Do “Anatomic” Distal Ulna Plating Systems Fit the Distal Ulna Without Causing Soft Tissue Impingement?

Hand ◽  
2020 ◽  
pp. 155894472093030
Author(s):  
Daniel A. Shaerf ◽  
Woo Jin Chae ◽  
Reza Sharif-Razavian ◽  
Vasiliki Vardakastani ◽  
Angela E. Kedgley ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Soft Tissue ◽  
Fracture Fixation ◽  
Safe Zone ◽  
Zone Size ◽  
Distal Ulna ◽  
Extensor Carpi Ulnaris ◽  
Soft Tissue Impingement ◽  
Narrow Area ◽  
Flexion And Extension

Background: Distal ulna fracture fixation plates commonly cause irritation, necessitating removal, due to the narrow area between the ulna articular cartilage and the extensor carpi ulnaris. This study defines the safe zone for plate application and determines whether wrist position affects risk of impingement. Methods: Four different distal ulna anatomic plates (Acumed, Medartis, Skeletal Dynamics, and Synthes) were applied to 12 cadaveric specimens. Safe zone size was measured in circumferential distance and angular arc. Impingement was examined in flexion and extension in neutral, pronation, and supination. Results: The distal ulna safe zone has dimensions of a 92° arc and perimeter circumference of 15 mm. Cumulative extensor carpi ulnaris (ECU) impingement occurred in 0% of the 6 simulated wrist/forearm positions for the Acumed plate, 22% for the Synthes plate, 31% for the Skeletal Dynamics plate, and 68% for the Medartis plate. Impingement was most common in supination. Likelihood of ECU impingement significantly decreased in the following order; Medartis > Skeletal Dynamics > Synthes > Acumed. Conclusion: The ECU tendon’s mobility can cause impingement on ulnarly placed distal ulna plates. Intra-operative testing should be performed in supination. Take home points regarding each plate from the 4 different manufacturers: contouring of Medartis plates, when placed ulnarly, is mandatory. The Acumed plate impinged the least but is not designed for far-distal fractures. The Synthes plate is least bulky but not suitable for proximal fractures. The Skeletal Dynamics plate appeared the most versatile with a reduced incidence of impingement compared to other ulnarly based plates.

STABILISATION OF THE DISTAL ULNA USING EXTENSOR CARPI ULNARIS TENODESIS AFTER HEMIRESECTION — INTERPOSITION TECHNIQUE

Hand Surgery ◽  
1998 ◽  
Vol 03 (01) ◽  
pp. 41-45
Author(s):  
Kazuhiro Masada ◽  
Takeshi Fuji ◽  
Satoru Fujita
Keyword(s):  
Soft Tissue ◽  
Range Of Motion ◽  
Grip Strength ◽  
Distal Ulna ◽  
Wrist Extension ◽  
Extensor Carpi Ulnaris ◽  
Dorsal Aspect ◽  
Subjective Pain ◽  
Wrist Joints

A new stabilisation technique has been developed by the authors for the prevention of instability of the distal ulna after performance of Bower's hemiresection-interposition technique in rheumatoid patients, is described. This technique consists of the transfer of the extensor carpi ulnaris over the dorsal aspect of the distal ulna and suturing it to the soft tissue over the distal ulna. Operation was performed in 16 rheumatoid patients with 20 wrist joints. The results were evaluated in terms of both subjective (pain during rotation, pain on compression of the ulna) and objective evaluations (wrist/forearm range of motion, grip strength). After the operation, the pain almost disappeared in all but two cases which had insufficient bone excision. Wrist extension/flexion and pronation/supination improved after operation. Average grip strengths also improved. None of the cases showed instability of the distal ulna after the operation. Wrist extension strength did not decrease after operation in spite of tenodesis of the extensor carpi ulnaris. This technique is simple and useful for prevention of instability of the distal ulna after hemiresection-interposition technique has been carried out in rheumatoid patients.

scholarly journals Arthroscopic treatment of anteromedial ankle impingement

2020 ◽  
Vol 14 (3) ◽  
pp. 260-263
Author(s):  
Guillermo Arrondo ◽  
Daniel Gómez ◽  
Germán Joannas ◽  
Xavier Martín-Oliva ◽  
Matías Iglesias ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Range Of Motion ◽  
Case Series ◽  
Functional Results ◽  
Level Of Evidence ◽  
Bony Impingement ◽  
Soft Tissue Impingement ◽  
Arthroscopic Removal ◽  
Physical Impact

Objective: Impingement syndromes are recognized as an important cause of chronic ankle pain, which results from the entrapment of an inflamed soft-tissue component between the osteophytes. The predominant site of occurrence is the anterolateral aspect of the ankle for soft-tissue impingement, and anteromedial aspect for bony impingement. Symptoms related to the physical impact of bone or soft-tissue pain often result in limited ankle range of motion. Methods: We conducted a retrospective study of 34 patients (34 ankles) with anteromedial bony impingement. All patients underwent arthroscopy, with a mean follow-up of 34 months. Results: All osteophytes were removed, and the ankle range of motion improved. The AOFAS score improved from 73 preoperatively to 95 postoperatively. Conclusion: The arthroscopic removal of the anteromedial osteophytes of the ankle had excellent functional results. It is an effective procedure that allows rapid patient recovery. Level of Evidence IV; Therapeutic Studies; Case Series.

Arthroscopic Management of Soft Tissue Impingement in the Elbow

2004 ◽  
pp. 322-325
Author(s):  
Daniel J. Gurley ◽  
Larry D. Field ◽  
Felix H. Savoie
Keyword(s):  
Soft Tissue ◽  
Arthroscopic Management ◽  
Soft Tissue Impingement

Soft Tissue Impingement of the Ankle

2016 ◽  
Vol 33 (4) ◽  
pp. 503-520 ◽  
Author(s):  
Amber M. Shane ◽  
Christopher L. Reeves ◽  
Ryan Vazales ◽  
Zachary Farley
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Impingement

scholarly journals ROM mapping of ligamentous constraints on avian hip mobility: implications for extinct ornithodirans

2018 ◽  
Vol 285 (1879) ◽  
pp. 20180727 ◽  
Author(s):  
Armita R. Manafzadeh ◽  
Kevin Padian
Keyword(s):  
Articular Cartilage ◽  
Soft Tissue ◽  
Femoral Head ◽  
Joint Capsule ◽  
Three Dimensions ◽  
Joint Mobility ◽  
Hip Joints ◽  
Mobility Data ◽  
Hip Abduction ◽  
Common Quail

Studies of soft tissue effects on joint mobility in extant animals can help to constrain hypotheses about joint mobility in extinct animals. However, joint mobility must be considered in three dimensions simultaneously, and applications of mobility data to extinct taxa require both a phylogenetically informed reconstruction of articular morphology and justifications for why specific structures' effects on mobility are inferred to be similar. We manipulated cadaveric hip joints of common quail and recorded biplanar fluoroscopic videos to measure a ‘ligamentous’ range of motion (ROM), which was then compared to an ‘osteological’ ROM on a ROM map. Nearly 95% of the joint poses predicted to be possible at the hip based on osteological manipulation were rendered impossible by ligamentous constraints. Because the hip joint capsule reliably includes a ventral ligamentous thickening in extant diapsids, the hip abduction of extinct ornithodirans with an offset femoral head and thin articular cartilage was probably similarly constrained by ligaments as that of birds. Consequently, in the absence of extraordinary evidence to the contrary, our analysis casts doubt on the ‘batlike’ hip pose traditionally inferred for pterosaurs and basal maniraptorans, and underscores that reconstructions of joint mobility based on manipulations of bones alone can be misleading.

Mechanical Properties of Injured Human Cervical Spine Ligaments and Corresponding Effect on Spinal Kinematics

2011 ◽  
Author(s):  
P. Devin Leahy ◽  
Christian M. Puttlitz
Keyword(s):  
Cervical Spine ◽  
Soft Tissue ◽  
Dynamic Range ◽  
Traumatic Injury ◽  
Soft Tissue Injuries ◽  
Neurological Impairment ◽  
Cervical Instability ◽  
Cervical Spine Instability ◽  
Tissue Injuries ◽  
Flexion And Extension

The assessment of cervical spine instability following traumatic injury is controversial [1, 4, 5, 8]. Typical definitions of cervical instability are based on the presence of several key detectable injuries using simple radiographs, computed tomography (CT), and magnetic resonance (MR) imaging. Although these imaging modalities have been shown to be relatively reliable for detection of fractures and very large soft tissue injuries, they are largely deficient for determining the presence of smaller soft tissue injuries, such as hyperstrained ligaments [1, 3]. Soft tissue injuries of this nature may be revealed with dynamic range of motion (ROM) assessment, such as a flexion and extension test with radiography. However, these tests are currently inadequate for determining the existence of specific injuries. Cervical soft tissue injuries demand further analysis, given the risk of severe and permanent neurological impairment that may accompany these injuries [2, 5].

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