Elbow Dislocation With Intra-Articular Fracture: The Results of Operative Treatment Without Repair of the Medial Collateral Ligament

Background The present report describes subluxation and dislocation of the elbow with articular fracture of the distal humerus and injury to the medial collateral ligament, a type of elbow fracture-dislocation about which little is available in the literature. Methods Twenty-two patients with subluxation or dislocation of the elbow (with injury to the medial collateral ligament) and a fracture of the distal humerus articular surface (capitellum/trochlea) were identified. Seventeen patients had a minimum of 12 months follow-up and eight patients returned for a long-term follow-up at a median of 36 months (range 12 months to 154 months) after injury. Results Nine patients had one or more subsequent surgeries. Seven patients had surgery to address complications and two had a planned implant removal. The final median arc of elbow flexion was 120° (range 100° to 145°) and the median arc of forearm rotation was 175° (range 150° to 180°). The median Broberg and Morrey score was 88 points (range 63 points to 100 points) and the median Disabilities of the Arm Shoulder and Hand score was 9 points (range 1 point to 43 points). Discussion Some elbow dislocations and subluxations are associated with osteochondral fractures of the distal humeral articular surface.

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Comparison between Operative and Non-Operative Treatment of the Medial Collateral Ligament: Histological and Ultrastructural Findings during Early Healing in the Epiligament Tissue in a Rat Knee Model

Cells Tissues Organs ◽

10.1159/000496985 ◽

2018 ◽

Vol 206 (3) ◽

pp. 165-182

Author(s):

Georgi P. Georgiev ◽

Georgi Kotov ◽

Alexandar Iliev ◽

Plamen Kinov ◽

Jordanka Angelova ◽

...

Keyword(s):

Statistical Analysis ◽

Operative Treatment ◽

Medial Collateral Ligament ◽

Normal Function ◽

Ultrastructural Changes ◽

Vascular Bundles ◽

Collateral Ligament ◽

Electron Microscopic ◽

Thin Sections ◽

Significant Difference

The medial collateral ligament of the knee joint is one of the most commonly injured ligaments of the knee. Recent data have shown that the thin layer of connective tissue covering the ligament, known as the epiligament, is essential for its nutrition and normal function, as well as its healing after injury. The aim of the present study was to investigate and compare the changes in the epiligament of the medial collateral ligament which occurred during operative and non-operative treatment throughout the first month after injury. We used 27 male Wistar rats randomly allocated to three groups. In the 9 rats belonging to the first group, the medial collateral ligament was fully transected and left to heal spontaneously without suture. In the 9 rats belonging to the second group, the transected ends were marked with a 9–0 nylon monofilament suture. The 9 rats in the third group were used as normal controls. Three animals from each group were sacrificed on days 8, 16, and 30 after injury. Light microscopic analysis was performed on semi-thin sections stained with 1% methylene blue, azure II, and basic fuchsin. Transmission electron microscopy was used to study and compare the ultrastructural changes in the epiligament. The statistical analysis of the obtained data was performed using the Kruskal-Wallis H test and Mood’s median test. The normal structure of the epiligament of the medial collateral ligament was presented by fibroblasts, fibrocytes, adipose cells, mast cells, collagen fibers, and neuro-vascular bundles. On days 8 and 16 postinjury, the epiligament appeared hypercellular and returned to its normal appearance on the thirtieth day postinjury. The electron microscopic study revealed the presence of different types of fibroblasts with the typical ultrastructural features of collagen-synthetizing cells. The comparative statistical analysis on the respective day showed that there was no statistically significant difference in the number of cells between spontaneously healing animals and animals recovering with suture application. These data further prove that spontaneous healing of the medial collateral ligament yields similar results to surgical treatment and may be used as a basis for the development of treatment regimens with improved patient outcome.

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Operative Treatment for a Painful Nonunion Avulsion Fracture of the Femoral Attachment of the Medial Collateral Ligament in a Teenager

JBJS Case Connector ◽

10.2106/jbjs.cc.17.00281 ◽

2019 ◽

Vol 9 (2) ◽

pp. e0281-e0281 ◽

Cited By ~ 1

Author(s):

Jacob G. Calcei ◽

Jensen K. Henry ◽

Joash R. Suryavanshi ◽

Jonathan M. Schachne ◽

Peter D. Fabricant

Keyword(s):

Operative Treatment ◽

Medial Collateral Ligament ◽

Avulsion Fracture ◽

Collateral Ligament ◽

Femoral Attachment

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Non-operative treatment of acute medial collateral ligament lesions of the knee joint

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/bf01565459 ◽

1993 ◽

Vol 1 (2) ◽

pp. 93-96 ◽

Cited By ~ 33

Author(s):

J. Petermann ◽

T. von Garrel ◽

L. Gotzen

Keyword(s):

Knee Joint ◽

Operative Treatment ◽

Medial Collateral Ligament ◽

Collateral Ligament

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Development of 3D Finite Element Model of Human Elbow to Study Elbow Dislocation and Instability

ASME 2009 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2009-206282 ◽

2009 ◽

Cited By ~ 4

Author(s):

Samer Khodor Al Kork ◽

Farid Amirouche ◽

Edward Abraham ◽

Mark Gonzalez

Keyword(s):

Finite Element ◽

Medial Collateral Ligament ◽

Inverse Dynamics ◽

Elbow Dislocation ◽

Lateral Collateral Ligament ◽

Element Model ◽

Fe Model ◽

Collateral Ligament ◽

Coronoid Fracture ◽

Flexion Extension

The mechanics of elbow dislocation and its stages of dislocation are complex and not well understood. Reconstructing a fall where someone lands on their hand is one of the most challenging problem in biomechanics. Current models which attempt to reconstruct falls usually focus on experimental kinematical conditions that cause the fall coupled with inverse dynamics to determine the joint and muscles forces [1,2] to provide on insight into the joint instability. Our hypothesis based on our experimental investigation is that the mechanism of posterior elbow dislocation is initiated at radial head where the ulna and coronoid fracture followed by anterior tearing of the joint capsule, lateral collateral ligament will then rupture followed by posterior medial collateral ligament rupture and then the medial collateral ligament peeling off the ulna. In this study we developed a quasi-static three-dimensional finite element of human elbow joint, and conducted several cadaveric studies to study elbow dislocation. The FE model is used to investigate how the ligaments, cartilages behave under different flexion, extension of the elbow. Dislocation is investigated as function of different loads and moments applied to the radius-ulna with arm being flexed and configured into a supination or pronation.

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