Proximal Ulna Research Articles

Mid-term Surgical Results of Proximal Ulnar and Radial Fracture-dislocations Classified and Treated With a New Comprehensive Classification System

Mid-term Surgical Results of Proximal Ulnar and Radial Fracture-dislocations Classified and Treated With a New Comprehensive Classification System

Instability of the proximal radioulnar joint in Monteggia fractures\u2014an experimental study

BackgroundA Monteggia fracture is defined as a fracture of the proximal ulna combined with a luxation of the radial head. The aim of the present work is to evaluate the extent of instability of the radius head in the proximal radioulnar joint (PRUJ) as a function of the severity of elbow fracture and ligamentous injury in an experimental biomechanical approach.MethodsEight fresh-frozen cadaver arms were used. All soft tissues were removed except for the ligamentous structures of the PRUJ and forearm. A tensile force of 40 N was exerted laterally, anteriorly or posteriorly onto the proximal radius. The dislocation in the PRUJ was photometrically recorded and measured by two independent examiners. After manual dissection of the ligamentous structures up to the interosseous membrane, the instability was documented and subsequently measured. The following dissection levels were differentiated: intact ligamentous structures, dissection of annular ligament, oblique cord and proximal third of interosseous membrane.ResultsAn anterior instability remains relatively constant until the proximal third of the interosseous membrane is dissected. The radial head already dislocates relevantly in the posterior direction after dissection of the annular ligament with an additional considerable stability anteriorly and laterally. Subsequently, the posterior instability increases less pronouncedly in regard of distal resected structures. The lateral instability increases constantly during the progressing resection of the ligamentous structures.ConclusionOn the one hand, a complete healing of the ligament injury after functional treatment is hardly conceivable with ligamentary damage up to the level of the proximal interosseous membrane. A remaining instability of the proximal radius could therefore be a possible cause for the unsatisfactory clinical results after certain Monteggia fractures. On the other hand, the present study may give a possible explanation (i.e. early dorsal radius head dislocation after dissection of annular ligament) why the Bado II injury is the most frequent type of Monteggia fractures.

Nailing of proximal ulna fractures: biomechanical comparison of a new locked nail with angular stable plating.

Proximal ulna fractures are common injuries and frequently treated with angular stable plating. This surgical option shows good functional results. Relevant drawbacks such as large soft tissue exposure, compromised blood supply of fracture fragments and disturbing osteosynthetic material are described. The aim of this study was to compare a new locked proximal ulna nail with angular stable plating in a biomechanical testing setup for extraarticular proximal ulna fractures. Ten pairs of sawbones with a Jupiter type IIB proximal ulna fracture (OTA 2U1A3.1) were tested after osteosynthesis with the mentioned implants in a servo-pneumatic testing machine. The testing setup simulates physiological joint motion (0°-90°) under cyclic loading (30-300N). Primary stability and loosening of both constructs were quantified using micromotion video-analysis after 608 test cycles. The micromotion analysis showed significantly higher primary stability of the locked nail (0.29 ± 0.13mm) compared to the angular stable plate (0.97 ± 0.30mm, p < 0.001). Both implants showed a low amount of loosening after completion of the test cycles. The construct with the locked nail (0.08 ± 0.06mm) showed significantly lower dislocation of the fragments measured at the anterior cortex (plate 0.24 ± 0.13mm, p < 0.001). Nailing of proximal ulna fractures shows significantly higher primary stability and lower loosening compared to angular stable plating in our testing setup.

456P - Use of gamma irradiated bone allografts in treatment of various bone tumours

BackgroundOsteogenic augmentation is required in various orthopaedic conditions. Defects caused by removal of malignant or local bone tumours requires reconstructive surgeries to restore skeletal continuity and bone grafts to fill bone defects. Different modalities which can help to increase osteogenesis include autografts, allografts and synthetic bone graft substitutes. Autograft is the gold standard, provides osteogenic, osteoinductive and osteoconductive properties but has limitations of requirement for additional incisions, poor bone quality in elderly patients, increases operation time, causes donor site pain and morbidity and likely permanent residual disability and limited amount. Autograft is the gold standard but is available in limited amount and morbidities associated with it. Bone graft substitutes are costly, limited in quantity and don’t integrate with host bone. Bone allografts are a good option, but not widely used in India and there are sparse reports in literature from developing countries. Our study signifies use of gamma irradiated deep freezed bone allografts in treatment of various bone tumours. MethodsIt’s a prospective descriptive study. Strict inclusion and exclusion criteria, as per standard guidelines of American and European Association of Tissue Banking, were followed. We have a in-house facility of gamma irradiated deep freezed bone allografts available in hospital. 20 patients with giant cell tumours of proximal tibia, proximal ulna and distal radius, aneurysmal bone cysts of proximal humerus and distal radius, etc were operated during one year and followed up for atleast 24 weeks thereafter. Sloof's Criteria was used for assessing osteointegration of grafts. ResultsAllografts have not only accepted well but defects have healed and bone integration is at various stages. Only one patient got infected (5%). 19 out of 20 patients (95 %) in our study group had either attained or at various stages of osteointegration and healing. ConclusionsWe conclude that deep freezed bone allografts is a viable option in patients with large bone defects after resection of bone tumours, thus give satisfactory surgical outcome, with no serious side effects. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Anatomic and Biomechanical Evaluation of Ulnar Tunnel Position in Medial Ulnar Collateral Ligament Reconstruction

Background: Although numerous techniques of reconstruction of the medial ulnar collateral ligament (mUCL) have been described, limited evidence exists on the biomechanical implication of changing the ulnar tunnel position despite the fact that more recent literature has clarified that the ulnar footprint extends more distally than was appreciated in the past. Purpose: To evaluate the size and location of the native ulnar footprint and assess valgus stability of the medial elbow after UCL reconstruction at 3 ulnar tunnel locations. Study Design: Controlled laboratory study. Methods: Eighteen fresh-frozen cadaveric elbows were dissected to expose the mUCL. The anatomic footprint of the ulnar attachment of the mUCL was measured with a digitizing probe. The area of the ulnar footprint and midpoint relative to the joint line were determined. Medial elbow stability was tested with the mUCL in an intact, deficient, and reconstructed state after the docking technique, with ulnar tunnels placed at 5, 10, or 15 mm from the ulnotrochlear joint line. A 3-N·m valgus torque was applied to the elbow, and valgus rotation of the ulna was recorded via motion-tracking cameras as the elbow was cycled through a full range of motion. After kinematic testing, specimens were loaded to failure at 70° of elbow flexion. Results: The mean ± SD length of the mUCL ulnar footprint was 27.4 ± 3.3 mm. The midpoint of the anatomic footprint was located between the 10- and 15-mm tunnels across all specimens at a mean 13.6 mm from the joint line. Sectioning of the mUCL increased elbow valgus rotation throughout all flexion angles and was statistically significant from 30° to 100° of flexion as compared with the intact elbow (P < .05). mUCL reconstruction at all 3 tunnel locations restored stability to near intact levels with no significant differences among the 3 ulnar tunnel locations at any flexion angle. Conclusion: Positioning the ulnar graft fixation site up to 15 mm from the ulnotrochlear joint line does not significantly increase valgus rotation in the elbow. Clinical Relevance: A more distal ulnar tunnel may be a viable option to accommodate individual variation in morphology of the proximal ulna or in a revision setting.

Long-term efficacy of modified Sauvé-Kapandji procedure for treatment of degenerative arthritis of distal radioulnar joint

Objective To investigate the long-term clinical efficacy of modified Sauve-Kapandji procedure in the treatment of degenerative arthritis of distal radioulnar joint (DRUJ). Methods From June 2010 to April 2015, 16 patients with DRUJ degenerative arthritis were treated with modified Sauve-Kapandji procedure. The ulna of 1.0 to 1.5 cm length was excised at 2 to 3 cm proximal to the ulna head. The distal ulna and DRUJ were fused with the radius. The proximal ulna was suspended with a splited 1/2 extensor carpi ulnaris tendon. After operation, the long arm plaster was fixed for 3 to 4 weeks, then functional exercise was performed, and normal work was restored after bone healing. Results After the operation all the patients were follow-up for 3.3 to 7.0 years with an average of 4.2 years. Postoperative pain relieved, grip strength increased, forearm rotation had no significant effect, and no instability of ulna stump occurred. The pain was improved from 6.2 to 1.5 points by using the visual analogue scales (VAS). The grip strength of both hands was measured by Jamar gripper, and the percentage of grip strength of the affected hand to the healthy side recovered from an average of 30% to 85% after the operation. The total wrist function was assessed by Mayo score from 56 preoperatively to 87 postoperatively, and DASH score from 67 preoperatively to 28 postoperatively. Conclusion The application of modified Sauve-Kapandji procedure for treatment of DRUJ degenerative arthritis can stabilize ulnar stump, prevent wrist instability, relieve wrist-ulnar pain and improve forearm rotation. The clinical effect is satisfactory after operation. Key words: Osteoarthritis; Treatment outcome; Distal radioulnar joint; Sauve-Kapandji procedure

Clinical and radiological evaluation of surgical management in olecranon fracture-dislocations.

The treatment of olecranon fracture-dislocations (OFDs) remains challenging. OFDs are often misdiagnosed as Monteggia lesions, and the real frequency is actually higher. However, studies on OFDs are limited. This study aimed to report on the surgical management of OFDs and to highlight the importance of three-dimensional computed tomography (3D CT) evaluation in the treatment of OFDs. The study participants included 18 patients (11 men, 7 women, mean age 44years (range 24-78) with OFDs. Each patient's medical records, radiographs, and 3D CT scans were reviewed for demographics, injury details, operative findings, and information about radiological and functional outcomes. The patients were divided into 2 groups according to the direction of the dislocation: the posterior dislocation group (group 1, 7 patients) and anterior dislocation group (group 2, 11 patients). The clinical evaluation was performed according to Broberg-Morrey and the American Shoulder and Elbow Surgeons-Elbow (ASES-E) scoring systems. The mean follow-up period was 39months (range 25-62months). The Broberg-Morrey results were excellent in 4, good in 9, fair in 3, and poor in 2 patients. The mean ASES-E score was 84.83 (range 48-100) points. There were signs of ulna-humeral arthrosis in 5 elbows. Arthrosis was graded as grade 1, grade 2, and grade 3 in 3, 1, and 1 elbows, respectively. Partial sensory recovery was observed in one patient with postoperative ulnar neuropathy at the last follow-up visit. OFDs are complex injuries of the proximal ulna and may involve the radial head, coronoid process, and lateral collateral ligament. The effective treatment of OFDs begins with the proper identification of the injury with 3D CT. A secure fixation including the coronoid process is mandatory for the elbow joint stability. Insufficient restoration of the trochlear notch may lead to problems with loss of motion and arthrosis. Although an application of a pre-contoured locking anatomical olecranon plate can simplify the fixation procedure in most cases, the surgeons' equipment should also include radial head implant, coronoid plates, headless screws, small cannulated screw system, suture anchors, fluoroscopy, and articulated external fixator.

Clinical course of treatment of proximal one third ulna fracture by plate osteosynthesis in skeletally mature individuals

Objective: To study the clinical course including radiological union, fracture union time and functional outcome of plate osteosynthesis for proximal one third ulna fracture in skeletally mature individuals.Method: 30 patients of proximal ulna fractures who were treated by plate osteosynthesis were included in this study.Result: 30 patients were followed up for minimum duration of 6 months and the clinical outcomes were assessed according to the Mayo Elbow Performance Score (MEPS). Out of 30, our study included 21 olecranon fractures and 9 monteggia fractures. At final follow up of 6 month, our case series of olecranon fractures resulted mean MEPS of 89.3with 57.1% excellent results and 42.9 % good results, and all patients returning to pre-injury daily activities. For monteggia fractures, resulted mean MEPS score is 93.8 with 88.9% excellent result & 11.1 % good results. All fractures in our study had united by 6 months, both clinically and radiologically. Our study group had reported the complication of delayed union in 6 cases of olecranon fractures. No complications reported in treatment of monteggia fractures.Conclusion: Our study has yielded excellent results in respect of functional outcome, radiological and clinical union without any implant related complications in internal fixation of proximal one third ulna fracture including olecranon fractures and monteggia fractures with plate osteosynthesis. Monteggia fractures treated with plate osteosynthesis yielded slightly better outcome in respect of functional outcome, radiological and clinical union than olecranon fractures. Plate osteosynthesis can be done in comminuted along with non-comminuted proximal one third ulna fractures. We recommend plate osteosynthesis for proximal one third ulna fracture, because of its consistent results with respect to fracture union, stability across the fracture site and early mobilization for better functional results.

Radial head fractures.

The shape and size of the radial head is highly variable but correlates to the contralateral side. The radial head is a secondary stabilizer to valgus stress and provides lateral stability. The modified Mason-Hotchkiss classification is the most commonly used and describes three types, depending on the number of fragments and their displacement. Type 1 fractures are typically treated conservatively. Surgical reduction and fixation are recommended for type 2 fractures, if there is a mechanical block to motion. This can be done arthroscopically or open. Controversy exists for two-part fractures with >2 mm and <5 mm displacement, without a mechanical bloc as good results have been published with conservative treatment. Type 3 fractures are often treated with radial head replacement. Although radial head resection is also an option as long-term results have been shown to be favourable. Radial head arthroplasty is recommended in type 3 fractures with ligamentous injury or proximal ulna fractures. Failure of primary radial head replacement may be due to several factors. Identification of the cause of failure is essential. Failed radial head arthroplasty can be treated by implant removal alone, interposition arthroplasty, revision radial head replacement either as a single stage or two-stage procedure.

Double ulnar osteomy for the treatment of congenital radial head dislocation

ObjectiveThe aim of this study was to retrospectively evaluate the effects of our double osteotomy technique in the treatment of congenital radial head dislocation (CRHD). MethodsA total 14 children (14 elbows; 71.42% male; mean age: 9.31 ± 3.06 years) with CRHD who underwent double osteotomy of the proximal ulna between April 2010 and June 2015 were included in the study. The patients with CRHD were identified according to medical history, plain radiographs or magnetic resonance imagings. The outcomes were evaluated through comparison of the preoperative and postoperative motion range of elbow and Mayo Elbow Performance Score (MEPS). ResultsAfter a follow-up of 13–35 months (22.29 ± 5.80), compared with pre-operation, the flexion (132.14 ± 3.23° vs 123.21 ± 7.75°, P = 0.003), extension (8.21 ± 4.21° vs 1.07 ± 3.50°, P = 0.003), and pronation of elbow (83.21 ± 4.21° vs 80.36 ± 4.14°, P = 0.011) improved significantly in all patients. Furthermore, the carrying angle was recovered to the normal level (5–15°) in all of these patients (18.57 ± 5.69° vs 8.21 ± 2.49°, P = 0.001). MEPS score was significantly increased postoperatively (96.79 ± 2.49 vs. 90.71 ± 1.82, P = 0.000), with the good outcome in CRHD patients. ConclusionThe results of our study suggested that this double osteotomy on the proximal ulna might be an effective method for the treatment of CRHD. Level of EvidenceLevel IV, Therapeutic Study.

Fractures of the proximal radius and ulna

Acute injuries of the proximal radius and ulna can be challenging to manage. This review article summarizes the classification, injury patterns, treatment and outcome of fractures of the olecranon, coronoid process, adult Monteggia fracture dislocations and radial head fractures. Undisplaced fractures and stable injuries can be treated conservatively and displaced and complex injuries should be treated surgically to permit early range of motion with a functional rehabilitation programme.

Ulnar trochlear notch articular surface has three morphological patterns: a neglected major anatomical feature.

The typical anatomical illustration of the trochlear notch articular surface includes a transverse rough non-articular ridge which separates the olecranon and coronoid part of the joint. This transverse ridge, the "bare area", is not covered by cartilage and represents the optimal entry point for olecranon osteotomies. Aim of the present study was to encounter the anatomical variations in the morphology of the trochlear notch articular surface. Two-hundred seventy-three dried ulnae were inspected and a qualitative classification of the variations of the trochlear notch articular surface was done. Correlation to gender and side was examined. Three distinct morphological patterns were observed. Separate olecranon and coronoid facets (Type I) were the most common pattern (165/273, 60.4%). Partial fusion of olecranon and coronoid facets (Type II) was observed in 75 out of 273 bones (27.5%), while a single olecranon and coronoid facet (Type III) was present in 33 out of 273 bones (12.1%). The occurrence of Type II and III was significantly more common in females (p < 0.001). The most common morphological pattern of the proximal ulna articular surface was the olecranon and coronoid facets separated by the transverse ridge, which is considered as the typical anatomical pattern. The partial fusion of olecranon and coronoid facets was the second most common pattern (27.5%) and the single olecranon and coronoid facet with no transverse ridge present was the rarest one (12.1%). These variations affect the area covered by cartilage. They are noticeable in an elbow MRI and they may have implications on olecranon osteotomy. Absence of the transverse ridge may confuse the surgeon during elbow arthroscopy.

Distal Metaphyseal Osteotomy Allows for Greater Ulnar Shortening Compared to Diaphyseal Osteotomy for Ulnar Impaction Syndrome: A Biomechanical Study.

Purpose To compare the biomechanical characteristics between diaphyseal and metaphyseal ulnar-shortening osteotomy with respect to (1) maximal shortening achieved at each osteotomy site and (2) force required to achieve shortening at each site. Methods Nine fresh frozen cadaveric upper extremities were affixed through the proximal ulna to a wooden surgical board. A metaphyseal 20-mm bone wedge was resected from the distal ulna and sequential shortening was performed. A load cell was attached to a distal post that was clamped to the surgical board and used to measure the force required for each sequential 5-mm of shortening until maximal shortening was achieved. The resected bone was reinserted, and plate fixation was used to restore normal anatomy. A 20-mm diaphyseal osteotomy was performed, and force measurements were recorded in the same manner with (1) interosseous membrane intact, (2) central band released, and (3) extensive interosseous membrane and muscular attachments released. Results Metaphyseal osteotomy allowed greater maximal shortening than diaphyseal osteotomy with the interosseous membrane intact and with central band release but similar shortening when extensive interosseous membrane and muscle release was performed. Force at maximal shortening was similar between metaphyseal and diaphyseal osteotomy. Sequential soft tissue release at the diaphysis allowed for increased shortening with slightly decreased shortening force with sequential release. Conclusion Metaphyseal ulnar osteotomy allows greater maximal shortening but requires similar force compared with diaphyseal osteotomy. Sequential release of the interosseous membrane permits increased shortening at the diaphysis but requires extensive soft tissue release. Clinical Relevance Both sites of osteotomy can achieve sufficient shortening to decompress the ulnocarpal joint for most cases of ulnar impaction syndrome. The greater shortening from metaphyseal ulnar osteotomy may be reserved for severe cases of shortening, especially after distal radius malunion or in the setting of distal radius growth arrest in the pediatric population. Level of Evidence This is a Level V, basic science study.

Reconstruction of traumatic tubular bone defects using vascularized fibular graft

Large segmental bone defects due to major trauma constitute a major challenge for the orthopaedic surgeon, especially when combined with poor or lost soft tissue envelope. Vascularized fibular transfer is considered as the gold standard for the reconstruction of such defects of the extremities due to its predictable vascular pedicle, long cylindrical shape, and tendency to hypertrophy, and resistance to infection. Vascularized bone grafts remain viable throughout the healing period and are capable of inducing rapid graft union without prolonged creeping substitution, osteogenesis and hypertrophy at the reconstruction site, and fight with infection.The fibular graft can be transferred solely, or as a composite flap including muscle, subcutaneous tissue, skin and even a nerve segment in order to reconstruct both bone and soft tissue components of the injury at single stage operation. Such a reconstruction can even be performed in the presence of local infection, since vascularized bone and adjacent soft tissue components enhances the blood flow at the traumatized zone, allowing for the delivery of antibiotics and immune components to the infection site.In an effort to preserve growth potential in pediatric patients; the fibular head and proximal growth plate can be included to the graft. This practice also enables to reconstruct the articular ends of various bones, including distal radius and proximal ulna. Apart from defect reconstruction, vascularized fibular grafts also proved to be a reliable in treating atrophic nonunions, reconstruction of osteomyelitic bone segments. These grafts are superior to alternative reconstructive techniques, as bone grafts with intrinsic blood supply lead to higher success rates in reconstruction and accelerate the repair process at the injury site in cases where blood supply to the injury zone is defective, poor soft tissue envelope, and local infection at the trauma zone.

Vascularized Olecranon Bone Graft: An Anatomical Study and Novel Technique

Autologous bone grafting is commonly used in reconstructive hand surgery. Various sources of nonvascularized autologous bone grafts have been described in the literature. However, in some situations, a vascularized bone graft may be needed. Popular vascularized bone grafts aretaken from the distal radius, iliac crest, and medial femoral condyle. The purpose of this study was to examine the feasibility of harvesting a free vascularized bone flap from the proximal ulna. Latex was injected via the brachial artery to facilitate visualization of perforators in 10 cadaveric specimens. Dissections were performed of the olecranon; all periosteal perforators were noted, and their lengths and diameters recorded. Corticocancellous bone flaps with their supplying pedicles were harvested. Three additional fresh specimens were injected with india ink via the pedicles to demonstrate perfusion of the harvested bone flap. Consistent vascular anatomy supplied the olecranon. A perforator from the posterior ulnar recurrent artery supplied the proximal ulna and olecranon, from which a vascularized bone flap can be harvested. Branches to the flexor carpi ulnaris muscle may allow chimeric flaps to be harvested. Average pedicle length was 5.8 cm and average pedicle diameter was 2.4 mm. India ink injection of the pedicles showed perfusion of the periosteum as well as intraosseous cancellous bone. A vascularized olecranon free flap can be harvested based on the posterior ulnar recurrent artery. Vascular anatomy is consistent and flap harvest is simple and straightforward in all cadaveric specimens. A vascularized olecranon free flap represents a potential new surgical option when vascular bone flap reconstruction is considered.

Posterolateral instability of elbow following radial head excision: A retrospective cross sectional study

Purpose: To study the occurrence of posterolateral instability of elbow joint following radial head excision in patients with radial head fracture and to determine the coexisting condition which contributes to instability.Methods: A retrospective cross sectional study designed to assess the occurrence of posterolateral instability of elbow following radial head excision. 30 patients who had undergone radial head excision for Masons type 2, 3, and 4 fracture between March 2010 to July 2018 were included in the study. On their follow up visit persistent symptom of elbow pain, signs of elbow instability (pivot shift test and chair push up test), mayo elbow score and radiological features were assessed for diagnosing the posterolateral instability of the elbow.Results: Of the 30 patients evaluated 2 of them had associated ulnar fracture and 1 had elbow dislocation. All 3 complained of pain and discomfort at the elbow joint. Pivot Lateral shift test and chair push up test were positive in these 3 cases, with an average Mayo elbow score of 70 in these 3 patients. The average arc of motion among these 3 patients ranged from 5° to 120° with pronation being 88° and supination of 86° as compared to the ones without instability. Two of the three patients showed radiological features of instability.Conclusion: Most radial head fractures treated with radial head excision have good outcome clinically, provided it is not associated with any concomitant injury of the elbow and if immobilized properly for minimum of 3 weeks post-surgery to allow for soft tissue healing. A small proportion of patients who have concomitant elbow dislocation or ulna fracture with persistent elbow pain, should undergo further clinical and radiological evaluation in the form of MRI and decision should be taken regarding need for ligament reconstruction or radial head replacement. Hence c existence of elbow dislocation or proximal ulna fracture should be a red flag sign for increased chances of posterolateral instability of the elbow.

Three-Dimensional Joint Kinematics in a Canine Elbow Joint with Medial Coronoid Disease before and after Bi-Oblique Dynamic Proximal Ulnar Osteotomy

Abstract Objective The aim of this study was to report the humeroulnar joint kinematics in a dog with medial coronoid process disease (MCPD) before and after dynamic proximal ulnar osteotomy (DPUO). Study Design A 15-month-old female Labrador Retriever with advanced MCPD was treated by DPUO and fragment removal. Bi-planar fluoroscopic kinematography of the affected joint was performed before and 12 weeks after DPUO along with computed tomography. Static axial radioulnar incongruence (sRUI), dynamic relative proximodistal radioulnar motion (dynamic RUI), axial humeroulnar rotation, as well as humeroulnar joint contact at the medial coronoid process (MCP) were calculated. Results Static axial radioulnar incongruence was reduced from 2.3 to 1.5 mm after DPUO but dynamic RUI remained unchanged (0.2 vs. 0.3 mm). Mean humeroulnar rotational amplitude increased from 2.6° (standard deviation 0.4) to 4.5° (standard deviation 2.0). Joint contact area at the MCP became substantially increased as well as broadly distributed among the MCP following DPUO (52.5 vs. 63.0%; p = 0.0012). Conclusion Dynamic proximal ulnar osteotomy failed to restore the radioulnar congruence and increased the humeroulnar rotational instability. No effect was observed on dynamic RUI. Nevertheless, joint contact area at the MCP was increased and became more homogeneously distributed, which might explain the beneficial effect of clinical outcome in this case.

Treatment of long bone cyst in children by autologous bone marrow blood injection and elastic intramedullary needle

To observe the clinical effect of autologous bone marrow blood injection combined with elastic intramedullary needle implantation in the treatment of long bone cyst in children. From January 2010 to December 2015, 29 children with long bone cyst were treated with autologous bone marrow blood injection combined with elastic intramedullary nail implantation, including 22 males and 7 females, aged 2 to 12 years old with an average age of 7.7 years old, and the course of disease was 12 to 84 months. Among them, 17 cases were proximal humerus, 9 cases were proximal femur, 2 cases were distal femur and 1 case was proximal ulna. All children with bone cyst underwent preoperative X-ray examination and CT or MRI examination if necessary. After definite diagnosis, bone marrow blood injection combined with elastic intramedullary needle support and drainage were used as treatment methods. After operation, multiple X-ray examination and follow-up were carried out. The curative effect was evaluated with Capanna bone cyst treatment evaluation criteria. Twenty-seven of 29 children were followed up for 12 to 60 months with an average of 31.8 months. According to the evaluation criteria of Capanna bone cyst, 26 cases were cured and 1 case was partially healed with residual lesions. Autologous bone marrow blood injection combined with elastic intramedullary needle has the characteristics of definite curative effect, high cure rate, fewer complications and objectively controllable treatment process for simple long bone cyst in children.

Clinical Application and Outcomes of Upper Extremity Double Plating.

Dual plating in fractures of the upper extremity is well established for the distal humerus. The indication for the use of dual plating has been expanded over the last few years. While dual plating was originally frequently used in revisions of non-unions, it is nowadays also used in primary fixation of diverse complex fractures of the upper extremity. The high biomechanical fixation strength of dual plating is advantageous in regions with high bending and torsional stresses, such as the humeral shaft. An additional anterior plate provides high fixation strength and reduces the risk of loss of reduction in complex proximal humeral fractures and allows for direct fixation of lesser tuberosity fragments. Low-profile plates have been introduced for complex proximal ulna fractures. In dual plating the improved mechanical stability is combined with a reduced risk of implant related soft tissue irritations. The present article provides an overview of current indications for dual plating of upper extremity fractures and outlines technical aspects as well as advantages over conventional fixation techniques.

Dual reconstruction of lateral collateral ligament is safe and effective in treating posterolateral rotatory instability of the elbow.

Although reconstruction of the lateral ulnar collateral ligament (LUCL) has been considered the procedure of choice for posterolateral rotatory instability (PLRI), recent studies have reported that the entire lateral collateral ligament complex (LCLC), rather than its posterior part only, contributes to preventing PLRI. Thus, it was hypothesized that dual reconstruction of the radial collateral ligament (RCL) and LUCL for the treatment of elbow PLRI could provide favourable clinical results regardless of the mechanism of injury. This retrospective study reviewed the clinical results of 21 patients who underwent dual reconstruction of the RCL and LUCL between 2011 and 2016. Functional outcomes were assessed using the numeric rating scale (NRS) score, Mayo Elbow Performance Score (MEPS), quick Disabilities of the Arm, Shoulder, and Hand (quick DASH) score, and manual varus instability. To identify any difference in outcomes according to the aetiologies for LCLC insufficiency, our patients were divided into LCLC insufficiency associated with elbow dislocation and that with lateral epicondylitis. At a median follow-up of 27months (range 13-65months), all patients showed resolved instability and achieved a functional arc of motion. In addition, lateral pivot shift tests were negative in all patients. The median MEPS significantly improved after surgery from 70 (range 60-75) to 85 (range 75-100) (p < 0.001), while the median quick DASH score improved from 38.6 (range 26.6-54.5) to 11.4 (range 0-34.1) (p < 0.001). Clinical outcomes according to the aetiology of LCLC insufficiency were not significantly different except for the NRS score. The results suggest that the dual reconstruction technique leads to a clinical outcome similar to that of conventional LUCL reconstruction in LCLC insufficiency regardless of aetiology. In addition, the dual reconstruction technique was technically easier than the conventional LUCL reconstruction technique and may be a potential alternative when a bone tunnel created at the proximal ulna by the original technique has failed. IV.