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Ulnar instability

Ji Hun Park, Jong Woong Park
Background: Tears of the triangular fibrocartilage complex (TFCC) can result in instability of the distal radioulnar joint (DRUJ) and ulnar-sided wrist pain. This study evaluates clinical results of arthroscopic transosseous repair for both proximal and distal components of TFCC tear with DRUJ instability. Materials and Methods: Ten patients who underwent both proximal component and distal component of TFCC repair were retrospectively reviewed. The proximal component of TFCC was repaired through arthroscopic one-tunnel transosseous suture technique, and the combined distal component tear was repaired to the ulnar capsule using same transosseous tunnel in all cases...
November 2018: Indian Journal of Orthopaedics
Jamil F Soni, Weverley R Valenza, Anna Carolina Pavelec
PURPOSE OF REVIEW: The chronic Monteggia may lead to pain, mobility limitation, progressive valgus deformity, lateral elbow instability, late ulnar nerve paralysis, and degenerative changes. In this review, we discuss the current procedures in the literature focused on correcting chronic Monteggia to avoid these complications. RECENT FINDINGS: Correction of the ulnar deformity with elongation and angulation of the ulna in the opposite direction of the dislocation of the radial head is the most important factor for the reduction and consequent preservation of the radial head...
December 6, 2018: Current Opinion in Pediatrics
Christopher L Camp, Michael Fu, Hamidreza Jahandar, Vishal S Desai, Alec M Sinatro, David W Altchek, Joshua S Dines
BACKGROUND: Injury to the lateral ulnar collateral ligament (LUCL) complex of the elbow often results in posterolateral rotatory instability. Although surgical reconstruction of the LUCL is often required, gaps in our understanding of the LUCL complex remain. The purpose of this study was to provide a robust and accurate characterization of the lateral elbow ligamentous complex. METHODS: The LUCLs, radial collateral ligaments, and annular ligaments in 10 cadaveric elbows were 3-dimensionally digitized and reconstructed using computed tomography...
December 6, 2018: Journal of Shoulder and Elbow Surgery
John B Fuller, John C Dunn, Nicholas A Kusnezov, Leon J Nesti, Kelly G Kilcoyne
BACKGROUND: Medial ulnar collateral ligament (MUCL) reconstruction outcomes are well described in competitive throwers but not in nonthrowers. This investigation elucidated epidemiologic variables, functional outcomes, and prognostic factors after MUCL reconstruction in young active patients. METHODS: United States military service members undergoing MUCL reconstruction were isolated using the Management Analysis and Reporting Tool (M2) database from 2009 to 2016...
November 28, 2018: Journal of Shoulder and Elbow Surgery
Michael Rutter, Louis C Grandizio, W James Malone, Joel C Klena
PURPOSE: To assess the use of preoperative, dynamic ultrasound to predict ulnar nerve instability following in situ decompression for cubital tunnel syndrome. METHODS: Prior to undergoing in situ decompression, 43 consecutive patients underwent dynamic ultrasound to assess the stability of the ulnar nerve during elbow flexion. The dynamic ultrasound findings were compared with the intraoperative assessment of nerve stability following in situ decompression. RESULTS: The preoperative dynamic ultrasound agreed with intraoperative findings in 38 of 43 patients (88%)...
November 27, 2018: Journal of Hand Surgery
Ryan M Greene, Jacqueline E Bader, Libby Mauter, Benjamin W Sears, Conrad J Tirre, Armodios M Hatzidakis
CASE: A 49-year-old right-hand-dominant man sustained an auger-related injury that resulted in open dislocation at the left wrist and palm, with complete amputation of the distal aspect of the forearm and the hand. The injury at the elbow included instability with an ulnar coronoid fracture, posterior dislocation of the ulna, and posterolateral dislocation of the radius. To restore stability of the forearm stump and elbow, we performed a complete resection of the radius, open reduction and internal fixation of the coronoid tip, a repair of the lateral collateral ligament, and transfer of the distal biceps tendon to the coronoid...
November 28, 2018: JBJS Case Connector
Joon Kyu Lee, Jae-Yeon Hwang, Suk Yoon Lee, Bong Cheol Kwon
BACKGROUND: The triangular fibrocartilage complex (TFCC) tear is a common cause of ulnar-side wrist pain; however, its natural course is not well understood. QUESTIONS/PURPOSES: We sought (1) to determine the natural course of TFCC tears without distal radioulnar joint (DRUJ) instability, and (2) to identify the factors associated with poor prognosis after nonsurgical treatment of TFCC tears. METHODS: Over a 3-year period, we treated 117 patients with TFCC tears who did not have DRUJ instability...
October 22, 2018: Clinical Orthopaedics and related Research
Nana Nagura, Kiyohito Naito, Ahmed Zemirline, Yoichi Sugiyama, Mayuko Kinoshita, Kenji Goto, Yoshiyuki Iwase, Kazuo Kaneko
Introduction: We report the case of volar dislocation of the ulnar head occurred after osteosynthesis for the treatment of distal radius fracture. Presentation of case: The patient, 68-year-old female, had the dorsal displaced left distal radius fracture and volar dislocation of the ulnar head. Osteosynthesis was performed using a volar locking plate without postoperative immobilization. Two weeks after surgery, volar dislocation of the ulnar head in distal radioulnar joint (DRUJ) was noted on CT...
November 2018: Annals of Medicine and Surgery
Andy F Zhu, Geoffrey Burns, Breana Siljander, Jennifer F Waljee, Kagan Ozer
Background  The triangular fibrocartilage complex (TFCC) provides stability to the wrist and disruption of this complex can result in axial instability which can lead to ulnocarpal abutment. Purpose  This article determines the individual contributions of the volar radioulnar ligament (VRUL), dorsal radioulnar ligament (DRUL), and foveal attachment of the TFCC to longitudinal stability of the forearm under axial load. Materials and Methods  Eighteen cadaveric specimens were randomly assigned into three groups representing the component of the TFCC to be initially transected: VRUL, DRUL, and foveal attachment...
November 2018: Journal of Wrist Surgery
P Arrigoni, F Luceri, D Cucchi, J Tamini, P S Randelli
PURPOSE: The aim of this study is to describe a new surgical procedure to plicate the anterior bundle medial collateral ligament (aMCL) into its humeral footprint using a suture anchor, and to present the results of a preliminary clinical series. METHODS: Eight patients with posttraumatic medial elbow pain and signs of medial elbow instability underwent aMCL plication with suture anchors and decompression of ulnar nerve. Arthroscopic evaluation permitted to define signs of minor medial elbow instability; 70°-scope was used to document from an intra-articular point of view of the aMCL status...
October 2018: Musculoskeletal Surgery
G Canton, B Hoxhaj, R Fattori, L Murena
Chronic Monteggia fracture is defined as dislocation of the radial head that is still present 4 weeks after injury. The cause may reside in residual ulnar deformity after internal fixation, in failure of annular ligament healing, or both. This situation may lead to elbow pain, decreased motion, neurologic problems and valgus deformity. The aim of the present study is to investigate indications and surgical technique for annular ligament reconstruction (ALR) in chronic Monteggia fractures. Relevant articles on annular ligament anatomy and biomechanics, clinical-radiographic evaluation of chronic Monteggia lesions and surgical techniques for ALR were reviewed...
October 2018: Musculoskeletal Surgery
M Bartoli, L A Pederzini, G Severini, F Serafini, M Prandini
PURPOSE: This study aims to clinically evaluate, at mid-term follow-up, a group of patients treated by the senior author in the last 6 years with our anatomical double-bundle reconstruction surgical technique for the medial ulnar collateral ligament (M-UCL) insufficiency. METHODS: In this study, we included only patients affected by chronic valgus elbow instability, diagnosed with an accurate clinical evaluation combined with an MRI, without associated fractures that had been surgically treated in the past and without additional instability detected during the first checkup and in the preoperative evaluation under anesthesia...
October 2018: Musculoskeletal Surgery
R J Molenaars, B J A Schoolmeesters, J Viveen, B The, D Eygendaal
PURPOSE: Allografts play an important role in tendon, ligament, and bone reconstruction surgery, particularly when suitable available autologous tissue is limited. Enthusiasm for the use of allografts in reconstructive orthopedic surgery has increased over the past decade, with an increase in allograft use in a variety of procedures. The purpose of this review is to provide an overview of the various applications and indications for the use of allografts in reconstructive surgical procedures of the elbow and forearm...
October 19, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Jung-Taek Hwang, Youngbok Kim, Maegan N Shields, Daniel R Bachman, Lawrence J Berglund, Alessandro T Fitzsimmons, James S Fitzsimmons, Shawn W O'Driscoll
BACKGROUND: The interosseous membrane (IOM) and distal radioulnar joint (DRUJ) provide axial stability to the forearm. Our hypothesis was that injury to these structures alters force transmission through the elbow. METHODS: A custom-designed apparatus that applies axial loads from the wrist to the elbow was used to test 10 cadaveric upper limbs under the following simulated conditions (1) intact, (2) DRUJ injury, (3) IOM injury, or (4) IOM + DRUJ injury. IOM injury was simulated by osteotomies of the IOM attachment to the radius, and DRUJ injury was simulated by distal ulnar oblique osteotomy...
October 15, 2018: Journal of Shoulder and Elbow Surgery
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...
December 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...
November 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
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