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Introduction: Dislocations of the elbow are the second most frequent upper-body injury after shoulder dislocations, comprising 11–28% of all elbow injuries. Complex elbow dislocations pose challenging management due to the involvement of critical stabilizing structures. This study aimed to investigate functional and subjective outcomes (MEPS, DASH, Oxford score) in 44 patients with complex elbow dislocations who underwent surgery between 2018 and 2020, with subgroup analysis focusing on gender and age differences. Material and methods: A retrospective analysis was conducted on patients treated at C.T.O. Hospital, Turin, for complex elbow dislocations between January 2018 and December 2020. Surgical approaches included radial head synthesis, coronoid fixation, ligamentous repair, and ulnar nerve management. Postoperatively, patients followed a standardized or individualized program. Data analysis involved t-tests to assess score differences between subgroups. Results: Among the 44 analyzed patients, the mean age was 48 years, and the mean follow-up time was 29 months. Various types of complex dislocations were identified, with radial head and coronoid fractures classified accordingly. Surgical approaches included multiple methods of reduction and synthesis. While most patients adhered to postoperative programs, subsequent reoperations were conducted in 11% of cases. Scores did not significantly differ between genders, although a trend toward better DASH scores in males was observed. Younger patients showed better, though not statistically significant, outcomes in mobility and functional measures. Conclusion: This study underscores the importance of pre-operative assessment for positive surgical outcomes in complex elbow dislocations. Additionally, findings suggest that younger age may correlate with slightly better functional outcomes. Despite limitations such as retrospective design and sample size, the study enhances our understanding of complex dislocation outcomes and provides valuable insights for future interventions. [ABSTRACT FROM AUTHOR]

Background: In the treatment of terrible triad injury of the elbow (TTIE), the indication and the appropriate approach and sequence for coronoid process (CP) fixation remain debatable. No gold standard protocol has been established for CP fixation. In this study, we evaluated the midterm outcomes of coronoid-first repair through an anterior approach in patients with unstable TTIE. Materials and methods: This prospective observational study included patients with TTIE who exhibited posterior or posterolateral subluxation/dislocation during examination under anesthesia (EUA) at our institute between January 2019 and December 2021. All patients underwent coronoid-first repair through an anterior approach, regardless of fragment size. After CP fixation, radial head fixation/replacement and lateral ulnar collateral ligament repair were performed through the lateral Kocher approach. Radiographic and functional (Mayo Elbow Performance Score [MEPS] and Disabilities of Arm, Shoulder, and Hand score [DASH]) assessments were performed 3, 6, 12, and 24 months after surgery. Complications such as recurrent subluxation/dislocation, synostosis, heterotopic ossification, traumatic arthritis, and stiffness were examined at the follow-up visits. Results: The analysis included 27 patients. The mean follow-up duration was 29.9 (range 24–44) months. At the 3-, 6-, 12-, and 24-month follow-up, the mean flexion–extension arcs were 88.7° ± 14.7°, 107.9° ± 11.9°, 128.3° ± 15.5°, and 130.9° ± 15.3°; the mean supination–pronation arcs were 143.7° ± 9.9°, 160.4° ± 7.6°, 165.0° ± 6.0°, and 167.9° ± 4.9°; the mean DASH scores were 18.7 ± 5.7, 4.5 ± 6.1, 2.7 ± 6.5, and 2.0 ± 6.8; and the mean MEPS were 79.1 ± 10.3, 90.2 ± 8.3, 94.8 ± 6.6, and 95.9 ± 5.7, respectively. At the 24-month follow-up, 26 patients had excellent and 1 patient had good results according to MEPS. Only one patient had a complication: they exhibited stiffness and did not have a 30–130° flexion–extension arc at 24 months postoperatively. Conclusions: The EUA findings, rather than fragment size alone, may be a good indicator of whether the CP needs to be repaired. Midterm follow-up results implied that coronoid-first repair through an anterior approach yields satisfactory functional outcomes with minimal complications. Level of evidence: Therapeutic level II. [ABSTRACT FROM AUTHOR]

Acute elbow pain can be the result of traumatic and atraumatic processes. Pathologic processes include osseous, ligamentous, and tendinous etiologies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Background: Terrible triad of the elbow (TTE) is a complex dislocation associating radial head (RH) and coronoid process (CP) fractures. There is at present no reproducible anatomic model for TTE, and pathophysiology is unclear. The main aim of the present study was to create and validate an anatomic model of TTE. Secondary objectives were to assess breaking forces and relative forearm rotation with respect to the humerus before dislocation. Methods: An experimental comparative study was conducted on 5 fresh human specimens aged 87.4 ± 8.6 years, testing 10 upper limbs. After dissection conserving the medial and lateral ligaments, interosseous membrane and joint capsule, elbows were reproducibly positioned in maximal pronation and 15° flexion, for axial compression on a rapid (100 mm/min) or slow (10 mm/min) protocol, applied by randomization between the two elbows of a given cadaver, measuring breaking forces and relative forearm rotation with respect to the humerus before dislocation. Results: The rapid protocol reproduced 4 posterolateral and 1 divergent anteroposterior TTE, and the slow protocol 5 posterolateral TTE. Mean breaking forces were 3,126 ± 1,066 N for the lateral collateral ligament (LCL), 3,026 ± 1,308 N for the RH and 2,613 ± 1,120 N for the CP. Comparing mean breaking forces for all injured structures in a given elbow on the rapid protocol found a p-value of 0.033. Comparison of difference in breaking forces in the three structures (LCL, RH and CP) between the slow and rapid protocols found a mean difference of -4%. Mean relative forearm rotation with respect to the humerus before dislocation was 1.6 ± 1.2° in external rotation. Conclusions: We create and validate an anatomic model of TTE by exerting axial compression on an elbow in 15° flexion and maximal pronation at speeds of 100 and 10 mm/min. [ABSTRACT FROM AUTHOR]

Abstract Background In the treatment of terrible triad injury of the elbow (TTIE), the indication and the appropriate approach and sequence for coronoid process (CP) fixation remain debatable. No gold standard protocol has been established for CP fixation. In this study, we evaluated the midterm outcomes of coronoid-first repair through an anterior approach in patients with unstable TTIE. Materials and methods This prospective observational study included patients with TTIE who exhibited posterior or posterolateral subluxation/dislocation during examination under anesthesia (EUA) at our institute between January 2019 and December 2021. All patients underwent coronoid-first repair through an anterior approach, regardless of fragment size. After CP fixation, radial head fixation/replacement and lateral ulnar collateral ligament repair were performed through the lateral Kocher approach. Radiographic and functional (Mayo Elbow Performance Score [MEPS] and Disabilities of Arm, Shoulder, and Hand score [DASH]) assessments were performed 3, 6, 12, and 24 months after surgery. Complications such as recurrent subluxation/dislocation, synostosis, heterotopic ossification, traumatic arthritis, and stiffness were examined at the follow-up visits. Results The analysis included 27 patients. The mean follow-up duration was 29.9 (range 24–44) months. At the 3-, 6-, 12-, and 24-month follow-up, the mean flexion–extension arcs were 88.7° ± 14.7°, 107.9° ± 11.9°, 128.3° ± 15.5°, and 130.9° ± 15.3°; the mean supination–pronation arcs were 143.7° ± 9.9°, 160.4° ± 7.6°, 165.0° ± 6.0°, and 167.9° ± 4.9°; the mean DASH scores were 18.7 ± 5.7, 4.5 ± 6.1, 2.7 ± 6.5, and 2.0 ± 6.8; and the mean MEPS were 79.1 ± 10.3, 90.2 ± 8.3, 94.8 ± 6.6, and 95.9 ± 5.7, respectively. At the 24-month follow-up, 26 patients had excellent and 1 patient had good results according to MEPS. Only one patient had a complication: they exhibited stiffness and did not have a 30–130° flexion–extension arc at 24 months postoperatively. Conclusions The EUA findings, rather than fragment size alone, may be a good indicator of whether the CP needs to be repaired. Midterm follow-up results implied that coronoid-first repair through an anterior approach yields satisfactory functional outcomes with minimal complications. Level of evidence: Therapeutic level II.

Posteromedial dislocation of the elbow is a rare entity even exceptional if associated with a lateral condylar fracture. Very few isolated cases are reported in the English literature. We report an additional case of a 14-year-old child admitted for elbow trauma during scholar sport and presented a posteromedial elbow dislocation associated with a fracture of the lateral humeral condyle. The surgical treatment was made by using 3 cortical screws. The results were satisfying including range motion and he has resumed sports activities at 5 months. Elbow dislocation is a rare affection in children. It represents 3% to 6% of elbow injuries. The association of posteromedial elbow dislocation with a Milch type I is remarkably rare. We review the mechanism, classifications, and therapeutic modalities of this injury. Elbow dislocations associated with a lateral condylar fracture are exceptional and need an early reduction followed by an anatomical internal fixation to ensure articular congruity.

Abstract Background Terrible triad of the elbow (TTE) is a complex dislocation associating radial head (RH) and coronoid process (CP) fractures. There is at present no reproducible anatomic model for TTE, and pathophysiology is unclear. The main aim of the present study was to create and validate an anatomic model of TTE. Secondary objectives were to assess breaking forces and relative forearm rotation with respect to the humerus before dislocation. Methods An experimental comparative study was conducted on 5 fresh human specimens aged 87.4 ± 8.6 years, testing 10 upper limbs. After dissection conserving the medial and lateral ligaments, interosseous membrane and joint capsule, elbows were reproducibly positioned in maximal pronation and 15° flexion, for axial compression on a rapid (100 mm/min) or slow (10 mm/min) protocol, applied by randomization between the two elbows of a given cadaver, measuring breaking forces and relative forearm rotation with respect to the humerus before dislocation. Results The rapid protocol reproduced 4 posterolateral and 1 divergent anteroposterior TTE, and the slow protocol 5 posterolateral TTE. Mean breaking forces were 3,126 ± 1,066 N for the lateral collateral ligament (LCL), 3,026 ± 1,308 N for the RH and 2,613 ± 1,120 N for the CP. Comparing mean breaking forces for all injured structures in a given elbow on the rapid protocol found a p-value of 0.033. Comparison of difference in breaking forces in the three structures (LCL, RH and CP) between the slow and rapid protocols found a mean difference of -4%. Mean relative forearm rotation with respect to the humerus before dislocation was 1.6 ± 1.2° in external rotation. Conclusions We create and validate an anatomic model of TTE by exerting axial compression on an elbow in 15° flexion and maximal pronation at speeds of 100 and 10 mm/min.

Shoulder dislocations and elbow dislocations are common presentations to the emergency department (ED). Simultaneous ipsilateral elbow and shoulder dislocations are rarely reported and typically occur secondary to trauma. A 45-year-old female presented to the ED after a fall from standing and complained of upper right extremity pain. Radiographs revealed posterior dislocation of the right elbow and anterior dislocation of the right shoulder without fractures. Successful reduction of the elbow and shoulder were both achieved, and the patient was placed in a long-arm splint and sling. This case describes the unique mechanism of injury of a simultaneous ipsilateral shoulder and elbow dislocation without trauma. [ABSTRACT FROM AUTHOR]

Objective: The study aims to explain whether or not minimal invasive surgery (MIS) would be feasible in elbow fracture–dislocation with coronoid process fracture. Methods: At Taipei Veterans General Hospital, patients who had elbow dislocations with coronoid process fractures underwent a single surgeon's MIS techniques which included the fluoroscopy-guided ulnar anteromedial (FGUAM) approach in the stage of reducing the coronoid process. When there is a proximal ulnar fracture, the posterior incision should be necessary, followed by the incision over the lateral or medial elbow for treating radial fractures or ligament injuries. Results: The Flow Diagram for approach recommendation was established on the basis of defining MIS as that which does not include cross-plane dissection. The importance of anterior rigid fixation for the coronoid process was also emphasized. Conclusions: MIS can be achieved by multiple limited surgical incisions. Although the posterior extensile approach is necessary in situations of ulnar metaphysis or ligament avulsion fracture, the FGUAM approach decreases the cross-plane dissection. [ABSTRACT FROM AUTHOR]

Key Clinical Message: In LMICs, the nonoperative management of posterior elbow dislocation associated with radial head fracture is still a therapeutic option with favorable outcomes. Elbow dislocation associated with radial head fracture is a rare lesion. The occurrence of such a lesion requires high energy trauma. The restoration of joint and radial head fracture that allows early mobilization is the best guarantee of a good functional outcome. We report a case of posterior elbow dislocation associated with radial head fracture managed by closed reduction and 1 week cast immobilization in neutral prono‐supination and 90°flexion followed by early mobilization was performed favorable functional outcome was obtained after 12 weeks. We review the different pattern of elbow dislocation and question the need of open reduction and internal fixation for displaced radial head fractures. [ABSTRACT FROM AUTHOR]

Purpose: Despite standardized treatment algorithms, patients with complex elbow fracture-dislocation frequently suffer from poor post-operative elbow function leading to reduced quality of life. Up to now, there is no valuable data regarding risk factors that lead to poor post-operative outcome after surgical reconstruction of complex elbow fracture-dislocations. Methods: From 06/2010 to 12/2020 134 patients (51.3 ± 15.1 years, 44% women) undergoing surgical treatment of complex elbow fracture-dislocations could be included in this study. Follow-up period was 4.4 years (SD 2.5). All patients were clinically evaluated for elbow movement, elbow stability and common elbow scores (MEPS, OES, DASH-Score). Potential risk factors for poor post-operative outcome were identified using bi- and multivariate analyses. Results: Overall good post-operative outcome has been achieved, mean MEPS was 88.8 ± 17.6. Post-operative complications occurred in 31.3% of the cases, while 25.4% required surgical revision. Patients with transolecranon dislocation fractures showed the significantly worst functional outcomes (p = 0.01). In addition, it has been shown that a patient's age of more than 70 years (OR = 10, p = 0.003) and a BMI of more than 35 kg/m2 (OR = 7.6, p = 0.004) are independent risk factors for a poor post-operative outcome. In contrast, gender and time to surgery showed no significant influence on post-operative outcome. Conclusion: In most cases, good post-operative functional results can be achieved using standardized treatment protocols. However, complication and revision rates remain high. Patients older than 70 years of age or with a BMI over 35 kg/m2 are at risk for an inferior outcome and require close follow-up monitoring. [ABSTRACT FROM AUTHOR]

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Pediatric elbow fractures and dislocations have always been a challenge from a diagnostic and therapeutic point of view, primarily due to the complex nature of the pediatric elbow, especially its developmental anatomy. They must be diagnosed and treated on time to prevent numerous complications with long-term consequences. With the development of radiology and pediatric surgery and orthopedics, as well as the development of modern osteosynthesis materials, concerning current scientific and professional knowledge, the outcomes are getting better, with fewer acute and chronic complications. This comprehensive review aims to provide clinicians current knowledge about pediatric elbow fractures and dislocations so that in daily practice they have as few doubts as possible with the best possible treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: For the treatment of coronoid process fractures, medial, lateral, anterior, anteromedial, and posterior approaches have been increasingly reported; however, there is no general consensus on the method of fixation of coronal fractures. Here, we present a highly-extensile minimally invasive approach to treat coronoid process fractures using a mini-plate that can achieve anatomic reduction, stable fixation, and anterior capsular repair. Further, the study aimed to determine the complication rate of the anterior minimally invasive approach and to evaluate functional and clinical patient-reported outcomes during follow-up. Methods: Thirty-one patients diagnosed with coronoid fractures accompanied with a "terrible triad" or posteromedial rotational instability between April 2012 and October 2018 were included in the analysis. Anatomical reduction and mini-plate fixation of coronoid fractures were performed using an anterior minimally invasive approach. Patient-reported outcomes were evaluated using the Mayo Elbow Performance Index (MEPI) score, range of motion (ROM), and the visual analog score (VAS). The time of fracture healing and complications were recorded. Results: The mean follow-up time was 26.7 months (range, 14–60 months). The average time to radiological union was 3.6 ± 1.3 months. During the follow-up period, the average elbow extension was 6.8 ± 2.9° while the average flexion was 129.6 ± 4.6°. According to Morrey's criteria, 26 (81%) elbows achieved a normal desired ROM. At the last follow-up, the mean MEPI score was 98 ± 3.3 points. There were no instances of elbow instability, elbow joint stiffness, subluxation or dislocation, infection, blood vessel complications, or nerve palsy. Overall, 10 elbows (31%) experienced heterotopic ossification. Conclusion: An anterior minimally invasive approach allows satisfactory fixation of coronoid fractures while reducing incision complications due to over-dissection of soft tissue injuries. In addition, this incision does not compromise the soft tissue stability of the elbow joint and allows the patient a more rapid return to rehabilitation exercises. [ABSTRACT FROM AUTHOR]

Dislocation of the elbow joint, which has not been treated for more than 3 weeks, is considered outdated. Due to the high risk of complications and the uncertainty of the effectiveness of the treatment of an old dislocation of the elbow joint, it is quite a difficult task for surgeons. There are various described techniques for repairing the lateral ligamentous complex (including the LUCL) and the medial collateral ligament. Objective. To describe the author's unique technique, which consists in using one graft to restore both lateral and medial ligaments. Methods. The personal experience of treating 14 patients with chronic dislocation of the elbow joint with deformation and multidirectional instability is presented. All patients were operated on by one surgeon using the arthrolysis method in combination with MCL, LUCL reconstruction using an ipsilateral autograft of the triceps tendinous fascia. Further observation was carried out at 3, 6 and 12 weeks, as well as at 6 and 9 months. In our case, we evaluated stability, range of motion, and the presence of pain syndrome. The results. Satisfactory results were obtained in terms of pain-free full range of motion and adequate stability of the elbow joint in all cases. All patients performed their active routine exercise with minimal limitation. Conclusions. The advantage of the technique is a unique comprehensive approach that uses one circular graft to restore both the lateral and medial ligament complexes, which ensures stability and possible early rehabilitation. This leads to an excellent functional result -- a quick restoration of the full range of motion in the joint and its stability. [ABSTRACT FROM AUTHOR]

Case: We present a case of type II (intraosseous) entrapment of the median nerve in a patient who was diagnosed based on clinical examination and magnetic resonance imaging and who was treated with medial epicondyle osteotomy, neurolysis, and transposition of the nerve to its anatomical position within a month of injury. Our patient made a complete motor and sensory recovery at 5 months with complete functionality and grip strength. Conclusion: Median nerve entrapment after posterolateral elbow dislocation is a rare complication with roughly 40 cases reported in the literature. This case illustrates the importance of prompt diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic elbow dislocations are among the most common injuries in sport climbing. They occur most frequently in bouldering (a climbing discipline with strong upward trend often performed indoors) due to the typical low-height backward fall into crashpads. There is still no data about the functional outcome and return to sport of this typical bouldering injury. Materials and methods: All Patients with elbow dislocations due to a bouldering associated fall between 2011 and 2020 were identified retrospectively in our level I trauma centre. Trauma mechanisms, injury types and therapies were obtained. Follow-up was performed with an online questionnaire including sports-related effects, return to sport and the Elbow Self-Assessment Score (ESAS). Results: 30 patients with elbow dislocations after bouldering accidents were identified. In 22 (73.3%) patients the injury was a simple dislocation. The questionnaire was completed by 20 patients. The leading mechanism was a low-height fall into crashpads. Surgical procedures were performed in every second patient. 18 patients (90%) reported return to bouldering after 4.7 ± 2.1 months. 12 patients (66.7%) regained their pre-injury level. Mid-/Long-term follow-up (mean 105 ± 37.5 months) showed excellent results in ESAS score (97.2 ± 3.9 points). Persistent limited range of motion or instability was reported by only 3 patients (15%). Conclusion: Most athletes are able to return to bouldering but only two thirds regain their pre-injury performance level in this demanding upper-extremity sport. The unique low-height trauma mechanism may create a false sense of security. Specific awareness and safety features should be placed for climbing athletes to reduce elbow injuries. [ABSTRACT FROM AUTHOR]

Objective: Numerous surgical techniques for addressing ulnar coronoid process fractures are available; however, a consensus on the optimal approach remains elusive. This study aimed to use the anterior neurovascular interval approach for the surgical management of ulnar coronoid process fractures and to evaluate its clinical outcomes over short‐ to mid‐term follow‐up. Methods: This retrospective clinical study included 20 patients with ulnar coronoid process fractures who were treated using the anterior neurovascular interval approach between January 2018 and December 2022. Participants comprised 16 males and four females, aged between 20 and 64 years (mean, 34.3 ± 12.44 years). Clinical and radiological evaluations were based on elbow joint range of motion (ROM), Visual analogue scale (VAS), and Mayo elbow performance score (MEPS). A paired t‐test was used to compare the pre‐operative and final follow‐up VAS and MEPS scores. Results: The follow‐up duration for all patients was at least 12 months (average, 12.65 ± 1.60 months). At the final follow‐up, measurements of elbow ROM included a mean extension of 2.85 ± 3.17°, mean flexion of 135 ± 7.25°, mean pronation of 86.4 ± 4.56°, and mean supination of 84.85 ± 5.54°. All participants reached their target MEPS, with an average score of 97.25 ± 4.72 points, and the final mean VAS score was 0.2 ± 0.52 points. The VAS score was significantly lower and MEPS score was higher at the final follow‐up than those before surgery (p < 0.05). Throughout the follow‐up period, all the fractures united, and the stability of the affected elbows was satisfactory. Conclusion: Employing the anterior neurovascular interval approach for open reduction and internal fixation to manage coronoid process fractures effectively facilitates anatomical restoration and robust fixation of ulnar coronoid process fractures. [ABSTRACT FROM AUTHOR]

Background: Monteggia fractures entail a proximal ulnar fracture with associated radial head dislocation. Primarily observed as a fracture in the pediatric population, there have been rare occurrences in adults. In rare instances, various associated fractures have been reported with Monteggia fractures. However, during our literature review, a type I Monteggia fracture had not been reported along with ipsilateral diaphyseal humerus and capitellar fractures. Here, we present a successful post-operative outcome for a unique fracture distribution and form of fixation that has yet to be reported in the literature. [ABSTRACT FROM AUTHOR]

Background: In acute treatment of radial head fractures, a radial head prosthesis can be considered if open reduction and internal fixation are not technically feasible. Methods: We reviewed the data of 27 consecutive bipolar Judet radial head prostheses implanted in patients with unreconstructable radial head fractures and no other concomitant fractures (coronoid or olecranon factures). The lesions of the lateral collateral ligament were rated according to the McKee classification. Twenty-three patients with more than ten-year follow-up participated in this retrospective study All patients underwent assessments for pain, range of motion and stability using the Mayo Elbow Performance Score, the QuickDash questionnaire and a Visual Analogue Scale for pain. Radiography assessment was performed to determine the correct setting of the implant, presence of periprosthetic loosening, prosthetic disassembly, heterotopic ossification, capitellum and ulnohumeral degenerative changes. Results: Mean follow-up was 149 months (± 12.2). Mean range of motion in flexion-extension was 111° (± 10.55), mean extension was 18° (± 14.32) and mean flexion was 130° (± 11.4). Mean arc of motion in supination-pronation was 150° (± 12.26). The mean Mayo Elbow Performance Score was 88, the mean QuickDash score was 7.3; 86% of the patients were satisfied. Seven patients (26%) required secondary surgery. The most frequent complication was heterotopic ossification, which had negative consequences on the functional result. Conclusions: Bipolar radial head prostheses are an option for acute treatment of isolated unreconstructable radial head fractures. During follow-up, three patients required implant revision and removal; the capitellum surface presented severe degenerative changes and the prosthesis was not replaced. Another complication was the risk of implant dislocation, in relation to implant design, incorrect positioning of the radial head stem or else to inadequate reconstruction of the lateral collateral ligament. Further work is needed to establish the long-term follow-up results of Judet implants in complex elbow fractures. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the range of motion (ROM), elbow function and predictors for good elbow function after conservative treatment of non-displaced radial head fractures. Material and methods: All patients with non-displaced radial head fractures (displacement < 2 mm), that were diagnosed between January 1st 2017 and December 31st 2021 in a level I trauma center, were included in this retrospective case series and the charts were evaluated for ROM and elbow function. Elbow function was categorized as "good" or "bad" depending on the ROM measured defined by Morrey et al. Overall, 73 patients (33 male, 40 female) with an average age of 38 years (+/- 13 years) could be included. Results: Conservative treatment had good clinical results for ROM and elbow function. After 6 weeks mean flexion was 131° (SD 13°), extension 8° (SD 7°), Pronation 83° (SD 11°) and Supination 83° (SD 13). Patients with a good elbow function after one week showed a good elbow function after completing the treatment. Conclusions: A clinical assessment after one week should always be performed and the study showed that it is a good predictor for good elbow function. In cases of bad elbow function further controls should be considered. [ABSTRACT FROM AUTHOR]

Background: Monteggia, an Italian surgeon, first to describe the combination of a proximal ulna fracture and dislocated radial head. With the use of Kirschner wires, surgical stabilization could be achieved. The aim of the study was to determine closed reduction and percutaneous k-wire fixation can maintain satisfactory reduction and fixation in pediatric Monteggia fractures. Methods: Twelve patients with Monteggia fractures were admitted to Zagazig University Hospital and Tripoli University Hospital- Libya in this prospective study. All were treated by close reduction and percutaneous k-wire fixation. Postoperatively, patients were weekly dressed and checked for pin sites. AP / Lat X-rays elbow at 6 weeks for fracture union, wires removed. Using the Stewart Hundley, VAS, Mayo, and DASH scoring systems, the elbow and forearm were evaluated for a range of motion in all directions. Results: Age was distributed as 7.88±2.63 years, regarding gender distribution males were 55.6% and females were 44.4%. Mechanism of injury FD was majority with 72.2% and DT 27.8%. Bado classification majority were type I 41.7%, type II 33.3%, type III 25%, and type IV no cases. The time of union was distributed as 2.72±0.80 months. Stewart Hundley's score excellent was the majority with 83.3%, good 8.3%, and fair 8.3%. Mayo's score was distributed as 88.33±10.44; regard Mayo's excellent were majority with 66.7% then good and fair with 16.7% each. And regarding DASH excellent was also the majority but with 61.1% then good 22.2% then fair 11.1% then poor only one case 5.6%. Conclusions: Closed Reduction and Percutaneous Kirschner Wires Fixation of Monteggia Fracture in Children are less invasive, and give satisfactory radiological and clinical outcomes. Percutaneous interventions could be an option for Monteggia Fracture in Children. [ABSTRACT FROM AUTHOR]

Osteochondritis dissecans (OCD) of the elbow mainly occurs in overhead athletes (OHAs). This narrative review aimed to comprehensively analyze the epidemiological data, etiological factors, clinical and imaging features, treatment options, and outcomes of OHAs with the diagnosis of elbow OCD. A literature search was performed in PubMed/MEDLINE, Scopus, and Web of Science. Individuals with elbow OCD were usually 10–17 years of age with incidence and prevalence varying between studies, depending on the sport activity of the patients. The etiology of OCD lesions is multifactorial, and the main causes are believed to be repetitive trauma, the biomechanical disproportion of the articular surfaces, poor capitellar vascular supply, and inflammatory and genetic factors. Athletes usually presented with elbow pain and mechanical symptoms. The mainstay for the diagnosis of elbow OCD is MRI. The treatment of elbow OCD lesions should be conservative in cases of stable lesions, while various types of surgical treatment are suggested in unstable lesions, depending mainly on the size and localization of the lesion. The awareness of medical practitioners and the timely diagnosis of OCD lesions in OHAs are key to favorable outcomes. [ABSTRACT FROM AUTHOR]

Background: The ideal treatment of terrble triad injuries and whether fixation of coronoid process fractures is needed or not are still debated. Therefore, we aimed to investigate if terrible triad injuries necessitate coronoid fracture fixation and evaluate if non-fixation treatments have similar efficacies and outcomes as fixation-treatments in cases of terrible triad injuries. Methods: From August 2011 to July 2020, 23 patients with acute terrible triad injuries without involvement of the anteromedial facet of the coronoid process were included to evaluate the postoperative clinical and radiological outcomes (minimum follow-up of 20 months). According to the preoperative height loss evaluation of the coronoid process and an intraoperative elbow stability test, seven patients underwent coronoid fracture fixation, and the other eight patients were treated conservatively. The elbow range of motion (ROM), Mayo Elbow Performance Score (MEPS), and modified Broberg-Morrey score were evaluated at the last follow-up. In addition, plain radiographs were reviewed to evaluate joint congruency, fracture union, heterotopic ossification, and the development of arthritic changes. Results: At the last follow-up, the mean arcs of flexion-extension and supination-pronation values were 118.2° and 146.8° in the fixation group and 122.5° and 151.3° in the non-fixation group, respectively. The mean MEPSs were 96.4 in the fixation group (excellent, nine cases; good, tow cases) and 96.7 in the non-fixation group (excellent, ten cases; good, two cases). The mean modified Broberg-Morrey scores were 94.0 in the fixation group (excellent, sevev cases; good, four cases) and 94.0 in the non-fixation group (excellent, ten cases; good, tow cases). No statistically significant differences in clinical scores and ROM were identified between the two groups. However, the non-fixation group showed a significantly lower height loss of the coronoid process than the fixation group (36.3% versus 54.5%). Conclusions: There were no significant differences in clinical outcomes between the fixation and non-fixation groups in terrible triad injuries. [ABSTRACT FROM AUTHOR]

Purpose: To determine outcomes following surgical management of terrible triad injuries in patients treated with and without a hinged elbow orthosis (HEO) in the post-operative setting. Methods: This study was a retrospective review of 41 patients who underwent surgical treatment of terrible triad injuries including radial head fracture, coronoid fracture, and ulnohumeral dislocation between 2008 and 2023 with at least 10-week follow-up. Results: Nineteen patients were treated post-operatively without HEO, and 22 patients were treated with HEO. There were no differences in range of motion (ROM) between patients treated with and without HEO in final flexion–extension arc (118.4° no HEO, 114.6° HEO, p = 0.59) or pronation–supination arc (147.8° no HEO, 141.4° HEO, p = 0.27). Five patients treated without HEO and one patient treated with HEO returned to the operating room for stiffness (26%, 5%, p = 0.08). QuickDASH scores were similar between groups (p = 0.69). Conclusions: This study found no difference in post-operative ROM, complications, or QuickDASH scores in patients treated post-operatively with or without HEO. Based on these results, we cannot determine whether the use of HEO adds additional stability to the elbow while initiating ROM exercises post-operatively. [ABSTRACT FROM AUTHOR]

Persistent and recurrent postoperative elbow instability includes a spectrum of pathologies ranging from joint incongruity and subluxation to dislocation. Restoration of osseous anatomy, particularly the coronoid, is a priority in restoring elbow alignment and maintaining ulnohumeral joint stability. After managing bony deficiencies, soft-tissue and ligamentous structures are typically addressed. When required, both static and dynamic adjunctive stabilization procedures have been described, which aid in maintaining a concentric reduction. In these complex procedures, both complication avoidance and early recognition of postoperative complications assist in obtaining a good result. In this review, we discuss current treatment options for revision stabilization for patients with persistent and recurrent elbow subluxation or dislocation after primary stabilization. [ABSTRACT FROM AUTHOR]

Key Clinical Message In LMICs, the nonoperative management of posterior elbow dislocation associated with radial head fracture is still a therapeutic option with favorable outcomes. Abstract Elbow dislocation associated with radial head fracture is a rare lesion. The occurrence of such a lesion requires high energy trauma. The restoration of joint and radial head fracture that allows early mobilization is the best guarantee of a good functional outcome. We report a case of posterior elbow dislocation associated with radial head fracture managed by closed reduction and 1 week cast immobilization in neutral prono‐supination and 90°flexion followed by early mobilization was performed favorable functional outcome was obtained after 12 weeks. We review the different pattern of elbow dislocation and question the need of open reduction and internal fixation for displaced radial head fractures.

Purpose: The goal of surgical management for unstable elbow injuries is the restoration of joint concentricity and stability. After internal fixation, concerns may exist regarding instability or durability of the fixation construct. Historically, these scenarios were treated with options such as transarticular pinning or external fixation. Recently, an internal joint stabilizer (IJS) that allows postoperative mobilization was introduced. Our objective was to systematically review the literature to aggregate the clinical and biomechanical evidence for the IJS of the elbow. Methods: A systematic review of the PubMed and Google Scholar databases was performed, following the PRISMA guidelines. The search results were narrowed from 2015 through 2023 to coincide with the inception of the device being reviewed. Results: A total of nine retrospective reports on the IJS (N = 171) cases at a mean follow-up of 10.8 months were included. The pooled rate of implant failure was 4.4%, and recurrent instability was 4.1%. Additionally, the we included seven case reports and two biomechanical reports. Conclusions: The aggregate literature describes satisfactory clinical outcomes with low rates of recurrent instability and device failure for the IJS of the elbow. The limited biomechanical investigations conclude efficacy for stability profiles. Clinical relevance: Across a spectrum of unstable elbow cases, the IJS prevented recurrent instability during the early postoperative period. Notably, the device requires an additional procedure for removal, and the long-term impact of the retained devices is currently unclear.

PURPOSE OF THE STUDY This manuscript aims to identify an indication algorithm for the surgical treatment of radial head fractures associated with elbow dislocation. The study compares the mid-term functional outcomes of patients with multifragment radial head fracture treated by resection with the outcomes of patients treated with radial head replacement. MATERIAL AND METHODS The cohort of 34 patients who sustained a radial head fracture at the mean age of 42.5 years (age range 20-81 years) was broken down into two groups by type of surgery. The EXT group consists of 20 patients with the radial head fracture treated by radial head resection. The END group includes 14 patients treated with the radial head replacement. In all patients, the radial head fracture was associated with elbow dislocation (type IV fracture according to the Mason-Johnston classification). The modified Kocher’s surgical approach was used in all patients of both the groups. In the EXT group, resection of the fragmented radial head was performed. In the END group, the ExploR® Modular Radial Head System (Zimmer, Biomet, USA) was used, consisting of a CoCr (cobalt chromium) alloy head and a titanium stem. The pain and the range of motion of the elbow and forearm were evaluated after the completion of the outpatient rehabilitation (the mean follow-up period was 2.4 years). Simultaneously, the elbow joint stability was assessed. Radiographs were taken to detect heterotopic ossifications, proximalization of the radius, and any signs of prosthesis loosening. The frequency of reoperations was followed-up. The MEPS (Mayo Elbow Performance Score) was calculated. RESULTS In the EXT group, the mean elbow fl exion was 117.5° and the mean pronation/supination was 166.9°. In 50% of patients, the MEPS obtained was greater than 90 points, which means an excellent functional outcome. In 1 patient (5%), recurrent elbow dislocation occurred which was the reason for revision surgery (elbow transfixation with the Kirschner wires and medial collateral ligament suture). Revision surgery was also performed in 2 patients (10%) in whom not all the radial head fragments were removed. Moreover, also observed was elbow joint instability (2 patients) and temporary radial nerve paralysis (1 patient). In 1 case discrete proximalization of the radius developed. The patients in the END group showed the mean elbow fl exion of 112° and the mean pronation/supination of 135°. The MEPS obtained from 69% of patients was greater than 90 points, which means an excellent outcome. The pain under load was reported by 3 patients (21%). In 5 patients (35%), the X-rays showed radiolucent zone around the stem of the prosthesis. Neither revision surgery, nor prosthesis removal has been performed yet in any patient. No instability, neurological complications or infections have been reported. In both EXT and END group heterotopic ossifications have developed in 4 patients. CONCLUSIONS Radial head replacement compared to the radial head resection in the management of multifragment fractures associated with elbow dislocations increase the elbow and forearm stability. The group of patients with an implanted radial head prosthesis shows a higher percentage of patients achieving excellent functional outcome than the group of patients with radial head resection. [ABSTRACT FROM AUTHOR]

Background: Current treatment concepts for simple elbow dislocation involve conservative and surgical approaches. The aim of this systematic review was to identify the superiority of one treatment strategy over the other by a qualitative analysis in adult patients who suffered simple elbow luxation. Study design: A systematic review in accordance with the PRISMA guidelines and following the suggestions for reporting on qualitative summaries was performed. A literature search was conducted using PubMed and Scopus, including variations and combinations of the following keywords: elbow, radiohumeral, ulnohumeral, radioulnar, luxation, and therapy. Seventeen studies that performed a randomized controlled trial to compare treatment strategies as conservative or surgical procedures were included. Reviews are not selected for further qualitative analysis. The following outcome parameters were compared: range of motion (ROM), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand outcome measure (Quick-DASH), recurrent instability, pain measured by visual analog scale (VAS) and time to return to work (RW). Results: Early mobilization after conservative treatment strategies showed improved ROM compared to immobilization for up to 3 weeks after surgery with less extension deficit in the early mobilization group (16° ± 13°. vs. 19.5° ± 3°, p < 0.05), as well as excellent clinical outcome scores. Surgical approaches showed similar results compared to conservative treatment, leading to improved ROM (115 vs. 118 ± 2.8) and MEPS: 95 ± 7 vs. 92 ± 4. Conclusion: Conservative treatment with early functional training of the elbow remains the first-line therapy for simple elbow dislocation. The surgical procedure provides similar outcomes compared to conservative treatment regarding MEPS and ROM for patients with slight initial instability in physical examination and radiographs. People with red flags for persistent instability, such as severe bilateral ligament injuries and moderate to severe instability during initial physical examination, should be considered for a primary surgical approach to prevent recurrent posterolateral and valgus instability. Postoperative early mobilization and early mobilization for conservatively treated patients is beneficial to improve patient outcome and ROM. [ABSTRACT FROM AUTHOR]

Case: A 23-year-old man presented with a right upper limb injury after a 10-m fall. Initial evaluation demonstrated a terrible triad elbow injury associated with a trans-scaphoid perilunate dislocation. Elbow stabilization with radial head replacement and carpal fixation was performed. Radiographs on postoperative day 7 demonstrated an ipsilateral Essex-Lopresti injury, which had been initially missed, and revision surgery was performed to reconstruct the interosseous membrane. Conclusion: Surgeons should maintain a high degree of suspicion for an ipsilateral Essex-Lopresti injury in patients with a terrible triad elbow fracture-dislocation in combination with a trans-scaphoid perilunate dislocation. Both preoperative imaging, including the contralateral side, and intraoperative evaluation are recommended to rule out longitudinal instability of the forearm in the setting of combined wrist and elbow fracture-dislocations. [ABSTRACT FROM AUTHOR]

Background: Research into artificial intelligence (AI)-based fracture detection in children is scarce and has disregarded the detection of indirect fracture signs and dislocations. Objective: To assess the diagnostic accuracy of an existing AI-tool for the detection of fractures, indirect fracture signs, and dislocations. Materials and methods: An AI software, BoneView (Gleamer, Paris, France), was assessed for diagnostic accuracy of fracture detection using paediatric radiology consensus diagnoses as reference. Radiographs from a single emergency department were enrolled retrospectively going back from December 2021, limited to 1,000 radiographs per body part. Enrolment criteria were as follows: suspected fractures of the forearm, lower leg, or elbow; age 0–18 years; and radiographs in at least two projections. Results: Lower leg radiographs showed 607 fractures. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were high (87.5%, 87.5%, 98.3%, 98.3%, respectively). Detection rate was low for toddler's fractures, trampoline fractures, and proximal tibial Salter-Harris-II fractures. Forearm radiographs showed 1,137 fractures. Sensitivity, specificity, PPV, and NPV were high (92.9%, 98.1%, 98.4%, 91.7%, respectively). Radial and ulnar bowing fractures were not reliably detected (one out of 11 radial bowing fractures and zero out of seven ulnar bowing fractures were correctly detected). Detection rate was low for styloid process avulsions, proximal radial buckle, and complete olecranon fractures. Elbow radiographs showed 517 fractures. Sensitivity and NPV were moderate (80.5%, 84.7%, respectively). Specificity and PPV were high (94.9%, 93.3%, respectively). For joint effusion, sensitivity, specificity, PPV, and NPV were moderate (85.1%, 85.7%, 89.5%, 80%, respectively). For elbow dislocations, sensitivity and PPV were low (65.8%, 50%, respectively). Specificity and NPV were high (97.7%, 98.8%, respectively). Conclusions: The diagnostic performance of BoneView is promising for forearm and lower leg fractures. However, improvement is mandatory before clinicians can rely solely on AI-based paediatric fracture detection using this software. [ABSTRACT FROM AUTHOR]

Abstract Background Approach need to be considered when surgeons dealt with complex elbow injuries and the choice of the approach is a challenge for surgeons due to the complex anatomy. On the basis of releasing the lateral collateral ligament, we modified the dislocation technique to pursue the superior exposure including not only the distal humeral surface but also the anterior facet of the coronoid process. Methods A total of 4 cadaver specimens and 8 elbows were included in the study. Each cadaver provided one elbow for either the elbow dislocation approach or the posterior olecranon approach. The exposed distal articular surface of humerus, humeral capitulum, humeral trochlea, anterior trochlea of distal humerus, posterior trochlea of distal humerus and the ulnar coronoid process surface were marked by image J software and calculated for a comparison for each surgical approach. Results The total distal humeral surface was exposed as a median of 98.2 (97.6, 99.6)% and 62.0 (58.3, 64.5)% for the elbow dislocation approach and the olecranon osteotomy approach (P

OBJECTIVE: To evaluate utilization, range of mobility at the end of the follow-up, DASH scores, and the necessity for additional operations. METHODOLOGY: Twelve patients with acute or chronic elbow dislocation from Jan 2022 to March 2023 were selected for study after written consent. Sampling was done with a non-probability sampling technique. Infection and age less than 20 & more than 70 years were exclusion criteria. RESULTS: Average extension-flexion arcs at the final follow-up were 21.84-108.57 degrees, while pronation-supination motion under normal level was 10.2-120 degrees. 91.66 percent of patients achieved > 100-degree arcs of both flexion-extension. The average DASH score was 17.99. CONCLUSION: Modified IJS is an affordable method of elbow stabilization with an early range of motion, and concentric reduction is modified IJS. It is simple to use and delivers good functional results.

Background: Radial head and neck fractures are one of the common fractures of the elbow in adult patients. There are controversies in the treatment of nondisplaced head and neck fractures. However, nonoperative treatment remains a treatment choice for nondisplaced radial head fracture without motion block. Case Report: We presented a 23-year-old patient who had a bilateral nondisplaced radial head fracture. The patient was managed with conservative treatment and early elbow range of motion (ROM). Finally, the patient had a full ROM without pain in both elbows. Conclusion: Conservative management with early mobilization remains an effective approach for treating bilateral nondisplaced radial head fracture, yielding satisfactory outcomes. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to evaluate the functional outcome of type III and IV radial head fractures treated by radial head prosthesis. Material & Methods: A retrospective study included 40 patients of type III and IV radial head and neck fractures according to Mason's classification. They were admitted and treated in the Department of Orthopaedics with radial head prosthesis over the duration of 2 years. Results: Out of 40 cases, 24 cases were <40 years and 16 cases were >40years. The mean age was 36.4 years. Maximum age was 56 years, minimum age was 32 years. Majority were females as compared to males. Mechanism of injury most of the cases i.e. 70% were due to history of fall and remaining were due to RTA. 30 cases (75%) were right side dominant and 10 cases (25%) were left side dominant. In our case study group, out of 40 cases, 32 cases (80%) were under Modified Mason's classification type Ill and 8 cases (20%) were under Modified Mason's classification type IV. Out of 40 cases, 30 cases (75%) were not associated with any ligamentous injury, 4 cases of LUCL and 6 cases of MCL injury was noted. The P value of flexion, extension, pronation and supination was found to be very significant. 27 cases (67.5%) had MEPI score (Mayo Elbow Performance Index) >90 which indicates excellent result, 8 cases (20%) had MEPI score 75-89 which is good result and 5 cases (12.5%) had MEPI score 60-74 which indicates fair result. Conclusion: Radial Head Prosthesis is a viable option in communited and irreparable radial head fractures. Proper preoperative planning, good Intraoperative technique and rigorous postoperative rehabilitation give predictable results. [ABSTRACT FROM AUTHOR]

Background: Approach need to be considered when surgeons dealt with complex elbow injuries and the choice of the approach is a challenge for surgeons due to the complex anatomy. On the basis of releasing the lateral collateral ligament, we modified the dislocation technique to pursue the superior exposure including not only the distal humeral surface but also the anterior facet of the coronoid process. Methods: A total of 4 cadaver specimens and 8 elbows were included in the study. Each cadaver provided one elbow for either the elbow dislocation approach or the posterior olecranon approach. The exposed distal articular surface of humerus, humeral capitulum, humeral trochlea, anterior trochlea of distal humerus, posterior trochlea of distal humerus and the ulnar coronoid process surface were marked by image J software and calculated for a comparison for each surgical approach. Results: The total distal humeral surface was exposed as a median of 98.2 (97.6, 99.6)% and 62.0 (58.3, 64.5)% for the elbow dislocation approach and the olecranon osteotomy approach (P < 0.001), the capitulum 100% and 32.4 (28.0, 39.2)% (P < 0.001), the trochlea 93.2(90.1, 96.9)% and 72.5 (65.2, 78.8)% (P < 0.001), the anterior trochlear articular surface 96.0(93.0, 97.4)% and 50.3 (43.6, 59.1)% (P < 0.001), the posterior trochlear articular surface 95.4 (93, 100)% and 100% (P = 0.76) and the articular surface of the coronoid process of ulna 71.3 (66.0, 74.2)% and 0% (P < 0.001). Conclusion: For complex elbow fractures, the technique of elbow dislocation provides complete exposure of the distal humerus surface and a significant portion of the coronoid process surface, facilitating direct visualization for reduction and fixation. Level of evidence Anatomy Study; Cadaver Dissection. [ABSTRACT FROM AUTHOR]

Fractures around the elbow are often challenging to treat and in most cases require an extensive approach. Since the development of elbow arthroscopy, most authors have pointed out the potential advantages of a less invasive technique that can be useful for visualization and reduction of the articular fragments with an eventual percutaneous fixation. Arthroscopic techniques provide a limited exposure that may lead to a faster wound healing, lower rate of complications and thus, better recovery of range of motion. However, elbow arthroscopy is also a demanding technique, especially in a swollen and fractured joint, and it is not exempt of risks. The overall rate of complications has been rated from 1.5% to 11% and nerve injury rates from 1.26–7.5%. The objective of this review is to present the arthroscopic setup and general surgical technique for the management of elbow trauma and to define some clear indications. Patient positioning and operating room display is key in order to obtain success. In addition to the arthroscopic equipment, fluoroscopy is almost always necessary for percutaneous fixation and precise preparation is mandatory. In the last decade, literature regarding new portals or surgical tips for arthroscopic treatment of elbow fractures have been published. The main indications for fracture arthroscopic-assisted fixation are those articular fractures involving the coronoid, distal humerus shear fractures in the coronal plane (trochlear and capitellum fractures) and, more controversially, those affecting the radial head. The treatment of these type of fractures all arthroscopically is exponentially demanding as it might also require ligament repair. For coronoid fractures, it can be useful in Morrey type II and III, and O´Driscoll anteromedial facet fractures associated to a posteromedial instability pattern that also require a repair of the LCL. Although excellent results have been published, comparative series are scarce. Radial head fractures can also be approached arthroscopically in simple non-comminute fractures that can be fixed percutaneously. In conclusion, arthroscopy of the elbow is an excellent tool to better understand and visualize articular fractures of the elbow. However, despite the advances in surgical technique, whether it improves clinical and radiological results is still to be proven. [ABSTRACT FROM AUTHOR]

Background: Radial head arthroplasty is a viable option in cases with terrible triad injuries of elbow, wherein the radial head sustains significant comminution that precludes reconstruction. Nevertheless, this alternative is not recommended for individuals with poor elbow skin conditions, accompanied neuropsychiatric disorders, or low patient compliance. This case report presents a patient with bilateral terrible triad injury, along with the aforementioned conditions. The report outlines the treatment challenges of such a case and proposes potential solutions. Case presentation: A 37-year-old Persian male patient presenting with a bilateral terrible triad fracture–dislocation and a history of psychoactive substance abuse, was admitted to our emergency department. The patient underwent radial head replacement using a cement spacer containing antibiotics, due to the comminuted radial head in the presence of a contaminated wound on the left elbow. The fracture of the right side was successfully fixed. Subsequent to discharge, the patient did not attend any follow-up appointments. After a period of 6 months, he was admitted to the psychiatric ward and orthopedic consultation was requested to evaluate the patient. Conclusion: In acute terrible triad injuries with unreconstructable radial head fractures where arthroplasty with metallic prostheses may not be suitable due to contaminated wounds, unstable psychiatric condition, and low patient cooperation, temporary orthopedic cement spacers can maintain elbow biomechanics, stability, and sterility. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to describe the epidemiology, physiopathology, and outcomes of elbow "unhappy triad" trauma in children, combining a posterior dislocation, a proximal radius fracture, and a third lesion (i.e. bony or capsuloligamentous injury). Methods: A retrospective bicentric study was conducted between 1999 and 2020. All skeletally immature children who presented to the emergency department and underwent surgery for a proximal radius injury were selected. Among this selection, only patients with two associated ipsilateral elbow injuries (i.e. posterior elbow dislocation and a bony and/or capsuloligamentous injury) were included. Active elbow ranges of motion, Mayo Elbow Performance Score and Quick-Disabilities Of The Arm, Shoulder And Hand scores and standard radiographs were recorded at last follow-up. Results: Twenty-one patients met the inclusion criteria (mean age at surgery = 11.4 years) among 737 selected. The "unhappy triad" diagnosis was made preoperatively in nine cases (bone lesion only), intraoperatively in nine cases, and postoperatively in one case. The third lesions were surgically treated when the lesion was a bony fracture or if the elbow remains unstable between 60° and 90° of flexion (i.e. capsuloligamentous injury). Twenty patients were reviewed (mean follow-up = 5.8 years). The complications and re-operations rates were of 10%. Conclusion: The "unhappy" triad of the child's elbow is a rare injury, where the preoperative diagnosis is frequently missed and lead to 10% of complications and re-operations. Level of evidence: level III. [ABSTRACT FROM AUTHOR]

Post-traumatic coronoid deficiency in the elbow can lead to chronic pain, instability and arthritis. A variety of osteochondral grafts have been used to reconstruct the coronoid, and restore elbow stability. The radial head and iliac crest grafts are the most common in the literature but have limitations. The olecranon tip is a promising alternative, with both cadaveric and computer models demonstrating superior congruency, without compromising elbow stability or disrupting the extensor mechanism. We present a small, case series demonstrating the technique for contralateral and ipsilateral grafts in both the acute and chronic setting. [ABSTRACT FROM AUTHOR]

The Boyd approach is a single-incision posterior approach to the proximal radius and ulna based on a lateral anconeus muscle reflection and release of the lateral collateral ligamentous complex. This approach remains a lesser-used technique following early reports of proximal radioulnar synostosis and postoperative elbow instability. Although limited by small case series, recent literature does not support these early reported complications. This study presents a single surgeon's outcomes using the Boyd approach for the treatment of simple to complex elbow injuries. Following institutional review board approval, a retrospective review of all patients with simple to complex elbow injuries treated consecutively using a Boyd approach by a shoulder and elbow surgeon was conducted from 2016 to 2020. All patients with at least 1 postoperative clinic visit were included. Data collected included patient demographics, injury description, postoperative complications, elbow range of motion, and radiographic findings including heterotopic ossification and proximal radioulnar synostosis. Categorical and continuous variables were reported using descriptive statistics. A total of 44 patients were included with an average age of 49 years (range 13-82 years). The most commonly treated injuries were Monteggia fracture-dislocations (32%) and terrible triad injuries (18%). Average follow-up was 8 months (range 1-24 months). Final average elbow active arc of motion was from 20° (range 0°-70°) of extension to 124° (range 75°-150°) of flexion. Final supination and pronation were 53° (range 0°-80°) and 66° (range 0°-90°), respectively. There were no cases of proximal radioulnar synostosis. Heterotopic ossification contributing to less than functional elbow range of motion occurred in 2 (5%) patients who elected conservative management. There was 1 (2%) case of early postoperative posterolateral instability due to repair failure of injured ligaments that required revision using a ligament augmentation procedure. Five (11%) patients experienced postoperative neuropathy, including 4 (9%) with ulnar neuropathy. Of these, 1 underwent ulnar nerve transposition, 2 were improving, and 1 had persistent symptoms at final follow-up. This is the largest case series available demonstrating the safe utilization of the Boyd approach for the treatment of simple to complex elbow injuries. Postoperative complications including synostosis and elbow instability may not be as common as previously understood. [ABSTRACT FROM AUTHOR]

For patients with elbow pain, a comprehensive history and physical examination can identify the mechanism of injury and specific tests can help determine the underlying pathology. When imaging is indicated, x-ray typically is the initial modality. Indications for ultrasonography include the need for static, dynamic, and stress visualization of elbow cartilage, tendons, ligaments, and osseous structures. Magnetic resonance imaging study is preferred for assessment of chronic elbow pain because of its ability to detect bone marrow edema, tendinopathy, nerve entrapment, and joint effusion. In children, common elbow conditions and injuries include supracondylar fracture, posterior elbow dislocation, medial epicondyle apophysitis (Little Leaguers elbow), ulnar collateral ligament injury, and chronic lateral elbow pain. Primary and secondary bony ossification centers and the presence of growth plates affect management of these conditions in children. In adults, common conditions and injuries are radial head fractures, lateral epicondylitis, medial epicondylitis, and ulnar nerve compression. Radial head fractures are categorized according to the Modified Mason Classification. Patients with type III and IV fractures should be referred for surgical management. Lateral and medial epicondylitis are overuse injuries diagnosed based on signs and symptoms. Surgical management should be considered for patients who do not improve with conservative management. [ABSTRACT FROM AUTHOR]

Background: We report two cases of biceps brachii and brachialis paralysis due to musculocutaneous nerve injury in which elbow joint flexion was reconstructed using rotational transfer of the latissimus dorsi muscle with sutures to the radial and ulnar tuberosities, thereby enabling flexion by simultaneous activation of the humeroradial and humeroulnar joints. In cases of associated brachialis paralysis, weaker flexion strength can be expected when the forearm is in a pronated position than when it is in a supinated state. To the best of our knowledge, no previous study has reported the rotational position of the forearm during elbow joint flexion reconstruction. Case presentation: Case 1 involved a 30-year-old Asian male who presented with a rupture of the musculocutaneous, median, radial, and ulnar nerves. Reconstruction was performed by rotational transfer of the latissimus dorsi muscle. In this case, the supination and pronation flexion forces were equal. Case 2 involved a 50-year-old Asian man who presented with partial loss of the musculocutaneous nerve, biceps brachii, and pectoralis major due to debridement. Reconstruction was performed by rotational transfer of the latissimus dorsi muscle. In this case, supination and pronation flexion strengths were demonstrated to be equal. Our reconstruction method used the rotational transfer of the latissimus dorsi muscle; the distal muscle flap was divided into radial and ulnar sides to allow elbow joint flexion by simultaneously activating the humeroradial and humeroulnar joints. These sides were then fixed to the anchors at the radial and ulnar tuberosities. Finally, they were wrapped around the myotendinous junction of the biceps brachii or brachialis and secured using sutures. Conclusions: Although larger studies are required to verify these methods, this case study successfully demonstrates the following: (1) the flexion strength in the supinated position was equal to that in the pronated position; (2) the stability of the humeroradial and humeroulnar joints was unaffected by the forearm's rotational position; and (3) a satisfactory range of motion of the elbow joint was obtained, with no complications. [ABSTRACT FROM AUTHOR]