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PubMedDate not supplied

"Isolated" traumatic radial-head dislocation.

A delay in diagnosis of a traumatic radial-head dislocation in the absence of a concurrent ulnar fracture is common. Published reports of this injury imply an isolated injury to the radius without involvement of the ulna. This hypothesis is challenged by a retrospective study of all cases over an 8-year period that demonstrates an identifiable injury to the ulna in every case. A new radiographic sign, the "ulnar bow sign," is described to assist in the proper recognition of this injury pattern. A radial-head dislocation or subluxation should be suspected if the posterior border of the ulna on a true lateral radiograph deviates > 0.01 mm from a straight line.

Child↗
PubMed1993

Comminuted fractures of the proximal radius and ulna.

Forty-three comminuted fractures of the proximal radius and ulna in 34 patients were treated with operative stabilization using AO/ASIF techniques. The patients were divided into three groups, according to the type of injury: Group I, isolated comminuted fractures of the olecranon (18 patients); Group II, isolated fractures of the radial head (eight patients); Group III, combined olecranon and radial head fractures (eight patients). All fractures were followed until union. The average follow-up period was 18 months (range, 12-48 months). At the time of this review, the average limits of elbow motion were 20 degrees extension, 118 degrees flexion, 65 degrees pronation, and 62 degrees supination. Two patients were unable to return for follow-up examination. Using the functional classification of Broberg and Morrey, results were rated as excellent in nine cases, good in 15, fair in five, and poor in three. The complication rate in this series was 19%: Two patients developed nonunion, and one patient lost reduction during rehabilitation. All of these patients required reoperation, with eventual satisfactory outcome. Three patients developed heterotopic ossification, two of which were minor and one of which produced ankylosis of the elbow joint. Each of these patients had delayed (more than 72 hours postinjury) stabilization. A functional elbow was achieved in 29 of the 32 patients who returned for follow-up examination. Operative stabilization of comminuted fractures of the proximal radius and ulna provides a stable painless joint with a functional, but not full, range of motion.

Adolescent↗
PubMed1985

The epidemiology and treatment of radial head subluxation.

The incidence and treatment of radial head subluxation were evaluated in emergency room and private office settings. Factors associated with recurrence and with successful reduction were identified, and ways to prevent this common injury were sought. Of 54 reductions during which a click was either felt or heard, all but one reduction resulted in reuse of the arm within 30 minutes. Of 13 reductions in which a click was neither felt nor heard, only four reductions resulted in reuse of the arm within 30 minutes. A supination maneuver resulted in reuse of the arm within 30 minutes in all 27 patients seen two or more hours after injury vs 85% (34/40) of patients seen less than two hours after injury. Remanipulation 12 to 106 hours later resulted in reuse of the arm in all those children who had failed to respond to previous treatment.

Child↗
PubMedDate not supplied

Displaced pediatric supracondylar humerus fractures: biomechanical analysis of percutaneous pinning techniques.

Supracondylar humerus fractures are a common childhood occurrence. Displaced fractures are typically treated with closed reduction and percutaneous pinning. Controversy continues over the appropriateness of various pinning techniques. The most common include crossed or lateral pins. A biomechanical comparison of crossed pins, "parallel" lateral pins, and "divergent" lateral pins was performed using a pediatric synthetic bone model. Mechanical testing of each pin configuration was performed in extension, varus, valgus, internal rotation, and external rotation. The divergent configuration provided statistically greater stability than parallel pins under varus and valgus loading. Divergent pins had similar stability compared with crossed pins in extension, varus, and valgus testing. In axial rotation testing, crossed pins were more stable. If the surgeon feels confident in the ability of lateral pins to provide satisfactory fracture stability, divergent lateral pins provide greater stability than parallel lateral pins while avoiding ulnar nerve injury (associated with crossed pins).

Analysis of Variance↗
PubMedDate not supplied

Predicting ulnar nerve location in pinning of supracondylar humerus fractures.

Thirty-four consecutive patients with displaced supracondylar humerus fractures were treated with reduction and percutaneous pinning. The precise location of the ulnar nerve to the medial pin was determined by intraoperative nerve stimulation. In 22 of the 34 patients, the authors attempted to predict the location of the ulnar nerve by palpation and placing a mark on the skin. They also recorded the ability to feel the anatomic landmarks for pin fixation, including the medial epicondyle and ulnar nerve. The average distance from the medial pin to the predicted location was 9.3 mm, whereas the actual distance measured 7.6 mm, for a significant difference of 1.7 mm. Statistically, the authors could not accurately predict the location of the ulnar nerve prior to blind percutaneous crossed K-wire fixation of supracondylar humerus fractures. However, clinically they were fairly close in their prediction and documented safe insertion and distance from the nerve. Intraoperative nerve stimulation may assist in localizing the nerve prior to placement of the medial pin. Stimulation of the pin itself following insertion is another technique to ensure safe pin placement and decrease the risk of injury.

Adolescent↗
PubMed1999

Isolated posterolateral dislocation of the radial head in a boy.

Isolated dislocation of the radial head in children is a rare injury. We report an isolated posterolateral dislocation of the radial head in a boy after a fall on the outstretched arm. Immediate closed reduction and early active motion achieved satisfactory results.

Accidental Falls↗
PubMedDate not supplied

Comparison of percutaneous pinning with casting in supracondylar humeral fractures in children.

BACKGROUND: In Children Supracondylar fracture of humerus is one of the most common fractures in first decade of life. There are various treatment modalities for this fracture i.e. Close reduction and casting, open reduction and internal fixation, skeletal traction and Percutaneous Pinning. This study was conducted to know the outcome of Percutaneous Pinning in the management of displaced supracondylar humeral fracture in children and to compare the results with close reduction and castings and published literature. METHODS: This descriptive study was conducted in Orthopaedic department of Ayub Teaching Hospital Abbottabad and Lady Reading Hospital, Peshawar from January 2002 till December 2003 on 40 children. Patients included were of either gender with age range from 3 to 12 years with displaced supracondylar fracture presenting within 72 hours of injury. Two treatment modalities were studied for comparison. Cross k-wires fixation through each humeral condyle was done after closed reduction of fracture under image intensifier in general anesthesia. Casting/Backslab was applied after reduction of fracture without image intensifier under anesthesia or analgesia. Out come measures were according to Flynn criteria that are functional and cosmetic factor which is based on loss of elbow motion and carrying angle in degrees respectively. RESULTS: Cross percutaneous pinning gave excellent results in 13 (65%), good outcome in 4 (20%) and poor outcome in 3 (15%) patients. While patients treated with close reduction and casting showed excellent results in 4 patients (20%), good in 8 patients (40%), fair in 2 patients (10%) and poor in 6 patients (30%). CONCLUSION: Closed reduction and cross percutaneous pinning for displaced supracondylar humerus fractures in children is safe, cost and time effective method and gives stable fixation with excellent outcome as compared to close reduction and casting.

Casts, Surgical↗
PubMedDate not supplied

Management of chronic posttraumatic radial head dislocation in children.

We describe a new procedure for the management of chronic posttraumatic radial head dislocation, which uses two drill holes in the proximal ulna. The holes are placed at the original attachments of the annular ligament and thereby allow repair of the annular ligament (frequently avulsed from one attachment and impinged within the joint) or reconstruction of the annular ligament with whatever tissue or material desired (triceps tendon is convenient). It secures the radial head in its normal position from any dislocated position. It also allows for osteotomy of any accompanying deformity of the ulna or radius. This operation developed gradually between 1967 and 1995 while we treated seven female patients. The average age at time of injury was 5 years 10 months (range, 3 years 4 months to 8 years 11 months). The interval between injury and operation averaged 30 months (range, 3 months to 7 years). The age at time of surgery averaged 8 years 4 months (range, 5 years 4 months to 13 years 5 months). The only criterion for surgery was a normal concave proximal radial articular surface. Follow-up averaged 48 months. At final follow-up, all patients were fully active and had no elbow pain or instability. Analysis of these cases suggests that the criteria for surgical repair should be based on two features: (a) normal concave radial head articular surface, and (b) normal shape and contour of the ulna and radius (deformity of either should be corrected by osteotomy). The age of the patient and duration of the dislocation are unimportant.

Child↗
PubMed1999

[Muscle strength after surgical treatment of ruptures of the long biceps tendon by refixation to the short head].

Operative treatment for ruptures of the long biceps tendon still is discussed controversially. In the present literature surgical repair is advised for sporting and high demand patients due to favourable functional results and low loss of strength. Until now only few objective and reproducible results were published. In the present literature the keyhole-technique is recommended due to favourable bio-mechanical conditions. To evaluate postoperative strength 19 patients were investigated after an average follow-up of 6.5 years, by clinical examination and isokinetic measurement. Compared with the non-operated shoulder isokinetic determination of isometric maximal peak torque and strength during concentric stress for elbow-flexion, shoulder-abduction and shoulder-flexion yield to almost identical results for the operated shoulder. According to the criteria of the Constant-Score all patients achieved very good and good results. Refixation to the short head can be advised for treatment of ruptures of the long biceps tendon due to the certain technique with a low complication rate and very good functional outcome.

Adult↗
PubMed2004

Medial collateral ligament tears in the throwing athlete.

Medial collateral ligament (MCL) injuries of the elbow in throwing athletes are part of a spectrum of valgus extension overload injuries. Clinicians should consider reconstruction of the injured MCL in those patients who are unable to return to sports activities or work after an interval of rest and rehabilitation. Surgical treatment of this disorder has continued to evolve from the original technique developed by Jobe and associates. The authors' surgical technique involves reconstruction of the MCL using a single ulnar tunnel and single humeral tunnel that is performed through a muscle-splitting approach that usually obviates the need for ulnar nerve transposition. Knowledge of the biology and biomechanics of MCL function is important in the diagnosis and treatment of MCL injuries of the elbow in the throwing athlete.

Arthroplasty↗
PubMed2000

[Proximal and distal humerus fractures in advanced age].

In contrast to distal humeral fractures, humeral head fractures represent a common injury to the old patient. For both fracture localizations osteoporosis and multi-morbidity are of significant importance. The classification for humeral head fractures in one-, two-, three- and four-part fractures is generally accepted. Valgus impacted head fractures as well as head-splitting fractures are considered a separate entity. In none or minimally displaced fractures good functional results are achieved by conservative means. Although numerous therapeutical procedure are offered in the treatment of displaced fractures of the proximal humerus the result are often disappointing. Generally, minimal invasive surgical procedures should be preferred. However, in dislocated multi-part fractures a primary humeral head replacement is often the treatment of choice. In patients with multifarious morbidity a conservative treatment is always to be included into the therapeutical considerations. Distal fractures of the humerus are classified into extraarticular, intraarticular uni-condylar and intraarticular bi-condylar fractures. The therapeutical recommendations, also in the elderly, is relatively homogeneous: primary open reduction and internal fixation (ORIF) should be carried out aiming for an early postoperative functional treatment. Depending from soft tissue conditions and accompanying injuries the functional results are often good or moderate and are generally comparable to those of younger patients. Following a correct indication for surgical intervention the main priority for both distal and proximal humeral fractures is an early definitive surgical treatment.

Aged↗
PubMed1991

Massive bone allografts for traumatic skeletal defects.

Large bone allograft transplants have been successfully used to reconstruct skeletal defects created by tumor resections and failed arthroplasties, but little has been reported on their use in traumatic defects. Of approximately 500 allograft procedures done at the Massachusetts General Hospital from 1979 to 1988, 11 were done for restoration of traumatic bone loss. The average age of the patients was 30 (range 11 to 71 years), and the location of the defect was the tibia or femur in 10 of the 11 patients studied. Eight osteoarticular grafts (six hemicondylar and two total condylar) and three intercalary grafts were used for six open and five closed fractures. The time from injury to reconstruction averaged 17 months (3 to 96 months). Primary reconstruction was done in three cases and a salvage procedure in eight. Patients were assessed by the operating surgeon and a physical therapist using an evaluation system that considers function, life-style, and emotional acceptance. According to the system, nine patients had excellent or good results (six hemicondylar grafts, three intercalary grafts), one patient had a fair result (total elbow graft), and one patient had failure of a total condylar graft and subsequently required an amputation. This study suggests that large bone allografts are of value in reconstructing traumatic skeletal defects, especially those involving an articular surface in a young patient.

Adolescent↗
PubMed2006

Treatment of chronic radial head dislocations in children.

From 1990 to 2005 our department treated nine patients with chronic radial head dislocation by an ulnar osteotomy and indirect reduction by interosseous membrane. The patients varied in age from 2 years and 8 months to 10 years, and the time from the injury to operation ranged from 40 days to 3 years. The range of functional motion and carrying angle was restored in all nine patients, and no complications, such as recurrent dislocation, infection, or neurovascular injury were observed. This technique has proven to be a successful approach to treating such cases, with a low range of complications and good functional results.

Child↗
PubMed2005

Management of cubitus varus and valgus.

BACKGROUND: Many types of osteotomy have been proposed for the treatment of cubitus varus and valgus, but they have limitations, such as poor internal fixation, residual protrusion of the lateral or medial condyle, technical difficulty, the need for long-term immobilization, a risk of neurovascular injury, and patient discomfort. We reviewed the results of a simple step-cut translation osteotomy that overcomes these limitations. METHODS: Between 1993 and 2002, we treated nineteen cases of cubitus varus and thirteen cases of cubitus valgus with use of a simple step-cut translation osteotomy and fixation with a Y-shaped humeral plate. After surgery, the patients were observed closely for more than one year. We compared preoperative and postoperative humerus-elbow-wrist angles, ranges of motion, and lateral or medial prominence indices for all patients. The results were evaluated according to the modified criteria of Oppenheim et al. The presence of tardy ulnar nerve palsy and its duration, and postoperative lazy-s deformity or unsightly scarring, were also noted. RESULTS: There were twenty-six excellent and six good results. In the nineteen patients with cubitus varus, the average amount of correction of the humerus-elbow-wrist angle was 26.0 degrees , to a mean postoperative angle of 8.6 degrees , and the average increase in the lateral prominence index was 8.2%. In the thirteen patients with cubitus valgus, the average correction in the humerus-elbow-wrist angle was 27.6 degrees , resulting in a final angle of 9.1 degrees , and the average increase in the medial prominence index was 11.9%. In all patients, the desired range of motion, good alignment, and complete union of the bone were achieved. CONCLUSIONS: Step-cut translation osteotomy, with a wedge-shaped osteotomized surface, fixed with a Y-shaped humeral plate is a relatively simple procedure resulting in very firm fixation that allows early movement of the joint with good clinical results.

Adolescent↗
PubMed1997

[Functional, neuropsychological and social outcome of polytrauma patients with severe craniocerebral trauma].

The aim of this study was to identify, in (pre-) clinically obtained data, parameters predicting the outcome of patients with multiple trauma and severe head injury. Fifty-eight patients aged 27 +/- 10 years were investigated an average of 5.8 years after the accident. The Hanover Polytrauma Score was 34 +/- 11 points, the initially assessed Glasgow Coma Scale (GCS) was 6.2 +/- 3.2 points; and the duration of coma was 15.4 +/- 14.4 days. The primary length of stay in hospital averaged 33.4 days, including 22.9 days in the intensive care unit and 20.2 days of ventilation. For a further 223 days the patients were treated at the Neurologic Clinic of Hessisch Oldendorf. Besides different neurologic deficiency symptoms, the psychometric tests showed deficits in all areas. In particular, information processing speed, concentration, recent memory and learning performance were impaired. There was free mobility of all joints in 33% of the patients. Due to injury the elbow and ankle joint developed the worst restriction. Central paralysis and heterotopic ossification also caused a restriction in joint mobility. Half of the patients were confronted with different social changes. The rate of return to work was dependent on age. Some 42% of all patients had taken up their former profession, 5% were still in training or at college, 32% were retrained to other professions, 16% were unemployed and 5% were completely retired on pension. Age, injury severity, GCS, duration of coma and duration of weaning were suitable predictors in correlation- and regression analysis. The Glasgow Outcome Scale showed good recovery and moderate disability in 53%, severe disability in 33% and persistent vegetative state in 14% of the patients.

Activities of Daily Living↗