Elbow Joint In Children Research Articles

Diagnosis and Treatment of Varus Posteromedial Rotational Instability of the Elbow Joint in Children: Re-Understanding of the Injury Mechanism Associated With Coronoid Process Fractures.

To investigate the injury mechanism, diagnosis, and treatment of varus-posteromedial rotational instability of the elbow joint in children. According to the diagnostic criteria of varus posteromedial rotational instability of elbow joint, 16 children with coronoid process fractures treated in our department from July 2013 to July 2017 were re-evaluated. There were 14 males and 2 females, aged 7 to 14 years, with an average age of 11.6 years. Eight cases on left and 8 cases on right side. An associated elbow dislocation occurred in 8 of 16 cases. Nine patients were treated with a lateral soft tissue repair only. In 7 other patients in addition to the lateral soft tissue repair, the coronoid process fractures were treated with open reduction and fixation. At the last clinical follow-up, each elbow joint range of motion was recorded, radiographs were obtained, and functional performance was evaluated by the Mayo elbow performance score (MEPS). The average follow-up time was 81.9 months for the 9 patients treated with lateral elbow soft tissue repair. At the last follow-up, 2 of the patients had MEPS scores as excellent, 1 was good, and 6 were rated as moderate or poor. Four patients had a cubitus varus deformity. The average follow-up time was 30.3 months for the 7 patients treated with both soft tissue repair and coronoid fracture stabilization. The elbow joint MEPS scores for each of these 7 patients was excellent at the last follow-up, and no complications such as cubitus varus occurred. The results of the study suggest that children could also develop elbow varus-posterior medial rotational instability injuries under the same mechanism. Although the morbidity rate is low, due to insufficient understanding of the injury mechanism, it is prone to missed diagnosis, misdiagnosis, and delayed treatment, resulting in severe complications such as elbow instability, dislocation, traumatic arthritis, and elbow stiffness. On the contrary, according to the treatment principle of the posterior medial rotational instability of the elbow joint in adult, while the lateral repair is carried out, strong and effective reduction and fixation of the coronoid process fractures are adopted, it is expected that such children with rare elbow injuries can obtain excellent treatment outcomes.

Creation of elbow joint in children with humeroradial synostosis. A clinical case

Humeroradial synostosis is a severe rare anomaly of the upper limb, leading to the development of disability. This congenital anomaly may be a separate nosological unit, or a part of a genetic syndrome. Multi-stage surgical treatment is correct for all components of the deformity. The most difficult stage of treatment is the creation of an elbow joint. There are few studies on this problem in the literature. The article presents the results of surgical treatment of two children with humeroradial synostosis, who had the elbow joint created using two techniques. Patient A. underwent microsurgical transplantation of 2–3 metatarsophalangeal joints into the area of the elbow joint that had been absent since birth. Patient B. underwent total arthroplasty of the elbow joint with an individual implant. The unsatisfactory result of the treatment of patient A. is associated with the impossibility of early development of movements in the elbow joint due to the presence of axial pins. The stable position of the endoprosthesis in patient B. made it possible to conduct a course of early development of movements and get a good long-term result. Due to small number of patients, it is impossible to reliably assess the advantage of one of the presented methods. Improvement of the results of treatment in children with humeroradial synostosis requires further research.

Professor Girey Alievich Bairov (1922–1999) (to the 100th anniversary of the birth)

An outstanding Soviet and Russian pediatrician and pediatric surgeon, one of the founders of pediatric surgery in the USSR and the founder of the Leningrad Scientific School of Pediatric Surgeons, Doctor of Medical Sciences (1960), Corresponding Member of the USSR Academy of Medical Sciences (1963) and RAMS (1992), laureate of the USSR State Prize (1979), Honored Doctor and Honored Scientist of the RSFSR (1994), Professor (1962) Girey Alievich Bairov was born on May 2, 1922 in Alushta. In 1955, G. A. Bairov was the first in the Soviet Union to successfully operate on a newborn boy with esophageal atresia and tracheoesophageal fistula. In 1959, he was elected head of the Department of Pediatric Surgery with Orthopedics and Anesthesiology at the Leningrad Pediatric Medical Institute. In 1960, he defended his doctoral dissertation on the topic: «Fractures in the elbow joint in children». G. A. Bairov was a very versatile surgeon: he perfectly operated on newborns, children of different ages with various diseases of the chest and abdomen, performed urological, traumatological and orthopedic interventions, operated on the spine. In 1963, for outstanding achievements in the development of pediatric surgery, he was elected a corresponding member of the USSR Academy of Medical Sciences. For the development of methods of surgical treatment of congenital and acquired diseases of young children, he was awarded the State Prize of the USSR in 1979. G. A.Bairov was the author and co-author of about 400 scientific papers, including 20 monographs and textbooks, more than 40 inventions, rationalization proposals, new methods of surgical interventions. Under his direct supervision, 31 doctoral and 120 master’s theses were defended. Professor G. A. Bairov passed away on July 6, 1999 and was buried at the Smolensky cemetery in St. Petersburg.

Arthroscopic diagnosis and treatment of intra-articular injuries of the elbow joint in children

Experience in elbow arthroscopy in children (36 patients, 5-16 years) was presented in native literature for the first time. Diagnostic arthroscopy was performed in 4 cases, diagnostic arthroscopy + miniarthrotomy in 3 cases, diagnostic and operative arthroscopy in 29 cases. Comparative assessment of radiologic, ultrasound, CT and arthroscopic data showed evident preference of arthroscopy for the diagnosis of intra-articular elbow injuries in children. Main and additional portals decreasing the probability of neurovascular structure injury were suggested. The technique of diagnostic and operative arthroscopy was determined. The indications for the elbow arthroscopy in children were defined. In 91.7% of patients the positive outcomes with complete or almost complete restoration of elbow function were achieved.

Active Joint Position Sense in Children With Unilateral Cerebral Palsy.

ObjectiveThe aim of the study was to examine the differences in joint position sense at the elbow joint between 15 children with unilateral cerebral palsy (CP) and 15 typically developing (TD) controls without neurological or other health deficits.MethodologyJoint position sense, a major proprioceptive component, was evaluated actively using a Kin Com 125 AP isokinetic dynamometer (Chattanooga Group, Chattanooga, TN).ResultsA significant interaction was found (p<0.05) between disability and side, with respect to the active reproduction movement scores. Post-hoc independent t-tests, with Bonferroni adjustments, revealed significant differences for the dominant (t=-3.63, p=0.001) and non-dominant sides respectively (t=-6.19, p=0.000). Repeated measures t-test revealed wider errors with the non-dominant (affected side) in the active reproduction test, compared to the dominant (nonaffected) side for the CP group of children (t=-4.73, p=0.000). A positive correlation was evident between the level of spasticity and joint position sense (Rho=0.71, p=0.003).ConclusionsBased on our findings, joint position sense is impaired at the elbow joint in children with spastic hemiplegia. The proprioceptive deficit is present at both the affected and unaffected sides and is related to the level of spasticity.

The state of the problem of fractures of the distal metepiphysis of the humerus in children and adolescents

Annotation. One of the most frequent injuries of the distal end of the humerus is the trans-condylar and supracondylar fractures of the humerus, which make up 47.5-80% of all intraarticular fractures of the elbow joint in children. Among the injuries of the distal humerus, the supracondylar and supracondylar fractures occur with the greatest frequency and is one of the most common domestic injuries in children aged 3 to 12 years. Our work is based on a retrospective analysis of the treatment of 255 patients treated in the Lviv City Children's Hospital for the period 2013-2017. 83.1% of patients were diagnosed with flexion fracture, 16.9% – flexion fracture. Transvertebral fractures of the shoulder were diagnosed in 85.5% of cases of the study array, supragingival – in 14.5%. The treatment of patients with the consequences of injuries of the elbow joint presents great difficulties and remains one of the most difficult problems in pediatric traumatology. Depending on the presence of rotational displacement and the severity of the fracture, the following types of treatment are most often used: conservative, osteosynthesis with spokes or Ilizarov apparatus. An ideal reposition and stable fixation of fragments during these injuries is necessary not only to ensure timely consolidation of the fracture, restoration of the anatomical integrity and shape of the distal humerus, but also to prevent the development of deformation in the elbow joint. Deformations of the elbow joint during supracondylar and supracondylar fractures of the shoulder, unlike deformation of another localization, cannot be adjusted and subsequently only increase and as a result can lead to impaired function of the elbow joint, and often to disability already in childhood. Thus, complicated anatomical localization of supracondylar and supracondylar fractures of the humerus in children, great technical difficulties in comparing and fixing fragments, there is a high probability of neurological and vascular disorders, both at the time of injury and during the provision of medical care, impaired function of the elbow joint determine the need for further study of this problem.

Estimation of Age through Elbow Joint in children of Karnataka

70(35 male and 35 females) children aged between 11 to 18 years were studied for ossification of elbow joint&#x0D; radiologically, 4(11.4%) were 11 years 5(14.2%) were 12 years, 7 (20%) were 13 years of age, 5(14.2%)&#x0D; were 14 years, 3(8.57%) were 15 years were 16 years, 3 (8.57%) were 17 years and 4 (11.4%) were 18 years&#x0D; old. The radiological study of elbow joint was Appearance of trochlea was observed only in female at 11&#x0D; year. Fusion of trochlea was in males at 14 to 15 years of age and in 12 to 14 years in females. Appearance&#x0D; of lateral Epicondyle in male was 11 to 12 years but in females at 11 years only. Fusion of lat epicondyle in&#x0D; males was between 13 to 16 years and in females 13 to 14 years. Fusion of medial epicondyle in males was&#x0D; between 14 to 16 years but in females between 11 to 15 years. Fusion of head of Radius in males between&#x0D; 14 to 16 years of age but in females between 11 to 13 years only. Appearance of olecranon process in males&#x0D; between 11 to 13 years and in females between at 11 years only. Fusion of olecranon process in males was&#x0D; between 17 to 18 years of age in females between 15 to 16 years only.&#x0D; This study of elbow appearance and joint in which early appearance and ossification of females bones&#x0D; will be helpful to medico-legal expert, orthopedician, radiologist, anthropologist and anatomist. Moreover&#x0D; this study has ethnic and regional importance because morphometric values of mesodermal derivatives are&#x0D; uncertain

Evaluation of the carrying angle of the elbow joint in children’s and adolescents and its correlation with various parameters

Background: The carrying angle is acute angle between median axis of the upper arm with fully extended and supinated forearm. It is important to know the carrying angles of both elbows in the evaluation of deformities around the joint which may guide the management protocol. Method: This cross-sectional study was conducted on120 children’s in out-patient department at Mandya Institute of Medical Sciences, Mandya (Karnataka), India. Results: For the purpose of analysis two set of age groups were made. The groups were 5-12 years and 13-18 years. Carrying angle was more in females and on right side. Positive correlation was found between carrying angle with various parameters measured. Conclusion: The result of the study could be useful in the management of elbow displacement, fractures and surgical planning for elbow reconstruction.

Differentiated surgical tactics of surgery of a capitellum pseudoarthrosis of humerus with cubitus valgus deformation in children

Actually Damages of bone structures of an elbow joint in children, according to various authors are occurred between 16 and 40% among all of skeleton fractures and makes up 50-80% from all intraarticulate damages of the upper extremity. It was required to develop of a differentiated surgical tactics for surgery of capitellum pseudoarthrosis of humerus with cubitus valgus in child aged patients, that, the cases associated with the nonunion of capitellum or the extension necrosis process, causing to be hypermobility of elbow joint and to pull of ulnar nerve. Object of research was the capitellum pseudoarthrosis with or without cubitus valgus, which is diagnosed in 59 patients, whom three types of surgical correction are spent depending on weight of deformation, prescription of the got trauma and age of the patients. The capitellum pseudoarthrosis liquidation or necrosis field resection are made in 21 (35,6%) patients, for 8 (13,6 %) patient are admitted the extraarticular supracondylar osteotomy of humerus with ulnar nerve transposition and stabilization by Ilizarov’s apparatus and other 30 (50,8 %) patients was corrected by the developing own clinic technique - «Capitellum pseudoarthorosis resection of the humerus, supracondylar osteotomy of humerus and osteosynthesis by Ilizarov’s apparatus». Conclusion We believe it is reasonable to use our repair techniques when dealing with nonunion of the lateral humeral condyle with cubitus valgus. These differential techniques help to shape the distal part of humerus, thus, restoring the function of the elbow joint.

Pyogenic arthritis of elbow joint in children; a case report

Pyogenic arthritis of elbow joint in children; a case report

Injuries of the proximal radius

Osseous lesions and injuries around the elbow joint in children are feared lesions since the turn of the nineteenth century. Complications are often and blunders in treatment have often been published. Skeletal healing and remodelling is modest. Furthermore there are other characteristics than in adult lesions related to the pattern of lesions, diagnostics and treatment. Comparative x-rays of the non-injured side are strictly contraindicated. Radial head subluxation is a typical lesion of toddlers and young children and the diagnosis is made based on the history of a pulled arm and physical findings. Fractures of the radial neck are almost exclusively metaphyseal and epiphysiolysis lesions (Harris-Salter I and II). Due to blood supply disturbances a radial head overgrowth is often observed. Best therapeutic outcome is achieved with conservative treatment. Up to the age of 9–10 years corrective potential and remodelling is excellent. Open procedures and extensive osteosynthesis are associated with major complications. The Monteggia fracture in children has a better prognosis than in adults, provided dislocation of the radial head was diagnosed and conservative treatment is possible in nearly 50% of cases. Reconstructive procedures after missed dislocations are possible but children end up with a clearly inferior result.

Tuberculosis of the Elbow Joint in Children

There is scarce information regarding osteoarticular tuberculosis of the elbow in children, even in countries where tuberculosis is endemic. We report our experience with ten patients who were managed nonoperatively. We retrospectively assessed ten children with elbow tuberculosis with regard to their presentation, diagnosis, management, response to standard antitubercular drugs, and outcome at the completion of antitubercular therapy. All patients were managed nonoperatively with splinting for as long as six weeks, followed by mobilization along with multidrug antitubercular medication for twelve months. Swelling of the elbow that did not respond to initial treatment was the most common cause for referral to our clinic. The proximal ulnar metaphysis was most commonly involved. The average duration of follow-up was twenty-six months. The average time for healing of draining sinuses was twelve weeks (range, four to fourteen weeks). Lytic lesions, including coke-like sequestrum, healed radiographically at an average of 7.4 months (range, six to nine months). Range of motion improved with treatment, but some motion restriction always persisted, depending on the extent of joint destruction. In the Indian subcontinent, the presentation of elbow tuberculosis is usually exudative with abscess formation, and the disease is fairly advanced at the time of diagnosis. An "ice cream scoop" appearance of the proximal part of the ulna in children should raise suspicion for tuberculosis. Elbow tuberculosis in children can be treated adequately with use of nonoperative means, regardless of the extent of osseous destruction, with a good outcome.

Operative corrections of posttraumatic deformities of the elbow joint in children

Posttraumatic deformities with need for surgical correction are rare and demanding in the pediatric population. The consequences of a bad outcome may last a life time. The best prevention of deformities around the elbow joint is proper initial treatment. The most common deformities are cubitus varus, cubitus valgus, chronic dislocation of the radial head and pseudarthrosis of the radial condyle. In contrast to the wide spread opinion to await the effect of the further growth, the deformity should be treated contemporarily to the underlying injury. This strategy will optimize the outcome. In special cases treatment with delay is justified.

Arthroscopy of the elbow joint in children

Die Arthroskopie des Ellenbogens ist bei Kindern nicht zuletzt dank der Weiterentwicklung des Instrumentariums zu einem wertvollen Verfahren geworden. Die fur das Ellenbogengelenk wichtige funktionelle Nachbehandlung gelingt wegen der geringen postoperativen Schmerzen gerade bei jungen Patienten problemlos.

The Role of sonography in detecting radial head subluxation in a child

Injuries around the elbow joint in children can be difficult to diagnose on the basis of findings on physical examination and radiographs. We present the case of a 4-year-old girl with a probable subluxation of the radial head, based on the findings on physical examination and radiographs. Radiography raised the possibility of a radial head subluxation. Sonography demonstrated displacement of the cartilaginous head of the radius away from the capitellum in the affected elbow. The child underwent corrective surgery. During fluoroscopy, results of an ulnar stress test were positive for lateral ligament tears. The patient's arm was put in a cast for 6 weeks. At 1-year follow-up, the patient had full range of motion of the elbow without pain. We present the findings of sonographic studies used to confirm the diagnosis.

Does the meniscus exist in the elbow joint in children?

The authors report a case of meniscus at the elbow joint in a 15-month-old infant causing a limitation of elbow extension. Histological examination demonstrated that this tissue was not a synovial fold or a chondroid metaplasia of the synovial fold. As a meniscus does not appear at any stage of the embryological evolution of the elbow joint, it has been concluded that the presence of the meniscus can be considered as an abnormal condition.

Ultrasound anatomy and pathology of the elbow joint in the child and in the adult

The aim of this study was to evaluate the sonographic anatomy of the elbow joint in children and adults and to point out the indications for an ultrasound examination after elbow joint trauma. The study was carried out using isolated joint specimens, muscle specimens and cadaver limbs. Additionally, a clinical trial was performed using high-resolution ultrasound probes (7.5-12 MHz). When assessing standard sections, one has to consider both the position of the elbow joint in the frontal plane and the position of the forearm during pro- and supination. The outstanding advantage of this method, especially in children, is the possibility of a dynamic examination with evaluation of the articular cartilage and with a comparison to the healthy contralateral elbow joint.

The Comparative Sturdy of Treatment between the Skeletal Traction and the Operation of the Supracondylar Fracture in Children

The most common fracture about the elbow joint in children is supracondylar fracture. That treatment has many fitsfalls and had writtened about its method and the prevention of serious complication such as Volkmann ischemic contracture and cubitus varus deformity. The authors analyzed the follow-up results of 58 cases of supracondylar fractures treated by skeletal traction, percutaneous pinning and open reduction in Presbyterian Medical Center from March 1992 to November 1996. The average follow-up was 20 months(12-54 months). The results were as follows. 1. The mean age was 7.8 years, ranged from 1 year to 15 years, and the male and the female ratio was 1.9:1. 2. Seventeen cases were treated with skeletal traction group, thirty cases with closed reduction and percutaneous pinning group, eleven cases with open reduction and internal fixation group. 3. The average duration of admission in skeletal traction group was 23.5 days, 5.2 days in percutaneous pinning group and 14.7 days in open reduction and internal fixation group. 4. The ratio of hospital cost to that in the skeletal group were 0.85±0.18 in the percutneous

Monteggia fracture-dislocation in children.

Monteggia fracture-dislocations are uncommon in childhood. Correct early diagnosis is essential to avoid elbow dysfunction and the necessity for open reduction of the radial head. This retrospective analysis of 220 forearm fractures in children shows that 50% of Monteggia fractures were misdiagnosed by accident and emergency (A&E) department senior house officers (SHOs) and 25% were misdiagnosed by senior radiologists. Instruction in correct clinical and radiological examination of the elbow joint in children to junior A&E doctors, with early review of suspicious cases by senior medical staff, may help to reduce the incidence of missed Monteggia fractures.

Aseptic osteonecrosis of the humeral trochlea (Hegemann's disease)

A differential diagnosis of diseases affecting the elbow joint in children should also give due consideration to osteonecroses. They are very rare in the context of the humeral trochlea, the case with which we are concerned being one of a total of 15. In the light of this syndrome's relative rarity, we will report on the case of a 7-year-old boy. This is also the first time that a MR image of Hegemann's disease has been shown.