Ulnar Research Articles

Fingers print of Libyan population in Benghazi City

This study aims to characterize finger dermatoglyphic traits and to analyze bisexual and bilateral differences in Libyan population at Benghazi city. The sample was collected from a student at university of Benghazi includes 487 males and 587 females aged between 18and 24 years old. Fingers prints were obtained by standard ink procedure. Prints were classified into digital patterns-arches, ulnar loops, radial loops, and whorls using the lens. Ulnar loops were higher (56.9 %) than whorls (37.2 %) whereas both arches and radial loops were low (3.5, 2.4 %), respectively. Order pattern frequency decreased from finger to finger in the following order III> V>I>IV>II for ulnar loops while it was IV>I>II>V>III for whorls, respectively. The highest frequency for arch found in finger II in both sex and hand. Differences in frequency patterns were found between males and females and right and lift hand . Dankmejers, Furuhata, and Pattern Intensity Indices were 9.43, 62.73 and 13.37, respectively. The frequency distribution obtained in this study is very close to those of Arabs North African and Mediterranean populations.

Ulnar Intramedullary Fixation in the Treatment of Acute Pediatric Monteggia Fractures: To Bury or Not

Purpose: Pediatric Monteggia fractures often require surgical intervention to stabilize the ulna and maintain reduction of the radiocapitellar joint. There is a paucity of research comparing ulnar percutaneous intramedullary fixation to buried intramedullary fixation in acute pediatric Monteggia fractures. This study analyzes the difference between the two types of ulnar intramedullary fixation. We hypothesized that percutaneous fixation yields equivalent results to buried intramedullary fixation while eliminating a second surgery for hardware removal. Methods: A retrospective review identified patients who suffered …

Are the standard AP and lateral views enough to detect the rotational malalignment intraoperatively during CRPP of Gartland III pediatric supracondylar humerus fractures

Background: Displaced pediatric supracondylar humerus fractures (SCHF) can lead to residual deformity if not accurately reduced and stabilized. Most publications concerning SCHF reduction have focused on malalignment in the coronal and sagittal plane without considering the rotational malalignment. However, malrotation has been identified in 60% of patients with cubitus varus deformity following a SCHF. In addition, tardy ulnar nerve palsy has been correlated with the degree of internal rotation deformity in these patients. Intraoperatively, inability to restore anatomic rotation can narrow the corridor for intraosseous pinning and make it difficult to obtain a stable …

THE CUBITAL TUNNEL SYNDROME CAUSED BY MULTIPLE GANGLION CYSTS-A CASE REPORT

Cubital tunnel syndrome (CuTS) is the second most common nerve compression neuropathy in the upper extremity. Intraneural ganglion cyst (IGC) within the ulnar nerve around the elbow, might present as CuTS. A 51-year-old Chinese man presented with paresthesia at the ulnar two digits of the left hand for one year. He was clinically diagnosed as severe CuTS. Nerve conduction study revealed marked axonal damage of the left ulnar nerve and ultrasonography showed a mass along the ulnar nerve, three centimetres proximal to the medial epicondyle, which was highly suggestive of Schwannoma. The mass was explored by a longitudinal incision. Intraoperatively, multiple cystic lesions were found within the epineurium of the ulnar nerve. Communication was seen between the elbow joint and the cyst. Swellings were partially excised under microscope. Decompression or partial excision of the cyst along with ligation of the articular branch should be the treatment of choice to prevent recurrence in case of IGC.

Incidence of De Quervain’s Tenosynovitis in Computer Operators

Background: De Quervain’s tenosynovitis is an inflammatory disease in which the pain is felt over the radial border of the wrist especially in the thumb with the ulnar deviation of the wrist. The objective of the study was to find out the incidence of De Quervain’s tenosynovitis in regular computer operators. Materials and Methods: Each participating person among the 147 regular computer operators was examined for the Finkelstein’s Test in order to diagnose the De Quervain’s tenosynovitis. Along with this a wrist pain questionnaire was asked to be filled in order to check the prevalence of wrist pain in regular computer operators. Results: Among 147 regular computer operators there were 74 (50.3%) males and 73 (49.7%) females with a mean age of 22.44 ± 1.81 years. Among 147 participating regular computer operators 99 (67.3%) showed the Finkelstein’s test positive whereas 48 (32.7%) showed the pain in Finkelstein’s test as being negative. Conclusion: It is concluded that the incidence of De Quervains Tenosynovitis among the regular computer operators on the basis of Finkelstien Test was quite high.

Clinical efficacy analysis of double plate fixation in the treatment of distal radius fracture combined with ulnar head fracture

Objective To investigate the clinical efficacy of double plate fixation in the treatment of distal radius fracture combined with ulnar head fracture. Methods From March 2014 to August 2017, 16 cases of distal radius fracture combined with ulnar head fracture were treated with open reduction and double plate fixation. Postoperative active rehabilitation exercise was performed after operation. According to the general situation of patients, postoperative radiographic parameters and Gartland-Werley wrist score, the operation effect was evaluated. The feasibility, indications and key points of this method in the treatment of distal radius fracture combined with ulnar head fracture were analyzed. Results Fourteen patients were follow-up and 2 patients were lost. The follow-up period ranged from 12 to 15 months with an average of 13 months. The radiographic results showed that all the fractures healed and achieved anatomical reduction. According to Gartland-Werley wrist score, the results were rated as excellent in 10 cases, good in 2 cases, fair in 2 cases. The average angle of the affected wrist was (69.51±1.97)° in flexion, (70.26±2.71)° in extension, (76.55±3.41)° in pronation and (71.35±1.54)° in supination. There was no significant difference in range of motion between the affected side and the healthy side (P>0.05). Conclusion The function of the wrist recovered well after the treatment of distal radius fracture combined with ulnar head fracture with double plate fixation, which is worthy of clinical application. Key words: Radius fractures; Treatment outcome; Double plate fixation; Ulnar head

Application of pulleys forceps in the surgical treatment of basal fractures of the first metacarpal bone involving carpometacarpal joint

Objective To investigate the application and clinical efficacy of pulley forceps in the surgical treatment of basal fractures of the first metacarpal bone involving carpometacarpal joint. Methods From June 2014 to December 2018, 14 cases of basal fractures of the first metacarpal bone involving carpometacarpal joint were treated. The space between abductor pollicis longus tendon and extensor pollicis brevis tendon was served as the first operative window. The fracture end and carpometacarpal joint of thumb were exposed. The periosteum was cut on the ulnar side of the extensor pollicis brevis tendon served as the second operative window. C-shaped pulley forceps was placed on the volar and ulnar side of the bone fragments. The bone fragments were hooked and controlled. The first metacarpal bone was pulled and pronated by an assistant. Under direct vision, anatomical reduction of bone fragments can be seen. Kirschner wire with a diameter of 1.0 or 1.2 mm was used to fix the fracture and carpometacarpal joint of thumb at the second and first operation windows respectively. After 4 weeks of plaster fixation, Kirschner wire was removed which was used for fixation of carpometacarpal joint of thumb and brace was used for fixation. The rehabilitation training of each joint of thumb was done intermittently. After 2 to 3 months, the remaining Kirschner wires were removed according to the fracture healing. Results After operation, all the wounds achieved primary healing. The articular surface was anatomically reduced and the fracture position was good. 10 patients were follow-up for 6 to 36 months. According to Gu Yudong evaluation method of opposition function, all the results were rated as excellent. The movement of carpometacarpal joint of thumb was normal in all directions. The VAS score was 0 in 7 cases, 1 in 1 case and 2 in 2 cases. Conclusion In the operation of the basal fractures of the first metacarpal bone involving carpometacarpal joint, C-shaped pulley forceps can reduce the operation difficulty, simplify the operation and improve the operation efficacy, which has a strong promotion significance. Key words: Fracture fixation; Treatment outcome; Pulley forceps; The base of the first metacarpal bone

Electrophysiological analysis of the patients with hourglass-like constriction of radial nerve/posterior interosseous nerve

Objective To analyze the electrophysiological characteristics of the patients with hourglass-like constriction of radial nerve (RN)/posterior interosseous nerve (PIN) and explore the possible causes. Methods From January 2011 to November 2018, 18 patients with hourglass-like constriction of RN/PIN were treated in our hospital. The electrophysiological results of them were analyzed retrospectively. The extent and degree of lesion involvement were evaluated. Results The course of disease was 3 weeks to 13 months before electrophysiological examination in 18 patients. 14 patients (77.8%) suffered from complete injury and 4 patients (22.1%) suffered from incomplete injury. The coincidence rate between electrophysiological results and intraoperative findings was 94.4%. In addition to the abnormalities directly related to hourglass-like constriction, 88.9% of RN hourglass-like constriction patients and 11.1% of PIN hourglass-like constriction patients were associated with other neurological abnormalities. Among them, 8 patients with RN hourglass-like constriction were complicated with the abnormalities of median nerve (50%), ulnar nerve (50%), musculocutaneous nerve (37.5%), axillary nerve (25%), suprascapular nerve (25%), triceps brachii branch (75%), and the nerves of contralateral upper extremity (25%), contralateral phrenic nerve (12.5%) and the nerves of four extremities (12.5%). The main manifestations were abnormal insertion potential, resting spontaneous fibrillation potential, prolongation of light contraction time limit, simple phase of forced contraction and decrease of amplitude of motor evoked potential in sensory and motor nerve conduction. There was no obvious abnormality in nerve conduction velocity. Conclusion The hourglass-like constriction of RN/PIN is often associated with other neural abnormalities. The higher the location of hourglass-like constriction, the wider the range of involvement. It is different from the electrophysiological characteristics of peripheral nerve entrapment, indicating possible presence of neuralgic amyotrophy. Key words: Electrophysiology; Radial nerve; Posterior interosseous nerve; Hourglass-like constriction

Differential diagnosis and treatment of posterior Monteggia fracture and posterior dislocation of proximal ulna fracture

A classical Monteggia fracture is defined as an ulnar fracture with dislocation of the proximal radioulnar joints. If combined with posterior dislocation of the radial head (posterior dislocation of the radiocapitellar joints), it is called a posterior Monteggia fracture. And for those without dislocation of the proximal radioulnar joints, it should not be defined as the posterior Monteggia fracture, but as the posterior dislocation of the proximal ulna fracture. For dislocation of the proximal radioulnar joints, the Monteggia fractures, clinical are relatively rare. The coronoid process fracture is comminuted, the proximal radioulnar joints are destroyed, the membrane and the annular ligament is injured. After restoring osseous structure and repairing the lateral ligament complex, we must also pay attention to the stability of proximal radioulnar joints, and the prognostic efficacy not sure. However, posterior dislocation of proximal ulna fractures is relatively common in clinical practice, and the coronal process fracture is usually complete, with the annular ligament and interosseous membrane intact. In treatment, the bone structure is mainly restored, and the lateral ligament complex of elbow joint is treated at the same time, with good prognosis. Through anatomical basis, imaging characteristics, injury characteristics, treatment and prognosis, we can distinguish with the posterior Monteggia fracture and posterior dislocation of proximal ulna fracture.

Role of high-resolution sonography and doppler imaging in detecting nerve damage in leprosy patients

Leprosy is the chronic infectious disease-causing peripheral nerve damage leading to functional impairment of limbs, ulcer formation, and deformities. Pathological findings of leprosy are nerve enlargement and inflammation, with the help of high-resolution sonography and color Doppler (CD) imaging to demonstrate nerve enlargement and inflammation. Aims: To assess the role of high-resolution sonography in detecting nerve damage in leprosy patients. Methods and Materials: The study group of 30 cases of leprosy performed on e Soate My lab 40 and evaluated bilateral US of the ulnar (UN), lateral popliteal (LP), and posterior tibial (PT) nerves compared this with the sonographic findings in 30 healthy controls. Results and Conclusions: The nerves were significantly thicker in the leprosy patients as compared with healthy controls (P

Applied anatomied study in bilobed micro-flap of second dorsal metacarpal artery and dorsal digital artery

Objective To observe the location and the distribution of distal 1/3 segment of the second dorsal metacarpal artery, the finger web artery and the dorsal digital artery, and to provide anatomical data for repairing the soft tissue defect on the hand with bilobed or multi-lobed micro-flap with second metacarpal dorsal artery-dorsal digital artery. Methods From June, 2018 to March, 2019, 34 fresh adult upper limb specimens were selected. The radial and ulnar arteries were perfused with red latex in 24 specimens. The radial and ulnar arteries were infused with cast materials to make cast specimens in 10 specimens. The location and distribution of the distal 1/3 segment of the second dorsal metacarpal artery, the finger web and the dorsal digital artery were observed. Results The distal 1/3 segment of second dorsal metacarpal artery extended (4±1) cutaneous branches, and continued to become the finger web artery at the plane of the articular surface. The length of the finger web artery was (2.5±0.6) cm, and there were 4 types anastomic methods of communication with arteries. The second dorsal metacarpal artery extended 2 finger dorsal artery to the proximal dorsal skin of the middle finger and index finger. The length of dorsal digital artery was 2.6±0.4 cm and the diameter was 0.2±0.1 mm. Four to 6 micro-cutaneous branches were extended and consistent with the nearby skin cutaneous branches. Conclusion The distal segment of the second dorsal metacarpal artery and the dorsal digital artery is anatomically constant. The distal segment of the second dorsal metacarpal artery and dorsal digital artery are the pedicle for the design of the bilobed flap of middle finger and index finger to repair small soft tissue defect on the thumb and purlicue. Key words: Second dorsal metacarpal artery; Finger web artery; Dorsal digital artery; Bilobed flap; Applied anatomy

The influence of radial displacement in distal radius fracture on the stability of distal radioulnar joint

Objective To investigate the causes of instability of distal radioulnar joint caused by displacement in distal radius fracture, and to analyze the importance of radial displacement in distal radius fracture to wrist stability. Methods There were 60 patients with distal radius fracture, 22 males and 38 females, aged from 26 to 67 years, with an average age of 41 years. There were 29 cases with ulnar styloid process fracture and 31 cases without ulnar styloid process fracture. According to the degree of displacement, they were divided into three groups: 13 cases with displacement less than 2 mm, 20 cases with displacement more than 2 mm and less than 4 mm, and 27 cases with displacement more than 4 mm. All the patients were treated with open reduction and plate internal fixation of distal radius fracture. The stability of distal radioulnar joint was examined after plate fixation. Fifteen patients with unstable distal radioulnar joint examined by intraoperative physical examination (associated with ulnar styloid process fracture) were divided into two groups. In one group, the styloid process of ulna was fixed with steel wire, while in the other group the styloid process of ulna was not fixed. The effect of radial displacement on ulnar styloid process after distal radius fracture and the effect of ulnar styloid process fracture on the stability of distal radioulnar joint were analyzed. The degree of radial displacement of distal radius fracture and the effect of ulnar styloid process fracture on the stability of distal radioulnar joint were evaluated according to the postoperative follow-up of palmar inclination angle, ulnar deviation angle and wrist function score. Results The injury of TFCC when radial displacement of distal radius fracture was greater than 4 mm was the main cause of instability of distal radioulnar joint and affecting wrist function. There was statistically significant difference in the incidence of distal radioulnar joint instability whether distal radial fractures accompanied by ulnar styloid process fractures or not. There was significant difference between radial displacement greater than 4 mm and ulnar styloid process fracture. Conclusion The radial displacement of distal radius fracture has great influence on the stability of distal radioulnar joint. There are more patients with ulnar styloid process fracture in the instability of distal radioulnar joint. The ulnar styloid process fracture suggests a higher risk of TFCC injury. The good reduction of ulnar styloid process plays an important role in the stability of distal radioulnar joint. Key words: Radius; Fractures,bone; Distal radioulnar joint; Triangular fibrocartilage complex; Ulnar styloid process

A 3D CT-based fracture map study of intra-articular distal radial fractures

Objective To map OTA/AO type B and type C distal radial fractures according to three-dimensional (3D) CT scan data, and to describe the morphological distribution of fracture lines. Methods A total of 468 cases of distal radius fractures admitted to the Affiliated Hospital of Chengdu University from January 2016 to March 2019 were analyzed and AO classification were performed. AO type B and type C fractures meet the inclusion criteria and then CT data were 3D reconstructed, and morphological description were performed on the fracture lines of each joint surface, including fracture shape angle, fracture area and fracture ratio. At the same time, the articular surface fracture model was superimposed on the standard model, then fracture line and fracture area distribution map were drawn to create the fracture map of intra-articular distal radial fractures. Result Intra-articular fractures of the distal radius were 209 cases, accounting for 44.7% (209/468) of the distal radius fractures, among which 67 cases of AO type B fracture. In type B fractures, average fracture height were 20.30±11.26 mm, average fracture width were 12.24±6.83 mm, average fracture area were 189.61±101.84 mm2, average angle were 57.23°±14.95°, and average area ratio of fracture (fracture zone area/joint surface area ratio) were 32.42%±10.24%. 142 cases were OA type C fracture, the average fracture height were 24.43±11.37 mm, average fracture width were 20.38±7.59 mm, average fracture area were 425.26±314.31 mm2, average angle were 51.26°±13.17°, and average area ratio of fracture were 73.81%±26.29%. According to fracture map formed by main fracture lines, five different fracture areas were identified: ① 63 cases in central area; ② 25 cases in Lister's nodule area; ③ 59 cases in scaphoid area; ④ 36 cases in lumbar fossa area; ⑤ 26 cases in lower iliac area. Main fracture lines were concentrated in the area on the dorsal side of the central area and the scaphoid area. The fracture lines of type B fracture mainly concentrated in scaphoid region, which accounted for 29.85% (20/67), and dorsal side and central area accounted for 26.87% (18/67). The fracture lines of type C fracture accounted for 27.46% (39/142) in scaphoid area and 31.69% (45/142) in central area. The fracture line of type C fracture increased in the lumbar fossa region (17.61%, 25/142) and the lower ulnar region (12.68%, 18/142) compared with type B fracture (28.69%). Compared with the type B fracture, the overall distribution of the fracture line of the type C fracture is more central. Conclusion The map of intra-articular fracture of distal radius was drawn and morphological distribution of fracture lines were quantified. Fracture-prone site and shape of fracture line were visually recognized. At the same time, description of articular surface fracture line and fracture area of type B and type C fractures of OA classification were improved, which may help with new classification and diagnosis. Key words: Radius fractures; Intra-articular fractures; Imaging, three-dimensional; Maps

Design of a novel anatomical plate for fractures of ulnar coronoid process

Objective To evaluate a self-designed novel anatomical bone plate for fractures of ulnar coronoid process in cadaveric specimens. Methods Our database search in the Imaging Center, Qilu Hospital of Shandong University (Qingdao) yielded CT reconstruction images of 45 normal adult elbows (26 males and 19 females) which met our criteria. On the 3D reformatted CT images, sagittal curvature angle of the ulnar coronal process (△1), tangent angle of the coronal process apex to olecranon fossa (△2), projective length (L) and projective height (H) were measured; the transverse width of the coronal process was also measured at 5 mm and 10 mm from the tip (K1 and K2). The minimum value was used for △2° in order to avoid cutting into the joint while the mean value for other parameters. After the shape of the plate and angles of the screws were designed using computer 3D software, a new anatomic plate for coronal process was produced. Five cadaver specimens were used to test the internal fixation of the coronal process with our novel anatomic bone plate. Attachment of the bone plate to the coronal process and screw penetration into the joint cavity were observed by X-ray and 3D CT scanning. Results △1 was 45.52°±6.07°, △2 65.25°±7.09° (the minimum value 53.2°), L 52.27±7.78 mm, H 21.62±2.63 mm, K1 16.32±2.22 mm and K2 14.58±2.18 mm. Our new anatomic bone plate was designed based on the above data. X-ray and 3D CT scan after plate internal fixation showed that our self-designed bone plate produced fine attachment and no screws penetrated into the joint. Conclusion Our new anatomical bone plate may perfectly fit the anatomy of the adult ulnar coronal process in size and shape so that the coronary process can be fully covered and no screws will penetrate into the joint cavity. Key words: Bone plate; Elbow Joint; Anatomy; Cadaver

Analysis the cause of failure in primary surgery of cubital tunnel syndrome and clinical evaluation of revision cubital tunnel surgery

Objective To explore the reasons for the failure of primary cubital tunnel syndrome (CuTS) surgery, summarize the technical details of cubital tunnel revision and evaluate the clinical efficacy. Methods From January 2015 to December 2016, 20 patients with persistent or new symptoms of CuTS after primary operation were treated with revision. The technical details of revision of cubital tunnel were summarized and the clinical efficacy was evaluated by observing the compression of ulnar nerve during operation and following up the improvement of clinical symptoms. Results The incomplete release of common compression points of ulnar nerve in elbow and improper preparation of fascial tissue flaps for anterior ulnar nerve were the main reasons for the failure of operation. After at least 12 months of follow-up, the strength of hand intrinsic muscles, skin sensation and pain symptoms of ulnar nerve innervation were significantly improved. Conclusion For the cases of CuTS with severe symptoms or new symptoms after primary operation, the main reason for failure is improper handling of details. The clinical efficacy of revision of CuTS is satisfactory, but it is worse than that of successful primary surgery. Key words: Cubital tunnel syndrome; Treatment failure; Revision; Neuropathic pain; Medial antebrachial cutaneous nerve

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

Free cutaneous fibular flap combined with antibiotic-loaded artificial bone graft for the treatment of antibrachial osteomyelitis of Cierny-Mader type IV

Objective To investigate the effect and application value of transplantation of the free cutaneous fibular flap combined with antibiotic-loaded calcium sulfate artificial bone graft for the treatment of antibrachial chronic osteomyelitis of Cierny-Mader type IV. Methods From August, 2013 to May, 2017, 12 cases of ulna or(and) radius chronic osteomyelitis of Cierny-Mader type IV were treated by transplantation of the free cutaneous fibular flap combined with antibiotic-loaded calcium sulfate artificial bone graft. There were 7 males and 5 females, with an average age of 36.3 (21-47) years. Pure ulnar osteomyelitis in 7 cases, radius osteomyelitis in 4 cases, and both ulnar and radius osteomyelitis in 1 case. The average range of osteomyelitis lesions was 6.3 (3.0-9.0) cm. The area of soft tissue defect (including bone scar) ranged from 8.0 cm×2.0 cm to 15.0 cm×5.0 cm. The area of the flap was 10.0 cm×3.5cm-17.0 cm×7.0 cm. The average length of the fibular flap was 8.8 (5.0-12.0) cm. Locking plate internal fixation was used in 9 cases, external fixator in 2 cases, and plate combined with external fixator in 1 case. Vancomycin/gentamicin, an effective component of calcium sulfate artificial bone, averaged 0.64 g/102.7 kU (0.4 g/64 kU-1.0 g/160 kU). Routine postoperative treatment. And monthly outpatient review in the first half year after operation, and outpatient review every 3 months after half a year. One year after operation, comprehensive evaluation of elbow, forearm and wrist function with Mayo Elbow Function Index, Anderson Forearm Double Fracture Evaluation System and Cooney Wrist Function Score. Results Vascular crisis occurred in 1 case after operation, prompt surgical exploration, and ultimately all flaps survived completely. The donor sites healed well in all cases. The lower extremity functions of donor sites had no change compared with that before operation. Followed-up of an average of 22.7 months, there were 2 cases who had sensory disturbance in the ulnar nerve innervation area and returned to normal 3 months after operation. The fibular flaps healed satisfactorily with an average healing time of 4.7 (3-6) months. No calcium sulphate artificial bone granules were seen on X-ray at 3 months after operation. One year after operation, bone healing, forearm appearance and wrist function recovered well, but elbow and forearm motor function recovered unsatisfactorily. Conclusion On the basis of mastering the applied anatomy and vascular anastomosis techniques of microsurgery, this method of transplantation of the free cutaneous fibular flap combined with antibiotic-loaded calcium sulfate artificial bone graft for the treatment of antibrachial chronic osteomyelitis of Cierny-Mader type IV has achieved satisfactory results. The recipient area is beautiful. The bone healing is reliable. And it has little influence on the recipient area and the donor area. It is worthy of clinical application. Key words: Fibular flap; Osteomyelitis; Forearm; Artificial bone; Transplantation; Microsurgical technique

Modified venous grafting to replant an amputated thumb with obstinate arteriospasm

Objective To evaluate the therapeutic effects of bridging the proper digital artery and the radial artery with a vein graft in replantation of an amputated thumb with obstinate arteriospasm. Methods From June 2011 to May 2017, 9 patients received replantation of an amputated thumb at Department of Hand Surgery, The Second Hospital of Tangshan. They were all male, aged from 21 to 55 years (average, 39.2 years). Two right thumbs were involved in 2 cases and 7 left thumbs in 7 cases. During replantation, obstinate arteriospasm which could not be alleviated occurred of their bilateral proper digital arteries. A free forearm superficial vein graft was used to bridge the distal end of ulnar proper digital artery of thumb and the radial artery in tabatiere anatomique to establish blood supply by end-to-end or end-to-side anastomosis. At final follow-up, the outcomes were assessed by the tentative criteria set by The Hand Surgery Society of Chinese Medical Association. Results All the 9 replanted thumbs survived with primary wound healing. They were followed up for 6 to 12 months (mean, 7.9 months). All the patients were satisfied with the appearance and function of the replanted thumb except that mild atrophy was observed in 2 digits with preoperative rotatory avulsion. According to the tentative criteria set by The Hand Surgery Society of Chinese Medical Association at final follow-up, the outcomes were rated as excellent in 7 cases and as good in 2. The pulp two-point discrimination was between 3 and 8 mm, with an average of 5.3 mm. Conclusions An amputated thumb with obstinate arteriospasm can be replanted by bridging the ulnar proper digital artery of thumb and the deep branch of radial artery using a vein graft to establish adequate blood supply to the replanted thumb, leading to satisfactory efficacy. As the technique is easy, it is worthy of popularization. Key words: Thumb; Replantation; Vasospasm; Vascular Grafting

Analysis of influencing factors of wrist dorsal extension angle and function after radius distal fracture surgery

Objective To explore the influencing factors of wrist dorsal extension angle and wrist function recovery after distal radius fractures. Methods From July 2012 to January 2016, 116 patients with distal radius fractures were treated with palmar plate internal fixation. Follow-up included wrist range of motion, X-ray, measurement of imaging parameters, complications, grip strength, pinch strength, PRWE and DASH scores. According to the recovery of dorsal extension angle and Gartland-Werley scoring criteria, patients with dorsal extension angle less than 45° were classified as groupⅠ (functional restricted group), and patients with dorsal extension angle more than 45° were classified as group Ⅱ (functional unrestricted group). Then, the differences of age, injury side, fracture type, imaging parameters, ulnar styloid process fracture and complications between the two groups were compared, and whether these factors were the influencing factors of different dorsal extension angles were judged. The effects of these factors on wrist PRWE and DASH scores were analyzed. Results There were no significant differences in age, injured side, fracture type, imaging parameters and whether there were fractures of ulnar styloid process between the two groups (P>0.05). There were significant differences in wrist flexion angle, ulnar deviation angle, pronation angle and grip strength between the two groups. The parameters of groupⅠwere lower than those of groupⅡ(P<0.05). The survival analysis of influencing factors of wrist dorsal extension recovery showed that the recovery of ulnar inclination and palmar inclination had an effect on wrist dorsal extension by univariate analysis, while age had an effect on wrist dorsal extension by multivariate analysis; age and ulnar variation had an effect on PRWE score by univariate analysis, and gender and ulnar variation had an effect on PRWE score by multivariate analysis; age had an impact on DASH score by univariate analysis, and gender had an impact on DASH score by multivariate analysis. Conclusion Patients' age, ulnar inclination and palmar inclination are important factors affecting wrist dorsal extension, while age, gender and ulnar variation affect PRWE and DASH scores in varying degrees. Key words: Radius fractures; Wrist joint; Dorsal extension; Influencing factors

Treatment of deep branch injury of ulnar nerve

Objective To explore the clinical treatment of deep branch of ulnar nerve injury. Methods From January 2013 to August 2018, 20 cases of deep branch of ulnar nerve injury were treated. The etiology, diagnosis and surgical treatment of deep branch of ulnar nerve injury were analyzed retrospectively. Results All the patients were follow-up for 8.9 to 68.1 months with an average of 37.0 months. According to the criteria of upper extremity functional evaluation issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 11 cases, good in 4 cases, fair in 4 cases and poor in 1 case. Conclusion The injury of the deep branch of ulnar nerve requires early diagnosis and early surgical treatment. The effect of nerve suture or neurolysis is related to the degree of neurodegeneration or intrinsic myofibrosis. Key words: Ulnar nerve; Treatment outcome; Deep branch; Diagnosis; Surgical treatment