Mayo Elbow Performance Index Research Articles

COMPARISION OF CLINICAL AND FUNCTIONAL OUTCOME IN MONTEGGIA FRACTURE: MANAGED WITH RUSH NAIL COMPARED WITH MANAGED BY PLATTING

Introduction- Monteggia is a fracture of the proximal third of the ulna with dislocation of the radial head from both the proximal radioulnar and radio-capitellar joints. At present in most case scenario all the monteggia fractures in adults operated with ORIF platting but hereby we have study about monteggia fracture managed with CRIF with rush nail compared with ORIF and platting. This study aimed to see the clinical and functional outcome of m Aim- onteggia fracture xation with Rush nail compared to platting in adult. A prospective study was conducted over 6 months of a total of 30 patients Material and Method- with monteggia fracture operated with rush nail and 30 patient operated with platting. Patients were divided by randomized controlled trial. All these 60 patients were followed up for mean duration of 6 months. The postoperative Mayo Elbow Performance Index at the tim Results- e of follow-up ranged from 65 to 100, with twenty-two excellent, ve good, three fair, and no poor results in operated case with rush nail and twenty-three excellent, four good, three fair, no poor result in operated case with platting. The radial head remained in a completely reduced position in twenty-ve patient (86%) and was subluxated in ve patients (14%) in operated case with rush nail and radial head completely reduced position in twenty-eight patient (94%) and was subluxated in two patient (6%) in operated case with platting at the time of the latest follow-up. Radiographically, there were twenty-six good, four fair, and no poor results operated with rush nail. A good radiographic result was obtained in all of the patients who had undergone open reduction and platting within three years after the injury. In overall comparison of Conclusion- clinical, functional and radiological outcome it was found that Rush nail gives superior results than platting.

Functional outcome of minimal invasive anterior bridge plating for humerus shaft fractures

Objectives: To study clinical & functional outcomes and complications in patients with humeral shaft fractures treated using anterior bridge plating. Materials and Methods: 25 patients with fractures of middle third humerus were treated with Minimum invasive Anterior Bridge plating in a case study at tertiary care hospital Surat. Both male and female patients above 20 years of age with closed and OG type I & II diaphyseal fractures of Humerus were included. Pathologic fracture, OG III fractures, Fractures in skeletally immature patients, Old neglected fractures, Those who Refused to provide informed consent and Fractures with neuromuscular disorders / neurovascular insufficiency were excluded. Functional outcome where analyzed by constant murley shoulder outcome score &Mayo elbow performance index. Results: The totals of twenty-five patients were included in the study. Out of total twenty-five patients 17 were males and 8 were females with the average age of 39 years. Right side fracture was found in 20 patients out of total 25. The average time for the surgery for the entire patient was 68 minutes.

Functional outcome of minimal invasive anterior bridge plating for humerus shaft fractures

Objectives: To study clinical & functional outcomes and complications in patients with humeral shaft fractures treated using anterior bridge plating. Materials and Methods: 25 patients with fractures of middle third humerus were treated with Minimum invasive Anterior Bridge plating in a case study at tertiary care hospital Surat. Both male and female patients above 20 years of age with closed and OG type I & II diaphyseal fractures of Humerus were included. Pathologic fracture, OG III fractures, Fractures in skeletally immature patients, Old neglected fractures, Those who Refused to provide informed consent and Fractures with neuromuscular disorders / neurovascular insufficiency were excluded. Functional outcome where analyzed by constant murley shoulder outcome score &Mayo elbow performance index. Results: The totals of twenty-five patients were included in the study. Out of total twenty-five patients 17 were males and 8 were females with the average age of 39 years. Right side fracture was found in 20 patients out of total 25. The average time for the surgery for the entire patient was 68 minutes. The average mean union time was found to be two months (10 weeks) for initial union of surgery.

Neglected Monteggia Fractures in Children—A Retrospective Study

(1) Background: A Monteggia fracture is an infrequent injury in children. It can be missed during an initial consultation in 20–50% of patients. Chronic radial head dislocation may lead to several complications. Thus, surgical reconstruction of chronic Monteggia injuries is justified. The aim of this study is to analyze the single tertiary center experience in the treatment of neglected Monteggia fractures. (2) Methods: A retrospective study of patients treated for missed Monteggia fractures was conducted. Hospital records, operative charts, follow-up records and a set of X-rays were analyzed for each patient. Radiographic results were graded as good, moderate or poor. The functional status of elbows was estimated using the Mayo Elbow Performance Index. (3) Results: A total of 13 patients (8 boys and 5 girls) aged 4–12 years (mean 7.15) were treated during the study period. An angulation osteotomy of the ulna was performed in ten patients and a radial shortening osteotomy in three patients. A Bell–Tawse annular ligament reconstruction was performed in five patients, and a direct repair was performed in two patients. Eight patients had radiocapitellar trans-fixation. There were nine good radiographic results, three moderate and one poor. The functional result was excellent in nine patients, good in three and poor in one. (4) Conclusions: Our work has many limitations (only 13 patients and different types of operations), and conclusions should be drawn very carefully from such a small and diverse group. The surgical reconstruction of neglected Monteggia fractures in children should be attempted in all patients. Angulation and elongation osteotomies of the ulna are suitable for most patients. If there is a marked overgrowth of the radius, gradual ulnar lengthening and radial head reduction using the Ilizarov method may be a better option. Annular ligament reconstruction is not mandatory.

Humerus cisim kırıklarında minimal invaziv perkütan plak osteosentezi (MIPPO)

Amaç: Kliniğimizde minimal invaziv perkütan plak osteosentezi (MIPPO) ile tedavi edilen humerus cisim kırıklarının radyolojik ve fonksiyonel sonuçlarının değerlendirilmesi amaçlanmıştır.
 Gereç ve Yöntem: MIPPO ile tedavi edilen 20 hastanın 21 humerus cisim kırığına ait verileri retrospektif olarak değerlendirildi. Hastaların demografik verileri, yaralanma şekilleri, AO sınıflaması ve bölgesine göre kırık sınıflaması, sigara kullanımı, radial sinir yaralanması kaydedildi. Radyografik olarak 6. ayda kaynama durumu ve dizilim değerlendirildi. Hastaların son kontrollerinde omuz ve dirsek hareket açıklığı ile objektif, Amerikan Omuz ve Dirsek Derneği (ASES) skoru, California Üniversitesi Los Angeles (UCLA) skoru, Mayo dirsek performans indeksi (MEPI), Kol Omuz El Engellilik (DASH) skoru ve Constant omuz skoru ile subjektif değerlendirme yapıldı.
 Bulgular: Hastaların ortalama omuz fleksiyonu 169,5°±26,4°, abdüksiyonu 169,5°±26,4° idi. Ortalama dirsek hareket arkı 131,4°±19,8° bulundu. Ortalama ASES ve UCLA skorları sırasıyla 88,5±16,4 ve 32,1±5,2, MEPI ve DASH skoru sırasıyla 93,1±11,3 ve 11,8±20,0, ortalama Constant skoru 9,1±15,3 bulundu. İki hastada 6. ayda kaynamama gözlendi.
 Sonuç: MIPPO yöntemi humerus cisim kırıklarının tedavisinde; minimal yumuşak doku hasarı, korunmuş omuz ve dirsek fonksiyonları ile başarılı bir tekniktir.

3D-printed model and osteotomy template technique compared with conventional closing-wedge osteotomy in cubitus varus deformity

Cubitus varus deformity is the most common late complication of malunited supracondylar fracture that requires corrective osteotomy and fixation. From 2009 to 2017, 40 consecutive patients with cubitus varus deformity were included. Twenty patients underwent the conventional closing-wedge osteotomy (conventional group), while the other twenty patients underwent the 3D-printed model and osteotomy template osteotomy (3D-printed template group). The functional outcome was evaluated using the Mayo Elbow Performance Index (MEPI) Score and Flynn criteria. There were no statistically significant differences were observed regarding the humerus-elbow-wrist angle and tilting angle between the two groups, both preoperatively and postoperatively at 24 months. No statistically significant differences were observed regarding the elbow ROM (127.0 ± 4.7° VS 128.9 ± 3.8°) and MEPI score (93.5 ± 3.3 VS 94.3 ± 4.1) between the groups. All patients were satisfied both cosmetically and functionally as per the Flynn criteria and MEPI score. The conventional osteotomy and 3D-printed model and osteotomy template techniques both met the treatment requirements of cubitus varus deformity. The 3D-printed template technique showed better osteotomy accuracy, but no significant advantage regarding the functional and cosmetic results than conventional osteotomy.

Mini fragment plating provides a middle ground between tension band wiring and conventional olecranon plating in the management of comminuted olecranon fractures: A case series

BackgroundThe management of comminuted olecranon fractures has plenty of room for improvement. There remains controversy for the ideal treatment modality, with tension band wiring (TBW) and locked plate fixation (LPF) being the most commonly utilised options. However, TBW and LPF have their own benefits and drawbacks. We explore a novel treatment strategy for comminuted olecranon fractures, utilising TBW in conjunction with mini-fragment plate (MFP) fixation. Case detailsWe treated five cases of Mayo Type IIB olecranon fractures with this method. All five patients were found to have union of the fracture. All patients were found to have good or excellent functional outcome. Only one patient complained of hardware prominence. None of the patients were found to have infection, wound complications, nor underwent revision surgery. The radiological outcome in terms of fracture union time and functional outcome in terms of Mayo Elbow Performance Index and Quick Disabilities of Arm Shoulder and Hand Score were comparable to reported outcomes of LPF in similar cases. ConclusionWe therefore propose the use of mini-fragment plates in conjunction with TBW to combine the advantages of TBW and plating, while limiting the drawbacks of traditional locked plate fixation.

Long-term results of olecranon fractures treated using the XS nail® system

PurposeOlecranon fractures are particularly vulnerable to distraction and subsequent fracture dislocation due to the high tensile forces. Surgical treatment aims at reducing the fracture and restoring the anatomical joint surface condition, as well as neutralizing the strain inhibiting fracture healing. The XS nail® (Intercus GmbH, Bad Blankenberg, Germany), an intramedullary implant exerting compression across the entire fracture surface, unlike plates, leaves a minimal extra-cortical profile, and can be secured with threaded locking wires, thereby retaining the anatomical reduction without displacement or steps within the articular surface, which was often found in tension band wiring. After encouraging initial results, the long-term outcome was assessed. MethodsThis retrospective study evaluated the long-term outcome of patients surgically treated at our trauma center between January 2002 and December 2005 using the XS nail®. Patients over the age of 18 years eligible for the study must have undergone surgery for isolated, recent (less than 14 days) traumatic olecranon fractures, without concomitant injuries to the ipsilateral elbow and forearm. Further exclusion criteria were pseudarthrosis, re-fractures and osteotomy for distal humerus surgery, as well as polytraumatized patients unable to aid in their own recovery. Data were retrospectively gathered by standardised questionnaire and patient records, as well as surgery and anesthesiology reports. Data analysis was performed using Microsoft Office Excel® 2016. ResultsThere were 32 patients, 13 males (mean age 49.0 years) and 19 females (mean age 68.9 years) with 11 Schatzkers type D, 7 each type A and C, 5 type B and 2 type E at an average of 55.2 months, all showing complete consolidation. Of them, 6 patients had a loss of range of motion with more than 10° in the sagittal plane, and only 1 patient exceeded 10° reduction of supination. Twenty-five patients reported being pain-free under all circumstances, and all but 2 patients (93.75%) had returned to their previous activity level. The average disabilities of the arm, shoulder and hand score was 21.15 (range 0–88.3), and the overall Mayo elbow performance index was 91.87, without complications, such as wound infection, neurovascular impairment or premature hardware removal. ConclusionUsing the XS nail® system, all fracture types can be successfully treated and the rate of complications was lower than that treated by standard methods published in current literature. An excellent functional outcome, high range of motion as well as good retention of reduction without soft tissue irritation makes this a very suitable implant for fractures subject to tension.

Evaluation of Results of Open Reduction and Internal Fixation of Intraarticular Fracture of Distal Humerus AO type 13-C1 by 90-90 Plate Through Triceps Sparing Approach

Background & objective: The complex anatomy of the distal end of the humerus with its unique orientation of articular surfaces supported by cancellous bone makes its fracture a constant challenge to orthopaedic surgeons. Internal fixation techniques seek to stabilize these fractures by using a plate on both columns. Without this dual plate arrangement, stability of fixation can be inadequate. Materials & Methods: This observational, descriptive, longitudinal, prospective study was carried out in the outpatient and inpatient at Department of National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka over a period of two years, between July 2014 to June 2016. Participants were 18 in number and aged between 18 to 50 years. Fractures are classified according to AO classification system and only closed intra-articular fractures of distal humerus AO type 13-C1 was included in this study. Patients with open fractures, fracture more than 2 weeks old and fractures in children were excluded from this study. Majority of cases 11(61.11%) were operated within 1 week of injury. Open reduction internal fixation by pre-contoured 90-90 locking plate was performed in all cases through triceps sparing approach. The plaster cast was removed 2 weeks after operation and rehabilitation was encouraged during this period and afterwards. Patients were advised to come for follow up after discharge in different scheduled date till the fracture union was achieved. The final outcome of the patient was graded according to Mayo Elbow Performance Index (MEPI). Chi-square test was used for testing statistical significance. Statistical significance was set at p < 0.05. Results: Most of the injury was caused by motor vehicle accident 9(50.00%) and rest of the injury caused by fall 5(27.77%). Final outcome by MEPI showed that 15(83.33%) were excellent, 2(11.11%) were good, 1(05.56%) was fair, there was no poor Result. Complications were seen during the follow up period that included wound scar, delayed union which was treated conservatively and union occurred at 18th week. Conclusion: Open reduction and internal fixation of closed intra-articular fractures of distal humerus AO type 13-C1 by 90-90 plate in sagittal plane on medial column and in coronal plane on lateral column through triceps sparing approach is an effective procedure to provide sufficient stability for the postoperative rehabilitation with an excellent union rate and a very good clinical outcome. TAJ 2021; 34: No-2: 71-79

Long-term outcomes of open arthrolysis combined with radial head arthroplasty for post-traumatic elbow stiffness: results are durable over 8 years.

Post-trauma elbow stiffness (PTES) is a common complication after elbow trauma that causes severe upper limb disability. Open elbow arthrolysis (OEA) with radial head arthroplasty (RHA) is an effective method to treat PTES with rotation limitation, or persistent pain/instability after radial head resection. However, no long-term results have been reported for this technique. This study aimed to show the clinical and radiographic outcomes of OEA with RHA over 8 years and compare its efficacy at 3 years (short-term). Patients with PTES treated by OEA with RHA between September 2010 and December 2012 were retrospectively reviewed. Seventeen patients were followed up over 8 years (range, 100-106 months). A bipolar prosthesis of RHA was performed during OEA. Preoperative, 3-year, and 8-year elbow and forearm motion, upper limb function, radiographic outcomes, and complications were recorded. Clinically important improvements in elbow motion and forearm rotation were obtained, from 34° and 58° preoperatively, to 109° and 135° at 3 years, which were maintained over 8 years, to 113° (P = .262) and 134° (P = .489). The Mayo Elbow Performance Index had clinically important increases from the preoperative level of 58 to 94 points at 3 years, and was maintained over 8 years (95 points, P = .422), with 100% reporting excellent to good outcomes. Pain and nerve symptoms were also improved. Complications consisted of new-onset ulnar nerve symptoms in 1 patient, nonclinically significant heterotopic ossification recurrence in 3, humeroulnar arthritis exacerbation in 4, and periprosthetic lucency in8. OEA with RHA yielded satisfactory short-term outcomes for PTES at 3 years, with substantial improvements in elbow mobility and function, and the results were durable over the long term (8 years).

Return to Sport Following Distal Triceps Repair

The purpose of this investigation was to examine the timeline of return-to-sport following distal triceps repair; evaluate the degree of participation and function upon returning to sport; and identify risk factors for failure to return to sport. Patients who underwent distal triceps repair with a minimum of 1 year of follow-up were retrospectively reviewed. Patients completed a subjective sports questionnaire and were scored on a visual analog scale for pain; the Mayo Elbow Performance Index; the Quick Disabilities of the Arm, Shoulder, and Hand; and the Single Assessment Numerical Evaluation. Out of 113 eligible patients who had a distal triceps repair, 81 patients (71.7%) were contacted. Sixty-eight patients (84.0%) who participated in sports prior to surgery were included at 6.0 ± 4.0 years after surgery, and the average age was 46.6 ± 11.5 years. Sixty-one patients (89.7%) resumed playing at least 1 sport by 5.9 ± 4.4 months following distal triceps repair. However, 18 patients (29.5%) returned to a lower level of activity intensity. The average postoperative Quick Disabilities of the Arm, Shoulder, and Hand; Mayo Elbow Performance; visual analog scale for pain; and Single Assessment Numerical Evaluation scores were 8.2 ± 14.0, 89.5 ± 13.4, 2.0 ± 1.7, and 82.2 ± 24.3, respectively. No patients underwent revision surgery at the time of final follow-up. Distal triceps repair enables 89.7% of patients to return to sport by 5.9 ± 4.4 months following surgery. However, 29.5% of patients were unable to return to their preinjury level of activity. It is imperative that patients are appropriately educated to manage postoperative expectations regarding sport participation following distal triceps repair. Therapeutic IV.

Arthroscopic lateral collateral ligament imbrication for treatment of atraumatic posterolateral rotatory instability.

Among the causative lesions of lateral elbow pain, atraumatic posterolateral rotatory instability (PLRI) is a rare condition, but it produces pain and disability to the elbow. It still lacks published specific treatment literature. According to the development of arthroscopy, the arthroscopic lateral collateral ligament (LCL) imbrication can possibly be an alternative minimal invasive procedure that can eradicate the atraumatic PLRI. Hypothesis/Purpose: To report clinical results of arthroscopic LCL imbrication for the treatment on atraumatic PLRI elbow. Methods: Thirty-three patients with chronic atraumatic lateral elbow pain were presented to our institution between July 2015 and December 2021. Eight patients were diagnosed with atraumatic PLRI and underwent arthroscopic LCL imbrication. Comparison between the pre- and post-operative scores were recorded, which were The Quick-Disabilities of Arm, Shoulder, and Hand (Quick-DASH) score, Mayo Elbow Performance Index (MEPI) and Visual Analog Scale for pain (VAS). Results: Mean follow-up was 16months (9-24months). Comparing between pre-operation and post-operation, all of eight patients had significant improved Quick-DASH score (mean 55.62 vs 7.62, p = .004), MEPI (mean 50.00 vs 96.87, p = .000) and VAS for pain (mean 8.14 vs 1.28, p = .000). Conclusion: Atraumatic PLRI is a concerning lesion in patients with lateral elbow pain. Arthroscopic LCL imbrication can be simultaneously performed with other lateral elbow pain causations, such as tennis elbow and pathological plica, and provide painless, stable, and functional elbow. Case Series (Level of evidence: 4).

Evaluation of the results of anterior minimally invasive plate osteosynthesis in treating humeral shaft fractures

Background The advantages of minimally invasive plate osteosynthesis (MIPO) are less soft tissue dissection and less blood loss with excellent results. This study aims to assess the outcomes of MIPO in treating humeral shaft fractures. Patients and methods Anterior MIPO was performed on 30 patients from March 2017 to January 2019. The inclusion criteria for this prospective study included a fracture located at the middle third of the humeral shaft, a fracture with polytrauma, and fractures with early conservative treatment failure. Type A fracture was the most common according to the AO-OTA classification (13 cases), followed by type B (11 cases) and type C (six cases). The space between biceps and brachialis was identified, and a locking compression plate or limited contact dynamic compression plate was used. The minimum follow-up period was 1 year. The outcome measurements included fracture union, alignment, infection, range of motion, functional assessment as per the University of California at Los Angeles shoulder score, and elbow function as evaluated using the Mayo elbow performance index. Results The mean operation time was 90.30 min (range, 80–180 min), and mean radiation exposure was 204 s (range, 110—420 s). All fractures united. The mean fracture union time was 15.3 weeks (range, 10–18 weeks). There was no incidence of implant failures. The mean University of California at Los Angeles end-result score was 34 points (range, 32–35). The mean Mayo elbow performance index was 98 points (range, 90–100). The mean range of motion was 135° (range, 100–140°). The functional outcome was satisfactory. Conclusion MIPO is an excellent method for treating humeral shaft fractures. It might decrease the perioperative complications with a reduced operation time.

FUNCTIONAL OUTCOME OF TREATMENT OF DEVIATED OLECRANON FRACTURE (MAYO 2A) BY AN INTRAMEDULLARY SCREW WITH TENSION BAND COMPARED TO CLASSIC TENSION BAND - A PROSPECTIVE RANDOMIZED STUDY.

evaluate the functional treatment outcome of deviated transverse olecranon fractures (Mayo 2A) after treatment with tension-banded intramedullary screw (PIBT) compared to classical tension band (BTC). Prospectively collect all deviated transverse olecranon fractures from 2012 to 2016 and randomize them into PIBT and BTC groups. Range of motion (ROM) was measured after 2 and 5 weeks, 3 and 6 months, and 1 and 2 years. Functional assessments (DASH, Oxford Elbow Score, and Mayo Elbow Performance Index) were performed after 3 and 6 months and 1 and 2 years. Complications were collected up to 2 years of follow-up. 22 patients were included, 11 in each group. The mean age was 47.9 years, and the left side was injured in 13 (59.0%) patients. All patients completed the 2-year follow-up. There was no ROM difference at any time between the two groups (p> 0.005). Flexion and extension gain was maximum at three months and remained unchanged until two years. Neither flexion nor extension returned to normal, missing around 10°. Pronation and supination returned to normal. All three functional scores showed almost complete recovery of elbow function after three months postoperatively, with no difference between the groups. No group had complications, no reoperation, and no implant removal. PIBT had similar results in ROM and functional score compared to BTC. Both had low complication rates and no need for implant removal. Level of evidence I; Randomized Trial .

A combined paratricipital and triceps-splitting approach for distal humeral metaphyseal-diaphyseal fractures in adults.

Distal metaphyseal-diaphyseal fractures of the hume-rus can be challenging. The success lies in achieving a stable fixation that could allow early functional recovery. Our aim is to combine dif-ferent approaches already reported, to obtain an ideal surgical strategy for treating these fracture patterns. In this retrospective study, we present the clinical outco-me of a 12-patient cohort in which we used a combined paratricipital and triceps-splitting approach to the distal humerus. The mean age of the group was 50 years (range 17 - 88). Clinical and radiographic evaluation was performed at 1, 3, 6, and 12 months after surgery and thereafter, depending on the necessity of a further control. Patients' range of motion (ROM) of the elbow was reported, and functional outcome was assessed using the Mayo Elbow Performance Index (MEPI).The minimum follow-up was fixed at 12 months. Union was achieved in all fractures. After a median follow-up of 15.7 months (range 12-21), none of the patients complained of any limitation in daily activities. The ROM at the last follow-up was complete in eight patients. Instead, three patients had ROM limitations, but none of them mentioned limitations in the activities of daily living. We observed a single iatrogenic radial nerve palsy undergoing a full functional recovery at the final follow-up. No further complications occurred. We believe that the here presented modified approach could represent a solution that meets the modern demands for both ro-bust fixation and early mobilization, with minimal soft tissues damage around distal humeral fractures.

Nonoperative treatment of distal humerus fractures in the elderly yields satisfactory functional outcomes and low conversion to delayed surgery: a systematic review

Distal humerus fractures (DHFs) pose a treatment challenge in elderly patients. We sought to systematically review and report the clinical outcomes of the nonoperative approach (eg, "bag of bones") for the treatment of these injuries and the rate of conversion to delayed surgery. A comprehensive review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was conducted. Studies involving outcomes after nonoperative treatment of DHF in patients >65 years of age were included from 1985 to present. Data regarding patient age, DHF type, nonoperative treatment method, complications, conversion to delayed surgery, range of motion, union rate, and surgeon- and patient-reported outcome measures were extracted. A total of five studies met inclusion criteria (all level IV evidence), yielding a total of 143 patients (mean age: 73.5 years to 87.4 years) with 7.1 months to 55 months of follow-up. The mean Mayo Elbow Performance Index scores were good to excellent across several studies (range 83-93.1). Multiple studies reported good range of motion (mean arc of motion: 81 to 106 degrees) and low levels of upper extremity disability (mean Quick Disability of the Arm-Shoulder-Hand scores: 31.3 to 38.5) at the final follow-up. The rate of conversion to total elbow arthroplasty and operative fixation ranged from 0% to 7.5% and 0% to 5%, respectively. Nonoperative management of distal humerus fractures in the elderly seems to be associated with acceptable functional outcomes and low rates of delayed surgery. This information is important for patient counseling and treatment decision-making.

Dynamic fixation using rigid tape in rehabilitation after surgery of terrible triad injury of the elbow: A randomized trial.

The aim of the study was to identify the efficacy of dynamic fixation using rigid tape (RT) in rehabilitation after surgery of terrible triad injury of the elbow (TTIE). Sixty patients who underwent surgery of TTIE were equally randomly divided into RT group and hinged external fixation brace (HEFB) group. Dynamic fixations were applied for 8 weeks. General rehabilitation programs were performed for 3months, 5 times a week. Follow-up (FU) was at six months. Main outcomes included pain (Visual Analogue Scale, VAS), muscle strength, range of motion (ROM), Elbow Function (Mayo Elbow Performance Index, MEPI), Quality of Life (QOL) (Short Form 36 Questionnaire, SF-36). There were significant time x group interactions for pain, ROM, MEPI, SF-36 (all p= 0.000), which demonstrated positive efficacy of both the two interventions. Difference at each time-point (except for baseline) of pain and ROM between the two groups was statistically significant (all p< 0.05). Some differences between the two groups were not statistically significant which at 14d on MEPI (p= 0.108) and at 21d (p= 0.259) and FU (p= 0.402) on QOL. Moreover, the increased muscle strength at each time-point had no statistically significant difference between the two groups (all p> 0.05). Both RT and HEFB could significantly improve the postoperative functional outcomes of the TTIE. However, early rehabilitation intervention could increase pain, which affected the corresponding function (MEPI) and QOL. Note that this kind of impact was short-term and reversible. The muscle strength and ROM were not affected by the increased severe pain, maintaining a trend of improvement. In addition, the subjects in the RT group improved faster and more efficiently and had better results with pain, ROM, MEPI, and QOL compared to the subjects in the HEFB group.

Operative Versus Nonoperative Management for Distal Biceps Brachii Tendon Lesions: A Systematic Review and Meta-analysis.

Background:Both nonoperative and operative treatments have been proposed to manage distal biceps brachii tendon avulsions. However, the advantages and disadvantages of these approaches have not been properly quantified.Purpose:To summarize the current literature on both nonoperative and operative approaches for distal biceps brachii tendon ruptures and to quantify results and limitations. The advantages and disadvantages of the different surgical strategies were investigated as well.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic literature search was performed in March 2020 using PubMed Central, Web of Science, Cochrane Library, MEDLINE, Iscrctn.com, clinicaltrials.gov, greylit.org, opengrey.eu, and Scopus literature databases. All human studies evaluating the clinical outcome of nonoperative treatment as well as different surgical techniques were included. The influence of the treatment approach was assessed in terms of the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Mayo Elbow Performance Index; extension, flexion, supination, and pronation range of motion (ROM); and flexion and supination strength ratio between the injured and uninjured arms. Risk of bias and quality of evidence were assessed using the Cochrane guidelines.Results:Of 1275 studies, 53 studies (N = 1380 patients) matched the inclusion criteria. The results of the meta-analysis comparing operative versus nonoperative approaches for distal biceps tendon avulsion showed significant differences in favor of surgery in terms of DASH score (P = .02), Mayo Elbow Performance Index (P < .001), flexion strength (94.7% vs 83.0%, respectively; P < .001), and supination strength (89.2% vs 62.6%, respectively; P < .001). The surgical approach presented 10% heterotopic ossifications, 10% transient sensory nerve injuries, 1.6% transient motor nerve injuries, and a 0.1% rate of persistent motorial disorders. Comparison of the different surgical techniques showed similar results for the fixation methods, whereas the single-incision technique led to a better pronation ROM versus the double-incision approach (81.5° vs 76.1°, respectively; P = .01).Conclusion:The results of this meta-analysis showed the superiority of surgical management over the nonoperative approach for distal biceps tendon detachment, with superior flexion and supination strength and better patient-reported outcomes. The single-incision surgical approach demonstrated a slightly better pronation ROM compared with the double-incision approach, whereas all fixation methods led to similar outcomes.

Involvement of the medial and lateral epicondyles in distal humeral coronal shear fractures: Case series and literature review.

Epicondyle involvement in capitellar and trochlear fractures is often considered a simple associated lesion that does not substantially change treatment or prognosis. Although theoretically predicted in reviews, case series almost never report elbow prosthesis use in comminuted coronal shear injuries associated with epicondylar fracture in the elderly. The purpose of this study is to focus on this underestimated injury pattern that can be a negative risk factor for treatment and prognosis. We retrospectively reviewed all cases with coronal shear fracture of the distal humerus treated from 2016 to 2019. Fractures were classified according to Dubberley. Open reduction and internal fixation (ORIF) were performed when possible. Partial or total elbow replacement was used in severely comminuted fractures with epicondylar involvement in four elderly patients. Nineteen consecutive patients were selected (mean age: 62.4years), of which 10 had type 3A/3B fractures, and seven had both medial and lateral epicondylar involvement. The mean follow-up duration was 31.78months. The average Mayo Elbow Performance Index (MEPI) score was 81.05 points, with 7 excellent, 8 good, 1 fair, and 3 poor results. The average MEPI score of Dubberley's type 1 and type 2 was better than that of type 3 (mean: 92 vs. 72, p = 0.02). Further, the results of average range of motion were better in patients who had sustained Dubberley types 1 and 2 lesions than those with Dubberley type 3 lesion (mean: 133° vs. 85°, p = 0.002). Two patients out of three who required intra-operative conversion to total elbow arthroplasty had poor outcomes. The simultaneous presence of fracture of one or both epicondyles are usually associated with severe joint comminutions and makes ORIF more challenging, especially among elderly women. In these cases, primary total elbow prosthesis implantation could be a valid treatment option.

INTERNAL FIXATION OF TYPE I CAPITELLUM FRACTURE WITH HEADLESS SCREWS: A CASE REPORT

Background: Capitellum fractures are relatively rare. Distal humeral fractures that include capitellum and trochlea constitute approximately 6% of all distal humeral fractures and 1% of all elbow fractures. Despite the rarity of these injuries, an increasing number of clinical series have emerged, enhancing our understanding of these fractures.Case Report: A 26-year-old woman came to the emergency department with complaints of swelling and localized pain on the lateral side of her left elbow 2 hours after she fell off her motorcycle. Routine imaging such as plain radiographs and computed tomography scanning confirmed the fracture. She underwent open reduction and internal fixation surgery, stabilization of articular fragments with headless screws, and was fixated by a back slab and arm sling. The patient was also encouraged to do early elbow mobilization to avoid contractures and joint stiffness, routine follow-up every two weeks for a ROM evaluation. Preoperative Mayo Elbow-Performance Index score (MEPI) was 15, and postoperative 100.Discussion: The aim of capitellum fracture treatment is anatomical reconstruction and fixation to reduce the risk of non-union. In this case, we performed open reduction, secured two headless screws, which allow rigid fixation at the fracture site, provide fracture site compression through variable thread pitch design, and remained not removed later. These screws are suitable for use in anteroposterior and posteroanterior directions.Conclusion: The patient at two months follow-up has shown significant improvement. Accurate reduction, stable fracture fixation, and early postoperative mobilization were reported to provide good results with a MEPI score of 100.