A Complicated Course of a Coronal Shear Fracture Type IV of the Distal Part of Humerus Resulting in Resurfacing Radiocapitellar Joint Replacement

Schmidt, Ingo

doi:10.2174/1874325001711010248

Cited by 7 publications

(9 citation statements)

References 28 publications

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“…The radial head acts as a secondary valgus stabilizer and transfers up to 60% of the axial force load applied through the elbow, which is related to the amount of flexion [58,59]. After resection of the radial head, the load will be transferred to the ulnohumeral joint only and making that joint prone to subsequent osteoarthritis that could only be treated by total elbow arthroplasty, whereas radiocapitellar osteoarthritis can be treated by unicompartmental resurfacing radiocapitellar replacement which has been lesser complications and it allows higher loading for activities of daily living than total elbow arthroplasty ( Figure 10C) [60,61]. It was already stated by Essex-Lopresti in 1951 as well that a radial head prosthesis would be the method of choice to obtain the length of radius [24].…”

Section: Discussionmentioning

confidence: 99%

“…Note that there is no overstuffing (blue and green transverse lines). (C) Non-cemented unicompartmental resurfacing radiocapitellar replacement utilizing an ultra-high molecular weight polyethylene -cobalt-chromium articulation for treatment of isolated posttraumatic radiocapitellar osteoarthritis [61]. Cementation should only be done when the bone stock is poor.…”

Section: Discussionmentioning

confidence: 99%

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Who introduced the "quadrangular-construct" modification of the Sauvé Kapandji procedure first? Case presentation and brief overview of literature with regard to general, specific and practicable aspects to primary trauma-related surgical treatment including possible salvage options at the distal radioulnar joint

Schmidt¹,

Schmitz²,

Muradyan³

et al. 2017

Trauma Emerg Care

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A 26-year-old male sustained a left wrist injury after an occupational fall from height that was diagnosed as wrist sprain and treated conservatively by a plaster splint in another institution. Eight weeks after injury, the patient could be re-employed in his original occupation as a truck driver. Six years after injury, the patient came in our institution for the first time, and reported increasing pain in his left wrist accompanied with marked restriction of his left forearm's supination and pronation leading to the non-ability to carry out his occupational job 8 weeks previously. On clinical examination, there was pronounced dorsal subluxation of the ulnar head without any given possibilities for it manual closed reduction (i.e. static instability in transverse plane) ( Figure 1A). Posterior-anterior (PA) radiographs of both wrists showed no concomitant ulnar positiv variance (UPV) (i.e. no longitudinal instability) and no posttraumatic arthritic changes in the distal radioulnar joint (DRUJ), but the configuration of the ulnar styloid at the formerly injured left wrist could not be well assessed that suggested an additional rotation deformity of the ulnar head ( Figure 1B). Lateral radiographs of both wrist showed marked fixed subluxation of the ulnar head in dorsal direction (i.e. static instability in transverse plane) ( Figure 1C). Due to these findings, the Sauvé-Kapandji procedure, modified by creating a "quadrangularconstruct", was detected by us. At the preoperative radiographs of the left elbow in both planes there were no signs of any pre-existing degenerative changes with specific regard to the radiocapitellar joint.Intraoperatively, first, the 2 cm long ulna segment was excised typically proximal to the DRUJ, then a Kirschner-wire was drilled into the ulnar head parallel to the plane of the operation table on which the left forearm was positioned at terminal range of pronation (i.e. 90°) ( Figure 2A). After that, the ulnar head was rotated 90° perpendicular to the operation table's plane in dorsal direction using the formerly drilled Kirschner-wire, and so the neutral position of DRUJ could be achieved in which the arthrodesis had to be performed ( Figure 2B). Then, the cartilage of both corresponding surfaces in DRUJ was excised, and the DRUJ arthrodesis in neutral position was carried out using a 3.5 mm titanium malleolar screw, and the Kirschner-wire was removed. The next step included the several years later introduced "quadrangularconstruct" modification of the original Sauvé-Kapandji procedure: After decorticalization of the corresponding radius and ulna shafts proximal to the DRUJ arthrodesis and distal to resection plane of the ulna segment, the formerly excised ulna segment has been inserted transversely between both forearm bones and fixated with a second 3.5 mm titanium cortical screw through the ulna segment graft, and finally, complete restoration of rotation motion arc could be achieved ( Figures 2C-D). The correctly performed surgical procedure was confirmed intraoperatively by flu...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Who introduced the "quadrangular-construct" modification of the Sauvé Kapandji procedure first? Case presentation and brief overview of literature with regard to general, specific and practicable aspects to primary trauma-related surgical treatment including possible salvage options at the distal radioulnar joint

Schmidt¹,

Schmitz²,

Muradyan³

et al. 2017

Trauma Emerg Care

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“…Arthroplasty options range from resurfacing capitellar hemiarthroplasty and resurfacing radiocapitellar arthroplasty to distal humeral hemiarthroplasty and total elbow arthroplasty. 68-70 However, distal humeral hemiarthroplasty is not currently Food and Drug Administration (FDA) approved; and of the 2 reported radiocapitellar arthroplasty systems, the Lateral Resurfacing Elbow system (Biomet, Warsaw, Indiana) and UNI-Elbow Radio Capitellum system (Stryker, Kalamazoo, Michigan), only the Uni-Elbow was previously FDA approved, but per our communication with Styker during the writing of this paper, is not currently available in the United States. 71-73 Surgeons should therefore be cautious in choosing these treatment options.…”

Section: Complicationsmentioning

confidence: 99%

Coronal Shear Fractures of the Distal Humerus: A Review of Diagnosis, Treatment, and Outcomes

Fram

Seigerman

Ilyas

2019

Hand (New York, N,Y.)

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Fractures of the capitellum and trochlea are uncommon fractures of the elbow and can be challenging to treat due to their size, location, and articular nature. Because of their intra-articular nature and predilection toward displacement, these fractures are typically treated operatively. Furthermore, capitellum fractures have high rates of associated injuries, including radial head fractures or lateral collateral ligament injury in ~30% to 60% of patients. In addition to open reduction internal fixation, operative options include fragment excision, arthroscopic assisted reduction and fixation, and elbow arthroplasty. In this article, we undertake a comprehensive literature review of capitellum fractures of the distal humerus, in an attempt to summarize the existing body of evidence and propose areas of future study.

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“…posttraumatic osteoarthritis), the salvage options (i.e. "fourth stage of management") are joint replacement, joint arthrodesis with or without required correction of misalignment ( Figures 9A-C with or without exposure of osteosynthesis plates or endoprostheses with or without infection, treatment of other trauma-or surgeryrelated complications such as malignancy or failed ORIF, and silicone epitheses can become necessary to restore or improve statics, function, and aesthetics in the further course ( Figures 10A-B) [10,37,[54][55][56][57][58][59][60]. It must be noted that surgical amputation after complication of minor trauma or surgery regardless any problems with the wound healing can be the "last exit" for functional recovery of patients with psychiatric disorders as well [61].…”

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confidence: 99%

“…posttraumatic osteoarthritis), the salvage options (i.e. "fourth stage of management") are joint replacement, joint arthrodesis with or without required correction of misalignment ( Figures 9A-C), or amputation when limb salvage procedures become not possible [19,28,[36][37][38][39][40][41][42][43][44][45]. A reasonable option to O(C)RIF for highly comminuted fractures can be primary motion preserving total or partial joint replacement at the lower and upper extremities for surgeons who are familiar with its use (Figures 5C-D and 7C-E) [46][47][48][49][50][51][52][53].…”

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confidence: 99%

Necessity of secondary Syme amputation of the foot after severely destroyed hindfoot injury due to suicidal jump from height in a psychiatric patient: Case presentation and brief review of literature

Schmidt¹,

Schmieder²

2017

Trauma Emerg Care

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Abbreviations: 3D CT : three-dimensional computed tomography; CREF: closed reduction and external fixation; DPNFCSAF: distally pedicled neurofasciocutaneous sural artery flap; O(C)RIF: open (closed) reduction and internal fixation. Case presentationA 44-year-old obese female (body mass index 37.2 kg/m 2 ) presented with open severely destroyed injuries of her both hindfoots after a suicidal jump from approximately 4 m height out of her private balcony. There was a longstanding history of a psychiatric disorder (schizophrenia) treated by psychopharmaca. The left foot showed an open Gustilo-Anderson II hindfoot injury at the lateral aspect of calcaneus, and three-dimensional computed tomography (3D CT) revealed a highly comminuted hindfoot fracture-dislocation injury involving the calcaneus, the subtalar joint, and the Chopart joint ( Figure 1A). The right foot showed an open Gustilo-Anderson IIIB hindfoot injury at the medial-plantar aspect of calcaneus, and 3D CT revealed a highly comminuted calacaneus fracture ( Figure 1B).Both injuries were initially treated by closed reduction and external fixation (CREF) accompanied with percutaneous pinning, negative-pressure vacuum assisted closure (VAC) therapy, and intravenous application of antibiotics (cefuroxime). Against our strict recommendations not to load her both legs, the patient mobilized herself with full-weight bearing and went away several times from our hospital and so nearly all pins of external and internal fixations were broken. As a consequence, the overall pins for external and internal fixation of both foots had to be removed 4 weeks after primary surgery, resulting in severe posttraumatic flat foot on both sites based on pronounced bony destruction and fragment dislocation and diastases of the calcaneus bones accompanied with re-dislocation in her left Chopart joint (Figures 2A and 3A). After intermittent negativepressure VAC therapy, a secondary wound closure of her left open II injury could be achieved without additional soft tissue coverage 3 weeks after injury. For closure of her right open IIIB injury, wound coverage with the use of a distally pedicled neurofasciocutaneous sural artery flap (DPNFCSAF) was performed 1 week after removal of the pins. For this purpose, the pedicle of the flap was primarily covered by a synthetic skin substitute (Epigard) at its 160° pivot point extending up distally to the flap, and secondarily covered by split-thickness skin grafts 1 week later that was associated with an uneventful wound healing (i.e. flap survival) ( Figures 2B-C).At the left foot, the further course after secondary wound closure of her open II injury without the need of coverage was complicated by development of severe osteomylitis of the hindfoot involving the distal tibia metaphysis presented with marked swelling of the overall foot and an infectious fistula at the lateral aspect of calcaneus (Staphylococcus aureus) ( Figures 3A-B). Hence, the Syme amputation was detected and performed by us that was associated with an uneventful course ( Fi...

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A Complicated Course of a Coronal Shear Fracture Type IV of the Distal Part of Humerus Resulting in Resurfacing Radiocapitellar Joint Replacement

Cited by 7 publications

References 28 publications

Coronal Shear Fractures of the Distal Humerus: A Review of Diagnosis, Treatment, and Outcomes

Necessity of secondary Syme amputation of the foot after severely destroyed hindfoot injury due to suicidal jump from height in a psychiatric patient: Case presentation and brief review of literature

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