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PubMed2002

[Differential therapy in radial head fractures].

The therapeutic regimen of radial head fractures, especially of displaced and comminuted types is controversial. The radial head resection has been critically reviewed over the past years. From 1984-1993 and 1996-1999, 105 radial head fractures were treated in our hospital. 74 were subject to clinical and radiological follow-up. Fracture-types were classified according to Mason. Undisplaced fractures were treated conservatively, displaced 2-fragment-fractures by an open reduction and screw fixation, and multifragment-fractures by a radial head resection. The results were studied on a functional and radiological basis using the "Functional Rating Index" of Broberg and Morrey and the radiological Score of Albrecht and Ganz. After conservative therapy over 80 % achieved excellent and good as well as 12.5 % satisfactory and 6.3 % unsatisfactory results. After reduction and internal fixation again 80 % had excellent and good results. After radial head resection excellent and good results were achieved in 54.6 % of the cases, satisfactory results in 24.2 % and in 21.2 % unsatisfactory results, however prognosis-influencing concomitant injuries were often present in the latter group. Using the right indication and technique, the radial head resection still is a recommendable therapeutic procedure with an altogether good prognosis. This especially applies to isolated radial head fractures where excellent and good results can be achieved in approximately 70 %.

Adolescent↗
PubMed1986

Swimming injuries of the knee, foot and ankle, elbow, and back.

The practitioner need not be an expert in swimming but should understand the rudiments of the stroke and training techniques such patients are subjected to. This will aid in proper identification and analysis of the problem. The solution may require the resources of physician, therapist, coach, and parent as well as swimmer.

Ankle Injuries↗
PubMed2003

[Proximal and distal ruptures of the biceps brachii tendon].

Proximal ruptures. Ruptures of the long head of the M. biceps humeri are commonly caused by degenerative changes within the tendon. Non-operative treatment gives good results, the loss of power regarding elbow flexion and supination amounts to only 8-21%. Refixation may be indicated for cosmetic reasons and offers a small but evident improvement of flexion and supination power. Deformity of the slipped muscle can be corrected effectively. Residual complaints after conservative treatment often result from associated subacromial problems. Distal ruptures. Ruptures of the distal tendon should be treated operatively. The loss of power after conservative treatment is evident (30-40% for flexion, >50% for supination). Extra-anatomical tenodesis to the brachialis muscle or anatomical fixation to the radial tuberosity can be applied. Flexion power and cosmesis can be addressed by both techniques. If supination strength is to be restored, the tendon has to be fixed anatomically. Preparation of the tuberosity bears the risk of heterotopic ossification or nerve damage. Mini-open techniques, using only a limited anterior approach, may decrease risks.

Adult↗
PubMed1993

[Monteggia injury in childhood: a frequent cause of chronic dislocation of the head of the radius].

Two cases of chronic dislocation of the radial head after Monteggia lesions in children are described. The late reconstruction with open reduction of the radial head combined with osteotomy of the ulna is mentioned as the therapy of choice before skeletal maturity, because the pathophysiology of the lesion is best considered. The operative procedure in detail is given. Finally, alternative procedures are presented and discussed.

Child↗
PubMed2002

Osteosynthesis for nonunion of the lateral humeral condyle.

The treatment of established nonunion of the lateral humeral condyle is controversial. Twenty patients who had osteosynthesis of the nonunion were evaluated to clarify the changes in range of motion and the factors influencing those changes. The average age of the patients at surgery was 13.6 years (range, 6-25 years). The average duration of followup was 8.8 years. Outcome was rated as excellent in seven patients and good in 13 patients according to the score of Broberg and Morrey. In five of the 20 patients, the preoperative range of motion was limited and their motion improved an average of 35 degrees as a result of surgery. In the remaining 15 patients, the range of motion did not change or was reduced an average of 19 degrees postoperatively. Of the 15 patients, 11 had Milch Type II injuries and four had Milch Type I injuries. In the 11 patients with Milch Type II injuries, the loss of range of motion postoperatively averaged 13 degrees. However, in the four patients with Milch Type I injuries, loss of range of motion postoperatively averaged 21 degrees. Complications such as delayed union, nonunion, or infection occurred in five patients. The main factors influencing the results of osteosynthesis are the age of the patient, the preoperative symptoms, and the postoperative complications.

Adolescent↗
PubMed2006

[Diagnosis and treatment of the Essex-Lopresti lesion. Literature review and four case reports].

BACKGROUND: A fracture of the radial head in combination with a rupture of the interosseous membrane and lesion of the distal radioulnar joint known as Essex-Lopresti lesion is a rare injury. Usually it is caused by a high-energy trauma. Initially unrecognized distal radioulnar dislocations often show poor results. MATERIAL AND METHOD: Four case reports are presented to discuss the trauma mechanism together with diagnostic and treatment options. Especially the accuracy of ultrasound to diagnose an interosseous membrane disruption was evaluated. RESULTS: After an average of 35 months all patients were examined using the Morrey score and the modified score of Green and O'Brien. Initially the extent of the injury was not diagnosed in three cases. According to the score values the average results have been fair. CONCLUSIONS: An early diagnosis is the key for the correct treatment of an Essex-Lopresti lesion based on the classification of Edwards and Jupiter. In addition to the clinical and radiological assessment ultrasound should be used to diminish the rate of unrecognized interosseous membrane disruptions.

Adult↗
PubMed2002

The joint jack: report of a new technique essential for elbow arthroscopy.

Visualization and access are of fundamental importance in arthroscopy, including arthroscopy of the elbow. A new technique not previously described in the literature improves both of these factors for key areas within the elbow that would otherwise be inaccessible. This technique employs the application of gentle leverage to pry apart the surfaces of the ulnohumeral articulation when viewing and working posteriorly to improve visualization and access to the ulnohumeral and radiocapitellar articular spaces. We believe this technique is essential for full arthroscopic viewing of the intra-articular regions of the ulnohumeral and radiocapitellar joints.

Adult↗
PubMed1993

Protothecosis in a patient with systemic lupus erythematosus.

A rare case of protothecosis in a 40-year-old Japanese woman with systemic lupus erythematosus, under long-term prednisolone treatment is presented. The patient developed extensive ulcerative skin lesions after injury. The characteristic histopathological findings and biochemical sugar assimilation tests indicated infection by Prototheca wicherhamii. The lesions improved following treatment with amphotericin B. The immunodeficient state of this patient seemed to contribute to the infection with Prototheca.

Abscess↗
PubMed2000

Fractures of the medial humeral condyle in adults.

BACKGROUND/AIM OF STUDY: Fractures of the medial condyle of humerus are uncommon in adults. The aims of this study were (i) to highlight the rarity of this injury, (ii) to focus on the problems in management of cases which present late, and (iii) to compare the results of surgical excision of medial condyle with those of internal fixation. METHODS: Seven adult medial humeral condyle fractures were seen over a 10-year period. Four cases were surgically fixed within three weeks of the injury; one case refused operation. Two cases which presented late, one with an isolated trochlear fracture, and another Milch type I fracture comminution and compounding, were treated by excision of the condyle and supervised post excision physiotherapy. RESULTS: All six operated cases regained good function. The two patients with excised condyle had no significant instability and had good range of movements. The results were comparable to those managed by open reduction and internal fixation. CONCLUSIONS: Medial condyle fractures presenting early (within 3 weeks), should be managed by accurate open reduction and rigid fixation: non operative management leads to relatively poor results. In late/neglected cases, or those with extensive comminution, open reduction and fixation may lead to stiff and painful elbow, whereas excision of the condylar fragment does not lead to instability.

Adult↗
PubMedDate not supplied

Medial oblique compression fracture of the coronoid process of the ulna.

The most widely recognized coronoid fractures have been described as occurring in the coronal plane according to the amount of process detached from the ulna. Over the last few years, we have recognized that the coronoid fracture is a much more complex injury than originally thought. This report calls attention to an oblique, medial compression fracture of the coronoid, a fracture so subtle as to be missed by routine assessment but sometimes associated with joint subluxation or dislocation. The currently accepted classification system based on a simple fracture pattern in the coronal plane may be too simplistic to characterize fractures of the coronoid fully.

Accidental Falls↗
PubMed1989

[Isolated dislocation of the radius head in childhood].

In a collective study 24 isolated dislocations of the radial head in children were analysed. Early diagnosis was made in only 13 cases, delayed diagnosis in 11 cases one week to 18 months after the injury. Closed reduction was impossible in all cases of delayed diagnosis. Early detection of the lesion led to excellent late results without exception. The final results after operative treatment of the 11 children with delayed diagnosis were good in only two cases, 6 were poor and 3 were unsatisfactory. The functional lesions after delayed treatment were caused by persistent dislocation or subluxation, deformity of the radial head, and humeroradial arthrosis.

Adolescent↗
PubMed2004

[Surgical treatment of capitellum fractures in the adult. Eight case reports].

Fracture of the capitellum is a rare intra-articular fracture and presents a frontal fracture line. It occurs in adolescents after the age of 13 years and in adults. We report a series of eight patients treated between 1992 and 2002. There were five females and three males with a mean age of 25 years (range: 20-34 years). According to the classification of Bryan and Morrey, three fractures were classified as type I, three as type II and two as type III. All patients were operated on within the first week after injury. The fixation techniques used were screw fixation in five cases and Kirschner wire fixation in three cases. Seven patients had excellent results and one patient had some limitation of range of movement. There were no instances of infection or avascular necrosis. Diagnosis of this fracture is often missed. Poor results of treatment are observed after imperfect reduction, delayed treatment or resection of the capitellum. We report in this study the results of surgical treatment.

Adult↗
PubMed2006

Primary nonoperative treatment of moderately displaced two-part fractures of the radial head.

BACKGROUND: Moderately displaced two-fragment fractures of the radial head have been treated predominantly nonoperatively. Recently, however, open reduction and internal fixation has gradually gained interest, without clear evidence that initial nonoperative treatment leads to an unfavorable outcome. As a consequence, the purpose of the present study was to evaluate the long-term outcome after the initial nonoperative treatment of this type of fracture. METHODS: Fifteen men and thirty-four women, with a mean age of forty-nine years at the time of the injury, were included in the study. All patients initially had been managed nonoperatively for a two-fragment fracture of the radial head that was displaced 2 to 5 mm and that included >/=30% of the joint surface (a Mason type-IIa fracture). Early mobilization had been used for twenty-seven patients, and cast immobilization for a mean of two weeks (range, one to four weeks) had been used for twenty-two. All patients were reevaluated with a questionnaire after a mean of nineteen years, and thirty-four also had a clinical and a radiographic evaluation. Six patients had had a delayed radial head excision because of an unsatisfactory primary outcome. RESULTS: Forty of the forty-nine patients had no subjective complaints, eight were slightly impaired as the result of occasional elbow pain, and one had daily pain. Flexion was slightly impaired in the injured elbows as compared with the uninjured elbows (137 degrees +/- 8 degrees compared with 139 degrees +/- 7 degrees ), as was extension (-3 degrees +/- 7 degrees compared with 1 degrees +/- 5 degrees ) and supination (86 degrees +/- 7 degrees compared with 88 degrees +/- 4 degrees ) (p < 0.05 for all comparisons). The prevalence of degenerative changes on radiographs was higher for the injured elbows than for the uninjured elbows (82% [twenty-eight of thirty-four] compared with 21% [seven of thirty-four]; p < 0.01). CONCLUSIONS: The initial nonoperative treatment of Mason type-IIa fractures of the radial head that are displaced by 2 to 5 mm is associated with a predominantly favorable outcome, especially if a delayed radial head excision is performed in the few cases in which the early outcome is unsatisfactory. LEVEL OF EVIDENCE: Therapeutic Level IV.

Adolescent↗
PubMed1992

Posttraumatic calcification of the annular ligament of the radius.

Eight cases of calcification following anterior dislocation of the head of the radius are described. It was demonstrated as early as 2 weeks after injury and in 7 cases appeared in the form of a shell on the volar aspect of the head. The other type exhibits a cuff of calcification related to the radial neck. Parallel cases are drawn from a literature review, and the distinction is made between calcification in the disrupted annular ligament/capsule or oblique cord and myositis ossificans. Regression in several cases may be a consequence of open reduction.

Adolescent↗
PubMed2002

Ipsilateral combination Monteggia and Galeazzi injuries in an adult patient: a case report.

Monteggia fractures represent approximately 1 to 2 percent of forearm fractures, whereas Galeazzi fractures represent 3 to 6 percent. The combination of these injuries in the same extremity is an exceedingly rare occurrence. We report a case of ipsilateral combination Monteggia and Galeazzi fractures in an adult patient. The patient was treated with anatomic reduction and rigid internal fixation. The radius was stabilized with a 3.5-millimeter dynamic compression plate (Synthes USA, Paoli, PA, U.S.A.) and the olecranon with tension band fixation. The radiocapitellar and distal radioulnar joint relationships were restored; the fractures healed; and the patient proceeded to obtain a satisfactory functional result at one year.

Adult↗
PubMed1989

[Fractures of the inner epicondyle of the humerus associated with dislocation of the forearm bones in children and adolescents].

The authors attract attention to frequent association of fracture of the inner epicondyle of the humerus with dislocation of the bones of the forearm, which is of great practical importance. On this basis classification of fractures of the inner epicondyle of the humerus is presented. The authors believe that in treating this injury the method of choice should consist in open reposition, which allows to achieve accurate reposition, sanation of the ulnar joint cavity and stable fixation of the fragment. Osteosynthesis by screw-awl provides for reliable fixation of the fragment and allows for early development of the movements in the ulnar joint. Surgical treatment mostly gave excellent and good results and complications were few. The complications observed were mainly connected with late admission of the patients.

Adolescent↗
PubMed1997

Island fasciocutaneous flap based on the proximal perforators of the radial artery for resurfacing of burned cubital fossa.

In the vast majority of burned patients, the injury is limited to the skin and superficial subcutaneous tissue, and the vasculature of the deeper fascia is spared. This fact encouraged me to design a flap in which the burned scar tissue is employed. The island fasciocutaneous flap is based only on the proximal septocutaneous perforators of the radial artery. The flap is used to resurface the anterior as well as the lateral burned cubital fossa after excision of the scar tissue and release of contracture. An anatomic study as well as clinical approach has been conducted.

Burns↗
PubMed1993

Bicondylar intraarticular fractures of the distal humerus in adults.

Bicondylar intraarticular fractures of the distal humerus, because of their rarity and often associated significant displacement, comminution, and osteopenia, present the orthopedist with a difficult injury to reliably treat successfully. As with any displaced intraarticular fracture, the principles of anatomic restoration of the articular surface, stable fixation, and early motion are the optimal treatment goals. To obtain reproducible results, an established treatment protocol is required and is described in detail here. The average excellent-to-good results with surgical treatment for Type C fractures ("T" or "Y" bicondylar fractures) is 75% (range, 65-100%). Complications include heterotopic ossification (4%), infection (4%), ulnar nerve palsy (7%), failure of fixation (5%), and non-union (2%).

Adult↗