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1.
Bettina Kniesel Jochen Huth Gerhard Bauer Frieder Mauch 《Archives of orthopaedic and trauma surgery》2014,134(12):1641-1647
Purpose
In recalcitrant epicondylitis innumerable operative techniques have been published, nevertheless a certain percentage of patients remains symptomatic after operative treatment. We developed an individual, systematic diagnostic pathway including arthroscopic assessment of elbow stability to identify the optimal and respectively less invasive therapy.Methods
We so far included 40 patients with recalcitrant lateral epicondylitis (mean age 46 ± 11). 5 patients had previous surgery. In all patients, we did an elbow arthroscopy and a systematic arthroscopic stability testing. 25 patients were treated exclusively arthroscopically once instability was excluded. In 13 patients with slight instability, we did an open debridement of the lateral tendon complex and local refixation. Two patients with severe instability were treated with open debridement and additional stabilization of the LUCL with a trizeps graft. With a minimum follow-up of 1 year, we assessed the DASH score and subjective patient satisfaction.Results
Mean follow-up was 24 ± 12 months, mean duration of symptoms before surgery was 19 ± 18 months. The mean DASH score at follow-up was 22 ± 19.36 patients reported symptoms improvement, 34 patients would repeat surgery given the same situation; in 30 cases, patients expectations had been fulfilled. We did not observe any intraoperative complications or infections. One patient developed joint stiffness requiring reoperation.Conclusion
Using a systematic diagnostic pathway including assessment of elbow stability and consecutive individualized, respectively, less invasive surgical procedure we acquired high patients satisfaction and good clinical outcome with a low complication rate.Level of evidence
Level III. 相似文献2.
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Objective
Re-establishment of radial stability within the elbow joint in cases of arthroscopically or clinically confirmed posterolateral rotatory instability.Indications
Posttraumatic or chronic degenerative posterolateral rotatory instability at least grade I–II according to O’Driscoll.Contraindications
Elbow stiffness or elbow arthritis and lateral epicondylitis, if a posterolateral rotatory instability has been excluded as the reason for the symptoms.Surgical technique
Reconstruction or augmentation of the insufficient lateral ulnar collateral ligament (LUCL) with an autologous triceps tendon graft. A stripe of the triceps tendon is fixed at the epicondylus humeri radialis and at the base of the annular ligament at the proximal radial ulna with tenodesis screws or buttons, then the extensor origins, which were detached before are fixated as well.Postoperative management
Postoperative treatment with an elbow orthesis for 6 weeks, in the first 4 weeks limitation of complete extension and flexion, full weight bearing after 3 months.Results
Retrospective analysis of 47 LUCL reconstructions from 2008–2010 with good results concerning pain reduction and acceptance, improvement of the Mayo Elbow Performance Score from 49 to 82, low complication rate with one elbow stiffness, one temporary ulnar nerve lesion, and one recurrent instability. 相似文献5.
Michael B. Cross Claus C. Egidy Ray H. Wu Daryl C. Osbahr Denis Nam Joshua S. Dines 《International orthopaedics》2014,38(4):791-795
Purpose
Several techniques for chronic distal biceps tendon repair have been reported; however, the literature is sparse.Methods
Seven male patients who underwent chronic distal biceps tendon reconstruction were retrospectively evaluated. All patients had significant retraction necessitating the use of an allograft for reconstruction. The procedure was done through a single incision using suture anchors and a tibialis anterior allograft. In each case, the graft was first fixed to the radial tuberosity with suture anchors, and then the allograft was sutured to the remnant of the native biceps tendon at 60° of elbow flexion. Patients were evaluated with the Mayo Elbow Performance Score (MEPS), Disabilities of Arm, Shoulder and Hand (DASH) scores and elbow range of motion (ROM).Results
The average time from injury to surgery was 25 (12–56) weeks, and the average follow-up was 16 (minimum 12) months. Average postoperative elbow ROM was as follows: extension 4° (0–12°), flexion 134° (130–140°), pronation 82° (75–85°) and supination 80° (70–85°); average MEPS was 94 (80–100); average DASH score was 6.67 (0–19.8). One patient developed a lateral antebrachial cutaneous neuritis postoperatively that resolved by three months.Conclusion
Though many reported techniques for chronic distal biceps tendon repair achieve satisfactory outcomes with limited complications, we present a technique with theoretical advantages of a single incision, use of suture anchors, use of a tibialis anterior allograft and tensioning after attachment of the graft to the radial tuberosity. In a series of complicated patients, early results were good to excellent. 相似文献6.
Introduction
Open reduction and internal fixation of multifragmentary intra-articular fractures of the distal humerus often do not provide satisfactory results in elderly patients with osteoporosis.Method
From December 2001 to January 2008 a total elbow arthroplasty (Coonrad-Morrey, Zimmer, USA) was performed on 12 patients (average age 81±9 ears) who presented with a type C distal humeral fracture. The mean time of follow-up with clinical and radiological assessment was 28±17 months.Results
The Mayo score showed a good functional result with an average of 81±9 out of 100. DASH and SECEC scores showed a fair result with respect to elbow function (43±8 and 68±7 points, respectively). The average range of motion of all patients was 120-33-0°. Heterotopic ossifications were found by X-ray examination in 4 cases and asymptomatic radiolucent lines in 4 cases.Conclusion
Primary total elbow arthroplasty for complex intra-articular distal humerus fractures in elderly patients has good functional results and is an alternative to osteosynthesis. 相似文献7.
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Khaled M. Balam Abdallah S. Zahrany 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2014,24(5):763-768
Objective
This is a prospective case series study, which was designed to evaluate the clinical outcome of posterior percutaneous plating of the humerus.Materials and methods
From the year 2010 to 2011, 37 patients with middle and distal third humeral fractures who met the inclusion criteria were surgically treated by minimally invasive plate osteosynthesis through posterior approach. Their age ranged from 19 to 43 with an average of 27.8 years. Type of fractures varied from B to C, and all of them were traumatic.Results
Patients were followed up for a period varied from 12 to 24 months with an average of 18. There were no cases of intraoperative complications, infection or metal failure. Union was achieved in all of them within 16–21 weeks with an average of 18. Iatrogenic postoperative temporary neuropraxia of the radial nerve palsy was observed in two patients. All patients achieved normal range of shoulder and elbow motion within 3 months after surgery. The average Quick DASH score at 12-month follow-up was 30. According to patient’s satisfaction, all of them returned to the usual pre-injury activity level within 6 months.Conclusions
This study suggests that the principles of minimally invasive plate osteosynthesis can be applied safely through posterior approach of the humerus to treat middle and distal third humeral fractures. This approach has the advantage of preserving the triceps anatomy and function facilitating rapid postoperative rehabilitation. 相似文献10.
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Purpose
The purpose of this study was to evaluate whether simultaneous bilateral endoscopic carpal tunnel release could be effectively and safely performed under local anaesthesia.Methods
We prospectively evaluated 85 consecutive patients (62 females) who underwent simultaneous one portal endoscopic bilateral carpal tunnel release with subcutaneous injection of 2 mL 2 % lidocaine. In case of pain after discharge, all patients were advised to take paracetamol (i.e., acetaminophen) and to record the dose of drug taken. Patients were reviewed at regular intervals until one year postoperatively.Results
The mean operative time was 31.2 min. Postoperatively, only nine patients (10.6 %) received on average 611 mg of paracetamol. Significant improvement was noticed in the parameters of numbness, pain, positive Phalen and Tinel tests, pinch strength, grip strength, tip pinch strength and Quick DASH Score. Patients returned fully to work after surgery in average 2.2 weeks. Conversion to open release took place in four wrists (2.4 %). Discomfort and pain from tourniquet pressure was reported from two patients (2.4 %). Two wrists (1.2 %) required revision surgery. One patient (1.2 %) reported temporary thenar numbness and another (1.2 %) had slight scar hypersensitivity.Conclusions
Simultaneous bilateral endoscopic carpal tunnel release under local anaesthesia is well tolerated by patients. The technique may be of benefit in young, active, high-demand patients who require fast recovery, early return to work and less disability time. 相似文献12.
Alisara Arirachakaran Amnat Sukthuayat Thaworn Sisayanarane Sorawut Laoratanavoraphong Wichan Kanchanatawan Jatupon Kongtharvonskul 《Journal of orthopaedics and traumatology》2016,17(2):101-112
Background
Clinical outcomes between the use of platelet-rich plasma (PRP), autologous blood (AB) and corticosteroid (CS) injection in lateral epicondylitis are still controversial.Materials and methods
A systematic review and network meta-analysis of randomized controlled trials was conducted with the aim of comparing relevant clinical outcomes between the use of PRP, AB and CS injection. Medline and Scopus databases were searched from inception to January 2015. A network meta-analysis was performed by applying weight regression for continuous outcomes and a mixed-effect Poisson regression for dichotomous outcomes.Results
Ten of 374 identified studies were eligible. When compared to CS, AB injection showed significantly improved effects with unstandardized mean differences (UMD) in pain visual analog scale (VAS), Disabilities of Arm Shoulder and Hand (DASH), Patient-Related Tennis Elbow Evaluation (PRTEE) score and pressure pain threshold (PPT) of ?2.5 (95 % confidence interval, ?3.5, ?1.5), ?25.5 (?33.8, ?17.2), ?5.3 (?9.1, ?1.6) and 9.9 (5.6, 14.2), respectively. PRP injections also showed significantly improved VAS and DASH scores when compared with CS. PRP showed significantly better VAS with UMD when compared to AB injection. AB injection has a higher risk of adverse effects, with a relative risk of 1.78 (1.00, 3.17), when compared to CS. The network meta-analysis suggested no statistically significant difference in multiple active treatment comparisons of VAS, DASH and PRTEE when comparing PRP and AB injections. However, AB injection had improved DASH score and PPT when compared with PRP injection. In terms of adverse effects, AB injection had a higher risk than PRP injection.Conclusions
This network meta-analysis provided additional information that PRP injection can improve pain and lower the risk of complications, whereas AB injection can improve pain, disabilities scores and pressure pain threshold but has a higher risk of complications.Level of evidence
Level I evidence13.
Mehmet Elmadag Mehmet Erdil Kerem Bilsel Mehmet Ali Acar Nejat Tuncer Ibrahim Tuncay 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2014,24(1):43-50
Introduction
Intra-articular distal humeral fractures can be approached in a variety of ways. The purpose of this study is to evaluate and compare the functional outcomes of two approaches: approach with olecranon osteotomy and triceps-lifting approach for the treatment of intra-articular distal humeral fractures.Methods
This study shows a consecutive series of 54 intra-articular distal humeral fractures of 54 patients who were treated with open reduction and internal fixation with anatomic plating. Lateral plating was performed in 10 (45.5 %) patients, and medial and lateral parallel plating was performed in 12 (54.5 %) patients in olecranon osteotomy group, while lateral plating was performed in 8 (25 %) patients, and medial and lateral parallel plating was performed in 24 (75 %) patients in triceps-lifting group.Results
Mean follow-up was 38.3 months for olecranon osteotomy group and 41.4 months for triceps-lifting group. Functional outcomes according to MAYO elbow score and extension-flexion motion arc values were significantly better in olecranon osteotomy group (p < 0.05).Conclusion
Approach with olecranon osteotomy provided better functional outcomes than triceps-lifting approach. Additionally, intra-articular distal humerus fractures can be safely treated with olecranon osteotomy which provides more control over the elbow joint and better visualisation and allows early postoperative rehabilitation.Level of evidence
IV. 相似文献14.
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Dragan Radoičić Ivan Micić Žarko Dašić Milimir Košutic 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2014,24(5):777-782
Background
Open intraarticular distal humerus fractures classified as Orthopaedic Trauma Association (OTA) 13 C may have devastating consequences for patient’s quality of life, especially if leading arm in younger active patient is involved. We conducted a study to determine whether the timing of open reduction and internal fixation of open intraarticular distal humerus fractures affects the outcomes.Patients and methods
Multicentric prospective study: In the first group, there were 15 patients, 10 men and 5 women, mean age 38.7 years, operated in <6 h of injury. In the second group 17 patients, 11 men and 6 women, mean age 42.3 years operatively treated in delayed settings, mean delay to operation 4.6 days of injury. In both groups, patients had open distal humerus articular metaphyseal multifragmentary fractures classified as OTA 13.C2 or 13.C3. Functional outcome was assessed with Mayo elbow performance score and Disabilities of Arm and Shoulder and Hand (DASH). Mean Mayo elbow performance (MEP) score in the first group was 71 (range 30–100); in the second, mean MEP was 64.3 (range 25–100). The mean DASH in the first group was 27.89 (range from 1.7 to 75.8), and in the second, mean DASH score was 32.6 (range 5.8–77.5). There were no statistically significant differences between two groups, MEP t(28) = 0.935, p < 0.358; DASH t(28) = ?0.636, p < 0.530.Conclusion
Our study shows that early open reduction and internal fixation of open distal articular humerus fractures reduces the hospital stay, but does not significantly affect the overall outcomes and complications. 相似文献16.
Dr. P. Simon F. Unterhauser P. von Roth G. Schmidmaier T. Winkler 《Der Unfallchirurg》2014,117(4):341-347
Background
The therapeutic algorithm for the treatment of Mason type II radial head fractures is still controversially discussed. This study describes the technique of percutaneous fracture reduction without additional internal fixation of the radial head as an alternative to open reduction and presents the results of the method.Material and methods
The data from 26 out of 30 patients with a Mason type II radial head fracture who had been consecutively treated with percutaneous fracture reduction were evaluated retrospectively. The analysis comprised the disabilities of shoulder and hand (DASH) score, the Mayo elbow performance score (MEPS) and data from the radiological examinations.Results
The average follow-up time was 21 months (range 6-47 months). In 22 cases (85 %) an anatomical reduction could be achieved, 2 cases (8 %) showed a complete redislocation of the fragment and 2 cases (8 %) a partial redislocation. The average DASH score was 5.6 points (range 0–56) and the average MEPS was 93.8 (range 60–100). Only 4 patients (15 %) reported persisting functional impairment with a DASH score >10.Conclusions
The method of percutaneous reduction of radial head fractures without additional internal fixation in Mason type II fractures has been demonstrated to be a good alternative to open reduction. 相似文献17.
Hong-jiang Ruan Shen Liu Cun-yi Fan Jun-jian Liu 《Archives of orthopaedic and trauma surgery》2013,133(2):179-185
Background
An ankylosed elbow is defined as an elbow having a range of motion of 0°. Movement is extremely limited. This study retrospectively analyzes the results of arthrolysis and hinged external fixation performed on 15 patients suffering from ankylosed elbows.Methods
Fifteen completely ankylosed elbows were treated by arthrolysis and hinged external fixation. Patients comprised nine men and six women, with a mean age of 37.93 years (37.93 ± 9.68) when arthrolysis was performed. Before surgery, the elbows were ankylosed at various angles ranging from 30° to 85°. Eleven patients underwent arthrolysis by medial and lateral approaches, three patients by the posterior approach, and one patient by posterior and lateral approaches. Hinged external fixators were applied to all patients. Subcutaneous anterior transposition of the ulnar nerve was performed in all patients.Result
All patients received satisfactory follow-up. The range of motion of the elbow improved from 0° preoperatively to a postoperative mean of 115.67° (115.67 ± 23.29). The Mayo Elbow Performance Score improved from a mean of 67.67 ± 11.00 to 86.67 ± 8.38 points, with excellent results in nine patients, good in five, and fair in one. This difference is statistically significant (t = ?6.862; p < 0.001).Conclusion
Open arthrolysis and monolateral hinged external fixation are effective in treating posttraumatic ankylosed elbow. Arthrolysis should be performed by a combination of lateral and medial approaches. In addition, routine hinged external fixation and anterior transposition of the ulnar nerve may improve the postoperative recovery of elbow stiffness. 相似文献18.
Ashutosh Kumar Singh G. R. Arun Nidhi Narsaria Anurag Srivastava 《Archives of orthopaedic and trauma surgery》2014,134(7):947-953
Background
The aim of this prospective comparative study was to compare outcomes and complications of humeral diaphyseal fracture non-unions managed with humerus interlocking nail (HIL) and locking compression plate (LCP).Materials and methods
40 patients with non-union of humeral diaphyseal fractures were included in this study and were randomly allocated in two groups; group A had 20 cases treated with HIL and group B had 20 cases treated with LCP. Clinico-radiological assessments were done for each case up to 2-year follow-up period. Primary outcome measures (time to fracture union, union rate) and secondary outcome measures (functional outcome and complication such as infection, malunion, delayed union, implant failure, joint stiffness and iatrogenic radial nerve palsy) were compared between both the groups. Disabilities of the arm, shoulder and hand (DASH) scoring and Steward and Hundley’s scoring system were used to assess functional outcome of the fracture fixation.Results
There was no significant difference (p = 0.12) in terms of mean fracture union time between group A (15.8 ± 4.2 weeks) and group B (17.2 ± 3.8 weeks). Group A had 95 % union rate and group B had 100 % union rate (p = 0.14). At the 2-year follow-up visit, there was no significant difference found between both the groups regarding range of motion of shoulder and elbow joint. There was no significant difference found in final functional outcomes between both the groups on comparing DASH score (p = 0.14) and Steward and Hundley’s score (p = 0.08). In terms of complications, there was insignificant difference found between both the groups.Conclusions
This study concludes that both the implants can be used in non-union of humeral shaft fractures with good functional outcomes and acceptable rate of complications. 相似文献19.
Gertraud Gradl Thomas Pillukat Thomas Fuchsberger Matthias Knobe David Ring Karl-Josef Prommersberger 《Archives of orthopaedic and trauma surgery》2013,133(9):1281-1287
Background
Intra-articular fractures of the distal radius (DRF) are associated with a twofold increase in the risk of scapholunate ligament injury (SLI). The aim of this study was to compare functional outcome, pain, and disability between patients with operatively treated DRF and either an acute, repaired scapholunate ligament injury or no ligament injury.Methods
We retrospectively analyzed 18 patients with an intraarticular DRF and SLI that was diagnosed and treated (Group I) and compared them with 20 patients with DRF without associated ligament injury (Group II) (20 women, 18 men; average age 55 years, range 19–72). The two cohorts were analyzed for differences in motion, grip strength, pain, Mayo wrist score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score an average of 43 months (range 12–73) after surgery. Radiographic assessment included fracture union, palmar tilt, radial inclination, ulnar variance, intercarpal angles, and arthrosis (according to Knirk and Jupiter). We used T-tests to compare range of motion, grip strength, pain (visual analog scale), DASH scores, and radiographic alignment between cohorts. A Chi-squared analysis was used to determine radiographic differences of arthritis.Results
There were no significant differences in mean range of motion, grip strength, Quick DASH score, Mayo wrist score, pain level, or radiographic arthrosis between cohorts. There was no correlation between radiographic signs of osteoarthritis and the QuickDASH score, and pain level.Conclusion
The outcomes of intraarticular fractures of the distal radius with operatively treated associated SLI are comparable with the outcomes of intraarticular fractures of the distal radius without associated SLI. 相似文献20.
R. Trentini T. Mangano I. Repetto P. Cerruti E. Kuqi C. Trompetto F. Franchin 《Musculoskeletal surgery》2015,99(1):91-97