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Reconstruction for elbow instability caused by congenital aplasia of the ulnar coronoid process--a case report.

Farr S, Rois J, Ganger R, Girsch W - Acta Orthop (2015)

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Affiliation: a Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery , Orthopaedic Hospital Speising , Vienna Austria.

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A 13-year-old girl presented at our tertiary referral center with bilateral posterior radial head dislocation and aplasia of the ulnar coronoid process (Figure 1)... After several years without any relevant restrictions during her daily life activities, she returned to our outpatient clinic at the age of 17 with increasing pain on both sides and distinct radiological signs of posterior humeroulnar dislocation due to aplasia of the ulnar coronoid process (Figure 2)... Thereafter, the bone graft was fixed with 2 cannulated 4.5-mm screws; the apophysis of the graft was orientated towards the trochlea humeri to serve as a joint surface (Figure 2)... No attempt was made to reduce the dislocated radial head... Congenital elbow deformities in children and adolescents are rare disorders, which are most often related to a congenital posterior (or less often anterior) dislocation of the radial head... While results after surgical reconstruction and nonoperative treatment in patients with congenital radial head dislocation have been reported (Bengard et al. ), we are not aware of any published case accompanied by an additional congenital aplasia of the ulnar coronoid process... Although generally mild to moderate functional impairment may be present in patients with congenital radial head dislocation, reports after surgical interventions have shown various outcomes, so surgery is (in our opinion) mainly indicated when pain is the primary complaint... A similar technique was previously reported in cases with comminuted coronoid fractures (Chung et al. ), and combined fractures of the olecranon, radial head, and coronoid process (Kohls-Gatzoulis et al. )... In contrast to other authors who investigated outcomes after different methods of open reduction and internal fixation techniques for coronoid fractures (Garrigues et al. ), we preferred the use of screws over suture lasso fixation because a good compression of the iliac bone graft could be achieved by this means... We observed neither implant failure nor malunion or heterotopic ossification at 1-year follow-up... Early mobilization is crucial to avoid elbow stiffness, as reported previously for a posttraumatic situation (Kohls-Gatzoulis et al. ); so the addition of temporary monolateral external fixation is in our opinion a good option to allow early remobilization... Nevertheless, patients should be counseled about the inherent risks of this procedure—such as recurrent instability, reduced joint range of motion, or potential osteoarthritis in the long term... RG revised the manuscript... WG operated on the patient and revised the manuscript.

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A and B. Postoperatively, with external fixator in place on the left side for guided and unloaded movement. Elbow extension was still restricted to 40 degrees on the left side at this time.
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Figure 0003: A and B. Postoperatively, with external fixator in place on the left side for guided and unloaded movement. Elbow extension was still restricted to 40 degrees on the left side at this time.

Mentions: The range of motion of the elbow was restricted to 40–110 degrees for 4 weeks in order to avoid shear forces on the graft during extension, and active and passive physiotherapy was initiated 2 days postoperatively. The fixator was removed 8 weeks postoperatively and replaced by a forearm splint until consolidation was seen on CT-scans 2 months postoperatively. At the latest follow-up examination 1 year postoperatively, the patient was very satisfied with the intervention (Figure 3). She had no pain and showed improved elbow range of motion (20–140 degrees) and forearm pronation and supination (80–60 degrees). 8 months after the index intervention, an identical procedure was performed on the contralateral side but without enforcement of the collateral ligaments. Elbow range of motion and forearm pronation and supination improved on this extremity to 20–140 and 80–45 degrees, respectively. The postoperative course remained uneventful without any complications on both operated extremities.Figure 3.


Reconstruction for elbow instability caused by congenital aplasia of the ulnar coronoid process--a case report.

Farr S, Rois J, Ganger R, Girsch W - Acta Orthop (2015)

A and B. Postoperatively, with external fixator in place on the left side for guided and unloaded movement. Elbow extension was still restricted to 40 degrees on the left side at this time.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940599&req=5

Figure 0003: A and B. Postoperatively, with external fixator in place on the left side for guided and unloaded movement. Elbow extension was still restricted to 40 degrees on the left side at this time.
Mentions: The range of motion of the elbow was restricted to 40–110 degrees for 4 weeks in order to avoid shear forces on the graft during extension, and active and passive physiotherapy was initiated 2 days postoperatively. The fixator was removed 8 weeks postoperatively and replaced by a forearm splint until consolidation was seen on CT-scans 2 months postoperatively. At the latest follow-up examination 1 year postoperatively, the patient was very satisfied with the intervention (Figure 3). She had no pain and showed improved elbow range of motion (20–140 degrees) and forearm pronation and supination (80–60 degrees). 8 months after the index intervention, an identical procedure was performed on the contralateral side but without enforcement of the collateral ligaments. Elbow range of motion and forearm pronation and supination improved on this extremity to 20–140 and 80–45 degrees, respectively. The postoperative course remained uneventful without any complications on both operated extremities.Figure 3.

View Article: PubMed Central - PubMed

Affiliation: a Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery , Orthopaedic Hospital Speising , Vienna Austria.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

A 13-year-old girl presented at our tertiary referral center with bilateral posterior radial head dislocation and aplasia of the ulnar coronoid process (Figure 1)... After several years without any relevant restrictions during her daily life activities, she returned to our outpatient clinic at the age of 17 with increasing pain on both sides and distinct radiological signs of posterior humeroulnar dislocation due to aplasia of the ulnar coronoid process (Figure 2)... Thereafter, the bone graft was fixed with 2 cannulated 4.5-mm screws; the apophysis of the graft was orientated towards the trochlea humeri to serve as a joint surface (Figure 2)... No attempt was made to reduce the dislocated radial head... Congenital elbow deformities in children and adolescents are rare disorders, which are most often related to a congenital posterior (or less often anterior) dislocation of the radial head... While results after surgical reconstruction and nonoperative treatment in patients with congenital radial head dislocation have been reported (Bengard et al. ), we are not aware of any published case accompanied by an additional congenital aplasia of the ulnar coronoid process... Although generally mild to moderate functional impairment may be present in patients with congenital radial head dislocation, reports after surgical interventions have shown various outcomes, so surgery is (in our opinion) mainly indicated when pain is the primary complaint... A similar technique was previously reported in cases with comminuted coronoid fractures (Chung et al. ), and combined fractures of the olecranon, radial head, and coronoid process (Kohls-Gatzoulis et al. )... In contrast to other authors who investigated outcomes after different methods of open reduction and internal fixation techniques for coronoid fractures (Garrigues et al. ), we preferred the use of screws over suture lasso fixation because a good compression of the iliac bone graft could be achieved by this means... We observed neither implant failure nor malunion or heterotopic ossification at 1-year follow-up... Early mobilization is crucial to avoid elbow stiffness, as reported previously for a posttraumatic situation (Kohls-Gatzoulis et al. ); so the addition of temporary monolateral external fixation is in our opinion a good option to allow early remobilization... Nevertheless, patients should be counseled about the inherent risks of this procedure—such as recurrent instability, reduced joint range of motion, or potential osteoarthritis in the long term... RG revised the manuscript... WG operated on the patient and revised the manuscript.

Show MeSH