Part Of Ulna Research Articles

Replacement of the distal radio-ulnar joint with asemi-constrained Scheker DRUJ prosthesis.

To describe the indications, operative technique, and long-term outcomes of patients treated with the Scheker (Aptis) distal radio-ulnar joint (DRUJ) prosthesis. The Scheker prosthesis is intended to replace the DRUJ in patients with rheumatoid, degenerative, or posttraumatic arthritis of the sigmoid notch and/or ulnar head, or in cases of gross instability of the DRUJ. Moreover, aScheker prosthesis can be used to treat failed salvage procedures, such as the Sauvé-Kapandji procedure, ulnar head resection, and ulnar head arthroplasty. Severe osteoporosis, active infection, immature skeleton, less than 14cm of the proximal ulna remaining. In supine position with the forearm in full pronation, an ulnar S‑shaped incision is made. The ulnar head is resected and the proximal part is brought to the palmar side to enable visualization of the sigmoid notch. Following preparation of the sigmoid notch and the proximal ulnar part of the radius, aradial plate is attached. When the position is verified with fluoroscopy, screw holes are drilled together with aseparate hole for the radial peg. Ametal stem is inserted in the ulnar shaft. Apolymer ball is then slid on to apolished peg on top of the ulnar stem. This polymer ball is seated in the socket of the radial plate and fixed with asmall metal cap. Radiographic images are made for confirmation of correct positioning and full pro- and supination is tested, after which the wound is closed. After 48 h of pressure bandages, patients are instructed to start with full range of motion and weight-bearing exercises under the guidance of ahand therapist. Weight-bearing is constrained to 10kg. We retrospectively assessed 50Scheker prostheses in 48patients treated between 2016 and 2021. The median age was 56years (IQR: 50-65) and 30 (60%) were female. Median follow-up was 29months (IQR: 12-48). The primary outcome was the PRWE score. The median PRWE score at the final follow-up was 23 (IQR: 4-52) for the operated side versus amedian PRWE score of 5 (IQR: 0-25) for the non-operated side (p < 0.005). Six patients had acomplication. Three patients developed extensor carpi ulnaris tendinitis with one patient requiring additional surgery. One patient developed aneuroma of the distal branch of the ulnar nerve that was surgically removed. One synovectomy was performed because of synovitis and one endoscopic ulnar release was performed because of hyperesthesia of the ulnar area. None of the prostheses had to be removed.

Tactile Perception of the Hand in Children With an Upper Neonatal Brachial Plexus Palsy

ObjectiveTo investigate factors that cause impairment of hand function in children with an upper Neonatal Brachial Plexus Palsy (NBPP), we performed an in-depth analysis of tactile hand sensibility, especially the ability to correctly localize a sensory stimulus on their fingers. DesignA cross-sectional investigation of children with NBPP, compared with healthy controls. The thickest Semmes-Weinstein (SW) monofilament was pressed on the radial or ulnar part of each fingertip (10 regions), while a screen prevented seeing the hand. SettingTertiary referral center for nerve lesions in an academic hospital in The Netherlands. The control group was recruited at their school. ParticipantsForty-one children with NBPP (mean age 10.0 y) and 25 controls (mean age 9.5 y; N=41). InterventionsNot applicable. Main Outcomes MeasuresCorrect localization of the applied stimuli was evaluated, per region, per finger, and per dermatome with a test score. The affected side of the NBPP group was compared with the non-dominant hand of the controls. ResultsThe ability to localize stimuli on the tips of the fingers in children with an upper NBPP was significantly diminished in all fingers, except for the little finger, as compared with healthy controls. Mean localization scores were 6.6 (thumb) and 6.3 (index finger) in the NBPP group and 7.6 in both fingers for controls (maximum score possible is 8.0). Localization scores were significant lower in regions attributed to dermatomes C6 (P<.001) and C7 (P=.001), but not to C8 (P=.115). ConclusionChildren with an upper NBPP showed a diminished and incorrect ability to localize sensory stimuli to their fingers. This finding is likely 1 of the factors underlying the impairment of hand function and should be addressed with sensory focused therapy.

Madelung Deformity: Surgical Correction with Radial Dome Osteotomy

Madelung deformity is a rare wrist malformation caused by a growth disturbance of the palmar and ulnar part of the distal radial physis. The aim of this study is to evaluate the outcome of radial dome osteotomy in patients affected by Madelung deformity. The endpoint of this operation is to improve the orientation of the articular surface of the radius, so as to support to the carpal bones. Between 2017 and 2019, in our clinic, 4patients were treated using this technique. Post-operative pain was evaluated using the NRS. Functional outcomes were assessed through evaluation of ROM, grip strength via Jamar dynamometer and using DASH questionnaire. The aesthetic defects were estimated using a section of the Michigan Hand Outcome Questionnaire. Correction of deformities was evaluated on post-operative RX using McCarrol Criteria. Were also analyzed the accuracy and tolerance of the plates used.

Transfert osseux libre de condyle fémoral médial pour la reconstruction d’une perte de substance osseuse carpo-métacarpienne après résection d’une tumeur à cellule géante des gaines synoviale

We report the case of a 23-year-old patient treated for a large giant cell tumour of the synovial sheaths of the ulnar edge of the hand and wrist invading the triquetrum, the hamatum, the ulnar part of the capitate as well as the bases of the 3rd, 4th and 5th metacarpals and the floor of the Guyon's canal and the carpal tunnel. A monobloc resection was performed in a healthy margin; the loss of bone substance was 7×3.5cm. We performed a bone reconstruction using a cortico-cancellous medial femoral condyle free flap of 8×4cm. Postoperative follow-up was uneventful and bone consolidation was achieved at 2,5 months postoperatively. The cortico-cancellous medial femoral condyle free flap is an interesting option for treating small and medium size bone loss in the hand and wrist. Its use in its pure bone form or in its chimeric form with muscle, cartilage or skin opens up a wide range of choices for the reconstructive surgeon.

Establishment of a critical segmental bone defect model in a rabbit ulna

Objective To establish a critical segmental bone defect model in a rabbit ulna. Methods Twenty male New Zealand white rabbits were randomly assigned into 5 groups according to the digital table, and then 14, 15, 16, 17 and 18mm segmental defects(contained periosteum) were created in the middle part of ulna on both sides, respectively.At 6 and 12 weeks after surgery, the repair of segmental bone defects was evaluated by naked eyes, X-ray and histological examination. Results At 12 weeks after surgery, all of the segmental defects with the length of 14 and 15mm were completely repaired.But none of the defects with the length of 16, 17 and 18mm was repaired. Conclusion The length of critical segmental bone defect in rabbit ulna was 16 mm. Key words: Fractures, ununited; Ulna; Bone defect; Models, animal; Rabbit; Animal experimentation; Length; Randomized controlled trial

The outside measurement study of micro-hardness distribution of ulna

Objective To study the micro-hardness distribution of ulna and explore its correlation with surgical procedures of ulnar fractures, internal fixator, total elbow arthroplasty and the epidemiology of ulna fracture. Methods The ulna wasdivided into proximal metaphysis, diaphysis, and distal metaphysis. The proximal metaphysis was divided into the olecranon and the metaphysis olecranon of ulna.Thedistal epiphysis included the head of ulna. The shaft of the ulna was divided equally into nine segments. Each ulna was sawed by a band saw into twelve parts, which were prepared for the micro-indention testing. The micro-indention testing samples precision cuts were conductedwith a Buehler Isomet 11-1280-250 low speed diamond saw. Each micro-indention sample was cut 3mm thickness and fixed on glass sheet with epoxy resin. The samples surface was polished with progressive grades of sandpaper. Micro-indentation was performed on each bone sample surface using a vicker micro-hardness tester, and the hardness value were measured as Hardness value (HV, HV=kgf/mm2). Twenty indentions were randomly selected on each sample, which were equally divided into four quadrants (anterior, medial, posterior and lateral). Hence, a total of 720 micro-indentations were performed on the three ulna. Before indention, each sample was controlled under the optical microscope where the bone surface was intact and not damaged. The micro-indentations were performed on each sample with a load of 50 g. The indentation time was set to 12 s. Hardness value (HV/0.05) was computed for each indentation. The lengths of the diagonals were measured under reflected light microscopy, and the Vickers hardness value was calculated. Indentations in which one diagonal was 10% longer or more than the other were ignored.The indention was repeated. These preliminary data were used to determine the appropriate sample size of micro=indentation to be performed on each bone segment. SPSS 19.0 statistical software was used for statisticalanalysis. The one=way ANOVA analysis was used to compare the difference of bone micro-hardness values in different parts, and P<0.05 was statistically significant. Results The hardest part of the ulna is the lower ulnaand the value of micro-hardness was 47.77 HV. The least hard part was the head of ulna and the value of micro-hardness was 29.64 HV. The proximal metaphysis hardness value was 34.39 HV. The shaft hardness value was 43.47 HV.Thedistal metaphysis hardness value was 29.64 HV.The hardness was higher in diaphysis than metaphysis in the ulna with statistical significance. There was no statistically significant difference in the hardness of ulna anterior, medial, posterior and lateral quadrant. Conclusion It is demonstrated that the micro-hardnessof ulna shaft is significant higher than other two parts of ulna. The micro-hardness value difference was not significant among the anterior, medial, posterior and lateral quadrant. This study revealed the distribution rule of ulna micro-hardness and provided data support for the total elbow arthroplasty with human physiological characteristics through 3D printing. Key words: Bone density; Ulna; Biomechanics; Comparative study

Clinical efficacy analysis of distal ulna resection with periosteum preservation

Objective To explore the feasibility and clinical efficacy of distal ulna resection with periosteum preservation to enhance the stability of ulnar stump. Methods A retrospective study was conducted on 26 cases of old distal radioulnar joint dislocation or total carpal arthritis treated with distal ulna resection with periosteum preservation. The joint pain, active rotation range of forearm and the X-ray radiograph were evaluated postoperatively to observe the clinical efficacy. The feasibility, indications and key points of the method for stabilizing ulnar stump were analyzed. Results All the patients were follow-up for 3 to 39 months with an average of 8.5 months. All the wounds all achieved primary healing. The postoperative visual analogue scale (VAS) and active rotation range of forearm were improved significantly (P<0.05) . The significant ossification of ulnar stump was found in 10 cases and it was limited within the reserved periosteum. The length of ossification was significantly positively correlated with the length of the osteotomy of the ulnar distal part (P<0.05) . The radioulnar convergence was found in 6 cases in different degrees, but no radioulnar impingement was identified. The reserved periosteum played a stable role in the suspension of the ulnar stump. No volar or distal deviation and excessive osteogenesis of the ulnar stump was observed from the X-ray film. Conclusion The distal ulna resection with periosteum preservation can significantly improve the joint pain as well as the function of forearm rotation in the patients with distal radioulnar joint injuries. The reserved periosteum has a good stabilizing effect on the ulnar stump, which can effectively avoid the occurrence of related complications. The ossification of ulnar stump has no influence on the forearm function. Key words: Retrospective studies; Treatment outcome; Periosteum preservation; Distal ulna resection

Method-of-limits; Cold and warm perception thresholds at proximal and distal body regions

ObjectiveThermal quantitative sensory testing with the ‘Method-of-Limits’ is an established rationale for detection of small nerve fiber dysfunction, but adequate reference values are crucial for such evaluations, regardless of the underlying cause. This study assessed reference data for cold- (CPT) and warm- (WPT) perception thresholds at both proximal and distal sites in eight body regions of the lower and upper extremities, all determined within the same test session for each subject. MethodsSeventy-five healthy subjects (aged 16–72 years) were tested according to the method-of-limit for CPT and WPT at the dorsum of the foot, the medial and lateral lower leg, the ventral thigh, the thenar eminence, the radial and ulnar part of the lower arm, and the anterior deltoid part of the upper arm. ResultsOverall, thermal perception thresholds (TPT) varied with test location, but were higher in the lower than in the upper part of the body, also WPT were generally higher than CPT. TPT at the dorsum foot highly correlated with age, while inconsistent correlations were noted between TPT and age or height at other tested locations. ConclusionThis study describes for the first time reference values at eight defined body regions, at both proximal and distal sites. SignificanceThe report enables refined evaluations of general small nerve fiber function, as assessed by quantitative thermal sensory testing with the Method-of-Limits.

Topographical Anatomy of the Distal Ulna Attachment of the Radioulnar Ligament

The deep component of the distal radioulnar ligament provides translational stability and rotational guidance to the forearm. However, controversy exists regarding the importance of this structure as well as the nature of its attachment to the distal ulna. We aimed to evaluate the topographic anatomy of the distal ulna attachment of both the superficial and the deep components of the radioulnar ligament and to assess the relationship between its internal and its external morphometry. Thirteen human distal ulnae attached by ulnar part of the distal radioulnar ligament were scanned using micro-computed tomography and reconstructed in 3 dimensions. In addition, the distal radioulnar ligaments were examined under polarized light microscopy to determine the histological characteristics of collagen contained within the ligaments. The deep limbs have broad marginal insertions at the fovea, whereas the superficial limbs have a circular and condensed insertion to the ulnar styloid. The center of the deep limb was separated from the base of the ulnar styloid by a mean of 2.0 ± 0.76 mm, and this distance was positively correlated with the width of the ulnar styloid. The mean distance between the center of the ulnar head and the center of the fovea was 2.4 ± 0.58 mm. The proportion of collagen type I was lower in the deep limb than in the superficial limb. This new observation of the footprint of the radioulnar ligament in the distal ulna indicates that the deep limb may serve as an internal capsular ligament of the distal radioulnar joint, whereas the superficial limb as the external ligament. Knowledge of the topographic anatomy of the radioulnar ligament's attachment to the distal ulna may provide a better understanding of distal radioulnar ligament-related pathologies.

Oblique cord (chorda obliqua) of the forearm and muscle-associated fibrous tissues at and around the elbow joint: a study of human foetal specimens.

In adults, the oblique cord or chorda obliqua separates the origins of the flexor pollicis longus (FPL) and flexor digitorum profundus (FDP) muscles from the supinator muscle and elbow joint. This study examined the topographic anatomy of the oblique cord and related muscles in foetuses. Semiserial sections of five mid-term foetuses of gestational age (GA) 14-16 weeks and 12 late-stage foetuses of GA 28-30 weeks were histologically examined and three forearms at GA 30 weeks were macroscopically evaluated. Late-stage foetuses showed a fascial structure between the supinator and FDP muscles. The latter extended proximally to the elbow joint and the muscle origin thickened the distal, ulnar part of the capsule. The FPL origin also extended proximally but did not reach the joint capsule. These morphologies were consistent with macroscopic examinations. The brachialis muscle was widely inserted into the proximal, anterior part of the capsule. In addition, the medial collateral ligament was not covered by the pronator-flexor muscles but by the triceps brachii muscle. The oblique cord apparently did not form prenatally. After birth, the proximal parts of the FDP and FPL muscles were likely replaced by collagenous tissues, providing a specific type of intermuscular septum i.e., the oblique cord. This type of muscle-ligament transition was observed in the annular ligament of the radius. The foetal elbow joint was characterised by strong support by the FDP, brachialis and triceps brachii muscles. Therefore, the foetal elbow is not a miniature version of the adult elbow.

A Slightly Dorsally Tilted Lunate on MRI can be Considered Normal.

Abnormal angulation of the lunate can be an indication of intercarpal pathology. On magnetic resonance images (MRIs) the lunate often looks dorsally angulated, even in healthy wrists. The tilt on individual slices can also be different and might be misinterpreted as pathological, contributing to inaccurate diagnoses and unnecessary surgery. The primary aim of this study was to determine the average radiolunate angle on sagittal wrist MRI images as well as the radiolunate angle in the most radial, central and most ulnar part of the lunate; also the interobserver reliability was determined. 140 MRIs from adult, non-pregnant patients presenting to the outpatient hand and upper extremity service between 2010 and 2013 with wrist pain were used for this retrospective study. One author measured the radiolunate and capitolunate angle (i.e., tangential and axial method) in all MRIs. Additionally, two authors measured the same angles independently in 46 MRIs to analyze interobserver reliability. The average radiolunate angle was 8.7 degrees dorsal. There were no significant differences in the radiolunate angles between the different parts of the lunate. A very good interrater agreement was measured considering the radiolunate angle and capitolunate angle (tangential and axial method). Our study showed that the lunate appears slightly dorsally angulated on an MRI of a healthy wrist. Regarding the radiolunate angle, 10 to 15 degrees of dorsal tilt can be considered normal. This study provides reference information of normal anatomy for carpal axial alignment that may facilitate diagnoses of wrist pathology.

An Original Technique in Madelung’s Deformity

Objective/Hypothesis: Madelung’s deformity results from a growth defect in the ventral and medial part of the growth plate of the distal extremity of the radius, causing a disorientation of the ulnar part of radial glenoid. Surgical procedures to improve aesthetics and function for Madelung’s deformity are numerous and difficult to assess because the disease is uncommon. We propose and evaluate an original technique in a retrospective study of 19 wrists: the reverse wedge osteotomy (RWO) of the distal radius. Materials and Methods: Twelve women and 1 man Madelung’s deformity were treated from 1992 to 2016. The wrists (6 bilateral, 7 unilateral) were reviewed by an independent examiner at an average follow-up of 6 years (6 months-22 years). Surgery was motivated by aesthetic and functional discomfort at the average age of 23 years, before any complication. RWO was developed to reorient the radial joint surface while reducing overall radius length as little as possible. Osteotomy was performed through an anteroradial or radial approach with an average time under 2 h. The bone wedge was harvested from the excess cortical on the dorsal and radial aspect of the radius. The circumferential wedge was then removed, reversed, and put back into the osteotomy to ensure closing on cortical excess and lengthening on the opposite side. Fixation was achieved by an anterior locking plate in all cases. An associated osteotomy of the ulna was necessary to avoid an ulnocarpal conflict for 4 cases with severe deformity. Objective (morphology of the wrist, range of motion, and grip strength) and subjective (Quick Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores) data were analyzed. Radiological settings were taken from McCarroll’s criteria. A vector model of the procedure was established to estimate osteotomy angles from 2 indexes from McCarroll. The nonparametric Wilcoxon test ( P &lt; .05) was used for statistical analysis. Results: All cases achieved fusion at 3 months. Eight of the 19 wrists had the plate removed. There was no complication except for hypoesthesia on the radial side of the thenar eminence in 2 cases. Aesthetics and range of motion improved. Improvement was significant for flexion, pronation, and supination with preserving the grip strength, as well as the radiological parameters of McCarroll: significant correction of the palmar and ulnar deviation of the radial epiphysis, as well as rising of the lunate and palmar displacement of the carpus. Average Quick Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores were less than 30 out of 100 at review. All patients were satisfied aesthetically and functionally. Conclusions: The corrective power of RWO is well adapted to the severe radial epiphyseal dystrophy of Madelung’s deformity. Clinical and radiological results are convincing and meet patients’ expectations. RWO has a special place among the techniques proposed so far. The flattening of the dorsal aspect of the wrist is hoped to provide long-term protection against extensor tendon tear. Vector model allows preoperative planning and optimizes the realization.

Subacute metacarpal osteomyelitis in a child

Subacute osteomyelitis is a rare affection. Clinical presentation is often unclear and can lead to a delay in diagnosis. As a matter of fact, subactue metacarpal osteomyelitis is usually missed at the first time, so that some complications may occur like brachymetacarpia or loss of motion. We report a 10 year-old boy, with a subacute metaphyseal osteomyelitis of the second right metacarpal bone. The radiological features can mimic various benign or malignant bone tumours and non-pyogenic infections. Histological confirmation is necessary to avoid a delay in diagnosis. Treatment was based on antibiotics and surgical debridement. No infectious agent was found in bacteriological exams. At 1 year of follow-up, noncompliance was reported with a normal motion of the finger. X-ray views showed a bone reconstruction with a fibrosis of ulnar part of the metaphysis without length discrepancy.

2G31 円柱物体把持における母指爪ひずみの非対称性

The purpose of this research was to measure thumbnail strain when grasping an cylindrical object and to determine whether asymmetric strain distribution occurs in the radioulnar direction. In addition, we examined the effects of object size and thumb-pressing force. Biaxial strain gauges were attached at three locations on the thumbnail surface (central, radial, and ulnar parts). Each axis of the biaxial strain gauges was aligned to the axial and transverse directions, respectively. The diameter of the cylindrical object were 50mm, 60mm, 80mm, 100mm, and 120mm. The thumb-pressing force were 1N, 3N, and 5N. When the diameter of the cylindrical object was small, the distribution of strain in the axial and transverse directions was asymmetric; however, when the diameter of the cylindrical object became large, the asymmetric nature of the strain distribution in transverse direction disappeared. The thumb-pressing force affected the ulnar strain, but not the radial strain. When grasping a small object, the ulnar surface of the thumb pad is an important contact surface. This was the factor in asymmetric strain distribution occurring in the radioulnar direction. When grasping a large object, the contact surface moves to the center of the fingerpad; however, it was assumed that the asymmetric strain distribution occurred because of the asymmetric nature of the internal structure of the thumb.

Subacute Metacarpal Osteomyelitis in a Child

Subacute osteomyelitis is a rare affection. Clinical presentation is often unclear and can lead to a delay in diagnosis. As a matter of fact, subactue metacarpal osteomyelitis is usually missed at the first time, so that some complications may occur like brachymetacarpia or loss of motion. We report a 10 year-old boy, with a subacute metaphyseal osteomyelitis of the second right metacarpal bone. The radiological features can mimic various benign or malignant bone tumours and non-pyogenic infections. Histological confirmation is necessary to avoid a delay in diagnosis. Treatment was based on antibiotics and surgical debridement. No infectious agent was found in bacteriological exams. At 1 year of follow-up, noncompliance was reported with a normal motion of the finger. X-ray views showed a bone reconstruction with a fibrosis of ulnar part of the metaphysis without length discrepancy.

Histological assessment of the triangular fibrocartilage complex.

The morphological structure of the seven components of triangular fibrocartilage complexes of 11 cadaver wrists of elderly people was assessed microscopically, after staining with Hematoxylin-Eosin and Elastica van Gieson. The articular disc consisted of tight interlaced fibrocartilage without blood vessels except in its ulnar part. Volar and dorsal radioulnar ligaments showed densely parallel collagen bundles. The subsheath of the extensor carpi ulnaris muscle, the ulnotriquetral and ulnolunate ligament showed mainly mixed tight and loose parallel tissue. The ulnolunate ligament contained tighter parallel collagen bundles and clearly less elastic fibres than the ulnotriquetral ligament. The ulnocarpal meniscoid had an irregular morphological composition and loose connective tissue predominated. The structure of the articular disc indicates a buffering function. The tight structure of radioulnar and ulnolunate ligaments reflects a central stabilizing role, whereas the ulnotriquetral ligament and ulnocarpal meniscoid have less stabilizing functions.

Three-dimensional ultrasonography for visualization of muscular anomalies in type VI and VII radial polydactyly.

To describe a technique and its clinical applications of three-dimensional ultrasonography to type VI and VII radial polydactyly for identification of potential muscular anomalies. Ultrasonographic examinations were performed at an out-patient department without sedation or an operative room prior to surgery. The palm was scanned in the transverse direction using a 18-MHz linear transducer under speed regulation at 3 mm/s. Sequential images acquired at 0.2 mm intervals were converted into volume data. After validation of the technique, patients with a radial polydactyly in association with triphalangism (type VII) or with polydactylies of metacarpal duplication (type VI) were included for the examination. Five hands of five patients, one with type VI and four with type VII, were included the study. All the patients were male and the ages at examination ranged from 7 months to 2 years. Of the five patients, four examinations were performed at an out-patient department without sedation and one was under anesthesia just prior to surgery. The muscular abnormalities identified were mal-positions of the thenar muscles in a type VI case and a deficiency of the abductor pollicis brevis muscle in a type VII case with a delta phalanx in the ulnar part. Three-dimensional ultrasound technique could be an aid to plan strategies in radial polydactyly if intrinsic muscular anomalies are suspected to be involved.

Ulnar Shortening Osteotomy After Distal Radius Fracture Malunion: Review of Literature

Malunion of distal radius fracture is often complicated with shortening of the radius with disturbed radio- ulnar variance, frequently associated with lesions of triangular fibrocartilage complex and instability of the distal radioulnar joint. Positive ulnar variance may result in wrist pain located in ulnar part of the joint, limited ulnar deviation and forearm rotation with development of degenerative changes due to the overloading that occurs between the ulnar head and corresponding carpus. Ulnar shortening osteotomy (USO) is the standard procedure for correcting positive ulnar variance. Goal of this procedure is to minimize the symptoms by restoring the neutral radio - ulnar variance. In this paper we present a variety of surgical techniques available for ulnar shorthening osteotomy, their advantages and drawbacks. Methods of ulnar shortening osteotomies are divided into intraarticular and extraarticular. Intraarticular method of ulnar shortening can be performed arthroscopically or through open approach. Extraarticular methods include subcapital osteotomy and osteotomy of ulnar diaphysis, which depending on shape can be transverse, oblique, and step cut. All of those osteotomies can be performed along wrist arthroscopy in order to dispose and treat possibly existing triangular fibrocartilage complex injuries. At the end we described surgical procedures that can be done in case of ulnar shorthening osteotomy failure.

Gantzer muscle. An anatomical study.

OBJECTIVE: The relationship of Gantzer muscle to the median and anterior interosseous nerve is debated. METHODS: Ìn an anatomical study with 80 limbs from 40 cadavers the incidence, origin, insertion, nerve supply and relations of Gantzer muscle have been documented. RESULTS: The muscle was found in 54 forearms (68% of limbs) and was supplied by the anterior interosseous nerve. It arose from the deep surface of the flexor digitorum superficialis muscle, (42 limbs), coronoid process (eight limbs) and medial epicondyle (seven limbs). Its insertion was to the ulnar part of flexor pollicis longus muscle. The Gantzer muscle always lay posterior to both the median and anterior interosseous nerve. CONCLUSION: The Gantzer muscle may contribute to the median nerve and anterior interosseous nerve compression. The muscle was found in 68% of limbs and should be considered a normal anatomical pattern rather than an anatomical variation. Level of Evidence IV, Case Series.

Arthroscopy for Galeazzi fractures, a way to demonstrate TFCC damage in extra-articular radius fracture: A series of 7 cases

Galeazzi fracture is a trauma associating diaphysal radius fracture and dislocation or subluxation of the distal radio-ulnar joint (DRUJ). Despite an anatomic reduction of the radius, DRUJ impairment, especially injury of triangular fibrocartilage complex (TFCC) may lead to partial instability with secondary pain and stiffness. This prospective case series proposes to perform wrist arthroscopy for Galeazzi fractures in order to diagnose ligamentous injuries and to enable their reparations. Over a period of 18 months, 7 recent Galeazzi closed fractures were operated on with wrist arthroscopy. We used a locking compression plate, a 1.9 mm arthroscope with 3 radio-carpal portals: 3-4, 4-5 and 6U. A dorsal forearm splint was kept for 3 weeks followed by an active/passive physiotherapy. Physical examination and X-ray were performed after 3, 6 and 12 weeks. Analysis criteria were: – perioperative: ligament impairment, duration of surgery; – postoperative: pain, wrist motion (flexion/extension; prono/suppination), grasp strength, time off work and sports, X-ray analysis (reduction, consolidation, secondary displacement). All patients were reviewed 3 times. The triangular ligament was injured in all cases, 3 cases in the radial part, 3 cases in the ulnar part and one both side. All ulnar injuries were repaired systematically. The radial TFCC injuries were only repaired when DRUJ instability persisted despite good reduction of the radius. After osteosynthesis of the radius, DRUJ remained instable in 3 cases, one ulnar lesion, one radial and one both side. The reparation of the triangular ligament improved stability of the DRUJ in 2 cases, one case remained instable despite TFCC reparation. About strength and mobility: – after 3 weeks: F/E: 50/60°, P/S 45°/45°, grasp 20%; – after 6 weeks: F/E: 80/80°, P/S 70°/60°, grasp 45%; – after 12 weeks: F/E: 85/80°, P/S 80°/75°, grasp 80%. We noticed 7 anatomic radius reductions and no secondary displacement. A dorsal DRUJ subluxation was noticed despite the ulnar TFCC repair; none nonunion was reported. Time off work was 7 weeks (4–10). Functional mobility was regained after 6 weeks, accompanied by good strength. TFCC reparation participate in DRUJ stabilization but was not always sufficient to fully stabilize the DRUJ. A next study with DRUJ MRI and prono-supination strength measurement should participate to demonstrate further benefits of TFCC reparation in Galeazzi fractures. A lesion of the TFCC was noticed in all cases suggesting that TFCC lesion could occur in some other extra-articular distal radius fractures.