Effect of early postoperative comprehensive rehabilitation on children and youth with supracondylar fracture of humerus complicated with ulnar nerve injury / 中国康复理论与实践

ObjectiveTo observe the therapeutic effect of early postoperative comprehensive rehabilitation on elbow joint dysfunction and ulnar nerve injury in children and adolecents with supracondylar fracture of humerus complicated with ulnar nerve injury. MethodsA total of 49 children with supracondylar fracture of humerus complicated with ulnar nerve injury after operation were selected from January, 2016 to December, 2021 in Wangjing Hospital, which were randomly divided into control group (n = 24) and treatment group (n = 25). The control group accepted wax therapy and acupuncture, and the treatment group accepted medicine fumigation, joint mobilization and electromyographic biofeedback, for twelve weeks. They were assessed with The Hospital for Special Surgery Elbow score (HSS) and Medical Research Neurotrauma Society Report (MCRR) before and after treatment. ResultsAfter treatent, the HSS scores increased in both groups (|t| > 8.345, P < 0.001). The HSS score was significantly higher in the treatment group than in the control group (t = 4.536, P < 0.001). The d-value of HSS scores before and after treatment was significantly higher in the treatment group than in the control group (t = 3.717, P < 0.05). The rate of excellent recovery of ulnar nerve function was significantly higher in the treatment group than in the control group (χ2 = 5.975, P < 0.05). ConclusionEarly postoperative comprehensive rehabilitation could romote the recovery of elbow function and ulnar nerve injury in children and youth with supracondylar fracture of humerus complicated with ulnar nerve injury.

Osteotomías correctoras en secuelas de fracturas supracondíleas de codo en la población pediátrica: revisión bibliográfica sistematizada

El cubito varo es la secuela más frecuente en las fracturas supracondíleas de humero en la población pediátrica, objetivo analizar los diferentes tipos de osteotomías y los métodos fijación para el tratamiento de estas lesiones. Materiales y métodos: se realizo una búsqueda bibliográfica utilizando como motor de búsqueda la plataforma Pubmed y OVID, las palabras claves fueron Cubitus AND varus AND osteotomy. Resultados: se seleccionaron 13 artículos, con un N de 237 pacientes, follow-up de 30 meses, edad al momento de la cirugía fue 8,78 años. La técnica de osteotomía más utilizada fue la de cierre lateral. 35.4% se fijaron con placas, 24.8% con fijadores externos y 33.3% fijación con kw/pins. Conclusión: las técnicas de osteotomías utilizadas actualmente logran corrección angular. No se encontraron diferencias significativas entre los resultados de las técnicas analizadas. No existe un implante que sea superior a otro a la hora de realizar la fijación de las osteotomías de humero distal. Cada implante tiene ventajas y desventajas.

Cubitus varus is the most frequent sequelae in supracondylar humeral fractures in the pediatric population, the objective is to analyze the different types of osteotomies and fixation methods for the treatment of these injuries. Materials and methods: a bibliographic search was carried out using the Pubmed and OVID platform as a search engine, the keywords were Cubitus AND varus AND osteotomy. Results: 13 articles were selected, 237 patients, follow-up of 30 months, age at the time of surgery was 8.78 years. The most used osteotomy technique was lateral closure. 35.4% were fixed with plates, 24.8% with external fixators and 33.3% fixation with kw/pins. Conclusion: the osteotomy techniques currently used achieve angular correction. No significant differences were found between the results of the analyzed techniques. There is no implant that is superior to another when fixing distal humerus osteotomies. Each implant has advantages and disadvantages.

A deformidade em varo do cotovelo é uma complicação comum das fraturas supracondilares do úmero na população pediátrica, o objetivo foi analisar os diferentes tipos de osteotomias e métodos de fixação para o tratamento dessas lesões. Materiais e métodos: foi realizada uma pesquisa bibliográfica utilizando as plataformas Pubmed e OVID como mecanismo de busca, as palavras-chave forom Cubitus AND varus AND osteotomy. Resultados: foram selecionados 13 artigos, com N de 237 pacientes, seguimento de 30 meses, idade no momento da cirurgia foi de 8,78 anos. A técnica de osteotomia mais utilizada foi a ressecção de cunha óssea com base laterala. 35,4% foram fixados com placas, 24,8% com fixações externas e 33,3% foram fixados com kw/pins. Conclusão: as técnicas de osteotomia utilizadas atualmente conseguem correção angular. Não forom encontradas diferenças significativas entre os resultados das técnicas analisadas. Não existe implante superior a outro na fixação de osteotomias distais do úmero. Cada implante tem vantagens e desvantagens.

Does the elbow position change the handgrip strength in Parkinson's disease? / A posição do cotovelo altera a força de preensão manual na doença de Parkinson?

Abstract The flexed elbow is a standardization position on the handgrip strength test, however the literature shows divergence in the values obtained from extended elbow. The aim of this study was to verify if there is such difference in people with Parkinson's disease. Cross-sectional study. Thirty-one elderly individuals with clinical diagnosis of Parkinson's disease, performed 2 handgrip tests, first with extended elbow and second with flexed elbow, with 48 hours of interval. There was not significantly different between positions for handgrip strength (p > 0.05). As well as, the effect size was insignificant (d < 0.19). The main results indicate there was no significant difference between the flexed and the extended protocol, the effect size was negative and very small, it shows there is no clinical effect. Since, there are no difference between elbow positions, The American Society of Hand Therapists standardized position is recommended for testing of handgrip strength.

Resumo O cotovelo flexionado é uma posição padronizada no teste de força de preensão manual, no entanto, a literatura mostra divergências nos valores obtidos com o cotovelo estendido. O objetivo deste estudo foi verificar se existe tal diferença em pessoas com a doença de Parkinson. Estudo transversal. Trinta e um idosos com diagnóstico clínico da doença de Parkinson realizaram 2 testes de preensão manual, o primeiro com o cotovelo estendido e o segundo com o cotovelo flexionado, com intervalo de 48 horas. Não houve diferença significativa entre as posições para a força de preensão manual (p > 0,05). Além disso, o tamanho do efeito foi insignificante (d < 0,19). Os principais resultados indicam que não houve diferença significativa entre o protocolo flexionado e o estendido, o tamanho do efeito foi negativo e muito pequeno, o que mostra que não há efeito clínico. Portanto, não há diferença entre as posições do cotovelo, recomenda-se a posição padronizada da Sociedade Americana de Terapeutas de Mão para o teste de força de preensão manual.

Acute Distal Biceps Tendon Injury: Diagnosis and Treatment / Lesões agudas do tendão distal do bíceps: Diagnóstico e tratamento

Abstract Acute distal biceps injuries clinically present with sudden pain and acute loss of flexion and supination strength. The main injury mechanism occurs during the eccentric load of the biceps. The hook test is the most significant examination test, presenting the highest sensibility and specificity for this lesion. Magnetic resonance imaging, the gold standard imaging test, can provide information regarding integrity and identify partial and/or complete tears. The surgical treatment uses an anterior or double approach and several reattachment techniques. Although there is no clinical evidence to recommend one fixation method over the other, biomechanical studies show that the cortical button resists better to failure. Although surgical treatment led to an 89% rate of return to work in 14 weeks, the recovery of high sports performance occurred in 1 year, with unsustainable outcomes.

Resumo As lesões agudas do tendão distal do bíceps se apresentam, clinicamente, com uma dor súbita associada a perda aguda de força de flexão e supinação. Seu principal mecanismo de lesão ocorre durante contração excêntrica do bíceps. O "Hook Test" é o principal teste semiológico, sendo o mais sensível e específico. A ressonância magnética, exame padrão ouro para o diagnóstico, pode fornecer informações sobre a integridade, identificando as lesões parciais e/ou completas. O tratamento cirúrgico pode ser realizado por duas vias principais: anterior e por dupla via porém as técnicas de reinserção tendínea são diversas não havendo evidência clínica que recomende um método de fixação em detrimento ao outro; embora o botão cortical apresente maior resistência a falha nos estudos biomecânicos. Com o tratamento cirúrgico o retorno as atividades laborais foi de 89% em 14 semanas (média) porém ao esporte de alto rendimento o prazo foi longo, média de 1 ano, e não duradouro.

Total Arthroplasty in Complex Elbow Injury / Artroplastia total na lesão complexa do cotovelo

Abstract The authors present an atypical case of a left elbow complex fracture with extensive loss of bone and muscle tissue. The patient was submitted to several surgical procedures, which resulted in a total arthroplasty of the left elbow with triceps reconstruction using a semitendinosus muscle tendon graft.

Resumo Os autores apresentam um caso atípico de fratura complexa do cotovelo esquerdo com perda extensa de tecido ósseo e muscular. O paciente foi submetido a diversos procedimentos cirúrgicos, que resultaram em uma artroplastia total do cotovelo esquerdo associada à reconstrução do tríceps com enxerto do tendão do músculo semitendíneo.

Fractura de capitellum en el adulto

Introducción: La fractura del extremo distal del húmero afecta la superficie articular y puede provocar incapacidad biomecánica de la articulación si no se trata adecuadamente. Objetivo: Presentar una paciente con fractura del capitellum, tratada mediante osteosíntesis. Presentación del caso: Paciente femenina de 49 años que se cayó sobre su mano en extensión. Presentó dolor intenso en el codo izquierdo y se le diagnosticó una fractura del capitellum desplazada. Se trató con osteosíntesis. Conclusiones: El tratamiento mediante osteosíntesis de la fractura del capitellum constituye la mejor opción para la rápida rehabilitación del paciente.

Introduction: The fracture of the distal end of the humerus affects the articular surface and it can cause biomechanical disability of the joint if it is not treated properly. Objective: To report the case of a patient with capitellum fracture, treated by osteosynthesis. Case report: This is the case of a 49-year-old female patient who fell on her outstretched hand. She complained of severe pain in her left elbow and she was diagnosed with a displaced capitellum fracture. The pateinmet was treated with osteosynthesis. Conclusions: The treatment by osteosynthesis of the capitellum fracture is the best option for the rapid rehabilitation of the patient.

Caracterización de las fracturas supracondíleas del húmero en niños que requirieron manejo quirúrgico en un hospital de Santander, Colombia / Characterization of Supracondylar Fractures of the Humerus in Children who Required Surgical Management at a Hospital in Santander, Colombia / Caracterização das fraturas supracondilianas do úmero em crianças que precisaram de tratamento cirúrgico em um hospital de Santander, Colômbia

Introducción. El objetivo del estudio fue describir las características sociodemográficas, tratamiento y complicaciones pre y posquirúrgicas de las fracturas supracondíleas del húmero distal en niños que requirieron manejo quirúrgico en un hospital de Santander, Colombia. Metodología. Se trata de un estudio observacional, descriptivo, de corte transversal con 58 pacientes que cumplieron los siguientes criterios de inclusión: edad entre 3 a 14 años, fracturas supracondíleas de manejo quirúrgico; como criterios de exclusión se tomó: antecedente de enfermedad ósea o neurológica previa y fracturas de más de 7 días de evolución. Para las variables continuas se usó medidas de tendencia central y dispersión, las categóricas en porcentajes y frecuencias absolutas. Resultados. La edad media de presentación fue de 6.2 años, el principal mecanismo de trauma fue caídas de altura con un 96.5%. El 65.5% provenía de zonas urbanas. El 13.8% se asoció con fracturas de antebrazo, y el 3.4% de epitróclea. La fijación se realizó en un 75% con técnica cruzada y un 17.2% se asoció con lesión iatrogénica del nervio ulnar. Discusión. En el estudio no se informaron lesiones vasculares; sin embargo, se documentó una alta prevalencia de lesión neurológica con la fijación medial, similar a lo descrito en la literatura (1.4%-17.7%); algunos autores describen técnicas que disminuyen estas lesiones hasta en un 0%. Conclusión. Las características sociodemográficas de nuestra población coinciden con la estadística publicada mundialmente; la principal complicación fue la lesión iatrogénica nervio ulnar, que se puede disminuir con un uso racional del pin medial y con el empleo de técnicas que busquen rechazar directamente el nervio. Palabras clave: Fracturas del Húmero; Fijación Interna de Fracturas; Clavos Ortopédicos; Codo; Niño; Nervio Cubital.

Introduction. The objective of this study was to describe sociodemographic characteristic, treatment, and pre- and post-surgical complications of supracondylar fractures of the distal humerus in children who required surgical management at a hospital in Santander, Colombia. Methodology. This was an observational, descriptive, and cross-sectional study involving 58 patients who met inclusion criteria: age between 3 and 14 years old, supracondylar fractures with surgical management; exclusion criteria include previous bone or neurological illness and fractures with more than 7 days of evolution. Central tendency and dispersion measures were used for continuous variables, and categorical variables in percentages and absolute frequencies. Results. The average age at presentation was 6.2 years old, the main mechanism of trauma was fall from height (96.5%). 65.5% came from urban zones. The 13.8% were associated with forearm fractures, and 3.4% with epitrochlear fractures. Pinning was performed at 75% with crossed technique and 17.2% were associated with iatrogenic ulnar nerve injury. Discussion. Study didn't inform vascular injuries. However, a high prevalence of neurological injury with medial pinning was documented, similar to that describe in the literature (1.4%-17.7%); some author described techniques that reduce these lesions by 0%. Conclusion. The sociodemographic characteristics of our population match with worldwide published statistics; the main complication was iatrogenic ulnar nerve injury, which can be reduced with the rational use of medial pin and with the application of techniques that seek to directly spare the nerve. Keywords: Humeral Fractures; Fracture Fixation, Internal; Bone Nails; Elbow; Child; Ulnar Nerve.

Introdução. O objetivo do estudo foi descrever as características sociodemográficas, o tratamento e as complicações pré e pós-cirúrgicas das fraturas supracondilianas do úmero distal em crianças que precisaram de tratamento cirúrgico em um hospital de Santander, Colômbia. Metodologia. Trata-se de um estudo observacional, descritivo e transversal com 58 pacientes que atenderam aos seguintes critérios de inclusão: idade entre 3 e 14 anos, fraturas supracondilianas tratadas cirurgicamente. Os critérios de exclusão foram: histórico de doença óssea ou neurológica prévia e fraturas com duração superior a 7 dias de evolução. Para variáveis contínuas foram utilizadas medidas de tendência central e dispersão, as categóricas em percentuais e frequências absolutas. Resultados. A média de idade de apresentação foi de 6.2 anos, o principal mecanismo de trauma foi a queda de altura com 96.5%. 65.5% vieram de áreas urbanas. 13.8% estavam associados a fraturas de antebraço e 3.4% a epitróclea. A fixação foi realizada em 75% com técnica cruzada e 17.2% esteve associada à lesão iatrogênica do nervo ulnar. Discussão. Nenhuma lesão vascular foi relatada no estudo. No entanto, foi documentada alta prevalência de lesão neurológica com fixação medial, semelhante à descrita na literatura (1.4%-17.7%). Alguns autores descrevem técnicas que reduzem essas lesões em até 0%. Conclusão. As características sociodemográficas da nossa população coincidem com as estatísticas publicadas mundialmente. A principal complicação foi a lesão iatrogênica do nervo ulnar, que pode ser reduzida com o uso racional do pino medial e com o uso de técnicas que buscam rejeitar diretamente o nervo. Palavras-chave: Fraturas do Úmero; Fixação Interna de Fraturas; Pinos Ortopédicos; Cotovelo; Criança; Nervo Ulnar

Fracturas supracondíleas en pacientes pediátricos tratados quirúrgicamente con Técnica de Cruzada. Hospital Central San Cristóbal / Supracondylar humerus fractures in childrens surgically treated by Crossed Wiring Technique. San Cristóbal Central Hospital

Las fracturas supracondíleas en niños se asocian con algunas complicaciones. Su tratamiento estándar es la reducción cerrada y la fijación con alambres en distintas configuraciones. Se realizó un estudio observacional, analítico, prospectivo y longitudinal con pacientes pediátricos que ingresaron con fracturas supracondíleas de húmero tratados quirúrgicamente con alambres de Kirschner con "Técnica Cruzada" en el Hospital Central San Cristóbal enero a junio de 2022. Se incluyeron 30 pacientes. La edad promedio fue 6,3±2,2(3-10) años. La causa más frecuente del traumatismo fue la precipitación de altura en 63,3% de los casos. La posición del codo al momento del accidente fue en extensión en 90%. Todas las fracturas fueron cerradas. El tiempo promedio desde el accidente hasta su atención en emergencia fue de 8,5±13,4(2-72) horas. Los signos clínicos más frecuentes fueron dolor en 100,0%, limitación funcional en 96,7%, aumento de volumen 73,3% y deformidad 50,0%. Según la clasificación AO la más frecuente fue del tipo 13-M/3. 1 III en el 50% de los casos y según Gartland, las tipo IIIA en 53,3%. A las 4 semanas, 100,0% de las fracturas consolidaron, 13,3% presentó valgo y 6,7% varo en la radiografía anteroposterior. Mientras que, en la lateral, 33,3% antecurvatum. La media del ángulo de Baumann fue de 20,27±1,39 grados. La tasa de complicaciones fue de 16,66%, 2(6,7%) casos presentaron neuropraxia y 3(10,0%) granuloma. En conclusión, la Técnica Cruzada es segura en términos de reducción, funcionalidad y tasas de complicaciones en el seguimiento a medio plazo(AU)

Supracondylar fractures in children are associated with some complications. Its standard treatment is closed reduction and fixation with wires in different configurations. An observational, analytical, prospective and longitudinal study was made, with pediatric patients admitted with supracondylar humeral fractures surgically treated with Kirschner wires with the "Cross Technique" at the Hospital Central San Cristóbal from January to June 2022. 30 patients were included. The mean age was 6,3±2,2(3-10) years. The most frequent cause of trauma was high altitude precipitation in 63,3% of the cases. The position of the elbow at the time of the accident was 90% extended. All fractures were closed. The mean time from the accident to emergency care was 8,5±13,4(2-72) hours. The most frequent clinical signs were pain in 100,0%, functional limitation in 96.7%, volume increase in 73,3%, and deformity in 50,0%. According to the AO classification, the most frequent was type 13-M/3. 1 III in 50% of cases and according to Gartland, type IIIA in 53,3%. At 4 weeks, 100,0% of the patients consolidated, 13,3% presented valgus and 6,7% varus on the anteroposterior radiograph. While, on the side, 33,3% antecurvatum. The mean Baumann angle was 20,27 ± 1.39 degrees. The rate of complications was 16,66%, 2 (6,7%) cases presented neuropraxia and 3 (10,0%) granuloma. In conclusion, the Crossover Technique is safe in terms of reduction, functionality, and complication rates in medium-term follow-up(AU)

Endoscopic Release of the Ulnar Nerve at the Elbow: Technique Description and Case Series / Liberação endoscópica do nervo ulnar no cotovelo: Descrição da técnica e série de casos

Abstract Objective The endoscopic release of the ulnar nerve reproduces a simple (in situ) procedure with smaller incisions, less soft tissue damage, and higher preservation of nerve vascularization. Endoscopy allows the clear visualization of the entire path of the nerve and surrounding noble structures. Moreover, it reveals any signs of compression and allows a safe release of 10cm distally or proximally to the medial epicondyle. Methods A retrospective survey revealed that 15 subjects (1 with a bilateral injury) underwent an ulnar nerve compression release at the elbow using the endoscopic technique with Agee (Micro-Aire Sugical Instruments, Charlottesville, VA, EUA) equipment from January 2016 to January 2020. Results Symptoms of ulnar nerve compression improved in all patients; on average, they resumed their work activities in 26.5 days. There was no recurrence or need for another procedure. In addition, there were no severe procedure-related complications, such as infection and nerve or vascular injury. One patient had transient paresthesia of the sensory branches to the forearm, with complete functional recovery in 8 weeks. Conclusion Our study shows that the endoscopic release of the ulnar nerve at the elbow with the Agee equipment is a safe, reliable technique with good outcomes.

Resumo Objetivo A liberação endoscópica do nervo ulnar permite reproduzir uma liberação simples (in situ), mas através de incisões menores e com menor lesão de partes moles e uma maior preservação da vascularização do nervo. A visualização clara através da endoscopia permite observar todo o trajeto do nervo e das estruturas nobres circundantes, mostrando os sinais de compressão, possibilitando realizar a liberação de forma segura em um trajeto de 10 cm nos sentidos distal e proximal ao epicôndilo medial. Método Foram encontrados, de forma retrospectiva, no período entre janeiro de 2016 e janeiro de 2020, 15 pacientes (sendo 1 com lesão bilateral) submetidos a liberação da compressão do nervo ulnar no cotovelo pela técnica endoscópica com equipamento de Agee (Micro-Aire Sugical Instruments, Charlottesville, VA, EUA). Resultados Todos os pacientes tiveram melhora dos sintomas de compressão do nervo ulnar e o período de retorno ao trabalho foi de em média 26,5 dias. Não houve recidivas e não houve a necessidade de outro procedimento. Também não houve complicações graves decorrentes do procedimento, como infecção, lesão nervosa ou vascular. Em um paciente, houve parestesia transitória dos ramos sensitivos para o antebraço, com retorno completo da função em 8 semanas. Conclusão Os resultados mostram que a liberação endoscópica do nervo ulnar no cotovelo comoequipamentodeAgeeéuma técnica segura, confiável e com bons resultados.

Comparison between Fixation with Smooth Kirschner Wire and Cannulated Screws in Displaced Fractures of the Lateral Humeral Condyle in Children / Comparação entre fixação de fio de Kirschner liso e de parafusos canulados em fraturas deslocadas do côndilo lateral do úmero em crianças

Abstract Objective To compare the use of cannulated screws and smooth Kirschner wires in terms of reducing the presence of exuberant callus and complications in pediatric displaced fractures of the lateral humeral condyle. Methods An analytical cross-sectional study of consecutive cases was conducted from May to October 2021 with 30 children with displaced external humeral condyle fractures. The functional results regarding pain and range of motion were stratified using the Dhillon grading system. Results A total of 19 patients underwent Kirschner wire fixation, and 11 underwent cannulated screw fixation. Closed fixation was performed in 14 cases (47%), and open fixation, in 16 (53%). Of the cases included, there was no loss to follow-up. Te sample was composed of 21 (70%) male patients, and the age ranged from 5 to 15 years, with a mean of 6.96 years. The most frequent cause of fracture was fall from height (50%), which was related to greater displacement on baseline radiographs. Complications that were not related to the reduction approach or the implant used were observed in 12 (40%) cases. Conclusion The present study shows no benefits in relation to the use of smooth pins or cannulated screws to reduce the presence of exuberant callus in the consolidation of the fracture. We see that the complications that arise are related to the severity of the injury, and benefits cannot be identified in the choice of one implant over another. We could see that the Weiss classification helps to define the behavior in favor of open or closed reduction without interfering in kindness of the smooth pin or the cannulated screw for fracture fixation.

Resumo Objetivo Comparar o uso de parafusos canulados e de fios de Kirschner lisos em termos da redução da presença de calo exuberante e de complicações em fraturas pediátricas deslocadas do côndilo lateral do úmero. Métodos Um estudo analítico transversal de casos consecutivos foi realizado de maio a outubro de 2021 com 30 crianças com fraturas deslocadas de côndilo umeral externo. Os resultados funcionais para dor e amplitude de movimento foram estratificados utilizando o sistema de classificação Dhillon. Resultados Ao todo, 19 pacientes foram submetidos à fixação de fio Kirschner, e 11 à fixação de parafusos canulados. A fixação realizada foi fechada em 14 casos (47%) e aberta em 16 (53%). Dos casos incluídos, não houve perda no acompanhamento. A amostra continha 21 (70%) pacientes do sexo masculino, e a idade variou de 5 a 15 anos, com média de 6,96 anos. A causa mais frequente de fratura foi queda de altura (50%), e esteve relacionada ao maior deslocamento nas radiografias da linha de base. Complicações que não estavam relacionadas à abordagem de redução ou ao implante utilizado foram observadas em 12 (40%) casos. Conclusão Este estudo não mostra benefícios em relação ao uso de pinos lisos ou de parafusos canulados para reduzir a presença de calo exuberante na consolidação da fratura. Vemos que as complicações que surgem estão relacionadas à gravidade da lesão, e não é possível identificar benefícios na escolha de um implante ou outro. Pudemos ver que a classificação de Weiss ajuda a definir o comportamento em favor da redução aberta ou fechada sem dar preferência ao pino liso ou ao parafuso canulado para a fixação da fratura.

Multidirectional Instability in a Neglected Elbow Dislocation Managed with Circumferential Ligament Reconstruction. A Case Report / Instabilidade multidirecional em uma luxação negligenciada do cotovelo gerenciada com reconstrução do ligamento circunferencial. Um relato de caso

Abstract Neglected elbow dislocation is an uncommon condition and its treatment remains challenging. We present a case of a middle-aged woman presenting with neglected elbow dislocation and multi-direction instability in whom open reduction of the elbow joint and circumferential ligamentous reconstruction with a gracilis tendon graft was done. The functional outcome assessed with the Mayo elbow performance index was excellent. This circumferential technique is undoubtedly a viable technique and the indications can be extended to even manage a neglected dislocation. This procedure reduces the need or diminishes the duration of external fixation requirement and thereby encourages early mobilization.

Resumo A luxação negligenciada do cotovelo é uma condição incomum e seu tratamento permanece desafiador. Apresentamos o caso de uma mulher de meia-idade que apresentou luxação negligenciada do cotovelo e instabilidade multidirecional, na qual foi realizada redução aberta da articulação do cotovelo e reconstrução ligamentar circunferencial com enxerto de tendão gracilis. O resultado funcional avaliado com o índice de desempenho do cotovelo de Mayo foi excelente. Essa técnica circunferencial é, sem dúvida, uma técnica viável e as indicações podem ser estendidas para gerenciar até mesmo um deslocamento negligenciado. Este procedimento reduz a necessidade ou diminui a duração da exigência de fixação externa e, assim, incentiva a mobilização precoce.

FUNCTIONAL OUTCOME FOLLOWING BI-COLUMNAR PLATING OF AO-TYPE 13C DISTAL HUMERUS FRACTURES.

Background: Intra articular fractures of the distal humerus are uncommon injuries and present the most difficult challenge among fractures of the distal end of the humerus. Objective of this study is to evaluate the functional outcome following bicolumnar plating of AO-Type 13C distal humerus fractures. A total of 20 int Materials and Methods: ra articular (AO TYPE C) distal humerus fractures were operated within a period of 2 years in KVG medical college and hospital Sullia were included in the study in which there were 12 males and 8 females.16 cases were due to RTA, 4 were due to self-fall, Out of 20 cases,1 (5%) was of AO C1 type of fracture, 16(80%) were of C2 and 3 (15%) were of C3 type of fractures. All the patients were operated with pre-countered distal humerus locking plates in orthogonal fashion and functional outcome was measured by Mayo's Elbow Performance Score (MEPS). In our series of 20 cases, the Results: average duration of the radiological union was 16±02 weeks. Excellent results were seen in 10, good in 6 and fair in 3, and poor in 1 According to Mayo's Elbow Performance Score (MEPS) at the end of 12 months follow up. Open reduct Conclusion: ion and internal fixation with bicolumnar plating is the ideal fixation for AO 13 type C distal humerus fractures. Use of locking plates, stable fixation, along with early elbow mobilization influence the final functional outcome. Bicolumnar plating provides better stability, allows early elbow range of motion and prevents elbow stiffness.

Common types and treatment of elbow injuries in skiing or snowboarding / 中华创伤骨科杂志

Objective:To investigate the common types of elbow joint injuries in skiing or snowboarding and their treatment.Methods:A retrospective study was conducted to analyze the data of 90 patients with elbow injury caused by skiing or snowboarding who had been admitted to Department of Upper Limbs, Sichuan Orthopaedic Hospital from February, 2015 to February, 2022. There were 53 males and 37 females with an age of (31.8±8.4) years. The types of elbow injury, visual analogue scale (VAS), range of motion (ROM) of the elbow and Mayo elbow performance score (MEPS) of the patients were recorded before treatment and at the last follow-up.Results:Of the patients, 18 were treated conservatively (3 simple Mason type I radial head fractures and 15 O'Driscoll type I coronal process fractures) and 72 surgically. Their follow-up time was (31.3±18.7) months. The fractures all healed by the time of the last follow-up. Simple elbow fracture was observed in 63 patients, simple elbow dislocation in 2 patients, fracture plus dislocation in 25 patients. The posterior dislocation was the most common (22 cases). Among the elbow fractures, radial head fracture occurred in 27 patients, ulnar coronoid process fracture in 41 patients, proximal ulnar fracture in 13 patients, and distal humeral fracture in 28 patients. Collateral ligament injuries were complicated in 65 cases. In the patients undergoing conservative treatment, their VAS, elbow ROM, and MEPS were all improved significantly from 4.7±1.4, 92.2°±14.4° and 63.9±6.5 before treatment to 0.4 (0,1.0), 110.6°±0.6°, and 92.2±3.9 at the last follow-up ( P<0.05); in the patients undergoing surgical treatment, their VAS, elbow ROM, and MEPS were also all improved significantly from 5.6±1.7, 24.3°±18.4°, and 26.9±12.2 before surgery to 0.6 (0,1.0), 97.4°±14.0° and 86.6±7.1 at the last follow-up ( P<0.05). After surgery, 8 patients presented with neurological symptoms and 7 patients developed heterotopic ossification. Conclusions:In skiing or snowboarding, the coronoid process of the ulna is the most vulnerable to fracture. In the elbow injuries due to skiing or snowboarding, posterior dislocation is the most common type which is often accompanied by injuries to the medial and lateral collateral ligaments. For simple Mason type Ⅰ radial head fractures and O'-Driscoll type Ⅰ coronoid process fractures in which the elbow is stable, conservative treatment can be adopted; surgical treatment is indicated for the other injuries.

Operative versus nonoperative treatment of isolated Mason type Ⅱ radial head fracture / 中华创伤骨科杂志

Objective:To compare the outcomes of isolated Mason type Ⅱ radial head fracture between operative and non-operative treatments.Methods:A retrospective study was conducted to analyze the data of patients who had been treated for isolated Mason type Ⅱ radial head fracture either operatively or nonoperatively at Department of Trauma and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University from January 2017 to October 2020. The patients were divided into a non-operative group and an operative group according to their treatment method. After 1:1 propensity score matching method was used to match the patients in the 2 groups, a total of 58 pairs of patients were successfully matched. In the operative group, there were 24 males and 34 females with a mean age of (40±14) years and a body mass index of (23.7±3.4) kg/m 2; in the non-operative group, there were 22 males and 36 females with a mean age of (42±13) years and a body mass index of (23.5±3.9) kg/m 2. Elbow flexion-extension, forearm rotation, Mayo elbow performance score (MEPS), Quick-disabilities of the arm, shoulder and hand (q-DASH) score and complications were compared between the 2 groups. Results:There was no significant difference in the baseline data between the 2 groups, indicating comparability ( P>0.05). All the patients were followed up for (24±9) months. At the last follow up in the operative and the non-operative groups, respectively, the elbow flexion-extension was 134° (132°, 136°) and 134°(131°, 136°), the forearm rotation 176° (174°, 179°) and 178° (175°, 179°), the MEPS 100 (100, 100) and 100 (100, 100), the q-DASH score 0 (0, 0) and 0 (0, 0), showing no significant differences between the 2 groups in the above items ( P>0.05). Elbow pain was reported respectively in 4 (6.9%) and 6 (10.3%) patients in the operative and non-operative groups, showing no significant difference between the 2 groups ( P>0.05). Conclusion:The outcomes of operative and non-operative treatments of isolated Mason type Ⅱ radial head fracture are comparable.

Olecranon sled fixation versus tension band wiring fixation in treatment of Mayo ⅡA olecranon fractures / 中华创伤骨科杂志

Objective:To compare the efficacy between olecranon sled fixation and tension band wiring fixation in the treatment of Mayo ⅡA olecranon fractures.Methods:A retrospective study was conducted to analyze the data of 54 patients with Mayo ⅡA olecranon fracture who had been admitted to Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital from October 2018 to February 2021. There were 20 males and 34 females with an age of (45.5±17.7 years), and 36 left and 18 right sides. They were divided into 2 groups according to different methods of internal fixation. Group A (25 cases) was subjected to olecranon sled fixation and group B (29 cases) to tension band wiring fixation. Preoperative data, operation time, reoperations and complications during follow-up were recorded and compared between the 2 groups. In both groups at the last follow-up, the range of the elbow motion, the Mayo elbow performance score (MEPS) and the Disabilities of the Arm, Shoulder and Hand (DASH) score were recorded to evaluate the elbow function.Results:The 2 groups were comparable because there were no significant differences in all their preoperative demographic data ( P>0.05). There were no significant differences between the 2 groups either in follow-up time [(32.8±8.9) months for group A and (35.8±9.0) months for group B] or in operation time [60.0 (60.0, 82.5) min for group A and 60.0 (60.0, 67.5) min for group B] ( P>0.05). At the last follow-up in group A and group B, respectively, the flexion and extension of the elbow was 141.0°±8.4° and 140.0 (140.0, 150.0)°, the pronation-supination 180.0 (175.0, 180.0)° and 180.0 (175.0, 180.0)°, the MEPS score 100.0 (85.0, 100.0) and 100.0 (92.5, 100.0), and the DASH score 4.2 (1.7, 6.3) and 5.8 (1.3, 8.3), all showing no statistically significant differences between the 2 groups ( P>0.05). Olecranon skin irritation occurred in 5 patients (20.0%,5/25) in group A and in 15 patients (51.7%,15/29) in group B, and 7 patients (28.0%,7/25) in group A and 21 patients (72.4%,21/29) in group B underwent removal of internal fixation, both showing statistically significant differences between the 2 groups ( P<0.05). Conclusion:In the treatment of Mayo ⅡA olecranon fractures, compared with tension band wiring fixation, olecranon sled fixation may lead to comparable efficacy in fixation and functional recovery, but significantly reduced rates of complications and internal fixation removal.

Acceptable residual rotational deformity after supracondylar fracture of the humerus in children / 中华创伤骨科杂志

Objective:To explore the effects of residual rotational deformity after supracondylar fractures of the humerus on the surgical efficacy in children.Methods:From January 2020 to December 2021, 453 patients with Gardland type Ⅲ supracondylar humeral fracture were treated with closed reduction and percutaneous pinning at Department of Pediatric Orthopedics, The Second Hospital of Fuzhou. They were assigned into 2 groups according to the quality of reduction. In the group of residual rotational deformity of 69 cases (group A), there were 44 boys and 25 girls, with an age of (6.3±2.9) years. The Baumann angle was maintained at 65° to 80° on the anteroposterior view of intraoperative fluoroscopy and the anterior humeral line passed through the anterior 1/3 of the capitellum on the lateral view with a normal carrying angle (from 4° to 23°). In the anatomical reduction group of 384 patients (group B), there were 242 boys and 142 girls, with an age of (5.9±2.7) years. The anteroposterior view and the lateral view of intraoperative fluoroscopy showed anatomical reduction of the fracture ends. The fluoroscopy frequency, operation time, intraoperative carrying angle, the carrying angle at 6 months after operation and the Flynn score at 6 months after operation were recorded and compared between the 2 groups.Results:There was no significant difference in gender, age, side or fixation time between the 2 groups before operation, showing they were comparable ( P>0.05). All patients were followed up for (6.3±2.9) months after operation. The median intraoperative fluoroscopy frequency was 6 (4, 6) times in group A, significantly lower than that in group B [8(6, 8)], and the median operation time was 20 (20, 25) min in group A, significantly shorter than that in group B [30(25, 30) min] ( P<0.05). There was no significant difference between group A and group B in the intraoperative rying angle (19.7°±2.7° versus 20.2°±2.8°) or in the carrying angle at 6 months after operation (17.4°±2.7° versus 17.6°±2.7°) ( P>0.05). By the Flynn scoring for the elbow joint at 6 months after operation, group A had 28 excellent cases, 30 good cases, 9 moderate cases, and 2 poor cases, yielding an excellent and good rate of 84.1%(58/69); group B had 241 excellent cases, 104 good cases, 34 moderate cases, and 5 poor cases, yielding an excellent and good rate of 89.8%(345/384). There was no statistically significant difference between the 2 groups ( P>0.05). No cubitus varus, delayed union, non-union, compartment syndrome, or iatrogenic ulnar nerve injury was observed in either group at postoperative 6-month follow-up. Conclusions:A certain degree of residual rotational deformity is acceptable after supracondylar fracture of the humerus in children, because it may have a little significant effect on the postoperative outcomes but may reduce fluoroscopy frequency and shorten operation time.

Efficacy of ultrasound-guided closed reduction in the treatment of supracondylar fractures of the humerus in children / 中国基层医药

Objective:To investigate the clinical efficacy of ultrasound-guided closed reduction and percutaneous Kirschner wire fixation in the treatment of supracondylar fractures of the humerus in children.Methods:The clinical data of 78 children with Gartland type II and type III straight-type supracondylar fractures of the humerus who received treatment in The First Affiliated Hospital of Anhui Medical University from October 2019 to October 2022 were retrospectively analyzed. These children were divided into an observation group ( n = 38) and a control group ( n = 40) according to different treatment methods. The observation group was subjected to ultrasound-guided closed reduction and percutaneous Kirschner wire fixation. The control group was given C-arm fluoroscopy-guided closed reduction and percutaneous Kirschner wire fixation. Mayo elbow performance score (MEPS), clinical healing time, operative time, and the incidence of intraoperative complications such as vascular and nerve injury were compared between the two groups. Results:Both groups of children achieved closed reduction without open reduction. The operative time in the observation group was (30.68 ± 5.45) minutes, which was significantly shorter than (40.54 ± 5.78) minutes in the control group ( t = 2.30, P < 0.05). The healing time of the fracture in the observation and control groups was (32.73 ± 4.56) days and (36.47 ± 6.24) days, respectively, and there was no significant difference between the two groups ( P > 0.05). The range of joint motion and elbow hyperextension angle range in the observation group were (148.78 ± 3.81)° and (8.72 ± 8.92)°, respectively, and they were (147.24 ± 4.36)° and (7.98 ± 8.86)°, respectively in the control group. There were no significant differences in the range of joint motion and elbow hyperextension angle range between the two groups (both P > 0.05). The excellent and good rate of joint function in the control and observation groups was 92.5% (37/40) and 92.1% (35/38), respectively. There was no significant difference in excellent and good rate of joint function between the two groups ( P > 0.05). There were three cases of postoperative nerve damage in the control group and no vascular or nerve damage was observed in the observation group. There were significant differences in the number of cases of vascular or nerve injury between the two groups ( χ2 = 3.97, both P < 0.05). Conclusion:Ultrasound-guided closed reduction and percutaneous Kirschner wire fixation for the treatment of supracondylar fractures of the humerus can shorten the operative time, decrease the incidence of intraoperative nerve injury, and reduce the X-ray exposure time of doctors and patients.

Recent advancements of ulnar nerve complications associated with elbow arthrolysis / 国际外科学杂志

Elbow arthrolysis is the most commonly used treatment for elbow stiffness. Ulnar nerve complications are one of the most important evaluation indicators of postoperative health status. However, there is no consensus on the management of ulnar nerve and the control of surgical indications. Combining relevant literature and clinical experience, this review discussed the necessity of ulnar nerve release and the choice of ulnar nerve operations during elbow arthrolysis with or without preoperative ulnar nerve symptoms. It is considered that more attention should be paid to the management of ulnar nerve complications and further research should be performed.

Clinical effects of modified open elbow arthrolysis in the treatment of post-traumatic elbow stiffness / 国际外科学杂志

Objective:To study the clinical efficacy of modified open elbow arthrolysis in the treatment of traumatic elbow stiffness.Methods:A retrospective analysis was performed on 120 patients who underwent modified open elbow arthrolysis in Beijing Jishuitan Hospital from January 2018 to December 2020. The age of the included patients was (37.7±12.4) years (ranged 18-64 years), including 54 males and 66 females. The medical records were reviewed, the range of motion (ROM) and functional status of the patients before operation and at the last follow-up were compared including visual analogue scale (VAS), Mayo elbow performance score (MEPS), Disabilities of the arm, shoulder and hand (DASH) score. Complications and secondary operations were also recorded. Measurement data with normal distribution were presented as mean ± standard deviation( ± s) and comparison between groups was conducted using the t-test; Measurement data of skewed distribution were expressed as M ( Q1, Q3), and Rank-sum test was used for inter-group comparison. Results:The preoperative extension of 120 patients was 43.6° (33.8°, 60.1°), the flexion was 78.7° (59.8°, 98.1°), and the flexion-extension ROM was 25.6° (0.0°, 54.5°); the preoperative pronation was 51.8° (33.0°, 67.0°), the supination was 85.1° (65.7°, 90.0°), and the rotation ROM was 136.9° (99.1°, 157.5°). Postoperative extension was 14.2° (7.0°, 24.8°), flexion was 129.5° (120.0°, 138.1°), flexion-extension ROM was 115.5° (94.4°, 127.3°); postoperative pronation was 65.0° (47.1°, 75.0°), the supination was 88.3° (78.6°, 90.0°), and the rotation ROM was 151.9° (131.7°, 163.4°). Postoperative extension, flexion, flexion-extension ROM, pronation, supination, and rotation ROM were all higher than those before operation, and the differences were statistically significant ( P<0.001). The VAS of 120 patients was 1.0 (0.0, 3.0) scores before operation and 0.0 (0.0, 1.0) scores after operation. The MEPS was 60.0 (50.0, 75.0) scores before operation and 100.0 (85.0, 100.0) scores after operation. The preoperative DASH was 37.5 (20.1, 51.3) scores, and the postoperative DASH was 7.9 (3.3, 13.3) scores. The postoperative VAS, MEPS, and DASH were significantly improved compared with those before operation, and the differences were statistically significant ( P<0.001). Residual ulnar nerve symptoms occurred in 18 cases, recurrence of heterotopic ossification in 42 cases, and hematoma in 3 cases. Conclusions:Modified open elbow arthrolysis is a safe and effective surgical method for the treatment of traumatic elbow stiffness. It can significantly improve the function of the patient, reduce the occurrence of elbow instability, avoid the use of external fixators, and reduce the cost of the patient.

Clinical efficacy of anterior radius head fracture combined with lateral ligament complex injury / 中华骨科杂志

Objective:To investigate the operation efficacy of anterior radius head fracture combined with lateral ligament complex injury.Methods:The patients with radial head fracture admitted from September 2017 to August 2021 were retrospectively analyzed, 51 males and 54 females, average age of 38.84±13.63 years (range of 16-70 years). Based on the radial head fractures of Mason classification of type II, the cases involving the anterior radius head fracture were divided into three subtypes according to the number of fracture blocks and the type of displacement: type A (53 cases): one part of the anterior radius head collapse fracture; type B (50 cases): two or more parts of the anterior radial head collapse fracture; type C (2 cases): anterior radius head dissociated and displaced fracture. All fractures were treated with open reduction and internal fixation. Among them, the lateral ligament complex of type B were elongated due to the injury but the continuity existed. Therefore, the lateral ligament complex in 21 cases were not repaired in the early period (unrepaired group); in recent years, 29 cases repaired the lateral ligament complex (repair group). The postoperative efficacy was evaluated by elbow range of motion, table-top relocation test, Mayo score, and Broberg Morrey score. the patients were evaluated at final follow-up, except table-top relocation test was recorded according to the actual completion time.Results:All operations were successfully completed. The mean follow-up was 14.08±1.52 months (range of 12-18 months). Type A: the flexion and extension range was 115.70°±6.35°; the completion time of the table-top relocation test was 75.68±11.90 days; the Mayo score was 93.72±2.40 point, and the Broberg Morrey score was 92.89±2.28 point. Type B: lateral ligament repair group (repaired group) 29 cases and unrepaired lateral ligament group (unrepaired group) 21 cases. The flexion and extension range of elbow in repaired group was 112.1°±4.4°, which was better than that in unrepaired group 105.8°±3.7° ( t=5.31, P<0.001). The completion time of table-top relocation test was 77.72±6.51 days in repaired group and 104.29±18.45 days in unrepaired group ( t=6.32, P<0.001). The Mayo score of the repaired group was 90.21±5.88 points and that of the unrepaired group was 87.14±5.26 points ( t=1.90, P=0.063), and there was no significant difference between the two groups. Broberg Morrey score of 90.93±6.43 points in the repaired group was better than 86.95±6.37 points in the unrepaired group ( t=2.17, P=0.035). Type C for 2 patients, the flexion and extension range of elbow were 107°and 106°; the completion time of table-top relocation test were 82 days and 98 days; the Mayo scores were 91 point and 87 point; Broberg Morrey scores were 93 point and 85 point. There was a patient developed myositis ossificans in unrepair group of tybe B. Conclusion:The elbow joint is stable when one part of the anterior radius head collapse fracture; there is a degree of instability in the elbow when two or more parts of the anterior radial head collapse fractures suggest to repair the lateral ligament complex. The elbow joint is extremely unstable when anterior radius head dissociated and displaced fractures, the lateral ligament complex should be repaired in time.