Wrist Hemiarthroplasty for Complex Intraarticular Distal Radius Fracture in a Patient with Manifest Osteoporosis.

Distal radius fracture (DRF) is one of the most common fractures of the elderly. The higher the degree of joint surface destruction, and the more adverse factors are involved, the more challenging proper treatment becomes. In this regard, osteoporosis as underlying systemic disease, chondropathy or degeneration of adjacent wrist bones as well as incompliance significantly impair the success of the chosen primary therapy. Wrist hemiarthroplasty has already been reported as primary or secondary procedure for DRFs. In this case report, we present a patient with a severely comminuted DRF including posttraumatic degeneration of the lunate as well as manifest osteoporosis. Wrist hemiarthroplasty using the ReMotion radius component in combination with proximal row carpectomy was performed as secondary surgery. This procedure proved to be a viable treatment option in terms of achieving low pain levels, high range of motion values and stable osteointegration over a course of 6.5 follow-up years.

Functional outcomes after arthroplasty of the distal radioulnar joint and hand therapy: a case series.

The purpose was to present a therapy protocol for use after implantation of an ulnar head endoprosthesis and to describe the functional outcomes after hand therapy. This is a retrospective review of a series of eight patients treated with a specified therapy protocol after ulnar head resection and implant arthroplasty. Marked improvements in pain and function were reported, though some pain with exertion remained. Two patients were on worker's compensation and both have returned to their premorbid work status. Functional use of the extremity was achieved by two to six weeks, with a mean of four weeks. Maximum medical improvement with good-to-excellent early results was achieved in all patients by 16 weeks. It is our experience that with this directed therapy protocol patients undergoing this procedure experience rapid recovery and an ability to return to activities of daily living in a timely manner. This paper provides a baseline protocol and rationale for use with patients who have undergone surgery with an ulnar head endoprosthesis.

When one has nothing, a little is a lot.

Volunteerism in Third World countries is a rewarding but humbling experience. Although different locations have specific issues that must be overcome, common threads are often found. Through experience, desire, and commitment, a great deal of value can be created by the work of volunteers-value for both the recipient and the giver. This article reflects some of my experiences and thoughts on this topic.

Surgical management of a long segmental defect of the humerus using a cylindrical titanium mesh cage and plates: a case report.

This is a case report of a patient who sustained multiple gunshots resulting in a Gustilo Anderson type IIIB mid-shaft humeral fracture associated with extensive segmental bone and soft-tissue loss. The patient was treated initially by multiple irrigations, wound debridement, and a unilateral external fixator. After the soft tissue healed without infection, the mid-shaft humeral defect of approximately 8 cm segmental bone loss was reconstructed with a cylindrical titanium mesh cage packed with a composite of cancellous allograft and demineralized bone matrix putty and stabilized with limited contact dynamic compression plates. At 13 months follow-up, plain radiographs demonstrated a healed construct with good alignment, and computed tomography images demonstrated bony in-growth through the cage. The patient had full range of motion at the shoulder and the elbow. This technique may be a reasonable alternative when treating large segmental bone defects of the humerus.