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2.
Pan Afr Med J ; 36: 144, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874408

RESUMO

Fractures of the radial neck accounts for 1% of all childhood fractures and 5% to 10% of childhood traumatic lesions involving the elbow. Intramedullary percutaneous nail reduction (Metaizeau technique) is considered the most effective surgical technique. The purpose of this study was to identify the main clinical features of radial neck fracture in children and to evaluate the anatomical and functional results of the Metaizeau technique. In this retrospective study, we evaluated 22 patients under the age of 16 who were treated for radial neck fracture at the orthopedic and trauma surgery department of Sahloul University Hospital in Sousse over a period of 16 years from January 2001 to April 2017. Authors used Metaizeau classification. Functional results were evaluated by Mayo elbow performance score (MEPS) and the radiological evaluation was based on standard images with measurement of the residual rocker. The average age was 8.6 years (5-13 years). Seven fracture were grade III injuries and three grade IV. In the immediate postoperative period, radiological measurements showed a residual rocker less than 20° in 86.3% and more than 20° in 13.7% of cases. At an average follow-up of 13 months and a half, the MEPS score was excellent and good for 17 patients. Four types of complications were found: necrosis of the radial head in 1 case, pseudarthrosis in 1 case, periarticular calcification in 2 cases and stiff-ness of the elbow in 3 cases. Despite the small number of patients in our series, we believe that the elastic stable intramedullary pinning according to the Metaizeau technique is the treatment of choice for displaced radial neck fractures in children.


Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas , Fraturas do Rádio/cirurgia , Adolescente , Pinos Ortopédicos/efeitos adversos , Criança , Pré-Escolar , Cotovelo/lesões , Cotovelo/fisiopatologia , Cotovelo/cirurgia , Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/reabilitação , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/instrumentação , Fixação Intramedular de Fraturas/métodos , Fixação Intramedular de Fraturas/reabilitação , Humanos , Masculino , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Período Pós-Operatório , Radiografia , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/lesões , Rádio (Anatomia)/fisiopatologia , Rádio (Anatomia)/cirurgia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/epidemiologia , Fraturas do Rádio/reabilitação , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento , Tunísia/epidemiologia
4.
Medicine (Baltimore) ; 99(34): e21830, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846828

RESUMO

Brachial plexus birth palsy (BPBP) is a neurologic injury that can result in mild to full paralysis of the affected upper extremity. In severe cases, nerve surgery is often performed before age 1 year. Several studies report gains in elbow flexion with onabotulinum toxin type A (OBTT-A) injections to the triceps; however, its use in infants is not widely reported. The purpose of this study is to present our experience using these injections before 6 months of age to therapeutically unmask elbow flexion and diagnostically guide surgical decision making.This is a retrospective observational cohort study. The cohort included infants with BPBP who received OBTT-A injection to the triceps before age 6 months. Indications for the injections include trace elbow flexion and palpable co-contraction of the biceps and triceps. Elbow flexion was evaluated using the Toronto Test score. Therapeutic success was defined as an increase in post-injection scores. These scores were then used diagnostically as an indication for surgery if the infant did not achieve full elbow flexion by 8 months. A treatment algorithm for OBTT-A triceps injection was developed based on all treatment options offered to infants with elbow flexion deficits seen in the clinic.Of the 12 infants that received OBTT-A triceps injections, 10 (83%) had improved Toronto test elbow flexion scores post-injection. Gains in elbow flexion once attained were maintained. Of the 9 OBTT-A infants with at least 2 years follow-up, 4 achieved full elbow flexion without surgery; the remainder after surgery. No complications with OBTT-A injections were noted and patients were followed on average 6 years. The average age at time of injection was 4 months (range: 2-5 months). Compared to other treatments given, OBTT-A infants tended to present with more elbow flexion than the 4 infants requiring immediate surgical intervention and less elbow flexion than the 16 infants treated conservatively.OBTT-A injection to the triceps in infants with BPBP before 6 months of age therapeutically improved elbow flexion and diagnostically guided surgical decisions when full elbow flexion was not achieved by 8 months of age with no known complications.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Articulação do Cotovelo/fisiopatologia , Músculo Esquelético/fisiopatologia , Paralisia do Plexo Braquial Neonatal/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Amplitude de Movimento Articular/efeitos dos fármacos , Braço , Toxinas Botulínicas Tipo A/administração & dosagem , Criança , Pré-Escolar , Tomada de Decisão Clínica , Seguimentos , Humanos , Lactente , Injeções Intramusculares , Paralisia do Plexo Braquial Neonatal/fisiopatologia , Paralisia do Plexo Braquial Neonatal/cirurgia , Fármacos Neuromusculares/administração & dosagem , Estudos Retrospectivos
5.
Bone Joint J ; 102-B(8): 967-980, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731835

RESUMO

AIMS: The aims of this study were to validate the outcome of total elbow arthroplasty (TEA) in patients with rheumatoid arthritis (RA), and to identify factors that affect the outcome. METHODS: We searched PubMed, MEDLINE, Cochrane Reviews, and Embase from between January 2003 and March 2019. The primary aim was to determine the implant failure rate, the mode of failure, and risk factors predisposing to failure. A secondary aim was to identify the overall complication rate, associated risk factors, and clinical performance. A meta-regression analysis was completed to identify the association between each parameter with the outcome. RESULTS: A total of 38 studies including 2,118 TEAs were included in the study. The mean follow-up was 80.9 months (8.2 to 156). The implant failure and complication rates were 16.1% (95% confidence interval (CI) 0.128 to 0.200) and 24.5% (95% CI 0.203 to 0.293), respectively. Aseptic loosening was the most common mode of failure (9.5%; 95% CI 0.071 to 0.124). The mean postoperative ranges of motion (ROMs) were: flexion 131.5° (124.2° to 138.8°), extension 29.3° (26.8° to 31.9°), pronation 74.0° (67.8° to 80.2°), and supination 72.5° (69.5° to 75.5°), and the mean postoperative Mayo Elbow Performance Score (MEPS) was 89.3 (95% CI 86.9 to 91.6). The meta-regression analysis identified that younger patients and implants with an unlinked design correlated with higher failure rates. Younger patients were associated with increased complications, while female patients and an unlinked prosthesis were associated with aseptic loosening. CONCLUSION: TEA continues to provide satisfactory results for patients with RA. However, it is associated with a substantially higher implant failure and complication rates compared with hip and knee arthroplasties. The patient's age, sex, and whether cemented fixation and unlinked prosthesis were used can influence the outcome. Level of Evidence: Therapeutic Level IV. Cite this article: Bone Joint J 2020;102-B(8):967-980.


Assuntos
Artrite Reumatoide/cirurgia , Artroplastia de Substituição do Cotovelo/métodos , Medição da Dor , Falha de Prótese , Amplitude de Movimento Articular/fisiologia , Adulto , Fatores Etários , Idoso , Artrite Reumatoide/diagnóstico , Artroplastia de Substituição do Cotovelo/efeitos adversos , Estudos de Coortes , Bases de Dados Factuais , Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Prótese de Cotovelo , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Resultado do Tratamento
6.
J Am Acad Orthop Surg ; 28(19): e839-e848, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32649440

RESUMO

Monteggia fractures involve proximal ulna fracture associated with a radiocapitellar joint dislocation. The Bado classification is primarily based on the direction of the radial head dislocation. The Jupiter subtype classification of Bado II fractures further characterizes the severity of proximal ulna comminution and the involvement of the coronoid fragment. This latter classification can better prognosticate the challenges of surgical reconstruction and clinical outcomes. Surgery for all adult Monteggia fractures is required to restore the anatomic alignment of the ulna, which indirectly reduces the radiocapitellar joint. The complexity of the injury is considerably increased by comminution of the proximal ulna, the degree of radial head fragmentation, the reduction of the radial head, and ulnohumeral instability. Anatomic reduction is considered critical to achieving a favorable outcome.


Assuntos
Mau Alinhamento Ósseo/cirurgia , Placas Ósseas , Fixação Interna de Fraturas/métodos , Fixação de Fratura/métodos , Fraturas não Consolidadas/cirurgia , Fratura de Monteggia/cirurgia , Rádio (Anatomia)/anormalidades , Adulto , Estudos de Coortes , Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Feminino , Fraturas não Consolidadas/fisiopatologia , Humanos , Masculino , Fratura de Monteggia/fisiopatologia , Rádio (Anatomia)/cirurgia , Amplitude de Movimento Articular , Fraturas da Ulna/fisiopatologia , Fraturas da Ulna/cirurgia
7.
J Pediatr Orthop ; 40(7): e547-e553, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32658393

RESUMO

INTRODUCTION: The incidence of residual deformity in the sagittal plane of the humerus (RDSPH) after nonoperative management of type II supracondylar humerus fractures (SCHFs), and the effects of such deformity on the overall arc of motion (AOM) of the elbow, are unknown. Our purpose was to analyze data collected prospectively on a large cohort of type II SCHF's to establish the incidence and extent of RDSPH, and the effects of the deformity on the elbow function, to further support our previously published recommendations on the treatment of type II SCHF. METHODS: The clinical data and radiographs of 1107 pediatric type II SCHFs enrolled in a prospective registry, and followed for a minimum of 8 weeks, were retrospectively reviewed. The radiographs obtained during the latest follow-up appointment were examined for the presence of RDSPH, as demonstrated by the anterior humeral line falling anterior or posterior relative to the center of the capitellum. The amount of RDSPH in the sagittal plane was then calculated. We compared the treatment outcome of elbows with and without RDSPH by assessing the patients' AOM, the arc of flexion (AOF), and relative arcs of motion (R-AOM) and relative arcs of flexion (R-AOF) (as compared with the unaffected, contralateral elbow). RESULTS: Overall, 799 (72.2%) fractures were treated nonsurgically, and 308 (27.8%) fractures were treated surgically. The overall incidence of RDSPH was 10.2%. None of the fractures managed operatively demonstrated residual deformity. The RDSPH was classified as mild in 35 fractures (3.2%), moderate in 64 fractures (5.7%) and severe in 14 fractures (1.3%). Therefore, the incidence of RDSPH in fractures treated nonoperatively was 14.1%. In fractures treated nonoperatively, the difference in AOM between those without (n=686) and with (n=113) RDSPH was <4 degrees (149.1 vs. 145.8 degrees, P=0.02). Those with and without RDSPH had a clinically similar AOF, with a mean difference of<4 degrees (134.5 vs. 137.9 degrees, P<0.0001). The differences in R-AOM and R-AOF between those with and without RDSPH were minimal (97.3% vs. 95.6% and 96.6% vs. 95.3%, respectively). A satisfactory outcome, defined as an R-AOM of at least 85% when compared with the unaffected, contralateral side at the latest follow-up, was achieved in 91% of fractures with RDSPH, and 93% of fractures without RDSPH. DISCUSSION AND CONCLUSION: The incidence of RDSPH in type II SCHF treated nonoperatively was 14%. In our cohort, nearly 99% of all RDSPH were mild to moderate. On the basis of the data presented in the current study, nonsurgical treatment of type II SCHF can provide a satisfactory recovery of AOM, AOF, R-AOM, and R-AOF, and a high rate of satisfactory outcomes, even in the presence of RDSPH.


Assuntos
Articulação do Cotovelo/diagnóstico por imagem , Fraturas do Úmero/terapia , Deformidades Articulares Adquiridas/epidemiologia , Adolescente , Algoritmos , Criança , Pré-Escolar , Estudos de Coortes , Progressão da Doença , Articulação do Cotovelo/fisiopatologia , Feminino , Humanos , Incidência , Lactente , Masculino , Radiografia , Amplitude de Movimento Articular , Sistema de Registros , Estudos Retrospectivos , Resultado do Tratamento
8.
J Shoulder Elbow Surg ; 29(8): 1522-1529, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32713463

RESUMO

BACKGROUND: There are no previous randomized trials comparing surgical to conservative treatment for post-traumatic elbow stiffness. The aim of our study was to compare elbow range of motion (ROM) and clinical outcomes among patients undergoing surgical treatment or a standardized rehabilitation for post-traumatic elbow stiffness. METHODS: Randomized clinical trial of patients with post-traumatic elbow stiffness for more than 6 months who failed conventional physical therapy for 4 months. Patients were randomized into 2 treatment groups. The conservative group underwent the rehabilitation protocol associated with the use of orthoses (static progressive for extension and dynamic for flexion) and continuous passive motion. The surgical group underwent surgical release by a posterior approach without triceps detachment, followed by a rehabilitation protocol similar to the conservative group. The primary outcome of the study was flexion-extension ROM at 6 months of follow-up. Secondary outcomes included the visual analog scale for pain, the Mayo Elbow Performance Score, the Disabilities of the Arm, Shoulder, and Hand score, absolute and relative increase in flexion-extension ROM, and complication rates. RESULTS: Thirty patients were analyzed in the study, 15 in each group. The mean elbow flexion-extension ROM at the end of 6 months of follow-up was 108° in the surgical group and 88° in the conservative group (P = .002). The mean absolute and the relative increase of elbow flexion-extension at 6 months were, respectively, 17° and 27% in the conservative group and 41° and 59% in the surgical group (P < .001). CONCLUSION: Surgical elbow release associated with the rehabilitation protocol resulted in a greater flexion-extension ROM, as well as a greater absolute and relative increase compared with rehabilitation alone at 6 months of follow-up. The groups did not differ regarding clinical scores and complication rates.


Assuntos
Articulação do Cotovelo/cirurgia , Artropatias/cirurgia , Procedimentos Ortopédicos/métodos , Modalidades de Fisioterapia , Amplitude de Movimento Articular/fisiologia , Adulto , Cotovelo , Articulação do Cotovelo/fisiopatologia , Feminino , Seguimentos , Humanos , Artropatias/fisiopatologia , Artropatias/reabilitação , Masculino , Resultado do Tratamento
9.
J Shoulder Elbow Surg ; 29(8): 1530-1537, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32713464

RESUMO

BACKGROUND: Ulnar collateral ligament reconstruction (UCLR) has allowed the return of overhead athletes to throwing sports. We describe a new double suspensory (DS) technique using a single tunnel in the ulna and humerus, achieving fixation with adjustable loop buttons. METHODS: Inclusion criteria included skeletally mature baseball players with clinical and magnetic resonance imaging diagnosis of UCL insufficiency who failed a trial of structured nonoperative treatment. A total of 36 baseball players underwent DS UCLR, between 2011 and 2017, by 1 surgeon with minimum 2-year follow-up. The graft was fixated with an adjustable button loop on the humeral side and a tension slide technique with a button on the ulnar side. Pre- and postoperative Kerlan-Jobe Orthopaedic Clinic and Single Assessment Numerical Evaluation and postoperative Conway scores were obtained. RESULTS: The mean age was 19.8 ± 4.6 years (range, 14-35 years). All were male. Mean years played before surgery was 14.3 ± 4.6 years (range, 8-28 years). There were 32 (89%) pitchers and 4 (11%) position players. There were 13 (36%) high school, 20 (55%) college, 2 (6%) minor league, and 1 (3%) adult league athletes. The mean follow-up was 55.3 ± 23.7 months (range, 26-97 months). There was significant improvement in Kerlan-Jobe Orthopaedic Clinic (33.2 ± 19.9 to 89.7 ± 15.1, P < .0001) and Single Assessment Numerical Evaluation (20.7 ± 16.7 to 93.6 ± 11.9, P < .0001) scores. Using Conway scoring, 25 (69%) had excellent, 5 (14%) good, 3 (8%) fair, and 3 (8%) poor scores. Mean return to play was 9 ± 1.5 months (range, 6-16 months). Only 1 (3%) athlete required a revision surgery and ultimately returned to play and 1 (3%) hardware removal. None developed ulnar nerve symptoms. CONCLUSION: DS fixation for UCLR in baseball players can lead to excellent clinical results and early return to play.


Assuntos
Beisebol/lesões , Ligamento Colateral Ulnar/cirurgia , Articulação do Cotovelo/cirurgia , Volta ao Esporte , Reconstrução do Ligamento Colateral Ulnar/métodos , Adolescente , Adulto , Ligamento Colateral Ulnar/lesões , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Masculino , Período Pós-Operatório , Reoperação , Adulto Jovem
10.
J Shoulder Elbow Surg ; 29(7): 1380-1386, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32553438

RESUMO

HYPOTHESIS: Heterotopic ossification (HO) is a common complication of surgically treated elbow fractures that can inhibit range of motion and impair quality of life. Although there are many treatment methods for HO, there is a lack of consensus as to the best option. We hypothesized that contracture release combined with Botox injection would lead to improved functional outcome scores when compared with current treatment methods. METHODS: A retrospective review was conducted of patients who presented to a single surgeon with HO secondary to elbow fracture between 2005 and 2018. A total of 59 patients were identified who met inclusion criteria. Data were classified into 3 groups: contracture release (control - CR), Botox injection with CR (Botox + CR), and radiation therapy with CR (CR + RT). Range of motion measurements were obtained, including flexion, extension, pronation, and supination. RESULTS: A total of 30 patients (30 of 59, 50.8%) received CR, 6 (6 of 59, 9.2%) were treated with CR + RT, and 23 (23 of 59, 40.0%) had CR + Botox. There was a significant difference between pre- and postoperative arc of motion for both CR + RT (P < .01) and CR + Botox (P < .01). In addition, there was a significant difference in pre- and postoperative extension for patients who received intraoperative Botox injections (P < .05). There was no significant difference between pre- and postoperative motion nor extension in the CR group. CONCLUSION: Intraoperative Botox injection with CR is an effective method in the treatment of post-traumatic elbow stiffness caused by HO.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Articulação do Cotovelo/cirurgia , Fraturas Ósseas/cirurgia , Liberação da Cápsula Articular , Fármacos Neuromusculares/uso terapêutico , Ossificação Heterotópica/terapia , Adulto , Terapia Combinada , Contratura/etiologia , Contratura/terapia , Cotovelo/lesões , Cotovelo/cirurgia , Articulação do Cotovelo/lesões , Articulação do Cotovelo/fisiopatologia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/etiologia , Radioterapia , Amplitude de Movimento Articular , Estudos Retrospectivos
11.
J Shoulder Elbow Surg ; 29(7): 1387-1393, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32553439

RESUMO

BACKGROUND: Hyperuricemia is considered a risk factor for increased postoperative complications and adverse functional outcomes in a variety of orthopedic surgeries. The purpose of this retrospective study was to investigate the clinical efficacy of patients with different uric acid levels after elbow arthrolysis. METHODS: The study included 131 patients with post-traumatic elbow stiffness who underwent arthrolysis between March 2014 and March 2016. All patients were divided into 4 groups based on the preoperative serum level of uric acid (UA). The quartile method was used for grouping patients, including 33 in Q1 (UA <293 µmol/L), 34 in Q2 (293-348 µmol/L), 32 in Q3 (348-441 µmol/L), and 32 in Q4 (441-710 µmol/L). At baseline and each time point of follow-up, functional performance, Mayo Elbow Performance Score, visual analog scale for pain, and complications were evaluated. RESULTS: Preoperative data were not significantly different among the 4 groups (Q1, Q2, Q3, and Q4). At the final follow-up, the following data showed significant differences among the 4 groups: extension (P = .031), flexion (P = .008), range of motion (P = .003), Mayo Elbow Performance Score (P = .011), and visual analog scale (P = .032). Interestingly, patients in the Q4 group had the poorest clinical outcomes. However, no significant differences were found among the 4 groups in new onset or exacerbation of nerve symptoms (P = .919), reduced muscle strength (P = .536), instability (P = .567), or infection (P = .374) at the last follow-up. CONCLUSION: This study confirms that in patients with post-traumatic elbow stiffness, abnormal serum uric acid metabolism was a risk factor for poor performance and postoperative pain after arthrolysis. Therefore, detecting the preoperative serum uric acid levels of the patients would be helpful for evaluating the postoperative outcomes.


Assuntos
Articulação do Cotovelo/fisiopatologia , Hiperuricemia/fisiopatologia , Artropatias/cirurgia , Ácido Úrico/sangue , Adulto , Articulação do Cotovelo/lesões , Articulação do Cotovelo/cirurgia , Fixadores Externos , Feminino , Humanos , Hiperuricemia/sangue , Artropatias/etiologia , Artropatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/sangue , Dor Pós-Operatória/etiologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
12.
Jt Dis Relat Surg ; 31(2): 291-297, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584728

RESUMO

OBJECTIVES: This study aims to present the results of 21 patients with capitellum fractures treated with open reduction and headless screws by a single experienced surgeon. PATIENTS AND METHODS: Twenty-one patients (13 males, 8 females; mean age 39 years; range, 18 to 63 years) who were admitted to our clinic between June 2011 and January 2018 with the diagnosis of capitellum fracture and followed-up for a mean period of 45 months (range, 12 to 90 months) were included in this retrospective study. The fractures were fixed with headless cannulated screws by a single surgeon. RESULTS: The mean range of motion was 102° (range, 65° to 140°) during flexion-extension and 165° (range, 130° to 180°) during supination-pronation. The mean preoperative visual analog scale (VAS) score was 8.5 (range, 6 to 10), whereas the mean postoperative VAS score was 2.2 (range, 0 to 6). According to the Mayo Elbow Performance score, nine patients were evaluated as excellent, six patients as good, four patients as fair, and two as poor. The mean Quick-Disabilities of the Arm, Shoulder and Hand score was 25.1 (range, 4 to 57). Avascular necrosis developed in three patients (14%) and heterotopic ossification was detected in one patient (4%). CONCLUSION: Capitellum fractures are difficult to diagnose and treat, and good results can only be achieved by an accurate diagnosis, careful surgical technique, and stable fixation. Larger and more comprehensive studies are required to establish a generalization and more accurate inferences on this limitedly studied subject.


Assuntos
Articulação do Cotovelo/fisiopatologia , Fixação Interna de Fraturas , Fraturas do Úmero , Redução Aberta , Complicações Pós-Operatórias/prevenção & controle , Amplitude de Movimento Articular , Adulto , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Humanos , Fraturas do Úmero/diagnóstico , Fraturas do Úmero/cirurgia , Masculino , Redução Aberta/efeitos adversos , Redução Aberta/instrumentação , Redução Aberta/métodos , Osteonecrose/etiologia , Osteonecrose/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento
13.
J Shoulder Elbow Surg ; 29(7): 1401-1405, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32418855

RESUMO

BACKGROUND: Although ulnar neuritis can occur secondary to ulnar collateral ligament pathology, stress fractures, and traction apophysitis, isolated ulnar nerve dysfunction can lead to medial elbow pain. The purpose of this study was to evaluate the short-term outcomes of overhead athletes undergoing anterior ulnar nerve transposition for ulnar neuropathy. METHODS: All overhead athletes who underwent isolated ulnar nerve transposition between 2009 and 2016 for refractory ulnar neuritis were identified. The primary outcome was return to sport, and secondary outcome measures included the Kerlan-Jobe Orthopaedic Clinic score; Mayo Elbow Performance Score; Quick Disabilities of the Arm, Shoulder and Hand score; Single Assessment Numeric Evaluation score; and visual analog scale score for pain. Complication and reoperation rates were recorded. RESULTS: A total of 26 overhead athletes (21 male and 5 female athletes) underwent ulnar nerve transposition at an average age of 18.4 years (range, 11-25 years). Of the patients, 24 (92%) returned to their sporting activity at an average of 2.7 months postoperatively, including 16 (62%) at the previous level of play. The average visual analog scale pain score improved from 4.7 (±2.5) to 0.4 (±1.5) (P = .015). The average postoperative patient-reported outcome scores were as follows: Kerlan-Jobe Orthopaedic Clinic score, 80 (95% confidence interval [CI], 72.7-87.0); Single Assessment Numeric Evaluation score, 85 (95% CI, 75.4-94.7); Quick Disabilities of the Arm, Shoulder and Hand score, 5 (95% CI, 2.1-7.7); and Mayo Elbow Performance Score, 91 (95% CI, 86.8-96.0). CONCLUSION: Cubital tunnel syndrome can cause medial elbow pain in overhead athletes in the presence of a normal ulnar collateral ligament. At mid-term follow-up, 92% of overhead athletes returned to sport after ulnar nerve transposition, with 62% resuming their previous level of performance.


Assuntos
Traumatismos em Atletas/cirurgia , Volta ao Esporte , Neuropatias Ulnares/cirurgia , Adolescente , Adulto , Criança , Síndrome do Túnel Ulnar/complicações , Síndrome do Túnel Ulnar/cirurgia , Articulação do Cotovelo/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Dor Musculoesquelética/etiologia , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Reoperação , Neuropatias Ulnares/complicações , Adulto Jovem
14.
J Shoulder Elbow Surg ; 29(8): 1538-1547, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32381474

RESUMO

BACKGROUND: Post-traumatic elbow stiffness is a frequent and disabling complication after elbow trauma. Surgical release is needed if conservative treatment fails. In contrast to open surgical release, arthroscopic arthrolysis is a good and least invasive option to restore joint mobility. The aim of this study was to evaluate the clinical outcomes, range of motion (ROM), and function of post-traumatic elbow contracture after arthroscopic arthrolysis and to assess health-related quality of life (HRQL). METHODS: Between 2007 and 2013, 44 patients with post-traumatic elbow stiffness were treated by arthroscopic arthrolysis and followed up in a consecutive series. Clinical (ROM) and functional analyses (Disabilities of the Arm, Shoulder, and Hand Questionnaire [DASH], Mayo Elbow Performance Index [MEPI]) were performed at final follow-up 3 (1-7) years postoperatively. Furthermore, HRQL was evaluated (EQ-5D, 36-Item Short Form Health Survey [SF-36]). DISCUSSION: The average arc of elbow motion increased from 84° ± 28° preoperatively to 120° ± 18° postoperatively. All applied scores significantly improved pre- to postoperatively: the MEPI (59.8 ± 17.3 / 84.3 ± 14.0), DASH (43.5 ± 23.1 / 16.8 ± 15.6), EQ-5D (72.8 ± 16.6 / 84.0 ± 13.6), and SF-36 showed improved results in all categories. Univariate logistic regression revealed that preoperative pain level predicts a poorer postoperative outcome measured with the MEPI score. Revision arthroscopy was needed in 1 case because of persistent pain. CONCLUSIONS: Arthroscopic arthrolysis leads to good clinical and functional results in post-traumatic elbow stiffness regarding ROM, pain relief, functionality, and quality of life. The complication rate as well as the revision rate is very low.


Assuntos
Artroscopia , Contratura/cirurgia , Articulação do Cotovelo/cirurgia , Artropatias/cirurgia , Adolescente , Adulto , Idoso , Traumatismos do Braço/complicações , Contratura/etiologia , Contratura/fisiopatologia , Cotovelo/lesões , Articulação do Cotovelo/fisiopatologia , Feminino , Seguimentos , Humanos , Artropatias/etiologia , Artropatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Período Pós-Operatório , Qualidade de Vida , Amplitude de Movimento Articular , Inquéritos e Questionários , Adulto Jovem
15.
J Shoulder Elbow Surg ; 29(8): 1548-1553, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32381475

RESUMO

BACKGROUND: Distal biceps tendon avulsions account for 3%-10% of all biceps ruptures. Treated nonoperatively, these injuries lead to a loss of endurance, supination strength, and flexion strength compared with operative repair or reconstruction. Operative management of chronic injury has classically been with graft tissue to augment the contracted muscle. We present our results for chronic distal biceps avulsions secured with suture button through a single transverse incision in high flexion without the need for allograft augmentation. MATERIALS AND METHODS: This was a retrospective review of 20 patients with 21 injuries who underwent primary surgical repair of chronic distal biceps tendon avulsions at an average of 10 weeks (range 4-42 weeks). All patients were treated with a single transverse incision with a suture button armed with nonabsorbable no. 2 core sutures. Postoperatively patients were found to have 50°-90° flexion contracture. All patients were placed in a simple sling postoperatively with gentle extension to gravity as tolerated immediately and no formal physical therapy. Patients were surveyed regarding pre- and postoperative American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, visual analog scale (VAS) score, Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and overall satisfaction. Range of motion (ROM), flexion, and supination strength compared to the contralateral uninjured extremity were evaluated at final follow-up. RESULTS: Mean clinical follow-up was 26 months. All patients regained full ROM and 5/5 flexion and supination strength at final follow-up. MEPSs were 100 for all responding patients compared with an average 47.5 preoperatively (P < .0001). The mean postoperative ASES score was 97.2 compared with 41.9 preoperatively (P < .0001). Mean OESs pre- and postoperatively were 24.2 and 48, respectively (P < .0001). The mean VAS score was 4.4 preoperatively and was reported as 0 by all patients at final follow-up (P < .0001). Two patients had transient sensory radial nerve neuropathy, and 1 patient has persistent palsy. No synostoses occurred. Four patients reported supination fatigue postoperatively compared with the uninjured extremity. CONCLUSION: Given these results, we feel that chronic distal biceps tendon ruptures can be repaired successfully with a single incision using suture button technique without the use of a graft. Though the flexion contracture is significant postoperatively, all patients regained full ROM and had excellent postoperative functional outcome scores.


Assuntos
Traumatismos do Braço/cirurgia , Técnicas de Sutura/instrumentação , Traumatismos dos Tendões/cirurgia , Adulto , Traumatismos do Braço/fisiopatologia , Contratura/etiologia , Contratura/fisiopatologia , Articulação do Cotovelo/fisiopatologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Músculo Esquelético/fisiopatologia , Dor Musculoesquelética/etiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Ruptura/complicações , Ruptura/fisiopatologia , Ruptura/cirurgia , Supinação , Suturas , Traumatismos dos Tendões/complicações , Traumatismos dos Tendões/fisiopatologia , Resultado do Tratamento
16.
J Shoulder Elbow Surg ; 29(7): 1394-1400, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32279987

RESUMO

HYPOTHESIS AND BACKGROUND: An elbow contracture in a young person can be a devastating problem. Significant contractures will lead to functional loss of the extremity. Appropriately performed contracture release can have profound implications on the overall well-being of the patient. The purpose of this study was to report improvements in sagittal-plane range of motion and the complication rate following an anterior elbow release for flexion contractures in patients 21 years or younger. METHODS: We performed a retrospective review of 27 patients with a median age of 16.8 years who were treated surgically for elbow flexion contracture with an anterior approach. Follow-up was possible in 18 of these patients at an average of 31 months. An anterior approach was performed in all 18 patients, with 4 patients undergoing an additional posterior incision to address posterior structures limiting extension. RESULTS: Elbow extension improved by an average of 35°, from -54° to -19°. The mean total arc of elbow motion improved by 37°, from 65° to 102°. Two complications occurred: traction-related neurapraxia of the lateral antebrachial cutaneous nerve and transient neurapraxia of the posterior interosseous nerve. DISCUSSION AND CONCLUSION: Elbow contracture release through an anterior approach is an acceptable surgical option. Significant improvement is obtained with a low risk of complications.


Assuntos
Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Cotovelo/cirurgia , Liberação da Cápsula Articular/métodos , Adolescente , Criança , Contratura/etiologia , Contratura/fisiopatologia , Contratura/cirurgia , Cotovelo/lesões , Cotovelo/patologia , Articulação do Cotovelo/lesões , Feminino , Seguimentos , Humanos , Liberação da Cápsula Articular/efeitos adversos , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Adulto Jovem
17.
Phys Ther ; 100(7): 1142-1152, 2020 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-32266379

RESUMO

OBJECTIVE: To date, no attention has been devoted to the employment of eccentric contractions to manage spasticity in multiple sclerosis. This single-system case series aimed to explore the effects of eccentric training on spasticity-related resistance to passive motion in people with multiple sclerosis with elbow flexor spasticity. METHODS: Six people with multiple sclerosis (median Expanded Disability Status Scale score = 4.8, range = 2.0-5.5; Modified Ashworth Scale [MAS] score ≤ 3) underwent a 6-week eccentric strength training of the spastic muscles. Before and after the intervention, the following outcomes were assessed: resistive peak torque (RPT), isometric strength, resting limb position, passive range of motion and active range of motion, severity of hypertonia by MAS, and numerical rating scale. At baseline, the primary outcome (RPT) was tested over 3 time points to ensure a stable measurement. The 2-SD method was used to test pre-post training effects at individual level. Group-level analyses were also performed. RESULTS: Following the intervention RPT decreased by at least 2 SDs in all participants but 1, with a significant reduction at group level of 41.6 (29.6)%. Four people with multiple sclerosis reported a reduction in perceived spasticity severity. No changes in MAS score were detected. Group-level analyses revealed that maximal strength increased significantly in the trained elbow flexors (+30.9 [9.1]%). Elbow flexion at rest was found to be significantly reduced (-35.5 [12.4]%), whereas passive range of motion (+4.6%) and active range of motion (+11.8%) significantly increased. CONCLUSION: Eccentric training is feasible and safe to manage spasticity in people with multiple sclerosis. Preliminary data showed that this protocol can reduce resistance to passive motion, also improving strength, spasticity-free range of motion, and limb positioning. IMPACT: Patients with multiple sclerosis-related spasticity and moderate-to-severe disability can benefit from adding slow submaximal eccentric contractions to the conventional management of spasticity.


Assuntos
Articulação do Cotovelo/fisiopatologia , Esclerose Múltipla/complicações , Espasticidade Muscular/reabilitação , Debilidade Muscular/reabilitação , Treinamento de Resistência , Adulto , Feminino , Humanos , Movimento/fisiologia , Espasticidade Muscular/fisiopatologia , Debilidade Muscular/fisiopatologia , Amplitude de Movimento Articular/fisiologia
18.
Am J Sports Med ; 48(5): 1220-1225, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32119563

RESUMO

BACKGROUND: The incidence rate of elbow injuries has been rising in recent years among professional baseball pitchers. Determining valid screening procedures that allow practitioners to identify pitchers at an increased risk of such injuries is therefore of critical importance. PURPOSE: To validate the use of countermovement jump (CMJ) tests as a diagnostic tool for pitcher conditioning. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: More than 500 pitchers at a single professional baseball organization performed preseason CMJ assessments on a force plate before the 2013 to 2018 seasons. Three measurements were extracted from ground-reaction force data during the test: eccentric rate of force development (ERFD), average vertical concentric force (AVCF), and concentric vertical impulse (CVI). Athletic trainers at the organization collected detailed information on elbow and shoulder injury rates as well as workload (pitch count) throughout the rest of the season. Poisson regression models were fit to investigate the dependency of injury rates on CMJ test performance. RESULTS: ERFD, CVI, and AVCF were all significant predictors of elbow injury risk after accounting for pitcher age, weight, and workload. The analysis identified 3 specific indicators of heightened risk based on the results of a CMJ scan: low ERFD, a combination of low AVCF and high CVI, and a combination of high AVCF and low CVI. In contrast, shoulder injury risk was roughly independent of all 3 CMJ test measurements. CONCLUSION: This study supports the hypothesis of the entire kinetic chain's involvement in pitching by establishing a link between CMJ test performance and elbow injury risk in professional baseball pitchers. CMJ assessment may be a powerful addition to injury risk alert and prevention protocols. Pitchers in high-risk groups can be prescribed specific exercise plans to improve movement imbalances.


Assuntos
Traumatismos do Braço/diagnóstico , Beisebol , Articulação do Cotovelo/fisiopatologia , Cotovelo/lesões , Estudos de Casos e Controles , Teste de Esforço , Humanos
19.
J Shoulder Elbow Surg ; 29(6): 1242-1248, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32139286

RESUMO

BACKGROUND: Tension band wiring (TBW) is the standard method for treating transverse olecranon fractures, but high rates of complications and reoperations have been reported. Plate fixation (PF) with locking screws has been introduced as an alternative method that may retain the fracture reduction better with a higher load to failure. METHODS: Twenty paired cadaveric elbows were used. All soft tissues except for the triceps tendon were removed. A standardized transverse fracture was created, and each pair was allocated randomly to TBW or PF with locking screws. The triceps tendon was mounted to the materials testing machine with the elbow in 90° of flexion. Construct stiffness was compared 3 times. Then, the elbows underwent a chair lift-off test by loading the triceps tendon to 300 N for 500 cycles. Finally, a load-to-failure test was performed, and failure mechanism was recorded. RESULTS: The construct stiffness of PF was higher in the first of 3 measurements. No difference was observed in the cyclic test or in load to failure. Hardware failure was the failure mechanism in 8 of 10 TBW constructs, and all failures occurred directly under the twists of the metal wire. Hardware failure was the cause of failure in only 1 elbow in the PF group (P < .01). CONCLUSION: There was no difference in fracture displacement following fixation with TBW and PF with locking screws in transverse olecranon fractures. However, assessment of the mode of hardware failure identified the metal cerclage twist as the weakest link in the TBW construct.


Assuntos
Parafusos Ósseos , Fios Ortopédicos , Fixação Interna de Fraturas/instrumentação , Fraturas Intra-Articulares/cirurgia , Olécrano/lesões , Fraturas da Ulna/cirurgia , Idoso , Cadáver , Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Análise de Falha de Equipamento , Humanos , Pessoa de Meia-Idade , Olécrano/cirurgia , Amplitude de Movimento Articular
20.
J Shoulder Elbow Surg ; 29(4): 845-852, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32197769

RESUMO

BACKGROUND: Cubitus varus deformity is a well-known late complication of supracondylar fractures in children. In this retrospective study, the primary objective was to compare clinical and radiologic outcomes of lateral closing-wedge osteotomy with either internal fixation or external fixation in pediatric patients with cubitus varus deformities. MATERIALS AND METHODS: From 2010 to 2017, 35 consecutive patients with cubitus varus deformities secondary to supracondylar fractures were included in this study. After corrective osteotomy was performed via a limited lateral approach, the method of definitive fixation was chosen between internal and external. Retrospectively, patients who underwent external fixation on the lateral aspect of the elbow were defined as group I (n = 16) whereas patients with unilateral single-plate fixation were defined as group II (n = 19). The functional outcome was evaluated using the Mayo Elbow Performance Score and Flynn criteria. RESULTS: No significant difference in age was found between the 2 groups (P = .15). Significantly lower costs, a shorter operation duration, smaller scars, and a shorter time for plaster cast use postoperatively were found in group I (P < .001). No nonunion or failure of fixation was found. No significant difference was noted in postoperative elbow range of motion or Mayo Elbow Performance Score (P = .64). Both groups achieved satisfactory functional and cosmetic results. CONCLUSIONS: In pediatric patients with cubitus varus, both methods of fixation after lateral closing-wedge corrective osteotomy are reliable, with a low rate of complications and satisfactory functional results. External fixation is more advantageous in terms of easier preoperative planning, shorter operative times, lower costs, and easier postoperative fixation removal.


Assuntos
Articulação do Cotovelo/cirurgia , Fixação de Fratura/métodos , Fraturas do Úmero/complicações , Deformidades Articulares Adquiridas/cirurgia , Osteotomia/métodos , Amplitude de Movimento Articular/fisiologia , Estudos de Casos e Controles , Criança , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/fisiopatologia , Feminino , Humanos , Fraturas do Úmero/diagnóstico , Fraturas do Úmero/cirurgia , Deformidades Articulares Adquiridas/diagnóstico , Deformidades Articulares Adquiridas/etiologia , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
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