ABSTRACT Purposes Open elbow arthrolysis (OEA) is a common method for treating post‐traumatic elbow stiffness, which may lead to severe bleeding when resecting heterotopic ossification (HO) and fibrous scar tissue. The purpose of this study is to compare the efficacy and safety among three different ways of using tranexamic acid (TXA) in reducing total blood loss and drainage volume in OEA. Patients and Methods This was a pilot, double‐blinded, randomized controlled trial involving a total of 60 patients of post‐traumatic elbow stiffness. Patients in the IV group (n = 20) received TXA intravenously, those in the intra‐articular group (n = 20) received TXA topically, and those in the combined group (n = 20) received TXA both intravenously and topically. The primary outcome measure was postoperative blood loss and drainage volume. The secondary outcome measures included elbow function, complications, and secondary surgery. Results The postoperative blood loss on the first and third days and the drainage volume on the first day was similar among the three groups (p > 0.05). The total postoperative drainage volume in the IV group was significantly higher than in the combined and intra‐articular group, with no significant difference observed between the combined and intra‐articular group (534.5 mL vs. 378.0 mL vs. 356.5 mL; p < 0.05). There were no significant differences in elbow flexion‐extension and rotation range of motion (ROM) and the Visual Analogue Scale (VAS) and Mayo Elbow Performance Score (MEPS) scores at the follow‐up (p > 0.05). Conclusion Intravenous, topical, or combined TXA administration showed no significant difference in reducing postoperative blood loss after OEA. However, both combined and topical TXA significantly reduced postoperative drainage volume compared to intravenous administration. Level of Evidence Therapeutic Level I.

BACKGROUND:The development of heterotopic ossification (HO) is a common yet debilitating complication after elbow injuries and related surgical procedures. We intend to evaluate the regional distribution features of HO around the elbow joint in patients with post-traumatic elbow stiffness (PTES), and explore the independent risk factors for HO development in different regions. MATERIALS AND METHODS:Patients who presented with PTES attributed to HO from January 2018 to December 2019 were consecutively enrolled. The pattern of HO distribution was analyzed using Mimics software (Mimics 21.0, Materialise NV, Leuven, Belgium) and classified into 8 distinct regions: anteromedial (AM), anterolateral (AL), posteromedial (PM), posterolateral (PL), posterior (P), medial (M), lateral (L), and proximal radioulnar (PRU) regions. The initial injuries were further categorized based on the presence or absence of 5 fundamental injury types: distal humerus fracture, olecranon fracture, radial head fracture, coronoid fracture, and elbow dislocation. With the occurrence of HO in a specific region as the dependent variable and the initial injury patterns and baseline clinical data as independent variables, logistic regression analyses were conducted to identify the associated independent risk factors for HO development in different regions. RESULTS:A total of 170 patients were included. We identified PM HO in 166 patients (97.6%), P HO in 135 patients (79.4%), PL HO in 128 patients (75.3%), AM HO in 92 patients (54.1%), AL HO in 57 patients (33.5%), PRU HO in 32 patients (18.2%), M HO in 12 patients (7.1%), and L HO in 11 patients (6.5%). The results of logistic regression analyses: (1) AM HO: time interval between the initial injury and this admission ≥1 year (odds ratio [OR] = 2.338), the presence of elbow dislocation (OR = 3.193) and olecranon fracture (OR = 0.305); (2) AL HO: high energy trauma (OR = 2.073) and the presence of olecranon fracture (OR = 0.367); (3) P HO: immobilization for more than 2 weeks after the initial injury or subsequent surgical procedures (OR = 2.466); (4) PL HO: the presence of radial head fracture (OR = 2.805); (5) PRU HO: the presence of radial head fracture (OR = 8.186); (6) PM + P + PL HO: the presence of radial head fracture (OR = 2.235). CONCLUSION:The regional distribution of HO in patients with PTES exhibits distinct features, and PM HO is observed in almost all patients. The type of initial injury and its subsequent management are closely related to the occurrence and development of HO in different regions. Our findings provide valuable insights and serve as a useful reference for the clinical assessment of HO in patients with PTES.

Background: Coronoid fractures are often part of a complex fracture-dislocation of the elbow. For an optimum prognosis, it is important to understand the characteristics of coronoid fractures in different elbow injury patterns. Significant differences in these characteristics have been observed in various studies, but these previous studies have suffered from limitations, such as insufficient quantification and unknown prognostic differences among different injury patterns. Therefore, we aimed to quantitatively analyze coronoid fracture characteristics and functional outcomes in different elbow injury patterns using three-dimensional computed tomography. Methods: All patients with coronoid fractures surgically treated at our hospital between January and December 2017 were categorized into 3 groups according to elbow injury pattern: posterolateral rotational instability (PLRI), varus posteromedial rotational instability (VPMRI), and olecranon fracture-dislocation (OFD). 3D models were reconstructed using Mimics 17.0, and the total volume and number of coronoid fragments were measured. The coronoid process edge was classified into different anatomical regions, and each region was assigned a number to quantify the distribution of fracture lines. At the last follow-up, the range of motion, visual analog scale, Mayo Elbow Performance Score, complications and reoperations were recorded. Results: The 92 patients enrolled had an average age of 42 +/- 15 years and a male-to-female ratio of 66:26. The median total volume in PLRI patients was less than that in VPMRI patients [431 (132, 818) mm3 vs. 1125 (746, 1421) mm3, adjusted P < .001] and OFD patients [431 (132, 818) mm3 vs. 2565 (381, 4076) mm3, adjusted P = .001]. The median number of coronoid fragments in PLRI patients was also less than that in VPMRI patients [1(1, 2) vs. 2 (1, 3), adjusted P = .043]. Most of the PCFL-Rs (79%) were located around the volar edge of the lesser sigmoid notch. Compared with that of PLRI, the PCFL-Us of the VPMRI and OFD tended to be located on the more ulnodorsal side of the coronoid process edge. The median ROM [110 (90, 133), P = .001] and the median Mayo Elbow Performance Score [85 (68, 95), P = .038] of patients with OFD were significantly less than those of patients with the other 2 patterns. The incidence of elbow stiffness (56%, 5/9, P = .001) and implant-related irritation (44%, 4/9, P < .001) in the OFD group was significantly higher than that in the other 2 groups. Conclusion: Coronoid fractures differ significantly in fragment volume, comminution severity, and fracture line distribution among different elbow injury patterns. OFD has the worst functional outcomes among complex elbow injury patterns. Level of evidence: Level III; Retrospective Cohort Comparison; Prognosis Study (c) 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

ABSTRACTObjectivePlate fixation is the preferred method for treating forearm shaft fractures. However, it remains controversial regarding the necessity of implant removal after bone union. This review aims to assess refracture risk after plate removal.MethodsWe searched various data sources, including PubMed, Embase, Web of Science, and Cochrane Library. A total of 6749 papers were identified, of which 23 studies were eligible for final quantitative syntheses. Subgroup analyses and sensitivity analyses were conducted to reduce heterogeneity and make the results more reliable.ResultsThe total risk difference (RD) was 0.06 (0.04–0.09), indicating that the difference was significant. In the “Reasons for Removal” subgroup analysis, the RD of the “No Symptom” subgroup was 0.07 (95% CI = 0.04–0.11), while the RD of the “Symptoms” subgroup was 0.04 (95% CI = −0.02 to 0.10). In the “Plate Type” subgroup analysis, the RD of the “LCP” subgroup was 0.07 (95% CI = 0.02–0.13), while the RD of the “DCP” subgroup was 0.07 (95% CI = 0.01–0.13). After omitting each study one by one, the RDs were all significant.ConclusionsPlate retention is significantly associated with a lower rate of refracture than plate removal. Consequently, it is not recommended to remove implants, especially for patients without implant‐related symptoms, but more reliable evidence is still needed.Trial RegistrationThe review was registered on PROSPERO and the registration ID is CRD42023424743, and a protocol was not prepared

Objective:To study the clinical efficacy of modified open elbow arthrolysis in the treatment of traumatic elbow stiffness.Methods:A retrospective analysis was performed on 120 patients who underwent modified open elbow arthrolysis in Beijing Jishuitan Hospital from January 2018 to December 2020. The age of the included patients was (37.7±12.4) years (ranged 18-64 years), including 54 males and 66 females. The medical records were reviewed, the range of motion (ROM) and functional status of the patients before operation and at the last follow-up were compared including visual analogue scale (VAS), Mayo elbow performance score (MEPS), Disabilities of the arm, shoulder and hand (DASH) score. Complications and secondary operations were also recorded. Measurement data with normal distribution were presented as mean ± standard deviation( ± s) and comparison between groups was conducted using the t-test; Measurement data of skewed distribution were expressed as M ( Q1, Q3), and Rank-sum test was used for inter-group comparison. Results:The preoperative extension of 120 patients was 43.6° (33.8°, 60.1°), the flexion was 78.7° (59.8°, 98.1°), and the flexion-extension ROM was 25.6° (0.0°, 54.5°); the preoperative pronation was 51.8° (33.0°, 67.0°), the supination was 85.1° (65.7°, 90.0°), and the rotation ROM was 136.9° (99.1°, 157.5°). Postoperative extension was 14.2° (7.0°, 24.8°), flexion was 129.5° (120.0°, 138.1°), flexion-extension ROM was 115.5° (94.4°, 127.3°); postoperative pronation was 65.0° (47.1°, 75.0°), the supination was 88.3° (78.6°, 90.0°), and the rotation ROM was 151.9° (131.7°, 163.4°). Postoperative extension, flexion, flexion-extension ROM, pronation, supination, and rotation ROM were all higher than those before operation, and the differences were statistically significant ( P<0.001). The VAS of 120 patients was 1.0 (0.0, 3.0) scores before operation and 0.0 (0.0, 1.0) scores after operation. The MEPS was 60.0 (50.0, 75.0) scores before operation and 100.0 (85.0, 100.0) scores after operation. The preoperative DASH was 37.5 (20.1, 51.3) scores, and the postoperative DASH was 7.9 (3.3, 13.3) scores. The postoperative VAS, MEPS, and DASH were significantly improved compared with those before operation, and the differences were statistically significant ( P<0.001). Residual ulnar nerve symptoms occurred in 18 cases, recurrence of heterotopic ossification in 42 cases, and hematoma in 3 cases. Conclusions:Modified open elbow arthrolysis is a safe and effective surgical method for the treatment of traumatic elbow stiffness. It can significantly improve the function of the patient, reduce the occurrence of elbow instability, avoid the use of external fixators, and reduce the cost of the patient.

双下肢不等长并不罕见.双下肢长度相差0. 5～1. 5 cm者约占全部人群的1/3;双下肢长度相差1. 5 cm以上的人群约占5％ [1].对于双下肢长度相差超过2 cm的患者,可考虑行骨延长手术予以矫正[2].目前Ilizarov牵张成骨原理仍然是肢体延长的金标准.然而,单纯通过外固定架技术实现牵张成骨时仍存在软组织栓系、关节僵硬、针道感染、舒适度和美观程度较差、长期佩戴影响患者心理和工作生活等问题[3-4].为减少外架肢体延长术的并发症,各种内外结合的新技术应运而生,如Paley等[5]在Ilizarov技术的基础上提出的单臂外固定架结合髓内钉的骨延长技术( lengthening over nail,LON).该技术可减少外固定架的佩戴时间和拆除外固定架后的骨折发生率,提高了舒适度,但存在患者术后深部感染的风险[6].因此,完全置入式髓内延长钉成为了肢体延长领域的研究重点.经过30余年的发展,髓内延长钉显示出了明显的优势,在世界范围内被广泛应用.

Background: We aimed to evaluate the biomechanical stiffness and strength of different internal fixa-tion configurations and find suitable treatment strategies for low transcondylar fractures of the distal humerus.Methods and materials: Thirty 4th generation composite humeri were used to create low transcondy-lar fracture models that were fixed by orthogonal and parallel double plates as well as posterolateral plate and medial screw (PPMS) configurations (n = 10 in each group) using an anatomical locking com-pression plate-screw system and fully threaded medial cortical screws. Posterior bending (maximum 50 N), axial loading (maximum 200 N) and internal rotation (maximum 10 Nmiddotm) were tested, in that order, for each specimen. Stiffness under different biomechanical settings among different configurations were compared. Another 18 sets of fracture models were created using these three configurations (n = 6 in each group) and the load to failure under axial loading among different configurations was compared.Results: Under posterior bending, the stiffness of parallel group was higher than orthogonal group (P < 0.001), and orthogonal group was higher than PPMS group (P < 0.001). Under axial loading, the stiff-ness of parallel group was higher than orthogonal group (P = 0.001) and PPMS group (P < 0.001); however, the difference between orthogonal and PPMS group was not statistically significant (P > 0.05). Under inter-nal rotation, the stiffness of parallel group was higher than orthogonal group (P = 0.044), and orthogonal group was higher than PPMS group (P = 0.029). In failure test under axial loading, the load to failure in the orthogonal group was lower than parallel group (P = 0.009) and PPMS group (P = 0.021), but the differ-ence between parallel group and PPMS group was not statistically significant (P > 0.05). All specimens in orthogonal group demonstrated "distal medial failure"; most specimens had "distal medial and trochlear failure" in the parallel group; most specimens exhibited "contact failure" in the PPMS group.Conclusion: For treating low transcondylar fractures, the overall stiffness and strength of the parallel configuration were superior to those of the orthogonal and PPMS configurations. Nevertheless, the PPMS configuration can provide adequate stability and stiffness comparable to double-plate configurations un-der axial loading. Therefore, the PPMS construct may have certain clinical value.(c) 2022 Published by Elsevier Ltd.

BACKGROUND:Open elbow arthrolysis (OEA) is an established treatment for posttraumatic elbow stiffness (PTES); however, its efficacy is debatable for some patients. Poor surgical outcomes have been associated with anxiety and depression in other orthopedic conditions, but no studies have examined this association in OEA. In this study, we aimed to determine whether a high preoperative anxiety and depression score is associated with a worse functional outcome in OEA for PTES. METHODS:A retrospective review of prospectively collected data was carried out in patients undergoing OEA between April 2021 and March 2022. Mental state evaluated by Hospital Anxiety and Depression Scale (HADS), subjective elbow function valued by Disabilities of the Arm, Shoulder, and Hand (DASH) score, objective elbow function valued by Mayo Elbow Performance Score (MEPS), pain score measured by visual analog scale (VAS) and the flexion-extension range of motion (ROM) of the affected elbow were collected before and after surgery in outpatient clinic follow-up at 3 months and 6 months. Patient satisfaction was only recorded 6 months postoperatively. All patients were divided into 2 groups based on the preoperative HADS score for analysis: Group A was the nonanxiety-depression group, and Group B was the anxiety-depression group. RESULTS:A total of 49 patients were included. Both groups improved in DASH, MEPS and ROM at 3 months and at 6 months. The HADS score in Group B decreased significantly at 6 months, showing that the mental state of patients in Group B improved after surgery. Group A had a lower DASH at 3 months and 6 months, larger 6-month ROM and higher satisfaction rate than Group B. Comparing the differences between preoperative and postoperative measurements, Group A improved more in ROM at 6 months. There was no significant difference in other outcome measures between the two groups. CONCLUSIONS:OEA is a safe and effective treatment for PTES, and can achieve good clinical outcomes in the short-term follow-up, regardless of whether the patients suffer from anxiety or depression. Patients with a HADS score ≥11 before OEA, however, have worse outcomes than those with a HADS score <11. LEVEL OF EVIDENCE:Level II; Retrospective Design; Prognosis Study.

Objective:To study the locational distribution characteristics of the heterotopic ossification (HO) following traumatic elbow stiffness and the risk factors for HO development at different locations.Methods:Consecutively included according to our inclusion criteria in the present study were the patients who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from January 2018 to December 2018 for elbow release due to traumatic elbow stiffness but developed postoperative HO. Their baseline data and CT data were collected and processed using Mimics 20.0. The HO distribution for each patient was characterized at the anteromedial, anterolateral, posteromedial, posterolateral, posterior, medial, lateral, and proximal radioulnar locations. The patient's original injury was categorized into 5 types: distal humerus fracture, olecranon fracture, radial head fracture, coronoid fracture, and elbow dislocation. After the univariate analysis with the HO occurrence at a specific location as the dependent variable and the original injury and baseline data as the independent variables, the factors with P value less than 0.1 were included in the logistic regression analysis to determine the risk factors for HO at each location.Results:A total of 91 patients were included in this study. Of them, 88 had posteromedial HO (96.7%, 88/91), 62 posterior HO (68.1%, 62/91), 60 posterolateral HO (65.9%, 60/91), 41 anteromedial HO (45.1%, 41/91), 26 anterolateral HO (28.6%, 26/91), 13 proximal radioulnar HO (14.3%, 13/91), 8 lateral HO (8.8%, 8/91), and 7 medial HO (7.7%, 7/91). Logistic regression analysis showed that presence of ulnar nerve symptoms ( OR=4.354, P=0.017) and presence of original elbow dislocation ( OR=2.927, P=0.042) were the independent risk factors for the anteromedial HO development and that presence of original olecranon fracture ( OR=0.277, P=0.023) was the protective factor for the anteromedial HO development. Presence of original radial head fracture was the independent risk factor for the anterolateral HO development ( OR=2.891, P=0.033) and the posterolateral HO development ( OR=3.123, P=0.043). Conclusions:HO development in patients with post-traumatic elbow stiffness is closely related to their original injury. Posteromedial HO may develop in almost all the patients. Patients with ulnar nerve symptoms and original elbow dislocation are more prone to anteromedial HO development, but patients with original olecranon fracture are less likely to develop anteromedial HO. Patients with original radial head fracture are more likely to develop anterolateral and posterolateral HO.

Objective:To investigate the efficacy of TiRobot navigation for hinged external fixation in elbow arthrolysis.Methods:The 11 patients were retrospectively analyzed who had been treated by elbow arthrolysis at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital using TiRobot navigation for hinged external fixation. There were 9 males and 2 females with a mean age of 39.3 years (from 21 to 66 years). Their elbow range of motion (ROM) was compared between preoperation and the final follow-up. Their visual analogue scale (VAS) and Mayo elbow performance score (MEPS) and complications were documented at the final follow-up.Results:The rotation axis of the elbow joint was positioned with the aid of intraoperative robot navigation in 11 patients.The deviation of entry point averaged 0.21 mm (from 0.05 to 0.41 mm) and the deviation of exit point 0.23 mm (from 0.06 to 0.38 mm). The follow-up time for the 11 patients averaged 25.8 months (from 16 to 32 months). Their elbow flexion and extension was 133.0° (134.9°, 138.7°) and rotation 164.6° ±17.5° at the final follow-up, significantly improved compared with their preoperative values [0.8°(0°, 33.7°) and 122.9°±49.0°] ( P<0.05). Their VAS averaged 0.2 (from 0 to 1) and MEPS 96.8 (from 85 to 100) at the final follow-up, giving 9 excellent and 2 good cases. There was no case of radial nerve injury, pin instability, pin breakage, pin infection or peri-pin fracture. Conclusion:When TiRobot navigation is used for hinged external fixation in elbow arthrolysis, the axis of rotation can be accurately located, leading to satisfactory functional outcomes for the patients.

Abstract Background Selecting the correct size of head component is challenging in radial head arthroplasty, particularly in comminuted fractures. This study aimed to investigate the relationship between measurements of the ipsilateral capitellum and the prosthetic radial head size, which may be used to predict the size of the radial head prosthesis preoperatively. Methods Our study enrolled all patients who underwent radial head arthroplasty at Beijing Jishuitan Hospital. Demographic, injury-related and radiographic data were collected. The prosthetic radial head size was recorded from the surgical notes. Three-dimensional models of preoperative CT scans were reconstructed, on which the lateral capitellar diameter, the capitellar width and the width between the capitellum and trochlea were measured. The correlations between measurements of the ipsilateral capitellum and the prosthetic radial head size were evaluated, and linear regression equations were established. Results The study enrolled 37 patients, with an average age of 42.8 ± 11.5 years and a male–female ratio of 20:17. The median diameter of the radial head prostheses was 22 (20, 22) mm. The average lateral capitellar diameter was 20.71 ± 1.93 mm, the mean capitellar width was 14.90 ± 1.40 mm, and the mean width between the capitellum and trochlea was 19.29 ± 1.78 mm. The lateral capitellar diameter (R = 0.820, P < 0.001), the capitellar width (R = 0.726, P < 0.001) and the width between the capitellum and trochlea (R = 0.626, P < 0.001) were significantly positively correlated with the size of the radial head prosthesis. The linear regression equation between the lateral capitellar diameter and the size of the radial head prosthesis was calculated and defined as follows: D = 7.44 + 0.67*d (D: diameter of radial head prosthesis; d: lateral capitellar diameter; and adjusted R 2 = 0.719, P < 0.001). Conclusions There are positive correlations between the anatomical parameters of the ipsilateral capitellum and the prosthetic radial head size. The lateral capitellar diameter can be measured on three-dimensional CT preoperatively to predict the size of the radial head prosthesis intraoperatively.

Background The enhanced recovery after surgery (ERAS) program is aimed to shorten patients' recovery process and improve clinical outcomes. This study aimed to compare the outcomes between the ERAS program and the traditional pathway among patients with ankle fracture and distal radius fracture. Methods This is a multicenter prospective clinical controlled study consisting of 323 consecutive adults with ankle fracture from 12 centers and 323 consecutive adults with distal radial fracture from 13 centers scheduled for open reduction and internal fixation between January 2017 and December 2018. According to the perioperative protocol, patients were divided into two groups: the ERAS group and the traditional group. The primary outcome was the patients' satisfaction of the whole treatment on discharge and at 6 months postoperatively. The secondary outcomes include delapsed time between admission and surgery, length of hospital stay, postoperative complications, functional score, and the MOS item short form health survey-36. Results Data describing 772 patients with ankle fracture and 658 patients with distal radius fracture were collected, of which 323 patients with ankle fracture and 323 patients with distal radial fracture were included for analysis. The patients in the ERAS group showed higher satisfaction levels on discharge and at 6 months postoperatively than in the traditional group (P < 0.001). In the subgroup analysis, patients with distal radial fracture in the ERAS group were more satisfied with the treatment (P=0.001). Furthermore, patients with ankle fracture had less time in bed (P < 0.001) and shorter hospital stay (P < 0.001) and patients with distal radial fracture received surgery quickly after being admitted into the ward in the ERAS group than in the traditional group (P=0.001). Conclusions Perioperative protocol based on the ERAS program was associated with high satisfaction levels, less time in bed, and short hospital stay without increased complication rate and decreased functional outcomes.

Background The open reduction and internal fixation (ORIF) was a standard treatment approach for fracture at distal humerus intercondylar, whereas the optimal way before ORIF remains inconclusive. We, therefore, performed a systematic review and meta-analysis to assess the efficacy and safety of olecranon osteotomy vs. triceps-sparing approach for patients with distal humerus intercondylar fracture. Methods The electronic searches were systematically performed in PubMed, EmBase, Cochrane library, and Chinese National Knowledge Infrastructure from initial inception till December 2019. The primary endpoint was the incidence of excellent/good elbow function, and the secondary endpoints included Mayo elbow performance score, duration of operation, blood loss, and complications. Results Nine studies involving a total of 637 patients were selected for meta-analysis. There were no significant differences between olecranon osteotomy and triceps-sparing approach for the incidence of excellent/good elbow function (odds ratio [OR]: 1.37; 95% confidence interval [CI]: 0.69-2.75; P = 0.371), Mayo elbow performance score (weight mean difference [WMD]: 0.17; 95% CI: -2.56 to 2.89; P = 0.904), duration of operation (WMD: 4.04; 95% CI: -28.60 to 36.69; P = 0.808), blood loss (WMD: 33.61; 95% CI: -18.35 to 85.58; P = 0.205), and complications (OR: 1.93; 95% CI: 0.49-7.60; P = 0.349). Sensitivity analyses found olecranon osteotomy might be associated with higher incidence of excellent/good elbow function, longer duration of operation, greater blood loss, and higher incidence of complications as compared with triceps-sparing approach. Conclusions This study found olecranon osteotomy did not yield additional benefit on the incidence of excellent/good elbow function, while the duration of operation, blood loss, and complications in patients treated with olecranon osteotomy might be inferior than triceps-sparing approach.

Abstract Background To evaluate the difference of functional outcomes between OTA/AO type C, Gustilo type I/II open fractures and closed fractures of the distal humerus after open reduction and internal fixation. Methods We retrospectively analyzed the clinical data of patients with OTA/AO-C distal humerus fractures who were treated in our department from January 2014 to December 2016. The patients were divided into an open fracture group and a closed fracture group. Their baseline characteristics and functional outcomes were analyzed and compared. Results A total of 64 patients treated by operative fixation were identified (25 open and 39 closed injuries), and the average follow-up time was 35.1 ± 13.6 months. There were no significant differences in the range of motion (ROM) of the elbow, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, complications, hospitalization time, operation time, intraoperative blood loss, or medical costs between the two groups (P > 0.05). Conclusion OTA/AO type C, Gustilo I/II distal humeral open fractures can yield satisfactory clinical results similar to those of closed distal humeral fractures after open reduction and internal fixation. Level of evidence Therapeutic Level III; Retrospective Cohort Comparison; Treatment Study.

Objective:To compare the clinical outcomes between OTA/AO-C open and closed fractures of the distal humerus treated by open reduction and internal fixation.Methods:The clinical data were retrospectively analyzed of the 70 patients who had been treated at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital for OTA/AO-C fractures of the distal humerus from January 2014 to June 2017. Of them, 22 suffered from open fractures (Gustilo types Ⅰ/Ⅱ) and 48 closed fractures. There were 18 males and 4 females with an age of (42.6±13.0) years in the open group and 21 males and 27 females with an age of (42.2±17.1) years in the closed group. Analyzed were interval from injury to surgery, hospitalization time, injury energy and functional outcomes which included range of motion (ROM) in elbow flexion and extension, ROM in elbow rotation, Mayo elbow performance score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH), complications and rate of secondary surgery.Results:There was no significant difference between the 2 groups in age, injury energy or interval from injury to surgery ( P>0.05), but there were significantly more males in the open group than in the closed group ( P=0.011). The follow-up time for all the patients averaged 34.0 months (from 25 to 54 months). There were no statistically significant differences between the 2 groups in hospitalization time [9.5(6.0, 13.0) d versus 8.5 (6.0, 11.0) d], ROM in flexion and extension [120.0° (100.0°, 137.8°) versus 128.5° (110.0°, 140.0°)], ROM in rotation [155.0° (151.3°, 155.0°) versus 155.0° (155.0°, 155.0°)], MEPS [95.0 (80.0, 100.0) versus 95.0 (80.0, 100.0)] or DASH [2.6 (0.63, 9.2) versus 1.7 (0.0, 8.5)] ( P>0.05). There were no statistically significant differences between the 2 groups either in rate of secondary surgery [36.4% (8/22) versus 33.3% (16/48)], ulnar nerve symptoms [54.5% (12/22) versus 60.4% (29/48)], local irritability in the region of internal fixation [9.1% (2/22) versus 6.3% (3/48)] or elbow stiffness [13.6% (3/22) versus 10.4% (5/48)] ( P>0.05). Conclusion:Open reduction and internal fixation can lead to similar clinical outcomes in the treatment of both open (Gustilo types Ⅰ/Ⅱ) and closed distal humeral fractures of OTA/AO-C, with no significant differences in postoperative ROM, functional scores or complications.

Background To evaluate and compare the functional outcomes of combined medial-lateral approach open arthrolysis with and without hinged external fixation. Methods We retrospectively collected and analyzed the clinical data of patients with severe elbow stiffness who were treated in our institution from January 2018 to January 2019. All of them were treated with combined medial-lateral approach arthrolysis. There were 20 patients who had the hinged external fixation placed and 29 patients without the placement of the external fixation. Their baseline characteristics and functional outcomes were evaluated and compared. Results The average follow-up time was 28.4 ± 3.7 months. There were no significant differences in the ROM of the elbow, MEPS, VAS, DASH, or complications between the two groups. The operation time and treatment cost of the patients without external fixation were significantly lower than patients with external fixation. Conclusion Combined medial-lateral approach open elbow arthrolysis without external fixation is a safe and effective way to treat elbow stiffness. Level of evidence Therapeutic Level III; Retrospective Cohort Comparison; Treatment Study.

Background: This study aimed to report the surgical techniques and results of treating coronoid process and radial head fracture combined with dislocation of the elbow (terrible triad of the elbow) using a single lateral incision, known as the extensor digitorum communis (EDC) split approach. Methods: A retrospective analysis was performed of 109 patients with terrible triad of the elbow who had been treated by the authors from January 2013 to December 2019. The participants included 67 males and 42 females, with a mean age of 42.2 years (14-71 years). All participants were treated via a single lateral approach. The coronoid process was fixated with Kirschner wires combined with anterior capsule suture lasso fixation. For the radial head fracture, 58 cases were fixated by AO headless cannulated screw (AO HCS) and 51 cases by acumed radial head replacement. In repair of the lateral collateral ligament (LCL) complex and the common extensor tendon, 28 cases used ETHIBOND suture through bone holes at the humeral lateral epicondyle, and the other 81 cases used suture anchors. No medial collateral ligament was repaired. A total of 46 participants were fixated with a Stryker dynamic joint distractor (DJD) II hinged external fixator to protect the bone and soft tissue. Results: All participants were followed up from 6 to 60 months (mean, 36.1 months). Their elbow range of flexion and extension averaged 123.4 degrees +/- 20.7 degrees, forearm rotation 151.0 degrees +/- 25.6 degrees, and Mayo elbow performance score (MEPS) 92.3 +/- 8.8. There were 22 participants (19.5%) with ulnar nerve symptoms, 16 (14.7%) who had elbow stiffness, and 7 underwent secondary surgery, including 6 removals of internal fixation, 5 arthrolyses of the elbow, and 2 ulnar neurolyses. Conclusions: Coronoid fractures, radial head fractures, and LCL injuries of the terrible triad of the elbow can be treated satisfactorily through a lateral minimal incision, combined with a hinged external fixation if necessary.

Total elbow arthroplasty (TEA) is an effective surgical method for treatment of end-stage elbow arthritis. However, compared with hip and knee arthroplasties, the implant survival rate of TEA remains low, with a high postoperative complications rate and a high revision rate. The main reasons for revision include aseptic loosening, periprosthetic infection, periprosthetic fracture, component failure, and postoperative instability, of which the most common cause is aseptic loosening. Unlike the initial TEA, revision surgery usually needs to deal with complicated conditions such as infection, scars, bone defects, prosthetic stem extraction and cement removal, making the operation more difficult. There are few clinical studies related to TEA revision in China. Therefore, the authors review the reasons for postoperative revision, the management of key intraoperative issues, and the outcomes of treatment to provide the basis for future clinical application and academic research of TEA revision surgery in China.

Background: The purpose of this study was to propose the modified trochleocapitellar index (mTCI), assess its reliability, and evaluate its correlation with post-traumatic elbow stiffness in type C2-3 distal humeral fractures among adults. Methods: From January 2013 to June 2017, a total of 141 patients with type C2-3 distal humeral fractures were included. The mTCI was calculated as the ratio between the modified trochlear and capitellar angles relative to the humeral axis (mTCI-HA), lateral humeral line (mTCI-LHL), and medial humeral line (mTCI-MHL) from anteroposterior radiographs taken immediately after the operation. The patients were divided into group A (with elbow stiffness) and group B (without elbow stiffness) based on follow-up results. To determine risk factors for elbow stiffness, univariate and logistic regression analyses were performed on each radiographic parameter separately, together with other clinical variables. Interrater reliability was assessed for all measurements. Results: Specific optimal ranges of value were identified for mTCI-HA (0.750-0.875), mTCI-LHL (0.640-1.060), and mTCI-MHL (0.740-0.900), beyond which the likelihood of elbow stiffness significantly increased (P<.001). By multivariate analysis, mTCI-HA (odds ratio [OR] 26.22, 95% confidence interval [CI] 3.39-203.07, P=.002), mTCI-LHL (OR 5.37, 95% CI 2.17-13.28, P<.001), and mTCI-MHL (OR 5.95, 95% CI 1.91-18.56, P=.002) values beyond the optimal ranges were identified as the independent risk factors for elbow stiffness. The interrater reliability of mTCI-HA, mTCI-LHL, and mTCI-MHL was 0.986, 0.983, and 0.987, respectively. Conclusion: The mTCI measurement method is reliable. Either too small or too large mTCI values were associated with post-traumatic elbow stiffness among adult patients with type C2-3 distal humeral fractures. The mTCI-HA showed a better predictive value than mTCI-LHL and mTCI-MHL. Level of evidence: Basic Science Study; Development of Classification System (C) 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Chronic elbow dislocation has a low incidence, but high disability rate, often leads to complications such as stiffness and instability, whose management is still a huge challenge in orthopedics traumatology. The mainstream strategy now is to reduce the elbow after extensive soft tissue release, repair or reconstruct collateral ligaments, stabilize the elbow with a hinged external fixator, and start rehabilitation as soon as possible. However, as evidence supporting treatment approaches comes mostly from small case series and case reports, controversies still remain in some intraoperative issues, such as the choice of surgical approach, the indications and methods of triceps lengthening and the reconstruction of ligaments. Combining relevant literature and clinical experience, the authors discussed the research progress in diagnosis and treatment of chronic elbow dislocation, suggesting that clinical doctors should focus on prevention rather than treatment of this disease, and advocated further reducing the incidence and disability rate of chronic elbow dislocation.