Comparison of the efficacy of three types of Kirschner wire tension bands for ulnar olecranal fracture / 中国骨伤

OBJECTIVE@#To compare the clinical effect of three types of Kirschner wire tension band for olecranon fracture.@*METHODS@#The clinical data of 64 patients with olecranon fracture treated by Kirschner wire tension band fixation from March 2016 to May 2020 were retrospectively analyzed. Among them, 19 patients were treated with intramedullary K-wires fixation(group A) including 8 males and 11 females with an average of (48.2±18.3) years old, 3 patients were typeⅠ, and 16 patients were typeⅡ according to Mayo classification;20 patients were treated with transcortical K-wires fixation (group B) including 13 males and 7 females with an average of (43.5±20.4) years old, 3 patients were typeⅠand 17 patients were typeⅡ according to Mayo classification;25 patients were treated with perforated Kirschner wire(group C) including 15 males and 10 females with an average of (55.2±17.5) years old, 4 patients were typeⅠand 21 patients were typeⅡ according to Mayo classification. The operative time, intraoperative blood loss, times of Intraoperative fluoroscopy, fracture healing time and complications of 3 groups were compared. At the final follow-up, elbow function was assessed using the Mayo Elbow Function Scale.@*RESULTS@#There were differences in operative time, intraoperative fluoroscopy times, postoperative VAS and soft tissue irritation among the three groups(P<0.05). The operative time, intraoperative fluoroscopy times in group A and C was better than that in group B. The postoperative VAS score, skin irritability in group C was better than that of group B. The difference was statistically significant on Mayo elbow function score at the final follow-up among three groups(P<0.05), the scores of group A and C were higher than that of group B.@*CONCLUSION@#Compared with transcortical K-wires screw fixation, both intramedullary K-wires screw fixation and perforated Kirschner wire fixation, which can significantly reduce the occurrence of soft tissue irritation, reduce surgical complications and shorten the operation time.

Clinical observation of double mini locking plate in the treatment of olecranon fracture / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of double mini-locking plates in the treatment of ulna olecranon fractures.@*METHODS@#From March 2017 to May 2020, 19 patients with olecranon fractures were treated with double mini locking plates, including 12 males and 7 females, aged from 20 to 75 years old with an average of (40.50±7.62) years old;10 patients had the injuries on the left side and 9 patients on the right side. All the 19 patients were fresh closed fractures without ulnar coronoid process fracture, elbow dislocation and other injuries. The fracture healing time and complications were recorded, and the clinical efficacy was evaluated by Mayo elbow performance score (MEPS) before operation and 12 months after operation.@*RESULTS@#All the 19 patientswas followed up, and the duration ranged from 12 to 17 months with an average of (13.51±3.17) months. Postoperative follow-up showed all fractures healed. Fracture healing time ranged from 2 to 6 months, with an average of(3.77±1.24) months. There was no internal fixation fracture, screw loosening, infection, internal fixation irritation, heterotopic ossification, elbow stiffness and other complications occurred. The MEPS score of affected elbow at 12 months after operation was 91.26±3.87, which was significantly different from that before operation 56.18±9.56 (@*CONCLUSION@#It is a reliable fixation method to treat olecranon fracture with double mini locking plate. The incision lengh is small and the fracture fixation is reliable. Elbow joint function exercise can be performed early after operation. Postoperative internal fixation has less skin irritation and satisfactory elbow joint function recovery.

Closed folding apex manipulation combined with splinting for the treatment of double fractures of distal ulna and radius in children / 中国骨伤

OBJECTIVE@#To investigate specific technique and clinical effects of closed folding top consolidation maneuver combined with splint fixation maneuver for consolidation and cedar bark external fixation splint for the treatment of double fractures of distal ulna and radius in children.@*METHODS@#From January 2017 to December 2019, 17 children with double fractures of distal ulna and radius were treated with closed folded apex consolidation maneuver, including 13 males and 4 females, aged from 4 to 11 years old with an average of (7.29±2.34) years old. The fractures were fixed with cedar bark splint and followed up for 6 months, and alignment of fracture was evaluated according to the latest X-rays by follow up, and function of the affected limbs was evaluated by Anderson forearm function evaluation criteria.@*RESULTS@#Fifteen of 17 children were successfully reset immediately, and 2 children were successfully reset again. The average fixed time was (25.00±3.35) days. At 6 months of follow up, 12 patients got excellent results, 3 good, 2 fair, and 0 poor according to Anderson forearm function evaluation criteria. The position of all children were larger than 3/4, and 10 children were received anatomical reduction, alignment of 4 children was less than 10°, 3 children was less than 15°. No complications such as fracture displacement, nonunion, compartment syndrome, and forearm rotation dysfunction occurred.@*CONCLUSION@#Restoration of distal radius double fracture in children with the combination of the closed folding and top fixation maneuver and splint fixation maneuver has advantages of higher success rate, lower complications, which could reduce operating difficultyand pain of patients.

Pseudoartrosis diafisaria de cúbito y radio con minifijador externo modelo RALCA® e injerto óseo homólogo / Diaphyseal Pseudoarthrosis of the Ulna and Radius Treated with the RALCA® Model External Minifixator and Homologous Bone Graft

RESUMEN Introducción: Las pseudoartrosis diafisarias de cúbito y radio constituyen un desafío terapéutico para el cirujano ortopédico, a causa de la dificultad para lograr y mantener la reducción de dos huesos paralelos en presencia de músculos pronadores y supinadores que ejercen influencias angulares y rotacionales. Objetivo: Evaluar la eficacia de la aplicación del minifijador externo combinado con el injerto óseo homólogo en esta afección. Métodos: Se realizó un estudio longitudinal, retrospectivo de corte transversal en 74 pacientes operados de pseudoartrosis diafisaria de cúbito y radio desde enero de 2000 hasta diciembre de 2014, en el Complejo Científico Ortopédico Internacional Frank País, en los que se utilizó el modelo de minifijación externa RALCA® e injerto óseo homólogo del Banco de Tejidos ORTOP. Resultados: La pseudoartrosis fue más frecuente en hombres (73 por ciento) y en las edades comprendidas entre 30 y 39 años. La localización más frecuente fue en el cúbito, en su tercio superior (52 por ciento). La mayoría de los pacientes presentaron una pseudoartrosis no viable (56 por ciento). Se consolidó en 66 por ciento de los pacientes antes de las 18 semanas y en solo uno no se obtuvo la consolidación. El hueso que menos tiempo requirió para consolidar fue el radio. En la evaluación de la eficacia de la técnica quirúrgica se obtuvo 62 por ciento de resultados buenos, 33 por ciento regulares y 5 por ciento malos. Conclusiones: La asociación de la minifijación externa modelo RALCA® e injerto óseo homólogo de banco mostró buenos resultados en el tratamiento de la pseudoartrosis de cúbito y radio(AU)

ABSTRACT Introduction: Diaphyseal pseudoarthroses of the ulna and radius constitute a therapeutic challenge for the orthopedic surgeon, due to the difficulty to achieve and maintain the reduction of two parallel bones in the presence of pronator and supinator muscles that exert angular and rotational influences. Objective: To evaluate the effectiveness of using external minifixator combined with homologous bone graft in the treatment of this condition. Method: A longitudinal, retrospective and cross-sectional study was carried out with 74 patients operated on, from January 2000 to December 2014, for diaphyseal pseudoarthrosis of the ulna or radius at Frank País International Orthopedic Scientific Complex, cases in which RALCA® external minifixation and homologous bone graft from the ORTOP Tissue Bank were used. Results: Pseudoarthrosis was more frequent in men (73 percent) and at ages 30-39 years. The most frequent location was the ulna, in its upper third (52 percent). Most of the patients had nonviable pseudoarthrosis (56 percent). The condition was consolidated in 66 percent of the patients within 18 weeks, and only one did not achieve consolidation. The bone that took the least time to heal was the radius. In the evaluation of the effectiveness of the surgical technique, 62% obtained good outcomes; 33 percent fair outcomes; and 5 percent, poor outcomes. Conclusions: The association of the RALCA® model miniexternal fixation and homologous bone graft from the Bank showed good outcomes in the treatment of ulna and radius pseudoarthrosis(AU)

Aloenxertos ósseos e enxerto sintético de hidroxiapatita em falha óssea ulnar em galinhas (Gallus gallus domesticus), aspectos radiográficos e histológicos / Bone allografts and synthetic grafts hydroxyapatite on ulnar bone defect in fowl (Gallus gallus domesticus), radiographic and histological aspects

Dos atendimentos ortopédicos realizados em aves no HCV-UFRGS, 86% são fraturas, sendo aproximadamente 30% delas cominutivas com perda óssea expressiva, justificando a importância da utilização de enxertos em fraturas de aves. O objetivo deste trabalho foi avaliar dois aloenxertos e enxerto sintético de hidroxiapatita em defeito ósseo de galinhas. Utilizaram-se 30 galinhas separadas em três grupos: aloenxerto congelado em ultra-freezer (GUF), aloenxerto congelado em nitrogênio líquido (GNL) e enxerto sintético de hidroxiapatita deficiente em cálcio (GHA). Nos três grupos, os enxertos foram aplicados com placas e parafusos bloqueados de 2mm na ulna direita das aves, avaliando-se a evolução por meio de exames radiográficos até serem completados 90 dias de pós-operatório e o resultado final mediante exame histológico. A média e desvio-padrão relacionando o tempo de consolidação óssea radiográfica foi: GNL 61,67±21,79 dias (90% de consolidação), GUF 47,14±13,50 dias (70% de consolidação) e GHA 70±18,17 dias (60% de consolidação). Houve diferença significativa no tempo de consolidação óssea entre o GUF e o GHA. Histologicamente, os enxertos do GUF foram os que estavam em consolidação mais avançada. Os aloenxertos do GNL foram superiores no preenchimento de falha óssea ulnar de galinhas.(AU)

Of the orthopedic visits performed on birds at HCV-UFRGS, 86% are fractures, and approximately 30% of them are comminuted with expressive bone loss, justifying the importance of the use of grafts in bird fractures. The objective of this work was to test two allografts and a synthetic HADC graft on finishing in Gallus gallus domesticus. 30 laying hens were used, divided in three groups: frozen allograft in ultrafreezer (UFG); frozen allograft in liquid nitrogen (LNG); calcium deficient synthetic hydroxyapatite graft (HAG). The three graft groups were exposed to serial radiographs until the 90 postoperative days, as well as the histological examination at the end of the experiment were: LNG 61.67±21.79 days (90% consolidation), UFG 47.14±13.50 days (70% consolidation) and HAG 70±18.17 days (60% consolidation). There was a significant difference in bone healing time between GUF and GHA. Histologically, GUF grafts were the ones that were in the most advanced consolidation. LNG allografts were superior in filling ulnar bone failure of fowl.(AU)

Choice of internal fixation selection and clinical effect of olecranon fracture / 中国骨伤

OBJECTIVE@#To compare clinical effects of common Kirschner wire, anatomical plate and perforated Kirschner wire in treating olecranon fracture.@*METHODS@#From March 2014 to May 2017, clinical data of 79 patients with olecranon fracture treated with different internal fixation was retrospectively analyzed. Among them, 26 patients treated with common Kirschner wire (group A), including 19 males and 7 females aged from 23 to 51 years old with an average of (37.2±9.6) years old;11 patients were typeⅠ, and 15 patients were typeⅡ according to Mayo classification. Twenty eight patients were treated with olecroanon anatomical plate internal fixation, including 16 males and 12 females aged from 25 to 52 years old with an average of (36.6±8.9) years old;10 patientswere typeⅠ and 18 patients were typeⅡ according to Mayo classification. Twenty five patients were treated with perforated Kirschner wire, including 13 males and 12 females aged from 26 to 51 years old with an average of (38.2±9.2) years old;9 patients were typeⅠand 16 patients were typeⅡ according to Mayo classification. Operation time, intraoperatve blood loss, fracture healing time and postoperative complications among three groups were compared; VAS score at 1 week after operation was used to evaluate pain relief, Broberg-Morrey function score of elbow joint at the final follow up was applied to evaluate clinical effect.@*RESULTS@#Seventy nine patients were followed up from 13 to 23 months with an average of (18.3±4.5) months. Operation time, intraoperatve blood loss, fracture healing time in group A were (82.9±19.7) min, (113.5±32.3) ml, (4.2±0.6) months respectively;in group B were(101.2±24.5) min, (150.2±39.5) ml, (4.6±0.8) months respectively;in group C were (83.3±18.7) min, (119.3±34.3) ml, (4.1±0.5) months respectively. Operation time, intraoperatve blood loss, fracture healing time in group A and group C were better than that of group B(0.05).@*CONCLUSION@#Common Kirschner wire has more complications; anatomical plate has greater surgical trauma and long fracture healing time;while perforated Kirschner wire was not only benefit for fracture union with less trauma, but also could reducing the incidence of postoperative complications, and it is the appropriate method for patients with olecranon fracture.

Effects of ulnar styloid and sigmoid notch fractures on postoperative wrist function of patients with distal radius fracture / 北京大学学报(医学版)

OBJECTIVE@#To study the effects of ulnar styloid and sigmoid notch fractures on postoperative wrist function in patients with distal radius fracture.@*METHODS@#In total, 139 patients treated for distal radius fracture in the Department of Orthopedic Trauma at Peking University People's Hospital from Jan. 2006 to June 2016 were selected for outpatient follow-ups. Evaluation was based on Sartiento's modification of the Gartland and Werley scores. Efficacy was assessed with wrist pain as the focus.@*RESULTS@#The excellent and good efficacy rate was 97.1% (excellent: n=107, 77.0%; good: n=28, 19.4%; and fair: n=4, 2.9%). Gender, age, and whether the ulnar styloid fracture achieved union did not significantly impact the scores (P>0.05). The scores of the basal fracture group were significantly different (P=0.001). Internal fixation of ulnar styloid fracture was associated with a significant difference in scores (P=0.005). The effect of sigmoid notch fracture was also associated with a significant difference in scores (P=0.024). This study included 22 cases of ulnar wrist pain, and the overall incidence of ulnar wrist pain was 15.8%. Gender, age, whether the ulnar styloid fracture achieved union, and whether internal fixation was conducted for ulnar styloid fracture and sigmoid notch fracture had no significant effect on the occurrence of ulnar wrist pain (P>0.05). The incidence of ulnar wrist pain was higher in basal fractures than that in tip fractures. Among ulnar styloid fractures, the union rate of basal fracture was higher than that of tip fractures. The union rates of basal fracture and tip fracture were significantly different (P<0.001). Basal fractures were significant risk factors for ulnar wrist pain (P=0.028). Basal fracture of the ulnar styloid group and sigmoid notch fracture group had poor wrist function scores. Wrist function score improved significantly after internal fixation of ulnar styloid fracture. The incidence of ulnar wrist pain was higher in basal fracture group. The union rate in basal fracture group was higher than in tip fracture group.@*CONCLUSION@#The overall effect of surgical treatment of distal radius fracture is satisfactory. Ulnar styloid basal fracture and sigmoid notch fracture are risk factors for postoperative wrist dysfunction in patients with distal radius fracture, and the basal fracture is one of the risk factors of ulnar wrist pain. The union rate of ulnar styloid basal fractures is better than that of tip fractures. Internal fixation of ulnar styloid fracture can improve wrist function.

Tratamiento conservador versus tratamiento quirúrgico de fracturas de estiloides cubital en el contexto de fracturas del radio distal / Conservative vs. surgical management of ulnar styloid fractures associated with distal radius fractures

Objetivo: Determinar si los resultados clínicos y radiográficos difieren después del tratamiento conservador y el tratamiento quirúrgico para las fracturas de la estiloides cubital asociadas a fracturas inestables del radio distal tratadas mediante placa volar bloqueada. Materiales y Métodos: Estudio multicéntrico, retrospectivo y descriptivo que incluye pacientes operados en cuatro instituciones, entre 2009 y 2012. Todos tenían fracturas de la estiloides cubital en el contexto de una fractura del radio distal. Las fracturas de la estiloides cubital fueron tratadas de forma conservadora (grupo I) o con cirugía (grupo II). Resultados: El seguimiento promedio fue de 56 meses. Se evaluó a 57 pacientes; grupo I (29 casos) y grupo II (28 casos). Los pacientes del grupo II tuvieron 2,76 veces (IC95% 1,086; 8,80) más posibilidades de lograr una consolidación que aquellos del grupo I. El puntaje DASH y el dolor, tanto en reposo como en actividad, no presentaron diferencias significativas (p = 0,276 y p = 0,877). La desviación cubital y la fuerza obtuvieron mejores resultados en el grupo I (p = 0,0194 y p = 0,024). Conclusiones: Aunque los pacientes con estabilización quirúrgica de la estiloides cubital tuvieron 2,76 más posibilidades de lograr la consolidación que aquellos del grupo I, no hubo diferencias significativas en la evaluación subjetiva (DASH y dolor) entre ambos grupos. Tampoco hubo diferencias significativas cuando se consideró el grado de compromiso de la estiloides cubital, pero la fuerza y la desviación cubital presentaron mejores resultados en el grupo sin fijación de la estiloides cubital. Nivel de Evidencia: III

Objectives: To evaluate potential differences in clinical and radiological outcomes after surgical versus conservative management of ulnar styloid fractures associated with unstable distal radius fractures treated by locked volar plating. Materials and Methods: This was a multicenter, retrospective and descriptive study including surgical patients treated at four different institutions between 2009 and 2012 for ulnar styloid fractures associated with unstable distal radius fractures. Ulnar styloid fractures were treated conservatively in group I and surgically in group II. Results: The average follow-up was 56 months. The study included 57 patients divided into two groups (group I [29 cases] and group II [28 cases]). Patients in group II had 2.76 times (95% CI: 1.086; 8.80) more chances of achieving bone union than those in group I. DASH and pain scores, both at rest and during activity, did not show significant differences between the two groups (p = 0.276 and p = 0.877). Group I presented milder ulnar deviation and better strength (p = 0.0194 and p = 0.024). Conclusions: Although patients who underwent surgery for ulnar styloid fractures had 2.76 more chances of achieving bone union than those who received conservative management, there were no significant differences between both groups in subjective evaluations (DASH and pain scores) or when considering the degree of ulnar styloid involvement. However, the parameters of strength and ulnar deviation were better in the conservative management group. Level of Evidence: III

Intramedullary Flexible Nailing for Diaphyseal Fractures of Forearm Bones in Children / Fixação intramedular flexível para fraturas diafisárias dos ossos do antebraço em crianças

Abstract Objectives Most of the fractures of the bones of the forearm in children are successfully treated conservatively with closed reduction and casting. The outcomes remain variable and the patients may require additional fracture manipulation or formal surgical intervention due to residual angulations. The present study assesses the radiological and functional outcomes of treating displaced forearm fractures in children with intramedullary flexible titanium elastic nailing. Methods A total of 31 patients aged between 7 and 15 years old with displaced forearm fractures underwent flexible titanium elastic nailing. The patients were followed-up for a mean period of 8.51 months (range: 6-12 months) and were assessed for radiological and functional outcomes. The Price criteria were used to assess the functional outcome. Results Out of 31 patients, 21 patients underwent closed reduction, and 10 required a minimal opening of the fracture site during reduction. A total of 29 patients had excellent results with normal forearm and elbow range of motion (ROM), and 2 patients had good results. In all patients, good radiological union was seen at an average time of 7.9 weeks. Five patients had minor complications, such as skin irritation over the prominent ulnar nail (n = 2), superficial nail insertion site infection (n = 2), and backing out of the ulnar nail (n = 1), requiring early removal. Conclusion Flexible nailing is an efficient application of internal fixation for shaft fractures of both bones of the forearm in children, enabling early mobilization and return to the normal activities of the patients, with low and manageable complications.

Resumo Objetivos A maioria das fraturas dos ossos do antebraço em crianças é tratada com sucesso de forma conservadora com redução fechada e imobilização gessada. No entanto, alguns pacientes podem necessitar de manipulação adicional da fratura ou intervenção cirúrgica devido a angulações residuais. O presente estudo avalia o resultado clinico e radiológico do tratamento de fraturas com desvio do antebraço em crianças fixadas com haste elástica intramedular de titânio. Métodos Um total de 31 pacientes com idades entre 7 e 15 anos com fraturas com desvio do antebraço foram submetidos a haste elástica de titânio flexível. Os pacientes foram acompanhados por um período médio de 8,51 meses (variação: 6-12 meses) e avaliados quanto aos resultados funcionais pelos critérios de Price e radiológicos. Resultados Dos 31 pacientes, 21 foram submetidos a redução fechada e 10 necessitaram de abertura mínima do local da fratura durante a redução. Um total de 29 pacientes tiveram excelentes resultados com arco de movimento normal, e 2 pacientes apresentaram bons resultados. Em todos os pacientes, a consolidação ocorreu em um tempo médio de 7,9 semanas. Cinco pacientes tiveram complicações menores, como irritação da pele sobre a haste proeminente (n = 2), infecção superficial do local de inserção no rádio (n = 2) e recuo da haste ulnar (n = 1), que exigiu remoção precoce. Conclusão A haste flexível é um método eficiente para tratamento da fratura do antebraço em crianças, permitindo mobilização precoce e retorno às atividades normais dos pacientes, com baixas e tratáveis complicações.

Clinical observation of olecranon sled for the treatment for olecranal fracture / 中国骨伤

OBJECTIVE@#To explore clinical effect of olecranon sled in treating olecranal fracture.@*METHODS@#Four patients with olecranal fracture treated by olecranon sled in March 2017, including 2 males and 2 females, age of 40, 46, 47, 72 years old, 3 patients on the left side and 1 patient on the right side. All patients were caused by falling down. Fracture were transverse, oblique and slightly compressive articular surface fracture. The time from injury to operation ranged from 1 to 3 days. Operative time, blood loss, complications and flexion and extension of elbow joint, and function of forearm were observed, VAS score was used to evaluate relieve degree of pain, and Mayo score was applied to assess recovery of elbow function.@*RESULTS@#Four patients were followed up until September 2018. Operative time ranged from 40 to 60 min, blood loss was for 20 to 40 ml, and no complications occurred. All fracture were healed at 4 months after operation. Elbow flexion was for 140° to 150°, extension of elbow was from 0° and extend to 10°, activity of flexion and extension ranged from 140 ° to 160°, MEPS score was 100. No pain occurred during doing activity, and VAS score was 0.@*CONCLUSIONS@#Low-profile design and integrated design of olecranon sled could avoid irritation of tension band and plate, and it is a simple and ideal internal fixation method for simple and mildly comminuted olecranon fracture, which is not suitable for severely comminuted olecranon fracture.

Fracturas diafisarias radiocubitales en pacientes pediátricos. Revisión de resultados de tratamiento / Forearm diaphyseal fractures in pediatric patients. Review of treatment results

Resumen: Objetivo: Describir los tipos de fracturas más comunes en pacientes menores de 16 años de edad a nivel de antebrazo y evaluar, dependiendo del nivel de la fractura, el tratamiento con mejores resultados. Material y métodos: Realizamos un análisis retrospectivo para determinar frecuencia de las fracturas de antebrazo en menores de 16 años, en el período de Enero 2013-Julio 2017. Se ingresó en sistema los siguientes diagnósticos: fractura de antebrazo, fractura de radio, fractura de cúbito y fractura radiocubital. Resultados: Se incluyeron 573 pacientes: 413 hombres, 160 mujeres; lado afectado derecho: 230, izquierdo 338, bilateral 5; nivel afectado: 438 distales, 102 medias y 33 proximales. La edad pico de presentación fue a los ocho años. El tratamiento inicial fue conservador en 92%, seguido de reducción cerrada y fijación percutánea con 4.71% y se tuvo 2.4% para reducción abierta y fijación interna con placas. Se tuvo un tratamiento inicial fallido en 3.83% al encontrarse una reducción inadecuada. Discusión: Encontramos que el tratamiento de las fracturas en nuestra institución es conservador en 92%, se usa la reducción cerrada y fijación percutánea sólo en 4.71% y sólo se realiza de primera intención la reducción abierta y fijación interna en 2.4% siendo la mayor prevalencia en pacientes mayores de 12 años con fracturas diafisarias medias radiocubitales.

Abstract: Objective: To describe the most common types of fractures in patients under 16 years of age at the forearm level, and to evaluate depending on the level of the fracture, the treatment with better results. Material and methods: We perform a retrospective analysis to determine the frequency of forearm fractures in patients under 16 years, in the period from January 2013-July 2017. The following diagnoses were entered into the system: forearm fracture, radius fracture, ulnar fracture and bilateral fracture. Results: We included 573 patients: 413 male, 160 females; right affected side: 230, left: 338, bilateral 5. Affected level: 438 distal, 102 mid-shaft and 33 proximal. The peak age of presentation was eight years. The initial treatment was conservative in 92%, followed by closed reduction and percutaneous fixation with 4.71 and 2.4% for open reduction and internal fixation with plates. There was a failed initial treatment at 3.83% when an inadequate reduction was found. Discussion: We found that the treatment of this fractures in our institution is conservative in 92%, closed reduction and percutaneous fixation in 4.71% and open reduction and internal fixation in a 2.4% being The highest prevalence in patients older than 12 years with bilateral mid-shaft fractures.

Fragmento dorso-ulnar en fracturas de radio distal: clasificación y manejo / Dorso-ulnar fragment in distal radius fractures: classification and treatment

INTRODUCCIÓN: El fragmento dorso-ulnar (FDU) en la fractura intraarticular de radio distal es de especial importancia puesto que implica una alteración en la articulación radio-carpiana así como también en la articulación radio-ulnar distal (RUD), donde la incongruencia articular permanente puede generar secuelas a largo plazo. OBJETIVO: Proponer una clasificación del FDU, definiendo cuándo realizar el procedimiento quirúrgico con asistencia artroscópica, basado en una serie consecutiva de casos operados de fractura del radio distal estudiados con tomografía computada (TC). MÉTODO: Estudio descriptivo de una serie de casos de pacientes operados por fractura del radio distal entre enero del 2015 y diciembre del 2016. En base a eso, se elabora una clasificación del FDU y se sugiere un esquema de manejo específico. Se describe el FDU como aquel fragmento específico ubicado en la esquina dorso-ulnar de la carilla articular del radio distal, con compromiso de más del 30% de la superficie articular RUD y más de 5mm desde el borde ulnar hacia radial de la cortical dorsal del radio observado en el corte axial de la TC preoperatoria. Se considera un fragmento mayor (FM) cuando el rasgo de fractura compromete hacia radial hasta el tubérculo de Lister y se considera fragmento menor (Fm) cuando el rasgo no alcanza a comprometer el tubérculo de Lister. Nuestra propuesta de clasificación reconoce 4 tipos: tipo I (FM sin desplazamiento, en fracturas tipo C de la AO); tipo II (FM con desplazamiento, en fracturas tipo C de la AO); tipo III (Fm independiente del desplazamiento, en fracturas tipo C de la AO) y tipo IV (FM/Fm con desplazamiento, en fracturas tipo B2 de la AO). Esquema de manejo: Tipo I síntesis con placa bloqueada por abordaje palmar, sin obligación de asistencia artroscópica. Tipo II síntesis con placa bloqueada por abordaje palmar, con asistencia artroscópica requerida. Tipo III síntesis percutánea dorsal contornillo canulado, bajo asistencia artroscópica. Tipo IV síntesis dorsal con placa o tornillo mediante abordaje dorsal bajo visión directa o con asistencia artroscópica, usando portales artroscópicos volares. RESULTADOS: Se operaron 488 fracturas de radio distal durante el período mencionado; 375 fracturas clasificadas como tipo C de la AO. Del total operadas, solo 392 fracturas contaban con TC peroperatoria, que permitía evaluar la presencia del FDU, el cual estuvo presente en 127/392 de los casos (32,4%). Analizados por grupo, 38 casos presentaban fragmentos tipo I, 22 tipo II, 69 tipo III y 7 tipo IV. DISCUSIÓN: El FDU se presentó en un 32,4% de los casos evaluables por TC en nuestra serie. El manejo dirigido de este fragmento con asistencia artroscópica permitió una reducción anatómica con fijación estable específica de éste. CONCLUSIÓN: Proponemos una nueva clasificación del FDU basada en la TC preoperatoria que permite realizar un adecuado plan prequirurgico y abordar este fragmento de manera específica sugiriendo cuando utilizar asistencia artroscópica.

INTRODUCTION: The dorsal-ulnar fragment (DUF) in the distal radius fracture is of special importance since it implies an alteration in the radio-carpal joint as well as in the distal radio-ulnar joint (DRUJ), where permanent joint incongruence can generate long-term sequelae. OBJECTIVE: To propose a classification of the DUF, advising when to perform arthroscopic assistance, based on a consecutive series of operated cases of distal radius fracture studied with computed tomography (CT). METHODS: Descriptive study of a series of cases of patients operated of distal radius fracture between January 2015 and December 2016. We describe a classification of the DUF and suggest a specific treatment scheme. The DUF is described as that specific fragment located in the dorso-ulnar corner of the articular surface of the distal radius, which involves more than 30% of the articular surface of the DRUJ and more than 5mm of the ulnar edge of the dorsal cortex of the radius observed in the axial section of the preoperative CT. It is considered a major fragment (FM) when the fracture compromises the Lister tubercle and is considered a minor fragment (Fm) when it does not. Our classification recognizes 4 types of DUF: type I (FM without displacement, in type C fractures of the AO); Type II (FM with displacement, in type C fractures of the AO); Type III (Fm independent of displacement, in fractures type C of the AO) and type IV (FM/Fm with displacement, in fractures type B2 of the AO). Treatment scheme: Type I: synthesis with a palmar locked plate without arthroscopic assistance required. Type II: synthesis with palmar locked plate with arthroscopic assistance. Type III dorsal percutaneous synthesis with cannulated screw with arthroscopic assistance. Type IV dorsal synthesis with plate or screw by dorsal approach under direct vision or with arthroscopic assistance using volar portals. RESULTS: A total of 488 distal radius fractures were operated during this period. Only 392 fractures had preoperative CT, which allowed to evaluate the presence of the DUF. It was present in 127/392 of the cases (32.4%). Analyzed by group, 38 cases presented fragments type I, 22 cases type II, 69 cases type III and 7 cases type IV. DISCUSSION: The DUF was presented in 32.4% of the cases in our series. The management of this fragment with arthroscopic assistance allowed an anatomical reduction with specific stable fixation of this fragment. CONCLUSION: We propose a novel classification of the DUF based on preoperative CT that allows a specific management of this fragment and suggest when to use arthroscopic assistance.

Injerto óseo vascularizado pediculado del radio distal para tratar la seudoartrosis recalcitrante del cúbito / Vascularized bone graft of the distal radius for recalcitrant ulnar pseudoarthrosis

Introducción: El objetivo de este trabajo es presentar los resultados clínicos y radiológicos de una serie de pacientes tratados con injerto óseo vascularizado pediculado del radio distal para seudoartrosis recalcitrantes de cúbito diafisario o proximal. Materiales y Métodos: Se realizó un estudio retrospectivo que incluyó a pacientes con seudoartrosis del cúbito diafisario o proximal con defectos <6 cm y, al menos, tres cirugías previas y un seguimiento mínimo de dos años tratados con injerto óseo vascularizado pediculado del radio distal. Se registró la cantidad de cirugías previas. Se evaluaron el rango de movilidad del codo y la muñeca, la fuerza de puño comparativa, el dolor mediante la escala analógica visual, el cuestionario QuickDASH y el puntaje de la Clínica Mayo para codo. Resultados: Se incluyó a siete pacientes. La edad media fue de 42 años (rango 26-64). El número promedio de cirugías previas fue 4 (rango 3-7). El seguimiento medio fue de 31 meses (rango 24-43). Todas las seudoartrosis consolidaron. El puntaje de la Clínica Mayo fue bueno en 4 pacientes, excelente en 2 pacientes y moderado en uno. El puntaje QuickDASH posoperatorio promedio fue de 13 (rango 0-29). El arco de flexo-extensión de la muñeca fue del 81% del contralateral. El rango de movilidad del codo fue >100° en 5 pacientes y de 50°-100° en 2 pacientes. Conclusión: El injerto óseo vascularizado pediculado del radio distal es una alternativa eficaz para el tratamiento de la seudoartrosis del cúbito. Nivel de Evidencia: IV

Introduction: The purpose of this study was to analyze the clinical and radiological outcomes of a series of patients treated with pedicled distal radius vascularized bone graft for recalcitrant ulnar nonunions. Methods: A retrospective study was performed. The inclusion criteria were patients with diaphyseal or proximal ulnar nonunions with bone defects <6 cm, at least three previous surgeries and a minimum follow-up of 2 years, treated with pedicled vascularized bone graft of distal radius. The number of previous surgeries was recorded. Elbow and wrist range of motion, comparative grip strength, and pain using the Visual Analogue Scale, QuickDASH questionnaire and Mayo Clinic score for elbow were evaluated. Results: Seven patients were included. The mean age was 42 years (range 26-64). The average number of previous surgeries was 4 (range 3-7). The mean follow-up was 31 months (range 24-43). All pseudoarthrosis consolidated. The Mayo Clinic score was good in 4 patients, excellent in 2 patients and moderate in one patient. The mean postoperative Quick- DASH score was 13 (range 0-29). Flexion-extension arch of the wrist was 81% of the contralateral. The elbow range of motion was >100° in 5 patients and 50°- 100° in 2 patients. Conclusion: The pedicled vascularized bone graft of the distal radius is an effective alternative for the treatment of recalcitrant ulnar nonunions. Level of Evidence: IV

Osteossíntese de rádio e ulna em Gavião Caboclo (Buteogallus meridionalis) / Radius and ulna osteosynthesis in a Savanna Hawk (Buteogallus meridionalis)

Foi atendido um Gavião Caboclo (Buteogallus meridionalis), de vida livre e histórico desconhecido. O paciente apresentava impotência funcional da asa direita e solução de continuidade de aspecto recente envolvendo a região de rádio e ulna direitos caracterizando fratura aberta grau II. Os achados radiológicos foram fratura completa cominutiva de diáfise média de ulna e fratura completa tranversa de diáfise média de rádio. A estabilização da fratura de rádio foi realizada com miniplaca de 1,5mm de 6 orifícios, com 2 parafusos proximais e 2 parafusos distais e, osteossíntese de ulna com placa bloqueada de 2,0mm de 12 orifícios, com 3 parafusos proximais e 2 parafusos distais. Aos 180 dias de pós-operatório, os implantes ortopédicos foram removidos e o paciente recebeu alta. Conclui-se que o emprego de placa bloqueada para tratamento de fraturas abertas em ulna de Gavião Caboclo, pode propiciar adequada consolidação e retorno à função do membro sendo capaz de voar.(AU)

A wild Savanna Hawk (Buteogallus meridionalis) of unknown history, was seen at the veterinary hospital. The patient presented with a dropped right wing and soft tissue damage that appeared to be a recent wound involving the right radius and ulna region, characterizing an open fracture grade II. The radiological findings were a comminuted complete fracture of the ulnar diaphysis and complete transverse fracture of the radial diaphysis. Stabilization of the radius fracture was performed with a 1.5mm miniplate with 6 holes, with 2 proximal screws and 2 distal screws, and ulna osteosynthesis with a 2.0mm locking plate with 12 holes, with 3 proximal screws and 2 distal screws. At 180 postoperative days, the implants were removed and the patient was discharged. The use of locking plate for the treatment of open fractures in ulna of Savanna Hawks may provide adequate healing and return to limb function being able to fly.(AU)

Defectos óseos diafisarios postraumáticos en la extremidad superior de niños / Post-traumatic diaphyseal bone defects in the upper extremity of children

Introducción: El objetivo de este estudio fue evaluar si la combinación de osteosíntesis asociadas a autoinjerto óseo representa un método terapéutico eficaz y confiable en niños con defectos óseos segmentarios diafisarios crónicos en el húmero o los huesos del antebrazo. Materiales y Métodos: Se evaluó retrospectivamente a nueve niños, tratados entre 2005 y 2015, con fracturas en huesos largos de la extremidad superior que se infectaron y resultaron en defectos óseos segmentarios; todas con ≥6 meses de evolución desde el trauma inicial. Se incluyó a 7 niños y 2 niñas, con una edad promedio de 9.9 años. Cuatro defectos óseos se localizaban en el húmero; tres, en el cúbito y dos, en el radio. Todos habían sido sometidos a intervenciones quirúrgicas (promedio 3,7) que originaron defectos óseos de 4,5 cm en promedio. El tiempo entre el trauma inicial y la cirugía definitiva promedió los 21.8 meses. Resultados: El seguimiento promedio fue de 2.2 años. Se obtuvo la consolidación en todos los casos. En un paciente, se utilizó espaciador de cemento y, en otro, injerto libre de peroné. Dos pacientes con lesión en el húmero presentaron un acortamiento significativo. Todos los niños retomaron sus actividades deportivas y recreativas sin limitaciones. Conclusiones: Mediante la combinación de diferentes tipos de autoinjerto óseo, diversas placas colocadas puenteando la lesión y la técnica de la membrana inducida, se logró la consolidación y los nueve niños con defectos óseos diafisarios segmentarios en húmero, cúbito o radio retornaron a sus actividades normales. Nivel de Evidencia: IV

Introduction: The aim of this study was to evaluate the results achieved in children with chronic segmental bone defects at the humerus or forearm. Methods: Nine children, treated between 2005 and 2015, presenting long bone upper extremity fractures that got infected resulting in segmentary bone defects were retrospectively evaluated; all lesions had 6 or more months from trauma. Seven patients were male and two female, with an average age of 9.9 years. Four defects were located at the humerus, three at the ulna, and two at the radius. All patients had had previous surgical interventions (average 3.7), originating bony defects that averaged 4.5 cm. Time from initial trauma to definitive surgery averaged 21.8 months. Results: Follow-up averaged 2.2 years. Union was achieved in all patients. A cement spacer was used in one case, in another case a free fibular bone graft was used. Two patients with humeral defects had significant shortening. All patients returned to their recreational and sports activities without limitations. Conclusions: The combination of different types of bone autograft, various plaques placed bypassing the lesion and the induced membrane technique allowed us to obtain consolidation and return to normal activity in the nine children with segmental bone defects in humerus, ulna or radius. Level of Evidence: IV

Distal Radioulnar Joint Arthritis / 대한정형외과학회잡지

The distal radioulnar joint (DRUJ) is a complex structure that enables sufficient, painless forearm rotation and provides weight-bearing capabilities of the upper extremity. Arthritis of DRUJ is multifactorial; the most common causes are trauma, congenital anomalies, as well as degenerative and inflammatory diseases. Congenital etiologies, as well as degenerative and inflammatory causes of arthritis are more common in women. Conventionally, initial management of symptomatic DRUJ arthritis is nonsurgical; surgery is generally reserved for patients with refractory pain. Moreover, advanced arthritis arising from trauma can be prevented by early interventions in the form of corrective osteotomy for malunited distal radius and distal ulna fractures, repair/reconstruction of the triangular fibrocartilage complex, and ulnar shortening osteotomy. Although the outcomes are typically positive following excision of the distal ulna in definitive arthritis, postoperative complications, such as instability and impingement of the residual distal ulna stump, can be serious. Procedures managing unstable residual ulna include soft tissue stabilization techniques and DRUJ implant arthroplasty.

Treatment of a forelimb fracture and rehabilitation of a free-ranging iberian wolf (canis lupus signatus) / Osteossíntese de fratura localizada no membro torácico num lobo ibérico (canis lupus signatus) selvagem e sua reabilitação

The surgical treatment of an exposed compounded comminuted fracture of the right radius and ulna in a free-ranging adult female Iberian Wolf (Canis lupus signatus) with an osteosynthesis plate and screws and subsequent post-operative care are described. The evolution of the fracture healing was very similar to those expected in a dog of the same size. The prompt surgical intervention and a proper housing, feeding and wound management adapted to a free-ranging wolf, in view to reduce manipulation and post-operative complications, allowed the subsequent rehabilitation and release of the animal. After 10th post-operative weeks the wolf was fitted with a Global Positioning System (GPS) for wildlife tracking collar and released in the same area where it has been caught. GPS telemetry data showed that the animal covered increasingly large distances confirming a complete functionality of the right thoracic limb and its successfully return to the wild. This report could constitute the first detailed report of a long bone fracture treatment in a free-ranging wolf and its successfully rehabilitation, release and adaptation to the wild.

O objetivo do presente artigo é a descrição da realização da estabilização de uma fratura cominutiva exposta do rádio e ulna do membro torácico direito em Lobo Ibérico selvagem por meio de osteossíntese com placa e parafusos ósseos bem como o manejo pós-operatório. A evolução da cicatrização da fratura óssea foi similar à esperada num canídeo doméstico de porte idêntico. A intervenção cirúrgica realizada rapidamente, bem como o alojamento adequado, alimentação e manejo adaptado a um lobo selvagem, visando minimizar a manipulação e o aparecimento de possíveis complicações pós-operatórias permitiram o sucesso na reabilitação e posterior libertação do animal. Na 10ª semana pós-operatória foi colocado um colar GPS no animal para deteção permanente da sua localização, tendo sido o animal libertado na mesma área onde havia sido capturado. Os dados obtidos por telemetria GPS demostraram que o lobo percorreu distâncias consideráveis, confirmando a completa recuperação do membro torácico direito e o sucesso da sua reintrodução na natureza. Este artigo poderá constituir a primeira descrição pormenorizada sobre a estabilização de fratura de ossos longos em um lobo selvagem com a sua posterior reintrodução na vida selvagem com sucesso.

The Radial Bow following Square Nailing in Radius and Ulna Shaft Fractures in Adults and its Relation to Disability and Function

One of the points made against nailing in radius and ulna shaft fractures has been the loss of radial bow and its impact on function. The aims of the study were to assess the change in magnitude and location of the radial bow in radius and ulna shaft fractures treated with intramedullary square nails and to assess the impact of this change on functional outcome, patient reported disability and the range of motion of the forearm. We measured the magnitude of radial bow and its location in the operated extremity and compared it to the uninjured side in 32 adult patients treated with intramedullary square nailing for radius and ulna shaft fractures at our institute. The mean loss of magnitude of maximum radial bow was 2.18 mm which was statistically significant by both student-T test and Mann-Whitney U test with p value less than 0.01. The location of maximum radial bow shifted distally but was statistically insignificant. The magnitude of maximum radial bow had a negative correlation with DASH score that was statistically insignificant (R=- 0.22, p=0.21). It had a positive, statistically significant correlation to the extent of supination in the operated extremity (R = 0.66, p = 0.0004). A loss of up to 2mm of radial bow did not influence the functional outcome as assessed by criteria reported by Anderson et al. The magnitude of radial bow influenced the supination of the forearm but not the final disability as measured by DASH score. Intramedullary nailing did decrease the magnitude of radial bow but a reduction of up to 2mm did not influence the functional outcome.

Surgical treatment for Mayo II B comminuted fracture of the olecranon / 中国骨伤

<p><b>OBJECTIVE</b>To study clinical effects of surgery for the treatment of Mayo II B comminuted fracture in ulna olecranon.</p><p><b>METHODS</b>From May 2008 to March 2015, a total of 37 patients with Mayo II B comminuted fracture in ulua olecranon were treated, including 20 males and 17 females, ranging in age from 40 to 65 years old ,with an average of 53 years old. All the patients were treated with open reduction and internal fixation within 4 to 7 days after injuries. All the patients had pain and functional disorder uf elbow joint. The X-ray and CT examination showed ulna olecranon comminuted fracture of Mayo II B. Postoperative complications were observed ,and Broberg-Morrey criteria was used tu evaluate therapeutic effects.</p><p><b>RESULTS</b>All the patients were followed up ,and the duraiton ranged from 9 to 30 months ,with a mean of 15 months. Two patients had surface infection around incision ,and were healed by changing dressings. No other complications occurred such as needle slipping to stimulate skin ,screw loosening and wire broken. One patient had slight uneveness of joint surface without obvious functional disorder. According to Broberg-Morrey elbow fracture curative effect criteria, 11 paients got an excellent result, 24 good and 2 fair,and the total score was 87.0 ± 7.3.</p><p><b>CONCLUSION</b>For the Mayo II B comminuted fracture in ulna olecranon, preoperative preparation, intraoperative restoring of the articular surface smooth and reasonable internal fixation, and postoperative rehabilitation actively, can obtain satisfactory clinical effects.</p>