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Ulnar instability

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...
July 3, 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...
June 29, 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...
June 28, 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
Ludovic Ardouin, Alexandre Durand, André Gay, Marc Leroy
The management of distal radius fractures needs to be adapted to the increasingly complex traumas in patients with greater functional requirements. The goal remains to restore normal anatomy in order to preserve function. A pre-operative assessment using x-rays and thin-slice CT scans with three-dimensional reconstructions enables the best possible understanding of the fracture prior to surgery and planning of the pre-operative strategy. Arthroscopy is a technique that allows visualisation of the bone fragments and their displacement, as well as their reduction...
June 19, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
R E López-Cervantes, M García-Elias, I Bermúdez Soto
Background  Axial carpal dislocations and fracture dislocations are 1.4 to 2.08% of all the fractures and dislocations of the wrist. These injuries are caused by high-energy blast or compression mechanisms. Only 11 cases of axial-radial-ulnar (ARU) fracture dislocations have been described in the literature. Case Description  We describe a case with a traumatic transtrapezoid, peritrapezium, transhamate, peripisiform ARU in a patient with acute compartment syndrome, traumatic transverse flexor retinaculum (TFR) rupture, and radial nerve palsy...
July 2018: Journal of Wrist Surgery
Kagan Ozer, Andy F Zhu, Breana Siljander, Jeffrey N Lawton, Jennifer F Waljee
Background  Forearm rotation results in change in ulnar variance. Axial loading of the wrist is required to maintain daily activities. Change in ulnar variance during axial loading has not been investigated previously. Purpose  To measure the change in ulnar variance on axially loaded wrists. Patients and Methods  We examined 21 asymptomatic individuals and 24 patients with unilateral ulnar-sided wrist pain. All patients underwent standard neutral posteroanterior wrist radiographs without load and under axial loading on bilateral wrists...
July 2018: Journal of Wrist Surgery
Thomas J M Kootstra, Wouter F van Leeuwen, Neal Chen, David Ring
Background  There is controversy regarding the value of repair of the triangular fibrocartilage complex (TFCC). Given that an acute tear of the TFCC associated with a displaced distal radius fracture uncommonly benefits from repair, the role of repair in other settings is uncertain. Our impression is that TFCC repair is highly variable from surgeon-to-surgeon. Purpose  The purpose of this study is to determine the rate of TFCC repair in patients who had a magnetic resonance imaging (MRI) scan of the wrist obtained for ulnar-sided wrist pain, and that showed signal changes in the TFCC...
July 2018: Journal of Wrist Surgery
Todd A Rubin, Matthew J Gluck, Michael R Hausman
Essex-Lopresti Lesions are rare injuries that are often missed in the acute setting. Delayed intervention may lead to chronic wrist and elbow pain and overall poor outcomes. The literature currently supports treatments that involve shortening of the ulna to reduce the relative degree of ulnar impaction, followed by attempted reduction of the distal radioulnar joint. Although such techniques may help to temporarily reduce wrist pain secondary to ulnar impaction, they do not address the proximal migration of the radius and ipsilateral radial head dislocation at the elbow...
June 14, 2018: Techniques in Hand & Upper Extremity Surgery
T Poujade, N Balagué, J-Y Beaulieu
The aim of this study was to assess distal radioulnar joint stability after unipolar ulnar head replacement for post-Darrach instability. All the patients who underwent ulnar head replacement between1999 and 2015 for post-Darrach procedure instability at our clinic were reviewed. Seven Hebert-type and two uHead (SBI/Stryker) prostheses were implanted. None of the implants were cemented. We assessed stability, pain, range of motion and strength pre- and postoperatively. The changes in the radiographic appearance between immediate postoperative and the last follow-up were determined...
June 4, 2018: Hand Surgery and Rehabilitation
Hui Qian, Guozhao Chen, Zongbao Liu
RATIONALE: Dislocation of the distal radioulnar joint and injury to distal forearm are commonly encountered. However, delayed diagnosis or misdiagnosis has been relatively rare due to improved diagnosis and treatment. Treatment of old dislocation of radioulnar joint is challenging due to development of secondary chronic instability and difficulties in restoration of joint function. PATIENT CONCERNS: This report describes three cases of patients complained about inability to extend their little fingers...
June 2018: Medicine (Baltimore)
Koichi Yano, Yasunori Kaneshiro, Hideki Sakanaka
We report a 34-year-old man who presented with ulnar wrist pain, painful click, and locking during forearm rotation following a motorcycle accident. Plain radiographs showed a loose body in the distal radioulnar joint (DRUJ), deformity of the sigmoid notch and ulnar head, and ulnar minus variant. The DRUJ deformity was assumed to be associated with physeal injury of the distal ulna during childhood. Conservative treatment with a splint and oral analgesics for 3 months failed. During DRUJ arthroscopy, osteoarthritic changes were found, and the loose body was resected using DRUJ arthroscopy...
May 22, 2018: Acta Orthopaedica et Traumatologica Turcica
M-D Kunze, F Neubrech, M Sauerbier
BACKGROUND: A stable distal radioulnar joint (DRUJ) is mandatory for the rotation and load transmission in the forearm and wrist. Salvage procedures such as the Darrach operation, Bowers arthroplasty, and the Kapandji-Sauvé procedure include the potential risk of dynamic radioulnar instability and impingement, despite stabilizing techniques addressing the soft tissues. PROSTHESES: In an attempt to stabilize the distal forearm mechanically following ulnar head resection, various endoprostheses have been developed to replace the ulnar head...
May 24, 2018: Der Orthopäde
Jung-Pan Wang, Hui-Kuang Huang, Duretti Fufa
Persistent distal radioulnar joint (DRUJ) instability after internal fixation of distal radius fractures can be managed with soft tissue or bony stabilization and prolonged immobilization. However, these strategies limit postoperative motion. To address this limitation, we report our technique of indirect ulna shortening by radial distraction followed by early mobilization and provide a case example. We use this technique in cases of persistent DRUJ instability during standard volar plating of distal radius fractures...
May 2018: Journal of Hand Surgery
Thomas Rohwedder, Martin Fischer, Peter Böttcher
OBJECTIVE: To prospectively compare relative axial (internal-external) humero-ulnar rotation in normal and dysplastic canine elbow joints. MATERIAL AND METHODS: Six normal elbows (five dogs) and seven joints (six dogs) with coronoid disease were examined. After implantation of 0.8 mm tantalum beads into humerus and ulna, biplanar x-ray movies of the implanted elbows were taken while dogs were walking on a treadmill. Based on the 2D bead coordinates of the synchronized x-ray movies virtual 3D humero-ulnar animations were calculated...
April 2018: Tierärztliche Praxis. Ausgabe K, Kleintiere/Heimtiere
Jonathan Jetsmark Bjerre, Finn Elkjær Johannsen, Martin Rathcke, Michael Rindom Krogsgaard
AIM: To develop practical guidelines for diagnosis and treatment of the painful snapping elbow syndrome (SE). METHODS: Clinical studies were searched in the databases PubMed and Scopus for the phrases "SE", "snapping triceps", "snapping ulnar nerve" and "snapping annular ligament". A total of 36 relevant studies were identified. From these we extracted information about number of patients, diagnostic methods, patho-anatomical findings, treatments and outcomes...
April 18, 2018: World Journal of Orthopedics
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