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PubMed2006

The impact of trauma in an urban pediatric orthopaedic practice.

BACKGROUND: National data documenting the impact of pediatric trauma in general and of pediatric orthopaedic trauma in particular on the rates of hospital admissions and emergency-room visits have been reported. This study documents the frequency of and work involved in the care of pediatric orthopaedic trauma by a single urban pediatric orthopaedic group practice. METHODS: The computerized billing records of a single practice group of 3.4 full-time-equivalent, fellowship-trained pediatric orthopaedic surgeons practicing in a freestanding pediatric hospital with a level-I trauma center were analyzed for one year (from July 2004 through June 2005). Every office visit and operative procedure was specifically sorted to determine the component of trauma care in the group's pediatric orthopaedic practice. Descriptive statistics, including the actual numbers and percentages of office fracture visits and operations for fracture care as well as the actual numbers and percentages of work relative value units generated by the physicians, are presented. RESULTS: The practice generated 36,771 work relative value units, with 18,693 units (51%) from treatment provided in the operating room and 18,078 units (49%) from treatment provided in the office. A total of 1903 new fractures was seen and accounted for 5698 work relative value units (32% of all work relative value units for treatment provided in the office). The four fractures that were most frequently seen in the office were in the distal aspect of the radius (23%), forearm (14%), tibia (13%), and elbow (10%). Of the 18,693 work relative value units generated in the operating room, 5975 (32%) were from fracture care, representing the largest single category of work done in the operating room. Trauma-related operations were most commonly done for fractures of the elbow (25.3%), tibia (12%), femur (9.8%), forearm (5.5%), and the distal aspect of the radius (5%). Technically demanding fixation techniques, which are commonly used to treat fractures in adults, were frequently used, particularly for femoral and tibial fractures. CONCLUSIONS AND CLINICAL RELEVANCE: This study documents the frequency and work relative value of the care of musculoskeletal injuries in an urban pediatric orthopaedic practice in the outpatient and inpatient settings. It is a snapshot in time of current trends in pediatric orthopaedic practice, but these data may have implications for future resource allocation of the pediatric orthopaedic manpower in North America.

Child↗
PubMed1985

Separation of the distal humeral epiphysis in the neonate. A combined clinical and roentgenographic diagnosis.

Separation of the distal humeral epiphysis in the neonate or young child can be diagnosed confidently by combining roentgenographic and clinical information. Such diagnosis is critical, as two abnormalities included in the differential diagnosis--irreducible elbow dislocation and fracture to the lateral humeral condyle--often require open reduction, unlike distal humeral epiphyseal separation, which can be treated conservatively. We describe two patients and review the pertinent literature.

Birth Injuries↗
PubMed1987

The radiographic evaluation of shoulder and elbow pain in the athlete.

This article presents the important anatomic features of the shoulder joint and the abnormalities to which the athlete is most susceptible leading to pain and disability. It also reviews the pertinent elbow anatomy and discusses the radiographic techniques currently employed in diagnosing elbow problems in the athlete, including tomography, arthrography, and computed tomography.

Athletic Injuries↗
PubMedDate not supplied

Evaluation of the late neurologic deficits accompanied by hypertrophic scars and keloids in children with elbow fractures.

In this study, the relation between hypertrophic scar and keloid (HSc) lesions around incisions and late neurologic deficits was investigated in operated elbow fractures in children. Six elbow fracture patients with HSc lesions were evaluated for neurologic deficits with late onset. The fractures were all closed and treated with open reduction and internal fixation. No neurologic deficit was detected before surgery and in the early postoperative periods. Late neurologic deficits observed in these patients were evaluated according to British Medical Research Committee scoring scale on admission and after therapy. In the reoperations for neurologic deficits, the nerve segments were found to be compressed in intensive scar tissue. Typical pseudoneuromas were observed in the proximal part of compression; however, the corporal integrity of the nerves was not interrupted. External neurolysis were performed in all patients. Excellent improvements in sensory and motor functions were detected and no recurrence occurred in follow-up. Elbow fracture patients, especially those with HSc lesions around their incisions, should be followed up for possible neurologic deficits with late onset.

Child↗
PubMed2001

[Bipolar dislocation of the forearm: elbow and perilunate dislocation].

We report a case of bifocal dislocation of the forearm due to posterior dislocation of the elbow and transcaphocapital retrolunate dislocation of the carpus, Fenton's syndrome, associated with fracture of both bones of the forearm. The emergency procedure achieved reduction of the elbow, plate fixation of the radius and ulna, used a posterior and an anterior access to achieve reduction and osteosynthesis of the radial styloid, the scaphoid, and the capitatum and temporary schapholunate, triquetrolunate, scaphocapitate, and radiolunate pinning. At ten months, the patient only complained of moderate pain for exceptional efforts. Complete amplitude elbow motion was restored. Wrist flexion and extension were 50 degrees and 30 degrees respectively. X-rays demonstrated union of the scaphoid and the capitatum. There was no scapholunate diastasis and the scapholunate angle was normal.

Accidental Falls↗
PubMed1988

Radial head fractures with acute distal radioulnar dislocation. Essex-Lopresti revisited.

Seven adults with displaced radial head fractures had concurrent dislocation of the distal radioulnar joint. Because support of the radius was lost at both the elbow and wrist, proximal migration of the radius from 5 to 10 mm occurred. Different types of fractures were classified to designate the best method of restoring radial length to prevent chronic wrist pain and stiffness. Type I fractures had large displaced radial head fragments with minimal or no comminution and amenable to interfragmentary fixation. Type II fractures had severe comminution requiring radial head excision and prosthetic replacement. Type III were old injuries with irreducible proximal migration of the radius managed by ulnar shortening and radial head prosthetic replacement. There were three Type I, two Type II, and two Type III fractures. Results of treatment were graded as 3, excellent; 2, good; 1, fair; and 1, poor. The three excellent results were in patients in which restoration of radial length was achieved within one week of injury. Suboptimal results occurred in the remaining four patients when definitive surgery was delayed four to ten weeks. The poor result was in a patient treated only by radial head excision and who refused further surgery. Recommendations include meticulous clinical and roentgenographic examination of the distal radioulnar joint in all patients with displaced radial head fractures. Preservation of the radial head with anatomic reduction and rigid internal fixation is preferred, but radial head replacement may be necessary in cases with extensive comminution. Radial head excision alone, though contraindicated, may be restructured by ulnar shortening and radial head prosthetic replacement.

Adult↗
PubMed1995

[Transitory lesion of the radial nerve after fall onto the outstretched arm].

A patient presented with a bony avulsion of the radial collateral ligament of the elbow combined with a partial lesion of the radial nerve after a fall onto the outstretched arm. Probably the nerve was compressed at its penetration through the lateral intermuscular septum by a sudden contraction of the triceps tendon. Conservative treatment led to complete recovery.

Accidental Falls↗
PubMedDate not supplied

Tendonitis of the wrist and elbow.

Although common and frequently transitory, tendonitis in the upper extremity may be quite disabling and resistant to treatment. The physician's best hope for a swift and successful resolution lies in a careful history of all possible precipitating causes and a precise localization of symptoms to obtain an exact diagnosis.

Humans↗
PubMed2003

Functional latissimus dorsi island pedicle musculocutaneous flap to restore elbow flexion in replantation or revascularisation of above-elbow amputations.

Two total and one subtotal above-elbow amputations had replantation or revascularization for their severely damaged upper extremities followed by functional latissimus dorsi island pedicle musculocutaneous flap to restore elbow flexion. The mean follow-up was 68 months (range: 14 to 121 months). At final follow-up examinations, the patients had sufficient range-of-motion of their elbows with good strength. Restoring elbow function eliminates one of the most important limiting factors for above-elbow replantations. Functional latissimus dorsi island pedicle musculocutaneous flap is very reliable, has minimal donor-site morbidity and offers a wider choice when deciding about arm replantation in the upper arm region by providing a chance of restoring functions.

Accidents, Occupational↗
PubMed1999

Osteochondritis dissecans of the elbow.

Osteochondritis dissecans of the elbow remains one of the leading causes of permanent elbow disability in adolescents and young adults engaged in throwing sports or gymnastics. The insidious onset of lateral elbow pain and restriction of full extension should alert the physician and prompt further investigation. Early recognition and appropriate treatment may allow for the prevention of long-term sequelae. Conservative care following early detection provides the best opportunity for a complete recovery. Surgical management at this point consists primarily of excision or removal of the osteochondral fragment with drilling or burring of the base of the lesion. Prognosis is fair with approximately half of all patients experiencing chronic pain or limitation of motion in the elbow. Research efforts are currently focusing on the treatment of established articular surface defects. Newer procedures such as the transplantation of osteochondral, perichondral, and periosteal tissues, chondrocyte transplantation, and the biochemical manipulation of the chondrocyte environment may provide us with exciting new approaches to an old problem. Osteochondritis dissecans of the elbow continues to present a difficult challenge to the treating physician. The current literature provides very little guidance for the clinician but active and innovative investigations into the treatment of articular cartilage defects may soon provide the answers.

Adolescent↗
PubMed1998

Disorders of the forearm axis.

Forearm pronosupination is a complex, integrated activity that demands specialized function of all structures between the elbow and wrist. This article describes the forearm axis as a comprehensive concept to unify these relationships. The anatomy and biomechanics of the forearm axis are reviewed. Pathologies that affect the entire axis are summarized.

Biomechanical Phenomena↗
PubMed1995

Fracture of a supracondylar humeral myositis ossificans.

Although myositis ossificans is a well-known sequela of elbow trauma, reinjury to the affected region can also occur, resulting in acute symptoms from a fracture of the myositis ossificans. An 18-year-old man presented with localized pain, soft-tissue swelling, and a bony mass along the anterolateral distal humerus with restricted elbow range of motion after injury to his elbow during football. One year earlier he had sustained a similar crush injury to his elbow that resulted in a limited, although painless, arc of motion. Radiographs and tomograms established the diagnosis of a fractured supracondylar humeral myositis ossificans. Surgical excision of the large mature ossified fragment confirmed the diagnosis and restored a full range of motion of the elbow.

Adolescent↗
PubMed1986

Arthroscopy of the elbow.

For arthroscopy of the elbow to be safe and effective, the arthroscopist must develop a systematic and reproducible arthroscopic examination technique. We believe that the technique and the identification of anatomic structures described in this article provide a safe and reliable means of performing this procedure. Attention to detail, especially when establishing the portals, is essential in performing a safe examination and in avoiding damage to the neurovascular structures. We prefer the 4-mm, 30-degree-angled arthroscope. It provides the wide field of view necessary for both diagnostic and operative elbow arthroscopy. The large percentage of excellent and good results in patients who have had correction of mechanical disorders of the elbow has been encouraging. Removal of loose bodies and resection of impinging olecranon osteophytes produced the best functional results. Chondroplasties of the radial head and capitellum produced less satisfactory results than did the correction of mechanical disorders. In conclusion, arthroscopy of the elbow is an effective diagnostic procedure and is effective in treating certain intraarticular problems with minimal morbidity and rapid return to function. However, attention to detail is essential to prevent compromise of the surrounding neurovascular structures or damage to the delicate articular cartilage.

Arthroscopy↗
PubMed1978

Extensor fasciotomy for tennis elbow: a long-term follow-up study.

In 37 of 43 cases (86%) the late results of fasciotomy for chronic lateral epicondylitis were excellent or good. The initial result was maintained for an average of 8.0 years. The procedure is simple and morbidity is minimal. Patient selection and technical factors appeared to account for the failures.

Adult↗
PubMed1978

Comparison between the early use of skin flap and skin graft for the correction of large tissue loss at the elbow.

Six patients with soft and hard tissue injuries of the elbow region during the 1973 Yom-Kippur war are discussed. These six patients were treated with two types of procedures. One group was initially treated with application of a split-thickness skin graft followed by a thoracoabdominal, abdominal, or chest skin flap. The second group was initially treated with the application of a thoracoabdominal flap. There are few descriptions in the literature or in textbooks of the plan design method, nor are there comparisons of two types of procedures. In both groups the end results were the same. The differences were the time of hospitalization and the cooperation of the patients during treatment. In both groups the flap was transferred before further surgical reconstruction of bones and joints.

Adult↗