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PubMed1986

A three-quarter type below-elbow socket for myoelectric prostheses.

The Muenster and Northwestern sockets have become universally prescribed for below-elbow amputees with myoelectric prostheses. The most attractive feature of these sockets is that they are self-suspending, thereby obviating the need for a harness. The sockets are designed to encompass the patient's whole elbow. Because of the intimate fit, heat build-up inside the socket is a problem. Patients with myoelectric prostheses are denied the benefit of a stump sock. Ventilation inside the socket is almost zero and excessive perspiration occurs. This leads to maceration and skin problems which negatively affect control, comfort and wearing time. This paper reports on a technique whereby the problem of no ventilation is overcome through the removal of the proximal-posterior quadrant of the socket.

Adult↗
PubMed1995

Intraoperative monitoring of ulnar nerve function during replacement of the rheumatoid elbow via the lateral approach.

Neurography of the ulnar nerve was performed pre-, intra- and postoperatively in 8 arms of 7 patients with rheumatoid arthritis operated on with total elbow replacement via the lateral approach. Ulnar nerve decompression was performed in 4 elbows before implantation. A reduction in the amplitude of compound muscle action potential (CMAP) recorded from the abductor digiti minimi on stimulation of the ulnar nerve in the axilla, was observed during elbow dislocation at surgery in all patients, in 5 cases transiently and in 3 cases until the end of surgery. The ulnar nerve had been decompressed in all patients with lasting amplitude reduction. One of them had a mild sensory ulnar nerve palsy, while the other 2 had normal nerve function at the postoperative clinical examination. All 3 had a reduction in the amplitude of compound sensory nerve action potential (SNAP) and 2 of them also in CMAP amplitude at the postoperative neurographic examination. In patients with transient reduction during surgery, the CMAP amplitude quickly normalized on relocation of the elbow and both the SNAP and the CMAP were preserved at the postoperative neurographic examination. The authors conclude that dislocation of the laterally approached elbow carries a risk of ulnar nerve injury, which is not prevented by decompression of the ulnar nerve, but frequent relocation of the elbow during surgery seems important. It is suggested that the ulnar nerve should not be decompressed routinely, and that the dislocated elbow should be frequently relocated.

Action Potentials↗
PubMed1996

The stiff elbow.

Contracture of the elbow is a common complication of fractures, dislocations, burns, etc., around the elbow. The stiff or contracted elbow is defined as an elbow with a reduction in extension greater than 30 degrees, and/or a flexion less than 120 degrees. Although supination and pronation are often reduced as well, this will not be considered further as contracture of the elbow is not related to forearm rotation. Stiffness of the elbow impairs hand function, because this is highly dependent on elbow extension and flexion and forearm rotation. A 50% reduction of elbow motion can reduce the upper extremity function by almost 80%. Surgery of the posttraumatic stiff elbow is a challenging and demanding procedure. During recent years a more aggressive approach to the treatment of chronic contractures around the elbow joint in combination with more specific surgical techniques and an advanced postoperative rehabilitation have improved the final outcome. The purpose of my article is to define a reasonable and specific approach for the clinician in the surgical management of the posttraumatic stiff elbow, based on a review of the literature and my personal experience.

Adolescent↗
PubMed1986

The effect of the radial head and prosthetic radial head replacement on resisting valgus stress at the elbow.

Five fresh nonembalmed elbows were tested for resistance to valgus stress in their anatomic state, after radial head resection, and after insertion of Silastic and polymethylmethacrylate (PMMA) radial head replacements. The resistance to valgus stress was found to be reduced an average of 28% after radial head resection. The PMMA and Silastic implants restored valgus stiffness an average of 86% and 78% respectively, as compared to intact elbow values for corresponding flexion angles. Testing in pronation, supination and neutral forearm rotation demonstrated no difference in valgus stiffness. For each elbow, resistance to valgus stress was greatest at full extension and dropped approximately 30% at all other flexion angles as compared to corresponding full extension value. These data support the concept of the radial head as a stabilizer to valgus stress in the in vitro elbow. Further, this data demonstrated the ineffectiveness of current radial head replacement systems in restoring this biomechanical function and suggest that the use of a stiffer implant material may be beneficial in resisting valgus stress. Additional testing is indicated to determine the performance of a stiffer implant at the clinical and biological levels.

Adult↗
PubMedDate not supplied

Total elbow replacement.

Elbow joint replacement is performed primarily in patients with severe elbow pain and elbow joint destruction caused by rheumatoid arthritis. The capitellocondylar implant is the prototype of the nonconstrained elbow resurfacing implant. Successful total elbow joint replacement can result in pain relief and improve rotation and flexion of the arm. Outpatient and inpatient nursing intervention in coordination with occupational therapy promotes optimum function.

Arthritis, Rheumatoid↗
PubMed1990

The osteo-anconeus flap. An approach for total elbow arthroplasty.

Twenty-seven consecutive primary total elbow arthroplasties were done with a technique that preserved the continuity of the attachment of the triceps brachii muscle with a wafer of bone from the reflected extra-articular portion of the olecranon and with the lateral fascia of muscles of the forearm. During closure, the wafer was reattached to the broad cancellous surface of the olecranon with sutures through the bone. The elbows were immobilized for an average of sixteen days postoperatively. The patients who were available for follow-up were re-examined at an average of 3.9 years, and the strength of the triceps muscle was checked. No extensor lag or avulsion of the triceps occurred, and mild extensor weakness was seen in only two elbows. No patient had early or late drainage of the wound or infection. The average range of motion compared favorably with that in other reported series. This osteo-anconeus posterior approach is advocated for total elbow arthroplasty because it provides rapid and wide exposure, it is associated with a low rate of complications related to the wound, and it preserves the strength of the triceps.

Elbow Joint↗
PubMedDate not supplied

Advances in implant arthroplasty in the upper extremity, circa 1988.

Artificial joint replacement has paralleled that in the lower extremity during the past 15 years. The ability to replace the shoulder, elbow, and the wrist joint has relieved pain and restored function to the upper extremities of patients with rheumatoid arthritis. Engineering developments have led to improved design, sufficient enough that the implant durability appears to exceed that of the patients' themselves. The kinematics and design of these implants has been under intensive and continuing study since the inception of these procedures. The exact anatomical restoration of the centers of motion and alignment for movement are essential for the success of these arthroplasties. We report here our long-term experience with shoulder replacement arthroplasties in which the success rate in terms of good and excellent results has been 90%. Similar results have been achieved with elbow replacement arthroplasties during a 14 year follow-up. Wrist replacement arthroplasties have also shown high good to excellent results during a nine-year follow-up period. Experience has demonstrated that if infection and wound complications are minimized, the long-term results are excellent in terms of pain relief, movement, and restoration of function.

Elbow Joint↗
PubMed1988

[Surgical therapeutic possibilities of the elbow in chronic polyarthritis].

The natural history of rheumatoid arthritis of the elbow often includes impairment of the function of the upper extremity in advanced stages of the disease. Synovectomy performed by a large radial incision is considered a worthwhile procedure for stages 1-3 according to the classification of Larsen et al. Radiosynoviorthesis is possible in stages 0 and 1. In the authors' opinion, resection- and interposition arthroplasty remains the procedure of choice for advanced stages 4 and 5. For elbows with severe instability alloarthroplasty may be considered. The radial head should generally not be resected. Entrapment neuropathy of the ulnar and the posterior interosseus nerves is possible in rheumatoid arthritis patients. The surgical treatment consists in decompression, if necessary with transposition and synovectomy of the elbow joint.

Arthritis, Rheumatoid↗