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Objective:To evaluate the surgical treatment of acute convergent dislocation of elbow after failed closed reduction.Methods:A retrospective study was conducted of the 8 patients with acute convergent dislocation of elbow who had been admitted from January 2017 to December 2020 for surgical treatment after failed closed reduction and completely followed up at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. There were 3 males and 5 females, with an average age of 30.9 years (from 15 to 51 years). Five left and 3 right elbows were injured. Combined injuries included radial head fracture in 6 cases, distal radius fracture in 2 cases, coronoid fracture in one, medial epicondyle fracture of the humerus in one, scaphoid fracture in one, and distal radioulnar dislocation in one. All patients underwent surgery after failure of closed reduction. Intraoperative exploration found in every case a longitudinal tear on the brachialis tendon. The radial head protruded from the front into the tear and twisted the tendon so that the reduction of the radial head was frustrated. At the last follow-up, the elbow flexion and extension and forearm rotation were recorded, and the Mayo elbow performance score (MEPS) was used for function assessment.Results:All the 8 patients were followed up for a mean of 6.1 months (from 2 to 12 months). At the last follow-up, the elbow flexion and extension averaged 101.9° (from 65° to 150°), the forearm rotation 132.5° (from 75° to 170°), and the MEPS 96.3 (from 90 to 100). None of the patients had significant pain or joint instability. Various degrees of joint mobility limitation existed in 7 patients, one of whom underwent elbow arthrolysis and another of whom underwent ulnar neurolysis and anterior transposition due to ulnar nerve injury.Conclusions:For treatment of acute convergent dislocation of elbow, if closed reduction fails, surgical treatment should be performed on time, because the surgical efficacy is more reliable. As the severity and combined injuries of the convergent dislocation vary from person to person, the therapy algorithm should be individualized.
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Objective:To explore the surgical treatment of isolated traumatic radial head dislocation (ITRHD) after failed close reduction.Methods:A retrospective study was conducted of the 8 patients with ITRHD who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital for operation after failed close reduction from January 2011 to December 2020. They were 2 males and 6 females, aged from 15 to 41 years (average, 27 years). The left elbow was injured in 3 patients and the right elbow in 5. At the last follow-up, elbow flexion-extension and forearm pronation-supination were recorded and Mayo Elbow Performance Score (MEPS) was used to evaluate functional recovery.Results:The 8 patients were followed up for 2 to 13 months (mean, 4.5 months). At the last follow-up, elbow flexion-extension averaged 136.9° and forearm pronation-supination 143.8°. None of the 8 patients had significant pain or joint instability. Of them, 7 had good motor function but one reported significant limitation of forearm rotation. All the 8 patients scored a full MEPS mark.Conclusions:If close reduction failed, ITRHD should be treated in time by operative treatment the efficacy of which is reliable. Fixation of the proximal radial-ulnar joint with Kirschner wire should be avoided. Early exercise for full range of elbow motion is necessary.
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Objective To investigate the effect of radial head replacement with metal prosthesis and reduction with stabilization of the distal radio-ulnar joint as a treatment of established Essex-Lopresti injury.Methods From March 2012 to December 2015,5 patients with established Essex-Lopresti injury,whose radiuses had moved proximally since radial head had been resected in the earlier operation,were operated in our department,including 4 males and 1 female,aged from 25 to 50 years (average,38.8 years).The interval from the radial head resection to the operation in our department was 2 to 7 months (average,4.6 months).All the 5 patients were operated with radial head replacement with metal prosthesis under no longitudinal stress,and 4 of them got distal ulnar shortening for reduction of the distal radio-ulnar joint.2 of the 5 cases acquired distal radial-ulnar joint stability after reduction,and the other 3 could not acquired stability and needed open reduction and repairing ligament structure of the wrist and pinning fixation for 4-6 weeks.The Mayo elbow and wrist function score were used to evaluate pre-and post-operative function,with recording the range of motion of the elbow,forearm and wrist.Results All the 5 patients were followed-up for 24 to 60 months (average 45 months).The Mayo elbow function score was improved from preoperative 62 (range,45-75) to 96 (range,80-100) at the latest follow-up.The Mayo wrist functional score was improved from 54 (range,15-65) to 81 (range,55-90) at the latest follow-up.All patients got significant improvement of involved upper extremity function,without proximal shifting of radius,radial head prosthesis failure or instability of the distal radio-ulnar joint.Conclusion It is effective for treatment of established Essex-Lopresti injury to replace radial head with metal prosthesis and to reduce and stabilize the distal radio-ulnar joint with distal ulnar shortening while necessary.
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Objective To investigate diagnosis and surgical treatment of bipolar fracture-dislocation of the forearm.Methods A retrospective study was conducted of 16 patients with forearm bipolar fracture-dislocation who had been treated and completely followed up at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from March 2011 to September 2017.They were 14 males and 2 females,aged from 17 to 48 years (average,35.8 years).Their injury involved 7 left and 9 right sides,and 10 dominant and 6 non-dominant sides as well.Their proximal injury was divergent elbow dislocation in 4 cases,convergent elbow dislocation in one case,Monteggia fracture-dislocation in 9 cases (2 ones of type Ⅰ,2 ones of type ⅡB,4 ones of type ⅡC and one of type Ⅳ),and upper radioulnar dislocation in 2 cases.Their distal injury was distal radial fracture (intra-articular) + lower radioulnar dislocation in 7 cases,distal radioulnar fracture + lower radioulnar dislocation in 2 cases,Galeazzi fracture (1/3 distal humeral shaft) in 3 cases,and middle and upper middle radial fracture + lower radioulnar dislocation in 4 cases.Open reduction and internal fixation was performed for all the shaft fractures and most of the distal radial fractures.One distal radius fracture was treated with closed reduction and external fixation,one case with external fixation,one case with needle insertion and external fixation,3 radial head fractures with internal fixation,3 cases with radial head replacement,2 cases untreated,5 cases with open ligament repair because their primary closed reduction failed,and 2 cases with hinged external fixation of the elbow.Their functional exercise started according to judgment of joint stability after surgery.At the last follow-up,the overall function of the forearm was evaluated according to the Anderson's scoring.Results The 16 patients were followed up for an average of 26.0 months (from 6 to 60 months).All fractures healed at the internal fixation sites after operation with no abnormality affecting the function.No infection occurred.All the elbow joints and upper and lower radioulnar joints were stable.All the radial head replacements were in good position.The range of elbow flexion and extension averaged 123.2° (from 60° to 140°),the range of wrist flexion and extension 150.3° (from 120° to 160°),and the rotational mobility of the forearm 144.4° (from 70° to 170°).At the last follow-up,according to the Anderson's scores,11 cases were rated as excellent,3 cases as satisfactory,one case as unsatisfactory and one case as failure.Conclusions Most of the forearm bipolar fractures and dislocations are high-energy injury.The key to treatment is to achieve good reduction of distal and proximal dislocations and to start rehabilitative exercise as early as possible.Intraoperative fixation of fractures should be based on stable reduction of the dislocation.Fine reduction of bipolar dislocations and early rehabilitation can lead to good functional recovery.
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Objective To investigate the clinical outcomes of terrible triad of the elbow treated with single lateral incision versus combined lateral and medial incisions.Methods This retrospective cohort research involved 57 patients with terrible triad of the elbow operated between July 2010 and June 2013.According to the surgical approaches,the patients were assigned to single lateral incision (Group A,n =32) and combined lateral and medial incisions (Group B,n =25).Group A consisted of 21 males and 11 females,with a mean age of (40.2 ± 3.3) years.Group B consisted of 18 males and seven females,with a mean age of (39.1 ± 2.6) years.Operation time,blood loss,postoperative complications,elbow range of motion,Mayo elbow performance score (MEPS) and Hastings and Graham heterotopic ossification classification were compared between groups.Results There were no significant differences in operation time and blood loss between Group A and B (P ＞ 0.05).Incidence of ulnar nerve injury and strength decrease were higher in Group A than Group B (P＜0.05).Mter a mean follow-up of 25.9 months,elbow extension-flexion and forearm pronation-supination in Group A [(123.4 ± 6.5) ~,(167.5 ± 6.0) °] were better than those in group B [(84.9 ± 27.2) °,(136.5 ± 8.5)°] (P ＜ 0.01),and MEPS in Group A [(95.8 ± 1.2) points] was also better than that in Group B [(84.9 ± 3.1) points] (P ＜ 0.01).Heterotopic ossification was more serious in Group B than Group A (P ＜ 0.01).Conclusion Single lateral incision is associated with better function and lower rate of heterotopic ossification than combined lateral and medial incisions in treating terrible triad of the elbow.
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Objective To compare the effect of coronoid fixation combined with lateral collateral ligament repair versus hinged external fixator in treatment of elbow varus posteromedial rotational instability.Methods This retrospective cohort research included 34 patients with elbow varus posteromedial rotational instability operated between January 2011 and June 2015.All patients had coronoid process fractures of O'Driscoll type Ⅱ[(six with subtype 1,24 with subtype 2 and four with subtype 3).Fifteen of the 34 patients were operated by coronoid fixation combined with lateral collateral ligament repair (Group A) and other 19 patients were operated by coronoid fixation combined with placing hinged external fixator (Group B).Interval between injury and operation,operation time and blood loss were recorded.At final follow-up,elbow range of motion,Mayo elbow performance score (MEPS) and Hastings and Graham heterotopic ossification classification were measured.Results There were no significant differences in the interval between injury and operation,operation time and blood loss between the two groups (P ＞0.05).Median period of follow-up was 30 months in Group A and 40 months in Group B.Last follow-up showed flexion of the affected elbow in Group B [145° (135°-150°)] was better than that in Group A [140° (130°-145°)] (P ＜ 0.05),while between-group differences were insignificant in elbow extension,elbow extension-flexion,forearm pronation-supination and heterotopic ossification classification (P ＞ 0.05).MEPS in Group A scored 100 in 10 patients,90 in three,85 in one and 70 in one;MEPS in Group B scored 100 in 13 patients,90 in one,85 in four and 80 in one.There was no significant difference in MEPS between the two groups (P ＞ 0.05).Conclusion For treating elbow varus posteromedial rotational instability,either lateral collateral ligament repair or hinged external fixation after anatomic reduction and coronoid fixation can achieve good results.
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Objective To investigate the alignment of the elbow after Coonrad-Morrey (CM) total elbow arthroplasty (TEA),and to establish normal radiographic parameters correlated with prosthesis design in Chinese adults,as well as to detect whether CM prosthesis fits for Chinese.Methods Forty-two healthy volunteers were recruited and underwent radiographs of bilateral elbows in a standardized anterior-posterior (AP) fashion.Furthermore,99 AP radiographs of normal elbows and 54 AP radiographs of elbows after CM TEA were both collected from Picture Archiving and Communication System.The following radiographic parameters were measured:humerus-elbow-wrist (HEW) angle,the angle between the axis of humerus medullary cavity and the hinge axis of elbow (H-H angle),the angle between the axis of middle ulna medullary cavity and the hinge axis of elbow (MU-H angle),the angle between the axis of proximal ulna medullary cavity and the hinge axis of elbow (PU-H angle),the horizontal distance between the axis of humerus medullary cavity and the axis of proximal ulna medullary cavity (medullary translation).The differences in above parameters between normal elbows and elbows after CM TEA were compared.For normal elbows,the radiographic differences between male and female and that between right and left were analyzed,as well as the correlation with height.Results HEW angle (2.71°±8.08°) and medullary translation (1.79±3.49 mm) in patients after CM TEA were significantly less than that in normal (11.30°±7.21°,5.25±2.55 mm respectively),while H-H angle (89.92°±3.64°),MU-H angle (93.34°±6.30°) and PU-H angle (78.87°±4.79°) were significantly larger than that in normal (87.59°±5.62°,89.23°±5.66°,76.22°±4.69° respectively).The right HH angle of female was significantly larger than that in male.There were no significant difference in other parameters between male and female,and between right and left.All of the correlations between these parameters and height were not significant.Conclusion Elbow valgus decreases and forearm translates laterally after CM TEA in Chinese patients.Currently,the CM prosthesis can theoretically cause decreasing elbow valgns and lateral translation of forearm.
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Objective To investigate the alignment of the elbow after Coonrad-Morrey (CM) total elbow arthroplasty (TEA),and to establish normal radiographic parameters correlated with prosthesis design in Chinese adults,as well as to detect whether CM prosthesis fits for Chinese.Methods Forty-two healthy volunteers were recruited and underwent radiographs of bilateral elbows in a standardized anterior-posterior (AP) fashion.Furthermore,99 AP radiographs of normal elbows and 54 AP radiographs of elbows after CM TEA were both collected from Picture Archiving and Communication System.The following radiographic parameters were measured:humerus-elbow-wrist (HEW) angle,the angle between the axis of humerus medullary cavity and the hinge axis of elbow (H-H angle),the angle between the axis of middle ulna medullary cavity and the hinge axis of elbow (MU-H angle),the angle between the axis of proximal ulna medullary cavity and the hinge axis of elbow (PU-H angle),the horizontal distance between the axis of humerus medullary cavity and the axis of proximal ulna medullary cavity (medullary translation).The differences in above parameters between normal elbows and elbows after CM TEA were compared.For normal elbows,the radiographic differences between male and female and that between right and left were analyzed,as well as the correlation with height.Results HEW angle (2.71°±8.08°) and medullary translation (1.79±3.49 mm) in patients after CM TEA were significantly less than that in normal (11.30°±7.21°,5.25±2.55 mm respectively),while H-H angle (89.92°±3.64°),MU-H angle (93.34°±6.30°) and PU-H angle (78.87°±4.79°) were significantly larger than that in normal (87.59°±5.62°,89.23°±5.66°,76.22°±4.69° respectively).The right HH angle of female was significantly larger than that in male.There were no significant difference in other parameters between male and female,and between right and left.All of the correlations between these parameters and height were not significant.Conclusion Elbow valgus decreases and forearm translates laterally after CM TEA in Chinese patients.Currently,the CM prosthesis can theoretically cause decreasing elbow valgns and lateral translation of forearm.
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Angiogenesis is the process of capillary formation from the existing blood vessels, which is regulated by many cytokines.Balance of these cytokines plays an important role in angiogenesis.Unbalance of these cytokines, lead-ing to excessive or insufficient blood vessel, relates to a variety of diseases, such as tumor, ophthalmic diseases and wound healing.Recently, it has been observed that angiogenesis is also involved in Parkinson’s disease and Alzheimer’s disease. This review mainly discusses the molecular mechanism of angiogenesis and related diseases, and emphasizes the value of targeting angiogenesis as a strategy to develop drugs for those diseases.
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Objective:To study a new positioning method of elbow external fixation rotation axis,and to evaluate its feasibility.Methods:Four normal adult volunteers and six Sawbone elbow models were brought into this experiment.The kinematic data of five elbow flexion were collected respectively by opti-cal positioning system.The rotation axes of the elbow joints were fitted by the least square method.The kinematic data and fitting results were visually displayed.According to the fitting results,the average moving planes and rotation axes were calculated.Thus,the rotation axes of new kinematic methods were obtained .By using standard clinical methods,the entrance and exit points of rotation axes of six Sawbone elbow models were located under X-ray.And The kirschner wires were placed as the representatives of rotation axes using traditional positioning methods.Then,the entrance point deviation,the exit point de-viation and the angle deviation of two kinds of located rotation axes were compared.Results:As to the four volunteers,the indicators represented circular degree and coplanarity of elbow flexion movement tra-jectory of each volunteer were both about 1 mm.All the distance deviations of the moving axes to the ave-rage moving rotation axes of the five volunteers were less than 3 mm.All the angle deviations of the mo-ving axes to the average moving rotation axes of the five volunteers were less than 5 °.As to the six Saw-bone models,the average entrance point deviations,the average exit point deviations and the average angle deviations of two different rotation axes determined by two kinds of located methods were respective-ly 1.697 2 mm,1.838 3 mm and 1.321 7°.All the deviations were very small.They were all in an ac-cep-table range of clinical practice.Conclusion:The values that represent circular degree and coplanari-ty of volunteer's elbow single curvature movement trajectory are very small.The result shows that the elbow single curvature movement can be regarded as the approximate fixed axis movement.The new method can replace the traditional method in accuracy.It can make up the deficiency of the traditional fixed axis method.