Tardy Posterolateral Rotatory Instability of the Elbow due to Cubitus Varus

O’Driscoll, Shawn W.; Spinner, Robert J.; McKee, Michael D.; Kibler, W. Ben; Hastings, Hill; Morrey, B.F.; Kato, Hiroyuki; Takayama, Seiji; Imatani, Junya; Toh, Satoshi; Graham, H. Kerr

doi:10.2106/00004623-200109000-00011

Cited by 255 publications

(180 citation statements)

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“…These tests were performed in the operating room directly after surgery. For patients who had closed reduction alone, spontaneous redislocation was used as an indication for fixator placement [25]. Exclusion criteria were pathologic fractures, preexistent injuries of the affected arm, collateral ligament repair, a fracture of the ipsilateral distal humerus, and additional traumatic injuries to the affected arm (ie, ipsilateral distal radius fracture).…”

Section: Participants/study Subjectsmentioning

confidence: 99%

Good Functional Recovery of Complex Elbow Dislocations Treated With Hinged External Fixation: A Multicenter Prospective Study

Iordens

Hartog

Lieshout

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background After a complex dislocation, some elbows remain unstable after closed reduction or fracture treatment. Function after treatment with a hinged external fixator theoretically allows collateral ligaments to heal without surgical reconstruction. However, there is a lack of prospective studies that assess functional outcome, pain, and ROM. Questions/purposes We asked: (1) In complex elbow fracture-dislocations, does treatment with a hinged external fixator result in reduction of disability and pain, and in improvement in ROM, function, and quality of life? (2) Does delayed treatment (7 days or later) have a negative effect on ROM after 1 year? (3) What are the complications seen after external fixator treatment?Methods During a 2-year period, 11 centers recruited 27 patients 18 years or older who were included and evaluated at 2 and 6 weeks and at 3, 6, and 12 months after surgery as part of this prospective case series. During the study period, the participating centers agreed on general indications for use of the hinged external fixator, which included persistent instability after closed reduction alone or closed reduction combined with surgical treatment of associated fracture(s), when indicated. Functional outcome was evaluated using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH; primary outcome) score, the Mayo Elbow Performance Index (MEPI), the Oxford Elbow Score, and the level of pain (VAS). ROM, adverse events, secondary interventions, and radiographs also were evaluated. A total of 26 of the 27 patients (96%) were available for followup at 1 year.The institution of one or more of the authors (GITI, DDH, EMMVL, PP, MHJV) has received, during the study period, funding from the Osteosynthesis and Trauma Care ( Results All functional and pain scores improved. The median QuickDASH score decreased from 30 (25 th -75 th percentiles [P 25 -P 75 ], 23-40) at 6 weeks to 7 (P 25 -P 75 , 2-12) at 1 year with a median difference of À25 (p \ 0.001). The median MEPI score increased from 80 (P 25 -P 75 , 64-85) at 6 weeks to 100 (P 25 -P 75 , 85-100) at 1 year with a median difference of 15 (p \ 0.001). The median Oxford Elbow Score increased from 60 (P 25 -P 75 , 44-68) at 6 weeks to 90 (P 25 -P 75 , 73-96) at 1 year with a median difference of 29 (p \ 0.001). The median VAS decreased from 2.8 (P 25 -P 75 , 1.0-5.0) at 2 weeks to 0.5 (P 25 -P 75 , 0.0-1.9) at 1 year with a median difference of À2.1 (p = 0.001). ROM also improved. The median flexionextension arc improved from 50°(P 25 -P 75 , 33°-80°) at 2 weeks to 118°(P 25 -P 75 , 105°-138°) at 1 year with a median difference of 63°(p \ 0.001). Similarly, the median pronation-supination arc improved from 90°(P 25 -P 75 , 63°-124°) to 160°(P 25 -P 75 , 138°-170°) with a median difference of 75°(p \ 0.001). At 1 year, the median residual deficit compared with the uninjured side was 30°( P 25 -P 75 , 5°-35°) for the flexion-extension arc, and 3°( P 25 -P 75 , 0°-25°) for the pronation-supination arc. Ten patients (37%) experienced a fixa...

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Section: Participants/study Subjectsmentioning

confidence: 99%

Good Functional Recovery of Complex Elbow Dislocations Treated With Hinged External Fixation: A Multicenter Prospective Study

Iordens

Hartog

Lieshout

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…The triceps line of pull is consequently shifted medially, which in turn displaces and/or compresses the ulnar nerve. This can lead to ulnar neuropathy and dislocation of the ulnar nerve and a portion of the medial triceps [17,[23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Cubitus Valgus and Tardy Ulnar Nerve Palsy Due to an Intracapsular Ulnar Nerve

Sharma

Skinner

Spinner

2013

Hand (New York, N,Y.)

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Background We describe a patient with tardy ulnar neuropathy and cubitus valgus deformity found to have an intracapsular ulnar nerve. Methods An 89-year-old woman presented with severe neuropathic pain in the ulnar digits of the hand, advanced degenerative arthritis of the elbow, and tardy ulnar nerve palsy. Her pain was exacerbated with elbow movement, particularly flexion. She had paralysis of ulnar nerve innervated muscles, hypersensitivity with absence of two-point discrimination in her ulnar 1-1/2 digits, and a fixed ulnar claw deformity. She also had a grossly unstable elbow. Results Plain films revealed a cubitus valgus deformity (38°), an absent radial head, a dislocated proximal radioulnar joint and advanced arthritic changes. Ultrasonography revealed an indistinct ulnar nerve within the cubital tunnel which penetrated the joint. Electrophysiological studies revealed evidence of a severe ulnar neuropathy at the level of the elbow. Intraoperatively, an attenuated 2 cm length of the retrocondylar ulnar nerve was observed to be incorporated into the joint capsule tethered by a fibrous/synovial band which was released. A large effusion was drained. The ulnar nerve was transposed subcutaneously. The capsular rent was repaired in layers. She noted immediate and sustained (2 year follow-up) pain relief and regained moderate function in her interossei. Conclusions We believe that the chronic cubitus valgus deformity and secondary degenerative elbow joint changes led to an altered course of the nerve and attenuation of the medial joint capsule such that the ulnar nerve spontaneously buttonholed itself intra-articularly.

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“…The primary functions of the complex are to restrain varus and rotational articulations 2) and to stabilize the structure between ulnohumeral and radiocapitellar articulations 3,4) . The LUCL adheres to both the lateral epicondyle of the humerus (blending with the fibers of the AL) and the supinator crest of the ulna 5) , and it plays a major role in providing restraint to control posterolateral stability 5,6) .…”

Section: Introductionmentioning

confidence: 99%

Reinvestigation of the Morphological Characteristics of the Lateral Ulnar Collateral Ligament in Humans

Tokunaga

Sato

Tajima

et al. 2017

Okajimas Folia Anat. Jpn.

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Summary: To clarify the cause of posterolateral rotatory instability after damage to the lateral ulnar collateral ligament (LUCL), the morphological characteristics of the LUCL were reinvestigated and three-dimensional (3D) image of the ligament was reconstructed using 35 human elbows. The results were as follows: 1) the insertion point of the LUCL on the humerus was almost at the center of the capitellum, and its width was 2.61 ± 1.02 mm. The insertion point of the LUCL on the ulna was located from the lesser sigmoid notch to the supinator crest and had a width of 9.0 ± 2.8 mm. The proximal insertion of the LUCL on the ulna was 7.0 ± 3.0 mm, and the distal part was on the articular surface of the radial head. 2) Three-dimensional imaging of the LUCL revealed an anterior curved shape that covered the radial head. Based on these results, it was clear that both the supinator crest and the lesser sigmoid notch could be useful as osseous landmarks. We think that these anatomical results are useful for surgeons performing LUCL reconstruction.

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Tardy Posterolateral Rotatory Instability of the Elbow due to Cubitus Varus

Cited by 255 publications

References 17 publications

Good Functional Recovery of Complex Elbow Dislocations Treated With Hinged External Fixation: A Multicenter Prospective Study

Good Functional Recovery of Complex Elbow Dislocations Treated With Hinged External Fixation: A Multicenter Prospective Study

Cubitus Valgus and Tardy Ulnar Nerve Palsy Due to an Intracapsular Ulnar Nerve

Reinvestigation of the Morphological Characteristics of the Lateral Ulnar Collateral Ligament in Humans

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