Extended Kocher Approach for Total Elbow Arthroplasty

PURPOSE: Total elbow arthroplasty is most commonly performed through a posterior approach by splitting or reflecting the triceps off the olecranon, but triceps avulsion, triceps weakness, and wound healing problems have been reported. We present the clinical results of total elbow arthroplasty using extended Kocher approach. MATERIALS AND METHODS: From September 2005 to October 2007, five patients who underwent total elbow arthroplasty using triceps preserving approach were evaluated. There were 4 women and 1 man. The mean age of the patients was 58 years (range, 36~68). The mean follow- up was 10 months. The patients were placed in the lateral decubitus position, and lateral Kocher interval is made through a straight posterior incision. Elbow joint is exposed by supinating the forearm and prosthesis was inserted. Postoperatively, the elbow was immobilized in extension for 1 week, and active range of motion exercise was begun. Range of motion, triceps strength, Mayo elbow performance score, Korean DASH questionnaire were evaluated at the last follow-up. RESULTS: Average operation time was 115 minutes (range, 97~138). Postoperative complications such infection, skin necrosis were not developed. Triceps strength was measured as grade IV in all patients except one who has triceps insufficiency preoperatively. Mean elbow range of motion was from 8 degrees to 124 degrees. Mean Mayo elbow performance score was 87 (range 75~95), and DASH score was 18 (range 9~34). CONCLUSIONS: Extended Kocher approach can be a reasonable alternative for total elbow arthroplasty. Linking the assembly can be difficult, so modification of the implant design is needed to solve this problem.

Recompression of Vertebral Bodies after Balloon Kyphoplasty for Vertebral Compression Fractures : Preliminary Report / 대한척추외과학회지

STUDY DESIGN: This is a retrospective and preliminary study. OBJECTIVES: We wanted to evaluate the characteristics of recompression of vertebral bodies without trauma after balloon kyphoplasty (KP) for treating osteoporotic vertebral compression fractures (VCF). SUMMARY OF THE LITERATURE REVIEW: KP has been used for fracture reduction, maintenance of vertebral height and relief of pain in VCF. Despite of numerous satisfactory results, several factors have been noted to affect the clinical results of KP. MATERIALS AND METHODS: Six patients with recompression of vertebral bodies without trauma after KP were reviewed. All the patients were female and their mean age was 75.9+/-4.1 years old. The follow-up period was 17.2+/-8.5 months. The compression rates of the operated vertebral bodies (CR) and the kyphotic angles (KA) were checked by using plain roentgenograms at the initial, postoperative and last follow-up periods. The preoperative MRIs were also reviewed. The clinical results were checked using the VAS. RESULTS: The CRs at the initial, postoperative and last follow-up periods were 33.7+/-14.8%, 13.4+/-7.6% and, 26.9+/- 9.9%, respectively. The KAs were 19.2+/-7.2degrees , 14.8+/-6.2degrees and 20.5+/-7.4degrees for each period, respectively. Statistically, the CR and KA at the initial-postoperative period and at the postoperative-last follow-up period showed significant differences (p < 0.05). Intervertebral clefts were found in all the cases on MRI. Normal bones superior or inferior to cement were also seen in all the cases after KP. The VAS scores were 8.5+/-0.5, 2.3+/-0.5 and 3.0+/-0.6, retrospectively, and there were significant differences between each periods (p<0.05). CONCLUSIONS: Recompression of a vertebral body without trauma after KP for treating VCF was observed in the cases with a intervertebral cleft seen on MRI and normal bones superior or inferior to the cement were observed after KP. The causes of recompression may be subsequent compression or resorption of the remaining vertebral body.