Selecting the diameter of a radial head implant: an assessment of local landmarks.

Introduction: Little information exists on radial head implant diameter sizing methods. When the native head is absent due to extensive comminution or previous excision, the lesser sigmoid notch may be a useful landmark for sizing. We evaluated the reliability of native radial head measurements, and the lesser sigmoid notch, as landmarks for radial head implant diameter sizing.

Identifying the location and volume of bony impingement in elbow osteoarthritis by 3-dimensional computational modeling.

Purpose: To determine the locations and volumes of bone requiring resection to restore range of motion in patients with osteoarthritis of the elbow, using computational modeling.

Methods: A total of 30 patients with primary osteoarthritis of the elbow and restricted range of motion underwent computed tomography. We used the computed tomography data to generate 3-dimensional models.

The bicipital tuberosity and distal radius are unreliable landmarks for radial head implant alignment.

Background: As more anatomic asymmetric radial head implants emerge, it is necessary to determine the optimal landmarks to ensure correct rotational orientation. The bicipital tuberosity and distal radius are possible bony landmarks that can be used for rotational alignment of asymmetric prostheses; however, they have not been validated. The purpose of this study was to evaluate the reliability of the bicipital tuberosity and distal radius as rotational landmarks for orientation of asymmetric radial head prostheses.

Comparison of lesser tuberosity osteotomy to subscapularis peel in shoulder arthroplasty: a randomized controlled trial.

Background: Controversy exists regarding the optimal technique of subscapularis tendon mobilization during shoulder arthroplasty. The purpose of the present randomized double-blind study was to compare two of these techniques-lesser tuberosity osteotomy and subscapularis peel-with regard to muscle strength and functional outcomes.

Methods: Patients undergoing shoulder arthroplasty were randomized to undergo either a lesser tuberosity osteotomy or a subscapularis peel.

Classic versus congruent coracoid positioning during the Latarjet procedure: an in vitro biomechanical comparison.

Purpose: The purpose of this biomechanical study was to compare the classic Latarjet technique and congruent-arc modification with respect to glenohumeral stability, joint stiffness, translation, and range of motion.

Methods: Eight cadaveric forequarters were tested on a shoulder simulator that applied loads independently to the conjoint tendon, long head of biceps, rotator cuff, and deltoid. The test conditions included: intact, 30% glenoid defect, and reconstruction of the defect with the classic and congruent Latarjets.

Surgical Technique for Single and Double-Incision Method of Acute Distal Biceps Tendon Repair.

Introduction: Distal biceps tendon ruptures can be repaired with either a single or a double-incision technique.

Step 1 Single-incision Technique Surgical Exposure And Preparation Of The Tendon: Through a single anterior incision, identify the tendon and debride the distal degenerated portion.

Step 2 Single-incision Technique Preparation Of The Radius: Expose the bicipital tuberosity and prepare the bone for insertion of suture anchors.

Proximal humerus cortical bone thickness correlates with bone mineral density and can clinically rule out osteoporosis.

Background: Bone mineral density measurements with dual-energy x-ray absorptiometry (DXA) are commonly used to diagnose osteoporosis and assess fracture risk. This study describes the association between radiographic measures of proximal humeral cortical bone thickness and bone mineral density measured by DXA. The study also assesses the discriminative capability of clinical cortical bone thickness measurements at the proximal humerus to differentiate patients with osteoporosis.

Radial head fractures.

Fractures of the radial head are the most common fractures in the elbow, and they frequently have associated ligamentous, cartilaginous, or other bony injuries. Clinical assessment and radiological investigation allow for accurate diagnosis and the formulation of a management plan. Undisplaced or minimally displaced fractures with no rotational block to motion can be treated nonoperatively with excellent results expected.

The shoulder remplissage procedure for Hill-Sachs defects: does technique matter?

Background: This biomechanical study evaluated the effects of 3 remplissage techniques on shoulder stability and motion in a Hill-Sachs (HS) instability model.

Materials And Methods: Cadaveric forequarters were tested on an active shoulder simulator. Three remplissage techniques were performed for 15% and 30% HS defects.

Landmarks for rotational alignment of the humeral component during elbow arthroplasty.

Background: The reference points for rotational orientation of the humeral component during elbow arthroplasty typically are on the articular surface or the humeral epicondyles. With bone loss, these landmarks may be compromised. Our purpose was to assess whether the flat posterior humeral cortex proximal to the olecranon fossa is a reliable landmark with which to orient the humeral component during elbow arthroplasty.

Do the traditional and modified latarjet techniques produce equivalent reconstruction stability and strength?

Background: The Latarjet procedure has been described as a reconstructive option for instability associated with substantial glenoid bone defects. A modification, termed the Congruent-Arc, is thought to improve glenoid reconstruction through better articular congruency and greater bone reconstitution. The strengths of these techniques, however, have not been reported.

Does the dynamic sling effect of the Latarjet procedure improve shoulder stability? A biomechanical evaluation.

Introduction: Glenohumeral instability with glenoid bone loss is commonly treated with the Latarjet procedure. The procedure involves transfer of the coracoid and conjoint tendon, which is thought to provide a stabilizing sling effect; however, its significance is unknown. This study evaluated the effects of the Latarjet procedure, with and without conjoint tendon loading, on shoulder stability and range of motion (ROM).

Regional variations in radial head bone volume and density: implications for fracture patterns and fixation.

Background: Fractures of the radial head are common with most partial articular fractures resulting in an anterolateral fragment. The exact mechanism of radial head fracture is unknown; however, forces transmitted and variations in local bone density are believed important. This study quantifies the regional variations in bone density and volume of the radial head to better understand the pathomechanics of fracture patterns.

Rehabilitation of the medial- and lateral collateral ligament-deficient elbow: an in vitro biomechanical study.

Design: In vitro biomechanical research using an elbow motion simulator.

Introduction: The optimal rehabilitation of elbow dislocations with medial collateral ligament (MCL) and lateral collateral ligament (LCL) injuries has not been defined.

Purpose: To determine a safe rehabilitation protocol for elbow dislocations with MCL and LCL injuries.

Healing rates and subscapularis fatty infiltration after lesser tuberosity osteotomy versus subscapularis peel for exposure during shoulder arthroplasty.

Background: Controversy exists regarding the optimal technique of subscapularis mobilization during shoulder arthroplasty. The purpose of this study was to compare healing rates and subscapularis fatty infiltration in patients undergoing a lesser tuberosity osteotomy (LTO) versus subscapularis peel for exposure during shoulder arthroplasty.

Materials And Methods: Eighty-seven patients, with a mean age of 67.

Single versus double-incision technique for the repair of acute distal biceps tendon ruptures: a randomized clinical trial.

Background: This clinical trial was done to evaluate outcomes of the single and double-incision techniques for acute distal biceps tendon repair. We hypothesized that there would be fewer complications and less short-term pain and disability in the two-incision group, with no measureable differences in outcome at a minimum of one year postoperatively.

Methods: Patients with an acute distal biceps rupture were randomized to either a single-incision repair with use of two suture anchors (n = 47) or a double-incision repair with use of transosseous drill holes (n = 44).

The effect of the remplissage procedure on shoulder stability and range of motion: an in vitro biomechanical assessment.

Background: The remplissage procedure may be performed as an adjunct to Bankart repair to treat recurrent glenohumeral dislocation associated with an engaging Hill-Sachs humeral head defect. The purpose of this in vitro biomechanical study was to examine the effects of the remplissage procedure on glenohumeral joint motion and stability.

Methods: Cadaveric shoulders (n = 8) were mounted on a biomechanical testing apparatus that applies simulated loads to the rotator cuff and the anterior, middle, and posterior heads of the deltoid muscle.

Analysis of Radial Head Implant Length with Use of Contralateral Elbow Radiographs.

Introduction: This article describes a technique in which measurements are obtained from radiographs of the contralateral, normal elbow to predict the magnitude of overlengthening resulting from use of a metallic radial head prosthesis.

Step 1 Obtain Bilateral Elbow Radiographs: Obtain bilateral digital anteroposterior radiographs of the elbows that are orthogonal to the forearm in 45° of flexion and neutral forearm rotation.

Step 2 Perform Radiographic Measurements Of The Contralateral Normal Elbow: Draw the angle on the radiograph of the normal elbow.

The influence of proximal ulnar morphology on elbow range of motion.

Background: Physiologic dorsal apex angulation of the proximal ulna is present in 96% of the population. We hypothesize that a correlation exists between the physiologic dorsal ulnar angulation and elbow range of motion (ROM).

Methods: Fifty healthy adults underwent bilateral lateral elbow radiographs in neutral forearm rotation in the following positions: terminal flexion (TF), 90° of flexion, and terminal extension (TE).

Incidence of elbow dislocations in the United States population.

Background: There is minimal published information regarding the epidemiology of simple elbow dislocations. The purpose of this study was to report the estimated incidence of elbow dislocations in the United States, with use of the National Electronic Injury Surveillance System (NEISS) database.

Methods: The NEISS database includes 102 hospitals representing a random sampling of all patients presenting to U.

Evidence-based indications for elbow arthroscopy.

Purpose: The purpose was to review the literature on the outcomes of elbow arthroscopy and to make evidence-based recommendations for or against elbow arthroscopy for the treatment of various conditions. Our hypothesis was that the evidence would support the use of elbow arthroscopy in the management of common elbow conditions.

Methods: A literature search was performed by use of the PubMed database in October 2010.

Rehabilitation considerations in the management of terrible triad injury to the elbow.

An elbow dislocation associated with a radial head and coronoid fractures is termed a terrible triad. This injury almost always renders the elbow unstable requiring surgical intervention. The primary goal of surgery is to stabilize the elbow to permit early motion to prevent stiffness.

Moderate to large engaging Hill-Sachs defects: an in vitro biomechanical comparison of the remplissage procedure, allograft humeral head reconstruction, and partial resurfacing arthroplasty.

Background: The management of engaging Hill-Sachs defects (HSD) is controversial. The purpose of this study was to biomechanically compare 3 treatment strategies.

Materials And Methods: Eight specimens were tested on a shoulder simulator.

An off-loading triceps suture for augmentation of plate fixation in comminuted osteoporotic fractures of the olecranon.

Comminuted osteoporotic olecranon fractures in the elderly are relatively common. Open reduction and internal plate fixation is a frequently used treatment option. In highly comminuted osteoporotic bone, fixation may be tenuous leading to an increased risk of fixation failure with loss of reduction and displacement of fracture fragments.