During the second half of the 1900s, total elbow joint replacement began its ascent. Since then, many prosthetic models have been used. The main objective of elbow joint replacement in arthritic diseases is to decrease pain, increase joint stability and improve overall range of motion. In this study, 18 patients affected with elbow arthritis were treated with the Coonrad-Morrey and Discovery total elbow prostheses. All patients were assessed clinically before and after surgery using the Mayo Elbow Performance Score, the Disabilities of the Arm, Shoulder and Hand questionnaire and through radiograph analysis. Excellent and good results were observed in 88.9% of the cases at a mean follow-up of 5 years. Significant statistical differences in all parameters between preoperative and final follow-up values confirm the efficacy of these devices.
Complex fractures of the distal radius are articular lesions and comminuted at the level of the epiphysis and metaphysis. Their treatment is difficult and in most cases surgical. Of all the different osteosynthesis methods available, internal fixation with plate and screws is the most commonly used. In particular, angular stability plates are superior in terms of rigidity and stability to conventional volar and dorsal plates. DVR plate has these mechanical characteristics, and its low profile has reduced frictions with surrounding soft tissues. For these reasons, this device implanted through a single volar approach, can stabilize the majority of volarly and dorsally displaced unstable distal radius fractures. In this study, 48 patients, affected by complex fractures of the distal radius treated with DVR volar plates, were assessed by the Mayo modified wrist score, the Italian version of the disability of the arm, shoulder and hand. The satisfactory results observed confirm the efficacy of this device.
The aim of this study was to assess outcomes following open reduction and internal fixation in complex fractures of the distal humerus. Between 2000 and 2006, 34 patients were operated for complex fractures of the distal humerus. Bone fixation was obtained with a reverse Y-shaped reconstruction plate in 13 cases and with double plating in 21 cases. At final follow-up, all the patients were assessed with the Mayo Elbow Performance Score. Satisfactory results were observed in 71% of the cases despite a high rate of complications. Age over 65 years is correlated with increased risk for an inferior postoperative result. Complex distal humeral fractures are difficult to treat and are associated with a high incidence of complications. It is therefore mandatory to obtain good anatomical reduction and a stable fixation of lateral and medial columns of the distal humerus. The results observed in older patients suggest that an alternative treatment for these patients may be joint replacement.
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