Acute Distal Biceps Tendon Injury: Diagnosis and Treatment / Lesões agudas do tendão distal do bíceps: Diagnóstico e tratamento

Abstract Acute distal biceps injuries clinically present with sudden pain and acute loss of flexion and supination strength. The main injury mechanism occurs during the eccentric load of the biceps. The hook test is the most significant examination test, presenting the highest sensibility and specificity for this lesion. Magnetic resonance imaging, the gold standard imaging test, can provide information regarding integrity and identify partial and/or complete tears. The surgical treatment uses an anterior or double approach and several reattachment techniques. Although there is no clinical evidence to recommend one fixation method over the other, biomechanical studies show that the cortical button resists better to failure. Although surgical treatment led to an 89% rate of return to work in 14 weeks, the recovery of high sports performance occurred in 1 year, with unsustainable outcomes.

Resumo As lesões agudas do tendão distal do bíceps se apresentam, clinicamente, com uma dor súbita associada a perda aguda de força de flexão e supinação. Seu principal mecanismo de lesão ocorre durante contração excêntrica do bíceps. O "Hook Test" é o principal teste semiológico, sendo o mais sensível e específico. A ressonância magnética, exame padrão ouro para o diagnóstico, pode fornecer informações sobre a integridade, identificando as lesões parciais e/ou completas. O tratamento cirúrgico pode ser realizado por duas vias principais: anterior e por dupla via porém as técnicas de reinserção tendínea são diversas não havendo evidência clínica que recomende um método de fixação em detrimento ao outro; embora o botão cortical apresente maior resistência a falha nos estudos biomecânicos. Com o tratamento cirúrgico o retorno as atividades laborais foi de 89% em 14 semanas (média) porém ao esporte de alto rendimento o prazo foi longo, média de 1 ano, e não duradouro.

Total Arthroplasty in Complex Elbow Injury / Artroplastia total na lesão complexa do cotovelo

Abstract The authors present an atypical case of a left elbow complex fracture with extensive loss of bone and muscle tissue. The patient was submitted to several surgical procedures, which resulted in a total arthroplasty of the left elbow with triceps reconstruction using a semitendinosus muscle tendon graft.

Resumo Os autores apresentam um caso atípico de fratura complexa do cotovelo esquerdo com perda extensa de tecido ósseo e muscular. O paciente foi submetido a diversos procedimentos cirúrgicos, que resultaram em uma artroplastia total do cotovelo esquerdo associada à reconstrução do tríceps com enxerto do tendão do músculo semitendíneo.

Multidirectional Instability in a Neglected Elbow Dislocation Managed with Circumferential Ligament Reconstruction. A Case Report / Instabilidade multidirecional em uma luxação negligenciada do cotovelo gerenciada com reconstrução do ligamento circunferencial. Um relato de caso

Abstract Neglected elbow dislocation is an uncommon condition and its treatment remains challenging. We present a case of a middle-aged woman presenting with neglected elbow dislocation and multi-direction instability in whom open reduction of the elbow joint and circumferential ligamentous reconstruction with a gracilis tendon graft was done. The functional outcome assessed with the Mayo elbow performance index was excellent. This circumferential technique is undoubtedly a viable technique and the indications can be extended to even manage a neglected dislocation. This procedure reduces the need or diminishes the duration of external fixation requirement and thereby encourages early mobilization.

Resumo A luxação negligenciada do cotovelo é uma condição incomum e seu tratamento permanece desafiador. Apresentamos o caso de uma mulher de meia-idade que apresentou luxação negligenciada do cotovelo e instabilidade multidirecional, na qual foi realizada redução aberta da articulação do cotovelo e reconstrução ligamentar circunferencial com enxerto de tendão gracilis. O resultado funcional avaliado com o índice de desempenho do cotovelo de Mayo foi excelente. Essa técnica circunferencial é, sem dúvida, uma técnica viável e as indicações podem ser estendidas para gerenciar até mesmo um deslocamento negligenciado. Este procedimento reduz a necessidade ou diminui a duração da exigência de fixação externa e, assim, incentiva a mobilização precoce.

Patella cubiti - a continuing etiological mystery / Patella cubiti: un misterio etiológico continuo

SUMMARY: A sesamoid bone in the elbow joint is a rare anatomical variation described as a Patella cubiti. Although this variation has been known for centuries its exact etiology is still unclear. Congenital, developmental, and traumatic hypotheses have been proposed. It seldom causes clinical manifestations than elbow stiffness or hypomobility. Herein, we present a case of a 31-year-old patient admitted to our department with complaints of swelling and erythema in the right elbow. An X-ray image revealed a triangular accessory bone with rounded edges, which was diagnosed as a Patella cubiti in combination with olecranon bursitis. Knowledge of this rare elbow abnormality is paramount for orthopedic surgeons and roentgenologists in their daily medical practice.

Un hueso sesamoideo en la articulación del codo es una rara variación anatómica descrita como Patella cubiti. Aunque esta variación se conoce desde hace siglos, su etiología exacta aún no está clara. Se han propuesto hipótesis congénitas, de desarrollo y traumáticas. Rara vez causa manifestaciones clínicas que no sean rigidez o hipomovilidad del codo. Presentamos el caso de un paciente de 31 años que ingresó en nuestro servicio por presentar tumefacción y eritema en el codo derecho. Una imagen de rayos X reveló un hueso accesorio triangular con márgenes redondeados, que se diagnosticó como una Patella cubiti en combinación con bursitis del olécranon. El conocimiento de esta rara anomalía del codo es fundamental para los cirujanos ortopédicos y los médicos radiólogos en su práctica médica diaria.

Postoperative Functional Evaluation in Patients Undergoing Surgical Treatment of the Terrible Triad Injury of the Elbow / Avaliação funcional pós-operatória em pacientes submetidos a tratamento cirúrgico da tríade terrível do cotovelo

Abstract Objective To evaluate the functional results of patients submitted to a surgical approach for the treatment of the terrible triad of the elbow, analyzing the treatment methods used and associated epidemiological variables. Methods Patients who underwent surgical treatment for the terrible triad of the elbow from February 2018 to June 2020 at our service were evaluated. The identified sample consisted of 17 patients, but of these, only 13 completed all stages of the study and, therefore, were considered as the universe to be considered. Epidemiological information of interest was collected: age, sex, hand of dominance, affected side, characteristics and classification of injuries, trauma mechanism, time to surgery, type of procedure performed and range of motion. The Mason classification was used for radial head fractures and the Regan and Morrey classification for the coronoid process. In order to perform a functional analysis, the DASH and BRUCE questionnaires were applied. Results About 77% of the patients were male, 92% of the fracture mechanisms were due to high-energy trauma. Contrary to this, the predominance of the non-dominant side was observed as the most affected. Evaluating the results according to the time to start the treatment, the patients operated within 14 days had statistically better functional results. Conclusion Surgical treatment of TTIE generates acceptable functional results in most cases. The success of the treatment is related to the time interval between the trauma and the first surgery, in addition to the severity of the injuries.

Resumo Objetivo Avaliar os resultados funcionais dos pacientes submetidos a abordagem cirúrgica para o tratamento da tríade terrível do cotovelo, analisando os métodos de tratamento utilizados e variáveis epidemiológicas associadas. Métodos Foram avaliados pacientes submetidos aotratamento cirúrgico de tríade terrível do cotovelo de fevereiro de 2018 a junho de 2020 em nosso serviço. A amostra identificada foi de 17 pacientes, mas destes apenas 13 concluíram todas as etapas das pesquisas e por isso foram considerados como o universo a ser levado em consideração. Coletou-se informações epidemiológicas de interesse: idade, sexo, dominância, lado acometido, características e classificações das lesões, mecanismo do trauma, tempo para cirurgia, tipo de procedimento realizado e o arco de movimento. Foi utilizada a classificação de Mason para a fratura de cabeça do rádio e a de Regan e Morrey, para o processo coronoide. A fim de realizar uma análise funcional, aplicou-se os questionários de DASH e BRUCE. Resultados Cerca de 77% dos pacientes foram do sexo masculino, 92% dos mecanismos de fratura foram por trauma de alta energia. Contrariamente a esta, observou-se a predominância do lado não dominante como o mais afetado. Avaliando os resultados de acordo com o tempo para início do tratamento, os pacientes operados em até 14 dias obtiveram resultados funcionais estatisticamente melhores. Conclusão O tratamento cirúrgico da TTC gera resultados funcionais aceitáveis na maioria dos casos. O sucesso do tratamento está relacionado ao intervalo de tempo entre o trauma e a primeira cirurgia, além de se relacionar com a gravidade das lesões.

PACS and Photoshop assisted isosceles triangle osteotomy and Kirschner wire tension buckle fixation in the treatment of cubitus varus in children / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy of picture archiving and communication system (PACS) and Photoshop assisted isosceles triangle osteotomy and Kirschner wire fixation with tension band in the treatment of cubitus varus in children.@*METHODS@#The clinic data of 20 children with cubitus varus treated with isosceles triangle osteotomy of distal humerus and Kirschner wire fixation with tension band from October 2014 to October 2019, were retrospectively analyzed. There were 13 males and 7 females, aged from 3.2 to 13.5 years old, the median age was 6.65 years old. PACS system was applied for the osteotomy design preoperatively, simulating and measuring the side length of isosceles triangle osteotomy. Then, Photoshop system was used to simulate the preoperative and postoperative osteotomy graphics, which could guide precise osteotomy during operation.@*RESULTS@#All the 20 patients were followed up for 20 to 24 months, with a median of 22.5 months. At the last follow-up, the carrying angle of the affected limb was 5 ° to 13 °, with a median of 8.3 °. The clinical efficacy was evaluated according to the Flynn elbow function score:excellent in 16 cases, good in 2 cases, and fair in 2 cases.@*CONCLUSION@#The treatment of cubitus varus in children by isosceles triangle osteotomy and Kirschner wire fixation with tension band assisted by PACS and Photoshop system has shown good clinical outcome.

Olecranon osteotomy approach for Dubberley type Ⅲ coronal fractures of the distal humerus / 中国骨伤

OBJECTIVE@#To retrospectively analyze the clinical efficacy of olecranon osteotomy approach in the treatment of Dubberley type Ⅲ coronal fractures of the distal humerus and summarize the treatment experience.@*METHODS@#From January 2016 to June 2020, 17 patients (5 males and 12 females) with Dubberley type Ⅲ coronal fractures of the distal humerus were treated by olecranon osteotomy approach. The age ranged from 37 to78 years old with an average of (58.5±12.9) years old. According to Dubberley classification, there were 5 cases of type Ⅲ A and 12 cases of type Ⅲ B. The curative effect was evaluated using the Borberg-Morrey elbow function score. The flexion, extension and rotation range of motion of the elbow joint, complications and postoperative imaging evaluation were recorded.@*RESULTS@#All the 17 patients got bony union. The follow-up time ranged from 12 to 33 months with an average of (15.6±5.6) months. There was 1 case of ischemic necrosis of capitulum humeri, 2 cases of traumatic arthritis and 1 case of heterotopic ossification, 1 case of malunion of fracture. The range of motion was (114.80±19.50) °. The Broberg-Morrey score was 85.3±8.2, excellent in 5 cases, good in 9 cases, fair in 3 cases and poor in 0 case.@*CONCLUSION@#Through olecranon osteotomy approach, the articular surface of distal humerus could be fully exposed, and the operation is convenient. Anatomical reduction and rigid fixation of the articular surface of distal humerus are the key factors for the succesful outcome.

Correlation between Elbow Flexor Muscle Strength and Needle Electromyography Parameters after Musculocutaneous Nerve Injury / 法医学杂志

OBJECTIVES@#To explore the changes of elbow flexor muscle strength after musculocutaneous nerve injury and its correlation with needle electromyography (nEMG) parameters.@*METHODS@#Thirty cases of elbow flexor weakness caused by unilateral brachial plexus injury (involving musculocutaneous nerve) were collected. The elbow flexor muscle strength was evaluated by manual muscle test (MMT) based on Lovett Scale. All subjects were divided into Group A (grade 1 and grade 2, 16 cases) and Group B (grade 3 and grade 4, 14 cases) according to their elbow flexor muscle strength of injured side. The biceps brachii of the injured side and the healthy side were examined by nEMG. The latency and amplitude of the compound muscle action potential (CMAP) were recorded. The type of recruitment response, the mean number of turns and the mean amplitude of recruitment potential were recorded when the subjects performed maximal voluntary contraction. The quantitative elbow flexor muscle strength was measured by portable microFET 2 Manual Muscle Tester. The percentage of residual elbow flexor muscle strength (the ratio of quantitative muscle strength of the injured side to the healthy side) was calculated. The differences of nEMG parameters, quantitative muscle strength and residual elbow flexor muscle strength between the two groups and between the injured side and the healthy side were compared. The correlation between elbow flexor manual muscle strength classification, quantitative muscle strength and nEMG parameters was analyzed.@*RESULTS@#After musculocutaneous nerve injury, the percentage of residual elbow flexor muscle strength in Group B was 23.43% and that in Group A was 4.13%. Elbow flexor manual muscle strength classification was significantly correlated with the type of recruitment response, and the correlation coefficient was 0.886 (P<0.05). The quantitative elbow flexor muscle strength was correlated with the latency and amplitude of CMAP, the mean number of turns and the mean amplitude of recruitment potential, and the correlation coefficients were -0.528, 0.588, 0.465 and 0.426 (P<0.05), respectively.@*CONCLUSIONS@#The percentage of residual elbow flexor muscle strength can be used as the basis of muscle strength classification, and the comprehensive application of nEMG parameters can be used to infer quantitative elbow flexor muscle strength.

Limited internal fixation combined with a hinged external fixator in treatment of peri-elbow bone infection / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the effectiveness of limited internal fixation combined with a hinged external fixator in the treatment of peri-elbow bone infection.@*METHODS@#The clinical data of 19 patients with peri-elbow bone infection treated with limited internal fixation combined with a hinged external fixator between May 2018 and May 2021 were retrospectively analyzed. There were 15 males and 4 females with an average age of 44.6 years (range, 28-61 years). There were 13 cases of distal humerus fractures and 6 cases of proximal ulna fractures. All the 19 cases were infected after internal fixation of fracture, and 2 cases were complicated with radial nerve injury. According to Cierny-Mader anatomical classification, 11 cases were type Ⅱ, 6 cases were type Ⅲ, and 2 cases were type Ⅳ. The duration of bone infection was 1-3 years. After primary debridement, the bone defect was (3.04±0.28) cm, and the antibiotic bone cement was implanted into the defect area, and the external fixator was installed; 3 cases were repaired with latissimus dorsi myocutaneous flap, and 2 cases were repaired with lateral brachial fascial flap. Bone defects repair and reconstruction were performed after 6-8 weeks of infection control. The wound healing was observed, and white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reaction protein (CRP) were reexamined regularly after operation to evaluate the infection control. X-ray films of the affected limb were taken regularly after operation to observe the bone healing in the defect area. At last follow-up, the flexion and extension range of motion and the total range of motion of the elbow joint were observed and recorded, and compared with those before operation, and the function of the elbow joint was evaluated by Mayo score.@*RESULTS@#All patients were followed up 12-34 months (mean, 26.2 months). The wounds healed in 5 cases after skin flap repair. Two cases of recurrent infection were effectively controlled by debridement again and replacement of antibiotic bone cement. The infection control rate was 89.47% (17/19) in the first stage. Two patients with radial nerve injury had poor muscle strength of the affected limb, and the muscle strength of the affected limb recovered from grade Ⅲ to about grade Ⅳ after rehabilitation exercise. During the follow-up period, there was no complication such as incision ulceration, exudation, bone nonunion, infection recurrence, or infection in the bone harvesting area. Bone healing time ranged from 16 to 37 weeks, with an average of 24.2 weeks. WBC, ESR, CRP, PCT, and elbow flexion, extension, and total range of motions significantly improved at last follow-up ( P<0.05). According to Mayo elbow scoring system, the results were excellent in 14 cases, good in 3 cases, and fair in 2 cases, and the excellent and good rate was 89.47%.@*CONCLUSION@#Limited internal fixation combined with a hinged external fixator in the treatment of the peri-elbow bone infection can effectively control infection and restore the function of the elbow joint.

The Baumann Angle: An Analysis from Theory to Practice / O ângulo de Baumann: Uma análise da teoria à prática

Abstract Objective To analyze how the Baumann angle (BA) is affected by inadequate radiographic inclinations. Methods The study was performed from radiographs of the distal humerus of children aged 3 to 10 years. The BA measurements performed by five observers were compared, and each radiograph was evaluated for its quality as "adequate" or "inadequate." The correlation between radiographic quality and the normality of the angles was evaluated. Results Sample was composed of 141 patients, 44% between 3 and 6 years of age and 56% between 7 and 10. We observed the BA between 52.01 and 89.82 degrees, with about 16% of the measurements outside the normal limits of the literature. A total of 33.3% of the evaluated radiographs were classified as "inadequate". On the BA measurements outside the normality parameter, we observed that its proportion was higher among images with inadequate radiographic quality (31.1 vs. 6.2%), and this difference was significant (p< 0.001). Conclusions The BA is a very variable measurement and, alone, it is unreliable for the evaluation of angular deformities of the pediatric elbow, with radiographic quality proven to be an important causal factor of this variability.

Resumo Objetivo Analisar como o ângulo de Baumann (AB) é afetado por inclinações radiográficas inadequadas. Métodos Estudo realizado a partir de radiografias do úmero distal de crianças de 3 a 10 anos. Foram comparadas as aferições do AB realizadas por cinco observadores, e cada radiografia foi avaliada quanto à sua qualidade em "adequada" ou "inadequada". A correlação entre a qualidade radiográfica e a normalidade dos ângulos foi avaliada. Resultados Amostra composta por 141 pacientes, 44% entre 3 e 6 anos e 56% entre 7 e 10. Observamos AB entre 52,01 e 89,82 graus, tendo cerca de 16% das medidas fora dos limites de normalidade da literatura. Um total de 33,3% das radiografias avaliadas foram classificadas como "inadequadas". Sobre as medidas do AB fora do parâmetro da normalidade, observamos que sua proporção foi maior entre as imagens com qualidade radiográfica inadequada (31,1% vs. 6,2%), tendo essa diferença se mostrado significativa (p< 0,001). Conclusões O AB é uma medida muito variável e, isoladamente, pouco confiável para a avaliação de deformidades angulares do cotovelo pediátrico, tendo a qualidade radiográfica se mostrado um fator causal importante dessa variabilidade.

Luxaciones complejas de codo con inestabilidad póstero-lateral: ¿cuáles son las mejores opciones de tratamiento? revisión bibliográfica sistematizada / Complex elbow dislocations with postero-lateral instability: what are the best treatment options? systematized bibliographic review / Luxações complexas do cotovelo com instabilidade póstero-lateral: quais são as melhores opções de tratamento? revisão bibliográfica sistematizada

Introducción: El 25% de las luxaciones de codo corresponden a luxaciones complejas, que se definen como aquellas luxaciones que se acompañan de lesiones óseas, siendo las mismas más inestables que la luxaciones puras o simples. Estas lesiones han planteado un importante desafío terapéutico, ya que históricamente se han obtenido pobres resultados funcionales. El objetivo de este trabajo es revisar la bibliografía acerca del tratamiento de las luxaciones complejas de codo con inestabilidad posterolateral, y valorar los resultados de las múltiples opciones terapéuticas. Materiales y Métodos: Se realizó la búsqueda sistematizada utilizando el buscador PubMed, obteniéndose un total de 1450 artículos, de los cuales 32 cumplieron con los criterios de inclusión y exclusión establecidos. Resultados: Los estudios analizados fueron de bajo nivel de evidencia, III o IV, correspondiendo en su mayoría a series de casos retrospectivos. Destaca la gran cantidad de variantes terapúticas existentes, con diferentes protocolos terapéuticos, que arrojan resultados funcionales similares. Conclusiones: Las luxaciones complejas del codo corresponden a lesiones complejas, capaces de causar secuelas funcionales importantes en los pacientes. El establecimiento de protocolos terapéuticos es clave para obtener mejores resultados funcionales.

Introduction: 25% of elbow dislocations correspond to complex dislocations, which are defined as those dislocations that are accompanied by bone injuries, being more unstable than pure or simple dislocations. These lesions have set an important therapeutic challenge, since historically poor functional results have been obtained. The objective of this study is to review the literature on the treatment of complex elbow dislocations with posterolateral instability, and to assess the results of the multiple therapeutic options. Materials and Methods: The systematized search was carried out using the Pubmed search engine, obtaining a total of 1450 articles, of which 32 met the established inclusion and exclusion criteria. Results: The studies analyzed were of a low level of evidence, III or IV, corresponding mostly to retrospective case series. The large number of existing therapeutic variants stands out, with different therapeutic protocols, which yield similar functional results. Conclusions: Complex elbow dislocations correspond to complex injuries, capable of causing important functional sequelae in patients. The establishment of therapeutic protocols is key to obtaining better functional results.

Introdução: 25% das luxações do cotovelo correspondem a luxações complexas, que são definidas como aquelas luxações acompanhadas de lesões ósseas, sendo as mesmas mais instáveis ​​que as luxações puras ou simples. Essas lesões representam um importante desafio terapêutico, uma vez que resultados funcionais historicamente ruins têm sido obtidos. O objetivo deste trabalho é revisar a literatura sobre o tratamento das luxações complexas do cotovelo com instabilidade póstero-lateral e avaliar os resultados das múltiplas opções terapêuticas. Materiais e Métodos: Foi realizada uma busca sistematizada por meio do mecanismo de busca PubMed, obtendo-se um total de 1450 artigos, dos quais 32 atenderam aos critérios de inclusão e exclusão estabelecidos. Resultados: Os estudos analisados ​​foram de baixo nível de evidência, III ou IV, correspondendo em sua maioria a séries de casos retrospectivas. Destaca-se o grande número de variantes terapêuticas existentes, com diferentes protocolos terapêuticos, que apresentam resultados funcionais semelhantes. Conclusões: As luxações complexas do cotovelo correspondem a lesões complexas, capazes de causar sequelas funcionais importantes nos pacientes. O estabelecimento de protocolos terapêuticos é fundamental para obter melhores resultados funcionais.

Does range of motion measurement and reference values differ?: a multi-centered study

This study is aimed to estimate and measure reference values in the normal range of motion of extremity joints in females and to provide a database for the assessment of impairments related to the mobility of the joints. This observational cross-sectional study was conducted at seven major educational institutes areas of Rawalpindi and Islamabad in Pakistan from January to June 2020 with a sample size of 600 healthy females aged 15 to 45 years and divided into three groups through non-probability sampling technique. In study Instruments, an electronic Goniometer was used for the measurement of the range of motions for different joints and then those ranges were recorded. The questionnaire had two sections demographic characteristics and ROM for both upper and lower limbs. Data was analyzed using SPSS V21. A p < 0.05 was considered statistically significant.In the result,Out of 600 participants,there was a statistically significant difference of (p < 0.001) in both upper and lower extremities motion between all the three groups for the measurements and noticeably no significant difference (p > 0.005) between group 1, 2 comparisons for the knee joint extension.To conclude, In most joints, the range of motion increases with age. The transition from group 1 to group 2 was aided by increased hormone participation in growth, an active lifestyle, and generally good health. Because of degenerative changes and joint stiffness, group 3's range of motion deteriorated, leading to a sedentary lifestyle and lack of physical activity. Standardized biomechanical measurements can help health practitioners, such as physiotherapists, choose appropriate therapy interventions to assess musculoskeletal disorders. To resolve the inconsistencies in the reliability and validity of goniometry values, more research is required.

Neurotizaciones para la flexión del codo en lesiones traumáticas del plexo braquial / Nerve transfers for elbow flexion in traumatic brachial plexus injuries

Objetivo: Evaluar los resultados de diferentes neurotizaciones utilizadas para la flexión del codo en pacientes con lesión traumática del plexo braquial. materiales y métodos: Entre abril de 2012 y enero de 2019, se operaron 13 pacientes (12 hombres) con lesión traumática del plexo braquial, 5 con parálisis totales sin recuperación, 4 con parálisis totales que recuperaron el tronco inferior parcialmente y 4 con parálisis altas. Las neurotizaciones para la flexión del codo fueron: 3 nervios intercostales con injerto sural a nervio musculocutáneo o su(s) rama(s) motora(s) (4 pacientes), 3 nervios intercostales a nervio musculocutáneo sin injerto (3 pacientes), nervio espinal accesorio a ramas motoras del nervio musculocutáneo con injerto sural (2 pacientes), fascículos del nervio cubital a rama motora del bíceps (3 pacientes) y fascículos del nervio cubital y fascículos del nervio mediano a ramas motoras del bíceps y braquial anterior (3 pacientes). Se evaluaron la fuerza de flexión del codo (M0-M5), el dolor con la escala analógica visual y se utilizó el puntaje DASH. El seguimiento promedio fue de 50 meses. Resultados: La fuerza de flexión del codo fue M5 (1 paciente), M4 (7 pacientes), M3 (1 paciente), M2 (1 paciente) y M1 (2 pacientes). El puntaje DASH promedio fue de 54,1 antes de la cirugía y 29,5 en el posoperatorio. El puntaje de dolor preoperatorio fue de 7 y de 0,9 posoperatorio. No hubo complicaciones. Conclusiones: Las neurotizaciones lograron resultados satisfactorios en la reconstrucción de la flexión activa del codo en pacientes con lesión del plexo braquial. Nivel de Evidencia: IV Serie de casos

Objective: To evaluate the results of different nerve transfers used for elbow flexion in patients with traumatic brachial plexus injury. Materials and methods: Between April 2012 and January 2019, 13 patients (12 men) with traumatic brachial plexus injury underwent surgery. 5 patients had total paralysis and did not recover, 4 had total paralysis and partially recovered the lower trunk, and 4 had high paralysis. The nerve transfers performed for elbow flexion were: 3 intercostal nerves with a sural graft to the musculocutaneous nerve or its motor branch(es) (4 patients), 3 intercostal nerves to the musculocutaneous nerve without graft (3 patients), the accessory spinal nerve to motor branches of the musculocutaneous nerve with sural graft (2 patients), fascicles of the ulnar nerve to the motor branch of the biceps (3 patients) and fascicles of the ulnar nerve and fascicles of the median nerve to the motor branches of the biceps and anterior brachialis (3 patients). We assessed elbow flexion strength (M0-M5), pain on the visual analog scale, and DASH score. The average follow-up was 50 months. Results: Elbow flexion strength was M5 (1 patient), M4 (7 patients), M3 (1 patient), M2 (1 patient), and M1 (2 patients). The mean DASH score was 54.1 before surgery and 29.5 postoperatively. The preoperative pain score was 7 and 0.9 postoperatively. There were no complications. Conclusions: Nerve transfers achieved satisfactory outcomes for active elbow flexion reconstruction in patients with brachial plexus injury. Level of Evidence: IV Case report

Fracturas de olécranon. Nueva alternativa terapéutica / Olecranon fractures. A new therapeutic alternative

Introducción: Las fracturas de olécranon desplazadas mayoritariamente requieren de fijación quirúrgica. Las técnicas más usadas son las clavijas con alambre en 8 y las placas anatómicas, pero están asociadas a altas tasas de insatisfacción por irritación de las partes blandas. Una nueva opción quirúrgica es la fijación con suturas de alta resistencia y tornillo canulado. El objetivo de este estudio fue evaluar los rangos de movilidad, la consolidación ósea y las complicaciones utilizando esta técnica. Materiales y Métodos: Se presenta a 6 pacientes con fracturas tipo IIA y un promedio de edad de 43 años (rango 24-60) tratados con suturas de alta resistencia y tornillo canulado intramedular entre enero de 2020 y abril de 2021. Se evaluó el rango de movilidad posoperatorio, la consolidación ósea y las complicaciones. Todos fueron evaluados hasta el mes 6 posoperatorio. Resultados: A los 6 meses de la cirugía, el promedio de flexión fue de 143° (rango 90°-160°) y la extensión promedio, de 19° (0°-55°). Se logró la consolidación ósea en 5 pacientes y hubo un retraso de la consolidación con rigidez articular (complicación 16,6%). No hubo segundas intervenciones. Conclusión: La fijación con suturas de alta resistencia y tornillo canulado para las fracturas simples desplazadas de olécranon es una técnica simple, reproducible y económica, ya que no necesitaría de segundas intervenciones, como sí sucede con las fijaciones tradicionales. Nivel de Evidencia: IV

Objective: Displaced olecranon fractures mostly require surgical fixation. The most commonly used techniques are tension band wiring and plate fixation, but they are associated with high rates of discomfort due to soft tissue irritation. An alternative surgical option is fixation with high-strength sutures with intramedullary screws. The aim of this study is to evaluate the range of motion, bone healing and complications using this technique. Materials and Methods: Six patients with type IIA fractures with an average age of 43 years (range 24-60 years) treated with high strength suture and intramedullary screw between January 2020 - April 2021 were included. Post-operative range of motion, bone healing and complications were evaluated. All were evaluated up to 6 months postoperatively. Results: At the 6th postoperative month, the average flexion was 143° (range 90°-160°), average extension 19° (0°-55°), there was bone healing in 5 patients, and 1 nonunion with joint stiffness (complication 16.6%). There were no second surgeries. Conclusion: Simple displaced olecranon fractures treated with high-strength suture with intramedullary screws is a simple, reproducible and economical technique since it does not require a second surgery, as is the case with traditional fixation methods for this pathology. Level of Evidence: IV

Osteosintesis de fracturas complejas de húmero distal. Nuestra experiencia / Osteosynthesis of complex fractures of the distal humerus. Our experience

Objetivo: Describir los resultados obtenidos en el tratamiento de las fracturas de húmero distal mediante reducción abierta y fijación interna y reflejar si el abordaje empleado tuvo impacto en el resultado funcional. Materiales y métodos: Se llevó a cabo un estudio retrospectivo de presentación de casos. Se evaluó a 19 pacientes con diagnóstico de fractura de húmero distal compleja tratados con reducción abierta y fijación interna entre 2015 y 2021. Se realizó un control radiográfico periódico y se evaluó el resultado funcional mediante escalas internacionales, como DASH y MEPS. Luego se procedió a extrapolar las variables obtenidas utilizando un programa estadístico. Resultados: Se logró la consolidación de todas las fracturas. Se empleó el abordaje de Alonso Llames en 7 pacientes (37%) y la osteotomía de olécranon en 12 casos (63%). El puntaje DASH promedio fue de 11,31, lo que determinó discapacidades leves. El puntaje MEPS obtenido fue excelente en un paciente (5,26%), bueno en 10 (52,6%), regular en 7 (36,84%) y pobre en 1 (5,26%). Conclusiones: La reducción abierta y la fijación interna son eficaces para tratar las fracturas complejas de húmero distal, permiten lograr buenos resultados posquirúrgicos. En esta serie, el 57% de los pacientes obtuvo resultados excelentes o buenos. No se halló una diferencia estadísticamente significativa con respecto a la elección de un abordaje u otro. Nivel de Evidencia: IV

Objective: To describe the results obtained in the treatment of distal humerus fractures by open reduction and internal fixation (ORIF) and to reflect whether the approach used had an impact on the functional outcome. Materials and methods: We carried out a retrospective case study of 19 patients with a diagnosis of complex distal humerus fracture who were treated with ORIF from 2015 to 2021. Periodic radiographic controls were performed and the functional outcome was evaluated using internationally known scales such as the DASH and Mayo Elbow performance Score (MEPS), then the variables obtained were extrapolated using statistical software. Results: A 100% consolidation rate was achieved; in 7 patients (37%), the Alonso Llames approach was used and in 12 cases (63%), we performed an olecranon osteotomy. The average DASH was 11.31, which determined mild disabilities. The MEPS obtained was excellent in 1 patient (5.26%), good in 10 (52,6%), fair in 7 (36.84%), and poor in 1(5.26%). When comparing the results obtained through the different approaches a P = 0.4197 was obtained in the ANOVA test and P =0.4723 in the Mann-Whitney/Wilcoxon Two sample Test. Conclusions: We conclude that ORIF is effective in the treatment of complex fractures of the distal humerus, allowing the surgeon to obtain good post-surgical results. In this series, the average DASH was 11.31, with excellent and good results in 57% of the patients. We found no statistically significant difference regarding the choice of one approach or the other. Level of Evidence: IV

Fracturas articulares complejas del húmero distal. Recomendaciones para optimizar los resultados y disminuir las complicaciones / Complex articular fractures of the distal humerus. Recommendations to optimize outcomes and reduce complications

Las fracturas articulares complejas del húmero distal suponen un gran desafío para el cirujano ortopédico. La complejidad de la anatomía, la presencia de múltiples fragmentos y la mala calidad ósea representan algunas de las principales dificultades para resolver. La relativa infrecuencia de estas fracturas atenta directamente contra el entrenamiento y la sistematización del procedimiento quirúrgico y, por consiguiente, tiene impacto sobre el resultado final y la tasa de complicaciones. El objetivo de esta comunicación es proporcionar herramientas al cirujano a través de la revisión de la bibliografía y la experiencia de los autores para disminuir las complicaciones y optimizar los resultados en el tratamiento de estas fracturas..Nivel de Evidencia: V

Complex articular fractures of the distal humerus represent a real challenge for orthopedic surgeons. The complexity of the anatomy, fracture patterns, the presence of multiple fragments, and low bone density in the elderly represent some difficulties to address. The relatively low frequency of these fractures directly undermines training and systematization of the surgical procedure and therefore has an impact on the final functional outcome and complication rate. The aim of this article is to provide practical tools to the novel surgeon, through the review of the literature and the author ́s experience, to reduce complications and optimize the treatment of these fractures. Level of Evidence: V

Bilateral triceps tendon approach is flexible and efficient in the treatment of type C distal humerus fractures / 中华创伤杂志(英文版)

PURPOSE@#The purpose of this study was to assess and compare elbow range of motion, triceps extension strength and functional results of type C (AO/OTA) distal humerus fractures treated with bilateral triceps tendon (BTT) approach and olecranon osteotomy (OO). At the same time, we are also trying to know whether BTT approach can provide sufficient vision for comminuted intra-articular fractures of the distal humerus, and whether it is convenient to convert to the treatment to total elbow arthroplasty (TEA) or OO.@*METHODS@#Patients treated with OO and BTT approaches for type C distal humerus fractures between July 2014 and December 2017 were retrospectively reviewed. Inclusion criteria include: (1) patients' age were more than 18 years old, (2) follow-up was no less than 6 months, and (3) patients were diagnosed with type C fractures (based on the AO/OTA classification). Exclusion criteria include: (1) open fractures (Gustillo type 2 or type 3), (2) treated by other approaches, and (3) presented with combined injuries of ipsilateral upper extremities, such as ulnar nerve. Elbow range of motion and triceps extension strength testing were completely valuated, when the fractures had healed. Assessment of functional results using the Mayo elbow performance score and complications were conducted in final follow-up. The data were compared using the two tailed Student's t-test. All data were presented as mean ± standard deviation.@*RESULTS@#Eighty-six patients of type C distal humerus fractures, treated by OO and BTT approach were retrospectively reviewed between July 2014 and December 2017. Fifty-five distal humerus fractures (23 males and 32 females, mean age 52.7 years) treated by BTT approach or OO were included in this study. There were 10 fractures of type C1, 16 type C2 and 29 type C3 according to the AO/OTA classification. Patients were divided into two surgical approach groups chosen by the operators: BTT group (28 patients) and OO group (27 patients). And the mean follow-up time of all patients was 15.6 months (range, 6-36 months). Three cases in BTT group were converted to TEA, and one converted to OO. Only one case in BTT group presented poor articular reduction with a step more than 2 mm. There were not significantly different in functional outcomes according to the Mayo elbow performance score, operation time and extension flexion motion are values between BTT group and OO group (p > 0.05). Complications and reoperation rate were also similar in the two groups. Triceps manual muscle testing were no significant difference in the two groups, even subdivided in elder patients (aged >60 years old).@*CONCLUSION@#BTT is a safe approach to achieve similar functional result comparing with OO. BTT were not suitable for every case with severe comminuted pattern, but it avoids the potential complications related to OO, and has no complications concerning with triceps tendon. It is convenient for open reduction internal fixation and flexible to be converted to OO, as well as available to be converted to TEA in elder patients.

Follow control of upper limb rehabilitation training based on Kinect and NAO robot / 生物医学工程学杂志

Gesture imitation is a common rehabilitation strategy in limb rehabilitation training. In traditional rehabilitation training, patients need to complete training actions under the guidance of rehabilitation physicians. However, due to the limited resources of the hospital, it cannot meet the training and guidance needs of all patients. In this paper, we proposed a following control method based on Kinect and NAO robot for the gesture imitation task in rehabilitation training. The method realized the joint angles mapping from Kinect coordination to NAO robot coordination through inverse kinematics algorithm. Aiming at the deflection angle estimation problem of the elbow joint, a virtual space plane was constructed and realized the accurate estimation of deflection angle. Finally, a comparative experiment for deflection angle of the elbow joint angle was conducted. The experimental results showed that the root mean square error of the angle estimation value of this method in right elbow transverse deflection and vertical deflection directions was 2.734° and 2.159°, respectively. It demonstrates that the method can follow the human movement in real time and stably using the NAO robot to show the rehabilitation training program for patients.