scholarly journals The patient-specific implant created with 3D printing technology in treatment of a severe open distal humerus fracture with complete loss of the lateral column

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902096025
Author(s):  
Suriya Luenam ◽  
Arkaphat Kosiyatrakul ◽  
Kantapat Phakdeewisetkul ◽  
Chedtha Puncreobutr
Keyword(s):  
Articular Surface ◽  
Lateral Collateral Ligament ◽  
Humeral Fracture ◽  
Distal Humerus ◽  
Patient Specific ◽  
Iliac Crest Bone Graft ◽  
Favorable Result ◽  
Printing Technology ◽  
Lateral Column ◽  
Distal Humeral Fracture

The open distal humeral fracture associated with the major loss of the articular surface and bony structure is a challenging problem for orthopedic surgeons. In this case report, we describe a case of complete missing lateral column of the distal humerus with severe articular destruction of capitellum and lateral trochlear ridge which was treated with the patient-specific implant created with three-dimensional printing technology. Apart from anatomic replacement of the articular surface, the lateral collateral ligament complex and extensor muscle which are the key soft tissue stabilizers of elbow were repaired by reattaching their bony origins to the impacted iliac crest bone graft inside the implant. Due to the favorable result at 2-year follow-up, this modality is a potentially viable surgical option in treating of the severe open distal humeral fracture associated with entire lateral condylar damage.

scholarly journals Chronic type C3 distal humeral fracture associated with massive bone defects treated by open reduction and internal fixation with iliac crest autografts: a case report

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yejun Zha ◽  
Kehan Hua ◽  
Maoqi Gong ◽  
Xieyuan Jiang
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Iliac Crest ◽  
Humeral Fracture ◽  
Distal Humerus ◽  
Bone Defects ◽  
Trochlear Groove ◽  
Chronic Type ◽  
Distal Humeral Fracture ◽  
Massive Bone

Abstract Background Chronic intercondylar fractures of the distal humerus with massive bone defects and severe comminution in the metaphysis are rare and complex injuries that are challenging for surgeons to treat, as reconstructing the triangular structure of the distal humerus is difficult and may have a severe impact on functional outcomes, especially in young patients, for whom total elbow arthroplasty is usually not a suitable option due to significant impairment in upper limb strength. Here, we report a patient in such scenario who was young and active and was treated by structural iliac bone autografting and internal fixation. Case presentation A 26-year-old male patient experienced a major car accident and was diagnosed with an open fracture (Gustilo-Anderson type IIIB) of the right distal humerus with massive bone defects and severe intra-articular involvement, without neurovascular injuries or other associated injuries. Surgical debridement, negative pressure vacuum sealing drainage, and immobilization by braces were initially performed, and the wound was closed after 15 days. When the wound had finally healed and the soft tissue was in good condition without infection or effusion 45 days later, this young and active patient was diagnosed with a chronic type C3 distal humeral fracture associated with massive bone defects at the supracondylar level in both columns and severe comminution at the trochlear groove. We performed surgical debridement and arthrolysis around the fracture site, and then, we successfully reconstructed the triangular structure of the distal humerus using structural iliac crest autografts in both columns as well as in the defective trochlear groove. Finally, internal fixation via a parallel double-plate configuration was performed. Over a follow-up period of 3 years, the patient achieved almost full recovery of range of motion and an excellent functional score, without minor or major postoperative complications. Conclusion In this study, we proposed a surgical reconstruction strategy for complex chronic distal humeral fractures associated with massive bone defects and severe articular involvement in young and active patients using metaphyseal shortening and structural iliac crest bone autografting together with open reduction and internal fixation via a parallel configuration.

scholarly journals The Patient-Specific Implant Created with 3D Printing Technology in Treatment of the Irreparable Radial Head in Chronic Persistent Elbow Instability

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Suriya Luenam ◽  
Arkaphat Kosiyatrakul ◽  
Chanon Hansudewechakul ◽  
Kantapat Phakdeewisetkul ◽  
Boonrat Lohwongwatana ◽  
...  
Keyword(s):  
3D Printing ◽  
Radial Head ◽  
Radial Head Fracture ◽  
Present Report ◽  
Patient Specific ◽  
Favorable Result ◽  
Elbow Instability ◽  
Printing Technology ◽  
3D Printing Technology ◽  
Orthopedic Surgeons

Successful treatment of the chronic persistent elbow instability is a challenge for orthopedic surgeons. In this form, it is important to recognize and restore the osseous stabilizer in order to obtain the concentric reduction. In the present report, we describe a case of such injury with irreparable radial head treated with patient-specific radial head prosthesis which was created with 3D printing technology. To our knowledge, this is the first report in clinical use of this kind of prosthesis for the radial head fracture. At a 24-month follow-up visit, the patient was satisfied with the functional outcomes. The Mayo Elbow Performance Index (MEPI) increased from 20 points at the preoperative day to 85 points, and the patient-based Disabilities of the Arm, Shoulder, and Hand (DASH) was reduced from 88.33 points to 28.33 points. Due to the favorable result, replacement of the radial head with the patient-specific implant could be a useful treatment for the irreparable radial head in chronic persistent elbow instability.

scholarly journals The use of locking plates in complex midfoot fractures

2012 ◽  
Vol 94 (8) ◽  
pp. 593-596 ◽  
Author(s):  
E Bayley ◽  
N Duncan ◽  
A Taylor
Keyword(s):  
Articular Surface ◽  
Open Reduction Internal Fixation ◽  
Locking Plates ◽  
Lateral Column ◽  
Improved Outcomes ◽  
Fracture Dislocations ◽  
Angle Stable ◽  
Post Traumatic ◽  
Neurological Injuries

INTRODUCTION Complex fracture dislocations of the midfoot are uncommon. Improved outcomes have been demonstrated where it has been possible to restore and maintain the length and alignment of the medial column as well as the congruity of the articular surfaces. We present our experience with the use of angle-stable locking plates in the stabilisation of complex midfoot fracture dislocations. METHODS Twelve patients were identified on a prospective trauma database between 2003 and 2009. All fractures involved the medial column with four associated fracture subluxations of the lateral column also. Patients underwent open reduction internal fixation (ORIF) with restoration of the medial column axis, reduction of the articular surface congruity and stabilisation with angle-stable locking plates. RESULTS There were no post-operative infections or neurological injuries. Ten of the twelve patients required metalwork removal. There were no implant failures prior to removal of the metalwork. At a mean follow-up of 12.4 months (range: 4–32 months), 11 patients had minimal symptoms of swelling, discomfort or stiffness in the midfoot. This did not restrict their daily activities. One patient developed post-traumatic arthritis and collapse of the medial longitudinal arch. Two patients declined removal of the metalwork. CONCLUSIONS Angle-stable locking plates provide satisfactory stabilisation following ORIF of complex midfoot fracture dislocations. Most patients will require removal of the metalwork. Following removal of metalwork, the majority of patients will maintain the length, alignment and stability of the midfoot.

scholarly journals Study of clinical outcome in intra articular distal humerus fractures treated with dual plating

2017 ◽  
Vol 5 (6) ◽  
pp. 2438
Author(s):  
Riyaz B. Shaik ◽  
Venugopala Reddy P. ◽  
Ashok Naidu K.
Keyword(s):  
Clinical Outcome ◽  
Road Traffic ◽  
Distal Humerus ◽  
Complex Nature ◽  
Lateral Column ◽  
Dual Plating ◽  
Surgical Fixation ◽  
Humerus Fractures ◽  
Distal Humerus Fractures ◽  
Fracture Humerus

Background: In adults, distal humerus fractures are uncommon and intra-articular, oftenly involve both the medial and lateral columns. Open reduction and surgical fixation with plating gives good results. The aim of this study is to evaluate clinical outcome in intra articular distal humerus fractures treated with dual plating.Methods: This is a prospective type of study of 20 cases of supra condylar fracture humerus with inter condylar extension treated surgically with dual plating one on the medial boarder and another on posterior surface of lateral column using standard dorsal approach, olecranon osteotomy.Results: The range of age was between 18-52 years, with mean age of 32.55 years. The maximum incidence was between 18 to 40 years i.e. 16 cases (80%). With road traffic accident (RTA) as major cause of injury. Most   of the patients were males 14 (70%) with right upper limb was involved in 12 (60%) cases. According   to MEP score clinical outcome was excellent in 4(20%) good in 10(50%) fair in 5(25%) and poor in one (10%).Conclusions: Distal humerus fractures are known for their complex nature and technical difficult in surgical management. Proper anatomical articular reconstruction and stable fixation helps in restoring painless and functional elbow.

Effect of Calcaneal Lengthening on Relationships among the Hindfoot, Midfoot, and Forefoot

Foot & Ankle ◽  
1993 ◽  
Vol 14 (3) ◽  
pp. 136-141 ◽  
Author(s):  
Bruce J. Sangeorzan ◽  
Vincent Mosca ◽  
Sigvard T. Hansen
Keyword(s):  
Pitch Angle ◽  
Articular Surface ◽  
Angular Measurement ◽  
Pes Planus ◽  
Lateral Column ◽  
Medial Side ◽  
Significant Correction ◽  
Before And After ◽  
Calcaneal Lengthening ◽  
The Relationship

To better understand the bony component of pes planus and the means by which the Evans calcaneal lengthening corrects them, we studied the standing radiographs of seven adult patients who had undergone calcaneal lengthening to treat symptomatic pes planus. Weightbearing AP and lateral views done preoperatively and postoperatively were used for the study. For each set of films, the following parameters were measured: on the lateral view; overall length of the calcaneus, lateral talometatarsal angle, lateral talocalcaneal angle, and the calcaneal pitch angle; and on the dorsoplanar view, the talometatarsal and talocalcaneal angle. In addition, the relative coverage of the talus by the navicular was described by an angular measurement based on the relationship of the center of the talus to the center of the navicular. The average improvements in lateral talocalcaneal angle (a reflection of hind-foot valgus) was 6.4° when the long axis of the calcaneus was used and 6.8° when the inferior surface of the calcaneus was used for the measurement. The lateral talometatarsal angle improved an average 11.3° (from an average of 19.7° to 8.4°). The dorsoplantar talometatarsal angle (a measure of forefoot adduction/abduction) improved 15.8° (preoperative average 26.8°, postoperative average 11°). The calcaneal pitch angle improved an average 10.8° (preoperative average 3.2°, postoperative average 14°). The relationship between the talus and navicular was defined by an angular measurement based on the center of each articular surface before and after correction using this measurement. An average improvement of 26° occurred in the alignment of these two articular surfaces. This study confirms Evans' belief that significant correction can be obtained by lateral column lengthening, that the relationship between navicular and talus can be restored without fusion, and that the forefoot position corrects without operative intervention to the medial side of the foot. This study also provides numerical guidelines for the surgeon planning surgical correction of symptomatic pes planus, and since bony relationships can be observed before and after correction, some insight may be gained into tarsal morphology of pes planus.

scholarly journals 3D printing technology for the classification of complex distal humerus fractures

2018 ◽  
Vol 3 ◽  
pp. 96-96 ◽  
Author(s):  
Thomas M. Gregory ◽  
Jaber Alkhaili ◽  
Jonathan Silvera ◽  
Bruno Vitis ◽  
Camilo Chaves ◽  
...  
Keyword(s):  
3D Printing ◽  
Distal Humerus ◽  
Printing Technology ◽  
3D Printing Technology ◽  
Humerus Fractures ◽  
Distal Humerus Fractures

Elbow Dislocation and Articular Fracture of the Distal Humerus

2010 ◽  
Vol 2 (2) ◽  
pp. 111-117 ◽  
Author(s):  
Thierry G. Guitton ◽  
Andrew D. Duckworth ◽  
Margaret M. Mcqueen ◽  
Peter Kloen ◽  
David Ring
Keyword(s):  
Medial Collateral Ligament ◽  
Articular Surface ◽  
Present Report ◽  
Elbow Dislocation ◽  
Distal Humerus ◽  
Fracture Dislocation ◽  
Elbow Fracture ◽  
Collateral Ligament ◽  
Articular Fracture

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.

scholarly journals An anterior neurovascular interval approach to coronal shear fractures of the distal humerus: a prospective clinical study with short- to mid-term follow-up

2019 ◽  
Vol 65 (3) ◽  
pp. 355-360
Author(s):  
Xiao-Hua Yang ◽  
Chen Wei ◽  
Guo-Ping Li ◽  
Jian-Ji Wang ◽  
Hai-Tao Zhao ◽  
...  
Keyword(s):  
Shear Fracture ◽  
Articular Surface ◽  
Vascular Complications ◽  
Distal Humerus ◽  
Prospective Clinical Study ◽  
Time Interval ◽  
X Rays ◽  
Interval Approach ◽  
Elbow Function

SUMMARY OBJECT: To explore the treatment effect of the anterior medial neurovascular interval approach to coronal shear fractures of the distal humerus. METHODS: This prospective study included two female patients who were 30-64 years old, with a mean age of 47 years. Fractures were caused by falling from a bicycle. The time between the injury and operation was 1-2 days, with a mean time interval of 1.5 days. Two patients with coronal shear fracture of the distal humerus were treated with open reduction and internal fixation using anterior neurovascular interval approach. RESULTS: There were no intraoperative and postoperative neurological and vascular complications or infections, and the fracture was united. At 12 months after the surgery, the patient returned to work without pain, and with a normal range of motion for elbow and forearm rotation. The X-rays revealed excellent fracture union, no signs of heterotopic ossification, and no traumatic arthritis. According to Mayo's evaluation standards for elbow function, a score of 100 is excellent. CONCLUSIONS: The application of the anterior neurovascular interval approach of the elbow in the treatment of shear fracture of the articular surface of the distal humerus, particularly the trochlea of the humerus, can reduce the stripping of the soft tissue.

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