Dataset Information

Engaging Posterior Capitellum Fracture and Elbow Posterolateral Rotatory Instability: Is It Always Necessary to Treat the Bone Defect?

ABSTRACT: Case:We present a 23-year-old male with 7 episodes of left elbow dislocation during a two-year period. He had a positive pivot shift test with engaging. The original treatment plan included lateral ulnar collateral ligament reconstruction and eventually bone defect grafting and osteosynthesis. However, a bone graft was not performed. After 2 years of follow-up, the DASH score was 3.3. The Mayo Score was 90. Conclusion:Posterolateral instability associated with an engaging bone defect, in every elbow extension and pivot shift test, was not found in the literature. The capitellum defects are associated with PLRI and make it worse. Bone reconstruction may not be indicated.

SUBMITTER: Patino JM

PROVIDER: S-EPMC7079214 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Engaging Posterior Capitellum Fracture and Elbow Posterolateral Rotatory Instability: Is It Always Necessary to Treat the Bone Defect?

Patiño Juan M JM Torres Moirano Juan M JM

Case reports in orthopedics 20200226

<h4>Case</h4>We present a 23-year-old male with 7 episodes of left elbow dislocation during a two-year period. He had a positive pivot shift test with engaging. The original treatment plan included lateral ulnar collateral ligament reconstruction and eventually bone defect grafting and osteosynthesis. However, a bone graft was not performed. After 2 years of follow-up, the DASH score was 3.3. The Mayo Score was 90.<h4>Conclusion</h4>Posterolateral instability associated with an engaging bone def ...[more]

PMID: 32206364

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Project description:BackgroundPosterolateral rotator instability (PLRI) is the most common pattern of recurrent elbow instability, and current imaging to aid PLRI diagnosis is limited. Thus, we sought to define use of ultrasound (US) to determine normal lateral ulnohumeral joint measurements, with and without posterolateral drawer testing to provide an insight into how US may aid diagnosis.MethodsSixty elbows were evaluated in thirty healthy volunteers. The lateral ulnohumeral gap (LUHG) was measured with US in the resting position while the posterolateral drawer stress test maneuver was applied. Joint laxity was calculated as the difference between maximum stress and average rest measurements. Two independent readers assessed each elbow with comparison performed between stress and rest positions.ResultsDifferences in the LUHG were evident between stress and rest conditions (reader 1: P < .0001 and reader 2: P = .0002). At rest, median LUHG values were 2.31 mm and 2.05 mm for readers 1 and 2 respectively, while at stress 2.88 mm and 2.9 mm for readers 1 and 2. Median joint laxity was 0.8 mm for reader 1 and 1.1 mm for reader 2. Pearson correlation was r = 0.457 (absolute intraclass correlation coefficient [ICC] = 0.608) while under stress and r = 0.308 (absolute intraclass correlation coefficient [ICC] = 0.417) at rest. Median joint laxity demonstrated a Pearson correlation of r = 0.161 and absolute intraclass correlation coefficient [ICC] = 0.252.ConclusionsThis study demonstrates a dynamic US assessment for PLRI, which aimed to assess the usefulness and feasibility of a laxity measurement after the application of a posterolateral drawer stress maneuver in a healthy population. Although establishing concordance between readers in measuring an LUHG under stress, the utility of a laxity measurement alone is not clear as correlation of measurements is not excellent; hence, an upper limit of normal for the ulnohumeral gap under stress may be more useful. Further evaluation of this technique is required in patients with PLRI.

Dataset Information

Engaging Posterior Capitellum Fracture and Elbow Posterolateral Rotatory Instability: Is It Always Necessary to Treat the Bone Defect?

Publications

Engaging Posterior Capitellum Fracture and Elbow Posterolateral Rotatory Instability: Is It Always Necessary to Treat the Bone Defect?

Similar Datasets

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