Prospective clinical results of an additive ligament bracing for stabilizing simple and complex elbow instabilities.

INTRODUCTION: Ligament bracing augments ligament repair using a non-absorbable suture tape. Although biomechanically an increase in primary stability has been proven, there is a lack of clinical evidence. Purpose of this study was to evaluate clinical results of patients treated with ligament bracing due to primary elbow instability, including an analysis of complications. Furthermore, clinical results for patients treated with and without early functional mobilization were compared. MATERIALS AND METHODS: This prospective case-series evaluated clinical and functional results from patients treated with ligament bracing due to primary elbow instability. Clinical outcome measures were range of motion (ROM) as well as objective and subjective elbow scores [Mayo Elbow Performance Score (MEPS); Disabilities of Arm, Shoulder and Hand Score (DASH score)]. Stability was evaluated sonographically by humero-radial gapping under varus stress. RESULTS: This study involved 34 patients treated with ligament bracing. After a mean follow-up of 12.9 months ROM was 112° ± 29, MEPS 88 ± 13 points, DASH 91 ± 11 points, and 84% were satisfied with their result. Lateral joint gapping was 2.4 mm. No significant difference was observed regarding a postoperative mobilization with and without limitations. Most common complication after ligament bracing was elbow stiffness including heterotopic ossifications in four patients (12%). CONCLUSION: Operatively treated elbow instability with additional ligament bracing results in good clinical outcomes with high patient satisfaction and recovery of elbow stability. The high primary stability of the ligament bracing allows early functional mobilization without bracing, which facilitates postoperative rehabilitation. Elbow stiffness with heterotopic ossification seems to be a potential complication. Furthermore, the optimal tensioning of the ligament bracing remains challenging, including the risk of an over tensioning. LEVEL OF EVIDENCE: III.

Clinical evaluation of double-plate osteosynthesis for olecranon fractures: A retrospective case-control study.

INTRODUCTION: Single, dorsal plating is a commonly used technique for treating olecranon fractures. Double-plate osteosynthesis is an alternative treatment. Aim of this study was to present the surgical technique using this novel double-plate implant for olecranon fractures and review clinical results, complication rates and revision surgeries. Results were compared to single, dorsal plating. HYPOTHESIS: Does double-plate osteosynthesis for olecranon fractures improve material's tolerance with respect to osteosynthesis by single dorsal plating? PATIENTS AND METHODS: Between February 2011 and March 2015, we retrospectively evaluated 47 patients who were included in this study: 25 were treated with a low-profile double-plate osteosynthesis and 22 with an anatomically pre-shaped 3.5mm locking compression plate (LCP). The 2 groups were the result of a change of implants in our department in 2013. Patient satisfaction, range of motion, patient related outcome scores (Mayo Elbow Performance Score [MEPS], Disabilities of Arm, Shoulder and Hand Score [DASH]), complications and revision surgeries were evaluated. Results between both implant types were statistically compared using the Mann-Whitney U test. RESULTS: After a mean follow-up of 41 months (range: 25-61), the low-profile double-plate group showed a range of motion of 127°, MEPS of 94 and DASH of 6. The 3.5mm LCP group was found to have a range of motion of 130°, MEPS of 96 and DASH of 8. No clinical difference was found between groups. A total of 9 revision surgeries after double-plate osteosynthesis were recorded including seven implant removals and two intraarticular screws. One loosening of a screw without revision surgery was reported. The 3.5mm LCP group had 9 revision surgeries including eight implant removals and one intraarticular screw. DISCUSSION: Low-profile double-plate osteosynthesis is a safe and effective alternative treatment of olecranon fractures. Subjective and objective clinical outcome measures revealed a low complication rate and excellent results. Still, implant removal due to soft tissue irritation remains an issue. These findings were comparable to common dorsal plate osteosynthesis. LEVEL OF EVIDENCE: III, retrospective case-control study.

Outcomes after locked plating of displaced patella fractures: a prospective case series.

PURPOSE: Tension band wiring remains a common treatment for patella fractures, but complication rates are high, with unsatisfactory results. The purpose of this observation study was to evaluate clinical results and complication rates of a novel patella locking plate fixation. METHODS: Twenty patients (mean age, 59.2 ± 18 years) with displaced patella fractures were prospectively enrolled. Range of motion, knee scores (Tegner, Lysholm, Kujala), complications, and revision surgeries were assessed six weeks, six months, 12 months, and 24 months after surgery. Results were compared to the situation before trauma in regards to the time of follow-up using a paired sample t test. RESULTS: According to the OTA classification, the fractures were classified as follows: one A1, four C1, six C2, and nine C3. Range of motion improved from 121° after six weeks to 140°, 141°, and 143° within the follow-up period. While the Tegner, Lysholm, and Kujala scores were 4.1/97/97, respectively, before trauma, they improved from 2.6/80/89 to 3.6/94/89, 3.7/95/94, and 4.1/97/97 within the follow-up period. Three patients had a complication (15%): one fracture dislocation, one reactive bursitis, and one renewed fracture. Four patients reported discomfort or anterior knee pain especially when kneeling on the implant. CONCLUSIONS: The patella locking plate is a safe and effective treatment for patella fractures, including comminuted fractures. Function can be restored within six months after surgery, and the complication rate is low. Nonetheless, the implant can cause discomfort or anterior knee pain especially when kneeling, which can necessitate an implant removal.