ABSTRACT
Objective: To test the null hypothesis that patients with the terrible triad of the elbow (dislocation together with fractures of the radial head and coronoid process) who are treated with open reduction and internal fixation of the radial head have final results that are comparable with those of patients treated with arthroplasty or partial resection of the radial head. Methods: Twenty-six patients with the terrible triad of the elbow who were operated by a single surgeon were evaluated on average 23 months after the surgery (range: 16–36 months). There were 17 men and nine women of mean age 41 ± 13.4 years. The fractures of the radial head were treated by means of osteosynthesis (12 patients), arthroplasty (nine) or resection of a small fragment or no treatment (five). Fixation of the coronoid process/anterior capsule was performed in 21 patients. The lateral ligament complex (LLC) was repaired in all the patients, while the medial ligament complex (MLC) was repaired in three patients whose elbows remained unstable after treatment for the radial head and LLC, but without fixation of the coronoid process. Results: The mean final range of flexion and extension was 112°. The mean pronation was 70° and supination, 6°. The mean DASH score (Disabilities of the Arm, Shoulder & Hand) was 12 and mean MEPI (Mayo Elbow Performance Index) was 87. According to the MEPI scores, 21 patients (80%) had good and excellent results. There was no statistically significant difference in the results between the patients who underwent fixation of the radial head and those who underwent arthroplasty or resection of a small fragment. Conclusion: There was no difference between the patients treated with arthroplasty of the radial head and those treated with other techniques. .
Objetivo: Testar a hipótese nula de que os pacientes com a tríade terrível do cotovelo (luxação associada a fraturas da cabeça do rádio e do processo coronoide) tratados com redução aberta e fixação interna da cabeça do rádio têm resultado final comparável aos pacientes tratados com artroplastia ou ressecção parcial da cabeça do rádio. Métodos: Foram avaliados, em média aos 23 meses (16 a 36) após a cirurgia, 26 pacientes com a tríade terrível do cotovelo operados por um único cirurgião. Eram 17 homens e nove mulheres, com média de idade de 41 anos (± 13,4). As fraturas da cabeça do rádio foram tratadas com osteossíntese (12 pacientes), ou artroplastia (nove), ou ressecção de um fragmento pequeno ou nenhum tratamento (cinco). Fixação do processo coronoide/cápsula anterior foi feita em 21 pacientes. O complexo ligamentar lateral (LCL) foi reparado em todos os pacientes, enquanto que o complexo ligamentar medial (LCM) foi reparado em três pacientes cujos cotovelos persistiam instáveis após o tratamento da cabeça do rádio e do LCL, mas sem fixação do processo coronoide. Resultados: O arco final médio de flexão e extensão foi de 112°. A pronação média foi de 70° e a supinação, de 6°. O escore Dash (Disabilities of Arm, Shoulder & Hand) médio foi de 12 e o Mepi (Mayo Elbow Performance Index) médio foi de 87. De acordo com o Mepi, 21 pacientes (80%) tiveram bons e excelentes resultados. Não houve diferença estatisticamente significativa entre os resultados dos pacientes submetidos a fixação da cabeça do rádio e aqueles submetidos a artroplastia ou ressecção de um fragmento pequeno. Conclusão: Não há diferença ...
Subject(s)
Humans , Male , Female , Adolescent , Adult , Elbow Joint , Elbow/injuries , Joint DislocationsABSTRACT
The authors report two cases of osteosarcoma in the hand. They review the literature and show the different approaches to these rare lesions.