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PubMedDate not supplied

Vitallium radial head prosthesis for acute and chronic elbow fractures and fracture-dislocations involving the radial head.

This retrospective study aims to evaluate the radiographic, functional, and patient-derived outcomes of 16 patients who each received a Vitallium radial head prosthesis for unreconstructable acute fractures of the radial head, as well as previously treated fractures of the radial head associated with residual instability, pain, and stiffness. Follow-up averaged 33 months. A trend toward greater disability and poorer motion was noted in the delayed treatment group compared with the acute replacement group. Overall, the results were excellent in 5 patients, good in 10, and poor in 1, as determined by the Mayo Elbow Performance Score. All elbows were stable at follow-up, and no patient reported wrist pain. Four required further operative treatment of their elbow injuries. Metallic radial head arthroplasty yields satisfactory results in acute unreconstructable radial head fractures or as a salvage procedure for previously treated radial head fractures.

Acute Disease↗
PubMed1995

Performance of above elbow body-powered prostheses in visually guided unconstrained motion tasks.

The "classical" body-powered above elbow arm prosthesis continues to be used by a large majority of arm prosthesis users, even though many more modern devices are available. This paper presents a set of experiments designed to compare performance of unimpaired arms and body-powered prostheses of six unilateral amputees. The experiments were designed to measure quantitatively how well the body-powered prosthesis can be used to perform free-motion tasks, as well as to study the qualitative features of movement common to both the prosthesis and unimpaired arm. It was found that regular peaks in velocity were common to both the unimpaired arm and prosthesis movements, suggesting that movements were composed of a sequence of successive actions. In addition, it was found that the body-powered prosthesis generally required more movements than the unimpaired arm to meet an accuracy constraint and could not keep up with the unimpaired arm when a speed constraint was imposed, even though the body-powered prosthesis was able to match the unimpaired arm in a simple nondynamic task.

Adult↗
PubMed2006

[Allograft-prosthesis composite arthroplasty for posttraumatic floating elbow].

Loss of bone stock in the elbow joint raises serious problems for reconstruction surgery. Total allograft-prosthesis composite arthroplasty is an attractive alternative to revision prosthesis and isolated osteoarticular allografts known to have many drawbacks. Use of this method is rather recent for revision procedures and tumor surgery and posttraumatic cases are rare (five reported cases). We report a case of posttraumatic floating elbow treated with this technique. At 75 months follow-up, the clinical result was excellent with the Mayo Clinic performance score at 100/100. Allograft-native bone fusion was complete and there were no complications, particularly no loosening. This composite technique is particularly well adapted for patients with major bone and joint loss. It can avoid the specific problems associated with each of the techniques used alone. The allograft reconstructs bone stock while the prosthetic component avoids the clinical expression of graft epiphyseal lysis.

Arthroplasty, Replacement↗
PubMed1994

Prosthesis training as a context for studying occupational forms and motoric adaptation.

OBJECTIVES: Occupational therapy authors frequently emphasize the importance of the use of objects in the development of motor skill. This study investigated the use of object-produced visual input in learning control of flexion and extension of an above-elbow training prosthesis. METHOD: Fifty-two male college students were randomly assigned to two training procedures: (a) two 1.5-min periods in which they used a flashlight attached to the hook of the prosthesis to connect dots on paper with light, or (b) the same time periods in which they had the opportunity to practice moving an equally weighted prosthesis, but without the light or dots. To assess motoric adaptation after training under one of the two conditions, each subject traced a continuous line through a maze with a pen attached to the hook. Deviations from the line were measured reliably. RESULTS: Data analysis with a Mann-Whitney test revealed that subjects in the group that trained with added materials traced with significantly more skill than subjects in the other group (one-tailed U = 225.5, p = .02). CONCLUSION: As predicted by occupational therapy theory, the object-produced visual input enhanced the learning of a motor skill relevant to rehabilitation. Although there is a need for more study across different occupations and populations, clinicians are urged to consider the possible benefits of the use of objects in the development of motor skills, as opposed to objectless exercise. Prosthetic training provides a useful context for future research addressing theoretical issues in motor learning.

Adolescent↗
PubMedDate not supplied

Long-term results of unconstrained Roper-Tuke total elbow arthroplasty in patients with rheumatoid arthritis.

We evaluated the long-term results of 12 unconstrained Roper-Tuke total elbow replacements that were performed in 12 patients with rheumatoid arthritis from 1983 to 1989. The mean follow-up period was 9.5 years (range 8 to 13 years). We used the Ewald elbow-scoring system to chart results. This showed that the scores for the 12 elbows had improved from an average preoperative score of 39 points (range 17 to 72 points) to an average postoperative score of 80 points (range 45 to 97 points). The greatest improvements were in terms of pain relief, function, and range of motion. Eight elbows were free of pain by the end of follow-up. Average elbow flexion increased from 115 degrees before operation to 140 degrees after operation, and pronation and supination increased from 52 degrees to 61 degrees and 42 degrees to 71 degrees, respectively. Radiographs of the 12 elbows showed constant wear of the ulnar polyethylene with loosening of 2 ulnar components. Revision of the prosthesis was necessary in 2 elbows because of aseptic loosening. Complications included 1 subluxation, 1 supracondylar fracture, and 2 ulnar neuropathies. Despite some excellent clinical results with a follow-up of over 10 years, the authors no longer recommend the use of this kind of elbow prosthesis in patients with rheumatoid arthritis because of the high complication rate and the impossibility of adapting this implant in the event of bone loss. The authors propose a new classification of humeral bone loss that will allow for better planning of primary and revision total elbow arthroplasties.

Adult↗
PubMed2000

Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients.

Distal humeral fractures are difficult to treat. In the elderly population, the problems are compounded by osteoporosis and gross comminution. Open reduction and internal fixation for such fractures is sometimes difficult and may be associated with poor results. Total elbow arthroplasty has been suggested as a last-ditch effort to salvage functional use for such difficult fractures in the elderly. We followed seven patients (seven elbows) with a mean age of 81.7 years at the time of injury. Open reduction and internal fixation was considered a difficult option for these fractures. They were treated with a total elbow arthroplasty using the semi-constrained Coonrad-Morrey elbow replacement prosthesis. The duration of follow up at present is between 2 and 4 years. At the latest follow up the mean arc of flexion is 20-130 degrees. Six patients have no pain while one complains of mild pain. All elbows are stable. The Mayo elbow performance score for five elbows is excellent and two scored good. All but one patient are satisfied with the result. One patient developed superficial wound infection which resolved after antibiotic therapy. One patient has developed post-operative triceps weakness. There have been no cases of deep infection, ulnar nerve neuritis or component failure. The rarity of this procedure suggests its very narrow spectrum of indication. We feel that the short-term results do suggest an important role for semi-constrained total elbow arthroplasty in managing carefully selected comminuted distal humeral fractures in the elderly, especially those that cannot be treated by conventional open reduction and internal fixation.

Aged↗
PubMed2004

The use of targeted muscle reinnervation for improved myoelectric prosthesis control in a bilateral shoulder disarticulation amputee.

A novel method for the control of a myoelectric upper limb prosthesis was achieved in a patient with bilateral amputations at the shoulder disarticulation level. Four independently controlled nerve-muscle units were created by surgically anastomosing residual brachial plexus nerves to dissected and divided aspects of the pectoralis major and minor muscles. The musculocutaneous nerve was anastomosed to the upper pectoralis major; the median nerve was transferred to the middle pectoralis major region; the radial nerve was anastomosed to the lower pectoralis major region; and the ulnar nerve was transferred to the pectoralis minor muscle which was moved out to the lateral chest wall. After five months, three nerve-muscle units were successful (the musculocutaneous, median and radial nerves) in that a contraction could be seen, felt and a surface electromyogram (EMG) could be recorded. Sensory reinnervation also occurred on the chest in an area where the subcutaneous fat was removed. The patient was fitted with a new myoelectric prosthesis using the targeted muscle reinnervation. The patient could simultaneously control two degrees-of-freedom with the experimental prosthesis, the elbow and either the terminal device or wrist. Objective testing showed a doubling of blocks moved with a box and blocks test and a 26% increase in speed with a clothes pin moving test. Subjectively the patient clearly preferred the new prosthesis. He reported that it was easier and faster to use, and felt more natural.

Anastomosis, Surgical↗
PubMed1984

Surface replacement of the elbow in rheumatoid arthritis. Early results with the Wadsworth prosthesis.

Fifteen patients with rheumatoid arthritis had 19 elbow arthroplasties with the Wadsworth type of surface replacement prosthesis. After a follow-up period averaging 30 months, 11 patients with 15 elbow arthroplasties were entirely satisfied with their freedom from pain and range of movement. Radiologically, however, the humeral component was loose in 10 of the 19 elbows and the ulnar component in 5. Two patients had reoperation, one to remove a prosthesis for early deep infection and one to exchange a humeral component which was loose. The risk of mechanical loosening is reduced by accurate positioning of the humeral component, but there is a high potential for failure. Changes in the design of the prosthesis and better instrumentation for alignment of the components are desirable. Prosthetic replacement of the elbow should still be regarded as experimental.

Adult↗
PubMed2001

Revision total elbow replacement using the Souter-Strathclyde prosthesis.

The Souter-Strathclyde prosthesis was used in 52 evisions of total elbow replacements (TERs) between August 1986 and May 1997. Of these, 50, carried out in 45 patients, were prospectively followed for a mean of 53 months (14 to 139). The procedure produced reliable relief of pain, and the range of movement was preserved. There was a considerable incidence of adverse events associated with revision (30%), and 12 further procedures have been required. Nonetheless, a revision is the preferred salvage procedure for failed primary arthroplasty in the absence of sepsis.

Adult↗
PubMed1985

Evaluation of a myoelectric hand prosthesis for children with a below-elbow absence.

A clinical evaluation of a myoelectric hand prosthesis was carried out within a multicentre trial in three centres in the United Kingdom. The aim was to assess its effectiveness as an acceptable device for young children and to evaluate its technical efficiency. The trial ran for 2 3/4 years and included 87 children. The methodology used and the results obtained are presented with indications towards future developments.

Artificial Limbs↗
PubMed1994

[Radial head prosthesis with floating cup in recent and old injuries of the elbow: preliminary results].

PURPOSE OF THE STUDY: In recent traumatology (complex radial head fractures with severe sprain of the medial collateral ligament), as well as in sequellae (extensive release for severe elbow stiffness), the implantation of a radial head prosthesis may be necessary to stabilize the humero-ulnar joint and the radial shaft. Its major advantage consists of allowing immediate postoperative mobilization. Swanson first proposed a silastic replacement of the radial head which turned out to have serious mechanical and biological disadvantages. MATERIAL AND METHODS: We propose a new Titanium implant, which is stiffer, and made of 2 parts connected by a spherical joint, thus maintaining an optimum congruence between the prosthetic component and the humeral condyle in any position of the joint (flexion/extension or pronosupination). This prosthesis was implanted in 4 recent fractures and reviewed after an average follow-up of 23 months [12-36]. RESULTS: Results were excellent in 2 cases, and good in 1 case: functional assessment was fair in the last case, in which the initial lesion consisted of a complex ulnar fracture associated with a Mason 3 fracture of the radial head. An osteosynthesis of the ulnar shaft and olecranon had preceeded implantation of the radial head prosthesis. In 5 additional cases with severe posttraumatic elbow stiffness, the prosthesis was implanted during elbow release, regularly allowing durable stabilization of the joint in an anatomic position, and in 2 of these cases, permanent correction of the radio-ulnar index. In these last cases, proximal migration of the radial shaft had occurred after resection of the radial head. In one case, this migration had resulted in ulnar fusion complicating a Sauve-Kapandji procedure. In the other case, proximal migration of the radius had resulted in painful distal radio-ulnar dislocation. In this second group, patients were followed-up an average of 31 months [12-46]. No complication has yet been recorded (no osteolysis, no stem breakage, no wear, no loosening). DISCUSSION: Indications for implantation of a radial head prosthesis were deduced from these observations: in recent trauma, implantation of the prosthesis should only be indicated in those fractures, in which osteosynthesis appears not to be possible (Mason 3 or 4), with the following associations: radial head fracture with severe sprain of the medical collateral ligament--patients with positive radio-ulnar index--extensive lesions of the interosseous membrane (Essex-Lopresti, or Monteggia affecting the ulnar shaft)--associated fracture of the proximal ulna (olecranon, coronoid process...). In sequellae, we propose the following indications: extensive elbow release compromising elbow stability--painful inferior radio-ulnar dislocation complicating resection of the radial head--valgus instability complicating radial head resection.

Adolescent↗
PubMed1991

Salvage of thrombosed forearm polytetrafluoroethylene vascular access grafts by reversal of flow direction and venous bypass grafting.

A technique is described for salvage of looped forearm polytetrafluoroethylene (PTFE) vascular access grafts that fail because of thrombosis due to cephalic vein outflow obstruction. It entails reversal of blood flow direction through the graft and construction of a new venous outflow in the medial upper arm. This procedure was performed in nine patients and, at the present time, has increased the graft life by an average of 6.2 months (range: 2 to 14 months) in eight. We conclude that this is a useful alternative to abandoning failed looped forearm PTFE grafts that have cephalic vein outflow obstruction.

Anastomosis, Surgical↗
PubMed1988

Semiconstrained elbow prostheses with special reference to the GSB III prosthesis.

Fully constrained metal-to-metal elbow prostheses are not used anymore because of a high loosening rate. Today semiconstrained or condylar prostheses are the two possibilities when replacement of a destroyed elbow joint is considered. A careful analysis of the most recent publications in the world literature reveals a high complication rate for both types of prostheses, each one having specific advantages and disadvantages. The Gschwend-Scheier-Bähler (GSB) III prosthesis is a semiconstrained prosthesis, requires little bone resection, and is therefore easily salvaged. The results in regard to pain relief and improvement in range of motion are satisfactory in a high percentage of patients. The rate of lasting complications is lower than with most of the other prostheses. The authors' transtricipital approach is also a factor that contributes to the high success rate. In case of a failed arthroplasty the authors' method of reconstructing the humeral condyles allows a better salvage.

Adult↗
PubMedDate not supplied

Body-powered hand prosthesis with low operating power for children.

For unilateral below-elbow amputated children a new elbow-controlled hand prosthesis has been developed. Since the triceps of young children have insufficient power to activate normal spring-closing hands, a special mechanism with low operating power has been developed for this prosthesis. A stiff spring gives a good gripping force. When the elbow is slightly extended this spring is switched off, and by further extension the hand is opened against a weak spring. So far, six children have used this special prosthesis. Their initial enthusiasm resulted in an improved system, which is now being designed.

Artificial Limbs↗