Extension Of Elbow Joint Research Articles

Surface electromyography character of upper limb muscle after open reduction combine with ulnar osteotomy in children with neglected Monteggia fracture.

This study aims to investigate the surface electromyography (sEMG) characteristics of upper limb muscles in children with neglected Monteggia fracture after open reduction of radial head dislocation and ulna osteotomy and bone grafting internal fixation, and to understand the recovery of muscle activity in children after operation, provide reference for clinical rehabilitation. A retrospective analysis was conducted on sixteen children with neglected Monteggia fracture who underwent ulna osteotomy at our hospital from January 2021 to August 2022. The biceps brachii, triceps brachii, flexor carpi radialis, and extensor carpi ulnaris muscle activities were recorded during grip strength tests, flexion and extension of elbow joint while holding a 1 kg dumbbell, as well as gripping tasks. The root mean square (RMS) values of sEMG signals, co-contraction ratio, and elbow joint function scores were compared between pre- and post-operation periods as well as between the affected side and unaffected side. The preoperative maximum grip strength, as well as the average RMS values of flexor carpi radialis and average RMS value of extensor carpi ulnaris on the affected side were significantly lower. After surgery, both the maximum RMS value of biceps brachii and maximum and average RMS value of extensor carpi ulnaris on the affected side remained lower. Prior to surgery, when performing elbow flexion and extension tests while holding a 1 kg dumbbell, both mean RMS values of biceps brachii and flexor carpi radialis on the affected side were smaller. However, after surgery, there was an increase in mean RMS values of biceps brachii on the affected side. Furthermore, postoperative elbow function scores were significantly higher than preoperative scores. Open reduction of radial head dislocation combined with ulna osteotomy and bone grafting can achieve good functional activities in the treatment of neglected Monteggia fractures in children. The EMG activity of the extensor carnosus ulnalis muscle on the affected side related to grip strength was low, and the desired effect was not achieved within the expected time.

Reliability and validity of muscle activity analysis using wearable electromyographs.

[Purpose] The aim of this study was to develop a novel wearable surface electromyograph called NOK, and compare its reliability and validity to an existing electromyograph. [Participants and Methods] The study participants were 23 healthy university students (Seven males and 16 females; age 20.3 ± 1.1 years [mean ± standard deviation]; height 162.0 ± 6.7 cm; weight 58.4 ± 10.1 kg) who all gave informed written consent. The newly developed electromyograph (NOK) features a rubberized skin contact surface that requires no electrodes and allows the acquisition of up to 10 channels of muscle waveforms on a portable personal computer. After measuring maximal isometric elbow extension and flexion, we examined muscle waveforms during isometric contractions of elbow joint flexion and extension at approximately 50% of maximal voluntary contraction using both NOK and Delsys electromyographs and compared the results of the two devices. [Results] We found a significant moderate correlation between the measurements by the two devices for biceps and triceps. The measurements by the two devices also showed strong measure-retest reliability. Systematic errors were observed for elbow flexion and extension in the two measurements, indicating limited agreement between the two measurement methods. [Conclusion] Although the new device also has high repeatability and reliability, it is unsuitable for analyzing detailed muscle activity. However, since it can measure up to 10 channels of muscle activity, it is expected to be used in the rehabilitation and sports field in the future.

Ergonomic learning curves on gynecological laparoendoscopic single-site (LESS) surgery

BackgroundFew previous studies have introduced general techniques to overcome the “chopstick effect” in laparoendoscopic single-site surgery (LESS). We aim to investigate and highlight the key ergonomic methodologies for gynaecologic LESS based on the surgeon’s hands-on performance.MethodsThe first author surgeon A reviewed and analyzed the LESS procedures performed by herself and how she taught surgeon B from January 2021 to April 2022. The procedures were classified based on technical difficulty and learning periods, and the hands-on technical skills of LESS module were evaluated.ResultsSurgeon A conducted 580 LESS procedures, which were divided into the novice (n = 48) and intermediate (n = 33) periods, and the remaining cases were included in the routine period. We formed a special ergonomic LESS operating methodology: Maintain good LESS laparoscopic spatial sensation, keep hand-eye coordination, well cooperation between the main surgeon and the assistant; Experienced multiport laparoscopy surgery (MPS) skills, improve basic LESS technique: grasp, lift, transfer, place, blunt separating, coagulation and cutting. Coordination location, orientation, movements, and flexion or extension of shoulders, arms, elbow, wrist and finger joints; Maintain strength, tension and ambidexterity postures with joint and muscular efforts to control instruments. Surgeon B learned the above experiences by performing 39 LESS procedures under the guidance of surgeon A.ConclusionThis educational research sheds light on the common challenges faced in LESS and presents the importance of ergonomic hands-on performance skills in improving surgical outcomes, which could serve as a guide for future training and education in LESS.

ANÁLISE DOS EFEITOS DO TREINAMENTO DE FORÇA DE ALTA INTENSIDADE SOBRE A MUSCULATURA E O METABOLISMO DE ESTUDANTES UNIVERSITÁRIOS

ABSTRACT Introduction: Recent studies shows that college students have decreased physical fitness and increased obesity rates, and the rate of obesity will continue to increase over time. Objective: Study the effect of high-intensity strength training on college students’ muscle optimization and metabolic recovery. Methods: This paper adopts the experimental control method. An experimental group performed high-intensity strength training and completed the training with the help of the existing equipment in our school's gym. The control group used normal aerobic training to complete the running training and other movements in athletics. The experimental and control groups were trained three times a week for one hour at a time. Results: In the experimental group, left arm elbow joint extension was optimized to (18.405 ± 2.8878) kg after the experiment, P<0.05; right leg knee joint extension was optimized to (38.754 ± 6.6556) kg after the experiment, P<0.01; serum total cholesterol was optimized to (3.682 ± 0.2643) mmol/L after the experiment, P<0.01. Conclusion: High-intensity strength training, when compared with ordinary aerobic training, has a better optimizing effect on college students’ indicators and higher exercise efficiency. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Automatic Diagnosis of Elbow Arthritis Based on Edge Algorithm

Osteoarthritis is an age-related degenerative joint disease; it is mainly because the cartilage tissue between bones is worn and thinned, which leads to the damage of the periosteum and bone including the surrounding ligaments. Clinically, its manifestations are mainly joint pain, swelling, stiffness, and even partial loss of function, which seriously affects the quality of life of patients. The main clinical manifestations are elbow joint pain and limited movement. Elbow articular cartilage degenerates and falls off, and the more serious manifestation is subchondral hyperosteogeny and sclerosis, which leads to unsmooth articular surface and narrow joint space. Finally, elbow joint pain is severe with different degrees of mobility disorder, elbow joint extension and flexion range is getting smaller and smaller, and elbow joint pain is getting more and more serious. In this paper, the segmentation of left and right elbow images is completed based on gray projection through the analysis of image gray distribution. After obtaining the region of interest of elbow joint, the extraction algorithm of elbow joint hard bone edge is studied. Firstly, the extraction of elbow joint hard bone contour edge is completed based on active shape model algorithm combined with image characteristics. Finally, according to the extraction results of hard bone contour edge, this paper realizes the automatic diagnosis of multiple elbow arthritis indexes and compares with the results given by the image set, which proves that the whole algorithm has good adaptability and accuracy.

Three-dimensional printing combined with distal humeral osteotomy for cubital varus deformity in children

To explore clinical effect of three-dimensional(3D) printing combined with distal humerus osteotomy for children with cubital varus deformity. From January 2017 to January 2020, 17 cubital varus deformity children treated with distal humerus osteotomy were retrospective analysis, included 11 boys and 6 girls, aged from 5 to 11 years old with an average of (7.8±1.7) years old. A model of affected side elbow joint was made by 3D printing technique before operation, pre-operation was performed on the model. Three-dimensional model was successfully used for distal humeral osteotomy during operation. Carrying angle, flexion and extension angle of elbow joint were compared before and six months after operation, and Flynn scoring criteria was used to evaluate clinical effect. All children were followed up for 6 to 12 months with an avergae of (9.6±1.7) months. One child occurred wound infection and healed completely after dressing change. No complications such as nonunion, internal fixation and nerve injury occurred. Carrying angle of affected limb was improved from (-20.8±2.4)°before operation to (7.2±2.3)°at 6 months after operation (P<0.01). Angle of affected elbow joint extension improved from (-5.6±3.9)° before opeation to(-2.6±2.1)°at 6 months after operation (P<0.01). There was no significant difference in extension angle of elbow joint between preopertaion and postopertaion at 6 months (P>0.05). While there was no difference in elbow joint function on the healthy side and affected side at 6 months after opertaion (P>0.05). According to Flynn scoring criteria, 13 patients got excllent results and 4 moderate. Three-dimensional printing combined with distal humerus osteotomy in treating elbow varus deformity could receive satisfactory clinical effect, which could accurately assist correction of cubital varus deformity, restore physiological structure and function of elbow joint.

Morphological affinities of a fossil ulna (KNM-WS 65401) from Buluk, Kenya

The morphological affinities of a primate proximal ulna (KNM-WS 65401) recovered from the late Early Miocene site Buluk, Kenya, are appraised. Nineteen three-dimensional landmarks on ulnae from 36 extant anthropoid species (n = 152 individuals) and KNM-WS 65401, as well as a subset of 14 landmarks on six ulnae belonging to other East African Miocene catarrhine taxa, were collected. To quantify ulnar shape, three-dimensional geometric morphometric techniques were used and linear dimensions commonly cited in the literature were derived from the landmark data. KNM-WS 65401 is situated between monkeys and hominoids in the principal components morphospace. KNM-WS 65401 shares features such as a short olecranon process, broad trochlear notch, and laterally oriented radial notch with extant hominoids, whereas features such as an anteriorly directed trochlear notch and flat, proximodistally elongated, and anteroposteriorly narrow radial notch are shared with extant monkeys. Principal component scores and linear metrics generally align KNM-WS 65401 with both suspensors and arboreal quadrupeds, but quadratic and linear discriminant analyses of principal component score data provide posterior probabilities of 80% and 83%, respectively, for assignment of KNM-WS 65401 to the suspensory group. Compared with fossil ulnae from other Miocene primates, KNM-WS 65401 is morphologically most distinct from KNM-LG 6, attributed to Dendropithecus macinnesi, and morphologically most similar to KNM-WK 16950R, attributed to Turkanapithecus kalakolensis. The KNM-WS 65401 individual likely possessed more enhanced capabilities for elbow joint extension, perhaps during suspensory behaviors, compared with other Miocene primates in the sample.

BOXING SPEED AND MUSCLE SCIENTIFIC TRAINING

ABSTRACT Introduction: Boxing is a sport that requires a lot of explosive power, that is, it demands from its practitioners not only to use their strength, but to do so very rapidly. Objective: To analyze the influence of muscle training on the explosive power of boxers, providing a theoretical reference for the training of their core strength. Methods: This article makes a statistical analysis of boxing explosive power and analyzes the factors relevant to punch speed. Results: The key factors that affect the maximum speed of the straight punch in boxing are the maximum elbow joint flexion and extension, angular velocity, and the maximum trunk angular velocity. Conclusion: In daily training, attention should be paid to upper limb strength and core strength training, which is the only way for boxers to have a correct body posture and ensure a reliable center of gravity when punching. Level of evidence II; Therapeutic studies - investigation of treatment results.

Throwing kinematics and elbow varus torque relative to ball size in junior baseball players.

[Purpose] The purpose of this study was to investigate changes in the shoulder and elbow joint angles, upper limb angular velocities, and elbow varus torque when throwing balls of two different sizes. [Participants and Methods] The pitching motion of 26 junior baseball players was analyzed using an optical motion capture system. The balls used were a standard baseball and a small ball of equal weight. Shoulder external rotation/abduction and elbow flexion were measured. The maximum values of shoulder joint internal rotation, elbow joint extension, wrist flexion angular velocity, and elbow joint varus torque were also evaluated. The ball velocity was determined as an index of pitching performance. [Results] The shoulder external rotation and elbow flexion angles were higher when pitching with a small ball. The joint angular velocity was also significantly higher when pitching with a small ball for all items examined. The ball speed was significantly higher with the small ball. The maximum varus torque of the elbow joint divided by the ball velocity was significantly lower for the small ball. [Conclusion] For a junior baseball player with a small hand length, using a small ball enables pitching with low stress on the elbow joint.

Intraoperative arthrography monitoring assisted closed reduction and internal fixation for intercondylar fracture of humerus in children

To investigate clinical effects of intraoperative arthrography monitoring assisted closed reduction and internal fixation for intercondylar fracture of humerus in children. From January 2013 to July 2018, 18 children with intercondylar fracture of humerus were treated by operation, including 13 males and 5 females aged from 3 to 12 years old with an average age of (8.50±2.57) years old. According to Toniolo & Wilkinson classification, 8 children were typeⅠand 10 children were typeⅡ. During the operation, closed reduction and internal fixation were performed under the monitoring of intraoperative radiography, open reduction and internal fixation were performed in necessity. Mayo score of elbow joint was used to evaluate clinical effect at 6 months after operation. All children were underwent arthrography monitoring during operation, 5 children were treated with closed reduction and internal fixation for intraoperative arthrography found no fracture of articular cartilage, 11 children by closed reduction and internal fixation because of fracture of articular cartilage involving the joint space with displacement less than 2 mm, and 2 children by closed or open reduction and internal fixation for fracture of articular cartilage surface with displacement above 2 mm, which 1 child with smooth of joint surface was performed closed reduction and internal fixation, 1 child without smooth of joint surface and displacement above 2 mm was performed open reduction and internal fixation. All children were followed up from 8 to 26 months with an average of (20.28±4.40) months. All factures were healed from 6 to 9 weeks with an average of (7.33±0.77) weeks. Postoperative Mayo score of elbowjoint at 6 months was (89.44±11.36), and 12 patients got excellent results, 5 good and 1 poor. One patient occurred partial limitation of flexion or extension of elbow joint. No elbow deformity and other complications occurred. The treatment of intercondylar fracture of humerus in children under monitoring of intraoperative radiography could reduce opertaion injuries and complications, confirm the reduction effect of articular surface of cartilage in time and clearly, and promote recovery of elbow joint function.

A new approach of inducing proprioceptive illusion by transcutaneous electrical stimulation

BackgroundNeurotraumas or neurodegenerative diseases often result in proprioceptive deficits, which makes it challenging for the nervous system to adapt to the compromised sensorimotor conditions. Also, in human machine interactions, such as prosthesis control and teleoperation, proprioceptive mismatch limits accuracy and intuitiveness of controlling active joints in robotic agents. To address these proprioceptive deficits, several invasive and non-invasive approaches like vibration, electrical nerve stimulation, and skin stretch have been introduced. However, proprioceptive modulation is still challenging as the current solutions have limitations in terms of effectiveness, usability, and consistency. In this paper, we propose a new way of modulating proprioception using transcutaneous electrical stimulation. We hypothesized that transcutaneous electrical stimulation on elbow flexor muscles will induce illusion of elbow joint extension.MethodEight healthy human subjects participated in the study to test the hypothesis. Transcutaneous electrodes were placed on different locations targeting elbow flexor muscles on human subjects and experiments were conducted to identify the best locations for electrode placement, and best electrical stimulation parameters, to maximize induced proprioceptive effect. Arm matching experiments and Pinocchio illusion test were performed for quantitative and qualitative analysis of the observed effects. One-way repeated ANOVA test was performed on the data collected in arm matching experiment for statistical analysis.ResultsWe identified the best location for transcutaneous electrodes to induce the proprioceptive illusion, as one electrode on the muscle belly of biceps brachii short head and the other on the distal myotendinous junction of brachioradialis. The results for arm-matching and Pinocchio illusion tests showed that transcutaneous electrical stimulation using identified electrode location and electrical stimulation parameters evoked the illusion of elbow joint extension for all eight subjects, which supports our hypothesis. On average, subjects reported 6.81° angular illusion of elbow joint extension in arm-matching tests and nose elongated to 1.78 × height in Pinocchio illusion test.ConclusionsTranscutaneous electrical stimulation, applied between the the synergistic elbow flexor muscles, consistently modulated elbow joint proprioception with the illusion of elbow joint extension, which has immense potential to be translated into various real-world applications, including neuroprosthesis, rehabilitation, teleoperation, mixed reality, and etc.

Research of Intelligent Angle Correction Manipulator in Treatment of Joint Injury After Operation

Abstract With the continuous development of medical technology, it is very important for patients with upper limb injury caused by various reasons to carry out postoperative functional recovery treatment. In order to facilitate the clinical rehabilitation treatment after operation, the mechanical arm assisted with limb joint movement is used to help patients with rehabilitation training. However, due to the complexity of human limb movement, the axis of using the robot is not coincident with the axis of robot motion, and a certain position deviation is easy to restrict or even damage the elbow wrist joint movement of patients. In this article, based on the application of artificial intelligence technology, the motion pair of elbow wrist joint is equivalent to data, and the human body mechanism is equivalent to a multi-rigid body open chain mechanism. In the biological fusion elbow wrist rehabilitation manipulator composed of human body mechanism and mechanical structure, the length of human forearm is identified through the position analysis of elastic moving pair, and the elbow joint flexion and extension is realized by intelligent angle correction. In addition, the accuracy of motion control of rehabilitation robot is improved.

Developing a Method to Control an Arm-Assist-Suit by Predicting Arm-Trajectory Using Electromyography.

Many researchers have developed assist-suits to support repetitive and strenuous physical labor, but existing suits show unsatisfactory responsiveness and restrict arm motions. Therefore, we propose a method for an arm-assist-suit that synchronizes arm motions by using electromyography (EMG) to predict arm trajectory. EMG is used to measure and record electrical signals while muscles are active. Further, predicted arm-joint motions and estimated arm-joint angles are used for arm trajectory predictions. In this study, we attempted the prediction of elbow-joint motions and the timing of motion changes. Two subjects executed twelve types of elbow-joint movements that had four start and endpoints. We measured seven muscle types with EMG points on the right arm(hand, elbow, and shoulder) a motion capture system, respectively. After processing these data, we applied a multiclass logistic regression, which is a machine-learning technique, to predict elbow-joint motions, namely, rest, flexion, and extension. The precision in elbow joint motion prediction shows a difference between the two subjects for the three motions analyzed. Additionally, the rest prediction accuracy is lower than both flexion and extension for each subject. The prediction of elbow-joint motion change timing does not correlate with the elbow-joint motion predictions, with the timing prediction precision being very low and thus, causing some difficulties. To overcome these difficulties, and improve precision in future work, we plan to apply an independent component analysis to eliminate noise and add or change features.Clinical Relevance- This study aims to establish a benchmark for future research on the improvement of responsiveness and range-of-motion of arm-assist-suits.

Evaluation of anterior oblique ligament tension at the elbow joint angle—a cadaver study

The ulnar collateral ligament complex, particularly the anterior oblique ligament (AOL), is mainly a static stabilizer controlling valgus. Various studies have been conducted on the kinematics of elbow joints after ligament cutting; however, no biomechanical studies have measured the tension applied to the ligament. Finite element modeling (FEM) is a very useful tool for biomechanical evaluation of the elbow. However, an accurate FEM of elbow joints cannot be developed without information on the potential tension of ligaments applied during the flexion and extension of elbow joints. We believe that FEM of the elbow joint could be obtained by measuring the material properties and potential tension of the ligament applied during the flexion and extension of the elbow joint. This study aimed to measure the potential tension and material properties of the ligament during the flexion and extension of the elbow, by identifying the relation between ligament length and tension using mechanical testing. We included 10 elbows harvested from 7 fresh-frozen cadavers. The average age of the cadavers was 83.7 ± 5.65 years, and the samples included 8 elbows from 6 male cadavers and 2 elbows from 1 female cadaver. We measured the ligament length at each elbow angle by changing the elbow joint from 0° to 120° in 15° intervals. Thereafter, we extracted the AOL and divided into an anterior band (AB) and a posterior band (PB)and performed a mechanical test to calculate ligament stress. The ligament length of the AB gradually decreased as the flexion angle increased. Conversely, the ligament length of the PB gradually increased as the flexion angle increased. AB and PB lengths were approximately the same between 60° and 75°. The average ligament tension and stress of the AB gradually increased with elbow extension. In contrast, the average ligament tension and stress of the PB gradually increased with elbow flexion. The tension and stress of the AB and PB were balanced around the elbow joint at 60°. The AB was tenser on elbow extension, and the PB was tenser following elbow flexion. Also, the angle at which the AOL stress was equalized was 60°, suggesting that ∼60° is the angle at which the AOL is unlikely to be damaged.

Dynamic contraction dependence on the instantaneous motor unit firing rates

The effect of voluntary muscle contraction is to regulate position change about a joint involving recruitment and rate coding of motor units (MU) to produce torque results in the shortening velocity component. Unlike isometric (static) muscle contractions, isotonic (dynamic) muscle contractions can involve feedback to slow the shortening velocity as the joint reaches the terminal position. During dynamic conditions of increasing velocity targets, evidence indicates that the neuromuscular initiation of movement is greater than at isometric conditions, possibly being enhanced by the motor neuron secondary firing rate range. Our objective was to further characterize voluntary neuromuscular control at the level of instantaneous motor unit action potential firings during dynamic shortening muscle contractions. During isometric and isotonic contractions, intramuscular fine‐wire electromyography (EMG) was used to record MU potentials from the anconeus and triceps brachii muscles in healthy younger men and women (range 20–35 years, n= 15). Isotonic contractions were normalized to the maximal isotonic velocity and were loaded at 20% of the maximal isometric voluntary contraction torque. For analysis, the EMG was digitally high‐pass filtered (1 kHz, 3rd order Butterworth) and MU action potential waveforms were determined and sorted by template matching (Spike2 Wavemark, version 7) with manual inspection. Torque, velocity and position were also measured and at each individual firing rate time‐point and these vectors were aligned. From this, 627 MU trains (mean±standard deviation 42±19, n= 15) during the isotonic contractions in the anconeus muscle and 226 MU trains (38±14, n= 6) in the long head of the triceps brachii muscle were measured. To explore a more comprehensive model related to firing rates, the torque, velocity and position were modelled by linear regression with the residuals of MU train number, participant, testing session, sex, muscle and target velocity removed. From the full model when comparing slope coefficients, there was no significant interactions between torque (β= 48.1x) and velocity (β= −28.5x) on firing rate dependence (p= 0.2). Position (β= 0.4x) had a smaller coefficient on firing rates as compared to torque and velocity and a significant interaction effect with torque (p&lt; 0.05), but not velocity (p= 0.4). These results indicate that a model of instantaneous firing rate dependence on torque, velocity and position requires a re‐examination, especially because the interaction of torque and velocity were significantly correlated (r= 0.5, p&lt; 0.05). Shortening velocity of muscles causing elbow joint extension must be first initiated by a rate of torque development, further supporting that a different conceptual approach may be necessary to understand MU output during dynamic contractions. It may be important in this task to model firing rates as the independent variable (time vector) that will affect succeeding dependent changes of torque, velocity and position.Support or Funding InformationSupported by NSERC.

Human-robot cooperative control based on sEMG for the upper limb exoskeleton robot

An exoskeleton robot is a mechanical structure that integrates with the exterior of the human body to improve the wearer’s muscular power. The key to ensure performances and comfort of the system is human–robot cooperation. This paper proposes a human–robot cooperative control method based on sEMG (surface Electromyography) signals to drive a pneumatic upper limb exoskeleton to act in accordance with the wearer’s motion intentions. The intended movement information of the human is estimated by combining the regression method with the classification method. Based on the joint torque estimation model which is originated from the Hill-type musculoskeletal model, the regression method is used to estimate the joint’s desired torque by merging the sEMG signal with the joint angle. To avoid shaking and keep the robot’s limbs in the static condition, a classification method with the support vector machine is developed to find out the joint state that the human intends to keep. It was then applied to the exoskeleton’s elbow joint flexion and extension movement experiments to verify the controller’s effectiveness. The experimental results demonstrate that the controller can estimate human’s motion intention accurately and is appropriate for the human–robot collaboration.

Is anterior transposition of ulnar nerve beneficial during open reduction and internal fixation for intercondylar humerus fractures

To compare activity, function and postoperative ulnar nerve function of elbow joint by anterior transposition of ulnar nerve or not during open reduction and internal fixation for intercondylar humerus fractures. From January 2013 to May 2017, 168 patients with intercondylar humerus fractures were treated surgically with open reduction and internal fixation (ORIF). The patients were divided into anterior subcutaneous transposition group and simple decompression group according to handling method of ulnar nerve. There were 48 patients in transposition group, including 23 males and 25 females with an average age of (42.5±15.7) years old ranging from 14 to 77 years old, and ulnar nerve treated enough free and anterior subcutaneous transpostion after reduction of intercondylar humerus fractures; while there were 120 patients in simple decompression group, including 62 males and 58 females with an average age of (43.4±17.3) years old ranging from 14 to 81 years old, ulnar nerve returned to sulci nervi ulnaris. Activity of flexion and extension of elbow joint, range of rotation of forearm were recorded at the latest following-up, Mayo score of elbow joint was used to evaluate clinical effect, McGowan grading was used to assess dysfunction of unlnar nerve. There was 1 patient delayed union, and 2 patients occurred joint stiffness in transposition group; while 1 patient suffered from incision infection, 1 fracture nonunion, and 4 joint stiffness in simple decompression group; and there was no statistical difference between two groups(P>0.05). Forty-eight patients in transposition group were followed-up from 12 to 59 months with an average of (32.2±14.2) months, activity of flexion and extension of elbow joint was (116±28)°, range of rotation of forearm was (152±12)°, MEPS score was 88.6±11.6; and 28 patients got excellent results, 16 good, 3 moderate and 1 poor. There were 17 patients occurred injury of ulnar nerve, and 7 patients still occurred dysfunction of ulnar nerve, and 6 patients were grade I, 1 patient was grade II according to McGowan grading. In simple decompression group, there were 120 patients were followed-up from 13 to 61 months with an average of (32.0±14.9) months, activity of flexion and extension of elbow joint was (119±27)°, range of rotation of forearm was (154±16)°, MEPS score was 88.9±12.5; and 67 patients got excellent results, 44 good, 7 moderate and 2 poor. There were 42 patients occurred injury of ulnar nerve, and 22 patients still occurred dysfunction of ulnar nerve, and 18 patients were grade I, 4 patients were grade II according to McGowan grading. There were no statistical differences in following time, activity of flexion and extension of elbow joint, range of rotation of forearm, MEPS score and dysfunction of ulnar nerve. Whether anterior transposition of ulnar nerve or not has no clarified effects for open reduction and internal fixation for intercondylar humerus fractures.

Clinical observation of olecranon sled for the treatment for olecranal fracture

To explore clinical effect of olecranon sled in treating olecranal fracture. Four patients with olecranal fracture treated by olecranon sled in March 2017, including 2 males and 2 females, age of 40, 46, 47, 72 years old, 3 patients on the left side and 1 patient on the right side. All patients were caused by falling down. Fracture were transverse, oblique and slightly compressive articular surface fracture. The time from injury to operation ranged from 1 to 3 days. Operative time, blood loss, complications and flexion and extension of elbow joint, and function of forearm were observed, VAS score was used to evaluate relieve degree of pain, and Mayo score was applied to assess recovery of elbow function. Four patients were followed up until September 2018. Operative time ranged from 40 to 60 min, blood loss was for 20 to 40 ml, and no complications occurred. All fracture were healed at 4 months after operation. Elbow flexion was for 140° to 150°, extension of elbow was from 0° and extend to 10°, activity of flexion and extension ranged from 140 ° to 160°, MEPS score was 100. No pain occurred during doing activity, and VAS score was 0. Low-profile design and integrated design of olecranon sled could avoid irritation of tension band and plate, and it is a simple and ideal internal fixation method for simple and mildly comminuted olecranon fracture, which is not suitable for severely comminuted olecranon fracture.

Ilizarov technique for treatment of distal radius deformity and bone defect after trauma

To investigate the effectiveness on the distal radius deformity and bone defect after trauma by using Ilizarov external fixator. The clinical data of 9 patients of post-traumatic distal radius deformity with bone defect treated by Ilizarov technique between January 2012 and December 2016 were retrospectively analyzed. There were 7 males and 2 females with an average age of 25.6 years (range, 11-46 years). Of the 9 cases, 4 were radial baseball hand deformity with large bone defect, 4 were short deformity of distal radius, 1 was distal radius deformity with radial deflection and pronation deformity, all with distal dislocation of the distant radial-ulnar joint. The time from injury to operation was 6 months to 6.2 years (mean, 1.5 years). The bone defect was 1.4-6.8 cm (mean, 3.6 cm). After complete debridement, the forearm was fixed with Ilizarov external fixator. At 7 days after operation, bone transport or bone lengthening was performed at the rate of 0.8-1 mm/d, 4 times a day, the deformity was slowly corrected and the bone defect was repaired. According to the loss of palmar tilt angle and ulnar tilt angle measured before operation, the position of distal radial articular surface was gradually adjusted in the course of moving or prolonging, so as to restore palmar tilt angle and ulnar tilt angle as far as possible. All wounds healed by first intention and no leakage or rupture occurred. All the 9 patients were followed up 15-36 months (mean, 23 months). All the radius defects healed and the distal deformity was corrected, the healing time was 92.4-138.6 days (mean, 104.7 days); the external fixation index was 32.6-51.1 days/cm (mean, 40.2 days/cm). After 2 months of external fixator removal, the wrist joint flexion was (42.6±3.1)°, the wrist dorsum extension was (48.5±4.7)°, the palm inclination angle was (11.5±1.3)°, and the ulnar deviation angle was (21.2±3.7)°; the elbow flexion was (128.2±6.4)°, the elbow extension was (3.2±2.1)°, the forearm pronation was (71.5±4.3)°, and the forearm rotation was (38.2±6.5)°; the wrist and elbow joint extension and forearm rotation were significantly improved when compared with preoperative values ( P<0.05). At last follow-up, wrist function was assessed according to Gartland-Werley standard, the results were excellent in 3 cases, good in 5 cases, and fair in 1 case. Four cases had pinhole infection, and were cured after anti inflammatory dressing change or replacement of needles; 3 cases did not heal at the bone junction, and were healed after bone grafting; 4 cases deviated from the radial force line, and the deformity was corrected after adjusting the needle. Ilizarov technique can correct deformity and reconstruct bone defect of the post-traumatic distal radius simultaneously, so it is a good method to treat this kind of disease.

Ulna osteotomy and joint capsule release and tight for old Monteggia's fracture in children

To explore the experience and effect of surgical treatment in old Monteggia fracture in children. From January 2013 to December 2017, 32 cases of old Monteggia's fracture were treated including 18 males and 14 females with an average age of(5.3±1.2) years old ranging from 2 to 9 years old. No symptoms of radial nerve injury were found. The preoperative symptoms of the patients were the pain and deformity of the elbow joint, the flexion and extension and the limited forearm rotation. The X-ray showed the union of the ulna or the "arched sign", the dislocation of the radial head or the subluxation of the head. The posterior incision of the ulna ridge was performed in the operation, and the long oblique osteotomy was performed at the most obvious point of the ulna angle deformity. Then the Boyd incision was used to expose the humeral and radial joint and the upper ulnar radial joint. The scar tissue in the joint was cleaned and the radial head was repositioned. On the premise of maintaining the stability of the elbow joint, the ulna osteotomy was treated with plate and screw internal fixation. All 32 cases were followed up for 12 to 24 months with an average of 14.8 months, of which 1 case had incision infection. There were no pain symptoms of elbow and wrist in 32 patients after operation, 29 patients with elbow joint flexion and extension (130±5)°/0°, forearm pronation and supination 90°/(85±5)°; 2 patients with elbow flexion and extension(119°/8°, 121°/7°), forearm pronation and supination (90°/75°, 85°/60°); 1 patient with elbow flexion and extension 90°/10°, forearm pronation and supination 80°/60°. According to Mackay criteria, the result was excellent in 29 cases, good in 2 cases, medium in 1 case. Ulna osteotomy, elbow posterior capsular release, anterior capsule contraction is a effective method in the treatment of old Monteggia's fracture in children.