Gerard T. Gabel

Intraarticular fractures of the distal humerus in the adult

Intraarticular fractures of the distal humerus are notoriously difficult to treat. Three basic treatment methods are available: closed reduction, traction, and open treatment. In the past, functional results with all these methods generally have been poor because of disabling limitations of elbow motion. Thirteen adult patients were treated by open reduction and application of medial and lateral buttress plates providing rigid internal fixation and early motion. The patients were evaluated for range of motion, infection, nerve injury, avascular necrosis, myositis ossificans, varus/valgus deformity, pain, instability, weakness, and degenerative changes. Ten of the 13 patients were available for follow-up study for an average of two years. Nine of the ten achieved good or excellent results. Based on these observations, the treatment of choice is internal fixation with dual plates combined with early active postoperative motion.

Post-Traumatic Heterotopic Ossification About the Elbow

To evaluate the effect of surgical timing on the formation of heterotopic ossification about the elbow, 71 consecutive patients with elbow trauma requiring operative management were evaluated. Fourteen patients were excluded because they suffered from head injury, burns, or severe open injuries requiring surgery on two or more occasions. Sixteen patients were lost to follow-up, leaving a group of 41 patients. The average age of patients was 35 years. The fractures involved the olecranon in 19, distal humerus in 12, and radial head/neck in 10 patients. Six of these fractures were accompanied by a dislocation. Eleven were open injuries; the remaining 30 were closed. Bone grafting was performed in nine patients. The interval between injury and surgical intervention averaged 57 hours. None (0%) of 17 patients treated within 48 hours developed grade II, III, or IV heterotopic ossification, whereas 8 (33%) of 24 patients treated after 48 hours developed grade II, III, or IV heterotopic ossification. There were no significant differences in demographic or injury parameters between these two groups. These findings suggest that fixation of unstable elbow fractures within 48 hours of injury may reduce the formation of ectopic bone.

Tibial Nerve Grafting for Restoration of Plantar Sensation

Five patients with a segmental loss of the tibial nerve and insensate plantar aspect of the foot were evaluated at an average of 5 years (2.5–9.5) postsural nerve grafting of the tibial nerve. Free-tissue transfer was required in three patients. The results as graded by restoration of superficial sensation, healing of plantar ulceration, and absence of neurogenic pain were four good and one fair at follow-up over 2 years. Assessment at 2 years or less yielded one good and four poor results, indicating a prolonged recovery period. Nerve grafting may be indicated in segmental injuries of the tibial nerve to restore plantar sensation, but ultimate recovery may require up to 4 years.

Premature partial physeal arrest. Diagnosis by magnetic resonance imaging in two cases.

The management of premature physeal arrest requires accurate assessment of not only the location but also the extent of the bar. Numerous imaging techniques are available to evaluate the physis. Multiplanar tomography has proven to be the most precise method. The utility of magnetic resonance imaging (MRI) of physeal bars has not been demonstrated. This article presents MRI results in two cases of physeal bars. MRI provides a means of assessing physeal bar formation with an accuracy approaching that of multiplanar tomography. In certain instances, its efficacy may exceed that of tomography, specifically when the physis cannot be properly oriented for tomographic evaluation, when more planes are desired, and when radiation exposure is thought to be excessive. With improvement of its capabilities and availability (which may also reduce cost), it may become the diagnostic imaging technique of choice.

Greenstick intercondylar fracture of the distal humerus. A case report.

A greenstick intercondylar fracture of the distal humerus occurred in a 14-year-old boy. The minimal displacement and stability of the injury allowed early range of motion with healing in an anatomic position and restoration of the preinjury arc of motion.