桡骨远端骨瓣转移治疗晚期月骨无菌性坏死

目的 报告以桡动脉腕背分支为蒂的桡骨远端骨瓣转移治疗晚期月骨无菌性坏死的手术方法及初步疗效.方法 对2例晚期(Ⅳ期)月骨无菌性坏死患者,采用桡动脉腕背分支为蒂的桡骨远端骨瓣转移治疗.术后随访患者症状、腕关节活动度和腕关节影像学的改变,并用Krimmer 评分表和DASH评分表进行功能评定.结果 2例患者随访时间分别为3年和6个月,静息时疼痛均已消失,活动时疼痛程度减低.影像学表现:例1患者X线片月骨可见高密度坏死骨质已吸收,有新骨质形成;例2患者MRI显示坏死骨和腕骨塌陷无进一步进展.2例腕关节功能按Krimmer评分、DASH评分均较术前有明显的改善.结论 桡动脉腕背分支为蒂的桡骨远端骨瓣转移术治疗晚期月骨无菌性坏死.初步疗效良好.     

桡动脉腕掌支蒂桡骨瓣移植治疗腕月骨骨坏死

目的探讨应用桡动脉腕掌支蒂桡骨瓣移植治疗腕月骨骨坏死的手术方法。方法根据桡骨远端血液供应的解剖学基础,设计带桡动脉腕掌支蒂桡骨瓣,移植治疗腕月骨早期骨坏死6例。结果术后随访11个月～3年5个月,5例腕痛完全消失,1例腕关节用力活动后,出现酸痛不适。腕关节活动度明显改善,腕关节背伸平均45°,屈曲平均37°,患手握力比术前明显增加,达正常侧的85．6%。X线照片显示月骨密度恢复正常。结论桡动脉腕掌支蒂桡骨瓣移植治疗腕月骨骨坏死具有血管解剖恒定、血供可靠、手术操作简单,是治疗腕月骨早期骨坏死的一种有效手术方法。     

掌侧接骨板治疗老年桡骨远端背侧移位骨折临床分析

目的 探讨掌侧万向锁定加压双柱接骨板治疗老年人桡骨远端背侧移位骨折的临床疗效。方法 分析2012年7月至2015年7月采用掌侧万向锁定加压双柱接骨板治疗的37例桡骨远端背侧移位C型骨折患者,男 11例,女26例;年龄60～78岁,平均70．7岁;骨折按AO分型：c1型7,c2型13例,c3型17例。末次随访时通过术后X线片评估桡骨远端骨折复位情况、测量各项影像学参数,并采用Gart land---Werley评定疗效。结果 所有患者术后获6～27个月(平均19．6个月)随访。X线片示骨折愈合时间3～4个月,平均3．5个月。按照Garland—Werley评分：优16例,良 14例,可6例,1例因疼痛再次手术,优良率81.08％,无感染及不愈合。末次随访时桡骨茎突高度 8．30～12．52 mm,平均10．42mm;掌倾角10°～14.20°,平均12．60°;尺偏角 17.30°～23.40°,平均2I．00°。结论 掌侧万向锁定加压双柱接骨板是治疗老年桡骨远端背侧移位骨折的有效方法。     

锁定钢板治疗桡骨远端粉碎性骨折

目的研究锁定加压钢板治疗累及桡骨远端粉碎性骨折的效果。方法26例桡骨远端骨折,平均年龄61岁。按照AO骨折分型C1型8例;C2型12例;C3型6例。其中2例为开放性骨折,另2例分别合并肩与肘关节脱位。均采用掌侧入路,T型锁定钢板固定。结果26例术后随访6~20个月,平均8个月。骨折平均愈合时间为8周(6~12周)。腕关节活动度平均为掌屈40°,背伸45°,尺偏30°,桡偏20°,旋前70°,旋后65°。最近1次随访X线片与术前相比,桡骨茎突平均长度自术前6(-10~10)mm增加至11(8~14)mm。平均掌倾角自术前-15°(-40°~10°)增加至8°(-5°~15°)。平均尺偏角从12°(-5°~20°)增加至20°(10°~25°)。关节面骨折块平均间距从6(1~18)mm减少至0(0~3)mm。术侧握力为健侧的78%(55%~100%)。根据Gartland与Werley评分标准,优7例,良12例,一般5例,差2例。结论对于累及关节面的粉碎性桡骨远端骨折,T型锁定钢板可以较好地维持骨折复位,允许术后早期功能锻炼,并可获得满意的腕关节功能。     

T型接骨板加有限钢丝治疗桡骨远端粉碎性骨折

目的探讨应用T型钢板螺钉加有限钢丝固定治疗桡骨远端粉碎性骨折的可行性及临床应用价值。方法桡骨远端骨折患者16例,男6例,女10例;年龄19~66岁,平均33岁。按AO分类为C2型和C3型。切开复位后按AO内固定原则,使用T型钢板螺钉加有限钢丝固定进行治疗。结果术后随访12~16个月。最后1次采用腕关节功能及X线片测量指标进行综合评定,优8例,良6例,可2例,总优良率为87.5%。术前为-35°~0°,平均-15°;术后为7°~14°,平均10°。术前尺偏角为-20°~15°,平均9.5°;术后为18°~24°,平均21.1°。无医源性神经、血管损伤等并发症。结论采用T型钢板螺钉加钢丝治疗C2型和C3型桡骨远端骨折,能够牢固维持于术中复位达到的解剖位置,有利于患肢术后早期行功能锻炼。     

经股骨粗隆部旋转截骨术治疗股骨头坏死

目的探讨经股骨粗隆部旋转截骨术治疗股骨头坏死的适应证,手术技术及临床疗效.方法 1992年10月～2001年5月,19例23髋股骨头坏死行经股骨粗隆部截骨术.其中男14例,女5例.年龄22～43岁(平均33.4岁).其中酒精性坏死10例12髋、皮质类固醇性坏死6例7髋、创伤性坏死2例2髋、减压病性坏死1例2髋.按Ficat分期,Ⅱ期8例8髋,Ⅲ期11例15髋.术前Harris评分为46～74分(平均56分).术前摄双髋关节正位和屈髋90°,外展45°旋转中立X线片,以确定坏死部位和角度.按日本Sugioka技术,在股骨粗隆部截骨,将股骨头颈及部分粗隆向前或向后旋转(依坏死部位确定),2～3枚松质骨加压螺钉固定.17例19髋获得18个月～11年随访(平均54个月).结果随访时Harris评分为55～94分(平均80.5分),其中大于80分(优和良)14髋,优良率73.2%,小于79分5髋,其中4髋已行全髋关节置换术.股骨头颈旋转角度55°～80°,平均60°.所有患者粗隆部截骨均达骨性愈合,1例大粗隆截骨因加压钢丝断裂不愈合.术中并发症为旋股内动脉断裂1髋,股骨粗隆下骨折2髋.结论经股骨粗隆旋转截骨术可用于选择性治疗股骨头坏死,即坏死区位于负重面,股骨头未被坏死累及面大于1/3,Ficat Ⅱ期和Ⅲ期早期的中青年(<45岁)患者.后旋及加大旋转度效果更好.该手术有一定的技术难度,有较长的学习曲线,应慎重从事.     

头状骨移位治疗月骨无菌性坏死

目的　介绍以骨间前动脉背侧支为蒂的头状骨移位治疗晚期月骨无菌性坏死。方法　对 18例Lichtman分Ⅲ、Ⅳ期月骨无菌性坏死患者采用坏死月骨摘除 ,以骨间前动脉背侧支为蒂的头状骨移位替代坏死月骨。结果　术后随访 1～ 5年 ,平均 32个月 ,移位头状骨有可靠血运 ,16例腕痛消失 ,2例仍有轻度腕痛 ,优良率 10 0 %。结论　应用该法替代月骨支撑腕关节 ,符合腕关节功能解剖 ,是治疗Ⅲ、Ⅳ期月骨无菌性坏死的有效方法     

桡骨远端截骨治疗腕关节创伤性关节炎

腕关节创伤性关节炎是腕部附近骨折的并发症，常见于舟状骨骨折、月骨骨折及桡骨远端骨折后，特别是舟状骨、月骨不愈合及无菌坏死。腕关节创伤性关节炎常伴有腕关节疼痛，影响关节活动，治疗较困难，我院自1989-1995年采用桡骨远端楔形截骨治疗腕关节创伤性关节炎10例．取得满意疗效。报告如下：     

掌侧斜T形钢板治疗老年桡骨远端不稳定性骨折

[目的]探讨掌侧斜T形钢板在治疗老年桡骨远端不稳定性骨折的应用及临床治疗效果。[方法]2001年1月~2003年4月使用掌侧斜T形钢板治疗老年桡骨远端不稳定性骨折42例。男18例,女24例;年龄60~75岁,平均65.1岁。按AO分类:A2型4例,A3型7例,B1型5例,B3型3例,C1型9例,C2型11例,C3型3例。28例骨缺损破坏严重,支撑不满意的行人工骨植入恢复局部稳定性。[结果]全部病例得到12~24个月随访,平均18.2个月。X线片检查结果:掌倾角平均3.66°(-7°~10°),尺偏角20.1°(15°~25°),桡骨短缩6例,平均1.59mm(1~5 mm),短缩≥4 mm的2例,关节面分离、移位6例,平均>1 mm(1~4 mm)。平均关节活动度:掌屈58.2°(30°~70°),背伸55.6°(25°~65°),桡偏16.5°(10°~25°),尺偏24.6°(20°~30°),前臂旋前79.2°(60°~90°),旋后70.1°(50°~90°);握力平均为对侧的65%(35%~105%)。根据Sarm iento改良Gartland andW erley评分标准,优25例、良11例、可4例、差2例。[结论]掌侧斜T形钢板治疗老年桡骨远端不稳定骨折是安全有效的治疗选择。可提供稳定的固定,早期功能训练,获得较好的效果,避免背侧固定固有的并发症。充分植骨能有效防止复位丢失。     

头状骨移位治疗月骨无菌性坏死

目的 介绍以骨间前动脉背侧支为蒂的头状骨移位治疗晚期月骨无菌性坏死。方法 对18例Lichtman分Ⅲ、Ⅳ期月骨无菌性坏死患者采用坏死月骨摘除，以骨间前动脉背侧支为蒂的头状骨移位替代坏死月骨。结果 术后随访1～5年，平均32个月，移位头状骨有可靠血运，16例腕痛消失，2例仍有轻度腕痛，优良率100％。结论 应用该法替代月骨支撑腕关节，符合腕关节功能解剖，是治疗Ⅲ、Ⅳ期月骨无菌性坏死的有效方法。     

Radial Head Fractures: Indications and Technique for Primary Arthroplasty

Abstract The treatment of complex radial head fractures remains a challenge for the orthopedic surgeon. Novel implants and improved surgical techniques have made reconstruction of the radial head with open reduction and internal fixation possible in most cases. However, extremely comminuted radial head fractures with associated instabilities still require replacement of the radial head with a prosthesis to allow rehabilitation with early motion of the elbow, and thereby optimizing the functional results of these potentially devastating injuries. In this article we discuss the surgical considerations related to radial head replacement, encompassing the indications for radial head arthroplasty, implant selection, surgical technique, rehabilitation protocols, and complications related to radial head prosthesis.     

Isolated radial shaft fracture with unreducable posterior dislocation of the radial head and rupture of the lateral collateral ligament: A case report

Combined injuries associated with forearm shaft fractures and elbow dislocations are well recognized. We describe an uncommon case of an isolated radial shaft fracture with an unreducable posterior dislocation of the radial head and associated rupture of the lateral collateral ligament of the elbow.     

The effect of grip strength on radial bone in postmenopausal women

This communication explores the correlation in 255 postmenopausal women of grip strength to bone tissue density (BTD) and cross-sectional area (CSArea) of the radius. While grip strength correlated cross-sectionally with the baseline measures of both BTD and CSArea, grip strength affected differentially the changes that transpired in the two bone parameters over the 3 years of the study. Thus, the increases in the CSArea of the radius were significantly enhanced by higher grip strength, while BTD losses were not. Since the power of muscle contraction is a factor in the mechanical loading of a bone, it is argued that the differential effects of grip strength on the two bone parameters of the radius suggest that moderate loading can effect favorable changes in the geometry of the bone, without necessarily affecting changes in BTD.     

Surgical correction of distal radius malunions using an anatomic radial locking plate

Background

Correction of a distal radius fracture malunion is challenging technically. These malunions most classically deform dorsally, but often the deformity involves three planes.

Methods

Using an anatomically designed radial plate that takes into consideration the three planes, correction of the deformity can be obtained. In this video we see a patient with a classic dinner fork deformity that is associated with a dorsal malunion involving the distal radius. Correction of a distal radius malunion can be performed using a radial approach and an anatomic radial plate.

Results

The authors have used this technique for difficult distal radius fracture malunions and have achieved superb correction, returning patients to early range of motion and an active lifestyle.

Conclusions

Careful mobilization of the branches of the lateral antebrachial cutaneous nerve and the superficial branch of the radial nerve is required. This technique affords the surgeon excellent access to three sides of the radius to help perform this complex surgery.

Electronic supplementary material

The online version of this article (doi:10.1007/s11552-015-9758-7) contains supplementary material, which is available to authorized users.     

Prosthetic radial head stem pull-out as a mode of failure: a biomechanical study

Purpose

Press-fit cementless radial head implant longevity relies on adequate bone ingrowth. Failed implant osseointegration remains a clinical concern and has been shown to lead to prosthetic failure. The purpose of this study was to test the hypothesis that implants with sufficient initial press-fit stability would be less likely to fail due to implant pull-out, as demonstrated by an increasing amount of energy required to remove the prosthesis from the canal.

Methods

Ten cadaveric radii were implanted with five sizes (6–10 mm in 1-mm increments) of grit-blasted, cementless radial head stems. A customised slap hammer was used to measure the energy required to remove each stem. Stem-bone micromotion was also measured.

Results

The suboptimally sized stem (Max − 1) (i.e. 1 mm undersized) required less energy (0.5 ± 0 J) to pull out than the optimally sized stem (Max) (1.7 ± 0.3 J) (p = 0.008). The optimally sized stem demonstrated greater initial stability (45 ± 7 μm) than the suboptimally sized stem (79 ± 12 μm) (p = 0.004).

Conclusions

This investigation demonstrates the importance of obtaining adequate press-fit stability for the prevention of radial head stem pull-out failure. These data add to the relatively scant knowledge in the literature regarding radial head biomechanics. The energy required to remove a prosthetic radial head ingrowth stem decreases in conjunction with diameter. The use of an inadequately sized stem increases the stem’s micromotion as well as the risk of prosthetic loosening due to pull-out.     

Incidence and predictors of radial nerve palsy with the anterolateral brachialis splitting approach to the humeral shaft

Purpose: Fractures of the humeral shaft are common and account for 3%e5% of all orthopedic injuries. This study aims to estimate the incidence of radial nerve palsy and its outcome when the anterior approach is employed and to analyze the predictive factors. Methods: The study was performed in the department of orthopaedics unit of a tertiary care trauma referral center. Patients who underwent surgery for acute fractures and nonunions of humerus shaft through an anterior approach from January 2007 to December 2012 were included. We retrospectively analyzed medical records, including radiographs and discharge summaries, demographic data, surgical procedures prior to our index surgery, AO fracture type and level of fracture or nonunion, experience of the operating surgeon, time of the day when surgery was performed, and radial nerve palsy with its recovery condition. The level of humerus shaft fracture or nonunion was divided into upper third, middle third and lower third. Irrespective of prior surgeries done elsewhere, the first surgery done in our institute through an anterior approach was considered as the index surgery and subsequent surgical exposures were considered as secondary procedures. Results: Of 85 patients included, 19 had preoperative radial nerve palsy. Eleven (16%) patients developed radial nerve palsy after our index procedure. Surgeons who have two or less than two years of surgical experience were 9.2 times more likely to induce radial nerve palsy (p=0.002). Patients who had surgery between 8 p.m. and 8 a.m. were about 8 times more likely to have palsy (p=0.004). The rest risk factor is AO type A fractures, whose incidence of radial nerve palsy was 1.3 times as compared with type B fractures (p=0.338). For all the 11 patients, one was lost to follow-up and the others recovered within 6 months. Conclusion: Contrary to our expectations, secondary procedures and prior multiple surgeries with failed implants and poor soft tissue were not predictive factors of postoperative deficit. From our study, we also conclude that radial nerve recovery can be reasonably expected in all patients with a postoperative palsy following the anterolateral approach.