Restricted Wrist Rotation after an Ulnar Head Fracture: A Report of Two Cases

Abstract Background Isolated ulnar head fracture is a rare entity, and the restriction of range of motion in the wrist is rarely reported. Case Description We report two cases of conservatively treated ulnar head malunion with restricted supination and pronation. The increased tension of the volar portion of the triangular fibrocartilage complex was observed, and the surgical treatment significantly improved the range of motion. Literature Review There are a few reports on isolated ulnar head fracture. Other causes of restricted supination and pronation of the wrist are mostly due to the interposition of soft tissues or loose bodies. Clinical Relevance Malunion after ulnar head fracture can cause restriction of wrist supination and pronation. Surgical intervention may be considered if restricted range of motion remains after conservative treatment.

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Reconstruction for DRUJ Instability

Hand ◽

10.1007/s11552-007-9034-6 ◽

2007 ◽

Vol 2 (3) ◽

pp. 123-126 ◽

Cited By ~ 32

Author(s):

Ericka Lawler ◽

Brian D. Adams

Keyword(s):

Soft Tissue ◽

Soft Tissues ◽

Senior Author ◽

Triangular Fibrocartilage Complex ◽

Radius Of Curvature ◽

Anatomical Studies ◽

Ulnar Head ◽

Sigmoid Notch ◽

Triangular Fibrocartilage ◽

Inherent Stability

The skeletal architecture of the DRUJ provides minimal inherent stability, as the sigmoid notch is shallow and its radius of curvature is 50% greater than that of the ulnar head [Af Ekenstam F, Hagert CG. Anatomical studies on the geometry and stability of the distal radio ulnar joint. Scand J Plast Reconstr Surg 1985;19(1):17–25]. Due to its incongruent articulation, the DRUJ relies strongly on the surrounding soft tissues for stability. The triangular fibrocartilage complex (TFCC) is generally accepted as the major soft tissue stabilizer of the DRUJ of which the volar and dorsal radioulnar ligaments are the primary components. Restoration of the radioulnar ligaments offers the best possibility to restore the normal DRUJ primary constraints and kinematics. This article presents an update of the procedure developed by the senior author that anatomically reconstructs the palmar and dorsal radioulnar ligaments at their anatomic origins and insertions.

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Wrist Arthrography

Acta Radiologica ◽

10.1177/028418519303400201 ◽

1993 ◽

Vol 34 (2) ◽

pp. 111-116 ◽

Cited By ~ 2

Author(s):

S.-G. Fransson

Keyword(s):

Mr Imaging ◽

Soft Tissues ◽

Surgical Intervention ◽

Clinical Signs ◽

Plain Radiography ◽

Wrist Injury ◽

Technical Modifications ◽

Triangular Fibrocartilage ◽

Diagnostic Importance ◽

Chronic Wrist Pain

The ligaments of the proximal row of carpal bones and the triangular fibrocartilage (TFC) strongly influence the function and stability of the wrist. Injury to the ligaments may result in chronic wrist pain or instability. Wrist arthrography is valuable in the investigation of such damage when surgical intervention is considered and plain radiography is unrewarding. There are also several technical modifications of the standard radiocarpal arthrography available. Owing to the possibility of congenital perforations and degenerative changes in these ligaments the arthrographic findings should be related to the clinical signs and the age of the patient. CT has less diagnostic importance in this respect while MR imaging is an alternative and may become the method of choice. Both these methods have great potential in the evaluation of soft tissues of the wrist other than the TFC.

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Closed Reduction of an Acute Volar Dislocation of the Distal Radio-Ulnar Joint by a Modified Technique

Case Reports in Orthopedics ◽

10.1155/2018/4289406 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Samuel Larrivée ◽

Graeme Matthewson ◽

Laurie Barron

Keyword(s):

Range Of Motion ◽

Closed Reduction ◽

Surgical Intervention ◽

Conventional Technique ◽

Wrist Pain ◽

Interosseous Membrane ◽

Modified Technique ◽

Ulnar Head

There is scarce literature describing treatment of volar dislocation of the distal radio-ulnar joint (DRUJ). Irreducible dislocation is usually treated surgically. We present the case of a 37-year-old male with acute right wrist pain and loss of pronation. A diagnosis of volar DRUJ dislocation was made. Reduction using conventional technique was unsuccessful. A second attempt was successful by applying pressure over the interosseous membrane of the forearm and manipulating the ulnar head. At three weeks, the patient had minimal pain, a stable DRUJ, and near complete range of motion. This modified technique for reduction of a locked anterior DRUJ dislocation can be used to avoid an unnecessary surgical intervention.

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The Optimal Suture Placement and Bone Tunnels for TFCC Repair: A Cadaveric Study

Journal of Wrist Surgery ◽

10.1055/s-0038-1661361 ◽

2018 ◽

Vol 07 (05) ◽

pp. 375-381 ◽

Cited By ~ 1

Author(s):

Peter Tang ◽

Keiji Fujio ◽

Robert Strauch ◽

Melvin Rosenwasser ◽

Taiichi Matsumoto

Keyword(s):

Distal Radioulnar Joint ◽

Radioulnar Joint ◽

Ulnar Head ◽

Transosseous Repair ◽

Triangular Fibrocartilage ◽

The Mean ◽

Group 5 ◽

Bone Tunnels ◽

Isometric Point ◽

Suture Placement

Background Transosseous repair of foveal detachment of the triangular fibrocartilage complex (TFCC) is effective for distal radioulnar joint stabilization. However, studies of the optimal foveal and TFCC suture positions are scant. Purpose The purpose of this study was to clarify the optimal TFCC suture position and bone tunnels for transosseous foveal repair. Materials and Methods Seven cadavers were utilized. The TFCC was incised at the foveal insertion and sutured at six locations (TFCCs 1–6) using inelastic sutures. Six osseous tunnels were created in the fovea (foveae 1–6). Fovea 2 is located at the center of the circle formed by the ulnar head overlooking the distal end of the ulna (theoretical center of rotation); fovea 5 is located 2 mm ulnar to fovea 2. TFCC 5 is at the ulnar apex of the TFCC disc; TFCC 4 is 2 mm dorsal to TFCC 5. TFCC 1 to 6 sutures were then placed through each of the six osseous tunnels, resulting in 36 combinations, which were individually tested. The forearm was placed in five positions between supination and pronation, and the degree of suture displacement was measured. The position with the least displacement indicated the isometric point of the TFCC and fovea. Results The mean distance of suture displacement was 2.4 ± 1.6 mm. Fovea 2, combined with any TFCC location, (0.7 ± 0.6 mm) and fovea group 5, combined with TFCC 4 location (0.8 ± 0.8) or with TFCC 5 location (0.9 ± 0.6) had statistically shorter suture displacements than any other fovea groups. Conclusion For TFCC transosseous repair, osseous tunnel position was more important than TFCC suture location.

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A Rare Case of Extramedullary Relapse of Multiple Myeloma Causing Bowel Obstruction

Case Reports in Hematology ◽

10.1155/2019/4962678 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Prarthna V. Bhardwaj ◽

Shrinkhala Khanna ◽

Majd D. Jawad ◽

Syed S. Ali

Keyword(s):

Multiple Myeloma ◽

Bowel Obstruction ◽

Rare Case ◽

Soft Tissues ◽

Plasma Cells ◽

Case Reports ◽

Rare Entity ◽

Risk Gene ◽

Gene Profiles ◽

Extramedullary Relapse

Extramedullary myeloma, defined by presence of plasma cells outside the bone marrow, is a rare entity accounting for about 3–9% of all cases. It usually is aggressive with a median survival of <6 months. It is also associated with adverse prognostic factors including 17p deletions and high-risk gene profiles. While common extramedullary sites include bones, there have been several case reports of hematogenous extramedullary myeloma to the liver, lungs, pancreas, breast, skin, and soft tissues. Extramedullary myeloma to the mesentery is a rare entity with only a handful of cases reported. We present a case of 69-year-old man presenting with relapse of multiple myeloma to the mesentery, resulting in bowel obstruction to highlight the various presentations of myeloma.

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Serial Casting of the Ankle and Knee in a Child With Vascular Anomaly of the Calf Musculature: A Case Report

Physical Therapy ◽

10.1093/ptj/pzz147 ◽

2019 ◽

Author(s):

Colleen Peyton

Keyword(s):

Lower Extremity ◽

Range Of Motion ◽

Vascular Anomaly ◽

The Novel ◽

Case Description ◽

Limited Evidence ◽

Posterior Compartment ◽

Serial Casting ◽

Toe Walking ◽

Gait Impairments

Abstract Background and Purpose Contracture and toe-walking in children due to vascular anomaly of the calf musculature is rarely described and there is limited evidence regarding treatment. The purpose of this case is to describe the novel use of serial casting, combining the knee and ankle, to reduce contracture in a child with hemangioma of the calf. Case Description An 11-year-old girl received 12 casts of the ankle and knee, followed by custom orthotics, to address chronic contracture and gait impairments caused by a vascular anomaly in the posterior compartment of the lower extremity. Outcomes After casting, the patient had fully restored knee range of motion and improved ankle range of motion by 45 degrees. She received custom orthotics and maintained her range of motion four months after casting. Discussion Serial casting of the knee and ankle may be a useful alternative to surgical lengthenings in patients with chronic contractures caused by vascular anomalies of the lower extremity.

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Long-Term Outcomes of All-Arthroscopic Pre-Tied Suture Device Triangular Fibrocartilage Complex Repair

Journal of Wrist Surgery ◽

10.1055/s-0039-1688949 ◽

2019 ◽

Vol 08 (05) ◽

pp. 403-407 ◽

Cited By ~ 3

Author(s):

Eric J. Sarkissian ◽

Matthew B. Burn ◽

Jeffrey Yao

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Triangular Fibrocartilage Complex ◽

Study Cohort ◽

Inclusion Criteria ◽

Level Of Evidence ◽

Triangular Fibrocartilage ◽

Suture Device

Background A pre-tied suture device has been utilized for all-arthroscopic peripheral triangular fibrocartilage complex (TFCC) repairs with promising early clinical results. Purpose The purpose of this study was to evaluate long-term functional outcomes of these repairs. Patients and Methods A retrospective review of patients undergoing arthroscopic TFCC repair was performed. Inclusion criteria were the Palmer type 1B TFCC tears diagnosed on arthroscopy and repaired using the all-arthroscopic pre-tied suture device. Patients with any evidence of concomitant wrist injury at the time of surgery, history of prior wrist surgery, or nonrepairable and nonperipheral TFCC tears were excluded. Postoperative complications, range of motion, grip strength, and outcome assessments were recorded for each patient. Results Eleven patients (mean age, 36 years; range, 20–64 years) satisfied our inclusion criteria and comprised the study cohort. The mean follow-up period was 7.0 years (range, 4.3–10.9 years). Mean range of motion of the wrist revealed flexion of 76 ± 11 degrees and extension of 73 ± 12 degrees. Mean grip strength was 98 ± 15% of the nonsurgical extremity. QuickDASH, modified Mayo, and patient-rated wrist evaluation (PRWE) average scores were 9 ± 8, 80 ± 6, and 12 ± 12, respectively. No surgical complications were observed and no patient required any further surgical intervention. Conclusions Our cohort of patients following all-arthroscopic pre-tied suture device repair of isolated Palmer type 1B TFCC tears demonstrated excellent clinical function at a mean follow-up of 7 years. These findings indicate that the pre-tied suture device is a reliable, safe, effective, and most importantly, durable treatment option for repair of peripheral TFCC tears. Level of Evidence This is a Level IV, therapeutic study.

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A young female patient with reflex sympathetic dystrophy of the upper limb in whom amputation became inevitable

Prosthetics and Orthotics International ◽

10.3109/03093649709164545 ◽

1997 ◽

Vol 21 (2) ◽

pp. 159-161 ◽

Cited By ~ 8

Author(s):

J. H. B. Geertzen ◽

J. S. Rietman ◽

A. J. Smit ◽

K. W. Zimmerman

Keyword(s):

Range Of Motion ◽

Female Patient ◽

Upper Limb ◽

Reflex Sympathetic Dystrophy ◽

Young Female ◽

Restricted Range ◽

Burning Pain ◽

Life Threatening ◽

Unbearable Pain ◽

Autonomic Disturbances

Reflex sympathetic dystrophy (RSD) is characterized mostly by: (burning) pain, restricted range of motion, oedema and autonomic disturbances. Amputations in case of RSD patients should only be performed in cases of a dysfunctional limb, life threatening conditions such as untreatable infections or in cases of unbearable pain. The authors describe a patient in whom amputation became inevitable because of threatening infections.

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