Three-Dimensional Quantitative Study and Functional Outcome Analysis of Coronoid Fracture in Different Elbow Injury Patterns.

BACKGROUND: Coronoid fractures are often part of a complex fracture-dislocation of the elbow. For an optimum prognosis, it is important to understand the characteristics of coronoid fractures in different elbow injury patterns. Significant differences in these characteristics have been observed in various studies, but these previous studies have suffered from limitations, such as insufficient quantification and unknown prognostic differences among different injury patterns. Therefore, we aimed to quantitatively analyze coronoid fracture characteristics and functional outcomes in different elbow injury patterns using 3D-CT. METHODS: All patients with coronoid fractures surgically treated at our hospital between January and December 2017 were categorized into three groups according to elbow injury pattern: PLRI, VPMRI and OFD. 3D models were reconstructed using Mimics 17.0, and the total volume (TV) and number of coronoid fragments (NCF) were measured. The coronoid process edge was classified into different anatomical regions, and each region was assigned a number to quantify the distribution of fracture lines. At the last follow-up, the ROM, VAS, MEPS, complications and reoperations were recorded. RESULTS: The ninety-two patients enrolled had an average age of 42±15 years and a male-to-female ratio of 66:26. The median TV in PLRI patients was less than that in VPMRI patients [431 (132, 818)mm3 vs. 1125 (746,1421)mm3,adjusted P<0.001] and OFD patients [431 (132, 818) mm3 vs. 2565 (381, 4076)mm3, adjusted P =0.001]. The median NCF in PLRI patients was also less than that in VPMRI patients [1 (1, 2) vs. 2 (1, 3), adjusted P=0.043]. Most of the PCFL-Rs (79%) were located around the volar edge of the lesser sigmoid notch. Compared with that of PLRI, the PCFL-Us of the VPMRI and OFD tended to be located on the more ulnodorsal side of the coronoid process edge. The median ROM [110 (90, 133), P=0.001] and the median MEPS [85 (68, 95), P=0.038] of patients with OFD were significantly less than those of patients with the other two patterns. The incidence of elbow stiffness (56%, 5/9, P=0.001) and implant-related irritation (44%, 4/9, P<0.001) in the OFD group was significantly higher than that in the other two groups. CONCLUSION: Coronoid fractures differ significantly in fragment volume, comminution severity and fracture line distribution among different elbow injury patterns. OFD has the worst functional outcomes among complex elbow injury patterns.

Diagnosis and Treatment of Varus Posteromedial Rotational Instability of the Elbow Joint in Children: Re-Understanding of the Injury Mechanism Associated With Coronoid Process Fractures.

PURPOSE: To investigate the injury mechanism, diagnosis, and treatment of varus-posteromedial rotational instability of the elbow joint in children. METHODS: According to the diagnostic criteria of varus posteromedial rotational instability of elbow joint, 16 children with coronoid process fractures treated in our department from July 2013 to July 2017 were re-evaluated. There were 14 males and 2 females, aged 7 to 14 years, with an average age of 11.6 years. Eight cases on left and 8 cases on right side. An associated elbow dislocation occurred in 8 of 16 cases. Nine patients were treated with a lateral soft tissue repair only. In 7 other patients in addition to the lateral soft tissue repair, the coronoid process fractures were treated with open reduction and fixation. At the last clinical follow-up, each elbow joint range of motion was recorded, radiographs were obtained, and functional performance was evaluated by the Mayo elbow performance score (MEPS). RESULTS: The average follow-up time was 81.9 months for the 9 patients treated with lateral elbow soft tissue repair. At the last follow-up, 2 of the patients had MEPS scores as excellent, 1 was good, and 6 were rated as moderate or poor. Four patients had a cubitus varus deformity. The average follow-up time was 30.3 months for the 7 patients treated with both soft tissue repair and coronoid fracture stabilization. The elbow joint MEPS scores for each of these 7 patients was excellent at the last follow-up, and no complications such as cubitus varus occurred. CONCLUSION: The results of the study suggest that children could also develop elbow varus-posterior medial rotational instability injuries under the same mechanism. Although the morbidity rate is low, due to insufficient understanding of the injury mechanism, it is prone to missed diagnosis, misdiagnosis, and delayed treatment, resulting in severe complications such as elbow instability, dislocation, traumatic arthritis, and elbow stiffness. On the contrary, according to the treatment principle of the posterior medial rotational instability of the elbow joint in adult, while the lateral repair is carried out, strong and effective reduction and fixation of the coronoid process fractures are adopted, it is expected that such children with rare elbow injuries can obtain excellent treatment outcomes.

Traumatic divergent dislocation of the elbow in the adults.

PURPOSE: This retrospective study aimed to investigate the clinical outcomes of DDE in adults. METHODS: From September 2010 to March 2020, adult patients with traumatic DDEs admitted to Beijing Chaoyang Hospital and Beijing Jishuitan Hospital were included in this study. Each patient underwent operative or conservative treatment during hospitalization. The clinical and radiological examinations were followed up. The primary outcomes included the Mayo Modified Wrist Score (MMWS), the Mayo Elbow Performance Score (MEPS), the Broberg and Morrey functional index, the Disabilities of the Arm, Shoulder and Hand (DASH) score, and the Visual Analogue Scale (VAS) score that were performed. Post-operative complications and secondary surgery details were also collected. RESULTS: Of the fourteen patients, clinical and radiographic results were reviewed at a mean of 53.2 months (18 to 110 months) postoperatively. There were 11 men and three women with an average age of 31.5 years (17 to 51 years). At the final follow-up, the average MMWS, MEPS, Broberg and Morrey functional index, and DASH scores were 91.4 points, 93.4 points, 92.6 points, and 10.7 points. The mean VAS at rest and during activities was 0.4 and 1.7 points. Two patients required a secondary procedure due to radial malalignment and elbow contracture, respectively. In addition, two patients were found degeneration. CONCLUSIONS: Within the context of high-energy DDE combined with simultaneous upper limb injuries, our study recommended obtaining the mechanical benefit of the forearm ring with concentric elbow stability. Despite the various and complicated traumatic patterns of DDE, great clinical results could be acquired based on adequate surgical treatments and early rehabilitation training.

Tibial plateau fractures: three dimensional fracture mapping and morphologic measurements.

PURPOSE: The injury mechanisms and classifications of tibial plateau fractures (TPFs) are still controversial. The aim of this study is to show 3D fracture mapping of different types of tibial plateau fractures. Moreover, combined with Schatzker and ten-segment classification, we aimed to analyze the injury frequency and characteristics of different segments. METHODS: In total, 346 patients with TPFs treated at level I trauma centres from 2017 to 2021 were reviewed. The CT files of the included cases were typed and categorized. 3D reconstruction of TPFs patients' CT files were performed using software. All fracture lines were superimposed on the standard model by the software to create TPFs 3D fracture mapping. RESULTS: This study included 204 male and 142 female patients (average age, 47 years [range, 18 to 83 years]) with a tibial plateau fracture. Using the Schatzker classification, we found 39 type I (11.27%), 103 type II (29.77%), nine type III (2.60%), 71 type IV (20.52%), 52 type V (15.03%), 59 type VI (17.05%) fractures, and 13 others (3.76%). The density areas of fracture lines are mainly located in the ALC and PLC segments (74.3%, 69.1%). In different views, fracture lines of different Schatzker types showed distinct distribution characteristics. CONCLUSIONS: Schatzker classification combined with 3D fracture mapping provides a new presentation of tibial plateau fracture morphology. According to the 3D fracture mapping, different types of TPFs have distinctly different distribution characteristics of fracture lines. There are significant differences between different types of fracture injury segments.

Symptomatic primary hyperparathyroidism in a young woman presenting with multiple skeletal destructions: a case report and review of literature.

BACKGROUND: Multiple pathological manifestations are rarely present in patients with primary hyperparathyroidism (PHPT). Here we described a case of a young woman who presented with multiple skeletal destructions and received an unclear diagnosis at several hospitals. CASE PRESENTATION: A 30-year-old woman was admitted to our hospital due to pain in both knees and walking difficulty that lasted for 6 and 2 years, respectively. Her laboratory test results revealed a high parathyroid hormone level (822 pg/ml) and hypercalcemia (2.52 mmol/L) in the blood. Parathyroid imaging revealed a lumpy concentration of radioactive uptake detected at the lower pole in the right lobe of the thyroid, and was nearly 2.2 cm * 2.4 cm in size. Next, the patient was treated with parathyroidectomy that resulted in a significant improvement in physiological and clinical symptoms. Moreover, the skeletal destruction and bone mineral density were significantly improved after a 5-years follow-up period. CONCLUSIONS: Multiple skeletal destructions can be caused by PHPT that should be taken into consideration in young patients with complex bone lesions.

Chronic type C3 distal humeral fracture associated with massive bone defects treated by open reduction and internal fixation with iliac crest autografts: a case report.

BACKGROUND: Chronic intercondylar fractures of the distal humerus with massive bone defects and severe comminution in the metaphysis are rare and complex injuries that are challenging for surgeons to treat, as reconstructing the triangular structure of the distal humerus is difficult and may have a severe impact on functional outcomes, especially in young patients, for whom total elbow arthroplasty is usually not a suitable option due to significant impairment in upper limb strength. Here, we report a patient in such scenario who was young and active and was treated by structural iliac bone autografting and internal fixation. CASE PRESENTATION: A 26-year-old male patient experienced a major car accident and was diagnosed with an open fracture (Gustilo-Anderson type IIIB) of the right distal humerus with massive bone defects and severe intra-articular involvement, without neurovascular injuries or other associated injuries. Surgical debridement, negative pressure vacuum sealing drainage, and immobilization by braces were initially performed, and the wound was closed after 15 days. When the wound had finally healed and the soft tissue was in good condition without infection or effusion 45 days later, this young and active patient was diagnosed with a chronic type C3 distal humeral fracture associated with massive bone defects at the supracondylar level in both columns and severe comminution at the trochlear groove. We performed surgical debridement and arthrolysis around the fracture site, and then, we successfully reconstructed the triangular structure of the distal humerus using structural iliac crest autografts in both columns as well as in the defective trochlear groove. Finally, internal fixation via a parallel double-plate configuration was performed. Over a follow-up period of 3 years, the patient achieved almost full recovery of range of motion and an excellent functional score, without minor or major postoperative complications. CONCLUSION: In this study, we proposed a surgical reconstruction strategy for complex chronic distal humeral fractures associated with massive bone defects and severe articular involvement in young and active patients using metaphyseal shortening and structural iliac crest bone autografting together with open reduction and internal fixation via a parallel configuration.

Comparative study of the functional outcomes of combined medial-lateral approach arthrolysis with or without external fixation for severe elbow stiffness.

BACKGROUND: To evaluate and compare the functional outcomes of combined medial-lateral approach open arthrolysis with and without hinged external fixation. METHODS: We retrospectively collected and analyzed the clinical data of patients with severe elbow stiffness who were treated in our institution from January 2018 to January 2019. All of them were treated with combined medial-lateral approach arthrolysis. There were 20 patients who had the hinged external fixation placed and 29 patients without the placement of the external fixation. Their baseline characteristics and functional outcomes were evaluated and compared. RESULTS: The average follow-up time was 28.4 ± 3.7 months. There were no significant differences in the ROM of the elbow, MEPS, VAS, DASH, or complications between the two groups. The operation time and treatment cost of the patients without external fixation were significantly lower than patients with external fixation. CONCLUSION: Combined medial-lateral approach open elbow arthrolysis without external fixation is a safe and effective way to treat elbow stiffness. LEVEL OF EVIDENCE: Therapeutic Level III; Retrospective Cohort Comparison; Treatment Study.

Comparative study of functional outcomes between OTA/AO type C, Gustilo type I/II open fractures and closed fractures of the distal humerus treated by open reduction and internal fixation.

BACKGROUND: To evaluate the difference of functional outcomes between OTA/AO type C, Gustilo type I/II open fractures and closed fractures of the distal humerus after open reduction and internal fixation. METHODS: We retrospectively analyzed the clinical data of patients with OTA/AO-C distal humerus fractures who were treated in our department from January 2014 to December 2016. The patients were divided into an open fracture group and a closed fracture group. Their baseline characteristics and functional outcomes were analyzed and compared. RESULTS: A total of 64 patients treated by operative fixation were identified (25 open and 39 closed injuries), and the average follow-up time was 35.1 ± 13.6 months. There were no significant differences in the range of motion (ROM) of the elbow, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, complications, hospitalization time, operation time, intraoperative blood loss, or medical costs between the two groups (P > 0.05). CONCLUSION: OTA/AO type C, Gustilo I/II distal humeral open fractures can yield satisfactory clinical results similar to those of closed distal humeral fractures after open reduction and internal fixation. LEVEL OF EVIDENCE: Therapeutic Level III; Retrospective Cohort Comparison; Treatment Study.

Identification of independent factors affecting bone mineral density after successful parathyroidectomy for symptomatic hyperparathyroidism.

BACKGROUND: Studies have shown that the response of bone mineral density (BMD) to parathyroidectomy for symptomatic primary hyperparathyroidism (PHPT) is heterogeneous and difficult to predict. However, the independent factors affecting BMD in PHPT patients after parathyroidectomy remains limited and inconclusive. This study aimed to explore the independent factors affecting BMD changes in symptomatic PHPT patients after parathyroidectomy. METHODS: This study retrospectively analyzed 105 patients with symptomatic PHPT treated at Beijing Jishuitan Hospital between January 2010 and December 2015. The primary outcome was a > 10% increase in BMD at 3 years after parathyroidectomy compared with the preoperative value, whereas the secondary outcomes were BMD changes at various measurement sites. RESULTS: A total of 105 patients with a mean age of 46.37 years were included in this study. Univariate logistic regression analysis indicated that hypertension (odds ratio [OR[: 0.032; 95% confidence interval [CI]: 0.001-0.475; P = 0.012), and parathyroid hormone level (OR: 1.006; 95% CI: 1.004-1.009; P = 0.044) were associated with the > 10% BMD increase. However, these results were not significant after adjustments for potential confounders. Moreover, the BMD values at the lumbar spine, femoral neck, femoral trochanter, Ward's triangle, and whole body after parathyroidectomy were significantly greater than those before the operation (P < 0.05). CONCLUSIONS: This study suggests that patient characteristics were not associated with the > 10% BMD increase. However, the BMD values of the femur and lumbar spine were significantly increased in symptomatic PHPT patients after parathyroidectomy.

Correlation between modified trochleocapitellar index and post-traumatic elbow stiffness in type C2-3 distal humeral fractures among adults.

BACKGROUND: The purpose of this study was to propose the modified trochleocapitellar index (mTCI), assess its reliability, and evaluate its correlation with post-traumatic elbow stiffness in type C2-3 distal humeral fractures among adults. METHODS: From January 2013 to June 2017, a total of 141 patients with type C2-3 distal humeral fractures were included. The mTCI was calculated as the ratio between the modified trochlear and capitellar angles relative to the humeral axis (mTCI-HA), lateral humeral line (mTCI-LHL), and medial humeral line (mTCI-MHL) from anteroposterior radiographs taken immediately after the operation. The patients were divided into group A (with elbow stiffness) and group B (without elbow stiffness) based on follow-up results. To determine risk factors for elbow stiffness, univariate and logistic regression analyses were performed on each radiographic parameter separately, together with other clinical variables. Interrater reliability was assessed for all measurements. RESULTS: Specific optimal ranges of value were identified for mTCI-HA (0.750-0.875), mTCI-LHL (0.640-1.060), and mTCI-MHL (0.740-0.900), beyond which the likelihood of elbow stiffness significantly increased (P < .001). By multivariate analysis, mTCI-HA (odds ratio [OR] 26.22, 95% confidence interval [CI] 3.39-203.07, P = .002), mTCI-LHL (OR 5.37, 95% CI 2.17-13.28, P < .001), and mTCI-MHL (OR 5.95, 95% CI 1.91-18.56, P = .002) values beyond the optimal ranges were identified as the independent risk factors for elbow stiffness. The interrater reliability of mTCI-HA, mTCI-LHL, and mTCI-MHL was 0.986, 0.983, and 0.987, respectively. CONCLUSION: The mTCI measurement method is reliable. Either too small or too large mTCI values were associated with post-traumatic elbow stiffness among adult patients with type C2-3 distal humeral fractures. The mTCI-HA showed a better predictive value than mTCI-LHL and mTCI-MHL.

[Evaluation of total elbow arthroplasty in treatment of distal humeral fracture in the elderly].

OBJECTIVE: To evaluate the efficacy of total elbow arthroplasty in treatment of distal humeral fracture in the elderly. METHODS: A total of 24 elderly patients who were diagnosed of distal humeral fracture and received Coorad-Morry prosthesis arthroplasty were retrospectively selected and analyzed from Beijing Jishuitan Hospital from 2003 to 2009. X ray examination of elbow joint and clinical evaluation were conducted in the follow-up; Mayo Elbow Performance Score (MEPS) was used in the last follow-up to evaluate patients' elbow function. RESULTS: A total of 20 patients with intact follow-up information were included in the final analysis, with mean follow-up length 92 months (65 - 136), mean VAS score 0.8 (0 - 2), extension degree of elbow 25 (0 - 60)degrees, flexion degree 112 (80 - 135)degrees; Mean MEPS was 88.5, with 7 excellent, 8 good, and 1 fair. Two patients had severe heterotopic ossification, 3 patients had ulnar neuropathy, 2 of which were temporary. One patient had superficial infection, and 1 had aseptic loosening in the humeral part, but did not receive revision surgery. CONCLUSION: Total elbow arthroplasty can successfully treat distal humeral fracture in the elderly and achieve satisfactory result which can last for a long time.

The diagnosis and treatment of Criss-Cross injury of the forearm: A retrospective analysis.

BACKGROUND: Due to the paucity of 'Criss-Cross' injury, the pathological changes and injury patterns have not been clearly described; as well as the treatment and prognosis. This retrospective study aimed to investigate the treatment and clinical outcomes of 'Criss-Cross' injury of the forearm. METHODS: All patients diagnosed with Criss-Cross injury meeting the inclusion and exclusion criteria in our Level 3 hospital (most advanced level) from 2010 to 2022, were enrolled in the study. A total of 12 patients were enrolled in our retrospective analysis. Closed reduction was successful in 3 patients, open reduction performed in the remaining patients. 6 patients associated with a fracture, while 2 cases had a concomitant convergent elbow dislocation. The follow-up time in conservative patients was 23.0 months on average (3-51 months), while 38.4 months in surgery group on average (3-108 months). The forearm function was evaluated with the Anderson's forearm function score. The range of motion (ROM) of the elbow and wrist and forearm rotation including any complications was also documented during the follow-up. RESULTS: On final follow-up, ROM of the elbow, wrist, and forearm rotation significantly improved after conservative treatment (50.0 ± 24.5° to 128.3 ± 2.9°, 55.0 ± 7.1° to 166.7 ± 5.8°, 83.3 ± 20.8° to 165.0 ± 15.0°, respectively, p < 0.001) and surgical treatment (41.7 ± 22.4° to 102.8 ± 21.1°, 42.2 ± 16.4° to 125.6 ± 25.1°, 34.4 ± 26.5° to 138.3 ± 22.6°, respectively, p < 0.001). However, compared with the contralateral side, there were still significant difference regarding the ROM of the elbow (102.8 ± 21.1° to 143.9 ± 4.9°), wrist (125.6 ± 25.1° to 167.8 ± 5.1°), and forearm rotation (138.3 ± 22.6° to 163.3 ± 3.5°) after surgical treatment (P < 0.01). Anderson's Forearm Function Score was excellent in all conservative cases and 2 of 9 patients treated with operation. 2 patients complained about occasional elbow locking, wrist pain and reduced power after conservative treatment. 2 patients reported ulnar neuritis after the operation, one of which was treated with anterior transposition of the ulnar nerve. CONCLUSION: The Criss-Cross injury could be associated with different fractures and/or simultaneous convergent elbow dislocation. The basic principle of treatment is to reduce both PRUJ and DRUJ by closed reduction or surgery, with early rehabilitation. Most of the patients regained good forearm function after receiving either conservative or surgical treatment.

Single-cell RNA sequencing uncovers cellular heterogeneity and the progression of heterotopic ossification of the elbow.

Heterotopic ossification of the elbow (HOE) is a complicated pathologic process characterized by extra bone formation in the elbow. Bone formation is a complex developmental process involving the differentiation of mesenchymal stem cells into osteoblasts. The aim of this study was to explore the cellular origin and progression of HOE by single-cell RNA sequencing. We identified 13 clusters of cells in HOE and further analyzed the subclusters for 4 of the main cell types. Six subclusters of osteoblasts, nine subclusters of chondrocytes, six subclusters of fibroblasts, and five subclusters of mononuclear phagocytes (MPs) were identified and analyzed. The new findings on osterix (OSX) and SOX9 expression in osteoblast subclusters and chondrocyte subclusters indicate that HOE is mediated through endochondral ossification. Further identification of the corresponding signature gene sets of distinct subclusters indicated that subclusters of osteoblasts_3, osteoblasts_4, osteoblasts_5, and osteoblasts_6 are relatively more mature during the osteoblastic progression of HOE. The trajectory analysis of the osteoblasts demonstrated that some genes were gradually downregulated, such as CRYAB, CCL3, SFRP4, WIF1, and IGFBP3, while other critical genes were upregulated, such as VCAN, IGFBP4, FSTL1, POSTN, MDK, THBS2, and ALPL, suggesting that these factors may participate in HOE progression. Cell-cell communication networks revealed extensive molecular interactions among the 13 HOE clusters. Ligand-receptor pairs for IL6, COL24A1, COL22A1, VWF, FZD6, FGF2, and NOTCH1 were identified, suggesting that multiple signaling pathways may be involved in HOE. In conclusion, this study provided the cellular atlas for HOE. We have established a greater extent of the heterogeneity of HOE cells than previously known through transcriptomic analysis at the single-cell level. We have observed gradual patterns of signature gene expression during the differentiation and maturation progression of osteoblasts from stem cells in HOE with higher resolution. The cell heterogeneity of HOE deserves further investigation to pave the way for identification of potential targets for HOE early diagnosis and therapeutic treatment.

Clinical outcomes of olecranon sled fixation in patients with Mayo type II olecranon fractures.

Background: Tension band wiring and plate fixation are common internal fixation methods used for olecranon fractures, but complications and reoperations are common. The purpose of this study is to investigate the clinical outcomes of displaced olecranon fractures treated with olecranon sled internal fixation. Methods: The data of 39 patients with olecranon fractures treated with olecranon sled in the Department of Traumatology of Beijing Jishuitan Hospital between May 2018 and April 2020 were retrospectively analyzed. There were 17 males and 22 females; the mean age was 44.0 ± 15.8 (range, 18-68 years). Preoperative olecranon fractures were classified according to the Mayo classification: 24 cases were type IIA and 15 cases were type IIB. Elbow range of motion (extension and flexion) and forearm rotation (protonation and supination) were observed at the last follow-up. The Mayo elbow performance score (MEPS), Disabilities of the arm, shoulder and hand (DASH) and visual analogue scale (VAS) scores were used to evaluate elbow function and pain, and complications were also recorded. Results: Thirty-nine patients were followed up for 33.6 ± 8.3 months (range, 25-51 months) after the operation. At the last follow-up, the mean flexion-extension arc was 137° ± 15° (range, 60°-160°), and the mean pronation-supination arc was 178° ± 4° (range, 160°-180°). The mean MEPS was 94.9 ± 9.9 (range, 50.0-100.0). The mean DASH score was 5.4 ± 4.3 (range, 0-18.3). The mean VAS score was 0.4 ± 0.8 (range, 0-3). Seven patients developed olecranon skin irritation, and 3 of them had the internal fixation device removed. Two patients developed heterotopic ossification, of whom 1 patient suffered elbow stiffness. Conclusion: Olecranon sled internal fixation has good clinical outcomes in the treatment of Mayo type II olecranon fractures with a low rate of reoperations.

Posterior Olecranon Fracture Dislocations in Adults: A Systematic Review.

Posterior olecranon fracture dislocations (POFDs) were considered posterior Monteggia lesions, which were less described in the literature. The purpose of this study was to provide a systematic review of the diagnosis, treatment, prognosis, and complications of POFDs in adults. A systematic review was performed to identify all relevant studies on the POFDs in the PubMed, Web of Science, Embase, and MEDLINE databases. The methodological quality of the studies was scored using the Methodological Index for Non-Randomized Studies (MINORS). A total of 117 patients were identified in the nine studies selected. The high-energy injuries accounted for 42.7% of the included studies. The rates of concomitant coronoid process, radial head fractures, and lateral collateral ligament injury were 84.6% (99/117), 87.2% (102/117), and 5% (6/117), respectively. The procedure was performed with a dorsal mid longitudinal approach to reconstruct all injury components. The postoperative clinical scores included the Broberg/Morrey rating, with a mean rating of excellent or good at 66%, the mean DASH score was 20.6, and the mean ASES score was 83. The flexion and extension arc and forearm rotation arcs were 100° and 134°, respectively. Complications included arthrosis in 28.2% (33/117) of cases, fracture nonunion or delayed union in 9.4% (11/117) of cases, heterotopic ossification in 7% (8/117) of cases, and the re-operation rate was 16% (19/117). There was nearly no postoperative ulnohumeral instability. The main characteristics of POFDs were disruptions of the trochlear notch, including the olecranon and coronoid processes, and severe radial head fractures, while the lateral collateral ligament was spared. Although the POFDs had a low frequency of instability, the prognosis was relatively poor. The POFDs should be considered independently.

Convergent dislocation of the elbow in adults: A retrospective study.

BACKGROUNDS: This study aims to evaluate the surgical treatment and clinical outcomes of convergent dislocation of the elbow (CDE) in adults. METHODS: Between January 2017 and September 2022, we performed a retrospective study of patients with CDE presenting in XXX and XXX Hospital and receiving operative treatments after failed closed reductions. The elbow and the forearm's range of motion (ROM) were measured and compared using a paired t-test between pre- and post-operation. Furthermore, the Mayo Elbow Performance Score (MEPS) assessed objective elbow evaluation and functional outcomes. RESULTS: Eleven patients were followed up for an average period of 9.8 months. Four males and seven females were enrolled, aged 31.5 ± 9.0 years. The average ROM of flexion-extension at the elbow was significantly improved after surgery (27.3 ± 12.3° vs. 116.8 ± 23.7°, p < 0.001). The average pronation-supination also showed a similar increase (21.8 ± 9.3° vs. 106.4 ± 23.4°, p < 0.001). The MEPS of the final follow-up was 95.9 ± 7.0 points. However, seven cases were found to have varying degrees of elbow stiffness. Furthermore, secondary procedures were performed in three cases, including the elbow arthrolysis and the anterior transposition of the ulnar nerve. CONCLUSIONS: Our study showed several operative methods following failed closed reduction attempts where anatomical reduction of humeroulnar and proximal radioulnar joints and instant rehabilitation obtained relatively satisfactory clinical outcomes.

Effectiveness and Accuracy of a Patient-Specific Instrumentation System for Total Hip Arthroplasty.

OBJECTIVE: Traditional total hip arthroplasty (THA) is often performed by visual inspection due to the lack of reliable reference, which results in inappropriate position of prosthesis and poor outcomes. This study attempts to introduce a novel patient-specific instrumentation (PSI) system and assess its effectiveness and accuracy compared with freehand operation and robot system through bone model experiments. METHODS: Equally divide 30 sawbone models into the freehand group, PSI group, and robot group. Ten sets of prosthesis parameters were randomly generated as planning, and the three groups underwent simulated THA depending on these parameters. After the placement of the femoral prosthesis, the acetabular anteversion plan was adjusted in the PSI and robot groups so that the combined anteversion was maintained before and after adjustment. After the surgery, the actual prosthesis parameters of all bone models were measured and analyzed statistically. RESULTS: No statistically significant difference was found in femoral anteversion error among the three groups (p = 0.951). The errors of acetabular cup anteversion, acetabular cup abduction, and combined anteversion in PSI group were 3.92° (2.94°, 4.62°), 5.65° (4.63°, 6.70°), and 3.93° (2.94°, 4.62°), respectively, which were significantly smaller than those in the freehand group [11.84° (9.92°, 13.87°), 13.54° (9.81°, 15.21°), 16.04° (8.18°, 19.25°), respectively, p < 0.05], but significantly larger than those in the robot group [1.34° (0.98°, 1.70°), 1.80° (1°, 2.02°), 1.34° (0.98°, 1.70°), respectively, p < 0.05]. CONCLUSION: Compared with the traditional freehand operation, the patient-specific instrumentation system is feasible in total hip arthroplasty because it improves the accuracy of prosthesis placement. In addition, the rapid measurement of intraoperative femoral prosthesis parameters can help surgeons optimize preoperative planning.

Risk of ozone exposure-induced fracture.

Introduction: Ozone (O3) is known to induce oxidative stress that influences various cells and tissues, which may further lead to diminished bone mineral density. Nevertheless, few studies have investigated the association between O3 exposure and fractures. Considering the similar growing trends of O3 concentrations and fracture morbidity in recent years, in the present study, we aimed to examine whether O3 exposure is associated with the fracture morbidity. Methods: Using a retrospective cohort study design, we analyzed the records of 8,075 patients with fracture admitted in the warm season to Beijing Jishuitan Hospital from 2014 to 2019 and matched them to the corresponding exposure time and concentration of O3. Results: The results showed that increased odds of fracture were associated with increased O3 concentrations, presumably because O3 induces oxidative stress (OS) that leads to bone mineral density (BMD) loss. Discussion: Our findings suggest that O3 exposure is a risk factor for fractures, providing new evidence of the adverse health effect induced by air pollution. We can conclude that more intensive air pollution control is needed for the prevention of fracture occurrence.

Anxiety and depression are associated with poor outcomes in open elbow arthrolysis.

BACKGROUND: Open elbow arthrolysis (OEA) is an established treatment for posttraumatic elbow stiffness (PTES); however, its efficacy is debatable for some patients. Poor surgical outcomes have been associated with anxiety and depression in other orthopedic conditions, but no studies have examined this association in OEA. In this study, we aimed to determine whether a high preoperative anxiety and depression score is associated with a worse functional outcome in OEA for PTES. METHODS: A retrospective review of prospectively collected data was carried out in patients undergoing OEA between April 2021 and March 2022. Mental state evaluated by Hospital Anxiety and Depression Scale (HADS), subjective elbow function valued by Disabilities of the Arm, Shoulder, and Hand (DASH) score, objective elbow function valued by Mayo Elbow Performance Score (MEPS), pain score measured by visual analog scale (VAS) and the flexion-extension range of motion (ROM) of the affected elbow were collected before and after surgery in outpatient clinic follow-up at 3 months and 6 months. Patient satisfaction was only recorded 6 months postoperatively. All patients were divided into 2 groups based on the preoperative HADS score for analysis: Group A was the nonanxiety-depression group, and Group B was the anxiety-depression group. RESULTS: A total of 49 patients were included. Both groups improved in DASH, MEPS and ROM at 3 months and at 6 months. The HADS score in Group B decreased significantly at 6 months, showing that the mental state of patients in Group B improved after surgery. Group A had a lower DASH at 3 months and 6 months, larger 6-month ROM and higher satisfaction rate than Group B. Comparing the differences between preoperative and postoperative measurements, Group A improved more in ROM at 6 months. There was no significant difference in other outcome measures between the two groups. CONCLUSIONS: OEA is a safe and effective treatment for PTES, and can achieve good clinical outcomes in the short-term follow-up, regardless of whether the patients suffer from anxiety or depression. Patients with a HADS score ≥11 before OEA, however, have worse outcomes than those with a HADS score <11. LEVEL OF EVIDENCE: Level II; Retrospective Design; Prognosis Study.

Biomechanical comparison of three internal fixation configurations for low transcondylar fractures of the distal humerus.

BACKGROUND: We aimed to evaluate the biomechanical stiffness and strength of different internal fixation configurations and find suitable treatment strategies for low transcondylar fractures of the distal humerus. METHODS AND MATERIALS: Thirty 4th generation composite humeri were used to create low transcondylar fracture models that were fixed by orthogonal and parallel double plates as well as posterolateral plate and medial screw (PPMS) configurations (n=10 in each group) using an anatomical locking compression plate-screw system and fully threaded medial cortical screws. Posterior bending (maximum 50 N), axial loading (maximum 200 N) and internal rotation (maximum 10 N·m) were tested, in that order, for each specimen. Stiffness under different biomechanical settings among different configurations were compared. Another 18 sets of fracture models were created using these three configurations (n=6 in each group) and the load to failure under axial loading among different configurations was compared. RESULTS: Under posterior bending, the stiffness of parallel group was higher than orthogonal group (P<0.001), and orthogonal group was higher than PPMS group (P<0.001). Under axial loading, the stiffness of parallel group was higher than orthogonal group (P=0.001) and PPMS group (P<0.001); however, the difference between orthogonal and PPMS group was not statistically significant (P>0.05). Under internal rotation, the stiffness of parallel group was higher than orthogonal group (P=0.044), and orthogonal group was higher than PPMS group (P=0.029). In failure test under axial loading, the load to failure in the orthogonal group was lower than parallel group (P=0.009) and PPMS group (P=0.021), but the difference between parallel group and PPMS group was not statistically significant (P>0.05). All specimens in orthogonal group demonstrated "distal medial failure"; most specimens had "distal medial and trochlear failure" in the parallel group; most specimens exhibited "contact failure" in the PPMS group. CONCLUSION: For treating low transcondylar fractures, the overall stiffness and strength of the parallel configuration were superior to those of the orthogonal and PPMS configurations. Nevertheless, the PPMS configuration can provide adequate stability and stiffness comparable to double-plate configurations under axial loading. Therefore, the PPMS construct may have certain clinical value.