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Dear colleagues,
after a trauma to the elbow and following inadequate diagnostics or treatment or both, the results will potentially be devastating to our patients with a massive decline in their later quality of life. To avoid such catastrophic results, a pain-free, stable elbow with full range of motion must always be our highest goal in treating patients who suffer from such an injury. Therefore, to facilitate diagnostics and therapy and to bring back into focus the patients with elbow trauma, this EJTES’ ‘‘Focus on Elbow Fractures’’ will deal with the following two complex entities:
1. We all know that in the adult patient group the number of fractures around the elbow in itself is only slightly increasing, but we also do know that the incidence of patient presentations with more complex fracture types, especially those fractures that are osteoporosis associated in the aged population, is dramatically increasing and that these fractures can be extremely difficult to treat. Difficult because of poor bone stock and quality, and extremely distal fracture lines in the humerus, such that the distal main fragments are comminuted and small. In consequence to this, standard applications of ORIF techniques will give limited purchase of screws and only limited stability after surgery for early range of motion exercises. Even the highly recommendable application of angular stable implants in such a situation does not really alleviate us from this pressing problem. This is why I asked the colleagues Patton & Johnstone from the prestigious Royal Infirmary in Aberdeen, Scottland, to give us their opinion and experience on ‘‘The role of total elbow arthroplasty in complex distal humerus fractures’’ and their paper really puts into focus our state of the art approach that we have today in this patient group [1].
2. The elbow, at a rate of 20% (see Jungbluth et al. in this issue [2]), is the second most dislocated joint in the human body. Dislocations can be classified into simple and complex types depending on whether or not there are associated ligamentous disruptions and/or fractures of articulating bones. As mentioned before, after treatment, we want an elbow joint that is pain-free, has full range of motion, and is mechanically stable.
Achievement of mechanical stability after an elbow dislocation depends on adequate diagnostics with detection of all injured structures, be they ligamentous, cartilagineous, or bony. There must be an adequate classification of the injury, which classifies thesoft tissue trauma and the potential trauma to the radial head, the coronoid process, and the distal humerus (capitellum, trochlea, and osteocartilagineous flakes of any of the latter). Only after full understanding of the mechanism of injury, detection of all structures that are lacerated, and with a complete understanding of the contribution of any individual structure to elbow stability can adequate therapy be initiated.
The Paper by Jungbluth et al., ‘‘Current Concepts: Simple and Complex Elbow Dislocations—Acute and Definitive Treatment,’’ describes the mechanisms of injury in elbow dislocation and expands on diagnostics, classification, and primary and definitive treatment depending on whether there is a simple or a complex dislocation type.
In addition to this information, colleagues Samii & Zellweger from the Royal Perth Hospital in Western Australia give us their highly respected opinion on ‘‘Fractures of the Coronoid Process of the Ulna: Which Ones to Fix and Which Ones to Leave Alone’’ with, as they truly and realistically see it, the coronoid process being ‘‘crucial for elbow stability’’ [3].
Their clear contribution together with Jungbluth’s paper and the last paper in this focus ‘‘Radial Head Fractures: Indications and Technique for Primary Arthroplasty’’ by Madsen & Flugsrud [4] from the wellknown University Hospital in Oslo, Norway, will allow the attentive and open-minded reader to better treat elbow dislocations in the future. This is due to the fact that refixation of the coronoid process, the right decision- making in those complex dislocations where the radial head is not reconstructable, to primarily implant a radial head prosthesis and how to do this technically correct is of greatest importance for a successful treatment.
I would like to thank all contributing authors for their fine papers and their highly appreciated effort and wish you, the concerned colleagues, an interesting time reading the articles of this Focus.
Kind regards
Johannes Maria Rueger
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