Open reduction and corrective ulnar osteotomy for missed radial head dislocations in children

The treatment of chronic radial head dislocation remains controversial. Open reduction of the radial head in combination with correction of malalignment with ulnar osteotomy can be the key to a good surgical result. Between 2001 and 2006, 9 (6 female, 3 male, average age 8.4 (5-11) years) patients were treated surgically for chronic radial head dislocation by one surgeon. The time between trauma and surgery was 7 (1.5-14) months. The procedure consisted of open reduction of the dislocated radial head and reconstruction of the annular ligament in combination with an ulnar osteotomy. An upper arm cast was applied with the forearm in neutral rotation for six weeks. Plates were removed in all patients. Clinical and radiological evaluation took place preoperatively and after an average of 23 (10-49) months. At radiograph 8/9 showed a reduced radial head; in one an anterior subluxation was seen. The range of motion remained the same in 4 patients who had a full range of motion preoperatively. In 2/5 patients with loss of range of motion preoperatively, improvement was seen. There were no serious surgical complications beside one infection. Open reduction and corrective ulnar osteotomy shows good results for missed radial head dislocations in children

How to optimise the fidelity of exercises in an unsupervised golf injury prevention programme? A pilot study

Background:Golf is an individual sport that is usually done without the supervision of a trainer or coach. Therefore, an injury prevention programme in golf will primarily be performed without supervision and feedback. However, the effectiveness of any preventive exercise programme is determined by exercise fidelity. Objective:To investigate the different instruction options of an injury prevention programme on exercise fidelity in individual golfers. Methods:We randomly assigned golfers to one of three groups receiving different exercise instructions. One group received only instructional cards (A), one received only instructional videos (B) and a third group (C) received both instructional cards and videos. The golfers were allowed to familiarise themselves with the exercises based on the provided instruction option, after which we recorded their exercise execution on video. Two authors independently scored each exercise’s fidelity from these recordings. Results: In total, 18 golfers (12 women and 6 men, average age of 61.94 years) were equally divided across the 3 study groups completed 108 exercises. In group A 73.7% of exercises were executed as intended, in group B 88.6% and in group C 86.3%. Significantly more exercises were conducted correctly in groups B and C compared with group A (p&lt;0.05). Conclusion:Golfers who received instructions that included a video explanation had a higher exercise fidelity when compared to only written instructions.</p

Long-term sequel of posterolateral rotatory instability of the elbow: a case report

The natural course of untreated posterior lateral rotatory instability of the elbow is unclear. A case of elbow arthrosis with progressing deformity and flexion contracture after an episode of elbow dislocation about 20 years ago presented the possibility the long term outcome of untreated posterior lateral rotatory instability of the elbow

The incidence of associated fractures of the upper limb in fractures of the radial head

Radial head fractures are common injuries. In American publications, one-third of the patients with these fractures have been shown to have associated injuries. The aim of this retrospective study is to describe the epidemiology of radial head fractures and associated fractures of the ipsilateral upper extremity in a European population. This study describes the epidemiology of radial head and associated fractures of the upper extremity in a Dutch population by a retrospective radiographic review of all patients with a radial head fracture between 1 January 2006 and 1 July 2007. A total of 147 radial head fractures were diagnosed in 145 patients. The incidence in the general population was 2.5 per 10.000 per year. The average age was 45.9 (SD 17.3) years and male–female ratio was 2:3. The mean age of males was significantly lower (37.1, SD 14.2 years) than of women (53.9, SD 16.4 years). Associated fracture of the upper extremity was found in 10.2%. Coronoid fractures were most common (4.1%). Associated upper limb fractures in patients with a radial head fracture are common in the European population. It is of clinical importance to suspect associated lesions and to perform a thorough physical examination and additional radiological examination on demand

The effectiveness of a golf injury prevention program (GRIPP intervention) compared to the usual warm-up in Dutch golfers:protocol design of a randomized controlled trial

BACKGROUND: Sixty million golfers around the world play golf. Golf injuries are most frequently located in the spine, elbow, wrist, hand and shoulder. Those injuries are often seen in golfers with more playing hours and suboptimal swing biomechanics, resulting in overuse injuries. Golfers who do not perform a warm-up or do not warm-up appropriately are more likely to report an injury than those who do. There are several ways to warm-up. It is unclear, which warm-up is most useful for a golfer to perform. Moreover, there is currently no evidence for the effectiveness of a warm-up program for golf injury prevention. We previously have developed the Golf Related Injury Prevention Program (GRIPP) intervention using the Knowledge Transfer Scheme (KTS). We aim to evaluate the effect of the GRIPP intervention on golf-related injuries. The hypothesis is that the GRIPP intervention program will reduce the number of golf-related injuries. METHODS AND DESIGN: The GRIPP study is a two-armed randomized controlled trial. Twenty-eight golf clubs with 11 golfers per club will be randomly allocated to the intervention or control group. The intervention group will perform the GRIPP intervention program, and the control group will perform their warm-up as usual. The GRIPP intervention is conducted with the Knowledge Transfer Scheme framework, which is a systematic process to develop an intervention. The intervention consists of 6 exercises with a maximum total of 10 min. The primary outcome is the overall prevalence (%) of golf injuries measured with the Oslo Sports Trauma Research Center (OSTRC-H) questions on health problems every fortnight. The secondary outcome measures will be exposure to golf and compliance to the intervention program. DISCUSSION: In other sports warm-up prevention programs are effective in reducing the risk of injuries. There are no randomized trials on golf injury prevention. Therefore, an individual unsupervised golf athlete intervention program is conducted which reflects the daily practice of predominantly unsupervised exposure of amateur golfers. TRIAL REGISTRATION: The trial is retrospectively (28 October 2021) registered at the Dutch Trial Register: NL9847 (https://trialsearch.who.int)

The management of elbow trauma from a historical perspective

The origins of contemporary orthopedics can be traced all the way back to antiquity. Despite the absence of modern imaging techniques, a few bright minds were able to lay the groundwork for understanding these fractures. This historical review will cover the process behind the various treatments for elbow fractures, such as splinting and casting, mobilization, amputation, fracture fixation, arthroplasty, and arthroscopy.</p

Intraoperative arthroscopic classification tool for posterolateral elbow instability

Background: Introducing and implementing an arthroscopic classification tool for posterolateral elbow instability. Methods: Thirty arthroscopies were performed on 30 patients, and all recordings were collected, blinded, and labeled. Three orthopedic surgeons reviewed and scored all 30 recordings three times with a period of at least seven days in between to analyze the intraobserver and interobserver reliability. The classification consisted of five different grades. Results: Indications for elbow arthroscopy included impingement (n = 7), osteochondritis dissecans (n = 5), pain (n = 7), osteoarthritis (n = 6), and other (n = 5). The kappa value for intrarater reliability was 0.71, indicating good reliability, while the kappa value for inter-rater reliability was 0.38 indicating fair reliability. Conclusion: This new classification is a tool for an arthroscopic assessment of PLRI and can be used as a standardized grading system for further research and communication between orthopedic surgeons. We demonstrated good intrarater reliability (k = 0.71) with fair inter-rater reliability (k = 0.38). However, further research is necessary to study the clinical significance.</p

Diagnosis and Treatment of Children with a Radiological Fat Pad Sign without Visible Elbow Fracture Vary Widely:An International Online Survey and Development of an Objective Definition

Children often present at the emergency department with a suspected elbow fracture. Sometimes, the only radiological finding is a ‘fat pad sign’ (FPS) as a result of hydrops or haemarthros. This sign could either be the result of a fracture, or be due to an intra-articular haematoma without a concomitant fracture. There are no uniform treatment guidelines for this common population. The aims of this study were (1) to obtain insight into FPS definition, diagnosis, and treatment amongst international colleagues, and (2) to identify a uniform definition based on radiographic measurements with optimal cut-off points via a receiver operating characteristic (ROC) curve. An online international survey was set up to assess the diagnostic and treatment strategies, criteria, and definitions of the FPS, the probability of an occult fracture, and the presence of an anterior and/or posterior FPS on 20 radiographs. Additionally, the research team performed radiographic measurements to identify cut-off values for a positive FPS, as well as test–retest reliability and inter-rater reliability via intraclass correlation coefficients (ICC). A total of 133 (paediatric) orthopaedic surgeons completed the survey. Definitions, further diagnostics, and treatments varied considerably amongst respondents. Angle measurements of the fat pad as related to the humeral axis line showed the highest reliability (test–retest ICC, 0.95 (95% CI 0.88–0.98); inter-rater ICC, 0.95 (95% CI 0.91–0.98)). A cut-off angle of 16° was defined a positive anterior FPS (sensitivity, 1.00; specificity, 0.87; accuracy, 99%), based on the respondents’ assessment of the radiographs in combination with the research team’s measurements. Any visible posterior fat pad was defined as a positive posterior FPS. This study provides insight into the current diagnosis and treatment of children with a radiological fat pad sign of the elbow. A clear, objective definition of a positive anterior FPS was identified as a ≥16° angle with respect to the anterior humeral line