Biomechanical significance of the collateral ligaments in transolecranon fracture-dislocations - Matthew Provencher, MD | Orthopedic Knee & Shoulder Surgeon

Authors:

Kaare S Midtgaard, Philip-Christian Nolte, Jon W Miles, Kira K Tanghe, Liam A Peebles, Matthew T Provencher, Lars Adolfsson

Abstract:

Background: It is widely accepted that transolecranon fracture-dislocations are not associated with collateral ligament disruption. The aim of the present study was to investigate the significance of the collateral ligaments in transolecranon fractures.

Methods: Twenty cadaveric elbows with a mean age of 46.3 years were used. All soft tissue was dissected to the level of the capsule, leaving the anterior band of the medial collateral ligament (MCL) and lateral collateral ligament (LCL) intact. A standardized, oblique osteotomy starting from the distal margin of the cartilage bare area of the ulna was made. The elbows were loaded with an inferiorly directed force of 5 and 10 N in the intact, MCL cut, LCL cut, and both ligaments cut states. All measurements were recorded on lateral calibrated radiographs.

Results: The mean inferior translation with intact ligaments (n = 20) when the humerus was loaded with 5 and 10 N was 1.52 mm (95% confidence interval [CI], 1.02-2.02) and 2.23 mm (95% CI, 1.61-2.85), respectively. When the LCL was cut first (n = 10), the inferior translation with 5 and 10 N load was 4.11 mm (95% CI, 0.95-7.26) and 4.82 mm (95% CI, 1.91-7.72), respectively. When the MCL was cut first (n = 10), the inferior translation when loaded with 5 and 10 N was 3.94 mm (95% CI, 0.796-7.08) and 5.68 mm (95% CI, 3.03-8.33), respectively. The inferior translation when loaded with 5 and 10 N and both ligaments cut was 15.65 mm (95% CI, 12.59-18.79) and 17.50 mm (95% CI, 14.86-20.13), respectively. There was a statistical difference between the intact and MCL cut first at 10 N and when both ligaments were cut at 5 and 10 N.

Conclusions: The findings suggest that collateral ligament disruption is a prerequisite for a transolecranon fracture-dislocation. An inferior translation of more than 3 mm suggests that at least one of the collateral ligaments is disrupted, and more than 7.5 mm indicates that both collateral ligaments are disrupted.

For the complete study: Biomechanical significance of the collateral ligaments in transolecranon fracture-dislocations

Matthew Provencher, MD

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66 reviews

James Wilson

Oct 11, 2024

by James Wilson on Matthew Provencher, MD

Senior Electronics development engineer

Wow the Steadman clinic and Doctor Matthew Provencher now that;s a super combination of expertise, experience, empathy, skill and a cherry picked staff with truly outstanding nurses and professional support staff. I was scared of shoulder surgery until I read Dr. Provencher BIO and talked to him. If your considering shoulder replacement surgery this is the place. In three weeks out now and people are amazed at my ability of movement and flexibility I have now. I love the Steadman Clinic and Dr. Matthew Provencher, He's Superman

Anne Miller

Jun 18, 2024

by Anne Miller on Matthew Provencher, MD

Grateful to Dr Provencher and his team

I am a 75-year old, active, athletic woman. Over the last few years, both of my shoulders reached a point where severe arthritis was affecting even day to day tasks. It started with one shoulder in 2021 and recently the second reverse shoulder replacement – both with Dr Provencher. Before my first one, I had received various recommendations including adjusting my lifestyle. Dr Provencher looked at my MRI and x-ray and asked what I enjoy doing and was quick to let me know I could be back to my active lifestyle soon – and he was right. He reads images faster and more accurately than any doctor I have consulted. He has many options available and if you need surgery he is the one to do it. Surgery is quick and the recovery is much easier than I anticipated. I am 10 days out from my second reverse shoulder and have no pain and gaining mobility already! My case for both shoulders was a bit more complicated due to bone integrity, severe arthritis and bicep tears. Dr Provencher has dealt innovatively with both complications and makes it seem straightforward although I know it was not. He is not only one an extraordinary surgeon, but also, a caring human being who takes the time with his patients and makes himself available if questions arise. His team is second to none – Maddy, Madison, Sam, Scott, Jasmin and in pre-op, Layla and Kevin – in terms of commitment, competence, compassion and responsiveness. Both times I have felt cared for and that resolving my situation mattered to him. Wherever you live, Dr Provencher and his team are the ones to trust. There is no need to live a compromised life!

Gene reiling

Jul 21, 2023

by Gene reiling on Matthew Provencher, MD

Success

If you are planning to see Dr Provencher ,do not hesitate ,do it. In 2018 Dr Provencher replaced my LCL. I had no complications and very little pain. I did my physical therapy as prescribed. I was able to ski 30 plus days the winter of 2019-2020. Before seeing dr Provencher I had spent a years time trying to solve my problem locally. I saw a pain specialist, orthopedic urgent care and a orthopedic surgeon. All had access to an mri done locally. It was also read by local radiologist. Pain dr gave injections as did orthopedic urgent care. No relief from pain. Orthopedic surgeon told me about arthritis, meniscus needing cleaning up and general deterioration from age. Told me to take ibuprofen for pain. At that time I reached out to Steadman Clinic. By luck of the draw I was assigned Dr Provencher. I took with me the mri that had been done locally and viewed by 3 local Drs and 1 PA. It took Dr Provencher less than a minute to tell me my problem was my LCL after viewing my mri. He told me my options . I selected surgery as I wanted to continue an active life style. It was a complete success!!

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