Radiological Evaluation of Volar Cortical Angle in the Anatolian Population / Evaluación Radiológica del Ángulo Cortical Volar en la Población Anatoliana

SUMMARY: Distal radius fractures are the most common fractures of the upper limb. The most commonly used method in the repair of these fractures is volar locking plates. Recently, the frequency of removal of volar locking plates after surgery has increased. There are many factors in its reduction. Anatomically, incompatibility of the distal end of the radius with volar locking plates is one of them. In previous studies, different volar cortical angle (VCA) values were found in other races. For this reason, this study aimed to determine the mean values by making VCA measurements of the Anatolian population. The study was designed retrospectively. In the study, measurements were made on computed tomography (CT) images of the distal end of the radius of 53 men and 28 women. Radial width, intermediate volar angle, and radial volar angle were measured in the images. On average, the radius width was 23.35±1.96 mm, and the intermediate volar angle was 26.02±.3.83°, radial volar angle was 24±3.07°. Radial width, intermediate volar angle, and radial volar angle differed significantly by gender (p<0.001). A significant correlation was found between radius width, intermediate volar angle, and radial volar angle values (p<0.001). It has been determined that the Anatolian population has a different VCA value than the European, Asian, and other populations. When using volar locking plates in distal radius fracture surgery, volar locking plates should be selected by considering the average values of the races.

Las fracturas del radio distal son las fracturas más comunes del miembro superior. El método más utilizado en la reparación de estas fracturas son las placas de bloqueo volar. Recientemente, ha aumentado la frecuencia de extracción de placas de bloqueo volar después de la cirugía. Existen muchos factores en su reducción y anatómicamente, la incompatibilidad de la extremidad distal del radio con las placas de bloqueo volar es una de ellas. En estudios anteriores, se encontraron diferentes valores del ángulo cortical volar (VCA) en otras grupos. Por esta razón, este estudio tuvo como objetivo determinar los valores medios, realizando mediciones de VCA de la población de Anatolia. El estudio fue diseñado de manera retrospectiva. En el estudio, se realizaron mediciones en imágenes de tomografía computarizada (TC) de la extremidad distal del radio de 53 hombres y 28 mujeres. En las imágenes se midieron el ancho radial, el ángulo volar intermedio y el ángulo volar radial. En promedio, el ancho del radio fue de 23,35 ± 1,96 mm, el ángulo volar intermedio fue de 26,02 ± 3,83° y el ángulo volar radial fue de 24 ± 3,07°. El ancho radial, el ángulo volar intermedio y el ángulo volar radial difirieron significativamente según el sexo (p<0,001). Se encontró una correlación significativa entre los valores del ancho del radio, el ángulo volar intermedio y el ángulo volar radial (p<0,001). Se ha determinado que la población de Anatolia tiene un valor de VCA diferente al de las poblaciones europeas, asiáticas y otras. Cuando se utilizan placas de bloqueo volar en cirugía de fractura de la extremidad distal del radio, las placas deben seleccionarse considerando los valores promedio de los individuos de diferentes grupos.

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.

Double-column Die-punch fractures of distal radius treated with butterfly plate fixation via Henry approach / 中国骨伤

OBJECTIVE@#To explore clinical effect of open reduction and internal fixation with Henry's approach butterfly plate in treating double-column Die-punch fractures of distal radius.@*METHODS@#From January 2018 to June 2021, 26 patients with double-column Die-column distal radius were treated with open reduction and internal fixation through Henry's surgical approach and using distal radius volar column plate(butterfly plate), including 14 males and 12 females, aged from 20 to 75 years old with an average age of (44.2±3.4) years old. Postopertaive complications were observed, Gartland-Werley score at 12 months after opertaion was used to evaluate wrist joint function.@*RESULTS@#All 26 patients were followed up from 10 to 18 months with an average of(13.4±0.8) months. All fractures were obtained fracture union, the time ranged from 8.5 to 15.8 weeks with an average of (11.4±0.5) weeks. All incisions healed at stageⅠwithout infection, nerve injury and internal fixation failure occurred. Postoperative Gartland-Werley score at 12 months was (3.65±0.36), and 16 patients got excellent result, 8 good and 2 moderate.@*CONCLUSION@#Open reduction and internal fixation with butterfly plate for the treatment of double-column Die-punch fractures of the distal radius through volar Henry approach could obtain satisfactory clinical outcomes.

Clinical analysis of distal radius core decompression for chronic wrist pain / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of distal radius core decompression in the treatment of chronic wrist pain caused by various etiologies.@*METHODS@#A retrospective analysis was performed for the clinical data of 10 patients with chronic wrist pain treated with distal radial core decompression between January 2018 and December 2021. There were 6 males and 4 females with an average age of 37.4 years (range, 21-55 years). The disease duration ranged from 7 to 72 months, with an average of 26.5 months. Preoperative MRI examination showed that 10 cases had bone marrow edema at the distal radius on the affected side, and 8 cases had bone marrow edema in the carpal bones such as scaphoid and lunate bone. Among them, 3 patients had a history of wrist fracture, and 2 patients had Kienböck diseases (1 case each in stage ⅡB and stage ⅢA). Three cases were combined with triangular fibrocartilage complex (TFCC) type 1A injury. Two cases were combined with osteoarthritis, 1 of them was complicated with severe traumatic arthritis, the wrist arthroscopy showed that the TFCC was completely lost and could not be repaired, and the cartilage of the lunate bone and the ulnar head were severely worn.Visual analogue scale (VAS) score was used to evaluate the relief of wrist pain before operation, at 6 months after operation, and at last follow-up, and the range of motion of the affected wrist in dorsiflexion, palmar flexion, ulnar deviation, and radial deviation was measured. The degree of bone marrow edema was evaluated according to T1WI, T2WI, and STIR sequences of MRI.@*RESULTS@#All the patients were followed up 12-22 months, with an average of 16.4 months. Except for 1 patient who experienced persistent wrist joint pain and limited mobility after operation, the remaining 9 patients showed significant improvement in pain symptoms and wrist joint mobility. The VAS score and range of motion of wrist dorsiflexion, palmar flexion, ulnar deviation, and radial deviation at 6 months after operation and at last follow-up were significantly improved when compared with those before operation, the VAS score and the range of motion of wrist ulnar deviation and radial deviation at last follow-up were further improved when compared with those at 6 months after operation, all showing significant differences ( P<0.05). There was no significant difference in wrist dorsiflexion and palmar flexion between at 6 months after operation and at last follow-up ( P>0.05). Bone marrow edema was improved in 6 patients on MRI at 6 months after operation, and was also improved in other patients at last follow-up.@*CONCLUSION@#For chronic wrist pain caused by a variety of causes, distal radius core decompression can directly reduce the pressure of the medullary cavity of the distal radius, improve the blood supply of the corresponding distal structure, significantly alleviate chronic wrist pain, and provide an option for clinical treatment.

Madelung Deformity - Esthetic and Functional Outcomes from the Surgical Treatment with Distal Radial Dome Osteotomy and Vickers Ligament Section / Deformidade de Madelung - Resultado estético e funcional do tratamento cirúrgico com osteotomia em cúpula do rádio distal e secção do ligamento de Vickers

Abstract Objective The present study aimed to evaluate esthetic and functional outcomes from the surgical treatment of Madelung deformity in children. MethodThis is a retrospective study of pediatric patients with Madelung deformity who were surgically treated with dome osteotomy of the distal radius and Vickers ligament section from 2015 to 2018. Patients with a minimum postoperative follow-up period of 12 months were included. Demographic data, surgical technique, clinical and radiographic outcomes were analyzed. Pre and postoperative radiographic evaluation consisted of ulnar tilt, lunate subsidence lunate fossa angle, and palmar carpal displacement measurements. The postoperative clinical evaluation consisted of ranges of motion of the wrist, visual analog scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) score. Results Four patients were included, two with idiopathic Madelung deformity and two with bone dysplasia. All patients were females and presented bilateral disease. Six wrists were operated on. The median age at surgery was 15.5 years old, and the median postoperative follow-up time was of 37.5 months. The postoperative radiographic analysis revealed an average correction of 8.8 ± 7.5° for ulnar tilt, 3.0 ± 3.9 mm for lunate subsidence 8.2 ± 6.6° for lunate fossa angle, and 4.7 ± 2.6 mm for palmar carpal displacement. Average postoperative ranges of motion of the wrist joint were 75.8 ± 3.4° for flexion, 62.5 ± 14.1° for extension, 25.7 ± 2.9° for radial deviation, 40.0 ± 2.9° for ulnar deviation, 88.3 ± 2.4° for pronation, and 82.5 ± 2.5° for supination. The median VAS was 1 for residual pain, 0 for functional deficit, 0 for esthetic impairment, and 10 for recommending the surgical procedure. The median DASH score was 0. Conclusion Madelung deformity treatment using dome osteotomy of the distal radius and Vickers ligament section results in excellent esthetic and functional outcomes.

Resumo Objetivo Avaliar o resultado estético e funcional do tratamento cirúrgico da deformidade de Madelung em idade pediátrica. MétodoEstudo retrospectivo dos pacientes com deformidade de Madelung em idade pediátrica tratados cirurgicamente através de osteotomia em cúpula do rádio distal e secção do ligamento de Vickers entre 2015 e 2018. Foram incluídos doentes com tempo de seguimento pós-operatório mínimo de 12 meses. Foram analisados dados demográficos, técnica cirúrgica, resultados clínicos e radiográficos. A avaliação radiográfica pré e pós-operatória consistiu na medição da inclinação ulnar, do afundamento semilunar, do ângulo da fossa semilunar e do desvio palmar do carpo. A avaliação clínica pós-operatória consistiu na medição das amplitudes articulares do punho, escala visual analógica (EVA) e score Disabilities of the Arm, Shoulder and Hand (DASH). Resultados Foram incluídos quatro pacientes, dois com Madelung idiopática e dois com displasia óssea, todos do sexo feminino e com doença bilateral. Foram operados 6 punhos, a idade mediana à data de cirurgia foi 15,5 anos, e o tempo mediano de seguimento pós-operatório foi de 37,5 meses. Na análise radiográfica pós-operatória, verificou-se uma correção média de 8,8 ± 7,5° da inclinação ulnar, de 3 ± 3,9 mm do afundamento semilunar, de 8,2 ± 6,6° do ângulo da fossa semilunar e de 4,7 ± 2,6 mm do desvio palmar do carpo. Na avaliação da amplitude articular média pós-operatória, registrou-se uma flexão de 75,8 ± 3,4°; extensão de 62,5 ± 14,1°; desvio radial de 25,7 ± 2,9°; desvio cubital de 40,0 ± 2,9; pronação de 88,3 ± 2,4°; supinação de 82,5 ± 2,5°. Registou-se EVA mediana para dor residual = 1, défice funcional = 0, prejuízo estético = 0, e recomendação de procedimento cirúrgico = 10. A mediana do score DASH foi 0. Conclusão O tratamento da deformidade de Madelung através da osteotomia em cúpula do rádio distal e secção do ligamento de Vickers permite obter um excelente resultado estético e funcional.

Three-dimensional analysis of the gap space under forearm casts / 中华创伤杂志(英文版)

PURPOSE@#Secondary displacement represents a frequent complication of conservative treatment of fractures, particularly of the distal radius. The gap space between skin and cast may lead to a certain degree movements and this increased mobility might favor redisplacement. The aim of this study was to develop a new 3D method, to measure the gap space in all 3 geometrical planes, and to validate this new technique in a clinical setting of distal radius fractures.@*METHODS@#This study applies 3D imaging to measure the space between plaster and skin as a potential factor of secondary displacement and therefore the failure of conservative treatment. We developed and validated a new methodology to analyze and compare different forearm casts made of plaster of Paris and fiberglass. An unpaired t-test was performed to document differences between the investigated parameters between plaster of Paris and fiberglass casts. The significance level was set at p < 0.05.@*RESULTS@#In a series of 15 cases, we found the width of the gap space to average 4 mm, being slightly inferior on the radial side. Comparing the two different casting materials, plaster of Paris and fiberglass, we found a significantly larger variance of space under casts made of the first material (p=0.39). A roughness analysis showed also a markedly significantly higher irregularity of the undersurface of plaster of Paris as compared with fiberglass.@*CONCLUSION@#This study allows for a better understanding of the nature of the "gap space" between cast and skin and will contribute to develop and improve new immobilization techniques and materials.

Use of aromatase inhibitors in patients with breast cancer is associated with deterioration of bone microarchitecture and density

ABSTRACT Objective: To evaluate changes in bone density and architecture in postmenopausal women with breast cancer (BC) and use of aromatase inhibitor (AI). Subjects and methods: Thirty-four postmenopausal women with BC, without bone metastasis, renal function impairment and who were not receiving bone-active drugs were selected from a population of 523 outpatients treated for BC. According to the presence of hormonal receptors, HER2 and Ki67, seventeen had positive hormonal receptors and received anastrozole (AI group), and seventeen were triple-negative receptors (non-AI group), previously treated with chemotherapy. Areal bone mineral density (aBMD) and vertebral fracture assessment (VFA) analyses were performed by DXA; vBMD and bone microarchitecture were evaluated by HR-pQCT. Fracture risk was estimated using the FRAX tool. Results: No patient referred previous low-impact fracture, and VFA detected one moderate vertebral fracture in a non-AI patient. AI patients showed lower aBMD and BMD T-scores at the hip and 33% radius and a higher proportion of osteoporosis diagnosis on DXA (47%) vs non-AI (17.6%). AI group had significantly lower values for vBMD at the entire, cortical and trabecular bone compartments, cortical and trabecular thickness and BV/TV. They also had a higher risk for major fractures and for hip fractures estimated by FRAX. Several HR-pQCT parameters evaluated at distal radius and distal tibia were significantly associated with fracture risk. Conclusion: AI is associated with alterations in bone density and microarchitecture of both the cortical and trabecular compartments. These findings explain the overall increase in fracture risk in this specific population.

Anatomical features of some bones of the forelimbs of lions (Panthera leo) / Características anatómicas de algunos huesos de los miembros torácicos de leones (Panthera leo)

SUMMARY: We studied the bones of forelimb of four adult lions (Panthera leo) of both sexes to record the gross anatomical and morphometrical features of the scapula, humerus, radius and ulna. We observed some unique anatomical features that will be helpful for radiographic interpretation and forensic investigations. The lateral surface of scapula was unequally divided into supraspinous (fossa supraspinata) and infraspinous fossa (fossa infraspinata) by a well developed spine (spina scapulae). The acromion process was subdivided into suprahamate process (processus suprahamatus)and hamate process (processus hamatus); the later one was over hanged the glenoid cavity (cavitas glenoidalis), but the supraglenoid tubercle (tuberculum supraglenoidalis) was absent. The shaft (diaphysis) of humerus was compressed craniocaudally in proximal part, rounded to oval in middle part and compressed mediolaterally in distal part. A long, narrow supracondyloid foramen was found at distal limb just above the medial epicondyle (epicondylus medialis) which didn't connect the radial fossa (fossa radialis) with the olecranon fossa (fossa olecrani). The radius and ulna were twin bones where radius was articulated craniolateral to the ulna proximally and craniomedial to the ulna distally. However, the ulna was the longest bone in the forelimb of lion. The olecranon tuberosity of this bone had three prominences - two were cranially, whereas the caudal one was the largest and rounded. Distally projected styloid processes (processus styloideus) were found in the distal limb of both radius and ulna.

RESUMEN: Estudiamos los huesos de las miembros torácicos de cuatro leones adultos (Panthera leo) de ambos sexos para registrar las características anatómicas y morfométricas macroscópicas de la escápula, el húmero, el radio y la ulna. Se observaron algunas características anatómicas únicas que serán útiles para la interpretación radiográfica y las investigaciones forenses. La superficie lateral de la escápula se dividió de manera desigual en fosa supraespinosa y fosa infraspinosa por una columna bien desarrollada (espina de la escápula). El proceso del acromion se subdividió en proceso suprahamato (processus suprahamatus) y proceso hamato (processus hamatus); el tubérculo supraglenoideo (tuberculum supraglenoidalis) estaba ausente. La diáfisis (diafisis) del húmero estaba comprimida craneocaudalmente en la parte proximal, redondeada a ovalada en la parte media y comprimida mediolateralmente en la parte distal. Se encontró un foramen supracondileo largo y estrecho en la extremidad distal, por encima del epicóndilo medial (epicondylus medilaris) que no conectaba la fosa radial (fosa radial) con la fosa olecraneana (fossa olecrani). El radio y la ulna eran huesos idénticos en los que el radio se articulaba craneolateral a la ulna proximalmente, y craneomedial a la ulna distalmente. Sin embargo, la ulna era el hueso más largo del miembro torácico del león. La tuberosidad del olécranon de este hueso tenía tres prominencias: dos eran craneales, mientras que la caudal era la más grande y redondeada. Se encontraron procesos estiloides proyectados distalmente (processus styloideus) en la extremidades distales del radio y la ulna.

Estudio morfométrico del radio proximal en una población chilena / Morphometric study of the proximal radius in a Chilean population

RESUMEN: El objetivo de esta investigación fue determinar la morfometría del extremo proximal del radio, mediante mediciones efectuadas en la cabeza, cuello y tuberosidad del radio, en una población chilena y compararlas según sexo. Se efectuó un estudio transversal analizando exámenes de Tomografía Computarizada (TC) de codo, realizados entre enero de 2014 y diciembre de 2018. Se incluyó 32 TC, correspondientes a 16 hombres y 16 mujeres. Se transfirió las imágenes formateadas al software RadiAnt, para efectuar las mediciones en el radio proximal. El análisis estadístico de los resultados se realizó mediante el software SPSS 22. El diámetro de la cabeza del radio en hombres osciló entre 22,8±1,3 y 25,0±1,7 mm; en mujeres osciló entre 19,4±1,4 y 20,7±1,4 mm. El diámetro del cuello del radio proximal en hombres osciló entre 14,0±0,8 y 15,6±0,7 mm; en mujeres osciló entre 11,7±0,8 y 13,3±1,3 mm. El diámetro del cuello del radio distal en hombres osciló entre 14,4±1,0 y 16,0±1,2 mm; en mujeres osciló entre 12,5±1,0 y 13,8±1,5 mm. El diámetro de la tuberosidad radial en hombres osciló entre 15,1±1,5 y 17,7±1,8 mm; en mujeres osciló entre 13,2±1,1 y 15,5±1,8 mm. El promedio de altura de la cabeza del radio fue de 11,2±1,2 mm en hombres y de 9,5+0,8 mm en mujeres. El análisis comparativo entre sexos mostró diferencias estadísticamente significativas en todas las mediciones precedentes. El promedio de altura del cuello del radio fue de 11,2±1,2 mm en hombres y 10,1±1,6 mm en mujeres, sin diferencia significativa (p= 0,15). Los valores promedios de la morfometría del radio proximal de la población chilena difieren de los descritos para la población europea y presentan algunas similitudes con la población china. Nuestros resultados pueden ser de utilidad para el diseño de implantes y prótesis para el extremo proximal del radio y para una correcta planificación quirúrgica en ortopedia y traumatología.

SUMMARY: The aim of this research was to determine the morphometry of the proximal radius in a Chilean population, by means of measurements made in head of radius, neck of radius and radial tuberosity, and to compare them according to sex. A cross-sectional study was conducted analyzing Computed Tomography scans (CT) of elbows, performed between January 2014 and December 2018. Thirty-two CT corresponding to 16 men and 16 women were included. The formatted images were transferred to the RadiAnt software in order to perform measurements in the proximal radius. The statistical analysis of the results was performed using the SPSS 22 software. The diameter of the head of radius in men ranged between 22.8±1.3 and 25.0±1.7 mm; in women it ranged between 19.4±1.4 and 20.7±1.4 mm. The diameter of the proximal neck of radius in men ranged between 14.0±0.8 and 15.6±0.7 mm; in women, it ranged between 11.7±0.8 and 13.3±1.3 mm. The diameter of the distal neck of radius in men ranged between 14.4±1.0 and 16.0±1.2 mm; in women, it ranged between 12.5±1.0 and 13.8±1.5 mm. The diameter of radial tuberosty in men ranged between 15.1±1.5 and 17.7±1.8 mm; in women, it ranged between 13.2±1.1 and 15.5±1.8 mm. The mean height of the head of radius was 11.2±1.2 mm in men and 9.5±0.8 mm in women. Statistically significant sex differences were revealed in all the preceding measurements. The mean height of the neck of radius was 11.2±1.2 mm in men and 10.1±1.6 mm in women, with no significant difference (p= 0.15). The average values of morphometry of the proximal radius of the Chilean population differ from those describing the European population, and show some similarities with the Chinese population. Our results may be useful to design of implants and prostheses for the proximal radius, and to correct surgical planning in orthopedics and traumatology.

Reconstruction with a Custom made Prosthetic Wrist Arthrodesis after Bone Tumor Resections of the Distal Radius. Single Centre Experience / Reconstrução com implante metálico personalizado de artrodese após ressecções de tumor ósseo do rádio distal. Experiência em um único centro

Abstract Objective The present study aimed at analyzing the clinical, radiological and functional results of the reconstruction of the distal radius after tumor resection with a custom-made metal arthrodesis implant and compare them with other types of distal radius reconstruction, as presented in the literature. To our best knowledge, this is the first article describing this particular type of implant and patient functionality. Methods Functional outcomes of reconstruction of the distal radius were assessed in a series of 4 patients. Three of the patients having had resection of giant cell tumors (GCTs), one patient having had resection of osteosarcoma. Results There were no major implant-related complications like infection, nonunion or loosening. Two patients had to undergo further surgery for protruding metalwork. Overall function was good according to the Musculoskeletal Tumor Society MSTS and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Conclusion The present study shows that custom-made metal arthrodesis implant benefits from the fact that it can be used as a salvage option when other treatments have failed, or it can be used as a primary option in cases in which there is limited bone stock after distal radius tumor resection.

Resumo Objetivo O presente estudo teve como objetivo analisar os resultados clínicos, radiológicos e funcionais da reconstrução do rádio distal após a ressecção do tumor com implante metálico personalizado de artrodese e compará-los com outros tipos de reconstrução do rádio distal, conforme apresentado na literatura. Pelo que conhecemos, este é o primeiro artigo descrevendo esse tipo particular de implante e funcionalidade no paciente. Métodos Os desfechos funcionais de reconstrução do rádio distal foram avaliados em uma série de 4 pacientes. Três dos pacientes tiveram ressecção de tumores de células gigantes (TCGs), sendo um paciente com ressecção de osteossarcoma. Resultados Não houve complicações relacionadas ao implante, como infecção, não sindicalidade ou afrouxamento. Dois pacientes tiveram que passar por uma nova cirurgia para a protusão da prótese metálica. A função geral foi boa de acordo com as pontuações da Musculoskeletal Tumor Society (MSTS) e Disabilities of the Arm, Shoulder, and Hand (DASH). Conclusão O estudo mostra que o implante metálico personalizado de artrodese se beneficia do fato de que pode ser usado como opção de salvamento quando outros tratamentos falharam, ou pode ser usado como opção primária nos casos em que há estoque ósseo limitado após a ressecção do tumor do rádio distal.

Clinical observation of different surgical methods for metaphyseal sequelae of ulna / 中国骨伤

OBJECTIVE@#To investigate the effect and safety of ulnar osteochondroma resection, ulnar minimally invasive osteotomy, external fixation and ulnar lengthening in the treatment of forearm deformity of metaphyseal extension of ulna.@*METHODS@#From August 2005 to December 2013, there were 20 cases of ulnar metaphyseal sequelae, including 15 males and 5 females, aged from 7 to 13(10.00±2.34) years, the course of disease ranged for 6 to 11(8.10±1.52) months. The clinical manifestations were shortening of the affected forearm and bending to the ulnar side. The postoperative evaluation included pain, activities of daily living, orthopedic effect and the range of motion of wrist, elbow and forearm. The radiological evaluation included ulnar length, radial joint inclination angle and wrist epiphysis growth.@*RESULTS@#All patients healed without infection. The only operation related to complications was ulnar lengthening, including 1 case of nonunion, 2 cases of ulnar lengthening callus fracture and 1 case of temporary radial nerve palsy. All patients were followed up for 4 to 7.5 years, with an average of (6.03±1.33) years. There were statistically significant differences in changes of wrist radial deviation, ulnar deviation, forearm pronation and supination in all cases (@*CONCLUSION@#Ulnar lengthening is not beneficial to prevent the development of long-term deformity. Simple resection of osteochondroma of distal ulna is beneficial to prevent the development of deformity. Patients with limited rotation of wrist joint and forearm and strong demand for improvement of appearance can be actively treated.

Closed folding apex manipulation combined with splinting for the treatment of double fractures of distal ulna and radius in children / 中国骨伤

OBJECTIVE@#To investigate specific technique and clinical effects of closed folding top consolidation maneuver combined with splint fixation maneuver for consolidation and cedar bark external fixation splint for the treatment of double fractures of distal ulna and radius in children.@*METHODS@#From January 2017 to December 2019, 17 children with double fractures of distal ulna and radius were treated with closed folded apex consolidation maneuver, including 13 males and 4 females, aged from 4 to 11 years old with an average of (7.29±2.34) years old. The fractures were fixed with cedar bark splint and followed up for 6 months, and alignment of fracture was evaluated according to the latest X-rays by follow up, and function of the affected limbs was evaluated by Anderson forearm function evaluation criteria.@*RESULTS@#Fifteen of 17 children were successfully reset immediately, and 2 children were successfully reset again. The average fixed time was (25.00±3.35) days. At 6 months of follow up, 12 patients got excellent results, 3 good, 2 fair, and 0 poor according to Anderson forearm function evaluation criteria. The position of all children were larger than 3/4, and 10 children were received anatomical reduction, alignment of 4 children was less than 10°, 3 children was less than 15°. No complications such as fracture displacement, nonunion, compartment syndrome, and forearm rotation dysfunction occurred.@*CONCLUSION@#Restoration of distal radius double fracture in children with the combination of the closed folding and top fixation maneuver and splint fixation maneuver has advantages of higher success rate, lower complications, which could reduce operating difficultyand pain of patients.

Tuberosity Healing after Reverse Shoulder Arthroplasty for Proximal Humerus Fractures: Is there Clinical Improvement? / Consolidação dos tubérculos na artroplastia reversa do ombro após fratura proximal do úmero: Existe melhoria nos resultados funcionais?

Abstract Objective To compare the functional results of patients with complex proximal humerus fracture submitted to total shoulder reverse arthroplasty with and without tuberosity healing. The secondary goal was to know the tuberosity healing rate after reverse shoulder arthroplasty with our surgical technique. Methods A retrospective, cohort type study, with a prospective database collection. In total, 28 patients fulfilled the inclusion criteria: age ≥ 65 years, reverse shoulder arthroplasty for complex proximal humerus fracture (type-3 or -4, according to Neer), and a minimum of 24 months of follow-up. At six months of follow-up, all of the patients were evaluated radiographically for tuberosity, and then they were divided into 2 groups: those with healed tuberosities and those with non-healed tuberosities. A clinical evaluation using the Constant score, active range of motion and the Visual Analog Scale (VAS) at the last follow-up was also performed. Results Tuberosity healing occurred in 21 patients (76.3%). There were statistically significant differences in the Constant scoring system (p < 0.001), forward elevation (p = 0.020), internal rotation (p = 0.001) and external rotation (p = 0.003) when comparing the group of healed tuberosities with the group of non-healed tuberosities. No differences were found regarding the VAS score. Conclusion Tuberosity healing results in an improvement of the functional outcomes of patients submitted to reverse shoulder arthroplasty as a treatment for complex proximal humeral fractures in the elderly.

Resumo Objetivo Comparar os resultados funcionais entre pacientes com fratura complexa do úmero proximal submetidos a artroplastia reversa com tubérculos consolidados e tubérculos não consolidados. O objetivo secundário foi determinar a taxa de consolidação dos tubérculos com este tipo de prótese. Métodos Estudo de tipo coorte, retrospectivo, com coleta prospectiva de dados. No total, 28 pacientes cumpriram os critérios de inclusão: idade superior a 65 anos, prótese reversa do ombro por fratura complexa do úmero proximal (3 ou 4 partes, segundo Neer), e tempo de seguimento mínimo de 24 meses. Aos seis meses, todos os pacientes foram avaliados radiograficamente quanto à consolidação dos tubérculos e divididos em dois grupos: grupo com tubérculos consolidados e grupo com tubérculos não consolidados. A avaliação funcional realizou-se segundo o sistema de pontuação de Constant, da amplitude de movimento ativo, e da Escala Visual Analógica (EVA) à data da última consulta. Registaram-se todas as complicações. Resultados A consolidação dos tubérculos ocorreu em 21 pacientes (76,3%). Verificou-se diferenças estatisticamente significativas no sistema de pontuação de Constant (p < 0.001), elevação anterior (p = 0.020), rotação interna (p = 0.001) e externa (p = 0.003), quando se comparou o grupo dos tubérculos consolidados com o grupo dos tubérculos não consolidados. Não houve diferenças significativas na EVA entre os 2 grupos. Conclusão A consolidação dos tubérculos traduz uma melhoria dos resultados funcionais em pacientes submetidos a artroplastia reversa do ombro como tratamento de fraturas complexas do úmero proximal em idosos.

Anatomical Study of the Motor Branches of the Radial Nerve in the Forearm / Estudo anatômico dos ramos motores do nervo radial no antebraço

Abstract Objective To analyze the anatomical variations of the motor branches of the radial nerve in the elbow region. The origin, course, length, branches, motor points and relationships with neighboring structures were evaluated. Materials and Methods Thirty limbs from15 adult cadavers were dissected and prepared by intra-arterial injection of a 10% glycerin and formaldehyde solution. Results The first branch of the radial nerve in the forearm went to the brachioradialis muscle (BR), originating proximally to the division of the radial nerve into superficial branch of the radial nerve (SBRN) and posterior interosseous nerve (PIN) in all limbs. The branches to the extensor carpi radialis longus muscle (ECRL) detached from the proximal radial nerve to its division into 26 limbs, in 2, at the dividing points, in other 2, from the PIN. In six limbs, the branches to the BR and ECRL muscles originated from a common trunk. We identified the origin of the branch to the extensor carpi radialis brevis muscle (ECRB) in the PIN in 14 limbs, in the SBRN in 12, and in the radial nerve in only 4. The branch to the supinator muscle originated from the PIN in all limbs. Conclusion Knowledge of the anatomy of the motor branches of the radial nerve is important when performing surgical procedures in the region (such as the approach of the proximal third and the head of the radius, release of compressive syndromes of the posterior interosseous nerve and radial tunnel, and distal nerve transfers) in order to understand the order of recovery of muscle function after a nerve injury.

Resumo Objetivo Analisar as variações anatômicas dos ramos motores do nervo radial na região do cotovelo. Foram avaliadas a origem, curso, comprimento, ramificações, pontos motores e relações com estruturas vizinhas. Materiais e Métodos Foram dissecados 30 membros de 15 cadáveres adultos, preparados por injeção intra-arterial de uma solução de glicerina e formol a 10%. Resultados O primeiro ramo do nervo radial no antebraço foi para o músculo braquiorradial (BR), que se origina proximalmente à divisão do nervo radial em ramo superficial do nervo radial (RSNR) e nervo interósseo posterior (NIP) em todos os membros. Os ramos para o músculo extensor radial longo do carpo (ERLC) se desprenderam do nervo radial proximalmente à sua divisão em 26 membros, em 2, nos pontos de divisão, em outros 2, do NIP. Em seis, os ramos para os músculos BR e ERLC originavam-se de um tronco comum. Identificamos a origem do ramo para o músculo extensor radial curto do carpo (ERCC) no NIP em 14 membros, no RSNR em 12, e no nervo radial em apenas 4. O ramo para o músculo supinador originou-se do NIP em todos os membros. Conclusão O conhecimento da anatomia dos ramos motores do nervo radial é importante quando se realizam procedimentos cirúrgicos na região, como a abordagem do terço proximal e da cabeça do rádio, a liberação das síndromes compressivas do nervo interósseo posterior e do túnel radial, as transferências nervosas distais, e para entender a ordem de recuperação da função muscular após uma lesão nervosa.

Fracturas intraarticulares de radio distal: reducción bajo fluoroscopía versus asistencia artroscópica. Revisión sistemática / Distal radius intraarticular fractures: fluoroscopy reduction versus arthroscopic assistance. Systematic review

Resumen: Introducción: Las fracturas intraarticulares de radio distal son un desafío terapéutico para el cirujano ortopedista. Hay estudios que avalan el uso de la fluoroscopía y otros promueven la artroscopia. Con este trabajo intentamos resumir la evidencia, para determinar si la asistencia artroscópica aporta beneficios adicionales para evitar incongruencias articulares en comparación con los resultados obtenidos bajo asistencia fluoroscópica. Material y métodos: Búsqueda sistemática de estudios prospectivos, retrospectivos, de cohortes, seguimiento, ensayos clínicos en PubMed, MEDLINE, Scopus, Scielo, Embase, Google Scholar y otras fuentes nacionales, incluyendo como palabras clave los términos: intraarticular distal radius fracture, wrist arthroscopy, arthroscopy, fluoroscopy. Los valores medios y desvíos estándar para cada característica, obtenidos de los trabajos seleccionados fueron analizados usando estadística descriptiva y gráficos ilustrativos. Resultados: Fueron evaluados 463 pacientes (256 mujeres y 207 hombres), con una edad promedio de 48.29 años y rango de 39 a 64 años. Los dos tratamientos (A y F) fueron homogéneos en cuanto a la edad de los pacientes que reportan (p = 0.5820) y el tiempo de seguimiento promedio (p = 0.9597). Sólo la desviación cubital y el DASH, para las cuales el grupo de artroscopía tuvo mejor desempeño, en las variables restantes las diferencias no fueron significativas. Conclusión: La evidencia disponible hasta la fecha es controvertida y no permite hacer recomendaciones a favor o en contra de estas intervenciones, encontrando otros factores que podrían influir en la toma de decisiones.

Abstract: Introduction: Intraarticular distal radius fractures are a therapeutic challenge for the orthopedist surgeon there are studies that support the use of fluoroscopy, and others promote arthroscopy, with this work we try to summarize the evidence, to determine whether arthroscopic assistance provides additional benefits to avoid joint incongruities compared to results obtained under fluoroscopic assistance. Material and methods: Systematic search for prospective, retrospective, cohort, follow-up, clinical trials on PubMed, MEDLINE, Scopus, Scielo, Embase, Google Scholar and other national sources, including as keywords the terms: «intra-articular distal radius fracture¼, «wrist arthroscopy¼, «arthroscopy¼, «fluoroscopy¼. The average values and standard offsets for each characteristic, obtained from the selected works, were analyzed using descriptive statistics and illustrative graphs. Results: 463 patients (256 women and 207 men) were evaluated, with an average age of 48.29 years and range from 39 to 64 years. The two treatments (A and F) were homogeneous in terms of the age of the patients reporting (p = 0.5820) and the average follow-up time (p = 0.9597). Only the ulnar deviation and DASH score, for which the arthroscopy group performed best, in the remaining variables the differences were not significant. Conclusion: The evidence available to date is conflicting, and does not allow recommendations to be made for or against these interventions, finding other factors that could influence decision-making.

Radiographic Evaluation of Patients Submitted to Percutaneous Fixation With Solid Screw for Distal Radius Fracture Treatment / Avaliação radiográfica dos pacientes submetidos a fixação percutânea com parafuso maciço para tratamento de fraturas da extremidade distal do radio

Abstract Objective The present paper aims to present results from radiographic evaluations of patients with extra-articular distal radius fractures submitted to percutaneous fixation with a 3.5 mm solid screw. Methods Analytical, descriptive and retrospective case series of 16 patients with evaluation of the radiographic parameters. Results The average age of the study population was 46.5 years old (25-60 years old); 81.25% of the sample was female. The average time until surgery was 8.8 days (4-14 days). The mean preprocedural volar tilt was - 7.41° (−23.48°-5.29°, standard deviation [SD] ± 6.59°). The mean volar tilt immediately after surgery was 5.93° (SD ± 6.23°, p< 0.001). There was no statistical difference in volar tilt values after 6 months of follow-up. The mean preprocedural radial height was 4.13 mm (−7.8 mm-9.5 mm, SD ± 5.06 mm). There was a statistically significant increase at the immediate postoperative period to 10.04 mm (p= 0.002), and a significant reduction at 6 months to 9.55 mm (p= 0.012). The consolidation rate was 100% with the technique used, with a minimal complication rate. No patient had infection or required a reoperation. Conclusion The technique was effective for the treatment of distal radial extra-articular fractures at 6 months, with a low complication rate; radiographic parameters values were acceptable and close to the anatomical ones.

Resumo Objetivo Apresentar o resultado das avaliações radiográficas dos pacientes com fraturas extra-articulares do rádio distal submetidos a fixação percutânea com parafuso maciço de 3.5mm. Métodos Série de casos, analítica, descritiva e retrospectiva de 16 pacientes com avaliação dos parâmetros radiográficos da técnica utilizada. Resultados A média de idade da população estudada foi de 46,5 anos (25-60 anos), sendo 81,25% do sexo feminino. O tempo de espera até a cirurgia foi de 8,8 dias (4-14 dias). O tilt volar médio pré-procedimento foi - 7,41° (−23,48°-5,29°, desvio padrão [DP] ± 6,59°). O tilt volar imediatamente após o procedimento cirúrgico foi de 5,93° (DP ± 6,23°, p< 0,001). Sem diferença estatística nos valores de tilt volar ao final de 6 meses de evolução. A altura radial pré-procedimento foi de 4,13 mm (−7,8°-9,5°, DP ± 5,06°). Aumento estatisticamente significativo no pós-operatório imediato para 10,04 mm (p= 0,002). Redução significativa ao final de 6 meses para 9,55 mm (p= 0,012). Atingimos 100% de consolidação com a técnica utilizada, com índice mínimo de complicações. Nenhum paciente apresentou infecção ou precisou ser reoperado. Conclusão A técnica mostrou-se eficaz para o tratamento de fraturas extra-articulares da extremidade distal do rádio ao final de 6 meses, com baixo índice de complicações e parâmetros radiográficos aceitáveis e próximos dos valores anatômicos.

Open pulling reduction and bone graft by overstretched wrist traction and internal fixation for the treatment of distal radius type Fernandez Ⅲ fractures / 中国骨伤

OBJECTIVE@#To explore the clinical effect of the treatment of Fernandez type Ⅲ fracture of the distal radius with hyperextension traction prying, volar reduction, bone grafting and internal fixation.@*METHODS@#From February 2017 to March 2018, 11 cases of Fernandez type Ⅲ fracture of the distal radius were treated with intraoperative hyperextension traction and volar prying reduction and bone grafting and internal fixation, including 6 males and 5 females, aged 55 to 67 years. Preoperative X-ray and CT evaluated the distal radius fracture dorsal angulation with articular surface compression, collapse. According to Fernandez, all of them were type Ⅲ. After operation, the reduction of articular surface and fracture healing were evaluated. VAS score and Cooney wrist score were used to evaluate the curative effect.@*RESULTS@#All the patients were followed up for 12 to 14 months. All the fractures healed. Cooney wrist score scale was used to evaluate the curative effect, 9 cases were excellent, 1 case was good and 1 case was fair.@*CONCLUSION@#In the operation of Fernandez type Ⅲ fracture of the distal radius, hyperextension traction was used to enlarge the angle, and through the volar fracture end prying reduction and internal fixation with bone graft, the collapsed articular surface could be effectively reduced and fixed. The early functional exercise after the operation had satisfactory clinical effect.

Tension Band Wiring Technique for Distal Radius Fracture with a Volar Articular Marginal Fragment: Technical Note

Most distal radius fractures are currently being treated with anterior plating using anatomical precontoured locking compression plates via the anterior approach. However, it is difficult to fix the volar articular marginal fragment because these anatomical plates should be placed proximally to the watershed line. There were just a few methods of fixation for this fragment on medical literature. Herein, we introduced a tension band wiring technique for fixation of a volar articular marginal fragment in the distal radius.

Paget's Disease of Bone Affecting Peripheral Limb: Difficulties in Diagnosis: A Case Report

In terms of management of Paget's disease of bone (PDB), early diagnosis and proper management achieving remission is essential with lifelong specialist follow-up. We present the case of a 40-year-old woman with PDB affecting mainly the distal extremities (ankle and wrist). The patient visited our hospital in 2012 with heel pain. Plain radiography revealed osteoporosis, and a bone scan revealed hot uptake. Initial laboratory investigations showed normal serum calcium, 25-hydroxy-vitamin D, and parathyroid hormone levels; however, osteocalcin, C-terminal telopeptide of type I collagen, and bone alkaline phosphatase levels were elevated. A bone mineral density scan showed T- and Z-scores of −2.5 and −2.7, respectively, and bisphosphonate treatment was initiated. Biopsy performed on the calcaneal lateral wall revealed inconclusive findings. Follow-up biopsy on the left distal radius was performed 7 years later to investigate wrist pain, and this examination led to a final diagnosis as PDB. We suggest inconclusive biopsy result during the early phase of PDB and highly recommend follow-up evaluation in osteoporosis with atypical behavior.

Evaluation and Management of Osteoporosis and Sarcopenia in Patients with Distal Radius Fractures

Distal radius fractures (DRFs) are one of the most common fractures seen in elderly people. Patients with DRFs have a high incidence of osteoporosis and an increased risk of subsequent fractures, subtle early physical performance changes, and a high prevalence of sarcopenia. Since DRFs typically occur earlier than vertebral or hip fractures, they reflect early changes of the bone and muscle frailty and provide physicians with an opportunity to prevent progression of frailty and secondary fractures. In this review, we will discuss the concept of DRFs as a medical condition that is at the start of the fragility fracture cascade, recent advances in the diagnosis of bone fragility including emerging importance of cortical porosity, fracture healing with osteoporosis medications, and recent progress in research on sarcopenia in patients with DRFs.