Browsing by Author "Aravena, Cristian"
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Item Results of standardized treatment of elbow fracture dislocations as per their injury pattern: a retrospective cohort of 89 patients(2021) Reinares, Felipe; Rojas, Nicolás; Calvo, Andrés; Aravena, Cristian; Rieutord, Juan Pablo; Callejas, Orlando; Montegu, Roberto; Paccot, DanielBackground: Elbow fracture dislocations represent difficult injuries to treat, with a high percentage ofcomplications. Classically, they are divided into posterolateral, posteromedial and transulnar pattern. It isessential to distinguish them to guide intraoperative treatment to achieve an anatomic and stablereduction that allows early mobility. Methods: A retrospective study of 89 adult patients diagnosed with elbow fracture dislocations whounderwent a standardized surgery between 2013 and 2018 with a minimum follow-up of 12 months. Demographic data, characteristics of the injury, and associated procedures were collected. Patients wereevaluated with functional scores (Mayo elbow performance score/Broberg and Morrey score) and ranges of movement at the end of the follow-up. Results: The mean age was 41 ± 12 years, mostly men (82%), with an average follow-up of 29 months. We present 42 patients with posterolateral fracture dislocation (47%), 21 posteromedial (24%) and 26 transulnar (29%). The average range of motion at the end of follow-up was 12 ± 11 extension, 124 ± 20 flexion, 76 ± 16 pronation, and 73 ± 20 supination, with a Mayo elbow performance score of 88.7 ± 12 points and 87.2 ± 12 points in the Broberg and Morrey scale. Reoperation rate was 23%, with no infection or heterotopic ossification cases. Transulnar fracture dislocations have significantly worse extension and supination. As per the functional result (Mayo elbow performance score/Broberg and Morrey scale), there are no significant differences between the different patterns. Conclusion: Proper injury pattern recognition and a standardized surgical management lead to a stable joint and good results in range of motion. Functional results are encouraging at least at short term, despite the high reoperations rate.Publication Transolecranon fracture dislocation and transolecranon basal coronoid fracture dislocation; results of standardized treatment in a retrospective cohort(2025) De la Paz, Joaquín; Lecaros, Juan José; Calvo, Andrés; Ariztia, Antonio; Aravena, Cristian; Reinares, FelipeBackground: Our understanding of transolecranon fracture dislocation (TOFD) has evolved to include associate ligament, coronoid, and radial head lesions impacting stability, rather than solely bone stability. Similarly, the understanding of coronoid fracture patterns has progressed. O’Driscoll et al state that basal subtype 2 coronoid fractures correspond to a TOFD, with a fracture passing through the base of the coronoid. In the literature, there is no clear differentiation between basal coronoid TOFD (BC-TOFD) and pure-TOFD outcomes. The main objective of this study is to evaluate the functional results and complications of TOFD using a standardized surgical technique. The secondary objectives are to describe the associated injuries and to compare the results between pure-TOFD and BC-TOFD. Methods: This retrospective study included all patients with a TOFD treated with a standardized surgical procedure and rehabilitation protocol between 2013 and 2018 in a single trauma level 1 center. The surgical procedure mainly consisted of fixing the olecranon with a plate, using the same screws for coronoid fixation and coronoid plate if necessary. Radial head management involved either arthroplasty or screw fixation, with ligament repair performed as needed. Demographic data and the associated bone and ligament injuries were reviewed. The clinical outcomes (range of motion, Mayo Elbow Performance Score (MEPS), and Broberg and Morrey (B&M) scores) were evaluated at the final follow-up, after a minimum of 2 years. Complications and reoperations were assessed. Results: 24 patients were included, and 75.0% were men. The average follow-up was 57.9 ± 22.0 months. The mean age was 42.0 ± 15.1 years. 18 (75.0%) were BC-TOFD and 6 (25.0%) were pure-TOFD. Ligament injuries requiring repair and radial head fracture were present in 8 (33.3%) and 11 (45.8%), respectively. The average range of motion were flexion 119.0 ± 17.6, extension deficit 20.4 ± 12.6 , pronation 68.9 ± 20.4 , and supination 63.1 ± 27.4 . MEPS and B&M mean scores were 82.3 ± 16.5 and 82.0 ± 16.1, respectively. The reoperation rate was 33.3%. No significant differences were found between pure-TOFD and BC-TOFD. A significant distribution difference was found in MEPS (P ¼ .001), B&M (P ¼ .002), range of flexion (P ¼ .011), and extension deficit (P ¼ .005) between patients who had reintervention and those who did not. Conclusion: A standardized protocol for TOFD allows good to excellent functional results. There are no significant differences between pure-TOFD and BC-TOFD. One-third underwent reintervention. Patients with reintervention presented worse outcomes.