Chronic disruption of the distal biceps tendon is a challenging problem and can lead to considerable disability. We conducted a group-matched retrospective study comparing clinical outcomes of chronic distal biceps reconstruction using our previously described “Anatomic Length Method” and those with an acute distal rupture and primary repair. Forty-six patients were included into the analysis; 23 underwent acute distal biceps repair, and 23 underwent chronic distal biceps reconstruction. Demographic and surgical data were reviewed retrospectively. Patients were evaluated and clinical outcome measures were obtained at least 1 year after surgical treatment. There were no significant differences in Patient-Rated Elbow Evaluation scores (6.0 vs. 4.4, respectively; P=0.53) and biceps shape contour satisfaction (19/19 vs. 6/7, respectively; P=0.093). No significant difference emerged in complication rates. This study suggests that chronic reconstruction of the distal biceps tendon using the “Anatomic Length Method” is a safe technique that produces similar clinical results to acute distal biceps primary repair.
Symptomatic nonunion of medial epicondyle fractures of the humerus is a rare entity. The surgical technique can be difficult due to anatomic and biomechanical factors, such as the high tension and the torsional forces applied from the flexor-pronator tendon origin. The most common complications of nonunion of the medial humeral epicondyle fracture are chronic pain, instability in valgus of the elbow, and neuropathy of the ulnar nerve. We described the case of 1 patient with symptomatic medial humeral epicondyle nonunion, who underwent open reduction and internal fixation with excellent clinical evolution after 1 year of follow-up from time of surgery. The purpose of this study was to evaluate the outcome of open reduction and internal fixation of a medial epicondyle nonunion fragment in 1 case and present a review of the literature.
Infection after total elbow arthroplasty can be a devastating problem. Eradication of the infection can often be difficult and may compromise the already tenuous bone and soft tissue, particularly the elbow extensor mechanism. Resection arthroplasty with the complete removal of all foreign material is often necessary to adequately treat the infection. Components may be well fixed and removal may further compromise bone and soft tissue. The authors present a technique of ulnar cortical window that facilitates the removal of a well-fixed ulnar component and the associated cement mantle. An illustrative surgical case is also included with pertinent intraoperative and radiographic images. This technique provides reliable, atraumatic access to the ulnar canal, cement mantle, and component for safe extraction of a well-fixed implant. When comparing with other techniques in the removal of the ulnar component, such as transverse ulnar osteotomy, and extended olecranon osteotomy, our technique did not breach the bony integrity of ulna, and it did not require wiring for rigid fixation of the bony fragment. This may be more applicable in excisional arthroplasty for the management of infected total elbow arthroplasty.
Chronic tears of the distal triceps tendon are extremely uncommon lesions. Surgical therapy can be performed with a direct reattachment of the 2 sides of the lesion or-in case of significant tendon retraction-using grafts to fill the resulting gap. Herein, we report a case of a torn distal triceps tendon that occurred in a 33-year-old patient suffering from paraplegia. The resulting functional impairment of the elbow impeded her to use a wheelchair, causing a substantial limitation to her mobility and autonomy. Preoperative clinical evaluation, x-rays, muscle-tendon ultrasound, and magnetic resonance imagingwas been performed. In consideration of a 6 cm retraction at the surgery, we reconstructed the tendon using a combination of suture anchors (5 mm Super Reevo ConMed) and a cadaver fascia lata allograft. After surgery, the elbow was immobilized in extension inside a brachio-metacarpal cast for 30 days. In the following month, the cast was replaced with a hinged elbow brace and progressive mobilization was permitted. Five months postoperatively, the patient regained her previous active flexion-extension articular ROM and was able to use her wheelchair again. No complication occurred.
The authors describe the treatment of a 13-year-old patient with a severe, posteriorly dislocated, epiphysiolysis fracture of the proximal radius. This is called a Jeffery type II lesion when the epiphysiolysis fracture takes place at the radial neck during the reduction of elbow posterior dislocation, thus causing radial head posterior displacement. There are <30 cases described in the literature about such kind of lesion, and only. Chotel and colleagues has carried out the percutaneous form of treatment. He advocated a varus stress onto the elbow joint so that its subluxation would open the lateral space to facilitate manipulation and head reduction toward its anatomic position. The authors also describe a closed reduction technique for such fracture by using 2 Kirschner wires, whereas the first is inserted into the fracture site, thus acting as a guide and fulcrum, so that the second wire would push the radial head toward its anatomic position. The authors regard that such modification of Chotel and colleagues’ technique is an effective and less aggressive maneuver that reduces the risk of iatrogenic ligament and chondral injuries. The purpose is to demonstrate the surgical technique of the novel, effective, and safe method of treatment to Jeffery type II radial neck pediatric fractures.
