Hemangioma of bone arising in the ulna: imaging findings with emphasis on MR

An 18-year-old woman presented with left elbow joint pain. Radiographs and computed tomographic scan showed a well-defined osteolytic lesion of the left ulna associated with a honeycomb appearance on the radiographs. Magnetic resonance images showed intermediate signal intensity on T1-weighted images and mixed intermediate and high signal intensities on T2-weighted images. Only the periphery of the lesion enhanced with intravenously injected gadolinium-diethylenetriamine pentaacetic acid. The lesion was curetted to avoid pathologic fracture, and a histologic diagnosis of cavernous hemangioma of bone was made. Hemangioma involving the ulna is rare, but should be included in the differential diagnosis of a radiographic osteolytic lesion with a honeycomb appearance. Received: 17 September 1999 Revision requested: 31 October 1999 Revision received: 10 December 1999 Accepted: 13 December 1999     

An inception cohort analysis to predict nonunion in tibia and 17 other fracture locations

IntroductionThe epidemiology of fracture nonunion has been characterized so it is potentially possible to predict nonunion using patient-related risk factors. However, prediction models are currently too cumbersome to be useful. We test a hypothesis that nonunion can be predicted with ≤10 variables, retaining the predictive accuracy of a full model with 42 variables.MethodsWe sought to predict nonunion with prospectively-acquired inception cohort data for 18 different bones, using the smallest possible number of variables that did not substantially decrease prediction accuracy. An American nationwide claims database of ∼90.1 million participants was used, which included medical and drug expenses for 2011–2012. Continuous enrollment was required for 12 months after fracture, to allow sufficient time to capture a nonunion diagnosis. Health claims were evaluated for 309,330 fractures. A training dataset used a random subset of 2/3 of these fractures, while the remaining fractures formed a validation dataset. Multivariate logistic regression and stepwise logistic regression were used to identify variables predictive of nonunion. P value and the Akaike Information Criterion (AIC) were used to select variables for reduced models. Area-under-the-curve (AUC) was calculated to characterize the success of prediction.ResultsNonunion rate in 18 fracture locations averaged 4.93%. Algorithms to predict nonunion in 18 locations in the full-model validation set had average AUC = 0.680 (±0.034). In the reduced models, average validation set AUC = 0.680 (±0.033) and the average number of risk factors required for prediction was 7.6. There was agreement across training set, validation set, and reduced set; in tibia, reduced model validation AUC = 0.703, while the full-model validation AUC = 0.709. Certain risk factors were important for predicting nonunion in ≥10 bones, including open fracture, multiple fracture, osteoarthritis, surgical treatment, and use of certain medications, including anticoagulants, anticonvulsants, or analgesics.DiscussionNonunion can be predicted in 18 fracture locations using parsimonious models with <10 patient demography-related risk factors. The model reduction approach used results in simplified models that have nearly the same AUC as the full model. Reduced algorithms can predict nonunion because risk factors important in the full models remain important in the reduced models. This prognostic inception cohort study provides Level I evidence.     

儿童桡骨远端骨骺损伤致尺骨撞击征一例报告

To investigate the clinical characteristics of ulnocarpal impingement syndrome in children induced by distal radial epiphyseal injuries in long term. A retrospective analysis of one child with distal radial epiphyseal injuries combined with dislocations was performed. The child had a sore wrist at 6 years after manual reduction. The diagnosis of ulnar impingement was conifrmed according to the patient history, symptoms, physical signs and radiological examinations of bilateral wrist joints. Ulnar impingement would occur in children with distal radial epiphyseal injuries in long term. Repeated manual reduction should be avoided in children with distal radial epiphyseal injuries, in order to minimize secondary epiphyseal injuries and reduce the risk of early epiphyseal closure. Furthermore, the growth imbalance of the ulna and radius in long term would be avoided and the risk of ulnar impingement in the wrist joint would be reduced. Clinical surgeons should pay great attention to the early diagnose and treatmont which could signiifcantly lower the disability rate.     

解剖型锁定加压接骨板修复尺骨鹰嘴骨折:肘关节功能6个月随访评价

背景：尺骨鹰嘴骨折治疗不当会影响肘关节功能,为了减少并发症的发生,使肘关节功能得到良好恢复,给予尺骨鹰嘴骨折准确复位和牢固的内固定尤为重要。
　　目的：探索解剖型锁定加压接骨板修复尺骨鹰嘴骨折的效果。
　　方法：对36例尺骨鹰嘴骨折病例采用尺骨鹰嘴解剖型锁定加压接骨板行切开复位内固定治疗,评价分析术后肘关节功能恢复情况。
　　结果与结论：36例尺骨鹰嘴骨折病例采用尺骨鹰嘴解剖型锁定加压接骨板行切开复位内固定治疗,随访6个月以上,术后切口无感染及血肿等早期并发症,均一期愈合,Broberg 和 Morrey 评估优良率94%(34/36)。因此认为应用尺骨鹰嘴解剖型锁定加压接骨板内固定治疗尺骨鹰嘴骨折手术操作简便、内固定牢靠、术后可早期活动、并发症少、肘关节功能恢复良好。     

尺骨近端解剖学研究及其临床意义

目的:探讨国人尺骨近端解剖参数特点,为临床修复和重建尺骨近端及假体设计提供参考依据。方法:对30具60侧新鲜成人尸体上肢作研究,分别测量男女冠突的高度;冠突高1/2处的冠状面宽度、矢状面厚度;鹰嘴高度;尺骨鹰嘴尖到冠突尖中线位置处矢状面厚度、冠状面宽度;尺骨鹰嘴矢状面跨径;尺骨滑车切迹开口径;开角等,并根据性别对上述参数进行比较。结果:正常成人男性尺骨鹰嘴平均高度、宽度、厚度、矢状面跨径分别为9.7±1.2mm、18.5±2.6mm、14.2±1.3mm、14.3±1.6mm,冠突高度、宽度、厚度分别为18.4±0.6mm、22.5±0.8mm、8.2±0.4mm,尺骨滑车切迹开口径20.1±1.7mm;女性尺骨鹰嘴平均高度、宽度、厚度、矢状面跨径分别为8.5±0.9mm、16.7±2.4mm、12.6±1.4mm、12.5±1.8mm,冠突高度、宽度、厚度分别为16.4±0.4mm、19.8±0.6mm、6.3±0.9mm,尺骨滑车切迹开口径18.6±1.1mm。经统计学分析男性上述指标明显大于女性(P<0.05),与男性平均身高及尺骨长度比女性大有关。而开角的大小约30°,无性别差异(P>0.05),与身高及尺骨的长度无关。结论:根据正常成人尺骨近端参数特点,可为临床修复和重建尺骨鹰嘴及尺骨冠突,以及尺骨近端的假体设计提供参考依据。     

手法整复闭合穿针内固定配合外敷促愈膏治疗尺桡骨骨折

目的:观察尺桡骨骨折采用手法整复,闭合穿针内固定,配合外敷促愈膏的疗效。方法:手法整复,闭合穿针内固定配合外敷促愈膏。结果:治疗不稳定性尺桡骨骨折28例,愈后良好占88.5%。结论:此方法操作简单,创伤小,费用低,疗效好。     

三步正骨手法整复尺桡骨中下段双骨折的多中心临床研究

目的：比较观察三步正骨手法整复及髓内针内固定治疗尺桡骨中下段双骨折的疗效。方法：随机分实验组105例和对照组105例，实验组接受拔伸旋转、夹挤分离和折顶回旋三步正骨手法复位加小夹板外固定，对照组接受手术开放复位，髓内针内固定治疗。结果：随访6个月，骨折解剖对位及近解剖对位情况，对照组优于实验组；骨折愈合及功能恢复情况，实验组均优于对照组。结论：应用三步正骨手法整复尺桡骨中下段双骨折，有利于伤肢功能恢复并能减少骨折延迟愈合、不愈合的发生。     

鹰嘴窝再造治疗青少年肘关节僵直

目的　再造外伤后畸形或发育不良的尺骨鹰嘴窝。方法　行肘关节软组织松解后伸直肘关节 ,标记出尺骨鹰嘴对应的鹰嘴窝部位 ,自该处软骨近端用尖嘴咬骨钳咬除骨质后掀起软骨 ,将其下方松质骨逐步咬除 ,将软骨压下成窝状 ,至鹰嘴能合适嵌入其中 ,关节能伸直为止。结果　 9例患者经术后6个月～ 4年 (平均 3 0个月 )的随访 ,7例肘关节屈肘功能超过 0°、 -10°、-115° ,2例超过 0°、-11°、-10 0°。8例鹰嘴窝再造处未见明显异常 ,1例再造鹰嘴窝周围可见轻度骨质增生。结论　采用鹰嘴窝再造治疗青少年肘关节屈曲位僵直可获得良好关节功能