Mayo Elbow Performance Score Score Research Articles

Treatment of Ulnar Coronoid Process Fracture Using the Anterior Neurovascular Interval Approach: A Retrospective Clinical Study with Short- to Mid-term Follow-up.

Numerous surgical techniques for addressing ulnar coronoid process fractures are available; however, a consensus on the optimal approach remains elusive. This study aimed to use the anterior neurovascular interval approach for the surgical management of ulnar coronoid process fractures and to evaluate its clinical outcomes over short- to mid-term follow-up. This retrospective clinical study included 20 patients with ulnar coronoid process fractures who were treated using the anterior neurovascular interval approach between January 2018 and December 2022. Participants comprised 16 males and four females, aged between 20 and 64 years (mean, 34.3 ± 12.44 years). Clinical and radiological evaluations were based on elbow joint range of motion (ROM), Visual analogue scale (VAS), and Mayo elbow performance score (MEPS). A paired t-test was used to compare the pre-operative and final follow-up VAS and MEPS scores. The follow-up duration for all patients was at least 12 months (average, 12.65 ± 1.60 months). At the final follow-up, measurements of elbow ROM included a mean extension of 2.85 ± 3.17°, mean flexion of 135 ± 7.25°, mean pronation of 86.4 ± 4.56°, and mean supination of 84.85 ± 5.54°. All participants reached their target MEPS, with an average score of 97.25 ± 4.72 points, and the final mean VAS score was 0.2 ± 0.52 points. The VAS score was significantly lower and MEPS score was higher at the final follow-up than those before surgery (p < 0.05). Throughout the follow-up period, all the fractures united, and the stability of the affected elbows was satisfactory. Employing the anterior neurovascular interval approach for open reduction and internal fixation to manage coronoid process fractures effectively facilitates anatomical restoration and robust fixation of ulnar coronoid process fractures.

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.

Outcomes in children with delayed surgical treatment of medial humeral condyle fractures.

Medial humeral condyle (MHC) fractures are easily overlooked in young patients. This can lead to delayed or incorrect diagnosis, resulting in delayed treatment, which is often associated with complications such as nonunion, osteonecrosis, fishtail deformity, and cubitus varus. The purpose of this study is to evaluate the clinical and radiographic outcomes in a cohort of paediatric patients who underwent delayed surgery for an untreated MHC fracture. From January 2017 to December 2022, we conducted a retrospective study of paediatric patients who underwent delayed treatment for a MHC fracture. In all cases, the initial diagnosis was incorrect and surgery was performed at least one week after injury. Patients were divided into two groups based on the time between trauma and surgery: Group 1 consisted of individuals who underwent early delayed treatment within seven to 30days of injury, while Group 2 consisted of those who underwent late delayed treatment more than one month after injury. Elbow function was assessed using the Mayo Elbow Performance Score (MEPS) and range of motion (ROM). The related literature was also reviewed (1970-2023). We enrolled 12 patients (7 boys, 5 girls); the average age at the time of surgery was 7.7years (range, 2-14years). Six patients underwent early delayed treatment (Group 1) while another six underwent late delayed treatment (Group 2). The mean time from injury to surgery was 17.7days (range, 7-30days) and 33.3months (range, 70days-9years) in Groups 1 and 2, respectively. Open reduction and internal fixation were performed via a medial approach in 11 patients, while one patient underwent closing wedge osteotomy and internal fixation to correct cubitus varus deformity. The mean duration of follow-up was 39.4months (range, 8-60months). The average MEPS score was 98.3 in Group 1 (range, 95-100) and 94.2 in Group 2 (range, 85-100; P = 0.21). The following postoperative complications were recorded: heterotopic ossification (n = 2), fishtail deformity (n = 1), MHC necrosis (n = 1), and reduction of elbow ROM (n = 1); one complication occurred in Group 1 and five occurred in Group 2 (P = 0.18). We reviewed nine related studies (n = 14 patients). Diagnosis of MHC fractures can be challenging in paediatric patients, especially in younger individuals with incompletely ossified trochlea. Patients requiring surgery for delayed MHC fractures with an unossified trochlea should undergo ORIF to prevent progressive varus deformity. On the other hand, in patients with cubitus varus and an already ossified trochlea, distal humeral osteotomy should be considered instead of ORIF. This will minimize the potential negative impact on joint mobility.

A Feasibility Study on Using Hanging Arm Test to Assess Elbow Stability During Surgical Treatment for Varus Posteromedial Rotatory Instability.

The aim of this study to investigate the safety and effectiveness of performing the hanging arm test during surgical treatment for elbow varus posteromedial rotatory instability (VPMRI) to assess elbow stability and determine whether to repair the lateral ulnar collateral ligament (LUCL). In a retrospective study from August 2014 to March 2019, 27 patients with VPMRI who had a negative result in the hanging arm test after fixation of coronoid fracture were selected. Intraoperative bleeding, operative time, elbow range of motion (ROM), and complications were recorded. Elbow function was evaluated with the Mayo elbow performance score (MEPS) and the disabilities of the arm, shoulder, and hand (DASH) score. The operation time was 85.9 ± 11.06min (range 65-110). The intraoperative blood loss was 70.7 ± 9.31ml (range 60-100). At the last follow-up, the elbow joint averaged 73.8° ± 2.931° in pronation, 78.9° ± 2.941° in supination, 7.2° ± 3.207° in extension, and 123.3° ± 6.651° in flexion. The MEPS score was 90.7 ± 4.36 (range 74-95), and the DASH score was 9.8 ± 2.58 (range 6.67-13.3). One patient presented with symptoms of ulnar nerve entrapment 2months after operation and was treated with ulnar nerve release. The symptom of numbness went away completely 1week after operation. No complications such as wound infection, arthritis, or chronic instability of the elbow were found in the other patients. Our findings suggest that not all VPMRI patients need the LUCL to be repaired, and the hanging arm test is a safe and reliable method to assess whether to repair the LUCL in the treatment of elbow VPMRI. Level IV; Retrospective studies.

Surgical Treatment for Simple Isolated and Displaced Olecranon Fractures: Comparison between Plate and Tension Band Wire Fixation.

Background: Olecranon fractures are common injuries of the upper limb in adults. Simple displaced trasverse fractures are generally surgically treated with tension-band wiring (TBW) or plate fixation (PF). The purpose of this retrospective study is to compare the clinical-functional outcome, complications and reoperation rates between TBW and PF for Mayo IIA fractures. Methods: 72 patients treated with PF or TBW at our institution, completed our survey and clinical evaluation and their demographic and clinical data were recorded and analysed. The clinical-functional outcomes were evaluated assessing ROMs and three validated scoring systems: the Disabilities of the Arm, Shoulder, and Hand (DASH), the Mayo Elbow Performance Score (MEPS) and the Patient American Shoulder and Elbow Surgeons Standardized Elbow Assessment score (pASES-e). Results: 38 patients (53%) underwent TBW and 34 (47%) PF. The mean DASH, MEPS and pASES-e scores were respectively 14.5 ± 17.2, 80.5 ± 14.7 and 83.6 ± 12.4 in the TBW group and 21 ± 21.7, 75.6 ± 15.3 and 75.1 ± 19.2 in the PF group (p = 0.16, p = 0.17 and p = 0.03). The mean duration of surgery and hospitalisation period were longer in the PF group (p = 0.002, p = 0.37) whereas the complication and reoperation rates were higher after TBW (p = 0.15, p = 0.24). Conclusions: According to the literature, both TBW and PF resulted comparable valid surgical options for the treatment of simple isolated displaced olecranon fractures. Our results corroborate previous findings, showing good/excellent outcomes without significant differences.

Operative Treatment of Ulnar Collateral Ligament Injury in Female Athletes.

Ulnar collateral ligament (UCL) reconstruction has been the standard surgical intervention for elite male athletes with UCL insufficiency. Recently, UCL repair and augmentation with an internal brace has been increasingly performed. To evaluate the clinical and functional outcomes as well as return-to-sport rate after UCL repair in female athletes. Case series; Level of evidence, 4. Included were 15 female athletes (mean age, 16.5 ± 3.5 years) who underwent UCL repair between 2011 and 2021 at a single institution. Data collected included age, sport played, competition level, symptom onset, previous surgeries, mechanism of injury, surgical intervention, and return to sport. Patients were contacted via phone at minimum 24-month follow-up, and postoperative outcomes were evaluated using the Mayo Elbow Performance Score (MEPS) and the Single Assessment Numeric Evaluation (SANE). Of the 15 female athletes, there were 4 cheerleaders, 3 softball players, 2 volleyball players, 2 soccer players, 1 gymnast, 1 tennis player, 1 dancer, and 1 javelin thrower. Ten of the 15 athletes (67%) competed at the high school level, 4 (26%) at the collegiate level, and 1 patient (7%) was a recreational volleyball player. In all patients, there was an acute onset of symptoms after injury. Ten patients underwent UCL repair with an internal brace (67% of athletes), while 5 underwent standard UCL repair. The median MEPS for athletes with and without an internal brace was 100 (range, 80-100). There was no significant difference of MEPS (P = .826) or SANE scores (P = .189) between the patients who received an internal brace and those who did not. Thirteen of the 15 athletes (86.7%) returned to sport. The UCL injuries in the female athletes in this study were the result of acute trauma. Primary UCL repair, both with and without internal bracing, was an effective surgical treatment for returning these athletes to sport.

Surgical outcomes and complication rates of arthroscopic-assisted fixation versus open fixation for coronoid fractures: A systematic review and meta-analysis

Background Coronoid fractures often occur with complex elbow dislocations, accounting for 15% of elbow fractures. The effectiveness of open reduction internal fixation (ORIF) versus arthroscopic-assisted reduction internal fixation (ARIF) surgeries for coronoid fractures remains uncertain. This study aimed to compare the outcomes of these two surgical approaches in treating varus posteromedial injuries. Methods This study was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study protocol was registered with PROSPERO. The primary outcomes assessed in this study were the functional outcomes measured by the Mayo Elbow Performance Score (MEPS) and the complications associated with each surgical approach. Results Analysis of the data from 759 patients included in this study revealed that the mean postoperative MEPS score was higher in the ARIF group compared to the ORIF group (97.5 Vs. 90.7), with the mean improvement in MEPS was 16.6 points (19 for ORIF and 14.3 for ARIF). The complication rate in the ORIF group was 24.6%, while the ARIF group reported a complication rate of 6%. Conclusion This study suggests that ARIF surgery can yield comparable and promising outcomes to ORIF surgery for coronoid fractures. Level of evidence IV

Anconeus-sparing minimally invasive approach for lateral ulnar collateral ligament reconstruction using a triceps tendon autograft is an effective and safe treatment for chronic posterolateral instability of the elbow

Surgical treatment helps to restore stability of the elbow in patients with posterolateral rotatory instability (PLRI). The anconeus muscle is one of the most important active stabilizers against PLRI. A minimally invasive anconeus-sparing approach for lateral ulnar collateral ligament (LUCL) reconstruction using a triceps tendon autograft has been previously described. The purpose of this study was to evaluate the outcome of this intervention and identify risk factors that influenced the clinical and patient-reported outcomes. Sixty-one patients with chronic PLRI and no previous elbow surgery who underwent surgical reconstruction of the LUCL using a triceps tendon autograft in a minimally invasive anconeus-sparing approach during 2012 and 2018 were evaluated. Outcome measures included a clinical examination and the Oxford Elbow Score (OES) and the Mayo Elbow Performance Score (MEPS) questionnaires. Subjective patient outcomes were evaluated with the visual analog scale (VAS) for pain and the Subjective Elbow Value (SEV). Integrity of the common extensor tendons and centering of the radial head were assessed preoperatively on standardized magnetic resonance images (MRIs). Fifty-two patients were available at final follow-up. The mean age of patients was 51±12 years with a mean follow-up of 53±14 months (range 20-76). Clinical examination after surgery (n=41) showed no clinical signs of instability in 98% of the patients (P<.001) and a nonsignificant improvement in range of motion. OES, MEPS, and VAS scores averaged 40±10 of 48 points, 92±12 of 100 points, and 1±2 points, respectively, all corresponding with good or excellent outcomes. The SEV was 88%, indicating very high satisfaction with the surgery. Only 1 patient had revision surgery due to pain, and there were no reported postoperative complications in this cohort. A radial head subluxation in the MRI correlated significantly with worse postoperative outcomes. The anconeus-sparing minimally invasive technique for posterolateral stabilization of the elbow using a triceps tendon autograft is an effective and safe treatment for chronic posterolateral instability of the elbow with substantial improvements in elbow function and pain relief with a very low rate of persistent clinical instability.

Lateral ulnar collateral ligament reconstruction enhancing secondary stabilizers in chronic PLRI of the elbow provides good to excellent clinical results with no recurrent instability

PurposeThe adopted treatment for chronic elbow PLRI is lateral ulnar collateral ligament reconstruction. However, the most frequently reported complication after primary reconstruction is recurrent instability – up to 25%. It was thus hypothesized that enhancing the secondary stabilizers will provide successful results with a lower rate of recurrent instability in comparison to techniques with primary reconstruction only. This study aimed to demonstrate a novel surgical technique involving secondary stabilizers. MethodsIn this retrospective study of 29 cases with chronic PLRI the mean duration of symptoms was 39.6 ±4.9 months. The mean age was 47.9 years with mainly male patients. The surgeries were performed by one senior surgeon at a single institution. The Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) were recorded. ResultsThe mean follow-up was 36.8 ±7.7 months. The MEPS score improved significantly from 59.8 ±13.1 to 84.7 ±7.6 (p<0.001). 23/29 patients (79.2%) had converted to good and excellent results (MEPS >75 points). The DASH score improved from 40.8 ±4.6 to 20.9 ±7.2 (p<0.001). The total complication rate was 10.3% (N=3). No recurrent instability was recorded in comparison to 12.2% for primary reconstruction only, as reported in the literature (p<0.05). ConclusionEnhancing the secondary stabilizers by utilizing an adjacently located autograft provided good and excellent results with no recurrent instability. This novel surgical procedure is easy to reproduce and provides a safe and reliable alternative in cases of chronic PLRI when compared to techniques with primary reconstruction only.

Comparative Outcomes of Early, Elective, and Delayed Treatment for Lateral Condyle Fracture of the Humerus in Children: A Retrospective Study from a Single Center in Turkey (2013-2021).

BACKGROUND Lateral condyle fracture of the humerus in children should be diagnosed and treated quickly to avoid the complications of malunion and varus deformity of the elbow. Worldwide, pediatric orthopedic departments experienced delays in patient diagnosis and treatment during the COVID-19 pandemic. This retrospective study from a single center in Turkey aimed to compare outcomes from early treatment, elective treatment, and delayed treatment in 140 children with lateral condyle fracture of the humerus between 2013 and 2021. MATERIAL AND METHODS In the study, 140 patients with Milch type 2 fractures were included. Patients underwent fixation with K-wires or screws after open or closed reduction. Data collected included age, sex, trauma details, surgery timing, operating conditions, perioperative issues, and rehabilitation outcomes. Fracture union and complications were monitored through clinical examinations and X-rays. Clinical outcomes were evaluated using the Mayo Elbow Performance Score (MEPS). RESULTS There were 58 patients in the early group, 52 in the elective group, and 30 in the delayed group. Surgery durations varied among the groups (P=0.000). The early and delayed groups as well as the early and elective groups had significantly different incision sizes (P=0.000 for both). The early and delayed groups and the early and elective groups had significantly different MEPS scores (P=0.002 and P=0.011, respectively). CONCLUSIONS In patients with late-presenting lateral condyle fractures, although complications increase, surgical treatment does not yield worse outcomes. Standardization of fracture management should be maintained during periods such as COVID-19.

A review on functional outcomes of intra-articular distal humerus fractures treated with recon plate using Mayo Elbow Performance Score (MEPS).

Objective: To Review on Functional Outcomes of Intra-articular Distal Humerus Fractures Treated with Recon Plate Using the Mayo Elbow Performance Score (MEPS). Study Design: Retrospective study. Setting: Department of Orthopaedic &amp; Spine Surgery, Ghurki Trust Teaching Hospital, Lahore. Period: 2015 to 2021. Material &amp; Methods: A total of 353 patients meeting the inclusion criteria enrolled in the study. Patients were followed up at three months postoperatively to assess functional outcome using the Mayo Elbow Performance Score (MEPS). All data were recorded on the proforma. All the collected data were entered and analyzed through SPSS version 22. The chi-square test was applied post-stratification, taking p≤0.05 as significant. Results: In this study, 353 patients were included; among these majority, 220(62.4%) were males, and 133 were female (37.7%). The mean Age of patients was 42.5±14.32, ranging from 18 to 75 years. 182(51.6%) were affected on the left side compared to the right Side 170(48.2%). In most cases, the history of a mode of injury was fall 266(75.3%), and only 87(24.6%) had RTA history. The average MEPS score was 87.37±15.81, ranging from 40 to 100. According to the distribution of functional outcome, 265(75.1%) reported excellent outcome, 52(14.7%) with good, 26(7.5%) as fair, and only 10(2.8%) reported poor outcome. Stratification of functional outcome and patient demographic history showed a statistically significant association between age, gender, side effect, mode of injury, and functional outcome as p&lt;.05. Conclusion: It is concluded that Recon plates provided patients who had distal humerus fractures an excellent functional result. It provides reliable stabilization for fractures of the distal humerus. Due to its improved stability, the device aids early mobility even in fractures with complications. Therefore, the surgeon should use this technique to avoid complications.

Reconstruction of the proximal radius with 3D-printed personalized prosthesis after tumor resection: case series

Giant cell tumor of bone (GCTB) (Campanacci III) or malignant tumors extend to the epiphyseal region, and intra-articular resection of the proximal radius is often needed. In the present study, we present the patients who underwent reconstruction of the proximal radius with 3D-printed personalized prosthesis after tumor resection, aiming to describe the prosthesis design and surgical technique and evaluate the clinical outcomes of this method. Between November 2018 and January 2021, nine patients received radial hemiarthroplasty with 3D-printed personalized prostheses after tumor resection. The pathological diagnosis was GCTB (Campanacci III) in seven patients, osteosarcoma (IIB) in one patient, and synovial sarcoma (IIB) in one patient. The range of motion (ROM) and strength in terms of elbow flexion/extension and forearm supination/pronation were evaluated. Pain was assessed by the visual analog scale (VAS) preoperatively and at each follow-up visit. To evaluate the functional outcome, the Mayo Elbow Performance Score (MEPS) system and the Musculoskeletal Tumor Society (MSTS) scoring system were administered at each follow-up visit. Complications and oncological outcomes were recorded. The patients were followed from 24 to 51 months, with a median follow-up of 35 months. No patients were lost to follow-up. During the follow-up, local recurrence and metastasis were not observed. The VAS score improved from a median of 5 points (range 4 to 7) preoperatively to 1 point (range 0 to 2) at the last follow-up visit. The mean MEPS score was 88.5% (83 to 93), and the mean MSTS score was 25.3 (24 to 27) at the last follow-up visit. No complications such as infection and aseptic loosening were detected. The implantation of a 3D-printed personalized prosthesis after proximal radial resection showed excellent oncologic outcomes and postoperative function at short-term follow-up and is a viable alternative method for reconstruction of the proximal radius bone defect after tumor resection.

Conservative versus surgical management of isolated O'Driscoll II coronoid fracture: A systematic review

PurposeThe purpose of this systematic review is to summarize the current literature on conservative and surgical management of isolated O'Driscoll II coronoid fracture. Study DesignSystematic review. MethodsWe systematically searched Medline, Embase, Google Scholar, and Web of Science databases for published studies by complying with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using the keywords “isolated coronoid fracture,” “O'Driscoll type 2 coronoid fracture,” “anteromedial coronoid fracture,” “anteromedial facet coronoid fracture,” “posteromedial rotatory instability,” and “varus posteromedial rotatory instability.” Patients were divided into conservative treatment and surgical treatment groups. Oxford Centre for Evidence-Based Medicine and Methodological Index for Non-Randomized Studies were assessed to determine each article’s quality. The primary outcomes of the present reviews were the Mayo elbow performance score (MEPS) and the disabilities of the arm, shoulder, and hand (DASH) score, and the secondary outcomes were associated with complications and reoperations. Eligible trials were independently chosen by two review authors, and a third reviewer resolved all disagreements. ResultsThe search yielded 458 records, among which 446 articles were of relevance, and 12 were included. In the final review, 138 patients were evaluated—98 (71%) who received surgical treatment and 40 (29%) who received conservative treatment. The mean MEPS score and the DASH score of surgical treatment were 91 and 8, respectively; 69.8% of patients had excellent scores, and 27.0% had good scores. The mean MEPS score and the DASH score of conservative treatment were 92 and 12, respectively; 70.6% of patients had excellent scores, and 23.5% had good scores. ConclusionsIn select cases, conservative treatment can achieve good results in the treatment of isolated O'Driscoll II coronoid fracture when a stricter indication is followed. However, there is insufficient evidence to recommend the appropriate treatment for a particular fracture subtype, and there is a need for more high-quality randomized controlled trials to determine which treatment is superior.

Risk factors of elbow stiffness after open reduction and internal fixation of intercondylar fracture of humerus

To investigate the risk factors of elbow stiffness after open reduction and internal fixation of intercondylar fracture of humerus. From March 2015 to February 2019, 120 patients with humeral intercondylar fractures were treated with open fixation including 59 males and 61 females, aged from 25 to 77 years with an average of(53.5±3.2) years. According to the occurrence of elbow stiffness after operation, 120 patients were divided into stiffness group(37 cases) and control group(83 cases). The related factors of elbow stiffness were analyzed by single factor analysis, and the risk of elbow stiffness after internal fixation of humeral intercondylar fracture was analyzed by logistic regression factor. There were 37 cases of elbow stiffness(stiff group), and 83 cases had no elbow stiffness(control group). The incidence of joint stiffness was 30.83%. There were significant differences between the stiffness group and the control group in age, injury energy, fracture to operation time, AO classification of fracture, open injury and postoperative premature or hyperactivity. Multivariate logistic regression analysis showed that age>50 years old, high energy injury, AO classification of fracture, open fracture and postoperative premature or hyperactivity were risk factors for elbow stiffness after internal fixation of humeral intercondylar fracture. The postoperative mobility and Mayo elbow performance score(MEPS) scores of the postoperative stiffness group were lower than those of the non-stiffness group with statistical significance(P<0.05). There were no significant differences in postoperative mobility and MEPS scores between flexion stiffness and rotation stiffness after humeral intercondylar fracture(P>0.05). In view of the risk factors of elbow stiffness after internal fixation of humeral intercondylar fracture, reasonable operation plan and rehabilitation strategy should be formulated before operation to minimize the incidence of elbow stiffness.

Comparison of clinical outcomes between the olecranon osteotomy approach and the Bryan-Morrey approach for total elbow arthroplasty.

This study aims to investigate the clinical efficacy of the olecranon osteotomy approach and the Bryan-Morrey approach in total elbow arthroplasty (TEA). In this retrospective study, 49 patients with elbow disease were treated with TEA. A total of 22 patients with TEA by olecranon osteotomy approach were designated as group A, and 27 patients with TEA by Bryan-Morrey approach were designated as group B. There were 22 males and 27 females, aged 32-82years with a mean age of 62years. There were 44 cases of unilateral elbow joint, including 27 cases on the left elbow and 17 cases on the right elbow, and 5 cases of the bilateral elbow joint. There were 6 cases of osteoarthritis (7 elbows), 18 cases of rheumatoid arthritis (22 elbows), 14 cases of traumatic arthritis (14 elbows), 7 cases of distal humeral fractures (7 elbows), and 4 cases of elbow tuberculosis (4 elbows). For each group, we recorded the operative time, intraoperative bleeding, elbow flexion, extension, pronation, supination, postoperative complication rates, and Mayo Elbow Performance Score after surgery. Operative time and intraoperative bleeding were less in group A than in group B (53-120min [70 (62.5, 78) min] vs. 64-105min [77 (73, 87) min], and 10-200ml [50 (20, 90) ml] vs. 5-250ml [100 (50, 150) ml], P<.028). The elbow flexion, pronation activity, and Mayo Elbow Performance Score were higher in group A than in group B, [(121±12)° vs. (112±10)°, 85 (85,85)° vs. 80 (77,85)°, and (94±3) points vs. (91±4) points, P<.036], while elbow extension and supination activity and complication rates were not statistically significant in either group. Compared to Bryan-Morrey approach, the olecranon osteotomy approach to TEA provides adequate visualization, saves operative time and reduces bleeding, provides better flexion activity, effectively improves elbow function, and achieves satisfactory clinical outcomes.

Prognostic Factors of Function in Nonoperatively Treated Radial Head Fractures - A Prospective Cohort Study.

To identify patient-related factors and fracture characteristics influencing the functional outcomes of non-operatively treated radial head fractures and to determine function at one year. Prospective cohort study. Academic level 1 trauma center. Consecutive isolated radial head fractures fitting the inclusion criteria between May 2013 and July 2016. Nonoperative treatment of isolated radial head fractures. Logistic regressions between potential prognostic factors and function assessed with the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder and Hand (DASH) score and Range of Motion (ROM) at 1.5-3-6-12 months. 114 patients were included (78% Mason I [OTA/AO 2R1B1], 20% Mason II [OTA/AO 2R1B3] and 2% Mason III [OTA/AO 2R1C3]). Mean MEPS and DASH score at the last follow-up were excellent [96.4 ± 7.6 and 3.7 ± 8.6] with respectively 79.8% and 92.7% of satisfactory results. Depressive symptoms at injury baseline (Quick Inventory of Depressive Symptomatology > 5) are a constant predictor of unsatisfactory function (MEPS <90 or DASH >17]). Older age and female sex were all linked to worse function at the first follow-ups (p <0.05), whereas lower socioeconomic class and receiving financial compensations were associated to unsatisfactory function at 1-year (p <0.05). While most non-operatively treated radial head fractures heal with excellent function, some patients still exhibit unsatisfactory results at 1-year. Symptoms of depression at injury baseline are a constant and significant predictor of unsatisfactory function. Early detection of depressive symptoms would allow interventions that may optimize function.

Extracorporeal Shock Wave Combined with Warm Acupuncture for External Humeral Epicondylitis: A Randomized Clinical Trial.

The purpose of this study was to evaluate the clinical efficacy of extracorporeal shock wave combined with warm acupuncture for external humeral epicondylitis. Eighty-two patients with external humeral epicondylitis were randomly divided into an observation group and a control group. Patients in the control group were treated with extracorporeal shock waves while those in observation group with warm acupuncture on the basis of the control group. Patients in both groups were evaluated by Visual Analogue Scale (VAS), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) before and after treatment. The inflammatory factors such as IL-6, IL-10, TNF-ɑ and clinical outcomes were contrasted before and after treatment. There were statistically significant differences in VAS score, MEPS score and DASH score between the two groups before and after treatment (P<0.05), and the improvement of each score in the observation group was more obvious than that in the control group. After treatment, the inflammatory factors of the two groups were lower than those before treatment, and the difference was statistically significant (P<0.05). The decrease of inflammatory factors in the observation group was more obvious than that in the control group. The total effective rate of the observation group was higher than that of the control group, and the difference was statistically significant (P<0.05). Extracorporeal shock wave combined with warm acupuncture could effectively improve the pain symptoms and dysfunction of external humeral epicondylitis and reduce the expression of inflammatory factors, and its effect may be better than that of extracorporeal shock wave treatment alone. ChiCTR2200066075.

The effect of early surgical treatment on functional outcomes in terrible triad of elbow: a comparative study

Objectives: In our study, we aimed to evaluate the effect of early surgical treatment on functional results in the terrible triad of the elbow. Methods: Fifty-four patients operated for the terrible triad of elbow (TTE) injuries were included in the study. The study groups were determined as Group A (operated within 24 hours) and Group B (operated after one week). The same surgical procedure and rehabilitation program were applied to all patients. The follow-up period was 16.4 ± 8.4, with a minimum of 6 months. In the last follow-up, the flexion-extension range and supination-pronation interval were evaluated. Mayo Elbow Performance Score (MEPS) and Oxford Elbow Score were used for functional scoring. Results: There was no significant difference between the two groups in terms of age, gender, injury type, and fracture classification. Elbow motion in group A was higher than in group B (p &amp;lt; 0.01). Moreover, group A had better higher MEPS and Oxford Elbow Score, an excellent and good rate than group B at the final clinical visit (p &amp;lt; 0.01). No postoperative pain or complication rate differences were found between the two groups. Conclusions: Early operation for TTE patients resulted in better functional recovery than delayed operation.

A PROSPECTIVE STUDY ON FUNCTIONAL OUTCOME OF DISTAL HUMERUS FRACTURE TREATED BY ORTHOGONAL PLATING

The distal humeral fractures, especially the comminuted intra articular, remain one of the most challenging injuries to treat. Various problems in distal humerus fracture management include frequent articular involvement, metaphyseal comminution, bone loss and osteopenia. The study analysed the functional outcome of twenty patients of distal humeral fractures treated surgically with orthogonal plating with average follow up of 13months (6 months – 2 ½ years). The good anatomical alignment, absolute stabilization and early mobilization were of prime importance in elbow fractures. Subjects of this prospective study were 20 consecutive patients based on the exclusion and inclusion criteria. All patients underwent ORIF with orthogonal plating through Olecranon osteotomy (Chevron) approach. The patients were followed up periodically based on the MEPS (Mayo Elbow Performance Score) and radiological outcome were analysed. The Mean age of the patients was 45 years ranging from 20 to 65 years.AO type C3 fractures constituted 50% while C2 fractures constituted 45%And C1 fractures constituted only 5% of our cases. In our study, the average surgical time delay was 6 days ranging from 5 to 20 days. Two patients had infection. None of them had ulnar nerve damage post operatively. Stiffness was noted in 2 patients. No patient died during treatment or follow up. The average time to union was about 14 weeks. There was no hardware failure or non-union in any patient. The mean exion-extension arc was 96°. The mean MEPS score was 78 in our study. Of the 20 patients, 9(45%) patients had Excellent, 5(25%) patients had good, 4(20%)patients had fair, 2(10%)patients had poor nal outcome. We conclude that with good anatomical reduction with a stable internal xation, preserving the blood supply to the bone along with protection of the ulnar nerve and early elbow mobilization ensure the good functional outcome and early return to activities

Primary repair of acute versus chronic ruptures of the distal biceps tendon. Comparison of functional results in a case-control study

BackgroundIn the event of a rupture of the distal tendon of the biceps brachii, most authors recommend early reinsertion to recover optimal elbow function. However, these ruptures are not always diagnosed or promptly referred to surgeons, thus creating a delay in treatment. Studies reporting functional results in cases of chronic repair (greater than 21 days) of the distal biceps brachii tendon show an increased rate of complications. HypothesisPrimary repairs of chronic ruptures (treatment delayed for more than 21 days) and acute ruptures of the distal biceps give the same functional results and the same rate of complications. Material and methodsWe conducted a retrospective study between January 2017 and December 2021 comparing chronic primary repair of the distal biceps at the elbow (experimental group, comprising 75 patients) and acute (control group, comprising 135 patients) by endobutton. We analyzed the time between trauma and surgery, and assessed short- and long-term functional recovery by measuring residual pain (VAS), a collection of the following functional scores: Mayo Elbow Performance Score (MEPS), Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) and Patient-Rated Elbow Evaluation (PREE), as well as a measure of strength (as a percentage of the healthy side). We evaluated the rate of complications and radiographically analyzed the rate of heterotopic ossification. ResultsThe mean time between trauma and surgery was 73±66 days (experimental group) versus 11.2±5 days (control group). In the short-term (4.79±2.09 months), there was no significant difference in the MEPS, Q-DASH and PREE functional scores between the two groups (p=0.354, p=0.412 and p=0.958, respectively). In the long-term (28.9±17.9 months), the functional evolution remained similar. The recovery of strength in flexion and supination was 89.19±13.43% and 77.48±16.68%, respectively, and similar in the two cohorts (p=0.476 and p=0.395). There was no difference in the rate of complications; however, the rate of heterotopic ossification was higher in the control group (p=0.006). DiscussionThe functional results and the recovery of strength did not change according to the time until surgery. Although the overall complication rate was similar, repairs of the biceps in less than 21 days led to more heterotopic ossification. Level of evidenceIII; retrospective case-control study.