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. 2021 Jul 3;20:101495. doi: 10.1016/j.jcot.2021.101495

Table 2.

The clinical assessment of a failing TER includes an evaluation of the actual and potential (after explantation) concerns about the integument, subfascial soft tissues, the implants, and bone stock.

Observation Clinical exam Simple Tests Special tests
Skin and superficial fascial compartment Infection Look/feel Microbiological assessment:
Tethering (risk to skin flap perfusion) Serology: CRP, ESR, WCC and differential
Dehiscence (risk to skin flap healing) Biopsy, aspiration
Atrophy of skin (need for additional skin restoration tactic) IgE
Existing skin blood supply/healing potential (dysautonomic signs)
Olecranon pressure ridge/olecranon bursitis (previous olecranon bursal infection)
Cutaneous protective sensation, 2-point discrimination (especially over olecranon) Feel Sensory mapping
Subfascial compartment (anterior) Continuity of biceps tendon Look/feel/move USS MARS MRI
Major nerve trunks Ulnar, MCNA, MCNF, Median, LCNF, Radial, PIN, SRN, PCNF Look/feel/move Sensorimotor mapping EMG, NCS, USS (with Doppler mode),
MR angiogram
Specific Ulnar nerve Prior ulnar nerve surgery: anatomical location Look/feel/move (instability of nerve trunk) EMG, NCS, USS (with Doppler mode)
Muscular compartments Bulk, tone and activity Look/move USS MARS MRI
  • -

    juxta-articular collateral shunt muscle function (CFO & CEO) including anconeus,

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    pronosupination muscles

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    anterior and posterior shunt muscles (deep triceps and short head biceps)

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    anterior compartment (flexor)

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    posterior compartment (extensor):

Specific Triceps ‘mechanism’ What was the primary triceps mechanism management Look/feel/move USS MARS MRI
Implants Malalignment/instability Look/feel/move – squeaking of implant XR Orthogonal views EUA ± arthrogram
Loosening Feel/move CT ± arthrogram ± biopsy
Bone: bone loss (potential/actual) loosening Feel/move XR Orthogonal views CT ± arthrogram ± biopsy
  • -

    extent of bone loss: actual and potential after explantation
  • -

    predicted bone stock- post explantation

 3-D CT (custom planning)
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    fracture (periprosthetic, distant)
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    predicted challenges of secondary bone- and bone- implant healing
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    extra-articular heterotopic ossification

 Fracture: classification; relevance to future implantation strategy Look/feel
Heterotopic ossification Feel/move