Bone and joint injuries of the wrist and forearm

2018 ◽  
Author(s):  
Zaf Naqui ◽  
David Warwick
Keyword(s):  
Forearm Rotation ◽  
Non Union ◽  
Stable Function ◽  
Ligament Rupture ◽  
Anatomic Reduction ◽  
Complex Reconstruction ◽  
Displaced Fracture ◽  
Carpal Ligaments ◽  
Plaster Immobilization

The forearm is a complex quadrilateral structure linked by the proximal and distal radioulnar joints, ligaments, which include the interosseous membrane and triangular cartilage, and several obliquely orientated muscles. A displaced fracture or ligament rupture within this forearm is likely to involve other structures. Treatment requires anatomic recovery of stable function. The ulnar corner can sustain fractures or ligament ruptures which affect stable, pain-free, congruous forearm rotation. The distal radius may fracture after high- or low-energy trauma; anatomic reduction may not be essential in all; inaccuracy may lead to loss of rotation and ulnocarpal abutment but long-term arthritis is unusual. Children’s fractures are managed with consideration of remodeling potential. The scaphoid is vulnerable to non-union; plaster immobilization, early percutaneous fixation, and later bone-grafting all have roles. Salvage for osteoarthritic non-union may reduce pain but compromises function. Rupture of the carpal ligaments may cause substantial disruption and require complex reconstruction.

Long-Term Results of Radioscapholunate Fusion Following Fractures of the Distal Radius

1997 ◽  
Vol 22 (6) ◽  
pp. 705-710 ◽  
Author(s):  
L. NAGY ◽  
U. BÜCHLER
Keyword(s):  
Long Term Results ◽  
Short Term ◽  
Non Union ◽  
Partial Fusion ◽  
Traumatic Lesions ◽  
Residual Motion ◽  
Radioscapholunate Fusion ◽  
Wrist Fusion

Fifteen patients with radioscapholunate (RSL) fusion for traumatic lesions of the radiocarpal junction, whose short-term results have been previously reported, were reassessed after an average follow-up time of 8 years. Five patients had undergone wrist fusion because of non-union or early progressive arthritis. Of the ten wrists with retained mobility, eight continued to function satisfactorily. Two wrists were painful for reasons other than secondary midcarpal arthritis. Patient satisfaction was comparable in both groups with the wrist score better for wrists with residual motion. The survival of RSL partial wrist fusion corresponded inversely with the number of preceding operations and the range of motion before partial fusion. Secondary midcarpal arthritis, if present, arose early and was well tolerated. Failures were strongly linked to technical mistakes and complications.

scholarly journals Ivor–Lewis oesophagogastrectomy with Roux-en-Y duodenal bypass

2016 ◽  
Vol 98 (2) ◽  
pp. 116-120
Author(s):  
J Cartwright ◽  
E Forbat ◽  
A Botha
Keyword(s):  
Gastric Tube ◽  
Case Series ◽  
Poor Quality ◽  
Benign Disease ◽  
Ivor Lewis ◽  
Biliary Diversion ◽  
Complex Reconstruction ◽  
Long Term Result

Oesophagectomies and gastrectomies are performed predominantly for the treatment of malignant disease. However, in this case series, we describe three patients with benign disease who had a laparoscopic oesophagogastrectomy with gastroduodenal detachment and Roux-en-Y biliary diversion, and discuss the operative feasibility and consequent patient outcomes. Our aim was to modify the procedure using an established reconstruction already practised in gastric and bariatric surgery, thereby preventing operative sequelae that lead to a poor quality of life (eg reflux oesophagitis and vomiting). During the first postoperative year, our first two patients experienced weight loss, indigestion and lower bowel symptoms with no apparent improvement in gastric function compared with a standard gastric tube pull-up reconstruction. In the longer term, in both patients, the gastric tube interpositions appeared to function well and there was no evidence of gastro-oesophageal reflux disease, delayed gastric emptying or troublesome indigestion. Our third patient, who had lifelong severe reflux symptoms, was eating normally three months after the operation with no need for antacid medication. We therefore conclude that laparoscopic Ivor–Lewis oesophagogastrectomy with Roux-en-Y bypass is a more complex reconstruction with added risks but may in the long term result in better overall outcomes and satisfaction for patients, particularly those with benign disease.

SCAPHOID BONE BRUISING – PROBABLY NOT THE PRECURSOR OF ASYMPTOMATIC NON-UNION OF THE SCAPHOID

2007 ◽  
Vol 32 (3) ◽  
pp. 337-340 ◽  
Author(s):  
N. LA HEI ◽  
I. MCFADYEN ◽  
M. BROCK ◽  
J. FIELD
Keyword(s):  
Bone Marrow ◽  
Clinical Outcomes ◽  
Classification System ◽  
Complete Resolution ◽  
Scaphoid Bone ◽  
Bone Bruise ◽  
Radiological Findings ◽  
Non Union ◽  
Bone Bruising

The MRI finding of bone marrow oedema, without fracture, following trauma to the scaphoid has been called a ‘bone bruise’. A similar injury is found in the knee, considered benign and managed conservatively. In the scaphoid, there is the concern that this lesion may lead to scaphoid non-union. This study addresses that concern. The clinical and radiological findings of 41 patients with a scaphoid bone bruise on MRI are described, an MRI classification system proposed and clinical outcomes investigated. Patients were immobilised for 6 weeks. At 3 months, 8 remained symptomatic and had repeat MRI. Four of these showed complete resolution of the bruise, the others improvement. At 6 months, 2 of the 8 complained of minor, intermittent discomfort but progressed to resolution of symptoms. This study suggests that the scaphoid bone bruise is a benign injury with predictable recovery and is unlikely to result in long-term morbidity in the form of non-union.

Arthroscopic assisted tendon reconstruction for triangular fibrocartilage complex irreparable tears

2017 ◽  
Vol 42 (4) ◽  
pp. 346-351 ◽  
Author(s):  
R. Luchetti ◽  
A. Atzei
Keyword(s):  
Late Onset ◽  
Tendon Graft ◽  
Triangular Fibrocartilage Complex ◽  
Forearm Rotation ◽  
Level Of Evidence ◽  
Evaluation Scores ◽  
Complex Reconstruction ◽  
Arthroscopically Assisted ◽  
Triangular Fibrocartilage

We report our 11-year experience of performing arthroscopically assisted triangular fibrocartilage complex reconstruction in the treatment of chronic distal radio-ulnar joint instability resulting from irreparable triangular fibrocartilage complex injuries. Eleven patients were treated. Three skin incisions were made in order to create radial and ulna tunnels for passage of the tendon graft, which is used to reconstruct the dorsal and palmar radio-ulnar ligaments, under fluoroscopic and arthroscopic guidance. At a mean follow-up of 68 months all but one had a stable distal radio-ulnar joint. Pain and grip strength, Mayo wrist score, Disability of the Arm Hand and Shoulder and patient-rated wrist and hand evaluation scores improved. The ranges of forearm rotation remained largely unchanged. Complications included an early tendon graft tear, two late-onset graft ruptures, one ulna styloid fracture during surgery and persistent wrist discomfort during forearm rotation requiring tendon graft revision in one case. An arthroscopic assisted approach for triangular fibrocartilage complex reconstruction appears safe and produces comparable results with the open technique. Level of evidence: IV

Symphyseal fracture in a three-month-old infant

2021 ◽  
Vol 14 (12) ◽  
pp. e245661
Author(s):  
Amir Labib ◽  
Amir Samir Elbarbary
Keyword(s):  
Conservative Management ◽  
Male Infant ◽  
Fracture Site ◽  
Mandibular Fractures ◽  
Management Options ◽  
Mandibular Growth ◽  
Long Term Follow Up ◽  
High Index Of Suspicion ◽  
Displaced Fracture

Mandibular fractures are rare in infants, and diagnosis can be easily missed due to the difficulty in obtaining an adequate history and the subtle signs. A high index of suspicion and detailed history taking from the caregiver are mandatory to pick up these cases.There are a plethora of management options that have been reported in dealing with such fractures. They range from conservative management to internal fixation by absorbable plates. While conservative management does not interfere with mandibular growth and teeth development, any surgical intervention can carry this risk. Nevertheless, a severely displaced fracture may need anatomical reduction and fixation to allow early nutrition.This study reports a 3-month-old male infant with a fracture in the mandibular symphysis who underwent reduction of the fracture and circummandibular fixation using immobilisation by an acrylic splint for 4 weeks. His long-term follow-up after 20 months showed adequate dentition with proper healing of the fracture site.

scholarly journals Intermediate to Long Term Clinical and Radiographic Outcomes of Triple Arthrodesis: A 422 Case Retrospective Review

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0025
Author(s):  
Jesse King ◽  
Karl Henrikson ◽  
Thomas Harper ◽  
Mike Anderson ◽  
Chris Stauch ◽  
...  
Keyword(s):  
Infection Rate ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Triple Arthrodesis ◽  
Non Union ◽  
Radiographic Outcomes ◽  
Diabetic Status ◽  
Radiographic Data

Category: Ankle Arthritis, Hindfoot Introduction/Purpose: Triple arthrodesis is a commonly performed surgical treatment for hindfoot arthritis and deformity. No study has clearly delineated correlates of both clinical and radiographic outcomes in a sample size this large. The purpose of this study is to explore predictive and demographic outcome measures with long-term followup after triple arthrodesis. Methods: With IRB approval, an institutional radiology database was queried for patients undergoing triple arthrodesis between 2004 and 2016, by a single surgeon at a single institution. A total of 465 cases were identified. Pre- and post-operative clinical and radiographic data was collected retrospectively. Demographic and predictive data included: age, Body Mass Index (BMI), American Society of Anesthesiologists Score (ASA), Charleston Comorbidity Index (CCI), diabetic status, osteoporosis, hypothyroidism, and neuromuscular disease status. Clinical outcomes including infection rate, reoperation rate and clinical nonunion were recorded. Unintended return to the operating room defined clinical failure. Radiographic data including non-union rate, pre- and post- operative ankle degenerative joint disease was also recorded. Statistical analysis was then performed to evaluate the relationship between predictive measures and various outcomes including reoperation, infection, and non-union rates. 23 cases were lost to follow-up. Results: A total of 442 feet (397 patients) were analyzed. The average age was 54 years (14 to 85) with the majority of cases being female (60%). Average follow up was 593 days (40 to 4079). Overall failure rate was 13.7% with clinical nonunion rate of 4.5%. Infection rate was 5.9%. Mortality rate was 0% at 2 years post-operatively. Predictors of failure included: increased BMI, elevated ASA, history of diabetes, underlying neuromuscular disorder (Figure 1). We found no significant difference between pre and post-operative degenerative joint disease rates in the midfoot (9.4%, 12.5%) and ankle (11.7%,13.7%), respectively. Conclusion: Triple arthrodesis is a highly effective procedure for treating hindfoot arthritis. Certain predictive measures including BMI, ASA score, diabetic status and underlying neuromuscular disorders significantly correlate with radiographic union. Additionally, diabetic status significantly correlates with infection status postoperatively. An understanding of these predictive measures may help surgeons in their preoperative planning to improve their clinical and radiographic success rates.

Bone transport osteogenesis for treatment of canine osteomyelitis

2010 ◽  
Vol 23 (02) ◽  
pp. 134-140 ◽  
Author(s):  
S. W. Petersen ◽  
L. M. Déjardin ◽  
D. Ting
Keyword(s):  
Bone Defects ◽  
Bone Transport ◽  
Infected Nonunion ◽  
Non Union ◽  
Post Surgery ◽  
Bone Segment ◽  
Extensive Debridement ◽  
Segmental Bone ◽  
Osseous Defects

SummaryBone transport osteogenesis, as described by Ilizarov, has been used to resolve segmental bone defects in both human and veterinary patients. These defects are created when a large osseous tumour, sequestrum, or non-union fracture is resected. This report documents two cases in which the principle of bone transport osteogenesis was applied by utilising the Ilizarov technique to bridge large osseous defects resulting from debridement of an infected nonunion fracture (case 1) and debridement of a sequestrum (case 2). Defects were treated by transporting either a complete or a hemi-circumferential bone segment. Both cases had resolution of osteomyelitis, satisfactory fracture union, and functional usage of the limb 39 weeks and 15 weeks post-surgery, respectively. Although manageable complications were encountered during the treatment of these cases, the long-term clinical outcome was eventually favorable. The authors believe that bone transport osteogenesis offers a valid restorative option in the treatment of bone defects resulting from extensive debridement and sequestrectomy.

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