Elbow Joint Function Research Articles

An Individualized Intra-Articular Stabilization Device Designed Based on 3D Printing Technology for Traumatic Instability of the Ulnohumeral Joint.

We aimed to design an individualized intra-articular stabilization device based on 3D printing technology and investigate the clinical effects of this device for treating traumatic instability of the ulnohumeral joint. This study enrolled nine patients with traumatic instability of the ulnohumeral joint (age: 47.2 ± 1.80 years) who received treatment between March 2018 and March 2019 in our hospital. All patients underwent a thin-layer computed tomography (CT) scan of the elbow before surgery. The original injury and repair models of the elbow were printed using 3D printing technology based on CT data. An individualized intra-articular stabilization device was designed with a 2.0 mm Kirschner wire based on the repair model. Nine patients agreed to receive surgical treatment for elbow disease and placement of the intra-articular stabilization device. The nine patients underwent open reduction through a posterior median approach, and the intra-articular stabilization device was placed in the elbow. Operation time, intraoperative blood loss, and postoperative complications were recorded and followed up. The device was removed at two postoperative months, and the Mayo score was used to evaluate elbow function. Four months after removing the intra-articular stabilization device, elbow joint function was evaluated again using the Mayo score. The mean operation time was 100.1 ± 8.2 min, and the mean intraoperative blood loss was 35.5 ± 7.1 ml. No complications occurred after operation. Two months after surgery, eight patients received an excellent Mayo score, and one patient received a good Mayo score. Four months after removal of the intra-articular stabilization device, eight patients received an excellent Mayo score, and one patient received a good Mayo score. The individualized intra-articular stabilization device can increase ulnohumeral stability and achieve rapid functional recovery of the elbow.

An Adaptive Fast Terminal Sliding Mode Controller of Exercise-Assisted Robotic Arm for Elbow Joint Rehabilitation Featuring Pneumatic Artificial Muscle Actuator

Due to the time-varying nonlinear dynamic, uncertain model and hysteresis characteristics of the pneumatic artificial muscle (PAM) actuator, it is not easy to apply model-based control algorithms for monitoring, as well as controlling, the operation of systems driven by PAM actuators. Hence, the main aim of this work is to propose an intelligent controller named adaptive sliding controller adding compensator (ASC + C) to operate a robotic arm, featuring a pneumatic artificial muscle actuator, which assists rehabilitation exercise of the elbow joint function. The structure of the proposed controller is a combination between the fuzzy logic technique and Proportional Integral Derivative (PID) algorithm. In which, the input of fuzzy logic controller is the sliding surface, meanwhile, its output is the estimated value of the unknown nonlinear function, meaning that the model-based requirement is released. A PID controller works as a compensator with online learning ability and is designed to compensate because of the approximate error and hysteresis characteristic. Additionally, to improve convergence and to obtain stability, a fast terminal sliding manifold is introduced and online learning laws for parameters of the controller are attainted through the stable criterion of Lyapunov. Finally, an experimental apparatus is also fabricated to evaluate control response of the system. The experimental result confirmed strongly the ability of the proposed controller, which indicates that the ASC + C can obtain a steady state tracking error less than 5 degrees and a position response without overshoot.

Closed reduction and radial parallel Kirschner wire internal fixation for the treatment of Gartland Ⅲ supracondylar fracture of humerus in children

To investigate clinical effect of closed reduction and radial parallel Kirschner wire internal fixation in treating Gartland Ⅲ supracondylar fracture of humerus in children. From May 2015 to October 2019, 72 children with Gartland Ⅲ supracondylar fracture of humerus were treated by closed reduction and radial parallel Kirschner wire internal fixation, including 52 males and 20 females, aged from 3 to 10 years old with an average of (5.4±1.3) years old;39 patients classified to Gartland ⅢA and 33 patients classified to Gartland Ⅲ B. Operation time, fracture healing time, and functional exercise time were observed, Flynn elbow joint function score was used to evaluate clinical effects. All patients were followed up from 2 to 6 months with an average of (3.5±1.4) months. Operation time was 25~90 (37.8±10.4) min, fracture healing time was 28~45(38.8±9.4) days, functional exercise time was 22~60(36.9±11.2) days. No cubitus varus, iatrogenic neurovascular injury, reduction loss, compartment syndrome, infection or other complications occurred. According to Flynn elbow joint function score, 60 patients got excellent results, 10 good and 2 fair. Closed reduction and radial parallel Kirschner wire internal fixation in treating Gartland Ⅲ supracondylar fracture of humerus in children has advantages of minimally invasive, stable fixation, shorter operation time, easy to remove internal fixation, and less complications.

Surgical Treatment of Comminuted Coronal Shear Fracture of Distal Humerus.

ObjectiveTo investigate the surgical approach, fixation, and clinical effect of comminuted coronal shear fracture of distal humerus.MethodsFrom March 2017 to February 2019, we had used open reduction and internal fixation to treat 19 cases of comminuted distal humeral coronal shear fracture. There were 8 males and 11 females, with an average age of 44.6 years (19–72 years). There were 10 cases on left side and 9 cases on right side. All cases were closed fractures. According to Dubberley's classification, there were six cases of type 1, six cases of type 2, and seven cases of type 3. The lateral Kocher approach, extended Kocher approach, extended Kocher approach combined with a medial incision and the olecranon osteotomy approach were used for exposure. Headless screw, Kirschner wire, and suture were used to fix the fractures. Two cases were fixed with hinged elbow fixators additionally. The follow‐up was evaluated by Mayo Elbow Performance Score (MEPS).ResultsAll patients were followed up for an average of 17.1 months (range, 12 to 30 months). The average time of fracture union was 8.8 ± 1.9 weeks. There were three cases of degenerative osteoarthritis of elbow and one case of heterotopic ossification after operation. A total of 10 patients underwent removal of implants. At the last follow‐up, the elbow flexion‐extension arc was 130.5° ± 10.5°. The forearm rotation arc was 167.4° ± 6.1°. The MEPS was 85.8 ± 8.5, the results were classified as excellent in nine cases, good in eight, and fair in two. The excellent and good rate was 89.5%. The time of fracture union of type 1 was shorter than type 3 (P = 0.024), the elbow flexion‐ extension arc of type 1 fracture was better than type 2 (P = 0.043) and type 3 (P = 0.012), the forearm rotation arc of type 1 fracture was better than type 3 (P = 0.006), the MEPS of type 1 fracture was better than type 2 (P = 0.009) and type 3 (P = 0.002).ConclusionOpen reduction and internal fixation with headless screw, Kirschner wire, and suture can be used for the treatment of comminuted distal humeral coronal shear fractures. The elbow joint function can be restored satisfactorily.

Satisfaction With Elbow Function and Return Status After Autologous Osteochondral Transplant for Capitellar Osteochondritis Dissecans in High School Baseball Players

Background: Osteochondral autograft transplant (OAT), a surgical treatment for capitellar osteochondritis dissecans (OCD), has favorable rates of elbow recovery and return to sports in adolescents. However, few reports have investigated how long patients continue to play baseball after OAT and their satisfaction with their treatment outcome. Purpose: To evaluate the rate of boys who played baseball and received OAT for OCD in junior high school or earlier (age <15 years) and continued to play baseball in high school and the players’ satisfaction with their elbow function during play. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 32 elbows of boys who played baseball and received OAT at age ≤15 years (mean, 14.1 years) were examined and divided into pitcher (n = 11) and nonpitcher (n = 21) groups according to their player position before surgery. The clinical Timmerman-Andrews score at the end of their high school baseball, participation percentage of players who continued to play baseball, and satisfaction level during play (on a scale of 0-10 during pitching and batting and in a 4-choice format) were compared between the 2 groups. Results: The Timmerman-Andrews scores significantly improved after surgery in both groups, with no significant difference between the groups. Of the 32 players, 30 (93.8%) continued to play baseball throughout high school, including all players in the pitcher group and 19 (90.5%) of those in the nonpitcher group. The percentage of players who continued to pitch was 55.6% (6/11) in the pitcher group. Satisfaction with elbow joint function at the time of pitching was significantly lower in the pitcher group. Further, 5 players reported being “a little unsatisfied” because of elbow pain during pitching. All of the players indicated satisfaction with elbow function during batting. Conclusion: The percentage of players who received OAT for OCD in junior high school and continued to play baseball in high school was favorable. However, satisfaction with elbow function during throwing was lower in pitchers than in nonpitchers. Clinical Relevance: Before surgery, consent should be obtained from patients who are pitchers after it is explained that satisfaction with elbow joint function during pitching could be decreased after OAT.

Treatment of ulnar coronoid process fracture via a modified anteromedial approach

To investigate the effectiveness of a modified anteromedial approach in the treatment of ulnar coronoid process fracture. Between February 2017 and July 2018, 15 patients with ulna coronoid process fracture were reviewed. There were 9 males and 6 females, with an average age of 42.3 years (range, 24-60 years). The causes of injury included falling in 10 cases and traffic accidents in 5 cases, all cases were closed injury. According to the O'Driscoll classification, there were 4 cases of type Ⅰ, 6 cases of type Ⅱ, and 5 cases of type Ⅲ. The time from injury to operation was 2-8 days (mean, 3.7 days). All fractures were treated via a modified anteromedial approach between the pronator teres and the flexor carpi radialis plus with partial incision of flexor tendon aponeurosis. The fracture healing, muscle strength of forearm, postoperative complications were observed. At last follow-up, the elbow mobility were measured, the function of elbow was evaluated by Mayo elbow performance score (MEPS). All cases were followed up 10-18 months (mean, 13.3 months). Fracture union was achieved in all patients with a mean time of 10 weeks (range, 8-14 weeks). No obvious decrease of hand grip strength, nerve injury, and infection occurred. One patient had slight heterotopic ossification without special treatment. At last follow-up, all patients had stable elbows with good flexion-extension and varus-valgus stability, the mean flexion was 123.3° (range, 100°-140°), mean extension loss compared with that before operation was 6.7° (range, 0°-20°), mean pronation was 76.0° (range, 60°-85°), and mean supination was 75.8° (range, 55°-90°). The MEPS score was 65-100 (mean, 90.3) with the result of excellent in 10 cases, good in 4 cases, and fair in 1 case. The treatment of ulnar coronoid process fracture via the modified anteromedial approach provides excellent exposure, minimal invasion, fewer complications, and satisfactory prognosis, which is conducive to elbow joint function recovery.

Repair of skin and soft tissue defects in shoulder and elbow with rotator scapular artery perforator flap, lateral thoracic perforator flap, or medial brachial artery perforator flap

From January 2014 to June 2018, 12 patients with skin and soft tissue defects in shoulder and elbow were admitted to General Hospital of Ningxia Medical University with skin and soft tissue defect size of 6 cm×5 cm to 11 cm×8 cm, including 9 males and 3 females aged 15-56 years. Wounds of 5 patients were repaired with rotator scapular artery perforator flap (flap area of 8 cm×7 cm to 12 cm×6 cm), and the donor flap area was sutured directly. Wounds of 3 patients were repaired with lateral thoracic perforator flap (flap area of 8 cm×7 cm to 13 cm×9 cm). The donor flap area of two patients was sutured directly, the majority of the donor flap area of one patient was sutured directly, and a small part was covered by split-thickness skin graft from ipsilateral thigh. Wounds of 4 patients were repaired with medial brachial artery perforator flap (flap area of 6 cm×5 cm to 12 cm×10 cm). The donor flap area of two patients was sutured directly, and two patients were covered with split-thickness skin graft from left chest wall. The flaps of 11 patients survived after surgery. Blood flow disorder at the distal end of the flap was observed in one patient. After treatment, the distal end of the flap presented 3 cm×2 cm necrosis, and the skin graft survived after second skin grafting and debridement. During the follow-up of 6 to 24 months post surgery, all patients had good texture of flap, with light scar hyperplasia in the donor flap area, and good recovery of elbow and shoulder joint function. The rotator scapular artery perforator flap, lateral thoracic perforator flap, and medial brachial artery perforator flap with the advantages being of relatively simple operation, high survival rate, and good surgical outcome, are good choices for repairing the skin and soft tissue defects in shoulder and elbow.

Clinical application of individualized 3D-printed navigation template to children with cubitus varus deformity

BackgroundCubitus varus deformity is a common sequela of elbow fractures in children. Cubitus varus deformity treatment is tending toward 3D correction, which is challenging for orthopedic surgeons. This study aims to explore whether individualized 3D-printed navigation templates can assist with accurate and effective corrective treatment of children with cubitus varus deformity.MethodsThirty-five patients were treated for cubitus varus deformity from June 2015 to April 2017, including 21 boys and 14 girls, aged 4.6–13.2 years (average, 7.5 years). Of these cases, 17 deformities were on the left side and 18 were on the right side. All were treated with wedge osteotomy of the lateral distal humerus. 3D-printed navigation templates were used in 16 cases, while traditional surgery was used in 19 cases. All patients underwent computed tomography scans before surgery. Computer software was used to analyze the measurements and design and print individualized navigation templates. The navigation templates were matched, and surgery was initially simulated. Intraoperative individualized navigation templates were used to assist with accurate osteotomy and Kirschner wire fixation. Operation times were recorded in all cases, the carrying angles before and after surgery were assessed by computer, and postoperative elbow joint function was evaluated using Bellemore criteria. All measurement data were presented as means ± SD, and Student’s t test was used to examine differences between groups. All count data between both groups were compared using the chi-square test or Fisher’s exact test analysis.ResultsAll individualized navigation templates matched well with the corresponding anatomical markers and were consistent with preoperative planning, simulated surgery, and intraoperative procedures. Average operation times from clear exposure to fixed Kirschner wire were 11.69 min (9.6–13.5 min) for the individualized navigation template group and 22.89 min (17.7–26.8 min) for the traditional operation group (p < 0.001). Average differences in postoperation carrying angles between affected and healthy sides were 1.13° (0–2.0°) and 4.21° (0–7.5°), respectively (p < 0.001). Follow-up 6–12 months postoperation showed that elbow function did not differ significantly between groups using the Bellemore criteria (p > 0.05).ConclusionsIndividualized navigation templates simplify procedures, reduce operation time, and improve accuracy when used in orthopedic surgery to treat children with cubitus varus deformity.

Operative effect and treatment strategies for the low distal humerus fracture

Objective: To explore the operative effect and treatment strategies for the low distal humerus fracture. Methods: A retrospective analysis was conducted on the clinical data of 16 patients with the low distal humerus fracture between January 2016 and January 2018 at Department of Orthopaedics, Shanghai Tongji Hospital Affiliated to Tongji University.All fractures were coronal fractures of humeral head, partly combined fractures of humeral trochlea or posterior part. Fractures were classified according to Dubberley classification as 9 cases in type Ⅰ, 3 cases in typeⅡ and 4 cases in type Ⅲ.Selection of the kind of operative approach and internal fixation was made according to the fracture type and shape. For simple coronal fractures of humeral head or combining humeral trochlea fractures, which were relatively stable, single or multiple countersunk screws fixation by the lateral approach were chosen.For humeral head coronal fractures, which combining obviously displaced comminuted humeral trochlea factures, posterolateral locking plates and countersunk screws internal fixation by the olecranon osteotomy approach were chosen. The incision and elbow soft tissues were observed within 2 weeks after operation.The radiographic evaluation of fracture reduction, bone healing, internal fixation, arthritis and elbow range of motion were made at 3, 6, 12 months after operation. The Mayo elbow functional scores were documented for analysis of elbow joint function, and compared between different surgery groups by Kruskal-Wallis H test. Results: The follow-up time was (22.1±9.2)months(range: 15 to 39 months). The incisions healed well in 2 weeks after operation without soft tissue infection, necrosis or vascular complications. There was no fracture reduction loss or internal fixation loosening according to radiographic evaluation 3 months after operation. One case of ectopic ossification was observed 6 months after operation and inhibited by the treatment of non steroidal anti-inflammatory drugs.One case of ulnar neuritis occurred after operation and released after removing the long screw and loosing the ulnar.Osteoarthritis images were observed at the end of follow-up.Arc of motion was (120.4±11.2) ° in flexion and (5.5±1.9) ° in extension. The Mayo score was 88.7±9.1, including 11 excellent, 4 good, and 1 fair.The Mayo score was 90.1±3.7 in Dubberley classification type Ⅰcases, 89.7±4.6 in type Ⅱ cases and 84.5±5.8 in type Ⅲ cases. There were no significant differences in Mayo scores between 3 types cases according to Kruskal-Wallis H test. Conclusion: Choosing the appropriate surgical approach and composite internal fixation according to the fracture types and shapes of low distal humerus fracture, anatomic reduction of the articular surface and early functional exercise are the keys to obtain ideal curative effect.

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Multifragmentary fractures of the distal humerus have traditionally presented a treatment challenge for the orthopaedic surgeon because of the growing incidence, severity of injury and compromised elbow joint function. This is a comprehensive review of the current literature that details treatment options of distal humerus fractures. Objective Our aim in this article is to provide the readers with a review of current approaches to the treatment of multifragmentary fractures of the distal humerus

Development and Testing of Multi-mode Elbow Joint Muscle Strength Training Device

Muscle strength training plays an important role in improving limb movement function, preventing muscle atrophy and promoting muscle function recovery in patients with various bone and joint diseases. The sports function of elbow joint is closely related to people's daily life activity ability. At present, Chinese muscle strength training devices are depended on import. Therefore, it is of great significance to develop muscle strength training devices. Based on the concepts and characteristics of isometric training, isotonic training, passive training and isokinetic training, in the upper computer, the servo driver and servo motor are controlled through the LabView interface, and the real-time torque is detected by the torque sensor, realizing four training modes. The main parameters of the multi-mode elbow joint muscle strength training device meet the requirements, and the trainers have a good experience.

Effects of medial upper arm bilobed free flaps in the repair of two skin and soft tissue defects of hand

Objective: To summarize the effects of medial upper arm bilobed free flaps in the repair of two skin and soft tissue defects of hand. Methods: From May 2014 to May 2016, 7 patients of two skin and soft tissue defects of hand with exposures of phalanges and tendons were treated in Xuzhou Renci Hospital, including 5 males and 2 females, aged from 19 to 41 years. Each defect area ranged from 3.0 cm×1.5 cm to 6.0 cm×3.0 cm. The medial upper arm bilobed free flaps were used to repair the defects, and the area of each lobe of the flaps ranged from 4.0 cm×2.0 cm to 8.0 cm×3.5 cm. The donor sites were sutured directly. The survival of the flaps was recorded. During follow-up, the recovery of donor and recipient sites was observed, the two-point discrimination distance of the flaps was measured, and the hand function was assessed by the trial criteria of the upper limb functional assessment of the Hand Surgery Society of the Chinese Medical Association. Results: All flaps survived smoothly, and the wounds and donor site incisions were healed. All patients were followed up, and the follow-up time lasted for 6 to 15 months. The color and texture of the flaps were similar to the surrounding normal skin, and the shape of the flaps was good. There was no obvious scar in the donor site, and the elbow joint function was normal. One patient developed ulnar numbness one month after operation and relieved after 3 months of treatment with neurotrophic drugs and local physiotherapy, etc. Six months after operation, the two-point discrimination distance of the flaps was 5.5-8.0 mm, and the hand function evaluation was excellent in 3 cases, good in 3 cases, and middle in 1 case. Conclusions: The medial upper arm bilobed free flap has both good texture and good appearance, and the scar of donor site is concealed. It is a good method to repair two skin and soft tissue defects of hand.

Comparison of lateral approach versus anterolateral approach with Herbert screw fixation for isolated coronal shear fractures of humeral capitellum

BackgroundFor coronal shear fractures of humeral capitellum, the lateral approach is the most commonly used surgical approach. However, exposure range of the anterior aspect of the distal humerus is inadequate. The anterolateral approach has also been adopted to overcome this disadvantage. However, this approach seems anatomically complex due to the risk of iatrogenic injury to the radial nerve. So far, the optimal approach for the treatment of capitellar shear fractures remains inconclusive. The purpose of this study is to prospectively review and compare the early clinical and radiographic outcomes of treated with open reduction and Herbert screw internal fixation through the lateral approach or the anterolateral approach.MethodsTwenty-six patients with isolated capitellar shear fractures were enrolled from January 2013 to December 2017, and randomly assigned to lateral approach group or anterolateral approach group. All the fractures were treated with open reduction and Herbert screw internal fixation through lateral approach or anterolateral approach. Operation time, wound healing complication, elbow joint function, and radiographic evidence were evaluated and compared between two groups.ResultsThe operation via the anterolateral approach took significantly shorter time than via lateral approach (p < 0.05). There were no wound healing problems and infection for both groups. One patient from anterolateral approach group sustained incomplete posterior interosseous nerve palsy, which recovered completely in 4 weeks without residual compromise. All fractures healed well in their normal anatomic position as seen on radiographs. At the final follow-up, no significant difference was found between two groups with respect to the ROM in supination-pronation, ROM in pronation-supination, loss of flexion-extension motion, or loss of pronation-supination motion (p > 0.05). There is no significant difference with respect to MEPI score of elbow joint between two groups (p > 0.05).ConclusionBased on our findings, both lateral approach and anterolateral approach with Herbert screw internal fixation are suitable for coronal shear fractures of capitellum with satisfactory early outcomes. Compared with the lateral approach, the anterolateral approach made the surgical procedure easier and time saving in current series. When the medial aspect of the trochlea is involved for capitellar coronal fractures, the anterolateral lateral approach should be preferred.

Repair of resurfacing soft tissue defect of hand with radial collateral artery polyfoliate perforator flap

To explore the feasibility and effectiveness of radial collateral artery polyfoliate perforator flap in repair of resurfacing soft tissue defect of hand. Between September 2017 and September 2018, the radial collateral artery polyfoliate perforator flaps were transplanted to repair 5 cases of two adjacent wounds of hand and wide or irregular wounds. All patients were male, aged from 27 to 52 years, with an average of 42.5 years. The time from injury to admission was 4 hours to 3 weeks, with an average of 7.3 days. Causes of injury included traffic accident in 2 cases, crushing injury in 2 cases, and paint injection injury in 1 case. The wounds were located at the dorsum of hand in 3 cases, the dorsum of finger in 1 case, and the thumb and thumb web in 1 case. The area of wound ranged from 8 cm×6 cm to 10 cm×8 cm. The area of skin flap ranged from 6.0 cm×3.0 cm to 11.0 cm×4.5 cm, all of which carried the posterior cutaneous nerve of the arm, and the donor site was closed directly. All flaps survived and healed by first intention. All patients were followed up 3-11 months (mean, 6.5 months). The patients were satisfied with the appearance of hands. The flaps were not bulky, and the color and texture were similar to the hand. There was only linear scar in the donor site, no radial nerve injury occurred, and elbow joint function was not affected. One patient underwent finger-splitting and skin flap thinning at 6 months after operation. The radial collateral artery polyfoliate perforator flap is a good method for repairing two adjacent wounds and wide or irregular wounds of hand.

Therapeutic Effect of Resection, Prosthetic Replacement and Open Reduction and Internal Fixation for the Treatment of Mason Type III Radial Head Fracture

Aim of the Study: Mason type III radial head fractures are a source of concern due to the severe injury and poor recovery. At present, radial head resection, open reduction and internal fixation (ORIF), and prosthetic replacement are three common treatment methods for these fractures. The clinical efficacy and postoperative complications are controversial, which makes it difficult for physicians to determine the most appropriate regimen. Herein, this present prospective, non-randomized, parallel-controlled study was conducted to compare the therapeutic effects and identify the most effective treatment method for Mason type III radial head fracture. Materials and Methods: We assessed patients with Mason type III radial head fracture treated with resection, prosthetic replacement, and ORIF to compare preoperative and postoperative pain condition, elbow joint function, curative effect, and complication rate. A visual analog scale was used to score pain. The elbow joint function was observed using the Broberg–Morrey elbow joint score. Results: No significant differences were found in patient demographics among the resection, prosthetic replacement, and ORIF groups. The prosthetic replacement and ORIF procedures were more complex and had higher technical requirements. Prosthetic replacement and ORIF enabled higher elbow joint scores and lower pain scores than resection. Excellent and good ratings were highest and complication rates were lowest in the prosthetic replacement group, followed by the ORIF group. Conclusion: Our results showed that prosthetic replacement is more effective than ORIF and radial head resection in relieving pain, functional recovery and reducing complications in the treatment of Mason type III radial head fractures.

Comparison of platelet rich plasma and corticosteroids in the management of lateral epicondylitis: A meta-analysis of randomized controlled trials.

To compare the clinical efficacy of platelet-rich plasma (PRP) injections with that of corticosteroids in patients with lateral epicondylitis (LE). We searched for relevant studies on the comparison of PRP and corticosteroids in the management of lateral epicondylitis in electronic databases, including PubMed, Embase, Ovid, Cochrane Library, Web of Science, Wan Fang and China National Knowledge Internet, up to March 2019. The outcomes were pain score, elbow joint function and adverse effects after local injection. For continuous data, the weighted mean difference (WMD) and 95% confidence intervals (CIs) was used. Risk difference (RD) with a 95% CI were calculated for dichotomous outcomes. Cochrane Collaboration's tool was used to assess the risk of bias. The data were collected and input into the STATA software. A total of seven randomized controlled trials (RCTs) involving 515 patients were finally included in our study. The present meta-analysis indicated that PRP injection yielded statistically significant superior in pain scores and elbow joint function at a 6-month follow up compared with local corticosteroid injection. No significant difference was identified between two groups regarding the post-injection adverse events. Local PRP injections was associated with superior outcomes for reducing pain and improving elbow joint function compared with local corticosteroids treatment for LE at a follow-up of 6 months.

Fragment volume and surgical methods in radial head fracture

Objective To investigate the relationship between volume of fracture fragment and surgical methods in patients with radial head fracture. Methods A retrospective study was conducted of the 60 patients with radial head fracture of Mason type Ⅲ who had been admitted to the Department of Hand Surgery, Wuhan Pu＇ai Hospital from January 2013 to December 2016. They were 28 males and 32 females, aged from 26 to 71 years (average, 54.5 years). Of them, 41 underwent open reduction and internal fixation (incision group) and 19 radial head replacement (replacement group). The volumes of radial head and fracture fragment were measured by CT scan and three-dimensional reconstruction of the elbow joint before operation. A volume-weighted ratio R corresponding to a specific radial head fragment was calculated. Correlation between the volume-weighted ratio R of the radial head fragment and the Broberg-Morrey elbow function score was calculated. At the last follow-up, the Broberg-Morrey elbow function score was used to assess the efficacy and complications were recorded in the 2 groups. Results All the 60 patients were followed up for 20 to 36 months (mean, 28.6 months). At the last follow-up, the Broberg-Morrey elbow function score was 86.5±1.3 points (from 72 to 91 points) for the incision group and 93.6±1.4 points (from 78 to 95 points) for the replacement group; the complication rate was 17.1% (7/41) for the former and 15.8% (3/19) for the latter. There was a linear relationship between the volume-weighted ratio R of the radial head fragment and the Broberg-Morrey elbow function score in the incision group. The linear regression equation between the two was: y=65.63+0.67x (R2=0.85, P=0.0006). There was no linear relationship between the volume-weighted ratio R of the radial head fragment and the Broberg-Morrey elbow function score in the replacement group (P=0.053). When the Broberg-Morrey elbow joint function score (93.6 points) for the replacement group was substituted into the linear regression equation y=65.63+0.67x (y=93.6), x=41.7. Conclusions In the patients with radial head fracture of Mason type Ⅲ, open reduction and internal fixation may lead to a better prognosis for those with a volume ratio ≥41.7 between the radial head and fracture fragment while radial head replacement may lead to a better prognosis for those with a volume ratio < 41.7 between the radial head and fracture fragment and for those elderly ones with osteoporosis. Key words: Elbow joint; Arthroplasty, replacement; Bone plates; Relationship; Radial head fracture

Therapeutic effect of dual plate internal fixation through triceps approach for the treatment of type C3 fracture of distal radius

To investigate clinical efficacy of dual plate internal fixation triceps through approach for the treatment of type C3 fracture of distal radius. Totally 21 patients with type C3 fracture of distal radius were retrospectively analyzed from December 2011 to June 2017. Among them, including 13 males and 8 females, aged from 15 to 68 years old with an average of (40.7±3.4) years old. The time from injury to operation ranged from 3 to days with an average of (5.0±1.2)days. Fracture healing and postoperative complications were observed, Mayo elbow joint performance score(MEPS) was used to evaluate recovery of elbow joint function, VAS score was used to evaluate relieve degree of pain at 3 months after operation. All patients were followed up for 8 to 24 months with an average of (14.0±2.6) months. The time of fracture healing ranged from 2.5 to 4.0 months with an average of(3.0±1.2) months without complications. Postoperative MEPS score at 3 months was 91.0±2.3, and 15 patients got excellent results, 4 good, and 2 moderate; VAS score was 1.95±0.34 at 3 months after operation. Dual plate internal fixation triceps through approach for the treatment of type C3 fracture of distal radius could provide satisfactory surgical field exposure, facilitate for reduction and internal fixation of joint fracture, could obtain good elbow joint function and is beneficial for early functional exercise.

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.

Research on Combined Rehabilitation Method and Its Mechanism of Traditional Chinese Medicine Daoyin Technique with Biofeedback Technique

Objective: To study an anti resistance active exercise training method which is consistent with the principle of “transcendental goal power” to promote the plasticity change of central nervous system (CNS) in order to recover the motor function after CNS injury, observe its clinical effect and explore its mechanism. Methods: The potential of CNS was induced by six-step Daoyin technique of Chinese medicine, and the potential signal was received in real time by bio-electrical signal receiving equipment and displayed in curve form. Combined with the Operant conditioning biofeedback technique, targeted guidance was given to patients to continuously enhance the action muscle signal intensity and weaken the antagonistic muscle signal intensity, so that the motor program was gradually re-established. Sixty-four patients with hemiplegic elbow dysfunction of old cerebral infarction who had been trained but could not be improved further and had a history of more than 1 year were treated for one course, 90 times and 45 minutes each time. Lovett, Elbow Rom, Fugl-Meyer, program signal intensity and proportion were evaluated before and after treatment. The data were analyzed statistically. Before and after treatment, Lovett MMT, ROM of elbow joint, Fugl Meyer, motor program signal intensity and proportion were assessed, and the data were statistically analyzed. Results: After treatment and before treatment, there was a significant difference between the functional evaluation data (P < 0.01). The function of elbow joint was improved; this is the result of reconstructing the motor program on the basis of developing the potential of CNS by means of the “transcendental goal power” mechanism of the method. There was no recurrence after 6 months of follow-up. Conclusion: The Chinese Medicine Daoyin feedback rehabilitation technique is an effective method to improve elbow joint function of hemiplegia patients with cerebral infarction.