尺桡骨近端粉碎骨折伴肘关节后脱位的治疗

目的探讨尺桡骨近端粉碎骨折伴肘关节后脱位的治疗方法和疗效。方法尺桡骨近端粉碎骨折伴肘关节后脱位患者30例,男23例,女7例;年龄18～52岁,平均年龄30岁。采用钢板螺钉内固定治疗,其中一期植骨20例。桡骨小头骨折部分,如骨折粉碎不严重,复位后用克氏针固定,并修补环状韧带;如骨折粉碎严重,则行人工桡骨头置换,同时取自体掌长肌腱重建环状韧带。尺骨冠突骨折部分,选用克氏针或拉力螺钉固定骨折块,同时探查尺侧副韧带前束,如损伤予以修复或重建;如合并尺骨鹰嘴骨折,采用钢板螺钉内固定治疗。结果患者伤口均一期愈合,骨折愈合率为100%。术后随访10～48个月,平均29个月。5例有创伤性关节炎表现,2例发生轻度创伤性骨化。肘关节平均屈伸范围100°～110°,前臂平均旋转活动范围为90°～100°。按照Morrey等肘关节功能评分标准进行评价：优12例,良15例,可2例,差1例,总优良率为90%。结论治疗尺桡骨近端粉碎骨折伴肘关节后脱位可采用钢板螺钉固定尺桡骨近端骨折,必要时行一期植骨,注意对桡骨,尺骨冠突骨折及肘关节侧副韧带损伤的治疗,以防止肘关节不稳定。     

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.     

Surgical fixation of the adult distal radius fracture: when and why?

Distal radius fractures (DRF) are common. They have a bimodal distribution typically occurring as a high-energy injury in the young or a low-energy injury in the older patient with osteoporosis. With the number of DRF predicted to rise, it is important to know how to manage DRF appropriately. The options for the surgical management of adult DRF can appear varied and bewildering. This is further confused by the expanse of literature available regarding the different options, the different types of plate design, and the almost bipartisan belief that either minimalist techniques may be all that are required versus the compulsion to meticulously restore normal anatomy in an attempt to maximize function and reduce disability.     

Reconstruction of coronoid process of the ulna: a literature review

As a pivotal part of the elbow joint structure, the coronoid process of the ulna plays a vital role in maintaining elbow joint stability. Loss of coronoid process height causes instability of the elbow joint depending on the fracture characteristics and size. The diagnosis and treatment of coronoid process fractures has gained widespread attention from orthopedic surgeons. Nevertheless, few reports have described reconstruction of coronoid process fractures and defects that affect elbow joint stability. Treatment of elbow joint instability induced by coronoid process defects is challenging because most cases are complicated by other elbow joint injuries. Moreover, the clinical efficacy remains unclear. The present narrative review was performed to examine the research progress on reconstruction of the coronoid process. The findings of this review provide evidence for clinical repair and reconstruction of coronoid process defects and contribute to the published literature on this topic.     

Prediction of standing height among Israeli older adults: Results from a national survey

Background: An accurate measurement of full height while standing is sometimes not possible among older adults, in particular among the frail elderly. For such cases, the use of knee height (KH) and ulna bone length (UL) has been suggested for standing height estimation. Studies have shown that predictive equations of height were ethnic-specific.

Aim: This study attempted to develop representative equations to predict standing height based on KH, UL and waist circumference (WC) for older adult Israeli women and men.

Subjects and methods: A random sample of 1500 older adults (aged 74.48 ± 6.09 years old). Participants were interviewed in their homes and measurements of Standing height, KH, UL and WC were taken. A quadratic regression analysis, for each sex separately, was performed to predict standing height based on age, KH, UL and WC.

Results: The adjusted r ² standing height prediction equations were 0.51 and 0.67 for women and men, respectively.

Conclusions: The prediction of the standing height of frail elderly Israelis, by KH, UL, WC and age, may be an alternative method when actual standing height is difficult or not possible to measure.     

尺骨鹰嘴骨折四种固定的比较与选择

目的:总结尺骨鹰嘴骨折治疗体会,为选择合理方法提供依据。方法:对分别采用“8”字钢丝内固定(A组)、螺丝钉内固定(B组)、张力带钢丝内固定(C组)、鹰嘴钩外固定(D组)4种方法收治的162例该病患者的临床资料进行回顾性分析。结果:根据远期临床功能恢复情况疗效评价,达优良率者ABCD组分别为62.5％、65.6％、94.3％和96.2％,D组与C组疗效无显著差异(P>0.05),与A组和B组相差显著(P<0.05),C组优良率高于A组和B组(P<0.01)。结论:尺骨鹰嘴骨折四种固定疗法中“8”字钢丝法、螺丝钉法不应作为常规首选,张力带钢丝法有效可靠,鹰嘴钩法可作为最佳的选择。     

Fibroblastic Type Osteosarcoma of the Ulna: a Case Report of a Tumor in a Rare Location with Atypical Imaging Findings

The ulna is a rare site of origin for osteosarcoma, and purely osteolytic osteosarcomas are uncommonly noted on conventional radiographs. We present a patient with a lytic lesion of the distal ulna for which imaging findings suggested an aneurysmal bone cyst. The lesion was histologically confirmed to be a fibroblastic osteosarcoma.     

益气活血汤对桡骨缺损动物尺骨应力的影响

根据负重能促进骨的生长和修复的理论，观察了桡骨缺损的家兔在任其自由活动情况下其同侧尺骨的反应，以及自拟益气活血汤对尺骨这种应力反应的影响。结果发现，对照组损伤侧尺骨骨髓腔较健侧明显变细，用药组则更细，明显小于对照组。用药组血液流变学较对照组有明显改善，体重增长也高于对照组。因此推论，整体机能的提高可能是促进尺骨应力反应的原因。     

前臂骨折牵引固定器的研制及临床应用——附210例临床分析

为解决尺桡骨远端不稳定性骨折固定困难的问题,经长期研究,设计出一种以改良传统前臂背侧长夹板和腕部牵引套及拉力牵引装置组成的前臂骨折牵引固定器,。经２１０ 例治疗观察,随防６ 个月～２ 年,治疗前后Ｘ 线检查及临床疗效评定优１８６ 例,良１８ 例,可６ 例。认为该固定器操作简便,固定牢靠,有持续牵引作用,能使骨折局部固定和持续牵引相结合,且不介入体内,疗效可靠,是一种治疗尺桡骨远端不稳定性骨折比较新颖和理想的外固定器具。