Mayo Elbow Score Research Articles

Long-term outcomes and trends in elbow arthroplasty with Coonrad-Morrey prosthesis: a retrospective study in large group of patients.

Total Elbow Arthroplasty (TEA) was first developed to treat severe rheumatoid arthritis, but its uses have grown to encompass end-stage osteoarthritis, post-traumatic arthritis, and distal humeral fractures. This study analyzes indications changes, long-term survival, complications, and post-operative functional results of the Coonrad-Morrey prostheses, enhancing the existing literature on this technique and substantial case history. We included 122 arthroplasties in 117 patients, 28 males and 89 females (mean age of 67 years) treated in our hospital between 2002 and 2016. Minimum follow-up was four years. We collect functional parameters of 48 patients (51 elbows), due to death of patients due to old age and loss at follow-up. Survival rate at five years was 90%, 85% at 10 years and 83% at 15 years. The overall medium Mayo elbow score was 79.7 ± 18.3 with the highest result in osteoarthritis patients (p < 0.005); QuickDASH score was 33.1 ± 25.5 with the worse result in rheumatoid group. Average post-operative arc of motion (ROM) was 95°±27°. There were complications in 46 out of 122 cases (37.7%) and revision surgeries were performed in 12 of them (9.8%): seven aseptic loosening, four late septic loosening, one bushing wear. In 27 instances (22.1%) was reported ulnar nerve involvement. Coonrad-Morrey prosthesis has shown satisfactory clinical results in the treatment of a wide range of pathologies. The long-term implant survivorship was satisfactory, yet the occurrence of failures and complications cannot be overlooked, above all the ulnar nerve paresthesia. There was a good recovery in quality of life, pain-free with limited residual limb disability.

Minimum four-year clinical outcomes after on-table reconstruction technique for Dubberley type III in coronal shear fractures of the capitellum and trochlea: a report of 10 patients

PurposeComminuted coronal shear fractures of the distal humerus represent rare injuries and are difficult to treat, especially comminuted capitellum and trochlear fractures (Dubberley Type III). The on-table reconstruction technique of comminuted articular fractures may be an option, although it has not been reported in the coronal shear fracture of the distal humerus. The aim of the present case series is to determine the functional and radiological outcomes of on-table reconstructed Dubberley III fractures.MethodsA retrospective review was conducted of 10 patients with Dubberley type III fractures in coronal shear fractures of the capitellum and trochlea who underwent an ‘on-table’ reconstruction technique between January 2009 and October 2019. All patients were evaluated using the disabilities of the arm, shoulder, and hand (DASH) score, American Shoulder and Elbow Surgeons(ASES) score, Mayo Elbow Score Performance Index (MEPI) score and at least 4 years later.ResultsAll cases achieved union. At the final follow-up, the mean range of elbow motion was 11.5°of flexion contracture and 131.9° of further flexion. The mean DASH score was 21.2 (5.7) points (range 13.3–32.5). The mean ASES score was 88.6 ± 7.4 (range, 77 to 100). The mean MEPI score was 87 (10) points (range 70–100). In complication, partial osteonecrosis of capitellum is developed in one patient. One patient had heterotopic ossification without functional impairment.ConclusionThe on-table reconstruction technique can be a reliable option in the surgical treatment of complex distal humerus fractures. This technique allows anatomical reduction of comminuted capitellum and trochlea, with a low risk of avascular necrosis over 4 years of follow-up.Level of evidenceLevel IV, retrospective case series.

Efficacy of low molecular weight hyaluronic acid (500–730 kDa) in post-traumatic pathology of periarticular soft tissues at different sites: data from an open-label pilot clinical study

Local injection therapy (LIT) with hyaluronic acid (HA) medications is one of the most promising methods for the treatment of periarticular soft tissue pathology (PASTP) caused by injury or overuse. Objective: to evaluate the efficacy and safety of LIT with HA medication with a molecular weight of 500–730 kDa in patients with various post-traumatic PASTP. Material and methods. The study included 30 patients with rotator cuff syndrome (RCS), lateral epicondylitis (LE) and plantar fasciitis (PF) after trauma. Inclusion criteria were the presence of moderate/severe pain (≥40 mm on a visual analogue scale (VAS)) over a 3-month period and the absence of effect of LIT with glucocorticoids. All patients were administered HA peritendinously three times (7 days apart) under ultrasound guidance. Treatment results were evaluated after 1 and 3 months based on the dynamics of pain intensity (VAS) and functional indicators using the ASES (American Shoulder and Elbow Surgical Evaluation), MES (Mayo Elbow Score) and FFI (Foot Functional Index) questionnaires. Results and discussion. In the general group, there was a statistically significant decrease in pain intensity after 1 and 3 months from a mean of 57.6 ± 14.7 to 37.0 ± 14.8 and 35.0 ± 14.3 mm according to VAS respectively (p &lt; 0.05). In the patient groups with different PASTP, the average assessment of pain intensity and functional impairment at baseline and after 1 and 3 months was: for RCS (n = 11) 59.0 ± 15.1, 39.0 ± 15.7, 36.3 ± 16.2 mm according to VAS and 49.1 ± 14.3, 60.1 ± 13.7, 61.7 ± 3.8 according to ASES, respectively; with LE (n = 10) 54.0 ± 13.4, 35.0 ± 9.7, 34.0 ± 11.7 mm according to VAS and 71.5 ± 11.1, 78.3 ± 9.0, 81.5 ± 8.3 according to MES; with PF (n = 9) 61.0 ± 16.5, 36.6 ± 19.3, 34.4 ± 15.8 mm according to VAS and 47.2 ± 22.8, 39.6 ± 39.7, 39.0 ± 29.9 according to FFI. None of the patients experienced any adverse events during treatment. Conclusion. HA medication with a molecular weight of 500–730 kDa showed good efficacy and safety in LIT of PASTP of the shoulder, elbow joint and foot. Further studies are needed to evaluate the possibility of a broad use of the drug for the treatment of PASTP in real clinical practice.

Lateral Humeral Condyle Fracture in Childhood: Results of a New Surgical Technique.

Fractures of the lateral condyle of the humerus are one of the most common fractures in children, accounting for between 10% and 20% of fractures involving the elbow, with a peak incidence at 6 years of age. Treatment is often surgical for displaced fractures > 2 mm, according to Milch and Jakob classification. There is no consensus in the literature about the appropriate surgical management of these fractures. Objectives: The aim of this study is to describe, propose, and evaluate outcomes and complications of the surgical technique of reduction and osteosynthesis using trans-bone suture with resorbable threads. Methods: Patients with lateral condyle fractures treated with this surgical technique from 2015 to 2019 were included in this retrospective study, with a minimum follow-up of 24 months. For clinical and functional assessment of the elbow, Mayo Elbow Scores were recorded; we assessed the time of fracture healing, carrying angles, and Baumann angle of the affected limb compared to the healthy contralateral elbow for radiographic data. Complications have also been described. Results: We achieved satisfactory results; 36 patients with lateral condyle fractures were included in this study. Radiological healing was achieved in all cases. There was only one complication. No cases required additional surgical procedures. Almost all patients achieved a complete flexion of 110 degrees or more and complete extension. Conclusions: This surgical technique has good functional outcomes and fracture healing, a lower incidence of complications when compared to other surgical techniques, and no mechanical failure with good clinical and radiological results.

Outcome of Olecranon Fracture Treated with Tension Band Wiring Versus Anatomical Locking Plate Fixation

Aim: Up to 10% of all upper limb fractures involve the olecranon, and this type of fracture is the most common osseous injury of the elbow joint. These show a bimodal distribution occurring in younger patients due to high-energy trauma and in elderly cohorts with low bone quality after low-energy falls. Objective: To compare functional outcome of tension band wiring versus anatomical locking plate fixation for reduction of olecranon fracture Materials and Methods: This randomized controlled trial study was conducted in the Department of Orthopedic, Lady Reading Hospital, Medical Teaching Institute Peshawar from December 2022 to June 2023. Non-probability consecutive sampling technique was used in this study. Sample size was calculated using WHO calculator keeping 95% confidence interval 80 % power of study, 10% absolute precision, mean Mayo elbow score was 84.0±9.3 in the TBW group and 88.3±9.1 in the locking plate fixation group (4). Expected sample size is 32 patients in each group, total 72 patients. Patients of both genders have age range from 20 to 70 year with Mayo type 2A olecranon fractures, more than 2 mm of joint displacement determined on X-ray elbow, and elbow extension loss determined on physical examination presented within 7 days of the injury were included in the study while Patients with open fracture and revision surgery were excluded from the study. Results: In this study age distribution among 72 patients was analyzed as n= 20-30 Years 17(27.4%) 31-40 Years 14(22.6%) 41-50.Years 11(17.7%) 51-70 Years 20(32.3%). Mean age was 47.1 Years with SD ± 2.87. Gender wise Distribution among 72 Patients was analyzed as Male were 31(50.0%) and female were 31(50.0%). Distribution of duration of disease among 72 patients were analysed as n= 1-2 weeks were 47(75.8%) and 3-4 weeks were 15(24.2%) Practical Implication: There are no established guidelines for the treatment of olecranon fracture in our institution. Most olecranon fractures are treated according to surgeon preferences and surgical experience of the surgeon. Previous studies showed variables results with no consensus. We will provide rationale basis for universal use of standard treatment of olecranon fracture. Conclusion: Although there were no statistically significant differences in clinical outcomes between the two groups, the ALP group had a higher proportion of any complication than the RP group. Keywords: Anatomical locking plate; complications; eyelet wire; olecranon fracture; tension band wiring.

Comparing Lateral Versus Both Medial and Lateral Percutaneous K-Wire Fixation of Displaced Supracondylar Humerus Fracture in Paediatric Patients

Supracondylar humerus fractures are the most common injuries in paediatric age group. For displaced fractures [III and IV], closed reduction and internal fixation with K-wires is the most preferred option. The current study aims to compare the outcomes of the management of Gartland type III and IV supracondylar humerus fractures with crossed and lateral pinning. We included 40 patients in our study between the age of 2-12 years with Gartland Type III and IV fractures, Weight &lt; 40 kg, less than 10 days old, closed fractures. Randomization was done where the Odd numbered patients were put in Group 1 and even number in Group 2. Group 1 participants were managed by lateral K-wire fixation and Group 2 by crossed K-wire fixation. All the patients were assessed for any loss of reduction and iatrogenic neurovascular injuries, alignment, Flynn’s criteria, Mayo elbow score. The flexion-extension range in Group 1 was about 110.27° ± 14.39° as compared to 103° ± 12.05° in Group 2. Supination to pronation was about 87.7° ± 1.62° in Group 1 as compared to 87° ± 2.42° in Group 2. Functionally (p&gt;0.05) and radiographically both groups did not show any significant difference. Thus, we concluded that lateral pinning in good hands is as stable as crossed pinning with lower chances of nerve injury and is relatively safe.

Computer-simulated osteotomy based on health-side combined with guide plate technique in treatment of cubitus varus deformity in adolescents

To explore the feasibility and early effectiveness of computer-simulated osteotomy based on the health-side combined with guide plate technique in the treatment of cubitus varus deformity in adolescents. The clinical data of 23 patients with cubitus varus deformity who met the selection criteria between June 2019 and February 2023 were retrospectively analyzed. There were 17 males and 6 females, ranging in age from 4 to 16 years with an average of 8.5 years. The time from injury to operation was 1-4 years. The angle of distal humerus rotation was defined by humeral head posterior inclination angle using low radiation dose CT to scan the patient's upper extremity data at one time, and the preoperative rotation of the distal humerus on the affected side was (33.82±4.39)°. The CT plain scan data were imported into 9yuan3D digital orthopaedic system (V3.34 software) to reconstruct three-dimensional images of both upper extremities. The simulated operation was performed with the healthy upper extremity as the reference, the best osteotomy scheme was planned, overlapped and compared, and the osteotomy guide plate was prepared. The patients were followed up regularly after operation, and the formation of callus in the osteotomy area was observed by X-ray examination. Before and after operation, the carrying angle of both upper extremities (the angle of cubitus valgus was positive, and the angle of cubitus varus was negative) and anteversion angle were measured on X-ray and CT images. At the same time, the flexion and extension range of motion of elbow joint and the external rotation range of motion of upper extremity were measured, and Mayo score was used to evaluate the function of elbow joint. The operation time ranged from 34 to 46 minutes, with an average of 39 minutes. All patients were followed up 5-26 months, with a mean of 14.9 months. All the incisions healed by first intention after the operation; 2 patients had nail path irritation symptoms after Kirschner wire fixation, which improved after dressing change; no complication such as breakage and loosening of internal fixators occurred after regular X-ray review. Continuous callus formed at the osteotomy end at 4 weeks after operation, and the osteotomy end healed at 8-12 weeks after operation. At last follow-up, the carrying angle, anteversion angle, external rotation range of motion, and extension and flexion range of motion of the elbow joint of the affected side significantly improved when compared with preoperative ones ( P<0.05). Except for the extension range of motion of the healthy elbow joint ( P<0.05), there was no significant difference in other indicators between the two sides ( P>0.05). At last follow-up, the Mayo elbow score was 85-100, with an average of 99.3; 22 cases were excellent, 1 case was good, and the excellent and good rate was 100%. Computer-simulated osteotomy based on health-side combined with guide plate technique for treating cubitus varus deformity in adolescents can achieve precise osteotomy, which has the advantages of short operation time and easy operation, and the short-term effectiveness is satisfactory.

Effect of Repetitive Corticosteroid Injection on Tennis Elbow Surgery

Background: Lateral epicondylitis is a chronic tendinopathy of humeral origin of the common extensor tendon. Most patients show improvement after nonoperative treatment. However, 4% to 11% of patients require surgical treatment. Although corticosteroid injection is one of the most commonly applied nonoperative treatment methods, to the authors’ knowledge, no study has reported the effect of the number of preoperative corticosteroid injections on the final postoperative outcome. Thus, the objective of this study was to determine the effect of the number of preoperative corticosteroid injections on postoperative clinical outcomes. Hypothesis: The number of corticosteroid injections before surgical treatment does not affect postoperative clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: As a retrospective review, from January 2007 to December 2019, a total of 99 patients who had undergone surgical treatment of lateral epicondylitis with a modified Nirschl technique were enrolled. The number of preoperative corticosteroid injections was investigated by medical record review. Outcome measurements included visual analog pain scale; Disabilities of the Arm, Shoulder and Hand (DASH) score; Mayo Elbow Performance Score; and the Nirschl and Pettrone grade. Grip power and wrist extension power were measured using a digital dynamometer. Results: A total of 99 patients were included in this study. The mean total number of injections of patients was 4.37 ± 2.46 times (range, 1-15 times). Total duration of nonoperative treatment before surgery was 25.4 ± 20.5 months (range, 4-124.8 months). The mean postoperative follow-up period was 42.8 ± 28.0 months (range, 12-110 months). For all injection numbers, clinical scores showed significant improvement in visual analog pain scale, DASH score, Mayo elbow score, grip power, and wrist extension power after surgery. Regression analysis showed that the degree of improvement according to the injection number was not statistically significant. The Nirschl and Pettrone grade was excellent in 82 (82.8%) patients, good in 14 (14.1%) patients, fair in 2 (2%) patient, and failure in 1 (1%) patient. Conclusion: The number of preoperative corticosteroid injections does not appear to affect postoperative clinical outcomes of patients with lateral epicondylitis who undergo surgery with a modified Nirschl technique.

Ultrasound guided percutaneous tenotomy for lateral epicondylosis

Lateral elbow tendinopathy is a common condition affecting two to three percent of the population. While non-operative management is the mainstay of treatment, 10-15% remain refractory. Ultrasonic percutaneous tenotomy is a recent therapeutic option for clinicians to treat lateral elbow tendinopathy. The goal of this study was to evaluate the survival rate of ultrasonic percutaneous tenotomy in the treatment of lateral elbow tendinopathy. 83 patients underwent ultrasonic percutaneous tenotomy from September 2015 to August 2018 and met full inclusion criteria to participate. 63 patients consented to enroll in the study, with 50 (79.4%) completing the postoperative questionnaire. Data obtained included range of motion, patients’ report of improvement, Quick Dash Score (Q-Dash), Visual Analogue Scale (VAS) pain, VR 12, Mayo Elbow Performance, patient satisfaction, further post-operative adjunct procedures which included additional steroid injections, platelet-rich plasma (PRP) injections or need for reoperation at a minimum of 12 months post procedure. Overall survival rate for ultrasonic percutaneous tendinopathy was 94% (47/50). Three patients required post-operative adjunct procedures, two received steroid injections and one required PRP injection. Mean VAS score improved from 8.1 to 2.8 in the no failure group vs 7.9 to 2.7 in the failure group. Mean postoperative Mayo Elbow score and Q-DASH score was 89 (range 60 to 100) and 12.7 (range 2.3 to 61.4), respectively. 84 percent of patients were either very satisfied (N=31) or satisfied (N=11) with their procedure. This three year study demonstrates that ultrasonic percutaneous tenotomy appears to be a safe and efficacious therapeutic option with a high survival rate for patients with recalcitrant lateral elbow tendinopathy.

Treatment of Comminuted Radial Head Fractures with Personalized Radial Head Prosthesis Produced with 3D Printing Technology.

The radial head is the forearm's pivot point for supination-pronation motions. Although radial head resection can be performed in comminuted radial head fractures, radial head prosthesis has gained popularity in order to prevent possible complications such as progressive valgus instability in the elbow and secondary ulnocarpal impaction that may develop due to proximal displacement of the radius. As for radial head prostheses, standard prosthetic designs do not provide the same results in everyone, and the alignment of the radial head and radial neck angle cannot be fully achieved. We believe that the radial head, considered the pivot point of the elbow joint, must be reconstructed with a complete anatomical implant. We designed and applied personalized prostheses to our patients, and in this study, we wished to share the 2-year results of these patients. In this study, 23 patients who had comminuted radial head fractures were applied personalized radial head prostheses. Preoperative variables such as type of injury, age, side, additional ligament injury, operation time, number of radial head parts, neck angle of individual prosthesis, stem length, and stem diameter were noted. Mean operating time was 26 ± 9 minutes. One month postoperatively, after physical therapy, elbow ROM, loss of strength compared to the opposite joint, Mayo elbow scores, QuickDASH scores, and patient satisfaction were evaluated. Patients were summoned two years postoperatively. QuickDASH and Mayo elbow scores were satisfactorily good (mean QuickDASH score: 9.091, mean Mayo score: 91.08). According to the results of the patient satisfaction questionnaire, 16 of the 23 patients reported excellent satisfaction, 5 patients good satisfaction, and 2 patients moderate satisfaction. None of the patients reported poor results. Since a personalized radial head prosthesis consists of a single monoblock, its surgical application consists of a single step and has a short operating time. As the applications in the literature increase and more studies are conducted, this subject will be better understood. Our study demonstrated that these patients, whose anatomy were individually replicated, achieved good range of motion and patient satisfaction. In fact, none of the patients reported negative results. In comminuted radial head fractures, surgical implantation of personalized radial head prosthesis is a treatment modality with easy application, short operating time, and good functional results due to nearly complete preservation.

Outcomes of the Posterior Approach for the Treatment of Radial Head Fractures and Associated Elbow Injuries: A Retrospective Observational Study.

The lateral approach to the radial head remains the routinely used approach for surgical fixation or replacement despite the risk of injury to lateral soft tissue structures. Multiple approaches are required when dealing with complex elbow injuries involving other bony and soft tissue structures which lead to greater soft tissue dissection, prolonged immobilization, and a higher rate of elbow stiffness. This article utilizesa single posterior approach involving the Boyd interval in the surgical management of radial head fractures with an associated elbow injury. Thirteen patients with radial head fractures and related elbow injuries treated with the posterior approach to the elbow were retrospectively analyzed. All patients were operated on by a single surgeon and followed up for a minimum of 18 months postoperatively. Functional evaluation of the patients was performed at the final follow-up which comprised a range of movements of the elbow, visual analogue scale (VAS), Disability of Arm, Shoulder, and Hand (QuickDASH), and the Mayo Elbow Performance Score (MEPS). The mean VAS score was 2.16, QuickDASH score, and Mayo elbow score were 7.15 ± 2.96 and 78.46 ± 8.26 respectively. The flexion-extension arc of the elbow was 128.46 ± 4.27 degrees and the supination-pronation arc was 133.92 ± 4.04 degrees at one-year follow-up. Two patients developed early postoperative complications (elbow stiffness and ulnar nerve neuropraxia) and recovered spontaneously. No patients developed neuropraxia of the posterior interosseous nerve (PIN). The single incision posterior (Boyd) approach to the elbow offers complete access to the radial head, olecranon, coronoid, and lateral ligamentous structures in complex elbow injuries and provides good functional outcomes in our small observational study.

Functional and clinical outcome of minimally invasive anterior bridge platting in humerus shaft fractures

Introduction: To assess the functional and radiological outcomes of minimally invasive anterior bridge plating (ABP) for mid-shaft humerus fractures. This study is done to evaluated the clinical, radiological, and functional outcome of mid shaft humerus fractures in 30 patients, all of which were managed with MIPPO. over an average follow up period of 12 months.Materials and Method: 30 patients fulfilling inclusion criteria were treated with ABP by using a 4.5-mm dynamic/locking compression plate and followed for a period of 12 month. Functional outcome was assessed using the UCLA & Mayo elbow scores. Range of motion (ROM), subjective strength, and radiographic union were assessed.Results: Out of the 30 patients in the study, 24 were males and 6 were females. The mean age was 36 years (range 26 to 65 years). 22 out of 30 patients (73%) had the dominant side fractured. Mean surgical time in minutes was 60 min (range: 35-80 min).The mean fracture union (radiological) time was 10.6 weeks (range: 08–16 weeks). However Shoulder function was excellent to good in 28 cases (93.3%) and fair in 2 case (6.7%) on the UCLA score and excellent in 28 cases(93.3%) and fair in 2 cases (6.7%) on mayo elbow score.The majority of patients (28 patients, 93.3%) who fell in the excellent or very good category according to our questionnaire were extremely satisfied. There were 2 cases (6.7%) of non-union.Conclusion: ABP is fundamentally different from traditional open posterior plating or conventional intramedullary nailing. It works on the principal of relative stability with union taking place by callus formation, and a longer plate on the tensile surface ensures that the humerus can withstand greater amount of rotational and bending stresses. The minimally invasive nature preserves the soft tissue envelope and, if done correctly, causes no damage to the vital structures in proximity. ABP for mid-shaft humerus fractures is a safe and effective treatment modality yielding high rates of union, excellent functional recovery, minimal biological disruption, better cosmesis, and superior satisfaction rates.

Radial head distalisation with an external ring fixator as a therapy option in children with chronic posttraumatic radiocapitellar dislocations.

Missed monteggia-type injuries in children can result in chronic radial head dislocation with anatomic changes and osteoarticular remodeling of the radial head. In later stages, joint reconstruction is impossible and a functional radial head distalization can be a therapy option in symptomatic patients. From 2010 to 2018, 46 patients (18 female and 28 male, mean age 11.8 (4-20)) with chronic radius head dislocation treated in our institution were retrospectively analyzed. A radial head distalization was performed in symptomatic patients at the time of ulna lengthening and angulation by use of an external ring fixator. We analyzed the surgical and radiographic data as well as the clinical outcome of the patients measured by DASH and Mayo Elbow score. 16 patients (6 female, 10 male) fulfilled the criteria for functional radial head distalization. Main reason was Monteggia injury in 11 cases, and radial head fracture in 5 cases. Average follow-up was 5.1years (range 1-9, SD 2.1). Mean time from injury was 4.14years (range: 4months to 12years, SD 3.5years). Mean duration of external fixation was 106days (range 56-182, SD 31.2), lengthening was 21.3mm (range 12-42, SD 8.8). Average degree of sagittal angulation 14.8° (0-32°, SD 10.7°), coronal angulation 4.4° (0-25°, SD 7.3°). DASH score showed a good result with 2.4, and the MAYO Elbow Score was excellent (95/100). No secondary luxation of the radius head was detected. Radial head distalization with external ring fixator can be a therapy option for chronic radius head dislocations in symptomatic patients without losing stability of the elbow joint in contrast to radial head resection.

Radial Head Arthroplasty among Patients with Radial Head Fracture in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Proximal radial fractures are a common type of fracture around the elbow joint. Among these comminuted radial head fractures are commonly associated with secondary injuries and instability of the elbow joint. Management of the radial head in such cases is very important in restoring the stability of the elbow joint and starting early mobilization. The aim of this study was to find out the prevalence of radial head arthroplasty among patients with radial head fracture in a tertiary care centre. A descriptive cross-sectional study was conducted from 25 January 2019 to 25 December 2020 among patients with a radial head fracture at the Department of Orthopaedics of a tertiary care centre. Ethical approval was obtained from the Institutional Review Committee (Reference number: 076/77-08A). A convenience sampling method was used. The study group consisted of patients between 20 to 60 years of age with isolated radial head fractures. Radial head arthroplasty was done for Mason types III and IV fractures and functional outcome was calculated postoperatively with Mayo elbow score on follow-up at 3-, 6- and 12-month intervals. Point estimate and 95% Confidence Interval were calculated. Out of 96 patients with radial head fracture, 22 (22.92%) (17.59-28.25, 95% Confidence Interval) underwent radial head arthroplasty. The mean Mayo elbow score was 96.33±7.74 at 12 months of follow-up. The prevalence of radial head arthroplasty among irreparable radial head fractures was similar compared to other studies done in a similar setting. arthroplasty; elbow prosthesis; radius fractures.

Treatment of Unstable Elbow Injuries with a Hinged Elbow Fixator: Subjective and Objective Results.

IntroductionInjuries around the elbow pose a challenging problem for orthopaedic surgeons. The complex bony architecture of the joint should be restored and the thin soft tissue envelope needs to be handled with meticulous care. Elbow instability is a complication seen after dislocations and fractures of the elbow and remains a treatment challenge. The purpose of this study was to provide subjective and objective results following the surgical treatment of unstable elbow dislocations with an external hinged fixation technique.MethodsForty-six consecutive patients with complex trauma of the elbow with instability after ligament reconstruction were enrolled between January 2017 and December 2019. The parameters used to quantify the subjective and objective functional results were the Mayo Elbow Score (MES, objective) and Oxford Elbow Score (OES, subjective), and clinical stability of the elbow joint. We also performed a radiological follow-up of the fractures.ResultsThe mean MES and OES scores were good at the 12-month follow-up. We had 38 patients with stable joints and 8 patients with minor instability. Using the stress test, we saw a significant difference in the affected joint under varus stress (6.7 ± 1.8 mm) compared to the healthy joint (5.8 ± 1.2 mm) laterally. Furthermore, medially the gap was significantly larger (5.8 ± 0.8 mm, treated elbow) than the contralateral gap under valgus stress (4.3 ± 0.8 mm) (p <0.001). Twenty-one complications occurred in 46 patients (46%): Seven patients had a clinical change of elbow axis: Three valgus (6%), four varus (9%); Superficial wound infection occurred in one case (2%) and ulnar nerve dysfunction in two (4%). The most common medium-term complication was post-traumatic osteoarthritis in eight cases (17%). Heterotopic ossification occurred in five patients (11%) and elbow stiffness in five cases (11%).ConclusionThe use of the hinged elbow external fixator in the treatment of complex elbow trauma is a valid therapeutic adjunct to ligamentous reconstruction showing encouraging results with acceptable complications.How to cite this articleMeccariello L, Caiaffa V, Mader K, et al. Treatment of Unstable Elbow Injuries with a Hinged Elbow Fixator: Subjective and Objective Results. Strategies Trauma Limb Reconstr 2022;17(2):68–73.

Comparison of Clinical and Radiological Results of Orthogonal and Parallel LC-DCP Plating in AO Type C Distal Humerus Fractures

Objective: AO (Arbeitsgemeinschaft für Osteosynthesefragen) type C distal humerus fractures are difficult fractures to reduce and fix due to the difficulty of the elbow anatomy and small size of the broken bone parts. We hypothesize that although parallel plating technique is biomechanically superior for humerus distal fracture, orthogonal plating technique in clinical conditions is as reliable and effective as a method of parallel plating for Type C humerus fractures. Materials and Methods: Between 2012 and 2018, 36 patients who underwent operations for AO type C distal humerus fractures and met the inclusion criteria were evaluated retrospectively. Parallel plating was performed in 20 patients and orthogonal plating (medial and posterolateral plating) in 16 patients. All patients were fixed with LC-DCP plates. Quick DASH, Mayo elbow, and VAS scores; grip strength; elbow ROM (Range of Motion); extension loss; and evaluations complications at the last visit. Results: There was no statistically significant difference between the groups in terms of the Quick DASH, Mayo elbow, or VAS scores, grip strength, elbow ROM, extension loss, union time, postoperative heterotrophic ossification, elbow and olecranon nonunion, post-op neuropraxia, or other complications (P > 0.05). There was a statistically significant difference between the two groups regarding ulnar nerve transposition (P <0.05). Conclusion: There are no functional, radiological, or complicated advantages between parallel plating and orthogonal plating, which are frequently used in the literature, for treating type C distal humerus fractures. The surgeon can safely use both techniques, depending on the type of fracture and how both columns are broken.

Functional outcome of autologous platelet rich plasma injection in plantar fasciitis and tennis elbow

Recent developments in cellular and molecular biology have emerged as a potent tool in the management of orthopaedic illnesses and injuries. Upon binding to the target cell receptor, the growth factor from platelets triggers the activation of an intracellular signal transduction system, which results in a biological response that is essential for chemotaxis, cell proliferation, and osteoblastic differentiation. The aim of this study is to determine the efficacy and safety of autologous platelet-rich plasma injection in tennis elbow and plantar fasciitis. We conducted a prospective study with patients who were suffering from plantar fasciitis (n=37) or tennis elbow (n=23) and were given with autologous platelet-rich plasma injection. A short term follow up of all these cases were done at regular intervals for 1, 4, 8, and 12 weeks. The clinical outcomes were analyzed with severity of pain and movements of the pathological part. The functional outcomes were analyzed with VAS and AOFAS scoring for plantar fasciitis and VAS and Mayo’s elbow scoring for tennis elbow. All these patients were statistically analyzed by repeated measures ANOVA test. Our investigation found a statistically significant difference between pre-procedural and post-procedural scores in both the subjective (VAS) and functional (AOFAS and Mayo elbow score) grading systems used in this study. Patients who received an autologous platelet-rich plasma injection experienced a statistically significant (p &amp;#60;0.05) improvement in their ability to combat both of the musculoskeletal illnesses studied. Autologous platelet-rich plasma acts as a promising efficacious biological therapeutic agent for use in musculoskeletal disorders such as plantar fasciitis and tennis elbow without major complications upon its usage.

A case series of chronic elbow dislocations treated with open reduction without formal reconstruction or augmentation of ligaments using collateral approach

Elbow joint serves important functions for the purpose of carrying out routine activities. Chronic dislocations of this joint block the smooth functioning of the elbow joint, thus hampering patient’s self-care and making day to day tasks difficult to perform. Chronic elbow dislocation is defined as a dislocation that has remained unreduced for 2 weeks. The extensive soft-tissue fibrosis and contractures along with skeletal changes that develop during this time usually prevent successful closed reduction. A total of 3 patients with chronically dislocated elbow joints were enrolled in the case series and were managed with the similar technique of open reduction of delivering out the distal humerus out and reduction without any formal reconstruction or augmentation of any of the ligaments by the same surgeon in the same hospital set up followed by the same post operative rehabilitation protocol. All the patients achieved considerably good, stable and painless elbow joint with significant improvement in range of motion as compared to pre operative one. The outcomes were measured using mayo elbow score (MEPS). Conclusion: This technique of treating elbow joint dislocation is very effective and gives patient a clinically stable, painless and mobile elbow joint. The results were evaluated with the Mayo elbow performance score (MEPS) which showed a considerable improvement in post-surgery score as compared to pre surgery one.

A NEW FLUOROSCOPY TECHNIQUE FOR SUPRACONDYLAR HUMERUS FRACTURES.

ABSTRACTIntroduction To compare two different intraoperative fluoroscopy techniques used for closed reduction and percutaneous pinning (CRPP) in pediatric patients with supracondylar humerus fractures (SHF).Materials and Methods Thirty-six patients who underwent SHF surgery from May 2011 to June 2019 were included in the study. During surgery, the classical fluoroscopy method (CFM) was used in 21 patients and the new fluoroscopy method (NFM) was used in the remaining 15 patients.Results The mean age was 5.14±1.13 years in the NFM group and 5.38±1.36 years in the CFM group. Mean operative time was 38.14±5.92 minutes in the CFM group and 21.54±3.48 minutes in the NFM group (p=0.001), while mean fluoroscopy times were 25.65±3.91 seconds and 39.84±7.50 seconds in the NFM and CFM groups, respectively (p=0.001). The NFM and CFM groups demonstrated similar functional capacity as measured by the Mayo Elbow Score (p=0.168). Direct radiographs obtained to measure Baumann’s angle also showed that the two groups had similar results (p=0.848).Conclusions The NFM is a reliable and successful technique as it leads to shorter operative and fluoroscopy times, as well as providing improvement in functional scores and radiological outcomes in short-term follow-up. Level of Evidence III, Therapeutic Studies-Investigating the Results Level of Treatment.

English

BACKGROUND Humerus fractures, mainly midshaft are one of the most common fractures treated by orthopaedicians around the globe, either conservatively or by internal fixation by plate and screw or by intramedullary humerus nail. Each has its own merits and demerits. The objective of our study was to assess functional and radiological results of minimally invasive anterior bridge plating of humerus shaft as well as lower third shaft fractures and prove its efficacy, in fact, supremacy over other used techniques till day. METHODS 38 patients, fulfilling inclusion criteria were operated by minimally invasive anterior bridge plating using dynamic compression /locking compression plates. UCLA shoulder &amp; MAYO elbow scores were used for assessing shoulder and elbow function and radiographical assessment was done to confirm healing and union. RESULTS Out of 38 patients in the study, 26 were males and 12 were females, the mean age was 40.184 years (range 25 to 56 years). 29 patients had mid-shaft fractures and 9 patients had lower mid-shaft humerus fractures. Mean surgical time was 77.868 (range 60 min to 100 min ), mean union time (radiological ) was 13.78 weeks (range 10 to 19 weeks), shoulder function was good to excellent in 36 cases (94.7 % ) and moderate in 2 cases (5.26 %) on UCLA score. CONCLUSIONS Our study proved to be a huge success, with excellent rates of union and very good functional results. Minimally invasive anterior bridge plating is a biological fixation and proves itself a very efficacious surgical treatment option for mid-shaft and lower mid-shaft humerus fractures. This method is very safe, with the best outcomes, and can be considered as the best technique for such fractures of the humerus to date. KEY WORDS Anterior Bridge Plating, Mid Shaft, Lower Mid Shaft Humerus Fractures, UCLA Score