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1.
J Orthop Traumatol ; 23(1): 1, 2022 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-34985595

RESUMO

BACKGROUND: Ulna shortening osteotomy (USO) for ulnar impaction syndrome (UIS) aims to improve pain and function by unloading the ulnar carpus. Previous studies often lack validated patient-reported outcomes or have small sample sizes. The primary objective of this study was to investigate patient-reported pain and hand function at 12 months after USO for UIS. Secondary objectives were to investigate the active range of motion, grip strength, complications, and whether outcomes differed based on etiology. MATERIALS AND METHODS: We report on 106 patients with UIS who received USO between 2012 and 2019. In 44 of these patients, USO was performed secondary to distal radius fracture. Pain and function were measured with the Patient Rated Wrist/Hand Evaluation (PRWHE) before surgery and at 3 and 12 months after surgery. Active range of motion and grip strength were measured before surgery and at 3 and 12 months after surgery. Complications were scored using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions (ICHAW) tool. RESULTS: The PRWHE total score improved from a mean of 64 (SD = 18) before surgery to 40 (22) at 3 months and 32 (23) at 12 months after surgery (P < 0.001; effect size Cohen's d = -1.4). There was no difference in the improvement in PRWHE total score (P = 0.99) based on etiology. Also, no clinically relevant changes in the active range of motion were measured. Independent of etiology, mean grip strength improved from 24 (11) before surgery to 30 (12) at 12 months (P = 0.001). Sixty-four percent of patients experienced at least one complication, ranging from minor to severe. Of the 80 complications in total, 50 patients (47%) had complaints of hardware irritation, of which 34 (32%) had their hardware removed. Six patients (6%) needed refixation because of nonunion. CONCLUSION: We found beneficial outcomes in patients with UIS that underwent USO, although there was a large variance in the outcome and a relatively high number of complications (which includes plate removals). Results of this study may be used in preoperative counseling and shared decision-making when considering USO. LEVEL OF EVIDENCE: Therapeutic III.


Assuntos
Ulna , Articulação do Punho , Humanos , Osteotomia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Ulna/cirurgia , Articulação do Punho/cirurgia
2.
J Pediatr Orthop B ; 31(1): 55-59, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33528228

RESUMO

Distal radio-ulnar joint (DRUJ) injuries are under-reported in the paediatric population. No single study has discussed methods of DRUJ reconstruction in immature patients with chronic instability. We present a physeal sparing ligamentoplasty for chronic DRUJ instability and describe the outcomes in two patients. Two consecutive children with chronic DRUJ instability were treated using physeal sparing ligamentoplasy. After the failure of triangular fibrocartilage complex repair, reconstruction was done using palmaris longus tendon graft that was tunnelled through the distal radius epiphysis and wrapped subperiosteally around the ulnar neck. Graft was tied in a neutral forearm position. DRUJ stability was achieved in both patients. Grip strength averaged 90% of the healthy side. Prono-supination range of motion (ROM) averaged 88 and 86%, respectively, of the healthy side, without intraoperative nor postoperative complications. Our novel technique was effective in the regain of DRUJ stability with minor effect on the prono-supination ROM. Further studies are planned to experiment the biomechanical effectiveness of our technique. Level of evidence: Therapeutic IV.


Assuntos
Instabilidade Articular , Fibrocartilagem Triangular , Criança , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Ligamentos , Supinação , Ulna/diagnóstico por imagem , Ulna/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
3.
J Int Med Res ; 49(12): 3000605211064390, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34929099

RESUMO

Nora's lesion, also known as bizarre parosteal osteochondromatous proliferation (BPOP), is a very rare benign lesion with few published cases. BPOP is more common in adults during the second to third decades of life, and usually occurs on the hands and feet. Radiologically, it appears as a calcified mass attached to the bone cortex that grows rapidly and that recurs easily following resection. Aggressive features on imaging and confusing histopathological findings usually result in misdiagnosis or mistreatment. Herein, we present a case of a rare bony tumour involving the distal ulna presenting as a painless growing mass. An excisional biopsy with clear margins was performed without disturbing the ulnar nerve and arteries. There was no recurrent mass or calcified lesion 1 year after surgery. Based on its rarity and difficult diagnosis, BPOP should be considered in the differential diagnosis of a painless mass in the distal ulnar region. Careful follow-up after surgery is essential, even without lesion recurrence.


Assuntos
Ulna , Humanos , Ulna/diagnóstico por imagem , Ulna/cirurgia
4.
BMJ Case Rep ; 14(11)2021 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-34764115

RESUMO

In recent years, denosumab has been used to treat giant cell tumour of bone (GCTB) not only in cases where surgery is complicated but also preoperatively to decrease the preoperative grade or to facilitate surgery for Campanacci grade II and III cases. However, there are no clear protocols regarding the preoperative use of denosumab before en bloc resection. There are a few reports of recurrent cases after en bloc resection; however, the association with the use of denosumab is unknown. We present the clinical, radiological and histopathological findings of a case of Campanacci grade III GCTB at the distal end of the ulna, which resulted in soft tissue recurrence after en bloc resection with the preoperative use of denosumab.


Assuntos
Conservadores da Densidade Óssea , Neoplasias Ósseas , Tumor de Células Gigantes do Osso , Conservadores da Densidade Óssea/uso terapêutico , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/cirurgia , Denosumab/uso terapêutico , Tumor de Células Gigantes do Osso/diagnóstico por imagem , Tumor de Células Gigantes do Osso/tratamento farmacológico , Tumor de Células Gigantes do Osso/cirurgia , Humanos , Recidiva Local de Neoplasia , Estudos Retrospectivos , Ulna/diagnóstico por imagem , Ulna/cirurgia
5.
BMC Musculoskelet Disord ; 22(1): 943, 2021 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-34758801

RESUMO

PURPOSE: Approximately 30% of patients with hereditary multiple osteochondromas (HMO) have forearm deformity and dysfunction. The aim of this retrospective study was to review our experience with the surgical treatment of children with HMO and Masada IIb forearm deformities. METHODS: Data of eight children treated for HMO Masada IIb forearm deformity at our hospital between 2015 and 2019 were collected from the hospital records and retrospectively reviewed. All patients underwent ulnar lengthening by distraction osteogenesis using either the Orthofix or Ilizarov external fixator. Range of movements at the elbow and wrist joints, and forearm supination/pronation, before and after the operation were recorded. Radiographs were evaluated by the Fogel method, and wrist joint function by the Krimmer method. RESULTS: Follow-up radiographs showed significant improvement in relative ulnar shortening after treatment (pre-operative 9.23 ± 5.21 mm; post-operative 0.33 ± 4.13 mm). Changes in radial articular angle (pre-operative 33.55° ± 3.88° to 32.78° ± 6.57°) and carpal slip (pre-operative 45.00% ± 19.09%; post-operative 43.13% ± 16.68%) were not significant. Elbow flexion and extension, wrist flexion and extension, ulnar and radial deviation at wrist, and forearm rotation were significantly improved after surgery. Wrist function was graded as excellent in seven patients and as good in one patient. One patient treated with the Ilizarov external fixator had poor radial head reduction. CONCLUSION: Ulnar lengthening with distraction osteogenesis is an effective treatment for HMO Masada IIb deformities. The optimum site for ulnar osteotomy appears to be at the proximal one-third to one-fourth of the ulna.


Assuntos
Exostose Múltipla Hereditária , Criança , Exostose Múltipla Hereditária/diagnóstico por imagem , Exostose Múltipla Hereditária/cirurgia , Antebraço/cirurgia , Humanos , Osteotomia , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Ulna/diagnóstico por imagem , Ulna/cirurgia
6.
Tech Hand Up Extrem Surg ; 25(4): 251-257, 2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-34779422

RESUMO

Campanacci grade 3 distal radius giant cell tumors are difficult to treat and just doing a curettage and bone grafting is insufficient. These lesions are associated with a high chance of recurrence. We are presenting our technique and series of 5 patients who underwent enbloc excision and ulna transposition with ulno-scapholunate fusion. Between 2014 and 2017 5 patients underwent en bloc excision of Campanacci grade 3 giant cell tumor of the distal radius, ulna transposition and ulno carpal fusion. These patients were regularly followed for evidence of union, range of motion, grip strength, and to look for recurrence of tumor. All 5 patients were Campanacci grade 3 tumors. The average duration of symptoms was 5 months (1 to 9 mo). The average duration of follow-up was 33 months (24 to 48 mo). The average time for ulno-scapholuante fusion was 8 weeks (6 to 10 wk) and the average time to radio ulnar fusion was 14.5 weeks (12 to 16 wk). The average arc of wrist flexion and extension was 34 degrees. The average grip strength was 58.2% of the contralateral side (48% to 69%). In conclusion vascularized ulnar transposition with partial wrist fusion for a Camapanacci grade 3 giant cell tumor is an alternate procedure in the management of these difficult tumors.


Assuntos
Neoplasias Ósseas , Tumor de Células Gigantes do Osso , Neoplasias Ósseas/cirurgia , Tumor de Células Gigantes do Osso/cirurgia , Humanos , Recidiva Local de Neoplasia , Rádio (Anatomia)/cirurgia , Ulna/cirurgia
7.
Orthop Surg ; 13(7): 2061-2069, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34596957

RESUMO

OBJECTIVE: The aim of the present study was to assess the effect of suspension fixation with button plates on the reconstruction of the distal radioulnar joint dislocation (DRUJ). METHODS: This was a case series of six patients (two men and four women) who underwent suspension fixation with button plates for DRUJ dislocation between January 2015 and May 2017. Physical examination, radiography, MRI, functional activity of the wrist joint, grip strength of the wrist joint, Garland-Werley wrist score, Mayo wrist score, and visual analog scale (VAS) score were used to evaluate the effect of this procedure. All patients were followed up every 3 months. The evaluation time point was 12 months after the operation. Comparisons of the functional indexes of wrist function before and after the operation were performed using paired statistical tests. RESULTS: The mean range of motion of the affected limb was 70° at forearm pronation and 75° at forearm supination. The subjective assessments and tests of the motor function of the wrist showed improvement after surgery. The Garland-Werley wrist score was 13.50 ± 2.66 preoperatively, the Mayo wrist score was 56.67 ± 18.35, and the VAS score was 4.83 ± 1.17. The Garland-Werley wrist score was 2.83 ± 1.33 postoperatively at 12 months, the Mayo wrist score was 87.5 ± 6.89, and the VAS score was 0.50 ± 0.55. At 12 months, the Garland-Werley wrist score, the Mayo wrist score, and the VAS score showed significant improvements when compared with those before surgery (P = 0.000, P = 0.003, and P = 0.000, respectively). Radiographic examination revealed that the internal fixation device was in place, and no dislocation of the DRUJ could be observed. None of the patients had internal fixation device removal or re-dislocation of the DRUJ. None of the patients had re-dislocation of the DRUJ. No secondary ulnar or radial fractures and nerve injury were reported during and after surgery. No tumor recurrence was observed in patients with giant cell tumors of the tendon sheath. No loosening and displacement of screws were reported. CONCLUSION: The new method of suspension fixation with button plates for the surgical reconstruction of a DRUJ dislocation is simple, with minimal trauma, and maintains the stability of the DRUJ without the need for intra-articular or extra-articular reconstruction of the ligament. Furthermore, it allows early functional exercise and achieves satisfactory postoperative functional recovery.


Assuntos
Fixação Interna de Fraturas/métodos , Luxações Articulares/cirurgia , Fraturas do Rádio/cirurgia , Ulna/lesões , Ulna/cirurgia , Traumatismos do Punho/cirurgia , Adulto , Placas Ósseas , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Amplitude de Movimento Articular
8.
Sci Rep ; 11(1): 17891, 2021 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-34504202

RESUMO

Ulnar shortening osteotomy (USO) for ulnar impaction syndrome potentially leads to degenerative changes of the distal radioulnar joint (DRUJ). This study was performed to evaluate the effect of the sigmoid notch morphology on the stress distribution pattern of the DRUJ using computed tomography (CT) osteoabsorptiometry (CT-OAM). We reviewed the pre- and postoperative transverse CT images of 15 wrists that had undergone USO. The examined wrists were classified into two groups based on the sigmoid notch morphology: the linear-type notch (type L) and the curved-type notch (type C). We calculated and statistically compared the percentage of the high-density area (%HDA) in each divided region of the sigmoid notch. In type L, %HDA was significantly larger in the distal-dorsal region of the sigmoid notch before USO. Postoperatively, in type L, no specific regions showed a significantly different %HDA. In type C, %HDA was significantly larger in the distal-volar region of the sigmoid notch before USO. Postoperatively, %HDA of type C was significantly larger in the proximal-volar region. Our results suggest that in patients with ulnar impaction syndrome, morphological evaluation of the sigmoid notch can serve as a predictor of osteoarthritis in the DRUJ with or without USO.


Assuntos
Osteoartrite/cirurgia , Osteotomia , Ulna/cirurgia , Articulação do Punho/fisiopatologia , Articulação do Punho/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/fisiopatologia , Osteotomia/efeitos adversos , Osteotomia/métodos , Lesões do Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/cirurgia , Tomografia Computadorizada por Raios X/métodos , Ulna/fisiopatologia
9.
J Hand Surg Asian Pac Vol ; 26(3): 467-471, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34380389

RESUMO

Growth arrest following paediatric distal radius and ulnar fractures infrequently results in a symptomatic deformity. The distal radioulnar joint (DRUJ) plays a complex role in the motion of the wrist, allowing for forearm rotation, and acceptable reconstruction options are limited when severe deformity does occur. We present a case of symptomatic severe post traumatic growth arrest of the distal radioulnar joint which was treated by osteotomy and Scheker total distal radioulnar joint arthroplasty.


Assuntos
Crescimento Psicológico Pós-Traumático , Artroplastia , Criança , Humanos , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/cirurgia , Ulna/diagnóstico por imagem , Ulna/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
10.
J Hand Surg Asian Pac Vol ; 26(3): 371-376, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34380400

RESUMO

Background: Since the Sauvé-Kapandji procedure was introduced in 1936, many modifications were created using dynamic stabilizer, such as the ECU (extensor carpi ulnaris), the FCU (flexor carpi ulnaris), pronator teres to solve proximal ulnar stump pain. We believe that this modification is also another option for distal ulnar stump instability. Methods: From January 1998 to February 2017, there were 13 patients received the Sauvé-Kapandji (S-K) procedure with tenodesis of the ECU to the carpus and interosseous membrane. The average age at operation was 52 years (range, 28 to 63 years). Four had traumatic arthritis (two from distal radial fracture malunion, two had instability of distal radioulnar joint from Essex-Lopresti injury), four had primary osteoarthritis of the distal radio-ulnar joint, two had rheumatoid arthritis, one had gouty arthritis, two had madelung deformity. The average follow-up was 30 months (range, 15 to 72 months). Results: Postoperative pronation/supination of the forearm had significantly improved with the exception of the wrist flexion/extension. After surgery, the mean radioulnar distance was narrowed from 11 mm to 9 mm, but no significant difference in 12 patients. All patients had improved in wrist pain, 10 patients had no pain and 3 patients with mild pain over the distal ulnar stump. The mean grip strength had significantly improved from 51% of the contralateral side to 75%. The lateral and stress X-ray films showed no instability of the distal ulnar stump after surgery. Conclusions: In conclusion, the modified S-K procedure using the tenodesis of ECU provides a multi-directional stability and is a reliable surgical procedure for distal radioulnar disorders.


Assuntos
Tenodese , Adulto , Antebraço , Humanos , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Ulna/diagnóstico por imagem , Ulna/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
11.
J Hand Surg Asian Pac Vol ; 26(3): 455-459, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34380407

RESUMO

A double-barreled fibular graft was used to reconstruct both forearm bones and the humeroradial joint after tumor resection. The patient had a tumor of radius that invaded the ulna and extensor groups. After a wide tumor resection, vascularized fibular autograft and soft tissue reconstruction was performed. A fibular graft were placed as a double barrel in the proximal ulnar and radial defects including the radial head and fixed using two locking plates. Simultaneously, reconstruction of the humeroradial joint and wrist dorsiflexion was performed. Two years postoperatively, the patient is satisfied with his elbow function while performing activities of daily living. Although amputation was one of the options considered during the preoperative planning in this case, the affected limb could be preserved by grafting a double-barreled fibula and tendon transfer, which could maintain the function of his upper left limb.


Assuntos
Fíbula , Antebraço , Atividades Cotidianas , Fíbula/diagnóstico por imagem , Fíbula/cirurgia , Antebraço/cirurgia , Humanos , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/cirurgia , Ulna/diagnóstico por imagem , Ulna/cirurgia
12.
J Orthop Trauma ; 35(Suppl 3): s11-s16, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34415876

RESUMO

SUMMARY: Injuries to the distal aspect of the ulna and the distal radioulnar joint (DRUJ) commonly occur concurrently with distal radius fractures. These fractures may also involve the sigmoid notch of the lunate facet of the radius. Each of these structures merits consideration when managing ulnar-sided injuries associated with distal radius fractures. Improper management of distal radioulnar complex injuries may result in limited wrist motion, persistent DRUJ instability, and pain despite successful fracture union. The distal ulna is the keystone of the distal radioulnar articulation. An understanding of the components of the distal radioulnar complex and methods to manage injuries of each of these components contributes to improved functional outcomes by restoring this keystone effect. The classification of distal radioulnar injuries discussed herein provides a framework for understanding the disruption of the ligamentous stabilizers of the DRUJ and identifying residual distal radioulnar instability after fracture fixation. Proper treatment of residual DRUJ instability will restore stability and minimize persistent functional impairment.


Assuntos
Instabilidade Articular , Fraturas do Rádio , Fraturas da Ulna , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Rádio (Anatomia) , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Ulna/diagnóstico por imagem , Ulna/cirurgia , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
13.
Zhongguo Gu Shang ; 34(7): 636-40, 2021 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-34318639

RESUMO

OBJECTIVE: To investigate the effect and safety of ulnar osteochondroma resection, ulnar minimally invasive osteotomy, external fixation and ulnar lengthening in the treatment of forearm deformity of metaphyseal extension of ulna. METHODS: From August 2005 to December 2013, there were 20 cases of ulnar metaphyseal sequelae, including 15 males and 5 females, aged from 7 to 13(10.00±2.34) years, the course of disease ranged for 6 to 11(8.10±1.52) months. The clinical manifestations were shortening of the affected forearm and bending to the ulnar side. The postoperative evaluation included pain, activities of daily living, orthopedic effect and the range of motion of wrist, elbow and forearm. The radiological evaluation included ulnar length, radial joint inclination angle and wrist epiphysis growth. RESULTS: All patients healed without infection. The only operation related to complications was ulnar lengthening, including 1 case of nonunion, 2 cases of ulnar lengthening callus fracture and 1 case of temporary radial nerve palsy. All patients were followed up for 4 to 7.5 years, with an average of (6.03±1.33) years. There were statistically significant differences in changes of wrist radial deviation, ulnar deviation, forearm pronation and supination in all cases (P<0.05). Radiological evaluation parameters (ulnar variance, radial joint angle, wrist slip) were improved, and the differences were statistically significant(P<0.05). The modified Green and O'Brien wrist function scores at the last follow-up were significantly different from those before operation (P<0.05). The clinical effect of wrist joint was significantly different from that before operation (P<0.05). The Mayo elbow function scoreat the latest follow-up was significantly different from that before operation (P<0.05). The clinical effect of elbow joint was significantly different from that before operation (P<0.05). CONCLUSION: Ulnar lengthening is not beneficial to prevent the development of long-term deformity. Simple resection of osteochondroma of distal ulna is beneficial to prevent the development of deformity. Patients with limited rotation of wrist joint and forearm and strong demand for improvement of appearance can be actively treated.


Assuntos
Atividades Cotidianas , Articulação do Cotovelo , Feminino , Humanos , Masculino , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/cirurgia , Amplitude de Movimento Articular , Resultado do Tratamento , Ulna/diagnóstico por imagem , Ulna/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
14.
J Shoulder Elbow Surg ; 30(12): 2824-2831, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34216785

RESUMO

BACKGROUND: The coronoid process is an important stabilizer of the elbow, and its anatomy has been extensively studied. However, data documenting the relationship of the coronoid relative to the radial head (RH) are limited. The latter is a good landmark for the surgeon when débriding or reconstructing the coronoid. This imaging-based study quantified the anatomic relationship between the coronoid and the proximal radius and ulna. METHODS: We investigated 80 cadaveric upper extremities (18 paired elbows) by 3-dimensional digital analysis of computed tomography data. After construction of a standardized coordinate system, the relationships between the coronoid, the anterior-most point of the RH, the deepest point of the articular surface of the RH, the top of the lesser sigmoid notch, and the deepest point of the guiding ridge of the trochlear notch were analyzed. RESULTS: The mean height of the tip of the coronoid was 36 ± 4 mm (range, 26-43 mm). The mean height of the anterior-most point of the RH was 40 ± 4 mm (range, 28-47 mm). The mean distance between the tip of the coronoid and the anterior-most point of the RH was 4.5 ± 1 mm (range, 2-10 mm). For paired elbows, the heights of the tip of the coronoid and the anterior-most point of the RH were similar between sides. CONCLUSION: This study described the relationship between the coronoid and RH. This information should prove useful when reconstructing a coronoid from a medial approach in the case of an intact RH. The difference in radiographic height between the tip of the coronoid and anterior RH in the normal elbow averages 5 mm. However, when we account for the normal cartilage thickness of the RH and coronoid, a 3- to 6-mm difference in height would be seen at surgery depending on whether the cartilage of the coronoid process is intact or removed. The distance between the tip of the coronoid and the anterior-most point of the RH is similar to the size of shavers used when débriding osteophytes during arthroscopy.


Assuntos
Articulação do Cotovelo , Fraturas da Ulna , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Humanos , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/cirurgia , Tomografia Computadorizada por Raios X , Ulna/diagnóstico por imagem , Ulna/cirurgia
15.
Injury ; 52 Suppl 3: S33-S37, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34088470

RESUMO

INTRODUCTION: Forearm shaft fracture is common in young adult patients and associated with soft tissue and organ injuries. In open fractures in polytrauma patients, damage control orthopaedics (DCO) is well indicated. The aim of this study is to describe intramedullary Steinmann pin fixation of the ulna as a DCO procedure for the forearm and present a case series. DESCRIPTION OF THE TECHNIQUE: A 3.0 mm Steinmann pin is inserted retrograde in the ulna proximal fragment through the fracture site using the open wound as the approach. With direct visualization of the reduction, the pin is advanced into the distal fragment. The reduction of the longitudinal axis and shortening is thus achieved. PATIENTS AND METHODS: This method was used for all open fractures of forearm both-bone fractures in polytrauma patients undergoing DCO from 2014 to 2019. The alignment and length of the ulna were evaluated radiographically after pin fixation and before and after definitive fixation. Differences in the need for secondary procedures and infection rate between DCO and definitive fixation were also evaluated. RESULTS: There were 30 males (85.7%) with an average age of 32.9 ± 12.0 years and a mean ISS (Injury Severity Score) of 29.4 (range, 18.0-41.0). The most common associated injuries were thoracic trauma (62.8%) and head trauma (45.7%). In the radius and ulna, 51.4% and 60.0% of fractures, respectively, were multifragmentary (types B and C). Gustilo type IIIA represented 77.1% of the injuries. Pin fixation achieved good alignment and length in all cases. The mean time between DCO and definitive fixation was 12.0 days, and no secondary procedure was needed, nor any case developed either superficial or deep infection. The conversion from DCO to definitive fixation was considered easy in all cases. CONCLUSION: Intramedullary Steinmann pin fixation of the ulna is a viable option for DCO for forearm both-bone fractures in open fractures in polytrauma patients.


Assuntos
Traumatismos do Antebraço , Fixação Intramedular de Fraturas , Fraturas Expostas , Ortopedia , Fraturas do Rádio , Fraturas da Ulna , Adulto , Antebraço , Traumatismos do Antebraço/diagnóstico por imagem , Traumatismos do Antebraço/cirurgia , Fraturas Expostas/diagnóstico por imagem , Fraturas Expostas/cirurgia , Humanos , Masculino , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Ulna/diagnóstico por imagem , Ulna/cirurgia , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/cirurgia , Adulto Jovem
16.
J Pediatr Orthop ; 41(Suppl 1): S6-S13, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34096531

RESUMO

BACKGROUND: Distal radius physeal bar with associated growth arrest can occur because of fractures, ischemia, infection, radiation, tumor, blood dyscrasias, and repetitive stress injuries. The age of the patient as well as the size, shape, and location of the bony bridge determines the deformity and associated pathology that will develop. METHODS: A search of the English literature was performed using PubMed and multiple search terms to identify manuscripts dealing with the evaluation and treatment of distal radius physeal bars and ulnar overgrowth. Single case reports and level V studies were excluded. RESULTS: Manuscripts evaluating distal radial physeal bars and their management were identified. A growth discrepancy between the radius and ulna can lead to distal radioulnar joint instability, ulnar impaction, and degenerative changes in the carpus and triangular fibrocartilage complex. Advanced imaging aids in the evaluation and mapping of a physeal bar. Treatment options for distal radius physeal bars include observation, bar resection±interposition, epiphysiodeses of the ulna±completion epiphysiodesis of the radius, ulnar shortening osteotomy±diagnostic arthroscopy to manage associated triangular fibrocartilage complex pathology, radius osteotomy, and distraction osteogenesis. CONCLUSIONS: Decision-making when presented with a distal radius physeal bar is multifactorial and should incorporate the age and remaining growth potential of the patient, the size and location of the bar, and patient and family expectations.


Assuntos
Deformidades Adquiridas da Mão , Procedimentos Ortopédicos/métodos , Rádio (Anatomia) , Ulna , Articulação do Punho , Desenvolvimento Ósseo , Criança , Deformidades Adquiridas da Mão/diagnóstico , Deformidades Adquiridas da Mão/etiologia , Deformidades Adquiridas da Mão/cirurgia , Humanos , Seleção de Pacientes , Radiografia/métodos , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/crescimento & desenvolvimento , Rádio (Anatomia)/cirurgia , Ulna/diagnóstico por imagem , Ulna/crescimento & desenvolvimento , Ulna/cirurgia , Articulação do Punho/patologia , Articulação do Punho/fisiopatologia
17.
Orthop Traumatol Surg Res ; 107(5): 102970, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34052512

RESUMO

INTRODUCTION: Treatment of ulnar impaction syndrome (UIS) is based on ulnocarpal decompression, which may be achieved by ulna shortening osteotomy. The aim is to restore zero or negative ulnar variance. Tolat et al. described 3 distal radioulnar joint (DRUJ) morphologic types: vertical, oblique and reverse. Joint type has been thought to influence the clinical result of shortening, especially in the reverse type. HYPOTHESIS: DRUJ type does not influence clinical results in ulna shortening osteotomy. MATERIAL AND METHODS: Twenty-nine wrists were operated on in 27 patients: 13 female, 14 male; mean age at surgery, 43 years (range, 18-72 years). In 20 cases, UIS was idiopathic and in 7 post-traumatic. Mean preoperative ulnar variance was 3.6mm (range, 2-18mm). The osteotomy was fixed by screwed plate. RESULTS: Twenty-five patients (27 wrists) were assessed at a mean 64 months (range, 18 months to 13 years). There were no cases of infection or hematoma. DRUJ was type 1 (vertical) in 6 cases (22%), type 2 (oblique) in 14 (52%) and type 3 (reverse) in 7 (26%). Mean postoperative pain score on VAS was 0.7/10 (range, 0-4); 9 wrists remained painful. Mean Quick-DASH was 16.9 (range, 0-48) and mean PRWE 21.9 (range, 16.9-59). Thirteen patients were very satisfied, 11 satisfied, 1 moderately satisfied, and 2 dissatisfied. Mean postoperative ulnar variance was -0.1mm (range, -4 to +8mm). Three wrists developed osteoarthritis, all following traumatic UIS. There were no significant correlations between DRUJ type and other clinical or radiological parameters. DISCUSSION: Ulna shortening osteotomy has proven efficacy in UIS. The literature reports excellent or good results in 75% of cases. In the present study, 96% of patients considered themselves cured or improved by surgery, and none reported worsening. Ulna shortening osteotomy can be used in all 3 DRUJ types; DRUJ coronal morphology does not impact clinical result. LEVEL OF EVIDENCE: IV-retrospective study.


Assuntos
Osteoartrite , Articulação do Punho , Feminino , Humanos , Masculino , Osteotomia , Estudos Retrospectivos , Resultado do Tratamento , Ulna/diagnóstico por imagem , Ulna/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
18.
Injury ; 52(8): 2300-2306, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33832704

RESUMO

BACKGROUND: We postulated that residual distal radioulnar joint (DRUJ) instability after distal diaphyseal or metaphyseal fracture in the radius or ulna may occur due to malaligned or malunited bony structures as well as primary or secondary soft issue stabiliser. Here, we report the outcomes of corrective osteotomy in a retrospective study. METHODS: Patients undergoing the osteotomy for DRUJ instability between March 2000 and February 2018 were included in the study. Thirteen patients were evaluated. The initial injury occurred at a mean age of 12.3 years and corrective osteotomy was performed at a mean age of 20.8 years. The mean follow-up period was 33.1 months. The male to female ratio was 8:5 and the corrected radius/ulna ratio was 11:2. DRUJ instability was diagnosed clinically and radiologically based on the stress/clunk test and the distance between the cortex of the radius, and the radioulnar ratio. All osteotomies in the radius and ulna were of the open wedge type and were performed using plates/screws. RESULTS: The radioulnar ratio was significantly higher than the normal ratio (p < 0.001). All osteotomies healed well without any serious complications. The preoperative distance between the cortex of the radius and ulna was significantly decreased at the final follow-up, from 4.74 ± 0.82 to 1.16 ± 0.46 mm (p < 0.001). Positive findings of two instability tests were all converted to negative. The ranges of motion of the flexion-extension and pronation-supination arcs were significantly improved. Finally, preoperative VAS pain and DASH scores improved to 0.23 ± 0.44 and 3.92 ± 1.84, respectively (p < 0.001). CONCLUSIONS: Malunited radius or ulna plays a role in DRUJ instability, affecting the bony geometry in terms of the relationship between the sigmoid notch and ulnar head. Treatment of malunion by corrective osteotomy represents a useful option for resolving instability. LEVEL OF EVIDENCE: Level IV, Retrospective therapeutic study.


Assuntos
Fraturas Mal-Unidas , Fraturas do Rádio , Fraturas da Ulna , Adulto , Criança , Feminino , Fraturas Mal-Unidas/diagnóstico por imagem , Fraturas Mal-Unidas/cirurgia , Humanos , Masculino , Osteotomia , Rádio (Anatomia) , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Estudos Retrospectivos , Ulna/diagnóstico por imagem , Ulna/cirurgia , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/cirurgia , Articulação do Punho , Adulto Jovem
19.
J Hand Surg Am ; 46(9): 822.e1-822.e7, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33820657

RESUMO

Ulnar impaction syndrome (UIS) and triangular fibrocartilage complex (TFCC) tear are common causes of ulnar-sided wrist pain. As a standard surgical treatment, ulnar-shortening osteotomy (USO) and TFCC repair are used respectively. Patient spectrums of UIS accompanied by distal radioulnar joint instability or traumatic TFCC foveal tear with UIS symptoms exist, and both USO and TFCC repair are necessary for treating some of these patients. However, there have been few reports on the procedure for performing these 2 operations concurrently. We introduce a combined procedure to concurrently perform USO and TFCC repair. We performed a USO in the ulnar metaphysis using a locking plate and open TFCC knotless repair using a suture anchor at the ulnar fovea. In this technique, USO is conducted in the metaphysis, which is favorable to union, using a small plate that is easy to handle, and knotless TFCC repair can be performed simultaneously through a single small incision.


Assuntos
Instabilidade Articular , Fibrocartilagem Triangular , Traumatismos do Punho , Artroscopia , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Osteotomia , Fibrocartilagem Triangular/diagnóstico por imagem , Fibrocartilagem Triangular/cirurgia , Ulna/diagnóstico por imagem , Ulna/cirurgia , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Articulação do Punho
20.
J Int Med Res ; 49(4): 3000605211008323, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33858252

RESUMO

As a pivotal part of the elbow joint structure, the coronoid process of the ulna plays a vital role in maintaining elbow joint stability. Loss of coronoid process height causes instability of the elbow joint depending on the fracture characteristics and size. The diagnosis and treatment of coronoid process fractures has gained widespread attention from orthopedic surgeons. Nevertheless, few reports have described reconstruction of coronoid process fractures and defects that affect elbow joint stability. Treatment of elbow joint instability induced by coronoid process defects is challenging because most cases are complicated by other elbow joint injuries. Moreover, the clinical efficacy remains unclear. The present narrative review was performed to examine the research progress on reconstruction of the coronoid process. The findings of this review provide evidence for clinical repair and reconstruction of coronoid process defects and contribute to the published literature on this topic.


Assuntos
Articulação do Cotovelo , Instabilidade Articular , Fraturas da Ulna , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Epífises , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Ulna/diagnóstico por imagem , Ulna/cirurgia , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/cirurgia
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