RESUMEN
Abstract Objective To compare the use of cannulated screws and smooth Kirschner wires in terms of reducing the presence of exuberant callus and complications in pediatric displaced fractures of the lateral humeral condyle. Methods An analytical cross-sectional study of consecutive cases was conducted from May to October 2021 with 30 children with displaced external humeral condyle fractures. The functional results regarding pain and range of motion were stratified using the Dhillon grading system. Results A total of 19 patients underwent Kirschner wire fixation, and 11 underwent cannulated screw fixation. Closed fixation was performed in 14 cases (47%), and open fixation, in 16 (53%). Of the cases included, there was no loss to follow-up. Te sample was composed of 21 (70%) male patients, and the age ranged from 5 to 15 years, with a mean of 6.96 years. The most frequent cause of fracture was fall from height (50%), which was related to greater displacement on baseline radiographs. Complications that were not related to the reduction approach or the implant used were observed in 12 (40%) cases. Conclusion The present study shows no benefits in relation to the use of smooth pins or cannulated screws to reduce the presence of exuberant callus in the consolidation of the fracture. We see that the complications that arise are related to the severity of the injury, and benefits cannot be identified in the choice of one implant over another. We could see that the Weiss classification helps to define the behavior in favor of open or closed reduction without interfering in kindness of the smooth pin or the cannulated screw for fracture fixation.
Resumo Objetivo Comparar o uso de parafusos canulados e de fios de Kirschner lisos em termos da redução da presença de calo exuberante e de complicações em fraturas pediátricas deslocadas do côndilo lateral do úmero. Métodos Um estudo analítico transversal de casos consecutivos foi realizado de maio a outubro de 2021 com 30 crianças com fraturas deslocadas de côndilo umeral externo. Os resultados funcionais para dor e amplitude de movimento foram estratificados utilizando o sistema de classificação Dhillon. Resultados Ao todo, 19 pacientes foram submetidos à fixação de fio Kirschner, e 11 à fixação de parafusos canulados. A fixação realizada foi fechada em 14 casos (47%) e aberta em 16 (53%). Dos casos incluídos, não houve perda no acompanhamento. A amostra continha 21 (70%) pacientes do sexo masculino, e a idade variou de 5 a 15 anos, com média de 6,96 anos. A causa mais frequente de fratura foi queda de altura (50%), e esteve relacionada ao maior deslocamento nas radiografias da linha de base. Complicações que não estavam relacionadas à abordagem de redução ou ao implante utilizado foram observadas em 12 (40%) casos. Conclusão Este estudo não mostra benefícios em relação ao uso de pinos lisos ou de parafusos canulados para reduzir a presença de calo exuberante na consolidação da fratura. Vemos que as complicações que surgem estão relacionadas à gravidade da lesão, e não é possível identificar benefícios na escolha de um implante ou outro. Pudemos ver que a classificação de Weiss ajuda a definir o comportamento em favor da redução aberta ou fechada sem dar preferência ao pino liso ou ao parafuso canulado para a fixação da fratura.
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Humanos , Niño , Adolescente , Tornillos Óseos , Hilos Ortopédicos , Lesiones de Codo , Fracturas del Húmero/cirugíaRESUMEN
PURPOSE: Ligament repair with suture-tape augmentation has been used in the operative treatment of joint instability and may have advantages with respect to early motion and stability. The purpose of this investigation was to describe the clinical results of traumatic elbow instability treated with lateral ulnar collateral ligament repair with suture-tape augmentation. METHODS: All cases of acute and chronic elbow instability treated surgically between 2018 and 2020 were included if they underwent ligament repair with suture-tape augmentation of the lateral ulnar collateral ligament as part of the procedure. Cases with <6 months of follow-up were excluded. A manual chart review was performed to record patient demographics as well as injury and surgery characteristics. Radiographic outcomes, range of motion, and patient-reported outcome measures, including the visual analog pain scale and Disabilities of the Arm, Shoulder, and Hand, were recorded. Range of motion measurements were recorded at the end of the clinical follow-up, as were surgical complications. RESULTS: Eighteen cases were included with a mean follow-up of 20 months. Five (28%) cases involved a high-energy mechanism, and 11 (62%) cases involved terrible triad fracture dislocations. The mean Disabilities of the Arm, Shoulder, and Hand questionnaire and visual analog pain scale scores were 17 and 2, respectively. The mean flexion-extension arc was 124°, and 2 (11%) cases had <100° flexion-extension arc. There were 2 (11%) postoperative complications, and both cases had postoperative instability requiring reoperation. We observed no cases of capitellar erosion from the suture-tape material. CONCLUSIONS: For complex elbow instability, ligament repair with suture-tape augmentation of the lateral ulnar collateral ligament results in acceptable functional outcomes and a reoperation rate comparable with other joint stabilization procedures. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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Ligamento Colateral Cubital , Ligamentos Colaterales , Lesiones de Codo , Articulación del Codo , Inestabilidad de la Articulación , Humanos , Codo , Articulación del Codo/cirugía , Ligamento Colateral Cubital/cirugía , Ligamento Colateral Cubital/lesiones , Inestabilidad de la Articulación/cirugía , Resultado del Tratamiento , Suturas , Ligamentos Colaterales/lesiones , Rango del Movimiento ArticularRESUMEN
Abstract Objective To evaluate the functional results of patients submitted to a surgical approach for the treatment of the terrible triad of the elbow, analyzing the treatment methods used and associated epidemiological variables. Methods Patients who underwent surgical treatment for the terrible triad of the elbow from February 2018 to June 2020 at our service were evaluated. The identified sample consisted of 17 patients, but of these, only 13 completed all stages of the study and, therefore, were considered as the universe to be considered. Epidemiological information of interest was collected: age, sex, hand of dominance, affected side, characteristics and classification of injuries, trauma mechanism, time to surgery, type of procedure performed and range of motion. The Mason classification was used for radial head fractures and the Regan and Morrey classification for the coronoid process. In order to perform a functional analysis, the DASH and BRUCE questionnaires were applied. Results About 77% of the patients were male, 92% of the fracture mechanisms were due to high-energy trauma. Contrary to this, the predominance of the non-dominant side was observed as the most affected. Evaluating the results according to the time to start the treatment, the patients operated within 14 days had statistically better functional results. Conclusion Surgical treatment of TTIE generates acceptable functional results in most cases. The success of the treatment is related to the time interval between the trauma and the first surgery, in addition to the severity of the injuries.
Resumo Objetivo Avaliar os resultados funcionais dos pacientes submetidos a abordagem cirúrgica para o tratamento da tríade terrível do cotovelo, analisando os métodos de tratamento utilizados e variáveis epidemiológicas associadas. Métodos Foram avaliados pacientes submetidos aotratamento cirúrgico de tríade terrível do cotovelo de fevereiro de 2018 a junho de 2020 em nosso serviço. A amostra identificada foi de 17 pacientes, mas destes apenas 13 concluíram todas as etapas das pesquisas e por isso foram considerados como o universo a ser levado em consideração. Coletou-se informações epidemiológicas de interesse: idade, sexo, dominância, lado acometido, características e classificações das lesões, mecanismo do trauma, tempo para cirurgia, tipo de procedimento realizado e o arco de movimento. Foi utilizada a classificação de Mason para a fratura de cabeça do rádio e a de Regan e Morrey, para o processo coronoide. A fim de realizar uma análise funcional, aplicou-se os questionários de DASH e BRUCE. Resultados Cerca de 77% dos pacientes foram do sexo masculino, 92% dos mecanismos de fratura foram por trauma de alta energia. Contrariamente a esta, observou-se a predominância do lado não dominante como o mais afetado. Avaliando os resultados de acordo com o tempo para início do tratamento, os pacientes operados em até 14 dias obtiveram resultados funcionais estatisticamente melhores. Conclusão O tratamento cirúrgico da TTC gera resultados funcionais aceitáveis na maioria dos casos. O sucesso do tratamento está relacionado ao intervalo de tempo entre o trauma e a primeira cirurgia, além de se relacionar com a gravidade das lesões.
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Humanos , Masculino , Femenino , Cúbito/lesiones , Articulación del Codo , Lesiones de Codo , Fracturas Radiales de Cabeza y CuelloRESUMEN
Es conocido que el codo se disloca con frecuencia, y corresponde a la primera causa de luxación en niños y a la segunda causa en adultos. Respecto a las fracturas distales, representan un tercio de todas las fracturas del húmero en población adulta. Por lo general, se presentan en una distribución bimodal que afecta a hombres jóvenes o a mujeres ancianas. En este artículo, reportamos un caso clínico poco frecuente de luxación de codo izquierdo complicada, producto de fractura del húmero distal, en una mujer de 64 años. La lesión comprende una luxación posterolateral de codo izquierdo complicada con fractura articular parcial (compromiso del cóndilo y de la tróclea humeral externa), sagital, multifragmentaria, de húmero distal que requirió tres intervenciones quirúrgicas y terapia de rehabilitación por seis meses que finalizaron en recuperación funcional de la estabilidad de la articulación del codo. El caso reportado es particular debido a la individualidad del paciente con sus comorbilidades, el mecanismo de producción de la luxofractura, el abordaje quirúrgico, y el éxito del tratamiento instaurado. Sin embargo, este éxito terapéutico debe ser confirmado en series de casos
It is known that the elbow is dislocated frequently, representing the first cause of dislocation in children and the second cause in adults. Regarding distal humerus fractures, they represent a third of all humerus fractures in the adult population. They generally occur in a bimodal distribution, affecting young men or elderly women. In the present article, we report a rare clinical case of a complicated left elbow dislocation due to a distal humerus fracture in a 64-year-old woman. The lesion includes a posterolateral dislocation of the left elbow complicated by a sagittal, multifragmentary, partial articular fracture (compromise of the condyle and external humeral trochlea) of the distal humerus which required three surgical interventions and rehabilitation therapy for six months and resulted in functional recovery of the stability of the elbow joint. The case herein reported is particular due to the individuality of the patient, with her comorbidities, the mechanism of production of the fracture-dislocation, the surgical approach, and the success of the established treatment. This therapeutic success must be confirmed in series of cases
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Humanos , Femenino , Persona de Mediana Edad , Luxaciones Articulares/cirugía , Lesiones de Codo/cirugía , Fracturas Humerales Distales/cirugía , Tomografía Computarizada por Rayos X/métodos , Luxaciones Articulares/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Lesiones de Codo/diagnóstico por imagen , Fracturas Humerales Distales/diagnóstico por imagenRESUMEN
Ulnar collateral ligament (UCL) injuries of the elbow are common in overhead throwing athletes. With throwing, the elbow experiences substantial valgus stress and repetitive microtrauma can lead to injury. Increasing rates of injury among both youth and professional throwers has resulted in a "UCL epidemic." Ulnar collateral ligament reconstruction ("Tommy John Surgery") became a part of the public consciousness after Tommy John returned to professional baseball after a UCL reconstruction with Dr Frank Jobe for what was once considered a career-ending injury. Partial tears and some athletes with complete UCL injuries can be managed without surgery. Since the introduction of UCL reconstruction, technical modifications have aimed to decrease complications and increase return-to-play rates. Ulnar collateral ligament repair has reemerged as a potential surgical option for some throwers. Future prospective and comparative studies are necessary to better define the optimal operative treatment for these injuries.
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Traumatismos en Atletas , Béisbol , Ligamento Colateral Cubital , Ligamentos Colaterales , Lesiones de Codo , Articulación del Codo , Reconstrucción del Ligamento Colateral Cubital , Adolescente , Atletas , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/cirugía , Béisbol/lesiones , Ligamento Colateral Cubital/lesiones , Ligamento Colateral Cubital/cirugía , Ligamentos Colaterales/lesiones , Ligamentos Colaterales/cirugía , Codo/cirugía , Articulación del Codo/cirugía , Humanos , Reconstrucción del Ligamento Colateral Cubital/métodosRESUMEN
BACKGROUND: Isolated fractures of the olecranon process of the ulna in pediatric patients with open physes are classically considered pathognomonic for osteogenesis imperfecta (OI). The purpose of this study was to distinguish the clinical manifestations of isolated olecranon fractures in patients with and without OI to help practitioners assess when further evaluation for OI may be necessary. METHODS: All patients younger than 18 years old who were treated for an isolated olecranon fracture at a pediatric tertiary care center between 2009 and 2021 were identified. Patients without radiographs available for review, those with known skeletal dysplasia other than OI, and patients with multiple fractures (eg, polytraumas) or with concomitant dislocations were excluded. Of the 701 patients identified, 403 were included for analysis. Demographic variables, mechanism of injury, treatment type, and determination of OI diagnosis were collected. Patients with a previously confirmed diagnosis of OI or with genetic confirmation of OI following their fracture were designated as OI (+), and the remainder were designated OI (-). The Mann-Whitney U and χ2 tests were used to compare groups. RESULTS: Of the 403 patients, the median age was 7.8 years (interquartile range 5.2 to 12.5), and 270 (67%) were male. There were 14 confirmed cases of OI (3.5%). The OI (+) and OI (-) groups did not differ significantly by age or sex (P>0.05). OI (+) patients were more likely to sustain an injury from low-energy mechanisms (86% vs. 32%, P<0.001), sustain displaced fractures (86% vs. 21%, P<0.001) and undergo operative treatment (86% vs. 20%, P<0.001), and to report a history of previous fracture (79% vs. 16%, P<0.001) than OI (-) patients. 36% of OI (+) patients sustained a second olecranon fracture during the study period; there were no subsequent olecranon fractures in the OI (-) group. CONCLUSIONS: Isolated olecranon fractures may not be pathognomonic for OI. However, orthopaedists must be vigilant about the possibility of OI in patients who sustain displaced, isolated olecranon fractures under low-energy mechanisms with a history of previous fracture(s). LEVEL OF EVIDENCE: Level III.
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Lesiones de Codo , Fracturas Óseas , Olécranon , Osteogénesis Imperfecta , Fracturas del Cúbito , Adolescente , Niño , Fracturas Óseas/complicaciones , Humanos , Masculino , Olécranon/diagnóstico por imagen , Olécranon/lesiones , Osteogénesis Imperfecta/complicaciones , Osteogénesis Imperfecta/diagnóstico por imagen , Fracturas del Cúbito/cirugíaRESUMEN
BACKGROUND: Complex fracture-dislocations of the elbow, including terrible triad of the elbow, are serious injuries with guarded outcomes in adults. Although described extensively in adults, little is known about similar complex fracture-dislocations of the elbow in the pediatric population. The purpose of this study was to describe patterns of elbow dislocations with associated fractures in children and report the outcomes of these injuries. METHODS: This was a retrospective review of patients who presented to a level I trauma center from 2007 to 2019 with an elbow dislocation and at least 2 associated fractures. Demographic data, fracture locations, and treatment modality were recorded. Operative reports and radiographs were reviewed to determine clinical outcomes and complications. RESULTS: A total of 26 patients (mean age, 9.8 y) were identified. The majority of patients sustained an elbow dislocation and a medial epicondyle fracture (n=16). The most common third fractures involved the lateral condyle (n=8) or radial neck (n=7). At mean 6.03±3.11 months follow-up, 3 patients lacked ≥10 degrees of extension, and 2 patients lacked ≥15 degrees of flexion. Most patients had a Flynn score of "excellent" (n=20, 76.9%) or "good" (n=2, 7.7%). One patient with significant residual stiffness (>30 degrees flexion contracture) eventually underwent open contracture release. CONCLUSIONS: The most common complex elbow fracture-dislocation pattern in this series was an elbow dislocation with fracture of the medial epicondyle and lateral condyle or radial neck. In contrast to adult terrible triad injuries, most patients had a favorable clinical outcome, with nearly 80% excellent results and a low rate of complications. LEVEL OF EVIDENCE: Therapeutic Level IV-case series.
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Lesiones de Codo , Fractura-Luxación/cirugía , Adolescente , Niño , Preescolar , Epífisis , Femenino , Humanos , Masculino , Pediatría , Radiografía , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVES: In patients with elbow fractures, when there is suspected injury to underlying nerves, it is imperative for surgeons to elicit the function in the immediate postoperative period. Brachial plexus blocks like interscalene, supraclavicular and infraclavicular approaches can be a hurdle in such situations. The block planned should allow assessment of integrity of the nerves immediately in the postoperative period. CASE REPORT: We describe two cases in which we administered a block not yet described in literature. We blocked the cutaneous and articular branches innervating the elbow under ultrasound guidance. General anesthesia was administered in both cases. The block provided stable intraoperative hemodynamics, good postoperative analgesia and also allowed surgeons to test the viability of the nerve. CONCLUSION: In situations where nerves are injured during elbow fractures, selective articular cutaneous block at elbow can be used as it provides good perioperative analgesia, besides allowing evaluation of motor and sensory components in the postoperative period.
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Codo/cirugía , Fracturas Óseas/cirugía , Bloqueo Nervioso/métodos , Adulto , Anciano , Anestesia General/métodos , Femenino , Humanos , Masculino , Lesiones de CodoRESUMEN
BACKGROUND: Pediatric ipsilateral supracondylar humerus and forearm fractures (floating elbow), are historically reported to have a high rate of complications, including pediatric acute compartment syndrome (PACS). As a result, treatment paradigms for these types of injuries differ in the urgency, extent of fixation, and type of immobilization than if each fracture were treated in isolation. We aimed to systematically review the literature on pediatric floating elbow injuries and assess the reported risk of PACS along with risk factors for poor outcomes. METHODS: A systematic review was performed in November 2019 in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An exhaustive search of the PubMed and Embase databases was conducted for peer-reviewed literature between 1999 and 2019. Two reviewers filtered the results, looking for articles in English that reported >10 pediatric floating elbow cases. Primary outcomes were the rate and risk factors for developing PACS. Secondary outcomes included patient and injury characteristics, treatment strategies, other complications (eg, neurovascular injuries), and final outcomes. RESULTS: The initial search yielded a total of 150 studies. Following review, 11 studies were included, with 433 patients available for review. The mechanism of injury was a fall in 96% of cases. Closed reduction and percutaneous pinning was the most common treatment performed for both fractures. Only 8/433 patients (2%) developed PACS. The incidence of a pulseless limb at presentation was 4%, and all patients regained a pulse following reduction. Three cases of iatrogenic ulnar nerve injury were reported in the setting of medial pin placement. Good to excellent results were reported in 83% to 100% of patients, based on the modified Flynn criteria. CONCLUSIONS: Despite being limited to heterogenous and retrospective case series, the evidence reviewed in this study contradicts the current belief of a high risk of PACS or other complications in pediatric floating elbows. PACS is much more common with displaced fractures in the setting of delayed treatment. The rate of other complications is comparable to isolated supracondylar humerus fractures. Evidence supports treating these injuries in an urgent fashion in the setting of a displaced fracture, although fixation of both distal and proximal fractures is not supported by evidence. The outcomes of pediatric floating elbows are generally good and do not reflect the poor prognosis that adult floating elbows represent. LEVEL OF EVIDENCE: Level IV-systematic review of level IV studies.
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Síndromes Compartimentales , Lesiones de Codo , Traumatismos del Antebrazo , Fijación de Fractura , Complicaciones Posoperatorias , Niño , Síndromes Compartimentales/etiología , Síndromes Compartimentales/terapia , Traumatismos del Antebrazo/complicaciones , Traumatismos del Antebrazo/cirugía , Fijación de Fractura/efectos adversos , Fijación de Fractura/métodos , Humanos , Incidencia , Evaluación de Procesos y Resultados en Atención de Salud , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Factores de RiesgoRESUMEN
CASE: The lateral ulnar collateral ligament (LUCL) is one of the primary stabilizers of the elbow. Disruption typically occurs from the humeral origin and may be because of an elbow dislocation or fracture/dislocation. If not identified and properly managed, posterolateral rotatory instability may result from LUCL insufficiency. We describe the case of a patient with bipolar LUCL disruption consisting of an avulsion fracture of the crista supinatoris and a soft-tissue avulsion from the lateral epicondyle. CONCLUSION: Bipolar disruption of the LUCL is a previously unreported injury pattern that may lead to posterolateral instability if not identified and treated.
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Ligamento Colateral Cubital/lesiones , Lesiones de Codo , Fracturas del Cúbito/cirugía , Accidentes por Caídas , Adulto , Ligamento Colateral Cubital/cirugía , Articulación del Codo/cirugía , Humanos , Masculino , Tomografía Computarizada por Rayos X , Fracturas del Cúbito/diagnóstico por imagen , Reconstrucción del Ligamento Colateral CubitalRESUMEN
BACKGROUND: Medial epicondyle fractures represent up to 20% of elbow fractures in children and adolescents. There is a growing body of literature to support surgical fixation for displaced fractures. However, controversy regarding imaging modality for displacement measurement and surgical indications remain controversial. The purpose of this survey was to gauge Latin American surgeons' practices and preferences for the evaluation and treatment of medial epicondyle fractures. METHODS: A web-based survey containing 19 questions was distributed to active members of SLAOTI (Sociedad Latinoamericana de Ortopedia y Traumatología Infantil) in November 2018. The survey elicited information regarding surgeon demographics, evaluation methods, the factors involved in the decision to perform surgery, and their experience in cases of symptomatic nonunion. Categorical variables were summarized using frequencies and proportions. Analysis of associations between surgeon demographics and treatment preferences were carried out. RESULTS: A total of 193 out of 354 completed questionnaires were returned (54% response rate). In total, 74% of the participants (142/193) favored radiographs for the evaluation of the fracture displacement, and 25.4% (49/193) added a computed tomography scan for a more detailed evaluation. The majority of respondents (48.2%) would consider a 5 mm displacement as the cutoff for surgical treatment, 21.8% 2 mm, 20.7% 10 mm, and 9.3% 15 mm. There were no differences between the experience of the participants, academic versus private setting, or training regarding surgical/nonsurgical management. CONCLUSIONS: There are significant differences in opinions between SLAOTI members as to the optimal management of medial epicondyle fractures. Implications of disagreement in evaluation and treatment support the need for multicenter prospective studies to develop evidence-based guidelines for the management of this fracture. LEVEL OF EVIDENCE: Level V-expert opinion. Cross-sectional electronic survey.
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Lesiones de Codo , Articulación del Codo , Fractura-Luxación , Fijación de Fractura , Radiografía/métodos , Tomografía Computarizada por Rayos X/métodos , Niño , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/cirugía , Fractura-Luxación/diagnóstico , Fractura-Luxación/cirugía , Fijación de Fractura/métodos , Fijación de Fractura/estadística & datos numéricos , Humanos , América Latina , Pautas de la Práctica en Medicina/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
CASE: Massive bone loss around the elbow is a challenging clinical condition. Short periarticular osseous segments present few reconstructive options in the setting of distal humerus bone loss. We report the case of a 20-year-old man who sustained an open, intra-articular distal humerus fracture with a massive metaphyseal defect of 15 cm after a motorcycle accident. The defect was reconstructed using an induced membrane technique with temporary ulnohumeral bridge plate stabilization. CONCLUSION: Temporary ulnohumeral spanning plate fixation is a reliable method for periarticular reconstruction in the setting of massive distal humerus bone loss.
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Trasplante Óseo/métodos , Lesiones de Codo , Fracturas del Húmero/cirugía , Placas Óseas , Humanos , Fracturas del Húmero/complicaciones , Masculino , Reoperación , Adulto JovenRESUMEN
This is a case report of a previously healthy athlete who did not use oral anticoagulant, suffered a rupture of the distal biceps brachii tendon, and evolved with arm compartment syndrome. An emergency fasciotomy and the repair of the tendon were performed. After surgery the patient had a good recovery of the paresthesia and sensibility. This complication is rare and, when reported, is usually associated with patients who use anticoagulant therapy. Due to growth of rupture of distal biceps tendon cases, physicians should be aware that this complication must be treated as an emergency.
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Traumatismos del Brazo/complicaciones , Síndromes Compartimentales/etiología , Traumatismos de los Tendones/complicaciones , Anciano , Traumatismos del Brazo/cirugía , Traumatismos en Atletas/complicaciones , Traumatismos en Atletas/cirugía , Síndromes Compartimentales/cirugía , Articulación del Codo/cirugía , Fasciotomía/métodos , Humanos , Masculino , Rotura , Traumatismos de los Tendones/cirugía , Resultado del Tratamiento , Lesiones de CodoRESUMEN
Lateral condyle fractures of the humerus are the second most common fracture about the elbow in children. The injury typically occurs as a result of a varus- or valgus-applied force to the forearm with the elbow in extension. Plain radiographs are sufficient in making the diagnosis; however, an elbow arthrogram permits optimal visualization of the articular surface in minimally displaced fractures. Traditionally, nonsurgical management is indicated for fractures with ≤2 mm of displacement and a congruent articular surface. Closed reduction and percutaneous pinning is performed for fractures with >2 mm of displacement with an intact cartilaginous hinge at the articular surface. Open reduction and internal fixation is often necessary for fractures with ≥4 mm of displacement or if there is articular incongruity. Complications include malunion, delayed presentation, fishtail deformity, lateral spurring, and growth arrest. Evolving management concepts include relative indications for surgical management, the optimal pin configuration, and the use of cannulated screw and bioresorbable fixation.
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Lesiones de Codo , Articulación del Codo/cirugía , Fijación Interna de Fracturas/métodos , Fracturas del Húmero/cirugía , Reducción Abierta/métodos , Niño , Articulación del Codo/diagnóstico por imagen , Humanos , Fracturas del Húmero/diagnóstico por imagen , Complicaciones PosoperatoriasRESUMEN
BACKGROUND: Athletes are prone to both acute and chronic overuse injuries of the elbow joint. The purpose of this study was to describe the frequency, anatomic distribution, and severity of magnetic resonance imaging (MRI)-detected elbow joint injuries among athletes who competed in the Rio de Janeiro 2016 Summer Olympics. METHODS: All sports injuries reported by the National Olympic Committee medical teams and the Organizing Committee medical staff during the 2016 Summer Olympics were analyzed. Magnetic resonance imaging was performed at the International Olympic Committee's polyclinic within the Olympic Village, using 3- and 1.5-T scanners. The MRIs were read centrally and retrospectively by musculoskeletal radiologists with expertise in sports injuries. The distribution of elbow joint injuries by anatomic location and sports discipline and the severity of injuries were recorded. RESULTS: A total of 1101 injuries were reported in the 11,274 athletes from 207 teams at the Games. Central review of MRI revealed elbow joint injuries in 15 athletes (60% male; median age, 22 years; range, 18-39 years). Ligamentous injuries were most common, with injuries of the ulnar collateral ligament being the most prevalent (n = 12; 80%), followed by the common flexor tendon (n = 8; 53%). Osseous injuries were far less common (n = 3; 20%), with no acute fractures seen. Weightlifting (n = 4; 27%) and judo (n = 4; 27%) athletes were most commonly affected. CONCLUSION: Magnetic resonance imaging-detected elbow injuries during the 2016 Summer Olympics affected mainly the ulnar collateral ligament and the common flexor tendon, with the highest occurrence in weight lifting and judo.
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Traumatismos en Atletas/diagnóstico por imagen , Lesiones de Codo , Traumatismos de los Tendones/diagnóstico por imagen , Adulto , Atletas , Traumatismos en Atletas/epidemiología , Brasil , Codo/diagnóstico por imagen , Articulación del Codo/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética/instrumentación , Masculino , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Traumatismos de los Tendones/epidemiología , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVES: Costoclavicular brachial plexus block is an anesthesia performed through the infraclavicular route described in the literature as a safe and effective route for upper limb anesthesia distal to the elbow. The following report describes the case of a patient whose traditional plexus blocking techniques presented ultrasound visualization difficulty, but the costoclavicular approach was easy to visualize for anesthetic blockade. CASE REPORT: A grade 3 obese patient scheduled for repair of left elbow fracture and dislocation. Ultrasound examination revealed a distorted anatomy of the supraclavicular region and the axillary region with skin lesions, which made it impossible to perform the blockade in these regions. It was decided to perform an infraclavicular plexus block at the costoclavicular space, where the brachial plexus structures are more superficial and closer together, supported by a muscular structure, lateral to all adjacent vascular structures and with full view of the pleura. The anesthetic block was effective to perform the procedure with a single injection and uneventfully. CONCLUSION: Costoclavicular brachial plexus block is a good alternative for upper limb anesthesia distal to the elbow, being a safe and effective option for patients who are obese or have other limitations to the use of other upper limb blocking techniques.
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Brazo , Bloqueo del Plexo Braquial/métodos , Lesiones de Codo , Fracturas Óseas , Luxaciones Articulares , Obesidad , Ultrasonografía Intervencional , Adulto , Articulación del Codo/cirugía , Fracturas Óseas/complicaciones , Fracturas Óseas/cirugía , Humanos , Luxaciones Articulares/complicaciones , Luxaciones Articulares/cirugía , Masculino , Obesidad/complicacionesRESUMEN
Pediatric radial neck fractures will inevitably be encountered by the general orthopaedist, and they carry great potential for poor outcomes. Acceptable displacement varies by age, and unlike adults, most of these injuries can be managed by closed means. If they are taken to the operating room, the mainstays of treatment are percutaneous techniques. Increasing patient age, inadequate reduction, unnecessary open reductions, and prolonged immobilization are all associated with worse outcomes, most commonly manifesting as significant elbow stiffness. Knowledge of the age-specific acceptable displacement criteria, a stepwise approach to closed and percutaneous techniques, and safe strategies for open reduction when needed as a last resort will greatly improve treatment success.
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Reducción Cerrada/métodos , Lesiones de Codo , Cirujanos Ortopédicos/estadística & datos numéricos , Fracturas del Radio/cirugía , Rango del Movimiento Articular/fisiología , Clavos Ortopédicos/estadística & datos numéricos , Hilos Ortopédicos/estadística & datos numéricos , Niño , Preescolar , Reducción Cerrada/efectos adversos , Servicios de Salud Comunitaria/estadística & datos numéricos , Articulación del Codo/cirugía , Femenino , Estudios de Seguimiento , Curación de Fractura/fisiología , Humanos , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Fracturas del Radio/diagnóstico por imagen , Medición de RiesgoRESUMEN
Indications for total elbow arthroplasty (TEA) were traditionally reserved for patients with advanced rheumatoid disease and posttraumatic conditions of the elbow. The indications have expanded for TEA to include patients with acute elbow trauma, dysfunctional instability, and end-stage osteoarthritis. Many of these patients are younger and place a greater demand on their TEA. This evolution of TEA use combined with the concern of soft tissue handling and triceps function has led to increased interest regarding surgical exposure for TEA. Three generalized approaches to TEA are predicated on the handling of the triceps tendon: triceps reflecting, triceps splitting, and triceps sparing. Each of these approaches has its own inherent advantages and disadvantages. As indications grow for TEA and the possibility of revision surgery increases with use in younger, higher demand patients, it is important for treating surgeons to use these various exposures so that they are capable of treating patients in a variety of settings.
Asunto(s)
Artroplastia de Reemplazo de Codo/métodos , Lesiones de Codo , Articulación del Codo/cirugía , Músculo Esquelético/cirugía , Humanos , Posicionamiento del PacienteRESUMEN
Illness and injury associated with sport and physical activities may occur in the school setting. Although most sport-related illness and injury in students are considered minor emergencies, life- and limb-threatening illnesses or injuries may occur, such as sudden cardiac arrest, heat stroke, status asthmaticus, catastrophic brain or cervical spine injuries, hypoglycemia, blunt chest/abdominal injuries, or extremity fractures requiring surgery. It is important for the school nurse to recognize potential life- and limb-threatening emergencies associated with sport and physical activity, to initiate stabilization of the student with life- and limb-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary healthcare provider's office, or directly to the closest emergency department via emergency medical services). This article describes the initial assessment and management of three common emergencies associated with sport and physical activities.
Asunto(s)
Urgencias Médicas/enfermería , Pautas de la Práctica en Enfermería , Deportes , Adolescente , Traumatismos del Tobillo/enfermería , Traumatismos en Atletas/enfermería , Golpe de Calor/enfermería , Humanos , Luxaciones Articulares/enfermería , Masculino , Esguinces y Distensiones/enfermería , Lesiones de CodoRESUMEN
PURPOSE: Elbow flexion deficit is a frequent problem in traumatic brachial plexus injuries and reestablishment of this function is the primary treatment goal. When management is delayed, or the initial acute approach fails, free functional transfer of the gracilis muscle for elbow flexion is the treatment of choice. In this report, the authors present the results of a comparison study on different donor nerves (spinal accessory and ulnar) in elbow flexion reconstruction with gracilis flap for traumatic adult brachial plexus injuries. METHODS: Retrospective analysis of patients with both total or partial traumatic brachial plexus injuries was carried out. Of the 38 patients enrolled, 37 were male (97.4%) with a mean age of 28.3 years. The mean follow-up period was 25 months. Postoperative function of the gracilis muscle flap was recorded and patients were divided into two groups according to donor nerve: spinal accessory nerve (SAN) (18 cases), and motor fascicles of the ulnar (ULNAR) (20 cases). RESULTS: Twenty-six cases obtained elbow flexion strength M3 or M4 (68.4%): 0 M0 (0.0%), 4 M1 (10.5%), 8 M2 (21.1%), 9 M3 (23.7%) and 17 M4 (44.7%). The mean interval to first recorded M3 muscular strength was 12.4 months. Functional elbow flexion strength (≥ M3) had the following distribution: SAN 83.3% (15/18) and ULNAR 55.0% (11/20) (p = .086). CONCLUSION: No statistical difference for final muscle strength was found between donor nerve groups.