bess 2015 elbow review
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What I learned at BESS What I learned at BESS 20152015
Adam C WattsConsultant Elbow and Upper Limb Surgeon, Wrightington
Hospital
Visiting Professor, Manchester University
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18 patients had DHH for trauma with minimum follow up 24 months
Key message: Distal humerus hemiarthroplasty has favourable outcomes (mean QuickDASH 12)
Strengths: largest series with triceps on approach
Weaknesses: small sample size
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33 radial head replacements followed for average 12 months
Key message: Radial head replacement for trauma results in favourable outcomes but with some pain
Strengths: relatively large series for these implants
Weaknesses: short follow up
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Survey of 142 BESS members found 31% performed 2-5 TER in 2014 and 23% 5-10. 62% agree that minimum required is 5 p.a.
Key message: enthusiasm to improve TER provision with hub and spoke model favoured
Strengths: important and current question
Weaknesses:low response rate (1/4 BESS surgeons)
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Case series 64 primary Latitude TER reporting 93% survival at 3 years mean QuickDASH improved from 72 to 41
Key Message: comparable outcome to other implants but concern about radial head
Strengths: first case series of UK latitude TER
Weaknesses: short follow up
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Case series 28 primary Discovery TER with radiographic analysis at minimum 36 months
Key message: ulnar malalignment is a significant risk factor for humeral loosening
Strengths: analysis of causes of loosening
Weaknesses: small sample and questionable accuracy of measurement
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Case series of 18 single stage revision TER for aseptic loosening with minimum 5 year follow up found 85% survival at 9 years
Key message: favourable outcome revision TER with Coonrad-Morrey
Strengths: long follow-up
Weaknesses: questionable statistics
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Case series 28 infected TER with two-stage revision reported 87% success at eradicating infection
Key Message :multi-disciplinary team and regional referral
Strengths: relatively large series
Weaknesses: no comparison group
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Case series 7 patients with distal humerus non-union treated with TER at minimum 6 month follow up.
Key Message: TER is a good salvage option
Strengths: little in the literature
Weaknesses: small series with very short follow up
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TER - what we have learned?TER - what we have learned?
Consensus minimum 5-10 per annum
Alignment important
Referral networks
Multi-disciplinary team approach
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Distal Biceps RepairDistal Biceps Repair
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Case series 50 distal biceps ruptures in 47 patients with minimum 6 month follow-up. 40 operative and 10 non-operative
Key message: Significantly better strength and function with operative repair
Strengths: measurement of strength with isokinetic BME machine
Weaknesses: selection bias
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Case series 22 patients after distal biceps repair with immediate mobilisation
Key Message: immediate mobilisation not associated with any complication
Strengths: first series with immediate mobilisation
Weaknesses: no comparison group
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case series 5 patients with failed primary distal biceps repair treated with revision.
Key message: patients with persistent pain after primary repair probably have gapping and benefit from revision
Strengths: first detailed description of this problem
Weaknesses: small sample size
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DBR - what have we learned?DBR - what have we learned?
DBR better than natural history
Immediate mobilisation is not harmful with
button repair
Patient’s with ongoing pain should be
investigated for failure to heal by gapping with
FABS view MRI
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