The Relationship between Plate and Screw to Ulnar Nerve in Distal Humeral Fracture: A Cadaveric Study

2021 ◽  
Vol 104 (6) ◽  
pp. 911-915
Keyword(s):  
Ulnar Nerve ◽  
Screw Fixation ◽  
Humeral Fracture ◽  
Elbow Flexion ◽  
Mean Difference ◽  
Cadaveric Study ◽  
Medial Condyle ◽  
Distal Humeral Fracture ◽  
Flexion Extension ◽  
The Mean

Background: Plate and screw fixation during the treatment of distal humeral fracture in adults is considered to be a gold standard that makes anatomic and articular reduction. Injury of the ulnar nerve is a common condition that can be found in pre-operative, intraoperative, and postoperative. Intraoperative anterior subcutaneous transposition is still a controversial issue. Objective: To understand the variation of distance of the ulnar nerve during elbow motion with the anatomical landmark of distal humeral bone and plate position after fixation. Materials and Methods: The authors have studied ten fresh adult cadavers, who underwent autopsy at the Department of Forensic Medicine of Srinakharinwirot University. Results: The results showed that in zone 2, the Center of the medial condyle was the position of the distal humeral bone with the most variation in position changing during elbow flexion/extension. In the sagittal plane (+2.56 to –4.58 mm), the mean difference equaled to 7.14 mm, while in the coronal plane (+1.70 to –5.14 mm), the mean difference equaled to 6.84 mm, with the highest percentage of irritation up to 70%. Furthermore, 14 cases of ulnar nerve subluxation were found in 20 studies (70%). Conclusion: From the present study, the Medial condyle was the landmark with the most irritation and position changing of ulnar nerve during elbow flexion. The incidence of ulnar subluxation occurred after in situ release for plate fixation was also found higher than in previous studies. Keywords: Plate and screw fixation; Ulnar nerve injury; Distal humeral fracture; Anterior subcutaneous nerve transposition; Cadaveric study; Anatomical bony landmark of distal humeral bone; Ulnar nerve subluxation

Unipolar Latissimus Dorsi Transfer for Restoration of Elbow Flexion in Residual Post-traumatic Brachial Plexus Palsy Associated with Distal Humeral Fractures

2021 ◽  
Author(s):  
Ahmed Fathy Sadek ◽  
Mohamed A. Ellabban
Keyword(s):  
Brachial Plexus ◽  
Latissimus Dorsi ◽  
Humeral Fracture ◽  
Elbow Flexion ◽  
Fracture Group ◽  
Latissimus Dorsi Transfer ◽  
Distal Humeral Fracture ◽  
Distal Humeral Fractures ◽  
Post Traumatic ◽  
The Mean

Abstract Introduction Elbow flexion is indispensable for both functioning and nonfunctioning hands. It is well perceived that restoration of elbow function is the first reconstructive priority in cases of brachial plexus injuries. The authors assessed the impact of associated distal humeral fractures on the functional outcome after unipolar latissimus dorsi transfer (ULDT) for restoration of elbow flexion in patients with residual brachial plexus palsy (BPP). Patients and Methods Twenty-three patients operated for restoring elbow flexion after residual post-traumatic BPP (with or without distal humeral fracture) by unipolar latissimus dorsi transfer (ULDT) were reviewed for a retrospective study. Patients were divided into two groups; associated distal humeral fracture group (HF-group; 10 patients) and non-associated distal humeral fracture group (NHF-group; 13 patients). Elbow flexion active range of motion (AROM), flexion deformity in addition to Mayo Elbow Performance Score (MEPS) were assessed. Results In both groups there were statistically better postoperative MEPS grading (p = 0.007, p = 0.001, respectively) and scoring with a mean of 81 ± 16.1 and 90 ± 4.6, respectively (p < 0.001). The mean postoperative elbow flexion AROM was statistically better in both groups. The mean supination AROM was better in NHF group (p = 0.057). Conclusion The use of ULDT in residual post-traumatic BPP is an efficient procedure in regaining functional flexion and supination. An associated distal humeral fracture does not significantly affect the final functional outcome. Level of Evidence Level IV.

Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries

2004 ◽  
Vol 16 (5) ◽  
pp. 313-318
Author(s):  
Thomas H. Tung ◽  
Christine B. Novak ◽  
Susan E. Mackinnon
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Elbow Flexion ◽  
Musculocutaneous Nerve ◽  
Nerve Transfers ◽  
Brachialis Muscle ◽  
Nerve Fascicle ◽  
The Mean ◽  
Mean Time ◽  
Flexion Strength

Object In this study the authors evaluated the outcome in patients with brachial plexus injuries who underwent nerve transfers to the biceps and the brachialis branches of the musculocutaneous nerve. Methods The charts of eight patients who underwent an ulnar nerve fascicle transfer to the biceps branch of the musculocutaneous nerve and a separate transfer to the brachialis branch were retrospectively reviewed. Outcome was assessed using the Medical Research Council (MRC) grade to classify elbow flexion strength in conjunction with electromyography (EMG). The mean patient age was 26.4 years (range 16–45 years) and the mean time from injury to surgery was 3.8 months (range 2.5–7.5 months). Recovery of elbow flexion was MRC Grade 4 in five patients, and Grade 4+in three. Reinnervation of both the biceps and brachialis muscles was confirmed on EMG studies. Ulnar nerve function was not downgraded in any patient. Conclusions The use of nerve transfers to reinnervate the biceps and brachialis muscle provides excellent elbow flexion strength in patients with brachial plexus nerve injuries.

Minimum Ten-Year Outcomes of Partial Ulnar Nerve Transfer for Restoration of Elbow Flexion in Patients with Upper Brachial Plexus Injury

2019 ◽  
Vol 24 (03) ◽  
pp. 283-288
Author(s):  
Yusuke Nagano ◽  
Daisuke Kawamura ◽  
Alaa Terkawi ◽  
Atsushi Urita ◽  
Yuichiro Matsui ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Functional Outcomes ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
The Mean ◽  
Flexion Strength

Background: Partial ulnar nerve transfer to the biceps motor branch of the musculocutaneous nerve (Oberlin’s transfer) is a successful approach to restore elbow flexion in patients with upper brachial plexus injury (BPI). However, there is no report on more than 10 years subjective and objective outcomes. The purpose of this study was to clarify the long-term outcomes of Oberlin’s transfer based on the objective evaluation of elbow flexion strength and subjective functional evaluation of patients. Methods: Six patients with BPI who underwent Oberlin’s transfer were reviewed retrospectively by their medical records. The mean age at surgery was 29.5 years, and the mean follow-up duration was 13 years. The objective functional outcomes were evaluated by biceps muscle strength using the Medical Research Council (MRC) grade at preoperative, postoperative, and final follow-up. The patient-derived subjective functional outcomes were evaluated using the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at final follow-up. Results: All patients had MRC grade 0 (M0) or 1 (M1) elbow flexion strength before operation. Four patients gained M4 postoperatively and maintained or increased muscle strength at the final follow-up. One patient gained M3 postoperatively and at the final follow-up. Although one patient achieved M4 postoperatively, the strength was reduced to M2 due to additional disorder. The mean score of QuickDASH was 36.5 (range, 7–71). Patients were divided into two groups; three patients had lower scores and the other three patients had higher scores of QuickDASH. Conclusions: Oberlin’s transfer is effective in the restoration of elbow flexion and can maintain the strength for more than 10 years. Patients with upper BPI with restored elbow flexion strength and no complicated nerve disorders have over ten-year subjective satisfaction.

Wrist arthroscopy for the treatment of scaphoid delayed or nonunions and judging the need for bone grafting

2019 ◽  
Vol 44 (6) ◽  
pp. 594-599 ◽  
Author(s):  
Bo Liu ◽  
Feiran Wu ◽  
Chye Yew Ng
Keyword(s):  
Bone Grafting ◽  
Screw Fixation ◽  
Wrist Arthroscopy ◽  
Scaphoid Bone ◽  
Percutaneous Screw Fixation ◽  
Level Of Evidence ◽  
Flexion Extension ◽  
The Mean ◽  
Dorsal Intercalated Segment Instability

This study reports outcomes of arthroscopy in the treatment of delayed or nonunions of 25 scaphoids (25 patients). The surgery was performed between 8 and 43 weeks after injury. Intraoperatively, 11 fractures were deemed stable to probing and underwent percutaneous screw fixation only; 14 were unstable and received arthroscopic bone grafting with percutaneous screw fixation. All fractures united. At a mean follow-up of 21 months (range 12–48), the mean Mayo wrist score was 96, and patient-rated wrist evaluation was 4, and the flexion–extension arc was 90% of the contralateral wrist. We conclude that arthroscopy is valuable in the treatment of scaphoid delayed or nonunions and in judging the need for bone grafting. Our data indicate that regardless of cystic formation in the scaphoid, bone grafting is not always necessary. Percutaneous fixation alone is sufficient when scaphoid delayed or nonunions are between 8 weeks and 1 year following injury, without scaphoid nonunion advanced collapse or dorsal intercalated segment instability, and when forceful probing confirms stability of the scaphoid arthroscopically. Level of evidence: IV

Transfer of a Single Fascicle from the Ulnar Nerve to the Biceps Muscle after Avulsions of Upper Roots of the Brachial Plexus

2000 ◽  
Vol 25 (4) ◽  
pp. 325-328 ◽  
Author(s):  
A. SUNGPET ◽  
C. SUPHACHATWONG ◽  
V. KAWINWONGGOWIT ◽  
A. PATRADUL
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Elbow Flexion ◽  
Pinch Strength ◽  
Biceps Muscle ◽  
Motor Branch ◽  
The Mean ◽  
Grade 3 ◽  
Better Than

Thirty-six patients with avulsions of upper roots of the brachial plexus underwent transfer of a single fascicle from the ulnar nerve to the proximal motor branch of the biceps muscle to restore elbow flexion. The mean period of follow-up was 22 months. The average reinnervation time for the biceps muscle was 3.3 months. Thirty-four patients achieved biceps strength of Medical Research Council grade 3 or better. The operative results in the patients with C5, C6 avulsions were better than those with C5, C6, C7 avulsions. At the last follow-up examination, grip strength, pinch strength, moving two-point discrimination and the strength of flexion of the wrist on the affected side was not worse than before surgery in any patient.

Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries

2003 ◽  
Vol 98 (2) ◽  
pp. 313-318 ◽  
Author(s):  
Thomas H. Tung ◽  
Christine B. Novak ◽  
Susan E. Mackinnon
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Elbow Flexion ◽  
Musculocutaneous Nerve ◽  
Content Type ◽  
Nerve Transfers ◽  
Nerve Fascicle ◽  
The Mean ◽  
Flexion Strength ◽  
Fine Print

Object. In this study the authors evaluated the outcome in patients with brachial plexus injuries who underwent nerve transfers to the biceps and the brachialis branches of the musculocutaneous nerve. Methods. The charts of eight patients who underwent an ulnar nerve fascicle transfer to the biceps branch of the musculocutaneous nerve and a separate transfer to the brachialis branch were retrospectively reviewed. Outcome was assessed using the Medical Research Council (MRC) grade to classify elbow flexion strength in conjunction with electromyography (EMG). The mean patient age was 26.4 years (range 16–45 years) and the mean time from injury to surgery was 3.8 months (range 2.5–7.5 months). Recovery of elbow flexion was MRC Grade 4 in five patients, and Grade 4+ in three. Reinnervation of both the biceps and brachialis muscles was confirmed on EMG studies. Ulnar nerve function was not downgraded in any patient. Conclusions. The use of nerve transfers to reinnervate the biceps and brachialis muscle provides excellent elbow flexion strength in patients with brachial plexus nerve injuries.

scholarly journals Tension of the Ulnar, Median, and Radial Nerves During Ulnar Nerve Neurodynamic Testing: Observational Cadaveric Study

2015 ◽  
Vol 95 (6) ◽  
pp. 891-900 ◽  
Author(s):  
Nicole Manvell ◽  
Joshua J. Manvell ◽  
Suzanne J. Snodgrass ◽  
Susan A. Reid
Keyword(s):  
Internal Rotation ◽  
Ulnar Nerve ◽  
Upper Limb ◽  
Repeated Measures ◽  
External Rotation ◽  
Elbow Flexion ◽  
Cadaver Study ◽  
Mean Difference ◽  
Shoulder Abduction ◽  
Human Cadavers

Background The ulnar nerve upper limb neurodynamic test (ULNT3) uses upper limb positioning to investigate symptoms arising from the ulnar nerve. It is proposed to selectively increase tension of the nerve; however, this property of the test is not well established. Objective The aim of this study was to determine the upper limb position that results in: (1) the greatest tension of the ulnar nerve and (2) the greatest difference in tension between the ulnar nerve and the other 2 major nerves of the upper limb: median and radial. Design This was an observational cadaver study. Methods Tension (in newtons) of the ulnar, median, and radial nerves was measured simultaneously using 3 buckle force transducers in 5 upper limb positions in 10 embalmed human cadavers (N=20 limbs). Repeated-measures analysis of variance (ANOVA) with Bonferroni post hoc tests determined differences in tension among nerves and among limb positions. Results The addition of shoulder horizontal abduction (H.Abd; 12.62 N; 95% confidence interval [95% CI]=10.76, 14.47) and combined shoulder abduction and internal rotation (H.Abd+IR; 11.86 N; 95% CI=9.96, 13.77) to ULNT3 (scapular depression, shoulder abduction and external rotation, elbow flexion, forearm pronation, and wrist and finger extension) produced significantly greater ulnar nerve tension compared with the ULNT3 alone (8.71 N; 95% CI=7.25, 10.17). The ULNT3+H.Abd test demonstrated the greatest difference in tension among nerves (mean difference between ulnar and median nerves=11.87 N; 95% CI=9.80, 13.92; mean difference between ulnar and radial nerves=8.47 N; 95% CI=6.41, 10.53). Limitations These results pertain only to the biomechanical plausibility of the ulnar nerve neurodynamic test and do not account for other factors that may affect the clinical application of this test. Conclusions The ULNT3+H.Abd is a biomechanically plausible test for detecting peripheral neuropathic pain related to the ulnar nerve. In situations where the shoulder complex will not tolerate the combination of shoulder external rotation in abduction, performing upper limb neurodynamic tests with internal rotation instead of external rotation is a biomechanically plausible alternative.

Analysis of human acellular nerve allograft combined with contralateral C7 nerve root transfer for restoration of shoulder abduction and elbow flexion in brachial plexus injury: a mean 4-year follow-up

2020 ◽  
Vol 132 (6) ◽  
pp. 1914-1924 ◽  
Author(s):  
Liang Li ◽  
Jiantao Yang ◽  
Bengang Qin ◽  
Honggang Wang ◽  
Yi Yang ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Nerve Root ◽  
Functional Outcomes ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Allograft Reconstruction ◽  
Acellular Nerve Allograft ◽  
The Mean ◽  
Monofilament Test

OBJECTIVEHuman acellular nerve allograft applications have increased in clinical practice, but no studies have quantified their influence on reconstruction outcomes for high-level, greater, and mixed nerves, especially the brachial plexus. The authors investigated the functional outcomes of human acellular nerve allograft reconstruction for nerve gaps in patients with brachial plexus injury (BPI) undergoing contralateral C7 (CC7) nerve root transfer to innervate the upper trunk, and they determined the independent predictors of recovery in shoulder abduction and elbow flexion.METHODSForty-five patients with partial or total BPI were eligible for this retrospective study after CC7 nerve root transfer to the upper trunk using human acellular nerve allografts. Deltoid and biceps muscle strength, degree of shoulder abduction and elbow flexion, Semmes-Weinstein monofilament test, and static two-point discrimination (S2PD) were examined according to the modified British Medical Research Council (mBMRC) scoring system, and disabilities of the arm, shoulder, and hand (DASH) were scored to establish the function of the affected upper limb. Meaningful recovery was defined as grades of M3–M5 or S3–S4 based on the scoring system. Subgroup analysis and univariate and multivariate logistic regression analyses were conducted to identify predictors of human acellular nerve allograft reconstruction.RESULTSThe mean follow-up duration and the mean human acellular nerve allograft length were 48.1 ± 10.1 months and 30.9 ± 5.9 mm, respectively. Deltoid and biceps muscle strength was grade M4 or M3 in 71.1% and 60.0% of patients. Patients in the following groups achieved a higher rate of meaningful recovery in deltoid and biceps strength, as well as lower DASH scores (p < 0.01): age < 20 years and age 20–29 years; allograft lengths ≤ 30 mm; and patients in whom the interval between injury and surgery was < 90 days. The meaningful sensory recovery rate was approximately 70% in the Semmes-Weinstein monofilament test and S2PD. According to univariate and multivariate logistic regression analyses, age, interval between injury and surgery, and allograft length significantly influenced functional outcomes.CONCLUSIONSHuman acellular nerve allografts offered safe reconstruction for 20- to 50-mm nerve gaps in procedures for CC7 nerve root transfer to repair the upper trunk after BPI. The group in which allograft lengths were ≤ 30 mm achieved better functional outcome than others, and the recommended length of allograft in this procedure was less than 30 mm. Age, interval between injury and surgery, and allograft length were independent predictors of functional outcomes after human acellular nerve allograft reconstruction.

Robotic-Assisted Patellofemoral Replacement—Correlation of Preoperative Planning with Intraoperative Implant Position and Early Clinical Experience: A Minimum 2-Year Follow-up

2020 ◽  
Author(s):  
Veenesh Selvaratnam ◽  
Andrew Cattell ◽  
Keith S. Eyres ◽  
Andrew D. Toms ◽  
Jonathan R. P. Phillips ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Preoperative Planning ◽  
Trochlear Dysplasia ◽  
Oxford Knee Score ◽  
Implant Position ◽  
Robotic Assisted ◽  
Implant Positioning ◽  
Flexion Extension ◽  
The Mean

AbstractPatello-femoral arthroplasty (PFA) is successful in a selected group of patients and yields a good functional outcome. Robotic-assisted knee arthroplasty has been shown to provide better implant positioning and alignment. We aim to report our early outcomes and to compare Mako's (Robotic Arm Interactive Orthopaedic System [RIO]) preoperative implant planning position to our intraoperative PFA implant position. Data for this study was prospectively collected for 23 (two bilateral) patients who underwent robotic-assisted PFA between April 2017 and May 2018. All preoperative implant position planning and postoperative actual implant position were recorded. Presence of trochlear dysplasia and functional outcome scores were also collected. There were 17 (two bilateral) female and 6 male patients with a mean age of 66.5 (range: 41–89) years. The mean follow-up period was 30 (range: 24–37) months. Eighteen knees (72%) had evidence of trochlear dysplasia. The anterior trochlear line was on average, 7.71 (range: 3.3–11.3) degrees, internally rotated to the surgical transepicondylar axis and on average 2.9 (range: 0.2–6.5) degrees internally rotated to the posterior condylar line. The preoperative planning range was 4-degree internal to 4-degree external rotation, 4-degree varus to 6-degree valgus, and 7-degree flexion to 3-degree extension. The average difference between preoperative planning and intraoperative implant position was 0.43 degrees for rotation (r = 0.93), 0.99 degrees for varus/valgus (r = 0.29), 1.26 degrees for flexion/extension (r = 0.83), and 0.34 mm for proudness (r = 0.80). Six patients (24%) had a different size component from their preoperative plan (r = 0.98). The mean preoperative Oxford Knee Score (OKS) was 16 and the mean postoperative OKS was 42. No patient had implant-related revision surgery or any radiological evidence of implant loosening at final follow-up. Our early results of robotic PFA are promising. Preoperative Mako planning correlates closely with intraoperative implant positioning. Longer follow-up is needed to assess long-term patient outcomes and implant survivorship.

scholarly journals Do we need to improve the reporting of evidence in tendinopathy management? A critical appraisal of systematic reviews with recommendations on strength of evidence assessment

2021 ◽  
Vol 7 (1) ◽  
pp. e000920
Author(s):  
Dimitris Challoumas ◽  
Neal L Millar
Keyword(s):  
Systematic Reviews ◽  
Assessment Tool ◽  
Data Extraction ◽  
Cochrane Collaboration ◽  
Mean Difference ◽  
Strength Of Evidence ◽  
The Mean ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
The Cochrane Collaboration

ObjectiveTo critically appraise the quality of published systematic reviews (SRs) of randomised controlled trials (RCTs) in tendinopathy with regard to handling and reporting of results with special emphasis on strength of evidence assessment.Data sourcesMedline from inception to June 2020.Study eligibilityAll SRs of RCTs assessing the effectiveness of any intervention(s) on any location of tendinopathy.Data extraction and synthesisIncluded SRs were appraised with the use of a 12-item tool devised by the authors arising from the Preferred Reporting Items in Systematic Reviews and Meta-Analyses statement and other relevant guidance. Subgroup analyses were performed based on impact factor (IF) of publishing journals and date of publication.ResultsA total of 57 SRs were included published in 38 journals between 2006 and 2020. The most commonly used risk-of-bias (RoB) assessment tool and strength of evidence assessment tool were the Cochrane Collaboration RoB tool and the Cochrane Collaboration Back Review Group tool, respectively. The mean score on the appraisal tool was 46.5% (range 0%–100%). SRs published in higher IF journals (>4.7) were associated with a higher mean score than those in lower IF journals (mean difference 26.4%±8.8%, p=0.004). The mean score of the 10 most recently published SRs was similar to that of the first 10 published SRs (mean difference 8.3%±13.7%, p=0.54). Only 23 SRs (40%) used the results of their RoB assessment in data synthesis and more than half (n=30; 50%) did not assess the strength of evidence of their results. Only 12 SRs (21%) assessed their strength of evidence appropriately.ConclusionsIn light of the poor presentation of evidence identified by our review, we provide recommendations to increase transparency and reproducibility in future SRs.

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