Range Of Supination Research Articles

In Vivo Three-Dimensional Analysis of Malunited Forearm Diaphyseal Fractures with Forearm Rotational Restriction.

The aim of this study was to clarify the mechanisms of rotational restriction in malunited forearm diaphyseal fractures. We retrospectively analyzed the cases of 18 patients with malunited forearm diaphyseal fractures and rotational restriction. All patients underwent bilateral computed tomography (CT) of the forearm in maximum supination, pronation, and neutral positions. From these images, we created 3-dimensional (3-D) bone surface models. We quantified the 3-D deformities, identified instances of osseous impingement between the radius and the ulna during forearm rotation, calculated the path length of the central band (CB) of the interosseous membrane, and measured forearm range of motion. Sixteen patients had extension deformity of the radius (the RE group) and 2 had flexion deformity (the RF group). In the RE group, extension deformity of the radius and valgus deformity of the ulna had significant negative correlation with pronation range of motion (R = -0.50, p = 0.046) and supination range of motion (R = -0.63, p = 0.027), respectively. Osseous impingement was mainly observed during pronation (15 of 16 patients). The CB path with the largest changes in length originated from the distal CB attachment area of the radius and ran toward the proximal area of the ulna (the transverse CB). The transverse CB significantly increased in length in supination compared with that in pronation (p < 0.001). Therefore, tightness of the transverse CB appeared to cause supination restriction in the RE group. In the RF group, osseous impingement caused supination restriction. The greatest increases in the transverse CB length were observed in pronation in the RF group, which appeared to cause pronation restriction. In the RE group, pronation restriction was associated with osseous impingement that was due to extension deformity of the radius, and supination restriction was associated with CB tightness that was due to valgus deformity of the ulna. In the RF group, our results suggested that pronation restriction was caused by CB tightness and that supination restriction was caused by osseous impingement. Three-dimensional corrective osteotomy for extension deformity of the radius in malunited forearm diaphyseal fractures would improve rotational restriction by relieving osseous impingement during pronation and CB tightness during supination.

Radiological follow up of volar locking plating of distal radius fracture

Introduction: Fracture of the distal end radius constitutes one of the most common skeletal injuries treated by an orthopaedic surgeon. This study was aimed to assess the clinical and radiological outcome of the intra-articular fracture distal end radius treated with variable angle mini-fragment volar plate fixation. Methodology: In the prospective study, patients presenting with distal end radius fracture and then operated with mini-fragment volar locking distal radius plating were included. All patients were evaluated by a senior orthopaedic surgeon at 3, 6 and 24 weeks post-operatively, during which patients underwent a physical examination of the wrist and forearm motion and grip strength, followed by radiological evaluation. Range of movement and complications were noted for all patients at each follow up visit.Results: 64% of the patients were below the age of 40 years. Approximately three fourths of all patients were classified as Frykmann distal radius fracture type VIII. The mean radial inclination, length and tilt were maintained throughout the follow up period. The range of dorsiflexion, palmarflexion, supination and pronation improved significantly at each follow up. 8% had superficial skin infection, 4% had serous discharge and loss of reduction each and 84% did not report any complications.Conclusions: Primary volar mini-fragment variable angle plate fixation of freshly displaced distal radius fracture provides complete union, with immediate mobilization, better functional outcomes, minimizes chances of delayed/malunion.

Locking plate versus external fixation for type C distal radius fractures: A meta-analysis of randomized controlled trials

PurposeDistal radial fracture is one of the most common fractures. Up to now, locking plates (LP) and external fixation (EF) are two conventional surgical approaches to type C radius fracture. Which method is superior has not yet reached a consensus. We try to assess the clinical effectiveness of the two interventions by this meta-analysis. MethodsWe used network to search the PubMed, Embase, and Cochrane Medical Library of randomized controlled clinical trials about the type C distal radius fractures performed according to the search strategy mentioned in Cochrane Handbook 5.1.0 from Jan. 2005 to Jan. 2016. Patients in the experimental group were used LP, in the control group were included EF and other surgical approaches. Publication language was restricted to English. Studies that patient population and surgical indication did not define had been excluded. Studies must report at least one of the outcomes as follow: radial inclination, palmar tilt, ulnar variance, range of wrist flexion and extension, and range of wrist supination and pronation. The trials in which participants included children were excluded. We used Jadad study scores to appraise the study. ResultsSeven studies included 162 patients (LP group) and 190 patients (EF group). We compared the radial inclination, palmar tilt, ulnar variance, range of wrist flexion and extension, and range of wrist supination and pronation. The radial inclination were revealed a difference favoring LP over EF [WMD = 1.84, 95% CI (0.17, 3.50), p = 0.03] and the palmar tilt and ulnar variance was no significant difference between the two groups [(WMD = 3.61, 95% CI (0.00, 7.23), p = 0.05; WMD = 0.05, 95% CI (−0.99, 1.09), p = 0.93]. The functional activities of range of flexion and extension and range of supination and pronation between the two groups was no difference [WMD = 10.04, 95% CI (−6.88, 26.96), p = 0.24; WMD = 12.53, 95% CI (−9.99, 35.06), p = 0.28]. ConclusionLocking plate and external fixation is feasible to heal radius type C fracture. We found the small difference between the two groups on imaging examination. The locking plate has the advantage on maintaining reduction, however no significant difference regarding outcomes has been found between the two groups.

Reliability assessment of measuring active wrist pronation and supination range of motion with a smartphone

This study aimed to improve clinical examination techniques by determining the reliability of different methods to evaluate forearm movements. Two methods using the iPhone™ 5 and its gyroscope application (alone [I5] or attached to a selfie stick [ISS]) were compared with two conventional measurement devices (a plastic goniometer with a hand-held pencil [HHP] and a bubble goniometer [BG]) to evaluate the active range of movement (AROM) of the wrist during pronation and supination. Two independent groups of subjects took part in this prospective single-center diagnostic study: 20 healthy subjects and 20 patients. The four evaluation methods had high intra-observer consistency after three measurements (intra-class correlation coefficient [ICC] [3, 1] of 0.916 for the HHP; 0.944 for ISS; 0.925 for BG; 0.933 for I5) and excellent inter-observer reliability (ICC [2, k] of 0.926 for HHP; 0.934 for ISS; 0.899 for BG; 0.894 for I5), with an agreement of plus or minus 2°. When these devices are used with rigorous methodology, they are reliable for the goniometric evaluation of AROM of wrist pronation and supination.

La plaque Lasso. Un implant original pour le traitement des fractures Regan-Morrey I et II de la coronoïde ulnaire

IntroductionCoronoid fractures are notoriously difficult to manage particularly when there is a small fragment. We report a retrospective analysis of our experience with consecutive type I and II Regan-Morrey coronoid fractures using a lasso plate. HypothesisType I and II Regan-Morrey coronoid fractures can be effectively managed using a lasso plate. MethodsFrom October, 2011 and December, 2013, 25 patients (21 males and 4 females, mean age 40.0 years) with type I and II Regan-Morrey coronoid fractures were treated with the open reduction and internal fixation (ORIF) using the lasso plate. Postoperative measurements of the elbow range of motion were recorded. Elbow function was evaluated by the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) score. ResultsAll patients were re-examined at a mean follow-up of 32.7 months (range, 24–49 months). The mean fractures healing time was 13.6 weeks (range, 6–18 weeks). The mean flexion range of the elbow was 121.8° (range, 90°–135°), and the mean extention range of the elbow was 10.6° (range, 0°–20°). The mean pronation range of the forearm was 75.8° (range, 65°–85°). The mean supination range of the forearm was 80.4° (range 70°–90°). The mean DASH score was 10.2 (range 0–28). The mean MEPS was 83.4 (range 55–95), 8 patients (32 %) were rated excellent, 14 patients (56 %) were rated good, 2 (8 %) patients were rated fair. 1 (4 %) patient were rated poor. No patient was seriously infected, implant breakage was found in one case. Two cases of elbow heterotopic ossification (HO) were observed. Two cases of elbow medial instability were observed. DiscussionThe type I and II Regan-Morrey coronoid fractures combined with the instability of the elbow should be operated. The lasso plate reduces the pressure between the wire and the insertion of capsule. A tight wire results in greater stability than ordinary suture fixation, thus enabling early functional exercise. ConclusionIn the treatment of type I and II Regan-Morrey coronoid fractures, lasso plate can provide concentric fracture reduction of the elbow and stable fixation to allow for early rehabilitation. Good clinical outcomes can be anticipated. Level of evidenceLevel IV: retrospective study.

A study of surgical management of fracture both bones forearm treated with limited contact dynamic compression plate and screws

Background and Objective: Fractures of the forearm bones may result in severe loss of function unless adequately treated. In addition to regaining length, apposition and axial alignment and normal rotational alignment is necessary for good range of pronation and supination. Bone healing of both radius and ulna is slow because of small contactsurfaces at the fracture site and is the reason why stable fixation of fragments is necessary. The advantages of plating are. 1) Excellent control of fracture fragments 2) Anatomical realignment is possible. 3) Very low rate of non-union. 4) Good to excellent functional results. So we decided to study and evaluate the results of internal fixation with LC-DCP to confirm its present day relevance.

Giant cell tumor of distal radius treated with ulnar translocation and wrist arthrodesis.

The aim is to analyze the functional outcomes of patients of giant cell tumor (GCT) of distal radius treated with ulnar translocation and wrist arthrodesis. Study included 25 patients of aggressive GCT of distal radius, resected and reconstructed using ulnar translocation and wrist arthrodesis. The ulna-carpal radius fixation was performed with plate and screws. The patients were followed to bony union and minimum follow-up was 1 year. Twenty-two patients were of Campanacci grade 3 and three patients were of Campanacci grade2. The mean follow-up was of 23 months (12-36). All patients had an excellent range of pronation and supination. The mean Musculoskeletal Tumor Society score was 24 (range 22-28). Grip strength of affected hand compared to the contra lateral hand was found good in 17 cases and average in 7 cases. The mean bone union time at ulna to radius junction was at 6.5 (5-8) months and ulna to carpal junction at 4.5 (4-6) months. The complications were surgical site infection (one case), recurrence (one case) and failure of union (one case), and ulna graft fracture with implant failure in (two cases). Reconstruction of distal end of radius using ulnar translocation and wrist arthrodesis provides excellent functional outcomes with preservation of rotational movement of forearm and hand function. Reconstruction of the distal radius by ulnar translocation without complete detachment from surrounding soft tissues functions like vascularized graft without use of microvascular techniques.

Dynamic Ulnar Deviation Deformity of Wrist Due to Post Infective/Posttraumatic Contracture of Isolated Musculotendinous unit—A Report of Two Unusual Cases

Keywords Extensor carpi ulnaris.Flexor carpi ulnaris.Z PlastyIntroductionDeformities at wrist are commonly attended in an orthope-dic outpatient department. The causes in young rotatearound epiphyseal plate growth disturbances, which may becongenital as in madelung deformity or acquired afterinfection, trauma or tumor. Shortening of extensor carpiulnaris (ECU) musculotendinous unit as sequelae ofinfection or flexor carpi ulnaris (FCU) musculotendinousunit as sequelae of trauma leading to a dynamic wristdeformity has not been reported in literature yet.Case reportCase 1 A 15 years old male presented with c/o deformity(ulnar deviation) of left wrist for last 6 years. Patient wasapparently all right 6 years back when he suffered trauma todorso ulnar aspect of left upper forearm followed bydevelopment of an abscess, which was incised and drainedby a local practitioner. Patient started developing ulnardeviation at left wrist which kept on progressivelyincreasing (it has been static for last 1 year). Patient hadsome functional disability as a result of this deformity, inparticular, in picking up objects and holding glass (glassholding requires radial deviation at wrist). However thepower grip (in ulnar deviation of hand) was normal. Therewas no complaint of any numbness or weakness.On local examination a 5 cm×2 cm scar was seen ondorso-ulnar aspect of upper 1/3rd of left forearm (i.e. thesite of previous I&D) (Fig. 1a). There was fixed ulnardeviation deformity of left wrist—45° (Fig. 1b). The rangeof supination and pronation was full. Range of motion ofelbow was full and painless. Dorsiflexion and palmarflexion were 80° and 90° respectively. No radial deviationwas possible. Ulnar deviation ranged from 45° to 60° withwrist in neutral dorsi/palmar flexion. On attempt at activeulnar deviation and dorsiflexion by the patient contractionof ECU muscle belly could be felt. Ulnar lengths measuredfrom olecranon tip to ulnar styloid and radial lengths fromradial head to radial styloid were bilaterally symmetricaland hence normal.Ulnar deviation deformity at wrist manifested itselfcompletely on palmar flexion but disappeared on dorsi-flexion (60° ulnar deviation deformity on palmar flexionand no ulnar deviation deformity on dorsiflexion) (Fig. 1cand d) .ECU tendon got taut and became prominent onattempted radial deviation (Fig. 1e).This is a fixed length phenomenon suggestive ofshortened ECU. No neurovascular deficit was found. X-rays of bilateral wrist and left elbow with forearm werenormal. A provisional diagnosis of left ECU contracturewith dynamic ulnar deviation deformity of left wrist wasmade.Written informed consent was taken from the patient andhis parents for surgery and they were also informed that thiscase will be considered for publication in some scientificjournal including electronic publication on the internet.

Long-term results after a free vascularized adipofascial graft for congenital proximal radioulnar synostosis with an average follow-up of 10 years: a series of four cases

The aim of this study was to observe the long-term and chronologic changes in clinical and radiologic findings after a free vascularized adipofascial graft interposition with radial osteotomy for congenital proximal radioulnar synostosis (PRUS). Six forearms in 4 patients with congenital PRUS who underwent a free vascularized adipofascial graft interposition combined with radial osteotomy were followed up for an average of 10 years (8-12 years) postoperatively. Extension and flexion angles of the elbow and pronation and supination angles of the forearm as well as radiographs were evaluated preoperatively and throughout the postoperative follow-up period. The average extension/flexion angles of the elbow and the average pronation/supination angles of the forearm were 3°/130° and 14°/- before surgery, -4°/135° and 39°/23° at 1 year after surgery, 6°/138° and 44°/30° at 3 years after surgery, and -2°/139° and 35°/7° at the time of the final follow-up, respectively. Final radiographs showed hypertrophy of the radial head in 4 patients, dislocation of the radial head in 2 patients, and deformity of the radial head in 1 patient. Extension and flexion angles of the elbow in patients with congenital PRUS were constant and the average range of pronation was relatively well maintained throughout the postoperative period, but the average range of supination decreased by 16° from 1 year postoperatively to the time of the final follow-up.

Arthroscopic-assisted repair of triangular fibrocartilage complex foveal avulsion in distal radioulnar joint injury.

Background:Disruption of the triangular fibrocartilage complex (TFCC) foveal insertion can lead to distal radioulnar joint (DRUJ) instability accompanied by ulnar-sided pain, weakness, snapping, and limited forearm rotation. We investigated the clinical outcomes of patients with TFCC foveal tears treated with arthroscopic-assisted repair.Materials and Methods:Twelve patients underwent foveal repair of avulsed TFCC with the assistance of arthroscopy between 2011 and 2013. These patients were followed up for an average of 19 months (range 14–25 months). The avulsed TFCC were reattached to the fovea using a transosseous pull-out suture or a knotless suture anchor. At the final followup, the range of motion, grip strength and DRUJ stability were measured as objective outcomes. Subjective outcomes were assessed using the Visual Analog Scale (VAS) for pain, patient rated wrist evaluation (PRWE), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score) and return to work.Results:Based on the DRUJ stress test, 5 patients had normal stability and 7 patients showed mild laxity as compared with the contralateral side. Postoperatively, the mean range of pronation supination increased from 141° to 166°, and the mean VAS score for pain decreased from 5.3 to 1.7 significantly. The PRWE and DASH questionnaires also showed significant functional improvement. All patients were able to return to their jobs. However, two patients complained of persistent pain.Conclusions:Arthroscopically assisted repair of TFCC foveal injury can provide significant pain relief, functional improvement and restoration of DRUJ stability.

The effect of age on elbow range of motion in pitchers

BackgroundAlteration of elbow range of motion (ROM) has been observed in baseball pitchers. This study aims to compare dominant elbow ROM between early-puberty, late-puberty, and young–adult pitchers. MethodsWe recruited 62 pitchers, consisting of 17 early-puberty (mean age 13.1 years old), 22 late-puberty (mean age 17.7 years old), and 23 young–adult players (mean age 19.4 years old). Dominant elbow ROMs was measured. One-way ANOVA was used to compare the differences in elbow ROM variables between 3 groups. ResultsLate-puberty pitchers exhibited a significantly lower elbow hyperextension and flexion than early-puberty or young–adult pitchers (P < .05). Valgus angle was significantly lower in young–adult (7.7°±5.5°) versus early-puberty (12.1°±2.3°) and late-puberty pitchers (13.0°±4.1°; P < .05). Young–adult pitchers had the largest forearm supination range (101.2°±18.1°), followed by early-puberty (82.5°±6.5°; P < .05) and late-puberty pitchers (70.6°±15.8°). Elbow flexion-hyperextension total range was smallest in late-puberty pitchers (130.3°±7.4°), followed by young–adult (142.6°±9.3°) and early-puberty pitchers (144.6°±8.3°; P < .05). Forearm pronation–supination total range was also smallest in late-puberty pitchers (142.0°±20.3°), followed by early-puberty (159.8°±9.5°) and young–adult pitchers (177.2°±20.8°; P < .05). ConclusionsThese results indicate that careful monitoring of the elbow and forearm range of motion should be undertaken in adolescent baseball pitchers to prevent and or minimize injury risk.

Effect of Volarly Angulated Distal Radius Fractures on Forearm Rotation and Distal Radioulnar Joint Kinematics

To examine the effect of volar angulation deformities of the distal radius with and without triangular fibrocartilage complex (TFCC) rupture on forearm range of motion and the kinematics of the ulnar head at the distal radioulnar joint (DRUJ) during simulated active forearm rotation. Volar angulation deformities of the distal radius with 10° and 20° angulation from the native orientation were created in 8 cadaveric specimens using an adjustable apparatus. Active supination and pronation were performed using a forearm motion simulator. Pronation and supination range of motion was quantified with each deformity. In addition, changes in the dorsovolar position of the ulnar head relative to the radius were calculated after simulating each distal radial deformity. Testing was performed with the TFCC intact and sectioned. Volar angulation deformities of 20° decreased the supination range with preservation of pronation. There was no effect of TFCC status on the range of forearm rotation. With the TFCC intact, volar angulation deformities translated the ulna slightly dorsally in pronation and volarly in supination. After sectioning the TFCC, volar angulation deformities of 10° and 20° translated the ulna dorsally throughout forearm rotation. Volar angulation deformities reduce supination range and alter the DRUJ kinematics. The increased tension in the intact TFCC caused by volar angulation deformities likely prevented the expected dorsovolar displacement at the DRUJ and restricted supination. Dividing the TFCC released the constraining effect on the DRUJ and allowed the ulna to translate dorsally. However, supination remained limited, presumably because of impediment from the dorsally subluxated ulna. This study demonstrated the importance of correcting volar angulation deformities of the distal radius to less than 20° in order to maintain normal range of forearm rotation and to less than 10° to maintain normal DRUJ kinematics when the TFCC is ruptured.

Treatment of distal biceps tendon rupture: why, when, how? Analysis of literature and our experience.

The rupture of the distal biceps tendon is a relatively uncommon lesion. Even if conservative treatment may be an option in low demanding patients, young and active subjects may benefit from an early surgical reinsertion. Many techniques and fixation devices have been described, but in the literature, there are no clinical evidences that show the superiority of any of these. In this article, we report an analysis of the "state of the art" and our case series of surgical reinsertion with the double approach transosseous technique. Between 2003 and 2013, 26 patients underwent surgical reinsertion, either for acute or for chronic lesions of distal biceps tendon. We evaluated 21 acute cases treated with double approach using DASH and SECEC Elbow Scores. The mean follow-up was 22 months. Range of motion, supination and flexion strength were also recorded. Mean final ROM was 6-132° in F/E and 89-0-87° in P/S; flexion and supination strength were 96 and 88 % compared to the opposite side. The main complications were two cases of heterotopic ossifications: one asymptomatic fracture of the proximal radius and one temporary neurapraxia of the radial nerve. Analysing the literature and our outcomes, we underline the importance of timing for surgery, in young and compliant patients, with a valid rehabilitation protocol for excellent results. The choice of surgical technique remains controversial, and we believe that the double approach transosseous reinsertion is a safe, costless and relatively non-invasive technique, offering satisfactory results when performed early.

Analysis of the forearm rotational efficiency in extant hominoids: New insights into the functional implications of upper limb skeletal structure

The greatly diversified locomotor behaviors in the Hominoidea impose different mechanical requirements in the upper limb of each species. As forearm rotation has a major role in locomotion, the skeletal structures involved in this movement may display differences among taxa that reflect functional adaptations. To test this, we use a biomechanical model that quantifies the rotatory capacity of pronator teres (rotational efficiency) from skeletal measurements. Using a large sample of hominoids, we aim to identify the morphological adaptations that confer differences in the mechanics of forearm motion and to assess the functional advantage of these adaptations. Forearm positions along the pronation–supination range where rotational efficiency is maximal depend on the orientation of the humeral medial epicondyle and differ among taxa. Our results indicate that these are related to locomotor mode. Knuckle-walkers exhibit a medial epicondyle more posteriorly directed, which, in elbow angles close to extension, causes rotational efficiency to be maximal in pronated positions of the forearm. Species with a significant amount of arboreal locomotion, such as vertical climbing, i.e., Pongo spp., Pan troglodytes and Gorilla gorilla, display more proximally oriented epicondyles, which, in elbow flexion, leads to maximum rotational efficiencies in supinated positions of the forearm. Hylobatidae, with the less posteriorly and proximally oriented epicondyle, show their maximum rotational efficiencies closer to the forearm neutral position throughout most of the flexion–extension range, which may be linked to brachiation in this taxon. In humans, the epicondylar orientation and thus the positions of the maximum rotational efficiencies fall between arboreal and terrestrial hominoids. This may be related to the enhanced manipulative skills of the upper limb. In conclusion, the current analysis indicates that the orientation of the humeral medial epicondyle is linked to the locomotor habits of extant hominoids and therefore can be used for locomotor inferences in fossil taxa.

Outcome Assessment after Aptis Distal Radioulnar Joint (DRUJ) Implant Arthroplasty.

Conventional treatments after complicated injuries of the distal radioulnar joint (DRUJ) such as Darrach and Kapandji-Sauvé procedures have many drawbacks, which may eventually lead to a painful unstable distal ulna. The development of DRUJ prosthesis has significantly evolved over the past years. In this study, we assessed the outcome results of patients after DRUJ implant arthroplasty using the Aptis (Scheker) prosthesis. We identified 13 patients with 14 prosthesis during the past 10 years. Patients underwent DRUJ arthroplasty due to persistent symptoms of instability, chronic pain, and stiffness. Records and follow-up visits were reviewed to find the final post-operative symptoms, pain, range of motion, and grip strength with a mean follow-up of 12 months (range: 2-25 months). Also, patients were contacted prospectively by phone in order to administer the disabilities of the arm shoulder and hand (DASH), patient rated wrist evaluation (PRWE), and visual analogue scale (VAS), and to interview regarding satisfaction and progress in daily activities. Eleven patients out of 13 could be reached with a median follow-up time of 60 months (range: 2 to 102 months). No patient required removal of the prosthesis. Only two patients underwent secondary surgeries in which both required debridement of the screw tip over the radius. The median DASH score, PRWE score, VAS, and satisfaction were 1.3, 2.5, 0, and 10, respectively. The mean range of flexion, extension, supination, and pronation was 62, 54, 51, and 64, respectively. Distal radioulnar joint injuries are disabling and patients usually undergo one or more salvage surgeries prior to receiving an arthroplasty. The Scheker prosthesis has shown satisfactory results with 100% survival rate in all reports. The constrained design of this prosthesis gives enough stability to prevent painful subluxation.

Sup-ER orthosis: An innovative treatment for infants with birth related brachial plexus injury

Impairments in active and passive range of upper extremity supination and shoulder external rotation are common sequelae for children with delayed recovery from birth related brachial plexus injury. Orthotic intervention may complement traditional treatment strategies commonly employed in the newborn period. These authors describe their custom fabricated orthosis designed to balance shoulder growth and muscular function, and improve prognosis of long term functional outcomes for children with birth related brachial plexus injury. – Victoria Priganc, PhD, OTR, CHT, CLT, Practice Forum Editor

NON OPERATIVE TREATMENT

Background: Pediatric forearm fractures result in substantial morbidity andcosts. Despite the success of public health efforts in the prevention of other injuries, the incidenceof pediatric forearm fractures is increasing. Most forearm fractures occurred during the springseason. Objective of the study is to determine the functional outcome of conservatively treatedradius ulna fractures in Children. Design: Descriptive study. Setting: Department of Orthopedicsand Traumatology, Khyber Teaching Hospital Peshawar. Period: March 2009 to April 2010.Methodology: Total 236 children with radius ulna fractures were manipulated and above elbowplaster Cast applied for 6-8 weeks and reviewed every second week. After plaster cast removalPronation and supination measured with goniometer and fortnightly thereafter for 6 weeks.Results: All the fractures united. Normal range of pronation and supination at the end of followsup period was in 182(80.53%) children. Loss of pronation and supination of average 10 degreeswere in 9(3.98%) patients. Patients having displacement of the fracture and opted for surgerywere 35(15.46%). Conclusions: Closed reduction of diaphyseal fractures in children results innormal pronation and Supination in majority of the patients.

Long-term functional donor site morbidity of the free radial forearm flap in head and neck cancer survivors

BackgroundTo assess the functional donor site morbidity of the forearm free flap in patients surviving at least 2 years after ablative head and neck cancer surgery in a tertiary care centre.MethodsThis study involved nine long-term survivors (2 year post-operative) who had forearm free flaps to reconstruct head and neck defects. All flaps were raised from the non-dominant arm. The non-donor side acted as a control for all patients. Objective measurements were as follows: grip, tip pinch and key pinch strength measured with dynamometers; flexion, extension, radial and ulnar deviation and pronation and supination range of motion at the wrist measured with goniometry; A timed manual dexterity task was performed with a grooved pegboard test, and sensation of the radial nerve was tested with Semmes Weinstein monofilaments. Subjective measurements included a validated patient questionnaire of hand function and opinions of scar appearance as well as a validated scar assessment from two different observers.ResultsPronation at the wrist, manual dexterity and sensation were found to be significantly reduced in the donor side compared to the non-donor side. Inter-rater agreement between the two observers was found to be poor, except for an acceptable correlation between overall scar opinions. No correlations were found between any subjective or objective items or between the patient’s and the observers’ subjective evaluations.ConclusionsDonor site morbidity can be demonstrated with objective testing however this is accepted and well tolerated by head and neck cancer patients.

Comparative study of the closed reduction percutaneous cannulated screw fixation and open reduction palmar locking plate fixation in the treatment of AO type A2 distal radius fractures

The present study was designed to demonstrate the efficacy of standard 4.0 mm cannulated screw fixation by comparing it with palmar locking plate fixation in the treatment of acute, unstable, simple extra-articular distal radius fractures. We prospectively collected and retrospectively analyzed outcomes data for 65 patients aged between 18 and 60 with AO type A2 fractures treated with closed reduction, percutaneous cannulated screw fixation (CRPCS n = 34) or open reduction palmar locking plate fixation (ORPLP n = 31). Range of motion, grip strength, Gartland-Werley and QuickDASH scores were compared at 2 months after surgery, and final follow-up (mean 32 months, range 12-90). Deterioration in radiographic parameters were measured and compared. Operative time and return to preinjury activity were evaluated. Parameters did not differ significantly between the groups at either time point with respect to grip strength or range of motion, except pronation and supination; they were better in the CRPCS group (p = 0.005 and 0.025, respectively) at 2 month follow-up. The Gartland-Werley and QuickDASH scores obtained at final follow-up were similar for each group and lacked statistical significance. Group comparison for the deterioration of radiologic parameters showed no significant difference. CRPCS group had significantly shorter operative time (p = 0.001) and there was no significant differences between the groups regarding the return to preinjury activity (p = 0.129). CRPCS group was found to be as successful as ORPLP group and it may be suitable in the case of young, active individuals with AO type A2 distal radius fractures.

A study to compare two goniometric methods for measuring active pronation and supination range of motion

Introduction Movement of the forearm allows positioning the hand during several functional activities of daily living. Assessing range of motion of supination and pronation is essential for clinical identification of functional limitations, although many methods can be used. Confounding values can be found due to different techniques used by therapists. The purpose of this study was to compare two standard goniometric methods for measuring active range of motion of forearm pronation and supination, aiming to define its reliability and ease of use. Methods The study included 33 individuals, 13 injured and 20 non-injured volunteers. We analyzed two standard goniometric methods for measuring pronation and supination. For the first method, the volunteers had to hold a pencil as a guide for the movable arm of the goniometer and for the second method the movable arm was in contact with the distal dorsal surface of the wrist near the ulna head, and the hand was free. Two trained examiners performed the evaluations. Intraclass correlation coefficient and limits of agreement of Bland and Altman were used to analyze the data. Results Intraclass correlation coefficient values were excellent for both groups and movements at inter-rater and inter-methods comparison. Bland and Altman plots showed that, although excellent reliability, some data dispersion was present. Conclusion These data suggest that both methods could be used in clinical practice with excellent reliability. The goniometric method with the movable arm placed in contact with the distal dorsal surface of the wrist near the ulna head might be easier to perform and useful in cases where finger prehension is absent or weak, which would prevent the use of a pencil as reference.