Effect of ulnar tunnel location on elbow stability in double-strand lateral collateral ligament reconstruction.

BACKGROUND: Double-strand lateral ulnar collateral ligament (LUCL) reconstruction is an effective treatment for posterolateral rotatory instability (PLRI) of the elbow, but anatomic landmarks for ulnar tunnel placement are often difficult to identify intraoperatively, which potentially can result in a nonanatomic LUCL reconstruction. This study investigated the effect of ulnar tunnel location on joint stability in double-strand LUCL reconstruction. METHODS: PLRI was artificially created in 7 cadaveric elbows, and double-strand LUCL reconstruction was performed. Five different ulnar tunnels were made along the length of the ulna. In each specimen, each possible pair of 2 tunnels (10 total) were used for graft passage. Varus and posterolateral joint gapping was measured after joint loading using a 3-dimensional digitizer system and X-ray image intensifier. RESULTS: No significant gapping was observed at the posterolateral ulnohumeral joint regardless of the location of the ulnar tunnels (P > .05). In contrast, the lateral radiocapitellar joint showed statistically significant varus gapping when both ulnar tunnels were placed proximal to the radial head-neck junction (P < .05). DISCUSSION: This findings of study suggest that the location of the ulnar tunnels may not be as critical as that of the humeral tunnel during double-strand LUCL reconstruction and that posterolateral rotatory elbow stability can be achieved reasonably well as long as at least 1 of the 2 ulnar tunnels is located at or distal to the radial head-neck junction level.

Intraoperative Catastrophic Failure of a Mizuho OSI Orthopedic Trauma Table Top: A Case Report.

CASE: During orthopaedic open reduction and internal fixation, early fatigue failure of a Mizuho OSI Orthopedic Trauma Table Top occurred. The patient fell toward the ground but was uninjured. A material failure characterized by a crack in the spar tube leading to complete table component separation was identified. To our knowledge, this report is the first of its kind to specifically highlight surgical table device failure intraoperatively. CONCLUSION: Although rare, early fatigue failure of operating tables is possible, leading to hazardous intraoperative situations and the potential for serious patient injury or death. Operating tables and equipment should be inspected rigorously and with proper documentation to prevent such events.