Simple medial elbow dislocations: a rare injury at risk for early instability.

PURPOSE: To report the presentation, treatment, and outcomes of a series of simple medial elbow dislocations and to identify features distinguishing this injury from the more common dislocation patterns. METHODS: From 2000 to 2011, 4 cases of simple medial elbow dislocations were treated at a single referral center. Retrospective review was conducted to evaluate presentation, treatment, and outcomes. RESULTS: The mean patient age was 56 years (range, 49-61 y). All dislocations were in the nondominant arm of women after a fall from standing height. Two elbows had immediate closed reduction, and 2 elbows could not be reduced acutely. All elbows presented within 2.5 weeks of injury with recurrent instability or dislocation. Two patients also had acute symptoms of ulnar neuropathy. All patients had surgical repair of the lateral collateral ligament complex and extensor tendon origin. Three patients had ulnar nerve decompressions. All elbows were stable to valgus, varus, and rotatory stress testing, with no subjective instability at a minimum follow-up of 8 months (range, 8-144 mo). Three patients reported no pain. Symptoms of ulnar neuropathy resolved in all patients. Mean elbow range of motion was from 13° to 135° of extension/flexion, with full pronation and supination. CONCLUSIONS: Simple medial elbow dislocations may be at risk for early instability and may represent a more noteworthy soft tissue injury than typical dislocation patterns. Surgical treatment of early instability in these injuries led to acceptable patient outcomes.

Extensile surgical exposures of the radius: a comparative anatomic study.

PURPOSE: To evaluate and compare exposures of the radius using 3 surgical approaches. Our hypotheses were that the anterior flexor carpi radialis approach allows greater exposure of the distal radius than does the volar-ulnar approach, and the extensile flexor carpi radialis approach allows comparable proximal and midshaft exposure of the radius compared with the dorsal Thompson approach. METHODS: We performed anterior and dorsal exposures of the radius on 10 matched pairs of cadavers (20 forearms) randomly assigned to 1 anterior and 1 dorsal approach. We measured and compared the anatomic features and limits of the anterior flexor carpi radialis approach, volar-ulnar approach to the distal radius, and the dorsal Thompson approach. RESULTS: The anterior flexor carpi radialis approach exposed 3.3 cm of distal radius width, was convertible to an extensile approach proximally, required sacrifice of 3 arterial branches, and was limited by the junction of the radial and ulnar arteries. This approach provided 79% of radius exposure and ended 4.7 cm distal to the radiocapitellar joint. The volar-ulnar approach to the distal radius exposed 3.1 cm of distal radius width. The dorsal Thompson approach sacrificed no arterial branches, provided 69% of radius exposure, was limited by the first compartment distally and the posterior interosseous nerve proximally, and ended within 2.6 cm of the radiocapitellar joint. The posterior interosseous nerve coursed 19, 14, and 6 mm dorsolateral to the distal, middle, and proximal margins, respectively, of the supinator insertion on the radius. CONCLUSIONS: The volar-ulnar approach provided less access to the radial styloid and was not as extensile as the flexor carpi radialis approach. The Thompson approach provided more proximal exposure than the flexor carpi radialis approach. CLINICAL RELEVANCE: Improved knowledge of the anatomy, limits of exposure, and comparison of features between approaches to the radius may facilitate surgical planning and exposure.

Intermediate-term outcomes for floating elbow and floating elbow variant injuries.

BACKGROUND: There are limited outcome studies describing floating elbow injuries. The purpose of this report is to describe patient outcomes after floating elbow injury using the American Shoulder and Elbow Surgeons (ASES) elbow assessment form. MATERIALS AND METHODS: From 1994 to 2004, 19 patients were retrospectively identified at 3 Level I trauma centers and returned for follow-up evaluation after treatment of their floating elbow injury. Patient outcomes were assessed based on physical examination and the ASES elbow form. RESULTS: The 19 patients were evaluated at a mean of 6.7 years (range, 2.3-13.4 years) after treatment of their floating elbow injuries. The mean ASES elbow score was 89 (range, 13-99), and the mean visual analog scale satisfaction with elbow surgery was 8.7 (range, 7-10). Fifteen of 19 patients reported continued pain in the elbow. Patient age, arm dominance, type of humeral fixation, type of forearm fixation, open fracture, multiple surgeries, and fracture pattern were not significantly associated with outcomes. Nerve injury was associated with lower ASES elbow scores (P = .03). There was also a significant correlation between the ASES elbow score and follow-up time, indicating that patients with a longer duration of follow-up had better subjective outcomes (Spearman coefficient = 0.55; P = .02). CONCLUSION: Floating elbow fractures represent high-energy trauma and have significant associated injuries. Nerve injury is correlated with lower subjective outcomes. Patients continue to improve for several years with acceptable mid-term results.

Distal biceps tendon tears in women.

HYPOTHESIS: Is the presentation and outcome of surgical treatment of distal biceps tendon tears different in women than men? MATERIALS AND METHODS: From 1999 to 2008, 15 cases of distal biceps tendon tears in 13 female patients were treated surgically at a single institution. Mean age was 63 years (range, 48-79 years). A retrospective review evaluated patient presentation, diagnosis, and treatment. Postoperative outcomes were assessed by physical examination, a patient satisfaction survey, the American Shoulder and Elbow Surgeons (ASES) elbow assessment form, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. RESULTS: Two-thirds of the tears were in the dominant arm, of which 7 resulted from a single injury, and 8 reported insidious onset of symptoms. All patients presented with pain in the antecubital fossa. A distinct cystic mass was palpable in 6. Of the 15 cases, 13 were partially detached, 1 was completely detached, and 1 was weakly attached. Fourteen regained full strength, and all had nearly complete range of motion. Mean follow-up was 46 months (range, 2-117 months). Eleven completed a postoperative patient satisfaction survey, ASES elbow, and DASH questionnaire. Mean scores were 95 (range, 58-100) for ASES and 7 (range, 0-43) for DASH. The only complication was a transient lateral antebrachial cutaneous nerve sensory palsy. DISCUSSION: Distal biceps tendon tears in women present at an advanced age with no history of an acute injury. They are frequently associated with a cystic mass and have a predominance of partial tears. CONCLUSIONS: Distal biceps tendon tears in women present differently than in men. The tears are rarely complete and they respond well to surgical repair.