Lengthening of the Forearm by Callus Distraction

1996 ◽  
Vol 21 (2) ◽  
pp. 151-163 ◽  
Author(s):  
M. ABE ◽  
H. SHIRAI ◽  
M. OKAMOTO ◽  
T. ONOMURA
Keyword(s):  
Distal Radius ◽  
Radial Head ◽  
Callus Formation ◽  
Congenital Dislocation ◽  
Growth Disturbance ◽  
Distal Ulna ◽  
And Function ◽  
Pin Track ◽  
Delayed Consolidation

Ten patients aged 3 to 13 years (mean, 9 years and 7 months) underwent forearm lengthening by callotasis. The indications for lengthening were shortening and/or deformity of the forearm due to exostosis of the distal ulna in five cases, enchondroma of the distal ulna in one, growth disturbance after fracture of the distal radius in one, radial club hand in one, congenital amputation of the forearm in one and congenital dislocation of the radial head in one. Four had lengthening of the ulna, one of the radius and five of both the radius and the ulna. The average lengthening achieved was 30 mm. Complications encountered were pin track discharge in three cases, callus fracture in five, delayed consolidation of the callus in one and no callus formation in one. Review after 1 to 7 years follow-up (with a mean of 4 years and 9 months) showed satisfactory improvement in appearance and function especially in patients who had tumorous conditions or traumatic epiphyseal arrest.

scholarly journals Comparative Study of Internal Fixation of the Ulna and Distal Ulna Resection in Patients Older Than 70 Years With Distal Radius and Distal Metaphyseal Ulna Fractures

Hand ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 540-546
Author(s):  
Jorge G. Boretto ◽  
Ezequiel E. Zaidenberg ◽  
Gerardo L. Gallucci ◽  
Alejandro Sarme ◽  
Pablo De Carli
Keyword(s):  
Internal Fixation ◽  
Distal Radius ◽  
The Elderly ◽  
Acute Management ◽  
Distal Ulna ◽  
Radiographic Appearance ◽  
Patient Demographics ◽  
Ulna Fractures

Background: Acute management of fractures of the distal ulna that are associated with fractures of the distal radius remains difficult, particularly in the elderly. Methods: In this study, we investigated whether internal fixation of the distal ulna is associated with a higher rate of complications than resection of the distal ulna in patients older than 70 years. Twenty-four consecutive patients were included in this study, 12 of whom had undergone open reduction and internal fixation (ORIF) of the distal ulna, and 12 who had undergone distal ulna resection. Patients were retrospectively assessed for range of motion, grip strength, pain, and radiographic appearance. The functional outcome was evaluated by the Mayo Wrist Score. Complications were classified according to the Classification of Surgical Complications. Results: There were no differences in patient demographics between the 2 groups, except patient age. Clinical evaluation showed no difference at follow-up; however, there were significantly more complications associated with ORIF compared with resection. Conclusions: The results from our study show that women older than 70 years with fracture of the distal radius and distal ulna have a higher rate of complications if ORIF of the distal ulna is performed. Patients should be warned, by surgeons, of this in cases where ORIF of the distal ulna is suggested.

Treatment Modality of Distal Ulnar Head and Neck Fractures Associated With Operatively Treated Distal Radius Fractures Does Not Affect Outcomes

Hand ◽  
2020 ◽  
pp. 155894472092292
Author(s):  
Georgina Glogovac ◽  
Allison K. Perry ◽  
Michael D. Wigton ◽  
Peter J. Stern
Keyword(s):  
Head And Neck ◽  
Distal Radius ◽  
Nonoperative Treatment ◽  
Distal Radius Fractures ◽  
Complication Rates ◽  
Radius Fractures ◽  
Distal Ulna ◽  
Ulnar Head ◽  
Patient Reported

Background: This study compares the functional outcomes and complications between operatively and nonoperatively treated distal ulnar head and neck fractures associated with internal fixation of concomitant distal radius fractures. Methods: A 7-year retrospective chart review was performed to identify patients with operatively treated distal radius fractures associated with distal ulnar head and neck fractures. Ulnar styloid fractures were excluded. Fifty-eight patients who had a minimum of 6 months of follow-up were identified. Patients were divided into 3 treatment groups: nonoperative, open reduction internal fixation (ORIF), and distal ulna resection. Reviewed data included demographics, injury and treatment details, complications, and patient-reported outcome measures. Outcomes measures included Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity and Patient-Rated Wrist Evaluation (PRWE) surveys. Due to inadequate power, 5 patients treated with distal ulna resection were excluded from statistical analysis. Results: The average patient age was 56 years, with an average follow-up of 27 months. All patients underwent ORIF of the distal radius fracture. Distal ulna fractures were treated nonoperatively in 25 patients, with ORIF in 28 patients, and with distal ulna resection in 5 patients. There were no statistically significant differences in wrist or forearm range of motion, complication rates, secondary procedure rates, PRWE scores, or PROMIS scores between ORIF and nonoperative treatment. Conclusion: No differences in wrist or forearm range of motion, complication rates, secondary procedure rates, PRWE scores, or PROMIS scores were observed between ORIF and nonoperative treatment of distal ulnar head and neck fractures associated with operatively treated distal radius fractures.

Unusual Forearm Deformity Solved by 3D Custom Made Guides

2019 ◽  
Vol 24 (04) ◽  
pp. 483-487
Author(s):  
Maria de los Angeles De la Red Gallego ◽  
Jose Couceiro Otero ◽  
Marta De Prado Tovar ◽  
Higinio Ayala Gutierrez ◽  
Manuel Ruben Sanchez Crespo
Keyword(s):  
Range Of Motion ◽  
Radial Head ◽  
3D Model ◽  
Three Dimensional ◽  
Distal Ulna ◽  
Ulnar Head ◽  
Custom Made ◽  
Ulnar Fracture ◽  
Cutting Guides

We report a case of a symptomatic forearm deformity due to a premature distal ulnar fracture solved by 3D custom made cutting guides. Our patient is a sixteen years old girl referred to us due to a forearm deformity and a dysplasic ulnar head associated to pain at the dorsum of the distal ulna and at the radial head at the elbow. Using custom-made cutting guides on a 3D model, a both bone forearm osteotomy was performed. At 18 months of follow up, the range of motion did not improve significantly but our patient referred no pain and she was satisfied with the procedure. The accuracy of single cut osteotomies, utilizing three-dimensional planning and custom patient guides has been previously established. This technique helped with the pain in our case.

scholarly journals Case report: congenital dislocation of the radial head –a two-in-one approach

F1000Research ◽  
2014 ◽  
Vol 3 ◽  
pp. 22 ◽  
Author(s):  
Raju Karuppal ◽  
Anwar Marthya ◽  
Rajendran V Raman ◽  
Sandhya Somasundaran
Keyword(s):  
Radial Head ◽  
Open Reduction ◽  
Skeletal Maturity ◽  
Functional Results ◽  
Congenital Dislocation ◽  
History Of ◽  
One Year ◽  
Nail Patella Syndrome ◽  
Delayed Intervention

Background: Congenital dislocation of the radial head of the elbow is rare. It is genetically transmitted in some cases and is often associated with syndromes, such as Nail-Patella syndrome, antecubital pterygium and ulnar dysplasia. About two thirds are posterior, with the remainder being either anterior (15%) or lateral (15%). The natural history of the condition is that symptoms are relatively benign, with only some limitation of motion and deformity. Treatment either involves early attempts at reconstruction or delayed intervention at skeletal maturity with radial head excision. We evaluated the radiographic and functional results of a two-in-one procedure (radial shortening and open reduction) in the treatment of congenital dislocation of the radial head of an eight year old girl.Objective: To describe a technique for easy reduction and maintenance of normal radiocapitellar joint anatomy in cases of congenital dislocation of the radial head.Method: We have introduced one modification to the Sachar’s method of open reduction by adding radial shortening. This can be described as a ‘two incision approach’ with the first incision for the radial shortening and the second for the open reduction of the radiocapitellar joint. The radial shaft was osteotomised first before we performed the radial head relocation. Then the overlapping part of radial shaft was trimmed. It was stabilized with a transarticular K wire fixation.Results: At one year follow up, the elbow is stable with no valgus or fixed flexion deformity. Supination has increased to 40 degrees from zero degrees. An X-ray showed reformation of the radial head with good congruity of the radiocapitellar joint and correction of the radial bow.Conclusion: As far as the authors are aware, this is the first report of congenital dislocation of the radial head being treated by radial shortening and open reduction of radiocapitellar joint through a two incision approach (two-in-one approach). This paper describes this new technique, which we implemented for easy reduction maintenance of normal radiocapitellar joint anatomy.

scholarly journals Benign Fibrous Histiocytoma of the Distal Radius with Congenital Dislocation of the Radial Head: A Case Report

2005 ◽  
Vol 13 (1) ◽  
pp. 83-87 ◽  
Author(s):  
S Sanatkumar ◽  
N Rajagopalan ◽  
B Mallikarjunaswamy ◽  
S Srinivasalu ◽  
NP Sudhir ◽  
...  
Keyword(s):  
Case Report ◽  
Distal Radius ◽  
Radial Head ◽  
Fibrous Histiocytoma ◽  
Benign Lesion ◽  
Ossifying Fibroma ◽  
Congenital Dislocation ◽  
Benign Fibrous Histiocytoma ◽  
College Hospital ◽  
Rare Tumour

Benign fibrous histiocytoma is such a rare tumour that only a few cases have been reported in the literature. A patient with an apparently benign lesion of the distal radius, along with congenital dislocation of the radial head, was presented at St. John's Medical College Hospital in Bangalore, India. Pain was the chief symptom. There were histological features of non-ossifying fibroma in the lesion. Because of its unusual radiological appearance and atypical clinical course, the lesion was diagnosed as fibrous histiocytoma. In this case report, we review similar cases in the literature and discuss an unusual association with congenital dislocation of the radial head.

scholarly journals Bifocal osteosynthesis to treat radial shortening deformity with dislocation of the inferior radioulnar joint

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Junjie Guan ◽  
Hongjiang Ruan ◽  
Jimin Yin ◽  
Yimin Chai ◽  
Qinglin Kang
Keyword(s):  
Wound Care ◽  
Delayed Union ◽  
Ilizarov Method ◽  
Radioulnar Joint ◽  
Outcome Scores ◽  
Post Operation ◽  
And Function ◽  
Pin Track ◽  
Radiographic Data

Abstract 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.

scholarly journals DISTAL ULNA PHYSEAL ARREST FOLLOWING DISTAL FOREARM FRACTURES IN CHILDREN

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0019
Author(s):  
Trevor J. Shelton ◽  
J. Ryan Taylor ◽  
Lauren Agatstein ◽  
Andrea Bauer ◽  
Brian Haus
Keyword(s):  
Distal Radius ◽  
Common Mechanism ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Post Injury ◽  
Distal Ulna ◽  
Physeal Fracture ◽  
Distal Forearm Fractures

Background: Pediatric forearm fractures are a common injury with only a small subset of these involving the distal physes of the radius and ulna. A common mechanism of injury in these fractures are from sports related injuries or fall on outstretch hand. Physeal fractures of the distal radius are well-studied, with varying rates of growth arrest and potential for deformity depending on the type of physeal fracture. The incidence and long-term complications of pediatric forearm fractures involving the distal ulna physis remains largely unknown. Distal ulnar physeal arrest can lead to the development of radioulnar length discrepancy and angular deformities. Two previous studies of limited sample size report a 50-55% of physeal arrest when the ulnar physiss was involved in the fractur, which seems higher than what is seen at our institution. The purpose of this study was to investigate the demographic distribution, as well as the incidence of physeal arrest following a physeal fracture of the distal ulna. Methods: After institutional review board approval, a retrospective study was performed of all patients with distal forearm fractures treated at our institution from January 2003 until December 2017. We included patients < 18 years of age who presented to our level-1 emergency department or to our orthopaedic department and excluded those with extra-physeal fracture and closed physis. Wrist x-rays of 1,618 patients with distal forearm fractures were reviewed revealing a total of 52 patients with distal ulna physeal fracture. Patient demographics including age, gender, height, weight, mechanism of injury, and age at follow up was recorded. Each injury x-ray was reviewed and the distal ulna physeal fracture was categorized using the Salter-Harris (SH) classification system. Concomitant injuries were also recorded and if there was a radial physeal injury the SH classification system was used again. All follow up radiographs > 6 months post-injury were reviewed to assess for physeal arrest. Results: There were a total of 11 patients (average age at injury 10 ± 2 years; 5 males, 6 females; average height 1.5 0.2 m, average weight 47 ± 23 kg) with at least 6 months follow up post injury (average follow up time 2.4 ± 2.2 years. Of these, the most common mechanism was fall on outstretch hand occurring 64% of the time (n = 7), followed by sports in 18% (1 football, 1 baseball), and 9% fall from bike (n = 1), and 9% from ATV accident (n = 1). The most frequent distal ulna physeal fracture was SH type 2 occurring 55% of the time (n = 6), while 36% had a SH type 3 (n = 4), and 9% had a SH type 1 (n = 1). Eight patients had an ipsilateral radius fracture with 45% having a metaphyseal fracture (n = 5) and 27% having a distal radius physeal fracture (n = 3; one SH type 1, and two SH type 2). One patient had an ipsilateral supracondylar fracture and another patient had a Galeazzi fracture. Casting was the most frequent treatment occurring 64% of the time (n = 7), followed by closed reduction and casting in 18% (n = 2). Closed reduction and percutaneous pinning was done in 9% (n = 1), and open reduction and internal fixation (ORIF) was done in 9% (n = 1). None of these patients developed distal ulna physeal arrest (while one of them developed a distal radius physeal arrest. The one patient with the Galezzi fracture did go on to develop a malunion with clicking of his wrist despite being treated with ORIF and required a revision osteotomy 7 months later. The remainder of patients had no complications. Conclusion/Significance: The most important finding of this study is that the rate of distal ulna physeal arrest following fracture was 0%. This is in contrast to previous studies of limited sample size that reported a rate of 50-55%. Our results demonstrate a much lower incidence of distal ulnar physeal arrest than previously thought in the pediatric population with distal forearm fractures. These findings suggest that the majority of patients with distal ulna physeal fractures do well with conservative management, and may only require routine clinical and radiographic follow up.

scholarly journals Evaluation of two different types of radial head prosthesis in practical use. Using either Evolve® or MoPyC® radial head prosthesis in the treatment of comminuted radial head fractures

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Tim Friedrich Raven ◽  
Lukas Banken ◽  
Gerhard Schmidmaier ◽  
Stefan Studier-Fischer ◽  
Bahram Biglari ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Radial Head ◽  
Radial Head Fracture ◽  
Radial Head Prosthesis ◽  
Radial Head Fractures ◽  
Functional Scores ◽  
System Assessment ◽  
And Function ◽  
Comminuted Radial Head Fracture

The aim of this retrospective study was to undertake a comparative evaluation of the Evolve® modular metallic radial head implant prosthesis and the MoPyC® pyrocarbon prosthesis in acute care. Seventyfive patients having a comminuted radial head fracture with an Evolve® prosthesis (=G1) and 11 with a MoPyC® prosthesis (=G2) were available for a follow-up. Postoperative patient outcomes were evaluated according to a standardized follow-up protocol which included the Morrey rating system. Assessment criteria were range of motion (ROM), functional scores, and rate of complications. G1 showed a mean Morrey score of 86 points. Four direct prosthesis complications were observed in this group (n=75). The average achieved Morrey score in G2 was 84 points. In this group (n=11), 2 direct prosthesis complications were diagnosed. The average range of motion did not differ greatly between both groups. Radial head replacement with either prosthesis yielded sufficient to satisfactory results in a mid-term perspective regarding the range of motion and function of the elbow joint when performed in carefully selected patients. The Evolve® Prothesis appears to show a slightly lower rate of complication by way of a similar functional outcome.

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