Stability Of Elbow Joint Research Articles

Ligament Sparing Elbow Hemiarthroplasty: A Novel Technique for the Management of Distal Humeral Fractures.

Intra-articular distal humerus fractures present various challenges with a wide array of treatment options. Open reduction internal fixation remains the treatment of choice. In older patient populations with poor bone quality and short-end segment fractures with articular comminution, open reduction internal fixation, however, may bring on unsurmountable technical challenges. Total elbow arthroplasty and elbow hemiarthroplasty (EHA) may offer superior functional outcomes in these cases. During EHA for fractures, the medial and lateral columns are reconstructed with the collateral ligaments to restore elbow stability. We hypothesize that in coronal sheer fracture patterns where the columns are intact, maintaining the native collateral ligaments and columns will provide both an anatomic and stable elbow joint. We introduce the ligament sparing EHA technique for unreconstructible coronal shear fractures. We describe this novel technique and compare our postoperative outcomes in 2 patients who underwent this surgery to those described in the literature. The postoperative Disabilities of the Arm, Shoulder, and Hand scores for the 2 patients were 13.8 and 10.3, respectively. The Mayo Elbow Performance Score for the 2 patients were 80 and 85, respectively. The operative arm presented a grip strength of 82% and 89% when compared with the contralateral arm, for the patients respectively. The range of motion varied between 78% and 100% of the contralateral arm for both patients. Although our results are promising and the ligament sparing EHA technique may be a more anatomic option in certain fracture patterns, further research with larger cohorts and multiple surgeons is needed to reinforce our results.

Radial Head Replacement: Management of Elbow and Forearm Instability after Comminuted Radial Head Fractures Associated with Elbow Dislocation

This manuscript aims to identify an indication algorithm for the surgical treatment of radial head fractures associated with elbow dislocation. The study compares the mid-term functional outcomes of patients with multifragment radial head fracture treated by resection with the outcomes of patients treated with radial head replacement. The cohort of 34 patients who sustained a radial head fracture at the mean age of 42.5 years (age range 20-81 years) was broken down into two groups by type of surgery. The EXT group consists of 20 patients with the radial head fracture treated by radial head resection. The END group includes 14 patients treated with the radial head replacement. In all patients, the radial head fracture was associated with elbow dislocation (type IV fracture according to the Mason-Johnston classification). The modified Kocher's surgical approach was used in all patients of both the groups. In the EXT group, resection of the fragmented radial head was performed. In the END group, the ExploR® Modular Radial Head System (Zimmer, Biomet, USA) was used, consisting of a CoCr (cobalt chromium) alloy head and a titanium stem. The pain and the range of motion of the elbow and forearm were evaluated after the completion of the outpatient rehabilitation (the mean follow-up period was 2.4 years). Simultaneously, the elbow joint stability was assessed. Radiographs were taken to detect heterotopic ossifications, proximalization of the radius, and any signs of prosthesis loosening. The frequency of reoperations was followed-up. The MEPS (Mayo Elbow Performance Score) was calculated. In the EXT group, the mean elbow flexion was 117.5° and the mean pronation/supination was 166.9°. In 50% of patients, the MEPS obtained was greater than 90 points, which means an excellent functional outcome. In 1 patient (5%), recurrent elbow dislocation occurred which was the reason for revision surgery (elbow transfixation with the Kirschner wires and medial collateral ligament suture). Revision surgery was also performed in 2 patients (10%) in whom not all the radial head fragments were removed. Moreover, also observed was elbow joint instability (2 patients) and temporary radial nerve paralysis (1 patient). In 1 case discrete proximalization of the radius developed. The patients in the END group showed the mean elbow flexion of 112° and the mean pronation/supination of 135°. The MEPS obtained from 69% of patients was greater than 90 points, which means an excellent outcome. The pain under load was reported by 3 patients (21%). In 5 patients (35%), the X-rays showed radiolucent zone around the stem of the prosthesis. Neither revision surgery, nor prosthesis removal has been performed yet in any patient. No instability, neurological complications or infections have been reported. In both EXT and END group heterotopic ossifications have developed in 4 patients. Radial head replacement compared to the radial head resection in the management of multifragment fractures associated with elbow dislocations increase the elbow and forearm stability. The group of patients with an implanted radial head prosthesis shows a higher percentage of patients achieving excellent functional outcome than the group of patients with radial head resection. radial head, elbow, fracture, dislocation, resection, prosthesis.

Biomechanical comparison of different internal fixation devices for transversely unstable Mason type II radial head fractures.

Background: The integrity of the radial head is critical to maintaining elbow joint stability. For radial head fractures requiring surgical treatment, headless compression cannulated screw fixation is a less invasive scheme that has fewer complications. The aim of this study was to compare the mechanical stability of different fixation devices, including headless compression cannulated screws and mini-T-plates, for the fixation of transversely unstable radial head fractures. Methods: Forty identical synthetic radius bones were used to construct transverse unstable radial head fracture models. Parallel, cross, and tripod headless compression cannulated screw fixation and mini-T plate fixation were applied. The structural stiffness of each group was compared by static shear loading. Afterward, cyclic loading was performed in each of the three directions of the radial head, and the shear stability of each group was compared by calculating the maximum radial head displacement at the end of the cycle. Findings: The mini-T plate group had the lowest structural stiffness (51.8 ± 7.7N/mm) and the highest relative displacement of the radial head after cyclic loading (p < 0.05). The tripod headless compression cannulated screw group had the highest structural stiffness among all screw groups (p < 0.05). However, there was no significant difference in the relative displacement of the radial head between the screw groups after cyclic loading in different directions (p > 0.05). Interpretation: In conclusion, the biomechanical stability of the mini-T plate for fixation of transverse unstable radial head fractures is lower than that of headless compression cannulated screws. Tripod fixation provides more stable fixation than parallel and cross fixation with headless compression cannulated screws for the treatment of transversely unstable radial head fractures.

Static stability of novel uncemented elbow hemiarthroplasty stabilized with ligament reconstruction

The purpose of this study was to create a model to simulate treatment of unreconstructable distal humerus fractures with hemiarthroplasty. Stability was restored with a new plate-system that simultaneously tensions medial and lateral collateral ligament grafts. Static varus and valgus elbow stability was tested in 11 cadaver elbows with intact ligaments and capsule at five flexion angles (0, 30, 60, 90, 120 degrees). The elbows were then destabilized via release of all ligaments and capsular attachments. The distal humerus articular cartilage was excised and replaced with an uncemented hemiarthroplasty. Ligament reconstruction was subsequently performed, and elbow stability was measured and compared to the native state. Dimensions of the hemiarthroplasty component were compared to native elbow dimensions to assess and quantify any existing relationship to elbow stability. A hemiarthroplasty was implanted in all specimens. A size mismatch occurred between the distal humerus trochlea and the olecranon fossa in all specimens and averaged 6.3 mm. Following ligament reconstruction, specimens reproduced the flexion angle-dependent stability of native elbows to both varus and valgus stress. On the medial side, elbow joint stability in mid-flexion was approximately 7% tighter after hemiarthroplasty. Laterally, the elbow was approximately 15% tighter after hemiarthroplasty and demonstrated peak stability in full flexion. The three assessed hemiarthroplasty components and bony dimensions did not exhibit any relationship between implant-bone mismatch and elbow stability after ligamentous reconstruction. Cadaveric elbow specimens underwent uncemented hemiarthroplasty with soft tissue stabilization with a novel technique for ligament reconstruction. Following hemiarthroplasty and ligament reconstruction, these specimens maintained secure fixation between ligament and bone. Static stability was maintained at varying degrees of elbow flexion regardless of variable mismatch between the hemiarthroplasty component and the native olecranon fossa.

The With Or Without Olecranon K-wire (WOW OK) Trial of tension band wire fixation versus cerclage fixation without K-wires in displaced stable olecranon fractures: study protocol for a randomized controlled trial

BackgroundDisplaced olecranon fractures with a stable elbow joint are classified as Mayo type 2a or 2b and are commonly operated with tension band wiring, i.e. two K-wires and a cerclage. Retrospective studies have reported fewer reoperations and complications with cerclage fixation alone when compared to tension band wiring, though with similar long-term results. We decided to compare tension band wiring to cerclage fixation of displaced, stable olecranon fractures in adults in a randomized controlled trial.MethodsAll patients ≥ 18 years old with Mayo type 2a and 2b fractures presenting at Skåne University hospital will be eligible for study inclusion, unless exclusion criteria are met. Two hundred participants will be included and randomized 1:1 to cerclage fixation or tension band wiring.Outpatient physiotherapist follow-up appointments will be scheduled at 2 and 6 weeks and at 3, 12, and 36 months at the Dept. of Orthopaedics. A lateral view radiograph of the elbow will be analysed at 6 months. The primary outcome of our study is the rate of reoperations. Secondary outcomes are complication rates, severity of complications, and patient-reported outcome measures (QuickDASH, Short Musculoskeletal Function Assessment, pain level, and patient satisfaction). The sample size was calculated to give 80% power for detecting a statistically significant difference in reoperation rates (with alpha-value 0.05), based on a previous retrospective study.DiscussionReoperation and complication rates after tension band wiring of olecranon fractures are high. Treatment of these injuries is debated, and several ongoing trials compare tension band wiring with plate fixation, suture fixation, and non-operative treatment. As data from retrospective studies indicate that cerclage fixation may be superior to tension band wiring, we see a need for a randomized controlled trial comparing these methods. The WOW-OK Trial aims to obtain level-1 evidence that may influence treatment choice for this type of fracture.Trial registrationClinicalTrials.gov NCT05657899. Registered on 16 November 2022. The trial complies with SPIRIT and CONSORT guidelines. The SPIRIT figure is found in Table 2.

A novel and superior Lasso-plate technique in treatment for coronoid process fracture in the terrible triad of elbow

The treatment of ulna coronal process fractures in the terrible triad of elbow, especially type I and II Regan–Morrey coronoid fractures, still have been controversial. The purpose of this retrospective study was to evaluate the novel Lasso-plate technique to have a more reliable fixation and a well clinical outcomes for type I and II Regan–Morrey coronoid fractures in a terrible triad of the elbow (TTE). Patients with simple TTE, closed fracture, aged > 18 years, duration of injury < 2 weeks, type I and II Regan–Morrey coronoid process fracture fixed by the Lasso-plate technique or ORIF were enrolled in the study. Total 144 patients with type I and II Regan–Morrey coronoid fracture in TTE were included in the Lasso-plate group or ORIF (open reduction and internal fixation) group in the Xi’an Honghui Hospital from January 2017 to December 2020. Eighty-six patients in Lasso-plate group underwent surgery using a novel Lasso-plate technique. And other 58 patients in ORIF group underwent surgery using ORIF. The data of two groups, including the X-ray films, Computed tomography (CT), the range of elbow motion, Mayo Elbow Performance Score (MEPS) and the surgical complications, were extracted from the hospital’s patient records. All patients in both groups were followed up at least 12 months. The mean operation time (88.2 ± 12.3 min) in Lasso-plate group is shorter than that of ORIF group (109.1 ± 13.0 min). There was one patient with injury of deep branch of radial nerve and one patient with superficial surgical incision infection in Lasso-plate group. There were two patients with surgical incision infection in ORIF group. There were three heterotopic ossifications in Lasso-plate group and eight heterotopic ossifications in ORIF group. There were 5 elbow joints stiffness in Lasso-plate group and 12 in ORIF group. At 12 months follow up, the mean range of flexion–extension motion in Lasso-plate group was 122.9° ± 13.4° versus 113.2° ± 18.1° in ORIF group (p < 0.01), the mean 89.7 ± 5.6 MEPS in Lasso-plate group versus mean 83.7 ± 6.1 MEPSin ORIF group. The fixation of coronoid process fracture in TTE by the Lasso-plate technique, especially type I and II Regan–Morrey coronoid fracture, could be easier to master and operate, could provide the sufficient stability of elbow joint to enable early functional exercise, along with a better clinical outcome, a lower surgical complication. For the treatment of TTE, we recommend the fixation of type I and II Regan–Morrey coronoid fracture with the Lasso-plate technique, which would result in a better clinical outcome.

Mid-term results of the treatment of acute postero-lateral rotational instability of the elbow joint

Background: Dislocations of the forearm are rare injuries with the annual incidence of 6.1 cases per 100 000 population. Postero-lateral rotational instability is the most common complication after the conservative treatment of forearm dislocations. To restore the congruency and provide early movements in the elbow joint, the primary repair or reconstruction of the damaged ligaments of the elbow are required. Aim: to evaluate the clinical and functional results after the surgical repair of the elbow joint ligaments in acute postero-lateral rotational instability. Methods: The study was based on a retrospective analysis of a series of clinical cases, including 17 patients with acute postero-lateral rotational instability, among them 5 simple forearm dislocations, 9 fracture-dislocations of the forearm and 3 fractures of the radial head. Refixation of the lateral ulnar ligament was performed with anchor fixation or bone tunnels. The evaluation was performed using the clinical aspects (the lateral pivot shift test, the range of motion), according to the scale for the evaluation of the elbow joint functional condition (MEPS), Oxford scale of the elbow joint evaluation (OEC), the X-ray results were also estimated. Results: In all the cases the elbow joint stability had been achieved, according to the X-ray and clinical aspects. In 4 cases, additional plasty of the medial collateral ligament was needed and performed after the restoration of the lateral ligament complex. According to the MEPS scale, 58% of the achieved results were excellent, 35% were good and 5.8% were satisfactory. Conclusion: The restoration of the lateral ulnar collateral ligament complex is a safe and effective procedure, which restores the elbow joint stability and allows the patients to return to full physical activity and avoid the development of postero-lateral rotational joint instability.

Open Arthrolysis for Chronic Elbow Dislocation with Extremely Severe Stiffness in Children.

Studies on extremely severe elbow stiffness after chronic dislocation in children are scarce. This study aims to investigate the choice of surgical treatment modalities and to analyze their treatment efficacy in children with chronic elbow dislocation with extremely severe periarticular stiffness. Data of 21 children with chronic elbow dislocation with extremely severe periarticular stiffness diagnosed and treated in our department between February 2015 and February 2021 were retrospectively analyzed. Twenty boys and one girl were included in the study, their mean age was 11 ± 2.5 years, and they had concomitant distal humerus fractures. For the treatment protocol, all children with extremely severe elbow stiffness were treated with open arthrolysis, and elbow joint stability was intraoperatively assessed. All children performed passive functional exercises the day after surgery. The elbow flexion and extension angles, range of motion (ROM), and Mayo score were evaluated preoperatively and at the final follow-up. Of the 21 children, only one had recurrent severe stiffness of the elbow joint after surgery; nevertheless, the function was still improved compared with that before surgery. Preoperatively, the mean elbow extension and flexion angles were 72.2° ± 12.7° and 93.6° ± 11.1°, respectively, and the range of motion (ROM) of the elbow joint was 17.8° ± 8.3°. At the final follow-up, the mean elbow extension and flexion angles were 22.7° ± 18.6° and 118.8° ± 15.4°, respectively, and the elbow joint ROM was 96.1° ± 17.4°. The differences in the preoperative and postoperative ROMs, flexion angles, and extension angles of the elbow joint were significant (p < 0.01). The MEPS at the final follow-up was 78.57 ± 14.24, which was significantly higher than preoperative (29.76 ± 10.89), and the excellent rate was 81%. Open arthrolysis and open reduction and internal fixation of the elbow joint are effective in treating chronic elbow dislocation with extremely severe stiffness in children.

Morphological and radiological study of the shoulder and elbow joints of the giant anteater (Myrmecophaga tridactyla).

The giant anteater (Myrmecophaga tridactyla) has specialized thoracic limbs to forage by breaking the walls of anthills and termite mounds. They also play critical roles in defense posture and locomotion. This study aimed to provide a morphological and radiographic description of the shoulder joint and elbow joint of the giant anteater. Both joints of 13 tamanduas were assessed by morphological dissections and histological evaluation and radiographies without and with positive contrast. The radiographic projections selected to this study were the mediolateral and craniocaudal projections. The radiographic and anatomical findings were compared with the following results: the shoulder joint had a continuous joint capsule with the tendon sheaths of the short head and long head of the biceps brachii muscle, which could be visualized with an injection of 3 ml of intra-articular contrast. The shoulder joint arthrography was performed with the needle positioned cranially to the joint for contrast injection. The elbow joint presented three articular compartments, and the insertion of the joint capsule was proximal to the radial fossa and distal to the radial tuberosity in the radial notch of the ulna, which were possible to identify with 2 ml of intra-articular contrast. The elbow joint arthrography was performed with the needle positioned laterally to the joint for contrast injection. Moreover, the joint capsule presented a caudomedial distention and fat pads. The powerful muscles of the forelimb play a fundamental role in maintaining the shoulder joint and elbow joint stability due to bony adaptations and the absence of usual ligaments. The morphological and radiological study provided relevant information on the soft-tissue characteristics of shoulder and elbow joints, which may aid clinical-surgical and diagnostic imaging procedures.

Type 4 congenital proximal radio-ulnar synostosis mimicking as malunited radial neck and deformed radial head with insidious onset extension block: a case report and results after excision

&lt;p class="abstract"&gt;Proximal radio ulnar synostosis is a rare entity presenting with restriction of supination and pronation. Among the various types, type 4 variety is even more-rare and its presentation, can pose a diagnostic challenge specially, if with history of trauma. Radiologically, it is usually overlooked as a malunited radial neck and therefore needs thorough evaluation. We presented a case of a 15-year-old male who complains of new onset extension block following trauma, with chronically restricted supination and pronation. History suggested the restriction in supination and pronation since birth, and the extension block occurring de novo. Radiographs and CT scan of the elbow revealed proximal radio-ulnar synostosis and anteriorly dislocated, mushroom-shaped radial head, misleading and mimicking like an old, neglected and malunited radial neck fracture with a deformed radial head. The family insisted to not address the restriction of supination pronation but, asked for solution to more disabling extension block. Thus, patient was managed with open procedure, involving radial head-neck excision and removal of malformed radial head. At 1-year follow-up, the child has a well-reduced and stable elbow joint with a functional range of flexion and extension movements with restricted supination and pronation. Type 4 congenital radio ulnar synostosis not only leads to conventionally known restriction of supination pronation but also give rise to extension block de novo as presented in this case. Excision of the deformed head and neck can treat the restriction in extension, however the synostosis will require various other augmented procedures.&lt;/p&gt;

No effect of coactivation on fatigue-induced decreases in isokinetic and isometric torque in healthy young male adults

BackgroundAntagonist activation may contribute to fatigue-induced decreases in torque while assisting in the maintenance of joint stability. This study utilized a reciprocal, slow velocity (60°·s−1) forearm flexion and extension fatiguing task to examine the contributions of coactivation to torque production at slow and moderate (180°·s−1) velocities, as well as during a maximal voluntary isometric contraction (MVIC). MethodsTwelve recreationally active men (mean ± SD: age = 21.7 ± 1.6 years; body mass = 83.5 ± 8.8 kg; height = 179.4 ± 5.2 cm) completed isokinetic (60 and 180°·s−1) and isometric pre-testing of forearm flexion and extension, followed by 50 maximal, reciprocal, isokinetic muscle actions at 60°·s−1, followed by post-testing. The amplitude (AMP) of the electromyographic (EMG) signals from the biceps and triceps brachii were simultaneously recorded. Torque and EMG AMP were normalized to the corresponding values from the pre-testing peak torque movements. Repeated measures ANOVAs and pairwise comparisons were used to identify mean changes in torque, EMG AMP, and coactivation ratios. ResultsThe torque analyses indicated greater (p < 0.03) decreases for 180°·s−1 (24%) and MVIC (23%) than 60°·s−1 (14%) for forearm flexion. For forearm extension, there were no differences (p > 0.05) in fatigability between velocities. For EMG AMP there were no changes (p > 0.05) from pre- to post-testing for any velocity or movement. There were no changes (p > 0.05) in the coactivation ratio for forearm flexion, but significant increases (13.6 ± 6.6 to 16.9 ± 6.0; p = 0.003) for forearm extension, collapsed across Velocity. ConclusionsThere was velocity- and movement-specific fatigability for forearm flexion and extension. The parallel, fatigue-induced EMG AMP responses indicated that coactivation did not contribute to the decreases in torque and would not affect elbow joint stability.

Finite Element Analysis of Elbow Joint Stability by Different Flexion Angles of the Annular Ligament.

The injury of the annular ligament can change the stress distribution and affect the stability of the elbow joint, but its biomechanical mechanism is unclear. The present study investigated the biomechanical effects of different flexion angles of the annular ligament on elbow joint stability. A cartilage and ligament model was constructed using SolidWorks software according to the magnetic resonance imaging results to simulate the annular ligament during normal, loosened, and ruptured conditions at different buckling angles (0°, 30°, 60°, 90°, and 120°). The fixed muscle strengths were 40 N (F1), 20 N (F2), 20 N (F3), 20 N (F4), and 20 N (F5) for the triceps, biceps, and brachial tendons and the base of the medial collateral ligament and lateral collateral ligament. The different elbow three-dimensional (3D) finite element models were imported into ABAQUS software to calculate and analyze the load, contact area, contact stress, and stress of the medial collateral ligament of the olecranon cartilage. The results showed that the stress value of olecranon cartilage increased under different conditions (normal, loosened, and ruptured annular ligament) with elbow extension, and the maximum stress value of olecranon cartilage was 2.91 ± 0.24 MPa when the annular ligament was ruptured. The maximum contact area of olecranon cartilage was 254 mm2 with normal annular ligament when the elbow joint was flexed to 30°, while the maximum contact area of loosened and ruptured annular ligament was 283 and 312 mm2 at 60° of elbow flexion, and then decreased gradually. The maximum stress of the medial collateral ligament was 6.52 ± 0.23, 11.51 ± 0.78, and 18.74 ± 0.94MPa under the different conditions, respectively. When the annular ligament ruptures, it should be reconstructed as much as possible to avoid the elevation of stress on the surface of the medial collateral ligament of the elbow and the annular cartilage, which may cause clinical symptoms.

Complications and range of motion of patients with an elbow dislocation treated with a hinged external fixator: a retrospective cohort study

PurposeElbow dislocations are at risk for persistent instability and stiffness of the joint. Treatment with a hinged external fixation provides elbow joint stability, and allows early mobilization to prevent stiffness. Mounting a hinged elbow fixator correctly, however, is technically challenging. The low incidence rate of elbow dislocations with persistent instability suggests that centralization would result in higher surgeon exposure and consequently in less complications. This study aimed to investigate the results of treatment of elbow dislocations with a hinged elbow fixator on the rate of complications, range of motion, level of pain and restrictions in activities of daily living.MethodsA retrospective observational cohort study in a level I trauma center, in which the majority of patients was treated by a dedicated elbow surgeon, was performed. All patients of 16 years or older treated with a hinged external elbow fixator between January 1, 2006 and December 31, 2017 were included. The fixator could be used (1) for the treatment of persistent instability in acute/residual simple and complex dislocations or (2) as revision surgery to treat joint incongruency or a stiff elbow. Patient and injury characteristics, details on treatment, complications, secondary interventions, and range of motion were extracted from the patients’ medical files.ResultsThe results of treatment of 34 patients were analyzed with a median follow-up of 13 months. The fixator was removed after a median period of 48 days. Fixator-related complications encountered were six pintract infections, one redisclocation, one joint incongruency, one muscle hernia, and one hardware failure. The median range of motion at the end of follow-up was 140° flexion, 15° constraint in extension, 90° pronation, and 80° supination.ConclusionA hinged elbow fixator applied by a dedicated elbow surgeon in cases of elbow instability after elbow dislocations can result in excellent joint function. Fixator-related complications are mostly mild and only temporary.

Revisiting the Anconeus using Functional Ultrasound Imaging

IntroductionThe anconeus is a small triangular muscle originating on the posterior aspect of the lateral epicondyle of the humerus with a broad insertion along the postero‐lateral proximal ulna. Cadaveric studies have assessed its potential involvement as an elbow joint stabilizer, whereas electromyographic (EMG) studies have focused on its contribution to elbow extension. However, changes in fascicle length (Lf) and pennation angle (Pa) during voluntary contractions have not been assessed to help elucidate its function. Clinically, the anconeus has been sacrificed for use in various muscle flap transplant and reconstructive surgeries, but the impact of this loss on elbow joint function has not been resolved. Thus, the purpose of this study was to assess the relative architectural changes during in vivo elbow extension and flexion contractions to better understand its functional role.MethodsIn six healthy participants to date (2 females and 4 males) aged 22‐30 years, ultrasound imaging was used to assess Lf and Pa changes in the anconeus. Participants were seated in a Humac Norm dynamometer with their shoulders abducted to 90 degrees and the elbow joint aligned to the axis of rotation. The anconeus was imaged at four different elbow joint angles (35, 90, 135, and 180°) at rest, and during ramp (~5s) isometric maximal voluntary contractions (MVC) of both elbow extension and flexion. Participants also performed maximal‐torque isokinetic (20 degrees/s) extension and flexion contractions through the same 145° range of motion (35 to 180°). For both isometric and isokinetic contractions, Lf and Pa were measured from the ultrasound images using ImageJ software at the same four elbow angles.ResultsAt the four elbow angles (35, 90, 135 and 180°) at rest Lf was 2.92 ± 0.32 cm, 2.77 ± 0.25 cm, 2.52 ± 0.16 cm, 2.29 ± 0.31 cm, whereas Pa was 10.66 ± 2.49°, 12.19 ± 1.98°, 13.88 ± 1.68°, and 16.26 ± 2.13°, respectively. During isometric extension MVCs, Lf decreased by ~10%, 23%, 22%, 10%, whereas Pa increased by ~50%, 59%, 78%, and 46%, at each respective elbow angle. Changes in these parameters made during the isokinetic (dynamic) contractions matched those taken during the isometric contractions at the same four joint angles. During isometric and dynamic isokinetic maximal elbow joint flexion, there were negligible changes in both architectural parameters at the four joint angles.ConclusionDuring elbow extension actions there was a significant decrease in Lf and a significant increase in Pa at all joint angles, however no changes occurred during elbow flexion. The largest change of both parameters was at 90 and 135°, suggesting this is the optimal position for anconeus function. Lack of changes during elbow flexion indicates a minimal functional role during this task which may relate to the anconeus having less importance for overall elbow joint stability. These results highlight the significant architectural changes of the anconeus muscle and illustrate its presumed functional importance during elbow extension. Future studies using in vivo EMG recordings would be useful to further understand its role in elbow joint actions that may have clinical implications.

Clinical Study of Surgical Management of Olecranon Fracture

Background and Objective When displaced ,Open reduction and internal fixation with k-wires and figure of eight tension band wiring for simple transverse fractures and olecranon hook plate for comminuted fractures The present study is undertaken to evaluate the results of surgical management, the merits and demerits and to asses elbow joint motion and stability after the procedure. Materials and Methods It is a prospective study which was carried out from September 2010 to September 2012 in Bapuji Hospital and Chigateri General Hospital attached to J.J.M Medical College, Davangere. In this study period of 25 cases of fracture olecranon treated by Tension band wiring with Kirshner wire for Simple transverse fractures and Olecranon hook plate for Communited fractures Results In our series, majority of the patients were males, middle aged, with road traffic accident being the commonest mode of injury, Most of the cases were Type II B fractures i.e., oblique and transverse fractures according to Colton’s classification Surgery was performed with in 3.48 average days, Union was noted clinically and radiologically and functional evaluation was done by Mayo elbow performance score. Excellent results was present in 18 patients (72%), 4(16%) good and 3(12%) fair with no poor results. Interpretation / Conclusion From the present study it is concluded that the technique of open reduction and internal fixation with Kirschner wires and tension band wiring for simple transverse and oblique fractures and olecranon plate fixation for comminuted fractures are effective means and gold standard technique of treating fractures of olecranon and is based on sound biomechanical principle.

Clinical Study of Surgical Management of Olecranon Fracture

Background and Objective When displaced ,Open reduction and internal fixation with k-wires and figure of eight tension band wiring for simple transverse fractures and olecranon hook plate for comminuted fractures The present study is undertaken to evaluate the results of surgical management, the merits and demerits and to asses elbow joint motion and stability after the procedure. Materials and Methods It is a prospective study which was carried out from September 2010 to September 2012 in Bapuji Hospital and Chigateri General Hospital attached to J.J.M Medical College, Davangere. In this study period of 25 cases of fracture olecranon treated by Tension band wiring with Kirshner wire for Simple transverse fractures and Olecranon hook plate for Communited fractures Results In our series, majority of the patients were males, middle aged, with road traffic accident being the commonest mode of injury, Most of the cases were Type II B fractures i.e., oblique and transverse fractures according to Colton’s classification Surgery was performed with in 3.48 average days, Union was noted clinically and radiologically and functional evaluation was done by Mayo elbow performance score. Excellent results was present in 18 patients (72%), 4(16%) good and 3(12%) fair with no poor results. Interpretation / Conclusion From the present study it is concluded that the technique of open reduction and internal fixation with Kirschner wires and tension band wiring for simple transverse and oblique fractures and olecranon plate fixation for comminuted fractures are effective means and gold standard technique of treating fractures of olecranon and is based on sound biomechanical principle.

The three-column concept of elbow joint stability and the Wrightington elbow fracture-dislocation classification, emphasizing the role of cross-sectional imaging.

Elbow fracture-dislocation is a complex injury with a combination of osseous and soft tissue disruption. Different classification systems have been used to describe the injury pattern and help guide the management. The article describes the important cross-sectional findings in complex elbow fracture-dislocation injuries based on the relatively new Wrightington classification. This includes the various elements and patterns seen in elbow fracture-dislocations providing a simple and comprehensive system to classify these injuries and help guide the surgical management. The article also describes the three-column concept of elbow joint stability, dividing the elbow joint osseous structures into lateral, middle and medial columns. Detailed radiological assessment of the fractures pattern is vital to understand the mechanism of injury, allowing clinicians to predict the associated capsuloligamentous injury and help guide the management decisions. The Wrightington elbow fracture-dislocation classification categorizes the injuries according to the ulnar coronoid process and radial head fractures. Type A is an anteromedial coronoid fracture. Type B is a bifacet or basal coronoid fracture, with B + indicating associated radial head fracture. Type C is a combined anterolateral facet and radial head or comminuted radial head fractures. Type D is a diaphyseal ulnar fracture, with D + indicating associated radial head fracture.

Reconstruction of coronoid process of the ulna: a literature review.

As a pivotal part of the elbow joint structure, the coronoid process of the ulna plays a vital role in maintaining elbow joint stability. Loss of coronoid process height causes instability of the elbow joint depending on the fracture characteristics and size. The diagnosis and treatment of coronoid process fractures has gained widespread attention from orthopedic surgeons. Nevertheless, few reports have described reconstruction of coronoid process fractures and defects that affect elbow joint stability. Treatment of elbow joint instability induced by coronoid process defects is challenging because most cases are complicated by other elbow joint injuries. Moreover, the clinical efficacy remains unclear. The present narrative review was performed to examine the research progress on reconstruction of the coronoid process. The findings of this review provide evidence for clinical repair and reconstruction of coronoid process defects and contribute to the published literature on this topic.

A retrospective comparison of olecranon osteotomy and paratricipital approach in treatment of distal humerus intra-articular fractures

Aim: Paratricipital approach and Olecranon osteotomy are most commonly used to treat intra-articular distal humerus fractures in adults. In this study we have analysed the patients in whom we performed open reduction and internal fixation with and withoutolecranon osteotomy and evaluated the advantages and disadvantages of both methods.Materials and Methods: Between 2014 and 2018, 36 adult patients with intra-articular distal humerus fracture were retrospectively analysed. According to AO classification system 9, patient has Type B2, 1 Type B3, 7 Type C1, 10 Type C2 and 9 Type C3 fractures. Mayo Elbow Performance Score for evaluation of the elbow joint stability and Disabilities of Arm, Shoulder and Hand score to evaluate the functionality of shoulder, arm and hand was used.Results: Paratricipital approach was used in 12 patients (8 male , 4 female) and olecranon osteotomy in 24 patients. Mayo Elbow Performance Score and Disabilities of Arm, Shoulder and Hand scores were found respectively 15.808 and 81.25 in the Paratricipital group whereas those values were determined as 17.37 and 79.17, respectively. No statistically significant difference was found between two groups in terms of these two scorings (p=0.147 and p=0.244, respectively) A statistically significant difference was detected between the groups in terms of heterotopic ossification ( p=0.008). In the paratricipital group; no heterotopic ossification was found in 7 (58.3%) patients whereas Type 1 heterotopic ossification was detected in 5 (41.7%) patients. In the olecranon osteotomy group; no heterotopic ossification was found in 4 (16.7%) patients whereas Type 1 and Type 2 heterotopic ossification were detected in 16 (66.7%) and 4 (17.7%) patients, respectively (p=0.008). A statistically significantly higher rate of elbow degeneration and heterotopic ossification was observed in the patients who underwent osteotomy compared with those who were not performed osteotomy (p=0.008)Conclusions: Paratricipital approach can be performed as an alternative treatment option in the distal humerus fractures to reduce the postoperative complications even though it does not allow to perform a comprehensive preoperative evaluation of the joint as well as olecranon osteotomy approach.

Mason II-III radial head and neck fractures treated with locking plate fixation

Introduction :Internal fixation of radial head and neck fractures is difficult and postoperative complications are common. Our aim in this study was to evaluate elbow function and postoperative complications in patients who underwent internal fixation with the diagnosis of mason 2 and 3 radial head and neck fractures and we discuss our findings in light of the recent literature Materials and Methods: We included 27 patients with treatment radial head and neck fractures. Patients were an average age of 35.4 years (23 – 58) and mean follow up time was 31.6 months (13 – 61). 5 patients (18.5%) had a Mason type 2 fracture and 22 patients (81.5%) Mason type 3 fracture. Postoperative assessments included evaluation of range ofmotion, functional scores, and radiologic findings. We assessed fracture healing, surgical complications,revision surgery, and the need for metal removal. Results: The mean extension deficit was 8° (range 0°- 25°), average elbow flexion 138° (range 95°- 160°), pronation 70° (range 30°- 90°) and supination was 64° (range 20°- 90°). The Mayo Elbow Performance Score showed a mean score of 92 (range 60 – 100). The mean Disability of Arm, Shoulder and Hand score was 15.5 (range 2.5 - 55.2). There were 7 (25,9 %) complications. A total of 6 patients underwent a revision surgery (22.2 %). Conclusions: In conclusion, internal fixation could be an advantageous treatment modality for type II – III radial head and neck fractures. On the other hand, achieving a stable elbow joint should take precedence and arthroplasty should be considered in severely comminuted cases where fixation is not possible.