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PubMed1995

[Infection following shoulder and elbow arthroplasty. Diagnosis and therapy].

The rate of infection reported in recent publications is 0.8% after shoulder arthroplasty and ten times higher (8.1%) after elbow arthroplasty. The figures for shoulder arthroplasty correspond well with our own rate of revision for infection of 0.5% after 363 primary shoulder replacements. However, our average rate of revision for infection (1.8%) after 278 GSB-III elbow arthroplasties was considerably lower and included rheumatoid as well as post-traumatic indications. Our experience concerning etiologic factors, nature, diagnosis, treatment options, and long-term consequences of superficial and deep infections after shoulder and elbow arthroplasty are discussed for each joint separately and in relation to the literature.

Aged↗
PubMed1995

[Multiple joint replacement in chronic rheumatoid arthritis: results, indications].

Rheumatoid arthritis, steadily progressive and affecting many joints, is a real challenge for the orthopaedic surgeon. Thorough assessment and long-term planning to maximize overall performance requires clear orthopaedic thinking based on wide experience. The final aim is to enable the patients to walk and be independent. Over the last 30 years, the surgery of the rheumatic diseases has become a well-established specialty within orthopaedic surgery. Open synovectomy still has a place. In badly damaged joints, however, only prosthetic joint replacement has a fair chance. Total hip replacement is now a common procedure. Yet many problems regarding long-term performance remain unclear. This is even more pertinent for total knee replacement. Operations on the upper limbs must enable the patient to become less dependent of other people's help. Artificial shoulder joints have become more popular, and elbow joint replacement has been a particularly important field at the Wilhelm Schulthess Clinic. Multiple joint replacement is often necessary and can improve the quality of life for these badly stricken patients.

Arthritis, Rheumatoid↗
PubMed1994

Revision total elbow replacement.

Revision total elbow surgery is technically demanding with high complication rates. It requires precise preoperative planning and a surgeon prepared to use any of several surgical options during surgery. Satisfactory results can be achieved in complex cases.

Arthrodesis↗
PubMed1994

Infection following total elbow arthroplasty.

Total elbow arthroplasty can be a safe, effective means of relieving the pain and loss of motion owing to arthritis of the elbow; however, infection is a frequent and devastating complication that occurs in 1 of every 20 total elbows. Through careful patient selection, meticulous operative technique, and vigilant postoperative care, this risk can be decreased. If infection does develop, early, aggressive operative management provides the best hope for salvage of the joint.

Elbow Joint↗
PubMed1994

[Arthroplasty of the elbow joint].

The authors present a review on the development of arthroplasties of the elbow. Modern arthroplasties are divided into basic groups and their main advantages and disadvantages are characterized. The authors describe in detail the construction and technique of Souter-Strathclyde total endoprostheses of the elbow based on the authors' own experience. Total endoprostheses of the elbow are the only solution which can ensure at the same time marked relief from pain, a satisfactory range of movement and stability of the operated joint.

Elbow Joint↗
PubMedDate not supplied

[The "Kompomed" elbow joint endoprosthesis from the Central Research Institute of Traumatology and Orthopedics].

Elbow joint implants having a metallic and polymeric mobility center and flattened structurilized stems have been developed, patented and allowed for commercial production. The construction of the implant allows for its firm joint with appropriate bones. The metallic and polymeric mobility center makes friction efforts relatively small. These qualities significantly lower the shaking properties of the stem and the implant operates long without displaying any signs of instability.

Academies and Institutes↗
PubMed1998

Non-constrained elbow arthroplasty for mutilans deformity in rheumatoid arthritis: a report of six cases.

Six highly unstable elbows with severe bone loss due to rheumatoid arthritis were replaced by a non-constrained, unlinked prosthesis. Bone defects were filled with autogenous bone grafts. The mean follow-up was 4.5 years (2 to 8). The clinical results were excellent in four elbows and good in two, with good varus-valgus stability in all. Radiological follow-up showed no appreciable signs of loosening, and the bone grafts had retained most of their original size, with minimal resorption. There were no major complications such as dislocation, skin necrosis, infection or ulnar neuropathy. The study has shown that the so-called mutilans elbow can be successfully replaced using a properly selected type of non-constrained, unlinked prosthesis with bone grafting of the major defects.

Alloys↗
PubMed2005

Hinged elbow external fixators: indications and uses.

Hinged external fixation of the elbow joint can play an important role in managing complicated fracture-dislocations, joint instability after extensive contracture release, and distraction interposition arthroplasty. Application of these devices requires accurate alignment of the fixator axis with the anatomic axis of the elbow. The primary therapeutic goal is to allow joint motion while protecting the healing ligaments. Common complications include pin loosening, injury to adjacent neurovascular structures, cellulitis, and loss of reduction. Although reported data are limited, this technique is a useful adjunct in patients with complex elbow instability.

Contracture↗
PubMed1991

[Endoprosthesis of the elbow joint in sequelae of gunshot wounds].

5 patients have been implanted the endoprostheses of Sivash K. M. to restore functions of the upper limb after the gunshot injury in the area of elbow joint with the clinico-roentgenologic bone defect detection. Coarse cicatricial changes in the area of an articulation with presence of foreign bodies are characteristic for those patients. There have been achieved significant improvement of restoration of active movement of elbow joint and upper limb in whole with 4 of them in spite of high danger of possible post-operative inflammation. In one case due to hard physical labour there have been noted break of an endoprosthesis with the subsequent inflammation. The endoprosthesis has been removed. The most stable positive outcomes proved by physiological tests of the neuromuscular system of upper limbs are observed at endoprosthetics of elbow joint with replacement of the soft tissue defect with completely vascularized musculocutaneous autotransplant.

Adolescent↗
PubMed1981

Kinematics of the elbow.

Previous studies of elbow kinematics produced conflicting results because of technical limitations. Kinematic analyses of eight normal elbows (four in cadavera and four in living subjects) using true lateral roentgenograms made by a special technique showed that flexion occurs about a single axis. This axis passes through the centers of the arcs outlined by the bottom of the trochlear sulcus and the periphery of the capitellum. Motion of the joint surfaces is of a sliding type except at the extremes of flexion and extension where rolling motion occurs. The carrying angle of the forearm remains constant as the elbow flexes. Based on these findings, total elbow prostheses ideally should be uniaxial, with the axis of flexion of the prosthesis the same as the axis of the normal joint.

Biomechanical Phenomena↗
PubMed1996

Latissimus dorsi musculocutaneous free flap transplantation to salvage below-elbow amputation in an emergency operation: a case report.

We used a free latissimus dorsi musculocutaneous flap (LD m-c flap) to cover a large skin defect at the stump of a forearm in an emergency operation. The patient we discuss is a 52-year-old man. Amputation at the distal one third of the left forearm occurred after catching his hand and wrist in a machine. The amputated left hand was severely damaged and there were wide skin defects. The function of the elbow joint was well preserved. Both the radius and ulna were cut 7 cm distal from the elbow joint. A 20 x 8 cm square of LD m-c flap was transplanted, to the stump of the forearm. The flap survived without incident. The range of motion of the elbow joint was from 20 degrees to 85 degrees. The prosthesis was well fitted to the stump, and the patient returned to his workshop 9 months after injury.

Amputation Stumps↗
PubMed1998

[Prosthesis of the upper extremity].

In functional impairment of a joint due to pain and (or) limited mobility in which conservative measures are inadequate, an operation may be considered. The principal possibilities are arthrodesis and implantation of an artificial joint. Reasons to opt for a prosthesis are involvement of adjacent articulations (in rheumatoid arthritis) and preservation of mobility which, together with stability, is necessary for good articular function. The principal indications for implantation of an artificial joint in the upper extremity are rheumatoid arthritis and (to a lesser degree) osteoarthritis and posttraumatic impairments. The functional results of prostheses in the shoulder, elbow and wrist are good, but the proportion of complications is relatively large (compared with that in hip and knee prostheses) and follow-up so far has only been short.

Arthritis, Rheumatoid↗
PubMed2003

[A bipolar radial head prosthesis after comminuted radial head fractures: indications, treatment and outcome after 5 years].

The treatment of comminuted fractures of the radial head with concomitant injuries of the ulnar complex by resection of the radial head usually does not provide satisfactory long-term results. Other than joint instability in the elbow and a limited range of motion, radius proximalisation in the sense of ulnocarpal impingement, osteoarthritis and pain in the elbow have been described. Between 1995 and 1997, 11 radial head prostheses were implanted in ten patients who had sustained a comminuted fracture of the radial head with concomitant injury to the ulnar complex. A follow-up survey was conducted with the patients on average 5 years after the injury. Eight patients with nine implants participated in the follow-up, one patient had died and another refused to participate but declared that he did not suffer from any impairment. According to the Morrey score, two of the results were found to be very good, five to be good, one to be fair and one to be poor. Despite the severe injuries sustained by the elbow, neither joint instability in the elbow nor proximalisation of the radius, cubitus valgus, ulnar nerve syndrome, nor loosening of the prosthesis were found in any of the patients. In the event of comminuted fractures of the radial head which are impossible to reconstruct by osteosynthesis and which occur with concomitant ulnar ligamentous or osseous injury, the implantation of a prosthesis is preferred over the resection of the head of the radius.

Adult↗