Open reduction in neglected elbow dislocation  in children: a case series

Background Elbow deformity in children due to neglected proper fracture management is a devastating condition. The stiffness and pain complicated the function in daily activity. Successful management of neglected elbow dislocation is a challenging problem for orthopedic surgeons. In this study, we aimed to evaluate results of open reduction for neglected elbow dislocation in children. Case Description This is a case series of 13-14 years old neglected elbow dislocations, for up to 15 months. Open reduction after external distractor and followed by intensive rehabilitation was implemented. Clinical and functional outcome were evaluated within 4-7 years. Initial average elbow flexion was 53,3°, extension was 0°, arc of flexion was 53,3°, arc of pronation-supination was 150° and Mayo Elbow Performance Index (MEPI) was 80. Clinical and functional outcome were evaluated within 4-7 years. At follow-up after open reduction, the improvement in whole range of movement was significant. Average elbow flexion was 118,3°, extension was 36,67°, arc of flexion was 81,67°, arc of pronation-supination was 133°. The average improvement of flexion was 65°, arc of flexion was 31,67°, and arc of pronation-supination was 8,3°. The average loss of flexion was 15,5%, arc of flexion was 44,2%, and arc of pronation-supination was 10,7% compared with uninjured side. The average Mayo Elbow Performance Index (MEPI) was 96,67; all with excellent results. Conclusion Planned and well execution open reduction in pediatric neglected elbow dislocation may bring back the painless movement within normal daily function.

Download Full-text

A Rare Case of Bilateral Spaghetti Injuries in Children due to Assault by Mother and Analysis of Functional Outcome at Three Years

Journal of Hand and Microsurgery ◽

10.1055/s-0041-1735346 ◽

2021 ◽

Author(s):

Parag B. Lad ◽

N. Venkateshwaran ◽

M. R. Thatte ◽

Sanket Tanpure

Keyword(s):

Functional Outcome ◽

Case Series ◽

Sensory Loss ◽

Nerve Reconstruction ◽

Range Of Movement ◽

Flexor Tendons ◽

Tendon Lengthening ◽

Flexor Tendon Injuries ◽

Life Threatening

AbstractManagement of child abuse with flexor tendons, neurovascular injuries, and life-threatening conditions is challenging. It needs a multisectoral coordinated and synchronized team effort for successful outcomes. We present a case series of children abused by a parent with a sharp object. The children sustained multiple flexor tendon injuries, neurovascular injuries in upper limbs, and tracheal injury compromising respiration. We performed a tracheostomy to save a child and subsequently repaired numerous flexor tendons, nerves, and arteries. During follow-up, these children required secondary reconstruction (tenolysis, tendon lengthening, nerve reconstruction) for flexor contractures, stiffness, and sensory loss in distal forearms. We measured the range of movements and assessed the children’s functional outcome using the Strickland score at 3-year follow-up. The range of movement and functional outcome was excellent in both children in our series. A timely performance of surgery, aided with efficient intensive care, therapy, and consistent posttraumatic psychosocial rehabilitation, produced excellent results in our series.

Download Full-text

PROXIMAL HUMERUS FRACTURES;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.12.571 ◽

2017 ◽

Vol 24 (12) ◽

pp. 1788-1793

Author(s):

Faisal Abdul Jabbar ◽

Rehana Ali Shah

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Avascular Necrosis ◽

Open Reduction ◽

Proximal Humerus ◽

Case Series ◽

Proximal Humerus Fractures ◽

Humerus Fractures ◽

The Mean

Objectives: The aim of our study is to study the radiological and functionaloutcome of proximal humerus fractures treated via open reduction and internal fixation usingthe proximal humerus internal locking system or PHILOS. Study Design: Case series study.Period 05 years duration from January 2011 to December 2015. Setting: Large tertiary carecentre in Karachi, Pakistan. Materials and methods: The study population consisted of n=50patients all of whom underwent open reduction and internal fixation utilizing the proximalhumeral internal locking system or PHILOS for fractures of the proximal humerus. The inclusioncriterion was all the patients with closed fractures of the proximal humerus and were belongingto 2,3 and 4 part of the Neer system of classification. Physiotherapy was started as soon aspossible for the patients. Serial radiographic imaging in two views was done at 6, 12, 24 and52 weeks postoperatively. For the functional outcome of the procedure Constant and Murleyscoring system was used. Data was analyzed using IBM SPSS version 21. Results: The studypopulation consisted of n= 50 patients of which n= 35 were males and n= 15 were femaleshaving a mean age of 38.50 years. The mean duration of follow up was 24 months. All thepatients in the study had union of fracture both radiographically and clinically, the mean timeduration for the radiographically evident union of the humerus bone was 12 weeks with a rangeof 8 to 20 weeks, the mean Constant Murley score for the functional outcome of the shoulderjoint was 79 at the final follow up with a range of 50 to 100. Complications were found in n= 9patients and varus malunion was the most common complication. In our case series we did notobserve complications such as avascular necrosis, non union or implant failure. Conclusion:According to the results of our study the proximal humerus internal locking system or PHILOSis a good method for open reduction and internal fixation of the proximal humerus fractures andprovides a stable fixation, and has lower incidence of complications such as avascular necrosis.

Download Full-text

Functional outcome of elbow joint in AO type 13C fractures treated with open reduction and internal fixation using dual plates

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191793 ◽

2019 ◽

Vol 5 (3) ◽

pp. 509

Author(s):

Uyyalawada Sreedhar Reddy ◽

Bheemsingh Samorekar ◽

Vinay J. Mathew ◽

Anil Kumar Mettu

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Distal Humerus ◽

Range Of Movement ◽

Excellent Outcome ◽

Significant Difference ◽

Dual Plating ◽

Type C ◽

A Prospective Study

Background: Distal end of the humerus, with its unique orientation of articular surfaces supported by a meagre amount of cancellous bone, makes its fracture a constant challenge to orthopaedic surgeons. Aim of the study is to evaluate the functional outcome of surgical management of intercondylar AO type C fractures of distal end of humerus using dual plating.Methods: A prospective study was conducted at our hospital between January 2015 to December 2016. Thirty five consecutive patients with intercondylar (AO Type C) fracture of distal humerus, included in study as per inclusion criteria. All patients were treated surgically using triceps reflecting approach and posterior trans-olecranon approach with ulnar nerve exploration and fixation using dual plating and tension band wiring for olecranon osteotomy wherever done.Results: In 35 patients, final results using MEPS scoring system excellent outcome is noticed in 15 patients (42.86%), good results is noticed in 13 patients (37.14%), fair result is noticed in 5 patients (14.29%) and poor result is noticed in 2 patients (5.71%). There was statistical significant difference in flexion range of movement arc at 2 and 6 months in our study.Conclusions: Open reduction and internal fixation of AO type 13C fractures is challenge to surgeon, preoperative planning and mastering the technique over a period of time gives good to excellent functional outcomes.

Download Full-text

Open reduction, triceps lengthening, and collateral ligaments reconstruction in neglected elbow dislocation: a case report

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20205329 ◽

2020 ◽

Vol 8 (12) ◽

pp. 4488

Author(s):

Henry Tirtosuharto ◽

Made Bramantya Karna ◽

Anak Agung Gde Yuda Asmara ◽

Putu Feryawan Meregawa

Keyword(s):

Open Reduction ◽

Articular Surface ◽

Elbow Dislocation ◽

Tendon Graft ◽

Fascia Lata ◽

Collateral Ligaments ◽

Range Of Movement ◽

Left Elbow ◽

Satisfactory Outcome ◽

Elbow Contracture

Neglected elbow dislocations are common in developing countries. Neglected elbow dislocation leads to retraction of triceps muscles and collateral ligaments. This cause limitation of range of movement that is inadequate for the activities of daily living. A 48 years old man presented with stiffness on the left elbow. He fell down with arm in extension position 8 months prior to admission and was treated by a traditional bonesetter before seeking medical treatment. Active ROM of the left elbow was limited to 15ᵒ during flexion. The patient diagnosed as left elbow contracture due to neglected left elbow dislocation. Open reduction, MCL-LCL reconstruction and triceps lengthening was performed. Left elbow ROM was improved and MEPI score was good on 5 months evaluation. Open reduction surgery was done to avoid the risk of fracture or articular surface damage. The posterior approach provides good exposure to the retracted posterior structures and give easier access to perform V-Y plasty used for triceps lengthening. Collateral ligaments repair provides immediate stability and give better functional results. Docking technique was used for collateral ligaments repair using fascia lata tendon graft. Immobilization and physical rehabilitation are done to improve elbow joints range of movement. Open reduction surgery, triceps lengthening and collateral ligaments reconstruction using tendon graft from tensor fascia lata give satisfactory outcome for elbow contracture due to neglected left elbow dislocation.

Download Full-text

Early outcome of open reduction and cross kirschner's wire fixation of neglected elbow dislocation: A case series

Nigerian Journal of Orthopaedics and Trauma ◽

10.4103/njot.njot_2_21 ◽

2021 ◽

Vol 20 (1) ◽

pp. 32

Author(s):

ObinnaHenry Obiegbu

Keyword(s):

Open Reduction ◽

Case Series ◽

Elbow Dislocation ◽

Early Outcome ◽

Wire Fixation

Download Full-text

Outcome of Neglected Elbow Dislocation Treated with Open Reduction at Rural Tertiary Care Hospital in Nepal

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v18i3.3093 ◽

2020 ◽

Vol 18 (3) ◽

pp. 525-528

Author(s):

Mangal Rawal ◽

Poojan Kumar Rokaya ◽

Dhan Bahadur Karki ◽

Kailash Kumar Bhandari ◽

Abhishek Kumar Thakur

Keyword(s):

Internal Fixation ◽

Performance Index ◽

Open Reduction ◽

Tertiary Care ◽

Elbow Dislocation ◽

Open Reduction Internal Fixation ◽

Care Hospital ◽

Dominant Hand ◽

Superficial Infection ◽

Replacement Arthroplasty

Background: Chronic unreduced dislocation of elbow is a rare injury. Treatment options include open reduction internal fixation with K wire, replacement arthroplasty, excisional arthroplasty, arthrodesis, and hinged external fixator. The aim of this study is to determine the outcome of open reduction internal fixation with trans-olecranon K wire for neglected elbow dislocation. Methods: This is a retrospective study done in three rural hospital of Karnali. Hospital records were reviewed from July 2015 to May 2018 to identify 11 cases who underwent open reduction internal fixation for neglected elbow dislocation. Pre and Postoperative outcome was assessed using range of motion and Mayo Elbow Performance Index. Data analysis was done using SPSS version 17. Results: The average age of patient was 22.7 years (range 9-50 years). Non dominant hand was involved in 54.55%. The average preoperative elbow extension was 5.9 degree whereas postoperative extension was 15.9 degree. The average preoperative and postoperative elbow flexion was 24.5? and 113.6? respectively. Preoperative and postoperative Mayo elbow performance index was 18.6 and 86.3 respectively. Outcome was excellent in four patients, good in five patients and fair in two patients with one case having superficial infection. Conclusions: Open reduction and internal fixation with trans-olecranon k wire is an effective treatment method for neglected elbow dislocation. Postoperatively, elbow function is better with minimal complications. Keywords: Dislocation; elbow; neglected; open reduction

Download Full-text

Paediatric Capitellar Fracture

Asian Journal of Medicine and Biomedicine ◽

10.37231/ajmb.2020.4.1.325 ◽

2020 ◽

Vol 4 (1) ◽

pp. 19-22

Author(s):

Kow RY ◽

Jaya Raj J ◽

Nik Nor Imam N.M.Z ◽

Mohd Daud KN

Keyword(s):

Open Reduction ◽

Case Reports ◽

Plain Radiograph ◽

Case Series ◽

Paediatric Population ◽

Lateral View ◽

Type I ◽

Range Of Movement ◽

Oblique View ◽

Excellent Outcome

Capitellar fracture in the paediatric population is extremely rare. There have been only a handful of case reports or case series in the literature. For this reason, it is likely to be missed or misdiagnosed. An untreated capitellar fracture poses a risk of severe compromise of the elbow function and range of movement. We present a rare case of type I capitellar fracture in an 11-year-old girl. She underwent open reduction and percutaneous Kirschner wiring and she subsequently recovered with excellent outcome. A high index of suspicion is needed to diagnose a capitellar fracture. The lateral view of a plain radiograph must be carefully screened and sometimes an oblique view may be helpful in making the diagnosis. Keywords: capitellum; fracture; open reduction

Download Full-text

Functional outcome of fixation of tibial bony avulsion of the posterior cruciate ligament with open reduction and cancellous screw fixation using posteromedial approach

National Journal of Clinical Orthopaedics ◽

10.33545/orthor.2019.v3.i4a.174 ◽

2019 ◽

Vol 3 (4) ◽

pp. 16-19

Author(s):

Dr. Akula Srinivasa Rao ◽

Dr. Vella Sandeep ◽

Dr. Chintala Manoj

Keyword(s):

Functional Outcome ◽

Posterior Cruciate Ligament ◽

Open Reduction ◽

Screw Fixation ◽

Cruciate Ligament ◽

Cancellous Screw ◽

Bony Avulsion

Download Full-text

Nerve Graft Length and Recovery of Elbow Flexion Muscle Strength in Patients With Traumatic Brachial Plexus Injuries: Case Series

Operative Neurosurgery ◽

10.1093/ons/opab007 ◽

2021 ◽

Author(s):

Mariano Socolovsky ◽

Gilda di Masi ◽

Gonzalo Bonilla ◽

Ana Lovaglio ◽

Kartik G Krishnan

Keyword(s):

Brachial Plexus ◽

Case Series ◽

Target Function ◽

Elbow Flexion ◽

Nerve Graft ◽

Spinal Accessory Nerve ◽

Accessory Nerve ◽

Nerve Reconstruction ◽

Muscle Recovery ◽

Spinal Accessory

Abstract BACKGROUND Traumatic brachial plexus injuries cause long-term maiming of patients. The major target function to restore in complex brachial plexus injury is elbow flexion. OBJECTIVE To retrospectively analyze the correlation between the length of the nerve graft and the strength of target muscle recovery in extraplexual and intraplexual nerve transfers. METHODS A total of 51 patients with complete or near-complete brachial plexus injuries were treated with a combination of nerve reconstruction strategies. The phrenic nerve (PN) was used as axon donor in 40 patients and the spinal accessory nerve was used in 11 patients. The recipient nerves were the anterior division of the upper trunk (AD), the musculocutaneous nerve (MC), or the biceps branches of the MC (BBs). An index comparing the strength of elbow flexion between the affected and the healthy arms was correlated with the choice of target nerve recipient and the length of nerve grafts, among other parameters. The mean follow-up was 4 yr. RESULTS Neither the choice of MC or BB as a recipient nor the length of the nerve graft showed a strong correlation with the strength of elbow flexion. The choice of very proximal recipient nerve (AD) led to axonal misrouting in 25% of the patients in whom no graft was employed. CONCLUSION The length of the nerve graft is not a negative factor for obtaining good muscle recovery for elbow flexion when using PN or spinal accessory nerve as axon donors in traumatic brachial plexus injuries.

Download Full-text