Ulnar Fracture Research Articles

Treatment of unstable forearm fractures at the metaphyseal-diaphyseal junction in children: antegrade ESIN vs. transepiphyseal intramedullary K-wire fixation.

Treatment of unstable forearm fractures in the metaphyseal-diaphyseal junction (MDJ) zone is still a matter of debate. Major drawbacks of all types of fixations include either invasiveness, technical impracticality, or lack of acceptance by patients. This study reports results after antegrade ESIN (a-ESIN) compared to transepiphyseal intramedullary K-wire (TIK) for unstable MDJ forearm fractures. The MDJ of the forearm was defined as the square over the joints of both forearm bones subtracted with the square over the metaphysis of the radius alone. The data of 40 consecutive patients < 16 years of age who were treated either by a-ESIN (later treatment period) or TIK (early treatment period) for an unstable MDJ forearm fracture at a single high-volume pediatric trauma center were retrospectively analyzed. The average age was slightly lower in the first group (TIK = 7.42 years; a-ESIN = 10.5 years). An additional ulna fracture was found in 50% of cases and was treated with a classic antegrade ESIN in 10/20 (TIK) and 6/20 cases (a-ESIN). Additional plaster cast immobilization was performed in all cases with TIK and in three cases with a-ESIN. After TIK, no complication, malalignment, or functional limitation occurred. After a-ESIN, 19/20 patients had an event-free course with stable retention and healing without axial malalignment. In one case, a temporary sensor dysfunction occurred. The same patient suffered a refracture two months after the original trauma, which required a closed reduction. Metal removal was performed after 84 days (TIK) and 150 days (a-ESIN). The outcome in all patients was good. Both a-ESIN and TIK are minimally invasive procedures that are technically easy to perform. Both methods are safe and lead to a complete restoration of the forearm's range of motion. The decisive advantage of a-ESIN is the possibility of postoperative immobilization-free rehabilitation.

Incidence and predictors of dorsal comminution in older adults with low-energy distal radius fracture.

To identify the incidence of dorsal comminution using computed tomography (CT) images and identify predictors of this phenomenon in older adults with low-energy distal radius fractures (DRFs). A total of 150 patients aged > 50 years with fall-induced dorsally angulated DRFs were enrolled in this study. Patients were divided into two groups based on the presence of dorsal comminution, defined as a metaphyseal void of greater than one-third of the maximum posterior to anterior depth of the bone on at least three cuts in the sagittal plane on post-reduction CT images. Data on participants' basic demographics, including age, sex, body mass index (BMI), and AO classification of DRFs, were collected. Bone mineral density (BMD) was assessed using T-scores of the femoral neck, and cortical thickness of the distal radius was determined from plain post-reduction radiographs. Radiological parameters and combined ulnar fractures were measured on plain pre-reduction radiographs. Among study participants, 91 (61%) had dorsal comminution, whereas 59 (39%) had no dorsal comminution on CT images. Both patient groups were compared based on presence of dorsal comminution, and showed no significant differences in age, sex, BMI, BMD, or cortical thickness on radiographs. However, all radiological parameters were better in the no dorsal comminution group than in the dorsal comminution group, and the proportion of patients with combined ulnar fractures was higher in the dorsal comminution group. In the multivariate analysis, the presence of combined ulnar fractures was the only significant predictor of dorsal comminution (p = 0.029, odds ratio = 2.267, 95% confidence interval: 1.085-4.736). The incidence of dorsal comminution is relatively high in patients with low-energy DRFs aged > 50 years. In particular, the presence of combined ulnar fractures is closely associated with dorsal comminution of DRFs. Thus, surgeons should exercise caution when evaluating this phenomenon.

Impact and torsional behavior of additive layer-manufactured biopolymer: An advancement for orthopedic applications.

Distal ulna locking bone plates (DLBPs) are commonly employed in the treatment of distal ulna fractures. However, commercially available metallic bone plates experience stress shielding and lack corrosion resistance. Poly lactic acid (PLA) is highly favored biopolymer due to its biocompatible and bioabsorbable nature with human tissues. The use of additive layer manufacturing (ALM) is gaining attention for creating customized implants with intricate structures tailored to patient autonomy. ALM-based PLA bone plates must provide high resistance against impact and torsional forces, necessitating the adjustment of printing process parameters. This study focuses on examining the influence of key printing parameters, on the impact strength and torque-withstanding capability of DLBPs. Experimental results, along with microscopic images, reveal that an increase in infill density (IF) and wall thickness imparts strong resistance to layers against crack propagation under impact and torsional loads. On the contrary, an increase in layer height and printing speed leads to delamination and early fracture of layers during impact and torsional testing. IF significantly contributes to improving the impact strength and torque-withstanding capability of DLBPs by 70.53% and 80.65%, respectively. The study highlights the potential of the ALM technique in developing DLBPs with sufficient mechanical strength for biomedical applications.

OPerative versus non-opERAtive management of isolated ULNAr diaphyseal fractures (OPERA-Ulna): protocol for a randomized controlled trial.

Isolated fractures of the ulnar diaphysis are uncommon, occurring at a rate of 0.02 to 0.04 per 1,000 cases. Despite their infrequency, these fractures commonly give rise to complications, such as nonunion, limited forearm pronation and supination, restricted elbow range of motion, radioulnar synostosis, and prolonged pain. Treatment options for this injury remain a topic of debate, with limited research available and no consensus on the optimal approach. Therefore, this trial aims to compare clinical, radiological, and functional outcomes of two treatment methods: open reduction and internal fixation (ORIF) versus nonoperative treatment in patients with isolated ulnar diaphyseal fractures. This will be a multicentre, open-label, parallel randomized clinical trial (under National Clinical Trial number NCT01123447), accompanied by a parallel prospective cohort group for patients who meet the inclusion criteria, but decline randomization. Eligible patients will be randomized to one of the two treatment groups: 1) nonoperative treatment with closed reduction and below-elbow casting; or 2) surgical treatment with ORIF utilizing a limited contact dynamic compression plate and screw construct. The primary outcome measured will be the Disabilities of the Arm, Shoulder and Hand questionnaire score at 12 months post-injury. Additionally, functional outcomes will be assessed using the 36-Item Short Form Health Survey and pain visual analogue scale, allowing for a comparison of outcomes between groups. Secondary outcome measures will encompass clinical outcomes such as range of motion and grip strength, radiological parameters including time to union, as well as economic outcomes assessed from enrolment to 12 months post-injury. This trial has been approved by the lead site Conjoint Health Research Ethics Board (CHREB; REB14-2004) and local ethics boards at each participating site. Findings from the trial will be disseminated through presentations at regional, national, and international scientific conferences and public forums. The primary results and secondary findings will be submitted for peer-reviewed publication.

Isolated Ulnar Fractures Postoperative Infection: Incidence and Possible Causes

Isolated Ulnar Fractures Postoperative Infection: Incidence and Possible Causes

Distinct patterns of fracture propagation in distal radial fractures and the relationship to the ulnar head

BackgroundThe aim was to assess the direction of distal radius fractures and their relationship to the ulnar head. MethodsWe reviewed the 160 wrist radiographs. The fracture line was measured on the postero-anterior and lateral radiographs relative to the long axis of the forearm and the relationship to the ulnar head. FindingsPA radiographs: the fracture line ran distal ulnar to proximal radial (ulnar to radial) in 11%, transverse in 74% and distal radial to proximal ulnar (radial to ulnar) in 16%. Lateral radiographs: the fracture line ran distal volar to proximal dorsal in 88%, transverse in two 1% and dorsal to volar in 11%. Radial shift (7.5%) only occurred with ulnar to radial or transverse fractures.The ulnar to radial fracture line started at the proximal end of the ulnar head/distal radio-ulnar joint in 88%. The radial to ulnar fracture line started ended a mean of 2.5 mm proximal to the distal radio-ulnar joint (p < 0.01). The transverse fracture line started at the base of the distal radio-ulnar joint in 53% and proximally in 47%. InterpretationThere are two distinct coronal patterns: radial to ulnar ending c. 2 mm proximal to the distal radio-ulnar joint; ulnar to radial starting at the proximal distal radio-ulnar joint. There may be third pattern - transverse fractures; these may be variants of the above. Sagittally the main direction is volar to dorsal but 11% are obverse.This is the first description of distinct fracture patterns in extra-articular distal radius fractures. In addition the fracture patterns appear to correlate with different directions of force transmission which fit with our understanding of falling and the relatively uncontrolled impact of the wrist/hand with the ground.These patterns of fracture propagation help understand how the biomechanics of wrist fractures and may enable prediction of collapse.

Post-traumatic carpal tunnel syndrome in children

BackgroundGiven limited information about acute carpal tunnel syndrome (CTS) in children, the purpose of this study is to describe the presentation and treatment results of CTS after traumatic wrist or forearm injury in a pediatric population. MethodsIn this retrospective single-center cohort study, all children with post-traumatic CTS were identified. Demographic and clinical presentation, treatment, and outcomes data were collected from the electronic medical record. Descriptive statistics were calculated for variables of interest, and Χ2 and independent sample t-tests were used for subgroup comparisons. Results18 patients (16 male, average age 12.8 ± 3.6 years) with post-traumatic CTS were identified. 13 presented acutely (<3 days) versus 4 subacutely (1–6 weeks) and one delayed presentation (>6 weeks) after injury. Of associated traumas, 83% (15/18) involved distal radius fractures, of which 40% (6/15) had an associated ulna fracture. The most common symptoms were numbness (78%), paresthesias (33%), and increasing pain (28%). Three patients had clinical concerns for concomitant compartment syndrome. 6 patients were initially monitored (2 acute, 3 subacute, 1 delayed). Ultimately, 16/18 underwent operative release (13/13 acute, 2/4 subacute, 1/1 delayed). At follow-up, 81% of the surgically treated patients had complete symptomatic relief. There was no statistically significant difference in treatment outcomes between acute versus subacute or delayed presentation (OR: 6.67, p = .214). Of patients with acute CTS, delayed surgery resulted in prolonged recovery (28.0 vs. 2.4 weeks, p < .001). ConclusionsPost-traumatic CTS more often presents acutely than as a delayed complication of distal radius fractures in children. The type of injury and clinical presentation can vary, but patients most often present with median neuropathy symptoms like numbness. Acute CTS should be treated urgently with carpal tunnel release. While patients with delayed presentation can trial observation, the patient will likely warrant surgery for complete symptom relief. Operative treatment for both acute and subacute cases generally results in positive outcomes. Key Concepts(1)Post-traumatic CTS may present acutely as a complication of distal radius fractures in children with symptoms of numbness, paresthesias, and increasing pain.(2)Acute CTS should be treated with urgent carpal tunnel release to avoid prolonged recovery.(3)Children with delayed presentation of CTS can be safely monitored, but the patient often needs surgery to experience complete symptom relief.(4)Operative treatment for post-traumatic CTS in children generally results in positive outcomes. Level of EvidenceIV Case Series

Evaluation of optimizing Monteggia fracture-dislocation care: surgical innovations, radiological insights, and functional rehabilitation in adult patients

Background: Monteggia fractures, rare in adults, involve proximal ulna fracture and radial head dislocation. Managing these injuries poses challenges, fueling historical debates and driving advancements in internal fixation. Watson Jones' frustration highlights the ongoing pursuit of effective surgical approaches for optimal outcomes and functional limb restoration. his study aims to evaluate Monteggia fracture-dislocation treatment by analyzing radiological outcomes for structural insights and alignment post-surgery. Methods: This prospective observational study, conducted at Swapno general hospital, Mirpur-2, Dhaka, Bangladesh from 1st January 2021 to 31 January 2024, enrolled 30 patients with radiologically confirmed Monteggia fracture-dislocation. Surgical procedures involved creating an interval, anatomical reduction, and fixation, with regular follow-ups assessing outcomes, including range of motion, X-rays, and VAS scores, while statistical analysis utilized SPSS version 23. Results: The highest frequency percentage in the age distribution was observed among individuals aged 41-45, constituting 20% of the total sample, while the lowest frequencies were recorded in the 31-35 and &gt;51 age groups, each representing 10% of the sample. Physical assault emerged as the leading cause of injury, accounting for 40% of cases, followed by road traffic accidents at 36.66% and falls at 23.33%. In terms of final outcomes, the majority of patients (43.33%) achieved a good outcome, while the lowest percentage (10%) resulted in poor outcomes. Conclusions: In conclusion, addressing Monteggia fracture-dislocation in adults requires navigating inherent complexities. Modern internal fixation methods prove impactful, emphasizing the need for precise classification and stable anatomical reduction.

Epidemiology of Paediatric Fractures at Koshi Hospital, A Tertiary Center in Eastern Nepal

Introduction: Paediatric trauma is a leading cause of disability, hospitalization and may lead to mortality in pediatric population. Incidence and nature of fracture varies according to region, culture, seasonal variations and age. Children are more prone to have injury at play grounds, due to fall from height and also due to road traffic accident due to unmanaged traffic and lack of road safety measures. Identification of specific high-risk injury patterns may lead to improved care and outcome. This study aims to find out the epidemiological profile of paediatric injuries presenting to a tertiary care hospital in eastern Nepal. Objective: To study the common fractures and their management in the paediatric age group at Koshi hospital. Methodology: This was a hospital based retrospective cross-sectional study done among 424 paediatric patients at Koshi hospital from January 2021 to December 2021.Ethical clearance was taken from Nepal health research council . Data collection was done from the outpatient (OPD), emergency and the operation room records and was compiled in Microsoft excel 2007. Results: A total of 424 paediatric fractures were taken into study over the duration of one year. Out of which 288 were male (67.92%) and 136(32.08%) were female. Playground injuries were the most common cause of paediatric fractures (49.76%) followed by fall from height (27.35%) and road traffic accident (12.26%). Distal radius and ulna fracture was found to be most common (30.89%). Conclusion: Distal radius and ulna is the commonly fractured bone followed by supracondylar fractures of the humerus. Most of the paediatric fractures can be managed conservatively. Supervised play in the grounds, at home and at schools are important because paediatric injuries most of the times can be prevented to decrease the morbidity and mortality in the paediatric population. Proper knowledge and awareness of the traffic rules and zebra crossings should be implemented with local community participation and cooperation.

Ulnar carpal translation following palmar locking plate fixation for distal radius fractures: a retrospective analysis

BackgroundConcomitant injuries to the radiocarpal ligaments may occur during episodes of distal radius fractures, which may not cause acute subluxation or dislocation but can lead to radiocarpal instability and progress over time. This study aimed to analyze the occurrence of ulnar carpal translation (UCT) after open reduction and internal fixation of distal radius fractures and evaluate the associated factors of UCT.MethodsThe retrospective study has been done now and includes patients treated between 2010 and 2020 who had undergone reduction and locking plate fixation of distal radius fractures. We assessed radiographs taken immediately after the operation and at 3 months post-operation, enrolling patients with UCT for evaluation. In addition to demographic data, we evaluated radiographic parameters, including fracture pattern, fragment involvement, and ulnar variance. We also assessed the palmar tilt-lunate (PTL) angle to determine associated rotatory palmar subluxation of the lunate (RPSL).ResultsAmong the 1,086 wrists, 53 (4.9%) had UCT within 3 months post-operation. The majority of wrists with UCT exhibited normal to minus ulnar variance (49 wrists; mean: −1.1 mm), and 24 patients (45.3%) had concomitant RPSL. Fracture classification was as follows: 19 type A3 (35.8%), 5 type C1 (9.4%), 11 type C2 (20.8%), and 18 type C3 (34.0%). Radial styloid was involved in 20 wrists (37.7%), palmar rim in 18 wrists (34.0%), dorsal rim in 25 wrists (47.2%), and die-punch fractures in 3 wrists (5.7%). Concomitant ulnar styloid fractures were present in 29 wrists (54.7%).ConclusionThis study highlights the potential for UCT to occur following reduction and fixation of distal radius fractures, particularly in cases with a more severe fracture pattern and combined with ulnar minus variance. The high incidence of concomitant RPSL provides further evidence for the possibility of associated radiocarpal ligament insufficiency after distal radius fracture.

Type I Monteggia Fracture with Associated Ipsilateral Capitellar and Humeral Diaphyseal Fractures in an Adult

Background: Monteggia fractures entail a proximal ulnar fracture with associated radial head dislocation. Primarily observed as a fracture in the pediatric population, there have been rare occurrences in adults. In rare instances, various associated fractures have been reported with Monteggia fractures. However, during our literature review, a type I Monteggia fracture had not been reported along with ipsilateral diaphyseal humerus and capitellar fractures. Here, we present a successful post-operative outcome for a unique fracture distribution and form of fixation that has yet to be reported in the literature.

Children’s orthopaedics

The April 2024 Children’s orthopaedics Roundup360 looks at: Ultrasonography or radiography for suspected paediatric distal forearm fractures?; Implant density in scoliosis: an important variable?; Gait after paediatric femoral shaft fracture treated with intramedullary nail fixation: a longitudinal prospective study; The opioid dilemma: navigating pain management for children’s bone fractures; 12- to 20-year follow-up of Dega acetabuloplasty in patients with developmental dysplasia of the hip; Physeal fractures of the distal ulna: incidence and risk factors for premature growth arrest; Analysis of growth after transphyseal anterior cruciate ligament reconstruction in children; Management of lateral condyle humeral fracture associated with elbow dislocation in children: a retrospective international multicentre cohort study.

Bridge plating is an effective adjunct treatment for complex elbow instability

Managing persistent elbow instability and chronic dislocations presents challenges despite traditional treatments. Supplementary methods like immobilization and various fixations, though common, can carry high complication rates. This study assesses the efficacy of bridge plating in treating complex elbow instability through a retrospective review of patients. Data on characteristics, treatment duration, range of motion, complications, and evaluation scores were analyzed, providing insights into outcomes complications associated with bridge plating. Eleven patients were reviewed at a mean follow-up of 80±68 weeks postoperatively. The mean age was 53±14 years and there were 5 females and 6 males. The mean body mass index was 38. Bridge plating was used for a spectrum of complex elbow injuries. The mean time from injury to bridge plating in acute cases was 29±19 days and 344±381 days in chronic cases. The mean duration of bridge plating was 121±72 days. At the time of plate removal, mean intraoperative elbow motion was extension 58°±12°, flexion 107°±14°, supination 66°±23° and pronation 60°±26°. At the latest follow-up visit, mean elbow motion was extension 37°±22°, flexion 127°±17°, supination 72°±15°, and pronation 63°±18°. There were 6 complications (55%): heterotopic ossification, ulnar neuropathy, wound failure over the plate in a thin patient, an ulnar shaft periprosthetic fracture due to a seizure-induced fall, and persistent elbow subluxation despite bridge plate fixation. Finally, 1 patient sustained a fracture of a 3.5-mm locking bridge plate. One patient required a contracture release for persistent stiffness. Four of these complications can be directly attributed to the use of the bridge plate (36%). At final follow-up, the mean patient-rated elbow evaluation score was 34, with 0 indicating no pain and disability. The mean Single Assessment Numeric Evaluation score was 66% for the 8 patients who had this available, with 100% being the best possible attainable score. Bridge plating effectively maintains joint reduction in selected complex elbow instability cases. However, patients with bridge plates often require a second surgery for removal and experience high rates of general complications because of the complexity of their condition.

Prefabricated curvature internal fixation with Kirschner needle for forearm fracture in children

To explore clinical effect of precast curvature internal fixation with Kirschner needle in treating forearm fracture in children. From October 2019 to December 2022,32 children with forearm fractures were treated with precast curvature internal fixation with Kirkler's needles,including 25 males and 7 females,aged from 3 to 15 years old with an average of (8.0±0.5) years old,18 patients on the left side and 14 on the right side,24 patients with double fractures of radial and ulna,3 patients with Monteggia fractures,and 4 patients with Galeazzi fractures,and 1 patient with radial neck fracture of crooked cap. Operation time,intraoperative blood loss,C-arm fluoroscopy,fracture healing time and complications were recorded,and disabilities of arm,shoulder and hand (DASH) scale and Grace-Eversman forearm double fracture evaluation system were used to evaluate clinical efficacy of precast curvature internal fixation with Kirschner's needle for forearm fracture in children. All 32 patients were followed up for 2 to 12 months with an average of (7.16±2.51) months. Intraoperative blood loss was (20.68±5.50) ml,C-arm fluoroscopy was(5.80±2.50),and operation time was (24.34±5.10) min,fracture healing time was (8.82±1.62) weeks. Two patients occurred complications,including postoperative rupture of extensor pollicis longus tendon in 1 patient and obvious displacement of fracture caused by rotation of prefabricated curvature Kirschler needle on bone marrow cavity in 1 patient. DASH scores ranged from 0 to 16 scores with an average of (8.32±1.50) scores. According to Grace-Eversman double fracture evaluation system,28 patients got excellent result,2 good and 2 fair. The treatment of forearm fracture with Kirschner's needle prefabricated curvature internal fixation has advantages of less trauma,less bleeding,good reduction,stable fixation,fast fracture healing and good functional recovery.

Clinical effect analysis of different treatment schemes for children with ulnar and radial double fractures.

The objective of the study is to evaluate the safety and efficacy of three different treatment methods for pediatric ulnar and radial double fractures. 120 children with ulnar and radial double fractures were included in the study. According to the different treatment plans, children were divided into three groups: manual reduction, splint external fixation, double elastic intramedullary fixation, and double plate fixation. Surgical indicators, radiological results, clinical efficacy, and complications were evaluated and compared among the groups. The average hospital stay and operation time were significantly longer in the double plate internal fixation group compared to the other two groups. The double elastic intramedullary nailing group showed a higher fracture healing rate at 3 months compared to the other groups. There were no significant differences in clinical efficacy among the three groups. Complications were observed in all groups but did not show significant statistical differences. Double elastic intramedullary nailing fixation demonstrated favorable outcomes in terms of surgical indicators and fracture healing rates for pediatric ulnar and radial double fractures.

Geriatric chronic recurrent multifocal osteomyelitis (CRMO) mimicking multifocal multiple myeloma: a first in an octogenarian

Chronic recurrent multifocal osteomyelitis (CRMO), an autoinflammatory bone disorder characterized by non-bacterial osteomyelitis causing recurrent multifocal bone lesions, is a well-known, yet uncommon pediatric condition that rarely affects adults; to date, it has never been diagnosed over the age of 75. The following report will discuss the first octogenarian diagnosed with CRMO and therefore represents an exceptionally rare presentation of a rare disease. An 83-year-old woman presented with progressive right shoulder, forearm, and hip pain, with associated weight loss and global weakness, requiring a wheelchair for mobility. Imaging revealed a pathologic right ulna fracture in addition to lytic lesions of the right proximal humerus and proximal femur. The clinical picture was thus that of a patient with probable multiple myeloma versus metastatic disease. After an extensive workup, however, the lesions were not malignant; histologic findings were instead suggestive of chronic osteomyelitis with negative cultures. Given the multifocal nature of this condition, combined with a lack of clinical symptoms of infection, a diagnosis of CRMO was rendered. The patient underwent intramedullary nailing of the right femur and splinting of the ulna, with a subsequent remarkable recovery to painless ambulation, complete union of the right ulna fracture, and resolution of the lytic lesions without receiving any targeted medical treatment. This case highlights the importance of maintaining CRMO on the differential for multifocal skeletal lesions, regardless of age. Performing a thorough workup with necessary imaging, biopsy, and culture are critical to establishing this diagnosis, which can only made as a diagnosis of exclusion.

Long term trends in the incidence of distal radius fractures in Sindhudurg, west coast of Maharashtra Retrospective analysis of 1776 distal radius fractures (1989 to 1999), hospital based study

The over all incidences related to age, gender with secular trends and seasonal variation in the catchment area of Sindhudurg, are reported in this study. This study included all the patients of distal radius fractures treated by the author at Government. hospital Kudal, Sindhudurg between 1989 to 1999. A retrospective analysis was done extracting the data from Government hospital OPD registers, indoor case papers, cross-checked with operation theatre, radiology files. Overall 1776 distal radius fractures conferred of which 692(39.0%) were women. The annual incidence was 1.41 for 1989 and 2.58 for 1999 per 10,000 inhabitants. There was an exponential increase in incidence of adolescents of 11 to 20 years [26(22.1%) in 1989 and 56(25.4%) in 1999] and between 51 to 70 years age group [37(31.4%) in 1989 and 82(37.2%) in 1999] in both genders. After 71 years there was gradual decline in incidence in both men and women. Low velocity injuries due to indoor and outdoor falling was the most common mechanism of injury in 1340(75.5%). Associated ulnar styloid fracture was seen in 912(51.3%). Surgical intervention was done in 522(57.2%) with ulnar styloid fracture and in 186(21.5%) with intact ulnar styloid.The annualincidence of distal radius fracture is consistently increasing over a decade time, much more so in adolescents. Men and women between 51 to 70 years had a higher risk of fracture than other groups. Low energy injuries were most predominant.

U-shaped kirschner wire transfixation: effective treatment for Skier’s thumb

BackgroundSkier’s thumb is a type of injury to the ulnar collateral ligament of the metacarpophalangeal joint of the thumb, which can result in bone fragmentation and joint instability.ObjectiveThe objective of this study was to compare the traditional Kirschner wire fixation method with the U-shaped Kirschner wire method for treating small bone fragments with displacement, rotation, or instability in skier’s fractures.MethodA retrospective study was conducted on 30 patients with skier’s thumb who were treated at Tianjin Hospital from January 2019 to December 2021. Patients were divided into two groups: Group A received traditional Kirschner wire fixation, while Group B received U-shaped Kirschner wire fixation. Functional assessments and complications during the perioperative period were evaluated.ResultsBoth surgical methods significantly reduced postoperative pain and increased joint range of motion. Group B had a lower incidence of pain during follow-up and showed significant functional improvement in Tip-pinch and Grip tests compared to Group A. U-shaped Kirschner wire fixation significantly reduced complications during the perioperative period.ConclusionThe U-shaped Kirschner wire internal fixation is a safe and effective treatment for the thumb proximal phalanx base ulnar side avulsion fracture.

Epidemiology and Management of Distal Radioulnar Injuries at Hadji Boejasin General Hospital, Pelaihari

Distal radius fracture is one of the most common fractures, especially in the elderly. This fracture often followed by an ulna fracture, causing interference with the distal radioulnar joint (DRUJ). The aim of this study is to provide an overview of DRUJ trauma management along with its indications. This research is a retrospective descriptive study. Data collection was carried out from the medical record data of DRUJ trauma patients who were treated through the ED of H. Boejasin General Hospital. There were 19 samples that met the inclusion criteria, aged 18-60 years. A total of 7 patients (36.84%) underwent ORIF, 12 patients (63.16%) LAC (91.67%), and 1 patient underwent SAC (8.33%). Surgery is the main choice of treatment by orthopedic surgeons for DRUJ trauma patients due to high impact injuries, while conservative management is sufficient for low impact injuries.

Headless screw fixation of unstable ulnar styloid base fractures after distal radial fractures fixation

Ulnar styloid fractures occur frequently concomitant with distal radial fractures. Although unstable distal radial fractures are mostly surgically treated, ulnar styloid fractures are often ignored. Unstable fractures at the base of the ulnar styloid may lead to persistent ulnar pain, due to distal radioulnar joint instability or ulnar styloid non-union.We retrospectively analyzed a single-surgeon cohort series of surgically treated distal radial fractures on how these concomitant ulnar styloid fractures were regarded: indications for surgery and surgical technique with headless screw fixation.119 surgically treated distal radial fractures were assessed. 51 (42.8%) of the surgically treated distal radial fractures had a distal ulnar fracture, and more specifically 23 (19.3%) had a base fracture of the ulnar styloid. 9 (7.6%) of the wrists had a base fracture of the ulnar styloid which was considered after distal radial fracture fixation as persistently unstable, during distal radioulnar joint ballottement translation test. This fracture subtype was immediately treated with headless screw fixation, resulting in all cases in bony union, with a mean active pronation of 85°, a mean active supination of 80° and a clinical stable distal radioulnar joint, with minimal ulnar pain after 6 weeks (mean Visual Analogue Scale 1). After at least 12 months, persistent pain did not occur and mean QuickDASH was 2.5.According to this single-surgeon cohort series, headless screw fixation provides a reliable treatment for unstable base fractures of the ulnar styloid after distal radial fixation.