Artéria ulnar superficial diagnosticada por ultrassom vascular: relato de caso / Superficial ulnar artery diagnosed by vascular ultrasound: case report

Resumo O maior ramo da divisão terminal da artéria braquial é a artéria ulnar, que se origina após a fossa cubital. Essa artéria usualmente tem trajeto profundo aos músculos do antebraço anterior e é responsável pela vascularização da musculatura superficial e profunda da região ulnar do antebraço e hipotênar da mão, sendo a principal responsável pela formação do arco palmar superficial após o retináculo dos flexores. Reportamos uma variação anatômica após diagnóstico com ultrassom vascular na qual a artéria ulnar situava-se em posição superficial no antebraço. A ocorrência da artéria ulnar superficial é rara, porém de grande importância para clínicos, cirurgiões e profissionais de enfermagem.

Abstract The largest branch of the terminal division of the brachial artery is the ulnar artery, which arises after the cubital fossa. This artery usually has a deep path in the muscles of the anterior forearm and is responsible for vascularization of the superficial and deep musculature on the ulnar side of the forearm and hypothenar area of the hand. We report an anatomical variant diagnosed by Doppler ultrasound in which the ulnar artery had a superficial position in the forearm. Occurrence of a superficial ulnar artery is rare, but it is an important fact for clinicians, surgeons, and nursing professionals.

Caracterización de las fracturas supracondíleas del húmero en niños que requirieron manejo quirúrgico en un hospital de Santander, Colombia / Characterization of Supracondylar Fractures of the Humerus in Children who Required Surgical Management at a Hospital in Santander, Colombia / Caracterização das fraturas supracondilianas do úmero em crianças que precisaram de tratamento cirúrgico em um hospital de Santander, Colômbia

Introducción. El objetivo del estudio fue describir las características sociodemográficas, tratamiento y complicaciones pre y posquirúrgicas de las fracturas supracondíleas del húmero distal en niños que requirieron manejo quirúrgico en un hospital de Santander, Colombia. Metodología. Se trata de un estudio observacional, descriptivo, de corte transversal con 58 pacientes que cumplieron los siguientes criterios de inclusión: edad entre 3 a 14 años, fracturas supracondíleas de manejo quirúrgico; como criterios de exclusión se tomó: antecedente de enfermedad ósea o neurológica previa y fracturas de más de 7 días de evolución. Para las variables continuas se usó medidas de tendencia central y dispersión, las categóricas en porcentajes y frecuencias absolutas. Resultados. La edad media de presentación fue de 6.2 años, el principal mecanismo de trauma fue caídas de altura con un 96.5%. El 65.5% provenía de zonas urbanas. El 13.8% se asoció con fracturas de antebrazo, y el 3.4% de epitróclea. La fijación se realizó en un 75% con técnica cruzada y un 17.2% se asoció con lesión iatrogénica del nervio ulnar. Discusión. En el estudio no se informaron lesiones vasculares; sin embargo, se documentó una alta prevalencia de lesión neurológica con la fijación medial, similar a lo descrito en la literatura (1.4%-17.7%); algunos autores describen técnicas que disminuyen estas lesiones hasta en un 0%. Conclusión. Las características sociodemográficas de nuestra población coinciden con la estadística publicada mundialmente; la principal complicación fue la lesión iatrogénica nervio ulnar, que se puede disminuir con un uso racional del pin medial y con el empleo de técnicas que busquen rechazar directamente el nervio. Palabras clave: Fracturas del Húmero; Fijación Interna de Fracturas; Clavos Ortopédicos; Codo; Niño; Nervio Cubital.

Introduction. The objective of this study was to describe sociodemographic characteristic, treatment, and pre- and post-surgical complications of supracondylar fractures of the distal humerus in children who required surgical management at a hospital in Santander, Colombia. Methodology. This was an observational, descriptive, and cross-sectional study involving 58 patients who met inclusion criteria: age between 3 and 14 years old, supracondylar fractures with surgical management; exclusion criteria include previous bone or neurological illness and fractures with more than 7 days of evolution. Central tendency and dispersion measures were used for continuous variables, and categorical variables in percentages and absolute frequencies. Results. The average age at presentation was 6.2 years old, the main mechanism of trauma was fall from height (96.5%). 65.5% came from urban zones. The 13.8% were associated with forearm fractures, and 3.4% with epitrochlear fractures. Pinning was performed at 75% with crossed technique and 17.2% were associated with iatrogenic ulnar nerve injury. Discussion. Study didn't inform vascular injuries. However, a high prevalence of neurological injury with medial pinning was documented, similar to that describe in the literature (1.4%-17.7%); some author described techniques that reduce these lesions by 0%. Conclusion. The sociodemographic characteristics of our population match with worldwide published statistics; the main complication was iatrogenic ulnar nerve injury, which can be reduced with the rational use of medial pin and with the application of techniques that seek to directly spare the nerve. Keywords: Humeral Fractures; Fracture Fixation, Internal; Bone Nails; Elbow; Child; Ulnar Nerve.

Introdução. O objetivo do estudo foi descrever as características sociodemográficas, o tratamento e as complicações pré e pós-cirúrgicas das fraturas supracondilianas do úmero distal em crianças que precisaram de tratamento cirúrgico em um hospital de Santander, Colômbia. Metodologia. Trata-se de um estudo observacional, descritivo e transversal com 58 pacientes que atenderam aos seguintes critérios de inclusão: idade entre 3 e 14 anos, fraturas supracondilianas tratadas cirurgicamente. Os critérios de exclusão foram: histórico de doença óssea ou neurológica prévia e fraturas com duração superior a 7 dias de evolução. Para variáveis contínuas foram utilizadas medidas de tendência central e dispersão, as categóricas em percentuais e frequências absolutas. Resultados. A média de idade de apresentação foi de 6.2 anos, o principal mecanismo de trauma foi a queda de altura com 96.5%. 65.5% vieram de áreas urbanas. 13.8% estavam associados a fraturas de antebraço e 3.4% a epitróclea. A fixação foi realizada em 75% com técnica cruzada e 17.2% esteve associada à lesão iatrogênica do nervo ulnar. Discussão. Nenhuma lesão vascular foi relatada no estudo. No entanto, foi documentada alta prevalência de lesão neurológica com fixação medial, semelhante à descrita na literatura (1.4%-17.7%). Alguns autores descrevem técnicas que reduzem essas lesões em até 0%. Conclusão. As características sociodemográficas da nossa população coincidem com as estatísticas publicadas mundialmente. A principal complicação foi a lesão iatrogênica do nervo ulnar, que pode ser reduzida com o uso racional do pino medial e com o uso de técnicas que buscam rejeitar diretamente o nervo. Palavras-chave: Fraturas do Úmero; Fixação Interna de Fraturas; Pinos Ortopédicos; Cotovelo; Criança; Nervo Ulnar

QUALITATIVE STUDY: DERMATOGLYPHIC PATTERN IN PATIENTS WITH TYPE II DIABETES MELLITUS

Aims and objectives: To study the dermatoglyphic patterns in healthy and Type II diabetes mellitus subjects. To study the arches, Ulnar loop, Radial loop and Whorl patterns The present study was conducted i Methods: n the Department of Anatomy, Index Medical College, Indore (M.P.), India. Subjects of the age group 35-65 years was chosen from North Indian Population. Patients and controls were selected randomly from Index Medical College and Hospital, Indore (M.P.) India. The bilateral rolled finger and palm prints of 100 Diabetes Mellitus II patients were compared to 100 controls. Results: Shows that the comparison of right ulnar loop, right whorl, left ulnar loop, left radial loop, and left whorl in male between healthy subjects and type II diabetes mellitus patients, which are statistically significant. (p <0.001). whereas right arch, right radial loop, and left arch is not statistically significant. Fingertip ridge count of right ulnar loop, Conclusions: right radial loop and left ulnar loop, is increased in healthy male subjects as compared to type II diabetes mellitus. While right arch, right whorl, left arch, left radial loop, and left whorl is decreased.

Endoscopic Release of the Ulnar Nerve at the Elbow: Technique Description and Case Series / Liberação endoscópica do nervo ulnar no cotovelo: Descrição da técnica e série de casos

Abstract Objective The endoscopic release of the ulnar nerve reproduces a simple (in situ) procedure with smaller incisions, less soft tissue damage, and higher preservation of nerve vascularization. Endoscopy allows the clear visualization of the entire path of the nerve and surrounding noble structures. Moreover, it reveals any signs of compression and allows a safe release of 10cm distally or proximally to the medial epicondyle. Methods A retrospective survey revealed that 15 subjects (1 with a bilateral injury) underwent an ulnar nerve compression release at the elbow using the endoscopic technique with Agee (Micro-Aire Sugical Instruments, Charlottesville, VA, EUA) equipment from January 2016 to January 2020. Results Symptoms of ulnar nerve compression improved in all patients; on average, they resumed their work activities in 26.5 days. There was no recurrence or need for another procedure. In addition, there were no severe procedure-related complications, such as infection and nerve or vascular injury. One patient had transient paresthesia of the sensory branches to the forearm, with complete functional recovery in 8 weeks. Conclusion Our study shows that the endoscopic release of the ulnar nerve at the elbow with the Agee equipment is a safe, reliable technique with good outcomes.

Resumo Objetivo A liberação endoscópica do nervo ulnar permite reproduzir uma liberação simples (in situ), mas através de incisões menores e com menor lesão de partes moles e uma maior preservação da vascularização do nervo. A visualização clara através da endoscopia permite observar todo o trajeto do nervo e das estruturas nobres circundantes, mostrando os sinais de compressão, possibilitando realizar a liberação de forma segura em um trajeto de 10 cm nos sentidos distal e proximal ao epicôndilo medial. Método Foram encontrados, de forma retrospectiva, no período entre janeiro de 2016 e janeiro de 2020, 15 pacientes (sendo 1 com lesão bilateral) submetidos a liberação da compressão do nervo ulnar no cotovelo pela técnica endoscópica com equipamento de Agee (Micro-Aire Sugical Instruments, Charlottesville, VA, EUA). Resultados Todos os pacientes tiveram melhora dos sintomas de compressão do nervo ulnar e o período de retorno ao trabalho foi de em média 26,5 dias. Não houve recidivas e não houve a necessidade de outro procedimento. Também não houve complicações graves decorrentes do procedimento, como infecção, lesão nervosa ou vascular. Em um paciente, houve parestesia transitória dos ramos sensitivos para o antebraço, com retorno completo da função em 8 semanas. Conclusão Os resultados mostram que a liberação endoscópica do nervo ulnar no cotovelo comoequipamentodeAgeeéuma técnica segura, confiável e com bons resultados.

Variaciones anatómicas de las arterias radial y ulnar en miembros superiores plastinados / Anatomical variations of radial and ulnar arteries in plastinated upper limbs

Los avances en el área de la salud, con el desarrollo de nuevos procedimientos diagnósticos y quirúrgicos, requieren un conocimiento cada vez más preciso de la anatomía humana. La difusión de la disposición variable de la anatomía resulta primordial no sólo en el campo de la especialización o el postgrado, sino por sobre todo, en el pregrado, desde donde se formarán los especialistas que luego desarrollarán esas nuevas prácticas clínicas y quirúrgicas que requerirán una sólida formación anatómica. Es por esto que la aplicación correcta de técnicas anatómicas en las muestras anatómicas es fundamental para que esta enseñanza en el pregrado pueda desarrollarse de manera eficiente, teniendo la plastinación un rol fundamental en este sentido. El objetivo de este trabajo consistió en dar a conocer el hallazgo de variaciones anatómicas arteriales en los miembros superiores de una muestra humana sometida al proceso de plastinación para fomentar, por un lado, la importancia del conocimiento anatómico en el pregrado, el postgrado y las especialidades, como así también la relevancia de la preservación a largo plazo de material biológico para la difusión continua de la anatomía.

SUMMARY: Advances in the area of health with the development of new diagnostic and surgical procedures require an increasingly precise knowledge of human anatomy. The diffusion of the variable arrangement of anatomy is essential not only in the field of specialization or postgraduate, but above all, in the undergraduate, from where the specialists will be trained who will later develop these new clinical and surgical practices that will require a solid anatomical background. This is why the correct application of anatomical techniques in anatomical samples is essential for this undergraduate teaching to be developed efficiently, plastination having a fundamental role in this regard. The aim of this work was to report the discovery of anatomical variations in the upper limbs of a human sample subjected to the plastination process to promote, on one hand, the importance of anatomical knowledge in undergraduate, postgraduate and specialties, as well as the relevance of long- term preservation of biological material for the continued dissemination of anatomy.

Ramo comunicante entre los nervios mediano y ulnar en el antebrazo humano / Communicanting branch between median and ulnar nerves in the human forearm

El ramo comunicante mediano-ulnar (RCMU) es la conexión que se origina del nervio mediano (NM) o alguno de sus ramos, para unirse al nervio ulnar (NU) en el antebrazo humano. Cuando este RCMU está presente, determina una prevalencia que oscila entre un 8 % y un 32 %, de tal manera los axones del NM se trasladen al NU, modificando la inervación habitual de los músculos de la mano. Nuestro objetivo fue determinar la prevalencia, biometría, topografía y relaciones anatómicas del RCMU. Adicionalmente, se estableció la coexistencia de otras conexiones entre los NM y NU en el antebrazo y la mano. Se realizó un estudio descriptivo, cuantitativo, no experimental y transeccional. Disecamos 30 antebrazos humanos de individuos adultos, pertenecientes al programa de donación cadavérica de la Pontificia Universidad Católicade Chile. Las muestras estaban fijadas en formalina y a 4 °C. El RCMU se presentó en 5 casos (17 %). De estos ramos, tres surgieron del nervio interóseo anterior (NIA) (60 %) y dos (40 %) del ramo que el NM aporta a los músculos superficiales del compartimiento anterior del antebrazo. Estos se clasificaron de acuerdo a la literatura, así el tipo Ic se presentó en tres casos (60 %), y el tipo Ia en dos (40 %). La longitud promedio del RCMU fue de 53,9 mm. El origen del RCMU se ubicó en el tercio proximal y la conexión de este con el NU se estableció en el tercio medio del antebrazo. En tres casos (60 %) se observó la coexistencia del RCMU y una conexión entre los ramos digitales palmares comunes. Estos hallazgos confirman que el RCMU mayoritariamente se extiende entre el nervio interóseo anterior y el NU, y su presencia podría modificar la distribución nerviosa de la mano.

SUMMARY: The median-ulnar communicating branch (MUCB) is the communication that originates from the median nerve (MN) or one of its branches, to join the ulnar nerve (UN) in the human forearm. With a prevalence that oscillates between 8% and 32%, when this MUCB is present, it establishes that axons from the MN move to the UN, modifying the normal innervation of the muscles of the hand. Our aim was to determine the prevalence, biometry and topography and anatomical relationships of the MUCB. Additionally, the coexistence of this MUCB with other connections between the MN and UN was established. A descriptive, quantitative, non experimental and transectional study was conducted. Thirty adult human forearms belonging to the cadaveric donation program of the Pontificia Universidad Católica de Chile were dissected. The samples were fixed in formalin and stored at 4 °C. The MUCB appeared in 5 cases (17%). Of these, three originated from the anterior interosseous nerve (60%) and two (40%) arose from the branch that the MN gives it to the superficial muscles of the anterior compartment of the forearm. These were classified according to the literature consulted, obtaining that Group Ic occurred in three cases (60%), and Group Ia in two (40%). The average MUCB length was 53.9 mm. The origin of the MUCB was on average 21% of the length of the forearm from the biepicondylar line. The connection of this MUCB with the UN was located on average at 44% from this line. In three cases (60%) the coexistence of the MUCB and a connection between the common palmar digital nerves was observed. These findings confirm that the RCMU is generally established between the anterior interosseous nerve of forearm and NU, and its presence could modify the nerve distribution of the hand.

Anatomical and histomorphometric study of the ulnar nerve at the wrist / Estudio anatómico e histomorfométrico del nervio ulnar en la muñeca

SUMMARY: The ulnar nerve (UN) is the main nerve responsible for innervation of the intrinsic musculature of the hand. It is of great importance to have a deep anatomical knowledge of the UN. The aim of this study is to enrich the knowledge of the UN anatomy at the wrist and provide useful reference information for clinical and surgical applications. In this descriptive cross-sectional study, 44 upper limbs of fresh cadavers were evaluated. The UN, the superficial branch of the ulnar nerve (SBUN), and the deep branch of the ulnar nerve (DBUN) were evaluated. Morphometric variables were measured using a digital caliper, and samples of nervous tissue were taken to evaluate the histomorphometry. Before entering the Guyon's canal, the UN had a diameter of 3.2 ± 0.4 mm. In 36 samples (82 %) the UN presented a bifurcation pattern and in the remaining 8 samples (18 %) a trifurcation was shown. The diameter of the DBUN was 1.9 ± 0.33 mm and that of the SBUN was 1.29 ± 0.22 mm. In the bifurcation patterns, the SBUN had a trunk of 5.71 ± 1.53 mm before bifurcating into the common digital nerve (fourth and fifth fingers) and an ulnar digital collateral nerve (fifth finger). The DBUN had an area of 2.84 ± 0.7 mm2 and was made up of 8 ± 1.4 fascicles and 3595 ± 465 axons. The SBUN area was 1.31 ± 0.27 mm2, it was made up of 6 ± 1.1 fascicles and 2856 ± 362 axons. The reported findings allow the hand surgeon to improve his understanding of the clinical signs of patients with UN pathologies at the wrist level and thus achieve greater precision while planning and performing surgical approaches and dissections.

El nervio ulnar (NU) es el principal nervio responsable de la inervación de la musculatura intrínseca de la mano. Es de gran importancia tener un profundo conocimiento anatómico del NU. El objetivo de este estudio fue enriquecer el conocimiento de la anatomía del NU en la muñeca y proporcionar información de referencia útil para aplicaciones clínicas y quirúrgicas. En este estudio descriptivo transversal se evaluaron 44 miembros superiores de cadáveres frescos. Se evaluó el NU, el ramo superficial del nervio ulnar (RSNU) y el ramo profundo del nervio ulnar (RPNU). Las variables morfométricas se midieron con un caliper digital y se tomaron muestras del nervio para evaluar la histomorfometría. Antes de ingresar al canal del nervio ulnar (canal Guyon), el ONU tenía un diámetro de 3,2 ± 0,4 mm. En 36 muestras (82 %) el ONU presentó un patrón de bifurcación y en las 8 muestras restantes (18 %) se presentó una trifurcación. El diámetro del RPNU fue de 1,9 ± 0,33 mm y el del RSNU de 1,29 ± 0,22 mm. En los patrones de bifurcación, el RSNU presentó un tronco de 5,71 ± 1,53 mm antes de bifurcarse en el nervio digital común (cuarto y quinto dedo) y un nervio digital colateral ulnar (quinto dedo). El RPNU tenía un área de 2,84 ± 0,7 mm2 y estaba formado por 8 ± 1,4 fascículos y 3595 ± 465 axones. El área del RSNU fue de 1,31 ± 0,27 mm2, estaba formado por 6 ± 1,1 fascículos y 2856 ± 362 axones. Los hallazgos reportados permiten al cirujano de mano mejorar su comprensión de los signos clínicos de los pacientes con patologías del NU a nivel de la muñeca y así lograr una mayor precisión en la planificación y realización de abordajes y disecciones quirúrgicas.

Radiographic morphometry of the distal end radius in Anatolian population / Morfometría radiográfica del extremo distal del radio en la población de Anatolia

SUMMARY: Distal radius fractures are one of the most common orthopedic injuries encountered by orthopedic surgeons. Correction of dorsal tilt and radial height is essential to restore normal biomechanics of the wrist joint. Comprehensive knowledge of the morphometry of the distal radius of the local population becomes critical for the treating surgeon. This study aims to report the morphometry of the distal radius in the Anatolian population and compare it with similar studies in other races and humans. Radiographs of one hundred and twenty-four people were included in the study. Four radiological parameters were examined on all radiographs: radial height, radial tilt, ulnar variance, and palmar tilt. Radial tilt was 23.35°±1.96; palmar tilt was 15.7°±2,87 radial height (mm) was 10.55±4.34, ulnar variance (mm) was 0.32±1.79. The highest rate of negative ulnar variance was found. According to the study's results, reference data varying by race for anatomical fit should be considered in treating DER injuries.

Las fracturas de la parte distal del radio son probablemente las lesiones ortopédicas más comunes que encuentran los cirujanos ortopédicos. La corrección de la inclinación dorsal y la altura radial es esencial para restaurar la biomecánica normal de la articulación de la muñeca. El conocimiento integral de la morfometría del radio distal de la población local es importante para el cirujano tratante. Este estudio tuvo como objetivo reportar la morfometría de la parte rdistal del radio en la población de Anatolia y compararla con estudios similares en otras razas y humanos. Se incluyeron ciento veinticuatro radiografías simples consecutivas de la articulación de la muñeca. Se examinaron cuatro parámetros radiológicos: altura radial, inclinación radial, variación ulnar e inclinación palmar. El ángulo de inclinación radial fue de 23,35±1,96; el ángulo de inclinación palmar fue de 15,7±, la altura radial (mm) fue de 10,55±4,34, la varianza ulnar (mm) fue de 0,32±1,79. Se encontró la tasa más alta de varianza ulnar negativa (43,5%). Los resultados de este estudio deben tenerse en consideración al tratar fracturas de la parte distal del radio, con datos de referencia que varían según la raza para el ajuste anatómico.

Endoscopic Cubital Tunnel Release in Leprosy Neuritis of the Ulnar Nerve / Liberação endoscópica do túnel cubital na neurite hansênica do nervo ulnar

Abstract Objectives To better characterize the role of endoscopic cubital tunnel release in leprosy neuritis and determine whether there is an improvement in pain, sensitivity, and strength with the use of this minimally invasive technique. Methods A total of 44 endoscopic procedures for ulnar nerve decompression at the elbow were performed in patients who were previously diagnosed with leprosy neuritis. The inclusion criteria were surgical indication for ulnar nerve release and clinical treatment failure for 4 weeks in patients with cubital tunnel syndrome who had their ulnar nerve function, whether motor or sensitive, deteriorated progressively despite the treatment with prednisone 1 mg/kg/day and physiotherapy. For endoscopic release, the CTS Relief Kit (Linvatec. Largo, FL, USA) and a standard 4mm 30° arthroscope were used. Results The study included 39 patients, 29 (74.4%) males and 10 (25.6%) females. The age of the patients ranged from 12 to 64 years (33 ± 14.97). Five patients underwent bilateral release. The release demonstrated a statistically significant improvement in pain (p 0.002), in sensitivity (p< 0.001), and in strength (p< 0.001). The best results were obtained when ulnar release was performed less than 6 months after surgery indication. None of the procedures were converted from endoscopic to open. No major complications (infection, vascular injury, and nervous injury) were reported. One patient had ulnar nerve subluxation. Conclusion The endoscopic release of the ulnar nerve at the elbow in leprosy neuritis entails true and safe benefits for the patient, such as improvement in pain, sensitivity and strength.

Resumo Objetivos Os objetivos deste estudo foram caracterizar melhor o papel da liberação endoscópica do túnel cubital na neurite hansênica e determinar se há melhora da dor, sensibilidade e força com esta técnica minimamente invasiva. Métodos Um total de 44 procedimentos endoscópicos para descompressão do nervo ulnar no cotovelo foram realizados em pacientes previamente diagnosticados com neurite por hanseníase. Os critérios de inclusão foram indicação cirúrgica para liberação do nervo ulnar e insucesso do tratamento clínico por 4 semanas em pacientes com síndrome do túnel cubital que sofreram deterioração progressiva da função motora ou sensitiva do nervo ulnar apesar do tratamento de 1 mg/kg/dia de prednisona e fisioterapia. A liberação endoscópica foi realizada com CTS Relief Kit (Linvatec. Largo, FL, EUA) e um artroscópio padrão de 4 mm e 30°. Resultados O estudo incluiu 39 pacientes, sendo 29 (74,4%) homens e 10 (25,6%) mulheres. A idade dos pacientes variou de 12 a 64 anos (33 ± 14,97). Cinco pacientes foram submetidos à liberação bilateral. A liberação provocou melhora estatisticamente significativa de dor (p= 0,002), sensibilidade (p <0,001) e força (p <0,001). Os melhores resultados foram obtidos quando a liberação ulnar foi realizada em menos de 6 meses após a indicação da cirurgia. Nenhum procedimento foi convertido de endoscópico para aberto. Não foram relatadas complicações maiores (infecção, lesão vascular e lesão nervosa). Um paciente apresentou subluxação do nervo ulnar. Conclusão A liberação endoscópica do nervo ulnar no cotovelo na neurite hansênica traz benefícios verdadeiros e seguros para o paciente, como melhora da dor, sensibilidade e força.

Recent advancements of ulnar nerve complications associated with elbow arthrolysis / 国际外科学杂志

Elbow arthrolysis is the most commonly used treatment for elbow stiffness. Ulnar nerve complications are one of the most important evaluation indicators of postoperative health status. However, there is no consensus on the management of ulnar nerve and the control of surgical indications. Combining relevant literature and clinical experience, this review discussed the necessity of ulnar nerve release and the choice of ulnar nerve operations during elbow arthrolysis with or without preoperative ulnar nerve symptoms. It is considered that more attention should be paid to the management of ulnar nerve complications and further research should be performed.

Clinical effect of Kirschner wire intramedullary fixation in the treatment of pediatric both-bone forearm fractures at high altitude area / 中国骨伤

OBJECTIVE@#To explore the clinical effect of Kirschner wire intramedullary fixation in the treatment of both-bone forearm fractures in children of high altitude area.@*METHODS@#From August 2020 to December 2021, 19 children were treated with Kirschner wire intramedullary fixation including 11 males and 8 females, aged from 4 to 13 years old with an average of (8.16±2.71) years old. The course of disease was 1 to 10 days, with a mean of (4.11±2.51) d. First, close reduction was performed. If the reduction was unsuccessful, limited open reduction was performed, followed by Kirschner wire intramedullary fixation of the radius and ulna. The fracture healing was evaluated by X-ray after operation, and the curative effect was evaluated by Anderson forearm function score standard.@*RESULTS@#The wound healed well after operation, 2 cases had clinical manifestations of needle tail irritation after operation, and the symptoms disappeared after removing the internal fixation. The average follow-up time was(7.68±3.50) months (3 to 14 months). X-ray showed that all fracture healing in follow-up, Anderson forearm function score showed excellent in 16 cases, good in 2 cases and fair in 1 case at the final follow-up.@*CONCLUSION@#Children with fractures in plateau areas often have delayed medical treatment, lack of medical conditions and insufficient compliance. Based on these characteristics, Kirschner wire intramedullary fixation for the treatment of children's double forearm fractures has the advantages of small injury and rapid recovery. It is a kind of operation method that can be popularized.

Application of ulnar nerve diameter changes examined by HRUS in patients with cubital tunnel syndrome / 中国骨伤

OBJECTIVE@#To evaluate the value of high-resolution ultrasound the diagnosis and prognosis of cubital tunnel syndrome.@*METHODS@#From January 2018 to June 2019, 47 patients with cubital tunnel syndrome were treated with ulnar nerve release and anterior subcutaneous transposition. There were 41 males and 6 females, aged from 27 to 73 years old. There were 31 cases on the right, 15 cases on the left, and 1 case on both sides. The diameter of ulnar nerve was measured by high-resolution ultrasound pre-and post-operatively, and measured directly during the operation. The recovery status of the patients was evaluated by the trial standard of ulnar nerve function assessment, and the satisfaction of the patients was assessed.@*RESULTS@#All the 47 cases were followed up for an average of 12 months and the incisions healed well. The diameter of ulnar nerve at the compression level was (0.16±0.04) cm pre-operatively, and the diameter of ulnar nerve was (0.23±0.04) cm post-operatively. The evaluation of ulnar nerve function:excellent in 16 cases, good in 18 cases and fair in 13 cases. Twelve months post-operatively, 28 patients were satisfied, 10 patients were general and 9 patients were dissatisfied.@*CONCLUSION@#The preoperative examination of ulnar nerve by high-resolution ultrasound is consistent with the intuitive measurement during operation, and the result of postoperative examination of ulnar nerve by high-resolution ultrasound is consistent with follow-up results. High-resolution ultrasound is an effective auxiliary method for the diagnosis and treatment of cubital tunnel syndrome.

Analysis of the effectiveness of sequential plate internal fixation in correction of Madelung deformity after ulnar osteotomy and shortening / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of sequential plate internal fixation in the correction of Madelung deformity after ulnar osteotomy and shortening.@*METHODS@#The clinical data of 13 patients with Madelung deformity admitted between September 2015 and July 2021 were retrospectively analyzed. There were 5 males and 8 females with an average age of 18.3 years ranging from 17 to 23 years. The disease duration ranged from 12 to 24 months, with an average of 17 months. Three cases had a clear history of trauma. All patients had external radial deviation deformity and limited movement of the ulnar deviation, and the ulnar impact pain was significant during ulnar deviation movement; 9 patients had limited wrist joint supination movement, and the supination movement was normal. In the first stage, ulnar osteotomy and shortening combined with external fixator were used to correct wrist deformity in 13 patients. After operation, bone transfer was performed 6 times per day, with adjustments made every 4 hours, which was 1 mm per day. After the osteotomy was in place, the ulnar plate internal fixation was performed to reconstruct the ulnar stability in the second stage. The Cooney wrist joint score was used to assess the pain, function, range of motion, flexion and extension range of motion, and grip strength of the wrist joint before operation and before the removal of internal fixator. The subjective feeling and appearance satisfaction of patients were recorded.@*RESULTS@#After the second-stage operation, all the 13 patients were followed up 10-22 months, with an average of 15 months. The deformity of wrist joint disappeared after operation, and the flexion, extension, and ulnar deviation were basically normal. There was no complication such as ulnar impingement sign, nonunion or infection. Wrist function, pain, and range of motion were significantly improved after operation, except for 1 patient who had no significant improvement in rotation and pain. The ulnar internal fixator was removed at 10-18 months after the second-stage operation. The scores of pain, function, range of motion, flexion and extension range of motion, and grip strength in the Cooney wrist score before removal of internal fixator significantly improved when compared with those before operation ( P<0.05). Subjective and appearance satisfaction of patients were excellent in 9 cases, good in 3 cases, and fair in 1 case.@*CONCLUSION@#Ulnar osteotomy and shortening with sequential plate internal fixation for correction of Madelung deformity, with mild postoperative pain, can effectively avoid bone nonunion, improve wrist joint function, and have significant effectiveness.

Pseudoaneurisma de artéria ulnar superficial / Superficial ulnar artery pseudoaneurysm

Resumo A artéria ulnar é o maior ramo terminal da artéria braquial, ela apresenta origem na fossa cubital e é coberta pelos músculos flexores do antebraço. Reportamos uma variação anatômica, na qual a artéria ulnar situava-se em posição superficial no antebraço. Por falta de conhecimento sobre essa variação, ocorreu a lesão após uma tentativa de punção venosa, a qual levou à formação de um pseudoaneurisma.

Abstract The ulnar artery is the larger terminal branch of the brachial artery. It originates in the cubital fossa and is covered by the flexor muscles of the forearm. We report an anatomic variant in which the ulnar artery was in a superficial position in the forearm. Since this variant was unknown, an attempted venous puncture injured the artery, causing formation of a pseudoaneurysm.

Study of the median and ulnar nervous branks to kaplan's line / Estudo entre os ramos dos nervos mediano e ulnar com a linha de kaplan

ABSTRACT Objective: This study aims to present lines A1 and A2 in association with Kaplan's cardinal line (LCK), and relate them to the thenar motor branch of the median nerve (RMTNM) and to the deep branch of the ulnar nerve (RPNU). Methods: Ten hands of five adult cadavers were dissected. Results: The RMTNM origin was positioned proximal to the LCK in all limbs. In two, the RMTNM was positioned exactly on the A1 line; in seven, it was on the ulnar side in relation to A1. In one, it was on the radial side relative to the A1. The origin of the RPNU was identified between the pisiform and the LCK in nine limbs; in one, the RPNU was positioned from the ulnar nerve in relation to A2; and in two, the A2 passed exactly at the point of division of the ulnar nerve into superficial branches and deep. We did not identify the positioning of the RPNU on the radial side of the A2 line. Conclusion: The impact of this study was to identify the anatomical trajectory of these nerves by detaching A1 and A2 along with the KCL, avoiding iatrogenic lesions during surgical procedures. Level of Evidence IV, Case Series.

RESUMO Objetivo: Apresentar as linhas A1 e A2 em associação com a linha cardinal de Kaplan (LCK) e relacioná-las ao ramo motor tenar do nervo mediano (RMTNM) e ao ramo profundo do nervo ulnar (RPNU). Métodos: Foram dissecadas dez mãos de 5 cadáveres adultos. Resultados: Em todos os membros, a origem do RMTNM posicionou proximal a LCK. Em dois, o RMTNM foi posicionado exatamente na linha A1, em sete foi no lado ulnar em relação à A1. Em um, foi no lado radial em relação à A1. A origem do RPNU foi identificada entre o pisiforme e o LCK em 9 membros, em um, o RPNU foi posicionado a partir do nervo ulnar em relação à A2, em dois, a A2 passou exatamente no ponto de divisão do nervo ulnar em ramos superficial e profundo. Não identificamos o posicionamento do RPNU no lado radial da linha A2. Conclusão: O impacto deste trabalho é que, ao destacar A1 e A2 juntamente com o LCK, conseguimos identificar a trajetória anatômica desses nervos e, evitar lesões iatrogênicas durante os procedimentos cirúrgicos. Nível de Evidência IV; Série de Casos.

Concomitant Ulnar Styloid Fractures in Distal Radius Osteosynthesis Does Not Impact Radiographic Outcomes, Ulnar Sided Symptoms and Patient Outcomes

@#Introduction: Current literature reports varied significance of ulnar styloid fractures (USF) associated with distal radius fractures. Our study assesses the role of ulnar styloid fractures and fragment size in surgically managed distal radius fractures. Materials and methods: We reviewed patients who underwent surgical fixation of distal radius fractures between January 2004 to June 2006. Patients were divided into those with (Group 1) and without (Group 0) USFs. Post-operative radiographic parameters, clinical outcomes and overall wrist function were analysed. Outcomes included ulnar-sided wrist pain, extensor carpi ulnaris (ECU) tendinitis, triangular fibrocartilage complex (TFCC) grind test, distal radioulnar joint (DRUJ) instability and pain. Overall wrist function was assessed with range of motion and Disabilities of the Arm, Shoulder and Hand (DASH) score. Results: Our study cohort included 31 males and 23 females, and 38.9% of these patients had concomitant USFs. There was no difference in terms of demographic data and fracture configuration between groups. Radiographic parameters were similar, except for palmar tilt, which was significantly higher in Group 1 (4.6º vs 9.4º, p=0.047). At 24 months, there were no differences in clinical outcomes and overall wrist function. A sub-group analysis showed that mean USF fragment size was larger in patients with a positive TFCC grind test (3.9mm vs 7.3mm, p=0.033). Conclusion: The presence of USFs in surgically managed distal radius fractures does not compromise clinical and functional outcome. Similarly, the size of USFs does not impact clinical and functional outcome but is associated with the presence of a positive TFCC grind test.

Clinical efficacy of anterior radius head fracture combined with lateral ligament complex injury / 中华骨科杂志

Objective:To investigate the operation efficacy of anterior radius head fracture combined with lateral ligament complex injury.Methods:The patients with radial head fracture admitted from September 2017 to August 2021 were retrospectively analyzed, 51 males and 54 females, average age of 38.84±13.63 years (range of 16-70 years). Based on the radial head fractures of Mason classification of type II, the cases involving the anterior radius head fracture were divided into three subtypes according to the number of fracture blocks and the type of displacement: type A (53 cases): one part of the anterior radius head collapse fracture; type B (50 cases): two or more parts of the anterior radial head collapse fracture; type C (2 cases): anterior radius head dissociated and displaced fracture. All fractures were treated with open reduction and internal fixation. Among them, the lateral ligament complex of type B were elongated due to the injury but the continuity existed. Therefore, the lateral ligament complex in 21 cases were not repaired in the early period (unrepaired group); in recent years, 29 cases repaired the lateral ligament complex (repair group). The postoperative efficacy was evaluated by elbow range of motion, table-top relocation test, Mayo score, and Broberg Morrey score. the patients were evaluated at final follow-up, except table-top relocation test was recorded according to the actual completion time.Results:All operations were successfully completed. The mean follow-up was 14.08±1.52 months (range of 12-18 months). Type A: the flexion and extension range was 115.70°±6.35°; the completion time of the table-top relocation test was 75.68±11.90 days; the Mayo score was 93.72±2.40 point, and the Broberg Morrey score was 92.89±2.28 point. Type B: lateral ligament repair group (repaired group) 29 cases and unrepaired lateral ligament group (unrepaired group) 21 cases. The flexion and extension range of elbow in repaired group was 112.1°±4.4°, which was better than that in unrepaired group 105.8°±3.7° ( t=5.31, P<0.001). The completion time of table-top relocation test was 77.72±6.51 days in repaired group and 104.29±18.45 days in unrepaired group ( t=6.32, P<0.001). The Mayo score of the repaired group was 90.21±5.88 points and that of the unrepaired group was 87.14±5.26 points ( t=1.90, P=0.063), and there was no significant difference between the two groups. Broberg Morrey score of 90.93±6.43 points in the repaired group was better than 86.95±6.37 points in the unrepaired group ( t=2.17, P=0.035). Type C for 2 patients, the flexion and extension range of elbow were 107°and 106°; the completion time of table-top relocation test were 82 days and 98 days; the Mayo scores were 91 point and 87 point; Broberg Morrey scores were 93 point and 85 point. There was a patient developed myositis ossificans in unrepair group of tybe B. Conclusion:The elbow joint is stable when one part of the anterior radius head collapse fracture; there is a degree of instability in the elbow when two or more parts of the anterior radial head collapse fractures suggest to repair the lateral ligament complex. The elbow joint is extremely unstable when anterior radius head dissociated and displaced fractures, the lateral ligament complex should be repaired in time.

THE CLINICAL AND DEVELOPMENTAL SIGNIFICANCE OF ULNAR ARTERY VARIATION DURING SURGERIES AND MEDICAL INTERVENTIONS

Background – Ulnar artery is a branch of brachial artery,it descends superficially and vertically between the FCU and FDS in lower two third of forearm. Then it passes above the fiexor retinaculum at wrist later forming superficial palmar arch. During routine dissection in S.N Medical College, Agra, an unusual finding was Case Report- identified in both the upper limb of a 60 year old male cadaver. Ulnar artery runs laterally to ulnar nerve and then passes underneath the fiexor retinaculum. Then it joins with the Superficial Branch of Radial Artery to form Superficial palmar arch. Variation of Ulnar artery is uncommon.It is important in surgical cases of Carpal tunnel release surgery, also can be confused with superficial veins during interventions

Evaluación de las relaciones entre la rama palmar profunda de la arteria ulnar y el ramo profundo del nervio ulnar en la región palmar / Evaluation of the relationship between the deep palmar branch of ulnar artery and the deep branch of the ulnar nerve in the palmar region

RESUMEN: Nos motivó esta presentación los hallazgos observados en la sala de disección sobre las relaciones de la rama palmar profunda de la arteria ulnar y el ramo profundo del nervio ulnar, las diferentes disposiciones de esta rama, el cruzamiento, cuando existe, entre ambos elementos y las pocas referencias sobre el tema, todo con miras a favorecer el abordaje profundo de la palma de la mano y contribuir al conocimiento del área en donde se practican las neurotomías del ramo profundo del nervio ulnar y/ o sus ramas.

SUMMARY: We are motivated by the findings observed in the dissection room on the relationship between the deep palmar branch of ulnar artery and the deep branch of ulnar nerve, the different dispositions of this branch, the crossing, when it exists, between both elements and the few references on the subject, all with a view to favoring the deep approach to the palm and contributing to the knowledge of the area where neurotomies of the deep branch of ulnar nerve and/or its branches are performed.

Evaluations of Repaired Artery Patency in Forearm Wounds Using the Allen Test, Handheld Doppler and Doppler Ultrasonography / Avaliações do lúmen da artéria reparada em lesões do antebraço usando o teste de Allen, Doppler portátil e ultrassonografia com Doppler

Abstract Objective The purpose of the present study was to evaluate the rate of patency in the postoperative period of arterial injuries of the forearm secondary to penetrating trauma. The injuries were subjected to primary repair and examined with the Allen test and a handheld Doppler device, and the results were later confirmed with Doppler ultrasonography. Methods Eighteen patients were included, with a total of 19 arterial lesions, 14 ulnar lesions, and 5 radial lesions; one patient had lesions on both forearms. All patients underwent surgery and three clinical evaluations: the Allen test and assessment of arterial blood flow by a handheld Doppler device at 4 and 16 weeks after surgery and Doppler ultrasonography performed at 12 weeks after surgery. Results At the first clinical evaluation, 77% of the patients had patency based on the Allen test, and 72% had a pulsatile sound identified by the handheld Doppler device. In the second evaluation, 61% of the patients had patency based on the Allen test, and the rate of pulsatile sound by the handheld Doppler device was 72%, similar to that observed 2 months earlier. Based on the Doppler ultrasonography evaluation (~12 weeks after surgery), the success rate for arteriorrhaphy was 88%. Regarding the final patency (Doppler ultrasonography evaluation) and trauma mechanism, all patients with penetrating trauma had patent arteries. Conclusion We cde that clinical evaluation using a handheld Doppler device and the Allen test is reliable when a patent artery can be palpated. However, if a patent artery cannot be located during a clinical examination, ultrasonography may be required.

Resumo Objetivo O objetivo deste estudo foi avaliar a taxa de perviedade pós-operatória de lesões arteriais do antebraço secundárias a traumatismo penetrante. As lesões foram submetidas a reparo primário e examinadas com o teste de Allen e um dispositivo Doppler portátil; posteriormente, os resultados foram confirmados à ultrassonografia com Doppler. Métodos Dezoito pacientes foram incluídos, com um total de 19 lesões arteriais, 14 lesões ulnares e 5 lesões radiais; um paciente tinha lesões em ambos os antebraços. Todos os pacientes foram submetidos à cirurgia e três avaliações clínicas: o teste de Allen e a avaliação do fluxo sanguíneo arterial com um dispositivo portátil de Doppler na 4ª e 16ª semanas após a cirurgia e ultrassonografia com Doppler 12 semanas após o procedimento. Resultados Na primeira avaliação clínica, 77% dos pacientes apresentavam perviedade segundo o teste de Allen e 72% apresentavam som pulsátil identificado pelo Doppler portátil. Na segunda avaliação, 61% dos pacientes apresentaram perviedade com base no teste de Allen e a taxa de som pulsátil ao Doppler portátil foi de 72%, semelhante à observada 2 meses antes. À ultrassonografia com Doppler (cerca de 12 semanas após a cirurgia), a taxa de sucesso da arteriorrafia foi de 88%. Em relação à perviedade final (avaliação por ultrassonografia com Doppler) e mecanismo de trauma, todos os pacientes com traumatismo penetrante apresentavam artérias pérvias. Conclusão Concluímos que a avaliação clínica com um dispositivo Doppler portátil e o teste de Allen é confiável caso a artéria pérvia possa ser palpada. No entanto, a ultrassonografia pode ser necessária em caso de impossibilidade de localização de uma artéria pérvia durante o exame clínico.