 months. The incision healed well and no heterotopic ossification was found. According to the modified Cassebaum elbow function score, the result was excellence in 14 cases, good in 3 cases, fair in 1 case. According to the fracture type, the appropriate surgical approach and fixation were selected in order to get anatomic reduction. Rigid fixation, and early functional exercise is important condition for successful operation and satisfactory functional recovery in intercondylar fracture of the humerus.

Three dimensional printing technology and materials for treatment of elbow fractures.

3D printing is a rapid prototyping technology that uses a 3D digital model to physically build an object. The aim of this study was to evaluate the peri-operative effect of 3D printing in treating complex elbow fractures and its role in physician-patient communication and determine which material is best for surgical model printing. Forty patients with elbow fractures were randomly divided into a 3D printing-assisted surgery group (n=20) and a conventional surgery group (n=20). Surgery duration, intra-operative blood loss, anatomic reduction rate, incidence of complications and elbow function score were compared between the two groups. The printing parameters, the advantages and the disadvantages of PLA and ABS were also compared. The independent-samples t-test was used to compare the data between groups. A questionnaire was designed for orthopaedic surgeons to evaluate the verisimilitude, the appearance of being true or real, and effectiveness of the 3D printing fracture model. Another questionnaire was designed to evaluate physician-patient communication effectiveness. The 3D group showed shorter surgical duration, lower blood loss and higher elbow function score, compared with the conventional group. PLA is an environmentally friendly material, whereas ABS produce an odour in the printing process. Curling edges occurred easily in the printing process with ABS and were observed in four of ten ABS models but in only one PLA model. The overall scores given by the surgeons about the verisimilitude and effectiveness of the 3D model were relatively high. Patient satisfaction scores for the 3D model were higher than those for the 2D imaging data during physician-patient discussions. 3D-printed models can accurately depict the anatomic characteristics of fracture sites, help surgeons determine a surgical plan and represent an effective tool for physician-patient communication. PLA is more suitable for desktop fused deposition printing in surgical modeling applications.

Artificial radial head replacement for the treatment of comminuted fractures of the radial head

To assess the clinical effects of artificial radial head prosthesis replacement for the treatment of comminuted fracture of the radial head. From June 2011 to June 2015, 25 patients with radial head comminuted fracture were treated with artificial radial head replacement, including 10 males and 15 females, ranging in age form 24 to 61 years old(mean, 40 years old). The functional recovery of the patients suffering from limb and elbow in different periods, the activity degree of the elbow joint and the function of the elbow in the latest follow-up were compared. All the patients were followed up, and the duration ranged from 12 to 48 months, averaged 26 months. There were no complications such as infection, elbow instability, subluxation of the distal radioulnar joint, and myositis ossificans. The VAS, Broberg and Morrey elbow function score were improved 6, 9 months after operation compared with that 3 months after operation(P<0.05). There were significant differences in elbow flexion and extension, rotation activity between injured side and healthy side 3, 6, 9 months after operation(P<0.01), but no significant differences between injured side and healthy side at the latest follow-up(P>0.05). At the latest follow-up, according to Broberg and Morrey elbow function evaluation criteria, 16 cases got an excellent result, 7 good and 2 poor. It can maximize the recovery of elbow joint stability and quicken early functional exercise, prevent and reduce the occurrence of complications by using the artificial radial head replacement therapy to repair comminuted fracture of the radial head. The short-term curative effect is satisfactory, but the long-term effect needs further observation.

Open reduction and internal fixation for capitellum fractures in adolescents

Objective To report the clinical outcomes of open reduction and internal fixation for capitellum fractures in adolescents. Methods From January 2010 to January 2015, 14 adolescents with capitellum fracture were admitted to our department. They were 12 males and 2 females, aged from 12 to 16 years (13.7 years). By the Dubberley classification, we had 2 cases of type ⅠA, 8 cases of type ⅡA, 3 cases of type ⅢA and one of type ⅢB. We summarized their clinical characteristics and injury mechanisms. At the last follow-up, the therapeutic efficacy was assessed by the Mayo elbow function scores, and the ranges of motion of the elbow and forearm on the affected side were recorded. Results The 14 patients obtained an average follow-up of 12 months (from 6 to 18 months). All the cases achieved fracture union within 3 months, but malunion appeared in one. At the last follow-up, the ranges of flexion and extension of the affected elbow averaged 120.6° (from 110° to 135°), and the ranges of lateral rotation of the affected forearm averaged 160.3° (from 150° to 175°). According to the Mayo scores at the last follow-up, the elbow function was rated as ex-cellent in 12 and as good in one. Mild traumatic arthritis occurred in 3 cases. Conclusions Capitellum fractures in adolescents are often Dubberley type A ones without a complicated fracture of the posterior condyle. Usually, the capitellum is impacted by the radial head in the process of elbow extension with valgus stress. After definite diagnosis, open anatomical reduction and reasonable and reliable internal fixation can result in good clinical results. Key words: Elbow joint; Fracture fixation, internal; Adolescent; Injury mechanism

Mini-locking plates for the treatment of Regan-Morrey type III fracture of ulnar coronoid process through anterior approach of elbow joint

To explore clinical effects of mini-locking plates for the treatment of Regan-Morrey type III fractures of ulnar coronoid process through an anterior approach of elbow joint. A retrospective analysis on 12 patients with Regan-Morrey type III fractures of the ulnar coronoid process was performed from January 2011 to June 2014, who were treated with unini-locking plates through the anterior approach of elbow joint. There were 7 males and 5 females, ranging in age from 23 to 65 years old, averaged 43 years old. Four patients had fractures on the left and 8 patients had fractures on the right. The X-ray films were taken to evaluate the location and healing of the fracture before and after operation. Clinical evaluation included analysis on surgical complications, range of motion and Mayo elbow function score. All the patients were treated with mini-locking plates, and the elbow joint was stable after operation. All the patients were followed up, and the duration ranged from 14 to 36 months. All the fractures were healed, and the healing time ranged from 12 to 20 weeks. The average healing time was 15.6 weeks. There were no complications occurred such as heterotopic ossification, traumatic arthritis and others. At the latest follow-up, the average angle of elbow flexion was (127.0±5.6)°(120° to 135°); the average extension angle was(4.2±4.5)° (0° to 10°); the average pronation angle of forearm was (86.0±6.1)°(75° to 90°); the average supination angle of forearm was (87.0±6.9)°(80° to 100°). Mayo elbow function score was 80 to 96 points, with an average of 88 points, of which 2 cases got an excellent result, 10 good. Elbow anterior approach can clearly expose the Regan-Morrey type III coronoid fractures, and mini-locking plate fixation has a satisfactory effect.

Does operative fixation affect outcomes of displaced medial epicondyle fractures?

PurposeLong-term functional results remain equivocal between operative fixation and closed management of displaced humeral medial epicondyle fractures. The purpose of this study was to determine whether a functional difference exists between treatment types.MethodsOne hundred and forty patients with a displaced medial epicondyle fracture between 2007 and 2014 met the inclusion criteria. Of this large cohort, only 12 patients agreed to return to clinic at a mean follow-up of 3 years for prospective evaluation. Data collection included radiographs, physical examination, validated outcome tools, and grip strength testing with a Jamar dynamometer.ResultsBoth groups were comparable with regard to age, dominant side injured, length of follow-up, preinjury sports involvement, and initial displacement (10 mm operative vs. 9 mm nonoperative); however, half of the surgical group presented with an associated unreduced elbow dislocation versus 0 % in the nonoperative group. Both treatment methods resulted in high patient satisfaction and elbow function scores. There were four osseous nonunions (67 %) and one malunion (17 %) in the nonoperative group versus none in the operative group (p = 0.015). Patients treated nonoperatively had a nonsignificant decrease in grip strength (9 ± 6 lbs) as compared to operative patients (6 ± 5 lbs, medium effect size eta = 0.25, p = 0.25).ConclusionsIn this small cohort, operative management of displaced medial epicondyle fractures resulted in a higher rate of fracture union and return to sports. Other objective and subjective measures were similar between the two treatment groups.

The clinical outcome and activity levels of patients under 55 years treated with distal humeral hemiarthroplasty for distal humeral fractures: minimum 2-year follow-up.

The aim of the present study was to describe the clinical outcomes and activity levels of young patients after distal humeral hemiarthroplasty (DHH). Six patients under 55 years (mean 44 years; range 29 years to 52 years) treated with DHH at a mean postoperative time of 81 months (range 24 months to 133 months) were studied retrospectively. Two other patients had been revised for aseptic loosening and were excluded. The mean Mayo Elbow Score (MEPS) (88), Subjective Elbow Value (SEV) (89), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) (12) and American Shoulder and Elbow Surgeons (ASES) elbow pain (6), function (23) and satisfaction scores (9) were satisfactory. The mean University of California, Los Angeles (UCLA) activity score was 7.2. Although only rarely indicated, DHH has satisfactory clinical outcomes in young patients and allows a higher level of function than is generally advised after total elbow arthroplasty.

Feasibility of four-dimensional preoperative simulation for elbow debridement arthroplasty.

BackgroundRecent advances in imaging modalities have enabled three-dimensional preoperative simulation. A four-dimensional preoperative simulation system would be useful for debridement arthroplasty of primary degenerative elbow osteoarthritis because it would be able to detect the impingement lesions.MethodsWe developed a four-dimensional simulation system by adding the anatomical axis to the three-dimensional computed tomography scan data of the affected arm in one position. Eleven patients with primary degenerative elbow osteoarthritis were included. A “two rings” method was used to calculate the flexion-extension axis of the elbow by converting the surface of the trochlea and capitellum into two rings. A four-dimensional simulation movie was created and showed the optimal range of motion and the impingement area requiring excision. To evaluate the reliability of the flexion-extension axis, interobserver and intraobserver reliabilities regarding the assessment of bony overlap volumes were calculated twice for each patient by two authors. Patients were treated by open or arthroscopic debridement arthroplasties. Pre- and postoperative examinations included elbow range of motion measurement, and completion of the patient-rated questionnaire Hand20, Japanese Orthopaedic Association-Japan Elbow Society Elbow Function Score, and the Mayo Elbow Performance Score.ResultsMeasurement of the bony overlap volume showed an intraobserver intraclass correlation coefficient of 0.93 and 0.90, and an interobserver intraclass correlation coefficient of 0.94. The mean elbow flexion-extension arc significantly improved from 101° to 125°. The mean Hand20 score significantly improved from 52 to 22. The mean Japanese Orthopaedic Association-Japan Elbow Society Elbow Function Score significantly improved from 67 to 88. The mean Mayo Elbow Performance Score significantly improved from 71 to 91 at the final follow-up evaluation.ConclusionWe showed that four-dimensional, preoperative simulation can be generated by adding the rotation axis to the one-position, three-dimensional computed tomography image of the affected arm. This method is feasible for elbow debridement arthroplasty.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-0996-9) contains supplementary material, which is available to authorized users.

Preoperative patient-reported scores can predict postoperative outcomes after shoulder arthroplasty

Total shoulder arthroplasty and reverse total shoulder arthroplasty are increasingly used to improve pain and function in patients with glenohumeral arthritis or cuff tear arthropathy. Our objective was to determine if preoperative patient-reported outcome measures predict which patients will achieve clinically meaningful improvements after shoulder arthroplasty. Preoperative and 1-year postoperative 12-Item Short Form Health Survey (SF-12) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores and American Shoulder and Elbow Surgeons (ASES) pain and function scores were prospectively collected from 107 patients who underwent total or reverse shoulder arthroplasty. The minimum clinically important difference (MCID) defined meaningful clinical improvement. Receiver operating characteristic analysis was used to calculate threshold values and C statistic. Multivariate logistic regression analysis was performed to determine preoperative measures that were indicative of achieving the MCID postoperatively. Threshold values below which patients were more likely to achieve MCID were 12 for ASES function, 25 for ASES pain, 46 for SF-12 PCS, and 42 for SF-12 MCS. Multivariate analysis revealed that preoperative ASES function (area under the curve, 0.79; P = .006) and ASES pain (area under the curve, 0.90; P < .001) measures were predictive of achieving the MCID postoperatively. Patients with higher preoperative SF-12 MCS scores had a higher likelihood of achieving MCID for each measure. We determined threshold values that predict clinically meaningful improvement after shoulder arthroplasty. Patients with higher preoperative mental health scores and lower physical function and pain scores were more likely to gain significant benefits from surgery. These results can be used to facilitate shared decision-making and to forecast expected benefits after shoulder arthroplasty.

Elbow osteoarthritis: Results of arthroscopic osteocapsular arthroplasty

Elbow osteoarthritis is a common condition. The formation of bone spurs, loose bodies and capsular contracture produce disabling end-range and exertion pain, locking and stiffness. Arthroscopic osteocapsular arthroplasty is a minimal invasive and effective option to relieve patients’ symptoms and improve their function. It could also be a viable buy-time procedure before arthroplasty. A retrospective review was conducted on 38 elbows with primary osteoarthritis in 37 patients (32 male, 6 female, average age of 52) who underwent arthroscopic osteocapsular arthroplasty from Jan 2010 to Apr 2014. The mean follow-up duration was 26 months (5–56). Preoperative pain, motion, elbow function score were compared with those at the latest follow-up. The mean flexion range improved from 105 to 126.4, extension from −35.4 to −7.2, motion arc from 71 to 118.9, and elbow function score from 60 to 92. Pain score improved from 6/10 to 1.7/10. Only one patient had the motion returned to preoperative level 16 months postoperatively, although pain score was zero. None had pain worsen, range deteriorated, diminished elbow function score, or neurological complication. One patient had deep infection and was effectively cured by arthroscopic lavage and antibiotics. One had cubital tunnel syndrome 1 month after the surgery as the elbow flexion range was gained, which was effectively cured by medial epicondylectomy. Our clinical results reviewed that arthroscopic osteocapsular arthroplasty provided effective and rewarding outcomes with high patient satisfaction. The development of computer aided surgical modelling and navigation assisted surgery helped to provide a better preoperative planning and increase the accuracy of arthroscopic surgery.

Clinical Outcome Measures Following Suture Anchor Repair for Traumatic Rupture of the Distal Triceps Tendon (SS-53)

Introduction Rupture of the triceps tendon is an uncommon injury with few published reports of surgical repairs. These publications include case reports and small series, which assess elbow strength and motion, but fail to report any commonly used or validated elbow outcome measures for the patients. These reports all utilize braided polyester sutures through bone tunnels in the olecranon for the reattachment of the distal triceps tendon. While recent publications have described the surgical technique and biomechanical properties of distal triceps tendon repair using suture anchors, there are no published outcomes using this technique. The purpose of this study is to report the clinical outcomes following suture anchor repair of the ruptured triceps tendon with high strength sutures. An extensive literature review failed to identify any other report which evaluated the clinical results using validated elbow outcome measures or to report the clinical results following distal triceps suture anchor repair. Methods A consecutive series of traumatic distal triceps tendon ruptures from a single institution between 2006 and 2010 was reviewed. All cases were surgically repaired using suture anchors and high strength sutures. The patients were evaluated postoperatively using the Disabilities of the Arm, Shoulder, and Hand (DASH) outcome measure, the Oxford Elbow Score, the American Shoulder and Elbow Surgeons (ASES) elbow assessment form, and the Mayo Elbow Performance index. Results A total of five male patients with at least six months follow-up underwent suture anchor repair for traumatic rupture of the distal triceps tendon. Of the five distal triceps tendon tears, three involved the dominant arm and two involved the non-dominant arm. The average patient age was 46.8 years (range, 35 to 54) and the average follow-up was 27.4 months (range 6 to 49 months). Postoperatively, the mean DASH score was 2.2 (from 0-100, lower score indicates less disability and better function), the mean ASES elbow score was 99.2 (from 0-100, higher score indicates better outcome), the mean Mayo Elbow Performance Index was 95.8 (from 0-100, higher score indicates better outcome), the mean Oxford Elbow Pain Score was 98.8 (from 0-100, higher score indicates less pain and better outcome), the mean Oxford Elbow Function Score was 100 (from 0-100, higher score indicates better function), and the mean Oxford Elbow Social Score was 96.2 (from 0-100, higher score indicates better outcome). Conclusion Distal triceps tendon ruptures can be successfully repaired using high strength sutures in suture anchors instead of conventional sutures in bone tunnels. This technique results in minimal pain and excellent elbow function based on validated clinical outcome measures.

Treatment of chronic isolated radial head dislocation by reconstruction of annular ligament with pedicled deep fascia

Objective To evaluate the clinical outcomes of treating chronic isolated radial head dislocation by reconstruction of annular ligament with pedicled deep fascia. Methods Ten children with chronic radial head dislocation were treated between January 2004 and January 2009. The patients varied in age from 5 to 16 years (mean 9.7 years). They were treated by reconstruction of annular ligament with pedicle deep fascia. A clinical and radiographic assessment was undertaken at follow-up. The results were rated according to the Broberg-Morrey scoring for elbow function. Results All cases were follow-up for 1 to 6 years, the average follow-up time being 2.5 years. According to the Broberg-Morrey elbow function scores, the results were rated excellent in 4 cases (40%), good in 5 cases (50%), and poor in 1 case ( 10% ). The overall satisfactory rate was 90%. The range of functional motion and carrying angle was restored in all ten patients. No complications,such as recurrent dislocation, infection, or neurovascular injury were observed. Conclusion Reconstruction of annular ligament with pedicled deep fascia in pediatric chronic isolated radial head dislocation is fundamental to obtain stable reduction of the dislocated radial head, maintain humeroradial and ulnoradial alignment, and restore elbow function. However this procedure should be considered with caution for patients older than 14 to 16 years especially when their epiphyseal plate is closed. Key words: Radius; Dislocations; Annular ligament

Double-column fixation for type C fractures of the distal humerus in the elderly

Although several studies reported good results of open reduction and internal fixation of displaced fracture of the adult distal humerus, few studies have specifically addressed the results of such surgical fixation in osteoporotic bone in the elderly. This study focused on AO type C fractures in the elderly by using 2 plates for fixation of the lateral and medial columns to reconstruct a stable triangular frame of the distal humerus. The study comprised 35 patients, and 32 were available for final evaluation at a mean follow-up of 24.5 months (range, 14-60 months). Mayo Elbow Function Score showed 25 patients (78%) achieved an excellent functional result, and 7 (22%) had a good result. No patients were considered to have a fair or poor result. At the final follow-up, the mean range of flexion to extension of the elbow was 22 degrees (range, 10 degrees -40 degrees) to 125 degrees (range, 100 degrees -140 degrees). All fractures united at average of 3.5 months (range, 2.5-5.3 months). Open reduction and internal fixation using double-columned plating is a useful and effective technique in the management of displaced, comminuted, intra-articular fractures of the distal humerus in elderly patients. Level 4; Case series, treatment study.

Comparion of 6 functional tests for postoperative elbow function evaluation

Objective Several elbow function scores are used in research, but there is no universally adopted standard. In this study 6 elbow out,me scales were compared to provide basis for selection of postoperative elbow functional evaluation criteria. Methods Thirty-one patients who underwent elbow surgery for humeral condyle fractures or supracondyle fractures from January 2004 to August 2006 were involved in the study. Postoperatively their elbow function was evaluated using 6 widely applied elbow scores, clinical examinafions, and radiographic examinations. Pearson correlations were calculated between the total scores of the 6 instruments, between the components of the scales, and with age. Regression equations were calculated between scales. Results There was no obvious relationship between the total scores. However the relationship between components of different score systems was tight. There was a negative correlation between age and function and between function and pain. The age factor had a high negative correlation score with every score system. Conclusion Mayo score, HSS2 score particularly emphasize on patients's ubjective assessment. Modified An and Morrey score and HSS score emphasize more on objective examination. Modified Breberg and Money score and de Boer YA score were relatively balanced for both subjective and objective assessment. We recommend HSS score as the first choice for clinician based outcomes and recommend HSS2 score to evaluate patient reported outcomes. Key words: Elbow joint; Treatment outcomes; Function; Assessment

Intraarticular distal fractures of the humerus in old aged patients

Treatment of intraarticular distal humeral fractures often leads to unsatisfying results mainly due to remaining limitation of active motion or pain. In aged patients this situation is aggravated by osteoporosis and multimorbidity.We review a series of intraarticular distal humeral fractures in twenty-nine patients aged over 80 during a period of ten years. 19 of these patients underwent surgery, the others were treated by closed reduction and cast fixation.After a mean follow-up of 2.6 years (0.8 to 9.0) the results of 20 patients were classified according to the scales by Caja and Cassebaum. Although the elbow function scores in operated patients were better compared to non-operatively treated patients (mean Caja-scale 71.4 points versus 65.0 points), some serious complications occurred, i.e. one case of implant failure due to repetitive falls. In one patient a total elbow prosthesis had to be implanted after intraoperative failure of the planned ORIF procedure.In the majority of patients treated by non-operative means (7 out of 10) a stationary admission could be avoided, leaving them in their accustomed social environment.The authors conclude that only in case of severe osteoporosis and multimorbidity closed reduction and cast fixation is an acceptable alternative to surgery.

Functional outcomes of "floating elbow" injuries in adult patients.

To assess elbow function, complications, and problems of floating elbow fractures in adults receiving surgical treatment. Retrospective clinical review. Level I trauma center in Kanagawa, Japan. Fourteen patients with fifteen floating elbow injuries, excluding one immediate amputation, seen at the Kitasato University Hospital from January 1, 1984, to April 30, 1995. All fractures were managed surgically by various methods. In ten cases, the humeral and forearm fractures were treated simultaneously with immediate fixation. In three cases, both the humeral and forearm fractures were treated with delayed fixation on Day 1, 4, or 7. In the remaining two cases, the open forearm fracture was managed with immediate fixation and the humerus fracture with delayed fixation on Day 10 or 25. All subjects underwent standardized elbow evaluations, and results were compared with an elbow score based on a 100-point scale. The parameters evaluated were pain, motion, elbow and grip strength, and function during daily activities. Complications such as infections, nonunions, malunions, and refractures were investigated. Mean follow-up was forty-three months (range 13 to 112 months). At final follow-up, the mean elbow function score was 79 points, with 67 percent (ten of fifteen) of the subjects having good or excellent results. The functional outcome did not correlate with the Injury Severity Score of the individual patients, the existence of open injuries or neurovascular injuries, or the timing of surgery. There were one deep infection, two nonunions of the humerus, two nonunions of the forearm, one varus deformity of the humerus, and one forearm refracture. Based on the present data, we could not clarify the factors influencing the final functional outcome after floating elbow injury. These injuries, however, potentially have many complications, such as infection or nonunion, especially when there is associated brachial plexus injury. We consider that floating elbow injuries are severe injuries and that surgical stabilization is needed; beyond that, there are no specific forms of surgical treatment to reliably guarantee excellent results.