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/fisiologíaRESUMEN
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 JovenRESUMEN
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/complicacionesRESUMEN
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 imagenRESUMEN
BACKGROUND: The relationship between abnormalities of the ulnar collateral ligament (UCL) on magnetic resonance imaging (MRI) and elbow symptoms in baseball players remains unclear. PURPOSE/HYPOTHESIS: This study aimed to compare findings of the UCL on microscopic MRI between asymptomatic and symptomatic elbows in baseball players. We hypothesized that the MRI grade of UCL injuries would exhibit no correlation with medial elbow symptoms in baseball players. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: The study participants were skeletally mature baseball players who underwent high-resolution microscopic MRI of the medial elbow including for medical checkups. Elbows with previous surgical treatment or traumatic UCL injuries were excluded. The patients were divided into symptomatic and asymptomatic groups. The UCL appearance on microscopic MRI was categorized into 4 grades and compared between the groups. Abnormal findings in the medial elbow including bony fragments at the medial epicondyle, osteophytes or bony fragments in the sublime tubercle, and bone marrow edema (BME) in the sublime tubercle were also evaluated. RESULTS: A total of 426 baseball players (426 elbows) with a mean age of 20 years (range, 14-41 years) were included. The asymptomatic and symptomatic groups included 158 and 268 elbows, respectively. In the asymptomatic group, based on MRI grading of the UCL, 46 (29%) elbows were rated as grade I, 64 (41%) as grade II, 40 (25%) as grade III, and 8 (5%) as grade IV. In the symptomatic group, 75 (28%) elbows were rated as grade I, 118 (44%) as grade II, 61 (23%) as grade III, and 14 (5%) as grade IV. There was no significant difference in the MRI grades between the groups (P = .9). BME in the sublime tubercle was more frequently seen in the symptomatic group than in the asymptomatic group (P < .001). CONCLUSION: There was no difference in MRI grades of the UCL between symptomatic and asymptomatic elbows in baseball players; approximately 30% of elbows demonstrated high-grade UCL injuries in both groups. BME in the sublime tubercle was more frequently seen in symptomatic elbows than in asymptomatic elbows. BME in the sublime tubercle was a better indicator of symptoms than was MRI grading of the UCL.
Asunto(s)
Béisbol , Ligamento Colateral Cubital , Lesiones de Codo , Imagen por Resonancia Magnética , Humanos , Béisbol/lesiones , Ligamento Colateral Cubital/lesiones , Ligamento Colateral Cubital/diagnóstico por imagen , Estudios Transversales , Adolescente , Adulto Joven , Adulto , Masculino , Articulación del Codo/diagnóstico por imagen , Traumatismos en Atletas/diagnóstico por imagenRESUMEN
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 , RadiografíaRESUMEN
PURPOSE: Comminuted coronal shear fractures of the distal humerus represent rare injuries and are difficult to treat, especially comminuted capitellum and trochlear fractures (Dubberley Type III). The on-table reconstruction technique of comminuted articular fractures may be an option, although it has not been reported in the coronal shear fracture of the distal humerus. The aim of the present case series is to determine the functional and radiological outcomes of on-table reconstructed Dubberley III fractures. METHODS: A retrospective review was conducted of 10 patients with Dubberley type III fractures in coronal shear fractures of the capitellum and trochlea who underwent an 'on-table' reconstruction technique between January 2009 and October 2019. All patients were evaluated using the disabilities of the arm, shoulder, and hand (DASH) score, American Shoulder and Elbow Surgeons(ASES) score, Mayo Elbow Score Performance Index (MEPI) score and at least 4 years later. RESULTS: All cases achieved union. At the final follow-up, the mean range of elbow motion was 11.5°of flexion contracture and 131.9° of further flexion. The mean DASH score was 21.2 (5.7) points (range 13.3-32.5). The mean ASES score was 88.6 ± 7.4 (range, 77 to 100). The mean MEPI score was 87 (10) points (range 70-100). In complication, partial osteonecrosis of capitellum is developed in one patient. One patient had heterotopic ossification without functional impairment. CONCLUSION: The on-table reconstruction technique can be a reliable option in the surgical treatment of complex distal humerus fractures. This technique allows anatomical reduction of comminuted capitellum and trochlea, with a low risk of avascular necrosis over 4 years of follow-up. LEVEL OF EVIDENCE: Level IV, retrospective case series.
Asunto(s)
Articulación del Codo , Fracturas Conminutas , Fracturas del Húmero , Rango del Movimiento Articular , Humanos , Masculino , Estudios Retrospectivos , Femenino , Fracturas del Húmero/cirugía , Fracturas del Húmero/diagnóstico por imagen , Persona de Mediana Edad , Adulto , Resultado del Tratamiento , Fracturas Conminutas/cirugía , Fracturas Conminutas/diagnóstico por imagen , Articulación del Codo/cirugía , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/fisiopatología , Fijación Interna de Fracturas/métodos , Anciano , Estudios de Seguimiento , Procedimientos de Cirugía Plástica/métodos , Adulto JovenRESUMEN
BACKGROUND: For the treatment of coronoid process fractures, medial, lateral, anterior, anteromedial, and posterior approaches have been increasingly reported; however, there is no general consensus on the method of fixation of coronal fractures. Here, we present a highly-extensile minimally invasive approach to treat coronoid process fractures using a mini-plate that can achieve anatomic reduction, stable fixation, and anterior capsular repair. Further, the study aimed to determine the complication rate of the anterior minimally invasive approach and to evaluate functional and clinical patient-reported outcomes during follow-up. METHODS: Thirty-one patients diagnosed with coronoid fractures accompanied with a "terrible triad" or posteromedial rotational instability between April 2012 and October 2018 were included in the analysis. Anatomical reduction and mini-plate fixation of coronoid fractures were performed using an anterior minimally invasive approach. Patient-reported outcomes were evaluated using the Mayo Elbow Performance Index (MEPI) score, range of motion (ROM), and the visual analog score (VAS). The time of fracture healing and complications were recorded. RESULTS: The mean follow-up time was 26.7 months (range, 14-60 months). The average time to radiological union was 3.6 ± 1.3 months. During the follow-up period, the average elbow extension was 6.8 ± 2.9° while the average flexion was 129.6 ± 4.6°. According to Morrey's criteria, 26 (81%) elbows achieved a normal desired ROM. At the last follow-up, the mean MEPI score was 98 ± 3.3 points. There were no instances of elbow instability, elbow joint stiffness, subluxation or dislocation, infection, blood vessel complications, or nerve palsy. Overall, 10 elbows (31%) experienced heterotopic ossification. CONCLUSION: An anterior minimally invasive approach allows satisfactory fixation of coronoid fractures while reducing incision complications due to over-dissection of soft tissue injuries. In addition, this incision does not compromise the soft tissue stability of the elbow joint and allows the patient a more rapid return to rehabilitation exercises.
Asunto(s)
Placas Óseas , Articulación del Codo , Fijación Interna de Fracturas , Fracturas Conminutas , Rango del Movimiento Articular , Fracturas del Cúbito , Humanos , Masculino , Femenino , Fracturas del Cúbito/cirugía , Fracturas del Cúbito/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Persona de Mediana Edad , Adulto , Fracturas Conminutas/cirugía , Fracturas Conminutas/diagnóstico por imagen , Articulación del Codo/cirugía , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/fisiopatología , Resultado del Tratamiento , Estudios Retrospectivos , Estudios de Seguimiento , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Curación de Fractura , Anciano , Medición de Resultados Informados por el Paciente , Adulto JovenRESUMEN
OBJECTIVE: In this study, we investigated the efficacy of percutaneous poking reduction and Kirschner wire fixation in older children with irreducible supracondylar flexion-type fractures of the humerus. METHODS: This retrospective investigation included 27 children, comprising 15 males and 12 females, aged between 10 years and 3 months to 14 years and 11 months, all diagnosed with a flexion-type supracondylar fracture of the humerus within one week of trauma. All patients underwent surgery under general anesthesia. Following unsuccessful manual reduction, percutaneous poking reduction with Kirschner wires was performed under C-arm fluoroscopy to achieve fracture reduction. Following successful reduction, three 2.0 mm Kirschner wires were inserted in a cross pattern to secure the fracture ends. Postoperatively, the elbow joint was immobilized in a functional position with a plaster cast for four weeks. RESULTS: Follow-up in the outpatient department ranged from 9 to 36 months. Clinical functional assessment using Flynn's criteria rated 24 cases as excellent, 2 as good, and 1 as fair, yielding an overall efficacy of 96.3%. No cases of fracture re-displacement, fracture fragment necrosis, or other complications such as nonunion, iatrogenic nerve injury, myositis ossificans, or long-term elbow joint dysfunction were observed during the postoperative follow-up. CONCLUSION: The percutaneous poking reduction and Kirschner wire fixation technique is a simple and reliable procedure for treating irreducible flexion-type supracondylar fractures of the humerus in older children, with minimal trauma. This technique offers substantial stability for the fracture and results in excellent long-term recovery of joint function.
Asunto(s)
Hilos Ortopédicos , Fracturas del Húmero , Procedimientos Quirúrgicos Mínimamente Invasivos , Humanos , Femenino , Masculino , Niño , Fracturas del Húmero/cirugía , Fracturas del Húmero/diagnóstico por imagen , Estudios Retrospectivos , Adolescente , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Fijación Interna de Fracturas/métodos , Rango del Movimiento Articular , Resultado del Tratamiento , Estudios de Seguimiento , Articulación del Codo/cirugía , Articulación del Codo/diagnóstico por imagenRESUMEN
The human body constantly experiences mechanical loading. However, quantifying internal loads within the musculoskeletal system remains challenging, especially during unconstrained dynamic activities. Conventional measures are constrained to laboratory settings, and existing wearable approaches lack muscle specificity or validation during dynamic movement. Here, we present a strategy for estimating corresponding joint torque from muscles with different architectures during various dynamic activities using wearable A-mode ultrasound. We first introduce a method to track changes in muscle thickness using single-element ultrasonic transducers. We then estimate elbow and knee torque with errors less than 7.6% and coefficients of determination (R2) greater than 0.92 during controlled isokinetic contractions. Finally, we demonstrate wearable joint torque estimation during dynamic real-world tasks, including weightlifting, cycling, and both treadmill and outdoor locomotion. The capability to assess joint torque during unconstrained real-world activities can provide new insights into muscle function and movement biomechanics, with potential applications in injury prevention and rehabilitation.
Asunto(s)
Músculo Esquelético , Torque , Ultrasonografía , Dispositivos Electrónicos Vestibles , Humanos , Masculino , Ultrasonografía/métodos , Ultrasonografía/instrumentación , Fenómenos Biomecánicos , Adulto , Músculo Esquelético/fisiología , Músculo Esquelético/diagnóstico por imagen , Adulto Joven , Articulación de la Rodilla/fisiología , Articulación de la Rodilla/diagnóstico por imagen , Articulación del Codo/fisiología , Articulación del Codo/diagnóstico por imagen , Femenino , Movimiento/fisiología , Articulaciones/fisiología , Articulaciones/diagnóstico por imagen , Contracción Muscular/fisiologíaRESUMEN
Radial neck fractures with radial head rotation are very rare and extremely difficult to manage. We present the case of an 11-year-old girl who fell on her outstretched left upper extremity and damaged her left elbow in a road traffic accident. An arthrotomy was performed under a C-Arm fluoroscope, which confirmed the radial head displacement of 180° along with the fracture. The fracture site was reduced and fixed with two Kirschner wires, cutting the wire short at its distal end for a complete closure. Open reduction and internal fixation were followed by casting for five weeks. After two years of follow-up, she had complete pain free range of motion of the affected limb. No post-operative complications have been observed till date. Open reduction and internal fixation with two Kwires is a viable option for such complex injuries. However, further evaluation of outcomes and post-operative complications are required.
Asunto(s)
Fijación Interna de Fracturas , Fracturas Radiales de Cabeza y Cuello , Niño , Femenino , Humanos , Accidentes de Tránsito , Hilos Ortopédicos , Lesiones de Codo , Articulación del Codo/cirugía , Articulación del Codo/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Reducción Abierta/métodos , Fracturas Radiales de Cabeza y Cuello/diagnóstico por imagen , Fracturas Radiales de Cabeza y Cuello/cirugía , Rango del Movimiento Articular , RotaciónRESUMEN
ABSTRACT: Chen, P-T, Lin, Y-C, Chang, H-Y, Chiu, C-H, Chen, C-Y, Chen, P, and Lin, Y-H. Effects of shoulder corrective training program on pitching loads and sonographic morphology in elbow joint in youth baseball players. J Strength Cond Res 38(8): e440-e447, 2024-We assessed the effects of a 12-week shoulder corrective training program for shoulder flexibility and strengthening on pitching loads and sonographic morphology of the elbow joints in youth baseball players. Seventeen subjects were recruited and underwent evaluations before and after the training program. We found that following training, subjects demonstrated significantly increased ranges of shoulder internal rotation (38.9 ± 12.9° vs. 69.2 ± 10.8°, p < 0.001), external rotation (91.2 ± 14.6° vs. 107.3 ± 9.5°, p = 0.004), and horizontal adduction (21.5 ± 8.0° vs. 32.7 ± 7.3°, p = 0.002); improved strength in the shoulder internal rotators (8.7 ± 1.6 kg vs. 9.8 ± 2.1 kg, p = 0.04), external rotators (6.5 ± 1.9 kg vs. 7.5 ± 2.8 kg, p = 0.04), middle trapezius (12.7 ± 2.1 kg vs. 14.3 ± 2.4 kg, p = 0.04), and middle deltoid muscles (10.8 ± 3.3 kg vs. 14.8 ± 3.2 kg, p = 0.001); and decreased thickness of the ulnar collateral ligament (6.1 ± 0.6 mm vs. 4.8 ± 0.7 mm, p = 0.002). Although there was no substantial change in elbow torque and arm speed, significantly increased ball speed (51.2 ± 4.6 mph vs. 54.1 ± 4.5 mph, p < 0.001) and decreased arm slot (63.8 ± 11.9° vs. 53.0 ± 12.7°, p = 0.02) were observed. We suggest that adequate corrective training should be performed regularly to minimize or mitigate adverse soft tissue changes at the elbow in youth baseball players. Balanced shoulder strength and flexibility may decrease medial elbow stress during pitching. Future studies should consider the kinetic and kinematic effects of other corrective training programs on the shoulder or elbow joint during pitching.
Asunto(s)
Béisbol , Articulación del Codo , Rango del Movimiento Articular , Ultrasonografía , Humanos , Béisbol/fisiología , Articulación del Codo/fisiología , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/anatomía & histología , Adolescente , Masculino , Rango del Movimiento Articular/fisiología , Articulación del Hombro/fisiología , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/anatomía & histología , Fuerza Muscular/fisiología , Rotación , Hombro/fisiología , Hombro/diagnóstico por imagen , Hombro/anatomía & histología , NiñoRESUMEN
The pediatric elbow is a complex joint that undergoes rapid growth and development. The normal anatomy of the elbow varies depending on the age of the patient, which can be challenging for imaging interpretation. This article reviews developmental variants and common pathologies of the pediatric elbow, with a focus on their radiologic features. Normal anatomy and development of the pediatric elbow are discussed, including the six ossification centers and elbow alignment. Congenital anomalies such as longitudinal deficiencies of the upper extremity are reviewed. Some common injuries that affect the elbow, such as supracondylar fracture, lateral condyle fracture, medial epicondyle avulsion, and radial head dislocation are also described.
Asunto(s)
Lesiones de Codo , Articulación del Codo , Humanos , Niño , Articulación del Codo/diagnóstico por imagen , Artropatías/diagnóstico por imagen , Preescolar , Diagnóstico por Imagen/métodos , LactanteRESUMEN
OBJECTIVE: The goal of minced cartilage implantation (MCI) is to restore an intact cartilage surface in focal osteochondral lesions of the humeral capitellum. INDICATIONS: The indications for MCI are limited osteochondral lesions at the humeral capitellum, also at the head of the radius, with intact cartilage border as well as in situ or a completely detached fragment, and free joint bodies (grade II-grade V according to Hefti). CONTRAINDICATIONS: Contraindications for MCI are already concomitant or associated cartilage damage as well as bilateral osteochondral lesions and insufficient available cartilage material. SURGICAL TECHNIQUE: After diagnostic arthroscopy to detect possible concomitant pathologies and to exclude already corresponding cartilage lesions, the arthroscope is flipped posterolaterally over the high posterolateral portal and a second portal is created under visualization via the soft spot. Initially, debridement of the focal cartilage defect, assessment of the marginal zone, and/or salvage of free joint bodies. Using a smooth shaver and the filter provided, the partially or even completely detached cartilage fragment is unidirectionally fragmented under continuous suction. The remaining defect with a stable marginal zone is cleanly curetted, and the joint is completely dried. The fragmented cartilage collected in the filter is bonded to a membrane using autologous conditioned plasma (ACP) and then arthroscopically applied to the defect via a cannula, sealed using thrombin and fibrin. POSTOPERATIVE MANAGEMENT: Postoperative immobilization in a cast for at least 24â¯h is required. Afterwards, free exercise of the joint is possible, but no loading should be maintained for 6 weeks. Return to sport after 3 months. RESULTS: Good to very good clinical and MRI morphologic results are already evident in the short-term course. Prospective and retrospective multicenter studies are needed to evaluate future long-term results.
Asunto(s)
Cartílago Articular , Humanos , Resultado del Tratamiento , Masculino , Cartílago Articular/cirugía , Cartílago Articular/diagnóstico por imagen , Femenino , Adulto , Artroscopía/métodos , Articulación del Codo/cirugía , Articulación del Codo/diagnóstico por imagen , Lesiones de Codo , Húmero/cirugía , Húmero/diagnóstico por imagen , Persona de Mediana EdadRESUMEN
Elbow computerized tomography (CT) scans have been widely applied for describing elbow morphology. To enhance the objectivity and efficiency of clinical diagnosis, an automatic method to recognize, segment, and reconstruct elbow joint bones is proposed in this study. The method involves three steps: initially, the humerus, ulna, and radius are automatically recognized based on the anatomical features of the elbow joint, and the prompt boxes are generated. Subsequently, elbow MedSAM is obtained through transfer learning, which accurately segments the CT images by integrating the prompt boxes. After that, hole-filling and object reclassification steps are executed to refine the mask. Finally, three-dimensional (3D) reconstruction is conducted seamlessly using the marching cube algorithm. To validate the reliability and accuracy of the method, the images were compared to the masks labeled by senior surgeons. Quantitative evaluation of segmentation results revealed median intersection over union (IoU) values of 0.963, 0.959, and 0.950 for the humerus, ulna, and radius, respectively. Additionally, the reconstructed surface errors were measured at 1.127, 1.523, and 2.062 mm, respectively. Consequently, the automatic elbow reconstruction method demonstrates promising capabilities in clinical diagnosis, preoperative planning, and intraoperative navigation for elbow joint diseases.
Asunto(s)
Algoritmos , Articulación del Codo , Imagenología Tridimensional , Tomografía Computarizada por Rayos X , Humanos , Articulación del Codo/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Imagenología Tridimensional/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Radio (Anatomía)/diagnóstico por imagen , Cúbito/diagnóstico por imagen , Húmero/diagnóstico por imagenRESUMEN
CASE: We present a case of type II (intraosseous) entrapment of the median nerve in a patient who was diagnosed based on clinical examination and magnetic resonance imaging and who was treated with medial epicondyle osteotomy, neurolysis, and transposition of the nerve to its anatomical position within a month of injury. Our patient made a complete motor and sensory recovery at 5 months with complete functionality and grip strength. CONCLUSION: Median nerve entrapment after posterolateral elbow dislocation is a rare complication with roughly 40 cases reported in the literature. This case illustrates the importance of prompt diagnosis and treatment.
Asunto(s)
Lesiones de Codo , Luxaciones Articulares , Humanos , Luxaciones Articulares/cirugía , Luxaciones Articulares/diagnóstico por imagen , Masculino , Articulación del Codo/cirugía , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/inervación , Síndromes de Compresión Nerviosa/cirugía , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/diagnóstico por imagen , Neuropatía Mediana/cirugía , Neuropatía Mediana/etiología , Niño , Imagen por Resonancia Magnética , Nervio Mediano/lesiones , Nervio Mediano/cirugía , Nervio Mediano/diagnóstico por imagenRESUMEN
CASE: A 10-year-old, postmenarchal girl presented to the emergency department with a closed, displaced, intercondylar T-type distal humerus fracture. Open reduction and internal fixation was performed 3 days following initial presentation. The patient healed but experienced elbow stiffness in the 7 months following the procedure. Implant removal and capsular release were performed at that time. At the 31-month follow-up, the patient reported satisfactory elbow functionality. CONCLUSION: There is limited literature available discussing optimal management and associated outcomes of intercondylar T-type distal humerus fractures in the young-adolescent population. This report presents a possible method for management of the initial injury and the most common associated complication.
Asunto(s)
Fijación Interna de Fracturas , Fracturas del Húmero , Humanos , Femenino , Fracturas del Húmero/cirugía , Fracturas del Húmero/diagnóstico por imagen , Niño , Fijación Interna de Fracturas/métodos , Lesiones de Codo , Articulación del Codo/cirugía , Articulación del Codo/diagnóstico por imagen , Fracturas Humerales DistalesRESUMEN
CASE: A 14-year-old adolescent boy with SCN1B mutation experienced frequent seizures and recurrent elbow dislocation, occurring up to 30 times per day. Following failed conservative treatment, the decision was made to surgically repair the lateral collateral ligament complex and stabilize the elbow with the internal joint stabilizer (IJS). At more than 3 years postoperatively, the patient has not had a dislocation event and will retain the device for the foreseeable future to maintain predictable elbow stability. CONCLUSION: Although there is scant evidence supporting the use of the IJS in pediatric cases, the current case supports its use in pediatric elbow instability.