RESUMEN

BACKGROUND: Recent literature has found a consensus in favor of conservative treatment for type II supracondylar humeral fractures (SCHF). This retrospective observational study compares the short- to medium-term functional outcomes of conservative versus surgical treatment in 31 patients with SCHF (Gartland II and III) to assess the potential superiority of one approach over the other. MATERIALS AND METHODS: Thirty-one pediatric patients treated for SCHF-19 classified as Gartland II and 12 as Gartland III-were assessed in our department. Eight patients underwent closed reduction and cast immobilization, 22 were treated with closed reduction and percutaneous pinning, and one underwent open reduction and internal fixation with plates. Clinical and functional data were collected during follow-up, including elbow and forearm range of motion (ROM), grip strength, carrying angle, Flynn's criteria, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. RESULTS: The average follow-up was 3.3 years (± 1.4 years). All patients demonstrated good functional recovery. According to Flynn's criteria, 85% and 81% of the patients achieved a satisfactory outcome in elbow flexion and carrying angle, respectively. No cases of nerve injuries were reported. Four patients developed cubitus varus in the Gartland II group, which was treated with closed reduction and casting with the initial alignment maintained (without a loss of reduction during the first week). However, compared to this group that was conservatively treated, functional and clinical outcomes were significantly better in the group with SCHF Gartland II treated with reduction and pinning (p < 0.05). CONCLUSIONS: Although some recent studies have demonstrated positive outcomes with conservative treatment for both Gartland IIA and IIB fractures, the short- to medium-term functional results in our study emphasize that superior outcomes were obtained with surgical treatment for Gartland II fractures when compared to those treated conservatively. TRIAL REGISTRATION: This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval was obtained from our institute's ethics committee (registry no. 3511). LEVEL OF EVIDENCE: Therapeutic level III.

Asunto(s)

Fijación Interna de Fracturas , Fracturas del Húmero , Rango del Movimiento Articular , Humanos , Fracturas del Húmero/cirugía , Femenino , Masculino , Estudios Retrospectivos , Niño , Resultado del Tratamiento , Fijación Interna de Fracturas/métodos , Preescolar , Moldes Quirúrgicos , Tratamiento Conservador/métodos , Adolescente , Recuperación de la Función , Estudios de Seguimiento , Fuerza de la Mano , Articulación del Codo/cirugía , Articulación del Codo/fisiopatología , Reducción Cerrada/métodos , Reducción Abierta/métodos

RESUMEN

ABSTRACT: The management of obstetric brachial plexus palsy (OBPP) can be challenging, particularly in neglected patients. We report the long-term results of the surgical management of a late-presenting adolescent girl with severe left shoulder and elbow flexor paralysis secondary to OBPP. She was subjected to staged shoulder and elbow reconstruction in the form of trapezius transfer and latissimus and teres major transfer to enhance shoulder abduction and lateral rotation, and flexor-pronator transfer to the anterior distal humerus to enhance elbow flexion. Flexor-pronator plasty was successful in restoring elbow flexion and function and maintaining joint stability in the long term in a patient with severe OBPP. This further consolidates its role as a feasible secondary reconstructive procedure in carefully selected patients with elbow flexor paralysis. Shoulder function improved less remarkably, yet it augmented the overall upper extremity function and correlated with pre-operative residual shoulder function. Fulfilling the candidacy for each surgical procedure is important to a successful outcome.

Asunto(s)

Neuropatías del Plexo Braquial , Procedimientos de Cirugía Plástica , Rango del Movimiento Articular , Humanos , Femenino , Neuropatías del Plexo Braquial/cirugía , Procedimientos de Cirugía Plástica/métodos , Estudios de Seguimiento , Adolescente , Articulación del Codo/cirugía , Articulación del Hombro/cirugía , Traumatismos del Nacimiento/cirugía , Traumatismos del Nacimiento/complicaciones , Resultado del Tratamiento , Factores de Tiempo

RESUMEN

BACKGROUND: Radial head fractures are the most common bony injury of the elbow in adults. The current literature does not agree on whether isolated stable type II radial head fractures should be treated operatively or nonoperatively. This review aims to determine the preferred treatment for Mason type II radial head fractures and compare the outcomes of conservative and surgical treatment. METHODS: Our study used PRISMA guidelines and conducted a thorough search of multiple electronic databases, including PubMed, Cochrane, Embase, Web of Science, CNKI, and Wanfang databases, initially identifying 545 relevant publications on surgical and conservative treatment of Mason type II radial head fractures. The final search date for this study is July 7, 2024.Through a comprehensive meta-analysis, we evaluated several outcomes, including functional scores (DASH, OES, and MEPS scores), clinical outcomes (elbow flexion, elbow extension deficit, elbow pronation, and elbow supination), and complication rate (total complications and elbow pain). The mean difference (MD) was compared for continuous outcomes, and the odds ratios (ORs) were compared for categorical outcomes. RESULT: A total of 271 patients from 4 studies met the inclusion criteria. Among them, 142 patients received surgical treatment and 129 patients received non-surgical treatment. The study found no statistically significant differences between surgical and non-surgical treatments in DASH, OES, MEPS, elbow flexion, elbow extension impairment, and elbow pain. Compared with surgical treatment, non-surgical treatment was associated with greater elbow pronation (OR = -3.10, 95% CI = [-4.96, -1.25], P = 0.55, I2 = 0%) and a lower complication rate (OR = 5.54, 95% CI = [1.79, 17.14], P = 0.42, I2 = 0%). CONCLUSION: Based on the current evidence, conservative management of isolated Mason II radial head fractures yields favorable therapeutic outcomes with a low incidence of complications.

Asunto(s)

Tratamiento Conservador , Fracturas del Radio , Humanos , Fracturas del Radio/terapia , Fracturas del Radio/cirugía , Resultado del Tratamiento , Tratamiento Conservador/métodos , Articulación del Codo/cirugía , Masculino , Adulto , Rango del Movimiento Articular , Femenino , Lesiones de Codo , Fracturas Radiales de Cabeza y Cuello

RESUMEN

Plate fixation is a common treatment option for radial head fractures (RHFs). Due to the benefits of less invasiveness and fewer complications of internal fixation, the application of small-diameter headless compression screws (HCSs) to treat RHFs has become a new trend. This study aimed to compare the mechanical stability of four distinct internal fixation protocols for transversely unstable RHFs via finite element analysis. Using computed tomography data from 10 patients, we developed 40 patient-specific FE models of transversely unstable RHFs fixed by parallel, crossed, and tripod HCSs and mini-T plate (MTP). Under simulated physiological loading of the elbow joint, the construct stiffness, displacement, and von Mises stresses were evaluated and verified by a biomechanical experiment. Under shear loading, the MTP group exhibited lower construct stiffness, larger displacement, and higher Von Mises stress than the HCSs group. The stiffness of tripod HCSs was greater than parallel and crossed screw fixation techniques. There was a strong relationship between apparent bone density and construct stiffness (R = 0.98 to 0.99). In the treatment of transversely unstable RHFs, HCSs have superior biomechanical stability than MTP. The tripod technique was also more stable than parallel and crossed fixation.

Asunto(s)

Tornillos Óseos , Análisis de Elementos Finitos , Fijación Interna de Fracturas , Fracturas del Radio , Humanos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Masculino , Femenino , Fracturas del Radio/cirugía , Fracturas del Radio/fisiopatología , Persona de Mediana Edad , Adulto , Fenómenos Biomecánicos , Placas Óseas , Tomografía Computarizada por Rayos X , Articulación del Codo/fisiopatología , Articulación del Codo/cirugía , Estrés Mecánico , Anciano , Fracturas Radiales de Cabeza y Cuello

RESUMEN

Although an increase in ulnar variance with power grip is well documented in the medical literature, there is a paucity of information concerning its mechanism. This concept was examined in five healthy individuals using computed tomography of their wrists and elbows. Images were obtained of both joints in the resting position and with maximum power grip. Ulnar variance at the wrist increased an average of 0.64 mm (range: 0.3 to 1.2 mm). While the ulnohumeral joint remained unchanged, the radiocapitellar distance shortened an average of 0.62 mm (range: 0.3 to 1.0 mm; p = 0.03), which correlated directly with the change at the wrist. Our study showed that the increase in ulnar variance with grip was due to proximal shift of the radius and not to any distal migration of the ulna, which may have clinical implications in reconstruction or arthroplasty of the elbow.

Asunto(s)

Articulación del Codo , Fuerza de la Mano , Cúbito , Articulación de la Muñeca , Humanos , Cúbito/diagnóstico por imagen , Fuerza de la Mano/fisiología , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/cirugía , Masculino , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/cirugía , Adulto , Femenino , Tomografía Computarizada por Rayos X , Voluntarios Sanos , Fenómenos Biomecánicos , Adulto Joven , Radio (Anatomía)/diagnóstico por imagen , Valor Predictivo de las Pruebas , Persona de Mediana Edad , Rango del Movimiento Articular/fisiología

RESUMEN

BACKGROUND: Symptomatic idiopathic ulnar nerve instability (IUNI) in the elbow is an uncommon condition characterized by symptoms of ulnar neuritis resulting from frictional injury to the ulnar nerve from repetitive subluxation out of the cubital tunnel. This study reports the 1-year clinical outcomes after treatment of IUNI with anterior transposition of the ulnar nerve. METHODS: This is a retrospective case study of five patients. Ulnar nerve instability was diagnosed clinically based on the presence of ulnar neuritis symptoms in combination with a positive "ulnar nerve push past" test. Electromyography (EMG) was performed on all patients. After failure of nonsurgical treatment, five patients underwent anterior subcutaneous transposition of the ulnar nerve at the elbow. Clinical outcome scores and time to resolution of symptoms were recorded at a minimum follow-up of 12 months. RESULTS: The mean age of the patients at the time of surgery was 37.8 years (range: 18 to 57 years). The mean duration of symptoms prior to surgery was 15.7 ± 4.9 months. All five patients reported neuritis symptoms in the distribution of ulnar nerve in the hand and had ulnar nerve instability in the cubital tunnel on clinical examination. All patients were symptom free within 6 months after anterior transposition of the ulnar nerve.

Asunto(s)

Electromiografía , Nervio Cubital , Neuropatías Cubitales , Humanos , Adulto , Persona de Mediana Edad , Nervio Cubital/cirugía , Nervio Cubital/fisiopatología , Estudios Retrospectivos , Masculino , Resultado del Tratamiento , Femenino , Adulto Joven , Adolescente , Neuropatías Cubitales/cirugía , Neuropatías Cubitales/etiología , Neuropatías Cubitales/diagnóstico , Neuropatías Cubitales/fisiopatología , Recuperación de la Función , Factores de Tiempo , Articulación del Codo/cirugía , Articulación del Codo/fisiopatología , Síndrome del Túnel Cubital/cirugía , Síndrome del Túnel Cubital/diagnóstico , Síndrome del Túnel Cubital/fisiopatología , Síndrome del Túnel Cubital/etiología , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/efectos adversos

RESUMEN

Brachial artery access for coronary diagnostic or therapeutic procedures is associated with a greater risk of vascular complications. To determine whether 3D printing of a novel elbow joint fixation device could reduce postoperative complications after percutaneous coronary diagnostic or therapeutic procedures through the brachial artery. Patients who underwent percutaneous coronary diagnostic or therapeutic procedures by brachial access were randomly assigned to receive either a 3D-printed elbow joint fixation device (brace group) or traditional compression (control group) from March 2023 to December 2023. The severity of puncture site-related discomfort at 24 h postsurgery was significantly lower in the brace group (P = 0.014). Similarly, the upper arm calibration rate at 24 h postsurgery was significantly lower in the brace group [0.024 (0.019-0.046) vs. 0.077 (0.038-0.103), P < 0.001], as was the forearm calibration rate [0.026 (0.024-0.049) vs. 0.050 (0.023-0.091), P = 0.007]. The brace group had a significantly lower area of subcutaneous hemorrhage at 24 h postsurgery [0.255 (0-1.00) vs. 1 (0.25-1.75) cm2]. In patients who underwent percutaneous coronary diagnostic or therapeutic procedures by brachial access after manual compression hemostasis, the novel elbow joint fixation device was effective at reducing puncture site-related discomfort, alleviating the degree of swelling, and minimizing the subcutaneous bleeding area. Additionally, no significant complications were observed.Trial registration: China Clinical Trial Registration on 01/03/2023 (ChiCTR2300068791).

Asunto(s)

Arteria Braquial , Articulación del Codo , Intervención Coronaria Percutánea , Complicaciones Posoperatorias , Humanos , Masculino , Femenino , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/prevención & control , Persona de Mediana Edad , Anciano , Articulación del Codo/cirugía

RESUMEN

INTRODUCTION: Our study aims to characterize the results of Monteggia fractures treated in our practice and to determine factors associated with good or poor outcomes. METHODS: A retrospective review of children aged 17 and under with acute, subacute, or chronic Monteggia fractures who were treated at our institution was performed. The primary outcomes were initial reduction and maintenance of joint reduction, while the secondary outcomes were elbow flexion/extension and forearm supination/pronation. RESULTS: Seventeen patients with Monteggia fractures were identified. Two patients were excluded: 1 was lost to follow-up and 1 had congenital absence of the elbow flexors. Thus, our final cohort was 15 patients (acute n = 3, subacute n = 4, chronic group n = 8). Median final follow-up was 1.9 years (range = 34 days-8 years). CONCLUSION: Preoperative range of motion (ROM) was the most important factor in determining postoperative ROM in this cohort of patients with chronic Monteggia fractures. All patients who presented with excellent preoperative ROM, regardless of their timing category, had an excellent ROM outcome. Time from initial injury also played an important role. All patients in the acute and subacute categories had good or excellent postoperative ROM. Patients who were further from the initial injury were more likely to present with worse preoperative ROM and, in turn, had worse outcomes with postoperative ROM.

Asunto(s)

Articulación del Codo , Fractura de Monteggia , Rango del Movimiento Articular , Humanos , Fractura de Monteggia/cirugía , Fractura de Monteggia/fisiopatología , Masculino , Estudios Retrospectivos , Femenino , Niño , Rango del Movimiento Articular/fisiología , Adolescente , Enfermedad Crónica , Articulación del Codo/cirugía , Articulación del Codo/fisiopatología , Preescolar , Supinación/fisiología , Resultado del Tratamiento , Enfermedad Aguda , Pronación/fisiología , Fijación Interna de Fracturas/métodos , Estudios de Seguimiento

RESUMEN

BACKGROUND: There is no clear consensus on whether total elbow arthroplasty (TEA) or hemiarthroplasty (HA) is superior for treating distal humerus fractures in the elderly. This study analysed the functional outcomes and re-operation rates following TEA and HA for intra-articular distal humerus fractures in patients aged ≥65 years. METHODS: 19 patients (TEA = 12, HA = 7) treated between 2016 and 2022 were retrospectively reviewed. Mean age was 73 years and mean follow-up was 46 months. Functional outcomes and quality of life were assessed using the Mayo Elbow Performance Score (MEPS), Quick-DASH (Q-DASH), Oxford Elbow Score (OES), SF-12 Physical Component Score (PCS) and Mental Component Score (MCS), and EQ-5D. Complications requiring re-operation were recorded. RESULTS: HA showed superior outcomes in MEPS (93.6 vs 75.0, p = 0.0339), Q-DASH (13.3 vs 31.3, p = 0.0182), OES (41.7 vs 33.2, p = 0.0346), SF-12 PCS (55.5 vs 36.9, p = 0.0008) and EQ-5D (83 vs 67, p = 0.0023). One HA patient required revision to TEA for prosthetic joint infection. One TEA patient required revision for a periprosthetic ulna fracture. CONCLUSION: HA provides better functional outcomes compared to TEA in the treatment of distal humerus fractures in the elderly. Data is limited by selection bias and low patient numbers with a multicentre randomised controlled trial warranted.

Asunto(s)

Artroplastia de Reemplazo de Codo , Articulación del Codo , Hemiartroplastia , Fracturas del Húmero , Calidad de Vida , Rango del Movimiento Articular , Humanos , Femenino , Anciano , Masculino , Fracturas del Húmero/cirugía , Hemiartroplastia/métodos , Estudios Retrospectivos , Resultado del Tratamiento , Anciano de 80 o más Años , Articulación del Codo/cirugía , Articulación del Codo/fisiopatología , Reoperación/estadística & datos numéricos , Centros de Atención Terciaria , Recuperación de la Función , Complicaciones Posoperatorias , Fracturas Humerales Distales

RESUMEN

BACKGROUND: Tension band wire fixation (TBW) is a well-described method for treating displaced olecranon fractures. Further surgery is often needed due to wound breakdown or prominent hardware. An all-suture technique has recently been described as an alternative to TBW but radiographic and clinical outcome are not well established. The aim of this single-center retrospective cohort study was to evaluate outcome after treatment with all-suture technique for simple displaced olecranon fractures. METHODS: A retrospective review of olecranon fractures in patients (> 18 years) treated for displaced olecranon fractures with tension band suture fixation (TBSF) between February and August 2019 was performed in our facility. Primary outcome was revision surgery, which was assessed four years after surgery. Clinical and radiographical follow-up was performed at two weeks, six weeks, three months and six months to assess union rate, fracture displacement, range of motion (ROM), Quick-DASH and Oxford Elbow Score. RESULTS: A total of 24 patients were included. Median age was 64 years [IQR:39-73], 9 patients were male and median ASA score was 2 [IQR:1-2]. 15 fractures were Mayo type 2 A and 9 type 2B with minor comminution. At four-year follow-up, three patients had died. None of the remaining 21 patients had undergone revision surgery. At six months, the median Quick-DASH and Oxford Elbow Score were 2.3 [IQR:0-4.5] and 47 [IQR:46-48], respectively. Median elbow extension and flexion deficits were 0° [IQR:0-2.25] and 0° [IQR:0-0], respectively. Radiographic union was achieved in all patients. In two cases radiographic loss of reduction and malunion was observed but both patients were asymptomatic and had no functional deficits. One patient refractured the elbow due to a second trauma and was reoperated. CONCLUSIONS: TBSF is a promising technique for Mayo type 2 A and 2B fractures with minor comminution. There were no revision surgeries within the first four years. We found good functional outcomes and a high union rate.

Asunto(s)

Fijación Interna de Fracturas , Fractura de Olécranon , Técnicas de Sutura , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hilos Ortopédicos , Articulación del Codo/cirugía , Articulación del Codo/diagnóstico por imagen , Estudios de Seguimiento , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Fractura de Olécranon/diagnóstico por imagen , Fractura de Olécranon/cirugía , Olécranon/lesiones , Olécranon/cirugía , Olécranon/diagnóstico por imagen , Radiografía , Rango del Movimiento Articular , Reoperación , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven

RESUMEN

BACKGROUND: Osteochondritis dissecans (OCD) of the humeral capitellum is a rare and challenging condition to treat. Several surgical options exist, but in the last few years, the pendulum has swung from debridement and microfracture to restoration of the articular surface. Osteochondral autografts from the rib and knee have been described, but donor-site morbidity is a concern. PURPOSE: To expand the results of fresh osteochondral allograft transplantation (FOCAT) in a previously published report with inclusion of additional patients and a longer follow-up period. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: After institutional review board approval, the charts of patients who underwent FOCAT for OCD of the capitellum between 2006 and 2022 by a single surgeon were reviewed. The majority of cases (94%) had unstable lesions (Minami grades 2 and 3). A trial of nonoperative treatment had failed in all. All patients underwent diagnostic arthroscopy, followed by a mini-open, ligament-sparing approach with grafting using commercially available guides and instruments. RESULTS: A total of 35 patients were identified, of whom 25 were male. The mean age was 16 ± 3.9 years (range, 11-32 years). There were 24 baseball players (19 pitchers and 5 position players), 5 gymnasts, 3 cheerleaders/tumblers, 1 tennis player, 1 student (who did not participate in athletics), and 1 patient with avascular necrosis from chemotherapy. Eighteen patients had a mean flexion contracture of 14.1°± 11.9°. A single osteochondral allograft plug was used in 23 patients (mean diameter, 11.3 ± 2.8 mm), and 12 patients required 2 plugs (Mastercard technique). The mean follow-up was 92.6 ± 54.5 months (range, 24-204 months). There was significant improvement in Oxford (from 25.5 ± 4.9 to 46.7 ± 3.5; P < .00001) and visual analog scale for pain (from 7.5 ± 2 to 0.3 ± 1.0; P < .0001) scores. The mean Single Assessment Numeric Evaluation score at the time of follow-up was 90.6 ± 10.8 (range, 60-100). In overhead athletes, there was significant improvement in the Kerlan-Jobe Orthopaedic Clinic score (from 40.8 ± 11.8 to 90.6 ± 10.8; P < .00001). A postoperative magnetic resonance imaging scan was obtained in 16 (46%) patients at a mean of 32.6 months. In all cases, the graft was incorporated. All overhead athletes were able to return to their sport and perform at the same level or higher for >2 years. Two elbows required a subsequent arthroscopy for loose-body removal; otherwise, there were no other complications. CONCLUSION: FOCAT is an excellent option for treating OCD lesions of the humeral capitellum. Excellent outcomes and high return-to-sport rates were observed, with midterm follow-up showing no graft failures. FOCAT eliminates donor-site morbidity.

Asunto(s)

Osteocondritis Disecante , Humanos , Osteocondritis Disecante/cirugía , Masculino , Adolescente , Femenino , Niño , Adulto , Adulto Joven , Estudios Retrospectivos , Trasplante Óseo/métodos , Húmero/cirugía , Trasplante Homólogo , Artroscopía/métodos , Aloinjertos , Articulación del Codo/cirugía , Resultado del Tratamiento

RESUMEN

CASE: A 27-year-old man sustained chemical burns affecting 54% of his body caused by steam and acetic acid at a dyeing factory. He developed restricted bilateral elbow and shoulder motion because of heterotopic ossification (HO) beginning 3 months after the incident. The skin healed within 1 year, but ankylosis developed because of progressing ossification. We performed HO surgical excision in 4 stages. Two years after the final surgery, the function of both upper extremities had recovered. CONCLUSION: For HO caused by severe burns, improvement in upper extremity function can be achieved even if surgery is performed after skin healing.

Asunto(s)

Articulación del Codo , Osificación Heterotópica , Articulación del Hombro , Humanos , Osificación Heterotópica/cirugía , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/etiología , Masculino , Adulto , Articulación del Hombro/cirugía , Articulación del Hombro/diagnóstico por imagen , Articulación del Codo/cirugía , Articulación del Codo/diagnóstico por imagen , Quemaduras Químicas/cirugía , Quemaduras Químicas/complicaciones

RESUMEN

AIM: Elbow joint release surgery is commonly used to treat elbow joint stiffness. Though it can restore elbow joint mobility, some patients may still experience range of motion (ROM) loss after surgery. Therefore, this study aims to explore the factors influencing ROM loss after elbow joint release surgery in elderly patients with traumatic elbow stiffness. METHODS: This retrospective study included 122 elderly patients with traumatic elbow stiffness who underwent elbow joint release surgery at Hanzhong Central Hospital from January 2023 to April 2024. The patients with range of motion loss were included in the observation group (n = 41), and those without range of motion loss were placed in the control group (n = 81). The general data of the two groups were compared, and Logistic regression analysis was performed to identify factors influencing the loss of ROM after elbow joint release surgery in elderly patients with traumatic elbow stiffness. A risk prediction model was also established based on the identified risk factors. RESULTS: Multivariate Logistic regression analysis unveiled that high-energy injury (odds ratio (OR) = 4.632, 95% confidence interval (CI) = 1.363∼15.737), open injury (OR = 3.967, 95% CI = 1.308∼12.029), passive rehabilitation method (OR = 10.115, 95% CI = 1.113∼91.924), injury-to-release surgery time of ≥6 months (OR = 5.983, 95% CI = 1.677∼21.350), heterotopic ossification traumatic factors (OR = 5.409, 95% CI = 1.316∼22.224), and complex elbow joint damage (OR = 5.658, 95% CI = 1.457∼21.962) were all independent risk factors for ROM loss following elbow joint release surgery in elderly patients with traumatic elbow stiffness (p < 0.05). A risk prediction model was developed based on these factors, indicating a predictive sensitivity of 73.17%, a specificity of 69.14%, and an area under the curve (AUC) of 0.767. CONCLUSIONS: Clinically, the independent risk factors identified in this study should be closely monitored. Furthermore, treatment should be tailored based on the specific conditions of the patient, and high-risk factors should be effectively controlled to reduce the risk of ROM loss after elbow joint release surgery in traumatic elbow joint stiffness elderly patients.

Asunto(s)

Lesiones de Codo , Articulación del Codo , Rango del Movimiento Articular , Humanos , Estudios Retrospectivos , Articulación del Codo/cirugía , Articulación del Codo/fisiopatología , Anciano , Femenino , Masculino , Factores de Riesgo , Complicaciones Posoperatorias/etiología , Anciano de 80 o más Años , Persona de Mediana Edad

RESUMEN

OBJECTIVES: This study aims to investigate the etiological distribution of primary and metastatic malignancies around the elbow and the effect of surgical and adjuvant treatments on clinical outcome. PATIENTS AND METHODS: Between January 2006 and December 2020, medical records of a total of 33 patients with elbow neoplasm (15 males, 18 females; median age: 55 years; range, 39 to 71 years) who underwent surgical treatment and with or without clinical treatment were retrospectively analyzed. The outcomes and frequencies of the elbow metastatic and primary malignancies were evaluated. Data were collected from patients' medical and radiological documents, and a dedicated archive was created for this study. RESULTS: Most tumors occurred on the right side and were intra-articular or distal to the humerus. A total of 75.8% (25/33) of the patients had tumors of any diameter ≥5 cm. Most patients were treated with extensive resection. A total of 81.8% (27/33) of the patients had wide resected tumor margins, and 18.2% (6/33) had intralesional tumor margins. The median follow-up was 42 (range, 1 to 83) months. Synovial sarcoma and malignant peripheral nerve sheath tumors were the most common soft tissue sarcomas, and pulmonary adenoma and multiple myeloma were found in metastatic lesions. CONCLUSION: Elbow surgery is particularly challenging due to the interrelationship of major neurovascular structures. Synovial sarcoma and malignant peripheral nerve sheath tumors are the most common soft tissue sarcomas, and pulmonary adenoma and multiple myeloma are found in metastatic lesions. Limb-sparing surgery is the gold-standard method recently.

Asunto(s)

Neoplasias Óseas , Articulación del Codo , Humanos , Masculino , Persona de Mediana Edad , Femenino , Adulto , Anciano , Estudios Retrospectivos , Articulación del Codo/cirugía , Articulación del Codo/patología , Neoplasias Óseas/secundario , Resultado del Tratamiento , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/cirugía , Codo/patología

RESUMEN

CASE: A 10-year-old girl presented after closed reduction of an elbow fracture dislocation. She demonstrated intact vascularity but a dense median nerve palsy. Preoperative magnetic resonance neurography (MRN) precisely mapped the median nerve entrapped within the medial epicondylar fracture. Intraoperatively, the median nerve was freed preceding reduction and fracture fixation. Postoperatively, neurological symptoms completely resolved, and she regained full elbow function. CONCLUSION: Median nerve injury can present without associated vascular injury. In this case, MRN was helpful in preoperatively illustrating the spatial relationship between the median nerve and the medial epicondyle.

Asunto(s)

Lesiones de Codo , Imagen por Resonancia Magnética , Humanos , Femenino , Niño , Imagenología Tridimensional , Fractura-Luxación/diagnóstico por imagen , Fractura-Luxación/cirugía , Neuropatía Mediana/cirugía , Neuropatía Mediana/diagnóstico por imagen , Neuropatía Mediana/etiología , Síndromes de Compresión Nerviosa/diagnóstico por imagen , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/cirugía , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/cirugía , Nervio Mediano/diagnóstico por imagen , Nervio Mediano/lesiones , Nervio Mediano/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen

Asunto(s)

Articulación del Codo , Humanos , Articulación del Codo/cirugía , Lesiones de Codo

RESUMEN

BACKGROUND: Due to its unique anatomical characteristics, supracondylar fractures of the humerus are often difficult to achieve firm fixation with internal fixation equipment, resulting in delayed functional exercise, often leaving cubitus varus deformity, elbow stiffness, contractures, and other complications. Here, we report an adult patient with a supracondylar fracture of the humerus who underwent internal fixation through an anterior median incision in the humerus with our self-developed anterior anatomical locking plate of the distal humerus. CASE PRESENTATION: A 29-year-old male patient of Chinese ethnicity with trauma-induced right supracondylar fracture of the humerus and multiple soft tissue contusions, without nerve damage, blood vessel damage, or other injuries, underwent an internal incision in our hospital using a new anatomical locking plate for the anterior distal humerus fixed treatment. During the 16-month follow-up period, the patient's elbow range of motion was almost completely restored, functional scores were excellent, and there were no minor or major postoperative complications. CONCLUSION: In this study, we propose a surgical reconstruction strategy for adult patients with supracondylar humeral fractures. Through the anterior median incision of the humerus, open reduction and internal fixation were performed with an anatomic locking plate on the anterior side of the distal humerus to restore and fix the structure of the distal humerus, and satisfactory clinical results were achieved in our case.

Asunto(s)

Placas Óseas , Fijación Interna de Fracturas , Fracturas del Húmero , Rango del Movimiento Articular , Humanos , Masculino , Adulto , Fracturas del Húmero/cirugía , Fijación Interna de Fracturas/métodos , Articulación del Codo/cirugía , Resultado del Tratamiento , Lesiones de Codo

RESUMEN

Elbow arthroscopy is a useful tool that can be applied in a variety of surgical indications. However, performing the procedure safely demands a thorough understanding of the proximity of neurovascular structures around the elbow. Although nerve injuries in elbow arthroscopy are rare, complications can further be avoided by adhering to a set of principles designed to protect the surrounding neurovascular structures. Before making portals, the surgeon should palpate and mark the ulnar nerve to confirm its location in the groove. Next, the joint should be insufflated with fluid to distend the joint capsule and increase the distance between instruments and the anterior neurovascular structures. Anterior portals ideally should be made proximal to the medial and lateral epicondyles, thereby increasing distance from the median and radial nerve, respectively. Once in the joint, it is critical to stay oriented by maintaining instruments and the articular surfaces in the same view. Special caution should be exercised when in proximity to the capsule in the posteromedial gutter to protect the ulnar nerve. Similarly, the anterior inferior capsule should be approached with caution, as its violation puts branches of the radial nerve, specifically the posterior interosseous nerve, at risk. Elbow arthroscopy can be safely performed with proper knowledge and application of anatomy around the elbow when making portals and understanding at-risk areas beyond the capsule when working within the joint.

Asunto(s)

Artroscopía , Articulación del Codo , Traumatismos de los Nervios Periféricos , Humanos , Artroscopía/métodos , Articulación del Codo/cirugía , Traumatismos de los Nervios Periféricos/prevención & control , Traumatismos de los Nervios Periféricos/etiología , Nervio Cubital/lesiones , Nervio Radial/lesiones , Nervio Radial/anatomía & histología

RESUMEN

SUMMARY: Monteggia fracture is a complex fracture consisting of a proximal ulna fracture with a dislocation of the radial head. This review article highlights the relevant anatomy, clinical evaluation, classification, surgical management, recent innovation, and advancements with treating these injuries. A thorough understanding of these fractures allows for detailed operative plans and reconstitution of normal anatomy.

Asunto(s)

Fijación Interna de Fracturas , Fractura de Monteggia , Humanos , Fractura de Monteggia/cirugía , Fractura de Monteggia/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Articulación del Codo/cirugía , Articulación del Codo/diagnóstico por imagen , Lesiones de Codo , Luxaciones Articulares/cirugía , Luxaciones Articulares/diagnóstico por imagen , Fractura-Luxación/cirugía , Fractura-Luxación/diagnóstico por imagen , Radiografía

RESUMEN

Heterotopic ossification (HO) is characterized by the formation of pathological bone within the soft tissues. HO predominantly affects elbow joints and may be accompanied by tardy ulnar nerve palsy. This study aimed to explore the clinical and functional outcomes of patients with tardy ulnar nerve palsy caused by HO following surgical treatment, with a review of the relevant literature. A retrospective study was conducted on 4 patients with tardy ulnar nerve palsy caused by HO, who underwent anterior subcutaneous ulnar nerve transposition between 2015 and 2020. The patients were followed up for more than 1 year and the cause of HO was also identified. Clinical and functional outcomes were evaluating using the grip strength and pinch strength, visual analog scale (VAS) pain score and Quick disabilities of the arm, shoulder and hand (DASH) score. The causes of HO were repetitive micro-trauma in 1 case and excessive physical or rehabilitation therapy in 3 cases. The average follow-up period was 15.6 months (range; 12-21 months). The grip strength increased from an average of 14kg to 26.5kg. The pinch strength increased from an average of 1.5 kg to 3.63 kg. The Quick DASH score decreased from an average of 55.6 to 6.15. The VAS score for pain decreased from an average of 7 to 0.25. Rapid surgical treatment, including removal of the heterotopic bone and ulnar nerve anterior transposition, might improve outcomes in patients with tardy ulnar nerve palsy caused by HO.

Asunto(s)

Osificación Heterotópica , Humanos , Osificación Heterotópica/cirugía , Masculino , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Adulto , Neuropatías Cubitales/cirugía , Neuropatías Cubitales/etiología , Fuerza de la Mano , Articulación del Codo/cirugía , Articulación del Codo/fisiopatología , Nervio Cubital/cirugía , Resultado del Tratamiento , Dimensión del Dolor , Anciano