Orthopaedics and Trauma最新文献

Total elbow arthroplasty (TEA) has a relatively high revision rate compared to conventional joint arthroplasties (4–7% at 5 years). The cause for revision is most commonly implant loosening. A thorough work-up with history, examination, bloods, radiographs and joint tissue or fluid samples are all required to rule out peri-prosthetic infection. Patient factors and soft tissue management must be considered before revising a TEA to ensure the best outcome and longevity of the revised implant. Surgical strategies for TEA revision include single or two-stage revision, bearing exchange, bone windows and strut grafts.

Distal biceps tendons are a potential source of anterior elbow pain, with pathology ranging from tendinopathy to degenerative ruptures and acute traumatic ruptures. In some instances, non-surgical management is appropriate, but the majority of acute ruptures should be managed surgically for superior outcomes. This article will discuss distal biceps pathology, the relevant surgical anatomy, fixation and approach options and the potential complications following repair and reconstruction.

Lateral elbow pain and tennis elbow have been considered almost synonymous, in that historically all patients with lateral elbow pain were assumed to have tennis elbow. With the evolution of diagnostic imaging, elbow arthroscopy and further understanding of the pathological processes, alongside analysis of failed tennis elbow treatment, a whole host of possible differential diagnoses that might cause lateral elbow pain became recognized. In addition to tendinopathies (tennis and golfers elbow), these include intraarticular mechanical issues (radiocapitellar plica and snapping annular ligament), elbow instability, nerve compression syndromes, osteochondral defects and degenerative joint disease (radiocapitellar joint arthritis). Accurate clinical assessment and diagnosis is key, alongside selective use of investigations that can confirm or refute diagnoses and guide ongoing management. This article serves to provide an overview of the history, examination findings, investigations and management options for lateral elbow pain. Whilst we will cover the whole scope of possible diagnoses responsible for lateral elbow pain, we will not be considering in detail those covered in other articles in this issue (tennis elbow, osteochondritis dissecans, elbow instability). The focus of this article will be to elaborate on the tips and tricks within the clinical assessment, and how to properly assess the lateral side of the elbow. We will mention the rarer conditions encountered (posterior interosseous nerve entrapment, synovial plica syndrome and snapping annular ligament) and discuss the reconstructive ladder for lateral sided degenerative joint disease.

The elbow joint consists of the ulnohumeral joint, radiocapitellar joint and the proximal radio-ulnar joint. The osseous anatomy, static ligamentous restraints and dynamic stabilizers all contribute to maintain elbow stability. Elbow instability is a commonly encountered condition in clinical practice. There are several ways to classify elbow instability. Instability can be classified as simple or complex based on presence of an associated fracture, it could be classified based on mechanism of injury or it could be classified in a temporal fashion as acute or chronic. It is critical to understand injury patterns that can be treated non-operatively with physiotherapy and mobilization and the ones that need surgery. Surgical management of elbow instability could involve a combination of interventions addressing various ligaments like the lateral ulnar collateral ligament and medial collateral ligament; osseous structures including the radial head, coronoid and proximal ulna based on the mechanism and extent of injury. Adjunctive and salvage procedures may be necessary in delayed presentations or severe injuries. These include application of an internal joint stabilizer, external fixator, internal bracing of the ligament and bone grafting of the coronoid. The goal of treatment of instability is to provide an elbow that is stable and amenable to early active mobilization.

The major peripheral nerves supplying motor and sensory function to the forearm and hand traverse the elbow joint. The complex anatomical relationships of these nerves to the joint and its surrounding musculotendinous structures creates a series of sites where these nerves are vulnerable to compression. Compression syndromes result in distressing constellations of pain, paraesthesia, weakness and loss of coordinated motor function. This article discusses the anatomy and pathophysiology of compressive neuropathies around the elbow joint, their presentation, how they are investigated and diagnosed, and the available management options.

Posttraumatic elbow stiffness can have a large impact on the ability of a patient to perform activities of daily living. Following a stepwise approach to treatment helps clinicians in this otherwise difficult-to treat condition. Treatment in adults is based on dealing with the involvement of soft tissue contracture, osseous impingement or both. Unlike adults, posttraumatic elbow stiffness in children has distinctly different causes and the thrust of treatment is primarily non-surgical. In skeletally immature children, the skeletal growth potential should be properly assessed and closely followed, observing either progression or natural correction of the deformity. Early active motion aided by physiotherapy is the first step in treatment for both adults and children. Following physiotherapy, brace therapy is a proven cheap and effective therapy for treatment-resistant stiffness. If adequate conservative treatment is unsuccessful, the next step is surgical arthrolysis. This procedure can be performed either open or arthroscopically, with the decision dependent on multiple factors. Early active mobilization after surgery is equally important, with the addition of bracing or continuous passive motion (CPM) in pending contractures following surgery. This paper provides a review of the current literature and a state-of-the-art guidance on the management of posttraumatic elbow stiffness in adult and paediatric patients.

Distal humerus fractures are common, and when they occur in elderly patients with osteoporotic bone or poor subchondral bone stock, intra-articular fragmentation is common and management can be challenging. Osteosynthesis may be impossible or associated with a high risk of complications in this subset of patients, and total elbow replacement may be the preferred treatment. Elbow hemiarthroplasty for unreconstructable distal humerus fractures has emerged as an alternative treatment option and now accounts for over 50% of arthroplasty procedures for distal humerus fractures in England. This article aims to look at the indications, contraindications, surgical anatomy and technique as well as the outcomes and complications of elbow hemiarthroplasties.