{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T00:30:12Z","timestamp":1760920212250,"version":"build-2065373602"},"reference-count":33,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2019,3,12]],"date-time":"2019-03-12T00:00:00Z","timestamp":1552348800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,3,12]],"date-time":"2019-03-12T00:00:00Z","timestamp":1552348800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Arthroscopic fixation of radial head radial head fractures is an appealing alternative to open reduction and internal fixation, which presents the advantage of minimal surgical trauma. The aim of this study was to evaluate if modifications to the standard anteromedial (AM) and anterolateral (AL) portals could allow screw placement for radial head fracture osteosynthesis closer to the plane of the radial head articular surface.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eight fresh\u2010frozen specimens were prepared to mimic arthroscopic setting. Standard AL (ALst) and AM (AMst) and distal AL (ALdi) and AM (AMdi) portals were established. Eleven independent examiners were asked to indicate the optimal trajectory, when aiming to place a cannulated screw parallel to the radial head surface for radial head osteosynthesis. A three\u2010dimensional digital protractor was used to measure the angle between the indicated position and a Kirschner wire placed parallel to the radial head articular surface (<jats:italic>\u03b1<\/jats:italic>). The Shapiro\u2013Wilk normality test was used to evaluate the normal distribution of the samples. Means, standard deviations, and 95% confidence intervals (95% CI) were calculated for each portal. A coefficient of variation (CoV) was calculated to determine agreement among observers and intra\u2010observer variability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean <jats:italic>\u03b1<\/jats:italic> angles were 25.1\u2009\u00b1\u200911.5\u00b0 for AMst, 13.8\u2009\u00b1\u20094.8\u00b0 for AMdi, 17.1\u2009\u00b1\u200913.4\u00b0 for ALst, \u20102.6\u2009\u00b1\u20099.2\u00b0 for ALdi. No overlapping in the 95% CI of ipsilateral standard and distal portals was observed, indicating that the difference between these means was statistically significant. The distal portals showed smaller inter\u2010observer CoV as compared to the standard ones (AMst: 10.0%; AMdi: 4.6%; ALst: 12.5%; ALdi: 10.6%). Intra\u2010observer CoV was similar for all portals (AMst: 5.5%; AMdi: 6.1%; ALst: 7.7%; ALdi: 7.1%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The use of distal AM and AL portals permits to obtain \u03b1 angles closer to the radial head articular surface than standard AM and AL portals. This is expected to allow screw placement in a flatter trajectory, which should correlate with a superior biomechanical performance of fixation. Good reproducibility of Kirschner wire placement from distal portals was observer among different examiners. Modifications to the standard AM and AL elbow arthroscopy portals allow to place screws for radial head fracture osteosynthesis in a position which should guarantee superior biomechanical performance of fixation.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-019-05411-8","type":"journal-article","created":{"date-parts":[[2019,3,12]],"date-time":"2019-03-12T02:15:51Z","timestamp":1552356951000},"page":"3276-3283","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Modified anteromedial and anterolateral elbow arthroscopy portals show superiority to standard portals in guiding arthroscopic radial head screw fixation"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6284-7977","authenticated-orcid":false,"given":"Davide","family":"Cucchi","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics and Trauma Surgery Universit\u00e4tsklinikum Bonn Sigmund\u2010 Freud\u2010Str. 25 53127 Bonn Germany"},{"name":"<!--<label>2<\/label>--> Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health Universit\u00e0 degli Studi di Milano Via Mangiagalli 31 20133 Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Arrigoni","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health Universit\u00e0 degli Studi di Milano Via Mangiagalli 31 20133 Milan Italy"},{"name":"<!--<label>3<\/label>--> U.O. Clinica Ortopedica e Traumatologica Universitaria CTO Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini\u2010CTO Piazza Cardinal Ferrari 1 20122 Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Luceri","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> U.O. Clinica Ortopedica e Traumatologica Universitaria CTO Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini\u2010CTO Piazza Cardinal Ferrari 1 20122 Milan Italy"},{"name":"<!--<label>4<\/label>--> Universit\u00e0 degli Studi di Milano Via Mangiagalli 31 20133 Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra","family":"Menon","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health Universit\u00e0 degli Studi di Milano Via Mangiagalli 31 20133 Milan Italy"},{"name":"<!--<label>5<\/label>--> 1\u00b0 Clinica Ortopedica ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini\u2010CTO Piazza Cardinal Ferrari 1 20122 Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico","family":"Guerra","sequence":"additional","affiliation":[{"name":"<!--<label>6<\/label>--> Shoulder and Elbow Unit Ortopedico Rizzoli Via Pupilli 1 40136 Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars Peter","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"<!--<label>7<\/label>--> Center for Orthopedic and Trauma Surgery University Medical Center Kerpenerstrasse 62 50937 Cologne Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christof","family":"Burger","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics and Trauma Surgery Universit\u00e4tsklinikum Bonn Sigmund\u2010 Freud\u2010Str. 25 53127 Bonn Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denise","family":"Eygendaal","sequence":"additional","affiliation":[{"name":"<!--<label>8<\/label>--> Department of Orthopaedic Surgery, Academic Medical Center University of Amsterdam Amsterdam The Netherlands"},{"name":"<!--<label>9<\/label>--> Department of Orthopaedic Surgery, Upper Limb 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Author PA declares payment for development of educational presentations from Arthrex, outside the submitted work. Author FL declares that he has no conflict of interest. Author AM declares that she has no conflict of interest. Author EG declares that he has no conflict of interest. Author LPM declares consultancy for Arthrex, Medartis and Tornier, outside the submitted work; payment for travel\/accommodations expenses from Arthrex, Medartis and Tornier, outside the submitted work; institutional grants from Medartis and Tornier, outside the submitted work. Author CB declares that he has no conflict of interest. Author DE is educational consultant for AO and educational consultant for Lima. Author KW declares consultancy for Arthrex, Medartis and Tornier, outside the submitted work; payment for travel\/accommodations expenses from Arthrex, Medartis and Tornier, outside the submitted work; institutional grants from Medartis and Tornier, outside the submitted work.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Nicola\u2019s Foundation & ICLO Research Center (ID10603). This article does not contain any studies with human participants performed by any of the authors (cadaveric study).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}