The aim of this study was to compare elbow joint proprioception measurements between physically disabled individuals who are active in sports and those who are not. The study included 30 athletes, 30 sedentary individuals, 30 physically disabled athletes, and 30 physically disabled sedentary individuals as volunteers. Elbow joint proprioception measurements were conducted using a sensitive digital goniometer with a precision of 1 degree. The joint position sense test method was used to perform the active angle repetition technique. Target angles were determined to be 30°, 60°, and 120°. A significant difference was observed in the comparison of proprioception between the dominant and non-dominant elbow joints of athletes and physically disabled sedentary individuals (p<0.05). Elbow joint proprioception was found to be highest in physically disabled athletes at the target angles. Conversely, the lowest elbow joint proprioception levels were found in physically disabled sedentary patients compared with the other groups.
Das Ziel dieser Studie ist es, Ellenbogengelenk-Propriozeptionsmessungen von körperlich behinderten Personen, die aktiv Sport treiben, und denjenigen, die es nicht tun, zu vergleichen.An der Studie nahmen 30 Athleten, 30 sitzende Personen, 30 körperlich behinderte Athleten und 30 körperlich behinderte sitzende Personen als Freiwillige teil. Ellenbogengelenk-Propriozeptionsmessungen wurden mit einem empfindlichen digitalen Goniometer mit einer Genauigkeit von 1° durchgeführt. Die Methode des Gelenkstellungssinns wurde verwendet, um die aktive Winkelwiederholungstechnik durchzuführen. Die Zielwinkel wurden auf 30°, 60° und 120° festgelegt. Ein signifikanter Unterschied wurde im Vergleich der Propriozeption zwischen den dominanten und nicht dominanten Ellenbogengelenken von Athleten und körperlich behinderten sitzenden Personen festgestellt (p<0,05).Die Ellenbogengelenkpropriozeption war bei körperlich behinderten Athleten in den Zielwinkeln am höchsten. Im Gegensatz dazu wurden die Propriozeptionsniveaus des Ellenbogengelenks bei körperlich behinderten sitzenden Patienten im Vergleich zu den anderen Gruppen als am niedrigsten eingestuft.

CONCLUSIONS: Monteggia fracture is a complex fracture consisting of a proximal ulna fracture with a dislocation of the radial head. This review article highlights the relevant anatomy, clinical evaluation, classification, surgical management, recent innovation, and advancements with treating these injuries. A thorough understanding of these fractures allows for detailed operative plans and reconstitution of normal anatomy.

Elbow arthroscopy is a useful tool that can be applied in a variety of surgical indications. However, performing the procedure safely demands a thorough understanding of the proximity of neurovascular structures around the elbow. Although nerve injuries in elbow arthroscopy are rare, complications can further be avoided by adhering to a set of principles designed to protect the surrounding neurovascular structures. Before making portals, the surgeon should palpate and mark the ulnar nerve to confirm its location in the groove. Next, the joint should be insufflated with fluid to distend the joint capsule and increase the distance between instruments and the anterior neurovascular structures. Anterior portals ideally should be made proximal to the medial and lateral epicondyles, thereby increasing distance from the median and radial nerve, respectively. Once in the joint, it is critical to stay oriented by maintaining instruments and the articular surfaces in the same view. Special caution should be exercised when in proximity to the capsule in the posteromedial gutter to protect the ulnar nerve. Similarly, the anterior inferior capsule should be approached with caution, as its violation puts branches of the radial nerve, specifically the posterior interosseous nerve, at risk. Elbow arthroscopy can be safely performed with proper knowledge and application of anatomy around the elbow when making portals and understanding at-risk areas beyond the capsule when working within the joint.

METHODS: A 27-year-old man sustained chemical burns affecting 54% of his body caused by steam and acetic acid at a dyeing factory. He developed restricted bilateral elbow and shoulder motion because of heterotopic ossification (HO) beginning 3 months after the incident. The skin healed within 1 year, but ankylosis developed because of progressing ossification. We performed HO surgical excision in 4 stages. Two years after the final surgery, the function of both upper extremities had recovered.
CONCLUSIONS: For HO caused by severe burns, improvement in upper extremity function can be achieved even if surgery is performed after skin healing.

Physical therapy is often essential for complete recovery after injury. However, a significant population of patients fail to adhere to prescribed exercise regimens. Lack of motivation and inconsistent in-person visits to physical therapy are major contributing factors to suboptimal exercise adherence, slowing the recovery process. With the advancement of virtual reality (VR), researchers have developed remote virtual rehabilitation systems with sensors such as inertial measurement units. A functional garment with an integrated wearable sensor can also be used for real-time sensory feedback in VR-based therapeutic exercise and offers affordable remote rehabilitation to patients. Sensors integrated into wearable garments offer the potential for a quantitative range of motion measurements during VR rehabilitation. In this research, we developed and validated a carbon nanocomposite-coated knit fabric-based sensor worn on a compression sleeve that can be integrated with upper-extremity virtual rehabilitation systems. The sensor was created by coating a commercially available weft knitted fabric consisting of polyester, nylon, and elastane fibers. A thin carbon nanotube composite coating applied to the fibers makes the fabric electrically conductive and functions as a piezoresistive sensor. The nanocomposite sensor, which is soft to the touch and breathable, demonstrated high sensitivity to stretching deformations, with an average gauge factor of ~35 in the warp direction of the fabric sensor. Multiple tests are performed with a Kinarm end point robot to validate the sensor for repeatable response with a change in elbow joint angle. A task was also created in a VR environment and replicated by the Kinarm. The wearable sensor can measure the change in elbow angle with more than 90% accuracy while performing these tasks, and the sensor shows a proportional resistance change with varying joint angles while performing different exercises. The potential use of wearable sensors in at-home virtual therapy/exercise was demonstrated using a Meta Quest 2 VR system with a virtual exercise program to show the potential for at-home measurements.

BACKGROUND: Due to its unique anatomical characteristics, supracondylar fractures of the humerus are often difficult to achieve firm fixation with internal fixation equipment, resulting in delayed functional exercise, often leaving cubitus varus deformity, elbow stiffness, contractures, and other complications. Here, we report an adult patient with a supracondylar fracture of the humerus who underwent internal fixation through an anterior median incision in the humerus with our self-developed anterior anatomical locking plate of the distal humerus.
METHODS: A 29-year-old male patient of Chinese ethnicity with trauma-induced right supracondylar fracture of the humerus and multiple soft tissue contusions, without nerve damage, blood vessel damage, or other injuries, underwent an internal incision in our hospital using a new anatomical locking plate for the anterior distal humerus fixed treatment. During the 16-month follow-up period, the patient\'s elbow range of motion was almost completely restored, functional scores were excellent, and there were no minor or major postoperative complications.
CONCLUSIONS: In this study, we propose a surgical reconstruction strategy for adult patients with supracondylar humeral fractures. Through the anterior median incision of the humerus, open reduction and internal fixation were performed with an anatomic locking plate on the anterior side of the distal humerus to restore and fix the structure of the distal humerus, and satisfactory clinical results were achieved in our case.

暂无摘要。

UNASSIGNED: The relationship between abnormalities of the ulnar collateral ligament (UCL) on magnetic resonance imaging (MRI) and elbow symptoms in baseball players remains unclear.
UNASSIGNED: This study aimed to compare findings of the UCL on microscopic MRI between asymptomatic and symptomatic elbows in baseball players. We hypothesized that the MRI grade of UCL injuries would exhibit no correlation with medial elbow symptoms in baseball players.
UNASSIGNED: Cross-sectional study; Level of evidence, 3.
UNASSIGNED: The study participants were skeletally mature baseball players who underwent high-resolution microscopic MRI of the medial elbow including for medical checkups. Elbows with previous surgical treatment or traumatic UCL injuries were excluded. The patients were divided into symptomatic and asymptomatic groups. The UCL appearance on microscopic MRI was categorized into 4 grades and compared between the groups. Abnormal findings in the medial elbow including bony fragments at the medial epicondyle, osteophytes or bony fragments in the sublime tubercle, and bone marrow edema (BME) in the sublime tubercle were also evaluated.
UNASSIGNED: A total of 426 baseball players (426 elbows) with a mean age of 20 years (range, 14-41 years) were included. The asymptomatic and symptomatic groups included 158 and 268 elbows, respectively. In the asymptomatic group, based on MRI grading of the UCL, 46 (29%) elbows were rated as grade I, 64 (41%) as grade II, 40 (25%) as grade III, and 8 (5%) as grade IV. In the symptomatic group, 75 (28%) elbows were rated as grade I, 118 (44%) as grade II, 61 (23%) as grade III, and 14 (5%) as grade IV. There was no significant difference in the MRI grades between the groups (P = .9). BME in the sublime tubercle was more frequently seen in the symptomatic group than in the asymptomatic group (P < .001).
UNASSIGNED: There was no difference in MRI grades of the UCL between symptomatic and asymptomatic elbows in baseball players; approximately 30% of elbows demonstrated high-grade UCL injuries in both groups. BME in the sublime tubercle was more frequently seen in symptomatic elbows than in asymptomatic elbows. BME in the sublime tubercle was a better indicator of symptoms than was MRI grading of the UCL.

OBJECTIVE: Interposition arthroplasty of the elbow involves the interposition of a fascia lata or dermis autograft or allograft between the distal humerus and the ulna or radius, while preserving the original form of articulation.
METHODS: Interposition arthroplasty is indicated for young patients with high functional demands who suffer from end-stage elbow arthritis and associated pain or joint stiffness.
METHODS: Contraindications include acute or subacute infection, skeletal immaturity, bone loss, deformity, or gross instability.
METHODS: Once the ulnar nerve has been secured, joint access is established via a posterior approach. The radial collateral ligament (RCL) and the common extensor tendon origin (CEO) are detached, while preserving the anconeus muscle and the lateral ulnar collateral ligament (LUCL). Subsequently, a capsular release is required to maintain adequate joint exposure and address the accompanying stiffness. Three to four transosseous drill holes are placed at the level of the distal humerus to secure the graft. After the graft has been positioned successfully within the joint space using two guide sutures, it can be secured to the distal humerus using a horizontal mattress stitch. Finally, the detached tendon and ligament structures are reconstructed.
METHODS: After initial immobilization, early functional exercise of the elbow is performed in the motion orthosis, avoiding valgus or varus stress.
RESULTS: The efficacy of elbow interposition arthroplasty has been demonstrated, particularly for young and active patients with severe inflammatory or post-traumatic osteoarthritis. Despite the results in terms of postoperative function and pain reduction are satisfactory, the current literature reports high complication, subsequent treatment, and revision rates. In the event of interposition arthroplasty failure, revision with another interposition procedure or conversion to endoprosthesis may be considered.
UNASSIGNED: OPERATIONSZIEL: Im Rahmen der Interpositionsarthroplastik des Ellenbogens wird ein Faszien- oder Dermis-Auto- bzw. -Allograft zwischen distalen Humerus und Ulna bzw. Radius interponiert, wobei die ursprüngliche Artikulationsform erhalten bleibt.
UNASSIGNED: Die Indikation zur Interpositionsarthroplastik kann insbesondere bei jungen Patienten mit hohen funktionellen Ansprüchen gestellt werden, die unter endgradiger dysfunktionaler Kubitalarthrose und damit assoziierten Schmerzen bzw. Gelenksteife leiden.
UNASSIGNED: Akute oder subakute Infektionen, grobe Instabilitäten, skelettale Unreife sowie knöcherner Substanzverlust oder Deformitäten gelten als Kontraindikationen.
UNASSIGNED: Über einen posterioren Zugang erfolgt nach Sicherung des N. ulnaris die Etablierung des Gelenkzugangs. Das radiale Kollateralband (RCL) und der gemeinsame Strecksehnenursprung (CEO) werden unter Erhalt des M. anconeus und des lateralen ulnaren Kollateralbandes (LUCL) abgelöst. Um eine ausreichende Gelenkexposition zu erhalten und die begleitende Steife zu adressieren, ist ein anschließendes, aggressives Kapselrelease erforderlich. Zur Fixierung des Transplantats werden 3 bis 4 transossäre Bohrlöcher auf Höhe des distalen Humerus gesetzt. Nach erfolgreicher Positionierung im Gelenkspalt mittels zweier Führungsfäden kann das Transplantat mit horizontalen Matratzennähten am distalen Humerus befestigt werden. Abschließend erfolgt die Rekonstruktion der abgelösten Sehnen- bzw. Bandstrukturen.
UNASSIGNED: Nach initialer Ruhigstellung erfolgt eine frühfunktionelle Beübung des Ellenbogens in der Bewegungsorthese unter Vermeidung von Valgus- bzw. Varusstress.
UNASSIGNED: Die Interpositionsarthroplastik stellt ein „Salvage-Procedure“ für junge und aktive Patienten mit schwerer inflammatorischer oder posttraumatischer Arthrose des Ellenbogens dar. Trotz zufriedenstellender Ergebnisse hinsichtlich postoperativer Funktion und Schmerzreduktion berichtet die aktuelle Literatur über hohe Komplikations‑, Nachbehandlungs- und Revisionsraten. Bei Versagen der Interpositionsarthroplastik ist eine Revision mittels eines weiteren Interpositionsverfahrens oder eine Konversion zur Endoprothese möglich.

OBJECTIVE: The goal of minced cartilage implantation (MCI) is to restore an intact cartilage surface in focal osteochondral lesions of the humeral capitellum.
METHODS: The indications for MCI are limited osteochondral lesions at the humeral capitellum, also at the head of the radius, with intact cartilage border as well as in situ or a completely detached fragment, and free joint bodies (grade II-grade V according to Hefti).
METHODS: Contraindications for MCI are already concomitant or associated cartilage damage as well as bilateral osteochondral lesions and insufficient available cartilage material.
METHODS: After diagnostic arthroscopy to detect possible concomitant pathologies and to exclude already corresponding cartilage lesions, the arthroscope is flipped posterolaterally over the high posterolateral portal and a second portal is created under visualization via the soft spot. Initially, debridement of the focal cartilage defect, assessment of the marginal zone, and/or salvage of free joint bodies. Using a smooth shaver and the filter provided, the partially or even completely detached cartilage fragment is unidirectionally fragmented under continuous suction. The remaining defect with a stable marginal zone is cleanly curetted, and the joint is completely dried. The fragmented cartilage collected in the filter is bonded to a membrane using autologous conditioned plasma (ACP) and then arthroscopically applied to the defect via a cannula, sealed using thrombin and fibrin.
METHODS: Postoperative immobilization in a cast for at least 24 h is required. Afterwards, free exercise of the joint is possible, but no loading should be maintained for 6 weeks. Return to sport after 3 months.
RESULTS: Good to very good clinical and MRI morphologic results are already evident in the short-term course. Prospective and retrospective multicenter studies are needed to evaluate future long-term results.
UNASSIGNED: OPERATIONSZIEL: Das Ziel der Minced-Cartilage-Implantation (MCI) ist die Wiederherstellung einer intakten Knorpeloberfläche bei fokalen Knorpelschäden am Capitulum humeri.
UNASSIGNED: Die Indikationen für die MCI sind fokal begrenzte osteochondrale Läsionen am Capitulum humeri oder auch am Radiuskopf mit intakten Knorpelgrenzen sowie in situ oder vollständig gelöstem Fragment, auch als freier Gelenkkörper (Grad II bis Grad V nach Hefti).
UNASSIGNED: Kontraindikationen für die MCI sind bereits begleitende oder korrespondierende Knorpelschäden sowie bilaterale osteochondrale Läsionen und nicht ausreichend zur Verfügung stehendes Knorpelmaterial.
UNASSIGNED: Nach diagnostischer Arthroskopie zur Erfassung möglichen Begleitpathologien sowie zum Ausschluss von bereits korrespondierenden Knorpelveränderungen wird das Arthroskop über das hohe posterolaterale Portal nach posterolateral umgeschwenkt und über den Softspot ein zusätzliches Portal unter Sicht angelegt. Zunächst Débridement des fokalen Knorpeldefekts, Beurteilung der Randzone und/oder Bergen von freien Gelenkkörpern. Mittels eines glatten Shavers und dem dafür vorgesehenen Gewebekollektor wird das teils oder gar vollständig gelöste Knorpelfragment unter kontinuierlichem Sog unidirektionell fragmentiert. Der verbliebene Defekt mit stabiler Randzone wird sauber kürettiert, das Gelenk vollständig getrocknet. Der in dem Kollektor gesammelte, fragmentierte Knorpel wird mittels autologen konditionierten Plasmas zu einer Membran verbunden und anschließend über eine Kanüle auf den Defekt arthroskopisch aufgebracht, mittels Thrombin und Fibrin versiegelt.
UNASSIGNED: Postoperativ ist eine Ruhigstellung im Gips für mindestens 24 h erforderlich. Anschließend ist eine freie Beübung des Gelenkes möglich, eine Entlastung sollte für 6 Wochen eingehalten werden. Back-to-Sport nach 3 Monaten.
UNASSIGNED: Klinisch wie MRT-morphologisch zeigen sich bereits gute bis sehr gute Ergebnisse im kurzfristigen Verlauf. Prospektive sowie retrospektive Multicenterstudien dienen zukünftig zur Bewertung der Langzeitergebnisse.