Shoulder and Elbow Trauma and its Complications The

Elbow

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Contents

List of contributors xi
Woodhead Publishing Series in Biomaterials xiii

Part One   Elbow trauma 1

1 Simple elbow dislocation 3

J.N. Shillingford and W.N. Levine
1.1 Introduction 3
1.2 Epidemiology 3
1.3 Elbow anatomy and biomechanics 4
1.4 Evaluation and initial management 5
1.5 Nonoperative management 8
1.6 Patient outcomes 8
1.7 Complications 9
1.8 Further directions 11
References11

2 Complex elbow dislocations 13

J.D. Wyrick and S.K. Dailey
2.1 Introduction 13
2.2 Anatomy 13
2.3 Elbow biomechanics 15
2.4 Valgus posterolateral rotatory injury 18
2.5 Varus posteromedial rotatory injury 29
2.6 Axial loading injuries 33
2.7 Complications of complex elbow dislocations 38
2.8 Future directions 40
2.9 Summary 41
References41

3 Management of acute and chronic distal biceps ruptures 47

A.V. Metzler and R.M. Greiwe
3.1 Introduction 47
3.2 Distal biceps anatomy 47
3.3 Surgical anatomy 48
3.4 Epidemiology 49
3.5 Etiology 49
vi Contents

3.6 Clinical evaluation 49

3.7 Imaging 50
3.8 Treatment 50
3.9 Outcomes 57
3.10 Future trends 61
3.11 Conclusion 61
Disclosures62
References62

4 Distal humerus fractures: open reduction and internal fixation 65

R.M. Greiwe
4.1 Introduction 65
4.2 Anatomy and biomechanics 66
4.3 Classification system 72
4.4 Preoperative evaluation 74
4.5 Surgical decision-making 77
4.6 Technical considerations 77
4.7 Principles of fixation 79
4.8 Surgical technique 81
4.9 Surgical factors that affect outcome 84
4.10 Coronal shear fractures 84
4.11 Postoperative rehabilitation 87
4.12 Outcomes 87
4.13 Complications 89
4.14 Future trends/additional sources of reference 92
References92

5 Arthroplasty for treatment of distal humerus fractures 99

B.M. Steen, M.M. Hussey and M.A. Frankle
5.1 Introduction 99
5.2 Evaluation and workup 102
5.3 Surgical techniques 105
5.4 Outcomes 110
5.5 Complications and their management 112
5.6 Important points 114
5.7 Future directions 115
5.8 Other resources and information 116
References116

6 Fractures of the proximal forearm 119

N. Kazemi and R.M. Greiwe
6.1 Introduction 119
6.2 Anatomy 119
6.3 Evaluation of patients with proximal forearm fractures 121
6.4 Olecranon fractures 121
6.5 Radial head and neck fractures 131
Contents vii

6.6 Summary 136

6.7 Future trends 137
References137

7 Fractures of the proximal radius and ulna: coronoid fractures 145

J.D. Wyrick and A.W. Jimenez
7.1 Introduction 145
7.2 Anatomy 145
7.3 Imaging 146
7.4 Mechanisms of injury and fracture patterns 148
7.5 Classification 150
7.6 Biomechanics 151
7.7 Management 153
7.8 Outcomes 161
7.9 Complications 162
7.10 Future directions 162
References163

8 Olecranon fractures 167

G.N. Lervick
8.1 Introduction 167
8.2 Anatomy 167
8.3 Fracture anatomy/classification 168
8.4 Epidemiology 169
8.5 Initial evaluation 170
8.6 Treatment 171
8.7 Rehabilitation 182
8.8 Complications 185
8.9 Future directions 187
8.10 Summary 187
Bibliography188

9 Fractures of the proximal radius and ulna: Monteggia

injuries193
T.J. Parisi and J.B. Jupiter
9.1 Background 193
9.2 Anatomy 193
9.3 Classification/pattern of injury 194
9.4 Preoperative evaluation 198
9.5 Management 201
9.6 Postoperative management 210
9.7 Expected outcomes 212
9.8 Complications 213
9.9 Future directions 218
9.10 Sources for further reference 218
References218
viii Contents

Part Two   Managing complications of elbow trauma 223

10 Persistent elbow instability 225

J.D. Wyrick and T.J. Keller
10.1 Introduction 225
10.2 Anatomy and biomechanics 225
10.3 Injury patterns 227
10.4 Imaging 230
10.5 Previous studies 230
10.6 Management 232
10.7 Surgical approach 233
10.8 Coronoid reconstruction 239
10.9 Postoperative management 240
10.10 Complications 240
10.11 Future developments 242
10.12 Summary 242
References243

11 Fracture of the radial head: fixation, failure, and replacement 247

T.C. Moen, D. Worrel and R.C. Ostermann
11.1 Introduction 247
11.2 Incidence/epidemiology 247
11.3 Anatomy/biomechanics of the radial head 247
11.4 Radial head fractures: clinical and radiographic assessment 248
11.5 Classification 248
11.6 Decision-making 249
11.7 Nonoperative treatment 249
11.8 Operative treatment—ORIF 250
11.9 Operative treatment—prosthetic replacement 250
11.10 Failure of treatment of radial head fractures 251
11.11 Conclusion 252
11.12 Future directions for research 253
References253

12 Distal humerus nonunion 257

E.C. Fu and D. Ring
12.1 Background/epidemiology 257
12.2 History and physical exam 257
12.3 Radiographic evaluation 258
12.4 Classification 258
12.5 Treatment techniques 258
12.6 Conclusions 266
12.7 Source for further reference 266
References267
Contents ix

13 Olecranon and proximal ulna nonunion 269

M. Mighell
13.1 Introduction 269
13.2 Nonunions of nonoperatively treated olecranon and proximal
ulna fractures 269
13.3 Nonunions of operatively treated olecranon fractures 277
13.4 Nonunions of operatively treated proximal ulna fractures 285
13.5 Technical pearls 289
13.6 Future trends/additional resources 289
References290

14 Treatment of the stiff elbow: capsular contracture and heterotopic

ossification293
B.P. Kleinhenz
14.1 Introduction 293
14.2 Pathophysiology 294
14.3 Epidemiology 294
14.4 Classification 294
14.5 Presentation 296
14.6 Physical examination 297
14.7 Imaging 298
14.8 Management 299
14.9 Nonsurgical treatment 299
14.10 Surgical treatment 300
14.11 Lateral “column” procedure 301
14.12 Medial “over-the top” approach 301
14.13 Posterior “Outerbridge-Kashiwagi” procedure 302
14.14 Elbow arthroscopy for capsular stiffness 302
14.15 Arthroscopic debridement 303
14.16 Outcomes section 303
14.17 Complications section 304
14.18 Rehabilitation 305
14.19 Heterotopic ossification 306
14.20 Prophylaxis of HO 307
14.21 Conclusions 307
14.22 Areas for further research 308
References308

15 Complex post-traumatic elbow stiffness: nonunion, malunion, and

post-traumatic arthritis 313
G.A. Fierro Porto and R.M. Greiwe
15.1 Introduction 313
15.2 Pathophysiology 313
15.3 Classification 325
x Contents

15.4 Medical decision-making 325

15.5 Treatment 327
15.6 Complications 339
15.7 Conclusions/future trends 342
References343

Index353
List of contributors

S.K. Dailey University of Cincinnati, Cincinnati, OH, USA

G.A. Fierro Porto Universidad del Rosario – Fundación Santa Fe de Bogotá, Bogotá,
Colombia

M.A. Frankle Florida Orthopaedic Institute, Temple Terrace, FL, USA

E.C. Fu Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

R.M. Greiwe Commonwealth Orthopaedic Centers, Edgewood, KY, USA

M.M. Hussey Arkansas Specialty Orthopaedics, Little Rock, AR, USA

A.W. Jimenez University of Cincinnati, Cincinnati, OH, USA

J.B. Jupiter Massachusetts General Hospital, Harvard Medical School, ­Boston,

MA, USA

N. Kazemi Mount Sinai Medical Center, New York, NY, USA

T.J. Keller University of Cincinnati, Cincinnati, OH, USA

B.P. Kleinhenz TriHealth Hand Surgery Specialists, Cincinnati, OH, USA

G.N. Lervick Minnesota Orthopedic Sports Medicine Institute (MOSMI), Twin ­Cities
Orthopedics, Edina, MN, USA

W.N. Levine New York Presbyterian/Columbia University Medical Center,

New York, NY, USA

A.V. Metzler Commonwealth Orthopaedic Centers, Edgewood, KY, USA

M. Mighell The American Board of Orthopaedic Surgery, Chapel Hill, NC, USA;
Department of Orthopaedic Surgery, University of South Florida, Tampa, FL, USA;
Shoulder and Elbow Fellowship Program, Florida Orthopaedic Institute Tampa, FL,
USA; Uniformed Services University of the Health Sciences, F. Edward Hébert School
of Medicine, Bethesda, MD, USA
xii List of contributors

T.C. Moen Carrell Clinic, Dallas, TX, USA

R.C. Ostermann Medical University of Austria, Vienna, Austria

T.J. Parisi Massachusetts General Hospital, Harvard Medical School, B

­ oston,
MA, USA

D. Ring Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

J.N. Shillingford New York Presbyterian/Columbia University Medical Center,

New York, NY, USA

B.M. Steen Florida Orthopaedic Associates, DeLand, FL, USA

D. Worrel Carrell Clinic, Dallas, TX, USA

J.D. Wyrick University of Cincinnati, Cincinnati, OH, USA

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