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1.
Bone Joint J ; 102-B(2): 227-231, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009431

RESUMO

AIMS: The purpose of this study was to evaluate the relationships between the degree of injury to the medial and lateral collateral ligaments (MCL and LCL) and associated fractures in patients with a posterolateral dislocation of the elbow, using CT and MRI. METHODS: We retrospectively reviewed 64 patients who presented between March 2009 and March 2018 with a posterolateral dislocation of the elbow and who underwent CT and MRI. CT revealed fractures of the radial head, coronoid process, and medial and lateral humeral epicondyles. MRI was used to identify contusion of the bone and collateral ligament injuries by tear, partial or complete tear. RESULTS: A total of 54 patients had a fracture; some had more than one. Radial head fractures were found in 25 patients and coronoid fractures in 42. Lateral and medial humeral epicondylar fractures were found in eight and six patients, respectively. Contusion of the capitellum was found in 43 patients and rupture of the LCL was seen in all patients (partial in eight and complete in 56), there was complete rupture of the MCL in 37 patients, partial rupture in 19 and eight had no evidence of rupture. The LCL tear did not significantly correlate with the presence of fracture, but the MCL rupture was complete in patients with a radial head fracture (p = 0.047) and there was significantly increased association in those without a coronoid fracture (p = 0.015). CONCLUSION: In posterolateral dislocation of the elbow, LCL ruptures are mostly complete, while the MCL exhibits various degrees of injury, which are significantly associated with the associated fractures. Cite this article: Bone Joint J 2020;102-B(2):227-231.


Assuntos
Ligamentos Colaterais/diagnóstico por imagem , Articulação do Cotovelo/diagnóstico por imagem , Fraturas do Úmero/diagnóstico por imagem , Luxações Articulares/diagnóstico por imagem , Fraturas do Rádio/diagnóstico por imagem , Fraturas da Ulna/diagnóstico por imagem , Adulto , Idoso , Ligamentos Colaterais/lesões , Articulação do Cotovelo/lesões , Feminino , Humanos , Fraturas do Úmero/complicações , Luxações Articulares/complicações , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/complicações , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Ulna/diagnóstico por imagem , Ulna/lesões , Fraturas da Ulna/complicações , Adulto Jovem
2.
Bone Joint J ; 102-B(1): 42-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888361

RESUMO

AIMS: Patient engagement in adaptive health behaviours and interactions with their healthcare ecosystem can be measured using self-reported instruments, such as the Patient Activation Measure (PAM-13) and the Effective Consumer Scale (ECS-17). Few studies have investigated the influence of patient engagement on limitations (patient-reported outcome measures (PROMs)) and patient-reported experience measures (PREMs). First, we assessed whether patient engagement (PAM-13, ECS-17) within two to four weeks of an upper limb fracture was associated with limitations (the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), and Patient-Reported Outcome Measurement Information System Upper Extremity Physical Function computer adaptive test (PROMIS UE PF) scores) measured six to nine months after fracture, accounting for demographic, clinical, and psychosocial factors. Secondly, we assessed the association between patient engagement and experience (numerical rating scale for satisfaction with care (NRS-C) and satisfaction with services (NRS-S) six to nine months after fracture. METHODS: A total of 744 adults with an isolated fracture of the proximal humerus, elbow, or distal radius completed PROMs. Due to multicollinearity of patient engagement and psychosocial variables, we generated a single variable combining measures of engagement and psychosocial factors using factor analysis. We then performed multivariable analysis with p < 0.10 on bivariate analysis. RESULTS: Patient engagement and psychosocial factors combined to form a single factor (factor 1) accounting for 20% (QuickDASH, semi-partial R2 = 0.20) and 14% (PROMIS UE PF, semi-partial R2 = 0.14) of the variation in limitations six to nine months after fracture. Factor 1 also accounted for 17% (NRS-C, semi-partial R2 = 0.17) of variation in satisfaction with care, and 21% (NRS-S, semi-partial R2 = 0.21) of variation in satisfaction with services. Demographic factors (age, sex, work status) and measures of greater pathophysiology (type of fracture, high-energy injury, post-surgical complications), accounted for much less variation. CONCLUSION: Patients who actively manage their health and demonstrate effective emotional and social functioning share a common underlying trait. They have fewer limitations and greater satisfaction with care during recovery from upper limb fractures. Future efforts should focus on evaluating initiatives that optimize patient engagement, such as patient education, coaching, and a communication strategy for healthcare professionals. Cite this article: Bone Joint J 2020;102-B(1):42-47.


Assuntos
Articulação do Cotovelo/lesões , Comportamentos Relacionados com a Saúde , Fraturas do Úmero/cirurgia , Fraturas Intra-Articulares/cirurgia , Participação do Paciente , Fraturas do Rádio/cirurgia , Atividades Cotidianas , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Articulação do Cotovelo/cirurgia , Feminino , Fraturas Ósseas , Promoção da Saúde , Humanos , Fraturas do Úmero/psicologia , Fraturas Intra-Articulares/psicologia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Estudos Prospectivos , Fraturas do Rádio/psicologia , Autoeficácia , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
3.
Emerg Med Clin North Am ; 38(1): 81-102, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757256

RESUMO

This article provides an updated review of the emergent evalution and treatment of elbow and forearm injuries in the emergency department. Clinically necessary imaging is discussed. Common and uncommon injuries of the elbow and forearm are reviewed with an emphasis on early recognition, efficient management, and avoidance of complications. The astute emergency physician will rely on a focused history and precise examination, applied anatomic knowledge, and strong radiographic interpretative skills to avoid missed injuries and complications.


Assuntos
Gerenciamento Clínico , Articulação do Cotovelo/lesões , Emergências , Traumatismos do Antebraço/diagnóstico , Procedimentos Ortopédicos/métodos , Radiografia/métodos , Articulação do Cotovelo/diagnóstico por imagem , Traumatismos do Antebraço/terapia , Humanos
4.
Bone Joint J ; 101-B(12): 1489-1497, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31786989

RESUMO

AIMS: The aim of this meta-analysis was to compare the outcome of total elbow arthroplasty (TEA) undertaken for rheumatoid arthritis (RA) with TEA performed for post-traumatic conditions with regard to implant failure, functional outcome, and perioperative complications. MATERIALS AND METHODS: We completed a comprehensive literature search on PubMed, Web of Science, Embase, and the Cochrane Library and conducted a systematic review and meta-analysis. Nine cohort studies investigated the outcome of TEA between RA and post-traumatic conditions. The preferred reporting items for systematic reviews and meta-analysis (Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)) guidelines and Newcastle-Ottawa scale were applied to assess the quality of the included studies. We assessed three major outcome domains: implant failures (including aseptic loosening, septic loosening, bushing wear, axle failure, component disassembly, or component fracture); functional outcomes (including arc of range of movement, Mayo Elbow Performance Score (MEPS), and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire), and perioperative complications (including deep infection, intraoperative fracture, postoperative fracture, and ulnar neuropathy). RESULTS: This study included a total of 679 TEAs for RA (n = 482) or post-traumatic conditions (n = 197). After exclusion, all of the TEAs included in this meta-analysis were cemented with linked components. Our analysis demonstrated that the RA group was associated with a higher risk of septic loosening after TEA (odds ratio (OR) 3.96, 95% confidence interval (CI) 1.11 to 14.12), while there was an increased risk of bushing wear, axle failure, component disassembly, or component fracture in the post-traumatic group (OR 4.72, 95% CI 2.37 to 9.35). A higher MEPS (standardized mean difference 0.634, 95% CI 0.379 to 0.890) was found in the RA group. There were no significant differences in arc of range of movement, DASH questionnaire, and risk of aseptic loosening, deep infection, perioperative fracture, or ulnar neuropathy. CONCLUSION: The aetiology of TEA surgery appears to have an impact on the outcome in terms of specific modes of implant failures. RA patients might have a better functional outcome after TEA surgery. Cite this article: Bone Joint J 2019;101-B:1489-1497.


Assuntos
Artrite Reumatoide/cirurgia , Artroplastia de Substituição do Cotovelo , Articulação do Cotovelo/lesões , Artroplastia de Substituição do Cotovelo/reabilitação , Articulação do Cotovelo/cirurgia , Humanos , Complicações Intraoperatórias/etiologia , Complicações Pós-Operatórias/etiologia , Falha de Prótese/etiologia , Recuperação de Função Fisiológica , Resultado do Tratamento
5.
Bone Joint J ; 101-B(11): 1362-1369, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674247

RESUMO

AIMS: The aim of this study was to analyze the results of two radiocapitellar prostheses in a large case series followed prospectively, with medium-term follow-up. PATIENTS AND METHODS: A total of 31 patients with a mean age of 54 years (27 to 73) were analyzed; nine had primary osteoarthritis (OA) and 17 had post-traumatic OA, three had capitellar osteonecrosis, and two had a fracture. Overall, 17 Lateral Resurfacing Elbow (LRE) and 14 Uni-Elbow Radio-Capitellum Implant (UNI-E) arthroplasties were performed. Pre- and postoperative assessment involved the Mayo Elbow Performance Score (MEPS), the Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score, and the modified American Shoulder Elbow Surgeons (m-ASES) score. RESULTS: The mean follow-up was 6.8 years (3.8 to 11.5). The mean MEPS, m-ASES, and Q-DASH scores improved significantly by 50 (p < 0.001), 55 (p < 0.001), and 54 points (p < 0.001), respectively, with no differences being detected between the implants. Preoperative pronation and supination were worse in patients in whom the UNI-E was used. Two patients with the UNI-E implant had asymptomatic evidence of gross loosening. CONCLUSION: Radiocapitellar arthroplasty yielded a significant improvement in elbow function at a mean follow-up of 6.8 years, with a high implant survival rate when the LRE was used in patients with primary or post-traumatic OA, without radial head deformity, and when the UNI-E was used in patients in whom radial head excision was indicated. Cite this article: Bone Joint J 2019;101-B:1362-1369.


Assuntos
Artroplastia de Substituição do Cotovelo/normas , Adulto , Idoso , Articulação do Cotovelo/lesões , Prótese de Cotovelo/normas , Feminino , Seguimentos , Humanos , Fraturas do Úmero/fisiopatologia , Fraturas do Úmero/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite/fisiopatologia , Osteoartrite/cirurgia , Osteonecrose/fisiopatologia , Osteonecrose/cirurgia , Falha de Prótese , Fraturas do Rádio/fisiopatologia , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(44): e17728, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689815

RESUMO

The effects of soft tissue damage and ulnar angulation deformity on radial head instability in Monteggia fractures are unclear. We tested the hypothesis that radial head instability correlates with the magnitude of ulnar angular deformity and the degree of proximal forearm soft tissue injury in Bado type I Monteggia fractures.We performed a biomechanical study in 6 fresh-frozen cadaveric upper extremities. Monteggia fractures were simulated by anterior ulnar angulation osteotomy and sequential sectioning of ligamentous structures. We measured radial head displacement during passive mobility testing in pronation, supination, and neutral rotation using an electromagnetic tracking device. Measurements at various ligament sectioning stages and ulnar angulation substages were statistically compared with those in the intact elbow.Radial head displacement increased with sequential ligament sectioning and increased proportionally with the degree of anterior ulnar angulation. Annular ligament sectioning resulted in a significant increase in displacement only in pronation (P < .05). When the anterior ulnar deformity was reproduced, the radial head displaced least in supination. The addition of proximal interosseous membrane sectioning significantly increased the radial head displacement in supination (P < .05), regardless of the degree of anterior ulnar angulation.Our Monteggia fracture model showed that radial head instability is influenced by the degree of soft tissue damage and ulnar angulation. Annular ligament injury combined with a minimal (5°) ulnar deformity may cause elbow instability, especially in pronation. The proximal interosseous membrane contributes to radial head stability in supination, regardless of ulnar angulation, and proximal interosseous membrane injury led to significant radial head instability in supination.


Assuntos
Articulação do Cotovelo/fisiopatologia , Traumatismos do Antebraço/fisiopatologia , Instabilidade Articular/fisiopatologia , Fratura de Monteggia/fisiopatologia , Lesões dos Tecidos Moles/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Cadáver , Articulação do Cotovelo/lesões , Feminino , Traumatismos do Antebraço/complicações , Humanos , Instabilidade Articular/etiologia , Masculino , Pessoa de Meia-Idade , Fratura de Monteggia/complicações , Rádio (Anatomia)/lesões , Amplitude de Movimento Articular , Lesões dos Tecidos Moles/complicações , Ulna/lesões
7.
Zhonghua Wai Ke Za Zhi ; 57(11): 818-823, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31694129

RESUMO

Objective: To investigate the mid-term efficacy of extracapsular arthroscopic surgery for refractory tennis elbow and explore prognostic factors. Methods: A retrospective study of 38 patients suffered from refractory tennis elbow and underwent extracapsular arthroscopic surgery performed by the same group of doctors during March 2012 to January 2016 at Institute of Sports Medicine, Peking University Third Hospital. There were 15 males and 23 females with age of 44.2 years(range: 32-59 years). Fifteen cases on the left and 23 cases on the right. Visual analogue scale(VAS), Mayo elbow performance score and Disability of Army, Shoulder and Hand (DASH) score were collected preoperatively and postoperatively, and compared by paired-t test. Independent sample t test, χ(2) test, multivariate logistic regression were used to analyze the relationship between scores and various potential influencing factors. Results: All 38 patients were followed up for 24 months. There was no complication such as infection or nerve injury recorded. VAS decreased from 7.0(1.2) (M(Q(R))) preoperative to 0(1) (Z=-5.40, P=0.00), Mayo increased from 55(26) to 100(0) (Z=-5.38, P=0.00),DASH decreased from 56.7(27.3) to 0.8(5.8)(Z=-5.37,P=0.00). The Mayo elbow performance score was excellent in 36 cases (94.7%) and good in 2 cases (5.3%). Women was significantly associated with poor prognosis. Conclusions: The mid-term effect of extracapsular arthroscopic treatment of refractory tennis elbow is satisfactory with few postoperative complications. Women was associated with poor prognosis.


Assuntos
Artroscopia , Cotovelo de Tenista/cirurgia , Adulto , Cotovelo/lesões , Cotovelo/cirurgia , Articulação do Cotovelo/lesões , Articulação do Cotovelo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
8.
J Comput Assist Tomogr ; 43(6): 981-985, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31738202

RESUMO

BACKGROUND: Athletes are prone to both acute and chronic overuse injuries of the elbow joint. The purpose of this study was to describe the frequency, anatomic distribution, and severity of magnetic resonance imaging (MRI)-detected elbow joint injuries among athletes who competed in the Rio de Janeiro 2016 Summer Olympics. METHODS: All sports injuries reported by the National Olympic Committee medical teams and the Organizing Committee medical staff during the 2016 Summer Olympics were analyzed. Magnetic resonance imaging was performed at the International Olympic Committee's polyclinic within the Olympic Village, using 3- and 1.5-T scanners. The MRIs were read centrally and retrospectively by musculoskeletal radiologists with expertise in sports injuries. The distribution of elbow joint injuries by anatomic location and sports discipline and the severity of injuries were recorded. RESULTS: A total of 1101 injuries were reported in the 11,274 athletes from 207 teams at the Games. Central review of MRI revealed elbow joint injuries in 15 athletes (60% male; median age, 22 years; range, 18-39 years). Ligamentous injuries were most common, with injuries of the ulnar collateral ligament being the most prevalent (n = 12; 80%), followed by the common flexor tendon (n = 8; 53%). Osseous injuries were far less common (n = 3; 20%), with no acute fractures seen. Weightlifting (n = 4; 27%) and judo (n = 4; 27%) athletes were most commonly affected. CONCLUSION: Magnetic resonance imaging-detected elbow injuries during the 2016 Summer Olympics affected mainly the ulnar collateral ligament and the common flexor tendon, with the highest occurrence in weight lifting and judo.


Assuntos
Traumatismos em Atletas/diagnóstico por imagem , Articulação do Cotovelo/lesões , Cotovelo/lesões , Traumatismos dos Tendões/diagnóstico por imagem , Adulto , Atletas , Traumatismos em Atletas/epidemiologia , Brasil , Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética/instrumentação , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença , Traumatismos dos Tendões/epidemiologia , Adulto Jovem
9.
J Shoulder Elbow Surg ; 28(10): 1998-2006, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31540725

RESUMO

HYPOTHESIS: We hypothesized that arthroscopic osteocapsular arthroplasty has a comparable outcome to that of the corresponding open procedure. METHODS: Patients treated with osteocapsular arthroplasty for post-traumatic stiffness were assigned to open procedure (OPEN) and arthroscopic procedure (ARTHRO) groups. The clinical outcomes were measured based on range of motion (ROM), Mayo Elbow Performance Score (MEPS), and visual analog scale (VAS) score. Based on the initial trauma, the patients were grouped into either intra-articular fracture (I) or extra-articular fracture (E) groups, followed by comparison of the 2 groups. RESULTS: The overall, ROM, VAS, and MEPS scores showed improvement in both groups. Preoperative VAS scores improved from 6.6 ± 1.4 to 2.2 ± 0.9 following OPEN and from 6.5 ± 1.2 to 2.1 ± 1.0 following ARTHRO. Preoperative flexion improved from 88° ± 14° to 113° ± 17° following OPEN and from 102° ± 15° to 122° ± 8° following ARTHRO. Preoperative extension improved from 36° ± 14° to 17° ± 12° following OPEN and from 30° ± 8° to 15° ± 7.4° following ARTHRO. Preoperative MEPS improved from 48.9 ± 11.5 to 80.0 ± 14.8 following OPEN and from 52.3 ± 12.2 to 80.8 ± 7.9 following ARTHRO. All values for the clinical outcomes were worse in group I than in group E. CONCLUSIONS: Arthroscopic osteocapsular arthroplasty is comparable to the corresponding open procedure with regard to the use of our indications. The clinical outcomes in the intra-articular fracture group as a previous trauma were worse than those in the extra-articular fracture group.


Assuntos
Artroplastia/métodos , Artroscopia , Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Fraturas Intra-Articulares/cirurgia , Adulto , Articulação do Cotovelo/lesões , Feminino , Humanos , Fraturas Intra-Articulares/complicações , Fraturas Intra-Articulares/fisiopatologia , Cápsula Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
Clin Orthop Surg ; 11(3): 302-308, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31475051

RESUMO

Background: To compare the stability of fixed- versus variable-angle locking constructs for the comminuted distal humerus fracture (AO/OTA 13-A3). Methods: Eight pairs of complete humeri harvested from eight fresh frozen cadavers were used for the study. We fixed the intact humeri using 2.7-mm/3.5-mm locking VA-LCP stainless steel distal humerus posterolateral (nine-hole) and medial (seven-hole) plates. An oscillating saw was used to cut a 1-cm gap above the olecranon fossa. The specimens were loaded in axial mode with the rate of 1 mm per 10 seconds to failure, and stress-strain curves were compared in each pair. The mode of failure was recorded as well as the load needed for 2- and 4-mm displacement at the lateral end of the gap. Results: The stiffness of the constructs, based on the slope of the stress-strain curve, did not show any difference between the fixed- versus variable-angle constructs. Likewise, there was no difference between the force needed for 2- or 4-mm displacement at the lateral gap between the fixed- and variable-angle constructs. The mode of failure was bending of both plates in all specimens and screw pull-out in four specimen pairs in addition to the plate bending. Conclusions: Our results did not show any difference in the biomechanical stability of the fixed- versus variable-angle constructs. There was not any screw breakage or failure of the plate-screw interface.


Assuntos
Parafusos Ósseos/efeitos adversos , Articulação do Cotovelo/cirurgia , Fraturas Cominutivas/fisiopatologia , Fraturas Cominutivas/cirurgia , Fraturas do Úmero/fisiopatologia , Fraturas do Úmero/cirurgia , Idoso , Fenômenos Biomecânicos , Placas Ósseas , Cadáver , Articulação do Cotovelo/lesões , Análise de Falha de Equipamento , Fixação Interna de Fraturas/instrumentação , Humanos , Masculino , Estresse Mecânico
11.
J Pediatr Orthop ; 39(9): e647-e651, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503219

RESUMO

BACKGROUND: Incarcerated medial epicondyle fractures in association with elbow trauma are rare and an absolute indication for intervention. Because of the infrequent nature, outcomes following this injury are not well documented. We studied a large cohort of these injuries to determine factors associated with functional outcomes. It was hypothesized that a greater duration between initial presentation and time of surgery would lead to poorer outcomes. METHODS: A total of 32 patients aged 18 and under who underwent surgical treatment for an incarcerated medical epicondyle fracture at a level-1 pediatric trauma center from 2003 to 2015 were identified. All patients had a confirmed diagnosis of an incarcerated medial epicondyle at surgery. Medical records and radiographs were reviewed to determine the patient demographics, mechanism of injury, preoperative neurological symptoms, time of primary presentation, time of elbow reduction, and time to surgical intervention. Postoperative outcomes, including pain, range of motion, and ulnar nerve symptoms, were also collected. The Roberts outcome score was determined for each subject. RESULTS: A radiographically confirmed elbow dislocation was identified in 25 subjects. The mean age at injury was 13.2 years (range, 7.3 to 17.8 y). Initial presentation was at a referring institution in 30 patients (94%). First closed reduction attempt of the ulnohumeral joint occurred in the emergency room in 24 subjects (75%); of these 7 subjects (22%) had a first reduction attempted in the emergency room at our institution, 2 patients experienced first elbow reduction during surgical intervention. The median time from first presentation to surgery was 21.9 hours (interquartile range, 15 to 40). Fourteen subjects displayed preoperative ulnar nerve symptoms. Of these, 9 subsequently reported postoperative ulnar nerve symptoms. There was no effect of time to surgical intervention on the Roberts outcome scores at follow-up, nerve symptoms, symptomatic hardware, or need for second surgery to remove hardware. There were 16 subjects with excellent outcomes, 13 with good outcomes, 3 with fair outcomes, and 0 with poor outcomes (based on the Roberts criteria). CONCLUSIONS: Incarcerated medial epicondyle fractures are commonly associated with ulnar nerve symptoms; however, they are not associated with a significant rate of other complications. There was no increased risk of complications in subjects who had a longer duration between initial presentation and surgery. This suggests that, while the presence of an incarcerated medial epicondyle fracture is certainly an indication for timely operative intervention; the injury in isolation does not need to be considered emergent. Other factors including neurovascular status and ability to achieve joint reduction may still necessitate emergency operative care. LEVEL OF EVIDENCE: Level IV-therapeutic study, case series.


Assuntos
Articulação do Cotovelo/lesões , Fraturas do Úmero/reabilitação , Complicações Pós-Operatórias/epidemiologia , Adolescente , Boston/epidemiologia , Criança , Cotovelo/lesões , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/patologia , Articulação do Cotovelo/cirurgia , Feminino , Fixação Interna de Fraturas , Humanos , Fraturas do Úmero/epidemiologia , Fraturas do Úmero/patologia , Fraturas do Úmero/cirurgia , Luxações Articulares/cirurgia , Masculino , Morbidade , Radiografia , Amplitude de Movimento Articular , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Nervo Ulnar , Neuropatias Ulnares/epidemiologia
12.
J Bone Joint Surg Am ; 101(15): e75, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31393432

RESUMO

BACKGROUND: Coronal shear fractures of the distal aspect of the humerus that involve the capitellum and the trochlea are rare; nevertheless, they are difficult to treat because of the complex fracture patterns and osteochondral nature of the fragments, limiting optimal screw placement. The use of anterior-to-posterior screw fixation by a lag technique (without countersinking) could potentially improve the strength of the construct. Our primary research question was to anatomically determine if there is a non-articulating zone for screw placement along the anterior aspect of the lateral trochlear ridge (aLTR) throughout normal elbow range of motion. METHODS: Eight fresh-frozen cadaveric elbows were used. The region of interest was defined with 3 polymeric pins inserted in the inferior, middle, and superior-most aspects of the aLTR of each elbow, with use of an extensor digitorum communis (EDC) split approach. The elbows were then mounted on a magnetic resonance imaging (MRI)-compatible compression frame and subjected to high-resolution 7-T MRI at 90°, 120°, and 145° of flexion (positions of potential impingement), and at neutral and maximal pronation and maximal supination for each position of flexion. Portions of the aLTR that had free adjacent space were identified using the sagittal and coronal scans. This non-articulating region was identified as the "non-articulating zone" (NAZ). RESULTS: The NAZ was found to encompass the proximal 38.2% (range, 30.2% to 48.9%) of the aLTR, measuring, on average, 5.2 mm in width. It was consistently located either directly adjacent to the apex of the ridge or just medial to it. The distal 61.8% of the aLTR articulated with either the ulna or the radial head in some of the elbows. CONCLUSIONS: Our results suggest that there is a portion of the aLTR that, despite being covered with articular cartilage, is non-articulating throughout normal elbow range of motion. CLINICAL RELEVANCE: In situations in which headless anterior-to-posterior and posterior-to-anterior screw insertion results in inadequate fixation of capitellar-trochlear fractures, anterior-to-posterior lag screw instrumentation along the non-articulating portion of the aLTR may provide a location for additional fixation in some patients. However, because of variation between patients, each case must be individualized.


Assuntos
Parafusos Ósseos , Articulação do Cotovelo/cirurgia , Fixação Interna de Fraturas/instrumentação , Fraturas do Úmero/cirurgia , Fenômenos Biomecânicos , Cadáver , Articulação do Cotovelo/lesões , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Fraturas Intra-Articulares/cirurgia , Masculino , Variações Dependentes do Observador , Pronação/fisiologia , Amplitude de Movimento Articular/fisiologia , Sensibilidade e Especificidade , Supinação/fisiologia
15.
J Pediatr Orthop ; 39(8): e592-e596, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393295

RESUMO

BACKGROUND: Medial epicondyle fractures are a common pediatric and adolescent injury accounting for 11% to 20% of elbow fractures in this population. This purpose of this study was to determine the variability among pediatric orthopaedic surgeons when treating pediatric medial epicondyle fractures. METHODS: A discrete choice experiment was conducted to determine which patient and injury attributes influence the management of medial epicondyle fractures by pediatric orthopaedic surgeons. A convenience sample of 13 pediatric orthopaedic surgeons reviewed 60 case vignettes of medial epicondyle fractures that included elbow radiographs and patient/injury characteristics. Displacement was incorporated into the study model as a fixed effect. Surgeons were queried if they would treat the injury with immobilization alone or open reduction and internal fixation (ORIF). Statistical analysis was performed using a mixed effect regression model. In addition, surgeons filled out a demographic questionnaire and a risk assessment to determine if these factors affected clinical decision-making. RESULTS: Elbow dislocation and fracture displacement were the only attributes that significantly influenced surgeons to perform surgery (P<0.05). The presence of an elbow dislocation had the largest impact on surgeons when choosing operative care (ß=-0.14; P=0.02). In addition, for every 1 mm increase in displacement, surgeons tended to favor ORIF by a factor of 0.09 (P<0.01). Sex, mechanism of injury, and sport participation did not influence decision-making. In total, 54% of the surgeons demonstrated a preference for ORIF for the included scenarios. On the basis of the personality Likert scale, participants were neither high-risk takers nor extremely risk adverse with an average-risk score of 2.24. Participant demographics did not influence decision-making. CONCLUSIONS: There is substantial variation among pediatric orthopaedic surgeons when treating medial epicondyle fractures. The decision to operate is significantly based on the degree of fracture displacement and if there is a concomitant elbow dislocation. There is no standardization regarding how to treat medial epicondyle fractures and better treatment algorithms are needed to provide better patient outcomes. LEVEL OF EVIDENCE: Level V.


Assuntos
Fraturas do Úmero/terapia , Luxações Articulares/terapia , Ortopedia/métodos , Pediatria/métodos , Adulto , Pré-Escolar , Tomada de Decisão Clínica , Articulação do Cotovelo/lesões , Feminino , Fixação Interna de Fraturas , Humanos , Fraturas do Úmero/complicações , Fraturas do Úmero/diagnóstico por imagem , Imobilização , Luxações Articulares/etiologia , Masculino , Pessoa de Meia-Idade , Redução Aberta , Padrões de Prática Médica , Radiografia , Resultado do Tratamento
16.
Radiol Clin North Am ; 57(5): 1051-1062, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351535

RESUMO

MR imaging is the modality of choice to evaluate musculoskeletal pathologies of the upper limb in most settings. However, due to the complexity in anatomy, MR imaging can give a false pathologic appearance and lead to several errors in the interpretation of MR imaging findings. Also, several artifacts can be confused with pathologic entities. This article reviews the most frequently encountered conditions in shoulder, elbow, and wrist MR imaging that can represent diagnostic pitfalls mimicking true pathology, together with some possible tips and tricks that can be useful to solve these equivocal cases and achieve a correct diagnosis.


Assuntos
Artefatos , Erros de Diagnóstico/prevenção & controle , Imagem por Ressonância Magnética/métodos , Extremidade Superior/diagnóstico por imagem , Extremidade Superior/lesões , Diagnóstico Diferencial , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/lesões , Humanos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/lesões , Traumatismos do Punho/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem
17.
Radiol Clin North Am ; 57(5): 911-930, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351541

RESUMO

The acutely injured elbow can present as a diagnostic challenge, encompassing a spectrum of conditions that involve the various osseous and soft tissue structures of this complex joint. Imaging plays a vital role in the management of these patients by providing an accurate interpretation of the underlying trauma sustained, which can have important implications on the preservation of joint function and stability. This article examines the mechanisms, patterns, classifications, and imaging findings of acute elbow injuries, providing key concepts for the radiologist in the interpretation of these injuries.


Assuntos
Diagnóstico por Imagem/métodos , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/lesões , Cotovelo/diagnóstico por imagem , Cotovelo/lesões , Fraturas Ósseas/diagnóstico por imagem , Doença Aguda , Humanos , Luxações Articulares/diagnóstico por imagem , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Ultrassonografia
18.
Radiol Clin North Am ; 57(5): 931-942, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351542

RESUMO

Repetitive microtrauma in the elbow from chronic overuse occurs in athletes and nonathletes. Although the diagnosis is often made clinically, imaging is helpful to confirm the diagnosis, grade the injury, and guide treatment. MR imaging is particularly helpful in evaluating overuse injuries in the elbow, as tendons, ligaments, and bones/cartilage can be assessed. Tendinopathy can be distinguished from partial- or full-thickness tears, and reactive changes in the bone marrow can be easily identified. This article focuses on the MR imaging appearance of overuse injuries of the elbow involving tendons, ligaments, and bones.


Assuntos
Transtornos Traumáticos Cumulativos/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/lesões , Humanos , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/lesões , Imagem por Ressonância Magnética , Radiografia , Traumatismos dos Tendões/diagnóstico por imagem , Tomografia Computadorizada por Raios X
19.
Radiol Clin North Am ; 57(5): 977-1000, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351545

RESUMO

Imaging has a paramount role in postsurgical assessment. Radiologists need to be familiar with the different surgical procedures to be able to identify expected postsurgical appearances and also detect potential complications. This article reviews the indications, normal expected postsurgical appearances, and complications of the most frequently used surgical procedures in the shoulder, elbow, and wrist. The emphasis is on points that should not be overlooked in the surgical planning.


Assuntos
Diagnóstico por Imagem/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Extremidade Superior/diagnóstico por imagem , Extremidade Superior/cirurgia , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/lesões , Articulação do Cotovelo/cirurgia , Humanos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/lesões , Articulação do Ombro/cirurgia , Extremidade Superior/lesões , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
20.
J Shoulder Elbow Surg ; 28(8): 1431-1440, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31327393

RESUMO

BACKGROUND: The purpose of this study was to identify factors associated with limitations in function measured by patient-reported outcome measures (PROMs) 6-9 months after elbow fractures in adults from a range of demographic, injury, psychological, and social variables measured within a week and 2-4 weeks after injury. METHODS: We enrolled 191 adult patients sustaining an isolated elbow fracture and invited them to complete PROMs at their initial visit to the orthopedic outpatient clinic (within a maximum of 1 week after fracture), between 2 and 4 weeks, and between 6 and 9 months after injury; 183 patients completed the final assessment. Bivariate analysis was performed, followed by multivariable regression analysis accounting for multicollinearity. This was evaluated using partial R2, correlation matrices, and variable inflation factor assessment. RESULTS: There was a correlation between multiple variables within a week of injury and 2-4 weeks after injury with PROMs 6-9 months after injury in bivariate analysis. Kinesiophobia measured within a week of injury and self-efficacy measured at 2-4 weeks were the strongest predictors of limitations 6-9 months after injury in multivariable regression. Regression models accounted for substantial variance in all PROMs at both time points. CONCLUSIONS: Developing effective coping strategies to overcome fears related to movement and reinjury and finding ways of persevering with activity despite pain within a month of injury may enhance recovery after elbow fractures. Heightened fears around movement and suboptimal coping ability are modifiable using evidence-based behavioral treatments.


Assuntos
Adaptação Psicológica/fisiologia , Artralgia/psicologia , Articulação do Cotovelo/lesões , Fraturas Ósseas/psicologia , Medidas de Resultados Relatados pelo Paciente , Amplitude de Movimento Articular , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artralgia/diagnóstico , Artralgia/etiologia , Articulação do Cotovelo/fisiopatologia , Feminino , Fraturas Ósseas/complicações , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Adulto Jovem
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