Fragment Excision With Flexor-Pronator Mass Repair for Chronic Medial Humeral Epicondyle Nonunions

Background: The medial epicondyle nonunion becomes symptomatic valgus instability with medial elbow pain and joint instability due to dysfunction of the medial collateral ligament (MCL), thus requiring surgical treatment. The purpose of the present study is to report the clinical result of the fragment excision and ligament reconstruction by free tendon graft in the treatment of symptomatic medial epicondyle nonunion. Methods: A retrospective study of five consecutive patients was performed. All five patients had signs and symptoms of valgus instability of the elbow. The mean period of nonunion was 25 years, and their injuries progressed asymptomatically until symptoms developed in adulthood after a second injury. Results: All patients were treated by fragment excision and MCL reconstruction. At the final follow-up, no patients exhibited pain or instability. The mean joint range of motion was 0o of extension and 138o of flexion, with an MEPS of 100 points in all patients. Conclusions: By ligament reconstruction for MCL insufficiency and removing the bone fragments avoided irritation by the bone fragments, pain and instability disappeared, good range of motion was restored, and excellent outcomes were achieved in all patients. We believe that fragment excision and MCL reconstruction should be considered as the treatment option for symptomatic medial epicondyle nonunion of the humerus.

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Far Lateral Disc Herniations Treated by Microscopic Fragment Excision

Spine ◽

10.1097/00007632-199507000-00011 ◽

1995 ◽

Vol 20 (13) ◽

pp. 1500-1505 ◽

Cited By ~ 60

Author(s):

Bruce V. Darden ◽

J. Frederick Wade ◽

Robert Alexander ◽

Kenneth E. Wood ◽

Alfred L. Rhyne ◽

...

Keyword(s):

Disc Herniations ◽

Far Lateral ◽

Fragment Excision

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Chronic (Ten Years) Ischial Tuberosity Avulsion Fracture Nonunion Treated with Fragment Excision and Simultaneous Primary Repair of the Hamstring Tendon

JBJS Case Connector ◽

10.2106/jbjs.cc.m.00176 ◽

2013 ◽

Vol 3 (4) ◽

pp. e137 ◽

Cited By ~ 2

Author(s):

Steven K. Dailey ◽

Barton Branam ◽

Michael T. Archdeacon

Keyword(s):

Avulsion Fracture ◽

Primary Repair ◽

Hamstring Tendon ◽

Ischial Tuberosity ◽

Fracture Nonunion ◽

Fragment Excision

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First Chromosomal Restriction Map ofActinobacillus pleuropneumoniae and Localization of Putative Virulence-Associated Genes

Journal of Bacteriology ◽

10.1128/jb.181.14.4161-4169.1999 ◽

1999 ◽

Vol 181 (14) ◽

pp. 4161-4169 ◽

Cited By ~ 18

Author(s):

Winfried Oswald ◽

Denis V. Konine ◽

Judith Rohde ◽

Gerald-F. Gerlach

Keyword(s):

Southern Blot ◽

Reference Strain ◽

Housekeeping Genes ◽

Actinobacillus Pleuropneumoniae ◽

Genetic Maps ◽

Restriction Map ◽

Physical Maps ◽

Serotype 1 ◽

Reference Strains ◽

Fragment Excision

ABSTRACT Combined physical and genetic maps of the genomes ofActinobacillus pleuropneumoniae AP76 (serotype 7 clinical isolate) and of A. pleuropneumoniae ATCC 27088 (serotype 1 reference strain) were constructed by using the restriction endonucleases ApaI, AscI, NotI, andSalI. The chromosome sizes as determined by the addition of estimated fragment sizes were 2.4 Mbp, and both maps had a resolution of approximately 100 kbp. The linkages between the ApaI,AscI, NotI, and SalI fragments and their relative positions were determined by (i) fragment excision and redigestion and (ii) partial digests of defined fragments and Southern blot using end-standing probes. The single SalI site within the chromosome of strain A. pleuropneumoniae AP76 was defined as position 1 of the map; for the map of A. pleuropneumoniae ATCC 27088, the corresponding SalI site was chosen. Putative virulence-associated genes (apx,omlA, sodA, tbpBA,ureC, and a repeat element) and housekeeping genes (glyA, metJ, recA, andrhoAP) were positioned on the physical maps and located on the ApaI and NotI fragments of A. pleuropneumoniae serotype reference strains.

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Accessory caudal glenoid ossification centre as possible cause of lameness in nine dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632800 ◽

2004 ◽

Vol 17 (03) ◽

pp. 131-135 ◽

Cited By ~ 8

Author(s):

A. Piras ◽

D. J. Marcellin-Little ◽

P. Borghetti ◽

A. Vezzoni ◽

M. Olivieri

Keyword(s):

Articular Cartilage ◽

Histological Examination ◽

Shoulder Joint ◽

Clinical Signs ◽

Ossification Centre ◽

Concomitant Lesions ◽

Possible Cause ◽

Fragment Excision

SummaryAn accessory centre of ossification was identified on the caudal aspect of the glenoid (ACGOC) in nine dogs. In three of the dogs, concomitant lesions were found in the same shoulder joint. When they appeared to be loose, the fragments were removed using arthroscopy in eight dogs. Upon histological examination in four dogs, the presence of articular cartilage on these ACGOC confirmed the fact that they represented a portion of the glenoid. The resolution of the clinical signs in six cases with isolated ACGOC after fragment excision and without concomitant lesions suggests that ACGOC was the cause of lameness in these affected dogs.

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Treatment of Symptomatic Bipartite Patella by Fragment Excision, Capsular Repair and Novel ITB Release

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00191 ◽

2017 ◽

Vol 5 (5_suppl5) ◽

pp. 2325967117S0019

Author(s):

Bruce Caldwell ◽

Sarah O’Reilly-Harbridge

Keyword(s):

Bone Scan ◽

Absorbable Suture ◽

Capsular Repair ◽

Bipartite Patella ◽

Average Improvement ◽

History Of ◽

Lateral Patella ◽

Capsular Incision ◽

Patella Tracking ◽

Fragment Excision

Objectives: The aim of this paper is to present the mid-term results of a novel technique used to treat symptomatic bipartite patella. Methods: Diagnosis of symptomatic bipartite patella was made by history, examination, Xray, MRI and/or bone scan. Patients with typical localised pain, pain on manually stressing the fragment, a positive ITB tightness test, a typical Xray and either, a hot bone scan or bone oedema on MRI were considered for treatment. All patients had a pre-op Kujala and Lysholm score recorded. Surgical Technique: Under GA and tourniquet a 4 part procedure was performed: Routine arthroscopy to assess patella tracking and fragment stability A 2 cm incision was made on the distal thigh 10-12 cm above the joint line over the ITB. A zig-zag incision was made across the ITB/IPB from anteriorly to the corner of the intermuscular septum. A 4 cm incision was made over the edge of the lateral patella. A longitudinal capsular incision was made at the edge of the patella. The capsule was reflected off the dorsal patella by sharp dissection and the bipartite fragment was excised through the synchondrosis. A watertight repair of the lateral capsule was performed with absorbable suture. Routine closures were performed. Comment: The author considers the ITB/IPB to be an important factor in the development and progression of the disorder. The addition of the novel release allows a tension-free capsular repair, reducing lateral facet loads, improving patella tracking without affecting patella stability Results: Over an 11 year period twenty patients underwent the procedure. 15 were available with a minimum 2 year and mean 6.35 year follow-up. Pre-op and post-op Kujala and Lysholm scores were compared. Patients were predominantly male (14:1) between ages 10-54 years. A clear history of trauma was present in 6 patients while in 9 symptoms were related to overuse. The pre-op Kujala score ranged from 28-90 with an average of 59. Post-op scores improved markedly with range 70-100 with 12 patients (80%) scoring >90 and an average improvement of 32 pts. Lysholm scores similarly improved significantly, with an average 32 pts improvement (range 1-66). Complications were minimal. Conclusion: Fragment excision, capsular repair and novel ITB release resulted in significant reproducible improvements in both objective and subjective outcome measures. Resolution of symptoms occurred in all patients suggesting the technique is a useful option in the treatment of symptomatic bipartite patella.

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