RESUMEN
Isolated volar distal radioulnar joint (DRUJ) dislocation is a rare condition with only a few cases reported in the literature. Its diagnosis is often overlooked in the acute phase, and there is no consensus in its management. We present the case of a 20-year-old male patient with an isolated volar radioulnar dislocation, together with a review of the literature. The aim is to present and summarize the acute management of this condition and propose a therapeutic algorithm.
RESUMEN
BACKGROUND: Third-generation total elbow arthroplasties (TEAs) have shown better mechanical characteristics than older designs. However, these results remain purely mechanical and lack clinical evidence. The purpose of this study was to evaluate clinical and radiographic outcomes of the new-generation semiconstrained Nexel TEA performed at our center. MATERIALS AND METHODS: Between 2015 and 2017, 9 Nexel TEAs were implanted in 9 patients (mean age 61 years, range 38-71). Indication for further surgery, range of motion, mean Mayo Elbow Performance Score (MEPS), Subjective Elbow Value (SEV), radiolucency lines, outcome measures that included implant survival, complications, and revisions were assessed. RESULTS: The mean follow-up was 28 months (5-46 months). Average range of motion significantly improved from pre- to postoperation, with flexion from 120° (70°-140°) to 140° (130°-155°) and supination from 60° (0°-80°) to 80° (80°). Average MEPS improved from 33 (5-45) to 85 points (30-95). During the study period, 5 elbows (56%) experienced complications and 2 (22%) underwent revision. Aseptic humeral loosening was the main indication for revision. The survivorship rate without revision was 75% at 45 months. CONCLUSIONS: The short-term clinical results of the Nexel TEA are satisfactory. However, an unusually high rate of complications and revisions was observed, mainly at the humeral component. Further research with longer follow-up and more patients included are needed to validate this new prosthesis.
Asunto(s)
Artroplastia de Reemplazo de Codo , Articulación del Codo , Prótesis de Codo , Adulto , Anciano , Codo , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/cirugía , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Rango del Movimiento Articular , Reoperación , Resultado del TratamientoRESUMEN
BACKGROUND: Total elbow arthroplasty (TEA) is a treatment option for end-stage arthritis. Even though results are satisfactory for the elderly population, TEA surgery is subject to controversy in younger patients. The purpose of this study was to evaluate clinical and radiographic outcomes of semiconstrained TEA performed for arthritis in patients younger than 55 years. MATERIALS AND METHODS: Between 1998 and 2008, 19 TEAs were implanted in 17 patients younger than 55 years (mean age, 46 years; range, 29-54 years). We assessed the indication for further surgery; range of motion; mean Mayo Elbow Performance Score; QuickDASH (short version of the Disabilities of the Arm, Shoulder and Hand questionnaire) score; radiolucent lines; and outcome measures that included implant survival, complications, and revisions. RESULTS: The average follow-up period was 10 years (range, 2-16 years). Average range of motion significantly improved, from 120° (range, 90°-140°) to 140° (range, 130°-155°) for flexion and from 40° (range, 0°-60°) to 25° (range, 0°-90°) for extension. The average Mayo Elbow Performance Score was 85 (range, 55-100). During the study period, 11 elbows (58%) experienced complications and 8 (42%) underwent revision. Aseptic loosening (3 ulnar and 2 bipolar) was the main indication for revision. The survivorship rate without revision was 94% at 5 years and 75% at 10 years. CONCLUSIONS: TEA gave satisfactory results in a younger patient population. However, a high rate of complications and revisions was observed with follow-up. Thus, TEA should be considered with caution in young patients, and other therapeutic options must be discussed.
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Artritis/cirugía , Artroplastia de Reemplazo de Codo/métodos , Articulación del Codo/cirugía , Prótesis de Codo , Rango del Movimiento Articular/fisiología , Adulto , Artritis/diagnóstico , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
BACKGROUND: Total elbow arthroplasty is a therapeutic option for severe rheumatoid arthritis. We hypothesized that the semiconstrained characteristics of the Coonrad-Morrey prosthesis do not compromise the survival rate of the implant in a rheumatoid elbow. METHODS: Between 1997 and 2012, there were 54 Coonrad-Morrey total elbow prostheses performed for rheumatoid arthritis in 46 patients. Minimum follow-up was 2 years. There were 35 women and 11 men with a mean age of 60 years (29-83 years). According to the Mayo classification for rheumatoid elbow, there were 30 type IIIA, 21 type IIIB, and 3 type IV. The surgical procedure was the same for all patients. Survivorship was assessed with use of the Kaplan-Meier method, with revision surgery as the end point. RESULTS: The survival rate was 97% (95% confidence interval, 83.6-99.6) at 5 years and 85% (95% confidence interval, 68.3-93.7) at 10 years. At an average of 7 years of follow-up (2-16 years), the mean Mayo Elbow Performance Score was 91 points (55-100 points), and the shortened version of the Disabilities of the Arm, Shoulder, and Hand score was 34 points (0-75 points). There was a significant improvement in Mayo Elbow Performance Score and in all range of motion at latest follow-up in comparison to preoperative values (P < .0001). Radiolucencies were observed in 6 cases around the humeral component and in 6 cases around the ulnar component. Bushing wear was observed in 16 cases (29%). There were 14 complications (26%). Revisions were performed in 6 of them (11%). CONCLUSION: The Coonrad-Morrey prosthesis provides satisfactory results with follow-up. The rate of complications remains high even if the rate of implant revision stayed low.
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Artritis Reumatoide/cirugía , Artroplastia de Reemplazo de Codo/métodos , Articulación del Codo/cirugía , Prótesis de Codo , Predicción , Rango del Movimiento Articular/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Articulación del Codo/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
INTRODUCTION: The most common reason for removal of well-fixed radial head prostheses is painful loosening. We hypothesised that short-stemmed prostheses, used for radial head arthroplasty, are not associated with an increased risk of implant loosening. METHODS: From 2002 to 2014, 65 patients were enrolled in a retrospective single-centre study. The radial head prostheses were classified as having either a long (30-mm) or short (16- to 22-mm) stem. The long-stemmed implants comprised 30 GUEPAR® DePuy Synthes (West Chester, PA, USA) and 20 Evolutive® Aston Medical (Saint-Etienne, France) devices; the short-stemmed implants comprised nine RECON and six STANDARD rHead® SBI-Stryker (Morrisville, PA, USA) devices. At last follow-up, clinical (range of motion, Disabilities of the Arm, Shoulder, and Hand score, Mayo Elbow Performance score) and radiographic (osteolysis) outcomes were assessed. RESULTS: At a mean follow-up of 76.78 months (24-141), the rate of painful loosening [6 (40%) vs 8 (16%), p = 0.047] and osteolysis [12 (80%) vs 23 (46%), p = 0.02] were significantly higher in patients with short-stemmed versus long-stemmed implants. Despite the significant difference in loosening between stems as groups, individual stem length was not determined. CONCLUSIONS: Tight-fitting implants with short stems are more prone to painful loosening.
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Artroplastia/instrumentación , Articulación del Codo/cirugía , Prótesis de Codo/efectos adversos , Falla de Prótesis/efectos adversos , Fracturas del Radio/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia/efectos adversos , Artroplastia/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteólisis/epidemiología , Osteólisis/etiología , Diseño de Prótesis/efectos adversos , Diseño de Prótesis/métodos , Radio (Anatomía)/cirugía , Rango del Movimiento Articular , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
INTRODUCTION: Surgical treatment of persistent non-union of the humeral shaft is a complex situation because of the risk of failure and surgery-related complications. The primary objective of this study was to evaluate clinical and radiological results of a continuous series of persistent non-union treated with plating and bone grafting. The secondary objective was to expose factors contributing to the failure of prior bone union attempts. MATERIAL AND METHODS: Sixteen patients (average age of 52 years) were treated for persistent non-union of the humeral shaft in our department; six of these patients had predisposing comorbidities or addictions. The persistent non-union was treated by plating with autologous bone graft from the iliac crest in a single-stage procedure in 12 cases and a two-stage procedure in three cases; one case was treated with plating and vascularized fibula graft. RESULTS: At a minimum follow-up of 12 months (average 78 months), four (25 %) failed to heal. The 12 other patients had bone union after an average of eight months. The average QuickDASH score was 48 points (18-72). A retrospective analysis of the prior attempts to treat the non-union revealed three cases of unstable fixation, four cases with no osteogenic supply and seven cases of positive microbiological cultures at the non-union site. CONCLUSION: Plating and autologous bone grafting resulted in union in only 75 % of persistent non-union of the humeral shaft. The persistent nature of the humeral shaft non-union could be attributed to deviating from validated rules for surgical treatment and/or the presence of a surgical site infection.
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Placas Óseas/efectos adversos , Trasplante Óseo/métodos , Fijación Interna de Fracturas/métodos , Fracturas no Consolidadas/cirugía , Fracturas del Húmero/cirugía , Trasplante Autólogo/métodos , Anciano , Trasplante Óseo/efectos adversos , Femenino , Peroné/trasplante , Estudios de Seguimiento , Fijación Interna de Fracturas/efectos adversos , Curación de Fractura , Humanos , Húmero/cirugía , Ilion/trasplante , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Trasplante Autólogo/efectos adversos , Resultado del TratamientoRESUMEN
PURPOSE: The primary objective was to describe the reasons for surgical re-intervention after radial head arthroplasty. The secondary objective was to analyze the radiographic and clinical outcomes after surgical re-intervention at the elbow with implant conservation. METHODS: Among the 70 radial head arthroplasties with bipolar radial head implant performed between 2002 and 2014, 29 required surgical re-interventions. Reasons for surgical re-intervention were gathered from operative notes and follow-up documentation. Patients who underwent re-intervention with implant retention were reassessed via clinical and radiographic examinations by an independent reviewer. RESULTS: Twenty nine re-operations were performed at a mean follow-up of 16 ± 11.7 months (0.2-36 months). The prosthesis was removed in 18 cases and retained in 11. There was a significant difference in mean time to re-intervention between the implant removal and preservation groups, 23.1 ± 8.3 months (7-36 months) and 4.4 ± 4.7 months (0.2-13 months), respectively (p < 0.001). The primary reason for surgical re-intervention was painful loosening (13 cases). Radio-capitellar instability was the most frequent reason for re-intervention with implant retention (5 cases). Midterm quickDASH and MEPS after surgical re-intervention with implant retention were 15.4 ± 5.4 and 82.27 ± 7.3, respectively. At least one degenerative lesion was reported in nine cases (81.8%) (i.e. 5 periprosthetic osteolysis, 5 capitellar wear, 5 periarticular heterotopic ossification). CONCLUSIONS: Painful loosening and capitellar instability are the primary reasons for surgical re-intervention with or without implant removal. Midterm clinical results are favourable despite an elevated rate of degenerative lesions after surgical re-intervention with implant retention.
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Artroplastia/efectos adversos , Articulación del Codo/cirugía , Fracturas del Radio/cirugía , Radio (Anatomía)/cirugía , Reoperación/estadística & datos numéricos , Adulto , Anciano , Femenino , Humanos , Prótesis Articulares/efectos adversos , Masculino , Persona de Mediana Edad , Implantación de Prótesis/efectos adversos , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Radial head prostheses are indicated for treatment of complex radial head fractures not amenable for fixation. After the initial experience with silastic implants, metallic or pyrocarbon arthroplasty have been used for 20 years. Little is known about complications related to these implants. Main complications are related to loosening whether they are cemented or not cemented. Hypotheses have been proposed like inadequate stem design, insufficient cement technique, stress shielding, and foreign body reactions secondary to polyethylene wear. Pain and stiffness are other common complications often related to oversized radial head component or overstuffing of the joint with excessive lengthening of the radius. Instability can be another complication in the context of more complex trauma with lateral collateral ligament complex lesion and coronoid fracture. Fixation of the coronoid fracture, reinsertion of the lateral collateral ligament complex, and the use of monobloc radial head prosthesis are recommended to stabilize the joint. Finally, osteoarthritis is common with follow-up.
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Articulación del Codo/cirugía , Prótesis de Codo/efectos adversos , Fracturas del Radio/cirugía , Radio (Anatomía)/cirugía , Femenino , Humanos , Masculino , Osteoartritis/etiología , Osteoartritis/cirugía , Complicaciones Posoperatorias/etiologíaRESUMEN
Treatment of mid-shaft fractures of both forearm bones in adults typically consists of individual plate fixation of each bone according to AO principles. The primary objective of this multicentre retrospective study was to identify predictive and prognostic factors of failed bone union after internal fixation with a standard plate in adults. 130 mid-shaft fractures of both forearms occurred in 92 men and 38 women, who had a mean age of 35.1 years were reviewed; 42 were open: 31 were Gustilo type I, 10 were type II and 1 was type III. All patients underwent ORIF using a direct approach over the supinator crest for the ulnar fracture and using an anterior approach at the level of the radial fracture by dynamic compression plate in 90 cases and a limited-contact dynamic compression plate in 40 cases, all with 3.5 mm diameter screws. The radiographs from all patients were reviewed after a minimum follow-up of 12 months: primary union of both forearm bones occurred in 121 of the 130 cases after a mean of 4.6 months (±2.6). 104 patients were reviewed clinically with a minimum follow-up of 12 months and a mean of 36 months (±21.7). According to Tscherne-Oestern classification, 79 % of patients had a very good outcome, 6 % had a good outcome, 10 % had a fair outcome and 5 % had a poor outcome Non-union occurred in 9 patients (one septic): 4 times at both fracture sites, 4 times at the ulna only and once at the radius only. The mean age was higher in the patients with non-union: 46.4 years versus 34.2 (P = 0.08). Smoking, alcoholism, associated head trauma, presence of pre-operative nerve deficit and open fracture did not appear to be risk factors for non-union. The type of plate used and the number of screws placed on either side of the fracture site had no effect on union. This patient series had a similar non-union rate to the one reported in other published studies, likely because the technical rules were followed. A lack of statistical power probably prevented us from identifying prognostic factors for bone union.
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Placas Óseas , Fijación Interna de Fracturas , Curación de Fractura , Fracturas no Consolidadas , Fracturas del Radio , Fracturas del Cúbito , Humanos , Masculino , Femenino , Fracturas del Cúbito/cirugía , Fracturas del Cúbito/diagnóstico por imagen , Adulto , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Estudios Retrospectivos , Fracturas del Radio/cirugía , Fracturas del Radio/diagnóstico por imagen , Fracturas no Consolidadas/cirugía , Persona de Mediana Edad , Resultado del Tratamiento , Radiografía , Anciano , Estudios de Seguimiento , Tornillos Óseos , Adolescente , Adulto JovenRESUMEN
BACKGROUND: Revision total elbow arthroplasty (TEA) has increased, especially in young patients with high functional expectations. The objective of this study was to evaluate the long-term results of revision TEA with a single semiconstrained prosthesis. METHODS: Thirty-four revision TEAs were performed with a Coonrad/Morrey prosthesis in 32 patients; 2 patients had bilateral procedures. The mean patient age was 61 years (range, 22 to 76 years), and the revision TEA was performed at a mean time of 7.8 years (range, 1.6 to 21 years) after the primary TEA. Etiologies for revisions were humeral and ulnar aseptic loosening (n = 14), ulnar aseptic loosening (n = 8), humeral aseptic loosening (n = 6), septic arthritis (n = 4), and unstable unlinked prostheses (n = 2). Clinical and radiographic evaluations were performed with systematic preoperative infection workup and quantification of bone loss. The mean follow-up was 11.4 years (range, 2 to 21 years). RESULTS: The Mayo Elbow Performance Score (MEPS) at the last follow-up was excellent in 6 cases, good in 18 cases, fair in 8 cases, and poor in 2 cases, with a mean improvement (and standard deviation) between the preoperative values at 42.4 ± 16.1 points and the postoperative values at 81.8 ± 12 points (p < 0.001). The mean pain scores improved significantly from 6.7 ± 1.3 points preoperatively to 1.4 ± 1.4 points postoperatively (p < 0.001). The flexion-extension arc increased significantly (p = 0.02) from 74° ± 27° preoperatively to 100° ± 31° postoperatively. The total number of complications was 29 in 19 revision TEAs (56%). Twenty of the 29 complications simply required monitoring without surgical intervention. Six repeat surgical procedures were required, and 3 implant revisions (9%) were performed. CONCLUSIONS: Revision TEA with a semiconstrained prosthesis can provide good clinical results that can be maintained during follow-up. The rate of complications is high. Proper evaluation of the risk-benefit ratio is essential for each revision TEA and should be discussed with the patient. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Artroplastia de Reemplazo de Codo/instrumentación , Prótesis Articulares/efectos adversos , Falla de Prótesis/tendencias , Reoperación/instrumentación , Adulto , Anciano , Artroplastia de Reemplazo de Codo/efectos adversos , Artroplastia de Reemplazo de Codo/estadística & datos numéricos , Artroplastia de Reemplazo de Codo/tendencias , Articulación del Codo/fisiología , Articulación del Codo/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Rango del Movimiento Articular/fisiología , Reoperación/efectos adversos , Reoperación/estadística & datos numéricos , Reoperación/tendencias , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: Fractures of the distal radius only rarely give rise to complications in the immediate postoperative period. Combined median and ulnar nerve palsy is a complication that can be missed by the surgeon. MATERIALS AND METHODS: Three cases diagnosed early after surgery are reported here. The patients were 15, 16, and 30 years of age, respectively. None had preoperative neurological deficits. The youngest patient was injured during sports and the other 2 patients during traffic accidents. All 3 patients had a displaced fracture of the distal radius combined with a fracture of the distal fourth of the ulna or ulnar styloid process and were treated by anterior plate fixation. Operative times were 47, 62, and 120minutes, respectively. Compartment syndrome was ruled out based on low pain intensity and absence of forearm tightness to palpation. RESULTS: The electrophysiological study performed 1 month post-injury in all 3 patients showed severe impairments of both median and ulnar nerve function. Median and ulnar nerve release surgery was performed in the 15-year-old 6 weeks post-injury. No nerve damage or fibrosis was seen during the procedure. All patients recovered fully within 3 months and had normal findings from follow-up electrophysiology testing after 6 months. DISCUSSION: Combined median and ulnar nerve palsy has rarely been reported and is among the rare complications of distal radial fractures that can develop in the event of a high-energy trauma and/or major displacement. Both previously published data and our experience indicate that surgical nerve release is unnecessary. Clinical recovery within 3 months is the rule. LEVEL OF EVIDENCE: IV, case-reports.
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Neuropatía Mediana/etiología , Fracturas del Radio/complicaciones , Fracturas del Radio/cirugía , Neuropatías Cubitales/etiología , Adolescente , Adulto , Placas Óseas/efectos adversos , Fijación Interna de Fracturas , Humanos , Masculino , Neuropatía Mediana/cirugía , Fracturas del Radio/diagnóstico por imagen , Recuperación de la Función , Fracturas del Cúbito/complicaciones , Fracturas del Cúbito/cirugía , Neuropatías Cubitales/cirugíaRESUMEN
Scaphocapitate arthrodesis with lunate excision was performed for treatment of advanced Kienböck disease in 17 patients (18 wrists). Ten were women and seven men. Five were Lichtmann Stage IIIA, 12 Stage IIIB, and one Stage IV. Minimum follow-up period was 24 months; mean follow-up was 10.7 years (range 2.3 to 22 years, SD 7.1). At the latest follow-up, six patients were very satisfied, nine were satisfied and two were disappointed. Pain was significantly decreased in all cases. Wrist mobility was unchanged. Grip strength was significantly increased. Consolidation of the arthrodesis was confirmed in 17 wrists. We encountered a scaphocapitate nonunion at 12 years follow-up and two cases of styloscaphoid arthritis at 17 and 22 years. Scaphocapitate arthrodesis with lunate excision performed in an advanced stage of Kienböck disease significantly alleviates pain, while preserving functional mobility and satisfactory grip strength in the long term. LEVEL OF EVIDENCE: IV.
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Artrodesis/métodos , Hueso Grande del Carpo/cirugía , Hueso Semilunar/cirugía , Osteonecrosis/cirugía , Hueso Escafoides/cirugía , Adulto , Hueso Grande del Carpo/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Fuerza de la Mano , Humanos , Hueso Semilunar/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Osteonecrosis/diagnóstico por imagen , Dimensión del Dolor , Satisfacción del Paciente , Hueso Escafoides/diagnóstico por imagenRESUMEN
OBJECTIVE: Evaluate the diagnostic value of cone beam computed tomography (CBCT) for scaphoid and wrist fractures that are missed on standard radiographs. MATERIALS AND METHODS: Between September 2014 and October 2015, we prospectively enrolled 49 patients with a clinically suspected scaphoid fracture following an acute injury but had normal radiographs. Each patients underwent radiographs, CBCT and (magnetic resonance imaging) MRI within 7days of the initial injury event. Both exam were evaluated independently by two radiologists. RESULTS: For scaphoid cortical fractures CBCT sensitivity is 100% (95% CI: 75%-100%), specificity 97% (95% CI: 83%-100%). CBCT diagnosed all 24 corticals wrist fractures, corresponding to a sensitivity of 100% (95% CI: 83%-100%), specificity of 95% (95% CI: 75%-100%). Kappa agreement rate between the two radiologists was K=0.95 (95% CI: 0.85-1) for scaphoid fractures and K=0.87 (95% CI: 0.73-1) for wrist fractures. CONCLUSIONS: CBCT is superior to radiographs for diagnosing occult cortical fractures. Because of its low radiation dose, we believe that CBCT can be used in current practice as a replacement or supplement to radiographs to detect these fractures and optimize the cost-effectiveness ratio by limiting the number of needless immobilizations.