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Type I Monteggia fracture dislocation associated with ipsilateral distal radial epiphyseal injury.

SUMMARY: Ipsilateral elbow and wrist injuries are rare in children. We present a previously undescribed case of a Bado Type I Monteggia fracture with a Salter-Harris Type II epiphyseal injury of the distal radius. A satisfactory result was achieved but required surgical intervention. Complete diagnostic evaluation is imperative to avoid missed injuries and achieve satisfactory outcome.

Bone Plates↗

Brachial artery injury. A complication of posterior elbow dislocation.

A case is presented of a 32-year-old man who sustained a closed posterior dislocation of the left elbow. The dislocation was reduced immediately under intravenous sedation. When, after reduction, the pulse remained weak, angiography revealed a complete tear of the brachial artery. The artery was repaired with end-to-end anastomosis, resulting in a good radial pulse at the end of the procedure. Though dislocation of the elbow is a relatively common traumatic injury, associated brachial artery injury is rare. The authors note that the diagnosis of arterial trauma in such cases should rely heavily on angiography.

Adult↗

Salvage of functional elbow range of motion in complex open injuries using a sensate transposition lateral arm flap.

Complex open posterior elbow injuries pose three principal challenges to the reconstructive surgeon. First, the surgeon must provide stable soft-tissue closure over the joint/skeletal reconstruction. Second, the coverage must be thin and supple and promote the free gliding of the underlying structures. Finally, secondary and tertiary procedures must be anticipated beneath the flap, because a stiff, scarred, and adherent flap will only compromise these procedures. The results of 10 consecutive fasciocutaneous transposition lateral arm flaps for coverage of posterior elbow wounds are reported. This flap provides coverage that is thin and supple and that allows subsequent elevation for secondary procedures. Functionally, these flaps allowed for the development of an average arc of motion of 20 to 114 degrees and an average pronation-supination motion of 119 degrees.

Adult↗

The role of ultrasound in the evaluation of sports medicine injuries of the upper extremity.

The two major imaging modalities used for assessment of soft tissue injuries are ultrasound and MRI. Although ultrasound of the extremities is used only to a limited extent in the United States, it is widely used in many other countries for evaluation of extremity injuries. This article first considers the advantages and disadvantages of MRI and ultrasound. Understanding these differences will help the reader understand the role of ultrasound as compared with MRI in evaluating upper extremity injuries. The uses of ultrasound for evaluating sports medicine injuries in specific regions of the upper extremity are then reviewed. Where the data are available, the reported accuracy of ultrasound is compared with MRI for each type of injury.

Athletic Injuries↗

Fractures of the elbow and forearm.

Fractures and dislocations of the elbow usually occur secondary to indirect trauma. In the adult, fractures of the distal humerus almost always involve the condyles. Fractures of the radial head and neck may be subtle, and the appearance of secondary signs, such as the elevated fat pads from an elbow joint effusion, may be diagnostically useful. Dislocations of the elbow can be associated with fractures, such as those involving the ulnar coronoid process. In children, the presence of epiphyseal and apophyseal ossification centers can confuse the inexperienced observer in the setting of elbow trauma. Osteochondral injury may be difficult to identify without adjunctive imaging techniques, such as magnetic resonance (MR) imaging. Soft tissue injury at the elbow is also well characterized by MR imaging. Fractures of a single forearm bone may occur in isolation, usually due to a direct blow, but these are usually associated with fracture of displacement of the other bone in that forearm.

Adult↗

Fractures of the radial head in adults with the complication "cubitus valgus".

Cubitus valgus is a well-known complication of fracture of the bones of the elbow in childhood, but it is an uncommon deformity in adults. Three adult patients are presented, in each of whom cubitus valgus developed as a complication of a fracture and resection of the radial head. The importance of reestablishing the integrity of the ligaments of the elbow following severe injuries to the elbow is stressed.

Adult↗

The role of MR imaging in the management of elbow problems.

In the past several years, the role of MR imaging in diagnosing pathologic conditions of the elbow has dramatically increased. Aside from imaging soft-tissue tumors, it can accurately visualize partial and complete tears of tendons and ligaments, as well as displacement of epiphyseal fractures in children. Its role in identifying loose bodies, particularly when they are nonosseous, and areas of osteochondritis dissecans has also increased. The use of MR imaging for diagnosing neuropathies, particularly when electrodiagnostic studies are negative, offers exciting possibilities as additional technical improvements are developed.

Collateral Ligaments↗

Dynamic sonography with valgus stress to assess elbow ulnar collateral ligament injury in baseball pitchers.

Sonography is a valuable method for imaging superficial tendons and ligaments. The ability to obtain comparison images easily with dynamic stress allows assessment of ligament and tendon integrity. We studied the medial elbow joints of two baseball pitchers using MR imaging and dynamic sonography. Both sonography and MR imaging identified the ulnar collateral ligament tears. Dynamic sonography uniquely demonstrated the medial joint instability.

Adolescent↗

Prognostic factors for major limb re-implantation at both immediate and long-term follow-up.

We performed a prospective study in 186 patients with a minimum follow-up of two years in order to attempt to predict successful major re-implantation of the upper limb. There were 137 men and 49 women with 24 amputations of the palm, 75 of the wrist, 50 of the forearm, 9 disarticulations through the elbow, and 28 amputations through the upper arm. The degree of injury to the amputated segment and the stump were good predictors of the rate of success and the final outcome. Adequate preservation, contraction of the muscle in the amputated part after stimulation, the level of injury and a smoking habit were fair indicators, but the serum potassium concentration in the amputated segment was the best objective predictor. When it is higher than 6.5 mmol/l 30 minutes after re-perfusion, re-implantation should be avoided. A high systemic venous serum potassium concentration was also found before clinical signs of the re-perfusion syndrome were seen.

Adult↗

[Fractures of the upper extremity in the elderly].

PROBLEM: The primary goal in treating fractures in elderly persons is safe and rapid restoration of their functional capabilities to secure independence in everyday activities. The intention of this paper is to present an overview of treatment principles useful in this age group. METHODS: We analysed a series of 404 patients above the age of 70 years who underwent surgery for fractures of the arm between 1981 and 1997. RESULTS: Diaphyseal fractures are less frequent in this age group and their treatment does not differ significantly from principles established for younger patients. The majority of fractures of the proximal humerus and the distal radius can be treated by conservative means. Unstable fractures are frequent in the distal humerus and the olecranon requiring operative reduction and osteosynthesis. CONCLUSIONS: Preferred operative techniques in aged persons inflict minimal surgical trauma and have a low rate of complications and secondary interventions. In contrast, anatomical reconstruction has the highest priority in younger individuals.

Aged↗