Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Distal Radius Fractures

Introduction Distal radius fractures are the most common upper extremity fracture in patients in the United States, accounting for 0.7%–2.5% of emergency department visits. , Worldwide, the incidence of distal radius fractures has increased over the past 40–50 years, almost doubling in certain populations. , Distal radius fractures occur in a bimodal distribution with the highest frequency in youths under the age of 18 years and…

Technique Spotlight: ORIF of Both Bones Forearm Fractures—Approaches

Indications Surgical indications for both bones forearm fractures include the following: (1) nondisplaced or minimally displaced both bones forearm fractures with a propensity for instability (comminution, initial displacement prior to reduction, and polytrauma patients) and (2) significantly displaced or angulated radius or ulna or both bones forearm fractures. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership…

Radial and Ulnar Shaft Fractures: Choice of Approach, Nails vs. Plates, Compression Tips and Tricks

Relevant Anatomy The diaphyseal forearm functions to provide a stable platform upon which the hand can be positioned in space, as well as to facilitate forearm rotation. The ulna functions as the dominant load-bearing structure, with the radius rotating about it in pronation and supination. The soft tissue envelope about the diaphysis of the forearm is composed of the superficial and deep volar compartments, the extensor…

Technique Spotlight: Interosseous Membrane Reconstruction

Indications The primary indication to reconstruct the interosseous membrane (IOM) is a longitudinal radioulnar dissociation also known as an Essex-Lopresti injury (ELI). An ELI is an injury triad involving fracture of the radial head, rupture of the interosseous ligaments, and instability of the distal radioulnar joint (DRUJ). Early diagnosis is paramount for a favorable outcome, as timing affects the strategy of treatment. In the acute setting,…

Essex-Lopresti—When Do All Three Levels Require Attention?

History Although the eponym for forearm longitudinal instability is known as Essex-Lopresti, Dr. Peter Essex-Lopresti was not the first person who reported the injury. It was first described by Brockman in 1931. Curr and Coe later reported on a case of a dislocation “on both ends of the radius” 15 years later in 1946. However, in a case report by Dr. Essex-Lopresti in 1951, he correctly…

Technique Spotlight: ORIF Monteggia Fractures

Introduction A Monteggia fracture-dislocation, defined as a proximal ulna fracture with a concurrent proximal radioulnar joint dislocation, is a rare but complex injury of the forearm and elbow. Monteggia fracture-dislocations account for 1%–2% of forearm fractures and are commonly secondary to a direct force to the forearm while the elbow is extended and the forearm is pronated. Several classification systems have been proposed to describe these…

Technique Spotlight: Anterior (Trans-olecranon) Olecranon Fracture-Dislocation

Indications Anterior olecranon fracture-dislocation of the elbow (also referred to as transolecranon fracture-dislocation) is characterized by disruption of the trochlear notch, loss of radiocapitellar alignment, maintenance of some apposition of the articular surfaces, intact collateral ligaments, and a normal radioulnar relationship ( Fig. 54.1 ). , The loss of the elbow congruity is due to fracture of the olecranon and coronoid rather than ligament injury. The…

Technique Spotlight: ORIF with Intramedullary Screw Fixation

Olecranon fractures have historically been treated with tension band wires and recently plates. Plate and tension band hardware have been associated with soft tissue irritation from hardware prominence and migration due to improper seating at the time of surgery. Another treatment option is intramedullary (IM) screws. The goals of proximal ulna fracture fixation are joint reduction, rigid fixation, and early range of motion. IM screw fixation…

Proximal Ulna Fractures and Fracture-Dislocations—Monteggia and Beyond

Introduction Proximal ulna fractures and fracture-dislocations present a unique challenge to the orthopedic surgeon. It is one of the few joints with multiple articulations and degrees of freedom. Due to these intricate relationships, the disruption of the elbow’s complex osseous and ligamentous anatomy can have profound effects on the ability to perform activities of daily living. Recognition of the patterns of injury and timely treatment are…

Technique Spotlight: Approach to Chronic Elbow Instability

The elbow is a complex joint comprising three distinct articulations and stabilized by multiple osseous and ligamentous structures. As a result, elbow instability can be a challenging problem to successfully treat. Elbow instability can present on a spectrum of severity, ranging from subtle ligamentous laxity to severe multidirectional instability with bony changes. Indications Patients with subtle instability often present with complaints of pain, mechanical symptoms, or…

Technique Spotlight: ORIF Medial Coronoid Fracture

Indications Indications for open reduction internal fixation of a medial coronoid fracture include a large medial coronoid fracture in the setting of an unstable elbow. Regan and Morrey described coronoid fractures based upon the lateral plain film radiographs ( Fig. 49.1 ), but the advent and widespread use of computed tomography (CT) scan with two- and three-dimensional reconstructions expanded our understanding of coronoid fracture anatomy and…

Coronoid Fractures and the Terrible Triad: An Algorithm for Successful Management

Relevant Anatomy The elbow is a complex hinge joint connecting the distal end of the humerus with the proximal ends of the radius and ulna, forming three articulations: the ulnohumeral, radiocapitellar, and proximal radioulnar joints ( Fig. 47.1 ). The primary degrees of freedom allowed by the elbow are flexion/extension and pronation Flexion/extension is accomplished through the ulnohumeral and radiocapitellar joints, while pronation/supination involves the radiocapitellar…

Technique Spotlight: Radial Head Arthroplasty

Indications Radial head arthroplasty (RHA) is a valuable surgical option for complex, comminuted radial head fractures with associated elbow instability. An RHA is recommended when anatomic repair and fixation of a radial head fracture is not possible and removal of the radial head alone may not be advantageous due to instability. Injury to the lateral ulnar collateral ligament (LUCL) complex and the medial collateral ligament (MCL)…

Technique Spotlight: ORIF Radial Head and Neck

Indications Open reduction internal fixation (ORIF) is recommended for Mason Type II fractures with a mechanical block and Mason Type III fractures where stable fracture fixation is feasible. Radial head fractures with concomitant injuries (e.g., coronoid, olecranon, and/or capitellum fractures) or substantial elbow instability that requires a soft tissue repair provide an opportunity for an ORIF to be performed. There is no clear consensus on the…

Isolated Radial Head/Neck Fractures

Introduction Fractures of the radial head are the most common elbow injuries, accounting for approximately 30% of all elbow fractures in adult patients. The majority of patients are between 20 and 64 years of age with no gender predominance. , The mechanism of injury is typically a fall on an outstretched arm with the elbow extended and the forearm pronated. Radial head fractures occur with associated…

Technique Spotlight: Static, Hinged, and Internal Elbow Joint Fixators

Indications Damage to bony, muscular, and ligamentous structures from injuries such as simple but unstable elbow dislocations or fracture-dislocations may result in elbow instability. Attempts to repair these structures may not address the resultant elbow instability. When instability persists, the use of an elbow fixator may be necessary to maintain ulnohumeral joint reduction and/or protect the repaired structures. Elbow fixators may also be indicated for instability…

Technique Spotlight: Ulnar Collateral Ligament Reconstruction

Introduction Ulnar collateral ligament (UCL) reconstruction has grown dramatically in popularity and utilization since the time of Frank Jobe and Tommy John. Over this period, UCL reconstruction constructs have evolved significantly from the original Jobe technique. Modifications have included refinements in approach, ulnar nerve (UN) management, tunnel positioning, and graft fixation. Today, “docking” techniques offer the benefit of sparing the common flexor tendon (CFT) origin, standardizing…

Technique Spotlight: Reconstruction of the Lateral Ulnar Collateral Ligament

Indications The most common indication for lateral ulnar collateral ligament (LUCL) reconstruction is a chronic posttraumatic posterolateral rotatory instability of the elbow resulting in mechanical symptoms, pain, and disability. While prior trauma is the most common etiology of LUCL insufficiency, other causes of chronic LUCL instability include the following: Severe lateral epicondylitis, particularly if several corticosteroid injections were used for treatment, or an aggressive surgical debridement…