Repairing the annular ligament is not necessary in the operation of Mason type 2, 3 isolated radial head fractures if the lateral collateral ligament is intact: Minimum 5 years follow-up

Injury ◽  
2013 ◽  
Vol 44 (12) ◽  
pp. 1851-1854 ◽  
Author(s):  
Soo Hong Han ◽  
Soon Chul Lee ◽  
Keun Jung Ryu ◽  
Jin Hyun Lee
Keyword(s):  
Radial Head ◽  
Lateral Collateral Ligament ◽  
Annular Ligament ◽  
Collateral Ligament ◽  
Radial Head Fractures

scholarly journals Radial Head Arthroplasty: Does Ligaments Repair Influence Outcomes? A Minimum Two Years Follow-Up Radiographic Multi-Center Study

2021 ◽  
Author(s):  
Cristina Galavotti ◽  
Sara Padovani ◽  
Alessandro Nosenzo ◽  
Margherita Menozzi ◽  
Pietro Maniscalco ◽  
...  
Keyword(s):  
Radial Head ◽  
Revision Rate ◽  
Radial Head Fracture ◽  
Degenerative Changes ◽  
Annular Ligament ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Multi Center Study ◽  
Center Study

Abstract Purpose: The current indication for comminuted radial head fractures is radial head arthroplasty (RHA). The main purpose of this study was to investigate any statistical differences in terms of prosthesis revision or removal and radiographic-degenerative changes by comparing patients who underwent RHA and ligaments repair to those who underwent only RHA implant at minimum two-years follow up. The secondary aim was to delineate a trend profile of RHA implants.Methods: All patients who underwent RHA surgery for traumatic pathology between January 2012 and December 2017 were eligible. Two researchers independently and retrospectively reviewed the patients’ charts and collected the following data: type of prosthesis, associated surgical procedures and revision surgery. They also looked for any radiographic sign of prosthesis loosening, overstuffing, capitellar osteopenia, heterotopic ossification and degenerative changes. No clinical evaluation was performed. Results: In six years 124 RHA were implanted (74 Female, 50 Male, mean age 56). The main diagnoses were: terrible-triad, trans-olecranon fracture and isolated radial head fracture. It was found no significant statistical difference between the two groups, nevertheless the cohort of patients that underwent ligaments repair had a lower revision rate in comparison to the other. Suture of the annular ligament seems to be critical. The overall revision rate was 10.5%.Conclusion:This multi-center study found no evidence that ligaments repair, as an associated surgical procedure, improves RHA longevity, except for annular ligament. Nevertheless, it seems to prevent degenerative changes at mid-term follow-up.

scholarly journals Detachment of Extensor Carpi Ulnaris and Anterior Branches of the Radial Collateral Ligament from the Epicondyle: A Modification of Kocher Lateral Approach for the Treatment of Radial Head Fractures

Joints ◽  
2019 ◽  
Vol 07 (02) ◽  
pp. 031-036
Author(s):  
Georgios Touloupakis ◽  
Elena Biancardi ◽  
Stefano Ghirardelli ◽  
Guido Antonini ◽  
Cornelio Crippa
Keyword(s):  
Radial Head ◽  
Soft Tissues ◽  
Case Series ◽  
Lateral Approach ◽  
Collateral Ligament ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Radial Head Fractures ◽  
Radial Collateral Ligament

Abstract Purpose The aim of this study is to present clinical results of a retrospective case series that includes patients treated with an extensive modification of the Kocher lateral approach to the elbow with surgical detachment of the anterior branches of the radial collateral ligament. Methods From January 2016 to January 2018, nine patients with closed isolated displaced or multifragmentary radial head fractures (Mason type II, III, or IV) who underwent osteosynthesis or arthroplasty through a modified Kocher lateral elbow approach were available for follow-up. Results There were six female and three male patients. The median age at the time of surgery was 52 years old (range: 26–70). The dominant upper limb was injured in 22.2% of patients. After a median follow-up of 8 (range: 6–27) months, all patients regained completely all their daily activities and no cases of infections were recorded. Conclusion We believe that the approach proposed can be a useful choice to deal with these challenging injuries. Our strategy may represent a valid alternative to more popular approaches as the use of anchors decreases the risk of instability that is the major danger considered in the past when soft tissues as tendons and ligaments are detached. Level of Evidence This is a level IV study (therapeutic case series).

scholarly journals Severe traumatic valgus instability of the elbow: pathoanatomy and outcomes of primary operation

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Lei Zhang ◽  
Laixu Wang ◽  
Shiyang Yu ◽  
Zhanhui Lv ◽  
Peng Zhang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Medial Collateral Ligament ◽  
Radial Head ◽  
Dash Score ◽  
Collateral Ligament ◽  
Anterior Capsule ◽  
Radial Head Fractures ◽  
Primary Operation ◽  
Valgus Instability

Abstract Background The objective of the study was to depict the pathoanatomy of traumatic valgus instability of the elbow and to report clinical outcomes of primary operation. Methods Thirty-one patients presented with traumatic valgus instability of the elbow without dislocation. Thirty-one patients underwent surgical intervention of radial head fractures (28 open reduction and internal fixation and 3 radial head resection) and anatomical repair of the anterior bundle of medial collateral ligament (AMCL) with suture anchors. Twenty patients with disruption of the flexor-pronator tendon (FPT) and 14 patients with tears of the anterior capsule had primary repair of the FPT and anterior capsule simultaneously. Clinical outcomes were evaluated with the Mayo Elbow Performance Score (MEPS), modified hospital for special surgery assessment scale (HSS), and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results The median follow-up was 37.3 months (range, 15–53 months). Radial head fractures and complete avulsion of the medial collateral ligament (MCL) from its humeral footprint were confirmed in all patients intraoperatively. Intraoperative findings indicated disruption of the FPT in 20 patients and tears of the anterior capsule in 14 patients. Twenty-nine of 31 patients returned to previous activity and work levels within 6 months after surgery. The MEPS, modified HSS, and DASH score were 94 ± 4, 91 ± 5, and 8 ± 2 at the latest follow-up. Conclusions Radial head fractures with avulsion of the MCL can lead to severe valgus instability of the elbow. Primary operation to repair these disrupted structures, especially repair of the AMCL, can effectively restore valgus stability.

scholarly journals Repair of a Divergent Elbow Dislocation with Distal Ulnar Fracture in a Dog Using TightRope and External Skeletal Fixation

VCOT Open ◽  
2021 ◽  
Vol 04 (01) ◽  
pp. e58-e64
Author(s):  
Marcos Garcia ◽  
Camille Bismuth ◽  
Claire Deroy-Bordenave
Keyword(s):  
Elbow Dislocation ◽  
Lateral Collateral Ligament ◽  
Normal Activity ◽  
Long Term Results ◽  
Collateral Ligament ◽  
Elbow Luxation ◽  
Ulnar Fracture ◽  
Fixation System

AbstractThe aim of this study was to report the outcome in a 6-year-old male English Setter dog that suffered a combination of divergent elbow dislocation and open distal ulnar fracture. This study is a case report. After surgical reduction in the elbow luxation, the dog was treated with the TightRope fixation system used as replacement of the lateral collateral ligament, a radioulnar positional screw, and external skeletal fixation. Removal of all implants was performed 3 months postoperatively. The 6-month follow-up visit found the dog without lameness, displaying normal activity, and with normal elbow range of motion and normal Campbell's test. Successful surgical management was achieved with good long-term results using TightRope, a positional screw, and an external skeletal fixator.

scholarly journals A Hybrid Technique Combining Intramedullary Pinning With Extramedullary Plate Fixation in Unstable and Comminuted Radial Head Fractures Following on-Table Reconstruction

2020 ◽  
Author(s):  
Xu Gao ◽  
Fei Li ◽  
Yong-Qiang Sui ◽  
Rui Huang ◽  
Hai-yu Fan ◽  
...  
Keyword(s):  
Radial Head ◽  
Plate Fixation ◽  
Visual Analog Scale Score ◽  
Reconstruction Technique ◽  
Hybrid Technique ◽  
Self Assessment ◽  
Radial Head Fractures ◽  
Mayo Elbow Performance Score ◽  
Intramedullary Pinning

Abstract BackgroundManagement of comminuted radial fractures remains controversial. Currently, the emergence of on-table reconstruction technique has made fixation in comminuted radial head fractures more viable. However, since only a few previous studies have investigated small amounts of patients with conflicting complication rates, the treatment effects of on-table technique may be discrepant in different cases and its reliability needs to be evaluated cautiously in the practical surgical process. The present study reported an intro-operative unstable displacement from the reconstructed radial head to the neck during plate fixation, characterized by a poor radiocapitellar contact and incongruity between the radial head and neck. Subsequently, a hybrid technique combining with intramedullary pining was performed to restore the normal alignment and maintain the stability of fixation. Therefore, the purpose of this article aimed to prove the feasibility of unstable comminuted radial head fractures treated with the extramedullary plate and intramedullary pinning fixation using titanium elastic nails. MethodsFive patients with unstable comminuted radial head fractures (Mason type-III) were selected from January 2012 to May 2018 in this study. All patients were treated with open reduction and internal fixation using extramedullary plate and intramedullary pinning. During follow-up, the radiographic examination was conducted to evaluate the status of bone union, heterotopic ossification and post-traumatic arthritis. The functional assessment was performed to evaluate clinical effects, which included measurements of range of motion in the elbow, Visual Analog Scale score, Elbow Self-Assessment score, Mayo Elbow Performance score, and Disabilities of the Arm, Shoulder, and Hand (DASH)Outcome Measure score.ResultsAfter a mean follow-up of 44 months (range, 36 to 48), the average range of motion in elbow flexion-extension was 125° with supination of 84°and pronation of 74°. Based on the Elbow Self-Assessment score, there was one very good, two good, one satisfied, and one sufficient, respectively. The mean Visual Analog Scale score for pain was 1 (range, 0 to 3) and the mean Mayo Elbow Performance score was 83 (range, 70 to 95). The DASH score revealed good to excellent results with a mean score of 10 (range, 2.3 to 27). Two patients had mild signs of posttraumatic arthritis, and heterotopic ossifications rating as grade I were observed in three patients. However, none of them was affected in daily life. ConclusionCollectively, intramedullary pinning with extramedullary plate fixation is feasible in unstable comminuted radial head fractures, which can be considered as a remedial surgery for on-table reconstruction technique.

Lateral Collateral Ligament Repair for Hallux Metatarsophalangeal Joint Instability in a Collegiate Sumo Wrestler: A Case Report

2021 ◽  
Vol 111 (1) ◽  
Author(s):  
Sadanori Shimizu ◽  
Tetsuya Sato ◽  
Tomohiko Tateishi ◽  
Tsuyoshi Nagase ◽  
Teruhiko Nakagawa ◽  
...  
Keyword(s):  
Athletic Performance ◽  
Joint Instability ◽  
Lateral Collateral Ligament ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Bone ◽  
Burr Hole ◽  
Ligament Repair ◽  
Collateral Ligament ◽  
Surgical Treatments

Although sprains of the hallux metatarsophalangeal (MTP) joint ligaments occur in barefooted martial arts athletes, few studies discuss the surgical treatments for lateral collateral ligament damage. We report herein a case of lateral collateral ligament repair for chronic hallux MTP joint instability. A 21-year-old male collegiate sumo wrestler injured his left hallux by snagging it on a sumo straw bale at 14 years of age. After entering university (4 years after the injury), he could no longer put weight on his foot at the left hallux; his athletic performance deteriorated, and he was referred to our department by his doctor. He had instability in the MTP joint of the left hallux, and magnetic resonance imaging revealed a tear in the attachment of the lateral collateral ligament to the metatarsal bone. Conservative treatment, such as taping, did not improve the symptoms; thus, surgery was performed, which consisted of passing a strong suture attached to the capsular ligament through a burr hole made in the metatarsal bone and fixing it to the burr-hole wall using an anchor. Postoperatively, the patient's joint instability improved, and he returned to competitive wrestling 4 months after surgery. He was able to put weight on his left hallux, and his athletic performance improved. The follow-up period after surgery was 2 years. In competitive sumo wrestling, hallux weakness and joint instability lead to a significant reduction in performance. Thus, ligament repair is an effective treatment for hallux MTP joint instability that cannot be treated by conservative means.

Elbow Trauma

2019 ◽  
pp. 62-64
Author(s):  
Michael O’Keeffe ◽  
Kiran Khursid ◽  
Peter L. Munk ◽  
Mihra S. Taljanovic
Keyword(s):  
Operative Treatment ◽  
Radial Head ◽  
Preoperative Assessment ◽  
The Body ◽  
Synovial Joint ◽  
Radial Head Fractures ◽  
Elbow Trauma ◽  
Acute Injuries ◽  
Large Joint

Chapter 14 discusses elbow trauma. The elbow is a hinge synovial joint that consists of the ulnohumeral, radiocapitellar, and proximal radioulnar joints. The olecranon and radial head fractures are common and may occur secondary to direct trauma or with transmitted forces from an injury such as a fall on an outstretched hand. The elbow is the second most commonly dislocated large joint of the body. Radiographs are the mainstay in the evaluation of acute injuries and treatment follow-up. CT examination is helpful in preoperative assessment of complex fractures/injuries. All elbow dislocations are initially close reduced and splinted. Further conservative versus operative treatment depends on complexity of injury.

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