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
{"title":"Prosthetic resurfacing of engaging posterior capitellar defects in recurrent posterolateral rotatory instability of the elbow.","authors":"Dani Rotman,&nbsp;Jorge Rojas Lievano,&nbsp;Shawn W O'Driscoll","doi":"10.5397/cise.2022.01424","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f1/50/cise-2022-01424.PMC10497932.pdf","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinics in Shoulder and Elbow","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5397/cise.2022.01424","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
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.

Abstract Image

Abstract Image

Abstract Image

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。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
0.30
自引率
0.00%
发文量
55
审稿时长
15 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信