Treatment strategies for simple elbow dislocation - a systematic review

Abstract Background Current treatment concepts for simple elbow dislocation involve conservative and surgical approaches. The aim of this systematic review was to identify the superiority of one treatment strategy over the other by a qualitative analysis in adult patients who suffered simple elbow luxation. Study design A systematic review in accordance with the PRISMA guidelines and following the suggestions for reporting on qualitative summaries was performed. A literature search was conducted using PubMed and Scopus, including variations and combinations of the following keywords: elbow, radiohumeral, ulnohumeral, radioulnar, luxation, and therapy. Seventeen studies that performed a randomized controlled trial to compare treatment strategies as conservative or surgical procedures were included. Reviews are not selected for further qualitative analysis. The following outcome parameters were compared: range of motion (ROM), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand outcome measure (Quick-DASH), recurrent instability, pain measured by visual analog scale (VAS) and time to return to work (RW). Results Early mobilization after conservative treatment strategies showed improved ROM compared to immobilization for up to 3 weeks after surgery with less extension deficit in the early mobilization group (16° ± 13°. vs. 19.5° ± 3°, p < 0.05), as well as excellent clinical outcome scores. Surgical approaches showed similar results compared to conservative treatment, leading to improved ROM (115 vs. 118 ± 2.8) and MEPS: 95 ± 7 vs. 92 ± 4. Conclusion Conservative treatment with early functional training of the elbow remains the first-line therapy for simple elbow dislocation. The surgical procedure provides similar outcomes compared to conservative treatment regarding MEPS and ROM for patients with slight initial instability in physical examination and radiographs. People with red flags for persistent instability, such as severe bilateral ligament injuries and moderate to severe instability during initial physical examination, should be considered for a primary surgical approach to prevent recurrent posterolateral and valgus instability. Postoperative early mobilization and early mobilization for conservatively treated patients is beneficial to improve patient outcome and ROM

Prognostic and therapeutic potential of microRNAs for fracture healing processes and non-union fractures: A systematic review

Background: Approximately 10% of all bone fractures result in delayed fracture healing or non-union; thus, the identification of biomarkers and prognostic factors is of great clinical interest. MicroRNAs (miRNAs) are known to be involved in the regulation of the bone healing process and may serve as functional markers for fracture healing. Aims and methods: This systematic review aimed to identify common miRNAs involved in fracture healing or non-union fractures using a qualitative approach. A systematic literature search was performed with the keywords 'miRNA and fracture healing' and 'miRNA and non-union fracture'. Any original article investigating miRNAs in fracture healing or non-union fractures was screened. Eventually, 82 studies were included in the qualitative analysis for 'miRNA and fracture healing', while 19 were selected for the 'miRNA and fracture non-union' category. Results and conclusions: Out of 151 miRNAs, miR-21, miR-140 and miR-214 were the most investigated miRNAs in fracture healing in general. miR-31-5p, miR-221 and miR-451-5p were identified to be regulated specifically in non-union fractures. Large heterogeneity was detected between studies investigating the role of miRNAs in fracture healing or non-union in terms of patient population, sample types and models used. Nonetheless, our approach identified some miRNAs with the potential to serve as biomarkers for non-union fractures, including miR-31-5p, miR-221 and miR-451-5p. We provide a discussion of involved pathways and suggest on alignment of future research in the field.ISSN:2001-132

Recreational athletes during downhill-mountain biking (DMB) show high incidence of upper extremity fractures in combination with soft-tissue injuries

Abstract Downhill-mountain biking (DMB) is a high-risk sport and often leads to several injuries, especially in non-professional athletes. We retrospectively analyzed the most common injuries and profiled the injury mechanism. Until now, there is no such analysis of injuries by non-professional mountain bike athletes. We collected patient data from patients who suffered from an injury during DMB. The inclusion criteria were (1) injury during the summer season of 2020 and 2021, (2) injury during off-road and downhill mountain bike sports activity, and (3) treatment at the Department of Traumatology of the Klinik Diakonissen Schladming. Patient data was analyzed regarding the type of injury, location of the injury, patient age and gender of the patients. Most patients with injury are at the age of 26–35. Second most are between 36 and 71 years old. The type of injury differs between age and gender. Mostly upper-extremity injuries occur with a high probability of shoulder injuries. In the elderly patients, we found additional injuries of the thorax and chest. To conclude, most common types of injuries are soft-tissue injuries, often in combination with fractures. The risk for injuries is higher for recreational athletes with different injury characteristics than professional athletes