A brachial artery pseudoaneurysm in the form of a “malignant tumour” as a complication of a proximal humerus exostosis

Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 1 | Jan- June 2019 | Page 3-6 | Michał Górecki, Piotr Czarnecki

Authors: Michał Górecki [1], Piotr Czarnecki [2].

[1] Student Research Group of Hand Surgery, University of Medical Sciences Poznań, Poland
[2] Department of Traumatology, Orthopaedics and Hand Surgery of Viktor Dega Orthopedic and Rehabilitation Clinical Hospital

Address of Correspondence
Dr. Michał Górecki,
Mścibora 74, 61-062 Poznań, Poland
E-mail: michalmgorecki@gmail.com


Background: Osteochondromas are the most common form of benign bone tumour. They are mostly asymptomatic, but sometimes they can irritate surrounding structures, like vessels or nerves, and cause complications. More often they apply to the lower extremities, especially around the knee joint. Osteochondromas which cause complications in the upper extremities are much less common. This paper presents a rare case of a brachial artery pseudoaneurysm as a complication of a proximal humerus exostosis, which was initially described and treated as malignant tumour of the arm. A comprehensive review of the literature has also been carried out.
Methods: A 19-year-old male patient was admitted with acute pain of the left arm. Eight years earlier he had been diagnosed with hereditary multiple osteochondromas. Examination revealed a palpable, non-painful tumour of the axilla’s area and the posterior part of the left arm. An magnetic resonance imaging (MRI) with contrast demonstrated three osteochondromas in the area of the proximal humerus. From the free end of one of these, a big, nodular structure was spreading. From the MRI, a chondrosarcoma was suspected. Samples were taken for histopathological examination. After the surgery, increased pulsations were observed around the operative area. A ultrasonography (USG) revealed a fibrotic pseudoaneurysm of the left brachial artery. Histopathological examination showed deposits of heamosiderin without any cancer cells. With the change in diagnosis, the next stage of treatment was planned – artery reconstruction using a saphenous vein graft and an osteochondroma excision.
Results: A few weeks after surgery, the patient recovered full function of the upper extremity and did not report any discomfort. A control USG showed proper flow through the brachial artery and venous graft.
Conclusion: In the case of a tumour in the area of an osteochondroma, caused by trauma, a pseudoaneurysm should be suspected. Diagnostic and therapeutic treatment must be properly planned, as unrecognised it could cause a severe, life-threatening haemorrhage during the operation.
Keywords: pseudoaneurysm, osteochondroma, malignant transformation, brachial artery, chondrosarcoma.


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How to Cite this article: Górecki M, Czarnecki P. A brachial artery pseudoaneurysm in the form of a “malignant tumour” as a complication of a proximal humerus exostosis. Acta of Shoulder and Elbow Surgery Jan- June 2019;3(1):3-6.

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Why a new Shoulder and Elbow Journal?

Acta of Shoulder and Elbow Surgery | Volume 1 | Issue 1 | Oct-Dec 2016 | Page 2-3 | José Carlos Garcia Jr.

Author: José Carlos Garcia Jr. [1].

[1] NAEON-Santa Catarina Hospital

Address of Correspondence
Dr. Jose Carlos Garcia Jr., MD, MSc, PhD
NÆON-Hospital Santa Catarina-SP-Brazil
Email: jose.cjunior@hsl.org.br

Most Shoulder and Elbow Surgery journals are written in a far beyond context than most developing countries are up to. Distinguished features related to developed countries impact on the way people make surgeries, use materials and even make researches.

Availability of materials and devices, costs, local regulatory agencies and many other points need to be considered when talking about developing countries.Sometimes solutions adapted for these countries will not make sense for people of developed countries, with a different reality.
Then researches using some of the developing countries’ solutions will don’t make sense for reviewers from developed countries.
In the opposite side, discussing these solutions may be very important to develop shoulder and elbow surgery in developing countries. It is not about making second class researches, it is about looking researches within a different way of view. The first answer therefore is: We made this journal because we need to discuss issues adapted to our reality. We need to demonstrate results that can improve techniques possible to be reproduced all over the world. Consequently we will need to makeresearches that can be more suitable to our day by day. It does not mean bad research or bad results, it means a different way to make good things.
The second answer is: Because low cost innovations will make the world better and more equal. This journal has begun with an editorial board capable of diffusing the most recent concepts at no cost, making data easy to spread and replicate.
The third answer is: Considering that, in general, developing countries need some degree of refinement in shoulder and elbow surgery yet, transformations will be required. A rational step towards this new paradigm is an intersection of the two worlds, developed and developing countries.
This journal aims to promote this intersection by using new surgical techniques, researches and symposiums. As one wants to go further, one must have a general panorama of what is going on around to better know where to go. That is the purpose of the Current Concepts section of this journal whose content is a summary of the main journals of Shoulder and Elbow Surgery. It is not intend to explore the deepness of all research published but just a general panorama. Our concept is by accessing just this journal one can know what is going on around the world of Shoulder and Elbow Surgery and also have access to researches, symposiums and many other academical papers.
Combining all these characteristics in a single journal is essential to make surgeons updated and open minded to innovations.
This journal also begins by bringing a new concept to understand researches within the surgical field, it uses new ideas from IDEAL-Collaboration, Oxford, aiming to improve research methodology on surgical field.
We hope Acta of Shoulder and Elbow Surgery can be the new channel for all orthopedic surgeons interested in the area.
You are invited to be our reader, contributor and friend.

Warm Regards

José Carlos Garcia Jr.

How to Cite this article:.JC Garcia Jr. Why a new Shoulder and Elbow Journal?. Acta of Shoulder and Elbow Surgery Oct – Dec 2016;1(1):1

José Carlos Garcia Jr., MD

José Carlos Garcia Jr., MD

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Long Head of Biceps Interposition as a cause of Persistent Pain and Subluxation following Acute Anterior Shoulder Dislocation

Acta of Shoulder and Elbow Surgery | Volume 5 | Issue 1 | January-June 2021 | Page — | Robert J. Burton, Anna LR Porter, Yusuf Michla

Authors:  Robert J. Burton [1], Anna LR Porter [1], Yusuf Michla [1]

[1] Department of Orthopaedics, Sunderland Royal Hospital, Sunderland, UK.

Address of Correspondence
Dr. Anna LR Porter
Sunderland Royal Hospital, Kayll Road, Sunderland, UK.
E-mail: Annalrporter1@gmail.com


A 65 year old gentleman presented with persistent severe pain and joint incongruity on plain radiographs following a first time traumatic anterior shoulder dislocation without concurrent fracture to the tuberosities. Further investigation with MRI scan demonstrated interposition of the long head of biceps tendon within the glenohumeral joint, causing persistent pain and the subtle incongruity seen on AP and Axillary radiographs. Under arthroscopy the tendon was grossly tendinopathic at it’s insertion into the labrum, and reduction into the inter-tubucular groove was not possible. Tenotomy was performed, which immediately resolved the patients symptoms. Repeated radiographs demonstrated that the joint congruity had been restored. This case demonstrates that long head of biceps displacement is possible without concurrent fracture, and is a rare but important cause for persistent disproportionate pain post-reduction. Radiographs should be examined carefully for any evidence of joint in-congruity, and ultrasound or MR scanning will adequately demonstrate interposition of the long head of biceps within the glenohumeral joint.

Key Words: Anterior shoulder dislocation; Biceps tendon interposition; Glenohumeral-subluxation.


1. Allard J, Bancroft J. Irreducible posterior dislocation of the shoulder; MR and CT findings. Journal of computer assisted tomography. 1991;15 (4); 694-696. https://pubmed.ncbi.nlm.nih.gov/2061493/
2. Goldman A, Sherman O, Price A, Minkoff J. Posterior fracture-dislocation of the shoulder with biceps tendon interposition. The Journal of Trauma; Injury, Infection and Critical Care.1987; 27(9):1083-1086. https://pubmed.ncbi.nlm.nih.gov/3656473/
3. Gudena R, Iyengar K, Nadkuri J, Loh W. Irreducible shoulder dislocation – a word of caution. Orthopaedics & Traumatology, Surgery and Research. 2011; 97(4): 451-453. 10.1016/j.otsr.2011.02.004. https://pubmed.ncbi.nlm.nih.gov/21511554/
4. Seradge H, Orme G. Acute Irreducible Anterior Dislocation of the Shoulder. The Journal of Trauma: Injury, Infection and Critical Care. 1982;22(4):330-332. https://pubmed.ncbi.nlm.nih.gov/7077691/
5. Velghe A, Humblet P, Lesire M, Liselele D. Fresh posterior luxation of the shoulder: irreducibility due to interposition of the long biceps. Ap-ropos of 2 cases. Revue de chirurgie orthopaedique et reparatrice de l’appareil moteur. 1998;74(8):782-785. https://pubmed.ncbi.nlm.nih.gov/3253850/
6. Wyatt A, Porrino J, Shah S, Hsu J. Irreducible superolateral dislocation of the glenohumeral joint. Skeletal Radiology. 2015:44(9);1387-1391. 10.1007/s00256-015-2183-8. https://pubmed.ncbi.nlm.nih.gov/26051805/

How to Cite this article: Burton RJ, Porter ALR, Michla Y | Long Head of Biceps Interposition as a cause of Persistent Pain and Subluxation following Acute Anterior Shoulder Dislocation | Acta of Shoulder and Elbow Surgery | January-June 2021; 5(1): —-.

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Safe Elbow Surgery

Acta of Shoulder and Elbow Surgery | Volume 4 | Issue 1 | January-June 2020 | Page 20-22 |  Benjamin W. Sears, Mitchell J. Sungelo, Jacqueline E. Bader, Armodios M. Hatzidakis, Charles L. Getz

Authors:  Subbiah Venkatesh Babu [1]

[1] Deparment of Orthopaedics & Trauma Surgery, Sri Sakthi Hospital, Tirunelveli, Tamil Nadu, India.

Address of Correspondence
Dr. S Venkatesh Babu,
Consultant Orthopaedic & Trauma Surgeon, Sri Sakthi Hospital, Tirunelveli, Tamil Nadu, India.
E-mail: drsvbabu@hotmail.com


Today, the surgical treatment is being done for most of the elbow diseases and fractures openly, minimally invasive and arthroscopically. The complications after elbow surgery are also in significant proposition. This review exhibits the need of applied anatomical knowledge and operative skills for the surgeon who intends to operate the elbow safely.
Keywords: Safe Surgery, Trauma, Injury, Elbow.


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2. Stanley Hoppenfeld et al., , (2009) Surgical Exposures in Orthopaedics, The Anatomic Approach, Fourth Edition, Lippincott Williams & Wilkins
3. Zhiquan An et al., (2010) Plating osteosynthesis of mid-distal humeral shaft fractures: minimally invasive versus conventional open reduction technique, International Orthopaedics (SICOT) 2010, 34 : 131-138
4. Jaechon M Kim et al., (2011) Complications of Total Elbow Arthroplasty , J Am Acad Orthop Surg 2011 Jun, 19(6): 328-39
5. Reduan Elfeddali et al., (2013) Arthroscopic Elbow surgery, Is it safe? J Shoulder Elbow Surg , 2013 May; 22 (5): 647-52
6. Nelson et al., (2014) Elbow Arthroscopy: early complications and associated risk factors, J Shoulder Elbow Surg, 2014 Feb: 23(2) : 273-8
7. Rodrigo Kallas Zogaib et al.,(2014) Minimal Invasive Ostheosynthesis for treatment of diaphiseal transverse humeral shaft fractures, Acta Orthop Bras ., 2014; 22(2) : 94-8
8. Daniel Romano Zogbi et al., (2014) Fracture of Distal Humerus : MIPO Technique with visualisation of the Radial Nerve, Acta Orthop Bras , 2014; 22(6) : 300-3
9. Cheung EV et al., (2015) Complications of Elbow Trauma, Hand Clin, 2015, Nov; 31(4) :683-91
10. Izzak F Kodde et al., (2015) Current Concepts in the management of radial head fractures, World J Orthop 2015 December 18;6(11): p 954-960
11. Mohsen Mardani-Kivi et al., (2018), Indications, Results and Complications of Elbow Arthroscopy treatment in Eighteen Patients, Shiraz E-Med J, 2018 June ;19(6):e62606
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14. Olga D Savvidou et al., Complications of Open Reduction and Internal Fixation of distal humerus fractures, (2018), Trauma, EFFORT Open Reviews, EOR |Volume 3|October 2018|p 558-567
15. Samuel S Ornell et al.,(2019) Fungal infection following Total Elbow Arthroplasty, Case Rep Orthop ., 2019 : Sep 4; 2019: 1-5
16. Jae-Man Kwak et al., (2019), Total Elbow Arthroplasty; Clinical Outcomes, Complications and Revision Surgery, Clinics in Orthopaedic Surgery 2019;11:p366-379
17. WHO guidelines for safe surgery: safe surgery saves lives, 2009
18. Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use(2015), NICE Guidelines, UK.

How to Cite this article: Babu SV | Safe Elbow Surgery | Acta of Shoulder and Elbow Surgery | January-June 2020; 4(1): 20-22.

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Superior Capsular Reconstruction for Shoulder with an Irreparable Massive Posterosuperior Rotator Cuff Tear – A Case Report

Acta of Shoulder and Elbow Surgery | Volume 4 | Issue 1 | January-June 2020 | Page 11-14 |  Dinesh Chidambaram

Authors:  Dinesh Chidambaram [1]

[1] Department of Orthopaedics, Royal Care Superspeciality
Hospital, Neelambur, Coimbatore, Tamil Nadu, India.

Address of Correspondence
Dr. Dinesh Chidambaram,
Consultant Trauma and Arthroscopy Surgeon,
Royal Care Superspeciality Hospital, Neelambur,
Coimbatore, Tamil Nadu, India.
E-mail: dineshchidambaram75@gmail.com


A 65 year old gentleman presented with complaints of progressive pain over right shoulder for the past six months following fall onto his right shoulder one year back. He was diagnosed with massive retracted irreparable posterosuperior rotator cuff tear, for which superior capsular reconstruction with fascia lata autograft was performed. At 9 months follow up, patient has normal range of shoulder movements without any pain.
Keywords: Superior capsular reconstruction, Fascia lata graft


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14.Mihata T, Lee TQ, Watanabe C, Fukunishi K, Ohue M, Tsujimura T, et al. Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy. 2013; 29(3):459-70
15.Hirahara AM, Andersen WJ, Panero AJ. Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-up. Am J Orthop. 2017; 44(6):266-78.
16.Burkhart SS, Denard PJ, Adams CR, Brady PC, Hartzler RU. Arthroscopic superior capsular reconstruction for massive irreparable rotator cuff repair. Arthrosc Tech. 2016; 5(6):e1407-18.
17.Clark JM, Harryman DT 2nd. Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy. J Bone Joint Am. 1992; 74(5):713-25.
18.Ishihara Y, Mihata T, Tamboli M, Nguyen L, Park KP, McGarry MH, et al. Role of the superior shoulder capsule in passive stability of the glenohumeral joint. J Shoulder Elbow Surg. 2014; 23(5):642-8.
19.Mihata T, McGarry MH, Kahn T, Goldberg I, Neo M, Lee TQ. Biomechanical effect of thickness and tension of fascia lata graft on glenohumeral stability for superior capsule reconstruction in irreparable supraspinatus tears. Arthroscopy. 2016; 32(3):418-26.
20.Mihata T, Bui CNH, Akeda M, Cavagnaro MA, Kuenzler M, Peterson AB, et al. A biomechanical cadaveric study comparing superior capsule reconstruction using fascia lata allograft with human dermal allograft for irreparable rotator cuff tear. J Shoulder Elbow Surg. 2017; 26(12):2158-66.
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How to Cite this article: Chidambaram D | Superior Capsular Reconstruction for Shoulder with an Irreparable Massive Posterosuperior Rotator Cuff Tear – A Case Report | Acta of Shoulder and Elbow Surgery | January-June 2020; 4(1): 11-14.

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Proximal Humerus Fracture: Surgical Outcome and Complications in A Prospective Study Of 99 Patients and review of literature

Acta of Shoulder and Elbow Surgery | Volume 4 | Issue 1 | January-June 2020 | Page 15-19 |  Dheeraj Attarde, Dhruv Verma, Chetan Puram, Chetan Pradhan, Atul Patil, Parag Sancheti, Ashok Shyam

Authors:  Dheeraj Attarde [1], Dhruv Verma [1], Chetan Puram [1], Chetan Pradhan [1], Atul Patil [1], Parag Sancheti [1], Ashok Shyam [1,2]

[1] Department of Orthopaedics, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India.
[2] Indian Orthopaedic Research Group, Thane, India.

Address of Correspondence
Dr. Dheeraj Attarde,
Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India.
E-mail: dheerajattarde@yahoo.co.in


Objective: To report the outcomes of proximal humerus fracture operated with angular stability locking plate with regards to fracture pattern.
Design: Prospective clinical study.
Setting: Level 1 trauma center.
Patients: During a 24-month period, 99 patients with proximal humerus fracture with OTA type 11A, 11B, 11c were treated operatively with open reduction and internal fixation with angular stability locking plate at a level 1 trauma center. 37 patients were OTA type 11A, 33 and 29 patients were OTA 11B and OTA 11C respectively.
Main Outcome Measurements: Radiological outcome, functional outcome and complication of proximal humerus fractures with respect to fracture pattern, age, and gender.
Results: At 1 year follow up DASH score, Constant Murley score and range of motion showed a significant difference with respect to fracture type. Outcome was better in <50years of age group while gender showed no difference. Varus collapse was observed with 5 cases, stiffness and restricted mobility in 4 patients, implant loosening and avascular necrosis in 3 patients each, post op infection, rotator cuff weakness, screw backout, screw penetration and sub acromial impingement due to superior plate placement was found in 1 patient each.
Conclusions: Angular Locking plate fixation for proximal humerus fracture gives satisfactory results, good functional and radiological outcome. Occurrence of complications is independent of age and gender. Older patients (>50 years of age) have inferior functional outcomes as compared to younger patients (<50 years of age).
Keywords: PHILOS, Angular stability locking compression plate, Proximal humerus fracture, Neer’s fracture.


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How to Cite this article: Attarde D, Verma D, Puram C, Pradhan C, Patil A, Sancheti P, Shyam A | Proximal Humerus Fracture: Surgical Outcome and Complications in A Prospective Study Of 99 Patients and review of literature | Acta of Shoulder and Elbow Surgery | January-June 2020; 4(1): 15-19.

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Does addition of Remplissage procedure cause external rotation deficit in the patient undergoing standard Bankart repair for recurrent shoulder dislocation with engaging Hill-Sach’s lesions ?

Acta of Shoulder and Elbow Surgery | Volume 4 | Issue 1 | January-June 2020 | Page 7-10 |  Nilesh Kamat, Ashutosh Ajri, Vivek M Sodhai, Vikrant Kalamb, Ashok K Shyam, Parag K Sancheti

Authors:  Nilesh Kamat [1], Ashutosh Ajri [1], Vivek M Sodhai [1], Vikrant Kalamb [1], Ashok K Shyam [1,2], Parag K Sancheti [1]

[1] Department of Orthopaedics, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India.
[2] Indian Orthopaedic Research Group, Thane, India.

Address of Correspondence
Dr. Vivek Sodhai
Clinical Fellow, Department of Orthopaedics,
Sancheti Institute Of Orthopaedics and Rehabilitation, Pune, India.
E-mail: vivek.sodhai89@gmail.com


Background: To determine the effect of Remplissage procedure with Bankart repair compared to standard Bankart repair alone on resultant external rotation of the shoulder in patients of anterior shoulder instability with engaging Hill-Sach’s lesion.
Methods: Out of 46 patients, 18 patients underwent arthroscopic Remplissage combined with Bankart repair (group I) and the other 28 patients underwent arthroscopic standard Bankart repair alone (group II). Clinical outcomes were retrospectively evaluated by assessing the range of motion, complications, recurrence rates, and functional results were assessed utilizing the UCLA and ROWE score.
Results: Average follow-up period of 23.88 ± 5.26 (range, 12-48) months. Average external rotation loss compared to normal side in group I was of 5.00° ± 0.44° (range, 70°-90°)( p=0.031) in external rotation in abduction and 1.67° ± 0.18° (range, 75°-90°)( p=0.36 ) in external rotation in neutral at the last follow up and in group II it was 0.86°±0.35° (range, 70°-90°)( p=0.559 ) in external rotation in abduction and 0.89° ± 0.38° (range, 70°-90°)( p=0.646 ) in external rotation in neutral at the last follow-up. The average UCLA score was 34.00 ± 1.46 (range, 32-35) in group I and 33.29 ± 1.86 (range, 30-35) in group II (p=0.154). Average Rowe score was 92.22 ± 6.24 (range, 95-100) in the group I and 96.55±5.99 (range, 90-100) in the group II (p=0.025).
Conclusion: The addition of Remplissage procedure with standard Bankart repair causes significant loss of external rotation in abduction in patients of engaging Hill-Sach’s lesion compared to standard Bankart repair alone.
Level of Evidence: Level III
Keywords: Anterior shoulder instability, Remplissage procedure, Bankart’s repair, External rotation, Hill-Sach’s lesion.


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How to Cite this article: Kamat N, Ajri A, Sodhai VM, Kalamb V, Shyam AK, Sancheti PK | Does addition of Remplissage procedure cause external rotation deficit in the patient undergoing standard Bankart repair for recurrent shoulder dislocation with engaging Hill-Sach’s lesions ? | Acta of Shoulder and Elbow Surgery | January-June 2020; 4(1):7-10.

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Outcomes Following Open Reduction Internal Fixation of Extra Articular or Simple Articular Distal Humerus Fractures in Patients over 75 Years of Age

Acta of Shoulder and Elbow Surgery | Volume 4 | Issue 1 | January-June 2020 | Page 2-6 |  Benjamin W. Sears, Mitchell J. Sungelo, Jacqueline E. Bader, Armodios M. Hatzidakis, Charles L. Getz

Authors:  Benjamin W. Sears [1], Mitchell J. Sungelo [2], Jacqueline E. Bader [1], Armodios M. Hatzidakis [1], Charles L. Getz [3]

[1] Western Orthopaedics, 1830 Franklin St Ste 450 Denver, CO 80218
[2] University of Colorado School of Medicine, 13001 E. 17th Place Aurora, CO 80045
[3] Rothman Institute, 925 Chestnut St Philadelphia, PA 19107

Address of Correspondence
Dr. Benjamin W. Sears,
Western Orthopaedics, 1830 Franklin St Ste 450 Denver, CO 80218
E-mail: bwsears@gmail.com


Introduction: Treatment of distal humerus fractures in the aged population remains controversial due to concerns for bone quality, healing capacity, and integrity of the surrounding soft tissue envelope. We evaluated outcomes of open reduction internal fixation (ORIF) in patients aged ≥75 years with extra articular or simple articular distal humerus fractures (AO Type A or B).
Methods: Between 2011 to 2016, 13 patients 75 years of age or older identified in the last five years at two tertiary elbow centers as having undergone ORIF for AO Type A or B distal humerus fractures were retrospectively reviewed.
Results: The final average Mayo Elbow Performance Scores (MEPS) was 83.1 (range, 50-100). Average range of motion included lack of extension to 15° (range, 0-40°), and an average flexion to 128° (range, 115-140°). Average time to union was 12.2 weeks; however, two patients treated with percutaneous pinning resulted in nonunion. One required conversion to total elbow arthroplasty for pain with osseous collapse. There were no triceps or ulnar nerve issues, and no associated perioperative medical complications.
Conclusions: ORIF for AO Type A or B distal humerus fractures in the elderly population provides for immediate/early, functional use of the extremity, predictable union, limited perioperative complications and no long-term weight bearing restrictions. Conversion to total elbow arthroplasty can be utilized as a salvage procedure.
Level of evidence: Level IV.
Keywords: Distal humerus fracture, Elderly, ORIF, Arthroplasty, Fixation, Osteoporosis, Percutaneous pinning, Locked plates.


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How to Cite this article: Sears BW, Sungelo MJ, Bader JE, Hatzidakis AM, Getz CL | Outcomes Following Open Reduction Internal Fixation of Extra Articular or Simple Articular Distal Humerus Fractures in Patients over 75 Years of Age | Acta of Shoulder and Elbow Surgery | January-June 2020; 4(1):2-6.

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