Amjid Ali

Total elbow arthroplasty for distal humeral fractures: Indications, surgical approach, technical tips, and outcome

BACKGROUND Twenty-six consecutive total elbow arthroplasties were performed for comminuted distal humeral fractures between 1995 and 2002. At review, 3 patients had died from unrelated causes, 2 had been lost to follow-up, and 1 could not be assessed due to dementia. The mean age of the remaining 20 patients was 72 years (range, 62-92). There were 4 men and 16 women. METHOD The mean follow-up was 63.2 months (range, 36-108). The mean Mayo Elbow Performance Score was 92 (75-100) with a mean flexion arc of 27 degrees - 125 degrees . RESULT One patient had a postoperative superficial infection, which required a course of antibiotic therapy, and 1 patient who had a radial nerve neuropraxia recovered spontaneously after 6 weeks. Radiographs showed 19 implants were well fixed with no evidence of loosening, while 1 patient had a nonprogressive radio-lucent line on the ulna side of the prosthesis. Additionally, 2 patients developed heterotopic ossification without identifying pre-disposing factors. CONCLUSION Total elbow arthroplasty for distal humeral fractures in elderly patients without inflammatory arthritis can be expected to five good results at a mean follow-up of 5 years.

Distal Biceps Tendon Rupture A New Repair Technique in 14 Patients Using the Biotenodesis Screw

Background Distal biceps tendon ruptures are uncommon injuries. Operative treatment has been shown to improve functional outcomes. A variety of surgical repair techniques have been described for distal biceps ruptures. Purpose The authors present their experience with a new technique to anatomically repair distal biceps tendon ruptures through a single-incision approach that they believe is a safe and reliable method of achieving repair. Study Design Case series; Level of evidence, 4. Materials and Methods Fourteen patients with 14 biceps tendon ruptures underwent a repair with a bioabsorbable Biotenodesis screw. All 14 patients underwent clinical assessment using the Mayo Elbow Performance Score, measurement of range of motion, and flexion strength testing. Mean follow-up was 29.1 months. Results Three patients had a good result and 11 patients had an excellent result. The mean elbow flexion arc was 141.4° (range, 125°–155°; standard deviation, 7.19°) with no flexion contractures in the operated side compared with the unaffected elbow. All patients achieved an equal range of pronation/supination to the unaffected side. The mean flexion strength in the injured arm was 25.7 kg, compared with 26.9 kg in the uninjured side. No complications were noted about the elbow. Conclusion The authors believe this new technique gives a good functional outcome with reproducible results.

Early experience of managing proximal humerus fractures with the S3 plate

Background Fractures of the proximal humerus contribute a large number of admissions to our unit each year both for operative and conservative treatment. They can be a cause of great morbidity in many of these patients. Open reduction and internal fixation of fractures is performed in those patients who have displaced fractures and who are significantly independent to warrant surgical management. Methods This is a retrospective study evaluating the early experiences of a new type of plate fixation, the S3 plate (DePuy, Warsaw, IN, USA), in patients with displaced three- and four-part fractures. The case notes of those patients with more than 1 year of follow-up following fixation of their humeral fracture with a S3 plate were retrospectively reviewed. Each patient was also sent an Oxford Shoulder Score in the post for completion. Fifty-three patients were identified for inclusion in the study from 2007 onwards. Patients with a two-part fracture (n = 10) were excluded from the study because it was felt that these patients represented a group in whom conservative management was often the more commonly used treatment modality. Results Mean age was 54.1 years (range 21 years to 76 years); the male to female ratio was 1 : 2.4; and there were 25 three-part fractures and 17 four-part fractures. Time to discharge ranged from 4 months to 16 months, with a mean of 6.7 months. There were no intra-operative complications, one superficial wound infection and only one patient required further surgery. At 1 year, we have seen a low complication rate with good return to activity. Conclusions The implant has a very low revision rate and union was seen in most fractures by 6 months. The present study was limited by documented union time, numbers and differing discharge protocols. This new plating technique appears to offer a decreased complication rate compared to other plating systems without compromising patient outcomes.

The Provision of Primary and Revision Elbow Replacement Surgery in the NHS

BESS Surgical Procedure Guidelines (SPGs). Optimising Surgical Outcomes for Shoulder and Elbow patients. The British Elbow and Shoulder Society (BESS) SPGs are a series of evidence and consensus Best Practice Recommendations developed by BESS surgeons and physiotherapists to help drive quality improvement and achieve the best possible surgical outcomes for UK patients. This SPG on primary and revision elbow replacement surgery is supported and endorsed by both the British Orthopaedic Association (BOA) and the Getting It Right First Time (GIRFT) Programme.

The Sheffield bone block procedure: a new operation for the treatment of glenoid bone loss in patients with anterior traumatic shoulder instability.

Background The purpose of the present study was to evaluate the results of the Sheffield bone block procedure for anteroinferior bone loss in traumatic shoulder instability. In this modified open technique, the medial half of coracoid process without its soft tissue attachments is used to provide congruent augmentation of the anteroinferior glenoid and secured with two screws. Methods In this retrospective consecutive case series (2007–11), all patients having recurrent traumatic instability with glenoid bone loss > 20% and/or a large Hill–Sachs lesion were included. The shoulder function was evaluated clinically and by Oxford Shoulder Instability Score (OSIS; by post/telephone). Results There were 84 patients in this series with a large proportion engaged in contact sports. Mean (range) age was 33 years (16 years to 45 years); male : female, 59 : 8; mean (range) follow-up period was 48 months (36 months to 84 months) and the response rate 89% (75/84). Mean postoperative OSIS was 43 (33 to 46) and one patient had re-dislocation (1.3%). No neurovascular complications/hardware failure/non-union/infections were noted. By 6 months, 85% patients had returned to pre-injury sport and 93% had returned to pre-injury work. Conclusions The Sheffield bone block procedure provides reliable and satisfactory results in patients having recurrent instability with glenoid bone loss and/or a large Hill–Sachs lesion with minimal complications and an excellent chance of returning to original sport and occupation.