A new autocentering hinged external fixator of the elbow: a device that stabilizes the elbow axis without use of the articular pin

Bigazzi, Prospero; Biondi, Marco; Pfanner, Sandra; Checcucci, Giuseppe; Ceruso, Massimo

doi:10.1016/j.jse.2015.05.036

Cited by 10 publications

(2 citation statements)

References 21 publications

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“…The most critical step is the correct placement of the axis pin. However, accurate pin positioning is a challenging task: the freehand accurate alignment of the hinge to the center of rotation of the elbow or insertion of a provisional pin into the distal humerus under navigation guidance requires a steep learning curve, is time-consuming, and requires additional exposure to radiation [ 30 ]. In our surgical protocol, the posterior approach was used via a single curved incision that provided adequate exposure to identify soft tissue and bony structures associated with the lesion.…”

Section: Discussionmentioning

confidence: 99%

Using External Joint Stabilizer – Elbow (EJS-E) for treating elbow instability—biomechanical assessment and clinical outcomes

Chiu

et al. 2022

BMC Musculoskelet Disord

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Background This study aimed to evaluate the outcome of using an External Joint Stabilizer – Elbow (EJS-E) for persistent elbow instability based on biomechanical experiments and analysis of clinical results. Methods An EJS-E was used in 17 elbow instability patients. The median follow-up was 26 months (range, 12–42 months). We evaluated the flexion–extension and pronation-supination movement arcs, visual analog scale (VAS) score, Mayo Elbow Performance Score (MEPS), Broberg and Morrey classification system, and occurrence of complications in these patients. Moreover, construct stiffness and maximum strength tests were performed to evaluate the strength of the fixation techniques. Results The final median range of the extension-to-flexion and pronation-to-supination arc of the elbow was 135° (range, 110°–150°) and 165° (range, 125°–180°), respectively. The VAS pain scores were > 3 in two patients. The median MEPS was 90 (range, 80–100 points). Five patients showed signs of grade I post-traumatic osteoarthritis according to the Broberg and Morrey radiographic classification system, while grade II changes were observed in three patients. Complications included axis pin loosening with pin-tract infection in two patients, transient ulnar nerve symptoms in two patients, heterotopic ossification in two patients, and suture anchors infection in one patient. Based on the biomechanical testing results, the EJS-E exhibited higher stiffness and resisting force in varus loading. It was 0.5 (N/mm) stiffer and 1.8 (N·m) stronger than the internal joint stabilizer (IJS) by difference of medians (p < 0.05). Conclusions Biomechanical and clinical outcomes show that EJS-E via the posterior approach can restore mobility and stability in all patients, thus serving as a valuable alternative option for the treatment of persistent instability of the elbow.

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Section: Discussionmentioning

confidence: 99%

Using External Joint Stabilizer – Elbow (EJS-E) for treating elbow instability—biomechanical assessment and clinical outcomes

Chiu

et al. 2022

BMC Musculoskelet Disord

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“…As an alternative to fixator axis placement by the surgeon, hinged fixators can also be designed as self-centering devices. This recent development was shown to be effective in a study with seven patients, who all had correct alignment of the external fixator and had no complications [ 18 ]. Awaiting the introduction of such developments into common practice, we recommend adding the RD as anatomical landmark when using fluoroscopy for aligning hinged external fixators with the elbow rotation axis.…”

Section: Discussionmentioning

confidence: 99%

Accuracy in identifying the elbow rotation axis on simulated fluoroscopic images using a new anatomical landmark

Wiggers¹,

Snijders²,

Dobbe³

et al. 2017

Strategies in Trauma and Limb Reconstruction

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External fixation of the elbow requires identification of the elbow rotation axis, but the accuracy of traditional landmarks (capitellum and trochlea) on fluoroscopy is limited. The relative distance (RD) of the humerus may be helpful as additional landmark. The first aim of this study was to determine the optimal RD that corresponds to an on-axis lateral image of the elbow. The second aim was to assess whether the use of the optimal RD improves the surgical accuracy to identify the elbow rotation axis on fluoroscopy. CT scans of elbows from five volunteers were used to simulate fluoroscopy; the actual rotation axis was calculated with CT-based flexion–extension analysis. First, three observers measured the optimal RD on simulated fluoroscopy. The RD is defined as the distance between the dorsal part of the humerus and the projection of the posteromedial cortex of the distal humerus, divided by the anteroposterior diameter of the humerus. Second, eight trauma surgeons assessed the elbow rotation axis on simulated fluoroscopy. In a preteaching session, surgeons used traditional landmarks. The surgeons were then instructed how to use the optimal RD as additional landmark in a postteaching session. The deviation from the actual rotation axis was expressed as rotational and translational error (±SD). Measurement of the RD was robust and easily reproducible; the optimal RD was 45%. The surgeons identified the elbow rotation axis with a mean rotational error decreasing from 7.6° ± 3.4° to 6.7° ± 3.3° after teaching how to use the RD. The mean translational error decreased from 4.2 ± 2.0 to 3.7 ± 2.0 mm after teaching. The humeral RD as additional landmark yielded small but relevant improvements. Although fluoroscopy-based external fixator alignment to the elbow remains prone to error, it is recommended to use the RD as additional landmark.

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External Fixation in the Setting of Elbow Instability

2016

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A new autocentering hinged external fixator of the elbow: a device that stabilizes the elbow axis without use of the articular pin

Cited by 10 publications

References 21 publications

Using External Joint Stabilizer – Elbow (EJS-E) for treating elbow instability—biomechanical assessment and clinical outcomes

Using External Joint Stabilizer – Elbow (EJS-E) for treating elbow instability—biomechanical assessment and clinical outcomes

Accuracy in identifying the elbow rotation axis on simulated fluoroscopic images using a new anatomical landmark

External Fixation in the Setting of Elbow Instability

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