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PubMedDate not supplied

Idiopathic or traumatic olecranon bursitis. Clinical features and bursal fluid analysis.

Thirty cases of idiopathic olecranon bursitis were studied. Most had previous local trauma. The process was unilateral and often associated with nontender pitting edema in cases of short duration. Ten patients exhibited a bony spur at the olecranon process, and amorphous calcific deposits were seen in 6. The bursal fluid was hemorrhagic with a xanthochromic supernatant, and the mucin clot test was poor or fair. Leukocyte count averaged 878/mm3, predominantly mononuclears. Many cells contained inclusion bodies. Glucose, total protein, and complement (C3) concentration averaged 80, 60, and 60% of the respective serum values.

Adult↗
PubMed1995

Prednisone treatment of elderly-onset rheumatoid arthritis. Disease activity and bone mass in comparison with chloroquine treatment.

OBJECTIVE: Prednisone is frequently used in the treatment of elderly-onset rheumatoid arthritis (RA), but the balance between efficacy and toxicity, including the effect on bone mass, has not been investigated in long-term studies. This prospective, randomized study was undertaken to compare disease activity and bone mass during long-term treatment with prednisone versus chloroquine in this patient population. METHODS: Patients with active RA diagnosed at age > or = 60 were randomized to receive prednisone (15 mg/day for 1 month, with the dosage tapered as low as possible thereafter) (n = 28) or chloroquine (n = 28). Patients who did not show a response received other second-line drugs as an adjunct to prednisone or as a replacement for chloroquine. Bone mass was measured by dual-energy x-ray absorptiometry. The study duration was 2 years. RESULTS: During the 2 years, treatment with other second-line drugs was needed for 12 patients in the prednisone group (43%) and 8 in the chloroquine group (29%). Functional capacity and disease activity improved significantly in both groups and did not differ significantly between the groups, except for a greater improvement in the prednisone group at 1 month. Radiographic scores for joint destruction progressed similarly in both groups. There was a nonsignificant excess bone loss of 1.8% in the spine and 1.5% in the hip in the prednisone group, compared with the chloroquine group. CONCLUSION: Neither treatment was entirely satisfactory since a significant number of patients needed an additional second-line drug over the 2-year period.

Aged↗
PubMed1975

Loose bodies in the elbow.

This is a retrospective study of 52 patients with loose bodies in the elbow joint. The major cause was osteoarthrosis, accounting for 37 per cent of the cases, and the commonest site was the anterior compartment of the joint. Restriction of elbow extension by 10 degrees or more was the most constant clinical finding. Thirty-three patients were subjected to arthrotomy, with a low complication rate.

Elbow Joint↗
PubMedDate not supplied

MR assessment of posttraumatic flexion contracture of the elbow.

Preoperative assessment of posttraumatic flexion contracture of the elbow includes plain radiographs and tomograms, which are difficult to obtain in the coronal plane due to the contracture. We conducted this study to determine the usefulness of MR imaging in the work-up of these patients. Twelve patients with flexion contracture of the elbow were studied. In addition to standard spin-echo sequences, a sagittally acquired spoiled gradient-recalled echo 3D data set of the flexed elbow was obtained and reformatted coronally using a curved plane of reconstruction. The MR findings were compared to the plain films, tomograms and surgical results. MRI allowed identification of loose bodies that were sometimes poorly visualized, or not seen, on plain films, and demonstrated degenerative changes equally as well as tomograms. MR showed soft tissue abnormalities including capsular and collateral ligament thickening. Curvilinear reconstructions were helpful in the assessment of collateral ligaments in patients with severe contractures. We conclude that MR is useful in the evaluation of elbow flexion contractures, particularly in assessing soft tissue causes.

Adult↗
PubMed1987

Valgus stability of the elbow.

The valgus stabilizers of the elbow have been identified anatomically, but their relative importance has not been quantified. The purpose of this study was to analyze the acute changes of the torque-displacement curve to valgus stress following (a) section of the posterior portion of the medial collateral ligament; (b) excision of the radial head; (c) prosthetic replacement of the radial head; and (d) excision of the anterior portion of the medical collateral ligament. Thirty cadaver specimens underwent load-displacement testing in three positions: 0 degrees, 45 degrees, and 90 degrees of flexion. The anterior portion of the medial collateral ligament was the primary stabilizer of the elbow to valgus stress. The relative contribution of the posterior ligament was minimal. After excision of the radial head alone, the slope of the load-displacement curve decreased an average of 30%. Silicone rubber radial head replacement did not significantly improve the stability to valgus stress after radial head excision.

Biomechanical Phenomena↗
PubMed1995

Refinements in the one-stage procedure for management of chronic osteomyelitis.

Posttraumatic osteomyelitis remains a frequent problem and requires aggressive surgical treatment to be cured. Radical debridement of all involved soft and hard tissues, obliteration of dead space, and neovascularization of the involved area are obligatory for successful management of the disease. Microvascular free tissue transfer provides the necessary tissue bulk and neovascularization to reconstruct the resulting defect. The transplanted muscle can be optimally mobilized and adjusted in size to obliterate the dead space in contrast to local transposition flaps. This is facilitated by smoothening the bony cavity using a rotating drill system. With an optimal interface between the muscle and the wall of the cavity, small foci of infection can be eliminated. Moreover after free muscle transfer, the optimal environment for secondary bone reconstruction is created. These principles of radical debridement combined with muscle transfer for dead space obliteration, are generally accepted in literature. Nevertheless to achieve this goal several different treatment schedules of repetitive debridements, prolonged antibiotic regimes, and finally various flap transfers have been advocated. We present 16 patients with chronic osteomyelitis treated with radical debridement and immediate free muscle transfer using the latissimus dorsi muscle preferably. Postoperatively an antibiotic course of only 12 days was given. With a mean follow-up of 2 years all patients remained symptom free. Therefore, our results indicate that this long-term problem can be solved by a one-stage procedure using a free flap combined with a short course of antibiotics. However definite conclusions should be reserved for 20 years.

Adult↗
PubMed1995

A radiological sign in pulled elbows.

A new radiological sign of distal shift of the radius compared to the ulna is described in the condition of pulled elbow. This measurement has been termed the proximal radial length and was altered in 21 out of 25 cases of pulled elbow diagnosed clinically. The normal relationship was restored after manipulation.

Child↗
PubMed1994

[Experiences with internal fixation of isolated fractures of the head of the radius].

The advantages of internal fixation of fractures, with the possibility of immediate resumption of the function of the fractured bone, are in contrast to the well-known complications described in the literature. These complications and our own unsatisfactory results after surgical treatment of fractures of the head of the radius induced us to carry out a randomized prospective study of primary functional treatment of such fractures without external or internal stabilization. From December 1991 through December 1992, a total of 70 patients were treated according to a strict treatment protocol at the Graz Hospital for Accident Surgery, and CT was used for observation of the healing process. The positive early results, which in 91% of all cases were classified as very good or good, the lack of complications that sometimes follow surgical treatment, the markedly earlier recovery of the patient's working capacity, and the clearly shorter--albeit somewhat more expensive--treatment period required have led us to continue using this method at our hospital and also to recommend its use elsewhere.

Adult↗
PubMed1992

Case report 725. Posterior displacement of proximal end of the right radius and capitulum with supracondylar fracture causing a displaced fracture rather than a fracture dislocation.

An 11-month-old boy with a swollen, painful right elbow demonstrated a supracondylar fracture on plain film radiographic studies. Sonography was subsequently performed to exclude dislocation of the elbow and demonstrated the supracondylar fracture as well as a normal relationship of the capitulum and radius, signifying a displaced fracture without associated dislocation. A bone dislocation would generally require dosed reduction alone, whereas distal humeral epiphyseal separation usually requires open reduction or percutaneous (pin) fixation. This case demonstrates the utility of ultrasound in the evaluation of physeal disruption and dislocation in the elbow prior to ossification of the secondary centers of ossification.

Diagnosis, Differential↗
PubMed1981

[Fracture of condylus radialis humeri during skeletal growth (author's transl)].

A long term follow-up study of 54 fractures of the lateral condyle of the humerus was done to assess their special problems during the period of skeletal growth. It was demonstrated, that valgisation of the carrying angle will always be a result of an increasing displacement of the peripheral fragment. Furthermore it was shown that the most significant growth disturbance following this fracture is a partial stimulation of the radial part of the growth plate. This leads to radial overgrowth and thereby to varus deformity of the axis of the elbow joint. The extent of this varus deformity is significantly dependent on the time interval between fracture and consolidation. The premature partial closure of the radial side of the growth plate is of no importance clinically. The causes for general growth disturbance as well as fishtail deformities are shown. To eliminate instability of the fracture and to reduce the duration of the consolidation period a metaphyseal AO-screw for compression osteosynthesis is recommended.

Bone Development↗
PubMed1976

[The operative treatment of recurrent and simple traumatic dislocations of the elbow by the method of Osborne and Cotterill (author's transl)].

The essential pathological defect causing dislocation of the elbow is failure of the postero-lateral ligamentous and capsular structures. A pocket of the capsule is created into which the head of the radius is received as it slides off its articulation with the humerus. Damage to the osteochondral surface of the radius and capitulum humeri is often significant in recurrent and also simple traumatic dislocations of the elbow joint. An osteochondral fracture may occur in simple dislocation happening but once and predispose for recurrent dislocation. For treatment of recurrent dislocation we prefer the simple method of Osborne and Cotterill because in our opinion it attacks the essential lesion. More complicated techniques such as bone blocks or tendon transfers, are believed to be less effective and unnecessary. Four patients with recurrent dislocation of the elbow joint were treated successfully by this method, based on an follow-ups of from 2 to 4 years. Encouraged by the results we transferred the method to the treatment of simple traumatic dislocations in 10 patients. A follow-up of these patients has shown that an early operation will give satisfactory functional results. In the meanwhile the method of Osborne and Cotterill has become a standard technique for the treatment of osteochondrosis dissecans too by the authors.

Adolescent↗