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At least 937 records · Page 52Linked to original sources
PubMed1990

Management of vascular injuries in displaced supracondylar humerus fractures without arteriography.

One hundred forty-three displaced (type III) supracondylar fractures of the humerus in children were treated over a 5.5-year period with 17 (11.9%) having signs of vascular impairment at the time of presentation. Rapid reduction and Kirschner wire stabilization without arteriogram was performed in each case. In three cases in which satisfactory blood supply to the hand was not present after reduction, circulation was restored after exploration of the brachial artery revealed two intimal tears and one arterial entrapment. The remaining 14 patients were normal at follow-up with no late vascular compromise. Based on these findings, we feel prereduction arteriography is not indicated in this injury.

Arm↗
PubMed1999

Late repair of simultaneous bilateral distal biceps brachii tendon avulsion with fascia lata graft.

A 50 year old rock climber sustained a bilateral rupture of the distal biceps brachii tendons. He retained some flexion power in both arms but minimal supination, being weaker on the non-dominant right side. As the patient presented late, with retraction and shortening of the biceps muscle bellies, reconstruction was carried out using fascia lata grafts on both sides. Because of residual weakness on the left (dominant) side, three further surgical procedures had to be carried out to correct for elongation of the graft. A functionally satisfactory outcome, comparable with that on the right side, was eventually obtained. In summary, bilateral fascia lata grafts to bridge the gap between the retracted biceps bellies and the radial tuberosities were successful in restoring function and flexion power to the elbow. Despite being the stronger side, the dominant arm did not respond as well to the initial surgery. This may be due to overuse of this arm after the operation.

Arm Injuries↗
PubMed1998

Repair of nonunion lateral humeral condyle: a case report.

Epiphyseal injury of the lateral condyle of distal humerus is found commonly in children. Complications following such an injury can result in nonunion with late development of angular deformity and ulnar nerve neuritis. Nonunion at this area is extremely troublesome and difficult to treat. Controversy exists as whether late open reduction and fixation can restore the anatomy of the elbow joint and improve the function. We describe a technique of corrective osteotomy to correct the cubitus valgus deformity and repair the nonunion. The patient was treated successfully with 4 years follow-up.

Child↗
PubMed1998

Type four fracture of the medial epicondyle: a true indication for surgical intervention.

Fourteen consecutive cases with type 4 fracture of the medial epicondyle were evaluated following open reduction and internal fixation of the displaced medial epicondyle. The mean age was 9.7 years (range 6-16) and the mean follow-up was 17.2 months (range 12-24). Operative treatment yielded excellent results with no loss of functional range of motion, residual deformity or instability. There were three cases with pre-operative symptoms of ulnar nerve injury which made a good recovery following neurolysis of the ulnar nerve. Type 4 fractures are commonly associated with intra-articular entrapment of the ulnar nerve and result from serious damage to the soft tissues on the medial side of the elbow. Assessing instability is therefore of key importance, as is the intra-operative gravity stress-valgus test in assessing instability.

Adolescent↗
PubMed1994

Bioresorbable pins and screws in paediatric traumatology.

Bioresorbable implants are suited to the treatment of joint and shaft fractures in children. These conclusions were drawn from clinical and experimental investigations at the University of Heidelberg. Since 1990 13 fractures, including 5 medial malleolus fractures, 2 retropatella flake fractures, 1 metacarpal fracture, 2 lateral condyle, 2 epicondyle fractures and a secondary dislocated forearm fracture were treated with BIOFIX pins. 11 of these cases were without complications. There was one case of infection, and due to material failure the stability was insufficient in one case. In a post-mortem study torsional fractures were produced in femora of children between 5 and 15 months. The fractures were then fixed with one resorbable screw and put under torsional loading until the bone refractured. The post-fixation force (torsional) amounted to 77% of the original fracture force, and the degree of rotation at fracture was post-fixation 84% of the original. The stability of bioresorbable screws in the treatment of femoral spiral fractures in children can therefore be confirmed.

Ankle Injuries↗
PubMed2006

Chronic posttraumatic anterior dislocation of the radial head in children: thirteen cases treated by open reduction, ulnar osteotomy, and annular ligament reconstruction through a Boyd incision.

OBJECTIVE: To report the results of open reduction, ulnar osteotomy, and annular ligament reconstruction all through a Boyd incision for chronic radial head dislocations in children. DESIGN: Retrospective review. SETTING: Tertiary pediatric orthopaedic care unit at a general hospital in Taichung, Taiwan. PATIENTS/PARTICIPANTS: From 1986 to 2003, 13 children, aged 4 to 13 (mean, 8.3) years, who had a chronic traumatic anterior dislocation of the radial head were treated at our institute. These patients were seen at our hospital 2 to 36 (mean, 8.2) months after injury. INTERVENTION: Open reduction of the radial head, ulnar osteotomy, then rigid fixation with plate/screws, and annular ligament reconstruction with forearm fascia, all performed through a Boyd incision. MAIN OUTCOME MEASUREMENTS: Forearm radiographs for reduction and osteotomy site union, physical examinations for elbow mobility, and Kim's elbow performance scores for overall elbow function. Evaluations were done at a special follow-up clinic for this study by a pediatric orthopaedic surgeon who was not involved in the patients' previous care. RESULTS: Patient follow-up averaged 7.8 (range, 1-16.9) years after surgery. Twelve of our cases had successful radial head reductions, satisfactory elbow mobility, and excellent functional outcome. One case had a redislocation, was retreated, and had a fair result. Other complications included 1 patient with transient posterior interosseous nerve palsy, and 1 delayed union of an ulnar osteotomy site, which healed without further intervention at 1 year with an excellent result. CONCLUSION: This surgical procedure provides a high success rate with a low level of complications for chronic radial head dislocations in children.

Child↗
PubMed1996

Repair of the distal biceps tendon using suture anchors and an anterior approach.

The authors describe a technique for repair of the biceps tendon rupture from the radial tuberosity. A single anterior incision, limited volar dissection, and implantable bone anchors were used. With this technique, the authors have repaired the distal biceps tendon in 5 men (mean age, 39 years). Four patients were laborers and 1 was an athlete. Mechanism of injury was a single traumatic event with an unanticipated large load being applied to the flexed arm. Four patients were treated acutely and 1 was treated 6 months after injury. All patients returned to preinjury activity levels by 5 months after repair of the tendon. Clinically, all repairs remained intact (mean followup, 2.5 years). Range of motion was symmetric. No evidence of associated nerve injuries, heterotopic bone formation, or olecranon tenderness occurred. Subjective, as well as objective, results were excellent in those 5 patients whose distal biceps tendon was repaired by the single volar incision and implantable anchors.

Adult↗
PubMed1996

Long term evaluation of repaired distal biceps brachii tendon ruptures.

A long term evaluation was performed on 8 patients who had rupture of the distal biceps tendon repaired using the 2-incision technique. The length of followup ranged from 1 to 11 years with an average of 6 years. Goniometric range of motion and isokinetic strength testing were performed on all patients. All patients attained a full arc of elbow flexion and extension. Supination was diminished more than 30 degrees in 3 patients and pronation was diminished more than 30 degrees in 1 patient. Subjectively, 6 of 8 patients were completely satisfied with the function of their involved arm. Strength and work performed during repetitive exercise were regained to the expected normal levels in elbow flexion. Six of 8 patients continued to have less strength in supination of the injured arm than the uninjured arm. All 8 patients performed less total work with repetitive supination of the injured arm than the uninjured arm.

Adult↗
PubMedDate not supplied

Neuroanatomy in elbow arthroscopy.

An injury to the median nerve from within the joint during an arthroscopic synovectomy prompted a study of the relationship of the nerves to the capsule and bones of the elbow. Six pairs of cadaveric elbows frozen in 90 degrees of flexion and one pair frozen in extension were sectioned at 5-mm intervals, and the distances from the major nerves to the bones and capsule were recorded. One elbow joint in each pair was filled with saline solution. Saline solution insufflation increased the nerve-to-bone distance with the elbow in flexion. The results were 12 mm for the median nerve and 6 mm for the radial nerve. The capsule-to-nerve distance was affected little by insufflation and was as narrow as 6 mm in three specimens. Extension eliminated the protective effects of insufflation and brought the nerves closer to the bone. These findings confirm (1) the importance of flexion and insufflation in portal placement, (2) that insufflation does not improve the capsule-to-nerve distance, and (3) the potential for "from within-out" injury in synovial procedures.

Arthritis, Juvenile↗
PubMedDate not supplied

Electromyographic analysis of elbow function in tennis players.

Muscle activity about the elbow during tennis strokes in nine professional and collegiate level players was studied using indwelling EMG and high speed photography. Eight muscles were evaluated for the serve, forehand, and backhand strokes. The serve was divided into six stages and the ground strokes into four stages. EMG tracings were subjected to analog-to-digital conversion and a relative measure of quantity was obtained. Analysis of variance and Turkey tests were then done to assess statistical significance (P less than 0.05). The ground strokes showed low activity in all muscles tested during the preparation phase. During the acceleration phase, both the backhand and forehand showed a generalized increase in all muscle activity. Both strokes showed marked activity of the wrist extensors and, in addition, the forehand showed high activity in the brachialis and biceps. In the follow-through phase, there was a generalized decrease in muscle activity. The serve showed low activity in all muscles tested during the wind-up phase. The wrist extensors increased their activity in the cooking phase, with marked activity in late cooking. The pronator teres and the triceps showed increased activity in the acceleration phase. Follow-through phase showed low muscle activity except for the biceps, which increased in late follow-through. In conclusion, the muscles of the elbow help stabilize the elbow as a unit during the ground strokes in these high level players. Power in the serve comes from increased activity in the triceps and pronator teres. The predominant activity of the wrist extensors in all strokes may be one explanation for predisposition to injury.

Athletic Injuries↗
PubMedDate not supplied

[X-ray diagnosis of ruptures of the distal radioulnar joint].

The paper describes 42 intact, 14 damaged and 52 ruptured radioulnar joints. The joints width was measured, the radioulnar index calculated, x-ray pictures filtered. Variants of isolated injuries of the joints in different bone dislocation, changes in combined ruptures and injuries are described. The radioulnar index proved the best in quantitation of the joint damage.

Adult↗
PubMed2002

[Traumatic dislocation of the radial head associated with ipsilateral fracture of the radial shaft: a case report].

Ipsilateral radial head dislocation with radial shaft fracture is a rare injury. A few cases have been reported in the literature. We report the case of a 39-year-old man who presented with a radial shaft fracture and ipsilateral dislocation of the radial head caused by hyperpronation trauma of the forearm with hyperflexion of the elbow. The dislocation was reduced by manipulation after open reduction of the radial shaft fracture, which was then fixed with a plate. The clinical and radiological outcome was good with 2 years follow-up.

Adult↗
PubMed1990

Nerve transposition for the restoration of elbow flexion following brachial plexus avulsion injuries.

Despite technical advances, the ability to restore motor function following a brachial plexus avulsion is limited. Twenty patients who suffered the loss of elbow flexion following a brachial plexus avulsion injury underwent a neurotization procedure in an attempt to restore that lost function. Of 16 patients who underwent intercostal to musculocutaneous nerve anastomosis, seven obtained good elbow flexion. Four patients who no longer had a viable biceps brachialis muscle underwent an anastomosis between transposed intercostal nerves and a free vascularized gracilis muscle grafted to the position of the biceps. Two of these patients obtained good elbow flexion. Although synkinesis between the biceps brachialis and the inspiratory muscles can be demonstrated during coughing and deep inspiration, the patients learn to flex their reinnervated biceps brachialis muscle and maintain flexion independent of respiration.

Adolescent↗
PubMed1993

A long-term follow-up study of children with supracondylar fractures of the humerus.

A retrospective study to assess the long-term results of the treatment of supracondylar fractures of the humerus was undertaken to provide guidance on the management of these troublesome injuries. In our experience as long as there was less than 25% displacement on an anteroposterior (A/P) or lateral x-ray, and less than 10 degrees angulation on an A/P or lateral x-ray, it is not essential to achieve an anatomical reduction, and good elbow function could be expected. Although children do not appear to correct for valgus or varus deformity there was no functional deficit from this deformity in this series. It was found that major displacements were more likely to have a worse result than undisplaced or minimally displaced fractures. These results would support a conservative approach to the management of these fractures--closed reduction followed by three weeks in a collar and cuff. If the position proved unstable, closed reduction was re-attempted or internal fixation performed. Conservative treatment was safe and effective, and the results comparable with other series that advocate internal fixation.

Child↗