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Purpose: Knowledge of ulnar nerve position is of utmost importance to avoid iatrogenic injury in elbow arthroscopy. The aim of this study was to determine how accurate surgeons are in locating the ulnar nerve after fluid extravasation has already occurred, and basing their localization solely on palpation of anatomical landmarks.Methods: Seven cadaveric elbows were used and seven experienced surgeons in elbow arthroscopy participated. An arthroscopic setting was simulated and fluids were pumped into the joint from the posterior compartment for 15 min. For each cadaveric elbow, one surgeon was asked to locate the ulnar nerve solely by palpation of the anatomical landmarks, and subsequently pin the ulnar nerve at two positions: within 5 cm proximal and another within 5 cm distal of a line connecting the medial epicondyle and the tip of the olecranon. Subsequently, the elbows were dissected using a standard medial elbow approach and the distances between the pins and ulnar nerve were measured.Results: The median distance between the ulnar nerve and the proximal pins was 0 mm (range 0-0 mm), and between the ulnar nerve and the distal pins was 2 mm (range 0-10 mm), showing a statistically significant difference (p = 0.009). All seven proximally placed pins (100%) transfixed the ulnar nerve versus two out of seven distally placed pins (29%) (p = 0.021).Conclusions: In a setting simulating an already initiated arthroscopic procedure, the sole palpation of the anatomical landmarks allows experienced elbow surgeons to accurately locate the ulnar nerve only in its course proximal to the medial epicondyle (7/7, 100%), whereas a significantly reduced accuracy is documented when the same surgeons attempt to locate the nerve distal to the medial epicondyle (2/7, 29%; p = 0.021). Current findings support the establishment of a proximal anteromedial portal over a distal anteromedial portal to access the anterior compartment after tissue extravasation has occurred with regard to ulnar nerve safety. [ABSTRACT FROM AUTHOR]

Background Radiographs are part of routine clinical care after radial head arthroplasty (RHA). Therefore, the aim of this diagnostic study was to assess the interobserver reliability of radiographic assessment following RHA. Methods Anteroposterior (AP) and lateral radiographs of 24 consecutive patients who underwent press-fit bipolar RHA were evaluated with respect to 14 parameters by 14 orthopaedic surgeons specializing in the elbow: shaft loosening (AP, lateral), subcollar bone resorption, nonbridging heterotopic ossification, capitellar erosion, capitellar osteopenia, implant size, ulnohumeral joint gapping, ulnohumeral joint degeneration, proximal radio-ulnar joint congruency, stem size, stem positioning (AP, lateral) and component dissociation or polyethylene wear of the head with increased angulation. Observer agreement was evaluated using the multirater kappa (κ) measure. Results Nine of 14 parameters had poor interobserver agreement [κ = 0.0 to 0.20, confidence interval (CI) = 0.0 to 0.31). Four parameters had fair agreement: subcollar bone resorption (κ = 0.27, CI = 0.12 to 0.40), capitellar erosion (κ = 0.30, CI = 0.20 to 0.40), ulnohumeral joint degeneration (κ = 0.35, CI = 0.22 to 0.51) and stem positioning in AP view (κ = 0.24, CI = 0.14 to 0.36). One parameter had moderate agreement: nonbridging heterotopic ossification (κ = 0.47, CI = 0.31 to 0.64). Conclusions The overall interobserver reliability of radiographic assessment following press-fit bipolar RHA was poor among experienced elbow surgeons. Therefore, radiographic evaluation after RHA should be interpreted with caution when making treatment decisions. [ABSTRACT FROM AUTHOR]

Purpose: In this anatomical cadaver study, the distance between major nerves and ligaments at risk for injury and portal sites created by trainees was measured. Trainees, inexperienced in elbow arthroscopy, have received a didactic lecture and cadaver instruction prior to portal placement. The incidence of iatrogenic injury from novice portal placement was also determined.Methods: Anterolateral, direct lateral, and anteromedial arthroscopic portals were created in ten cadavers by ten inexperienced trainees in elbow arthroscopy. After creating each portal, the trajectory of the portal was marked with a guide pin. Subsequently, the cadavers were dissected and the distances between the guide pin in the anterolateral, direct lateral, and anteromedial portals and important ligaments and nerves were measured.Results: The difference between the distance of the direct lateral portal and the posterior antebrachial cutaneous nerve (PABCN) (22 mm, p < 0.001), the lateral antebrachial cutaneous nerve (4.0 mm, p < 0.001), and the radial nerve (25 mm, p < 0.001) was different from the average reported distances in the literature. A difference was found between the distance of the anterolateral portal and the PABCN (32 mm, p < 0.001) compared to previous studies. Three major iatrogenic complications were observed, including: laceration of the posterior bundle of the medial ulnar collateral ligament, lateral ulnar collateral ligament midsubstance laceration, and median nerve partial laceration.Conclusion: Surgeons increasingly consider arthroscopic treatment as an option for elbow pathology. In the present study a surgical complication rate of 30 % was found with novice portal placement during elbow arthroscopy. Furthermore, as the results from this study have indicated, accurate, precise, and safe portal placement in elbow arthroscopy is not easily achieved by didactic lecture and cadaver instruction session alone. Level of evidence V. [ABSTRACT FROM AUTHOR]

Purpose: To determine the rate of donor-site morbidity after osteochondral autologous transplantation (OATS) for capitellar osteochondritis dissecans.Methods: A literature search was performed in PubMed/MEDLINE, Embase, and Cochrane Library to identify studies up to November 6, 2016. Criteria for inclusion were OATS for capitellar osteochondritis dissecans, reported outcomes related to donor sites, ≥10 patients, ≥1 year follow-up, and written in English. Donor-site morbidity was defined as persistent symptoms (≥1 year) or cases that required subsequent intervention. Patient and harvest characteristics were described, as well as the rate of donor-site morbidity. A random effects model was used to calculate and compare weighted group proportions.Results: Eleven studies including 190 patients were included. In eight studies, grafts were harvested from the femoral condyle, in three studies, from either the 5th or 6th costal-osteochondral junction. The average number of grafts was 2 (1-5); graft diameter ranged from 2.6 to 11 mm. In the knee-to-elbow group, donor-site morbidity was reported in 10 of 128 patients (7.8%), knee pain during activity (7.0%) and locking sensations (0.8%). In the rib-to-elbow group, one of 62 cases (1.6%) was complicated, a pneumothorax. The proportion in the knee-to-elbow group was 0.04 (95% CI 0.0-0.15), and the proportion in the rib-to-elbow group was 0.01 (95% CI 0.00-0.06). There were no significant differences between both harvest techniques (n.s.).Conclusions: Donor-site morbidity after OATS for capitellar osteochondritis dissecans was reported in a considerable group of patients.Level Of Evidence: Level IV, systematic review of level IV studies. [ABSTRACT FROM AUTHOR]

Background: Limited information exists related to the treatment of periprosthetic fractures of the ulna after semiconstrained elbow arthroplasty. Our goals were to characterize the clinical and radiographic features of periprosthetic fractures around the stem of a loose ulnar component and to determine the outcomes after surgical treatment. Methods: Between 1980 and 2008, thirty consecutive periprosthetic fractures around the ulnar stem were treated surgically at our institution. Eighteen fractures occurred after primary arthroplasty, and twelve occurred after revision arthroplasty. The mean time between the index arthroplasty and the fracture was eight years. All ulnar components were loose. Ulnar bone loss was moderate in fourteen elbows and severe in sixteen. Surgical reconstruction included revision of the ulnar component in all cases. Fracture fixation was achieved with a longer stemmed implant only in two elbows. Strut allografts were used in twenty elbows, with additional impaction graft augmentation in eight of them. Three additional elbows were revised with impaction grafting alone, and five were reconstructed with an allograft ulnar prosthetic composite. Seven patients were lost to follow-up, one died, and one was managed with conversion to a resection arthroplasty following a deep infection. The remaining twenty-one patients were followed for a mean of 4.9 ± 2.6 years. Results: At the time of the most recent follow-up, eighteen patients reported no pain or mild pain and three patients reported moderate pain. The mean arc of elbow flexion and extension was 112°. The Mayo Elbow Performance Score was 82 points (with fifteen good or excellent results and six fair or poor results). Fracture-healing was achieved in the twenty-one followed patients. Complications included three deep infections, one superficial infection, one case of ulnar component loosening, and one case of transient dysfunction of both the median and radial nerves. Conclusions: Periprosthetic ulnar fractures around the stem of a loose ulnar component after total elbow arthroplasty usually combine implant loosening and severe bone loss. Revision of the ulnar component may require additional strut allografts, allograft-prosthetic composites, or impaction grafting. Satisfactory outcomes were seen after the majority of revisions; however, deep infections and component loosening continue to be serious complications. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]