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Distraction arthroplasty in old post-traumatic contractures of the elbow joint
J. Shoulder Elbow Surg. January~February 1995
$20 Abstracts
13
DISTRACTION ARTHROPLASTY IN OLD POSTTRAUMATIC CONTRACTURES OF THE ELBOW JOINT. S.V. Gyulnazarova,MD, Urals Institute of Orthopaedy and Traumatology, Ekaterinburg, Russia Report gives the results of 72 surgeries on 66 patients with posttraumatic severe old restriction of mobility of elbow joint. All patients were treated with the help of VolkovOganesyan's apparatus of external fixation. In case of contractures with non-injured articular surfaces and old dislocations upto 3-4 months (26) the apparatus was externally applied and subsequent restoration of mobility of joint was performed. All the other patients were operated on. Old dislocations with high degree of displacement in 6 patients were first externally eliminated by the apparatus. Arthroplasty was performed without interpositional material. Motion in the joint was started in 10-12 days after the operation. The apparatus was used to restore mobility for 4-8 weeks.0bservation time after surgeries:2 to 12 years. In 59 patients the joint function is good and satisfactory,in 7 patients - imfavourable. Distraction arthroplasty allows to obtain quite favourable results in case of very severe injuries of elbow. This method is most advisable for young and middle-aged patients as an alternative to total joint replacement.
15
THE ELBOW FLEXION TEST. T.G. Wadsworth, S.T. Donell, D.E.H. Flanagan, K. Nagendran. London, England.
16
In the normal elbow, the volume of the cubltal tunnel is least in full elbow flexion: then, the arcuate ligament, fo£ming t h e ~oof, iS t a u t and also ~he medial ligament of the elbow joint bulges into the tunnel. The elbow flexion test for the cubital tunnel syndrome, first described by the author in 1977, is simply performed by the patient fully flexing the elbow and avoiding surface pressure: the wrist should be at neutral in order to avoid confusion with the Phalen test for carpal tunnel syndrome. The test is positive when symptoms of tingling and/or numbness are initiated or aggravated in the area of the hand confined to the ulnar serve distribution: in positive cases symptoms have been found to appear between twenty seconds and four minutes, usually under two minutes. Recent clinical and electromyographic studies have found that the elbow flexion test has a sensitivity of 86%, specificity of 86% and a predictive value of 86% for males and a sensitivity of Z5%, specificity of 85% and a predictive value of 20% for females. Despite the low predictive value for the few females in this series, the elbow flexion test was still found to be useful in women as it could be used to select those patients suitable for neuropbysiological assessment. The Wadsworth elbow flexion test has been found to exclude other levels of ulnar neuropathy: in patients found to have lesions of the ulnar nerve outside the elbow the test was found to be negative and there were no false positives. Negative testing was found in patients with other neurological disorders sometimes confused clinically with ulnar neuropathy.
RELEASE OF THE STIFF ELBOW FOLLOWED BY CONTINUOUS PASSIVE MOTION AND INDOMETHACIN TREATMENT. J . O . S ~ } j b j e r g , M D , P. K j a e r s g a a r d - A n d e r s e n , M D, H.V.Johanssen,MD, & O.Sneppen,MD. Shoulder and Elbow Clinic, University Hospital in Aarhus, Denmark. The results of release of 30 stiff elbows were reviewed minimum 2 years after surgery. The preoperative range of motion in extension and flexion averaged 52 degrees. Sixteen had extrinsic pathology of the elbow, 14 had intrinsic. The ulnar and lateral ligament complexes and the anterior capsule were released, and heterotopic bone and bony exostosis were removed, followed by postoperative CPM and prophylactic indomethacin treatment. At follow up 21 patients had a painfree or only slightly painful ROM greater than 100 degrees. This treatment effectively improves the function of the elbow suffering extrinsic contracture of the elbow. In the present study good functional results were obtained in 88 % and the gain in ROM was mean 68%. However, in patients with a contracture due to intrinsic joint pathology the results are less promising, with good functional results in only 57 % and a gain in ROM of mean 44%, mainly due to pain.
ULNAR NERVE TRANSPOSITION A T THE ELBOW THROUGH A TRANSVERSE SKIN INCISION. Alberto Lluch, MD. Institut Kaplan. Barcelona, Spain. The purpose of this study was to modify the classical longitudinal incision used for the release of the ulnar nerve, in order to avoid injury to the cutaneous nerve branches on the medial side of the elbow. Nineteen patients, w h o underwent ulnar nerve decompression and anterior transposition through a longitudinal incision, were reviewed. Three of the patients (16%) developed a painful amputation neuroma which required secondary surgery to alleviate the symptoms. From our review we found that injury to the dorsal branch of the medial antebrachial cutaneous nerve (MACN) is a common complication to which little attention has been given, as it is rarely mentioned in the literature. Through this incisionn, four to five centimeters long, one is less likely to injure any of the branches of the MACN, which run in an anterior-posterior direction. Over the past six years, we employed this surgical incision in twelve patients, allowing for an adequate ulnar nerve release and anterior transposition without any sequelae of hyposthesia or amputation neuromas, as well as a far superior aesthetic result.
$20 Abstracts
13
DISTRACTION ARTHROPLASTY IN OLD POSTTRAUMATIC CONTRACTURES OF THE ELBOW JOINT. S.V. Gyulnazarova,MD, Urals Institute of Orthopaedy and Traumatology, Ekaterinburg, Russia Report gives the results of 72 surgeries on 66 patients with posttraumatic severe old restriction of mobility of elbow joint. All patients were treated with the help of VolkovOganesyan's apparatus of external fixation. In case of contractures with non-injured articular surfaces and old dislocations upto 3-4 months (26) the apparatus was externally applied and subsequent restoration of mobility of joint was performed. All the other patients were operated on. Old dislocations with high degree of displacement in 6 patients were first externally eliminated by the apparatus. Arthroplasty was performed without interpositional material. Motion in the joint was started in 10-12 days after the operation. The apparatus was used to restore mobility for 4-8 weeks.0bservation time after surgeries:2 to 12 years. In 59 patients the joint function is good and satisfactory,in 7 patients - imfavourable. Distraction arthroplasty allows to obtain quite favourable results in case of very severe injuries of elbow. This method is most advisable for young and middle-aged patients as an alternative to total joint replacement.
15
THE ELBOW FLEXION TEST. T.G. Wadsworth, S.T. Donell, D.E.H. Flanagan, K. Nagendran. London, England.
16
In the normal elbow, the volume of the cubltal tunnel is least in full elbow flexion: then, the arcuate ligament, fo£ming t h e ~oof, iS t a u t and also ~he medial ligament of the elbow joint bulges into the tunnel. The elbow flexion test for the cubital tunnel syndrome, first described by the author in 1977, is simply performed by the patient fully flexing the elbow and avoiding surface pressure: the wrist should be at neutral in order to avoid confusion with the Phalen test for carpal tunnel syndrome. The test is positive when symptoms of tingling and/or numbness are initiated or aggravated in the area of the hand confined to the ulnar serve distribution: in positive cases symptoms have been found to appear between twenty seconds and four minutes, usually under two minutes. Recent clinical and electromyographic studies have found that the elbow flexion test has a sensitivity of 86%, specificity of 86% and a predictive value of 86% for males and a sensitivity of Z5%, specificity of 85% and a predictive value of 20% for females. Despite the low predictive value for the few females in this series, the elbow flexion test was still found to be useful in women as it could be used to select those patients suitable for neuropbysiological assessment. The Wadsworth elbow flexion test has been found to exclude other levels of ulnar neuropathy: in patients found to have lesions of the ulnar nerve outside the elbow the test was found to be negative and there were no false positives. Negative testing was found in patients with other neurological disorders sometimes confused clinically with ulnar neuropathy.
RELEASE OF THE STIFF ELBOW FOLLOWED BY CONTINUOUS PASSIVE MOTION AND INDOMETHACIN TREATMENT. J . O . S ~ } j b j e r g , M D , P. K j a e r s g a a r d - A n d e r s e n , M D, H.V.Johanssen,MD, & O.Sneppen,MD. Shoulder and Elbow Clinic, University Hospital in Aarhus, Denmark. The results of release of 30 stiff elbows were reviewed minimum 2 years after surgery. The preoperative range of motion in extension and flexion averaged 52 degrees. Sixteen had extrinsic pathology of the elbow, 14 had intrinsic. The ulnar and lateral ligament complexes and the anterior capsule were released, and heterotopic bone and bony exostosis were removed, followed by postoperative CPM and prophylactic indomethacin treatment. At follow up 21 patients had a painfree or only slightly painful ROM greater than 100 degrees. This treatment effectively improves the function of the elbow suffering extrinsic contracture of the elbow. In the present study good functional results were obtained in 88 % and the gain in ROM was mean 68%. However, in patients with a contracture due to intrinsic joint pathology the results are less promising, with good functional results in only 57 % and a gain in ROM of mean 44%, mainly due to pain.
ULNAR NERVE TRANSPOSITION A T THE ELBOW THROUGH A TRANSVERSE SKIN INCISION. Alberto Lluch, MD. Institut Kaplan. Barcelona, Spain. The purpose of this study was to modify the classical longitudinal incision used for the release of the ulnar nerve, in order to avoid injury to the cutaneous nerve branches on the medial side of the elbow. Nineteen patients, w h o underwent ulnar nerve decompression and anterior transposition through a longitudinal incision, were reviewed. Three of the patients (16%) developed a painful amputation neuroma which required secondary surgery to alleviate the symptoms. From our review we found that injury to the dorsal branch of the medial antebrachial cutaneous nerve (MACN) is a common complication to which little attention has been given, as it is rarely mentioned in the literature. Through this incisionn, four to five centimeters long, one is less likely to injure any of the branches of the MACN, which run in an anterior-posterior direction. Over the past six years, we employed this surgical incision in twelve patients, allowing for an adequate ulnar nerve release and anterior transposition without any sequelae of hyposthesia or amputation neuromas, as well as a far superior aesthetic result.