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At least 721 records · Page 40Linked to original sources
PubMed2005

Results with Kudo elbow prostheses in non-traumatic indications : a study of 36 cases.

With a mean follow-up of 62 months, we reviewed 13 Kudo type 4 and 23 Kudo type 5 elbow prostheses implanted for non-traumatic indications in 30 patients. Clinical results were assessed with the Mayo Clinic Performance Index (MCPI) taking into account pain, mobility, stability and daily activities. Postoperatively, pain disappeared or decreased, ulnar nerve dysfunction was improved and the functional status was significantly improved. The average range of motion increased by 7.8 degrees in extension and by 11.5 degrees in flexion; pronation and supination remained unchanged. Clinically, 89% of patients scored poorly on the MCPI preoperatively, whereas 61% had excellent or good scores postoperatively. Twenty-two patients out of 30 were satisfied. There were two early prosthetic dislocations, and prosthetic instability, assessed clinically, was found in 6 cases (17%). The rate of loosening was 28% (10/36) and seven elbows were revised. Metallosis, loosening and instability were significantly correlated. The survival rate of 82% at 54 months (SD = 7) is lower than that reported for non-constrained and semi-constrained prostheses in the literature.

Adult↗
PubMed1978

The place of surgery in rheumatoid arthritis.

The medical and surgical management of patients with rheumatoid disease has improved over recent years. Despite the improvements, much disability and pain arise from the condition. The major surgical advances in recent years have been in the field of joint replacement, and these advances are continuing. Joint replacement units have evolved, allowing further specialization in this rapidly advancing field. Close liaison between the general practitioner, rheumatologist, orthopaedic surgeon and allied health professionals is most important in achieving the best possible results in the management of these patients.

Ankle Joint↗
PubMedDate not supplied

A prosthetic appliance for a patient with a brachial plexus injury and forearm amputation: a case report.

Among the prosthetic and orthotic appliances available, neither a conventional mechanical prosthesis nor the myoelectric control system provided optimal results for a 19-year-old patient with a traumatic, irreversible paralysis of the brachial plexus and below-elbow amputation. A new device was therefore constructed that combined the mechanical pull of the first system and the electric hand of the second. Its functions, the training program, and the end result are reported.

Adult↗
PubMed2005

[Therapy for radial head fractures].

The treatment of radial head fractures is challenging for the trauma surgeon due to the complex functional anatomy of the elbow. Satisfactory results can only be achieved if the function and stability of the humeroradial joint are entirely restored. Thus, depending on the fracture type, ranging from non-displaced Mason type I fractures to comminuted Mason type III fractures, an individual treatment concept has to be established. Treatment protocols range from conservative treatment with short-term cast immobilization to open reduction and internal fixation according to AO-principles or to the implantation of a radial head prosthesis. In case of severe comminution of the radial head, resection arthroplasty might be indicated.

Arthroplasty, Replacement↗
PubMed1987

Treatment of isolated fractures of the proximal end of the radius in adults. Remarks concerning 168 cases.

The review of a series of 168 cases of isolated fractures of the upper end of the radius in adults allows the authors to note the advantage of functional therapy. The early physical therapy contributed to obtain an important rate of good results with the different types of Mason's classification. An osteosynthesis, when performed, must permit the early mobilisation of the elbow in order to avoid stiffness. Such a short experience does not allow the authors to conclude in favor of the necessity for the emergency use of a radial prosthesis instead of an isolated resection.

Adolescent↗
PubMedDate not supplied

Elbow joint stability following experimental osteoligamentous injury and reconstruction.

Elbow joint dislocation was simulated in cadaveric specimens to quantify laxity induced by radial head and coronoid process lesions, either alone or in combination with collateral ligament insufficiency. The effects of lateral ligament reconstruction and radial head prosthesis replacement were also considered. Absence of the radial head and the coronoid process induced rotatory laxity of 145% and 128% (both P <.01), respectively, compared with the intact joint. When both were absent, the joints subluxated regardless of collateral ligament status. Isolated radial head prosthesis implantation prevented this subluxation, and laxity almost normalized. Lateral collateral ligament reconstruction prevented major laxity even in the absence of the radial head. Lateral collateral ligament reconstruction and radial head prosthetic replacement yielded restraint against gross instability in the maximal unstable situation (terrible triad). The lateral collateral ligament is the prime stabilizer to external rotation, and reconstruction of this alone, even with an absent radial head, is beneficial.

Aged↗
PubMed2003

[Differential arthroplasty and endoprosthesis indications in rheumatoid arthritis of the elbow joint].

Management of patients with rheumatoid arthritis of the elbow has changed significantly over the last several years. From a medical standpoint, the disease-modifying agents have decreased the number of patients requiring a synovectomy. When synovectomy is indicated, arthroscopic synovectomy has lessened the morbidity of this procedure, but the long-term effectiveness as a definitive reconstructive procedure has yet to be determined. Both coupled and uncoupled elbow joint replacements have emerged as reliable interventions for this diagnosis. Mayo's experience with 78 patients with rheumatoid arthritis undergoing total elbow arthroplasty has revealed a satisfactory outcome of approximately 92% at 12 years. The complication rate is approximately 15% consisting primarily of delayed avulsions or deficiency of the triceps tendon (2%), deep infection (2%), and ulnar nerve irritation (3%).

Arthritis, Rheumatoid↗
PubMed2003

Improving elbow torque output of stroke patients with assistive torque controlled by EMG signals.

This paper develops an assistive torque system which uses homogeneic surface electromyogram (EMG) signals to improve the elbow torque capability of stroke patients by applying an external time-varying assistive torque. In determining the magnitude of the torque to apply, the incorporated assistive torque algorithm considers the difference between the weighted biceps and triceps EMG signals such that the applied torque is proportional to the effort supplied voluntarily by the user. The overall stability of the assistive system is enhanced by the incorporation of a nonlinear damping element within the control algorithm which mimics the physiological damping of the elbow joint and the co-contraction between the biceps and triceps. Adaptive filtering of the control signal is employed to achieve a balance between the bandwidth and the system adaptability so as to ensure a smooth assistive torque output. The innovative control algorithm enables the provision of an assistive system whose operation is both natural to use and simple to learn. The effectiveness of the proposed assistive system in assisting elbow movement performance is investigated in a series of tests involving five stroke patients and five able-bodied individuals. The results confirm the ability of the system to assist all of the subjects in performing a number of reaching and tracking tasks with reduced effort and with no sacrifice in elbow movement performance.

Aged↗
PubMed2002

Biomimetic actuators in prosthetic and rehabilitation applications.

Where humans and mechanical systems operate in close proximity there is a need to provide drive systems that combine the positive attributes of conventional actuator design with a 'softer' safer interaction capacity. This is achieved by natural muscle, and engineering emulation of this functionality could have a significant benefits in many areas, but particularly the medical domain. This work will study the use of compliance regulated and controlled pairs of antagonistic pneumatic Muscle Actuators (pMAs) in two medical scenarios; i) The construction of dexterous prosthetic hands having a high power and low mass potential, ii) The construction of a power assist device that can be used to augment the strength of those suffering from degenerative muscle wasting diseases.

Amputation, Surgical↗
PubMed2002

Periprosthetic humeral fractures after total elbow arthroplasty: treatment with implant revision and strut allograft augmentation.

BACKGROUND: Periprosthetic fractures are among the most challenging complications of elbow arthroplasty, and published information about the outcome of treatment is limited. The purpose of the present study was to determine the results of implant revision and strut allograft augmentation for the treatment of humeral periprosthetic fractures that occur around a loose humeral component. METHODS: Between 1991 and 1999, eleven periprosthetic fractures that occurred around a loose humeral component were treated with cortical strut allograft augmentation and revision arthroplasty with use of a Coonrad-Morrey semiconstrained implant. Six fractures occurred after a primary arthroplasty, and five occurred after a revision arthroplasty. Two parallel strut grafts were used for fracture fixation in most cases. Patients were followed for an average of three years (range, nine months to 7.8 years) and were evaluated clinically and radiographically. RESULTS: Clinical and radiographic fracture union was obtained in ten of the eleven patients. One patient required revision surgery because of aseptic loosening of the humeral component seven years and nine months after fracture union; there were no other implant failures. Complications included one additional nondisplaced humeral periprosthetic fracture after surgery that failed to heal with closed treatment, one olecranon fracture, one permanent ulnar nerve injury, and one case of triceps insufficiency. At the time of the most recent follow-up, seven of the eight patients with an intact reconstruction had a functional arc of motion and no or slight pain and one had limited motion and moderate pain. CONCLUSIONS: Periprosthetic humeral fractures that are associated with a loose humeral component can be effectively treated with revision elbow arthroplasty and strut allograft augmentation. The technique is associated with a high rate of fracture union, implant survival, and satisfactory clinical results. However, the complication rate is substantial.

Adult↗
PubMed2003

Total elbow replacement for distal humerus fractures and traumatic deformity: results and complications of semiconstrained implants and design rationale for the Discovery Elbow System.

Recent advances in elbow replacement design have further extended its usefulness as an expedient reconstructive method for restoring elbow function following trauma. This is particularly true in elderly patients, for whom treatment is complicated by the frequent presence of osteoporosis, severe comminution with small condylar fracture fragments, and diminished bone-healing capacity. This article addresses the role of elbow replacement for fracture, traumatic deformity, post-traumatic arthritis, and instability. Indications, techniques, and results are presented. Complications of semiconstrained implants are presented, and the design rationale for, and examples of, the latest-generation Discovery Elbow System (Biomet Orthopedics, Warsaw, Indiana) are discussed.

Aged↗
PubMedDate not supplied

Isolated fracture of the humeral capitellum.

Twenty-nine patients with fractures of the capitellum of the humerus were treated at the New York Orthopaedic Hospital during 15-year period; 17 were available for follow-up assessment. A classification based upon the specific nature of the fracture and the degree of trochlear involvement is a suggested guide to treatment and prognosis. Long-term follow-up studies compare resection, replacement with fixation, and closed reduction. Choice of treatment should be selective and individualized depending on age, character of the bone, and type of fracture.

Adolescent↗
PubMed1995

Semiconstrained elbow replacement for distal humeral nonunion.

We have reviewed 36 of 39 consecutive patients with an average age of 68 years who had semiconstrained elbow replacement for distal humeral nonunion at an average follow-up of 50.4 months (24 to 127). Of these, 31 (86%) had satisfactory results, three (8%) had fair, and two (6%) had poor results; 32 patients (88%) had moderate or severe pain before and 91% had no or only mild discomfort after the procedure. Motion had improved from a mean arc of 29 degrees to 103 degrees before operation to 16 degrees to 127 degrees after surgery. All five flail extremities were stable at last assessment. There were seven complications (18%): two patients had deep infection, two had particulate synovitis, two had ulnar neuropathy and one had worn polyethylene bushes. Five of these seven, excluding the two with transient nueropathy, required reoperation (13%). Joint replacement arthroplasty can be a safe and reliable treatment for this difficult clinical condition, seen most commonly in elderly patients. This is a significant advance, since repeated osteosynthesis has been shown to be ineffective in most patients.

Activities of Daily Living↗
PubMed1991

[A comparative study of the treatment of fractures of the radial head by resection or by Swanson silastic implant].

The authors report 62 fractures of the head of the radius treated either by excision or silastic implant arthroplasty. Fifty-two patients were reviewed with a mean follow-up period of 5 years (range 1 to 13). Of 22 prosthetic replacements, 12 were satisfactory while of 30 excisions only 10 were rated good or excellent. Excision usually yielded valgus deformity of the elbow (range 9 to 35 degrees) and with a risk of shortening of the radius. Range of flexion-extension was identical after both procedures but pronation supination was better after prosthesis replacement (78/70) than after radial head excision (65/60) 3 fractures of the implant were found at 6, 9 and 10 years postoperatively; only one of them was associated with pain and required removal of the loose fragments.

Adolescent↗
PubMed1991

[Comparative study of the treatment of fractures of the head of the radius by resection or by Swanson's silastic implant].

The authors report 62 fractures of the head of the radius treated either by excision or silastic implant arthroplasty. Fifty-two patients were reviewed with a mean follow-up period of 5 years (range 1 to 13). Of 22 prosthetic replacements, 12 were satisfactory while of 30 excisions only 10 were rated good or excellent. Excision usually yielded valgus deformity of the elbow (range 9 to 35 degrees) and with a risk of shortening of the radius. Range of flexion-extension was identical after both procedures but pronation supination was better after prosthesis replacement (78/70) than after radial head excision (65/60) 3 fractures of the implant were found at 6, 9 and 10 years postoperatively; only one of them was associated with pain and required removal of the loose fragments.

Adolescent↗