Triceps tendon avulsion and associated injuries of the elbow (original) (raw)
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Management and Treatment of Elbow and Forearm Injuries
Emergency Medicine Clinics of North America, 2010
Orthopedic injuries to the upper extremity are frequently seen in the emergency department (ED). The emergency medicine practitioner must be proficient in recognizing these injuries and their associated complications, and be able to provide appropriate orthopedic management. This article highlights the most frequent forearm and elbow injuries seen in the ED.
Triceps avulsion associated with capitellum fracture: An unusual lesional combination in the elbow
Trauma Case Reports, 2018
Triceps avulsion and fracture of the capitellum is a rare lesional combination. Elbow dislocation with radial head fracture, coronoid process fracture or capitellum fracture, and Monteggia fractures, the “Terrible Triade”, are well-known lesional combinations. Several authors have recently reported new lesional combinations at in the elbow involving the triceps [1–5]. Only one case reports this specific lesional association of triceps avulsion with fracture of the capitellum [1]. We have encountered one case of capitellum fracture concomitant with bony triceps avulsion, and we have performed a literature review for this rare lesional association in the elbow.
Preservation of active range of motion after acute elbow trauma predicts absence of elbow fracture
The American Journal of Emergency Medicine, 2008
Previous studies indicate that an inability to fully extend the elbow after elbow trauma is indicative of fracture. We hypothesized that maintenance of active range of motion (ROM) of the elbow in flexion, extension, pronation, and supination after elbow trauma is very specific for the absence of fracture or effusion, and limitation of ROM is sensitive for fracture or effusion. This was a prospective observational study with convenience sampling of a carefully selected patient population. This would allow certain types of patients to be excluded from the study. Patients with elbow injury receiving radiographs and meeting enrollment criteria were enrolled between June 2006 and March 2007 at 4 emergency departments in the local region. Demographics, active ROM, and presence of point tenderness at the olecranon, epicondyles, and radial head were recorded by enrolling clinicians. All enrolled patients received standard elbow radiographs. Radiographs were reviewed by blinded radiologists for the presence of fracture and effusion. Sensitivity, specificity, and 95% confidence intervals (CIs) of examination findings were calculated. One hundred thirteen patients were enrolled. Limitation of active ROM was 100% (95% CI, 0.93-1.00) sensitive for fracture or effusion. Preservation of active ROM was 97% (95% CI, 0.89-1.00) specific for the absence of fracture. Point tenderness was also highly sensitive but not specific. Individuals with preservation of active ROM after acute elbow trauma have a very low risk of associated fracture and may not require radiographic studies.
Acute and overuse elbow trauma: radio-orthopaedics overview
Acta bio-medica : Atenei Parmensis, 2018
The correct management of acute, subacute and overuse-related elbow pathologies represents a challenging diagnostic and therapeutic problem. While major trauma frequently requires a rapid surgical intervention, subluxation and minor trauma allow taking more time for diagnostics and planning the correct elective treatment after careful clinical and radiological investigation. In these conditions, communication between orthopaedic surgeon and radiologist allow to create a detailed radiology report, tailored to the patient's and surgeon's needs and optimal to plan proper management. Imaging technique as X-Ray, CT, US, MRI, CTA and MRA all belong to the radiologist's portfolio in elbow diagnostics. Detailed knowledge of elbow pathology and its classification and of the possibilities and limits of each imaging technique is of crucial importance to reach the correct diagnosis efficiently. The aim of this review is to present the most frequent elbow pathologies and suggest a su...
Strategies in Trauma and Limb Reconstruction
Background: Complex elbow injuries (CEIs) are severe and rare lesions, difficult to treat correctly due to the different patterns of clinical presentations. Standard methods cannot often be applied. The main goals of the treatment are performing a stable osteosynthesis of all fractures, obtaining a concentric and stable reduction of the elbow by repairing the soft tissue constraint lesions, and allowing early motion. Since the introduction of virtual reality (VR) approaches in clinical practice, three-dimensional (3D) computed tomography (CT) and 3D printing have revolutionised orthopaedic surgeries, thus helping to understand the anatomy and the pathology of complex cases. Case description: We discussed a case of CEI, characterised by an extended soft tissue (IIIB Gustilo classification) and neurovascular lesions associated with bone loss in a young female patient. Olecranon fracture was type IIIB according to Mayo classification. We outlined the steps of a pluri-tissue reconstructive approach and stressed the importance of 3D printing in the preoperative planning for such cases. Finally, peculiar final functional patient outcomes were reported. Conclusion: In this case, we found out that triceps reinsertion and scar process may provide for the joint stability in a low-demanding patient. 3D printing and VR approaches in clinical practice can be useful in the management of CEIs associated with an important bone and soft tissue loss.
Elbow Injuries in the Adolescent Thrower
Current Reviews in Musculoskeletal Medicine, 2018
Purpose of Review With an increasing rate of adolescent elbow injuries, especially in throwing athletes, the purpose of this review is to investigate the current literature regarding the diagnosis, treatment, and non-operative and operative outcomes of medial epicondyle fractures, ulnar collateral ligament repair, osteochondritis dissecans of the elbow, and olecranon stress fractures. Recent Findings Acceptable outcomes with both non-operative and operative treatments of medial epicondyle fractures have been reported, with surgical indications continuing to evolve. Unstable osteochondritis dissecans lesions, especially in patients with closed growth plates, require operative fixation, and emerging open and arthroscopic techniques including lesion debridement, marrow stimulation, autograft transfer, and allograft transplantation are described with good outcomes. Ulnar collateral repair has emerged as an exciting treatment option for an avulsion of either end of the ligament in young throwing athletes, with faster rehabilitation times than traditional ulnar collateral ligament reconstruction. Olecranon stress fractures are increasing in prevalence, and when a non-operative treatment course is unsuccessful, athletes have a high return-to-play rate after percutaneous cannulated screw placement. Summary With proper indications, non-operative and operative treatment modalities are reported with a high return-to-play and acceptable clinical outcomes for common elbow injuries, including medial epicondyle fractures, ulnar collateral ligament repair, osteochondritis dissecans of the elbow, and olecranon stress fractures, in adolescent throwing athletes. Further research is needed to better define treatment algorithms, surgical indications, and outcomes. Keywords Medial epicondyle fracture. Ulnar collateral ligament repair. Elbow osteochondritis dissecans. Olecranon stress fractures. Persistent olecranon physis. Adolescent elbow injuries Medial Epicondyle Fractures This article is part of the Topical Collection on Injuries in Overhead Athletes
Journal of Hand Therapy, 2007
Traumatic injuries of the elbow are frequent in patients of all ages but are particularly common in young children and adolescents engaged in normal play and athletic competition. Injury may result primarily due to direct trauma or may be secondary to transmission of forces through the elbow following a fall on an outstretched hand. In middle-aged and older individuals, chronic repetitive injuries tend to predominate. In all patients, radiographs remain the initial imaging study of choice. Many patients, however, may need advanced cross-sectional imaging (i.e. MRI, CT, or ultrasound) either at presentation or during the course of their treatment and follow-up. This article reviews the imaging appearance of common acute and chronic traumatic disorders of the elbow.
The Journal of Bone and Joint Surgery-American Volume, 2009
Background: It is postulated that fractures of the anteromedial facet of the coronoid process and avulsion of the lateral collateral ligament lead to posteromedial subluxation and arthritis of the elbow. It is not clear which injuries require internal fixation and whether repair of the lateral collateral ligament is sufficient. We hypothesized that increasing sizes and subtypes of anteromedial facet fractures cause increasing instability and that isolated lateral collateral ligament repair without fracture fixation would restore elbow stability in the presence of small subtype-I fractures. Methods: Ten fresh-frozen cadaveric arms from donors with a mean age of 66.3 years at the time of death were used in this biomechanical study. Passive elbow flexion was performed with the plane of flexion oriented horizontally to achieve varus and valgus gravitational loading. An in vitro unconstrained elbow-motion simulator was used to simulate active elbow flexion in the vertical position. Varus-valgus angle and internal-external rotational kinematics were recorded with use of an electromagnetic tracking system. Testing was repeated with the coronoid intact and with subtype-I, subtype-II, and subtype-III fractures. Instability was defined as an alteration in varus-valgus angle and/or in internalexternal rotation of the elbow. All six coronoid states were tested with the lateral collateral ligament detached and after repair. Results: In the vertical position, the kinematics of subtype-I and subtype-II anteromedial coronoid fractures with the lateral collateral ligament repaired were similar to those of the intact elbow. In the varus position, the kinematics of 2.5-mm subtype-I fractures with the lateral collateral ligament repaired were similar to those of the intact elbow. However, 5-mm fractures demonstrated a mean (and standard deviation) of 6.2°± 4.5°of internal rotation compared with a mean of 3.3°± 3.1°of external rotation in the intact elbow (p < 0.05). In the varus position, subtype-II 2.5-mm fractures with the lateral collateral ligament repaired demonstrated increased internal rotation (mean, 7.0°± 4.5°; p < 0.005). Subtype-II 5-mm fractures demonstrated instability in both the varus and valgus positions (p < 0.05). Subtype-III fractures with the lateral collateral ligament repaired were unstable in all three testing positions (p < 0.05). Conclusions: This study suggests that the size of the anteromedial coronoid fracture fragment affects elbow kinematics, particularly in varus stress. The size of an anteromedial coronoid fracture and the presence of concomitant ligament injuries may be important determinants of the need for open reduction and internal fixation. Clinical Relevance: This biomechanical study suggests that small subtype-I anteromedial coronoid fractures may be managed with isolated repair of the lateral collateral ligament while larger fragments probably should be treated with internal fixation in addition to lateral collateral ligament repair. Additional clinical studies are needed to determine the outcomes of operative and nonoperative treatment of anteromedial coronoid fractures.