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Arthroscopic Surgery for Radial Head Fractures: A Prospective Series of 14 Cases
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ABSTRACTS
Introduction: To measure the area of the articular surfaces of the elbow visualised during arthroscopy using standard portals in order to demonstrate the regions which may be overlooked. Methods: 13 Soffix prepared cadavers were arthroscoped by a senior surgeon using a 30 degree arthroscope and 4 portals (medial, lateral and 2 posterior). The margins of the articular surface visualised were stained using picro-sinus red stain, nile blue stain and india green ink stain. The elbows were then dissected and the areas digitally photographed and measured. Results: The following field of views were quantified: radial head (16.05%), trochlear notch (4.14%), humerus from anteromedial and anterolateral portals (90%), humerus from posterior portal (84.6%). Conclusion: There are significant areas of the articular surface of all three bones in the elbow joint which may be overlooked during standard elbow arthroscopy. The surgeon needs to be aware of this in both the pre-operative planning and in being aware of the possible need for additional portal selection to ensure that pathology is not missed. Ultrasonography as Applied to the Moving Valgus Stress Test is Reliable for Assessment of the Elbow UCL in Professional Pitchers SS-45 Friday, April 24 at 1:45 PM DERIK GEIST, M.D., PRESENTING AUTHOR MARK SCHWEPPE, M.D. ELLEN SHANLEY, PH.D., P.T. CHARLES THIGPEN, PH.D., P.T., A.T.C. LANE BAILEY, P.T., D.P.T., PH.D., C.S.C.S. THOMAS NOONAN, M.D. DOUGLAS WYLAND, M.D. JOHN TOKISH, M.D. MICHAEL KISSENBERTH, M.D. Introduction: Much attention has been placed on elbow ulnar collateral ligament (UCL) injuries given the apparent rise in incidence among professional pitchers. Stress ultrasonography is a critical tool in the evaluation of the UCL, and recent studies have outlined its use, albeit in non-provocative positions. Thus we sought to measure ulnohumeral gapping and UCL thickness within the scope of the moving valgus stress test arc. Methods: Ultrasonography was used to assess the UCL of 70 asymptomatic professional baseball pitchers during spring training. A 15-MHz linear-array transducer was used to capture images of the dominant (D) and nondominant (ND) throwing elbows under two loaded conditions within the moving valgus stress test arc: (1) valgus gravity stress and (2) 10 lbs of valgus force using a dynamometer. Ulnohumeral gapping and UCL thickness was measured on sagittal images using the OsiriXTM platform. Intra- and inter-rater reliability was established by calculating intraclass correlation coefficients (ICC) and standard errors of the mean (SEM). Paired t-tests utilizing averaged rater values were used to assess significance between the D and ND elbows.
Results: Reliability to measure elbow gapping and UCL thickness was acceptable with ICC values ranging from .94 -.98 for intra- and .82-.87 for inter-rater reliability for all elbow measures. Standard error of measure (SEM) demonstrated accuracy to within .14-.26 mm for a single rater and .38-.65mm for multiple raters. There were significant differences(p¼0.001) between D and ND elbows for all measures within the cohort (Figure 1). Conclusion: This is the first study to our knowledge evaluating stress ultrasonography of the UCL within the context of the provocative throwing arc. This method is reliable, more efficient, and clinically, a more applicable method for UCL morphologic and functional assessment. Significant increases in dynamic (and static) ulnohumeral gapping and UCL thickness exist in D versus ND pitching arms. Arthroscopic Surgery for Radial Head Fractures: A Prospective Series of 14 Cases SS-46 Friday, April 24 at 1:50 PM PIERRE CROUTZET, M.D., PRESENTING AUTHOR REGIS GUINAND, M.D. JEAN KANY, M.D. Introduction: The main complication of radial head fracture is elbow stiffness, mainly consequence of ligament injuries due to the trauma and those due to the surgery Our goal was to performed an arthroscopic procedure for reduction and internal fixation in radial head fractures : -enabling a complete diagnosis of ligament impairments (medial, volar, lateral) -sparing the collateral lateral ligaments during the reduction and fixation Methods: Over a 2-year period, 14 displaced fractures were operated with arthroscopy. We only retained recent Mason 2 & 3 fractures without dislocation. We used 3 portals, percutaneous cannulated screws, an antalgic splint for 3 weeks and an immediate activo-passive physiotherapy Physical examination and X-ray were done after 3, 6 and 12 weeks Analysis criteria were: -perioperative: ligament impairment, time of surgery -post-operative: motion, grasp strength, time without working and sports, X-ray analysis (reduction, consolidation, secondary displacement) Results: Time of surgery went down from 90 to 25 minutes; annular ligament was initially intact in 10/14 cases. Active range of motion was : 3 weeks : F/E 90 , P/S 150 . 6 weeks : F/E 110 , P/S 160 12 weeks : F/E 120 , P/ S 160 We noticed 11 anatomic reductions (all Mason 2) and no secondary displacement. Time without working was 4 weeks (0-12) Conclusion: Active motion was almost fully recovered after 6 weeks. The absence of secondary displacement suggests benefits of harder initial rehabilitation. Range of motion is at the minimum the same as other studies with shorter convalescence. None second time surgery was needed. Arthroscopic surgery for radial head fracture is a reliable and efficient procedure enabling rapid working and sports recovery.
ABSTRACTS
Introduction: To measure the area of the articular surfaces of the elbow visualised during arthroscopy using standard portals in order to demonstrate the regions which may be overlooked. Methods: 13 Soffix prepared cadavers were arthroscoped by a senior surgeon using a 30 degree arthroscope and 4 portals (medial, lateral and 2 posterior). The margins of the articular surface visualised were stained using picro-sinus red stain, nile blue stain and india green ink stain. The elbows were then dissected and the areas digitally photographed and measured. Results: The following field of views were quantified: radial head (16.05%), trochlear notch (4.14%), humerus from anteromedial and anterolateral portals (90%), humerus from posterior portal (84.6%). Conclusion: There are significant areas of the articular surface of all three bones in the elbow joint which may be overlooked during standard elbow arthroscopy. The surgeon needs to be aware of this in both the pre-operative planning and in being aware of the possible need for additional portal selection to ensure that pathology is not missed. Ultrasonography as Applied to the Moving Valgus Stress Test is Reliable for Assessment of the Elbow UCL in Professional Pitchers SS-45 Friday, April 24 at 1:45 PM DERIK GEIST, M.D., PRESENTING AUTHOR MARK SCHWEPPE, M.D. ELLEN SHANLEY, PH.D., P.T. CHARLES THIGPEN, PH.D., P.T., A.T.C. LANE BAILEY, P.T., D.P.T., PH.D., C.S.C.S. THOMAS NOONAN, M.D. DOUGLAS WYLAND, M.D. JOHN TOKISH, M.D. MICHAEL KISSENBERTH, M.D. Introduction: Much attention has been placed on elbow ulnar collateral ligament (UCL) injuries given the apparent rise in incidence among professional pitchers. Stress ultrasonography is a critical tool in the evaluation of the UCL, and recent studies have outlined its use, albeit in non-provocative positions. Thus we sought to measure ulnohumeral gapping and UCL thickness within the scope of the moving valgus stress test arc. Methods: Ultrasonography was used to assess the UCL of 70 asymptomatic professional baseball pitchers during spring training. A 15-MHz linear-array transducer was used to capture images of the dominant (D) and nondominant (ND) throwing elbows under two loaded conditions within the moving valgus stress test arc: (1) valgus gravity stress and (2) 10 lbs of valgus force using a dynamometer. Ulnohumeral gapping and UCL thickness was measured on sagittal images using the OsiriXTM platform. Intra- and inter-rater reliability was established by calculating intraclass correlation coefficients (ICC) and standard errors of the mean (SEM). Paired t-tests utilizing averaged rater values were used to assess significance between the D and ND elbows.
Results: Reliability to measure elbow gapping and UCL thickness was acceptable with ICC values ranging from .94 -.98 for intra- and .82-.87 for inter-rater reliability for all elbow measures. Standard error of measure (SEM) demonstrated accuracy to within .14-.26 mm for a single rater and .38-.65mm for multiple raters. There were significant differences(p¼0.001) between D and ND elbows for all measures within the cohort (Figure 1). Conclusion: This is the first study to our knowledge evaluating stress ultrasonography of the UCL within the context of the provocative throwing arc. This method is reliable, more efficient, and clinically, a more applicable method for UCL morphologic and functional assessment. Significant increases in dynamic (and static) ulnohumeral gapping and UCL thickness exist in D versus ND pitching arms. Arthroscopic Surgery for Radial Head Fractures: A Prospective Series of 14 Cases SS-46 Friday, April 24 at 1:50 PM PIERRE CROUTZET, M.D., PRESENTING AUTHOR REGIS GUINAND, M.D. JEAN KANY, M.D. Introduction: The main complication of radial head fracture is elbow stiffness, mainly consequence of ligament injuries due to the trauma and those due to the surgery Our goal was to performed an arthroscopic procedure for reduction and internal fixation in radial head fractures : -enabling a complete diagnosis of ligament impairments (medial, volar, lateral) -sparing the collateral lateral ligaments during the reduction and fixation Methods: Over a 2-year period, 14 displaced fractures were operated with arthroscopy. We only retained recent Mason 2 & 3 fractures without dislocation. We used 3 portals, percutaneous cannulated screws, an antalgic splint for 3 weeks and an immediate activo-passive physiotherapy Physical examination and X-ray were done after 3, 6 and 12 weeks Analysis criteria were: -perioperative: ligament impairment, time of surgery -post-operative: motion, grasp strength, time without working and sports, X-ray analysis (reduction, consolidation, secondary displacement) Results: Time of surgery went down from 90 to 25 minutes; annular ligament was initially intact in 10/14 cases. Active range of motion was : 3 weeks : F/E 90 , P/S 150 . 6 weeks : F/E 110 , P/S 160 12 weeks : F/E 120 , P/ S 160 We noticed 11 anatomic reductions (all Mason 2) and no secondary displacement. Time without working was 4 weeks (0-12) Conclusion: Active motion was almost fully recovered after 6 weeks. The absence of secondary displacement suggests benefits of harder initial rehabilitation. Range of motion is at the minimum the same as other studies with shorter convalescence. None second time surgery was needed. Arthroscopic surgery for radial head fracture is a reliable and efficient procedure enabling rapid working and sports recovery.