Objective To explore the effectiveness of computer-aided technology in the treatment of primary elbow osteoarthritis combined with stiffness under arthroscopy. Methods The clinical data of 32 patients with primary elbow osteoarthritis combined with stiffness between June 2018 and December 2020 were retrospectively analyzed. There were 22 males and 10 females with an average age of 53.4 years (range, 31-71 years). X-ray film and three-dimensional CT examinations showed osteophytes of varying degrees in the elbow joint. Loose bodies existed in 16 cases, and there were 7 cases combined with ulnar nerve entrapment syndrome. The median symptom duration was 2.5 years (range, 3 months to 22.5 years). The location of bone impingement from 0° extension to 140° flexion of the elbow joint was simulated by computer-aided technology before operation and a three-dimensional printed model was used to visualize the amount and scope of impinging osteophytes removal from the anterior and posterior elbow joint to accurately guide the operation. Meanwhile, the effect of elbow joint release and impinging osteophytes removal was examined visually under arthroscopy. The visual analogue scale (VAS) score, Mayo elbow performance score (MEPS), and elbow range of motion (extension, flexion, extension and flexion) were compared between before and after operation to evaluate elbow function. Results The mean operation time was 108 minutes (range, 50-160 minutes). All 32 patients were followed up 9-18 months with an average of 12.5 months. There was no other complication such as infection, nervous system injury, joint cavity effusion, and heterotopic ossification, except 2 cases with postoperative joint contracture at 3 weeks after operation due to the failure to persist in regular functional exercises. Loose bodies of elbow and impinging osteophytes were removed completely for all patients, and functional recovery was satisfactory. At last follow-up, VAS score, MEPS score, extension, flexion, flexion and extension range of motion significantly improved when compared with preoperative ones (P<0.05). Conclusion Arthroscopic treatment of primary elbow osteoarthritis combined with stiffness using computer-aided technology can significantly reduce pain, achieve satisfactory functional recovery and reliable effectiveness.
Objective To review the injury mechanism and the treatment progress of terrible triad of the elbow, and to analyze the direction of further research. Methods Related literature concerning terrible triad of the elbow was extensively reviewed and comprehensively analyzed. Results The main treatment of terrible triad of the elbow is operation. The ultimate goal of treatment is to reconstruct sufficient stability of the elbow. The treatment includes fixation of the coronoid by suture, screw or plate; fixation of radial head by screw and plate, partial or complete replacement of the radial head; fixation of lateral collateral ligament and the medial collateral ligament by bone suture or anchors and the application of the external fixator. These surgical treatments have their own indications and advantages, most get satisfactory results. Conclusion Generally, surgery is needed to maintain the stability of the elbow for patients of terrible triad elbow. However, medial ligament repair or not, the choice of approach, and mechanism of injury still need further study.
【Abstract】 Objective To research the method and effectiveness of V-Y advancement of skin flap pedicled with the upper limb lateral branch in the treatment of small skin defect in the dorsal elbow. Methods Between March 2008 and August 2010, 6 cases of skin defect in the dorsal elbow were treated by V-Y advancement of skin flap pedicled with the upper limb lateral branch, including 4 males and 2 females with a mean age of 53 years (range, 16-76 years). Defects were caused by crushing in 3 cases, by punching in 2 cases, and the disease duration was 4 hours 30 minutes to 7 days (mean, 29.5 hours); and by chronic infection in 1 case, and the disease duration was 12 months. The defect size ranged from 4.0 cm × 2.5 cm to 9.5 cm × 3.5 cm, all complicating by bone or tendon exposure. The flap size ranged from 6.0 cm × 4.0 cm to 12.5 cm × 9.5 cm; the donor sites were sutured directly. Results All flaps survived completely, wounds and incisions at donor sites healed by first intention. Six cases were followed up 6-12 months after operation. The flaps had good texture and color. Two-point discrimination of the skin flap was 12-16 mm. The function of limb was normal, and elbow flexion and extension activity averaged 105° (range, 95-125°). Conclusion It is ideal to treat small skin defect in the dorsal elbow with V-Y advancement of skin flap pedicled with the upper limb lateral branch because of easier operation and less injury at donor site.
ObjectiveTo compare the effectiveness of transosseous tunnel fixation and drilling fixation for repair of lateral collateral ligament complex (LCLC) in treatment of terrible triad of elbow (TTE).MethodsA clinical data of 50 patients with TTE between June 2012 and January 2018 were retrospectively analyzed. The LCLC was repaired with transosseous tunnel fixation in 22 patients (transosseous tunnel fixation group) and with drilling fixation in 28 patients (drilling fixation group). There was no significant difference between the two groups (P>0.05) in gender, age, fracture side, time from injury to admission, coronoid process fracture classification, radial head fracture classification, and TTE classification. The operation time, intraoperative blood loss, fracture healing time, and complications of the two groups were recorded. At last follow-up, the Mayo elbow performance system (MEPS) score, range of motion of elbow joint, and Broberg-Morrey classification were recorded.ResultsThe operation of two groups were successfully completed. There was no significant difference in the operation time and intraoperative blood loss between the two group (P>0.05). The follow-up time was (24.43±6.84) months in the transosseous tunnel fixation group and (21.55±6.16) months in the drilling fixation group, and the difference was not significant (t=1.534, P=0.132). X-ray films showed that the coronoid process and radial head fractures in the two groups healed, and there was no significant difference in the healing time (P>0.05). At last follow-up, there was no significant difference in the flexion-extension activity, rotation activity, MEPS score, and Broberg-Morrey grading (P>0.05). During the follow-up, there was no re-dislocation or instability of the elbow joint. The incidence of complication was 28.57% (8/28) in the transosseous tunnel fixation group and 27.27% (6/22) in the drilling fixation group, showing no significant difference (χ2=2.403, P=0.121).ConclusionBoth transosseous tunnel fixation and drilling fixation can achieve good results in repair of LCLC for TTE.
ObjectiveTo explore the clinical significance of anterior median approach combined with lateral approach to the elbow joint in the treatment of terrible triad of the elbow.MethodsWe retrospectively collected the data of 63 cases who used the anterior median approach of the elbow joint combined with the lateral approach (group A, n=36) or the medial and lateral approach of the elbow (group B, n=27) in the treatment of terrible triad of the elbow between March 2014 and July 2019. The operation time, postoperative complications, and postoperative Mayo score of the elbow were compared between the two surgical approaches.ResultsThe operation time of group A and group B was (93.78±7.78) and (106.93±10.35) min, respectively, and the difference was statistically significant (P<0.05). The patients in both groups completed operations successfully, without vascular or nerve injury. All the wounds healed by first intention. No redislocation or reoperation occurred. Ten months after operation, there was no significant difference in the excellence rate of Mayo score of the elbow (83.3% vs. 85.2%) or postoperative complication rate (16.7% vs. 14.8%) between the two groups (P>0.05).ConclusionThe anterior median approach of the elbow joint combined with the lateral approach and the medial and lateral elbow approach for the treatment of terrible triad of the elbow are equivalent to the postoperative elbow function recovery. The operation time of the former is shorter than that of the latter, and the anterior approach reveals the coronal process intuitively and sufficiently. In the case that there is no medial ligament injury, the anterior median approach of the elbow joint combined with the lateral approach can be preferred.
ObjectiveTo investigate the short-term effectiveness of free radial head reconstruction of coronoid process, artificial radial head replacement, and ulna olecranon internal fixation in the treatment of the complex terrible triad of the elbow.MethodsRetrospective analysis was made on the clinical data of 12 patients with complex terrible triad of the elbow treated with free radial head reconstruction of coronoid process, artificial radial head replacement, and ulna olecranon internal fixation between April 2011 and April 2018. There were 8 males and 4 females with an average age of 44.5 years (range, 26-62 years). The causes of injury included 5 cases of traffic accident, 7 cases of falling from hight. The Regan-Morrey classification of ulnar coronoid process fractures was type Ⅲ; Mason classification of radial head fractures was type Ⅲ in 7 cases and type Ⅳ in 5 cases. The time from injury to operation was 5-14 days, with an average of 6.0 days. The operation time, intraoperative blood loss, and complications were recorded. After operation, X-ray film of elbow joint was reexamined, fracture healing condition was observed, and fracture healing time was recorded. The flexion, extension, and rotation of the elbow joints on the healthy and affected sides were recorded and measured. The elbow function was evaluated according to Mayo elbow function score.ResultsThe operation time was 90-140 minutes (mean, 110 minutes); the intraoperative blood loss was 100-300 mL (mean, 150 mL). None of the patients had vascular injury during the operation. One patient developed numbness in the ulnar nerve innervation area and recovered completely after symptomatic treatment for 1 week. All the 12 patients were followed up 12-22 months, with an average of 16 months. At last follow-up, the fracture healed completely, 1 patient developed ectopic ossification of elbow joint, and 2 patients developed traumatic arthritis of elbow joint. No internal fixation-related complications occurred. There was no significant difference in the range of motion of elbow flexion, extension, pronation, and supination between the affected and healthy sides (P>0.05). The median Mayo elbow function score was 96, and the interquartile range was (94, 97), and the excellent and good rate was 91.7%.ConclusionFor patients with complex terrible triad of the elbow with ulna coronoid process fractures of Regan-Morrey type Ⅲ and radial head fractures of Mason type Ⅲ, Ⅳ combined with ulna olecranon fractures, the free radial head reconstruction, artificial radial head replacement, and ulna olecranon internal fixation, through active rehabilitation function exercise after operation, can achieve more satisfactory short-term effectiveness.
Three-dimensional finite element model of elbow was established to study the effect of medial collateral ligament (MCL) in maintaining the stability of elbow joint. In the present study a three-dimensional geometric model of elbow joint was established by reverse engineering method based on the computed tomography (CT) image of healthy human elbow. In the finite element pre-processing software, the ligament and articular cartilage were constructed according to the anatomical structure, and the materials and contacts properties were given to the model. In the neutral forearm rotation position and 0° flexion angle, by comparing the simulation data of the elbow joint with the experimental data, the validity of the model is verified. The stress value and stress distribution of medial collateral ligaments were calculated at the flexion angles of elbow position in 15°, 30°, 45°, 60°, 75°, 90°, 105°, 120°, 135°, respectively. The result shows that when the elbow joint loaded at different flexion angles, the anterior bundle has the largest stress, followed by the posterior bundle, transverse bundle has the least, and the stress value of transverse bundle is trending to 0. Therefore, the anterior bundle plays leading role in maintaining the stability of the elbow, the posterior bundle plays supplementary role, and the transverse bundle does little. Furthermore, the present study will provide theoretical basis for clinical recognizing and therapy of elbow instability caused by medial collateral ligament injury.
Objective To analyze the effectiveness of binocular loupe assisted mini-lateral and medial incisions in lateral position for the release of elbow stiffness. Methods The clinical data of 16 patients with elbow stiffness treated with binocular loupe assisted mini-internal and external incisions in lateral position release between January 2021 and December 2022 were retrospectively analyzed. There were 9 males and 7 females, aged from 19 to 57 years, with a median age of 33.5 years. Etiologies included olecranon fracture in 6 cases, elbow dislocation in 4 cases, medial epicondyle fracture in 2 cases, radial head fracture in 4 cases, terrible triad of elbow joint in 2 cases, supracondylar fracture of humerus in 1 case, coronoid process fracture of ulna in 1 case, and humerus fracture in 1 case, with 5 cases presenting a combination of two etiologies. The duration of symptoms ranged from 5 to 60 months, with a median of 8 months. Preoperatively, 12 cases had concomitant ulnar nerve numbness, and 6 cases exhibited ectopic ossification. The preoperative range of motion for elbow flexion and extension was (58.63±22.30)°, the visual analogue scale (VAS) score was 4.3±1.6, and the Mayo score was 71.9±7.5. Incision lengths for both lateral and medial approaches were recorded, as well as the occurrence of complications. Clinical outcomes were evaluated using Mayo scores, VAS scores, and elbow range of motion both preoperatively and postoperatively. Results The lateral incision lengths for all patients ranged from 3.0 to 4.8 cm, with an average of 4.1 cm. The medial incision lengths ranged from 2.4 to 4.2 cm, with an average of 3.0 cm. The follow-up duration ranged from 6 to 19 months and a mean of 9.2 months. At last follow-up, 1 patient reported moderate elbow joint pain, and 3 cases exhibited residual mild ulnar nerve numbness. The other patients had no complications such as new heterotopic ossification and ulnar nerve paralysis, which hindered the movement of elbow joint. At last follow-up, the elbow range of motion was (130.44±9.75)°, the VAS score was 1.1±1.0, and the Mayo score was 99.1±3.8, which significantly improved when compared to the preoperative ones (t=−12.418, P<0.001; t=6.419, P<0.001; t=−13.330, P<0.001). ConclusionThe binocular loupe assisted mini-lateral and medial incisions in lateral position integrated the advantages of traditional open and arthroscopic technique, which demonstrated satisfying safety and effectivity for the release of elbow contracture, but it is not indicated for patients with posterior medial heterolateral heterotopic ossification.
Objective To analyse short-term cl inical effect of total elbow arthroplasty in treatment of distal comminuted humeral fracture with serious osteoporosis in geratic patients. Methods From April 2006 to October 2007, five cases of distal comminuted humeral fractures were treated by total elbow arthroplasty with bone cement. Of them, there were 2 males and 3 females, aging 50-76 years old (mean 67.6 years old), including 4 cases of closed fracture and 1 case of open fracture (II type Gustilo-Anderson). All fractures were caused by tumbl ing. According to classification of AO, there were 2 cases of type C1, 2 cases of type C2 and 1 case of type C3. The Barnett index of osteoporosis was 0.40-0.45. The time from injury to operation was 4 to 18 days (mean 7.2 days). The rehabil itation exercise of function was done after 2 days of operation. Results The operative time was from 120 to 180 minutes (mean 150 minutes), the bleeding amount was from 150 to 250 mL (mean 200 mL). All incision achieved primary heal ing. No compl ication occurred. Five cases were followed up for 19 to 36 months (mean 24.5 months). The mean motion range of elbow joint include 141.6° for flection, 6.5° for extention, 10.2° for the degree of ectropion, 81.7° for revolve forward, and 73.8° for revolve behind respectively after 4 months of operation. The length discrepancy of upper l imb was less than 1.5 cm, the muscle force for flexion and extention of finger and wrist was normal. The X-ray films showed that the position of artificial joint was satisfactory without prosthesis dislocation or loosening. According to Mayo elbow performance score, the excellent and good rate was 80% (excellent in 1 case, good in 3 cases, and fair in 1 case). Conclusion Total elbow arthroplasty with bone cement is an effective method in treatment of distal comminuted humeral fracture with serious osteoporosis obviously in the geratic patients, but indication and technique of operation should be mastered strictly.
ObjectiveTo evaluate the effectiveness of internal fixation with headless compression hollow embedding screws in the treatment of intraarticular fracture of elbow.MethodsBetween March 2012 and September 2018, 12 patients with intraarticular fracture of elbow were treated with internal fixation with headless compression hollow embedding screws. There were 7 males and 5 females with an average age of 50.3 years (range, 22-65 years). Cause of injury included falling in 7 cases, falling from high places in 4 cases, and traffic accident in 1 case. Ten patients were distal humerus fractures which were classified as type 13-B3 in 8 cases and type 13-C3 in 2 cases according to the International Association of Internal Fixation Research (AO/ASIF). Two patients were radial head fractures which were classified as type Ⅲ according to the modified Mason classifications. The preoperative visual analogue scale (VAS) score was 8.25±0.83. The time from injury to operation was 3-5 days (mean, 3.7 days).ResultsAll incisions healed by first intention. All 12 patients were followed up 6-15 months, with an average of 8.4 months. The results of X-ray films and CT examination showed that the fracture ends were anatomic reduction, and the fractures healed at 6-11 months after operation, with an average of 7.8 months. One patient had heterotopic ossification at 4 months after operation. The VAS scores were 5.17±0.79 at 2 weeks after operation and 0.50±0.50 at last follow-up. There were significant differences between the time points (P<0.05). At last follow-up, the Mayo elbow function score was 68-95, with an average of 83.9. The activity of elbow joint recovered.ConclusionThe intraarticular fracture of elbow can be firmly fixed by the headless compression hollow embedding screw, which can allow the early functional training of the elbow joint, reduce the incidence of heterotopic ossification, and obtain good effectiveness.