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Orthopaedics & Traumatology, Surgery &... Feb 2021Terrible triad of the elbow associates posterior dislocation, radial head fracture and coronoid process fracture. It is a complex trauma, associating severe bone and... (Review)
Review
Terrible triad of the elbow associates posterior dislocation, radial head fracture and coronoid process fracture. It is a complex trauma, associating severe bone and ligament lesions, with high more-or-less long-term risk of residual instability, stiffness, pain and osteoarthritis. During the last 20 years, pathologic, biomechanical and clinical knowledge has greatly progressed. Prevention of these severe complications requires initial understanding of the lesion mechanism and precise analysis of all lesions. Surgery aims to restore perfect stability by sequential anatomic repair, enabling early mobilization to prevent onset of stiffness. The aims of the present paper were to summarize the anatomic and pathophysiological bases, highlight the crucial importance of the humeroradial column and lateral collateral ligament, and to determine the importance of the coronoid process. Some aspects of treatment are controversial: systematic medial collateral ligament repair, or use of an articulated external fixator. Finally, we propose a simple algorithm to guide repair.
Topics: Elbow; Elbow Joint; Fracture Fixation, Internal; Humans; Joint Dislocations; Radius Fractures; Range of Motion, Articular; Treatment Outcome; Ulna Fractures
PubMed: 33333276
DOI: 10.1016/j.otsr.2020.102784 -
Journal of Orthopaedics and... Mar 2019The radial head plays a critical role in the stability of the elbow joint and its range of motion. Injuries may occur across a spectrum of severity, ranging from low... (Review)
Review
The radial head plays a critical role in the stability of the elbow joint and its range of motion. Injuries may occur across a spectrum of severity, ranging from low energy non-displaced fractures to high energy comminuted fractures. Multiple classification systems exist to help characterize radial head fractures and their associated injuries, as well as to guide treatment strategies. Depending on the type of fracture, non-operative management may be possible if early range of motion is initiated. Other options include open reduction and internal fixation or excision followed by arthroplasty. A lateral approach is typically used for adequate surgical exposure. Controversy still remains regarding operative management of more severe fractures, but studies have shown good outcomes after radial head replacement for these fractures. We will review the current treatments available for radial head fractures, highlighting gaps in knowledge, as well as providing recommendations for the care of these injuries.Level of evidence: Level V.
Topics: Elbow Joint; Fracture Fixation, Internal; Fractures, Comminuted; Humans; Radius Fractures; Range of Motion, Articular; Treatment Outcome; Elbow Injuries
PubMed: 30904970
DOI: 10.1186/s10195-019-0523-5 -
Journal of Orthopaedic Surgery and... Sep 2021Distal humerus fractures (DHFs) constitute one-third of elbow fractures approximately. In this study, we aim to define and analyze the fracture lines and morphological...
BACKGROUND
Distal humerus fractures (DHFs) constitute one-third of elbow fractures approximately. In this study, we aim to define and analyze the fracture lines and morphological features of DHFs using mapping technique.
METHODS
One hundred and two DHFs were retrospectively reviewed. All the computed tomography (CT) data were used to manually reconstruct and virtually reduce the DHF fragments to fit a standard 3D model. Smooth curves were depicted accurately onto the surface of the template to represent the fracture lines. All the curves were overlapped onto the model to create the 3D fracture map and heat map.
RESULTS
Our analysis was based on 102 CT images of DHFs, contributed by 59 male and 43 female patients (mean age, 46 years; range, 18-93 years), and included 15 type A, 25 type B, and 62 type C fractures. On mapping, the hot zones were located in the radial fossa, coronoid fossa, olecranon fossa, and the external part of the trochlear. Conversely, the cold zones were noted in medial condyle, the medial side of the trochlear, and the anterolateral area on the supracondylar ridge.
CONCLUSIONS
Our study firstly shows the fracture lines and morphological features of distal humeral fractures by three-dimensional mapping technology. Distal humerus fracture lines are characteristic and highly related to the micro-architecture difference of distal humerus, which may provide some guidance for the treatment plan selection and surgical fixation design.
Topics: Elbow Joint; Epiphyses; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Humeral Fractures; Humerus; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 34479569
DOI: 10.1186/s13018-021-02691-0 -
Current Reviews in Musculoskeletal... Mar 2019The purposes of this review are to discuss the management of shoulder and elbow fractures in athletes to optimize the return to sport and to highlight treatment impact... (Review)
Review
PURPOSE OF REVIEW
The purposes of this review are to discuss the management of shoulder and elbow fractures in athletes to optimize the return to sport and to highlight treatment impact on the return to play.
RECENT FINDINGS
Fractures of the shoulder and elbow can have profound implications in an athlete career. Recent technique of fractures management trended toward to preserve soft tissue which is critical for an early recovery in athletic population. Arthroscopy presents a strong interest for the treatment of intra-articular fracture, and minimally invasive approach as developed in humeral shaft fracture can be considered to avoid soft tissue damage. Non-articular, stable, and minimally displaced fractures are mainly treated conservatively. However, we encourage a more aggressive approach in shoulder and elbow injuries in the athletes including minimally invasive and stable fixation to preserve vascularity and muscle environment.
PubMed: 30706285
DOI: 10.1007/s12178-019-09530-0 -
Clinical Orthopaedics and Related... Jul 2014
Topics: Biomechanical Phenomena; Elbow Joint; Forearm Injuries; Humans; Joint Instability; Orthopedic Procedures; Radius Fractures; Range of Motion, Articular; Recovery of Function; Treatment Outcome; Elbow Injuries
PubMed: 24711132
DOI: 10.1007/s11999-014-3599-5 -
Acta Bio-medica : Atenei Parmensis Jan 2018The correct management of acute, subacute and overuse-related elbow pathologies represents a challenging diagnostic and therapeutic problem. While major trauma... (Review)
Review
The correct management of acute, subacute and overuse-related elbow pathologies represents a challenging diagnostic and therapeutic problem. While major trauma frequently requires a rapid surgical intervention, subluxation and minor trauma allow taking more time for diagnostics and planning the correct elective treatment after careful clinical and radiological investigation. In these conditions, communication between orthopaedic surgeon and radiologist allow to create a detailed radiology report, tailored to the patient's and surgeon's needs and optimal to plan proper management. Imaging technique as X-Ray, CT, US, MRI, CTA and MRA all belong to the radiologist's portfolio in elbow diagnostics. Detailed knowledge of elbow pathology and its classification and of the possibilities and limits of each imaging technique is of crucial importance to reach the correct diagnosis efficiently. The aim of this review is to present the most frequent elbow pathologies and suggest a suitable diagnostic approach for each of them.
Topics: Cumulative Trauma Disorders; Diagnostic Imaging; Elbow Joint; Fractures, Bone; Humans; Joint Dislocations; Joint Instability; Tennis Elbow; Elbow Injuries
PubMed: 29350642
DOI: 10.23750/abm.v89i1-S.7016 -
Orthopaedics & Traumatology, Surgery &... Feb 2023Elbow fracture is frequent in children, and often requires surgery. There are many potential sequelae: neurovascular, ligamentous and osseous. Some are liable to be... (Review)
Review
Elbow fracture is frequent in children, and often requires surgery. There are many potential sequelae: neurovascular, ligamentous and osseous. Some are liable to be overlooked, due to young age and the cartilaginous nature of the joint. There is little bone remodeling in the elbow and displacement fracture, and especially supracondylar or lateral condyle fracture, has to be corrected rigorously, notably in older children. In case of lateral tilt in fracture of the neck of the radial head, on the other hand, remodeling is effective. Deformity in cubitus varus and cubitus valgus leads to neurological lesions and instability. Treatment should be early, with adapted surgery in expert hands. Post-traumatic stiffness is rare. Early intensive physiotherapy is unsuited to children and could worsen the stiffness due to inflammation. Lateral condyle non-union is a classic complication of fracture. Simple percutaneous screwing is a useful option. The equivalent in the medial epicondyle is well-tolerated, and simple monitoring now suffices. Late posterolateral rotational instability is a poorly known complication. It should be considered in case of cubitus varus that becomes painful after a long asymptomatic course. Radiocapitellar subluxation is seen on X-ray. Residual radial head dislocation after primary treatment (Monteggia lesion) responds well to the Bouyala technique of ulnar flexion osteotomy associated to annular ligament repair, without requiring ligament reconstruction.
Topics: Child; Humans; Elbow Fractures; Fractures, Bone; Elbow Joint; Ulna; Joint Dislocations
PubMed: 36302449
DOI: 10.1016/j.otsr.2022.103454