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PubMed1983

[Our experience with endoprosthesis in surgery for bone tumors].

Endoprosthesis is a method allowing a valuable substitution of bone defects (articular ends of long tubular bones, both articular ends of the bones making the articulation, whole long tubular bones with articulations). The employment of endoprostheses is expedient for the substitution of defects of the breast bone, pelvis, hand bones as well. Endoprosthesis in combination with preoperative radiotherapy and post-operative modern chemotherapy allows preserving the extremities in certain patients with osteogenic sarcoma, chondrosarcoma, reticulosarcoma, chondrosarcoma and solitary plasmacytoma. The experience with 204 operations of endoprosthesis of bones is presented.

Bone Neoplasms↗
PubMed1993

Allograft salvage of failed total elbow arthroplasty. A report of two cases.

Infection after total elbow arthroplasty (TEA) is a devastating complication. Current management options include (1) salvage of the implant with debridement and parenteral antibiotics, (2) resection arthroplasty, and (3) arthrodesis. Most infected TEA patients ultimately require resection arthroplasty. Inadequate bone may preclude both revision TEA and successful resection arthroplasty. It is in these cases that the patient may benefit from allograft reconstruction. Two patients with painful flail elbows secondary to previous resection arthroplasties were treated successfully with cadaver allograft augmented with in situ autograft. Use of the allograft resulted in improvement from failure to excellent in this patient with posttraumatic arthrosis at five years after operation and from failure to good in a rheumatoid patient at two years after operation. Autograft-augmented allografts in the resected failed-TEA patient are a valuable and bone-preserving option. This may be especially useful in patients with significant bone loss or young patients with posttraumatic arthrosis, for whom arthrodesis may be the only other surgical option. The method should not preclude further revision TEA.

Aged↗
PubMed1976

[Partial replacement of the humerus].

Based on twelve cases, this paper reviews the possibilities of partial replacement of the humerus. In 6 cases an interpolation was successfully performed replacing a resected part of the humeral shaft while maintaining the shoulder and elbow joint. The interpolated material is polyethylene, centrally reinforced by metal. A resection of up to 17 cm was performed. The longest period of observation is more than 2 years. This operative procedure is preferred to the methods so far used in cases of extensive destruction of the humeral shaft. Primarily, osteolyses are an indication for this type of operation.

Adult↗
PubMed2002

[Comminuted radial head fractures. Initial experiences with a Judet radial head prosthesis].

PURPOSE OF THE STUDY: Comminuted fractures of the radial head represent a particular therapeutic problem. Due to characteristic complications the resection as well as the implantation of the Swanson-prothesis could not convince. MATERIAL AND METHODS: We applied the radial head prothesis of Judet in 16 cases (14 type IV and 4 type III by Mason). RESULTS: At the moment we survey the follow up of 15 patients after 12 to 45 months (average 18.2), the evaluation was performed using the score of Radin and Riseborough and the score of Morrey. With the score of Radin and Riseborough we found in 7 cases good, in 6 case fair and in 2 case poor results. With the score of Morrey we found 2 excellent, 11 good and 1 fair and poor results. The radiological examination did not show an increase of the carrying angle of the elbow, an osteoporosis, a proximal migration of the radius and a distal radio-ulnar dissociation. CONCLUSION: Compared with resection or Swanson-prothesis the bipolar prothesis of Judet has definite advantages.

Adult↗
PubMed2006

Revision total elbow arthroplasty for prosthetic fractures.

BACKGROUND: Fractures of total elbow arthroplasty components are uncommon, and the literature provides little guidance regarding the management and outcomes of treatment of these complications. The goal of this report was to investigate the prevalence and management of fractures of ulnar and humeral components following total elbow arthroplasty and to review our experience with cement-within-cement reconstruction for revision following such fractures. METHODS: Between 1979 and 2003, twenty-four patients with a total of twenty-seven fractured total elbow arthroplasty components (seventeen ulnar and ten humeral) of different designs presented to our institution. Twenty-six implants underwent subsequent revision elbow arthroplasty at our institution. Fourteen of those revisions were done with a cement-within-cement technique, and twelve, with traditional methods. Twenty-one patients (twenty-three implants) were available for final follow-up, and data that had been acquired prospectively and entered into the institutional arthroplasty database were reviewed retrospectively. At the time of final follow-up, the Mayo Elbow Performance Score (MEPS) was calculated and preoperative, postoperative, and most recent radiographs were examined for bone loss, bushing wear, and integrity of the bone-cement interface. RESULTS: The prevalences of humeral and ulnar component fracture following primary total elbow arthroplasties performed at our institution were 0.65% and 1.2%, respectively. At a mean of 5.1 years following revisions for those fractures, the MEPS was excellent for eight patients, good for five, fair for six, and poor for two. The average MEPS was 82 points following the revision total elbow arthroplasties done with the cement-within-cement technique and 78 points following the revisions done with the traditional method of cement removal and insertion of a revision component. Complications included seven intraoperative cortical perforations; five nerve injuries, two of which were permanent; three triceps avulsions; and one deep infection. CONCLUSIONS: Implant fractures following total elbow arthroplasty are uncommon. They occur for several reasons, such as notch sensitivity, component design, and high stresses due to bone deficiency. Revision techniques, such as cement-within-cement reimplantation, are reliable for relieving pain and restoring function; however, the rate and spectrum of complications are a cause for concern. LEVEL OF EVIDENCE: Therapeutic Level IV.

Adult↗
PubMed1998

The triceps preserving approach to total elbow arthroplasty.

Elbow arthroplasty most commonly is performed through a posterior approach by detaching or reflecting the triceps off the olecranon. Surgical approaches to the elbow joint that dissociate the triceps from the olecranon have distinct disadvantages. Triceps avulsion, triceps weakness, and wound healing problems have been reported. Such complications necessitate more surgery and predispose the joint to an infection. To avoid these complications a modified posterior approach to the elbow joint that preserves the triceps muscle insertion on the olecranon was used in 10 consecutive elbow arthroplasties. This method provides adequate exposure, allows early rehabilitation, and avoids triceps weakness.

Arthritis↗
PubMed1975

Proportionally controlled linear power assist device for artificial arms.

A new prosthetic add-on device is being developed which promises to provide an economical means of adding power assist to a patient's existing conventional cable-operated prosthesis. Only minor modifications by a prosthetist would be required. Patients wearing conventional cable-operated above-elbow prostheses, who lack adequate function because they cannot generate the necessary cable excursion, are expected to dramatically improve their performance with little or no retraining. The proposed system will operate at speeds comparable to those of a conventional cable-operated prosthesis. The system will retain considerable function even if there is no power assist, and it will imporve the quality of the sensory feedback normally associated with a conventional cable-operated body powered prosthesis.

Arm↗
PubMed1989

Prosthetic limb use in Australia 1981-1985 under the Free Limb Scheme.

A study has been made of data on 19,421 prosthetic limbs prescribed for 12,143 Australians under the Free Limb Scheme in the years 1981-1985. These prostheses consisted of 18,119 legs and 1,302 arms. The mean age of the lower limb prosthesis user was 52.8 and the upper limb prosthesis user 31.3 years. Males outnumbered females by 3 to 1 in the upper limb prosthesis users, and 2.8 to 1 with lower limb prosthesis users. Below-knee prostheses, patellar-tendon-bearing and thigh-lacing prostheses, made up 58.7% of all prostheses prescribed in the time span. Below-elbow prostheses were the commonest upper limb prostheses with children being the most frequent users. Comparisons with other studies of large number of prosthesis users show an older mean age in Australia and more below-knee prosthesis users than in American studies.

Adolescent↗
PubMed1999

Extensible endoprostheses of the humerus after resection of bone tumours.

We carried out extensible endoprosthetic replacement of the proximal or total humerus in 18 children aged between six and 12 years, after resection of primary bone tumours mainly for osteosarcoma and Ewing's sarcoma. In 11 patients we performed 44 lengthening procedures, with an average of two per child annually and a mean total extension of 29.9 mm per patient. We were able to achieve lengthening of the operated limb with few complications and a mean functional rating of 79.3% according to the Enneking system. Progressive lengthening of these prostheses does not adversely affect the overall function of the arm, and superior subluxation of the head of the prosthesis has not been a problem.

Bone Neoplasms↗
PubMed1992

Ligamentous reconstruction for posterolateral rotatory instability of the elbow.

Eleven consecutively seen patients who had posterolateral rotatory instability of the elbow joint were managed operatively. The radial collateral-ligament complex was advanced and imbricated in three of them. In seven patients, the ulnar band of the radial collateral ligament (the lateral ulnar collateral ligament) was reconstructed with the palmaris longus tendon and in two of the seven, the reconstruction was augmented with a prosthetic ligament. The ligament was reconstructed with the lateral one-third of the triceps fascia in the remaining patient. Stability was obtained in ten patients, and seven patients had an excellent functional result. There was one failure in one of the patients in whom the ulnar band of the radial collateral ligament had been reconstructed with the palmaris longus tendon and augmented with a prosthetic ligament.

Adolescent↗
PubMed1999

Humeral hemiarthroplasty of the elbow joint in young patients with rheumatoid arthritis: a report on 7 arthroplasties.

This article evaluates the early results of 7 humeral hemiarthroplasties of the elbow joint in 5 female rheumatoid patients using only the humeral component of the capitellocondylar prosthesis. The follow-up period was 25 to 109 months. All patients were 50 years old or younger; 3 patients were between 22 and 26 years. Because all patients were rather young, the intention was to perform a procedure that conserves a maximal amount of bone stock for future salvage procedures. One prosthesis had to be removed because of an infection unrelated to the primary procedure. The remaining bone stock provided a stable and pain-free excision arthroplasty. The other arthroplasties showed good pain relief; however, postoperative motion was not as reliable as described for total capitellocondylar prostheses.

Adult↗
PubMed1997

[Cervico-omo-brachial pain and disability in a person of advanced age].

A person of advanced age usually has degenerative changes of bone, joint and ligament, which can be causes of cervico-omo-brachial pain and disability. He or she may also suffer from metastatic bone tumor of cervical spine or upper extremity. This article described pathology, signs and symptoms and recent treatment of these diseases. Cervical myelopathy and radiculopathy, which are most common causes of cervico-omo-brachial symptoms, are sometimes accompanied by peripheral entrapment neuropathy such as cubital tunnel syndrome or carpal tunnel syndrome (double crush syndrome). In this complicated situation, decompression of neural tissue in both cervical spine and carpal tunnel are necessary. In treatment for carpal tunnel syndrome, release of transverse carpal ligament under an arthroscope has proven to be useful and has been becoming popular. This minimally invasive surgery is also useful in shoulder surgery such as subacromial decompression in aged patients with rotator cuff tear and removal of calcium deposit in the shoulder joint. Osteoarthritis of the elbow also cause pain or disability of the elbow and the hand. Some metastatic bone tumors are treated by tumor resection and reconstruction with instruments, prosthesis or composite grafts, which are attempted not to cure the disease but to maintain or improve the quality of life of the patient.

Aged↗