RESUMEN
BACKGROUND: Tennis elbow is a common condition that usually responds to conservative measures. In refractory cases, surgical intervention is indicated. A plethora of surgical techniques have been described. We report the mid- to long-term outcomes of the Boyd-McLeod procedure for refractory tennis elbow. METHODS: A retrospective analysis and current review of patients that had undergone the Boyd-McLeod procedure over a 12-year period was undertaken. Demographics, time to discharge, length of follow-up and outcome scores were collected. RESULTS: Seventy patients underwent surgery. Mean time to discharge was 15.35 weeks, with 88% successful outcomes. Fifty-four patients were available for current follow-up at mean of 5.52 years (range 1.17 years to 11.49 years). Range of motion in all patients was unchanged. There were no revision procedures. Mean (SD) Mayo Elbow Performance Score was 90.85 (13.11), with 75.5% returning a good or excellent score and 24.5% a fair outcome. The mean (SD) Oxford Elbow Score was 44.04 (6.92); mean (SD) pain score was 89.5 (17.58); mean (SD) function score was 95.34 (9.59) and mean (SD) socio-psychological score was 91.50 (17.01). Overall, 83% of patients had an Oxford Elbow Score of 43 or greater, suggesting excellent outcome. CONCLUSIONS: We show that the Boyd-McLeod procedure is an excellent option over both the short- and long-term for refractory tennis elbow.
RESUMEN
BACKGROUND: Distal biceps tendon rupture is not a very common injury and the literature remains scarce, mainly limited to case series. While surgical repair has become popular, it is not universally accepted and there are insufficient data regarding patient satisfaction following repair. The purpose of this study was to assess the results of anatomical reinsertion according to objective muscle strength testing and patient-reported outcome measures. PATIENTS AND METHODS: Twenty-four patients underwent surgical repair over the last 10 years. All patients underwent clinical assessment using the Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score and Oxford Elbow score. Measurement of range of motion, supination and flexion strength testing was done using a Biodex isokinetic dynamometer. RESULTS: Ninety-five percent of the patients had good or excellent results following surgery as defined by Mayo and Oxford Elbow scores. The average DASH score following surgery was 7.1, nearly the same as the score of 6.2 in the normal population. The mean elbow flexion arc was 134° ± 10.8 (range, 125-150°; 95% confidence interval (CI) 129.6-137.8) with no flexion contractures in the operated side compared with the unaffected elbow. The range of pronation-supination was also comparable in both sides. The average torque in flexion improved by 19.8% (p = 0.25) while supination torque was reduced by 4% (p = 0.12) when compared to the uninjured side. There was 8% incidence of persistent neuropraxia of the antebrachial cutaneous nerve of the forearm and 4% incidence of asymptomatic heterotopic ossification. CONCLUSION: Surgical repair of distal biceps ruptures provides consistently good results in terms of patient-scored outcomes. Objective muscle strength testing does not reveal statistical difference between the injured and the opposite side.
Asunto(s)
Articulación del Codo/cirugía , Fuerza Muscular , Osificación Heterotópica/cirugía , Pronación , Supinación , Traumatismos de los Tendones/cirugía , Articulación del Codo/fisiopatología , Humanos , Inmovilización , Masculino , Persona de Mediana Edad , Osificación Heterotópica/etiología , Osificación Heterotópica/fisiopatología , Rango del Movimiento Articular , Rotura/cirugía , Autoinforme , Anclas para Sutura , Traumatismos de los Tendones/complicaciones , Traumatismos de los Tendones/fisiopatología , Torque , Resultado del TratamientoRESUMEN
This article reviews a study in which distal forearm fractures in children were treated with a below elbow semi-rigid cast, with instructions for removal at home. Patient satisfaction surveys established that children and parents were pleased they did not have to return to hospital to have the cast removed, and most patients returned to normal activity immediately or within one week after removing the plaster at home. Although semi-rigid casts are slightly more expensive to apply than standard plaster, the authors believe this is outweighed by the advantages of patients not having to return to the fracture clinic. Hospital clinics were significantly less busy, allowing them to create slots for new referrals.