Long-term outcome of operatively treated fracture-dislocations of the olecranon

OBJECTIVES: To report the long-term results of operative treatment of anterior and posterior olecranon fracture-dislocations and compare them with the results recorded fewer than 2 years after surgery. DESIGN: Retrospective case series with long-term evaluation. SETTING: Level I trauma center. PATIENTS AND PARTICIPANTS: Ten patients with anterior olecranon fracture-dislocation and ten patients with posterior olecranon fracture-dislocation were evaluated after an average of 18 years (range, 11 to 28 years) after injury. Fifteen patients had an early follow-up available at an average 14 months (range, 6 to 24 months) after surgery. The average age at injury was 30 years (range, 14 to 53 years). INTERVENTION: Treatment included plate and screw fixation (11 patients), tension band wiring (8 patients), and radiocapitellar transfixation (1 patient). Six patients had additional elbow surgery before the final evaluation. MAIN OUTCOME MEASUREMENTS: Flexion arc, arthrosis, Mayo Elbow Performance Index (MEPI), Disability of Arm Shoulder and Hand questionnaire (DASH). RESULTS: The mean arc of elbow flexion was 105 degrees (range, 15 to 140 degrees) at 1 year and 122 degrees (range 10 to 145 degrees; P = 0.01) at final evaluation. Radiographic arthrosis was observed in 14 patients (70%): severe in 3, moderate in 2, and mild in 9 patients. Five patients (25%) had ulnar nerve dysfunction at the final evaluation. The MEPI was excellent in 13 patients, good in 4, fair in 2, and poor in 1. The mean DASH score was 9 points (range, 0 to 53 points). CONCLUSION: The initial results of operative treatment of fracture-dislocations of the olecranon are durable over time.     

A figure-eight suture loop with Kirschner wires for fixation of anteromedial coronoid process fractures: A case series

PurposeSufficient fixation of an anterior or anteromedial facet fracture of the coronoid process in fracture-dislocation of elbow is important to maintain joint stability. The purpose of this study was to report our experience with 11 patients who were managed with an original fixation technique using a “figure-eight” suture loop.MethodsFrom February 2010 to March 2011, 11 cases with a fracture of the anterior or anteromedial facet of the coronoid process were treated by coronoid fixation using a figure-eight suture loop. For cases with comminuted fractures, to prevent a suture from sliding into the fracture line, a 3- or 4-hole phalanx plate was enclosed in the suture loop to compress multiple fragments. Accompanying injuries, such as a radial head fracture or olecranon fracture, were fixed with repair of lateral collateral ligament injuries.ResultsOn final evaluations at an average of 18 months after injury, the mean elbow arc of motion was 125.5° and the mean forearm rotation arc of 124.1°. All fractures were united with an average postoperative score according to the Mayo Elbow Performance Index of 91 points. All patients achieved satisfactory scores (seven excellent, four good). All 11 fractures were united at final follow-up with no joint incongruity, dislocation, or subluxation of the injured elbow.ConclusionsThe figure-eight suture loop technique is an easy and effective technique to fix anterior or anteromedial facet fractures of the coronoid process.     

成人尺骨近端向后孟氏损伤的诊断与治疗

目的 探讨成人尺骨近端向后孟氏损伤的诊断、鉴别诊断及治疗策略.方法 2004年4月至2007年12月共手术治疗16例成人尺骨近端向后孟氏损伤患者,其中对13例患者获得随访,随访时间12～58个月,平均28个月.手术均采用肘关节后正中入路.术中尽量对桡骨头骨折和冠状突骨折进行复位和固定.对尺骨近端的固定,7例采用单纯钢板,2例钢板加克氏针,3例钢板加克氏针张力带,1例克氏针张力带加螺钉.结果 末次随访时均无明显疼痛及肘关节不稳定.患肢肘关节伸屈活动范围平均为100°(0°～145°),前臂旋转活动范围平均为119°(0°～170°).Mayo肘关节功能评分(MEPS评分)平均为93.1分(67～100分),优良率92.3%.Broberg-Morrey评分平均为88.8分(53～100分),优良率76.9%.结论 对尺骨近端向后孟氏损伤要注意正确的诊断与鉴别诊断.手术治疗的关键要重建尺骨近端长度和对线,尽量对其进行解剖复位并牢固固定.     

经鹰嘴肘关节骨折脱位的骨折特点及手术策略

目的探讨经鹰嘴肘关节骨折脱位的骨折特点及手术策略。 方法回顾性分析2013年1月至2018年1月山东大学附属省立医院采用切开复位内固定治疗的24例经鹰嘴肘关节骨折脱位患者的临床资料及随访结果，其中男性13例，女性11例。年龄25 ~ 64岁，平均36.4岁。受伤原因为：交通伤12例、高坠伤6例、摔伤6例。尺骨鹰嘴横型或斜型骨折4例，粉碎性骨折20例；合并冠突骨折15例，根据Regan-Morrey分型均为III型；合并桡骨头骨折2例。受伤至手术时间为7 ~ 19 d，平均10.5 d。所有患者均采用肘关节后方正中入路复位固定冠突、桡骨头和尺骨鹰嘴骨折，恢复滑车切迹解剖完整性。其中2例患者因冠突固定欠佳，加用肘前方入路复位固定冠突骨折。 结果所有患者术后均获得随访，随访时间12 ~ 24个月，平均13.2个月。所有骨折均获得骨性愈合，平均愈合时间为（2.8±0.5）个月。术后12个月Mayo肘关节功能评分平均为（85.1±4.1）分,其中优8例，良12例，可4例，优良率83.3%。所有患者末次随访均未出现创伤性关节炎、肘关节不稳定、骨折不愈合等并发症。 结论经鹰嘴肘关节骨折脱位是一种发病率较低的复杂损伤，可涉及尺骨鹰嘴、冠突及桡骨头骨折。良好地复位及牢固固定各骨折块，尤其是滑车切迹的平整，同时术后积极规范的功能锻炼，可以获得很好的临床效果。     

Functional outcome after operative treatment of eight type III coronoid process fractures

BACKGROUND: There have been few reports about surgical outcomes of coronoid process fractures. Eight cases of clinical results of type III coronoid process fractures were reviewed. METHODS: Eight patients with coronoid type III fracture were retrospectively reviewed. All were men with an average age of 33 years. There were three isolated fractures, two elbow dislocations, two radial head and neck fractures, and one medial collateral ligament rupture. An open reduction and internal fixation through an anterior approach with cannulated screws was used. The patients were followed up for a mean of 31 months (range, 24-60 months). RESULTS: Average active elbow joint motion at the most recent follow-up was 105 degrees. The average Mayo Elbow Performance Score was 76.9 (range, 50-95). Of the results, there was one excellent, four good, two fair, and one poor. CONCLUSION: Early open reduction and stable internal fixation provided a reliable method for the treatment of type III coronoid process fractures. Any associated injuries to the elbow and fracture comminution were considered as important prognostic factors.     

人工桡骨头置换在肘关节恐怖三联征中的应用

 目的 观察人工桡骨头置换治疗肘关节恐怖三联征的近期疗效。方法 2011年6月至2012年6月采用人工桡骨头置换治疗肘关节恐怖三联征6例,男4例,女2例;年龄23~50岁,平均39岁。新鲜肘关节骨折脱位5例,陈旧性骨折1例。桡骨头骨折MasonⅡ型2例,MasonⅢ型4例。对肘关节恐怖三联征进行切开复位,尺骨冠突骨折固定（螺钉固定1例、不可吸收缝线固定4例）、人工桡骨头置换、外侧韧带复合体修复及环状韧带修复或重建（修复环状韧带1例、掌长肌腱重建环状韧带2例）。术后第5至7天逐步开始肘关节功能锻炼。术后复查肘关节正侧位X线片,术后3个月复查肘关节三维CT,并采用Myao肘关节功能评分（Myao elbow performance score,MEPS）评价肘关节功能。结果 6例均获得随访,随访时间10~24个月,平均16.8个月。术后3个月肘关节MEPS评分85~95分,平均91.7分;优5例,良1例。肘关节活动度（采用标准中立位0度法测量）：屈82°~95°,平均87°;伸15°~32°,平均21°;旋前82°~90°,平均86°;旋后45°~80°,平均56°。随访期间未出现肘关节不稳、脱位或半脱位、创伤性关节炎及感染。1例因桡骨头假体位置欠佳使肱骨与桡骨头假体间隙变窄而影响肘关节屈曲活动度。2例出现未影响肘关节功能的Hahi 1级异位骨化。结论 采用人工桡骨头置换治疗伴有桡骨头粉碎性骨折的肘关节恐怖三联征能恢复肘关节稳定性,减少肘关节僵硬、脱位及半脱位等并发症的发生。     

ARM: a modular hinged joint for the AO tubular external fixator

Certain complex traumatic elbow lesions challenge the orthopaedic and trauma surgeon. If they are not treated correctly, they cause a high rate of disability, arising from elbow instablility and stiffness, either by fibrosis or joint incongruity. Injuries such as complex fractures of the proximal third of the ulna, coronoid fractures associated with radial head fractures (the "terrible triad"), are even worse if they are accompanied by soft tissue lesions. Hinged external fixators, complemented by other surgical procedures, are, for many, a recommended alternative when dealing with irreparable lesions. The AO tubular external fixator, by virtue of its versatility, is a very important tool in orthopaedics and trauma, but there is not the possibility of using it as a hinged fixator. The authors describe a prototype of a hinged joint that can be applied easily to the AO tubular external fixator, converting it into a hinged one. This hinged joint, in conjunction with the AO tubular external fixator, has been applied in 5 patients; 2 "terrible triads", one posterior elbow fracture-dislocation with radial head fracture, one Monteggia fracture-dislocation and an anterior elbow dislocation that developed a forearm compartment syndrome. The patients' age range was between 20 and 72 years (median 45,6); 4 were male and 1 female. In 3 patients, either a type III coronoid fracture or a radial head fracture, could not be repaired. One radial head was totally removed and another one partially removed. The remaining indications were because of severe soft tissue lesions. Results were evaluated using the Mayo Elbow Score Scale and the Broberg and Morrey radiographic evaluation scale. The median follow up was 18 months(range 6 to 48 months). All 5 patients got a maximum score of 100 points in the Mayo's Elbow Score Scale, indicating excellent results. No patient suffered elbow pain, or any type of elbow instability. The median range of motion in flexion was of 127.5 degrees (max. 140 degrees and min. 120 degrees ) and the median extension loss was 20 degrees (max. 25 degrees and min. 15 degrees ). One patient had pronation limited to 70 degrees and one had supination limited to 70 degrees . Every patient was able to resume a normal daily life activity and returned to normal work. In 3 patients the radiographic evaluation was Grade 0 and in the other 2, Grade I. Two complications occurred, one was a distal ulnar Schanz screw loosening with osteolysis and the other was a superficial infection of one Schanz screw. It can be concluded that good results can be obtained in injuries with severe elbow instability and soft tissue lesions, using this hinged external fixator. With this new clamp, the AO tubular external fixator is transformed into a hinged one and a new use is added to this already very versatile system. This clamp is very easy to apply.     

Monteggia fracture dislocation equivalents ---analysis of eighteen cases treated by open reduction and internal fixation

Objective: Monteggia fracture dislocation equivalent, though already described by Bado, is still an unclassified entity. We aimed to retrospectively analyze 18 cases of Monteggia variants and discuss the injury mechanisms, management, and outcome along with a re view of the literature. Methods: A retrospective record of Monteggia fracture dislocation (2003-2008) was reviewed from medical record department of our institute. Classic Monteggia fracture dislocation, children below 12 years or adults over 50 years, as well as open grade Ⅱ & Ⅲ cases were excluded from this study. Monteggia variant inclusion criteria included fracture of the proximal ulna together with a fracture of the radial head or neck and skeletal maturity. Totally 26 patients were identified with Monteggia variants and 18 were available for follow-up, including 11 males and 7 females with the mean age of 35 years. The ulna fracture was treated by compression plating along with tension band wiring. Radial head/neck was reconstructed in 12 patients while excised in 6 patients. Results: Follow-up ranged from 1 -4 years, mean 2.6 years. Patients were assessed clinicoradiologically. Mayo Elbow Performance Score was employed to assess the outcomes. At final follow-up, the results were excellent in 10 patients, good in 4, fair in 2 and poor in 2. Mean range of motion of the elbow was 20°, 116°, 50° and 55° for extension, flexion, pronation and supination, respectively. Two patients had complications in the form of heterotopic ossification and stiffness of the elbow. One nonunion ulna, primarily treated by tension band wiring, was managed by refixation with locking reconstruction plate and bone grafting. Bone grafting was only required in this patient for nonunion. Another patient had implants removed on his request. The results in our series closely correlated with extent of intraarticular damage, coronoid fracture and comminuted fractures. Conclusions: Monteggia fracture dislocation equivalents are rare injuries and pre-surgery recognition by radiographs and 3-D CT helps make optimal plan. The poor results usually relate to intraarticular damage, coronoid fractures and comminution of the ulna and radial head fractures.     

修复前关节囊在"肘关节恐怖三联征"手术治疗中的疗效观察

目的探讨修复前关节囊在"肘关节恐怖三联征"手术治疗中的疗效。 方法自2015年5月至2017年12月苏州大学附属瑞华医院手外科采用手术修复前关节囊治疗8例肘关节恐怖三联征患者，根据影像学评价观察骨折愈合情况。采用Mayo肘关节功能评分评估肘关节功能情况。 结果所有患者均获得6~36个月随访，平均18个月。切口均Ⅰ期愈合。骨折均愈合，时间为8~12周，平均10周。根据术后6个月随访，肘关节屈位0°~15°，伸位130°~145°，平均活动范围为115°，旋前60°~90°，旋后40°~70°，平均旋转范围120°。术后无骨折块移位、内固定失效、锁定接骨板螺钉松动或断裂、切口感染、异位骨化等并发症发生。肘关节功能恢复良好，采用Mayo肘关节功能评分：优6例，良2例。 结论在肘关节恐怖三联征时修复前关节囊，恢复肘关节的稳定性，并发症少，骨折愈合快，及早配合正规的康复锻炼，肘关节功能恢复好，疗效确切。     

The Compass Elbow Hinge: indications and initial results

The Compass Elbow Hinge uses Illizarov's methods of fixation to externally hold the elbow reduced and allow both passive and active motion. Eleven patients with degenerative disease, contracture or instability were treated with the Compass Elbow Hinge and were retrospectively evaluated at an average follow-up of 29 months (range: 18-62 months). One was lost to follow-up. Patients with degenerative changes underwent fascia lata interposition while those treated for contractures underwent anterior and posterior capsular release with or without fascia lata interposition. Those with elbow instability underwent ligament reconstruction. The device was removed after 6 weeks and seven of the 11 patients were satisfied with the outcome of the operation. Stability could not be achieved in two patients with coronoid fractures that were not reconstructed. One patient did not tolerate the device and requested its removal with subsequent subluxation. We conclude that patient selection and compliance are key elements in achieving a satisfactory outcome with the device.     

青壮年患者肱骨近端严重骨折脱位的内固定治疗

目的探讨青壮年患者肱骨近端严重骨折脱位行锁定钢板内固定保头治疗的临床疗效。 方法回顾性分析荆门市第一人民医院自2012年6月至2017年6月收治的24例肱骨近端严重骨折脱位患者的临床资料,其中男15例,女9例;年龄31~59岁,平均39.2岁;右侧8例,左侧16例;本组均为新鲜骨折,骨折按Neer分型：三部分6例,四部分18例;肱骨头前脱位21例,肱骨头后脱位3例。记录手术时间、术中出血量、住院时间,观察切口愈合、骨折愈合情况及术后并发症情况,末次随访采用Neer肩关节功能评分标准评定肩关节功能。 结果本组患者获随访12~37个月,平均19.7个月;手术时间69~113 min,平均82.3 min;术中出血量100~500 ml,平均197.5 ml;住院时间6~14 d,平均8 d;患者切口均Ⅰ期愈合,末次随访时21例患者骨折获得临床愈合,1例患者术后半年发现感染,后分期行人工肱骨头置换治疗,2例患者出现肱骨头坏死,但患者自觉可耐受未行特殊处理。术后肩关节前屈活动范围82°~165°,平均136°;后伸活动范围20°~45°,平均40°;外展活动范围87°~170°,平均147°;内旋活动范围L5~T9水平,平均L1水平;与术前比较差异均有统计学意义（P<0.05 ）。根据Neer肩关节功能评分标准：优8例,良11例,可4例,差1例,总体优良率79.17%。 结论对于青壮年患者肱骨近端严重骨折脱位行锁定钢板内固定保头治疗,临床疗效较好,也是一种治疗选择。     

可调节外固定支架治疗高龄开放性肘关节损伤的临床疗效分析

目的:探讨应用可调节外固定支架治疗高龄肘关节开放性损伤的临床疗效分析。方法:自2013年8月至2019年3月,我们采用可调式外固定支架治疗肘关节开放性损伤高龄患者5例。肘关节开放性损伤包括肘关节后脱位、桡骨头骨折、尺骨鹰嘴骨折、肱骨髁骨折、冠状突骨折等病例。术后随访应用Mayo肘关节功能评分进行疗效评价。结果:术后所有...     

寰椎骨折合并不连续下颈椎骨折脱位的外科治疗

目的:探讨寰椎骨折合并不连续下颈椎骨折脱位的治疗方法及效果.方法:回顾性分析2005年10月～2011年5月收治的20例寰椎骨折合并不连续下颈椎骨折脱位患者的一期手术治疗效果.男13例,女7例,平均年龄36岁.5例寰椎粉碎性骨折合并有寰椎侧块内侧骨性结构附着处横韧带撕裂(DickmanⅡ型),3例双侧前弓骨折(前1/2 Jefferson骨折),5例单侧前后弓双骨折(半环Jefferson骨折),2例前3/4 Jefferson骨折(前弓二处、后弓一处骨折),5例后3/4 Jefferson骨折(前弓一处、后弓二处骨折).其中并存下颈椎骨折脱位按Allen分型:屈曲压缩型5例,牵张压缩型3例,垂直压缩型8例,屈曲牵张型2例,伸展牵张型2例.20例患者均行上、下颈椎一期手术治疗:5例行后路C1-C2固定融合术,7例行口咽入路钢板内固定术,8例行单纯C1后路螺钉固定术;9例并发脊髓不完全损伤来自于下颈椎骨折脱位者,先行下颈椎融合固定,无脊髓损伤11例患者,先固定相对不稳定节段.随访观察治疗效果.结果:平均手术时间200min( 180～240min);平均失血量760ml(500～1600ml).2例因电刀灼伤C1-C2间血管静脉丛导致出血,行止血纱布、脑棉片填塞止血,未出现颅脑缺血症状;其他病例未出现与手术直接相关并发症及长期卧床所导致的并发症.患者均于术后3d颈托固定后下地行走.随访8～42个月,平均26个月.9例合并脊髓不完全损伤者术后神经功能Frankel分级均有1个级别恢复.复查X线片和CT,未发现患者颈椎失稳或复位丢失,螺钉位置良好,无松动、断钉,寰椎骨折及下颈椎骨折脱位均获骨性愈合.结论:手术治疗寰椎骨折合并不连续下颈椎骨折脱位利于患者早期下床活动,减少长期卧床并发症,可获得较好疗效.     

Shear fracture-dislocations of the thoracic and lumbar spine associated with forceful hyperextension (lumberjack paraplegia).

Twelve patients sustained a shear fracture-dislocation of their thoracic or lumbar spines by a hyperextension mechanism of injury. Ten male and two female patients were injured; their average age was 29 years (range, 22 months to 56 years). Ten fracture-dislocations occurred in the thoracic spine, one at the thoracolumbar junction, and one in the lumbar spine. Eleven patients had complete paraplegia, and one had incomplete paraplegia at the time of injury. Dural tears were found in six of the patients. Eleven patients were treated by posterior spinal fusion with instrumentation, and one was treated with a brace. Three patients were treated with Harrington distraction rods alone, six had Harrington distraction rods supplemented with a midline Harrington compression rod or interspinous wiring, and two were treated with Cotrel-Dubousset instrumentation. No patient was lost to follow-up. The average length of follow-up was 3.5 years (range, 1-9 years). Six of the patients treated with Cotrel-Dubousset instrumentation or Harrington distraction rods supplemented with either a midline compression rod or interspinous wiring healed anatomically; two patients developed pseudarthroses. None of the patients treated with Harrington distraction rods alone healed in an anatomic position. The use of Harrington distraction rods alone was associated with overdistraction and nonanatomic alignment of the spine. The disruption of the anterior stabilizing structures of the spine associated with hyperextension injuries necessitates the use of instrumentation that can stabilize the spine and prevent overdistraction. This injury can be successfully treated with Cotrel-Dubousset or Harrington distraction rods supplemented with either a midline compression rod or interspinous wiring.     

The treatment of the displaced fractures of the radial head with open reduction and internal fixation using Herbert screws]

The purpose of this retrospective study was to evaluate the results following open reduction and internal fixation of fractures of the radial head with the Herbert screws. 18 patients had been treated from 2001 to 2005, 10 men and 8 females with an average age of 39 years and 6 months (range, twenty to fifty six years). In 7 cases (38%) the fracture were part of a more complex elbow injury pattern; posterior dislocation of the elbow 4, posterior dislocation with rupture of the medial collateral ligament 1, posterior dislocation with concomitant fracture of the coronoid process and medial collateral ligament rupture 3.9 had Mason Type- II and 9 Mason Type III fracture. Stabilization was performed with one to three Herbert screws. Twenty patients were reexamined after a mean time 3 year and six months (range 1 to 5 years). According Mayo Elbow Performance Score the results were excellent in 9 patients, good in 2, and fair in 1 patient.     

Operative treatment of osteochondral nonunion of the distal humerus

Three patients with ununited osteochondral fracture fragments of the distal humerus (2 anterior capitellum and trochlea; 1 posterior trochlea) who had debridement and realignment of the nonunion, autogenous cancellous bone graft, and internal fixation an average of 6 (range, 5-8) months after injury were studied. The preoperative arc of elbow flexion was 80 degrees, 35 degrees, and 25 degrees. All 3 fractures healed without implant related complications or osteonecrosis. At 28, 27, and 46 months after the index procedure for nonunion, the patients had 95 degrees, 90 degrees, and 115 degrees arcs of elbow flexion. The scores on the Mayo Elbow Performance Index were 80, 80, and 95 (2 good, 1 excellent). Based on this limited experience, it seems that operative treatment of ununited osteochondral fracture fragments can achieve union without osteonecrosis. Attempts to improve the function of the native elbow rather than salvage the situation with interpositional or prosthetic arthroplasty are worthwhile.     

双微型锁定钢板治疗尺骨鹰嘴骨折的疗效观察

目的:探讨双微型锁定钢板治疗尺骨鹰嘴骨折的临床疗效。方法:自2017年3月至2020年5月,采用双微型锁定钢板治疗19例尺骨鹰嘴骨折患者,其中男12例,女7例;年龄20~75(40.50±7.62)岁;左侧10例,右侧9例。19例患者均为新鲜闭合骨折且不合并尺骨冠状突骨折、肘关节脱位等损伤。记录患者骨折愈合时间及并发症情况,并于术前、术后12个月采用Mayo肘关节功能评分标准(Mayo elbow performance score,MEPS)进行临床疗效评价。结果:19例患者术后均获得随访,时间12~17(13.51±3.17)个月。术后所有骨折获得骨性愈合,时间2~6(3.77±1.24)个月,未发生内固定断裂、螺钉松动、感染、内固定激惹、异位骨化、肘关节僵硬等并发症。术后12个月患侧肘关节MEPS评分(91.26±3.87)分与术前(56.18±9.56)分比较差异有统计学意义(P0.05);按照Mayo肘关节功能评分标准,结果优11例,良7例,中1例。结论:采用双微型锁定钢板治疗尺骨鹰嘴骨折,手术切口小,骨折固定可靠,术后可早期行肘关节功能锻炼,术后内固定对皮肤激惹小,肘关节功能恢复满意,是一种可靠的固定方法。     

Operative treatment of olecranon nonunion.

Records of five patients treated surgically for nonunion of the olecranon were reviewed. Four of the five fractures leading to nonunion were comminuted or oblique. Three nonunions occurred after tension band wiring, one nonunion occurred after open reduction internal fixation with a semitubular plate, and one nonunion occurred after treatment with a cast. The median interval from fracture to treatment of nonunion was 8 months. All nonunions were treated surgically. Four patients were treated with a tension band plate technique. All nonunions united at a median of 3 months. The median follow-up period was 36 months (range, 12-48 months).     

Radial head replacement with unipolar and bipolar SBi system: a clinical and radiographic analysis after a 2-year mean follow-up

Radial head prosthetic replacement is indicated in case of comminuted fracture not amenable to internal fixation, especially when the radial head fracture is part of a pattern of lesions configuring a complex instability of the elbow. Thirty-one SBi radial head prostheses were implanted in 30 patients (one bilateral simultaneous fracture) over a 2 years period. In 10 patients, the mean time from trauma to surgical treatment was 2.4 days, while the remaining 20 patients were treated as "second opinion" cases presenting with elbow stiffness or instability after an average of 19 days from trauma. The implants were monopolar in 12 cases and bipolar in 19. The clinical results were evaluated through the Mayo Elbow performance scoring system. At an average follow-up of 2 years (range 13-36 months), the mean MEPS was 90 points (range 65-100). At late radiographic analysis, radiolucent lines around the stem were found in 11 of the 31 cases. Heterotopic ossifications were found in 14 cases. Bone resorption was observed in 9 cases. Two of the 31 prostheses were removed after 16 and 20 months, in one case to correct stiffness in pronation/supination, in the other one for asymptomatic aseptic mobilization. These short-term results are satisfactory, especially when considering that they were obtained in complex elbow lesions treated in many cases at a delayed stage. Our preference over time went more and more to bipolar implants, but from a comparison of the results we could find no evidence of a superiority of bipolar or monopolar implants. The evolution of these prostheses needs to be evaluated with further studies to assess mid-term and long-term follow-up results.     

Endoprosthetic joint replacement of the contracted elbow joint

In a retrospective study 14 patients were reviewed 63 months after the implantation of a semi-constrained total elbow prosthesis in fourteen stiff or ankylosed elbows with a preoperative range of elbow motion of 30 degrees or less. The result, according to the Mayo Elbow Performance score, was excellent for four elbows, good for four, fair for one, and poor for five. The average arc of flexion improved from 7 to 68 degrees postoperatively with an average increase of 34 degrees in flexion, and 27 degrees in extension. There were seven complications affecting seven of the 14 elbows and four of these seven elbows underwent a revision procedure. Replacement for a stiff elbow is the least predictable, has the lowest overall rate of success and highest complication rate, than any other procedure. Nevertheless, these disadvantages must be placed in the context of alternative intervention options. The semiconstrained total elbow arthroplasty seems to be a useful option for patients older than 50 years with intrinsic stiffness involving more than 50% of the articular surface and with an ankylosed or very stiff elbow.