The aims of this study were to validate the outcome of total elbow arthroplasty (TEA) in patients with rheumatoid arthritis (RA), and to identify factors that affect the outcome. We searched PubMed, MEDLINE, Cochrane Reviews, and Embase from between January 2003 and March 2019. The primary aim was to determine the implant failure rate, the mode of failure, and risk factors predisposing to failure. A secondary aim was to identify the overall complication rate, associated risk factors, and clinical performance. A meta-regression analysis was completed to identify the association between each parameter with the outcome.Aims
Methods
The aim of this study was to report the mid-term clinical outcome
of cemented unlinked J-alumina ceramic elbow (JACE) arthroplasties
when used in patients with rheumatoid arthritis (RA). We retrospectively reviewed 87 elbows, in 75 patients with RA,
which was replaced using a cemented JACE total elbow arthroplasty
(TEA) between August 2003 and December 2012, with a follow-up of
96%. There were 72 women and three men, with a mean age of 62 years
(35 to 79). The mean follow-up was nine years (2 to 14). The clinical condition
of each elbow before and after surgery was assessed using the Mayo
Elbow Performance Index (MEPI, 0 to 100 points). Radiographic loosening
was defined as a progressive radiolucent line of >1 mm that was
completely circumferential around the prosthesis.Aims
Patients and Methods
The crucial role of the radial head in the stability of the elbow in terrible triad injury is acknowledged. This retrospective study aims to compare the results of resection of a severely comminuted radial head with or without prosthetic arthroplasty as part of the reconstruction for this injury. The outcome of radial head resection was compared with prosthetic arthroplasty in 29 and 15 patients with terrible triad injuries, respectively. There were ten female patients (34.5%) in the resection group and six female patients (40%) in the prosthesis group. The mean age was 40.7 years (Aims
Patients and Methods
Improvements in the evaluation of outcome after nerve transfers
are required. The assessment of force using the Medical Research
Council (MRC) grades (0 to 5) is not suitable for this purpose.
A ceiling effect is encountered within MRC grade 4/5 rendering this
tool insensitive. Our aim was to show how the strength of flexion
of the elbow could be assessed in patients who have undergone a
re-innervation procedure using a continuous measurement scale. A total of 26 patients, 23 men and three women, with a mean age
of 37.3 years (16 to 66), at the time of presentation, attended
for review from a cohort of 52 patients who had undergone surgery
to restore flexion of the elbow after a brachial plexus injury and
were included in this retrospective study. The mean follow-up after
nerve transfer was 56 months (28 to 101, standard deviation (Aims
Methods
The primary aim of this study was to define the standard minimum
follow-up required to produce a reliable estimate of the rate of
re-operation after radial head arthroplasty (RHA). The secondary
objective was to define the leading reasons for re-operation. Four electronic databases, between January 2000 and March 2017
were searched. Articles reporting reasons for re-operation (Group
I) and results (Group II) after RHA were included. In Group I, a
meta-analysis was performed to obtain the standard minimum follow-up,
the mean time to re-operation and the reason for failure. In Group
II, the minimum follow-up for each study was compared with the standard
minimum follow-up.Aims
Materials and Methods
The aim of this study was to investigate whether clinical and radiological outcomes after intramedullary nailing of displaced fractures of the fifth metacarpal neck using a single thick Kirschner wire (K-wire) are noninferior to those of technically more demanding fixation with two thinner dual wires. This was a multicentre, parallel group, randomized controlled noninferiority trial conducted at 12 tertiary trauma centres in Germany. A total of 290 patients with acute displaced fractures of the fifth metacarpal neck were randomized to either intramedullary single-wire (n = 146) or dual-wire fixation (n = 144). The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire six months after surgery, with a third of the minimal clinically important difference (MCID) used as the noninferiority threshold. Secondary outcomes were pain, health-related quality of life (EuroQol five-dimensional questionnaire (EQ-5D)), radiological measures, functional deficits, and complications.Aims
Patients and Methods
Delayed diagnosis is a well-known complication of a Monteggia
fracture-dislocation. If left untreated, the dislocated radial head
later becomes symptomatic. The purposes of this study were firstly,
to evaluate the clinical and radiological results of open reduction
of the radial head and secondly, to identify the factors that may
affect the outcome of this procedure. This retrospective study evaluated 30 children with a chronic
Monteggia lesion. There were 18 boys and 12 girls with a mean age
of 7.4 years (4 to 13) at the time of open reduction. The mean interval
to surgery, after the initial fracture, was 23.4 months (6 to 120).
Clinical grading used a Kim modified elbow score: radiological outcome
was recorded. The effect of the patient’s age, gender, duration
from initial injury, Bado classification, and annular ligament reconstruction
were analyzed. The mean follow-up was 42.2 months (15 to 20).Aims
Materials and Methods
We review our experience of Coonrad-Morrey total elbow arthroplasty
(TEA) for fractures of the distal humerus in non-rheumatoid patients
with a minimum of ten years follow-up. TEA through a triceps splitting approach was peformed in 37 non-rheumatoid
patients for a fracture of the distal humerus between 1996 and 2004.
One patient could not be traced and 17 had died before the tenth
anniversary of their surgery. This left 19 patients with a minimum
follow-up of ten years to form the study group. Of these, 13 patients
were alive at the time of final review. The other six had died,
but after the tenth anniversary of their elbow arthroplasty. Their
clinical and radiological data were included in the study. Aims
Patients and Methods
Supracondylar fractures are the most frequently occurring paediatric
fractures about the elbow and may be associated with a neurovascular
injury. The British Orthopaedic Association Standards for Trauma
11 (BOAST 11) guidelines describe best practice for supracondylar
fracture management. This study aimed to assess whether emergency
departments in the United Kingdom adhere to BOAST 11 standard 1:
a documented assessment, performed on presentation, must include
the status of the radial pulse, digital capillary refill time, and
the individual function of the radial, median (including the anterior
interosseous), and ulnar nerves. Stage 1: We conducted a multicentre, retrospective audit of adherence
to BOAST 11 standard 1. Data were collected from eight hospitals
in the United Kingdom. A total of 433 children with Gartland type
2 or 3 supracondylar fractures were eligible for inclusion. A centrally
created data collection sheet was used to guide objective analysis
of whether BOAST 11 standard 1 was adhered to. Stage 2: We created
a quality improvement proforma for use in emergency departments.
This was piloted in one of the hospitals used in the primary audit
and was re-audited using equivalent methodology. In all, 102 patients
presenting between January 2016 and July 2017 were eligible for inclusion
in the re-audit.Aims
Materials and Methods
Cubitus varus is the most common late complication of a supracondylar
fracture of the humerus in children. Correction can be performed
using one of a number of techniques of osteotomy but each has disadvantages.
We describe a new technique for correcting post-traumatic cubitus
varus using a lateral closing wedge isosceles triangular osteotomy. A lateral closing wedge isosceles triangular osteotomy was performed
in 25 patients (15 male and ten female with a mean age of 9.5 years
(6 to 12)) between May 2010 and April 2013. All patients had cubitus
varus secondary to malunion of a supracondylar fracture, with good
function of the elbow and a full range of movement. The osteotomy
lines were marked on the bone with an isosceles triangular template
made before surgery, after which the osteotomy was performed leaving
the medial cortex intact. Fixation was performed using two lateral
2 mm Kirschner (K)-wires and patients were immobilised in an above-elbow
plaster. By six to eight weeks callus was present and the wires
and cast were removed. Patients were reviewed at four and six weeks,
three, six and 12 months and then every two years until skeletal
maturity. Clinical and radiographic outcomes were categorised as excellent,
good or poor.Aims
Patients and Methods
The aim of the study was to analyze the results of primary tendon
reinsertion in acute and chronic distal triceps tendon ruptures
(DTTRs) in the general population. A total of 28 patients were operated on for primary DTTR reinsertions,
including 21 male patients and seven female patients with a mean
age of 45 years (14 to 76). Of these patients, 23 sustained an acute
DTTR and five had a chronic injury. One patient had a non-simultaneous
bilateral DTTR. Seven patients had DTTR-associated ipsilateral fracture
or dislocation. Comorbidities were present in four patients. Surgical
treatment included transosseous and suture-anchors reinsertion in
22 and seven DTTRs, respectively. The clinical evaluation was performed
using Mayo Elbow Performance Score (MEPS), the modified American
Shoulder and Elbow Surgeons Score (m-ASES), the Quick Disabilities
of the Arm, Shoulder and Hand score (QuickDASH), and the Medical
Research Council (MRC) Scale.Aims
Patients and Methods
