Ulna In Patients Research Articles

A Comparison of Outcomes of ‘Extensor Carpi Ulnaris Tenodesis’ versus ‘No Tenodesis’ after Resection of the Distal Ulna in Patients with Giant Cell Tumor

Background: One of the methods of stabilizing the stump of the ulna following resection of the distal ulna is tenodesis of the extensor carpi ulnaris (ECU). Some studies have recommended stabilization, whereas others have not found it useful. Most of these studies have a mix of different pathologies and often do not have a control group. The aim of this study is to compare the outcomes of ECU tenodesis versus no tenodesis after resection of the distal ulna in patients with grade III giant cell tumor (GCT) of the distal ulna. Methods: The retrospective study included 10 patients with Campanacci grade III GCT of the distal ulna treated by resection of the distal ulna between 2014 and 2019. Patients were stratified into two groups based on whether they underwent ECU tenodesis (n = 5) or no tenodesis (n = 5). The patients were assessed at 6 weeks, 6 months, and 12 months for complications and outcomes using the Mayo wrist score (MWS) and the revised musculoskeletal tumor society score (MSTS). Results: The MWS and the MSTS were significantly better in the ECU tenodesis group at 6 weeks. At 6 months, MWS was similar in both groups, but MSTS continued to be significantly better in ECU tenodesis group. At 12 months, both groups reported similar MWS and MSTS. There were no recurrences in either groups. One patient in the ECU tenodesis group developed ECU tendonitis that resolved with conservative treatment. Conclusions: The outcomes of ECU tenodesis were better in the short term (6 months), although both groups reported similar outcomes at 12 months. Level of Evidence: Level III (Therapeutic).

Use of Corrective Ulnar Osteotomy and Radial Head Relocation Into Preserved Annular Ligament in the Treatment of Radiocapitellar Instability Secondary to Pediatric Chronic Monteggia Fracture–Dislocation

Opening-wedge osteotomy of the ulna restores normal ulnar length and corrects the angulation of the ulna in patients with chronic Monteggia fracture-dislocations. In addition, this eases the reduction of the radial head. Morbidity caused by annular ligament reconstruction surgery can be prevented by preserving the intact annular ligament. After dilatation and mobilization of the annular ligament, reduction of the radial head can be accomplished. This study evaluated the effectiveness of corrective opening-wedge ulnar osteotomy and radial head relocation into the intact annular ligament in the treatment of radiocapitellar instability secondary to pediatric chronic Monteggia fracture-dislocation. Fourteen patients diagnosed with radial head dislocation associated with plastic deformation of the ulna or ulnar fracture were included in the study. Radiologic and clinical results of these patients who underwent corrective ulnar osteotomy and radial head relocation into an intact annular ligament were evaluated retrospectively. The mean age of the patients at the time of injury was 7.4 years (range, 3 years to 12 years). The average time between the injury and surgery was 19.1 months (median, 8 months; range, 3 months to 66 months); the average follow-up period was 28.7 months (range, 12 months to 60 months). The mean Kim score was 69.6 (range, 50 to 75) preoperatively and 92.9 (60 to 100) at last follow-up. According to Kim score, the results were considered excellent in 12 cases and poor in 2 cases. Radial head subluxation recurred in 2 separate cases. In addition, chondrolysis changes were seen in 1 case. Reduction loss and osteoarthritic changes in the radiocapitellar joint were considered poor results in follow-up radiographs. Corrective ulnar osteotomy and relocating the radial head into the intact annular ligament can be safely used for treating chronic Monteggia fracture-dislocation cases without radial head and capitellum deformity. Therapeutic IV.

Clinical and molecular characterization of four patients with Robinow syndrome from different families.

Robinow syndrome (RS) is a rare heterogeneous disorder characterized by short stature, short-limbs, craniofacial, oro-dental abnormalities, vertebral segmentation defects, and frequently genital hypoplasia. Both autosomal dominant and recessive patterns of inheritance are observed with many causative genes. Here, we present the phenotypes and genotypes of four children with RS from different Indian families. Sequence variants were identified in genes ROR2, DVL1, and DVL3. Our results expand the mutational spectrum of RS and we also highlight the radiological changes in the radius and ulna in patients with ROR2 sequence variants which are primarily characteristic for ROR2 related RS but have been reported in WNT5A related RS.

Gradual Lengthening of the Ulna in Patients with Multiple Hereditary Exostoses with a Dislocated Radial Head

PurposeMultiple hereditary exostoses of the forearm typically form in the distal ulna, causing disturbances in the growth of the ulna and functional disability. Multiple hereditary exostoses inhibit the growth of the ulna, leading to an acquisition of a varus deformity in the radius, which sometimes leads to dislocation of the radial head, the development of limitations in the pronation-supination of the forearm, and cosmetic problems.Materials and MethodsWe retrospectively reviewed the cases of four patients who had deformities of the forearm with radial head dislocation associated with multiple hereditary exostoses, and evaluated the radiologic and clinical results of excision of the osteochondromas from the distal ulna and gradual ulnar lengthening with an Ilizarov external fixator.ResultsGood clinical and radiological results were obtained after a mean follow-up of 25 months. At the most recent follow-up, radial bowing, ulnar shortening, carpal slip, and the pronation/supination arch of the forearm had improved. There was little change in terms of preoperative radial articular angle and the flexion/extension arch of the elbow by the most recent follow-up.ConclusionTreatment of four forearms from four patients by excision of osteochondromas and gradual lengthening of the ulna with an Ilizarov external fixator spontaneously reduced dislocations of the radial heads without the need for any additional operative intervention. All patients were satisfied with the final results.

Computed Tomography Osteoabsorptiometry Alterations in Stress Distribution Patterns Through the Wrist After Radial Shortening Osteotomy for Kienböck Disease

The distribution pattern of subchondral bone density is considered to closely reflect the stress distribution across a joint under physiological loading conditions. Our purpose was to determine alterations in the distribution pattern of subchondral bone density across the distal articular surfaces of the radius and the ulna in patients with Kienböck disease after radial shortening. We collected preoperative and postoperative computed tomography (CT) image data from 7 wrists of 7 patients who had undergone radial shortening for Kienböck disease. We measured the distribution of subchondral bone density through the distal articular surface of the radius and the ulna using a CT osteoabsorptiometry method. The obtained data were quantitatively assessed by calculating the high-density area ratio of the entire radiocarpal joint surface, scaphoid fossa, lunate fossa, and distal ulnar surface. At the mean postoperative period of 27 months, the mean high-density area ratio in the entire distal articular surface of the radius significantly decreased from 0.413 preoperatively to 0.141 postoperatively. The postoperative value in each fossa demonstrated a significant reduction from 0.253 to 0.096 in the scaphoid fossa and from 0.160 to 0.045 in the lunate fossa. No significant alteration in the value was found in the distal ulna at follow-up. Our CT osteoabsorptiometry analysis suggests that the distribution of subchondral bone density in both scaphoid and lunate fossae notably decreases after radial shortening. This indicates that radial shortening unloads the lunate by reducing the actual stress across the distal articular surface of the radius in subjects with Kienböck disease. Therapeutic IV.

Protective effect of female gender against bone loss in the forearm following clean-cut tendon injuries, repair, and passive mobilization

The aim of this study was to investigate whether there is any significant difference in bone loss between female and male patients as a result of early passive mobilization after surgery for acute tendon-artery-nerve clean-cut injuries at the wrist level. A total of 51 patients who underwent such operations were enrolled in this study. Group I consisted of 40 male patients (mean age 30.2 +/- 9.1 years, age range 15-44 years) and group II consisted of 11 female patients (mean age 24.1 +/- 9.9 years, age range 14-43 years); postmenopausal women were not included in this group. Twenty-one patients in group I and six patients in group II were operated on for clean-cut tendon injury combined with nerve injury, artery injuries, or both. Bone mineral density (BMD) measurements of injuired forearms were obtained at 1 week, 6 weeks, 3 months, and 12 months after operation. The BMD of the radius and ulna did not change significantly throughout the follow-up period in group II (P > 0.05). In group I, BMD values were reduced significantly in the distal regions of the ulna and in the ultradistal region of the radius at the follow-up measurements when compared to the values at week 1 and the reduction was higher in month 3 than at other times. On the other hand, after 12 months, the BMD values of the ultra-distal region of the ulna and radius were higher than those after 3 months. In conclusion, our results showed that there is considerable bone loss of the radius and ulna in patients operated on for acute clean-cut tendon injuries on the volar side of the wrist at postoperative month 3 in male patients. These bone losses were recovered after 12 months. Additionally, female patients are less likely to experience immobilization-induced bone loss than male patients.

Functional Outcome Following Extensor Synovectomy and Excision of the Distal Ulna in Patients with Rheumatoid Arthritis

We prospectively measured hand and wrist function in rheumatoid patients undergoing excision of the distal ulna. Range of motion, visual analogue pain scores and grip strength were measured in 22 wrists, and the Jebsen hand function test was administered to seven patients, preoperatively and at 3 and 12 months. At 1 year there were improvements in forearm pronation ( P=0.04), supination ( P=0.03) and wrist extension ( P=0.02), but a reduction in flexion ( P=0.009). Active radial deviation was reduced and ulnar deviation increased. There was a significant improvement in grip strength ( P=0.05) and reduction in wrist pain ( P=<0.0001). At 1 year the Jebsen hand function test showed improvements in simulated feeding, stacking checkers, and lifting large empty cans. Excision of the distal ulna in rheumatoid patients results in an improvement in some aspects of hand function.

Radiographic changes after resection of the distal ulna in patients with rheumatoid arthritis.

Radiographic changes in the wrist after resection of the distal ulna in 61 rheumatoid patients (63 wrists) were evaluated more than five years after operation. The wrists were classified on preoperative radiographs into stable or unstable forms as defined by Simmen and Huber. Of 63 wrists, 52 were classified as stable and the remaining 11 were classified as unstable. At follow up, 50 of 52 wrists (96%) that were stable before operation had remained stable. Five of the 11 wrists that were unstable before operation had bony ankylosis or partial radiocarpal ankylosis, and in the remaining six cases there was carpal collapse. Resection of the distal ulna yields good results in stable wrists but operation is not indicated for unstable ones.

Excision of the distal ulna in patients with rheumatoid arthritis.

The results of excision of the distal ulna in 34 wrists of 25 patients with chronic rheumatoid arthritis of the distal radio-ulnar joint were reviewed. Rest pain had been cured or relieved in 77%, pain on pronation-supination in 86%, and limitation of pronation-supination in 90%, while 88% of the patients graded the result as excellent or fair. Despite this marked relief of symptoms, function of the upper limb was improved in only 25% of patients and remained unchanged in 60%. Ulnar subluxation of the carpus had occurred in 24% but seemed to be related to the destructive disease process rather than to the operation itself. The length of ulna resected was not related to the outcome of the operation.

Ulnar bone mineral concentration in metabolic bone diseases.

This paper deals with the measurement of bone mineral concentration in the distal third of the ulna in patients suffering from a variety of diseases, all of which affect in some way the bony skeleton. These diseases are somewhat loosely described as metabolic bone diseases. For convenience, osteoporosis of unknown cause is included in this group. In most instances, the whole of the bony skeleton is presumed to be affected by these diseases, but not all bones and not all parts of one bone need be equally or even similarly affected. For all practical purposes, there are only three kinds of abnormality encountered in metabolic bone diseases, osteomalacia, osteoporosis and osteosclerosis. The paper by Nordin and Barnett (1961) has clearly illustrated the fundamental distinction between osteomalacia and osteoporosis. Osteosclerosis can be defined in similar terms. Osteoporosis and osteomalacia both result in a reduced mineral content per unity volume of bone. At any one site in any one bone it is not possible ...