Posttraumatic bacterial arthritis with luxation of the elbow

Summary Trauma predisposes an individual to bacterial arthritis. This report describes a case of posttraumatic bacterial arthritis with luxation of the elbow. It was necessary to perform synovectomy as a complement to systemic antibiotic treatment in order to control infection and reduce the dislocation. The use of external fixation is demonstrated.

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Zusammenfassung Trauma disponiert zur bakteriellen Arthritis. Im vorliegenden Bericht wird eine posttraumatische bakterielle Arthritis mit Luxation des Ellbogengelenkes beschrieben. Um die Infektion unter Kontrolle zu bringen und die Luxation zu reponieren wurde zusätzlich zur systemischen Behandlung mit Antibiotika eine Synovektomie durchgeführt und das Ellbogengelenk durch externe Fixation ruhiggestellt.

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Grants: Stiftelsen för Bistånd åt Vanföra i Skåne, Helsingborg and C.O. Lundbergs Minnesfond     

Posterior dislocation of the elbow

Posterior dislocation of the elbow is associated with significant morbidity and incomplete recovery. In this series of 32 patients, those with associated fractures, posterolateral dislocations, delayed reduction, and rigid immobilization had the least satisfactory outcome.     

Posttraumatic bacterial arthritis with luxation of the elbow. A case report

Trauma predisposes an individual to bacterial arthritis. This report describes a case of posttraumatic bacterial arthritis with luxation of the elbow. It was necessary to perform synovectomy as a complement to systemic antibiotic treatment in order to control infection and reduce the dislocation. The use of external fixation is demonstrated.     

Posterior surgical approaches to the elbow: a comparative anatomic study

Triceps splitting, triceps reflecting, and olecranon osteotomy are the most common posterior surgical approaches to the adult elbow, but no comparative data exist as to the exposure provided by each approach. The aim of this study was to determine which of these approaches provides the greatest exposure of the distal humeral articular surface. Each approach was performed on 4 adult cadaveric elbows. After the completion of each approach, the visible articular surface was painted with methylene blue. The elbow was then disarticulated, and the percentage of articular surface visible was measured. The median exposed articular surface for the triceps splitting, triceps reflecting, and olecranon osteotomy approaches was 35%, 46%, and 57%, respectively. Olecranon osteotomy exposed more articular surface than the triceps splitting approach (Mann-Whitney test, P =.03) but was not significantly greater than the triceps reflecting approach. However, even the olecranon osteotomy approach failed to provide visualization of more than 40% of the distal humeral articular surface.     

Posterior dislocation of the elbow in children

A series of 58 traumatic dislocations of the elbow observed over a 5-year period is reported. Average age of the children was 12 years old (range, 6 to 15 years). All dislocations were posterior. Neurovascular complications were few and transient in all cases. Associated fractures were present in 64% of the cases. In six cases (10%) closed reduction of the dislocation failed. Nineteen children (33%) were operated on, in most cases because of an associated fracture of the medial epicondyle. Results were the following: 21 excellent, 12 good, four fair, and two poor. Functional impairment was present only in the two cases with poor results. These occurred in patients in whom an associated fracture of the neck of the radius was present and were due to radioulnar synostosis.     

Fracture-dislocation of the hip joint. II. Central luxation]

64 cases of central luxation are analysed by the authors. 4--10 years after the injury 31 patients appeared at the check-inspection. It has been stated by the authors that because of the severity of the injury and the age of the injured patients surgical intervention may be performed even in case of greater dislocation but rarely. The result of the conservative treatment is in the case of congruency of the loading surface satisfactory, but it is even in the case of incongruency generally better than it may be supposed on the basis of the roentgenogram. For the prevention of later occurring severe arthrosis the importance of the rehabilitation is emphasized by the authors.     

Posterior dislocation of the elbow. A simplified method of closed reduction

Reduction of a posterior elbow dislocation can be accomplished by many methods and can require special positioning of the patient, trained assistants, and special equipment. A method that provides a simplified alternative is described. Leverage rather than forceful strength is the prerequisite. The maneuver is performed with the patient in the supine position, without any skilled assistant or special equipment. In the author's patient group the leverage technique has provided prompt and effective reduction without compromise to the neurovascular status of the limb.     

Congenital knee luxation]

The authors discuss the frequency, etiology, symptoms and classification as well as treatment of congenital dislocation of the knee. 8 own cases are reported in the article. The authors suggest that congenital dislocation of the may be well influenced by non-operative methods. Etappe redressement by means of plaster does not interfere with the functional treatment of the hip dislocation usually treated with the Pavlik braces. Associated foot deformities may be easily corrected at the same time. The so called "earliest treatment" is most important in all the three deformities (knee-hip dislocation, club foot), the authors emphasise.     

Pure posterior luxation of the elbow in adults: immobilization or early mobilization. A randomized prospective study of 50 cases

INTRODUCTION: Pure posterior dislocation of the elbow is frequent in young subjects. The objective of treatment must be to reduce the dislocation and avoid complications, the most frequent being stiffness, but also elbow instability. The objective of this prospective study was to evaluate the functional and anatomical characteristics of two treatment modalities: plaster immobilization and early mobilization. MATERIAL AND METHODS: 50 cases of pure posterior dislocation of the elbow were included in a prospective study and randomized to two groups: Group I: twenty six cases were treated by reduction under general anaesthesia and plaster immobilization for three weeks, followed by rehabilitation. Group II: twenty four cases were treated by reduction under general anaesthesia, followed by early mobilization. RESULTS: We evaluated our results in terms of loss of amplitude of elbow movement (particularly extension), stiffness, instability, relapses, pain and ossification. This study demonstrated better recovery of elbow function in patients treated by early mobilization: 96% of good results with recovery of normal extension in group II versus 81% of cases in group I. Stiffness was observed in 19% of patients in group I versus 4% in group II; this difference was very significant. Comparison of pain revealed no significant difference and no relapses, instability or ossifications were observed in either of the two groups. DISCUSSION AND CONCLUSION: Early mobilization is superior to plaster immobilization, as it allows recovery of better quality elbow function without inducing instability or recurrence.     

Isolated luxation of the trapezium bone]

The luxation of the os trapezium without fracture - a very rare lesion - is reported. This is the first publication in the Hungarian literature of this sort. Proper diagnosis was established after the patient's admission. Covered reduction of the luxation was made, and the luxated bone was fixed by percutaneous wiring and plaster-bandage. The patient recovered without complications.     

Metacarpophalangeal luxation of the thumb. Apropos of 30 cases]

A retrospective study of a series of 30 cases of metacarpo-phalangeal luxation of thumb (18 dorsal and 12 palmar) showed the relatively high frequency of the palmar variety both in adults and children. Prognosis was better for dorsal than for palmar luxations, the latter being associated with other lesions; cutaneous, tendinous and/or bony, these constituting the severity factor.     

Cerebral vasospasm. Experimental study]

We have studied chronic vasospasm (V.S.) on a primate model (Cynomolgus monkey). The conclusion of several studies are: V.S. is related to the presence of adherent clots along cerebral arteries and when severe may lead to cerebral infarction. Clots removal within 48 h. following subarachnoid hemorrhage reduces V.S. intensity. Free radicals and iron dependent lipidic peroxidation have been involved in cerebral ischemia development. A new aminosteroid (U 74006 F) can act as a free radical phagocyte and antagonize iron dependent lipid oxidation. Histological V.S. changes are less important after S.A.H. with 74006F treatment. Oxyhemoglobin high concentration from red blood cells (R.B.C.) hemolysis has been reported to be responsible for V.S. Therefore induction of R.B.C. release from the clots before hemolysis occurs could prevent from high concentration of oxyhemoglobin. Plasminogen activator can prevent V.S. when used during 72 h. following subarachnoid hemorrhage.     

Posterior elbow dislocation with associated vascular injury after blunt trauma.

BACKGROUND: Injury of the brachial artery is a rare (5-13%) but serious complication after closed elbow dislocation without associated fractures. METHOD: Retrospective analysis of long-term results (mean, 4.1 years) in four patients. RESULTS: All patients underwent emergency repair of the arterial injury within 2.5 hours. In three patients, a reversed saphenous vein graft was used; in one patient the artery was sutured. This latter patient needed another operation with interposition of a reversed saphenous graft, because the primary anastomosis occluded. The capsule and the collateral ligaments were immediately reconstructed in three patients because of instability. No patient showed claudication of the arm. In three patients, a sensory deficiency of median nerve persisted. Average range of motion was 128 degrees of flexion (120-135 degrees) and an extension deficit of 7.5 degrees (15-0 degrees). CONCLUSION: Primary repair of vascular injury after closed elbow dislocation with vein graft and immediate reconstruction of ligamentous injuries results in good long-term functional outcome.