We present six patients with chronic dislocation of the elbow who were treated by primary semiconstrained total elbow arthroplasty. All were women with a mean age of 65 years (51 to 76), the mean interval between dislocation and surgery was 17 weeks (5 to 52) and the mean follow-up 58 months (24 to 123). The most dramatic improvement was in function. The mean American Shoulder and Elbow Surgeon score was 5.2 times better (p < 0.001) and the mean total range of movement increased from 33° to 121° (p < 0.001) after operation. Three patients developed wear of polyethylene. One required revision for a periprosthetic fracture, and another required a bushing exchange. Primary semiconstrained elbow arthroplasty provides significant, predictable functional improvement. Potential solutions for wear of polyethylene include a different operative technique or design of implant. Despite the high incidence of such wear, total elbow arthroplasty should be considered as a viable treatment option for chronic dislocation of the elbow in elderly patients

1. Three cases of fracture of the neck of the radius with medial displacement of the head are described. 2. It is proposed that such injuries be classified into two types: 1) displacement of the radial head without dislocation of the elbow; and 2) displacement during posterior dislocation of the elbow

Eighteen patients with marginal depressed or comminuted fractures of the head of the radius, nine of whom had an associated posterior dislocation of the elbow, had a Silastic replacement carried out shortly after injury. After an average follow-up of twenty-six months satisfactory clinical results were observed in seventeen cases; three prostheses broke. The prosthesis has been particularly effective in the group with an associated posterior dislocation of the elbow

A total of 33 children were treated for acute traumatic dislocation of the elbow between 1994 and 2002; 30 dislocations were posterior and three anterior. Eight children had a pure dislocation and 25 had an associated fracture of the elbow. Two had compound injuries. Two children had injury to the ulnar nerve, one to the radial nerve and one to the median nerve together with injury to the brachial artery. Twenty required open reduction. Complications included pseudarthrosis of the medial epicondyle in one child and loss of flexion and rotation of between 10° and 30° in ten others. Meticulous clinical and radiological assessment is mandatory in children with dislocation of the elbow to exclude associated injuries. The results were excellent to good in 22 patients, fair in ten and poor in one

1. Thirty-nine displaced fractures of the lateral humeral condyle in children are reported. In one-third of the children the injury was accompanied by postero-lateral dislocation of the elbow. In some cases there was evidence that dislocation had occurred even when there was little persistent displacement of the condylar fragment. 2. All the fractures were treated by internal fixation with a specially designed screw. Thirtyfive children attended for review. 3. lt is concluded that all displaced fractures should be treated by internal fixation and that the method described is simple and reliable. Undisplaced fractures, or those with little displacement, may be treated conservatively when there is no evidence of associated dislocation of the elbow

Aims

Medial humeral epicondyle fractures (MHEFs) are common elbow fractures in children. Open reduction should be performed in patients with MHEF who have entrapped intra-articular fragments as well as displacement. However, following open reduction, transposition of the ulnar nerve is disputed. The aim of this study is to evaluate the need for ulnar nerve exploration and transposition.

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

The aim of this study was to evaluate the kinematics of the elbow following increasing length of the radius with implantation of radial head arthroplasties (RHAs) using dynamic radiostereometry (dRSA).

1. The mechanism of production of injury to the lateral condyle epiphysis is discussed. 2. A technique of closed reduction of rotational displacements of the epiphysis is described. Nine cases in which the method was successful are noted. 3. It is suggested that the injury should be classified with dislocation of the elbow

The case illustrated substantiates the explanation of the rare epiphysial separation of the head of the radius with 90 degrees backward tilting referred to above as Group 2. It suggests also that the initial fall on the hand may loosen the capital epiphysis. The undesirability of reducing dislocations of the elbow merely by pulling on the hand of the injured limb is emphasised. The dislocation should be reduced by gentle traction accompanied by pressure with the thumbs on the front of the displaced olecranon

We describe a patient with a Mason type-III fracture of the head of the radius associated with traumatic dislocation of the elbow. The radial head was intact throughout its circumference despite being completely detached from the shaft and devoid of any soft-tissue attachments. Severe comminution of the radial neck prevented reconstruction by internal fixation and precluded prosthetic replacement of the head. The head was fixed to the shaft with a tricortical iliac-crest bone graft which replaced the neck. Two years later, the patient had a stable elbow with flexion from 10° to 130°. Radiologically, the head of the radius appeared to be viable and the bone graft had incorporated

1. Fifty-nine patients with fractures of the medial epicondyle of the humerus have been reviewed, of whom more than one-third also had a dislocation of the elbow. 2. The final disability has been shown to be very slight. Non-union occurs very often with conservative treatment, but gives no disability. Union can be obtained by fixation with a Pidcock pin. 3. Operative treatment is advised only when the fragment is included in the joint. It is suggested that the best position of the elbow in patients treated conservatively is about 60 degrees below the right angle

1. Isolated dislocation of the radius at the elbow occurs most commonly as a pronation injury, associated with slight elbow flexion and a varus strain. Disruption of the radio-ulnar articulation occurs primarily because of tearing of the annular ligament, which is the most important reinforcing structure of this joint. The tensing of the interosseous membrane through neutral into supination, and consequently the approximation of the radius to ulna, supports the recognised supination manoeuvre to reduce such an injury. 2. It is suggested that this injury may be more common than previously appreciated. It may be not diagnosed, it may be over-diagnosed as total dislocation of the elbow, or it may be belatedly diagnosed as a congenital dislocation of the radial head

The treatment of fractures of the neck of the radius in children is difficult, particularly if the angulation of the fracture exceeds 60°. Since 1994 we have used closed reduction and stabilisation with an intramedullary Kirschner wire in patients with grade-IV fractures according to the classification of Judet et al. In a retrospective analysis of a two-year period (1994 to 1996), 324 children with fractures of the elbow were treated in our department. Of these, 29 (9%) had a fracture of the neck of the radius; six were grade-IV injuries (1.9%). Five of the latter had an excellent postoperative result with normal movement of the elbow and forearm. One patient with a poor result had a concomitant dislocation of the elbow. Our results suggest that closed reduction and intramedullary pinning of grade-IV fractures allows adequate stabilisation while healing occurs

After dislocation of the elbow with avulsion of the medial epicondyle, the management of the latter is controversial. Of 28 children followed up after initial closed reduction of the elbow, 19 had a satisfactory closed reduction of the epicondyle and were treated in plaster. At follow-up, 11 children had a normal elbow and eight had lost an average of 15 degrees of flexion. Nine children had had open reduction and internal fixation of the fragment, one for an open injury, three for displacement of the epicondyle and six for intra-articular entrapment of the fragment. Five of these children had ulnar nerve contusion or compression, four requiring anterior transposition of the nerve. At review, only three had normal elbows and six had lost an average of 37 degrees of flexion. We agree with other authors that surgery is indicated only for children in whom the epicondyle is trapped in the joint or is significantly displaced after closed reduction

An attempt has been made to describe some of the ways in which the element of rotation, which is so important a part of the function of the normal forearm, has a bearing upon the mechanism and treatment of forearm injuries. In particular, distinction is drawn between those injuries in which the shaft of the radius remains in continuity, and those in which there is a complete fracture of the bone. In the former, rotation of the hand in the reduction will be transmitted to the upper end of the radius, and extremes of rotational movement may safely be used to obtain and hold a reduction. In the latter there is likely to be a rotational deformity between the two radial fragments, and the lower radial fragment must be placed in accurate rotational alignment with the upper. In the first group reduction, and in certain cases immobilisation, in full pronation or full supination has been shown to have a place in the treatment of those cases in which a rotation violence has shaped the pattern of the injury. Soft tissues may be used to guide and hold a reduction in a rotational injury, just as in injuries of other types. An injury caused by forced pronation should logically be treated in full supination, for only thus are the intact soft tissues on the "pronation side" of the limb used to the best advantage. In the mechanism of injuries caused by rotation violence it is emphasized that vertical compression is usually the basic force, to which a rotation force may be added by the direction of momentum of the body weight. Such injuries may be grouped into forced rotation injuries (in which the violence applied has taken the limb beyond the normal ranges of rotational movement), and injuries occurring while the limb is pronating or supinating. In the latter group the rotational element determines the pattern of the injury: pronation and flexion are closely allied, and a fracture occurring while the forearm is pronating will develop a backward angulation: so also a supination injury will produce a forward angulation. On the basis of these considerations injuries of the forearm may be classified as follows:. Injuries in which the shaft of the radius remains in continuity. Forced proiiation injuries:. 1) Forward dislocation of the head of the radius. 2) Backward dislocation of the lower end of the ulna. 3) The anterior Monteggia fracture-dislocation. These injuries should be reduced and immobilised in full supination to prevent recurrence of deformity. The lateral and posterior Monteggia injuries are probably variants of dislocation of the elbow and are not caused by rotation violence. In general it is considered that all dislocations of the head of the radius are best treated in full supination. Pronation injuries:. Greenstick fractures of the radius, and of both bones of the forearm, with backward angulation. Reduction of deformity is most easily obtained by manipulating into full supination. Certain fractures may with advantage be immobilised in this position. Supination injuries:. Greenstick fractures of the forearm with forward angulation. Reduction is best obtained by full pronation. Injuries in which the shaft of the radius is in two separate fragments. This group includes all complete fractures of the shaft of the radius and of both bones of the forearm. There is nearly always a rotational deformity between the two radial fragments and its correction is a dominant factor in the treatment

This study describes the surgical technique used for reconstruction and reinforcement of the lateral collateral ligament complex in patients with posterolateral instability of the elbow and the results. A triceps tendon graft from the ipsilateral elbow which was inserted through bone tunnels and fixed with bone anchors augmented the reconstruction. The operation was performed on 18 consecutive patients with instability after an acute traumatic dislocation. The mean follow-up was 44 months (14 to 88). There were no recurrent dislocations. The elbow was stable in 14 patients; three had some minor limitation of movement. Thirteen had no or only occasional slight pain, 15 returned to their normal level of activity and 17 were satisfied with the outcome. There was only one failure

Objectives

Adult mice lacking the transcription factor NFAT1 exhibit osteoarthritis (OA). The precise molecular mechanism for NFAT1 deficiency-induced osteoarthritic cartilage degradation remains to be clarified. This study aimed to investigate if NFAT1 protects articular cartilage (AC) against OA by directly regulating the transcription of specific catabolic and anabolic genes in articular chondrocytes.