Regional distribution prevalence of heterotopic ossification in the elbow joint: a 3D study of patients after surgery for traumatic elbow injury.

BACKGROUND: Heterotopic ossification (HO) is a common complication after elbow fracture surgery and can lead to severe upper extremity disability. The radiographic localization of postoperative HO has been reported previously. However, there is no literature examining the distribution of postoperative HO at the three-dimensional (3D) level. This study aimed to investigate 1) the distribution characteristics of postoperative HO and 2) the possible risk factors affecting the severity of postoperative HO at a 3D level. METHODS: A retrospective review was conducted of patients who presented to our institution with HO secondary to elbow fracture between 13 January 2020 and 16 February 2023. Computed tomography scans of 56 elbows before elbow release surgery were reconstructed in 3D. HO was identified using density thresholds combined with manual identification and segmentation. The elbow joint and HO were divided into six regions according to three planes: the transepicondylar plane, the lateral ridge of the trochlear plane, and the radiocapitellar joint and coronoid facet plane. The differences in the volume of regional HO associated with different initial injuries were analyzed. RESULTS: Postoperative HO was predominantly present in the medial aspect of the capsule in 52 patients (93%), in the lateral aspect of the capsule in 45 patients (80%), in the medial supracondylar in 32 patients (57%), and in the lateral supracondylar, radial head, and ulnar region in the same number of 28 patients (50%). The median and interquartile range volume of total postoperative HO was 1683 (777-4894) mm3. The median and interquartile range volume of regional postoperative HO were: 584 (121-1454) mm3 at medial aspect of capsule, 207 (5-568) mm3 at lateral aspect of capsule, 25 (0-449) mm3 at medial supracondylar, 1 (0-288) at lateral supracondylar, 2 (0-478) at proximal radius and 7 (0-203) mm3 at the proximal ulna. In the subgroups with Injury Severity Score > or = 16, Gustilo-Anderson II, normal uric acid levels, elevated alkaline phosphatase, and body mass index > or = 24, the median HO volume exceeds that of the respective control groups. CONCLUSION: The medial aspect of the capsule was the area with the highest frequency and median volume of postoperative HO among all initial elbow injury types. Patients with higher Gustilo-Anderson grade, Injury Severity Score, alkaline phosphatase or Body Mass Index had higher median volume of postoperative HO.

Compartment syndrome after distal biceps brachii tendon rupture in an athlete / Síndrome compartimental em paciente atleta após ruptura do tendão distal do músculo bíceps do braço

ABSTRACT This is a case report of a previously healthy athlete who did not use oral anticoagulant, suffered a rupture of the distal biceps brachii tendon, and evolved with arm compartment syndrome. An emergency fasciotomy and the repair of the tendon were performed. After surgery the patient had a good recovery of the paresthesia and sensibility. This complication is rare and, when reported, is usually associated with patients who use anticoagulant therapy. Due to growth of rupture of distal biceps tendon cases, physicians should be aware that this complication must be treated as an emergency.

RESUMO Relato de caso de paciente atleta, previamente hígido e que não utilizava anticoagulantes orais, com lesão do tendão distal do músculo bíceps braquial, que evoluiu com síndrome compartimental do braço. Realizaram-se fasciotomia de emergência e reparo cirúrgico do tendão, apresentando bom seguimento com recuperação da parestesia e sensibilidade. Essa complicação é bastante rara e, quando relatada, geralmente é associada a pacientes em uso de medicamentos anticoagulantes orais. Contudo, com o aumento da incidência de rupturas do tendão do músculo bíceps braquial, é preciso estar atento à tal complicação que deve ser conduzida como emergência.

Quiste mediastínico de origen traumático: presentación caso clínico / Mediastinic cyst of traumatic origin: clinical case

Se presenta el caso de una menor de 16 años atropellada en el mes de Noviembre de 1999. La radiografía simple de tórax reveló una fractura de clavícula derecha, y como hallazgo se encontró una masa mediastínica anterosuperior hacia el lado derecho. Al no poder precisar si se trataba de una lesión preexistente se intervino, extirpándola por videotoracospía (VTC) derecha. La paciente evolucionó satisfactoriamente dándose de alta a las 48 horas de postoperada

Artroplastía de interposición con mínima resección ósea en el tratamiento de la artrosis postraumática del codo / Interposition plasty and minimal bone resection for treatment of the traumatic pseudoarthrosis of the elbow

Se realizó una evaluación retrospectiva en pacientes con diagnóstico de artritis traumática del codo a quienes se les realizó una artroplastía de interposición con resección mínima ósea como tratamiento para restaurar la función de la articulación en el periodo comprendido de mayo de 1995 a septiembre de 1997. Se incluyeron 10 pacientes 7 hombres y 3 mujeres con edades de 51 a 65 años, promedio 41.9, con afección predominante del codo derecho en 70 por ciento de los casos, con tiempo promedio de la lesión de 6.9 meses, con rigidez del codo en extensión en el 90 por ciento de los casos y un seguimiento postoperatorio promedio de 6.4 meses. La indicación quirúrgica se determinó de acuerdo con el grado de incapacidad funcional más que al grado de la sintomatología dolorosa. De acuerdo con la valoración funcional obtuvimos buenos resultados en el 60 por ciento de los casos, 30 por ciento regulares y 10 por ciento de malos resultados. Las complicaciones principales obtenidas fueron una dehiscencia de la herida quirúrgica en una paciente, una recidiva de la rigidez articular del codo en otro de los pacientes

Tratamento da distrofia simpático-reflexa no membro superior pelo programa de reabilitaçäo baseado no stresse muscular de traçäo e compressäo ativa / Reflex sympathetic dystrophy treatment on th upper limbs by a rehabilitation program based on muscle traction stress and compressive active traction: stress loading program

Foram avaliados 25 pacientes com distrofia simpático-reflexa pelo programa de reabilitaçäo baseado no estresse muscular de traçäo e compressäo ativa. Utilizou-se parâmetros clínicos para avaliar dor, edema, alteraçöes vasomotoras, a goniometria e oponência do polegar comparativos no pré e pós-tratamento. Concluímos que este programa mostrou-se eficaz na reduçäo da dor e normalizaçäo das alteraçöes vasomotoras, com ganho de amplitude articular, exceto em dois pacientes encaminhados tardiamente à terapia

Aneurisma traumático de la infancia: a propósito de un caso / Traumatic childhood aneurysm: report of a case

Se presenta un raro caso de aneurisma traumático en la arteria humeral en una infante de 18 meses de edad. Se describe el cuadro clínico, radiológico y la técnica quirúrgica aplicada en este caso. Se demuestran los resultados satisfactorios del tratamiento. Se hace un alerta a madres y pediátras de la posibilidad real de esta enfermedad. Se revisa la literatura médica nacional e internacional al respecto