Distal Ulnar Metaphysis Research Articles

Bilateral ulnar retained cartilage cores causing thoracic angular limb deformities in a cat

AbstractA 6‐month‐old, female, neutered, Bengal‐cross cat presented for bilateral thoracic angular limb deformity. Radiographs and computed tomography revealed well‐defined, flame‐shaped radiolucent and hypoattenuating defects within the medullary cavity of the distal ulnar metaphyses, surrounded by a thin rim of sclerosis. Surgical correction of initially the right angular limb deformity involved radial and ulnar ostectomies, and a bone biopsy of the distal ulnar metaphysis was submitted for histopathology. The morphological diagnosis was consistent with retained cartilage core, never previously reported in a cat.

Distal Ulnar Metaphyseal Wedge Osteotomy for Ulnar Abutment Syndrome.

Background Ulnar shortening osteotomy of the diaphysis is a common and effective surgical procedure for ulnar abutment syndrome. However, this procedure has some disadvantages, such as a long period until union and a relatively high nonunion rate. To overcome these disadvantages, we have developed distal ulnar metaphyseal wedge osteotomy. The purpose of this article is to describe the technique and to report its clinical results. Patients and Methods Distal ulnar metaphyseal wedge osteotomy consists of resection of the wedge fragment at the distal ulnar metaphysis, compressing the distal fragment of the ulna toward the radial-proximal direction and fixation with a Herbert type headless screw. We performed this procedure for 58 patients with ulnar abutment syndrome, and the clinical data of 43 patients who were followed for > 6 months were analyzed. We evaluated range of motion, grip strength, and HAND20 which is a validated subjective scoring system in Japan. Results All patients experienced relief from their ulnar wrist pain, and bone union was achieved within an average of 2.6 months. The range of dorsiflexion improved from 63° preoperatively to 69° postoperatively, grip strength compared with the contralateral hand improved from 77% preoperatively to 87% postoperatively, and HAND20 improved from 41.3 points preoperatively to 22.4 points postoperatively. Discussion This procedure has advantages especially in early bone union. This procedure should be taken into consideration as one of the options to treat ulnar abutment syndrome.

Lambeau osseux interosseux postérieur pour l’avant-bras pédiatrique

Posterior interosseous bone flap (PIBF) is a reliable vascularised bone graft in adults for treatment of forearm and elbow difficult nonunions. In our best knowledge there is no published experiments on this technique in children. We reviewed our patients and found 6 patients with PIBF for treatment of forearm nonunions and distal radius physeal arrest. From May 2015 to December 2017, six patients from 2 to 8 years old underwent PIBF from distal ulna. The indication of this treatment were, radius congenital pseudoarthrosis two patients, non-union due to chronic osteomyelitis one patient, radius traumatic non-union one patient, distal radius physeal arrest due to enchondroma two patients. In non-union cases, one half of diameter from 2–3 cm of distal ulnar metaphysis harvested on the base of posterior interosseous vessels and transferred to non-union site of the radius. For transfer of the physis whole distal 2 cm of ulna, including physis harvested on the base of these vessels and transferred to the distal radius after resecting damaged physis. All nonunions healed in 3 to 4.5 months. Ulnar fracture and radial head gradual dislocation occurred in one patent with congenital pseudoarthrosis. Non of physeal transfers ended to normal growth due to bony bridge. Non-union is rare in paediatric forearm but if it stablished it is difficult to be treated. Congenital pseudoarthrosis and chronic osteomyelitis are the examples of underlying disease, which make the treatment so difficult. Free fibular transfer is the treatment of choice, but it is a demanding technique and the donor site complications is frequent. Pedicle bone graft is a simple alternative for this procedure. In our patients PIBF worked with complete union in an acceptable time without sever complications. Distal radius physeal arrest especially in young children is a disabling condition. Lengthening over the time is a time consuming procedure. Free phseal transfer is an attractive idea. Unfortunately with PIBF technique transferred physis didn’t work, because of bony bridge around the physis. PIBF works in the paediatric difficult forearm nonunions. But because of smaller size of the ulna, more meticulous techniques should be done. Physeal transfer of distal ulna to radius is not successful with this technique and needs further investigations.

A Study of Conservative Treatment for Colles’ Fractures Using the Novel Classification by Lateral Radiographic View

Objective: The objective of this study is to elucidate the changes in radiographic parameters over time in conservative treatment of Colles’ fractures. Participants and Methods: The participants were 60 patients with Colles’ fractures (60 wrists) that were treated conservatively. They were l3 males and 47 females with a mean age of 72.5 years (range, 55-96 years). Based on the AO Foundation and Orthopaedic Trauma Association (AO/OTA) fracture and dislocation classification, the numbers of patients with type A2, A3, Cl, C2, and C3 fractures were 33, 5, 5, l2, and 5, respectively. The cause of injury was limited to a fall from eye height, and we excluded patients with a concurrent fracture of the distal ulnar metaphysis and patients with comminution of the palmar cortex. All the patients underwent manipulative reduction immediately after diagnosis. We focused on the palmar cortex in lateral radiographic views to classify the fractures into the intramedullary type, the anatomical type, and the extramedullary type, and measured the palmar tilt (PT), radial inclination (RI), and ulnar variance (UV) at the time of injury, immediately after reduction, and in final observation. Statistical Analysis: We analyzed the correction loss of PT, RI, and UV by Tukey-Kramer after one-way analysis of variance (ANOVA). Results: The fracture types immediately after reduction were the intramedullary type in 11 patients, the anatomical type in 42 patients, and the extramedullary type in 7 patients. The correction loss in PT and in RI was negative in each group, with no significant differences among the 3 groups, whereas UV was positive in each group. The correction loss was significantly greater in the intramedullary group than in the anatomical group and the extramedullary group. Conclusion: We analyzed radiographic parameter changes over time associated with reduced position in the conservative treatment of Colles’ fractures. The correction loss in UV immediately after reduction until the final observation was significantly greater in the intramedullary group than in the anatomical group and the extramedullary group.

Biomechanical Analysis of the Distal Metaphyseal Ulnar Shortening Osteotomy

To investigate the effect of a closing wedge osteotomy at the distal ulnar metaphysis on unloading the ulnar side of the wrist. Seven fresh frozen cadaver arms mounted in a wrist simulator were used for the analysis. A 6-degrees-of-freedom load cell was mounted on the distal radius and another on the distal ulna. Radioulnar carpal joint forces and transverse distal radioulnar joint (DRUJ) load were measured at static wrist positions and during dynamic wrist motions before and after the distal metaphyseal ulnar shortening osteotomy (DMUSO) was performed. At each static position, significant decreases in ulnar load were noted after DMUSO. In addition, mean and maximum loads decreased for each dynamic wrist motion. There were no statistically significant differences in transverse forces across the DRUJ after DMUSO. This study showed that DMUSO is an effective way to decrease the load across the ulnocarpal joint. The geometry of the osteotomy and resultant change in the position of the ulnar head did not increase transverse joint reaction forces. This technique is an alternative to open diaphyseal techniques or methods that damage the articular surface of the distal ulna. Clinical studies will be necessary to associate the biomechanical correction noted in this study with clinical symptom improvement.

Intra-articular distal ulnar fractures associated with distal radial fractures in older adults: early experience in fixation of the radius and leaving the ulna unfixed

There is no clear consensus about the best management of intra-articular distal ulnar fractures associated with distal radial fractures in older adults. We describe a treatment wherein the distal radial fractures were securely fixed with a palmar plate, leaving the associated ulnar fractures unfixed. The wrists of 14 patients with a mean age of 74 years were reviewed at an average of 18 months after surgery. The results were excellent in 11 cases and good in three, according to the modified Gartland and Werley score. All fracture sites displayed union, and there was no instability of the distal radioulnar joint. A widening of the distal radioulnar joint space was present in one wrist. Angular deformity of the distal ulnar metaphysis was seen in five wrists. This treatment could be an alternative to open reduction with internal fixation for intra-articular distal ulnar fractures in older adults.

Resolution of severe, adolescent-onset hypophosphatemic rickets following resection of an FGF-23-producing tumour of the distal ulna

Oncogenic hypophosphatemic osteomalacia (OHO) is an uncommon hypophosphatemic syndrome characterized by bone pain, proximal muscle weakness and rickets. It has been postulated that OHO results from overproduction of a humoral phosphaturic factor by an occult tumour. Recently, some OHO tumours have been shown to elaborate fibroblast growth factor-23 (FGF-23), which causes renal phosphate wasting when administered to mice. The purpose of this study was to undertake detailed investigations to confirm the diagnosis of OHO in a pediatric patient and to document the biochemical, radiographic and bone histological phenotype before and after tumour removal. We describe an 11-year-old, previously healthy girl with significant pain and functional disability associated with hypophosphatemic rickets. Circulating 1,25-(OH) 2 vitamin D was very low (14 pM; N: 40–140) while the FGF-23 serum level was markedly elevated [359.5 reference units (RU)/ml, N: 33–105]. An iliac bone biopsy revealed severe osteomalacia, but periosteocytic lesions, as are typical for X-linked hypophosphatemic rickets, were not seen. Sequence analyses of the PHEX and FGF23 genes were normal. A radiographic skeletal survey revealed a small exostosis of the left, distal ulnar metaphysis. A tumour was subsequently removed from this site and the pathology was consistent with benign, fibro-osseous tissue. Serum FGF-23 was normal when measured at 7 h post-operatively, while serum phosphate reached the low-normal range at 16 days following surgery. An iliac bone biopsy taken 5 months after the operation showed improvement, but not yet resolution, of the osteomalacia. Biochemical parameters of bone and mineral metabolism suggested that complete resolution of the osteomalacia was not achieved until 12 months following surgery. One year after tumour removal, the patient was pain-free and had resumed a normal level of activity. The rapid normalization of FGF-23 levels following removal of a benign tumour and the subsequent improvement in the biochemical and histological parameters of bone and mineral metabolism suggest that FGF-23 played a key role in this girl's disease.

Salvage procedure for failed Bowers' hemiresection interposition technique in the distal radioulnar joint

Three patients who continued to have distal radioulnar joint pain following Bowers' hemiresection interposition technique were treated by converting the resection arthroplasty into a Sauvé-Kapandji procedure. The resected 10 mm segment from the distal ulnar metaphysis was used as an interposition bone graft in the arthrodesis site, placed between the sigmoid notch of the radius and distal end of the ulna. After a minimum follow-up of 3 years, all three patients were satisfied with the procedure, were pain-free, and the preoperative range of wrist and forearm motion had increased. All three returned to their previous working activities.

Fractures of the distal radius and ulna

Associated fractures of the distal ulnar metaphysis were present in 19 of 320 distal radial fractures requiring either closed manipulation or surgical treatment over a 2-year period. Four morphological patterns of ulnar fracture were encountered, the commonest being the type 1 simple extra-articular fracture of the distal end of ulna with minimal comminution (eight out of 19). 15 patients were treated conservatively and two each were treated by internal and external fixation. 15 patients were reviewed after a mean follow-up of 23.8 months and there were four excellent, five good, five fair clinical results and one poor result. Radiographically the distal radio-ulnar joint (DRUJ) was normal in eight wrists, but longitudinal or horizontal disruption of the DRUJ was present in seven wrists. Fracture callus encroached on the DRUJ in three patients, who also had limitation of forearm rotation. Two comminuted ulnar fractures (type 4) developed non-union, but both patients had full forearm rotation, in contrast to restriction of forearm rotation in four out of five patients with type 1 fractures.

A RADIOGRAPHIC STUDY ON THE DEVELOPMENT OF THE ANTEBRACHIUM IN GREAT DANE PUPS, RAISED UNDER STANDARDIZED CONDITIONS

Radiographic examination of the antebrachium was performed in 16 healthy Great Danes, raised under standardized conditions, at six‐week intervals from 9 to 27 weeks of age. The dogs were fed according to the National Research Council's nutrient requirements of dogs (1974). The development of the secondary ossification centers and the growth in length of the radius and ulna were noted. In the majority of dogs changes in the shape and structure of the distal ulnar metaphysis resembled disturbances in cartilage maturation and bone maturation and remodelling. An improvement in the radio‐graphic appearance of the distal ulnar metaphysis was noted at the age of 27 weeks. It is concluded that the delicate processes that are involved in skeletal development may be frequently disturbed in fast growing, giant‐breed dogs, without causing clinical problems.

A RADIOGRAPHIC STUDY ON THE DEVELOPMENT OF THE ANTEBRACHIUM IN GREAT DANE PUPS ON DIFFERENT CALCIUM INTAKES

Radiographic examination of the radius and ulna was performed in three groups of Great Danes fed diets containing high, normal, and low calcium contents from the ages of 7 to 21 weeks. Development and maturation of secondary ossification centers, architecture of the distal ulnar metaphysis, and growth in length of the radius were noted. In the dogs fed a high‐calcium diet, there was retardation in the development of the ulnar styloid process, the humeral medial epicondyle, the olecranal apophysis, and the anconeal process. In addition, these dogs developed severe changes over the entire width of the distal ulnar metaphysis, whereas the other groups developed only focal changes. The dogs fed a low‐calcium diet developed severe signs of nutritional hyperparathyroidism. It is concluded that the development of the secondary ossification centers and the growth in length of the radius are inversely related to calcium intake.

MINERALIZATION OF NORMAL AND OSTEOCHONDROTIC BONE IN SWINE

Bone mineralization of the ulna and femur was studied using 20 market weight boars. On postmortem examination, 17 animals demonstrated osteochondrosis in the distal ulnar metaphysis and/or the distal femoral epiphysis with no apparent lesions in the distal ulnar epiphysis, distal femoral metaphysis or the diaphysis of either bone. Three animals showed no apparent abnormalities in any site of these bones. Lesion areas displaying abnormal ossification in the distal ulnar metaphyses had markedly reduced (P < 0.05) calcium and phosphorus concentrations, however, mineralization appeared to be normal in the apparently normal adjacent areas. Calcium and phosphorus concentrations were greater (P < 0.05) in the femur than in the ulna. There was no significant correlation between lesion scores and bone analysis values, between lesion scores and average daily gain, and between average daily gain and bone analysis values.