Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jul 2014
Terrible triad injuries of the elbow: does the coronoid always need to be fixed?
The "terrible triad" of the elbow is a complex injury that can lead to pain, stiffness, and posttraumatic arthritis if not appropriately treated. The primary goal of surgery for these injuries is to restore stability of the joint sufficient to permit early motion. Although most reports recommend repair and/or replacement of all coronoid and radial head fractures when possible, a recent cadaveric study demonstrated that type II coronoid fractures are stable unless the radial head is removed and not replaced. ⋯ Level IV, therapeutic study. See Guidelines to Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Jul 2014
Comparative StudyOpen reduction and internal fixation of radial head fractures: do outcomes differ between simple and complex injuries?
Radial head fractures can occur in isolation or in association with elbow and forearm injuries. Treatment options include nonoperative management, fragment or whole-head excision, open reduction and internal fixation (ORIF), and radial head arthroplasty. However, the evidence supporting ORIF for repairable radial head fractures is inconclusive. ⋯ Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Jul 2014
Comparative StudyComplications of hinged external fixation compared with cross-pinning of the elbow for acute and subacute instability.
Elbows that are unstable after injury or reconstructive surgery often are stabilized using external fixation or cross-pinning of the joint supplemented by cast immobilization. The superiority of one approach or the other remains a matter of debate. ⋯ Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Jul 2014
Revision allograft reconstruction of the lateral collateral ligament complex in elbows with previous failed reconstruction and persistent posterolateral rotatory instability.
Primary reconstruction of the lateral collateral ligament complex (LCLC) using graft tissue restores elbow stability in many, but not all, elbows with acute or chronic posterolateral rotatory instability (PLRI). Revision reconstruction using a tendon allograft is occasionally considered for persistent PLRI, but the outcome of revision ligament reconstruction in this setting is largely unknown. ⋯ Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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While the majority of terrible triad elbow injuries (ulnohumeral dislocation with radial head and coronoid fractures) are managed surgically, nonoperative treatment may be appropriate in selected patients, but results with this approach have been limited by very small studies. ⋯ Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.