Morrey’s The Elbow and Its Disorders 5th Edition by Bernard Morrey ISBN 0323497299 9780323497299

Part I Fundamentals and General Considerations

1 Phylogeny

Introduction

Evolution of the Vertebrate Elbow

Comparative Primate Anatomy of the Elbow Region

Fossil Evidence

Acknowledgments

References

2 Anatomy of the Elbow Joint

Topical Anatomy and General Survey

Osteology

Elbow Joint Structure

Vessels

Nerves

Muscles

References

3 Biomechanics of the Elbow

Introduction

Kinematics

Elbow Stability

Force Across Elbow Joint

References

4 History and Physical Examination of the Elbow

Introduction

History

Physical Examination

References

5 Functional Evaluation of the Elbow

Introduction

Significance

Elbow Motion

Strength

Stability

Functional Evaluation of the Elbow

References

6 Radiography of the Elbow

Introduction

Radiographic Imaging

Arthrography

References

7 Computed Tomography of the Elbow

Introduction

Technique and Recent Innovations

Computed Tomography of the Elbow: Clinical Applications

References

8 Magnetic Resonance Imaging of the Elbow

Introduction

Technique

Magnetic Resonance Imaging of the Elbow: Clinical Applications

References

9 Ultrasound Imaging of the Elbow

Introduction

Technique

Clinical Applications

References

10 Extensile Surgical Exposures

Introduction

Extensile Anterior Lateral Approach of the Humerus

Extensile Posterior Medial Exposure of the Humerus

Posterior Triceps-Splitting Approach

References

11 Surgical Exposures of the Elbow

Introduction

General Principles

Lateral Approaches

Posterior Exposures

Medial Approaches

Anterior Exposures

Results

Complications

References

12 Surgical Exposures of the Forearm

Anterior Exposure of the Radius

Posterior Exposure of the Radius

Exposure of the Ulnar Shaft

References

13 General and Regional Anesthesia and Postoperative Pain Control

Introduction

Intraoperative Anesthetic Management

Postoperative Analgesia

Multimodal Analgesia and Peripheral Blockade

Conventional Analgesic Methods

Continuous Brachial Plexus Analgesia

Intraarticular Catheters

Summary

References

14 Principles of Elbow Rehabilitation

Introduction

Establish a Complete and Accurate Diagnosis

Patient Participation

Reduce Pain and Inflammation

Implement Early Atraumatic Motion

Timing

Restore Regional Neuromuscular Control

Integration Into the Kinetic-Kinematic Chain

Summary

References

15 Continuous Passive Motion

Introduction

Indications

Contraindications

Logistical Considerations

Application

Treatment Program

Complications

Results

References

16 Splints and Bracing of the Elbow

Introduction

Elbow Stiffness

Pathology of Elbow Contracture

Management of Elbow Stiffness With Mobilization Splinting

References

17 Examination Under Anesthesia

Introduction

Indications

Contraindications

Preoperative Planning

Technique

Results

Complications

References

Part II Elbow Arthroscopy

18 General Principles of Elbow Arthroscopy

Introduction

Anatomy

Surgical Indications

Contraindications

Patient History

Pertinent Physical Examination Findings

Pertinent Imaging

General Principles and Equipment to Complete Procedure

Postoperative Protocol

Potential Complications

References

19 Arthroscopic Management of Lateral Epicondylitis

Introduction

Indications

Technique

Conclusions

References

20 Arthroscopic Management of Elbow Plica and Loose Bodies

Introduction

Loose Bodies

Surgical Indications

Surgical Technique

Outcomes

Arthroscopic Synovectomy

Symptomatic Plicae

Surgical Indications

Summary

References

21 Arthroscopy for Arthritis of the Elbow

Introduction

History and Physical Examination

Diagnostic Imaging

Indications for Surgery

Contraindications

Arthroscopic Technique

Steps in the Management of the Arthritic Elbow (Box 21.1)

Summary

References

22 Arthroscopic Management of Osteochondritis Dissecans of the Capitellum

Introduction

Natural History

Pathophysiology

Histopathology

Presentation

Physical Exam

Panner’s Disease

Imaging

Classification of OCD Lesions

Treatment

Complications

Conclusion

References

23 Complications of Elbow Arthroscopy

Introduction

Information and Clinical Experience

Anatomy

Pathology

Surgical Procedure

Vascular Insult

Incidence

Prevention

References

24 Advanced and Future Trends in Elbow Arthroscopy

Introduction

Arthroscopic Triceps Tendon Repair

Arthroscopic Fracture Repair

Endoscopic Biceps Repair

Lateral Collateral Ligament Repair

Arthroscopic Resurfacing

Arthroscopic Management of the Stiff Elbow

Conclusions

References

Part III The Child and Adolescent Elbow

25 The Pediatric Elbow

Introduction

Anatomy

Imaging

References

26 Congenital Abnormalities of the Elbow

Introduction

Classification and Causes of Congenital Anomalies

Bone and Joint Anomalies

Soft Tissue Anomalies

Combined Bone and Soft Tissue Anomalies

Treatment of Bone and Joint Anomalies

Treatment of Soft Tissue Dysplasias and Combined Bone and Soft Tissue Dysplasias

Complications

Summary

Acknowledgments

References

27 Supracondylar Fractures of the Elbow in Children

Introduction

Incidence and Etiology

Classification

Diagnosis and Radiographic Evaluation

Treatment

Postoperative Care

Complications

Acknowledgment

References

28 Complications of Supracondylar Fractures of the Elbow

Introduction

Neurovascular Problems Associated With Supracondylar Fractures

Ischemic Injuries

Osseous Complications

Indications for Corrective Surgery

References

29 Physeal Fractures of the Elbow

Anatomy and Growth

Epidemiology

Classification

Evaluation

Management

Distal Humerus

Lateral Condyle Fracture

Medial Condyle Fracture

Medial Epicondyle

Lateral Epicondyle

Proximal Radial Physis

Proximal Ulnar Physis

Premature Growth Arrest

Fishtail Deformity

References

30 Proximal Radius Fractures in Children

Introduction

Pathoanatomy and Applied Anatomy Related to Mechanism of Injury

Fracture Classification

Assessment of Injury

Treatment

Operative Treatment

Surgical Procedure

Conclusion

References

31 Olecranon and Monteggia Fractures in Children

Introduction

Monteggia Fractures

Transolecranon Fracture–Dislocations

Olecranon Fractures

Summary

References

32 Pediatric Elbow Dislocations

Introduction

Anatomic Factors Predisposing to Elbow Dislocation in Children

Types of Dislocations of the Radial Head

Treatment of Acute Dislocations

Additional Types of Elbow Dislocations

Complications of Elbow Dislocations

Summary

References

33 Osteochondritis Dissecans

Introduction

Osteochondrosis of the Capitellum (Panner Disease)

Osteochondritis Dissecans

Etiology

Classification

Treatment

Summary

References

34 Elbow Stiffness in Children and Adolescents

Introduction

Etiology

Natural History and Prevention

Clinical History

Physical Exam

Imaging

Nonoperative Treatment

Operative Treatment

Postoperative Rehabilitation

Variables That May Affect Outcomes

References

Part IV Acute Trauma

35 Simple Elbow Dislocation

Introduction

Classification

Pathomechanics

Associated Injuries

Management of the Acute Simple Elbow Dislocation

Complications of Simple Elbow Dislocations

Conclusions

References

36 Complex Elbow Instability

Introduction

Definition

Contribution to Normal Stability

Major Stabilizers of the Elbow Joint

Clinical Management: Principles

Fracture of the Proximal Part of the Ulna

Treatment

References

37 Radial Head Fracture

Introduction

Epidemiology

Anatomy, Biomechanics, and Function of the Radial Head

Associated Injuries

Classification of Fracture

Fracture Management

References

38 Radial Head Fracture

Introduction

Authors’ Preferred Treatment

References

39 Prosthetic Radial Head Replacement

Introduction

Indications

Contraindications

Design Considerations

Technique

Aftercare

Technical Notes

Results

Prognostic Factors

Complications

Summary

References

40 Radial Head Fracture

Epidemiology

Failure Mechanisms

Evaluation

Treatment Alternatives

Summary

References

41 Essex-Lopresti Injuries

Introduction

Epidemiology

Anatomy and Biomechanics

Diagnosis

Treatment

Salvage Treatment

Conclusions

References

42 Olecranon Fractures and Monteggia Fractures

Introduction

Anatomic Considerations

Evaluation

Treatment

Preferred Techniques

Monteggia Fractures

References

43 Coronoid Fractures

Introduction

Epidemiology

Classification

Evaluation

Treatment

References

44 Low Transcondylar Fractures of the Distal Humerus

General Considerations

Nonsurgical Treatment

Surgical Treatment

Extraarticular Fractures

References

45 Distal Humerus Fractures

Introduction

Epidemiology

Patient Evaluation

Management Options

Internal Fixation: Surgical Technique

Outcome and Complications

Conclusion

References

46 Distal Humerus Fractures

Introduction

Anatomy

Epidemiology

Injury Mechanism

Function of the Capitellum

Classification

Diagnosis

Treatment

Complications

References

47 Distal Humerus Fractures

Introduction

Surgical Decision Making

Surgical Tactics

Postoperative Management

Complications

Outcomes

References

48 Hinged External Fixators of the Elbow

Introduction

Rationale and Options

Indications

Contraindications

Selection of Fixator Configuration: Basic and Clinical Experience

Technique

Results

Complications

Summary

References

Part V Complications of Trauma and Elbow Stiffness

49 Persistent Elbow Instability

Introduction

Etiology

Treatment

Rehabilitation/Postoperative Care

Complications

Conclusion

Acknowledgment

References

50 Nonunion and Malunion of Distal Humerus Fractures

Introduction

Distal Humeral Nonunion

Distal Humeral Malunion in the Adult Patient

References

51 Nonunion of the Olecranon and Proximal Ulna

General Considerations

Incidence

Diagnosis

Clinical Presentation

Factors Causing Nonunion

Classification

Treatment Options

Complications of Treatment of Nonunions

Results

Conclusions

References

52 Chronic Unreduced Elbow Dislocation

Introduction

Chronic Unreduced Elbow Joint

Presentation

Surgical Technique

Results

Author’s Preference

Conclusions

References

53 Elbow Stiffness

Introduction

Pathology

Pathogenesis

Classification

Presentation

Investigations

Management

Stiffness in the Presence of Instability

Conclusions

References

54 Extrinsic Contracture

Introduction

Etiology and Incidence

Presentation

Diagnosis

Indications

Contraindications

Preoperative Planning

Technique: Column Procedure

Medial Release

Description of Exposure

Closure

Aftercare

Results

Complications

References

55 Elbow Stiffness

Introduction

General Principles

Technical Aspects

Outcome

Summary

References

56 Elbow Stiffness

Introduction

Summary

References

57 Heterotopic Ossification

Introduction

Basic Science and Physiopathology

Heterotopic Ossification Classification

Patient Evaluation

Heterotopic Ossification Treatment

Heterotopic Ossification Prophylaxis

Summary

References

58 Healing and Wound Problems

Introduction

Strategies to Avoid Wound Complications

Diagnosis and Management of Wound Complications

Summary

References

Part VI Sports and Soft Tissue Injuries

59 Lateral Epicondylitis/Tendinosis

Introduction

Indications/Contraindications

Preoperative Planning

Surgery (Lateral Tendinosis)

Postoperative Management

Results

Complications and Surgical Failure

References

60 Percutaneous Ultrasound Tenotomy Treatment of Epicondylitis

Introduction

Rationale

Indications

Contraindications

Preoperative Assessment

Aftercare

Complications

Results

Conclusion

References

61 Medial Epicondylitis/Tendinosis

Introduction

Indications

Contraindications

Presentation and Classification

Preoperative Planning

Surgery

Postoperative Management

Results

Complications and Surgical Failure

References

62 Managing Surgical Failure in Tennis Elbow

Introduction

Patient Evaluation

Classification

Physical Examination

Diagnostic Measures

Treatment

Surgical Treatment

Results

Other Reports

Conclusion

References

63 Elbow Tendinopathies

Introduction

Types

Demographics

Anatomy and Pathoanatomy

Presentation

Management

Acute Partial (Incomplete) Distal Biceps Tendon Rupture

Summary

References

64 Elbow Tendinopathies

Introduction

Presentation

Diagnosis

Imaging Studies

Treatment

Aftercare

Results

References

65 Elbow Tendinopathies

Anatomy of the Triceps Tendon

Triceps Tendon Ruptures

Imaging

Treatment

Surgical Technique

Results

Rehabilitation

Residua and Complications

Triceps Tendon Snapping

References

66 The Thrower’s Elbow

Introduction

Pathomechanics

Evaluation

Treatment

Outcomes

References

67 Articular Injuries in the Athlete

Introduction

Anatomy

Diagnosis

Injuries in Adolescence

Injuries in Adults

Rehabilitation

References

68 Medial Collateral Ligament Reconstruction

Introduction

Pathophysiology

Epidemiology

Diagnosis

Management of MCL Insufficiency

Operative Treatment

Surgical Techniques

Surgical Considerations

Postoperative Rehabilitation

Clinical Outcomes

Summary

References

69 Ulnar Collateral Ligament Reconstruction

Introduction

Examination

Treatment

Revision Ulnar Collateral Ligament Reconstruction Outcomes

Conclusion

References

70 Medial Collateral Ligament Reconstruction

Introduction

Rationale

Diagnosis

Technique

Aftercare

Results

References

71 Lateral Collateral Ligament Insufficiency

Introduction

Basic Science

Etiology

Diagnosis

Imaging Studies

Treatment

Revision Reconstruction of the Lateral Collateral Ligament Complex

Summary

References

72 Nerve Entrapment Syndromes

Introduction

Neurophysiology of Nerve Compression Lesions

References

73 Atypical Pain Presentation in the Elbow

Introduction

Understanding Mechanisms of Pain

Complex Regional Pain Syndrome

Conclusion

References

74 Bursitis

Introduction

Anatomy

Deep Bursae

Superficial Bursae

Olecranon Bursitis

Clinical Presentation

Treatment

Acute Bursitis

Chronic Bursitis

Operative Intervention

Reconstructive Options

Results

Complications

References

Part VII Pathologic Conditions of the Elbow

75 Posttraumatic Elbow Osteoarthritis

Introduction

Patient Evaluation: History and Physical Examination

Imaging and Other Complementary Tests

Treatment

Summary

References

76 Primary Osteoarthritis of the Elbow

Introduction

Incidence and Etiology

Clinical Presentation

Diagnosis

Treatment

Results

Mayo Experience: Most Recent Experience

Extended Débridement

Prosthetic Replacement

References

77 Rheumatoid Arthritis

Introduction

Epidemiology

Pathophysiology

Clinical Features

Extraarticular Manifestations

Laboratory Studies

Management and Complications

References

78 Seronegative Inflammatory Arthritis

Introduction

Spondyloarthropathies

Crystalline Arthropathies

Adult Still Disease

References

79 Hematologic Arthritis

Introduction

Hemophilic Arthropathy

Sickle Cell Disease

Leukemia and Other Myeloproliferative Disorders

References

80 Septic Arthritis

Introduction

Epidemiology

Bacteriology

Clinical Presentation

Diagnosis

Treatment

Prognosis

References

81 Neoplasms of the Elbow

Introduction and Relevance

Clinical Presentation

Preoperative Evaluation

Biopsy

Staging

Prosthetic Replacement

Bone Tumors

Soft Tissue Tumors

References

82 Neuropathic Arthropathy

Introduction

Pathogenesis

Associated Conditions

Evaluation and Treatment

References

83 Elbow Pathology From Metabolic Disease

Introduction

Rickets

Osteomalacia

Tumoral Calcinosis

Hyperparathyroidism

Acromegaly

Wilson Disease (Hepatolenticular Degeneration)

Hyperlipoproteinemia Type II (Familial Essential Hypercholesterolemia)

Osteoporosis

Steroid-Induced Avascular Necrosis

References

84 Loose Bodies and Ossification Centers About the Elbow

Introduction

Accessory Ossification

Medial Epicondyle Accessory Ossicle

Patella Cubiti

Os Supratrochleare Dorsale

Etiology

Diagnosis

Osteochondral Fracture

Loose Bodies of Degenerative Origin

Treatment

Synovial Chondromatosis

Treatment

References

Part VIII Joint Replacement Arthroplasty

Section A Fundamentals

85 Elbow Arthroplasty

Introduction

Initial Efforts: Before 1950

Subsequent Efforts: 1950 to 1970

The Modern Era of Prosthetic Replacement: Early Period, 1970 to 1980

The Modern Era of Prosthetic Replacement: Intermediate Period, 1980 to 2000

The Modern Era: 2000 to the Present

References

86 Biomechanics of Joint Reconstruction

Introduction

Motion

Constraints

Joint Forces

Design Considerations

References

87 Radiocapitellar Prosthetic Arthroplasty for Isolated Radiocapitellar Arthritis

Introduction

Presentation

Imaging

Indications and Contraindications

Radiocapitellar Replacement

Results

Complications

Conclusion

References

88 Distal Humeral Hemiarthroplasty

Introduction

Indications

Contraindications

Implants

Alternative Treatments

Results

Preoperative Planning

Surgical Technique

Nonacute Pathology

Postoperative Management

Outcome Assessment

Complications and Troubleshooting

Conclusion

References

89 Unlinked and Convertible Arthroplasty

Introduction

Design Considerations

Indications

Contraindications

Surgical Considerations of Unlinked Designs

Surgical Considerations of Convertible Designs

Surgical Technique

Rehabilitation

Complications

Results

References

90 Linked Elbow Arthroplasty

Introduction

The Semiconstrained Linked Implants

The “Next Elbow”: the Nexel Device

References

Section B Technique and Outcome by Indication and Diagnosis

91 Elbow Arthroplasty in Inflammatory Arthritis

Introduction

Evaluation of the Rheumatoid Elbow

Elbow Arthroplasty in Inflammatory Arthritis

Elbow Arthroplasty in Juvenile Idiopathic Arthritis

Summary

References

92 Distal Humeral Fractures

Introduction

Nonsurgical Management

Fracture Fixation

Acute Total Elbow Arthroplasty

Surgical Technique

Summary

References

93 Total Elbow Arthroplasty for Distal Humeral Nonunion

Introduction

Rationale, Indications, and Contraindications

Surgical Technique

Postoperative Management

Outcome

Summary

References

94 Posttraumatic Arthrosis

Introduction

Indications

Contraindications

Special Considerations in Posttraumatic Arthritis

Semiconstrained Total Elbow Arthroplasty for Posttraumatic Arthritis

Conclusion

References

95 Total Elbow Arthroplasty for Primary Osteoarthritis

Introduction

Indications

Technical Considerations

Implant Selection

Technique

Aftercare

Results

Complications

Conclusion

References

96 Failed Interposition Arthroplasty of the Elbow

Introduction

Failure Modes

Options and Indications

Contraindications

Preoperative Assessment

Surgical Technique

Results

Conclusion

References

97 Dysfunctional Instability

Introduction

Preoperative Evaluation

Nonoperative Treatment

Surgical Indications

Contraindications

Surgical Technique

Postoperative Management

Outcomes

Complications

Conclusions

References

98 The Fused Elbow

Introduction

Indications and Patient Selection

Contraindications

Preoperative Assessment

Radiographic Evaluation

Surgical Technique

Postoperative Care

Results

Complications

Conclusion

References

Part IX Complications and Salvage of Failed Arthroplasty

99 Complications of Elbow Replacement Arthroplasty

Introduction

Complications Not Usually Requiring Surgery

Complications Requiring Reoperation

References

100 Diagnosis of Deep Infection After Elbow Arthroplasty

Introduction

Etiology and Incidence

Clinical Evaluation and History

Imaging

Laboratory Tests

Intraoperative Histology and Culture

Advanced Diagnostic Methods

Authors’ Preferred Algorithm

Summary

References

101 Treatment of the Infected Total Elbow Arthroplasty

Introduction

Etiology and Incidence

Prevention of Infection

Patient Profile

Duration of Symptoms

Fixation of Components

Bacteriology

Treatment Options

Complications

Conclusion

References

102 Triceps Insufficiency Following Total Elbow Arthroplasty

Introduction

Presentation and Symptoms

Pathology

Management

Achilles Tendon Reconstruction

References

103 Periprosthetic Elbow Fractures

Introduction

Prevalence and Risk Factors

Mechanism of Injury

Classification

Evaluation

Staged Revision

Treatment and Surgical Technique

Postoperative Care

Outcome and Complications

Prevention

References

104 Isolated Polyethylene Wear and Elbow Replacement

Introduction

Clinical and Radiological Features

Indications for Treatment

Treatment

Results

Conclusions

References

105 Instability After Unlinked Total Elbow Arthroplasty

Introduction

Classification of Total Elbow Arthroplasty Instability

Etiology

Evaluation

Treatment

Conclusions

References

106 Revision of Nonseptic Failed Total Elbow Arthroplasty With Osseous Integrity

Introduction

Classification of Failure

Circumstances Allowing Reimplantation

Indications and Presentation

Reimplantation Procedures

Summary

References

107 Revision Total Elbow Arthroplasty With Strut Augmentation

Rationale

Indications

Surgical Technique

Outcome

Summary

References

108 Revision of Failed Total Elbow Arthroplasty With Osseous Deficiency

Introduction

Choice of Impaction Grafting vs. Type I APC

Impaction Grafting

References

109 Revision of Failed Total Elbow Arthroplasty With Osseous Deficiency

Introduction

Rationale and Perspective

Additional Considerations

Essential Technical Concepts

Mayo Classification of APC Elbow Reconstruction

Postoperative Management

Results

Mayo Experience

Total Humeral Replacement

References

Part X Nonprosthetic Alternatives and Salvage Procedures

110 Synovectomy of the Elbow

Introduction

Indications and Patient Selection

Contraindications

Techniques

Nonsurgical Synovectomy

Surgical Synovectomy

Osseous and Capsular Débridement

Summary

References

111 Ulnohumeral Arthroplasty

Introduction

Incidence and Etiology

Clinical Presentation

Radiographic Features

Treatment

Results

Mayo Experience: Ulnohumeral Arthroplasty

Prosthetic Replacement

References

112 Osteochondral Allograft Reconstruction

Introduction

Allograft Replacement

Results

Summary

References

113 Anconeus Interposition Arthroplasty

Introduction

Anatomy

Indications

Surgical Technique

Postoperative Care

Outcomes

References

114 Interposition Arthroplasty of the Elbow

Introduction

Historical Aspects

Interposed Tissues

Indications

Contraindications

Preferred Tissue

Preferred Technique: Achilles Tendon Allograft

Cutis Arthroplasty

Results

Complications

Salvaging the Salvage

Conclusion

References

115 Elbow Arthrodesis

Introduction/Indications

Position

Military/Combat Injuries

Techniques

Postoperative Management

Results

Complications

Conversion to Prosthesis

References

116 Soft Tissue Coverage of the Elbow

Introduction

Patient Assessment

Reconstructive Methods

References

117 Flaccid Dysfunction

Introduction

General Principles

Restoration of Elbow Flexion

Restoration of Elbow Extension

Tendon Transfer

Transfers for Restoration of Forearm Pronation

References

118 Spastic Dysfunction of the Elbow

Cerebral Palsy

Traumatic Brain Injury

Stroke and Head Trauma in Adults

Preoperative Evaluation

Treatment Options

Acknowledgment

References

119 Elbow Resection Arthroplasty

Introduction

Indications

Surgical Technique

Postoperative Immobilization and Care

Outcome

Summary

References

120 Elbow Disarticulation Amputation

Introduction

Demographics

Elbow Disarticulation Amputation

Amputation Surgery

Immediate Postamputation Management

Prosthetic Management

Functional Outcomes

Summary

References

Index