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PubMed2002

[New biodegradable polylactide implants (Polypin-C) in therapy for radial head fractures].

Dislocated radial head fractures of the type Mason II are usually treated with screws and buttress plates. The implants are generally removed at a later date. Biodegradable implants can be applied successfully for the reduction of small radial head fractures subject to shearing forces and slight loads. The implants are completely absorbed once the fracture has healed, making a second operation for the removal of the implant unnecessary. The Polypin C-Pin is made of poly(L, DL-lactide) mixed with 10% beta-tricalcium phosphate to ensure controlled, slow degradation with no significant side effects. This new Polypin C fixation pin was clinically tested on 35 patients with radial head fractures (CCF 21B2.1 and 21B2.2) from 31.10.1996 until 1.4.2002. A total of 34 of the patients (97.1%) underwent a clinical and conventional radiological follow-up examination after an average of 38.2 months. In 29 cases a CT was also carried out. Between 18 and 24 months, two cases of grade 1 osteolysis were observed around the pin head. No trace of osteolysis was observed at the final examination in either case. According to the Broberg score, an average of 96 out of a possible 100 points were attained at the final examination (31 excellent, 2 good, 1 unsatisfactory). After a period of 24 months, the pins were no longer visible on a conventional x-ray. A CT evaluation showed a density similar to that of spongioid bone in the original pin cavities after 3 years. These excellent clinical results prove that the Polypin C is a good method to treat dislocated radial head fractures.

Absorbable Implants↗
PubMed1995

Humeral fractures after shoulder arthroplasty.

Nine humeral fractures occurred subsequent to 499 shoulder arthroplasties that had been performed between December 1978 and November 1987 at the Mayo Clinic. The time from the arthroplasty to the fracture averaged thirty-nine months (range, eight to 101 months). Seven patients were women and two were men, and the average age was seventy years (range, forty-five to eighty-five years). The arthroplasties were performed for rheumatoid arthritis in five patients and for the sequelae of trauma in four. Six patients had advanced osteopenia, and two had had an ipsilateral total elbow arthroplasty. Six of the fractures were centered at the tip of the prosthesis; one fracture (type A) extended proximally, and five (type B) did not. The three remaining fractures (type C) involved the humeral shaft distal to the implant and extended into the distal humeral metaphysis. Four fractures healed with non-operative treatment. Two fractures that had unacceptable alignment were treated successfully with operative intervention. Three fractures that were treated with immobilization in a splint failed to heal; two of those fractures eventually united after a revision of the prosthesis and bone-grafting was performed, and one fracture remained ununited. Radial nerve palsy developed postoperatively in two patients, and it resolved within three months. Five patients had poor active motion before the fracture, and two of them had even less motion after the fracture was treated. Our experience suggests that long oblique and spiral fractures can be successfully treated non-operatively, provided that the skeletal alignment is acceptable.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1996

[Retrospective analysis of 78 surgically repaired fractures of the radial head].

The authors present a analysis of 78 cases of radial head fracture operated in the same department. 16 cases were added to the first study of 62 cases operated between 1967 and 1988 and published in 1991. According to the Mason classification modified by Morrey, there were 22 type II, 24 type III and 32 type IV. Surgical treatment consisted in an osteosynthesis in 35 cases, a fracture fragment excision in 9 cases, a resection of the head in 24 cases, a silastic prosthesis in 10 cases. The results have been studied on a functional and radiological basis with follow-up from 2 to 23 years (mean 5 years). The authors noted the good results of the type II fractures which had an osteosynthesis, the satisfactory results in more than 50% of the cases with resection of the radial head. The comparison of both series established the absence of prosthesis in the recent one. The poor results of the comminutive fractures with elbow dislocation lead the authors to consider the prothesis in these fractures, as a possible indication.

Adolescent↗
PubMed1994

[Prosthesis of the head of the radius in long-term follow-up--vitallium versus silastic].

At the Graz Hospital for Accident Surgery, seven Vitallium prostheses were implanted in the period from 1964 to 1968, and nine Silastic prostheses in the period from 1984 to 1991. In January 1993 we were able to do control examinations in eleven patients. Five of them with fractures of type B2.3, five of B3.3 and one of C3.3 according to the AO-Classification. Secondary treatment was done in four patients by prosthetic substitution. All patients had to wear a cast postoperatively for two to eight weeks. Our results--like those already described in relevant literature--clearly confirm the markedly poorere outcome of secondary treatment by prosthetic substitution of the head of the radius. On the basis of our results we therefore recommend in all cases where resection seems to be unavoidable to perform primary atraumatic resection with complete removal of all bone splinters and subsequent prosthetic substitution of the head of radius, if it is not possible to an osteoynthetic operation without immobilisation. We did not find any correlation to the classivication of the fracture types.

Adult↗
PubMed1999

Survivorship and radiological analysis of the standard Souter-Strathclyde total elbow arthroplasty.

We undertook a radiological analysis of 186 standard Souter implants to determine survivorship and to analyse the pattern of failure in those needing revision. The implants had been inserted as a primary procedure in patients with rheumatoid arthritis of the elbow at our hospital over the last 12 years. Taking revision as an endpoint, the survivorship after 12 years was 87%. If, however, revision and loosening, defined as the Hindex value equivalent to demarcation of 1 mm around the whole implant, are also included, the survivorship falls to 80%. Of the 24 implants revised, 18 (75%) were for problems with the humeral component, three (12.5%) with the ulnar component and three (12.5%) for instability. Loosening of the humeral component occurred when the implant extended into the humerus, with the tip moving anteriorly on to the anterior humeral cortex. Our study indicates that loosening can be predicted by the rate of change in this angle of extension of the prosthesis.

Aged↗
PubMed1986

A new unconstrained elbow. A prospective review of 60 replacements.

Sixty unconstrained elbow replacements of a new design have been followed prospectively for three to nine years. Review showed that 50% had excellent relief of pain and return of function, 27% had had major complications requiring removal or revision of the prosthesis and 23% had minor complications which marred the result. Further research in this field seems worthwhile.

Adult↗
PubMed1990

The Guildford elbow.

A new unconstrained elbow replacement is described and the results of 44 primary and 5 revision operations assessed. A high incidence of pain relief (82%) and functional improvement (73%) was achieved. However 23% of primary replacements later underwent loosening as assessed radiologically and 12% have undergone revision for pain. Minor complications not affecting the final result occurred in 28%. The causes and significance of the complications are analysed.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Total elbow arthroplasty failure due to overuse, C-ring failure, and/or bushing wear.

Semiconstrained, linked total elbow arthroplasty gives excellent functional results. However, the complication rate is relatively high, and complications are frequently significant enough to require revision surgery. The purpose of this study is to report on bushing wear and C-ring failure as a mid- to late-term complication of the Coonrad-Morrey total elbow arthroplasty. Two surgeons at different institutions treated 10 patients who had a previous Coonrad-Morrey total elbow arthroplasty and presented with C-ring and/or bushing wear. There were 8 men and 2 women. The mean age at the time of the initial total elbow arthroplasty was 54 years (range, 37-67 years). Time to revision averaged 60 months (range, 9-156 months). Common associated factors were posttraumatic arthritis (3), supracondylar nonunion (5), male sex, young age, and high activity level. A proposed mechanism of failure is postulated.

Activities of Daily Living↗
PubMed2001

Treatment of instability after total elbow arthroplasty.

Instability after total elbow arthroplasty can be due to incorrect component selection or position, inadequacy of the medial or lateral ligaments or triceps tendon, polyethylene wear, limb malalignment, or trauma. Patients with significant loss of bone structure, ligament deficiency, and tendon deficiency around the elbow are at increased risk of instability following total elbow arthroplasty.

Arthroplasty, Replacement↗
PubMed1995

Loose-hinge total elbow arthroplasty. An experimental study of the effects of implant alignment on three-dimensional elbow kinematics.

A previous study suggested that the kinematics of a loose-hinge total elbow arthroplasty (TEA) are those of a truly semiconstrained joint. This study addresses the effects of malposition of the implant. The three-dimensional elbow kinematics during simulated active motion were studied in six cadaver specimens using an electromagnetic tracking device. In addition to simulated active elbow flexion, flexion arcs were obtained under an elbow varus or valgus moment, to calculate the structural varus-valgus laxities. The results after four different Coondrad-Morrey TEA positions of implantation were compared with those of the intact elbow. The flexion-extension amplitudes were not significantly decreased after TEA implantation, except with external rotation of the ulnar component, which resulted in a loss of extension. In the intact elbow and after TEA implantation in any position, the mean varus-valgus deviations throughout elbow flexion were in a narrower range than the structural limits imposed by the ligaments (intact elbow) or the TEA hinge design. With internal malrotation of the humeral component over 10 degrees, however, the valgus structural limit was reached and, conversely, the varus limit with external rotation over 10 degrees. The clinical improvement observed with the semiconstrained TEA is derived from the benefits of the less constrained articulation. The proximodistal changes of TEA implantation have no consequence on the kinematic pattern. Rotational malpositioning of either humeral or ulnar component should be avoided, the first because it changes the kinematic pattern toward the structural limits of the implant and, therefore, may lead to excessive stresses at the bone-cement-implant interfaces and to early loosening, and the latter because it causes loss of extension.

Biomechanical Phenomena↗
PubMedDate not supplied

Salvage of failed total elbow arthroplasty.

We had to revise 14 total elbow arthroplasties, three for infection, six for aseptic loosening, four for instability, and one for a failed bearing mechanism. All of the infected elbows were converted to resection arthroplasty with elimination of infection but with poor function; in one acceptable motion was achieved after a fascial arthroplasty. Those that failed aseptically were salvaged with reimplantation of other devices, either a custom implant or a semiconstrained device, which was also used in those nonconstrained elbows that failed because of dislocation. All of the noninfected elbows were successfully revised with relief of pain and motion comparable to or better than that present before revision.

Elbow Joint↗
PubMed1987

Biomechanical basis for elbow hinge-distractor design.

Experimental studies of flexion-extension motion were carried out on five fresh elbow autopsy specimens to determine the average axis of rotation (AAR). The AAR is defined as the best fit single axis of rotation for the full range of flexion-extension. AAR was determined on all five elbows and found to approximate the center of the capitellum and trochlea. The motion of the elbows approximated a fixed axis, and the carrying angle defined in reference to humeral shaft and forearm axis decreased from 13 degrees to 22 degrees in extension to close to zero in full flexion. The average axis of rotation, with guidelines for its anatomic location, was used as the basis for the design and placement of a hinge-distractor in treating posttraumatic elbows with poor motion.

Biomechanical Phenomena↗
PubMed1984

The development of an unconstrained elbow arthroplasty. A clinical review.

This paper describes the development, operative technique and results of an unconstrained total elbow arthroplasty. Forty-seven elbow replacements were carried out in 44 patients between 1974 and 1982. There was a high rate of loosening in the early condylar replacements. The results in patients with post-traumatic arthritis were poor. The later design employs an ulnar stem, with a humeral stem if the distal humeral bone stock is poor. When used in carefully selected patients with rheumatoid arthritis, pain is reduced significantly, stability and movement are preserved and function is improved.

Adult↗
PubMed2002

The Souter-Strathclyde elbow arthroplasty. A clinical and radiological study of 525 consecutive cases.

We present the results of 525 primary Souter elbow arthroplasties undertaken in 406 patients between 1982 and 1997. There were 372 women and 34 men with a mean age of 57 years; 119 patients had a bilateral procedure. The elbows were affected by chronic inflammatory disease, usually rheumatoid arthritis, which had been present for a mean of 24.7 years (2 to 70). In about 30% the joints were grossly destroyed with significant loss of bone. In 179 elbows the ulnar components were metal-backed and retentive; in the remaining 346, with better bone stock, non-retentive, all-polyethylene prostheses were used. Because of complications, 108 further operations were required in 82 patients. During the early years the incidence of complications was higher. Dislocation was the indication for 30 further procedures in 26 patients. Thirty patients underwent 33 revision procedures for aseptic loosening, 12 had 29 operations because of deep infection, two for superficial infection, and 14 further operations were done for other reasons. The cumulative rate of success, without aseptic loosening, five and ten years after surgery, was 96% and 85%, respectively.

Adult↗