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How To Approach Monteggia-Like Lesions In Adults
No full textBackground
Monteggia-like lesions encompass a wide spectrum of forearm and elbow fractures associated with dislocations, subluxations and ligamentous lesions.
Many attempts have been made to classify these injuries, not only to understand their pathology but also to develop optimal treatments.
Unfortunately, although some of these classifications are complete, they are complex, not immediately usable and not exhaustive. An orthopedic surgeon who aims to rapidly treat this kind of injury needs a visual classification and knowledge of the best surgical approach.
Objectives
According to our wide experience in treating these rare lesions and taking advantage of our mistakes, we suggest a practical guide to best surgically approach the various types of Monteggia like lesions. Some technical tips and pitfalls are also described.
Study Design & Methods
In the past 24 months, we treated 15 Monteggia-like lesions (10 females and 5 males). We used different surgical approaches and devices chosen on the base of different fracture patterns and on our pre-operative planning. The average age of the patients was 60,1 y.o. (min 31-max 75). All patients were available for clinical and radiological review. The mean follow-up was 9 months (6 to 24 months).
Results
X-rays check showed in 10 cases the fracture healing and an asymptomatic nonunion of some fragments in other three. Two patients had symptomatic nonunion and needed bone grafting and revision plating at a mean time of 6 months after surgery.
Three patients had asymptomatic loosening of the radial head prosthesis. Heterotopic ossification was present in 10 cases (66 %).
Mayo Elbow Performance Score results were good, with a mean value 66.7 (5 - 100): 3 excellent (20%), 6 good (40%), 3 fair (20%), and 3 poor (20%).
The mean QUICK-DASH score was 27,3 (5,7 - 59,09): 5 excellent (33%), 5 good ( 33%), 2 fair ( 14%) and 3 poor ( 20%).
The mean pronation and supination of the forearm was 70° (0° to 90°) and 65° (0° to 90°), respectively. The mean flexion of the elbow was +120° ( from 90° fixed flexion to 140°). The mean extension of the elbow was -30° (from -60° fixed extension to 0°).
Conclusions
Our results are fair and good, not excellent. This is probably due not only to the complexity of these lesions but also to surgical mistakes.
Monteggia like lesions requests a precise pre-operative planning. Every hardware option should be available in the operating room. Since any error could be fatal in performing and completing all surgical steps, these lesions do not allow any mistake
Radial Head Fractures: Outcomes Of Different Surgical Treatments
No full textBackground
Fractures of radial head account for 2,5 of all fractures and 1/3 of fractures involving the elbow. This kind of lesion is often underappreciated; multifragmentary patterns, concomitant elbow dislocation or associated fractures can lead to poor outcomes.
Objectives
The aim of this study was to evaluate outcomes of patients treated surgically with three different techniques (resection of radial head, radial head arthroplasty and osteosynthesis), outline possible predictive factors of worse results and identify the best surgical option for Mason type III and Mason type IV fractures.
Study Design & Methods
Data were retrospectively collected for 59 patients treated surgically in our department between January 2006 and December 2017. At follow-up a clinical evaluation with the Mayo elbow performance score (MEPS) and a radiographic assessment were performed. Results were statistically analyzed using SPSS IBM software. Mann-Whitney tests were performed in order to investigate if any single surgical procedure was preferable over another according to the pattern of fracture; multiple linear regression analyses were performed to identify predictive factor of worse MEPS, worse range of motion, instability and increased pain.
Results
The average age was 50; the mean follow-up was 48 months. 7 patients (12%) had Mason type II fractures, 23 type III (39%), 29 type IV (49%). Mason II fractures were all treated with osteosynthesis; Mason III in 6 cases with osteosynthesis, 15 with radial head resection and 2 with prosthesis. Mason IV patterns were treated in 7 cases with osteosynthesis, in 12 with radial head resection and in 10 with replacement of the radial head. Statistical analysis did not show significant difference for MEPS at follow-up between fractured and contralateral elbow. Age, gender, side, associated lesions, grade of osteoarthritis, type of treatment, duration of postoperative rehabilitation were not predictive factors of poor MEPS; conversely, coronoid fractures were associated to a lower stability of the elbow. Mason type IV fractures treated with radial head arthroplasty were associated with higher outcomes (p=0,012).
Conclusions
In Mason type II patterns the osteosynthesis is advisable and simple to execute.Regarding Mason type IV, the terrible triad represent the harder challenge for the surgeon; when primary stabilizer of the elbow are injured, the perfect congruency of radiohumeral joint is mandatory to restore the stability and radial head arthroplasty is the best choice. For Mason III fractures it was not possible in our data analysis to identify the best choice of treatment, proving the difficulty, as shown in the literature, to have an univocal and safe management; the discriminating factor on the treatment is, in our opinion, the maintenance of elbow stability that must be always assessed intraoperatively
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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