Mean Mayo Elbow Performance Score Research Articles

Joint replacement surgery for elbow tumours: a systematic review of outcomes

Tumour resection followed by joint reconstruction is a surgical option in the appropriate patient. The evidence for such reconstructive surgery of the elbow joint is limited. The aim of this study is to review the literature to evaluate the outcomes of joint replacement surgery in tumours of the elbow. A systematic review of PUBMED and EMBASE databases was conducted. Case series and comparative studies reporting results after total elbow arthroplasty, modular endo-prosthetic replacement and custom prosthesis were eligible for inclusion. Eleven eligible studies were identified (n = 134). At mean follow-up of 44 months, the overall revision rate was 14% and complication rate was 28%. The mean Mayo Elbow Performance Score was 75, with 56% of patients reporting good or excellent outcomes. The mean post-operative range of motion was 97°. Elbow prosthesis reconstruction after tumour resection can provide good functional outcomes at mid-term follow-up. The complication and revision rates are comparable to other indications for elbow replacement surgery. Further prospective studies are required to compare outcomes between different elbow arthroplasty options after tumour resection.

Total elbow arthroplasty for acute distal humeral fractures with humeral condyle resection or retention: a long-term follow-up study.

BackgroundOpen reduction and internal fixation is the gold standard for the operative treatment of intra-articular distal humeral fractures. However, in elderly patients the approach involves a high rate of complications. We reviewed the long-term outcomes of 13 primary total elbow arthroplasties (TEAs) performed to treat acute fractures in non-rheumatoid patients who at the time of trauma were aged less than 70 years. The aim of the study was to establish whether condyle retention enhances hinge stability and influences outcomes in these patients, who are younger than those who typically undergo TEA.MethodsIn 13 consecutive patients with acute distal humeral fractures aged 61-67 years, a linked semi-constrained Coonrad-Morrey prosthesis was implanted. The medial and lateral condylar bone fragments were resected (7 patients) or stabilized to the diaphysis using k-wires or plates (6 patients).ResultsAt a mean follow-up of 12 years, the mean Mayo Elbow Performance Score was 88 and patient satisfaction was 85%. Nine patients (70%) did not require surgical revision. All revisions involved the group managed by condyle resection.DiscussionTEA can be considered in elderly subjects with acute distal humeral fracture. In our patients, resection of the medial and lateral condyle fragments did not influence outcomes, although clinical observation suggested that it involves greater mechanical stress on the hinge, heightening the long-term risk of bushing wear. Condyle fixation with plates or k-wires seems to afford longer implant survival and is recommended in younger patients with higher functional demands.

Complex fractures of the distal humerus in the elderly: primary total elbow arthroplasty or open reduction and internal fixation? Mid-term follow-up.

To compare the mid-term outcomes in intra-articular distal humerus fracture (AO/OTA type C) treated with either open reduction-internal fixation (ORIF) or total elbow arthroplasty (TEA) in patients older than 75 years and with more than fiveyears of follow-up. Retrospective study including 24 patients (11 TEA vs. 13 ORIF) with a mean age of 82 years and being all females. Results assessed included (1) radiographic measures; (2) functional results: range of motion, Mayo Elbow Performance Score (MEPS), quick-DASH; and (3) complications. TEA group vs. ORIF group achieved a mean flexion of 117° ± 9.6° vs. 106° ± 14°, extension loss of 38° ± 17° vs. 30.8° ± 16°, pronation 75° ± 5° vs. 85° ± 7° and supination 75° ± 4° vs. 70° ± 5°. Mean MEPS score was 71.6 vs. 83.6 (p = .183) and mean quick-DASH was 44.8 vs. 42.6 (p = .789). All 13 patients in the ORIF group demonstrated radiographic signs of bone union and none underwent conversion to TEA. Sixty-three percent of the patients in the TEA group underwent re-operation at an average of 72 months (62.4-75.2 months), including three for periprosthetic fracture and four for implant loosening. Whereas in the ORIF group, 23% of the patients were re-operatedupon excluding olecranon osteotomy hardware, two for stiffness, and one for an olecranon tension band wire failure. Although there were no differences in mid-term functional outcomes between either treatment, our results suggest that the recent trend towards the use of TEA instead of ORIF in the elderly should be re-examined due to the high rate of complications beyond five years of follow-up with TEA.

Long-term outcomes of radial head arthroplasty for radial head fractures-a systematic review at minimum 8-year follow-up.

The purpose of this study was to systematically review the literature to evaluate the functional outcomes, radiologic outcomes, and revision rates following radial head arthroplasty (RHA) at a minimum of 8 years follow-up. Two independent reviewers performed a literature search using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines using PubMed, Embase, and Web of Science databases. Only studies reporting on outcomes of RHA with a minimum of mean 8 years' follow-up were considered for inclusion. Our search found 10 studies including 432 elbows (51% males), with average age of 50 years (15-93) and mean follow-up of 117 months (98-145) met our inclusion criteria. At final follow-up, the mean Mayo Elbow Performance Score and Quick Disabilities of the Arm, Shoulder, and Hand questionnaire score were 83 (45-100) and 17 (0-63) respectively, and 86% of patients reported having no or minimal pain. The overall dislocation, subluxation, ulnar neuritis, and infection rates were 2%, 4%, 3%, and 3%, respectively. The rates of radiologic loosening, radiolucency, degenerative change, and heterotopic ossification were 9%, 46%, 27%, and 38%, respectively. The overall surgical revision rates were 20%, with 3%, 15%, and 5% requiring RHA implant revision, removal of metal or implants, and arthrolysis, respectively. Our systematic review established that RHA results in satisfactory clinical outcomes and modest complication and revision rates at long-term follow-up, despite high levels of radiologic degenerative changes over the same period.

Is systematic 1-stage exchange a valid attitude in chronic infection of total elbow arthroplasty?

IntroductionSurgical treatment for chronic infection of total elbow arthroplasty (TEA) generally involves 2-stage exchange. In the lower limb, 1-stage strategies are increasingly implemented, but few cases have been reported for the elbow. We present results in a preliminary series, with the aim of: (1) assessing control of infection in systematic 1-stage exchange for chronic TEA infection, (2) detailing clinical and radiological results, and (3) analyzing intra- and post-operative complications. HypothesisSystematic 1-stage exchange for chronic TEA prosthetic joint infection provides satisfactory control of infection. Material and MethodsSeven non-selected patients were operated on by 1-stage exchange for chronic infection of TEA during the study period. Two died before the minimum 2 years’ follow-up, from causes unrelated to the infection. Thus 5 patients (4 women, 1 man; mean age at surgery, 61 years [range: 48–69 years]) were included for analysis. At a minimum 2 years’ follow-up, all underwent clinical examination and elbow X-ray. Infection was monomicrobial in 4 cases and polymicrobial in 1. Isolates comprised Staphylococcus aureus in 40% of cases (2/5), Staphylococcus epidermidis in 60% (3/5) and Staphylococcus Warneri in 20% (1/5). Three patients showed fistula. Three were under immunosuppression/immunomodulation treatment. ResultsAt a mean 40 months’ follow-up (range: 24–60 months), 4 patients (80%) were free of infection and 1 showed signs of persistent infection. Mean range of flexion-extension was 81° (range: 60–95°) and pronation-supination 128° (range: 80–160°). Mean Mayo Elbow Performance Score was 75 points (range: 65–90). There were 2 intraoperative fractures and 1 neurologic deficit with partial regression. ConclusionOne-stage exchange provided control of infection in 80% of cases, despite cutaneous fistulae or immunosuppression treatment. Clinical results and complications rate were similar to those reported for 2-stage exchange. Level of evidenceIV; retrospective study without control group.

Résultats de l’arthroplastie de la tête radiale implantée en press-fit après fracture complexe de la tête radiale

IntroductionPress-fit radial head arthroplasty (RHA) is increasingly popular in treating complex radial head fractures. This study assessed the outcome of RHA, including the outcome following re-operation, and explored potentially influencing factors. HypothesisComplex radial head fractures treated with press-fit radial head prosthesis would have a favorable outcome. Material and methodsData on all consecutive patients treated with anatomic press-fit RHA from February 2002 to February 2015 were analyzed. Post-surgery clinical and x-rays assessments included a post-discharge evaluation of function. Standardized methods implemented include the assessment of range of motion (ROM), the Mayo Elbow Performance Score (MEPS) and subjective satisfaction scales. ResultsForty-five patients were recruited and 71 % were classified in Mason IV and 62.2 % had the “terrible triad”. Re-operation was performed in 26.7 % and prosthesis removal in 15.6 %. Mean follow-up was 140.8 months (95 % CI 117.7-164) and prosthesis survival was 69.5 % at 24 months. Mean MEPS before re-operations was 86.3±15.9. Pain and/or instability were the most common reasons for re-operation, and re-operations were significantly more frequent in patients having one or more “associated injuries” (p=0.05), but not the terrible triad; and in patients with radiological ‘loosening’ signs (p<0.01). Subjective scores were relatively good in most patients, although the functionality perceived in the re-operation with implant removal group was rather low. DiscussionSeveral studies of complex radial head fractures treated with press-fit radial head prosthesis have also shown favorable results, but the patients in such studies generally had less severe lesions. Moreover, differently from previous reports, this study with a long follow-up has included a younger population with high functionality requirements. Pain and/or instability, as observed in several previous reports, were the most common reasons for re-operation, but contrary to the expectation, the terrible triad was not associated with unfavorable outcome. ConclusionTreatment of complex fractures with press-fit radial head prosthesis, including re-operation with implant removal yields satisfactory results. Most scores of functional and subjective outcome improved following the re-intervention and most patients returned to their usual occupation. Level of evidenceLevel IV; Case Series; Treatment Study.

Clinical Outcomes of Low-Cost, Anchorless Repair of the Triceps Tendon Using a Proximal Knot Technique

PurposeTo use validated outcome measures to evaluate the clinical results of surgical repair of distal triceps tendon ruptures using transosseous tunnels and high-strength sutures with proximally based knots.MethodsA consecutive series of traumatic distal triceps tendon ruptures at a single institution was studied. All cases were surgically repaired by 1 surgeon using high-strength suture with a bone tunnel–based repair technique. Repair knots were oriented proximally instead of in the traditional distal position. All patients were evaluated at long-term follow-up with a physical examination performed by the orthopaedic surgeon and the following validated outcome measures: Disabilities of the Arm, Shoulder and Hand score; Mayo Elbow Performance Score; and visual analog scale score.ResultsSeven male patients with a mean age of 38 years (range, 19-50 years) and mean follow-up period of 4.1 ± 1.2 years underwent distal triceps tendon repair with bone tunnels and high-strength sutures with proximally positioned knots. Of the repairs, 4 involved the dominant arm. At final follow-up, the mean Disabilities of the Arm, Shoulder and Hand score was 1.3 ± 3.1; the mean Mayo Elbow Performance Score was 99.3 ± 1.9; and the mean visual analog scale score was 0. One additional patient who declined participation in the study had wound dehiscence and infection with an associated partial rerupture.ConclusionsThis case series of triceps tendon repairs using transosseous tunnels and proximally based knots showed favorable postoperative elbow function based on validated outcome measures.Level of EvidenceLevel IV, therapeutic case series.

A Surgical Protocol for Management of Post Traumatic Heterotopic Ossification of Elbow.

Open excision remains the gold standard of treatment for posttraumatic heterotopic ossification (HO) of the elbow. The purpose of this study is to evaluate the functional outcome of early surgical excision done by adhering to a proposed surgical protocol with exclusive posttraumatic HO of the elbow. A retrospective study was conducted with 31 patients (25 males and 6 females) with a mean follow-up of 40.5 ± 27.44months. Excision was done according to our surgical protocol based on the location of HO, associated fractures, stability, need for ulnar nerve transposition, previous operative scar. Improvement in elbow function, Mayo elbow performance score (MEPS) preoperatively and at final follow-up was compared, and statistical analysis was done. Mean flexion-extension arc, supination-pronation arc and MEPS improved by 74.68° ± 29.32°, 26.13° ± 32.93°, 30.48 ± 11.57, respectively. Flexion arc deteriorated by 10.81° ± 10.42° from intraoperative to final follow-up. Improvement at final follow-up was significant in all the cases (P < 0.05). 19 patients had limited HO, and 12 had global HO. Their mean flexion-extension arc increase was 77.63° ± 29.12° and 70° ± 30.3° respectively, and the final mean MEPS score was 96.05 ± 5.16 and 88.75 ± 11.51, respectively. Nine patients had no initial fracture (Group 1), 13 had some fracture (Group 2), nine had a fracture-dislocation of the elbow (Group 3). Their flexion-extension improvement, final MEPS were 88.33° ± 30.82°, 98.33 ± 5, (Group 1); 81.15° ± 16.73°, 92.31 ± 9.27 (Group 2) and 51.67° ± 31.32°, 89.44 ± 9.5 (Group 3), respectively. We had two complications (6.45%). The surgical protocol described here enabled us to achieve good functional results and was in concordance with similar studies done previously. The online version contains supplementary material available at 10.1007/s43465-021-00381-x.

The adjunct use of lateral hinged external fixator in the treatment of traumatic destabilizing elbow injuries.

The purpose of this study is to evaluate the results of using a lateral hinged external fixator as an adjunct stabilizer in the treatment of a variety of acute destabilizing elbow injuries. A retrospective review was performed on the medical records of patients in whom a lateral monolateral elbow hinged external fixator was applied by the senior author. The indication to apply the fixator corresponded to a variety of acute injury patterns ranging from simple elbow trauma or dislocation to complex fracture-dislocation, and the decision was based on either the presence of recurrent or persistent instability in any direction and/or to secure a vulnerable or weak bony fixation or soft tissue repair as intra-operatively judged by the surgeon. The fixator was inserted in the same setting after the repair of the associated ligamentous and/or bony structures. Patients operated after one month of the trauma and those presented with open elbow injury or associated humeral or ulnar shaft fracture were excluded. Rehabilitation was immediately started and the fixator removed at six to eightweeks with elbow testing and gentle manipulation under general anaesthesia, and resuming of rehabilitation after removal. Clinical assessment was performed for all patients according to the Mayo Elbow Performance Score (MEPS) with evaluation of range of motion at regular intervals till the end of the post-operative first year, then at final follow-up for the purpose of the study with radiographic assessment for evaluation of elbow reduction and concentricity. There were 13 patients with a mean age of 42 years. Two patients had instability secondary to LCL rupture; one patient had redislocation because of associated coronoid process fracture; one patient had radial head fracture with rupture of both collateral ligaments; five patients had terrible triad injury with variable association of collateral ligaments lesions; and four patients had posterior Monteggia fracture-dislocation. The mean MEPS was 90 at a mean follow-up of seven years with six excellent, six good, and one fair result. All patients had a concentrically reduced and stable elbow as assessed clinically and radiologically with a mean functional arc of motion of 132° for extension-flexion and 178° for pronation-supination. The hinged elbow external fixator represents a valuable adjunct in the therapeutic arsenal for the treatment of unstable elbows after bony and soft tissue repair. It provides satisfactory results in terms of stability and function and should be available in the operating room when a surgeon treats a complex elbow dislocation or fracture-dislocation.

Long-term outcomes of the modified Nirschl technique for lateral Epicondylitis: a retrospective study

BackgroundAlthough the Nirschl technique was introduced approximately 40 years ago, only limited information is available about the long-term results, especially concerning extensor power changes after surgery.The purpose of this study was to investigate long-term clinical results of surgical treatment of lateral epicondylitis using the modified Nirschl technique. The main outcome variable was muscle strength for wrist extension because the extensor origin was not reattached after removal of the degenerative extensor tendon.MethodsData from 99 patients who underwent surgical lateral epicondylitis treatment between 2007 to 2012 were included in the study. The mean follow-up period was 8.5 years (5 to 10, ± 1.1 years) and the mean age at surgery was 44.8 years (32 to 70, ± 9.8 years). The surgeries were performed using the modified Nirschl method and did not include extensor origin reattachment. Outcome measurements included the Visual Analogue Scale (VAS) score, Disabilities of the Arm, Shoulder and Hand (DASH) score, the MAYO elbow performance score, and Nirschl and Pettrone’s grades. Wrist extension and grip strength were analyzed using a digital handgrip dynamometer (microFET2TM system) and JAMA hand dynamometer.ResultsMean time required to return to work was 2.4 months after surgery. At the last follow-up after surgery, the mean VAS score had significantly improved, from 4.9 to 1.1. Mean MAYO elbow performance scores significantly improved, from 64 to 90, and mean DASH scores improved from 50 to 13. The Nirschl and Pettrone’s grades were 80% rated as ‘excellent’ and 16% rated as ‘good’. After adjusting for power differences between the dominant and non-dominant arms, the difference between wrist extensor power of the operated elbow and the non-operated opposite elbow at the final follow-up was not statistically significant. No patients complained about wrist extension weakness.ConclusionAlthough reattachment of the extensor origin was not performed during the modified Nirschl surgical technique, there was no significant weakness in wrist extension power and the long-term follow-up revealed favorable clinical results.Level of evidenceLevel IV (case series). Retrospective study.

Surgical Treatment of Comminuted Olecranon Fracture Using Locking Compression Plate Fixation

Purpose: Several types of surgical methods from tension band wiring to plate fixation are used in olecranon fractures. In comminuted olecranon fractures, plate fixation is recommended as it is difficult to obtain stable fixation of the bone fragments and joint congruency. The authors performed operations using compression locking plate for olecranon fractures corresponding to Mayo classification IIB and IIIB, and report the radiologic and functional results.Methods: Twenty-one patients who underwent plate fixation surgery for comminuted olecranon fractures at our hospital from September 2011 to April 2019 were enrolled in this study. Patients were retrospectively analyzed for at least 1 year. The classification of olecranon fracture was performed using the Mayo classification. For the analysis of the postoperative results, radiological union time, postoperative range of motion, complications, and functional results based on Mayo elbow performance score (MEPS) were evaluated.Results: The union was achieved in all cases and three posttraumatic arthritis were observed at the final follow-up. The average range of motion was 134.3° in flexion, –9.8° in extension. The mean MEPS was 93.1. There was no statistically significant difference in MEPS between the group that used technique of interfragmentary fixation and the group that did not (p=0.534).Conclusion: Surgical treatment using a locking compression plate fixation in comminuted olecranon fracture resulted in excellent functional results. Restoration of articular surface using Kirschner wire or interfragmentary screw between small bone fragments is considered a useful method for obtaining good functional results.

Neglected Fractures of the Lateral Humeral Condyle in Children; Which Treatment for Which Condition?

Background: Neglected fractures of the lateral humeral condyle (LHC) are misdiagnosed or insufficiently treated fractures, presenting later than 3 weeks after injury. The management of neglected LHC fractures in children remains controversial. Methods: Twenty-seven children were included in this retrospective study. Charts and medical records were investigated for demographics, time interval between injury and treatment, and type of treatment. Baseline radiographs were assessed for fracture grading and displacement. Final radiographs were investigated for bone healing, avascular necrosis, elbow deformities and growth disturbances. Complications were classified by the Clavien–Dindo–Sink (CDS) system. Outcomes were assessed according to the Dhillon Score (DhiS) and Mayo Elbow Performance Score (MEPS). Results: The mean time from injury to presentation was 27 months. Treatments included nonoperative management (6 patients), “in-situ” fixation (7 patients), open reduction and internal fixation (11 patients) and corrective osteotomy (3 patients). The mean follow-up was 7 years (range: 2–16). Overall, we observed complications in 16 patients (59%); six complications were considered major (22%) and occurred in Weiss Grade 3 fractures, with lateral displacement ≥5 mm. At the latest follow-up, pain and functional scores improved in 23 of 27 patients (85%). Mean MEPS increased from an average of 62 points preoperatively to 98 points postoperatively, while mean DhiS improved on average from 5 to 8 points. CDS score and time interval between injury and treatment were independent predictors of MEPS and DhiS. Conclusion: Our study describes outcomes from a cohort of children undergoing different treatments for neglected LHC fractures. Prolonged time interval between injury and treatment and perioperative major complications negatively impacted the treatment outcomes. Our findings strengthen the requirement for widely agreed guidelines of surgical management in neglected LHC fractures.

Minimally Invasive Plate Osteosynthesis versus Intramedullary Nailing for Fixation of Humeral Shaft Fractures in Adults

Introduction: The two methods of treatment of humeral shaft fractures, namely minimally invasive plate osteosynthesis (MIPO), and antegrade intramedullary nailing (IMN) are reported as satisfactory procedures. Objective: To compare the clinical and radiological results of MIPO and IMN techniques in surgical treatment of mid humeral shaft fractures. Patients and methods: From March 2017 to July 2018, a prospective study on 60 patients with closed unilateral mid- humeral shaft fractures were surgically treated with MIPO or IMN. The intraoperative outcomes including operation time, bleeding volume, and the postoperative outcomes (clinically and radiologically) were recorded. The Constant-Murley scores were used for assessment of function of shoulder joint and Mayo score was used for measurement of elbow joint function. Complications in both groups have been reported. The follow-up duration ranged from 6 to 12 months with a mean duration of 6.7 months. Results: For group 1 having MIPO technique, the average operative time was 90.3 min (range 50–110), while mean blood loss was 167 ml (range 120–200). In group II patients (interlocking humeral nail), the average time of operation was 100.1 min (range 65–120), and mean blood loss was 118 ml (range 90–150). The mean Constant-Murley shoulder score was 86.95±15.7 in MIPO group and 88.75±13.7in IMN group. The mean Mayo Elbow Performance score in MIPO and IMN groups was 96.5 ± 5.87 and 95.8 ± 6.77, respectively. Radiologic bony union was achieved in 29 out of 30 patients in MIPO group and in 28 out of 30 in IMN group. All the wounds in both groups healed primarily. There was no iatrogenic radial nerve palsies in both groups. Shoulder impingement was found in 2 patients in IMN group. There was no statistically significant difference between two groups in all indexes mentioned above. Conclusion: Both the two methods were effective; however, MIPO method might be better for recovery of shoulder function and might reduce the nonunion rate.

Outcome of percutaneous kirschner wire fixation for supracondylar fractures of humerus in elderly comorbid patients

Background: Management of supracondylar fractures in young adults has evolved over the last two decades but management of these fractures in elderly comorbid patients is still matter of debate. In this study we present the outcome of supracondylar fractures of humerus in elderly comorbid patients treated by closed reduction and percutaneous kirschner wires crisscross fashion. Results: Mean age in our study was 64.5 years, with F:M ratio of 10:6. Left sided involvement was seen in 9 patients while right side was involved in 7 patients. The mean Mayo Elbow Performance Score at final follow up was 91.56 and was excellent in 11(68.75%) patients, good in 4(25%) patients, fair in 1(6.25%) patient. Mean time to union was 6.4 weeks.Conclusion: When aided with appropriate immobilization and timely rehabilitation, closed reduction & percutaneous kirschner wire fixation is a viable option for management of supracondylar fractures in elderly comorbid patients.

Outcomes of plate-screw fixation of humeral shaft fractures in three hospitals of the city of Yaoundé

Background: Surgical management of humeral fractures involves several methods including plate-screw fixation, intramedullary nailing, external fixation, and pinning. Nowadays, the most used surgical method is plate-screw fixation. Objective: The aim of this study was to present the short-, medium- and long-terms outcomes of plate-screw fixation of humeral fractures in three hospitals in the city of Yaoundé. Material and Methods: This was a descriptive and retrospective study with prospective evaluation carried out in the orthopedic and trauma surgery departments of three hospitals in the city of Yaoundé, over a period of 6 years and 4 months. We analyzed the medical records of the operated patients and did a physical reevaluation of the patients using a pre-conceived tested data sheet. The following variables were studied: socio-demographic characteristics, fracture profile, clinical and radiological profile, and the functional prognosis of the shoulder and elbow joints (using the Constant and Murley score, and the Mayo elbow performance score respectively). Data analysis was done using the software Statistical Package for Social Sciences (SPSS) version 23.0. Results: Eighty-two cases of osteosynthesis were recorded. The mean age of the patients was 37.9 ± 11.5 [16 – 71] years and there was a male predominance (sex ratio of 2.7). The dominant humerus was most involved (96.4%). Closed fractures were predominant (65.8%), and the majority (47%) of them were simple fractures. The diaphysis was the most affected bone part (69.5%). Road traffic accidents accounted for 70.7% of the fractures. Two patients had a polytrauma, 26 had multiple fractures, and 54 had an isolated humeral fracture. The mean operating time (for the osteosynthesis) was 122 min and the mean blood loss volume during surgery was 296 cc. There was a significant correlation between these two variables. Postoperative complications included 8 cases of postoperative radial palsies (who recovered within an average of 4 months), 06 cases of superficial skin infections, 05 cases of secondary displacements, 03 cases of implant damage and 02 cases of vicious callus. The bone reductions were sub-anatomical in 79% and cortical fixation was good in 72.6% of cases. Consolidation was achieved within an average of 18 weeks. The consolidation time significantly varied according to the type of fracture line and the type of reduction obtained. Functional recovery of the shoulder and elbow was nearly normal in all patients. The mean Constant and Murley score was 96.9 while the mean Mayo elbow performance score of 97.3. Conclusions: Plate-screw fixation enables an adequate management of humeral fractures with acceptable clinical and radiological results, low complication rates, and good functional outcomes.

Characteristics of Elbow Dislocation in Patients with Preexisting Cubitus Varus.

BackgroundThe aim of this study was to investigate the clinical presentations, patterns of soft-tissue injuries, and outcomes of treatment of elbow dislocations in patients with preexisting cubitus varus.MethodsFour cases of elbow dislocation in patients with preexisting cubitus varus, which were treated at 3 residency training hospitals, were retrospectively reviewed. Soft-tissue injury patterns were investigated using magnetic resonance imaging (MRI). Clinical outcomes were assessed at an average of 50.8 months (range, 34–82 months) after treatment using the Mayo Elbow Performance Score (MEPS) and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score.ResultsThe mean patient age was 49.5 years (range, 33–57 years). All patients had a posteromedial elbow dislocation, which was an indirect injury caused by a fall onto an outstretched hand. One patient had failed closed reduction; 3 others had redislocation or gross instability after closed reduction. Significant tears of the lateral collateral ligament complex and common extensor group were shown in MRI. All patients had surgical treatment including lateral complex repair only (n = 2), repair of both sides' complexes (n = 1), and corrective osteotomy with lateral complex repair (n = 1). At the final follow-up, the mean MEPS was 92.5 ± 8.7 and the mean QuickDASH score was 4.5 ± 6.4.ConclusionsElbow dislocation in patients with preexisting cubitus varus may present as posteromedial dislocation with acute instability. Surgical treatment of this injury led to acceptable clinical outcomes.

Clinical comparison of management of intra-articular distal humerus fractures with two surgical approaches; TRAP vs Olecranon osteotomy

Background: The aim of this study is to evaluate and compare the functional outcomes of patients with intra-articular distal humerus fractures treated with triceps-reflecting anconeus pedicle (TRAP) and olecranon osteotomy. Methods: Thirty three patients with intra-articular distal humerus fractures were retrospectively analysed. TRAP approach was used in 17 patients (10 males, 7 females; mean age 35.9 years, range 17-70), and olecranon osteotomy in 16 patients (11 males, 5 females; mean age 34.4 years, range 18-62). Fractures were classified using the AO/ASIF classification. Functional results were evaluated with the Mayo elbow performance score (MEPS) and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score. Results: The overall mean arc of elbow motion was 108° (range 70°-140°) in the TRAP group, whereas that of the olecranon osteotomy group was 102° (range 70°-130°). There were no significant differences noted between the two groups in terms of mean MEPS and DASH scores (p=0.318, p=0.236, respectively). The overall complication rate was 41.17% in the TRAP group and 56.25% in the olecranon osteotomy group. Conclusion: Intra-articular distal humerus fractures mandates surgical fixation for best functional outcomes. Both TRAP and olecranon osteotomy approaches can be used in the treatment of intra-articular distal humerus fractures. Both approaches yields no significant difference in clinical and functional results for intra-articular distal humerus fracture management.

Outcome of locking plate fixation in cases of comminuted proximal ulna fractures

Introduction: The purpose of this study was to report the clinical and radiological outcome following treatment with locking plate fixation in patients of comminuted fractures of the proximal ulna including olecranon and Monteggia fractures. Materials and Methods: Between 2015 and 2017, thirty patients with comminuted fractures of the proximal ulna including 21 cases of fracture olecranon and 9 cases of Monteggia fractures were managed with locking plate fixation. The patients were followed for clinical and radiological examination for minimum 6 months post operatively. Validated patient-oriented assessment scores involving the Mayo Elbow Performance Score (MEPS) and postoperative range of motion and patient's satisfaction were evaluated. Results: The mean arc of elbow motion in 21 cases of olecranon fractures was 108° and mean MEPS was 89.3 with 57% excellent and 43% good results. While in 9 cases of Monteggia fractures mean arc of motion was 108° and mean MEPS were 93.8 with 89% excellent and 11% good results. All patients achieved fracture union by 24 weeks. Mean duration of fracture union for olecranon fractures was 16.1 weeks and for Monteggia fractures 14.3 weeks. Conclusion: Locking plate is an effective fixation method for fractures of the proximal ulna allowing reliable stability for early elbow motion. The functional results are comparable with formerly described plating systems. The good radiological outcomes highlight the usefulness of plate fixation in cases of proximal ulna fractures, provided optimal plate positioning achieved. Keywords: Proximal ulna, Comminution, Locking plate, Olecranon fracture, Monteggia, Internal fixation.

Treatment of olecranon fractures using an intramedullary cancellous screw and suture tension band: minimum 2-year follow-up

Tension band wiring and plates are the most widely used treatments for transverse displaced fractures of olecranon despite high rates of hardware complications, subsequent implant removal, and associated costs. The purpose of this study was to report the outcomes of displaced transverse olecranon fractures treated with intramedullary screw and suture tension band. We performed an observational, retrospective, consecutive, monocentric, continuous multioperator study. We reviewed 31 Mayo type IIA displaced olecranon fractures treated in our institution with intramedullary 6.5 mm AO cancellous screw and high-strength suture tension band (No. 2 FiberWire®) from 2016 to 2018. Inclusion was limited to functionally independent patients with Mayo type IIA fractures and minimum 24-month follow-up for implant removal. We assessed clinical outcomes including range of motion; QuickDASH score; and Mayo Elbow Performance Score. Categorical data were analyzed with Fisher's exact test when appropriate. Continuous data were analyzed with the Student t-test or Mann-Whitney U test after assessment for normality. Statistical analysis was performed with STATA 16 software. Twenty-seven patients with a mean follow-up period of 38.4 ± 6.2 months (range, 24.1-50 months) were included in the study. The average flexion was 134.5° ± 14.8° (range, 70°-140°) and the mean extension was-5.9° ± 7.0° (range,-20°-0°). Mean pronation and supination were 85.8° ± 11.9° (range, 45°-90°) and 86.9° ± 14.3° (range, 20°-90°), respectively. The mean Mayo Elbow Performance Score was 90.8 ± 9.6 (range, 70-100) with 92.3% good and excellent results. The mean QuickDASH score was 17.1 ± 16 (range, 0-54.5). There were 3 hardware-related removals (11.1%). The overall removal rate was 18.5%. Univariate analysis of the factors associated with implant removal were pain in relation to the implant (60% vs. 11%, P = 0.0482), proximal screw migration (3.7 mm vs. 1.7 mm, P= 0.05), articular angle (22.5° vs. 27.7°, P= 0.0353), and olecranon width (22.2 mm vs. 24.4 mm, P= 0.0166). In total, 26.1% of the cases presented some degree of proximal migration of the implant (2.7 ± 1.8 mm of migration; range, 1.5-6.2 mm). Univariate analysis of the factors associated with implant proximal migration were proximal ulnar dorsal angulation (1.7° vs. 6.4°, P= 0.0179), anteroposterior endomedullary canal (7.3 mm vs. 6.0 mm, P= 0.0369), and lateral endomedullary canal (7.2 mm vs. 5.0 mm, P= 0.0219). The functional outcomes of simple transverse olecranon fractures treated with an intramedullary cancellous screw and a suture tension band are excellent, associated with a low rate of complications and material removal.

A Comparative Retrospective Analysis of Tension Band Wiring and 3.5 mm Precontoured Plate Used for Fixation of Chevron Osteotomy in Type C Distal Humerus Fractures

Abstract Introduction Complex distal humerus fractures are rare and difficult to treat and traditionally requires an open reduction and internal fixation via a transolecranon approach. However, controversy remains regarding the better method of fixation of the chevron osteotomy. The purpose of the present study was to compare the clinical efficacy of tension band wiring (TBW) and 3.5 mm precontoured plate in treating the chevron osteotomy. Materials and Methods A consecutive series of 49 patients who required olecranon osteotomy for type C distal humerus fractures were identified and grouped according to the construct used. Clinic–radiological evaluation was done at 3 months, 6 months, 1 year, and 2 years. A total of 34 males and 15 females with a mean age of 36.9 ± 12.64 years (18–62 years) were included in the study. Surgical duration, range of motion, Mayo elbow performance score (MEPS), and complications were noted at the follow-up. Results The mean range of motion was initially lower in the plate group (105 degrees ± 9.9 in plate, 107 degrees ± 9.15 in TBW) that subsequently increased at 6 months. The forearm rotation was similar in both the groups. The mean MEPS was found to be higher in the plate group at 2 years (81.83 ± 5.85 in plate, 77.76 ± 8.02 in TBW). A significantly higher rate of complications, that is, nonunion (p = 0.03), loss of reduction (p = 0.03), and revision (p = 0.04) was observed in the TBW group. However, other complications such as symptomatic hardware, wound complication, and removal of hardware were found to be higher in the plate group. Conclusion Both TBW and 3.5 mm precontoured plate provide comparable functional outcomes; however, the complication rate in terms of nonunion, loss of reduction, and revision is seen in the TBW, whereas wound complication and symptomatic hardware are more commonly seen in the plate.