Injury complexity factors predict heterotopic ossification restricting motion after elbow trauma.

Background: Heterotopic ossification (HO) is a common extrinsic cause of elbow stiffness after trauma. However, factors associated with the development of HO are incompletely understood.

Questions/purposes: We retrospectively identified (1) patient-related demographic factors, (2) injury-related factors, and (3) treatment-related factors associated with the development of HO severe enough to restrict motion after surgery for elbow trauma.

A comparison of the long-term outcome of partial articular (AO Type B) and complete articular (AO Type C) distal radius fractures.

Purpose: A short-term comparison of AO type B (shearing) and type C (compression) articular fractures of the distal radius found no significant differences in functional outcome, but long-term studies would provide important information. We tested the null hypothesis that there is no difference in arm-specific disability between patients with type B and C fractures in long-term follow-up.

Methods: We evaluated 46 patients (17 with type B fractures and 29 patients with 31 type C fractures of the distal radius) with a mean age of 39 years at the time of injury at a mean of 20 years after operative treatment.

Temporary joint-spanning external fixation before internal fixation of open intra-articular distal humeral fractures: a staged protocol.

Introduction: This study determined outcomes after temporary joint-spanning external fixation before internal fixation of open intra-articular distal humeral fractures.

Materials And Methods: A retrospective case analysis was done of all patients who were treated between 2000 and 2008 in 3 level I trauma centers with temporary joint-spanning external fixation before internal fixation of an open intra-articular distal humeral fracture. Healing rates, complications, Disabilities of Arm, Shoulder and Hand (DASH), and Smith and Cooney outcome scores were documented.

Predictors of diagnosis of ulnar neuropathy after surgically treated distal humerus fractures.

Purpose: Ulnar nerve dysfunction is a common sequela of surgical treatment of distal humerus fractures. This study addresses the null hypothesis that different types of distal humerus injuries have comparable rates of diagnosis of ulnar neuropathy.

Methods: We assessed diagnosis of ulnar neuropathy in 107 consecutive adults who had a surgically treated fracture of the distal humerus followed up at least 6 months after injury.

A prospective randomized controlled trial of dynamic versus static progressive elbow splinting for posttraumatic elbow stiffness.

Background: Both dynamic and static progressive (turnbuckle) splints are used to help stretch a contracted elbow capsule to regain motion after elbow trauma. There are advocates of each method, but no comparative data. This prospective randomized controlled trial tested the null hypothesis that there is no difference in improvement of motion and Disabilities of the Arm, Shoulder and Hand (DASH) scores between static progressive and dynamic splinting.

Diagnostic accuracy of 2- and 3-dimensional imaging and modeling of distal humerus fractures.

Purpose: This investigation used prospectively recorded intraoperative evaluation as the reference standard for distal humerus fracture type and characteristics, in order to measure the diagnostic performance characteristics of computed tomography (CT) and physical models. In secondary analyses, we assessed the reliability of classification.

Methods: Thirty-five fractures were evaluated by the treating surgeon and first assistant on radiographs and 2-dimensional CT (2DCT) images first; a second time based on radiographs and 2- and 3-dimensional CT (3DCT) images; a third time based on 2- and 3DCT as well as 3D physical models; and a fourth time based on intraoperative visualization of the fracture characteristics.

Quantitative 3-dimensional computed tomography measurement of distal humerus fractures.

Purpose: To measure the average number, size, shape and articular surface area of articular fracture fragments of the distal humerus using quantitative analysis of 3-dimensional computed tomography (3DCT) images.

Materials And Methods: Forty-eight computed tomography scans of distal humerus fractures were analyzed with quantitative 3DCT (Q3DCT). Twenty-one patients had a capitellum and trochlea fracture, and 27 patients had bicolumnar fractures of the distal humerus.

Nonunion of operatively treated capitellum and trochlear fractures.

Purpose: To test the hypothesis that comminuted fractures of the capitellum and trochlea with posterior comminution (Dubberley type 3B) have a greater risk of nonunion than other types of capitellum and trochlea fractures.

Methods: We observed 30 patients with operatively treated fractures of the capitellum and trochlea for an average of 34 months (range, 12-75 mo). We compared 18 fractures with comminution of the capitellum and trochlea and posterior comminution (type 3B according to Dubberley and colleagues) with 12 fractures consisting of single large anterior fracture fragments with (6 patients; Dubberley type 2B) or without (6 patients; Dubberley type 2A) posterior comminution.

Resection of heterotopic ossification of the elbow: a comparison of ankylosis and partial restriction.

Purpose: This study tests the hypothesis that the results of release of elbow stiffness related to heterotopic ossification (HO) are comparable whether there is partial or complete restriction (ankylosis) of flexion and extension.

Methods: Eighteen patients who had surgical release of complete bony ankylosis between the humerus and ulna were retrospectively compared to 27 matched patients who had surgical release of partial restriction of elbow flexion and extension related to HO. Patients were evaluated a minimum of 10 months after surgery, using the Disabilities of the Arm, Shoulder, and Hand questionnaire and the Broberg and Morrey rating system.

Loss of anterior translation of the distal humeral articular surface is associated with decreased elbow flexion.

Purpose: The normal anterior translation of the articular surface of the distal humerus with respect to the humeral diaphysis facilitates elbow flexion. We hypothesize that there is a correlation between anterior translation of the distal humeral articular surface and flexion after open reduction and internal fixation (ORIF) of a fracture of the distal humerus.

Methods: Two independent observers evaluated 141 lateral radiographs of patients more than 6 months after fracture of the distal humerus and 155 lateral radiographs of patients without injury of the distal humerus.

Magnetic resonance imaging signal abnormalities in enthesopathy of the extensor carpi radialis longus origin.

Purpose: Some surgeons use magnetic resonance imaging (MRI) findings in patients with enthesopathy of the extensor carpi radialis brevis (ECRB) origin (commonly referred to as lateral epicondylitis) to plan and justify surgical treatment. Overinterpretation of defects of the origin of the ECRB or associated abnormalities of the lateral collateral ligament (LCL) could affect decision-making. We tested the hypothesis that patients with MRI signal abnormalities consistent with enthesopathy of the ECRB are equally likely to have findings consistent with an ECRB defect or LCL abnormality whether they are being evaluated as part of preoperative planning for lateral elbow pain or for an elbow condition that does not feature lateral elbow pain.

Fractures of the medial column of the distal humerus in adults.

Purpose: Medial column fractures of the distal humerus are uncommon in adults. Among 26 patients identified in the English language literature, only 2 had articular fragmentation. We reviewed the experience of 2 trauma centers with isolated medial column fractures to evaluate our impression that these fractures often involve complex articular fragmentation.

Long-term outcome of operatively treated fracture-dislocations of the olecranon.

Objectives: To report the long-term results of operative treatment of anterior and posterior olecranon fracture-dislocations and compare them with the results recorded fewer than 2 years after surgery.

Design: Retrospective case series with long-term evaluation.

Setting: Level I trauma center.