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1.
《Acta orthopaedica》2013,84(3):360-364
Background and purpose Mechanisms of injury to ulnar-sided ligaments (stabilizing the distal radioulnar joint and the ulna to the carpus) associated with dorsally displaced distal radius fractures are poorly described. We investigated the injury patterns in a human cadaver fracture model. Methods Fresh frozen human cadaver arms were used. A dorsal open-wedge osteotomy was performed in the distal radius. In 8 specimens, pressure was applied to the palm with the wrist in dorsiflexion and ulnar-sided stabilizing structures subsequently severed. Dorsal angulation was measured on digitized radiographs. In 8 other specimens, the triangular fibrocartilage complex (TFCC) was forced into rupture by axially loading the forearm with the wrist in dorsiflexion. The ulnar side was dissected and injuries were recorded. Results Intact ulnar soft tissues limited the dorsal angulation of the distal radius fragment to a median of 32o (16–34). A combination of bending and shearing of the distal radius fragment was needed to create TFCC injuries. Both palmar and dorsal injuries were observed simultaneously in 6 of 8 specimens. Interpretation A TFCC injury can be expected when dorsal angulation of a distal radius fracture exceeds 32o. The extensor carpi ulnaris subsheath may be a functionally integral part of the TFCC. Both dorsal and palmar structures can tear simultaneously. These findings may have implications for reconstruction of ulnar sided soft tissue injuries. 相似文献
2.
Murat Songür Ercan ?ahin Sinan Zehir Mahmut Kalem 《International journal of surgery case reports》2014,5(12):1005-1009
INTRODUCTION
High energy distal radius fractures may cause significant soft tissue injuries. Dorsal displacement of median nerve and flexor tendons to dorsal compartment between distal radioulnar joint was an unreported type of soft tissue injury.PRESENTATION OF CASE
35-Year male admitted following fall from height diagnosed as closed distal radius fracture with dorsal displacement. The patient had no flexion and extension of all fingers with loss of sensation. Radial artery pulse was not palpable. Radiography and CT imaging revealed distal radius fracture with dorsal displacement with dorsal carpal dislocation. After failure of closed reduction, operative treatment was performed. At surgery, flexor tendons and median nerve was found to be placed at dorsal compartment. Reduction of the soft tissues was facilitated by distraction of distal radioulnar joint.DISCUSSION
Dorsal displacement of volar structures as the result of fracture dislocation was found to be an unreported type of injury. Difficulty during reduction of dorsally displaced structures is an important feature of the case.CONCLUSION
For severely displaced and deformed distal radial fractures and fracture dislocations, threshold for operative treatment should be kept low. 相似文献3.
Paritosh Gogna Sahil Gaba Reetadyuti Mukhopadhyay Rajesh Rohilla Amanpreet Singh 《Journal of orthopaedics and traumatology》2017,18(1):31-36
Background
To evaluate results of a technique for treating neglected epiphyseal injuries of the distal radius with ulnar impaction.Materials and methods
This retrospective study involved six cases (four males; two females), all of whom sustained the primary injury during childhood (range 9–12 years of age). All presented with wrist deformity and ulnar-sided wrist pain. They were managed with osteotomy of the distal radius, osteotomy and shortening of the ulna, harvesting the bone grafts, and distal radioulnar joint (DRUJ) reduction performed simultaneously through a dorsal midline approach. Mean follow-up was 30 months (range 24–36).Results
Deformity correction and pain relief was observed in all patients. Flexion arc increased from an average of 60° to 102.5°, supination from an average of 31.67° to 67.50°, and pronation from an average of 30.83° to 61.67°. The mean preoperative DASH score was 87.5, which improved to 18.72 postoperatively.Conclusion
Neglected epiphyseal injuries of the distal radius are difficult to manage and many variations are described for handing each of the associated problems. Our technique provides an option for managing this injury with an easy surgical approach, single incision, and cost effectiveness. All the four components of the surgery, which include osteotomy of the distal radius, osteotomy of the ulna, harvesting the bone grafts, and DRUJ reduction were done through a single incision and in a single sitting. Level of evidence IV.4.
Purpose
To study the effects of surgical and nonoperative treatment on wrist function in patients with distal radius fracture.Methods
In total, 97 patients treated for distal radius fracture in the Department of Orthopedic Trauma at the People's Hospital of Peking University from Jan. 2010 to Jun. 2016 were selected for outpatient follow-up, including manipulative reduction and dorsal splint fixation in 24 cases, bivalve cast fixation in 19 cases and open reduction and internal fixation in 54 cases. Evaluation was based on Sartiento's modification of the Gartland and Werley score. Efficacy was assessed with wrist pain as the focus.Results
The wrist function scores of the surgical group were better than nonoperative groups. There was no significant difference in wrist function scores between the dorsal splint group and the bivalve cast group. The ulnar wrist pain incidence had no significant difference in surgical and nonoperative groups. The displace rate in dorsal splint group was higher than other groups.Conclusion
The overall effect of surgical treatment of distal radius fracture is better than nonoperative treatment. The ulnar wrist pain incidence has no significant difference in these groups. Dorsal splint fixation is more prone to displace than bivalve cast fixation. 相似文献5.
The ulnar impaction syndrome is proven to be a common source of ulnar sided wrist pain. Ulna-shortening osteotomy represents a successful therapy for this kind of problem, both congenital or posttraumatic positive ulnar variance. Positive variance resulting from a distal radius fracture needs correct dorsal and radial angulation of the radius. In case of congenital positive variance arthroscopic debridement for decompression of the TFCC should be performed first. The adequate correction of the length is the major problem. Disorders of the distal radioulnar joint may result due to overcorrection. Oblique osteotomy using 7-hole-plates is our preferred treatment. 相似文献
6.
Dr. M. M��hldorfer-Fodor T. Pillukat T. Pausch K.-J. Prommersberger J. van Schoonhoven 《Operative Orthopadie und Traumatologie》2011,23(2):86-97
Objective
To provide painfree forearm rotation in patients with degenerative changes of the distal radioulnar joint (DRUJ). The primary goal is to stabilize the DRUJ in patients with an unstable stump of the distal ulna following resection arthroplasty with the secondary effect of restoring painfree forearm rotation.Indications
Instability of the distal ulna following various types of resection arthroplasties. Primary or secondary osteoarthritis of the DRUJ. Replacement of an ulnar head destroyed by tumor or trauma.Contraindications
Longitudinal instability of the forearm (e.g., following an Essex?CLopresti-type of injury, resection of the radial head). Inadequate soft tissue with severe ulnocarpal ligamentous insufficiency. Radial deformity (must be corrected before replacement of the ulnar head).Surgical technique
In cases of osteoarthritis of the DRUJ, dorsal exposure of the distal radioulnar joint to the depth of the 5th extensor compartment. Raising of an ulnar-based capsuloretinacular flap by sharp dissection off the ulnar neck proximally and off the dorsal part of the triangular fibrocartilage complex (TFCC) distally. Osteotomy of the distal ulna corresponding to the preoperatively planned size of the prosthesis and removal of the ulnar head, while preserving the attachment of the TFCC within the capsuloretinacular flap. Reaming of the ulnar medullary canal. Insertion of a trial prosthesis. The trial prosthesis has to fit accurately into the shaft with a fluoroscopically documented ulna minus situation of minus 1?C2?mm at the wrist joint level. After implanting the definite stem and ulnar head of the Herbert ulnar head prothesis (Martin Medizintechnik?, Tuttlingen, Germany), the capsuloretinacular flap is reattached to the dorsal rim of the sigmoid notch through drilling holes and under advanced tension. In patients with an unstable distal ulnar stump, the operative procedure is technically more demanding as it is more difficult to raise a sufficient capsuloretinacular flap and due to the loss of the ulnar head as an anatomic landmark.Postoperative management
Long arm cast with 70° elbow flexion, 40° forearm supination, and 20° wrist extension for 2?weeks. Subsequently forearm rotation is limited at 40° in a removable ulnar gutter splint. Six weeks postoperatively unlimited active range of motion is allowed and normal activities are gradually commenced. Return to maximum stress 12?weeks postoperatively.Results
Patient satisfaction is high due to an increased forearm rotation, stronger grip force, and remarkable pain relief. In most patients with an unstable distal ulnar stump following resection arthroplasty of the DRUJ, stability can be restored. 相似文献7.
Background and purpose
Promising results have been reported after volar locked plating of unstable dorsally displaced distal radius fractures. We investigated whether volar locked plating results in better patient-perceived, objective functional and radiographic outcomes compared to the less invasive external fixation.Patients and methods
63 patients under 70 years of age, with an unstable extra-articular or non-comminuted intra-articular dorsally displaced distal radius fracture, were randomized to volar locked plating (n = 33) or bridging external fixation. Patient-perceived outcome was assessed with the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and the Patient-Rated Wrist Evaluation (PRWE) questionnaire.Results
At 3 and 6 months, the volar plate group had better DASH and PRWE scores but at 12 months the scores were similar. Objective function, measured as grip strength and range of movement, was superior in the volar plate group but the differences diminished and were small at 12 months. Axial length and volar tilt were retained slightly better in the volar plate group.Interpretation
Volar plate fixation is more advantageous than external fixation, in the early rehabilitation period.The risk of a poor outcome after a fracture of the distal radius increases with malunion (Grewal and MacDermid 2007) and in highly unstable fractures, operative fixation is required to maintain a satisfactory anatomical position. Closed reduction and bridging external fixation rely on ligamentotaxis to reduce and keep the fracture in alignment. It has been used for unstable distal radius fractures for several decades. External fixation requires 5–6 weeks of immobilization, and some fracture redisplacement often occurs after the fixation device has been removed (Dicpinigaitis et al. 2004, Handoll et al. 2007). In later years, there has been a strong trend towards open reduction and internal fixation with volar locked plating in the management of unstable, dorsally displaced, fractures of the distal radius. Volar locked plating facilitates an anatomical reduction of the fracture, it stabilizes the fracture during the entire healing process, and it allows early wrist mobilization. Good results in terms of patient-rated outcome scores, objective function, and radiographic outcome have been reported both in younger and older patients (Orbay and Fernandez 2002, 2004, Kamano et al. 2005, Chung et al. 2006, Oshiege et al. 2007, Jupiter et al. 2009). Several studies have compared dorsal plating (Grewal et al. 2005, Kateros et al. 2010), fragment-specific systems (Abramo et al. 2009), or a mixture of dorsal and volar plating techniques (Kreder et al. 2005, Leung et al. 2008) with external fixation, but there is no substantial evidence to support the use of internal fixation instead of external fixation (Margaliot et al. 2005). Few studies have compared volar locked plating with external fixation, and there is still insufficient evidence regarding which gives the best outcome (Wright et al. 2005, Egol et al. 2008, Rizzo et al. 2008, Wei et al. 2009).We have carried out a randomized comparison of open reduction with volar locked plating and closed reduction with bridging external fixation for unstable dorsally displaced extra-articular and non-comminuted intra-articular fractures of the distal radius. Our hypothesis was that volar locked plating would result in better patient-perceived, objective functional, and radiographic outcome after 12 months than external fixation. 相似文献8.
Shigeru Santo Shohei Omokawa Akio Iida Takamasa Shimizu Hideo Hasegawa Yasuhito Tanaka 《Journal of orthopaedic science》2018,23(6):953-958
Background
We compared the incidence of extensor carpi ulnaris (ECU) tendon and distal radioulnar joint (DRUJ) abnormalities using magnetic resonance imaging (MRI) between patients with triangular fibrocartilage complex (TFCC) tears and subjects without ulnar wrist pain. Additionally, we aimed to identify potential predictors of these MRI lesions.Methods
The TFCC group comprised 70 consecutive patients with TFCC tears. The control group comprised 70 age- and sex-matched subjects without ulnar wrist pain. We evaluated the presence or absence of fluid collection in the DRUJ and ECU peritendinous area and longitudinal ECU tendon splitting. Dimensions of the fluid collection area around the ECU tendon were measured to evaluate the severity. The incidences of these abnormal MRI findings were compared between the two groups. We analyzed the correlation between the presence of ECU tendon and DRUJ lesions and variables including age, magnitude of ulnar variance, and type of TFCC tear.Results
Significant differences were found between the two groups in the incidence of fluid collection of the DRUJ and ECU peritendinous area, and longitudinal ECU tendon splitting. Among the 70 patients with TFCC tears, age and the magnitude of ulnar variance were significantly correlated with the severity of fluid collection around the ECU tendon. The magnitude of ulnar variance in patients with DRUJ fluid collection was significantly larger than that in patients without fluid collection. There was a significant correlation between the presence of disc tears and DRUJ fluid collection.Conclusion
We found a higher incidence of accompanying abnormal MRI findings of the ECU tendon and DRUJ in patients with TFCC tears than in the control group. The presence of disc tears, the magnitude of ulnar variance, and age may be risk factors for these MRI lesions associated with TFCC tears. 相似文献9.
L. Mannil W. Martin J. Dahmen T. Witte P. G. Juten F. Deneken M. Räder H. H. Homann 《European journal of trauma and emergency surgery》2016,42(1):29-35
Objective
Ruptures of ulnar-sided triangular fibrocartilaginous complex (TFCC) often occur in cases of trauma. Golden standard for diagnosis is the arthroscopy of the wrist. TFCC lesions are classified according to their location if traumatic in origin or if degenerative according to their severity.Materials and methods
Recent literature has focused on the ruptures of ulnar-sided triangular fibrocartilaginous complex. This article describes conservative, operative and arthroscopic surgical techniques to reconstruct the triangular fibrocartilaginous complex and restore distal radioulnar joint stability.Results
The main therapeutic goal should be the stabilization of the DRUJ by reattachment of the torn ligaments in ulnar-sided ruptures to the deep fibers in the fovea. This reinsertion can be performed by transosseous suture, a suture anchor or open.Conclusion
Central TFCC tears are typically located close to the sigmoid notch of the radius and are either traumatic or degenerative in origin. While central TFCC lesions are usually treated by arthroscopic debridement using small joint punches or a bipolar high frequency system, the ulnar TFCC avulsions can also be refixed arthroscopically in different techniques.10.
T. Pillukat R. A. Fuhrmann J. Windolf J. van Schoonhoven 《Operative Orthopadie und Traumatologie》2016,28(4):233-250
Objective
Refixation of the triangular fibrocartilage complex (TFCC) to the ulnar capsule of the wrist.Indications
Distal TFCC tears without instability, proximal TFCC intact. Loose ulnar TFCC attachment without tear or instability.Contraindications
Peripheral TFCC tears with instability of the distal radioulnar joint (DRUJ). Complex or proximal tears of the TFCC. Isolated, central degenerative tears without healing potential.Surgical technique
Arthroscopically guided, minimally invasive suture of the TFCC to the base of the sixth extensor compartment.Postoperative management
Above elbow plaster splint, 70° flexion of the elbow joint, 45° supination for 6 weeks. Skin suture removal after 2 weeks. No physiotherapy to extend pronation and supination during the first 3 months.Results
In an ongoing long-term study, 7 of 31 patients who underwent transcapsular refixation of the TFCC between 1 January 2003 and 31 December 2010 were evaluated after an average follow-up interval of 116 ± 34 months (range 68–152 months). All patients demonstrated an almost nearly unrestricted range of wrist motion and grip strength compared to the unaffected side. All distal radioulnar joints were stable. On the visual analogue scale (VAS 0–10), pain at rest was 1 ± 1 (range 0–2) and pain during exercise 2 ± 2 (range 0–5); the DASH score averaged 10 ± 14 points (range 0–39 points). All patients were satisfied. The modified Mayo wrist score showed four excellent, two good, and one fair result. These results correspond to the results of other series.Conclusion
Transcapsular refixation is a reliable, technically simple procedure in cases with ulnar-sided TFCC tears without instability leading to good results.11.
Steffen Löw Marion Mühldorfer-Fodor Thomas Pillukat Karl-Josef Prommersberger Jörg van Schoonhoven 《Archives of orthopaedic and trauma surgery》2014,134(1):131-137
Introduction
The treatment of ulnar-sided wrist pain after malunited distal radius fractures remains controversial. Radial corrective osteotomy can restore congruity in the distal radioulnar joint (DRUJ) as well as adequate length of the radius. Ulnar shortening osteotomies leave the radius’ angular deformities unchanged, risking secondary DRUJ osteoarthritis. We supposed that, even within the widely accepted limit of 20°, a greater angulation of the radius in the sagittal plane correlates with a higher rate of DRUJ osteoarthritis. Furthermore, we suspected worse results from an ulna shortened to a negative rather than a neutral or positive ulnar variance.Materials and methods
For this retrospective study, we reviewed 23 patients a mean 7.2 (range 5.6–8.5) years after ulnar shortening osteotomy for malunion of distal radius fractures. We compared 14 patients with up to 10° dorsal or palmar displacement from the normal palmar tilt of 10° to 9 patients with more than 10° displacement, and 15 patients whose post-operative ulnar variance was neutral or positive to 8 who had a negative one.Results
Ulnar-sided wrist pain decreased enough to satisfy 21 of the 23 patients. Clinical results tended to be better when radial displacement was minor and when post-operative ulnar variance was positive or neutral. A shorter ulna significantly increased the rate of DRUJ osteoarthritis, whereas a greater degree of radial displacement only increased the rate slightly.Conclusions
Radial corrective osteotomy should be discussed as alternative when displacement of the radius in the sagittal plane exceeds 10°. The ulna should be shortened moderately to reduce the risk of osteoarthritis in the distal radioulnar joint. 相似文献12.
《Journal of orthopaedic science》2022,27(4):881-886
IntroductionCertain type of injury of the triangular fibrocartilage complex associated with distal radius fracture can result in distal radioulnar joint instability (DRUJ). Untreated DRUJ instability may lead to poor result in the treatment of acute distal radius fractures. The aim of this study was to evaluate DRUJ instability in distal radius fractures through dorsal stress radiography comparing the affected and unaffected wrists intraoperatively.Materials and methods49 patients with a distal radius fracture who were operatively treated with a volar locking plate were included. Dorsal stress radiography was used to evaluate both affected and unaffected wrists peri-operatively to detect DRUJ instability. Under general anesthesia, a dorsal stress test was performed on the unaffected wrist. Additionally, after fixation of the affected wrist, a dorsal stress test was performed. The ulnar translation ratio (UTR) was measured through the dorsal stress radiograph. Arthroscopic examination was performed on all affected wrists according to Palmer's and Atzei classification.ResultsThe UTR of the affected wrist and the TFCC injury Palmer-type IB tendency were positively correlated (odds ratio: 1.18, p-value: 0.002). Additionally, as the UTR difference between the affected and unaffected wrists enlarged, it revealed a significant DRUJ instability tendency due to Palmer-type IB TFCC injury (p-value: 0.000006, Wilcoxon rank-sum test).ConclusionsDorsal stress radiography is a reliable, simple procedure to evaluate DRUJ instability intraoperatively. UTR value from dorsal stress radiography could be useful for evaluating DRUJ instability associated with distal radius fracture. 相似文献
13.
Introduction
The purpose of this study was to determine whether associated nonunion of ulnar styloid fracture following plate-and-screw fixation of a distal radius fracture (DRF) has any effect on wrist functional outcomes, ulnar-sided wrist pain or distal radioulnar joint (DRUJ) instability.Materials and methods
A total of 91 consecutive patients with a DRF and an accompanying ulnar styloid fracture treated by open reduction and volar locking plate fixation were included in this study. In the first part of the analysis, the 91 study subjects were subdivided according to the presence or not of ulnar styloid union (20 and 71, respectively) by radiography at final follow-up (average 23 months). These two cohorts were compared with respect to wrist functions at 3 months postoperatively and the final follow-up visit, and ulnar-sided wrist pain and DRUJ instability at the final follow-up visit and ulnar styloid length as determined radiographically at final follow-up. In the second part of the analysis, 49 of the 91 study subjects with an ulnar styloid base fracture were subdivided according to the presence or not of ulnar styloid base fracture union (12 and 37, respectively) at final follow-up by radiography. These two groups were also compared with respect to the above-mentioned parameters.Results
Ulnar styloid fractures united in 20 (22%) of the 91 patients at final follow-up visit (average 23 months). No significant differences were found at any time during follow-up between patients who achieved or did not achieve ulnar styloid fracture union or ulnar styloid base fracture union.Conclusion
Ulnar styloid nonunion does not appear to affect wrist functional outcomes, ulnar-sided wrist pain or DRUJ stability, at least when a DRF is treated by open reduction and volar plate fixation. 相似文献14.
Patrick G. Marinello Sebastian Peers Blaine T. Bafus Peter J. Evans 《Hand (New York, N.Y.)》2015,10(4):802-806
Distal radioulnar joint (DRUJ) stability requires competent static and dynamic soft tissues. Multiple DRUJ techniques have been described in the literature. Our method is a novel modification of the Gupta method of DRUJ stabilization used in a revision reconstruction on a patient with a total wrist arthroplasty. A brachioradialis graft is harvested and tunneled through Parona’s space volar to the pronator quadratus and through the muscle body. The tendon is then brought dorsal between the radius and ulna to the dorsal side of the distal ulna and sutured to the floor of the 5th extensor compartment, as well as to the surrounding extensor reticulum ulnar to the 6th compartment with nonabsorbable sutures. Our modification of the method described by Gupta prevents ulnar subluxaton of the extensor carpal ulnaris (ECU), allows the tendon graft construct to more adequately resist volar translation of the radius, and thus acts like a leash to pull the radius dorsally to the stationary ulna. This modification gives the graft a better force vector to resist the volar translation of the distal radius. We are able to present successful 30-month follow-up of this procedure.
Electronic supplementary material
The online version of this article (doi:10.1007/s11552-015-9752-0) contains supplementary material, which is available to authorized users. 相似文献15.
《Journal of orthopaedic science》2023,28(2):364-369
BackgroundUlnar shortening osteotomy (USO), as its name implies, is used to shorten the ulna. It subsequently tightens the triangular fibrocartilage complex (TFCC) and ulnar wrist. TFCC foveal insertion is a primary stabilizer of the distal radioulnar joint. It is unclear whether USO is effective in TFCC foveal injuries. The purpose of this study was to review the clinical outcomes of ulnar shortening osteotomies with and without TFCC foveal injuries.MethodsWe retrospectively reviewed patients with ulnar wrist pain treated with USO and wrist arthroscopy including the distal radioulnar joint (DRUJ). Sixty-five patients were included in this study. An algorithm was used to guide surgical decision-making. After arthroscopic confirmation of ulnar impaction syndrome, we performed USO with a locking compression plate (mean length of shortening, 2.7 mm; range, 1–7.5 mm). The flattened TFCC disc due to ulnar shortening was confirmed arthroscopically. If the DRUJ was unstable after USO, we repaired the TFCC foveal insertion.ResultsThere were 32 post-traumatic and 33 idiopathic cases. We detected TFCC disc injuries in 34 wrists and TFCC foveal injuries in 33 wrists; both types were found in 15 wrists. TFCC foveal injuries were not significantly correlated with patient age, history of trauma, or clinical outcome. Most patients showed good clinical outcomes; 31 of 65 patients had preoperative DRUJ instability, with a significant number having foveal but not disc injuries.ConclusionUSO achieved reasonable outcomes, even in patients with TFCC foveal injuries. In cases demonstrating ulnar impaction, USO should be prioritized over TFCC repair. 相似文献
16.
Objective
Anatomical reconstruction of the distal radius after intra-articular fractures with special consideration of the articular surface and treatment of concomitant ligament injuries.Indications
Intra-articular distal radius fractures in adults under 65 years of age.Contraindications
Osteoporotic deterioration of metaphyseal bone, radiocarpal fracture dislocation and open fractures.Surgical technique
Conventional palmar approach for plate fixation of the fracture with a fixed angle locking plate. Arthroscopy of the wrist is performed for reduction of the articular fracture component using the standard 3?4 and 6R portals. Following temporary Kirschner (K) wire fixation of the fracture, angle stable locking screws are inserted into the most distal portion of the plate. Finally, the intercarpal ligaments and the triangular fibrocartilage complex (TFCC) are checked for concomitant lesions and if necessary subsequent treatment within the same operation.Postoperative management
Plaster cast fixation for 4 weeks followed by a physiotherapy program.Results
After arthroscopically assisted reduction of an intra-articular distal radius fracture, 17 out of the 23 patients were available for follow-up examination an average of 31 months after the procedure. The mean disabilities of the arm, shoulder and hand (DASH) score was 4.9 and the mean patient-rated wrist evaluation (PRWE) score was 6.0 at final follow-up. Except for wrist flexion, an active range of motion at the wrist as well as forearm rotation of more than 90?% was achieved compared with the uninjured contralateral side. Grip strength averaged 96?% compared with the contralateral side and pain levels under stress varied between 1 and 3 on a visual analog scale (range 0–10).17.
Objective
Arthroscopic decompression (wafer procedure) of the ulnocarpal compartment in patients with ulnar impaction syndrome.Indications
The arthroscopic wafer procedure is recommended in ulnar-plus situations with up to 3 mm length-excess. To perform this procedure the ulnar head needs to be accessible for the burr through a pre-existing, impaction-related, centroradial lesion of the triangular fibrocartilage complex (TFCC). The additional presence of a distal radioulnar joint (DRUJ) type C confirms the indication.Contraindications
The wafer procedure is contraindicated if there is no consistent TFCC injury ensuring access to the ulnar head and furthermore in ulna-plus situations of more than 3 mm. Relative contraindications: in young patients due to lack of evidence-based studies.Surgical technique
Arthroscopic, semicircular, partial resection of the ulnar head in terms of oblique–helicoidal osteotomy using a 4.2 mm burr, while sparing the DRUJ and the dorsal and the palmar radioulnar ligaments.Postoperative management
Immobilization for 1 week in a palmar splint with immediate intensive exercising of pro- and supination under physiotherapeutic instruction.Results
Between 2008 and 2010, an arthroscopic wafer procedure was performed in 24 patients. The resection of the ulnar head was 2.5 mm on average. After a mean follow-up time of 13.25 months, very good results were archived in 23 of 24 patients; the ulnar impingement test was negative. On a visual analog scale (0–10) average postoperative pain was 1.16 at rest and 4.5 under stress. The mean postoperative DASH score was 13.4.18.
19.
Akio Minami Yukinobu Kamiya Yasuaki Tojo Satoko Matsumoto Harmon Kota Suda 《Journal of orthopaedic science》2018,23(3):516-520
Background
The Sauvé-Kapandji (SK) procedure is one of several surgical options in the treatment of distal radioulnar disorders by osteoarthritis (OA) and rheumatoid arthritis (RA). While satisfactory postoperative clinical results were obtained in most cases, instability of the proximal ulnar stump and radioulnar convergence are the most common complications. Minami et al. have developed a modification of the SK procedure that maintains the transverse diameter of the distal radioulnar joint and stabilizes the proximal ulnar stump, using a half-slip of the extensor carpi ulnaris tendon. In this study, the modified SK procedure was performed on 83 patients with distal radioulnar disorders, due to OA and RA.Materials and methods
We evaluated the clinical and radiographical postoperative results with an average follow-up period of 82.3 months.Results
Post-operative extension of the wrist and pronation/supination of the forearm had significantly improved with the exception of wrist flexion. Postoperative x-rays showed no instability of the proximal ulnar stump in both coronal and lateral planes. However, breakage of the drilled hole at the proximal ulnar stump occurred in 10 cases, and of these, there was instability of the proximal ulnar stump in 5 cases.Conclusions
This modification is very simple and does not require extension of the surgical field. This paper concludes that the modified SK procedure is a safe and effective surgical intervention of distal radioulnar disorders from OA and RA. 相似文献20.
Gokmen Deniz Ozkan Kose Serhat Yanik Tugrul Colakoglu Ali Tugay 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2014,24(7):1155-1159