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PubMed1992

Comminuted intra-articular fracture of the distal radius--results of early open reduction and internal fixation.

Comminuted intra-articular fracture of the distal radius remains a challenging problem. This article reviews the results of 15 consecutive cases which were treated with open reduction and internal fixation with T-plate after failing to achieve articular congruency with closed reduction. The follow-up ranges from 20 months to 28 months. In thirteen cases, articular congruency was restored. However, 4 of these 13 cases later lost some of the articular congruency. This suggests the need for supplementary bone grafting. Reduction of the extra-articular portion of distal radius was generally well maintained. There was an average of 2.4 mm loss in styloid height, an increase of 1.2 mm in ulnar variance and loss of 12.5 degrees of volar tilt. Seven patients (46%) were completely pain-free, with the remaining 8 patients (53%) experiencing mild pain associated with forceful activities involving the wrist. All patients achieved a functional range of motion. Grip strength averaged 81% of the uninjured side. Of the 12 patients who were engaged in active employment, 10 returned to their previous job within 4 months of injury (average 8.5 weeks). The only complication in this series was the development of reflex sympathetic dystrophy in a 68-year-old housewife. We recommend open reduction and internal fixation if closed reduction fails to achieve articular congruency in comminuted distal radius fractures.

Adult↗
PubMedDate not supplied

Epiphyseal separation of the distal end of the humeral epiphysis: a follow-up note.

Twenty-one children with fracture-separations of the distal end of the humeral epiphysis were treated. Fifteen of the 21 children developed cubitus varus deformity after treatment. Thirteen children were treated at our hospital, and seven of these children developed cubitus varus deformity. Eight children were treated elsewhere initially and were referred to our institution after development of cubitus varus deformity. Nine patients underwent osteotomies for correction of cubitus varus deformities. Ages at injury ranged from 1-10 years. Fourteen patients were < 6 years of age. Fractures were classified according to Ogden; one was type IA, 16 were type IIA, and four were type IIC. Follow-up was from 10 months to 17 years. Most of the patients who were initially treated at our institution regained nearly normal function. All nine patients who were treated with closing wedge osteotomies regained nearly normal carrying angles. The carrying angles after treatment of the injury and osteotomy for the deformity did not change except in one patient.

Adolescent↗
PubMed1990

Percutaneous phenol block of the musculocutaneous nerve to control elbow flexor spasticity.

Twenty-three extremities in 17 brain-injured adults were prospectively studied to evaluate the effectiveness of percutaneous phenol blocks of the musculocutaneous nerve in controlling spasticity of the biceps and brachialis muscles. Twenty-one (93%) of the extremities improved after the initial injection. The mean resting position decreased from 120 degrees of flexion to 69 degrees. Elbow range of motion increased an average of 53 degrees. There were no complications. Two patients did not respond to the initial injection and required repeat nerve blocks. Concomitant phenol motor point block of the brachioradialis muscle further improved elbow motion. The mean duration of the block was 5 months. Follow-up averaged 21 months. This study indicates that percutaneous phenol injection of the musculocutaneous nerve provides reliable, temporary relief of spasticity in patients with potential for further neurologic improvement.

Adolescent↗
PubMed2002

Acute shoulder and elbow dislocations in the athlete.

Dislocations of the elbow are less common than shoulder dislocations. The primary treatment is conservative, with a conscious effort toward early mobilization. Recurrence is rare, and improvement in function and motion can be expected for up to 1 year. Operative treatment should be reserved for baseball pitchers and cases of complex instability.

Acute Disease↗
PubMed1987

Rehabilitation of the shoulder and elbow after arthroscopy.

Rehabilitation after arthroscopic shoulder and elbow surgery requires an emphasis on flexibility, strength, range of motion, and a return to activity program. Care must be taken to include fitness and conditioning programs for the entire athlete, not just the upper extremity. A thorough program will allow the athlete to return to competition in the best possible condition.

Arthroscopy↗
PubMed1977

Anterior dislocation of the radial head in children.

Problems of unilateral isolated radial head dislocation have been reviewed in 28 children. A significant number indicated failure of recognition of the dislocation after injury. Disability due to increasing deformity and instability was consistently noted and indicated surgical reduction. Late reduction required reconstruction of the annular ligament. A modified method of reconstruction using a strip of triceps tendon is described. Good results are recorded in a small number of children in whom this was carried out.

Child↗
PubMed1990

[Results of plate osteosynthesis in comminuted fracture of the olecranon].

Comminuted fractures of the olecranon are an absolute indication for operative treatment. Adequate therapy is only possible when open reduction and plating are performed. In the last 20 years, 31 of our patients, i.e. 0.0001% of all patients treated for injuries, had this type of olecranon fracture, and in 25 follow-up examination was possible. The fracture type was classified according to the ASIF system. The range of motion, i.e., extension, flexion, pro- and supination, and pain, physical strength and rehabilitation were classified according to our own system. In cases with concomitant fracture of the radial head, reconstruction is necessary to provide adequate axial movement and strength in the forearm. Brief plaster fixation after the operation makes it possible to restrict the development of ankylosis in the elbow joint. The results were excellent in 10 patients, good in 5 patients, fair in 4 and poor in 6 patients. In 3 patients, i.e. 10% ankylosis was present in the elbow joint; this was considered to constitute an indication for arthroplasty, which gave a better postoperative range of motion.

Adult↗
PubMed2002

[Supracondylar corrective osteotomy in post-traumatic cubitus varus. 3 cases in 2 patients].

Supracondylar fractures of the humerus in childhood frequently result in cubitus varus deformity. Pain, functional impairment and cosmetic problems can request surgical correction. This is a report on an adult and on a mature child with such deformities. The boy had sustained three injuries with following bilateral cubitus varus and lengthening of one lower leg. Planning, surgical technique and outcome of the osteotomies are described. We should recommend the resection of a full wedge with two oblique osteotomies and internal fixation with two plates on either side of the humerus.

Adolescent↗
PubMed1994

[Traumatic foreign body embolism from the basilic vein].

Foreign body embolisms can be traumatic and iatrogenic. Traumatic foreign body emulsion are almost always induced by gunshot wounds. Central vessels with a large lumen are the most frequent site of entry. Foreign bodies are transported to peripheral body areas or produce pulmonary embolism. Clinical manifestations are dependent on the size and place of the foreign body. In this report a case of traumatic foreign body embolism is presented, in which the basilic vein was the site of entrance and the foreign body was transported to the right lower lobe of the lung. Foreign body embolism should always be considered in the differential diagnosis in the case of patients with no visible foreign body in the injury. Treatment is dependent on the clinical signs and on size and shape of the foreign body. Symptomatic foreign body embolism and large irregularly shaped foreign bodies should be extracted. When only a small foreign body with no clinical symptoms is present conservative management is most appropriate.

Adult↗
PubMed2004

Fracture-dislocation of the elbow: diagnosis, treatment, and prognosis.

There are two main goals for the surgeon treating injuries around the elbow joint: the maintenance of a stable, concentric reduction of the joint and the initiation of early motion to help prevent stiffness and maximize functional out-come. The presence of a fracture decreases joint stability and increases the risk for early subluxation or dislocation with motion. Operative repair thus is indicated for most of these injuries to restore sufficient osseoligamentous support to allow safe, early motion and provide a stable functional elbow in the long term.

Elbow Joint↗
PubMed2006

Comminuted fractures of the radial head: comparison of resection and internal fixation. Surgical technique.

BACKGROUND: Satisfactory internal fixation of comminuted radial head fractures is often difficult to achieve, and radial head resection has been the accepted treatment. In this study, we compared the results of radial head resection with those of open reduction and internal fixation in patients with a comminuted radial head fracture. METHODS: Twenty-eight patients with a Mason type-III radial head fracture (some with associated injuries) were enrolled in the study. Fifteen patients underwent radial head resection as the initial treatment (Group I), and thirteen patients underwent open reduction and internal fixation (Group II). The age at the operation averaged 41.1 and 38.2 years, respectively, and the duration of follow-up averaged ten and three years, respectively. The outcomes were assessed on the basis of pain, motion, radiographic findings, and strength measured with Cybex testing. The overall outcome was rated with the functional rating score described by Broberg and Morrey and with the American Shoulder and Elbow Surgeons Elbow Assessment Form. RESULTS: Elbow motion averaged 15.5 degrees (extension loss) to 131.4 degrees (flexion) in Group I and 7.1 degrees to 133.8 degrees in Group II. The carrying angle and ulnar variance averaged 8.2 degrees and 1.9 mm in Group I and 1.5 degrees and 0.5 mm in Group II. Compared with Group II, Group I had a loss of strength in extension, pronation, and supination (p < 0.01). The Broberg and Morrey functional rating score averaged 81.4 points in Group I and 90.7 points in Group II (p = 0.0034). The score on the American Shoulder and Elbow Surgeons Elbow Assessment Form averaged 87.3 points in Group I and 94.6 points in Group II (p = 0.0031). CONCLUSIONS: The patients in whom the comminuted radial head fracture was treated with open reduction and internal fixation had satisfactory joint motion, with greater strength and better function than the patients who had undergone radial head resection. These results support a recommendation for open reduction and internal fixation in the treatment of this fracture.

Adult↗
PubMed2000

Evaluation of the role of pin fixation versus collar and cuff immobilisation in supracondylar fractures of the humerus in children.

Long term results of children with supracondylar humeral fractures treated with manipulation and strapping and manipulation followed by pin fixation were evaluated. Forty patients were regarded as Gartland type II injuries. 33 of these were treated with closed reduction and collar and cuff immobilisation and 7 with closed reduction and percutaneous pinning. Two cases of cubitus varus were reported one from each treatment modality. Forty-four patients were included as Gartland type III injuries. Of these 14 were treated with closed reduction and collar and cuff immobilisation, 25 with closed reduction and percutaneous pinning and five with open reduction and pinning. There were two cases of cubitus varus and one case of cubitus valgus following pin fixation. In addition one case of extension lag and one significant ulnar nerve neurapraxia was recorded following pin fixation. One case of cubitus varus was seen following manipulation and collar and cuff treatment. There was no statistical difference between either treatment modality in terms of predicting a better outcome (p0.05). We conclude that pin fixation has no advantages over simple immobilisation in certain Gartland II and III type injuries. Although pin fixation is beneficial in unstable injuries collar and cuff immobilisation continues to have an important role in the treatment of stable supracondylar fractures.

Algorithms↗
PubMedDate not supplied

Continuous passive motion (CPM): theory and principles of clinical application.

Stiffness following surgery or injury to a joint develops as a progression of four stages: bleeding, edema, granulation tissue, and fibrosis. Continuous passive motion (CPM) properly applied during the first two stages of stiffness acts to pump blood and edema fluid away from the joint and periarticular tissues. This allows maintenance of normal periarticular soft tissue compliance. CPM is thus effective in preventing the development of stiffness if full motion is applied immediately following surgery and continued until swelling that limits the full motion of the joint no longer develops. This concept has been applied successfully to elbow rehabilitation, and explains the controversy surrounding CPM following knee arthroplasty. The application of this concept to clinical practice requires a paradigm shift, resulting in our attention being focused on preventing the initial or delayed accumulation of periarticular interstitial fluids.

Arthroplasty, Replacement, Knee↗
PubMed1994

Supracondylar humerus fractures. Current trends and controversies.

Supracondylar fractures of the humerus are one of the largest sources of serious problems and treatment controversy in childhood fractures. Improved understanding of the injuries to both the bone and soft tissue has contributed to improved outcomes. These fractures remain challenging to even the most experienced physician. This article reviews the pertinent biomechanics, outlines treatment principles, illustrates our reduction and percutaneous pin fixation technique, and highlights the major areas of controversy.

Biomechanical Phenomena↗
PubMed1993

Ipsilateral radial head dislocation with radial shaft fracture: case report.

An extremely rare injury, traumatic radial head dislocation with concomitant fracture of the radial shaft, is reported. The dislocated radial head could not be reduced by closed technique because of capsular interposition. Reduction of the radial shaft fracture was possible only after the dislocation of the radial head was reduced.

Adult↗
PubMed1993

[Child abuse--a surgical analysis].

Non-accidental injuries are frequently treated by surgeons without the real reason behind the trauma being identified: The differential diagnosis of child abuse would not be considered in this circumstance. This report gives hints as to the different aspects of this complex type of injury. With our case unusual (atypical) injury patterns have been shown and the diagnostic and therapeutic procedures with child abuse explained from a surgical point of view. It is of central importance to check, whether the trauma history according to the accompanying adults for the actual surgical type of injury is plausible. Incongruencies here must lead to search for further signs of trauma or its residues. When treating these children the surgeon is therefore in a key position especially to prevent future abuse, bearing in mind the special relevance of its striking high recidivation frequency.

Child↗
PubMed1992

Restoration of elbow flexion in root lesions of brachial plexus injuries.

A retrospective review of 87 patients with loss of elbow flexion secondary to root injuries of the brachial plexus was carried out. Results of nerve grafting, direct nerve transfer with the intercostal nerve, or tendon transfer were analyzed, and treatment recommendations were developed. Nerve transfer provided good or excellent results for injuries that included avulsion of the C5 and/or C6 roots. Nerve grafts were used successfully in cases of single or combined ruptures of C5 and C6. Tendon transfers provided good or excellent results in C5-C6 or C5-C7 avulsions, where nerve grafting was not possible and transferable muscles had good strength. Somatosensory evoked potentials were necessary to demonstrate nerve root avulsions in cases in which the roots appeared ruptured on visual inspection.

Adolescent↗
PubMed2001

[Traumatically-induced dislocation of the ulnar nerve].

Traumatic luxation of the ulnar nerve is a very rare injury. In the worldwide literature from 1960 to 2001 we could only find 4 reports concerning this trauma. When we take an exact anamnesis for granted making the diagnosis is very easy and it is not necessary to do highly sophisticated technical examinations. An X-ray and ENG-EMG examination and a precise clinical exploration of course is enough.

Accidents, Occupational↗