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Afreh YA, Twum KA, Amankwa AT, Ankomah K, Otoo OK, Oku C. Bilateral ulna hemimelia with humeroradial synostosis and oligodactyly: A case report. Radiol Case Rep 2024; 19:2211-2213. [PMID: 38523722 PMCID: PMC10959649 DOI: 10.1016/j.radcr.2024.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 03/26/2024] Open
Abstract
Hemimelia denotes the partial or complete absence of the distal half of a limb. Ulna hemimelia, a rare congenital anomaly, involves the complete or partial absence of the ulna in the upper limb, with an incidence of 1 in 150,000. This condition has been classified into 4 types, with the rare Type 4 variant involving humeroradial synostosis. We present a unique case of bilateral complete ulna hemimelia, humeroradial synostosis, and oligodactyly, in an 11-month-old female with bilateral upper limb shortening and restricted elbow movement since birth. Clinical examination revealed bilateral upper limb shortening, medial deviation of both wrist joints, fixed extension of both elbow joints, and bilateral absence of the cubital fossa. Radiographs confirmed bilateral micromelia, absence of ulna, humeroradial synostosis, and oligodactyly. This case, exhibiting bilateral Type 4 ulna hemimelia with Class 1 humeroradial synostosis, is a complex variant, rarely reported, and the first documented in Ghana. It also highlights the importance of radiological assessment in ensuring accurate diagnosis. Long-term follow-up and potential surgical interventions are crucial for optimizing upper limb function in such cases.
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Affiliation(s)
- Yaa Achiaa Afreh
- Radiology Directorate, Komfo Anokye Teaching Hospital (KATH). P.O. Box 1934, Kumasi, Ghana
| | - Kwasi Adjepong Twum
- Radiology Directorate, Komfo Anokye Teaching Hospital (KATH). P.O. Box 1934, Kumasi, Ghana
| | - Adu Tutu Amankwa
- Radiology Directorate, Komfo Anokye Teaching Hospital (KATH). P.O. Box 1934, Kumasi, Ghana
- Department of Radiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology (KNUST), Private Mail Bag, University Post Office, Kumasi, Ghana
| | - Kwasi Ankomah
- Radiology Directorate, Komfo Anokye Teaching Hospital (KATH). P.O. Box 1934, Kumasi, Ghana
| | - Obed Kojo Otoo
- Radiology Directorate, Komfo Anokye Teaching Hospital (KATH). P.O. Box 1934, Kumasi, Ghana
| | - Caroline Oku
- Radiology Directorate, Komfo Anokye Teaching Hospital (KATH). P.O. Box 1934, Kumasi, Ghana
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Mhiri A, Chermiti W, Hanafi A, Kaziz H, Naouar N, Bouattour K. Uncommon type 3 Monteggia equivalent lesion due to an ulnar shaft nonunion in adults: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241246879. [PMID: 38617996 PMCID: PMC11010738 DOI: 10.1177/2050313x241246879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/27/2024] [Indexed: 04/16/2024] Open
Abstract
It is uncommon to observe a nonunion of an isolated ulnar shaft fracture after surgical treatment; therefore, complications due to this nonunion are very rare. Adults are more likely to develop nonunions compared to children. We report the case of a 34-year-old man, who had a left ulnar shaft fracture, treated with a screwed plate. Four months later, a septic nonunion occurred causing a type 3 Monteggia equivalent lesion with a lateral dislocation of the radial head. We describe the consecutive methods of treatment that resulted in complete bone consolidation. The case report aims to underline the diagnostic particularities and the therapeutic challenges of this rare complication.
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Affiliation(s)
- Amir Mhiri
- Department of Orthopedic Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Wajdi Chermiti
- Department of Orthopedic Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Aymen Hanafi
- Department of Orthopedic Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Hamdi Kaziz
- Department of Orthopedic Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Nader Naouar
- Department of Orthopedic Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Karim Bouattour
- Department of Orthopedic Surgery, Sahloul Hospital, Sousse, Tunisia
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Joshi MA, Bains NJ, Stone AJ, Wells LJ, Phadnis JS. Considerable Variation in Current Coronoid Height and Fracture Measurement Techniques: A Systematic Review. J Shoulder Elbow Surg 2024:S1058-2746(24)00189-7. [PMID: 38521484 DOI: 10.1016/j.jse.2024.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/19/2024] [Accepted: 01/30/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Coronoid fractures usually occur in the presence of a significant osseo-ligamentous injury to the elbow. Fracture size and location correlate with degree of instability and many authors have attempted to analyze the effect of fracture variation on decision making and outcome. There remains no standardized technique for measuring coronoid height or fracture size. The aim of this study was to appraise the literature regarding techniques for coronoid height measurement in order to understand variation. METHODS Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A search was performed to identify studies with either a description of coronoid height, fracture size or bone loss using the terms (Coronoid) AND (Measurement) OR (Size) OR (Height). Articles were shortlisted by screening for topic relevance based on title, abstract and, if required, full text review. Exclusion criteria were non-English articles, those on non-human species or parts other than the ulna coronoid process, and studies that included patients with pre-existing elbow pathology. Shortlisted articles were grouped based on study type, imaging modality, measurement technique and measurement parameter as well as its location along the coronoid. RESULTS 30 out of the initially identified 494 articles met the inclusion criteria. 21 articles were clinical studies, 8 were cadaveric studies and 1 combined patients as well as cadavers. A variety of imaging modalities (plain radiographs, 2D CT, 3D CT, MRI or a combination of these) were used with CT scan (either 2D images or 3D reconstructions or both) being the most common modality used by 21 studies. Measurement technique also varied from uniplanar linear measurements in 15 studies to multiplanar area and volumetric measurements in 6 studies to techniques describing various angles and indices as an indirect measure of coronoid height in 8 studies. Across the 30 shortlisted studies, 19 different measurement techniques were identified. 15 studies measured normal coronoid height while the other 15 measured intact coronoid and/or fracture fragment height. The location of this measurement was also variable between studies with measurements at the apex of the coronoid in 24/30 (80%) of studies. Measurement accuracy was assessed by only 1 study. 12/30 (40%) studies reported on the inter-observer and intra-observer reliability of their measurement technique. CONCLUSION The systemic review demonstrated considerable variability between studies that report coronoid height or fracture size measurements. This variability makes comparison of coronoid height or fracture measurements and recommendations based on these between studies unreliable. There is need for development of a consistent, easy to use and reproducible technique for coronoid height and bone loss.
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Affiliation(s)
- Mithun A Joshi
- Trauma and Orthopaedics Department, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Niall Jj Bains
- Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Andrew Jm Stone
- Trauma and Orthopaedics Department, East Surrey Hospital, Redhill, United Kingdom
| | - Lucy J Wells
- Sussex Health Knowledge and Libraries, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Joideep S Phadnis
- Trauma and Orthopaedics Department, Brighton and Sussex University Hospitals, Brighton and Sussex Medical School, Brighton, United Kingdom
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Coskun M, Akbulut D, Mirzazada J. Case report: Distraction osteogenesis of focal fibrocartilaginous dysplasia and literature review. Int J Surg Case Rep 2024; 115:109271. [PMID: 38262218 PMCID: PMC10832495 DOI: 10.1016/j.ijscr.2024.109271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Focal fibrocartilaginous dysplasia (FFCD) is a rare disease of the ulna that requires early surgical intervention. CASE PRESENTATION We present a juvenile case and the outcomes of a corrected deformity. The fibrotic band that adhered to the ulna was resected, the ulna was osteotomized, and then an external fixator was placed for lengthening. The ulna's distal physis line was extended by 18 mm so that it would be the same length as the distal physis line of the radius. Full functional recovery occurred within three months. CLINICAL DISCUSSION There have been 22 cases of ulnar FFCD reported in the literature. Our patient is the oldest reported thus far who developed radial head subluxation, but no dislocation occurred. CONCLUSION FFCD is a broad-spectrum disease. Although its course is generally poor for patients with a late diagnosis, it is possible to obtain good results with correction procedures.
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Richard MJ, Vu CL. Forearm Nonunions-From Masquelet to Free Vascularized Bone Grafting. Hand Clin 2024; 40:25-34. [PMID: 37979988 DOI: 10.1016/j.hcl.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Forearm fractures present a unique challenge due to the anatomic relationship of the radius relative to the ulna. Associated with the complexity of the treatment for these fractures is the management of nonunion and malunion of the radius and ulna. Evaluation and management of forearm nonunions require a critical evaluation of contributing factors prior to surgical intervention. Timely and precise treatment of nonunion and malunion is necessary to restore function of the forearm.
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Affiliation(s)
- Marc J Richard
- Division of Hand, Upper Extremity, and Microvascular Surgery, Duke University, Duke University Medical Center, 5601 Arringdon Park Drive, Suite 300, Morrisville, NC 27560, USA
| | - Catphuong L Vu
- Division of Hand, Upper Extremity, and Microvascular Surgery, Duke University, Duke University Medical Center, 5601 Arringdon Park Drive, Suite 300, Morrisville, NC 27560, USA.
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Perloff A, Park S, Panganiban R, deVries J. Pediatric parosteal osteosarcoma of the distal radius causing extensive erosive mass effect of the adjacent ulna: a case report. BMC Musculoskelet Disord 2023; 24:950. [PMID: 38057715 PMCID: PMC10702084 DOI: 10.1186/s12891-023-07018-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/04/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION Parosteal osteosarcomas are low-grade bony malignancies that are treated primarily with surgical resection and reconstruction. This report discusses a unique case of a pediatric patient who presented with a parosteal osteosarcoma of the distal radius causing extensive erosive mass effect and growth disturbance of the adjacent ulna. Likely due to their slow-growing nonaggressive nature, parosteal osteosarcomas have not been previously described to abut adjacent bony structures through direct contact. The patient presented in a significantly delayed manner due to social circumstances, inadvertently revealing this novel behavior. This report reviews this rare case and describes the current understanding of this tumor. CASE PRESENTATION The patient is a 13-year-old male who presented with a parosteal osteosarcoma of his distal radius. He presented with a palpable wrist mass and wrist stiffness. He presented in a delayed manner with advanced local disease due to social factors. Imaging revealed an osseous radial mass that abutted the ulna and likely stunted its growth. The patient ultimately underwent complex resection and allograft reconstruction of both his distal radius and ulna. Intraoperative pathology was confirmed to have negative tumor margins. Allograft reconstruction of the radius and ulna was performed utilizing patient-specific custom cutting guides. At the 6-month postoperative visit, the patient had no recurrence of the mass, minimal pain, and had almost regained range of motion of the extremities. Clinical radiographs at the 6-month postoperative visit demonstrated allograft incorporation. CONCLUSIONS A previously unreported case of pediatric parosteal osteosarcoma of the distal radius with erosion of the adjacent ulna through direct contact is presented. The challenges in and the importance of arriving at a definitive diagnosis in a timely manner for the proper treatment of this malignancy are emphasized.
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Affiliation(s)
- Andrea Perloff
- Orthopedic Surgery Department, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, United States of America.
| | - SeHoon Park
- Orthopedic Surgery Department, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, United States of America
| | - Robert Panganiban
- Orthopedic Surgery Department, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, United States of America
| | - John deVries
- Orthopedic Surgery Department, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, United States of America
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Gilbert WB, Jitendra Desai M. Intramedullary Nailing of Forearm Fractures. Hand Clin 2023; 39:551-559. [PMID: 37827608 DOI: 10.1016/j.hcl.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
The primary goal in operative fixation of forearm fractures is to restore length, rotational stability, and maintenance of the radial bow. Plate osteosynthesis is well regarded as the gold standard of treatment though often necessitates soft tissue injury, periosteal stripping, and risk of refracture after hardware removal. While intramedullary nails have been utilized for forearm fixation since the early 1900s, technological advancements including locked intramedullary nails have lead to improved outcomes in intramedullary nail forearm fixation. In select patients, intramedullary nail fixation is an appropriate treatment option. For example, patients with mangled extremities, comminuted or segmental fractures, or soft tissue injury may benefit from this approach as it allows for smaller incisions and limits further soft tissue compromise.
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Affiliation(s)
- William Barritt Gilbert
- Department of Orthopedic Surgery, Vanderbilt University, PGY-3, 1215 21st Avenue South Suite 3200 and 4200, Nashville, TN, USA
| | - Mihir Jitendra Desai
- Department of Orthopedic Surgery, Vanderbilt University, 1215 21st Avenue South Suite 3200 and 4200, Nashville, TN, USA.
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Leow JM, Oliver WM, Bell KR, Molyneux SG, Clement ND, Duckworth AD. The Radiographic Union Score for ulnar fractures (RUSU) predicts ulnar shaft nonunion. Eur J Orthop Surg Traumatol 2023; 33:3167-3173. [PMID: 37071221 DOI: 10.1007/s00590-023-03556-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/19/2023]
Abstract
AIMS To develop a reliable and effective radiological score to assess the healing of isolated ulnar shaft fractures (IUSF), the Radiographic Union Score for Ulna fractures (RUSU). METHODS Initially, 20 patients with radiographs six weeks following a non-operatively managed ulnar shaft fracture were selected and scored by three blinded observers. After intraclass correlation (ICC) analysis, a second group of 54 patients with radiographs six weeks after injury (18 who developed a nonunion and 36 who united) were scored by the same observers. RESULTS In the initial study, interobserver and intraobserver ICC were 0.89 and 0.93, respectively. In the validation study, the interobserver ICC was 0.85. The median score for patients who united was significantly higher than those who developed a nonunion (11 vs. 7, p < 0.001). A ROC curve demonstrated that a RUSU ≤ 8 had a sensitivity of 88.9% and specificity of 86.1% in identifying patients at risk of nonunion. Patients with a RUSU ≤ 8 (n = 21) were more likely to develop a nonunion (n = 16/21) than those with a RUSU ≥ 9 (n = 2/33; OR 49.6, 95% CI 8.6-284.7). Based on a PPV of 76%, if all patients with a RUSU ≤ 8 underwent fixation at 6 weeks, the number of procedures needed to avoid one nonunion would be 1.3. CONCLUSION The RUSU shows good interobserver and intraobserver reliability and is effective in identifying patients at risk of nonunion six weeks after fracture. This tool requires external validation but may enhance the management of patients with isolated ulnar shaft fractures.
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Affiliation(s)
- Jun Min Leow
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Midlothian, EH16 4SA, UK.
| | - William M Oliver
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Midlothian, EH16 4SA, UK
| | - Katrina R Bell
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Midlothian, EH16 4SA, UK
| | - Samuel G Molyneux
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Midlothian, EH16 4SA, UK
| | - Nicholas D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Midlothian, EH16 4SA, UK
| | - Andrew D Duckworth
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Midlothian, EH16 4SA, UK
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, 49 Little France Crescent, Edinburgh, Midlothian, EH16 4SB, UK
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Hoelscher-Doht S, Zufall N, Heilig M, Heilig P, Paul MM, Meffert RH. "Mother and baby plate": a strategy to improve stability in proximal fractures of the ulna. Arch Orthop Trauma Surg 2023; 143:6251-6259. [PMID: 37460845 PMCID: PMC10491518 DOI: 10.1007/s00402-023-04979-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/29/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION Proximal ulna fractures with a large zone of comminution, such as in the context of Monteggia injuries, require mechanically strong osteosyntheses as they occur in regions with high physiological joint load. Consequently, implant failure and pseudarthrosis are critical and devastating complications, especially with the background of mainly young patients being affected. An effective solution could be provided by adding a small second plate 90° angulated to the standard dorsal plate in the area of non-union. Thus, this study investigates whether, from a biomechanical point of view, the use of such a mini or baby plate is worthwhile. MATERIALS AND METHODS Comminuted fractures distal to the coronoid process, equivalent to Jupiter type IIb fractures, are generated on artificial Sawbones® of the ulna and stabilized using two different plate osteosyntheses: in the first group, a dorsal locking compression olecranon plate is used (LCP group). In the second group, a small, ulnar 5-hole olecranon plate is added as a baby plate in addition to the mother plate at the level of the fracture zone (MBP group). Dynamic biomechanical loading in degrees of flexion from 0° to 90° is carried out to determine yield load, stiffness, displacement, and changes in fracture gap width as well as bending of the dorsal plate. RESULTS The "mother-baby-plate" osteosynthesis had a significantly higher yield load (p < 0.01) and stiffness (p = 0.01) than the LCP group. This correlates with the increased movement of the proximal fracture element during cyclic testing for the LCP group compared to the MBP group as measured by an optical metrology system. CONCLUSIONS Here, we show evidence that the addition of a small plate to the standard plate is highly effective in increasing the biomechanical stability in severe fractures equivalent to Jupiter type IIb. As it hopefully minimizes complications like pseudarthrosis and implant failure and as the additional preparatory effort leading to compromised blood supply is regarded to be negligible, this justifies and highly advises the use of a mother-baby-plate system.
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Affiliation(s)
- Stefanie Hoelscher-Doht
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Staße 6, 97080, Würzburg, Germany.
| | - Nicola Zufall
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Staße 6, 97080, Würzburg, Germany
| | - Maximilian Heilig
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Staße 6, 97080, Würzburg, Germany
| | - Philipp Heilig
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Staße 6, 97080, Würzburg, Germany
| | - Mila Marie Paul
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Staße 6, 97080, Würzburg, Germany
| | - Rainer Heribert Meffert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Staße 6, 97080, Würzburg, Germany
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Massard-Combe P, Debs A, De Tienda M, Pejin Z, Gaume M, Pannier S. Radiographic evaluation of ulnar deformity in patients with hereditary multiple osteochondroma and its relationship with radial head dislocation. Orthop Traumatol Surg Res 2023; 109:103591. [PMID: 36905956 DOI: 10.1016/j.otsr.2023.103591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 12/20/2022] [Accepted: 01/02/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION In patients who have hereditary multiple osteochondroma (HMO), progressive deformity of the forearm skeleton may lead to radial head dislocation. The latter is permanent, painful and causes weakness. HYPOTHESIS There is a relationship between the amount of ulnar deformity and the presence of radial head dislocation in patients with HMO. MATERIALS AND METHODS This was a cross-sectional radiographic study comprising an analysis of anterior-posterior (AP) and lateral x-rays of 110 forearms in children having a mean age of 8 years and 4 months who were followed for HMO between 1961 and 2014. Four factors reflecting on the ulnar deformity in the coronal plane were investigated on the AP view and three factors in the sagittal plane were investigated on the lateral view to identify any relationship between ulnar deformity and radial head dislocation. The forearms were separated into two groups: with radial head dislocation (26 cases) and without radial head dislocation (84 cases). RESULTS Ulnar bowing, intramedullary angle of ulnar bowing, tangent ulnar angle and overall ulnar angle were significantly higher in the group of children who had a radial head dislocation (0.05 vs 0.03, p<.001; 161 vs 167, p<001; 156 vs 162, p<001; 50 vs 30, p<.001) in univariate and multivariate analyses. DISCUSSION Ulnar deformity, evaluated using the method described here, is more often associated with radial head dislocation than other previously published radiological parameters. This provides new insight on this phenomenon and may help to determine which factors are associated with radial head dislocation and how to prevent it. CONCLUSION Ulnar bowing in the context of HMO, especially when evaluated on AP radiographs, is significantly associated with radial head dislocation. LEVEL OF EVIDENCE III; case-control study.
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Affiliation(s)
- Philippe Massard-Combe
- Service chirurgie orthopédique, Hôpital Necker - Université Paris Cité, 149 Rue de Sèvres, 75015 Paris, France.
| | - Alexandre Debs
- Service de santé publique du Pr. Carrat, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Marine De Tienda
- Service chirurgie orthopédique, Hôpital Necker - Université Paris Cité, 149 Rue de Sèvres, 75015 Paris, France
| | - Zagorka Pejin
- Service chirurgie orthopédique, Hôpital Necker - Université Paris Cité, 149 Rue de Sèvres, 75015 Paris, France
| | - Mathilde Gaume
- Service chirurgie orthopédique, Hôpital Necker - Université Paris Cité, 149 Rue de Sèvres, 75015 Paris, France
| | - Stéphanie Pannier
- Service chirurgie orthopédique, Hôpital Necker - Université Paris Cité, 149 Rue de Sèvres, 75015 Paris, France
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Hamiti Y, Yalikun A, Lu C, Yusufu A, Yushan M. Ilizarov technique in the treatment of bone defects of the radius and ulna: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:642. [PMID: 37649069 PMCID: PMC10469416 DOI: 10.1186/s13018-023-04126-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023] Open
Abstract
PURPOSE The objective of this systematic review and meta-analysis was to assess the efficacy of the Ilizarov method in the treatment of radius and ulna bone defects. METHODS The PubMed, Embase, Web of Science, Cochrane Library, Ovid MEDLINE, and Scopus databases were searched for articles published up to May 2023. The quality of the studies was evaluated using a modified version of the Newcastle-Ottawa scale. The effect size and confidence intervals at 95% for the main results were calculated. The heterogeneity was evaluated. The demographic data, defect size (DS), external fixation time (EFT), external fixation index (EFI), and complications were extracted and analyzed using the Stata version 16. RESULTS This meta-analysis identified and included seven studies involving 98 patients. The union rate of 100% was reported in all studies. According to the findings of the single-arm meta-analysis, the pooled DS was 3.42 cm (95% CI [2.64, 4.21], I2 = 53.5%, P = 0.045), EFT was 148.43 days (95% CI [97.49, 199.38], I2 = 91.9%, P = 0.000), and EFI was 41.32 days/cm (95% CI [35.72, 46.91], I2 = 62.2%, P = 0.021). Pin tract infection was the most common complication, as reported in six studies. CONCLUSION The findings of the present meta-analysis indicate that the Ilizarov technique is a successful treatment option for bone defects in the radius and ulna. This method has demonstrated efficacy in achieving expected clinical outcomes.
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Affiliation(s)
- Yimurang Hamiti
- Department of Microrepair and Reconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang, People's Republic of China
| | - Ainizier Yalikun
- Department of Microrepair and Reconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang, People's Republic of China
| | - Cheng Lu
- Department of Microrepair and Reconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang, People's Republic of China
| | - Aihemaitijiang Yusufu
- Department of Microrepair and Reconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang, People's Republic of China.
| | - Maimaiaili Yushan
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Xinjiang Medical University, Traditional Chinese Medicine Hospital of Xinjiang Uyghur Autonomous Region, Ürümqi, Xinjiang, People's Republic of China.
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Bui G, Rogers MJ, Shigley C, Huang JI. Staple Fixation in Ulnar-Shortening Osteotomies. J Hand Surg Glob Online 2023; 5:477-482. [PMID: 37521548 PMCID: PMC10382933 DOI: 10.1016/j.jhsg.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/25/2023] [Indexed: 08/01/2023] Open
Abstract
Ulnar-sided wrist pain is commonly caused by the ulnar impaction syndrome. Ulnar-shortening osteotomy is a surgical treatment that is used to address ulnar impaction syndrome that fails conservative management. Unfortunately, hardware irritation and nonunion are well-known complications of this procedure. This case report details the course of two patients with nonunion after ulnar-shortening osteotomy who were treated with a combination of a nitinol compression staple and neutralization plate. Further investigation is required to determine the long-term outcomes and indications for nitinol-staple fixation for nonunion after ulnar-shortening osteotomy.
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Affiliation(s)
- Gabrielle Bui
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA
| | - Miranda J. Rogers
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA
| | - Christian Shigley
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA
| | - Jerry I. Huang
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA
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Milinkov M, Vučinić N, Obradović M, Vukosav N, Tošić M, Krstonošić B. [Morphology of ulnar trochlear notch and defining ideal position for olecranon osteotomy]. CIR CIR 2023. [PMID: 37364892 DOI: 10.24875/ciru.22000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/21/2023] [Indexed: 06/28/2023]
Abstract
Aim The aim of the study was to calculate the most important parameters of ulna and to determine its gender. Classifying trochlear notch joint surface types and to establish their representation in Serbian population. To determine the ideal position for olecranon osteotomy. Material and methods The study included 69 bones. Gender determination was performed using digital scale and photographs of the ulna. The bones weight, maximum and physiological length were measured. The place for the ideal position of olecranon osteotomy (projection of the bare area on its posterior wall) was determined on profile images. Results Gender related, 45 (65.21%) bones belonged to males, 24 (34.79%) ulnas belonged to females. Type I of the bare area was present in 38 (55%) ulnas, type II in 20 (29%), whereas type III was present in 11 (16%) bones. The average value for the ideal position of olecranon osteotomy was 23.02 mm. In males' ulnas, it was 23.22 mm, in females, it was 22.59 mm. Conclusion Type I of the bare area is the most common type of trochlear notch joint surface in Serbian population. The average value for the ideal position of olecranon osteotomy was 23.02 mm. We believe that a uniform name for the bare area should be established.
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Affiliation(s)
- Milan Milinkov
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Nikola Vučinić
- Department of Anatomy, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Mirko Obradović
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina. Novi Sad, Serbia
| | - Nikola Vukosav
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina. Novi Sad, Serbia
| | - Milan Tošić
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina. Novi Sad, Serbia
| | - Bojana Krstonošić
- Department of Anatomy, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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Rodríguez L, García-González R, Arsuaga JL, Carretero JM. Uncovering the adult morphology of the forearm bones from the Sima de los Huesos Site in Atapuerca (Spain), with comments on biomechanical features. Anat Rec (Hoboken) 2023. [PMID: 37345623 DOI: 10.1002/ar.25281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023]
Abstract
The forearm skeleton is composed of two bones: the radius and the ulna. This is closely related to manipulative movements. The ulna is part of the elbow joint, whereas the radius and ulna together with the scaphoid and lunate bones, form the wrist joints. Thus, morphofunctional analysis of the adult Sima de los Huesos (SH) forearm bones, provides clues about manipulative activities in one Pleistocene population. From 1976 to the present, over 7000 human fossils have been recovered from the SH site. The radial sample comprised 98 labeled fragments, of which 49 belonged to adult individuals, representing at least 7 individuals. The ulnar sample included 31 labeled adult fossils representing at least nine individuals. In this study, we describe the SH radii and ulnae and analyze their functional implications for manipulative and forearm movements. We confirmed that the SH radii are long and curved, with variations in robusticity and radial tuberosity orientation. The SH ulnae are characterized by an anteriorly oriented trochlear notch, a massive olecranon process, an obliquely oriented radial notch, a blunt and short supinator crest, a gracile and curved diaphysis, and a round and anteriorly oriented pronator crests. In general, they exhibit Neanderthal morphology. The SH collection provides a unique opportunity to conduct morphological analyses of these bones in the Middle Pleistocene population.
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Affiliation(s)
- Laura Rodríguez
- Departamento de Biodiversidad y Gestión Ambiental, Universidad de León, Facultad de Ciencias Biológicas y Ambientales, León, Spain
- Laboratorio de Evolución Humana, Universidad de Burgos, Burgos, Spain
| | | | - Juan Luis Arsuaga
- Centro UCM-ISCIII de Investigación sobre Evolución y Comportamiento Humanos, Madrid, Spain
- Departamento de Geodinámica, Estratigrafía y Paleontología, Facultad de Ciencias Geológicas, Universidad Complutense de Madrid, Madrid, Spain
| | - José-Miguel Carretero
- Laboratorio de Evolución Humana, Universidad de Burgos, Burgos, Spain
- Centro UCM-ISCIII de Investigación sobre Evolución y Comportamiento Humanos, Madrid, Spain
- Unidad Asociada de I+D+I al CSIC Vidrio y Materiales del Patrimonio Cultural (VIMPAC), Burgos, Spain
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15
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Bellringer S, Jukes C, Dirckx M, Guryel E, Phadnis J. Strain reduction screws for nonunions following fixation around the elbow - A case series and review of the literature. J Clin Orthop Trauma 2023; 38:102129. [PMID: 36860994 PMCID: PMC9969280 DOI: 10.1016/j.jcot.2023.102129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 01/20/2023] [Accepted: 02/11/2023] [Indexed: 03/03/2023] Open
Abstract
Background Nonunions following fracture fixation result in significant patient morbidity and financial burden. Traditional operative management around the elbow consists of removal of metalwork, debridement of the nonunion and re-fixation with compression, often with bone grafting. Recently, some authors in the lower limb literature have described a minimally invasive technique used for select nonunions where simply placing screws across the nonunion facilitates healing by reducing inter-fragmentary strain. To our knowledge, this has not been described around the elbow, where traditional more invasive techniques continue to be employed. Aims The aim of this study was to describe the application of strain reduction screws for management of select nonunions around the elbow. Methods & Results We describe 4 cases (two humeral shaft, one distal humerus and one proximal ulna) of established nonunion following previous internal fixation, where minimally invasive placement of strain reduction screws were used. In all cases, no existing metal work was removed, the nonunion site was not opened, and no bone grafting or biologic stimulation was used. Surgery was performed between 9 and 24 months after the original fixation. 2.7 mm or 3.5 standard cortical screws were placed across the nonunion without lagging. Three fractures went on to unite with no further intervention required. One fracture required revision fixation using traditional techniques. Failure of the technique in this case did not adversely affect the subsequent revision procedure and has allowed refinement of the indications. Conclusion Strain reduction screws are safe, simple and effective technique to treat select nonunions around the elbow. This technique has potential to be a paradigm shift in the management of these highly complex cases and is the first description in the upper limb to our knowledge.
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Affiliation(s)
- S.F. Bellringer
- Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, East Sussex, England, UK
| | - C. Jukes
- Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, East Sussex, England, UK
| | - M. Dirckx
- Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, East Sussex, England, UK
| | - E. Guryel
- Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, East Sussex, England, UK
| | - J. Phadnis
- Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, East Sussex, England, UK
- Brighton and Sussex Medical School, UK
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Kodama A, Tanimoro K, Iwaguro S, Adachi N. Dual Corrective Osteotomy of the Radius and Ulna for Mature Madelung Deformity Using CT-based 3D Simulation: A Case Report. J Hand Surg Asian Pac Vol 2022; 27:1057-1060. [PMID: 36606355 DOI: 10.1142/s2424835522720559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We report a patient with mature Madelung deformity who underwent radial and ulnar corrective osteotomy using three-dimensional (3D) simulation. An osteotomy model was created using the computer-aided design (CAD) software based on the computed tomography (CT) data. After correcting the ulna, the osteotomy angle of the radius was determined using the location of the lunate as a landmark in the 3D plane created by the longitudinal axis of the corrected ulna. Consequently, the ulna was flexed 3° and shortened by 5 mm, and the radius was extended at 36° and ulna deviated at 25° by open wedge osteotomy. The radial inclinations, volar tilt and ulnar variance were 25°, 45° and 5 mm preoperatively, and improved to 22°, 10° and 0 mm after surgery. At the 18-month follow-up, the patient reported no pain even during sports activity. The preoperative 3D simulation enabled precise preoperative planning and accurate correction of the Madelung deformity. Level of Evidence: Level V (Therapeutic).
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Affiliation(s)
- Akira Kodama
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kaguna Tanimoro
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shogo Iwaguro
- Division of Dental Technician, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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17
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Facon JB, Mainard N, Faure PA, Wavreille G, Chantelot C, Auzias P. Results of isolated ulnar shaft shortening osteotomy in the treatment of idiopathic ulnocarpal impaction syndrome. Hand Surg Rehabil 2022; 41:589-594. [PMID: 35907617 DOI: 10.1016/j.hansur.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
The objective of this study was to evaluate the results of isolated ulnar shaft shortening osteotomy (USSO) in the treatment of idiopathic ulnocarpal impingement syndrome. This was a two-center retrospective study. All patients older than 18 years who underwent isolated USSO for idiopathic ulnocarpal impingement syndrome between 2006 and 2016 were included. The outcome measures were: patient satisfaction, decrease in pain intensity, change in occupation, QuickDASH and PRWE functional scores, secondary palliative surgery suggesting failure of the ulnar shaft shortening osteotomy, and postoperative ulnar variance. The main complications were analyzed. Thirty-one patients were included. Twenty-six (84%) were satisfied with the procedure. At an average follow-up of 62 months, there was no secondary palliative surgery. Mean pain intensity on VAS was 7/10 (range, 2-10) and 1.7/10 (range, 0-6) preoperatively and postoperatively, respectively, for a mean decrease of 5.3 ± 2.6 points; this decrease was statistically significant (p < 0.001). None of the manual workers had to alter their work. Mean postoperative QuickDASH score was 19.6/100 (range, 0-79.55) and mean postoperative PRWE score was 23/100 (range, 1-85). Mean postoperative ulnar variance was -0.5 mm. As for complications, 61% of patients (n = 19/31) had discomfort related to the plate; 9.7% (n = 3/31) had distal radioulnar osteoarthritis; 4% (n = 1/19) had a fracture after hardware removal; 13% (n = 4/31) had non-union. Despite a high rate of complications, the study confirmed the effectiveness, in terms of pain, of isolated USSO in the treatment of idiopathic ulnocarpal impingement syndrome. LEVEL OF EVIDENCE: IV; retrospective cohort.
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Affiliation(s)
- J-B Facon
- Service de Chirurgie Orthopédique 1, Hôpital Roger Salengro, Rue du Professeur Emile Laine, 59037 Lille cedex, France.
| | - N Mainard
- Département de Chirurgie Pédiatrique, Hôpital Jeanne de Flandre, Rue du Professeur Emile Laine, 59037 Lille cedex, France
| | - P-A Faure
- Service de Chirurgie Orthopédique 2, Hôpital Roger Salengro, Rue du Professeur Emile Laine, 59037 Lille cedex, France
| | - G Wavreille
- Centre SOS mains, Pôle Clinique Lille Sud, 43 Rue des meuniers, 59810 Lesquin, France
| | - C Chantelot
- Service de Chirurgie Orthopédique 1, Hôpital Roger Salengro, Rue du Professeur Emile Laine, 59037 Lille cedex, France
| | - P Auzias
- Service de Chirurgie Orthopédique 1, Hôpital Roger Salengro, Rue du Professeur Emile Laine, 59037 Lille cedex, France; Centre SOS mains, Pôle Clinique Lille Sud, 43 Rue des meuniers, 59810 Lesquin, France
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18
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Ma JL, Liao L, Wan T, Yang FC. Isolated cryptococcal osteomyelitis of the ulna in an immunocompetent patient: A case report. World J Clin Cases 2022; 10:6617-6625. [PMID: 35979300 PMCID: PMC9294900 DOI: 10.12998/wjcc.v10.i19.6617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/09/2022] [Accepted: 05/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cryptococcal osteomyelitis is a bone infection caused by cryptococcus. As an opportunistic infection, bone cryptococcosis usually occurs in patients with immunodeficiency diseases or in those undergoing immunosuppressive therapy and often displays characteristics of disseminated disease. Isolated cryptococcal osteomyelitis is extremely unusual in immunocompetent person. The pathogenic fungus often invades vertebrae, femur, tibia, rib, clavicle, pelvis, and humerus, but the ulna is a rare target.
CASE SUMMARY A 79-year-old woman complaining of chronic pain, skin ulceration and a sinus on her right forearm was admitted, and soon after was diagnosed with cryptococcal osteomyelitis in the right ulna. Unexpectedly, she was also found to have apparently normal immunity. After treatment with antifungal therapy combined with surgery debridement, the patient’s osteomyelitis healed with a satisfactory outcome.
CONCLUSION Although rare, cryptococcal osteomyelitis should be considered in the differential diagnosis of osteolytic lesions even in immunocompetent patients, and good outcomes can be expected if early definitive diagnosis and etiological treatment are established.
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Affiliation(s)
- Jing-Long Ma
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
- Guangxi Key Laboratory of Regenerative Medicine, Department of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
| | - Liang Liao
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
- Guangxi Key Laboratory of Regenerative Medicine, Department of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
| | - Tao Wan
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
- Guangxi Key Laboratory of Regenerative Medicine, Department of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
| | - Fu-Chun Yang
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
- Guangxi Key Laboratory of Regenerative Medicine, Department of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
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Walker MF, Kamineni S. Allograft reconstruction of olecranon after traumatic bone loss: a case report. JSES Rev Rep Tech 2022; 2:250-253. [PMID: 37587965 PMCID: PMC10426560 DOI: 10.1016/j.xrrt.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Despite 2.2 million bone allografts conducted annually, their complication rate remains high, with recipients incurring infection, fracture, instability, and failure to incorporate. Nonunion rates in massive bone allografts-a bone segment ≥5 cm in length that also contains the total circumference of replaced bone-have been documented as high as 50%. However, if early complication can be avoided, a 75% success rate at 20 years postoperatively has been reported. Nonmassive allografts may yield decreased nonunion rates, as massive bone allografts must overcome a greater metaphyseal to diaphyseal incorporation rate and osteoconduction may not ensue beyond the bone periphery. The patient in this case is a 23-year-old male demonstrating absent bone in the right olecranon process of the ulna without attachment of the triceps brachii after a motorbike accident. The patient underwent olecranon allograft reconstruction with triceps brachii tendon reattachment. Four and a half years after allograft reconstruction of the right olecranon, the patient presents with minimal symptoms. However, he reports occasional aching at the site of injury. His current active arc of sagittal motion was 20°-130°, and pronation-supination was 70°-80°. His triceps strength was 4/5 Medical Research Council grade. Radiographic evaluation revealed a well-incorporated graft with a recontoured olecranon tip. Overall, this report demonstrates that operations involving a nonmassive allograft about the olecranon process may display minimal side effects in comparison to massive allografts, specifically regarding nonunion. Furthermore, this operation allows for improved range of motion after bone loss, allowing the patient to partake in activities of daily living.
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Affiliation(s)
| | - Srinath Kamineni
- Department of Orthopedic Surgery, Elbow Shoulder Research Center, University of Kentucky College of Medicine, Lexington, KY, USA
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Ottow C, Schmidt S, Heindel W, Pfeiffer H, Buerke B, Schmeling A, Vieth V. Forensic age assessment by 3.0 T MRI of the wrist: adaption of the Vieth classification. Eur Radiol 2022; 32:7956-64. [PMID: 35505118 DOI: 10.1007/s00330-022-08819-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 04/05/2022] [Accepted: 04/14/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES In order to find a reliable method to correctly assess majority in both sexes by MRI, a study was conducted to evaluate the applicability of the recently presented Vieth classification in wrist MRI, after it had originally been proposed for knee MRI. METHODS After receiving a positive vote by the ethics committee, the left-hand wrists of 347 male and 348 female volunteers of German nationality in the age bracket 12-24 years were scanned. Before conducting the prospective, cross-sectional examinations, an informed consent was obtained from each volunteer. A 3.0 T MRI scanner was used, acquiring a T1 turbo spin-echo sequence (TSE) and a T2 TSE sequence with fat suppression by spectral presaturation with inversion recovery (SPIR). The images were assessed by applying the Vieth classification. Minimum, maximum, mean ± standard deviation, and median with lower and upper quartiles were defined. Intra- and interobserver agreements were determined by calculating the kappa coefficients. Differences between the sexes were analyzed using the Mann-Whitney U test. RESULTS By applying the unmodified Vieth classification with corresponding schematics, it was possible to assess majority in both sexes via the epiphyseal-diaphyseal fusion of the distal radius and in males also via the epiphyseal-diaphyseal fusion of the distal ulna. The Mann-Whitney U test implied significant sex-related differences for all stages. For both epiphyses, the intra- and interobserver agreement levels were very good (κ > 0.8). CONCLUSION If confirmed by further studies, it would be possible to determine the completion of the 18th year of life in both sexes by 3.0 T MRI of the wrist and using the Vieth classification. KEY POINTS • The Vieth classification allows determining majority in males and females alike based on the distal radius' epiphysis by 3.0 T MRI of the wrist. • The Vieth classification also allows determining majority in males based on the distal ulna's epiphysis by 3.0 T MRI of the wrist, but not in females. • The presented data can be deemed referential within certain discussed boundaries.
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Jang SH, Kim KW, Jang HS, Kim YS, Kim H, Kim Y. Topographical measurement of the attachments of the central band of the interosseous membrane on interosseous crests of the radius and ulna. Clin Shoulder Elb 2021; 24:253-260. [PMID: 34875732 PMCID: PMC8651595 DOI: 10.5397/cise.2021.00451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background To suggest a reasonable isometric point based on the anatomical consistency of interosseous membrane (IOM) attachment in association with topographic characteristics of the interosseous crests, the footprints of the central band (CB) of the IOM on the radial and ulnar interosseous crests (RIC and UIC) were measured. Methods We measured the distance from the CB footprints from each apex of both interosseous crests in 14 cadavers and the angles between the forearm axis of rotation (AOR) and the distal slopes of the RIC and UIC in 33 volunteers. Results The CB footprints lay on the downslope of both interosseous crests with its upper margin on average 3-mm proximal from the RIC's apex consistently in the radial length, showing normality (p>0.05), and on average 16-mm distal from the UIC's apex on the ulna without satisfying normality (p<0.05). The average angle between the UIC's distal slope and the AOR was 1.3°, and the RIC's distal slope to the AOR was 14.0°, satisfying the normality tests (p>0.05), and there was no side-to-side difference in both forearms (p<0.05). Conclusions The CB attached to the downslope just distal to the RIC's apex constrains the radius to the UIC that coincides with the AOR of the forearm circumduction, maintaining itself both isometrically and isotonically.
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Affiliation(s)
- Suk-Hwan Jang
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea
| | - Kyung-Whan Kim
- Department of Orthopedic Surgery, Zion Hospital, Busan, Korea
| | - Hyo Seok Jang
- Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University, Busan, Korea
| | | | - Hojin Kim
- Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University, Busan, Korea
| | - Youngbok Kim
- Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University, Busan, Korea
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22
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Cha SM, Shin HD, Ahn BK. Revision osteosynthesis after primary treatment of atypical ulnar fractures associated with bisphosphonate usage - Nonunion after ordinary open reduction and internal fixation. Arch Orthop Trauma Surg 2021; 141:1855-1862. [PMID: 32797295 DOI: 10.1007/s00402-020-03567-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND We performed revision surgeries to treat nonunion of bisphosphonate-associated ulnar fractures that had originally been treated, after misdiagnosis, using the typical open reduction/internal fixation (ORIF). METHODS Of nine cases of ulnar nonunion initially treated at other institutions, we performed revision surgeries on four that met our inclusion/exclusion criteria. All previous implants were removed; the areas of nonunion were resected, and strut bone grafts were inserted and fixed with locking plates. Radiological assessments were performed monthly for 3 months after surgery and then every 3 months for 1 year. RESULTS All patients were female, with a mean age of 71.8 years. All patients had been taking bisphosphonate for a mean of 7.2 years. The primary fixation methods used at other institutions were intra-medullary nailing (n = 1) and placement of 3.5-mm locking plates (n = 3). In one patient (patient 1), the contralateral (right) ulna developed a new fracture at 1 month after revision surgery on the left ulna. Another patient (patient 3) exhibited an incomplete fracture in the contralateral (right) ulna. All four patients exhibited hip fractures (bilateral in three). All revisions resulted in final union at a mean of 4.8 months postoperatively. CONCLUSION Atypical ulnar fractures should be suspected in elderly women on long-term bisphosphonate treatment. Union will fail with standard ORIF for atypical ulnar fractures, because the fracture occurred due to compromised normal bone metabolism as reflected in the bone resorption, remodeling, and healing processes. Revision osteosynthesis using a locking plate with callus resection and strut/cancellous bone graft provided satisfactory results. LEVEL OF EVIDENCE Therapeutic level IV.
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Affiliation(s)
- Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, 266 Munwha-ro, Jung-Gu, Daejeon, Korea
| | - Hyun Dae Shin
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, 266 Munwha-ro, Jung-Gu, Daejeon, Korea.
| | - Byung Kuk Ahn
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, 266 Munwha-ro, Jung-Gu, Daejeon, Korea
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23
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Kreulen RT, Nayar SK, Alfaki Y, LaPorte D, Demehri S. Advanced Imaging of Ulnar Wrist Pain. Hand Clin 2021; 37:477-486. [PMID: 34602127 DOI: 10.1016/j.hcl.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ulnar-sided wrist pain can be a diagnostic challenge for clinicians and radiologists. The ulnar wrist has complex morphology and is composed of many small bone and soft tissue structures. Within these structures, a wide variety of pathologic conditions can occur. To successfully diagnose and treat these pathologic conditions, clinicians and radiologists must have a strong understanding of the advanced imaging techniques available to them. In this review, the authors present a brief review of the normal ulnar wrist anatomy, discuss the differential diagnosis of ulnar-sided wrist pain, and examine the indications for different advanced imaging modalities.
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Affiliation(s)
- R Timothy Kreulen
- Johns Hopkins Department of Orthopaedic Surgery, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA.
| | - Suresh K Nayar
- Johns Hopkins Department of Orthopaedic Surgery, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA
| | - Yasmin Alfaki
- Johns Hopkins University, 3400 North Charles Street, Mason Hall, Baltimore, MD 21218, USA
| | - Dawn LaPorte
- Johns Hopkins Department of Orthopaedic Surgery, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA
| | - Shadpour Demehri
- Johns Hopkins Department of Musculoskeletal Radiology, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA
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Roulet S, Gubbiotti L, Lakhal W, Chaves C, Marteau E, Laulan J, Bacle G. Ulna shortening osteotomy for ulnar impaction syndrome: Impact of distal radioulnar joint morphology on clinical outcome. Orthop Traumatol Surg Res 2021; 107:102970. [PMID: 34052512 DOI: 10.1016/j.otsr.2021.102970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Treatment of ulnar impaction syndrome (UIS) is based on ulnocarpal decompression, which may be achieved by ulna shortening osteotomy. The aim is to restore zero or negative ulnar variance. Tolat et al. described 3 distal radioulnar joint (DRUJ) morphologic types: vertical, oblique and reverse. Joint type has been thought to influence the clinical result of shortening, especially in the reverse type. HYPOTHESIS DRUJ type does not influence clinical results in ulna shortening osteotomy. MATERIAL AND METHODS Twenty-nine wrists were operated on in 27 patients: 13 female, 14 male; mean age at surgery, 43 years (range, 18-72 years). In 20 cases, UIS was idiopathic and in 7 post-traumatic. Mean preoperative ulnar variance was 3.6mm (range, 2-18mm). The osteotomy was fixed by screwed plate. RESULTS Twenty-five patients (27 wrists) were assessed at a mean 64 months (range, 18 months to 13 years). There were no cases of infection or hematoma. DRUJ was type 1 (vertical) in 6 cases (22%), type 2 (oblique) in 14 (52%) and type 3 (reverse) in 7 (26%). Mean postoperative pain score on VAS was 0.7/10 (range, 0-4); 9 wrists remained painful. Mean Quick-DASH was 16.9 (range, 0-48) and mean PRWE 21.9 (range, 16.9-59). Thirteen patients were very satisfied, 11 satisfied, 1 moderately satisfied, and 2 dissatisfied. Mean postoperative ulnar variance was -0.1mm (range, -4 to +8mm). Three wrists developed osteoarthritis, all following traumatic UIS. There were no significant correlations between DRUJ type and other clinical or radiological parameters. DISCUSSION Ulna shortening osteotomy has proven efficacy in UIS. The literature reports excellent or good results in 75% of cases. In the present study, 96% of patients considered themselves cured or improved by surgery, and none reported worsening. Ulna shortening osteotomy can be used in all 3 DRUJ types; DRUJ coronal morphology does not impact clinical result. LEVEL OF EVIDENCE IV-retrospective study.
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Affiliation(s)
- Steven Roulet
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France.
| | - Laura Gubbiotti
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Walid Lakhal
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Camilo Chaves
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Emilie Marteau
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Jacky Laulan
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Guillaume Bacle
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
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Matsushita Y, Hanada M, Matsumoto Y, Kadota H, Nakashima Y. A Double-Barreled Fibular Graft for the Reconstruction of Both Forearm Bones and Humeroradial Joint after a Tumor Resection. J Hand Surg Asian Pac Vol 2021; 26:455-459. [PMID: 34380407 DOI: 10.1142/s2424835521720152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A double-barreled fibular graft was used to reconstruct both forearm bones and the humeroradial joint after tumor resection. The patient had a tumor of radius that invaded the ulna and extensor groups. After a wide tumor resection, vascularized fibular autograft and soft tissue reconstruction was performed. A fibular graft were placed as a double barrel in the proximal ulnar and radial defects including the radial head and fixed using two locking plates. Simultaneously, reconstruction of the humeroradial joint and wrist dorsiflexion was performed. Two years postoperatively, the patient is satisfied with his elbow function while performing activities of daily living. Although amputation was one of the options considered during the preoperative planning in this case, the affected limb could be preserved by grafting a double-barreled fibula and tendon transfer, which could maintain the function of his upper left limb.
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Affiliation(s)
- Yu Matsushita
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masuo Hanada
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideki Kadota
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Abstract
Physeal injuries are common in the developing small animal and can result in growth disturbances of the forelimb. Resulting deformities can include limb shortening, joint incongruity, angulation, and alterations in joint loading with subsequent osteoarthritis, remodeling, and debilitation. Because of the unique paired bone configuration, the antebrachium is the main source for malalignment resulting from physeal disturbance in the forelimb. Successful correction of deformities requires in-depth understanding of normal physeal activity; careful consideration of patient signalment; and the ability to quantify the location, magnitude, and plane of the deformity or deformities.
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Tawonsawatruk T, Kanchanathepsak T, Duangchan T, Aswamenakul K, Supokawej A. Feasibility of bone marrow mesenchymal stem cells harvesting from forearm bone. Heliyon 2021; 7:e07639. [PMID: 34381898 PMCID: PMC8334379 DOI: 10.1016/j.heliyon.2021.e07639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/03/2021] [Accepted: 07/19/2021] [Indexed: 10/31/2022] Open
Abstract
Introduction Mesenchymal stem cell is a promising therapeutic option in orthopedic filed and regenerative medicine. The feasibility of isolation method and characterization of Mesenchymal stem cell including growth kinetics, immunophenotypes and differentiation potency from small volume aspiration harvested from ulna and radius should be evaluated in order to utilize this cell in hand surgery. Materials and methods Mesenchymal stem cells were isolated and characterized from bone marrow of 12 patients who underwent internal fixation of fractures at radius or ulna. Population doubling time & clonogenic ability, immunophenotypes and trilineage differentiation potential of Mesenchymal stem cells were evaluated. Results Mesenchymal stem cells derived from bone marrow were attached to plastic flasks and became homogenous monolayer of fibroblast-like cells. They exhibited clonogenic ability and demonstrated positive markers which were shown by CD 73, CD 90, and CD 105 and negative markers which were shown by CD 34, CD 45. Mesenchymal stem cells derived from this source were capable of osteogenesis, chondrogenesis and adipogenesis. Discussion This study demonstrated the feasibility of bone marrow mesenchymal stem cells harvested from forearm bone marrow with small volume samples. This source should be useful in tissue engineering strategy or orthobiologic approach in orthopedic surgery.
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Affiliation(s)
- Tulyapruek Tawonsawatruk
- Department of Orthopedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Thepparat Kanchanathepsak
- Department of Orthopedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Thitinat Duangchan
- Department of Clinical Microscopy, Faculty of Medical Technology, Mahidol University, Phutthamonthon, Nakhon Pathom 73170, Thailand
| | - Kuneerat Aswamenakul
- Department of Clinical Microscopy, Faculty of Medical Technology, Mahidol University, Phutthamonthon, Nakhon Pathom 73170, Thailand
| | - Aungkura Supokawej
- Department of Clinical Microscopy, Faculty of Medical Technology, Mahidol University, Phutthamonthon, Nakhon Pathom 73170, Thailand
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Luceri F, Cucchi D, Rosagrata E, Zaolino CE, Viganò M, de Girolamo L, Zagarella A, Catapano M, Gallazzi MB, Arrigoni PA, Randelli PS. Novel Radiographic Indexes for Elbow Stability Assessment: Part A-Cadaveric Validation. Indian J Orthop 2021; 55:336-346. [PMID: 34306546 PMCID: PMC8275710 DOI: 10.1007/s43465-021-00407-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/16/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Elbow bony stability relies primarily on the high anatomic congruency between the humeral trochlea and the ulnar greater sigmoid notch. No practical tools are available to distinguish different morphotypes of the proximal ulna and herewith predict elbow stability. The aim of this study was to assess inter-observer reproducibility, evaluate diagnostic performance and determine responsiveness to change after simulated coronoid process fracture for three novel elbow radiographic indexes. METHODS Ten fresh-frozen cadaver specimens of upper limbs from human donors were available for this study. Three primary indexes were defined, as well as two derived angles: Trochlear Depth Index (TDI); Posterior Coverage Index (PCI); Anterior Coverage Index (ACI); radiographic coverage angle (RCA); olecranon-diaphisary angle (ODA). Each index was first measured on standardized lateral radiographs and subsequently by direct measurement after open dissection. Finally, a type II coronoid fracture (Regan and Morrey classification) was created on each specimen and both radiographic and open measurements were repeated. All measurements were conducted by two orthopaedic surgeons and two dedicated musculoskeletal radiologists. RESULTS All three indexes showed good or moderate inter-observer reliability and moderate accuracy and precision when compared to the gold standard (open measurement). A significant change between the radiographic TDI and ACI before and after simulated coronoid fracture was observed [TDI: decrease from 0.45 ± 0.03 to 0.39 ± 0.08 (p = 0.035); ACI: decrease from 1.90 ± 0.17 to 1.58 ± 0.21 (p = 0.001)]. As expected, no significant changes were documented for the PCI. Based on these data, a predictive model was generated, able to identify coronoid fractures with a sensitivity of 80% and a specificity of 100%. CONCLUSION New, simple and easily reproducible radiological indexes to describe the congruency of the greater sigmoid notch have been proposed. TDI and ACI change significantly after a simulated coronoid fracture, indicating a good responsiveness of these parameters to a pathological condition. Furthermore, combining TDI and ACI in a regression model equation allowed to identify simulated fractures with high sensitivity and specificity. The newly proposed indexes are, therefore, promising tools to improve diagnostic accuracy of coronoid fractures and show potential to enhance perioperative diagnostic also in cases of elbow instability and stiffness. LEVEL OF EVIDENCE Basic science study. CLINICAL RELEVANCE The newly proposed indexes are promising tools to improve diagnostic accuracy of coronoid fractures as well as to enhance perioperative diagnostic for elbow instability and stiffness.
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Affiliation(s)
- Francesco Luceri
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Venurberg-Campus 1, 53127 Bonn, Germany
| | - Enrico Rosagrata
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Residency Program, Università Degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Carlo Eugenio Zaolino
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Marco Viganò
- Laboratorio di Biotecnologie Applicate All’Ortopedia, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Laura de Girolamo
- Laboratorio di Biotecnologie Applicate All’Ortopedia, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Andrea Zagarella
- Servizio di Radiologia, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Michele Catapano
- Servizio di Radiologia, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Mauro Battista Gallazzi
- Servizio di Radiologia, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Paolo Angelo Arrigoni
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Pietro Simone Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
- U.O.C. 1° Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
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Kollnberger KV, de Andrade E Silva FB, Caiero MT, de Camargo Leonhardt M, Dos Reis PR, Dos Santos Silva J, Kojima KE. Intramedullary Steinmann pin nailing of the ulna: an option for the damage control orthopedics treatment of forearm fractures in open injuries in polytraumatized patients - A description of the technique and presentation of a case series. Injury 2021; 52 Suppl 3:S33-7. [PMID: 34088470 DOI: 10.1016/j.injury.2021.05.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/26/2021] [Accepted: 05/03/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Forearm shaft fracture is common in young adult patients and associated with soft tissue and organ injuries. In open fractures in polytrauma patients, damage control orthopaedics (DCO) is well indicated. The aim of this study is to describe intramedullary Steinmann pin fixation of the ulna as a DCO procedure for the forearm and present a case series. DESCRIPTION OF THE TECHNIQUE A 3.0 mm Steinmann pin is inserted retrograde in the ulna proximal fragment through the fracture site using the open wound as the approach. With direct visualization of the reduction, the pin is advanced into the distal fragment. The reduction of the longitudinal axis and shortening is thus achieved. PATIENTS AND METHODS This method was used for all open fractures of forearm both-bone fractures in polytrauma patients undergoing DCO from 2014 to 2019. The alignment and length of the ulna were evaluated radiographically after pin fixation and before and after definitive fixation. Differences in the need for secondary procedures and infection rate between DCO and definitive fixation were also evaluated. RESULTS There were 30 males (85.7%) with an average age of 32.9 ± 12.0 years and a mean ISS (Injury Severity Score) of 29.4 (range, 18.0-41.0). The most common associated injuries were thoracic trauma (62.8%) and head trauma (45.7%). In the radius and ulna, 51.4% and 60.0% of fractures, respectively, were multifragmentary (types B and C). Gustilo type IIIA represented 77.1% of the injuries. Pin fixation achieved good alignment and length in all cases. The mean time between DCO and definitive fixation was 12.0 days, and no secondary procedure was needed, nor any case developed either superficial or deep infection. The conversion from DCO to definitive fixation was considered easy in all cases. CONCLUSION Intramedullary Steinmann pin fixation of the ulna is a viable option for DCO for forearm both-bone fractures in open fractures in polytrauma patients.
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Rougereau G, Marty-Diloy T, Pietton R, Koneazny C, Fitoussi F, Vialle R, Mary P, Langlais T. Forearm reconstruction by induced-membrane technique after sarcoma resection in children: technique and functional outcome in three cases. Hand Surg Rehabil 2021; 40:799-803. [PMID: 34171528 DOI: 10.1016/j.hansur.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
Forearm sarcoma is rare in children. Here, we report three cases. One child presented undifferentiated soft-tissue sarcoma involving the ulna, another had Ewing's sarcoma of the ulna, and the third had Ewing's sarcoma of the proximal radius. In the first case, there were episodes of iterative aseptic nonunion, treated surgically. At last follow-up (respectively 11, 9 and 8 years postoperatively), the mean Musculoskeletal Tumor Society (MSTS) score was 80%, 90% and 77% respectively, and all cases were in remission. The induced membrane technique to reconstruct bone defect after sarcoma resection in children is a possible limb-salvage strategy.
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Affiliation(s)
- G Rougereau
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - T Marty-Diloy
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - R Pietton
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - C Koneazny
- The MAMUTH Hospital University, Department for Innovative Therapies in Musculoskeletal Disease, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - F Fitoussi
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; The MAMUTH Hospital University, Department for Innovative Therapies in Musculoskeletal Disease, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - R Vialle
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; The MAMUTH Hospital University, Department for Innovative Therapies in Musculoskeletal Disease, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - P Mary
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - T Langlais
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Department of Pediatric Orthopedics, Purpan Hospital, 330 Avenue de Grande Bretagne, 31300 Toulouse, France.
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Masood QM, Qulaghassi M, Grewal U, Bawale R, Kammela M, Singh B. Proximal ulna fractures in adults: A review of diagnosis and management. J Clin Orthop Trauma 2021; 20:101481. [PMID: 34211834 PMCID: PMC8240031 DOI: 10.1016/j.jcot.2021.101481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 11/19/2022] Open
Abstract
Proximal ulna fractures are relatively common upper limb injuries, which may represent fragility fractures or result from high-energy trauma. These include fractures of the olecranon, coronoid and associated radial head dislocations. A wide variety of treatment options are available for the management of these injuries that makes the selection of most appropriate treatment difficult. We aim to provide a brief overview of the treatment options for such injuries.
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Affiliation(s)
| | - Mahdi Qulaghassi
- Medway NHS Foundation Trust, Windmill Road, Gillingham, ME7 5, NY, UK
| | - Urpinder Grewal
- Frimley Park Hospital NHS Foundation Trust, Portsmouth Rd, Frimley, GU16 7UJ, UK
| | - Rajesh Bawale
- Medway NHS Foundation Trust, Windmill Road, Gillingham, ME7 5, NY, UK
| | - Madhavi Kammela
- Medway NHS Foundation Trust, Windmill Road, Gillingham, ME7 5, NY, UK
| | - Bijayendra Singh
- Medway NHS Foundation Trust, Windmill Road, Gillingham, ME7 5, NY, UK
- Corresponding author.
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Cha SM, Shin HD. Risk factors for atypical forearm fractures associated with bisphosphonate usage. Injury 2021; 52:1423-8. [PMID: 33268075 DOI: 10.1016/j.injury.2020.10.087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 10/08/2020] [Accepted: 10/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to find the diagnostic factors for atypical forearm fractures additional to atypical femur fractures, via a retrospective case-control study. Thus, our authors performed a complete enumeration survey for patients under the treatment of bisphosphonate (BP). METHODS We identified 53 patients that met the following inclusion criteria between March 2009 and February 2019: a BP therapy history or ongoing administration of at least 1 year, presence of simple radiographs of bilateral femurs and forearms, and availability of complete medical records and radiological data. The patients were divided into two groups: those with any lesion of atypical fractures of ulna or radius, regardless of the displacement of at least one side extremity in simple radiographs (group 1, 20 patients); and those without any lesions of pathognomonic finding or fractures in either forearm in simple radiographs (group 2, 33 patients). RESULTS Univariate analyses of basic demographic characteristic such as age, smoking, comorbidity of diabetes mellitus or any connective tissue disease needing steroid treatment, and BMD showed no significant differences between the groups (P > 0.05). The co-morbidity of malignant cancer inevitably needing BP usage was not different between the two groups. Multivariate analyses of the several variables that differed significantly between the two groups in univariate analyses demonstrated that total period and single prescribing physician/surgeon were significantly associated with forearm fractures. A cut-off value of 65 months for the total period predicted the presence atypical forearm fractures. CONCLUSIONS Atypical forearm fractures are probably more common than reported in the literature to date, and all forearm lesions were accompanied by preceding atypical femur fractures. The period of BP administration had the main effect on the occurrence of atypical forearm fractures, particularly if more than 65 months. Also, the prescription by multiple physician was predicting factor for forearms lesion additionally to AFFs, however, more evidence-based study is needed to understand the effects of cancer-related BP usage on the forearm. LEVEL OF EVIDENCE Level III, retrospective case-control study.
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Kale SY, Singh SD, Samant P, Bukalsaria D, Chaudhari P, Ghodke RJ. Treatment of diaphyseal forearm fracture with interlocking intramedullary nailing: A pilot study. J Clin Orthop Trauma 2021; 17:195-200. [PMID: 33898239 PMCID: PMC8047502 DOI: 10.1016/j.jcot.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/14/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION The present study was done to assess the functional outcome and complications of interlocking intramedullary (IM) radius ulna nailing to treat radio-ulna fractures in adults. METHODOLOGY Thirty adult patients with diaphyseal or segmental fractures of radius and ulna were included and treated with IM nailing. Grace and Eversmann rating system was used to assess functional evaluation and grip strength was measured using grasp dynamometer. RESULTS Mean age of the 30 eligible patients was 33.5 years, and males comprised 77% of the study population. Intra-operative complications like nail impaction and proximal screw locking problem for radius was present in one patient each. Increased swelling in three patients (10%) and posterior interosseous nerve palsy in one patient (3%) were observed post-operatively. In the post-operative period, all patients were able to move fingers, had 100° elbow range of motion and good grip strength. Pronation and supination till 80° was present in 80% and 57% of the patients respectively. Wrist flexion and dorsiflexion till 90° was present in 80% and 57% of the patients. Fracture union was confirmed radiologically in all cases at a mean of 3.6 weeks. Functional outcome was excellent in 73% and good in 13%. Grip strength was judged to be excellent in all cases. CONCLUSIONS Excellent and good functional outcomes were obtained in 86%, and no case developed mal-union or delayed union. Based on our results, IM nail for surgical treatment of radial and ulnar diaphyseal fractures can be used.
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Affiliation(s)
- Sachin Y. Kale
- Department of Orthopedics, DY Patil School of Medicine, Navi Mumbai, Maharashtra, India
| | - Shikhar D. Singh
- Department of Orthopedics, DY Patil School of Medicine, Navi Mumbai, Maharashtra, India,Corresponding author. Department of Orthopaedics, Padmashree Dr DY Patil Medical college, Navi Mumbai, India.
| | - Prakash Samant
- Department of Orthopedics, DY Patil School of Medicine, Navi Mumbai, Maharashtra, India
| | - Divyesh Bukalsaria
- Department of Orthopedics, DY Patil School of Medicine, Navi Mumbai, Maharashtra, India
| | - Prasad Chaudhari
- Department of Orthopedics, DY Patil School of Medicine, Navi Mumbai, Maharashtra, India
| | - Rahul J. Ghodke
- Department of Orthopedics, YMT Hospital, Kharghar, Maharashtra, India
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Ferreira N, Saini AK, Birkholtz FF, Laubscher M. Management of segmental bone defects of the upper limb: a scoping review with data synthesis to inform decision making. Eur J Orthop Surg Traumatol 2021; 31:911-922. [PMID: 33674937 DOI: 10.1007/s00590-021-02887-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/26/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Injuries to the long bones of the upper limb resulting in bone defects are rare but potentially devastating. Literature on the management of these injuries is limited to case reports and small case series. The aim of this study was to collate the most recent published work on the management of upper limb bone defects to assist with evidence based management when confronted with these cases. METHODS Following a preliminary search that confirmed the paucity of literature and lack of comparative trials, a scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) was conducted. A literature search of major electronic databases was conducted to identify journal articles relating to the management of upper limb long bone defects published between 2010 and 2020. RESULTS A total of 46 publications reporting on the management of 341 patients were reviewed. Structural autograft, bone transport, one-bone forearm and the induced membrane technique were employed in an almost equal number of cases. The implemented strategies showed similar outcomes but different indications and complication profiles were observed. CONCLUSION Contemporary techniques for the management of post-traumatic upper limb bone defects all produce good results. Specific advantages, disadvantages and complications for each modality should be considered when deciding on which management strategy to employ for each specific patient, anatomical location, and defect size.
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Affiliation(s)
- Nando Ferreira
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, South Africa.
| | - Aaron Kumar Saini
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, South Africa
| | - Franz Friedrich Birkholtz
- Walk-A-Mile Centre and Department of Orthopaedics, University of Pretoria, Pretoria, 0002, South Africa
| | - Maritz Laubscher
- Orthopaedic Research Unit (ORU), Division of Orthopaedic Surgery, Department of Surgery, University of Cape Town, Cape Town, 7505, South Africa
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Zapico SC, Adserias-Garriga J. Estimation of sex based on postcranial elements in European American and Latin American populations. J Forensic Leg Med 2020; 77:102098. [PMID: 33338798 DOI: 10.1016/j.jflm.2020.102098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 11/16/2022]
Abstract
This study assesses the use of postcranial elements for sex estimation taking population variability into account. European American and Latin American populations are independently analyzed. Nine measurements from postcranial elements were collected from 72 European American individuals, and 59 Latin American individuals. Statistical analyses were performed using the Statistical Package for Social Science (SPSS) version 15. Statistical analyses were conducted to corroborate that there were no intra- or interobserver errors. In both populations, significant differences were found on all measured traits between males and females, except Scapular Breadth in Latin Americans. According to Discriminant Function Analysis (DFA) in the European American population the Ulna Minimum Breadth of the Olecranon (UMBO) correctly classified 91.3% of individuals. When this parameter was combined with the Diameter of Humeral Head (HHD), the two correctly classified 98% of individuals. In Latin Americans, the UMBO correctly classified 82.4% of the individuals. When combined with HHD, the measurements correctly classified 79.4% individuals. UMBO is the most useful trait to correctly assign the sex of the remains in both populations. Including the HHD improved accuracy rates in the European American sample. These results are in agreement with previous studies, which named the humerus as one of the potentially useful bones to consider for sex estimation based on its accuracy. Thus, these two anatomical regions could be used alone or in combination with other methodologies for sex estimation, which is particularly important in situations of fragmentary remains and incomplete skeletons.
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Affiliation(s)
- Sara C Zapico
- International Forensic Research Institute, Florida International University, Miami, FL, United States; Department of Anthropology, National Museum of Natural History, Smithsonian Institution, Washington, DC, United States.
| | - Joe Adserias-Garriga
- Department of Applied Forensic Sciences, Mercyhurst University, Erie, PA, United States
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Abe K, Kimura H, Yamamoto N, Shimozaki S, Higuchi T, Taniguchi Y, Uto T, Tsuchiya H. Treatment strategy for atypical ulnar fracture due to severely suppressed bone turnover caused by long-term bisphosphonate therapy: a case report and literature review. BMC Musculoskelet Disord 2020; 21:802. [PMID: 33272231 PMCID: PMC7712635 DOI: 10.1186/s12891-020-03824-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atypical fractures may occur due to the combined effect of severely suppressed bone turnover (SSBT) caused by long-term bisphosphonate treatment and chronic repetitive bone microdamage. Atypical fracture of the ulna due to SSBT is a rare entity; there is no standardized treatment strategy for this condition. We successfully treated a patient with atypical fracture of the ulna. Herein, we present this patient, review the relevant literature, and discuss the treatment strategy. CASE PRESENTATION An 84-year-old woman presented with atypical fracture of the left ulnar shaft due to SSBT. She had a history of bisphosphonate therapy (ibandronate and alendronate) since more than 10 years; her bone turnover was severely suppressed. We performed open reduction and internal fixation (ORIF) using dual plate with some additional treatments. These included drilling and decortication, use of autogenous bone graft, low-intensity pulsed ultrasound (LIPUS) treatment, and administration of teriparatide. Finally, bone union was observed at 11 months after surgery. CONCLUSIONS Based on the literature review and our experience with this case, ORIF alone may not be adequate to achieve bone union; drilling, decortication, and use of cancellus bone graft is important to achieve favorable outcomes. Administration of teriparatide and LIPUS may facilitate early bone union, although further studies are required to provide more definitive evidence. Furthermore, ORIF using dual plate may help avoid implant failure owing to the long time required for bone union.
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Affiliation(s)
- Kensaku Abe
- Department of Orthopaedic Surgery, Japanese Red Cross Kanazawa Hospital, 2-251 Minma, Kanazawa, 921-8162, Japan
| | - Hiroaki Kimura
- Department of Orthopaedic Surgery, Japanese Red Cross Kanazawa Hospital, 2-251 Minma, Kanazawa, 921-8162, Japan.
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Shingo Shimozaki
- Department of Orthopaedic Surgery, Japanese Red Cross Kanazawa Hospital, 2-251 Minma, Kanazawa, 921-8162, Japan
| | - Takashi Higuchi
- Department of Orthopaedic Surgery, Japanese Red Cross Kanazawa Hospital, 2-251 Minma, Kanazawa, 921-8162, Japan
| | - Yuta Taniguchi
- Department of Orthopaedic Surgery, Japanese Red Cross Kanazawa Hospital, 2-251 Minma, Kanazawa, 921-8162, Japan
| | - Takaaki Uto
- Department of Orthopaedic Surgery, Japanese Red Cross Kanazawa Hospital, 2-251 Minma, Kanazawa, 921-8162, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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Bidmos MA, Mazengenya P. Accuracies of discriminant function equations for sex estimation using long bones of upper extremities. Int J Legal Med 2021; 135:1095-102. [PMID: 33179172 DOI: 10.1007/s00414-020-02458-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/05/2020] [Indexed: 10/23/2022]
Abstract
One of the scopes of practice of forensic anthropologists is the estimation of sex from skeletal remains. As a result, population-specific discriminant function equations have been developed from measurements of various bones of the human skeletons. Steyn, Patriquin (Forensic Sci Int 191 (1-3):113, 2009) noted that the lack of skeletal collections and data from most parts of the world has made this process impractical. Previous attempts to develop global discriminant function equations from measurements of the pelvis showed that population-specific equations are not necessary as equations derived from other populations yielded high sex estimation scores when applied to a different population. However, information on the suitability and applicability of generalised equations in sex estimation using long bones is still scarce. It is, therefore, the aim of this study to assess the accuracies of population-specific discriminant function equations derived from measurements of long bones of the upper limb of South African population groups. Data analysed in the current study were obtained from Mokoena, Billings, Bidmos, Mazengenya (Forensic Sci Int 278:404, 2017) and Mokoena, Billings, Gibbon, Bidmos, Mazengenya (Science & Justice 6(59):660-666, 2019) in which a total sample of 988 bones (humeri, radii, and ulnae) of South Africans of African descent (SAAD), South Africans of European descent (SAED) and Mixed Ancestry South Africans (MASA) were measured. Stepwise and direct discriminant function analyses were performed on the pooled data. Each function was used to estimate the sex of cases in each population group separately and average accuracies calculated. Thereafter, population-specific discriminant function equations were formulated for each population group and then applied to other population groups. The average accuracies of functions for pooled data ranged between 80.7 and 86.5%. The cross-validation average accuracies remained unchanged for most functions, confirming the validity of derived functions. A drop in average accuracies (0.8-5.3%) was observed when the functions were tested on a sample of SAAD while increased average accuracy was observed for the SAED and MASA (0.5-6.9%). When population-specific functions for a particular population group were applied to other groups, a wide range of a drop in average accuracies was observed (1.3 to 22.4%). This thereby confirms that population-specific equations should not be applied to other population groups. However, discriminant function equations from the pooled data of South Africans are accurate in the estimation of sex and efforts should be made towards the development and validation of such equations from as many bones of the human skeleton.
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Myrick KM, Myrick SA, Ezomo O. Ulnar stress fracture in a softball player. Clin Case Rep 2020; 8:1547-1552. [PMID: 32884793 PMCID: PMC7455444 DOI: 10.1002/ccr3.2933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/03/2020] [Accepted: 04/15/2020] [Indexed: 11/08/2022] Open
Abstract
Clinicians need to have a high index of suspicion in overhead athlete with persistent pain. MRI and bone scans are more sensitive than X-rays in detecting ulnar stress fractures. Increased awareness will improve diagnosis and patient outcomes.
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Affiliation(s)
- Karen M. Myrick
- School of Interdisciplinary Health and ScienceQuinnipiac University School of MedicineUniversity of Saint JosephWest HartfordCTUSA
- Quinnipiac University School of MedicineNorth HavenCTUSA
| | | | - Olohiere Ezomo
- Quinnipiac University School of MedicineNorth HavenCTUSA
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Abstract
OBJECTIVE To compare clinical effects of common Kirschner wire, anatomical plate and perforated Kirschner wire in treating olecranon fracture. METHODS From March 2014 to May 2017, clinical data of 79 patients with olecranon fracture treated with different internal fixation was retrospectively analyzed. Among them, 26 patients treated with common Kirschner wire (group A), including 19 males and 7 females aged from 23 to 51 years old with an average of (37.2±9.6) years old;11 patients were typeⅠ, and 15 patients were typeⅡ according to Mayo classification. Twenty eight patients were treated with olecroanon anatomical plate internal fixation, including 16 males and 12 females aged from 25 to 52 years old with an average of (36.6±8.9) years old;10 patientswere typeⅠ and 18 patients were typeⅡ according to Mayo classification. Twenty five patients were treated with perforated Kirschner wire, including 13 males and 12 females aged from 26 to 51 years old with an average of (38.2±9.2) years old;9 patients were typeⅠand 16 patients were typeⅡ according to Mayo classification. Operation time, intraoperatve blood loss, fracture healing time and postoperative complications among three groups were compared; VAS score at 1 week after operation was used to evaluate pain relief, Broberg-Morrey function score of elbow joint at the final follow up was applied to evaluate clinical effect. RESULTS Seventy nine patients were followed up from 13 to 23 months with an average of (18.3±4.5) months. Operation time, intraoperatve blood loss, fracture healing time in group A were (82.9±19.7) min, (113.5±32.3) ml, (4.2±0.6) months respectively;in group B were(101.2±24.5) min, (150.2±39.5) ml, (4.6±0.8) months respectively;in group C were (83.3±18.7) min, (119.3±34.3) ml, (4.1±0.5) months respectively. Operation time, intraoperatve blood loss, fracture healing time in group A and group C were better than that of group B(P<0.05). Five patients in group A occurred ineffective internal fixation, other groups did not occurred;9 patients in group A occurred skin irritability, 3 patients in group B and no patient occurred in group C; there were statistical differences in complications among three groups (P<0.05). There were no differences in VAS score at 1 week after operation and Broberg-Morrey function score of elbow joint at the final follow-up among three groups (P>0.05). CONCLUSION Common Kirschner wire has more complications; anatomical plate has greater surgical trauma and long fracture healing time;while perforated Kirschner wire was not only benefit for fracture union with less trauma, but also could reducing the incidence of postoperative complications, and it is the appropriate method for patients with olecranon fracture.
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Affiliation(s)
- Jun Zhang
- Department of Orthopaedics, Wenzhou Traditional Chinese and Western Medicine Hospital, Wenzhou 325000, Zhejiang, China
| | - Ding-Shuang Chen
- Department of Orthopaedics, Wenzhou Traditional Chinese and Western Medicine Hospital, Wenzhou 325000, Zhejiang, China
| | - Dong-Xu Liu
- Department of Orthopaedics, Wenzhou Traditional Chinese and Western Medicine Hospital, Wenzhou 325000, Zhejiang, China
| | - Feng Li
- Department of Orthopaedics, Wenzhou Traditional Chinese and Western Medicine Hospital, Wenzhou 325000, Zhejiang, China
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De Vitis R, Passiatore M, Cilli V, Maffeis J, Milano G, Taccardo G. Intramedullary nailing for treatment of forearm non-union: Is it useful? - A case series. J Orthop 2020; 20:97-104. [PMID: 32025132 PMCID: PMC6997666 DOI: 10.1016/j.jor.2020.01.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Intramedullary osteosynthesis is often considered a second-order method for treatment of forearm non-union. METHODS We evaluated clinical and functional results from 49 patients affected by radio and/or ulna non-union treated using intramedullary nailing, with possible tricortical autologous bone grafting. Healing rate (primary outcome), healing time and functional status have been assessed. RESULTS Healing was observed in 46 cases (93.9%), the average healing time was 6.3 (SD ± 2.5) months. Excellent result (Anderson score) was reached in 38 cases (77.6%), satisfactory in 7 cases (14.3%). CONCLUSIONS Forearm non-unions represent a therapeutic challenge. Intramedullary nailing is a successful option of treatment.
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Affiliation(s)
- Rocco De Vitis
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
- Istituto di Clinica Ortopedica, Italy
| | - Marco Passiatore
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Istituto di Clinica Ortopedica, Italy
| | - Vitale Cilli
- Centre Hôpitalier de la Haute Senne, Soignies, Belgium
| | | | | | - Giuseppe Taccardo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
- Istituto di Clinica Ortopedica, Italy
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Mumtaz H, Dallas M, Begonia M, Lara-Castillo N, Scott JM, Johnson ML, Ganesh T. Age-related and sex-specific effects on architectural properties and biomechanical response of the C57BL/6N mouse femur, tibia and ulna. Bone Rep 2020; 12:100266. [PMID: 32420415 PMCID: PMC7215114 DOI: 10.1016/j.bonr.2020.100266] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 12/22/2022] Open
Abstract
Aging is known to reduce bone quality and bone strength. We sought to determine how aging affects the biomechanical and architectural properties of various long bones, and if sex influences age related differences/changes. While researchers have extensively studied these changes in individual bones of mice, there is no comprehensive study of the changes in the bones from the same mice to study the changes with aging. We performed three point bending tests and microcomputed tomography (microCT) analysis on femurs, tibiae and ulnae. Three point bending tests were utilized to calculate biomechanical parameters and imaging was also performed using high resolution microCT to reveal both cortical and trabecular microarchitecture C57BL/6N mice were divided into three age groups: 6, 12 and 22 months. Each age and sex group consisted of 6–7 mice. The ultimate load to failure (UL), elastic stiffness (ES), modulus of elasticity (E) and the moment of inertia about bending axis (MOI) for each bone was calculated using three point bending test. MicroCT scans of all the bones were analyzed to determine cortical bone volume per tissue volume (C.BV/TV), trabecular bone volume per tissue volume (Tb.BV/TV), cortical bone area (B.Ar) using CTAn's microCT analysis and tested for correlation with the biomechanical parameters. Mean (standard error) values of UL in femur decreased from 19.8(0.6) N to 12.8(1.1) N (p < .01) and 17.9(0.6) N to 14.6(1.0) N (p = .02) from 6 to 22 months groups in males and females respectively. Similarly, UL in tibia decreased from 19.8(0.5) N to 14.3(0.2) N (p < .01) and 14.4(0.6) N to 9.5(1.0) N (p < .01) from 6 to 22 months group in males and females respectively. ES in femur decreased from 113.2(7) N/mm to 69.6(6.7) N/mm (p < .01) from 6 to 22 months in males only. ES in tibia decreased from 78.6(3.2) N/mm to 65.0(2.3) N/mm (p = .01) and 53.1(2.9) N/mm to 44.0(1.7) N/mm (p = .02) from 6 to 22 months in males and females respectively. Interestingly, ES in ulna increased from 8.2(0.8) N/mm to 10.9(1.0) N/mm (p = .051) from 6 to 22 months of age in females only. E in femur decreased from 4.0(0.4) GPa to 2.8(0.2) GPa (p = .01) and 6.7(0.5) GPa to 4.5(0.4) GPa (p = .01) from 6 to 22 months of age in males and females respectively while tibia showed no change. However, E in ulna increased from 7.0(0.8) GPa to 11.0(1.1) GPa (p = .01) from 6 to 22 months of age in females only. Changes in age and sex-related bone properties were more pronounced in the femur and tibia, while the ulna showed fewer overall differences. Most of the changes were observed in biomechanical compared to architectural properties and female bones are more severely affected by aging. In conclusion, our data demonstrate that care must be taken to describe bone site and sex-specific, rather than making broad generalizations when describing age-related changes on the biomechanical and architectural properties of the skeleton. Assess age/gender related biomechanical property changes in femur, tibiae and ulnae. C57Bl/6 mice were divided into three age groups: 6, 12 and 22 months. Significant decline in the biomechanical response of femurs and tibiae at the age of 22 months. Ulnae showed some improved properties with aging. Aging affected biomechanical rather than microCT properties and female bones
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Affiliation(s)
- Hammad Mumtaz
- University of Missouri-Kansas City, Department of Civil and Mechanical Engineering, 350K Robert H. Flarsheim Hall, 5110 Rockhill Road, Kansas City, MO 64110, USA
| | - Mark Dallas
- University of Missouri-Kansas City, School of Dentistry, Department of Oral and Craniofacial Sciences, Room 3143, 650 E 25th Street, Kansas City, MO 64108, USA
| | - Mark Begonia
- Virginia Polytechnic Institute and State University, Biomedical Engineering and Mechanics, 343 Kelly Hall, 325 Stanger Street MC 0298, Blacksburg, VA 24061, USA
| | - Nuria Lara-Castillo
- University of Missouri-Kansas City, School of Dentistry, Department of Oral and Craniofacial Sciences, Room 3143, 650 E 25th Street, Kansas City, MO 64108, USA
| | - JoAnna M Scott
- University of Missouri-Kansas City, Office of Research and Graduate Programs, Kansas City, MO 64108, USA
| | - Mark L Johnson
- University of Missouri-Kansas City, School of Dentistry, Department of Oral and Craniofacial Sciences, Room 3143, 650 E 25th Street, Kansas City, MO 64108, USA
| | - Thiagarajan Ganesh
- University of Missouri-Kansas City, Department of Civil and Mechanical Engineering, 350K Robert H. Flarsheim Hall, 5110 Rockhill Road, Kansas City, MO 64110, USA
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Abstract
The purpose of this study was to compare double-handed backhand kinematics of the non-dominant wrist of tennis players using either an eastern or continental grip position with the non-dominant hand. Trajectory data were captured using sixty reflective markers on sixteen sub-elite right-handed tennis players using a 12-camera VICON motion capture system (250 Hz). Participants executed double-handed backhands using two non-dominant grip positions (Eastern [E] and Continental [C]), aiming for two crosscourt zones (Deep [D] and Short [S]), totalling to four conditions (ED, CD, ES and CS). Three successful attempts from each condition were selected for analysis. The eastern grip demonstrated faster horizontal racket head velocity compared to the continental grip. However, no differences were observed in accuracy or spin rate between grips (p > 0.05). In the non-dominant upper limb, elbow flexion was smaller in the continental condition throughout the swing, whilst wrist extension and ulnar deviation was larger. Collectively, these data suggest that the continental grip may place the wrist in a position vulnerable to overuse injury. Future research into the kinetics of the double-handed backhand would help better understand the onset of ulnar-side wrist pain in tennis.
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Affiliation(s)
- Nicholas A Busuttil
- School of Allied Health, Human Services, and Sport, La Trobe University, Melbourne, Australia
| | - Machar Reid
- Game Insight Group, Tennis Australia, Melbourne, Australia
| | - Molly Connolly
- Game Insight Group, Tennis Australia, Melbourne, Australia.,Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Ben J Dascombe
- Applied Sport Science and Exercise Testing Laboratory, School of Life and Environmental Sciences, University of Newcastle, Ourimbah, Australia
| | - Kane J Middleton
- School of Allied Health, Human Services, and Sport, La Trobe University, Melbourne, Australia
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Abstract
Distal ulnar fractures are commonly accompanied by distal radial fractures, and several treatment options such as plate osteosynthesis and pinning with Kirschner's wires are used. In this study, we present a technique using headless compression screws to achieve bony union of distal ulnar fractures. From November 2016 to November 2018, we treated 11 patients with distal ulnar fractures combined with distal radial fractures with headless compression screws (DePuy Synthes). Patients were instructed to maintain a short-arm splint for less than two weeks after the treatment. The mean time to bony union was 6.5 weeks, mean Quick Disabilities of the Arm, Shoulder, and Hand score was 14.6 points, and mean visual analog scale score was 1.09 points. Full range of motion was possible in all directions after surgery and no specific complications were observed. The suggested technique allows minimal incision and minimally invasive intramedullary fixation and can promote bony union in a simple way without specific complications.
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Affiliation(s)
- Jin Rok Oh
- Department of Orthopedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jisu Park
- Department of Orthopedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
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Okuda A, Shigematsu H, Fujii H, Iwata E, Tanaka M, Morimoto Y, Masuda K, Yamamoto Y, Tanaka Y. Reliability Comparison between "Distal Radius and Ulna" and "Simplified Tanner-Whitehouse III" Assessments for Patients with Adolescent Idiopathic Scoliosis. Asian Spine J 2020; 14:280-286. [PMID: 31992028 PMCID: PMC7280927 DOI: 10.31616/asj.2019.0162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/19/2019] [Indexed: 11/23/2022] Open
Abstract
Study Design This is a retrospective clinical study. Purpose In this study, we aim to evaluate the reliability of the distal radius and ulna assessment (DRU) and simplified Tanner-Whitehouse III classification (sTW3) in Japanese patients with adolescent idiopathic scoliosis (AIS). Overview of Literature The greatest curvature of a scoliotic spine occurs at peak-height velocity (PHV), which is the time during which an individual’s height increases at the maximum rate. Diagnosing and appropriately treating AIS before PHV is the most effective way in order to prevent unnecessary deterioration of the scoliosis curve. Although it is difficult to detect scoliosis before PHV, DRU and sTW3, which involve evaluations using a left-hand radiograph, have been reported to be effective. Methods We retrospectively evaluated 54 hands of 40 girls with AIS who visited Nara Medical University Hospital from 2000 to 2015 using previously collected radiographs. The examiners included a spine surgeon and a pediatric orthopedic surgeon, each with over 10 years of experience. The reliability of the DRU and sTW3 was evaluated using the kappa coefficient. Results The left-hand radiographs of 40 female patients with AIS (mean age, 13.9±1.7 years; N=54 hands) were evaluated by two blinded examiners using the sTW3 and DRU methods. The highest inter-observer and intra-observer reliabilities (kappa, 0.64 and 0.62, respectively) for radius evaluation were determined. Radius evaluation by the DRU showed the highest agreement rate and smallest error between the inter- and intra-observer examinations. Conclusions The DRU was the most reliable assessment tool, and it has the potential to be useful for precisely determining the stage of skeletal maturity in outpatient clinics.
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Affiliation(s)
- Akinori Okuda
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Hideki Shigematsu
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Hiromasa Fujii
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Eiichiro Iwata
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Masato Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Yasuhiko Morimoto
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Keisuke Masuda
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Yusuke Yamamoto
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
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Kumar S, Jain VK, Prabhakar R. Melorheostosis of upper limb: A report of four rare cases. J Clin Orthop Trauma 2020; 11:321-323. [PMID: 32099304 PMCID: PMC7026615 DOI: 10.1016/j.jcot.2019.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/09/2019] [Accepted: 06/10/2019] [Indexed: 11/16/2022] Open
Abstract
Melorheostosis is a rare chronic bone disease, etiology of which remains unclear. It mostly affects lower limbs and clinical features vary in each case. Radiographs show characteristic "candle wax pattern" of hyperostosis. Herein we report four cases of upper limb affection with their symptoms, radiographic findings and treatment. First case presented with gradually progressive swelling in forearm which was initially misdiagnosed as filariasis. Plain radiograph eventually demonstrated melorheostosis of ulna. Second patient had deformity of index finger and pain in hand which was diagnosed on radiograph of hand. Third case presented with progressive flexion deformity of ring and little finger. Fourth patient had ulnar involvement which was an incidental diagnosis. First three patients were managed with bisphosphonates following which there was significant improvement in pain and fourth case was kept on follow-up as he was asymptomatic.
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Abstract
Minimally invasive plate osteosynthesis (MIPO) is a biologically friendly approach to fracture reduction and stabilization that is applicable to many radius and ulna fractures in small animals. An appropriate knowledge of the anatomy of the antebrachium and careful preoperative planning are essential. This article describes the MIPO technique, which entails stabilization of the fractured radius with a bone plate and screws that are applied without performing an extensive open surgical approach. This technique results in good outcomes, including a rapid time to union and return of function.
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Affiliation(s)
- Caleb C Hudson
- Gulf Coast Veterinary Specialists, 8042 Katy Fwy, Houston, TX 77024, USA.
| | - Daniel D Lewis
- Small Animal Surgery, Canine Sports Medicine and Comparative Orthopedics, Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 Southwest 16th Avenue, PO Box 100126, Gainesville, FL 32610-0126, USA
| | - Antonio Pozzi
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Zurich CH-8057, Switzerland
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Abstract
Ligamentous stability and joint congruity are prerequisites for a physiological function of the distal radioulnar joint (DRUJ). Impingement of the ulnar head may be caused by a congenital ulna-minus variance or by an iatrogenically excessive ulna shortening osteotomy. This impingement is detected by a positive compression test at the DRUJ. Radius correction osteotomy with shortening and correction of the radial inclination to restore the sigmoid notch may solve the problem by reducing the pressure between both joint partners and by promoting the remodelling of the DRUJ. This technique may restore the distal radioulnar joint and thus prevent the necessity of salvage procedures.
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Affiliation(s)
- H Krimmer
- Zentrum für Handchirurgie, St. Elisabeth Klinikum Ravensburg, Elisabethenstraße 15, 88212, Ravensburg, Deutschland.
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Abstract
OBJECTIVE The aim of the procedure is to visualize the proximal pouch of the DRUJ, the joint surfaces of the sigmoid notch and the ulnar head, the convexity of the ulnar head and the proximal ulnar side surface of the triangular fibrocartilage complex (TFCC). INDICATIONS Arthroscopy of the distal radioulnar joint is applied for the evaluation of joint pathologies in ulnar-sided wrist pain, especially in cases without diagnostic findings in standard X‑rays and MRIs and arthroscopically assisted procedures. SURGICAL TECHNIQUE In vertical extension, two portals of the wrist are created on the dorsal side of the DRUJ between the extensor digiti minimi and extensor carpi ulnaris tendons. By insertion of a small joint arthroscope via these portals visualization of the ulnar head, the sigmoid notch, the proximal pouch of the DRUJ and the proximal surface of the TFCC is accomplished. CONCLUSIONS Arthroscopy of the DRUJ is a rarely and not routinely performed procedure for the diagnosis and therapy of ulnar-sided wrist pain. It is technical demanding with a flat learning curve and anatomy-related obstacles. A complete view of the joint is not always accessible. Rare complications are injuries of the extensor digiti minimi tendon, as well as contusion or sectioning of the transverse branch of the dorsal branch of the ulnar nerve. In distinct cases, this procedure offers important additional information about the distal radioulnar joint. The procedure is especially valuable for the detection of proximal TFCC injuries that are missed otherwise.
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Affiliation(s)
- T Pillukat
- Klinik für Handchirurgie, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland.
| | - M Mühldorfer-Fodor
- Klinik für Handchirurgie, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland
| | - J Windolf
- Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - J van Schoonhoven
- Klinik für Handchirurgie, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland
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Abstract
BACKGROUND The triangular fibrocartilage complex (TFCC) widens the radiocarpal joint and takes part in load transmission from the carpus to the forearm. It is thereby prone to degenerative changes. The painful situation that can accompany degeneration is called ulnar impaction. DIAGNOSIS Clinical examination helps differentiate between various causes of ulnar-sided wrist pain. Standard X‑rays are needed to determine ulnar variance and stress radiographs can depict narrowing of the ulnocarpal joint space under load. MRI may prove degeneration of the TFCC itself or may indirectly confirm ulnar impaction in the presence of bone marrow edema in the ulnar head or at the proximal ulnar aspect of the lunate. TREATMENT If conservative treatment fails to alleviate symptoms, arthroscopy may be indicated. On the one hand, this completes the diagnostic cascade, and, on the other hand, allows decompression of the ulnocarpal joint space by resection of the TFCC with partial resection of the ulnar head (wafer resection). In the case of ongoing pain, ulnar shortening sufficiently alleviates ulnar-sided wrist pain. Thereby, modern standardized operation techniques are safe enough to ensure bone healing at the osteotomy site. The aim of alleviating ulnar-sided wrist pain is mostly achieved if the correct treatment option is chosen.
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Affiliation(s)
- S Löw
- Praxis für Handchirurgie und Unfallchirurgie, Wolfgangstraße 2, 97980, Bad Mergentheim, Deutschland.
| | - C K Spies
- Abteilung Handchirurgie, Vulpius-Klinik, Bad Rappenau, Deutschland
| | - F Unglaub
- Abteilung Handchirurgie, Vulpius-Klinik, Bad Rappenau, Deutschland.,Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland
| | - J Oppermann
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - M Langer
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - H Erne
- Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
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Blossey RD, Krettek C, Liodakis E. [Posttraumatic torsional deformities of the forearm : Methods of measurement and decision guidelines for correction]. Unfallchirurg 2018; 121:206-15. [PMID: 29392339 DOI: 10.1007/s00113-018-0457-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Forearm fractures are common in all age groups. Even if the adjacent joints are not directly involved, these fractures have an intra-articular character. One of the most common complications of these injuries is a painful limitation of the range of motion and especially of pronation and supination. This is often due to an underdiagnosed torsional deformity; however, in recent years new methods have been developed to make these torsional differences visible and quantifiable through the use of sectional imaging. The principle of measurement corresponds to that of the torsion measurement of the lower limbs. Computed tomography (CT) or magnetic resonance imaging (MRI) scans are created at defined heights. By searching for certain landmarks, torsional angles are measured in relation to a defined reference line. A new alternative is the use of 3D reformation models. The presence of a torsional deformity, especial of the radius, leads to an impairment of the pronation and supination of the forearm. In the presence of torsional deformities, radiological measurements can help to decide if an operation is needed or not. Unlike the lower limbs, there are still no uniform cut-off values as to when a correction is indicated. Decisions must be made together with the patient by taking the clinical and radiological results into account.
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