MyMedR

Ipsilateral fracture dislocation of the radial shaft head associated with elbow dislocation: case report

Shukur MH, Noor MA, Moses T

J Trauma, 1995 Jun;38(6):944-6.

A severe form of an extremely unusual injury, ipsilateral fracture dislocation of the radial shaft head associated with elbow dislocation, is described. Radial shaft fracture was irreducible even after the radial head and the elbow were reduced. Open reduction and internal fixation are viable options.

Matched MeSH terms: Elbow Joint/injuries*; Elbow Joint/surgery

Imaging bicipitoradial bursitis: a pictorial essay

Yap SH, Griffith JF, Lee RKL

Skeletal Radiol, 2019 Jan;48(1):5-10.

PMID: 29797016 DOI: 10.1007/s00256-018-2970-0

Although bicipitoradial bursitis is not commonly seen, when it does occur, it can frequently lead to diagnostic difficulty, mimicking either a soft-tissue tumor or infection. Lack of awareness of this uncommon entity can lead to unnecessary anxiety or tissue biopsy. This pictorial essay discusses the normal anatomy of the bicipitoradial bursa and the spectrum of imaging findings of bicipital bursitis.

Matched MeSH terms: Elbow Joint/pathology

Kinetic and kinematic determinants of shuttlecock speed in the forehand jump smash performed by elite male Malaysian badminton players

Ramasamy Y, Usman J, Sundar V, Towler H, King M

Sports Biomech, 2024 May;23(5):582-597.

PMID: 33663330 DOI: 10.1080/14763141.2021.1877336

Badminton is the fastest racket sport in the world with smash speeds reaching over 111 m/s (400 kph). This study examined the forehand jump smash in badminton using synchronised force plates and full-body motion capture to quantify relationships to shuttlecock speed through correlations. Nineteen elite male Malaysian badminton players were recorded performing forehand jump smashes with the fastest, most accurate jump smash from each player analysed. The fastest smash by each participant was on average 97 m/s with a peak of 105 m/s. A correlational analysis revealed that a faster smash speed was characterised by a more internally rotated shoulder, a less elevated shoulder, and less extended elbow at contact. The positioning of the arm at contact appears to be critical in developing greater shuttlecock smash speeds. Vertical ground reaction force and rate of force development were not correlated with shuttlecock speed, and further investigation is required as to their importance for performance of the jump smash e.g., greater jump height and shuttle angle. It is recommended that players/coaches focus on not over-extending the elbow or excessively elevating the upper arm at contact when trying to maximise smash speed.

Matched MeSH terms: Elbow Joint*

Delayed management of fracture of the lateral humeral condyle in children

Dhillon KS, Sengupta S, Singh BJ

Acta Orthop Scand, 1988 Aug;59(4):419-24.

PMID: 3421080

Thirty-nine displaced fractures of the lateral humeral condyle in children were followed for an average of 5 (2-5) years. The results were evaluated from functional and cosmetic aspects. Patients treated within 2 weeks by open reduction and internal fixation did well. Those operated on after 6 weeks did not do better than nonoperated on cases. Complications included cubitus varus and valgus deformities, osteonecrosis, nonunion and malunion, and loss of motion. We recommend that patients presenting late be left alone and any sequelae evaluated at a late stage.

Matched MeSH terms: Elbow Joint*

Fulltext Radiological analysis of the medial epicondyle in the adolescent throwing athlete

Ng WM, Chan CK, Takahashi N, Kawai N, Teh KK, Saravana R, et al.

Singapore Med J, 2017 Feb;58(2):103-106.

PMID: 26976222 DOI: 10.11622/smedj.2016061

INTRODUCTION: Injuries to the medial structures of the elbow due to overhead throwing games are well documented. However, variations of medial epicondyles are not well described, especially in athletes with fused medial epicondyles. In this study, we evaluated variations in the medial epicondyle of baseball players who were aged 15-17 years and had fused epicondyles.

METHODS: In this cross-sectional observational study, 155 skeletally mature baseball players with unilateral medial elbow pain and 310 elbow radiographs were reviewed by two independent reviewers. The medial epicondyles were categorised into three groups: normal, elongated or separated.

RESULTS: Among the 155 patients, 65 (41.9%) had normal epicondyles, 41 (26.5%) had elongated epicondyles and 49 (31.6%) had separated epicondyles. The medial epicondyle was larger on the dominant arm for 125 (80.6%) patients; the mean surface area on the dominant arm was 222.50 ± 45.77 mm2, while that of the non-dominant arm was 189.14 ± 39.56 mm2(p < 0.01). Among the three categories of medial epicondyles, separated epicondyles had the largest surface area, followed by elongated and normal epicondyles.

CONCLUSION: Medial epicondyles in adolescent throwing athletes can be categorised into three different groups according to their shape (normal, elongated and separated). We observed a correlation between the shape and the surface area of the medial epicondyle in adolescent throwing athletes, with separated medial epicondyles having the largest surface area. Further studies and follow-up are needed to determine the prognostic value and clinical significance of these morphological variations.

Study done in Japan

Matched MeSH terms: Elbow Joint/physiopathology

Fulltext Salvage of elbow function in chronic complex elbow fracture dislocation with total elbow arthroplasty: a case report

Muthu R, Foead AI, Ali A, Devadasan B

Med J Malaysia, 2013 Aug;68(4):353-5.

PMID: 24145266 MyJurnal

In patients with an elbow fracture dislocation the incidence of radial head fracture is 36%, where as coronoid process fractures occur in 13%, and olecranon fractures in 4% of patients. Combination of all these fractures with a 'terrible triad' is rarely reported in the literature. We describe a 40 year old lady involved in a polytrauma who had head injury, pnuemothorax and an open fracture dislocation of the left elbow. The Injury Severity Score initially on admission was 44. She presented with chronic elbow instability with pain 1 year later. A semi constrained total elbow arthroplasty (TEA) with a Coonrad-Morrey prosthesis was performed in this complex injury involving fractures of the coronoid, olecranon, proximal third of the ulna and radial head malunion with heterotrophic ossification around the elbow joint. Although the survivorship of total elbow replacements has improved, it is still a procedure reserved to older patients with low functional demand. At 1-year follow-up, the patient had full range in flexion and extension. The Mayo Elbow Performance Score (MEPS) was 100. TEA is a procedure which gains function and stability in a terrible triad elbow.

Matched MeSH terms: Elbow Joint

Fulltext Bilateral Olecranon Fracture in Adult. A Case Report

Zamzuri, Z., Nazri, M.Y., Amindudin, C.A., Azril, A., Shukrimi, A., Hafiz, A., et al.

International Medical Journal Malaysia, 2006;5(1):1-3.

MyJurnal

We report a case of a 14-year-old Malay male who fell at school and sustained bilateral olecranon fractures. He had undergone an open reduction and tension band wiring to stabilize the fracture. Three months after the surgery, the movement of both his elbows was satisfactory.

Matched MeSH terms: Elbow Joint

Missed proximal radioulnar joint translocation with ulnar nerve entrapment: an unusual injury in a child

Najid H, Abdul Rashid AH, Ibrahim S

J Pediatr Orthop B, 2019 Jan;28(1):79-84.

PMID: 30252793 DOI: 10.1097/BPB.0000000000000556

Traumatic elbow dislocation in a child is rare, and it is usually associated with fractures. Simultaneous proximal radioulnar joint (PRUJ) translocation with ulnar nerve palsy is even rarer. We report an unusual case of a missed PRUJ translocation with ulnar nerve entrapment in a 10-year-old child. The key to diagnosing the translocation is the position of the proximal radius, which lies medial to the ulna. This was treated by open reduction and release of the entrapped nerve. The ulnar nerve palsy recovered fully at the 1-year follow-up. Although PRUJ translocation with ulnar nerve entrapment is a rare injury, a successful outcome is possible with timely open reduction and release of the ulnar nerve.

Matched MeSH terms: Elbow Joint/injuries*; Elbow Joint/surgery

An elbow dislocation in a child with missed medial epicondyle fracture and late ulnar nerve palsy

Haflah NH, Ibrahim S, Sapuan J, Abdullah S

J Pediatr Orthop B, 2010 Sep;19(5):459-61.

PMID: 20555271 DOI: 10.1097/BPB.0b013e32833b6032

Elbow dislocations associated with a medial epicondyle fracture and ulnar nerve palsy are uncommon injuries. We present the case of an 11-year-old girl with an elbow dislocation treated by closed manual reduction. The medial epicondyle fracture was missed initially until she developed an ulnar nerve palsy 2 months later. Intraoperatively we discovered the bony epicondyle piercing the joint capsule and compressing the ulnar nerve. Removal of the bony fragment relieved her symptoms and she returned to normal activities at 1 year follow-up. We would like to highlight this rare occurrence and present the detailed history and management of this case.

Matched MeSH terms: Elbow Joint/pathology*; Elbow Joint/surgery

Syringomyelic neuropathic ulcer of the elbow: treatment with an external fixator

Yeap JS, Wallace AL

J Shoulder Elbow Surg, 2003 Sep-Oct;12(5):506-9.

PMID: 14564278 DOI: 10.1016/S1058-2746(03)00168-X

Matched MeSH terms: Elbow Joint/radiography; Elbow Joint/surgery*

Fulltext Modified pectoralis major tendon transfer for reanimation of elbow flexion as a salvage procedure in complete brachial plexus injury: a case report

Taran S, Nawfar S

Malays Orthop J, 2013 Mar;7(1):79-81.

PMID: 25722813 MyJurnal DOI: 10.5704/MOJ.1303.004

Traumatic brachial plexus injuries rarely recover spontaneously and if the window period for neurotisation has elapsed, the only option for restoration of function lies in a salvage procedure. Many such salvage procedures have been described in the literature with variable functional results. We report the case of a 16-year-old boy who presented after unsuccessful treatment for a complete brachial plexus injury; we performed a pectoralis major tendon transfer to attain elbow flexion. Postoperatively, the elbow was splinted with flexion at 100°. After 4 weeks of immobilization the splint was removed and the patient could actively flex his elbow from 30° to 100°.

Matched MeSH terms: Elbow Joint

Modified French Osteotomy for Humeroradial Synostosis in a Child with Multiple Synostoses Syndrome: A Case Report

Sahdi H, Rasit AH, Khoo CS, Bojeng A, Nur-Alyana BA

Malays Orthop J, 2019 Jul;13(2):52-55.

PMID: 31467654 DOI: 10.5704/MOJ.1907.011

Congenital humeroradial synostosis can occur as an isolated clinical entity or as part of a syndrome. Bilateral elbow fixed flexion deformity is very incapacitating and challenging to treat. Here we present the case of a boy with fixed flexion deformity of both elbows due bilateral humeroradial synostosis. Other characteristic features of multiple synostoses syndrome were also present in this child, his elder brother and mother. We elected to improve the position of the right elbow by adapting the modified French osteotomy described by Bellemore et al.

Matched MeSH terms: Elbow Joint

Fulltext Cubitus Valgus with Tardy Ulnar Nerve Palsy - Functional Outcome of Milch Osteotomy without Anterior Transposition of Ulnar Nerve

Gupta RK, Khiyani R, Majumdar KP, Potalia R

Malays Orthop J, 2020 Jul;14(2):120-125.

PMID: 32983386 DOI: 10.5704/MOJ.2007.021

Introduction: To assess the results of Milch osteotomy in terms of deformity correction and functional outcome in the absence of ulnar nerve transposition.

Material and Methods: Nine patients with cubitus valgus deformity greater than 20° with tardy ulnar nerve palsy (TUNP) operated between 2012 and 2017 were evaluated. Correction by Milch osteotomy and fixation was done in each case, without osteosynthesis of the non-union lateral condyle humerus or transposition of the ulnar nerve. At one year post-operatively, carrying angle, elbow function (Mayo Elbow Performance Score) and ulnar nerve symptoms were assessed.

Results: The mean carrying angle pre-operatively was 30.8° on the affected side which improved to a mean of 8.3° postoperatively with an average correction of 22.5°. The mean elbow flexion pre-operatively was 129.4° which improved to 133.3° post-operatively. The mean preoperative MEP score was 76.7 which improved to a mean of 92.2 post-operatively (p < 0.01). TUNP recovered completely in all the patients.

Conclusion: Milch osteotomy is an effective procedure for cubitus valgus deformity correction and its associated tardy ulnar nerve palsy without a decrease in elbow ROM. Correction of even severe valgus deformities without concurrent anterior transposition of the ulnar nerve is likely to improve ulnar nerve symptoms.

Matched MeSH terms: Elbow Joint

The carrying angle: racial differences and relevance to inter-epicondylar distance of the humerus

Allouh MZ, Abu Ghaida JH, Jarrar AA, Khasawneh RR, Mustafa AG, Bashaireh KM

Folia Morphol (Warsz), 2016 02 26;75(3):388-392.

PMID: 26916201 DOI: 10.5603/FM.a2016.0007

The human carrying angle (CA) is a measure of the lateral deflection of the forearm from the arm. The importance of this angle emerges from its functional and clinical relevance. Previous studies have correlated this angle with different parameters including age, gender, and handedness. However, no reports have focused on race-dependent variations in CA or its relation to various components of the elbow joint. This study aimed to investigate the variations in CA with respect to race and inter-epicondylar distance (IED) of the humerus. The study included 457 Jordanian and 345 Malaysian volunteers with an age range of 18-21 years. All participants were right-hand dominant with no previous medical history in their upper limbs. Both CA and IED were measured by well-trained medical practitioners according to a well-established protocol. Regardless of race, CA was greater on the dominant side and in females. Furthermore, CA was significantly greater in Malaysian males compared to Jordanian males, and significantly smaller in Malaysian females compared to their Jordanian counterparts. Finally, CA significantly decreased with increasing IED in both races. This study supports effects of gender and handedness on the CA independent of race. However, CA also varies with race, and this variation is independent of age, gender, and handedness. The evaluation also revealed an inverse relationship between CA and IED. These findings indicate that multiple factors including race and IED should be considered during the examination and management of elbow fractures and epicondylar diseases.

Matched MeSH terms: Elbow Joint

Fulltext Retrospective Review of Kirschner Wire Fixation andCasting for Displaced Lateral Condylar Fracture of theHumerus in Children

Gooi, S.G, Chee, E.K., Wong, C.L., Mohana, R., Khoo, E.H., Thevarajan, K.

Malays Orthop J, 2008;2(2):17-20.

MyJurnal

This study was conducted to assess the optimum period for Kirschner wire fixation and cast immobilization for displaced lateral condylar fracture of the humerus in children. We retrospectively reviewed 12 patients with displaced lateral condyle humerus fracture, ranging in age from 3-9 y, with injuries that occurred between Jan 2005 and Dec 2006. All patients were treated with two Kirschner wire fixation and elbow immobilization. In all except 2 patients, the Kirschner wires were maintained for 3 to 4 weeks. Mean time for union was 3.78 weeks and mean humeroulnar arch motion at last review was 138.7 degrees. Only one patient had a 5 degree increased carrying angle in valgus as compared to the non-injured side, and 50% had prominent scars > 4mm. We conclude that fracture union can be expected within three to four weeks for most children after open reduction and fixation with 2 Kirschner wires.

Matched MeSH terms: Elbow Joint

Fulltext The effects of forearm position on handgrip strength

Ali Md Nadzalan

Jurnal Sains Sukan & Pendidikan Jasmani, 2013;2(1):2-9.

MyJurnal

This study was conducted to investigate i) while the shoulder was in 180° of flexion and the elbow extended, which of the forearm position (supination, pronation and neutral) can generate the greatest handgrip strength, ii) is there any correlation of the handgrip strength between the dominant hand (right hand) and non-dominant hand (left hand) in each forearm position, and iii) will the dominant hand possessed 10% higher handgrip strength than the non-dominant hand. 100 right handed sedentary active students age 22.20 years old (± 1.03), height 172.83 cm (± 6.37), body mass 68.87 (± 11.52) and grip position 3.77 (± 0.77) were recruited in this study. The result indicated that for both the dominant and non-dominant hand, when the shoulder is in 180˚ flexion of the body with the elbow extended, the greatest grip strength was obtained when the forearm was in neutral position followed by pronation and supination position. Post Hoc analysis showed that for both dominant hand and non-dominant hand, pronation and supination forearm position produced greater strength score compared to supination forearm position (p0.05). In all forearm position, participants were shown to produced significantly greater strength in their dominant hand and all the scores were more than 10% greater compared to when using non-dominant hand. Positive relationships were also found for the strength score between dominant hand and non-dominant hand. As the conclusion, different shoulder, elbow and forearm position can affect handgrip strength.

Matched MeSH terms: Elbow Joint

Fulltext Pen and paper based observational method to assess postural problems: a review

Sukadarin, E.H., Deros, B.M., Nawi, N.S.M., Rambely, A.S., Bakar, S.A., Tamrin, S.B.M.

Malaysian Journal of Public Health Medicine, 2016;16(20):78-83.

MyJurnal

Posture is one of the most important factor that need to be considered in any postural analysis. Awkward, extreme,
and repetitive postures can increase the risk of musculoskeletal disorders (MSDs). As observational methods are more
widely used than instrumentation-based methods to assess postural problems, this study reviews and assesses the
scientific literature of observational methods and focused on pen and paper based specifically. In order to identify the
published methods, a list of English or Malay articles dating as far back as 1990 was compiled from PubMed, Science
Direct and Google Scholar. The keywords were ergo*, posture*, method*, observational*, postural problems*, pen and
paper*, posture analysis*, indirect* and macro-ergo*. In addition, a secondary search was also performed using
bibliography of retrieved articles so that additional papers for conducting review and evaluations can be collected. A
total of 121 articles that assessed postural problems in working activities were found. However, after intensive
screening process only 6 articles were selected to be further analyzed. Posture of upper arms/shoulder, lower arms/
elbow, wrist, neck, back/trunk and leg were highlighted in this study. The limitations and the strengths of the
published pen and paper based observational method focusing on those postures were also discussed. The finding of
this review will benefit researchers in the process of understanding unsafe posture in workplace. It could also provide
to researcher on how to improve the current pen and paper based observational method for assessing postural
problems.

Matched MeSH terms: Elbow Joint

Fulltext Ulnar Osteotomy with 2-Pin Unilateral Gradual Distraction for Treatment of Chronic Monteggia Fracture: A Case Report

Gooi SG, Wang CS, Saw A, Zulkiflee O

Malays Orthop J, 2017 Mar;11(1):79-81.

PMID: 28435583 MyJurnal DOI: 10.5704/MOJ.1703.015

Missed Monteggia fracture leading to chronic radial head dislocation is a known complication. The surgical treatment options remain challenging. The aim of treatment is to reduce the radial head and to maintain the stability of the elbow in all ranges of motion. A few surgical techniques have been described with complications. We report the case of a 13 years old boy with chronic radial head dislocation as a result of an unrecognised Monteggia fracture-dislocation for eight years. We successfully reduced the radial head and corrected the cubital valgus from 45 degrees to 10 degrees with a proximal ulna osteotomy and gradual distraction with 2-pin Monotube external fixator. The correction was uneventful with good functional outcome.

Matched MeSH terms: Elbow Joint

Fulltext Nonunion of Lateral Humeral Condylar Fracture in A Child with Cubitus Varus

Sulaiman, A.R., Munajat, I., Mohd, E.F., Sharifudin, M.A.

Malays Orthop J, 2010;4(3):29-31.

MyJurnal

Patients with cubitus varus deformity secondary to malunited supracondylar fracture are at risk for lateral humeral condylar (LHC) fracture. This report describes a child presenting with preexisting malunion of supracondylar fracture presenting along with nonunion of a LHC fracture following a recent injury. The patient underwent resection osteotomy of the metaphyseal proximal fragment of the fracture surface, reduction of the displaced LHC fragment and screw fixation. This procedure corrected the cubitus varus and treated the nonunion of the lateral condyle thus avoiding a supracondylar osteotomy procedure. Treatment resulted in solid union, good range of motion and no avascular necrosis.

Matched MeSH terms: Elbow Joint

Fulltext Anterior Displacement of Ulnar Nerve at the Elbow inChildren Based on Ultrasonography

Shamsul, H., Saw, A., John, G.

Malays Orthop J, 2007;1(1):29-33.

MyJurnal

This study involved evaluation of the elbows of 50 children between 4 to 14 years of age. Clinical examination for elbow flexion, extension, range of motion and carrying angle were performed, followed by ultrasonographic examination to determine position of the ulnar nerve in relation to the medial epicondyle upon elbow flexion and extension. Thirty-one elbows showed anterior displacement of the ulnar nerve, of which 14 were due to subluxation and 17 to dislocation. We found that anterior translation of ulnar nerve is present in the elbows up to 31% of children, especially those with increased range of elbow motion.

Matched MeSH terms: Elbow Joint

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