Simple chronic instability of the elbow joint is one of the urgent problems in modern traumatology due to the fact that the standard tactics of managing patients with traumatic injuries of the elbow joint due to dislocation, which amounts to its elimination, immobilization of the upper limb and subsequent development of movements in the joint, most often does not take into account damage to specific soft tissue structures. With untimely treatment for qualified help, with late or unsuccessful attempts to eliminate dislocation of the bones of the forearm, less often with chronic traumatization of the ligamentous apparatus of the elbow joint during some types of occupation, one of the most unpleasant complications may form, namely, chronic instability. This article discusses the main types of chronic instability of the elbow joint, analyzes approaches to the management of patients with simple chronic instability. Despite the not very high occurrence of this pathology, the effectiveness of modern surgical treatment options aimed at reconstruction of the ligamentous apparatus of the elbow joint, the percentage of unsatisfactory results of treatment of simple chronic recurrent and persistent instability of the elbow joint remains high.
The use of shoulder joint replacement has increased significantly since the early 2000s. The method, initially used as the gold standard for the treatment of osteoarthritis, has long gone beyond the generally accepted indications, expanding its use for the treatment of shoulder joint injuries and their consequences. The new generation of implants has led to improved outcomes such as functionality, range of motion in the shoulder joint and patient satisfaction. The decision to perform anatomical endoprosthetics (hemiarthroplasty, total shoulder joint replacement) depends on the degree of osteopenia, the viability of the humerus head, the integrity of the tubercles or the functional state of the rotator cuff of the shoulder. This type of arthroplasty remains for patients with a functional rotator cuff. Reversible endoprosthetics is today the preferred treatment option for non-fusion or improper fusion of the proximal humerus with a collapse of the humerus head or a non-functioning rotator cuff. Despite the limitations and complications reported in the literature, revision arthroplasty has a good potential for functional improvement in patients with the consequences of injuries of the proximal humerus. This is a group of patients, which is a difficult task for a surgeon. As further research is carried out, implant designs and their clinical application will continue to evolve.
Posterior fracture-dislocations often remain undiagnosed at initial medical attendance. In dislocation, the head of the humerus extends beyond the glenoid to form a zone of impaction, which “fixes” it. The injury is almost unidentifiable in standard frontal X-ray images. Meanwhile, continued fixation of the humerus in the state of posterior dislocation leads to a rapid progression of the traumatic impaction over up to 50% of the articular surface area. The associated damage to the articular lip of the scapula, rupture of the rotator cuff muscles, symptoms of shoulder instability after relocation, and severe pain syndrome require advanced treatments for this type of injury. Here we report a clinical case of anatomical neck fracture of the humerus with displaced consolidation, combined to posterior dislocation. To avoid subacromial impingement, instead of correcting the position of the head, we abandoned the reposition and performed an osteotomy with distal displacement of the greater tubercle of the humerus.
Introduction. Tactics of treatment of fractures of the metacarpal bones are sufficiently covered in domestic and foreign literature, however, the search for modern methods of the most effective fixation of fractures of the hand bones is still ongoing. The fixator should ensure the stability of bone fragments, have sufficient strength and undergo biodegradation after fusion, eliminate the need for repeated surgery. Purpose of the study: to evaluate results of fixation of 2-5 metacarpal fractures using bioabsorbable implants.Materials and methods: there was a retrospective study of 40 patients who had displaced closed fractures of 2-5 metacarpal bones. We performed surgical treatment: open reduction of the metacarpal fracture and internal fixation with bioabsorbable implants (Bioretec Activa Pin). Patients were examined before, 3 and 12 months after surgery.Results: All patients had union of metacarpal fracture 3 months after surgery. The function of the hand has improved, when evaluated on the DASH scale from 62 to 9.2 (p≤0.05). The pain level (VAS) was significantly decreased from 72 to 13.5 (p≤0.05). All parameters were comparable by 12 months after surgery.Conclusions: bioabsorbable implants are reliable way for internal fixation of fractures of 2-5 metacarpal bones with displaced fragments. Method is no need to remove the fixator.
Degenerative diseases that involve excessive formation of fibrous tissue are complex and common problems. These diseases cause pronounced and often irreversible changes, resulting in the dysfunction of the affected organ. Osteoarthritis, osteoarthritis, and arthrofibrosis are pathological conditions characterized by chronic inflammation and excessive proliferation of connective tissue. The elbow joint, being the most mobile and anatomically stable joint in humans, is often affected by arthrofibrosis, resulting in significant functional impairment and reduced quality of life for patients. This problem has significant social relevance. Understanding the mechanisms that lead to arthrofibrosis can help determine the most effective therapeutic interventions, the optimal timing for treatment and rehabilitation, and the use of preventive measures to reduce the risk of relapse.
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