Chemical Characterization of Terpene-Based Hydrophobic Eutectic Solvents and Their Application for Pb(II) Complexation during Solvent Extraction Procedure.

Solvents prepared from natural terpenes (menthol and thymol), as H-bond acceptors, and a series of organic acids (chain lengths of 8, 10, and 14 C atoms), as H-bond donors, were characterized and tested as reaction media for liquid-liquid extraction purposes. Due to their high hydrophobicity, they seem to be promising alternatives to conventional (nonpolar and toxic) solvents, since they possess relatively less toxic, less volatile, and consequently, more environmentally friendly characteristics. Assuming that the equilibrium is established between solvent and analyte during a ligandless procedure, it can be concluded that those nonpolar solvents can efficiently extract nonpolar analytes from the aqueous environment. Previous investigations showed a wide range of applications, including their use as solvents in extractions of metal cations, small molecules, and bioactive compounds for food and pharmaceutical applications. In this work, hydrophobic solvents based on natural terpenes, which showed chemical stability and desirable physicochemical and thermal properties, were chosen as potential reaction media in the liquid-liquid extraction (LLE) procedure for Pb(II) removal from aqueous solutions. Low viscosities and high hydrophobicities of prepared solvents were confirmed as desirable properties for their application. Extraction parameters were optimized, and chosen solvents were applied. The results showed satisfactory extraction efficiencies in simple and fast procedures, followed by low solvent consumption. The best results (98%) were obtained by the thymol-based solvent, thymol-decanoic acid (Thy-DecA) 1:1, followed by L-menthol-based solvents: menthol-octanoic acid (Men-OctA) 1:1 with 97% and menthol-decanoic acid (Men-DecA) 1:1 with 94.3% efficiency.

Plant-Mediated Synthesis of Magnetite Nanoparticles with Matricaria chamomilla Aqueous Extract.

Magnetite nanoparticles (NPs) possess properties that make them suitable for a wide range of applications. In recent years, interest in the synthesis of magnetite NPs and their surface functionalization has increased significantly, especially regarding their application in biomedicine such as for controlled and targeted drug delivery. There are several conventional methods for preparing magnetite NPs, all of which mostly utilize Fe(iii) and Fe(ii) salt precursors. In this study, we present a microwave hydrothermal synthesis for the precipitation of magnetite NPs at temperatures of 200 °C for 20 min and 260 °C for 5 min, with only iron(iii) as a precursor utilizing chamomile flower extract as a stabilizing, capping, and reducing agent. Products were characterized using FTIR, PXRD, SEM, and magnetometry. Our analysis revealed significant differences in the properties of magnetite NPs prepared with this approach, and the conventional two-precursor hydrothermal microwave method (sample MagH). FTIR and PXRD analyses confirmed coated magnetite particles. The temperature and magnetic-field dependence of magnetization indicate their superparamagnetic behavior. Importantly, the results of our study show the noticeable cytotoxicity of coated magnetite NPs-toxic to carcinoma cells but harmless to healthy cells-further emphasizing the potential of these NPs for biomedical applications.

Role of Preoperative Intra-Articular Corticosteroid Injections on Periprosthetic Joint Infection in Total Hip Arthroplasty and Its Association With Preoperative Timing: A Single-Center Series of 5,909 Hips.

BACKGROUND: Preoperative intra-articular corticosteroid injections to the hip joint increase the risk of periprosthetic joint infection (PJI) during primary total hip arthroplasty (THA). This study aimed to determine the relationship between preoperative timing of intra-articular corticosteroid injections and PJI risk following THA using data from a single-center hospital. METHODS: This single-center, retrospective cohort study included patients who underwent a THA between 2014 and 2020. Medical records were checked for intra-articular corticosteroid injections and PJI within 1 year of surgery. Patients were categorized into groups based on whether they received "no injection" or "injection 0 to 3 months," "3 to 6 months," and "> 6 months prior to THA." Hazard ratios (HRs) for these groups were calculated using multivariate Cox regression analysis, correcting for potential confounders, and presented with 95% confidence intervals [95% CIs]. RESULTS: In total, 4,507 patients (5,909 THAs) were identified. A total of 1,581 patients (27%) received an injection prior to THA. Without considering the timing factor, no increased risk for PJI following an intra-articular injection was noted (P = .19). Comparing the specified groups using multivariate analysis, corticosteroid injection within 3 months of THA showed an increased risk of PJI (HR 2.63, 95% CI 1.18 to 5.87, P = .018), but this effect was not observed for the "injection 3 to 6 months" group (HR 1.51, 95% CI 0.74 to 3.08, P = .264). CONCLUSIONS: Corticosteroid injections administered up to 3 months prior to THA increased the risk of PJI within 1 year after THA, with an HR of 2.63; however, injections between 3 and 6 months before surgery did not have a significantly higher infection rate.

Assessment of heavy metals bioaccumulation in Silver Birch (Betula pendula Roth) from an AMD active, abandoned gold mine waste.

Acid mine drainage (AMD) is generally outlined as one of the largest environmental concerns, characterized by very low pH value of mine waste, heavy metals and high sulphate content. This extremely hostile environment reduces plant ability to develop and grow. Present study focuses on a silver birch (Betula pendula Roth), a pioneer species that grows on an extremely hostile gold mine waste, to investigate the bioaccumulation of rare metals (thallium (Tl) and indium (In)), as well as nine other more common heavy metals (bismuth (Bi), cadmium (Cd), cobalt (Co), copper (Cu), lead (Pb), manganese (Mn), nickel (Ni), silver (Ag) and zinc (Zn)), and to asses phytoextraction and phytostabilization potential of silver birch. Additionally, parameters determining AMD process and overall contamination (pH, electrical conductivity (EC), sulphates (SO42-), arsenic (As), iron (Fe), oxidation-reduction potential (ORP), turbidity, dissolved oxygen (DO), total dissolved solids (TDS), acidity, hardness, X-ray diffraction (XRD) and radioactivity) were determined in mine waste and drainage water samples. To assess the heavy metals bioaccumulation and mine waste status, statistical geochemical indices were determined: bioaccumulation factor (BCF), pollution load index (PLI), geochemical abundance index (GAI) and exposure index (EI). The results show that silver birch bioaccumulates the essential elements Cu, Ni, Mn and Zn, and the nonessential elements Tl (average BCF = 24.99), In (average BC = 23.01) and Pb (average BCF = 0.84). Investigated mine waste was enriched by Bi, Ag and Cd according to positive values of GAI index. Present research provides a novel insight into bioaccumulation of nonessential heavy metals in silver birches who grow on the extremely hostile mine waste, and they exhibit significant phytoremediation potential.

Green Inhibition of Corrosion of Aluminium Alloy 5083 by Artemisia annua L. Extract in Artificial Seawater.

Plant extracts are increasingly being examined in the corrosion inhibition of metal and alloys in various environments due to their potent antioxidant properties. The use of Artemisia annua L. aqueous extract (AAE) as an aluminium alloy 5083 (ALA) corrosion inhibitor in artificial seawater (ASW) was investigated using electrochemical tests and spectroscopy tools, while the active biocompounds found in AAE were analyzed using high-performance liquid chromatography (HPLC). Electrochemical results showed that AAE acts as an anodic inhibitor through the physisorption (ΔG ≈ -16.33 kJ mol-1) of extract molecules on the ALA surface, thus reducing the active sites for the dissolution of the alloy in ASW. Fourier-transform infrared spectra confirmed that phenolic acids found in AAE formed the surface layer that protects ALA against the corrosive marine environment, while HPLC analysis confirmed that the main phytoconstituents of AAE were chlorogenic acid and caffeic acid. The inhibition action of phenolic acids and their derivatives found in the AAE was based on the physisorption of caffeic acid on the ALA surface, which improved physicochemical properties of the barrier film and/or conversion of Al3+ to elemental aluminium by phenolic acids as reducens, which slowed down the diffusion rate of Al3+ to or from the ALA surfaces. The protective effect of the surface layer formed in the presence of AAE against ASW was also confirmed by inductively coupled plasma-optical emission spectrometry (ICP-OES) whereby the measured concentration of Al ions after 1 h of immersion of ALA in the pure ASW was 15.30 µg L-1 cm-2, while after the addition of 1 g L-1 AAE, the concentration was 3.09 µg L-1 cm-2.

Implant survival of total elbow arthroplasty: analysis of 514 cases from the Dutch Arthroplasty Registry.

The aim of this study is to report the implant survival and factors associated with revision of total elbow arthroplasty (TEA) using data from the Dutch national registry. All TEAs recorded in the Dutch national registry between 2014 and 2020 were included. The Kaplan-Meier method was used for survival analysis, and a logistic regression model was used to assess the factors associated with revision. A total of 514 TEAs were included, of which 35 were revised. The five-year implant survival was 91%. Male sex, a higher BMI, and previous surgery to the same elbow showed a statistically significant association with revision (p < 0.036). Of the 35 revised implants, ten (29%) underwent a second revision. This study reports a five-year implant survival of TEA of 91%. Patient factors associated with revision are defined and can be used to optimize informed consent and shared decision-making. There was a high rate of secondary revisions.

Antioxidant Capacity of Herzegovinian Wildflowers Evaluated by UV-VIS and Cyclic Voltammetry Analysis.

Considering the vast cultural and traditional heritage of the use of aromatic herbs and wildflowers for the treatment of light medical conditions in the Balkans, a comparison of the antioxidant capacity of wildflowers extracts from Herzegovina was studied using both cyclic voltammetry and spectrophotometry. The cyclic voltammograms taken in the potential range between 0 V and 800 mV and scan rate of 100 mV s-1 were used for the quantification of the electrochemical properties of polyphenols present in four aqueous plant extracts. Antioxidant capacity expressed as mmoL of gallic acid equivalents per gram of dried weight of the sample (mmoL GAE g-1 dw) was deduced from the area below the major anodic peaks (Q400 pH 6.0, Q500 pH 4.7, Q600 pH 3.6). The results of electrochemical measurements suggest that the major contributors of antioxidant properties of examined plants are polyphenolic compounds that contain ortho-dihydroxy-phenol or gallate groups. Using Ferric reducing-antioxidant power (FRAP) and 2,2'-azino-bis spectrophotometric methods (3-ethylbenzthiazoline-6-sulphonic acid) radical cation-scavenging activity (ABTS) additionally determined antioxidant capacity. The FRAP results ranged from 2.9702-9.9418 mmoL Fe/g dw, while the results for ABTS assays expressed as Trolox equivalents (TE) ranged from 14.1842-42.6217 mmoL TE/g dw. The Folin-Ciocalteu procedure was applied to determine the total phenolics content (TP). The TP content expressed as Gallic acid equivalents (GAE) ranged from 6.0343-9.472 mmoL GAE/g dw. The measurements of total flavonoid (TF) and total condensed tannin (TT) contents were also performed to obtain a broader polyphenolic profile of tested plant materials. Origanum vulgare L. scored the highest on each test, with the exception of TT content, followed by the Mentha × piperita L., Artemisia annua L., and Artemisia absinthium L., respectively. The highest TT content, expressed as mg of (-)catechin equivalents per gram of dried weight of sample (mg CE/g dw), was achieved with A. absinthium extract (119.230 mg CE/g dw) followed by O. vulgare (90.384 mg CE/g dw), A. annua (86.538 mg CE/g dw) and M. piperita (69.231 mg CE/g dw), respectively. In addition, a very good correlation between electrochemical and spectroscopic methods was achieved.

Treatment of Unstable Elbow Injuries with a Hinged Elbow Fixator: Subjective and Objective Results.

Introduction: Injuries around the elbow pose a challenging problem for orthopaedic surgeons. The complex bony architecture of the joint should be restored and the thin soft tissue envelope needs to be handled with meticulous care. Elbow instability is a complication seen after dislocations and fractures of the elbow and remains a treatment challenge. The purpose of this study was to provide subjective and objective results following the surgical treatment of unstable elbow dislocations with an external hinged fixation technique. Methods: Forty-six consecutive patients with complex trauma of the elbow with instability after ligament reconstruction were enrolled between January 2017 and December 2019. The parameters used to quantify the subjective and objective functional results were the Mayo Elbow Score (MES, objective) and Oxford Elbow Score (OES, subjective), and clinical stability of the elbow joint. We also performed a radiological follow-up of the fractures. Results: The mean MES and OES scores were good at the 12-month follow-up. We had 38 patients with stable joints and 8 patients with minor instability. Using the stress test, we saw a significant difference in the affected joint under varus stress (6.7 ± 1.8 mm) compared to the healthy joint (5.8 ± 1.2 mm) laterally. Furthermore, medially the gap was significantly larger (5.8 ± 0.8 mm, treated elbow) than the contralateral gap under valgus stress (4.3 ± 0.8 mm) (p <0.001). Twenty-one complications occurred in 46 patients (46%): Seven patients had a clinical change of elbow axis: Three valgus (6%), four varus (9%); Superficial wound infection occurred in one case (2%) and ulnar nerve dysfunction in two (4%). The most common medium-term complication was post-traumatic osteoarthritis in eight cases (17%). Heterotopic ossification occurred in five patients (11%) and elbow stiffness in five cases (11%). Conclusion: The use of the hinged elbow external fixator in the treatment of complex elbow trauma is a valid therapeutic adjunct to ligamentous reconstruction showing encouraging results with acceptable complications. How to cite this article: Meccariello L, Caiaffa V, Mader K, et al. Treatment of Unstable Elbow Injuries with a Hinged Elbow Fixator: Subjective and Objective Results. Strategies Trauma Limb Reconstr 2022;17(2):68-73.

A registry study on radial head arthroplasties in the Netherlands: Indications, types and short-term survival.

BACKGROUND: This study aims to use the Dutch Arthroplasty Register data to report an overview of the contemporary indications and implant designs, and report the short-term survival of radial head arthroplasty. METHODS: From the Dutch Arthroplasty Register, data on patient demographics, surgery and revision were extracted for radial head arthroplasties performed from January 2014 to December 2019. Implant survival was calculated using the Kaplan-Meier method. RESULTS: Two hundred fifty-eight arthroplasties were included with a median follow-up of 2.2 years. The most common indication was a fracture of the radial head (178, 69%). One hundred thirty-nine (68%) of the prostheses were of bipolar design, and the most commonly used implant type was the Radial Head System (Tornier; 134, 51%). Of the 258 included radial head arthroplasties, 16 were revised at a median of six months after surgery. Reason for revision was predominantly aseptic loosening (9). The overall implant survival was 95.8% after one year, 90.5% after three years and 89.5% after five years. DISCUSSION: For radial head arthroplasties, acute trauma is the most common indication and Radial Head System the most commonly used implant. The implant survival is 89.5% after five years.

The Additive Influence of Propane-1,2-Diol on SDS Micellar Structure and Properties.

Micellar systems are colloids with significant properties for pharmaceutical and food applications. They can be used to formulate thermodynamically stable mixtures to solubilize hydrophobic food-related substances. Furthermore, micellar formation is a complex process in which a variety of intermolecular interactions determine the course of formation and most important are the hydrophobic and hydrophilic interactions between surfactant-solvent and solvent-solvent. Glycols are organic compounds that belong to the group of alcohols. Among them, propane-1,2-diol (PG) is a substance commonly used as a food additive or ingredient in many cosmetic and hygiene products. The nature of the additive influences the micellar structure and properties of sodium dodecyl sulfate (SDS). When increasing the mass fraction of propane-1,2-diol in binary mixtures, the c.m.c. values decrease because propane-1,2-diol is a polar solvent, which gives it the ability to form hydrogen bonds, decreasing the cohesivity of water and reducing the dielectric constant of the aqueous phase. The values of ΔGm0 are negative in all mixed solvents according to the reduction in solvophobic interactions and increase in electrostatic interaction. With the rising concentration of cosolvent, the equilibrium between cosolvent in bulk solution and in the formed micelles is on the side of micelles, leading to the formation of micelles at a lower concentration with a small change in micellar size. According to the 1H NMR, with the addition of propylene glycol, there is a slight shift of SDS peaks towards lower ppm regions in comparison to the D2O peak. The shift is more evident with the increase in the amount of added propane-1,2-diol in comparison to the NMR spectra of pure SDS. Addition of propane-1,2-diol causes the upfield shift of the protons associated with hydrophilic groups, causing the shielding effect. This signifies that the alcohol is linked with the polar head groups of SDS due to its proximity to the SDS molecules.

The influence of short-term complications on the outcomes of total elbow arthroplasty.

BACKGROUND: The reported complication rate after total elbow arthroplasty is high, and objective outcomes are not always predictive of satisfaction. This study aims to investigate the effect of a short-term complication on patient satisfaction and patient-reported outcome measures. METHODS: We retrospectively included 126 patients who received a primary total elbow arthroplasty at our hospital between 2008 and 2018 and compared outcomes between patients with a complication and patients without complications occurring within 1 year using t-tests or Mann-Whitney U tests. P-values were corrected using the Benjamini-Hochberg procedure. RESULTS: In total, 26 patients developed a complication (21%). At the 1-year follow-up, there were no significant differences between the groups. At the 3-year follow-up, patients with a complication had a lower median satisfaction score (8 vs. 10; P = .0288) and Oxford Elbow Score (27 vs. 43; P = .0048). At the 5-year follow-up, there were no differences between the groups. However, the number of patients who completed the 5-year follow-up is low (42 patients). DISCUSSION: Complications occurred in 21% of patients undergoing total elbow arthroplasty and lead to a decrease in satisfaction and Oxford Elbow Score after 3 years.

Potentiometric Response of Solid-State Sensors Based on Ferric Phosphate for Iron(III) Determination.

A novel ion-selective electrode with membranes based on iron(III) phosphate and silver sulfide integrated into a completely new electrode body design has been developed for the determination of iron(III) cations. The best response characteristics with linear potential change were found in the iron(III) concentration range from 3.97 × 10-5 to 10-2 mol L-1. The detection limit was found to be 2.41 × 10-5 mol L-1 with a slope of -20.53 ± 0.63 and regression coefficient of 0.9925, while the quantification limit was 3.97 × 10-5 M. The potential change per concentration decade ranged from -13.59 ± 0.54 to -20.53 ± 1.56 for Electrode Body 1 (EB1) and from -17.28 ± 1.04 to -24 ± 1.87 for Electrode Body 2 (EB2), which is presented for the first time in this work. The prepared electrode has a long lifetime and the ability to detect changes in the concentration of iron cations within 20 s. Membrane M1 showed high recoveries in the determination of iron cations in iron(III) standard solutions (98.2-101.2%) as well as in two different pharmaceuticals (98.6-106.5%). This proves that this type of sensor is applicable in the determination of ferric cations in unknown samples, and the fact that all sensor parts are completely manufactured in our laboratory proves the simplicity of the method.

Open Reduction and Internal Fixation Using Double Plating with Biological and Artificial Bone Grafting of Aseptic Non-unions of the Distal Humerus: Clinical Results.

AIM: Intra-articular non-union of fractures is an uncommon but complex problem because in general, it is characterised by marked instability, pain, strength loss and significant functional limitation. The aim of this study is to report our prospective medium-term outcomes of the treatment of intra-articular, distal humeral aseptic non-unions using open reduction and internal fixation, augmented with artificial bone. MATERIALS AND METHODS: A retrospective case series of 16 patients with intra-articular, aseptic non-unions of the distal humerus was analysed for range of motion, pain, Mayo Elbow Performance Scores (MEPS) and Oxford Elbow Scores (OES) after 12 months. Mean age was 44 years (range, 18-84 years) and mean total follow-up was 43 months (range, 24-62 months). RESULTS: All subjective and objective scores were significantly higher 12 months after treatment with internal fixation and artificial bone augmentation; the mean improvement on the MEPS was 18 points and 17 points on the OES. All patients returned to work, most without limitations. Autografts had worse outcomes compared to allografts regarding post-operative pain and time to return to work. No adverse events related to the artificial bone augmentation were seen and all fractures consolidated. CONCLUSION: The use of two locking plates and bone graft augmentation with autografts or allografts with artificial bone grafts is a successful treatment of intra-articular distal humeral non-unions after hardware failure or biological limitations. CLINICAL SIGNIFICANCE: The use of artificial bone in the treatment of septic non-unions of the upper limb is safe. When no autograft is possible because of concurrent morbidity, it can be used alone or combined with an allograft to reconstruct the affected bone without leading to extra morbidity or complications. HOW TO CITE THIS ARTICLE: Rollo G, Vicenti G, Rotini R, et al. Open Reduction and Internal Fixation Using Double Plating with Biological and Artificial Bone Grafting of Aseptic Non-unions of the Distal Humerus: Clinical Results. Strategies Trauma Limb Reconstr 2021;16(3):144-151.

The New Ion-Selective Electrodes Developed for Ferric Cations Determination, Modified with Synthesized Al and Fe-Based Nanoparticles.

The solid-state ion-selective electrodes presented here are based on the FePO4:Ag2S:polytetrafluoroethylene (PTFE) = 1:1:2 with an addition of (0.25-1)% microwave-synthesized hematite (α-Fe2O3), magnetite (Fe3O4), boehmite [γ-AlO(OH)], and alumina (Al2O3) nanoparticles (NPs) in order to establish ideal membrane composition for iron(III) cations determination. Synthesized NPs are characterized with Fourier-Transform Infrared (FTIR) spectroscopy, Powder X-Ray Diffraction (PXRD), and Scanning Electron Microscopy (SEM) with Energy Dispersive Spectroscopy (EDS). The iron oxides NPs, more specifically, magnetite and hematite, showed a more positive effect on the sensing properties than boehmite and alumina NPs. The hematite NPs had the most significant effect on the linear range for the determination of ferric cations. The membrane containing 0.25% hematite NPs showed a slope of -19.75 mV per decade in the linear range from 1.2∙10-6 to 10-2 mol L-1, with a correlation factor of 0.9925. The recoveries for the determination of ferric cations in standard solutions were 99.4, 106.7, 93.6, and 101.1% for different concentrations.

Surfactant-Free Microemulsions in Fragrance Tinctures.

Tinctures are alcoholic or hydroalcoholic solutions prepared from vegetable or chemical substances. The concentration of the solute varies up to a maximum of 50%, e.g., vanilla tincture. Tinctures are very useful in the perfume industry because they contain ethanol, which can dissolve molecules such as fragrant molecules, and consequently form hydroalcoholic formulations together. Recently, we have shown that nanostructures exist in the monophasic water-ethanol-citronellol system, and it is therefore a question whether such nanostructures exist in a system where a perfume molecule of citral is present as the oil component instead of citronellol. In this study, the single-phase region was mapped conductometrically and then measured by Dynamic Light Scattering (DLS) and UV/Vis spectroscopy to determine the presence of nanostructures similar to classical microemulsions.

Two-stage bone-and-strut technique in the treatment of septic non-unions in the upper limb.

Aim To report the results of a two-stage reconstruction of septic non-unions of the upper limb using the bone-and-strut technique with a follow-up of more than two years. Methods A total of 19 patients (12 males and seven females; age 27 to 85 years) were included in this cohort study. The evaluation endpoint was set at 24 months. Radiographic union, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores, pain and return to work were assessed. All patients were treated with debridement and antibiotic therapy. At a second stage, the nonunion focus was filled with a cancellous bone allograft. Stability was provided using a locking plate and a bone strut. Results After 24 months, the QuickDASH scores improved from a median of 28 (interquartile range, 13 - 35 points), to a median of 78 (interquartile range, 70 - 89 points). Mean pain scores improved from 8.1 (range, 0.3-10) to 0.6 (range 0-2). Radiographic and clinical union was seen in all patients. The majority of patients returned to work or previous activities when retired. A new neurological deficit, recurrence of infection, or other surgery-related adverse events were not observed. Conclusion The two-stage bone-and-strut technique is a safe and effective technique in the treatment of septic non-unions of the upper limb. The union rate is high, the complication rate is acceptable and return return-to-work is high. Recurrence of infectious sequelae during a follow-up period of at least two years was not seen. The patient-reported outcomes increased significantly.

Development of the New Fluoride Ion-Selective Electrode Modified with FexOy Nanoparticles.

A new modified ion-selective electrode with membranes of LaF3 single crystals with different internal contacts (solid steel or electrolyte) and with FexOy nanoparticles as loading was developed. The best response characteristic with linear potential change was found in the fluoride concentration range from 10-1 to 3.98 × 10-7 M. The detection limit for the electrolyte contact was determined at 7.41 × 10-8 M with a regression coefficient of 0.9932, while the regression coefficient for the solid contact was 0.9969. The potential change per concentration decade ranged from 50.3 to 62.4 mV, depending on whether the contact was solid or electrolytic. The prepared modified electrode has a long lifetime, as well as the possibility of application in different positions (solid contact), and it can also be used for the determination of iron ions. The electrode characterization was performed with scanning electron microscopy and elemental analysis with the technique of electron-dispersive X-ray spectroscopy.

Global trends in indications for total elbow arthroplasty: a systematic review of national registries.

National registries provide useful information in understanding outcomes of surgeries that have late sequelae, especially for rare operations such as total elbow arthroplasty (TEA).A systematic search was performed and data were compiled from the registries to compare total elbow arthroplasty outcomes and evaluate trends. We included six registries from Australia, the Netherlands, New Zealand, Norway, the United Kingdom and Sweden.Inflammatory arthritis was the most common indication for total elbow arthroplasty, followed by acute fracture and osteoarthritis. When comparing 2000-2009 to 2010-2017 data, total elbow arthroplasty for inflammatory arthritis decreased and total elbow arthroplasty for fracture and osteoarthritis increased. There was an increase in the number of revision TEAs over this time period.The range of indications for total elbow arthroplasty is broadening; total elbow arthroplasty for acute trauma and osteoarthritis is becoming increasingly more common. However, inflammatory arthritis remains the most common indication in recent years. This change is accompanied by an increase in the incidence of revision surgery. Cite this article: EFORT Open Rev 2020;5:215-220. DOI: 10.1302/2058-5241.5.190036.

Grafting and fixation after aseptic non-union of the humeral shaft: A case series.

PURPOSE: Non-unions after humeral shaft fractures are seen frequently in clinical practice at about 2-10% after conservative management and 30% after surgical treatment. Non-union, displacement of structures and fixation failure can be hazardous complications. The purpose of our study was to evaluate the outcomes of an on-lay bone graft strut construction with bone chips as grafting augmentation in the management of aseptic non-unions of the humeral shaft. METHODS: From 124 eligible patients with a humeral shaft non-union, we included 48 patients. In all cases an anterolateral humeral approach was used, with an on-lay bone graft using an allograft strut construction and with bone substitute augmentation in the non-union gap. To assess the bone healing on radiographs, we used the non-union scoring system according to Whelan. Patients were followed with objective and subjective scores. RESULTS: In all 48 patients we achieved full bone healing without major complications. The average period of union was 124 days. In 40 cases after healing the alignment was neutral, valgus deformation occurred in 6 cases a varus deformation in 2 cases. At twelve months after surgery, all patients recovered with satisfactory range of motion of shoulder and elbow and a good quality of life, without any radial nerve palsies or other major complications. CONCLUSION: Given the satisfactory results of full bone healing, recovery of the range of motion and the lack of major complications as seen in this study, we find that plating with supporting allograft as a good choice of treatment in the cases of aseptic non-union of the humeral shaft.

How Well do Orthopedic Surgeons Recognize Different Models of Total Elbow Arthroplasties on Plain Radiographs with the Use of a Diagnostic Flowchart?

BACKGROUND: Recognition of total elbow arthroplasties (TEAs) on plain radiographs is difficult due to a multitude of different types and models. Especially if surgery reports and documentation are not available, lost or when the primary surgery was performed in another hospital the prosthesis type may be undeterminable. Therefore we investigated in this platform study if a flowchart aids in recognition of thirteen different total elbow arthroplasty models on plain radiographs. METHODS: An online questionnaire on the Shoulder and Elbow Platform was developed. Plain radiographs of thirteen TEA models were shown with and without the help of an especially developed flowchart describing distinguishing features. RESULTS: Ten orthopedic surgeons specialized in upper extremity surgery completed the study. Recognition rates of the thirteen total elbow arthroplasty models ranged between 20 and 100 percent without the flowchart. Using the flowchart recognition varied between 40 and 90 percent. The recognition rates with the flowchart were not significantly higher. Inter-observer reliability did not increase on a significant level. CONCLUSION: Correct recognition of total elbow arthroplasty models with plain radiographs remains imperfect with our developed flowchart. The flowchart increased correct recognition rates and inter-observer reliability.