Complex open elbow fracture Gustilo-Anderson type IIIB treated with the primary elbow arthroplasty: A case report / 中华创伤杂志(英文版)

Total elbow arthroplasty as a treatment option for open elbow fracture is relatively rare described. We reported a 39 years old polytrauma patient with complex open elbow fracture (Gustilo-Anderson type IIIB). The patient presented with large soft tissues defect on dorsal part of the left elbow, ulnar palsy due to the irreparable loss of the ulnar nerve, distal triceps loss due to the complete loss of the olecranon, loss of both humeral condyles with collateral ligaments and complex elbow instability. Only few similar cases have been published. Reconstructive surgery included repetitive radical debridement, irrigation, vacuum assisted closure system therapy, external fixation, coverage of the soft tissue defect with fascia-cutaneous flap from the forearm. Four months after the injury, total elbow arthroplasty with autologous bone graft (from the proximal radius) inserted in the ulnar component, was performed. At 3 years postoperatively, the patient is able to perform an active flexion from 0° to 110° with full prono-supination. Only passive extension is allowed. The ulnar neuropathy is persistent. Patient has no signs of infection or loosening of the prosthesis.

Distal humeral fracture: an epidemiological analysis of orthopedic patients for children / Fratura de úmero distal: uma análise epidemiológica de pacientes ortopédicos infantis

ABSTRACT Objective: To analyze the epidemiological profiles of children with orthopedic distal humerus fractures. Methods: An analytical descriptive study was conducted with a retrospective approach using medical records of 665 orthopedic children who attended the Jesser Amarante Faria Children's Hospital, a reference hospital in the city of Joinville, Santa Catarina, between June 2012 and December 2016. Results: The results showed a predominance of male patients (64.2%), with a mean age of 7 years, and the age group of 6-10 years being the most frequent with 319 patients (48%). The main mechanism of trauma was fall of height in 59.7% of patients, Gartland type 1 fracture in 57.1%, and absence of vascular injury in 99.7%. Conservative management was implemented in 64.7% (95%) of patients. Absence of neurological lesion (95.6%) and closed lesion (99.4%) were the main epidemiological characteristics of patients in the study. A low complication rate was observed, with reduction losses in 1.7% of patients, followed by infections in 1.1%. Conclusion: We can conclude that the cases studied presented epidemiological characteristics similar to those described in the literature. Level of evidence IV, Description of a case series, with analysis of results, without a comparative study.

RESUMO Objetivo: Analisar o perfil epidemiológico de pacientes ortopédicos infantis com fratura de úmero distal. Método: Estudo analítico-descritivo, com abordagem retrospectiva dos prontuários médicos de 665 pacientes ortopédicos infantis, atendidos no Hospital Infantil Dr. Jeser Amarante Faria, referência no município de Joinville (SC), do período de junho de 2012 a dezembro de 2016. Resultados: Os resultados mostraram um predomínio de pacientes do sexo masculino (64,2%), com idade média de 7 anos, sendo a faixa etária de 6 a 10 anos a mais frequente, com 319 (48%) pacientes. O principal mecanismo do trauma foi por queda da própria altura (59,7%), com Gartland 1 em 57,1% dos casos e ausência de lesão vascular (99,7%). A conduta conservadora foi observada em 64,7% dos pacientes, além de ausência de complicações imediatas (97,1%), complicações tardias (95,3%) e lesão neurológica (95,6%). Lesão fechada (99,4%) foi a principal característica epidemiológica dos pacientes estudados. Uma baixa frequência de complicações foi observada, sendo mais prevalentes as perdas de reduções (1,7%), seguidas de infecções, em 1,1% dos casos. Conclusões: Os casos estudados apresentaram características epidemiológicas semelhantes àquelas descritas na literatura. Nível de evidência IV, Descrição de série de casos, com análise de resultados, sem estudo comparativo.

Effect of Muscle Energy Techniques with Visual Feedback on Function of Postoperative Elbow Joint / 中国康复理论与实践

@#Objective To study the effect of muscle energy techniques with visual feedback on the function of postoperative elbow joint. Methods From October, 2015 to August, 2017, 40 patients after operation for elbow fracture were randomly divided into control group (n=20) and treatment group (n=20). Both groups accepted arthrolysis and exercise guidance at home, while the control group accepted routine muscle energy techniques and the treatment group accepted muscle energy techniques with visual feedback, for eight weeks. They were measured with active range of motion (AROM) of elbow flexion and assessed with Disabilities of the Arm, Shoulder, and Hand (DASH) before and after treatment. Results AROM increased in both groups after treatment (t>15.223, P<0.001), and increased more in the treatment group than in the control group (t=3.072, P<0.01); while the DASH score decreased in both groups (t>27.991, P<0.001), and decreased more in the treatment group than in the control group (t=2.222, P<0.05).Conclusion The muscle energy techniques with visual feedback can improve the motion and function of elbow after operation more effectively.

Displaced Supracondylar Humerus Fractures in Children – Are They All Identical?

Introduction: This study aims to ascertain if there are any differences in supracondylar fractures between children under seven years of age and those above 7 years of age. Materials and Methods: All cases of displaced humerus supracondylar fractures that required surgical stabilization were identified and retrospectively reviewed. Demographic data, mode of injury, associated neurovascular injuries and details of surgery performed were obtained from clinical records. The Gartland classification and the extent of comminution of fractures were also documented from review of radiographs. Results: One hundred and twelve children were included in this study, of whom 61 (54.46%) were younger than seven years of age while 51 (45.5%) were aged seven years or older. Children aged seven or older had a greater incidence of associated neurological deficit at presentation (p=0.046). Of the six patients with nerve injury in the older age group, one patient (16.7%) had a radial nerve injury, two patients (33.3%) had ulnar nerve injuries while another two patients (33.3%) had median nerve injuries. There was one patient (16.7%) with both median and ulnar nerve injuries. Comminuted fractures were also more common in the older children (p=0.004). No significant differences were demonstrated between the groups with regard to age, gender and mechanism of injury, laterality, incidence of open fracture, vascular injuries and operative time. Conclusion: Children aged seven years or older who sustain supracondylar humeral fractures tend to get more comminuted fractures. There is also a higher incidence of associated neurological injury. These cases must be carefully examined for at presentation and parents need to be appropriately counselled about them.

Fracturas de tratamiento quirúrgico alrededor del codo en niños: descripción epidemiológica en Hospital Clínico San Borja Arriarán / Surgical treatment fractures around the elbow in children: epidemiological description in Clinical Hospital San Borja Arriaran

Introducción: los traumatismos de codo tienen una alta incidencia en la población infantil, la fractura de esta zona corresponde al 5 a 10 por ciento del total de fracturas en niños. El objetivo de nuestro trabajo es hacer una descripción epidemiológica de las fracturas de codo en niños operadas en el Hospital Clínico San Borja Arriaran. Materiales y métodos: Estudio retrospectivo, descriptivo. Se realizó revisión de fichas electrónicas de pacientes de edad pediátrica operados de fracturas alrededor del codo en el HCSBA desde el 1 de junio al 31 de 2014. Resultados: Se estudiaron 25 pacientes, 64 por ciento de sexo masculino y 36 por ciento de sexo femenino. La edad promedio fue de 5,5 años. Fracturas supracondilea de humero correspondieron a 64 por ciento, epicondilo de humero 24 por ciento, epitróclea de humero 8 por ciento y olecranon y cúpula radial 4 por ciento. Discusión: Las fracturas supracondileas de humero son la lesión más frecuente de codo en los niños. Las fracturas de epicondilo son la segunda en frecuencia. Las fracturas de epictroclea representan aproximadamente 10 por ciento, mientras que las fracturas del olécranon son relativamente poco comunes en los niños. Conclusiones: nuestro centro tiene una epidemiologia similar a la descrita por la literatura internacional en cuanto a frecuencia, complicaciones asociadas y presentación clínica.

Introduction: elbow injuries have a high incidence among children, breaking this area corresponds to 5-10 percent of all fractures in children. The aim of our work is to make an epidemiological description of the elbow fractures in children operated in the Hospital Clinico San Borja Arriaran. Materials and methods: Retrospective, descriptive study. Review of electronic records of pediatric patients operated on fractures around the elbow in the HCSBA from 1 June 31, 2014 was performed. Results: 25 patients, 64 percent male and 36 percent female, were studied. The average age was 5.5 years. Supracondylar humerus fractures accounted for 64 percent, 24 percent epicondyle of the humerus, 8 percent medial epicondyle of the humerus, olecranon and radial head 4 percent. Discussion: Supracondylar humerus fractures are the most common elbow injury in children. Epicondyle fractures are the second in frequency. Epictroclea fractures represent approximately 10 percent, while the olecranon fractures are relatively uncommon in children. Conclusions: our center is similar to that described by the international literature in frequency, associated complications epidemiology and clinical presentation.

Tratamiento funcional de fracturas desplazadas de olécranon en pacientes mayores de 70 años / Functional treatment of displaced olecranon fractures in patients older than 70 years

Objetivo: Reportar los resultados clínicos y radiológicos del tratamiento funcional de fracturas desplazadas de olécranon en pacientes >70 años. Materiales y Métodos: Se evaluaron 28 pacientes >70 años con fracturas desplazadas de olécranon. El tratamiento consistió en la inmovilización inicial con una valva de yeso (promedio 5 días) y, luego, movilización activa según tolerancia. No se indicó rehabilitación kinesiológica. Ningún paciente fue perdido en el seguimiento. El grupo estaba formado por 27 mujeres y un hombre. La edad promedio era de 82 años. Según la clasificación de la Clínica Mayo, 18 fracturas eran de tipo IIA y 10, de tipo IIB. El seguimiento promedio fue de 14 meses. Resultados: La flexo-extensión fue de 142°-15°. La fuerza muscular fue de M5 en 17 pacientes y de M4 en 9. La fuerza de puño fue un 93% del lado contralateral. El dolor según la escala visual analógica fue de 1. La satisfacción con el tratamiento según esta escala fue de 9. Según el puntaje de la Clínica Mayo, 22 pacientes tuvieron resultados excelentes y 6, buenos. El puntaje DASH promedio fue de 15. Veinticuatro pacientes evolucionaron hacia la seudoartrosis. El gap articular final fue, en promedio, de 16 mm. El gap a nivel de la cortical posterior final fue, en promedio de 22 mm. Conclusión: El tratamiento no quirúrgico de las fracturas desplazadas de olécranon en pacientes mayores ofrece un número elevado de buenos resultados funcionales con alto grado de satisfacción. Nivel de evidencia: IV.

Objective: To report the clinical and radiological outcomes of the functional treatment for displaced olecranon fractures in patients >70 years old. Methods: Twenty-eight patients >70 years old with displaced olecranon fractures were evaluated. The treatment included initial immobilization with a cast (average time 5 days) and then active movement as tolerated. Physiotherapy was not indicated. No patients were lost in the follow-up. The study group included 27 women and a man. Average age was 82 years old. According to the Mayo Clinic Classification, 18 fractures were type IIA and 10 were type IIB. Average followup was 14 months. Results: Flexion-extension was of 142°-15°. Muscular strength of the triceps was M5 in 17 patients and M4 in 9. Grip strength was 93% of the contralateral side. The score in the visual analogue scale for pain was 1. Satisfaction with the treatment according to this scale was 9. According to the Mayo Clinic classification, 22 patients presented excellent results, and 6 good results. Average DASH score was 15. Twenty-four patients evolved to a nonunion. Mean final joint gap was 16 mm. Mean final gap at the posterior cortical level of the olecranon was 22 mm. Conclusion: Functional treatment of displaced olecranon fractures in patients >70 years old is associated with a high degree of goods results and patient satisfaction. Level of evidence. IV.

Instabilidade do cotovelo causada por fratura sagital do processo coronoide / Instability of the elbow caused by sagittal fracture of the coronoid process

Introdução: Descrever um padrão diferente de fratura do processo coronoide associada à instabilidade do cotovelo tratada com sucesso em nosso serviço. Relato do caso: Um paciente de 27 anos, do sexo masculino e destro, havia sofrido luxação do cotovelo. Procurou nosso hospital com uma queixa de dor e instabilidade à extensão do cotovelo, apresentando instabilidade em varo-valgo e queixa de luxação eminente do cotovelo quando este atingia -30º de extensão. No exame radiográfico, observou-se uma fratura anteromedial do processo coronoide. Submetido ao tratamento cirúrgico fixando-se a fratura, reparando-se o ligamento colateral medial, imobilizado-se com uma tala gessada por dez dias e, depois, iniciando-se o programa de reabilitação. Após 21 meses de seguimento, o paciente mantinha 135º de flexão e 0º de extensão, 80º de pronação e 90º de supinação; força muscular grau V e sem instabilidade no exame físico. As radiografias de controle demonstraram consolidação completa sem ossificação heterotópica. Discussão: Apesar de ser um tipo raro de fratura do processo coronoide, é importante que seja devidamente diagnosticado pelo ortopedista para que se realize o tratamento adequado e se evite a instabilidade crônica. O presente caso foi tratado com sucesso por meio de redução aberta e fixação interna, sem nenhuma queixa de instabilidade após 21 meses de seguimento.

Introduction: Description of a different pattern of coronoid process fracture related to elbow instability, treated successfully at our institution. Case report: A 27-year-old right-handed male suffered an elbow dislocation and attended our clinic with a complaint of pain, presenting varus and valgus instability and reporting sensation of eminent dislocation with elbow in -30º of extension. The radiographs showed an antero-medial fracture of the coronoid process. Submitted to surgical treatment with fracture fixation and ligament repair, the patient used a splint for ten days and then started the rehabilitation program. After 21 months of follow-up, the patient presented a range of motion of 135º of flexion and 0º of extension, 80º of pronation and 90º of supination; complete muscle strengh and no instability at phisical examination. The postoperative radiographs showed complete fracture consolidation without heterotopic ossification. Discussion: Even tough it is a rare fracture of the coronoid process, it is important to be diagnosed by the orthopedist to provide appropriate treatment and to avoid chronic instability. The case reported was successfully treated with open reduction and internal fixation, with no complaint of instability after 21 months of follow-up.