RESUMEN
Posterolateral rotatory instability of the elbow is a three-dimensional displacement pattern of abnormal external rotatory subluxation of the ulna coupled with valgus displacement on the humeral trochlea. This pattern causes the forearm bones to displace into external rotation and valgus during flexion of the elbow. Injury to the lateral ulnar collateral ligament allows abnormal supination of the ulna on the humerus. The radial head, being locked in the sigmoid (radial) notch of the proximal ulna by the annular ligament, subluxates posterior to the capitellum. The abnormality is usually posttraumatic and presents with locking, snapping, clicking, catching, and recurrent dislocation of the elbow. The clinical diagnosis is suspected from history and confirmed by the physical examination, which includes the posterolateral rotatory instability test. This test often is best performed under fluoroscopy or general anesthesia. Usually the instability is managed with either a repair of the ligament or an isometric reconstruction using a tendon graft.
Asunto(s)
Lesiones de Codo , Luxaciones Articulares/cirugía , Inestabilidad de la Articulación/prevención & control , Procedimientos Ortopédicos/métodos , Artroscopía/métodos , Fenómenos Biomecánicos , Femenino , Estudios de Seguimiento , Humanos , Puntaje de Gravedad del Traumatismo , Luxaciones Articulares/diagnóstico , Inestabilidad de la Articulación/etiología , Masculino , Dimensión del Dolor , Rango del Movimiento Articular/fisiología , Recuperación de la Función , Rotación , Resultado del TratamientoRESUMEN
Success in elbow surgery depends on a thorough understanding of its anatomy and the access to its various compartments and components.This article has reviewed the current applied surgical anatomy of the elbow and the related surgical approaches. For acute elbow injuries the Global approach is preferred, because this incorporates a posterior skin incision to expose the medial and lateral sides of the joint. The "Z"arthrotomy algorithm avoids PLRI when exposing the lateral joint capsule. The acute distal biceps tendon avulsion can be repaired with a minimally invasive anterior approach.
Asunto(s)
Codo/anatomía & histología , Codo/cirugía , Procedimientos Ortopédicos/métodos , Traumatismos del Brazo/patología , Traumatismos del Brazo/cirugía , Humanos , Rotura/patología , Rotura/cirugía , Traumatismos de los Tendones/patología , Traumatismos de los Tendones/cirugía , Lesiones de CodoRESUMEN
Elbow dislocations occur following acute trauma to the elbow with associated disruption of the ligamentous complexes of the elbow. Observations regarding the details of ligament injuries are presented. Clinical presentation, examination, and investigations are included. Details of the management of dislocations including management of complex cases that require repair or reconstruction of the ligamentous complexes are included.
Asunto(s)
Traumatismos en Atletas/fisiopatología , Traumatismos en Atletas/terapia , Lesiones de Codo , Luxaciones Articulares/fisiopatología , Luxaciones Articulares/terapia , Medicina Deportiva/métodos , Adulto , Traumatismos en Atletas/complicaciones , Traumatismos en Atletas/diagnóstico , Fenómenos Biomecánicos , Niño , Articulación del Codo/anatomía & histología , Articulación del Codo/fisiopatología , Fracturas Óseas/diagnóstico , Fracturas Óseas/etiología , Fracturas Óseas/terapia , Humanos , Luxaciones Articulares/complicaciones , Luxaciones Articulares/diagnóstico , Pediatría/métodos , PronósticoRESUMEN
Five patients with localized little finger carpometacarpal arthritis were treated by excision of the little finger metacarpal base and arthrodesis of the little and ring metacarpals. A dorsal periosteal/capsular flap was used as an interposition graft. All patients achieved significant pain relief, good cosmesis and satisfactory grip strength. All returned to activities of daily living. This procedure, the Dubert procedure, is indicated for localized pathology of the hamate-little finger metacarpal joint. It has theoretical advantages over arthrodesis and resection or interposition arthroplasty as it preserves little finger length, rotation and alignment and maintains some mobility of the transverse carpal arch and the little finger ray.
Asunto(s)
Artrodesis/métodos , Articulación Metacarpofalángica/cirugía , Metacarpo/cirugía , Osteoartritis/cirugía , Actividades Cotidianas , Adulto , Anciano , Tornillos Óseos , Trasplante Óseo , Estética , Femenino , Fuerza de la Mano/fisiología , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
The management of open tibial fractures is a challenge to all orthopaedic trauma surgeons. The major goals are fracture union, uncomplicated soft tissue healing and return to pre-injury level of function. The geographical isolation and vastness of the Northern Territory of Australia complicates the management of these injuries by adding a significant delay to treatment. Forty-five patients sustained 48 open tibial fractures over the 30-month period of the study. Twelve received primary surgical treatment within 6h of injury but 33 were treated more than 6h after injury. The mean time to treatment in this latter group was 12h 15min (median 9h 45min, range 6-37h). The majority of injuries were high energy, with 23 patients having multiple injuries and 29 fractures (60%) being classified as AO C3 with 35 (73%) having Gustilo III soft tissue injuries. There was a mean time to union of 7.5 months and an overall complication rate of 42.2%. Thirteen patients (29%) required additional (late) surgical procedures subsequent to definitive fracture and soft tissue management. The zone of injury infection rate was 12.5%. The high incidence of open tibial fractures places a large financial burden on the state. However, despite the absence of a plastic surgical service and delays in presentation, satisfactory outcomes can be obtained by the application of the established surgical principles of thorough debridement, soft tissue management and fracture stabilisation.