Outcomes of Arthroscopic Elbow Contracture Release: Improvement for Severe Prosupination and Flexion Contracture.

PURPOSE: The purpose of this study was to investigate outcomes following arthroscopic elbow contracture release to describe the use of arthroscopy for improvement in extension/flexion and pronation/supination arcs of motion at a single institution for degenerative and posttraumatic etiologies. METHODS: Consecutive arthroscopic elbow arthrolysis performed between 2003 and 2015 were retrospectively reviewed. Basic patient demographics, indications for surgery, preoperative and postoperative elbow range of motion, postoperative patient outcome score, and all complications were recorded and analyzed. RESULTS: Fifty-two patients were included with an average follow-up of 5.1 years (range 1.4 to 9.4). Severe contractures made up 50% of cases, followed by 23% moderate, and 27% mild. Average extension/flexion for the post-traumatic group (n = 30) increased by 63° ± 31 and by 29° ± 24 for the degenerative group (n = 22). Average gain in pronosupination was 38° ± 62 in the post-traumatic group and 13°±23 in the degenerative group. Postoperative DASH scores were 17.5 ± 18.4 for post-traumatic cases and 12.8 ± 19.3 for degenerative cases. CONCLUSION: Arthroscopic elbow contracture release is an effective intervention for degenerative and post-traumatic elbow contracture for both flexion/extension and pronosupination contracture. Furthermore, a two-stage release should be considered when both flexion and pronosupinaton contractures are present. LEVEL OF EVIDENCE: IV, case series, treatment study.

Update on advances in upper extremity prosthetics.

Upper extremity amputations are common. Fortunately, most of these involve loss of only a finger or portion thereof. Hand and upper limb surgeons are best suited to lead the team and help these patients following these injuries. Proximal amputations can be devastating for the patient, but recent prosthetic advances have helped many patients lead a better life and, often, return to activities they were involved in before their amputation. The purpose of this article is to review the current prostheses available for upper extremity amputees.

A technique for humeral prosthesis placement in reverse total shoulder arthroplasty for fracture.

Recent trends have illustrated the benefits of treating displaced fractures of the proximal humerus with reverse total shoulder arthroplasty. Clinical results have demonstrated reliable restoration of function in situations where results following hemiarthroplasty have been variable and difficult to predict. Data have demonstrated landmarks to assist with humeral stem height in hemiarthroplasty. However, intraoperative landmarks to guide placement of the humeral component in reverse shoulder arthroplasty have not been described. In this technique, the superior border of the pectoralis tendon is utilized. A distance of 5.0 cm is used to assist in placement of the most superior aspect of the metallic humeral component and with humeral stem version. This technique can be used as a guide to assist a treating physician in situations where bony fracture and comminution make humeral stem height placement difficult to judge.

Accuracy and Reliability of Radiographic Estimation of Volar Lip Fragment Size in PIP Dorsal Fracture-Dislocations.

Background: A cadaveric study was performed to evaluate the accuracy and reliability of radiographic estimation of the volar lip fragment size in proximal interphalangeal joint fracture-dislocations. Methods: Middle phalangeal base volar lip fractures of varying size and morphology were simulated in 18 digits. Radiographs and digital photographs of the middle phalangeal joint surface were obtained pre- and postinjury. Ten orthopedic surgeons of varying levels of training estimated the fracture size based on radiographs. The estimated joint involvement on radiograph was compared with the digitally measured joint involvement. Results: Radiographic estimation underestimated the volar lip fragment size by 9.02%. Estimations possessed high intraobserver (0.76-0.98) and interobserver (0.88-0.97) reliabilities. No differences were detected between levels of surgeon training. Conclusions: The significant underestimation of the volar lip fragment size demonstrates the lack of radiographic estimation accuracy and suggests that surgeons should be mindful of these results when making treatment plans.