Monteggia-like lesions encompass a wide spectrum of fractures of the forearm and elbow associated with dislocations, subluxations and ligamentous lesions.Many attempts have been made to classify these injuries, not only to understand their pathology but also to develop optimal treatments.Unfortunately, although some of these classifications are complete, they are either complex, not immediately usable, or not exhaustive. An orthopedic surgeon who aims to rapidly treat this kind of injury needs a visual classification, and knowledge of the best surgical approach.Monteggia like lesions do not allow for mistakes during surgery, as even a minor error could be prove detrimental to performing and completing all surgical steps.In this paper, based on our extensive experience in treating these rare lesions, we suggest a practical guide to the best surgical approach for various types of Monteggia like lesions.Some technical tips and pitfalls are also described.
In irreparable radial head fractures, especially if primary stabilizers of the elbow are damaged, the prosthetic replacement prevents instability and stiffness. Concerns have arisen over the use of bipolar press-fit prostheses due to the frequent finding of osteolysis and the risk of instability if compared to monopolar implants. Our aim was to assess midterm clinical and radiological outcomes of bipolar implants and the influence of osteolysis on proximal pain. Seventeen patients with irreparable fractures of the radial head, treated in acute with the same prosthetic model (rHEAD recon SBI/Stryker) between January 2015 and December 2018, were enrolled. Clinical assessment was performed using MEPS and DASH scores; a radiographic study was done to identify heterotopic ossifications and periprosthetic osteolysis. Outcomes at the last follow-up, according to MEPS, were excellent in 10 cases, good in 5 and fair in 2; none of the patients had severe pain or instability. In 3 cases, it was necessary to remove the implant, mainly because of early loosening. Radiological findings of osteolysis were detected in 9 cases, but no statistical correlation was found with MEPS and proximal pain. The use of bipolar implants is reliable if an accurate repair of ligament tears is performed and provides a good stability. Nevertheless, the risk of early aseptic loosening in uncemented implants is not negligible, and the follow-up of the patient must be strict. Late osteolysis does not seem to have clinical relevance, but further prospective studies are necessary to clarify this topic.
Purpose: The current indication for comminuted radial head fractures is radial head arthroplasty (RHA). The main purpose of this study was to investigate any statistical differences in terms of prosthesis revision or removal and radiographic-degenerative changes by comparing patients who underwent RHA and ligaments repair to those who underwent only RHA implant at minimum two-years follow up. The secondary aim was to delineate a trend profile of RHA implants.Methods: All patients who underwent RHA surgery for traumatic pathology between January 2012 and December 2017 were eligible. Two researchers independently and retrospectively reviewed the patients’ charts and collected the following data: type of prosthesis, associated surgical procedures and revision surgery. They also looked for any radiographic sign of prosthesis loosening, overstuffing, capitellar osteopenia, heterotopic ossification and degenerative changes. No clinical evaluation was performed. Results: In six years 124 RHA were implanted (74 Female, 50 Male, mean age 56). The main diagnoses were: terrible-triad, trans-olecranon fracture and isolated radial head fracture. It was found no significant statistical difference between the two groups, nevertheless the cohort of patients that underwent ligaments repair had a lower revision rate in comparison to the other. Suture of the annular ligament seems to be critical. The overall revision rate was 10.5%.Conclusion:This multi-center study found no evidence that ligaments repair, as an associated surgical procedure, improves RHA longevity, except for annular ligament. Nevertheless, it seems to prevent degenerative changes at mid-term follow-up.
The current indication for comminuted radial head fractures is radial head arthroplasty (RHA). The main purpose of this study was to investigate any statistical differences in terms of prosthesis revision or removal and radiographic-degenerative changes by comparing patients who underwent RHA and ligaments repair to those who underwent only RHA implant at minimum two-years follow up. The secondary aim was to delineate a trend pro le of RHA implants. Methods:All patients who underwent RHA surgery for traumatic pathology between January 2012 and December 2017 were eligible. Two researchers independently and retrospectively reviewed the patients' charts and collected the following data: type of prosthesis, associated surgical procedures and revision surgery. They also looked for any radiographic sign of prosthesis loosening, overstu ng, capitellar osteopenia, heterotopic ossi cation and degenerative changes. No clinical evaluation was performed. Results:In six years 124 RHA were implanted (74 Female, 50 Male, mean age 56). The main diagnoses were: terrible-triad, trans-olecranon fracture and isolated radial head fracture. It was found no signi cant statistical difference between the two groups, nevertheless the cohort of patients that underwent ligaments repair had a lower revision rate in comparison to the other. Suture of the annular ligament seems to be critical. The overall revision rate was 10.5%. Conclusion:This multi-center study found no evidence that ligaments repair, as an associated surgical procedure, improves RHA longevity, except for annular ligament. Nevertheless, it seems to prevent degenerative changes at mid-term follow-up.
Background. This case-control study investigated arm recovery from surgery for a ruptured distal tendon in terms of maximal strength, power, and endurance compared to the healthy contralateral arm, taking into account limb dominance.Methods. An S-shaped single incision and suture anchor repair was used in all 15 patients. All patients were right-arm dominant and of them none participated in a specific postoperative physical therapy program. Outcomes were evaluated based on range of motion and with the Disability of the Arm, Shoulder and Hand (DASH) test, Mayo Elbow Performance Index (MEPI), and Bromberg and Morrey questionnaire. Muscle function was assessed with MuscleLab. Results. Average test scores were as follows: DASH, 3.53/100; MEPI, 93/100; and Bromberg and Morrey, 90.87/100. There were significant differences in supination (P = 0.007), maximum lifted weight (P = 0.005763), strength during endurance exercise (P = 0.004366), and maximum strength in flexion (P = 0.045584) between impaired and healthy arms. Conclusions. Limb dominance is not a critical issue for the choice of treatment and functional evaluation following surgical repair of ruptured distal tendon.
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