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1.
Rev. Asoc. Argent. Ortop. Traumatol ; 86(5) (Nro Esp - AACM Asociación Argentina de Cirugía de la Mano): 666-680, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353974

ABSTRACT

El objetivo de este artículo es actualizar los conocimientos sobre la impactación cubitocarpiana y su tratamiento. Estudios clásicos sobre la biomecánica del borde cubital de la muñeca han demostrado que los cambios milimétricos en la relación de longitud entre el cúbito y el radio alteran significativamente la transferencia de cargas entre los huesos del carpo, el radio y el cúbito. Así, un aumento relativo en la longitud del cúbito generará una carga excesiva sobre la articulación cubitocarpiana que producirá un espectro de cambios degenerativos progresivos en el domo cubital, el semilunar, el piramidal y el complejo del fibrocartílago triangular que finalizarán con artrosis cubitocarpiana y radiocubital distal. La impactación cubitocarpiana, en sus diversos estadios degenerativos, se puede tratar mediante osteotomías que buscan descomprimir la carga cubitocarpiana. Las osteotomías pueden ser extrarticulares o intrarticulares. Entre las extrarticulares, están las diafisarias, las metafisarias sin exposición articular (subcapitales) y las metafisarias distales con exposición articular y, entre las intrarticulares, la cirugía de resección en oblea (wafer), que reseca cartílago y hueso subcondral del domo cubital, y puede ser un procedimiento abierto o artroscópico. Si hay artrosis radiocubital distal, solo se podrá tratar con cirugías de rescate, como Darrach, Sauvé-Kapandji, Bowers, o una prótesis radiocubital distal. Estas técnicas de osteotomía se han analizado detalladamente para lograr definir sus ventajas y desventajas. Finalmente se propone una forma de tipificar la impactación cubitocarpiana, cuyo objetivo es orientar al lector hacia el mejor tratamiento posible, avalado por la bibliografía actual. Nivel de Evidencia: V


The purpose of this article is to provide updated knowledge about ulnocarpal impaction syndrome (UCIS) and its treatment. Classic studies on biomechanics of the ulnar side of the wrist have shown that millimetrical changes in the relative lengths of the ulna and the radius significantly alter the load transmission between the carpal bones, the radius and the ulna. Thus, an increase in the relative length of the ulna will generate an excessive load on the ulnocarpal joint, which will produce a spectrum of progressive degenerative changes in the ulnar dome, lunate, triquetrum, and the triangular fibrocartilage complex (TFCC), that will lead to ulnocarpal and distal radioulnar joint (DRUJ) osteoarthritis. In its various degenerative stages, UCIS can be treated with osteotomies that seek to decompress the ulnocarpal load. These can be extra-articular or intra-articular. Within the extra-articular osteotomies, we find the diaphyseal, metaphyseal without joint exposure (subcapital), and the distal metaphyseal with joint exposure. Within the intra-articular ones, we find the wafer procedure, which resects the cartilage and subchondral bone of the ulnar dome, and can be performed either openly or arthroscopically. If there is associated DRUJ osteoarthritis, it can only be treated with salvage surgeries such as the Darrach, Sauvé-Kapandji, and Bowers procedures, or a DRUJ arthroplasty. These osteotomy techniques will be analyzed in detail in order to define their advantages and disadvantages. Finally, we propose a way to typify the UCIS to guide the reader towards the best possible treatment supported by current literature. Level of Evidence: V


Subject(s)
Osteotomy , Ulna/surgery , Ulna/injuries , Wrist Injuries/surgery , Biomechanical Phenomena , Triangular Fibrocartilage
2.
Rev. Méd. Clín. Condes ; 23(3): 299-312, may 2012.
Article in Spanish | LILACS | ID: lil-733905

ABSTRACT

El dolor cubital de muñeca en el deportista es una causa frecuente de consulta médica. La presentación clínica puede variar desde un contexto agudo traumático a una lesión de evolución lenta y progresiva. Un diagnóstico diferencial preciso es fundamental para un pronóstico y tratamiento efectivo. Las lesiones del complejo fibrocartílago triangular, lesiones del ligamento semilunar-piramidal y el síndrome de impactación cubital son frecuentes. Los exámenes de imágenes como la radiografía simple, la resonancia magnética y el TAC son de gran ayuda, su interpretación debe ser en un contexto clínico y en comparación al lado sano. La toma de decisiones terapéuticas exige de un acertado criterio y juicio médico.


Ulnar side wrist pain is a common cause of medical consultation. The clinical presentation can vary from acute post traumatic injury to a slow and progressive pain. The differential diagnosis is essential for accurate and effective treatment. The triangular fibrocartilage complex injuries, luno-triquetral ligament tears, ulnocarpal impaction sindrome are common. Imaging tests as radiography, magnetic resonance imaging and CT are helpful, their interpretation should be in a clinical context and in comparison to the healthy side. Decision making requires an accurate therapeutic approachand medical judgments.


Subject(s)
Humans , Athletic Injuries , Ulna/injuries , Pain/etiology , Wrist Injuries , Diagnostic Imaging , Triangular Fibrocartilage
5.
J Indian Med Assoc ; 2007 Aug; 105(8): 466, 468
Article in English | IMSEAR | ID: sea-102704

ABSTRACT

Radial epiphyseal injuries are common. Ulnar epiphyseal injury is responsible for majority of cases of growth arrest and is commonly missed. The occurrence of associated ulnar epiphyseal injury is very rare and a concomitant type II injury of both radial and ulnar epiphyseal injury is also uncommon. A four-year follow-up of a 10-year-old boy with the above injury at right wrist is being reported in this article. At four years he has a negative ulnar variance but with excellent function and cosmesis.


Subject(s)
Child , Epiphyses/injuries , Humans , Male , Radius/injuries , Rare Diseases , Ulna/injuries
6.
Egyptian Orthopaedic Journal [The]. 2007; 42 (1): 6-10
in English | IMEMR | ID: emr-82413

ABSTRACT

The Sauve-Kapandji procedure has been advocated as a method of treating derangement of the distal radioulnar joint [DRUJ]; especially post-traumatic problems. This work included 13 patients with post-traumatic DRUJ disorders who were treated with Sauve-Kapandji procedure. Eleven patients were available for review after an average follow up period of 31.7 months. The average age at the time of operation was 33.6 years. A Mayo wrist score was used for pre- and post-operative clinical assessment; especially pain, rotation of forearm, and complications. At the end of follow up, the functional results were excellent in six cases, good in three, fair in one and poor in one. All cases except one returned forearm rotation to within 8 degrees of the un-injured side. Nine patients had no pain; while two had moderate or severe pain on heavy work. One patient had instability of the ulnar stump. Sauve-Kapandji procedure is a good operation in posttraumatic derangement of the DRUJ and a reliable technique for restoration of range of motion and amelioration of pain with few complications


Subject(s)
Humans , Male , Female , Ulna/injuries , Joints/surgery , Wrist Joint , Postoperative Complications , Range of Motion, Articular , Follow-Up Studies
7.
Acta ortop. bras ; 9(1): 12-20, jan.-mar. 2001. ilus, tab
Article in Portuguese | LILACS | ID: lil-297243

ABSTRACT

Foi realizado um estudo retrospectivo de 10 casos de desarranjo da articulação radio-ulnal distal tratados pela técnica de Sauvé-Kapandji. Os desarranjos eram resultantes de trauma (7), degeneração (2) e doença congênita (1) e as principais queixas pré-operatórias eram a dor, limitação da prono-supinação e deformidade. A idade média dos pacientes na época da operação era de 37,8 anos. Os pacientes foram submetidos a avaliação clínico-funcional e radiografia com um seguimento pós-operatório médio de 28,3 meses, particular atenção tendo sido dada a uma incidência radiográfica anteroposterior sob esforço de preensão manual. Todos os pacientes obtiveram melhora de suas queixas e o resultado final foi considerado satisfatório (excelente e bom) em 8, e insatisfatório (regular) 2. A artrodese da articulação radio-ulnal consolidou em 9 casos, independentemente do tipo de fixação empregado. O exame radiográfico sob esforço mostrou que todos os pacientes apresentavam deslocamento radial da ulna, mas isso aparentemente não interferiu com a função. Concluiu-se que a técnica de Sauvé-Kapandji é eficiente para o tratamento dos desarranjos da articulação radio-ulnal distal, pois ela não implica em perda funcional importante.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Forearm Injuries , Radius/surgery , Ulna/injuries , Outcome and Process Assessment, Health Care , Articulation Disorders/rehabilitation
8.
Yonsei Medical Journal ; : 503-508, 2001.
Article in English | WPRIM | ID: wpr-189141

ABSTRACT

Because no report has been issued on the healing effects of low-intensity pulsed ultrasound on moderate to large fracture gaps, we performed an experimental study using acanineulna full-defect model. Ten mongrel male dogs were divided into two groups: a small defect group and large defect group. The defects were made on the middle one third of both ulnae and one side only was randomly selected for ultrasound sonication, at 1 MHz, 200 microsecond bursting sine wave in 50 mW/cm2 spacial average and temporal average. Sonication was started on the day after surgery and applied for 15 minutes once a day for six days a week. In the small defect group, the means of the radiologic scores, as described by Lane and Sandhu, were 0.6, 4.4, and 8.4 in the control side and 1.8, 6.0, and 10.4 in the treatment side one, three, and five months after the operation, respectively (p=0.0372). In the large defect model, the corresponding means were 2.2, 3.4, and 6.0 in the control side and 3.3, 5.4, and 9.2 in the treatment side (p= 0.009). Low-intensity pulsed ultrasound enhanced new bone formation in small and large full-defects and decreased the incidence of nonunion in the large defect model.


Subject(s)
Animals , Dogs , Fractures, Bone/physiopathology , Male , Ulna/injuries , Ultrasonic Therapy/methods , Wound Healing/radiation effects
9.
Indian J Med Sci ; 2000 Apr; 54(4): 149-50
Article in English | IMSEAR | ID: sea-68917

ABSTRACT

A 25 year old male student presented with a discharging sinus and swelling over right forearm, which on culture yielded S. typhi, sensitive to Ciprofloxacin. Predisposing factors were absent but there was a history of surgery for chronic osteomyelitis of right ulna and injury with cricket ball at same site. Pus obtained during surgery was sterile. Patient responded to oral Ciprofloxacin. Soft tissue infections are uncommon manifestation of salmonellosis. This case is an unusual presentation of post-operative Salmonella typhi wound infection.


Subject(s)
Adult , Anti-Infective Agents/therapeutic use , Ciprofloxacin/therapeutic use , Humans , Male , Osteomyelitis/surgery , Pain, Postoperative/etiology , Salmonella Infections/drug therapy , Salmonella typhi/isolation & purification , Surgical Wound Infection/drug therapy , Treatment Outcome , Ulna/injuries
10.
Rev. mex. ortop. traumatol ; 10(2): 76-8, mar.-abr. 1996. ilus
Article in Spanish | LILACS | ID: lil-208091

ABSTRACT

Se intervinieron quirúrgicamante a 28 pacientes con fracturas diafisarias de radio y cúbito en el Servicio de Traumatología del Instituto Nacional de Ortopedia de enero de 1990 a diciembre de 1994. En este trabajo se incluyeron pacientes adultos de ambos sexos con fracturas cerradas de antebrazo que llenaron los criterios de inclusión, estos pacientes fueron tratados con el método del clavo HUNEC, el cual es intramedular bloqueado con tornillos, todos a foco cerrado. Se analizaron los resultados en base al inicio de la rehabilitación, tiempo de consolidación y al reintegro del paciente a sus labores habituales. En esta serie el inicio de la movilidad de las articulaciones vecinas fue a las 24 horas de postoperatorio, no se requirió de ningún tipo de inmovilización externa, la consolidación se observó a las 12 semanas en el 97 por ciento de los casos, el regreso a las actividades normales del paciente fue en corto tiempo. Las ventajas encontradas con esta técnica fueron principalmente la disminución de las complicaciones como infecciónes y pseudoartrosis, así como la reducción del tiempo quirúrgico


Subject(s)
Adolescent , Adult , Middle Aged , Humans , Male , Female , Arm Injuries/surgery , Bones of Upper Extremity , Bone Nails , Ulna/injuries , External Fixators/statistics & numerical data , Ulna Fractures/therapy , Orthopedics , Radius/injuries , Radius Fractures/therapy
11.
West Indian med. j ; 42(4): 164-6, Dec. 1993.
Article in English | LILACS | ID: lil-130564

ABSTRACT

The treatment of a young man with chronic symptomatic gross subluxation of the distal radio-urlnar joint of the right wrist secondary to traumatic disruption of the triangular fibrocartilage complex(TFCC) is described. At operation, a strip of tensor fascia lata was used to stabilize the distal radio-ulnar joint. Complete relief of pain and restoration of normal function was obtained following surgery. The literature on TFCC disorders is also reviewed.


Subject(s)
Humans , Adult , Male , Cartilage, Articular/injuries , Cartilage, Articular/surgery , Radius/injuries , Radius/surgery , Ulna/injuries , Ulna/surgery , Joint Dislocations/etiology , Wrist Joint
12.
Rev. Asoc. Argent. Ortop. Traumatol ; 50(1): 63-8, jun. 1985. ilus
Article in Spanish | LILACS | ID: lil-282721

ABSTRACT

La inestabilidad radiocubital distal, es una entidad clinica y anatomica, aun mal conocida y definida. En esta comunicacion se ha pretendido describirla con mas claridad, y sin dejar de admitir otras etiologias, se la vincula a la lesion del menisco articular o ligamento triangular. Se presentan comprobaciones histologicas de pacientes operados y de investigaciones anatomicas. Los resultados de los casos operados, mediante la modificacion de la operacion de Darrach, han sido satisfactorios


Subject(s)
Wrist Joint/surgery , Joint Instability , Ligaments, Articular/anatomy & histology , Ligaments, Articular/pathology , Radius/injuries , Ulna/injuries , Adult , Argentina , Pain
13.
Diagnóstico (Perú) ; 13(5): 149-54, mayo 1984. ilus
Article in Spanish | LILACS, LIPECS | ID: lil-91319

ABSTRACT

Se presentaron 40 casos de seudoartrosis correspondientes al Hogar Clínica San Juan de Dios y Hospital Hipólito Unánue, sobre los cuales se ha realizado un estudio con referencia a la etiología, tiempo de fractura, tratamiento previo a la seudoartrosis, localización, tratamientos empleados y sus resultados


Subject(s)
Humans , Infant , Child, Preschool , Fractures, Ununited/etiology , Fractures, Ununited/therapy , Child , Tibia/injuries , Femur/injuries , Ulna/injuries , Humerus/injuries , Radius/injuries
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