A New Biological Technique of Elbow Reconstruction Following an Extensive Tumoral Resection of the Proximal Ulna

Abstract Introduction This study aimed to describe the involvement of the lesser sigmoid notch in fractures to the coronoid process. We hypothesized that injuries to the lateral aspect of the coronoid process regularly involve the annular ligament insertion at the anterior lesser sigmoid notch. Material and Methods Patients treated for a coronoid process fracture at our institution between 06/2011 and 07/2018 were included. We excluded patients < 18 years, patients with arthritic changes or previous operative treatment to the elbow, and patients with concomitant injuries to the proximal ulna. In patients with involvement of the lesser sigmoid notch, the coronoid height and fragment size (anteroposterior, mediolateral, and craniocaudal) were measured. Results Seventy-two patients (mean age: 47 years ± 17.6) could be included in the study. Twenty-one patients (29.2%) had a fracture involving the lateral sigmoid notch. The mean anteroposterior fragment length was 7 ± 1.6 mm. The fragment affected a mean of 43 ± 10.8% of the coronoid height. The mean mediolateral size of the fragment was 10 ± 5.0 mm, and the mean cranio-caudal size was 7 ± 2.7 mm. Conclusion Coronoid fractures regularly include the lesser sigmoid notch. These injuries possibly affect the anterior annular ligament insertion which is important for the stability of the proximal radioulnar joint and varus stability of the elbow.

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Dynamic Proximal Ulnar Osteotomy for the Treatment of Ununited Anconeal Process in 17 Dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632614 ◽

1998 ◽

Vol 11 (02) ◽

pp. 76-79 ◽

Cited By ~ 14

Author(s):

B. M. Turner ◽

R. H. Abercromby ◽

J. Innes ◽

W. M. McKee ◽

M. G. Ness

Keyword(s):

Clinical Outcome ◽

Prospective Study ◽

Patient Population ◽

Clinical Results ◽

Radiographic Evaluation ◽

Proximal Ulna ◽

Ulnar Osteotomy ◽

A Prospective Study

SummaryA prospective study was made of 17 dogs with ununited anconeal process treated by osteotomy of the proximal ulna. The effect of the surgery on lameness was evaluated subjectively and the elbows were assessed radiographically for evidence of anconeal fusion and healing of the osteotomy. Whilst clinical outcome was generally good and complications infrequent, relatively few cases achieved anconeal fusion. These results do not compare well with the results of a previous study but this disparity may be due in part to differences in patient population and radiographic evaluation.Further work is required to establish how best to achieve predictable anconeal fusion.Proximal ulnar osteotomy was used to treat 17 dogs with ununited anconeal process. Clinical results were good but anconeal fusion was not achieved consistently. Further work is needed to determine how best to achieve predictable anconeal fusion.

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Role of Heart Rate Reduction in the Management of Myocarditis

Current Pharmaceutical Design ◽

10.2174/1381612824666180111105923 ◽

2018 ◽

Vol 24 (3) ◽

pp. 365-378 ◽

Cited By ~ 2

Author(s):

Chen Guang-Yi ◽

Ge Li-Sha ◽

Li Yue-Chun

Keyword(s):

Heart Rate ◽

Nitrosative Stress ◽

Ventricular Remodeling ◽

Animal Experiments ◽

Viral Myocarditis ◽

Protective Effects ◽

Heart Rate Reduction ◽

Rate Reduction ◽

Beneficial Effects ◽

Biological Technique

The morbidity of myocarditis demonstrates an upward tendency by years, is commonly defined as the inflammation of myocytes and is caused by multiple factors. With the development of the molecular biological technique, great breakthroughs in the diagnosis and understanding of pathophysiological mechanisms of myocarditis have recently been achieved. Several questions remain unresolved, however, including standard treatment approaches to myocarditis, which remain controversial and ambiguous. Heart rate, as an independent risk factor, has been shown to be related to cardiac disease. Recent studies also show that the autonomic nervous system is involved in immunomodulatory myocarditis processes. Heart rate reduction treatment is recommended in myocarditis based on a number of animal experiments and clinical trials. It is possible that heart rate-lowering treatments can help to attenuate the inflammatory response and myocyte injury and reverse ventricular remodeling. However, how to execute the protective effects of heart rate reduction on myocarditis is still not clear. In this review, we discuss the pathogenesis and pathophysiological process of viral myocarditis and propose heart rate lowering as a therapeutic target for myocarditis, especially in light of the third-generation β-blockade carvedilol and funny channel blocker ivabradine. We also highlight some additional beneficial effects of such heart rate reduction agents, including anti-inflammatory, antioxidation, anti-nitrosative stress, anti-fibrosis and antiapoptosis properties.

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Do irradiated osteo-articular recycled tumor autografts still hold promise for biological joint reconstruction? Our experience with acetabular and proximal ulna ECRT

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2020.12.011 ◽

2020 ◽

Author(s):

Manit K. Gundavda ◽

Ashik Bary ◽

Manish G. Agarwal

Keyword(s):

Proximal Ulna ◽

Joint Reconstruction

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First-ever intraosseous ancient schwannoma of the proximal ulna successfully treated using the cement technique

Journal of International Medical Research ◽

10.1177/0300060520987732 ◽

2021 ◽

Vol 49 (2) ◽

pp. 030006052098773

Author(s):

Kai Xuan Lim ◽

Karl Wu

Keyword(s):

Rare Case ◽

Pathological Fracture ◽

Soft Tissue Neoplasm ◽

Proximal Ulna ◽

Intraosseous Schwannoma ◽

First Case ◽

Primary Bone ◽

Primary Bone Tumours ◽

Current Report ◽

Neural Sheath

Schwannoma or neurilemmoma is a common soft tissue neoplasm arising from the neural sheath of Schwann cells. However, intraosseous schwannoma is rare, accounting for less than 0.2% of primary bone tumours. Several variants of schwannoma have been reported; among them, intraosseous schwannoma with ancient change is extremely rare. This current report presents an extremely rare case of ancient intraosseous neurilemmoma. The patient presented with right elbow pain and disability. A radiolucent, well-defined, lobulated lesion with a thin sclerotic rim in the proximal ulnar metaphysis that had caused a pathological fracture was noted. The mass was surgically excised using marginal resection and bone curettage was undertaken. The bone deficit was grafted with hydroxyapatite and β-tricalcium phosphate and augmented with bone cement. There were no signs of any recurrence after 3 years. This is the first case of an ancient intraosseous schwannoma of the proximal ulna. Although rare, intraosseous schwannoma should be considered in the differential diagnosis of radiographically benign-appearing osseous tumours in the bone. The cement technique is recommended for the treatment of intraosseous schwannoma.

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Internal Radioulnar Fixation for Treatment of Nonunion of Proximal Radius and Ulna Fractures in a Toy Breed Dog

VCOT Open ◽

10.1055/s-0041-1723831 ◽

2021 ◽

Vol 04 (01) ◽

pp. e24-e31

Author(s):

Luca Vezzoni ◽

Paolo Abrescia ◽

Aldo Vezzoni

Keyword(s):

Locking Plate ◽

Callus Formation ◽

Previous Treatment ◽

Bone Morphogenetic Protein 2 ◽

Distal Ulna ◽

Proximal Ulna ◽

Proximal Radius ◽

Locking Screws ◽

Morphogenetic Protein ◽

Ulna Fractures

AbstractIn this case report, we describe an alternative surgical procedure to treat proximal radius and ulnar nonunion in a toy breed dog. A 14-month-old, Maltese cross-breed dog was referred after previous treatment with external and internal fixation had failed, resulting in a nonunion of a fracture of the proximal radius and ulna with the proximal radius fragment too small and friable to be used for fixation. A craniomedial approach was made to debride the radius nonunion site and a second approach to the lateral aspect of the ulna was made. The fracture was realigned and a titanium locking plate was applied in bridging fashion, fixed to the proximal ulnar fragment with three locking screws in the most proximal plate holes, a fourth screw was inserted in the mid-shaft of the distal ulnar fragment and three locking screws were inserted in the distal most holes of the plate through the distal ulna to engage the distal radial fragment. A recombinant bone morphogenetic protein 2 graft was inserted into the radius and ulna fracture sites. The dog had a successful clinical and radiographic outcome with bridging of the defect 4 weeks postoperatively and complete callus formation 8 weeks postoperatively. Implants have undergone dynamization and then removal. Use of a locking plate as an internal fixator achieving fixation of the proximal ulna and distal radius can be considered an option for the treatment of proximal radioulnar nonunions with a small proximal radial fragment.

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3D-Printed Connector for Revision Limb Salvage Surgery in Long Bones Previously Using Customized Implants

Metals ◽

10.3390/met11050707 ◽

2021 ◽

Vol 11 (5) ◽

pp. 707

Author(s):

Jong-Woong Park ◽

Hyun-Guy Kang ◽

June-Hyuk Kim ◽

Han-Soo Kim

Keyword(s):

Limb Salvage ◽

Salvage Surgery ◽

Revisional Surgery ◽

Limb Salvage Surgery ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Proximal Ulna ◽

Custom Made ◽

Orthopedic Oncology ◽

3D Printed

In orthopedic oncology, revisional surgery due to mechanical failure or local recurrence is not uncommon following limb salvage surgery using an endoprosthesis. However, due to the lack of clinical experience in limb salvage surgery using 3D-printed custom-made implants, there have been no reports of revision limb salvage surgery using a 3D-printed implant. Herein, we present two cases of representative revision limb salvage surgeries that utilized another 3D-printed custom-made implant while retaining the previous 3D-printed custom-made implant. A 3D-printed connector implant was used to connect the previous 3D-printed implant to the proximal ulna of a 40-year-old man and to the femur of a 69-year-old woman. The connector bodies for the two junctions of the previous implant and the remaining host bone were designed for the most functional position or angle by twisting or tilting. Using the previous 3D-printed implant as a taper, the 3D-printed connector was used to encase the outside of the previous implant. The gap between the previous implant and the new one was subsequently filled with bone cement. For both the upper and lower extremities, the 3D-printed connector showed stable reconstruction and excellent functional outcomes (Musculoskeletal Tumor Society scores of 87% and 100%, respectively) in the short-term follow-up. To retain the previous 3D-printed implant during revision limb salvage surgery, an additional 3D-printed implant may be a feasible surgical option.

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