Shelf Osteotomy for Madelung’s Deformity in Adults: A Novel Technique

2021 ◽  
Author(s):  
Ricardo Kaempf de Oliveira ◽  
João P. F. Brunelli ◽  
Márcio Aita ◽  
Pedro J. Delgado ◽  
Francisco Soldado
Keyword(s):  
Distal Radius ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Treatment Method ◽  
Lunate Bone ◽  
Volar Approach ◽  
Radiographic Outcomes ◽  
Distal Epiphysis ◽  
Concept Change ◽  
Madelung’S Deformity

Abstract Background Madelung's deformity (MD) comprises increased volar and ulnar tilt of the distal radius joint facet, secondary to an idiopathic physeal dysplasia. Such change causes radial shortening and a consequent distal ulnar prominence, along with wrist pain and loss of motion. Classic surgical techniques are problematic for adults, as they are specific for children and adolescents whose distal radial physis is still open. Description of Technique It is suggested a new treatment method for MD in skeletally mature patients: a distal radius osteotomy and joint realignment are performed through a volar approach to increase the support area of the lunate bone. The rotation and lengthening of the distal epiphysis of the radius generate support and cover to the lunate bone, with improvement of both radiocarpal and distal radioulnar joints. Patients and Methods We describe the technique in details and report the treatment of a 25-year-old female patient. Results Early clinical and radiographic outcomes are encouraging for the treatment of symptomatic patients. Conclusion There is a plethora on the literature about conflicting opinions on the best treatment options and surgical techniques are quite variable, although usually with good results. Besides, the technique here described is indicated during a specific stage of disease presentation, consisting of young adults without any wrist-degenerative changes. Having said that, it is possible to claim that MD treatment with shelf osteotomy is a concept change. Our main goal is to reconstruct the diseased segment and improve wrist stability.

scholarly journals Madelung Deformity: Diagnosis and Treatment Options

2021 ◽  
Vol 49 (02) ◽  
pp. e140-e154
Author(s):  
Ricardo Kaempf de Oliveira ◽  
Samuel Ribak ◽  
João Pedro Farina Brunelli ◽  
Márcio Aita ◽  
Pedro J. Delgado
Keyword(s):  
Distal Radius ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Distal Radioulnar Joint ◽  
Lunate Bone ◽  
Radioulnar Joint ◽  
Madelung Deformity ◽  
Computed Tomography Scans ◽  
Tridimensional Reconstruction ◽  
Loss Of Motion

AbstractMadelung deformity (MD) comprises an increased volar and ulnar tilt of the joint facet of the distal radius, secondary to an idiopathic physeal dysplasia. Such change causes radial shortening and consequent distal ulnar prominence, along with wrist pain and loss of motion. Surgery becomes an option in patients with severe deformity that do not respond to conservative treatment.The classic surgical techniques are problematic for adults, as they are specific for children and adolescents, whose radial physis is still open. Very few papers discuss the treatment of adult patients; furthermore, most are focused on the distal radioulnar joint, and thus do not approach the origin of the pathology.When analyzing computed tomography scans with tridimensional reconstruction, a feature of MD, growth arrest of the volar and ulnar portions of the distal radius, is noted, causing the typical distal radius deformity that leads to lack of coverage of the lunate bone. That leads to palmar subluxation of the lunate bone and consequent radiocarpal instability.We herein describe the possibilities of treatment in different stages of evolution, summarizing the authors' view on MD.

scholarly journals Paradigmaváltás a csontmetasztázisok sebészetében. II. Gerincmetasztázisok kezelése

2018 ◽  
Vol 159 (8) ◽  
pp. 297-302
Author(s):  
Áron Lazáry ◽  
Zsolt Szövérfi ◽  
Péter Pál Varga
Keyword(s):  
Minimally Invasive ◽  
Spinal Metastasis ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Spinal Metastases ◽  
Treatment Method ◽  
Minimally Invasive Surgical ◽  
Published Evidence ◽  
Minimally Invasive Stabilization ◽  
Oncologic Treatment

Abstract: The incidence of spinal metastases is constantly growing, but due to the advancements in oncologic treatment methods, the survival and the quality of life of the patients are persistently improving. Choosing the optimal treatment method is essential, and several factors should be considered: type of the primary tumor, segmental stability, the symptoms caused by the metastasis and the general condition of the patient. Using modern radiotherapeutic methods combined with minimally invasive surgical techniques (minimally invasive stabilization, separation surgery) in the majority of patients permits adequate local control with low complication rate. In our review, we describe the state-of-the-art, modern spinal metastasis treatment options based on the recently published evidence. Orv Hetil. 2018; 159(8): 297–302.

MALUNITED FRACTURES OF THE DISTAL RADIUS TREATED WITH CORRECTIVE OSTEOTOMY USING VOLAR LOCKING PLATE AND A CORTICOCANCELLOUS BONE GRAFT FOLLOWING IMMEDIATE MOBILISATION

Hand Surgery ◽  
2007 ◽  
Vol 12 (03) ◽  
pp. 183-190 ◽  
Author(s):  
Denju Osada ◽  
Shuzo Kamei ◽  
Morimitsu Takai ◽  
Kazuo Tomizawa ◽  
Kazuya Tamai
Keyword(s):  
Distal Radius ◽  
Bone Grafting ◽  
Locking Plate ◽  
Corrective Osteotomy ◽  
Treatment Method ◽  
Contralateral Side ◽  
Volar Locking Plate ◽  
Forearm Rotation ◽  
Volar Approach

We describe our experience of using a volar locking plate for corrective osteotomy and bone grafting combined with early mobilisation in the treatment of distal radius malunions. Corrective osteotomy of the distal radius was performed through a volar approach, and fixated by a volar locking plate associated with corticocancellous iliac bone grafting in three patients aged 16, 71 and 75 years. Two patients had had volarly displaced malunion and one dorsally displaced malunion. Wrist motin was started immediately after surgery. The average follow-up was 15 months (range, 12–20 months). All osteotomies healed at an average 5.7 weeks post-operatively, resulting in a total arc of wrist motion of 133°, forearm rotation of 167°, and grip strength of 70% of that of the contralateral side. This treatment method proved to be effective and safe.

scholarly journals Radiographic Outcomes of Percutaneous Pinning for Displaced Extra-Articular Fractures of the Distal Radius: A Time Course Study

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Tien-Yu Yang ◽  
Yao-Hung Tsai ◽  
Shih-Hsun Shen ◽  
Kuo-Chin Huang
Keyword(s):  
Distal Radius ◽  
Bone Healing ◽  
Time Course ◽  
Surgical Techniques ◽  
Care Program ◽  
Percutaneous Pinning ◽  
Radiographic Outcomes ◽  
Articular Fractures ◽  
Radiographic Measurements ◽  
Time Course Study

Introduction. Although not all malunited distal radius fractures are symptomatic, the goal of treatment for displaced extra-articular fractures of the distal radius should be to restore and to maintain the radial geometry until bone healing. However, the time course change after surgery for these fractures is unclear.Methods. We, therefore, performed a retrospective cohort study on patients who sustained such fractures treated with percutaneous pinning. The main outcome measures in this study included four radiographic measurements: radial height, radial inclination, radial tilt, and ulnar variance.Results. Assessment of the monthly changes in these measurements revealed that early fracture collapse with loss of the reduced radial tilt occurred. Besides, among the 4 measurements, the normal radial tilt was the most difficult to be achieved when repositioning and pinning the fractured fragments.Conclusions. Even though the modified Kapandji technique provided a superior ability to maintain the reduced position until bone healing over the Willenegger method, we recommended that refinement of surgical techniques and postoperative hand care program may be necessary to fulfill the treatment objectives of stable surgical fixation and early joint motion.

The Flexor Carpi Radialis Portal for Arthroscopy-Assisted Reduction of the Dorsal Ulnar Fragment in Distal Radius Fractures

2021 ◽  
Author(s):  
Ricardo Kaempf de Oliveira ◽  
João Pedro Farina Brunelli ◽  
Marcio Aurelio Aita ◽  
Pedro Jose Delgado Serrano
Keyword(s):  
Distal Radius ◽  
Surgical Techniques ◽  
Distal Radius Fractures ◽  
Volar Plating ◽  
Radius Fractures ◽  
Volar Approach ◽  
Flexor Carpi Radialis ◽  
Anatomic Reduction ◽  
Specific Fixation ◽  
Made In

Abstract Background The importance of the dorsal ulnar fragment (DUF) for stability and articular congruence of the radius is widely recognized, and standard surgical techniques often fail to ensure its reduction. Description of Technique We describe a modification of volar wrist portals for arthroscopic management of the DUF of the distal radius. It is made in an outside-in fashion in line with the flexor carpi radialis (FCR) approach for the distal radius. Through this volar portal, we achieve wide and direct visualization of the DUF, with the advantage of protecting important anatomic structures such as the FCR tendon, the radial artery, and the median nerve; all protected with the previously made volar approach for the distal radius. In addition, easy manipulation and reduction of the DUF is obtained with instrumentation through standard dorsal portals. Patients and Methods We performed this procedure in 23 patients with distal radius fractures (DRF) with displaced DUF. Results Early and late postoperative evaluation demonstrated intraoperative reduction maintenance and adequate range of motion, compatible with the usual findings of standard volar plating, with the benefit of anatomic reduction of the DUF. Conclusion With our technique, volar plating associated with arthroscopy-assisted dorsal fragment specific fixation with dorsal standard and the FCR portals permits optimal surgical treatment of most DRFs.

Madelung’s deformity: a review

2009 ◽  
Vol 35 (3) ◽  
pp. 174-181 ◽  
Author(s):  
A. Dubey ◽  
M. Fajardo ◽  
S. Green ◽  
S. K. Lee
Keyword(s):  
Distal Radius ◽  
Clinical Experience ◽  
Current Literature ◽  
Surgical Techniques ◽  
Rare Condition ◽  
Adolescent Females ◽  
Distal Ulna ◽  
Madelung’S Deformity

Madelung’s deformity is a rare condition of the wrist characterized by a shortened distal radius with volar–ulnar curvature and a dorsally prominent distal ulna. It occurs predominantly in adolescent females who present with pain, decreased wrist mobility, and deformity. Although its aetiology remains unclear, its treatment is becoming more refined. Several different surgical techniques have recently been described in the literature. This review addresses Madelung’s deformity and suggests an algorithm for management based on current literature and the authors' own clinical experience.

Distal Radius Fracture Treatment Outcomes in Patients With Ipsilateral Hemiplegia or Hemiparesis

Hand ◽  
2021 ◽  
pp. 155894472199973
Author(s):  
Nicholas Munaretto ◽  
Adam Tagliero ◽  
Raahil Patel ◽  
Peter C. Rhee
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Case Series ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Functional Classification ◽  
Radius Fractures ◽  
Radiographic Outcomes ◽  
Ipsilateral Hemiparesis

Background Little information exists to guide decision-making with regard to distal radius fractures in the setting of ipsilateral hemiparesis or hemiplegia. Methods Patients who sustained a distal radius fracture in the setting of ipsilateral hemiparesis or hemiplegia secondary to brain injury were evaluated. Investigated variables included perioperative pain, preinjury House functional classification score, length of immobilization, radiographic outcome measurements, and time to union. Results There were 15 patients with distal radius fractures with a mean age of 65.9 years. The mean clinical and radiographic follow-up was 2.8 and 2.9 years, respectively. Wrists were placed into the nonoperative group (NOG, n = 10) and operative group (OG, n = 5). Pain significantly decreased at final follow-up for both groups. Baseline House functional classification scores averaged 1.3 and 1.6 for the NOG and OG, respectively, and were maintained at final follow-up. Length of immobilization for the NOG was 46 days and OG was 37 days, P = .15. Radiographic outcomes at final follow-up in the NOG and OG, respectively, were a mean radial height of 9.3 versus. 11.6 mm, radial inclination of 18.3° versus 22.3°, 4.2° dorsal tilt versus 5.3° volar tilt, and tear drop angle of 45.6° versus 44.5°. There were no significant differences in these measurements. Time to radiographic union averaged 58 days for the NOG and 67 days for the OG, P = .42. There were no revision surgeries. Conclusions Based on this small case series, patients with distal radius fracture and ipsilateral hemiparesis or hemiplegia may have similar clinical, functional, and radiographic outcomes, regardless of nonoperative or operative treatment.

scholarly journals CURRENT PHARMACOLOGICAL STATUS OF CARDIOPROTECTIVE PLANTS AGAINST ISOPROTERENOL INDUCED MYOCARDIAL INFARCTION

2018 ◽  
Vol 11 (4) ◽  
pp. 17
Author(s):  
Syeda Nishat Fathima ◽  
Vasudeva Murthy S
Keyword(s):  
Myocardial Infarction ◽  
Lifestyle Modification ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Cardiac Biomarkers ◽  
Therapeutic Interventions ◽  
Current Status ◽  
Plant Parts ◽  
Heart Muscle Cells ◽  
Modern Era

 Objective: Cardiovascular diseases are the major cause of morbidity and mortality in the modern era. Myocardial infarction is a condition where there is a significant decrease or block in the blood (oxygen) supply to the part of heart, leading to degeneration of a portion of the myocardium which triggers a cascade of cellular, inflammatory and biochemical events, leading eventually to the irreversible death (necrosis) of heart muscle cells. Various therapeutic interventions, including lifestyle modification, pharmacological treatment options, and surgical techniques are available. The present review focus on the plants that have been evaluated for cardioprotective activity against isoproterenol-induced myocardial infarction.Method: The current status of Cardioprotective plants was obtained from a literature search of electronic databases such as Google Scholar, Pubmed and Scopus up to 2017 for publications on medicinal plants used against isoproterenol-induced myocardial infarction. Isoproterenol, Isoprenaline, myocardial infarction, cardioprotective were used as keywords for the searching.Result: A total of 117 different plant parts and their extracts have till now been published to possess cardioprotection against isoproterenol-induced myocardial infarction. Isoproterenol a beta-adrenergic receptors agonist causes severe stress in myocardium resulting in the infarct-like lesion and produced cardiotoxic effects by elevating the levels of cardiac biomarkers and causing changes in ECG. Plant-based medicines with their antioxidant, antiapoptotic, antihyperlipidemic, platelet antiaggregatory, anti-lipid peroxidation property provide substantial evidence for the management of Ischemia.Conclusion: This review, therefore, provides a useful resource to enable a thorough assessment of the profile of plants that have cardioprotective activity against isoproterenol-induced myocardial infarction.

Volar Approach to Distal Radius Fractures

2008 ◽  
Vol 33 (6) ◽  
pp. 958-965 ◽  
Author(s):  
Themistocles S. Protopsaltis ◽  
David S. Ruch
Keyword(s):  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Volar Approach

Comparison of distal radius fracture intra-articular step reduction with volar locking plates and K wires: a retrospective review of quality and maintenance of fracture reduction

2016 ◽  
Vol 42 (2) ◽  
pp. 144-150 ◽  
Author(s):  
N. A. Johnson ◽  
J. J. Dias ◽  
C. J. Wildin ◽  
L. Cutler ◽  
B. Bhowal ◽  
...  
Keyword(s):  
Distal Radius ◽  
Retrospective Review ◽  
Locking Plate ◽  
Treatment Method ◽  
Volar Locking Plate ◽  
Initial Displacement ◽  
Level Of Evidence ◽  
Initial Reduction ◽  
Multiple Variables ◽  
K Wires

This study investigated the accuracy and maintenance of reduction of intra-articular steps achieved with closed reduction and percutaneous K wires and open reduction and a volar locking plate for the treatment of intra-articular distal radius fractures. We performed a retrospective review of 359 patients with an intra-articular fracture of their distal radius. Multivariate linear regression was undertaken to investigate the influence of multiple variables such as age, gender, initial displacement and treatment method on reduction despite differences between groups. A total of 36% of patients treated with K wires and 29% with volar locking plate had a step greater than or equal to 1 mm present on the first post-operative radiograph. A total of 23% treated with K wires and 28% with volar locking plate had a residual step of 1 mm or more on the last available radiograph. There was no difference identified between the two techniques for quality of initial reduction or persisting step on the last available radiographs. Step behaviour and further reduction of step post-operatively was similar for both treatment methods. Initial displacement and increased age influenced initial reduction. Initial fracture displacement shown radiologically was the only variable identified that influenced the persistence of a step on post-operative radiographs. Level of evidence: IV

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