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 Surgical Management of Paediatric Neglected Humeral Supracondylar Fracture: A Series of 3 Cases in 3 Years

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Kow Ren Yi ◽  
Low Chooi Leng ◽  
Nur Azuatul Akmal Kamaludin ◽  
Aziah Abdul Aziz ◽  
Kamariah Nor Mohd Daud
Keyword(s):  
Open Reduction ◽  
Posterior Approach ◽  
Corrective Osteotomy ◽  
Lateral Approach ◽  
Supracondylar Fracture ◽  
Humerus Fracture ◽  
Supracondylar Humerus Fracture ◽  
Left Elbow ◽  
Right Hand ◽  
K Wires

Introduction: Supracondylar fracture of the humerus is common among paediatric population. In our country, it is not uncommon for patients to present late to the hospital after an injury. Devnani reported a case series of 28 children who sustained supracondylar humerus fracture and presented late (mean 5.6 days) to the hospital. We report our experience in managing 3 patients who presented late (range 15 days to 8 months) with neglected supracondylar humerus fracture in 3 years. Case report: Case 1: A right hand-dominant 5-year-old boy sustained a fall 8 months prior to presentation to the hospital. He was treated with traditional methods immediately after the injury. He presented with malunion of left humeral supracondylar fracture with varus deformity and limited left elbow range of movements. An open reduction (lateral approach) and corrective osteotomy were performed and 2 lateral K-wires were inserted. Case 2: A 10-year-old boy with right hand dominance sustained a closed left supracondylar humerus fracture Gartland 3 after a fall. His parents initially refused any surgical intervention. However, they finally agreed for surgery on day 15 post-trauma. An open reduction (posterior approach) and callus removal were done and 2 crossed K-wires were inserted. Case 3: A right hand-dominant 5year-old girl had history of fall 1 month prior to presentation to the hospital. She was treated with traditional methods initially. She presented with malunion of the left supracondylar humerus fracture with limited range of motion of her left elbow. An open reduction (posterior approach) and corrective osteotomy were performed and 2 crossed K-wires were inserted. Discusssion: Two patients underwent open reduction via the posterior approach and 1 patient via the lateral approach. Only one patient required callus removal while 2 patients required osteoclasis. All patients recovered without complication and there was improved range of movement of the elbows. Conclusion: Surgical intervention is the treatment of choice in managing neglected supracondylar humerus fracture.

scholarly journals Anterior elbow fracture dislocation with ulnar nerve palsy in a six-year-old child

2020 ◽  
Vol 8 (2) ◽  
pp. 207-212
Author(s):  
Nur Ayuni Khirul Ashar ◽  
Siew Khei Liew ◽  
Nur Syahirah Azmi ◽  
Raymond Dieu Kiat Yeak ◽  
Rahul Lingam ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Nerve Palsy ◽  
Elbow Dislocation ◽  
Fracture Dislocation ◽  
Elbow Fracture ◽  
Medial Approach ◽  
Left Elbow ◽  
Ulnar Nerve Palsy ◽  
Elbow Fracture Dislocation ◽  
K Wires

Background. Anterior elbow fracture dislocation is rare, especially in paediatric age group. Of the reported cases to date, three-quarter were posterior dislocation of the elbow. Anterior elbow dislocation is rarely reported, with incidence of only 2%. Clinical case. A 6-year-old girl presented to casualty with left elbow deformity and pain after she tripped and fell in the toilet. Ulnar clawing was present with reduced sensation over ulnar nerve distribution. No wound was found, distal pulses and circulation were good. The X-rays showed anterior dislocation of the left elbow with olecranon fracture. Closed manual reduction was attempted but failed. Open reduction and percutaneous K-wire insertion under general anaesthesia was performed. Medial approach of the elbow was done. Intra-operatively ulnar nerve was found impinged by the distal ulnar fragment but was in continuity. The transverse olecranon fracture was fixed with two K-wires and the radial head was reduced. Ulnar nerve was mobilised until tension-free. Ulnar collateral ligament was repaired. The elbow was immobilised with a splint. Ulnar claw was resolved at 2 weeks. The fracture heals and the K-wires were removed at 6 weeks. At 8 weeks, range of movement of the elbow was full. The elbow was stable in varus and valgus. Discussion. Anterior elbow dislocation is a high energy trauma and one should be cautious of neurovascular injury. There was no clear recommendation in the literature regarding surgical approach. We chose medial approach of the elbow for ulnar nerve exploration and olecranon fixation. Conclusion. This rare injury should be treated with high index of suspicious. Surgical approach should be tailored individually according to the instability of the elbow joint and neurovascular status, as in this case was the posteromedial instability associated with ulnar nerve palsy.

Long Head of the Triceps Muscle Transfer for Active Elbow Flexion in Arthrogryposis

2010 ◽  
Vol 14 (2) ◽  
pp. 121-124 ◽  
Author(s):  
Gloria R. Gogola ◽  
Marybeth Ezaki ◽  
Scott N. Oishi ◽  
Idris Gharbaoui ◽  
James B. Bennett
Keyword(s):  
Elbow Flexion ◽  
Muscle Transfer ◽  
Triceps Muscle ◽  
Long Head

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

2019 ◽  
Vol 38 (1) ◽  
pp. 63
Author(s):  
Komang Agung Irianto ◽  
Raymond Parung ◽  
William Putera Sukmajaya
Keyword(s):  
Functional Outcome ◽  
Performance Index ◽  
Open Reduction ◽  
Case Series ◽  
Elbow Dislocation ◽  
Elbow Flexion ◽  
Range Of Movement ◽  
Average Improvement ◽  
Fracture Management ◽  
Average Loss

Background<br />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.<br /><br />Case Description<br />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.<br /><br />Conclusion<br />Planned and well execution open reduction in pediatric neglected elbow dislocation may bring back the painless movement within normal daily function.

scholarly journals Cerebrovascular Dynamics During Continuous Motor Task

2019 ◽  
pp. 997-1004
Author(s):  
M. Müller ◽  
M. Österreich
Keyword(s):  
Cerebral Blood Flow Velocity ◽  
Motor Task ◽  
Elbow Flexion ◽  
Low Frequencies ◽  
High Frequencies ◽  
Cerebrovascular Resistance ◽  
Left Elbow ◽  
End Tidal ◽  
The Right ◽  
Spontaneous Fluctuations

We investigated the cerebral autoregulation (CA) dynamics parameter phase and gain change when exposed to a longlasting motor task. 25 healthy subjects (mean age ± SE, 38±2.6 years, 13 females) underwent simultaneous recordings of spontaneous fluctuations in blood pressure (BP), cerebral blood flow velocity (CBFV), and end-tidal CO2 (ETCO2) over 5 min of rest followed by 5 min of left elbow flexion at a frequency of 1 Hz. Tansfer function gain and phase between BP and CBFV were assessed in the frequency ranges of very low frequencies (VLF, 0.02-0.07 Hz), low frequencies (LF, 0.07-0.15), and high frequencies (HF, >0.15). CBFV increased on both sides rapidly to maintain an elevated steady state until movement stopped. Cerebrovascular resistance fell on the right side (rest 1.35±0.06, movement 1.28±0.06, p<0.01), LF gain decreased from baseline (right side 0.97±0.07 %/mm Hg, left 1.01±0.09) to movement epoch (right 0.73±0.08, left 0.76±0.06, p≤0.01). VLF phase decreased from baseline (right 1.03±0.05 radians, left 1.10±0.06) to the movement epoch (right 0.81±0.07, left 0.82±0.10, p≤0.05). CA regulates continuous motor efforts by changes in resistance, gain and phase.

scholarly journals Bilateral Elbow Dislocation with Radial Head Fractures in a 33 Year Male – A Rare Case Report

2020 ◽  
pp. 100-106
Author(s):  
A. Raviraj ◽  
Vidyasagar Maalepati ◽  
K. Abhishek Sugumar ◽  
Vivek Kumar N. Savsani ◽  
Viresh B. Murgodi ◽  
...  
Keyword(s):  
Radial Head ◽  
Rare Case ◽  
Road Traffic ◽  
Radial Head Fracture ◽  
Elbow Dislocation ◽  
Radial Head Fractures ◽  
Left Elbow ◽  
Radial Neck Fracture ◽  
Neck Fracture ◽  
The Right

The authors report a rare case of bilateral elbow dislocation with associated radial head fractures in a 33 year male who presented to our hospital following a road traffic accident. The elbow dislocations were reduced in the emergency room, the left radial head fracture was treated conservatively in an above elbow slab for four weeks and the right radial head and neck fracture was treated operatively with Herbert screw fixation for the radial head fracture and buttress plating for the radial neck fracture. At six months follow-up, the patient was pain free and had functional range of flexion and extension of both elbows with pronation and supination of the right elbow up to 50° and 40° and that of the left elbow up to 60° and 45° respectively.

scholarly journals Lesión compleja del codo pediátrico: fractura de cóndilo externo asociada a luxación posteromedial de codo.

2020 ◽  
pp. 56-60
Author(s):  
A DARAS-BALLESTER ◽  
NADIA JOVER-JORGE ◽  
PEDRO DOMENECH-FERNANDEZ
Keyword(s):  
Open Reduction ◽  
Elbow Dislocation ◽  
Complex Case ◽  
Long Term Results ◽  
K Wires ◽  
Condyle Fracture ◽  
Clinical And Radiological Results ◽  
Humeral Condyle

Background and aim: External humeral condyle fracture associated with a posteromedial elbow dislocation is a very rare entity, of which there are very few cases published. Our objective is to present a complex case treated in our Hospital, the diagnosis, the treatment we chose, and the follow-up at 9 weeks after the intervention. Clinical case: 5-year-old boy with a posteromedial elbow dislocation associated with an external humeral condyle fracture, which was diagnosed by CT and treated surgically using an anterior approach over the elbow, open reduction, and osteosynthesis with K-wires. Results: clinical and radiological results 9 weeks after the intervention were excellent, presenting a Radiographic consolidation of the fracture and an excellent range of joint mobility. Conclusion: early diagnosis and surgical treatment through open reduction and osteosynthesis of the external condyle is the gold standard on treatment for these injuries, since a bad reduction leads to poor long-term results.

scholarly journals Forelimb bone curvature in terrestrial and arboreal mammals

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3229 ◽  
Author(s):  
Keith Henderson ◽  
Jess Pantinople ◽  
Kyle McCabe ◽  
Hazel L. Richards ◽  
Nick Milne
Keyword(s):  
Distal Part ◽  
Elbow Flexion ◽  
Distal Humerus ◽  
Muscle Action ◽  
Elbow Extension ◽  
Triceps Muscle ◽  
Longitudinal Loading ◽  
The Difference

It has recently been proposed that the caudal curvature (concave caudal side) observed in the radioulna of terrestrial quadrupeds is an adaptation to the habitual action of the triceps muscle which causes cranial bending strains (compression on cranial side). The caudal curvature is proposed to be adaptive because longitudinal loading induces caudal bending strains (increased compression on the caudal side), and these opposing bending strains counteract each other leaving the radioulna less strained. If this is true for terrestrial quadrupeds, where triceps is required for habitual elbow extension, then we might expect that in arboreal species, where brachialis is habitually required to maintain elbow flexion, the radioulna should instead be cranially curved. This study measures sagittal curvature of the ulna in a range of terrestrial and arboreal primates and marsupials, and finds that their ulnae are curved in opposite directions in these two locomotor categories. This study also examines sagittal curvature in the humerus in the same species, and finds differences that can be attributed to similar adaptations: the bone is curved to counter the habitual muscle action required by the animal’s lifestyle, the difference being mainly in the distal part of the humerus, where arboreal animals tend have a cranial concavity, thought to be in response the carpal and digital muscles that pull cranially on the distal humerus.

scholarly journals The burden of chronic elbow dislocations in Cambodia and early results of a cost-effective surgical approach

2018 ◽  
Vol 49 (1) ◽  
pp. 14-19
Author(s):  
Alice E Mortimer ◽  
Alex Nicholls ◽  
Aziz Rawal ◽  
Saqib Noor ◽  
Heang Oy ◽  
...  
Keyword(s):  
Posterior Approach ◽  
Elbow Dislocation ◽  
Cost Effective ◽  
Lateral Approach ◽  
Significant Loss ◽  
Range Of Movement ◽  
Loss To Follow Up ◽  
Early Results ◽  
The Mean

Chronic elbow dislocation presents a surgical challenge and there is difficulty in balancing stability with early mobilisation. We present a series of 103 patients treated with open reduction via a posterior approach and provide early results of an alternative combined medial and lateral approach (Soddo technique, Anderson et al.). Of the 103 patients, 81% initially consulted a traditional healer and the mean dislocation period was 11 weeks. There was significant loss to follow-up. Only 12 patients having undergone the posterior approach had complete datasets. The mean preoperative arc of movement was 10° and the postoperative arc was 65° at a mean follow-up of 16 weeks. Five patients treated with the Soddo technique had sufficient follow-up data. The mean preoperative arc was 20° and the mean postoperative arc was 95° (mean follow-up of 20 days). Those having undergone the Soddo technique achieved a 20° greater increase in range of movement and no re-dislocations.

scholarly journals Botulinum toxin for treatment of cocontractions related to obstetrical brachial plexopathy

2005 ◽  
Vol 63 (3a) ◽  
pp. 588-591 ◽  
Author(s):  
Carlos O. Heise ◽  
Lilian R. Gonçalves ◽  
Egberto R. Barbosa ◽  
Jose Luiz D. Gherpelli
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Type A ◽  
Elbow Flexion ◽  
Botulinum Toxin Type ◽  
Brachial Plexopathy ◽  
Elbow Extension ◽  
Triceps Muscle ◽  
Elbow Function ◽  
Persistent Disability

Botulinum toxin type A was recently introduced for treatment of biceps - triceps muscle cocontraction, which compromises elbow function in children with obstetrical brachial plexopathy. This is our preliminary experience with this new approach. Eight children were treated with 2 - 3 U/kg of botulinum toxin injected in the triceps (4 patients) and biceps (4 patients) muscle, divided in 2 or 3 sites. All patients submitted to triceps injections showed a long-lasting improvement of active elbow flexion and none required new injections, after a follow-up of 3 to 18 months. Three of the patients submitted to biceps injections showed some improvement of elbow extension, but none developed anti-gravitational strength for elbow extension and the effect lasted only three to five months. One patient showed no response to triceps injections. Our data suggest that botulinum toxin can be useful in some children that have persistent disability secondary to obstetrical brachial plexopathy.

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