Standard Elbow Research Articles

A New Correlation for Estimating Solid Particle Erosion in Elbows

Solid particle erosion prediction models have been developed previously based on limited data and without consideration of uncertainties involved in measurements. In this study, a new correlation is developed to estimate the maximum erosion rate caused by solid particles in standard elbow geometries. The novel development process of this correlation includes uncertainty estimation of erosion measurements. In order to estimate uncertainties in an erosion database, it is imperative to have a model that could be used to calculate accurate erosion values to have reliable references. For this purpose, a database of repeated erosion measurements for gas-sand flows at low-pressure collected by previous researchers is used that includes standard elbow geometries with 0.0762 m and 0.1016 m internal pipe diameter, sand particles with mean diameters of 75 and 300 μm. Then, the erosion values in this database are adjusted to agree with physical behaviors expected in erosion process. Finally, based on the adjusted erosion values, a new correlation is developed that accounts for important paramters such as pipe and particle diameters, and gas velocity. The results and comparison of this new model with other correlations/models in the literature show that this correlation performs very well in predicting solid-particle erosion values for elbow geometry with a RMSE value of 7.96E-02 mm/kg. The effect of superficial liquid velocity is also investigated and modeled based on a database of gas-liquid-sand erosion and the correlation is updated for predicting erosion in two-phase flow conditions. Furthermore, CFD results for higher pressure fluids and larger pipe diameters of 0.1524 m and 0.2032 m and mean particle sizes of 25, 75, 150 and 300 μm, are used to further develop and validate the correlation for larger pipe size and high-pressure fluids flows. In summary, three correlations have been developed in this research; one for low-pressure flows with application in uncertainty estimation, one for predicting erosion in two-phase flow conditions, and one for cases with larger pipe diameters or high-pressure fluids.

Numerical analysis of gas-solid flow erosion in different geometries as alternatives to a standard pipe elbow

This study was conducted with the aim of replacing different geometric fittings instead of the standard 90° elbow and trying to change the flow pattern to reduce erosion damage. Among fittings, the elbows are at a more serious risk. Numerical investigation of the present erosion with the novelty of research on non-spherical particles and changes in the impact angle of particles along with fluid flow using eight new proposed fittings, including two miter fittings, three blinded fittings, one reducer elbow fitting, and two spherical elbows fittings in comparison with the standard 90° elbow was controlled. The numerical simulation of the gas-solid two-phase flow of non-spherical particles was studied using the Euler-Lagrange approach. To carry out the study numerical, first, the gas flow was modeled by the Navier-Stokes equations and the turbulent Reynolds stress model, and then the solid particles were injected using Newton's equation. Finally, the erosion was calculated using Grant and Tabakoff model of the restitution of particles of after hitting the wall and the erosion model of Oka. The amount of erosion caused by changes in the flow pattern was investigated to evaluate the performance of the new proposed fittings. Numerical results for the most critical mode (Vin = 27 m/s and DP = 300 μm) showed that the new proposed fittings increase the erosion resistance by 22.5 % to 39.6 % compared to the standard 90° elbow. Also, in this research, the effect of different parameters including flow velocity, particle diameter size, particle input rate, and particle rotation on erosion were investigated.

Ulnar longitudinal deficiency - a unique case series from the Indian subcontinent.

Ulnar Longitudinal Deficiency (ULD) is a sporadic congenital difference affecting the upper-limb. There is a lack of information on this condition in the Indian subcontinent population, hence the importance of documenting ULD in this region and highlighting the novelty. This retrospective case-series aimed to describe the manifestations of ULD and document its unique presentation pattern in the South Asian population. We made a comprehensive assessment of medical records for all the patients from 2008 to 2023. We assessed and documented the demographic details, clinical features, and radiographic images of the upper-limb and associated investigations for other clinical presentations. Patients were grouped based on standard elbow, forearm, and hand classifications. We documented a total of 68 hands in 55 patients. We observed consanguinity among parents in eight (15%) patients with family-history of other deformities in five patients (9%). Most of our patients presented during the second to fifth year of age (35%). Fourteen (25%) of them presented after ten years. The most common pattern of the presentation was Aplasia of the Ulna, either partial or complete (17 each - 50% of limbs), fixed elbow deformity (28 limbs - 41.1%), absent first web-space affecting 27 (39.7%) limbs, and absent ulnar two fingers with 20 (29.4%) limbs. We observed radial-side deficiency of the hand in 46 (67.6%) patients. 62.3% (43/69) of the surgeries were done for hand deformity. Key features observed were the presence of consanguinity among parents, late presentation after the first decade, majority having radial-side hand defects and half presenting with elbow stiffness and ulnar aplasia.

A new method for evaluating radial neck fractures based on Judet classification.

To propose a new method for evaluating paediatric radial neck fractures and improve the accuracy of fracture angulation measurement, particularly in younger children, and thereby facilitate planning treatment in this population. Clinical data of 117 children with radial neck fractures in our hospital from August 2014 to March 2023 were collected. A total of 50 children (26 males, 24 females, mean age 7.6 years (2 to 13)) met the inclusion criteria and were analyzed. Cases were excluded for the following reasons: Judet grade I and Judet grade IVb (> 85° angulation) classification; poor radiograph image quality; incomplete clinical information; sagittal plane angulation; severe displacement of the ulna fracture; and Monteggia fractures. For each patient, standard elbow anteroposterior (AP) view radiographs and corresponding CT images were acquired. On radiographs, Angle P (complementary to the angle between the long axis of the radial head and the line perpendicular to the physis), Angle S (complementary to the angle between the long axis of the radial head and the midline through the proximal radial shaft), and Angle U (between the long axis of the radial head and the straight line from the distal tip of the capitellum to the coronoid process) were identified as candidates approximating the true coronal plane angulation of radial neck fractures. On the coronal plane of the CT scan, the angulation of radial neck fractures (CTa) was measured and served as the reference standard for measurement. Inter- and intraobserver reliabilities were assessed by Kappa statistics and intraclass correlation coefficient (ICC). Angle U showed the strongest correlation with CTa (p < 0.001). In the analysis of inter- and intraobserver reliability, Kappa values were significantly higher for Angles S and U compared with Angle P. ICC values were excellent among the three groups. Angle U on AP view was the best substitute for CTa when evaluating radial neck fractures in children. Further studies are required to validate this method.

Numerical investigation of the erosion reduction in elbows using separate and helical inner ring

This study presents a comprehensive numerical investigation of erosion in bends equipped with inner rings as a novel geometric concept for erosion control. The research aims to assess the effectiveness of these innovative configurations in reducing erosion through rigorous computational fluid dynamics (CFD) simulations. Numerical modeling for the gas-solid two-phase flow has been carried out based on one-way coupling using an Eulerian-Lagrangian approach. The CFD model employed in this work incorporates the RNG k-ε turbulence model for flow solution, the Oka model for simulating surface erosion, and the Grant and Tabakoff model to account for particle-wall collisions. The primary focus of the investigation is to evaluate the erosion reduction capabilities of different inner ring configurations. By systematically varying the number of inner rings, the study elucidates the influence of this parameter on erosion mitigation. The obtained numerical results are analyzed in terms of erosion patterns, erosion reduction percentages, and the integral erosion surface criterion. The findings reveal the elbow with two separate inner rings as the most effective configuration, exhibiting a remarkable decrease in erosion of up to 43 % compared to the standard elbow. Moreover, based on the integral erosion surface criterion, the elbow with five separate inner rings emerges as a more desirable alternative to the standard elbow. In addition, the study investigates the impact of an elbow with helical inner rings configuration on erosion. It is observed that this configuration intensifies flow velocity, thereby accelerating particle motion and leading to increased erosion along the outer wall.

Reliability Assessment of Gored Elbow in Erosive Two-Phase Flow with Sand Particles

Erosion, a major threat to the safety and reliability of piping components, can significantly impact their integrity and functionality. This study employs computational fluid dynamics (CFD) to systematically investigate the erosion behavior of four elbow designs (standard 90-degree elbow, 18-degree gored elbow, 22.5-degree gored elbow, and 30-degree gored elbow) subjected to multiphase air-sand and water-sand flows. Our primary objective is to identify the optimal elbow design that effectively mitigates erosion and enhances the safety and reliability of piping systems. Our findings reveal that the 22.5-degree gored elbow exhibits significantly lower erosion rates compared to other designs, particularly in air-sand flows, making it the superior choice for reducing erosion by up to 32% compared to the standard elbow. However, the standard 90-degree elbow demonstrates greater erosion resistance in water-sand flows. This research contributes valuable insights for selecting the optimal elbow design in multiphase flow, ultimately enhancing the design and longevity of piping systems.

Mitigation of Erosion Wear Produced by Fly-Ash Slurry on 90&lt;sup&gt;0&lt;/sup&gt; Elbow by Changing the Cross-Section Shape and Area Ratio

The predominant method of transporting fly ash involves conveying it in slurry form through pipelines within diverse industrial facilities. The key elements of slurry conveyance encompass bends, pumps, and valves. These components of the pipeline endure significant erosion and wear due to the impact of discrete particles. In this investigation, the study assessed the wear induced by slurry erosion in conventional 900 pipe bend and 900 square section elbows of different area ratios using ANSYS Fluent. The discrete phase model was used to estimate the slurry erosion wear for the fly ash-water suspension. From the investigation, the outcomes from the standard k-turbulence model were discovered to be in agreement with the experimental data. This study also looked at a number of other influencing factors, such as the solid concentration and velocity. The analysis reveals that the average erosion wear is lower in the square cross-section elbow compared to the standard elbow. Furthermore, the erosion wear is observed to decrease further with an increase in the cross-sectional area of the square section elbow.

Normal Elbow Angles in Saudi Population: Radiographic Study

Background: In this study, we aimed to measure normal elbow radiographic angles in the Saudi population and compare the normal range of elbow angles between Saudi males and females, as well as those previously measured in other populations. Methods: Anteroposterior and lateral plain radiographs of 304 normal elbows from 153 females and 151 males from the Saudi population, aged &gt; 18 years, were assessed. Radiographs, 174 right elbows, and 130 left elbows were studied retrospectively, between 2018 and 2023 in our institute. Only normal elbow radiographs with acceptable quality were included. The standard radiographic elbow measurements were collected. Data analysis was conducted with Student’s t-test for parametric data and Wilcoxon Mann–Whitney U test for nonparametric data. Two certified orthopedic surgeons performed the measurements independently. Interobserver and intraobserver errors were measured. Results: All the radiographic elbow measurements in Saudis did not show any significant sexual dimorphism or difference between sides. The radiographic angles obtained on the anteroposterior view appeared more reliable than lateral view angles. Unlike carrying angle (CA), measurements of radiographic elbow angles in Saudis were inconsistent with previously published values. Conclusions: The elbow radiographic anatomical parameters of the Saudi population were not consistent with previously published values except for CA. The presence of a significant impact of geographical or racial variation on elbow radiographic anatomy requires additional investigations.

Salmonella Osteomyelitis of Unknown Origin: An Underestimated Infection.

A poor response to treatment should raise questions about the initial diagnosis.Isolated metastatic lesions in the upper limbs are rare and require proper clinical and radiological evaluation to arrive at a correct diagnosis.

Test-retest reliability of joint position sense in the elbow among healthy adults

BackgroundProprioception of the elbow is necessary for daily activities. Proprioception can be impaired with injury or pathology, and rehabilitation efforts seek to improve proprioception for improved upper extremity functioning. In clinical practice, joint position sense (JPS) testing is often utilized to assess conscious proprioception; however, varying methods exist with little evidence of psychometric properties, especially for the elbow. PurposeThe primary aim of this study was to create a standardized elbow JPS test protocol using goniometry measurement to determine the most reliable testing position. The secondary aim was to determine if the elbow JPS test had acceptable test-retest reliability in healthy adults. Study DesignThis was a cross-sectional study using a convenience sample of healthy adults. MethodsThree elbow positions (45°, 60°, and 75° of elbow flexion) were measured twice on the same day by a single rater using a universal goniometer. We calculated the absolute error in degrees between each position and reposition and the intraclass correlation coefficient (3,1) for relative reliability. We also calculated the standard error of the measurement and visually inspected Bland-Altman plots for absolute reliability. ResultsSixty-eight healthy adults (mean age 27.9 years, standard deviation 8.59) were assessed. The mean absolute error for all positions for test and retest was 5.7°. The intraclass correlation coefficients were moderate to good (0.57-0.75), and the standard error of the measurement was 2° (rounded) for all positions. The limits of agreement were moderately narrow, and the Bland-Altman plots showed a random distribution of errors for each position, indicating clinically acceptable measurement error. ConclusionsThe joint position reproduction test for JPS using goniometry demonstrated moderate to good test-retest reliability and acceptable measurement error in healthy adults. The elbow joint angle of 60° flexion was the most reliable for JPS testing, providing insight for JPS assessment in clinical practice.

Revision Subpectoral Biceps Tenodesis Demonstrates a High Patient Satisfaction and Good Functional Outcomes

To clinically evaluate a subset of patients who underwent a revision subpectoral biceps tenodesis for a clinically failed proximal biceps tenodesis. This is a retrospective case series of patients with at least 2-year follow-up who had undergone a revision biceps tenodesis after clinical failure of a proximal biceps tenodesis between January 2008 and February 2020 by a single surgeon. Patients who underwent concomitant procedures, such as revision cuff repair, were excluded. Patients with a minimum of 2 years duration status postrevision subpectoral tenodesis were contacted for informed consent and outcome data, which included Simple Shoulder Test, American Shoulder and Elbow Surgeons score, visual analog scale for pain, and subjective reporting of arm weakness and satisfaction. Fourteen patients were initially identified as meeting inclusion criteria with a minimum 2-year follow-up achieved for 11 of 14patients (78.5% follow-up). The mean follow-up time was 8.1 years (range, 2.7-14.8 years). After the primary biceps tenodesis, a mean of 8.0 ± 9.6 months passed before the revision subpectoral biceps tenodesis was performed. The average postoperative active forward elevation and adducted external rotation were 159 ± 7° and 47 ± 17°, respectively. The mean ± standard deviation (range) follow-up American Shoulder and Elbow Surgeons score was 79 ± 23 (30-100), Simple Shoulder Test was 11 ± 2 (7-12), and visual analog scale for pain was 2.6 ± 2.8 (0-9). All 11 patients reported being satisfied with their operation and would elect to have the operation again. Revision subpectoral biceps tenodesis is a viable procedure for addressing patients with persistent pain following initial proximal biceps tenodesis. Although some persistent pain is common, revision subpectoral biceps tenodesis demonstrates a high patient satisfaction and good functional outcomes. Level IV, therapeutic case series.

Poster 178: Outcomes of SLAP Repair vs. Biceps Tenodesis of SLAP Lesions in Females: A Retrospective Review

Objectives: When surgically managing superior labrum from anterior to posterior (SLAP) tears, there is no consensus on whether SLAP repair or biceps tenodesis yields superior long term outcomes. Additionally, no previous studies have specifically examined outcomes of these procedures in female patients, despite evidence of sex-based differences in recovery following orthopedic surgery. The purpose of this study was to retrospectively compare outcomes after SLAP repair and biceps tenodesis in females. Prior to the start of the study, it was predicted that outcomes between patients who undergo SLAP repair and biceps tenodesis as a treatment will not significantly differ. Methods: Female patients who underwent arthroscopic SLAP repair or biceps tenodesis for treatment of an SLAP lesion between 1/1/2014 and 9/1/2019 at a single institution were retrospectively reviewed. Patients were queried using CPT codes for arthroscopic SLAP repair or biceps tenodesis: for those identified, electronic medical records were reviewed to confirm they met inclusion criteria. Exclusion criteria included: age less than 18 years old at the time of surgery, revision surgery, and concomitant rotator cuff repair at the time of surgery. Patients were contacted at a minimum of two-years post- surgery and asked to complete the standardized American Shoulder and Elbow Surgeons (ASES) score, single assessment numerical evaluation (SANE) survey, and visual analog scale (VAS) for pain. Patients were also given a custom survey assessing return to activity and level of activity following the operation. Patient demographics collected included age at time of surgery, BMI, laterality, and procedure type. Differences in post-operative function between the procedures were assessed using T-tests or Mann- Whitney U tests for numerical data and Chi-Square testing for categorical data. Results: The study included 118 patients. 61 (51.7%) underwent arthroscopic SLAP repair, and 57 (48.3%) underwent open or arthroscopic biceps tenodesis. Comparing demographic data for SLAP repair versus biceps tenodesis groups, mean age was 35.2±8.93 years versus 45.5±10.2 years (p&lt;0.001), mean BMI was 27.5 versus 29.2 (p=0.095), the rates of left shoulder repairs was 30 (50.8%) versus 14 (26.4%), and the rates of right shoulder repairs was 29 (49.2%) versus 39 (73.6%) (p=0.014). Concomitant pathologies were recorded in 68.9% of SLAP repairs and in 88.0% of biceps tenodesis (p=0.030). Concomitant procedures (including bursectomy, capsular release, and acromioplasty) were performed in 74.6% of SLAP repairs and in 92.0% of biceps tenodesis (p=0.033). The two groups showed no differences in two-year ASES scores (81.5 in SLAP repair vs 83.3 in biceps tenodesis, p=0.461), SANE scores (75.6 in SLAP repair vs 79.7 in biceps tenodesis, p=0.344) and VAS scores (20.2 in SLAP repair vs 21.1 in biceps tenodesis, p=0.645). Furthermore, rates of participation in sports prior to surgery was similar (55.4% in SLAP repair vs 42.6% in biceps tenodesis , p=0.251); of those who reported participation prior to surgery, rates of return to participation in sport following surgery was also similar (77.4% in SLAP repair vs 78.3% in biceps tenodesis, p=1.000). Conclusions: This is the first study to evaluate the outcomes of SLAP repair and biceps tenodesis for SLAP lesions in female patients. Female patients who underwent surgical treatment of SLAP lesions with SLAP repair or biceps tenodesis show comparable minimum two-year results with respect to level of function, self-reported pain, and ability to return to sports after these procedures. The incidence of concomitant pathologies and concomitant procedures at the time of SLAP repair and biceps tenodesis differed between the two groups, possibly related to group age disparity. Further research is necessary to define precise treatment indications for this pathology in this specific patient population.

CFD–DEM investigation of gas-solid flow and wall erosion of vortex elbows conveying coarse particles

Vortex elbows are generally used to mitigate erosive wear while conveying fine particles. This paper presents a modified vortex elbow designed to handle coarse particles. Gas–solid flows and wall erosion of the modified vortex elbow are studied by the combined approach of discrete element model for particles and computational fluid dynamics for the gas phase. The validity of the model is first examined by comparing the predicted pressure drop and wall erosion with experimental measurements for a standard elbow. Then, via the model, the effects of particle size on the flow characteristics and elbow erosion of the modified vortex elbow are quantified and compared with those of the standard elbow. The results show that the vortex elbow decreases the maximum penetration ratio and total penetration depth for all the particle sizes considered. These effects become more significant for larger particles. The wall erosion is also elucidated using flow characteristics.

Effect of pipe size on erosion measurements and predictions in liquid-dominated multiphase flows for the elbows

Solid particle erosion in pipelines and pipe fittings occurs when solids are produced in the oil and gas industries during transporting fluids. Erosion of elbows in series for liquid-dominated flows has gained recognition as many oil fields operate in deep-water subsea flow lines and also in conventional wells onshore. Although significant data is available for gas-dominated flows, the data for liquid-dominated flows are scarce and limited to 50.8 mm pipe elbows in dispersed bubble flow only. Thus, it is essential to determine erosion for different pipe sizes to investigate the pipe size effect and for different flow regimes. This work conducts experiments in vertical liquid-solid flows, and liquid-gas-solid churn flows to examine erosion using 340 μm sand particles in 50.8 mm and 76.2 mm standard SS316 elbows in series separated at a distance of three diameters between them. In addition, flow visualization and paint-removal experiments are conducted to predict the erosion patterns in the elbows. Furthermore, Computational Fluid Dynamics (CFD) simulations are performed to simulate the experimental conditions. Eulerian and VOF multiphase models with different turbulence models are used in CFD simulations to predict erosion on the elbows in series and compare with the experimental results. The CFD results, when modified to account for the lubrication effects of the liquid, can predict the experimentally observed erosion pattern and the magnitudes.

Modeling of sand transport and elbow erosion in horizontal two-phase slug flow

Horizontal wells play an important role in maximizing the recovery of hydrocarbons from oil and gas reservoirs. During production, if the rate of production of produced fluids with sand particles is low, the deposition of sand particles in horizontal flow lines can wreak havoc on production systems in such a way as to cause increased pressure loss and reduction or loss of production when the pipe is partially or completely blocked. On the other hand, if the production rate of fluids is high, the impact of sand particles on the wall of the pipe will erode the inner surface of the pipe fittings. In this case, erosion can be severe enough to cause a hazardous spill and complete shutdown of systems. Therefore, it is important to quantify the sand transport and erosivity of different flow regimes. Under moderate velocities, there exists a flow regime which is called slug flow which is characterized by the intermittent appearance of liquid slugs propagating through the pipe. Studying the sand deposition and erosion due to sand particles entrained in intermittent flows is extremely difficult since the solid particle velocity magnitudes are coupled with several multiphase flow parameters such as phase distribution and slippage between the phases. This work focuses on the improvement of mechanistic models for predicting critical deposition of sand particles in horizontal pipes and erosion in horizontal-horizontal elbows. In this investigation, a modified model is proposed to better predict the critical deposition velocity and the characteristic particle velocity as a function of the slug flow characteristics. The model predictions are compared with the sand transport and erosion data collected at the University of Tulsa and other research institutions. The results show that the new approach provides improved predictions for sand transport and maximum erosion in standard elbows when compared with existing models.

Numerical investigation of novel geometric solutions for erosion problem of standard elbows in gas-solid flow using CFD-DEM

As erosion by solid particles is a serious concern in the pipeline industry, especially in pneumatic transport pipelines, this study has investigated novel numerical geometric solutions to solve this problem using the computational fluid dynamics (CFD). The studied geometries included square section elbow (with a replaceable backing plate), T-plug, double T-plug, T-plug with axillary air and standard elbow with vane, ribbed-elbow (circular and square section) with different configurations, and elbow with air injection with different conditions. Results of the sensitivity analyses used to study the effects of the changes in the particle shape/size/velocity, mass loading, erosion model and turbulence model on erosion rate revealed that long-radius ribbed-elbow (circular and square section, θ = 30°), long-radius elbow with vane, long-radius elbow with square section, double T-plug and elbow with air injection (with Vinjection = 0.6Vmain and tilt angle = 45°) are good choices.

Comparing the performance of different geometric solutions for erosion problem of standard elbows in air-solid flow using CFD-DEM

Comparing the performance of different geometric solutions for erosion problem of standard elbows in air-solid flow using CFD-DEM

The Posterior Transtriceps Approach for Intra-articular Elbow Arthrography: A Painless Method?

We determined the diagnostic and patient experience advantage of the transtriceps approach for elbow arthrograms. MRIs of two patients who underwent an MRI arthrogram of the elbow in May and June 2022 were retrospectively evaluated. All procedures were performed under fluoroscopic guidance with the patient in the prone position and the arm of interest extended above the head, and the elbow of interest flexed at 90 degrees. A 25 gauge needle was utilized. All MRI examinations were performed on 3-Tesla MRI scanners (Siemens,Hamburg, Germany) and in accordance with our institution's standard elbow arthrogram MRI protocol. The arthrogram was deemed successful if contrast was visualized in the elbow joint, and the MRI examinations were assessed for diagnostic ability and extra-articular leakage. Patient comfort and pain were also assessed. Both arthrograms demonstrated adequate contrast in the elbow joint, and the MRIs confirmed no leakage of contrast or bubbles. The patients felt 0 pain during the procedure on a scale of 0-10. Although the radiocapitellar approach is commonly used for elbow arthrograms, we found the transtriceps approach to be diagnostically sound, painless, and easier to perform.

Arthroscopic lateral collateral ligament imbrication of the elbow: short-term clinical results.

Chronic posterolateral rotatory instability (PLRI) of the elbow results from an insufficient lateral collateral ligament (LCL) complex. Arthroscopic LCL imbrication may prove a minimally invasive alternative to open lateral ulnar collateral ligament (LUCL) reconstruction with a quicker rehabilitation. The purpose of this study is to analyze the validity of a modified arthroscopic imbrication technique. We hypothesized that arthroscopic LUCL imbrication would yield stable elbows in patients with grade 1 or 2 chronic PLRI at a minimum of 2 year of follow-up. We retrospectively assessed data of all PLRI patients who underwent arthroscopic LUCL imbrication from 2010 to 2013 (n=20). Stage 3 PLRIs (frank ulnohumeral dislocations) were excluded from this treatment. After confirmation of PLRI during standard elbow arthroscopy, a doubled absorbable suture is shuttled through as much LCL tissue as possible (from the lateral ulnar border to the area proximal to the lateral epicondyle) and the sutures are tied. This results in a plication of the entire LCL complex. Objective elbow stability was assessed using a combination of the pivot shift, table top, and posterior drawer tests. Of 20 included patients, 18 were stable subjectively and objectively at a minimum of 2 year of follow-up. Mean Mayo Elbow Performance Score improved from 48 preoperatively to 88.9 at final follow-up (P<.001). Mean Quick-Disabilities of the Arm, Shoulder, and Hand score improved from 53 preoperatively to 10.3 at final follow-up (P<.001). One patient developed elbow stiffness. Two patients reported tenderness of the subcutaneous PDS knots. As a less invasive alternative to open LCL reconstruction using a graft, arthroscopic LCL imbrication has demonstrated acceptable rates of perceived elbow stability among patients with stage 1 or 2 PLRI.

Proximal ulna non-union: treatment concept and postoperative outcome.

Non-union of the proximal ulna is a serious complication after surgical treatment of olecranon and complex elbow fractures, frequently leading to poor functional outcome. To date, there is a lack of data regarding optimal treatment strategies and functional outcome parameters after surgical revision. From 02/2010 to 12/2018, 31 patients undergoing surgical treatment of proximal ulna non-union could be included. Follow-up period was sevenyears (SD 2.5years). All patients were clinically assessed using a clinical assessment tool set and standard elbow scores (MEPS, OES, DASH score). All complications and unplanned revision surgeries were recorded and all radiographic material was analyzed. Initial non-union procedures were performed at an average of 6.6months (SD 3months) after the index procedures. Those included the use of autologous spongiosa graft in all patients and concomitant compression re-osteosynthesis in 28 patients. Radiological consolidation was achieved in all patients. Overall, patients achieved a good to fair functional outcome with Mayo elbow performance score measuring 78.5 (SD 9.1), DASH score 34.7 (SD 14.4), and Oxford elbow score 31.2 (SD 6.6) points. Initial malreduction/implant-malposition could be identified as a main reason for the occurrence of the non-union. Furthermore, inferior postoperative outcome was detected in patients > 60years and BMI > 30kg/m2. Using a standardized protocol, bony union and acceptable functional outcomes can be achieved in proximal ulna non-unions. However, surgeons should be aware of potential risk factors and proper initial fracture reduction as key to achieve sufficient bone healing.