We present a case of idiopathic osteonecrosis of the humeral
Introduction. A prospective study was done using Kirschner (K) wires to internally fix
The functional outcomes of twenty-eight patients with
Purpose: The identification of anatomical landmarks is an important aspect of joint surgery, to ensure proper placement and alignment for implants and other reconstructive procedures. At the elbow, the center of the
Aims. To propose a new method for evaluating paediatric radial neck fractures and improve the accuracy of fracture angulation measurement, particularly in younger children, and thereby facilitate planning treatment in this population. Methods. Clinical data of 117 children with radial neck fractures in our hospital from August 2014 to March 2023 were collected. A total of 50 children (26 males, 24 females, mean age 7.6 years (2 to 13)) met the inclusion criteria and were analyzed. Cases were excluded for the following reasons: Judet grade I and Judet grade IVb (> 85° angulation) classification; poor radiograph image quality; incomplete clinical information; sagittal plane angulation; severe displacement of the ulna fracture; and Monteggia fractures. For each patient, standard elbow anteroposterior (AP) view radiographs and corresponding CT images were acquired. On radiographs, Angle P (complementary to the angle between the long axis of the radial head and the line perpendicular to the physis), Angle S (complementary to the angle between the long axis of the radial head and the midline through the proximal radial shaft), and Angle U (between the long axis of the radial head and the straight line from the distal tip of the
Purpose: The literature contains little information on an objective method of measuring radiocapitellar joint translations, as would be seen with joint instability. The purpose of this study was to develop and validate a measurement method that was simple and that could be easily reproducible in a clinical setting or intra-operatively to assess radiocapitellar joint translations. Method: We performed a radiological study on a synthetic elbow specimen in order to quantify radial head translations as related to the
Purpose: Osteochondritis dissecans (OCD) of the
Aims: This study aimed to assess the outcome of arthroscopic debridement and removal of loose bodies from the elbows of patients with OCD of the
The purpose of this study is to describe a surgical procedure for unstable osteochondritis dissecans (OCD) of the
Displaced supracondylar fractures of the paediatric elbow are a serious, but well described injury. Although complications are common, avascular necrosis (AVN) of the
Objectives. Surgical treatment is standard for advanced osteochondritis dissecans (OCD) of the humeral
Hemiarthroplasty is a common procedure that is an attractive alternative to total arthroplasty because it conserves natural tissue, allows for quicker recovery, and has a lower cost. One significant issue with hemiarthroplasties is that they lead to accelerated wear of the opposing native cartilage, likely due to the high stiffness of the implant. The purpose of this study was to investigate the range of currently available biomaterials for hemiarthroplasty applications. We employed a finite-element (FE) model of a radial head implant against the native
Aims. The purpose of this study was to evaluate the relationships between the degree of injury to the medial and lateral collateral ligaments (MCL and LCL) and associated fractures in patients with a posterolateral dislocation of the elbow, using CT and MRI. Methods. We retrospectively reviewed 64 patients who presented between March 2009 and March 2018 with a posterolateral dislocation of the elbow and who underwent CT and MRI. CT revealed fractures of the radial head, coronoid process, and medial and lateral humeral epicondyles. MRI was used to identify contusion of the bone and collateral ligament injuries by tear, partial or complete tear. Results. A total of 54 patients had a fracture; some had more than one. Radial head fractures were found in 25 patients and coronoid fractures in 42. Lateral and medial humeral epicondylar fractures were found in eight and six patients, respectively. Contusion of the
Purpose: Coronal shear fractures of the humerus include the Kocher-Lorenz fracture, an osteochondral fracture of the capitellar articular surface, the Hahn-Steinthal fracture, a substantial shear fragment, extension into the trochlea, and complete involvement of the
Three 3mm transverse slices were sectioned from the distal cancellous region of seven fresh-frozen cadaveric humerii. Each slice was marked with a 3x3mm grid, and subjected to compressive testing using a flat cylindrical indenter (1.6mm diameter). Indentation modulus and strength were calculated for each site, and pooled into nine anatomically-defined regions. The most distal slice had higher moduli values (p<
0.05), and the posterior capitellar region had lower moduli values (p<
0.05). There were no slice or regional differences in strength. This suggests that surgical procedures requiring cancellous fixation utilize the most distal aspect of the humerus while avoiding the posterior
Purpose.
Background. Fractures of the radial head result from an axial force that causes impaction against the
Summary. The significance of matching radius of curvature of the radial head implant and the
Repeated trauma to the radial head may be one of the causative factors in the genesis of osteochondritis dissecans of the
Purpose. The measurement of radial head translation about the
Between 1995 and 2006, five intra-articular osteotomies of the head of the radius were performed in patients with symptomatic healed displaced articular fractures. Pre-operatively, all patients complained of persistent painful clicking on movement. Only patients with mild or no degenerative changes of the radial head and
Excision is not a suitable treatment for all comminuted fractures of the radial head. In elbows where instability can be predicted, a replacement arthroplasty of the radial head is more effective. The aim of this paper was to present the medium-term results of the Judet floating radial head prosthesis. This operation was performed on 14 patients between 1992 and 2003, of whom 12 were reviewed at a mean follow-up of five years and three months (1 to 12 years). The outcome was assessed using the Mayo elbow performance score and a modified Disability of Arm Shoulder Hand (DASH) questionnaire. There were six excellent results, four good, one fair and one poor, as graded by the Mayo score. The mean DASH score was 23.9/100 (0 to 65.8/100). The only significant complication occurred in one patient who developed a severe complex regional pain syndrome. There were no patients with secondary instability of the elbow, implant loosening, cubitus valgus, osteoporosis of the
Total elbow arthroplasty (TEA) usage is increasing owing to expanded surgical indications, better implant designs, and improved long-term survival. Correct humeral implant positioning has been shown to diminish stem loading in vitro, and radiographic loosening in in the long-term. Replication of the native elbow centre of rotation is thought to restore normal muscle moment arms and has been suggested to improve elbow strength and function. While much of the focus has been on humeral component positioning, little is known about the effect of positioning of the ulnar stem on post-operative range of motion and clinical outcomes. The purpose of this study is to determine the effect of the sagittal alignment and positioning of the humeral and ulnar components on the functional outcomes after TEA. Between 2003 and 2016, 173 semi-constrained TEAs (Wright-Tornier Latitude/Latitude EV, Memphis, TN, USA) were performed at our institution, and our preliminary analysis includes 46 elbows in 41 patients (39 female, 7 male). Patients were excluded if they had severe elbow deformity precluding reliable measurement, experienced a major complication related to an ipsilateral upper limb procedure, or underwent revision TEA. For each elbow, saggital alignment was compared pre- and post-operatively. A best fit circle of the trochlea and
Introduction. Isolated trochlea fractures are very rare and have only been described previously as case reports. Aims. To report on a case of isolated trochlea fracture and to present a review of the literature. Results. There have only been four previous reports of isolated trochlea fracture. Our fifth case is included in the analysis of the literature given below. Average age 26 (Range 12–33). 60% female, 80% left sided. Dominance only stated in 40% of cases- 50% dominant side. Mechanism of injury: 60% low velocity fall onto an outstretched hand, 40% high velocity- RTA & fall off horse- exact mechanism of injury unknown. Patients all presented with elbow held in flexion, pain and swelling over the medial aspect and a painfully reduced range of motion. Diagnosis made on plain radiographs in 80%, tomograms required in 20%. AP noted to be essential to differentiate from more common
To investigate the risk factors for unsuccessful radial head reduction (RHR) in children with chronic Monteggia fractures (CMFs) treated surgically. A total of 209 children (mean age 6.84 years (SD 2.87)), who underwent surgical treatment for CMFs between March 2015 and March 2023 at six institutions, were retrospectively reviewed. Assessed risk factors included age, sex, laterality, dislocation direction and distance, preoperative proximal radial metaphysis width, time from injury to surgery, reduction method, annular ligament reconstruction, radiocapitellar joint fixation, ulnar osteotomy, site of ulnar osteotomy, preoperative and postoperative ulnar angulation, ulnar fixation method, progressive ulnar distraction, and postoperative cast immobilization. Independent-samples Aims
Methods
Acute and chronic injuries of the interosseus membrane can result in longitudinal instability of the forearm. Reconstruction of the central band of the interosseus membrane can help to restore biomechanical stability. Different methods have been used to reconstruct the central band, including tendon grafts, bone-ligament-bone grafts, and synthetic grafts. This Idea, Development, Exploration, Assessment, and Long-term (IDEAL) phase 1 study aims to review the clinical results of reconstruction using a synthetic braided cross-linked graft secured at either end with an Endobutton to restore the force balance between the bones of the forearm. An independent retrospective review was conducted of a consecutive series of 21 patients with longitudinal instability injuries treated with anatomical central band reconstruction between February 2011 and July 2019. Patients with less than 12 months’ follow-up or who were treated acutely were excluded, leaving 18 patients in total. Preoperative clinical and radiological assessments were compared with prospectively gathered data using range of motion and the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) functional outcome score.Aims
Methods
The aim of this study was to analyze how proximal radial neck resorption (PRNR) starts and progresses radiologically in two types of press-fit radial head arthroplasties (RHAs), and to investigate its clinical relevance. A total of 97 patients with RHA were analyzed: 56 received a bipolar RHA (Group 1) while 41 received an anatomical implant (Group 2). Radiographs were performed postoperatively and after three, six, nine, and 12 weeks, six, nine, 12, 18, and 24 months, and annually thereafter. PRNR was measured in all radiographs in the four radial neck quadrants. The Mayo Elbow Performance Score (MEPS), the abbreviated version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), and the patient-assessed American Shoulder and Elbow Surgeons score - Elbow (pASES-E) were used for the clinical assessment. Radiological signs of implant loosening were investigated.Aims
Methods
Arthroplasties of the elbow, including total elbow arthroplasty, radial head arthroplasty, distal humeral hemiarthroplasty, and radiocapitellar arthroplasty, are rarely undertaken. This scoping review aims to outline the current research in this area to inform the development of future research. A scoping review was undertaken adhering to the Joanna Briggs Institute guidelines using Medline, Embase, CENTRAL, and trial registries, limited to studies published between 1 January 1990 and 7 February 2021. Endnote software was used for screening and selection, and included randomized trials, non-randomized controlled trials, prospective and retrospective cohort studies, case-control studies, analytical cross-sectional studies, and case series of ten or more patients reporting the clinical outcomes of elbow arthroplasty. The results are presented as the number of types of studies, sample size, length of follow-up, clinical outcome domains and instruments used, sources of funding, and a narrative review.Aims
Methods
Background. Humeral version is the twist angle of the humeral head relative to the distal humerus. Pre-operatively, it is most commonly measured referencing the transepicondylar axis, although various techniques are described in literature (Matsumura et al. 2014, Edelson 1999, Boileau et al., 2008). Accurate estimation of the version angle is important for humeral head osteotomy in preparation for shoulder arthroplasty, as deviations from native version can result in prosthesis malalignment. Most humeral head osteotomy guides instruct the surgeon to reference the ulnar axis with the elbow flexed at 90°. Average version values have been reported at 17.6° relative to the transepicondylar axis and 28.8° relative to the ulnar axis (Hernigou, Duparc, and Hernigou 2014), although it is highly variable and has been reported to range from 10° to 55° (Pearl and Volk 1999). These studies used 2D CT images; however, 2D has been shown to be unreliable for many glenohumeral measurements (Terrier 2015, Jacxsens 2015, Budge 2011). Three-dimensional (3D) modeling is now widely available and may improve the accuracy of version measurements. This study evaluated the effects of sex and measurement system on 3D version measurements made using the transepicondylar and ulnar axis methods, and additionally a flexion-extension axis commonly used in biomechanics. Methods. Computed tomography (CT) scans of 51 cadaveric shoulders (26 male, 25 female; 32 left) were converted to 3D models using medical imaging software. The ulna was reduced to 90° flexion to replicate the arm position during intra-operative version measurement. Geometry was extracted to determine landmarks and co-ordinate systems for the humeral long axis, epicondylar axis, flexion-extension axis (centered through the
This is a multicentre, prospective assessment of a proportion of the overall orthopaedic trauma caseload of the UK. It investigates theatre capacity, cancellations, and time to surgery in a group of hospitals that is representative of the wider population. It identifies barriers to effective practice and will inform system improvements. Data capture was by collaborative approach. Patients undergoing procedures from 22 August 2022 and operated on before 31 October 2022 were included. Arm one captured weekly caseload and theatre capacity. Arm two concerned patient and injury demographics, and time to surgery for specific injury groups.Aims
Methods
We analysed the axis of movement in the normal elbow during flexion in vivo using radiostereometric analysis (RSA). The results show an intraindividual variation in the inclination of the axis ranging from 2.1° to 14.3° in the frontal and from 1.6° to 9.8° in the horizontal plane analysed at 30° increments. The inclination of the mean axis of rotation varied within a range of 12.7° in the frontal and 4.6° in the horizontal plane. In both planes, the mean axes were located close to a line joining the centres of the trochlea and
A simple method of radiological assessment has been used to measure the angle between the long axis of the humeral shaft and the growth plate of the
We report the technique and results of a new method of debridement arthroplasty for advanced primary osteoarthritis of the elbow. Triceps and the periosteum of the olecranon are reflected towards the ulnar side and the joint is opened by dividing the radial collateral ligament. Osteophytes are removed, the olecranon and coronoid fossae are deepened and the fibrosed anterior joint capsule is excised. The degenerative changes are always more advanced on the radial side, with erosion of the
Purpose: The treatment of extension type II pediatric supracondylar humerus fractures remains controversial. Some argue that closed reduction and cast immobilization is sufficient to treat these fractures, while others advocate closed reduction and pinning. The purpose of this radiographic outcomes study was to determine whether closed reduction and cast immobilization could successfully obtain and maintain appropriate position of extension type II supracondylar humerus fractures. Method: The radiographs of 1017 pediatric patients treated for supracondylar fractures between 1987 and 2007 were retrospectively reviewed. Pre-reduction, immediate post-reduction, and final radiographs of 155 extension type II fractures were measured in order to assess the position and alignment of the fracture fragments. Measurements included the anterior humeral line, humeral-capitellar angle, Baumann’s angle, the Gordon index, and the Griffet index. The latter two indices calculate the rotational instability of the fracture, which can be predictive of reduction loss. Patients were excluded if insufficient radiographs failed to allow complete assessment of the measurement parameters, or if open reduction was required. Results: The average age of the subjects was 5.3 years (range 1–13 years) and had a mean follow-up of 5.3 months. Analysis of the final radiographs demonstrated that in 80% of subjects, the anterior humeral line remained anterior to the mid third segment of the
This in-vitro study evaluated the influence of ligament tensioning and the effectiveness of lateral collateral ligament (LCL) repair using transosseous sutures on the initial kinematics and stability of the elbow. Six fresh upper-extremities were mounted in a motion simulator with tracking system, which enabled both passive and simulated active elbow flexion. The intact elbow was tested then the LCL was sectioned from its humeral origin and repaired with a transosseous suture technique. Locking sutures were placed in the LCL and passed through a humeral bone tunnel entering at the centre of curvature of the
Osteochondral autologous transplantation (OATS) is a new technique for the treatment of osteochondral defects. In a prospective study between April 1996 und May 2001 we used the OATS technique to treat 201 patients (125 male, 76 female) with a mean osteochondral defect of 3,3 cm. 2. The defect was in the medial femoral condyle in 96 cases, the lateral femoral condyle in 16, the patella in 22, the trochlea in seven, the tibial plateau in one, the talus in 48, the tibial plafond in two and
Purpose: The successful placement of elbow prostheses, external fixators and ligament reconstructions is dependent on the accurate identification of the elbow’s flexion-extension (FE) axis. In the case of periarticular bone loss, the FE axis must be visually estimated, as the necessary anatomical landmarks may not be available. Hence, referencing the uninjured elbow anatomy may prove beneficial in accurately defining this axis. However, this is contingent on the morphological features being similar between the two sides. Our objective was to compare distal humeral morphology between paired specimens. Our hypothesis was that anthropometric measurements from the distal humerus would be similar to the contralateral side. Method: CT Images of 25 paired distal humeri were obtained. A right-to-left surface registration was then performed on each pair using the iterative closest point (icp) least-squares algorithm, thus placing each specimen in the same coordinate system.. Anthropometric characteristics measured (and compared between the left and right sides) included the angles of the FE and epicondylar axes in both the coronal and transverse planes, the anterior offset of the FE axis with respect to the humeral shaft axis, the length of the FE axis and the radius of curvature of the
Introduction Osteochondral autologous transplantation (OATS) is a technique to treat hyaline cartilage injuries in different joints. It delivers high quality hyaline cartilage to the defect. Methods In a prospective study we used the OATS technique in 201 patients (125 male, 76 female). The mean defect size was 3.3 sq cm. The medial femoral condyle was treated in 96 cases, the lateral femoral condyle in 16, the patella in 22, the trochlea in seven, the tibial plateau in one, the talus in 48, the tibial plafond in two and the
Osteochondral autologous transplantation (OATS) is a new technique for the treatment of osteochondral defects. In a prospective randomised study, between November 1996 and June 2000 we used the OATS technique to treat 136 patients (90 male, 46 female) with a mean osteochondral defect of 3.3 cm2. The defect was in the medial femoral condyle in 54 cases, the lateral femoral condyle in nine, the patella in 15, the trochlea in six, the tibial plateau in one, the talus in 29, the tibial plafond in two, the
The aim of this study was to analyze the results of two radiocapitellar prostheses in a large case series followed prospectively, with medium-term follow-up. A total of 31 patients with a mean age of 54 years (27 to 73) were analyzed; nine had primary osteoarthritis (OA) and 17 had post-traumatic OA, three had capitellar osteonecrosis, and two had a fracture. Overall, 17 Lateral Resurfacing Elbow (LRE) and 14 Uni-Elbow Radio-Capitellum Implant (UNI-E) arthroplasties were performed. Pre- and postoperative assessment involved the Mayo Elbow Performance Score (MEPS), the Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score, and the modified American Shoulder Elbow Surgeons (m-ASES) score.Aims
Patients and Methods
To evaluate the outcomes of terrible triad injuries (TTIs) in mid-term follow-up and determine whether surgical treatment of the radial head influences clinical and radiological outcomes. Follow-up assessment of 88 patients with TTI (48 women, 40 men; mean age 57 years (18 to 82)) was performed after a mean of 4.5 years (2.0 to 9.4). The Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and Disabilities of the Arm, Shoulder and Hand (DASH) score were evaluated. Radiographs of all patients were analyzed. Fracture types included 13 Mason type I, 16 type II, and 59 type III. Surgical treatment consisted of open reduction and internal fixation (ORIF) in all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) was performed if reconstruction was not possible.Aims
Methods
Non operative treatment of supracondylar fractures of the humerus has almost always resulted in failure. Closed reduction followed by prolonged immobilization until union, may be associated with an acceptable X-ray but with unacceptable function because of marked stiffness. Traction and early motion preserves movement but the incongruity of the joint leads to instability, early post-traumatic arthritis and pain. Traction also requires prolonged hospital admission which is not possible in modern health care settings. Attempts at early motion without reduction, the so called “bag of bones treatment” leads to gross malunions, non-unions and poor function. In order to function normally an elbow requires stability, a congruent articulation, freedom from pain, and a functional range of motion. After fracture one can achieve a normal elbow only after anatomic reduction fracture which is combined with absolutely stable fixation and early motion. These fractures are classified according to the Comprehensive Classification into Types: A, B, and C, with their respective groups and subgroups, all arranged in an ascending order of severity. Once a surgeon classifies a fracture he gains insight into the associated problems in treating it. Classification thus helps in proper decision making. In young patients these fractures are usually the result of a high energy trauma. Although multifragmentary and at times open, these are fractures of normal bone and are therefore often amenable to secure fixation. In the elderly the commonest mechanism is a slip and fall on to the point of the elbow. The olecranon is driven into the trochlea and splits the osteoporotic condyle of the humerus into a multitude of fragments. The resultant fractures are multifragmentary, displaced and often defy attempts at reduction and fixation. When one is deciding on treatment the factors which must be considered are patient factors, the fracture factors, and the treatment factors. The most important factors are: the patients age and the degree of osteoporosis, the comminution and displacement of the fractures, the association of neurovascular injuries, and whether the fracture is open or closed. An open reduction and internal fixation is best performed with the patient on the side with the injured elbow uppermost, or with the patient prone. The best surgical approach is posterior. Once the skin is incised one must isolate and protect the ulnar nerve. The facture is exposed by carrying out an osteotomy of the olecranon. In elderly patients in whom a prostheses might become the salvage, one should consider using a triceps splitting approach or a triceps peal as for an elbow arthroplasty. Commence fixation with an anatomic reduction of the trochlear fragment to the capitellar fragment. If bone is missing than instead of lag screws one uses fully threaded screws to prevent the narrowing of the distal articulation. Once securely fixed, the articular complex is fixed to the metaphysis and shaft. The fixation is carried out with two plates which should be positioned at 90 degrees to each other to achieve the strongest biomechanical construct. The plates commonly used are the 3.5mm LCDCP plates or the 3.5mm reconstruction plates. The choice of one or the other plate depends on the fracture pattern and on the necessary contouring of the plates. The usual choice are two reconstruction plates one medially and one posteriorly contoured to fit the posterior aspect of the
The aim of this study was to report the long-term outcome and
implant survival of the lateral resurfacing elbow (LRE) arthroplasty
in the treatment of elbow arthritis. We reviewed a consecutive series of 27 patients (30 elbows) who
underwent LRE arthroplasty between December 2005 and January 2008.
There were 15 women and 12 men, with a mean age of 61 years (25
to 82). The diagnosis was primary hypotrophic osteoarthritis (OA)
in 12 patients (14 elbows), post-traumatic osteoarthritis (PTOA)
in five (five elbows) and rheumatoid arthritis (RA) in ten patients
(11 elbows). The mean clinical outcome scores including the Mayo
Elbow Performance Score (MEPS), the American Shoulder and Elbow
Surgeons elbow score (ASES-e), the mean range of movement and the
radiological outcome were recorded at three, six and 12 months and
at a mean final follow-up of 8.3 years (7.3 to 9.4). A one sample Aim
Patients and Methods
The aim of this study was to evaluate the outcome of Monteggia-like lesions at midterm follow-up and to determine whether the surgical treatment of the radial head influences the clinical and radiological results. A total of 78 patients with a Monteggia-like lesion, including 44 women and 34 men with a mean age of 54.7 years (19 to 80), were available for assessment after a mean 4.6 years (2 to 9.2). The outcome was assessed using the Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), Mayo Modified Wrist Score (MMWS), and The Disabilities of the Arm, Shoulder and Hand (DASH) score. Radiographs were analyzed for all patients. A total of 12 Mason type I, 16 type II, and 36 type III fractures were included. Surgical treatment consisted of screw fixation for all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) or excision was performed if reconstruction was not possible.Aims
Patients and Methods