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PubMed1995

Use of distraction arthroplasty in unstable fracture dislocations of the elbow.

Patients with persistent instability after experiencing posterior dislocation of the ulnohumeral joint associated with large unstable fractures of the coronoid process of the ulna can be challenging to manage. To date, no reports have documented an effective treatment program for this injury. Joint stiffness or persistent instability results in most cases. Seven patients are discussed who were treated with a joint distraction device. Six (86%) of the 7 patients had successful outcomes at a minimum followup of 2 years. The mean arc of flexion before surgery was 33 degrees; after surgery, the arc increased to 88 degrees. The joint distraction device provides immobilization of periarticular fractures and simultaneously allows for joint movement, which results in a stable and mobile joint. Without this device, a 20% satisfactory result for this injury was reported; this percentage improved to 86% by rendering the joint stable with adequate motion.

Adult↗
PubMed2005

The Essex-Lopresti lesion: a variant with a bony distal radioulnar joint injury.

The Essex-Lopresti lesion is an unusual injury, consisting of a radial head or neck fracture, distal radioulnar joint (DRUJ) injury and interosseous membrane rupture. To date, all reported Essex-Lopresti lesions have consisted of soft tissue injuries at the DRUJ. We present a case of an Essex-Lopresti lesion with a bony variant, in which the DRUJ injury consisted of an ulnar head fracture associated with radial head fracture and acute proximal migration of the radius. The management involved plating of the ulnar head fracture and titanium replacement of the radial head.

Aged↗
PubMed1983

Infection after total elbow arthroplasty.

Deep sepsis occurred after fourteen (9 per cent) of 156 elbow-replacement procedures in 140 patients. This high frequency of infection was attributed to several factors. First, the patients were drawn from a population that was at high risk of infection, because rheumatoid arthritis and post-traumatic arthritis were the indications for arthroplasty. Second, many of the patients had had prior surgery, which significantly (p less than 0.02) increased the risk of sepsis in those with rheumatoid arthritis. Third, some patients had surgery after the arthroplasty, which also seemed to predispose to deep infection (p less than 0.05). In one patient the elbow was salvaged by early débridement, and in two others reimplantation of a total joint replacement was successful after removal of the first prosthesis and control of the infection. Resection arthroplasty was required to arrest the infection in ten patients, eight of whom had a satisfactory result. The high incidence of this significant complication attests to the hazardous nature of the elbow-replacement procedure and should warn orthopaedic surgeons to be cautious when recommending this form of treatment.

Adult↗
PubMed1998

[Combined fractures of the radius and the ulna at the elbow level in the adult. Analysis of 120 cases after more than 1 year].

PURPOSE OF THE STUDY: The purpose of this study was to increase the knowledge about these rare and serious injuries and to produce guidelines for a more successful ORIF. MATERIAL: 120 cases of combined fractures in adults with late results (minimum one year) stored in the AO Documentation-Center between 1979 and 1989 were analyzed. Monotrauma was dominant, additional injuries were rare. No vasculo-nervous lesions were reported. 15 fractures were open. For the ulna 4 fractures types were isolated, fractures of the coronoid process and the radial head (CR) 25 cases. Olecranon and radial head fracture (OR) 22 cases. Combination of anterior (coronoid) and posterior (olecranon) ulnar fracture with radial head fracture (COR) 41 cases. Metaphyseal ulnar and radial head fractures (MR) 32 cases. For the radial head we have distinguished partial (61) and complete (59) fractures, the latter including 14 neck fractures. RESULTS: In the CR type indirect fixation technique was never perfect. Best results were obtained after ORIF of partial radial fractures. After resection, arthrosis (8/11) and valgus (8/11) were very frequent. In the OR type the stability was restored in simple fractures by the tension band technique even when the radial head was resected. In the severe COR type good results were rare. Arthrosis was important and frequent (36/41) especially after radial head resection. In the MR type ORIF of the radial head combined with ulnar plating gave the best results. Ulnar union was delayed or missing in 13 cases especially after radial head resection. Functional results after one year were better than expected on X-rays. This was due to immediate ORIF (92/120) and early mobilization. There were only 3 infections and 2 reflex-dystrophies. DISCUSSION: The Coronoid is the key-fragment of the ulna. It is best reduced in CR-Type under vision by an anterior approach. In COR-lesions its reduction should be the first step of ulnar ORIF. Comminutions in OR, COR and MR-Types showed a high number of delayed or non union. The reason may be a biological weakness (reduced vascularization) in these areas. Therefore we advocate for bridging plates (and cancellous grafts) for the stabilization of such areas, especially for the metaphysis where a strong valgus force appears after radial resection. Radial head as the lateral pillar of the elbow should be restored by ORIF in partial fractures (excellent results) and even in complete fractures (5/10 excellent results) under favourable conditions. Prosthesis is indicated in severe radial comminution or serious ulnar instability.

Adult↗
PubMedDate not supplied

[Rehabilitative treatment in endoprosthesis of the elbow joint].

A technique of rehabilitation treatment was suggested and tested on 25 patients with an elbow joint endoprosthesis. The postoperative rehabilitation involved three periods: absolute immobilization, relative immobilization and postimmobilization. Therapeutic measures should be adjusted to each specific stage and imply different physiotherapeutic modalities according to clinical features and duration of the postoperative period: position treatment; passive, light active dynamic exercise, isometric training, underwater exercise; electrostimulation; manual and mechanical massage; occupational therapy. Positive response after adequate postoperative rehabilitation was registered in 20 patients.

Adult↗
PubMed2001

[Secondary reconstruction of stumps above the elbow. Five cases].

The authors report a serie of five patients with five stumps above the elbow who needed a secondary reconstruction to allow or facilitate a prosthesis. They used in the first case an expansion of the latissimus dorsi flap and of the axillary and prepectoral region in order to free the stump of the humerus sutured on the thorax. In the second case, a free parascapular flap covered an unstable scar of the clavicula after a scapulothoracic amputation. In the third case, the transfer of a free flap of fibula associated with a pedicled latissimus dorsi flap had allowed the elongation of the stump of the humerus. In the two last cases, a latissimus dorsi flap pedicled in one and free in the second one had allowed to preserved the length of the humerus for prosthesis. The technical choices are eclectic and different in every case. The purpose is to obtain an efficient trophicity and a thickness that can support the prosthesis and if possible a stump long enough to improve the adaptation of the prosthesis. The five operated patients were able to be apparated, reducing in this way their daily functional difficulties.

Activities of Daily Living↗
PubMed1985

The Tikhoff-Linberg procedure: report of ten patients and presentation of a modified technique for tumors of the proximal humerus.

The Tikhoff-Linberg resection is a limb-sparing surgical option to be considered for bony and soft-tissue tumors in and around the proximal humerus and shoulder girdle. Careful selection of patients whose tumor does not involve the neurovascular bundle in the axilla is required. The distal clavicle, upper humerus, and part or all of the scapula are resected. The tumor remains covered by the deltoid muscle plus portions of the muscles that arise from or insert into the resected specimen. In patients with tumors of the proximal humerus a custom prosthesis is used to maintain length and stabilize the distal humerus. Elbow flexion plus stability of the shoulder without the need of an orthosis may be achieved with muscle transfers. Function of the hand and forearm after Tikhoff-Linberg resection should be near normal. Review of results in 10 patients shows no local recurrences and excellent function. The major postoperative problem was nerve palsy. The Tikhoff-Linberg procedure should continue to be used for limb salvage in selected patients with tumors in or around the shoulder girdle.

Adolescent↗
PubMedDate not supplied

A comparative study between proximal radial morphology and the floating radial head prosthesis.

A morphometric study of the proximal radius was performed with computed tomography scanning in 51 healthy adults. These dimensions were then compared with those of a commercially available floating radial head prosthesis. Results were expressed as mean values, SD, and minimum and maximum values. The minimum and maximum diameters of the radial head were 21.9 +/- 1.9 mm and 22.9 +/- 1.9 mm, respectively. The minimum and maximum intramedullary diameters of the radial neck were 8.3 +/- 1.3 mm and 9.3 +/- 1.5 mm, respectively. The combined length of the radial head and neck was 22.47 +/- 2.84 mm. The implications for prosthetic design are as follows: the small floating cup (19 mm in diameter) is too small for the large majority of adults, the large floating cup (22 mm in diameter) is closer to the radial anatomy, the mean values are significantly different between male and female patients, and a single component would suffice for right and left elbows.

Adult↗
PubMed1992

Bimanual skill development in pediatric below-elbow amputation: a multicenter, cross-sectional study.

The purpose of this study was to investigate the following in children with unilateral below-elbow amputation: (1) development of bimanual functional skills, (2) development patterns relative to able-bodied children, and (3) the relationship between duration of prosthetic wear and bimanual functional performance. Sixty-nine children with unilateral below-elbow amputation, all less than ten years old, were assessed on 14 prosthesis-assisted bimanual ADL, including play, feeding, dressing, and hygiene activities, which have been studied previously in able-bodied children. Bimanual ADL skill development was not delayed in five of the 14 comparisons to previously published standards, but most development patterns had multimodal, nonmonotonic performance profiles. Duration of prosthetic wear and other factors previously believed to contribute to good prosthetic function were not well correlated to ADL skills (r less than .52). Although these children had no CNS dysfunction, it is apparent that below-elbow amputation impedes pediatric ADL skill development. The cause of these delays appears to be complex and is not expressed uniformly among all children; thus, the delays observed are not simply due to mechanical deficiencies of the prosthetic restoration.

Activities of Daily Living↗
PubMed1991

[The late results after mobilizing bone resections in posttraumatic rigidity of the elbow].

Two categories of posttraumatic rigidities are distinguished: partial and total. The severity of partial rigidities depends on the residual flexion-extension amplitude arch and they are divided accordingly into functional rigidities, with a residual amplitude arch of 60-100 degrees, and non-functional ones, with residual flexion amplitude arches of 0-80 degrees or over 100 degrees. The severity of total rigidities depends mainly on the preservation or loss of the pronation-supination movement. To the department where the authors are working were admitted during 16 years (1970-1986), 54 cases of posttraumatic rigidities of the elbow, on which 63 operations were performed. The surgical indications were established according to the anatomopathological type of lesions, to the time elapsed from the accident, to the age and occupation of the patient and to the residual amplitude arches. The late results were checked up after 1-10 years, on the average after 3-4 years, by comparison of pre- and postoperative Rocher indices. The flexion-extension movements benefitted postoperatively by 70% in total rigidities and by 45% in the partial ones and the pronation-supination movements, by 40%. The results regarding the change of the biomechanical functionality conditions following the mobilizing bone resections are shown in comparison with those obtained by arthrosis and total elbow prostheses.

Adult↗
PubMed1991

Total replacement for post-traumatic arthritis of the elbow.

Fifty-three of 55 consecutive elbow replacements for post-traumatic arthritis were followed for a minimum of two years (mean 6.3, range 2 to 14.4). The patients presented difficult management problems, having undergone an average of two previous operations per joint; 22 joints had suffered prior complications; 18 had less than 50 degrees of flexion and six were flail. One of three versions of the Coonrad prosthesis was employed in all. During the follow-up period, 10 patients underwent 14 revision procedures for aseptic loosening; 38 elbows are currently without progressive radiolucent lines. In two patients an elbow had to be resected, one for deep infection and the other for bone resorption following a foreign-body reaction to titanium. The current design of the Coonrad prosthesis offers a reliable option for the treatment of post-traumatic arthritis but should be used only in carefully selected patients over the age of 60 years.

Adult↗
PubMed1981

Silastic prosthetic replacement for the radial head.

Seventeen patients had a Silastic prosthesis for the radial head inserted following fracture of that structure. Follow-up averaged 6.7 years. Nine of the seventeen patients had had an associated dislocation of the elbow or a Monteggia fracture. Six patients received the implant at the time of the treatment for the fracture and all six were doing well, although the implant had failed radiographically in three of the six. There were five failures among the other eleven patients; four of the five had the prosthesis removed. On the basis of these data, we concluded that the indications for use of the Silastic radial-head prosthesis after fracture are extremely limited, and its routine use cannot be justified.

Adult↗
PubMed2006

The Unilateral Below Elbow Test: a function test for children with unilateral congenital below elbow deficiency.

The Unilateral Below Elbow Test (UBET) was developed to evaluate function in bimanual activities for both the prosthesis wearer and non-wearer. Nine tasks were chosen for each of four age-specific categories defined by development stages of hand function (2-4y, 5-7y, 8-10y, and 11-21y). Two scales, Completion of Task and Method of Use, were designed to rate performance. To measure reliability, four occupational therapists scored samples of videotaped UBET performances. For Completion of Task, an interval scale, agreement in scoring was measured with interclass correlation coefficients (ICC; n=9; five females, four males). For Method of Use, a nominal scale, chance-adjusted association was calculated with Cohen's kappa coefficients (interobserver n=198; 111 females, 87 males; intraobserver n=93; 56 females, 37 males). For Completion of Task, the average ICC was 0.87 for the prosthesis-on condition, and 0.85 for the prosthesis-off condition. ICCs exceeded 0.80 for eight out of nine tasks for the two older age groups, but for only five out of nine tasks in the younger age groups. Higher inter- and intraobserver kappa coefficients for Method of Use resulted when scoring children with their prostheses on versus off. The oldest age group had lower kappa values than the other three groups. The UBET is recommended for the functional evaluation of Completion of Task in children with unilateral congenital below elbow deficiency with and without their prostheses. Method of Use scoring can evaluate individuals for directed therapy interventions or prosthetic training.

Activities of Daily Living↗
PubMed2005

[Comparison of rheumatic and post-traumatic elbow joints after total elbow arthroplasty. Comprehensive and specific evaluation of clinical picture, function, and quality of life].

BACKGROUND: Patients with elbow destruction due to rheumatoid arthritis (RA) or trauma (PT) were compared to population-based normative data and to each other after total elbow arthroplasty. PATIENTS AND METHODS: Pain, function, and biopsychosocial health were multidimensionally assessed by the generic Short Form 36 (SF-36), the condition-specific Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), and the Patient Related Elbow Evaluation form (PREE) instrument and analyzed by uni- and multivariate methods. RESULTS: Compared to normative values, the examined 59 RA patients were significantly affected in the function scales of the SF-36 and in all DASH scales. The 20 PT patients were worse than the norm only in the DASH function. Function was lower in RA than in PT in the SF-36 scales and in the DASH (RA: 44.4, PT: 70.3, p<0.001). This difference was less distinct in the PREE. CONCLUSION: Total elbow arthroplasty led to a pain-free outcome and normal quality of life, but failed to restore complete function. Functional deficits were larger in the RA patients and could also be measured by the SF-36, possibly due to polyarticular affection.

Aged↗
PubMed1990

The island sensate ulnar artery flap for reconstruction around the elbow.

Elbow joint prostheses have now become reliable and provide stable movement. Some do have rather sharp edges on the ulnar component which, particularly in the rheumatoid arthritics and the elderly, may erode the skin, leading to exposure. Various flaps will provide cover to this area but do tend to re-ulcerate, probably due to inability to appreciate excess pressure. The ulnar artery flap, including the medial cutaneous nerve of the forearm, provides durable and sensitive cover, preventing re-exposure. Its successful use in two cases is described.

Adult↗
PubMed1995

Radiohumeral arthrodesis for salvage of failed total elbow arthroplasty.

Ulnohumeral arthrodesis is the standard technique for elbow fusion. The geometry and surface area of the distal humerus and proximal ulna enhance the chances of fusion while maintaining some wrist motion. A case of a patient with multiple failed elbow procedures in which the standard ulnohumeral fusion was not possible is presented. A radiohumeral arthrodesis was performed in an attempt to obtain a stable, nonpainful elbow. After complete healing of the fusion, the patient was able to use the arm for most functions. This technique is presented as an option for salvage failed elbow arthroplasty in the face of significant bone loss.

Arthrodesis↗