Ulnar stress reaction in an axillary crutch user.

Ulnar stress fractures have been reported in athletes performing repetitive, high-impact activities, such as baseball pitchers and gymnasts. Crutch-assisted walking also results in cyclical forearm loading. We report the first case of ulnar stress reaction due to axillary crutch use. A 23-year-old right-handed woman experienced right forearm pain and imaging confirmed a right ulnar stress injury. The patient was also found to have mild hypercortisolism, low bone mass and vitamin D deficiency. Crutches were discontinued and physical therapy to normalise weight bearing through the left leg was prescribed. The patient's right forearm symptoms resolved and she was started on oral vitamin D supplementation. Axillary crutch use may result in ulnar stress injury, particularly in vulnerable populations. The addition of an upper extremity injury to someone with impaired mobility may compound disability. As such, clinicians should be aware of the clinical presentation of ulnar stress fractures in the long-term axillary crutch user.

An Alternative to the Traditional Radiocapitellar Line for Pediatric Forearm Radiograph Assessment in Monteggia Fracture.

OBJECTIVE: To find a new reference for assessment of pediatric forearm radiographs besides the traditional RCL. METHODS: RCLs were drawn on the anteroposterior (AP) and lateral radiographs of 170 normal pediatric forearms. Three lines were drawn on each radiograph: the first was drawn along the longitudinal center of the radial neck (N-line); the second, along the radial shaft (S-line); and the third, through the midpoints of the proximal and distal radial physes (P-line). RESULTS: The P-line was least likely to miss the capitellum on both AP views and lateral views, and the P-line most frequently passed through the central third of the capitellum on both AP views and lateral views. CONCLUSIONS: Our proposed radiocapitellar P-line was found to be much more reliable in younger children than traditional RCLs.

Superimposed electrical stimulation improves mobility of pre-stiff thumbs after ulnar collateral ligament injury of the metacarpophalangeal joint: a randomized study.

OBJECTIVE: This study aimed at testing the ability of the superimposed electrical stimulation technique to restore the mobility of pre-stiff thumbs after operative repair for rupture of the ulnar collateral ligament. MATERIAL AND METHODS: Eight patients demonstrating a pre-stiff metacarpophalangeal joint were involved in two rehabilitation sessions of a counterbalanced design. In the voluntary contraction session, they performed 20min of repeated active flexions of the impaired metacarpophalangeal joint. In the superimposed electrical stimulation session, they performed 20min of percutaneous neuromuscular electrical stimulations which were superimposed to voluntary flexion. RESULTS: Mean active range of motion improvement from pre- to post-session was significantly greater in the superimposed electrical stimulation condition compared to the voluntary contraction condition (11±5 deg versus 3±4 deg; P<0.01). CONCLUSION: Superimposing electrical stimulation to voluntary contractions is an efficient technique to improve active range of motion of the pre-stiff metacarpophalangeal joint of the thumb.

[Manipulative reduction and splint fixation for the treatment of middle and lower segment fracture of ulnar and radius].

OBJECTIVE: To investigate the outcome of manipulative reduction and splint fixation for treatment of middle and lower fractures of ulnar and radius. METHODS: Sixty-eight patients with lower segment fractures of ulnar and radius included 46 male and 22 female, aged from 1 to 26 years. The course was from 10 min to 1 week. There were 39 cases in right and 29 in left; 45 in inferior segment and 23 in middle segment. All cases were closed fractures. According to fracture displacement, different methods of manipulation and splint or plaster splint fixation were used to reduction and fixation. RESULTS: Sixty-eight patient were followed-up for 0.5 to 1 year (mean 8 months), the fractures were all healing. According to the effective evaluation criteria, the results were excellent in 57 cases, good in 11. X-ray film showed anatomic reduction in 38 cases, similar to anatomic reduction in 20, functional reduction in 10. CONCLUSIONS: Manipulative reduction and splint fixation for the treatment of the ulnar and radial bone fractures is a method of simple, minimally invasive, effective and functional advantages of quick recovery.

[Tumor-like bone lesions of the forearm after karate training]. / Tumorartige Knochenalterationen am Unterarm nach Karatetraining.

INTRODUCTION: Differentiation between malignant bone tumors and tumor-like lesions after repetitive microtrauma following sport activities can be difficult just using radiographic methods. METHODS: We present the case of a fifteen year old karate fighter, who was examined by imaging diagnostics because of a progressive swelling and pain in the distal right forearm. RESULTS: A tumor-like appearance with bone mass formation in the x-ray, an enhancement in the surrounding tissue shown in the MRI and an increased activity in the bone scintigraphy made the diagnosis of an osteosarcoma very likely. Blood tests were not helpful. Only the evaluation of a bone biopsy could demonstrate hypertrophic reparative bone formation after multiple osseous microtrauma. Cast immobilisation reduced the osseous alteration. With the start of the training the swelling reappeared again but then finally vanished after modifying the training technique. DISCUSSION: The case demonstrates that even modern imaging techniques cannot always distinguish between tumor and tumor-like lesions caused by sports. It also stresses the importance of a correct technique in sports like karate.

Pattern duplication by retinoic acid treatment in the regenerating limbs of Korean salamander larvae, Hynobius leechii, correlates well with the extent of dedifferentiation.

In the regenerating limbs of Korean salamanders, Hynobius leechii, retinoic acid (RA) induces duplication of skeletal structures in the proximodistal (PD) axis and often in the transverse axes. In the present study, the stage-dependent effects of RA for the duplication of limb skeletal structures at two amputation levels, the distal stylopodium and the distal zeugopodium, were studied using larval limbs of Korean salamanders. The results showed that the mean level of proximalization (MLP) by RA treatment increased during the stages of dedifferentiation and early bud formation while the MLP declined thereafter in both amputation levels. The decline of the MLP at the later stages of regeneration was due to the high frequency of hypomorphic regeneration or blocked regeneration. When the effects of RA treatment at two amputation levels were compared, the overall trends were similar but the actual timing was delayed for 2-4 days in the proximal level of amputation. Furthermore, the peak level of proximalization was achieved earlier and the peak level remained longer in the distal stylopodial level of amputation compared to the distal zeugopodial level of amputation. Since the histological observations revealed that the dedifferentiation period was also extended up to 2-4 days in the proximal level of amputation, the acid phosphatase activity during the course of regeneration was measured to look for a quantitative relationship between the enzyme activity and the states of dedifferentiation. The results show that the level and the duration of acid phosphatase activity in the upper arm regenerates are both higher and longer than those in the lower arm regenerates. Furthermore, RA treatment caused an increase in acid phosphatase activity. Thus our results suggest that the state of dedifferentiation might be closely linked to the extent of proximalization of regenerating limbs by RA treatment.

Clinical and roentgenographic evaluation of nonunion of the forearm in relation to treatment with D.C. electrical stimulation.

A total of 50 nonunions of the forearm bones in 42 patients were reviewed. The mean age was 35.6 years, with the majority secondary to motor vehicle accidents. Five of the nine identified infections were due to primary closure of the initial open fracture. The middle third of the forearm was the most common site of the nonunion. The majority (96%) had significant displacement on the original roentgenograms. Open fractures were more apt to develop nonunions. A gap produced a significant therapeutic challenge and we conclude such are best managed with a bone graft. If a compression plate is applied in the presence of comminution, a bone graft is indicated. The overall success rate with 3 months of D.C. electrical stimulation in the absence of a gap or infection was 80.0%. This compares favorably with time-honored bone graft surgery for nonunion.