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1.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1383552

ABSTRACT

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.


Subject(s)
Humans , Orthopedic Procedures/methods , Joint Dislocations/therapy , Elbow Joint/injuries , Joint Instability/therapy , Clinical Protocols
2.
Article in Spanish | LILACS, BINACIS | ID: biblio-1367136

ABSTRACT

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


Subject(s)
Range of Motion, Articular , Treatment Outcome , Elbow Joint/injuries , Preoperative Period , Fracture Fixation, Internal , Humeral Fractures
3.
Article in Spanish | LILACS, BINACIS | ID: biblio-1392485

ABSTRACT

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


Subject(s)
Adult , Middle Aged , Osteotomy , Elbow Joint/injuries , Olecranon Process , Fracture Fixation, Internal , Humeral Fractures/surgery
4.
Chinese Journal of Traumatology ; (6): 145-150, 2022.
Article in English | WPRIM | ID: wpr-928488

ABSTRACT

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.


Subject(s)
Adolescent , Aged , Elbow Joint/injuries , Female , Fracture Fixation, Internal/methods , Fractures, Comminuted , Humans , Humeral Fractures/surgery , Humerus , Infant , Male , Middle Aged , Range of Motion, Articular , Retrospective Studies , Tendons , Treatment Outcome
5.
Rev. Asoc. Argent. Ortop. Traumatol ; 86(5) (Nro Esp - AACM Asociación Argentina de Cirugía de la Mano): 659-665, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353973

ABSTRACT

La luxación de codo aislada es muy infrecuente en esqueletos inmaduros. El manejo y el tratamiento no están estandarizados debido a la baja casuística. Las luxaciones aisladas en niños <10 años constituyen un cuadro descrito como evidencia compartida en estudios de niños más grandes. El objetivo de este artículo es comunicar dos casos de luxación aislada de codo en niños <10 años. Los niños consultan a la unidad de urgencias por dolor y deformidad en el codo a las pocas horas del trauma. En ambos casos, se realizaron evaluaciones clínicas y radiográficas en busca de lesiones asociadas antes de la reducción cerrada y después. Se descartó inestabilidad articular bajo anestesia y se inmovilizó por dos semanas. Los resultados funcionales fueron excelentes en ambos casos, a los tres meses de la lesión. Nivel de Evidencia: IV


Isolated elbow dislocation is extremely rare in immature skeletons. Due to the low casuistry, the management and treatment are not standardized. Isolated dislocations in children under 10 years of age constitute a pathology described as shared evidence in studies of older children. The objective of this report is to share the experience of two cases of isolated elbow dislocation in children under 10 years of age. The children consult the emergency unit about pain and elbow deformity a few hours after the trauma. For each case, a clinical and radiological evaluation was developed in search of associated lesions before and after closed reduction. Joint instability was ruled out under anesthesia and the patient is immobilized for two weeks. Excellent functional outcomes were obtained in both cases three months after the injury. Level of Evidence: IV


Subject(s)
Child , Joint Dislocations , Elbow Joint/injuries
6.
Rev. Asoc. Argent. Ortop. Traumatol ; 86(5) (Nro Esp - AACM Asociación Argentina de Cirugía de la Mano): 595-600, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353965

ABSTRACT

Introducción: Nuestros objetivos fueron: 1) evaluar los resultados subjetivos en pacientes esqueléticamente inmaduros que habían sido sometidos a una cirugía por fracturas desplazadas del cuello del radio, 2) comparar el desempeño del PROMIS y QuickDASH y 3) evaluar los efectos de piso y techo de las medidas de resultado. Materiales y métodos: Se evaluaron los datos demográficos, las lesiones asociadas, el tipo de fractura, la técnica quirúrgica y las complicaciones. La evaluación funcional se realizó con la escala QuickDASH y el instrumento PROMIS (Upper Extremity/Strength/Pain Interference). Las correlaciones de las escalas se efectuaron con el coeficiente rho de Spearman. El valor alfa se estableció en 0,05. Resultados: Se incluyó a 26 pacientes (13 varones) con una edad promedio de 7.5 años. El seguimiento promedio fue de 31 meses. Hubo correlaciones significativas entre las métricas QuickDASH y PROMIS Upper Extremity posoperatorias (rs = -0,64; p = 0,003). No se halló una correlación entre PROMIS Pain Interference y PROMIS Strength con el QuickDASH (rs = 0,001; p = 0,966 y rs = -0,39; p = 0,101, respectivamente). Se observaron efectos de techo o piso en todas las escalas. Conclusiones: Hubo una marcada correlación entre el PROMIS Upper Extremity y el QuickDASH para evaluar los resultados después de la cirugía de fracturas del cuello del radio en niños. Sin embargo, todas las medidas tuvieron marcados efectos de piso y techo, probablemente debido al tamaño de la cohorte y a que un alto porcentaje de estas fracturas suelen tener resultados clínicos favorables. Nivel de Evidencia: IV


Introduction: Objectives: 1) to evaluate the subjective outcomes in skeletally immature patients undergoing surgical treatment of displaced radial neck fractures, 2) to compare the performance between PROMIS and QuickDash, 3) to evaluate the floor/ceiling effects of the outcome measurements. We hypothesized that the PROMIS scale would correlate favorably with QuickDash and would demonstrate lower floor or ceiling effects. Materials and methods: Demographic data, associated lesions, fracture type, surgical technique, and complications were evaluated. QuickDash and PROMIS scales (PROMIS Upper Extremity (UE), PROMIS Strength and PROMIS Pain interference) were used for functional assessment. The Shapiro-Wilk test was used to analyze the normal distribution of the data. Metrics correlations were made with Spearman's rho coefficient. Ceiling and floor effects were further assessed. The alpha value was set at 0.05. Results: 26 patients were evaluated. Average age: 7.5 years; average follow-up: 31 months. There were significant correlations between the postoperative QuickDash and PROMIS UE metrics (rs = -0.64, p = 0.003). We found no correlation between PROMIS Pain and PROMIS Strength with QuickDash (rs = 0.001, p = 0.966 and rs = -0.39, p = 0.101 respectively). Ceiling or floor effects were observed at all scales. Conclusion: We observed a strong correlation between PROMIS UE and QuickDash assessing the results after surgical treatment of radial neck fractures in children. However, all the measures had evident floor/ceiling effects, probably due to the size of the cohort and the fact that a high percentage of these fractures usually present favorable clinical outcomes. Level of Evidence: IV


Subject(s)
Child , Radius Fractures , Treatment Outcome , Elbow Joint/injuries
7.
Einstein (Säo Paulo) ; 18: eRC4778, 2020. graf
Article in English | LILACS | ID: biblio-1056052

ABSTRACT

ABSTRACT This is a case report of a previously healthy athlete who did not use oral anticoagulant, suffered a rupture of the distal biceps brachii tendon, and evolved with arm compartment syndrome. An emergency fasciotomy and the repair of the tendon were performed. After surgery the patient had a good recovery of the paresthesia and sensibility. This complication is rare and, when reported, is usually associated with patients who use anticoagulant therapy. Due to growth of rupture of distal biceps tendon cases, physicians should be aware that this complication must be treated as an emergency.


RESUMO Relato de caso de paciente atleta, previamente hígido e que não utilizava anticoagulantes orais, com lesão do tendão distal do músculo bíceps braquial, que evoluiu com síndrome compartimental do braço. Realizaram-se fasciotomia de emergência e reparo cirúrgico do tendão, apresentando bom seguimento com recuperação da parestesia e sensibilidade. Essa complicação é bastante rara e, quando relatada, geralmente é associada a pacientes em uso de medicamentos anticoagulantes orais. Contudo, com o aumento da incidência de rupturas do tendão do músculo bíceps braquial, é preciso estar atento à tal complicação que deve ser conduzida como emergência.


Subject(s)
Humans , Male , Aged , Tendon Injuries/complications , Compartment Syndromes/etiology , Arm Injuries/surgery , Arm Injuries/complications , Athletic Injuries/surgery , Athletic Injuries/complications , Rupture , Tendon Injuries/surgery , Treatment Outcome , Compartment Syndromes/surgery , Elbow Joint/surgery , Elbow Joint/injuries , Fasciotomy/methods
8.
Rev. bras. anestesiol ; 69(5): 510-513, Sept.-Oct. 2019. graf
Article in English | LILACS | ID: biblio-1057461

ABSTRACT

Abstract Background and objectives: Costoclavicular brachial plexus block is an anesthesia performed through the infraclavicular route described in the literature as a safe and effective route for upper limb anesthesia distal to the elbow. The following report describes the case of a patient whose traditional plexus blocking techniques presented ultrasound visualization difficulty, but the costoclavicular approach was easy to visualize for anesthetic blockade. Case report: A grade 3 obese patient scheduled for repair of left elbow fracture and dislocation. Ultrasound examination revealed a distorted anatomy of the supraclavicular region and the axillary region with skin lesions, which made it impossible to perform the blockade in these regions. It was decided to perform an infraclavicular plexus block at the costoclavicular space, where the brachial plexus structures are more superficial and closer together, supported by a muscular structure, lateral to all adjacent vascular structures and with full view of the pleura. The anesthetic block was effective to perform the procedure with a single injection and uneventfully. Conclusion: Costoclavicular brachial plexus block is a good alternative for upper limb anesthesia distal to the elbow, being a safe and effective option for patients who are obese or have other limitations to the use of other upper limb blocking techniques.


Resumo Justificativa e objetivos: O bloqueio de plexo braquial via costoclavicular é uma anestesia feita por via infraclavicular, já descrita na literatura como uma via segura e efetiva para anestesia de membro superior distal ao cotovelo. O relato a seguir trata de um paciente em que as técnicas tradicionais para bloqueio de plexo apresentavam dificuldade de visibilização à ultrassonografia, já a via costoclavicular foi de fácil visibilização para execução do bloqueio anestésico. Relato de caso: Paciente com obesidade grau 3 a ser submetido a correção de fratura e luxação de cotovelo esquerdo apresentava anatomia da região supraclavicular distorcida à avaliação ultrassonográfica e região axilar com lesões de pele, que impossibilitavam o bloqueio nessas regiões. Optou-se por fazer o bloqueio de plexo via infraclavicular no espaço costoclavicular, região onde as estruturas do plexo braquial estão mais superficiais e unidas, amparadas por uma estrutura muscular, laterais a todas as estruturas vasculares adjacentes e com a visibilização plena da pleura. O bloqueio anestésico foi efetivo para a realização do procedimento sob punção única em pele e sem intercorrências. Conclusão: O bloqueio de plexo braquial via costoclavicular é uma boa opção para anestesia de membro superior distal ao cotovelo, é uma opção segura e efetiva para pacientes obesos ou que tenham outras limitações à aplicação de outras técnicas de bloqueio de membro superior.


Subject(s)
Humans , Male , Adult , Arm , Ultrasonography, Interventional , Joint Dislocations/surgery , Joint Dislocations/complications , Elbow Joint/injuries , Fractures, Bone/surgery , Fractures, Bone/complications , Brachial Plexus Block/methods , Obesity/complications , Elbow Joint/surgery
9.
Acta ortop. mex ; 33(5): 329-332, sep.-oct. 2019. graf
Article in Spanish | LILACS | ID: biblio-1284966

ABSTRACT

Resumen: Las fracturas de codo son secundarias a traumatismos de baja y alta energía, afectan el extremo distal del húmero, olécranon, cabeza radial o una combinación de las anteriores. Las fracturas complejas de codo dificultan la reducción y su posterior fijación, lo que representa un reto para el ortopedista. Es esencial el uso de auxiliares diagnósticos como la tomografía axial computarizada para su diagnóstico y posterior tratamiento. En la actualidad, las nuevas tendencias en la fijación de las mismas y los diversos implantes con los que se cuenta pueden mejorar el pronóstico del paciente. Se presentan dos casos clínicos de fracturas complejas de codo tratadas mediante osteosíntesis.


Abstract: Elbow fractures are secondary to low or high energy trauma affecting the distal humerus, olecranon, radial head or a combination of the above. Complex fractures of the elbow complicate the reduction and its subsequent fixation representing a real challenge for the orthopedic surgeon. It is essential the use of diagnostic aids such as computerized axial tomography for diagnosis and subsequent treatment. Currently new trends in the fixation of the same and the various implants with which it is counted, can improve improve the patient's prognosis. We present two clinical cases of complex elbow fractures treated by osteosynthesis.


Subject(s)
Humans , Elbow Joint/injuries , Olecranon Process , Humeral Fractures/surgery , Range of Motion, Articular , Treatment Outcome , Elbow , Fracture Fixation, Internal
10.
Arch. argent. pediatr ; 116(4): 630-634, ago. 2018. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-950057

ABSTRACT

La luxación de la cabeza radial suele asociarse a fractura o deformidad plástica cubital. La luxación aislada es rara. Sin tratamiento, puede evolucionar hacia deformidad cubital en valgo, lesión nerviosa, artrosis precoz y pérdida del rango de movilidad con limitación funcional. Se presenta a un paciente de 9 años que sufrió traumatismo de codo. Acudió a nuestra Institución a los 40 días y se diagnosticó luxación irreductible de la cabeza radial, primero desapercibida. La luxación era irreductible por un ojal en el ligamento anular y requirió ser reducida a cielo abierto. En ausencia de fractura, incluso sin evidencia de deformidad plástica del cúbito, debe sospecharse la luxación de la cabeza radial. La clínica, junto con el par radiográfico bilateral y el conocimiento de esta entidad poco frecuente, son el trípode necesario para alcanzar el diagnóstico y no demorar el tratamiento.


Anterior radial head dislocation in pediatric population is related to Monteggia fracture-dislocations. Isolated radial head dislocation is uncommon. Sometimes, radial head dislocation becomes irreducible. This entity can develop into chronic conditions such as nerve injuries, early osteoarthritis, limited range of motion and cubitus valgus. We describe a case of a 9-year-old patient who suffered elbow trauma. He was admitted to our institution 40 days after, where radial head dislocation was diagnosed. This condition was misdiagnosed at first stage. It was irreducible due to a tear in the annular ligament. He underwent open reduction. Radial head dislocation must be suspected even if there are no fractures or plastic deformity. Pure irreducible radial head dislocation is rare. Physical examination, together with plain bilateral radiographs and full acknowledgement of this rare condition are the basis to reach early diagnosis, which leads to proper non-delayed treatment.


Subject(s)
Humans , Male , Child , Radius/diagnostic imaging , Joint Dislocations/diagnostic imaging , Elbow Joint/diagnostic imaging , Monteggia's Fracture/diagnostic imaging , Radius/pathology , Radiography , Joint Dislocations/pathology , Elbow Joint/injuries , Ligaments, Articular/injuries , Monteggia's Fracture/pathology
11.
An. Facultad Med. (Univ. Repúb. Urug., En línea) ; 5(1): 68-81, jun. 2018. ilus, graf, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1088670

ABSTRACT

Introducción: Las luxaciones constituyen del 10 % al 25 % de todas las lesiones en el codo. Aproximadamente el 15% de los pacientes que la han sufrido quedan con algún síntoma compatible con inestabilidad. El objetivo de este trabajo es revisar en la literatura los diferentes tratamientos propuestos para esta complicación luego de una luxación simple de codo. Materiales y Métodos: Se realizó una búsqueda en bases de datos: Medline (interfase Pub-Med) y Bireme para estudios de los últimos diez años. Se seleccionaron los artículos que cumplieron los criterios de inclusión y exclusión, extrayendo de ellos los datos relevantes y resultados. La búsqueda arrojó un total de 596 artículos de los cuales 10 cumplían con los criterios de inclusión propuestos al iniciar la búsqueda. Discusión: Se analizaron y compararon las tasas de inestabilidad luego de la luxación, los diferentes tipos de tratamiento y las complicaciones. Conclusión: Existe consenso en la literatura analizada de que debe realizarse un examen de estabilidad del codo en agudo para definir el tratamiento. En cuanto al tratamiento en los codos que se presentan inestables la literatura es variable y faltan estudios comparativos para realizar recomendaciones.


Introduction: Dislocations are 10% to 25% of all elbow injuries. Up to 15% of patients with symptoms of instability can be observed. The aim of this study is to review in the literature the different treatments proposed for this complication after a simple elbow dislocation. Materials and Methods: The search was conducted on: Medline (PubMed interface) and Bireme including the last ten years studies. Articles that met the inclusion and exclusion criteria were selected, and the relevant data and results were extracted. We found a total of 596 articles, 10 met the inclusion criteria proposed at the start of the search. Discussion: We analyzed and compared the rates of instability after dislocation, the different types of treatment and complications. Conclusion: There is consensus in the analyzed literature that an elbow stability test should be performed in acute conditions to define the treatment.Comparative studies are lacking for recommending a definite treatment for elbow instability.


Introdução: Dislocaçõessão de 10% a 25% de todas as lesões no cotovelo. Aproximadamente 15% dos pacientes ficam com algum síntoma compatívelcom instabilidade. O objetivo deste trabalho é rever na literatura os diferentes tratamentos propostos para esta complicação a pósuma simples deslocação do cotovelo. Materiais e métodos: Uma pesquisa foi feita em bancos de dados: Medline (interface Pub-Med) e Bireme para estudos dos últimos dez anos. Foram selecionados artigos que atendem a os critérios de inclusão e exclusão, extraindo os dados relevantes e os resultados deles. A busca gerou um total de 596 artigos, dos quais 10 atendem a os critérios de incluso propostos no início da pesquisa. Discussão: Analisamos e comparamos as taxas de instabilidade após deslocamento, os diferentes tipos de tratamento e complicações. Conclusão: Existe consenso na literatura analisada segundo a qualum teste de estabilidade do cotobelo deve ser realizado em agudos para definir o tratamento. Sobre o tratamento os cotovelo sin stáveis a literatura é diversa e faltam estudos comparativos para realizar recomendações.


Subject(s)
Humans , Joint Dislocations/complications , Joint Dislocations/therapy , Elbow Joint/injuries , Joint Instability/therapy , Treatment Outcome , Immobilization/statistics & numerical data
12.
Rev. méd. Urug ; 34(1): 56-62, mar. 2018. tab, ilus
Article in Spanish | LILACS | ID: biblio-879958

ABSTRACT

Introducción: la fractura de epicóndilo medial representa 12% a 20% de las fracturas del codo pediátrico. Existe controversia en la indicación del tratamiento para las fracturas con un desplazamiento mayor de 2 mm. El objetivo de este trabajo es revisar la indicación y los resultados de los diferentes tratamientos realizados en las fracturas de epicóndilo medial desplazadas más allá de 2 mm. Material y método: se utilizaron las bases de datos electrónicas PubMed y Bireme. La búsqueda arrojó un total de 313 artículos de los cuales nueve cumplían con los criterios de inclusión propuestos al iniciar la búsqueda. Discusión: se analizaron y compararon los métodos de diagnóstico por imagen utilizados y su rendimiento, los diferentes tipos de tratamiento y las complicaciones. Conclusión: no debe ser el desplazamiento de la fractura lo que guíe el tratamiento sino la energía traumática y la estabilidad en valgo del codo. Se han reportado excelentes resultados tanto con tratamiento conservador como quirúrgico de las fracturas desplazadas de epicóndilo medial. Faltan estudios comparativos con seguimiento a largo plazo de buen nivel de evidencia para recomendar uno u otro tratamiento en las fracturas desplazadas de epicóndilo medial.


Introduction: fractures of medial epicondyle represent 12 to 20% of pediatric elbow fractures. Treating fractures with greater than 2 mm of displacement is a matter of debate. The study aims to review indications and results of the different treatments indicated for fractures of medial epicondyle with greater than 2 mm of displacement. Method: the PubMed and Bireme electronic data bases were used. Search revealed 313 articles, 9 of which met the inclusion criteria set upon initiation of the study. Discussion: imaging techniques used and their diagnostic yield were compared, as well as the different of treatments and complications. Conclusion: treatment should not be defined based on the fracture's displacement, but rather on the trauma energy and the valgus stability of the elbow. Excellent results were reported both with a conservative treatment and with a surgical approach to displaced fractures of medial epicondyle. Comparative studies need to be done with long term follow-up that is well recorded to recommend the right treatment for displaced fractures of medial epicondyle.


Introdução: a fratura de epicôndilo medial representa 12 a 20 % das fraturas do cotovelo em crianças. Existe controvérsia na indicação do tratamento para fraturas com deslocamento superior a 2 mm. O objetivo deste trabalho é revisar a indicação e os resultados dos diferentes tratamentos realizados nos casos de fraturas de epicôndilo medial com deslocamento de mais de 2 mm. Materiais e métodos: foram utilizadas as bases de dados electrónicas PubMed e de Bireme. A pesquisa bibliográfica recuperou 313 artículos sendo que 9 cumpriam com os critérios de inclusão propostos no inicio do trabalho. Discussão: foram analisados e comparados os métodos de diagnóstico por imagem utilizada e seu rendimento, os diferentes tipos de tratamento e as complicações. Conclusão: o deslocamento da fratura não deve ser o determinante do tratamento, mas sim a energia traumática e a estabilidade em valgo do cotovelo. Foram informados resultados excelentes tanto com tratamento conservador como cirúrgico das fraturas com deslocamento de epicôndilo medial. Faltam estudos comparativos com seguimento em longo prazo com evidencias de alta qualidade para recomendar o tipo de tratamento nos casos de fraturas com deslocamento de epicôndilo medial.


Subject(s)
Child , Elbow/injuries , Elbow Joint/injuries , Fractures, Bone/therapy , Humeral Fractures
13.
Rev. Asoc. Argent. Ortop. Traumatol ; 82(4): 299-305, dic. 2017. []
Article in Spanish | LILACS, BINACIS | ID: biblio-896272

ABSTRACT

Se presentan dos casos clínicos y la revisión de la literatura actual sobre luxación convergente de codo. En el primer caso, se muestra cómo un retraso en el diagnóstico conducirá a una reducción abierta y fijación con agujas de Kirschner, mientras que un diagnóstico temprano permite la reducción cerrada y el tratamiento conservador como se describe en el segundo caso. La clave de diagnóstico para la luxación convergente de codo radica en la correcta interpretación de las radiografías y el bloque de prono-supinación en el examen físico. Se recomienda el uso de indometacina para evitar calcificaciones heterotópicas. El resultado final es mejor cuando el diagnóstico es precoz, independientemente del método de reducción. Nivel de Evidencia: IV


We describe two clinical cases and review the available literature on convergent elbow dislocation. Our first case shows how a delay in the diagnosis will lead to an open reduction and internal fixation with K-wires. On the other hand, an early diagnosis prompts a closed reduction without fixation as it is described in the second case. The diagnostic key for the convergent dislocation of the elbow lies in the correct interpretation of radiographs and the prono-supination block on physical examination. The use of indomethacin is recommended to avoid heterotopic calcifications. The final outcome is better when an early diagnosis is achieved regardless of the reduction method. Level of Evidence: IV


Subject(s)
Child , Indomethacin/therapeutic use , Joint Dislocations/surgery , Joint Dislocations/diagnosis , Joint Dislocations/therapy , Elbow Joint/injuries
14.
Acta ortop. mex ; 31(5): 233-238, sep.-oct. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-886573

ABSTRACT

Resumen: Antecedentes: La «artrólisis¼ abierta ha sido el tratamiento estándar en la rigidez de codo, con buenos resultados; sin embargo, las complicaciones asociadas y los avances en la cirugía artroscópica han permitido incorporar esta técnica quirúrgica. Material y métodos: Entre Enero de 2014 y Marzo de 2016, seis pacientes con rigidez postraumática de codo fueron intervenidos mediante cirugía artroscópica por el mismo equipo quirúrgico. Se registró pre- y postoperatoriamente, el nivel de dolor según escala analógica visual numérica, rango de movilidad articular del codo con el uso de un goniómetro y cuestionario Mayo Elbow Performance Index. Resultados: El seguimiento medio de los pacientes fue de 14.5 meses. El valor medio en la escala analógica visual disminuyó de 4.5 a 0.3 puntos. El rango medio de movilidad del codo se incrementó de 55.3o a 130o, con una ganancia media de 75o. La puntuación media en el cuestionario MEPI pasó de 46.6 puntos a 95 puntos, con una ganancia media de 48.4 puntos. Como procedimientos asociados a la «artrólisis¼ artroscópica se realizó extracción del material de síntesis en las tres fracturas de olécranon. No hubo ningún caso de osificación heterotópica, infección superficial o neuropatía cubital. Ningún paciente precisó reintervención quirúrgica para una nueva «artrólisis¼ artroscópica o abierta. Conclusiones: La liberación artroscópica en la rigidez postraumática de codo es una técnica efectiva a corto plazo para recuperar la movilidad.


Abstract: Background: Open «arthrolysis¼ has been the standard treatment for elbow stiffness, with good results. However, the associated complications of open arthrolysis and the advancements in arthroscopic surgery have allowed including the latter as an additional approach. Material and methods: Between January 2014 and March 2016, 6 patients with posttraumatic elbow stiffness underwent arthroscopic surgery by the same surgical team. Pre- and post-operative assessment included pain with a numerical visual analogue scale, elbow joint range of motion with a goniometer and the Mayo Elbow Performance Index questionnaire. Results: Mean patient follow-up was 14.5 months. The mean VAS score decreased from 4.5 to 0.3. The mean elbow range of motion increased from 55.3o to 130o, with a mean gain of 75o. The mean MEPI questionnaire score went from 46.6 to 95, with a mean gain of 48.4 points. The procedures associated with arthroscopic «arthrolysis¼ included removal of the synthesis material from the 3 olecranon fractures. No cases of heterotopic ossification, superficial infection or ulnar neuropathy were reported. None of the patients required surgical reintervention to perform a new «arthrolysis¼, whether arthroscopic or open. Conclusions: Arthroscopic release to treat posttraumatic elbow stiffness is an effective technique to restore mobility in the short term.


Subject(s)
Humans , Arthroscopy , Range of Motion, Articular , Elbow Joint/injuries , Joint Diseases/surgery , Treatment Outcome
15.
Rev. Asoc. Argent. Ortop. Traumatol ; 82(2): 116-123, jun. 2017. []
Article in Spanish | LILACS, BINACIS | ID: biblio-896259

ABSTRACT

Introducción: El objetivo de este estudio fue evaluar las indicaciones y las complicaciones de una serie consecutiva de niños con fracturas a quienes se les realizó artrografía intraoperatoria. Materiales y Métodos: Se evaluó retrospectivamente a pacientes pediátricos con fracturas de codo o tobillo sometidos a una artrografía intraoperatoria, entre enero de 2009 y julio de 2014. Se analizaron los datos demográficos, la evolución clínica posoperatoria (criterios de la Clínica Mayo y puntaje de la AOFAS), la evolución radiográfica y las complicaciones derivadas del uso de material de contraste intrarticular. Resultados: Se evaluaron 25 pacientes (16 niños, 9 niñas) con una edad promedio de 7.6 años (rango 4-15). El seguimiento promedio fue de 30.1 meses. Quince tenían fracturas de codo y 10, de tobillo. Según el puntaje de la Clínica Mayo, 14 pacientes tuvieron resultados excelentes y uno fue bueno (promedio 99; rango 85-100). Los 10 pacientes con fracturas de tobillo obtuvieron resultados excelentes según el puntaje de la AOFAS (promedio 98,5; rango 95-100). No ocurrieron infecciones ni reacciones adversas relacionadas con el uso del medio de contraste. Tres pacientes tuvieron complicaciones no relacionadas con el uso del medio de contraste. Conclusión: La artrografía es un procedimiento simple, de bajo costo, que agrega poco tiempo quirúrgico y permite una mejor evaluación de estructuras intrarticulares para la toma de decisiones intraoperatorias. Es una herramienta útil que debe ser tenida en cuenta en el tratamiento de algunas fracturas en pediatría. Nivel de Evidencia: IV


Introduction: The objective of this study is to assess the indications and complications of a consecutive series of children with fractures where intraoperative arthrogram was performed. Methods: We retrospectively evaluated children with elbow or ankle fractures who underwent intraoperative arthrogram between January 2009 and July 2014. We assessed demographic data, postoperative clinical outcomes (Mayo Clinic and AOFAS scores), radiographic outcome and complications arising from the use of intra-articular contrast material. Results: Twenty-five patients (16 boys, 9 girls) with an average age of 7.6 years (range 4-15) were evaluated. The average follow-up was 30.1 months. There were 15 patients with elbow fractures and 10 with ankle fractures. According to Mayo Clinic score, results were excellent in 14 patients and good in one patient (average 99; range 85-100). Ten patients with ankle fractures presented excellent results according to AOFAS score (average 98.5; range 95-100). There were no in fections or adverse reactions related to the use of contrast. Three patients presented complications unrelated to the use of contrast. Conclusion: Arthrogram is a simple, low-cost procedure, adds short surgical time and allows better assessment of intraarticular structures for intraoperative decision-making. It is a useful tool that should be taken into account in the treatment of some pediatric fractures. Level of Evidence: IV


Subject(s)
Child , Arthrography/methods , Ankle Injuries/diagnosis , Elbow Joint/injuries , Fractures, Bone/diagnosis , Retrospective Studies
16.
Rev. pediatr. electrón ; 13(1): 21-30, abr. 2016. ilus
Article in Spanish | LILACS | ID: biblio-836289

ABSTRACT

Introducción: los traumatismos de codo tienen una alta incidencia en la población infantil, la fractura de esta zona corresponde al 5 a 10 por ciento del total de fracturas en niños. El objetivo de nuestro trabajo es hacer una descripción epidemiológica de las fracturas de codo en niños operadas en el Hospital Clínico San Borja Arriaran. Materiales y métodos: Estudio retrospectivo, descriptivo. Se realizó revisión de fichas electrónicas de pacientes de edad pediátrica operados de fracturas alrededor del codo en el HCSBA desde el 1 de junio al 31 de 2014. Resultados: Se estudiaron 25 pacientes, 64 por ciento de sexo masculino y 36 por ciento de sexo femenino. La edad promedio fue de 5,5 años. Fracturas supracondilea de humero correspondieron a 64 por ciento, epicondilo de humero 24 por ciento, epitróclea de humero 8 por ciento y olecranon y cúpula radial 4 por ciento. Discusión: Las fracturas supracondileas de humero son la lesión más frecuente de codo en los niños. Las fracturas de epicondilo son la segunda en frecuencia. Las fracturas de epictroclea representan aproximadamente 10 por ciento, mientras que las fracturas del olécranon son relativamente poco comunes en los niños. Conclusiones: nuestro centro tiene una epidemiologia similar a la descrita por la literatura internacional en cuanto a frecuencia, complicaciones asociadas y presentación clínica.


Introduction: elbow injuries have a high incidence among children, breaking this area corresponds to 5-10 percent of all fractures in children. The aim of our work is to make an epidemiological description of the elbow fractures in children operated in the Hospital Clinico San Borja Arriaran. Materials and methods: Retrospective, descriptive study. Review of electronic records of pediatric patients operated on fractures around the elbow in the HCSBA from 1 June 31, 2014 was performed. Results: 25 patients, 64 percent male and 36 percent female, were studied. The average age was 5.5 years. Supracondylar humerus fractures accounted for 64 percent, 24 percent epicondyle of the humerus, 8 percent medial epicondyle of the humerus, olecranon and radial head 4 percent. Discussion: Supracondylar humerus fractures are the most common elbow injury in children. Epicondyle fractures are the second in frequency. Epictroclea fractures represent approximately 10 percent, while the olecranon fractures are relatively uncommon in children. Conclusions: our center is similar to that described by the international literature in frequency, associated complications epidemiology and clinical presentation.


Subject(s)
Humans , Male , Adolescent , Female , Child, Preschool , Child , Elbow Joint/injuries , Fractures, Bone/surgery , Fractures, Bone/epidemiology , Epidemiology, Descriptive , Humeral Fractures/surgery , Humeral Fractures/epidemiology , Retrospective Studies
17.
Rev. Asoc. Argent. Ortop. Traumatol ; 80(2): 76-84, jun. 2015. ilus, tab
Article in Spanish | LILACS | ID: lil-757160

ABSTRACT

Objetivo: Reportar los resultados clínicos y radiológicos del tratamiento funcional de fracturas desplazadas de olécranon en pacientes >70 años. Materiales y Métodos: Se evaluaron 28 pacientes >70 años con fracturas desplazadas de olécranon. El tratamiento consistió en la inmovilización inicial con una valva de yeso (promedio 5 días) y, luego, movilización activa según tolerancia. No se indicó rehabilitación kinesiológica. Ningún paciente fue perdido en el seguimiento. El grupo estaba formado por 27 mujeres y un hombre. La edad promedio era de 82 años. Según la clasificación de la Clínica Mayo, 18 fracturas eran de tipo IIA y 10, de tipo IIB. El seguimiento promedio fue de 14 meses. Resultados: La flexo-extensión fue de 142°-15°. La fuerza muscular fue de M5 en 17 pacientes y de M4 en 9. La fuerza de puño fue un 93% del lado contralateral. El dolor según la escala visual analógica fue de 1. La satisfacción con el tratamiento según esta escala fue de 9. Según el puntaje de la Clínica Mayo, 22 pacientes tuvieron resultados excelentes y 6, buenos. El puntaje DASH promedio fue de 15. Veinticuatro pacientes evolucionaron hacia la seudoartrosis. El gap articular final fue, en promedio, de 16 mm. El gap a nivel de la cortical posterior final fue, en promedio de 22 mm. Conclusión: El tratamiento no quirúrgico de las fracturas desplazadas de olécranon en pacientes mayores ofrece un número elevado de buenos resultados funcionales con alto grado de satisfacción. Nivel de evidencia: IV.


Objective: To report the clinical and radiological outcomes of the functional treatment for displaced olecranon fractures in patients >70 years old. Methods: Twenty-eight patients >70 years old with displaced olecranon fractures were evaluated. The treatment included initial immobilization with a cast (average time 5 days) and then active movement as tolerated. Physiotherapy was not indicated. No patients were lost in the follow-up. The study group included 27 women and a man. Average age was 82 years old. According to the Mayo Clinic Classification, 18 fractures were type IIA and 10 were type IIB. Average followup was 14 months. Results: Flexion-extension was of 142°-15°. Muscular strength of the triceps was M5 in 17 patients and M4 in 9. Grip strength was 93% of the contralateral side. The score in the visual analogue scale for pain was 1. Satisfaction with the treatment according to this scale was 9. According to the Mayo Clinic classification, 22 patients presented excellent results, and 6 good results. Average DASH score was 15. Twenty-four patients evolved to a nonunion. Mean final joint gap was 16 mm. Mean final gap at the posterior cortical level of the olecranon was 22 mm. Conclusion: Functional treatment of displaced olecranon fractures in patients >70 years old is associated with a high degree of goods results and patient satisfaction. Level of evidence. IV.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Elbow Joint/injuries , Fractures, Bone/therapy , Olecranon Process/injuries , Pseudarthrosis/therapy , Patient Satisfaction , Range of Motion, Articular , Treatment Outcome
18.
Acta ortop. bras ; 23(3): 138-141, May-Jun/2015. tab, graf
Article in English | LILACS | ID: lil-748137

ABSTRACT

Objetivo: Avaliar os resultados funcionais de pacientes com tríade terrível do cotovelo tratados cirurgicamente. Métodos: Avaliação retrospectiva com utilização da escala MEPS (Mayo Elbow Performance Score) de pacientes diagnosticados com tríade terrível do cotovelo e submetidos a tratamento cirúrgico. Resultados: Foram avaliados 14 pacientes (nove homens e cinco mulheres) e 15cotovelos (um caso bilateral). Obtivemos a média de 78 pontos e86% de bons e excelentes resultados com a utilização da escala MEPS. Como complicações, tivemos um caso de infecção e três de neurapraxia do nervo ulnar. Conclusão: Os pacientes evoluíram com cotovelo estável, com boa função, porém, com diminuição do arco de movimento. Nível de Evidência IV, Série de Casos.


Objectives: To evaluate the functional outcome of patients with surgically treated terrible triad of the elbow. Methods: A retrospective evaluation was performed using the MEPS score (Mayo Elbow Performance Score) of patients diagnosed with terrible triad of the elbow who underwent surgical treatment. Results: 14 patients (nine men and five women) and 15 elbows (one bilateral case) were evaluated. A MEPS average score of 78 points and 86%good and excellent results was obtained. As complications, we had one case of infection and three of neuropraxia of the ulnarnerve. Conclusion: The patients had stable elbow with good function, however with reduced range of motion. Level of Evidence IV, Case Series.


Subject(s)
Humans , Male , Female , Young Adult , Middle Aged , Elbow Joint/injuries , Elbow/surgery , Joint Dislocations , Radius Fractures , Ulna Fractures
19.
Acta ortop. mex ; 29(3): 148-154, ilus, tab
Article in Spanish | LILACS | ID: lil-773375

ABSTRACT

Introducción: La cabeza radial es un estabilizador primario e importante del codo mayormente para la estabilidad en valgo, desplazamiento postero-lateral, axial del radio y carga en varo. Las fracturas de cabeza radial representan de 1.7 al 5% de todas las fracturas en adultos, de 17 al 19% en los traumas de codo y 33% de todas las fracturas del codo, siendo ésta la más común a este nivel. Para una fractura de cabeza radial que no se puede reconstruir, las opciones de tratamiento son excisión de la cabeza radial o hemiartroplastía. Objetivo: Evaluar la funcionalidad de los pacientes con hemiartroplastía de cúpula radial por fracturas tipo III y IV según Mason-Johnston, por medio de las escalas de Índice de Mayo de desempeño del codo (Mayo Elbow Performance Índex (IMDC)) y Quick-Dash (QD). Material y métodos: Se realizó un estudio, observacional, transversal y ambiespectivo, en el Servicio de Miembro Torácico del Hospital de Traumatología y Ortopedia "Lomas Verdes", en un período de un año, se incluyeron pacientes de 18 a 60 años de edad, con diagnóstico de fractura de cúpula radial tipo III y IV según Mason-Johnston manejados con hemiartroplastía de cúpula radial. Resultados: Fueron incluidos siete pacientes, de los cuales 3 fueron del sexo femenino (42.9%) y 4 fueron del sexo masculino (57.1%). De la clasificación de funcionalidad IMDC se obtuvieron los siguientes resultados. Excelente, 6 pacientes (85.7%); Bueno, 1 paciente (14.3%). La escala de funcionalidad y sintomatología de QD se obtuvieron seis pacientes con puntuación de 0 a 5 y un paciente con puntuación de más de 10. Conclusiones: El tratamiento quirúrgico consistente en hemiartroplastía de cúpula radial por fracturas tipo III y IV según Mason-Johnston es un buen tratamiento quirúrgico a corto plazo, debido a que nos ofrece una funcionalidad de excelente a buena, estabilidad en valgo y varo del codo, así como sintomatología mínima del codo.


Introduction: The radial head is a primary and important stabilizer of the elbow, mainly for valgus stability, posterolateral and axial displacement of the radius and varus loading. Radial head fractures account for 1.7-5% of all fractures in adults, 17-19% of elbow trauma, and 33% of all elbow fractures. The latter is the most common one at this level. The alternatives for a radial head fracture that cannot be reconstructed include excision of the radial head or hemiarthroplasty. Objective: To assess the function of patients who underwent radial head hemiarthroplasty for Mason-Johnston types III and IV fractures, using the Mayo Elbow Performance Index (MEPI) and Quick-Dash (QD). Material and methods: A one-year long observational, cross-sectional and ambispective study was conducted at the Thoracic Limb Service, "Lomas Verdes" Orthopedics and Traumatology Hospital. The patients included were ages 18 to 60 years, had a diagnosis of Mason-Johnston types III and IV radial head fractures and were treated with radial head hemiarthroplasty. Results: A total of seven patients were included, 3 females (42.9%) and 4 males (57.1%). The results of elbow function according to the MEPI were as follows: Excellent, 6 patients (85.7%); Good, one patient (14.3%). The results of the QD functionality and symptoms scale were: 6 patients had a score of 0-5, and one patient more than 10. Conclusions: Surgical treatment consisting of radial head hemiarthroplasty for Mason-Johnston types III and IV fractures yields good short-term results, because it provides excellent to good function, valgus and varus elbow stability, and minimum elbow symptoms.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Elbow Joint/surgery , Hemiarthroplasty/methods , Radius Fractures/surgery , Cross-Sectional Studies , Elbow Joint/injuries , Mexico , Treatment Outcome
20.
Article in English | WPRIM | ID: wpr-69214

ABSTRACT

BACKGROUND: Unstable simple elbow dislocation (USED) repair is challenged by the maintenance of joint reduction; hence, primary repair or reconstruction of disrupted ligaments is required to maintain the congruency and allow early motion of the elbow. We evaluated the effectiveness and the outcome of lateral collateral ligament (LCL) complex repair with additional medial collateral ligament (MCL) repair in cases of USED. METHODS: We retrospectively reviewed 21 cases of diagnosed USED without fractures around the elbow that were treated with primary ligament repair. In all cases, anatomical repair of LCL complex with or without common extensor origin was performed using suture anchor and the bone tunnel method. Next, the instability and congruency of elbow for a full range of motion were evaluated under the image intensifier. MCL was repaired only if unstable or incongruent elbow was observed. Clinical outcomes were evaluated using the Mayo elbow performance score (MEPS) and radiographic outcomes on last follow-up images. RESULTS: All cases achieved a stable elbow on radiographic and clinical results. LCL complex repair alone was sufficient to obtain the stable elbow in 17 of 21 cases. Four cases required additional MCL repair after restoration of the LCL complex. The overall mean MEPS was 91 (range, 70 to 100): excellent in 12 cases, good in 7 cases, and fair in 2 cases. All 17 cases with LCL complex repair only and 2 of 4 cases with additional MCL repair had excellent or good results by MEPS. CONCLUSIONS: USED requires surgical treatment to achieve a congruent and stable joint. If the repair of lateral stabilizer such as LCL complex acquires enough joint stability to maintain a full range of motion, it may not be necessary to repair the medial stabilizer in all cases of USED.


Subject(s)
Adult , Aged , Collateral Ligaments/surgery , Joint Dislocations/complications , Elbow Joint/injuries , Female , Humans , Joint Instability/complications , Male , Middle Aged , Orthopedic Procedures/methods , Range of Motion, Articular , Retrospective Studies , Young Adult
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