Outcomes after radioscapholunate arthrodesis for intra-articular malunion of distal radius fractures.

PURPOSE: To study the clinical, radiological, and functional outcomes after of radioscapholunate (RSL) fusion for intra-articular malunion of the distal radius. METHODS: This retrospective study included 26 patients (17 males and 9 females) with intra-articular malunion of distal radius fractures who underwent RSL arthrodesis using locked miniplates (without distal scaphoid excision) between 2012 and 2020. Their mean age was 43 years (range, 32-56). Patients were assessed radiographically for union and clinically for range of motion, grip strength, and pain (assessed by Visual Analogue Scale (VAS) for pain). Functional evaluation was performed by using the Mayo modified wrist score (MMWS) and the Disabilities for the Arm, Shoulder, and Hand (DASH) questionnaire. RESULTS: All patients showed complete healing at the fusion site after a mean of 8.7 weeks (range, 8-12). The mean follow-up period was 72 months (range, 60-84). The pinch strength improved from a mean of 6.2 kg (range, 3-12) to a mean of 9.8 kg (range, 5-18) which represents 80% of the contralateral side. The mean pinch strength was 7 kg (range, 5-18) which presents 80% of the other side. VAS for pain showed a mean improvement of 72.6%. The DASH score improved to a mean of 19.2 (range, 14-24). The MMWS improved to a mean of 68 (range, 45-86). At the final follow-up period, no degenerative changes were detected in the midcarpal joint. CONCLUSION: RSL arthrodesis (using locked miniplates without distal scaphoid excision) is a reliable surgical procedure to manage cases of radiocarpal OA after intra-articular malunion of distal radius fractures with good clinical and radiological outcomes. LEVEL OF EVIDENCE: Level IV- therapeutic.

Postoperative physical therapy program for latissimus dorsi and teres major tendons transfer to rotator cuff in children with obstetrical brachial plexus injury.

BACKGROUND: The transfer of latissimus dorsi and teres major tendons to rotator cuff have been developed to rebalance the muscular dysfunction and improve shoulder range of motion in children with obstetrical brachial plexus palsy (OBPP). No previous study reported the ideal postoperative physical therapy program for these cases. AIM: The aim of the present study was to design appropriate postoperative physical therapy (PT) program after latissimus dorsi and teres major tendons transfer to rotator cuff in OBPP to improve upper limb function. DESIGN: Time series design. SETTING: The patients were recruited from outpatient clinic of Kasr EL Aini Hospital, Cairo, Egypt. POPULATION: Forty seven OBPP infants (4.64±1.21 years with a range of 2.5 to 7 years, 21male and26 female) were allocated to one group. All patients had functional limitation in the involved arm due to muscle paralysis and contracture. Twenty-five patients had C5-C6 nerve root lesions while 22 had C5-C6-C7 nerve root lesions. METHODS: The children underwent the surgical procedures of the transfer of latissimus dorsi and teres major tendons to rotator cuff. After the surgery the children participated in a designed physical therapy program for 6 months. Active shoulder abduction, flexion and external rotation range of motion (ROM) were assessed by electrogoniometer, and functional assessments were measured using the modified Mallet scale. All measurements were taken preoperative, 6 weeks, 3 months, and 6 months postoperatively after the application of the designed PT program. RESULTS: Repeated measure analysis of variance (ANOVA) followed by Bonferroni post-hoc test were used to show the improvement in all measured variables. Analysis revealed that shoulder abduction, flexion and external rotation ROM and shoulder function measured by modified Mallet scale were significantly improved (P<0.0001) after the designed postoperative PT program. CONCLUSIONS: It can be concluded that the combination treatment of surgical procedure and the postoperative physical therapy program seem to be effective in improving shoulder and arm functions in children with OBPP. CLINICAL REHABILITATION IMPACT: This study describes a detailed physical therapy program after latissimus dorsi and teres major tendons transfer to rotator cuff in OBPP.

Treatment of post-infection nonunion of the supracondylar humerus with Ilizarov external fixator.

BACKGROUND: Nonunion of the supracondylar area of the humerus is a very difficult area to treat. The Ilizarov method has been shown to be effective in the treatment of nonunion of the humeral diaphysis. However, there is little in the literature regarding the treatment of nonunion of the supracondylar area especially in post-infection cases. METHODS: Eight patients with a mean age of 45.73 ± 11.42 years were treated for post-infection nonunion of the supracondylar area of the humerus with the Ilizarov method and followed up for 3 years. All had undergone at least 2 previous failed operations. The patients were evaluated radiologically and clinically with an outcome survey using the Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS: Solid union was achieved in all patients in a mean time of 6.87 ± 0.99 months. All patients had improvement in shoulder and elbow motion after treatment. The mean DASH score before surgery was 90.66 ± 5.66, whereas that after surgery was 24.62 ± 3.85. There was a significant improvement in the DASH score after surgery; the mean difference was 66.04 ± 1.81, with a t value of 35.88 (P < .001). All patients were satisfied with the treatment and returned to a more normal lifestyle with no pain, as well as complete soft-tissue recovery. None had recurrence of infection. CONCLUSION: Ilizarov treatment for post-infection nonunion of the supracondylar humerus was shown to be effective, reliable, and tolerated by the patients.