scholarly journals Engaging Posterior Capitellum Fracture and Elbow Posterolateral Rotatory Instability: Is It Always Necessary to Treat the Bone Defect?

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Juan M. Patiño ◽  
Juan M. Torres Moirano
Keyword(s):  
Bone Defect ◽  
Pivot Shift ◽  
Treatment Plan ◽  
Elbow Dislocation ◽  
Ulnar Collateral Ligament ◽  
Pivot Shift Test ◽  
Dash Score ◽  
Left Elbow ◽  
Mayo Score ◽  
Lateral Ulnar Collateral Ligament

Case. We present a 23-year-old male with 7 episodes of left elbow dislocation during a two-year period. He had a positive pivot shift test with engaging. The original treatment plan included lateral ulnar collateral ligament reconstruction and eventually bone defect grafting and osteosynthesis. However, a bone graft was not performed. After 2 years of follow-up, the DASH score was 3.3. The Mayo Score was 90. Conclusion. Posterolateral instability associated with an engaging bone defect, in every elbow extension and pivot shift test, was not found in the literature. The capitellum defects are associated with PLRI and make it worse. Bone reconstruction may not be indicated.

scholarly journals Osborne-Cotterill Lesion a Forgotten Injury: Review Article and Case Report

2020 ◽  
Vol 23 (1) ◽  
pp. 27-30
Author(s):  
Daniel Gaitán Vargas ◽  
Santiago Woodcock ◽  
Guido Fierro Porto ◽  
Juan Carlos Gonzalez
Keyword(s):  
Radial Head ◽  
Elbow Dislocation ◽  
Ulnar Collateral Ligament ◽  
Osteochondral Fracture ◽  
Left Elbow ◽  
Pathological Conditions ◽  
Lateral Ulnar Collateral Ligament ◽  
Bony Lesion ◽  
Work Up ◽  
Posterolateral Margin

Osborne-Cotterill lesion is an osteochondral fracture located in the posterolateral margin of the humeral capitellum, which may be associated with a defect of the radial head after an elbow dislocation. This lesion causes instability by affecting the lateral ulnar collateral ligament over its capitellar insertion, which is associated with a residual capsular laxity, thereby leading to poor coverage of the radial head, and hence resulting in frequent dislocations. We present a 54-year-old patient, a physician who underwent trauma of the left elbow after falling from a bike and suffered a posterior dislocation fracture of the elbow. The patient subsequently presented episodes of instability, and additional work-up studies diagnosed the occurrence of Osborne-Cotterill lesion. An open reduction and internal fixation of the bony lesion was performed, with reinsertion of the lateral ligamentous complex. Three months after surgery, the patient was asymptomatic, having a flexion of 130º and extension of 0º, and resumed his daily activities without any limitation. Currently, the patient remains asymptomatic 2 years after the procedure. Elbow instability includes a large spectrum of pathological conditions that affect the biomechanics of the joint. The Osborne-Cotterill lesion is one among these conditions. It is a pathology that is often forgotten and easily overlooked. Undoubtedly, this lesion requires surgical intervention.

Surgeon Experience Level Affects Mechanics of the Pivot Shift Test for Posterolateral Rotatory Instability of the Elbow

2009 ◽  
Author(s):  
Thomas Chu ◽  
Jen M. Ty ◽  
Bayram Orazov ◽  
Nicole Strauss ◽  
Oliver M. O’Reilly ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Ulnar Collateral Ligament ◽  
Pivot Shift Test ◽  
Full Extension ◽  
Rotatory Instability ◽  
Posterolateral Rotatory Instability ◽  
Lateral Ulnar Collateral Ligament ◽  
Surgeon Experience ◽  
Improve Accuracy ◽  
Level Of Training

Posterolateral rotatory instability (PLRI) of the elbow occurs secondary to an injury to the lateral ulnar collateral ligament and lateral stabilizing structures [2]. The lateral pivot-shift test (PST) is a clinical examination for diagnosing PLRI [1]. The test involves moving the elbow from full extension to flexion while applying simultaneous supination torque, valgus moment, and axial compression [2]; a positive result is characterized by ulnohumeral subluxation that is seen clinically as posterolateral movement of the radial head and an incongruent radiocapitellar joint [2]. The PST is difficult to reliably reproduce in an office setting [3]. This can be due to patient-guarding or inexperience of the examiner. It is likely that the experienced examiner may perform the test differently from the inexperienced examiner. The PST has not previously been characterized biomechanically in the laboratory. Thus, the objective of this study is to fully characterize the biomechanics of the PST for PLRI. We will evaluate the repeatability of the PST across multiple surgeons and determine how the clinician’s level of training affects their method of testing. These results will be useful in developing training guidelines to standardize PST application as well as to improve accuracy.

Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability of the Elbow: A Systematic Review

Hand ◽  
2020 ◽  
pp. 155894472091776
Author(s):  
Austin Fares ◽  
Nicholas Kusnezov ◽  
John C. Dunn
Keyword(s):  
Systematic Review ◽  
Elbow Dislocation ◽  
Ulnar Collateral Ligament ◽  
Tendon Graft ◽  
Common Mechanism ◽  
Collateral Ligament ◽  
Rotatory Instability ◽  
Posterolateral Rotatory Instability ◽  
Additional Surgery ◽  
Lateral Ulnar Collateral Ligament

Background: Posterolateral rotatory instability (PLRI) is a common form of recurrent elbow instability. The aim of this systematic review is to present the outcomes and complications of lateral ulnar collateral ligament (LUCL) reconstruction surgery for PLRI. Methods: A literature search of LUCL reconstructions was performed, identifying 99 potential papers; 11 of which met inclusion/exclusion criteria, accounting for 148 patients. Papers were included if they reviewed cases of PLRI from 1976 to 2016 with reported outcome measures. Data were pooled and analyzed focusing on patient demographics as well as subjective and objective patient outcomes and complications. Results: The average age of patients was 34 years with a mean follow-up time of 49.8 months. The most common mechanism of injury was a traumatic elbow dislocation (66%), followed by cubitus varus deformity (7%), and unknown mechanisms (7%). Overall, 90% of patients achieved elbow stability and 2.7% experienced a failed reconstruction that necessitated an additional surgery. Furthermore, 93% were satisfied with the outcome of the reconstruction, and 83% reported good to excellent outcomes with 11% reporting moderate to severe persistent pain. Nearly half (45%) of reconstructions were done using a palmaris longus tendon graft, 24% with a triceps tendon graft, and 7% with a synthetic graft. Conclusions: Outcomes following LUCL reconstruction for PLRI are excellent and revision rates are low. LUCL reconstruction is a safe and reliable procedure. Level of Evidence: IV Therapeutic

scholarly journals Effect of meniscal root tear on pivot shift test after anterior cruciate ligament-deficient

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0052
Author(s):  
Ming Zhou
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Pivot Shift Test ◽  
High Grade ◽  
Posterior Root ◽  
Meniscal Root Tear ◽  
Tibial Translation ◽  
Acl Deficient ◽  
Deficient Knee

Introduction: A review of the literature demonstrates that injury of the lateral meniscus, anterolateral capsule, and iliotibial(IT ) band or small lateral tibial plateau aggravate the instability of knee and contributes to a high-grade pivot shift in the ACL-deficient knee. Hypotheses: The hypothesis was that disruption of posterior root of the lateral meniscus will further destabilize the ACL-deficient knee and simulated a high-grade pivot shift but posterior root of medial meniscal not. Methods: 6 fresh-frozen cadaveric knees was performed the next test in a custom activity simulator.1.Determine the effect of PRLMT on the stability of ACL-deficient knee.In the pivot shift test, ITB force (50, 75, 100, 125, 150, and 175 N), internal rotation moments (1, 2, and 3 N.m),and valgus moments (5 and 7 N.m). tibial translation of front drawer test were performed by applying a 90-N anterior

scholarly journals Arthroscopically-assisted fixation of anteromedial coronoid facet fracture and lateral ulnar collateral ligament repair for acute posteromedial rotatory fracture dislocation of the elbow

2017 ◽  
Vol 11 (5) ◽  
pp. 378-383 ◽  
Author(s):  
Abbas Rashid ◽  
David Copas ◽  
Jeremy Granville-Chapman ◽  
Adam Watts
Keyword(s):  
Articular Surface ◽  
Ulnar Collateral Ligament ◽  
Fracture Dislocation ◽  
Ligament Repair ◽  
Collateral Ligament ◽  
Coronoid Fracture ◽  
Elbow Arthroscopy ◽  
Lateral Ulnar Collateral Ligament ◽  
Arthroscopically Assisted ◽  
Facet Fracture

If left untreated, varus posteromedial rotatory injuries of the elbow result in poor functional outcomes. Surgical treatment allows restoration of elbow kinematics, minimizing the chances of chronic varus instability and early onset osteoarthritis. However, large exposures are associated with extensive soft tissue stripping, a high risk of infection, nerve injury, poor visualization of the articular surface and longer recovery. Consequently, there has been renewed interest in the use of elbow arthroscopy to circumvent these problems. Arthroscopic treatment offers the potential advantage of a swift recovery, with instant rehabilitation, less stiffness and swelling than might be expected after open repair. We present the first combined arthroscopic-assisted anteromedial facet coronoid fracture fixation and lateral ulna collateral ligament repair in a varus posteromedial rotatory injury of the elbow.

Effect of Meniscocapsular and Meniscotibial Lesions in ACL-Deficient and ACL-Reconstructed Knees: A Biomechanical Study

2018 ◽  
Vol 46 (10) ◽  
pp. 2422-2431 ◽  
Author(s):  
Nicholas N. DePhillipo ◽  
Gilbert Moatshe ◽  
Alex Brady ◽  
Jorge Chahla ◽  
Zachary S. Aman ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Medial Meniscus ◽  
Pivot Shift ◽  
External Rotation ◽  
Posterior Horn ◽  
Pivot Shift Test ◽  
Anterior Tibial Translation ◽  
Anterior Tibial ◽  
Tibial Translation ◽  
Acl Deficient

Background: Ramp lesions were initially defined as a tear of the peripheral attachment of the posterior horn of the medial meniscus at the meniscocapsular junction. The separate biomechanical roles of the meniscocapsular and meniscotibial attachments of the posterior medial meniscus have not been fully delineated. Purpose: To evaluate the biomechanical effects of meniscocapsular and meniscotibial lesions of the posterior medial meniscus in anterior cruciate ligament (ACL)–deficient and ACL-reconstructed knees and the effect of repair of ramp lesions. Study Design: Controlled laboratory study. Methods: Twelve matched pairs of human cadaveric knees were evaluated with a 6 degrees of freedom robotic system. All knees were subjected to an 88-N anterior tibial load, internal and external rotation torques of 5 N·m, and a simulated pivot-shift test of 10-N valgus force coupled with 5-N·m internal rotation. The paired knees were randomized to the cutting of either the meniscocapsular or the meniscotibial attachments after ACL reconstruction (ACLR). Eight comparisons of interest were chosen before data analysis was conducted. Data from the intact state were compared with data from the subsequent states. The following states were tested: intact (n = 24), ACL deficient (n = 24), ACL deficient with a meniscocapsular lesion (n = 12), ACL deficient with a meniscotibial lesion (n = 12), ACL deficient with both meniscocapsular and meniscotibial lesions (n = 24), ACLR with both meniscocapsular and meniscotibial lesions (n = 16), and ACLR with repair of both meniscocapsular and meniscotibial lesions (n = 16). All states were compared with the previous states. For the repair and reconstruction states, only the specimens that underwent repair were compared with their intact and sectioned states, thus excluding the specimens that did not undergo repair. Results: Cutting the meniscocapsular and meniscotibial attachments of the posterior horn of the medial meniscus significantly increased anterior tibial translation in ACL-deficient knees at 30° ( P ≤ .020) and 90° ( P < .005). Cutting both the meniscocapsular and meniscotibial attachments increased tibial internal (all P > .004) and external (all P < .001) rotation at all flexion angles in ACL-reconstructed knees. Reconstruction of the ACL in the presence of meniscocapsular and meniscotibial tears restored anterior tibial translation ( P > .053) but did not restore internal rotation ( P < .002), external rotation ( P < .002), and the pivot shift ( P < .05). To restore the pivot shift, an ACLR and a concurrent repair of the meniscocapsular and meniscotibial lesions were both necessary. Repairing the meniscocapsular and meniscotibial lesions after ACLR did not restore internal rotation and external rotation at angles >30°. Conclusion: Meniscocapsular and meniscotibial lesions of the posterior horn of the medial meniscus increased knee anterior tibial translation, internal and external rotation, and the pivot shift in ACL-deficient knees. The pivot shift was not restored with an isolated ACLR but was restored when performed concomitantly with a meniscocapsular and meniscotibial repair. However, the effect of this change was minimal; although statistical significance was found, the overall clinical significance remains unclear. The ramp lesion repair used in this study failed to restore internal rotation and external rotation at higher knee flexion angles. Further studies should examine improved meniscus repair techniques for root tears combined with ACLRs. Clinical Relevance: Meniscal ramp lesions should be repaired at the time of ACLR to avoid continued knee instability (anterior tibial translation) and to eliminate the pivot-shift phenomenon.

scholarly journals Inveterate elbow dislocation: surgical reduction with triceps lengthening

2021 ◽  
Vol 8 (9) ◽  
Keyword(s):  
Mayo Clinic ◽  
Physical Therapist ◽  
Elbow Dislocation ◽  
Elbow Flexion ◽  
Plaster Cast ◽  
Lateral Approach ◽  
Surgical Reduction ◽  
Left Elbow ◽  
Triceps Muscle ◽  
K Wires

Inveterate elbow dislocations remain common in developing countries. We report the case of a 17-year-old child who consulted us after six months of trauma to the left elbow. Clinical examination revealed a deformed elbow, locked in extension with a mobility sector of 5°. The Mayo Clinic Elbow performance score was sixty-six; the downstream vasculo-nervous examination was normal. The face and profile X-ray of the elbow showed a pure posterolateral elbow dislocation. We used the posterior medial para-tricipital and lateral approach, a first stage of arthrolysis was performed. A complete reduction was achieved by progressive and non-traumatic gentle maneuvers. Intraoperative elbow flexion was less than 80°, indicating a retraction of the triceps muscle, so a Z-lengthening plasty was necessary. This reduction was then fixed with two olecranon-humeral K-wires. At the third week, the plaster cast and K-wires were removed. The patient was subsequently referred to a physical therapist. After a ten-month follow-up, an undistorted and functional elbow with a gain of twenty-one points according to the Mayo Clinic score was obtained. Surgical reduction of a neglected elbow dislocation with triceps lengthening plasty, followed by a codified physical therapy program, results in a remarkable restoration of elbow function and stability. Keyword : elbow, dislocation, inveterate, reduction, triceps.

scholarly journals 3D Printing Individualized Assisted Repair and Reconstruction of Irregular Bone Neoplastic Bone Defects: Exploration and Practice in Scapular Aneurysmal Cystic Bone Defects

2021 ◽  
Author(s):  
Guochen Luo ◽  
yao Zhang ◽  
Xiahua Wang ◽  
Shuaishuai Chen ◽  
Dongyi Li ◽  
...  
Keyword(s):  
3D Printing ◽  
Bone Defect ◽  
Bone Tumor ◽  
Surgical Approach ◽  
Treatment Plan ◽  
Operation Time ◽  
Bone Defects ◽  
Anatomical Structure ◽  
Medical Software

Abstract Objective: To explore the clinical efficacy of using 3D printing individualized treatment plan in the auxiliary repair and reconstruction of irregular bone tumor bone defect.Methods：Seven patients with aneurysmal bone cyst of scapula were selected. Based on the CT data of the patient, the scapula (including defect) and pelvis were reconstructed by computer Mimics Medical software. Print out the reconstructed scapula model with a 3D printer. Before operation, the model was used to design the surgical approach and simulate the operation process, to determine the length and Radian of the plate and the number and direction of screws, and to determine the bone mass of the ilium and make reasonable segmentation and distribution. The operation time, the amount of bleeding, the length and Radian of the plate, and the direction and number of screws were recorded.Results : The average follow-up time was 25.6 months, and none of the 7 patients had recurrence during the follow-up period; The surgical approach, the length and Radian of the internal fixation, the number and direction of screws were consistent with the designed operation plan. The anatomical structure of scapula and the function of shoulder joint gradually recovered.Conclusions: Compared with traditional methods, the use of 3D printing technology in the treatment of irregular bone tumor bone defect has less trauma, shorter operation time and less bleeding, which can reduce the waste of bone graft and reconstruct the anatomical structure of bone defect more completely.

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