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1.
Medicine (Baltimore) ; 99(16): e19782, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311987

RESUMO

RATIONALE: Congenital proximal radioulnar synostosis is a rare genetic malformation of the upper limb. This deformity, which is found mainly in preschool-aged children, has no recognized diagnosis and treatment. Current diagnostic methods cannot effectively assess both bone structure and soft tissue abnormalities, and most surgical treatments introduce complications and do not prevent recurrence. More work is needed; therefore, to address the diagnosis and treatment of this disease. PATIENT CONCERNS: An 8-year-old male patient was hospitalized in our department. He reported deformity and limited motion in his right elbow for the past 2 years. He denied a traumatic or family history of bony malformation. The chief complaint at the time of the hospitalization was the limitation in forearm rotation. DIAGNOSIS: Digital radiography of the right elbow joint showed proximal radioulnar synostosis and a valgus deformity. A 3-dimensional computed tomography scan further showed proximal ulna and radius dysplasia as well as anterior dislocation of the radius head. The patient was diagnosed with congenital right proximal radioulnar synostosis. INTERVENTIONS: Surgical procedures included arthrolysis of the right proximal radioulnar joint, osteotomy of the proximal radius, internal fixation with Kirschner wires, and reconstruction of the annular ligament. The right elbow was immobilized in plaster in a flexion and supination position for 2 weeks. OUTCOMES: Recurrence of the right proximal radioulnar synostosis was observed during the 6-month follow-up, but the rotation function of the patient's forearm was significantly improved. LESSONS: The findings from this case suggest that we should carefully monitor all patients younger than 6 years old who report long-term issues with forearm rotation. This case also highlights the need to assess soft tissue and epiphysis abnormalities in addition to bone assessments via digital radiography and 3-dimensional computed tomography. We suggest that surgery should not be performed until the proximal radius epiphysis has closed. Not all cases require surgical treatment, but when surgery is needed, a suitable method should be selected according to the individual needs of the patient. Any surgery performed should treat both the bony malformations and soft tissue abnormalities to maximize the therapeutic effect and reduce complications during and after surgery.


Assuntos
Procedimentos Ortopédicos/métodos , Rádio (Anatomia)/anormalidades , Sinostose/cirurgia , Ulna/anormalidades , Criança , Humanos , Masculino , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/cirurgia , Sinostose/diagnóstico por imagem , Ulna/diagnóstico por imagem , Ulna/cirurgia
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(3): 352-356, 2020 Mar 15.
Artigo em Chinês | MEDLINE | ID: mdl-32174082

RESUMO

Objective: To evaluate the long-term effectiveness of vascularized fibula flap in radiocarpal joint reconstruction following excision of Campanacci grade Ⅲ giant cell tumor (GCT) of distal radius. Methods: Between December 2010 and December 2014, 10 patients with Campanacci grade Ⅲ GCT of distal radius were treated with en bloc excision and inradiocarpal joint reconstruction using vascularized fibula flap. They were 6 males and 4 females, with an average age of 39.9 years (range, 22-65 years). The disease duration was 1.5-6.0 months (mean, 2.6 months). The length of distal radius defect was 6.0-12.5 cm (mean, 8.4 cm) after en bloc excision of GCT. Vascularized fibula flap with inferior lateral genicular vessels were performed in 6 patients and with inferior lateral genicular vessels and peroneal vessels in 4 cases. Results: All incisions healed by first intention. All patients were followed up 4.4-8.3 years (mean, 6.0 years). There was no tumor recurrence during follow-up. At last follow-up, the mean ranges of motion of wrist joint were 55.0° (range, 25-85°) in extension, 26.5° (range, 15-40°) in flexion, 12.0° (range, 5-25°) in radial deviation, 19.6° (range, 10-30°) in ulnar deviation, 50.5° (range, 5-90°) in pronation, and 66.5° (range, 20-90°) in supination. The mean grip strength of effected wrist was 75% (range, 60%-85%) of the healthy wrist. The mean Musculoskeletal Tumor Society (MSTS) score was 82.7% (range, 75%-90%). X-ray films showed that the fibula flap healed at 12-16 weeks after operation (mean, 14.1 weeks) and there were 9 cases of radiological complications. Conclusion: For Campanacci grade Ⅲ GCT of distal radius, application of the vascularized fibula flap in radiocarpal joint reconstruction after en bloc excision of GCT can obtain good wrist function.


Assuntos
Neoplasias Ósseas/cirurgia , Transplante Ósseo , Fíbula/transplante , Tumor de Células Gigantes do Osso/cirurgia , Articulação do Punho/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Rádio (Anatomia)/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Punho , Adulto Jovem
3.
Arch Orthop Trauma Surg ; 140(5): 675-680, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32193680

RESUMO

Posttraumatic malunion or secondary dislocation can cause wrist joint incongruency. Uncorrected malalignment increases the risk of secondary degenerative changes and chronic pain. Therefore, early correction using the available fixed-angle devices, cancellous bone grafting only becomes necessary in larger bony defects. Premounting the plate through a palmar approach with regard to the desired correction angles leads to predictable results by precise correction. In case of posttraumatic growth arrest with larger discrepancy of the radius and the ulna, a two-staged procedure is advisable.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas/métodos , Fraturas Mal-Unidas/cirurgia , Osteotomia/métodos , Fraturas do Rádio/cirurgia , Rádio (Anatomia)/cirurgia , Fraturas Mal-Unidas/diagnóstico , Humanos , Radiografia , Rádio (Anatomia)/diagnóstico por imagem , Fraturas do Rádio/diagnóstico , Reoperação
4.
Jt Dis Relat Surg ; 31(1): 14-9, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32160488

RESUMO

OBJECTIVES: This study aims to investigate if geometrical modelling in addition to three-dimensional (3D) modelling will standardize models and allow performing mathematical calculations easily for the compatibility of femoral implant curvature. PATIENTS AND METHODS: The study included 50 subjects (27 males, 23 females; mean age 55 years; range, 21 to 84 years). The femoral shaft intramedullary cavity was resembled into a chord of the ring cyclide, where the rotational radius was centered at its smallest radius. A 3D evaluation of the left femoral computed tomography data of the subjects was used to investigate the population parameters. The fitting was defined as being between the anterior and posterior border radii in the sagittal plane. RESULTS: The best fitting radius of implants was in between 90 to 99 cm in 72% of subjects in our sample. These radii values were lower than the mean intramedullary and cortical centerline radii which had only 62% and 50% fittings, respectively, among our population sample. The bowing radii and the smallest intramedullary width increased with the femoral length. These values were not affected by gender. CONCLUSION: This modelling may have value for understanding femoral shaft intramedullary cavity geometry and may be a good tool to assess implant fitting.


Assuntos
Fêmur/diagnóstico por imagem , Imageamento Tridimensional/métodos , Rádio (Anatomia)/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Feminino , Fêmur/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Rádio (Anatomia)/cirurgia
5.
J Pediatr Orthop ; 40(4): e306-e311, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32032220

RESUMO

BACKGROUND: Madelung deformity arises from a partial distal radial growth disturbance in combination with an abnormal hypertrophic ligament spanning the volar radius and carpus, termed, the Vickers ligament. The purpose of this study is to report long-term clinical and radiographic outcomes following Vickers ligament release and distal radial physiolysis in a population of skeletally immature patients with symptomatic Madelung deformity. METHODS: Medical records were retrospectively reviewed of patients with Madelung deformity surgically treated between 1994 and 2005. All eligible patients who underwent a Vickers ligament release and distal radial physiolysis were contacted and invited to return to the clinic for follow-up. RESULTS: Six patients (8 wrists) with Madelung deformity underwent Vickers ligament release and distal radial physiolysis. All were white females with a mean age at initial presentation of 11.4 years (10 to 12.8 y). Mean age at the time of initial surgery was 12.0 years (10.0 to 14.5 y). The median follow-up time was 10.6 years (5.8 to 21.9 y) and the average age at last follow-up was 23.1 years (17.5 to 32.2 y). Pain alone or in combination with concerns for deformity was the chief complaint in 6 of 8 of the wrists. At 1 year of clinical follow-up, 7 of 8 wrists were reported to be pain-free, and 6 of the 8 were noted to be completely pain-free at last follow-up. Motion in flexion, extension, pronation, supination, radial, or ulnar deviation was similar between the preoperative status and long-term follow-up. The average preoperative ulnar tilt was 35.1 degrees (SD: 8.5 degrees), average preoperative lunate subsidence was 1.9 degrees (SD: 1.8 degrees), and average preoperative palmar carpal displacement was 21.9 degrees (SD: 2.9 degrees). At the final follow-up, there was a large progression in lunate subsidence, but minimal change in ulnar tilt and palmar carpal displacement. At last clinical follow-up, 2 of the 6 patients had undergone a subsequent procedure including 1 radial dome osteotomy and 1 ulnar shortening osteotomy. CONCLUSION: In the skeletally immature patient population with Madelung deformity with growth potential remaining, distal radial physiolysis and Vickers ligament release is associated with relief of pain, preservation of motion, and, a reasonable rate of reoperation. TYPE OF STUDY: This was a therapeutic study. LEVEL OF EVIDENCE: Level II.


Assuntos
Transtornos do Crescimento/cirurgia , Ligamentos , Osteocondrodisplasias/cirurgia , Osteotomia , Rádio (Anatomia) , Articulação do Punho , Criança , Feminino , Humanos , Ligamentos/anormalidades , Ligamentos/cirurgia , Osteotomia/efeitos adversos , Osteotomia/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/cirurgia , Amplitude de Movimento Articular , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Tempo , Articulação do Punho/fisiopatologia , Articulação do Punho/cirurgia
6.
Tech Hand Up Extrem Surg ; 24(1): 37-42, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31368918

RESUMO

Radiocapitellar arthrosis represents a serious sequela of pediatric elbow injuries. Although persistent pain and disability are not uncommon in such cases, treatment remains controversial. The present study aimed to review the clinical outcomes after a new surgical treatment with partial radial head resection and corium interposition arthroplasty. To date, 3 adolescent cases underwent the surgical procedure and postoperative care. Thorough clinical and radiographic follow-up was performed. The mean age at the time of surgery was 14.4 years (range, 13 to 16 y) and mean duration of follow-up was 19 months (range, 12 to 29 mo). The postoperative range of motion was maintained in all cases. The outcome was rated as excellent in all 3 patients for the Disabilities of the Arm, Shoulder and Hand score (mean, 3; range, 0 to 6.7) and Mayo Elbow Performance Score (mean, 92; range, 80 to 100). The mean Timmermann score; however, was still rated as fair despite marked improvements (mean, 153; range, 145 to 165). No complications such as elbow stiffness, osteophytes formation, radial head overgrowth, or proximal radius migration occurred. In pediatric isolated posttraumatic radiocapitellar arthrosis, we believe that radial head resection and corium interposition arthroplasty is an effective salvage procedure to alleviate symptoms and maintain elbow function with good to excellent clinical outcomes and no proximal migration of the radius.


Assuntos
Artroplastia/métodos , Osteoartrite/cirurgia , Rádio (Anatomia)/cirurgia , Retalhos Cirúrgicos , Adolescente , Contraindicações de Procedimentos , Articulação do Cotovelo/lesões , Seguimentos , Humanos , Masculino , Osteoartrite/etiologia
7.
Arch Orthop Trauma Surg ; 140(1): 51-58, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31515620

RESUMO

INTRODUCTION: The purpose of this study is to analyze the mid-term outcomes of a modular monopolar type of radial head arthroplasty in the treatment of complex fractures associated with acute elbow joint instability. We postulated that radiographic changes are related to the development of clinical complications. MATERIALS AND METHODS: We evaluated at last follow-up 26 radial head arthroplasties in 26 consecutive patients who were followed for at least one and a half year. All patients had suffered radial head fractures (Mason III) in the context of unstable elbow injuries. Definitive treatment of the radial fracture was performed with modular and monopolar prosthesis which was inserted as a press fit. All patients were evaluated preoperatively and postoperatively. The evaluation included a clinical examination and a protocolized imaging study (standard X-Rays and CT) of the elbow. We analyzed the incidence of: heterotopic ossifications, secondary radiocapitellar joint osteoarthritis, hardware loosening, hardware disengagement, and joint infection. Diagnosis of clinical failure of the implant was defined as the time to the second surgery due to major complications related to the prosthesis, such as persistent lateral side pain or elbow stiffness and any kind of implant instability or dislocation. RESULTS: The implant-specific reoperation rate was 15% (four reoperations). The need for the second surgery was statistically associated with heterotopic ossifications, radiocapitellar osteoarthritis and cortical resorption around radial neck (p = 0.054, p = 0.033, and p = 0.019, respectively), being periprosthetic osteolysis the most likely factor related to failure, and radial pain the main symptom leading to surgical revision. CONCLUSIONS: Our study shows a positive association between radiographic findings and patient symptoms for postoperative complications after radial head arthroplasty. Failed radial head replacements may lead to reoperation mainly due to pain, and this can be distinguished from other causes of pain in elbow region based on its radial location. Radiological loosening was prevalent in this group of failed replacement.


Assuntos
Artroplastia , Fraturas do Rádio , Rádio (Anatomia) , Artroplastia/efeitos adversos , Artroplastia/estatística & dados numéricos , Seguimentos , Humanos , Prótese Articular , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/fisiopatologia , Rádio (Anatomia)/cirurgia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/epidemiologia , Fraturas do Rádio/fisiopatologia , Fraturas do Rádio/cirurgia , Tomografia Computadorizada por Raios X , Falha de Tratamento
8.
Bone Joint J ; 101-B(12): 1512-1519, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31787006

RESUMO

AIMS: The aim of this study was to evaluate the outcome of Monteggia-like lesions at midterm follow-up and to determine whether the surgical treatment of the radial head influences the clinical and radiological results. PATIENTS AND METHODS: A total of 78 patients with a Monteggia-like lesion, including 44 women and 34 men with a mean age of 54.7 years (19 to 80), were available for assessment after a mean 4.6 years (2 to 9.2). The outcome was assessed using the Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), Mayo Modified Wrist Score (MMWS), and The Disabilities of the Arm, Shoulder and Hand (DASH) score. Radiographs were analyzed for all patients. A total of 12 Mason type I, 16 type II, and 36 type III fractures were included. Surgical treatment consisted of screw fixation for all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) or excision was performed if reconstruction was not possible. RESULTS: The mean MEPS was 88.9 (40 to 100), mean OES was 40.1 (25 to 48), mean MMWS was 88.1 (50 to 100), mean DASH score was 14.7 (0 to 60.2), and mean movement was 114° (sd 27) in extension/flexion and 155° (sd 37) in pronation/supination. Mason III fractures, particularly those with an associated coronoid fracture treated with RHA, had a significantly poorer outcome. Suboptimal results were also identified in patients who had degenerative changes or heterotopic ossification on their latest radiograph. In contrast, all patients with successful radial head reconstruction or excision had a good outcome. CONCLUSION: Good outcomes can be achieved in Monteggia-like lesions with Mason II and III fractures, when reconstruction is possible. Otherwise, RHA is a reliable option with satisfactory outcomes, especially in patients with ligamenteous instability. Whether the radial head should be excised remains debatable, although good results were achieved in patients with ligamentous stability and in those with complications after RHA. Cite this article: Bone Joint J 2019;101-B:1512-1519.


Assuntos
Fixação de Fratura/métodos , Fratura de Monteggia/cirurgia , Rádio (Anatomia)/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fratura de Monteggia/diagnóstico por imagem , Avaliação de Resultados da Assistência ao Paciente , Rádio (Anatomia)/lesões , Estudos Retrospectivos , Resultado do Tratamento
9.
BMC Musculoskelet Disord ; 20(1): 440, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601273

RESUMO

BACKGROUND: Several methods have been reported to correct deformity and shortening of the distal radius. However, the results are not entirely satisfactory. The results of bifocal osteosynthesis were retrospectively analyzed in this study. METHODS: Eight patients treated with bifocal osteosynthesis were evaluated retrospectively. Pre-operative and post-operative clinical and radiographic examinations were performed. Subjective symptoms and objective joint function were assessed. Radiographic data of the extent of radial lengthening and distal radial articular angle were collected. RESULTS: The mean follow-up period was 46 months (37-68 months). Satisfactory wrist appearance and radial lengthening was achieved in all patients. All patients were satisfied with the wrist appearance and willing to undergo the same treatment again. The range of motion (ROM) of the forearm and wrist was significantly improved. Pin-track infections occurred in two patients, for which they received wound care and oral antibiotics. Complications such as fixation device failure, tendon rupture, fracture of regenerated bone or nerve impairment did not occur. The duration of lengthening depended on the shortening of the radius. Delayed union in the docking site was observed in two patients and union was achieved after bone grafting. CONCLUSIONS: Bifocal osteosynthesis using the Ilizarov method provides a useful method for correction of radial shortening deformity with dislocation of the inferior radioulnar joint. Despite the fact that we did not validate pre-and post-operation functional outcome scores, all patients were satisfied with the wrist appearance and function.


Assuntos
Técnica de Ilizarov , Luxações Articulares/cirurgia , Rádio (Anatomia)/cirurgia , Articulação do Punho/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/etiologia , Masculino , Satisfação do Paciente , Rádio (Anatomia)/anatomia & histologia , Rádio (Anatomia)/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Resultado do Tratamento , Articulação do Punho/fisiopatologia
10.
Medicine (Baltimore) ; 98(40): e17226, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577713

RESUMO

RATIONALE: Bone malformation occurs in 10% to 25% neurofibromatosis type 1 (NF-1) patients, and the manifestations are scoliosis, congenital arch and pseudo-joint formation, bone cyst, and pathologic fracture. However, a large segmental defect without obvious signs of bone destruction has rarely been reported. PATIENT CONCERNS: A 4.5-year-old male presented with a 4-year history of shortening of the right upper limb and radial head dislocation. The X-ray indicated a lack of the distal part of the right ulna and radial head dislocation. DIAGNOSIS: The X-ray showed obvious bone resorption at the right ulna distal, proximal stubble, and distal part of the epiphyseal residue, which was 4.3 mm shorter after 14 months. The patient was finally diagnosed with NF-1 according to the pathologic examination. INTERVENTIONS: The treatment included tumor resection, ulnar osteotomy, and fixation by an Ilizarov frame. OUTCOMES: The Ilizarov frame was removed after 2.7 months of surgery. The radial head was successfully repositioned, and the elbow joint function was significantly improved. No recurrence of the deformity was noted until now. LESSONS: Osteolysis (defect without bone destruction) is an extremely rare symptom in patients with NF1. Therefore, it is essential to make the right diagnosis by comprehensive and careful physical examination.


Assuntos
Mau Alinhamento Ósseo/complicações , Mau Alinhamento Ósseo/cirurgia , Neurofibromatose 1/complicações , Neurofibromatose 1/cirurgia , Osteólise/complicações , Rádio (Anatomia)/anormalidades , Ulna/cirurgia , Pré-Escolar , Humanos , Fixadores Internos , Masculino , Osteotomia , Rádio (Anatomia)/cirurgia , Ulna/patologia
11.
J Ayub Med Coll Abbottabad ; 31(3): 472-473, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31535533

RESUMO

Surgical fixation of radius to ulna has been described in the literature at various instances when deficiencies of either of the bones are encountered. The main concept of one bone forearm relies on an intact elbow and wrist articulations so a stable functioning limb can be achieved after union of radius to the ulna. This case report elaborates post infection loss of proximal ulna treated with fixation to radius.


Assuntos
Osteomielite/complicações , Rádio (Anatomia)/cirurgia , Ulna/cirurgia , Adolescente , Articulação do Cotovelo/fisiopatologia , Antebraço/fisiopatologia , Humanos , Masculino
12.
J Plast Reconstr Aesthet Surg ; 72(12): 1887-1899, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31563475

RESUMO

BACKGROUND: Limb salvage is important in pediatric patients with bone sarcomas. The vascularized fibula flap is a versatile option, combined or not with a bone allograft. The authors evaluated the functional long-term outcomes, complications, and survival of using this technique in pediatric patients. METHODS: A retrospective review of 27 pediatric patients reconstructed between 2011 and 2018 with the fibula flap after bone sarcoma resection was conducted. Long-term functional outcomes, complications, and survival were assessed. Variables analyzed were age, sex, Capanna technique, follow-up, complications, additional surgeries, time to weight bearing, length discrepancy, and sport practice. RESULTS: Twenty-seven patients with a mean age of 9.3 years were included. The mean follow-up was 44.33 months. The Capanna technique was performed in 15 patients. All extremities but one were salvaged. The overall complication rate was 74.07%. Fibula fracture and nonunion rates were 34.04% and 11.11%, respectively. Partial weight bearing was resumed at a mean of 9.07 months. About 79.17% of patients with a 12-month follow-up achieved full weight bearing. An age below 8 years was significantly associated with a lower major complication rate and a shorter time to weight bearing and full weight bearing. Major complications and additional surgeries were significantly associated with longer periods until weight bearing and full weight bearing. CONCLUSIONS: The fibula flap allows the majority of extremities to be reconstructed. However, a high rate of complications and additional surgeries should be anticipated. Full weight bearing is usually achieved within the first year, with modest functional increase afterward. Less complications and a faster functional recovery are expected in patients below the age of 8 years.


Assuntos
Neoplasias Ósseas/cirurgia , Transplante Ósseo/métodos , Fíbula/transplante , Osteossarcoma/cirurgia , Sarcoma de Ewing/cirurgia , Retalhos Cirúrgicos , Adolescente , Aloenxertos/irrigação sanguínea , Calcâneo/cirurgia , Criança , Pré-Escolar , Feminino , Neoplasias Femorais/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Espontâneas/cirurgia , Humanos , Úmero/cirurgia , Masculino , Complicações Pós-Operatórias/etiologia , Rádio (Anatomia)/cirurgia , Estudos Retrospectivos , Terapia de Salvação/métodos , Transplante Homólogo/métodos , Resultado do Tratamento
13.
Acta Ortop Mex ; 33(2): 73-80, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31480107

RESUMO

INTRODUCTION: The objective of this study is to assess the type, frequency and severity of complications after the implantation of the modular monopolar radial head prosthesis. MATERIAL AND METHODS: Forty-seven patients with 48 radial head prostheses implanted between 2009 and 2017 were reviewed retrospectively. Patients were evaluated clinical and radiographically for a mean follow-up of 43.55 months (range: 12-89). RESULTS: The same type of prosthesis was implanted in every patient (Ascension Modular Radial Head). The average score in the Mayo Elbow Performance Score was 88.29 ± 9.9 points. During the follow-up, three patients (6.25%) suffered from continuous pain. Twelve cases (25.5%) showed radiological oversizing, though only five were symptomatic. Heterotopic ossification was detected in twenty-seven cases (57.4%). Eleven patients (23.4%) developed postoperative stiffness. Nineteen cases (40.42%) showed periprosthetic osteolysis, from which seven were symptomatic. Thirteen patients (27%) developed surgery-related complications: three cases of infection, four cases of symptomatic loosening, two neurapraxies, one instability and three cases of oversizing with associated stiffness. Nine patients (18.75%) required reintervention. DISCUSSION: Our study obtains a 27% of overall complications, mostly related to oversizing and prosthetic loosening, and 19% of reinterventions. These results are similar to those presented in previous studies, with variations depending on the time of follow-up. Further research is also required to evaluate long-term results and the potential progression of the radiographic findings. CONCLUSION: Taken together, these data stress the need for improvement in both the surgical technique and the design of the implants.


Assuntos
Articulação do Cotovelo , Prótese Articular , Fraturas do Rádio , Rádio (Anatomia) , Humanos , Prótese Articular/efeitos adversos , Desenho de Prótese , Rádio (Anatomia)/patologia , Rádio (Anatomia)/cirurgia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
14.
J Hand Surg Asian Pac Vol ; 24(3): 276-282, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31438801

RESUMO

Background: Metaphyseal core decompression of the distal radius (MCD) is clinically effective in early lunate necrosis without changing individual wrist mechanics. Its concept is based on the induction of physiologic mechanisms known as physiologic fracture healing response. However, this biological concept does not yet have its place in the historically developed mechanical concepts about Kienböck's disease and requires more detailed clarifications to understand when a change of individual wrist mechanics might be unnecessary. Methods: Thirteen consecutive cases, Lichtman stage I (n = 1) or II (n = 12), confirmed by conventional MRI, were treated by MCD. Time off work, changes in magnetic resonance imaging of the lunate, as well as clinical outcome using modified Mayo wrist score were evaluated at final follow-up. Results: Return to work was at six (1-10) weeks after surgery. MRI controls at short-term generally demonstrated stop of progression and signs of bone healing. Independently from ulna variance complete signal normalization was observed in six and a distinct, yet incomplete decrease of lunate bone marrow edema and zones of fat necrosis was confirmed in further six cases after a mean of 21 (13-51) weeks. One patient had radiographic controls only, stating normal healing at 56 months. After a mean follow-up of 37 (12-70) months the clinical outcomes were excellent in eleven and good in two cases (mean 95% in modified Mayo wrist score). Conclusions: In stage I and II lunate necrosis MCD stops disease progression, it improves clinical symptoms and induces normalization of lunate bone signal alterations in MRI. Findings suggest that stage I and II lunate necrosis can be effectively treated without alterations of individual wrist mechanics. Future studies are necessary to readjust common concepts regarding Kienböck's disease, especially focusing on conservative therapy.


Assuntos
Descompressão Cirúrgica/métodos , Osso Semilunar/cirurgia , Osteonecrose/cirurgia , Rádio (Anatomia)/cirurgia , Adulto , Feminino , Seguimentos , Força da Mão , Humanos , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteonecrose/diagnóstico por imagem , Retorno ao Trabalho , Adulto Jovem
15.
J Hand Surg Asian Pac Vol ; 24(3): 289-296, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31438803

RESUMO

Background: Shortening has been described to treat severely mangled extremities, replantations and nonunions. Outcomes after this procedure in the forearm are vaguely described. This study addresses how the forearm rotation is affected by: (1) location of the shortening; (2) the amount of the shortening at different locations. Methods: Nine fresh cadaveric forearms were dissected preserving intact proximal and distal radio ulnar joints and interosseous membrane. The widest point of the interosseous space and its location over the ulna were measured, defining the peak interosseous distance (PID) and the peak interosseous distance level (PIDL). Stabilization and fixation of the specimens were performed by using a platform and external fixators. Consecutive ostectomies were performed within one centimeter intervals at the distal, middle and proximal forearm thirds. A repeated measures mixed-effects (RMME) specific model was designed for the statistical analysis. Results: Before intervention, the average full forearm rotation was 157° (101-185), supination 80° (56-90)/pronation 77° (45-95). The average PID was 15.6 mm in supination and 12.5 mm in pronation. The PIDP were 52.2% and 58.3% of the ulna length in supination and pronation, respectively. The rotation lost were: middle third 5.31°/cm in supination and 6.12°/cm in pronation, distal third 1.62°/cm in supination and 2.20°/cm in pronation, the proximal third was not affected by up to 5 cm of shortening. Conclusions: These data suggest that shortening of the middle and distal third of the forearm might have more significant adverse effect on forearm rotation compared with the proximal third.


Assuntos
Antebraço/fisiologia , Osteotomia , Pronação/fisiologia , Rádio (Anatomia)/cirurgia , Supinação/fisiologia , Ulna/cirurgia , Cadáver , Humanos , Masculino , Rotação
16.
J Bone Joint Surg Am ; 101(15): e74, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31393431

RESUMO

BACKGROUND: Salvaging the forearm is a major challenge in cases of massive bone loss from injuries in which the extremity is severely mangled or following bone resection secondary to pathological tissue excision. The purpose of this study was to evaluate the role of one-bone forearm (OBF) reconstruction as a salvage option in these difficult situations. METHODS: A total of 38 patients with forearm segmental bone loss (acute and chronic) treated between 1995 and 2014 were included (range of follow-up, 2 to 20 years). Sixteen of the patients, 8 with avulsion amputations and 8 with severely mangled extremities, were managed in the emergency department because they required immediate replantation and revascularization, respectively. In the chronic setting, bone loss was due to infection with nonunion in 16 patients, tumor of the radius in 2 patients, and pseudarthrosis of the forearm in 4 patients. The surgical technique included conversion to OBF by achieving union between the distal part of the radius and the proximal part of the ulna in the majority of cases, with distal radioulnar joint (DRUJ) fusion in 4 cases, and ulna to carpals in 5 cases. Direct bone contact was achieved in 16 patients, a free vascularized fibular graft was used to bridge the bone gap in 10 patients, and 12 patients required iliac crest bone-grafting. RESULTS: The mean patient age was 35.5 years (range, 6 to 87 years); there were 23 male and 15 female patients. Among those who underwent OBF for acute injuries, the mean time to union was 7.3 months; 14 patients had complete union, and 2 patients had infection with nonunion requiring secondary procedures. As assessed using the criteria of Chen, 10 patients had a grade-I functional outcome, 3 patients had a grade-II outcome, and 3 patients had a grade-III outcome. In the elective group of 22 patients, the average time to union was 7.1 months. Nonunion was reported for 2 patients. On the basis of the Peterson scoring system, the outcome was excellent for 12 patients, good for 6 patients, fair for 2 patients, and poor for 2 patients. CONCLUSIONS: OBF reconstruction is a viable surgical treatment alternative. It is a demanding reconstruction but functions better and is cosmetically more appealing than a forearm amputation. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Lesões por Esmagamento/cirurgia , Traumatismos do Antebraço/cirurgia , Salvamento de Membro/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reimplante/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação Traumática/cirurgia , Artrodese/métodos , Transplante Ósseo/métodos , Criança , Estudos de Coortes , Avaliação da Deficiência , Feminino , Traumatismos do Antebraço/diagnóstico , Consolidação da Fratura/fisiologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Rádio (Anatomia)/lesões , Rádio (Anatomia)/cirurgia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Ulna/lesões , Ulna/cirurgia , Cicatrização/fisiologia , Adulto Jovem
17.
Arch Orthop Trauma Surg ; 139(12): 1723-1729, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31385021

RESUMO

INTRODUCTION: Complex radial head fractures are difficult to treat. In cases where stable fixation cannot be achieved, radial head resection or primary arthroplasty are frequently performed. Ex situ reconstruction of comminuted fractures may also be an option. This technique has widely been neglected in the literature, and only two small case series report satisfactory results. The aim of the present case series was to determine the functional and radiological outcomes of ex situ reconstructed Mason III and Mason IV fractures. We expect that the on-table reconstruction of comminuted radial head fractures will lead to bony union with no avascular necrosis in the postoperative course, which will demonstrate that this operative procedure is a reasonable option. PATIENTS AND METHODS: Two Mason type III and seven Mason type IV fractures (including four Monteggia-like lesions) were reconstructed ex situ. The mean age of the patients was 47 years (range 22-64). The clinical examination included RoM tests, elbow stability tests, and a neurological examination. The functional outcome was assessed with the MEPS and DASH score. The radiographic examination included a.p. and lateral views of the elbow to detect non-unions, inadequacy or loss of reduction, radial head necrosis, heterotopic ossifications and signs of posttraumatic arthritis. RESULTS: The mean follow-up time was 39 months (range 11-64). The mean MEPS was 82 points (range 15-100), and the mean DASH score was 20 points (range 0-85). All ex situ-reconstructed radial heads survived, and no signs of avascular necrosis were observed. Bony union was achieved in all but one patient who presented with an asymptomatic non-union. Signs of posttraumatic arthritis were found in all patients. With regard to the radial head, neither secondary resection nor arthroplasty had to be performed. All patients returned to their pre-injury occupations. CONCLUSION: Ex situ radial head reconstruction can be a reliable option in the surgical treatment of complex radial head fractures associated with severe elbow trauma. Even in the midterm follow-up, no signs of avascular necrosis were observed. Modern implants may even extend the indications for reconstruction in such cases. LEVEL OF EVIDENCE: Level IV-retrospective cohort study.


Assuntos
Fraturas Cominutivas/cirurgia , Fraturas do Rádio/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Artroplastia de Substituição/métodos , Articulação do Cotovelo/cirurgia , Epífises/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/cirurgia , Próteses e Implantes , Rádio (Anatomia)/cirurgia , Estudos Retrospectivos , Adulto Jovem
18.
Chin J Traumatol ; 22(5): 304-307, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31443938

RESUMO

Treatment of infected forearm nonunion and defects represents a difficult task for the operating surgeons. Conventional methods like composite and vascularized fibular grafts and the induced membranes filled with cancellous autografts or the Masquelet technique have been reported to be useful and successful, but sometimes it is difficult to predict the outcome and cannot address simultaneous deformities or the need to apply gradual distraction for reduction of a chronically dislocated radial head. Ilizarov technique has an answer for such conditions. We report a 43 years old man with infected ulnar defect and dislocated radial head as a result of infected Monteggia fracture: the patient was successfully treated by Ilizarov bone transport after failed attempts by bone spacer and fibular graft.


Assuntos
Mau Alinhamento Ósseo/cirurgia , Técnica de Ilizarov , Fratura de Monteggia/cirurgia , Rádio (Anatomia)/anormalidades , Adulto , Mau Alinhamento Ósseo/etiologia , Doença Crônica , Humanos , Masculino , Fratura de Monteggia/complicações , Rádio (Anatomia)/cirurgia , Resultado do Tratamento
19.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 63(4): 281-288, jul.-ago. 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-188915

RESUMO

Introducción: La tríada terrible de codo es una enfermedad asociada a altas tasas de complicaciones, por ello queremos estudiar los resultados y las complicaciones. Material y métodos: Se ha utilizado la base de datos de nuestro hospital durante 2005-2015, recogiendo características del paciente, de la fractura, de la cirugía y las complicaciones asociadas, así como resultados funcionales y rango de movilidad. Resultados: Se obtuvieron un total de 62 tríadas, de las cuales 27 (43%) eran mujeres y 35 (56%) eran hombres. A todos se les realizó un abordaje lateral de Kaplan y en aquellos que lo necesitaron se complementó con un abordaje medial para reparar el LCM. La cabeza radial se sintetizó en 14 (22%) casos, se colocó una prótesis en 45 (74%) de casos y otras actuaciones en 3 (5%) casos. La osteosíntesis de la apófisis coroides se realizó mediante arpón+/-sutura transósea en 41 (62%) pacientes y mediante síntesis en 12 (19%) casos. En 9 (14%) casos no se realizó ninguna actuación. En el 100% de los casos se reparó el LCL y en 9 (14%) hubo que reparar también el LCM. Un 22% de los pacientes precisaron FE por inestabilidad tras la técnica quirúrgica. Respecto a resultados, se obtuvo un rango de movilidad de entre 120°/-20° de flexoextensión y 98°/85° de pronosupinación. En cuanto a complicaciones, obtuvimos un total de 17 (27%). Conclusiones: Las tríadas de codo son lesiones osteoligamentosas complejas donde es necesario realizar una cirugía protocolizada, a pesar de lo cual, existen un 27% de complicaciones


Background: Terrible triad of elbow is a complex lesion with a high rate of complications. Our goal is to analyse both clinical results and complications after performing protocolised surgery. Material and methods: The database of our hospital was used during 2005-2015, collecting characteristics of the patient, the fracture, the surgery and the associated complications, as well as functional results and range of mobility. Results: A total of 62 triads were obtained, of which 27 (43%) were women and 35 (56%) were men. All had a Kaplan lateral approach and those who needed it were complemented with a medial approach to repair the LCM. The radial head was synthesized in 14 (22%) cases, a prosthesis was placed in 45 (74%) cases and other actions in 3 (5%) cases. Osteosynthesis of the choroid process was performed by transosseous harpoon+/-suture in 41 (62%) patients and by synthesis in 12 (19%) cases. In 9 (14%) cases, no action was taken. In 100% of the cases the LCL was repaired and in 9 (14%) the LCM also had to be repaired. Twenty-two percent of the patients required ESA due to instability after the surgical technique. With respect to results, a range of mobility was obtained between 120°/-20° of flexoextension and 98°/85° of pronosupination. In terms of complications, we obtained a total of 17 (27%). Conclusions: Elbow triads are complex lesions where protocolised surgery is necessary, nevertheless the complication rate was 27% in our series


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Ligamentos Colaterais/cirurgia , Fixação Interna de Fraturas/métodos , Complicações Pós-Operatórias/etiologia , Rádio (Anatomia)/cirurgia , Fraturas do Rádio/cirurgia , Ligamentos Colaterais/lesões , Fixação Interna de Fraturas/efeitos adversos , Rádio (Anatomia)/lesões , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
20.
Orthopedics ; 42(4): 219-225, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31323105

RESUMO

The authors aimed to characterize surgical and functional outcomes of open fractures of the distal radius in patients younger than 65 years. At their level I trauma center, the authors conducted a retrospective review of 92 patients (age range, 16-64 years) who had 94 open fractures of the distal radius (average follow-up, 30 months; range, 3-95 months). Sixty-four fractures received definitive treatment at the time of initial débridement; 30 received definitive fixation and soft tissue coverage after staged débridement. Primary surgical outcome was development of deep surgical site infection requiring repeat surgical débridement; secondary surgical outcome was surgical complications requiring reoperation. Functional outcome was assessed by wrist range of motion. Overall infection rate was 15% (14 of 94 fractures). Seven (11%) of 64 fractures in the immediate definitive fixation group developed infection compared with 7 (23%) of 30 fractures in the staged treatment group (P=.13). Twenty-one (33%) of 64 fractures in the immediate definitive fixation group required reoperation compared with 15 (50%) of 30 in the staged treatment group (P=.11). Deep surgical site infections and surgical complications associated with open fractures of the distal radius are driven by soft tissue injury. [Orthopedics. 2019; 42(4):219-225.].


Assuntos
Fixação Interna de Fraturas/efeitos adversos , Fraturas Expostas/cirurgia , Fraturas do Rádio/cirurgia , Rádio (Anatomia)/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Adolescente , Adulto , Desbridamento/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
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