Computer-Assisted 3-Dimensional-Planned Corrective Osteotomy for Symptomatic Fracture Malunion: An Ulna-Only Case Study.

We present a case of an ulna malunion managed with computer-assisted 3-dimensional planned corrective osteotomy in a patient with a history of distal radius fracture treated with open reduction internal fixation and concurrent distal ulna fracture treated conservatively. The distal ulnar diaphyseal deformity was complex and existed in multiple planes, including a clinically significant rotational deformity. Preoperative computed tomography scans were used to plan 3-dimensional guides for the osteotomy, which were subsequently printed and used during surgery. After surgery, our radiologic findings showed a high degree of accuracy and the patient demonstrated pain-free, full range of motion and returned to contact sports 4 months after surgery. This could be a reliable and precise option for complex ulnar diaphyseal malunion corrective surgery.

Limited incision carpal tunnel release.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Limited incision techniques for carpal tunnel release are gaining popularity. The main advantages of these techniques are less scar load, less pillar pain, shorter recovery, and return-to-work time. However, the completeness of release, and risk of neurovascular injury are always a concern. We devised a method of limited incision release with two mini-incisions and use of nasal speculum and a probe. We aimed to evaluate the clinical and neurological outcome of this technique. MATERIALS AND METHODS: Twenty seven cases (9 male and 18 female, age 28-56 years) of isolated CTS cases were enrolled in the study. A total of 33 hands (six bilateral) underwent limited incision carpal tunnel release. In this study, two mini-incisions were used and release was done with the help of nasal speculum. Evaluation preoperatively and in 6 months and at 1-year postoperatively was done, namely, (a) clinical status examination, (b) motor testing using grip and pinch dynamometer, and (c) neurological outcome measure using nerve conduction study. RESULTS: All the patients had good clinical and neurological outcome with no recurrence during followup. The first symptom to get relieved was night pains, with a mean of 4.5 days (range 2-14 days). Compared to pain, improvement of sensory symptoms was delayed; the mean duration was 42.8 days (range 30-90 days). Scar tenderness was present only for a mean duration of 9 days (range 7-21 days). The mean duration for patients to resume their daily activities was12 days (range 7-28 days) and to work was 32 days (range 21-90 days). The hand grip showed mean values of 45.12 ± 16.16 g/mm2 preoperatively, 62.45 ± 18.86 g/mm2 at 6 months postoperatively, and 74.87 ± 20.35 g/mm2 at 1-year postoperatively. The key pinch showed mean values of 11.27 ± 3.51 g/mm2 preoperatively, 20.181 ± 3.94 g/mm2 at 6 months postoperatively, and 27.96 ± 94.42 g/mm2 at 1-year postoperatively. The tip pinch showed mean values of 8.88 ± 2.39 g/mm2 preoperatively, 15.393 ± 3.25 g/mm2 at 6 months postoperatively, and 19.27 ± 4.81 g/mm2 at 1-year postoperatively. The palmar pinch showed mean values of 14.42 ± 2.92 g/mm2 preoperatively, 19.303 ± 3.62 g/mm2 at 6 months postoperatively, and 22.97 ± 4.08 g/mm2 at 1-year postoperatively. CONCLUSION: Limited incision carpal tunnel release can be considered a feasible alternative to traditional open release and endoscopic release.