Orthobullets Review: Elbow Stiffness Treatment

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Questions and Answers

What is the next best step in treatment for posttraumatic elbow stiffness?

Static or dynamic progressive elbow splinting with a turnbuckle

What is the radiographic hallmark of Paget's disease?

Enlargement of a vertebral body

Which type of total elbow arthroplasty (TEA) is expected to have the longest implant survivorship in patients?

Semiconstrained TEA in RA patients

What does the winking owl sign indicate?

Absent pedicle sign Signup and view all the answers

What is the most common site of subsequent pathologic fracture when lung cancer metastasizes to bone?

Proximal femur Signup and view all the answers

What is the power of a study?

The likelihood of finding a statistically significant difference between two groups if one truly exists Signup and view all the answers

What does effect size estimate?

Magnitude of the difference in the means between two groups Signup and view all the answers

What is variance?

Average of the squares of each value's deviation from the mean Signup and view all the answers

What is a confidence interval?

Range within which it is probable that the true value lies for the population Signup and view all the answers

What is a P value?

Probability of obtaining a result equal to or more extreme than what was observed assuming the null hypothesis is true Signup and view all the answers

What does treatment for osteosarcoma generally include?

Neoadjuvant chemotherapy, surgical excision with reconstruction, and adjuvant chemotherapy Signup and view all the answers

What does 175 cc of fluid injected into the knee joint predict?

99% of inferolateral traumatic arthrotomies of the knee Signup and view all the answers

When is the medial ulnar collateral ligament subjected to the greatest tensile stress?

During the late cocking/early acceleration phase of throwing Signup and view all the answers

What conditions are associated with fibular hemimelia?

Femoral shortening, PFFD, developmental dysplasia of the hip (DDH), coxa vara, hypoplastic lateral femoral condyle/genu valgum, absent/deficient cruciates Signup and view all the answers

What are the types of tibial bowing?

Anterior-Lateral, Anterior-Medial, Posterior-Medial Signup and view all the answers

Study Notes

Post-Traumatic Elbow Stiffness

Objective of treatment: Restore functional elbow motion (30° to 130°).
Non-operative treatment is first-line; includes aggressive physical therapy.
Static or dynamic progressive elbow splinting with a turnbuckle shows superior functional outcomes.
Treatment duration typically spans 6 to 12 months.
Surgical intervention is considered if non-operative therapy fails.

Paget’s Disease

Radiographic hallmark: Enlargement of the vertebral body.
Characterized by diffuse thickening of cortical bone.
Imaging shows low T1 and high T2 signal alteration of the bone while preserving bone marrow.
Thickened cortex is termed "picture frame vertebral body."

Total Elbow Arthroplasty (TEA) Survivorship

Semiconstrained TEA is associated with longest implant survivorship in patients with rheumatoid arthritis (RA).

Winking Owl Sign

Absent pedicle sign indicative of spinal pathologies.
Associated conditions include spinal metastases, intraspinal malignancies, tuberculosis, and other infections.
Rarely, it may be related to primary bone lesions, such as lymphoma.

Pathologic Fractures from Lung Cancer Metastases

Most common skeletal site for metastatic disease: Spine.
Proximal femur is the most frequent site for pathologic fractures secondary to bone metastases.
Vulnerability of the proximal femur stems from stress risers making it prone to fracture.

Study Power

Defined as the likelihood of detecting a statistically significant difference between two groups, given a real difference exists.
Power formula: power = 1 - β; with adequate power considered to be greater than 80%.
Power analysis determines minimum patient numbers required for clinically significant outcomes; should be established before the study begins.

Effect Size

Represents the estimated magnitude of difference in means between two groups.

Variance

The average of the squared deviations of each value from the mean, indicating data dispersion.

Confidence Interval

A probable range within which the true population value lies.

P Value

Denotes the probability of obtaining results as extreme or more than observed if the null hypothesis is true.

Osteosarcoma Treatment

Recommended treatment encompasses neoadjuvant chemotherapy, surgical excision with reconstruction, and adjuvant chemotherapy.

Knee Joint Fluid Injection

Injection of 175 cc of fluid into the knee predicts a 99% accuracy for inferolateral traumatic arthrotomies.

Medial Ulnar Collateral Ligament Stress

Greatest tensile stress occurs during the late cocking to early acceleration phases of throwing.

Fibular Hemimelia Associations

Hip Conditions:
- Most common is femoral shortening (50% incidence).
- Others include PFFD and developmental dysplasia of the hip (DDH), and coxa vara.
Knee Conditions:
- Hypoplastic lateral femoral condyle, genu valgum, and absent or deficient cruciate ligaments.
Tibia:
- Characterized by anterior medial bowing (apex anterior and medial).
Foot and Ankle Issues:
- Includes ball and socket ankle, tarsal coalition (50% incidence), and absent lateral rays.

Types of Tibial Bowing

Anterior-Lateral & Anterior-Medial:
- Often associated with neurofibromatosis type I (diaphyseal pseudoarthrosis) and fibular hemimelia.
Posterior-Medial:
- Springs from physiological variations.

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Description

Test your knowledge on the management of post-traumatic elbow stiffness related to radial head fractures. This quiz focuses on clinical diagnosis and treatment options following injury. Perfect for medical professionals and students preparing for exams.