Deformidad de Madelung: presentación de un caso / Madelung deformity: a case presentation

La deformidad de Madelung es una alteración poco común de la articulación de las muñecas. Se vincula a mutaciones del gen SHOX y se caracteriza por alteraciones en el radio, carpo y cúbito, con predominio bilateral. Afecta principalmente a pacientes de sexo femenino y aparece al inicio de la adolescencia. Se presenta una paciente de 15 años de edad, con antecedentes de problemas de salud. Al entrar en la adolescencia comenzó a presentar deformidad en ambas muñecas, más marcada en el lado derecho acompañado de dolor. El diagnóstico de deformidad de Madelung se concluyó mediante la clínica asociado a la positividad de los estudios imagenológicos, basados en los criterios radiográficos de Dannenberg y otros. Se decidió tratamiento quirúrgico, mediante osteotomía doble correctora para longitud y fijación externa de la mano derecha, con la resolución completa de la deformidad y seguimiento en la Consulta Externa de Ortopedia(AU)

Madelung's deformity is a rare alteration of the wrist joint. It is linked to mutations of the SHOX gene. It is characterized by alterations in the radius, carpus and ulna, predominantly bilateral. It mainly affects female patients; signs and symptoms are evident at the beginning of adolescence. To present a case of a patient with a diagnosis of Madelung deformity. The case of a 15-year-old female patient with a health history and family history of interest of an equine clubfoot father is presented. When she entered adolescence, she began to present deformity in both wrists, more marked in the right side accompanied by pain. This is a patient with a Madelung deformity. The diagnosis was concluded by the clinic associated with the positivity of the imaging studies(AU)

Managing the Pediatric Spine: Growth Assessment

Management of pediatric spinal deformities requires an accurate prediction of growth spurts to allow for timely initiation of treatment and prevention of curve progression. Determining remaining growth potential is also important for avoiding prolonged unnecessary treatment, e.g. bracing for patients nearing skeletal maturity. Many clinical and radiological growth parameters have been developed to aid clinicians in growth prediction. Of these, several commonly used measures such as height and arm span growth trends, timing of menarche, and the Risser sign are mostly retrospective and lack strong predictive utility. Bone age assessments, such as digital skeletal age and the distal radius and ulna classification, are more accurate parameters, but further research is required to determine interethnic variations and develop their role in management decisions.

The Radial Bow following Square Nailing in Radius and Ulna Shaft Fractures in Adults and its Relation to Disability and Function

One of the points made against nailing in radius and ulna shaft fractures has been the loss of radial bow and its impact on function. The aims of the study were to assess the change in magnitude and location of the radial bow in radius and ulna shaft fractures treated with intramedullary square nails and to assess the impact of this change on functional outcome, patient reported disability and the range of motion of the forearm. We measured the magnitude of radial bow and its location in the operated extremity and compared it to the uninjured side in 32 adult patients treated with intramedullary square nailing for radius and ulna shaft fractures at our institute. The mean loss of magnitude of maximum radial bow was 2.18 mm which was statistically significant by both student-T test and Mann-Whitney U test with p value less than 0.01. The location of maximum radial bow shifted distally but was statistically insignificant. The magnitude of maximum radial bow had a negative correlation with DASH score that was statistically insignificant (R=- 0.22, p=0.21). It had a positive, statistically significant correlation to the extent of supination in the operated extremity (R = 0.66, p = 0.0004). A loss of up to 2mm of radial bow did not influence the functional outcome as assessed by criteria reported by Anderson et al. The magnitude of radial bow influenced the supination of the forearm but not the final disability as measured by DASH score. Intramedullary nailing did decrease the magnitude of radial bow but a reduction of up to 2mm did not influence the functional outcome.

Epiphyseal fusion at lower end of radius and ulna valuable tool for age determination.

Age estimation is an important task and valuable tool to assist in many civil and criminal procedures, especially in developing countries like India where illiterate population is not aware of the importance of registration of births or the record of registration may not be properly maintained. Physical methods for age estimation are not accurate and eruption of teeth (except third molar) is complete by the age of 16 years. Epiphyseal fusion of long bones is relatively constant in timings and important for age estimation in such cases up to the age of 22 years. This present prospective study is carried out at Forensic Medicine Department of B. J. Medical College, Ahmedabad during the year 2009-10 on 104 subjects of either sex with known age from 15-21 years. It was noticed that the epiphyseal fusion at lower end of radius and ulna processes and progresses bilaterally symmetrical, begins at the age of 16-18 years and completes by the end of 20 year. It was further noticed union at lower end of ulna occurs in advance of radius and females show union in advance of male subjects.

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

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 por cento) com lesões principalmente no terço distal (64,93 por cento 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 percent) with lesions mainly in the distal third (64.93 percent of the fractures). Animals that have been operated with smaller interval between the fracture occurrence and the surgery showed better results. There was a significant difference between osteosynthesis by external fixators and screwed plates when compared to external immobilization, independent on the fracture site.

Biomechanical comparison and analysis of three methods of treatment to middle-part radius and ulna fracture / 中国矫形外科杂志

[Objective]To discuss the difference of mechanical stability in using different fixation methods in treating radius and ulna fracture,in order to provide a theoretical basis for clinical applications.[Method]In the experiment,15 pieces of fresh radius and ulna were used to produce middle-part transverse fracture models(A3.2)which were fixed by three different methods(double plate fixation group,double-intramedullary nail fixation group,ulnar intramedullary nailing + radial plate group).Through biomechanical tests,axial stiffness,bending stiffness,torsional stiffness and the equivalent stiffness were compared.[Result]There were no difference between double-plate group and ulnar intramedullary nailing + radial plate group,the stability in these two groups were higher than that in double-intramedullary nail fixation group.[Conclusion]Ulnar intramedullary nailing + radial plate has a good biomechanical property,it can provide firm fixation and with less trauma.So it is a good fixation.

Congenital Pseudarthrosis of Bones of the Forearm: A Case Report / 대한정형외과학회잡지

Congenital pseudarthrosis of the tibia is a relatively rare but well known entity. Aside from the fibula, which is aften associated with tibia, the clavicle is probably the next preponderant site. Congenital pseudoarthrosis of other bones are extremely rare. We have found 10 cases of congenital pseudarthrosis of either the radius or the ulna in the English literature. Only one case of congenital pseudarthrosis of both bones of the forearm has been reported to our knowledge, A 30 year old man with congenital pseudarthrosis of the radius and the ulna associated with neurofibromatosis was seen at Seoul National University Hospital in March, 1985. Osteosynthesis was successful on the radius, but failed on the ulna. The distal fragment of the ulna eventulally disappeared altogether.