The April 2023 Shoulder & Elbow Roundup³⁶⁰ looks at: Arthroscopic Bankart repair in athletes: in it for the long run?; Functional outcomes and the Wrightington classification of elbow fracture-dislocations; Hemiarthroplasty or ORIF intra-articular distal humerus fractures in older patients; Return to sport after total shoulder arthroplasty and hemiarthroplasty; Readmissions after shoulder arthroplasty; Arthroscopic Bankart repair in the longer term; Bankart repair with(out) remplissage or the Latarjet procedure? A systematic review and meta-analysis; Regaining motion among patients with shoulder pathology: are all exercises equal?

Introduction:. Distal humerus fractures as well as elbow fracture dislocation are often accompanied by soft tissue damage that warrants early fixation with an external fixator. The distal humerus is a hazardous area for placement of an external fixator due to the close proximity of the radial nerve to the humerus in this area. No known safe zone has been identified on the lateral border of the humerus to avoid radial nerve damage. The aim of this study was to record the incidence of radial nerve damage by placing two 4 mm pins into the humerus and to note the relation of the nerve to the pins. Methods:. Two 4 mm pins used to fix an external fixator were drilled into the lateral border of the humerus at points 100 mm and 70 mm proximal to the lateral epicondyle of both arms of 39 cadavers. The 30 mm interval between the pins is the interval between the pins in a pinblock of a commonly-used external fixator. The arms were dissected by medical students and the incidence of radial nerve damage was recorded. Statistical analysis was done using a Fischer's exact test to identify the incidence of nerve damage relative to pin insertion. The number of damaged nerves was compared to the number of non-damaged nerves. A design based Chi Square test was carried out to test left and right arms. The proportions of interest were estimated along a 95% confidence interval. Results:. The radial nerve was hit (damaged) by 56.4% of the proximal and 20.5% of the distal pins. The radial nerve ran posterior to the proximal pin in 2.57% of arms and 0% to the distal pin. Conclusion:. Although no clear safe zone could be established, pins should be placed closer than 100 mm from the lateral epicondyle and as posterior on the humerus as possible to minimize the risk for radial nerve damage. Keywords: Radial nerve, external fixation, humerus fractures

With the aim of identifying appropriate treatment and diagnosis, this paper discusses 12 of 107 elbow dislocations and 56 elbow fracture dislocations seen over four years. One patient presented with arterial injury, two with olecranon fractures and dislocation, and three with radial head, olecranon and coronoid fractures. One patient had an intra-articular fracture, two had collateral ligamentous injuries and two had radial head fractures and dislocations. Depending on treatment, the results can be very poor or excellent. An awareness of the pitfalls in dislocations and fracture dislocations of the elbow is necessary to prevent poor outcomes

The December 2023 Shoulder & Elbow Roundup³⁶⁰ looks at: Clavicle fractures: is the evidence changing practice?; Humeral shaft fractures, and another meta-analysis…let’s wait for the trials now!; Hemiarthroplasty or total elbow arthroplasty for distal humeral fractures…what does the registry say?; What to do with a first-time shoulder dislocation?; Deprivation indices and minimal clinically important difference for patient-reported outcomes after arthroscopic rotator cuff repair; Prospective randomized clinical trial of arthroscopic repair versus debridement for partial subscapularis tears; Long-term follow-up following closed reduction and early movement for simple dislocation of the elbow; Sternoclavicular joint reconstruction for traumatic acute and chronic anterior and posterior instability.

Aims

This study aimed to gather insights from elbow experts using the Delphi method to evaluate the influence of patient characteristics and fracture morphology on the choice between operative and nonoperative treatment for coronoid fractures.

Aims

Heterotopic ossification (HO) is a common complication after elbow trauma and can cause severe upper limb disability. Although multiple prognostic factors have been reported to be associated with the development of post-traumatic HO, no model has yet been able to combine these predictors more succinctly to convey prognostic information and medical measures to patients. Therefore, this study aimed to identify prognostic factors leading to the formation of HO after surgery for elbow trauma, and to establish and validate a nomogram to predict the probability of HO formation in such particular injuries.

Aims

It is imperative to understand the risks of operating on urgent cases during the COVID-19 (SARS-Cov-2 virus) pandemic for clinical decision-making and medical resource planning. The primary aim was to determine the mortality risk and associated variables when operating on urgent cases during the COVID-19 pandemic. The secondary objective was to assess differences in the outcome of patients treated between sites treating COVID-19 and a separate surgical site.

Aims

The Wrightington classification system of fracture-dislocations of the elbow divides these injuries into six subtypes depending on the involvement of the coronoid and the radial head. The aim of this study was to assess the reliability and reproducibility of this classification system.

Aims

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.

The aim of the present study is to investigate if elbow extension in a supine position may be a diagnostic factor of signiþcant injury, in order to avoid unnecessary radiographs. Material and Method: Seventy patients, from 5 to 80 years of age, who suffered from an acute (< 6 hours) elbow injury, were examined in casualties. The inability to fully extend the elbow actively in a supine position, was deþned as a positive test. In order to avoid bias, the clinical examiner was the same and the radiographs were evaluated by a consultant radiologist, blinded to all clinical examination results. Sensitivity, speciþcity and positive and negative predictive values, along with their 95% conþdence intervals, were calculated for the elbow-extension test. Results: Forty out of seventy patients had a positive test. Elbow fracture or dislocation was identiþed radiographically in twenty-two patients with positive test. Only two out of thirty (with negative test) had a hairline radial-head fracture, which was found in the radiograph. Discussion: Based on the results of this study, the elbow-extension test has a high sensitivity of 92% and a speciþcity of 61%. The above clinical sign is valuable in the prediction of severe elbow injuries. Conclusions:the elbow-extension test can be considered as a sensitive screening test for acute elbow injuries. Patients with negative test may safely be treated without radiographic aid. Children with negative test may avoid useless radiological exposure

Introduction Complex fracture dislocation of the elbow can often be either irreducible or unstable with inability to hold the reduction or delayed subluxation or dislocation. This study looks at the aetiology of the instability, bony and ligamentous, and the results following stabilisation with a combination of internal fixation, ligament repair, radial head arthroplasty and or hinged external fixation. Methods Twenty-one consecutive unstable elbows referred to three tertiary centres were prospectively recruited for this study. All cases had fine-cut CT scans with sagittal, coronal and 3D reconstructions. All elbows were approached using a posterior ‘global’ incision. Ulnar neurolysis was routinely performed. Medial and lateral ligament complexes were inspected and repaired. Internal fixation of the radial head was attempted where indicated, or a radial head arthroplasty was performed. The coronoid-brachialis complex was repaired using pull-through sutures. Elbow stability was tested and a hinged external fixator used where indicated. The fixator was removed at six weeks. Indomethacin prophylaxis against heterotopic ossification was used routinely. Follow-up range of motion, articular congruity and DASH score were assessed at one year. All cases required a repair of the coronoid-brachialis complex. Radial head reconstruction was attempted in four cases, but abandoned in three. The radial head was replaced in 13 cases. A lateral repair alone was required in 12 cases, a medial repair alone in two cases and a combined medial and lateral repair in seven cases. Eighteen cases required a hinged device (nine Compass hinges and nine OpteROM distractors). Results The mean less of extension at one year was 12° (range 0 to 20) and the mean loss of flexion was 14° (range 0 to 20). All cases achieved at least a functional arc of motion from 30° to 130°. Three cases achieved a full range of motion. Despite Indomethacin prophylaxis three cases developed minor heterotopic ossification. The average DASH score was 23. Conclusions If managed appropriately, a very good anatomical and functional outcome can be achieved in difficult unstable elbows post fracture dislocation. Repair of the coronoid-brachialis complex is the key to stability, along with radial head reconstruction or replacement. A hinged external fixation device allows early mobilisation

We have developed an illustrated questionnaire, the Hand20, comprising 20 short and easy-to-understand questions to assess disorders of the upper limb. We have examined the usefulness of this questionnaire by comparing reliability, validity, responsiveness and the level of missing data with those of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

A series of 431 patients with disorders of the upper limb completed the Hand20 and the Japanese version of the DASH (DASH-JSSH) questionnaire. The norms for Hand20 scores were determined in another cross-sectional study.

Most patients had no difficulty in completing the Hand20 questionnaire, whereas the DASH-JSSH had a significantly higher rate of missing data. The standard score for the Hand20 was smaller than the reported norms for the DASH.

Our study showed that the Hand20 questionnaire provided validation comparable with that of the DASH-JSSH. Explanatory illustrations and short questions which were easy-to-understand led to better rates of response and fewer missing data, even in elderly individuals with cognitive deterioration.