Clinical outcomes for linked fixation of distal humerus fractures: a multicenter study.

BACKGROUND: O'Driscoll popularized the principle of linked column fixation for distal humerus fractures. Despite the linked column concept being widely accepted, there are few reported techniques to accomplish this goal. A novel device was designed based on the principles of linked columns. An interlocking beam is used to connect the medial and lateral plates, creating a unified fixed angle construct. Our primary objective was to report clinical outcomes across multiple institutions for a linking beam used in distal humerus fracture fixation. METHODS: A retrospective series was collected from 5 institutions for the TiBeam (Skeletal Dynamics) with a minimum follow-up of 6 months. Acute and chronic treatment of distal humerus fracture patterns and all plate configurations were included for analysis. RESULTS: A total of 36 cases were collected at a mean age of 52 years and a mean follow-up of 19.3 months. AO C-type fractures were 56% of the series. The median Mayo Elbow Performance Score was 85 (interquartile range [IQR] 76.3-90), the median DASH was 21.4 (IQR 15.9-30), and the median score on the visual analog scale for pain during activities of daily living was 3.5 (IQR 2-5). An olecranon osteotomy was used in 86% of cases, and an anatomic plate was used for fixation of the osteotomy in 94% of those cases. There were 3 cases of olecranon plate removal for a rate across the series of 13.7%. DISCUSSION: Our short-term results demonstrate satisfactory clinical outcomes with low rates of revision for distal humerus fracture fixed with a linking beam. Further, the rate of removal for the olecranon osteotomy plate was lower than historical reports for aggregate methods of osteotomy fixation.

The impact of anatomic alignment on radiocapitellar pressure following radial head arthroplasty.

BACKGROUND: The incidence of radial head fractures is increasing, and radial head arthroplasty (RHA) is being more frequently used as treatment for irreparable fractures. Our objective was to compare radiocapitellar pressure between the native joint and 2 radial head prosthesis conditions: (1) a prosthetic head that was aligned to the forearm axis of rotation and (2) the same prosthesis with an axisymmetric nonaligned head. METHODS: Ten cadaveric specimens received a pressfit radial head prosthesis (Align; Skeletal Dynamics) for both prosthetic testing conditions. Anatomic alignment (AL) was defined as the prosthetic head aligned to the forearm axis of rotation. Axisymmetric alignment (AX) was defined as the prosthetic radial head aligned to the axis of the prosthetic stem. Axial load was applied with the elbow in extension and the forearm pronated. Data were collected using a Tekscan 4000 sensor. RESULTS: The mean pressure in the AL and AX groups were significantly higher than the mean pressure in the native joint. Compared with the native joint, the mean pressure was 19% higher in the AL group and 56% higher in the AX group. Peak pressure beyond 5 MPa occurred in 0 specimens in the native joint group, in 1 specimen (10%) in the AL group, and in 5 specimens (50%) in the AX group. DISCUSSION: Our results demonstrated that a pressfit radial head prosthesis aligned with the forearm axis of rotation yields capitellar pressures that were more similar to the native condition than a nonaligned pressfit prosthesis. These findings suggest that anatomic alignment may optimize capitellar wear properties, improving the long-term durability of radial head arthroplasty.

Multifocal eosinophilic granuloma with femoral epiphyseal lesion mimicking an aneurysmal bone cyst.

Eosinophilic granuloma (EG) is a rare benign tumor-like disorder characterized by abnormal proliferation Langerhans cells. EG frequently presents as a solitary lesion in the axial skeleton and diaphysis long bones. Here we present the case of a 14-year-old male with multifocal EG with a lesion located in the femoral epiphysis mimicking an aneurysmal bone cyst that presented a diagnostic challenge. While the initial presentation of EG patients may appear uncommon, its overlapping features with other benign and malignant etiologies highlight the importance of increased awareness of this condition, as well as the need for an experienced multidisciplinary team in its diagnosis and treatment.

Sclerosis of the clavicle--A challenging diagnosis.

Condensing osteitis of the clavicle is a rare benign disease described as an increase in bone density at the medial end of the clavicle. Its clinical and radiographic presentation can frequently be equivocal and tissue sampling is necessary for diagnostic confirmation. Here we present the case of a 29-year-old female with condensing osteitis of the right medical clavicle, who remained undiagnosed for many years despite obtaining imaging studies and undergoing an initial biopsy. This disease presents oftentimes a challenging diagnosis due to its imaging features overlapping with many benign and malignant bone lesions. A qualified multidisciplinary team with expertise in rare bone conditions becomes oftentimes essential to arrive at an accurate diagnosis.