Abnormal Patterns of Biceps and Triceps Co-Contraction Following Elbow Surgery May Result in Elbow Stiffness.

Objectives: This study examines the pattern of muscular contraction and the intensity of this contraction of the biceps and triceps following elbow surgery.

Methods: We performed a prospective electromyographic study of 16 patients undergoing 19 surgical procedures on the elbow joint. We measured the resting EMG signal intensity of the biceps and triceps of the operated and the normal sides at 90 degrees.

Location of Osteochondritis Dissecans Lesions of the Capitellum.

Purpose: The location of capitellar osteochondritis dissecans (OCD) lesions in the sagittal plane guides the surgical approach, and lesion location in the coronal plane influences surgical management. Although most lesions have been reported to occur between 4 o'clock and 4:30 (120° to 135° anterior to the humerus), some lesions are located elsewhere in the capitellum. The primary aim was to define the region of the capitellum affected by OCD lesions using a novel clock-face localization system.

Nonspanning Total Wrist Arthrodesis with a Low-Profile Locking Plate.

 This study aims to compare the outcomes and complications of our technique for nonspanning total wrist arthrodesis using a locking plate with the standard carpometacarpal spanning technique.  A retrospective review of charts was performed to identify patients who underwent total wrist arthrodesis by the senior author (S.W.

Outcomes after operative treatment of elbow contractures in the pediatric and adolescent population.

Background: The role of elbow contracture release in the very young is unclear, with existing studies reporting conflicting results. This study evaluated the long-term results after open elbow contracture release in patients aged younger than 18 years.

Methods: Between 1994 and 2012, 32 patients underwent open elbow contracture release at a mean age of 13.

Injuries to the Collateral Ligaments of the Metacarpophalangeal Joint of the Thumb, Including Simultaneous Combined Thumb Ulnar and Radial Collateral Ligament Injuries, in National Football League Athletes.

Background: Thumb collateral ligament injuries occur frequently in the National Football League (NFL). In the general population or in recreational athletes, pure metacarpophalangeal (MCP) abduction or adduction mechanisms yield isolated ulnar collateral ligament (UCL) and radial collateral ligament (RCL) tears, respectively, while NFL athletes may sustain combined mechanism injury patterns.

Purpose: To evaluate the incidence of simultaneous combined thumb UCL and RCL tears among all thumb MCP collateral ligament injuries in NFL athletes on a single team.

Capitellum Fracture Fragment Excision: a Case Series.

Background: Fractures of the capitellum are rare injuries, and few studies have reported the results of fragment excision.

Questions/purposes: The purpose of this study was to determine range of motion and short-term clinical outcomes for patients treated with capitellum excision.

Methods: A retrospective review was performed to identify all patients with an isolated capitellum fracture who underwent excision as definitive treatment at our institutions.

Conservative management of elbow dislocations with an overhead motion protocol.

Purpose: To report the results of using an overhead motion protocol in 27 patients and to assess final range of motion and incidence of persistent instability in this cohort.

Methods: A total of 27 patients were included who sustained a simple elbow dislocation and were treated nonsurgically with an overhead motion protocol designed to convert gravity from a distracting to a stabilizing force. Motion was initiated within 1 week of injury and average follow-up was 29 months.

Outcomes of anconeus interposition for proximal radioulnar synostosis.

Background/hypothesis: Proximal radioulnar synostosis after elbow injuries can produce debilitating contractures. The estimated range of motion required to perform many activities of daily living is a 100° arc of forearm rotation. We hypothesized that excision of heterotopic bone and anconeus flap interposition could restore functional prono-supination in patients with proximal radioulnar synostosis.

Direct repair for managing acute and chronic lateral ulnar collateral ligament disruptions.

Purpose: Acute elbow injuries that disrupt the lateral ulnar collateral ligament and result in posterolateral rotatory instability usually require surgical treatment. The 2 technical options reported, direct repair and use of a palmaris longus tendon graft, have usually favored the use of the graft. To balance this emphasis, we report our experience with direct repair of the humeral origin in cases of trauma, whether acute, delayed, or recurrent.

Magnetic resonance imaging findings in acute elbow dislocation: insight into mechanism.

Purpose: To identify with magnetic resonance imaging the location and severity of ligamentous injury after acute elbow dislocations. Based on observations that many elbow dislocations arise from an initial acute valgus load, we hypothesized that all patients would have a high-grade medial injury but not all would demonstrate injury of the lateral ligaments.

Methods: The medial collateral ligament was subdivided into anterior bands of the anterior bundle of the medial collateral ligament (MCL) and posterior bands of the anterior bundle of the MCL, whereas the lateral collateral ligament was divided into the lateral ulnar collateral ligament and the radial collateral ligament.

An online video investigation into the mechanism of elbow dislocation.

Purpose: Acute elbow instability leading to dislocation is thought to be a spectrum initiated by an injury to the lateral stabilizing structures of the elbow. Previous cadaveric studies have shown elbow dislocations to occur in flexion. The purpose of this study was to analyze videographic evidence of the deforming forces and upper extremity position during elbow dislocations.

The influence of gravity on the unstable elbow.

Background: Safely permitting early range of motion after a destabilizing injury to the elbow is believed to optimize return of function. However, the range-of-motion exercises must be balanced against the risk of re-dislocation or subluxation. The goal of this study was to describe the position of the upper limb that permitted the greatest motion while minimizing the risk of re-dislocation or subluxation.

Indications and reoperation rates for total elbow arthroplasty: an analysis of trends in New York State.

Background: Total elbow arthroplasty was originally used to treat patients with arthritis. As familiarity with total elbow arthroplasty evolved, the indications were expanded to include other disorders. There continues to be a low number of total elbow arthroplasties performed each year in comparison with hip, knee, and shoulder arthroplasties, and few large studies have examined the indications and associated complications of total elbow arthroplasty.

Removal of locked volar plates after distal radius fractures.

Purpose: We present our experience with removal of locked volar distal radius plates and screws and note the indications for removal, types of plates removed, completeness of hardware removal, and complications occurring during plate removal.

Methods: We reviewed all distal radial volar locking plates removed at our institution from 2004 to 2009. A total of 28 patients operated on by 5 hand surgeons were identified.

Injectable collagenase clostridium histolyticum for Dupuytren's contracture.

Background: Dupuytren's disease limits hand function, diminishes the quality of life, and may ultimately disable the hand. Surgery followed by hand therapy is standard treatment, but it is associated with serious potential complications. Injection of collagenase clostridium histolyticum, an office-based, nonsurgical option, may reduce joint contractures caused by Dupuytren's disease.

Injectable hyaluronan for the treatment of carpometacarpal osteoarthritis: open label pilot trial.

Objective: Carpometacarpal osteoarthritis (CMC OA) is highly prevalent in older adults, and is often unresponsive to medical treatment. Intra-articular Hylan G-F 20 has been shown to improve pain and function in patients with knee OA; however, its effectiveness in CMC OA is less clear.

Methods: 32 patients with CMC OA were injected with Hylan G-F 20, once weekly for three consecutive weeks.

Outcome of open release for post-traumatic elbow stiffness.

Background: Post-traumatic elbow stiffness can be caused by a tether and/or a block, and these structures can exist both anteriorly and posteriorly about the joint to prevent motion. The purpose of this article is to report the outcome of elbow release performed for post-traumatic stiffness by a single surgeon.

Methods: A retrospective review of charts and radiographs was performed on 52 case of patients who underwent open surgical treatment for post-traumatic elbow contracture by the senior author (RHN).

Can the carpometacarpal joint be injected accurately in the office setting? Implications for therapy.

Objective: To investigate whether carpometacarpal (CMC) injections can be performed accurately in the office setting in patients with moderate to severe CMC osteoarthritis (OA).

Methods: Patients were recruited from rheumatology and hand surgical practices as part of an open label trial of hylan G-F 20 for CMC OA. CMC injections were performed without radiologic guidance, using anatomic landmarks to guide needle placement.

Lateral elbow instability: nonoperative, operative, and postoperative management.

The purpose of this article is to present a treatment approach that has been found to be effective in the early management of lateral elbow instability. Anatomy and joint mechanics related to stability of the elbow are reviewed. Operative and nonoperative treatment is outlined followed by a description of an innovative paradigm for the rehabilitation of elbow instability.

Locking horizontal mattress suture.

The horizontal mattress suture is useful in wounds in which there is a need for wound edge compression to provide hemostasis, closure is under moderate tension, or edge eversion is important. Its primary disadvantage is difficult suture removal and precise wound edge apposition. We describe a locking horizontal mattress technique that facilitates suture removal and provides more control over wound edge placement while providing hemostasis, tensile strength, and eversion.

Recalcitrant nonunion of the distal humerus: treatment with free vascularized bone grafting.

Unlabelled: We sought to determine whether open reduction and internal fixation in combination with free vascularized bone grafting and elbow contracture release is an effective treatment for patients with recalcitrant distal humeral nonunions with segmental bone loss. In addition, we wondered whether this treatment strategy has an acceptable complication rate. Five patients, with an average age of 48 years, form the basis of our study.

Hinged elbow external fixation for severe elbow contracture.

Background: When it was first introduced, it was hoped that hinged external fixation with a built-in gear mechanism for applying passive motion and static progressive stretch by turning a dial would improve the arc of ulnohumeral motion, by gradually stretching contracted muscles, after open release of a severe elbow contracture.

Methods: Forty-two patients were evaluated at an average of thirty-nine months after operative release of a severe posttraumatic elbow contracture (defined as < or =40 degrees of motion). Twenty-three patients had been treated, during the early part of the study, with a hinged external fixator that incorporated a worm gear to apply static progressive stretch postoperatively.