Joint replacement surgery for elbow tumours: a systematic review of outcomes.

BACKGROUND: Tumour resection followed by joint reconstruction is a surgical option in the appropriate patient. The evidence for such reconstructive surgery of the elbow joint is limited. The aim of this study is to review the literature to evaluate the outcomes of joint replacement surgery in tumours of the elbow. METHODS: A systematic review of PUBMED and EMBASE databases was conducted. Case series and comparative studies reporting results after total elbow arthroplasty, modular endo-prosthetic replacement and custom prosthesis were eligible for inclusion. RESULTS: Eleven eligible studies were identified (n = 134). At mean follow-up of 44 months, the overall revision rate was 14% and complication rate was 28%. The mean Mayo Elbow Performance Score was 75, with 56% of patients reporting good or excellent outcomes. The mean post-operative range of motion was 97°. DISCUSSION: Elbow prosthesis reconstruction after tumour resection can provide good functional outcomes at mid-term follow-up. The complication and revision rates are comparable to other indications for elbow replacement surgery. Further prospective studies are required to compare outcomes between different elbow arthroplasty options after tumour resection.

Indications and outcome in total elbow arthroplasty: A systematic review.

BACKGROUND: Total elbow arthroplasty (TEA) is the established treatment for end-stage rheumatoid arthritis but improved surgical techniques have resulted in expanded indications. The aim of this study is to review the literature to evaluate the evolution of surgical indications for TEA. METHODS: A systematic review of PubMed and EMBASE databases was conducted. Case series and comparative studies reporting results after three types of primary TEA were eligible for inclusion. RESULTS: Forty-nine eligible studies were identified (n = 1995). The number of TEA cases published annually increased from 6 cases in 1980 to 135 cases in 2008. The commonest indication for TEA throughout the review period was rheumatoid arthritis but its annual proportion reduced from 77% to 50%. The mean Mayo Elbow Performance Score significantly improved for all indications. Three comparative studies reported statistically improved functional outcomes in rheumatoid arthritis over the trauma sequelae group. Complication and revision rates varied; rheumatoid arthritis 5.2-30.9% and 11-13%, acute fracture 0-50% and 10-11%, trauma sequelae 14.2-50% and 0-30%, osteoarthritis 50% and 11%, respectively. DISCUSSION: TEA can provide functional improvements in inflammatory arthritis, acute fractures, trauma sequelae and miscellaneous indications. Long-term TEA survivorship appears satisfactory in rheumatoid arthritis and fracture cases; however, further research into alternative surgical indications is still required.

Sternoclavicular joint.

The sternoclavicular joint is a saddle shaped, synovial joint and is the only skeletal articulation between the axial skeleton and the upper limb. Here, a reviewis provided of the anatomy, biomechanics, traumatic and atraumatic conditions, and management options for the various conditions described.

Intra-Articular Synovial Haemangioma of the Elbow in an Adolescent Male.

Intra-articular haemangiomas are rare phenomena and are difficult to diagnose and manage. We describe a case in which a haemangioma was found at the time of elbow arthroscopy in an adolescent male. The case highlights the advantage of early arthroscopic assessment and also that synovial haemangiomas must be considered as a rare differential diagnosis in unexplained elbow and joint pain.

Olecranon bursitis: a systematic overview.

BACKGROUND: Olecranon bursitis is a common condition where the bursal cavity, superficial to the olecranon, becomes inflamed. This can occur either with or without infection and has been given pseudonyms relating to the repeated minor trauma from external pressure that often predisposes. As a result of the multiple aetiologies, olecranon bursitis can present to any medical specialty with reasonable frequency and, although many therapies are described, a single, evidence-based and standardized treatment pathway is not well described. METHODS: We summarize the key points within the literature and subsequently propose an evidence-based treatment pathway. RESULTS: Relevant evidence is presented from appropriate publications to add rational to existing decision-making processes, together with personal experience and suggested operative bursectomy techniques from an established upper limb surgeon. The common and significant aetiologies are summarized and, in particular, red flag symptoms are highlighted by way of warning to the unsuspecting investigator. CONCLUSIONS: The conclusion is provided in diagrammatic form, providing a suggested treatment pathway from history and examination through to operative intervention.

Management of traumatic anterior shoulder dislocation in the 17- to 25-year age group: a dramatic evolution of practice.

BACKGROUND: Anterior shoulder dislocation in the young patient is a common problem, yet there is no universal agreement on its management. METHODS: In this study, we comprehensively surveyed all members of the British Elbow and Shoulder Society (BESS) to ascertain their preferred methods of treating young patients with traumatic, anterior shoulder dislocation. We then repeated exactly the same survey 7 years later to find out whether practices had changed and if any consensus of opinion had been reached. RESULTS: The number of surgeons indicating their preferred stabilization procedure was arthroscopic more than quadrupled from only 16% in 2002 to 71% in 2009, while the numbers of those preferring an open technique fell in a correspondingly dramatic manner. The numbers who now potentially offer stabilization surgery to first-time dislocators virtually doubled from 35% to 68%. There was also a big rise in the use of magnetic resonance imaging (MRI) arthrograms as an investigation prior to surgery and in the use of bio-absorbable anchors during surgical stabilization. There remain, however, aspects of treatment and rehabilitation where little consensus exists. CONCLUSION: Rarely in the history of orthopaedic surgery has such a dramatic and widespread change in operative technique occurred in such a short space of time. Rarer still has such a change been prospectively documented.

Sequential metatarsal fatigue fractures secondary to abnormal foot biomechanics.

Sequential fatigue fractures of the fourth, second, and third metatarsals in the same foot are reported for a military aviator in the absence of abnormal stresses or underlying bone disease. The likely etiological factor is altered foot biomechanics, as identified in pedobarographic assessment. We have reviewed the literature regarding multiple metatarsal stress fractures.