POSTER ABSTRACTS - ISAKOS

were recorded. In part two of the study, we
investigated the benefit of reducing the sharp
edge at the tibial tunnel exit using the same
fixation techniques and the same two cyclic
loading protocols.
Being subjected to the sharp egde of the posterior
tibia, 5 of 10 extra-cortical and 8 of 10 anatomical
fixed grafts survived cyclic loading between 50 and
150 N. All extra-cortical fixed and 8 of 10
anatomical fixed grafts failed prior to 2000 cycles
between 50 and 300 N. Structural properties of
grafts fixed with interference screw were
statistically significant higher when compared to
extra-cotrical fixation. After rounding the sharp
edge of the tunnel, all grafts survived cycles
between 50 and 150 N and 6 out of 10 extracortical
and 8 of 10 anatomical fixed grafts
survived 2000 cycles between 50 and 300 N.
The results of this study suggest that a rounded
posterior aspect of the tunnel exit at the tibial
tunnel leads to significant less graft damage when
compared to the typical sharp edge of the tunnel
(killer turn). Additionally, the results show that
anatomical fixation of soft tissue grafts in PCL
reconstruction is superior when compared to an
extra-cortical fixation site.
ELBOW/WRIST/HAND
E-poster #200
Risks Evaluation in Posterior Transolecranon
Surgical Approach: A Traffic Lights Model
Andrea Emilio Salvi, Brescia, ITALY, Presenter
Orthopaedic and Traumatologic Clinic of Brescia,
BRESCIA, ITALY
The posterior transolecranon surgical approach of
the elbow is often used for the treatment of the
distal humerus fracture. It consists of an
olecranon osteotomy in order to visualize the
articular face including a part of the diaphysis.
Notwithstanding the advantages of the wide area
exposed, there are two hazards always to take into
consideration: the presence of the ulnar nerve and
the olecranon osteotomy-osteosynthesis
performing. Because of the possibility in making
mistakes during this approach, we have applied a
decreasing degree of risk passing from medial to
lateral that we have compared to a traffic lights
transverses the elbow. The maximum risk (red
light) is located in the medial side of the elbow
where it passes the ulnar nerve that can be
damaged. The intermediate risk (yellow light) is
located in the olecranon: an incorrect osteotomy
or an unsuitable osteosynthesis can fail the
operation. The complete lack of risk (green light)
is located in the lateral side of the elbow.
According to this point of view, the surgical
approach is performed starting from the
maximum risk identified by the red light, isolating
the ulnar nerve, coming along the olecranon with
its osteotomy-osteosynthesis and terminating the
surgical process on the lateral side. The
advantages of this ''traffic lights view'' lie in the
progressive risks decreasing from medial to lateral
since the surgeon can evaluate step by step all the
performed gestures during the operation.
E-poster #201
Malpositioning of the Ulnar and Humeral
Component of Total Elbow Prosthesis and
Revision Rate
Margarita van der Hoeven, Nijmegen,
NETHERLANDS, Presenter
Rinze Reinhard, Nijmegen, NETHERLANDS
Maarten de Vos, Nijmegen, NETHERLANDS
Denise Eygendaal, Nijmegen, NETHERLANDS
Sint Maartenskliniek, Nijmegen, NETHERLANDS
There is a lack of knowledge about malpositioning
of total elbow prosthesis components and
revision rate. In this study we tried to identify the
relation between malpositioning in varus/valgus
and flexion/extension direction and radiographic
loosening of the prosthesis, subsidence and
revision rate. In the period from 1990 to 1997 fiftynine
unconstrained total elbow prosthesis Kudo
type-4 were inserted in 47 patients with
rheumatoid arthritis. The group available for
follow up consisted of 36 patients, resulting in 45
elbows available for radiological assessment.
Anteroposterior (AP) and lateral radiographs of
the elbow, performed in a standardized way, taken
before the operation, six weeks after the
operation, and at evaluation were used for
radiological assessment. Malposition of the ulnar
component in varus as measured from the AP
view was related to more areas of radiographic
loosening around the ulnar component of the
prosthesis. With increasing extension angles of
the humeral component there was more
radiographic loosening around the humeral
component of the prosthesis as measured from
the lateral view. The revision rate was also
significantly higher with increasing varus angles of
the ulnar component of the prosthesis.
Malpositioning in other directions was not related
to radiographic loosening of the prosthesis,