Intra-articular distal humerus fractures present various challenges with a wide array of treatment options. Open reduction internal fixation remains the treatment of choice. In older patient populations with poor bone quality and short-end segment fractures with articular comminution, open reduction internal fixation, however, may bring on unsurmountable technical challenges. Total elbow arthroplasty and elbow hemiarthroplasty (EHA) may offer superior functional outcomes in these cases. During EHA for fractures, the medial and lateral columns are reconstructed with the collateral ligaments to restore elbow stability. We hypothesize that in coronal sheer fracture patterns where the columns are intact, maintaining the native collateral ligaments and columns will provide both an anatomic and stable elbow joint. We introduce the ligament sparing EHA technique for unreconstructible coronal shear fractures. We describe this novel technique and compare our postoperative outcomes in 2 patients who underwent this surgery to those described in the literature. The postoperative Disabilities of the Arm, Shoulder, and Hand scores for the 2 patients were 13.8 and 10.3, respectively. The Mayo Elbow Performance Score for the 2 patients were 80 and 85, respectively. The operative arm presented a grip strength of 82% and 89% when compared with the contralateral arm, for the patients respectively. The range of motion varied between 78% and 100% of the contralateral arm for both patients. Although our results are promising and the ligament sparing EHA technique may be a more anatomic option in certain fracture patterns, further research with larger cohorts and multiple surgeons is needed to reinforce our results.
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http://dx.doi.org/10.1097/BTH.0000000000000469 | DOI Listing |
Am J Sports Med
January 2025
Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Background: Anterior cruciate ligament (ACL) injuries are common in pediatric and adolescent patients. Understanding this population's injury characteristics and treatment strategies is vital for managing this high-risk group.
Purpose: To report the descriptive epidemiology and treatment strategies of a large cohort of skeletally immature patients with complete ACL tears.
Clin Pract
December 2024
Complex Operational Unit of Sports Traumatology and Joint Reconstruction, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy.
Multi-ligament reconstruction in adolescent patients affected by congenital femoral deficiency is an extremely rare and delicate surgical procedure. There are very few reported cases of complete anterior and posterior cruciate ligament agenesis in these patients. We present a complex case of a 16-year-old girl affected by congenital femoral deficiency and ipsilateral tibial hypoplasia who was treated successfully for a complete agenesis of the anterior (ACL) and posterior (PCL) cruciate ligament with single-sitting ACL and PCL reconstruction.
View Article and Find Full Text PDFJ Clin Med
December 2024
Department of Orthopedics, Akron Children's Hospital, Akron, OH 44307, USA.
The management of anterior cruciate ligament (ACL) injuries in pediatric patients presents unique challenges due to the presence of open growth plates in the proximal tibia and distal femur. Delaying ACL reconstruction until skeletal maturity may protect the physes but increases the risk of secondary injuries, such as meniscal tears and chondral damage, due to prolonged joint instability. Conversely, early surgical intervention restores knee stability but raises concerns about potential growth disturbances, including leg-length discrepancies and angular deformities.
View Article and Find Full Text PDFJ Pers Med
November 2024
Center for Diagnostic and Interventional Radiology and Nuclear Medicine, Charité-University Medicine Berlin, 10117 Berlin, Germany.
There remains considerable debate regarding the optimal management of anterior cruciate ligament (ACL) injuries in skeletally immature patients. This study aims to evaluate the clinical outcomes of transphyseal ACL reconstruction in patients with open growth plates. This retrospective study included skeletally immature patients with full-thickness ACL tears and confirmed open physis.
View Article and Find Full Text PDFArthrosc Tech
November 2024
Arthroscopy and Arthroplasty Unit, RNH Hospital, Nagpur, India.
Anterior cruciate ligament avulsion fractures are more commonly seen in children with open physes than in adults. Arthroscopic fixation is considered the gold standard in the management of such injuries. Our technique of anterior-row fixation for these injuries provides various advantages in the form of physeal-sparing, complete anatomic reduction with no anterior beaking, no arthrofibrosis, no residual instability, no intra-articular hardware, no need for a second operation to remove implants, and finally, a full range of movement with no loss of extension.
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