Medial Elbow Exposure for Coronoid Fractures: FCU-Split Versus Over-the-Top.

Medial Elbow Exposure for Coronoid Fractures: FCU-Split Versus Over-the-Top.

Filed under: Rehab Centers

J Orthop Trauma. 2013 Feb 13;
Huh J, Krueger CA, Medvecky MJ, Hsu JR

OBJECTIVE:: The optimal exposure interval for anteromedial coronoid fractures is unknown. The purpose of this study was to quantitatively compare the osseous and ligamentous exposure of the medial elbow utilizing the flexor-carpi-ulnaris (FCU)-Splitting and Hotchkiss Over-the-Top approaches. METHODS:: 40 surgical approaches were performed on 20 fresh-frozen cadaveric elbows using a randomized crossover design. Access to key anatomic landmarks (anteromedial facet, coronoid tip, sublime tubercle/anterior bundle of the medial collateral ligament (MCL), posterior bundle of the MCL, and radial head) was assessed. A calibrated digital image was taken from the surgeon’s perspective of each approach and these images were analyzed using a software program, ImageJ (NIH, Bethesda, MD), to calculate the surface area of osseous structures exposed. RESULTS:: The average surface area exposed was three times greater with the FCU-Splitting approach (13.3cm) compared to the Hotchkiss Over-the-Top approach (4.4cm) (p<0.0001). All key anatomic landmarks were directly visualized with the FCU-Splitting approach in each specimen. Visualization of the sublime tubercle/anterior bundle of the MCL and posterior bundle of the MCL was unobtainable with the Hotchkiss approach in 17 (85%) and 20 (100%) specimens, respectively. There were no statistically significant correlations between exposure and sequence of dissection, specimen age, gender or laterality. CONCLUSIONS:: The FCU-Splitting approach provides more extensive exposure of the anteromedial coronoid and proximal ulna as well as the medial ligamentous structures than the Hotchkiss Over-the-Top approach. HubMed – rehab

 

Fracture of the acetabulum: a retrospective review of ninety-one patients treated at a single institution.

Filed under: Rehab Centers

Eur J Orthop Surg Traumatol. 2013 Feb; 23(2): 155-63
Uchida K, Kokubo Y, Yayama T, Nakajima H, Miyazaki T, Negoro K, Takeno K, Sawaguchi T, Watanabe S, Sugita D, Takeura N, Yoshida A, Baba H

Acetabular fracture result in fairly good outcome after the anatomic reduction in the displaced fracture fragments and damaged joint structure, but some patients will inevitably suffer from hip joint problems during their courses after the insult. We retrospectively reviewed 91 patients with acetabular fractures to investigate the causes of clinical failure and relationship among the fracture types, selected treatment options and their courses. Ninety-one patients (73 men and 18 women) with an average age of 49 years (range 18-80) at the time of injury were followed up for an average of 8.6 years (range 2-18). Judet-Letournel classification of fracture type and Matta’s rating regimen of functional and radiographic patient’ assessment were conducted. Conservative treatment was provided in 20 patients, in which 19 attained excellent/good, and one fair clinical results. All achieved excellent/good radiographic outcome. Surgically treated patients (n = 71) with critical dislodgement of the fracture fragment showed that 64 (90%) attained excellent/good and 7 (10%) fair/poor clinical outcomes. Sixty-three (89%) attained excellent/good and 8 (11%) fair/poor postoperative radiographic outcome. Five patients with poor radiographic outcome after surgery subsequently required total hip arthroplasty, due to the development of hip joint osteoarthritis in 3 and femoral head avascular necrosis in 2. We conclude that displacement of the joint surface should be reduced to less than 3 mm in accordance with the selection of the most appropriate surgical approach for open reduction/fixation in each fracture type; however, comminuted fracture and avascular necrosis of the femoral head may be the cause of poor clinical results.
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Effects of muscular deficiency on postural and gait capacities in patients with Charcot-Marie-Tooth disease.

Filed under: Rehab Centers

J Rehabil Med. 2013 Feb 14;
Guillebastre B, Calmels P, Rougier P

Objective: The aim of this study was to examine the relationships between lower limb muscular deficiencies and postural and gait capacities. Design: Observational study. Subjects: A total of 26 patients with Charcot-Marie-Tooth disease and 19 health-matched healthy subjects. Methods: Barefoot gait and postural control were analysed using a walking mat and a force platform, respectively. Muscular strength of the plantar and dorsal ankle flexors were assessed using the Medical Research Council scale. Results: Gait parameters correlated with both dorsal- and plantar-flexors strength, whereas postural parameters correlated only with plantar-flexors strength. More particularly, patients with a weak deficit of the plantar-flexor muscles were characterized by normal postural control except along the antero-posterior axis. For gait control, the overall pattern defined from the gait cycle division was preserved, whereas other spatio-temporal parameters were impaired, and more so in patients with a high level of deficit of the plantar-flexor muscles. Conclusion: These data highlight behaviour differences in standardized tasks, such as standing still upright or gait. Improved knowledge of postural and gait capacities may constitute a basis to emphasize the corrections that should be enabled by rehabilitation exercises or orthotic devices.
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