Long-term outcomes of Kudo type-5 unlinked surface-replacing total elbow arthroplasty for rheumatoid arthritis: a 15-year average follow-up study.

BACKGROUND: Total elbow arthroplasty (TEA) has been used for various conditions including rheumatoid arthritis (RA). While the Kudo TEA has been associated with favorable short-term outcomes, there is limited information on the longer term outcomes of this device. The aim of this study was to investigate the average 15-year outcome of Kudo type-5 TEA in patients with RA. METHODS: For this retrospective cohort study, we reviewed 29 elbows in 28 patients (Larsen grade III, n = 8; IV, n = 19; V, n = 2) with RA who underwent Kudo type-5 TEA between 1999 and 2010. The patients were followed up for a mean of 15 (range: 10-21) years. We investigated the survival with setting revision/removal as the endpoints. The risk factors for revision/loosening were assessed. RESULTS: There was a significant improvement in elbow flexion after Kudo TEA. Preoperative and postoperative Mayo Elbow Performance Score improved significantly from 60.3 to 94.7. Complications included intraoperative medial humeral epicondyle fracture (n = 2), postoperative dislocations (n = 4), deep infections (n = 1), and persistent ulnar nerve neuropathy (n = 1). Aseptic loosening was observed in 7 elbows (24.1%; humerus, n = 3; ulna, n = 3; both sides, n = 1). The causes of the 5 revisions were postoperative dislocation (n = 1), deep infection (n = 1), aseptic loosening of the humerus (n = 2), and aseptic loosening of the ulna (n = 1). All 5 elbows underwent revision of the ulnar component (n = 2) or the linked TEA (n = 3). The survival rate was 81% at 15 years after surgery with setting revision/removal as the endpoints. A deviation of ulnar component insertion angle of over 5° in any plane was associated with more revision compared to those with accurately placed implants. CONCLUSION: The Kudo type-5 elbow showed good results for up to 15 years of follow-up. However, excessive deviation of insertion angle of the ulnar component (over 5°) was associated with more revision. Due to the small sample size, robust statistical analysis of risk factors for postoperative complications or revision could not be performed, and further research is warranted to resolve this limitation.

The usefulness of neutrophil CD64 expression for diagnosing infection after orthopaedic surgery in dialysis patients.

BACKGROUND: Dialysis patients undergoing orthopaedic surgery are at high risk for postoperative infection. Diagnosis of postoperative infection is difficult in dialysis patients due to presentation of signs and symptoms similar to infection, such as fever and elevated inflammatory marker levels. Neutrophil CD64 expression (CD64), a marker of infection, is upregulated by microbial wall components and several cytokines (interferon-γ and tumor necrosis factor-α). The purpose of this study is to evaluate the usefulness of CD64 for diagnosing postoperative infection in dialysis patients post orthopaedic surgery. PATIENTS AND METHODS: Between 2013 and 2014, we prospectively studied 36 dialysis patients (18 men, 18 women; mean age 65.9 years; 49 to 83) who underwent orthopaedic surgery. Dialysis patients were classified into three groups according to their postoperative course as follows; non-infected patients, infection suspected patients, and infected patients. Inflammatory markers such as white blood cell count (WBC), C-reactive protein (CRP) and CD64 were measured before operation and one week after surgery. Using the receiver-operating characteristic (ROC) curve and Akaike's Information Criterion (AIC), the cutoff value of CD64 and CRP was calculated leading to a determination of which inflammatory marker is best accurate for detecting postoperative infection. RESULTS: We found that postoperative CD64 and CRP levels presented a statistically significant difference between infected patients and non-infected patients (p < 0.05). Furthermore, comparison of the ROC curve and AIC value between postoperative CD64 and CRP levels exhibited that CD64 was more accurate infectious marker than CRP. CONCLUSION: CD64 is a useful marker for detecting postoperative infection after orthopaedic surgery in dialysis patients.

Digital Arterial Occlusion at the Metacarpophalangeal Joint with Hypothenar Hammer Syndrome-like Symptoms: A Case Report.

Introduction: We present a rare case of ischemia caused by blunt trauma at the metacarpophalangeal joint, with no fracture or dislocation. This case resulted in digital arterial injury of the little finger with a pathological mechanism similar to that of hypothenar hammer syndrome (HHS). Case Report: Pre-operative computed tomography (CT) revealed an occluded ulnar artery at the brachial artery bifurcation and occluded ulnar digital artery in the little finger. The blunt trauma to the radial digital artery of the little finger caused ischemia. Arterial anastomosis was performed microsurgically to preserve the little finger. Necrosis was successfully prevented. The condition of the finger improved gradually, with no restriction in the range of motion. Conclusion: When a patient presents with HHS-like symptoms and is unresponsive to conservative treatment, surgical treatment should be considered. We recommend using contrast-enhanced CT for evaluating the entire upper extremity, even for ischemia associated with blunt hand trauma, such as HHS.

Metaphyseal-diaphyseal Junctional Fractures of the Distal Humerus in Children: Two Case Series.

Introduction: Although there are few descriptions in textbooks and it is stated that the treatment of metaphyseal-diaphyseal junctional (MDJ) fracture is difficult, there is almost no detailed description on its treatment methods and precautions. Case Presentation: We encountered two patients, 9-year-old and 1-year and 11-month-old Japanese boys, with MDJ fractures of the distal humerus, which are very rare in children. Unlike supracondylar fractures of the distal humerus, the fractures were spiral fractures, which made percutaneous pinning very difficult. Open reduction was performed using a bilateral approach with two skin incisions. Both patients recovered completely and had no problems carrying out activities of daily living or playing sports. Conclusions: For patients that are old enough to receive a locking plate, we recommend fixation using a locking plate. In cases of unilateral pinning without cross-pinning, retrograde intramedullary nailing should be considered. MDJ fractures of the distal humerus should be treated as distal humeral shaft fractures, not as subtypes of supracondylar fractures of the humerus.

Extensive high-pressure injection injury of the hand due to epoxy resin paint: a case report.

Epoxy resin paint has rarely been inoculated in high-pressure injection injuries. We report the surgical management of a patient with a rare extensive high-pressure injection injury caused by epoxy resin paint. A pedicled groin flap was used, as it prevents tissue scarring, tendon adhesion, and contracture of the fingers.

Radiological improvements in global sagittal alignment after lumbar decompression without fusion.

STUDY DESIGN: A retrospective, radiographical study. OBJECTIVE: To evaluate short-term radiological changes in sagittal alignment after lumbar decompression without fusion for lumbar canal stenosis. SUMMARY OF BACKGROUND DATA: Although the importance of global sagittal balance is underscored recently, little is known about the changes in sagittal alignment after lumbar canal decompression. METHODS: We retrospectively reviewed 88 patients who underwent lumbar decompression without fusion at a single institution between November 2008 and May 2013, with a minimum follow-up of 5 months. Standing radiographs at the preoperative period and the final follow-up were assessed. Radiological parameters included the sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt, pelvic incidence (PI), occipital 7th cervical angle, and thoracic kyphosis, which were measured by 2 spine surgeons. The Zurich Claudication Questionnaire and visual analogue scale scores were obtained to assess the patient-based clinical outcomes. RESULTS: Both LL and thoracic kyphosis significantly increased postoperatively, whereas SVA, PI-LL (PI minus LL), and pelvic tilt significantly decreased (P<0.05). There were no significant differences between the preoperative and postoperative occipital 7th cervical angle and PI. The amount of increment in LL was greater in patients with small preoperative LL. The improvement in SVA was greater in those with a large preoperative SVA. The Zurich Claudication Questionnaire and visual analogue scale scores showed no significant correlation with the radiological parameters. CONCLUSION: Lumbar decompression without fusion can induce a reactive improvement in the lumbar and global sagittal alignment even if a sagittal imbalance exists preoperatively. LEVEL OF EVIDENCE: 4.