Operative Techniques in Orthopaedics RSS feed: Current Issue. Operative Techniques in Orthopaedics is an innovative, richly illustrated resource that keeps practitioners informed of significant advances in all areas of surgical management. Each issue of this atlas-style journal explores a single topic, often offering alternate approaches to the same procedure. Its current, definitive information keeps readers in the forefront of their specialty.http://www.optechorthopaedics.com/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Operative Techniques in Orthopaedics1048-6666201March 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.optechorthopaedics.com/article/PIIS1048666610000042/abstract?rss=yesMasthead10.1053/S1048-6666(10)00004-2Operative Techniques in Orthopaedics 20, 1 (2010)2010-03-01Operative Techniques in Orthopaedics2010-03-01201S1048-6666(10)X0002-7iihttp://www.optechorthopaedics.com/article/PIIS1048666610000054/abstract?rss=yesEditorial Board10.1053/S1048-6666(10)00005-4Operative Techniques in Orthopaedics 20, 1 (2010)2010-03-01Operative Techniques in Orthopaedics2010-03-01201S1048-6666(10)X0002-7iiiihttp://www.optechorthopaedics.com/article/PIIS1048666610000066/abstract?rss=yesTable of Contents10.1053/S1048-6666(10)00006-6Operative Techniques in Orthopaedics 20, 1 (2010)2010-03-01Operative Techniques in Orthopaedics2010-03-01201S1048-6666(10)X0002-7iiiiiihttp://www.optechorthopaedics.com/article/PIIS1048666610000078/abstract?rss=yesContributors10.1053/S1048-6666(10)00007-8Operative Techniques in Orthopaedics 20, 1 (2010)2010-03-01Operative Techniques in Orthopaedics2010-03-01201S1048-6666(10)X0002-7ivivhttp://www.optechorthopaedics.com/article/PIIS1048666609001967/abstract?rss=yesTremendous advances in reconstructive surgery options for the elbow have occurred over the last decade. We have invited recognized leaders in the field to address some of the “hot topics”, including management of terrible triad injuries, distal humerus fractures, and new and exciting options in elbow arthroplasty. We hope that readers of this edition will find it an invaluable resource in the management of patients with complex elbow disorders. We would like to thank Beth, Charlie, Sofie, Brady, Jill, Sonya, and Clare for their love and support. Finally, we would like to acknowledge the significant contributions of our administrative coordinator, Ms Michele Roberts.IntroductionWilliam N. Levine, Christopher S. Ahmad10.1053/j.oto.2009.11.004Operative Techniques in Orthopaedics 20, 1 (2010)2010-03-01Operative Techniques in Orthopaedics2010-03-01201S1048-6666(10)X0002-711http://www.optechorthopaedics.com/article/PIIS1048666609001098/abstract?rss=yesManagement of radial head fractures has evolved over the years, as have the techniques and implants used to treat them. However, no standardized treatment protocols exist because of the complexity with which radial head fractures may present. They range from stable, nondisplaced fractures to displaced, comminuted fractures with associated ligamentous, and osseous defects. Management of the complex fractures can be challenging. Historically, radial head excision was recommended for comminuted fractures, but with increased awareness of elbow and forearm biomechanics, the treatment choice for complex radial head injuries has evolved to internal fixation or replacement. The Mason classification may be used to guide treatment, however fracture characteristics and associated injuries must also be considered. Regardless of the treatment option, early range of motion and restoration of elbow anatomy with good surgical technique are imperative.Radial Head—Resect, Fix, or ReplaceCorinne VanBeek, William N. Levine10.1053/j.oto.2009.08.003Operative Techniques in Orthopaedics 20, 1 (2010)2010-03-01Operative Techniques in Orthopaedics2010-03-01201S1048-6666(10)X0002-7210http://www.optechorthopaedics.com/article/PIIS1048666609001347/abstract?rss=yesThe combination of an elbow dislocation with fractures of the radial head and coronoid process has been labeled the terrible triad of the elbow. We prefer to repair the coronoid, repair or replaced the radial head, and reattach the origin of the lateral collateral ligament to the lateral epicondyle. Repair of the medial collateral ligament is not usually necessary.My Approach to the Terrible Triad InjuryGeorge Dyer, David Ring10.1053/j.oto.2009.09.015Operative Techniques in Orthopaedics 20, 1 (2010)2010-03-01Operative Techniques in Orthopaedics2010-03-01201S1048-6666(10)X0002-71116http://www.optechorthopaedics.com/article/PIIS1048666609001359/abstract?rss=yesOlecranon fractures constitute a large proportion of injuries about the elbow. Several fracture patterns are recognized, with each pattern lending itself to a different treatment modality. Currently, there are many options available for treating these injuries ranging from cast immobilization to open reduction and internal fixation with precontoured locked plates. Nondisplaced fractures with an intact extensor mechanism allow a brief period of immobilization with early range of motion. Displaced fractures may be excised or internally fixed with olecranon plates, intramedullary devices, or tension band techniques. Excellent results can be expected if the treating surgeon considers the patient's functional demands and the injury pattern to make treatment decisions.Olecranon FracturesRyan P. Donegan, John-Erik Bell10.1053/j.oto.2009.09.016Operative Techniques in Orthopaedics 20, 1 (2010)2010-03-01Operative Techniques in Orthopaedics2010-03-01201S1048-6666(10)X0002-71723http://www.optechorthopaedics.com/article/PIIS1048666609001207/abstract?rss=yesDistal humerus fractures are common and represent 2% of all fractures and approximately 30% of those affecting the humerus. The management of distal humerus fractures is complicated by the complex 3-dimensional anatomy of the elbow, the limited bone stock for internal fixation, and often comminuted and osteopenic nature of the articular segment. Surgical treatment should be conducted in a systematic manner to minimize complications. Using the principles of anatomic articular reconstruction with stable fixation to allow early range to motion, good to satisfactory outcomes can be expected in most patients.Open Reduction and Internal Fixation of Distal Humerus FracturesDanny P. Goel, Jeffrey M. Pike, George S. Athwal10.1053/j.oto.2009.09.010Operative Techniques in Orthopaedics 20, 1 (2010)2010-03-01Operative Techniques in Orthopaedics2010-03-01201S1048-6666(10)X0002-72433http://www.optechorthopaedics.com/article/PIIS1048666609001955/abstract?rss=yesElbow contracture is a debilitating complication of trauma that can arise from intra-articular and extraarticular sources. When nonoperative treatment fails, operative intervention is indicated. Evaluation begins with thorough preoperative planning. The column approach allows excellent exposure and treatment of anterior and posterior capsular and osseous sources of contracture. For posterior medial capsular contraction, a medial approach is often indicated. This allows access for decompression and transposition of the ulnar nerve. Postoperative care involves early clinic follow up with continuous passive motion (CPM) and/or splinting.Treatment of the Stiff ElbowJonathan D. Barlow, Scott P. Steinmann10.1053/j.oto.2009.11.003Operative Techniques in Orthopaedics 20, 1 (2010)2010-03-01Operative Techniques in Orthopaedics2010-03-01201S1048-6666(10)X0002-73437http://www.optechorthopaedics.com/article/PIIS1048666609001104/abstract?rss=yesTreatment of distal humeral fractures remains a challenging problem. Recent advances in plating techniques have improved our ability to treat most fractures with open reduction and internal fixation. Although open reduction and internal fixation has become the gold standard, successful treatment requires adherence to the tenets of anatomic reconstruction and stable fixation. In some cases,—particularly in elderly patients with poor bone quality and comminuted, intra-articular fractures—stable, anatomic reconstruction cannot be reliably achieved. Situations in which stable reconstruction is capricious, elbow arthroplasty has emerged as a viable alternative. Total elbow arthroplasty is the procedure of choice for elderly patients, preexisting arthropathy, low functional demand, and when the medial or lateral condyles cannot be reconstructed. Distal humeral replacement (hemiarthroplasty) with an anatomic implant is an option for younger, active patients; however, this requires intact or reconstructible condyles and soft tissue constraints. We present our technique of elbow arthroplasty for unreconstructible distal humeral fractures.Elbow Arthroplasty for Distal Humeral Fractures—Technique, Pearls, and PitfallsMark A. Mighell, Mark A. Frankle, Philip J. Mulieri10.1053/j.oto.2009.08.004Operative Techniques in Orthopaedics 20, 1 (2010)2010-03-01Operative Techniques in Orthopaedics2010-03-01201S1048-6666(10)X0002-73847http://www.optechorthopaedics.com/article/PIIS1048666609001190/abstract?rss=yesLinked total elbow arthroplasty (TEA) is differentiated from unlinked arthroplasty by virtue of the captured articulation of the humeral and ulnar components. This physical linkage provides distinct advantages compared with implants where no linkage exists. However, there are some theoretic disadvantages as well. There are several linked implant systems in use in the USA. Each implant system shares the common feature of being linked and possessing a degree of laxity. However, there are unique design features of each system. Unfortunately, there is no available data comparing the outcomes using different systems. The results of linked TEA will be reviewed with particular attention to the underlying pathology. This will highlight the conditions where available implants perform well and conditions that continue to challenge current implants.Linked Total Elbow ArthroplastyMatthew L. Ramsey10.1053/j.oto.2009.09.009Operative Techniques in Orthopaedics 20, 1 (2010)2010-03-01Operative Techniques in Orthopaedics2010-03-01201S1048-6666(10)X0002-74857http://www.optechorthopaedics.com/article/PIIS1048666609001426/abstract?rss=yesIndications for total elbow arthroplasty have expanded beyond treatment of advanced rheumatoid arthritis to include higher demand situations, such as complex distal humeral fractures and nonunions, primary or post-traumatic osteoarthritis, dysfunctional instability, and periarticular tumors. With expansion of indications, the use of unlinked implants may become more appropriate. The surgeon may choose between a linked or an unlinked device, based on the quality and function of the surrounding soft tissues and bone. On occasion, the clinical situation may require an unlinked device to be converted to a linked one or vice versa. We present here our preferred technique for the use of a convertible total elbow arthroplasty with a triceps-on approach.Total Elbow Arthroplasty—ConvertibleDara Chafik, Shawn O'Driscoll, Graham W. King, Ken Yamaguchi10.1053/j.oto.2009.10.002Operative Techniques in Orthopaedics 20, 1 (2010)2010-03-01Operative Techniques in Orthopaedics2010-03-01201S1048-6666(10)X0002-75867