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Paper # 119: Distal Humeral Fracture Fixation – Results From General Orthopedic Surgeons
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ABSTRACTS
quence to receive arthroscopic rotator cuff repair without (n⫽45) or with (n⫽43) augmentation with autologous platelet-rich fibrin matrix (PRFM). The primary endpoint was the post-operative difference in the Constant score between the 2 groups. The secondary endpoint was the integrity of the repaired rotator cuff, as evaluated by MRI. Analysis was on an intention to treat basis. Results: All the patients completed follow-up at 16 months. There was no statistically significant difference in total Constant Score when comparing the results of arthroscopic repair of the 2 groups (95% confidence interval [CI], -3.43 - 3.9) (P⫽0.44). There was no statistically significant difference in MRI tendon score when comparing arthroscopic repair with or without PFRM (P⫽0.07). Conclusions: Our study does not support the use of autologous PRFM for augmentation of a double row repair of a small or medium RC tear to improve the healing of the RC. Our results are applicable to small and medium RC tears: it is possible that PRFM may be beneficial for large and massive RC tears. Also, given the heterogeneity of PRFM preparation products available on the market, it is possible that other preparations may be more effective. Paper # 118: The Results of Conservatively Treated Simple Elbow Dislocations HAYRETTIN KESMEZACAR, MD, TURKEY ILKER ABDULLAH SARIKAYA, MD, TURKEY · Istanbul Universtiy Cerrahpasa Medical Faculty Istanbul, TURKEY Summary: Although functional scores were excellent, most of the patients did not consider themselves fully recovered. Abstract: Objectives: Closed reduction and short time immobilization is generally acceptable treatment for simple elbow dislocations. However there are just a small number of studies published concerning the results of this method. In this study clinical and radiological results of conservative treatment are retrospectively evaluated. Methods: 21 patients who underwent closed reduction and immobilization for simple elbow dislocation were evaluated. After reduction 4 patients used plaster splint, 17 patients (81%) used brace and elbow motions started at mean 7th days. The patients were assessed clinically for range of motion, instability, atrophy after 34 months of mean follow up. Mayo Elbow Performance Score (MEPS) was used to evaluate functional outcome. Standard elbow x-rays were evaluated for degeneration, heterotopic ossification, concentric reduction.
Results: The mean age of patients was 35 (16-59) years. The average flexion arc and rotational arc were 131° and 172° respectively. The differences between the contralateral elbow motions were 10.9° for flexion arc, 3.1° for rotational arc. Four patients had residual instability. There were no muscular atrophy. Three patients reported mild, one patient moderate pain at rest. Six patients (28.6%) had mild-moderate neurological complaints related with ulnar nerve. Three patients had mild radiographic signs of arthrosis, 14 patients (66.7%) showed mild-moderate degree of heterotopic ossification. An average score of 96.9 was obtained using MEPS. Only four patients (19%) considered themselves fully recovered. Conclusion: Closed reduction and immobilization is a universal method for simple elbow dislocations. Although functional scores were excellent, most of the patients did not consider themselves fully recovered. Key words: elbow, dislocation, joint instability Paper # 119: Distal Humeral Fracture Fixation – Results From General Orthopedic Surgeons HARI KRISHNA ANKEM, MS(ORTH), DNB(ORTH), MRCS(EDIN, UK), INDIA SHRINATH KAMINENI, FRCS (TR & ORTH), USA · Hillingdon Hospital London, UNITED KINGDOM Summary: Fractures of distal humerus are complex injuries that constitute a fracture group requiring the acute intervention by centres that have specific sub-specialisation and adequate rehabilitation facilities Abstract: Purpose: Distal humeral fractures are often difficult injuries to treat. We hypothesise that more complex distal humeral fractures have unacceptable functional outcomes due to multi-factorial reasons. Methods: 42 patients with AO/ASIF type B and C fractures of the distal humerus who were treated with open reduction and internal fixation over a six year period were included in the study. All patients were from a single district general hospital. 37 (88%) were clinically, radiologically, and functionally assessed for this study, with the remainder either lost to follow-up or expired. Results: There were 21 type B and 16 type C fractures, all managed by open reduction and internal fixation. Various fixation techniques were utilised. These were performed by consultant surgeons in 14 cases and by surgeons in training in 23 cases. Average follow up was 38 months (range 22-54 months). The arc of elbow motion was
ABSTRACTS 94 degrees (range 58-130), with an average extension deficit of 28 degrees (range 20-55) and an average flexion deficit of 32 degrees (range 15-45). The average arc of forearm rotation was 136 degrees (range 45-140), with an average supination of 68 (range 35-85) and an average pronation of 72 (range 45-90). The complications (n⫽20/ 37) included superficial skin infection (n⫽4), ulnar nerve neurapraxia (n⫽3), non-union of the humerus fracture (n⫽2), non-union of olecranon osteotomy site (n⫽1), intraarticular screw placement (n⫽1), loosened plate (n⫽1), loose/backed out screw (n⫽2), fixed flexion deformity (n⫽4) and mild elbow instability (n⫽2). Second surgery was performed in 24% (n⫽9/37), revision of metal work (n⫽2), bone grafting (n⫽2), anterior capsulectomy (n⫽4), and removal of screw (n⫽1). Conclusions: Fractures of the distal humerus are often more complex than appreciated, and challenging to treat, with respect to fracture union and functional outcome. A generalist practice appears adequate for achieving bony union, but inadequate for obtaining low complication rates and functional outcomes. Our data suggest that such injuries may constitute a fracture group requiring the acute intervention by centres that have specific subspecialisation and adequate rehabilitation facilities.
Paper # 120: Reconstruction of Distal Humeral Fractures with Hemi-Arthroplasty: Indication, Surgical Technique and Medium-Term Results IRMA CEFO, MD, THE NETHERLANDS DENISE EYGENDAAL, MD, PHD, THE NETHERLANDS M. WAGENER, MD, THE NETHERLANDS MAARTEN DE VOS, THE NETHERLANDS · Amphia Hospital Breda, THE NETHERLANDS Summary: If reconstruction of the distal humerus, after complex distal humeral fractures in the elderly, can not adequately be achieved with open reduction and internal fixation, a hemi-arthroplasty of the distal humerus can be an option; the results after 2 years are promising. Abstract: Introduction: Gold standard for distal humeral fractures (DHF) in the elderly is open reduction and internal fixation (ORIF). In selected cases with severe comminution of the fracture in combination with osteopenia, primary total elbow arthroplasty (TEA) can be an option. The survival the TEA remains a point of concern, with early loosening of especially the ulnar component. Hemi-arthroplasty of the distal humerus has been developed to overcome this prob-
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lem. In this case series the medium term results of Distal Humeral Hemi-arthroplasty (DHH) are reported. Material and Methods: Eight patients with a mean age of 64 (50-77) years, 1 male and 7 females with a distal humeral fracture were treated with a DHH using a Latitude® Elbow replacement system (Tornier, Stafford, TX). In 3 patients the hemi-arthroplasty was placed shortly after trauma, in 5 patients the DHH was placed shortly after failure of an ORIF. Evaluation took place after 12 and 24 months and consisted of the range of motion (ROM), Mayo Elbow Performance Score (MEPS) and standard radiographs in AP and lateral direction. Results: Preoperatively all patients had a non-functional elbow, which necessitated immobilisation in splint. Functional outcome after 12 months: The mean flexion after 12 months was 124° ( range 105°-135°), the mean extension 27° (range 20°-45°), mean pronation 68° (range 60°-85°) and mean supination 68° (range 60°-80°). The categorical rating according to MEPS score was as follows: 3 patients had an excellent score (90-100 points), 2 patients a good score (75-89 points) and 3 patients fair (60-74 points). There was no significant difference between the outcomes after 12 and 24 months. All patients were satisfied with the result. No complications were noticed. Conclusion: If reconstruction of the distal humerus, after complex distal humeral fractures in the elderly, can not adequately be achieved with open reduction and internal fixation, a hemi-arthroplasty of the distal humerus can be an option; the results after 2 years are promising. Paper # 121: Innervation of the Supinator and its Relationship to Two-Incision Distal Biceps Tendon Repair: An Anatomic Study and Clinical Implications KAREN PERSER, MD, USA LESLIE DONNELLY, MD, USA LESLIE BISSON, MD, USA · SUNY - Buffalo Buffalo, NY, USA Summary: Surgeons wishing to perform a distal biceps repair using a two-incision approach should be aware of variability of branches from the PIN to the supinator and their proximity to the bicipital tuberosity, while being reassured that this technique may be safely performed without direct nerve injury. Abstract: Background: Distal biceps tendon repair can be performed with a single or two-incision approach. A recent systematic review demonstrated no difference in complications between the two approaches; however, there was increased loss of forearm rotation, motion, and strength with the two incision technique (Chavan, et al. AJSM
ABSTRACTS
quence to receive arthroscopic rotator cuff repair without (n⫽45) or with (n⫽43) augmentation with autologous platelet-rich fibrin matrix (PRFM). The primary endpoint was the post-operative difference in the Constant score between the 2 groups. The secondary endpoint was the integrity of the repaired rotator cuff, as evaluated by MRI. Analysis was on an intention to treat basis. Results: All the patients completed follow-up at 16 months. There was no statistically significant difference in total Constant Score when comparing the results of arthroscopic repair of the 2 groups (95% confidence interval [CI], -3.43 - 3.9) (P⫽0.44). There was no statistically significant difference in MRI tendon score when comparing arthroscopic repair with or without PFRM (P⫽0.07). Conclusions: Our study does not support the use of autologous PRFM for augmentation of a double row repair of a small or medium RC tear to improve the healing of the RC. Our results are applicable to small and medium RC tears: it is possible that PRFM may be beneficial for large and massive RC tears. Also, given the heterogeneity of PRFM preparation products available on the market, it is possible that other preparations may be more effective. Paper # 118: The Results of Conservatively Treated Simple Elbow Dislocations HAYRETTIN KESMEZACAR, MD, TURKEY ILKER ABDULLAH SARIKAYA, MD, TURKEY · Istanbul Universtiy Cerrahpasa Medical Faculty Istanbul, TURKEY Summary: Although functional scores were excellent, most of the patients did not consider themselves fully recovered. Abstract: Objectives: Closed reduction and short time immobilization is generally acceptable treatment for simple elbow dislocations. However there are just a small number of studies published concerning the results of this method. In this study clinical and radiological results of conservative treatment are retrospectively evaluated. Methods: 21 patients who underwent closed reduction and immobilization for simple elbow dislocation were evaluated. After reduction 4 patients used plaster splint, 17 patients (81%) used brace and elbow motions started at mean 7th days. The patients were assessed clinically for range of motion, instability, atrophy after 34 months of mean follow up. Mayo Elbow Performance Score (MEPS) was used to evaluate functional outcome. Standard elbow x-rays were evaluated for degeneration, heterotopic ossification, concentric reduction.
Results: The mean age of patients was 35 (16-59) years. The average flexion arc and rotational arc were 131° and 172° respectively. The differences between the contralateral elbow motions were 10.9° for flexion arc, 3.1° for rotational arc. Four patients had residual instability. There were no muscular atrophy. Three patients reported mild, one patient moderate pain at rest. Six patients (28.6%) had mild-moderate neurological complaints related with ulnar nerve. Three patients had mild radiographic signs of arthrosis, 14 patients (66.7%) showed mild-moderate degree of heterotopic ossification. An average score of 96.9 was obtained using MEPS. Only four patients (19%) considered themselves fully recovered. Conclusion: Closed reduction and immobilization is a universal method for simple elbow dislocations. Although functional scores were excellent, most of the patients did not consider themselves fully recovered. Key words: elbow, dislocation, joint instability Paper # 119: Distal Humeral Fracture Fixation – Results From General Orthopedic Surgeons HARI KRISHNA ANKEM, MS(ORTH), DNB(ORTH), MRCS(EDIN, UK), INDIA SHRINATH KAMINENI, FRCS (TR & ORTH), USA · Hillingdon Hospital London, UNITED KINGDOM Summary: Fractures of distal humerus are complex injuries that constitute a fracture group requiring the acute intervention by centres that have specific sub-specialisation and adequate rehabilitation facilities Abstract: Purpose: Distal humeral fractures are often difficult injuries to treat. We hypothesise that more complex distal humeral fractures have unacceptable functional outcomes due to multi-factorial reasons. Methods: 42 patients with AO/ASIF type B and C fractures of the distal humerus who were treated with open reduction and internal fixation over a six year period were included in the study. All patients were from a single district general hospital. 37 (88%) were clinically, radiologically, and functionally assessed for this study, with the remainder either lost to follow-up or expired. Results: There were 21 type B and 16 type C fractures, all managed by open reduction and internal fixation. Various fixation techniques were utilised. These were performed by consultant surgeons in 14 cases and by surgeons in training in 23 cases. Average follow up was 38 months (range 22-54 months). The arc of elbow motion was
ABSTRACTS 94 degrees (range 58-130), with an average extension deficit of 28 degrees (range 20-55) and an average flexion deficit of 32 degrees (range 15-45). The average arc of forearm rotation was 136 degrees (range 45-140), with an average supination of 68 (range 35-85) and an average pronation of 72 (range 45-90). The complications (n⫽20/ 37) included superficial skin infection (n⫽4), ulnar nerve neurapraxia (n⫽3), non-union of the humerus fracture (n⫽2), non-union of olecranon osteotomy site (n⫽1), intraarticular screw placement (n⫽1), loosened plate (n⫽1), loose/backed out screw (n⫽2), fixed flexion deformity (n⫽4) and mild elbow instability (n⫽2). Second surgery was performed in 24% (n⫽9/37), revision of metal work (n⫽2), bone grafting (n⫽2), anterior capsulectomy (n⫽4), and removal of screw (n⫽1). Conclusions: Fractures of the distal humerus are often more complex than appreciated, and challenging to treat, with respect to fracture union and functional outcome. A generalist practice appears adequate for achieving bony union, but inadequate for obtaining low complication rates and functional outcomes. Our data suggest that such injuries may constitute a fracture group requiring the acute intervention by centres that have specific subspecialisation and adequate rehabilitation facilities.
Paper # 120: Reconstruction of Distal Humeral Fractures with Hemi-Arthroplasty: Indication, Surgical Technique and Medium-Term Results IRMA CEFO, MD, THE NETHERLANDS DENISE EYGENDAAL, MD, PHD, THE NETHERLANDS M. WAGENER, MD, THE NETHERLANDS MAARTEN DE VOS, THE NETHERLANDS · Amphia Hospital Breda, THE NETHERLANDS Summary: If reconstruction of the distal humerus, after complex distal humeral fractures in the elderly, can not adequately be achieved with open reduction and internal fixation, a hemi-arthroplasty of the distal humerus can be an option; the results after 2 years are promising. Abstract: Introduction: Gold standard for distal humeral fractures (DHF) in the elderly is open reduction and internal fixation (ORIF). In selected cases with severe comminution of the fracture in combination with osteopenia, primary total elbow arthroplasty (TEA) can be an option. The survival the TEA remains a point of concern, with early loosening of especially the ulnar component. Hemi-arthroplasty of the distal humerus has been developed to overcome this prob-
e147
lem. In this case series the medium term results of Distal Humeral Hemi-arthroplasty (DHH) are reported. Material and Methods: Eight patients with a mean age of 64 (50-77) years, 1 male and 7 females with a distal humeral fracture were treated with a DHH using a Latitude® Elbow replacement system (Tornier, Stafford, TX). In 3 patients the hemi-arthroplasty was placed shortly after trauma, in 5 patients the DHH was placed shortly after failure of an ORIF. Evaluation took place after 12 and 24 months and consisted of the range of motion (ROM), Mayo Elbow Performance Score (MEPS) and standard radiographs in AP and lateral direction. Results: Preoperatively all patients had a non-functional elbow, which necessitated immobilisation in splint. Functional outcome after 12 months: The mean flexion after 12 months was 124° ( range 105°-135°), the mean extension 27° (range 20°-45°), mean pronation 68° (range 60°-85°) and mean supination 68° (range 60°-80°). The categorical rating according to MEPS score was as follows: 3 patients had an excellent score (90-100 points), 2 patients a good score (75-89 points) and 3 patients fair (60-74 points). There was no significant difference between the outcomes after 12 and 24 months. All patients were satisfied with the result. No complications were noticed. Conclusion: If reconstruction of the distal humerus, after complex distal humeral fractures in the elderly, can not adequately be achieved with open reduction and internal fixation, a hemi-arthroplasty of the distal humerus can be an option; the results after 2 years are promising. Paper # 121: Innervation of the Supinator and its Relationship to Two-Incision Distal Biceps Tendon Repair: An Anatomic Study and Clinical Implications KAREN PERSER, MD, USA LESLIE DONNELLY, MD, USA LESLIE BISSON, MD, USA · SUNY - Buffalo Buffalo, NY, USA Summary: Surgeons wishing to perform a distal biceps repair using a two-incision approach should be aware of variability of branches from the PIN to the supinator and their proximity to the bicipital tuberosity, while being reassured that this technique may be safely performed without direct nerve injury. Abstract: Background: Distal biceps tendon repair can be performed with a single or two-incision approach. A recent systematic review demonstrated no difference in complications between the two approaches; however, there was increased loss of forearm rotation, motion, and strength with the two incision technique (Chavan, et al. AJSM