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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.

Radial head replacement is a type of surgery that replaces an injured or damaged radial head with an artificial joint prosthesis. The radial head is an essential part of the elbow that enables its motion during bending and straightening of the joint as well as rotating the forearm.

When it becomes injured or suffers damage, it can impact the complete movement capabilities of the elbow and result in the need for a replacement radial head. In this guide, we’ll be exploring the exact circumstances in which radial head replacement surgery is needed and other key details you need to know about the procedure.

What are the symptoms of an injured or damaged radial head?

The radial head can be injured by a serious fracture or become damaged over time as a result of degenerative conditions like arthritis. If you have an injury or condition that is causing damage to the radial head, you will likely experience a lot of pain in the elbow, crepitation, and decreased motion and functionality in the joint.

What happens during a radial head replacement?

Radial head replacement surgery is performed under general anaesthetic, the surgeon will start by making an incision on the outside of the elbow joint. They will then move tendons and ligaments out of the way to expose the radial head. Once exposed, the surgeon can remove the damaged bone and prepare to fit the artificial implant. The implant will replicate the head and have a long metal stem. Each person’s bones will be different, which makes accurate sizing essential to choosing the right artificial implant for the patient’s anatomy.

ALIGN Radial Head Replacement

The ALIGN radial head from Skeletal Dynamics is a highly effective prosthesis that works to achieve as close to the patient’s natural anatomy as possible. It has a wide range of impressive features and simple instrumentation that ensure it generates the best possible outcomes for the patient, ensuring pain-free stability and a better range of movement. These features include:

• Side loading head with several stem and neck side options.
• Customised monoblock that aligns to the patients’ anatomy
• Long, press-fit design
• Digital stem flutes

This clinical paper, from 2022 demonstrates how the Align’s anatomical design, which is aligned to the patients’ axis of forearm rotation, produces satisfactory results across multiple surgeons and institutions.

Contact us today if you’d like more information about the ALIGN System.

When is radial head replacement needed?

Radial head replacement surgery is the best course of action if the radial head has been fractured so severely that it cannot be repaired via internal fixation. This is the only way to effectively restore as much mobility as possible to the elbow. Radial head replacement can also be used in certain cases of inflammatory arthritis.

Radial head fracture

The most common cause of a radial head fracture is falling directly onto an outstretched hand, which is why it is an injury that is frequently found in those who play fast and vigorous sports. Replacement surgery can offer relief from fracture symptoms like stiffness, pain, and swelling as well as the limitations in movement and function of the elbow. Not all radial head fractures will require replacement surgery.   LEDA Orthopaedics supplies the Skeletal Dynamics Distal Elbow Set, which includes the Align® radial head replacement as well as the Protean Radial Head Plate and the Reduct Headless Compression Screws. These options can also be considered for treatment of radial neck fractures and reconstructible (less comminuted) radial head fractures.

If the proximal radius is not displaced (meaning it’s still in the same position) then it can be treated by immobilisation and then physiotherapy. If the fracture is displaced, then it will likely need to be repositioned and stabilised with screws or pins. Both of these instances are when a more conservative treatment approach can be taken. However, for severe fractures, when it is displaced, comminuted (there are 3 or more bone fragments), and if the radial head has been irreversibly damaged, replacement surgery is typically the best treatment option. LEDA Orthopaedics also supply the patient-friendly eXo Splint, which may be a useful option for elbow fracture patients.

Arthritis

Again, not all cases of arthritis will require radial head replacement, it is a significant surgical procedure that isn’t carried out lightly. An example of when replacement could be the best treatment option is when the articular cartilage that covers the radial head becomes damaged due to serious inflammatory arthritis.

This type of cartilage damage can cause substantial pain and stiffness and limit the functionality of the joint. If the damage is severe, radial head surgery could be the appropriate treatment to ease the patient’s symptoms and help them get back to normal daily activities which may have previously been restricted by the arthritis.

Conclusion

Overall, radial head replacement is a necessary treatment in instances of severe and complex fractures and degenerative conditions like inflammatory arthritis. As a leading UK orthopaedic distributor, we understand the importance of providing innovative and effective medical solutions to orthopaedic surgeons that will support them and their patients in treating elbow trauma conditions. Explore more of the Skeletal Dynamics elbow and upper extremity products we supply online today.

Although fractures are a common injury, there are many different kinds depending on how the bones break. Different types of fracture must be addressed in a way that is appropriate to the trauma suffered and the area that has been affected. Oftentimes, severe fractures will need orthopaedic trauma surgery to ensure proper recovery. As such, devices are designed specifically to treat fractures of a certain type or fractures to a certain area of the body.

In this blog, we differentiate between two of the most common fractures, their causes, and how they should be treated.

Comminuted fractures

A comminuted fracture is a particularly serious type of injury where the bone breaks in multiple places. This produces several bone fragments that separate from the main bone structure. The primary cause of comminuted fractures is a high-impact event that results in severe trauma, such as a car accident.

Comminuted fractures that occur in key articular locations can be especially damaging for a patient’s range of movement.  If appropriate, specialist internal fixation and open reduction surgery is the best course of action to treat these fractures. For instance, the Align® Radial Head Replacement system has been designed to treat non-reconstructable, highly comminuted radial head fractures, while the Reduct® Headless Compression Screws can be used to piece together less comminuted fracture injuries of the radial head.

The advantage of LEDA’s Skeletal Dymamics Distal Elbow Set is that both the Align and the Reduct are available on the same kit, so the surgeon can make the choice between systems intraoperatively. The recovery time for surgeries to repair comminuted fractures varies depending on the bone that has been broken, along with other patient-specific factors. This market-leading supplier also have dedicated systems for the treatment of fractures elsewhere in the upper extremities, such as their FREEFIX® Forearm and Wrist Plating System.

Transverse fractures

A transverse fracture is a break in the bone that occurs perpendicular to the length of the affected bone. These fractures typically appear as a line that covers all or part of the bone’s circumference. Transverse fractures are more common in longer bones, such as the humerus, radius, tibia, and ulna. Transverse fractures are usually caused by trauma due to a fall. Nevertheless, surgery is frequently used to aid healing as the bones that often experience these fractures are responsible for important body movements.

Either of the fractures discussed here can vary depending on the displacement of the fractured bone. These categories are:

• Open – a wound that breaks the skin has been caused near the fracture site, often by a bone fragment.
• Closed – a break occurs in the bone that keeps the skin intact.
• Displaced – the fracture causes the affected bone to move out of its proper alignment.
• Non-displaced – the fracture leaves the bone in its accepted position, which allows it to heal without invasive measures.

Devices for fracture reduction and fixation

Comminuted and transverse fractures can affect anyone regardless of age or anatomy. As such, medical professionals need to be prepared to treat either throughout the year. LEDA Orthopaedics distributes systems and implants which have been designed by healthcare experts for the treatment of a variety of fractures. This includes trauma to the upper and lower extremities, as well as the ability to treat niche and complex injuries such as pelvic fractures. Contact us today if you have any questions about our product specifications, instrumentation or storage information.

52 Align cases across 6 surgical centres, with an average follow up of 50 months.

Results show great patient satisfaction and no loosening

Read Full Clinical Data