MyMedR

Fulltext Salvage of elbow function in chronic complex elbow fracture dislocation with total elbow arthroplasty: a case report

Muthu R, Foead AI, Ali A, Devadasan B

Med J Malaysia, 2013 Aug;68(4):353-5.

PMID: 24145266 MyJurnal

In patients with an elbow fracture dislocation the incidence of radial head fracture is 36%, where as coronoid process fractures occur in 13%, and olecranon fractures in 4% of patients. Combination of all these fractures with a 'terrible triad' is rarely reported in the literature. We describe a 40 year old lady involved in a polytrauma who had head injury, pnuemothorax and an open fracture dislocation of the left elbow. The Injury Severity Score initially on admission was 44. She presented with chronic elbow instability with pain 1 year later. A semi constrained total elbow arthroplasty (TEA) with a Coonrad-Morrey prosthesis was performed in this complex injury involving fractures of the coronoid, olecranon, proximal third of the ulna and radial head malunion with heterotrophic ossification around the elbow joint. Although the survivorship of total elbow replacements has improved, it is still a procedure reserved to older patients with low functional demand. At 1-year follow-up, the patient had full range in flexion and extension. The Mayo Elbow Performance Score (MEPS) was 100. TEA is a procedure which gains function and stability in a terrible triad elbow.

Matched MeSH terms: Elbow*; Elbow Joint

Patella cubiti

Gunn DR

Med J Malaya, 1965 Jun;19(4):314-7.

PMID: 4220858

Matched MeSH terms: Elbow/abnormalities*

Fulltext Radiological analysis of the medial epicondyle in the adolescent throwing athlete

Ng WM, Chan CK, Takahashi N, Kawai N, Teh KK, Saravana R, et al.

Singapore Med J, 2017 Feb;58(2):103-106.

PMID: 26976222 DOI: 10.11622/smedj.2016061

INTRODUCTION: Injuries to the medial structures of the elbow due to overhead throwing games are well documented. However, variations of medial epicondyles are not well described, especially in athletes with fused medial epicondyles. In this study, we evaluated variations in the medial epicondyle of baseball players who were aged 15-17 years and had fused epicondyles.

METHODS: In this cross-sectional observational study, 155 skeletally mature baseball players with unilateral medial elbow pain and 310 elbow radiographs were reviewed by two independent reviewers. The medial epicondyles were categorised into three groups: normal, elongated or separated.

RESULTS: Among the 155 patients, 65 (41.9%) had normal epicondyles, 41 (26.5%) had elongated epicondyles and 49 (31.6%) had separated epicondyles. The medial epicondyle was larger on the dominant arm for 125 (80.6%) patients; the mean surface area on the dominant arm was 222.50 ± 45.77 mm2, while that of the non-dominant arm was 189.14 ± 39.56 mm2(p < 0.01). Among the three categories of medial epicondyles, separated epicondyles had the largest surface area, followed by elongated and normal epicondyles.

CONCLUSION: Medial epicondyles in adolescent throwing athletes can be categorised into three different groups according to their shape (normal, elongated and separated). We observed a correlation between the shape and the surface area of the medial epicondyle in adolescent throwing athletes, with separated medial epicondyles having the largest surface area. Further studies and follow-up are needed to determine the prognostic value and clinical significance of these morphological variations.

Study done in Japan

Matched MeSH terms: Elbow/injuries*; Elbow Joint/physiopathology; Elbow Tendinopathy

Ipsilateral fracture dislocation of the radial shaft head associated with elbow dislocation: case report

Shukur MH, Noor MA, Moses T

J Trauma, 1995 Jun;38(6):944-6.

PMID: 7602642

A severe form of an extremely unusual injury, ipsilateral fracture dislocation of the radial shaft head associated with elbow dislocation, is described. Radial shaft fracture was irreducible even after the radial head and the elbow were reduced. Open reduction and internal fixation are viable options.

Matched MeSH terms: Elbow Joint/injuries*; Elbow Joint/surgery

Fulltext Modified pectoralis major tendon transfer for reanimation of elbow flexion as a salvage procedure in complete brachial plexus injury: a case report

Taran S, Nawfar S

Malays Orthop J, 2013 Mar;7(1):79-81.

PMID: 25722813 MyJurnal DOI: 10.5704/MOJ.1303.004

Traumatic brachial plexus injuries rarely recover spontaneously and if the window period for neurotisation has elapsed, the only option for restoration of function lies in a salvage procedure. Many such salvage procedures have been described in the literature with variable functional results. We report the case of a 16-year-old boy who presented after unsuccessful treatment for a complete brachial plexus injury; we performed a pectoralis major tendon transfer to attain elbow flexion. Postoperatively, the elbow was splinted with flexion at 100°. After 4 weeks of immobilization the splint was removed and the patient could actively flex his elbow from 30° to 100°.

Matched MeSH terms: Elbow; Elbow Joint

Modified French Osteotomy for Humeroradial Synostosis in a Child with Multiple Synostoses Syndrome: A Case Report

Sahdi H, Rasit AH, Khoo CS, Bojeng A, Nur-Alyana BA

Malays Orthop J, 2019 Jul;13(2):52-55.

PMID: 31467654 DOI: 10.5704/MOJ.1907.011

Congenital humeroradial synostosis can occur as an isolated clinical entity or as part of a syndrome. Bilateral elbow fixed flexion deformity is very incapacitating and challenging to treat. Here we present the case of a boy with fixed flexion deformity of both elbows due bilateral humeroradial synostosis. Other characteristic features of multiple synostoses syndrome were also present in this child, his elder brother and mother. We elected to improve the position of the right elbow by adapting the modified French osteotomy described by Bellemore et al.

Matched MeSH terms: Elbow; Elbow Joint

Fulltext Cubitus Valgus with Tardy Ulnar Nerve Palsy - Functional Outcome of Milch Osteotomy without Anterior Transposition of Ulnar Nerve

Gupta RK, Khiyani R, Majumdar KP, Potalia R

Malays Orthop J, 2020 Jul;14(2):120-125.

PMID: 32983386 DOI: 10.5704/MOJ.2007.021

Introduction: To assess the results of Milch osteotomy in terms of deformity correction and functional outcome in the absence of ulnar nerve transposition.

Material and Methods: Nine patients with cubitus valgus deformity greater than 20° with tardy ulnar nerve palsy (TUNP) operated between 2012 and 2017 were evaluated. Correction by Milch osteotomy and fixation was done in each case, without osteosynthesis of the non-union lateral condyle humerus or transposition of the ulnar nerve. At one year post-operatively, carrying angle, elbow function (Mayo Elbow Performance Score) and ulnar nerve symptoms were assessed.

Results: The mean carrying angle pre-operatively was 30.8° on the affected side which improved to a mean of 8.3° postoperatively with an average correction of 22.5°. The mean elbow flexion pre-operatively was 129.4° which improved to 133.3° post-operatively. The mean preoperative MEP score was 76.7 which improved to a mean of 92.2 post-operatively (p < 0.01). TUNP recovered completely in all the patients.

Conclusion: Milch osteotomy is an effective procedure for cubitus valgus deformity correction and its associated tardy ulnar nerve palsy without a decrease in elbow ROM. Correction of even severe valgus deformities without concurrent anterior transposition of the ulnar nerve is likely to improve ulnar nerve symptoms.

Matched MeSH terms: Elbow; Elbow Joint

Imaging bicipitoradial bursitis: a pictorial essay

Yap SH, Griffith JF, Lee RKL

Skeletal Radiol, 2019 Jan;48(1):5-10.

PMID: 29797016 DOI: 10.1007/s00256-018-2970-0

Although bicipitoradial bursitis is not commonly seen, when it does occur, it can frequently lead to diagnostic difficulty, mimicking either a soft-tissue tumor or infection. Lack of awareness of this uncommon entity can lead to unnecessary anxiety or tissue biopsy. This pictorial essay discusses the normal anatomy of the bicipitoradial bursa and the spectrum of imaging findings of bicipital bursitis.

Matched MeSH terms: Elbow Joint/pathology

Fulltext Retrospective Review of Kirschner Wire Fixation andCasting for Displaced Lateral Condylar Fracture of theHumerus in Children

Gooi, S.G, Chee, E.K., Wong, C.L., Mohana, R., Khoo, E.H., Thevarajan, K.

Malays Orthop J, 2008;2(2):17-20.

MyJurnal

This study was conducted to assess the optimum period for Kirschner wire fixation and cast immobilization for displaced lateral condylar fracture of the humerus in children. We retrospectively reviewed 12 patients with displaced lateral condyle humerus fracture, ranging in age from 3-9 y, with injuries that occurred between Jan 2005 and Dec 2006. All patients were treated with two Kirschner wire fixation and elbow immobilization. In all except 2 patients, the Kirschner wires were maintained for 3 to 4 weeks. Mean time for union was 3.78 weeks and mean humeroulnar arch motion at last review was 138.7 degrees. Only one patient had a 5 degree increased carrying angle in valgus as compared to the non-injured side, and 50% had prominent scars > 4mm. We conclude that fracture union can be expected within three to four weeks for most children after open reduction and fixation with 2 Kirschner wires.

Matched MeSH terms: Elbow; Elbow Joint

Fulltext The effects of forearm position on handgrip strength

Ali Md Nadzalan

Jurnal Sains Sukan & Pendidikan Jasmani, 2013;2(1):2-9.

MyJurnal

This study was conducted to investigate i) while the shoulder was in 180° of flexion and the elbow extended, which of the forearm position (supination, pronation and neutral) can generate the greatest handgrip strength, ii) is there any correlation of the handgrip strength between the dominant hand (right hand) and non-dominant hand (left hand) in each forearm position, and iii) will the dominant hand possessed 10% higher handgrip strength than the non-dominant hand. 100 right handed sedentary active students age 22.20 years old (± 1.03), height 172.83 cm (± 6.37), body mass 68.87 (± 11.52) and grip position 3.77 (± 0.77) were recruited in this study. The result indicated that for both the dominant and non-dominant hand, when the shoulder is in 180˚ flexion of the body with the elbow extended, the greatest grip strength was obtained when the forearm was in neutral position followed by pronation and supination position. Post Hoc analysis showed that for both dominant hand and non-dominant hand, pronation and supination forearm position produced greater strength score compared to supination forearm position (p0.05). In all forearm position, participants were shown to produced significantly greater strength in their dominant hand and all the scores were more than 10% greater compared to when using non-dominant hand. Positive relationships were also found for the strength score between dominant hand and non-dominant hand. As the conclusion, different shoulder, elbow and forearm position can affect handgrip strength.

Matched MeSH terms: Elbow; Elbow Joint

Fulltext Pen and paper based observational method to assess postural problems: a review

Sukadarin, E.H., Deros, B.M., Nawi, N.S.M., Rambely, A.S., Bakar, S.A., Tamrin, S.B.M.

Malaysian Journal of Public Health Medicine, 2016;16(20):78-83.

MyJurnal

Posture is one of the most important factor that need to be considered in any postural analysis. Awkward, extreme,
and repetitive postures can increase the risk of musculoskeletal disorders (MSDs). As observational methods are more
widely used than instrumentation-based methods to assess postural problems, this study reviews and assesses the
scientific literature of observational methods and focused on pen and paper based specifically. In order to identify the
published methods, a list of English or Malay articles dating as far back as 1990 was compiled from PubMed, Science
Direct and Google Scholar. The keywords were ergo*, posture*, method*, observational*, postural problems*, pen and
paper*, posture analysis*, indirect* and macro-ergo*. In addition, a secondary search was also performed using
bibliography of retrieved articles so that additional papers for conducting review and evaluations can be collected. A
total of 121 articles that assessed postural problems in working activities were found. However, after intensive
screening process only 6 articles were selected to be further analyzed. Posture of upper arms/shoulder, lower arms/
elbow, wrist, neck, back/trunk and leg were highlighted in this study. The limitations and the strengths of the
published pen and paper based observational method focusing on those postures were also discussed. The finding of
this review will benefit researchers in the process of understanding unsafe posture in workplace. It could also provide
to researcher on how to improve the current pen and paper based observational method for assessing postural
problems.

Matched MeSH terms: Elbow; Elbow Joint

Fulltext Ulnar Osteotomy with 2-Pin Unilateral Gradual Distraction for Treatment of Chronic Monteggia Fracture: A Case Report

Gooi SG, Wang CS, Saw A, Zulkiflee O

Malays Orthop J, 2017 Mar;11(1):79-81.

PMID: 28435583 MyJurnal DOI: 10.5704/MOJ.1703.015

Missed Monteggia fracture leading to chronic radial head dislocation is a known complication. The surgical treatment options remain challenging. The aim of treatment is to reduce the radial head and to maintain the stability of the elbow in all ranges of motion. A few surgical techniques have been described with complications. We report the case of a 13 years old boy with chronic radial head dislocation as a result of an unrecognised Monteggia fracture-dislocation for eight years. We successfully reduced the radial head and corrected the cubital valgus from 45 degrees to 10 degrees with a proximal ulna osteotomy and gradual distraction with 2-pin Monotube external fixator. The correction was uneventful with good functional outcome.

Matched MeSH terms: Elbow; Elbow Joint

Fulltext Anterior Displacement of Ulnar Nerve at the Elbow inChildren Based on Ultrasonography

Shamsul, H., Saw, A., John, G.

Malays Orthop J, 2007;1(1):29-33.

MyJurnal

This study involved evaluation of the elbows of 50 children between 4 to 14 years of age. Clinical examination for elbow flexion, extension, range of motion and carrying angle were performed, followed by ultrasonographic examination to determine position of the ulnar nerve in relation to the medial epicondyle upon elbow flexion and extension. Thirty-one elbows showed anterior displacement of the ulnar nerve, of which 14 were due to subluxation and 17 to dislocation. We found that anterior translation of ulnar nerve is present in the elbows up to 31% of children, especially those with increased range of elbow motion.

Matched MeSH terms: Elbow; Elbow Joint

Fulltext Neglected Anterior Dislocation of the Elbow Joint: Case Report of a Rare Injury

Nema SK, Behera G, Poduval M

Malays Orthop J, 2018 Jul;12(2):65-67.

PMID: 30112134 DOI: 10.5704/MOJ.1807.016

We present an unusual case of five months old neglected anterior dislocation of the right elbow joint in a 19-year old man. The patient had been initially treated by a traditional bone setter, but the elbow remained unreduced. He presented to us with pain, deformity and limited range of motion of his right elbow joint. Radiographs revealed an unreduced anterior dislocation of the right elbow joint. We describe the problems encountered during open reduction and rehabilitation and result one year after the operation with the patient having a stable elbow and a functional range of motion.

Matched MeSH terms: Elbow; Elbow Joint

Fulltext Brachial Artery Injury in a Child following Closed Elbow Dislocation: Case Report of a Rare Injury

Vickash K, Amer A, Naeem A, Falak S

Malays Orthop J, 2016 Nov;10(3):36-38.

PMID: 28553446 DOI: 10.5704/MOJ.1611.001

Elbow dislocation, though a common orthopaedic emergency is rare with brachial artery injury and is even more uncommon in the paediatric age group. We present the case of a child who sustained trauma resulting in closed elbow dislocation with brachial artery injury. Elbow dislocation with brachial artery injury can present with palpable distal pulses and good capillary refill because of rich collaterals at the elbow. But this patient presented with signs of frank ischemia distally, and was managed with ipsilateral reverse cephalic vein graft. He had good volume pulses at one year follow-up. Patients with such presentation should have careful clinical and radiological assessment to exclude complicated elbow dislocation.

Matched MeSH terms: Elbow; Elbow Joint

Fulltext Ultrasound-guided Percutaneous Lavage in the Treatment of Calcific Tendinopathy of Elbow Extensor Tendons: A Case Report

Abate M, Salini V, Schiavone C

Malays Orthop J, 2016 Jul;10(2):53-55.

PMID: 28435563 DOI: 10.5704/MOJ.1607.011

We report the efficacy of the ultrasound-guided percutaneous treatment in the management of elbow extensor tendons calcific tendinopathy. The ultrasound-guided percutaneous treatment is broadly used with positive results in patients suffering from rotator cuff calcific tendinopathy. However, this interventional method has been reported only in one patient in the medical literature. A 34 years-old female who complained pain, swelling and severe functional limitation of the right elbow was referred to our unit. Elbow radiographs and ultrasound examination showed a soft-fluid calcification above the origin of the extensor tendons. Ultrasound-guided percutaneous treatment was therefore performed. After one year, the patient reported no pain and regained complete range of elbow motion. This method, in well trained hands, is an alternative treatment in the management of the uncommon elbow calcific deposit.

Study done in Italy

Matched MeSH terms: Elbow; Elbow Joint

Fulltext Avulsion Fracture of Brachioradialis Muscle Origin: An Exceedingly Rare Entity: A Case Report

Behera G, Balaji G, Menon J, Sharma D, Komuravalli VK

Malays Orthop J, 2016 Jul;10(2):50-52.

PMID: 28435562 DOI: 10.5704/MOJ.1607.010

Avulsion fracture of the brachioradialis origin at its proximal attachment on the lateral supracondylar ridge of the distal humerus is exceedingly rare, and only two cases have been reported in the literature so far. In this article, we present a 38 years old patient who sustained a closed avulsion fracture of the lateral supracondylar ridge of left humerus at the proximal attachment of brachioradialis following a fall backwards on outstretched hand after being struck by a lorry from behind while riding on a two-wheeler (motorcycle). He was managed with above elbow plaster for four weeks followed by elbow and wrist mobilization. At final followup, the patient had painless full range elbow motion with good elbow flexion strength. The unique mechanism by which this avulasion fracture occurred is explained on the basis of the mode of injury, position of the limb and structure and function of the brachioradialis muscle.

Matched MeSH terms: Elbow; Elbow Joint

Fulltext Benign Subcutaneous Emphysema of the Upper Limb: A Case Report

Rabiul Islam SM, Mamman KG, Pande KC

Malays Orthop J, 2016 Nov;10(3):39-41.

PMID: 28553447 DOI: 10.5704/MOJ.1611.002

Subcutaneous emphysema is the presence of gas or air in the subcutaneous tissue plane. The term is generally used to describe any soft tissue emphysema of the body wall or limbs, it can result from benign causes, most commonly secondary to trauma or from a life-threatening infection by gas gangrene or necrotising fasciitis. A case of subcutaneous emphysema involving the upper limb resulting from a trivial laceration to the elbow is reported and the importance of distinguishing between the two causes of subcutaneous emphysema is highlighted.

Matched MeSH terms: Elbow; Elbow Joint

Kinetic and kinematic determinants of shuttlecock speed in the forehand jump smash performed by elite male Malaysian badminton players

Ramasamy Y, Usman J, Sundar V, Towler H, King M

Sports Biomech, 2024 May;23(5):582-597.

PMID: 33663330 DOI: 10.1080/14763141.2021.1877336

Badminton is the fastest racket sport in the world with smash speeds reaching over 111 m/s (400 kph). This study examined the forehand jump smash in badminton using synchronised force plates and full-body motion capture to quantify relationships to shuttlecock speed through correlations. Nineteen elite male Malaysian badminton players were recorded performing forehand jump smashes with the fastest, most accurate jump smash from each player analysed. The fastest smash by each participant was on average 97 m/s with a peak of 105 m/s. A correlational analysis revealed that a faster smash speed was characterised by a more internally rotated shoulder, a less elevated shoulder, and less extended elbow at contact. The positioning of the arm at contact appears to be critical in developing greater shuttlecock smash speeds. Vertical ground reaction force and rate of force development were not correlated with shuttlecock speed, and further investigation is required as to their importance for performance of the jump smash e.g., greater jump height and shuttle angle. It is recommended that players/coaches focus on not over-extending the elbow or excessively elevating the upper arm at contact when trying to maximise smash speed.

Matched MeSH terms: Elbow Joint*

Late presentation of supracondylar fracture of the humerus in children

Devnani AS

Clin Orthop Relat Res, 2005 Feb.

PMID: 15685053

In children with delayed presentation of displaced supracondylar fractures, closed or open reduction with K-wire fixation risks complications. Gradually reducing the fracture with traction potentially reduces these risks. An unacceptable deformity can be corrected later by an osteotomy. This concept was used for 28 children, with an average age of 7 years 6 months, who presented after an average delay of 5.6 days. Their stay in the hospital was 14 days on average. At followup (average, 24 months), five children (18%) who had cubitus varus greater than 10 degrees had corrective osteotomy. There were no additional neurovascular injuries after treatment. The results are comparable with other methods of treatment.

Matched MeSH terms: Elbow/injuries*; Elbow Joint/physiopathology

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