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Ulnar instability

Hisao Moritomo, Sayuri Arimitsu
We developed a novel procedure to treat a triangular fibrocartilage complex (TFCC) foveal tear, namely tenodesis of the ulnotriquetrum ligament (UTL) to the fovea. We attempted to reestablish the tension of the palmar radioulnar ligament by the procedure specifically in cases with palmar radius instability relative to the ulna. We used a palmar surgical approach to expose the palmar aspect of TFCC in which the ulnocarpal ligament merges with the palmar radioulnar ligament. UTL was distally excised at a 4 mm width from the triquetrum without disrupting its ligamentous connection to the palmar radioulnar ligament proximally...
October 8, 2018: Techniques in Hand & Upper Extremity Surgery
J E Dipierri, E Gutiérrez-Redomero, N Rivaldería, M C Alonso-Rodríguez, E Alfaro
Asymmetry is omnipresent in the living world and therefore is a measure of developmental noise and instability. The main stressing agent in high-altitude ecosystems is hypobaric hypoxia. The variation in bilateral dermatoglyphic symmetry in populations from the Province of Jujuy in northwest Argentina is analyzed, and these results are compared to those for other populations with different ethnic and environmental backgrounds. Fingerprints were collected from 310 healthy students (140 males and 170 females) aged 18-20 years from three localities in Jujuy Province-Abra Pampa (3484 m above sea level), Humahuaca (2939 m above sea level), and San Salvador de Jujuy (1260 m above sea level)...
September 29, 2018: Homo: Internationale Zeitschrift Für die Vergleichende Forschung Am Menschen
M Vlček, M Streck, I Čižmář, J Pech, I Landor
PURPOSE OF THE STUDY The aim of our study was to determine the indications for radial head resection at the present day. MATERIAL AND METHODS The radial head resection was performed in the period from 2008 to 2015 in 63 patients divided into three groups. The first group marked "CR" consisted of 33 patients with the Mason type III fracture. The second group marked "CRLUX" included 20 patients with the Mason-Johnston type IV fracture, i.e. a fracture of the proximal end of the radius with a dislocation of the elbow joint...
2018: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
I Čižmář, J Kovařík, M Vlček, P Korpa
PURPOSE OF THE STUDY The study evaluated the method of arthroscopic stabilisation of dynamic scapholunate (SL) instability by scapholunate joint resection using bone graft to create synarthrosis between the scaphoid and lunate. MATERIAL AND METHODS Twenty-six patients with chronic dynamic SL instability of Geisler-Messina - EWAS grade IIIB, C and IV were treated by artificial synarthrosis of SL joint using an arthroscopic technique. The mean follow-up period of the patients was 32.2 months (28-39 months, when the range of motion and grip strength were assessed...
2018: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Raffy Mirzayan, Joseph D Cooper
Medial epicondyle fracture nonunions of the elbow may lead to symptomatic instability in the high-demand or overhead athlete. These injuries are challenging to treat surgically because of the small residual bony fragment, the scarred and shortened chronically injured ulnar collateral ligament (UCL), which prevents it from being mobilized and reduced to its native position. To date, most described methods aim at reducing the displaced fragment and achieving union with the humerus. This usually can only be accomplished by releasing of the scarred UCL to mobilize the fragment...
September 18, 2018: Journal of the American Academy of Orthopaedic Surgeons
Kotaro Sato, Kenya Murakami, Yoshikuni Mimata, Norio Numata, Hideo Shiraishi, Minoru Doita
INTRODUCTION: Although volar locking plates (VLPs) have been exclusively used for unstable distal radius fractures (DRFs), the optimal management of distal ulna fractures (DUFs) remains controversial. Internal fixation using a plate for DUFs might be challenging because of the presence of osteoporotic bone and fragile bone fragments in elderly patients. HYPOTHESIS: We hypothesized that a strategy including VLP fixation for DRFs and non-intervention for DUFs with early wrist mobilization would provide encouraging results in elderly patients...
September 19, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Aisha N Young, Pierre Amsellem, Tammy L Muirhead, LeeAnn Pack, Andrea R Matthews
Distal ulnar ostectomy may be performed palliatively in patients with distal ulnar osteosarcoma. Concurrent arthrodesis of the carpus has been proposed to counteract joint instability following transection of carpal ligaments associated with removal of the distal ulna. The objective of this prospective one group pretest, posttest study was to assess stability of the carpus following distal ulnar ostectomy using pre- and postoperative stress radiographic views in a group of canine cadaver limbs. Seven thoracic limbs from six canine cadavers weighing more than 20 kg were obtained...
September 21, 2018: Veterinary Radiology & Ultrasound
Muxin Zheng, Xiaodong Lin, Shuchai Xu, Hongliang Liu, Jian Liu, Zexin Huang
Objective: To investigate the effectiveness of ulnar shortening osteotomy combined with elastic suspension fixation for ulnar impaction syndrome caused by relatively long ulna. Methods: Between October 2015 and August 2016, 3 cases of ulnar impaction syndrome were treated. One patient was male and 2 patients were females. The age was 32, 29, and 59 years, respectively. One patient was dislocation and impaction of distal radioulnar joint for more than 1 year after internal fixation due to ulnar and radial open fractures...
August 1, 2018: Chinese Journal of Reparative and Reconstructive Surgery
Julie E Adams, S Andrew Sems, Scott P Steinmann
Radial head fractures may commonly be treated by (1) open reduction and internal fixation (ORIF), (2) radial head excision, or (3) radial head replacement. If there is no associated elbow instability with lateral ulnar collateral ligament (LUCL) injury, the preferred approach is via a split in the extensor digitorum communis (EDC) origin. This provides a wide exposure but limits the risk of injury to the LUCL and associated instability. The radial head is fixed, excised, or replaced. Open treatment of radial head fractures begins with the following steps: (1) a laterally based incision is centered over the radiocapitellar joint, (2) the EDC is split at the midline of the radial head and elevated off the bone anteriorly and superiorly, and dissection proceeds distally, splitting the extensor origin along its fibers, and (3) the capsule is opened and the radial head fracture, identified...
December 28, 2017: JBJS Essential Surgical Techniques
Thomas J M Kootstra, Margriet H van Doesburg, Arnold H Schuurman
Background  Injury to the distal radioulnar joint (DRUJ) causes swelling and ulnar-sided wrist pain. The Adams procedure stabilizes the DRUJ and shows promising short-term results. Purpose  We studied the long-term functional outcome in patients who underwent the Adams procedure. We also tested the null hypothesis that there would be no difference in range of motion (ROM) and grip strength between the operated wrist compared to the unaffected side. Patients and Methods  We identified 74 consecutive patients that were operated from March 2005 to February 2014...
September 2018: Journal of Wrist Surgery
Yukio Abe, Kenzo Fujii, Takeyoshi Fujisawa
Purpose  Various surgical procedures for foveal tears of the triangular fibrocartilage complex (TFCC) have been reported, and the procedures can be grossly divided into open and arthroscopic repair. The surgical results of both procedures were compared. Materials and Methods  Twenty-nine patients underwent repair of a TFCC foveal tear. The 13 men and 16 women were in the age range of 14 to 72 years (average age, 30 years). Five patients had a history of distal radius fractures that healed uneventfully with nonoperative treatment...
September 2018: Journal of Wrist Surgery
Maurizio Fontana, Marco Cavallo, Graziano Bettelli, Roberto Rotini
BACKGROUND: Acute Essex-Lopresti injury is a rare and disabling condition of longitudinal instability of the forearm. When early diagnosed, patients report better outcomes with higher functional recovery. Aim of this study is to focus on the different lesion patterns causing forearm instability, reviewing literature and the cases treated by the Authors and to propose a new terminology for their identification. METHODS: Five patients affected by acute Essex-Lopresti injury have been enrolled for this study...
August 29, 2018: BMC Musculoskeletal Disorders
Alvin Chao-Yu Chen, Chih-Hao Chiu, Chun-Jui Weng, Shih-Sheng Chang, Chun-Ying Cheng
BACKGROUND: The role of surgical fixation of ulnar styloid fractures remains a subject of debate. The purpose of this study was to compare the surgical outcomes following early and late intervention. METHODS: We retrospectively reviewed 28 patients who underwent surgical repair for unilateral ulnar styloid fractures with distal radioulnar instability between 2004 and 2014. Surgical fixation was performed within 3 months of injury in 13 patients (group A) and beyond 3 months in 15 patients (group B)...
July 31, 2018: Journal of Orthopaedic Surgery and Research
Fiesky A Nunez, Peter J Evans
Restoration of longitudinal stability of the forearm continues to pose a difficult challenge for the hand surgeon, and no technique has demonstrated success above others. Longitudinal stability to the forearm is conferred by 3 structures: the radial head, which acts as a primary stabilizer, the interosseous membrane, more specifically, the central band and, the distal radioulnar ligaments which are part of the triangular fibrocartilage complex. A combination of techniques is described in this article to address chronic longitudinal instability of the forearm: (1) ulnar shortening osteotomy to restore ulnar variance, (2) pronator teres transfer was used to reconstruct the central band of the interosseous membrane, and (3) tightrope augmentation was used to prevent elongation during the healing process...
September 2018: Techniques in Hand & Upper Extremity Surgery
Alvin Chao-Yu Chen, Chun-Jui Weng, Ying-Chao Chou, Chun-Ying Cheng
BACKGROUND: This study aimed to report the radiographic findings and surgical outcomes of anteromedial facet (AMF) fracture of the ulnar coronoid process and to suggest an optimal approach. METHODS: In this retrospective study, 20 consecutive patients with unilateral AMF fracture of coronoid process were surgically treated and divided into two groups without (group A) and with (group B) additional proximal ulnar fractures in equal case number. Time from injury to surgery averaged 4...
July 23, 2018: BMC Musculoskeletal Disorders
Zi Hao Phang, Mohd Fadhli B Miskon, Sa'adon B Ibrahim
BACKGROUND: Blunt trauma causing brachial artery injury in a young patient is very rare. Cases of brachial artery injury may be associated with closed elbow dislocation or instability. Elbow dislocation may not be evident clinically and radiologically on initial presentation. CASE PRESENTATION: This is a case of a 37-year-old, right-hand dominant, Malay man who fell approximately 6 meters from a rambutan tree and his left arm hit the tree trunk on his way down. He was an active tobacco smoker with a 20 pack year smoking history...
July 18, 2018: Journal of Medical Case Reports
Joshua R Labott, William R Aibinder, Joshua S Dines, Christopher L Camp
The medial ulnar collateral ligament complex of the elbow, which is comprised of the anterior bundle [AB, more formally referred to as the medial ulnar collateral ligament (MUCL)], posterior (PB), and transverse ligament, is commonly injured in overhead throwing athletes. Attenuation or rupture of the ligament results in valgus instability with variable clinical presentations. The AB or MUCL is the strongest component of the ligamentous complex and the primary restraint to valgus stress. It is also composed of two separate bands (anterior and posterior) that provide reciprocal function with the anterior band tight in extension, and the posterior band tight in flexion...
June 18, 2018: World Journal of Orthopedics
Yuji Tomori, Takuya Sawaizumi, Mitsuhiko Nanno, Shinro Takai
PURPOSE: This study was performed to elucidate the cause of proximal ulnar stump pain by comparing the clinical results and radiographic changes among three treatment groups involving different Sauvé-Kapandji procedures. METHODS: Thirty-seven patients (38 wrists) with distal radioulnar joint disorders followed up for ≥ six months post-operatively were investigated. Patients were treated by one of three Sauvé-Kapandji procedures. In group A (13 wrists), the original Sauvé-Kapandji procedure was performed...
September 2018: International Orthopaedics
H-G Tünnerhoff
Traumatic ruptures of the triangular fibrocartilaginous complex (TFCC) may cause ulnar-sided wrist pain. These ruptures frequently lead to instability of the distal radioulnar joint (DRUJ) because the ulnoradial ligaments, which are interwoven with the TFCC, are avulsed from the fovea of the ulnar head or-very rarely-from the radius. Conservative treatment may be sufficient, and some instability may be tolerated over time. In the case of persistent pain, operative repair by reattachment of the TFCC and, thereby, the ligaments to the previously debrided bone in the fovea is effective in reestablishing a stable, pain free DRUJ...
August 2018: Der Orthopäde
M C Jansen, S Evers, H P Slijper, K P de Haas, X Smit, S E Hovius, R W Selles
PURPOSE: Carpal tunnel release (CTR) is typically offered to symptomatic patients with electrophysiological abnormalities when night orthoses no longer prevent waking with numbness and preferably before there is any static numbness, weakness, or atrophy. The ability to predict the amount of symptom relief after CTR could be beneficial for managing patient expectations and, therefore, improve treatment satisfaction. Therefore, the aim of this study was to identify predictors for symptom relief after CTR and to determine their contribution to symptom relief at 6 months after surgery...
June 23, 2018: Journal of Hand Surgery
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