Surgical anatomy and technique for the treatment of Dubberley type 1, 2 and 3 capitellar fractures via a limited anterior approach to the elbow

Coronal plane fractures of the elbow can affect the capitellum, the trochlea (or a combination of the two), the radial head and the coronoid processes.The Kocher lateral approach is the most commonly used for open reduction of this type of fractures, although an arthroscopic technique has been used in some cases. When the fracture extends to the trochlea, the Kocher lateral approach may be inadequate for the correct visualisation, reduction and fixation of the fracture. In such cases an associated medial elbow approach may be required, or a posterior transolecranon approach may be preferred. We think that the limited anterior approach to the elbow could be a valid option when treating these types of fractures, as it does not involve the de-insertion of any muscle group or ligament, thereby facilitating the recovery process. In cases involving trochlear fracture (which may or may not be dissociated) the approach can be extended medially. We can also treat associated injuries such as fractures of the radial head or coronoid process with this approach. In the present study we describe the dissection of the medial and lateral cubital fossa of the elbow in extension in 4 specimens, paying attention to the neurovascular structures of the area. We also describe the surgical technique for the limited approach to the medial and lateral cubital fossa. We demonstrate the accessibility via the cubital fossa to the capitellum, trochlea, radial head, and coronoid process

A Cadaver Based Comparison of Two Elastic Tension Proximal Interphalangeal Joint (PIPJ) Extension Orthoses with Focus on Force Generation and Pressure Distribution

Proximal interphalangeal joint flexion contracture is a frequent condition in hand therapy. Clinicians most frequently apply orthosis management for conservative treatment. Orthoses should apply forces for long periods of time following the total end range time (TERT) concept. These forces necessarily transmit through the skin; however, skin has physiological limitations determined by blood flow. Using three fresh frozen human cadavers, this study quantified and compared forces, skin contact surfaces and pressure of two finger orthoses, an elastic tension digital neoprene orthosis (ETDNO) and an LMB 501 orthosis. The study also investigated the effects of a new method of orthosis construction (serial ETDNO orthoses) that customizes forces to a specific finger position. We evaluated forces and contact surfaces for multiple ETDNO models tailored to the cadaver fingers in multiple PIP flexion positions. The results showed that the LMB 501 orthosis applied pressures beyond the recommended limits if applied for more than eight hours a day. This fact was the cause of time limited LMB orthosis application. This results also show that, at 30° of PIPJ flexion, straight ETDNOs created a mean pressure approaching the end of the recommended pressure limits. If the therapist modified the ETDNO design, the skin pressure decreased and reduced the risk of skin damage. With the results of this study, we concluded that for PIPJ flexion contracture, the upper limit of force application is 200 g (1.96 N). Forces beyond this amount would likely cause skin irritation and possibly skin injuries. This would cause a reduction in the daily TERT and limit outcomes

A Comparison between Two Intervals of Daily Total End Range Time for Treatment of Proximal Interphalangeal Joint Flexion Contracture Using an Elastic Tension Digital Neoprene Orthosis

Focusing on fingers with proximal interphalangeal joint flexion contractures, this study seeks to determine whether significant differences exist between the joint passive range of motion PROM improvement when receiving higher doses of daily total end range time (TERT) compared to those that receive lower doses. The study randomized a parallel group of fifty-seven fingers in fifty patients with concealed allocation and assessor blinding. Divided into two groups receiving different doses of daily total end range time with an elastic tension digital neoprene orthosis, they also participated in an identical exercise program. Patients reported orthosis wear time, and the researchers performed goniometric measurements at every session during the three-week period. The primary outcome related the time patients wore the orthosis to the degrees of improvement in PROM extension. Compared to group B (daily TERT of twelve hours), group A (TERT, twenty+ hours) showed a statistically significant greater improvement in PROM after three weeks of treatment. Group A improved by a mean of 29° compared to group B's mean of 19° improvement. This study provides evidence that a higher dose of daily TERT can generate better results in the treatment of the proximal interphalangeal joint flexion contractures

Estudio de la dinámica embrionaria aplicando técnicas de registro de vibraciones. Correlación morfofuncional del desarrollo articular del embrión de pollo

Utilizando un sensor de vibraciones (disco cerámico piezoeléctrico) y aparatos de medición y registro, se han estudiado las señales u ondas vibratorias producidas por los movimientos somáticos del embrión de pollo y su frecuencia cardiaca a lo largo de todo el periodo de desarrollo y bajo condiciones normales. Se obtuvieron datos dinámicos por tres vías diferentes que se complementan entre si: 1) Distribución temporal de los movimientos (periodos de actividad-inactividad de intensidad); 2) Distribución frecuencial de las vibraciones producidas por estos movimientos; y 3) Distribución de las intensidades de las vibraciones y nivel medio de las mismas. Se completó el estudio correlacionando los datos dinámicos con los datos morfológicos que se apreciaron en los cortes histológicos de las articulaciones de estos mismos embriones sacrificados en sucesivos estadios de desarrollo

Preliminary study of elastic-tension digital neoprene orthoses for proximal interphalangeal joint flexion contracture

Flexion contracture of the proximal interphalangeal joint (PIPJ) is one of the most frequent complications in finger trauma. Orthoses are the most widely used method to optimize total end-range time (TERT). No previous studies showed that an elastic tension orthosis could be applied for longer than 12 h. We aimed to demonstrate that the elastic-tension digital neoprene orthosis (ETDNO) can achieve higher TERT and therefore better range of motion than other elastic-tension orthoses (ETO) described in the literature. A prospective study of treatment of PIPJ flexion contracture included 10 PIP joints in 8 patients who met the selection criteria. They were instructed to use the ETDNO for around 23 h per day as far as possible, during a period of 3 weeks. Patients reported a mean TERT of 20.6 h a day. PIPJ contracture improved by a mean Torque Range of Motion (TROM) of 23.5° at 500 g and 22.9° at 800 g of passive extension force during the 3-week treatment. Based on the results of this study, the ETDNO appears to offer a highly effective approach for improving PIPJ flexion contracture, increasing range of motion in extension. ETDNO's efficacy probably lies in the significantly improved comfort and low-profile design, enabling excellent compliance and thus optimizing TERT. LEVEL OF EVIDENCE: Level II

Grupo de Anatomía Virtual y de Simulación AVS

Podeu consultar la Setena trobada de professorat de Ciències de la Salut completa a: http://hdl.handle.net/2445/4335