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At least 631 records · Page 35Linked to original sources
PubMed2004

Operative release of ankylosis of the elbow due to heterotopic ossification. Surgical technique.

BACKGROUND: Although uncommon, complete ankylosis of the elbow secondary to heterotopic ossification results in severe disability. The results of surgical management remain unclear. METHODS: A single surgeon used a consistent operative technique to treat complete osseous ankylosis of the elbow in eleven limbs in seven patients after severe burns and in nine elbows in eight patients after trauma. The elbows in the burn cohort were more often ankylosed in extension (average, 47 degrees of flexion) compared with those in the trauma cohort (66 degrees of flexion), and they had more skin problems (three elbows required a free microvascular muscle transfer for coverage) and associated problems of the shoulder, wrist, and hand. RESULTS: Four patients in the burn cohort and three patients in the trauma cohort failed to regain at least 80 degrees of ulnohumeral motion. After a repeat release in three burn patients and three trauma patients, and at an average follow-up of forty months, the average arc of ulnohumeral motion was 81 degrees in the burn cohort and 94 degrees in the trauma cohort. Six of the eleven limbs in the burn cohort and five of the nine in the trauma cohort had a good result. The average score according to the American Shoulder and Elbow Surgeons elbow assessment form was 72 points for the burn cohort and 76 points for the trauma cohort. CONCLUSIONS: Osseous ankylosis of the elbow is a severely disabling problem, and attempts to regain mobility are both worthwhile and safe. The results are comparable when the ankylosis is caused by burns or trauma despite the greater complexity of osseous ankylosis in the burned arm. Patients and surgeons should be aware of the small risk of recurrent heterotopic ossification and the moderate risk of pain or recurrent contracture after operative release.

Ankylosis↗
PubMed1991

Intra-articular fractures of the distal part of the radius treated with the small AO external fixator.

Thirty adults who had a severely comminuted intra-articular closed fracture of the distal part of the radius were treated by closed reduction and AO external fixation consisting of a converging-pin configuration with a double row of connecting bars. The patients were followed for an average of 2.6 years (range, two to four years). Twenty-seven patients had an excellent result; two, a good result; and one, a poor result, on the basis of pain, motion, strength, and radiographic appearance. Complications were rare, and there was no loss of fixation of the pins. The average grip strength was 92 per cent of normal. Motion of the wrist and rotation of the forearm averaged more than 90 per cent of that of the normal side. Carpal height was used as an indicator of distraction force produced by the fixator. There was an average increase in carpal height of four millimeters initially and 3.7 millimeters immediately before removal of the fixator, indicating near-constant distraction throughout the treatment. Radial length was well maintained, with shortening averaging less than one millimeter. The converging pins of the AO fixator prevent loosening, thereby diminishing the risks of infection, loss of reduction of the fracture, and breakage of the pins. This geometry of the pins allows the use of smaller-diameter (2.5-millimeter) pins and provides rigid fixation, even in osteoporotic bone.

Adult↗
PubMed1997

Ipsilateral fractures of the proximal ulna and distal radius (Colles type).

A 43-year-old female fell backward outside her home while carrying a watering can. She sustained an ipsilateral fracture of the proximal ulna and distal radius (Colles fracture). The ulnar fracture was plated, and the Colles fracture was managed by closed reduction and percutaneous Kirschner wiring. The patient recovered without incident. This association of forearm fractures is unusual. Both fractures can be caused by a fall on the hand with the wrist in mid-extension and the elbow flexed, and they probably occurred in quick succession.

Accidental Falls↗
PubMed2000

Diaper burn: accident, abuse, or neglect.

A 7-year-old, female with mental retardation and seizure disorder was admitted with burns. Reportedly, her brother who was 12 years old was cooking dinner for himself. A towel caught fire. He threw the towel over his head, and the patient's diaper ignited. She had partial thickness second-degree burns over her right elbow, upper abdomen, both inner thighs, and buttocks with multiple blistering, which was estimated to be 7% of the total body surface. The child abuse team took a diaper similar to the one the child was wearing at the time of injury and found that it easily ignited and melted in several seconds. This is the first medically reported burn case due to a disposable diaper.

Abdominal Injuries↗
PubMed2005

Osteoarthritis in other joints (hip, elbow, foot, ankle, toes, wrist) after sports injuries.

Osteoarthritis of nonknee joints, although less common than knee osteoarthritis, remains a significant and disabling condition for many present and former athletes. These injuries can be caused by repeated loads or following a specific traumatic event. The resulting pain and loss of motion can limit function and ability. Arthroscopic techniques in many cases enable surgeons to symptomatically treat limitations of range of motion and pain, prolonging active careers. Joint replacement remains the ultimate solution for hip osteoarthritis, and may be a viable option in ankle osteoarthritis.

Ankle Injuries↗
PubMedDate not supplied

EndoButton-assisted repair of distal biceps tendon ruptures.

This report represents a multifactorial investigation of a new technique in which a titanium EndoButton was used for repair of distal biceps tendon ruptures. Cadaveric cases were used to demonstrate the anatomic efficacy and safety of the procedure. Biomechanical testing was done to compare the fixation strength of traditional techniques with the EndoButton repair. Finally, clinical results of the repair were evaluated. In 15 fresh-frozen cadavers the mean distance of the button from the posterior interosseous nerve was 9.3 mm. Instron testing showed a mean pullout strength of 253 N for the Mitek G4 Superanchor, 177 N for a conventional bone bridge, and 584 N for the titanium button. The button was 3 times stronger than the bone bridge (P =.0001) and 2 times stronger than the Mitek anchor (P =.0007). Fourteen patients who had their tendons repaired by this technique were evaluated at a mean of 20 months postoperatively. BTE (Baltimore Therapeutic Equipment, Baltimore, MD) testing revealed recovery of 97% of flexion strength and 82% of supination strength. Patients were able to participate in an aggressive rehabilitation program and were able to regain strength and function rapidly, with satisfactory return to preinjury activities and occupations. This technique is safe, simple, and stronger than any currently available anchoring techniques and gives the surgeon a choice in bone preparation. By using a single anterior elbow approach, the development of synostosis associated with two incision techniques can be minimized.

Biomechanical Phenomena↗
PubMed1990

[Bilateral fractures of the proximal end of the radius].

Authors describe in connection with two cases of their own the vulnerability of the elbow joint originating from the physiological valgus position of this joint, i.e. the effect of the so-called "valgus stress". In the available literature no description of bilateral synchronous fracture of the radial head was found. They think, because of the bilateral injury, the correct operative therapy with the aim of reaching whole function, the stable osteosynthesis promising good result even in the fracture of the radial neck with major dislocation allowing also an early functional treatment, important.

Adult↗
PubMed1998

Upper extremity radionuclide bone imaging: shoulder, arm, elbow, and forearm.

Along with resurgence of physical activity during these fitness conscious times, there is increasing participation by people of all ages in sporting activities. Enrollment in organized and recreational sports among young adults and children has increased with as many as 30% of adolescents participating in competitive high school athletics. Despite improvements in equipment, the number of sports-related injuries presenting for medical attention has increased. Injuries to the upper extremities account for more than 25% of all sports-related injuries, but receive disproportionately less attention compared to lower extremity injuries. If neglected, upper extremity injuries can end the career of a professional athlete and cause sufficient damage to hinder daily activities in a recreational participant. Overuse syndromes, brought on by repetitive microtrauma are sports-specific, and often challenging to diagnose. Accurate diagnosis requires a thorough understanding about mechanism of injury, site of pain, and knowledge of the sport. After a thorough physical exam, a variety of radiographic testing is often necessary to promptly diagnose and manage the injury so athletes can return to competition as soon as possible.

Adolescent↗
PubMed2002

[Combination of ipsilateral supracondylar humeral- and forearm fractures in children].

In an 11-year period, from 01. 08. 1987 to 31. 08. 1998, a total of 72 children (mean age 7.6 years, range 2-12 years) with dislocated supracondylar humeral fractures were treated surgically in the Department for Traumatology, University Hospital, Essen. The combination of supracondylar humeral fracture and ipsilateral forearm fracture occurred in 8 children (11.1 %). 4 revealed a complete forearm fracture in the distal third, 4 children a fracture of the distal physis (Salter-Harris type II). The supracondylar humeral fractures were reduced openly via a single lateral approach and stabilized by crossed K-wire fixation. The distal forearm fractures were treated by closed reduction and percutaneous pinning. Fractures of the distal physis were treated by closed reduction and application of an above elbow cast. Excellent results were achieved in all children with ipsilateral supracondylar and forearm fractures.

Child↗
PubMed1993

Management of major penetrating glass injuries to the upper extremities in children and adolescents.

Penetrating glass injuries are a common cause of severe neurovascular damage, both in adults and in children. Frequently, an innocent skin wound disguises the extensive nature of the injuries beneath. Nineteen children and adolescents (ages 3-16 years) with a mean age of 9 years who sustained upper extremity penetrating glass wounds were evaluated retrospectively in order (1) to determine the incidence of unappreciated significant neurologic, musculotendonous, or vascular injury; (2) to provide indications for intraoperative evaluation under anesthesia; and (3) to further define the role of microneurorrhaphy in this population. Twelve patients sustained injuries above the elbow and seven patients injuries distal to the elbow. Above the elbow, the structures injured in order of frequency were the median nerve (75%), the brachial artery (58%), the ulnar nerve (50%), the musculocutaneous nerve (33%), sensory nerves of the arm and forearm and venae commitantes (42% each), the radial nerve (25%), and the chords of the brachial plexus (8%). Distal to the elbow, the ulnar nerve was the most frequently involved (71%), followed by the ulnar artery (57%), the flexor carpi ulnaris (57%), the superficialis and profundus flexor tendons (43%), the median nerve (43%), and the palmaris longus and flexor carpi radialis (14% each). Early exploration is critical to successful management. Vascular repairs and or microneurorrhaphy were necessary in all cases. A detailed follow-up evaluation to assess the results of these repairs was carried out from 4 to 9 years postsurgery. There were no clinical problems related to the vascular reconstructions. The results of the nerve repairs in this small series of children and adolescents were remarkably good.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Home↗
PubMed2002

Simultaneous dislocations of the radiocapitellar and distal radioulnar joints.

Posttraumatic instability of the distal radioulnar joint (DRUJ), occurring in isolation or in association with fractures of the radius, is well-documented. Few reports have identified simultaneous ipsilateral DRUJ instability and elbow dislocation. The authors of the present study describe a case of persistent radiocapitellar subluxation after closed reduction of an elbow dislocation, secondary to irreducible volar subluxation of the DRUJ.

Accidental Falls↗
PubMed1996

Unusual problems of the athlete's elbow, forearm, and wrist.

Early in their medical training physicians often are told, "When you hear hoofbeats, don't think of zebras." Such sage advice is helpful when facing the formidable challenges of information acquisition early on. Later, however, we must be familiar and consider these uncommon conditions when entrusted with the responsibility of properly caring for our patient athletes. This is particularly true in the athlete presenting with symptoms or findings disproportionate to his or her injury, or when symptoms persist despite seemingly appropriate treatment. A high index of suspicion and attention to radiographs and further appropriate work-ups result in detection of most occult unexpected lesions.

Athletic Injuries↗
PubMed2001

Partial tears of the distal biceps tendon: MR appearance and associated clinical findings.

PURPOSE: To describe the magnetic resonance (MR) appearance and associated clinical findings of partial distal biceps tendon tears. DESIGN: Twenty elbow MR images at 1.5 T, performed over a 7 year period, were reviewed for an appearance of partial tears in the distal biceps. These images were assessed by two musculoskeletal radiologists for the extent of: (a) abnormal signal intensity within the tendon, and the presence of (b) bicipitoradial bursitis, and (c) bony microavulsive injury of the radial tuberosity. Medical records for nine of the 20 cases were reviewed for the clinical findings of ecchymosis, trauma, sensation of a "pop", loss of function, and acuity of onset. RESULTS: Twenty partial distal biceps tendon tears were seen. All displayed an abnormally increased signal in the distal biceps tendon. Three of 20 (15%) showed a 25% to 50% tear, ten of 20 (50%) showed a 50% tear, and seven of 20 (35%) showed a 75% to 90% tear. Bicipitoradial bursitis was seen in 11 of 20 (55%) cases. Bony microavulsive injury of the radial tuberosity was observed in 10 of 20 (50%). Of the nine cases reviewed for associated clinical findings, surprisingly, only three (33%) experienced an acute traumatic episode with an abrupt onset of pain. An insidious onset was reported in four of nine (44%). Sensation of a "pop" was recorded in only two of nine (22%) cases. Ecchymosis and loss of function were not seen in any of the cases. Finally, surgical conformation was obtained for three cases. CONCLUSION: Partial distal biceps tendon tears have a characteristic MR appearance, demonstrate little functional deficit, and may be attritional in their etiology due to the observation of a low number of patients reporting trauma or an acute onset.

Adult↗
PubMed2006

Operative treatment of osteochondral nonunion of the distal humerus.

Three patients with ununited osteochondral fracture fragments of the distal humerus (2 anterior capitellum and trochlea; 1 posterior trochlea) who had debridement and realignment of the nonunion, autogenous cancellous bone graft, and internal fixation an average of 6 (range, 5-8) months after injury were studied. The preoperative arc of elbow flexion was 80 degrees, 35 degrees, and 25 degrees. All 3 fractures healed without implant related complications or osteonecrosis. At 28, 27, and 46 months after the index procedure for nonunion, the patients had 95 degrees, 90 degrees, and 115 degrees arcs of elbow flexion. The scores on the Mayo Elbow Performance Index were 80, 80, and 95 (2 good, 1 excellent). Based on this limited experience, it seems that operative treatment of ununited osteochondral fracture fragments can achieve union without osteonecrosis. Attempts to improve the function of the native elbow rather than salvage the situation with interpositional or prosthetic arthroplasty are worthwhile.

Adult↗