Mean Mayo Elbow Performance Score Research Articles

La plaque Lasso. Un implant original pour le traitement des fractures Regan-Morrey I et II de la coronoïde ulnaire

IntroductionCoronoid fractures are notoriously difficult to manage particularly when there is a small fragment. We report a retrospective analysis of our experience with consecutive type I and II Regan-Morrey coronoid fractures using a lasso plate. HypothesisType I and II Regan-Morrey coronoid fractures can be effectively managed using a lasso plate. MethodsFrom October, 2011 and December, 2013, 25 patients (21 males and 4 females, mean age 40.0 years) with type I and II Regan-Morrey coronoid fractures were treated with the open reduction and internal fixation (ORIF) using the lasso plate. Postoperative measurements of the elbow range of motion were recorded. Elbow function was evaluated by the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) score. ResultsAll patients were re-examined at a mean follow-up of 32.7 months (range, 24–49 months). The mean fractures healing time was 13.6 weeks (range, 6–18 weeks). The mean flexion range of the elbow was 121.8° (range, 90°–135°), and the mean extention range of the elbow was 10.6° (range, 0°–20°). The mean pronation range of the forearm was 75.8° (range, 65°–85°). The mean supination range of the forearm was 80.4° (range 70°–90°). The mean DASH score was 10.2 (range 0–28). The mean MEPS was 83.4 (range 55–95), 8 patients (32 %) were rated excellent, 14 patients (56 %) were rated good, 2 (8 %) patients were rated fair. 1 (4 %) patient were rated poor. No patient was seriously infected, implant breakage was found in one case. Two cases of elbow heterotopic ossification (HO) were observed. Two cases of elbow medial instability were observed. DiscussionThe type I and II Regan-Morrey coronoid fractures combined with the instability of the elbow should be operated. The lasso plate reduces the pressure between the wire and the insertion of capsule. A tight wire results in greater stability than ordinary suture fixation, thus enabling early functional exercise. ConclusionIn the treatment of type I and II Regan-Morrey coronoid fractures, lasso plate can provide concentric fracture reduction of the elbow and stable fixation to allow for early rehabilitation. Good clinical outcomes can be anticipated. Level of evidenceLevel IV: retrospective study.

Long-term clinical results in patients treated for recurrent posterolateral elbow joint instability using an ipsilateral triceps tendon graft

The aim was to report the long-term functional and radiologic outcomes in patients treated for recurrent posterolateral elbow joint instability using an ipsilateral triceps tendon graft. We included 18 patients previously treated for posterolateral elbow joint instability and evaluated for clinical results in 2003. Fifteen patients were examined with a mean follow-up period of 19 years (range, 17-22 years). We performed the clinical follow-up with clinical examination of stability, range of motion, pain score on a visual analog scale, Mayo Elbow Performance Score, and Danish version of Oxford Elbow Score. Furthermore, conventional anteroposterior and side-view radiographs of the elbow were obtained to evaluate osteoarthritis, calcifications in the ligaments, and joint subluxation. We evaluated the radiographs by the size of osteophytes, joint space narrowing, and subchondral sclerosis and classified the findings into 3 categories: no osteoarthritis, osteoarthritis, and severe osteoarthritis. All patients had a clinically stable elbow. None had pain while inactive or locking of the joint, and 4 had decreased range of motion. Two patients had a positive pivot-shift stress test, indicating laxity. The mean Mayo Elbow Performance Score was 93 (range, 70-100). The mean Oxford Elbow Score was 45. We observed 5 patients with osteoarthritis and 1 patient with severe osteoarthritis. The technique reported by Olsen and Søjbjerg in 2003 gives good long-term results in the treatment of symptomatic posterolateral elbow joint instability, though the development of elbow joint osteoarthritis may decrease the surgical result in the coming years.

Locking plate fixation for treatment of coronoid process fractures

Objective To evaluate the clinical outcomes of locking plate fixation for coronoid process fractures. Methods Thirteen patients with a coronoid process fracture were included in the study. According to O'Driscoll classification, there were five type -Ⅰ fractures, six type -Ⅱ fractures and two Type-Ⅲ fractures. Locking plate fixation via a medial approach in 8 cases and a posterior approach in 5 cases were performed within four days of the injury. Clinical, radiographic, and the Mayo Elbow Performance Score (MEPS) evaluations were conducted postoperatively. Results The follow-up time ranged from 24 to 31 months, with a mean of 27.2 months. All fractures healed at an average of 9.6 weeks (range, 8 to 14 weeks). The mean MEPS was 89.2 points (range, 75 to 100). Average range of motion was 118.8° for flexion-extension and 141.9° for pronation-supination. According to the Broberg-Morrey criteria, the signs of posttraumatic arthritis were observed in 4 patients, including 3 cases of grade 1 and 1 case of grade 2. No patient reported pain or had any subjective complaints consistent with elbow instability. Conclusion Locking plate fixation for coronoid process fracture followed by early rehabilitation can lead to functional range of motion and satisfactory outcomes. Key words: Ulna fractures; Fracture fixation, internal; Coronoid process; Locking plate

Lasso plate – An original implant for fixation of type I and II Regan-Morrey coronoid fractures

IntroductionCoronoid fractures are notoriously difficult to manage particularly when there is a small fragment. We report a retrospective analysis of our experience with consecutive type I and II Regan-Morrey coronoid fractures using a lasso plate. HypothesisType I and II Regan-Morrey coronoid fractures can be effectively managed using a lasso plate. MethodsFrom October 2011 and December 2013, 25 patients (21 males and 4 females, mean age 40.0 years) with type I and II Regan-Morrey coronoid fractures were treated with the open reduction and internal fixation (ORIF) using the lasso plate. Postoperative measurements of the elbow range of motion were recorded. Elbow function was evaluated by the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) score. ResultsAll patients were reexamined at a mean follow-up of 32.7 months (range: 24–49 months). The mean fractures healing time was 13.6 weeks (range: 6 to 18 weeks). The mean flexion range of the elbow was 121.8° (range: 90° to 135°) and the mean extension range of the elbow was 10.6° (range: 0° to 20°). The mean pronation of the forearm was 75.8° (range: 65° to 85°). The mean supination of the forearm was 80.4° (range: 70° to 90°). The mean DASH score was 10.2 (range: 0 to 28). The mean MEPS was 83.4 (range: 55 to 95), 8 patients (32%) were rated excellent, 14 patients (56%) were rated good, 2 (8%) patients were rated fair. One (4%) patient was rated poor. No patient was seriously infected but implant breakage was found in one case. Two cases of elbow heterotopic ossification (HO) were observed. Two cases of elbow medial instability were observed. DiscussionThe type I and II Regan-Morrey coronoid fractures combined with the instability of the elbow should be operated. The lasso plate reduces the pressure between the wire and the insertion of capsule. A tight wire results in greater stability than ordinary suture fixation, thus enabling early functional exercise. ConclusionIn the treatment of type I and II Regan-Morrey coronoid fractures, lasso plate can provide concentric fracture reduction of the elbow and stable fixation to allow for early rehabilitation. Good clinical outcomes can be anticipated. Level of evidenceLevel IV: retrospective study.

A modified approach for elbow arthroscopy using an adjustable arm holder

BackgroundPosition shifting from elbow arthroscopy to open surgery could complicate the surgical procedures; patient safety and risks of contamination are of concern. The aim of this study is to retrospectively assess the safety and efficacy of elbow arthroscopy in 32 elbows of 32 patients using a modified arm holder to facilitate subsequent open surgery in supine position.MethodsWe performed a retrospective study in arthroscopy of the elbow performed with patients in the supine position under general or regional anesthesia. Arthroscopic indications were intraarticular lesions with or without second disorders. The operated arm was securely supported using an adjustable arm holder, which allowed a second surgical procedure without repositioning the patient. We recorded arthroscopic findings, clinical outcome, and complications for all patients. The average duration of follow-up was 17.1 months. Functional assessment was based on the Mayo Elbow Performance Score.ResultsAll patients had either good or excellent results with a mean Mayo Elbow Performance Score of 89.2 ± 7.2. Final motion arc averaged 113.3 ± 11.8; residual motion limitation was noted in 2 patients with preoperative ankylosis. No complications were observed immediately after surgery or during follow-up except transient paresthesia along medial cutaneous nerve in 2 patients. A total of 17 patients (53.1%) underwent other surgeries (19 procedures) after arthroscopy; 16 of these surgeries were open elbow procedures including ligament repair (7), ligament reconstruction (5), and ulnar nerve transposition (4). The average time for arthroscopy was 45.2 min; the time interval between the end of arthroscopy and the start of the second surgery procedure averaged 6.5 min.ConclusionsArthroscopy of the elbow using an adjustable arm holder with the patients in the supine position was safe and efficacious. This procedure eliminates the need for repositioning the patient and thus may facilitate subsequent concomitant surgical procedures.

Application of distal radius–positioned hinged external fixator in complete open release for severe elbow stiffness

Radical release for severe stiff elbows may lead to instability. Hinged external fixation is used to treat unstable elbows. We hypothesized that extensive open release combined with a distal radius-positioned hinged external fixator would have good performance and low complications rate in treating severe elbow stiffness. Thus, the efficacy and security of this technique were assessed in this study. We retrospectively reviewed 38 post-traumatic elbows with severe stiffness that underwent arthrolysis between February 2011 and February 2014. All patients were assessed as having elbow instability after complete arthrolysis. Ligament repair was combined with implantation of a hinged external fixator (fixed to the humerus and distal radius) to maintain elbow stability. Flexion arc, forearm rotation, Mayo Elbow Performance Score, elbow stability, and radiographs were evaluated preoperatively and postoperatively, and complications were documented. Mean follow-up was 31 months. Significant improvement was noted in flexion-extension arc (from 27° to 126°), forearm rotation (from 148° to 153°), and mean Mayo Elbow Performance Score (from 68 points to 96 points). Mean pronation arc decreased from 66° preoperatively to 6° at 1.5 months of follow-up and showed a transient reduction during first 6 months postoperatively. Pin-related infection occurred in 2 patients, which was cured with conservative treatment. Two patients had moderate instability after removal of the fixator and regained stability at the 12-month follow-up. At the last follow-up, complications included ulnar nerve paralysis in 3, recurrence of heterotopic ossification in 1, and moderate pain in 1. Complete open release combined with a distal radius-positioned hinged external fixator is an effective treatment for severe stiff elbows. This technique had a low complication rate.

Results and outcome predictors after open release of complete ankylosis of the elbow caused by heterotopic ossification

Heterotopic ossification (HO) may lead to complete elbow ankylosis, resulting in severe disability. The prognostic factors that may be valuable in guiding treatment of this condition have not yet been evaluated. The goals of this study were to describe the outcomes of open release for ankylosed elbow caused by HO and to analyse factors associated with clinical outcomes. This retrospective study assessed 41 patients with ankylosed elbows treated by open release surgery. We report final clinical outcomes and analyses of the association between outcomes and clinical variables. Mean patient age was 36.4years; follow-up was 36.1months. Mean arc of motion increased from 0 to 112° post-operatively, mean pronation from 34 to 52°, supination from a mean of 51 to 76°, and Mean Mayo Elbow Performance Score (MEPS) from 42.8 to 84.2. Eight patients experienced recurrence, two of whom underwent a second operation: one for elbow instability and one for revision surgery. Linear regression analysis demonstrated that initial injury type (p = 0.020), articular surface damage (p = 0.001), coma iduringthe initial injury (p = 0.001) and concomitant radial head replacement (p = 0.029) were independent factors affecting the final MEPS. Satisfactory outcomes were achieved, indicating that open release is effective for ankylosed elbows. Our findings demonstrated that initial injury type, articular surface damage, coma and radial head replacement are outcome predictors affecting final outcomes.

Outcome after internal fixation of intraarticular distal humerus (AO type B & C) fractures: Preliminary results with anatomical distal humerus LCP system.

The treatment of intraarticular fractures of the distal humerus is challenging and involves the risk of complications and bad functional results. Anatomical and stable internal fixation with early postoperative mobilization is expected to improve the functional outcomes. The objective of this study was to evaluate the functional and radiological results, along with the complications associated, of open reduction and internal fixation using precontoured anatomical locking LCP plate system for intraarticular distal humerus fractures in adult patients. This prospective study consist of 31 patients with a mean age of 41.2 years (range 19-62) were treated with open reduction and angular stable internal fixation. All underwent posterior transolecranon surgical approach. Mean follow-up to the final interview was 10 months (from 6 to 20 months). All operated patients were available at the time of last followup. AO classification showed 26 C-fractures (9*13C 1, 12*13C2,5* 13C3) and 5 B-fracture (1* 13B1,1* 13B2,3* 13B3). There were 25 closed fractures and 6 open grade 1 fractures. The clinical followup using Mayo elbow performance score (MEPS) and radiographic follow up with elbow anterior-posterior and lateral view X-rays were performed postoperatively. The mean MEPS was 87.9 points out of 100 (range 55-100) with 61% Excellent, 29% good and 10% fair and poor scores. Mean elbow flexion of 115.8° (range 85°-150°). The mean deficit in extension was 19° (range 5°-35°). All olecranon osteotomy were united .Nonunion of distal humerus fracture occurred in 2 cases. Other complications were hardware prominence in 3 cases, superficial infection in 4 cases and Ulnar nerve neuropraxia in 1 case which was recovered uneventfully. Revision surgery was not required in any complication. Open reduction and internal fixation with precontoured distal humerus anatomical locking plate system is a good method of treatment for complex Supra- intercondylar fracture of distal humerus with good functional outcome and low rates of complications. Even though early results are promising, longer term investigations and larger patient groups are necessary to confirm the presented data.

Clinical Results of Supracondylar Dome Osteotomy for Cubitus Varus and Valgus Deformities in Adults

Background: Cubitus varus and cubitus valgus deformities are common complications of distal humeral fractures in children. We evaluated the usefulness of supracondylar dome osteotomy as a treatment option for adults with cubitus varus or valgus deformity developed during childhood. Methods: Ten patients who had received supracondylar dome osteotomy and stabilization with plates to treat cubitus varus or valgus deformity between July 2006 and August 2013 were included in this study. Their mean age at the time of surgery was 36.50 ± 10.22 years. The mean follow-up duration was 54.80 ± 32.50 months. We evaluated humerus-elbow-wrist angles (HEWA), improvements in the lateral prominence index (LPI) or medial prominence index (MPI), Mayo elbow performance scores (MEPS), and overall results in accordance with the Banerjee criteria. Results: For the six patients with cubitus varus, the mean postoperative HEWA, mean correction angle, and mean improvement in LPI were 9.72° ± 3.95°, 27.67° ± 10.75°, and 6.92% ± 3.40%, respectively. For the four patients with cubitus valgus, the mean postoperative HEWA, mean correction angle, and mean improvement in MPI were 14.73° ± 2.97°, 11.55° ± 3.26°, and 11.33% ± 6.39%, respectively. There was no significant difference between postoperative and preoperative mean MEPS. The subjective ulnar nerve symptoms were alleviated in all patients. The overall results were excellent in six and good in four patients. Conclusions: This study suggests that supracondylar dome osteotomy with secure fixation using double plates may be useful in correcting cubitus varus or cubitus valgus deformity, yielding good functional outcomes in adults.

The anconeus-triceps lateral flap approach for total elbow arthroplasty in rheumatoid arthritis.

The posterior approaches to the elbow are considered as to allow an excellent joint exposure for total elbow arthroplasty. One complication that is well recognized is the insufficiency of the extensor mechanism in particular with the patients with poor tendon quality as in the rheumatoid diseases. The purpose of this paper is to present a new triceps-splitting exposure for total elbow arthroplasty used in rheumatoid patients with their preliminary results. Fifteen consecutive patients with rheumatoid disease at grades III to V of the Larsen grading scale underwent total elbow replacement using the new triceps-splitting exposure called anconeus-triceps lateral flap and it preserves the integrity of the medial proper triceps tendon. The assessments were performed with a minimum follow-up of 2years. The mean Mayo Elbow Performance Score increased from 24 points to 95 points at a mean follow-up of 38months. The pain was calculated using the visual analogue score, it had a mean pre-operative value of 8.9 points and it became 0.5 points. Although elbow motion in flexion-extension and pronosupination was allowed from the day after surgery, we did not observe any insufficiency or secondary detachments of the triceps tendon reporting grade 4 to 5 according to the Medical Research Council scale. These preliminary outcomes suggest that the decision to preserve the medial proper triceps tendon insertion allows to start an earlier active unrestricted rehabilitation programme. This new triceps management improves the surgical exposure of the olecranon surface. Level IV.

Arthroscopic Lateral Collateral Ligament Repair.

Lateral ulnar collateral ligament injury following unstable elbow dislocation can induce posterolateral rotatory instability that requires surgery. The aim of this study was to determine the effectiveness of arthroscopic repair of the lateral collateral ligament (LCL) complex in an unstable elbow joint. The study group consisted of 13 patients who experienced posterolateral rotatory instability after an unstable elbow dislocation with an injury to the lateral ulnar collateral ligament. The diagnosis was confirmed with computed tomography (CT), magnetic resonance imaging (MRI), and physical examination. The patients underwent arthroscopically assisted surgery between May 2011 and January 2013 and were followed for a minimum of 18 months postoperatively. Coronoid and/or radial head fractures combined with the ligament injury were treated through an arthroscopic technique. Range of motion, pain, outcomes according to the Mayo Elbow Performance Score (MEPS) and Nestor grading system, and surgical complications were evaluated. CT and MRI were performed at 3 months postoperatively, and isometric muscle strength was measured at the time of final follow-up. At the time of final follow-up, at a minimum of 18 months, all 13 patients reported complete resolution of the instability and average (and standard deviation) extension of 3° ± 1°, flexion of 138° ± 6°, supination of 88° ± 5°, and pronation of 87° ± 6. The mean MEPS was 92 points and, according to this validated outcome score, the results were rated as excellent in 12 patients and good in 1 patient. According to the Nestor grading system, the results were rated as excellent in 11 patients and good in 2. Complete healing was seen on the 3-month follow-up MRI in 12 patients; however, 1 patient had mild widening of the radiocapitellar joint space with incomplete healing but no instability symptoms. All patients demonstrated normal strength on elbow flexion, extension, pronation, and supination at the final follow-up visit. Arthroscopic repair of the LCL complex in patients with posterolateral rotatory instability after an unstable elbow dislocation, with or without an intra-articular fracture, is an alternative treatment option for restoring elbow stability and achieving satisfactory clinical and radiographic results. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Modified anconeus flap approach for intercondylar humerus fractures

Objective To report a new surgical approach(modified anconeus flap approach)in which the anconeus and part of triceps are reflected in the treatment of distal intercondylar humerus fracture(AO type C). Methods To design the modified anconeus flap approach, the anatomy of the distal tendon of the triceps brachii and the anconeus was studied using 15 cadaveric adult specimens(30 sides). The new surgical approach was compared with the triceps-reflecting anconeus pedicle(TRAP)approach in terms of the area of exposure at the distal humeral articular surface. Furthermore, the new surgical approach was applied in 16 patients who had been treated for intercondylar humerus fracture(AO type C)from May 2005 to May 2013. The clinical outcomes were evaluated using the Mayo elbow performance score(MEPS)and Broberg-Morrey scoring systems. Results The blood supply and innervation of the anconeus was interrupted minimally during incision along the radical edge of triceps tendon. The area of exposure at the distal humeral articular surface provided by the part triceps and anconeus reflecting approach and the medial humerus approach was 42. 66% ±0. 03% at the elbow flexion from 0° to 50°. This was significantly smaller than that provided by the TRAP approach(46. 11% ± 0. 03%)(P< 0. 05). Of the 16 patients, 15 obtained complete follow-ups from 6 months to 4 years(average, 16. 5 months). The mean MEPS at the last follow-up was 90. 5 points(range, from 82 to 93 points), with 10 excellent and 4 good cases and one poor case. The Broberg & Morrey score system showed 11 patients with no articular cartilage degeneration(level-0), 3 patients with level-1 degeneration, and 2 patients with level-2 degeneration. Conclusion The modified anconeus flap approach proposed in the present study provides clear surgical vision and needs no olecranon osteotomy or olecranon dissection or ablation of the major triceps brachii tendon for intercondylar humerus fractures, thereby leading to early active motion and satisfactory clinical outcomes. Key words: Humeral fractures; Autopsy; Therapies, investigational; Surgical approach

A new posterior triceps approach for total elbow arthroplasty in patients with osteoarthritis secondary to fracture: preliminary clinical experience

During the past decade, total elbow arthroplasty (TEA) procedures have increased because of an increase in the number of trauma patients. Even though most current posterior approaches to the elbow provide excellent joint exposure, they involve the risk of extensor mechanism injury and of eventual insufficiency, particularly in patients with osteoarthritis (OA) secondary to fracture. I describe a new triceps exposure approach for TEA, the anconeus-triceps lateral flap, which has proved valuable in patients with distal humeral and olecranon fracture malunion, and its preliminary results at a minimum follow-up of 24 months. Twenty consecutive patients with OA due to distal humeral and olecranon fracture malunion underwent TEA by the anconeus-triceps lateral flap approach, which preserves the olecranon insertion of the medial portion of the triceps proper tendon. At a mean follow-up of 33 months, the mean Mayo Elbow Performance Score rose from 41.3 to 94.3. The mean pain score on the visual analog scale fell from 7.1 to 1.1. There were no patients with insufficiency, secondary detachment of the triceps tendon, or grade 4 to 5 of the Medical Research Council scale. These preliminary data suggest that preservation of the insertion of the medial portion of the triceps proper tendon enables earlier active rehabilitation. Moreover, the new approach provides optimum exposure of the olecranon also in patients with OA secondary to intra-articular fracture of the distal humerus and olecranon, where scarring and bone deformity usually hamper joint exposure.

Infection in total elbow arthroplasty with stable components: outcomes of a staged surgical protocol with retention of the components.

We describe the use of a protocol of irrigation and debridement (I&D) with retention of the implant for the treatment of periprosthetic infection of a total elbow arthroplasty (TEA). This may be an attractive alternative to staged re-implantation. Between 1990 and 2010, 23 consecutive patients were treated in this way. Three were lost to follow-up leaving 20 patients (21 TEAs) in the study. There were six men and 14 women. Their mean age was 58 years (23 to 76). The protocol involved: component unlinking, irrigation and debridement (I&D), and the introduction of antibiotic laden cement beads; organism-specific intravenous antibiotics; repeat I&D and re-linkage of the implant if appropriate; long-term oral antibiotic therapy. The mean follow-up was 7.1 years (2 to 16). The infecting micro-organisms were Staphylococcus aureus in nine, coagulase-negative Staphylococcus in 13, Corynebacterium in three and other in six cases. Re-operations included three repeat staged I&Ds, two repeat superficial I&Ds and one fasciocutaneous forearm flap. One patient required removal of the implant due to persistent infection. All except three patients rated their pain as absent or mild. Outcome was rated as good or excellent in 15 patients (mean Mayo Elbow Performance Score 78 points, (5 to 100) with a mean flexion-extension arc of 103° (40° to 150°)). A staged protocol can be successful in retaining stable components of an infected TEA. Function of the elbow may compare unfavourably to that after an uncomplicated TEA. Cite this article: Bone Joint J 2016;98-B:976-83.

Open arthrolysis with pie-crusting release of the triceps tendon for treating post-traumatic contracture of the elbow

Extensive loss of elbow flexion compromises the performance of daily activities. We examined the clinical outcomes of patients with post-traumatic extension contracture of the elbow treated with open arthrolysis and pie-crusting release of the triceps tendon. We retrospectively reviewed the records of 7 patients (5 men and 2 women; mean age, 35 years) who underwent open arthrolysis via a combined lateral and medial approach with pie-crusting release of the triceps tendon for the treatment of post-traumatic elbow stiffness. All the patients had heterotopic ossification that restricted elbow motion and underwent removal of the ossified tissue and capsular release. The triceps tendon was gradually stretched by making multiple stab incisions on the tendon by using a No. 11 surgical blade. The range of motion of the elbow was recorded both preoperatively and at the final postoperative follow-up. Elbow function was assessed with the Mayo Elbow Performance Score. The patients were followed up for a mean of 24 months. After treatment, significant improvement was noted in the total arc of motion (from 44° to 116°, P <.001), mean flexion (from 80° to 124°, P < .001), and mean extension (from 31° to 8°, P = .004). The mean Mayo Elbow Performance Score improved significantly from 59 points preoperatively to 92 points at the final evaluation. No major postoperative complications developed in any of the patients. Our findings indicate that open arthrolysis with pie-crusting release of the triceps tendon is an effective and safe treatment approach for post-traumatic extension contracture of the elbow.

Application of the suture bridge method to olecranon fractures with a poor soft-tissue envelope around the elbow: Modification of the Cha-Bateman methods for elderly populations

We further modified the suture bridge method using suture anchors especially for olecranon fractures in elderly patients with a poor soft-tissue envelope and report the radiologic and clinical results through a retrospective study. Our method was used in 13 patients with a mean age of 69.7 years. All patients had type IIA or IIIA fractures according to the Mayo classification; 9 had open fractures. We modified the step in which the first 2 anchors are inserted just distal to the fracture area in the previously known "suture bridge method." In our revised step, we created a transverse drill hole through which to pass the 4 strands of nonabsorbable sutures. The next steps, reducing the fractured fragment and providing reinforcement with other anchors, were the same as in previous methods. Additional procedures, such as skin graft, rotational flap, and nerve graft, were performed in 5 patients. The mean follow-up period was 27.5 months. All patients had achieved union at the 2-year follow-up, including 2 patients with delayed union. The mean Mayo Elbow Performance Score was 86, and the mean Disabilities of the Arm, Shoulder and Hand score was 16. No anchor pullout occurred, and no soft-tissue dehiscence or problems requiring secondary surgery were seen. Our modification of a recent method, which uses suture anchors and nonabsorbable sutures for olecranon fixation, appears to be effective in osteoporotic conditions, as well as with respect to the management of the soft tissue surrounding the elbow, particularly in elderly patients.

Feasibility of four-dimensional preoperative simulation for elbow debridement arthroplasty.

BackgroundRecent advances in imaging modalities have enabled three-dimensional preoperative simulation. A four-dimensional preoperative simulation system would be useful for debridement arthroplasty of primary degenerative elbow osteoarthritis because it would be able to detect the impingement lesions.MethodsWe developed a four-dimensional simulation system by adding the anatomical axis to the three-dimensional computed tomography scan data of the affected arm in one position. Eleven patients with primary degenerative elbow osteoarthritis were included. A “two rings” method was used to calculate the flexion-extension axis of the elbow by converting the surface of the trochlea and capitellum into two rings. A four-dimensional simulation movie was created and showed the optimal range of motion and the impingement area requiring excision. To evaluate the reliability of the flexion-extension axis, interobserver and intraobserver reliabilities regarding the assessment of bony overlap volumes were calculated twice for each patient by two authors. Patients were treated by open or arthroscopic debridement arthroplasties. Pre- and postoperative examinations included elbow range of motion measurement, and completion of the patient-rated questionnaire Hand20, Japanese Orthopaedic Association-Japan Elbow Society Elbow Function Score, and the Mayo Elbow Performance Score.ResultsMeasurement of the bony overlap volume showed an intraobserver intraclass correlation coefficient of 0.93 and 0.90, and an interobserver intraclass correlation coefficient of 0.94. The mean elbow flexion-extension arc significantly improved from 101° to 125°. The mean Hand20 score significantly improved from 52 to 22. The mean Japanese Orthopaedic Association-Japan Elbow Society Elbow Function Score significantly improved from 67 to 88. The mean Mayo Elbow Performance Score significantly improved from 71 to 91 at the final follow-up evaluation.ConclusionWe showed that four-dimensional, preoperative simulation can be generated by adding the rotation axis to the one-position, three-dimensional computed tomography image of the affected arm. This method is feasible for elbow debridement arthroplasty.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-0996-9) contains supplementary material, which is available to authorized users.

Primary Hinged External Fixation of Terrible Triad Injuries and Olecranon Fracture-Dislocations of the Elbow.

This study aimed to introduce a new treatment that apples primary hinged external fixation for complex fracture-dislocations of the elbow in 12 cases. We retrospectively assessed the functional outcomes of eight patients with terrible triad injuries and three patients with an olecranon fracture-dislocation of the elbow, who were treated at our hospital using a primary hinged external fixator between June 2012 and December 2014. Ten patients underwent repair or replacement of the radial head, while three underwent repair of the olecranon. In principle, they were treated without reconstruction of the coronoid fracture and collateral ligament injury. The patients were evaluated for a mean follow-up period of 16 months after the initial surgery. Early mobilization was encouraged while the hinged external fixator was in place. At the follow-up, the mean Mayo Elbow Performance Score was 93 points; the results were "excellent" in six cases and "good" in five. No patients had recurrent elbow instability. Only one patient needed an additional procedure after the initial operation. These results suggested that primary hinged external fixation without repair of the ligament and soft tissue is an effective minimally invasive surgery for the management of terrible triad injuries and olecranon fracture-dislocations of the elbow.

Pure elbow dislocation in the paediatric age group.

The main purpose of the present study was to evaluate the clinical results and prognosis of pure elbow dislocations in the paediatric age group following non-surgical treatment. Acute traumatic pure elbow dislocations treated between January 2008 and January 2013 were evaluated. The median age was eight years. The mean follow-up time was 46 months. Active and passive range of motion (ROM), elbow stability, neurovascular status, functional status and any early or late complications were evaluated and recorded at the latest follow-up. The mean flexion-extension ROM was measured as 119.5 degrees. The mean pronation and supination were 67 and 79 degrees. Moderate instability was diagnosed in four cases. The mean Mayo Elbow Performance Score (MEPS) score was 91.6 points; the clinical outcome was excellent in nine patients, good in two and fair in one. Acute traumatic pure elbow dislocation in childhood is a very rarely seen emergency that can be treated safely with closed reduction combined long-arm plaster splinting and physical rehabilitation.

Evaluation of total elbow arthroplasty in treatment of distal humeral fracture in the elderly

To evaluate the efficacy of total elbow arthroplasty in treatment of distal humeral fracture in the elderly. A total of 24 elderly patients who were diagnosed of distal humeral fracture and received Coorad-Morry prosthesis arthroplasty were retrospectively selected and analyzed from Beijing Jishuitan Hospital from 2003 to 2009. X ray examination of elbow joint and clinical evaluation were conducted in the follow-up; Mayo Elbow Performance Score (MEPS) was used in the last follow-up to evaluate patients' elbow function. A total of 20 patients with intact follow-up information were included in the final analysis, with mean follow-up length 92 months (65 - 136), mean VAS score 0.8 (0 - 2), extension degree of elbow 25 (0 - 60)degrees, flexion degree 112 (80 - 135)degrees; Mean MEPS was 88.5, with 7 excellent, 8 good, and 1 fair. Two patients had severe heterotopic ossification, 3 patients had ulnar neuropathy, 2 of which were temporary. One patient had superficial infection, and 1 had aseptic loosening in the humeral part, but did not receive revision surgery. Total elbow arthroplasty can successfully treat distal humeral fracture in the elderly and achieve satisfactory result which can last for a long time.