Classification of heterotopic ossification about the elbow.
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Adult↗
Biomedical subjects
G T Gabel
Publications and source records attributed to G T Gabel.
Latrogenic snapping of the medial head of the triceps after ulnar nerve transposition.
We postulate an iatrogenic cause for snapping of the medial head of the triceps. A patient whose ulnar nerve and triceps did not dislocate over the medial epicondyle preoperatively had snapping of a portion of the medial triceps after submuscular transposition of the ulnar nerve. We believe that release of the brachial fascia and excision of the medial intermuscular septum removed the restraint to anterior translation of the medial aspect of the triceps, permitting dislocation of a portion of the medial head of the triceps with elbow flexion in this case. Previous reports of snapping of the triceps resulting after ulnar nerve transposition occurred in patients whose ulnar nerve dislocated preoperatively; in these cases, the triceps was thought to have dislocated preoperatively (along with the ulnar nerve) but was not recognized. Careful intraoperative assessment of the triceps after ulnar nerve transposition should prevent medial triceps instability as a postoperative concern.
Adult↗
Acute and chronic tendinopathies at the elbow.
Chronic elbow tendinitis (medial or lateral epicondylitis and triceps tendinitis) are common disorders that, overall, have a good prognosis but, even with optimum management, require a minimum of 3 to 6 months to resolve. Patient education, activity modification, splinting, and corticosteroid injections each serve a role in symptom resolution; surgery is required in less than 10% of cases and has a similarly long period (3 to 6 months) of recovery. Acute tendon injuries (biceps and triceps ruptures) require early (< 4 weeks) surgical repair but may be misdiagnosed, thus delaying management and requiring more involved surgical reconstruction. With appropriate treatment, the prognosis for each of these disorders is very good.
Acute Disease↗
Gymnastic wrist injuries.
Wrist injuries in the gymnast are due to the transformation of the upper extremity into a weight bearing entity. Both acute and chronic disorders occur and are difficult to manage in these athletes because of the intensity of training and competition. Treatment is dependent on the injury as well as the expectations of the patient, coach, and family--a situation that at times may alter the usual management program.
Athletic Injuries↗
Post-traumatic heterotopic ossification about the elbow.
To evaluate the effect of surgical timing on the formation of heterotopic ossification about the elbow, 71 consecutive patients with elbow trauma requiring operative management were evaluated. Fourteen patients were excluded because they suffered from head injury, burns, or severe open injuries requiring surgery on two or more occasions. Sixteen patients were lost to follow-up, leaving a group of 41 patients. The average age of patients was 35 years. The fractures involved the olecranon in 19, distal humerus in 12, and radial head/neck in 10 patients. Six of these fractures were accompanied by a dislocation. Eleven were open injuries; the remaining 30 were closed. Bone grafting was performed in nine patients. The interval between injury and surgical intervention averaged 57 hours. None (0%) of 17 patients treated within 48 hours developed grade II, III, or IV heterotopic ossification, whereas 8 (33%) of 24 patients treated after 48 hours developed grade II, III, or IV heterotopic ossification. There were no significant differences in demographic or injury parameters between these two groups. These findings suggest that fixation of unstable elbow fractures within 48 hours of injury may reduce the formation of ectopic bone.
Adolescent↗
Surgical management of the extensor mechanism of the elbow.
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Arthroplasty↗
Operative treatment of medical epicondylitis. Influence of concomitant ulnar neuropathy at the elbow.
We performed a retrospective review of the long-term results of operative treatment of medial epicondylitis in thirty elbows (twenty-six patients). Sixteen elbows had concomitant ulnar neuropathy. All of the patients had tenderness over the medial epicondyle. The most sensitive provocative maneuver was resisted pronation of the forearm (a positive result for twenty-eight elbows), followed by resisted flexion of the wrist (a positive result for twelve elbows). The operative findings included an inflammatory focus in seventeen elbows and focal ulnar-nerve compression in nine. Débridement of the origin of the flexor-pronator tendon mass, with decompression or transposition of the ulnar nerve when indicated, was associated with an 87 per cent rate (twenty-six elbows) of good or excellent results at an average of seven years (range, two to fifteen years) after the operation. Twenty-four of the twenty-five elbows that had no or mild associated ulnar neuropathy (type-IA or IB medial epicondylitis) had a good or excellent result, while two of the five elbows that had moderate or severe associated ulnar neuropathy (type-II medial epicondylitis) had a good or excellent result. This difference was significant (p = 0.009). Nine patients (nine elbows) needed more than six months before maximum improvement was obtained.
Arm Injuries↗
Role of upper tibial osteotomy in pigmented villonodular synovitis of the knee.
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Adult↗
Anterior and posterior internal fixation of vertical shear fractures of the pelvis.
A laboratory study was undertaken to evaluate the effectiveness of alternative methods of fixation of unilateral vertical shear fractures of the pelvis. Prior to experimental testing, a biomechanical analysis was performed to estimate the forces that displace the hemipelvis in the presence of two different patterns of injury: an interforaminal sacral fracture and a disruption of the sacroiliac joint. These lesions were then experimentally created in five unembalmed human pelvises and sequentially fixed with an external Hoffmann frame alone, a Hoffmann frame with sacral bars, or sacral bars with either one or two bone plates placed across the symphysis pubis. Each pelvis/fixator system was mechanically tested by loading along the direction of the resultant muscle force predicted by the biomechanical analysis. During loading the proximal migration of the ilium was continuously recorded with a transducer. At intervals during loading, the three-dimensional displacement of the detached hemipelvis at the pubic symphysis was also measured using a stereophotographic technique. With both the sacral fracture and the sacroiliac disruption, the addition of posterior sacral rods substantially increased the strength and rigidity of fixation provided by the Hoffmann fixation frame alone (p less than 0.01). In specimens with a sacral fracture, the use of anterior plates with posterior rods restored 65-71% of the strength of the intact pelvis, in comparison with 46% observed with the combination of sacral rods with an anterior Hoffmann frame (p less than 0.01). All of the methods of fixation evaluated in this study were less successful in stabilizing the sacroiliac disruption.(ABSTRACT TRUNCATED AT 250 WORDS)
Biomechanical Phenomena↗
Thumb duplication and contralateral thumb hypoplasia in infant of mother with diabetes.
Uncontrolled maternal diabetes frequently results in congenital anomalies. This report describes an infant of a mother with diabetes born with thumb hypoplasia and contralateral thumb duplication without other associated anomalies. Maternal diabetes should be part of the etiologic differential diagnosis of thumb anomalies. The concomitant occurrence of thumb duplication and hypoplasia, apparently as a result of the same systemic insult, suggests a close relationship between hypoplasia and duplication.
Adult↗
Premature partial physeal arrest. Diagnosis by magnetic resonance imaging in two cases.
The management of premature physeal arrest requires accurate assessment of not only the location but also the extent of the bar. Numerous imaging techniques are available to evaluate the physis. Multiplanar tomography has proven to be the most precise method. The utility of magnetic resonance imaging (MRI) of physeal bars has not been demonstrated. This article presents MRI results in two cases of physeal bars. MRI provides a means of assessing physeal bar formation with an accuracy approaching that of multiplanar tomography. In certain instances, its efficacy may exceed that of tomography, specifically when the physis cannot be properly oriented for tomographic evaluation, when more planes are desired, and when radiation exposure is thought to be excessive. With improvement of its capabilities and availability (which may also reduce cost), it may become the diagnostic imaging technique of choice.
Ankle Joint↗
Total knee arthroplasty for osteoarthrosis in patients who have Paget disease of bone at the knee.
Thirteen patients who had had sixteen total knee arthroplasties for pagetic gonarthrosis were followed for a mean of seven years (range, two to fifteen years). Involvement of the femur or tibia with Paget disease was associated with multiple technical difficulties at operation and with a final position in suboptimum varus or valgus alignment (ten limbs) or suboptimum alignment of the mechanical axis (nine limbs). The presence of bone with Paget disease did not affect the amount of blood lost during the operation, the postoperative course, or the rate of loosening of the prostheses. At the most recent evaluation, nine patients had no pain, three had mild pain, and one had moderate pain. The mean Knee Society pain score improved from 42 points preoperatively to 88 points and the mean functional score, from 33 to 86 points.
Aged↗
Gymnast's wrist.
The wrist is a frequent site of symptoms and injury in the gymnast, both acute and chronic. The chronic injuries are due to repetitive loading of the musculoskeletal system, and their incidence rises as participation and level of competition rises. More attention needs to be directed toward prevention, but many of these injuries seem to be inherent to the sport as it transforms the upper extremities into weight-bearing limbs. Evaluation and recognition of wrist injuries in the gymnast will allow appropriate management for these patients; however, the compulsive and intense nature of many gymnasts can lead to recurrent or new injury and continued wrist symptoms. Much more sophisticated and detailed examination of the gymnast's wrist should be done before onset of training, before increase of intensity of training, before competition, and with the onset of any symptoms, including observed guarding. In addition, pretraining and annual follow-up wrist radiographs should be considered for the skeletally immature gymnast. Follow-up evaluation after skeletal maturity and retirement from active participation is needed to elucidate the long-term effect of gymnastics on the wrist.
Chronic Disease↗
Reoperation for failed decompression of the ulnar nerve in the region of the elbow.
Thirty patients who had a revision of a failed decompression of the ulnar nerve at the elbow were followed for a minimum of two years postoperatively. Most of the decompressions were revised by submuscular transposition of the nerve. A satisfactory result was obtained in all but eight patients. At the index procedure, the nerve was found to be compressed at several levels (average, 2.2 levels). For a reoperation to be successful, the ulnar nerve must be examined and all potential levels of compression must be released. An age of more than fifty years, electromyographic evidence of denervation, and previous submuscular transposition were associated with a poor outcome in this series.
Adolescent↗
Non-Hodgkin's lymphoma of bone.
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Bone Neoplasms↗
Greenstick intercondylar fracture of the distal humerus. A case report.
A greenstick intercondylar fracture of the distal humerus occurred in a 14-year-old boy. The minimal displacement and stability of the injury allowed early range of motion with healing in an anatomic position and restoration of the preinjury arc of motion.
Adolescent↗
Intraarticular fractures of the distal humerus in the adult.
Intraarticular fractures of the distal humerus are notoriously difficult to treat. Three basic treatment methods are available: closed reduction, traction, and open treatment. In the past, functional results with all these methods generally have been poor because of disabling limitations of elbow motion. Thirteen adult patients were treated by open reduction and application of medial and lateral buttress plates providing rigid internal fixation and early motion. The patients were evaluated for range of motion, infection, nerve injury, avascular necrosis, myositis ossificans, varus/valgus deformity, pain, instability, weakness, and degenerative changes. Ten of the 13 patients were available for follow-up study for an average of two years. Nine of the ten achieved good or excellent results. Based on these observations, the treatment of choice is internal fixation with dual plates combined with early active postoperative motion.
Adolescent↗