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Arthritis is a condition that is likely to affect many of us in our lifetime, especially as we get older. A Versus Arthritis study from 2023 reports that there are roughly 10 million people in the UK living with osteoarthritis, with an estimated 350,000 being diagnosed with the condition each year. Given that osteoarthritis is more problematic when it affects joints that see regular use, let’s examine the treatment options available for osteoarthritis of the hand and wrist.

Defining wrist osteoarthritis

Osteoarthritis in the wrist causes the soft tissue lining the joints to break down. When this happens, the cartilage can no longer serve its protective function and the two ends of bone begin to rub together (distal radius/ulna and scaphoid/lunate/triquetral). The result can be pain and stiffness at the affected area, along with potential loss of movement and bone deformities. Arthritis in any form is also one of the main contributing factors in upper and lower extremity fractures, such as a distal radius fracture. Read ‘Common causes of upper extremity fractures’ for more information.

What’s the difference between arthritis and osteoarthritis?

Osteoarthritis is a degenerative form of arthritis which is caused by wear and tear from excessive use of the affected joints. It is also the most common type of arthritis. While there are many more types of arthritis that can affect the bones in the hand and wrist, the other common types include Rheumatoid arthritis and Psoriatic arthritis.

What areas does hand osteoarthritis commonly affect?

Although osteoarthritis is common in the hand due to the number of different bones, it rarely affects all parts of the hand and wrist equally. Instead, it most often affects the following joints in the hand:

• The distal interphalangeal joint (DIP joint).
• The proximal interphalangeal joint (PIP joint).
• The trapeziometacarpal joint (TMC joint).
• The carpometacarpal joint (CMC joint).
• The tri-scaphoid joint (STT joint).

Treatment options for osteoarthritis of the hand and wrist

At the time of writing, it is still unclear what the root cause of osteoarthritis is. However, medical professionals like LEDA are aware of the factors that can make an individual more susceptible to hand and wrist osteoarthritis. This includes a patient’s age, weight, injuries, hobbies, sex, genetics, and any underlying joint health problems. Fortunately, there are many treatment options both orthopaedic and non-orthopaedic that surgeons may employ in cases of osteoarthritis.

MAIA CMCJ Replacement

One of the key areas in the hand that is susceptible to osteoarthritis are the carpometacarpal and trapeziometacarpal joint at the base of the thumb where it meets the wrist. This orthopaedic device from Group Lépine is a surgical treatment designed to restore motion and provide stability to the thumb. It consisted of a cup, neck, and stem which, when implanted, connect the two ends of bone at the joint. This is an osteotomy procedure as small pieces of bone at the joint must be removed to allow for the implantation of the MAIA device, which serves as a thumb joint replacement.

INCA STT Prosthesis

In cases of scaphotrapeziotrapezoid osteoarthritis, surgeons can use the INCA STT prosthesis for lasting treatment. The implant has been designed anatomically to make sure it fits perfectly with the anatomy of the patient’s joint surfaces. Stability is then encouraged through the stem shape, thereby requiring standard instrumentation to complete the procedure. This device can also achieve cementless fixation due to its double coating of porous titanium.

IMPLATE Wrist Arthrodesis Nails

The IMPLATE system from Skeletal Dynamics is intended for intramedullary wrist arthrodesis to restore strength and dexterity to the hand and wrist. This is an ideal treatment following a range of arthritis symptoms, including rheumatoid deformities, carpal instability, unremitting wrist pain, post septic arthritis, and more. A wrist arthrodesis plate such as this is effective at achieving. While the surgical technique for this implant contains more steps than most other hand and wrist orthopaedic devices, it can be the best option for patient quality of life. As well as osteoarthritis symptoms, IMPLATE can be used to treat trauma injuries (fractures) and congenital deformities.

Physical therapies

If it’s deemed the best course of action, there are a range of non-invasive treatment options for hand and wrist arthritis in the form of hand osteoarthritis exercises. These should focus on gentle movements that improve range of motion and help alleviate arthritis symptoms. Although the exact type of exercises prescribed will vary depending on the joints affected by the condition in that patient.

Orthopaedic devices for the treatment of osteoarthritis

LEDA Orthopaedics is a leading UK orthopaedic distributor committed to helping healthcare professionals deliver great patient outcomes. To this end, we work with suppliers all over the world with a focus on both the upper and lower extremities. One of the key areas these treatments target is osteoarthritis in the hand and wrist, as we know how many people it affects. Contact us to discuss our range of treatment options. Equally, if you are looking for one of our suppliers, we’re always happy to pass details over and establish working relationships.

Osteoarthritis is a common form of arthritis that affects millions of people in the UK. It can affect a range of bones in the body but tends to affect bones at key joint locations most heavily. As a result, osteoarthritis in the hand is very common due to the number of the bones and the frequent use that these joints see. This article discusses the main points around basal thumb osteoarthritis, including possible complications and treatment options.

What are the symptoms of thumb osteoarthritis?

The basal thumb joint is located where the bottom metacarpal bone of the thumb meets the trapezium bone in the wrist. This joint is vital for the use of the thumb as it’s involved in any movement of the digit. Osteoarthritis affecting the basal thumb joint can manifest in any of the following symptoms:

• Diminished ability to twist, bend, grip, or pinch using the thumb.
• Pain and swelling localised to the thumb and the surrounding area.
• Loss of strength and movement that extends to the wrist.
• In extreme cases, a bump at the base of the thumb caused by hyperextension of the MCP joint.

What causes basal thumb osteoarthritis?

At the time of writing, there is not a consensus on what causes arthritis in all its forms. However, there are a number of factors which are recognised as being contributary to the development and worsening of the condition. For osteoarthritis that affects the base of the thumb, this includes:

• Patient age.
• Height and weight (body mass index).
• Jobs and hobbies (repetitive stress).
• Certain metabolic diseases.
• Biological sex.
• Recent injuries or those with lasting repercussions.

Healthcare professionals should consider these factors when assessing whether a patient’s symptoms could be linked to osteoarthritis. This is also necessary to judge the severity of the condition and schedule appropriate treatments. Depending on the person, certain treatments could carry significantly more risk than they would otherwise. One of the most impactful effects of osteoarthritis is that it can be reduce bone stock and weaken joints. This leaves the patient more susceptible to bone injuries such as fractures, which can make it difficult to conduct osteotomies.

Treatment options for basal thumb osteoarthritis

As we’ve established, osteoarthritis in the thumb can cause significant disruption to someone’s everyday life due to the range of tasks we use our thumbs to complete on a daily basis. The following treatments are some of the options available to combat the effects of osteoarthritis in the thumb.

MAÏA Carpometacarpal Prosthesis

Joint replacement surgery can produce long lasting positive outcomes for patients. Through the removal of some or all of the thumb joint, an artificial implant can be inserted to restore motion and stabilise the thumb at the base. The MAÏA prosthesis from Group Lépine consists of a trapezial cup, offset neck, and metacarpal stem. Its dual mobility design is effective at reducing the chance of dislocation and ensuring stability. This system also comes with modern cannulated instrumentation to aid in surgical application.

Arthrodesis

Pain can be relieved by fusing joints in the thumb together. This can be achieved through the precise shaping of the trapezium and the hollowing of the metacarpal bone. Once the bone ends fit flush against each other, metal pins are used to hold the bones in place and allow them to knit together. It should be noted that this has the potential to be a lengthy open surgical procedure and so carries a relatively high complication rate. Although expertise and the use of leading arthrodesis screw and nail technology can reduce risk.

Movement restrictions

Efforts to limit movement and maintain positioning of the thumb can allow joints to repair themselves. A common way to do this, whilst also providing support and protection to the joint, is through the use of a hand or wrist splint. Although a medical professional may have to set the bones in the correct position first. They can also recommend exercises to help strengthen joints and improve function.

However, this treatment option may not be viable for every instance of osteoarthritis. For instance, a complex fracture could prevent blood flow from reaching the basal thumb joint thereby not allowing the bones to heal and making a splint an ineffective treatment.

Your UK orthopaedic distributor         

If you’re looking for a trusted third party to supply your clinic or hospital with arthritis implants, LEDA Orthopaedics can help. Our company is in collaboration with leading global suppliers of specialist orthopaedic implants for the treatment of osteoarthritis. Contact us and a member of our team will be happy to discuss how your needs in healthcare provision can be met.

An osteotomy of the ulna designed to shorten the bone can have many long-term positive patient outcomes. One of these is the removal of wrist pain and the restoration of a full range of movement in the joints of the hand and wrist. Surgeons should be aware of the pros and cons of an ulna shortening procedure so they can accurately advise patients on the treatment options which are best for them.

Causes of wrist pain in adults

Ongoing wrist pain that doesn’t go away can have a significant impact on someone’s quality of life. This is because the wrist typically flexes, undergoes strain, and carries weight on a regular basis. Pain in the wrist can also directly impact any actions that involve precise hand movements. The following are some of the most common causes of wrist pain in adults:

• Fracture or sprain due to a sudden impact.
• Repetitive stress or other long-term conditions such as carpal tunnel or arthritis.
• Ulnar impaction syndrome. This causes the ulna to be longer than the radius, resulting in occasional contact with some of the smaller bones in the wrist.

In most cases, wrist pain is accompanied by swelling, redness, or loss of movement and grip strength which can make it easier to diagnose. With ulna wrist pain specifically, a clicking sound can also accompany movement as the bones come into contact.

What is the process of ulna shortening?

As the name suggests, the purpose of ulnar shortening osteotomy is to reduce the length of the ulna. This can result in a tightening of the triangular fibrocartilage complex (TFCC), interosseous membrane, and ulnocarpal ligaments. These outcomes are desirable as they can help remove the risk of the ulna interfering in the wrist joint in cases of ulnar impaction syndrome. This procedure can also reduce the amount of load that goes through the ulnar side of the wrist compared to the radius side, thereby reducing the likelihood of wrist pain returning in the future.

The first step in an ulna shortening procedure is to check that it is safe to conduct. Once all the necessary safety measures have been taken and proper instrumentation is prepared, it can follow these broad steps:

• An incision is made to gain access to the ulna. Then a predetermined section of bone is removed to shorten it. This osteotomy can be done at either the distal or proximal end of the ulna.
• The two pieces of bone must then be pulled together, ensuring the ulna is now in a favourable position.
• Lastly, a forearm and wrist plating implant and orthopaedic screws must be applied to fix the bones in position. If the patient has suffered a fracture, this plate will be inserted at the fracture site. Otherwise, it will be positioned to provide maximum stability to the arm and wrist.

For more detail on the surgical procedure of ulna shortening, see Skeletal Dynamics’ Ulna Shortening System or the surgical procedure for the FREEFIX Forearm Plating System.

Ulna shortening as a treatment for wrist pain

An ulna shortening procedure should only be sought once more conservative treatment options for wrist pain have been exhausted. Examples include physical therapy or changing habits. When these fail, it will usually confirm the presence of an ulna bone that is pressing excessively on the wrist. The ulna shortening procedure is then more likely to result in long-term relief from wrist pain.

Specialised orthopaedic systems such as the FREEFIX Ulnar Shortening System give surgeons the flexibility to address patient specific pathologies. This device comes with options for both proximal and distal osteotomies, as well as accommodating compression screws and locking screws. Once internal fixation has been achieved, the ulna shortening plate maintains rotational stability in the forearm. For a more dedicated fracture reduction system, there’s the FREEFIX Forearm Plating System. This can be used to repair midshaft fractures of either the ulna or radius.

Orthopaedic devices for ulna shortening

LEDA are proud to work in collaboration with some of the leading orthopaedic suppliers across the globe in order to facilitate procedures such as ulna shortening. It’s one of our goals to bring innovations in orthopaedic surgery to the forefront of general medical use. As such, we don’t just supply devices for use in the upper extremities, we also distribute a range of implants for the treatment of lower extremity injuries complete with specialist instrumentation. This includes treatments for highly complex injuries, such as a pelvic fracture. Contact a member of the LEDA team today to get started.

Fractures in the forearm can be highly detrimental to patient quality of life as it impacts the ability to complete everyday tasks. As healthcare professionals we must therefore continue to provide effective treatment that will get the best results for the patients in our care. This means taking into account the severity of the fracture, patient anatomy, and anything in their medical history that could be a concern. In this article, we explain the various ways in which forearm fractures can be fixed.

Diagnosing a forearm fracture

A fracture in the forearm can affect the radius bone, the ulna bone, or both. Additionally, the nature and location of the fracture will need to be established. This is because different bone fractures require different approaches to treatment. For instance, a complex radial head fracture will require more extensive work to fix than a simple hairline fracture towards the middle of the bone. We discuss in greater detail the different methods for fixing a forearm fracture below.

The recent research ‘Insights and trends review: the role of three-dimensional technology in upper extremity surgery’ attests to the importance of 3-D technology in upper limb procedures. Detailed internal mapping images like those produced by L3D Osteotomy Planning technology gives surgeons the ability to accurately predetermine many key actions that will be taken in the procedure. This includes the location of incisions, which cuts need to be made, and the instrumentation that’s best suited to the procedure. The guides that are created specific to the patient’s anatomy, greatly increasing accuracy.

Ways to fix a forearm fracture

When a patient comes in exhibiting signs of a forearm fracture and once it has been assessed, practitioners must then construct a treatment plan. If this includes surgery, L3D Osteotomy Planning technology is now available to help simulate surgical solutions for upper extremity fractures. By creating detailed and accurate models of the patient’s anatomy, surgeons are able to plan procedures holistically. As mentioned, the treatment used will depend on a range of factors which the surgeon must consider.

Open reduction and internal fixation (ORIF)

Complex forearm fractures typically require a surgical procedure where the bone is accessed directly through an opening made in the skin. Hardware is then implanted at the fracture site to stabilise the two ends of the bone and maintain proper alignment for healing. The FREEFIX Forearm Plating System has been designed to mimic callus formations and strengthen the forearm bones following fixation. Medical professionals can use this product for dynamic compression on both the radius and ulna. Another option is the GEMINUS Distal Radius Volar Plate. This system is designed for the added fixation of marginal fragments and the protection of tendons.

In rare cases, external fixation may also be used to achieve healing in the bones of the forearm. This is typically only recommended in instances where internal devices are hindered by the presence of swelling or other soft tissue damage.

Casting

A healthcare professional may be able to use closed reduction to manipulate bones without the use of surgery. Achieving alignment in this way is typically only possible in cases where there hasn’t been significant bone displacement. A medical grade cast or elbow splint such as the Jake Design eXo Elbow Splint will then need to be worn for a number of weeks to promote healing.

Intramedullary nailing

Metal rods are inserted into the fractured bone to provide stability at the fracture site. This is not regularly used unless the fracture has occurred in the shaft of the radius or ulna.

Physical therapy

Depending on the nature and severity of the injury, non-surgical treatment options can be available. Various exercises may be recommended to restore range of motion to the forearm and allow the limb to return to full usefulness. A healthcare professional will advise the patient on when exercises should start and which ones they should do to help aid in recovery. Each patient’s rehabilitation process will differ based on the type of forearm fracture they received, as well as any underlying health conditions.

European and UK orthopaedics distributor

LEDA Orthopaedics stocks a range of instrumentation and systems for the treatment of fractures across the body. This includes fractures to the lower extremities, clavicle, hand, and pelvis. All the suppliers we work with are pioneers in the field of orthopaedics, implementing technologies that improve efficiency and delivery better results. Contact us to speak with a member of our team. We pride ourselves on being a trusted provider of niche trauma implants and innovative prostheses.

Compression screws are an important piece of instrumentation used in a wide range of orthopaedic surgeries. They are designed to treat bone fractures by compressing the fracture and allowing for internal fixation through the use of orthopaedic plates. Developments in compression screw technology therefore directly affect the orthopaedics industry, leading to benefits for both surgeons and patients.

In this blog, you will find information on the latest developments in compression screw technology and the benefits this brings for the orthopaedics industry.

History of the compression screw

Screws were first used by healthcare professionals as a pioneering treatment in the field of orthodontics. It was present in devices that resembled braces, which would rotate teeth and adjust the layout of the mouth to address dental issues such as overcrowding. Orthopaedic devices for open reduction and internal fixation started to see use towards the end of the 18^th century, although we don’t know exactly how frequent or successful these procedures were. The first detailed account of internal fixation using screws and plates came in 1858. However, at this stage there were still many improvements to be made to the screws to make fixations more stable and risk-free.

It was in the 20^th century that many technological advancements were made in compression screws. Developments were made steadily to improve implantation efficiency and patient experience, as well as to reduce risk. In most cases, fractures that are compressed properly lead to quicker recovery times and bones to heal in the correct way. Modern compression screws also allow orthopaedic devices to be removed more easily in instances where this course of action is recommended. Compression screw technology has only been around for the last 100 or so years. As such, there is lots of scope for further developments in this area.

Surgical uses of compression screws

Compression screws perform a vital role in orthopaedic surgery by aiding in bone fixation and securing orthopaedic devices. If the compression screws don’t function properly, it can compromise the effectiveness of the surgery and the patient is likely to experience potentially significant complications. Screws are typically inserted at multiple places around the fracture site to prevent the bone ends from moving, thereby allowing the bone to heal naturally.

There are a wide range of compression screw types employed by medical professionals today. These can differ based on design, features, materials, and finishes, with each typically being available in a range of sizes. Certain types of compression screw will be more suitable depending on the patient’s anatomy and the procedure being performed. The most common types of orthopaedic screws include:

• Arthrodesis screw.
• Cannulated screw.
• Partially or fully threaded screw.
• Cancellous screw.
• Cortical screw.
• Acutrak screw.
• Headless compression screw.

New compression screw technologies

In recent years, orthopaedic screw technology has advanced to provide surgical experts with a wider range of options. As a result, healthcare professionals have greater ability to treat fractures as they possess instrumentation specific to the trauma suffered. This has come in the form of a variety of locking options and multidirectional screws. Across different fracture surgeries, this has led to screws that instil angular stability and hold firm in peri-articular fractures. Modern designs also allow for axial movement to increase fixation effectiveness, meld with patient anatomy, and reduce risk.

Compression screws are provided in most of the systems that LEDA supplies for fixation of the hand and wrist, and elbow and shoulder. However, surgeons can gain access to a range of orthopaedic screws with the REDUCT® Headless Compression Screw System. As with all the devices available on our website, we only choose to distribute orthopaedic products that utilise market leading technologies. As such, the screws possess the following attributes:

• Headless design – allows for ease of screw implantation in areas where articulation occurs, thereby reducing risk of soft tissue damage and irritation.
• Variable thread pitch – leads to gradual compression of the two fragments as the wider threat pitch penetrates the bone faster than the narrower threads.
• Cannulated – facilitates more accurate screw insertion.
• Specific materials – modern compression screws can be made from a range of materials, depending on their intended use. Common examples include Stainless Steel, Titanium, and Cobalt Chromium alloy.
• Cutting flutes – forward facing cutting flutes for improved insertion.

It should be noted that compression screws can be provided both sterile and non-sterile. This will be stated in the system’s commercial documents, which therefore means certain devices are not recommended if your facility does not possess the means to sterilise components on site. This is important, as assessed by this recent clinical paper, the cost of care in the operating room can be influenced by the relevance of orthopaedic products.

Access surgical compression screws

At LEDA Orthopaedics, we take great pride in being a leading UK orthopaedic distributor. This means we are constantly aware of innovations being made that will affect orthopaedic implants, such as those in compression screw technology. We also like to take an innovative approach and work with suppliers who are working with products at the forefront of the industry. This means we are able to provide specialist orthopaedic systems and appropriate instrumentation together at short notice. Our expert team are on hand for your needs, so don’t hesitate to contact us to arrange a meeting or if you have any further questions.

Radial head fractures are a common type of intra-articular elbow fracture that are typically caused by falling onto your arm when it is outstretched. There are three types of radial head fractures and the type of fracture you have can influence the best treatment option for your elbow. In this guide, we’ll be exploring what the different types of radial head fractures are and other key information you need to know about them.

What is the radial head?

The radial head is the disc shaped part of your radius that sits at the top of the bone between where the radius meets the elbow. Fractures of the radial head are some of the most common types of elbow trauma injuries as it is a natural reaction to put your hands out when you fall.

When doing so, the force from the fall can travel up the forearm and dislocate your elbow and fracture the radial head. Many acute elbow injuries involve a radial head fracture and they are also commonly associated with elbow dislocations.

What are the symptoms of a radial head fracture?

If you think you might have fractured your radial head, you should check for the following symptoms:

• Inflammation in the elbow joint
• Discomfort on the outer side of the elbow
• Difficulty and pain when bending or straightening the elbow
• Struggling to turn or a complete inability to turn your forearm, in either direction

The types of radial head fractures and how to treat them

Types of fractures are categorised by how far out of place the bones are and the number of fragments the fracture has caused. These factors will also dictate how the fracture will be treated. Clinical studies have shown that radial head prostheses that align with a patient’s forearm axis of rotation are effective in arthroplasty procedures.

Type 1 fractures

If you have a type 1 fracture, the bone pieces are likely still together with no displacement and typically there are only small cracks in the bone. This type of fracture isn’t always visible initially on an X-ray but is more likely to be seen if the X-ray is taken roughly 3 weeks after the injury. Surgical treatment probably won’t be required, with many type 1 fractures being resolved through the use of a splint or sling for a relatively short period.

Along with exercises to gradually increase elbow and wrist movement, each case will vary, and healing will occur at different stages depending on how much pain the fracture is causing. If you try too much movement too quickly, the bones can move and become displaced, so a lot of care needs to be taken to ensure safe and correct recovery.

Type 2 fractures

Type 2 fractures involve a slight displacement and a larger piece of bone being broken. Depending on how displaced the elbow is, treatment can be similar to a type 1 fracture and involves wearing a sling or splint for a few weeks, as well as some exercises to improve range of motion. A small surgical procedure might be needed to remove bone fragments if they could cause long-term problems or restrict normal elbow movement.

If the large fragment is out of place, the first treatment approach will be to hold the bones together using screws and/or a plate. If this cannot be done, the broken pieces of the radial head will need to be removed. Any other soft tissue injuries like a torn ligament will be corrected where necessary.

Type 3 fractures

Type 3 fractures are the most serious type of radial head fracture and will have several broken bone pieces that won’t be able to be fixed to heal properly. Most type 3 fractures of the radial head also have substantial damage to the elbow joint and surrounding ligaments. Surgery will be a must for this type of fracture and an artificial replacement radial head can be required if the damage is severe enough to warrant the removal the radial head. To avoid stiffness and aid in recovery, early movement to stretch and bend the elbow will be necessary.

The ALIGN® Radial Head Replacement system has many features that make it ideal for use in radial head replacement surgery. For example, its digital stem flutes are proven to be effective at granting rotational stability and the monoblock can be customised to fit with patient anatomy. Contact us if you’d like more information regarding the ALIGN system.

Recovering from a radial head fracture

If your radial head fracture requires surgery to repair or replace, you won’t be able to put any weight on the arm or lift heavy objects for around 6 to 12 weeks. You might need a splint of cast for some of your recovery depending on the pattern of the fracture and other elbow injuries. The eXo Elbow Splint allows for small movement while keeping the arm stable for healing. Also, no matter what type of fracture you have, some exercises will be prescribed to help restore a better range of movement to the elbow and build up the strength of the joint. This will support your healing and ensure your elbow is functioning as it should with no pain or discomfort before you fully resume your normal activities. Patient recovery times will vary depending on a variety of factors such as age and underlying health conditions.

Conclusion

Hopefully, this guide has given you a greater insight into the different types of radial head fractures and the treatment options available. As a specialist orthopaedic distributor, LEDA Orthopaedics provide innovative and beneficial medical solutions to orthopaedic surgeons. This includes the ALIGN radial head system and PROTEAN Fragment Plates from Skeletal Dynamics, among others. Contact us today to learn more about our elbow and shoulder products.

A chronic elbow dislocation is a dislocation in the elbow joint that hasn’t healed and stays out of place for an extended period of time (normally 3 weeks or longer). If the condition is chronic, the elbow is loose and often feels like it is going to slip out of alignment. Also, chronic dislocation can mean a successful closed reduction is prevented by natural changes to the bones and soft tissue that occurs during that time. In this article, we’ll be looking at the causes of chronic elbow dislocation as well as how it can be repaired.

What is an elbow dislocation?

The elbow is the second most commonly dislocated joint, it occurs when the surfaces of the joint are forced apart. It takes a significant amount of force to dislocate the elbow, which oftentimes is enough to also cause the bone to fracture at the same time. This is why these injuries can occur and require treatment simultaneously. Elbow dislocations can be full or partial, the latter is known as a subluxation.

The causes of elbow dislocation

Given the force that is needed to create an elbow dislocation, this type of injury is mostly the result of some form of trauma. Typically, they occur from a fall onto an outstretched hand and arm. The level of force is sent rushing through the hand and forearm to the elbow as it hits the ground and pushes the elbow out of its socket.

Many elbow dislocations in adults happen during sports activities such as cycling, gymnastics, rugby, and football. Intense, high impact sports build up the type of force that it takes to cause elbow trauma injuries like dislocations and fractures.

Chronic elbow dislocation

Chronic elbow dislocation is typically associated with intra-articular fractures or generalised ligament laxity. It is a disabling condition that causes limitations in the elbow function and a high level of instability. If the elbow dislocation is chronic, it is likely to due to a dislocation that has been neglected, an incomplete examination and assessment of the instability in the elbow, or inadequate treatment has been given which has not suitably resolved the dislocation. When a treating a dislocation, if the elbow is not reduced, not only can this result in the condition becoming chronic, but it also presents the risk of arthritis developing in the future.

Treatment for elbow dislocations

Closed reduction surgery with an elbow splint is the main form of treatment for elbow dislocations and in many cases is the most effective. As part of this surgery and other beneficial surgeries for elbow dislocations like internal fixation and joint stabilisation, orthopaedic trauma surgeons often use new technologies and products to offer the best possible recovery and outcomes for patients. A good example of this is the Distal Elbow Set created by world-renowned medical device company Skeletal Dynamics.

The Distal Elbow Set includes several systems which can be bought separately or all together depending on the requirements of the orthopaedic surgical clinic. Each system within the set has specific functions to support healing and improve stability once the joint is back in the right place. They include:

• IJS Elbow – internal joint stabiliser
• ALIGN – radial head replacement
• PUP – proximal ulna plate
• PROTEAN – coronoid and radial head plates
• REDUCT – headless compression screws

Conclusion

As we have seen in this guide, it’s extremely important that any elbow dislocations are treated as soon as possible, with a thorough and accurate assessment of the dislocation completed to prevent it from becoming chronic. Forward-thinking and modern solutions like the Distal Elbow Set are the ideal tools for orthopaedic surgeons to solve the clinical challenges they face, and ensure their patients get the best possible treatment for their elbow dislocations. For more information on the Distal Elbow Set or any of our other products, contact us at LEDA Orthopaedics today.

Fractures to the upper extremities affect many people every year. Healthcare facilities are therefore likely to see patients with upper extremity fractures on a regular basis. As such, it is of the utmost importance that clinicians have access to the right trauma implants and prostheses, should they be need to treat these injuries. This enables treatment to be provided for fractures, which can vary drastically in nature, both in terms of severity and the area affected.

Below we break down the common causes of upper extremity fractures, along with the people most likely to be affected by the injury and how they can recognise their symptoms.

What areas are included in the upper extremities?

In healthcare, the upper extremity refers to the four main sections that make up the arm – the hand, forearm, upper arm, and shoulder. All these parts work in conjunction with each other to allow a huge range of motion. This includes bending, rotation, and extending. Additionally, due to the density of muscles surrounding this limb, the upper extremity is crucial to completing many daily tasks and recreational activities.

There are 30 total bones in the arm, along with many nerve endings, blood vessels, cartilage, and muscles. Fractures to the bones of the upper extremity can not only compromise limb functionality, but also cause further damage to surrounding soft tissues. This can have negative consequences for patients, such as ongoing loss of movement, joint instability, and the early onset of arthritis. Our suppliers offer a range of products which enable surgeons to provide the best quality of care to their patients. The Distal Elbow Set from Skeletal Dynamics for instance, contains five different specialised systems designed for use on a variety of upper extremity bone fractures.

Types of upper extremity fracture

There are a massive range of potential fractures that can occur in the upper extremity. This is because every bone in the arm can experience a fracture, which each come with potential side effects depending on the surrounding tissue, and the functionality of the affected bone. For instance, a thumb fracture would impact a patient’s ability grip things, whereas a radial head fracture is likely to impact their ability to bend the arm at the elbow.

Fractures can also differ based on how the bone breaks, what impact it has, and the displacement of the fracture. These types include:

• Intra-articular fracture – the break extends from the surface of the bone into the joint.
• Segmental fracture – the bone fractures in two places, leaving a section of bone unattached.
• Buckle fracture – an incomplete fracture commonly affecting the radius and ulna bones in children. It can cause the wrist joint to be impeded.
• Displaced fracture – breaks in the bone causes it to become bent.
• Non-displaced fracture – the bone breaks but does not cause it to change its orientation.
• Comminuted fracture – the bone breaks in at least three separate places, with a high risk of fragments being present at the site of the fracture.
• Transverse fracture – a straight line fracture that goes across the bone.
• Compression fracture – the bone is subject to crushing forces that cause it to deform outward, resulting in a wider appearance.
• Open fracture – the bone has broken completely, with one or both of the free ends breaking through the skin.

What are the causes of upper extremity fractures?

Upper extremity fractures are most often caused by high trauma events that cause significant force to be exerted on the body. Typically, the greater the force involved in the event, the greater the severity of the fracture that results. For example, a high speed traffic collision is likely to result in a complex comminuted fracture, or a fracture that’s accompanied by dislocation of the affected joint. A recent clinical study demonstrates how developments in 3-D technology is improving pre-surgical planning for upper extremity fractures.

Minor and middling severity upper extremity fractures are often caused by someone having an uncontrolled fall onto an outstretched hand. The sudden force travels up the length of the arm, placing additional strain on joints at the wrist, elbow, and/or shoulder. When the bone cannot withstand the pressure, a fracture can occur. Bones that are twisted at the time of the impact are more susceptible to fracturing. Upper extremity fractures can also be caused by stress placed on bones from overuse. This is common in athletes who are required to complete repetitive arm movements, or those involved in contact sports. Plating systems designed to treat fractures to a specific bodily area, such as the Initial C™ Kits from Newclip Technics, have been proven to improve the rate of bone union through internal fixation.

Patients suffering from an upper extremity fracture are likely to experience the following symptoms:

• Stiffness and difficulty of movement in the affected area. If the fracture is positioned at the site of a joint, this can prevent it from being fully extended.
• Pain and swelling at the site of the fracture.
• Loss of strength accompanied by numbness.
• Pain when twisting the arm.

Modern solutions for upper extremity fractures

LEDA Orthopaedics is proud to be able to support surgeons by providing a range of treatment options for upper extremity fractures. Our knowledge allows us to select suppliers based on the link between trauma and orthopaedics that leads to a modern solution. We work with suppliers of internal fixation devices, external stabilisation solutions, bone replacement implants, and more. We’re one of the UK’s top distributors of medical devices with a focus on innovation and patient/practitioner experience. Don’t hesitate to contact us if you have any questions about product specifications, instructions for use, or another query.

Radial head fractures are among some of the most common elbow injuries experienced by people of all ages. Located between the upper arm and the forearm, the radial head forms an important part of the elbow joint. Its longitudinal rotation allows us to move the forearm inwards and outwards, which is essential to many activities and everyday tasks.

This blog contains all the information you need to know to recognise a radial head fracture, along with details on why it’s important to become aware of elbow fractures and get treatment early.

What can cause a radial head fracture?

The radial head rotates inside the radial-capitellar joint to allow for a range of movement in the forearm. The joint is surrounded by a mass of ligaments and a thick capsule. Fractures to this bone can therefore result in an injury to other areas of the joint, for example a soft tissue injury to the elbow.

The primary cause of a radial head fracture is due to excessive force being exerted on the arm. The most common example being through a fall. When you put out your arm to cushion yourself from a fall, the impact travels up the arm from the wrist to the shoulder. As the force progresses it can cause bones to break under the increased weight, resulting in fractures. The radial head is one of the most common places a fracture can occur. Forces that directly impact the elbow, such as from a vehicle collision, can also cause radial head fractures. In the case of severe injuries like this, the ALIGN® Radial Head Replacement system may be recommended for use.

What are the potential complications of a radial head fracture?

Radial head fractures are classified according to the Mason classification, which separates different types of fracture by their severity. Each fracture type therefore has different potential complications associated with it. There are four kinds of radial head fractures, which are:

• Type 1 – Bones are displaced by a distance of less than 2mm or not at all.
• Type 2 – The fracture is displaced by more than 2mm.
• Type 3 – A comminuted fracture where the bone fractures into three or more separate pieces.
• Type 4 – A radial head fracture that is accompanied by dislocation of the elbow joint.

Any radial head fracture that’s left untreated can lead to the development of complications later in life, often due to the elbow joint healing incorrectly. This includes:

• Chronic instability: The elbow joint can become unstable due to suboptimal healing of the tendons and ligaments in the joint.
• Limited range of movement: Due to the key role of the radial head in allowing forearm motion, poor healing can cause bone surface imperfections that limit mobility. Trapped bone fragments can also disrupt movement at the joint.
• Bone death: Radial head fractures, particularly comminuted ones, can prevent blood vessels from reaching the bone. This can result in the necrosis of the radial head.
• Arthritis: Fractures resulting in cartilage wear can lead to the early onset of arthritis.

Clinical publications have shown that replacement radial head prostheses can be effective in relieving the above symptoms, so long as it aligns with the forearm axis of rotation. At LEDA, we understand that matching implants to patient anatomy is crucial to the success of orthopaedic procedures.

Signs of a radial head fracture

There can be many indications that you have suffered a radial head fracture, which can manifest both visually and as bodily sensations. These include:

• Pain on the outside of the elbow that emanates to the hand.
• Swelling and redness around the elbow joint.
• Difficulty bending or straightening the arm at the elbow, accompanied by pain.

Those who suspect they may have a radial head fracture can get confirmation by lightly triggering some of the symptoms above through pressing on the radial head. Turning the forearm inwards and outwards, as well as bending the arm, can cause extreme pain so be careful. Swelling is typically evidence of ligament damage caused by a radial head fracture. Other injuries associated with a radial head fracture are to the collateral ligaments, soft connective tissue, and carpal bones. As such, you will likely have these diagnosed at the same time when seeing a healthcare professional.

While some radial head fractures can heal without intervention, orthopaedic treatment may be advised to avoid the complications detailed above. Modern options we provide include the Proximal Ulna Plate, PROTEAN® Fragment Plate System, and the IJS Elbow system.

Radial head replacement treatment support

In cases where there is significant damage to the radial head in the form of a fracture, it is often best to have radial head replacement surgery. LEDA Orthopaedics have been working at the forefront of the orthopaedics implant industry for more than 10 years. As such, we stock devices for use in a wide range of surgical procedures, from complex treatments to modern solutions for regular injuries such as radial head fractures. Contact us today if you need more information on our products and what we can do for your institution.

Elbow instability is a painful and frustrating condition that can occur as a result of significant elbow trauma, dislocation of the elbow, previous elbow surgery, overuse of the joint, or an elbow deformity. Thankfully there are several new and innovative treatments for elbow instability to help restore the joint back to full working order. In this guide we’ll be exploring how to identify elbow instability and the treatment options available to help patients with their condition and ease their symptoms.

What is elbow instability?

Elbow instability is a condition that involves the elbow joint sliding out of alignment. Stability in the joint is formed by three key elements, the bones, ligaments, and muscles. The bones and ligaments that provide support to the elbow can suffer damage when they are subjected to stress or trauma while stabilising the joint, especially if the injury is not detected or treated.

Instability in the elbow is frequently a result of the exterior ligament of the elbow getting dislodged or thinning, usually due to an injury or repeated dislocation. In certain instances, it may also arise from disorders affecting soft tissue and collagen.

Spotting the symptoms of elbow instability

It’s not always easy to spot elbow instability but there are various signs and symptoms to look out for that could be an indication of the condition. These include:

• A clicking sound when moving the elbow
• Dislocation or fracture of the joint
• Locking or catching feeling in the elbow
• An unstable sensation
• Pain in the arm during various movements like bending or throwing

Patients have reported that their initial symptoms of instability have been a pain or aching sensation after certain activities. Also, there can sometimes be a feeling of weakness or loss of power during overhead motions.

Diagnosing elbow instability

If you’re a patient and you suspect you might have elbow instability, your doctor will likely carry out a physical examination and review your medical history. This will help them determine whether the symptoms you’re experiencing are from elbow instability. After an initial diagnosis, you will be sent for specialist imaging like an X-ray, MRI, or MRI arthrography to get a more in-depth view of the elbow and check for other potential injuries.

Treating elbow instability

There are several different approaches to treating elbow instability depending on the causes and severity of the condition.

Non-surgical treatment

Often before surgery is considered, there will be nonsurgical options pursued to try and ease the patient’s symptoms of elbow instability. This could include changes to activity with the joint, physical therapy, and possibly an external reduction if there is dislocation of the elbow. Also, a sling or brace might be provided to ensure the joint is kept immobile for a set period of time to allow it to heal. Some basic exercises could be suggested to increase strength and movement in the elbow.

Surgical treatment

For many serious cases of joint instability there is likely to be some surgical treatment needed to restore alignment and stability in the elbow. Surgery can involve repairing or reconstructing the damaged ligaments and realigning the bones if the joint is fractured or dislocated. External fixator devices have historically been used to offer additional support to the joint, but there are associated problems with a higher percentage of reoperations and superficial pin-site infections. In some instances, surgery can be needed to repair damaged blood vessels and nerves.

IJS Elbow System

A good alternative to external fixation, is the unique IJS Elbow System from Skeletal Dynamics. This effective internal fixation device offers temporary stabilisation of the elbow and improves range of motion and functionality in the upper arm. It provides stability between the distal humerus and proximal ulna.

The IJS features a universal baseplate construct, with several sizes of humeral axis pins, guided by precision instrumentation to ensure accurate implant alignment and positioning. All these elements provide the patient with impressive results in improving their elbow stability and there is growing evidence in the medical literature to support its use, see the below examples:

• Orbay et al, multi-centre trial
• Case series from Spain
• Case series from UK

Conclusion

Hopefully this article has given you a greater understanding of elbow instability and the treatment options available, whether you’re an individual looking for more insight on their symptoms, or a surgical practitioner who wants to utilise the latest and most effective orthopaedic technologies to aid their patients.

LEDA Orthopaedics is a specialist UK orthopaedic distributor for a wide range of innovative and niche products to allow patients to get the best possible solutions during their treatment. Contact us today to learn more about the products we supply.