Evaluation of the ulna lengthening by distraction osteogenesis in congenital radial deficiency.

PURPOSE: Publications evaluating the results of the ulna lengthening in congenital radial deficiency are based only on small groups of subjects which yield statistical studies of low scientific value. The aim was to examine the effectiveness of ulna lengthening in radial longitudinal deficiency and determine the number and quality of complications based on one of the most numerous study groups described in the literature. METHODS: The material consists of a study group with 31 upper limbs of unmatured patients diagnosed with type III and IV radial longitudinal deficiency. The study group was evaluated based on the parameters known from the literature. The difficulties during elongation were classified according to Paley's classification. RESULTS: The study group contained patients with a mean age of 9 years, and the number of boys and girls was comparable. Ulna length significantly increased after elongation compared to the initial bone length. The patient's age didn't affect the ulna lengthening, and the amount of elongation didn't significantly affect the total stabilization period. However, the total stabilization time increased with increasing patient age. Difficulties affected more than half of the cases. CONCLUSIONS: Ulna elongation in congenital radial deficiency results in significant lengthening of the ulna, and thus the entire forearm, compared to the initial bone length. This technique has a high percentage of difficulty, so its use should be considered after cautious discussion with the parents and patients.

Clinical and functional evaluation of patients after total elbow arthroplasty.

BACKGROUND: The operation of the total elbow arthroplasty (TEA) is recommended in case of advanced joint destruction. At present both in our country and abroad, the number of elbow arthroplasties performed per year is increasing. Surgical procedures are difficult, and postoperative complications may arise. The aim of this study is to evaluate the function of the elbow and the clinical status of patients after having undergone TEA. MATERIAL/METHODS: Our research is based on 18 patients who had undergone total elbow arthroplasty. The average patient age was 60. The follow-up time varied from 8-108 months. Postoperative assessment included the evaluation of the range of motion and grip strength using a dynamometer. Functional evaluation was carried out using Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) and the SECEC Elbow Score (SES). We had also assessed the pain level (VAS), postoperative complications and patient satisfaction. The study included X-rays of the elbow for the evaluation of prosthesis integrity and possible signs of implant loosening. RESULTS: The increase of the range of motion was seen among all patients. The amplitude of flexion and extension increased by an average of 25.3° (p<0.02). The results of all questionnaires of functional assessment showed a significant improvement comparing to results before surgery: DASH - 82.6 (±24.6) vs. 116.7 (±24.2), SECEC - 39.3 (±8.5) vs. 27.9 (±9.2), MEPS - 65 (±23.3) vs. 35.8 (±16.9). The VAS pain decreased from 10.9 (±3) to 5.3 (±4). In the postoperative period, 4 patients experienced inflammation, 2 patients had a loosening of prosthesis, and 6 needed a revision of the prosthesis. 94.4% patients were satisfied with the treatment. CONCLUSIONS: Total elbow arthroplasty effectively improves the clinical status of the patient by reducing pain, increasing range of motion and improving many activities of daily life.