Surgical treatment of patients with extra-articular fractures of the distal humerus

Background. The article deals with extra-articular fractures of the distal humerus, according to the АО/ASIF classification, which includes types 12A–C, depending on the plane of the fracture and the nature of the fragment displacement. The purpose was to study the features of the lower third humeral fractures and to conduct a comparative analysis of the outcomes of surgical treatment. Material and methods. One hundred and twenty-seven patients with extra-articular fractures of the distal humerus were under observation. For retrospective analysis, they were divided into a comparison group (n = 92) who underwent traditional bone osteosynthesis and a study group (n = 35) in whom a rod-type external fixation device developed by us was used. The short- and long-term functional results were studied using the Mayo Elbow Performance Score. Results. Various indicators, established by us for comparison, and treatment outcomes were analyzed in 101 patients (comparison group — 68 people, study group — 33). Many values of these parameters were quite comparable in terms of the age, gender, hospitalization terms, duration of surgeries, etc., but the revealed differences in indicators still did not reach the level of statistical reliability (p > 0.05). Evaluation of the clinical use of the device proposed by us showed restoration of the humeral anatomy, quite comparable to that in bone osteosynthesis, and the achievement of the final result of treatment. However, the number of complications by type and by total number was significantly higher (4.5 times; p ˂ 0.001) in the comparison group, where it accounted for the largest share of cases of neuropathies (16.18 %), nonunions (8.82 %), elbow contractures (8.82 %) and heterotopic ossification (4.42 %). The final score on the Mayo Elbow Performance Score in the comparison group was 84.9 ± 10.2 points, in the study group — 92.6 ± 3.7 points. At the same time, the total number of positive treatment outcomes after bone osteosynthesis was 66.18 %, after transosseous osteosynthesis — 81.82 %. Conclusions. The analysis of the data obtained allows us to recommend a method of minimally invasive osteosynthesis with a rod device of external controlled fixation as a method of choice for wider clinical use in the treatment of patients with lower third humeral fractures.

Comparison of Functional Outcomes in the Management of Intercondylar Fractures by Olecranon Osteotomy Approach versus Triceps on and Triceps off Approach

Intercondylar fracture of the distal humerus is a relatively rare and challenging intra-articular elbow fracture, with available choice of surgical treatment includes open reduction and extensive internal fixation. This systematic review aims to evaluate the effectiveness of the surgical approach regarding the functional outcome following intercondylar fracture treatment. A systematic search on literature was performed online from the inception dates to November 2020. Main outcome of interest included functional outcomes, Mayo Elbow Performance Score (MEPS) and The Disabilities of the Arm, Shoulder and Hand (DASH) Score. Animal studies, case reports, review articles and non-English papers were excluded. Four articles were included in this review. The functional outcome was different among the olecranon osteotomy approach, triceps on with the triceps sparing approach and triceps off with the triceps lifting approach or the TRAP approach. Triceps on approach with triceps sparing had lower MEPS in patients above 60 years of age but satisfactory in younger patients, while olecranon osteotomy approach showed excellent MEPS rate in all age groups. Olecranon osteotomy approach gives better exposure for more accurate anatomical reduction of the intra articular fracture resulting in better functional outcome. Mean DASH score was significantly higher in Triceps Reflecting anconeus (TRAP) group. Olecranon osteotomy approach was found to be better than triceps on approach, with better functional outcome. However, other triceps off (TRAP) did not show any significant differences in terms of functional outcome in the management of intercondylar fractures. Keywords: intercondylar fractures, olecranon osteotomy, triceps on, triceps off, functional outcome.

Outcomes of Treatment of Monteggia Fractures with Reduction and Internal Titanium Elastic Nail Fixation of the Ulna

Background. The purpose of this paper is to evaluate the usefulness of radiographic indices of humero-radial joint instability in order to predict treatment outcomes in Monteggia fractures. Material and methods. A retrospective analysis was conducted in a group of patients who underwent closed reduction and internal titanium elastic nail (TEN) fixation of the ulna and closed reduction of a dislocation of the radial head between 2016 and 2018. The indications for intrame­dullary fixation comprised transverse or short oblique fractures. The direction of the dislocation was classified according to Bado. The following radiographic indies were assessed: Radiocapitellar Line, Lateral Humeral Line, Proximity Index, and Radial Head Displacement Index. Results. Treatment outcomes were assessed with the Oxford Elbow Score and Mayo Elbow Performance Score, and com­plications were assessed with a modified Clavien-Dindo-Sink scale. No coincidence between poor functional and radio­graphic outcomes was demonstrated. Conclusions. 1. Regardless of the severity of the injury, eligibility for surgery and correctly performed surgical treatment guarantee a good final outcome. 2. Patients treated with TEN regain their preoperative mobility. 3. There was no coincidence between poor functional and radiographic outcomes, except for one patient in whom subluxation of the radial head persisted despite surgery and was confirmed radiographically and functionally. 4. It would be beneficial for clinical practice to introduce simple, reproducible radiographic parameters for unambiguous assessment of the effectiveness of treatment and predicting treatment outcomes; unfortunately none of the parameters we investigated were sufficiently reliable. 5. The radiographic parameters analysed in this paper are dependent on the quality of the radiological examinations performed.

A PROSPECTIVE FOLLOW UP STUDY OF FUNCTIONAL OUTCOME OF SUPRACONDYLAR HUMERUS FRACTURE WITH INTERCONDYLAR EXTENSION TREATED WITH OLECRANON OSTEOTOMY APPROACH

Introduction- Olecranon osteotomy is standard approach for low transcondylar and intercondylar distal humerus fractures. Distal humerus fractures are difcult to manage successfully because of the local anatomic constraints, the frequent presence of comminution,displacement and osteopenia. We studied the functional outcome and complications following surgical xation using this approach. Material And Methods- A total 20 consecutive patients(male:15,female:5),having mean age 42.1yrs, of Distal Humerus fractures who will attend the casualty or O.P.D during the thesis period(June2018 to October2020) at Mahatma Gandhi Hospital & Mathuradas Mathur Hospital Jodhpur (Rajasthan) will be included in study group and managed surgically using olecranon osteotomy approach. Functional outcome was evaluated using the Mayo Elbow Performance Score(MEPS) and complications were observed. Results- Mean loss of extension was 10°.Mean exion achieved was 122.75°.Mean range of movement at treated elbow was 113°. All fractures united by the end of 3 months. Final results were excellent in 8 cases; good in 7 cases; fair in 4 and poor in one case. Most common complication in our study was discomfort due to hardware(6 cases). Supercial infection occurred in 2 cases. Screw/wire backout occurred in 2 cases. Elbow stiffness and malunion happened in one case. Functional outcome was also dependant on fracture subtype. Conclusion- Intraarticular distal humerus fracture treated with olecranon osteotomy approach had good articular exposure and surgical xation. This approach had good functional outcome and fewer complications.

PROSPECTIVE RANDOMISED COMPARATIVE STUDY OF TENSION BAND WIRING AND OLECRANON PLATING FOR TREATMENT OF OLECRANON FRACTURES

Introduction- Olecranon fractures are one of the most commonly seen orthopedic injuries and account for approximately 10% of all proximal . forearm fractures. Operative treatment is open advocated in fractures with an articular incongruity of more than 2 mm, hence only a minority of patients are treated conservatively. The purpose of current study is to compare the clinical and radiological outcome of tension band wiring and plate xation in patients operated for olecranon fractures. Materials and methods- Current study was conducted in a tertiary care center from December 2018 to December 2020. Study compromises of 50 patients operated for olecranon fracture. Implant used -tension band wiring with 2 k wire ,1 ss wire and olecranon plate Classification used - Schatzker classication Clinical and functional outcome were assessed using mayo elbow performance score Results and observations- Study consists of 50 cases of fractures of the olecranon treated by Tension band wiring with Kirshner wire and Olecranon plate. The results were evaluated according to the Mayo elbow performance score. The results obtained in our series were excellent in 41 (82%) patients, good in 6 (12%) patients, fair in 3 (6%) patients and no poor results. Conclusion-it is concluded that the technique of open reduction and internal xation with Kirschner wires and tension band wiring and olecranon plate xation are effective means of treating fractures of olecranon.

Rotura aguda de bíceps distal: reparación mediante abordaje único anterior y dispositivo de anclaje cortical

Antecedentes: La rotura del tendón distal del bíceps braquial es una patología con una incidencia creciente, que puede ocasionar importantes alteraciones funcionales. Cuando la rotura es completa y el paciente activo, el tratamiento quirúrgico es de elección. Material y método: Varón de 47 años con dolor intenso y súbito en la fosa antecubital izquierda mientras levantaba peso. A la exploración, impotencia para la flexión y supinación activa del brazo izquierdo con pérdida de la silueta del bíceps braquial. La ecografía confirma el diagnóstico de rotura completa del tendón distal del bíceps braquial. Se decide tratamiento quirúrgico, realizando un abordaje único anterior y reinsertando el tendón en su “footprint” radial con ayuda de un dispositivo de anclaje cortical. Resultados: A los 12 meses, el paciente presenta flexo-extensión y prono-supinación completa, sin encontrar dificultades para realizar las actividades de su vida diaria y laboral, con puntación de 100 puntos en el Mayo Elbow Performance Score (MEPS). Conclusión: La rotura del bíceps distal es una lesión típica de pacientes activos con una incidencia creciente. Aunque no se han evidenciado diferencias significativas entre las distintas opciones de reparación, en nuestra experiencia la utilización de dispositivos de anclaje cortical con un abordaje único anterior aporta unos resultados muy satisfactorios.

Functional outcomes and complications following convertible primary total elbow arthroplasty: A single surgeon series

Background The data on convertible total elbow arthroplasty are limited and primarily based on multiple centre/multiple surgeon series. The aim of this study was to report the mid-term functional outcomes, radiological findings, complications and survivorship of the Latitude total elbow arthroplasty performed by a single surgeon. Study design & methods The study included 13 patients (10 females, mean age of 72 years and varying indications) over eight years. The Oxford Elbow Score (OES), Mayo Elbow Performance Score (MEPS), range of movements (ROM), Subjective Elbow Value (SEV), satisfaction score (SS) and the revision rate of the implant per 100 observed component years (OCY) were assessed. Results The mean follow-up was 5.9 years (3–10 years). The Oxford Elbow Score/Mayo Elbow Performance Score improved from 15 to 42 ( p value < 0.005)/26% to 93% ( p value < 0.005) respectively. The arc of extension-flexion/supination-pronation improved from 63° to 106° ( p = 0.00002)/123° to 142° ( p = 0.32) respectively. The Subjective Elbow Value/Satisfaction Score was 83/98 respectively. There was one re-operation for a deep infection. There were no radiologic signs of loosening and the revision rate was 0.15 per 100 observed component years. Conclusions With careful patient selection, convertible total elbow arthroplasty provides patients with good to excellent outcomes and substantial improvements in the range of movements.

Short-term Follow-up of Early Reconstructive Surgery Management in Neglected Supracondylar Humeral Fractures

BACKGROUND: The supracondylar humeral fracture is a fracture located in the proximal position of the trochlea and humeral capitulum. This fracture is the most common elbow fracture in children. Epidemiological research states that these fractures constitute 58% of all elbow fractures in children. It is also mentioned that 10–20% patients undergo belated admission to get therapy. Based on the literature, the fracture is categorized as neglected if the fracture treatment is 14 days post-trauma. Unfortunately, few reports can provide management guidelines. Some experts mention the “wait and see” attitude toward this fracture until a perfect remodeling happens to correct the deformity; however, a number of studies have shown good results after early reconstruction. AIM: We aimed to evaluate the short-term follow-up of supracondylar humeral fractures that came after 14 days of injury and then open reduction reconstructions were done, followed by the installation of K-wire and screws with the figure of eight patterns based on the quick disabilities of the arm, shoulder, and hand (Q-DASH) 9-score, Flynn’s Criteria, and Mayo Elbow Performance Score (MEPS). METHODS: The samples were five patients who underwent corrective open reduction and injury fixed with Kirschner (K)-wire and screws with the figure of eight patterns using the posterior approach at the Orthopedic Hospital from December 2019 to February 2020. Results were assessed with the quick disabilities of the arm, shoulder, and hand-9 score (Q-DASH-9 score), Flynn’s Criteria, and Mayo Elbow Performance Score (MEPS). RESULTS: All patients after reconstruction correction showed an increase in range of motion in the fractured elbow. No complications were found from the surgical treatment. CONCLUSIONS: Early reconstruction correction of patients with supracondylar humeral fractures gave satisfactory results based on the Q-DASH-9 Score, Flynn’s Criteria, and MEPS.

„Patient-reported outcome measures“ (PROMs) in der Schulter- und Ellenbogenchirurgie

Zusammenfassung„Patient-reported outcome measures“ (PROMs) sind Instrumente, mit denen der subjektive Gesundheitszustand eines Patienten gemessen werden kann. Sie gewinnen zunehmend an wissenschaftlicher, klinischer und gesundheitsökonomischer Bedeutung. Man unterscheidet zwischen generischen, gelenkspezifischen und krankheitsspezifischen PROMs. Um das Risiko von Verzerrungen oder erhöhter Variabilität zu vermeiden, müssen geeignete Übersetzungen mit transkulturellen Anpassungen und anschließender Validierung gemäß definierten Richtlinien durchgeführt werden. Für viele gängige Schulter- und Ellenbogenwerte existiert bis dato noch keine validierte Übersetzung. Die weltweit am häufigsten verwendeten Schulter-PROMs sind der Constant-Murley Score, der American Shoulder and Elbow Surgeons Shoulder Form und der Simple Shoulder Test. Studien zu Ellenbogenpathologien verwenden am häufigsten den Mayo Elbow Performance Score und den Disabilities of the Arm, Shoulder and Hand Score. Derzeit besteht jedoch kein wissenschaftlicher Konsens über die Verwendung von Schulter- und Ellenbogen-PROMs.