Non-operative management of distal humerus fractures in the elderly: a review of functional outcomes.

Comminuted distal humerus fractures in the elderly have traditionally been managed by ORIF or total elbow arthroplasty (TEA). This poses a treatment dilemma in elderly patients where anaesthetic and surgical risks combine with poor bone and wound healing. We aimed to assess the functional outcomes in patients managed non-operatively, with TEA being used as the salvage procedure. Retrospective analysis of patients over 65 years presenting to our unit between 2005 and 2015 was undertaken. Sixty-two patients were identified, 38 had died, and 5 were lost to follow-up leaving 5 with immediate TEA and 14 non-operatively managed, available for review. Mean follow-up was 55 months (range 17-131). Patient outcomes were measured using VAS scores for pain at rest and during activity, and the Oxford elbow score (OES) for TEA and non-operatively managed patients. Conversion to TEA for non-operative treatment and complications were also recorded. Notes interrogation of patients who had died or were lost to follow-up to ascertain outcomes was undertaken. The mean age at injury was 76 years (range 65-90) of which 79% (11/14) were females. The mean score on the OES was 46.2 (range 29-48). The mean VAS score at rest was 0.4 (range 0-6), and the mean VAS score during activity was 1.3 (range 0-9). 93% (13/14) of patients reported no pain in their injured elbow at rest and 79% (11/14) reported no pain during activity. No patients converted to TEA, and there were no complications. Of deceased patients, notes demonstrated one who had ongoing stiffness after physiotherapy, but no conversions to TEA were undertaken. Those managed primarily with TEA had worse OES (mean 40.8), but slightly better pain scores with means 0.2 at rest and 0.8 at activity. Non-operative management of comminuted distal humerus fractures should be considered for elderly patients, avoiding surgical risks whilst giving satisfactory functional outcomes in this low-demand group.

Post-traumatic flexion contractures of the elbow: Operative treatment via the limited lateral approach.

Varying surgical techniques, patient groups and results have been described regards the surgical treatment of post traumatic flexion contracture of the elbow. We present our experience using the limited lateral approach on patients with carefully defined contracture types.Surgical release of post-traumatic flexion contracture of the elbow was performed in 23 patients via a limited lateral approach. All patients had an established flexion contracture with significant functional deficit. Contracture types were classified as either extrinsic if the contracture was not associated with damage to the joint surface or as intrinsic if it was.Overall, the mean pre-operative deformity was 55 degrees (95%CI 48-61) which was corrected at the time of surgery to 17 degrees (95%CI 12-22). At short-term follow-up (7.5 months) the mean residual deformity was 25 degrees (95%CI 19-30) and at medium-term follow-up (43 months) it was 32 degrees (95%CI 25-39). This deformity correction was significant (p < 0.01). One patient suffered a post-operative complication with transient dysaesthesia in the distribution of the ulnar nerve, which had resolved at six weeks. Sixteen patients had an extrinsic contracture and seven an intrinsic. Although all patients were satisfied with the results of their surgery, patients with an extrinsic contracture had significantly (p = 0.02) better results than those with an intrinsic contracture. (28 degrees compared to 48 degrees at medium term follow up). Surgical release of post-traumatic flexion contracture of the elbow via a limited lateral approach is a safe technique, which reliably improves extension especially for extrinsic contractures. In this series all patients with an extrinsic contracture regained a functional range of movement and were satisfied with their surgery.

Motion analysis: a validated method for showing skill levels in arthroscopy.

PURPOSE: The purpose of this study was to show the validity of a motion analysis system in its ability to differentiate between surgeons and non-surgeons when performing simple arthroscopic tasks. METHODS: We divided 35 subjects into a surgeons group (n = 20) and a non-surgeons group (n = 15). The surgeons group was further subdivided based on the amount of previous arthroscopic experience. Each participant performed 2 separate simulated arthroscopic tasks while being assessed with motion analysis equipment. The time taken, total path length, and number of movements were recorded. RESULTS: A significant difference in performance was identified between surgeons and non-surgeons (P < .0001) and between senior and junior surgeons (P < .05). We identified trends toward decreased time taken and improved economy of movement with increasing arthroscopic experience. CONCLUSIONS: This study shows the validity of a motion analysis system as a means of objective assessment of arthroscopic skills in orthopaedics. The system has been shown to differentiate between non-surgeons, junior surgeons, and senior surgeons in performing simple arthroscopic tasks. CLINICAL RELEVANCE: In the context of concerns regarding reductions in training time, this study validates the use of a simple, affordable, and reliable means of objective assessment of arthroscopic skills and training in such skills. The motion analysis system could subsequently be used as an adjunct to more traditional methods of assessment when planning strategies to teach, learn, and practice arthroscopic skills in the future.