Pub Date : 2020-11-18DOI: 10.1097/BTE.0000000000000201
Ricardo Kaempf de Oliveira, M. Aita, J. P. Farina Brunelli, S. Ribak, Pedro José Delgado Serrano
The authors describe the treatment of a 13-year-old patient with a severe, posteriorly dislocated, epiphysiolysis fracture of the proximal radius. This is called a Jeffery type II lesion when the epiphysiolysis fracture takes place at the radial neck during the reduction of elbow posterior dislocation, thus causing radial head posterior displacement. There are <30 cases described in the literature about such kind of lesion, and only. Chotel and colleagues has carried out the percutaneous form of treatment. He advocated a varus stress onto the elbow joint so that its subluxation would open the lateral space to facilitate manipulation and head reduction toward its anatomic position. The authors also describe a closed reduction technique for such fracture by using 2 Kirschner wires, whereas the first is inserted into the fracture site, thus acting as a guide and fulcrum, so that the second wire would push the radial head toward its anatomic position. The authors regard that such modification of Chotel and colleagues’ technique is an effective and less aggressive maneuver that reduces the risk of iatrogenic ligament and chondral injuries. The purpose is to demonstrate the surgical technique of the novel, effective, and safe method of treatment to Jeffery type II radial neck pediatric fractures.
{"title":"Jeffery Type II Fracture of the Radial Neck of a Child: Description of the Lesion and Novel Method of Closed Reduction","authors":"Ricardo Kaempf de Oliveira, M. Aita, J. P. Farina Brunelli, S. Ribak, Pedro José Delgado Serrano","doi":"10.1097/BTE.0000000000000201","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000201","url":null,"abstract":"The authors describe the treatment of a 13-year-old patient with a severe, posteriorly dislocated, epiphysiolysis fracture of the proximal radius. This is called a Jeffery type II lesion when the epiphysiolysis fracture takes place at the radial neck during the reduction of elbow posterior dislocation, thus causing radial head posterior displacement. There are <30 cases described in the literature about such kind of lesion, and only. Chotel and colleagues has carried out the percutaneous form of treatment. He advocated a varus stress onto the elbow joint so that its subluxation would open the lateral space to facilitate manipulation and head reduction toward its anatomic position. The authors also describe a closed reduction technique for such fracture by using 2 Kirschner wires, whereas the first is inserted into the fracture site, thus acting as a guide and fulcrum, so that the second wire would push the radial head toward its anatomic position. The authors regard that such modification of Chotel and colleagues’ technique is an effective and less aggressive maneuver that reduces the risk of iatrogenic ligament and chondral injuries. The purpose is to demonstrate the surgical technique of the novel, effective, and safe method of treatment to Jeffery type II radial neck pediatric fractures.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"21 1","pages":"124 - 131"},"PeriodicalIF":0.0,"publicationDate":"2020-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48271240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-18DOI: 10.1097/BTE.0000000000000208
M. R. Rastegar, H. Namazi, E. Shafiee, Mohammad T Karimi
Various fixation methods have been used to fix olecranon fractures including the plate fixation, intramedullary screws, and tension band technique. Open reduction with tension band wire fixation (TBW) has been widely accepted for the treatment of transverse displaced olecranon fractures. The aim of this study was to determine the stress developed in different types of TBW fixations in olecranon fractures on the basis of finite element analysis. A 3-dimension model of the elbow joint was created on the basis of the computerized tomography scan images. Three different configurations of TBW fixations were evaluated in this study. The stress developed in various fragments and implant parts and relative motion of implant in various degrees of elbow flexion was assessed in this study. The stress of K-wires was higher in condition 1 (K-wire inserted from the posterior side to the posterior side) compared with other conditions. The relative displacement of the pin was the highest in condition 2 (K-wire from posterior to anterior) (higher than 2 mm), which occurred in elbow flexion angle of 40 to 50, followed by condition 3 (with K-wire, one from posterior to anterior and another one from posterior to posterior). It seems that the lowest value of displacement occurs in condition 1, compared with other conditions. The new methods suggested herein (conditions 2 and 3) provided sufficient stability for fracture fixation, similar to the conventional method (condition 1). In these 2 methods, the amount of complications seems to be lower because of the placement of K-wires, therefore, these 2 methods are recommended to reduce the complications of surgery.
{"title":"New Techniques of Olecranon Tension Band Fixation: Biomechanical Evaluation Using Finite Element Method","authors":"M. R. Rastegar, H. Namazi, E. Shafiee, Mohammad T Karimi","doi":"10.1097/BTE.0000000000000208","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000208","url":null,"abstract":"Various fixation methods have been used to fix olecranon fractures including the plate fixation, intramedullary screws, and tension band technique. Open reduction with tension band wire fixation (TBW) has been widely accepted for the treatment of transverse displaced olecranon fractures. The aim of this study was to determine the stress developed in different types of TBW fixations in olecranon fractures on the basis of finite element analysis. A 3-dimension model of the elbow joint was created on the basis of the computerized tomography scan images. Three different configurations of TBW fixations were evaluated in this study. The stress developed in various fragments and implant parts and relative motion of implant in various degrees of elbow flexion was assessed in this study. The stress of K-wires was higher in condition 1 (K-wire inserted from the posterior side to the posterior side) compared with other conditions. The relative displacement of the pin was the highest in condition 2 (K-wire from posterior to anterior) (higher than 2 mm), which occurred in elbow flexion angle of 40 to 50, followed by condition 3 (with K-wire, one from posterior to anterior and another one from posterior to posterior). It seems that the lowest value of displacement occurs in condition 1, compared with other conditions. The new methods suggested herein (conditions 2 and 3) provided sufficient stability for fracture fixation, similar to the conventional method (condition 1). In these 2 methods, the amount of complications seems to be lower because of the placement of K-wires, therefore, these 2 methods are recommended to reduce the complications of surgery.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"21 1","pages":"101 - 106"},"PeriodicalIF":0.0,"publicationDate":"2020-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43495122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-14DOI: 10.1097/BTE.0000000000000197
E. Bonicoli, M. Giuntoli, E. Ipponi, P. Battaglia, I. Angelini, M. Scaglione
Chronic tears of the distal triceps tendon are extremely uncommon lesions. Surgical therapy can be performed with a direct reattachment of the 2 sides of the lesion or—in case of significant tendon retraction—using grafts to fill the resulting gap. Herein, we report a case of a torn distal triceps tendon that occurred in a 33-year-old patient suffering from paraplegia. The resulting functional impairment of the elbow impeded her to use a wheelchair, causing a substantial limitation to her mobility and autonomy. Preoperative clinical evaluation, x-rays, muscle-tendon ultrasound, and magnetic resonance imagingwas been performed. In consideration of a 6 cm retraction at the surgery, we reconstructed the tendon using a combination of suture anchors (5 mm Super Reevo ConMed) and a cadaver fascia lata allograft. After surgery, the elbow was immobilized in extension inside a brachio-metacarpal cast for 30 days. In the following month, the cast was replaced with a hinged elbow brace and progressive mobilization was permitted. Five months postoperatively, the patient regained her previous active flexion-extension articular ROM and was able to use her wheelchair again. No complication occurred.
{"title":"Chronic Tear of the Distal Triceps Tendon Treated With Suture Anchors and Fascia Lata Allograft: Case Report, Surgical Technique and Literature Review","authors":"E. Bonicoli, M. Giuntoli, E. Ipponi, P. Battaglia, I. Angelini, M. Scaglione","doi":"10.1097/BTE.0000000000000197","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000197","url":null,"abstract":"Chronic tears of the distal triceps tendon are extremely uncommon lesions. Surgical therapy can be performed with a direct reattachment of the 2 sides of the lesion or—in case of significant tendon retraction—using grafts to fill the resulting gap. Herein, we report a case of a torn distal triceps tendon that occurred in a 33-year-old patient suffering from paraplegia. The resulting functional impairment of the elbow impeded her to use a wheelchair, causing a substantial limitation to her mobility and autonomy. Preoperative clinical evaluation, x-rays, muscle-tendon ultrasound, and magnetic resonance imagingwas been performed. In consideration of a 6 cm retraction at the surgery, we reconstructed the tendon using a combination of suture anchors (5 mm Super Reevo ConMed) and a cadaver fascia lata allograft. After surgery, the elbow was immobilized in extension inside a brachio-metacarpal cast for 30 days. In the following month, the cast was replaced with a hinged elbow brace and progressive mobilization was permitted. Five months postoperatively, the patient regained her previous active flexion-extension articular ROM and was able to use her wheelchair again. No complication occurred.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"21 1","pages":"79 - 83"},"PeriodicalIF":0.0,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000197","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41416246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-14DOI: 10.1097/BTE.0000000000000195
Teresa Doerre, A. Hallwachs, R. Fullick, W. Lowe
Acute latissimus dorsi tendon rupture is a rare injury, occurring nearly exclusively in athletes engaging in overhead motions. Given this patient population, return to elite function is a goal of treatment, often requiring surgery. When planning surgery, one finds a lack of sufficient evidence to recommend a specific fixation technique. We report a case of acute rupture of the latissimus dorsi in a competitive gymnast. Initial magnetic resonance imaging confirmed the injury and showed that the tendon had retracted 6 cm. Primary repair using bicortical button fixation, a novel fixation technique, was performed. The patient successfully returned to competition and reported personal best scores on high bar and parallel bars. Cadaveric studies comparing cortical buttons to sutures and suture anchors for tendon reattachment found cortical buttons to have higher loads to failure. Overall, this suggests the technique described here may provide superior outcomes for a patient population who will stress the repair at elite levels. Level of Evidence: Level V.
{"title":"Repair of an Acute Latissimus Dorsi Tendon Rupture Using Bicortical Button Fixation","authors":"Teresa Doerre, A. Hallwachs, R. Fullick, W. Lowe","doi":"10.1097/BTE.0000000000000195","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000195","url":null,"abstract":"Acute latissimus dorsi tendon rupture is a rare injury, occurring nearly exclusively in athletes engaging in overhead motions. Given this patient population, return to elite function is a goal of treatment, often requiring surgery. When planning surgery, one finds a lack of sufficient evidence to recommend a specific fixation technique. We report a case of acute rupture of the latissimus dorsi in a competitive gymnast. Initial magnetic resonance imaging confirmed the injury and showed that the tendon had retracted 6 cm. Primary repair using bicortical button fixation, a novel fixation technique, was performed. The patient successfully returned to competition and reported personal best scores on high bar and parallel bars. Cadaveric studies comparing cortical buttons to sutures and suture anchors for tendon reattachment found cortical buttons to have higher loads to failure. Overall, this suggests the technique described here may provide superior outcomes for a patient population who will stress the repair at elite levels. Level of Evidence: Level V.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"21 1","pages":"70 - 75"},"PeriodicalIF":0.0,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000195","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45260684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-14DOI: 10.1097/BTE.0000000000000193
A. Kandeel
Supplemental Digital Content is available in the text. On basis of a newly proposed classification of type-V superior labrum anterior to posterior (SLAP) lesion, this study was conducted to investigate this question: “Does concurrent anterosuperior labral anchor repair limit postoperative range of external rotation and increase postoperative pain compared with isolated Bankart repair?.” This prospective cohort study, conducted between September 2014 and December 2017, included 20 patients who were divided into the following groups: group-S (12 patients) of concurrent Bankart and type-IIA SLAP repair by 3 anchors, with one of them above the glenoid mid-equator, and group-B (8 patients) of isolated Bankart repair by 2 anchors. Patients were evaluated for demographics and preoperative and 2-year postoperative shoulder range of motion, Rowe Instability Score, University of California Los Angeles score, and instability recurrence. Statistically, group-S patients had significantly older mean age at first time of dislocation (24.7 vs. 18.2 y, respectively; P=0.034). Postoperatively, there was an insignificant difference between groups with regard to external rotation deficits at 0 and 90 degrees abduction compared with sound contralateral shoulder (10.0 vs. 5.00 degrees; P=0.080) and (17.1 vs. 12.5 degrees; P=0.087), respectively. The current study demonstrated that concurrent Bankart and anterosuperior labral anchor repair can offer outcomes comparable to isolated Bankart repair as regards postoperative pain, range of external rotation, function, return to work, and instability recurrence. Age at first time of glenohumeral dislocation can be a predictor for severity of labral detachment. The currently reported classification system can assist in more precise decision making and outcome assessment of type-V SLAP repair. Level of Evidence: Level III.
{"title":"Arthroscopic Repair of Type-V SLAP Lesion: A Prospective Cohort Study of an Anchor Above the Anterior Glenoid Mid-equator Based on a New Classification System","authors":"A. Kandeel","doi":"10.1097/BTE.0000000000000193","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000193","url":null,"abstract":"Supplemental Digital Content is available in the text. On basis of a newly proposed classification of type-V superior labrum anterior to posterior (SLAP) lesion, this study was conducted to investigate this question: “Does concurrent anterosuperior labral anchor repair limit postoperative range of external rotation and increase postoperative pain compared with isolated Bankart repair?.” This prospective cohort study, conducted between September 2014 and December 2017, included 20 patients who were divided into the following groups: group-S (12 patients) of concurrent Bankart and type-IIA SLAP repair by 3 anchors, with one of them above the glenoid mid-equator, and group-B (8 patients) of isolated Bankart repair by 2 anchors. Patients were evaluated for demographics and preoperative and 2-year postoperative shoulder range of motion, Rowe Instability Score, University of California Los Angeles score, and instability recurrence. Statistically, group-S patients had significantly older mean age at first time of dislocation (24.7 vs. 18.2 y, respectively; P=0.034). Postoperatively, there was an insignificant difference between groups with regard to external rotation deficits at 0 and 90 degrees abduction compared with sound contralateral shoulder (10.0 vs. 5.00 degrees; P=0.080) and (17.1 vs. 12.5 degrees; P=0.087), respectively. The current study demonstrated that concurrent Bankart and anterosuperior labral anchor repair can offer outcomes comparable to isolated Bankart repair as regards postoperative pain, range of external rotation, function, return to work, and instability recurrence. Age at first time of glenohumeral dislocation can be a predictor for severity of labral detachment. The currently reported classification system can assist in more precise decision making and outcome assessment of type-V SLAP repair. Level of Evidence: Level III.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"21 1","pages":"57 - 65"},"PeriodicalIF":0.0,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000193","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46610062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-14DOI: 10.1097/BTE.0000000000000194
K. Plancher, Joseph M. Ajdinovich, S. Petterson
Untreated lesions of the long head of the biceps tendon are a common cause of shoulder pain and dysfunction. Although the use of in-office arthroscopy has been described for biceps tenotomy, advances have led to portable arthroscopy devices. Tenotomy was performed in 10 cadaveric shoulders (average age 62.8) with an intact elbow and distal insertion point of the biceps tendon. A biceps tendon in the bicipital groove was confirmed using ultrasound. The portable arthroscopy device was introduced through an anterior-superior portal. Tenotomies were carried out under direct visualization with a standard straight arthroscopic punch through a separate adjacent portal. Following tenotomy, a second-look was performed to identify injuries caused by the procedure. Specimens were disarticulated and examined for iatrogenic injury to cartilage and completion of tenotomy. Biceps stump lengths were measured. Tenotomies were confirmed in 9 of 10 specimens with an average residual stump of 4.23±2.08 mm (range: 0 to 6.94 mm). Stability of the labrum was confirmed post-tenotomy. No iatrogenic injuries were observed on arthroscopy. This study demonstrates the safety and efficacy of an intra-articular, minimally invasive tenotomy of the long head of the biceps in a cadaveric model using a portable arthroscopy device as a possible alternative to operating room arthroscopic tenotomy.
{"title":"Feasibility of Biceps Tenotomy Using Small Needle Arthroscopy: A Cadaver Analysis","authors":"K. Plancher, Joseph M. Ajdinovich, S. Petterson","doi":"10.1097/BTE.0000000000000194","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000194","url":null,"abstract":"Untreated lesions of the long head of the biceps tendon are a common cause of shoulder pain and dysfunction. Although the use of in-office arthroscopy has been described for biceps tenotomy, advances have led to portable arthroscopy devices. Tenotomy was performed in 10 cadaveric shoulders (average age 62.8) with an intact elbow and distal insertion point of the biceps tendon. A biceps tendon in the bicipital groove was confirmed using ultrasound. The portable arthroscopy device was introduced through an anterior-superior portal. Tenotomies were carried out under direct visualization with a standard straight arthroscopic punch through a separate adjacent portal. Following tenotomy, a second-look was performed to identify injuries caused by the procedure. Specimens were disarticulated and examined for iatrogenic injury to cartilage and completion of tenotomy. Biceps stump lengths were measured. Tenotomies were confirmed in 9 of 10 specimens with an average residual stump of 4.23±2.08 mm (range: 0 to 6.94 mm). Stability of the labrum was confirmed post-tenotomy. No iatrogenic injuries were observed on arthroscopy. This study demonstrates the safety and efficacy of an intra-articular, minimally invasive tenotomy of the long head of the biceps in a cadaveric model using a portable arthroscopy device as a possible alternative to operating room arthroscopic tenotomy.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"21 1","pages":"66 - 69"},"PeriodicalIF":0.0,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000194","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48479795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-14DOI: 10.1097/BTE.0000000000000196
J. Barrett-Lee, G. Harper
Snapping scapula syndrome is characterized by painful crepitus at the scapulothoracic articulation, which is worse on movement, in the particular overhead activity. A number of bony causes of snapping scapula syndrome due to ventral scapular exostoses have been previously reported. However, we present a rare case of snapping scapula syndrome resulting from an osteochondroma of the second rib, causing pain at the superior scapula with shoulder movement. This required a novel surgical multidisciplinary approach. Surgical resection was performed via a posterior trapezius-splitting approach resulting in symptom resolution.
{"title":"Snapping Scapula Syndrome Caused by an Osteochondroma of the Second Rib: A Novel Surgical Technique and Case Report","authors":"J. Barrett-Lee, G. Harper","doi":"10.1097/BTE.0000000000000196","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000196","url":null,"abstract":"Snapping scapula syndrome is characterized by painful crepitus at the scapulothoracic articulation, which is worse on movement, in the particular overhead activity. A number of bony causes of snapping scapula syndrome due to ventral scapular exostoses have been previously reported. However, we present a rare case of snapping scapula syndrome resulting from an osteochondroma of the second rib, causing pain at the superior scapula with shoulder movement. This required a novel surgical multidisciplinary approach. Surgical resection was performed via a posterior trapezius-splitting approach resulting in symptom resolution.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"21 1","pages":"76 - 78"},"PeriodicalIF":0.0,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000196","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49190138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-14DOI: 10.1097/BTE.0000000000000198
R. Maanouk, M. Bensaka, A. Baroudi, S. Senhaji, H. Abid, M. Elidrissi, A. El Ibrahimi, A. Elmrini
Symptomatic nonunion of medial epicondyle fractures of the humerus is a rare entity. The surgical technique can be difficult due to anatomic and biomechanical factors, such as the high tension and the torsional forces applied from the flexor-pronator tendon origin. The most common complications of nonunion of the medial humeral epicondyle fracture are chronic pain, instability in valgus of the elbow, and neuropathy of the ulnar nerve. We described the case of 1 patient with symptomatic medial humeral epicondyle nonunion, who underwent open reduction and internal fixation with excellent clinical evolution after 1 year of follow-up from time of surgery. The purpose of this study was to evaluate the outcome of open reduction and internal fixation of a medial epicondyle nonunion fragment in 1 case and present a review of the literature.
{"title":"Symptomatic Nonunion of the Medial Humeral Epicondyle Fracture: A Case Report and Review of the Literature","authors":"R. Maanouk, M. Bensaka, A. Baroudi, S. Senhaji, H. Abid, M. Elidrissi, A. El Ibrahimi, A. Elmrini","doi":"10.1097/BTE.0000000000000198","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000198","url":null,"abstract":"Symptomatic nonunion of medial epicondyle fractures of the humerus is a rare entity. The surgical technique can be difficult due to anatomic and biomechanical factors, such as the high tension and the torsional forces applied from the flexor-pronator tendon origin. The most common complications of nonunion of the medial humeral epicondyle fracture are chronic pain, instability in valgus of the elbow, and neuropathy of the ulnar nerve. We described the case of 1 patient with symptomatic medial humeral epicondyle nonunion, who underwent open reduction and internal fixation with excellent clinical evolution after 1 year of follow-up from time of surgery. The purpose of this study was to evaluate the outcome of open reduction and internal fixation of a medial epicondyle nonunion fragment in 1 case and present a review of the literature.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"21 1","pages":"84 - 87"},"PeriodicalIF":0.0,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000198","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48457513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-01DOI: 10.1097/BTE.0000000000000191
Marcio Cohen, M. Monteiro, Raphael Fonseca, Marcelo Reis Pereira, A. Zaluski
The meso-acromion is the most common type of os acromiale and has been associated with subacromial impingement and rotator cuff tears. Surgical treatment might be indicated when nonoperative treatment has been nonsuccessful and depends on the size and location of the os acromiale. Numerous surgical procedures have been described in the current literature, most of them focusing on the os acromiale union. To this, fusion rates depend mostly on the surgical approach and fixation technique and when achieved, is generally associated with good clinical outcomes. The purpose of this article is to describe our preferred technique of internal fixation for a symptomatic meso-type os acromiale. An all-arthroscopic technique has the advantages of optimal visualization of the undersurface of the acromion and nonunion site minimizing morbidity of the open approach.
{"title":"Arthroscopic Internal Fixation of Symptomatic Os Acromiale","authors":"Marcio Cohen, M. Monteiro, Raphael Fonseca, Marcelo Reis Pereira, A. Zaluski","doi":"10.1097/BTE.0000000000000191","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000191","url":null,"abstract":"The meso-acromion is the most common type of os acromiale and has been associated with subacromial impingement and rotator cuff tears. Surgical treatment might be indicated when nonoperative treatment has been nonsuccessful and depends on the size and location of the os acromiale. Numerous surgical procedures have been described in the current literature, most of them focusing on the os acromiale union. To this, fusion rates depend mostly on the surgical approach and fixation technique and when achieved, is generally associated with good clinical outcomes. The purpose of this article is to describe our preferred technique of internal fixation for a symptomatic meso-type os acromiale. An all-arthroscopic technique has the advantages of optimal visualization of the undersurface of the acromion and nonunion site minimizing morbidity of the open approach.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88277546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-08DOI: 10.1097/BTE.0000000000000188
V. Varghese, K. Bhowmick, I. Prithishkumar, M. Nithyananth
The authors describe a new anteromedial (AM) approach for minimally invasive fixation of humerus fractures. A cadaveric study was done initially, followed by the clinical study in a single level 1 trauma center. The AM approach was initially described by cadaveric dissection where the proximal and distal intervals were delineated. The interval for the proximal incision was between the biceps and pectoralis major muscle and the distal interval was made by splitting the brachialis muscle above the medial epicondyle. Six cadavers (12 limbs) were dissected to describe this approach. The same approach was then used on a series of 5 patients with acute humerus fracture. The outcomes which were measured were intraoperative complications, radiologic evidence of union, and functional scores. The cadaveric dissection indicated that the median nerve, brachial artery, musculocutaneous nerve, and the ulnar nerve were safe during plate application. The radial nerve was not encountered during this approach. In the clinical series, all the patients had united with good functional scores and no infection. There were no intraoperative complications or nerve palsies. The AM minimally invasive approach for the humerus fracture fixation is a safe procedure in patients as demonstrated by our cadaveric study and verified by our clinical results.
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