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Objective To study the anatomical features of the distal humerus in Chinese healthy adults.Methods A total of 121 cases of normal elbow joint CT images were selected from the picture archiving and communication system (PACS),and reconstructed and measured on the AW4.5 workstation.Coronal plane and horizontal plane were determined by flexion-extension (FE) axis and humeral shaft,while the sagittal plane was perpendicular to the FE axis.The angle between the axis of humerus medullary cavity and the FE axis of elbow (H-FE angle) was measured on the coronal plane.The capitellar height (CH),lateral trochlear height (LTH),trochlear height (TH) and medial trochlear height (MTH) were measured on four different sagittal planes.The capitellar width (CW),capitellar depth (CD),anterior lateral trochlear width (ALTW),posterior lateral trochlear width (PLTW),trochlear width (TW),anterior medial trochlear width (AMTW),posterior medial trochlear width (PMTW),trochlear depth (TD),anterior lateral trochlear depth (ALTD),posterior lateral trochlear depth (PLTD),anterior medial trochlear depth (AMTD),posterior medial trochlear depth (PMTD),and distal humeral width (W) were measured on the horizontal plane.The gender differences in measured parameters,correlations between data,and differences in H-FE angle from 90° were analyzed.Results In male,CH was 21.5± 1.3 mm,CW 17.5±1.1 mm,CD 10.8±0.9 mm,TW 25.1±2.2 mm,TH 17.3±1.5 mm,TD 17.5±1.4 mm,ALTW 7.7±1.2 mm,PLTW 12.5±1.6 mm,AMTW 12.4±1.6 mm,PMTW 9.8±2.0 mm,ALTD 10.0±0.8 mm,PLTD 16.3±1.4 mm,AMTD 12.9±1.4 mm,PMTD 13.2±1.4 mm,LTH 20.6±1.3 mm,MTH 25.0±2.4 mm,W 42.6±2.5 mm.The above parameters in female was 18.7±1.1 mm,15.3± 1.1 mm,9.5±0.6 mm,21.7±1.5 mm,15.4±1.7 mm,15.6±1.5 mm,6.8±1.3 mm,10.7±1.4 mm,10.6±1.4 mm,8.5±1.4 mm,8.9±0.8 mm,14.5±1.1 mm,11.4±1.1 mm,11.5±1.0 mm,18.1±1.4 mm,21.6±1.4 mm and 37.0±1.8 mm,respectively.All the above anatomical parameters in men were larger than those in women with statistically significant difference (P＜0.05).However,the H-FE angle (male:87.4°±3.5°,female 87.8°±3.3°),CW/CH (male:0.8±0.1,female:0.8±0.1),TW/CW (male:1.4±0.2,female:1.4±0.1),MTH/LTH (male:1.2±0.1,female:1.2±0.1),AMTW/TW (male:0.5±0.1,female:0.5±0.1),PMTW/TW (male:0.4±0.1,female:0.4± 0.1),ALTW/TW (male:0.3±0.0,female:0.3±0.1),PLTW/TW (male:0.5±0.1,female:0.5±0.1) were not statistically different between male and female groups (P＞0.05).All measurements except for the H-FE angle had a positive correlation with the articular width (0.335≤r≤0.928,P＜0.05).The difference between the angle of the H-FE axis (87.6°±3.4°) and 90° was statistically significant (t=-7.287,P＜0.05).Conclusion The size of the distal humerus in male is larger than that in female without difference in shape.Distal humerus width can be used as an indicator to measure the size of the distal humerus.The humeral shaft is more biased toward the radial side.
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Objective@#To study the anatomical features of the distal humerus in Chinese healthy adults.@*Methods@#A total of 121 cases of normal elbow joint CT images were selected from the picture archiving and communication system (PACS), and reconstructed and measured on the AW4.5 workstation. Coronal plane and horizontal plane were determined by flexion-extension (FE) axis and humeral shaft, while the sagittal plane was perpendicular to the FE axis. The angle between the axis of humerus medullary cavity and the FE axis of elbow (H-FE angle) was measured on the coronal plane. The capitellar height (CH), lateral trochlear height (LTH), trochlear height (TH) and medial trochlear height (MTH) were measured on four different sagittal planes. The capitellar width (CW), capitellar depth (CD), anterior lateral trochlear width (ALTW), posterior lateral trochlear width (PLTW), trochlear width (TW), anterior medial trochlear width (AMTW), posterior medial trochlear width (PMTW), trochlear depth (TD), anterior lateral trochlear depth (ALTD), posterior lateral trochlear depth (PLTD), anterior medial trochlear depth (AMTD), posterior medial trochlear depth (PMTD), and distal humeral width (W) were measured on the horizontal plane. The gender differences in measured parameters, correlations between data, and differences in H-FE angle from 90° were analyzed.@*Results@#In male, CH was 21.5± 1.3 mm, CW 17.5±1.1 mm, CD 10.8±0.9 mm, TW 25.1±2.2 mm, TH 17.3±1.5 mm, TD 17.5±1.4 mm, ALTW 7.7±1.2 mm, PLTW 12.5±1.6 mm, AMTW 12.4±1.6 mm, PMTW 9.8±2.0 mm, ALTD 10.0±0.8 mm, PLTD 16.3±1.4 mm, AMTD 12.9±1.4 mm, PMTD 13.2±1.4 mm, LTH 20.6±1.3 mm, MTH 25.0±2.4 mm, W 42.6±2.5 mm. The above parameters in female was 18.7±1.1 mm, 15.3±1.1 mm, 9.5±0.6 mm, 21.7±1.5 mm, 15.4±1.7 mm, 15.6±1.5 mm, 6.8±1.3 mm, 10.7±1.4 mm, 10.6±1.4 mm, 8.5±1.4 mm, 8.9±0.8 mm, 14.5±1.1 mm, 11.4±1.1 mm, 11.5±1.0 mm, 18.1±1.4 mm, 21.6±1.4 mm and 37.0±1.8 mm, respectively. All the above anatomical parameters in men were larger than those in women with statistically significant difference (P<0.05). However, the H-FE angle (male: 87.4°±3.5°, female 87.8°±3.3°), CW/CH (male: 0.8±0.1, female: 0.8±0.1), TW/CW (male: 1.4±0.2, female: 1.4±0.1), MTH/LTH (male: 1.2±0.1, female: 1.2±0.1), AMTW/TW (male: 0.5±0.1, female: 0.5±0.1), PMTW/TW (male: 0.4±0.1, female: 0.4±0.1), ALTW/TW (male: 0.3±0.0, female: 0.3±0.1), PLTW/TW (male: 0.5±0.1, female: 0.5±0.1) were not statistically different between male and female groups (P>0.05). All measurements except for the H-FE angle had a positive correlation with the articular width (0.335≤r≤0.928, P<0.05). The difference between the angle of the H-FE axis (87.6°±3.4°) and 90° was statistically significant (t=-7.287, P<0.05).@*Conclusion@#The size of the distal humerus in male is larger than that in female without difference in shape. Distal humerus width can be used as an indicator to measure the size of the distal humerus. The humeral shaft is more biased toward the radial side.
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Objective The purpose of this study was to investigate the preliminary clinical outcomes of total elbow arthroplasty (TEA) in the treatment of elbow deformity caused by tumor-like lesions.Methods Between September 2009 and June 2017,the technique of triceps facial tongue exposure was adopted for all 11 patients who underwent total elbow arthroplasty.There were 5 females and 6 males with the mean age of 56.7±14.7 years.There were 6patients with synovial chondromatosis and 5 with pathologic hypertrophy of synovium.Seven of 11 patients were performed by posterior approach only,while the other 4by combined posterior-anterior approach.A semi-constrained Coonrad-Morrey prosthesis which provides 7° varas/valgus laxity was used in 7 patients,and custom-made total constrained prosthesis which only allow flexion and extension on a single plane was used in 4 cases.Preoperative average flexion range of elbow was 50.5°±14.0° (range,20°-70°).The ulnar nerve compression and claw hand deformity was identified in 2patients preoperatively and the nerve was transposed during operation.According to Mayo elbow function score (MEPS score),the average preoperative MEPS score was 42.1±12.7 points (range,15-60).Results Perioperative complications were not found.None of patients lost in thefollow-up and all the patients were alive.There was no pain in the joints,no triceps fracture or weakening of muscle strength,and no recurrence of the lesions.All 11 patients were followed up for 7 to 63 months with an average of 36.3±19.5 months.The mean MEPS score was improved to 89±7.2 point after surgery (t=-11.993,P=0.000).The average flextion-extension arc improved from preoperative 50.5° to 105.9° postoperatively (t=-8.697,P=0.000).The average pronation-supination arc improvement from preoperative 105°-123.2° postoperatively (t=-6.901,P=0.000).For the two patients with ulnar nerve deficit before surgery,one patient recovered 6 months after operation,however,the other patient did not 2 years later.One Coonrad-Morrey prosthesis with deep infection was treated by removing the implant.Three of 4 custom-made total constrained prostheses experienced implant failure due to loosening or periprosthetic fracture.The incidence of complications of semi-constrained prosthesis was lower than that of total constrained prosthesis (14％ vs.75％),however,it did not reach a significant difference.Conclusion This study reveals an acceptable outcome with triceps facial tongue exposure for TEA in the treatment of tumor-like lesions of elbow.TEA is a viable good alternative treatment for selected patients with large mass around the elbow or with severe deformation.However,the failure rate of fully constrained prosthesis tends to be higher than semi-constrained one,possible due to its design flaw.
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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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A artroplastia total é necessária no tratamento de casos graves de fraturas, artrite reumatoide e osteoartrose do cotovelo. Durante o procedimento, a cápsula articular é parcialmente ressecada, levando à perda de mecanorreceptores que seriam importantes para a percepção do movimento passivo em condições normais. Acreditamos que o desenvolvimento de um equipamento capaz de realizar a medição da cinestesia, através do limiar de percepção do movimento passivo (LPMP), ajudará a esclarecer o quanto este procedimento impacta negativamente a propriocepção, e se esse efeito repercute na esfera clínica. O Propriomaq II foi criado nesse contexto, permitindo a mobilização passiva da articulação e o acionamento de um botão pelos sujeitos examinados ao perceberem o movimento, viabilizando o cálculo do seu limiar de percepção. Vinte e um pacientes hígidos foram submetidos ao teste, repetindo as medidas após ao menos um dia, visando validar o método. Com o objetivo de esclarecer o efeito da artroplastia total sobre o LPMP do cotovelo, oito pacientes portadores de prótese total foram submetidos ao exame, comparando o lado operado ao contralateral. Os resultados demonstraram latência significativamente maior para a percepção do movimento passivo nos cotovelos operados, ou seja, pior propriocepção quando comparados ao lado contralateral. Não foi encontrado, entretanto, correlação significativa entre o LPMP e os resultados funcionais no lado artroplastia. O Propriomaq II apresentou boa reprodutibilidade (R2=0,94) na medição do LPMP do cotovelo, e evidenciou conclusivamente o prejuízo proprioceptivo presente em cotovelos submetidos a artroplastia total. Esses resultados demonstram a necessidade de maior preservação das partes moles periarticulares durante a artroplastia total do cotovelo, e uma ênfase da reabilitação fisioterapêutica visando recuperação da propriocepção
Total elbow arthroplasty is necessary in the treatment of severe fractures, rheumatoid arthritis and degenerative elbow arthritis. During the procedure, the articular capsule is partially resected, leading to loss of mechanoreceptors that would be important for the perception of articular motion in normal conditions. We believe that the creation of an equipment capable of assessing kinesthesia through the measurement of threshold to detection of passive motion (TDPM) will help quantify the negative effects this procedure has on elbow proprioception, and understand if this has any relevant impact in the clinical sphere. The Propriomaq II was created in this context, allowing passive mobilization of the elbow joint and the activation of a button by the examined subjects when motion is perceived, thus providing a means of calculating it's detection threshold. Twenty-one healthy patients were subjected to the test, repeating the measurements after at least one day, so the method could be validated. In order to clarify the effects of total arthroplasty on elbow TDPM, eight patients were subjected to the test, comparing the total elbow side to the contralateral side. The results revealed significantly higher thresholds to detection of motion, or worse proprioception, on the prosthesis side in comparison to the contralateral side. These results held no correlation, however, to the clinical outcome of the elbow replacement. The Propriomaq II proved reproducible (R2=0,94) in the measurement of elbow TDPM and has conclusively exposed the proprioceptive deficits present in total arthroplasty elbows. These results demonstrate the need for greater preservation of peri-articular soft tissues during total elbow arthroplasty, and an emphasis of rehabilitation on the recovery of proprioception
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Arthroplasty, Replacement, Elbow/adverse effects , Sensory ThresholdsABSTRACT
Objective To observe the short-term effect of radial head replacement for the treatment of terrible triad of the elbow.Methods In the period between June 2011 and June 2012,the radial head replacements were carried out in six patients with terrible triad of elbow.There were five acute elbow fracture-dislocation cases and one old fractnre case.All cases underwent open reduction and fixation coronoid fracture with screws or nonabsorbable sutures,radial head replacement,repair of lateral ligament complex and repair or reconstruction of annular ligament.All patients initiated the rehabilitation program under supervision within 5-7 days after surgery.The X-ray and Computed tomography of elbow was used to evaluate the posi tion of radial head prosthesis.Functional outcome of elbow was assessed by Mayo Elbow Performance Score (MEPS) and complications.Results All patients were participated in follow-up for 10-24 months and the mean duration of follow-up was 16.8 months.The MEPS was from 85 to 95 points and the mean MEPS was 91.7 points.The outcome of MEPS was excellent in 5 cases,good in 1 case.The range motion of elbow flexion was from 82 to 95 degrees and the average of elbow flexion was 87 degrees; the range motion of extension was from 15 to 32 degrees and the average of elbow extension was 21 degrees.The range motion of fore-ann pronation was from 82 to 90 degrees with 86 degrees in average.The motion range of supination was from 45 to 80 degrees with 56 degrees in average.All cases got persistent stability in elbow with painless movement.None of patient suffered traumatic arthritis and infection.The motion range of elbow was restricted due to the unfit relative position of radial head prosthesis and capi tellum in one case,characterized by decreasing radiocapitellar joint space.Two cases developed into heterotopic ossification in elbow without hampering the motion range of elbow.Conclusion The outcome of the radial head replacement on the treatment of radial head fracture in the elbow terrible triad was satisfactory.However,the longer duration of observation was essential to verify the favorable effect of radial head replacement on dealing with terrible triad in elbow.