RESUMO
BACKGROUND: Compared with single-incision (SI) distal biceps repair, double-incision (DI) repair has been described as permitting a more anatomic repair. We hypothesized that DI repair would result in greater terminal supination torque compared with SI repair for acute distal biceps ruptures. METHODS: Patients were included if they sustained an isolated, acute distal biceps rupture repaired between January 2012 and December 2017. Isometric forearm supination torque in 4 positions was measured using a validated uniaxial torque-testing device. Testing took place at least 12 months from surgery. The primary outcome was supination torque in the 60° supinated position. Secondary outcomes included supination torque in other forearm positions and functional outcome scores. RESULTS: The study included 37 patients: 15 underwent repair with the DI technique and 22 with the SI technique. The mean age was 47.3 years, the median follow-up time was 28.1 months, and demographic data were similar between cohorts. Mean supination torque, relative to the unaffected side, was 61% (95% confidence interval, 45%-77%) for DI repair vs. 80% (95% confidence interval, 69%-92%) for SI repair in the 60° supinated position (P = .036). In a multivariable linear regression model controlling for arm dominance, age, follow-up time, and workers' compensation status; SI repair was associated with greater mean supination torque than DI repair by 20% (P = .015). CONCLUSIONS: Contrary to our hypothesis, we found a 20% mean improvement in terminal supination torque for acute distal biceps ruptures repaired with the SI technique compared with the DI technique. This finding may have clinical significance for the more discerning, high-demand patient.
Assuntos
Supinação/fisiologia , Traumatismos dos Tendões/fisiopatologia , Traumatismos dos Tendões/cirurgia , Torque , Adulto , Braço , Antebraço/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético , Procedimentos Ortopédicos/métodos , Ruptura/fisiopatologia , Ruptura/cirurgiaRESUMO
OBJECTIVES: To identify associated injuries that occur in varus posteromedial rotatory instability (VPMRI) of the elbow and present their surgical management. DESIGN: Level II retrospective study. SETTING: Tertiary referral center. PATIENT/PARTICIPANTS: Twenty-seven patients with VPMRI injuries treated surgically over an 8-year period. INTERVENTION: Open reduction and internal fixation of anteromedial coronoid facet fracture, lateral collateral ligament repair, and associated injured soft-tissue repairs. MAIN OUTCOME MEASURED: Radiographic classification, associated medial and lateral bony and soft-tissue injuries, surgical fixation method, and complications were recorded. RESULTS: According to the O'Driscoll classification, there were 15 (55%) type 2-2, 11 (41%) type 2-3, and 1 (4%) type 3-1 fractures. Lateral and medial collateral ligament tears were found in 100% and 63%, respectively. Common extensor and flexor origin injuries occurred in 19 (70%) and 2 (7%) elbows, respectively. A marginal radial head fracture was found in 1 patient. Most patients were treated with a combination of fixation methods. Complications occurred in 7 (26%) patients. CONCLUSIONS: This study documents both associated findings and surgical fixation methods. In all cases, the lateral collateral ligament was disrupted, often in association with an injured common extensor origin. Medial collateral ligament injuries are commonly involved. Radial head fractures are rarely associated. The surgeon should have a high index of suspicion if an isolated coronoid fracture is encountered. Clinical and functional outcome scores are needed in future studies to further inform treatment of VPMRI of the elbow. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Lesões no Cotovelo , Fratura-Luxação/cirurgia , Fixação Interna de Fraturas/métodos , Instabilidade Articular/cirurgia , Redução Aberta/métodos , Adulto , Idoso , Fenômenos Biomecânicos , Estudos de Coortes , Articulação do Cotovelo/cirurgia , Feminino , Fixação Interna de Fraturas/instrumentação , Consolidação da Fratura/fisiologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Prognóstico , Radiografia/métodos , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Rotação , Centros de Atenção Terciária , Resultado do Tratamento , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/cirurgiaRESUMO
OBJECTIVES: This study examines depression and outcomes in patients older than 55 years with distal radius fracture. DESIGN: Prospective data collection included patient characteristics, treatment, general and limb symptoms and disability, and complications at baseline, 3 months, and 1 year. Bivariate analysis and multivariable linear regression were used to assess relationships between depression and outcome measures, specifically the Short Form-36 (SF-36), Disability of the Arm, Shoulder, and Hand (DASH) scores, and the Centre of Epidemiologic Studies Depression (CES-D) scale. SETTING: The study was conducted in a level-1 trauma center. PARTICIPANTS: All patients older than 55 years with isolated distal radius fracture were recruited (2007-2011). INTERVENTION: Patients were treated operatively or nonoperatively. MAIN OUTCOME MEASURES: The SF-36 and DASH scores measured general and upper extremity status. Depression was measured using CES-D scale. All complications were recorded. RESULTS: Of 228 patients, 25% were depressed at baseline, 32% at 3 months, and 26% after 1 year. Thirty-two patients (14%) had complications. There was no relationship between depression at baseline and complications; however, there was a statistically significant relationship at 3 months (P = 0.021). There was a statistically significant association between baseline depression and the worse 1-year SF-36. Patients with baseline depression had poorer 1-year DASH scores (20 ± 2.3) than nondepressed patients (11 ± 1.3) (P = 0.0031), and less improvement in DASH scores over the first year (P = 0.023). Multivariable linear regression demonstrated that baseline depression is the strongest predictor of poorer 1-year DASH scores (3.7, P = 0.0078) and change in DASH scores over the first year (2.9, P = 0.026). CONCLUSIONS: Baseline depression predicts worse function and disability outcomes 1 year from injury. Depression (CES-D ≥16) is the strongest predictor of worse 1-year DASH scores and SF-36 outcome measures, after controlling for other potential predictors. LEVEL OF EVIDENCE: Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Depressão/psicologia , Complicações Pós-Operatórias/psicologia , Qualidade de Vida/psicologia , Fraturas do Rádio/psicologia , Fraturas do Rádio/terapia , Idoso , Idoso de 80 Anos ou mais , Colúmbia Britânica/epidemiologia , Causalidade , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Prevalência , Fraturas do Rádio/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
BACKGROUND: Radial head fractures can occur in isolation or in association with elbow and forearm injuries. Treatment options include nonoperative management, fragment or whole-head excision, open reduction and internal fixation (ORIF), and radial head arthroplasty. However, the evidence supporting ORIF for repairable radial head fractures is inconclusive. QUESTIONS/PURPOSES: We compared patients undergoing ORIF for isolated radial head fractures or for radial head fractures associated with other fractures or elbow dislocations in terms of patient-related disability, presence of posttraumatic arthritis, complications, and rate of reoperation for capsular release. METHODS: Between 1997 and 2008, 52 patients underwent ORIF of the radial head for isolated radial head fractures (simple group) and 29 underwent ORIF for radial head fracture with an associated fracture or dislocation (complex group). General indications for ORIF included displaced radial fractures, large articular surface fragments, and greater than 2 mm of displacement and/or a mechanical block to forearm rotation or associated fractures or ligament injuries requiring surgery. Thirty-one patients (60%) in the simple group and 20 (69%) in the complex group were available for followup at a mean of 4 years (range, 1.0-9.5 years). We evaluated the patients using a validated self-reported pain and disability questionnaire (Patient-rated Elbow Evaluation [PREE]). Records review included radiographic examination and assessment of major complications and secondary surgery rates for capsular release. RESULTS: With the numbers available, the groups were not different in terms of the mean PREE scores (8 versus 15 for the simple and complex groups, respectively; p = 0.13, lower values indicate lower pain and disability). The simple and complex groups were also not different with the numbers available in terms of major complications (13% versus 25%, respectively; p = 0.29) or secondary capsular release (3% versus 20%, respectively; p = 0.07). CONCLUSIONS: At short term, we found no differences between patients treated with ORIF for isolated radial head fractures and those treated for radial head fractures in association with other elbow injuries with regard to pain and disability scores; loss to followup in this series precludes making statements with great confidence about function after these injuries. However, the substantial capsular release and complication rates should weigh into the preoperative discussion with patients before selecting ORIF for radial head fractures. LEVEL OF EVIDENCE: Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Articulação do Cotovelo/cirurgia , Fixação Interna de Fraturas , Luxações Articulares/cirurgia , Instabilidade Articular/cirurgia , Fraturas do Rádio/cirurgia , Rádio (Anatomia)/cirurgia , Adulto , Artrite/etiologia , Fenômenos Biomecânicos , Avaliação da Deficiência , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/fisiopatologia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Luxações Articulares/diagnóstico , Luxações Articulares/fisiopatologia , Instabilidade Articular/diagnóstico , Instabilidade Articular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/etiologia , Radiografia , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/lesões , Rádio (Anatomia)/fisiopatologia , Fraturas do Rádio/diagnóstico , Fraturas do Rádio/fisiopatologia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Reoperação , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Lesões no CotoveloRESUMO
PURPOSE: To report our results for ulnocarpal epiphyseal arthrodesis for recurrent or late-presenting wrist deformity in patients with radial longitudinal deficiency, using both objective data and long-term subjective follow-up evaluation. METHODS: A retrospective review of our surgical logs between 1970 and 2007 identified 12 postcentralization patients treated with ulnocarpal epiphyseal arthrodesis, and 1 patient (who had reached skeletal maturity) treated with traditional ulnocarpal arthrodesis. Indications for the arthrodesis included postcentralization recurrence of radial angulation to greater than 45°, an inability to actively extend the wrist to within 25° of neutral (ie, 25° of flexion), or both. We collected objective and radiographic data on all 12 patients by chart review at a mean of 89 months (range, 2-472 mo) after arthrodesis. We collected subjective data from 9 patients at a mean of 160 months (range, 14-602 mo) after arthrodesis. RESULTS: Ulnocarpal union was obtained in 11 wrists at an average of 4 months (range, 2-6 mo); the 1 case of nonunion was treated successfully with revision arthrodesis. The mean radial angulation position was 20° after arthrodesis (range, 0° to 35°), an average improvement of 42°. The mean position of wrist fusion was 11° of flexion (range, 0° to 35° of flexion), an average improvement of 7°. The mean postoperative Disabilities of the Arm, Shoulder, and Hand score was 24.5 (SD, 12.3; range, 6.8-36.4). Final postoperative Visual Analog Score rating for function averaged 8 (range, 4-10); for appearance, it averaged 7 (range, 5-10), and for pain, it averaged 1 (range, 0-5). CONCLUSIONS: Ulnocarpal and epiphyseal arthrodesis are appropriate surgical procedures to stabilize the carpus in postcentralization patients with recurrent or late-presenting wrist deformity. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Assuntos
Artrodese/métodos , Rádio (Anatomia)/anormalidades , Amplitude de Movimento Articular/fisiologia , Articulação do Punho/anormalidades , Articulação do Punho/cirurgia , Adolescente , Artrodese/instrumentação , Pinos Ortopédicos , Ossos do Carpo/cirurgia , Criança , Estudos de Coortes , Epífises/diagnóstico por imagem , Epífises/cirurgia , Feminino , Seguimentos , Humanos , Instabilidade Articular/prevenção & controle , Masculino , Anormalidades Musculoesqueléticas/diagnóstico por imagem , Anormalidades Musculoesqueléticas/cirurgia , Medição da Dor , Radiografia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Resultado do Tratamento , Ulna/cirurgia , Articulação do Punho/diagnóstico por imagem , Adulto JovemAssuntos
Traumatismos dos Dedos/cirurgia , Procedimentos Ortopédicos/métodos , Amplitude de Movimento Articular/fisiologia , Técnicas de Sutura , Traumatismos dos Tendões/cirurgia , Tendões/cirurgia , Adulto , Fenômenos Biomecânicos , Traumatismos dos Dedos/diagnóstico , Força da Mão , Humanos , Masculino , Músculo Esquelético/cirurgia , Prognóstico , Recuperação de Função Fisiológica , Transferência Tendinosa/métodos , Resistência à Tração , Resultado do TratamentoRESUMO
Radial head fractures are the most common fractures occurring around the elbow. Although radial head fractures can occur in isolation, associated fractures and ligament injuries are common. Assembling the clinical presentation, physical examination, and imaging into an effective treatment plan can be challenging. The characteristics of the radial head fracture influence the technique used to optimize the outcome. Fragment number, displacement, impaction, and bone quality are considered when deciding between early motion, fragment excision, and radial head excision, repair, or replacement. Isolated, minimally displaced fractures without evidence of mechanical block can be treated nonsurgically with early active range of motion (ROM). Partial, displaced radial head fractures without evidence of mechanical block can be treated either nonsurgically or with open reduction internal fixation (ORIF), as current evidence does not prove superiority of either strategy. For displaced fractures with greater than 3 fragments, radial head replacement is recommended. Radial head arthroplasty may be preferred over tenuous fracture fixation in the setting of associated ligament injuries when maintenance of joint stability could be compromised by ineffective fracture fixation.