Proximal Ulna Osteotomy for Complex Fractures of the Distal Humerus: A 3-Dimensional Laser Analysis and Comparison With Olecranon Osteotomy.

PURPOSE: The current methods of distal humerus (DH) articular surface visualization only allow a limited view of the joint. This study describes an osteotomy procedure that increases the visualization of and access to the DH articular surface for fixation without compromising ligaments. METHODS: Eighteen fresh-frozen human elbows (9 matched pairs) underwent proximal ulna osteotomy (PUO) or transverse olecranon osteotomy (OO) contralaterally. The visualized articular surface of the DH was demarcated, and the surface areas of the DH, capitellum, and trochlea were measured using 3-dimensional scanning. The angular arc of the articular surface of the capitellum and trochlea was measured using a goniometer. RESULTS: The 3-dimensional scans showed that 87.6% of the total DH surface area was visualized using PUO versus 65.6% using OO. When the trochlea and capitellum surface areas were separated, 94.0% versus 75.9% of the trochlea and 74.8% versus 44.7% of the capitellum were visualized using PUO and OO, respectively. The goniometric angles demonstrated that 98.2% versus 70.9% of the trochlea and 75.1% versus 43.5% of the capitellum articular surface arc angles were visualized using PUO and OO, respectively. After PUO with further release of the flexor-pronator mass was performed, 100% of the DH articular surface was visualized. CONCLUSIONS: Proximal ulnar osteotomy improves the visualization of the DH articular surface. CLINICAL RELEVANCE: Proximal ulna osteotomy spares ligaments, avoids osteotomizing the greater sigmoid notch, involves more robust metaphyseal bone for potentially better fixation, and may permit DH arthroplasty without compromising primary ligamentous elbow stabilizers. Further clinical studies are needed to assess the utility of this type of osteotomy.

Apparent Proximal Ulna Dorsal Angulation Variation Due to Ulnar Rotation.

OBJECTIVE: To investigate the effect of ulna rotation on the apparent proximal ulna dorsal angulation (PUDA). METHODS: Computed tomography images of 59 ulnas were included in this study, 48 being bilateral specimens and the remaining 11 were unilateral. Three-dimensional models of the entire ulna were obtained, and the ulnas were rotated in 5-degree increments in internal rotation or external rotation from neutral. PUDA, PUDA apex, varus angulation, and varus apex were measured on each ulna. RESULTS: With the ulna in neutral rotation, the mean (95% CI) PUDA was 3.7 (2.9-4.5) degrees, whereas the mean varus angle was 10.5 (9.8-11.1) degrees. The varus angle apex and PUDA apex were 28.9 (27.5-30.2)% and 19.6 (18.7-20.6)% along the total length of the ulna, respectively. As the ulna was rotated externally by 5, 10, and 15 degrees, the PUDA increased by 0.7 (0.5-0.9) degrees, 1.2 (0.9-1.4) degrees, and 1.4 (1.1-1.8) degrees, respectively. Conversely, with internal rotation of 5, 10, and 15 degrees, the PUDA decreased by 0.9 (0.8-1.1) degrees, 2.0 (1.8-2.3) degrees, and 3.3 (2.7-3.9) degrees, respectively. CONCLUSIONS: This study demonstrates that small degrees of ulna rotation result in a statistically significant change in the apparent PUDA; however, this may not represent a clinically significant difference. Because of the anatomic variation between patients, it is important to obtain a contralateral film to determine the PUDA for anatomic reduction of the ulna in complex cases. When using a contralateral image, it is important to obtain a true lateral film or consider using 3-dimensional imaging for preoperative planning.

Supercharge End-to-Side Anterior Interosseous Nerve to Ulnar Motor Nerve Transfer for Severe Ulnar Neuropathy: Two Cases Suggesting Recovery Secondary to Nerve Transfer.

INTRODUCTION: The supercharged end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar nerve transfer has been recently described for severe cubital tunnel syndrome. Previous studies have suggested that this technique augments or "babysits" the motor end plates until reinnervation occurs; however, it has more recently been suggested that reinnervation occurs by the donor nerve as evidenced in animal research. CASE REPORT: We present two cases of rapidly progressive ulnar neuropathy who underwent a SETS AIN to ulnar nerve transfer who demonstrated improvement in their electrodiagnostic studies in addition to improvement in their clinical and patient-reported outcome's scores postoperatively. CONCLUSION: Our findings provide further evidence that previously demonstrated in the literature that the SETS does more than "babysit" the motor end plates, but that there is axonal growth along the new pathway.

Comparison of vascular stiffness in vascular dementia, Alzheimer dementia and cognitive impairment.

Abstract Defining the vascular component(s) of the clinical diagnosis of vascular cognitive impairment (VCI) and vascular dementia (VaD) continues to be problematic. The goal of this study was to determine whether vascular stiffness, measured by pulse wave velocity (PWV), is altered in VaD, to study the utility of PWV in differentiating VaD from Alzheimer dementia (AD) and the relationship between PWV and cognitive function. A qualitative and quantitative structured analysis of the literature was conducted until September 2010, using a search strategy based on the key words: dementia, vascular dementia, dementia of vascular origin, cognitive function and arterial stiffness or pulse wave velocity. Seventeen studies assessed large vessel vascular stiff by PWV and related it to cognitive function or dementia. Six of these studies compared PWV in 154 persons with VaD, 207 with AD and 197 controls without dementia. Mean PWV was significantly (p < 0.0001) higher in VaD compared with controls. Mean PWV was significantly (p = 0.002) higher in VaD compared with AD. Fourteen studies examined the relationship between PWV and cognitive function. The majority of studies (nine of 14) reported a significant correlation between PWV and cognitive function. Four of eight studies that evaluated the relation using univariate analysis reported a significant correlation of PWV with the Mini Mental State Exam (MMSE) or Hasegawa Dementia Scale, and the correlation with MMSE between studies showed a close agreement of correlation coefficients (0.206 to 0.27). In multivariate analysis, adjusted for a wide range of possible confounding factors, the majority or 80% (eight out of 10) studies comprising a population of 6,034 individuals found a significant inverse relationship between PWV and cognitive function. In summary, vascular stiffness is inversely related to cognitive function. Vascular stiffness is greater in VaD compared with AD, suggesting PWV may be useful in identifying VaD.