Patient characteristics, fracture types, surgical choices, and cases of instability-related failure constituted elements of the data collection. Initial X-rays were employed by two independent raters to measure, on three separate occasions, the distance between the central points of the radial head and the capitellum. Statistical analysis was used to compare the median displacement of two groups of patients; one requiring collateral ligament repair for stability and the other not.
A study of 16 cases, with ages ranging from 32 to 85 years (mean 57), was conducted. Inter-rater agreement for displacement measurement was assessed using a Pearson correlation coefficient of 0.89. When collateral ligament repair was both indicated and executed, the median displacement measured 1713 mm, with an interquartile range (IQR) of 1043 to 2388 mm. Conversely, where this repair was neither performed nor required, the median displacement was significantly lower at 463 mm (IQR=268-658) (P=.002). Four cases, initially not slated for ligament repair, eventually required it, as dictated by the postoperative and intraoperative imaging and clinical outcomes. Regarding displacement, the middle value was 1559 mm, with a spread (IQR) of 1009-2120 mm; consequently, two required subsequent surgical stabilization.
In the red group, the radiographic evidence of displacement surpassing 10 millimeters on initial images consistently prompted the need for a lateral ulnar collateral ligament (LUCL) repair. Ligament repair was not needed for any instance of a tear beneath 5mm, specifically the green group of patients. For the prevention of posterolateral rotatory instability (amber group), following fracture fixation, the elbow must be carefully scrutinized for instability between 5 and 10 mm, with a low threshold for LUCL repair. These research findings motivate a traffic light system for predicting the need for collateral ligament repair in patients with transolecranon fractures and dislocations.
In all cases (red group) where the initial radiographs showed displacement exceeding 10mm, a lateral ulnar collateral ligament (LUCL) repair was performed. If the ligament's damage measured less than 5 mm, no repair was necessary in all cases (green group). To ensure stability, the elbow, following fracture repair, needs a thorough examination, specifically if its measurement falls between 5 and 10 mm, to prevent posterolateral rotatory instability (amber group) by implementing a low threshold for LUCL repair. These findings lead us to propose a traffic light model for predicting the requirement of collateral ligament repair in transolecranon fractures and dislocations.
The Boyd approach, a single posterior incision technique, targets the proximal radius and ulna, by utilizing the reflection of the lateral anconeous muscle and the release of the lateral collateral ligament complex. Although initially promising, the adoption of this approach has been hampered by early reports of proximal radioulnar synostosis and postoperative elbow instability. Even though restricted to limited case series, the current body of literature offers no support for those early-reported complications. This study investigates the effectiveness of the Boyd approach, as executed by a single surgeon, in treating elbow injuries, from basic to intricate instances.
A retrospective analysis of consecutive elbow injuries, ranging from simple to complex, treated using the Boyd approach by a shoulder and elbow surgeon, was undertaken from 2016 through 2020, following Institutional Review Board approval. Those patients who experienced at least one visit to the postoperative clinic following their surgery were incorporated into the study. Data acquired featured patient profiles, injury descriptions, postoperative issues, elbow range of motion, and radiographic findings, particularly heterotopic ossification and proximal radioulnar synostosis. Descriptive statistical methods were employed to summarize the categorical and continuous variables.
The study involved a total of 44 patients, with an average age of 49 years, ranging in age from 13 to 82. Monteggia fracture-dislocations, accounting for 32% of the most frequently treated injuries, were prevalent alongside terrible triad injuries, which comprised 18% of the cases. Across all cases, the average duration of follow-up was 8 months, with the timeframe fluctuating between 1 and 24 months. In the final assessment, the average active elbow motion exhibited a range from 20 degrees of extension (0-70 degrees) to 124 degrees of flexion (75-150 degrees). The final measurements for supination and pronation were 53 degrees (within a range of 0 to 80 degrees), and 66 degrees (within a range of 0 to 90 degrees), respectively. Cases of proximal radioulnar synostosis did not come to light. Heterotopic ossification, leading to less than functional elbow range of motion, was a factor for two (5%) patients who sought conservative management. A revisionary ligament augmentation procedure was undertaken in one (2%) patient who presented with early postoperative posterolateral instability, directly attributable to a failed repair of injured ligaments. Mediating effect Of the patients who underwent surgery, five (11%) experienced postoperative neuropathy, with four (9%) cases involving ulnar neuropathy. In the group of patients studied, one underwent the surgical intervention of ulnar nerve transposition, and two showed a positive trend in their condition, while one exhibited persistent symptoms during the final follow-up assessment.
The Boyd approach, as demonstrated in this extensive case series, stands as the definitive benchmark for the safe and effective treatment of a spectrum of elbow injuries, from uncomplicated to complex. Itacnosertib datasheet A reassessment of the prevalence of postoperative complications, including synostosis and elbow instability, is potentially warranted.
For elbow injuries, the Boyd approach's safe utilization, detailed in this extensive case series, showcases its effectiveness across simple to intricate problems. Postoperative complications, specifically synostosis and elbow instability, could be less widespread than previously recognized.
Compared to implant total elbow arthroplasty (TEA), elbow interposition arthroplasty is frequently the preferred surgical approach for young patients. However, the comparative study of post-traumatic osteoarthritis (PTOA) and inflammatory arthritis outcomes following interposition arthroplasty is insufficiently explored. In consequence, this study focused on contrasting outcomes and complication rates following interposition arthroplasty procedures performed on patients with both primary and inflammatory types of arthritis.
A systematic review, adhering to PRISMA guidelines, was conducted. Beginning with their initial entries and concluding with December 31, 2021, database queries were performed on PubMed, Embase, and Web of Science. The search process uncovered 189 studies in total, with 122 of those being unique. In the original set of studies, elbow interposition arthroplasty procedures were examined in patients under 65 who had experienced post-traumatic or inflammatory arthritis. Identification of suitable studies led to the selection of six for inclusion.
The query returned 110 elbows, with 85 patients diagnosed with primary osteoarthritis and 25 with inflammatory arthritis. Subsequent to the index procedure, the cumulative complication rate amounted to a remarkable 384%. In contrast to the 117% complication rate seen in patients with inflammatory arthritis, those with PTOA displayed a substantially higher rate of 412%. Furthermore, the aggregate reoperation rate was a remarkable 235%. A 250% reoperation rate was observed in PTOA patients, compared to a 176% rate among inflammatory arthritis patients. The average pain score recorded using the MEPS scale, pre-operatively, was 110, which improved to 263 in the post-operative period. Regarding PTOA pain, the average score before surgery was 43, and 300 afterward. Prior to the surgical procedure, inflammatory arthritis patients experienced a pain score of 0; however, their pain score following the surgery was 45. Preoperative evaluation of MEPS functional scores displayed a mean of 415, subsequently enhancing to 740 post-procedure.
The study's results show that interposition arthroplasty procedures are accompanied by a notable 384% complication rate and a 235% reoperation rate, in conjunction with improvements in pain and function. Patients under 65 years old who are not inclined to have implant arthroplasty might find interposition arthroplasty a suitable procedure.
The investigation into interposition arthroplasty discovered a 384% complication rate, a 235% reoperation rate, as well as favorable outcomes in pain and function. Patients younger than 65 who are not keen on implant arthroplasty may find interposition arthroplasty to be a viable option.
The research presented here examined the medium-term consequences of utilizing inlay and onlay humeral components in reverse shoulder arthroplasty (RSA), comparing the two. Specifically, we detail variations in revision frequency and functional results observed in the two design iterations.
The study focused on the three most common types of inlay (in-RSA) and onlay (on-RSA) implants, as recorded by volume in the New Zealand Joint Registry's data. In-RSA was characterized by a humeral tray situated in a recessed position within the metaphyseal bone, whereas on-RSA was characterized by a humeral tray positioned on the epiphyseal osteotomy surface. Pathologic response Revision procedures were evaluated for up to eight years following the operation as the primary outcome. Secondary outcome assessments included the Oxford Shoulder Score (OSS), implant survival, and the reasons for revision surgery, both for in-RSA and on-RSA procedures, along with specific details for each prosthesis.
The study population totalled 6707 patients, composed of 5736 patients residing in the RSA and 971 patients residing outside the RSA. Across all causative elements, in-RSA demonstrated a lower revision rate compared to on-RSA. The revision rate per 100 component years for in-RSA was 0.665, with a 95% confidence interval of 0.569 to 0.768, while the revision rate for on-RSA was 1.010, with a 95% confidence interval from 0.673 to 1.415. Importantly, the on-RSA group had a higher average OSS score after six months, with a mean difference of 220 (95% confidence interval 137-303; p < 0.001).