Treatment of Distal Radius Fracture Nonunion With Posterior Interosseous Bone Flap.

BACKGROUND: Nonunion of distal radius fractures is disabling. Treatment is difficult and the results are not predictable. However, posterior interosseous bone flap (PIBF) has been successful in treating forearm nonunion. OBJECTIVES: To treat distal radius fracture nonunion with PIBF as a new procedure. PATIENTS AND METHODS: This prospective non-randomized cohort study was performed at two hospitals in Tehran between January 2011 and September 2015. PIBFs were applied in nine patients (10 nonunions) with a mean age of 55 years. Union success rate, grip strength, wrist range of motion, and forearm rotation were then evaluated. RESULTS: Although four of the patients had a history of infection, all participants achieved fracture union at a mean time of 3.8 months. Grip strength improved by 12.4 kg. There was also 36° improvement in wrist flexion, 20° improvement in wrist extension, 60° improvement in forearm supination, and 46° improvement in forearm pronation. The range of motion and grip strength improvements were significant. CONCLUSIONS: Pedicled PIBF is a new option for treating distal radius fracture nonunion. The results are predictable in achieving union and good function, and this technique can be successfully used in cases with extensive soft-tissue damage or infection.

Trans-4 Portal as a New Portal for Accessing the Lunate in Wrist Arthroscopy: a Cadaveric Study.

BACKGROUND: Evolving wrist arthroscopy requires creating new portals, and creating portals reciprocally leads to increased indications for arthroscopic wrist procedures. To facilitate access to the lunate bone and fossa for new arthroscopic procedures, a new portal was used. This is a cadaveric study of this portal. OBJECTIVES: In this cadaveric study, we evaluated a portal in wrist arthroscopy for procedures involving the lunate bone and lunate fossa. MATERIALS AND METHODS: Seventeen wrists from 10 fresh cadavers were included in this study. After diagnostic arthroscopy, a portal (Trans-4) was made through the fourth extensor compartment, exactly along the lunate's long axis under direct visualization from the 3-4 portal. Strand retractors were used to protect the extensor tendons and posterior capsule. Lunate bone core decompression and osteoscopy were done through the portal. At the end of the procedure, the position of the decompression hole in the lunate and any possible injury to the extensor tendons, distal radius cartilage, lunate cartilage, and perilunate ligaments were investigated. RESULTS: Lunate bone decompression was performed successfully in all cases using the trans-4 portal. In 15 wrists, the lunate hole was located in the middle third. In the other two wrists, it was located slightly radial in one case and slightly on the ulnar side in the other case. There was no cortical penetration during decompression, and no extensor tendon, superficial nerve branches, or peri-lunate ligament injuries were observed. CONCLUSIONS: The trans-4 portal could be a safe working portal in wrist arthroscopy that enables access to the lunate bone and lunate fossa.

Treatment of Nonunion of Forearm Bones Using Radial Forearm Bone Flap.

BACKGROUND: Treatment of forearm fracture nonunion is challenging. Several surgical techniques for the treatment of forearm nonunion have been reported. OBJECTIVES: The aim of this prospective study was to evaluate the effects of the radial forearm bone graft technique in cases with forearm nonunion. PATIENTS AND METHODS: We treated 7 patients with forearm nonunions via radial forearm bone flap and internal plate fixation. On the preoperative examination and last follow-up, the quick disabilities of the arm, shoulder, and hand (Q-DASH) score, elbow, forearm and wrist arches of motion and grip force were measured. At the final follow-up, radiographic union and patient satisfaction and return to work were assessed. RESULTS: The mean follow-up duration was 34 ± 23 months. The Q-DASH scores improved from 70 ± 6 points preoperatively to 13 ± 15 points at final follow-up (P < 0.01). The preopetative range of motion (ROM) was 101 ± 26 degrees; whereas the final forearm ROM was 140 ± 17 (P = 0.01). All nonunions united uneventfully (range 3-6 months). At the last follow-up, the grip force was 83% of uninjured extremity and all patients were satisfied with the outcome of the operation. CONCLUSIONS: Radial forearm bone flap is a safe, useful and novel technique in cases with forearm nonunion.

Descriptive epidemiology of traumatic injuries in 18890 adults: a 5-year-study in a tertiary trauma center in iran.

BACKGROUND: Basic epidemiological data can provide estimates when discussing disease burden and in the planning and provision of healthcare strategies. There is little quantitative information in the literature regarding prevalence of traumatic injuries from developing countries. OBJECTIVES: The aim of the current preliminary study was to reveal the prevalence and age and gender distribution of various traumatic injuries in a tertiary referral orthopedic hospital in Iran. PATIENTS AND METHODS: In a prospective descriptive study, all traumatic injured patients attending the Orthopedic Trauma Unit of our center in a five year period were included. Demographic details, the cause of injury, injury classification and treatment were recorded. For each of the five-year age groups and each gender we calculated the numbers with fractures, dislocations, soft tissue injuries, ligamentous injuries and lacerations and derived average age and gender-specific prevalence as well as seasonal variations. RESULTS: A total of 18890 adults were admitted, 13870 (73.4%) males and 5020 (26.6%) females. There were 8204 (43.4%) fractures. The male fracture age distribution curve was unimodal and there was a detectable bimodal pattern in females. Under 65 years males are 3 times more likely to sustain a fracture than females which decreases to equal risk over the age of 65. The most common fracture site was distal radius/ulna (13.8%), followed by tibial diaphysis (8.8%), proximal femur (7.8%), finger phalanges (6.4%), metacarpals (6%) and metatarsals (5.9%). There were seasonal variations in fracture incidence with peaks in February, March and October. The least number of fractures occurred in June. CONCLUSIONS: The risk of traumatic injuries is higher among specific age groups with different patterns emerging for men and women. Thus, the descriptive epidemiology will provide useful information for treatment or injury prevention strategies, resource allocation, and training priorities.