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Sample records for distal ulna treated

  1. Congenital Deficiency of Distal Ulna and Dislocation of the Radial Head Treated by Single Bone Forearm Procedure

    Directory of Open Access Journals (Sweden)

    Paragjyoti Gogoi

    2014-01-01

    Full Text Available Congenital deficiency of part of distal ulna affecting the distal radio-ulnar joint is a rare disorder. It is even rarer to find the association of proximal radio-ulnar joint dislocation along with distal ulnar deficiency. This type of congenital forearm anomaly is difficult to treat. Conversion to a single bone forearm in the expense of pronation-supination movement is a viable option. By doing so the elbow and wrist can be stabilized; however movement is possible in only one plane. We are describing here a girl of 8 years having proximal radio-ulnar joint dislocation along with deficiency of distal ulna treated by converting into a single bone forearm.

  2. [Comparison of Short-Therm Results of Conservative versus Operative Treatment of Distal Ulna Fractures Associated with Distal Radius Fracture Treated by Plate Osteosynthesis].

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    Meluzinová, P; Kopp, L; Dráč, P; Edelmann, K; Obruba, P

    2017-01-01

    PURPOSE OF THE STUDY The study aims to evaluate and compare the results of conservative and operative treatment of individual types of distal ulna fractures associated with distal radius fracture treated by plate osteosynthesis and to verify the conclusions of the other authors regarding the recommended therapeutic procedures in these fractures. MATERIAL AND METHODS In the period from 08/2013 to 09/2015, a total of 81 patients participated in the prospective randomised study, with the mean follow-up period of 24 months (6-36). All the fractures of distal two thirds of ulnar styloid process were treated conservatively. The patients with the other types of ulnar fractures (fractures of the proximal third of ulnar styloid process, ulnar head fractures, subcapital fractures) were systematically divided into two cohorts, based on which the subsequent (conservative vs. operative) treatment of distal ulna fractures was indicated. The operative treatment of all the types of distal ulna fractures was performed by plate osteosynthesis using LCP Distal Ulna Plate implant so that a uniform method is applied. RESULTS In the post-operative follow-up not a single patient with tip fracture of ulnar styloid process in the cohort showed a posttraumatic instability or disorder of distal radioulnar joint (DRUJ) biomechanics (ROM 96.6% (91-100), MWS 61.3 points (75-100), QDASH 2.9 points (0-6.8)). The patients with a fracture of the proximal third of ulnar styloid process, a fracture of ulnar head and a subcapital fracture, treated operatively, achieved better early radiographic and functional outcome (ROM 95.7% (60-100), MWS 91.2 points (75-100), QDASH 3.5 points (0-11.4)) than patients treated conservatively (ROM 89.6% (64-100), MWS 70.4 points (35-85), QDASH 18.4 points (0-52.3)). DISCUSSION The study confirms the conclusions drawn by the other authors that tip fractures of ulna do not cause posttraumatic DRUJ instability and do not require operative treatment. Conservative

  3. Giant Cell Tumour of the Distal Ulna: A Rare Presentation

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    Ruben Jaya Kumar

    2011-07-01

    Full Text Available Giant-cell tumour (GCT of bone, a primary yet locally aggressive benign tumour, commonly affects patients between the ages of 20 and 40 years, with the peak incidence occurring in the third decade. Women are affected slightly more than men. The distal end of the ulna is an extremely uncommon site for primary bone tumours in general and giant cell tumours in particular. Wide resection of the distal ulna is the recommended treatment for GCT in such locations. Radio-ulna convergence and dorsal displacement of the ulna stump are known complications following ulna resection proximal to the insertion of the pronator quadratus. This leads to reduction in grip power and forearm rotatory motion. Stabilization of the ulna stump with extensor carpi ulnaris (ECU tendon after wide resection of the tumour has been described in the literature. We report a case of GCT of distal end of ulna treated with wide resection and stabilization with ECU tendon.

  4. following Wide Resection of Giant Cell Tumour of Distal Ulna

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    Elango Mariappan

    2013-01-01

    Full Text Available Giant cell tumour of the bone (GCT is a rare locally aggressive primary bone tumour with an incidence of 3% to 5% of all primary bone tumours. The most common location for this tumour is the long bone metaepiphysis especially of the distal femur, proximal tibia, distal radius, and the proximal humerus. Involvement of distal ulna is rare accounting for 0.45% to 3.2%. Considering local aggressive nature and high recurrence, wide resection is the treatment recommended. Instability of ulnar stump and ulnar translation of the carpals are known complications following resection of distal ulna. To overcome these problems, we attempted a newer technique of distal ulna reconstruction using proximal fibula and TFCC reconstruction using palmaris longus tendon following wide resection of giant cell tumour of distal ulna in a 44-year-old male. This technique of distal radioulnar joint reconstruction has excellent functional results with no evidence of recurrence after one-year followup.

  5. Fracture of the Distal Ulna Metaphysis in the Setting of Distal Radius Fractures.

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    Paksima, Nader; Khurana, Sonya; Soojian, Michael; Patel, Vipul; Egol, Kenneth

    2017-04-01

    Fracture of the metaphyseal region of the distal ulna is an uncommon injury that has been reported to occur concomitantly with distal radius fracture. We aimed to report the incidence and types of distal ulnar head and neck fractures associated with distal radius fractures and compare outcomes in operatively versus non-operatively treated patients. Over a 5-year period a distal radius fracture registry was maintained at our institution. Eleven of 512 consecutive patients had metaphyseal distal ulna fractures in association with distal radius fractures and at least 1-year follow-up. Baseline radiographs and functional data were obtained, and patients were followed at 1-week, 2-week, 3-week, 6-week, 3-month, 6-month, 1-year, and 2-year intervals. Patients were split into two treatment groups: Group 1 consisted of five non-operatively treated patients, and Group 2 consisted of six operatively treated patients. Four separate fracture patterns were observed: simple transverse or oblique fracture of the ulnar neck just proximal to the ulnar head, fracture of the neck region with concomitant fracture of the tip of the ulnar styloid, simple fracture of the ulnar head, and comminuted fracture of the ulnar head. There were no statistical differences between the two groups with regard to flexion, extension, supination, pronation, and functional outcomes. Ulnar fracture patterns observed did not easily fall into previously described categories, and we have proposed a new classification system. Simple fractures of the ulnar neck or head often do not require operative fixation.

  6. Load transfer at the distal ulna following simulated distal radius fracture malalignment.

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    Ferreira, Louis M; Greeley, Gillian S; Johnson, James A; King, Graham J W

    2015-02-01

    To measure the effects of distal radius malalignment on loading at the distal ulna. Using an adjustable mechanism to simulate angulated and translated malalignments, clinically relevant distal radius deformities were simulated in a cadaveric model. A custom-built load cell was inserted just proximal to the native ulna head to measure the resultant force and torque in the distal ulna. Loads were measured before and after transecting the triangular fibrocartilage complex (TFCC). There was an increase in distal ulna load and torque with increasing dorsal translation and angulation. Combined conditions of angulation and translation increased force and torque in the distal ulna to a greater extent than with either condition in isolation. Transecting the TFCC resulted in a reduction in distal ulna load and torque. A progressive increase in load at the distal ulna was observed with increasing severity of malalignment, which may be an important contributor to residual ulnar wrist pain and dysfunction. However, no clear-cut threshold of malalignment of a dorsally angulated and translated distal radius fracture was identified. These observations suggest that radius deformities cause articular incongruity, which increases TFCC tension and distal radioulnar joint load. Cutting of the TFCC decreased distal ulna loading, likely by releasing the articular constraining effect of the TFCC on the distal radioulnar joint, allowing the radius to rotate more freely with respect to the ulna. Anatomical reduction of a distal radius fracture minimizes the forces in the distal ulna and may reduce residual ulnar wrist pain and dysfunction. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  7. Concave distal end of ulna metaphysis alone is not a sign of rickets

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    Oestreich, Alan E. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, 5031, Cincinnati, OH (United States)

    2015-07-15

    Statements have been made in the literature and in legal testimony that misrepresent the radiographic finding of concave distal end of the ulnar metaphysis. To demonstrate that a concave distal end of the ossified ulna in infancy can be normal. Eighty distal wrists of randomly selected infants in the first year of life with radiographic evidence that ruled out rickets were reviewed. In 16 of the cases (20%), mild or moderate concavity of the distal end of the ulna was seen. An intact metaphyseal collar of distal radius or ulna confirmed the absence of radiographic rickets. The finding of 20% of concave distal ulnas in the first year of life confirms the widely acknowledged statements that concave distal end of the ulna alone is not indicative of rickets. Statements to the contrary are not justified. (orig.)

  8. Conventional bone plate fixation of distal radius and ulna fractures in toy breed dogs.

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    Ramírez, J M; Macías, C

    2016-03-01

    To describe the outcome of bone plate fixation of distal radius and ulna fractures in toy breed dogs treated with conventional bone plates. Records of 15 toy breed dogs with distal radius and ulna fractures were retrospectively reviewed for signalment, method of fixation, complications and clinical and radiographic assessments. A telephone-based owner questionnaire was conducted to determine long-term function and client satisfaction. Age ranged from 4 months to 6 years. Body weight ranged from 1 to 4 kg. Dynamic compression plates were used in 13 dogs and veterinary cuttable plates were used in 2 dogs as the means of fixation. Full radiographic and clinical follow-up data were available for 10 dogs and follow-up was performed between 6 and 8 weeks postoperatively. At that time, all fractures had healed and return to function was considered excellent in all 10 dogs. Five dogs did not return for hospital evaluation because they were judged by their owners to be free of lameness. In two cases, owners could not be contacted by telephone, but the referring veterinarians reported the dogs to be asymptomatic. No major complications occurred. Conventional bone plates are suitable choices for stabilisation of distal radius and ulna fractures in toy breed dogs and are not necessarily correlated with high rates of complication. © 2016 Australian Veterinary Association.

  9. Premature closure of the distal ulna in the dog. A case report

    International Nuclear Information System (INIS)

    Borges, Andréa Pacheco Batista; Araújo, Roberto Baracat de; Sampaio, Romeu; Del Carlo, Ricardo Junqueira; Pompermayer, Luiz Gonzaga

    1991-01-01

    A case of premature closure of the distal ulna in a ten-month-old crossbred dog is described. Diagnosis was suggested by clinical signs including lameness, angular deformity of the forelimb, and pain [pt

  10. Hyperextension trauma to the elbow joint induced through the distal ulna or the distal radius

    DEFF Research Database (Denmark)

    Tyrdal, Stein; Olsen, Bo Sanderhoff

    1998-01-01

    , 2) L-formed rupture of the origin of the pronator muscle with elongation of the anterior bundle of the medial collateral ligament, 3) partial rupture of the lateral collateral ligament and 4) small cartilage damage to the posterior or anteromedial edge of the ulna. In conclusion, hyperextension...

  11. Monteggia Type 1 Fracture Equivalent with Concomitant Ipsilateral Distal Radius and Ulna Fracture in an Adult: A Rare Case Report

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    Shankarlinga S Sajjan

    2017-10-01

    Full Text Available Monteggia fracture comprises of 5% to 10% of all forearm fractures. It represents severe forearm injuries which require operative intervention. We report a unique case of Monteggia variant in female patient aged 67-year-old presenting a fracture of proximal ulna and radial neck along with ipsilateral fracture of distal ulna and radius at its metaphyseal end, which cannot be classified under Monteggia fracture and its equivalents occurring in adults. We managed this case using dorsal approach surgically and patient had good functional result at the end of six months.

  12. Ulna Dimelia

    African Journals Online (AJOL)

    Josephine Nakato

    digits around a central digital axis producing seven or more digits. This patient had two ulna bones in the ... resection of the proximal part of the duplicated ulna. This improves forearm rotation and elbow flexion. Severe rotational deformities may require derotational osteotomy. The wrist is usually in flexion and is treated by ...

  13. Locking compression plate distal ulna hook plate fixation versus intramedullary screw fixation for displaced avulsion fifth Metatarsal Base fractures: a comparative retrospective cohort study

    OpenAIRE

    Xie, Lin; Guo, Xin; Zhang, Shu-Jun; Fang, Zhen-Hua

    2017-01-01

    Background Intramedullary screw (IMS) fixation was wildly used in fifth metatarsal base fractures (FMBFs) and the results were satisfactory. However, in the comminuted osteoporosis or small displaced avulsion FMBFs, anatomical reduction and stable fixation could not be achieved with IMS. The Locking Compression Plate (LCP) distal ulna hook plate fixation was a novel alternative fixation method. The aim of this retrospective cohort study was to determine if LCP distal ulna hook plate fixation ...

  14. Wide resection and stabilization of ulnar stump by extensor carpi ulnaris for giant cell tumor of distal ulna: two case reports

    OpenAIRE

    Singh, Manjeet; Sharma, Siddhartha; Peshin, Chetan; Wani, Iftikhar H; Tikoo, Agnivesh; Gupta, Sanjeev K; Singh, Dara

    2009-01-01

    The distal end of ulna is an extremely uncommon site for primary bone tumors in general and giant cell tumor in particular. Wide resection is usually indicated in such cases and at times it may be necessary to remove of a long segment of the distal ulna. Any ulnar resection proximal to the insertion of pronator quadratus can lead to instability in the form of radio-ulnar convergence and dorsal displacement (winging) of the ulnar stump. This can result in diminution of forearm rotation and wea...

  15. Biomechanical evaluation of the dynamic radioulnar convergence after ulnar head resection, two soft tissue stabilization methods of the distal ulna and ulnar head prosthesis implantation.

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    Sauerbier, Michael; Hahn, Michael E; Berglund, Lawrence J; An, Kai-Nan; Berger, Richard A

    2011-01-01

    The biomechanical performance of the Darrach procedure, its stabilizing methods and the effectiveness of an ulnar head prosthesis was evaluated in this experiment. The purpose of this study was to: (1) analyze the dynamic effects of the resection of the distal ulna on radioulnar convergence; and (2) evaluate the mechanical performance of two soft tissue stabilizing procedures (pronator quadratus advancement flap and ECU/FCU tenodesis) for the unstable distal ulnar stump and the implantation of an ulnar head prosthesis (uHead) following a distal ulnar resection (Darrach procedure) on radioulnar convergence. With a dynamic PC-controlled forearm simulator, cadaveric forearm rotation was actively and passively performed while simultaneously loading the relevant muscles. The resultant total forearm torque and the three-dimensional kinematics of the ulna, radius and third metacarpal were simultaneously recorded in seven fresh-frozen cadaver upper extremities. The resection of the distal ulna created an extreme instability of the forearm with movement of the radius toward the ulna (0.92-0.38 cm compared to the intact state) in each particular loading condition. The implantation of the ulnar head prosthesis effectively restored the stability of the DRUJ by simulating the geometry of the ulnar head. There were significantly better results after the implantation of the prosthesis compared with the Darrach and the soft tissue stabilization procedures. This study provides laboratory validity to the option of implanting an ulnar head endoprosthesis as an attempt to stabilize the distal forearm with instability after Darrach resection in lieu of performing soft tissue stabilization techniques.

  16. Wide resection and stabilization of ulnar stump by extensor carpi ulnaris for giant cell tumor of distal ulna: two case reports.

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    Singh, Manjeet; Sharma, Siddhartha; Peshin, Chetan; Wani, Iftikhar H; Tikoo, Agnivesh; Gupta, Sanjeev K; Singh, Dara

    2009-07-21

    The distal end of ulna is an extremely uncommon site for primary bone tumors in general and giant cell tumor in particular. Wide resection is usually indicated in such cases and at times it may be necessary to remove of a long segment of the distal ulna. Any ulnar resection proximal to the insertion of pronator quadratus can lead to instability in the form of radio-ulnar convergence and dorsal displacement (winging) of the ulnar stump. This can result in diminution of forearm rotation and weakness with grasp. Stabilization of the ulnar stump after resection for a giant cell tumor was described by Kayias & Drosos. We are adding two more cases to the literature. Both patients had excellent functional outcome and there were no instances of recurrence at three years of follow-up.

  17. Determinação da densidade mineral óssea da extremidade distal do rádio-ulna em gatos: correlação entre peso, sexo e idade Determination the bone mineral density of the distal extremity of the radius-ulna in cats: correlation between weight, sex and age

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    Luiz Carlos Vulcano

    2008-02-01

    Full Text Available Os valores de normalidade da densidade mineral óssea (DMO da extremidade distal de rádio-ulna em 120 gatos clinicamente saudáveis foram determinados usando-se a técnica de densitometria óptica em imagens radiográficas. Para a padronização da técnica e interpretação da DMO, foi utilizado um programa computacional especialmente desenvolvido para a medida de densidade óptica em imagens radiográficas, que contém a imagem radiográfica da extremidade distal de rádio-ulna, e uma escala de alumínio (penetrômetro, usada como referencial densitométrico, permitindo a medida da densidade mineral óssea do rádio-ulna correspondente ao valor em milímetros da escala. Os valores médios da densidade mineral óssea da extremidade distal do rádio-ulna foram de 1,98 ± 0,52mmAl para os machos e de 1,76 ± 0,41mmAl para as fêmeas. Foram observadas correlações estatisticamente significativas entre a DMO, o peso e a idade dos animais estudados (PThe normal values of bone mineral density (BMD at the distal end of the radius-ulna were established in 120 clinically healthy cats, using the technique of optical densitometry in radiographic images. The interpretation of BMD was performed using a computer software especially developed for measuring the optical density of the radiographic films, containing radiographic image of the distal extremity of the radius-ulna, and steps of an aluminum scale (penetrometer, used as a densitometric reference. This allowed the measurement of the BMD corresponding to the value in millimeters of the scale. The BMD mean values of the distal end of radius-ulna were: 1.98 ± 0.52mmAl for male and 1.76 ± 0.41 for female cats. Significant correlations were observed between BMD and weight and BMD and age (P<0.0005.

  18. Retrospective Analysis of Giant Cell Tumor Lower End Radius Treated with En bloc Excision and Translocation of Ulna.

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    Vyas, Amit; Patni, Purnima; Saini, Narender; Sharma, Rahul; Arora, Vinit; Gupta, S P

    2018-01-01

    Distal end of radius is third most common site for GCT of long bones and 1% of these metastasize mostly to lungs. Reconstruction methods commonly used are fibula (vascularized and nonvascularized), centralization of ulna, translocation of ulna, and endoprosthetic replacement. We report the outcome of series of twenty cases where we did en bloc excision of tumor with translocation of ulna. Twenty cases of giant cell tumor (GCT) of lower end of radius were included in this retrospective study. The mean age of patients was 33.15 years (range 21-55 years). We had 14 of Campanacci Grade III and 6 of Grade II. Preoperative radiographs and magnetic resonance imaging of the involved wrist and forearm were done. Of all twenty patients, 14 were males and 6 were females. Mean followup duration was 3.9 years (range 1.5-17 years). Mean grip strength of involved side as a percentage of normal side was 71% (range 42%-86%) and the actual mean value for operated side was 29 kg as compared to 40 kg for normal side. The average range of forearm movement was supination 80.25° (60°-90°) and pronation 77.5° (70°-90°). No patient was dissatisfied as far as cosmesis was concerned. In our opinion considering the propensity to recur with more aggressiveness after recurrence, en bloc excision with translocation of ulna has become a standard treatment option for GCT of lower end of radius, with advantages of better functional outcomes, retained vascularity, and elimination of risk of donor site morbidity.

  19. The proximal and distal position of the radius relative to the ulna through a full range of elbow flexion and forearm rotation.

    Science.gov (United States)

    Quigley, R J; Robicheaux, G W; Lee, T Q

    2014-06-01

    The purpose of this study was to measure the position of the radius relative to the ulna through a complete range of elbow flexion and forearm rotation. Twenty cadaveric upper extremities were mounted on a testing jig that allowed simultaneous control of elbow flexion and forearm rotation. The longitudinal position of the radius relative to the ulna was measured using a three-dimensional digitizer at full pronation, mid-pronation (45°), neutral (0°), mid-supination (45°) and full supination at 10°, 30°, 60°, 90° and 120° of elbow flexion. Our results showed that the radius is located distally when in supination and is located more proximally as it is rotated into pronation. The longitudinal position of the radius changes over 9 mm when moving through a complete arc of forearm rotation. The angle of elbow flexion had a secondary effect on the longitudinal position of the radius, causing changes of less than 0.8 mm. © The Author(s) 2013.

  20. Determinação da densidade mineral óssea da extremidade distal do rádio-ulna em gatos: correlação entre peso, sexo e idade

    OpenAIRE

    Vulcano,Luiz Carlos; Santos,Flávio Augusto Marques dos; Godoy,Carmen Lice Buchmann de

    2008-01-01

    Os valores de normalidade da densidade mineral óssea (DMO) da extremidade distal de rádio-ulna em 120 gatos clinicamente saudáveis foram determinados usando-se a técnica de densitometria óptica em imagens radiográficas. Para a padronização da técnica e interpretação da DMO, foi utilizado um programa computacional especialmente desenvolvido para a medida de densidade óptica em imagens radiográficas, que contém a imagem radiográfica da extremidade distal de rádio-ulna, e uma escala de alumínio ...

  1. Anatomic Relationships of the Distal and Proximal Radioulnar Joints Articulating Surface Areas and of the Radius and Ulna Bone Volumes - Implications for Biomechanical Studies of the Distal and Proximal Radioulnar Joints and Forearm Bones.

    Science.gov (United States)

    Malone, Paul S C; Shaw, Oliver G; Lees, Vivien C

    2016-01-01

    Previous work from this laboratory has evidenced the biomechanical role of forearm osseoligamentous structures in load transfer of applied forces. It has shown that forces transmitted across the distal radioulnar joint (DRUJ) and proximal radioulnar joint (PRUJ) are similar, though not identical, under axial loading conditions. The purpose of the study was to assess the articulating surface areas of the radioulnar joints and the volumes of the forearm bones addressing the hypothesis that there may be anatomic adaptations that reflect the biomechanical function of the integrated forearm unit. The articulating surface areas of PRUJ and DRUJ were assessed using a laser scanner in 24 cadaver forearms. The articulating joint surfaces were additionally delineated from standardized photographs assessed by three observers. The surface areas of matched pairs of joints were compared on the null hypothesis that these were the same within a given forearm specimen. An additional 44 pairs of matched forearm bone volumes were measured using water displacement technique and again compared through statistical analysis (paired sample t-test and Bland-Altman analysis). The findings of this study are that the articulating surface areas of the DRUJ and PRUJ as well as the bone volumes are significantly different and, yet, strongly correlated. The paired sample t-test showed a significant difference between the surface areas of the DRUJ and PRUJ (p radius to ulna bone volume ratio of 0.81. When the olecranon was disregarded, radius volume was on average of 4% greater than ulna volume. This study demonstrates and defines the anatomical relationships between the two forearm bones and their articulating joints when matched for specimen. The data obtained are consistent with the theory of integrated forearm function generated from published biomechanical studies.

  2. Open reduction and cranial bone plate fixation of fractures involving the distal aspect of the radius and ulna in miniature- and toy-breed dogs: 102 cases (2008-2015).

    Science.gov (United States)

    De Arburn Parent, Rebecca; Benamou, Jérôme; Gatineau, Matthieu; Clerfond, Pierre; Planté, Jérôme

    2017-06-15

    OBJECTIVE To determine outcomes and complication rates of open reduction and cranial bone plate fixation of fractures involving the distal aspect of the radius and ulna in miniature- and toy-breed dogs. DESIGN Retrospective case series. ANIMALS 102 miniature- and toy-breed dogs (105 fractures) weighing ≤ 7 kg (15.4 lb) that had undergone open reduction and cranial bone plate fixation of a fracture involving the distal aspect of the radius and ulna from 2008 through 2015. PROCEDURES Medical records were reviewed and information extracted regarding dog and fracture characteristics, surgical variables, and follow-up examination data (including postoperative complications). Postoperative radiographs were examined for distal fragment size, implant placement, apposition, alignment, and healing stage. A long-term follow-up questionnaire was completed by telephone interview with dog owners at least 6 months after surgery. RESULTS Mean length of the distal bone fragment in all fractures was 19.2 mm, with a mean distal-to-total radial length ratio of 0.21. At last follow-up examination (typically 6 weeks after surgery), 97 (95%) dogs had no signs of lameness; minor lameness was identified in 5 (5%) dogs. Complications developed in 26 (25%) fractures (23 [22%] minor and 3 [3%] major complications). Sixty-eight of 71 (96%) owners rated the overall and long-term outcome as excellent and 3 (4%) as good; 68 of 71 (96%) dogs reportedly had no signs of residual lameness. CONCLUSIONS AND CLINICAL RELEVANCE Open reduction and cranial bone plate fixation for the treatment of radius-ulna fractures in miniature- and toy-breed dogs provided an excellent outcome with a low complication rate.

  3. Anatomic relationships of the distal and proximal radioulnar joints articulating surface areas, and of the radius and ulna bone volumes – implications for biomechanical studies of the distal and proximal radioulnar joints and forearm bones

    Directory of Open Access Journals (Sweden)

    Paul S C Malone

    2016-07-01

    Full Text Available BackgroundPrevious work from this laboratory has evidenced the biomechanical role of forearm osseoligamentous structures in load transfer of applied forces. It has shown that transmitted forces across the distal radioulnar joint (DRUJ and proximal radioulnar joint (PRUJ are similar though not identical under axial loading conditions. The purpose of the study was to assess the articulating surface areas of the radioulnar joints and the volumes of the forearm bones addressing the hypothesis that there may be anatomic adaptations that reflect the biomechanical function of the integrated forearm unit.MethodsThe articulating surface areas of PRUJ and DRUJ were assessed using a laser scanner in 24 cadaver forearms. The articulating joint surfaces were additionally delineated from standardized photographs assessed by three observers. The surface areas of matched pairs of joints were compared on the null hypothesis that these were the same within a given forearm specimen. An additional 44 pairs of matched forearm bone volumes were measured using water displacement technique and again compared through statistical analysis (paired sample t-test, and Bland Altman analysis.ResultsThe findings of this study are that the articulating surface areas of the DRUJ and PRUJ as well as the bone volumes are significantly different and yet strongly correlated. The paired sample t-test showed a significant difference between the surface areas of the DRUJ and PRUJ (p<0.05. The PRUJ articulating surface area was marginally larger than the DRUJ with a PRUJ : DRUJ ratio of 1.02. Paired sample t-test showed a significant difference between the two bone volumes (p<0.01 with a radius to ulna bone volume ratio of 0.81. When the olecranon was disregarded, radius volume was on average 4% greater than ulna volume.ConclusionsThis study demonstrated defines the anatomical relationships between the two forearm bones and their articulating joints when matched for specimen. The data

  4. Distal Oblique Bundle Reinforcement for Treatment of DRUJ Instability

    NARCIS (Netherlands)

    Brink, P.R.G.; Hannemann, P.F.

    2015-01-01

    Background Chronic, dynamic bidirectional instability in the distal radioulnar joint (DRUJ) is diagnosed clinically, based on the patient's complaints and the finding of abnormal laxity in the vicinity of the distal ulna. In cases where malunion is ruled out or treated and there are no signs of

  5. Sauve-Kapandji operation for disorders of the distal radioulnar joint after Colles' fracture. Good results in 12 patients followed for 1.5-4 years

    DEFF Research Database (Denmark)

    Mikkelsen, Søren Søndergaard; Lindblad, Bent Erling; Larsen, Erik Roj

    1997-01-01

    Controversies continue concerning the treatment of the posttraumatic caput ulna syndrome. We have treated 12 patients, mean age 42 (23-77) years, with arthrodesis ad modum Sauve-Kapandji of the distal articulation between the radius and ulna, combined with resection of the ulnar neck. Before the ...

  6. OUTCOME OF FRACTURE OF INTRAARTICULAR DISTAL FEMUR TREATED WITH DISTAL FEMUR LOCKING COMPRESSION PLATE

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    Swapna Pran Saikia

    2017-10-01

    Full Text Available BACKGROUND The most challenging fractures faced by orthopaedic surgeons are the distal fractures of femur, especially the intraarticular distal femoral fractures. These fractures have been classified according to Orthopaedic Trauma Association (OTA 33-C3. Distal femoral fractures account to 4-7% of all femoral fractures and are less common compared to hip fractures. The aim of the study is to study the functional outcome of fracture of intraarticular distal femur treated with distal femur locking compression plate. MATERIALS AND METHODS This study is a prospective study, which comprised of 30 patients of intraarticular distal femur fracture AO classification 33-C3 who were treated by locking compression plate at Jorhat Medical College and Hospital, Jorhat, Assam. This study was conducted during February 2015 to April 2017. The functional outcome was studied using Neer’s score, outcome of radiology and complication with fracture fixation using LCP. RESULTS Out of 30 patients, 22 were males (73.3% and 8 were females (26.7%. 18 patients had fracture right hand side and 12 patients had left-handed fractures. A 19 years old was the youngest patient and 72 years was the oldest patient. About 70% patients had sustained road traffic accidents and 10% had sustained fall from a height. Four days was the average trauma to operative interval, 22 patients were operated extensile lateral approach and 8 patients were operated by swashbuckler approach. 12 weeks was the average weightbearing duration, 21 weeks was average time for fracture healing. 10 patients had C1 (33.3%, 12 patients had C2 (40% and 8 patients had C3 (26.7% type of fracture according to AO classification. Among 30 patients, 13 patients have shown excellent results, 7 patients have good results, 5 fair results and 5 poor results. Primary bone grafting was done in 4 patients for severely comminuted type C3 fracture. Secondary bone grafting was done in 2 patients who had delayed union at 4

  7. Monoaxial distraction of ulna to second metacarpal followed by single bone forearm in massive post infective radial bone loss

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    Jitendra N Pal

    2012-01-01

    Full Text Available Introduction: Radial bone loss associated with gross manus valgus deformity can be managed by open reduction internal fixation using intervening strut bone graft, callus distraction using ring or monoaxial fixator, and achieving union by distraction histogenesis. These methods are particularly suitable when bone loss is small. Single or staged procedure is described for congenital as well as in acquired extensive bone loss of radius. Distraction through radial proximal to distal segments, to achieve reduction of distal radio-ulnar joint (DRUJ, is also described in acquired cases. In the present series, functional results of distraction through ulna to 2 nd metacarpal is studied alongwith, functional status of hand, stability of wrist, level of patient′s satisfaction are also studied. Materials and Methods: 7 unilateral cases of radial loss (M = 5, F = 2 affecting 4 right hands of mean age 17 years (range 9 to 24 years were included in this study. They were treated by distracting through ulna to 2 nd metacarpal to achieve DRUJ alignment in first stage. Subsequently ulna was osteotomised and translated to distal stump of radius. It was then fixed to the distal radial remnant in 30° pronation in dominant and 30° supination non dominant hands. Results: Union was achieved in all cases associated with beneficial cross union of distal ulna. Hand functions improved near to normal, with fully corrected stable wrist joint, hypertrophied ulna and without recurrence. All of them had practically complete loss of forearm rotations, however patients were fully satisfied. Conclusion: This method is particularly suitable when associated with 6 cm or more radial bone loss. But when loss is small, sacrifice of one bone may not be justifiable.

  8. Fractures of the distal tibia treated with polyaxial locking plating.

    Science.gov (United States)

    Gao, Hong; Zhang, Chang-Qing; Luo, Cong-Feng; Zhou, Zu-Bin; Zeng, Bing-Fang

    2009-03-01

    We evaluated the healing rate, complications, and functional outcomes in 32 adult patients with very short metaphyseal fragments in fractures of the distal tibia treated with a polyaxial locking system. The average distance from the distal extent of the fracture to the tibial plafond was 11 mm. All fractures healed and the average time to union was 14 weeks. Six patients (19%) reported occasional local disturbance over the medial malleolus. There were two cases of postoperative superficial infections and evidence of delayed wound healing. Using the American Orthopaedic Foot and Ankle Society ankle score, the average functional score was 87.3 points (of 100 total possible points). Our results show the polyaxial locking plates, which offer more fixation versatility, may be a reasonable treatment option for distal tibia fractures with very short metaphyseal segments.

  9. Outcomes of Distal Femur Fracture Treated with Dynamic Condylar Screw

    International Nuclear Information System (INIS)

    Razaq, M. N. U.; Muhammad, T.; Ahmed, A.; Adeel, M.; Ahmad, S.; Ahmad, S.; Sultan, S.

    2016-01-01

    Background: Implants for open reduction and internal fixation of distal femoral fracture includes angle blade plate, rush nails, enders nail and interlocking nails. But all these devices are technically demanding and less effective in providing inter-fragmentary compression in osteoporotic bones. These problems can be solved with dynamic condylar screw (DCS).The objective of the study was to determine the frequency of different outcomes of distal femoral fracture treated with dynamic condylar screw Methods: This case series study was carried out in the Department of Trauma and Orthopaedics, Ayub Teaching Hospital Abbottabad from 1st October 2014 to August 2015, after approval of the ethical committee of the institution. Data of all patients with distal femoral fractures aged 20-70 years, recruited through emergency, OPD or consultant clinic collected on a proforma. Standard treatment of trauma was given to the patients. Detailed history was taken including the past medical and surgical history. Detailed examination including air-way, breathing and circulation, general physical examination and abdomino-pelvic examination was done in each patient. Investigations including urinalysis, haemoglobin percent, full blood count, X-ray (both AP and lateral view) of the involved femur (including hip and knee) was done. Results: Mean age of the patients was 43.18±14.647 ranging from 20 to 70 years. Mean duration of hospital stay in days was 2.21±1.111 ranging from 1 to 6 days. Patients follow-up assessment after 4 months of surgery for union of femoral fracture treated with dynamic condylar screw was found in 96 (94.1 percent), wound infection was found in 7 (6.9 percent), knee stiffness was found in 21 (20.6 percent) and limb shortening was found in 7 (6.9 percent). Conclusion: Dynamic condylar screw is an easy, scientifically less difficult and satisfying method of treatment for fractures of femur. (author)

  10. Outcome in corrective osteotomy for malunited distal radius fractures.

    Science.gov (United States)

    Samson, Lucjan; Treder, Mariusz; Kolarz, Krzysztof; Lorczyński, Adam

    2007-01-01

    This article reports outcome in osteotomy for malunion of distal radius fractures. We evaluated 12 patients with distal radius malunion (mean age 54), who were treated with corrective osteotomy. Wrist motion and grip strength were evaluated, along with examination of pre and post osteotomy radiographs. The indications for corrections were degree of deformity, limitation of function, pain, and the appearance of the wrist. The radiographic evaluation proved that the restoration of the normal anatomic relationship between the distal radius and ulna leads to significant improvement of the function of the hand, as measured by range of motion and grip strength. Osteotomy of the distal radius in cases of malunion gives favorable outcomes.

  11. Complicated distal femoral epiphyseolysis treated by Ilizarov method: Case report

    Directory of Open Access Journals (Sweden)

    Jovanović Vesna

    2010-01-01

    Full Text Available Introduction Injuries of the distal femur are rare in children; however, they are frequently associated with complications. They are almost always physeal, most frequently Salter-Harris type II epiphyseolysis. The treatment of such injuries is similar in all physeal injuries. It is intended to provide growth plate recovery by gentle reduction and stable fixation thus preventing secondary complications, and also to provide decompression of the segment to solve the compartment syndrome and recover the neurovascular structures. Case Outline A seven-year old boy presented with a right knee injury while sleigh riding. He was admitted three weeks following the injury with distal femoral epiphysiolysis associated with peroneal palsy. A day after admission to our Institute the reduction was performed using the Ilizarov device. Physical therapy was started immediately after surgery, as well as walking with weight bearing on the operated leg. Five months after surgery the patient was anatomically and functionally recovered. Conclusion The presented method is recommended in the treatment of such injuries because of several reasons; reposition is simple and complete, there is no need to open the fracture site, fixation is stable, the growth plate is preserved, there is no need for additional external immobilisation, and physical therapy involving walking with weight bearing on the operated leg may be started immediately after surgery. .

  12. Epiphyseal plate closure of radio-ulna bone in red Sokoto goat ...

    African Journals Online (AJOL)

    The radiographs of their forearms were taken and the proximal and distal epiphyseal plate lengths of both radius and ulna bones were measured. The radiographic images of the bones showed that the proximal and distal epiphyseal plates of the radius were opened at week 1 with mean lengths of 0.50±0.05mm and ...

  13. Comparação de osteossíntese com placa e osteossíntese com placa associada a enxerto de proteína morfogenética óssea em fratura bilateral distal de rádio e ulna em cão - relato de caso

    Directory of Open Access Journals (Sweden)

    Marcos Ishimoto Della Nina

    2007-08-01

    Full Text Available Os cuidados e dificuldades em reparação de fraturas de rádio-ulna de cães de porte pequeno são conhecidos, com a ocorrência freqüente de não-união óssea, principalmente no que tange as fraturas distais, relacionadas a características anatômicas inerentes, como pouco recobrimento de tecido muscular, canal medular de diâmetro reduzido, e pouca vascularização. Tendo em vista esta realidade, descreve-se a comparação entre o tratamento com placa e parafuso e placa e parafuso com adição de proteína morfogenética óssea em fratura completa transversa de terço distal bilateral de rádio-ulna, de semelhante apresentação em cão da raça Pinscher, atendido no Serviço de Cirurgia de Pequenos Animais do HOVET/USP. Avaliou-se, comparativamente, o tempo de formação de calo ósseo, por exames radiográficos, aos 30, 60, 90 e 120 dias de pós-operatório, onde foi encontrado tempo de cicatrização de 90 dias no membro controle enquanto que, no membro tratado com a proteína morfogenética óssea, o tempo de cicatrização foi de 30 dias, demonstrando a possibilidade de incremento que o uso de fatores de crescimento podem trazer ao tratamento de fraturas em cães de pequeno porte.

  14. Heterotopic ossification after surgery for fractures and fracture-dislocations involving the proximal aspect of the radius or ulna.

    Science.gov (United States)

    Foruria, Antonio M; Augustin, Salvador; Morrey, Bernard F; Sánchez-Sotelo, Joaquín

    2013-05-15

    The objectives of this study were to (1) determine the prevalence of heterotopic ossification after surgery for fractures and fracture-dislocations involving the proximal aspect of the radius or ulna, (2) identify risk factors associated with the development of heterotopic ossification in these injuries, and (3) characterize the severity and location of the heterotopic ossification and the associated range of elbow motion. From 2004 to 2008, 142 elbow fractures and fracture-dislocations involving the proximal aspect of the radius or ulna were treated surgically at our institution. Records and radiographs of 130 elbows with adequate follow-up were retrospectively reviewed to identify cases of heterotopic ossification, characterize the ectopic bone, and analyze associated risk factors. The most frequent injuries included olecranon fractures, Monteggia fracture-dislocations, and various combinations of fractures of the radial head and coronoid with or without dislocation or subluxation. Heterotopic bone was identified on the radiographs of forty-eight elbows (37%). Heterotopic ossification interfered with motion in twenty-six elbows (20%), and thirteen elbows (10%) underwent additional surgery to remove heterotopic bone with the goal of improving motion. Risk factors associated with the development of heterotopic ossification included elbow subluxation or dislocation at the time of presentation, an open fracture, a severe chest injury, and a delay in definitive surgical treatment. Ectopic bone was preferentially located at the origin of torn soft-tissue structures or around fracture sites, and it was particularly common around the posterior aspect of the ulna and the neck of the radius. Heterotopic ossification was classified on radiographs as hazy immature in twenty-two elbows, limited mature in eighteen, extensive mature in five, and a complete bone bridge in three. Heterotopic ossification was more common in patients with an associated distal humeral fracture

  15. Inter- and intra-observer agreement of the AO classification for operatively treated distal radius fractures.

    Science.gov (United States)

    van Buijtenen, Jesse M; van Tunen, Mischa L C; Zuidema, Wietse P; Heilbron, Emile A; de Haan, Jeroen; de Vet, Henrica C W; Derksen, Robert J

    2015-11-01

    The reproducibility of the AO classification for distal radius fractures remains a topic of debate. Previous studies showed variable reproducibility results. Important treatment decisions depend on correct classification, especially in comminuted, intra-articular fractures. Therefore, reliable reproducibility results need to be undisputedly determined. Hence, the study objective was to assess inter- and intra-observer agreement of the AO classification for operatively treated distal radius fractures. A database of 54 radiographs of all AO types (A, B and C) and groups (A2-3, B1-3, and C1-3) of distal radius fractures was assessed in twofold. Likewise, a subset of 152 radiographs of solely C-type groups (C1-3) was assessed. All fractures were classified by six observers with different experience levels: three consultant trauma surgeons, one sixth-year trauma surgery resident, a consultant trauma radiologist, and an intern with limited experienced. The inter-observer agreement of both main types and groups was moderate (κ = 0.49 resp. κ = 0.48) in combination with a good intra-observer agreement (κ = 0.68 resp. κ = 0.70). The inter-observer agreement of the subset C-type fractures group was fair (κ = 0.27) with moderate intra-observer agreement (κ = 0.43). According to these results, the reproducibility of the AO classification of main types and groups of distal radius fractures based on conventional radiographs is insufficient (κ < 0.50), especially at group level of C-type fractures.

  16. Long-term results of Galeazzi-equivalent injuries in adolescents--open reduction and internal fixation of the ulna.

    Science.gov (United States)

    Cha, Soo Min; Shin, Hyun Dae; Jeon, Je Hyung

    2016-03-01

    We diagnosed 10 Galeazzi-equivalent injuries. We report the radiological and clinical results at the end of growth in adolescents, including the results of ulnar lengthening. This study included 10 Galeazzi-equivalent injuries (seven patients requiring open reduction and three requiring closed reduction for ulnar lesions) seen since 2004. The periosteum was entrapped around the fractured physis in five patients and the extensor carpi ulnaris to the periosteum was interposed in two patients. Among the seven patients, ulnar lengthening was performed in only three patients. Ulnar variances at the time of the lengthening were -6, -6, and -5 mm. Gradual lengthening was performed. Radiologic abnormalities, including the ulnar variances, were investigated at the end of growth. In addition, pain scores, the range of wrist motion, and grip strength were evaluated and compared with nonlengthened ulnas. The mean age of the patients at the final follow-up was 19.7 years, and the mean total follow-up period was 6 years. The final ulnar variances were -5, -5, -3, and 0 mm in four patients with nonlengthened ulnas among the seven patients. Three patients with lengthened ulnas showed final neutral variances. In four nonlengthened ulnas, three ulnas bowed to the radial side and two ulnar heads had an inclined and deformed shape. Joint mismatch of the distal radioulnar joint surface was found in one patient with lengthened and one with nonlengthened ulnas. Three patients with nonlengthened ulnas showed decreased range of wrist motions. Comparison of contralateral grip strength indicated a significant difference between patients with or without lengthened ulnas. Long-term follow-up after Galeazzi-equivalent injuries may be essential to check for premature epiphyseal closure, length discrepancies, or joint incongruency. A procedure for a shortened ulna could be needed; however, the appropriate time and degree of lengthening remain to be investigated.

  17. Outcomes of the distal intraarticular humeral fractures treated by olecranon osteotomy

    Directory of Open Access Journals (Sweden)

    Erhan Yılmaz

    2009-01-01

    Full Text Available Objectives: To evaluate the management and outcome of intraarticular fractures of the distal humerus treated by open reduction and internal fixation using the olecranon osteotomy technique. Materials and methods: Twenty-one patients with in-traarticular fractures of the distal humerus were treated by open reduction and internal fixation. The mean age of the patients was 41.6 years and the mean follow-up pe-riod was 25.3 months. All fractures were type C accord-ing to the AO/ASIF fracture classification system. Chev-ron type olecranon osteotomy was performed within 12-24 h after the injury in all cases but 4 of them. Physical and radiological examination of patients with the appro-priate range checks were made.Results: All fractures united within average duration of 3.2 months. Excellent or good results were found in pa-tients less than 50 years-old, in women, when passing time from injury to surgery was within 12 hours and when early mobilization was achieved. The complica-tions were seen as 2 (9.6% transient neuropraxia of the ulnar nerve, 2 (9.6% failure of fixation, 1 (4.8% het-erotopic ossification and 1 (4.8% olecranon non-union. Fracture type (C1 and time from occurrence of injury to surgery (<12 hours are the main prognostic factors for achieving the excellent/ good functional results.Conclusions: The critical factors for a successful out-come of intraarticular fractures of the distal humerus in-cluded meticulous surgical technique, stable internal fix-ation, surgical experimentation and early controlled postoperative mobilization.

  18. Staphylococcal diaphyseal subacute osteomyelitis of the ulna in a child: an unusual cause of post-traumatic forearm swelling.

    LENUS (Irish Health Repository)

    Kearns, S R

    2004-01-01

    Paediatric subacute osteomyelitis (SAO) presents a diagnostic and therapeutic challenge to clinicians. Typically located in the metaphysis of long bones, diaphyseal SAO of the upper limb is rare. We present the case of a three-year-old girl referred to our fracture clinic as an occult fracture following trauma to her forearm with normal initial radiographs. Follow-up radiographs one week later showed cortical erosion of the distal ulna, while a subsequent MRI scan showed soft tissue swelling with an area of high signal in the distal ulna. A limited biopsy diagnosed staphylococcal subacute osteomyelitis of the ulna. The patient responded to high dose antibiotic therapy and made a full recovery. We present this case to highlight the high index of suspicion required to diagnose and appropriately manage this insidious condition, which may easily be confused with any number of benign and malignant bony lesions and provide a review of the relevant literature.

  19. Skeletal differences at the ulna and radius between pre-pubertal non-elite female gymnasts and non-gymnasts.

    Science.gov (United States)

    Burt, L A; Naughton, G A; Greene, D A; Ducher, G

    2011-09-01

    To compare skeletal parameters between the ulna and radius in pre-pubertal non-elite gymnasts and non-gymnasts. Fifty-eight non-elite artistic gymnasts, aged 6-11 years, were compared with 28 non-gymnasts for bone mineral content (BMC), total and cortical bone area (ToA, CoA), trabecular and cortical volumetric density (TrD, CoD) and estimated bone strength (BSI and SSIp), obtained by pQCT at the distal and proximal forearm. Gymnasts had greater estimated bone strength than non-gymnasts at both sites of the forearm. At the distal forearm, the gymnastics-induced skeletal benefits were greater at the radius than ulna (Z-scores for BMC, TrD and BSI +0.40 to +0.61 SD, pproximal forearm, the skeletal benefits were greater at the ulna than the radius (Z-scores for BMC, ToA, CoA and SSIp +0.59 to +0.82 SD, pproximal forearm emerged in young non-elite gymnasts. Benefits were larger when considering skeletal parameters at both the ulna and radius, than the radius alone as traditionally performed with pQCT. These findings suggest the ulna is worth investigating in future studies aiming to accurately quantify exercise-induced skeletal adaptations.

  20. Distal triceps injuries (including snapping triceps): A systematic review of the literature.

    Science.gov (United States)

    Shuttlewood, Kimberley; Beazley, James; Smith, Christopher D

    2017-06-18

    To review current literature on types of distal triceps injury and determine diagnosis and appropriate management. We performed a systematic review in PubMed, Cochrane and EMBASE using the terms distal triceps tears and snapping triceps on the 10 th January 2017. We excluded all animal, review, foreign language and repeat papers. We reviewed all papers for relevance and of the papers left we were able to establish the types of distal triceps injury, how these injuries are diagnosed and investigated and the types of management of these injuries including surgical. The results are then presented in a review paper format. Three hundred and seventy-nine papers were identified of which 65 were relevant to distal triceps injuries. After exclusion we had 47 appropriate papers. The papers highlighted 2 main distal triceps injuries: Distal triceps tears and snapping triceps. Triceps tear are more common in males than females occurring in the 4 th -5 th decade of life and often due to a direct trauma but are also strongly associated with weightlifting and American football. The tears are diagnosed by history and clinically with a palpable gap. Diagnosis can be confirmed with the use of ultrasound (US) and magnetic resonance imaging. Treatment depends on type of tear. Partial tears can be treated conservatively with bracing and physio whereas acute tears need repair either open or arthroscopic using suture anchor or bone tunnel techniques with similar success. Chronic tears often need augmenting with tendon allograft or autograft. Snapping triceps are also seen more in men than women but at a mean age of 32 years. They are characterized by a snapping sensation mostly medially and can be associated with ulna nerve subluxation and ulna nerve symptoms. US is the diagnostic modality of choice due to its dynamic nature and to differentiate between snapping triceps tendon or ulna nerve. Treatment is conservative initially with activity avoidance and if that fails surgical

  1. Radial Head Subluxation After Malalignment of the Proximal Ulna: A Biomechanical Study.

    Science.gov (United States)

    Sandman, Emilie; Canet, Fanny; Petit, Yvan; Laflamme, George Y; Athwal, George S; Rouleau, Dominique M

    2014-08-01

    Understanding the anatomy of proximal ulna is important when treating complex injuries, since nonanatomic reconstruction may lead to malunion, arthrosis, and instability. The proximal ulna has a sagittal bow, termed the proximal ulna dorsal angulation (PUDA). The purpose of this study was to evaluate the magnitude of angular malalignment at the PUDA that would lead to radial head subluxation. This biomechanical study was conducted on 6 fresh frozen upper extremities with an elbow movement simulator. An osteotomy was performed at the PUDA and stabilized with internal fixation at 5 angles. Lateral elbow fluoroscopic images were taken in 4 elbow and 3 forearm positions, with the annular ligament intact and then released. The displacement of the radial head was quantified with the radiocapitellar ratio measurement. A significant interaction exists between elbow positions, angles of malalignment, and annular ligament integrity (P subluxation were with annular ligament tear, ranging from -4% to 88% (P subluxation increased as malalignment was fixed into extension and with progressive elbow flexion. Posterior subluxation increased as malalignment advanced into flexion and decreased with elbow flexion. Proximal ulna malalignment combined with an annular ligament tear affect the biomechanics of the elbow and can lead to radial head subluxation. This study demonstrates the importance of an anatomic reconstruction, specifically recreation of each individual's unique PUDA. Thus, in the setting of a comminuted proximal ulna fracture with associated annular ligament insufficiency, radiographs of the contralateral elbow may assist with the restoration of the normal anatomy to limit radial head instability.

  2. Coronoid process of the ulna: paleopathologic and anatomic study with imaging correlation. Emphasis on the anteromedial ''facet''

    International Nuclear Information System (INIS)

    Freitas Valle de Lemos Weber, Marcio; Barbosa, Diogo Miranda; Belentani, Clarissa; Negrao Ramos, Pedro Miguel; Trudell, Debra; Resnick, Donald

    2009-01-01

    The purpose of this study was to provide a detailed description of the anatomy of the coronoid process of the ulna and to use magnetic resonance (MR) images and anatomic correlation with cadavers to show the macroscopic configuration of this structure. Photography and high-resolution radiography were performed in 26 ulna specimens from the collection of a local museum. MR imaging of the coronoid process of 11 cadaveric elbows was performed. The images were compared with those seen on anatomic sectioning. The anteromedial rim of the coronoid process of the ulna had a regular surface, without osseous irregularities or facets in 69.2% of the specimens. In 30.8% of the specimens, the anteromedial rim was not regular and a small ridge could be identified. The insertion site of the joint capsule was onto the anterior aspect of the coronoid process, at an average distance of 5.9 mm distal to the tip. The attachment of the anterior band of the ulnar collateral ligament at the sublime tubercle was flush with the articular margin in 63.6% of the specimens. In 36.4% of the specimens, a more distal attachment, with a separation between the undersurface of the ligament and the adjacent tubercle, was seen. The brachialis tendon was attached to the coronoid process at a mean distance of 12.1 mm distal to the tip. The coronoid process of the ulna is a small osseous structure with a complex anatomy and presents some anatomical variations. (orig.)

  3. Complex proximal ulna fractures: outcomes of surgical treatment.

    Science.gov (United States)

    Melamed, Eitan; Danna, Natalie; Debkowska, Monika; Karia, Raj; Liporace, Frank; Capo, John T

    2015-07-01

    To review the results of plating of various fracture patterns of proximal ulna fractures including isolated olecranon fractures, olecranon fractures combined with a coronoid fracture, and olecranon fractures combined with a coronoid and radial head fracture. The study included 38 patients with either an isolated olecranon fracture or combined injuries, all treated with open reduction and internal fixation of the olecranon. Other procedures were performed as needed, including radial head fixation or arthroplasty, fixation of the coronoid, and repair of the lateral collateral ligament complex. There were 27 men and 11 women with an average age of 49 years. Clinical and radiographic assessment was obtained at an average follow-up time of 15 and 8.4 months, respectively. All fractures healed within 5 months. The average arc of ulnohumeral motion was 91° (range 0°-140°); average pronation-supination arc was 128° (range 0°-180°). Subgroup analysis showed a statistically significant lower rotational motion arc in patients with associated radial head (73°) or coronoid fractures (68°) compared to isolated olecranon fractures. All other parameters including ulnohumeral motion, complication rate, and revision rate were similar among the groups. A stable, functional elbow can be restored in most patients with proximal ulna fractures treated with open reduction and internal fixation. Loss of full flexion is likely with high-energy trauma, complex fracture patterns, and concomitant injuries. Fracture patterns involving the coronoid and/or the radial head are associated with restricted forearm rotation. III.

  4. DNH 109: A fragmentary hominin near-proximal ulna from Drimolen, South Africa

    Directory of Open Access Journals (Sweden)

    Andrew Gallagher

    2011-05-01

    Full Text Available We describe a fragmentary, yet significant, diminutive proximal ulna (DNH 109 from the Lower Pleistocene deposits of Drimolen, Republic of South Africa. On the basis of observable morphology and available comparative metrics, DNH 109 is definitively hominin and is the smallest African Plio-Pleistocene australopith ulna yet recovered. Mediolateral and anteroposterior dimensions of the proximal diaphysis immediately distal to the m. brachialis sulcus in DNH 109 yield an elliptical area (π/4 *m-l*a-p that is smaller than the A.L. 333-38 Australopithecus afarensis subadult from Hadar. Given the unusually broad mediolateral/anteroposterior diaphyseal proportions distal to the brachialis sulcus, the osseous development of the medial and lateral borders of the sulcus, and the overall size of the specimen relative to comparative infant, juvenile, subadult and adult comparative hominid ulnae (Gorilla, Pan and Homo, it is probable that DNH 109 samples an australopith of probable juvenile age at death. As a result of the fragmentary state of preservation and absence of association with taxonomically diagnostic craniodental remains, DNH 109 cannot be provisionally assigned to any particular hominin genus (Paranthropus or Homo at present. Nonetheless, DNH 109 increases our known sample of available Plio-Pleistocene subadult early hominin postcrania.

  5. Distal tibial fracture treated by minimally invasive plate osteosynthesis after external fixation Retrospective clinical and radiographic assessment

    Directory of Open Access Journals (Sweden)

    Al. Șerban

    2014-02-01

    Full Text Available Fractures of the horizontal surface of the distal tibia are known commonly as pylon or plafond fractures, and represent 1-5% of lower extremity fractures, 7-10% of all tibial fractures. The protocol consisted of immediate (within eight to 24 hours open reduction and internal fixation of the fibula, using a fibular plate or one third tubular plate and application of an external fixator spanning the ankle joint. In the second stage, the treatment of proximal and distal tibial fractures with close reduction and MIPPO technique can preserve soft tissue, simplify operative procedure and decrease wound, obtain rigid internal fixation and guarantee early function exercises of ankle joint. In this study we evaluated 22 patients treated in Clinical Emergency Hospital Constanta between April 2012 - July 2013 diagnosed with multifragmentary fractures of the distal tibia. This study evaluates the treatment of complex fractures of distal tibia with locked plate after external fixation. There were 17 males and 5 females of mean age 51,7 years (31-68. The mean follow-up period was 14 weeks. (Ranging from 9-16 weeks. All patients were fully weight bearing at 16 weeks (ranging 9-16 weeks showing radiological union. There were no cases of failures of fixation, or rotational misalignment. No significant complication was observed in our patients. MIPO is an effective method of treatment for distal tibial fractures, reduce surgical trauma and maintain a more biologically favorable environment for fracture healing, reducing risks of infection and nonunion.

  6. Use of Fibula Bridge Graft Technique to Treat a Distal Tibia Non Union- A Case Report

    OpenAIRE

    Rajani, Amyn; Thakkar, C J; Shah, Ravi; Shyam, Ashok

    2013-01-01

    Introduction: Compound distal tibia fractures have high incidence of nonunions and have varied presentation as far as status of fibula is concerned. If fibula is sufficiently healthy we can use it for bridging the nonunion of tibia.Case Report: We present a case of 20 year old female with compound and segmental tibia fracture. Primary stablisation by external fixation and later cast brace application achieved union at the proximal end of the segmental fragment with non union at the distal en...

  7. Indicações de artroplastia radiocubital distal: relato de três casos clínicos Indications for distal radio-ulnar arthroplasty: report on three clinical cases

    Directory of Open Access Journals (Sweden)

    Cláudia Santos

    2011-01-01

    Full Text Available A artroplastia radiocubital distal é uma solução atrativa no tratamento de diferentes patologias da articulação radiocubital distal, pois permite restaurar a estabilidade, a transmissão de cargas e a função. As principais indicações são: o impingement radiocubital após ressecção parcial ou completa do cúbito distal e a artrite degenerativa, inflamatória ou pós-traumática da articulação radiocubital distal. Os autores apresentam três casos clínicos de patologia radiocubital distal: dois pacientes com sequelas pós-traumáticas e um caso de impingement radiocubital distal após operação de Sauvé-Kapandji. Os três casos foram tratados cirurgicamente com prótese metálica de substituição do cúbito distal tipo First Choice - Ascencion®. Os dois primeiros foram tratados com prótese tipo resurfacing e o último com prótese tipo modular. Em todos os pacientes obteve-se diminuição da dor e aumento da amplitude da RCD ao fim de um ano de seguimento pós-cirúrgico.Distal radioulnar arthroplasty is an attractive solution for treating various pathological conditions of the distal radioulnar joint because it allows restoration of stability, load transmission and function. The main indications are: radioulnar impingement after partial or complete resection of the distal ulna; and degenerative, inflammatory or post-traumatic arthritis of the distal radioulnar joint. The authors present three clinical cases of distal radioulnar pathological conditions: two patients with post-traumatic sequelae and one case of distal radioulnar impingement after a Sauvé-Kapandji operation. The three cases were treated surgically with a metallic prosthesis to replace the distal ulna (First Choice - Ascension®. The first two were treated with a resurfacing prosthesis and the last one with a modular prosthesis. All of the patients had achieved pain relief and increased movement of the distal radioulnar joint after one year of postoperative

  8. Distal femoral flexion deformity from growth disturbance treated with a two-level osteotomy and internal lengthening nail

    Directory of Open Access Journals (Sweden)

    Austin T. Fragomen

    2017-10-01

    Full Text Available Abstract Salter Harris fractures of the distal femur can lead to growth disturbance with resulting leg length inequality and knee deformity. We have looked at a case series (3 of patients who presented with a distal femur flexion malunion and shortening treated with a distal femoral osteotomy and plating and a proximal femoral osteotomy with a magnetic internal lengthening nail. Does a two-level osteotomy and internal fixation approach provide a reliable result both radiographically and functionally? The average knee extension loss was 12°, LLD 47 mm, PDFA 65°, MAD 2 mm. The patients were treated with an acute, posterior, opening wedge osteotomy of the distal femur stabilized with a lateral plate and screws and grafted with cancellous chips and putty. A second osteotomy was made proximally in the femur percutaneously, and the internal lengthening nail was inserted. Lengthening was done at approximately 1 mm/day. The average extension gain was 12°; amount of lengthening at the proximal site was 40 mm, LLD was 3 mm. The average PDFA was 81°, and MAD 3 mm. There were no complications. Functional results were excellent. Bone healing index was 24 days/cm. The average distance from the distal osteotomy to the joint line was 57 mm. The technique of two-level femur osteotomy stabilized with a plate and lengthening nail yielded excellent results with acceptable correction of deformity, full knee extension, and improved function. There were no complications including implant failure, infection, need for blood transfusion, knee stiffness, nonunion, compartment syndrome, or malunion.

  9. How should I treat a coronary "traffic jam"? A triple kissing balloon in distal left main trifurcation.

    Science.gov (United States)

    Testa, Luca; Bedogni, Francesco

    2011-03-01

    A 60-year-old man with relapsing unstable angina a year aftger an anterior acute myocardial infarction treated with PCI to proximal left anterior descending (LAD) and proximal intermediate branch (IB), resulting in a severely impaired LV function. Physical examination, laboratorytest, transthoracic echocardiogram, rest ECG, coronary angiography. Severe in-stent restenosis to IB, with a bulky plaque involving distal left main, obtuse marginal and proximal circumflex. Percutaneous coronary intervention/coronary artery bypass grafting.

  10. Fishtail deformity - a delayed complication of distal humeral fractures in children

    Energy Technology Data Exchange (ETDEWEB)

    Narayanan, Srikala [Massachusetts General Hospital, Department of Radiology, Division of Pediatric Imaging, Boston, MA (United States); University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA (United States); Shailam, Randheer; Nimkin, Katherine [Massachusetts General Hospital, Department of Radiology, Division of Pediatric Imaging, Boston, MA (United States); Grottkau, Brian E. [Massachusetts General Hospital, Department of Orthopaedics, Pediatric Orthopaedics, Boston, MA (United States)

    2015-06-15

    Concavity in the central portion of the distal humerus is referred to as fishtail deformity. This entity is a rare complication of distal humeral fractures in children. The purpose of this study is to describe imaging features of post-traumatic fishtail deformity and discuss the pathophysiology. We conducted a retrospective analysis of seven cases of fishtail deformity after distal humeral fractures. Seven children ages 7-14 years (five boys, two girls) presented with elbow pain and history of distal humeral fracture. Four of the seven children had limited range of motion. Five children had prior grade 3 supracondylar fracture treated with closed reduction and percutaneous pinning. One child had a medial condylar fracture and another had a lateral condylar fracture; both had been treated with conservative casting. All children had radiographs, five had CT and three had MRI. All children had a concave central defect in the distal humerus. Other imaging features included joint space narrowing with osteophytes and subchondral cystic changes in four children, synovitis in one, hypertrophy or subluxation of the radial head in three and proximal migration of the ulna in two. Fishtail deformity of the distal humerus is a rare complication of distal humeral fractures in children. This entity is infrequently reported in the radiology literature. Awareness of the classic imaging features can result in earlier diagnosis and appropriate treatment. (orig.)

  11. Gastroduodenal intussusception due to gastric schwannoma treated by Billroth II distal gastrectomy: one case report.

    Science.gov (United States)

    Yang, Jia-Hua; Zhang, Min; Zhao, Zhi-Hua; Shu, Yu; Hong, Jun; Cao, Yi-Jun

    2015-02-21

    Schwannomas are rarely observed in the gastrointestinal tract. The most common symptoms of a gastric schwannoma are abdominal pain or dyspepsia, gastrointestinal bleeding, and an abdominal mass. Many gastric schwannomas are asymptomatic and are discovered incidentally or at postmortem. The diagnosis of a schwannoma is based on immunohistochemical positivity for S-100 protein. We present a case report of a rare complication of gastric schwannoma causing gastroduodenal intussusception that was successfully managed by a Billroth II distal gastrectomy. In this rare case, the patient had intermittent, colicky abdominal pain, nausea, and vomiting for over 4 wk accompanied by a weight loss. A diagnosis of gastric intussusception was made by computed tomography. A Billroth II distal gastrectomy was then performed, and complete en bloc removal (R0 resection) was achieved. Pathology confirmed a gastric schwannoma through positive immunohistochemical staining for S-100 protein.

  12. Emprego de fixador externo circular no tratamento de complicações de fraturas do rádio e ulna em cães de raças pequenas Use of circular external fixator in the treatment of fracture complications of radius and ulna in small breed dogs

    Directory of Open Access Journals (Sweden)

    Sheila Canevese Rahal

    2005-10-01

    Full Text Available O objetivo deste estudo foi avaliar o método de Ilizarov no tratamento de complicações de fraturas do rádio e ulna em cães de raças pequenas. Um fixador de Ilizarov miniatura composto por anéis de alumínio e hastes de aço foi usado em três cães da raça poodle miniatura (casos 1, 2 e 3 e em um pinscher (caso 4. Os cães 1 e 4 apresentavam consolidação atrasada das porções médio-distal e distal, respectivamente, devido a prévio tratamento com tala externa. Foi aplicada uma montagem constituída por dois anéis proximais e um distal. Ambas as fraturas consolidaram, sendo que a do poodle apresentou leve desvio cranial das extremidades fraturadas. Os outros dois casos (2 e 3 consistiam de fraturas previamente tratadas por procedimento cirúrgico. O caso 2 apresentava rotação lateral do membro torácico e não-união do aspecto distal da diáfise radial com presença de pino intramedular e dois fios de cerclagem. O pino intramedular e um dos fios de cerclagem foram removidos e realizou-se a derrotação do foco da fratura. O aparelho foi montado como nos casos 1 e 4. A consolidação da fratura foi obtida com moderado desvio caudal do eixo ósseo. No caso 3, havia reabsorção óssea na diáfise do rádio e ulna devido ao emprego inadequado de fixador externo resina-pino. Empregou-se o transporte ósseo com o fixador de Ilizarov para induzir a regeneração óssea. Entretanto, este foi interrompido por falta de resposta. Manteve-se o fixador e o defeito ósseo foi tratado com enxerto esponjoso autólogo e biomateriais. A ulna ocupou parte do defeito segmentar do rádio. Foi possível concluir que o método de Ilizarov pode ser usado no tratamento de consolidação atrasada e não-união, mas o fixador externo circular é de difícil aplicação em cães de raças pequenas.The aim of this study was to evaluate the Ilizarov’s method for treating complications of radius and ulna fractures in small breed dogs. A miniature Ilizarov

  13. Distal Radius Fracture Treated by Internal Fixation with Plates, Screws and the RALCA® External Mini-fixator

    OpenAIRE

    Rafael López Cuellar; Yaniel Truffin Rodríguez; Yudit Pérez Álvarez

    2016-01-01

    Distal radius fractures are very common in medical practice. In our service, we may not have the most widely used devices for fixation of these fractures at a given moment. For this reason, we must consider all possible combinations within our power to correct them since most of the time, it is impossible to maintain a fracture reduction using a single technique. We present the case of a 24-year-old female patient treated at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienf...

  14. [The proximal crescentic osteotomy of the first metatarsal bone combined distal soft tissue reconstruction to treat severe hallux valgus].

    Science.gov (United States)

    Mao, Haijiao; Shi, Zengyuan; Dong, Wenwei; Xu, Dachuan; Keith, Wapner

    2015-09-01

    To explore the method of the treatment for hallux valgus with the proximal crescentic osteotomy of the first metatarsal bone, combining with distal lateral soft tissue release. From January 2008 to December 2012, 21 cases 21 hallux valgus feet were treated by operative procedure, included 1 male (1 foot) and 20 females (20 feet), with the mean age of 52 years (range, 36-68 years). Among all patients were followed up for 12 to 26 months, with the mean 16 months. The preoperative, post-operative and final follow-up X-ray films of all patients were collected. The hallux valgus angle, intermetatarsal angle and distal metatarsal articular angle were measured and analyzed. The surgical outcome was evaluated combined with the AOFAS score. The average hallux valgus angle decreased from 42.3° ± 1.8° preoperatively to 14.5° ± 1.8 postoperatively, the average intermetatarsal angle did from 21.9° ± 1.7 to 9.1° ± 1.8°, and the average distal metatarsal articular angle did from 14.9° ± 1.8 to 7.2° ± 1.5, respectively. There were significant differences between the preoperative and postoperative roentgenographic index. AOFAS score was improved from 44.0 ± 1.8 preoperatively to 83.9 ± 2.2 at the final follow-up. The proximal crescentic osteotomy of the first metatarsal bone combined distal soft tissue reconstruction obtained satisfactory results in severe hallux valgus patients with big intermetatarsal angle.

  15. Retrospective analysis of extra-articular distal humerus shaft fractures treated with the use of pre-contoured lateral column metaphyseal LCP by triceps-sparing posterolateral approach

    Directory of Open Access Journals (Sweden)

    Yatinder Kharbanda

    2016-11-01

    Full Text Available Abstract Management of extra-articular distal humerus fractures presents a challenge to the treating surgeon due to the complex anatomy of the distal part of the humerus and complicated fracture morphology. Although surgical treatment has shown to provide a more stable reduction and alignment and predictable return to function, it has been associated with complications like iatrogenic radial nerve palsy, infection, non-union and Implant failure. We in the present series retrospectively analysed 20 patients with extra-articular distal humerus shaft fractures surgically treated using the extra-articular distal humeral locking plate approached by the triceps-sparing posterolateral approach. The outcome was assessed using the DASH score, range of motion at the elbow and the time to union. The mean time to radiographic fracture union was 12 weeks.

  16. Retrospective analysis of extra-articular distal humerus shaft fractures treated with the use of pre-contoured lateral column metaphyseal LCP by triceps-sparing posterolateral approach.

    Science.gov (United States)

    Kharbanda, Yatinder; Tanwar, Yashwant Singh; Srivastava, Vishal; Birla, Vikas; Rajput, Ashok; Pandit, Ramsagar

    2017-04-01

    Management of extra-articular distal humerus fractures presents a challenge to the treating surgeon due to the complex anatomy of the distal part of the humerus and complicated fracture morphology. Although surgical treatment has shown to provide a more stable reduction and alignment and predictable return to function, it has been associated with complications like iatrogenic radial nerve palsy, infection, non-union and Implant failure. We in the present series retrospectively analysed 20 patients with extra-articular distal humerus shaft fractures surgically treated using the extra-articular distal humeral locking plate approached by the triceps-sparing posterolateral approach. The outcome was assessed using the DASH score, range of motion at the elbow and the time to union. The mean time to radiographic fracture union was 12 weeks.

  17. Thirty cases of distal humerus intra-articular fractures treated by open reduction and internal fixation: A 3-year review

    Directory of Open Access Journals (Sweden)

    Ajit Swamy

    2012-01-01

    Full Text Available Introduction: Fractures of the distal humerus involving articular surface remains one of the challenging situations for any orthopedic surgeon. Congruent articular reconstruction is mandatory for an acceptable functional recovery. Materials and Methods: This was a case series of 30 patients of distal humeral intraarticular fractures treated by open reduction and internal fixation and followed up at the end of 3 years.Fractures were classified according to AO [Arbeitsgemeinschaft für Osteosynthesefragen] and the results were evaluated using Cassebaums rating system, and other parameters. Results: Majority of the patients had a favourable outcome.There was no neurovascular complications and majority had a sound union. One case developed postoperative infection. Two cases resulted in nonunion. Conclusion: Open reduction and internal fixation with congruent articular reconstruction in young patients resulted in acceptable and good functional recovery. This was achieved with the use of recent AO ASIF plates. [AO/ASIF - Arbeitsgemeinschaft fuer Osteosynthesefragen - Association for the Study of Internal Fixation].

  18. A case report of osteoblastoma on the distal phalanx of the ring finger successfully treated with curettage and polymethylmethacrylate filling

    Science.gov (United States)

    Gumustas, Seyit Ali; Cagırmaz, Talat; Guler, Olcay; Ofluoglu, Onder; Kayahan, Sibel

    2015-01-01

    Background Osteoblastoma is an aggressive benign tumor whose presentation varies with location and size. This rare bone tumor is thus difficult to diagnose particularly when it occurs outside its most common location – the vertebral column and long bones. Case We report a case of osteoblastoma of the fourth distal phalanx of the left hand in an 18-year-old male, presented with pain and swelling and treated with curettage and polymethylmethacrylate filling followed by immobilization by a cast, which was opened 10 days later to start physical therapy. Patient was pain-free, recovered full function of his finger, and remained without pain at one month post-surgery. The finger was monitored closely for two years; sequential films showed a radiopaque interface and no evidence of local recurrence. Conclusion This is the first report of osteoblastoma on the distal phalanx. The possibility of osteoblastoma should be considered in cases of pain and swelling of phalanx, and if diagnosed, curettage and polymethylmethacrylate filling may be the treatment of choice. PMID:26072004

  19. Growth of the ulna after repeated bone lengthening in radial longitudinal deficiency.

    Science.gov (United States)

    Yoshida, Kiyoshi; Kawabata, Hidehiko; Wada, Mayuko

    2011-09-01

    Shortening of the ulna is one of the characteristic features of the radial longitudinal deficiency, which could be treated with repeated bone lengthening. The purpose of this study is to assess the changes in growth rate of the ulna after repeated bone lengthening in radial longitudinal deficiency. Five children (3 boys, 2 girls) who underwent twice bone lengthening of the ulna were reviewed. All patients had unilateral Bayne type IV radial longitudinal deficiency and had received centralization of the ulna previously. Ulnar length was measured on radiographs. Percent length against the normal side was used to measure differences between individuals. Ulnar growth rate was calculated as change in length over time. Ulnar length was 57.4% of the normal side on average at first visit to our hospitals. Percent length against the normal side became 88.9% immediately after the first lengthening. Then percent length decreased to 70.1% just before the second lengthening and became 101.7% after the second lengthening. Finally, it decreased to 82.9% at the last follow-up. Annual bone growth rate decreased after the first and second lengthening. Especially after the second lengthening, bone growth remarkably decreased. There were no complications except for pin-site infections at the first lengthening, whereas contracture of the elbow joint and callus fracture occurred at the second lengthening. Our study showed growth retardation occurred after bone lengthening and that the second lengthening resulted in remarkable growth retardation. We recommend delaying the second lengthening until the skeletal growth stops. Our series is small in number and we must investigate the influence of other factors (age, effect of the previous centralization, the amount of length, etc.). Further investigation will be needed to get firm conclusion. Level IV.

  20. Morphometric description of the feline radius and ulna generated from computed tomography.

    Science.gov (United States)

    Preston, Timothy; Glyde, Mark; Hosgood, Giselle; Snow, Lynne

    2015-12-01

    This study aimed to describe the length, internal and external diameters, cancellous bone volume and extent, and cortical thickness at predetermined locations in the radius and ulna of a cohort of skeletally mature, disease-free feline cadavers using radiography and computed tomography (CT). Five feline cadavers were used (mean weight 3.31 kg, range 2.55-4.24 kg). Antebrachii (n = 10) were radiographed to confirm skeletal maturity and normal radiographic appearance prior to CT. Reconstructed CT images were used to measure bone length, cortical thickness, internal and external diameters, and cancellous extent. Cancellous bone volume was calculated automatically using OsiriX after manual segmentation (350-850 Hounsfield units window) from axial CT slices. CT images were used to measure bone length, cortical thickness, internal and external diameters, and cancellous extent and volume. Mean radial length was 95.89 mm (95% confidence interval [CI] 88.52-103.26 mm) and mean ulna length was 114.67 mm (95% CI 105.53-123.81 mm). The olecranon had the largest mean cancellous bone volume (94.16 mm(3); 95% CI 72.09-116.23 mm(3)) and it extended a mean of 13.12 mm (95% CI 11.73-14.51 mm) distally. The radius at the level of the trochlea and the ulna at the level of the coronoid processes had the largest external diameters, respectively. The medullary canal narrowed at the level of the coronoid processes and became cranially eccentric at the proximal third of the diaphysis. The cranial cortex at the level of the coronoid processes and the caudal cortex of the olecranon were markedly thicker than other cortices at those levels. Morphometry of the feline antebrachium was described using CT, and should be a useful reference for future research investigations and clinical applications. © ISFM and AAFP 2014.

  1. Complaints in the follow-up of conservatively treated distal radius fractures - predictors in the initial radiograph

    International Nuclear Information System (INIS)

    Freund, W.; Aschoff, A.J.; Einsiedel, T.; Kramer, M.; Trnavac, S.; Bezirkskrankenhaus Guenzburg

    2007-01-01

    Purpose: Radius fractures are frequent in adults, and the long-term results of conservative treatment remain disappointing. This study examines predictors for the clinical outcome in the initial radiograph. This will help to identify patients who will benefit from surgical treatment. Materials and Methods: A cohort study including a standardized telephone interview (Cooney score) was used to identify all conservatively treated patients with a distal radius fracture over a five-year period. The additional selection criteria were: over 15 years old, initial X-ray available, patient reachable by phone for the follow-up interview. The following measurements were taken from the initial radiograph: Radius-base angle, radial shortening, radiopalmar angle and intraarticular displacement. Correlations and a simple test to predict negative outcome were computed. Results: Of the initially identified 2211 patients with distal radius fracture, 179 also fulfilled the other criteria. The patients were 56.2 years old on average (standard deviation SD = ± 22.45 years) and 72 % were female. 60 % of the fractures were on the right side. The average follow-up was 4.3 years (SD ± 1.66). The Cooney score results averaged 85 points (with 100 being the optimal and maximum score), indicating good or very good functional results in the long term follow-up for 61 % of patients. However, 31 % received a rating of fair or poor and therefore had an unfavorable outcome. With respect to the correlations, age and shortening of the radius (but not gender) had a significant influence on the functional result. Using an age of 75 years or above and a radial shortening of at least 4 mm to predict an unfavorable outcome, the sensitivity is only 16 %, but the positive predictive value is 73 % and the specificity is 96 %. (orig.)

  2. Clinical and non-clinical aspects of distal radioulnar joint instability

    NARCIS (Netherlands)

    Wijffels, M.; Brink, P.R.G.; Schipper, I.

    2012-01-01

    Untreated distal radioulnar joint (DRUJ) injuries can give rise to long lasting complaints. Although common, diagnosis and treatment of DRUJ injuries remains a challenge. The articulating anatomy of the distal radius and ulna, among others, enables an extensive range of forearm pronosupination

  3. Theoretical distribution of load in the radius and ulna carpal joint.

    Science.gov (United States)

    Márquez-Florez, Kalenia; Vergara-Amador, Enrique; de Las Casas, Estevam Barbosa; Garzón-Alvarado, Diego A

    2015-05-01

    The purpose of this study is to validate a model for the analysis of the load distribution through the wrist joint, subjected to forces on the axes of the metacarpals from distal to proximal for two different mesh densities. To this end, the Rigid Body Spring Model (RBSM) method was used on a three-dimensional model of the wrist joint, simulating the conditions when making a grip handle. The cartilage and ligaments were simulated as springs acting under compression and tension, respectively, while the bones were considered as rigid bodies. At the proximal end of the ulna the movement was completely restricted, and the radius was allowed to move only in the lateral/medial direction. With these models, we found the load distributions on each carpal articular surface of radius. Additionally, the results show that the percentage of the applied load transmitted through the radius was about 86% for one mesh and 88% for the coarser one; for the ulna it was 21% for one mesh and 18% for the coarser. The obtained results are comparable with previous outcomes reported in prior studies. The latter allows concluding that, in theory, the methodology can be used to describe the changes in load distribution in the wrist. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Evolutionary anatomy of the Neandertal ulna and radius in the light of the new El Sidrón sample.

    Science.gov (United States)

    Pérez-Criado, Laura; Rosas, Antonio

    2017-05-01

    This paper aims to improve our understanding of the phylogenetic trait polarity related to hominin forearm evolution, in particular those traits traditionally defined as "Neandertal features." To this aim, twelve adult and adolescent fragmented forelimb elements (including ulnae and radii) of Homo neanderthalensis recovered from the site of El Sidrón (Asturias, Spain) were examined comparatively using three-dimensional geometric and traditional morphometrics. Mean centroid size and shape comparisons, principal components analysis, and phylogenetic signal analysis were undertaken. Our investigations revealed that the proximal region of the ulna discriminated best between Neandertals and modern humans, with fewer taxonomically-informative features in the distal ulna and radius. Compared to modern humans, the divergent features in the Neandertal ulna are an increase in olecranon breadth (a derived trait), lower coronoid length (primitive), and anterior orientation of the trochlear notch (primitive). In the Neandertal radius, we observe a larger neck length (primitive), medial orientation of the radial tubercle (secondarily primitive), and a curved diaphysis (secondarily primitive). Anatomically, we identified three units of evolutionary change: 1) the olecranon and its fossa, 2) the coronoid-radius neck complex, and 3) the tubercle and radial diaphysis. Based on our data, forearm evolution followed a mosaic pattern in which some features were inherited from a pre-Homo ancestor, others originated in some post-ergaster and pre-antecessor populations, and other characters emerged in the specific Homo sapiens and H. neanderthalensis lineages, sometimes appearing as secondarily primitive. Future investigations might consider the diverse phylogenetic origin of apomorphies while at the same time seeking to elucidate their functional meaning. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. A case report of osteoblastoma on the distal phalanx of the ring finger successfully treated with curettage and polymethylmethacrylate filling

    Directory of Open Access Journals (Sweden)

    Seyit Ali Gumustas

    2015-01-01

    Conclusion: This is the first report of osteoblastoma on the distal phalanx. The possibility of osteoblastoma should be considered in cases of pain and swelling of phalanx, and if diagnosed, curettage and polymethylmethacrylate filling may be the treatment of choice.

  6. Metaphyseal Distal Tibia Fractures: A Cohort, Single-Surgeon Study Comparing Outcomes of Patients Treated With Minimally Invasive Plating Versus Intramedullary Nailing.

    Science.gov (United States)

    Barcak, Eric; Collinge, Cory A

    2016-05-01

    The purpose of this study was to compare clinical and functional outcomes of patients with distal tibia fractures treated with minimally invasive plating (MIPO) or intramedullary nailing (IMN). Cohort study. Level II regional trauma center. Overall, 86 patients with metaphyseal distal fractures (within 5 cm of joint) with simple or no articular involvement treated by a single, fellowship trained, orthopedic trauma surgeon from 2002 to 2013. Intramedullary nailing or minimally invasive plate osteosynthesis. Clinical and radiographic results were evaluated at a minimum of 1-year follow-up. Limb-specific outcomes (American Orthopedic Foot and Ankle Surgeons' ankle-hindfoot instrument) and whole-person measures [Short Form 36 (SF-36) instrument] were assessed at the final follow-up. We studied 86 patients with distal tibia fractures treated with MIPO (43 patients) and IMN (43 patients). Thirty-seven patients in the MIPO group and 27 in the IMN group met inclusion criteria. All patients ultimately healed, with the average time to union of 23 weeks in both the groups. Complications were similar between the 2 groups (MIPO vs. IMN, respectively), including nonunion (8% vs. 7%), malalignment (3.6% vs. 3%), wound complications (3.6% vs. 3%), and infection (0% vs. 3.6%). The need for secondary procedures for the removal of implants was 25.9% in the IMN group (distal locking screws only in 6/7) versus 8.3% in the MIPO group (P = 0.05). Additionally, the American Orthopedic Foot and Ankle Surgeons and all SF-36 version 2 domain scores were quantitatively higher for the IMN group, although only Role Emotional reached a level of statistical superiority between the groups. Similar clinical results and marginally enhanced functional outcomes were seen when treating nonarticular or minimally articular metaphyseal distal tibia fractures with IMN compared with MIPO. However, patients treated with IMN required more frequent secondary surgeries for the removal of painful distal locking

  7. [Stress fracture of the ulna in a table tennis player].

    Science.gov (United States)

    Dufek, P; Ostendorf, U; Thormählen, F

    1999-06-01

    This case report describes a stress fracture of the ulna in a 26-year-old professional table-tennis player. X-ray films remained negative so that the diagnostic is based on MRT. This stress fracture is caused by changing the intensity of training and changing the table-tennis-racket.

  8. Functional Outcome of Internal Fixation of Radial and Ulna Fracture

    Directory of Open Access Journals (Sweden)

    mehrdad Mansouri

    2006-02-01

    Conclusion: Anatomic reduction and internal fixation is the standard method for treatment of fractures by displacing radios and ulna in adults. According to results, it seems more intension to motions specially pronation and muscle strengthening foream after surgery will have affect on improving patients’ function specially pronation and Grip strength.

  9. Functional anatomy of the distal radioulnar joint in health and disease.

    Science.gov (United States)

    Lees, V C

    2013-04-01

    The distal radioulnar joint (DRUJ) is critical to the function of the forearm as a mechanical unit. This paper is concerned with the concepts and observations that have changed understanding of the function of the DRUJ, notably with respect to the biomechanics of this joint. The DRUJ has been shown to be important in acting to distribute load and removal of the ulna head leads to the biomechanical equivalent of a one-bone forearm. The soft tissues with topographical relations to the distal forearm and DRUJ have also been investigated in our experimental series with findings including the description of a clinical disorder termed subluxation-related ulna neuropathy syndrome.

  10. The effects of fixation of the ulna to the radius in young foals

    International Nuclear Information System (INIS)

    Clem, M.F.; DeBowes, R.M.; Douglass, J.P.; Leipold, H.W.; Chalman, J.A.

    1988-01-01

    The effects of radioulnar fixation were studied in 21 Quarter horse foals by applying a bone plate to the caudal aspect of the proximal part of the ulna, with screws engaging both the radius and the ulna. The plates were applied at 1 month of age in six foals (group I), 5 months of age in six foals (group II), and 7 months of age in three foals (group III). Six foals underwent sham operations at 1 month of age to serve as controls (group IV). Ulnar dysplasia and elbow subluxation developed in all treated foals. The magnitude of ulnar dysplasia was inversely related to the patient's age at fixation and was accompanied by degenerative joint disease and lameness in foals undergoing fixation at 1 and 5 months of age. Removal of the fixation appliances 16 weeks after implantation in three foals from each of groups I and II failed to reverse the degree of ulnar dysplasia. Although foals undergoing fixation at 7 months of age (group III) were not lame, radiographic evidence of subluxation and subtle degenerative changes in the articular cartilage of the treated elbow did develop. Recommendations for avoidance of radioulnar fixation were developed from these observations

  11. Use of circular external fixator in the treatment of fracture complications of radius and ulna in small breed dogs

    OpenAIRE

    Rahal, Sheila Canevese; Volpi, Reinaldo dos Santos; Hette, Khadije; Vulcano, Luiz Carlos; Büttner, Renata Cianni

    2005-01-01

    O objetivo deste estudo foi avaliar o método de Ilizarov no tratamento de complicações de fraturas do rádio e ulna em cães de raças pequenas. Um fixador de Ilizarov miniatura composto por anéis de alumínio e hastes de aço foi usado em três cães da raça poodle miniatura (casos 1, 2 e 3) e em um pinscher (caso 4). Os cães 1 e 4 apresentavam consolidação atrasada das porções médio-distal e distal, respectivamente, devido a prévio tratamento com tala externa. Foi aplicada uma montagem constituída...

  12. How well can step-off and gap distances be reduced when treating intra-articular distal radius fractures with fragment specific fixation when using fluoroscopy.

    Science.gov (United States)

    Thiart, M; Ikram, A; Lamberts, R P

    2016-12-01

    Although fragment specific fixation has proved to be an effective treatment regime, it has not been established how successfully this treatment could be performed using fluoroscopy and what the added value of arthroscopy could be. Establish gap and step-off distances after in intra-articular distal radius fractures that have been treated with fragment specific fixation while using fluoroscopy. Forty-four patients with an intra-articular distal radius fracture were treated with fragment specific fixation while using fluoroscopy. After the treatment of the intra-articular distal radius fracture with fragment specific fixation and the use of fluoroscopy, but before the completion of the surgical intervention, all gap, and step-off distances were determined by using arthroscopy. In addition, the joint was checked for any other wrist pathologies. Arthroscopy after the surgical intervention showed that in 37 patients no gap distances could be detected, while in six patients a gap distance of≤2mm was found and in one patient, a gap distance of 3mm. Similarly, arthroscopy revealed no step-off distances in 33 patients, while in 11 patients a step-off distance of≤2mm was found. Although additional wrist pathologies were found in 48% of our population, only one patient needed surgical intervention. Three months after the surgical intervention wrist flexion was 41±10°, wrist extension 51±17°, ulnar deviation 19±10°, radial deviation 32±12° while patients could pronate and supinate their wrist to 85±5° and 74±20°, respectively. Intra-articular distal radius fractures can be treated successfully with fragment specific fixation and the use of fluoroscopy. As almost all gap and step-off distances could be reduced to an acceptable level, the scope for arthroscopy to further improve this treatment regime is limited. The functional outcome scores that were found 3 months after the surgical intervention were similar to what has been reported in other studies using

  13. Alongamento simultâneo do rádio e ulna em cães pelo método de Ilizarov

    OpenAIRE

    Rahal S.C.; Volpi R.S.; Iamaguti P.; Vulcano L.C.

    2002-01-01

    Com o objetivo de avaliar a funcionalidade de uma montagem do aparelho de Ilizarov para o alongamento simultâneo do rádio e da ulna, foram utilizados 15 cães, sem raça definida, adultos, com peso entre 17 e 27kg. Aplicado um fixador composto de dois anéis e quatro hastes telescópicas, realizaram-se osteotomia subperiosteal diafisária distal do rádio e ulna e distração óssea, iniciada no sexto dia de pós-operatório. Os animais foram divididos em cinco grupos formados cada um por três cães, sub...

  14. Outcome of Displaced Fractures of the Distal Metaphyseal-Diaphyseal Junction of the Humerus in Children Treated With Elastic Stable Intramedullary Nails.

    Science.gov (United States)

    Marengo, Lorenza; Canavese, Federico; Cravino, Mattia; De Rosa, Vincenzo; Rousset, Marie; Samba, Antoine; Mansour, Mounira; Andreacchio, Antonio

    2015-09-01

    The main objective of this study was to retrospectively evaluate the clinical and radiographic outcomes of displaced distal humeral metaphyseal-diaphyseal junction fractures in children treated by elastic stable intramedullary nailing (ESIN). During the study period, 14 consecutive children with fractures of the distal humeral metaphyseal-diaphyseal junction were surgically treated by ESIN. All patients underwent full-length preoperative and postoperative anteroposterior and lateral radiographs of the injured humerus. One year after the index surgery, patients were asked to answer the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH). During the study period, fractures of the distal metaphyseal-diaphyseal humeral junction represented 1.5% (16/1100) of all humeral fractures. Fourteen patients underwent surgery and met the inclusion criteria. The male to female ratio was 1:1. The average patient age at the time of injury was 9.7 years (range, 3.6 to 13.7 y). The left and right sides were equally affected. The mean follow-up was 28.1 months (range, 20 to 38 mo).Radiologically, no secondary displacement, nail migration, loss of fixation, consolidation delay, nonunion, or refracture was noted. None of the patients showed signs of growth arrest on either radiologic or clinical assessment.All patients returned to their previous daily and sport activities without discomfort or difficulty, and they were free of pain at their last follow-up visits. The injured elbow range of motion was comparable with that of the contralateral side at the last follow-up visit in all patients. The mean Quick DASH score was 0.81 (range, 0 to 6.8). We recommend surgery for displaced fractures of the distal humeral metaphyseal-diaphyseal junction. ESIN results in stable reduction, good rotational control, and faster mobilization. Level IV.

  15. Minimally Displaced Distal Radius Fracture Treated with Closed Reduction and Percutaneous Fixation Resulting in an Iatrogenic Galeazzi Lesion.

    Science.gov (United States)

    Compagnone, Luce; Ghazal, Rakan; Canavese, Federico

    2016-12-01

    Galeazzi fracture in skeletally immature patients is a relatively uncommon injury. No previously published case has been associated with an iatrogenic mechanism. Here, we report a case of a 10-year-old boy with a minimally displaced distal radius fracture evolving into a Galeazzi lesion after unnecessary surgical treatment. Unnecessary surgical procedure associated with poor knowledge of bone growth and physiology contributed significantly to the reported condition.

  16. Fractures of the shafts of the radius and ulna

    International Nuclear Information System (INIS)

    Bender, C.E.; Campbell, D.C.

    1985-01-01

    Although the clinical presentation of fracture of the forearm bones is usually quite obvious, thorough radiologic examination of the radius and ulna and adjacent wrist and elbow joints is mandatory. Standard views of the forearm of the patient include the AP and lateral projections. The degree of shortening, angulation, rotation, and comminution should be noted. The selected films must be long enough to include the adjacent elbow and wrist joints

  17. Stress fracture of the ulna in an adolescent baton twirler

    Energy Technology Data Exchange (ETDEWEB)

    Fines, Bonnie P.; Stacy, Scott G. [Department of Radiology, University of Chicago Hospitals, IL (United States)

    2002-02-01

    Upper extremity stress fractures are rare, with the majority of those reported occurring in the ulna. The location of the fracture is influenced by the type of activity and mechanism of injury with which it is associated. We report the first case of a mid-ulnar stress fracture in a baton twirler due to chronic torsional stress. This patient was referred to our Orthopedic Oncology clinic with a preliminary diagnosis of osteoid osteoma. (orig.)

  18. Accelerated rehabilitation compared with a standard protocol after distal radial fractures treated with volar open reduction and internal fixation: a prospective, randomized, controlled study.

    Science.gov (United States)

    Brehmer, Jess L; Husband, Jeffrey B

    2014-10-01

    There are relatively few studies in the literature that specifically evaluate accelerated rehabilitation protocols for distal radial fractures treated with open reduction and internal fixation (ORIF). The purpose of this study was to compare the early postoperative outcomes (at zero to twelve weeks postoperatively) of patients enrolled in an accelerated rehabilitation protocol with those of patients enrolled in a standard rehabilitation protocol following ORIF for a distal radial fracture. We hypothesized that patients with accelerated rehabilitation after volar ORIF for a distal radial fracture would have an earlier return to function compared with patients who followed a standard protocol. From November 2007 to November 2010, eighty-one patients with an unstable distal radial fracture were prospectively randomized to follow either an accelerated or a standard rehabilitation protocol after undergoing ORIF with a volar plate for a distal radial fracture. Both groups began with gentle active range of motion at three to five days postoperatively. At two weeks, the accelerated group initiated wrist/forearm passive range of motion and strengthening exercises, whereas the standard group initiated passive range of motion and strengthening at six weeks postoperatively. Patients were assessed at three to five days, two weeks, three weeks, four weeks, six weeks, eight weeks, twelve weeks, and six months postoperatively. Outcomes included Disabilities of the Arm, Shoulder and Hand (DASH) scores (primary outcome) and measurements of wrist flexion/extension, supination, pronation, grip strength, and palmar pinch. The patients in the accelerated group had better mobility, strength, and DASH scores at the early postoperative time points (zero to eight weeks postoperatively) compared with the patients in the standard rehabilitation group. The difference between the groups was both clinically relevant and statistically significant. Patients who follow an accelerated rehabilitation

  19. Radiologic examination and measurement of the wrist and distal radio-ulnar joint

    International Nuclear Information System (INIS)

    Toernvall, A.H.; Ekenstam, F. af; Hagert, C.G.; Irstam, L.; Sahlgrenska Sjukhuset, Goeteborg; Uppsala Univ.

    1986-01-01

    Following fractures of the distal radius, a relatively high incidence of complications is caused by malalignment in the distal radio-ulnar (DRU) joint; recent anatomic and clinical investigations have shown a congruity of that joint to be of significant importance for restoring the function of the wrist. The radius forms a moderately arched bone, which moves around the ulna in pronation and supination. Biomechanically, the ulna may be regarded as the pillar around which the radius moves. In an anatomic investigation of 5 arm specimens, we have shown that the maximum cartilage contact in the DRU joint between the ulna head and the distal radius occurs in the neutral rotation position. A proposed routine examination method of the wrist and forearm includes a true antero-posterior and a lateral projection of the radius and the ulna, performed with the forearm and wrist in a neutral rotation, a neutral wrist deviation and with the elbow angled 90 degrees. Such an examination implies a standardized and reproducible method. In a radioanatomic investigation, a series of 50 healthy wrists and forearms were examined. A simple measuring technique is presented, applicable to the DRU joint and wrist favouring the ulna as the bone through which a reproducible long axis of the forearm/wrist may be drawn. It is suggested that the length of the radius should be judged relative to the ulna. Ulnar head inclination and radio-ulnar angle are new concepts, being major characteristics of the DRU joint. These angles of the right and left wrist were equal and no difference was found between the sexes. Minor alterations of the distal radius may be revealed when estimating these angles. (orig.)

  20. Radiologic examination and measurement of the wrist and distal radio-ulnar joint. New aspects

    Energy Technology Data Exchange (ETDEWEB)

    Toernvall, A.H.; Ekenstam, F. af; Hagert, C.G.; Irstam, L.

    Following fractures of the distal radius, a relatively high incidence of complications is caused by malalignment in the distal radio-ulnar (DRU) joint; recent anatomic and clinical investigations have shown a congruity of that joint to be of significant importance for restoring the function of the wrist. The radius forms a moderately arched bone, which moves around the ulna in pronation and supination. Biomechanically, the ulna may be regarded as the pillar around which the radius moves. In an anatomic investigation of 5 arm specimens, we have shown that the maximum cartilage contact in the DRU joint between the ulna head and the distal radius occurs in the neutral rotation position. A proposed routine examination method of the wrist and forearm includes a true antero-posterior and a lateral projection of the radius and the ulna, performed with the forearm and wrist in a neutral rotation, a neutral wrist deviation and with the elbow angled 90 degrees. Such an examination implies a standardized and reproducible method. In a radioanatomic investigation, a series of 50 healthy wrists and forearms were examined. A simple measuring technique is presented, applicable to the DRU joint and wrist favouring the ulna as the bone through which a reproducible long axis of the forearm/wrist may be drawn. It is suggested that the length of the radius should be judged relative to the ulna. Ulnar head inclination and radio-ulnar angle are new concepts, being major characteristics of the DRU joint. These angles of the right and left wrist were equal and no difference was found between the sexes. Minor alterations of the distal radius may be revealed when estimating these angles.

  1. Outcome of displaced distal tibial metaphyseal fractures in children between 6 and 15 years of age treated by elastic stable intramedullary nails.

    Science.gov (United States)

    Cravino, Mattia; Canavese, Federico; De Rosa, Vincenzo; Marengo, Lorenza; Samba, Antoine; Rousset, Marie; Mansour Khamallah, Mounira; Andreacchio, Antonio

    2014-12-01

    From June 1995 to August 2012, 18 children were treated surgically using elastic stable intramedullary nails for displaced closed fractures of the distal metaphysis of the tibia. The patients were followed radiographically and clinically on a regular basis until union was clinically and radiographically achieved. Thirteen boys and five girls with a mean age at trauma of 11 ± 2.9 years (range 6-15) were included in the study. Radiographically, all fractures healed without evidence of delayed union, re-fracture, hardware migration. All patients were pain free at last follow-up and all regained full, normal activities including sports. IV.

  2. [Clinical observation on the effect of joint mobilization in treating elderly patients after distal radius fractures operation].

    Science.gov (United States)

    Jia, Xue-Feng; Cai, Hong-Xin; Lin, Ge-Sheng; Fang, Ji-Shi; Wang, Yong; Wu, Zhi-Yong; Tu, Xu-Hui

    2017-07-25

    To investigate the effect of joint mobilization on postoperative wrist joint function, pain and grip strength for elderly patients with distal radius fracture. From January 2015 to June 2016, a total of 67 elderly patients with distal radius fracture were randomly divided into routine exercise group and joint mobilization group. Among them, 37 patients in the routine exercise group underwent conventional distal radius fracture postoperative joint function exercise regimen, including 16 males and 21 females with a mean age of (67.8±3.2) years old ranging from 60 to 72 years old;the injured side was dominant in 23 cases and non-dominant in 14 cases;injury mechanism was fall in 26 cases, traffic accident in 11 cases; for AO type, 6 cases were type B3, 18 cases were type C1, 7 cases were type C2, 6 cases was type C3. Other 30 patients in the joint mobilization group underwent joint mobilization on the basis of the routine exercise group including 14 males and 16 females with a mean age of (67.1±4.0) years old ranging from 61 to 74 years old; the injured side was dominant in 21 cases and non-dominant in 9 cases;injury mechanism was fall in 25 cases, traffic accident in 5 cases;for AO type, 8 cases were type B3, 13 cases were type C1, 6 cases were type C2, 9 cases were type C3. The wrist joint activity, Gartland-Werley wrist joint function score, VAS pain score and grip strength were observed at 3 months afrer treatment. After 3 months' treatment, the VAS in the routine exercise group was higher than that of the joint mobilization group ( P routine exercise group( P routine exercise group, the average angle of flexion, extension, radial deviation were significantly higher than those of joint mobilization group( P routine exercise group compared with joint mobilization group had no significant difference ( P >0.05). In the comparison of each item of Gartland-Werley, there was no significant difference between two groups in residual deformity and complication( P >0

  3. Distal tibial pilon fractures (AO/OTA type B, and C treated with the external skeletal and minimal internal fixation method

    Directory of Open Access Journals (Sweden)

    Milenković Saša

    2013-01-01

    Full Text Available Background/Aim. Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. Methods. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. Results. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60 years. The average follow-up was 21.86 (from 12 to 48 months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20 weeks. There were 4 (12.19% infections around the pins of the external skeletal fixator and one (3.22% deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90% patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. Conclusion. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for

  4. MÉTODOS ALTERNATIVOS PARA ESTABILIZAÇÃO DE FRATURAS DE RÁDIO E ULNA EM CÃES E GATOS ALTERNATIVES METHODS FOR FRACTURE STABILIZATION OF RADIO AND ULNA IN DOGS AND CATS

    Directory of Open Access Journals (Sweden)

    Amaro Fábio de Albuquerque Souza

    2001-02-01

    Full Text Available Devido à grande casuística de fraturas diafisárias e metafisárias distais de rádio e ulna em pequenos animais e ao alto custo dos implantes ortopédicos recomendados na literatura, tornou-se necessário o estudo de novos métodos de estabilização, que diminuíssem os inconvenientes inerentes à técnica de estabilização radial mediante à colocação de um único pino intramedular, sem encarecer o procedimento. Para tais fins, foram testados em 17 animais (15 caninos e 2 felinos, a imobilização interna do rádio com um pino intramedular, complementado por uma dupla hemicerclagem interfragmentar em X (10 animais, e a colocação de um pino intramedular no rádio e outro na ulna (7 animais, visando com isto, anular todas as forças atuantes no foco de fratura. Esses métodos, complementados com imobilização externa, demonstraram ser eficientes do ponto de vista cirúrgico, diminuindo significativamente os custos, o tempo anestésico, a freqüência de cuidados pós-operatórios, o tamanho da incisão e o grau de exposição óssea quando comparados com outros métodos citados na literatura.Due to the great number of distal diaphyseal and metaphyseal radio and ulna fractures in small animals and high cost of orthopedical implants recommended in literature, the study of new methods of stabilization for reducing inherent inconveniences to such techniques and costs of orthopedical surgeries was necessary. For such objective, an internal immobilization method of the radio with a single intramedullary pin complemented by a double interfragmentary hemicerclage in X (10 animals and the method of placement of an intramedullary pin in the radio and another in the ulna (7 animals, were tested in 17 animals (15 canine and 2 felines, thus trying, to block all forces present in the fracture focus. These methods, demonstrated to be surgically viable, diminishing costs, anesthesic period, frequency of aid after surgery, incision size and degree of

  5. Results of percutaneous fixation and distal radius core decompression in scaphoid waist non-unions treated without grafting.

    Science.gov (United States)

    Dedeoğlu, S S; İmren, Y; Çabuk, H; Tekin, A C; Türe, Y C; Gürbüz, H

    2018-02-01

    Scaphoid non-union management is still a challenge in clinical practice for orthopaedic surgeons. Though several treatment methods have been described, there is an ongoing debate about optimum management. Based on new concepts about avascular conditions, promising results were reported with metaphyseal decompression of the distal radius by increasing the vascularization of the radial column of the carpus. We aimed to evaluate the clinical, radiological, and functional outcomes of distal radius core decompression and fixation with palmar percutaneous cannulated compression screws without grafting in patients with scaphoid waist fracture non-union. Twenty-nine patients with scaphoid non-union were included in this prospective study. There were 27 male and 2 female patients with an average age of 29 years (range 18-45 years). Mean time from the injury to surgery was 18.3 months. The Slade and Geissler classification was used to classify the non-unions. Wrist range of motion (ROM), pain based on a visual analog scale (VAS), and the Mayo wrist score were used to assess the clinical outcomes. Postoperative radiographs and CT-scans were reviewed to assess fracture union, carpal alignment and screw position. The average clinical follow-up was 76 weeks (range: 74-87 weeks) postoperatively. Mean time to union was 11 weeks (range: 7-18 weeks). There was no humpback/no DISI in any of the cases. Twenty-six patients healed successfully with no additional procedures. Three patients with failed union underwent revision surgery with grafting. At the final follow-up, average wrist ROM was 61° (range: 30-80) in extension and 61° (range: 35-80) in flexion, the average Mayo wrist score was 66±20 (range: 20-90), and the mean VAS was 2±2 (range: 0-7). Percutaneous fixation without grafting associated with distal radius core decompression can provide satisfactory outcomes in surgical management of scaphoid non-unions. II. Copyright © 2017 SFCM. Published by Elsevier Masson SAS. All

  6. Fossil hominin ulnae and the forelimb of Paranthropus.

    Science.gov (United States)

    McHenry, Henry M; Brown, Cassandra C; McHenry, Lindsay J

    2007-10-01

    The discovery of Pan in the Middle Pleistocene deposits of the Kapthurin Formation of the Tugen Hills (McBrearty and Jablonski: Nature 437 (2005) 105-108) inspires new interest in the search for other chimpanzee fossils in the East African Rift Valley. Craniodental evidence of an eastward excursion of chimpanzee populations in the Plio-Pleistocene goes undetected in other hominin sites, but one enigmatic postcranial fossil, the Olduvai Hominid 36 ulna, has many chimp-like features. Analyses by Aiello et al. (Aiello et al.: Am J Phys Anthropol 109 (1999) 89-110) reveal that it is similar to extant Pan in some respects, but it also has unique traits not seen in other hominoid species. They refer it to Paranthropus boisei. In this study, we reassess the affinities of OH 36 using a different data set that includes more recently discovered hominin fossils including those attributed to Paranthropus. Despite its superficial resemblance to modern Pan, our results agree with those of Aiello et al. (Aiello et al.: Am J Phys Anthropol 109 (1999) 89-110) that OH 36 is distinctly different from modern chimpanzees. By default, it is reasonable to assign this specimen to P. boisei, but it is not at all similar to other ulnae referred to this genus. Ulnae attributed to Paranthropus from South Africa, Kenya, and Ethiopia are morphologically more heterogeneous than those within species of large-bodied Hominoidea. Although there are many apparent shared derived traits justifying a monophyletic Paranthropus clade, most if not all of these traits are related to a single functional complex (hypermastication) that may have evolved in parallel and thereby constituting a paraphyletic group of species. (c) 2007 Wiley-Liss, Inc.

  7. Morphological and taxonomic affinities of the Olduvai ulna (OH 36).

    Science.gov (United States)

    Aiello, L C; Wood, B; Key, C; Lewis, M

    1999-05-01

    The OH 36 ulna derives from Upper Bed II in the Olduvai Gorge, and is dated to circa 1.1-1.2 Myr. Multivariate analyses incorporating data from samples of modern humans, common and pygmy chimpanzees, gorillas, orangutans, and two other early hominin ulnae, Omo L40-19 and KNM-BK 66, suggest that OH 36 belonged to an individual with powerful forearms consistent with a locomotor repertoire that included arboreal locomotion. However, there is no compelling evidence that it made regular use of its forelimbs as supports when travelling on the ground. When compared with levels of intra- and intertaxon size and shape variation in the comparative sample (humans, chimpanzees, gorillas), the differences between OH 36, KNM-BK 66, and Omo L40-19 are compatible with OH 36 differing from the other two fossil hominin ulnae to the extent that modern humans differ from modern great apes. KNM-BK 66 and Omo L40-19 differ from each other in overall size and shape only to the degree that would be expected within any of the individual modern comparative samples. Based on these analyses, there is no evidence to support the hypothesis that OH 36 and Omo L40-19 belong to the same species of fossil hominin, or to two species that shared a similar forelimb locomotor repertoire. We suggest that OH 36 has the greater claim to be assigned to Paranthropus boisei, and we recommend that for the time being the latter be referred to the tribe Hominini gen. et sp. indet. The surprising result of these analyses is the overall size and shape similarity between Omo L40-19 and KNM-BK 66, two fossils that are separated in time by more than 1.5 million years, and which have traditionally been assumed to represent hominin species with quite different locomotor patterns.

  8. Impact of simulated reduced alveolar bone support, increased tooth mobility, and distal post-supported, root-treated abutment tooth on load capability of all-ceramic zirconia-supported cantilever FDP.

    Science.gov (United States)

    Naumann, M; von Stein-Lausnitz, M; Rosentritt, M; Walter, C; Meyer-Lückel, H; Sterzenbach, G

    2018-02-06

    The aim of this in vitro study was an analysis of the impact of simulated reduced alveolar bone support and post-restored, endodontically treated distal abutment tooth on load capability of all-ceramic zirconia-based cantilever-fixed dental prosthesis (CFDP). The roots of human lower sound premolars (n = 80) were divided into five experimental groups to be restored with all-ceramic zirconia-supported three-unit CFDP regarding bone loss (BL) relative to the cement-enamel junction (CEJ): 2 mm below CEJ = 0% BL (control group), group 25% distal BL, group 50% distal BL, group 50% mesial and distal BL, and group 50% distal BL and adhesive post-supported restoration. Specimens were exposed to simulated clinical function by thermo-mechanical loading (6.000 cycles 5°-55°; 1.2 × 10 6 cycles 0-50 N) and subsequent linear loading until failure. Tooth mobility increased significantly for groups with simulated bone loss (p tooth fractures at distal abutment teeth, whereas technical failures were more frequent in the control group (p = 0.024). Differences of alveolar bone support and respectively increased tooth mobility between mesial and distal abutments did not influence load capability. A distal adhesively post-and-core-supported, root-treated abutment tooth did not increase risk of three-unit CFDP failure. CFDPs are a treatment option used with caution when reduced alveolar bone support, increased tooth mobility, and distal post-supported, root-treated abutment teeth are involved.

  9. Treatment of diaphyseal non-unions of the ulna and radius.

    Science.gov (United States)

    Kloen, Peter; Wiggers, Jim K; Buijze, Geert A

    2010-12-01

    Non-unions of the forearm often cause severe dysfunction of the forearm as they affect the interosseus membrane, elbow and wrist. Treatment of these non-unions can be challenging due to poor bone stock, broken hardware, scarring and stiffness due to long-term immobilisation. We retrospectively reviewed a large cohort of forearm non-unions treated by using a uniform surgical approach during a period of 33 years (1975-2008) in a single trauma centre. All non-unions were managed following the AO-principles of compression plate fixation and autologous bone grafting if needed. The study cohort consisted of 47 patients with 51 non-unions of the radius and/or ulna. The initial injury was a fracture of the diaphyseal radius and ulna in 22 patients, an isolated fracture of the diaphyseal ulna in 13, an isolated fracture of the diaphyseal radius in 5, a Monteggia fracture in 5, and a Galeazzi fracture-dislocation of the forearm in 2 patients. Index surgery for non-union consisted of open reduction and plate fixation in combination with a graft in 30 cases (59%), open reduction and plate fixation alone in 14 cases (27%), and only a graft in 7 cases (14%). The functional result was assessed in accordance to the system used by Anderson and colleagues. Average follow-up time was 75 months (range 12-315 months). All non-unions healed within a median of 7 months. According to the system of Anderson and colleagues, 29 patients (62%) had an excellent result, 8 (17%) had a satisfactory result, and 10 (21%) had an unsatisfactory result. Complications were seen in six patients (13%). Our results show that treatment of diaphyseal forearm non-unions using classic techniques of compression plating osteosynthesis and autologous bone grafting if needed will lead to a high union rate (100% in our series). Despite clinical and radiographic bone healing, however, a substantial subset of patients will have a less than optimal functional outcome.

  10. A Prospective Study of Distal Metatarsal Chevron Osteotomies with K-Wire Fixations to Treat Hallux Valgus Deformities

    Science.gov (United States)

    Baig, Usman; Tariq, Ali; Din, Robert

    2017-01-01

    Introduction Hallux valgus is one of the most common forefoot deformities worldwide. Females are affected more often than males. The three most common clinical symptoms are the painful bunion, transfer metatarsalgia, and hammer or claw toes. Methods This case series consisted of 20 patients who had chevron osteotomy from January 2015 to January 2016. The clinical assessment was measured by The American Orthopedic Foot and Ankle Score (AOFAS), and radiologic assessment was determined by preoperative and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA). Results The patients’ mean age was 56 years. Out of 20 patients, 19 were female, and one was male. The mean AOFAS improved from 51 preoperatively to 82 postoperatively. The HVA improved from 26° preoperatively to 14°. There were five complications including four Kirschner (K)-wire complications. Conclusion Distal chevron osteotomy is a reliable and time-tested procedure. The K-wire fixation has a relatively high complication rate. We planned to use other methods of fixation and then compared them with K-wires fixation results for future studies. PMID:29167752

  11. A Prospective Study of Distal Metatarsal Chevron Osteotomies with K-Wire Fixations to Treat Hallux Valgus Deformities.

    Science.gov (United States)

    Baig, M N; Baig, Usman; Tariq, Ali; Din, Robert

    2017-09-20

    Introduction Hallux valgus is one of the most common forefoot deformities worldwide. Females are affected more often than males. The three most common clinical symptoms are the painful bunion, transfer metatarsalgia, and hammer or claw toes. Methods This case series consisted of 20 patients who had chevron osteotomy from January 2015 to January 2016. The clinical assessment was measured by The American Orthopedic Foot and Ankle Score (AOFAS), and radiologic assessment was determined by preoperative and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA). Results The patients' mean age was 56 years. Out of 20 patients, 19 were female, and one was male. The mean AOFAS improved from 51 preoperatively to 82 postoperatively. The HVA improved from 26° preoperatively to 14°. There were five complications including four Kirschner (K)-wire complications. Conclusion Distal chevron osteotomy is a reliable and time-tested procedure. The K-wire fixation has a relatively high complication rate. We planned to use other methods of fixation and then compared them with K-wires fixation results for future studies.

  12. Imaging of the Proximal and Distal Radioulnar Joints.

    Science.gov (United States)

    Ehman, Eric C; Felmlee, Joel P; Frick, Matthew A

    2015-08-01

    The proximal and distal radioulnar joints form a unique articular arrangement between the radius and ulna, allowing pivot motion of the forearm and positioning the hand in space. Typically imaged in conjunction with the elbow, radiographs, computed tomography (CT), and MR imaging of the proximal radioulnar joint contribute unique diagnostic information. Because dysfunction of the distal radioulnar joint is often a result of instability, dynamic CT protocols stressing the joint in addition to anatomic imaging with radiographs and MR imaging is valuable. Detailed knowledge of the patient's clinical condition and careful selection of imaging protocols will maximize the benefits. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Three-dimensional analysis of deformities of the radius and ulna in congenital proximal radioulnar synostosis.

    Science.gov (United States)

    Nakasone, Motoko; Nakasone, Satoshi; Kinjo, Masaki; Murase, Tsuyoshi; Kanaya, Fuminori

    2018-01-01

    We reconstructed three-dimensional images of radius and ulna in 38 forearms of 25 patients with congenital proximal radioulnar synostosis from their computed tomographic studies. We also analysed correlations between the deformities of radius and ulna and degrees of fixed pronation of these forearms. The average ulnar deviation, flexion and internal rotation deformities of the radius were 6°, 3° and 18°, respectively. The average radial deviation, extension and internal rotation deformities of the ulna were 3°, 4° and 30°, respectively. The flexion deformity of the radius and the internal rotation deformity of the radius and ulna were correlated significantly with degree of fixed pronation. We conclude that the patients with congenital proximal radioulnar synostosis have remarkable flexion deformity of the radius and internal rotation deformity of the radius and ulna, which might impede forearm rotation after corrective surgery in the proximal part of the forearm.

  14. Fracture severity of distal radius fractures treated with locking plating correlates with limitations in ulnar abduction and inferior health-related quality of life

    Directory of Open Access Journals (Sweden)

    Tsitsilonis, Serafim

    2016-07-01

    Full Text Available Introduction/background: The operative treatment of distal radius fractures has significantly increased after the introduction of locking plates. The aim of the present study was the evaluation of health-related quality of life, functional and radiological outcome of patients with distal radius fractures treated with the locking compression plate (LCP.Materials and methods: In the present study 128 patients (130 fractures that were operatively treated with the LCP (2.4 mm/3.5 mm, Synthes were retrospectively evaluated. Mean follow-up was (SD 10.6. The fractures were radiographically evaluated (radial inclination, palmar tilt, ulnar variance pre-, postoperatively and at the last follow-up visit. Range of motion (ROM was documented. Grip strength was assessed with the use of a JAMAR dynamometer. The score for disabilities of the arm, shoulder and hand (DASH and the Gartland-Werley score (GWS were evaluated. Health-associated quality of life was assessed with use of SF-36 Health Survey.Results: Postoperative reduction was excellent; at the last follow-up visit only minimal reduction loss was observed. Except for pronation, a statistically significant decrease of ROM was present; in most cases that was not disturbing for the patients. The injured side achieved 83.9% of grip strength of the intact side. Mean DASH was 18.9 and mean GWS was 3.5. Health-associated quality of life was generally not compromised. However, limitations in ulnar abduction correlated with inferior quality of life. Fracture severity correlated with inferior quality of life, despite the absence of correlation with the functional and radiological outcome. Complication rate was low.Conclusions: Fracture severity seems to affect ulnar abduction and therefore patient quality of life, despite almost anatomical reduction; the objective and subjective scores were in most cases excellent. Modern everyday activities, such as keyboard typing, could be associated with the present results.

  15. Distal radioulnar joint: functional anatomy, including pathomechanics.

    Science.gov (United States)

    Haugstvedt, J R; Langer, M F; Berger, R A

    2017-05-01

    The distal radioulnar joint allows the human to rotate the forearm to place the hand in a desired position to perform different tasks, without interfering with the grasping function of the hand. The ulna is the stable part of the forearm around which the radius rotates; the stability of the distal radioulnar joint is provided by the interaction between ligaments, muscles and bones. The stabilizing structures are the triangular fibrocartilage complex, the ulnocarpal ligament complex, the extensor carpi ulnaris tendon and tendon sheath, the pronator quadratus, the interosseous membrane and ligament, the bone itself and the joint capsule. The purpose of this review article is to present and illustrate the current understanding of the functional anatomy and pathomechanics of this joint.

  16. A Misdiagnosis of Traumatic Hypersupination of the Distal Radioulnar Joint: A Case Report

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    Vipin Asopa

    2013-01-01

    Full Text Available Traumatic hypersupination injury of the distal radioulnar joint is a rare injury, and occurs when sufficient supination force is applied to the joint so as to tear the volar radioulnar ligament, resulting in separation of the triangular fibrocartilage complex, and subluxation of the tendon of extensor carpi ulnaris. This allows the distal ulna to rotate such that the ulnar styloid comes to lie adjacent to the ulna notch of the radius. Treatment of this injury requires manipulation of the joint, under anaesthesia or sedation. We describe a case where posttraumatic radiological investigation of a patient with an anatomical variation of the wrist when in supination resembled a traumatic hypersupination injury of the distal radioulnar joint. A review of the literature has revealed this to be the first reported case of this type.

  17. STRESS FRACTURE OF THE ULNA IN A BREAK-DANCER

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    Yu-Hsu Chen

    2008-12-01

    Full Text Available Break dancing is a popular activity in teenagers and is associated with severe trauma to bones and tissues. We report the first known case of a break dancer with an ulnar stress fracture. Such injuries occur in a variety of sports due to substantial stress on the ulna and repetitive excessive rotation of the forearm. In this study we describe a patient who experienced an ulnar stress fracture during break dancing training. The diagnosis was established by history and physical examination. Initial radiographic findings were negative. However, radiographs taken 3 months after initial presented revealed callus formation over the ulnar shaft. This suggested that readjustment is required in break dancing training protocols. It is important to increase awareness of this injury among physicians to expedite the diagnosis and to prevent the possibility of conversion to an overt fracture in the future

  18. Stress Fracture of the Ulna in an Elite Ice Dancer

    Directory of Open Access Journals (Sweden)

    Davide Tornese

    2015-03-01

    Full Text Available Stress fracture of the ulna is a rare overuse injury often arising from repetitive excessive forearm rotation. Here we report the first case of ulnar stress fracture in a female ice dancer. Diagnosis was made by history and physical examination, with the aid of imaging studies (plain x-ray, computed tomography, and magnetic resonance imaging, and biomechanical analysis of forearm pronation and supination. Following identification and modification of the causal technical element, the ice dancer was able to continue training and competing without cessation of activity. Treatment was with a 30-day course of capacitively coupled bone stimulation to promote fracture healing, confirmed on radiography and magnetic resonance imaging. Such injuries to ice dancers may be prevented at the planning stage of technical elements in the dance program if coaches place more attention on the potentially deleterious effects of difficult positions the lifted dancer must sustain to reward points on the technical elements score.

  19. Clinical evaluation of a mini locking plate system for fracture repair of the radius and ulna in miniature breed dogs.

    Science.gov (United States)

    Kang, Byung-Jae; Ryu, Hak-Hyun; Park, Sungsu; Kim, Yongsun; Kweon, Oh-Kyeong; Hayashi, Kei

    2016-11-23

    To retrospectively evaluate the effectiveness of a novel 1.2 mm mini locking plate system in treating fractures of the radius and ulna in miniature breed dogs. Medical records and radiographs of miniature breed dogs with fractures treated with a 1.2 mm mini locking plate system were reviewed. The inclusion criteria were: body weight of 2.5 kg or less, transverse or short oblique fracture of the radius and ulna, and treatment with a mini locking plate system as the sole method of fixation. For each patient, data including signalment, time to radiographic union, use of bone graft or other agents, and previous repair attempts were recorded. The outcome and complications were determined from clinical and radiographic follow-up examinations. Fourteen cases with a mean radial width of 4.5 mm (± 0.8 mm) were included into this study. The fractures healed without failure of fixation in all cases. Mean time to adequate radiographic union was 8.4 weeks (± 2.6 weeks). Major complications were not seen in any of the cases, and minor complications occurred in three of the cases. Limb function was graded as 'normal' in 10 cases and 'occasional lameness' in four cases. The mini locking system evaluated in this study was an effective treatment method for radial and ulnar fractures in miniature breed dogs with a radial width smaller than 5.5 mm.

  20. [The Effect of Activation of the Shoulder Girdle Muscles on Functional Outcomes of Rehabilitation in Patients with Surgically Treated Distal Radius Fractures].

    Science.gov (United States)

    Jančíková, V; Opavský, J; Dráč, P; Krobot, A; Čižmář, I

    2017-01-01

    PURPOSE OF THE STUDY The aim of the study was to assess the functional outcomes of rehabilitation in patients with surgically treated distal radius fractures in the early postoperative period. We compared the functional outcomes of patients undergoing standard rehabilitation with the group of patients whose postoperative rehabilitation was extended with shoulder girdle exercises of the affected upper limb while the wrist was immobilized. Several indices and variables were used for the assessment of the functional therapeutic outcomes of the affected wrist. MATERIAL AND METHODS Forty patients (32 females and 8 males, the mean age 60.5 years) with distal radius fractures treated by internal fixation using volar surgical approach were involved in the study between 2013-2016. The tested subjects were randomized and split into two groups according to the selected method of rehabilitation. The tested subjects with standard rehabilitation extended with shoulder girdle muscles activation were labelled as group I. It included patients (n = 20) of the mean age 59.8 (age range 42-73 years) with immobilized wrist (i.e. for 3-4 weeks) performing shoulder girdle muscles exercises at the same time. Furthermore, standard kinesiotherapy continued after their fixation was removed. The other tested group, labelled as group II (n = 20), the mean age 61.3 (variation 40-74 years of age) involved patients with distal radius fractures. Only standard rehabilitation was performed in this group as late as their forearm fixation was removed. The following indices and parameters were assessed in the early postoperative period (i.e. by 8 weeks after the fixation removal): wrist and fingers range of motion (ROM), hand grip strength (dynamometry), local swelling, pain, scores of a nine hole peg test (NHPT), and a DASH score. RESULTS After the fixation had been removed, the group I reported statistically significantly higher values of movement compared to the values of the contralateral limb in

  1. The outcome of conservative treatment of adult distal radius fractures compared with the other wrist: radiological and functional evaluation

    Directory of Open Access Journals (Sweden)

    Mustafa Uslu

    2014-09-01

    Full Text Available Objective: This study was designed to evaluate anatomical and functional results of closed reduction-long arm cast treatment for distal radius fractures and compared other healthy wrist in the adults. Methods: 77 patients with distal radius fracture were treated conservatively between January 2010 and December 2010. The fractures were classified according to AO and Frykman classification system and investigated prospectively. The radiological and anatomical results were assessed by the Stewart score criteria. The functional results were assessed by Quick-Disability of Arm, Shoulder and Hand questionnaire (Q-DASH and the Stewart II score criteria. The mean follow-up of patients was 12 months. Results: The forty patients had right wrist fractured, 37 patients had left wrist fractured. According to Frykman classification 46 patients were type I-II fractured, according to AO classification 59 patients were type 23,A2,1 and 23,A2,2 fractured. According to Stewart the radiological and anatomical, the result were excellent in 57, good in 17, fair in 3. According to Stewart II functional criteria, the results were assessed excellent in 57, good in 8, fair in 12 The mean Q-DASH score was 6,37. The overall complication rate was 12.98%. Mild Carpal tunnel syndrome was observed in the two patients, ulna styloid nonunion in the four patients, pain of distal radioulnar joint in the one patient, mild carpal tunnel syndrome and tenderness of distal radioulnar joint in the three patients. Conclusion: Closed reduction and cast immobilization is still an effective and inexpensive treatment method in distal radial fractures. J Clin Exp Invest 2014; 5 (3: 403-409

  2. Complex fracture-dislocations of the proximal ulna and radius in adults: a comprehensive classification.

    Science.gov (United States)

    Giannicola, Giuseppe; Greco, Alessandro; Sacchetti, Federico Maria; Cinotti, Gianluca; Nofroni, Italo; Postacchini, Franco

    2011-12-01

    Complex fracture-dislocations of the proximal ulna and radius include multiple anatomic lesions, the management of which is known to be demanding. Although several classifications have been proposed, none appear to be exhaustive, and most of them have neither therapeutic nor prognostic value. The purpose of this study was to design a comprehensive classification that may provide a guide for the operative management of these injuries. The classification is aimed at identifying definite anatomic lesions, called the "main lesions," the presence of which can affect the prognosis and require peculiar treatments. The main lesions include (1) ulnar fracture (including its location with respect to the insertion of collateral ligaments and coronoid fracture), (2) radiohumeral dislocation, (3) proximal radioulnar dislocation, (4) radial fracture, (5) distal radioulnar joint and interosseous membrane lesion, and (6) humeral-ulnar dislocation. Intraobserver and interobserver reliability was assessed in 25 complex fracture-dislocations. Standard radiographs and computed tomography scans were analyzed by 3 independent observers. The main lesions were labeled by an alphanumeric system. Numbers 1 through 6 identified the type of ulnar fracture, and letters A through E indicated the dislocated joint or presence of a radial fracture. The direction of dislocation and the type of radial fracture were identified by Roman numerals, from I to III, placed after the letter. A κ value of 0.873 or greater resulted from intraobserver and interobserver evaluation. We created a comprehensive classification of complex fracture-dislocations of the elbow. The classification appeared to be reproducible and may represent a useful tool for the management of such difficult injuries. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  3. RESULT OF PRE-CONTOURED DISTAL RADIUS INDIAN LOCKING PLATES IN DISTAL RADIUS FRACTURE

    OpenAIRE

    Shaleen; Baljit; Aditya; Parminder; Simarpreet S

    2014-01-01

    BACKGROUND: Fractures of the distal radius are common, open reduction and internal fixation using an interlocking plate system has gained popularity for the treatment of dorsally displaced distal radius fractures. The aim of the study was to assess how adequately distal radial fracture reduction was reproduced and maintained with the pre-contoured distal radius Indian locking plates and to evaluate the functional and radiological results of treating unstable distal radius ...

  4. Stress fracture of the ulna in an elite ice dancer.

    Science.gov (United States)

    Tornese, Davide; Curci, Domenico; Nardo, Alice; Cuccia, Alessandra; Pozzi, Grazia

    2015-03-01

    Stress fracture of the ulna is a rare overuse injury often arising from repetitive excessive forearm rotation. Here we report the first case of ulnar stress fracture in a female ice dancer. Diagnosis was made by history and physical examination, with the aid of imaging studies (plain x-ray, computed tomography, and magnetic resonance imaging), and biomechanical analysis of forearm pronation and supination. Following identification and modification of the causal technical element, the ice dancer was able to continue training and competing without cessation of activity. Treatment was with a 30-day course of capacitively coupled bone stimulation to promote fracture healing, confirmed on radiography and magnetic resonance imaging. Such injuries to ice dancers may be prevented at the planning stage of technical elements in the dance program if coaches place more attention on the potentially deleterious effects of difficult positions the lifted dancer must sustain to reward points on the technical elements score. Key pointsThe technical elements in ice dancing can overload joints and bones due to the positions held by the skaters.To project a competition program as much as possible safe regarding overuse injury prevention an accurate knowledge of physiological parameters of the ice dancer and of ISU rules is necessary.

  5. The shaft fractures of the radius and ulna in children: current concepts.

    Science.gov (United States)

    Sinikumpu, Juha-Jaakko; Serlo, Willy

    2015-05-01

    The incidence of forearm shaft fractures in children has increased in recent years. They are challenging to treat and they can result in several long-lasting complications. The treatment of children's fractures needs to be individualized to their needs. Nonoperative care will be satisfactory for young, preschool children and it is primarily treatment in stable fractures of children at every age. Injury mechanism must be understood to perform appropriate closed reduction. Immobilization using a long-arm cast needs to be focused against the deforming muscle forces - in particular those that rotate - in the forearm, keeping the bones in alignment until bone healing. Operative stabilization by elastic stable intramedullary nailing is the primarily method of treatment in cases of unstable fractures, in particular, in children between preschool age and adolescence. For older children near to skeletal maturity, a rigid plate and screw fixation will be justified. The most common complication after closed treatment is worsening of the alignment and need for repetitive interventions. elastic stable intramedullary nailing results usually in good outcome, and range of forearm rotation is the main feature determining the clinical result. In this article, we report the current concept of paediatric shaft fractures in the radius and ulna.

  6. [Pseudarthrosis following surgically treated forearm fractures in children and adolescents].

    Science.gov (United States)

    Fernandez Fernandez, F; Langendörfer, M; Wirth, T; Eberhardt, O

    2013-08-01

    Due to the changing attitude of treating paediatric forearm fractures increasingly towards the surgical stabilisation rather than conservatively by the method of elastic stable intramedullary nailing (ESIN), we are confronted with complications which have not been described in childhood previously. Pseudarthrosis following surgically treated forearm fractures in children is only found in single reports with none in the German-speaking area. The goal of this study is to define predisposing factors which may lead to pseudarthrosis after surgery for forearm fractures. From 1990 to 2011 all children having sustained a pseudarthrosis following forearm fractures treated in our institution were included. All children who did not demonstrate a complete consolidation of the forearm fractures after 6 months from injury were considered for the study. Those pseudarthroses which were caused through systemic diseases were excluded. During the time period of 21 years, fourteen children were treated who fulfilled the criteria of having a pseudarthrosis. Nine of the fourteen children had primarily been treated in an outside hospital, five in our institution. The average age was 10.8 years (7-15 years). There were thirteen ulnar shaft and one radius shaft pseudarthroses. In 11 children the pseudarthrosis was located in the middle third and there was one child each with a pseudarthrosis in the proximal and distal third of the ulna. There were 13 ulnar shaft fractures and one monteggia lesion. Twelve of the fractures were primarily closed and there were two open cases. In nine cases an open reduction of the ulna was necessary, the radius was openly reduced in four patients. In five children technical mistakes of the osteosynthesis were identified to contribute to the formation of the pseudarthrosis. Five of the 14 children had experienced a re-fracture. Nine children had revision surgery. These children were treated by plate osteosynthesis or ESIN. In five patients the pseudarthrosis

  7. Radiological dorsal tilt analysis of AO type A, B, and C fractures of the distal radius treated conservatively or with extra-focal K-wire plus external fixateur

    Energy Technology Data Exchange (ETDEWEB)

    Hoffmann, Michael [University Medical Center Hamburg-Eppendorf, Department of Trauma, Hand and Reconstructive Surgery, Hamburg (Germany); Borders General Hospital, Department for Trauma and Orthopaedic Surgery, Melrose, Roxburghshire, Scotland (United Kingdom); Schroeder, Malte; Gruber-Rathmann, Michaela; Ruecker, Andreas H. [University Medical Center Hamburg-Eppendorf, Department of Trauma, Hand and Reconstructive Surgery, Hamburg (Germany); Kossow, Kai [Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg (Germany)

    2012-09-15

    Fractures of the distal radius are amongst the most common injury patterns. The dorsal tilt represents an important co-factor determining functional outcome. The purpose of this study was to analyze the radiological dorsal tilt and identify critical time frames in conservative and operative treatment of distal radius fractures. Eighty-seven conservatively treated (hematoma block assisted reduction and splinting) and 37 operatively treated (reduction, extra-focal K-wire fixation, bridging external fixateur) AO type A, B, and C fractures of the distal radius in 124 females were retrospectively analyzed. The dorsal tilt at the initial, post-reduction, and 2 weeks post-reduction stages was correlated with the final radiographic outcome at 6 weeks. Mean initial dorsal tilt was 16.53 in the conservatively treated group and 26.76 in the operatively treated group. Mean dorsal tilt after 6 weeks showed significant differences from the mean initial dorsal tilt at time of presentation within both groups (both groups p < 0.000). No significant differences between the two groups were found after 6 weeks of treatment (p = 0.194) regardless of the underlying AO fracture type. Conservatively treated radius fractures showed a significantly higher slip rate within the first 2 weeks (primary slip rate), whereas the operative group presented a significantly higher slip rate between the 2-week and 6-week radiographic checks (secondary slip rate). In terms of dorsal tilt, conservative (cast immobilization) and operative (K-wire fixation plus external fixateur) treatment demonstrated no significant differences at the final radiographic examination (6 weeks) regardless of the underlying AO fracture type. Both treatment groups showed treatment-associated different primary and secondary slip rates, indicating a need for more frequent radiographic checks within these critical time frames. (orig.)

  8. Use of a long distally fixed intramedullary stem to treat a periprosthetic femoral fracture following total hip arthroplasty using a thrust plate hip prosthesis: A case report

    OpenAIRE

    Hatanaka, Hiroyuki; Motomura, Goro; Ikemura, Satoshi; Sonoda, Kazuhiko; Kubo, Yusuke; Utsunomiya, Takeshi; Yamamoto, Takuaki; Nakashima, Yasuharu

    2017-01-01

    Introduction: The thrust plate hip prosthesis (TPP; Zimmer, Winterthur, Switzerland) is a hip prosthesis that is no longer in production. Few reports have focused on periprosthetic fractures following total hip arthroplasty (THA) with the use of a TPP. Presentation of case: We report a 57-year-old woman with a periprosthetic femoral fracture 13 years after THA with the use of a TPP. A plain radiograph showed a displaced subtrochanteric fracture of the right femur just below the distal tip ...

  9. Use of a long distally fixed intramedullary stem to treat a periprosthetic femoral fracture following total hip arthroplasty using a thrust plate hip prosthesis: A case report.

    Science.gov (United States)

    Hatanaka, Hiroyuki; Motomura, Goro; Ikemura, Satoshi; Sonoda, Kazuhiko; Kubo, Yusuke; Utsunomiya, Takeshi; Yamamoto, Takuaki; Nakashima, Yasuharu

    2017-01-01

    The thrust plate hip prosthesis (TPP; Zimmer, Winterthur, Switzerland) is a hip prosthesis that is no longer in production. Few reports have focused on periprosthetic fractures following total hip arthroplasty (THA) with the use of a TPP. We report a 57-year-old woman with a periprosthetic femoral fracture 13 years after THA with the use of a TPP. A plain radiograph showed a displaced subtrochanteric fracture of the right femur just below the distal tip of the lateral plate without implant loosening. She underwent revision surgery with a long distally fixed intramedullary stem in conjunction with a plate and cable system. Three months after surgery, bone union was confirmed using radiography and the patient was clinically asymptomatic. We encountered three major problems while planning surgical treatment, these being, discontinuation of the TPP system, loss of proximal femoral cancellous bone, and difficulties with the type of subtrochanteric fracture. After considering these problems, we planned revision surgery using a long distally fixed intramedullary stem in conjunction with a plate and cable system. This case shows that sufficient implant preparation based on precise preoperative planning is necessary to obtain good clinical results for the surgical treatment of periprosthetic femoral fractures following THA with the use of a TPP. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  10. Nonunion of Fractures of the Ulna and Radius Diaphyses: Clinical and Radiological Results of Surgical Treatment

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    Boussakri H

    2016-07-01

    Full Text Available Aseptic nonunion of the radius and ulna is a major complication of forearm fractures, accounting for 2% to 10% of all forearm fractures. The aim of our study is to evaluate the functional and radiological results of surgical treatment of diaphyseal aseptic nonunion of the radius and ulna, with autologous bone grafting, decortication and internal plate fixation. A series of 21 patients (26 nonunions was retrospectively reviewed, the average age was 35 years with a mean of 31,58 years (range 12-44 years . The fractures included isolated radius (n=6 and ulna (n=10, and both radius and ulna (n=5. The Grace and Eversmann score was used to evaluate our results. Fifteen had very good results, five good and one average. Consolidation of the two bones was attained in 6.2 months. Therefore, the functional prognosis of the upper limb imposes the need for an adequate treatment. This management strategy has enabled us to have satisfactory results. However, the best treatment of nonunion remains the preventive treatment with an optimal management and care of the forearm fractures.

  11. A modified rabbit ulna defect model for evaluating periosteal substitutes in bone engineering: a pilot study

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    Rania M El Backly

    2015-01-01

    Full Text Available The present work defines a modified critical size rabbit ulna defect model for bone regeneration in which a non-resorbable barrier membrane was used to separate the radius from the ulna to create a valid model for evaluation of tissue-engineered periosteal substitutes. Eight rabbits divided into two groups were used. Critical defects (15 mm were made in the ulna completely eliminating periosteum. For group I, defects were filled with a nanohydroxyapatite poly(ester urethane scaffold soaked in PBS and left as such (group Ia or wrapped with a tissue-engineered periosteal substitute (group Ib. For group II, an e-PTFE (GORE-TEX® membrane was inserted around the radius then the defects received either scaffold alone (group IIa or scaffold wrapped with periosteal substitute (group IIb. Animals were euthanized after 12-16 weeks, and bone regeneration was evaluated by radiography, computed microtomography (µCT, and histology. In the first group, we observed formation of radio-ulnar synostosis irrespective of the treatment. This was completely eliminated upon placement of the e-PTFE (GORE-TEX® membrane in the second group of animals. In conclusion, modification of the model using a non-resorbable e-PTFE membrane to isolate the ulna from the radius was a valuable addition allowing for objective evaluation of the tissue-engineered periosteal substitute.

  12. A Modified Rabbit Ulna Defect Model for Evaluating Periosteal Substitutes in Bone Engineering: A Pilot Study

    Science.gov (United States)

    El Backly, Rania M.; Chiapale, Danilo; Muraglia, Anita; Tromba, Giuliana; Ottonello, Chiara; Santolini, Federico; Cancedda, Ranieri; Mastrogiacomo, Maddalena

    2014-01-01

    The present work defines a modified critical size rabbit ulna defect model for bone regeneration in which a non-resorbable barrier membrane was used to separate the radius from the ulna to create a valid model for evaluation of tissue-engineered periosteal substitutes. Eight rabbits divided into two groups were used. Critical defects (15 mm) were made in the ulna completely eliminating periosteum. For group I, defects were filled with a nanohydroxyapatite poly(ester urethane) scaffold soaked in PBS and left as such (group Ia) or wrapped with a tissue-engineered periosteal substitute (group Ib). For group II, an expanded-polytetrafluoroethylene (e-PTFE) (GORE-TEX®) membrane was inserted around the radius then the defects received either scaffold alone (group IIa) or scaffold wrapped with periosteal substitute (group IIb). Animals were euthanized after 12–16 weeks, and bone regeneration was evaluated by radiography, computed microtomography (μCT), and histology. In the first group, we observed formation of radio-ulnar synostosis irrespective of the treatment. This was completely eliminated upon placement of the e-PTFE (GORE-TEX®) membrane in the second group of animals. In conclusion, modification of the model using a non-resorbable e-PTFE membrane to isolate the ulna from the radius was a valuable addition allowing for objective evaluation of the tissue-engineered periosteal substitute. PMID:25610828

  13. Geometrical adaptation in ulna and radius of cerebral palsy patients: measures and consequences

    NARCIS (Netherlands)

    de Bruin, M.; van de Giessen, M.; Vroemen, J. C.; Veeger, H. E. J.; Maas, M.; Strackee, S. D.; Kreulen, M.

    2014-01-01

    The presence of significant forearm bone torsion might affect planning and evaluating treatment regimes in cerebral palsy patients. We aimed to evaluate the influence of longstanding wrist flexion, ulnar deviation, and forearm pronation due to spasticity on the bone geometries of radius and ulna.

  14. Inter- and intrarater reliability of ulna variance versus lunate subsidence measurements in Madelung deformity.

    Science.gov (United States)

    Farr, Sebastian; Bae, Donald S

    2015-01-01

    To assess inter- and intrarater reliability of both ulna variance and lunate subsidence measurement methods in a large consecutive series of children with Madelung deformity. Ulnar variance and lunate subsidence were measured on 41 standard anteroposterior wrist radiographs from 31 patients with Madelung deformity. The patients had a mean age of 13 years (range, 5-25) at the time of presentation. Two pediatric orthopedic hand/upper limb surgeons evaluated all radiographs twice in a 4-week interval using standard digital imaging software. Intraclass correlation coefficients (ICCs) were calculated for inter- and intrarater reliability, and results were reported using the Landis and Koch criteria. The interrater ICC for the ulna variance measurements was substantial, and for the lunate subsidence almost perfect. The intrarater ICC for ulna variance was substantial for both raters. In contrast, the intrarater ICC for lunate subsidence was almost perfect for both raters. Measurement of lunate subsidence showed both superior interrater and intrarater reliability compared with the ulnar variance method. Whenever relative ulna length is assessed in children and adolescents with Madelung deformity, the lunate subsidence should be the preferred method to characterize deformity. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  15. A modified rabbit ulna defect model for evaluating periosteal substitutes in bone engineering: a pilot study.

    Science.gov (United States)

    El Backly, Rania M; Chiapale, Danilo; Muraglia, Anita; Tromba, Giuliana; Ottonello, Chiara; Santolini, Federico; Cancedda, Ranieri; Mastrogiacomo, Maddalena

    2014-01-01

    The present work defines a modified critical size rabbit ulna defect model for bone regeneration in which a non-resorbable barrier membrane was used to separate the radius from the ulna to create a valid model for evaluation of tissue-engineered periosteal substitutes. Eight rabbits divided into two groups were used. Critical defects (15 mm) were made in the ulna completely eliminating periosteum. For group I, defects were filled with a nanohydroxyapatite poly(ester urethane) scaffold soaked in PBS and left as such (group Ia) or wrapped with a tissue-engineered periosteal substitute (group Ib). For group II, an expanded-polytetrafluoroethylene (e-PTFE) (GORE-TEX(®)) membrane was inserted around the radius then the defects received either scaffold alone (group IIa) or scaffold wrapped with periosteal substitute (group IIb). Animals were euthanized after 12-16 weeks, and bone regeneration was evaluated by radiography, computed microtomography (μCT), and histology. In the first group, we observed formation of radio-ulnar synostosis irrespective of the treatment. This was completely eliminated upon placement of the e-PTFE (GORE-TEX(®)) membrane in the second group of animals. In conclusion, modification of the model using a non-resorbable e-PTFE membrane to isolate the ulna from the radius was a valuable addition allowing for objective evaluation of the tissue-engineered periosteal substitute.

  16. Functional analysis of the cross-section form and X-ray density of human ulnae

    International Nuclear Information System (INIS)

    Hilgen, B.

    1981-01-01

    On 20 ulnae the form of the cross sections and distribution of the X-ray density were investigated in five different cross-section heights. The analysis of the cross-section forms was carried through using plane contraction figures, the X-ray density was established by means of the equidensity line method. (orig.) [de

  17. A new total distal radioulnar joint prosthesis: functional outcome.

    Science.gov (United States)

    Schuurman, Arnold H; Teunis, Teun

    2010-10-01

    To present the evolution of design and the short-term functional outcome of our distal radioulnar joint (DRUJ) prosthesis. This total DRUJ prosthesis differs from others in that it consists of 2 parts and attains bony fixation by its hydroxyapatite coating. Nineteen patients received a DRUJ prosthesis after a failed Darrach procedure (n = 10), Sauvé-Kapandji procedure (n = 7), trauma (n = 1), or DRUJ synovitis (n = 1). Indications for the placement were decreased grip, decreased forearm motion, and pain due to ulnar impingement syndrome and instability of the distal ulna. Seven prostheses were removed, 5 due to loosening, 1 due to continuing pain, and 1 at the request of the patient. The 5 prostheses that loosened were an intermediate prototype no longer in use. In 12 remaining cases, range of motion, grip strength, and pinch strength were measured, and patients completed the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Pain was assessed with the visual analog scale (range, 0-10). A paired t-test was performed to assess the significance of the difference between preoperative and postoperative measurements. Statistically significant improvements were seen in forearm pronation, from an average of 79° to 88°; grip strength, from an average of 10 kg to an average of 16 kg; and visual analog scale score, decreased from a mean of 5.3 to a mean of 3.5. The distal ulna was clinically stable in all 12 patients who retained the prosthesis. The intermediate prototype had a high failure rate, 5 out of 5. The early results for the current prosthesis prototype show clinical improvement. Based on these results, we conclude that this prosthesis offers a new treatment option for ulnar instability after distal ulnar resection. Therapeutic IV. Copyright © 2010. Published by Elsevier Inc.

  18. Traumatic Distal Ulnar Artery Thrombosis

    Directory of Open Access Journals (Sweden)

    Ahmet A. Karaarslan

    2014-01-01

    Full Text Available This paper is about a posttraumatic distal ulnar artery thrombosis case that has occurred after a single blunt trauma. The ulnar artery thrombosis because of chronic trauma is a frequent condition (hypothenar hammer syndrome but an ulnar artery thrombosis because of a single direct blunt trauma is rare. Our patient who has been affected by a single blunt trauma to his hand and developed ulnar artery thrombosis has been treated by resection of the thrombosed ulnar artery segment. This report shows that a single blunt trauma can cause distal ulnar artery thrombosis in the hand and it can be treated merely by thrombosed segment resection in suitable cases.

  19. Descompensación distal postoperatoria (D.D.P. en curvas lenke 1a tratadas con tornillos pediculares: una revisión de 63 casos Descompensação distal pós-operatória (DDP em curvaturas lenke 1a tratadas com parafusos pediculares: análise de 63 casos Postoperative distal decompensation (PDD in lenke 1a curvatures treated with pedicular screws: analysis of 63 cases

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    Norberto Ventura

    2012-06-01

    central vertical até o sacro (LVS era superior a 10 mm de "distância vertebral" (DV. RESULTADOS: 8 casos (12,7% desenvolveram DDP. O sinal de Risser foi 0 em 2 pacientes (25% e 1 em 2 pacientes (25%. Relação VDI/VD: 4 pacientes (50% mesmo nível (VD +0, 4 pacientes (50% nível caudal (VD +1; relação VDI/VE: 5 pacientes (62,5% 2 níveis cefálicos (VE -2, 3 pacientes (37,5% 1 nível cefálico (VE -1; relação VDI/DV: 5 pacientes (62,5% um nível cefálico DV (-1, 3 pacientes mesmo nível (DV +0. CONCLUSÕES: Risco de descompensação distal pós-operatória:VDI mesmo nível VD (VD +0, 2 níveis cefálicos VE (VE -2, 1 nível cefálico DV (DV -1. Estratégia cirúrgica nas curvaturas Lenke 1A: VDI: 1/2 níveis caudal até VD (VD +1/+2, um nível cefálico até VE (VE -1, mesmo nível DV (DV +0.OBJECTIVE: To identify risk factors for postoperative distal decompensation (PDD and safe surgical strategy in curvatures Lenke type 1A, treated with pedicle screws. METHOD: Retrospective radiographic study of 63 patients with scoliosis Lenke 1A, with follow-up of at least one year. The parameters evaluated were age, sex, degrees of Cobb's angle, Risser sign, relationship of distal instrumented vertebra (DIV to the distal vertebra (DV of the curvature, to the stable vertebra (SV and to the vertebra which distance to the central vertical line to the sacrum (VLS was greater than 10 mm of "vertebral distance" (VD. RESULTS: 8 cases (12.7% developed DDP. The Risser sign was 0 in 2 patients (25% and 1 in 2 patients (25%. DIV/DV relationship: 4 patients (50% same level (DV +0, 4 patients (50% caudal level (DV +1; DIV/SV ratio: 5 patients (62.5% 2 cephalic levels (VD -2, 3 patients (37.5% 1 cephalic level (SV -1; DIV/VD relationship: 5 patients (62.5% 1 cephalic level (VD -1, 3 patients the same level (VD +0. CONCLUSIONS: Risk of postoperative distal decompensation: DIV same level DV (DV +0, 2 cephalic levels SV (SV -2, 1 cephalic level VD (VD -1. Surgical strategy in Lenke 1A

  20. [Treatment of the complex intraarticular fracture of the distal humerus with the latitude elbow prosthesis].

    Science.gov (United States)

    Burkhart, Klaus Josef; Müller, Lars Peter; Schwarz, Christina; Mattyasovszky, Stefan Georg; Rommens, Pol Maria

    2010-07-01

    Therapy of comminuted intraarticular distal humerus fractures in elderly patients with primary total elbow arthroplasty to achieve stable and painless function. Use of "third-generation" elbow prosthesis with the following options:--linked total elbow arthroplasty,--unlinked total elbow arthroplasty,--either with or without radial head replacement,--hemiarthroplasty. Comminuted intraarticular distal humerus fractures with poor bone quality, in which stable osteosynthesis is impossible. Failure of internal fixation without the technical possibility of revision osteosynthesis. Posttraumatic osteoarthritis or rheumatoid arthritis. Open fractures (Gustilo-Anderson type II or III) or contaminated wounds should not initially be treated with total elbow arthroplasty. Prosthetic replacement may be considered after consolidation of the soft tissue. Low compliance, high functional demands. Paralysis of the biceps muscle. Supine positioning of the patient. Surgical approach after Bryan-Morrey. Anterior transposition of the ulnar nerve. Preparation of the insertion of the triceps at the distal humerus, capsule and proximal ulna. Reflection of the triceps in continuity with the ulnar periosteum and the forearm fascia. Attempt at reconstruction of the epicondyles to achieve ligamentary stability and to implant an unlinked prosthesis. If this is technically not possible, the prosthesis is linked at the end of the operation. Removal of the distal humerus fragments. Determination of the prosthesis size. Detection of the extension-flexion axis. Opening of the humeral intramedullary canal. Determination of the offset. Preparation of the humeral prosthesis repository. Placement of the trial prosthesis. Potential implantation of a hemiprosthesis, if radial head, proximal ulna and ligaments are unaffected. Otherwise preparation of the ulnar prosthesis repository. If the radial head is unaffected, it can be preserved. Otherwise it has to be resected and preferably replaced. Placement of

  1. Tratamento dos desarranjos da articulação radio-ulnal distal pela técnica de Sauvé-Kapandji. Resultados preliminares Treatment of the distal radioulnar articulation disorders by the Sauvé-Kapandji technique

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    Nilton Mazzer

    2001-03-01

    Full Text Available Foi realizado um estudo retrospectivo de 10 casos de desarranjo da articulação radio-ulnal distal tratados pela técnica de Sauvé-Kapandji. Os desarranjos eram resultantes de trauma (7, degeneração (2 e doença congênita (1 e as principais queixas pré-operatórias eram a dor, limitação da prono-supinação e deformidade. A idade média dos pacientes na época da operação era de 37,8 anos. Os pacientes foram submetidos a avaliação clínico-funcional e radiografica com um seguimento pós-operatório médio de 28,3 meses, particular atenção tendo sido dada a uma incidência radiográfica anteroposterior sob esforço de preensão manual. Todos os pacientes obtiveram melhora de suas queixas e o resultado final foi considerado satisfatório (excelente e bom em 8, e insatisfatório (regular 2. A artrodese da articulação radio-ulnal consolidou em 9 casos, independentemente do tipo de fixação empregado. O exame radiográfico sob esforço mostrou que todos os pacientes apresentavam deslocamento radial da ulna, mas isso aparentemente não interferiu com a função. Concluiu-se que a técnica de Sauvé-Kapandji é eficiente para o tratamento dos desarranjos da articulação radio-ulnal distal, pois ela não implica em perda funcional importante.A retrospective study of 10 cases of derrangement of the distal radioulnar joint treated with the technique of Sauvé-Kapandji was carried out. Derrangements resulted from trauma (7, degeneration (2 and congenital disease (1 and the main preoperative complaints were pain, limitation of pronation and supination and deformity. The patients' average age by the time of the operation was 37.8 years (range: 19 - 68 years. All were submitted to clinical, functional and radiographic evaluation at 28.3 months after the operation on average, particular attention being paid to an anteroposterior X-ray view with the hand in a moderate hand grip effort. All patients improved from their complaints and the final

  2. Contemporary Management of Primary Distal Urethral Cancer

    NARCIS (Netherlands)

    Traboulsi, S.L.; Witjes, J.A.; Kassouf, W.

    2016-01-01

    Primary urethral cancer is one of the rare urologic tumors. Distal urethral tumors are usually less advanced at diagnosis compared with proximal tumors and have a good prognosis if treated appropriately. Low-stage distal tumors can be managed successfully with a surgical approach in men or radiation

  3. Autologous grafts of double-strut fibular cortical bone plate to treat the fractures and defects of distal femur: a case report and review of literature

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    CHEN Xu

    2012-02-01

    Full Text Available 【Abstract】We reported a 23-year-old man who was involved in a high-speed motorcycle accident. He sustained a closed fracture at the right distal femur. The primary fracture happened on February 2008. He underwent open reduction and internal fixation with cloverleaf plate. And one hundred days after the surgery, the proximal screws were pulled-out, but the bone union was not achieved. Treatment consisted of exchanging the cloverleaf plate with a locking compression plate and using an auto-iliac bone graft to fill the nonunion gap. In July 2009, the patient had a sharp pain in the right lower limb. The X-ray revealed that the plate implanted last year was broken, causing a nonunion at the fracture site. Immediately the plate and screws were removed and an intramedullary nail was inserted reversely from the distal femur as well as a 7 cm long bone from the right fibula was extracted and longitudinally split into two pieces to construct cortical bone plates. Then we placed them laterally and medially to fracture site, drilled two holes respectively, and fastened them with suture. We carried on auto-iliac bone grafting with the nonunion bone grafts. The follow-up at 15 months after operation showed that the treatment was successful, X-ray confirmed that there was no rotation and no angular or short deformity. We briefly reviewed the literature regarding such an unusual presentation and discussed in details the possible etiology and the advantages of autologous double-strut fibular grafts to cope with such an intractable situation. Key words: Femur; Transplantation, autologous; Bone screws

  4. Distal Radius Hemiarthroplasty.

    Science.gov (United States)

    Adams, Brian D; Lawler, Ericka A; Kuhl, Taften L

    2016-08-01

    Due to a higher risk for implant loosening, particularly of the distal component, patients with physically demanding lifestyles are infrequently considered for total wrist arthroplasty (TWA). A distal radius hemiarthroplasty may obviate the need for the strict restrictions recommended for patients treated by TWA, thus providing another surgical option for active patients with severe wrist arthritis, especially those with articular degeneration of the lunate facet of the radius, capitate head, or combination of both, who are not typically candidates for traditional motion-preserving procedures. Eight fresh-frozen cadaver limbs (age range, 43-82 years) with no history of rheumatoid arthritis or upper extremity trauma were used. Radiodense markers were inserted in the radius and hand. Posteroanterior (PA) fluoroscopic images with the wrist in neutral, radial deviation, and ulnar deviation, and lateral images with the wrist in neutral, flexion, and extension were obtained for each specimen before implantation, after distal radius hemiarthroplasty, and after combined hemiarthroplasty and PRC. On the PA images, the capitate remained within 1.42 and 2.21 mm of its native radial-ulnar position following hemiarthroplasty and hemiarthroplasty with PRC, respectively. Lateral images showed the capitate remained within 1.06 mm of its native dorsal-volar position following hemiarthroplasty and within 4.69 mm following hemiarthroplasty with PRC. Following hemiarthroplasty, capitate alignment changed 2.33 and 2.59 mm compared with its native longitudinal alignment on PA and lateral films, respectively. These changes did not reach statistical significance. As expected, significant shortening in longitudinal alignment was seen on both PA and lateral films for hemiarthroplasty with PRC. A distal radius implant hemiarthroplasty with or without a PRC provides good static alignment of the wrist in a cadaver model and thus supports the concept as potential treatment alternatives

  5. Persistent Medial Subluxation of the Ulna with Radiotrochlear Articulation.

    Science.gov (United States)

    Kachooei, Amir R; Ring, David

    2017-07-01

    Two patients-one with a terrible triad fracture dislocation and one with an anterior olecranon fracture dislocation-were treated for maltracking of the elbow (medial subluxation). The radial head articulated with the lateral trochlea while the ulnar trochlear notch was perched over the medial trochlea. The late revision surgery could not correct the subluxation because the joints were accustomed to the new alignment, however the overall function was reasonable.

  6. Association between distal ulnar morphology and extensor carpi ulnaris tendon pathology

    International Nuclear Information System (INIS)

    Chang, Connie Y.; Huang, Ambrose J.; Bredella, Miriam A.; Kattapuram, Susan V.; Torriani, Martin

    2014-01-01

    The purpose of this study was to evaluate the association between distal ulnar morphology and extensor carpi ulnaris (ECU) tendon pathology. We retrospectively reviewed 71 adult wrist MRI studies with ECU tendon pathology (tenosynovitis, tendinopathy, or tear), and/or ECU subluxation. Subjects did not have a history of trauma, surgery, infection, or inflammatory arthritis. MRI studies from 46 subjects without ECU tendon pathology or subluxation were used as controls. The following morphological parameters of the distal ulna were measured independently by two readers: ulnar variance relative to radius, ulnar styloid process length, ECU groove depth and length. Subjects and controls were compared using Student's t test. Inter-observer agreement (ICC) was calculated. There was a significant correlation between negative ulnar variance and ECU tendon pathology (reader 1 [R1], P = 0.01; reader 2 [R2], P 0.64 for all parameters. Distal ulnar morphology may be associated with ECU tendon abnormalities. (orig.)

  7. Comparison of Maxillary Molar Distalization with an Implant-Supported Distal Jet and a Traditional Tooth-Supported Distal Jet Appliance

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    Mauro Cozzani

    2014-01-01

    Full Text Available Aim. To investigate and compare the efficiency of two appliances for molar distalization: the bone-anchored distal screw (DS and the traditional tooth-supported distal jet (DJ for molar distalization and anchorage loss. Methods. Tests (18 subjects were treated with a DS and controls (18 subjects were treated with a DJ. Lateral cephalograms were obtained before and at the end of molar distalization and were analysed. Shapiro Wilk test, unpaired t-test, and Wilcoxon rank-sum test were applied according to values distribution. The α level was fixed at 0.05. Results. Maxillary first molars were successfully distalized into a Class I relationship in all patients. The mean molar distalization and treatment time were similar in both groups. The DS group exhibited a spontaneous distalization (2.1±0.9 mm of the first premolar with control of anchorage loss, distal tipping, extrusion, and skeletal changes. Conclusions. The DS is an adequate compliance-free distalizing appliance that can be used safely for the correction of Class II malocclusions. In comparison to the traditional DJ, the DS enables not only a good rate of molar distalization, but also a spontaneous distalization of the first premolars.

  8. Desmoplastic fibroma of ulna: Excision and reconstruction of olecranon with a fibular graft

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    Tarun Goyal

    2013-01-01

    Full Text Available Desmoplastic fibroma is a rare, well differentiated, locally aggressive fibrous tumor usually arising from soft tissues, and rarely from bones. Involvement of forearm bones is extremely unusual. We present a large desmoplastic fibroma of right ulna in a 15-year-old male. The tumor was excised with a wide margin, and the bony defect was reconstructed with nonvascular autologous fibular graft. Reconstruction of the olecranon process was attempted using the fibular head and the remaining olecranon. At 2-years followup, there was no recurrence, flexion extension arc of the elbow joint was 40°-130° and there was no restriction of activities of daily living.

  9. Estudo crítico do tratamento de 196 casos de fratura diafisária de rádio e ulna em cães A critical study about the treatment of 196 cases of diphiseal radial and ulnar fractures in dogs

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    Cássio Ricardo Auada Ferrigno

    2008-08-01

    Full Text Available Fraturas diafisárias de rádio e ulna em cães são freqüentes dentro dos quadros mórbidos ortopédicos em Medicina Veterinária, e seu tratamento merece especial atenção, face aos muitos quadros de insucesso observados. Foram comparados neste estudo os resultados de três métodos de osteossíntese, sendo estes a fixação esquelética externa, o uso de placas e parafusos e a imobilização externa, em quadros de fraturas de terço proximal, médio e distal de rádio e ulna em cães. Os dados demográficos e referentes à distribuição e classificação das fraturas, bem como o método utilizado para osteossíntese e suas conseqüências foram tabulados e os dados comparados estatisticamente. Como resultados, das 196 fraturas acompanhadas, pacientes com até 6,0 kg foram os mais acometidos (46,4% com lesões principalmente no terço distal (64,93% das fraturas. Animais que foram operados com intervalo menor entre a ocorrência da fratura e a cirurgia demonstraram melhores resultados. Houve diferença significativa entre as osteossínteses por fixadores externos e placas parafusadas, quando comparados à imobilização externa, independentemente da região fraturada.The results from three osteosynthesis methods in cases of proximal, mid and distal fractures of radio and ulna in dogs were compared: the skeletal external fixation, plates and screws and the external immobilization. Shaft fractures of radius and ulna in dogs are frequent among the orthopedic morbid cases in Veterinary Medicine and their treatment deserves special attention, due to the high number of unsuccessful cases observed. The demographic data with reference to distribution and classification of fractures, as well as the method used for osteosynthesis and its consequences, were tabulated and the data were statistically compared. As results, from the 196 fractures observed, patients with up to 6.0 kilograms were the most affected (46.4% with lesions mainly in the distal

  10. Pictorial essay: Distal colostography

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    Rahalkar Mukund

    2010-01-01

    Full Text Available Distal colostography (DC, also called distal colography or loopography, is an important step in the reparative management of anorectal malformations (ARMs with imperforate anus, Hirschsprung′s disease (occasionally and colonic atresia (rarely in children and obstructive disorders of the distal colon (colitis with stricture, carcinoma or complicated diverticulosis in adults. It serves to identify/confirm the type of ARM, presence/absence of fistulae, leakage from anastomoses, or patency of the distal colon. We present a pictorial essay of DC in a variety of cases.

  11. Stress fracture of the ulna associated with bisphosphonate therapy and use of walking aid.

    Science.gov (United States)

    Chiang, G S H; Grace, C S H; Koh, K W B; Kelvin, K W B; Chong, T W; Wei, C T; Tan, B Y; Yeow, T B

    2014-08-01

    We report a case of a stress fracture of the ulna secondary to long-term bisphosphonate therapy and walking cane. Physicians need to have a high index of suspicion of stress fractures occurring in patients complaining of chronic upper limb pain if they are on bisphosphonate therapy and are using walking aids. Stress fractures of the upper extremities are rare and are usually associated with athletes; however, a few recent case reports have shown an association between stress fractures of the upper extremities and the use of walking aids. The association between increased incidence of upper extremity stress fractures and the use of both bisphosphonates and walking aids in patients has not been well studied, with only one previously reported case. Here, we report a case of a complete stress fracture of the ulna in a 77-year-old female, premorbidly ambulant with walking cane, on long-term bisphosphonates without any pre-existing medical conditions which could result in secondary causes of bone loss. Investigations did not reveal any causes of pathological fracture. This fracture is attributed to the use of long-term bisphosphonate therapy in conjunction with the use of a walking cane. This case highlights the importance of entertaining the possibility of such fractures occurring in any patient who is on bisphosphonate therapy presenting with stress fractures of the upper extremity.

  12. Pisiform malalignment associated with distal radius fractures.

    Science.gov (United States)

    Tajima, Takafumi; Zenke, Yukichi; Yamanaka, Yoshiaki; Menuki, Kunitaka; Sakai, Akinori

    2018-03-01

    The association of scaphoid or other carpal bone fractures with distal radius fractures is frequently reported, whereas few studies have described pisiform malalignment associated with distal radius fractures. The purpose of this study was to investigate the frequency and characteristics of pisiform malalignment associated with distal radius fractures. We performed a retrospective study by reviewing the data of 152 consecutive patients with a mean age of 63 years who were treated surgically for distal radius fractures during a five-year period. We evaluated the pisotriquetral joint via preoperative sagittal computed tomography (CT) and assessed pisiform malalignment. Pisiform malalignment was defined as follows: (1) wide type, joint space ≥4.0 mm; (2) non-parallel type, loss of parallelism of the joint surface of ≥20°; or (3) overriding type, proximal or distal overriding of the pisotriquetral joint ≥2.0 mm. We investigated the relationship between pisiform malalignment and the patterns of distal radius fractures. Pisiform malalignment was assessed using postoperative CT to determine whether it had been reduced. Pisiform malalignment was observed in 48 cases involving 44 patients with a mean age of 58 (17-81) years. The patients included 16, 17, and 15 cases of the wide type, non-parallel type, and overriding type, respectively. Distal radius fractures with dorsal displacement exhibited pisiform malalignment significantly more frequently than those with volar displacement. No significant difference was noted between intra- and extra-articular fractures or between patients with and without distal ulnar fractures. Among the 22 pisiform malalignment cases assessed via postoperative CT, 15 cases were reduced, and 7 cases remained malaligned. The non-parallel type exhibited the lowest reduction rate among the 3 types. Among distal radius fractures, 29% were complicated by pisiform malalignment. Distal radius fractures with dorsal displacement exhibited a

  13. Distal digital replantation.

    Science.gov (United States)

    Jazayeri, Leila; Klausner, Jill Q; Chang, James

    2013-11-01

    Hand surgeons have been hesitant to perform distal digital replantation because of the technical challenges and the perception of a high cost-to-benefit ratio. Recent studies, however, have shown high survival rates and excellent functional and aesthetic results, providing renewed enthusiasm for distal replantation. The authors reviewed the literature and summarize key points regarding the surgical treatment, perioperative care, and outcomes of distal digital replantation. They describe specific techniques and considerations for surgical repair in each of four distal zones as described by Sebastin and Chung. Zone 1A replantation involves an artery-only anastomosis of a longitudinal pulp artery. Venous anastomosis first becomes possible in zone 1B. Zone 1C involves periarticular amputations where arthrodesis of the distal interphalangeal joint is usually indicated. Repair of the artery, vein, and nerve is technically optimal in zone 1D, where venous anastomosis should be performed. Overall, survival rates for distal digital replantation are similar to those reported for more proximal replantation. The literature reports good outcomes regarding nail salvage, fingertip sensibility, and range of motion, with restoration of length and aesthetic appearance. Distal replantation performed at institutions that specialize in microsurgery and specifically tailored to the level of injury is associated with good survival, function, and patient satisfaction and superior aesthetic outcome. More prospective data are needed to evaluate the cost of treatment, psychological outcomes, and functional outcomes of distal replantation compared with revision amputation.

  14. Stress fracture healing: fatigue loading of the rat ulna induces upregulation in expression of osteogenic and angiogenic genes that mimic the intramembranous portion of fracture repair.

    Science.gov (United States)

    Wohl, Gregory R; Towler, Dwight A; Silva, Matthew J

    2009-02-01

    Woven bone is formed in response to fatigue-induced stress fractures and is associated with increased local angiogenesis. The molecular mechanisms that regulate this woven bone formation are unknown. Our objective was to measure the temporal and spatial expression of osteo- and angiogenic genes in woven bone formation in response to increasing levels of fatigue-induced damage. We used the rat forelimb compression model to produce four discrete levels of fatigue damage in the right ulna of 115 male Fischer rats. Rats were killed at 0 (1 h), 1, 3 and 7 days after loading. Using qRT-PCR, we quantified gene expression associated with osteogenesis (BMP2, Msx2, Runx2, Osx, BSP, Osc), cell proliferation (Hist4), and angiogenesis (VEGF, PECAM-1) from the central half of the ulna. The spatial distribution of BMP2, BSP and PCNA was assessed by immunohistochemistry or in situ hybridization in transverse histological sections 1, 4, and 7 mm distal to the ulnar mid-diaphysis. One hour after loading, BMP2 was significantly upregulated in neurovascular structures in the medial ulnar periosteum. Expression of angiogenic markers (VEGF, PECAM-1) increased significantly between Day 0 and 1 and, as with BMP2 expression, remained upregulated through Day 7. While Osx and BSP were upregulated on Day 1, the other osteogenic genes (Msx2, Runx2, Osx, BSP and Osc) were induced on Day 3 in association with the initiation of periosteal woven bone formation and continued through Day 7. The magnitude of osteogenic gene expression, particularly matrix genes (BSP, Osc) was significantly proportional the level of fatigue damage. The woven bone response to fatigue injury is remarkably similar to the "intramembranous" portion of fracture repair - rapid formation of periosteal woven bone characterized by early BMP2 expression, cell proliferation, and upregulation of osteogenic genes. We speculate that woven bone repair of fatigue damage may be an abbreviated fracture response without the requirement

  15. Distal Insertional Footprint of the Brachialis Muscle: 3D Morphometric Study

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    Srinath Kamineni

    2015-01-01

    Full Text Available Objective. The purpose of this study is to describe the three-dimensional morphometry of the brachialis muscle at its distal attachment to the ulna. Methods. Fifty cadaveric elbows were dissected and the brachialis distal insertion was isolated on the ulna bone and probed with a three-dimensional digitizer, to create a three-dimensional model of the footprint. Measurements and analysis of each footprint shape were recorded and compared based on gender and size. Results. There was significant gender difference in the surface length (P= 0.002 and projected length (P= 0.001 of the brachialis footprint. The shapes of the footprint also differed among the specimens. Conclusion. The shape of the brachialis muscle insertion differed among all the specimens without significant variation in gender or sides. There was also a significant difference in muscle length between males and females with little difference in the width and surface area. Significance. The information obtained from this study is important for kinematic understanding and surgical procedures around the elbow joint as well as the understanding of the natural age related anatomy of the brachialis footprint morphology.

  16. Treatment of ununited anconeal process in 8 dogs by osteotomy and dynamic distraction of the proximal part of the ulna Tratamento da não união do processo ancôneo em 8 cães por osteotomia e distração dinâmica da porção proximal da ulna

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    Cássio R.A. Ferrigno

    2007-08-01

    Full Text Available A surgical technique for the treatment of ununited anconeal process in dogs treated by osteotomy and dynamic distraction of the proximal part of the ulna using a linear external skeletal fixator was evaluated. In all cases the osteotomy was distracted 1mm each day after the surgery until desired distraction had been achieved. Eight dogs and 9 joints diagnosed with ununited anconeal process were treated. The success of the procedure was determined by comparing clinical signs of lameness and degree of arthrosis at the time of diagnosis to 6 months after the surgical intervention. Radiographic union occurred in 88.9% of the affected joints between 21 and 42 days after the surgical procedure. Clinically, six elbows were classified as good, two as satisfactory and one as unsatisfactory. Six months after surgery two elbows had no arthrosis, one had Grade 1, two Grade 2 and one Grade 3. It is concluded the combination of ulnar osteotomy and dynamic distraction of the olecranon by a linear external skeletal fixator is a feasible procedure for the treatment of ununited anconeal process in dogs.Foi avaliada nova técnica de tratamento da não união do processo ancôneo em cães através da osteotomia e distração dinâmicada porção proximal da ulna utilizando fixador externo. Em todos os casos a taxa de distração foi de 1mm a cada dia após a cirurgia até que a distração desejada fosse adquirida. Oito cães com nove articulações afetadas foram tratados. O sucesso do tratamento foi determinado pela comparação dos sinais clínicos de claudica-ção e grau de artrose no tempo do diagnóstico, até 6 meses após a intervenção cirúrgica. Clinicamente, seis cotovelos foram classificados como bons, dois como satisfatório e um como insatisfatório. Seis meses após a cirurgia, dois cotovelos não apresentavam artrose, um apresentava Grau 1, dois Grau 2 e um Grau 3. Conclui-se que a combinação de osteotomia da ulna com distração dinâmica do

  17. Giant cell tumour of the distal radius: wide resection and reconstruction by non-vascularised proximal fibular autograft.

    Science.gov (United States)

    Bassiony, Ayman Abdelaziz

    2009-10-01

    Giant cell tumours of the bone are aggressive and potentially malignant lesions. Juxtaarticular giant cell tumours of the lower end radius are common and present a special problem of reconstruction after tumour excision. Out of the various reconstructive procedures described, non-vascularised fibular autograft has been widely used with satisfactory functional results. Ten patients with a mean age of 33.4 years, with either Campanacci grade II or III histologically proven giant cell tumours of lower end radius were treated with wide excision and reconstruction with ipsilateral non-vascularised proximal fibular autograft. Host graft junction was fixed with dynamic compression plate (DCP) in all cases. Wrist ligament reconstruction and fixation of the head of the fibula with carpal bones and distal end of the ulna using K-wires and primary cancellous iliac crest grafting at graft host junction was done in all cases. The follow-up ranged from 30 to 60 months (mean, 46.8). At last follow-up, the average combined range of motion was 100.5 degrees with range varying from 60 degrees to 125 degrees. The average union time was 7 months (range, 4 to 12). Non-union occurred in 1 case. Graft resorption occurred in another case. Localised soft tissue recurrence occurred in another case after 3 years and was treated by excision. There was no case of graft fracture, metastasis, death, local recurrence or significant donor site morbidity. A total of 3 secondary procedures were required. Enbloc resection of giant cell tumours of the lower end radius is a widely accepted method. Reconstruction with non-vascularised fibular graft, internal fixation with DCP with primary corticocancellous bone grafting with transfixation of the fibular head and wrist ligament reconstruction minimises the problem and gives satisfactory functional results.

  18. Giant distal humeral geode

    International Nuclear Information System (INIS)

    Maher, M.M.; Kennedy, J.; Hynes, D.; Murray, J.G.; O'Connell, D.

    2000-01-01

    We describe the imaging features of a giant geode of the distal humerus in a patient with rheumatoid arthritis, which presented initially as a pathological fracture. The value of magnetic resonance imaging in establishing this diagnosis is emphasized. (orig.)

  19. Comparison of Jones jig molar distalization appliance with extraoral traction.

    Science.gov (United States)

    Haydar, S; Uner, O

    2000-01-01

    In this study, 20 patients were evaluated. Ten were treated with intraoral distalization followed by fixed appliance therapy, and 10 were treated with extra oral traction followed by fixed appliance therapy. Molar relationship correction was achieved in 2.5 months with intraoral distalization and in 10.7 months with extraoral distalization. A significant anterior movement of the anchorage unit (P <.001) was observed with the intraoral distalization and a significant distal drift of premolars was observed in the headgear group (P <.05). Palatal plane was found to tip downward significantly in the headgear group (P <.05). Total outcome of the 2 methods were discussed evaluating the advantages and disadvantages of the 2 distalization methods.

  20. Distal driving of molar by smart distal-propeller appliance

    Directory of Open Access Journals (Sweden)

    U H Vijayashree

    2018-01-01

    Full Text Available In recent years, maxillary molar distalization with noncompliance mechanics has been an increasingly popular method for the resolution of Class II malocclusion. This communication describes one particular molar distalizing appliance, the Smart distal-propeller appliance which is simple, inexpensive, easily fabricated that can be used for unilateral or bilateral molar distalization.

  1. Potassium secretion in mammalian distal colon

    DEFF Research Database (Denmark)

    Sørensen, Mads Vaarby

    2009-01-01

    . This research project is the summary of 3 original papers addressing the functional role of different regulating factors on ion transport in mouse distal colon. The first paper addresses the effect of luminal nucleotides on electrogenic Na+ absorption. The distal colon, like the distal nephron is an aldosterone......2 subunits in mice treated on an aldosterone increasing diet (high K+). Immunolabelling showed BK channel localisation in the luminal membrane which also was up-regulated in animals treated on a high K+ diet. Taken together these results firmly prove that aldosterone-stimulated K+ secretion......-/- mouse, we could functionally isolate the cAMP-activated K+ conductance as the BK channel. In addition we found the cAMP-activated K+ conductance to be further up-regulated by aldosterone. Taken together, these results show cAMP-activated K+ secretion occurs via a regulated specific splice variant...

  2. Distal splenorenal shunt with partial spleen resection

    Directory of Open Access Journals (Sweden)

    Gajin Predrag

    2007-01-01

    Full Text Available Introduction: Hypersplenism is a common complication of portal hypertension. Cytopenia in hypersplenism is predominantly caused by splenomegaly. Distal splenorenal shunt (Warren with partial spleen resection is an original surgical technique that regulates cytopenia by reduction of the enlarged spleen. Objective. The aim of our study was to present the advantages of distal splenorenal shunt (Warren with partial spleen resection comparing morbidity and mortality in a group of patients treated by distal splenorenal shunt with partial spleen resection with a group of patients treated only by a distal splenorenal shunt. Method. From 1995 to 2003, 41 patients with portal hypertension were surgically treated due to hypersplenism and oesophageal varices. The first group consisted of 20 patients (11 male, mean age 42.3 years who were treated by distal splenorenal shunt with partial spleen resection. The second group consisted of 21 patients (13 male, mean age 49.4 years that were treated by distal splenorenal shunt only. All patients underwent endoscopy and assessment of oesophageal varices. The size of the spleen was evaluated by ultrasound, CT or by scintigraphy. Angiography was performed in all patients. The platelet and white blood cell count and haemoglobin level were registered. Postoperatively, we noted blood transfusion, complications and total hospital stay. Follow-up period was 12 months, with first checkup after one month. Results In the first group, only one patient had splenomegaly postoperatively (5%, while in the second group there were 13 patients with splenomegaly (68%. Before surgery, the mean platelet count in the first group was 51.6±18.3x109/l, to 118.6±25.4x109/l postoperatively. The mean platelet count in the second group was 67.6±22.8x109/l, to 87.8±32.1x109/l postoperatively. Concerning postoperative splenomegaly, statistically significant difference was noted between the first and the second group (p<0.05. Comparing the

  3. Desenvolvimento de um modelo experimental de falha óssea infectada na ulna de coelhos Development of an experimental model of infected bone void in the ulna of rabbits

    Directory of Open Access Journals (Sweden)

    Matheus Lemos Azi

    2012-01-01

    Full Text Available OBJETIVO: Desenvolver um modelo experimental que permita estudar a regeneração de grandes falhas ósseas em condições de infecção. MÉTODO: Falhas ósseas segmentares de 15mm foram criadas cirurgicamente na ulna de 12 coelhos e inoculadas com 5x10(8 unidades formadoras de colônia (UFC de S. aureus. O desbridamento da infecção foi realizado duas semanas após, seguida da aplicação sistêmica de gentamicina por quatro semanas. Os animais foram acompanhados por um período de 12 semanas para avaliação do controle da infecção e da regeneração óssea. RESULTADOS: A regeneração espontânea foi inferior a 25% do defeito na avaliação radiográfica e histológica. CONCLUSÃO: A Falha óssea infectada de 15mm na ulna de coelhos é incapaz de alcançar a regeneração completa sem tratamentos adicionais. Nível de Evidência V, Estudo experimental.OBJECTIVE: Develop a model that allowed the study of bone regeneration in infection conditions. METHOD: A 15 mm defect was surgically created in the rabbit ulna and inoculated with 5x10(8 colony-forming units (CFU of S. aureus. Surgical debridement was performed two weeks after and systemic gentamicin was administered for four weeks. Animals were followed up to 12 weeks to evaluate infection control and bone regeneration. RESULT: Bone regeneration was inferior to 25% of the defect in radiological and histological analysis. CONCLUSION: Infected bone defect of 15 mm in the rabbit ulna was unable to achieve full regeneration without further treatment. Level of Evidence V, Experimental Study.

  4. Distal radius fractures: what determines the outcome after surgery?

    NARCIS (Netherlands)

    Teunis, T.

    2016-01-01

    This thesis addresses current issues in the outcome of operatively treated distal radius fractures. The general aim was to determine factors associated with adverse events, loss of motion, functional limitations, and opioid use after surgery. Injury In 3D complete articular distal radius fracture

  5. [Diagnostic value of CT scan for AO B3 fracture of distal radius].

    Science.gov (United States)

    Li, S L; Wang, M Y; Lu, Y

    2017-08-18

    To determine whether 3-dimentional CT scans is able to effectively improve the detection rate of AO B3 distal radius fractures in clinics. From Jan 2013 to Jan 2014, 30 patients with distal radius fractures were retrospectively enrolled in this study, all the patients directly visited the skeletal trauma emergency department in Beijing Jishuitan Hospital post injury and all of them accepted open reduction and internal fixation of distal radius fractures at last. All the radiographic data including X ray films and 3-dimentional CT scans of these patients were collected. Two independent observers were required to make primary AO classifications for each fracture by X rays at first, then to make final AO classifications by 3-dimentional CT scans. Finally, the detection rates of CT scans and plain films for AO B3 distal radius fractures and B3.3 distal radius fractures were compared, the agreements of the two methods for diagnosing AO B3 and B3.3 fractures were calculated by Cohen's Kappa calculations. All the 30 fractures were confirmed to be AO B3 distal radius fractures intraoperatively, and 10 of them were B3.3 fractures. The results were completely consistent with the results of 3-dimensional CT scans. However, only 80%(24/30) AO B3 distal radius fractures and 60%(6/10) B3.3 distal radius fractures could be diagnosed only by X rays. The detection rate of CT scans was proved to be significantly higher than X rays for diagnosing B3 distal radius fractures(100% vs. 80%,PAO B3 distal radius fracture and B3.3 distal radius fracture (kappa=0). Most importantly, in the study process, two special kinds of B3 distal radius fracture were initially found and described by us. One was named as radial B3 fracture, and the other was named as ulna B3 fracture. 3-dimentional CT scans can effectively improve the detection rate of B3 and B 3.3 distal radius fractures, and also help find two special kinds of B3 fractures.

  6. [ESTABLISHMENT OF A NEW RADIUS DEFECT MODEL BASED ON ULNA ANATOMICAL MEASUREMENT IN RABBITS].

    Science.gov (United States)

    Liu, Hanjiang; Guo, Ying; Mei, Wei

    2016-02-01

    To introduce a new bone defect model based on the anatomical measurement of radius and ulna in rabbits for offering a standard model for further tissue engineering research. Fifteen healthy 4-month-old New Zealand rabbits were selected for anatomic measurement and radiological measurement of the radius and ulna. Another 30 healthy 4-month-old New Zealand rabbits were randomly divided into groups A, B, and C (n=10). The radius bone defect was created bilaterally in 3 groups. In group A, the periosteum and interosseous membranes were fully removed with jig-saw by approach between extensor carpi radialis muscle and musculus extensor digitorum. The periosteum and interosseous membranes were fully removed in group B, and only periosteum was removed in group C with electric-saw by approach between extensor carpi radialis muscle and flexor digitorum profundus based on anatomical analysis results of ulnar and radial measurement. The gross observation, X-ray, micro-CT three-dimensional reconstruction, bone mineral density (BMD), and bone mineral content (BMC) were observed and recorded at immediate and 15 weeks after operation. HE staining and Masson staining were performed to observe bone formation in the defect areas. Blood vessel injury (1 rabbit), tendon injury (2 rabbits), postoperative hematoma (1 rabbit), and infection (1 rabbit) occurred in group A, postoperative infection (1 rabbit) in group C, and no postoperative complications in group B; the complication rate of group A (50%) was significantly higher than that of groups B (0%) and C (10%) (P0.05). HE staining and Masson staining results showed bone formation in group A, with structure disturbance and sclerosis. New bone formed in groups B and C, cartilage cells were observed in the center of bone cells. The radius bone defect model established by approach between extensor carpi radialis muscle and flexor digitorum profundus is an ideal model because of better exposures, less intra-operative blood loss, less

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

    Directory of Open Access Journals (Sweden)

    Amir Reza Kachooei

    2014-09-01

    Full Text Available Background:  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. Methods: 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  minister the disabilities of the armshoulder 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 followup time of 60 months (range: 2 to 102 months.  Results: 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. Conclusions: 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.

  8. Reconstruction of Elbow by Free Fibular Graft in a Case of Osteoclastoma of Proximal Ulna: A Rare Case Report

    Directory of Open Access Journals (Sweden)

    Kiran Kalaiah

    2015-01-01

    swelling around right elbow since 4 months. Proximal ulna along with tumour was resected and elbow was reconstructed using nonvascularized free fibular graft. At two years of follow-up, patient is tumour-free and has functional range of movement in elbow. We are reporting the case because of its rare location and for the indigenous treatment modality of using free fibular graft for elbow reconstruction.

  9. Management of Malunions of the Distal Radius

    OpenAIRE

    Yaniel Truffin Rodriguez; Osmany Pérez Martínez; Rafael Esmandy Gómez Arregoitía; Indira L. Gómez Gil

    2015-01-01

    Fractures of the distal radius often present with a group of major complications. Of these, malunion is one of the most disabling. Its management through salvage procedures is essential for its correction. The case of a 60-year-old healthy woman of urban origin treated at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos because of a malunion of the distal end of the left radius as a result of a previous Colles' fracture is presented. The patient complained of severe p...

  10. Contemporary Management of Primary Distal Urethral Cancer.

    Science.gov (United States)

    Traboulsi, Samer L; Witjes, Johannes Alfred; Kassouf, Wassim

    2016-11-01

    Primary urethral cancer is one of the rare urologic tumors. Distal urethral tumors are usually less advanced at diagnosis compared with proximal tumors and have a good prognosis if treated appropriately. Low-stage distal tumors can be managed successfully with a surgical approach in men or radiation therapy in women. There are no clear-cut indications for the choice of the most appropriate treatment modality. Organ-preserving modalities have shown effective and should be used whenever they do not compromise the oncological safety to decrease the physical and psychological trauma of dismemberment or loss of sexual/urinary function. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Resultados clínico-radiológicos en pacientes jóvenes con fractura articular completa de radio distal tratados con placa palmar bloqueada. [Clinical and radiological results in young patients with complete articular distal radius fractures treated with volar locked plate.

    Directory of Open Access Journals (Sweden)

    Pablo De Carli

    2016-02-01

    Conclusión: El tratamiento de las fracturas de radio distal tipo C en pacientes jóvenes con placa palmar bloqueada muestra resultados clínicos y radiológicos favorables con corrección de la mayoría de los escalones articulares.

  12. Distal renal tubular acidosis

    Science.gov (United States)

    ... the body's immune system mistakenly attacks healthy tissue Wilson disease , an inherited disorder in which there is too much copper in the body's tissues Use of certain medicines, such as amphotericin B, lithium, and analgesics Symptoms Symptoms of distal renal tubular acidosis include any ...

  13. Determination on the mineral salt content of the peripheral skeleton (ulna and calcaneus) in thyroid patients using /sup 125/I gamma-radiation absorption measurement. Investigations on the dependence of the measured mineral salt values of various influencing parameters

    Energy Technology Data Exchange (ETDEWEB)

    Kotz, F.

    1979-07-17

    The bone mineral salt content (BMC) has been determined in this work for 69 female and 14 male hyperthyroid patients and 13 euthyroid adenoma patients by means of I/sup 125/ gamma-radiation absorption measurement. It could be seen by comparison to healthy patients that hyperthyroid patients lie statistically significantly below the corresponding age and sex standard values, whilst the euthyroid adenoma female patients' values are found in the BMC normal range. It was furthermore shown that the menopause did not essentially influence the BMC values of Ulna and calcaneus. A further chapter treats the dependence of the BMC values on the hyperthyroidosis duration. Queries on whether the height of the BMC values depend on the f T/sub 4/ index were treated, as well as whether patients showing different extents of clinical hyperthyroid indications, statistically significantly differ even with average BMC. A comparison of the average BMC values of pretreated and untreated hyperthyroidosis patients was made.

  14. Outcome following distally locked volar plating for distal radius fractures with metadiaphyseal involvement.

    Science.gov (United States)

    Matullo, Kristofer S; Dennison, David G

    2015-06-01

    The surgical treatment of metadiaphyseal distal radius fractures may be difficult due to the associated articular or periarticular extension that limits standard fixation techniques. Longer distal radius volar locking plates allow stable fixation of the distal fragments while providing standard plate fixation in the proximal radius. We hypothesize that this plating technique allows adequate fixation to both the distal radius and metadiaphyseal fragments. The purpose of the study is to describe the outcomes, radiographic parameters, secondary surgeries, and complication rate with this device. A retrospective chart review was conducted on adult patients with a distal radius fracture and metadiaphyseal involvement treated with a volar, distally locked plate. All patients were followed up for radiographic union, with a mean time of 219 days (range 38-575). Fracture patterns, outcomes of range of motion, grip strength, and complications, as well as injury, post open reduction and internal fixation (ORIF), and finally, healed radiographic parameters were recorded. Twenty patients with 21 fractures were included. At union, mean radiographic parameters were the following: volar tilt of 8°, radial inclination of 27°, radial height of 14 mm, and ulnar variance of -1 mm. The mean final range of motion was 52° flexion, 50° extension, 68° pronation, and 66° supination. Complications included one infection and one plate removal. Four patients developed a nonunion requiring secondary procedures. There were no incidents of hardware failure or adhesions requiring tenolysis. Distally locked long volar plating for metadiaphyseal distal radius fractures is a safe and effective treatment option for these complex fracture patterns allowing anatomic restoration of the radial shaft and distal radius.

  15. Distal finger replantation.

    Science.gov (United States)

    Scheker, Luis R; Becker, Giles W

    2011-03-01

    Reconstruction of the fingertip distal to the flexor tendon insertion by replantation remains controversial and technically challenging, but the anatomy of the fingertip has been well described and provides help in surgical planning. The open-book surgical technique is described with potential complications and is illustrated with clinical cases. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  16. Distal biceps tendon rupture.

    Science.gov (United States)

    Savvidou, Olga D; Papagelopoulos, Panayiotis J; Mavrogenis, Andreas F; Partsinevelos, Antonios A; Karadimas, Evangelos J; Korres, Demetrios S

    2004-09-01

    The authors report a rupture of the distal tendon of biceps brachii in a 42-year-old athlete. Magnetic resonance imaging confirmed the injury. Early surgical repair was performed by reinsertion of the tendon on the radial tuberosity according to modified Boyd-Anderson technique. Indomethacin was administered prophylactically. No complications were noted. At the latest follow-up, the patient had full elbow range of motion and participated successfully in athletic activities and job.

  17. Intramedullary nailing in distal tibial fracture

    Directory of Open Access Journals (Sweden)

    Damian Arroquy

    2015-11-01

    Methods The inclusion criteria of this study were skeletally mature patients with displaced fractures of the distal tibia treated with intramedullary nail with a minimum follow up of one year. Gustilo III open fractures and type C fractures of the AO classification (complete articular Stroke were excluded. The sample comprised 35 patients remained. The follow-up was 29.2 months. We evaluated the time of consolidation, malunion and complications. The functional results were described according to the AOFAS score. Results Of the 35 patients with fracture of the distal third of the tibia all of them presented fracture healing. The average time to union was 17.2 weeks (range: 11-26. Of the total sample, 5 patients had delayed union, requiring dynamic nail on average at 12 weeks. The malunion was present in 4 (11.4% patients. We found no  difference (p = 0.201 in the time to union between fractures associated with fractures of the fibula treated (13sem or not (17sem. The AOFAS score was 86 points. Conclusion Intramedullary nailing with multiple distal locks like a good alternative treatment for distal tibia fractures AO type A or B, with low complication rate and a high rate of consolidation.

  18. Comparison of three methods of calculating strain in the mouse ulna in exogenous loading studies.

    Science.gov (United States)

    Norman, Stephanie C; Wagner, David W; Beaupre, Gary S; Castillo, Alesha B

    2015-01-02

    Axial compression of mouse limbs is commonly used to induce bone formation in a controlled, non-invasive manner. Determination of peak strains caused by loading is central to interpreting results. Load-strain calibration is typically performed using uniaxial strain gauges attached to the diaphyseal, periosteal surface of a small number of sacrificed animals. Strain is measured as the limb is loaded to a range of physiological loads known to be anabolic to bone. The load-strain relationship determined by this subgroup is then extrapolated to a larger group of experimental mice. This method of strain calculation requires the challenging process of strain gauging very small bones which is subject to variability in placement of the strain gauge. We previously developed a method to estimate animal-specific periosteal strain during axial ulnar loading using an image-based computational approach that does not require strain gauges. The purpose of this study was to compare the relationship between load-induced bone formation rates and periosteal strain at ulnar midshaft using three different methods to estimate strain: (A) Nominal strain values based solely on load-strain calibration; (B) Strains calculated from load-strain calibration, but scaled for differences in mid-shaft cross-sectional geometry among animals; and (C) An alternative image-based computational method for calculating strains based on beam theory and animal-specific bone geometry. Our results show that the alternative method (C) provides comparable correlation between strain and bone formation rates in the mouse ulna relative to the strain gauge-dependent methods (A and B), while avoiding the need to use strain gauges. Published by Elsevier Ltd.

  19. Minimally invasive osteosynthesis of distal tibial fractures using anterolateral locking plate: Evaluation of results and complications

    OpenAIRE

    Lakhotia, Devendra; Sharma, Gaurav; Khatri, Kavin; Kumar, G.N. Kiran; Sharma, Vijay; Farooque, Kamran

    2016-01-01

    Purpose Soft tissue healing is of paramount importance in distal tibial fractures for a successful outcome. There is an increasing trend of using anterolateral plate due to an adequate soft tissue cover on anterolateral distal tibia. The aim of this study was to evaluate the results and complications of minimally invasive anterolateral locking plate in distal tibial fractures. Methods This is a retrospective study of 42 patients with distal tibial fractures treated with minimally invasive ant...

  20. Three-Dimensional Assessment of Bilateral Symmetry of the Radius and Ulna for Planning Corrective Surgeries

    NARCIS (Netherlands)

    Vroemen, J. C.; Dobbe, J. G. G.; Jonges, R.; Strackee, S. D.; Streekstra, G. J.

    2012-01-01

    Purpose The contralateral unaffected side is often used as a reference in planning a corrective osteotomy of a malunited distal radius. Two-dimensional radiographs have proven unreliable in assessing bilateral symmetry, so we assessed 3-dimensional configurations to assess bilateral symmetry.

  1. Contact mechanics of reverse engineered distal humeral hemiarthroplasty implants.

    Science.gov (United States)

    Willing, Ryan; King, Graham J W; Johnson, James A

    2015-11-26

    Erosion of articular cartilage is a concern following distal humeral hemiarthroplasty, because native cartilage surfaces are placed in contact with stiff metallic implant components, which causes decreases in contact area and increases in contact stresses. Recently, reverse engineered implants have been proposed which are intended to promote more natural contact mechanics by reproducing the native bone or cartilage shape. In this study, finite element modeling is used in order to calculate changes in cartilage contact areas and stresses following distal humeral hemiarthroplasty with commercially available and reverse engineered implant designs. At the ulna, decreases in contact area were -34±3% (p=0.002), -27±1% (pengineered and cartilage reverse engineered designs, respectively. Peak contact stresses increased by 461±57% (p=0.008), 387±127% (p=0.229) and 165±16% (p=0.003). At the radius, decreases in contact area were -21±3% (p=0.013), -13±2% (p0.999), 241±32% (p=0.010) and 61±10% (p=0.021). Between the three different implant designs, the cartilage reverse engineered design yielded the largest contact areas and lowest contact stresses, but was still unable to reproduce the contact mechanics of the native joint. These findings align with a growing body of evidence indicating that although reverse engineered hemiarthroplasty implants can provide small improvements in contact mechanics when compared with commercially available designs, further optimization of shape and material properties is required in order reproduce native joint contact mechanics. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Use of arthroscopy in the treatment of fragmented medial coronoid process of the ulna: case report in a dog

    Directory of Open Access Journals (Sweden)

    Paula Abi Rached

    2005-10-01

    Full Text Available O termo displasia de cotovelo (DC descreve um estado anormal da articulação úmero-rádio-ulnar, causada por desenvolvimento inadequado da mesma. As lesões mais comumente encontradas são fragmentação do processo coronóide medial (FPCM da ulna, osteocondrite dissecante (OCD da porção medial do côndilo umeral, não união do processo ancôneo (NUPA e incongruência articular (IA. O tratamento para FPCM pode ser conservativo ou cirúrgico. As técnicas cirúrgicas empregadas são variadas, mas em geral se baseiam na remoção de "flaps" cartilaginosos ou ósseos da articulação. Este trabalho relata o êxito do tratamento da FPCM da ulna utilizando-se a técnica de artroscopia.

  3. The biomechanical analysis of three-dimensional distal radius fracture model with different fixed splints.

    Science.gov (United States)

    Hua, Zhen; Wang, Jian-Wei; Lu, Zhen-Fei; Ma, Jian-Wei; Yin, Heng

    2018-01-30

    The distal radius fracture is one of the common clinical fractures. At present, there are no reports regarding application of the finite element method in studying the mechanism of Colles fracture and the biomechanical behavior when using splint fixation. To explore the mechanism of Colles fracture and the biomechanical behavior when using different fixed splints. Based on the CT scanning images of forearm for a young female volunteer, by using model construction technology combined with RPOE and ANSYS software, a 3-D distal radius fracture forearm finite element model with a real shape and bioactive materials is built. The material tests are performed to obtain the mechanical properties of the paper-based splint, the willow splint and the anatomical splint. The numerical results are compared with the experimental results to verify the correctness of the presented model. Based on the verified model, the stress distribution of different tissues are analyzed. Finally, the clinical tests are performed to observe and verify that the anatomical splint is the best fit for human body. Using the three kinds of splints, the transferred bone stress focus on the distal radius and ulna, which is helpful to maintain the stability of fracture. Also the stress is accumulated in the distal radius which may be attributed to flexion position. Such stress distribution may be helpful to maintain the ulnar declination. By comparing the simulation results with the experimental observations, the anatomical splint has the best fitting to the limb, which can effectively avoid the local compression. The anatomical splint is the most effective for fixing and curing the fracture. The presented model can provide theoretical basis and technical guide for further investigating mechanism of distal radius fracture and clinical application of anatomical splint.

  4. Management and treatment of distal ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Andrea Calafiore

    2013-12-01

    Full Text Available Ulcerative colitis (UC is a chronic inflammatory condition that is confined to the colonic mucosa. Its main symptoms include diarrhea, rectal bleeding and abdominal pain. Approximately two-thirds of UC patients have disease confined distal to the splenic flexure, which can be treated effectively with topical therapy. This means the active drug can be delivered directly to the site of inflammation, limiting the systemic absorption and potential side effects. Topical treatment with aminosalicylates is the most effective approach in the treatment of these forms, provided that the formulation reaches the upper margin of the disease. Given this, the suppository formulation is the treatment of choice for proctitis and distal sigmoiditis. Thanks to their proximal spread, enemas, foams and gels represent the treatment of choice for proctosigmoiditis and for distal ulcerative colitis. Oral aminosalicylates are less effective than topical therapies in patients with active disease, while the combination of topical and oral treatment is more effective in patients refractory to topical or oral mono-therapy. Topically administered aminosalicylates play an important role in the maintenance of remission, but the long-term adhesion to therapy is poor. For this reason, the oral formulation is the first-line therapy in the maintenance of remission. Refractory patients can be treated with topical steroids or systemic steroids and TNF-alpha inhibitors in severe forms.

  5. Biocompatibilidade e comportamento de compósitos de hidroxiapatita em falha óssea na ulna de coelhos Biocompatibility and behavior of hydroxyapatite on bone defect on rabbit's ulna

    Directory of Open Access Journals (Sweden)

    C.C. Vital

    2006-04-01

    Full Text Available Avaliaram-se os compósitos de hidroxiapatita sintética e carbono (HAC e hidroxiapatita sintética, carbono e fosfato biácido de sódio (HACF, ambos na forma sólida, como substituto ósseo em 36 coelhos adultos. Após protocolos anestésico e cirúrgico habituais, retirou-se um fragmento de aproximadamente 2cm de comprimento no terço médio da ulna esquerda. Os animais do grupo 1 receberam, em cada falha provocada, blocos de HAC e HACF, e os do grupo 2 somente HAC. Os do grupo 3 não receberam tratamento. Os animais foram submetidos a avaliações clínicas e radiológicas nos dias 8, 15, 30, 60, 120 e 180 de pós-operatório. Nas mesmas datas, dois animais de cada grupo foram sacrificados e deles colheu-se material para histologia. Observou-se evolução normal da regeneração óssea em todos os animais, sendo mais precoce nos dos grupos que receberam os compósitos. O uso de HAC e HACF na ulna de coelho mostrou-se um método eficiente, não apresentando sinais de infecção e nem evidência de rejeição.Composites of synthetic hydroxyapatite and carbon (HAC and synthetic hydroxyapatite, carbon and sodium biacid phosphate (HACF, both of them in solid form, as substitute in bone regeneration were studied. Thirty-six rabbits divided in three groups were used. After routine anesthetic and surgical procedure, a bone fragment with two-centimeter in length was taken from the middle part of the left ulna. Animals from group 1 received one block of HAC and HACF, from group 2 received only HAC, in the criated bone defect, and animals from group 3 did not receive any treatment. They were submitted to clinical and radiographic examinations at 8, 15, 30, 60, 120 and 180 days after surgery to evaluate bone healing. At the same dates, two animals of each group were enthanised and bone fragments were collected for histological evaluations. The results showed normal evolution of bone regeneration in all groups but faster in animals that received the

  6. Distal corporoplasty for distal cylinders extrusion after penile prosthesis implantation.

    Science.gov (United States)

    Carrino, Maurizio; Chiancone, Francesco; Battaglia, Gaetano; Pucci, Luigi; Fedelini, Paolo

    2017-02-03

    Distal extrusion of cylinders is a potential complication of the penile prosthesis implantation. Several methods have been proposed for repairing a distal penile erosion. We present our preliminary experience in "Distal corporoplasty" technique. We enrolled 18 consecutive patients whose underwent a distal corporoplasty with simultaneous reimplantation of an "AMS 700 inflatable penile prosthesis (LGX)" from January 2013 to November 2015 at our hospital. All procedures were performed by a single surgical team. Intraoperative and postoperative complications have been classified and reported according to Satava6 and Clavien-Dindo (CD) system.7 Mean values with standard deviations (±SD) were computed and reported for all items. Mean age of the patients was 53.61 (±11.90) years. Mean body max index (BMI) was 24.22 (±2.51). Mean operative time was 85.2 (±13.1) minutes. Blood losses were minimal. No intraoperative complications are reported according to Satava classification. Four out of 18 patients (22.22%) experienced postoperative complications according to CD system. All patients had sexual intercourse for the first time postsurgery after a mean of 59.11 ± 2.08 days. Mean follow-up was 22.11 (±9.95). Distal extrusion of cylinders is a potential complication of the penile prosthesis implantation. Distal corporoplasty was first described by Mulcahy. He reported a series of 14 patients with a follow-up of about 2 years with optimal functional outcomes. Moreover, distal corporoplasty resulted in shorter operative time, better function, less pain, and fewer recurrences than Gortex windsock repair.10 In our experience, distal corporoplasty is a simple and safe procedure in the treatment of distal cylinders extrusion when the prosthetic material is not exposed to the exterior.

  7. Distal esophageal spasm.

    Science.gov (United States)

    Roman, Sabine; Kahrilas, Peter J

    2015-07-01

    Distal esophageal spasm (DES) is a rare esophageal motility disorder associated with dysphagia and chest pain. In 2011, the diagnosis of DES was refined based on the occurrence of premature (rather than rapid) contractions by high-resolution manometry. New therapeutic options have also been recently proposed. Thus, a review on DES incorporating publications since 2012 is timely because of these revisions in definition and management. DES remains a heterogeneous clinical disorder. Its pathophysiology is still debated and DES might be related to achalasia. Alternatively, it might be secondary to medications, especially opiates. Endoscopic ultrasound might be informative diagnostically by demonstrating muscularis propria hypertrophy and thickening. Botulinum toxin injection in the esophageal body has been shown superior to placebo to relieve symptoms associated with DES. Finally, per oral endoscopic myotomy is a promising therapeutic approach, but may be less effective in DES than in achalasia. The diagnosis of DES should lead to a systematic search for medication that might promote the occurrence of esophageal dysmotility. Endoscopic treatment of DES (botulinum toxin injection or per oral endoscopic myotomy) should be further evaluated in controlled studies using current diagnostic criteria by high-resolution manometry.

  8. Ipsilateral olecranon and distal radius fracture: A case report.

    Science.gov (United States)

    Cengiz, Ömer; Polat, Gökhan; Karademir, Gökhan; Kara, Deniz; Erdil, Mehmet

    2015-01-01

    Concomitant ipsilateral olecranon and distal radius fracture are rare injuries. Their clinical presentation is unusual and investigation and management is poorly described. We present a 55-year-old woman patient who fell off sustaining a concomitant distal radius and olecranon fracture in the same extremity. On examination, there was gross swelling of the proximal and distal forearm and no neurovascular deficit. Radiographs confirmed distal radius and olecranon fracture. Patient was treated with open reduction and anatomic locking plate for olecranon and a closed reduction percuteneous K wire fixation with penning fixator for distal radius fracture. After physical therapy program, functional results were good and DASH score was 60. Several different combinations of fracture with dislocation have been described, but, to our knowledge, concurrent ipsilateral olecranon and distal radius fracture has not been reported before. In the literature review there are two similar cases in the English literature. Ipsilateral olecranon and distal radius fracture is a very rare injury due to different trauma mechanisms. However we should keep in mind that there may be adjacent joints and structures for concomitant injuries. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. Fractures of the distal radius in children: A retrospective evaluation

    Directory of Open Access Journals (Sweden)

    Selma Yazıcı

    2012-06-01

    Full Text Available Objectives: This study designed to evaluate the resultsof treatment, closed reduction and percutaneous wires, ofthe distal radius fractures in children.Materials and methods: A retrospective analysis wascarried out in children aged between 5-15 years who presentedwith a displaced fracture of the distal radius to ourhospital. They were initially treated with closed reductionand cast immobilization. If the fractures redisplaced treatedby percutaneous Kirschner (K- wire with scope undera general anaesthesia.Results: Totally 104 patients, who have distal radius fractureswere treated by closed reduction and immobilizationin a plaster cast. 13 patient who have distal radiusfractures were treated by closed reduction under generalanaesthesia and fixed by percutaneous Kirschner (K-wire. Patients with impaired the alignment of the fracturein late period were usually completely displaced fractures.(n=5, 4,3%, in early period, completely displaced fractures(n=5, 4,3% are superior to partial displaced fractures(n=2, 1,7%.Conclusion: In our study, when children with distal radiusfracture first come, they were treated by closed reductionand immobilization in a plaster cast. We thought that inredisplaced fractures patients were suitable for the closedreduction with percutaneous wire treatment.

  10. [Comparison of laparoscopic distal pancreatectomy and open distal pancreatectomy in pancreatic ductal adenocarcinoma].

    Science.gov (United States)

    Xu, K; Su, J J; Su, M; Yan, L; Feng, J; Xin, X L; Chen, Y L

    2017-10-23

    Objective: To compare and evaluate the curative effect of laparoscopic distal pancreatectomy(LDP) and traditional open distal pancreatectomy(ODP) in pancreatic ductal adenocarcinoma. Methods: The clinical data of 15 patients treated by LDP and 87 contemporaneous cases treated by ODP from January 2010 to November 2015 was collected, and the curative effect and prognosis of these patients were retrospectively analyzed. Results: The operation time of LDP group was (286.5±48.1) min, significantly longer than that of OPD group(226.6±56.8) min ( P 0.05). In both LDP group and ODP group, none occurred percutaneous drainage, re-admissions, second operation or perioperative death. Conclusions: Compared to ODP, LDP is much safer and more steady in perioperative periodand operation. Patients of pancreatic ductal adenocarcinoma received LDP can acquire more benefit and recovery sooner, and LDP is a safe and effective operative method.

  11. Cuttable plate fixation for small breed dogs with radius and ulna fractures: Retrospective study of 31 dogs.

    Science.gov (United States)

    Watrous, Gwyneth K; Moens, Noel M M

    2017-04-01

    This retrospective study evaluated complication rates for radius and ulna fractures in small breed dogs in which 1.5 mm to 2.7 mm cuttable bone plates were used for internal fixation. The medical records of all cases from 2004 to 2011 that were presented to our clinic were reviewed. Inclusion criteria were: dogs with body weight dogs met the inclusion criteria. Of 25 dogs that were available for follow-up, all achieved union, minor complications occurred in 9, and major complications occurred in 8. External coaptation was responsible for complications in 8 cases and the need for coaptation needs to be investigated. Excluding minor complications, 32% of patients required at least 1 additional surgery or additional hospitalization. All but 2 of the dogs returned to full function. The 1.5 mm straight plate was successfully used in all dogs with a body weight of 0.9 to 2.6 kg.

  12. Successful use of autogenous bone graft for the treatment of a radius-ulna nonunion in an amputee dog

    Directory of Open Access Journals (Sweden)

    B.W. Minto

    2015-08-01

    Full Text Available Fracture nonunions represent important complications in orthopedic surgeries. Nonunion repairs or bone defects are surgically challenging. Our aim was to describe a nonunion case, which was repaired with rapid bone recovery. An 8-month-old male mixed breed dog that has been previously operated was presented to the Veterinary Medical Teaching Hospital of São Paulo State University, with a right radius-ulna nonunion and an amputated contralateral forelimb. A cancellous bone graft was collected from a partially amputated limb, in order to correct the nonunion, and used in association with a locking plate. After four weeks, the bone graft had been incorporated into the original bone. Clinical union with good weight bearing was achieved after eight weeks.

  13. Computer-assisted planning and navigation for corrective distal radius osteotomy, based on pre- and intraoperative imaging

    NARCIS (Netherlands)

    Dobbe, J. G. G.; Strackee, S. D.; Schreurs, A. W.; Jonges, R.; Carelsen, B.; Vroemen, J. C.; Grimbergen, C. A.; Streekstra, G. J.

    2011-01-01

    Malunion after a distal radius fracture is very common and if symptomatic, is treated with a so-called corrective osteotomy. In a traditional distal radius osteotomy, the radius is cut at the fracture site and a wedge is inserted in the osteotomy gap to correct the distal radius pose. The standard

  14. Histologic Evaluation of Critical Size Defect Healing With Natural and Synthetic Bone Grafts in the Pigeon ( Columba livia ) Ulna.

    Science.gov (United States)

    Tunio, Ahmed; Jalila, Abu; Goh, Yong Meng; Shameha-Intan; Shanthi, Ganabadi

    2015-06-01

    Fracture and bone segment loss are major clinical problems in birds. Achieving bone formation and clinical union in a fracture case is important for the survival of the bird. To evaluate the efficacy of bone grafts for defect healing in birds, 2 different bone grafts were investigated in the healing of a bone defect in 24 healthy pigeons ( Columba livia ). In each bird, a 1-cm critical size defect (CSD) was created in the left ulna, and the fracture was stabilized with external skeletal fixation (ESF). A graft of hydroxyapatite (HA) alone (n = 12 birds) or demineralized bone matrix (DBM) combined with HA (n = 12 birds) was implanted in the CSD. The CSD healing was evaluated at 3 endpoints: 3, 6, and 12 weeks after surgery. Four birds were euthanatized at each endpoint from each treatment group, and bone graft healing in the ulna CSD was evaluated by histologic examination. The CSD and graft implants were evaluated for quality of union, cortex development, and bone graft incorporation. Results showed no graft rejection in any bird, and all birds had connective tissue formation in the defect because of the bone graft application. These results suggest that bone defect healing can be achieved by a combination of osteoinductive and osteoconductive bone graft materials for clinical union and new bone regeneration in birds. The combination of DBM and HA resulted in a better quality bone graft (P < .05) than did HA alone, but there was no significant differences in cortex development or bone graft incorporation at 3, 6, or 12 weeks. From the results of this study, we conclude that HA bone grafts, alone or in combination with DBM, with external skeletal fixation is suitable and safe for bone defect and fracture treatment in pigeons.

  15. External Fixation of Unstable Distal Radius Fracture. A Case Report

    OpenAIRE

    Yaniel Truffin Rodríguez; Rafael Esmandy Gámez Arregoitía; Indira L. Gómez Gil; José Julio Requeiro Morejón

    2014-01-01

    Unstable fracture of the distal radius is a common injury. If not properly treated, it can cause major disturbance in the radiocarpal joint and impaired hand function. A case of a 42-year-old patient of rural origin without a history of previous conditions treated at the Gustavo Aldereguía Lima Hospital in Cienfuegos is presented. He suffered a fall on the outstretched hand, which led to an unstable fracture of the left distal radius. Emergency surgery consisting of manual fracture reduction ...

  16. Repair of distal biceps brachii tendon ruptures.

    Science.gov (United States)

    Bell, R H; Wiley, W B; Noble, J S; Kuczynski, D J

    2000-01-01

    This study consisted of 26 male patients with distal biceps tendon ruptures, 2 of whom had bilateral injuries, making the total number of ruptures 28. The average age at injury was 45 years. The treatment groups were the following: 3 were treated without surgery, 4 were repaired with brachialis tenodesis, and 21 were reattached to the radial tuberosity by the 2-incision Boyd-Anderson approach. Patients underwent follow-up a minimum of 14 months after surgery, with the average being 43 months. Outcome was evaluated based on the physical examination, isokinetic testing of strength and endurance of flexion and supination, and radiographic analysis.

  17. Carpal alignment in distal radial fractures

    Directory of Open Access Journals (Sweden)

    Jain Pankaj

    2002-05-01

    Full Text Available Abstract Background Carpal malalignment following the malunited distal radial fracture is described to develop as an adaptation to realign the hand to the malunion. It worsens gradually after healing of the fracture due to continued loading of the wrist. It is also reported to develop during the immobilization itself rather than after fracture healing. The present work was aimed to study the natural course and the quantitative assessment of such adaptive carpal realignment following distal radial fracture. Methods In a prospective study, 118 distal radial fractures treated with different modalities were followed-up with serial radiographs for a year for assessment of various radiological parameters. Results Two patterns of carpal malalignment were identified depending upon the effective radio-lunate flexion (ERLF measured on pre-reduction radiographs. The midcarpal malalignment was seen in 98 radial fractures (83% with the lunate following the dorsiflexed fracture fragment and a measured ERLF of less than 25°. The second pattern of radio-carpal malalignment showed the fracture fragment to dorsiflex without taking the lunate with a measured ERLF of more than 25°. The scaphoid did not follow the fracture fragment in both the patterns of malalignment. Conclusion It is better to assess distal radial fractures for any wrist ligamentous injury on the post-reduction film with the restored radial anatomy than on the pre-reduction film since most carpal malalignments get corrected with the reduction of the fracture. Similar carpal malalignment reappear with the redisplacement of the fracture as seen in pre-reduction radiographs and develops during the immobilization rather than as a later compensatory mechanism for the malunion.

  18. Complications of resection and reconstruction in giant cell tumour of distal end of radius - An analysis

    Directory of Open Access Journals (Sweden)

    Saraf S

    2005-01-01

    Full Text Available Background: The bulk of literature on the subject focuses on the resection of the tumor followed by reconstruction using autologous fibula, however, papers analyzing the failures of this procedure are scanty. The aim is to analyze the various factors responsible for the failures. Methods: Study included 42 patients of aggressive GCT of distal radius, resected and reconstructed using nonvascularised autologous fibula. Host graft junction was fixed using screws (6, intramedullary nail (21 and plate (15. The minimum follow-up was 2 years or till a complication occurred requiring second surgery. Result: The major complications were recurrence in 6 cases (spillage of tumor tissue in 3, poor biopsy site 2, recurrence along the nail tract one case; failure of host graft union in 8 cases due to inadequate contact at host graft junction, poor implant selection, inadequate immobilization and infection; significant instability at wrist in 6 cases due to poor stabilization at carpo fibular junction in addition to inherent instability due to poor congruity between fibulocarpal articulations. Conclusion: Reconstruction of distal end of radius using auto fibula has much higher complication rates than usually believed. A meticulous planning and its execution is must to minimize the problems. Use of dynamic plate for host graft junction and fixation of fibular head to adjacent ulna/carpal bones improves the results.

  19. Giant cell tumor of the bone: aggressive case initially treated with denosumab and intralesional surgery

    Energy Technology Data Exchange (ETDEWEB)

    Von Borstel, Donald; Strle, Nicholas A. [Oklahoma State University Medical Center, Department of Radiology, Tulsa, OK (United States); Taguibao, Roberto A. [University of California, Irvine, UCI Medical Center, Department of Pathology, Orange, CA (United States); Burns, Joseph E. [University of California, Irvine, UCI Medical Center, Department of Radiological Sciences, Orange, CA (United States)

    2017-04-15

    Giant cell tumor of the bone (GCTB) is a locally aggressive benign tumor, which has historically been treated with wide surgical excision. We report a case of a 29-year-old male with histology-proven GCTB of the distal ulna. The initial imaging study was a contrast-enhanced magnetic resonance imaging (MRI) examination of the left wrist, which was from an outside facility performed before presenting to our institution. On the initial MRI, the lesion had homogenous T2-hyperintense and T1-hypointense signal with expansive remodeling of the osseous contour. A radiographic study performed upon presentation to our institution 1 month later showed progression of the lesion with atypical imaging characteristics. After confirming the diagnosis, denosumab therapy was implemented allowing for reconstitution of bone and intralesional treatment. The patient was treated with five doses of denosumab over the duration of 7 weeks. Therapeutic changes of the GCTB were evaluated by radiography and a post-treatment MRI. This MRI was interpreted as suspicious for worsening disease due to the imaging appearance of intralesional signal heterogeneity, increased perilesional fluid-like signal, and circumferential cortical irregularity. However, on subsequent intralesional curettage and bone autografting 6 weeks later, no giant cells were seen on the specimen. Thus, the appearance on the MRI, rather than representing a manifestation of lesion aggressiveness or a non-responding tumor, conversely represented the imaging appearance of a positive response to denosumab therapy. On follow-up evaluation, 5 months after intralesional treatment, the patient had recurrent disease and is now scheduled for wide-excision with joint prosthesis. (orig.)

  20. OUTCOME OF DISTAL TIBIA FRACTURE BY NAIL OR PLATE (MIPPO)- A COMPARATIVE STUDY

    OpenAIRE

    Madhuchandra R; Chandrashekhar Mudgal; Sandeep; Amol Shivaji Chavan

    2017-01-01

    BACKGROUND Distal tibial fracture often present a challenge to the orthopaedic surgeon. The best option for surgical management of distal tibial fracture is still unclear, whether nail or plate. MATERIALS AND METHODS The study consists of 24 patients of distal tibial fracture treated either with reamed intramedullary nails or locked plating/MIPPO with open reduction method or minimally-invasive techniques. RESULTS 24 patients included in the present study were divided i...

  1. Reverse Distal Transverse Palmar Arch in Distal Digital Replantation.

    Science.gov (United States)

    Wei, Ching-Yueh; Orozco, Oscar; Vinagre, Gustavo; Shafarenko, Mark

    2017-11-01

    Refinements in microsurgery have made distal finger replantation an established technique with high success rates and good functional and aesthetic outcomes. However, it still represents a technically demanding procedure due to the small vessel caliber and frequent lack of vessel length, requiring the use of interpositional venous grafts in some instances. We describe a new technique for anastomosis in fingertip replantation, whereby the need for venous grafts is eliminated. Applying the reverse distal transverse palmar arch technique, 11 cases of distal digital replantation were performed between January 2011 and July 2016. The described procedure was used for arterial anastomosis in 10 cases and arteriovenous shunting for venous drainage in 1 case. A retrospective case review was conducted. The technical description and clinical outcome evaluations are presented. Ten of the 11 replanted digits survived, corresponding to an overall success rate of 91%. One replant failed due to venous insufficiency. Blood transfusions were not required for any of the patients. Follow-up (range, 1.5-5 months) revealed near-normal range of motion and good aesthetic results. All of the replanted digits developed protective sensation. The average length of hospital admission was 5 days. All patients were satisfied with the results and were able to return to their previous work. The use of the reverse distal transverse palmar arch is a novel and reliable technique in distal digital replantation when an increase in vessel length is required, allowing for a tension-free arterial repair without the need for vein grafts.

  2. Endoprosthetic Reconstruction of distal Humerus following Resection of distal Humeral Giant Cell Tumours in Six Patients in Rural India

    Directory of Open Access Journals (Sweden)

    Balasubramanian N

    2017-07-01

    Full Text Available Giant cell tumour is a commonly occurring benign bone tumour in the Indian population. The common sites of involvement in descending order of frequency are distal femur, proximal tibia, distal radius and proximal humerus. The less commonly occurring sites are distal humerus, pelvis and proximal femur. We present six cases of giant cell tumour involving the distal humerus in rural India. After obtaining a tissue diagnosis by Trucut biopsy and classifying using Enneking's classification, we proceeded to perform wide resection followed by endoprosthetic reconstruction using custom mega prosthesis. We present here six patients (M: F: 2: 4 who were managed by us between 2008-2014. They presented to us with pain around the elbow and restriction in range of movements. They were each noted radiographically to have a lytic lesion involving the distal humerus with the likely diagnosis of giant cell tumour. Closed biopsy was done in all of them to obtain a definitive diagnosis. All patients underwent wide resection and reconstruction using distal humerus custom prosthesis. All patients were followed up at 6, 12, 18 and 24 weeks and thereafter six monthly until the last review. They were assessed using the DASH scoring system. All patients were well with no evidence of recurrence with good to fair functional outcome. We conclude that careful pre-operative planning with meticulous soft tissue dissection and good implant metallurgy and design, these tumours can be treated with good long term functional results.

  3. Endoprosthetic replacement of distal femoral tumors in Nigeria: A ...

    African Journals Online (AJOL)

    2015-08-12

    Aug 12, 2015 ... In this observational study, three consecutive patients who were treated for distal femur tumours using endoprosthetic replacement between June 2013 and June 2014 were studied. The patients were within the ages of 28-47 years at the time of surgery. All three patients had modular endoprosthesis ...

  4. Simultaneous ipsilateral fractures of distal and proximal ends of the radius

    OpenAIRE

    El Kadi, Khalid Ibn; Benabid, Mounir; Saliou, Sarr; El Assil, Oussama; Marzouki, Amine; Lahrach, Kamal; Boutayeb, Fawzi

    2017-01-01

    We treated a patient with a rare combination of ipsilateral fractures of the distal and proximal ends of the radius. A man aged 42 years had simultaneous fractures of the distal and proximal ends of the radius (radial neck) following a roadside accident. The distal end fracture of the radius was treated with surgical reduction and T-plate volar fixation, and the undisplaced radial neck fracture was treated by an above elbow splintage for 2 weeks. The elbow mobilization was started at 2 weeks....

  5. Proximal ulna stress fracture and stress reaction of the proximal radius associated with the use of crutches: a case report and literature review.

    Science.gov (United States)

    Venkatanarasimha, Nanda; Kamath, Sridhar; Kambouroglou, G; Ostlere, Simon J

    2009-09-01

    We report a case of complete stress fracture of the ulna and stress reaction of the radius resulting from the use of crutches in an overweight patient with severe lower extremity arthritis. Plain radiograph showed an undisplaced complete fracture of the proximal metaphysis of the ulna. Magnetic resonance imaging (MRI) was performed to exclude a pathological cause in view of the unusual fracture site, which confirmed the plain radiographic findings and additionally demonstrated a stress reaction in the proximal radius. There are three cases of stress fracture of the ulnar diaphysis resulting from the use of crutches reported previously in the English literature and a further case of bilaterally symmetrical ulnar diaphysial fracture reported in the Danish literature. We report the first case of ulnar metaphysis stress fracture with concomitant stress reaction of the radius.

  6. Thoracic stent grafts with a distal fenestration for the celiac axis

    NARCIS (Netherlands)

    Tielliu, IFJ; Verhoeven, ELG; Zeebregts, CJ; Prins, TR; van den Dungen, JJAM

    2005-01-01

    Descending thoracic aneurysms can be treated with a stent graft provided that there is sufficient proximal and distal aortic neck length above the celiac axis. One of the options for the treatment of thoracic aneurysms with a too short distal neck is described in this report. For this purpose, a

  7. Fractures of the bilateral distal radius and scaphoid: a case report

    Directory of Open Access Journals (Sweden)

    Ozkan Korhan

    2008-03-01

    Full Text Available Abstract Introduction Bilateral fractures of the distal radius and scaphoid are extremely rare injuries. Case presentation A patient with bilateral comminuted, displaced distal fractures of the radius and bilateral fractures of the scaphoid was treated via internal fixation of the scaphoid fractures with Herbert screws and internal fixation of the distal radius fractures with locked volar plating. Conclusion Rigid internal fixation of distal radius and scaphoid fractures is mandatory to start early active rehabilitation of the wrist without the need for wrist immobilization with a plaster or external skeletal fixation.

  8. Refined balloon pulmonary angioplasty driven by combined assessment of intra-arterial anatomy and physiology--Multimodal approach to treated lesions in patients with non-operable distal chronic thromboembolic pulmonary hypertension--Technique, safety and efficacy of 50 consecutive angioplasties.

    Science.gov (United States)

    Roik, Marek; Wretowski, Dominik; Łabyk, Andrzej; Kostrubiec, Maciej; Irzyk, Katarzyna; Dzikowska-Diduch, Olga; Lichodziejewska, Barbara; Ciurzyński, Michał; Kurnicka, Katarzyna; Gołębiowski, Marek; Pruszczyk, Piotr

    2016-01-15

    Balloon pulmonary angioplasty (BPA) is an emerging therapeutic method in CTEPH. We aimed to prove the safety and efficacy of refined BPA driven by combined assessment of intra-arterial anatomy (IVUS/OCT) and physiology (pulmonary pressure ratio, PPR) in non-operable distal CTEPH. 11 pts (mean age 76, 59–84, 7 males) were enrolled in the BPA program according to the following inclusion criteria: 1. Non-operable CTEPH; 2. RHC with mPAP > 30 mm Hg; 3. At least one segmental perfusion defect at lung scintigraphy; 4. WHO class > II. Overall, 9 pts underwent 27 BPA sessions (mean 3 sessions per patient, range 1–5), 50 pulmonary arteries were dilated (mean 6 vessels per patient, range 3–9; 2.03 dilated arteries per session). All the angioplasties were performed according to an algorithm, which incorporated anatomical and functional assessment of targeted lesions. We performed BPA of 32 web lesions, 5 ring-like stenosis and 13 complete obstructions. BPA resulted in clinical and hemodynamic improvement. WHO class improved from pre-BPA to post-BPA (p = 0.018), and 6 MWD increased from 304 m to 384 m (p = 0.03), NT-proBNP dropped from 1248 pg/ml to 730 pg/ml (p < 0.001). Mean PAP and PVR decreased (p = 0.01), while CO and CI increased (p = 0.01). All dilated arteries were patent at angiographic reassessment. No significant complications occurred and all treated patients are still alive. Insignificant transient reperfusion pulmonary oedema occurred in only 2 patients, who responded well to supplemental oxygen. Refined BPA with assessment of intrapulmonary physiology using a pressure wire and precise evaluation of anatomy with IVUS and OCT provides hemodynamic and functional improvement, with minimal complications in distal non-operable CTEPH. This observation requires further validation in a large prospective study.

  9. Association between distal ulnar morphology and extensor carpi ulnaris tendon pathology

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Connie Y.; Huang, Ambrose J.; Bredella, Miriam A.; Kattapuram, Susan V.; Torriani, Martin [General Hospital and Harvard Medical School, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts, Boston, MA (United States)

    2014-06-15

    The purpose of this study was to evaluate the association between distal ulnar morphology and extensor carpi ulnaris (ECU) tendon pathology. We retrospectively reviewed 71 adult wrist MRI studies with ECU tendon pathology (tenosynovitis, tendinopathy, or tear), and/or ECU subluxation. Subjects did not have a history of trauma, surgery, infection, or inflammatory arthritis. MRI studies from 46 subjects without ECU tendon pathology or subluxation were used as controls. The following morphological parameters of the distal ulna were measured independently by two readers: ulnar variance relative to radius, ulnar styloid process length, ECU groove depth and length. Subjects and controls were compared using Student's t test. Inter-observer agreement (ICC) was calculated. There was a significant correlation between negative ulnar variance and ECU tendon pathology (reader 1 [R1], P = 0.01; reader 2 [R2], P < 0.0001; R1 and R2 averaged data, P < 0.0001) and ECU tendon subluxation (P = 0.001; P = 0.0001; P < 0.0001). In subjects with ECU tendon subluxation there was also a trend toward a shorter length (P = 0.3; P <0.0001; P = 0.001) and a shallower ECU groove (P = 0.01; P = 0.03; P = 0.01; R1 and R2 averaged data with Bonferroni correction, P = 0.08). ECU groove depth (P = 0.6; P = 0.8; P = 0.9) and groove length (P = 0.1; P = 0.4; P = 0.7) showed no significant correlation with ECU tendon pathology, and length of the ulnar styloid process showed no significant correlation with ECU tendon pathology (P = 0.2; P = 0.3; P = 0.2) or subluxation (P = 0.4; P = 0.5; P = 0.5). Inter-observer agreement (ICC) was >0.64 for all parameters. Distal ulnar morphology may be associated with ECU tendon abnormalities. (orig.)

  10. Osteoblastoma-like osteosarcoma of the distal tibia

    Energy Technology Data Exchange (ETDEWEB)

    Abramovici, Luigia; Steiner, German C. [Department of Pathology and Laboratory Medicine, Hospital for Joint Diseases, New York, NY (United States); Kenan, Samuel [Department of Orthopaedic Oncology Surgery, Hospital for Joint Diseases, New York, NY (United States); Hytiroglou, Prodromos [Aristotle University, Thessaloniki (Greece); Rafii, Mahvash [Department of Radiology, Hospital for Joint Diseases, New York, NY (United States)

    2002-03-01

    We report a case of a 14-year-old boy with an intracompartmental lytic lesion with poorly defined margins in the right distal tibia that was originally treated with curettage and bone grafting. Histologic examination showed an osteoblastic tumor with unusual features, which was found on consultation to be an osteoblastoma-like osteosarcoma, a rare, low-grade variant of osteosarcoma. Subsequently, the patient underwent en bloc resection of the distal tibia, which was replaced with vascularized bone graft and followed by chemotherapy. Two years later, he is alive with lung metastases. (orig.)

  11. Comparative distalization effects of Jones jig and pendulum appliances.

    Science.gov (United States)

    Patel, Mayara Paim; Janson, Guilherme; Henriques, José Fernando Castanha; de Almeida, Renato Rodrigues; de Freitas, Marcos Roberto; Pinzan, Arnaldo; de Freitas, Karina Maria Salvatore

    2009-03-01

    In this study, we compared the dentoalveolar changes of Class II patients treated with Jones jig and pendulum appliances. The experimental group comprised 40 Class II malocclusion subjects, divided into 2 groups: group 1 consisted of 20 patients (11 boys, 9 girls) at a mean pretreatment age of 13.17 years, treated with the Jones jig appliance for 0.91 years; group 2 comprised 20 patients (8 boys, 12 girls) at a mean pretreatment age of 13.98 years, treated with the pendulum appliance for 1.18 years. Only active treatment time of molar distalization was evaluated in the predistalization and postdistalization lateral cephalograms. Molar, second premolar, and incisor angular and linear variables were obtained. The intergroup treatment changes in these variables were compared with independent t tests. The maxillary second premolars showed greater mesial tipping and extrusion in the Jones jig group, indicating more anchorage loss during molar distalization with this appliance. The amounts and the monthly rates of molar distalization were similar in both groups. The Jones jig group showed greater mesial tipping and extrusion of the maxillary second premolars. The mean amounts and the monthly rates of first molar distalization were similar in both groups.

  12. Dermal pocketing following distal finger replantation.

    Science.gov (United States)

    Puhaindran, Mark E; Paavilainen, Pasi; Tan, David M K; Peng, Yeong Pin; Lim, Aymeric Y T

    2010-08-01

    Replantation is an ideal technique for reconstruction following fingertip amputation as it provides 'like for like' total reconstruction of the nail complex, bone pulp tissue and skin with no donor-site morbidity. However, fingertips are often not replanted because veins cannot be found or are thought to be too small to repair. Attempts at 'cap-plasty' or pocketing of replanted tips with and without microvascular anastomosis have been done in the past with varying degrees of success. We prospectively followed up a group of patients who underwent digital replantation and dermal pocketing in the palm to evaluate the outcome of this procedure. There were 10 patients with 14 amputated digits (two thumbs, five index, four middle, two ring and one little) who underwent dermal pocketing of the amputated digit following replantation. Among the 14 digits that were treated with dermal pocketing, 11 survived completely, one had partial atrophy and two were completely lost. Complications encountered included finger stiffness (two patients) and infection of the replanted fingertip with osteomyelitis of the distal phalanx (one patient). We believe that this technique can help increase the chance of survival for distal replantation with an acceptable salvage rate of 85% in our series. Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  13. [Carpal malalignment following distal radius fracture].

    Science.gov (United States)

    Coulet, B; Gauci, M-O; Lazerges, C; Chammas, M

    2016-12-01

    Adaptive carpal malalignment is the consequence of malunion of the distal radius. Since the radial metaphysis and capitate have to be aligned, any disorientation of the radial epiphysis will force the proximal carpal row to adapt, as it is the only mobile element. There are two types of adaptation depending where the compensative occurs: (1) midcarpal - leading to flexion between the lunate and capitate, with the lunate maintaining a normal relationship with the radial epiphysis axis; (2) radiocarpal - combining flexion and dorsal displacement of the lunate relative to the axis of the radial epiphysis, with the midcarpal joint remaining aligned. Clinically, adaptive carpal malalignment is not the first reason for consultation in cases of distal radius malunion. It occurs in cases of moderate deformity with preserved pronation-supination in a young patient who has good mobility. It generates dorsal pain that may be associated with a snapping sensation. The diagnosis requires strict lateral X-ray views. Over time, the wrist becomes stiff but analgesic and is often well tolerated functionally. This type of deformity has not been shown to lead to osteoarthritis. Osteotomy to correct the malunion is the only way to treat adaptive carpal malalignment in active young patients who have a mobile but painful wrist. Copyright © 2016 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  14. Osteoid osteoma of the distal clavicle

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    Bernardo Barcellos Terra

    Full Text Available ABSTRACT The osteoid osteoma is a bone tumor that accounts for 10% of benign tumors. It was described in 1935 by Jaffe, as a tumor that affects the young adult population, with a predominance of males. This study aims to present a case of late diagnosis of a patient with osteoid osteoma of the distal clavicle region. Female patient, 44 years old, non-professional volleyball player, reported pain in the anterior and superior region of the shoulder girdle, specifically in the acromioclavicular joint, which worsened at night and had been treated for nine months as tendinitis of the rotator cuff and acromioclavicular joint arthritis. After confirming the diagnosis, the patient underwent open surgery with resection of the distal clavicle. At two years of follow-up, the patient presents without local pain. In the radiographic evaluation, coracoclavicular distance is preserved and there are no signs of recurrence. Tumors of the shoulder girdle are rare and are often diagnosed late. A high degree of suspicion for the diagnosis of tumors of the shoulder girdle is needed in order to avoid late diagnosis.

  15. [Proximal and distal rupture of the m. biceps brachii].

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    Lorbach, O; Kieb, M; Grim, C; Engelhardt, M

    2010-12-01

    Ruptures of the biceps tendon account for a high percentage of tendon ruptures. The aetiology of proximal ruptures of the long head of the biceps tendon is often degenerative and they are frequently associated with lesions of the rotator cuff. The clinical findings are often not specific and long lasting. Distal ruptures of the biceps tendon mostly occur during eccentric contraction of the biceps muscle.Clinical tests, the associated haematoma and a distalisation or proximalisation of the muscle belly in combination with ultrasound or MRI to rule out combined diseases lead to the diagnosis. The possible options include conservative and operative treatment. Tenotomy and tenodesis lead to comparable results in the literature. Therefore, conservative treatment is mostly recommended in proximal ruptures. Operative treatment is preferred in distal ruptures of the biceps tendon in order to achieve an anatomical reconstruction of the muscle function. Chronic ruptures of the distal biceps tendon can be successfully treated with free autografts or allografts.

  16. FUNCTIONAL RECOVERY AFTER MINIMALLY INVASIVE OSTEOSYNTHESIS IN FRACTURES OF THE SHAFT OF THE RADIUS AND ULNA

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    A. N. Chelnokov

    2016-01-01

    Full Text Available Introduction. Closed intramedullary nailing and external fixation are minimally invasive treatment options in radial and ulnar shaft fractures. We found no comparative studies of these methods in the current literature. Objective. A comparative analysis of both methods in radial and ulnar shaft fractures treated by closed intramedullary nailing and external fixation. Material and methods. 63 patients with forearm shaft fractures treated by closed intramedullary nailing (group I; 24 patients treated by external fixation (group II. All patients were operated within 30 days after injury. Postoperatively, all patients were evaluated clinically (range of motion of elbow and wrist, rotation of the forearm and radiologically. Disability of the Arm, Shoulder and Hand (DASH score was used to assess the functional status and quality of life. Results. The average time of radiological bone union in the group I and group II was 12,6 ± 1,4 weeks. and 12,7 ± 0,6 weeks, accordingly. Statistically significant differences in range of motion in the elbow and wrist occurred in 1 month after the surgery with the advantage in Group I. Restoration of rotation was faster in Group I up to 1 year after surgery. DASH scores in 2 month after the surgery were 11,2±1,96 in the nailing group (as in healthy population and 45,2±6,7 in the external fixation group. In 6 months after surgery the subjective assessment of the quality of life did not differ in both groups. Conclusion. Both minimally invasive methods of surgical stabilization provide restoration of anatomy of the forearm and complete functional recovery in final outcome, but closed intramedullary nailing results with significantly more rapid restoration of range of motions and quality of life measures.

  17. Complications of Minimally Invasive Percutaneous Plating for Distal Tibial Fractures.

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    Muzaffar, Nasir; Bhat, Rafiq; Yasin, Mohammad

    2016-07-01

    The management of distal tibia fractures continues to remain a source of controversy and debate. The aim of this study was to evaluate the various complications of minimally invasive percutaneous plate osteosynthesis (MIPPO) using a locking plate for closed fractures of distal tibia in a retrospective study. Twenty-five patients with distal tibial fractures, treated by minimally invasive percutaneous plate osteosynthesis, were evaluated in a retrospective study. We studied the rate, probable etiological factors and preventive and corrective measures of various complications associated with minimally invasive plating of distal tibia. Mean age of the patients was 41.16 years (range 22 - 65). There were 13 male and 12 female patients. All fractures united at an average duration of 16.8 weeks. There were two cases of superficial and two cases of deep infection, and deep infections required removal of hardware for cure. There were four cases of ankle stiffness, most of them occurring in intra-articular fractures, three cases of palpable implant, three cases of malunion, one case of loss of reduction and one patient required reoperation. The average AO foot and ankle score was 83.6. We found MIPPO using locking plate to be a safe and effective method for the treatment of distal tibial fractures in properly selected patients yet can result in a variety of complications if proper precautions before, during and after surgery are not taken care of.

  18. Fixador esquelético pino-resina acrílica e enxerto ósseo esponjoso no tratamento de complicações secundárias à imobilização inadequada de fratura do rádio e ulna em cães Acrylic-pin external fixator and cancellous bone graft in the treatment of complications caused by inadequate immobilization of radius and ulna fracture in dogs

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    Sheila Canevese Rahal

    2005-10-01

    Full Text Available O objetivo do estudo foi avaliar a eficácia do fixador esquelético pino-resina, configuração tipo II, coadjuvado pelo enxerto ósseo esponjoso autólogo, no tratamento das complicações secundárias à imobilização inadequada de fraturas do rádio e ulna em 10 cães, com peso entre 1,8 e 33,6 kg. Detectou-se não-união (n=4, osteomielite (n=1, má-união (n=1, falência ou quebra de implante (n=4, sendo 60% das lesões referente ao uso prévio de pino intramedular no rádio. A montagem do fixador foi realizada com transfixação de pinos lisos em sua maioria angulados, cujas extremidades excedentes foram dobradas e estabilizadas com resina acrílica. Em todos os casos, utilizou-se enxerto esponjoso autólogo fresco, após debridamento do foco de fratura. O tempo de permanência do aparelho variou entre 45 dias e 5 meses e a maior complicação foi o afrouxamento dos pinos transfixantes. A consolidação das fraturas ocorreu por formação de calo periosteal de mínimo a moderado, indicando boa rigidez da montagem.The aim of this study was to evaluate the acrylic-pin external fixator, type II-configuration, and cancellous bone autograft for treating complications of radius and ulna fractures in 10 dogs weighing between 1.8 and 33.6 kg. Nonunion (n=4, osteomyelitis (n=1, malunion (n=1, failure or breakage of implant (n=4 were detected, and 60 % of them were associated with previous intramedullary pin placement in the radius. The fixator frame was constructed using most of the smooth transfixation pins angled. The fixation rods were constructed by placing acrylic resin over the ends of the transfixation pins that were previously bent. In all cases fresh cancellous bone autograft was used after cleaning of the fracture site. The permanence time of the external fixator ranged from 45 days to 5 months, and the most important complication was pin loosening. Fracture healing was by minimal to moderate periosteal callus, suggesting good rigidity

  19. Evaluation of the Jones jig appliance for distal molar movement.

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    Brickman, C D; Sinha, P K; Nanda, R S

    2000-11-01

    The purpose of this study was to determine the effects of the Jones jig appliance on distal movement of maxillary molars and reciprocal effects on premolars and maxillary incisors. Cephalometric radiographs before and after orthodontic treatment of 72 consecutively treated patients, 46 females and 26 males, were measured to define treatment changes attributed to the Jones jig. Comparative measurements were made on a matched sample of 35 patients (20 females and 15 males) treated with cervical headgear by the same clinician. Both series of patients were treated to correct an Angle Class II molar relationship. The molar correction in the Jones jig patients consisted primarily of molar distal movement. Dental, soft tissue, and skeletal changes were evaluated and compared for significant differences between techniques. The results from the Jones jig sample showed the mean maxillary first molar distal movement was 2.51 mm, with distal tipping of 7.53 degrees. The mean reciprocal mesial movement of the maxillary premolar was 2.0 mm, with mesial tipping of 4.76 degrees. The maxillary first molar extruded 0.14 mm; the maxillary premolar extruded 1.88 mm. The maxillary second molars were also moved distally 2.02 mm and tipped distally 7.89 degrees. The longitudinal assessment (initial to completion of orthodontic treatment) showed significant differences between the Jones jig sample and the cervical headgear sample for lower lip to E-line and SNA. The Jones jig sample showed a mean decrease in lower lip to E-line of 0.25 mm versus 1.20 mm (P jig sample versus 1.20 degrees (P jig sample and cervical headgear sample did not show significant differences of the final position in either linear or angular measurements of the maxillary first molars and corresponding premolar-incisor anchor units. The Jones jig appliance demonstrated treatment results comparable with those of the sample treated with cervical headgear. The Jones jig sample demonstrated effective distal molar

  20. Locking plates in distal humerus fractures: study of 43 patients

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    Gupta Rakesh Kumar

    2013-08-01

    Full Text Available 【Abstract】Objective: The treatment of multi-fragmentary, intraarticular fractures of the distal humerus is difficult, even in young patients with bone of good quality. Small distal fragment, diminished bone mineral quality and increased trauma-associated joint destruction make stable joint reconstruction more problematic. The anatomically preshaped locking plates allow angular stable fixation for these complex fractures. We evaluated functional results of patients treated with open reduction and internal fixation with distal humerus locking plates for complex distal hu-merus fractures. Methods: Forty-three consecutive patients with ar-ticular fractures of the distal humerus were treated by open reduction and internal fixation with AO distal humerus plate system and locking reconstruction plates. Forty patients were available for the final outcome analysis. According to AO/ASIF classification, there were 2 cases of type A2, 4 cases of type A3, 1 case of type B1, 1 case of type B2, 14 cases of type C1, 7 cases of type C2 and 11 cases of type C3. Open reduction with triceps splitting technique was used in all patients. The clinical and radiographic follow-up was performed and outcome measures included pain assessment, range of motion, and Mayo elbow performance score. Results: Forty patients were available for the final outcome analysis. There were 29 males and 11 females with an average age of 38.4 years (18-73 years. Clinical and ra-diological consolidation of the fracture was observed in all cases at an average of 11.6 weeks (9-14 weeks. The average follow-up was 12 months (10-18 months. Using the Mayo elbow performance score the results obtained were graded as excellent or good results in 33 patients (82.5%. One pa-tient had superficial infection, and 4 had myositis ossificans. There were no cases of primary malposition or secondary displacement, implant failure or ulnar neuropathy. Conclusion: Anatomically preshaped distal humerus locking

  1. Spleen-preserving distal pancreatectomy in trauma.

    Science.gov (United States)

    Schellenberg, Morgan; Inaba, Kenji; Cheng, Vincent; Bardes, James M; Lam, Lydia; Benjamin, Elizabeth; Matsushima, Kazuhide; Demetriades, Demetrios

    2018-01-01

    Traumatic injuries to the distal pancreas are infrequent. Universally accepted recommendations about the need for routine splenectomy with distal pancreatectomy do not exist. The aims of this study were to compare outcomes after distal pancreatectomy and splenectomy versus spleen-preserving distal pancreatectomy, and to define the appropriate patient population for splenic preservation. All patients who underwent distal pancreatectomy (January 1, 2007, to December 31, 2014) were identified from the National Trauma Data Bank. Patients with concomitant splenic injury and those who underwent partial splenectomy were excluded. Demographics, clinical data, procedures, and outcomes were collected. Study groups were defined by surgical procedure: distal pancreatectomy and splenectomy versus spleen-preserving distal pancreatectomy. Baseline characteristics between groups were compared with univariate analysis. Multivariate analysis was performed with logistic and linear regression to examine differences in outcomes. Over the 8-year study period, 2,223 patients underwent distal pancreatectomy. After excluding 1,381 patients with concomitant splenic injury (62%) and 8 (pancreatectomy and splenectomy, those who underwent spleen-preserving distal pancreatectomy were younger (p pancreatectomy (p = 0.017). Complications, mortality, and intensive care unit LOS were not significantly different. In young patients after blunt trauma who are not severely injured, a spleen-preserving distal pancreatectomy should be considered to allow for conservation of splenic function and a shorter hospital LOS. In all other patients, the surgeon should not hesitate to remove the spleen with the distal pancreas. Therapy, level IV.

  2. Locking compression plate stabilization of 20 distal radial and ulnar fractures in toy and miniature breed dogs.

    Science.gov (United States)

    Gibert, S; Ragetly, G R; Boudrieau, R J

    2015-01-01

    To evaluate retrospectively the effectiveness of the Locking Compression Plate® (LCP), in the form of either a straight or notched head T-plate, for the treatment of fractures of the distal radius and ulna in a series of 20 toy and miniature breed dogs. The medical records of toy and miniature breed dogs (plate). Twenty fractures (20 dogs) satisfied the inclusion criteria; eight straight and 12 notched head T-plates were used, either 2.0 mm (n = 13) or 2.4 mm (n = 7). Hybrid fixation was performed in all dogs in one or both fragments. Mean time to radiographic union was 6.9 ± 2.5 weeks (range: 4-12 weeks) in 18/20 dogs with radiographic follow-up. One complication was observed: infection that resolved with antibiotic medication and implant removal. No other major complications occurred by the time of last follow-up. In all cases (mean follow-up: 15 ± 7 months), the reported limb function as evaluated by the referring veterinarian or owner was excellent. The LCP, used as a hybrid construct for the treatment of distal radial and ulnar fractures was shown to yield excellent clinical results with both uncomplicated healing and excellent functional outcomes in this series of toy and miniature breed dogs.

  3. Outcome of distal end clavicle fractures treated with locking plates

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    Raju Vaishya

    2017-02-01

    Conclusion: The precontoured locking plates with lateral extension may be a good method to fix the fractures of the lateral end clavicle, which provide a stable fixation with good functional outcome with very few instances of stiffness and decreased range of motion of the shoulder with the hook plates and failure of fixation in screw and K-wire fixations. It may well be the answer to the fixation questions of the lateral clavicle fractures, although larger comparative studies between the surgical treatment methods are required to confirm the same.

  4. Genetics Home Reference: distal hereditary motor neuropathy, type V

    Science.gov (United States)

    ... Distal hereditary motor neuropathy, type V Distal hereditary motor neuropathy, type V Printable PDF Open All Close All Enable ... link) PubMed OMIM (2 links) NEURONOPATHY, DISTAL HEREDITARY MOTOR, TYPE VA NEURONOPATHY, DISTAL HEREDITARY MOTOR, TYPE VB Sources ...

  5. Laparoscopic distal pancreatectomy for adenocarcinoma: safe and reasonable?

    Science.gov (United States)

    Postlewait, Lauren M.

    2015-01-01

    As a result of technological advances during the past two decades, surgeons now use minimally invasive surgery (MIS) approaches to pancreatic resection more frequently, yet the role of these approaches for pancreatic ductal adenocarcinoma resections remains uncertain, given the aggressive nature of this malignancy. Although there are no controlled trials comparing MIS technique to open surgical technique, laparoscopic distal pancreatectomy for pancreatic adenocarcinoma is performed with increasing frequency. Data from retrospective studies suggest that perioperative complication profiles between open and laparoscopic distal pancreatectomy are similar, with perhaps lower blood loss and fewer wound infections in the MIS group. Concerning oncologic outcomes, there appear to be no differences in the rate of achieving negative margins or in the number of lymph nodes (LNs) resected when compared to open surgery. There are limited recurrence and survival data on laparoscopic compared to open distal pancreatectomy for pancreatic adenocarcinoma, but in the few studies that assess long term outcomes, recurrence rates and survival outcomes appear similar. Recent studies show that though laparoscopic distal pancreatectomy entails a greater operative cost, the associated shorter length of hospital stay leads to decreased overall cost compared to open procedures. Multiple new technologies are emerging to improve resection of pancreatic cancer. Robotic pancreatectomy is feasible, but there are limited data on robotic resection of pancreatic adenocarcinoma, and outcomes appear similar to laparoscopic approaches. Additionally fluorescence-guided surgery represents a new technology on the horizon that could improve oncologic outcomes after resection of pancreatic adenocarcinoma, though published data thus far are limited to animal models. Overall, MIS distal pancreatectomy appears to be a safe and reasonable approach to treating selected patients with pancreatic ductal

  6. The effect of distal ulnar implant stem material and length on bone strains.

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    Austman, Rebecca L; Beaton, Brendon J B; Quenneville, Cheryl E; King, Graham J W; Gordon, Karen D; Dunning, Cynthia E

    2007-01-01

    Implant design parameters can greatly affect load transfer from the implant stem to the bone. We have investigated the effect of length or material of distal ulnar implant stems on the surrounding bone strains. Eight cadaveric ulnas were instrumented with 12 strain gauges and secured in a customized jig. Strain data were collected while loads (5-30 N) were applied to the medial surface of the native ulnar head. The native ulnar head was removed, and a stainless steel implant with an 8-cm-long finely threaded stem was cemented into the canal. After the cement had cured, the 8-cm stem was removed, leaving a threaded cement mantle in the canal that could accept shorter threaded stems of interest. The loading protocol was then repeated for stainless steel stems that were 7, 5, and 3 cm in length, as well as for a 5-cm-long titanium alloy (TiAl(6)V(4)) stem. Other stainless steel stem lengths between 3 and 7 cm were tested at intervals of 0.5 cm, with only a 20 N load applied. No stem length tested matched the native strains at all gauge locations. No significant differences were found between any stem length and the native bone at the 5th and 6th strain gauge positions. Strains were consistently closer to the native bone strains with the titanium stem than the stainless steel stem for each gauge pair that was positioned on the bone overlying the stem. The 3-cm stem results were closer to the native strains than the 7-cm stem for all loads at gauges locations that were on top of the stem. The results from this study suggest that the optimal stem characteristics for distal ulnar implants from a load transfer point of view are possessed by shorter (approximately 3 to 4 cm) titanium stems.

  7. Equine distal limb wounds: new and emerging treatments.

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    Alford, Christopher G; Caldwell, Fred J; Hanson, Reid

    2012-07-01

    Distal limb wounds occur commonly in horses, and treatment can be frustrating for owners and veterinarians. Caring for these wounds is often very expensive, labor intensive, and prolonged. Many commercial products and clinical techniques have been developed to help treat these wounds. Healing of these wounds depends on many factors. With proper wound evaluation and treatment, affected horses can return to function sooner than in the past.

  8. Simultaneous bilateral distal biceps tendon repair: case report

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    Thiago Medeiros Storti

    Full Text Available ABSTRACT Simultaneous bilateral rupture of the distal biceps tendon is a rare clinical entity, seldom reported in the literature and with unclear therapeutic setting. The authors report the case of a 39-year-old white man who suffered a simultaneous bilateral rupture while working out. When weightlifting with elbows at 90° of flexion, he suddenly felt pain on the anterior aspect of the arms, coming for evaluation after two days. He presented bulging contour of the biceps muscle belly and ecchymosis in the antecubital fossa, extending distally to the medial aspect of the forearm, as well as a marked decrease of supination strength and pain in active elbow flexion. MRI confirmed the rupture with retraction of the distal biceps bilaterally. The authors opted for performing the tendon repairs simultaneously through the double incision technique and fixation to the bicipital tuberosity with anchors. The patient progressed quite well, with full return to labor and sports activities, being satisfied with the result after two years of surgery. In the literature search, few reports of simultaneous bilateral rupture of the distal biceps were retrieved, with only one treated in the acute phase of injury. Therefore, the authors consider this procedure to be a good option to solve this complex condition.

  9. Laparoscopic versus open distal pancreatectomy for pancreatic cancer.

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    Riviere, Deniece; Gurusamy, Kurinchi Selvan; Kooby, David A; Vollmer, Charles M; Besselink, Marc G H; Davidson, Brian R; van Laarhoven, Cornelis J H M

    2016-04-04

    Surgical resection is currently the only treatment with the potential for long-term survival and cure of pancreatic cancer. Surgical resection is provided as distal pancreatectomy for cancers of the body and tail of the pancreas. It can be performed by laparoscopic or open surgery. In operations on other organs, laparoscopic surgery has been shown to reduce complications and length of hospital stay as compared with open surgery. However, concerns remain about the safety of laparoscopic distal pancreatectomy compared with open distal pancreatectomy in terms of postoperative complications and oncological clearance. To assess the benefits and harms of laparoscopic distal pancreatectomy versus open distal pancreatectomy for people undergoing distal pancreatectomy for pancreatic ductal adenocarcinoma of the body or tail of the pancreas, or both. We used search strategies to search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Science Citation Index Expanded and trials registers until June 2015 to identify randomised controlled trials (RCTs) and non-randomised studies. We also searched the reference lists of included trials to identify additional studies. We considered for inclusion in the review RCTs and non-randomised studies comparing laparoscopic versus open distal pancreatectomy in patients with resectable pancreatic cancer, irrespective of language, blinding or publication status.. Two review authors independently identified trials and independently extracted data. We calculated odds ratios (ORs), mean differences (MDs) or hazard ratios (HRs) along with 95% confidence intervals (CIs) using both fixed-effect and random-effects models with RevMan 5 on the basis of intention-to-treat analysis when possible. We found no RCTs on this topic. We included in this review 12 non-randomised studies that compared laparoscopic versus open distal pancreatectomy (1576 participants: 394 underwent laparoscopic distal pancreatectomy and 1182

  10. Fluoroscopic freehand and electromagnetic-guided targeting system for distal locking screws of humeral intramedullary nail.

    Science.gov (United States)

    Persiani, P; Gurzi, M; Moreschini, O; Di Giacomo, G; Villani, C

    2017-04-01

    The current techniques used to lock distal screws for the nailing of long bone fractures expose the surgeons, radiologists and patients to a hearty dose of ionizing radiation. The Sureshot™ Distal Targeting System is a new technique that, with the same results, allows for shorter surgery times and, consequently, less exposure to radiation. The study was performed on 59 patients (34 males and 25 females) with a simple humerus fracture diagnosis, type 1.2.A according to the AO classification, who were divided into two groups. Group 1 was treated with ante-grade intramedullary nailing with distal locking screws inserted with a freehand technique. Group 2 was treated with the intramedullary nail using the Sureshot™ Distal Targeting System. Two intra-operative time parameters were evaluated in both groups: the time needed for the positioning of the distal locking screws and the time of exposure to ionizing radiations during this procedure. Group 2 showed a lower average distal locking time compared to group 1 (645.48″ vs. 1023.57″) and also a lower average time of exposure to ionizing radiation than in group 1 (4.35″ vs. 28.96″). The Sureshot™ Distal Targeting System has proven to be equally effective when compared to the traditional techniques, with the added benefits of a significant reduction in both surgical time and risk factors related to the exposure to ionizing radiation for all the operating room staff and the patient.

  11. Laparoscopic distal pancreatectomy for adenocarcinoma of the pancreas

    Science.gov (United States)

    Björnsson, Bergthor; Sandström, Per

    2014-01-01

    Since the first report on laparoscopic distal pancreatectomy (LDP) appeared in the 1990s, the procedure has been performed increasingly frequently to treat both benign and malignant lesions of the pancreas. Many earlier publications have shown LDP to be a good alternative to open distal pancreatectomy for benign lesions, although this has never been studied in a prospective, randomized manner. The evidence for the use of LDP to treat adenocarcinoma of the pancreas is not as well established. The purpose of this review is to evaluate the current evidence for LDP in cases of pancreatic adenocarcinoma. We conducted a review of English language publications reporting LDP results between 1990 and 2013. All studies reporting results in patients with histologically proven pancreatic adenocarcinoma were included. Thirty-nine publications were found and included in the results for a total of 309 cases of pancreatic adenocarcinoma (potential double publications were not eliminated). Most LDP procedures are performed in selected cases and generally involve smaller tumors than open distal pancreatectomy (ODP) procedures. Some of the papers report unselected cases and include procedures on larger tumors. The number of lymph nodes harvested using LDP is comparable to the number obtained with ODP, as is the frequency of R0 resections. Current data suggest that similar short term oncological results can be obtained using LDP as those obtained using ODP. PMID:25309072

  12. VOLAR LOCKING PLATE OSTEOSYNTHESIS IN DISTAL END RADIUS FRACTURES

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    Gyan Ranjan

    2017-07-01

    Full Text Available BACKGROUND Distal end Radius fractures account for about 20% of all the fracture treated in emergency department of Kosi & Seemanhcal area in Bihar. The majority of osteoporotic fractures occur as a result of fall from standing height on outstretched hand while in young patients, distal end radius fractures are seen secondary to RTA & sports activities. We conducted a study of a small group to evaluate the functional outcome of ORIF & volar locking plate fixation done for distal end radius fractures after one year. MATERIALS AND METHODS Records of 19 men and 41 women aged 17 to 78 years who underwent volar locking plate fixation for distal radial fractures were reviewed. According to AO-Classification of Distal End Radius fractures. 2 Patients had A2 Type of fracture, 3 had A3 Type, both B2 & B3 had 4 cases each, 15 of C1 Type, 21 of C2 type and 11 0f C3 Type. Functional outcome was assessed by using “Demerit point rating system” of Gartland & Werley. In all the patients at their final follow-up visit at 12 months. RESULTS Out of all these 60 patients, 9 cases had 10 complications, 2 cases developed Grade (I Arthritis, 2 cases developed Grade (II arthritis, 1 case developed superficial skin infection with medium nerve compression symptoms, 2 cases developed superficial skin infection which was resolved by continuous dressing on alternate days & 5 cases developed median nerve compression symptoms in which for 2 cases symptoms resolved with time, in rest 3 cases carpal Tunnel Decompression was done. Overall 63.3% result were excellent, 23.3% were good & 13.3% fair outcomes. The residual deformity was 0.70 the subjective score was 1.47 the objective score was 1.70, the total demerit score was as per modification Garland & Werley scoring groups (Mean values was 3.67. In all the cases, stainless steel plate was used. CONCLUSION In distal end radius fractures open reduction and internal fixation with volar locking compression plate followed by

  13. Retrograde nailing for distal femur fractures in the elderly

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    Giddie Jasdeep

    2015-01-01

    Full Text Available Introduction: We report the results of treating a series of 56 fractures in 54 elderly patients with a distal femur fracture with a retrograde femoral nail. Methods: Fifty-four of the nails were inserted percutaneously with a closed reduction. After surgery all patients were allowed to weight bear as tolerated. Four fractures were supported in a temporary external splint. Results: The mean age of patients was 80.6 years (range 51–103 years, 52/54 (96% were females. There were no cases of nail related complications and no re-operations were required. One patient was lost to follow up. The 30-day mortality was 5/54 (9.3% and the one year mortality was 17/54 (31.5%. Conclusions: Distal femoral nail fixation provides a good method of fixation allowing immediate mobilisation for this group of patients.

  14. Use of brachial plexus blockade and medetomidine-ketamine-isoflurane anaesthesia for repair of radio-ulna fracture in an adult cheetah (Acinonyx jubatus).

    Science.gov (United States)

    Kimeli, Peter; Mogoa, Eddy M; Mwangi, Willy E; Kipyegon, Ambrose N; Kirui, Gilbert; Muasya, Daniel W; Mande, John D; Kariuki, Edward; Mijele, Dominic

    2014-10-10

    Regional anaesthetic techniques have been used in combination with systemic analgesics during small animal surgery to provide multimodal analgesia. Brachial plexus nerves block using local anaesthetics provides analgesia of the thoracic limb through desensitization of the nerves that provide sensory and motor innervation. This has been shown to reduce intra-operative anesthetic requirements and provide postoperative pain relief. Decreasing the doses of general anaesthetics allows more stable cardiopulmonary function during anaesthesia and the development of less side effects. The present case reports a successful use of brachial plexus blockade to supplement medetomidine-ketamine-isoflurane anaesthesia for repair of radio-ulna fracture in an adult cheetah (acinonyx jubatus). An adult male Cheetah weighing about 65 kg was presented with a history of leg carrying lameness of the left forelimb sustained following a car accident a week earlier. Clinical examination under general anaesthesia revealed slight dehydration and a swelling with a wound on the caudo-medial aspect of the left radio-ulna region. Crepitation was present on manipulation and radiography confirmed a complete transverse radio-ulna fracture of the left forelimb, which required open reduction and internal fixation. Brachial plexus blockade using lignocaine hydrochloride was used to supplement medetomidine-ketamine-isoflurane anaesthesia for the surgical procedure. Isoflurane anaesthesia was maintained at 0.5 - 2.0% throughout the surgical procedure, which was uneventful. Temperature and cardio-pulmonary parameters remained stable intra-operatively. Limb paralysis extended for 5 hours post-operatively, suggesting prolonged anaesthesia. To the researchers' knowledge, this is the first reported case of the use of brachial plexus blockade to supplement general anaesthesia to facilitate forelimb surgery in an adult cheetah. The use of brachial plexus block with a light plane of general anaesthesia proved to

  15. Distal movement of maxillary canines and premolars with sectional mechanics following Distal Jet application to molars.

    Science.gov (United States)

    Bolla, E; Doldo, T; Giorgetti, R

    2004-01-01

    to assess the effectiveness of Distal Jet without simultaneous fixed appliance treatment. twenty subjects with Class II malocclusion who received the Distal Jet appliance to move maxillary molars distally. Subsequently, the canine and premolar distal movements were achieved by the use of.017 x.025 Ni-Ti sectional wires and memory power chain. revealed that Distal Jet is more effective with less anchorage loss when this appliance is used independent of multibracket appliances. this study showed that Distal Jet is an effective and predictable appliance. The distal movements of upper premolars, canines and incisors with sectional wires fabricated from.017 x.025 Ni-Ti were biomechanically very effective, simple in clinical application, and did not require any patient compliance.

  16. Outcome Analysis of Fernandez Osteotomy in Malunited Extra-Articular Fractures of Distal Radius.

    Science.gov (United States)

    Bhattacharyya, A; Kumar, S

    2016-07-01

    Deformity of wrist is very common after mal union of extra articular fractures over distal end of Radius. It causes limitation of movements too in different directions with or without pain. Deformity may be treated by different types of corrective osteotomy. We treated cases of this type of malunion with Fernandez osteotomy. This study is to observe the amount of correction and recovery of functional status in patients with malunited distal radius fractures treated with Fernandez osteotomy. This is a prospective study. We treated 10 cases of malunited radius with Fernandez osteotomy from February 2013 to October 2014 in the Departments of Orthopaedics, Medical College and Hospital, Kolkata, India. There were six males and four females with mean age of thirty years (with range from twenty to forty years. Indications for surgical intervention include pain and functional deficit severe enough to interfere significantly with daily activities. Radius is exposed through distal dorsal radial incision and radial osteotomy done two and half centimetre proximal to the wrist joint and after achieving correction; gap is filled with iliac bone graft and fixed with contoured distal radius T-plate. Follow up was for an average one year and three months. Results were excellent in one, satisfactory in four cases, good in four cases and bad in one case. Fernandez osteotomy is valuable option for correction of malunited distal radius fracture especially in young demanding patients.

  17. MORPHOMETRIC STUDY OF THE NUTRIENT FORAMINA OF UNKNOWN RADIUS AND ULNA AND THEIR CLINICAL IMPORTANCE IN THE REGION OF KADAPA [RAYALASEEMA], ANDHRA PRADESH

    Directory of Open Access Journals (Sweden)

    Guthi Reddy Manoj Kumar

    2016-03-01

    Full Text Available AIM OF THE STUDY The aim of the present study is to determine the number, direction of nutrient foramina in human bones of forearm and to determine the most common location of nutrient foramina of bones in the forearm and to calculate the foramen index (FI of the bones of the forearm. PLACE OF THE STUDY This study was done in the Department of Anatomy of Rajiv Gandhi Institute of Medical Sciences[RIMS], Kadapa, Andhra Pradesh. PERIOD OF STUDY This study was conducted during the month of September-October 2015 (Two months study. MATERIALS AND METHODS One hundred and four unknown dry human forearm bones namely radius and ulna constituted the materials for the present study. These bones were studied [radii 54 (28Lt+26Rt, ulnae 50 (28Lt+22Rt] from the Dept. of Anatomy of Rajiv Gandhi Institute of Medical Sciences, Kadapa. Andhra Pradesh. Each bone was studied for the presence of nutrient foramina, their number, location and the direction were carefully studied and recorded in various tables. RESULTS Twenty eight radii of the left side were studied. A single nutrient foramen was present in 27 bones, double nutrient foramina seen in only one bone (Specimen No. 20, (Figure No. 1. Nutrient foramina were present on the anterior surface in 26 bones (Figure No. 2, and in two bones they were seen on the interosseous border (Specimen Nos. 6 and 14, (Figure No. 3. Twenty six radii of the right side were studied. A single nutrient foramen was present in twenty five bones, double NF seen in one bone. (Specimen No. 10. Nutrient foramen was present on the anterior surface in twenty three bones and in two bones, they were present on the interosseous border (Specimen Nos. 14 and 19 and in one bone on the posterior surface (Specimen No. 15, (Figure No. 4. The mean length of radius on left side was 23.6 cm; mean distance of NF from proximal end of bone was 7.8 cm. (Figure Nos. 8 and 9. The mean length of radius on right side was 24.6 cm; mean distance of nutrient

  18. Does electromagnetic-manual guided distal locking influence rotational alignment in antegrade femoral nailing?

    Science.gov (United States)

    Ciftdemir, Mert; Tuncel, Sedat A; Ozcan, Mert; Copuroglu, Cem; Erem, Murat

    2015-03-01

    The aim of this study was to determine whether distal locking using an electromagnetic-manual guided distal locking decreases the malrotation rate in femur fractures treated with intramedullary nailing. A total of 113 adult patients having unilateral femoral shaft fractures treated using IM nails were evaluated regarding demographic features, injury mechanism, fracture type, interval between trauma and nailing, operation time and number of image intensifier shots during the operation at least one year after nailing. Patients were divided into two groups according to distal locking technique. All patients had also undergone clinical examination for lower extremity alignment and range of motion and filled out the SF-36 questionnaire and undergone ultrasound measurement of femoral anteversion angles to reveal any rotational femoral malalignment. Group 1 consisted of 47 patients (41.6 %) with electromagnetic-manual targeting guided distal locking and group 2 consisted of 66 patients (58.4 %) with free-hand distal locking. Both groups were statistically similar regarding demographic features, injury mechanism, fracture type, interval between trauma and nailing, clinical examination and SF-36 results. Operation time and number of image intensifier shots were significantly less in group 1. No statistically significant difference was found between the femoral anteversion angles of injured and uninjured sides of the patients in both groups. Although there is no significant effect on malrotation, previously known advantages lead us to state that electromagnetic-manual guided distal interlocking is an advantageous treatment option in femoral shaft fractures.

  19. Genetics Home Reference: distal 18q deletion syndrome

    Science.gov (United States)

    ... Health Conditions Distal 18q deletion syndrome Distal 18q deletion syndrome Printable PDF Open All Close All Enable ... view the expand/collapse boxes. Description Distal 18q deletion syndrome is a chromosomal condition that occurs when ...

  20. MINIMUM INCISION PERCUTANEOUS PLATE OSTEOSYNTHESIS FOR DISTAL FIBULAR FRACTURES: A PROSPECTIVE STUDY

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    Ramkumar Reddy

    2015-09-01

    Full Text Available Distal fibular fractures are usually communitted and most of the times osteoporotic especially if they are occurring in females and in geriatric age group. These fractures are usu ally associated with other fractures, which necessitates them to be fixed accurately. Owing to the fact that distal fragment is subcutaneous with scanty soft tissue over bone, which pose these fracture fixations become difficult by open methods in view of wound healing. A prospective study of 26 patients with distal fibular fractures were treated with MIPPO with hook plate were healed with less complications and better outcome. With this background we suggest a minimally invasive incision over proximal frag ment where sufficient soft tissue cover is present. From there pushing the special hook plate subperiosteally to distal fragment, hooking the tip of fibula and fixing the proximal fragment after reduction gives a simple and effective stable fixation

  1. Monteggia fracture dislocation equivalents - analysis of eighteen cases treated by open reduction and internal fixation

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    Singh Ajay Pal

    2012-02-01

    Full Text Available 【Abstract】 Objective: Monteggia fracture dislocation equivalent, though already described by Bado, is still an unclassified entity. We aimed to retrospectively analyze 18 cases of Monteggia variants and discuss the injury mechanisms, management, and outcome along with a review of the literature. Methods: A retrospective record of Monteggia fracture dislocation (2003-2008 was reviewed from medical record department of our institute. Classic Monteggia fracture dislocation, children below 12 years or adults over 50 years, as well as open grade II & III cases were excluded from this study. Monteggia variant inclusion criteria included fracture of the proximal ulna together with a fracture of the radial head or neck and skeletal maturity. Totally 26 patients were identified with Monteggia variants and 18 were available for follow-up, including 11 males and 7 females with the mean age of 35 years. The ulna fracture was treated by compression plating along with tension band wiring. Radial head/neck was reconstructed in 12 patients while excised in 6 patients. Results: Follow-up ranged from 1-4 years, mean 2.6 years. Patients were assessed clinicoradiologically. Mayo Elbow Performance Score was employed to assess the outcomes. At final follow-up, the results were excellent in 10 patients, good in 4, fair in 2 and poor in 2. Mean range of motion of the elbow was 20°, 116°, 50° and 55° for extension, flexion, pronation and supination, respectively. Two patients had complications in the form of heterotopic ossification and stiffness of the elbow. One nonunion ulna, primarily treated by tension band wiring, was managed by refixation with locking reconstruction plate and bone grafting. Bone grafting was only required in this patient for nonunion. Another patient had implants removed on his request. The results in our series closely correlated with extent of intraarticular damage, coronoid fracture and comminuted fractures. Conclusions: Monteggia

  2. Setscrew distal locking for intramedullary nails: a biomechanical study.

    Science.gov (United States)

    Köse, N; Günal, I; Wang, X; Athanasiou, K A; Agrawal, C M; Mabrey, J D

    2000-08-01

    This biomechanical study was undertaken to examine the effectiveness of setscrew distal locking in a static intramedullary (IM) femoral nail on the stability of fixation of femoral shaft fractures. Fifteen fresh-frozen cadeveric femora were randomly separated into three groups of five bones and transversely sectioned immediately distal to the isthmus. After the insertion of the large-diameter nails, distal locking was obtained by conventional method in the first group. In the second group, set-screw design was used in which two transverse screws penetrated only the lateral cortex of the femur and compressed the nail in the intramedullary canal. No distal locking was used in the third group. All instrumented femurs were mounted on a servohydraulic testing machine and tested in both rotations (20 degrees) and axial compression (amplitude: 1,000 Newton). Loading-versus-displacement data, acquired at a ten-Hertz sampling rate, were calibrated and used to calculate maximum torque, stiffness, and energy capacity to failure. Maximum displacement and axial stiffness also were determined. Mean maximum torque at 10 degrees for each group were 15.3+/-4.8 newton-meters for the interlocking group, 8.5 +/-1.2 newton-meters for the setscrew group, and 3.6+/-2.7 newton-meters for the nonlocked femora. At 20 degrees of rotational displacement, the torque measured 37.4+/-2.6 newton-meters; 15.0+/-4.0 newton-meters; and 5.3+/-3.1 newton-meters, respectively (p 0.05). The setscrew design provided 87 percent of the torsional rigidity of the interlocking group. In the axial compression test, mean maximum shortening was 1.1+/-0.3 millimeters in the interlocking group and 1.4+/-0.6 millimeters in the setscrew group (p > 0.05). The mean stiffness on longitudinal compression provided by the interlocking screws and the setscrews was 918 and 860 newton-meters per millimeter, respectively. The distal setscrew design provides adequate distal fixation of intramedullary nail for patients in the

  3. Outcomes of Ulnar Shortening for Ulnar Impaction Syndrome Using the 2.7 mm AO Ulna Shortening Osteotomy System.

    Science.gov (United States)

    Finnigan, T; Makaram, N; Baumann, A; Ramesh, K; Mohil, R; Srinivasan, M

    2018-03-01

    Ulnar shortening osteotomy is a well-established treatment for ulnar impaction syndrome. Controversy remains regarding the most effective system to achieve efficient bony union, whilst minimising incidence of complications, particularly hardware irritation. We present outcomes at 2 years using the recently released low profile AO osteotomy system. 32 consecutive patients with significant pain from ulnar impaction syndrome (idiopathic or post-traumatic), without degenerative changes of the distal radio-ulnar joint, were included. Time to union, range of motion, grip strength, pain and complications were recorded. Median time to union was 10.14 weeks (9.27-11.01, 95%CI), with one nonunion. Visual Analogue Pain score, grip strength and range of motion improved significantly. No patient experienced hardware irritation. No plate required removal. Positive ulnar variance was reduced by 3.8 mm (mean). The low profile AO system appears effective in achieving bony union whilst minimising incidence of hardware irritation, at a follow up of 2 years.

  4. Analysis of preoperative antibiotic prophylaxis in stented, distal hypospadias repair.

    Science.gov (United States)

    Smith, Jacob; Patel, Ashay; Zamilpa, Ismael; Bai, Shasha; Alliston, Jeffrey; Canon, Stephen

    2017-04-01

    Surgical site infection [SSI] is a risk for any surgical procedure, including hypospadias repair. Prophylactic antibiotic therapy for patients having surgery is often effective in preventing SSIs, but with increasing rates of antibiotic resistance, this practice has been questioned. The objectives of this study are 1) to assess the incidence of SSIs in patients following stented, distal hypospadias repair and 2) to observe for any potential difference in the incidence of SSIs for patients with and without preoperative antibiotic utilization in this setting. We retrospectively reviewed consecutive patients treated with stented, distal hypospadias repair from 2011 to 2014 by three surgeons and compared two groups: patients who received preoperative antibiotics and patients who did not. Patients with a history of previous hypospadias repair were excluded from the study. Two hundred twenty-four subjects were identified. Group 1 (135) received preoperative antibiotic and Group 2 (89) did not receive preoperative antibiotics. There was no statistically significant difference in SSI prevalence with 0 patients in Group 1 and 1 patient in Group 2 having a SSI. Although prophylactic antibiotics prior to hypospadias repair are most often used by pediatric urologists, this study demonstrates further evidence that antibiotics prior to this procedure do not appear to lower the rate of SSI. This study is limited by its retrospective nature and disparate mean follow up in the two cohorts. Surgical site infection does not appear to be decreased by prophylactic antibiotic therapy before distal hypospadias repair.

  5. Necessity for fibular fixation associated with distal tibia fractures.

    Science.gov (United States)

    Taylor, Benjamin C; Hartley, Brandi R; Formaini, Nathan; Bramwell, Thomas J

    2015-12-01

    Intramedullary (IM) nailing is a well-accepted treatment for distal third tibia fractures in combination with injury to the fibula. However, the indications for operative stabilisation of the fibula remain controversial. The authors performed a retrospective review on a consecutive series of patients who underwent intramedullary nailing of a non-comminuted distal third tibia fracture with or without fibular fixation at a Level I urban trauma centre. A review of surgical records identified 120 patients who initially were included in this study, while a total of 98 patients who met the inclusion criteria were included in the final analysis. Our results found no difference in the mean value of coronal and sagittal plane alignment in both the immediate post-operative and follow-up time periods. We also saw no statistically significant difference when comparing malalignment between patients treated with or without fibula fixation. There were no deep infections between the two groups. No significant differences were seen between the fibular fixation group and the non-fixation group. Distal screw removal due to prominence or pain was the most common reason for future surgery in both groups. These findings suggest that the addition of fibular fixation does not affect whether or not alignment is maintained in either the immediate post-operative or short-term follow-up period. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Displaced Salter-Harris Type I Distal Fibula Fractures: Two Case Reports and a Review of the Literature.

    Science.gov (United States)

    Korsh, Jeremy; Adolfsen, Stephen

    Salter-Harris type I (SH-I) fractures of the distal fibula are commonly encountered in pediatric orthopedics. We describe 2 unique cases of adolescents with completely displaced SH-I distal fibula fractures that were treated operatively. In the first case, a closed reduction attempt failed and the patient required open reduction and internal fixation of the distal fibula and syndesmosis. The syndesmotic ligaments were avulsed from the distal fibular metaphysis. In the second case, closed reduction of the distal fibula fracture was partially successful, but anatomic reduction could not be achieved without open reduction. The distal fibula fracture was fixed with an intramedullary screw. We believe this pattern of injury represents a variant of the adolescent transitional ankle fracture. Because the distal tibial physes were nearing complete closure in these patients, the energy propagated through the distal fibular physis. To the best of our knowledge, this combination of injuries has not been previously reported. This type of physeal fracture raises concern for premature physeal closure, fibular growth disturbance, syndesmotic instability, and medial (deltoid ligament) injury. Both patients had excellent outcomes after anatomic reduction and fixation of the displaced SH-I distal fibula fractures at 1 and 6 years of follow up, respectively. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Minimally invasive plate osteosynthesis for distal radius fractures

    Directory of Open Access Journals (Sweden)

    Xu-ming Wei

    2014-01-01

    Full Text Available Background: Fractures of distal radius are common injury in all age groups. Cast treatment with or without close reduction is a viable option. However, the results are often unsatisfactory with restricted function. The open reduction and internal fixation often results in extensive soft tissue dissection and associated high rates of infection and delayed/nonunion. The distractor/external fixator have reported good functional and anatomical results but the incidence of pin traction infection nerve injury and cosmedic deformity are high. We introduced a modified operative technique for minimally invasive plate osteosynthesis (MIPO for distal radial fracture and evaluated the functional outcomes and complications. Materials and Methods: 22 distal radial fractures (10 left, 12 right were treated using the MIPO technique and two small incisions with a palmar locking plate from August 2009 to August 2010. The wrist function was assessed according to Dienst wrist rating system, and postoperative complications were recorded. Results: According to Dienst wrist rating system, 13 patients showed excellent results, 6 cases showed good results and 3 patients had moderate results. No patient had poor results. Thus, the excellent and good rate was 86.4%. One patient had anesthesia in the thenar eminence and this symptom disappeared after 3 months. One patient had delayed healing in the proximal wrist crease. Two patients had mild pain on the ulnar side of the wrist and two patients had limited wrist joint function. Conclusion: The MIPO technique by using two small palmar incisions is safe and effective for treatment of distal radial fractures.

  8. Villous adenoma of the distal appendix.

    Science.gov (United States)

    Taylor, J V; Thomas, M G; Kelly, S; Sutton, R

    1997-04-01

    Villous adenoma confined to the distal appendix has not been previously reported in conjunction with acute apendicitis. The presence of an adenoma indicates a need for further investigation due to an association with neoplasia elsewhere.

  9. Genetics Home Reference: distal arthrogryposis type 1

    Science.gov (United States)

    ... 1 is a disorder characterized by joint deformities (contractures) that restrict movement in the hands and feet. ... distal arthrogryposis type 1 . However, researchers speculate that contractures may be related to problems with muscle contraction ...

  10. Conceptualizing distal drivers in land use competition

    DEFF Research Database (Denmark)

    Niewhöner, Jörg; Nielsen, Jonas Ø; Gasparri, Gasparri

    2016-01-01

    This introductory chapter explores the notion of ‘distal drivers’ in land use competition. Research has moved beyond proximate causes of land cover and land use change to focus on the underlying drivers of these dynamics. We discuss the framework of telecoupling within human–environment systems...... as a first step to come to terms with the increasingly distal nature of driving forces behind land use practices. We then expand the notion of distal as mainly a measure of Euclidian space to include temporal, social, and institutional dimensions. This understanding of distal widens our analytical scope...... for the analysis of land use competition as a distributed process to consider the role of knowledge and power, technology, and different temporalities within a relational or systemic analysis of practices of land use competition. We conclude by pointing toward the historical and social contingency of land use...

  11. Osseous Anatomy of the Distal Radioulnar Joint: An Assessment Using 3-Dimensional Modeling and Clinical Implications.

    Science.gov (United States)

    Daneshvar, Parham; Willing, Ryan; Pahuta, Markian; Grewal, Ruby; King, Graham J W

    2016-11-01

    Using a novel technique, we assess and describe the distal radioulnar joint (DRUJ) anatomy. The purpose of this study was to provide the anatomic dimensions of the DRUJ and to evaluate contralateral symmetry. Computed tomography images of 100 cadaveric forearms were obtained. Three-dimensional models of the radius and ulna were generated and evaluated using 3-dimensional modeling software. Measurements of the radius of curvature of the sigmoid notch (SN) and ulnar head (UH), as well as the length of the SN and volar and dorsal lips were performed in the axial and coronal sequences. In addition, mid-coronal angular measurements were made of the SN and UH to quantify the obliquity of the DRUJ. All coronal measurements were performed with the forearm set to neutral rotation. The average ulnar variance was -0.9 ± 1.8 mm. The radius of curvature of the UH (8.2 ± 1.3 mm) was markedly smaller than that of the SN (18.2 ± 8.5 mm). The length of the SN in coronal sequences increased from volar to dorsal by 65%. The mid-coronal angle (DRUJ obliquity) of the SN and UH measured 6.0 ± 9.9° and 18.0 ± 9.9°, respectively. A direct inverse correlation was demonstrated in the obliquity of the DRUJ and ulnar variance. All anatomic measurements were similar when comparing bilateral specimens. The SN length tends to increase in size from volar to dorsal. Bilateral specimens from the same individual demonstrate similarities and can be cautiously used for comparison. The relationships and measurements demonstrated in this study can be a guide when considering reconstructive procedures or dealing with complex fractures involving the DRUJ. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  12. Subluxation of the distal radioulnar joint as a predictor of foveal triangular fibrocartilage complex tears.

    Science.gov (United States)

    Ehman, Eric C; Hayes, Meredith L; Berger, Richard A; Felmlee, Joel P; Amrami, Kimberly K

    2011-11-01

    The triangular fibrocartilage complex (TFCC) with its ulnar foveal attachment is the primary stabilizer of the distal radioulnar joint (DRUJ). The purpose of this study was to describe a technique for measuring the degree of subluxation of the DRUJ in wrist magnetic resonance imaging (MRI) examinations to predict tears involving the foveal attachment of the TFCC. We measured DRUJ geometry in wrist MRI examinations of 34 patients who were found to have foveal TFCC tears at surgery. We compared the results with DRUJ geometry in 11 asymptomatic controls. Subluxation of the ulnar head was assessed using transaxial MRI images obtained at the level of the DRUJ with the wrist in pronation. We quantified subluxation with a line spanning the sigmoid notch of the radius and a perpendicular line through the center of curvature of the articulating surface of the ulna. We calculated the ratio of the lengths of the dorsal and volar segments and normalized it to the center of the sigmoid notch. A total of 34 patients with intraoperatively confirmed tears of the foveal attachment of the TFCC had a mean dorsal ulnar subluxation measurement of 16% ± 4%, whereas the 11 controls had a mean subluxation measurement of 5% ± 4%. The results confirm the hypothesis that subluxation of the ulnar head relative to the sigmoid notch of the radius, as assessed by MRI with the wrist in pronation, is a predictor of tears of the foveal attachment of the TFCC. Diagnostic II. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  13. Simultaneous ipsilateral fractures of distal and proximal ends of the radius.

    Science.gov (United States)

    El Kadi, Khalid Ibn; Benabid, Mounir; Saliou, Sarr; El Assil, Oussama; Marzouki, Amine; Lahrach, Kamal; Boutayeb, Fawzi

    2017-01-01

    We treated a patient with a rare combination of ipsilateral fractures of the distal and proximal ends of the radius. A man aged 42 years had simultaneous fractures of the distal and proximal ends of the radius (radial neck) following a roadside accident. The distal end fracture of the radius was treated with surgical reduction and T-plate volar fixation, and the undisplaced radial neck fracture was treated by an above elbow splintage for 2 weeks. The elbow mobilization was started at 2 weeks. The distal radius was protected for another 4 weeks in a below elbow functional brace. Ipsilateral proximal and distal radial fracture is an uncommon injury pattern. The series illustrates a number of problems associated with this combination. Firstly, one should be aware of this rare injury pattern and there should be greater emphasis on clinical examination of elbow in cases of wrist injuries and vice versa. Once diagnosed, one faces the dilemma of appropriate management in these cases. The appropriate management will depend on the injury characteristics including the age of the patient and the fracture pattern. One should try to preserve the radial head to prevent a possible proximal radial migration especially in younger patients.

  14. A New Injectable Brushite Cement: First Results in Distal Radius and Proximal Tibia Fractures.

    Science.gov (United States)

    Ryf, Christian; Goldhahn, Sabine; Radziejowski, Marek; Blauth, Michael; Hanson, Beate

    2009-08-01

    The restoration of metaphyseal defects remains a challenge for the treating surgeon. Although injectable brushite cements may help to refill bone defects stabilized with internal fixation, human data remains unavailable. The main goal of this prospective multicenter study was to observe the performance of this material in a clinical setting. The study conducted in seven trauma units included closed metaphyseal distal radius and proximal tibia fractures with bone defects, stabilized with internal fixation and subsequent filling with brushite cement. At 6- and 12-month follow-ups, patient satisfaction (visual analog scale [VAS]) was recorded, as well as complications. Thirty-eight proximal tibia fractures and 37 patients with distal radius fractures were included. Overall patient satisfaction with the treatment was high (mean VAS = 92 and 91 for proximal tibia and distal radius, respectively), despite the loss of reduction being described in 11% of proximal tibia and 24% of distal radius fractures; the majority of them included severe fracture types. Radiological evaluation showed postoperative cement leakage in 20 cases, where the majority occurred at the distal radius (n = 15). In 13 distal radius fractures, the leakage was resorbed by the final examination. The tested material showed good outcome in the majority of patients and adequate resorption characteristics, even in the case of extravasation. Stable internal fixation, sufficient bone quality, and no contact between the cement and joint are essential requirements for chronOS Inject, which can be considered as an alternative to existing augmentation materials.

  15. Concomitant physeal fractures of the distal femur and proximal tibia

    Energy Technology Data Exchange (ETDEWEB)

    Sferopoulos, N.K. [Aristotle University of Thessaloniki, Department of Pediatric Orthopaedics, Thessaloniki (Greece)

    2005-07-01

    Concomitant physeal fractures of the distal femur and proximal tibia are very rare in children and adolescents. They are included in the classification of the ''floating knee'' injuries. Two cases with this combined injury are reported. They were closed injuries and in both patients the fracture of the proximal tibial epiphyseal plate was nondisplaced. In the first, a six-year-old girl, an early diagnosis was made radiographically. The intra-articular femoral fracture was operatively reduced and fixed. No growth abnormality was encountered 12 years later. The second patient, a 16-year-old boy, was conservatively treated for a displaced fracture-separation of the distal femoral epiphysis. Four weeks later there was physeal widening on both sides of the knee which indicated an associated fracture of the proximal tibial epiphyseal plate. One year after injury there was a varus deformity of the knee that was treated with a corrective osteotomy. Ten years later there is normal alignment of the leg. (orig.)

  16. Comparison of modern locked plating and antiglide plating for fixation of osteoporotic distal fibular fractures.

    Science.gov (United States)

    Switaj, Paul J; Wetzel, Robert J; Jain, Neel P; Weatherford, Brian M; Ren, Yupeng; Zhang, Li-Qun; Merk, Bradley R

    2016-09-01

    Fractures in osteoporotic patients can be difficult to treat because of poor bone quality and inability to gain screw purchase. The purpose of this study is to compare modern lateral periarticular distal fibula locked plating to antiglide plating in the setting of an osteoporotic, unstable distal fibula fracture. AO/OTA 44-B2 distal fibula fractures were created in sixteen paired fresh frozen cadaveric ankles and fixed with a lateral locking plate and an independent lag screw or an antiglide plate with a lag screw through the plate. The specimens underwent stiffness, cyclic loading, and load to failure testing. The energy absorbed until failure, torque to failure, construct stiffness, angle at failure, and energy at failure was recorded. The lateral locking construct had a higher torque to failure (p=0.02) and construct stiffness (p=0.04). The locking construct showed a trend toward increased angle at failure, but did not reach statistical significance (p=0.07). Seven of the eight lateral locking plate specimens failed through the distal locking screws, while the antiglide plating construct failed with pullout of the distal screws and displacement of the fracture in six of the eight specimens. In our study, the newly designed distal fibula periarticular locking plate with increased distal fixation is biomechanically stronger than a non-locking one third tubular plate applied in antiglide fashion for the treatment of AO/OTA 44-B2 osteoporotic distal fibula fractures. V: This is an ex-vivo study performed on cadavers and is not a study performed on live patients. Therefore, this is considered Level V evidence. Copyright © 2015. Published by Elsevier Ltd.

  17. Distal biceps rupture: the coil sign.

    Science.gov (United States)

    Austin, Luke; Pepe, Matt; VanBeek, Corinne; Tjoumakaris, Fotios

    2014-06-01

    Delayed repair of the distal biceps brachii tendon can lead to the formation of scar tissue and coiling of the tendon. Dissection of the scar tissue and unraveling of the tendon may allow for anatomic repair to the radial tuberosity. A 50-year-old man had a distal biceps brachii tendon tear with an intact lacertus fibrosis. Surgery was performed 22 days after injury. On inspection, the distal biceps tendon was coiled, encased in scar tissue, and unable to be reduced to the radial tuberosity. Dissection of the scar tissue and unraveling of the tendon provided additional length, allowing anatomic repair. Postoperatively, the patient regained full range of motion and strength and returned to work without restrictions. After a distal biceps brachii tear in which the lacertus fibrosis remains intact, the coiled tendon may become enveloped in a sheath of scar tissue. Dissection of the "pseudosheath" unveils the native tendon and allows reduction to the radial tuberosity. Cadaveric analysis shows that the pseudosheath may conceal 6 cm of coiled tendon. When the lacertus fibrosis remains intact after distal biceps tendon rupture, the tethered tendon stump may coil, become encased in scar tissue, and resemble the native tendon. Failure to identify the native tendon could result in the loss of 6 cm of tendon. Copyright 2014, SLACK Incorporated.

  18. Resection of osteoid osteoma of distal tibia using the intraoperative isotopic scan

    OpenAIRE

    M Alami; M Boufettal; M Mahfoud; M El Yaacoubi

    2012-01-01

    Osteoid osteomas are small-sized benign painful bony tumors. The authors report the case of an osteoid osteoma located in the distal third of the tibia, treated by the surgical excision of the nidus using the intraoperatively isotopic marking which allows reducing the incision size and the bony resection.

  19. Resection of osteoid osteoma of distal tibia using the intraoperative isotopic scan.

    Science.gov (United States)

    Alami, M; Boufettal, M; Mahfoud, M; El Yaacoubi, M

    2012-01-01

    Osteoid osteomas are small-sized benign painful bony tumors. The authors report the case of an osteoid osteoma located in the distal third of the tibia, treated by the surgical excision of the nidus using the intraoperatively isotopic marking which allows reducing the incision size and the bony resection.

  20. Resection of osteoid osteoma of distal tibia using the intraoperative isotopic scan

    Directory of Open Access Journals (Sweden)

    M Alami

    2012-01-01

    Full Text Available Osteoid osteomas are small-sized benign painful bony tumors. The authors report the case of an osteoid osteoma located in the distal third of the tibia, treated by the surgical excision of the nidus using the intraoperatively isotopic marking which allows reducing the incision size and the bony resection.

  1. Treatment of Occluded Distal Splenorenal Shunts with Endovascular Stents: A Report of Two Cases

    International Nuclear Information System (INIS)

    Lopez-Medina, Antonio; Peiro, Javier; Gonzalez de Garay, Miguel; Antonana, Miguel A.; Sustacha, Jon; Grande, Domingo

    2001-01-01

    Surgical treatment of an occluded or stenotic portosystemic shunt is difficult and carries a high risk of mortality. We report two cases of early thrombosis of distal splenorenal shunt (DSRS) successfully treated by transcatheter recanalization and stent placement. At 18-month follow-up, the patients remained asymptomatic and control venograms showed continued patency of the shunt with no evidence of stenosis or collaterals

  2. Combined Endoscopic-Radiological Rendezvous for Distal Tail Postoperative Pancreatic Fistula (POPF)

    Energy Technology Data Exchange (ETDEWEB)

    Lucatelli, Pierleone, E-mail: pierleone.lucatelli@gmail.com; Sacconi, Beatrice, E-mail: beatrice.sacconi@fastwebnet.it [“Sapienza” University of Rome, Department of Radiological Sciences, Oncological and Anatomo-pathological Sciences, Vascular and Interventional Radiology Unit (Italy); Cereatti, Fabrizio, E-mail: fcereatti@yahoo.com [“Sapienza” University of Rome, Department of General Surgery Paride Stefanini, Interventional Endoscopy Unit (Italy); Argirò, Renato, E-mail: renato.argiro@gmail.com; Corona, Mario, E-mail: mario.corona68@gmail.com; Bezzi, Mario, E-mail: mario.bezzi@uniroma1.it; Fanelli, Fabrizio, E-mail: fabrizio.fanelli@uniroma1.it [“Sapienza” University of Rome, Department of Radiological Sciences, Oncological and Anatomo-pathological Sciences, Vascular and Interventional Radiology Unit (Italy); Fiocca, Fausto, E-mail: fausto.fiocca@uniroma1.it [“Sapienza” University of Rome, Department of General Surgery Paride Stefanini, Interventional Endoscopy Unit (Italy); Saba, Luca, E-mail: lucasabamd@gmail.com [Azienda Ospedaliero Universitaria di Cagliari-Polo di Monserrato, Department of Radiology (Italy); Catalano, Carlo, E-mail: carlo.catalano@uniroma1.it [“Sapienza” University of Rome, Department of Radiological Sciences, Oncological and Anatomo-pathological Sciences, Vascular and Interventional Radiology Unit (Italy)

    2016-09-15

    Postoperative pancreatic fistula (POPF) with leakage of pancreatic juice is a rare, severe complication following pancreatic resection or, less commonly, splenectomy. Definitive treatment can require multidisciplinary approaches. We report a case of stenosis of the main pancreatic duct with distal tail GRADE C POPF, occurred after splenectomy for Hodgkin lymphoma, successfully treated with combined radiological-endoscopic approach.

  3. Plate fixation of paediatric fractures of the distal tibia and fibula.

    Science.gov (United States)

    He, Bingshu; Wang, Jun

    2012-10-01

    The role of surgery in the management of paediatric long-bone shaft fractures remains a matter of debate. We present a series of paediatric patients with unstable fractures of the distal tibia and fibula, treated with titanium plate fixation. Excellent results were obtained after plate fixation.

  4. Treating Infertility

    Science.gov (United States)

    ... Patients Search FAQs Treating Infertility Page Navigation ▼ ACOG Pregnancy Book Treating Infertility Patient Education FAQs Treating Infertility Patient Education Pamphlets - Spanish Treating ...

  5. Osteochondritis of the Distal Tibial Epiphysis

    Directory of Open Access Journals (Sweden)

    Firass EL Hajj

    2012-01-01

    Full Text Available Osteochondritis of the distal tibial epiphysis is a very rare entity. 9 cases have been described in 7 articles and 8 other cases have been mentioned in textbooks. This paper describes the 10th case of osteochondritis of the distal tibial epiphysis and summarizes the clinical and radiological presentations of the 9 other cases. The etiology of this entity is well debated in the literature. We believe that it results from a vascular abnormality in the distal tibial epiphysis associated with a mechanical stress (trauma, excessive overload, etc.. Since it is a self-limited disease, the prognosis is good and the younger the patient is the better the prognosis will be. In general, this entity responds well to conservative treatment.

  6. Diagnostic modalities for distal radioulnar joint.

    Science.gov (United States)

    Jens, S; Luijkx, T; Smithuis, F F; Maas, M

    2017-05-01

    The first imaging modality in patients suspected of distal radioulnar joint pathology should be conventional radiography to exclude or diagnose wrist pathology including osteoarthritis, rheumatoid arthritis, calcium pyrophosphate deposition disease, (healed) fractures, or impaction syndromes. When conventional radiography is inconclusive, high resolution 3 Tesla magnetic resonance imaging is advised. We provide a broad overview of the literature regarding the use of intra-articular contrast both with computed tomography (CTA) or magnetic resonance imaging (MRA). Conventional arthrography and unenhanced computed tomography are not indicated. This article discusses the most useful imaging techniques in terms of clinical indications, patient positioning, technical imaging requirements, and diagnostic performance in patients with suspected distal radioulnar joint pathology. Furthermore, the most prevalent pathologies are discussed, with the focus on imaging characteristics in both stable and unstable distal radioulnar joints.

  7. Endovascular management of distal anterior inferior cerebellar artery aneurysms: Report of two cases and review of the literature

    Science.gov (United States)

    Santillan, Alejandro; Gobin, Y. Pierre; Patsalides, Athos; Riina, Howard A.; Rosengart, Axel; Stieg, Philip E.

    2011-01-01

    Background: Aneurysms of the anterior inferior cerebellar artery (AICA), especially those located in the distal portion of the AICA, are rare. There are few reported cases treated with surgery or endovascular embolization. Case Description: We report two cases of fusiform distal AICA aneurysms presenting with subarachnoid hemorrhage. Parent artery occlusion with coils and n-butyl cyanoacrilate (n-BCA) resulted in complete aneurysm occlusion and prevented rebleeding. Both patients presented postprocedure neurological deficits, but have made a good recovery at 4 and 10 months, respectively. Conclusion: Occlusion of the parent artery for the treatment of ruptured fusiform distal AICA aneurysms is effective but has significant neurological risks. PMID:21748047

  8. Distal biceps tendon history, updates, and controversies: from the closed American Shoulder and Elbow Surgeons meeting-2015.

    Science.gov (United States)

    Schmidt, Christopher C; Savoie, Felix H; Steinmann, Scott P; Hausman, Michael; Voloshin, Ilya; Morrey, Bernard F; Sotereanos, Dean G; Bero, Emily H; Brown, Brandon T

    2016-10-01

    Understanding of the distal biceps anatomy, mechanics, and biology during the last 75 years has greatly improved the physician's ability to advise and to treat patients with ruptured distal tendons. The goal of this paper is to review the past and current advances on complete distal biceps ruptures as well as controversies and future directions that were discussed and debated during the closed American Shoulder and Elbow Surgeons meeting in 2015. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  9. Is the early percutaneous spine total care to treat the polytrauma patient a good way?

    Directory of Open Access Journals (Sweden)

    Gabriele Falzarano

    2015-03-01

    Full Text Available The “ideal“ timing and modality of fracture fixation for unstable thoracolumbar spine fractures in multiply injured patients remains controversial. The concept of “damage control orthopedics” is expressed. We presented a case report of a 27 years' old male who sustained a multilevel spine fractures associated a floating knee (Fraser's Type A, ulna fracture and carpal scaphoid fracture in July 2014 after car accident (very high energy trauma. All these fractures were treated in early total care. We reported a case control to discuss about the early spinal total care associated at orthopedic total care in patients with multiple trauma.

  10. Arthroscopic Resection of The Distal Clavicle With Concomitant Subacromial Decompression: A Case Series

    Directory of Open Access Journals (Sweden)

    HZ Chan

    2014-07-01

    Full Text Available Shoulder impingement syndrome and acromioclavicular joint osteoarthritis often occur simultaneously and easily missed. Kay et al. reported excellent results with combined arthroscopic subacromial decompression and resection of the distal end of the clavicle in patients with both disorders. Arthroscopic treatment of these disorders produces more favourable results than open procedures. We report two patients who were not responding to conservative management and were treated with direct arthroscopic distal clavicle excision and subacromial decompression in single setting. Both patients gained good postoperative outcome in terms of pain score, function and strength improvement assessed objectively with visual analogue score (VAS and University of California Los Angeles Score (UCLA.

  11. Management of distal femur fractures with modern plates and nails: state of the art.

    Science.gov (United States)

    Beltran, Michael J; Gary, Joshua L; Collinge, Cory A

    2015-04-01

    Fractures of the distal femur, even those with articular extension, are well suited to surgical fixation with modern precontoured anatomic plates and nails. Numerous adjuvant techniques are available to the treating surgeon to obtain and maintain reduction while preserving fracture biology. Yet despite their proven track record and benefits over older implants, technical errors are common and must be overcome with proper preoperative planning and intraoperative attention to detail. This review summarizes the current state of the art regarding distal femur fractures, with an emphasis on relevant modern plate and nail surgical techniques, tempered by our current understanding of implant biomechanics, fracture healing, and long-term outcomes.

  12. Distal radius hemiarthroplasty combined with proximal row carpectomy: case report.

    Science.gov (United States)

    Boyer, Jeffrey S; Adams, Brian

    2010-01-01

    Severe wrist arthritis is most commonly treated by complete wrist arthrodesis, which provides predictable pain relief but the loss of motion may reduce ease of function. In selected patients, motion preserving surgical options, including limited intercarpal fusion, proximal row carpectomy (PRC), and total wrist arthroplasty (TWA) are considered. However, limited fusion and PRC are typically possible only in less severe cases in which there are some articular surfaces showing minimal degeneration that can be retained. TWA is an option for patients who have lower activity demands and specific needs or desires to maintain some wrist motion. Recent utility and decision analysis studies demonstrate that arthroplasty is associated with higher qualify adjusted life year (QALY) than arthrodesis in patients with rheumatoid arthritis. Despite these positive aspects of TWA, the procedure is not as widely accepted as hip, knee, or shoulder arthroplasty. Early implants had problems related to both materials and design, with breakage, loosening and joint imbalance being common complications. Newer generation implants are improved with more predictable early function, less joint imbalance, and rare breakage, but distal component loosening remains a substantial problem. Thus, patients with poor bone stock and those with high activity demands are typically not candidates for TWA, and all patients are advised to restrict activities to reduce the risk of implant loosening. A new motion preserving procedure has recently been used at our institution in selected patients with severe arthritis who do not qualify for TWA but request an alternative to complete wrist fusion. In this procedure, a distal radius implant arthroplasty is combined with a PRC. The distal radius component of a Universal 2 (UNI 2) total wrist arthroplasty system (Integra life Sciences, Plainsboro, NJ) is used. To our knowledge, there have been no previous publications on this technique. We report our first two cases

  13. Medical Expulsive Therapy for Distal Ureteral Stones

    NARCIS (Netherlands)

    Tzortzis, Vassilios; Mamoulakis, Charalampos; Rioja, Jorge; Gravas, Stavros; Michel, Martin C.; de La Rosette, Jean J. M. C. H.

    2009-01-01

    Although minimally invasive treatments for ureteral stones are efficacious, they are not free of complications and are associated with high cost. Medical expulsive therapy (MET) has recently emerged as an alternative strategy for the initial management of small distal ureteral stories. A MEDLINE

  14. Endovascular treatment of ruptured distal posterior inferior ...

    African Journals Online (AJOL)

    2014-03-01

    Mar 1, 2014 ... Methods: 11 consecutive patients (7 women, 4 men, mean age of 49.2 years) with ruptured distal PICA aneurysms were studied retrospectively. All had onset of acute intraventricular or cerebellar haemorrhage, and subarachnoid hemorrhage. (SAH). Hunt-Hess (HH) grades were H-H I in 1 patient, H-H II in ...

  15. Urethral mobilization and advancement for distal hypospadias ...

    African Journals Online (AJOL)

    Background/purpose Despite the existence of numerous techniques for the repair of distal penile hypospadias, none of them is completely satisfactory. Advancing the urethra without mobilization for repair of glanular hypospadias has the advantage of avoiding a common problem occurring with other techniques: ...

  16. Double Plating of Distal Fibula Fractures.

    Science.gov (United States)

    Vance, Danica D; Vosseller, J Turner

    2017-12-01

    Distal fibula fractures are common orthopaedic injuries that often require open reduction internal fixation (ORIF) to anatomically reduce the fracture and minimize the risk of posttraumatic arthritis. In certain clinical situations, stouter fixation may be advantageous to decrease the risk of fixation failure. In this study, the authors report on 12 patients who underwent distal fibula ORIF with 2 one-third tubular plates. Twelve consecutive patients who underwent distal fibula ORIF with 2 one-third tubular plates were retrospectively reviewed. Clinical and radiographic outcomes were reviewed, and functional outcomes were obtained using the Foot and Ankle Outcome Score (FAOS). Institutional review board approval was obtained. All 12 fractures healed clinically and radiographically. One patient was lost to follow-up after healing of the fracture. One patient had removal of fibular hardware at 15 months after surgery. Ten patients had no hardware related pain and good ankle function. FAOS scores were obtained at a mean of 25.6 months after surgery and were as follows: pain (87.6, SD = 9.5), activities of daily living (90.4, SD = 14.5), symptoms (93.3, SD = 9.5), sports (89.5, SD = 18.1), and quality of life (57.4, SD = 21.3). Double plating of distal fibula fractures is a viable technique for problem fractures that potentially provides a readily accessible, low-cost alternative to other means of enhancing fixation. Level IV.

  17. Computed tomography diagnosis of distal radioulnar subluxation

    International Nuclear Information System (INIS)

    Wechsler, R.J.; Rifkin, M.D.; Edeiken, J.; Branch, H.M.

    1987-01-01

    Eight patients with suspected diagnosis of distal radioulnar joint (DRUJ) subluxation underwent computed tomographic (CT) scans of the wrist. Five underwent surgery and had DRUJ subluxation or dislocation; CT scans revealed subluxation in four. Three CT criteria for the evaluation of DRUJ subluxation are discussed and compared in this manuscript. (orig.)

  18. Class II malocclusion treatment effects with Jones Jig and Distal Jet followed by fixed appliances.

    Science.gov (United States)

    Vilanova, Lorena; Henriques, José Fernando Castanha; Janson, Guilherme; Patel, Mayara Paim; Reis, Rachelle Simões; Aliaga-Del Castillo, Aron

    2018-01-01

    To compare the skeletal, dentoalveolar, and soft tissue changes in Class II malocclusion patients treated with Jones Jig and Distal Jet distalizers followed by fixed appliances. The experimental groups comprised 45 Class II malocclusion subjects divided into two groups. Group 1 consisted of 25 patients treated with the Jones Jig, and group 2 consisted of 20 patients treated with the Distal Jet. Group 3 comprised 19 untreated Class II subjects. Cephalograms were analyzed before and after orthodontic treatment. For intergroup comparisons, one-way analysis of variance and post hoc Tukey tests were performed. During treatment, the experimental groups exhibited significant increases in occlusal plane inclination and maxillary second molar mesial tipping. Additionally, the molar relationship improved and overjet decreased significantly in the experimental groups. The Jones Jig group showed greater mandibular incisor proclination and greater overbite reduction than the control group. No significant intergroup differences in nasolabial angle changes were found. Treatment protocols using the Jones Jig and Distal Jet followed by fixed appliances were effective in correcting Class II malocclusion by means of dentoalveolar changes without significant skeletal and soft tissue changes. The experimental groups showed occlusal plane clockwise rotation and greater mesial tipping of maxillary second molars when compared to the untreated group.

  19. Ulnar shortening osteotomy for distal radius malunion.

    Science.gov (United States)

    Kamal, Robin N; Leversedge, Fraser J

    2014-08-01

    Background Malunion is a common complication of distal radius fractures. Ulnar shortening osteotomy (USO) may be an effective treatment for distal radius malunion when appropriate indications are observed. Methods The use of USO for treatment of distal radius fracture malunion is described for older patients (typically patients >50 years) with dorsal or volar tilt less than 20 degrees and no carpal malalignment or intercarpal or distal radioulnar joint (DRUJ) arthritis. Description of Technique Preoperative radiographs are examined to ensure there are no contraindications to ulnar shortening osteotomy. The neutral posteroanterior (PA) radiograph is used to measure ulnar variance and to estimate the amount of ulnar shortening required. An ulnar, mid-sagittal incision is used and the dorsal sensory branch of the ulnar nerve is preserved. An USO-specific plating system with cutting jig is used to create parallel oblique osteotomies to facilitate shortening. Intraoperative fluoroscopy and clinical range of motion are checked to ensure adequate shortening and congruous reduction of the ulnar head within the sigmoid notch. Results Previous outcomes evaluation of USO has demonstrated improvement in functional activities, including average flexion-extension and pronosupination motions, and patient reported outcomes. Conclusion The concept and technique of USO are reviewed for the treatment of distal radius malunion when specific indications are observed. Careful attention to detail related to surgical indications and to surgical technique typically will improve range of motion, pain scores, and patient-reported outcomes and will reduce the inherent risks of the procedure, such as ulnar nonunion or the symptoms related to unrecognized joint arthritis.  Level IV.

  20. [Proximal and distal ruptures of the biceps brachii tendon].

    Science.gov (United States)

    Klonz, A; Loitz, D; Reilmann, H

    2003-09-01

    Proximal ruptures. Ruptures of the long head of the M. biceps humeri are commonly caused by degenerative changes within the tendon. Non-operative treatment gives good results, the loss of power regarding elbow flexion and supination amounts to only 8-21%. Refixation may be indicated for cosmetic reasons and offers a small but evident improvement of flexion and supination power. Deformity of the slipped muscle can be corrected effectively. Residual complaints after conservative treatment often result from associated subacromial problems. Distal ruptures. Ruptures of the distal tendon should be treated operatively. The loss of power after conservative treatment is evident (30-40% for flexion, >50% for supination). Extra-anatomical tenodesis to the brachialis muscle or anatomical fixation to the radial tuberosity can be applied. Flexion power and cosmesis can be addressed by both techniques. If supination strength is to be restored, the tendon has to be fixed anatomically. Preparation of the tuberosity bears the risk of heterotopic ossification or nerve damage. Mini-open techniques, using only a limited anterior approach, may decrease risks.

  1. Dextranomer/hyaluronic acid copolymer implant calcification mimicking distal ureteral calculi on ultrasound.

    Science.gov (United States)

    Clark, Aaron T D; Guerra, Luis; Leonard, Michael

    2010-05-01

    We report 2 patients with a history of vesicoureteral reflux who were treated with intraureteral and/or subtrigonal injection of dextranomer/hyaluronic acid copolymer; they later developed calcification within the region of injection, as seen on ultrasound, which mimicked ureterovesical junction calculi. The radiologist reporting the studies suggested the presence of a distal ureteric calculus in the first case and a distal ureteric calcification in the second case. The ultrasound findings were incidental with no hydronephrosis and both patients were asymptomatic without hematuria. Follow-up ultrasound studies remained unchanged. Calcification of dextranomer/hyaluronic acid copolymer implants may mimic distal ureteral calculi, and careful initial observation is recommended. Copyright 2010 Elsevier Inc. All rights reserved.

  2. Ipsilateral distal femoral and proximal tibial epiphyseal growth plate injury: a case report.

    Science.gov (United States)

    Gulabi, Deniz; Erdem, Mehmet; Bulut, Guven; Avci, Cem Coskun; Asci, Murat

    2013-05-31

    Both the isolated distal femoral epiphysiolysis and the isolated proximal tibial epiphysiolysis are the least common epiphyseal injuries. Even though they are uncommon, they have a high incidence rate of complications. We present a case with Gustilo-Anderson grade 3b open and Salter-Harris type 1 epiphysiolysis of the distal femur and proximal tibia caused by a farm machinery accident. The patient was a 10-year-old boy, treated by open reduction and internal fixation. Although distal femoral and proximal tibial growth plate injuries are rarely seen benign fractures, their management requires meticulous care. Anatomic reduction is important, especially to minimize the risk of growth arrest and the development of degenerative arthritis. However, there is a high incidence of growth arrest and neurovascular injury with these type of fractures.

  3. Technical Aspects of Laparoscopic Distal Pancreatectomy for Benign and Malignant Disease: Review of the Literature

    Science.gov (United States)

    de Rooij, T.; Sitarz, R.; Busch, O. R.; Besselink, M. G.; Abu Hilal, M.

    2015-01-01

    Distal pancreatectomy is the standard curative treatment for symptomatic benign, premalignant, and malignant disease of the pancreatic body and tail. The most obvious benefits of a laparoscopic approach to distal pancreatectomy include earlier recovery and shorter hospital stay. Spleen-preserving distal pancreatectomy should be attempted in case of benign disease. Spleen preservation can be achieved preferably by preserving the splenic vessels (Kimura technique), but also by resecting the splenic vessels and maintaining vascularity through the short gastric vessels and left gastroepiploic artery (Warshaw technique). Several studies have suggested a higher rate of spleen preservation with laparoscopy. The radical antegrade modular pancreatosplenectomy has become mainstay for treating pancreatic cancer and can be performed laparoscopically as well. Evidence on the feasibility and safety of laparoscopic distal pancreatectomy for cancer is scarce. Despite the obvious advantages of laparoscopic surgery, postoperative morbidity remains relatively high, mainly because of the high incidence of pancreatic fistula. For decades, surgeons have tried to prevent these fistulas but to date no strategy has been confirmed to be effective in 2 consecutive randomized studies. Pragmatic multicenter studies focusing on technical aspects of laparoscopic distal pancreatectomy are lacking and should be encouraged. PMID:26240565

  4. Technical Aspects of Laparoscopic Distal Pancreatectomy for Benign and Malignant Disease: Review of the Literature

    Directory of Open Access Journals (Sweden)

    T. de Rooij

    2015-01-01

    Full Text Available Distal pancreatectomy is the standard curative treatment for symptomatic benign, premalignant, and malignant disease of the pancreatic body and tail. The most obvious benefits of a laparoscopic approach to distal pancreatectomy include earlier recovery and shorter hospital stay. Spleen-preserving distal pancreatectomy should be attempted in case of benign disease. Spleen preservation can be achieved preferably by preserving the splenic vessels (Kimura technique, but also by resecting the splenic vessels and maintaining vascularity through the short gastric vessels and left gastroepiploic artery (Warshaw technique. Several studies have suggested a higher rate of spleen preservation with laparoscopy. The radical antegrade modular pancreatosplenectomy has become mainstay for treating pancreatic cancer and can be performed laparoscopically as well. Evidence on the feasibility and safety of laparoscopic distal pancreatectomy for cancer is scarce. Despite the obvious advantages of laparoscopic surgery, postoperative morbidity remains relatively high, mainly because of the high incidence of pancreatic fistula. For decades, surgeons have tried to prevent these fistulas but to date no strategy has been confirmed to be effective in 2 consecutive randomized studies. Pragmatic multicenter studies focusing on technical aspects of laparoscopic distal pancreatectomy are lacking and should be encouraged.

  5. Minimally invasive osteosynthesis of distal tibial fractures using anterolateral locking plate: Evaluation of results and complications.

    Science.gov (United States)

    Lakhotia, Devendra; Sharma, Gaurav; Khatri, Kavin; Kumar, G-N; Sharma, Vijay; Farooque, Kamran

    2016-01-01

    Soft tissue healing is of paramount importance in distal tibial fractures for a successful outcome. There is an increasing trend of using anterolateral plate due to an adequate soft tissue cover on ante- rolateral distal tibia. The aim of this study was to evaluate the results and complications of minimally invasive anterolateral locking plate in distal tibial fractures. This is a retrospective study of 42 patients with distal tibial fractures treated with minimally invasive anterolateral tibial plating. This study evaluates the bone and soft tissue healing along with emphasis on complications related to bone and soft tissue healing. Full weight bearing was allowed in mean time period of 4.95 months (3-12 months). A major local complication of a wound which required revision surgery was seen in one case. Minor complications were identified in 9 cases which comprised 4 cases of marginal necrosis of the surgical wound, 1 case of superficial infection, 1 case of sensory disturbance over the anterolateral foot, 1 case of muscle hernia and 2 cases of delayed union. Mean distance between the posterolateral and anterolateral incision was 5.7 cm (4.5-8 cm). The minimally invasive distal tibial fixation with anterolateral plating is a safe method of stabilization. Distance between anterolateral and posterolateral incision can be placed less than 7 cm apart depending on fracture pattern with proper surgical timing and technique.

  6. The use of a single volar locking plate for AO C3-type distal radius fractures.

    Science.gov (United States)

    Earp, Brandon E; Foster, Brian; Blazar, Philip E

    2015-12-01

    A single volar locking plate (VLP) is now frequently used for open reduction and internal fixation (ORIF) of many types of distal radius fractures. Comminuted intra-articular distal radius fractures (AO C3-type) are typically the most challenging to surgically treat. No studies directly address the adequacy of a VLP alone for maintaining reduction of AO C-type fractures. We hypothesized that a single VLP provides an effective method for maintaining reduction for these fractures. We retrospectively evaluated radiographs of a series of AO C-type fractures. Seventy-seven patients with 77 AO C3-type fractures were identified from billing records and were eligible for the study. All patients were treated by fellowship-trained hand surgeons. Radiographs at the time of union were compared to those from immediately postoperatively. Sixty-nine of 77 (89.6 %) fractures treated with VLP fixation alone for AO C3-type distal radius fractures united without loss of reduction. Eight of 77 (10.4 %) patients treated with VLP for AO C3 fractures lost reduction. The most common fracture fragment to lose reduction was the lunate fossa (5 of 8); loss of reduction of the scaphoid fossa die-punch fragment (2 of 8) and the radial styloid (1 of 8) were also seen. The majority (89.6 %) of AO C3-type fractures treated with a single volar locking plate come to union without loss of reduction. Level IV.

  7. Fracture lines and comminution zones in OTA/AO type 23C3 distal radius fractures: The distal radius map.

    Science.gov (United States)

    Misir, Abdulhamit; Ozturk, Kahraman; Kizkapan, Turan Bilge; Yildiz, Kadir Ilker; Gur, Volkan; Sevencan, Ahmet

    2018-01-01

    This study was designed to define fracture lines and comminution zones in OTA/AO 23C3 distal radius fractures from axial computed tomography (CT) images that would influence surgical planning, development of new classifications, and possible implant designs. Thirty-four consecutive OTA/AO 23C3 fractures treated by a single surgeon between January 2014 and December 2014 were analyzed. For each fracture, maps of the fracture lines and zones of comminution were drawn. Each map was digitized and graphically superimposed to create a compilation of fracture lines and zones of comminution. Based on this compilation, major and minor fracture lines were identified and fracture patterns were defined. All major fracture lines were distributed in the central region of the radius distal articular surface. There is a recurrent fracture pattern with a comminution zone including the scaphoid and lunate fossa; Lister's tubercle; and ulnar, volar, and radial zones. It is important for the practicing surgeon to understand these four main fragments. Knowledge of this constant pattern should influence the development of new classifications and possible implant designs.

  8. Evaluation of the Stryker S2 IM Nail Distal Targeting Device for reduction of radiation exposure: a case series study.

    Science.gov (United States)

    Anastopoulos, George; Ntagiopoulos, Panagiotis G; Chissas, Dionisios; Loupasis, George; Asimakopoulos, Antonios; Athanaselis, Eustratios; Megas, Panagiotis

    2008-10-01

    Distal locking is one challenging step during intramedullary nailing of femoral shaft fractures that can lead to an increase of radiation exposure. In the present study, the authors describe a technique for the distal locking of femoral nails, implementing a new targeting device in an attempt to reduce radiation exposure and operational time. Over a 2-year period, 127 consecutive cases of femoral shaft fractures were included in the study. All cases were treated with nailing of femoral shaft fractures with an unslotted reamed antegrade femoral nail and distal locking was performed with the use of a proximally mounted aiming device. Mean duration of the procedure was 63.5 18.1 min while the duration for distal locking was 6.6 +/- 2.6 min. In all successful cases, exposure from intraoperative fluoroscopy was 17.2 +/- 7.4 s for the whole operative procedure, and for distal locking was 2 shots, 1.35 s (range, 0.9-2.2 s) and 1.9 mGy (range, 1.1-2.9 mGy). Five cases (3.9%) were unsuccessful, but overall no intraoperative complications were encountered from the application of this technique. The ability of the device to correspond to the level of nail deformation and to properly identify the distal holes, reduced exposure to radiation compared to other published reports, and should be considered as a valuable tool for distal locking of femoral fractures.

  9. Does computer use affect the incidence of distal arm pain?

    DEFF Research Database (Denmark)

    Mikkelsen, Sigurd; Lassen, Christina Funch; Vilstrup, Imogen

    2012-01-01

    To study how objectively recorded mouse and keyboard activity affects distal arm pain among computer workers.......To study how objectively recorded mouse and keyboard activity affects distal arm pain among computer workers....

  10. Distal Fibula Fractures in National Football League Athletes

    OpenAIRE

    Werner, Brian C.; Mack, Christina; Franke, Kristina; Barnes, Ronnie P.; Warren, Russell F.; Rodeo, Scott A.

    2017-01-01

    Background: Despite the frequency of distal fibula fractures in elite athletes and the significant potential impact on the athletes’ season and future careers, little data exist characterizing the epidemiology of these injuries or, more importantly, return to competition. Purpose: To (1) evaluate the incidence of acute distal fibula fractures in National Football League (NFL) athletes, including isolated distal fibula and combined ankle fracture patterns; (2) analyze distal fibula fracture ra...

  11. Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

    International Nuclear Information System (INIS)

    Foley, P. T.; Kavnoudias, H.; Cameron, P. U.; Czarnecki, C.; Paul, E.; Lyon, S. M.

    2015-01-01

    PurposeTo compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels.Materials and MethodsPatients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population.ResultsOf the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation—a difference that could not be attributed to differences in age, grade of injury or residual splenic volume.ConclusionIgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function

  12. Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

    Energy Technology Data Exchange (ETDEWEB)

    Foley, P. T., E-mail: pfoley@doctors.org.uk [The Canberra Hospital, Department of Medical Imaging (Australia); Kavnoudias, H., E-mail: h.kavnoudias@alfred.org.au [The Alfred Hospital, Radiology Research Unit, Radiology Department (Australia); Cameron, P. U., E-mail: paul.cameron@unimelb.edu.au [The Alfred Hospital, Infectious Diseases Unit (Australia); Czarnecki, C., E-mail: caroline.czarnecki@gmail.com [Royal Melbourne Hospital, Radiology Department (Australia); Paul, E., E-mail: eldho.paul@monash.edu [Monash University, Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Alfred Hospital (Australia); Lyon, S. M., E-mail: lyonsey@optusnet.com.au [Melbourne Endovascular (Australia)

    2015-10-15

    PurposeTo compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels.Materials and MethodsPatients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population.ResultsOf the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation—a difference that could not be attributed to differences in age, grade of injury or residual splenic volume.ConclusionIgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function.

  13. Surgical treatment of distal biceps rupture.

    Science.gov (United States)

    Sutton, Karen M; Dodds, Seth D; Ahmad, Christopher S; Sethi, Paul M

    2010-03-01

    Rupture of the distal biceps tendon accounts for 10% of all biceps brachii ruptures. Injuries typically occur in the dominant elbow of men aged 40 to 49 years during eccentric contraction of the biceps. Degenerative changes, decreased vascularity, and tendon impingement may precede rupture. Although nonsurgical management is an option, healthy, active persons with distal biceps tendon ruptures benefit from early surgical repair, gaining improved strength in forearm supination and, to a lesser degree, elbow flexion. Biomechanical studies have tested the strength and displacement of various repairs; the suspensory cortical button technique exhibits maximum peak load to failure in vitro, and suture anchor and interosseous screw techniques yield the least displacement. Surgical complications include sensory and motor neurapraxia, infection, and heterotopic ossification. Current trends in postoperative rehabilitation include an early return to motion and to activities of daily living.

  14. Distal tibial fractures: evaluation of different fixation techniques.

    Science.gov (United States)

    Jöstl, Julian; Tiefenböck, Thomas Manfred; Hofbauer, Marcus; Winnisch, Markus; Lang, Nikolaus; Hajdu, Stefan; Sarahrudi, Kambiz

    2017-03-01

    The purpose of this study was the comparison of the most commonly used surgical techniques (external fixation, intramedullary nailing, and plate fixation) for the treatment of distal tibial fractures (AO/OTA classification 42-A, B, C or 43-A, B1). A retrospective cohort study of patients who underwent surgical treatment for distal tibial fractures between 1992 and 2011 was performed. A total of 93 patients (52 male/41 female) met inclusion criteria. Statistically significant differences were found regarding the consolidation time of the intramedullary-nailing (147.32 ± 91.16 days) and the plate-fixation group (135.75 ± 110.75 days) versus the external-fixation group (163.12 ± 96.79 days; P = 0.001; P = 0.01). Significant differences were also observed in the range of motion (ROM) of the ankle joint in the intramedullary-nailing and plate-fixation group versus the ROM in the external-fixation group (P = 0.044; P = 0.025). The overall complication rate was 13/93 (14 %). Out of 66 patients treated with intramedullary nailing, 8 (12 %) suffered from complications. Out of the 15 patients treated with plate and 12 patients with external fixation, 2 (13 %) and 3 (25 %) showed complications, respectively. Our results demonstrate advantages in terms of shorter mobilization time and a better ROM of the ankle joint for intramedullary nailing and plate fixation compared with external fixation. Due to our results, we suggest internal fixation (intramedullary nailing or plate fixation) whenever patient's condition and the local fracture situation allow it.

  15. Minimally invasive distal pancreatectomy for PNETs: laparoscopic or robotic approach?

    Science.gov (United States)

    Zhang, Jiaqiang; Jin, Jiabin; Chen, Shi; Gu, Jiangning; Zhu, Yi; Qin, Kai; Zhan, Qian; Cheng, Dongfeng; Chen, Hao; Deng, Xiaxing; Shen, Baiyong; Peng, Chenghong

    2017-05-16

    The most effective and radical treatment for pancreatic neuroendocrine tumors (PNETs) is surgical resection. Minimally invasive surgery has been increasingly used in pancreatectomy. Initial results in robotic distal pancreatectomy (RDP) have been encouraging. Nonetheless, data comparing outcomes of RDP with those of laparoscopic distal pancreatectomy (LDP) in treating PNETs are rare. The aim of this study was to compare the safety and efficacy of RDP and LDP for PNETs. From September 2010 to January 2017, operative parameters and perioperative outcomes in an initial experience with 43 consecutive patients undergoing RDP were collected and compared with those in 31 patients undergoing LDP. Patients undergoing RDP and LDP demonstrated equivalent age, sex, ASA score, tumor location and tumor size. Operating time, length of resected pancreas, postoperative length of hospital stay and rates of conversion to open, pancreatic fistula, transfusion and reoperation were not statistically different. Patients in the RDP group were associated with significantly higher overall (79.1 vs. 48.4 %, P = 0.006) and Kimura spleen preservation rates (72.1 vs. 16.1%, P < 0.001) and had reduced risk of excessive blood loss (50 vs. 200mL, P < 0.001). Oncological outcomes in this series were superior for the RDP group with more lymph node harvest for G2 and G3 PNETs (3.5 vs. 2, P = 0.034). Both RDP and LDP are efficacious and safe methods in treating PNETs located in the body or tail of pancreas. Robotic approach offers advantages with less intraoperative blood loss, higher spleen preservation rate and more lymph node harvest. It may be sensible to choose RDP for patients who fit indications for scheduled spleen preservation.

  16. Fractures of the distal phalanx in the horse

    International Nuclear Information System (INIS)

    Yovich, J.V.

    1989-01-01

    Fractures of the distal phalanx are an important cause of lameness referable to the foot. Depending on the fracture configuration and articular involvement, conservative or surgical treatment may be required. Fractures of the distal phalanx have been divided into six categories based on fracture configuration. Discussion of clinical features, management, and prognosis for horses with distal phalangeal fractures is presented for each fracture type

  17. Dermoscopic features of distal lateral subungual onychomycosis

    Directory of Open Access Journals (Sweden)

    Thansiha Nargis

    2018-01-01

    Full Text Available Background: Onychomycosis is a very common disease and accounts for upto 50% of the diseases affecting the nail apparatus. Diagnosis of onychomycosis is usually confirmed with the help of a potassium hydroxide (KOH mount and fungal culture. Onychoscopy can be a handy and additional tool for the diagnosis. Aims and Objectives: To determine the dermoscopic findings in distal lateral subungual onychomycosis (DLSO. Materials and Methods: A prospective study of 60 nails with a clinical and mycological diagnosis (KOH with Chicago sky blue positive of DLSO. Dermoscopic examination was performed using a Heine delta 20 plus dermatoscope and the features were recorded. Results: Longitudinal striae and jagged proximal edges seen in all 60 (100% patients. Intermittent spiked pattern was seen in 47 nails (78.3%. Chromonychia and distal irregular termination were noticed in 23 (38.3% and 7 (11.7% nails, respectively. Conclusions: Onychoscopy can be used as an important diagnostic tool while evaluating nail disease, especially in DLSO. Limitations: Small study sample and lack of comparison with other nail diseases that manifests with distal onycholysis.

  18. Miastenia grave distal: relato de caso

    Directory of Open Access Journals (Sweden)

    Scola Rosana Herminia

    2003-01-01

    Full Text Available Relatamos o caso de uma mulher de 30 anos com quadro de fraqueza muscular nos membros inferiores com predomínio distal com início há 7 anos. Na evolução apresentou fraqueza muscular nos membros superiores. O exame físico mostrava nervos cranianos sem alterações, hipotrofia bilateral de quadriceps e interósseos dos pés, redução da força muscular mais intensa em tibiais anteriores e interósseos dorsais dos pés e reflexos tendinosos globalmente hipoativos. Foi realizado teste de estimulação repetitiva que mostrou decremento maior que 10% no nervo fibular e ulnar. A dosagem de anticorpos anti-receptor de acetilcolina foi positiva. Tomografia computadorizada de tórax foi normal. Dosagem de hormônios tireoidianos mostrou evidências laboratoriais de hipertireoidismo, porém sem manifestações clínicas. Foi iniciado tratamento com piridostigmina havendo melhora importante do quadro clínico. A fraqueza distal é um sintoma inicial raro na miastenia grave (MG. Contudo, a MG deve entrar no diagnóstico diferencial de doenças que cursam com fraqueza muscular distal de membros superiores ou inferiores.

  19. Bilateral distal fibula fractures in a woman on long-term bisphosphonate therapy.

    Science.gov (United States)

    Murray, J C; Audet, M C; Bédard, M; Michou, L

    2016-02-01

    We report the case of a 53-year-old female, treated by bisphosphonate for 12 years, who presented atraumatic fractures of both fibulas. Her X-rays showed bilateral distal fibula fractures with radiological features similar to atypical femur fractures. The distal fibula should be considered as a potential site for stress fractures in bisphosphonate users. Bisphosphonates are the most widely used drugs in the treatment of osteoporosis. During the last decade, the occurrence of atypical fractures, mostly subtrochanteric and diaphyseal femoral fractures, has been acknowledged in patients with long-term use of bisphosphonates. We report the case of a 53-year-old female on alendronate therapy for the past 12 years who presented with a few months history of atraumatic right, and subsequently left, lateral ankle pain. Her X-rays showed bilateral distal fibula fractures with radiological features similar to atypical femur fractures. She had been treated conservatively with walking boots and her treatment with bisphosphonate had been stopped 5 months prior to the fractures. Callus was progressively seen on serial follow-up X-rays, and both fractures healed completely within a reasonable period of 1 year. Investigations did not reveal any secondary causes of osteoporosis or metabolic bone disorders. To our knowledge, this is the first reported case of bilateral distal fibula fractures in a patient on long-term bisphosphonate therapy.

  20. Trends in the United States in the treatment of distal radial fractures in the elderly.

    Science.gov (United States)

    Chung, Kevin C; Shauver, Melissa J; Birkmeyer, John D

    2009-08-01

    Traditionally, distal radial fractures in the elderly have been treated nonoperatively with casting. However, since the introduction of the volar locking plating system in 2000, there has been an interest in the use of more aggressive treatment methods. The purpose of the present study was to assess changing trends in the treatment of distal radial fractures in elderly patients in the United States. We evaluated a 5% sample of Medicare data from 1996 to 1997 and a 20% sample from 1998 to 2005. Information on four treatment methods (closed treatment, percutaneous pin fixation, internal fixation, and external fixation) was extracted from the dataset. Other available data were diagnosis, physician specialty, and patient age, sex, and race. We calculated frequencies and rates to compare the utilization of different treatments over time. Over the ten-year time period examined, the rate of internal fixation of distal radial fractures in the elderly increased fivefold, from 3% in 1996 to 16% in 2005. Closed treatment, however, remained the predominant method (used for 82% of the fractures in 1996 and 70% in 2005). Fractures in patients with an age of eighty-five years or more were significantly more likely to be treated in a closed fashion (p < 0.0001). There was a large variation among physician specialties with regard to the fixation methods that were used. Orthopaedic surgeons were significantly more likely to use closed treatment than hand surgeons were, whereas hand surgeons were significantly more likely to use internal fixation than orthopaedic surgeons were. Since 2000, although the majority of distal radial fractures are still treated nonoperatively, there has been an increase in the use of internal fixation and a concurrent decrease in the rate of closed treatment of distal radial fractures in the elderly in the United States.

  1. Maxillary molar distalization with the dual-force distalizer supported by mini-implants: a clinical study.

    Science.gov (United States)

    Oberti, Giovanni; Villegas, Carlos; Ealo, Martha; Palacio, John Camilo; Baccetti, Tiziano

    2009-03-01

    The objective of this prospective study was to describe the clinical effects of a bone-supported molar distalizing appliance, the dual-force distalizer. The study group included 16 patients (mean age, 14.3 years) with Class II molar relationships. Study models and lateral cephalograms were taken before and after the distalizing movement to record significant dental and skeletal changes (Wilcoxon test). The average distalization time was 5 months, with a movement rate of 1.2 mm per month; the distalization amounts were 5.9 +/- 1.72 mm at the crown level and 4.4 +/- 1.41 mm at the furcation level. The average molar inclination was 5.6 degrees +/- 3.7 degrees ; this was less than the amount of inclination generated by bone-supported appliances that use single distalizing forces. The correlation between inclination and distalization was not significant, indicating predominantly bodily movement. The teeth anterior to the first molar moved distally also; the second premolars distalized an average of 4.26 mm, and the incisors retruded by 0.53 mm. The dual-force distalizer is a valid alternative distalizing appliance that generates controlled molar distalization with a good rate of movement and no loss of anchorage.

  2. An innovative technique to distalize maxillary molar using microimplant supported rapid molar distalizer

    Directory of Open Access Journals (Sweden)

    Meenu Goel

    2013-01-01

    Full Text Available Introduction: In recent years, enhancements in implants have made their use possible as a mode of absolute anchorage in orthodontic patients. In this paper, the authors have introduced an innovative technique to unilaterally distalize the upper left 1 st molar to obtain an ideal Class I molar relationship from a Class II existing molar relationship with an indigenous designed distalizer. Clinical Innovation: For effective unilateral diatalization of molar, a novel cantilever sliding jig assembly was utilized with coil spring supported by a buccally placed single micro implant. The results showed 3 mm of bodily distalization with 1 mm of intrusion and 2° of distal tipping of upper left 1 st molar in 1.5 months. Discussion: This appliance is relatively easy to insert, well-tolerated, and requires minimal patient cooperation compared to other present techniques of molar distalization. Moreover, it is particularly useful in cases that are Class II on one side and Class I on the other, with a minor midline discrepancy and nominal overjet. Patient acceptance level was reported to be within patients physiological and comfort limits.

  3. Robotic distal pancreatectomy versus conventional laparoscopic distal pancreatectomy: a comparative study for short-term outcomes.

    Science.gov (United States)

    Lai, Eric C H; Tang, Chung Ngai

    2015-09-01

    Robotic system has been increasingly used in pancreatectomy. However, the effectiveness of this method remains uncertain. This study compared the surgical outcomes between robot-assisted laparoscopic distal pancreatectomy and conventional laparoscopic distal pancreatectomy. During a 15-year period, 35 patients underwent minimally invasive approach of distal pancreatectomy in our center. Seventeen of these patients had robot-assisted laparoscopic approach, and the remaining 18 had conventional laparoscopic approach. Their operative parameters and perioperative outcomes were analyzed retrospectively in a prospective database. The mean operating time in the robotic group (221.4 min) was significantly longer than that in the laparoscopic group (173.6 min) (P = 0.026). Both robotic and conventional laparoscopic groups presented no significant difference in spleen-preservation rate (52.9% vs. 38.9%) (P = 0.505), operative blood loss (100.3 ml vs. 268.3 ml) (P = 0.29), overall morbidity rate (47.1% vs. 38.9%) (P = 0.73), and post-operative hospital stay (11.4 days vs. 14.2 days) (P = 0.46). Both groups also showed no perioperative mortality. Similar outcomes were observed in robotic distal pancreatectomy and conventional laparoscopic approach. However, robotic approach tended to have the advantages of less blood loss and shorter hospital stay. Further studies are necessary to determine the clinical position of robotic distal pancreatectomy.

  4. Topographic matching of distal radius and proximal fibula articular surface for distal radius osteoarticular reconstruction.

    Science.gov (United States)

    Zhang, H; Chen, S; Wang, Z; Guo, Y; Liu, B; Tong, D

    2016-07-01

    During osteoarticular reconstruction of the distal radius with the proximal fibula, congruity between the two articular surfaces is an important factor in determining the quality of the outcome. In this study, a three-dimensional model and a coordinate transformation algorithm were developed on computed tomography scanning. Articular surface matching was performed and parameters for the optimal position were determined quantitatively. The mean radii of best-fit spheres of the articular surfaces of the distal radius and proximal fibula were compared quantitatively. The radial inclination and volar tilt following reconstruction by an ipsilateral fibula graft, rather than the contralateral, best resembles the values of the native distal radius. Additionally, the ipsilateral fibula graft reconstructed a larger proportion of the distal radius articular surface than did the contralateral. The ipsilateral proximal fibula graft provides a better match for the reconstruction of the distal radius articular surface than the contralateral, and the optimal position for graft placement is quantitatively determined. © The Author(s) 2015.

  5. Distal renal tubular acidosis in recurrent renal stone formers

    DEFF Research Database (Denmark)

    Osther, P J; Hansen, A B; Røhl, H F

    1989-01-01

    (1.1%) had complete distal renal tubular acidosis and 14 (15.5%) incomplete distal renal tubular acidosis. Our results confirm that distal renal tubular acidification defects are associated with a more severe form of stone disease and make distal renal tubular acidosis one of the most frequent...... metabolic disturbances in renal stone formers. Distal renal tubular acidosis (dRTA) was relatively more common in female stone formers and most often found in patients with bilateral stone disease (36%). Since prophylactic treatment in renal stone formers with renal acidification defects is available...

  6. The role of hand-assisted laparoscopic distal gastrectomy for distal gastric cancer.

    Science.gov (United States)

    Kim, Y W; Bae, J M; Lee, J H; Ryu, K W; Choi, I J; Kim, C G; Lee, J S; Rho, J Y

    2005-01-01

    The aim of this study was to evaluate the role of hand-assisted distal gastrectomy (HALDG) for gastric cancer. This study prospectively enrolled 16 patients who underwent HALDG for early gastric cancer and matched them individually by sex, age, and body mass index to patients who underwent laparoscopically assisted distal gastrectomy (LADG) or open distal gastrectomy (ODG). Surgical outcomes were compared among the surgical methods. The mean operating time was the longest for the HALDG group, whereas wound size of the HALDG group was intermediate between that of the LADG and the ODG groups. The other surgical outcomes, such as the number of harvested lymph nodes, were not different among the groups. According to the findings, HALDG may not be as beneficial for patients with early gastric cancer as has been previously suggested. However, because of easier hand-eye coordination, HALDG may be an excellent bridge learning technique as a surgeon gains experience in laparoscopic gastrectomy.

  7. Fracture heuristics: surgical decision for approaches to distal radius fractures. A surgeon’s perspective

    Directory of Open Access Journals (Sweden)

    Wichlas, Florian

    2017-05-01

    Full Text Available Introduction: The aim of the present study is to develop a heuristic that could replace the surgeon’s analysis for the decision on the operative approach of distal radius fractures based on simple fracture characteristics.Patients and methods: Five hundred distal radius fractures operated between 2011 and 2014 were analyzed for the surgeon’s decision on the approach used. The 500 distal radius fractures were treated with open reduction and internal fixation through palmar, dorsal, and dorsopalmar approaches with 2.4 mm locking plates or underwent percutaneous fixation. The parameters that should replace the surgeon’s analysis were the fractured palmar cortex, and the frontal and the sagittal split of the articular surface of the distal radius. Results: The palmar approach was used for 422 (84.4% fractures, the dorsal approach for 39 (7.8%, and the combined dorsopalmar approach for 30 (6.0%. Nine (1.8% fractures were treated percutaneously. The correlation between the fractured palmar cortex and the used palmar approach was moderate (r=0.464; p<0.0001. The correlation between the frontal split and the dorsal approach, including the dorsopalmar approach, was strong (r=0.715; p<0.0001. The sagittal split had only a weak correlation for the dorsal and dorsopalmar approach (r=0.300; p<0.0001. Discussion: The study shows that the surgical decision on the preferred approach is dictated through two simple factors, even in the case of complex fractures. Conclusion: When the palmar cortex is displaced in distal radius fractures, a palmar approach should be used. When there is a displaced frontal split of the articular surface, a dorsal approach should be used. When both are present, a dorsopalmar approach should be used. These two simple parameters could replace the surgeon’s analysis for the surgical approach.

  8. Arthroscopic resection of the distal clavicle in osteoarthritis of the acromioclavicular joint

    Directory of Open Access Journals (Sweden)

    Tae-Soo Park

    2016-01-01

    Full Text Available Background: Symptomatic acromioclavicular joint (ACJ lesions are a common cause of shoulder complaints that can be treated successfully with both conservative and surgical methods. There are several operative techniques, including both open and arthroscopic surgery, for excising the distal end of the clavicle. Here, we present a new modified arthroscopic technique for painful osteoarthritis of the ACJ and evaluate its clinical outcomes. Our hypothesis was that 4- to 7-mm resection of the distal clavicle in an en bloc fashion would have several advantages, including no bony remnants, maintenance of stability of the ACJ, and reduced prevalence of heterotopic ossification, in addition to elimination of the pathologic portion of the distal clavicle. Materials and Methods: 20 shoulders of 20 consecutive patients with painful and isolated osteoarthritis of the ACJ who were treated by arthroscopic en bloc resection of the distal clavicle were included in the study. There were 10 males and 10 females with an average age of 56 years (range 42-70 years. The mean duration of followup was 6 years and 2 months (range 4-8 years 10 months. The results were evaluated using the University of California Los Angeles (UCLA shoulder rating score. Results: The overall UCLA score was 13.7 preoperatively, which improved to 33.4 postoperatively. All subscores were improved significantly ( P < 0.001. There were no specific complications at the latest followup. Conclusion: It is critical in this procedure to resect the distal clavicle evenly from superior to inferior in an en bloc fashion without any small bony remnants and to preserve the capsule and acromioclavicular ligament superoposteriorly. This arthroscopic procedure is a reliable and reproducible technique for painful osteoarthritis of the ACJ lesions in active patients engaged in overhead throwing sports and heavy labor.

  9. Fracture heuristics: surgical decision for approaches to distal radius fractures. A surgeon's perspective.

    Science.gov (United States)

    Wichlas, Florian; Tsitsilonis, Serafim; Kopf, Sebastian; Krapohl, Björn Dirk; Manegold, Sebastian

    2017-01-01

    Introduction: The aim of the present study is to develop a heuristic that could replace the surgeon's analysis for the decision on the operative approach of distal radius fractures based on simple fracture characteristics. Patients and methods: Five hundred distal radius fractures operated between 2011 and 2014 were analyzed for the surgeon's decision on the approach used. The 500 distal radius fractures were treated with open reduction and internal fixation through palmar, dorsal, and dorsopalmar approaches with 2.4 mm locking plates or underwent percutaneous fixation. The parameters that should replace the surgeon's analysis were the fractured palmar cortex, and the frontal and the sagittal split of the articular surface of the distal radius. Results: The palmar approach was used for 422 (84.4%) fractures, the dorsal approach for 39 (7.8%), and the combined dorsopalmar approach for 30 (6.0%). Nine (1.8%) fractures were treated percutaneously. The correlation between the fractured palmar cortex and the used palmar approach was moderate (r=0.464; p<0.0001). The correlation between the frontal split and the dorsal approach, including the dorsopalmar approach, was strong (r=0.715; p<0.0001). The sagittal split had only a weak correlation for the dorsal and dorsopalmar approach (r=0.300; p<0.0001). Discussion: The study shows that the surgical decision on the preferred approach is dictated through two simple factors, even in the case of complex fractures. Conclusion: When the palmar cortex is displaced in distal radius fractures, a palmar approach should be used. When there is a displaced frontal split of the articular surface, a dorsal approach should be used. When both are present, a dorsopalmar approach should be used. These two simple parameters could replace the surgeon's analysis for the surgical approach.

  10. Comparison of intramedullary nail and plate fixation in distal tibia diaphyseal fractures close to the mortise.

    Science.gov (United States)

    Yavuz, Umut; Sökücü, Sami; Demir, Bilal; Yıldırım, Timur; Ozcan, Cağrı; Kabukçuoğlu, Yavuz Selim

    2014-05-01

    In this study, we aimed to compare the functional and radiological results of intramedullary nailing and plate fixation techniques in the surgical treatment of distal tibia diaphyseal fractures close to the ankle joint. Between 2005 and 2011, 55 patients (32 males, 23 females; mean age 42 years; range 15 to 72 years) who were treated with intramedullary nailing (21 patients) or plate fixation (34 patients) due to distal tibia diaphyseal fracture were included in the study. The average follow-up period was 27.6 months (range, 12-82 months). The patients were evaluated with regard to nonunion, malunion, infection, and implant irritation. The AOFAS (American Orthopaedic Foot and Ankle Society) scale was used for the clinical evaluation. No statistically significant difference was found between the two surgical methods with respect to unification time, AOFAS score, accompanying fibula fracture, material irritation, and malunion. Nine patients had open fractures, and these patients were treated with plate fixation (p=0.100). Nonunion developed in three patients who were treated with plates. Infection occurred in one patient. Anterior knee pain was significantly higher in patients who were treated with intramedullary nails. There was no malunion in any patient. As the distal fragment is not long enough, plate fixation technique is usually preferred in the treatment of distal tibia diaphyseal fractures. In this study, we observed that if the surgical guidelines are followed carefully, intramedullary nailing is an appropriate technique in this kind of fracture. The malunion rates are not significantly increased, and it also has the advantages of being a minimally invasive surgery with fewer wound problems.

  11. [Bilroth-I subtotal resection and its efficacy in the treatment of distal gastric cancer].

    Science.gov (United States)

    Morgoshiia, T Sh

    2006-01-01

    The experience with 260 Bilrot-I resections for cancer of a distal part of the stomach is analyzed. Postoperative lethality was 2.69%, rate of dumping-syndrome -- 12.3%. Among 215 followed-up patients treated surgically 5- and 10-year survival was 65.1 and 24.7%, respectively. Original surgical methods for improvement of immediate and long-term functional results have been developed and applied in clinical practice.

  12. Periosteal osteoblastoma of the distal femur

    Energy Technology Data Exchange (ETDEWEB)

    Nakatani, Tetsuya; Yamamoto, Tetsuji; Akisue, Toshihiro; Marui, Takashi; Hitora, Toshiaki; Kawamoto, Teruya; Nagira, Keiko; Yoshiya, Shinichi; Kurosaka, Masahiro [Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe (Japan); Fujita, Ikuo; Matsumoto, Keiji [Department of Orthopaedic Surgery, Hyogo Medical Center for Adults, Akashi, Hyogo (Japan)

    2004-02-01

    Osteoblastomas located on the surface of the cortical bone, so-called periosteal osteoblastomas, are extremely rare. We report on a case of periosteal osteoblastoma arising from the posterior surface of the right distal femur in a 17-year-old man. Roentgenographic, computed tomographic, magnetic resonance imaging, and histologic features of the case are presented. Periosteal osteoblastoma should be radiologically and histologically differentiated from myositis ossificans, avulsive cortical irregularity syndrome, osteoid osteoma, parosteal osteosarcoma, periosteal osteosarcoma, and high-grade surface osteosarcoma. Although periosteal osteoblastoma is rare, this tumor should be included in the differential diagnosis of surface-type bone tumors. (orig.)

  13. Periosteal osteoblastoma of the distal femur

    International Nuclear Information System (INIS)

    Nakatani, Tetsuya; Yamamoto, Tetsuji; Akisue, Toshihiro; Marui, Takashi; Hitora, Toshiaki; Kawamoto, Teruya; Nagira, Keiko; Yoshiya, Shinichi; Kurosaka, Masahiro; Fujita, Ikuo; Matsumoto, Keiji

    2004-01-01

    Osteoblastomas located on the surface of the cortical bone, so-called periosteal osteoblastomas, are extremely rare. We report on a case of periosteal osteoblastoma arising from the posterior surface of the right distal femur in a 17-year-old man. Roentgenographic, computed tomographic, magnetic resonance imaging, and histologic features of the case are presented. Periosteal osteoblastoma should be radiologically and histologically differentiated from myositis ossificans, avulsive cortical irregularity syndrome, osteoid osteoma, parosteal osteosarcoma, periosteal osteosarcoma, and high-grade surface osteosarcoma. Although periosteal osteoblastoma is rare, this tumor should be included in the differential diagnosis of surface-type bone tumors. (orig.)

  14. Mini-implant-supported Molar Distalization

    Directory of Open Access Journals (Sweden)

    Amit Goyal

    2012-01-01

    Full Text Available Temporary anchorage devices popularly called mini-implants or miniscrews are the latest addition to an orthodontist′s armamentarium. The following case report describes the treatment of a 16-year-old girl with a pleasant profile, moderate crowding and Angle′s Class II molar relationship. Maxillary molar distalization was planned and mini-implants were used to preserve the anterior anchorage. After 13 months of treatment, Class I molar and canine relation was achieved bilaterally and there was no anterior proclination. Thus, mini-implants provide a viable option to the clinician to carry out difficult tooth movements without any side effects.

  15. Distal radius fracture after proximal row carpectomy

    OpenAIRE

    Igeta, Yuka; Naito, Kiyohito; Sugiyama, Yoichi; Obata, Hiroyuki; Aritomi, Kentaro; Kaneko, Kazuo; Obayashi, Osamu

    2015-01-01

    Introduction: We encountered a patient with distal radius fracture (DRF) after proximal row carpectomy (PRC). The mechanism of the DRF after PRC is discussed in this report. Presentation of case: The patient was a 73-year-old female who had undergone PRC due to Kienböck disease before. The wrist range of motion was: 45° on dorsiflexion and 20° on flexion. DRF has occurred at 3 years after PRC. The fracture type was extra-articular fracture. Osteosynthesis was performed using a volar lockin...

  16. [Dual plating fixation for distal fibular comminuted fractures].

    Science.gov (United States)

    Gu, Wenqi; Shi, Zhongmin; Mei, Guohua; Xue, Jianfeng; Zou, Jian

    2014-01-01

    To evaluate the technique and effectiveness of dual plating fixation for distal fibular comminuted fractures. Between November 2010 and November 2011, 16 patients with distal fibular comminuted fractures were treated, including 10 males and 6 females with an average age of 49.8 years (range, 35-65 years). All the patients had closed injury, which was caused by sprain in 9 cases, by traffic accident in 5 cases, and by falling in 2 cases. The average interval from injury to admission was 8 hours (range, 1-48 hours). Routine X-ray and CT scan were taken for confirmation of classification and involvement. According to Weber classification system, 11 cases were rated as type A, and 5 as type B; 5 cases had bimalleolar fractures with medial malleolar fracture, and 2 cases had trimalleolar fractures with posterior and medial malleolar fracture. Open reduction and dual plating fixation were performed after swelling was subsided. The X-ray films were taken during follow-up. The effectiveness was evaluated with visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot and ankle score system at last follow-up. The range of motion (ROM) of the ankle and complications were also been recorded. Delayed healing of incision occurred in 1 patient with diabetes, who was cured after changing dressing; primary healing was obtained in the other patients. Twelve patients were followed up 18 months on average (range, 12-24 months). Radiographic examination demonstrated the mean time of bone healing was 12 weeks (range, 10-14 weeks). No complication of implant failure, malunion, nonunion, or post-traumatic arthritis occurred during follow-up. The AOFAS hindfoot and ankle score was 79.6 +/- 6.5, and the VAS score was 1.3 +/- 1.5. The ROM of the ankle was (70.0 +/- 8.0) degrees of flexion and (84.0 +/- 5.1) degrees of extension. Dual plating fixation for distal fibular comminuted fractures can obtain a rigid stabilization with a low complication incidence

  17. Fractures of the distal radius. Current concepts for treatment.

    Science.gov (United States)

    Broos, P L; Fourneau, I A; Stoffelen, D V

    2001-06-01

    The authors review the treatment of fractures of the distal radius, based on their experience and from data in the literature. The choice of a treatment for any given fracture must take into account first of all the stability of the fracture. The best results are achieved in stable fractures. Only minimally displaced distal radius fractures can be treated functionally. However, a plaster cast for one week is indicated for the comfort of the patient. In displaced but stable fractures both closed reduction and percutaneous fixation are indicated. In case of closed reduction, the plaster cast should be applied for 5 to 6 weeks with an above-elbow cast for 3 weeks. Percutaneous fixation gives the best results in extraarticular fractures in younger patients. Because of its simplicity however, it should not be ignored in the elderly osteoporotic patients. In the authors' experience, both techniques were only used for extraarticular fractures. Good and excellent results were found in the closed reduction and plaster cast group in 74% of the patients; the Kapandji technique gave 75% good and excellent results. These results are in line with other findings which show that, for simple fracture types, the Kapandji technique and closed reduction seem to give similar results. External fixation is widely used for intra-articular comminuted fractures. Dynamic external fixation does not show any advantage over static devices. Additional K-wires or bone grafting may be necessary. External fixation gives superior results to plate and screw fixation. Internal fixation should be reserved for fractures with ventral comminution or severe displacement with unacceptable reduction by closed or minimally invasive techniques.

  18. [Retrograde intramedullary nailing for periprosthetic fractures of the distal femur].

    Science.gov (United States)

    Biber, R; Bail, H J

    2014-10-01

    Intramedullary stabilization of periprosthetic distal femoral fractures by interlocking nailing. Closed reduction by retrograde nail can be combined with the use of transmedullary support screws (TMS principle of Stedtfeld). Supracondylar fractures above stable knee arthroplasty (Rorabeck types I and II), femoral shaft fractures ipsilateral of stable hip and/or knee arthroplasty, contraindications for antegrade nailing Closed box design of femoral implant, intercondylar distance of the femoral component smaller than nail diameter, more than 40° flexion deficit of the knee, inability to place two bicortical distal interlocking screws. Relative contraindication: insufficient overlap with proximal implants Supine position and knee flexion of approximately 45°. Fluoroscopy should be possible between the knee and hip. Longitudinal skin incision into the pre-existing scar over the patellar tendon which is then split. The nail entry point is located in the intercondylar groove at the deepest point of Blumensaat's line, often predetermined by the femoral arthroplasty component. Reaming is rarely necessary. Transmedullary support screws may correct axial malalignment during nail insertion. Static interlocking in a direction from lateral to medial by the aiming device. Insertion of locking cap. Retrograde nailing normally allows full weight bearing. Range of motion does not need to be restricted. Out of 101 fractures treated between 2000 and 2013 with a Targon RF nail (Aesculap, Tuttlingen, Germany) 10 were periprosthetic, all were classified as Rorabeck type II and of these 6 fractures were metaphyseal and 4 were diaphyseal. In four cases proximal implants were present. The mean operative time for periprosthetic fracture fixation did not significantly differ from that for normal retrograde femoral nailing. There were no postoperative infections, fixation failures or delayed unions. There was one revision for secondary correction of maltorsion.

  19. Intramedullary nailing of proximal and distal one-third tibial shaft fractures with intraoperative two-pin external fixation.

    Science.gov (United States)

    Wysocki, Robert W; Kapotas, James S; Virkus, Walter W

    2009-04-01

    Fractures of the proximal and distal one thirds of the tibial shaft have historically higher malunion rates than those of the midshaft. This retrospective case series evaluates the postoperative radiographic outcome of intramedullary nailing of proximal and distal one-third tibial shaft fractures using intraoperative two-pin external fixation, often referred to as traveling traction. Between 2000 and 2005, 15 consecutive patients with proximal third and 27 consecutive patients with distal third displaced extra-articular fractures of the tibia were treated with statically locked intramedullary nailing and supplementary intraoperative two-pin rectangular frame external fixation. The external fixation was removed once the proximal and distal locking screws were in place. The alignment of the fractures was determined using standard postoperative anteroposterior and lateral radiographs. Postoperatively, 14 of 15 patients with proximal fractures and 25 of 27 patients with distal fractures had less than 5 degrees of angular deformity in both the coronal and sagittal planes and less than 1 cm shortening. Statically locked intramedullary nailing with simultaneous intraoperative traveling traction external fixation as treatment for proximal and distal one-third extra-articular tibial shaft fractures is successful in achieving a high rate of acceptable postoperative alignment.

  20. Maxillary molar distalization with first class appliance.

    Science.gov (United States)

    Ramesh, Namitha; Palukunnu, Biswas; Ravindran, Nidhi; Nair, Preeti P

    2014-02-27

    Non-extraction treatment has gained popularity for corrections of mild-to-moderate class II malocclusion over the past few decades. The distalization of maxillary molars is of significant value for treatment of cases with minimal arch discrepancy and mild class II molar relation associated with a normal mandibular arch and acceptable profile. This paper describes our experience with a 16-year-old female patient who reported with irregularly placed upper front teeth and unpleasant smile. The patient was diagnosed to have angles class II malocclusion with moderate maxillary anterior crowding, deep bite of 4 mm on a skeletal class II base with an orthognathic maxilla and retrognathic mandible and normal growth pattern. She presented an ideal profile and so molar distalization was planned with the first-class appliance. Molars were distalised by 8 mm on the right and left quadrants and class I molar relation achieved within 4 months. The space gained was utilised effectively to align the arch and establish a class I molar and canine relation.

  1. Biotin absorption by distal rat intestine

    International Nuclear Information System (INIS)

    Bowman, B.B.; Rosenberg, I.H.

    1987-01-01

    We used the in vivo intestinal loop approach, with short (10-min) and long (3-h) incubations, to examine biotin absorption in proximal jejunum, distal ileum, cecum and proximal colon. In short-term studies, luminal biotin disappearance from rat ileum was about half that observed in the jejunum, whereas absorption by proximal colon was about 12% of that in the jejunum. In 3-h closed-loop studies, the absorption of 1.0 microM biotin varied regionally. Biotin absorption was nearly complete in the small intestine after 3 h; however, only about 15% of the dose had been absorbed in the cecum and 27% in the proximal colon after 3 h. Independent of site of administration, the major fraction of absorbed biotin was recovered in the liver; measurable amounts of radioactive biotin were also present in kidney and plasma. The results support the potential nutritional significance for the rat of biotin synthesized by bacteria in the distal intestine, by demonstrating directly an absorptive capability of mammalian large bowel for this vitamin

  2. Distal radius fracture after proximal row carpectomy.

    Science.gov (United States)

    Igeta, Yuka; Naito, Kiyohito; Sugiyama, Yoichi; Obata, Hiroyuki; Aritomi, Kentaro; Kaneko, Kazuo; Obayashi, Osamu

    2015-01-01

    We encountered a patient with distal radius fracture (DRF) after proximal row carpectomy (PRC). The mechanism of the DRF after PRC is discussed in this report. The patient was a 73-year-old female who had undergone PRC due to Kienböck disease before. The wrist range of motion was: 45° on dorsiflexion and 20° on flexion. DRF has occurred at 3 years after PRC. The fracture type was extra-articular fracture. Osteosynthesis was performed using a volar locking plate. No postoperative complication developed, the Mayo score was excellent at 6 months after surgery, and the daily living activity level recovered to that before injury. Since the wrist range of motion decreased and the lunate fitted into the joint surface after PRC, making the forearm join with the hand like a single structure, pressure may have been loaded on the weak distal end of the radius from the dorsal side, causing volar displacement and fracture. The pressure distribution and range of motion of the radiocarpal joint after PRC are different from those of a normal joint, and the mechanism of fracture also changes due to PRC. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. Clinical profile of distal renal tubular acidosis

    Directory of Open Access Journals (Sweden)

    Ratan Jha

    2011-01-01

    Full Text Available To determine the clinical profile and progression of renal dysfunction in distal renal tubular acidosis (dRTA, we retrospectively studied 96 consecutive cases of dRTA diagnosed at our center. Patients with unexplained metabolic bone disease, short stature, hypokalemia, re-current renal stones, chronic obstructive uropathy or any primary autoimmune condition known to cause dRTA were screened. Distal RTA was diagnosed on the basis of systemic metabolic acidosis with urine pH >5.5 and positive urine anion gap. In those patients who had fasting urine pH >5.5 with normal baseline systemic pH and bicarbonate levels (incomplete RTA, acid load test with ammonium chloride was done. A cause of dRTA could be established in 53 (54% patients. Urological defect in children (22/44 and autoimmune disease in adults (11/52 were the commonest causes. Hypokalemic paralysis, proximal muscle weakness and voiding difficulty were the common modes of presentation. Doubling of serum creatinine during the study period was noted in 13 out of 27 patients who had GFR 60 mL/min (P <0.005. In conclusion, urological disorders were the commonest cause of dRTA in children while autoimmune disorders were the commonest asso-ciation in adults. Worse baseline renal function, longer duration of disease and greater frequency of nephrolithiasis/nephrocalcinosis and urological disorders were noted in those who had wor-sening of renal dysfunction during the study period.

  4. OUTCOME OF DISTAL TIBIA FRACTURE BY NAIL OR PLATE (MIPPO- A COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Madhuchandra R

    2017-02-01

    Full Text Available BACKGROUND Distal tibial fracture often present a challenge to the orthopaedic surgeon. The best option for surgical management of distal tibial fracture is still unclear, whether nail or plate. MATERIALS AND METHODS The study consists of 24 patients of distal tibial fracture treated either with reamed intramedullary nails or locked plating/MIPPO with open reduction method or minimally-invasive techniques. RESULTS 24 patients included in the present study were divided into two groups as nailing group A and plating group B. Nailing group included 12 patients and plating group included 12. Age range of patients was 21-62 years. Most common mode of trauma in both groups as RTA followed by accidental fall in 2 cases. The average time for union and weightbearing was 19 weeks in group A and 20.08 weeks in group B. Complications like malalignment, more surgical time were seen in group A and surgical site infection, skin necrosis, prolonged immobilisation were seen in group B. CONCLUSION Both IM nailing and plating are optional methods of treatment. Intramedullary nailing in distal tibial fractures result in early mobilisation is an easier technique, more economical and has fewer complications rate. Plating is preferred in cases where fracture is very close to ankle mortise and associate with higher rate of wound complications.

  5. A capsular-based vascularized distal radius graft for proximal pole scaphoid pseudarthrosis.

    Science.gov (United States)

    Sotereanos, Dean G; Darlis, Nickolaos A; Dailiana, Zoe H; Sarris, Ioannis K; Malizos, Konstantinos N

    2006-04-01

    To evaluate the clinical results of the application of a capsular-based dorsal distal radius vascularized bone graft in scaphoid proximal pole nonunions. Thirteen patients with symptomatic nonunion at the proximal pole of the scaphoid (10 with avascular necrosis) were treated and reviewed retrospectively. The vascularized bone graft was harvested from the distal aspect of the dorsal radius and was attached to a wide distally based strip of the dorsal wrist capsule. It was inserted press-fit into a dorsal trough across the nonunion site after scaphoid fixation with a Herbert screw. After a mean follow-up period of 19 months 10 of the 13 nonunions (8 of the 10 with avascular necrosis) achieved solid bone union. No complications other than the 3 persistent nonunions occurred. Results of the use of a capsular-based vascularized bone graft from the distal radius for proximal pole scaphoid nonunions compare favorably with the results of pedicled or free vascularized grafts. It is a simple technique that eliminates the need for dissection of small-caliber pedicle or microsurgical anastomoses. No donor site morbidity was observed. Therapeutic, Level IV.

  6. The Supination-Pronation Test for Distal Biceps Tendon Rupture.

    Science.gov (United States)

    Metzman, Louis S; Tivener, Kristin A

    2015-10-01

    Prompt diagnosis of a distal biceps tendon complete rupture increases the ability to perform a primary repair and to restore motion and strength. When examining an acute injury, it is important to isolate the biceps brachii tendon from the lacertus fibrosus and the brachialis because the examiner may mistakenly miss a distal tendon rupture by not isolating supination and pronation. The supination-pronation test can be performed easily in the acute setting and confirms attachment of the biceps tendon distally to the bicipital tuberosity of the radius. If the distal biceps tendon is intact, there is substantial change in the shape of the biceps as the arm is supinated (the biceps moves proximally), then pronated (the biceps moves distally). Clinically, the supination-pronation test has been found to be a reliable, pain-free test that should be incorporated in the physical examination to evaluate patients for distal biceps injury.

  7. Distal renal tubular acidosis in recurrent renal stone formers

    DEFF Research Database (Denmark)

    Osther, P J; Hansen, A B; Røhl, H F

    1989-01-01

    Renal acidification ability was examined in 90 recurrent renal stone formers, using fasting morning urinary pH levels followed by a short ammonium chloride loading test in subjects with pH levels above 6.0. Fifteen patients (16.6%) revealed a distal renal tubular acidification defect: one patient...... (1.1%) had complete distal renal tubular acidosis and 14 (15.5%) incomplete distal renal tubular acidosis. Our results confirm that distal renal tubular acidification defects are associated with a more severe form of stone disease and make distal renal tubular acidosis one of the most frequent...... metabolic disturbances in renal stone formers. Distal renal tubular acidosis (dRTA) was relatively more common in female stone formers and most often found in patients with bilateral stone disease (36%). Since prophylactic treatment in renal stone formers with renal acidification defects is available...

  8. Minimally invasive plate osteosynthesis of the distal fibula with the locking compression plate: first experience of 20 cases.

    Science.gov (United States)

    Hess, Florian; Sommer, Christoph

    2011-02-01

    The aim of this study was to evaluate the clinical feasibility and the possible complications associated with minimally invasive plate osteosynthesis of the distal fibula. Regional county hospital. All patients with Orthopaedic Trauma Association 42, 43, 44 fractures of the distal tibia requiring plate fixation of the distal fibula were included in this cohort study. A consecutive series of 701 internally fixed fractures of tibia and ankle yielded 20 fibular fractures treated with this technique. Fractures were treated with the minimally invasive plate osteosynthesis technique using an angular stable screw-plate system for the fibula. Clinical and radiologic outcomes at 24 months. Seventeen fractures healed without complication at an average of 9 weeks. Three aseptic nonunions were recorded: one in a pilon fracture (Orthopaedic Trauma Association 43-C3) and one in a distal lower leg fracture (Orthopaedic Trauma Association 43-A3), both with severe closed soft tissue injury (as a result of a crush mechanism). The third one was in an ankle fracture dislocation (OTA 44-C1) with delayed treatment and inadequate reduction of the simple fibula fracture. Although this technique is comparable to minimally invasive plate osteosynthesis in the tibia or femur, it appears to be more difficult as a result of small bone size. As a result, we reserve this technique for selected complex fractures of the distal fibula with critical soft tissue conditions.

  9. Extraction of challenging intracoronary thrombi: multi-device strategies using guide catheters, distal vascular protection devices and aspiration catheters.

    Science.gov (United States)

    Pornratanarangsi, Suwatchai; El-Jack, Seif S; Webster, Mark W I; McNab, Duncan; Stewart, James T; Ormiston, John A; Ruygrok, Peter N

    2008-09-01

    Patients with large intracoronary thrombi represent a difficult management problem for the interventional cardiologist. We report 10 cases of challenging thrombi treated percutaneously using varying combinations of deep guide catheter engagement, guide aspiration, dedicated catheter aspiration and withdrawal of a distal filter vascular protection device. These cases demonstrate interventional options which may be considered for such patients.

  10. [Treatment of type C3 distal radius fractures with AO 2.4 mm locking plate system after manipulative reduction].

    Science.gov (United States)

    Zhang, Chuan; Zhang, Zuo-Jun; Wang, Lei; Niu, Su-Ling; Wen, Ya-Fei; Guo, Yan-Xing

    2014-11-01

    To summarize our experiences in the treatment of type C3 (AO/OTA) distal radius fractures fixed with AO 2.4 mm locking plates combined with percutaneous pinning after manipulative reduction. From May 2009 to March 2012, 19 patients (2 cases of both sides) with type C3 (AO/OTA) distal radius fractures were treated with volar locking plates combined with percutaneous pinning for distal radius after manipulative reduction. Among the patients, the average age was (45.3 ± 17.4) years old (ranged, 31 to 66 years old). The fracture were complicated with ulnar styloid fracture in 14 wrists and 6 wrists had distal radioulnar joint instability. All the patients had closed fracture and the mean duration was (6.7 ± 3.5) days (4.5 to 9 days). The Henry approach was applied to expose the fracture site. Joint capsule and ligaments were retained for indirect reduction. After indirect reduction, the poking reduction technique was used to correct the residual compression, and congruence of distal ulnar radial joint was verified under fluorscopic guidance. Styloid process was first pinned percutaneously and then AO 2.4 mm volar locking plate was used to support rigid fixation. The fractures complicated with distal radioulnar joint instability and ulnar styloid fracture were treated with forearm plaster support in supination for 6 weeks. Nineteen patients (21 wrists) were followed up for an average duration of 10.5 months (ranged, 7 to 17 months). Radiographic bone union of distal radius was achieved in all cases, nonunion of the ulnar styloid occurred in 3 cases, and no distal radioulnar joint instability occurred. Tendon irritation was found in 2 cases and disappeared after the internal fixation was removed. The volar tilt, radial angle, radial length, incongruence of articular surface and distal radioulnar joint were observed at the follow-up. According to Batra and Gupta scoring system, 13 wrists were assessed to have a score of more than 80, 5 wrists 70 to 90, 3 wrists less

  11. Aquaporin-4 expression in distal myopathy with rimmed vacuoles

    OpenAIRE

    Hoshi, Akihiko; Yamamoto, Teiji; Kikuchi, Saeko; Soeda, Tomoko; Shimizu, Keiko; Ugawa, Yoshikazu

    2012-01-01

    Abstract Background Distal myopathy with rimmed vacuoles/hereditary inclusion body myopathy is clinically characterized by the early involvement of distal leg muscles. The striking pathological features of the myopathy are muscle fibers with rimmed vacuoles. To date, the role of aquaporin-4 water channel in distal myopathy with rimmed vacuoles/hereditary inclusion body myopathy has not been studied. Case presentation Here, we studied the expression of aquaporin-4 in muscle fibers of a patient...

  12. Refractory rickets caused by mild distal renal tubular acidosis

    OpenAIRE

    Ji-Ho Lee; Joo Hyun Park; Tae-Sun Ha; Heon-Seok Han

    2013-01-01

    Type I (distal) renal tubular acidosis (RTA) is a disorder associated with the failure to excrete hydrogen ions from the distal renal tubule. It is characterized by hyperchloremic metabolic acidosis, an abnormal increase in urine pH, reduced urinary excretion of ammonium and bicarbonate ions, and mild deterioration in renal function. Hypercalciuria is common in distal RTA because of bone resorption, which increases as a buffer against metabolic acidosis. This can result in intractable rickets...

  13. Actinomycosis of Distal Phalanx Twenty Years after Flap Reconstruction of Index Finger: A Case Report

    Directory of Open Access Journals (Sweden)

    Prashant N

    2018-03-01

    Full Text Available Actinomycosis is a chronic granulomatous suppurative infection caused by anaerobic bacteria from genus Actinomyces which are normal flora of mouth, colon and vagina. Actinomycosis of upper extremity is rare. We report a case of actinomycosis of the distal phalanx of finger many years after flap reconstruction. The patient presented with two months’ history of chronic discharging sinus from the tip of his right index finger, which had sustained a degloving injury 20 years previously. It had been treated with an anterior chest wall flap which had healed uneventfully but was bulky due to excess tissue from the donor site. Radiograph revealed osetomyelitis changes of distal phalanx. Debulking surgery with curettage of the distal phalanx was done. Wound healing was uneventful. He was treated with six weeks of metronidazole and ciprofloxacin. The discharge from the distal phalanx cultured actinomycosis odontolyticus. Histopathology of the debrided tissue showed chronic inflammation. As far as we are aware, there are no reports of actinomycosis in a flap involving the finger treated previously with a chest wall skin flap. The infection was probably dormant for many years before manifesting as a discharging sinus. Although the finger flap was bulky, it was not problematic until it started to have serous discharge. With a thorough debridement of all infected tissue, six weeks of antibiotic was adequate. Ciprofloxacin was prescribed based on discharge culture sensitivity. Metronidazole was added as actinomycosis is anaerobic. Response was prompt as patient was not immunocompromised. At follow-up six months post-surgery the finger had recovered with good function. If not for the discharging sinus, patient would probably have tolerated his bulky finger for the rest of his life.

  14. MANAGEMENT OF A RARE RECURRENCE OF DISTAL TIBIAL GIANT CELL TUMOUR BY SANDWICH TECHNIQUE

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    Rajesh Kishanrao

    2016-02-01

    Full Text Available INTRODUCTION First described by Jaffe et al in 1940, giant cell tumour (GCT constitutes 20% of all the skeletal neoplasms with a higher rate of recurrence after excision. Most common sites for the involvement are distal femur and proximal tibia followed by the distal end of radius. Ankle and foot involvement is rare <4%. Usually benign, they are locally aggressive and may occasionally undergo malignant transformation. The surgeon needs to strike a balance during treatment between being aggressive in order to reduce the incidence of local recurrence and being conservative in removing the normal bone to attain maximal function. Current literature suggests that intralesional curettage strikes the best balance between controlling disease and preserving optimum function in the majority of the cases though there may be occasions where the extent of the disease mandates resection to ensure adequate disease clearance. We report a case of Giant Cell Tumour of distal end of left Tibia in a 32-year-old female patient. Initially the condition was treated by curettage and bone grafting. But, due to recurrence of the condition within 9 months, she was treated with extended curettage using hydrogen peroxide, burr and bone cement as adjuvants and reconstruction using the “SANDWICH” Technique. At One year follow up there is no recurrence and reasonably good function around the ankle joint is maintained. Primary Giant Cell Tumours have been traditionally treated with curettage of the lesion followed by bone grafts/bone cement. Recurrent cases often require aggressive management. The adjuvant treatment used in our case offered good stability and allowed early mobilization of the ankle joint. This case substantiates the use of bone cement in the treatment of recurrent Giant Cell Tumour of distal tibia whenever the articular integrity is intact with reasonably good functional outcomes. However, a periodic follow-up is still recommended to watch-out for late re-recurrences

  15. Distal Xq duplication and functional Xq disomy

    Directory of Open Access Journals (Sweden)

    Schluth-Bolard Caroline

    2009-02-01

    Full Text Available Abstract Distal Xq duplications refer to chromosomal disorders resulting from involvement of the long arm of the X chromosome (Xq. Clinical manifestations widely vary depending on the gender of the patient and on the gene content of the duplicated segment. Prevalence of Xq duplications remains unknown. About 40 cases of Xq28 functional disomy due to cytogenetically visible rearrangements, and about 50 cases of cryptic duplications encompassing the MECP2 gene have been reported. The most frequently reported distal duplications involve the Xq28 segment and yield a recognisable phenotype including distinctive facial features (premature closure of the fontanels or ridged metopic suture, broad face with full cheeks, epicanthal folds, large ears, small and open mouth, ear anomalies, pointed nose, abnormal palate and facial hypotonia, major axial hypotonia, severe developmental delay, severe feeding difficulties, abnormal genitalia and proneness to infections. Xq duplications may be caused either by an intrachromosomal duplication or an unbalanced X/Y or X/autosome translocation. In XY males, structural X disomy always results in functional disomy. In females, failure of X chromosome dosage compensation could result from a variety of mechanisms, including an unfavourable pattern of inactivation, a breakpoint separating an X segment from the X-inactivation centre in cis, or a small ring chromosome. The MECP2 gene in Xq28 is the most important dosage-sensitive gene responsible for the abnormal phenotype in duplications of distal Xq. Diagnosis is based on clinical features and is confirmed by CGH array techniques. Differential diagnoses include Prader-Willi syndrome and Alpha thalassaemia-mental retardation, X linked (ATR-X. The recurrence risk is significant if a structural rearrangement is present in one of the parent, the most frequent situation being that of an intrachromosomal duplication inherited from the mother. Prenatal diagnosis is performed by

  16. [Evaluation of surgical repair of distal biceps tendon ruptures].

    Science.gov (United States)

    Behounek, J; Hrubina, M; Skoták, M; Krumpl, O; Zahálka, M; Dvorák, J; Fucík, M

    2009-02-01

    PURPOSE OF THE STUDY To present the results of surgical repair of ruptures of the distal tendon of the biceps brachii muscle and thus show the adequacy of this treatment. MATERIAL Between 1987 and 2006, 19 patients had surgery for distal biceps tendon rupture. Only one side was affected in each patient. All patients were men between 28 and 69 years (average age, 47.5 years) at the time of injury (surgery). When the patients were evaluated at the end of 2007, 18 patients were included, because one died a year after surgery. METHODS The surgical repair always included a single-incision anatomical reattachment into the radial tuberosity. In 11 patients, a modified Mac Reynolds method with screw and washer fixation was used; in seven patients the insertion was fixed with Mitek anchors and, in one, it was sutured to the adjacent soft tissues. The average follow-up was 7 years (range, 1 to 20.5 years). The patients were evaluated for the cause of injury, their physical activity, age, dominance of the injured arm, surgical procedure and complications. RESULTS In 18 patients surgical repair was done early and, in one, at 16 days after injury. In all of them the tendon was detached from its site of insertion, but never torn. The intra-operative complications included, in one patient, bleeding owing to iatrogenic damage to a branch of the brachial artery, and difficult separation of the tendon due to its previous healed injury in another patient. Early post-operative complications included superficial skin necrosis in one patient and transient neurological deficit of the dorsal brand of the radial nerve and of the lateral cutaneous nerve of the forearm in two and one patient, respectively. The late complications were heterotropic ossification in three patients and screw migration in the one treated by the Mac Reynolds method. Excellent results were recorded in 11 patients (61 %), and good outcomes with a slight restriction of motion or muscle strength not limiting the

  17. Refractory rickets caused by mild distal renal tubular acidosis

    Directory of Open Access Journals (Sweden)

    Ji-Ho Lee

    2013-09-01

    Full Text Available Type I (distal renal tubular acidosis (RTA is a disorder associated with the failure to excrete hydrogen ions from the distal renal tubule. It is characterized by hyperchloremic metabolic acidosis, an abnormal increase in urine pH, reduced urinary excretion of ammonium and bicarbonate ions, and mild deterioration in renal function. Hypercalciuria is common in distal RTA because of bone resorption, which increases as a buffer against metabolic acidosis. This can result in intractable rickets. We describe a case of distal RTA with nephrocalcinosis during follow-up of rickets in a patient who presented with clinical manifestations of short stature, failure to thrive, recurrent vomiting, dehydration, and irritability.

  18. Computed tomography diagnosis of distal radioulnar joint subluxation

    International Nuclear Information System (INIS)

    Lu Laijin; Nakamura, Ryogo; Nakao, Etsuhiro; Hidaka, Yasuhiro; Shionoya, Kaori.

    1995-01-01

    Although computed tomography (CT) provides the most reliable diagnostic information about distal radioulnar joint dislocation and subluxation, the method for assessing distal radioulnar joint integrity on CT is controversial. We studied roentgenographic diagnosis and three methods of CT diagnosis in 20 patients with suspected distal radioulnar dislocation or subluxation. Sensitivity was 35% in roentgenographic diagnosis and 70 to 100% in CT diagnosis. Of the three methods of CT diagnosis, Mino's radioulnar line method showed 100% sensitivity to subluxation including dislocation. We believe Mino's method is the most reliable method for the diagnosis of distal radioulnar dislocation in unilateral CT. (author)

  19. Computed tomography diagnosis of distal radioulnar joint subluxation

    Energy Technology Data Exchange (ETDEWEB)

    Lu Laijin [Bethune (N.) Medical Univ., Changchun, JL (China); Nakamura, Ryogo; Nakao, Etsuhiro; Hidaka, Yasuhiro; Shionoya, Kaori

    1995-08-01

    Although computed tomography (CT) provides the most reliable diagnostic information about distal radioulnar joint dislocation and subluxation, the method for assessing distal radioulnar joint integrity on CT is controversial. We studied roentgenographic diagnosis and three methods of CT diagnosis in 20 patients with suspected distal radioulnar dislocation or subluxation. Sensitivity was 35% in roentgenographic diagnosis and 70 to 100% in CT diagnosis. Of the three methods of CT diagnosis, Mino`s radioulnar line method showed 100% sensitivity to subluxation including dislocation. We believe Mino`s method is the most reliable method for the diagnosis of distal radioulnar dislocation in unilateral CT. (author).

  20. Post-transplant distal limb syndrome

    Directory of Open Access Journals (Sweden)

    María Florencia Borghi Torzillo

    2017-02-01

    Full Text Available The post-transplant distal limb syndrome is a not well known entity, with a prevalence of 5% in patients with renal transplant. Its diagnosis is based on clinical symptoms, bone scintigraphy and MRI, it has a benign course and the patient recovers without sequel. We present the case of a 37-year-old male, with medical history of hypertension, Berger's disease in 1999 that required dialysis three times a week for four years (2009-2013 and renal transplant in 2013. The patient consults on January 2014 referring severe pain in both feet, with sudden onset; he remembers the exact date of the beginning of the pain and denies trauma, pain prevents ambulation. The bone scintigraphy shows pathological uptake in both feet with no difference between the two. Although there is no treatment for this disease, it has a benign course

  1. Pre-bent elastic stable intramedullary nail fixation for distal radial shaft fractures in children.

    Science.gov (United States)

    Ge, Yi-hua; Wang, Zhi-gang; Cai, Hai-qing; Yang, Jie; Xu, Yun-lan; Li, Yu-chan; Zhang, Yu-chen; Chen, Bo-chang

    2010-08-01

    To investigate the functional and radiographic outcomes of pre-bent elastic stable intramedullary nail in treatment of distal radial shaft fractures in children. From January 2006 to December 2008, 18 children with distal radial shaft fracture were treated by close reduction and internal fixation with a pre-bent elastic stable intramedullary nail. The age range was from 5 years to 15 years, with an average of 9 years and 8 months. The minimum follow-up was 12 months. All fractures maintained good alignment postoperatively, and 94.4% (17/18) of the patients regained a full range of rotation of the forearm. One patient has limitation of rotation to less than 10°, this had improved by final follow-up. Complications included soft tissue irritation at the site of nail insertion in one patient and transient scar hypersensitivity in another. Fixation with a pre-bent elastic stable intramedullary nail is an effective, safe and convenient method for treating distal radial shaft fractures in children. © 2010 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.

  2. [Vitamin C and prevention of reflex sympathetic dystrophy following surgical management of distal radius fractures].

    Science.gov (United States)

    Cazeneuve, J F; Leborgne, J M; Kermad, K; Hassan, Y

    2002-12-01

    Reflex sympathetic dystrophy is a major complication following surgical treatment of fractures of the distal radius. Its pathogenesis is related to lipid peroxidation which damages vascular endothelial cells, increasing capillary permeability. Vitamin C is a natural antioxidant. The authors have made a comparative study of two groups of patients with isolated closed displaced fractures of the distal radius, which were reduced and stabilized by intrafocal pinning. Group 1 included 100 patients who were treated from 1995 until 1998 and who did not receive any vitamin C supplementation; group 2 included 95 patients who were treated from 1999 to 2002 and who received daily administration of one gram vitamin C orally during 45 days, starting on the day of fracture. The incidence of reflex sympathetic dystrophy was five time times lower in group 2 (2.1% versus 10%). This is in line with previous observations and lends credit to the value of vitamin C administration as a prophylactic measure to prevent the occurrence of reflex sympathetic dystrophy in patients who undergo surgical treatment of a displaced fracture of the distal radius.

  3. Ruptured distal AICA pseudoaneurysm presenting years after vestibular schwannoma resection and radiation.

    Science.gov (United States)

    Mascitelli, Justin R; McNeill, Ian T; Mocco, J; Berenstein, Alejandro; DeMattia, Joseph; Fifi, Johanna T

    2016-05-01

    Distal anterior inferior cerebellar artery (AICA) pseudoaneurysms are very rare lesions. Although cases have been previously reported, only a few have been reported as a result of vestibular schwannoma (VS) radiation, none have been reported as a result of VS resection, and only one has been reported as treated with parent vessel occlusion (PVO) with n-butyl cyanoacrylate (nBCA). We report a case of a 65-year-old man with a history of right-sided VS surgery and radiation who presented years later with a ruptured pseudoaneurysm of the distal right AICA and was treated with endovascular PVO using nBCA. The aneurysm was completely obliterated and the patient had no worsening of symptoms or neurological exam. The case illustrates a very rare complication of VS surgery and radiation as well as an effective treatment for distal AICA aneurysms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  4. Partial wrist arthrodesis versus arthroplasty for distal radius giant cell tumours.

    Science.gov (United States)

    Zhu, Zhongsheng; Zhang, Chunlin; Zhao, Shichang; Dong, Yang; Zeng, Bingfang

    2013-11-01

    The purpose of this study was to evaluate the clinical efficacy of using the proximal fibular graft for partial wrist arthrodesis or arthroplasty after the resection of giant cell tumours of the distal radius. Between February 2006 and August 2010, 14 patients (seven males, seven females; average age, 35.7 years) with grade II and III giant cell tumours of the distal radius were treated by tumour resection and autologous proximal fibular grafts to reconstruct the wrist in our hospital. Seven patients each were treated by wrist arthroplasty and partial wrist arthrodesis, and were followed up for 2.2-6.8 years (average, 3.9 years). All patients achieved primary healing. No tumour recurrence was observed during follow-up in any of the patients. No statistically significant difference in forearm rotation was observed between patients undergoing the two different treatments. However, wrist flexion-extension activities were significantly better and the wrist grip strengths were significantly worse in the arthroplasty group than in the arthrodesis group. The Musculoskeletal Tumour Society score did not significantly differ between the groups. Overall, joint arthroplasty remains a favourable treatment with regard to the functional outcome for giant cell tumours of the distal radius; however, some of these patients may have a weaker grip strength. In comparison, partial wrist fusion appears to provide a durable and stable wrist with good long-term functional outcome.

  5. Role of Appositional Screw Fixation in Minimally Invasive Plate Osteosynthesis for Distal Tibial Fracture.

    Science.gov (United States)

    Yang, Kyu-Hyun; Won, Yougun; Kang, Dong-Hyun; Oh, Jin-Cheol; Kim, Sung-Jun

    2015-09-01

    To determine the effect of interfragmentary appositional (gap-closing) screw fixation in minimally invasive plate osteosynthesis (MIPO) for distal tibial fractures on the clinical and radiologic results. Prospective nonrandomized study. Level I trauma center. Sixty patients who were diagnosed as distal metadiaphyseal oblique or spiral tibial fracture without displaced articular fragment. Thirty patients (group A) of the 60 patients were treated with MIPO without appositional screw fixation, and the other 30 (group B) were treated with the screw. Radiologic union, clinical union, clinical functional score [American Orthopaedic Foot and Ankle Society (AOFAS) score], and complications. The time for initial callus formation and radiologic union was significantly longer in group A than those in group B (76.8 vs. 58.0 days, P = 0.044; 409 vs. 258.7 days, P = 0.002, respectively). The rate of clinical union during 1 year was significantly higher in group B than in group A (P = 0.0063). Four nonunion patients in group A achieved bone union after placement of an additional bone graft. None of the patients in group B diagnosed with delayed union or nonunion (P screw fixation in distal tibia MIPO for the fixation of oblique or spiral fracture promoted callus formation and union rate compared with MIPO without appositional screw fixation. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  6. Salmonella osteomyelitis of the distal radius in a healthy young adult patient: report of a rare case and literature review.

    Science.gov (United States)

    Tonogai, Ichiro; Hamada, Yoshitaka; Hibino, Naohito; Sato, Ryosuke; Henmi, Tatsuhiko; Sairyo, Koichi

    2015-01-01

    Salmonella osteomyelitis of the radius in a healthy individual is very rare. We present such a case involving the distal radius of a healthy 23-year-old man without underlying disease or possible episode. He had right wrist pain for approximately 3 years, and osteolytic lesion was seen in the right distal radius. He underwent surgical treatment, and salmonella was isolated from pus in the lesion. Postoperative antibiotics successfully treated his infection. He had no sign of recurrence, but the point of entry for infection remains unknown.

  7. Successful Endovascular Occlusion of a Ruptured Distal Anterior Inferior Cerebellar Artery Aneurysm of the Caudal Trunk: Case Report

    Science.gov (United States)

    Kang, H.-S.; Roh, H.G.; Han, M.H.; Koh, Y.-C.

    2007-01-01

    Summary We report a rare case of a ruptured distal anterior inferior cerebellar artery (possibly dissecting) aneurysm of the caudal trunk, successfully treated by endovascular occlusion. A 41-year-old man presented with sudden severe headache and drowsiness. On the day of ictus, conventional angiography was performed to make the above diagnosis, followed by endovascular occlusion of the sac and the parent artery. The patient recovered completely without any neurologic deficit after treatment. Endovascular occlusion could be a safe and effective treatment option in a case of a ruptured distal AICA aneurysm of the caudal trunk. PMID:20566118

  8. [Retrograde locking nail osteosynthesis of distal femoral fractures with the distal femoral nail (DFN)].

    Science.gov (United States)

    Grass, R; Biewener, A; Rammelt, S; Zwipp, H

    2002-04-01

    Non-operative treatment with immobilization or isometric traction has been abandoned as treatment for fractures of the distal femur at the end of the 1960ies. The technique of open reduction and internal fixation with a condylar plate as suggested by the AO has been the golden standard since the 1970ies. However, anatomic reconstruction of the condylar region with interfragmentary screw fixation and axial realignment of the femur shaft with a plate are challenging procedures especially in the presence of severely compromised soft tissues and put periosteal blood supply at risk. Soft tissue complications, axial malalignment and delayed fracture healing times led to the consideration of alternative techniques, such as intramedullary nailing which has been practiced with success since the 1940ies by Gerhard Küntscher and colleagues for femoral shaft fractures with minimal complication rates and improved results after closed reduction. The era of retrograde femoral nailing began with the systematic approach through the intercondylar notch by Green. This paper reviews the biomechanical properties, indication, technique as well as potential hazards and pitfalls of fracture management with the AO "distal femoral nail" (DFN). With appropriate application this technique is suitable for all fractures of the distal third of the femoral shaft including highly instable bicondylar fractures without damage to the soft tissues and the knee joint.

  9. [Intramaxillary devices of molar distalization on fixed appliance and with aligners].

    Science.gov (United States)

    Dallel, Ines; Bergeyron, Patrice; Chok, Ameni; Tobji, Samir; Ben Amor, Adel

    2017-12-01

    Class II malocclusion is a dysmorphosis that can result from different skeletal and/or alveolar components of maxillary and/or mandibular origin. In dental class II cases due to mesial drift of the maxillary molars, it is sometimes interesting to retract the maxillary molars, in order to avoid in certain situations extractions of premolars. To this end, several devices have been described in the literature. The most recent intraoral devices allow a more controlled correction, and no longer require cooperation from the patient. In addition, in a number of cases of distalization, aligners now offer a useful therapeutic option since they are both esthetic and easy-to-use. In this study, we carried out a review of the various studies in the literature describing intra-oral distalization of the maxillary molars in the multi-bracket technique as well as using aligners, with a clinical illustration of a Class II case treated by aligners. © EDP Sciences, SFODF, 2017.

  10. The Dorsoulnar Artery Perforator Adipofascial Flap in the Treatment of Distal Radioulnar Synostosis

    Directory of Open Access Journals (Sweden)

    Alessia Pagnotta

    2017-01-01

    Full Text Available Posttraumatic radioulnar synostosis (RUS is a rare event following forearm fractures. Consequences are disabling for patients who suffer from functional limitation in forearm pronosupination. Distal RUS are even more rare and more difficult to treat because of high recurrence rates. The patient we describe in this paper came to our attention with a double distal RUS recurrence and a Darrach procedure already performed. We performed a radical excision of RUS and interposition with a vascularized dorsoulnar artery (DUA adipofascial perforator flap. Four years after surgery, the patient shows the same complete range of motion in pronosupination, and MRI confirms that the flap is still in place with signs of vascularization. Simple synostosis excision has been proven ineffective in many cases. Interposition is recommended after excision, and biological material interposition seems to be more effective than foreign material. Surgeons are increasingly performing vascularized interposition, and the results are very encouraging.

  11. Urethral advancement procedure in the treatment of primary distal ...

    African Journals Online (AJOL)

    Introduction: Distal hypospadias is the most common genital anomaly, occurring in almost 65% of all hypospadias cases. Although there are several surgical techniques for the treatment of distal hypospadias, it is clear that none can be used to correct all forms of hypospadias. The aim of the study was to evaluate urethral ...

  12. Experience with Quartey's Distal Penile Island Skin Flap ...

    African Journals Online (AJOL)

    Objective: To evaluate our experience with Quartey's distal penile island skin flap urethroplasty in the treatment of urethral stricture in two tertiary hospitals in South Western Nigeria. Patients and Methods: Between June 2002 and May 2005, 18 patients with a mean age of 42.2 years (range: 25 – 75 years) underwent distal ...

  13. Outcome of ureteroscopy for the management of distal ureteric calculi

    African Journals Online (AJOL)

    Objective: To review our 5 years' experience with ureteroscopy treatment of distal ureteric calculi. Patients and methods: We reviewed the medical records of 136 patients who underwent ureteroscopic procedures for the treatment of distal ureteric calculi from February 2007 to October 2012. Patient and stone characteristics, ...

  14. Clinical relevance of distal biceps insertional and footprint anatomy

    NARCIS (Netherlands)

    van den Bekerom, Michel P J; Kodde, Izaäk F.; Aster, Asir; Bleys, Ronald L A W|info:eu-repo/dai/nl/134440455; Eygendaal, Denise

    2016-01-01

    Purpose: The aim of this review was to present an overview, based on a literature search, of surgical anatomy for distal biceps tendon repairs, based on the current literature. Methods: A narrative review was performed using Pubmed/Medline using key words: Search terms were distal biceps,

  15. Current concepts in fractures of the distal femur.

    Science.gov (United States)

    Link, B-C; Babst, R

    2012-01-01

    This paper describes current treatment strategies of distal femoral fractures as well as their evidence based rationale. The treatment of distal femoral fractures has improved with the evolution of plating and nailing technologies. The commonly selected surgical approaches are outlined and surgical treatment techniques including both internal and external fixation are discussed.

  16. Distal clavicular osteolysis: MR evidence for subchondral fracture

    Energy Technology Data Exchange (ETDEWEB)

    Kassarjian, Ara; Palmer, William E. [Massachusetts General Hospital, Department of Radiology, Division of Musculoskeletal Radiology, Yawkey Center, Boston, MA (United States); Llopis, Eva [Hospital de la Ribera, Department of Radiology, Valencia (Spain)

    2007-01-15

    To investigate the association between distal clavicular osteolysis and subchondral fractures of the distal clavicle at MRI. This study was approved by the hospital human research committee, which waived the need for informed consent. Three radiologists retrospectively analyzed 36 shoulder MR examinations in 36 patients with imaging findings of distal clavicular osteolysis. The presence of a subchondral fracture of the distal clavicle, abnormalities of the acromioclavicular joint, rotator cuff tears and labral tears were assessed by MRI. These cases were then compared with 36 age-matched controls. At MRI, 31 of 36 patients (86%) had a subchondral line within the distal clavicular edema, consistent with a subchondral fracture. Of the 36 patients, 32 (89%) had fluid in the acromioclavicular joint, while 27 of 36 patients (75%) had cysts or erosions in the distal clavicle. There were 13 patients (36%) with associated labral tears, while eight patients (22%) had partial-thickness rotator cuff tears. In the control group one of 36 (3%) had a subchondral line (P<0.05), while ten of 36 (28%) had rotator cuff tears and 13 of 36 (36%) had labral tears. These latter two were not statistically significant between the groups. A distal clavicular subchondral fracture is a common finding in patients with imaging evidence of distal clavicular osteolysis. These subchondral fractures may be responsible for the propensity of findings occurring on the clavicular side of the acromioclavicular joint. (orig.)

  17. Complications of Minimally Invasive Percutaneous Plating for Distal Tibial Fractures

    OpenAIRE

    Muzaffar, Nasir; Bhat, Rafiq; Yasin, Mohammad

    2016-01-01

    Background The management of distal tibia fractures continues to remain a source of controversy and debate. Objectives The aim of this study was to evaluate the various complications of minimally invasive percutaneous plate osteosynthesis (MIPPO) using a locking plate for closed fractures of distal tibia in a retrospective study. Patients and Methods Twenty-five patients with dista...

  18. Distal tibiofibular synostosis in a Nigerian: A case report | Owoeye ...

    African Journals Online (AJOL)

    X-ray of the bones showed an oblique fracture in the distal end of the shaft of fibula which is suggestive of post traumatic tibiofibular synostosis (TFS). Knowledge of distal TFS is important in resolving the puzzle of chronic shin pain of unknown origin and in accurate diagnosis of causes of ankle deformity and malformations.

  19. Outcome of management of distal radius fractures in ...

    African Journals Online (AJOL)

    We tried to highlight that postmenopausal distal radius fractures attributed to osteoporosis, are not given much of consideration when lot of funds and researches are being diverted to osteoporosis and related diseases. Methods: 60 elderly female patients with distal radius fracture were studied for outcome. The primary ...

  20. Population-based epidemiology and incidence of distal femur fractures

    DEFF Research Database (Denmark)

    Elsoe, Rasmus; Ceccotti, Adriano Axel; Larsen, Peter

    2018-01-01

    The literature lacks recent epidemiological studies on the incidence, trauma mechanism and fracture classification of distal femur fractures. The aim of the present study was to provide up-to-date information concerning the incidence of distal femur fractures in a large and complete population...

  1. Radiographic study of distal radial physeal closure in thoroughbred horses

    International Nuclear Information System (INIS)

    Vulcano, L.C.; Mamprim, M.J.; Muniz, L.M.R.; Moreira, A.F.; Luna, S.P.L.

    1997-01-01

    Monthly radiography was performed to study distal radial physeal closure in ten male and ten female Throughbred horses. The height, thoracic circumference and metacarpus circumference were also measured, Distal radial physeal closure time was sooner in females than males, and took 701 +/- 37 and 748 +/- 55 days respectively

  2. Resection-reconstruction arthroplasty for giant cell tumor of distal radius

    Directory of Open Access Journals (Sweden)

    Saikia Kabul

    2010-01-01

    Full Text Available Background: Giant cell tumor (GCT of the distal radius poses problems for reconstruction after resection. Several reconstructive procedures like vascularized and non-vascularized fibular graft, osteo-articular allograft, ceramic prosthesis and megaprosthesis are in use for substitution of the defect in the distal radius following resection. Most authors advocate wrist arthrodesis following resection of distal radius and non vascularized fibular graft. Here we have analyzed the results of aggressive benign GCTs of the distal radius treated by resection and reconstruction arthroplasty using autogenous non-vascularized fibular graft. Materials and Methods: Twenty-four cases of giant cell tumor of the distal radius (mean age 32 years, mean follow-up 6.6 years treated by en-bloc resection and reconstruction arthroplasty using autogenous non-vascularized ipsilateral fibular graft with a minimum followup of two years have been included in this retrospective study. Nineteen cases were of Campanacci grade III and five were of Grade II recurrence. The mean resected length of the radius was 9.5 (8-12 cm. Routine radiographs and clinical assessments regarding pain, instability, recurrence, hand grip strength and functional status were done at regular intervals and functional results were assessed using (musculoskeletal tumor society MSTS-87 scoring. Results: Early radiological union at host-graft junction was achieved at mean 12.5 weeks, (range 12-14 weeks and solid incorporation with callus formation was observed in mean 29 weeks (range 28-32 weeks in all the cases. Satisfactory range of motion (mean 63%, range 52-78% of the wrist was achieved in 18 cases. Grip strength compared to the contralateral hand was found to be 67% (range 58-74%. Functional results were excellent in six cases (25%, good in 14 cases (58.3% and four (16.7% cases had fair results. Soft tissue recurrence was seen in one patient. The most commonly encountered complication was fibulo

  3. AO Distal Radius Fracture Classification: Global Perspective on Observer Agreement.

    Science.gov (United States)

    Jayakumar, Prakash; Teunis, Teun; Giménez, Beatriz Bravo; Verstreken, Frederik; Di Mascio, Livio; Jupiter, Jesse B

    2017-02-01

    Background  The primary objective of this study was to test interobserver reliability when classifying fractures by consensus by AO types and groups among a large international group of surgeons. Secondarily, we assessed the difference in inter- and intraobserver agreement of the AO classification in relation to geographical location, level of training, and subspecialty. Methods  A randomized set of radiographic and computed tomographic images from a consecutive series of 96 distal radius fractures (DRFs), treated between October 2010 and April 2013, was classified using an electronic web-based portal by an invited group of participants on two occasions. Results  Interobserver reliability was substantial when classifying AO type A fractures but fair and moderate for type B and C fractures, respectively. No difference was observed by location, except for an apparent difference between participants from India and Australia classifying type B fractures. No statistically significant associations were observed comparing interobserver agreement by level of training and no differences were shown comparing subspecialties. Intra-rater reproducibility was "substantial" for fracture types and "fair" for fracture groups with no difference accounting for location, training level, or specialty. Conclusion  Improved definition of reliability and reproducibility of this classification may be achieved using large international groups of raters, empowering decision making on which system to utilize. Level of Evidence  Level III.

  4. Proximal and distal muscle fatigue differentially affect movement coordination

    Science.gov (United States)

    Cowley, Jeffrey C.

    2017-01-01

    Muscle fatigue can cause people to change their movement patterns and these changes could contribute to acute or overuse injuries. However, these effects depend on which muscles are fatigued. The purpose of this study was to determine the differential effects of proximal and distal upper extremity muscle fatigue on repetitive movements. Fourteen subjects completed a repetitive ratcheting task before and after a fatigue protocol on separate days. The fatigue protocol either fatigued the proximal (shoulder flexor) or distal (finger flexor) muscles. Pre/Post changes in trunk, shoulder, elbow, and wrist kinematics were compared to determine how proximal and distal fatigue affected multi-joint movement patterns and variability. Proximal fatigue caused a significant increase (7°, p fatigue caused small but significant changes in trunk angles (2°, p fatigue protocols (p fatigue at either proximal or distal joints. The identified differences between proximal and distal muscle fatigue adaptations could facilitate risk assessment of occupational tasks. PMID:28235005

  5. Clinical relevance of distal biceps insertional and footprint anatomy.

    Science.gov (United States)

    van den Bekerom, Michel P J; Kodde, Izaäk F; Aster, Asir; Bleys, Ronald L A W; Eygendaal, Denise

    2016-07-01

    The aim of this review was to present an overview, based on a literature search, of surgical anatomy for distal biceps tendon repairs, based on the current literature. A narrative review was performed using Pubmed/Medline using key words: Search terms were distal biceps, insertional, and anatomy. Last decade, the interest in both reconstruction techniques, as well as surgical anatomy of the distal biceps tendon, has increased. The insights into various aspects of distal biceps tendon anatomy (two tendons, bicipital tuberosity, lacertus fibrosis, bicipital-radial bursa, posterior interosseous nerve, and lateral antebrachial cutaneous nerve) have evolved significantly in the last years. Thorough knowledge of the anatomy is essential for the surgeon in order to understand the biomechanics of rupture and reconstruction of the distal biceps tendon and to avoid injuries of the nerves. Some tips and tricks are provided, and some pitfalls were described to avoid complications and optimize surgical outcome. IV.

  6. Distal end radius fractures: evaluation of results of various treatments and assessment of treatment choice

    Directory of Open Access Journals (Sweden)

    Vargaonkar Gauresh

    2014-07-01

    Full Text Available 【Abstract】Objective:The rapid expansion of knowledge regarding the functional anatomy of hand and wrist, increasing functional demands of senior citizens and improved methodologies of achieving and maintaining anatomic restoration of distal radius fractures has generated a renewed interest in addressing these fractures in a more precise manner. The purpose of our study was to evaluate the difference in patients function among those treated by 1 closed reduction and Plaster of Paris cast, 2 distractor application, or 3 open reduction and internal fixation with a volar plate, and to assess the treatment choice for each particular fracture type. Methods: A prospective study was carried out on 60 patients with fractures of the distal end radius. Fractures were classified according to the AO classification into type A (extra-articular, type B (partial articular and type C (complete articular. After initial evaluation patients were taken up for either conservative or operative treatment and were followed up for two years. Results: Anatomical results were evaluated according to the Sarmiento’s modification of Lindstrom Criteria, which showed that excellent results were more frequent with open reduction and internal fixation using the plating technique. Clinical and functional results were evaluated according to the demerit point system of Gartland and Werley with Sarmiento modification, which was revealed to relate with the type of treatment techniques. Conclusion: There is no customized solution for all the fractures of the distal radius. The choice of treatment should be based on the fracture type, the patient’s characteristics, the patient’s demands and the treating surgeon’s experience and preference. Key words: Distal end radius fractures; Volar plate; Radial orthofix

  7. Clinical presentation and treatment of distal anterior inferior cerebellar artery aneurysms.

    Science.gov (United States)

    Tokimura, Hiroshi; Ishigami, Takashi; Yamahata, Hitoshi; Yonezawa, Hajime; Yokoyama, Shunichi; Haruzono, Akihiro; Obara, Soichi; Nishimuta, Yosuke; Nagayama, Tetsuya; Hirahara, Kazuho; Kamezawa, Takashi; Sugata, Sei; Arita, Kazunori

    2012-10-01

    Aneurysms located at the distal portion of the anterior inferior cerebellar artery (AICA) are rare, and their clinical features are not fully understood. We report the clinical features and management of nine distal AICA aneurysms in nine patients treated during the past decade at Kagoshima University Hospital and affiliated hospitals. Our series includes seven women and two men. Of their nine aneurysms, eight were ruptured and one was unruptured; six were saccular and three were dissecting aneurysms. The most prevalent location was the meatal loop (n = 5) followed by the postmeatal (n = 3) and premeatal segment (n = 1) of the AICA, suggesting hemodynamic stress as an etiology of these distal AICA aneurysms. Of the nine patients, five presented with angiographic features suggestive of increased hemodynamic stress to the AICA and the common trunk of the posterior inferior cerebellar artery, with vertebral artery stenosis, marked laterality, and a primitive hypoglossal artery. We addressed eight aneurysms (eight patients) surgically; one aneurysm in one patient disappeared in the course of 3 months without surgical treatment. Of the eight surgically treated aneurysms, seven were ruptured and one was unruptured, five were clipped via lateral suboccipital craniotomy, two were trapped via lateral suboccipital craniotomy, and one was embolized. Good outcomes were obtained in six of the eight patients who underwent operation (75 %). We consider increased hemodynamic stress attributable to anatomic variations in the AICA and related posterior circulation to be the predominant contributor to the development of distal AICA aneurysms. Direct clipping and trapping yielded favorable outcomes in our series.

  8. Simultaneous bilateral distal biceps tendon ruptures repaired using an endobutton technique: a case report.

    Science.gov (United States)

    Dacambra, Mark P; Walker, Richard Ea; Hildebrand, Kevin A

    2013-08-23

    The simultaneous rupture of both distal biceps tendons is a rare clinical entity that is difficult to treat and can have poor outcomes. A variety of treatment and rehabilitation options exist and have been reported for single sided and staged bilateral repairs, but none have described an approach for acute bilateral ruptures. Repairing distal biceps tendon ruptures using a single anterior incision and a cortical suspensory button technique has become increasingly popular in recent years. We present a report of our surgical approach using an endobutton technique and rehabilitation algorithm for this unusual injury pattern. A 43-year-old Caucasian man presented with acute onset bilateral elbow pain while lifting a large sheet of drywall off the ground. He initially felt a 'pop' on the right and almost immediately felt another on the left after having to quickly shift the weight. He was unable to continue working and sought medical attention. His pain was predominantly in his bilateral antecubital fossae and he had significant swelling and ecchymoses. His clinical examination demonstrated no palpable tendon, a retracted biceps muscle belly, and clear supination weakness. Magnetic resonance imaging was performed and showed bilateral distal biceps tendon ruptures with retraction on both sides. After discussion with our patient, we decided that both sides would be repaired using a single anterior incision with endobutton fixation, first his right followed by his left six weeks later. Overall, our patient did very well and had returned to full manual work by our last follow-up at 30 months. Although he was never able to return to competitive recreational hockey and was left with mild lateral antebrachial cutaneous nerve dysesthesias on his right, he felt he was at 85% of his premorbid level of function. We describe what we believe to be, to the best of our knowledge, the first case of simultaneous bilateral distal biceps tendon ruptures successfully treated with a single

  9. Reconstruction and restoration of neglected ruptured patellar tendon using semitendinosus and gracilis tendons with preserved distal insertions: two case reports.

    Science.gov (United States)

    Chen, Bin; Li, Runguang; Zhang, Sheng

    2012-08-01

    Neglected rupture of the patellar tendon is rare but becomes more difficult to repair the longer it is left untreated. The most common rupture sites are the inferior pole of the patella and distal insertion. Proximal retraction of the patella and extensor mechanism adhesions makes the treatment more difficult than acute tendon rupture. We report two patients with neglected patellar tendon rupture treated by reconstruction and restoration using semitendinosus-gracilis (STG) tendons with preserved distal insertions. Preserved distal insertion provided sufficient blood supply to accelerate healing, while combined fixation with tension-reducing wire, offered the initial stability of the closed-loop sutured tendon. Both patients reacquired near normal strength and stability of the patellar tendon and restoration of function after operation and rehabilitation. Copyright © 2011 Elsevier B.V. All rights reserved.

  10. Reconstruction of scaphoid nonunion fractures of the proximal one third with a vascularized bone graft from the distal radius.

    Science.gov (United States)

    Werdin, Frank; Jaminet, Patrick; Naegele, Beate; Pfau, Matthias; Schaller, Hans-Eberhard

    2014-01-01

    The treatment of proximal located scaphoid nonunion is a well-known and common problem. For these patients, we used a vascular pedicled bone graft of the distal radius. In the last 7 years, 75 patients were treated with the vascular pedicled bone graft. Retrospectively, patients' data, healing rates, and factors influencing scaphoid healing were analyzed. The overall healing rate in cases with proximal located nonunions (n = 54) was approximately 70%. Out of these 54 patients, 47 patients showed avascular proximal fragments. Multivariate analysis showed no significant impact for the factors age, smoking, duration of disease, or previous operation. In our negative selected patient group, we were able to achieve good results with the usage of a pedicled vascularized bone graft of the distal radius. Our results indicate a favorable outcome for the use of a pedicled vascularized distal radius bone graft in both scaphoid nonunion fractures of the proximal third, with or without an avascular proximal pole.

  11. Loss of implant-bone interface following distal radial locking-plate endoprosthesis limb-sparing surgery in a dog.

    Science.gov (United States)

    Venzin, C; Grundmann, S; Montavon, P M

    2012-01-01

    An eight-year-old, neutered female Rottweiler was presented with lameness of seven days duration. Radiographs were consistent with a distal radial bone tumour. Limb-sparing surgery was performed using a commercially available endoprosthesis with a locking bone plate. Histopathological examination of the resected bone revealed an intraosseous fibrosarcoma, and postoperative adjuvant chemotherapy was initiated three weeks after surgery. Despite initial satisfactory limb function, lameness worsened four months after surgery. Radiographs revealed large areas of bone lysis around the proximal and distal screws, leading to significant resorption of the radius and radial carpal bone with subsequent construct failure. Further treatment was declined by the owner and the dog was subsequently euthanased. This case illustrates that implant failure is not necessarily averted by the use of locking (compared with non-locking) implants combined with an endoprosthesis to treat distal radial tumours in dogs. © 2011 British Small Animal Veterinary Association.

  12. Limited open reduction is better for simple- distal tibial shaft fractures than minimally invasive plate osteosynthesis.

    Science.gov (United States)

    Li, Q; Zeng, B F; Luo, C F; Song, S; Zhang, C Q; Kong, W Q

    2014-07-24

    The aim of this study was to compare the effects and indications of minimally invasive plate osteosynthesis (MIPO) and limited open reduction (LOR) for managing distal tibial shaft fractures. A total of 79 cases of distal tibial shaft fractures were treated surgically in our trauma center. The 79 fracture cases were classified into type A, B, and C (C1) according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, with 28, 32, and 19 cases, respectively. Among the 79 fracture cases, 52 were closed fractures and 27 were open fractures (GUSTILO, I-II). After adequate preparation, 48 cases were treated with LOR and 31 cases were treated with MIPO. All cases were followed up for 12 to 18 months, with an average of 16.4 months. During the follow-up period, 76 fracture cases were healed in the first stage, whereas the 3 cases that developed non-union were treated by changing the fixation device and autografting. For types A, B, and some of C simple fractures (C1), LOR accelerated the fracture healing and lowered the non-union rate. One case suffered from regional soft tissue infection, which was controlled by wound dressing and intravenous antibiotics. Another case that developed local skin necrosis underwent local flap transplant. LOR promoted bone healing and lowered the non-union rate of several simple-distal tibial shaft fractures. Thereafter, the incidence of soft tissue complication was not significantly increased. However, for complex and comminuted fractures, MIPO was the preferred method for correcting bone alignment and protecting soft tissue, leading to functional recovery.

  13. Biceps brachii tendon ruptures: a review of diagnosis and treatment of proximal and distal biceps tendon ruptures.

    Science.gov (United States)

    Geaney, Lauren E; Mazzocca, Augustus D

    2010-06-01

    The biceps brachii is a unique muscle with 2 proximal tendons and a single distal tendon. Although these tendons are part of the same muscle, they have significantly different functions. It is hypothesized that the long head of the biceps acts as a pain generator in the shoulder, though the biomechanical function is still under debate. Conversely, the distal biceps tendon is the major supinator of the forearm and serves a secondary flexor. As such, injuries to these tendons must be evaluated independently. Biceps brachii ruptures most often occur in middle-aged men following a traumatic event. Injuries to the long head of the biceps are primarily treated nonoperatively with adequate results. Injuries of distal tendon occur less often, but are receiving significant attention in the literature in regard to treatment options. Surgical repair of distal biceps ruptures is indicated in patients who want to restore supination strength and endurance. It is unclear which operative technique is superior, although the most recent data suggest increased strength of the cortical button repair. This article provides a comprehensive review of both proximal and distal biceps brachii ruptures in addition to our treatment algorithm.

  14. Combined Isolated Laugier’s Fracture and Distal Radial Fracture: Management and Literature Review on the Mechanism of Injury

    Directory of Open Access Journals (Sweden)

    Walid Osman

    2016-01-01

    Full Text Available Introduction. Isolated fracture of the trochlea is an uncommon condition requiring a particular mechanism of injury. Its association with a distal radial fracture is rare. We aimed through this case report to identify the injury mechanism and to assess surgical outcomes. Case Presentation. We report a 26-year-old female who was admitted to our department for elbow trauma following an accidental fall on her outstretched right hand with her elbow extended and supinated. On examination, the right elbow was swollen with tenderness over the anteromedial aspect of the distal humerus. The elbow range was restricted. Standard radiographs showed an intra-articular half-moon-shaped fragment lying proximal and anterior to the distal humerus. There was a comminuted articular fracture of the distal radius with an anterior displacement. A computed tomography revealed an isolated shear fracture of the trochlea without any associated lesion of the elbow. The patient was surgically managed. Anatomical reduction was achieved and the fracture was fixed with 2 Kirschner wires. The distal radial fracture was treated by open reduction and plate fixation. The postoperative course was uneventful with a good recovery. Conclusion. Knowledge of such entity would be useful to indicate the suitable surgical management and eventually to obtain good functional outcomes.

  15. Palliative distal gastrectomy offers no survival benefit over gastrojejunostomy for gastric cancer with outlet obstruction: retrospective analysis of an 11-year experience.

    Science.gov (United States)

    Okumura, Yasuhiro; Yamashita, Hiroharu; Aikou, Susumu; Yagi, Koichi; Yamagata, Yukinori; Nishida, Masato; Mori, Kazuhiko; Nomura, Sachiyo; Kitayama, Joji; Watanabe, Toshiaki; Seto, Yasuyuki

    2014-11-29

    Either palliative distal gastrectomy or gastrojejunostomy are the initial treatment options for locally advanced gastric cancer with outlet obstruction when curative-intent resection is not feasible. Since chemotherapy is the mainstay for unresectable gastric cancer, the clinical value of palliative distal gastrectomy is controversial. We retrospectively reviewed the clinical data of patients with gastric cancer with outlet obstruction treated at our institution between January 2002 and December 2012. We compared the clinical outcomes of palliative distal gastrectomy with those of gastrojejunostomy patients and the factors affecting overall survival were evaluated. Elective palliative distal gastrectomy and gastrojejunostomy were performed in 18 and 25 patients, respectively. The median overall survival times in the gastrojejunostomy and palliative distal gastrectomy groups were statistically equivalent at 8.8 and 8.3 months, respectively (P = 0.73), despite the more locally advanced tumors in the gastrojejunostomy as compared with the palliative distal gastrectomy group. A multivariate Cox regression analysis showed absence of postoperative chemotherapy and higher postoperative complication grade to be associated with worse clinical outcomes. Palliative distal gastrectomy offers neither survival nor palliative benefit as compared to gastrojejunostomy. Minimizing the morbidity of intervention for outlet obstruction, followed by chemotherapy, appears to be the optimal initial strategy for incurable gastric cancer with outlet obstruction.

  16. Erişkin femur cisim kınklarının kilitli intramedüller çivileme ile tedavisi (Distal kilitlemede kolay bir teknik)

    OpenAIRE

    Arazi, Mehmet; Yel, Mustafa; Oktar, M.; Ogun, Tunc; Memik, Recep

    2004-01-01

    We describe an easy method for distal screw insertion in locked intramedullary nailing procedure and also present the early results of the femoral shaft fractures treated using this method and interlocking nailing. Between 1995 and 1997, 35 femoral shaft fractures which were not suitable for non-interlocked nailing because of localization and comminution were treated by interlocking nailing. The fractures were located in the proximal third of femur in 12 cases, middle in 15, and distal in 8. ...

  17. Deformidade angular do rádio e da ulna tratada pela distração osteogênica percutânea dinâmica - Relato de caso

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    Rezende C.M.F.

    2000-01-01

    Full Text Available O exame de um cão de quatro meses de idade, macho, sem raça definida, com peso de 5,7kg mostrou que ele se apoiava com os cotovelos e apresentava desvio acentuado bilateral do rádio e da ulna. Ao exame radiográfico, observou-se fratura proximal bilateral do rádio. Após avaliações clínica e radiológica foi indicada a osteotomia corretiva e distração osteogênica do membro anterior esquerdo. O procedimento cirúrgico constou de osteotomia na diáfise proximal do rádio e ulna e emprego de fixadores externos compostos por quatro pinos de Kirschner e duas barras metálicas rosqueadas, configurando um fixador tipo II, bilateral uniplanar dinâmico. Antes da fixação dos pinos com acrílico, os fragmentos ósseos fraturados foram separados em aproximadamente 0,5cm. Após 10 dias, iniciou-se a distração de 1,0mm/dia durante 30 dias. A consolidação da fratura foi observada radiograficamente aos 67 dias após a intervenção, quando o aparelho foi removido. Procedimento semelhante foi realizado no membro anterior direito, quando o animal se encontrava com 16 meses de idade. Foi necessária a retirada de uma cunha óssea de aproximadamente 1,0cm para a correção angular. Atualmente, o cão mostra apoio normal do membro anterior esquerdo e discreto desvio valgus do direito devido à quebra do implante.

  18. A comparison between robotic-assisted laparoscopic distal pancreatectomy versus laparoscopic distal pancreatectomy.

    Science.gov (United States)

    Goh, Brian K P; Chan, Chung Yip; Soh, Hui-Ling; Lee, Ser Yee; Cheow, Peng-Chung; Chow, Pierce K H; Ooi, London L P J; Chung, Alexander Y F

    2017-03-01

    This study aims to compare the early perioperative outcomes of robotic-assisted laparoscopic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP). The clinicopathologic features of 45 consecutive patients who underwent minimally-invasive distal pancreatectomy from 2006 to 2015 were retrospectively reviewed. Thirty-nine patients who met our study criteria were included. Eight patients underwent RDP and 31 had LDP. There were 10 (25.6%) open conversions. Six (15.4%) patients had major (> grade 2) morbidities and there was no in-hospital mortality. There were 14 (35.9%) grade A and 9 (23.1%) grade B pancreatic fistulas. Comparison between RDP and LDP demonstrated no significant difference between the patients' baseline characteristics except there was increased frequency of spleen-preserving pancreatectomies (3 (37.5%) vs 25 (80.6%), P=0.016) and splenic-vessel preservation (5 (62.5%) vs 4 (12.9%), P=0.003) in RDP. Comparison between outcomes demonstrated that RDP was associated with a longer median operation time (452.5 (range, 300-685) vs 245 min (range, 85-430), P=0.001) and increased frequency of the procedure completed purely laparoscopically (8 (100%) vs 18 (58.1%), P=0.025). RDP can be safely adopted and is equivalent to LDP in most perioperative outcomes. It is also associated with a decreased frequency of the need for hand-assistance laparoscopic surgery or open conversion but needed a longer operation time. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  19. Tratamento cirúrgico da tendinite distal da patela Surgical treatment of the distal patellar tendinitis

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    Marco Martins Amatuzzi

    2005-01-01

    Full Text Available A tendinite distal da patela é uma doença que acomete principalmente jovens esportistas e caracteriza-se por dor referida na extremidade distal da patela junto à inserção do ligamento patelar. O tratamento inicial preconizado é sempre conservador com fisioterapia. A grande maioria tem boa resposta a este tipo de conduta, mas em alguns raros casos os sintomas não regridem exigindo uma mudança de conduta. Para este grupo usamos o tratamento cirúrgico com técnica derivada de Trillat que se baseia na utilização de um enxerto de parte do tendão do músculo Grácil implantado dentro do ligamento patelar, inserido intra-ósseo na patela e fixado na tuberosidade anterior da tíbia. Foram operados seis pacientes, sendo que em dois casos a operação foi bilateral, totalizando oito joelhos. O seguimento mínimo foi de três anos, com avaliação final dentro do índice considerado como EXCELENTE, conforme a cotação ARPÉGE, para todos os joelhos.Distal patellar tendinitis is a young athlete's disease characterized by pain at the distal patellar pole, near the patellar ligament insertion. Early treatment recommended is generally conservative, with physical therapy. The great majority of patients present favorable responses to this approach, but, in some cases, the remission of symptoms does not occur, requiring a different approach. For this group, surgical treatment with a technique derived from that of Trillat was used, which is based on the use of a graft removed from a portion of gracillis muscle tendon into patellar ligament, intraosseously inserted in the patella and fixed at the tibial anterior tuberosity. Six patients were operated, bilaterally in two cases, totaling eight knees. The minimum follow-up time was three years, with all knees presenting an EXCELLENT score, according to ARPÉGE evaluation.

  20. Femoral derotation osteotomy in spastic diplegia. Proximal or distal?

    Science.gov (United States)

    Pirpiris, M; Trivett, A; Baker, R; Rodda, J; Nattrass, G R; Graham, H K

    2003-03-01

    We describe the results of a prospective study of 28 children with spastic diplegia and in-toed gait, who had bilateral femoral derotation osteotomies undertaken at either the proximal intertrochanteric or the distal supracondylar level of the femur. Preoperative clinical evaluation and three-dimensional movement analysis determined any additional soft-tissue surgery. Distal osteotomy was faster with significantly lower blood loss than proximal osteotomy. The children in the distal group achieved independent walking earlier than those in the proximal group (6.9 +/- 1.3 v 10.7 +/- 1.7 weeks; p spastic diplegia.

  1. Intra-Articular Osteotomy for Distal Humerus Malunion

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    René K. Marti

    2009-01-01

    Full Text Available Intra-articular osteotomy is considered in the rare case of malunion after a fracture of the distal humerus to restore humeral alignment and gain a functional arc of elbow motion. Traumatic and iatrogenic disruption of the limited blood flow to the distal end of the humerus resulting in avascular necrosis of capitellum or trochlea is a major pitfall of the this technically challenging procedure. Two cases are presented which illustrate the potential problems of intra-articular osteotomy for malunion of the distal humerus.

  2. Adenoma of the distal common bile duct -a case report-

    International Nuclear Information System (INIS)

    Do, Young Soo; Lee, Hyun Gon; Han, Ho Seong; Ko, Gyung Hyuck; Kim, Jae Hyoung; Kim, Hyung Jin; Chung, Sung Hoon

    1991-01-01

    On rare occasions, Obstructive Jaundice may be caused by a benign tumor of the biliary tract. We describe a patient in whom the diagnosis of an adenoma of the distal common bile duct (CBD) was established. The CT showed a soft tissue density mass in the distal CBD and diffuse dilatation of the intrahepatic duct, gall the bladder, and CBD. Endoscopic retrograde cholangiopnacreatography showed an irregularly marginated polypoid mass in the distal CBD. The clinical, radiological, and histological features of this neoplasm are reviewed. The clinical, radiological and histological features of this neoplasm are reviewed

  3. Distal tibial interosseous osteochondroma with impending fracture of fibula ? a case report and review of literature

    OpenAIRE

    Wani, Iftikhar H; Sharma, Siddhartha; Malik, Farid H; Singh, Manjeet; Shiekh, Irfan; Salaria, Abdul Q

    2009-01-01

    Osteochondromas arising from the interosseous border of the distal tibia and involving distal fibula are uncommon. We present a 16 year old young boy with an impending fracture, erosion and weakness of the distal fibula, secondary to an osteochondroma arising from the distal tibia. Early excision of this deforming distal tibial osteochondroma avoided the future risk of pathological fracture of the distal fibula, ankle deformities and syndesmotic complications.

  4. Potassium transport across guinea pig distal colon

    International Nuclear Information System (INIS)

    Rechkemmer, G.; Halm, D.R.; Frizzell, R.A.

    1986-01-01

    Active absorption and secretion of K was studied by measuring bidirectional 42 K fluxes across short-circuited guinea pig distal colon. Tissues were pretreated with mucosal (m) and serosal (s) indomethacin (1 μM) and amiloride (0.1 mM, m) to suppress spontaneous, electrogenic Cl secretion and Na absorption. Under these conditions, the short-circuit current (I/sub sc/) was 0.4 μeq/cm 2 h while electroneutral K absorption was 2.8 μeq/cm 2 h. Epinephrine (5 μM, s) stimulated electrogenic K secretion, reducing net K absorption to 1.3 μeq/cm 2 h. Bumetanide (0.1 mM, s) abolished this K secretion and restored K absorption to control values, suggesting mechanistic similarities between K and Cl secretion. K absorption was inhibited 40% by the gastric H/K ATPase inhibitor, omeprazole (0.1 mM, m), and was abolished by ouabain (0.1 mM, m). Neutral K absorption does not appear to be mediated by an apical membrane Na/K pump since: the effect of mucosal ouabain on K absorption does not require the presence of mucosal or serosal Na, unidirectional Na fluxes are not influenced by mucosal ouabain, and K absorption is not affected when Na absorption is abolished by amiloride. Net K transport is determined by the balance between electroneutral K absorption and electrogenic K secretion. The ouabain sensitivity of K absorption suggests that colonic H/K ATPase differs from its gastric counterpart

  5. Histology of the distal dural ring.

    Science.gov (United States)

    Graffeo, Christopher S; Perry, Avital; Copeland, William R; Raghunathan, Aditya; Link, Michael J

    2017-09-01

    The distal dural ring (DDR) is a conserved intracranial anatomic structure marking the boundary point at which the internal carotid artery (ICA) exits the cavernous sinus (CS) and enters the subarachnoid space. Although the CS has been well described in a range of anatomic studies, to our knowledge no prior study has analyzed the histologic relationship between the ICA and DDR. Correspondingly, our objective was to assess the relationship of the DDR to the ICA and determine whether the DDR can be dissected from the ICA and thus divided, or can only be circumferentially trimmed around the artery. The authors examined ten fresh-frozen, adult cadaveric specimens. A standard frontotemporal craniotomy, orbito-optic osteotomy, and extradural anterior clinoidectomy was performed bilaterally. The cavernous ICA, DDR, and supraclinoid ICA were harvested as an en bloc specimen. Specimens formalin-fixed and paraffin-embedded prior to routine histochemical staining with hematoxylin and eosin and Masson trichrome. In all specimens, marked microscopic investment of the DDR throughout the ICA adventitia was noted. Dural collagen fibers extensively permeated the arterial layers superficial to the muscularis propria, with no evidence of a clear separation between the DDR and arterial adventitia. Histologic analysis suggests that the ICA and DDR are highly interrelated, continuous structures, and therefore attempted intraoperative dissection between these structures may carry an elevated risk of injury to the ICA. We correspondingly recommend careful circumferential trimming of the DDR in lieu of direct dissection in cases requiring mobilization of the clinoidal ICA. Clin. Anat. 30:742-746, 2017. © 2017Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  6. Clinical effects of internal fixation for ulnar styloid fractures associated with distal radius fractures: A matched case-control study.

    Science.gov (United States)

    Sawada, Hideyoshi; Shinohara, Takaaki; Natsume, Tadahiro; Hirata, Hitoshi

    2016-11-01

    Ulnar styloid fractures are often associated with distal radius fractures. However, controversy exists regarding whether to treat ulnar styloid fractures. This study aimed to evaluate clinical effects of internal fixation for ulnar styloid fractures after distal radius fractures were treated with the volar locking plate system. We used prospectively collected data of distal radius fractures. 111 patients were enrolled in this study. A matched case-control study design was used. We selected patients who underwent fixation for ulnar styloid fractures (case group). Three control patients for each patient of the case group were matched on the basis of age, sex, and fracture type of distal radius fractures from among patients who did not undergo fixation for ulnar styloid fractures (control group). The case group included 16 patients (7 men, 9 women; mean age: 52.6 years; classification of ulnar styloid fractures: center, 3; base, 11; and proximal, 2). The control group included 48 patients (15 men, 33 women; mean age: 61.1 years; classification of ulnar styloid fractures: center, 10; base, 31; and proximal, 7). For radiographic examination, the volar tilt angle, radial inclination angle, and ulnar variance length were measured, and the union of ulnar styloid fractures was judged. For clinical examination, the range of motions, grip strength, Hand20 score, and Numeric Rating Scale score were evaluated. There was little correction loss for each radiological parameter of fracture reduction, and these parameters were not significantly different between the groups. The bone-healing rate of ulnar styloid fractures was significantly higher in the case group than in the control group, but the clinical results were not significantly different. We revealed that there was no need to fix ulnar styloid fractures when distal radius fractures were treated via open reduction and internal fixation with a volar locking plate system. Copyright © 2016 The Japanese Orthopaedic Association

  7. EARLY RESULTS OF UNSTABLE DISTAL RADIUS FRACTURES- ORIF WITH LOCKING COMPRESSION PLATE VERSUS LIGAMENTOTAXIS WITH EXTERNAL FIXATORS

    Directory of Open Access Journals (Sweden)

    Mondeep Gayan

    2017-04-01

    Full Text Available BACKGROUND External Fixation (EF and Open Reduction and Internal Fixation (ORIF have been the traditional surgical modalities for unstable distal radius fractures. The Locking Compression Plates (LCP acting as “internal external fixators” are particularly valuable in difficult situations of fractures. We undertook a study to evaluate the outcome of unstable distal radius fractures treated with ORIF with LCP versus those treated by ligamentotaxis with external fixators. MATERIALS AND METHODS A comparative study was carried out in a tertiary care centre with 30 cases of unstable distal radius fractures (15 cases in each group. In one group, open reduction and internal fixation with distal radius volar locking compression plate was carried out and in the other group ligamentotaxis with external fixator was done. The patients were treated and followed up over a period of one and a half year between June 2011 to November 2012. The fractures were classified according to AO classification (Arbeitsgemeinschaft für Osteosynthesefragen: German for “Association for the Study of Internal Fixation” or AO. The functional results were evaluated at the end of 6 months according to Demerit point system of Gartland and Werley modified by Sarmiento (1975 and the anatomical results as per Lindstrom criteria (1959 modified by Sarmiento (1980. RESULTS Overall 86.66% (13 cases had good-to-excellent anatomical results in external fixator group as compared to 93.33% (14 cases in LCP group. The functional outcome was excellent in 80% (12 and good in 13.33% (2 cases in external fixator group as compared to 66.66% (10 excellent and 26.66% (4 good in LCP group. CONCLUSION Both open reduction and internal fixation with locking compression plate and ligamentotaxis with external fixators are good treatment modalities for unstable distal radius fractures. However, the choice should be guided by the fracture configuration, surgeons’ experience and patient’s profile.

  8. A Comprehensive Study of Internal Distraction Plating, an Alternative Method for Distal Radius Fractures.

    Science.gov (United States)

    Jain, Mohit J; Mavani, Kinjal J

    2016-12-01

    The management of highly comminuted distal radius fractures still remains a major treatment challenge. Articular comminution and compromised bone quality are the culprits. One novel approach is the technique of Internal Distraction Plating which involves "bridging" the fracture with the use of a standard 3.5mm plate applied dorsally in distraction from the radius, proximal to the fracture, to the long finger metacarpal distally, bypassing the comminuted segment. The plate is removed once fracture union has been achieved. The present study was conducted with the aim to evaluate the role of internal dorsal distraction plating as an alternative method in the treatment of fracture distal radius in terms of special indications, technique and outcome. This study was a prospective longitudinal study on 20 patients (mean age 62 years) treated with internal distraction plating for comminuted distal radius fractures with specific indications. Regular follow-ups with standard radiographs and analysis were done upto 24 months. Functional outcome were assessed by DASH Score and the Gartland and Werley demerit score. At final follow-up, all fractures had united and X-rays showed mean palmar tilt of 7°, positive ulnar variance of 0.5mm, radial inclination of 18° and average loss of 2mm of radial height. Mean range of motion values for wrist flexion 46°, extension 50°, pronation 79° and supination 77° At final follow-up, the mean DASH score was 32. 85% patient had excellent to good result as per Gartland and Werley demerit score. This construct has yield satisfactory clinical and radiographic results with these very challenging injuries. The purpose of this study was to report the radiographic and the functional outcomes of treatment with this technique. External fixator and volar plating in communited distal end radius fractures are not always satisfactory in old age with osteoporotic bone because of complications associated with them. The current technique represents an

  9. Splenic vein thrombosis and pancreatic fistula after minimally invasive distal pancreatectomy.

    Science.gov (United States)

    Kang, C M; Chung, Y E; Jung, M J; Hwang, H K; Choi, S H; Lee, W J

    2014-01-01

    This study aimed to investigate the clinical relevance of splenic vein thrombosis (SVT) in the splenic vein remnant following minimally invasive distal pancreatosplenectomy (DPS). Medical records of patients who underwent laparoscopic or robotic distal pancreatectomy (DP) with or without splenectomy between January 2006 and August 2012 were reviewed. Rates of SVT and clinically relevant postoperative pancreatic fistula (POPF) were compared in a group of patients undergoing DPS and a group having spleen-preserving DP. Seventy-nine patients had minimally invasive DP, of whom 38 (48 per cent) developed SVT in the splenic vein remnant. DPS was associated with POPF (P = 0.001) and SVT (P SVT length was closely related to the amount of peripancreatic fluid collection (P = 0.025) and POPF (P = 0.045). In a comparison of splenic vessel-sacrificing, spleen-preserving DP and DPS, postoperative platelet count was significantly higher in the DPS group (P SVT (P = 0.092) and POPF (P = 0.065) tended to be associated with DPS, suggesting that SVT may be related to both splenectomy and POPF. Minimally invasive DPS is associated with SVT and POPF. Preservation of the spleen should be considered when treating patients with benign and borderline malignant tumours of the distal pancreas. © 2013 BJS Society Ltd. Published by John Wiley & Sons Ltd.

  10. Distal biceps tendon rupture reconstruction using muscle-splitting double-incision approach.

    Science.gov (United States)

    Tarallo, Luigi; Mugnai, Raffaele; Zambianchi, Francesco; Adani, Roberto; Catani, Fabio

    2014-08-16

    To evaluate the clinical and functional results after repair of distal biceps tendon tears, following the Morrey's modified double-incision approach. We retrospectively reviewed 47 patients with distal rupture of biceps brachii treated between 2003 and 2012 in our Orthopedic Department with muscle-splitting double-incision technique. Outcome measures included the Mayo elbow performance, the DASH questionnaire, patient's satisfaction, elbow and forearm motion, grip strength and complications occurrence. At an average 18 mo follow-up (range, 7 mo-10 years) the average Mayo elbow performance and DASH score were respectively 97.2 and 4.8. The elbow flexion range was 94%, extension was -2°, supination was 93% and pronation 96% compared with the uninjured limb. The mean grip strength, expressed as percentage of respective contralateral limb, was 83%. The average patient satisfaction rating on a Likert scale (from 0 to 10) was 9.4. The following complications were observed: 3 cases of heterotopic ossification (6.4%), one (2.1%) re-rupture of the tendon at the site of reattachment and 2 cases (4.3%) of posterior interosseous nerve palsy. No complication required further surgical treatment. This technique allows an anatomic reattachment of distal biceps tendon at the radial tuberosity providing full functional recovery with low complication rate.

  11. A PROSPECTIVE STUDY OF CLINICAL OUTCOME AFTER USING LIGAMENTOTAXIS IN MANAGEMENT OF DISTAL RADIUS FRACTURES

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    Chandrashekhar V. Mudgal

    2017-04-01

    Full Text Available BACKGROUND A study was done to evaluate the effect of the ligamentotaxis in the management of intraarticular fractures of the distal radius. MATERIALS AND METHODS 34 patients were studied prospectively between March 2014 and February 2016. All patients had intraarticular fracture of distal end of radius and all were treated with ligamentotaxis after closed reduction with fluoroscopic guidance. The follow-up period was 12 months. At the time of surgery, the mean age was 45.29 years. RESULTS In all fracture cases, the mean of fracture union was 5.8 weeks. During the final follow-up, the mean range of motion was 55.30 in flexion, 56.60 in extension, 21.0 in ulnar deviation, 9.00 in radial deviation, 70.30 in pronation and 67.10 in supination. According to the scoring system of Gartland and Werley, the clinical and functional outcomes showed that 15 patients (44.1% had excellent results, 14 (41.1% had good results, 3 (8.8% had fair results and 2 (5.8% had poor results. CONCLUSION Closed reduction under fluoroscopic image guidance and the ligamentotaxis is useful and effective in the treatment of intraarticular fractures of the distal radius.

  12. A patient with a de novo distal 22q11.2 microdeletion and anxiety disorder.

    Science.gov (United States)

    Verhoeven, Willem; Egger, Jos; Brunner, Han; de Leeuw, Nicole

    2011-02-01

    We report on a young female with normal intelligence evaluated for long-term anxiety. Her history includes prematurity, neonatal feeding problems, surgical correction of congenital heart defects, recurrent upper airway and urinary tract infections, and delayed motor and developmental milestones. Physical examination disclosed small stature and minor dysmorphisms. Chromosome analysis, 22q11.2 FISH analysis, and subtelomeric MLPA testing did not detect any abnormalities. Genome wide SNP Array analysis showed a de novo deletion in 22q11.21q11.22, the so-called distal 22q11 microdeletion that involves the MAPK1 gene. A diagnosis of panic disorder was made and the patient was successfully treated with a daily dose of 20 mg citalopram. To our knowledge, this is the first adolescent patient with a long history of complaints about anxiety and a distal 22q11 microdeletion. We speculate that genes from the deleted region, especially MAPK1, increase the neurobiological susceptibility to anxiety disorders that may be a part of the psychopathological phenotype of the distal 22q11.2 microdeletion syndrome. Copyright © 2010 Wiley-Liss, Inc.

  13. Minimally Invasive Distal Metatarsal Osteotomy for Mild-to-Moderate Hallux Valgus Deformity

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    Yu-Chuan Lin

    2009-08-01

    Full Text Available Minimally invasive surgery has recently been introduced for foot and ankle surgery, and hallux valgus surgery is no exception. The purpose of our study was to analyze the early results and to present our experience of minimally invasive distal metatarsal osteotomy in correcting mild-to-moderate hallux valgus deformities. Between September 2005 and December 2006, 31 consecutive patients (47 feet with mild-to-moderate hallux valgus deformities underwent minimally invasive distal metatarsal osteotomies. The clinical and radiographic outcomes were assessed. The satisfaction rate was 90.32%. The mean total American Orthopedic Foot and Ankle Society halluxmetatarsophalangeal-interphalangeal scale was 92.7 points. Complications included two (4.26% episodes of stiffness, six (12.77% episodes of pin tract infection, and one (2.13% deep infection. There were no cases with nonunion, malunion, overcorrection, transfer metatarsalgia or osteonecrosis. On weight-bearing anteroposterior foot radiographs, the mean hallux valgus angle and first intermetatarsal angle corrections were 11.8° and 6.3°, respectively, which is a statistically significant difference (p < 0.001 between the preoperative and postoperative status. Here, minimally invasive distal metatarsal osteotomy was associated with good satisfaction, functional improvement and low complication rates. This technique offers an effective, safe and simple way to treat hallux valgus with a first intermetatarsal angle less than 15°.

  14. Arthroscopic Treatment of Comminuted Distal Clavicle Fractures (Latarjet Fractures) Using 2 Double-Button Devices

    Science.gov (United States)

    Pujol, Nicolas; Desmoineaux, Pierre; Boisrenoult, Philippe; Beaufils, Philippe

    2013-01-01

    Complex distal clavicle fractures associated with a rupture of the coracoclavicular ligaments (Latarjet fractures) can result in delayed union or nonunion. There is no standard treatment for a clavicle fracture. This report introduces an arthroscopic technique for treating distal clavicle fractures associated with ruptured coracoclavicular ligament using 2 double-button devices. By use of posterior and anterior standard arthroscopic portals, the base of the coracoid process is exposed through the rotator interval. A 4-mm hole is drilled through the clavicle and the coracoid process with a specific ancillary drill guide. The first button is pushed through both holes down the coracoid process. The device is tightened, and the second button is fixed on top of the clavicle, allowing reduction and fixation of the proximal part of the fracture. Then, the undersurface of the lateral clavicle is dissected through standard posterior and lateral subacromial approaches. The inferior clavicle fragment is reduced and fixed to the clavicle body by a double button fixed down and at the top of the clavicle. With this technique, the arthroscopic treatment of distal clavicle fracture has been extended to comminuted fractures. PMID:23767010

  15. Conservative treatment of intra-articular distal phalanx fractures in horses not used for racing.

    Science.gov (United States)

    Ohlsson, J; Jansson, N

    2005-04-01

    To determine the success rate and whether specific patient and treatment factors influenced the outcome after conservative treatment with a bar shoe with quarter clips of intra-articular fractures of the distal phalanx in horses not used for racing. Retrospective study. Thirty-two client-owned horses. Hospital records of horses that had been treated conservatively for intra-articular fractures of the distal phalanx at Skara Equine Hospital or Halland Animal Hospital in Sweden between 1995 and 2001 were reviewed. Racehorses in active training and horses affected with other musculoskeletal diseases were excluded from the study. Follow-up was performed by questionnaire and telephone inquires to the owners 1 to 7 years after injury. Twenty-two horses (69%) returned to their previous or expected level of use and did not wear their bar shoe when they were put back into training. There was no statistically significant correlation between outcome and patient or treatment variables, or bony union of the fracture. Conservative treatment of intra-articular fractures of the distal phalanx carries a fair prognosis for return to previous or expected level of use in horses not used for racing. Radiographic evidence of fracture healing and age of the patient do not seem to influence the prognosis. Horses not used for racing do not need to be shod with a bar shoe with quarter clips for the rest of their athletic career.

  16. COMBINATION OF FIXATION TECHNIQUES IN THE MANAGEMENT OF COMPLEX DISTAL RADIUS FRACTURE- OUR EXPERIENCES

    Directory of Open Access Journals (Sweden)

    Isaac Sunder Sen

    2016-10-01

    Full Text Available BACKGROUND The aim of the study is to categorically suggest the apt method of surgical technique for a particular type of distal radius fracture (Frykman’s type III-VI. Distal radius fracture are among the most common fractures of the upper extremity inspite of increased focus on regular prevention of osteoporosis, early identification and its prompt management. Most distal radius fractures are the result of low energy mechanisms that can be successfully treated either nonoperatively or with a variety of operative techniques if indicated. Complex distal radius fractures occur most commonly in high-energy injuries with extensive comminution or bone loss and associated soft tissue or vascular injuries. These high-energy fractures can present challenges in reconstructing the distal radius. Effective restoration of the bony architecture requires a thorough knowledge of distal radius anatomy, understanding of the goals of treatment, versatility in surgical approaches and familiarity with multiple fixation options. Although, majority of the extra-articular fracture without signs of instability can be successfully managed with POP immobilisation for a period of 4-5 weeks followed by active physiotherapy, other types (Frykman’s III-VI need surgical management that too with combination of surgical techniques namely augmented spanning external fixator with supplemented K-wire fixation or external fixation followed by fragment specific volar locking compression plate osteosynthesis. MATERIALS AND METHODS I have studied 50 cases of distal radius fractures classified using Frykman’s classification using combination of techniques namely augmented spanning external fixator application with K-wire supplementation and spanning external fixator application followed by volar LCP fixation in which external fixator had been used as a reduction tool in majority of the cases and external fixator had been removed after plate osteosynthesis. In some cases retained

  17. Allogeneic Stem Cells Alter Gene Expression and Improve Healing of Distal Limb Wounds in Horses

    Science.gov (United States)

    Textor, Jamie A.; Clark, Kaitlin C.; Walker, Naomi J.; Aristizobal, Fabio A.; Kol, Amir; LeJeune, Sarah S.; Bledsoe, Andrea; Davidyan, Arik; Gray, Sarah N.; Bohannon‐Worsley, Laurie K.; Woolard, Kevin D.

    2017-01-01

    Abstract Distal extremity wounds are a significant clinical problem in horses and humans and may benefit from mesenchymal stem cell (MSC) therapy. This study evaluated the effects of direct wound treatment with allogeneic stem cells, in terms of gross, histologic, and transcriptional features of healing. Three full‐thickness cutaneous wounds were created on each distal forelimb in six healthy horses, for a total of six wounds per horse. Umbilical cord‐blood derived equine MSCs were applied to each wound 1 day after wound creation, in one of four forms: (a) normoxic‐ or (b) hypoxic‐preconditioned cells injected into wound margins, or (c) normoxic‐ or (d) hypoxic‐preconditioned cells embedded in an autologous fibrin gel and applied topically to the wound bed. Controls were one blank (saline) injected wound and one blank fibrin gel‐treated wound per horse. Data were collected weekly for 6 weeks and included wound surface area, thermography, gene expression, and histologic scoring. Results indicated that MSC treatment by either delivery method was safe and improved histologic outcomes and wound area. Hypoxic‐preconditioning did not offer an advantage. MSC treatment by injection resulted in statistically significant increases in transforming growth factor beta and cyclooxygenase‐2 expression at week 1. Histologically, significantly more MSC‐treated wounds were categorized as pro‐healing than pro‐inflammatory. Wound area was significantly affected by treatment: MSC‐injected wounds were consistently smaller than gel‐treated or control wounds. In conclusion, MSC therapy shows promise for distal extremity wounds in horses, particularly when applied by direct injection into the wound margin. stem cells translational medicine 2018;7:98–108 PMID:29063737

  18. Single and dual incision technique for acute distal biceps rupture: clinical and functional outcomes

    Science.gov (United States)

    Guglielmino, Claudia; Massimino, Paolo; Ioppolo, Francesco; Castorina, Sergio; Musumeci, Giuseppe; Di Giunta, Angelo

    2016-01-01

    Summary Background Distal bicep tendon injuries are a traumatic event though rather rare. The pathogenesis is not entirely clear. The most common cause for injury is an unexpected load on the biceps when the elbow is in an extended position. Although several studies have provided insight into the pathogenetic processes of the lesion, the literature suggests to treat all injuries surgically (whether partial or total) if there is high functional demand. Methods Between January 2006 and March 2016 were studied 20 patients surgically treated for a disconnected distal bicep, 15 with a total lesion and 5 with a partial lesion. The patients were divided into 2 groups. Surgical access with single incision was performed on 13 patients while a double surgical access was performed on 7 patients. The clinical and functional results were studied using an Ewald System Score (ESS). Results In both groups, the most rapid improvement was achieved for the parameters of pain and deformity with excellent results, while those of function and movement were normalized as gradual and progressive over next 2 months. Conclusion The clinical and functional outcomes during the follow-up examination after surgery showed excellent results in patients treated with both types of surgical procedures. PMID:28217566

  19. Endovascular treatment of ruptured distal posterior inferior ...

    African Journals Online (AJOL)

    Results: All patients were treated by endovascular treatment, seven cases got endosaccular coiling and four cases got parent artery occlusion at the same time. All the patients were followed up one to four years. Recurrences occurred in 1 patient two years post-treatment, and were successfully retreated by endosaccular ...

  20. Late Migration of Threaded Wire (Schanz Screw from Right Distal Clavicle to the Cervical Spine

    Directory of Open Access Journals (Sweden)

    Chun-Hao Tsai

    2009-01-01

    Full Text Available We report a 49-year-old man who had undergone osteosynthesis to treat right distal clavicular fracture with a threaded wire (Schanz screw. The wire could not be removed due to its firm fixation within the bone. Eight years later, migration of the broken wire to the right 7th cervical vertebra punctured the lamina, with no spinal cord injury noted. The threaded wire was extracted from the C7 lamina emergently. No complication occurred after pin removal or during the 1-year postoperative follow-up.

  1. Marsupialization and distal obliteration of a lumbosacral dural ectasia in a nonsyndromic, adult patient

    Directory of Open Access Journals (Sweden)

    Ha Son Nguyen

    2015-01-01

    Full Text Available Dural ectasia is frequently associated with connective tissue disorders or inflammatory conditions. Presentation in a patient without known risk factors is rare. Moreover, the literature regarding the treatment options for symptomatic dural ectasia is controversial, variable, and limited. A 62-year-old female presents with intractable, postural headaches for years. A lumbar puncture revealed opening pressure 3 cm of water. A computed tomography myelogram of the spine demonstrated erosion of her sacrum due to a large lumbosacral dural ectasia. An initial surgery was attempted to reduce the size of the expansile dura, and reconstruct the dorsal sacrum with a titanium plate (Depuy Synthes, Westchester, PA, USA to prevent recurrence of thecal sac dilatation. Her symptoms initially improved, but shortly thereafter recurred. A second surgery was then undertaken to obliterate the thecal sac distal to the S2 nerve roots. This could not be accomplished through simple ligation of the thecal sac circumferentially as the ventral dura was noted to be incompetent and attempts to develop an extradural tissue plane were unsuccessful. Consequently, an abundance of fibrin glue was injected into the thecal sac distal to S2, and the dural ectasia was marsupialized rostrally, effectively obliterating the distal thecal sac while further reducing the size of the expansile dura. This approach significantly improved her symptoms at 5 months follow-up. Treatment of dural ectasia is not well-defined and has been variable based on the underlying manifestations. We report a rare patient without risk factors who presented with significant lumbosacral dural ectasia. Moreover, we present a novel method to treat postural headaches secondary to dural ectasia, where the thecal sac is obliterated distal to the S2 nerve roots using an abundance of fibrin glue followed by marsupialization of the thecal sac rostally. This method may offer an effective therapy option as it serves to

  2. [Value of intramedullary locked nailing in distal fractures of the tibia].

    Science.gov (United States)

    Bonnevialle, P; Savorit, L; Combes, J M; Rongières, M; Bellumore, Y; Mansat, M

    1996-01-01

    This study is a retrospective analysis of 38 extra-articular distal tibial fractures treated by intramedullary locked nailing. 38 patients with a distal metaphyseal extra-articular fracture (43 A AO type) or with minimal ankle joint extension were managed. There was 26 men and 12 women with a mean age of 32.3 years, 10 fractures were open. The fractures were transverse or oblique in 13 cases, with torsional or flexion wedge in 12 cases and spiroïd in 13 cases. In only 2 cases was the fibula intact. AO classification was not useful because many fractures began more proximally than the limit described by Müller. All the fractures were fixed by closed locked intramedullary nailing : the nail was cut just after the distal hole and impacted close to the subchondral plate. In 7 cases the fibula was fixed too. There was no postoperative complication in 27 cases. Three patients had a transient nerve palsy (one tibial nerve and two common fibular nerve). In ten cases the nail was dynamized. One patient had a non union but healed with a new dynamic nail. Two patients had a delayed union and healed after dynamization and osteotomy of the fibula. The mean time to union was 5 months (2 to 8). 8 patients had a varus or a valgus deformity of 3 to 6 degrees. 11 patients suffered from anterior knee pain and in 5 patients the fracture site was painful. In 18 patients a CT scan was performed : 6 had a rotational deformity from 4 to 26 degrees, and 2 a tibial lengthening (discrepancy of 7 and 9 mm). Closed intramedullary nailing is a safe and effective method for the treatment of distal metaphyseal tibial fractures. The authors propose a new classification.

  3. Partial Tears of the Distal Biceps Brachii Tendon: A Systematic Review of Surgical Outcomes.

    Science.gov (United States)

    Behun, Michael A; Geeslin, Andrew G; O'Hagan, Emma C; King, Jeffrey C

    2016-07-01

    To systematically review the literature regarding surgical outcomes for treatment of partial tears of the distal biceps brachii tendon. This study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A systematic review of the literature regarding treatment of partial tears of the distal biceps tendon was conducted using PubMed, Embase, and Cochrane. Inclusion criteria consisted of studies in the English language on the treatment of partial distal biceps tendon tears. Exclusion criteria consisted of (1) studies without outcome data, (2) studies that did not specify the degree of distal biceps tendon tear (ie, complete rupture vs partial tear), and (3) studies without partial tear subgroup data. Two investigators independently reviewed the abstracts from all identified articles. Only 5 patients who underwent successful nonsurgical treatment were identified; all were treated with different algorithms, and because of the small number, outcomes for nonsurgical treatment are not included in this review. Therefore, 19 studies involving 86 partial tears that underwent surgical treatment are reported; at least 65 of these received a trial of nonsurgical treatment before surgery. Surgery resulted in 94% satisfactory clinical outcomes. Of the 16 studies (n = 83) that specified the presence or absence of surgical complications, lateral antebrachial cutaneous nerve paresthesia (17%), posterior interosseous nerve palsy (6%), elbow discomfort (2%), surgical revision (2%), and asymptomatic heterotopic ossification (1%) were reported. Surgical treatment including tendon tear completion and anatomic repair to the radial tuberosity can yield satisfactory results and appears to provide predictable outcomes. Further research is necessary to better define the optimal regimen and duration of nonsurgical treatment, as well as the indications for surgery. Therapeutic IV. Copyright © 2016 American Society for Surgery of the

  4. Closed treatment of overriding distal radial fractures without reduction in children.

    Science.gov (United States)

    Crawford, Scott N; Lee, Lorrin S K; Izuka, Byron H

    2012-02-01

    Traditionally, distal radial fractures with marked displacement and angulation have been treated with closed or open reduction techniques. Reduction maneuvers generally require analgesia and sedation, which increase hospital time, cost, patient risk, and the surgeon's time. In our study, a treatment protocol for pediatric distal radial fractures was used in which the fracture was left shortened in an overriding position and a cast was applied without an attempt at anatomic fracture reduction. Consecutive patients three to ten years of age presenting between 2004 and 2009 with a closed overriding fracture of the distal radial metaphysis were followed prospectively. Our protocol consisted of no analgesia, no sedation, and a short arm fiberglass cast gently molded to correct only angulation. Patients were followed for at least one year. All parents or guardians were given a questionnaire assessing their satisfaction with the treatment. Financial analysis was performed with use of Current Procedural Terminology codes and the average total cost of care. Fifty-one children with an average age of 6.9 years were included in the study. Initial radial shortening averaged 5.0 mm. Initial sagittal and coronal angulation averaged 4.0° and 3.2°, respectively. The average duration of casting was forty-two days. Residual sagittal and coronal angulation at the time of final follow-up averaged 2.2° and 0.8°, respectively. All fifty-one patients achieved clinical and radiographic union with a full range of wrist motion. All parents and guardians answered the questionnaire and were satisfied with the treatment. Cost analysis demonstrated that closed reduction with the patient under conscious sedation or general anesthesia is nearly five to six times more expensive than the treatment used in this study. Adding percutaneous pin fixation increases costs nearly ninefold. This treatment protocol presents an alternative approach to overriding distal radial fractures in children and

  5. Distal outflow occlusion with bypass revascularization: last resort measure in managing complex MCA and PICA aneurysms.

    Science.gov (United States)

    Esposito, Giuseppe; Fierstra, Jorn; Regli, Luca

    2016-08-01

    Partial trapping with or without bypass revascularization is a well-established strategy in the surgical management of complex aneurysms. Distal outflow occlusion is performed by occluding the efferent artery downstream of the aneurysm and represents an alternative to proximal inflow occlusion in partial trapping treatment. With this article we report a case series employing distal outflow occlusion for managing posterior-inferior cerebellar artery (PICA) and middle cerebral artery (MCA) complex aneurysms and discuss the rationale of this treatment strategy. A case series of eight patients who underwent surgery for complex PICA (n = 3) and MCA (n = 5) aneurysms by means of distal outflow occlusion and flow-replacement bypass is presented. Two out of the eight patients presented with subarachnoid hemorrhage (SAH) (1 PICA and 1 MCA aneurysm). In seven out of eight patients (87.5 %), total aneurysmal thrombosis was obtained; in one patient, postoperative neuroimaging showed a partial aneurysmal thrombosis. Aneurysm growth or delayed rupture was not observed. All the bypasses were patent at the end of the procedure and all but one at follow-up (asymptomatic occlusion). One patient had postoperative worsening, unrelated to bypass patency. All other patients improved. Three patients maintained an mRS score of 1, four patients had improved mRS scores by ≥1, and 1 patient had a worsened mRS score compared to preoperatively. We believe that partial trapping with distal outflow occlusion for treating complex intracranial aneurysms represents a useful strategy as a last resort measure. To avoid cerebral ischemia, flow-replacement bypass is key to success.

  6. [Distal perforator-based gluteus maximus muscle V-Y flap for treatment of sacral ulcers].

    Science.gov (United States)

    Tong, Renlian; Huang, Jun; Zhong, Xiaomin

    2006-12-01

    To explore the method of the distal perforator-based gluteus maximus muscle V-Y flap to treat the sacral ulcer and to simplify the operative procedures. From March 2002 to March 2005, 11 cases of sacral ulcer were repaired by distal perforator-based gluteus maximus muscle flaps. The area of sacral ulcer ranged from 13 cmX 11 cm to 18 cmX 14 cm. Of 11 cases, 7 were female and 4 were male, whose age ranged from 21 to 69 years, and the disease course was 8 months to 3 years. A triangular flap was designed to create a V-Y advancement flap. The length of the base was made almost equal to the diameter of the defect. The apex of the triangle was located near the great trochanter. The medial part of the flap was elevated as a fasciocutaneous flap by dissecting the layer between the fascia and the muscle. The distal part of the flap was elevated by dissecting the layer between the gluteus maximus muscle and the fascia of the deeper muscle group. The flap was advanced to the defect. All the flaps survived. After a follow-up of 5 months to 3 years, the bilateral buttocks were symmetry and whose appearance was satisfactory. Except for 1 case dying of other disease, no recurrence of ulcer was observed. All the flaps survived. The distal perforator-based fasciocutaneous V-Y flap for treatment of sacral ulcers is a simple and reliable technique, which has several advantages over the conventional V-Y flap technique,such as excellent excursion, viable coverage.with the fasciocutaneous component, high flap reliability, preservation of the contralateral buttock, and preservation of the gluteus maximus muscle function.

  7. Distal limb cast sores in horses: risk factors and early detection using thermography.

    Science.gov (United States)

    Levet, T; Martens, A; Devisscher, L; Duchateau, L; Bogaert, L; Vlaminck, L

    2009-01-01

    There is a lack of evidence-based data on the prevalence, outcome and risk factors of distal limb cast sores, and no objective tool has been described for the early detection of cast sores. To investigate the prevalence, location, outcome and risk factors of cast sores after application of a distal limb cast and to determine whether static thermography of the cast is a valuable tool for the assessment of sores. A prospective study was conducted on horses treated with a distal limb cast. At each cast removal, cast sores were graded as superficial sores (SS), deep dermal sores (DS) or full thickness skin ulcerations (FS). In several cases, a thermographic evaluation of the cast was performed immediately prior to removal and differences in temperature (AT) between the coolest point of the cast and 2 cast regions predisposed for sore development (dorsoproximal mc/mtIII and palmar/plantar fetlock) were calculated. Mean +/- s.d. total casting time of 70 horses was 31 +/- 18 days. Overall, 57 legs (81%) developed at least SS. Twenty-four legs (34%) ultimately developed DS and one horse had an FS. Multivariable analysis showed that the severity of sores was positively associated with increasing age (OR: 1.111, P = 0.028), a normal (vs. swollen) limb (OR: 3387, P = 0.023) and an increase in total casting time (OR per week: 1.363, P = 0.002). The thermographic evaluation (35 casts) revealed that the severity of sores was positively associated with increasing deltaT (OR: 2.100, P = 0.0005). The optimal cut-off values for the presence of SS and DS were set at, respectively, deltaT = 23 and 43 degrees C. Distal limb cast is a safe coaptation technique with increasing risk of developing sores with time. Thermography is a valuable and rapid clinical tool to monitor the development of cast sores.

  8. The Versatility of Perforator-Based Propeller Flap for Reconstruction of Distal Leg and Ankle Defects

    Directory of Open Access Journals (Sweden)

    Durga Karki

    2012-01-01

    Full Text Available Introduction. Soft tissue coverage of distal leg and ankle region represents a challenge and such defect usually requires a free flap. However, this may lead to considerable donor site morbidity, is time consuming, and needs facility of microsurgery. With the introduction of perforator flap, management of small- and medium-size defects of distal leg and ankle region is convenient, less time consuming, and with minimal donor site morbidity. When local perforator flap is designed as propeller and rotated to 180 degree, donor site is closed primarily and increases reach of flap, thus increasing versatility. Material and Methods. From June 2008 to May 2011, 20 patients were treated with perforator-based propeller flap for distal leg and ankle defects. Flap was based on single perforator of posterior tibial and peroneal artery rotated to 180 degrees. Defect size was from 4 cm × 3.5 cm to 7 cm × 5 cm. Results. One patient developed partial flap necrosis, which was managed with skin grafting. Two patients developed venous congestion, which subsided spontaneously without complications. Small wound dehiscence was present in one patient. Donor site was closed primarily in all patients. Rest of the flaps survived well with good aesthetic results. Conclusion. The perforator-based propeller flap for distal leg and ankle defects is a good option. This flap design is safe and reliable in achieving goals of reconstruction. The technique is convenient, less time consuming, and with minimal donor site morbidity. It provides aesthetically good result.

  9. Results of preputial reconstruction in 77 boys with distal hypospadias

    NARCIS (Netherlands)

    Klijn, A. J.; Dik, P.; de Jong, T. P.

    2001-01-01

    There is growing interest in preputial reconstruction combined with hypospadias repair. We retrospectively analyzed its results for future developments and patient information. We evaluated 77 boys who underwent distal hypospadias repair combined with preputial reconstruction to determine

  10. Surgical treatment of distal biceps tendon rupture: a case report

    Directory of Open Access Journals (Sweden)

    Cristina N. Cozma

    2017-11-01

    Full Text Available Objectives. Distal biceps tendon rupture affects the functional upperextremity movement, impairing supination and flexion strength. According to age, profession and additional risks treatment might be nonoperative or surgical. Methods. We describe the case of a 43 years old male patient who sustained an injury to his right distal biceps and was diagnosed with acute right distal biceps rupture. Surgical treatment was decided and biceps tendon was reinserted to the radius tuberosity using a combination of a cortical button fixation associated with an interference screw. Results. Postoperative functional result was favorable with no complications and with no movement limitation after one month. Conclusions. When possible, distal biceps tendon repair should be realized surgically because this permits restoring of the muscle strength to near normal levels with no loss of motion. Nerve complications are common; therefore the surgery should be realized by experienced upper extremity surgeons.

  11. Minimally invasive percutaneous plate fixation of distal tibia fractures.

    LENUS (Irish Health Repository)

    Bahari, Syah

    2007-10-01

    We report a series of 42 patients reviewed at a mean of 19.6 months after treatment of distal tibial and pilon fractures using the AO distal tibia locking plate with a minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Mean time to union was 22.4 weeks. All fractures united with acceptable alignment and angulation. Two cases of superficial infection were noted, with one case of deep infection. Mean SF36 score was 85 and mean AOFAS score was 90 at a mean of 19 months follow-up. We report satisfactory outcomes with the use of the AO distal tibia locking plate in treatment of unstable distal tibial fractures. Eighty-nine percent of the patients felt that they were back to their pre injury status and 95% back to their previous employment.

  12. OUTCOME OF LOCKING PLATES IN DISTAL TIBIA FRACTURES TREATMENT

    Directory of Open Access Journals (Sweden)

    Lokesh

    2016-05-01

    Full Text Available INTRODUCTION Most of these fractures except intra-articular fractures are treated with interlocking nail. 1,2 These nails are a boon for these fractures. But as the fracture nears to the joint stability the fracture fixation will be compromised due to malreduction and alignment, it leads to increased chances of delayed and nonunion. 3 Locking anatomical plates are evaluated for anatomical and relative stability fixation. Since then most intra and near intra-articular fractures are fixed with these plates with minimally invasive percutaneous plate osteosynthesis method, these plates have given excellent result 4 . But again these plates have some disadvantages 5 . This study is done to see the outcome of locking plates in distal tibia fracture. METHODS This study is done in the Department of Orthopaedics, Bangalore Medical College, Bangalore. This study is done from 2013 to 2015. 30 patients who came to outpatient department were treated with locking plates. All patients above 16 years having distal third tibia fracture are included. All open fractures except type 1 and elderly above 60 years and pathological fractures are excluded in our study. All patients were followed up for initial 5 months, thereafter, once in 3 months, for clinical and radiological evaluation of union status, knee range of motion, ankle range of motion and other complications. Assessment of the patient with functional recovery was done with American Orthopaedic Foot and Ankle Surgery(AOFAS 6 minimum 5 months after injury. RESULTS Majority of the patients are from age group 18-29 years (50%. Average age group was 30 years. Majority of the patients were males 80.6% (25. All fractures were closed fractures except 2 cases which are type 1. There were 12 cases of AO type A, 8 patients were AO type B and 10 patients were type C. Majority of the patients had fracture due to road traffic accidents, 74%. All fractures were united by the end of 20 weeks. There was delayed union in

  13. Distal vertebral artery reconstruction when managing vertebrobasilar insufficiency

    OpenAIRE

    D. M. Galaktionov; A. V. Dubovoy; K. S. Ovsyannikov

    2017-01-01

    This article presents a literature review devoted to the reconstruction of the distal vertebral artery and a clinical case of successful surgical treatment of a patient suffering from vertebrobasilar insufficiency caused by occlusion of the vertebral artery in a proximal segment. The external carotid artery-distal vertebral artery bypass was performed by using the radial artery.Received 27 February 2017. Revised 25 July 2017. Accepted 3 August 2017.Funding: The study did not have sponsorship....

  14. Pre-Liver Transplant: Tips Versus Distal Splenorenal Shunt

    Directory of Open Access Journals (Sweden)

    Thomas W. Faust

    1997-01-01

    Full Text Available Recurrent variceal bleeding in liver transplant candidates with end-stage liver disease can complicate or even prohibit a subsequent transplant procedure (OLT. Endoscopic sclero-therapy and medical therapy are considered as first-line management with surgical shunts reserved for refractory situations. Surgical shunts can be associated with a high mortality in this population and may complicate subsequent OLT. The transjugular intrahepatic portosystemic shunt (TIPS has been recommended in these patients as a bridge to OLT. This is a new modality that has not been compared with previously established therapies such as the distal splenorenal shunt (DSRS. In this study we report our experience with 35 liver transplant recipients who had a previous TIPS (18 patients or DSRS (17 patients for variceal bleeding. The TIPS group had a significantly larger proportion of critically ill and Child-Pugh C patients. Mean operating time was more prolonged in the DSRS group (P=0.014 but transfusion requirements were similar. Intraoperative portal vein blood flow measurements averaged 2132±725 ml/min in the TIPS group compared with 1120±351ml/min in the DSRS group (P<0.001. Arterial flows were similar. Mean ICU and hospital stays were similar. There were 3 hospital mortalities in the DSRS group and none in the TIPS group (P=0.1. We conclude that TIPS is a valuable tool in the management of recurrent variceal bleeding prior to liver transplantation. Intra0Perative hemodynamic measurements suggest a theoretical advantage with TIPS. In a group of patients with advanced liver disease we report an outcome that is similar to patients treated with DSRS prior to liver transplantation. The role of TIPS in the treatment of nontransplant candidates remains to be clarified.

  15. Update on the roles of distal airways in COPD

    Directory of Open Access Journals (Sweden)

    N. Roche

    2011-03-01

    Full Text Available This review is the summary of a workshop on the role of distal airways in chronic obstructive pulmonary disease (COPD, which took place in 2009 in Vence, France. The evidence showing inflammation and remodelling in distal airways and the possible involvement of these in the pathobiology, physiology, clinical manifestations and natural history of COPD were examined. The usefulness and limitations of physiological tests and imaging techniques for assessing distal airways abnormalities were evaluated. Ex vivo studies in isolated lungs and invasive measurements of airway resistance in living individuals have revealed that distal airways represent the main site of airflow limitation in COPD. Structural changes in small conducting airways, including increased wall thickness and obstruction by muco-inflammatory exudates, and emphysema (resulting in premature airway closure, were important determinants of airflow limitation. Infiltration of small conducting airways by phagocytes (macrophages and neutrophils, dendritic cells and T and B lymphocytes increased with airflow limitation. Distal airways abnormalities were associated with patient-related outcomes (e.g. dyspnoea and reduced health-related quality of life and with the natural history of the disease, as reflected by lung function decline and mortality. These data provide a clear rationale for targeting distal airways in COPD.

  16. Aquaporin-4 expression in distal myopathy with rimmed vacuoles.

    Science.gov (United States)

    Hoshi, Akihiko; Yamamoto, Teiji; Kikuchi, Saeko; Soeda, Tomoko; Shimizu, Keiko; Ugawa, Yoshikazu

    2012-04-27

    Distal myopathy with rimmed vacuoles/hereditary inclusion body myopathy is clinically characterized by the early involvement of distal leg muscles. The striking pathological features of the myopathy are muscle fibers with rimmed vacuoles. To date, the role of aquaporin-4 water channel in distal myopathy with rimmed vacuoles/hereditary inclusion body myopathy has not been studied. Here, we studied the expression of aquaporin-4 in muscle fibers of a patient with distal myopathy with rimmed vacuoles/hereditary inclusion body myopathy. Immunohistochemical and immunofluorescence analyses showed that sarcolemmal aquaporin-4 immunoreactivity was reduced in many muscle fibers of the patient. However, the intensity of aquaporin-4 staining was markedly increased at rimmed vacuoles or its surrounding areas and in some muscle fibers. The fast-twitch type 2 fibers were predominantly involved with the strong aquaporin-4-positive rimmed vacuoles and TAR-DNA-binding protein-43 aggregations. Rimmed vacuoles with strong aquaporin-4 expression seen in the distal myopathy with rimmed vacuoles/hereditary inclusion body myopathy patient were not found in control muscles without evidence of neuromuscular disorders and the other disease-controls. Aquaporin-4 might be crucial in determining the survival or degeneration of fast-twitch type 2 fibers in distal myopathy with rimmed vacuoles/hereditary inclusion body myopathy.

  17. Distal biceps brachii tendon rupture resulting in acute compartment syndrome.

    Science.gov (United States)

    Grandizio, Louis C; Suk, Michael; Feltham, Glen T

    2013-11-01

    Distal biceps brachii tendon rupture is an uncommon injury. Compartment syndrome of the upper arm is rarely described in the literature. The diagnosis of upper arm compartment syndrome requires a high index of suspicion, and emergent surgical treatment with fasciotomy in the acute setting is necessary to avoid devastating neurovascular complications. This article reports a case of acute compartment syndrome of the anterior compartment of the upper arm after a complete rupture of the distal biceps brachii tendon. A healthy 45-year-old man presented with increasing arm pain; paresthesia in the lateral antebrachial cutaneous nerve distribution; and a tense, swollen anterior compartment of his upper arm. Side port catheter absolute pressure measurement was 83 mm Hg with a diastolic blood pressure of 92 mm Hg. The patient underwent an emergent fasciotomy and was found to have a complete rupture of his distal biceps brachii tendon. He subsequently underwent distal biceps tendon repair and delayed primary closure of his incision. Postoperatively, his paresthesia improved and he has no neurological deficit. There is a paucity of case reports describing compartment syndrome after rupture of either the proximal or distal end of the biceps brachii tendon, and none of the reports describe compartment syndrome of the upper arm after rupture of the distal biceps tendon. This article highlights an unusual complication of an uncommon injury and reviews diagnostic and treatment principles for the management of acute compartment syndrome of the upper arm. Copyright 2013, SLACK Incorporated.

  18. Endovascular treatment for ruptured distal anterior inferior cerebellar artery aneurysm.

    Science.gov (United States)

    Oh, Jae-Sang; Yoon, Seok-Mann; Shim, Jai-Joon; Bae, Hack-Gun; Yoon, Il-Gyu

    2014-03-01

    A 42-year-old woman presented with Hunt and Hess grade (HHG) III subarachnoid hemorrhage (SAH) caused by a ruptured left distal anterior inferior cerebellar artery (AICA) aneurysm. Computed tomography showed a thin SAH on the cerebellopontine angle cistern, and small vermian intracerebral hemorrhage and intraventricular hemorrhage in the fourth ventricle. Digital subtraction angiography revealed the aneurysm on the postmeatal segment of left distal AICA, a branching point of rostrolateral and caudomedial branch of the left distal AICA. Despite thin caliber, tortuous running course and far distal location, the AICA aneurysm was obliterated successfully with endovascular coils without compromising AICA flow. However, the patient developed left side sensorineural hearing loss postoperatively, in spite of definite patency of distal AICA on the final angiogram. She was discharged home without neurologic sequela except hearing loss and tinnitus. Endovascular treatment of distal AICA aneurysm, beyond the meatal loop, is feasible while preserving the AICA flow. However, because the cochlear hair cell is vulnerable to ischemia, unilateral hearing loss can occur, possibly caused by the temporary occlusion of AICA flow by microcatheter during endovascular treatment.

  19. Biomechanical performance of flexible intramedullary nails with end caps tested in distal segmental defects of pediatric femur models.

    Science.gov (United States)

    Volpon, José Batista; Perina, Maurício Martins; Okubo, Rodrigo; Maranho, Daniel Augusto Carvalho

    2012-01-01

    Unstable distal femoral fractures in children are challenging lesions with restricted surgical options for adequate stabilization. Elastic nails have become popular for treating femoral shaft fractures, yet they are still challenging for using in distal fractures. The aim of this study was to test whether end caps (CAP) inserted into the nail extremity improved the mechanical stabilization of a segmental defect at the distal femoral metaphyseal-diaphyseal junction created in an artificial pediatric bone model. Two 3.5-mm titanium elastic nails (TEN) were introduced intramedullary into pediatric femur models, and a 7.0-mm-thick segmental defect was created at the distal diaphyseal-metaphyseal junction. Nondestructive 4-point bending, axial-bending, and torsion tests were conducted. After this, the end caps were inserted into the external tips of the nails and then screwed into the bone cortex. The mechanical tests were repeated. Stiffness, displacement, and torque were analyzed using the Wilcoxon nonparametric test for paired samples. In the combined axial-bending tests, the TEN+CAP combination was 8.75% stiffer than nails alone (Ptorsion tests, the TEN+CAP was 14% stiffer than nails alone (Pbending test did not show differences between the methods (P=0.91, stiffness; P=0.51, displacement). Thus, the end caps contributed to an increase in the construct stability for torsion and axial-bending forces but not for 4-point bending forces. These findings indicate that end caps fitted to elastic nails may contribute to the stabilization of fractures that our model mimics (small distal fragment, bone comminution, and distal bone fragment loss). Type II [therapeutic study: lesser-quality randomized controlled trial (eg, <80% follow-up, no blinding, or improper randomization)].

  20. Long Volar Plating for Metadiaphyseal Fractures of Distal Radius: Study Comparing Minimally Invasive Plate Osteosynthesis versus Conventional Approach.

    Science.gov (United States)

    Pire, Emilie; Hidalgo Diaz, Juan José; Salazar Botero, Santiago; Facca, Sybille; Liverneaux, Philippe A

    2017-08-01

    Background  Minimally invasive plate osteosynthesis (MIPO) has been used in wrist surgery for several years. The purpose of this retrospective study was to compare clinical and radiologic outcomes of MIPO technique with those of a conventional approach in the treatment of metadiaphyseal distal radius fracture by long volar plating. Materials and Methods  Our series consisted of 32 fractures in 31 patients, mean age 63.9 years, including 16 men and 15 women. MIPO technique was used in 15 wrists (group 1) and conventional approach (> 60 mm of skin incision) in 17 wrists (group 2). In group 1, a long volar plate was inserted under pronator quadratus through a 15- to 30-mm distal incision then fixed to the epiphysis of the distal radius. Then, through a 15- to 30-mm proximal incision, the plate was fixed to the diaphysis of the radius, thus reducing the fracture. Results  In group 1, mean distal incision size was 23.5 and 16.9 mm for proximal one. Mean total scar size (sum of both distal and proximal incisions) was 40.0 mm in group 1 and 84.1 mm in group 2. Mean tourniquet time was 58.4 minutes in group 1 and 68.9 minutes in group 2. At latest follow-up, no significant difference was noted in both the groups concerning pain, quick-DASH score, grip strength, ROM, and radiologic data. One extensor pollicis longus rupture treated by tendon transfer was done in group 1. Conclusion  The MIPO technique for metadiaphyseal fractures of the distal radius by long volar plating has cosmetic and economic advantages compared with the conventional approach. Conversion to conventional approach is possible at any time in case of technical difficulties. Level of Evidence  III.

  1. Complications of Elastic Stable Intramedullary Nailing for treating paediatric long bone fractures

    Science.gov (United States)

    Nisar, Aamer; Bhosale, Abhijit; Madan, Sanjeev S.; Flowers, Mark J.; Fernandes, James A.; Jones, Stanley

    2013-01-01

    This study reports the complications observed in children with long bone fractures treated using Elastic Stable Intramedullary Nailing (ESIN). One hundred and sixty-four (n = 164) fractures in 160 patients under the age of 16 years formed the basis of our review. This included 108 boys and 52 girls with the median age of 11 years and median follow up of 7.5 months. The analysis included fractures of the radius/ulna, humerus, femur and tibia. All pathological fractures were excluded. In this series 54 patients (34%) had complications however majority of these were minor complications with irritation due to prominent nail ends being the commonest complication. No long-term sequelae were encountered in our patients. PMID:24403743

  2. Outcome Assessment of Hybrid External Fixation in the Treatment of Comminuted Distal Femur and Proximal Tibial Fractures

    Directory of Open Access Journals (Sweden)

    Sarrafan

    2016-02-01

    Full Text Available Background Treatment of comminuted fractures of the distal femur and proximal tibia is difficult, and a challenge in the field of orthopedic trauma. Objectives The aim of this study was to assess the short-term results of hybrid external fixation in the treatment of these fractures. Patients and Methods In a prospective study, 44 patients with comminuted fractures of the distal femur or proximal tibia, with an overlying soft tissue injury treated by closed reduction and hybrid external fixation, were included. Parameters such as pin-track infection, union, limb shortening, knee motion, and alignment were evaluated during a mean follow-up period of 14 months. Results Forty-four patients with distal femoral (n = 23 and proximal tibial (n = 21 fractures were treated using hybrid external fixation. Bone union was seen in 35 (80% of the patients. Pin tract infection was seen in three patients (6.8%, one case (4.6% with a PTF and two cases (8% with DFFs. Malunion was observed in 4 patients (9.1%; of these, three cases (13% had DFF and one case (4.8% of pain was detected in the DFF group. One case had malunion and three cases had union. Findings showed satisfactory results in more than 80% of patients. In general, lower postoperative complications were detected in the proximal tibial fractures than the distal femoral fractures. According to a chi-square test, the difference between the patients with PTFs and those with DFFs was not clinically significant. Conclusions Closed reduction and hybrid external fixation can be used as a definitive treatment for severe comminuted fractures of the distal femur and proximal tibia, when the concomitant contusion of the skin and soft tissue damage prohibits safe open reduction and internal fixation.

  3. Evaluation of intravenous regional anaesthesia and four-point nerve block efficacy in the distal hind limb of dairy cows

    OpenAIRE

    Yavari, S.; Khraim, N.; Szura, G.; Starke, A.; Engelke, E.; Pfarrer, C.; Hopster, K.; Schmicke, M.; Kehler, W.; Heppelmann, M.; Kästner, S. B. R.; Rehage, J.

    2017-01-01

    Background Intravenous regional anaesthesia (IVRA) and hindfoot four-point nerve block anaesthesia (NBA) are recommended for local anaesthesia (LA) in the distal limb of dairy cows. Two studies were conducted to compare the efficacy, time until onset and stress responses to IVRA and NBA in dairy cows. In the first cross-over designed study, eight healthy unsedated German Holstein cows, restrained in lateral recumbency (LR) on a surgical tipping table, were treated with IVRA and NBA using proc...

  4. Reconstruction of Scaphoid Nonunion Fractures of the Proximal One Third With a Vascularized Bone Graft From the Distal Radius

    OpenAIRE

    Werdin, Frank; Jaminet, Patrick; Naegele, Beate; Pfau, Matthias; Schaller, Hans-Eberhard

    2014-01-01

    Objective: The treatment of proximal located scaphoid nonunion is a well-known and common problem. For these patients, we used a vascular pedicled bone graft of the distal radius. Methods: In the last 7 years, 75 patients were treated with the vascular pedicled bone graft. Retrospectively, patients’ data, healing rates, and factors influencing scaphoid healing were analyzed. Results: The overall healing rate in cases with proximal located nonunions (n = 54) was approximately 70%. Out of these...

  5. Comparison of bioabsorbable versus metallic implant fixation for physeal and epiphyseal fractures of the distal tibia.

    Science.gov (United States)

    Podeszwa, David A; Wilson, Philip L; Holland, Amy R; Copley, Lawson A B

    2008-12-01

    Transepiphyseal screw fixation of displaced distal tibial epiphyseal fractures is the most common method of treatment for these intraarticular injuries. Recent literature indicates that retained transepiphyseal metallic screws cause an increase in ankle joint contact pressure, thus favoring screw removal. Our hypothesis is that bioabsorbable screw fixation is an alternative to metallic fixation, which offers similar results without the need for screw removal. This is a retrospective review of distal tibial epiphyseal ankle fractures treated with screw fixation. Two groups, those treated with bioabsorbable screw fixation (group B, n = 24) and those with metallic screw fixation (group M, n = 26), were compared (t test) for differences in clinical and radiographic outcomes. Analysis of demographic data revealed no significant differences between groups for sex, ethnicity, age, and height. Group B was significantly heavier than group M (67.4 vs 55.6 kg; P = 0.0496). Each group had a similar number of Salter-Harris types III and IV medial malleolus fractures and transitional fracture types. There was no significant difference between groups in the time from injury to fixation or in operative time. Radiographically, there were no nonunions in either group, and at final follow-up, 1 patient in group B had distal tibial joint line irregularity versus 3 in group M. Clinically, there were no significant differences between groups in time to full weight bearing or time to full activities.There were fewer complications in group B. A single case of loss of reduction requiring revision fixation occurred in each group. There was one documented growth arrest in group M and 2 suspected growth arrests in each group. Two patients in group M were successfully treated for a superficial wound infection with oral antibiotics. Fourteen patients in group M underwent planned screw removal. Bioabsorbable screw fixation can be used for distal tibial epiphyseal fractures with no increase in

  6. [Treatment type C fracture of the distal radius with locking compression plate and external fixators].

    Science.gov (United States)

    Yang, Xiang; Zhao, You-ming; Chen, Lin; Ye, Cong-cong; Guo, Wei-jun; Wang, Bo

    2013-12-01

    To compare efficacy of unilateral external fixators and locking compression plates in treating type C fractures of the distal radius. From January 2009 to June 2010, 76 patients with distal radius fracture were treated with LCP and external fixators, 54 patients were followed up. Among them, 29 cases were male and 25 cases were female with an average age of 45.31 (ranged, 24 to 68) years old. There were 29 patients in LCP group. According to AO classification, 8 cases were type C1, 7 cases were type C2 and 14 cases were type C3. There were 25 cases in external fixators group. According to AO classification, 6 cases were type C1, 8 cases were type C2 and 11 cases were type C3. Radial height, volar tilt and radial inclination were compared, advanced Gartland-Werley scoring were used to assessed wrist joint function after 6 and 12 months' following up. Two cases were suffered from nail infection in external fixators group. Fifty-four patients were followed up from 12 to 24 months with an average of 21.3 months. Radial height was (9.60 +/- 0.72) mm, volar tilt was (9.55 +/- 0.80) degrees and radial inclination was (21.40 +/- 0.78) degrees in LCP group,while those were (9.40 +/- 0.70) mm, (9.47 +/- 0.71) degrees and (21.20 +/- 0.73) degrees in external fixtors group, and with no statistical significance (P>0.05). Advanced Gartland-Werley score after 6 months' following up was 3.31 +/- 1.17 in LCP group, 5.56 +/- 1.58 in external fixtors group, and with significant difference (t=-5.99,Pmeaning (t=-1.55, P>0.05). LCP and external fixtors can receive good curative effects in treating type C distal radius fracture, and LCP can obtain obviously short-term efficacy, while there is no significant difference between two groups in long-term results. For serious distal radius comminuted fracture which unable to plate internal fixation, external fixators is a better choice.

  7. [Iindividual choice of distal fibula internal fixation for ankle fractures in elderly].

    Science.gov (United States)

    Tang, Yang-Hua; Zeng, Lin-Ru; Xin, Da-Wei; Yue, Zhen-Shuang; Hu, Zhong-Qing; Xu, Can-da

    2016-12-25

    To explore individual choice and therapeutic effect of distal fibula internal fixation in treating ankle fractures in elderly. From May 2012 to April 2015, 68 elderly patients with ankle fractures were treated by surgical operation, included 37 males and 31 females with an average of 69.2 years old ranging from 62 to 81 years. According to Danis-Weber classification, there were 19 cases belong to type A, 31 cases belong to type B, and 18 cases belong to type C. According to Lange-Hanson classification, 22 cases were supinatio-extorsion, 18 were pronate-extorsion, 19 were supinatio-adduction, and 9 were pronate-abduction. All patients were performed individyually with different internal fixation methods for the treatment of distal fibula fracture according to different types of fracture. Clinical results were evaluated based on clinical examination, radiographic evaluation and AOFAS score. Twelve patients were treated with Herbert screw, 7 cases with Kirschner wire tension band, 5 cases with 1/3 tube plate, 6 cases with reconstruction plate, 17 cases with fibular end dissection steel plate composite, and 21 cases with distal fibula anatomic locking plate. All patients were followed up from 12 to 26 months with an average of 17.7 months. The operative incision of all patients were primary healed. And there was no bone nonunion, ankle instability, internal fixation loosening and fracture occurred. Fracture healing time ranged from 2.7 to 4 months with an average of 3.2 months, and had significant differences among different groups( P 0.05). Dorsal stretch was 6° to 18° with an average of 15°, plantar flexion ranged from 26°to 47° with an average of 37°. AOFAS score at the latest following-up was 88.4±4.3, 34 patients got an excellent result, 30 good and 4 fair. Good clinical results could be obtained by using individualized internal fixation for distal fibula fracture for the treatment of the ankle fractures in elderly.

  8. Tricky Treats

    Centers for Disease Control (CDC) Podcasts

    2008-08-04

    The Eagle Books are a series of four books that are brought to life by wise animal characters - Mr. Eagle, Miss Rabbit, and Coyote - who engage Rain That Dances and his young friends in the joy of physical activity, eating healthy foods, and learning from their elders about health and diabetes prevention. Tricky Treats shows children the difference between healthy snacks and sweet treats.  Created: 8/4/2008 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 8/5/2008.

  9. Giant cell tumor - distal end radius: Do we know the answer?

    Directory of Open Access Journals (Sweden)

    Panchwagh Yogesh

    2007-01-01

    Full Text Available Background: The distal end of the radius is one of the common sites of involvement in giant cell tumors (GCTs with reportedly increased propensity of recurrence. The objective of the present analysis was to study the modalities of management of the different types of distal end radius GCTs so as to minimize the recurrence rates and retain adequate function. Materials and methods: Twenty-four patients of distal end radius GCTs treated between January 2000 and December 2004 were retrospectively reviewed. Nineteen cases were available for follow-up with an average follow-up of 37.5 months. There was one Campanacci Grade 1 lesion, nine Grade 2 and 14 Grade 3 lesions. Thirteen (54% of these patients were treated elsewhere earlier and presented with recurrence. The operative procedures that were performed were: curettage and cementing (five, curettage and bone grafting (seven, excision and proximal fibular arthroplasty (two, excision and wrist arthrodesis (nine and excision of soft tissue recurrence (one. Results: Functional status was evaluated using Musculo Skeletal Tumor Society scoring system which averaged 78%. The recurrence rate was 32%. Complications included local recurrence (six, nonunion at the graft bone junction (one, infection (one, deformity (two, stiffness (two, subluxation (two and bony metastasis (one. Conclusions: The majority of patients undergoing curettage were either Campanacci Grade 1 or 2. Patients undergoing curettage and reconstruction had a better functional result (82% as compared to arthrodesis or fibular arthroplasty (69%. Previous intervention did not appear to increase the recurrence rates. Even though complications occur, judicious decision-making and an appropriate treatment plan can ensure a satisfactory outcome in the majority of cases.

  10. Biomechanical analysis of distal biceps tendon repair methods.

    Science.gov (United States)

    Henry, Jon; Feinblatt, Jeff; Kaeding, Christopher C; Latshaw, James; Litsky, Alan; Sibel, Roman; Stephens, Julie A; Jones, Grant L

    2007-11-01

    The 1-incision and 2-incision techniques are commonly used methods to repair a distal biceps rupture, and they differ in the location of reinsertion of tendon into bone. The native distal biceps brachii tendon inserts on the posterior-ulnar aspect of the bicipital tuberosity, which functions as a cam, increasing the tendon's moment arm during its principal action of forearm supination. Repair of the distal biceps tendon to the anterior aspect of the tuberosity compromises forearm supination due to absence of the bicipital tuberosity's cam effect. Controlled laboratory study. Eleven matched pairs of fresh-frozen cadaveric upper extremities were prepared for repair of the distal biceps tendon using either anterior or posterior reattachment with transosseous suture fixation. Specimens were tested on a materials testing machine with intact distal biceps insertion and after repair. A load cell at the distal radial-ulnar joint measured resultant elbow flexion and forearm supination torque produced by 100-N force applied to the proximal aspect of the tendon. Although there was a trend (P= .104) toward loss of supination torque with the anterior reconstruction method, no significant differences in torque (0.80 vs 0.89 N.m) or flexion force (11.87 vs 12.07 N) were found between the anterior and posterior reconstruction techniques. There is no statistically significant difference in flexion force or supination torque between the anterior and posterior reconstruction techniques. This study supports existing limited clinical data suggesting no functional differences exist between 2 common repair methods. Further biomechanical and clinical investigations directly comparing the results of distal biceps tendon repairs made to the anterior aspect versus the posterior aspect of the tuberosity are necessary to definitely determine if differences exist in resultant elbow flexion and forearm supination functions.

  11. Isolated Late Metastasis of a Renal Cell Cancer Treated by Radical Distal Pancreatectomy

    Directory of Open Access Journals (Sweden)

    J. P. Barras

    1996-01-01

    Full Text Available A 53–year-old man underwent right nephrectomy for a locally advanced renal cell carcinoma with concomitant resection of a solitary metastasis in the right lung. Ten years later, he presented with haematochezia caused by a tumour in the tail of pancreas, invading the transverse colon and the greater curvature of the stomach. The tumour was radically resected, and histological examination revealed a solitary metastasis of the previous renal cell carcinoma. This case illustrates a rare indication for pancreatic resection because of pancreatic metastasis.

  12. Successful use of continuous vasodilator infusion to treat critical vasospasm threatening a distal bypass

    OpenAIRE

    Gregory A. Magee, MD, MSc; Anastasia Plotkin, MD; Jeniann A. Yi, MD, MS; Kathryn E. Bowser, MD; David P. Kuwayama, MD, MPA

    2018-01-01

    Vasospasm immediately after lower extremity arterial bypass may represent an uncommon cause of early graft failure. We report a successful case of catheter-directed, intra-arterial continuous vasodilator infusion to salvage a bypass graft threatened by severe, refractory vasospasm after incomplete response to nicardipine, verapamil, and nitroglycerin boluses. A continuous nitroglycerin infusion was administered for 24 hours, by which time the vasospasm resolved. At 12 months postoperatively, ...

  13. Ex-vivo release of Pipeline Embolization Device polytetrafluoroethylene (PTFE) sleeves for improved distal landing zone accuracy in-vivo: A technical note.

    Science.gov (United States)

    Griessenauer, Christoph J; Gupta, Raghav; Moore, Justin; Thomas, Ajith J; Ogilvy, Christopher S

    2016-12-01

    Distal landing zone accuracy is critical in some intracranial aneurysms treated with the Pipeline Embolization Device (PED), and delayed opening of the distal end of the device can complicate the procedure. Here, we report a technical nuance that facilitates accurate placement of the distal end of the PED by ex-vivo, pre-implantation release of the PED Flex polytetrafluoroethylene (PTFE) sleeves. The PED Flex is partially pushed out of the introducer sheath ex-vivo, pre-implantation until the distal PED opens entirely and the PTFE sleeves are located distal to the device. Without inverting the PTFE sleeves, the PED is carefully pulled back into the introducer sheath placing the PTFE sleeves inside the device. The PED is loaded into the microcatheter and advanced toward the site of implantation. When the PED is initially deployed and pushed out of the microcatheter, it opens immediately and provides an anchor for the remainder of the deployment process. We present a video (supplementary material) that illustrates the technique along with an illustrative case. Ex-vivo, pre-implantation release of the PTFE sleeves is an option in aneurysm treatment where distal landing accuracy is critical. Even without the protection of the PTFE sleeves, our clinical observation shows that the PED can be advanced safely through the microcatheter in selected cases. © The Author(s) 2016.

  14. Treatment of humeroulnar subluxation with a dynamic proximal ulnar osteotomy: a review of 13 cases

    International Nuclear Information System (INIS)

    Gilson, S.D.; Piermattei, D.L.; Schwarz, P.D.

    1989-01-01

    Humeroulnar subluxation was treated surgically in 13 dogs with 18 affected elbows using a proximal osteotomy of the ulna that allowed the ulna to elongate dynamically. Distal humeroulnar subluxation was secondary to premature closure of the distal ulnar physis in 16 elbows. One distal subluxation was secondary to a radioulnar synostosis, and one proximal subluxation developed after premature closure of the distal radial physis. The mean follow-up time was 22 months. Twenty-eight percent of the elbows were judged to have excellent results, 22% good results, 50% fair results, and none was judged to have a poor outcome. The presenting lameness grade and the severity of preoperative and postoperative humeroulnar subluxation had significant correlations with the prognosis. Associated orthopedic abnormalities and complications of concurrent surgical procedures affected the outcome in several dogs. Overall, the dynamic proximal ulnar osteotomy was a simple and effective technique for the treatment of uncomplicated humeroulnar subluxation

  15. A New Orthodontic Appliance with a Mini Screw for Upper Molar Distalization.

    Science.gov (United States)

    Ozkalayci, Nurhat; Yetmez, Mehmet

    2016-01-01

    The aim of this study is to present a new upper molar distalization appliance called Cise distalizer designed as intraoral device supported with orthodontic mini screw for upper permanent molar distalization. The new appliance consists of eight main components. In order to understand the optimum force level, the appliance under static loading is tested by using strain gage measurement techniques. Results show that one of the open coils produces approximately 300 gr distalization force. Cise distalizer can provide totally 600 gr distalization force. This range of force level is enough for distalization of upper first and second molar teeth.

  16. A New Orthodontic Appliance with a Mini Screw for Upper Molar Distalization

    Directory of Open Access Journals (Sweden)

    Nurhat Ozkalayci

    2016-01-01

    Full Text Available The aim of this study is to present a new upper molar distalization appliance called Cise distalizer designed as intraoral device supported with orthodontic mini screw for upper permanent molar distalization. The new appliance consists of eight main components. In order to understand the optimum force level, the appliance under static loading is tested by using strain gage measurement techniques. Results show that one of the open coils produces approximately 300 gr distalization force. Cise distalizer can provide totally 600 gr distalization force. This range of force level is enough for distalization of upper first and second molar teeth.

  17. Shock wave lithotripsy versus ureteroscopy for distal ureteral calculi: a prospective study.

    Science.gov (United States)

    Honeck, P; Häcker, A; Alken, P; Michel, M S; Knoll, T

    2006-06-01

    We performed a prospective, non-randomised study to determine the appropriate first-line treatment modality for distal ureteral stones. Between 2003 and 2004, a total of 124 patients with distal ureteral calculi were entered into the study (mean age 48 years, 35 women and 99 men). Sixty-two patients were treated with shock wave lithotripsy (SWL) and 62 patients with ureteroscopy (URS). The average stone size was 6.9 mm (3-33 mm) for SWL and 7.2 mm (3-30 mm) for URS. The treatment decision depended on the patients' preference and clinical parameters (i.e. contraindications for anaesthesia). URS was performed under general anaesthesia, using semirigid 8 Fr instruments. SWL was performed under analgo-sedation using a Modulith SLX. Of patients treated with SWL, 84% had a treatment success within 7 days, 98% after URS. These results show a significant success (P=0.005) in favour of URS. The average in-patient stay after SWL was 3 days and for URS 4 days (not significant). The results show a high efficacy and a low complication rate for both modalities. The attained stone-free rate shows a significant advantage for primary URS.

  18. Proximal to distal approach in the treatment of tandem occlusions causing an acute stroke.

    Science.gov (United States)

    Spiotta, Alejandro M; Lena, Jonathan; Vargas, Jan; Hawk, Harris; Turner, Raymond D; Chaudry, M Imran; Turk, Aquilla S

    2015-03-01

    A tandem occlusion is a rare presentation of acute stroke that involves an occlusion of the internal carotid artery at the bifurcation with an intracranial middle cerebral artery occlusion. This study describes the experience at our institution in treating tandem occlusions with a proximal to distal approach in the acute stroke setting. A retrospective review of acute strokes caused by tandem occlusions requiring thrombectomy were performed. 16 cases were identified with a mean National Institutes of Health Stroke Scale score at presentation of 13.1 ± 3.9. The proximal occlusion was crossed initially with a microwire in all cases. All carotid occlusions were treated with stenting, and intracranial vessel thrombectomy was performed with a variety of devices. Procedure related complications occurred in two (12.5%) patients. Eight patients (50%) achieved a good outcome (modified Rankin Scale score of 0-2). A tandem occlusion of the carotid artery at the bifurcation with a concomitant intracranial occlusion is a relatively rare and complex presentation of acute stroke. We have found that addressing the proximal lesion first and covering it with a stent prior to performing distal thrombectomy appears to be a safe and effective option in the treatment algorithm. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  19. Distal tibial fractures are a poorly recognised complication with fibula free flaps.

    Science.gov (United States)

    Durst, A; Clibbon, J; Davis, B

    2015-09-01

    The fibula free flap is ideal for complex jaw reconstructions, with low reported donor and flap morbidity. We discuss a distal tibial stress fracture two months following a vascularised fibula free flap procedure. Despite being an unrecognised complication, a literature review produced 13 previous cases; only two were reported in the reconstructive surgery literature, with the most recent claiming to be the first. The majority of these studies treated this fracture non-operatively; none reported their patient follow-up. Each case presented with ipsilateral leg pain, which has been cited as an early donor site morbidity in as many as 40% of fibula free flap cases. It is known that the fibula absorbs at least 15% of leg load on weight bearing. Studies have shown severe valgus deformities in up to 25% of patients with fibulectomies. We treated our patient operatively, first correcting his worsening valgus deformity with an external fixator, then reinforcing his healed fracture with a long distal tibial plate. We believe that this complication is underreported, unexpected and not mentioned during the consenting process. By highlighting the management of our case and the literature, we aim to increase awareness (and thus further reporting and appropriate management) of this debilitating complication.

  20. Bovine Serum Albumin-Glutaraldehyde Sealed Fish-Mouth Closure of the Pancreatic Remnant during Distal Pancreatectomy

    Directory of Open Access Journals (Sweden)

    Fritz Klein

    2017-01-01

    Full Text Available Introduction. Postoperative pancreatic fistula formation remains the major complication after distal pancreatectomy. At our institution, we have recently developed a novel bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure technique of the pancreatic remnant during distal pancreatectomy. The aim of this study was to analyze the impact of this approach with regard to technical feasibility and overall postoperative outcome. Patients and Methods. 32 patients who underwent a bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure of the pancreatic remnant during distal pancreatectomy between 2012 and 2014 at our institution were analyzed for clinically relevant postoperative pancreatic fistula formation (Grades B and C according to ISGPF definition and overall postoperative morbidity. Results. Three out of 32 patients (9.4% developed Grade B pancreatic fistula, which could be treated conservatively. No Grade C pancreatic fistulas were observed. Postpancreatectomy hemorrhage occurred in 1 patient (3.1%. Overall postoperative complications > Clavien II were observed in 5 patients (15.6%. There was no postoperative mortality. Conclusion. The performance of a bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure of the pancreatic remnant was shown to be technically feasible and may lead to a significant decrease of postoperative pancreatic fistula formation after distal pancreatectomy.

  1. Outcomes and complications of fractures of distal radius (AO type B and C): volar plating versus nonoperative treatment.

    Science.gov (United States)

    Sharma, Himanshu; Khare, Ghanshyam Narayan; Singh, Saurabh; Ramaswamy, Arun Govindraj; Kumaraswamy, Vinay; Singh, Ashutosh Kumar

    2014-07-01

    Management of AO type B and C fractures of the distal radius is controversial. This study compares outcomes and complications of AO type B and C fractures of the distal radius treated with volar locked plating and nonoperative methods. Sixty-four patients with fractures of the distal radius (AO type B and C) were included in this study, according to inclusion criteria, and were allocated to the volar plating group or nonoperative group by alternate randomization: 32 patients with odd numbers went into the nonoperative group and the other 32 with even numbers went into the volar plating group. Patients in the nonoperative group were managed with closed reduction of the fracture and plaster cast application under an image intensifier. Those in the volar plating group were managed by open reduction and fixation with a volar locked plate. Preoperative and postoperative serial clinico-radiological follow-up was done. The range of movement, grip strength, functional outcome scores and radiological parameters were compared. Student's t-test was used for statistical analysis with significance at p AO type B or C fractures of the distal radius, volar locked plating provides anatomical stable fixation and early mobilization with better clinico-radiological outcome as compared to conservative treatment.

  2. Novel management of distal tibial and fibular fractures with Acumed fibular nail and minimally invasive plating osteosynthesis technique

    Science.gov (United States)

    Wang, Tie-Jun; Ju, Wei-Na; Qi, Bao-Chang

    2017-01-01

    Abstract Rationale: Anatomical characteristics, such as subcutaneous position and minimal muscle cover, contribute to the complexity of fractures of the distal third of the tibia and fibula. Severe damage to soft tissue and instability ensure high risk of delayed bone union and wound complications such as nonunion, infection, and necrosis. Patient concerns: This case report discusses management in a 54-year-old woman who sustained fractures of the distal third of the left tibia and fibula, with damage to overlying soft tissue (swelling and blisters). Plating is accepted as the first choice for this type of fracture as it ensures accurate reduction and rigid fixation, but it increases the risk of complications. Diagnosis: Closed fracture of the distal third of the left tibia and fibula (AO: 43-A3). Interventions: After the swelling was alleviated, the patient underwent closed reduction and fixation with an Acumed fibular nail and minimally invasive plating osteosynthesis (MIPO), ensuring a smaller incision and minimal soft-tissue dissection. Outcomes: At the 1-year follow-up, the patient had recovered well and had regained satisfactory function in the treated limb. The Kofoed score of the left ankle was 95. Lessons: Based on the experience from this case, the operation can be undertaken safely when the swelling has been alleviated. The minimal invasive technique represents the best approach. Considering the merits and good outcome in this case, we recommend the Acumed fibular nail and MIPO technique for treatment of distal tibial and fibular fractures. PMID:28328865

  3. The effect of select pulp cavity conditions on stress field development in distal abutments in two types of fixed dental prostheses.

    Science.gov (United States)

    Manda, Mirianthi; Galanis, Christos; Venetsanos, Dimitrios; Provatidis, Christofer; Koidis, Petros

    2011-01-01

    Insufficient coronal tooth structure may require restoration of endodontically treated (ET) teeth with cast posts and cores (CPCs). The prognosis for these teeth is a matter of scientific debate, especially if they serve as distal abutments in cantilever fixed dental prostheses (FDPs). The purpose of this study was to study stress field development in distal abutments in two types of FDPs with different pulp cavity conditions. The methodology involved the development of four digital models in which the right mandibular premolars were splinted via an FDP with: (1) no cantilever and a vital distal abutment, (2) no cantilever and an ET CPC distal abutment, (3) a single-unit cantilever and a vital distal abutment, and (4) a single-unit cantilever with an ET CPC distal abutment. The models were analyzed using a three-dimensional finite element program, and von Mises stress values and patterns were evaluated. The results revealed that although the stress distribution patterns in dentin were dissimilar, the von Mises stress values registered for the vital and ET CPC distal abutment were not considerably different. However, higher stress values were detected in the dentin area surrounding the post-gutta-percha interface after CPC placement. The addition of the cantilever resulted in a considerable increase in stress on the dental tissue structures. CPCs appear to create a risk of potential fracture that is initiated in the dentin at the apex of the post. The type of restoration appears to have a much more serious impact on the stress pattern developed in the distal abutment, and the addition of a cantilever appears to biomechanically compromise both biologic and restorative structures.

  4. Recurrent Giant cell tumour in distal Humerus: A Case report

    Directory of Open Access Journals (Sweden)

    Y Bhanu Rekha

    2013-07-01

    Full Text Available Introduction: Giant cell tumour of bone (GCT is a common benign primary bone tumour, seen commonly in the distal Femur, proximal Tibia and distal Radius. Very few cases of GCT are reported in distal humerus. We report an unusual presentation of recurrent Giant cell tumour in a 25 year old male in the medial condyle and epicondyle of left Humerus. Case Report: Patient presented elsewhere with lytic lesion of left elbow three years ago. As it is an uncommon site for tumors, it was misdiagnosed as tuberculous osteomyelitis and was inadequately curetted. Patient presented to us with recurrence of tumor one year after the primary surgery. We did en-bloc resection of the tumour, with judicious removal of partial trochlea. Though reconstruction was planned, it was found to be not necessary as the elbow was stable per-operatively. Patient regained near normal movements of the elbow with no instability. His Mayo Elbow Performance score improved from 30 to 85.There is no recurrence or metastasis of the tumor in the two-year follow-up. Conclusion: Though bone tumors are rare in distal Humerus, biopsy is needed to confirm the diagnosis of any lytic lesion in this region for proper management. Keywords: Recurrent Giant cell tumor, resection of GCT, GCT distal Humerus.

  5. Optimal location of a single distal interlocking screw in intramedullary nailing of distal third femoral shaft fractures.

    Science.gov (United States)

    George, C J; Lindsey, R W; Noble, P C; Alexander, J W; Kamaric, E

    1998-05-01

    This biomechanical study was done to determine the effect of the level of a single distal screw in a static intramedullary (IM) femoral nail on the stability of fixation of a fracture in the distal third of the femur. Fifteen composite fiberglass femora were osteotomized transversely in the distal third of the femur. A Grosse-Kempf nail was implanted into the femurs, which were divided into three groups of five specimens. Single screw distal nail locking was varied distal to the osteotomy site for each group at 2.5, 5.0, and 7.5 centimeters, respectively. All instrumented femurs were mounted on a servohydraulic testing machine and fitted with transducers to measure axial, rotational, and bending displacements. Specimens were cyclically loaded (one hertz) in simultaneous torsion (moment: +/- 10 newton-meters) and axial compression (amplitude: 2,000 newtons) for 500 cycles with a 250-pound abductor force. Data from linear and rotational transducers were sampled at 100 hertz for five cycles before cycling, every 100 cycles of loading, and immediately after cycling. Custom computer software was developed to convert transducer signals into static and dynamic measurements of axial motion (in millimeters), rotation (in degrees), and angulation (in degrees). Osteotomy site dynamic rotation increased significantly in specimens locked at 7.5 centimeters when compared with the 2.5-centimeter group. There was minimal difference between the stability of the 5.0-centimeter and 7.5-centimeter groups. There was no significant change in position at the fracture site before or after cyclic loading with respect to axial shortening, rotation, or bending. Both dynamic axial and angular displacements were also unaffected by screw position. The location of a single distal interlocking screw in static IM nail fixation of distal third femur fractures can significantly affect rotational stability but not axial or angular fixation.

  6. Commentary on Kataoka et al. Palmar reconstruction of the triangular fibrocartilage complex for instability of the distal radioulnar joint: a biomechanical study

    NARCIS (Netherlands)

    Bentohami, A.; Bijlsma, T. S.; Goslings, J. C.; de Reuver, P.; Kaufmann, L.; Schep, N. W. L.

    2013-01-01

    The purpose of this study was to assess the association between arm-specific disability measured with the QuickDASH questionaire and radiological criteria in patients with extra-articular distal radial fractures. A consecutive series of 385 patients were initially treated non-operatively for an

  7. [Repair of distal biceps brachii tendon rupture: a case report].

    Science.gov (United States)

    Oztürk, Kahraman; Sahin, Vedat

    2002-01-01

    The rupture of the distal tendon of the biceps brachii muscle is a rarely encountered injury, causing flexion and supination losses. There are literature reports giving good results with the use of two-incision technique that fixes the distal biceps brachii tendon to the radial tuberosity. We used this technique in a 49-year-old male patient who had had left distal tendinous rupture of the biceps brachii muscle caused by lifting heavy weight. Functional evaluation at the end of 16 months with the use of the Cybex 350 test machine showed normal range of motions for flexion and extension in the left elbow. There was a 25 percent loss of strength and 5 percent loss of endurance in flexion, and 11 percent loss of endurance in pronation. No complications were observed and a very good functional result was achieved.

  8. Surgical Management of Fossa Navicularis and Distal Urethral Strictures.

    Science.gov (United States)

    Daneshvar, Michael; Hughes, Michael; Nikolavsky, Dmitriy

    2018-04-17

    Urethral reconstruction has evolved in the last several decades with the introduction of various techniques including fasciocutaneous skin flaps and buccal mucosal grafts. However, distal urethral strictures have continued to be a reconstructive challenge due to tendency for adverse cosmetic outcomes, risks of glans dehiscence or fistula formation, and stricture recurrence. The surgical options for treatment of distal urethral strictures have changed throughout the years; however, there is no one universally accepted technique for their treatment. The current trend for treatment is shifting away from multi-staged procedures or the use of local skin flaps to single-stage transurethral procedures that utilize buccal mucosa with glans preservation. This chapter will describe the evolution of distal urethral stricture treatments tracking gradual improvements and modifications over time. The different interventions include transurethral approaches, such as dilations and visual urethrotomy, meatotomy, and meatoplasty/urethroplasty techniques including genital skin flaps and single- and double-stage repairs with buccal mucosal grafts.

  9. Distal mycotic aneurysm of the AICA mimicking intracanalicular acoustic neuroma.

    Science.gov (United States)

    DiMaio, Salvatore; Mohr, Gérard; Dufour, Jean-Jacques; Albrecht, Steffan

    2003-11-01

    Among cases of cerebellopontine angle lesions, vascular lesions involving the internal auditory canal are extremely rare. We report a distal fusiform mycotic pseudoaneurysm of the anterior inferior cerebellar artery (AICA) that simulated an acoustic neuroma on presentation. A 60-year-old woman was investigated for recent onset of acute dizziness. Laboratory and radiographic investigations are presented, as well as the surgical management of the patient and pathological examination of the aneurysm. An exceptionally rare case of distal mycotic intracanalicular pseudoaneurysm of the AICA with intraluminal thrombus and fusiform anatomy is described. In our review of the literature (1966-present), only five other intracanalicular AICA-aneurysms were encountered, none of which were infectious in etiology. The possible pathophysiologic mechanisms of distal AICA-aneurysms are discussed along with the currently available literature.

  10. Evaluation of intravenous regional anaesthesia and four-point nerve block efficacy in the distal hind limb of dairy cows.

    Science.gov (United States)

    Yavari, S; Khraim, N; Szura, G; Starke, A; Engelke, E; Pfarrer, C; Hopster, K; Schmicke, M; Kehler, W; Heppelmann, M; Kästner, S B R; Rehage, J

    2017-11-07

    Intravenous regional anaesthesia (IVRA) and hindfoot four-point nerve block anaesthesia (NBA) are recommended for local anaesthesia (LA) in the distal limb of dairy cows. Two studies were conducted to compare the efficacy, time until onset and stress responses to IVRA and NBA in dairy cows. In the first cross-over designed study, eight healthy unsedated German Holstein cows, restrained in lateral recumbency (LR) on a surgical tipping table, were treated with IVRA and NBA using procaine 2% as a local anaesthetic. Distal limb desensitization was tested by electrical (e-), mechanical (m-) and thermal (t-) nociceptive stimulation 10 min before and 15 and 30 min after LA. Hormonal-metabolic (blood concentrations of cortisol, lactate, non-esterified fatty acids, and glucose) and cardio-respiratory (heart and respiratory rate, mean arterial blood pressure) stress responses to treatment were assessed at predetermined intervals. In the second study, six healthy, unsedated German Holstein cows in LR were treated (crossover design) with IVRA and NBA. Short-interval e-stimulation was measured by the time until complete distal limb desensitization. In the first study, four of eight cows responded to e-stimulation 15 min after IVRA, while none of the cows treated with NBA responded until the safety cut-off level was reached. E-stimulation revealed complete desensitization of the distal limb 30 min after LA in all cows. Half of the cows did not respond to m- and t-stimulation before LA, so no further evaluation was performed. Stress reactions to IVRA and NBA treatment were similar, but differences may have been masked by stress response to LR restraint. In the second study, complete desensitization was achieved 12.5 min after NBA, while one of the six cows still responded to e-stimulation 20 min after IVRA. Hindfoot nerve block anaesthesia and intravenous regional anaesthesia induced complete desensitization of the distal hind limb in dairy cows. However, the anaesthesia

  11. STUDY OF FUNCTIONAL OUTCOME OF DISTAL FEMORAL FRACTURES MANAGED WITH LOCKING COMPRESSION PLATE

    Directory of Open Access Journals (Sweden)

    Majji Chandrasekharam Naidu

    2017-12-01

    Full Text Available BACKGROUND We reviewed a series of 30 displaced supracondylar and intercondylar fractures of the distal end of the femur that were treated over a 2 years period by open reduction and internal fixation using the distal femur LCP. A strict rating scale incorporating subjective data and objective motion of the involved knee was used for the results. At a mean follow-up of 2 years, the results in 8 patients were rated excellent, the results in 12 were rated as good, the results in 4 as fair and the results in 1 as poor. Complications were found in 2 patients (6.66%. Complications included postoperative osteomyelitis in one and superficial infection and wound haematoma in one patient. MATERIALS AND METHODS In this study, we have included consecutive 30 supracondylar and intercondylar fractures of femur (both Muller’s type ‘A’, type ‘B’ and type ‘C’ fractures and treated with open reduction and internal fixation by locking compression plate in the Department of Orthopaedics, ACSR GMC, Nellore, from August 2015 to November 2017. RESULTS At a mean follow-up of 2 years, the results in 8 patients were rated excellent, the results in 12 were rated as good, the results in 4 as fair and the results in 1 as poor. Complications were found in 2 patients (6.66%. Complications included postoperative osteomyelitis in one and superficial infection and wound haematoma in one patient. CONCLUSION The goals of treatment are anatomic reduction of the articular surface, restoration of limb alignment, length and rotation and stable fixation that allows for early mobilisation. Nonetheless, internal fixation of the distal femur can be difficult for several reasons- thin cortices, a wide medullary canal, compromised bone stock and fracture comminution that make stable internal fixation often difficult to achieve.3,4 Although, better methods of fixation have dramatically improved clinical results, the operative management of these difficult fractures is not

  12. Clinical and Radiographic Results of Reconstruction with Fibular Autograft for Distal Radius Giant Cell Tumor.

    Science.gov (United States)

    Qi, Dian-Wen; Wang, Peng; Ye, Zhao-Ming; Yu, Xiu-Chun; Hu, Yong-Cheng; Zhang, Guo-Chuan; Yan, Xiao-Bo; Zheng, Kai; Zhao, Li-Ming; Zhang, Hui-Lin

    2016-05-01

    To evaluate the result of en bloc resection and reconstruction of the distal radius with a non-vascularized fibular autograft for giant cell tumor (GCT) of bone. Between 2005 and 2015, 12 eligible patients (seven males, five females, mean age 31.3 years) with grade III GCT of the distal radius were treated by en bloc resection and reconstruction with non-vascularized proximal fibular autografts in four Chinese institutions (members of Giant Cell Tumor Team of China). The patients had a clinical and radiographic review every 6 months for the first 2 years then annually thereafter. The functional, oncologic and radiological outcomes of the patients were analyzed. The mean duration of follow-up was 39.6 months. Bony union was achieved in all cases. None of the patients were dissatisfied with the shape and appearance of the wrist. The mean MSTS score was 25.23 ± 2.38 (range, 22-29). The mean DASH score was 13.0 (range, 6.7-33.3). The average range of motion of the wrist was: 35.8° ± 14.5° of extension, 14.0° ± 8.4° of flexion, 15.5° ± 6.7° of radial deviation, 19.4° ± 10.1° of ulnar deviation, 57.2° ±18.9° of pronation and 44.0° ± 24.8° of supination. The average percentage of grip strength was 55.2% ± 29.0% compared with that of the contralateral side. One localized soft tissue recurrence occurred; it was successfully managed by excision. Lung metastases developed postoperatively in one case and were treated by gamma knife radiotherapy. There was radiographic evidence of radiocarpal arthritis in eleven patients, bone resorption in ten, distal radioulnar joint diastasis in six, ulnar deviation of the wrist in seven, subluxation of the carpal bone in three and dislocation of the carpal bone in one patient. Reconstruction with a non-vascularized proximal fibular autograft is a reasonable option after en bloc resection of the distal radius for giant cell tumor of bone. © 2016 Chinese Orthopaedic Association and John

  13. Minimally Invasive Distal Pancreatectomy: Review of the English Literature.

    Science.gov (United States)

    Wang, Kai; Fan, Ying

    2017-02-01

    Recently, the superiority of the minimally invasive approach, which results in a better cosmetic result, faster recovery, and shorter length of hospital stay, is a technique that has been progressively recognized as it has developed. And the minimally invasive approach has been applied to distal pancreatectomy (DP), which is a standard method for the treatment of benign, borderline, and part of malignant lesions of the pancreatic body and tail. This article aims to analyze the types, postoperative recovery, and outcomes of laparoscopic distal pancreatectomy (LDP). A systematic search of the scientific literature was performed using PubMed, EMBASE, online journals, and the Internet for all publications on LDP. Articles were selected if the abstract contained patients who underwent LDP for pancreatic diseases. All selected articles were reviewed and analyzed. If there were no contraindications for LDP, this operation is suitable for benign, borderline, or malignant tumors of the pancreatic body and tail, which should try to be performed with preservation of the spleen. LDP is safe and feasible under some conditions to experienced surgeon. Single-incision laparoscopic distal pancreatectomy (S-LDP) and robotic laparoscopic distal pancreatectomy (R-LDP) perioperative outcomes are similar with conventional multi-incision laparoscopic distal pancreatectomy (C-LDP). And the advantages of S-LDP and R-LDP require further exploration. With the application of enhanced recovery program (ERP), length of hospital stay and costs are reduced. LDP is safe and feasible under some conditions. Compared with open distal pancreatectomy, LDP has a lot of advantages; a trend was observed for LDP to replace traditional open surgery. LDP combined with ERP is expected to become standard in the treatment of pancreatic body and tail lesions.

  14. Current concepts in the treatment of distal radial fractures.

    Science.gov (United States)

    Ruch, David S; Weiland, Andrew J; Wolfe, Scott W; Geissler, William B; Cohen, Mark S; Jupiter, Jesse B

    2004-01-01

    Surgical indications for the treatment of distal radial fractures are evolving. It is important to identify the various articular fragments and their significance to facilitate optimal surgical treatment of these fragments from the standpoint of both internal and external fixation. New techniques in the visualization and stabilization of the articular surface and the treatment of defects in the metaphysis, including the use of cement to buttress the articular surface, have been brought to the forefront. A treatment algorithm for associated injuries to the distal radioulnar joint is also helpful.

  15. Neglected Distal Humeral Epiphyseal Injury - Two Case Reports

    Directory of Open Access Journals (Sweden)

    Dr. Pankaj Kumar

    2008-07-01

    Full Text Available Distal humeral epiphyseal separation is an uncommon injury in children, which can be missed or misdiagnosed at initial presentation. Awareness of this injury and appropriate radiological assessment helps in proper management. Neglected cases because of inappropriate diagnosis can result in cubitus varus deformity. Full range of movements of elbow can be achieved if properly diagnosed and managed. We present two cases of neglected distal humeral epiphyseal injury in children that resulted in cubitus varus deformity in one case. Full range of movements was achieved in both cases after proper management.

  16. Galeazzi fracture with volar dislocation of the distal radioulnar joint.

    Science.gov (United States)

    Kim, Suezie; Ward, James P; Rettig, Michael E

    2012-11-01

    Galeazzi fracture dislocations are fractures of the distal one-third of the radial diaphysis with traumatic disruption of the distal radioulnar joint (DRUJ). This injury results in subluxation or dislocation of the ulnar head. We present a case of a Galeazzi fracture with a volar dislocation of the DRUJ. Open reduction of the DRUJ with Kirschner wire fixation in pronation was necessary to reduce the joint and maintain anatomic alignment. Repair of the triangular fibrocartilage complex was also necessary to maintain stability of the DRUJ.

  17. Traumatisk distal humerus-epifysiolyse hos nyfødt

    DEFF Research Database (Denmark)

    Al-Aubaidi, Zaid; Nielsen, Keld Daubjerg

    2010-01-01

    Traumatic distal humerus epiphysiolysis (TDHE) is a rare injury in infants with an incidence of about 1:35,000 births. It is primarily a birth injury, but it is also seen in cases of battered child syndrome. Because of its rare occurrence and the diagnostic difficulties, the lesion may be overloo......Traumatic distal humerus epiphysiolysis (TDHE) is a rare injury in infants with an incidence of about 1:35,000 births. It is primarily a birth injury, but it is also seen in cases of battered child syndrome. Because of its rare occurrence and the diagnostic difficulties, the lesion may...

  18. Distal vertebral artery reconstruction when managing vertebrobasilar insufficiency

    Directory of Open Access Journals (Sweden)

    D. M. Galaktionov

    2017-11-01

    Full Text Available This article presents a literature review devoted to the reconstruction of the distal vertebral artery and a clinical case of successful surgical treatment of a patient suffering from vertebrobasilar insufficiency caused by occlusion of the vertebral artery in a proximal segment. The external carotid artery-distal vertebral artery bypass was performed by using the radial artery.Received 27 February 2017. Revised 25 July 2017. Accepted 3 August 2017.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest. 

  19. Distal renal tubular acidosis and amelogenesis imperfecta: A rare association

    Directory of Open Access Journals (Sweden)

    P Ravi

    2013-01-01

    Full Text Available Renal tubular acidosis (RTA is characterized by a normal anion gap with hyperchloremic metabolic acidosis. Primary distal RTA (type I is the most common RTA in children. Childhood presentation of distal RTA includes vomiting, failure to thrive, metabolic acidosis, and hypokalemia. Amelogenesis imperfecta (AI represents a condition where the dental enamel and oral tissues are affected in an equal manner resulting in the hypoplastic or hypopigmented teeth. We report a 10-year-old girl, previously asymptomatic presented with the hypokalemic paralysis and on work-up found out to have type I RTA. The discoloration of teeth and enamel was diagnosed as AI.

  20. Screening renal stone formers for distal renal tubular acidosis

    DEFF Research Database (Denmark)

    Osther, P J; Hansen, A B; Røhl, H F

    1989-01-01

    A group of 110 consecutive renal stone formers were screened for distal renal tubular acidosis (RTA) using morning fasting urinary pH (mfUpH) levels followed by a short ammonium chloride loading test in patients with levels above 6.0. In 14 patients (12.7%) a renal acidification defect was noted...... RTA in renal stone formers. Regardless of whether the acidification defect is primary or secondary to stone formation, however, all renal stone formers with distal RTA can expect to benefit from prophylactic alkaline therapy and it is recommended that the screening procedure, which is easy to use...

  1. Single‑incision technique for the internal fixation of distal fractures of the tibia and fibula: a combined anatomic and clinical study.

    Science.gov (United States)

    Yu, Baoqing; Huang, Gan; George, Josiah T; Li, Wenrui; Pan, Sihua; Zhou, Haiyan

    2013-12-01

    clinical outcomes in 49 patients with combined distal tibial and fibular fractures who underwent reduction and fixation with the single-incision technique, revealed uneventful fracture healings in 47 patients; and two cases of superficial wound necrosis which were treated and healed in 4 months. There was no case of delayed union or non-union. Distal fibula fracture occurring with distal tibia fracture poses a challenge for stable fixation. This has necessitated the need for dual incisions on the distal leg to approach each fracture for reduction and fixation. However, a single anterolateral incision enables the safe approach to the lateral aspects of the distal tibia and fibula thus eliminating the need for two separate incisions and minimizing the soft tissue complication to some extent. Meanwhile, the neurovascular bundle at risk during operation, distal tibia and fibula is clearly exposed in the single anterior-lateral incision.

  2. Percutaneous pins versus volar plates for unstable distal radius fractures: a biomechanic study using a cadaver model.

    Science.gov (United States)

    Knox, Jeffrey; Ambrose, Heidi; McCallister, Wren; Trumble, Thomas

    2007-01-01

    A biomechanic study using a cadaver model of a dorsally unstable distal radius fracture was used to compare the stability of percutaneous pinning and volar fixed-angle plating. Among the many surgical options for treating distal radius fractures are percutaneous pinning and internal plate fixation. Although percutaneous pin fixation requires less soft-tissue trauma and has low complication rates, plate fixation allows for early active movement with good clinical results. The biomechanic stability of these 2 methods was studied by using a cadaver model of a dorsally unstable intra-articular distal radius fracture. This study was performed on 7 fresh-frozen cadaver arms, in each of which an unstable intra-articular fracture with dorsal comminution was created. The fracture was first fixed with 0.062-mm K-wires inserted in standard crossed fashion and was tested in a pneumatic loading device that indirectly loaded the wrists through the 5 motor tendons 3 times at each level of force in flexion and extension. Testing was then repeated after removal of the pins and fixation with a fixed-angle DVR distal volar radius plate system (Hand Innovations, Inc., Miami, FL). Testing was performed in flexion up to 68 N and in extension up to 100 N, and the distance across the fracture site was measured. Volar plating was significantly more stable than pinning, with an average movement across the fracture site of 2.51 mm for pin fixation and 1.07 mm for plate fixation. The pins also showed a substantial degree of slipping after repeated stressing, but the plates remained stable. These results show the superior biomechanic stability of internal fixation using plates for dorsally comminuted intra-articular distal radius fractures in this cadaver model. Further clinical correlations are needed.

  3. Biomechanical Assessment of the Dorsal Spanning Bridge Plate in Distal Radius Fracture Fixation: Implications for Immediate Weight-Bearing.

    Science.gov (United States)

    Huang, Jerry I; Peterson, Bret; Bellevue, Kate; Lee, Nicolas; Smith, Sean; Herfat, Safa

    2017-04-01

    The goal of this study was to compare the biomechanical stability of a 2.4-mm dorsal spanning bridge plate with a volar locking plate (VLP) in a distal radius fracture model, during simulated crutch weight-bearing. Five paired cadaveric forearms were tested. A 1-cm dorsal wedge osteotomy was created to simulate an unstable distal radius fracture with dorsal comminution. Fractures were fixed with a VLP or a dorsal bridge plate (DBP). Specimens were mounted to a crutch handle, and optical motion-tracking sensors were attached to the proximal and distal segments. Specimens were loaded in compression at 1 mm/s on a servohydraulic test frame until failure, defined as 2 mm of gap site displacement. The VLP construct was significantly more stable to axial load in a crutch weight-bearing model compared with the DBP plate (VLP: 493 N vs DBP: 332 N). Stiffness was higher in the VLP constructs, but this was not statistically significant (VLP: 51.4 N/mm vs DBP: 32.4 N/mm). With the crutch weight-bearing model, DBP failed consistently with wrist flexion and plate bending, whereas VLP failed with axial compression at the fracture site and dorsal collapse. Dorsal spanning bridge plating is effective as an internal spanning fixator in treating highly comminuted intra-articular distal radius fracture and prevents axial collapse at the radiocarpal joint. However, bridge plating may not offer advantages in early weight-bearing or transfer in polytrauma patients, with less axial stability in our crutch weight-bearing model compared with volar plating. A stiffer 3.5-mm DBP or use of a DBP construct without the central holes may be considered for distal radius fractures if the goal is early crutch weight-bearing through the injured extremity.

  4. Double plating for the treatment of distal tibia and fibula fractures: case series of twenty five patients.

    Science.gov (United States)

    Ma, H; Wang, C; Wei, Q; Li, Z H; Yu, B Q

    2013-08-01

    The treatment of fractures of the distal third of the tibia and fibula usually involves two incisions, thus raising the risk of wound dehiscence, wound necrosis, infection, and the delayed union or non-union of distal tibial fractures. To decrease and prevent aforementioned serious complications, one-incision double-plating technique was advocated here. The aim of this work was to evaluate the results and effects of the one-incision, double-plating technique in the fractures of distal third of the tibia-fibula and fibula. Twenty-five patients with fractures of the distal third of the tibia-fibula, were treated with one incision, double plating between June 2007 and January 2009. The reduction and fixation of the tibia and fibula were conducted in all patients using one incision. The type of fractures based on AO classification were A1 (n = 6), A2 (n = 4), B1 (n = 12) and C1 (n = 3). All patients were followed-up at least until the patient was fully weight-bearing and the soft tissues had healed (median, 15 months; range, 12-24). Postoperative follow-up showed that 24 fractures healed within the range of the normal healing time. Only one patient with delayed union healed without surgical intervention by 7 months postoperatively. There were no cases of malunion or non-union. Importantly, at their last follow-up visit, the fracture was in excellent position and healed radiographically, and the patient could walk without pain and support. One-incision double-plating is a safe and effective alternative for treatment of distal tibia and fibula fractures.

  5. Management of Endovascular Aortic Aneurysm Complications via Retrograde Catheterization Through the Distal Stent-Graft Landing Zone.

    Science.gov (United States)

    Zhang, Xicheng; Sun, Yuan; Chen, Zhaolei; Jing, Yuanhu; Xu, Miao

    2017-08-01

    A retrograde technique through the gap between the distal stent landing zone and the iliac artery wall has been applied to treat type II endoleak after endovascular aortic aneurysm repair (EVAR). In this study, we tried to investigate its efficacy in the management of type III endoleak and intraoperative accidental events. We reported 2 complications of EVAR that were difficult to treat with conventional methods. One patient had a sustained type III endoleak after EVAR, and the right renal artery was accidentally sealed by a graft stent in the other patient during the operation. Both complications were managed by the retrograde technique from the distal stent landing zone. In the first case, the endoleak was easily embolized by the retrograde catheterization technique, and in the second case, a stent was implanted in the right renal artery using the retrograde technique to restore blood flow. In some EVAR cases, the technique of retrograde catheterization through the distal stent-graft landing zone is feasible, safe, and easy to perform.

  6. A comparative study of intramedullary interlocking nailing and minimally invasive plate osteosynthesis in extra articular distal tibial fractures.

    Science.gov (United States)

    Daolagupu, Arup K; Mudgal, Ashwani; Agarwala, Vikash; Dutta, Kaushik K

    2017-01-01

    Extraarticular distal tibial fractures are among the most challenging fractures encountered by an orthopedician for treatment because of its subcutaneous location, poor blood supply and decreased muscular cover anteriorly, complications such as delayed union, nonunion, wound infection, and wound dehiscence are often seen as a great challenge to the surgeon. Minimally invasive plate osteosynthesis (MIPO) and intramedullary interlocking nail (IMLN) are two well-accepted and effective methods, but each has been historically related to complications. This study compares clinical and radiological outcome in extraarticular distal tibia fractures treated by intramedullary interlocking nail (IMLN) and minimally invasive plate osteosynthesis (MIPO). 42 patients included in this study, 21 underwent IMLN and 21 were treated with MIPO who met the inclusion criteria and operated between June 2014 and May 2015. Patients were followed up for clinical and radiological evaluation. In IMLN group, average union time was 18.26 weeks compared to 21.70 weeks in plating group which was significant ( P plating group. Lesser complications in terms of implant irritation, ankle stiffness, and infection, were seen in interlocking group as compared to plating group. Average functional outcome according to American Orthopedic Foot and Ankle Society score was measured which came out to be 96.67. IMLN group was associated with lesser duration of surgery, earlier weight bearing and union rate, lesser incidence of infection and implant irritation which makes it a preferable choice for fixation of extra-articular distal tibial fractures. However, larger randomized controlled trials are required for confirming the results.

  7. Celiac Trunk Embolization, as a Means of Elongating Short Distal Descending Thoracic Aortic Aneurysm Necks, Prior to Endovascular Aortic Repair

    International Nuclear Information System (INIS)

    Belenky, Alexander; Haddad, Menashe; Idov, Igor; Knizhnik, Michael; Litvin, Sergey; Bachar, Gil N.; Atar, Eli

    2009-01-01

    The purpose of this study was to report our experience in elongating short distal necks of descending thoracic aortic aneurysms (DTAAs) by coil embolization of the celiac trunk prior to endovascular aneurysm repair (EVAR). During 6 years seven patients (five men and two women; mean age, 74) who had DTAAs with short distal necks unsuitable for conventional EVAR, and well patent superior and inferior mesenteric arteries based on CT, were treated in one session with EVAR after the celiac trunk was coil embolized to elongate the neck. All patients were followed by CT every 3 months in the first year and every 6 months thereafter. Technical success was achieved in all patients, and no early or late ischemic complications were noted. No procedural complications occurred and good aneurysm sealing was obtained in all patients. Three endoleaks were identified after 3 months (one patient) and 6 months (two patients); all were treated successfully with insertion of an additional stent-graft. In patients with DTAAs who are candidates for EVAR but have short aneurysm distal necks, celiac trunk embolization-only if the superior and inferior mesenteric arteries are patent-is a good and safe way to elongate the neck and enable EVAR.

  8. Clinical therapeutic effects of AO/ASIF clavicle hook plate on distal clavicle fractures and acromioclavicular joint dislocations.

    Science.gov (United States)

    Dou, Qingjun; Ren, Xiaofeng

    2014-07-01

    The aim of this study was to evaluate the security and effectiveness of AO/ASIF clavicle hook plate in the treatment of distal clavicle fractures and acromioclavicular joint dislocations. One hundred patients with distal clavicle fractures and acromioclavicular joint dislocations who were admitted in our hospital from January 2012 to January 2013 were selected as the study subjects. They were then randomly divided into a control group and an observation group (n=50). The observation group was treated with AO/ASIF clavicle hook plates, and the control group was treated with Kirschner-wire tension bands. The outcomes were recorded and compared. The JOA scores of the two groups were similar before surgery (P>0.05). The two groups both had obviously increased JOA scores in the postoperative 6th and 12th weeks, and the score in the postoperative 12th week was higher. There were statistically significant intra-group differences (PAO/ASIF clavicle hook plate functioned more effectively than Kirschner-wire tension band in clinical treatment of distal clavicle fractures and acromioclavicular joint dislocations. The former protocol enjoyed small incisions, firm fixation and early shoulder mobility. Therefore, it is a safe and effective surgical method that is worthy of being widely applied in clinical practice.

  9. The effect of steroid-abuse on anatomic reinsertion of ruptured distal biceps brachii tendon.

    Science.gov (United States)

    Pagonis, Thomas; Givissis, Panagiotis; Ditsios, Kostantinos; Pagonis, Athanasios; Petsatodis, Georgios; Christodoulou, Anastasios

    2011-11-01

    There is an increase in the number of anabolic-steroid (AS)-abusing trainees, who suffer from sports injuries, needing reconstruction surgery. Rupture of the distal biceps brachii tendon is a common injury in this group. The study aimed to investigate the effect of AS abuse in the anatomic reconstruction of the ruptured distal biceps brachii tendon along with an immediate range-of-motion postoperative protocol. We conducted an observation study of 17 male athletes suffering from distal biceps tendon ruptures. Six of them reported that they abused AS (group A), whereas the non-users comprised group B (n=11). Both groups were treated with the modified single-incision technique with two suture anchors and an immediate active range-of-motion protocol postoperatively. Follow-up was at 4, 16 and 52 weeks postoperatively, with a final follow-up at 24 months. Follow-up at 4, 16 and 52 weeks postoperatively showed a statistical significance in favour of group A for therapeutic outcomes concerning flexion, supination, pronation, Disabilities of the Arm, Shoulder and Hand (DASH) Disability Symptom Scores, Mayo Elbow Performance Elbow Scores and isometric muscle strength tests for both flexion and supination. Twenty-four months postoperatively, statistical significance in favour of group A was recorded in isometric muscle strength tests for both flexion and supination and also in DASH Disability Symptom Score. The results of our study suggest that there is a correlation between the effect of AS and the quicker and better recuperation and rehabilitation observed in group A. Nonetheless, these results must be interpreted with caution, and further in vivo research is needed to confirm these findings. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. Laparoscopic versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a single-center experience.

    Science.gov (United States)

    Zhang, Ai-Bin; Wang, Ye; Hu, Chen; Shen, Yan; Zheng, Shu-Sen

    2017-06-01

    The aim of this study was to compare complications and oncologic outcomes of patients undergoing laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP) at a single center. Distal pancreatectomies performed for pancreatic ductal adenocarcinoma during a 4-year period were included in this study. A retrospective analysis of a database of this cohort was conducted. Twenty-two patients underwent LDP for pancreatic ductal adenocarcinoma, in comparison to seventy-six patients with comparable tumor characteristics treated by ODP. No patients with locally advanced lesions were included in this study. Comparing LDP group to ODP group, there were no significant differences in operation time (P=0.06) or blood loss (P=0.24). Complications (pancreatic fistula, P=0.62; intra-abdominal abscess, P=0.44; postpancreatectomy hemorrhage, P=0.34) were similar. There were no significant differences in the number of lymph nodes harvested (11.2±4.6 in LDP group vs. 14.4±5.5 in ODP group, P=0.44) nor the rate of patients with positive lymph nodes (36% in LDP group vs. 41% in ODP group, P=0.71). Incidence of positive margins was similar (9% in LDP group vs. 13% in ODP group, P=0.61). The mean overall survival time was (29.6±3.7) months for the LDP group and (27.6±2.1) months for ODP group. There was no difference in overall survival between the two groups (P=0.34). LDP is a safe and effective treatment for selected patients with pancreatic ductal adenocarcinoma. A slow-compression of pancreas tissue with the GIA stapler is effective in preventing postoperative pancreatic fistula. The oncologic outcome is comparable with the conventional open approach. Laparoscopic radical antegrade modular pancreatosplenectomy contributed to oncological clearance.

  11. Percutaneous pinning for non-comminuted extra-articular fractures of distal radius

    Directory of Open Access Journals (Sweden)

    Abhishek K Das

    2011-01-01

    Full Text Available Background: Various treatment modalities have been described for the treatment of extra-articular distal radius fractures each with its own merits and demerits. Most of the work done with percutaneous pinning has shown a significant residual stiffness of the hand and wrist. Our technique involves percutaneous pinning of the fracture and immobilization in neutral position of the wrist for three weeks. This study′s aim was to examine the functional outcome of percutaneous K-wiring of these extra-articular distal radius fractures with immobilization in neutral position of the wrist. Materials and Methods: This is a prospective study of 32 patients aged between 18 and 70 years with extra-articular distal radius fracture. Patients were treated with closed reduction and percutaneous pinning using two or three K-wires. A below- elbow plaster of paris dorsoradial slab was applied in neutral position of the wrist for 3 weeks. At the end of 3 weeks, the slab was removed and wrist physiotherapy started. The radiographs were taken postoperatively, at 3 weeks, 6 weeks and 6 months. The functional evaluation of the patients was done at 6 months follow-up. We used Sarmiento′s modification of Lindstrom criteria and Gartland and Werley′s criteria for evaluation of results. Results: Excellent to good results were seen in 93.75% of the cases while 6.25% had fair results. The complications observed were pin loosening (n=13, pin tract infection (n=2, malunion (n=2, wrist joint stiffness (n=2, reduced grip strength (n=2 and injury to the superficial radial nerve (n=1. Conclusion: Percutaneous pinning followed by immobilization of the wrist in neutral position is a simple and effective method to maintain reduction and prevent stiffness of wrist and hand.

  12. Biomechanical Evaluation of Plate Versus Lag Screw Only Fixation of Distal Fibula Fractures.

    Science.gov (United States)

    Misaghi, Amirhossein; Doan, Josh; Bastrom, Tracey; Pennock, Andrew T

    2015-01-01

    Traditional fixation of unstable Orthopaedic Trauma Association type B/C ankle fractures consists of a lag screw and a lateral or posterolateral neutralization plate. Several studies have demonstrated the clinical success of lag screw only fixation; however, to date no biomechanical comparison of the different constructs has been performed. The purpose of the present study was to evaluate the biomechanical strength of these different constructs. Osteotomies were created in 40 Sawbones(®) distal fibulas and reduced using 1 bicortical 3.5-mm stainless steel lag screw, 2 bicortical 3.5-mm lag screws, 3 bicortical 3.5-mm lag screws, or a single 3.5-mm lag screw coupled with a stainless steel neutralization plate with 3 proximal cortical and 3 distal cancellous screws. The constructs were tested to determine the stiffness in lateral bending and rotation and failure torque. No significant differences in lateral bending or rotational stiffness were detected between the osteotomies fixed with 3 lag screws and a plate. Constructs fixed with 1 lag screw were weaker for both lateral bending and rotational stiffness. Osteotomies fixed with 2 lag screws were weaker in lateral bending only. No significant differences were found in the failure torque. Compared with lag screw only fixation, plate fixation requires larger incisions and increased costs and is more likely to require follow-up surgery. Despite the published clinical success of treating simple Orthopaedic Trauma Association B/C fractures with lag screw only fixation, many surgeons still have concerns about stability. For noncomminuted, long oblique distal fibula fractures, lag screw only fixation techniques offer construct stiffness similar to that of traditional plate and lag screw fixation. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Osteochondral fragmentation of the distal aspect of the patella in horses

    International Nuclear Information System (INIS)

    McIlwraith, C.W.

    1990-01-01

    A condition characterised by osteochondral fragmentation of the distal aspect of the patella in 15 horses is described. The problem was unilateral in six horses and bilateral in nine. There were eight Quarterhorses, three Thoroughbreds, two American Saddlebreds, one American Paint and one Warmblood-Thoroughbred cross. A previous medial patellar desmotomy had been performed on 12 of the 15 horses. The condition manifested as hindlimb lameness and stiffness ranging from mild to severe. There was fibrous thickening in the stifle area in the 12 cases with a previous medial patellar desmotomy, and synovial effusion in seven of 12 cases. Synovial effusion was present in two of the three cases in which a previous medial patellar desmotomy was not performed. The radiographic changes included bony fragmentation, spurring (with or without an associated subchondral defect), subchondral roughening and subchondral lysis of the distal aspect of the patella. All horses were treated with arthroscopic surgery. The lesions at arthroscopy varied from flaking, fissuring, undermining or fragmentation of the articular cartilage to fragmentation or lysis of the bone at the distal aspect of the patella. The subchondral bone was involved in all cases that had a previous medial patellar desmotomy. Of the 12 horses that had a previous medial patellar desmotomy, eight became sound at their intended use, one was sold in training without problems, one is in early training without problems, one never improved and one is in convalescence. Of the three that did not have a patellar desmotomy, two performed their intended use well but one was unsatisfactory

  14. Propeller Flap for Complex Distal Leg Reconstruction: A Versatile ...

    African Journals Online (AJOL)

    have been described in the axilla, periolecranon, forearm, lower extremity,[1] hand,[6] and trunk.[7] In spite of the versatility of perforator‑based flaps, literature search reveals ... Anatomy of distal leg perforators. Perforators are small diameter vessels that originate from a main pedicle and perforate the fascia or muscle to ...

  15. A traction jig for reduction of distal radial fractures.

    Science.gov (United States)

    Wise, David; Coats, Tim; Persad, Ram

    2004-01-01

    A traction jig is described which facilitates the closed reduction of extra-articular distal radial fractures and which maintains the reduction whilst a plaster cast is applied. The jig is suitable for use by a single operator in an Accident and Emergency department setting.

  16. Distal skin vasodilation promotes rapid sleep onset in preterm neonates.

    Science.gov (United States)

    Barcat, Lucile; Decima, Pauline; Bodin, Emilie; Delanaud, Stephane; Stephan-Blanchard, Erwan; Leke, Andre; Libert, Jean-Pierre; Tourneux, Pierre; Bach, Veronique

    2017-10-01

    Although sleep is of paramount importance for preterm neonates, care of the latter in a neonatal intensive care unit does not favour sleep. Given that several studies in adults have described a 'vegetative preparedness to sleep' (in which distal skin vasodilation before lights-out promotes rapid sleep onset), we looked at whether or not this process operates in preterm neonates. Sleep propensity was assessed in terms of the duration of a spontaneous episode of wakefulness (W). Skin temperatures at six body sites (the abdomen, pectoral region, eye, hand, thigh and foot) were measured (using infrared thermography) during nocturnal polysomnography in 29 9-day-old preterm neonates (postmenstrual age: 209 ± 9 days). We then determined whether the duration of the W episode depended upon the local skin temperatures measured at the start, during and end of the episode. The W episode was shorter when distal skin temperatures (thigh, hand and foot) and the pectoral temperature were higher at the end of the episode (i.e. at sleep onset). The relationship with the duration of the W episode was not significant for temperatures measured at the start of the W episode. We observed gradual distal vasodilation at the pectoral region, the thigh, hand and foot (i.e. affecting most of the body's skin surface) during W episodes. Our results constitute initial evidence to show that distal vasodilation may have a key role in facilitating sleep onset in very preterm neonates. © 2017 European Sleep Research Society.

  17. Proximal and distal environmental correlates of adolescent obesity.

    Science.gov (United States)

    Nesbit, Kathryn C; Kolobe, Thubi A; Arnold, Sandra H; Sisson, Susan B; Anderson, Michael P

    2014-08-01

    The purpose of this study was to determine how proximal (home) and distal (neighborhood) environmental characteristics interact to influence obesity in early and middle adolescents. This was a descriptive, cross-sectional study using the 2007 National Survey of Children's Health (NCSH). Participants were 39,542 children ages 11 to 17 years. Logistic regressions were used to examine the relationship between adolescent obesity and environmental factors, the relative strength of these factors, and the influence of age and gender. Proximal environmental factors were stronger correlates of adolescent obesity than distal environmental factors. Sedentary behavior related to TV watching time at home was the strongest correlate of adolescent obesity overall (OR 1.13, 95% CI 1.11-1.15). Parks and playgrounds (OR 0.86, 95% CI 0.08-0.92), as well as recreation centers (OR 0.91, 95% CI 0.85-0.97) were significant distal environmental factor correlates. Girls and middle adolescents were at less risk for obesity than boys and early adolescents (OR 0.51, 95% CI 0.68-0.82; OR 0.75, 95% CI 0.68-0.96). The results of this study reveal the importance of proximal environmental characteristics on adolescent obesity relative to distal environmental characteristics. Obesity intervention strategies for adolescents should target sedentary behavior and opportunities for physical activity with a focus on early adolescents and boys.

  18. Surgical management of acute distal biceps tendon rupture ...

    African Journals Online (AJOL)

    Acute distal biceps tendon rupture constitute a rare lesion of biceps injuries, typically, easy to diagnosis after lifting a heavy object. Treatment is controversial, nonoperative for sedentary and elderly patients; surgical for young and active individuals. Many operative techniques are described, they all aim to restore an ...

  19. Evaluation of various filling techniques in distal canals of mandibular ...

    African Journals Online (AJOL)

    Evaluation of various filling techniques in distal canals of mandibular molars instrumented with different single-file nickel-titanium systems. ... Comparisons between groups were applied using Student's t-test or one-way ANOVA for normally distributed data. The Mann-Whitney U-test or Kruskal-Wallis test was used when ...

  20. Distal adding-on phenomenon in Lenke 1A scoliosis

    DEFF Research Database (Denmark)

    Wang, Yu; Hansen, Ebbe Stender; Høy, Kristian

    2011-01-01

    the instrumentation) from the CSVL (the vertical line that bisects proximal sacrum). Five methods for determining LIV were compared in both the adding-on group and no adding-on group. RESULTS: Out of the 278 patients reviewed, 45 met the inclusion criteria; 23 of these met the definition for distal adding...

  1. Distal biceps reconstruction 13 years post-injury.

    Science.gov (United States)

    Burrus, M Tyrrell; Chhabra, A Bobby

    2015-04-01

    Distal biceps tendon ruptures are relatively rare injuries most commonly caused by an eccentric contraction of the biceps brachii. The majority of complete ruptures receive early surgical intervention, however, some patients do present in a delayed fashion. There are many surgical options at this time for acute and chronic injuries, and this case report describes an Achilles allograft reconstruction in a male who sustained a complete tear 13 years prior to presentation. At 12-month follow up, he had regained full function of his dominant extremity as evidence by returning to work with no limitations and by a Disabilities of the Arm, Shoulder, and Hand (DASH) score of zero. We are unaware of a successfully surgically reconstructed distal biceps tendon of this chronicity. As the literature on this subject is sparse, this case report gives credence to the idea that certain patients with a chronic distal biceps rupture should be considered for operative reconstruction and not relegated to continued failed conservative treatment. Discussed are the surgical treatment options and controversies for chronic distal biceps ruptures, and we review various outcome studies using different surgical techniques.

  2. Bilateral ruptures of the distal biceps brachii tendon.

    Science.gov (United States)

    Schneider, Adam; Bennett, J Michael; O'Connor, Daniel P; Mehlhoff, Thomas; Bennett, James B

    2009-01-01

    The purpose of this study was to identify characteristics associated with bilateral ruptures of the distal biceps tendons. We present a retrospective case series of 25 patients who sustained non-simultaneous bilateral distal biceps brachii tendon ruptures that were repaired surgically, with follow-up available on 10 patients. The average age of the patients was 50 years (range 28-76). All patients were male. The mean time from the first tendon rupture to the contralateral tendon rupture was 2.7 years (range 0.5 - 6.3). Follow-up averaged 45 months (range 24-85). Patients with bilateral ruptures tended to be middle-aged men, who commonly participated in weight lifting, manual labor, or sports, and who had higher rates of nicotine (50%) and anabolic steroid use (20%) than the general population. After surgical repair of 9 of 10 patients, patients with bilateral distal biceps tendon ruptures had good to excellent outcomes. With the numbers available, outcomes were not statistically associated with manual labor, past medical history, prescription medications, prior tendon injury, body mass index, current activity in sports, use of nutritional supplements, or anabolic steroid use, although worker's compensation claims approached statistical significance (p = 0.059). Patients who sustained bilateral distal biceps tendon ruptures tended to be middle-aged men with higher rates of nicotine and anabolic steroid use than the general population.

  3. Distal Renal Tubular Acidosis, an Uncommonly diagnosed Cause of ...

    African Journals Online (AJOL)

    Five cases of distal renal tubular acidosis aged between 2½ weeks and 2½ months are described. The presenting features included lethargy, refusal to feed, high density of periodic respiration, vomiting and recurrent episodes of unexplained metabolic acidosis. A constant feature was failure to thrive despite caloric intakes ...

  4. Conservative management of distal leg necrosis in lung transplant recipients.

    Science.gov (United States)

    Aigner, F; Husmann, M; Huber, L C; Benden, C; Schuurmans, M M

    2017-05-01

    Critical limb ischemia (CLI) with distal leg necrosis in lung transplant recipients (LTR) is associated with a high risk for systemic infection and sepsis. Optimal management of CLI has not been defined so far in LTR. In immunocompetent individuals with leg necrosis, surgical amputation would be indicated and standard care. We report on the outcome of four conservatively managed LTR with distal leg necrosis due to peripheral arterial disease (PAD) with medial calcification of the distal limb vessels. Time interval from lung transplantation to CLI ranged from four years (n = 1) to more than a decade (n = 3). In all cases a multimodal therapy with heparin, acetylsalicylic acid, iloprost and antibiotic therapy was performed, in addition to a trial of catheter-based revascularization. Surgical amputation of necrosis was not undertaken due to fear of wound healing difficulties under long-term immunosuppression and impaired tissue perfusion. Intensive wound care and selective debridement were performed. Two patients developed progressive gangrene followed by auto-amputation during a follow-up of 43 and 49 months with continued ambulation and two patients died of unrelated causes 9 and 12 months after diagnosis of CLI. In conclusion, we report a conservative treatment strategy for distal leg necrosis in LTR without surgical amputation and recommend this approach based on our experience. Copyright © 2017 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  5. Propeller Flap for Complex Distal Leg Reconstruction: A Versatile ...

    African Journals Online (AJOL)

    Reverse sural artery fasciocutaneous flap has become a workhorse for the reconstruction of distal leg soft tissue defects. When its use is not feasible, perforator‑based propeller flap offers a better, easier, faster, and cheaper alternative to free flap. We present our experience with two men both aged 34 years who sustained ...

  6. Laparoscopic versus open distal pancreatectomy for pancreatic cancer

    NARCIS (Netherlands)

    Riviere, D.M.; Gurusamy, K.S.; Kooby, D.A.; Vollmer, C.M.; Besselink, M.G.; Davidson, B.R.; Laarhoven, C.J.H.M. van

    2016-01-01

    BACKGROUND: Surgical resection is currently the only treatment with the potential for long-term survival and cure of pancreatic cancer. Surgical resection is provided as distal pancreatectomy for cancers of the body and tail of the pancreas. It can be performed by laparoscopic or open surgery. In

  7. Laparoscopic versus open distal pancreatectomy for pancreatic cancer

    NARCIS (Netherlands)

    Riviere, Deniece; Gurusamy, Kurinchi Selvan; Kooby, David A.; Vollmer, Charles M.; Besselink, Marc G. H.; Davidson, Brian R.; van Laarhoven, Cornelis J. H. M.

    2016-01-01

    Surgical resection is currently the only treatment with the potential for long-term survival and cure of pancreatic cancer. Surgical resection is provided as distal pancreatectomy for cancers of the body and tail of the pancreas. It can be performed by laparoscopic or open surgery. In operations on

  8. Autosomal dominant distal myopathy: Linkage to chromosome 14

    Energy Technology Data Exchange (ETDEWEB)

    Laing, N.G.; Laing, B.A.; Wilton, S.D.; Dorosz, S.; Mastaglia, F.L.; Kakulas, B.A. [Australian Neuromuscular Research Institute, Perth (Australia); Robbins, P.; Meredith, C.; Honeyman, K.; Kozman, H.

    1995-02-01

    We have studied a family segregating a form of autosomal dominant distal myopathy (MIM 160500) and containing nine living affected individuals. The myopathy in this family is closest in clinical phenotype to that first described by Gowers in 1902. A search for linkage was conducted using microsatellite, VNTR, and RFLP markers. In total, 92 markers on all 22 autosomes were run. Positive linkage was obtained with 14 of 15 markers tested on chromosome 14, with little indication of linkage elsewhere in the genome. Maximum two-point LOD scores of 2.60 at recombination fraction .00 were obtained for the markers MYH7 and D14S64 - the family structure precludes a two-point LOD score {ge} 3. Recombinations with D14S72 and D14S49 indicate that this distal myopathy locus, MPD1, should lie between these markers. A multipoint analysis assuming 100% penetrance and using the markers D14S72, D14S50, MYH7, D14S64, D14S54, and D14S49 gave a LOD score of exactly 3 at MYH7. Analysis at a penetrance of 80% gave a LOD score of 2.8 at this marker. This probable localization of a gene for distal myopathy, MPD1, on chromosome 14 should allow other investigators studying distal myopathy families to test this region for linkage in other types of the disease, to confirm linkage or to demonstrate the likely genetic heterogeneity. 24 refs., 3 figs., 1 tab.

  9. Stressfrakturer af distale fibula hos en patient med osteoporose

    DEFF Research Database (Denmark)

    Schwartz, Frederik; Heerfordt, Ida Marie

    2014-01-01

    We report a case of an 81-year-old osteoporotic woman, who suffered stress fractures of the distal fibula on both sides within a two-year period. The risk factors for stress fractures are reviewed and the importance of a high index of suspicion for stress fractures is emphasized. When a stress fr...

  10. Evaluation of Various Filling Techniques in Distal Canals of ...

    African Journals Online (AJOL)

    2017-03-06

    Mar 6, 2017 ... treatment.[10] The percentage of GP-filled areas (PGFAs) has been used as a measure of the quality of the root filling.[7] Therefore, the aim of this study was to compare different filling techniques in the distal canals of lower molars, instrumented by different single-file systems, and the canal area in terms of ...

  11. Non-Vascularised Fibular Grafting After Resection of Distal Femoral ...

    African Journals Online (AJOL)

    Background: Vascularized fibular grafting, allografting, megaprosthesis and allograft-prosthesis composite are suitable limb salvage techniques after resection of ... the initial observation showed such a wide non-vascularized fibular grafting for arthrodesis of the knee after resection of the distal femoral tumours is a feasible ...

  12. Snodgrass repair for distal hypospadias: a review of 75 cases

    African Journals Online (AJOL)

    urologists for distal hypospadias correction. We review our cases to find out whether there was any difference in the rate of urethrocutaneous fistula after the use of single- versus double-layer tubularization, the use of thick versus thin dorsal prepuce subcutaneous flap (DPF), the use of. DPF versus the ventral dartos flap for ...

  13. Urethral advancement procedure in the treatment of primary distal ...

    African Journals Online (AJOL)

    advancement in the repair of primary distal penile hypospadias with regard to feasibility, complication rates .... stones and growth, and any associated congenital anomaly. Meticulous local examination was performed ... with a tourniquet placed on the root of the penis. A submeatal crescent-like incision was performed a few.

  14. Neglected distal humeral epiphyseal injury - Two Case Reports ...

    African Journals Online (AJOL)

    We present two cases of neglected distal humeral epiphyseal injury in children that resulted in cubitus varus deformity in one case. Full range of movements was achieved in both cases after proper management. Keywords: Neglected epiphyseal injury; Cubitus varus; Diagnosis; Treatment Internet Journal of Medical Update ...

  15. Unusual migration of ventriculo peritoneal distal catheter into vagina

    Directory of Open Access Journals (Sweden)

    Sghavamedin Tavallaee

    2015-04-01

    Full Text Available VP shunt is one of the most popular methods for ICP reduction and treatment of hydrocephalus. Various complications of this method are not uncommon such as shunt malfunction, infection and unusual migration of distal catheter. I present a case of migration of the peritoneal catheter out of the vagina.

  16. Subtrochanteric and Distal Femur Fractures in a Patient with ...

    African Journals Online (AJOL)

    There was an improvement of the preinjury function attributed to the osteotomy of the femoral diaphyseal, which alleviated the anterior thigh discomfort. Keywords: Amputation, Distal femur fracture, Femoral shaft fracture, Femur, Femur fractures, Fracture fixation, Fracture malunion, Fractures, Intramedullary nail, Knee ...

  17. Class II correction prior to orthodontics with the carriere distalizer.

    Science.gov (United States)

    McFarlane, Bruce

    2013-01-01

    Class II correction is a challenge in orthodontics with many existing devices being complex, too compliance-driven, or too prone to breakage. The Carriere Distalizer allows for straightforward Class II correction prior to orthodontics (fixed or clear aligners) at a time when no other mechanics interfere, and compliance is at its best.

  18. An electro-myographic study of the distal porcine ureter

    NARCIS (Netherlands)

    Roshani, H.; Dabhoiwala, N. F.; Dijkhuis, T.; Ongerboer de Visser, B. W.; Kurth, K. H.; Lamers, W. H.

    2000-01-01

    PURPOSE: The accumulation of urine in the renal pelvis causes depolarisation of non-specific muscular pace-maker cells. The wave of depolarisation spreads distally in the ureteric smooth muscle cells via gap junctions. This wave of excitation causes a coordinated peristaltic contraction which

  19. Outcome of management of distal radius fractures in ...

    African Journals Online (AJOL)

    Background and Purpose: Distal radial fractures are common fractures of postmenopausal age group patients. They are often called fractures of osteoporosis. These fractures are considered to be one of the commonest minor injuries to cause major morbidity in the community. A lot of patient who need surgery, fail to afford ...

  20. Genetics Home Reference: CAV3-related distal myopathy

    Science.gov (United States)

    ... gene causes a peculiar form of distal myopathy. Neurology. 2002 Jan 22;58(2):323-5. Erratum in: Neurology 2002 Mar 12;58(5):839. Itoyoma Y [ ... 3 cause four distinct autosomal dominant muscle diseases. Neurology. 2004 Feb 24;62(4):538-43. Review. ...

  1. Spontaneous resolution of splenic infarcts after distal splenorenal ...

    African Journals Online (AJOL)

    Background: In cases of portal hypertension with splenic infarcts, splenectomy with proximal splenorenal shunt has been recommended. We are sharing our experience with distal splenorenal shunt in these cases contrary to the popular belief. Materials and Methods: Splenic infarcts were graded as mild, moderate and ...

  2. Local repair of distal thoracal aortic dissections (Locus minoris resistencia).

    Science.gov (United States)

    Belov, Iu V; Komarov, R N; Stepanenko, A B; Gens, A P; Charchian, E R

    2007-01-01

    The paper presents the method of local repair of distal aortic dissections. Local aortic grafting for surgical correction of type B dissecting aortic aneurysms helped to decrease hospital mortality up to 15.4%, the rate of paraparesis and multiorgan failure - up to 11.5%.

  3. Length of Distal Resection Margin after Partial Mesorectal Excision for Upper Rectal Cancer Estimated by Magnetic Resonance Imaging

    DEFF Research Database (Denmark)

    Bondeven, Peter; Hagemann-Madsen, Rikke Hjarnø; Bro, Lise

    BACKGROUND: Rectal cancer requires surgery for cure. Partial mesorectal excision (PME) is suggested for tumours in the upper rectum and implies transection of the mesorectum perpendicular to the bowel a minimum of 5 cm below the tumour. Reports have shown distal mesorectal tumour spread of up to 5...... cm from the primary tumour; therefore, guidelines for cancer of the upper rectum recommend PME with a distal resection margin (DRM) of at least 5 cm or total mesorectal excision (TME). PME exerts a hazard of removing less than 5 cm - leaving microscopic tumour cells that have spread in the mesorectum....... Studies at our department have shown inadequate DRM in 75 % of the patients estimated by post-operative MRI of the pelvis and by measurements of the histopathological specimen. Correspondingly, a higher rate of local recurrence in patients surgically treated with PME for rectal cancer - compared to TME...

  4. Extra-articular distal tibia facture (AO-43A): A retrospective study comparing modified MIPPO with IMN.

    Science.gov (United States)

    Shen, Jun; Xu, Jun; Tang, Ming-Jie; Luo, Cong-Feng; Zhang, Chang-Qing

    2016-10-01

    We introduce a new MIPPO procedure which is simple and effective for the treatment of extra-articular distal tibia facture (AO-43A). The aim of this retrospective study was to compare our modified MIPPO with IMN. This retrospective study included 64 patients treated with our modified MIPPO and 61 patients with IMN. The data of sex, age, operation time, blood loss, wound complications, mal-reduction, shortening and fracture healing was analyzed. The operation time was significantly shorter in the MIPPO group than in the IMN group (56.0min vs. 85.0min, P1cm and nonunion in both groups. Our results have shown that our modified MIPPO has enormous advantages over IMN for extra-articular distal tibia fracture (AO-43A). Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Physeal fractures of the distal tibia and fibula (Salter-Harris Type I, II, III, and IV fractures).

    Science.gov (United States)

    Podeszwa, David A; Mubarak, Scott J

    2012-06-01

    Physeal fractures of the distal tibia and fibula are common and can be seen at any age, although most are seen in the adolescent. An understanding of the unique anatomy of the skeletally immature ankle in relation to the mechanism of injury will help one understand the injury patterns seen in this population. A thorough clinical exam is critical to the diagnosis and treatment of these injuries and the avoidance of potentially catastrophic complications. Nondisplaced physeal fractures of the distal tibia and fibula can be safely treated nonoperatively. Displaced fractures should undergo a gentle reduction with appropriate anesthesia while multiple reduction attempts should be avoided. Gapping of the physis >3 mm after reduction should raise the suspicion of entrapped periosteum that will increase the risk of premature physeal closure. Open reduction of displaced Salter-Harris type III and IV fractures is critical to maintain joint congruity and minimize the risk of physeal arrest.

  6. Laparoscopic radical nephroureterectomy: dilemma of the distal ureter.

    Science.gov (United States)

    Steinberg, Jordan R; Matin, Surena F

    2004-03-01

    Laparoscopic nephroureterectomy has recently emerged as a safe, minimally invasive approach to upper tract urothelial cancers. The most controversial and challenging feature of laparoscopic nephroureterectomy is the management of the distal ureter. We review the most common methods of managing the distal ureter, with emphasis on contemporary oncologic outcomes, indications, advantages, and disadvantages. There are currently in excess of five different approaches to the lower ureter. These techniques often combine features of endoscopic, laparoscopic, or open management. They include open excision, a transvesical laparoscopic detachment and ligation technique, laparoscopic stapling of the distal ureter and bladder cuff, the "pluck" technique, and ureteral intussusception. Each technique has distinct advantages and disadvantages, differing not only in technical approach, but oncological principles as well. While the existing published data do not overwhelmingly support one approach over the others, the open approach remains one of the most reliable and oncologically sound procedures. The principles of surgical oncology dictate that a complete, en-bloc resection, with avoidance of tumor seeding, remains the preferred treatment of all urothelial cancers. The classical open technique of securing the distal ureter and bladder cuff achieves this principle and has withstood the test of time. Transvesical laparoscopic detachment and ligation is an oncologically valid approach in patients without bladder tumors, but is limited by technical considerations. The laparoscopic stapling technique maintains a closed system but risks leaving behind ureteral and bladder cuff segments. Both transurethral resection of the ureteral orifice (pluck) and intussusception techniques should be approached with caution, as the potential for tumor seeding exists. Additional long-term comparative outcomes are needed to solve the dilemma of the distal ureter.

  7. Distal pancreatectomy and splenectomy: a robotic or LESS approach.

    Science.gov (United States)

    Ryan, Carrie E; Ross, Sharona B; Sukharamwala, Prashant B; Sadowitz, Benjamin D; Wood, Thomas W; Rosemurgy, Alexander S

    2015-01-01

    The role and application of robotic surgery are debated, particularly given the expansion of laparoscopy, especially laparoendoscopic single-site (LESS) surgery. This cohort study was undertaken to delineate differences in outcomes between LESS and robotic distal pancreatectomy and splenectomy. With Institutional Review Board approval, patients undergoing LESS or robotic distal pancreatectomy and splenectomy from September 1, 2012, through December 31, 2014, were prospectively observed, and data were collected. The results are expressed as the median, with the mean ± SD. Thirty-four patients underwent a minimally invasive distal pancreatectomy and splenectomy: 18 with robotic and 16 with LESS surgery. The patients were similar in sex, age, and body mass index. Conversions to open surgery and estimated blood loss were similar. There were two intraoperative complications in the group that underwent the robotic approach. Time spent in the operating room was significantly longer with the robot (297 vs 254 minutes, P = .03), although operative duration (i.e., incision to closure) was not longer (225 vs 190 minutes; P = .15). Of the operations studied, 79% were undertaken for neoplastic processes. Tumor size was 3.5 cm for both approaches; R0 resections were achieved in all patients. Length of stay was similar in the two study groups (5 vs 4 days). There was one 30-day readmission after robotic surgery. Patient outcomes are similar with LESS or robotic distal pancreatectomy and splenectomy. Robotic operations require more time in the operating room. Both are safe and efficacious minimally invasive operations that follow similar oncologic principles for similar tumors, and both should be in the surgeon's armamentarium for distal pancreatectomy and splenectomy.

  8. Effectiveness of the Gastrocsoleous Flap for Coverage of Soft Tissue Defects in Leg with Emphasis on the Distal Third

    Directory of Open Access Journals (Sweden)

    Ali Karbalaeikhani

    2015-07-01

    Full Text Available Background: The standard methods for reconstruction of soft tissue defects in the leg include gastrocnemius flap for proximal third defects, soleus flap for middle third and free flap in the distal third. However, there are problems with the use of free flap, like increased operative time, damage of major vessels and the need for experienced microsurgeon. Mathods: This prospective study was undertaken on 23 patients (20 male and 3 female with the mean age 32.13 years (14 to 65. This group consisted of all of the patients referred to Dr Bahonar Hospital, Kerman with soft tissue defects between April 2011 and April 20012 and would give informed consent for participation in the study and treatment of the defect with muscle flaps. 8 patients with proximal third defects were treated with were treated with gastrocnemius flap, 4 with middle third defects with soleus flap and 3 with reverse soleus flap and 8 with distal third defects with reverse soleus flap. The patients were followed up for at least 1 year. Finally the results were analyzed by SPSS 16. Results: In patients with soft tissue defect in proximal and middle third of leg repair was successful in all. In 5 patients with soft tissue defect in distal third of leg repair was complete but in 3 of them flap failure was seen. Overall success rate for reverse soleous flap was 72.7%. Conclusion: The success rate of the flap for the upper and lower thirds was similar to other studies and seems that this is the standard method. In the distal third defects the reverse soleous flap failed in 3 cases and it seems that preoperative investigations such as angiography must be performed before embarking on such a procedure.

  9. Treatment of tailgut cysts by extended distal rectal segmental resection with rectoanal anastomosis.

    Science.gov (United States)

    Volk, Andreas; Plodeck, Verena; Toma, Marieta; Saeger, Hans-Detlev; Pistorius, Steffen

    2017-04-01

    Complete surgical resection is the treatment of choice for tailgut cysts, because of their malignant potential and tendency to regrow if incompletely resected. We report our experience of treating patients with tailgut cysts, and discuss diagnostics, surgical approaches, and follow-up. We performed extended distal rectal segmental resection of the tailgut cyst, with rectoanal anastomosis. We report the clinical, radiological, pathological, and surgical findings, describe the procedures performed, and summarize follow-up data. Two patients underwent en-bloc resection of a tailgut cyst, the adjacent part of the levator muscle, and the distal rectal segment, followed by an end-to-end rectoanal anastomosis. There was no evidence of anastomotic leakage postoperatively. At the time of writing, our patients were relapse-free with no, or non-limiting, symptoms of anal incontinence, respectively. This surgical approach appears to have a low complication rate and good recovery outcomes. Moreover, as the sphincter is preserved, so is the postoperative anorectal function. This approach could result in a low recurrence rate.

  10. Minimally invasive plating osteosynthesis for mid-distal third humeral shaft fractures.

    Science.gov (United States)

    Lian, Kejian; Wang, Lei; Lin, Dasheng; Chen, Zhiwen

    2013-08-01

    Mid-distal third humeral shaft fractures can be effectively treated with minimally invasive plating osteosynthesis and intramedullary nailing (IMN). However, these 2 treatments have not been adequately compared. Forty-seven patients (47 fractures) with mid-distal third humeral shaft fractures were randomly allocated to undergo either minimally invasive plating osteosynthesis (n=24) or IMN (n=23). The 2 groups were similar in terms of fracture patterns, fracture location, age, and associated injuries. Intraoperative measurements included blood loss and operative time. Clinical outcome measurements included fracture healing, radial nerve recovery, and elbow and shoulder discomfort. Radiographic measurements included fracture alignment, time to healing, delayed union, and nonunion. Functional outcome was satisfactory in both groups. Mean American Shoulder and Elbow Surgeons score and Mayo score were both better for the minimally invasive plating osteosynthesis group than for the IMN group (98.2 vs 97.6, respectively, and 93.5 vs 94.1, respectively; Pshaft fractures. Minimally invasive plating osteosynthesis is more suitable for complex fractures, especially for radial protection and motion recovery of adjacent joints, compared with IMN for simple fractures. Copyright 2013, SLACK Incorporated.

  11. TACTICS OF TREATMENT IN CHILDREN WITH INTRAARTICULAR FRACTURES OF THE DISTAL HUMERUS

    Directory of Open Access Journals (Sweden)

    Y. N. Proshchenko

    2012-01-01

    Full Text Available Material and methods. The authors studied 121 patients with intra-articular fractures of the distal humerus in age from 3 to 18 years. In the study group (consisted of 81 patients the displacement of the distal fragment retained after a single unsuccessful reduction. In these children open reduction and fixation were performed. In cases of damaged neurovascular bundle the authors carried out revision and reconstruction of damaged nerve and vascular trunks. The control group consisted of 40 children who were treated conservatively (closed reposition. Follow-up was at least 6 months after discharge. Results. Evaluation of the functional results showed improvement in 67,0% of patients in the study group and 33,0% - in the control group. In study group a good anatomic result was achieved in 73 (90% patients, satisfactory - in 6 (7,5% and poor - in 2 (2,5%. In the control group a good anatomical results were obtained in 7 (17,5% patients, satisfactory - in 14 (35%, poor -in 19 (47,5%. Conclusion. Indications for surgical treatment: secondary displacement of bone fragments after a single failure or closed reduction. Elimination of fragment displacement prevents posttraumatic contractures and deformities of the upper extremity, and contribute to the full restoration of elbow joint function.

  12. Flexible intramedullary nailing for distal femoral fractures in patients with myopathies.

    Science.gov (United States)

    Huber, Hanspeter; André, Guillaume; Rumeau, Francine; Journeau, Pierre; Haumont, Thierry; Lascombes, Pierre

    2012-06-01

    Distal femoral fractures are quite common in nonambulating patients with myopathies, as they present marked osteoporosis. The deterioration of preexisting knee flexion contracture is a known problem, as these fractures are usually angulated posteriorly. The goals of treatment are to reduce immobilization and bed rest to a minimum, prevent function loss, and prevent refracture. The aim of our work was to investigate if these goals can be achieved by an operative treatment with closed reduction and flexible intramedullary nailing (FIN). Six distal femoral fractures in four nonambulating patients with myopathies (three Duchenne muscular dystrophy and one nemaline myopathy) were treated with FIN between 2005 and 2011. Patient charts and radiographs were reviewed to determine if intra- or postoperative complications occurred and to detect the interval to wheelchair mobilization and hospital discharge. Pre- and postoperative knee flexion contracture was noted from the patient charts of our reeducation unit, where patients were already known preoperatively. Wheelchair mobilization without further immobilization after an interval of 2-3 days was possible. No aggravation of knee flexion contracture was detected in our patient series. No complications associated to the operative treatment itself and no refractures in the follow up occurred. Our experience showed that FIN is a low invasive and sufficiently stable osteosynthesis in such fractures. Left in place, nails will reinforce mechanical stability.

  13. Micromotion in the fracture healing of closed distal metaphyseal tibial fractures: A multicentre prospective study.

    Science.gov (United States)

    Vicenti, G; Pesce, V; Tartaglia, N; Abate, A; Mori, C M; Moretti, B

    2014-12-01

    The dynamic locking screw (DLS) in association with minimally invasive plate osteosynthesis (MIPO) in a bridging construct for simple metadiaphyseal long bone fractures enables modulation of the rigidity of the system and facilitates the development of early and triplanar bone callus. Twenty patients affected by distal tibial fracture were treated with MIPO bridging technique and DLS at the proximal side of the fracture. Time of consolidation, quality of the reduction, complications and American Orthopaedic Foot and Ankle Society (AOFAS) score were monitored and the results compared with those from a control group treated with only standard screws on both fracture sides. Student t-test for independent samples was used for the comparison of means between the two groups. Chi-square test was used for the comparison of proportions. A multiple logistic regression model was constructed to assess the possible confounding effects. Performance was considered significant for p<0.05. The mean healing time was 17.6 ± 2.8 weeks in the group treated with standard screws and 13.5 ± 1.8 weeks in the group treated with DLS (t=5.5, p<0.0001). The DLS was associated with early healing and triplanar bone callus. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Eccentric circummeatal based flap with limited urethral mobilization: An easy technique for distal hypospadias repair.

    Science.gov (United States)

    Ekinci, Saniye; Çiftçi, Arbay Özden; Karnak, İbrahim; Şenocak, Mehmet Emin

    2016-04-01

    patients were treated using dilatation, fistula repair, meatoplasty, and secondary repair with the same technique, respectively. Eventually all patients had a vertical slit-like meatus on the tip of a natural looking glans. The most commonly used distal hypospadias repair techniques are glanular approximation, meatal advancement and glanuloplasty, Koff, Mathieu, Thiersch-Duplay procedure, tubularized incised plate repairs, and modifications of these techniques. Cosmetic and functional results and complication rates of ECMB-LUM technique are comparable with those of the commonly used techniques. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  15. Proximal Intermetatarsal Divergence in Distal Chevron Osteotomy for Hallux Valgus: An Overlooked Finding.

    Science.gov (United States)

    Akpinar, Evren; Buyuk, Abdul Fettah; Cetinkaya, Engin; Gursu, Sarper; Ucpunar, Hanifi; Albayrak, Akif

    2016-01-01

    The goal of distal chevron osteotomy for hallux valgus is to restore proper first-toe joint alignment by performing lateral translation of the distal first metatarsal fragment (the metatarsal head). We hypothesized that in some patients this procedure might also result in involuntary medial translation of the proximal first metatarsal fragment, which we called proximal intermetatarsal divergence. The aim of the present study was to compare the pre- and postoperative radiographs of patients with hallux valgus to determine whether we could identify proximal intermetatarsal divergence. We retrospectively compared the pre- and postoperative radiographs of 29 feet in 28 patients treated with distal chevron osteotomy. Two different methods were used to measure the intermetatarsal angles: the anatomic intermetatarsal angle (aIMA) and the mechanical intermetatarsal angle (mIMA). The maximum intermetatarsal distance (MID) was also measured. We defined proximal intermetatarsal divergence as a postoperative increase in the aIMA or MID, coupled with a decrease in the mIMA. For data analysis, we divided the patients into low-angle (mild deformity) and high-angle (severe deformity) groups, according to their preoperative mIMA. The mean ± standard deviation patient age was 41 ± 14 years. In the low-angle group, the mean mIMA decreased (from 10.91° to 7.00°), the mean aIMA increased (from 11.80° to 13.55°), and the mean MID increased (from 17.97 mm to 20.60 mm; p = .001, for all). In the high-angle group, the mean mIMA decreased (from 14.30° to 6.90°; p = .001), the mean aIMA decreased (from 14.77° to 13.54°; p = .06), and the mean MID decreased (from 20.74 mm to 20.37 mm; p = .64). The results of our study suggest that proximal intermetatarsal divergence might occur after distal chevron osteotomy for hallux valgus, primarily in patients with a low preoperative mIMA. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All

  16. Outcome of Distal Both Bone Leg Fractures Fixed by Intramedulary Nail for Fibula & MIPPO in Tibia.

    Science.gov (United States)

    Gupta, Anil; Anjum, Rashid; Singh, Navdeep; Hackla, Shafiq

    2015-04-01

    Fractures of the distal third of the tibia are mostly associated with a fibular fracture that often requires fixation. The preferred treatment of distal tibial fracture is the minimally invasive percutaneous plate osteosynthesis (MIPPO) procedure. However, there are no clear cut guidelines on fixation of the fibular fracture and currently most orthopedic surgeons use a plate osteosynthesis for the fibula as well. A common complication associated with dual plating is an increased chance of soft tissue necrosis, infection, and in some cases resulting in an exposed implant. We conducted a prospective study to analyze the results of fractures of the distal in both leg bones managed by the MIPPO procedure for tibial fractures and a rush nail for fibular fractures. The study was conducted in a tertiary care hospital from November 2012 to May 2014, a total of 30 fractures in 30 patients (18 males, 12 females) with a mean age of 42.4 years (26-60 years) were treated in our institution in the aforesaid time period with MIPPO for tibia and rush nail for fibular fractures. All the cases were operated on by a single surgeon in emergency within 24 hours. The patients with skin blistering and compound fractures were excluded from this study. Rehabilitative measures were proceeded as per patient's pain profile, isometric and isotonic exercises were started on the first post-operative day, with full weight bearing at 10-12 weeks after assessing clinical and radiological union. Regular follow up of patients was done, radiographs were taken at the immediate post-operative period and at 3, 6, 12 and 24 weeks. All the patients were available for regular follow up. Radiological and clinical union proceeded normally in all the patients, no patients had signs of any deep infection, delayed union or nonunion, three patients had a superficial infection of the tibial incision that healed with a change in antibiotic. The use of dual plating for fixation of the lower tibia and fibula

  17. Effects of unfocused extracorporeal shock wave therapy on healing of wounds of the distal portion of the forelimb in horses.

    Science.gov (United States)

    Silveira, Andressa; Koenig, Judith B; Arroyo, Luis G; Trout, Donald; Moens, Noël M M; LaMarre, Jonathan; Brooks, Andrew

    2010-02-01

    To determine effects of extracorporeal shock wave therapy (ESWT) on healing of wounds in the distal portion of the forelimb in horses. 6 horses. Five 6.25-cm2 superficial wounds were created over both third metacarpi of 6 horses. Forelimbs were randomly assigned to treatment (ESWT and bandage) or control (bandage only) groups. In treated limbs, each wound was treated with 625 shock wave pulses from an unfocused electrohydraulic shock wave generator. In control limbs, each wound received sham treatment. Wound appearance was recorded weekly as inflamed or healthy and scored for the amount of protruding granulation tissue. Standardized digital photographs were used to determine the area of neoepithelialization and absolute wound area. Biopsy was performed on 1 wound on each limb every week for 6 weeks to evaluate epithelialization, fibroplasia, neovascularization, and inflammation. Immunohistochemical staining for A smooth muscle actin was used to label myofibroblasts. Control wounds were 1.9 times as likely to appear inflamed, compared with treated wounds. Control wounds had significantly higher scores for exuberant granulation tissue. Treatment did not affect wound size or area of neoepithelialization. No significant difference was found for any of the histologic or immunohistochemical variables between groups. Treatment with ESWT did not accelerate healing of equine distal limb wounds, but treated wounds had less exuberant granulation tissue and appeared healthier than controls. Therefore, ESWT may be useful to prevent exuberant granulation tissue formation and chronic inflammation of such wounds, but further studies are necessary before recommending ESWT for clinical application.

  18. Biomechanical comparison of orthogonal versus parallel double plating systems in intraarticular distal humerus fractures

    Directory of Open Access Journals (Sweden)

    Ata C. Atalar

    2017-01-01

    Conclusion: Our study showed that both plating systems had similar biomechanical stabilities when anatomic plates with distal locking screws were used in intraarticular distal humerus fractures in artificial humerus models.

  19. Multicentre prospective evaluation of implant-assisted mandibular bilateral distal extension removable partial dentures: patient satisfaction

    NARCIS (Netherlands)

    Wismeijer, D.; Tawse-Smith, A.; Payne, A.G.T.

    2013-01-01

    Objective To compare the levels of patient satisfaction with either conventional mandibular bilateral distal extension partial dentures or those assisted by bilateral distal implants. Materials and methods Forty-eight participants who were dissatisfied with their existing conventional mandibular

  20. Minimally invasive versus open distal pancreatectomy (LEOPARD) : Study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    de Rooij, Thijs; van Hilst, Jony; Vogel, Jantien A.; van Santvoort, Hjalmar C.; de Boer, Marieke T.; Boerma, Djamila; van den Boezem, Peter B.; Bonsing, Bert A.; Bosscha, Koop; Coene, Peter-Paul; Daams, Freek; van Dam, Ronald M.; Dijkgraaf, Marcel G.; van Eijck, Casper H.; Festen, Sebastiaan; Gerhards, Michael F.; Koerkamp, Bas Groot; Hagendoorn, Jeroen; van der Harst, Erwin; de Hingh, Ignace H.; Dejong, Cees H.; Kazemier, Geert; Klaase, Joost; de Kleine, Ruben H.; van Laarhoven, Cornelis J.; Lips, Daan J.; Luyer, Misha D.; Molenaar, I. Quintus; Nieuwenhuijs, Vincent B.; Patijn, Gijs A.; Roos, Daphne; Scheepers, Joris J.; van der Schelling, George P.; Steenvoorde, Pascal; Swijnenburg, Rutger-Jan; Wijsman, Jan H.; Abu Hilal, Moh'd; Busch, Olivier R.; Besselink, Marc G.

    2017-01-01

    Background: Observational cohort studies have suggested that minimally invasive distal pancreatectomy (MIDP) is associated with better short-term outcomes compared with open distal pancreatectomy (ODP), such as less intraoperative blood loss, lower morbidity, shorter length of hospital stay, and