Linear fractures in the proximal ulna (a frequently missed injury)

Ten cases of linear, hairline fractures of the proximal ulna are presented. These fractures are subtle and frequently missed. However, if one appreciates the underlying mechanism for their production and knows where to look for them, there is far less chance that they will be missed. These fractures can occur alone or in association with other fractures around the elbow, but it is in their isolated form that they are most likely to be missed.     

山东地区健康中老年人桡、尺骨骨矿含量的调查

测定了山东地区１６８２名健康中老年人左侧桡、尺骨的骨矿含量（ＢＭＣ），男性峰值骨量在４０～４９岁年龄组，女性在３０～３９岁年龄组；男、女ＢＭＣ均随年龄增长而逐渐降低，女性下降的程度高于男性且与绝经年限密切相关；ＢＭＣ还与职业、吸烟、饮酒、运动有关，骨质疏松症患病率男为１５．２％，女为２４．８％。     

倒凹形旋转截骨术治疗先天性尺桡骨近端联结

先天性尺桡骨近端骨性联结(congenital radioulnar synostosia)是一种少见的先天性畸形，主要是尺骨和桡骨近端发生骨性联结，使前臂固定在不同角度的旋前位。尺桡骨近端截骨术是目前公认的较好的治疗方法之一，自1987年以来，在传统截骨方法的基础上加以改良，采用倒凹形旋转截骨术治疗先天性尺桡骨近端骨性联结9例，效果良好，现报告如下。     

超薄钢片置入治疗创伤性尺桡骨融合

目的：置入超薄钢片，防止尺桡骨间骨桥再次形成，改善患者前臂旋转功能。方法：本组共５例创伤后尺桡骨骨性融合病例，切除骨桥后将超薄钢片置入尺桡骨间，防止再次发生尺桡骨融合，以改善患者前臂旋转功能。结果：本组患者随访时间为１８个月～４年，取得了良好效果。前臂旋转功能得到改善：旋前角度改善２５°～４０°，平均３０°；旋后角度改善３０°～６０°，平均４０°。超薄钢片在体内未发现有不良反应。结论：在切除骨桥位置置入超薄钢片，防止了骨桥再次形成，前臂旋转功能得到了改善。超薄钢片在人体内生物相容性好，无不良反应。     

Importance of measurement methods and demographic characteristics in evaluating ulnar variance: A retrospective comparative study

ObjectiveThis study aimed to compare 2 methods of ulnar variance (UV) measurement (the perpendicular method and the circular method) and to determine whether UV changed based on the demographic characteristics (sex and age).MethodsUV was measured on bilateral wrist radiographs of 124 patients (62 men, 62 women; mean age=48.5 years; range=18–79 years) who had no history of trauma, congenital wrist anomaly, previous wrist surgery, and wrist osteoarthritis by a single radiologist with 4 years of experience. All measurements were made on standardized radiographic images using 2 methods: the perpendicular method and the circular method. All the patients were then divided into groups based on sex and age, and the study population was determined by selecting a similar number of patients for each sex and age group.ResultsThe mean UV of the right and left wrists was measured as 0.33 (range=−4.3 to 5.7) mm by the perpendicular method and as 0.034 (range=−5 to 5.7) mm by the circular method. A significant difference was determined between the 2 measurement methods (p<0.001). There was a statistically significant difference between sex and UV values in the left wrist measurements by both methods (p<0.05). A significant correlation was found between the UV and age in both right and left side measurements, indicating a statistically significant difference between the methods (p<0.001).ConclusionThe results of our study demonstrated significant differences in the UV measurement between the 2 methods. Furthermore, UV measurement may change based on age and sex. These differences should be considered in the treatment planning of patients with wrist disorders.Level of EvidenceLevel IV, Therapeutic Study     

闭合折顶整复手法结合夹板固定治疗儿童尺桡骨远端双骨折

目的:探讨闭合折顶整复手法结合杉树皮外固定夹板治疗儿童尺桡骨远端双骨折的手法操作及其临床疗效。方法:自2017年1月至2019年12月,采用闭合折顶整复手法治疗儿童尺桡骨远端双骨折患者17例,男13例,女4例;年龄4~11(7.29±2.34)岁。整复后予以杉树皮夹板固定并随访6个月,根据末次随访复查的X线片评价骨折整复的对线对位,采用Anderson前臂功能评定标准评价患肢功能。结果:17例患儿中15例1次复位成功,2例再次复位成功,固定时间(25.00±3.35)d。随访6个月时,根据Anderson疗效评定标准,优12例,良3例,可2例,差0例。对位对线:所有病例对位>3/4,其中解剖复位10例,对线<10°者4例,对线<15°者3例。未出现骨折移位、不愈合、骨筋膜室综合征、前臂旋转功能障碍等并发症。结论:闭合折顶整复手法结合夹板固定手法复位儿童尺桡骨远端双骨折复位成功率高,并发症少,降低术者操作难度同时减轻患者痛苦。     

改良尺骨鹰嘴截骨治疗肱骨髁间骨折

目的:探讨改良尺骨鹰嘴截骨治疗肱骨髁间骨折的手术方法和疗效。方法:2007年5月至2012年12月采取改良尺骨鹰嘴截骨入路治疗肱骨髁间骨折32例,男21例,女11例;年龄18~65岁,平均46.3岁;右侧19例,左侧13例。AO分型,C1型7例,C2型11例,C3型14例;开放性骨折5例(GustiloⅠ型3例,GustiloⅡ型2例)。6例合并其他处骨折,4例合并尺神经损伤,2例合并桡神经损伤。术后定期复查及X线检查,按Cassebaum评分系统评定肘关节功能。结果:32例均获随访,时间9个月~5年,平均1.9年;截骨块愈合时间6~10周,平均7.4周。未发生尺骨鹰嘴关节内骨折,无截骨块不愈合。2例肘后内固定隆起处屈肘轻度疼痛不适,1例骨折块松动,2例出现异位骨化。肘关节功能评定:优19例,良8例,可4例,差1例。结论:改良尺骨鹰嘴截骨治疗肱骨髁间骨折具有不侵袭关节、术中截骨简便、固定简单、截骨块力学稳定性好、截骨并发症发生率低等优点。     

A Prospective Study on the Initial Results of a Low Profile Ulna Shortening Osteotomy System

Extra-articular ulna shortening osteotomy, in principle, is an accepted treatment option for symptomatic degenerative and traumatic triangular fibrocartilage complex (TFCC) tears. Despite the benefits of this surgical approach, potential disadvantages include risk of nonunion, soft tissue irritation, and the need for future hardware removal. A recently introduced low profile ulna shortening system was designed to decrease these potential complications. A single-surgeon prospective study was performed to evaluate this system. Ten consecutive patients undergoing ulna shortening for ulnar-sided wrist pain compatible with TFCC pathology participated in the study. Subjective, objective, and radiographic assessments were performed preoperatively and up to 24 weeks postoperatively. Based on visual analog scale (VOS) ratings (0 to 10), pain scores significantly improved (p < 0.05) and average patient satisfaction was 8.7. DASH and PRWE scores improved at three month follow-up (p < 0.05). Osteotomy healing time averaged 10.3 weeks, and there were no nonunions. Average discomfort associated with palpation of the plate at final follow-up was 3.3 (using VOS), and one patient requested removal of the hardware. In this short-term follow-up study, the assessed ulna shortening system appears effective and, in general, well tolerated.     

An anomalous bifid distal ulna: A case report

INTRODUCTIONWe report a case of an osteochondroma in the form of an anomalous bifid distal ulna following mal-union of an epiphyseal injury. There has been no previous case of this reported in the medical literature.PRESENTATION OF CASEA 19-year-old man presented with wrist stiffness and complete loss of pronation and supination twelve months after having undergone open reduction and internal fixation for a volarly displaced distal radius fracture. Further investigation with a CT scan showed a bifid distal ulna. As this was not present on plain radiographs one year prior, it was proposed that this was an osteochrondromatous growth caused by injury to the distal ulnar epiphysis. An operation was performed to excise one of the distal ulna heads, and reconstruct the TFCC to allow improved rotational movements. At one year follow-up, the patient has made an almost full recovery without complication.DISCUSSIONWe postulate that the patient sustained an occult physeal injury resulting in an osteochondromatous lesion that grew towards the joint effectively forming a second ulna head.CONCLUSIONThis is a unique case of the development of a bifid distal ulna due to physeal injury one year prior. Such a lesion has not previously been described in the distal ulna.     

国产可吸收螺钉在尺骨鹰嘴骨折中的临床应用

目的 探讨国产聚-DL-乳酸可吸收螺钉治疗尺骨鹰嘴骨折的效果. 方法 1999年12月至2006年12月,对54例尺骨鹰嘴骨折分别采用国产聚-DL-乳酸可吸收螺钉(22例)和张力带钢丝(32例)同定,对两组的疗效进行对比.结果 所有患者均一期愈合,随访7～49个月(平均24.8个月).按照Weseley标准评定肘关节功能:螺钉组优良率为90.9%(20/22).无肘后疼痛及局部隆起,螺钉致上尺桡关节固定1例,术后5个月时旋转功能完全恢复.1例伴尺桡骨中段骨折者于术后2周复查X线片时发现鹰嘴骨折部内固定失效,骨折块分离移位,改行张力带钢丝固定,术后12个月复查,肘关节功能为良.张力带组优良率为93.8%(30/32),无内固定失效,肘后隆起伴活动时刺痛9例(28.1%),X线片显示克氏针退针3例(9.4%).所有患者均在手术后8～15个月内行第二次手术,取出内固定物.经非参数检验(Wilcoxon检验),两组优良率差异无统计学意义(W=845.0,P=0.485). 结论 国产聚-DL-乳酸可吸收螺钉完全能用于治疗尺骨鹰嘴横形、斜形及骨块较大且相对完整的粉碎性骨折,且效果满意.由于可吸收螺钉能完全降解,避免二次手术,在减少患者治疗时间和费用、更快恢复原有工作方面具有明显的优势.