Presentation of the vascular supply of the proximal ulna using a sequential plastination technique

The purpose of this study was to demonstrate the peri- and intraosseous vascular supply of the proximal ulna. Eleven fresh human cadaveric elbows were sequentially plastinated beginning with arterial injection, followed by block and secondary slice plastination of the whole elbow. With this technique, we obtained completely transparent cadaveric slices in which the peri- and intraosseous vascular architecture could be studied. Proximal ulna vascularization is due to an arterial network: a superior and inferior collateral ulnar artery and the profunda brachial artery climbing to the olecranon from proximal. An anterior artery and a posterior recurrent artery climb up distally to the medial parts of the ulna and an interosseous recurrent artery is responsible for the lateral and posterolateral proximal part of the ulna. The intraosseous vascularization is due to directly penetrating branches out of the posterior recurrent ulnar artery and a vascular plexus at the olecranon tip. In addition, we saw a major distal bone penetration branch coming from the recurrent posterior artery, climbing intraosseously without junction to the proximal penetrating branches. The peri- and intraosseous vascularization of the proximal ulna was shown. A transitional zone of the intraosseous vascularization of the proximal ulna was detected

Treatment of unstable elbow dislocations with hinged elbow fixation-subjective and objective results

Background: The aim of this study was to provide subjective and objective results of surgical treatment of unstable elbow dislocations with the hinged external fixation technique. Methods: Twenty-six patients were available for re-examination after treatment. Parameters used to quantify the subjective functional results were the Mayo Elbow Performance Score, the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire, and the stability of the elbow joint. In addition, we measured the medial and lateral joint space by varus and valgus stress ultrasound examinations of the elbow. Results: The mean Mayo Elbow Performance Score was 93.5 (+/- 8.3 standard deviation), and the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire showed an average of 7.3 points (+/- 8.9 standard deviation). We saw 18 patients with stable joints and 8 patients with slight instability. In the ultrasound stress test, we saw a significant difference of the affected joint under varus stress (7.8 +/- 1.7 mm) compared with the healthy joint (5.8 +/- 1.2 mm) laterally. Furthermore, medially the gap was significantly larger (4.8 +/- 0.9 mm; treated elbow) than contralaterally under valgus stress (3.3 +/- 0.7 mm) (P < .001). Conclusion: Closed reduction and hinged external fixation of unstable elbow dislocations resulted in good and very good results. We could identify a slight difference in the stability of the affected elbow compared with the contralateral side in all patients without clinical relevance. (C) 2015 Journal of Shoulder and Elbow Surgery Board of Trustees

Rare implant-specific complications of the MoPyC radial head prosthesis

Background: According to currently available data, the clinical short-term results of the MoPyC radial head prosthesis (Bioprofile, Tornier, Montbonnot-Saint-Martin, France) seem favorable. However, we have encountered several implant-specific complications in recent years. Hence, this case series reports rare complications after radial head arthroplasty with the MoPyC prosthesis to make surgeons aware of their existence and to provide information about the underlying cause and possible salvage strategies. Methods: A retrospective chart review from 2011 to 2016 was conducted to identify all adult patients with a minimum 2-year follow-up who underwent or were referred after radial head arthroplasty with the MoPyC radial head prosthesis and experienced implant-related complications. Results: Five patients with 7 implant-related complications were found. One patient experienced breakage of the pyrocarbon head. In another patient, breakage of the stem and-after revision surgery-partial breakage were observed. Disassembly of the prosthesis was seen in 1 case. Extensive periprosthetic stress shielding was seen in 3 patients resulting in symptomatic loosening (1), periprosthetic radial neck fracture (1), and stem migration (1). Conclusions: Whereas clinical short-term results of the MoPyC radial head prosthesis are satisfactory, rare implant-related complications can occur. Surgeons should be aware of these complications as they may lead to a poor outcome. (C) 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved

Percutaneous iliosacral screw fixation after osteoporotic posterior ring fractures of the pelvis reduces pain significantly in elderly patients

Introduction: Osteoporotic posterior ring fractures of the pelvis are common injuries in the elderly, but the treatment of these fractures still remains controversial. Percutaneous iliosacral screw fixation is one surgical option if conservative treatment cannot provide sufficient pain reduction. The aim of this study is to provide short-term results of elderly patients with percutaneous screw fixation. Methods: 30 patients with posterior ring fractures were treated between 12/2009 and 01/2014 with percutaneous iliosacral screw fixation. Patients' mean age was 78.4 years. Concerning short-term outcome, we focused on initial pain level and postoperative pain reduction together with intra-and postoperative complications. Results: The average hospital stay was 23.7 days, with surgical treatment performed after an average of 9.2 days. 90% of our patients were female. All 30 patients had a lower level of pain at discharge compared with admission or immediately prior to surgery. The difference in pain level at admission compared with the pain level upon discharge showed a mean reduction from 6.8 to 1.8 with a statistically significant change (P <= 0.001). 24 of 30 patients had no registered complications, one screw malpositioning with postoperative nerve irritation occurred. Discussion: Conventional percutaneous iliosacral screw fixation is a successful operative treatment for elderly patients with persistent lower back pain after unstable posterior ring fractures of the pelvis. Intra-and postoperative complications are rare, so this treatment can be regarded as a safe procedure. Level of evidence: IV (retrospective study). (C) 2015 Elsevier Ltd. All rights reserved