Dorsal bridging plates for the treatment of high and low energy distal radius fractures

Distal radius fractures are common and treatment of complex fracture pattens can be challenging. We assessed functional outcomes, radiographic analysis, and complications of 26 distal radius fractures treated with dorsal bridging plate (DBP) at a mean of 14 months post plate removal (6–34 months). Radiographic parameters were measured pre- and post-operatively and patient reported wrist evaluation scores, patient reported wrist range of movement and satisfaction scores. Mean post-operative total PRWE was 26 (range 0–76) and mean wrist mobility 52° flexion (range 10°–85°) and 50° extension (range 10°–85°). Mean post-operative patient satisfaction score was 89% (range 50–100%). Four patients developed complications (one EPL rupture and three developed CRPS). DBP can reliably restore distal radius anatomy and is associated with good functional outcome scores, return of functional range of wrist movement and high levels of patient satisfaction.Level of EvidenceIII     

Corrective osteotomy is an effective method of treating distal radius malunions with good long-term functional results

IntroductionMalunion occurs in approximately 23% of non-operatively treated and 11% of operatively treated distal radius fractures. The decision whether to correct a malunion is primarily based on functional impairment and wrist pain. The purpose of this study was to assess the long-term functional outcomes of corrective osteotomies for symptomatic malunited distal radius fractures.MethodsAll consecutive corrective osteotomies of the distal radius performed in one centre between January 2009 and January 2016 were included. The primary outcome was the functional outcome assessed with the Disability of the Arm, Shoulder and Hand (DASH) and the Patient-Rated Wrist Evaluation (PRWE) score. Secondary outcomes were range of motion, grip strength, pain as indicated on the Visual Analogue Scale (VAS) before and after corrective osteotomy, radiological parameters, time to union and complications. Additionally, we aimed to determine if there were any difference in graft versus no graft usage.ResultsA total of 48 patients were included. The median age was 54.5 years (IQR 39–66) and 71% was female. The median time to follow-up was 27 months. The median DASH and PRWE score were respectively 10.0 (IQR 5.8–23.3) and 18.5. (6.5–37.0). Except for pronation and supination, range of motion and grip strength of the injured wrist were significantly less compared to the uninjured side. Palmar and dorsal flexion and radial and ulnar deviation of the injured wrist were significantly less compared with the uninjured side. VAS pain scores decreased significantly from 6.5 preoperative to 1.0 postoperative. The median time to union was 23 weeks (IQR 12–29.5). Eighteen patients (38%) had a complication for which additional treatment was required. Except for a significant difference in radial inclination and length after the corrective osteotomy in favour of graft usage, there were no significant differences between graft an no graft usage.ConclusionsCorrective osteotomy is an effective method of treating symptomatic distal radius malunions with good long-term functional results, measured with the DASH and PRWE score, and improvement in radiographic parameters and pain scores. Additionally, no differences in functional outcomes were found between graft and no graft usage.     

Outcomes of surgically treated distal radius fractures associated with triangular fibrocartilage complex injury

Study DesignProspective cohort.IntroductionClinical studies that evaluate the correlation between associated lesions of the triangular fibrocartilage complex (TFCC) and outcome of distal radius fractures expressed with the patient-rated disability are missing. The purpose of this study was to evaluate the outcomes of distal radius fractures associated with or without an injury of the TFCC.MethodsPatients undergoing operative treatment for distal radius fracture were prospectively enrolled (n = 70). TFCC was examined by wrist arthroscopy and injuries classified according to Palmer. Comparative analyses were performed on 45 patients with TFCC injury (injured group) and 25 patients with intact TFCC (intact group). The outcome measures included the Patient-Rated Wrist Evaluation (PRWE) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires, 3 and 12 months after injury.ResultsTFCC was injured in 45 patients (64%). In patients with intact TFCC, mean total PRWE score was 27 (3 months) and 16 (12 months), compared to patients with TFCC injury with 40 (at 3 months) and 24 (at 12 months). Mean DASH scores were 26 and 13 at 3 and 12 months for the intact group and 39 and 27 for the injured group. PRWE and DASH results showed significant difference at 3 and 12 months when compared with Mann–Whitney test.DiscussionPRWE and DASH scores evaluation showed that patients with associated TFCC injury had greater pain and disability at 3 and 12 months after injury.ConclusionsDisability outcomes were worse in patients with distal radius fracture, where TFCC was injured. TFCC injuries are an important cofactor affecting the outcome of distal radius fractures.     

Intra-articular corrective osteotomy for intra-articular malunion of distal radius fracture using three-dimensional surgical computer simulation and patient-matched instrument

BackgroundCorrective osteotomy of malunited intra-articular distal radius fracture is challenging. In this study, we investigated the results in patients with malunited intra-articular distal radius fracture who underwent intra-articular corrective osteotomy through an extra-articular approach using three-dimensional (3-D) computer simulation and a patient-matched instrument (PMI).MethodsWe retrospectively studied five consecutive patients with symptomatic malunited intra-articular distal radius fracture who underwent corrective osteotomy using a PMI. The maximal step-off on computed tomography and the deformity angle on plain radiographs were evaluated. The clinical examination parameters included range of motion (ROM), grip strength, pain according to visual analog scale (VAS), and Patient-Rated Wrist Evaluation (PRWE) score.ResultsThe maximal step-off was significantly reduced from 4.9 ± 1.8 to 1.0 ± 0.2 mm (p = 0.008). The absolute differences between the affected side and the normal contralateral side in radial inclination were significantly reduced from 5.4° ± 3.4°–1.2° ± 1.1° (p = 0.043). These differences were not significantly reduced postoperatively in the volar tilt and ulnar variance. VAS was significantly reduced from 4.1 ± 1.6 to 0.9 ± 0.7 cm (p = 0.006). The PRWE score significantly improved from 41.6 ± 22.0 to 15.7 ± 19.5 (p = 0.043). Grip strength was significantly increased from 54.0% ± 14.8%–85.8% ± 18.8% (p = 0.003). The preoperative and postoperative total arc of the wrist and forearm ROM were not significantly different.ConclusionsIntra-articular corrective osteotomy using PMI could be one of the reliable treatment options for intra-articular malunion. PMI has exceptionally high precision performance, and it is also anticipated to yield superior surgical results.     

Evaluation of the Korean version of the patient-rated wrist evaluation

Study designClinical measurements. Longitudinal.PurposeTo translate and cross-culturally adapt the original patient-rated wrist evaluation (PRWE) into a Korean version (K-PRWE), and to measure the reliability, validity, and responsiveness of the K-PRWE for the evaluation of distal radius fractures (DRFs).MethodsK-PRWE was developed by forward and backward translations of the PRWE and resolution of cultural discrepancies. Sixty-three DRF patients that underwent open reduction and volar plate fixation completed the K-PRWE at 3 months and 6 months postoperatively. Grip strength, wrist range of motion, VAS for wrist pain and the Korean version of DASH were performed at 3 months postoperatively. Reliability was measured by determining test-retest reliability (intraclass correlation coefficient) and internal consistency (Cronbach's alpha coefficient). Criterion and construct validity testing was performed using Spearman's correlation test. Responsiveness was evaluated using effect size (ES) and standardized response mean (SRM).ResultsCronbach's alpha coefficient and the intraclass correlation coefficient of the K-PRWE were 0.94 and 0.96, respectively, which indicated that the internal consistency of the questionnaire items was sound and reliable. The correlation coefficient between K-PRWE and K-DASH scores was 0.74 and between K-PRWE and VAS scores was 0.69. Responsiveness was good with an ES of 0.84 and an SRM of 0.89.ConclusionsThe Korean version of the PRWE was found to be reliable, valid, and responsive to evaluate the pain and disability associated with distal radius fractures.     

Functional outcome of en bloc resection and osteoarticular allograft reconstruction with locking compression plate for giant cell tumor of the distal radius

Background

Giant cell tumors of the distal radius at Campanacci grade III are particularly challenging to treat. We have treated 15 cases of giant cell tumor of the distal radius by en bloc excision and osteoarticular allograft reconstruction with locking compression plate (LCP). The purpose of this study was to assess the intermediate outcomes of all patients treated with this surgery.

Methods

From July 2002 to January 2009, we followed up 15 patients with giant cell tumors of the distal radius who were treated with en bloc excision and osteoarticular allograft reconstruction with LCPs that were long enough to approach the distal end of the allograft. All of the cases were evaluated based on clinical and radiologic examinations, the passive range of motion of the wrist joint, complications, Mayo wrist score, and short form (SF)-36.

Results

The clinical follow-up time after reconstruction averaged 5.2 years. The mean resected length of the radius was 8.1 cm. One patient had tumor recurrence in the soft tissues after 3 years (recurrence rate 6.67 %). No patient had allograft bone fracture, nonunion, or metastases. Subchondral bone alterations and joint narrowing were present in all cases, with 1 patient suffering from the pain, but the pain could be endured without the need for analgesics. The average range of motion of the wrist was 46.7° of dorsiflexion, 33.3° of volar flexion, 61.3° of supination, and 72.3° of pronation. The mean Mayo wrist score was 70 and the mean modified SF-36 score was 71.

Conclusions

En bloc excision and osteoarticular allograft reconstruction with an appropriate LCP for a Campanacci grade III giant cell tumor of the distal radius result in a reasonable functional outcome at intermediate follow-up evaluation. This method can excise the tumor integrally with a low rate of recurrence, good function, and a satisfactory range of motion.     

Extended intralesional curettage preferred over resection–arthrodesis for giant cell tumour of the distal radius

Background

Distal radius giant cell tumour (GCT) is known to be associated with distinct management difficulties, including high rates of local recurrence and lung metastases compared to other anatomic locations. Multiple treatment options exist, each with different outcomes and complications.

Questions/purposes

To compare oncological and functional outcomes and complications following treatment of patients with distal radius GCT by extended intralesional curettage (EIC) or resection–arthrodesis.

Methods

Patients operated on for distal radius GCT were identified from prospectively collected databases at four Canadian musculoskeletal oncology specialty centres. There were 57 patients with a mean age of 35.4 years (range 17–57). Thirteen tumours were Campanacci grade 2, and 40 were Grade 3 (4 unknown). Twenty patients presented with an associated pathologic fracture. There were 34 patients treated by EIC and 23 by en bloc resection and wrist arthrodesis. All resections were performed for grade 3 tumours. The mean follow-up was 86 months (range 1–280).

Results

There were a total of 11 (19%) local recurrences: 10 of 34 (29%) in the EIC group compared to only 1 of 23 (4%) in the resection–arthrodesis group (p = 0.028). For the 10 patients with local recurrence following initial treatment by EIC, 7 underwent repeat EIC, while 3 required resection–arthrodesis. The one local recurrence following initial resection was managed with repeat resection–arthrodesis. Six of the 11 local recurrences followed treatment of Campanacci grade 3 tumours, while 4 were in grade 2 lesions and in one case of recurrence the grade was unknown. There were no post-operative complications after EIC, whereas 7 patients (30%) had post-operative complications following resection–arthrodesis including 4 infections, one malunion, one non-union and one fracture (p = 0.001). The mean post-operative Musculoskeletal Tumor Society score was 33.5 in the curettage group compared to 27 in the resection group (p = 0.001). The mean Toronto Extremity Salvage Score was 98.3% following curettage compared to 91.5% after resection (p = 0.006). No patients experienced lung metastasis or death.

Conclusions

EIC is an effective alternative to wide resection–arthrodesis following treatment of distal radius GCT, with the advantage of preserving the distal radius and wrist joint function, but with a higher risk of local recurrence. Most local recurrences following initial treatment by EIC could be managed with iterative curettage and joint preservation. Wide excision and arthrodesis were associated with a significantly lower risk of tumour recurrence but was technically challenging and associated with more frequent post-operative complications. EIC was associated with better functional scores. Resection should be reserved for the most severe grade 3 tumours and recurrent and complex cases not amenable to treatment with EIC and joint salvage.

Level of evidence

III, retrospective comparative trial.

     

Bone transport for the treatment of infected forearm nonunion

ObjectiveThe objective of this study was to evaluate the effectiveness of the treatment of infected forearm nonunion by bone transport.Materials and methodsWe retrospectively reviewed 16 patients with infected forearm nonunion treated by bone transport. Our study included 10 males and 6 females with a mean of age 38.25 years. The site of bone defects involved 9 radius and 7 ulna. The average length of the bone defects after radical debridement was 3.81 cm (range 2.2–7.5 cm).ResultsThe mean follow-up after removal of the frame was 39.63 months (range 26–55 months). No patient was lost to follow-up. All the patients had bone union and no recurrence of infection was observed. The mean external fixation time was 6.19 months (range 3–10 months), and the mean external fixation index was 1.63 months/cm (range 1.14–2.00 months/cm). The mean degrees of wrist flexion were 49.69° (range 45–55°), and the mean degrees of wrist extension were 50.63° (range 40–60°). The mean degrees of elbow flexion were 143.12° (range 135–150°), and the mean degrees of elbow extension were 4.69° (range 0–20°). The mean degrees of forearm pronation were 82.50° (range 70–90°), and the mean degrees of forearm supination were 83.75° (range 75–90°).ConclusionOur study suggested that bone transport in the treatment of infected forearm nonunion acquired satisfied functional results. Radical debridement is the key step to control bone infection.     

Wrist hemiarthroplasty for irreparable DRF in the elderly

Introduction

The authors update their results of wrist hemiarthroplasty for irreparable distal radius fracture in the elderly, at a minimum of 2-year follow-up.

Materials and methods

Between 2011 and 2018, 25 consecutive independent elderly patients (24 female, 27 wrists) were treated with wrist hemiarthroplasty for distal radius fracture at a single institution. The average age was 77 years (range 65–88). They all were independent at home. A total of 19 wrists were treated at the acute stage, and 8 secondary procedures. The average follow-up was 32 months (range 24–44).

Results

There was no dislocation, loosening, infection nor removal of the implants. We observed 3 CRPS. At final follow-up, the average VAS pain was 1/10, mean forearm pronation/supination arc was 150°, and mean active flexion–extension arc was 60°. Average wrist extension was 36°. Mean grip strength was 68% of contralateral side. Mean Lyon wrist score was 74%. Mean Quick DASH score was 26%, and mean PRWE score was 25%.

Discussion

Our data suggest that treatment of acute irreparable distal radius fracture in the independent elderly patient with a bone-preserving primary wrist hemiarthroplasty may be a viable option. Longer-term follow-up are needed to confirm these preliminary data.

     

Resection-reconstruction arthroplasty for giant cell tumor of distal radius

Background:

Giant cell tumor (GCT) of the distal radius poses problems for reconstruction after resection. Several reconstructive procedures like vascularized and non-vascularized fibular graft, osteo-articular allograft, ceramic prosthesis and megaprosthesis are in use for substitution of the defect in the distal radius following resection. Most authors advocate wrist arthrodesis following resection of distal radius and non vascularized fibular graft. Here we have analyzed the results of aggressive benign GCTs of the distal radius treated by resection and reconstruction arthroplasty using autogenous non-vascularized fibular graft.

Materials and Methods:

Twenty-four cases of giant cell tumor of the distal radius (mean age 32 years, mean follow-up 6.6 years) treated by en-bloc resection and reconstruction arthroplasty using autogenous non-vascularized ipsilateral fibular graft with a minimum followup of two years have been included in this retrospective study. Nineteen cases were of Campanacci grade III and five were of Grade II recurrence. The mean resected length of the radius was 9.5 (8-12) cm. Routine radiographs and clinical assessments regarding pain, instability, recurrence, hand grip strength and functional status were done at regular intervals and functional results were assessed using (musculoskeletal tumor society) MSTS-87 scoring.

Results:

Early radiological union at host-graft junction was achieved at mean 12.5 weeks, (range 12-14 weeks) and solid incorporation with callus formation was observed in mean 29 weeks (range 28-32 weeks) in all the cases. Satisfactory range of motion (mean 63%, range 52-78%) of the wrist was achieved in 18 cases. Grip strength compared to the contralateral hand was found to be 67% (range 58-74%). Functional results were excellent in six cases (25%), good in 14 cases (58.3%) and four (16.7%) cases had fair results. Soft tissue recurrence was seen in one patient. The most commonly encountered complication was fibulo-carpal subluxation (10 cases, 41.7%).

Conclusion:

Resection of the distal radius and reconstruction arthroplasty with non-vascularized proximal fibular graft is useful in preserving the functional movement and stability of the wrist as well as achieving satisfactory range of movement and grip strength.     

Custom-made wrist prosthesis in a patient with giant cell tumor of the distal radius

Introduction

Treatment for giant cell tumors of the distal radius is challenging when motion is to be preserved. As standard wrist prostheses typically do not achieve favorable results, we treated a 36-year-old man with giant cell tumor of the distal radius with a new, custom-made implant.

Methods

A custom-made wrist prosthesis with a long shaft was designed according to the patient’s X-ray findings. After complete tumor resection, the prosthesis was subsequently implanted into the distal radius without complications.

Results

Two months after surgery, range of motion was 30°-0-25° for extension/flexion, 10°-0-5° for ulnar/radial abduction, 80°-0-0 for pronation/supination, complete range of motion for the fingers, and a grip strength of 6 kg. Two years after surgery, implant position was still correct and range of motion was 45°-0-10° for extension/flexion, 10°-0-20° for ulnar/radial abduction, and 80°-0-10° for pronation/supination. Grip strength was 16 kg, and DASH score was 25 compared to 39 before surgery. The patient returned to work as a craftsman.

Conclusion

Custom-made wrist prostheses could become a practical option in patients with large defects of the distal radius who desire to preserve wrist motion.     

Outcomes of wrist arthroplasty using a free vascularized fibular head graft for Enneking stage II giant cell tumors of the distal radius

The purpose of this study was to report the clinical outcomes of wrist arthroplasty with a free vascularized fibular head graft (FVFHG) and to highlight some considerations that may affect outcomes. FVFHG was performed on 12 patients with giant cell tumors of the distal radius between April 1984 and July 2005. The mean age of patients was 33 years. All 12 patients were classified as Enneking stage 2. Outcomes were evaluated with radiographic and functional assessments, including the scale of Enneking. The mean follow‐up period was 6.26 years. Bone union was achieved in all patients at a mean of 15.7 weeks after surgery. Skin grafting was performed at the recipient site in 5 patients and had good skin healing. Subluxation in the wrist joint was observed in 5 patients and was related to the length of the transplanted fibula. The 5 patients with subluxation experienced considerable osteoarthritic change. The mean arc of flexion‐extension and rotation of the wrist joint was 73.1° and 102.9°, respectively. The mean grip strength was 57.25% of the contralateral side. The mean functional score was 26.4 points. Wrist arthroplasty with a FVFHG is a useful option to treat Enneking stage 2 giant cell tumors of the distal radius. We believe that wrist instability is not determined by the choice of laterality of the fibula, which can be minimized by transplanting a short fibula with the anterior tibial artery as a donor artery. The recipient sites can be successfully resurfaced by skin grafting. © 2012 Wiley Periodicals, Inc., Microsurgery, 2013.     

Dorsal capsular-based vascularized distal radius graft for proximal pole scaphoid nonunion with avascular necrosis

BackgroundScaphoid nonunion involving the proximal pole with the presence of avascular necrosis is difficult to reconstruct. We aimed to determine the efficacy of surgical treatment of proximal pole scaphoid nonunion with avascular necrosis using a dorsal capsular-based vascularized distal radius graft.MethodsBetween 2000 and 2018, 64 patients with established proximal pole scaphoid nonunion with avascular necrosis were treated using a dorsal capsular-based vascularized distal radius graft. This graft was harvested from the dorsal aspect of the distal radius with its dorsal wrist capsule attachment. Fixation of the scaphoid nonunion was performed with a small cannulated screw, followed by insertion of the vascularized graft into the dorsal trough at the scaphoid nonunion site. In the last 47 patients of this series, a micro suture anchor was placed into the scaphoid to augment graft fixation.ResultsUnion rate was 86% (55 of 64 scaphoid nonunions with avascular necrosis) at a mean time of 12 weeks. Persistent non-union was noted in eight patients and fibrous union in one patient. No patients developed donor site morbidity. No graft dislodgment was noted. There was significant improvement of the wrist functional outcomes at the final follow up.ConclusionsThe dorsal capsular-based vascularized distal radius graft is a safe and effective treatment in patients with scaphoid nonunion with avascular necrosis of the proximal pole. This pedicle vascularized bone graft is derived from a location that can easily reach the proximal third of the scaphoid avoiding microsurgical dissection or anastomosis.     

Fixed-Angle Volar Plate Fixation for Distal Radius Fractures in Immunosuppressed Patients

The aim of this study was to define the outcome and complications following open reduction and internal fixed-angle plating of distal radius fractures for patients on chronic immunosuppression medications. A retrospective study identified 11 patients with distal radius fractures that had been on chronic immunosuppressive medication. The mean patient age was 59.9 years (40–82 years). According to the Orthopedic Trauma Association classification, there was one 23A3, one 23B3, and nine 23C type fractures. There were two open fractures. All patients received preoperative antibiotics and underwent reduction and fixation with a volar, fixed-angle plate. Postoperative measurements included postoperative and final radiographic indices, wrist flexion and extension, forearm rotation, and grip strength. Clinical follow-up averaged 13 months, and radiographic follow-up averaged 14.9 months. Statistical analysis was performed comparing means of various parameters with a two-sided t test with an alpha value ≤0.05. All fractures healed, and there were no infections. The final mean ulnar variance, volar tilt, and radial inclination were −0.1 mm (ulnar negative; −2.0 to +2.5 mm), 13° (5–23°), and 21° (15–27°), respectively. The mean articular gap or step was 0.4 mm. There was a small but significant decrease between the final and postoperative mean ulnar variance (p = 0.03). Mean wrist flexion was 47°, extension 47°, pronation 77°, and supination was 76°. Grip strength averaged 16.3 kg versus 25.1 kg for the opposite extremity. The one major complication included a postoperative carpal tunnel syndrome. Fixed-angle volar plate fixation for distal radius fractures in patients with chronic immunosuppression was associated with union (with acceptable radiographic alignment), no wound-healing problems or infections, and with functional wrist and forearm motion and grip strength.     

The role of VFG in wrist arthrodesis: Long term results in a series of 11 patients and literature review

BackgroundTotal wrist fusion (TWF) is indicated for longstanding degenerative, posttraumatic and/or post-oncological conditions to provide pain relief and wrist stability at partial expense of wrist motion.Patients and MethodsA total of 11 consecutive patients who had completed TWF with Vascularized Fibula Graft (VFG) for massive distal radius defects were identified retrospectively from our center using inpatient records. We evaluated bone fusion times and long term functional outcomes following the procedure. Post-operative grip strength (GS) and prono-supination were objectively measured. The new Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to rate disability and symptoms; pre- and post- operative pain with the Visual Analog Scale (VAS) was assessed. A literature review of the present studies about TWF with VFG was performed, with the aim of comparing long-term functional results of the surgical techniques so far reported in the English literature.ResultsOur experience with TWF using VFG appeared slightly better than that found in the literature. The procedure was successful in all the cases, achieving bone union in 4,8 months on average. Complication rate was 27,2%, no flap loss was recorded. There were no wrist instability, deformation or dislocation; mean pronation/supination (P/S) was 57,5°/61,2° Average grip strength resulted 59% of the contralateral side. Mean recorded levels of visual analog scale (VAS) for pain postoperatively were 2,32 ± 0,792, which improved significantly from the pre-operatively value of 7,90 ± 0,79. Mean overall satisfaction was good and all the patients comfortably returned to normal activities.ConclusionsWrist arthrodesis by means of VFG resulted to be an effective and reliable option in dealing with massive defects of distal radius with involvement of radio-carpal joint. Although the cohort analyzed is relatively small and definitive conclusions cannot be drawn, the long term radiographs and the overall functional outcomes encourage to use the described surgical option over other techniques, such as prosthetic replacement and non-vascularized bone grafts.     

Outcome Following Acute Primary Distal Ulna Resection for Comminuted Distal Ulna Fractures at the Time of Operative Fixation of Unstable Fractures of the Distal Radius

Optimal acute management of the highly comminuted distal ulna head/neck fracture sustained in conjunction with an unstable distal radius fracture requiring operative fixation is not well established. The purpose of the present study was to determine the clinical, radiographic, and functional outcomes following acute primary distal ulna resection for comminuted distal ulna fractures performed in conjunction with the operative fixation of unstable distal radius fractures. Between 2000 and 2007, 11 consecutive patients, mean age 62 years (range, 30–75) were treated for concomitant closed, comminuted, unstable fractures of the distal radius and ulna metaphysis. All 11 patients underwent distal ulna resection through a separate dorsal ulnar incision with ECU tenodesis following surgical fixation of the distal radius fracture. According to the Q modifier of the Comprehensive Classification of Fractures, there were six comminuted fractures of the ulnar neck (Q3) and five fractures of the head/neck (Q5). Operative fixation of the distal radius fracture included volar plate fixation in four patients and spanning external fixation with supplemental percutaneous Kirschner wires in seven patients. At a mean of 42 months (range, 18–61 months) postoperatively, clinical, radiographic, and wrist-specific functional outcome with the modified Gartland and Werley wrist score were evaluated. At latest follow-up, mean wrist range of motion measured 53° flexion (range, 35–60°), 52° extension (range, 30–60°), 81° pronation (range, 75–85°), and 77° supination (range, 70–85°). Mean grip strength measured 90% of the contralateral, uninjured extremity (range, 50–133%). No patient had distal ulna instability. Final radiographic assessment demonstrated restoration of distal radius articular alignment. According to the system of Gartland and Werley as modified by Sarmiento, there were seven excellent and four good results. No patient has required a secondary surgical procedure. Acute primary distal ulna resection yields satisfactory clinical, radiographic, and functional results in appropriately selected patients and represents a reliable alternative to open reduction and internal fixation when anatomic restoration of the distal ulna/sigmoid notch cannot be achieved. Primary distal ulna resection with distal radius fracture fixation may help avoid secondary procedures related to distal ulna fixation or symptomatic post-traumatic distal radioulnar joint arthrosis.     

带血管蒂腓骨瓣移植重建CampanacciⅢ级桡骨远端骨巨细胞瘤切除术后桡腕关节的远期疗效

目的总结CampanacciⅢ级桡骨远端骨巨细胞瘤(giant cell tumor,GCT)瘤段切除后,采用带血管蒂自体腓骨瓣移植重建桡腕关节的远期疗效。方法2010年12月-2014年12月,收治10例CampanacciⅢ级桡骨远端GCT患者。其中男6例,女4例;年龄22~65岁,平均39.9岁。病程1.5~6.0个月,平均2.6个月。4例合并病理性骨折。肿瘤切除后桡骨远端骨缺损长度为6.0~12.5 cm,平均8.4 cm。采用自体腓骨瓣移植重建桡腕关节,6例吻合膝下外侧血管,4例吻合膝下外侧血管+腓血管双套血管蒂。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间4.4~8.3年,平均6.0年。随访期间肿瘤无复发。末次随访时,腕关节活动范围:背伸25~85°,平均55.0°;掌屈15~40°,平均26.5°;桡偏5~25°,平均12.0°;尺偏10~30°,平均19.6°;前臂旋前5~90°,平均50.5°;旋后20~90°,平均66.5°。患侧握力达健侧60%~85%,平均75%。美国骨与软组织肿瘤协会(MSTS)评分为75%~90%,平均82.7%。X线片复查示移植腓骨瓣均愈合,愈合时间12~16周,平均14.1周;9例出现影像学并发症。结论CampanacciⅢ级桡骨远端GCT切除后,采用带血管蒂腓骨瓣移植重建桡腕关节,能够有效保留腕关节功能。     

Allograft replacement with distal radioulnar joint fusion and ulnar osteotomy for treatment of giant cell tumors of the distal radius

Three patients with advanced giant cell tumors of the distal radius received a frozen allograft replacement of the distal radius, accompanied by a distal radioulnar arthrodesis with ulnar osteotomy proximal to the wrist. Follow-up ranged from 2 to 4 years. During this time this combined procedure provided the following advantages: complete tumor resection, no donor site morbidity, retention of pronation-supination, and avoidance of pain or subluxation at the distal radial ulnar joint.     

桡骨远端巨细胞瘤切除自体腓骨头移植重建的远期疗效观察

目的 观察桡骨远端巨细胞瘤切除后取自体腓骨头移植重建的远期疗效.方法 对1994年3月至2004年11月31例桡骨远端巨细胞瘤患者行肿瘤大段切除,取自体腓骨上段移植重建.其中男性12例,女性19例;年龄19～48岁,平均31岁.Campanacci分期Ⅲ期24例,Ⅱ期7例.采用吻合血管的腓骨移植6例,其余25例行单纯腓骨移植.对本组患者进行临床及影像学评估,测量患者腕关节活动度、前臂旋前及旋后的活动度,测量患肢的握力.分别以MSTS评分及Mayo腕关节评分系统评价上肢及腕关节功能.结果 随访时间41～169个月,平均86.3个月.吻合血管的腓骨移植骨愈合时间为3～9个月,平均5.1个月.单纯腓骨移植患者骨愈合时间为7～15个月,平均10.3个月.1例单纯腓骨移植患者术后出现骨不愈合.1例患者术后出现肿瘤局部复发,复发率为3.2%.5例患者术后出现桡腕关节脱位.患者术后腕关节活动度为背伸(67.3±9.4)°、掌屈(31.2±5.1)°、桡偏(14.1±4.7)°、尺偏(19.4±3.9)°、前臂旋前(33.8±6.6)°、前臂旋后(15.3±4.0)°.对桡腕关节成型的28例患者进行握力测量为15.5～52.1 kg,平均33.1 kg,占健侧握力的73%.MSTS评分为23～29分,平均25.5分,Mayo腕关节功能评分40～65分,平均56分.结论 取自体腓骨上端移植重建是治疗桡骨远端巨细胞瘤的有效方法,术后患者腕关节功能恢复理想.腕关节囊的重建对于维持桡腕关节的术后稳定具有重要意义.     

Treatment of diaphyseal forearm fracture with interlocking intramedullary nailing: A pilot study

IntroductionThe 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.MethodologyThirty 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.ResultsMean 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.ConclusionsExcellent 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.