Direkte anteriore Knochenblocktransplantation zur Behandlung von Knochendefekten und Dysplasie des Processus coronoideus [Direct anterior bone block grafting for treatment of bone defects and dysplasia of the coronoid process]
Details
Serval ID
serval:BIB_DFAD2660C296
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Direkte anteriore Knochenblocktransplantation zur Behandlung von Knochendefekten und Dysplasie des Processus coronoideus [Direct anterior bone block grafting for treatment of bone defects and dysplasia of the coronoid process]
Journal
Unfallchirurgie
ISSN
2731-703X (Electronic)
ISSN-L
2731-7021
Publication state
Published
Issued date
10/2024
Peer-reviewed
Oui
Volume
127
Number
10
Pages
743-747
Language
german
Notes
Publication types: English Abstract ; Journal Article ; Review
Publication Status: ppublish
Publication Status: ppublish
Abstract
The aim of the surgery was to treat an elbow instability caused by critical coronoid bone loss (CCBL), lateral ulnar collateral ligament (LUCL) insufficiency,and general hyperlaxity by performing a direct anterior coronoid bone graft (CBG) and LUCL reconstruction in the same setting.
In cases with CCBL isolated ligament reconstruction harbors a high failure rate, necessitating supplementary bony procedures. The diagnosis of CCBL is confirmed through lateral radiographs and further quantified through computed tomography (CT) imaging. Objective assessment of instability is conducted with standardized arthroscopic tests. Performing an anterior approach for CBG offers distinct advantages, notably in terms of achieving precise positioning of plates and screws and providing access to the proximal radioulnar joint.
Usual contraindications to surgery, coronoid bone loss less than 40%.
The surgical procedure is thoroughly illustrated with a video of the operation that can be accessed online: reconstruction of the LUCL with a semitendinosus allograft, harvesting of the graft from the iliac crest, exposure of the coronoid process with a direct anterior approach, freshening up of the graft bed. Temporary fixation of the graft with a Kirschner wire. Assessment of joint congruency, stability and range of motion (ROM) prior to definitive fixation with a 2.4 mm buttress plate and screws.
Nonsteroidal anti-inflammatory drugs (NSAID) to prevent heterotopic ossification. Elbow mobilization in pronation from day 1 with an overhead motion protocol. Removable splint for 4 weeks, free mobilization at 6 weeks, return to sport at 3 months.
Durable elbow stability was achieved along with free ROM and high patient satisfaction.
In cases with CCBL isolated ligament reconstruction harbors a high failure rate, necessitating supplementary bony procedures. The diagnosis of CCBL is confirmed through lateral radiographs and further quantified through computed tomography (CT) imaging. Objective assessment of instability is conducted with standardized arthroscopic tests. Performing an anterior approach for CBG offers distinct advantages, notably in terms of achieving precise positioning of plates and screws and providing access to the proximal radioulnar joint.
Usual contraindications to surgery, coronoid bone loss less than 40%.
The surgical procedure is thoroughly illustrated with a video of the operation that can be accessed online: reconstruction of the LUCL with a semitendinosus allograft, harvesting of the graft from the iliac crest, exposure of the coronoid process with a direct anterior approach, freshening up of the graft bed. Temporary fixation of the graft with a Kirschner wire. Assessment of joint congruency, stability and range of motion (ROM) prior to definitive fixation with a 2.4 mm buttress plate and screws.
Nonsteroidal anti-inflammatory drugs (NSAID) to prevent heterotopic ossification. Elbow mobilization in pronation from day 1 with an overhead motion protocol. Removable splint for 4 weeks, free mobilization at 6 weeks, return to sport at 3 months.
Durable elbow stability was achieved along with free ROM and high patient satisfaction.
Keywords
Humans, Elbow Joint/surgery, Elbow Joint/diagnostic imaging, Bone Transplantation/methods, Joint Instability/surgery, Ulna/surgery, Ulna/diagnostic imaging, Collateral Ligament, Ulnar/surgery, Collateral Ligament, Ulnar/injuries, Adult, Male, Coronoid bone defect, Coronoid dysplasia, Coronoid reconstruction, Elbow instability, Ligament reconstruction
Pubmed
Web of science
Create date
09/08/2024 9:32
Last modification date
28/09/2024 7:09