Critical time period for recovery of functional range of motion after surgical treatment of complex elbow instability: Prospective study on 76 patients (original) (raw)
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The present clinical work was conducted in the orthopaedic department of Uttar Pradesh University of medical sciences, after obtaining the permission from the ABSTRACT Background: The injury around the elbow joint is a common condition in any age group, especially in children as a result of fall, during the course of a child's normal play. The aim of the present study was to study the relationship between the recovery of movements and the anatomical alignment in fractures around the elbow. Methods: In the present study, 122 cases of fractures around elbow were included. The treatment with conservative or operative procedure depends on the surgeon concerned and his priorities. Sixty-six cases were treated conservatively, and 56 cases required operative intervention. At the time of follow up examination, cases were assessed as to the anatomical and functional point of view according to Flynn's criteria. We evaluated the reduction as per alignment in anteroposterior axis, lateral axis, and angulation. The patients were followed up for over 24 months. Results: Patients who had good anatomical alignment (grade A) showed 96.87% satisfactory result as compared to the patient who had fair anatomical alignment (91.66%) and poor anatomical alignment (54.54%). Thus in grade A where alignment was up to 76 points, we had satisfactory result in 96.87% patients, where as in grade C where alignment was less than 50 points, the result in 45.5% of patients was poor. Conclusions: Patients who had good anatomical alignment achieved, showed higher recovery of movement compared to the patient who had fair anatomical alignment and poor anatomical alignment.
Rehabilitation of the Elbow in the Throwing Athlete
Journal of Orthopaedic & Sports Physical Therapy, 1993
ehabilitation following an injury to the elbow is a common occurrence in orthopaedic and sports physical therapy practice. However, relatively little has been written discussing the rehabilitative process of the injured elbow. T h e unique orientation of the elbow complex consists of three bones articulating to form four articulations. This contributes to a high degree of joint congruence and accounts for much of the difficulty experienced by the therapist in obtaining normal function after injury or surgery. As a result of the many unique anatomical considerations of the elbow complex, the therapist is faced with multiple clinical challenges to successfully rehabilitate the injured elbow. T h e purpose of this paper is to discuss these challenges and to suggest possible treatment options that may lead to a successful rehabilitative outcome. Rehabilitation following an elbow injury o r elbow surgery progresses through a multiphased a p proach that is sequential and progressive. T h e ultimate goal of this process is returning the athlete t o his sport o r activity as quickly and safely as possible. T o enable the athlete to return to sporting activities, the elbow must have full, nonpainful range of motion, n o pain o r tenderness on clinical exam, satisfactory muscular strength, power, and endurance, and a satisfactory clinical Rehabilitation following an injury to the elbow joint complex i s common in physical therapy practice. The unique anatomical considerations of the elbow joint provide a significant challenge to the therapist in rehabilitating elbow injuries. The purpose of this paper i s to describe the rehabilitation process for various elbow pathologies and provide a rationale for their treatment. The rehabilitation process for the injured elbow presented in this paper will emphasize phases that are progressive, sequential, and based on clinical and scientific research.
Management of complex elbow instability
MUSCULOSKELETAL SURGERY, 2010
Complex elbow instability is a challenging injury even for expert elbow surgeons. The preoperative radiographs should be carefully evaluated to recognize all lesions that may occur in complex elbow instabilities. Recognizing all the possible lesions is critical to achieve an optimal outcome. The most common types of injuries are as follows: (1) radial head fractures associated with lateral and medial collateral ligaments lesions (with or without elbow dislocation); (2) Coronoid fractures and lateral collateral ligament lesion (with or without elbow dislocation);
Reconstruction of Posttraumatic Elbow Instability
Clinical Orthopaedics and Related Research, 2000
Successful reconstruction of posttraumatic elbow instability depends on restoration of the anatomic contributors to stability. The osseous and articular structures are paramount. The radial head and coronoid should be repaired or reconstructed and the olecranon (proximal ulna) should be repaired in anatomic alignment so that the contour and dimensions of the trochelar notch are restored and the radiocapitellar joint is aligned appropriately. The lateral collateral ligament complex is commonly disrupted and usually can be reattached to its origin from the lateral epicondyle. Patients with longstanding subluxation or dislocation may require temporary hinged external fixation or reconstruction of the collateral ligaments with tendon grafts. Posttraumatic instability of the elbow is a complex condition about which little has been written and few data have been pubsubtle instability that contributes to the gradual development of ulnohumeral arthrosis, as symptomatic instability limiting the ability to use the upper extremity for forceful tasks, as lished.
MUSCULOSKELETAL SURGERY, 2016
Background In the recent years, considerable improvements have come in biomechanical knowledge about the role of elbow stabilizers. In particular, the complex interactions among the different stabilizers when injured at the same time have been better understood. Anyway, uncertainties about both nomenclature and classification still exist in the definition of the different patterns of instability. Material and methods The authors examine the literature of the last 130 years about elbow instability classification, analyzing the intuitions and the value of each of them. However, because of the lack of a satisfactory classification, in 2015 a working group has been created inside SICSeG (Italian Society of Shoulder and Elbow Surgery) with the aim of defining an exhaustive classification as simple, complete and reproducible as possible. Results A new all-inclusive elbow instability classification is proposed. This classification considers two main parameters: timing (acute and chronic forms) and involved stabilizers (simple and complex forms), and four secondary parameters: etiology (traumatic, rheumatic, congenital…), the involved joint (radius and ulna as a single unit articulating with the humerus or the proximal radio-ulnar joint), the degree of displacement (dislocation or subluxation) and the mechanism of instability or dislocation (PLRI, PMRI, direct axial loading, pure varus or valgus stress). Conclusions This classification is at the same time complete enough to include all the instability patterns and practical enough to be effectively used in the clinical practice. This classification can help in defining a shared language, can improve our understanding of the disorder, reduce misunderstanding of diagnosis and improve comparison among different case series.
Journal of Shoulder and Elbow Surgery, 2009
Purpose: This study determined whether elbow stability could be restored with open reduction and internal fixation (ORIF) of type II coronoid fractures and evaluated the role of collateral ligament repair. Methods: Passive varus and valgus and simulated active vertical motion were performed using an in vitro elbow motion simulator. Varus/valgus angle and internal/external rotation were measured with the coronoid intact, with 50% removed, and after ORIF. Testing was performed with the collateral ligaments detached and repaired. Results: Vertical: stability was normal when both the lateral collateral ligament (LCL) and medial collateral ligament (MCL) were repaired, irrespective of the coronoid state. Kinematics were altered with a repaired LCL, incompetent MCL, and type II coronoid fracture (P < .05). Varus: LCL repair restored coronal stability but did not restore internal rotation (P < .05). Conclusions: These findings suggest that repair of type II coronoid fractures and injured collateral ligaments should be performed where possible. Over-tensioning the LCL, in the setting of MCL and coronoid deficiency, may contribute to instability.
Journal of Shoulder and Elbow Surgery, 2013
Background: Restriction of elbow mobility is a very frequent complaint after trauma or surgery. The objective of this study was to assess and compare the effectiveness of dynamic, static, or staticprogressive bracing in patients with elbow stiffness of traumatic or postoperative origin and without evidence of ossification. For the purpose of this study, effectiveness was measured as the increase in total range of motion, as well as extension and flexion. Materials and methods: We performed a systematic search of the keywords ''elbow AND (stiffness OR stiff) AND (brace OR splint OR conservative)'' in the online databases PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library. We included all clinical studies using dynamic or static bracing in patients with elbow stiffness. Eligible outcomes were changes in total range of motion, flexion, and extension; sustainability of results; and complications. Results: We included 13 eligible studies, providing data on 14 treated groups in 247 patients. The mean age of these patients was 34.5 AE 10.4 years, and female patients comprised 46% AE 12%. The mean duration from the incident to the start of brace treatment was 6.9 AE 5.1 months. The mean improvement in range of motion during the course of treatment was 38.4 AE 8.9 (95% confidence interval, 39.5 -41.8 ).
Reconstruction of the elbow: Surgeons' perspective
Journal of Hand Therapy, 1999
Understanding and treating elbow dislocation and the resultant instability can be demanding. Ligaments about the elbow provide roughly 50% of joint stability.' This review will begin with acute and recurrent medial and posterolateral instability, discussing the most significant contributions of the last decade in anatomy, ligament reconstruction, and rehabilitation. Medial Instability An acute tear of the medial collateral ligament is the most frequently isolated ligamentous injury of the elbow. Originally described in javelin throwers, this injury is seen almost exclusively in throwing athletes because of the enormous valgus stresses on the elbow during the late cocking and acceleration phases of throwing." Repetitive microtrauma can also cause inflammation and microscopic tears in the ligament.' The medial collateral ligament complex is composed of three parts: an anterior oblique ligament, a fan-shaped posterior oblique ligament, and a This paper is followed, on p. 73, by a paper presenting a hand therapist's commentary on the same subject.
Discovery Elbow System: clinical and radiological results after 2- to 10-year follow-up
European Journal of Orthopaedic Surgery and Traumatology, 2017
Background Discovery Elbow System (DES) is a semiconstrained prosthesis, mainly used for patients with rheumatoid arthritis (RA). Methods Records from 79 patients with RA (90 DES arthroplasties) were reviewed; 47 patients with 55 DES elbows were reexamined. Range of motion (ROM) of both elbows, upper limb function, and quality of life (Disabilities of the Arm, Shoulder, and Hand [DASH] score, Mayo Elbow Performance Score [MEPS], and the RAND 36-Item Health Survey [RAND-36]) were assessed. Cementing quality was assessed, and radiolucent lines measured from plain radiographs. Mean follow-up was 64 (range 24-123) months. Results Pre-operatively to post-operatively, mean elbow flexion improved from 120°to 146°(p \ 0.001) and mean extension lag improved from 29°to 24°(p = 0.02), respectively. At follow-up, mean supination was 66°, mean pronation was 69°, and mean grip strength was 14 kg. Grip strength and ROM (except supination) were similar between the DES elbow and contralateral un-operated elbow. Mean post-operative MEPS was 93 points (excellent, n = 38; good, n = 14; fair, n = 2; and poor, n = 1). Mean DASH score was 43 points. The RAND-36 showed that physical functioning, physical role functioning, bodily pain, and general health were lower than the Finnish reference values. Primary cementing was challenging, and radiolucent lines appeared during follow-up. Four prostheses were revised because of aseptic loosening (n = 3) and periprosthetic fracture (n = 1). Conclusion DES provides significant improvement in patient's flexion-extension arc. Cementing of the elbow prosthesis was challenging; radiolucent lines appeared during the 5-year follow-up, but their clinical relevance remains unclear. First-generation locking screws may loosen over time. Level of evidence Level IV.