Abstract
Introduction
Outerbridge–Kashiwagi ulnohumeral arthroplasty is an effective method in treating elbow osteoarthritis; however, distal humerus fracture after surgery can become a critical issue. A previous biomechanical study has shown that the failure load of the distal humerus decreases after a fenestration, but the size of the fenestration hole has not yet been discussed.
Materials and methods
32 fresh-frozen cadaveric distal humeri were obtained. Two drill sizes were chosen for fenestration: 12 and 15 mm in diameter. Two directions of force were applied with a materials testing machine for biomechanical testing: 5° flexion for axial loading and 75° flexion for anterior–posterior (AP) loading. Each specimen randomly received one of the two fenestration sizes, and force directions. All specimens were loaded to failure at a rate of 2 mm/min.
Results
The failure loads of the 12 and 15 mm groups were not significantly different in either axial loading(3886 ± 1271 N vs 4286 ± 901 N) or AP loading(2303 ± 803 N vs 1897 ± 357 N). All specimens loaded with axial force failed via the fenestration holes; however, during AP loading, some specimens failed through the fenestration holes, while others at diaphysis (p = 0.28).
Conclusions
The failure load of distal humeri did not differ significantly after fenestration of 12 or 15 mm. The clinical relevance is that as the risk of distal humerus fracture is not exacerbated, a larger-size fenestration hole could be of help to improve the effectiveness of this surgical procedure.
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References
Allen DM, Devries JP, Nunley JA (2004) Ulnohumeral arthroplasty. Iowa Orthop J 24:49–52
Krishnan SG, Harkins DC, Pennington SD, Harrison DK, Burkhead WZ (2007) Arthroscopic ulnohumeral arthroplasty for degenerative arthritis of the elbow in patients under fifty years of age. J Shoulder Elbow Surg 16(4):443–448. https://doi.org/10.1016/j.jse.2006.09.001
Phillips NJ, Ali A, Stanley D (2003) Treatment of primary degenerative arthritis of the elbow by ulnohumeral arthroplasty. A long-term follow-up. J Bone Jt Surg Br 85(3):347–350
Raval P, Ellanti P, Harrington P (2015) Ulnohumeral debridement arthroplasty: a retrospective study and midterm outcome results. Eur J Orthop Surg Traumatol 25(5):847–850. https://doi.org/10.1007/s00590-015-1593-6
Degreef I, De Smet L (2011) The arthroscopic ulnohumeral arthroplasty: from mini-open to arthroscopic surgery. Minim Invasive Surg 2011:798084. https://doi.org/10.1155/2011/798084
Vingerhoeds B, Degreef I, De Smet L (2004) Debridement arthroplasty for osteoarthritis of the elbow (Outerbridge–Kashiwagi procedure). Acta Orthop Belg 70(4):306–310
Degreef I (2009) Arthroscopic fenestration of the distal humerus: a viable option for painful elbow impingement in sportsmen. Acta Orthop Belg 75(5):678–680
DeGreef I, Samorjai N, De Smet L (2010) The Outerbridge–Kashiwaghi procedure in elbow arthroscopy. Acta Orthop Belg 76(4):468–471
Kroonen LT, Piper SL, Ghatan AC (2017) Arthroscopic management of elbow osteoarthritis. J Hand Surg Am 42(8):640–650. https://doi.org/10.1016/j.jhsa.2017.05.023
Redden JF, Stanley D (1993) Arthroscopic fenestration of the olecranon fossa in the treatment of osteoarthritis of the elbow. Arthroscopy 9(1):14–16
Hong CK, Chou AT, Su WR, Li CL (2018) A rare case of supracondylar humerus fracture after the Outerbridge–Kashiwagi procedure: a case report. Formos J Musculoskelet Disord. https://doi.org/10.6492/FJMD.20170116
Degreef I, Van Audekercke R, Boogmans T, De Smet L (2011) A biomechanical study on fracture risks in ulnohumeral arthroplasty. Chirurgie de la main 30(3):183–187. https://doi.org/10.1016/j.main.2011.03.001
Minami M, Kato S, Kashiwagi D (1996) Outerbridge–Kashiwagi’s method for arthroplasty of osteoarthritis of the elbow—44 elbows followed for 8–16 years. J Orthop Sci 1(1):11–15. https://doi.org/10.1007/BF01234111
Wijeratna MD, Ek ET, Hoy GA, Chehata A (2015) Use of a bone graft drill harvester to create the fenestration during arthroscopic Ulnohumeral arthroplasty. Arthrosc Tech 4(5):e503-505. https://doi.org/10.1016/j.eats.2015.05.002
Hungerer S, Wipf F, von Oldenburg G, Augat P, Penzkofer R (2014) Complex distal humerus fractures-comparison of polyaxial locking and nonlocking screw configurations-a preliminary biomechanical study. J Orthop Trauma 28(3):130–136
Morrey BF (2008) Morrey’s the elbow and its disorders, 4th edn. Saunders Elsevier, Philadelphia
Papatheodorou LK, Baratz ME, Sotereanos DG (2013) Elbow arthritis: current concepts. J Hand Surg Am 38(3):605–613. https://doi.org/10.1016/j.jhsa.2012.12.037
Gallo RA, Payatakes A, Sotereanos DG (2008) Surgical options for the arthritic elbow. J Hand Surg Am 33(5):746–759. https://doi.org/10.1016/j.jhsa.2007.12.022
Kokkalis ZT, Schmidt CC, Sotereanos DG (2009) Elbow arthritis: current concepts. J Hand Surg Am 34(4):761–768. https://doi.org/10.1016/j.jhsa.2009.02.019
Nagpal S, Jain N, Sanyal S (2012) Stress concentration and its mitigation techniques in flat plate with singularities: a critical review. Eng J 16(1):1–15. https://doi.org/10.4186/ej.2012.16.1.1
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Chih-Kai Hong, Ming-Long Yeh, I-Ming Jou, Cheng-Li Lin, Chih-Hsun Chang, Chih-Hung Chang, and Wei-Ren Su declare that they have no conflict of interest.
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Hong, CK., Yeh, ML., Jou, IM. et al. The effect of humeral-fenestration diameter in Outerbridge–Kashiwagi arthroplasty on failure load of the distal humerus: a cadaveric biomechanical study. Arch Orthop Trauma Surg 138, 623–628 (2018). https://doi.org/10.1007/s00402-018-2876-2
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DOI: https://doi.org/10.1007/s00402-018-2876-2