1,721,110 research outputs found
Radial head fractures: review of current evidence about assessment, classification and management
No full textThe radial head fractures are frequent elbow injuries with several fracture patterns and associated lesions. The literature highlights the importance of correct patient management right from the earliest stages to achieve the best results and to avoid complications. The purpose of this article was to provide an overview of current concepts of the management of radial head fractures. The main goal of each treatment should be to restore elbow biomechanics, kinematics and stability to achieve a complete range of motion and to early begin rehabilitation programs. For Mason type 1 fractures the nonoperative management is the best choice providing good or excellent results in most patients. There is less agreement regarding Mason type 2 fractures, in term of nonoperative or surgical treatment. When surgical treatment is chosen, open reduction and internal fixation seems to guarantee the best clinical outcomes with excellent results reported. The Mason type 3 or 4 fractures are managed with surgical treatment. However, the best method of treatment remains controversial in literature between open reduction and internal fixation, radial head arthroplasty and radial head excision. In the last years, arthroscopy is going to assume an important role in the management of elbow diseases, not only as diagnostic tool but also as surgical solution and probably in the future its role will become more and more relevant. Further studies with long-term follow-up are needed to determine the best form of treatment of these complex injuries. (Cite this article as: Tarallo L, Negri A, Novi M, Micheloni G, Keeling E, Porcellini G. Radial head fractures: review of current evidence about assessment, classification and management
Efficacy, usability and tolerability of a dynamic elbow orthosis after collateral ligament reconstruction: a prospective randomized study
No full textPurpose: To assess the efficacy, usability and tolerability of a dynamic orthosis compared with a standard plaster splint after the reconstruction of elbow medial or lateral collateral ligaments (MCL, LCL).Methods: Twenty-six subjects undergoing MCL (n = 23) or LCL (n = 3) reconstruction were randomly assigned to immobilization with an orthosis (n = 13; group A “Innovator X”) or with a plaster splint (n = 13; group B “Plaster splint”). Outcome measures were visual analogue scale pain score, mid-arm (MA) circumference, grip strength, Oxford elbow score (OES) and range of motion (ROM). Patients were assessed at baseline and at 2, 6, 12 and 24 weeks.Results: Significant pain reduction was reported by all patients at 6, 12 and 24 weeks (p < 0.05). Mean MA circumference was significantly higher in group A at all time points (all p < 0.05). Mean grip strength was greater in group A on weeks 2 and 6 (p < 0.05), whereas the difference found on weeks 12 and 24 was not significant. The OES and passive ROM values of the two groups were not significantly different at any time point.Conclusions: The dynamic orthosis and the plaster splint both provided effective and safe elbow immobilization after MCL or LCL reconstruction. The orthosis provided greater pain reduction, faster recovery of muscle trophism and grip strength, and was better tolerated
Calcific tendinitis of the rotator cuff with trochiteal osteolysis. A rare clinical radiologic complication
No full textAmong cases of calcific tendinitis that are unresponsive to any type of non-surgical treatment, the authors report 3 cases, out of a total of 32 submitted to surgery, that presented with an osteolytic cavity filled with calcium salts in the insertional region of the supraspinous tendon. These patients presented with pain that they had been experiencing for an average of 4 years, with acute recurrent episodes. When this pathology can be determined radiographically, early surgery is recommended, considering that any type of non-surgical treatment is destined to fail
Fracture of the coracoid process associated with fracture of the clavicle: description of a rare case
No full textThe authors report on a case of fracture of the coracoid process associated with fracture of the clavicle. Open reduction and internal fixation of the coracoid process lead to a good clinical and radiographic outcome
Ultrasound-guided subacromial injections of sodium hyaluronate for the management of rotator cuff tendinopathy: A prospective comparative study with rehabilitation therapy
No full textBackground: Rotator cuff (RC) tendinopathy is a common cause of pain and shoulder dysfunction. The literature evidence suggests that a combination of overuse and extrinsic compression may induce chronic RC tendinopathy. Aim of the current study was to compare the results of subacromial sodium hyaluronate injections with rehabilitation therapy. Materials and methods: We enrolled 48 patients (M/F: 26/22; mean age: 50 years; shoulder right/left: 29/19) with persistent shoulder pain for at least 4 months. Exclusion criteria were as follows: RC tear, calcifying tendinitis, glenohumeral instability, osteoarthritis, rheumatic diseases, physical therapy and/or injection in the previous 4 months, shoulder surgery, anesthetic nerve block, trauma, and severe medical diseases. The included subjects received either two ultrasound-guided subacromial hyaluronic acid (HA) injections (25 patients, HA group) at baseline and 14 days, or underwent rehabilitation therapy (23 patients, Physio group) including active shoulder mobilization, soft tissue stretching and humeral head positioner and propeller muscles strengthening for 30 days (3 sessions every week). Clinical assessment of shoulder function was performed with visual analog scale score for pain (0-100), Oxford Shoulder Score (OSS), and Constant-Murley Score (CS). Overall, patients were examined at baseline, week 2, week 4, week 12, and week 24. Statistical significance was set at 5 % (p 0.05), week 12 (p > 0.05), and week 24 (p > 0.05). CS and OSS in the HA group increased significantly at week 2 (p 0.05). A significant improvement of CS and OSS we found in the Physio group at week 2 (p 0.05). Conclusions: Subacromial HA injections could be an effective and safe alternative treatment for patients suffering from RC tendinopathy. We believe that the results of this study are encouraging but not lasting and we might suppose that a series of three to four subacromial sodium hyaluronate injections could provide good mid- and long-term clinical benefits. © 2013 Istituto Ortopedico Rizzoli
Tears of the rotator cuff associated with neurologic disorders: a description of two cases
No full textBased on their clinical experience with the two cases described, the authors analyze the association between surgically treatable tear of the rotator cuff and neurologic pathology. A semeiologic sign is emphasized, which may be of help in differential diagnosis involving isolated lesion of the rotator cuff. Furthermore, after a review of the literature, the authors express doubts as to the type of surgical treatment to be carried out
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