Simple acute postero-lateral elbow dislocation: A historical perspective.

PURPOSE: The aims of this study were to summarize (1) the historical knowledge of the posterolateral elbow dislocation (PLED) pattern and the biomechanical, radiographic, and clinical data that engendered its evolution; and (2) to help clinicians better understand the management of PLED. METHODS: A literature search was performed using Ovid, Scopus and Cochrane Library, and the Medical Subject Headings vocabulary. Results are discussed as a chronologic review of the relevant literature between 1920-2022. RESULTS: In 1966 Osborn and Cotterill were the first to describe posterolateral rotatory instability (PLRI) causing the PLED. Several theories on PLED were then published by others surgeons as our understanding of elbow biomechanics continued to improve. Multiple treatment protocols have been designed based on the aforementioned theories. Conservative and surgical treatment for PLED provides excellent functional outcomes. However, high rates of persistent pain stiffness and instability have been reported long-term, and no single approach to treatment has been widely accepted. CONCLUSION: Despite a growing body of biomechanical evidence, there is no consensus surgical indication for the treatment of PLED. Both conservative and surgical management result in satisfactory functional outcomes after PLED. However, elevated rates of residual pain, and instability have also been described and may limit heavy labor and sports participation. The next challenge for elbow surgeons will be to identify those patients who would benefit from surgical stabilization following PLED.

The sacro-iliac joint: A potentially painful enigma. Update on the diagnosis and treatment of pain from micro-trauma.

The sacro-iliac joint (SIJ) located at the transition between the spine and the lower limbs is subjected to major shear forces. Mobility at the SIJ is very limited but increases during pregnancy and the post-partum period. Familiarity with the anatomy and physiology of the SIJ is important. The SIJ is a diarthrodial joint that connects two variably undulating cartilage surfaces, contains synovial fluid, and is enclosed within a capsule strengthened by several ligaments. This lecture does not discuss rheumatic or inflammatory diseases of the SIJ, whose diagnosis relies on imaging studies and blood tests. Instead, it focuses on micro-traumatic lesions. Micro-trauma causes chronic SIJ pain, which must be differentiated from hip pain and spinal pain. The diagnosis rests on specific clinical provocation tests combined with a local injection of anaesthetic. Findings are normal from radiographs and magnetic resonance imaging. Non-operative treatment with exercise therapy and stretching aims primarily to strengthen the latissimus dorsi, gluteus, and hamstring muscles to increase SIJ coaptation. Other physical treatments have not been proven effective. Radiofrequency denervation of the dorsal sensory rami has shown some measure of efficacy, although the effects tend to wane over time. Patients with refractory pain may benefit from minimally invasive SIJ fusion by trans-articular implantation of screws or plugs, which has provided good success rates.