Biomedical subjects

Job N Doornberg

Publications and source records attributed to Job N Doornberg.

6 recordsLinked to original sources

PubMed2006

Reference points for radial head prosthesis size.

PURPOSE: Metallic radial head implants are useful when the radial head cannot be repaired reliably and when either the elbow or the forearm is unstable. Problems arise when the radial head prosthesis is too thick, causing erosions of the capitellum and incongruity of the ulnohumeral joint. We used quantitative 3-dimensional computed tomography analysis to investigate the relative height of the radial head relative to the lateral edge and central ridge of the coronoid process as reference points for optimal insertion of a radial head prosthesis. METHODS: Seventeen computed tomography scans of the elbow were analyzed. The anatomic coronal plane of the forearm was determined using 3-dimensional images and a 2-dimensional image bisecting the articular surface of the radial head was created in this plane. The distance between the plane of the articular surface of the radial head and parallel planes at the most proximal aspect of the coronoid (the central ridge) and the lateral edge of the coronoid articular surface were measured. Negative values indicate the radial head is proximal to the coronoid. RESULTS: The average distance between the planes defined by the radial head articular surface and the coronoid central ridge was -0.8 mm. The average distance between the planes defined by the radial head articular surface and the lateral edge of the coronoid articular surface was -0.9 mm. CONCLUSIONS: Because the radial head was on average only 0.9 mm more proximal than the lateral edge of the coronoid process and because the key is to not overstuff the joint a useful general guideline would be to place the plane of the articular surface of the radial head even with or just slightly more proximal than the lateral edge of the coronoid articular surface. Considering the substantial variability of the normal height of the articular surface of the radial head with respect to that of the coronoid, preoperative radiographs of the opposite elbow may be useful to avoid overstuffing the elbow.

Adolescent↗

PubMed2006

Coronoid fracture patterns.

PURPOSE: It has been suggested that specific types of coronoid fractures are associated strongly with specific patterns of traumatic elbow instability. This hypothesis was tested in a review of a large consecutive series of patients with a fracture of the coronoid as part of a fracture-dislocation of the elbow. METHODS: One surgeon repaired 67 coronoid fractures as part of a fracture-dislocation of the elbow over a 7-year period. Each coronoid fracture was characterized on the basis of surgical exposure. Pearson chi-square analysis was used to evaluate the association of the coronoid fracture type with 1 of 4 common patterns of elbow fracture-dislocation. RESULTS: The coronoid fracture was associated with an anterior (6 patients) or posterior (18 patients) olecranon fracture-dislocation in 24 patients, an elbow dislocation and radial head fracture in 32 patients, and a varus posteromedial rotational instability pattern injury in 11 patients. Among the 24 patients with olecranon fracture-dislocations 22 had large coronoid fractures and 2 had small (<50%) coronoid fractures. All 32 patients with terrible-triad injuries had small (<50%) coronoid fractures with 1 of these being a fracture of the anteromedial facet of the coronoid. Among patients with varus posteromedial rotational pattern injuries 9 had small fractures of the anteromedial facet and 2 had larger fractures. The association of coronoid fracture type with injury pattern was strongly statistically significant for both classification systems. CONCLUSIONS: The following strong associations were confirmed by this study: large fractures of the coronoid process with anterior and posterior olecranon fracture-dislocations, small transverse fractures with terrible-triad injuries, and anteromedial facet fractures with varus posteromedial rotational instability pattern injuries. An awareness of these associations and their exceptions may help guide the optimal management of these injuries. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adolescent↗

PubMed2006

Static progressive splinting for posttraumatic elbow stiffness.

OBJECTIVES: To determine the value of static progressive splinting in helping patients with posttraumatic elbow stiffness regain functional motion and avoid operative treatment for stiffness. DESIGN: Retrospective case series. SETTING: Level I Trauma Center. PATIENTS AND INTERVENTION: Over a 3-year period, 29 consecutive patients with elbow stiffness after trauma (flexion contracture greater than 30 degrees or flexion less than 130 degrees) were treated with static progressive elbow splinting when a standard exercise program was no longer achieving gains in motion. Three patients were treated after the injury alone; 14 were treated after operative treatment of the initial injury, and 12 after a secondary operative contracture release for posttraumatic stiffness. Splinting was initiated on an average of 55 days (range, 15 to 200 d) after injury or operative treatment. MAIN OUTCOME MEASUREMENTS: Ulnohumeral range of motion before and after splint treatment. RESULTS: The flexion arc improved from 71 degrees (range, 0 to 100 degrees) before splinting to 112 degrees (range, 20 to 150 degrees) after splinting. After splinting, 3 patients had a flexion contracture greater than 30 degrees and 10 patients (34%) had fewer than 130 degrees of flexion. Only 3 patients-2 with heterotopic bone and 1 with an associated ulnar neuropathy-requested an operation to address elbow stiffness. Patients who were splinted after the initial injury (n=17, average improvement (fl-ext)=51+/-37 degrees) regained greater motion during splint wear than patients treated after elbow capsulectomy (n=12, average improvement (fl-ext)=22+/-24 degrees). CONCLUSIONS: Static progressive splinting can help gain additional motion when standard exercises seem stagnant or inadequate, particularly after the original injury. Operative treatment of stiffness was avoided in most patients.

Adolescent↗

PubMed2006

Fracture of the anteromedial facet of the coronoid process.

BACKGROUND: Fracture of the anteromedial facet of the coronoid was recently recognized as a distinct type of coronoid fracture resulting from a varus posteromedial rotational injury force. Very few reports are available to help guide the management of these injuries. METHODS: Eighteen patients with a fracture of the anteromedial facet of the coronoid process were treated over a six-year period. Twelve patients were treated for the acute fracture, and six were managed after initial treatment elsewhere. All but three patients (two with concomitant fracture of the olecranon and one with a second fracture at the base of the coronoid) had avulsion of the origin of the lateral collateral ligament complex from the lateral epicondyle. The initial treatment was operative in fifteen patients and nonoperative in three. The coronoid fracture was secured with a plate applied to the medial surface of the coronoid in nine patients, a screw in one patient, and sutures in one patient. It was not repaired in the remaining seven patients. RESULTS: At the final evaluation, an average of twenty-six months after the injury, six patients had malalignment of the anteromedial facet of the coronoid with varus subluxation of the elbow, which was due to the fact that the fracture had not been specifically treated in four patients and to loss of fracture fixation in two patients. All six had development of arthrosis and a fair or poor result according to the system of Broberg and Morrey. The remaining twelve patients had good or excellent elbow function. CONCLUSIONS: Anteromedial fractures of the coronoid are associated with either subluxation or complete dislocation of the elbow in most patients. Secure fixation of the coronoid fracture usually restores good elbow function.

Adolescent↗

PubMed2005

Pain dominates measurements of elbow function and health status.

BACKGROUND: Elbow function can be quantified with use of physician-based elbow-rating systems and health status questionnaires. Our hypothesis was that pain has a strong influence on these scores, which overwhelms the influence of objective factors such as motion. METHODS: One hundred and four patients were evaluated, at a minimum of six months (average, forty-six months) after the latest surgery for an intra-articular fracture of the elbow, with use of three physician-based evaluation instruments (Mayo Elbow Performance Index [MEPI], Broberg and Morrey rating system, and American Shoulder and Elbow Surgeons Elbow Evaluation Instrument [ASES]), an upper-extremity-specific health status questionnaire (Disabilities of the Arm, Shoulder and Hand [DASH]), and a general health status questionnaire (Short Form-36 [SF-36]). Multivariate analysis of variance and regression modeling were used to identify the factors that account for the variability in scores derived with these measures-in other words, which factors have the strongest influence on the final score. RESULTS: Pain alone accounted for 66% of the variability in the MEPI scores, 59% of the variability in the Broberg and Morrey scores, and 57% of the variability in the ASES scores. Models that included other factors accounted for only slightly more variability (73%, 79%, and 79%, respectively), and those that did not include pain accounted for only 22%, 41%, and 41% of the variability. Thirty-six percent of the variability in the DASH scores could be accounted for by pain alone, and 45% could be accounted for by pain and range of motion. Models not including pain accounted for only 17% of the variability in the DASH scores. CONCLUSIONS: Pain has a very strong influence on both physician-rated and patient-rated quantitative measures of elbow function. Consequently, these measures may be strongly influenced by the psychosocial aspects of illness that have a strong relationship with pain, and objective measures of elbow function such as mobility may be undervalued. It may be advisable to evaluate pain separately from objective measures of elbow function in physician-based elbow ratings.

Adult↗

PubMedDate not supplied

Coronoid fracture height in terrible-triad injuries.

PURPOSE: The coronoid fractures that occur in the terrible-triad pattern of traumatic elbow instability (posterior dislocation with fractures of the radial head and coronoid) usually are small transverse fragments. Attempts to classify these fragments according to height as suggested by Regan and Morrey have been inconsistent and contentious. The purpose of this study was to quantify coronoid fracture height in terrible-triad injuries. METHODS: The height of the coronoid process of the ulna and the coronoid fracture fragment were measured on computed tomography scans of 13 patients with terrible-triad-pattern elbow injuries. Two observers performed the measurements with excellent intraobserver and interobserver reliability. RESULTS: The total height of the coronoid process of the ulna averaged 19 mm. The average height of the coronoid fracture fragment was 7 mm. This corresponds to an average of 35% of the total height of the coronoid process. CONCLUSIONS: The transverse coronoid fractures associated with terrible-triad elbow injuries have a variable height that may not be easy to classify according to the system of Regan and Morrey. Classification of coronoid fractures according to fracture morphology and injury pattern may be preferable.

Adult↗