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
Reconstruction after osteoarticular resection of the proximal ulna for tumours is technically difficult and little has been written about the options that are available. We report a series of four patients who underwent radial neck to humeral trochlea transposition arthroplasty following proximal ulnar osteoarticular resection. Between July 2020 and July 2022, four patients with primary bone tumours of the ulna underwent radial neck to humeral trochlea transposition arthroplasty. Their mean age was 28 years (12 to 41). The functional outcome was assessed using the range of motion (ROM) of the elbow, rotation of the forearm and stability of the elbow, the Musculoskeletal Tumor Society score (MSTS), and the nine-item abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH-9) score.Aims
Methods
This study aimed to quantify the shoulder kinematics during an apprehension-relocation test in patients with anterior shoulder instability (ASI) and glenoid bone loss using the radiostereometric analysis (RSA) method. Kinematics were compared with the patient’s contralateral healthy shoulder. A total of 20 patients with ASI and > 10% glenoid bone loss and a healthy contralateral shoulder were included. RSA imaging of the patient’s shoulders was performed during a repeated apprehension-relocation test. Bone volume models were generated from CT scans, marked with anatomical coordinate systems, and aligned with the digitally reconstructed bone projections on the RSA images. The glenohumeral joint (GHJ) kinematics were evaluated in the anteroposterior and superoinferior direction of: the humeral head centre location relative to the glenoid centre; and the humeral head contact point location on the glenoid.Aims
Methods
This study aims to describe a new method that may be used as a supplement to evaluate humeral rotational alignment during intramedullary nail (IMN) insertion using the profile of the perpendicular peak of the greater tuberosity and its relation to the transepicondylar axis. We called this angle the greater tuberosity version angle (GTVA). This study analyzed 506 cadaveric humeri of adult patients. All humeri were CT scanned using 0.625 × 0.625 × 0.625 mm cubic voxels. The images acquired were used to generate 3D surface models of the humerus. Next, 3D landmarks were automatically calculated on each 3D bone using custom-written C++ software. The anatomical landmarks analyzed were the transepicondylar axis, the humerus anatomical axis, and the peak of the perpendicular axis of the greater tuberosity. Lastly, the angle between the transepicondylar axis and the greater tuberosity axis was calculated and defined as the GTVA.Aims
Methods
The aim of this study was to develop and internally validate a prognostic nomogram to predict the probability of gaining a functional range of motion (ROM ≥ 120°) after open arthrolysis of the elbow in patients with post-traumatic stiffness of the elbow. We developed the Shanghai Prediction Model for Elbow Stiffness Surgical Outcome (SPESSO) based on a dataset of 551 patients who underwent open arthrolysis of the elbow in four institutions. Demographic and clinical characteristics were collected from medical records. The least absolute shrinkage and selection operator regression model was used to optimize the selection of relevant features. Multivariable logistic regression analysis was used to build the SPESSO. Its prediction performance was evaluated using the concordance index (C-index) and a calibration graph. Internal validation was conducted using bootstrapping validation.Aims
Methods
Post-traumatic elbow stiffness is a disabling condition that remains challenging for upper limb surgeons. Open elbow arthrolysis is commonly used for the treatment of stiff elbow when conservative therapy has failed. Multiple questions commonly arise from surgeons who deal with this disease. These include whether the patient has post-traumatic stiff elbow, how to evaluate the problem, when surgery is appropriate, how to perform an excellent arthrolysis, what the optimal postoperative rehabilitation is, and how to prevent or reduce the incidence of complications. Following these questions, this review provides an update and overview of post-traumatic elbow stiffness with respect to the diagnosis, preoperative evaluation, arthrolysis strategies, postoperative rehabilitation, and prevention of complications, aiming to provide a complete diagnosis and treatment path. Cite this article:
This study aimed to determine the minimal detectable change (MDC), minimal clinically important difference (MCID), and substantial clinical benefit (SCB) under distribution- and anchor-based methods for the Mayo Elbow Performance Index (MEPI) and range of movement (ROM) after open elbow arthrolysis (OEA). We also assessed the proportion of patients who achieved MCID and SCB; and identified the factors associated with achieving MCID. A cohort of 265 patients treated by OEA were included. The MEPI and ROM were evaluated at baseline and at two-year follow-up. Distribution-based MDC was calculated with confidence intervals (CIs) reflecting 80% (MDC 80), 90% (MDC 90), and 95% (MDC 95) certainty, and MCID with changes from baseline to follow-up. Anchor-based MCID (anchored to somewhat satisfied) and SCB (very satisfied) were calculated using a five-level Likert satisfaction scale. Multivariate logistic regression of factors affecting MCID achievement was performed.Aims
Methods
Revision total elbow arthroplasty (TEA) is often challenging.
The aim of this study was to report on the clinical and radiological
results of revision arthroplasty of the elbow with the Latitude
TEA. Between 2006 and 2010 we used the Latitude TEA for revision in
18 consecutive elbows (17 patients); mean age 53 years (28 to 80);
14 women. A Kudo TEA was revised in 15 elbows and a Souter-Strathclyde
TEA in three. Stability, range of movement (ROM), visual analogue score (VAS)
for pain and functional scores, Elbow Functional Assessment Scale
(EFAS), the Functional Rating Index of Broberg and Morrey (FRIBM)
and the Modified Andrews’ Elbow Scoring System (MAESS) were assessed
pre-operatively and at each post-operative follow-up visit (six,
12 months and biennially thereafter). Radiographs were analysed
for loosening, fractures and dislocation. The mean follow-up was
59 months (26 to 89).Aims
Patients and Methods
Unlinked, linked and convertible total elbow
arthroplasties (TEAs) are currently available. This study is the
first to report the clinical results of the convertible Latitude
TEA. This was a retrospective study of a consecutive cohort of 63
patients (69 primary TEAs) with a mean age of 60 years (23 to 87).
Between 2006 and 2008 a total of 19 men and 50 women underwent surgery.
The mean follow-up was 43 months (8 to 84). The range of movement,
function and pain all improved six months post-operatively and either
continued to improve slightly or reached a plateau thereafter. The
complication rate is similar to that reported for other TEA systems.
No loosening was seen. Remarkable is the disengagement of the radial
head component in 13 TEAs (31%) with a radial head component implanted. Implantation of both the linked and the unlinked versions of
the Latitude TEA results in improvement of function and decreased
pain, and shows high patient satisfaction at mid-term follow-up. Cite this article:
Lateral epicondylitis, or ’tennis elbow’, is
a common condition that usually affects patients between 35 and
55 years of age. It is generally self-limiting, but in some patients
it may continue to cause persistent symptoms, which can be refractory
to treatment. This review discusses the mechanism of disease, symptoms
and signs, investigations, current management protocols and potential
new treatments. Cite this article:
Medium-term results of the Discovery elbow replacement
are presented. We reviewed 51 consecutive primary Discovery total
elbow replacements (TERs) implanted in 48 patients. The mean age
of the patients was 69.2 years (49 to 92), there were 19 males and
32 females (37%:63%) The mean follow-up was 40.6 months (24 to 69).
A total of six patients were lost to follow-up. Statistically significant
improvements in range movement and Oxford Elbow Score were found
(p <
0.001). Radiolucent lines were much more common in, and
aseptic loosening was exclusive to, the humeral component. Kaplan–Meier
survivorship at five years was 92.2% (95% CI 74.5% to 96.4%) for
aseptic loosening. In four TERs, periprosthetic infection occurred
resulting in failure. A statistically significant association between
infection and increased BMI was found (p = 0.0268). Triceps failure
was more frequent after the Mayo surgical approach and TER performed
after previous trauma surgery. No failures of the implant were noted. Our comparison shows that the Discovery has early clinical results
that are similar to other semi-constrained TERs. We found continued
radiological surveillance with particular focus on humeral lucency
is warranted and has not previously been reported. Despite advances
in the design of total elbow replacement prostheses, rates of complication
remain high. Cite this article:
We report our experience of performing an elbow
hemiarthroplasty in the treatment of comminuted distal humeral fractures
in the elderly patients. A cohort of 42 patients (three men and 39 women, mean age 72;
56 to 84) were reviewed at a mean of 34.3 months (24 to 61) after
surgery. Functional outcome was measured with the Mayo Elbow Performance
Score (MEPS) and range of movement. The disabilities of the arm,
shoulder and hand questionnaire (DASH) was used as a patient rated
evaluation. Complications and ulnar nerve function were recorded.
Plain radiographs were obtained to assess prosthetic loosening,
olecranon wear and heterotopic bone formation. The mean extension deficit was 23.5° (0° to 60°) and mean flexion
was 126.8° (90° to 145°) giving a mean arc of 105.5° (60° to 145°).
The mean MEPS was 90 (50 to 100) and a mean DASH score of 20 (0
to 63). Four patients had additional surgery for limited range of
movement and one for partial instability. One elbow was revised
due to loosening, two patients had sensory ulnar nerve symptoms,
and radiographic signs of mild olecranon wear was noted in five
patients. Elbow hemiarthroplasty for comminuted intra-articular distal
humeral fractures produces reliable medium-term results with functional
outcome and complication rates, comparable with open reduction and
internal fixation and total elbow arthroplasty. Cite this article:
The eccentric glenosphere was principally introduced into reverse
shoulder arthroplasty to reduce the incidence of scapular notching.
There is only limited information about the influence of its design
on deltoid power and joint reaction forces. The aim of our study was to investigate how the diameter and
eccentricity of the glenosphere affect the biomechanics of the deltoid
and the resultant joint reaction forces. Different sizes of glenosphere and eccentricity were serially
tested in ten cadaveric shoulders using a custom shoulder movement
simulator.Aims
Methods
Determining and accurately restoring the flexion-extension
axis of the elbow is essential for functional recovery after total
elbow arthroplasty (TEA). We evaluated the effect of morphological
features of the elbow on variations of alignment of the components
at TEA. Morphological and positioning variables were compared by
systematic CT scans of 22 elbows in 21 patients after TEA. There were five men and 16 women, and the mean age was 63 years
(38 to 80). The mean follow-up was 22 months (11 to 44). The anterior offset and version of the humeral components were
significantly affected by the anterior angulation of the humerus
(p = 0.052 and p = 0.004, respectively). The anterior offset and
version of the ulnar components were strongly significantly affected
by the anterior angulation of the ulna (p <
0.001 and p <
0.001). The closer the anterior angulation of the ulna was to the joint,
the lower the ulnar anterior offset (p = 0.030) and version of the
ulnar component (p = 0.010). The distance from the joint to the
varus angulation also affected the lateral offset of the ulnar component
(p = 0.046). Anatomical variations at the distal humerus and proximal ulna
affect the alignment of the components at TEA. This is explained
by abutment of the stems of the components and is particularly severe
when there are substantial deformities or the deformities are close
to the joint. Cite this article:
To prevent insufficiency of the triceps after
total elbow arthroplasty, we have, since 2008, used a triceps-sparing ulnar
approach. This study evaluates the clinical results and post-operative
alignment of the prosthesis using this approach. We reviewed 25 elbows in 23 patients. There were five men and
18 women with a mean age of 69 years (54 to 83). There were 18 elbows
with rheumatoid arthritis, six with a fracture or pseudoarthrosis
and one elbow with osteoarthritis. Post-operative complications included one intra-operative fracture,
one elbow with heterotopic ossification, one transient ulnar nerve
palsy, and one elbow with skin necrosis, but no elbow was affected
by insufficiency of the triceps. Patients were followed for a mean of 42 months (24 to 77). The
mean post-operative Japanese Orthopaedic Association Elbow Score
was 90.8 (51 to 100) and the mean Mayo Elbow Performance score 93.8
(65 to 100). The mean post-operative flexion/extension of the elbow
was 135°/-8°. The Manual Muscle Testing score of the triceps was
5 in 23 elbows and 2 in two elbows (one patient). The mean alignment
of the implants examined by 3D-CT was 2.8° pronation (standard deviation
( The triceps-sparing ulnar approach allows satisfactory alignment
of the implants, is effective in preventing post-operative triceps
insufficiency, and gives satisfactory short-term results. Cite this article: 2015;97-B:1096–1101.
