Conservative Treatment with Active Exercises in Osteoarthritis of the Hip

Six patients with cubitus varus deformity after a supracondylar fracture of the humerus had ulnar nerve palsy 7 (3–14) years following the fracture. All the patients showed anterior dislocation of the ulnar nerve during elbow flexion. In cubitus varus deformity, medial shifting of the triceps muscle occurs, which pushes the ulnar nerve anteriorly and frequently causes ulnar-nerve dislocation. Five of the 6 patients under-went surgery with subsequent improvement.     

Ulnar nerve palsy after supracondylar humerus fracture

Six patients with cubitus varus deformity after a supracondylar fracture of the humerus had ulnar nerve palsy 7 (3-14) years following the fracture. All the patients showed anterior dislocation of the ulnar nerve during elbow flexion. In cubitus varus deformity, medial shifting of the triceps muscle occurs, which pushes the ulnar nerve anteriorly and frequently causes ulnar-nerve dislocation. Five of the 6 patients under-went surgery with subsequent improvement.     

Ulnar nerve palsy after supracondylar humerus fracture

Six patients with cubitus varus deformity after a supracondylar fracture of the humerus had ulnar nerve palsy 7 (3-14) years following the fracture. All the patients showed anterior dislocation of the ulnar nerve during elbow flexion. In cubitus varus deformity, medial shifting of the triceps muscle occurs, which pushes the ulnar nerve anteriorly and frequently causes ulnar-nerve dislocation. Five of the 6 patients underwent surgery with subsequent improvement.     

The “floating forearm” injury in a child: a case report

Abstract: The case of a eleven-year-old girl who had a fracture dislocation of the left elbow with entrapment of the ulnar nerve into the dislocated ulnar epicondyle anlage and unstable forearm fracture of the ipslateral upper extremity is described. This severe injury to the elbow and the ipsilateral forearm is termed “floating forearm” injury. The forearm was stabilized percutaneously and the elbow fracture dislocation, remaining unstable after internal fixation was treated with a pediatric elbow fixator with motion capacity. Electronic supplementary material The online version of this articlecontains supplementary material, which is available on SpringerLink     

Ulnar fracture with late radial head dislocation: delayed Monteggia fracture

Monteggia fractures are rare but commonly discussed lesions, with increasing complications due to late diagnosis. This article describes a case of a Monteggia fracture with delayed dislocation of the radial head. Previous radiographs of a 2-year 8-month-old boy show complete fracture of the distal ulna, with no radial head dislocation. The radial head remained well positioned after 4 weeks. Seven years later, he sustained another arm injury. He was diagnosed with a hematoma but was later believed to have nursemaid's elbow. He presented to our institution 5 weeks after the injury, and the radial head was found to be chronically dislocated, indicating a displacement occurring sometime during the past 7 years. After failing conservative treatment, the patient underwent surgical repair. The annular ligament was reconstructed using a harvested triceps fascia band, and an ulnar osteotomy was performed. A review of the literature found few reports of delayed Monteggia fractures, which accounted the delayed dislocations to ulnar angulation. However, our patient showed minimal ulnar angular deformity. We propose that the initial fracture disrupted the annular ligament and the radial head spontaneously relocated prior to being seen, which put the radial head at risk for later dislocation. We present an alternative hypothesis of dislocation after fracture healing and report the longest known period of delay between fracture and dislocation.     

Fracture-dislocation of the base of the fifth metacarpal with an ulnar motor nerve lesion: case report

We report a case of delayed diagnosis of a fracture dislocation of the base of the fifth metacarpal with a resultant ulnar motor nerve lesion. The patient achieved marked improvement after fracture reduction and ulnar neurolysis.     

Neglected reverse Essex-Lopresti injury with ulnar nerve compression

A 45 year old woman was diagnosed as having anteromedial radial head dislocation and distal radius fracture five months after her injury on right forearm.The radial head dislocation led to ulnar nerve compression.She had severe restriction of her elbow movements. She was treated with arthrolysis, decompression of the ulnar nerve and radial head resection. The reverse Essex Lopresti injury and radial head dislocation compressing the ulnar nerve has not been reported in English language literature to the best of our knowledge. A mechanism is proposed for the injury. In acute presentations, restoration of both the radioulnar joints should be done and neglected nature of such injury leads to suboptimal outcomes.     

下尺桡脱位合并桡骨头脱位的诊断与治疗

目的探讨下尺桡脱位合并桡骨头脱位的的诊断和治疗。方法本文报道的2个典型病例,一例是下尺桡背侧脱位同时合并桡骨头后脱位,另一例是下尺桡掌侧脱位合并桡骨头前脱位,均不合并尺桡骨干的骨折。用单纯桡骨头脱位或下尺桡脱位的机制不能很好地解释。对于急性损伤,应先在麻醉下试行闭合复位,如不成功可考虑切开复位。结果根据目前研究,“绞锁损伤”的机制能比较好得解释这种损伤,骨间膜在前臂两骨之间起到一个“枢轴”的作用。早期诊断和治疗能达到良好的效果。结论早期诊断和早期复位固定非常重要,需要和孟氏骨折、盖氏骨折或Essex—Lopresti损伤等相鉴别。     

Open irreducible fracture/dislocation of the four ulnar metacarpals at the metacarpophalangeal joints: case report

Open irreducible fracture/dislocation of multiple metacarpophalangeal joints is an exceedingly rare injury and, to our knowledge, not yet described in the literature. An earlier belief that metacarpophalangeal dislocations were high-energy injuries is questioned by this case report due to an unusual case of open irreducible fracture/dislocation of the four ulnar metacarpals that occurred in a hand trauma. A 24-year-old man presented in the emergency department with an open irreducible fracture/dislocation of the four ulnar metacarpals and impaired flexion of the metacarpophalangeal joint of his left hand. The injury was described as an open injury of his third metacarpal head with an associated fracture of the fourth metacarpal head and dorsal dislocation of the four ulnar metacarpals after a fall onto the outstretched hand. Early recognition and anatomical reduction are essential to achieve good long-term outcomes. Massive edema, interposed volar ligaments, and overlapping metacarpal bases are the usual obstacles to a successful closed reduction. Use of a palmar approach was the key to reduce the displacement. Joint stability and osteosynthesis with K-wires were achieved, and the patient has been asymptomatic for more than 24 months.     

Injuries of the terminal branches of the infraclavicular brachial plexus: patterns of injury, management and outcome

We reviewed 101 patients with injuries of the terminal branches of the infraclavicular brachial plexus sustained between 1997 and 2009. Four patterns of injury were identified: 1) anterior glenohumeral dislocation (n = 55), in which the axillary and ulnar nerves were most commonly injured, but the axillary nerve was ruptured in only two patients (3.6%); 2) axillary nerve injury, with or without injury to other nerves, in the absence of dislocation of the shoulder (n = 20): these had a similar pattern of nerve involvement to those with a known dislocation, but the axillary nerve was ruptured in 14 patients (70%); 3) displaced proximal humeral fracture (n = 15), in which nerve injury resulted from medial displacement of the humeral shaft: the fracture was surgically reduced in 13 patients; and 4) hyperextension of the arm (n = 11): these were characterised by disruption of the musculocutaneous nerve. There was variable involvement of the median and radial nerves with the ulnar nerve being least affected. Surgical intervention is not needed in most cases of infraclavicular injury associated with dislocation of the shoulder. Early exploration of the nerves should be considered in patients with an axillary nerve palsy without dislocation of the shoulder and for musculocutaneous nerve palsy with median and/or radial nerve palsy. Urgent operation is needed in cases of nerve injury resulting from fracture of the humeral neck to relieve pressure on nerves.     

Radiocarpal dislocations: classification and proposal for treatment. A review of twenty-seven cases

BACKGROUND: The radiographic characteristics and treatment of radiocarpal dislocation are not well defined. There have been only two reported series of more than eight patients. Thus, there are many questions concerning treatment and functional results. METHODS: Two groups of patients were defined. Group 1 included all patients with pure radiocarpal dislocation and patients with only a fracture of the tip of the radial styloid process. Group 2 included patients with radiocarpal dislocation and an associated fracture of the radial styloid process that involved more than one-third of the width of the scaphoid fossa. A retrospective review and a clinical evaluation were performed. RESULTS: From 1975 to 1998, we observed twenty-seven cases of radiocarpal dislocation. Four were displaced volarly, and twenty-three were displaced dorsally. Fourteen patients presented with associated lesions. Four patients were treated with closed reduction and immobilization in a plaster cast; five, with percutaneous Kirschner wire fixation and cast immobilization; and two, with an external fixator. Eleven patients had open reduction with Kirschner wire fixation and cast immobilization. The seven patients in Group 1 had a highly unstable injury, and four of the seven patients presented with ulnar translation of the carpus. At the time of follow-up, at an average of 26.8 months, pronation averaged 76 degrees; supination, 66 degrees; wrist flexion, 54 degrees; wrist extension, 54 degrees; radial inclination, 15 degrees; and ulnar inclination, 18 degrees. The average grip strength was 27 kg. Group 2 included twenty patients. Only thirteen, with dorsal dislocation, were evaluated at the time of follow-up, which averaged fifty-one months. At that time, six reported no pain; four, slight pain; and two, moderate pain. Pronation averaged 63 degrees; supination, 76 degrees; wrist flexion, 51 degrees; wrist extension, 56 degrees; radial inclination, 21 degrees; and ulnar inclination, 39 degrees. Grip strength averaged 38 kg. Seven patients had complications. CONCLUSIONS: On the basis of our experience and a review of the literature, we believe that patients with pure radiocarpal dislocation or with radiocarpal dislocation with a fracture of the tip of the radial styloid process should be treated with reattachment of the ligaments through a volar approach. In patients with radiocarpal dislocation and a fracture of the radial styloid process that involves more than one-third of the width of the scaphoid fossa, the ligaments are still attached to the radial fragment. We believe that in this group of patients, exact articular reduction should be performed through a dorsal approach. Additional studies are needed to support these hypotheses.     

Fracture of the distal radius with ulnar nerve palsy

A patient with immediate palsy of the ulnar nerve secondary to a distal fracture of the radius and possibly a dislocation of the distal radio-ulnar joint (Galeazzi's fracture) is described. Surgery demonstrated a serious contusion of the nerve, scarring around the nerve, and thrombosis of the ulnar artery. Symptoms rapidly disappeared after neurolysis.     

Management of severely displaced medial epicondyle fractures

The role of surgical fixation of the displaced medial epicondyle fracture remains controversial. We reviewed 20 patients with displaced (mean 10 mm) fractures, all associated with elbow dislocation. All elbows were therefore unstable, and all were managed nonoperatively. Although all fractures healed by fibrous union, the functional results were good. Clinical and radiological tests were used to assess the static stability of the ulnar collateral ligament. All patients had demonstrable ulnar collateral ligament laxity, but only one patient had slight impairment of elbow function. None had late-onset ulnar neuritis. We have shown that even the severe forms of this injury can be managed without internal fixation.     

Biepicondylar fracture dislocation of the elbow joint concomitant with ulnar nerve injury

In this article, we present a case of humeral biepicondylar fracture dislocation concomitant with ulnar nerve injury in a seventeen year-old male patient. Physical examination of our patient in the emergency room revealed a painful, edematous and deformed-looking left elbow joint. Hypoesthesia of the little finger was also diagnosed on the left hand. Radiological assessment ended up with a posterior fracture dislocation of the elbow joint accompanied by intra-articular loose bodies. Open reduction-Internal fixation of the fracture dislocation and ulnar nerve exploration were performed under general anesthesia at the same session as surgical treatment of our patient. Physical therapy and rehabilitation protocol was implemented at the end of two weeks post-operatively. Union of the fracture lines, as well as the olecranon osteotomy site, was achieved at the end of four months post-operatively. Ulnar nerve function was fully restored without any sensory or motor loss. Range of motion at the elbow joint was 20-120 degrees at the latest follow-up.     

Rare double fracture-dislocation of the thumb： a case report and review of the literature

Simultaneous fracture/dislocation of the thumb carpometacarpal (CMC)joint and dislocation of the metacarpophalangeal (MCP)joint is considered as a rare injury pattern.We report an unusual case of dorsa...     

Operative treatment of Medial epicondyle fractures in children

Thirty-one patients with fractures of the medial epicondyle displaced more than 2 mm were evaluated an average of four years after their injury. Twenty-three patients had good results regardless of the degree of displacement or the presence of an elbow dislocation. One patient, had a poor result due to a technical error in pin placement. The remaining seven patients had the fracture fragment trapped in the joint and did worse, with three poor results. There was no correlation between range of motion and degree of displacement, length of immobilization, time from injury to surgery, presence of a dislocation, or open versus percutaneous treatment. Operative treatment of medial epicondyle fractures displaced greater than 2 mm gave consistently good results with a good range of motion, good stability, no ulnar nerve symptoms, and no deformity.     

子母螺钉固定治疗Regan-MorreyⅡ型尺骨冠突骨折

目的 探讨子母螺钉固定治疗Regan-MorreyⅡ型尺骨冠突骨折的初期临床疗效.方法 回顾性分析2010年10月至2012年6月,采用子母螺钉固定治疗12例Regan-MorreyⅡ型尺骨冠突骨折患者资料,男8例,女4例;年龄19～69岁,平均42.3岁.其中9例合并桡骨头骨折,2例合并尺骨近端骨折,1例合并尺神经损伤,8例合并韧带损伤,7例合并肘关节脱位;7例诊断为肘关节恐怖三联征.先治疗桡骨头骨折,然后采用1枚子母螺钉固定治疗冠突骨折,最后复位肘关节及修复韧带损伤.采用Mayo肘关节功能评分(Mayo elbow performance score,MEPS)评估临床功能,以Broberg-Morrey影像学标准对骨关节炎进行分级.结果 12例患者均获得5～18个月随访,肘关节屈伸活动度平均为121.8°,旋转活动度为平均145.1°.MEPS评分为72～100分;优4例,良7例,可1例,优良率91.7％.术后2例(16.7％)有骨关节炎征象,其中Broberg-Morrey分级1级1例,2级1例.末次随访时1例发生轻度异位骨化.肘关节均得到解剖复位;骨折均愈合,愈合时间1.8～3.4个月.1例尺神经损伤患者术后3个月完全恢复.术后无一例发生继发性关节脱位、内固定松动、移位或断裂、感染及行二次手术.结论 采用切开复位子母螺钉固定治疗Regan-MorreyⅡ型尺骨冠突骨折,术后肘关节功能恢复良好,并发症少.     

Unrecognized dislocation of the medial portion of the triceps: another cause of failed ulnar nerve transposition

OBJECT: Failed surgical treatment for ulnar neuropathy or neuritis due to dislocation of the ulnar nerve presents diagnostic and therapeutic challenges. The authors of this paper will establish unrecognized dislocation (snapping) of the medial portion of the triceps as a preventable cause of failed ulnar nerve transposition. METHODS: Fifteen patients had persistent, painful snapping at the medial elbow after ulnar nerve transposition, which had been performed for documented ulnar nerve dislocation with or without ulnar neuropathy. The snapping was caused by a previously unrecognized dislocation of the medial portion of triceps over the medial epicondyle. Seven of the 15 patients also had persistent ulnar nerve symptoms. The correct diagnosis of snapping triceps was delayed for an average of 22 months after the initial ulnar nerve transposition. An additional surgical procedure was performed in nine of the 15 cases and, in part, consisted of lateral transposition or excision of the offending snapping medial portion of the triceps. Of the four patients in this group who had persistent neurological symptoms, submuscular transposition was performed in the two with more severe symptoms and treatment of the triceps alone was performed in the two with milder neurological symptoms. Excellent results were achieved in all surgically treated patients. Six patients declined additional surgery and experienced persistent snapping and/or ulnar nerve symptoms. CONCLUSIONS: Failure to recognize that dislocation of both the medial portion of the triceps and the ulnar nerve can exist concurrently may result in persistent snapping, elbow pain, and even ulnar nerve symptoms after a technically successful ulnar nerve transposition.     

Posterior dislocation of the ulna at the elbow with associated fracture of the radial shaft

An exceptional case of posterior dislocation of the ulna at the elbow, associated with fracture of the radial shaft, is reported. Diagnosis was established with anteroposterior and lateral radiographs of the forearm, elbow and wrist. Treatment consisted of closed reduction of the ulnar dislocation and open reduction and internal fixation of the radius with an AO plate. A long arm cast was applied for 3 weeks with the elbow held at 90 °. Six months later full function of the limb had been achieved.     

Lateral condylar fracture and ipsilateral ulnar shaft fracture: Monteggia equivalent lesions?

Displaced ulnar shaft fractures are frequently associated with radiohumeral dislocation, producing the Monteggia fracture-dislocation. Fractures not previously thought to coexist were seen in a young boy following a severe automobile-pedestrian accident. The displaced ulnar shaft fracture was associated with a displaced lateral condylar fracture with preservation of the radiocapitellar joint and capsule. This fracture was treated with rigid internal fixation in spite of the open nature of the ulnar shaft fracture. This treatment permitted early range of motion of the elbow with early use of ambulatory aids for other associated injuries and an excellent follow-up at 13 months with a normal range of motion of the elbow.