The purpose of this study is to present the preliminary results after treatment of shoulder sepsis with prolonged implantation of an antibiotic-loaded cement spacer in a selected group of compromised patients.

The current study included 11 patients (9 males and 2 females) with a mean age of 64 years (range: 36–79 years). All patients were treated with radical debridement, implantation of an antibiotic-impregnated polymethylmethacrylate spacer, and 6 weeks of antibiotic therapy. The subjective complaints, range of motion of the shoulder, functional outcome (mini-DASH score), and radiographic findings were evaluated. Nine patients at a mean follow-up time of 21 months (range: 13–18 months) were free of infection with pain relief and adequate shoulder function for activities of daily living. Radiographic evaluation revealed no loosening or fracture of the spacer and no progressive degenerative changes involving the glenoid.

Prolonged implantation of the spacer may be a useful alternative in selected patients with poor general condition.

Aim of the study: To define the dimensions of the radial head, as well as the radiocapitellar and proximal radio-ulnar joints. The most congruent portions of the radial head articulations were determined.

Materials & Methods: Computed tomography scans of twenty-two cadaveric adult elbows were obtained in three forearm positions – supination, neutral, pronation. The radial head dimensions, the radiocapitellar joints, and the proximal radioulnar joints were also measured. Multivariate analysis of variance was used to determine which portions of each articulation were the most congruent.

Results: At the level of the radial trough, the maximum diameter was 22.3 mm, the minimum diameter was 20.9 mm, and the diameter difference was 1.4 mm. This difference represented only 6.3% of the overall maximum diameter. The depth of curvature of the radial head trough was 2.3 mm, the radial head length was 9.8 mm, and the radial neck length was 10.7 mm. At the isthmus of medullary canal, the maximum diameter was 9.7 mm, the minimum diameter was 8.2 mm, and the diameter difference was 1.5 mm. This difference represented 15.6% of the maximum diameter. The average radiocapitellar distance at the radial lip was 4.0 mm, the trough 2.4 mm, and the ulnar lip 2.2 mm. Thus, the radial head tended to become uncovered at the radial lip (p < 0.0001). The radiocapitellar joint was tighter in pronation than in supination (p = 0.0008). The proximal radioulnar joint was most congruent at the MPRUJ (middle proximal radioulnar joint), at the midportion and posterior aspects, rather than the anterior aspect (p < 0.0001). The PRUJ coverage was between 69.0 and 79.2 degrees.

Conclusions: Prosthesis trial sizing should be judged by the articulations providing the most congruency –

1) the ulnar lip or trough of the radiocapitellar joint in pronation and

Aim: The posterior interosseous nerve (PIN) is often at risk during surgical approaches to the proximal radius. The forearm is pronated during the approach to retract the PIN further away from the dissection. We hypothesized that a fracture of the radius would decrease the protection provided by the pronation maneuver.

Material and Methods: The position of the PIN in cadaveric elbows was measured using CT scans made after the PIN sheath was injected with radiopaque dye. Senventeen elbows were injected and CT scans were made in both full supination and pronation. The same elbows then had a radial osteotomy performed at the proximal-middle third junction and were re-scanned in supination and pronation. Finally the same elbows had the fascia around the osteotomy sutured and were scanned a third time. Measurements on the axial CT scans at the level of the radial head were taken of the angle formed by the olecranon, head, and PIN, as well as of the distance between the PIN and the lateral most aspect of the radial head.

Results: In the control group with intact radii, pronation increased the distance between the lateral radial head and the PIN by 6.44 mm. With radial osteotomy, the mean increase was 3.88 mm. The excursion of the nerve along the long axis of the radius decreased from 29.6 degrees to 23.3 degrees.

Conclusions: Radial osteotomy decreased the excursion of the PIN provided by pronation for the forearm by 40%. The Kocher approach requires additional care in light of a radial shaft fracture, but pronation is still beneficial.

Aims: The purpose of this study was to evaluate the incidence of combined osseous and ligamentous injuries by MRI in patients admitted with displaced or comminuted radial head fractures. Methods: A retrospective study was undertaken on twenty-four consecutive patients with an acute radial head fracture (Mason type II & III) without documented dislocation or tenderness at the distal radioulnar joint (DRUJ). The evaluation was done with elbow antero-posterior and lateral x-ray images and MRI images performed with the patient in a splint in sagittal, coronal, axial, axial oblique and coronal oblique planes. We investigated the integrity of both medial and lateral collateral ligaments, the presence of capitellar osteochondral defects or bone bruises and loose bodies. Results: The MRI evaluation of the participants in this study revealed the presence of a high percentage of ligamentous injuries. The incidence of associated injuries was: medial collateral ligament not intact: 13/24 (54.16%), lateral collateral ligament not intact: 18/24 (80.1%), both collateral ligaments not intact: 12/24 (50%), capitellar osteochondral defects 7/24 (52.4%), capitellar bone bruises 23/24 (95.83%) and loose bodies 22/24 (91.67%). Conclusions: High level of suspicion should be employed when treating displaced or comminuted radial fractures because concurrent osseous and/or ligamentous injuries might be present This speciþc type of injury with the broad range of presentation and accompanying injuries tests the clinician and makes the treatment challenging.

Aims: The purpose of our study was to determine the radiographic anatomy of the proximal radius in three different views in order to identify that position, which has the smallest value for the angle between the axis of forearm rotation (AFR) and the radial neck axis (RNA). It is our hypothesis that such a position should offer the optimal situation for the radial neck cut in radial head replacement, as it will approximate the normal biomechanical axis of forearm rotation. Methods: Anteroposterior (AP) and lateral radiographs of 20 healthy volunteersñ forearms were taken in three views (full supination, neutral, full pronation). Radial head maximum diameter and angular measurements between the axis of forearm rotation (AFR) and the radial neck axis (RNA) were made utilizing digital calipers. Results: Repeated-measures analysis of variance (ANOVA) revealed a statistically signiþcant difference between the three AP groups, with supination having the smallest values (p< 0.0001), but not for the lateral groups (p=0.128). Comparison of the AFR-RNA angle between the AP supinated position and the three lateral views revealed a statistically signiþcant difference among all the pairs with the AP supinated position having the smallest values. Conclusions: The RNA most closely approximates the AFR with the forearm in the supinated position. To best approximate the native AFR during radial head replacement, the cut should be made perpendicular to the neck axis with the elbow extended and the forearm in the supinated position.

We studied the origin of extensor carpi radialis brevis using 40 fresh frozen human cadaver specimens. Ten were stained with haematoxylin and eosin and trichrome which showed the collagenous structure of the extensor tendons at their origin. Gross anatomical observation showed that there was no definitive separation between brevis and communis at the osseotendinous junction. The histological findings confirmed the lack of separation between the two tendons. The extensor tendons were in close proximity to the joint capsule but trichrome staining showed no interdigitation of the tendon with the capsule. The validity of ascribing the pain of lateral epicondylitis to extensor carpi radialis brevis must be questioned. It appears to arise more from the ‘common extensor’ origin.