MRI of the Elbow - Update 2024.

Elbow pain can result in significant morbidity. MRI can help diagnosing the cause of elbow pain.Based on a systematic literature search as well as knowledge gained through frequent participation in conferences dedicated to advances in musculoskeletal imaging, this review aims to give a brief overview of normal anatomy and common pathologies of tendons and ligaments of the elbow on magnetic resonance imaging.

Successful Implant Retention in a Chronified Hematogenous Bilateral Periprosthetic Hip Joint Infection With .

We present a case with bilateral hematogenous hip periprosthetic joint infection with Enterococci which could be treated successfully with implant retention despite chronification and partial loosening. A debridement and replacement of the modular components was carried out with replacement of a loose acetabular cup on the right side. Considering poor local infection control, antibiotic treatment was enhanced by local application of vancomycin.

Functional and Radiologic Outcomes of Degenerative Versus Traumatic Full-Thickness Rotator Cuff Tears Involving the Supraspinatus Tendon.

Background: Arthroscopic rotator cuff repair (ARCR) is among the most commonly performed orthopaedic procedures. Several factors-including age, sex, and tear severity-have been identified as predictors for outcome after repair. The influence of the tear etiology on functional and structural outcome remains controversial.

Early failure of a highly cross-linked polyethylene inlay after total hip arthroplasty probably due to insufficient irradiation.

Highly cross-linked polyethylene (XLPE) is a major advance in total hip arthroplasty (THA), as it suffers from less wear and thus is associated with lower revision rates than standard ultra-high molecular weight polyethylene. Early failures are reported rarely, and associated with specific design or manufacturing issues. We report a case requiring early revision due to adverse reaction to polyethylene particles.

Fluoroscopy-guided vs. navigated iliosacral screw placement with intraoperative 3D scan or postoperative CT control: Impact of the clinical workflow on patients' radiation exposure: Radiation exposure of different workflows for iliosacral screw placement.

Introduction: To guide iliosacral screws (ISS) and verify safe placement different techniques, e.g. Fluoroscopy-guided (FSG) or 3D navigation are known.

The surgical management of highly unstable fragility fractures of the sacrum with spinopelvic dissociation: A case series and proposal of a surgical treatment algorithm.

Introduction: U- and H-shaped fragility fractures of the sacrum (FFP IVb) are unstable fractures. Non-operative treatment may be associated with impaired walking abilities, chronic pain and the potential loss of independency. However, different treatment options are still controversially debated.

The impact of the fluoroscopic view on radiation exposure in pelvic surgery: organ involvement, effective dose and the misleading concept of only measuring fluoroscopy time or the dose area product.

Introduction: Minimally invasive fluoroscopy-guided screw fixation is an established technique to stabilize fractures of the posterior pelvic ring in orthopaedic surgery. However, safe placement of the screws may be associated with prolonged intervention time and extensive fluoroscopy is a concern. In the current literature, the dose area product (DAP) and fluoroscopy time are often used to describe radiation exposure of the patient.

Protective effects of new femoral reaming techniques (Reamer irrigator aspirator, RIA I and II) on pulmonary function and posttraumatic contusion (CT morphology) - results from a standardized large animal model.

Introduction: The effects of reaming for preparation of intramedullary fixation in long bone fractures have been widely studied. We compared pulmonary and systemic effects between conventional reaming with reamer irrigator aspirator and unreamed nailing in an acute porcine trauma model with a standardized femur fracture.

Materials And Methods: In a standardized porcine model, (moderate blunt chest trauma, abdominal injury and femoral shaft fracture), the femur was submitted to intramedullary nailing after resuscitation and normalization of pulmonary function.

Use of cortical buttons for the fixation of the distal biceps tendon in combination with the double-incision technique-the relationship between the drill trajectory and the proximity to the posterior interosseous nerve: a cadaveric study.

Background: The aim of this cadaveric study was to investigate different defined drill trajectories through the radial tuberosity for the placement of a cortical button and their proximity to the posterior interosseous nerve (PIN) by using the double-incision technique.

Methods: A total of 10 elbows from 5 fresh entire cadavers were used in this study. Detachment of the distal biceps tendon was performed to simulate its rupture.

Nonoperative Treatment of Midshaft Clavicle Fractures in Adults.

Clavicle fractures are among the most common skeletal injuries accounting for 2-5% of all adult fractures. Historically, nonoperative treatment of midshaft clavicular fractures was considered the gold standard of care. Furthermore, nonoperative treatment has been challenged by an increasing popularity and rate of surgical fixations in recent years despite a lack of clear evidence in the current literature.

Reverse shoulder arthroplasty for complex fractures of the proximal humerus in elderly patients: impact on the level of independency, early function, and pain medication.

Background: This study investigated early functional outcome, quality of life, and the level of independency in elderly patients after primary reverse shoulder arthroplasty (RSA) for complex fractures of the proximal humerus.

Methods: This was a prospective case series that included 33 patients, aged ≥70 years, with a high level of independency who received RSA for complex fractures of the humerus (Orthopaedic Trauma Association B2/C) from January 2012 to April 2014.

Results: Level of independency, quality of life (Short Form 36 Health Survey score), early functional outcome (Constant-Murley score, Disabilities of the Arm, Shoulder and Hand Outcome Measure), and pain medication (World Health Organization grading) were obtained at the 6-month follow-up and 1 year after surgery.

Effect of Mirrored Views on Endoscopic and Arthroscopic Skill Performance.

Background: Arthroscopic procedures may be technically challenging because of impaired vision, limited space, and the 2-dimensional vision of a 3-dimensional structure. Spatial orientation may get more complicated when the camera is pointing toward the surgeon.

Hypothesis: Spatial orientation and arthroscopic performance may be improved by simply mirroring the image on the monitor in different configurations regarding the position and orientation of camera and instrument.

Minimally invasive lateral plate placement for metadiaphyseal fractures of the humerus and its implications for the distal deltoid insertion- it is not only about the radial nerve. A cadaveric study.

Introduction: Minimally invasive lateral placement of plates on the humerus may be associated with a risk of injury to the radial nerve. Whereas this potential complication has been investigated in several studies, there is no data regarding potential injuries to the distal insertion of the deltoid muscle when the plates are passed distally in a submuscular tunnel.

Methods: Minimally invasive plate placement was performed on eight arms in fresh cadavers.

The extended medial elbow approach-a cadaveric study.

Background: The two most commonly used approaches to expose medial elbow structures are the flexor carpi ulnaris split and the Hotchkiss over-the-top approach. The aim of this study was to define the extended medial approach to the elbow, featuring advantages of over-the-top (proximal exposure) and additional complete exposure of the coronoid and proximal medial ulna, while respecting the internervous plane between the flexor pronator mass and flexor carpi ulnaris muscle.

Methods: In this comparative anatomic study, 12 fresh frozen cadaveric elbows were dissected alternately to study the distal limitation and exposed area of the extended medial elbow approach compared with splitting the flexor carpi ulnaris.

Deltoid Tuberosity Index: A Simple Radiographic Tool to Assess Local Bone Quality in Proximal Humerus Fractures.

Background: Osteoporosis may complicate surgical fixation and healing of proximal humerus fractures and should be assessed preoperatively. Peripheral quantitative CT (pQCT) and the Tingart measurement are helpful methods, but both have limitations in clinical use because of limited availability (pQCT) or fracture lines crossing the area of interest (Tingart measurement). The aim of our study was to introduce and validate a simple cortical index to assess the quality of bone in proximal humerus fractures using AP radiographs.

Inferior results of salvage arthrodesis after failed ankle replacement compared to primary arthrodesis.

Background: Up to now, there has been no evidence that salvage arthrodesis would perform inferior when compared with primary ankle arthrodesis. The purpose of this study was to compare their clinical and radiographic results.

Methods: A retrospective analysis was performed using 2 validated scores and assessment of radiographic union by comparing 23 patients who underwent salvage ankle arthrodesis (group SA = salvage arthrodesis) after failed total ankle replacement with 23 matched patients who received primary ankle arthrodesis (group PA = primary arthrodesis).

How many radiographs are needed to detect angular stable head screw cut outs of the proximal humerus - a cadaver study.

Introduction: Cut out of locking head screws is the most common complication of locking plates in fracture fixation of the proximal humerus with potentially disastrous consequences. Aim of the study was to find the single best and combination of radiographic projections to reliably detect screw cut outs.

Materials And Methods: The locking plate was fixed to six cadaveric proximal humeri.

Primary stability and stiffness in ankle arthrodes-crossed screws versus anterior plating.

Background: Ankle arthrodesis is commonly used for the treatment of osteoarthritis or failed arthroplasty. Screw fixation is the predominant technique to perform ankle arthrodesis. Due to a considerable frequency of failures research suggests the use of an anatomically shaped anterior double plate system as a reliable method for isolated tibiotalar arthrodesis.

Endostatin inhibits Callus remodeling during fracture healing in mice.

Information on the impact of endogenous anti-angiogenic factors on bone repair is limited. The hypothesis of the present study was endostatin, an endogenous inhibitor of angiogenesis, disturbs fracture healing. We evaluated this hypothesis in a closed femoral fracture model studying two groups of mice, one that was treated by a daily injection of 10 µg recombinant endostatin subcutaneously (n = 38) and a second one that received the vehicle for control (n = 37).

Short- or long-stem prosthesis for intramedullary bypass of proximal humeral fractures with severe metaphyseal bone loss: evaluation of primary stability in a biomechanical model.

Background: Proximal humeral fractures with substantial metaphyseal comminution are challenging to treat. In the elderly with osteoporotic bone, arthroplasty sometimes remains the only valuable option; however, the minimally required length of stem fixation is not known. The aim of this study was to investigate the primary stability of cemented short- and long-stem prostheses with different intramedullary fracture bypass lengths.

Early detection of subclinical organ dysfunction by microdialysis of the rectus abdominis muscle in a porcine model of critical intra-abdominal hypertension.

The aim of this study was to evaluate microdialysis of the rectus abdominis muscle (RAM) for early detection of subclinical organ dysfunction in a porcine model of critical intra-abdominal hypertension (IAH). Microdialysis catheters for analyses of lactate, pyruvate, and glycerol levels were placed in cervical muscles (control), gastric and jejunal wall, liver, kidney, and RAM of 30 anesthetized mechanically ventilated pigs. Catheters for venous lactate and interleukin 6 samples were placed in the jugular, portal, and femoral vein.

The varus ankle and instability.

Varus ankle associated with instability can be simple or complex. Multiple underlying diseases may contribute to this complex pathologic entity. These conditions should be recognized when attempting proper decision-making.

C-clamp and pelvic packing for control of hemorrhage in patients with pelvic ring disruption.

Background: Exsanguinating hemorrhage is the major cause of death in patients with pelvic ring disruption.

Aims: The aim of this study was to document outcomes after the stabilization of pelvic ring injuries by a C-clamp and control of hemorrhage by pelvic packing. Physiological parameters were tested as prognostic factors.