wenty-one cases with injurys of upper trunk of brachial plexus in 18 and poliomyelitis in 3were treated by transfer of flexor carpi ulnaris muscle to restore flexion of elbow from may, 1981through November, 1992. There were 16 males and 5 females with an average age of 28 years old(ranged 17-60 years). All of the patients was combined with incompetence of abduction function ofshoulder, 6 cases with incompotence of extenxor function of elbow and 11 cases with incompotence ofsupifiation fu...
Objective To evaluate of the valgus stability of the elbow after excision of the radial head, release of the medial collateral ligament (MCL), radial head replacement, and medial collateral ligament reconstruction.Methods Twelve fresh human cadaveric elbows were dissected to establish 7 kinds of specimens with elbow joint and ligaments as follow:①intact(n=12)； ②release of the medial collateral ligament(n=6)；③ excision of the radial head(n=6)；④excision of the radial head together with release of the medial collateral ligament(n=12)；⑤radial head replacement(n=6)；⑥medial collateral ligament reconstruction(n=6)；⑦radial head replacement together with medial collateral ligament reconstruction(n=12). Under two-newton-meter valgus torque, and at 0, 30, 60, 90 and 120 degrees of flexion with the forearm in supination, the valgus elbow laxity was quantified: All analysis was performed with SPSS 10.0 software.Results The least valgus laxity was seen in the intact state and its stability was the best. The laxity increased after resection of the radial head. The laxity was more after release of the medial collateral ligament than after resection of the radial head (Plt;0.01). The greatest laxity was observed after release of the medial collateral ligament together with resection of the radial head, so its stability was the worst. The laxity of the following implant of the radial head decreased. The laxity of the medial collateral ligament reconstruction was as much as that of the intact ligament (Pgt;0.05). The laxity of the radial head replacement together with medial collateral ligament reconstruction became less.Conclusion The results of this studyshow that the medial collateral ligament is the primary valgus stabilizer of the elbow and the radial head was a secondary constraint to resist valgus laxity.Both the medial collateral ligament reconstruction and the radial head replacement can restore the stability of elbow. If the radial head replacement can notbe carried out, the reconstruction of the medial collateral ligament is acceptable.
Objective To evaluate the effectiveness of the AO anatomical locking compression plate in treating type C distal humeral fracture. Methods Between July 2008 and April 2009, 13 cases of type C distal humeral fracture were treated with the AO anatomical locking compression plates. There were 5 males and 8 females with an average age of 52.1 years (range, 24-80 years). Fractures were caused by tumbl ing in 7 cases, by traffic accident in 4 cases, and by fall ing from height in2 cases. According to Association for Osteosynthesis/Orthopaedic Trauma Association (AO/OTA) classification, there were 3 cases of type C1, 6 cases of type C2, and 4 cases of type C3. Two cases compl icated by ulnar nerve injuries, 1 by radial nerve injury, 2 by fractures of ulnar olecranon, 3 by fractures of other parts of extremities, and 6 by osteoporosis. The time from injury to hospital ization ranged from 3 hours to 4 days (0.9 day on average). Results All the incisions achieved heal ing by first intention. Thirteen cases were followed up 12 to 21 months with an average of 15.9 months. According to the X-ray films, unions were achieved both at fracture site and the olecranon osteotomy site with a heal ing time of 8 to 13 weeks (10 weeks on average). The function of elbows recovered from 3 to 32 weeks (10 weeks on average). No fixation failure, myositis ossifican, delayed union, or malunion occurred during the follow-up. The Mayo Elbow Performance score ranged from 75 to 100 with an average score of 95.8; the results were excellent in 9 cases, good in 3 cases, and fair in 1 case with an excellent and good rate of 92.3%. Conclusion The AO anatomical locking compression plate has a good fixation in treating type C distal humeral fracture. Through the approach of olecranon osteotomy, it is easy to get anatomical reduction, stable fixation, and early exercise.
Objective To review the basic research and cl inical progress of elbow heterotopic ossification after injury. Methods The recent l iterature concerning heterotopic ossification of the elbow was reviewed. Results Heterotopic ossification was caused by variety of stimul i and conditions. The current methods of prevention and treatment were to improve surgical techniques, to reduce trauma and bleeding, to rinse the area with bone fragments with plenty of salt water, and to use non-steroidal anti-inflammatory drugs. Conclusion Once heterotopic ossification occurred, surgical treatment is unique treatment method, so emphasis is to prevent heterotopic ossification.
our patients with brachial plexus root arulsion, who had undergone various nerve operationswith no functional recovery of the limb, were treated with transfer of sternocledomastoid muscle toreconstruct the function of elbow fleaion. The sternocleidomastoid muscle was datached from itsincertions and was lengthened by fascia lata graft from the thigh , and then , was transferred under theclavicle to the radiai shaft just distal to the radial tuberosity. After the recostruction, The potient...
【Abstract】 Objective To review the progress in pathoanatomy, diagnosis, and treatment of posterolateral rotatory instability (PLRI) of the elbow. Methods Related literature concerning PLRI of the elbow was extensively reviewed, comprehensive analysis was done. Results The lateral collateral ligament complex (LCLC), radial head, capitellum, and coronoid process are important constraints to PLRI. Muscle groups that cross the lateral elbow are secondary constraints to PLRI. Clinical examination includes lateral pivot-shift test, lateral pivot-shift apprehension test, chair sign, active floor push-up sign, tabletop relocation test, and posterolateral rotatory drawer test. Radiology, arthroscopy, and ultrasound can help diagnosis of PLRI. Reconstruction of bony fixation or soft tissue fixation can be used for treatment of injured LCLC. Conclusion The primary constraints to PLRI is LCLC. Ultrasound imaging is accurate for identification and measurement of normal LCLC. Therefore, ultrasound may prove valuable in assessment of abnormal lateral ulnar collateral ligaments. Reconstruction of soft tissue fixation, which can avoid iatrogenic fracture, is a selective treatment method.
Objective To investigate the method and effectiveness of operative treatment of Dubberley type 3B capitulum-trochlea fractures. Methods Between January 2009 and December 2012, 8 cases of Dubberley type 3B capitulum-trochlea fractures were treated. There were 2 males and 6 females with an average age of 55 years (range, 43-65 years). The injury was caused by falling in 6 cases, electric bicycle accident in 1 case, and traffic accident in 1 case. All fractures were fresh and closed injury. No neural or vascular injury was found. The time between injury and operation was 3-15 days (mean, 5.9days). Olecranon osteotomy was performed by a posterior midline skin incision of the elbow; 3.0 mm Herbert compression screws placed from posterior to anterior, 2.4 mm L shape locking compression plate designed for distal radius or 2.7 mm anatomical locking compression plate designed for distal humerus and 1.0 mm Kirschner wires or 3.0 mm Herbert screw for the transverse and coronal plane in the subchondral of anterior articular surface were used for fixation; and the lateral and medial collateral ligaments were repaired. Results All incisions healed by first intention. The patients were followed up 12-18 months (mean, 14.5 months). The X-ray films showed that fracture healing was achieved at 12-24 weeks (mean, 15 weeks) in 7 cases. Fracture nonunion and partial bone resorption in the capitellum were observed in 1 case. No failure of internal fixation, ulnohumeral joint instability, or traumatic arthritis occurred. At last follow-up, the range of motion of injured elbow was 0-40° in extension (mean 25.0°), 100-135° in flexion (mean, 116.3°), 60-70° in pronation (mean, 61.3°), and 80-90° in supination (mean, 81.3°). The elbow function score was 64-96 (mean, 81.1) according to the Broberg-Morrey evaluation criteria; the results were excellent in 2 cases, good in 4 cases, and fair in 2 cases with an excellent and good rate of 75%. The visual analogue scale (VAS) score was 0-3 (mean, 1). Conclusion For Dubberley type 3B capitulum-trochlea fractures, an early anatomic reconstruction of capitellar and trochlea, repair of the medial and lateral collateral ligament, and early active mobilization can obtain good functional results.
Objective To investigate the effect of complete anterior bundle of medial collateral ligament (MCL) on the valgus stability of the elbow after reconstruction and to assess the efficacy of artificial tendon and interference screw in reconstruction the anterior bundle of MCL. Methods The bone-tendon of the elbow were made in 12 adult upper limb specimens. There were 8 males and 4 females, left side and right side in half. Using biomechanic ways and pressure sensitive film, the valgus laxity, the stress area of the humeroulnar joint, and the intra-articular pressure were measured in integrated anterior bundle of MCL (control group, n=12) and reconstructed anterior bundle of MCL with artificial tendon and interference screw (experimental group, n=12) in elbow flexion of 0, 30, 60, and 90°. Results There was no significant difference in the valgus laxity within group and between groups in different flexion degrees (P gt; 0.05). No significant difference was found in the intra-articular pressure in elbow flexion of 30, 60, and 90° within group and between groups (P gt; 0.05) except in elbow flexion of 0° (P lt; 0.05). The stress area of the humeroulnar joint in 0° flexion was significantly larger than that in 30, 60, and 90° flexion in the control group (P lt; 0.05), but no significant difference was found within group and between groups in the other flexion degrees (P gt; 0.05). Conclusion The anterior bundle of MCL has important significance for maintaining the valgus stability of the elbow, after reconstructing the anterior bundle by using artificial tendon and interference screw, the medial stability of elbow can be recovered immediately.
Objective To explore the effect of arthroscopy in diagnosis and treatment of osteochondritis dissecans of elbow joint in adolescent. Methods From May 2003 to February 2006, 11 patients with osteochondritis dissecans of elbowjoint were diagnosed and treated with arthroscopy. There were 6 males and 5 females, aging from 13 to 19 years. The left joints were involved in 4 cases and right joints in 7 cases. Seven patients had obvious history of injury. The interval of injury and operation was from 7 months to 12 years. The score of VAS was 80±10, the range of flexion and extend of joint 80±10°, the range of rotation of joint 100±5° preoperatively. The brachial plexus anesthesia, the elbow hung to traction, soft spot, interna and extrapathway were given to explore and debride elbow joint and remove corpus liberum. Results All patients recovered daily life and work 7 to 12 dayspostoperatively. There were no complications of blood vessel and nerve injuries. Eleven cases were followed up for 6 to 18 months (mean 12-5 months). The results wereexcellent in 7 and good in 4 according to HSS scoring system. At the final followup, the score of VAS was 32±15, showing statistically significant difference when compared with preoperation (Plt;0.05). The range of flexion and extend of joint was 110±10°，the range of rotation of joint was 120±5° postoperatively, showing statistically significant differences when compared with preoperation (Plt;0.05). Conclusion The elbow arthroscopy might be a reliable methodto diagnose and treat osteochondritis dissecans of elbow joint in adolescent with minor trauma，quick recovery，significant improving function and less complications.
ObjectiveTo observe the effectiveness of open release combined with distal radius fixation hinged external fixation for the treatment of elbow stiffness.MethodsA total of 77 patients with elbow stiffness caused by trauma were enrolled in this study between October 2014 and October 2015. The patients were divided into control group (39 cases) and observation group (38 cases) by random number table method. The patients in the observation group were treated with elbow joint opening and release combined with distal radial fixation hinged external fixation, while the control group was treated with traditional release. There was no significant difference in gender, age, disease causes, original damage diagnosis, the time from injury to operation, preoperative flexion and extension activity of elbow joint, and preoperative Mayo elbow joint function score between 2 groups (P>0.05). After operation, the function of elbow joint was evaluated by the flexion and extension activity of the elbow joint and the Mayo elbow joint function evaluation standard.ResultsThe incisions healed by first intention in 2 groups. In observation group, there were 1 case infection of nail tract, 2 cases ulnar nerve symptoms, 1 case elbow ossification, and 1 case moderate pain in the elbow; while in control group, there were 2 cases of infection of nail tract, 2 cases of ulnar nerve symptoms, and 3 cases moderate pain in the elbow. The patients in 2 groups were followed up 6 weeks to 12 months, with an average of 6 months. The flexion and extension activity of elbow joint and Mayo elbow joint function score at last follow-up were significantly improved when compared with preoperative ones (P<0.05); at last follow-up, the flexion and extension activity of elbow joint and Mayo elbow joint function score in observation group patients were significantly better than those in control group (P<0.05). According to the Mayo elbow function evaluation standard, the results were excellent in 27 cases, good in 10 cases, and fair in 1 case, with an excellent and good rate of 97.4% in observation group; and the results were excellent in 12 cases, good in 21 cases, fair in 4 cases, and poor in 2 cases, with an excellent and good rate of 84.6% in control group; showing no significant difference between 2 groups (P=0.108).ConclusionOpen release combined with distal radius fixation hinged external fixation can significantly improve the elbow function of patients with traumatic elbow stiffness, its recovery of elbow function was superior to the traditional release.