MRI in acute simple elbow dislocations: correlation of preoperative imaging and intraoperative findings of collateral ligaments and associated soft tissue injuries.

PURPOSE: The aim of our study was the evaluation of correspondence among collateral ligaments and other soft tissue injuries detected by MRI and by intraoperative findings in a consecutive series of patients treated for simple elbow dislocation. METHODS: After clinical and MRI examination, 16 out of 59 consecutive patients with moderate or severe instability after simple elbow dislocation were addressed to surgical treatment. There were 14 men and 2 women. The mean age was 39.6 years (range 16-69 years). RESULTS: MRI showed full-thickness lesion of MCL in 9/16 patients (53.3%) and partial lesion in 6/16 patients (40%), and in 1 case, the MCL was considered intact. On the lateral side, MRI showed complete injury of LCL in 7/16 patients (46.6%) and partial injury in 7/16 patients (40%). No lesions of LCL were observed in 2 patients (13.4%). MCL was surgically explored in all the patients. We observed 10/16 full-thickness lesions (62.5%) and 6/16 partial lesions (37.5%). LCL was surgically explored in 11/16 patients. We observed 6/11 full-thickness lesions (54.6%) and 5/11 partial lesions (45.4%). In 3 cases, associated soft tissue injuries were detected. The rate of concordance between MRI and surgical findings was 87.5% (14/16 cases) on the medial side and 90.9% (10/11 cases) on the lateral side. CONCLUSION: Our study demonstrated that MRI is a reliable and useful tool to investigate collateral ligaments and soft tissue injuries around the elbow and to plan the most adequate surgical treatment.

One bone forearm with vascularized fibular graft. Clinical experience and literature review.

One-Bone-Forearm (OBF) is a procedure in which the proximal stump of the ulna is fixed to the distal stump of the radius. Historically, the indications for OBF have been represented by forearm instability due to trauma, infection, tumor resection, and congenital deformities with severe radius and ulna bone loss. When major bone loss prevents direct fixation between ulna and radius a Vascularized Fibular Bone Graft (VFBG) may allow forearm bone reconstruction and fixation. In this study we report our clinical experience in 4 cases of OBF with VFBG performed in 3 patients. Compared to standard OBF technique with direct osteodesis, OBF with VFBG showed similar clinical results and high rate of healing even in case of bone infection. Moreover, composite osteocutaneous VFBG might concurrently allow to treat local soft tissue defects.

The posterior bundle of the elbow medial collateral ligament: biomechanical study and proposal for a new reconstruction surgical technique.

BACKGROUND: The medial collateral ligament (MCL) is one of the primary elbows stabilizers. It is composed of an anterior bundle (AB), a posterior bundle (PB) and a transverse bundle. In elbow dislocations, until today MCL reconstruction has addressed the AB only. The purpose of this paper is to understand the biomechanical role of the PB of the MCL and to propose a new surgical technique for the simultaneous reconstruction of the anterior and posterior bundles, preventing the risk of recurrent posterior dislocation or posteromedial rotational instability (PMRI). MATERIALS AND METHODS: Sixteen cadaveric elbows were subjected to a force in compression, supination valgus and pronation varus. The residual stability was evaluated in three conditions: intact MCL, sectioned AB and sectioned AB + PB. The tests were performed in collaboration with the Department of Mechanical and Aerospace Engineering of the Politecnico di Torino. In six elbows, the MCL was then reconstructed with the new technique. RESULTS: Complete posterior elbow dislocation does not occur until the PB is sectioned. The section of the AB alone causes elbow instability in valgus stress, but not a dislocation. The reconstruction of the AB and the PB using the described technique allows a good recovery of range of motion and joint stability. CONCLUSIONS: The PB of the MCL has a primary role in elbow stability against valgus stress, and it prevents elbow posterior dislocation at all flexion angles. The described reconstruction technique should reduce the risk of residual PMRI.

Treatment of distal biceps tendon rupture: why, when, how? Analysis of literature and our experience.

INTRODUCTION: The rupture of the distal biceps tendon is a relatively uncommon lesion. Even if conservative treatment may be an option in low demanding patients, young and active subjects may benefit from an early surgical reinsertion. Many techniques and fixation devices have been described, but in the literature, there are no clinical evidences that show the superiority of any of these. In this article, we report an analysis of the "state of the art" and our case series of surgical reinsertion with the double approach transosseous technique. MATERIALS AND METHODS: Between 2003 and 2013, 26 patients underwent surgical reinsertion, either for acute or for chronic lesions of distal biceps tendon. We evaluated 21 acute cases treated with double approach using DASH and SECEC Elbow Scores. The mean follow-up was 22 months. Range of motion, supination and flexion strength were also recorded. RESULTS: Mean final ROM was 6-132° in F/E and 89-0-87° in P/S; flexion and supination strength were 96 and 88 % compared to the opposite side. The main complications were two cases of heterotopic ossifications: one asymptomatic fracture of the proximal radius and one temporary neurapraxia of the radial nerve. CONCLUSIONS: Analysing the literature and our outcomes, we underline the importance of timing for surgery, in young and compliant patients, with a valid rehabilitation protocol for excellent results. The choice of surgical technique remains controversial, and we believe that the double approach transosseous reinsertion is a safe, costless and relatively non-invasive technique, offering satisfactory results when performed early.

The judet quadricepsplasty: Long-term outcome of 21 cases.

BACKGROUND: The lack of knee flexion represents a possible complication in severe femur fractures. In 1956, Judet proposed a quadricepsplasty technique that allowed for a graded release without the disruption of the vastus medialis obliqus, vastus lateralis, or rectus femoris. METHODS: This article reports the clinical outcome of 21 cases of Judet quadricepsplasty after an average follow-up of 101.0 months (range, 21-204 months). The definitive flexion gain was classified as excellent, good, fair, or poor. Excellent when >100 degrees, good when >80 <99 degrees, fair when >50 degrees <79 degrees, poor when <50 degrees. The flexion and extension strength were graded from 0 to 5, according to the Daniel's scale. RESULTS: The average strength score was 4.71 in flexion, 4.81 in extension. The average definitive flexion was 95.67 degrees (range, 54-128 degrees) and the average definitive flexion gain was 72.43 degrees (range, 40-122 degrees). When the patients were grouped on the basis of the definitive flexion, excellent results were observed in eight cases (38.10%), were good in nine (42.86%), and fair in four (19.05) with zero poor results. CONCLUSIONS: Our experience has shown that, even if first proposed in 1956, the Judet procedure still gives a reproducible amount of good results.