Consistent with an aging population, the overall number of distal humeral fractures in the elderly is increasing. Indications for application of acute total elbow arthroplasty (TEA) in the setting of distal humeral fr...Consistent with an aging population, the overall number of distal humeral fractures in the elderly is increasing. Indications for application of acute total elbow arthroplasty (TEA) in the setting of distal humeral fractures are still being defined. A variety of factors including chronologic age, physiologic age, bone quality, presence of pre-existing arthritis and pre-existing medical conditions need to be considered. Optimally the decision to proceed with TEA verses open reduction internal fixation (ORIF) is made preoperatively. The need to abandon ORIF may be not be apparent until after fracture exposure, and the presence of an olecranon osteotomy makes performing TEA challenging. A case is presented of acute conversion from ORIF to TEA following olecranon osteotomy, utilizing internal fixation bridging the ulnar component and its cement mantle.展开更多
The elbow joint is a complex joint, which, when impaired in function, leads to severe disability. In some cases however, an arthroplasty might be an appropriate treatment. In the past four decades, large steps havebee...The elbow joint is a complex joint, which, when impaired in function, leads to severe disability. In some cases however, an arthroplasty might be an appropriate treatment. In the past four decades, large steps havebeen taken to optimize this treatment in order to achieve better post-operative outcomes. To understand these progresses and to discover aspects for upcoming improvements, we present a review on the past developments, the present state of affairs and future developments which may improve patient care further.展开更多
Background： Infection and aseptic loosening are common complications of total elbow arthroplasty （TEA） and often require revision surgery. However, bone defects, along with other complications, bring an extra diffi...Background： Infection and aseptic loosening are common complications of total elbow arthroplasty （TEA） and often require revision surgery. However, bone defects, along with other complications, bring an extra difficulty to the second surgery, especially for patients with a massive bone defect in the proximal ulna. Several methods including allograft or autograft have been introduced into practice, but none sufficiently solves these problems. Methods： We conducted a new surgical method for patients with a massive ulnar bone defect needing revision TEA. During revision arthroplasty, the ulnar prosthesis was inserted into the radius as a salvage procedure. Four consecutive patients received revision arthroplasty with this method between 2013 and 2016. Patients＇ data were collected to evaluate the clinical outcome. Results： All patients had a Grade Ill ulnar bone defect. At the last follow-up session, all patients reported a painless, functional elbow joint. Three patients suffered from a periprosthetic infection that was completely cured using the two-stage method. No major complications, including infection, aseptic loosening, or wound problems were found. One patient had a transient ulnar neuritis, and another had a transient radial neuritis. Both patients had full recovery at the last follow-up session. Conclusions： Inserting an ulnar prosthesis into the radius is a novel procedure for patients with a massive bone defect due to infection or aseptic loosening. It is a safe, quick, and effective treatment with a promising short-term outcome. This method should be provided as a salvage procedure for patients with a nonreconstructable ulnar bone defect.展开更多
Managing fractures of distal humerus in patients with rheumatoid arthritis (RA) is technically challenging. Total elbow arthroplasty (TEA) is one of the treatment options for these fractures. While elbow motion is lar...Managing fractures of distal humerus in patients with rheumatoid arthritis (RA) is technically challenging. Total elbow arthroplasty (TEA) is one of the treatment options for these fractures. While elbow motion is largely regained by TEA, comminuted condyle fragments are often ignored. Although numerous approaches for repair of condylar fragments around TEA are described, any universal fixation strategy for these fractures has not been established. This report describes, for the first time, application of an ultra-high molecular weight polyethylene (UHMWPE) tape for the treatment of distal humerus fracture in 2 patients with rheumatic elbow arthropathy. The post-operative clinical courses were good. Radiographs showed bony union of the condylar fragments without loosening in two cases. Because of its flat configuration, softness, and flexibility, UHMWPE tape is a promising material for stabilizing fracture of the distal humerus associated with TEA.展开更多
文摘Consistent with an aging population, the overall number of distal humeral fractures in the elderly is increasing. Indications for application of acute total elbow arthroplasty (TEA) in the setting of distal humeral fractures are still being defined. A variety of factors including chronologic age, physiologic age, bone quality, presence of pre-existing arthritis and pre-existing medical conditions need to be considered. Optimally the decision to proceed with TEA verses open reduction internal fixation (ORIF) is made preoperatively. The need to abandon ORIF may be not be apparent until after fracture exposure, and the presence of an olecranon osteotomy makes performing TEA challenging. A case is presented of acute conversion from ORIF to TEA following olecranon osteotomy, utilizing internal fixation bridging the ulnar component and its cement mantle.
文摘The elbow joint is a complex joint, which, when impaired in function, leads to severe disability. In some cases however, an arthroplasty might be an appropriate treatment. In the past four decades, large steps havebeen taken to optimize this treatment in order to achieve better post-operative outcomes. To understand these progresses and to discover aspects for upcoming improvements, we present a review on the past developments, the present state of affairs and future developments which may improve patient care further.
文摘Background： Infection and aseptic loosening are common complications of total elbow arthroplasty （TEA） and often require revision surgery. However, bone defects, along with other complications, bring an extra difficulty to the second surgery, especially for patients with a massive bone defect in the proximal ulna. Several methods including allograft or autograft have been introduced into practice, but none sufficiently solves these problems. Methods： We conducted a new surgical method for patients with a massive ulnar bone defect needing revision TEA. During revision arthroplasty, the ulnar prosthesis was inserted into the radius as a salvage procedure. Four consecutive patients received revision arthroplasty with this method between 2013 and 2016. Patients＇ data were collected to evaluate the clinical outcome. Results： All patients had a Grade Ill ulnar bone defect. At the last follow-up session, all patients reported a painless, functional elbow joint. Three patients suffered from a periprosthetic infection that was completely cured using the two-stage method. No major complications, including infection, aseptic loosening, or wound problems were found. One patient had a transient ulnar neuritis, and another had a transient radial neuritis. Both patients had full recovery at the last follow-up session. Conclusions： Inserting an ulnar prosthesis into the radius is a novel procedure for patients with a massive bone defect due to infection or aseptic loosening. It is a safe, quick, and effective treatment with a promising short-term outcome. This method should be provided as a salvage procedure for patients with a nonreconstructable ulnar bone defect.
文摘Managing fractures of distal humerus in patients with rheumatoid arthritis (RA) is technically challenging. Total elbow arthroplasty (TEA) is one of the treatment options for these fractures. While elbow motion is largely regained by TEA, comminuted condyle fragments are often ignored. Although numerous approaches for repair of condylar fragments around TEA are described, any universal fixation strategy for these fractures has not been established. This report describes, for the first time, application of an ultra-high molecular weight polyethylene (UHMWPE) tape for the treatment of distal humerus fracture in 2 patients with rheumatic elbow arthropathy. The post-operative clinical courses were good. Radiographs showed bony union of the condylar fragments without loosening in two cases. Because of its flat configuration, softness, and flexibility, UHMWPE tape is a promising material for stabilizing fracture of the distal humerus associated with TEA.
