Prosthetic resurfacing of engaging posterior capitellar defects in recurrent posterolateral rotatory instability of the elbow.

IF 1.8 Q2 ORTHOPEDICS
Dani Rotman, Jorge Rojas Lievano, Shawn W O'Driscoll
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引用次数: 1

Abstract

Background: Posterolateral rotatory instability (PLRI) is a common mechanism of recurrent elbow instability. While the essential lesion is a deficiency in the lateral ulnar collateral ligament (LUCL), there are often associated concomitant bony lesions, such as an Osborne-Cotterill lesions (posterior capitellar fractures) and marginal radial head fractures, that compromise stability. Currently, there is no standard treatment for posterior capitellar deficiency associated with recurrent PLRI.

Methods: We conducted a retrospective review of five patients with recurrent PLRI of the elbow associated with a posterior capitellar impaction fracture engaging with the radial head during normal range of motion. The patients were treated surgically with LUCL reconstruction or repair and off-label reconstruction of the capitellar joint surface using a small metal prosthesis designed for metatarsal head resurfacing (HemiCAP toe classic).

Results: Five patients (three adolescent males, two adult females) were treated between 2007 and 2018. At a median follow-up of 5 years, all patients had complete relief of their symptomatic instability. No patients had pain at rest, but two patients had mild pain (visual analog scale 1-3) during physical activity. Three patients rated their elbow as normal, one as almost normal, and one as greatly improved. On short-term radiographic follow-up there were no signs of implant loosening. None of the patients needed reoperation.

Conclusions: Recurrent PLRI of the elbow associated with an engaging posterior capitellar lesion can be treated successfully by LUCL reconstruction and repair and filling of the capitellar defect with a metal prosthesis. This treatment option has excellent clinical results in the short-medium term. Level of evidence: IV.

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肘关节后外侧旋转不稳复发性后小头缺损的修复。
背景:后外侧旋转不稳定(PLRI)是复发性肘关节不稳定的常见机制。虽然主要病变是外侧尺侧副韧带(LUCL)缺陷,但通常伴有骨病变,如osborn - cotterill病变(后小头骨折)和桡骨头边缘骨折,会损害稳定性。目前,对于复发性PLRI相关的后小头骨缺损尚无标准治疗方法。方法:我们对5例在正常活动范围内肘关节复发性PLRI合并桡骨头后小头嵌塞骨折的患者进行回顾性分析。手术治疗患者采用LUCL重建或修复,并使用设计用于跖骨头置换的小型金属假体(HemiCAP脚趾经典)进行小头关节表面的非适应症重建。结果:2007 - 2018年共收治5例患者(3例青少年男性,2例成年女性)。在中位5年的随访中,所有患者的症状不稳定都得到了完全缓解。没有患者在休息时出现疼痛,但有2例患者在运动时出现轻度疼痛(视觉模拟评分1-3)。3名患者认为肘部正常,1名认为几乎正常,1名认为有很大改善。在短期的x线随访中,没有发现植入物松动的迹象。所有患者均无需再手术。结论:肘关节复发性PLRI合并后小头病变可通过LUCL重建、修复和金属假体填充小头缺损成功治疗。这种治疗方案在中短期内具有良好的临床效果。证据等级:四级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
0.30
自引率
0.00%
发文量
55
审稿时长
15 weeks
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