Triceps brachii insertional footprint: Under-estimated complexity.

Background: The detailed complexity of triceps brachii insertional footprint continues to challenge surgeons as evidenced by continued reports of triceps-associated complications following elbow procedures. The purpose of this study is to describe the three-dimensional footprint of the triceps brachii at its olecranon insertion at the elbow. Methods: 22 cadaveric elbows were dissected leaving only the distal insertion of the triceps intact. The insertion was defined and probed with a three-dimensional digitizer to create a digital three-dimensional footprint allowing width, height, and surface area of the footprint to be recorded relative to the bare area. The insertional soft tissues of tendon versus muscle along with the shape of the footprints were qualitatively described. Results: The mean width and surface area of the lateral segment was greater in males than in females (30.07 mm vs. 24.37 mm, p = 0.0339 and 282.1 mm vs. 211. 56 mm, p = 0.0181, respectively). No other statistically significant differences between the sexes were noted. The triceps insertional footprint was "crescent-shaped" and consisted of three regions: central tendon, medial muscular extension, and lateral muscular extension. Discussion: These findings can help explain the importance of avoiding these muscular structures during triceps-off approaches and provides the framework for future clinical studies. Clinical Relevance: Basic Science, anatomy study, cadaver dissection.

Radiocapitellar arthroplasty.

This article sets out the evidence demonstrating that the clinical need for a prosthetic arthroplasty designed specifically for the radiocapitellar joint has been underestimated. The prevalence of radiocapitellar degenerative change requiring treatment is discussed and the relationship between 'isolated' radiocapitellar joint arthritis and more generalised elbow arthritis is explained. Current literature now supports our view that radiocapitellar joint arthroplasty is not only an effective long-term solution for patients with localised radiocapitellar arthritis but also for those patients with more severe degenerative changes involving the elbow joint irrespective of their cause. We consider that is important to avoid resection of the radial head and therefore that resurfacing implants rather than joint replacement implants are more likely to provide a good longterm outcome for patients with elbow arthritis.

Total elbow replacement - patient selection and perspectives.

Total joint replacements for elbow arthritis were developed in the late 1960s at the same time as total joint replacements for knee joint arthritis. Since then, there has been a continuing annual increase in the number of patients treated with total knee joint replacement for arthritis, in line with replacement arthroplasty of the other major limb joints, but in contrast to total elbow joint replacement which is falling, since reaching a peak in the 1990s. Which raises the question, why? Continuing controversy about implant design, the relatively high reported complication rates associated with total elbow replacement (TER) and the difficulties encountered in revision surgery are identified as reasons together with changes in the patient population currently treated with TER. The purpose of this review is to explore the reasons for this in the context of the patient population requiring implant surgery for elbow arthritis and our current perspective of elbow pathology requiring treatment. This is not a systematic review of the whole of the literature concerning total elbow joint replacement arthroplasty but is drawn largely from the supporting literature that reflects my own clinical experience and illustrated with teaching materials I have commissioned together with radiographs and intraoperative photographs of patients I have treated.

Total elbow joint replacement for fractures in the elderly--Functional and radiological outcomes.

AIM: The purpose of this paper was to review the literature on the treatment of intra-articular fractures of the distal humerus in the elderly in order to evaluate the place for total elbow replacement (TER) in the light of our experience over the past 15 years. METHODS: A review of the records of 11 consecutive patients over the age of 60 years who underwent primary TER for comminuted fractures of the distal humerus between 1997 and 2011 were reviewed and the surviving patients were interviewed. The Scopus database was used to perform a pragmatic review of the literature published between the mid-1990s and the present-day. RESULTS: At the time of the most recent follow-up 3.5 years following surgery (range: 2-6 years) 7 patients assessed with the Mayo elbow performance index were classified as excellent, 4 were classified as good. There were no complications requiring further procedures encountered. Five surviving patients remain satisfied with the function of their TER. The number of papers recommending TER for treatment of these fractures continues to increase with time. CONCLUSIONS: TER is now the treatment of choice for unreconstructable fractures of the distal humerus in the elderly. This option should therefore be available at the time of surgery for all distal humeral fractures in this patient population. A surgical approach other than olecranon osteotomy, which would preclude TER is therefore required.

Mechanism of loosening of the Souter-Strathclyde total elbow replacement evidence from revision surgery.

Nine Souter-Strathclyde humeral and ulnar components retrieved from revision surgery for aseptic loosening were examined macro- and microscopically. The wear patterns were compared and photographed. Humeral components demonstrated no evidence of wear. All ulnar components exhibited similar wear patterns. Six of the nine exhibited macroscopic evidence taking the form of deep linear grooves on either the medial or lateral articulating surfaces. Microscopic examinations revealed wear on all nine, exhibited as disruption of the polyethylene machining lines on the articular surfaces, but almost complete preservation on the central gliding ridge. We believe our observations are explained by 'rocking' of the humeral component on the ulnar as a result of the congruent surfaces of the Souter-Strathclyde prosthesis, which resist rotational and translational movements, characteristic of the normal elbow.

Lateral compartment cartilage changes and lateral elbow pain.

The aim of our study is to document the arthroscopic findings in resistant lateral elbow pain. We have reviewed the findings in a consecutive series of 117 elbow arthroscopies performed on patients with lateral elbow pain resistant to conservative treatment. We found established degenerative changes involving articular cartilage in 68 patients (59%). In 60 of these 68 patients (88%) the degenerative changes were confined to the lateral compartment and contrasted with a normal appearance of the articular cartilage of the medial compartment. Primary lateral compartment arthritis is more common than previously thought, it mostly affects a young population and could easily be misdiagnosed as lateral epicondylitis.