Aakash Chauhan

Background: Perform computed tomography (CT) three-dimensional (3D) mapping analysis of the ipsilateral olecranon tip to determine its suitability as an autograft for unrepairable coronoid fractures. Methods: CT was evaluated using Mimics 13.0 and 3-matic software (Materialise, Inc., Leuven, Belgium). Coronoid fracture fragment was measured from the medial sublime tubercle to the halfway point of the proximal radioulnar joint. Ipsilateral olecranon tip graft was measured at the equivalent height of the coronoid fragment and the angle of graft “cut” necessary to match the coronoid fragment was measured. The overall width of each graft site was measured in thirds and the congruity of surface geometry was measured by overlapping both fragments. The ipsilateral olecranon tip lateral facet which rotates to become the coronoid medial facet was also measured. Results: The olecranon tip and coronoid fragments were similar in average maximum height and width. The average angle of graft cut needed to match the coronoid fragment was 86°. The average difference between the medial facet of the coronoid and lateral facet of the olecranon was <2 mm. Discussion: The ipsilateral olecranon tip can be harvested through the same surgical incision and function as a local autograft during reconstruction of unrepairable coronoid fractures.

Case: We report 2 cases of a spiral nerve variant that has only 1 previously reported description in the literature. A pretendinous cord was found to branch into a “Y” configuration, extending distally on both the radial and ulnar sides of the same digit, with the radial and ulnar digital nerves spiraling around each limb of the “Y cord”. Conclusion: Rare spiral nerve variants exist which place the digital neurovascular bundles (NVBs) at risk. Awareness of these variants and adherence to conservative surgical principles allow the surgeon to identify these scenarios intraoperatively and safely dissect the digital NVBs free of pathologic tissue.

* Careful scrutiny of radiographs is important in the assessment of pediatric elbow injuries. Disruption of the radiocapitellar line and an increased bow of the posterior ulnar border are sometimes subtle signs of a Monteggia injury. * An attempt at closed reduction up to 4 weeks after injury has been cited in the literature as successfully treating some missed injuries. * Operative reduction of chronic radial-head dislocation provides good to excellent range of motion and functional outcome in the setting of irreducible chronic radial-head dislocation. * Ulnar osteotomy and correction of the ulnar deformity component of the missed Monteggia injury are the key to indirect anatomic reduction of the radiocapitellar joint. * Supplemental procedures aimed at increasing the stability of the radiocapitellar joint (e.g., annular ligament reconstruction, radiocapitellar Kirschner wire fixation, radioulnar Kirschner wire fixation) should be directed by a thorough assessment of radiocapitellar stability following ulnar osteotomy and correction of the ulnar deformity.