The role of the joint capsule in the stability of the elbow joint.

Existing studies lack a clear understanding of the interaction of the joint capsule with surrounding tissues and the local mechanical environment. Particularly, a finite element model of human elbow joint incorporating active behavior of muscle was constructed. The simulation was performed during the elbow joint flexion movement under different injury conditions of capsule (anterior capsule, posterior capsule, medial anterior capsule, lateral anterior capsule, medial posterior capsule, and lateral posterior capsule). The stress distribution and transfer of the joint capsule, ulnar cartilage, and ligaments were obtained under different injuries and flexion angles, to explore the influence of capsule injures on the stability of the elbow joint. In medial injury posterior capsule, the peak stress of the ulnar cartilage occurred at 60° flexion and shifted from posteromedial to anteromedial. And the stress was about 1.8 times that of no injury capsule. In several cases of posterior capsule injury, the stress of capsule decreased significantly and the peak stress was 40% of that in no injury joint capsule. In the case of anterior capsular injury, the cartilage stress did not change significantly, and the stress of anterior bundle and annular ligament changed slightly in the late flexion movement. These findings provide some help for doctors to treat elbow injury and understand the interaction of tissues around the joint after trauma.

Multiple Cantilever K-wiring Technique for Severely Comminuted Articular Fragments in Neglected Distal Humerus Fracture with Anterior Elbow Dislocation: A Case Report.

Introduction: Anterior dislocation of the elbow is comparatively less frequent and is often associated with fractures of the distal humerus. Such injuries require surgical intervention at the earliest but with the surge of COVID-19 pandemic and different protocols being followed by surgeons, such cases are getting neglected. We present a 5-week-old neglected anterior dislocation of the right elbow joint with lateral condyle and medial epicondyle humerus fracture and a unique cantilever K-wiring technique used for its treatment. Case Presentation: A 30-year-old man presented with pain, deformity, and limited range of movement of his right elbow joint and a non-healing wound over the olecranon after he had a road traffic accident 5 weeks back. The patient had been initially treated in a local hospital where he tested positive for COVID-19 and was managed conservatively. Radiographs revealed lateral condyle and medial epicondyle humerus fracture and an unreduced anterior dislocation of the right elbow joint. Conclusion: Neglected fracture-dislocation of the elbow is challenging and is further complicated by comminuted fragments with loss of bone stock. A unique use of multiple Kirschner wires in a cantilever fashion provides a good fixation alternative for such cases.

Pediatric anterior elbow dislocation due to a rare mechanism of injury: A case report.

INTRODUCTION & IMPORTANCE: Elbow dislocations are rare among the pediatric population as their ligaments are stronger than bones. Anterior dislocations of the elbow are even rarer entity usually caused by anteriorly directed force on the hyper-flexed elbow. We present a case of a rotational force on an extended elbow causing anterior dislocation of the shoulder in an 11-year-old boy. CASE PRESENTATION: An 11-year-old boy presented to the Accident & Trauma unit with pain & swelling of the right elbow following a twisting injury by a spinning washing machine. The child was in pain. CLINICAL DISCUSSION: His elbow was semi flexed and deformed. Distal neurovascular status was found normal. Radiographs of the right elbow revealed anteromedial dislocation of the elbow with the medial epicondyle avulsion. Emergent relocation of the elbow joint has been performed. A concentric reduction, absence of incarcerated bony fragments and stability has been confirmed by the fluoroscopic examination. Post reduction neurovascular examinations unremarkable. The child was discharged with the above-elbow splint. The range of motion exercises has been commenced after three weeks. The child achieved full range of motion at six weeks of post-injury. CONCLUSION: Anterior dislocations are a rare entity in pediatric orthopaedic practice. Evaluation of the causative mechanism of injury is the clue. A rare type of mechanism of injury also should be kept in mind to prevent the delay in diagnosis and treatment.

An Unusual Case of Anterior Elbow Dislocation Without Bony Injury.

While elbow dislocation is a common occurrence, the vast majority of them dislocate posteriorly and are due to disruption of the elbow stabilizers, which start on the lateral side and proceed medially, disrupting the anterior and posterior stabilizing structures. We present an unusual case of anterior elbow dislocation, with disruption of the medial stabilizing structures and anterior capsule, without any bony injury. A 44-year-old man presented to the ED after being assaulted. While the exact mechanism of injury was unclear, the patient believes he had been struck with a heavy object on the posterior aspect of his elbow. His dislocation was reduced in the ED, but was highly unstable after reduction. Further imaging revealed disruption of his medial collateral ligaments and common flexor origin. He went on to have an open repair of his medial structures with suture anchors. After six weeks of follow-up he was doing well, with no further episodes of instability and a good functional range of movement. Though rare, anterior elbow dislocations have been reported sporadically in the literature. Surgeons and ED doctors dealing with these injuries should be aware that the maneuvers to relocate the elbow will be different compared to the standard maneuvers used for posterior dislocations. Patients should be examined for stability after reduction, especially on valgus stressing. We would advocate for low threshold for performing an examination under anesthesia (EUA), with open repair of the stabilizing structures if persistently unstable after reduction.

Trauma or tumour: giant cell tumour of distal biceps tendon sheath, an unusual cause of elbow pain.

We report the case of a middle-age lady who presented following minor trauma, with dominant-sided anterior elbow pain and swelling of 6 months in duration. She was assessed clinically, and underwent investigations, which confirmed features consistent with giant cell tumour (GCT) of distal biceps tendon sheath. She underwent uneventful en-bloc excisional surgery. She did not have radiotherapy. She is now 5 years postoperatively asymptomatic, with full function, and with no signs of recurrence.

Anterior Dislocation of Elbow with Neurovascular Injury: A Rare Case Report.

INTRODUCTION: Anterior elbow dislocation is an infrequent lesion, produced by direct trauma to the proximal ulna after a fall on the elbow in flexion and injury to the neurovascular bundle is not infrequent. Authors report a case of acute anterior dislocation of the elbow joint with neurovascular injury. CASE REPORT: A 30-year-old male admitted with a history of accidental fall followed by pain, swelling over his left elbow. Clinical, radiological, Doppler investigations revealed anterior dislocation of the elbow with brachial artery injury with posterior interosseous nerve palsy without any bony injury. Immediate closed reduction, primary vascular repair with fasciotomy was done following which elbow function improved. CONCLUSION: Anterior dislocations of elbow joint are among the rarest of injuries. Because the dislocation is anterior, injury to nerve and vessel can occur frequently. Therefore, a careful assessment for neurovascular injury mandatory. Early proper reduction and management of neurovascular injury if any is necessary for good elbow function.

Lateral elbow approach combined with anterior median approach in treatment of terrible triad of elbow / 局解手术学杂志

Objective To analyze the clinical efficacy of lateral elbow approach combined with anterior median approach in the treatment of terrible triad of elbow.Methods Retrospectively analyzed 20 patients of terrible triad elbow who were admitted into our hospital from April 2012 to January 2015 and treated with lateral elbow approach combined with anterior median approach.The postoperative recovery of arthrosis,forearm rotation range,and range of motion were evaluated by Mayo score system.Results All patients wounds were with primary healing.There were 11 cases of excellent and 4 cases of good through Mayo score system,with the good rate of 75％.At the final follow-up,the range of motion was (122.06 ± 24.17) ° and the forearm rotation was (136.28 ± 8.9) °.Conclusion Lateral elbow approach combined with anterior median approach for the treatment of terrible triad of elbow has clear visual field,excellent surgical rate,without complications such as elbow instability and nerve damage.

Partial Tears of the Distal Biceps Brachii Tendon: A Systematic Review of Surgical Outcomes.

PURPOSE: To systematically review the literature regarding surgical outcomes for treatment of partial tears of the distal biceps brachii tendon. METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A systematic review of the literature regarding treatment of partial tears of the distal biceps tendon was conducted using PubMed, Embase, and Cochrane. Inclusion criteria consisted of studies in the English language on the treatment of partial distal biceps tendon tears. Exclusion criteria consisted of (1) studies without outcome data, (2) studies that did not specify the degree of distal biceps tendon tear (ie, complete rupture vs partial tear), and (3) studies without partial tear subgroup data. Two investigators independently reviewed the abstracts from all identified articles. RESULTS: Only 5 patients who underwent successful nonsurgical treatment were identified; all were treated with different algorithms, and because of the small number, outcomes for nonsurgical treatment are not included in this review. Therefore, 19 studies involving 86 partial tears that underwent surgical treatment are reported; at least 65 of these received a trial of nonsurgical treatment before surgery. Surgery resulted in 94% satisfactory clinical outcomes. Of the 16 studies (n = 83) that specified the presence or absence of surgical complications, lateral antebrachial cutaneous nerve paresthesia (17%), posterior interosseous nerve palsy (6%), elbow discomfort (2%), surgical revision (2%), and asymptomatic heterotopic ossification (1%) were reported. CONCLUSIONS: Surgical treatment including tendon tear completion and anatomic repair to the radial tuberosity can yield satisfactory results and appears to provide predictable outcomes. Further research is necessary to better define the optimal regimen and duration of nonsurgical treatment, as well as the indications for surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Early results of anterior elbow release with and without biceps lengthening in patients with cerebral palsy.

PURPOSE: To investigate the effect of partial biceps lengthening on elbow flexion posture and active elbow flexion and extension in patients with cerebral palsy. METHODS: We retrospectively reviewed 29 patients with cerebral palsy who underwent anterior elbow release as part of multilevel upper extremity surgery. The early series of the patients (N = 14; group 1) had lacertus fibrosus division, brachialis fractional lengthening, and denuding of the pretendinous adventitia off the biceps tendon. The later series of patients (N = 15; group 2) had partial biceps tendon lengthening in addition to the procedures in group 1. We compared the 2 sets of patients for elbow flexion posture, active elbow flexion and extension, forearm rotation, and House scores, with mean follow-ups of 72 months for group 1 and 31 months for group 2. RESULTS: The 2 groups were comparable in terms of mean age, number of procedures, and preoperative House scores. Group 2 patients had more improvement in flexion posture (53° vs. 44°) and active extension (23° vs. 15°) than group 1 postoperatively. However, group 2 had a mean decrease of 7° in active elbow flexion, whereas group 1 had no changes. There was no difference in forearm supination or in the improvement of House scores between groups. CONCLUSIONS: Early results of partial lengthening of the biceps tendon showed that it may improve elbow flexion posture and active elbow extension in patients with flexion deformity in cerebral palsy. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.