Total Elbow Arthroplasty: Elbow Biomechanics and Failure.

Total elbow arthroplasty (TEA) has lower revision-free survivorship than other major joint replacement. Despite this, elbow replacement has remained popular. Surgical technique for TEA destabilizes the elbow by removing the medial and lateral collateral ligaments and, frequently, the radiocapitellar articulation. Current semiconstrained implants aim to allow for physiological varus and valgus motion by employing a sloppy hinge; however, over time, these designs fail owing to nonanatomic force transmission. Nonanatomic force transmission results from ligament release, force transmission primarily to the humeral and ulnar shafts, and radial head resection. These altered biomechanics may be the source of complications seen in semiconstrained arthroplasty. These complications perpetuate the cycle of failure and ultimately have poor salvage options.

Polymethyl Methacrylate for Elbow Arthroplasty: Is There Another Way?

Polymethyl methacrylate remains the only US Food and Drug Administration-approved method of total elbow arthroplasty fixation and exhibits high aseptic loosening rates that result in challenging revision surgeries and potential morbidity secondary to bone-cement implantation syndrome. In this policy paper, the authors aim to explore the historical background of polymethyl methacrylate and the complications that arise in association with its use. We will review arthroplasty trends in the elbow and lower extremities and the challenges with the US Food and Drug Administration-approval process.

Long-Term Outcomes and Return to Work After Isolated Coronal Shear Fractures of the Capitellum.

Purpose: The purpose of this study was to analyze the ability of patients to return to work after ORIF of isolated capitellar shear fractures and assess long-term functional outcomes. Methods: We retrospectively reviewed the cases of 18 patients with isolated capitellar shear fractures with or without lateral trochlear extension and investigated demographic data, occupation, worker's compensation status, injury characteristics, surgical details, motion, radiographic appearance at final in-person follow-up, complications, and return to work status via in-person and long-term telemedicine follow-ups. Results: Final follow-up was at an average of 76.6 (7-222.6) months or 6.4 (0.58-18.6) years. Of the 14 patients working at the time of injury, 13 patients had returned to work at final clinical follow-up. The work status of the remaining patient was not documented. Mean elbow motion at final follow-up was 4° (range, 0-30) to 138° (range, 130-145) of flexion, 83° of supination, 83° of pronation. Two patients had complications that required reoperation but had no further complications. For the 13 of 18 patients with long-term telemedicine follow-up, the average Quick Disabilities of the Arm, Shoulder, and Hand score was 6.8 (0-25). Conclusions: In our series, rates of return to work were high after ORIF of coronal shear fractures of the capitellum with or without lateral trochlear extension. This was true across all occupational classes including manual labor, clerical, and professional. With anatomic restoration of articular congruity, stable internal fixation, and postoperative rehabilitation, these patients had excellent ROM and functional scores at an average of 7.9 years of follow-up. Clinical relevance: After ORIF of isolated capitellar shear fractures with or without lateral trochlear extension, patients can expect a high rate of return to work with excellent ROM and functionality and low long-term disability.

Accuracy of Surgeon Diagnosis in Predicting Carpal Tunnel Syndrome.

Background: The utility of electrodiagnostic studies (EDX) continues to be a point of debate in the diagnosis of carpal tunnel syndrome (CTS). If surgeons can predict the results of EDX with high accuracy, it may suggest that ordering the test is unnecessary from a diagnostic standpoint. Methods: Two surgeons with subspecialty training in hand surgery were asked to classify hands into "definitely having or not having CTS" or into an "unclear category" when presented with patients having a chief complaint of hand paresthesias. Clinical diagnosis was compared against EDX, ordered after the initial patient visit, as the reference standard. Results: Of the 175 hands, 111 hands were predicted to have CTS, 37 hands were predicted not to have CTS, and 27 hands had an unclear diagnosis. Overall surgeon accuracy was 86% (124/148). Accuracy was improved when subdivided by a positive prediction of CTS (88%) compared with a negative prediction of CTS (70%) (P = .03). Sensitivity was 90% and specificity was 67%. The senior surgeon had a higher accuracy at 90% than the more junior surgeon at 74% (P = .02). Conclusions: Surgeons with sub-specialty training in hand surgery are able to accurately diagnose CTS without EDX. Surgeon experience is important and resulted in a higher accuracy in predicting EDX results.