Application of a novel shape-memory alloy concentrator in displaced olecranon fractures: a report of the technique and mid-term clinical results.

PURPOSE: Olecranon fracture is a common upper limb fracture, and several surgical approaches have been advocated for its fixation. To overcome the complications associated with common techniques, we present a novel shape-memory alloy concentrator, an alternative for tension band compression, to fix olecranon fracture. METHODS: Fifty-seven patients (26 men and 31 women) with olecranon fracture, with a mean age of 45 years, were included in this study. Each patient had undergone open reduction and internal fixation using the Nitinol (Ni-Ti) arched shape-memory connector (ASC). The clinical assessments were performed using the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and the Mayo Elbow Performance (MEP) score, which were both recorded at the final follow-up visit. RESULTS: The patients were followed up for 44 months on average (range, 31 to 56 months). No patients were lost to follow-up, and all of the olecranon fractures healed in an average of 15 weeks (range, 10 to 34 weeks). The mean DASH score was 8.6 (range, 0 to 32.4), and the mean MEP score was 92.5 (range, 74 to 100). Nine patients showed postoperative complications: prominent hardware (2), infection (1), loss of the range of functional motion (5), and heterotopic ossification (1). CONCLUSION: The ASC may serve as a favorable device for multi-fragmented and comminuted fractures with rare hardware irritation and may also provide continuous concentrative compression to accelerate osseous healing, thereby aiding the restoration and permitting an early rehabilitation with a low incidence of postoperative complications.

Serious games therapy associated with conventional physical therapy intervention accelerated hand muscles strengthening and hand functioning after complex fracture of the wrist: A case report.

STUDY DESIGN: Case report. INTRODUCTION: A severe wrist fracture can cause permanent physical disabilities and deformities, leading to limit patients in their occupation and social environment. PURPOSE OF THE STUDY: We aim at presenting a treatment protocol and the functional outcome of a patient with severe clinical state after a rare wrist fracture. METHODS: We provided physical therapy intervention associated with serious games for muscle strengthening. RESULTS AND DISCUSSION: There was an increase in strengthening and a decrease in Disability of the Arm, Shoulder and Hand score and Patient Rated Wrist Evaluation scores. The International Classification of Functioning scores have changed from severe to light or to absent in many of the domains. CONCLUSION: The use of serious games combined with a conventional physical therapy intervention played a fundamental role in recovery and return to work activities, and there was also an important recovery of general health condition.

Release Rates and Complications for Birds of Prey With Antebrachial Fractures at a Veterinary Teaching Hospital.

A retrospective case series that included 253 free-ranging birds of prey admitted to a rehabilitation center was conducted to describe the treatment and outcome of antebrachial fractures. Medical records from birds of prey belonging to 21 species admitted with antebrachial fracture between 1989 and 2015 at the University of California, Davis, were reviewed. Species distribution on admission, treatment, outcome, and complications were described by fracture category and species. Among 134 birds treated after initial triage on the day of admission, 4 bone/ wing categories were identified: 83 birds had an ulnar fracture only; 18 birds had a radial fracture only; 28 birds had a concomitant fracture of the radius and ulna on the same wing; and 5 birds had bilateral antebrachial fractures. Logistic regressions were performed to determine which factors were associated with a positive outcome within each of these 4 categories. Among birds having only an ulnar fracture, those with a closed fracture were significantly more likely to be released than birds with open fractures (P = .03; odds ratio = 5.43, 95% confidence interval: 1.29-28.12). In addition, birds with a fracture of the middle third of the ulna were significantly more likely to be released than birds diagnosed with a single fracture of the proximal third of the ulna (P = .02; odds ratio = 4.54, 95% confidence interval: 1.35-16.64). No significant prognostic factor was detected in other fracture categories.

Ulnar Nerve Injury in Pediatric Midshaft Forearm Fractures: A Case Series.

OBJECTIVES: To describe a midshaft forearm fracture pattern that places the ulnar nerve at risk in the pediatric population and provide 7 clinical case examples describing the injury pattern and treatment methods. DESIGN: Retrospective observational case series, review of literature, cadaver dissection, and treatment recommendations. SETTING: Multi-institutional, Southeast United States. PATIENTS: Seven pediatric patients (5 male and 2 female) with mean age of 8.7 years (range, 3-14) who sustained a significantly displaced closed, or grade I open, middle to distal one-third both-bone forearm fracture with subsequent ulnar nerve dysfunction. INTERVENTIONS: Manual reduction and casting of both-bone forearm shaft fractures, operative debridement, fracture fixation, nerve exploration, neurolysis, nerve repair, and nerve grafting. MAIN OUTCOME MEASUREMENTS: Radiographic fracture union, clinical ulnar nerve motor and sensory function testing, along with selective electric nerve testing and advanced imaging were monitored throughout follow-up postinjury. RESULTS: Five of 7 patients underwent surgical treatment and 2 others were treated with conservative measures. The ulnar nerve was entrapped within the fracture site of one patient with an open fracture along with partial nerve transection, and 4 patients were found to have the nerve encased in hypertrophic scar tissue or bony callus upon surgical exploration at 3-12 months postinjury. CONCLUSIONS: The ulnar nerve lies in a precarious position in the middle to distal one-third forearm and is bound by anatomic constraints that place the nerve at risk of injury. This article offers a treatment algorithm that includes conservative treatment, acute exploration, early exploration (≤3 months), and late exploration (>3 months). LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The impact of varus angulation on proximal fractures of the ulna.

BACKGROUND: We studied anteromedial varus angulation (VA) in the proximal third of the ulna. The importance of restoration of the anatomical orientation of the ulnar after a proximal fracture is unclear. The purpose of this study was to evaluate the impact of minimal proximal ulna malunion on elbow function after a proximal ulna fracture. METHODS: We reviewed the follow-up of 60 patients who had undergone open reduction with internal fixation (ORIF) of a proximal fracture of the ulna. Patients were divided into two groups, defined as either more or less than 5° of the difference between the VA of the fractured and contralateral ulna. The range of motion(ROM)of elbow flexion, extension and forearm rotation on both sides, Mayo Elbow Performance Score (MEPS) and Visual Analogue Scale (VAS) were measured. RESULTS: The average postoperative time was 3.1 years (1-5 years). Mean VA of the fractured arm was different from the normal side (7.8 ± 3.0 vs 12.7 ± 3.0). Compared to the unfractured arm there was a loss in mean elbow flexion (14.2 ± 4.9 vs 18.0 ± 5.9), extension ROM (7.1 ± 2.5 vs 9.3 ± 1.9, p < 0.05) and forearm rotation ROM (15.6 ± 8.6 vs 21.8 ± 9.5) that were statistically significant (p < 0.05). There were no statistically significant differences in the MEPS and VAS score results between the two groups (p > 0.05). CONCLUSIONS: The function of the elbow and forearm was restricted after VA malunion in the proximal ulna, but the quality of life of these patients had not been significantly affected. We suggest that orthopedic surgeons should assess whether the specialized structures of the proximal ulna are damaged or not before surgery. If the anatomy of the fractured bone cannot be restored through manipulation of the connected end directly, it is better to image the anatomical structure of the healthy side from using an elbow X-ray before surgery, and then reset using a pre-shaped plate to prevent malunion.

Case Series of Comminuted Olecranon Fracture Treated by Plate Fixation; Do We Have to Remove the Plate?

Comminuted olecranon fracture requires surgical intervention. Plate fixation has been performed on the majority of cases. We reviewed the cases of comminuted olecranon fracture in young and middle age treated by plate osteosynthesis and analyzed the functional outcome, complications and ratio and timing of hardware removal. Fifteen cases of comminuted olecranon fractures treated by plate fixation were reviewed. Bone union was achieved in all cases, the average range of motion at the final follow up was -11° in extension, 133° in flexion, 89° in pronation and 88° in supination. Hardware removal performed in 12 cases in average 8.3 months postoperatively, in 2 cases elbow joint contracture release was performed during the hardware removal. In the co-payment (+) group, 4 cases (67%) removed the plate at average six months postoperatively. On the other hand, no co-payment group (workman's compensation insurance or automobile liability insurance) underwent hardware removal surgery in 8 cases (89%) at 9.6 months postoperatively. There was no statistical difference between the timing or prevalence of hardware removal between the groups. The present study showed high removal rate of hardware despite the excellent clinical result. The surgeons should be aware that plate fixation of the olecranon fracture requires the removal of a plate in the majority of cases.

Early range of motion exercise in pediatric patients with olecranon fractures treated with tension band suture with double loops and double knots.

BACKGROUND: Pediatric patients with olecranon fractures are uncommon. The tension band suture technique was introduced to reduce the burden of implant removal and other complications. However, to our knowledge, early range of motion (ROM) exercise has not been introduced in this population of patients. Double Vicryl loops and knots with 2 cross-pins are used to maintain the benefits of the tension band suture technique and to enhance fixation tensile strength. We believe that early ROM exercises could be achieved without nonunion or fixation failure. METHODS: Twelve pediatric patients with olecranon fractures were treated with tension band suture with double loops and knots between 2004 and 2015. Vicryl No. 1 was used for wiring. ROM exercises were initiated 1 week postoperatively with a customized functional brace. Early functional outcomes were evaluated by the Mayo Elbow Performance Score at every visit after 8 weeks postoperatively. RESULTS: Nine boys and 3 girls (average age, 10.6 years; range, 5 years 7 months-16 years 2 months) were included in the study. Initial displacement and angulation of the fractures were 5 mm (2-7 mm) and 12° (4°-25°), respectively. Two cases had radial neck fractures of the ipsilateral elbow. All patients had a perfect Mayo Elbow Performance Score after 8 weeks postoperatively. Pin removals were performed at 13.1 weeks. No complications, including growth arrest, were observed. DISCUSSION/CONCLUSION: Tension band suture with double loops and knots, combined with early ROM exercise, may be a complete alternative to tension band wiring.

[Fractures of the olecranon]. / Die Olekranonfraktur.

OBJECTIVE: Fractures of the olecranon are the most common fractures of the elbow in adults. Due to the dislocating force of the triceps muscle, internal fixation is the treatment of choice. INDICATIONS: All fractures of the olecranon without contraindications. CONTRAINDICATIONS: Infection and severe soft tissue damage. SURGICAL TECHNIQUE: Dorsal approach to the olecranon with the patient in a prone position. Open reduction and internal fixation with tension band wiring or plate fixation according to fracture pattern. POSTOPERATIVE MANAGEMENT: Treatment goal is early functional mobilization. No load bearing allowed for 6-8 weeks; full load bearing is allowed after fracture healing. RESULTS: The quality of published studies concerning the surgical treatment of olecranon fractures is poor. Published functional results are predominantly good and excellent. Hardware removal was often required.

[Operative treatment of terrible triad injury of the elbow : Open reduction and internal fixation]. / Operative Therapie der Terrible-Triad-Verletzung des Ellenbogens : Offene Reposition und interne Fixation.

AIM OF SURGERY: Reconstruction of the most important ligamentous and osseus structures of the elbow after terrible triad injury via the radial head to the lateral collateral ligament complex (LCL) and if necessary beginning at the coronoid process. The aim is a stable concentrically guided elbow with early functional follow-up treatment. The approach depends on the intraoperatively tested stability. INDICATIONS: Osteoligamentous terrible triad injury pattern with or without subluxation position following reduction and temporary immobilization. CONTRAINDICATIONS: Inoperable due to comorbidities. Concentric elbow with radial head fracture without impairment of pronation/supination, coronoid fragment <50% and stable range of motion up to 30°. OPERATIVE TECHNIQUE: Lateral access according to Kaplan or Kocher in order to address the anterior capsule/coronoid tip. Stabilization of the radial head with mini fragment screws and plates or radial head prosthesis. Osseous reinsertion of the LCL at its origin with transosseous sutures/bone anchors on the radial epicondyle of the humerus. In cases of persisting instability (hanging arm test) treatment with lateral movement fixation and/or the medial collateral ligaments from medial. FOLLOW-UP TREATMENT: Immobilization in upper arm plaster cast in the first postoperative days, active assistive pain-adapted movement therapy in the cast from postoperative day 1 and after 6-8 weeks resistive therapy in the whole elbow. RESULTS: Control of 15 terrible triad patients (mean age 45.9 years, range 20-87 years) after 9.6 months (range 2.6-31.6 months), extent of movement flexion/extension 131/14/0°, pronation/supination 78/0/67°. Arthrolysis after an average of 38 weeks in 4 patients, signs of joint arthrosis in 8, heterotopic ossification in 7 and neuropathic complaints in the region of the ulnar nerve in 1 patient. Early functional therapy with reproducible results by stabilization of osteoligamentous structures.

Treatment of a forelimb fracture and rehabilitation of a free-ranging iberian wolf (canis lupus signatus) / Osteossíntese de fratura localizada no membro torácico num lobo ibérico (canis lupus signatus) selvagem e sua reabilitação

The surgical treatment of an exposed compounded comminuted fracture of the right radius and ulna in a free-ranging adult female Iberian Wolf (Canis lupus signatus) with an osteosynthesis plate and screws and subsequent post-operative care are described. The evolution of the fracture healing was very similar to those expected in a dog of the same size. The prompt surgical intervention and a proper housing, feeding and wound management adapted to a free-ranging wolf, in view to reduce manipulation and post-operative complications, allowed the subsequent rehabilitation and release of the animal. After 10th post-operative weeks the wolf was fitted with a Global Positioning System (GPS) for wildlife tracking collar and released in the same area where it has been caught. GPS telemetry data showed that the animal covered increasingly large distances confirming a complete functionality of the right thoracic limb and its successfully return to the wild. This report could constitute the first detailed report of a long bone fracture treatment in a free-ranging wolf and its successfully rehabilitation, release and adaptation to the wild.

O objetivo do presente artigo é a descrição da realização da estabilização de uma fratura cominutiva exposta do rádio e ulna do membro torácico direito em Lobo Ibérico selvagem por meio de osteossíntese com placa e parafusos ósseos bem como o manejo pós-operatório. A evolução da cicatrização da fratura óssea foi similar à esperada num canídeo doméstico de porte idêntico. A intervenção cirúrgica realizada rapidamente, bem como o alojamento adequado, alimentação e manejo adaptado a um lobo selvagem, visando minimizar a manipulação e o aparecimento de possíveis complicações pós-operatórias permitiram o sucesso na reabilitação e posterior libertação do animal. Na 10ª semana pós-operatória foi colocado um colar GPS no animal para deteção permanente da sua localização, tendo sido o animal libertado na mesma área onde havia sido capturado. Os dados obtidos por telemetria GPS demostraram que o lobo percorreu distâncias consideráveis, confirmando a completa recuperação do membro torácico direito e o sucesso da sua reintrodução na natureza. Este artigo poderá constituir a primeira descrição pormenorizada sobre a estabilização de fratura de ossos longos em um lobo selvagem com a sua posterior reintrodução na vida selvagem com sucesso.

Plate osteosynthesis versus intramedullary nailing for both forearm bones fractures.

PURPOSE: Given the continuing improvements in nail implants, intramedullary nailing could become an alternative treatment option to osteosynthesis for the treatment of fractures in both forearm bones, with the proper indication. The aim of this prospective study was to evaluate and compare the results of plate osteosynthesis and intramedullary nailing for the treatment of diaphyseal fractures in both forearm bones. METHODS: Sixty-seven patients (mean age, 41 years; range, 22-76 years) of this prospective study were divided into two groups according to treatment randomly: ORIF group (plate osteosynthesis) and IMN group (intramedullary nail). The results were assessed on the basis of the time to union, functional recovery (range of motion and functional outcomes [Grace and Eversmann rating system and DASH]), restoration of the ulna and the radial bow, operating time, exposure time to fluoroscopy, complications, and patient satisfaction. The ratio of the magnitude of the maximum radial bow on the injured side to that on the contralateral side (i.e., "the ratio of the contralateral side") was determined to evaluate the effectiveness of radial bow restoration between groups. RESULTS: The time to union and the exposure time to fluoroscopy were significantly shorter in ORIF group than in IMN group. The presence of butterfly segment and severe displacement were factors leading to the increase in the time of union in IMN group. No intergroup differences were observed in the restoration and magnitude of the maximum radial bow on the injured side. However, ORIF group showed a significantly improved ratio of the contralateral side compared to IMN group. In terms of the location of maximum radial bow and ratio of the contralateral side, significant differences were found between groups. The functional outcomes did not significantly differ between the two groups, irrespective of the time of assessment. All patients achieved union in both groups, with the exception of a single case of nonunion in IMN group and one case of refracture after implant removal in ORIF group. CONCLUSION: Based on the significant differences in the ratio of the contralateral side, plate osteosynthesis resulted in a more excellent extent of restoration to the conditions prior to the injury. Nevertheless, such significant differences in the restoration of the bow had no effect on the final clinical outcome. If the indication is properly selected, our results suggested intramedullary nailing can be acceptable and effective treatment options for fractures in both forearm bones.

Percutaneous autologous concentrated bone marrow grafting in the treatment for nonunion.

The purpose of this study was to evaluate the clinical and radiographic treatment effects of percutaneous autologous concentrated bone marrow grafting in nonunion cases and to evaluate the effectiveness of this grafting procedure. We enrolled 17 cases those had atrophic changes due to continuous nonunion for over 9 months after injury and had undergone low-intensity pulsed ultrasound treatment for more than 3 months. The site of nonunion was the femur in 10 cases, the tibia in 5 cases, the humerus in 1 case, and the ulna in 1 case. They underwent percutaneous autologous concentrated bone marrow grafting and continued low-intensity pulsed ultrasound stimulation treatment after grafting. Patients were evaluated using the visual analogue scale for pain at immediately before the procedure, 3, 6, and 12 months after grafting. Plain radiographs of the affected site were taken and evaluated about the healing of the nonunion site at each clinical evaluation. As quantitative assessment, CT scans were undertaken before the procedure and 6 months after grafting. The visual analogue scale pain score was reduced consistently after grafting in all patients. About the healing at the nonunion site, 11 and 13 cases of bone union were observed at 6 and 12 months after grafting. The mean volume of callus formation based on CT images was 4,147 (262-27,392) mm3 total between grafting and 6 months. Percutaneous autologous concentrated bone marrow grafting is an effective procedure for the treatment of patients with nonunion.

Fractura incarcerada de epitróclea con lesión del nervio cubital / Incarcerated epitrochlear fracture with a cubital nerve injury

Las epifisiólisis de la epitróclea son lesiones relativamente frecuentes, que afectan fundamentalmente a niños entre los 7 y los 15 a˜nos. Las características anatómicas de esta apófisis puede dificultar el diagnóstico en las fracturas mínimamente desplazadas. En un peque˜no porcentaje de casos el fragmento fracturario puede ocupar el surco retroepitroclear. La presencia de disestesias en el territorio del nervio cubital obliga a la reducción abierta urgente del fragmento incarcerado. Se presenta el caso de un paciente varón de 7 a˜nos de edad, que precisó de una revisión quirúrgica por una fractura desplazada de epitróclea asociada a lesión del nervio cubital. Se realiza una revisión de la literatura médica respecto a esta enfermedad (AU)

Injuries of the medial epicondyle are relatively common, mostly affecting children between 7 and 15 years. The anatomical characteristics of this apophysis can make diagnosis difficult in minimally displaced fractures. In a small percentage of cases, the fractured fragment may occupy the retroepitrochlear groove. The presence of dysesthesias in the territory of the ulnar nerve requires urgent open reduction of the incarcerated fragment. A case of a sevenyear- old male patient is presented, who required surgical revision due to a displaced medial epicondyle fracture associated with ulnar nerve injury. A review of the literature is also made (AU)

Clinical results of olecranon fractures treated with multiplanar locked intramedullary nailing.

BACKGROUND: Proximal ulnar fractures have traditionally been fixed with either tension band wiring or plate and screw fixation. These traditional techniques often irritate the surrounding soft tissues, potentially leading to subsequent secondary hardware removal surgeries. Intramedullary proximal ulnar fixation provides similar rigid fixation, however, no review yet exists to support the clinical use of currently available implants. OBJECTIVES: To investigate the clinical and radiographic short-term outcomes for multiplanar locked intramedullary nails used to treat proximal ulnar fractures. METHODS: A retrospective multicenter review was conducted in 28 patients with unstable olecranon fractures treated with a new multiplanar locked intramedullary nailing system (OlecraNail, Mylad Orthopedic Solutions, McLean, VA). Radiographic union was estimated, and serial clinical outcome up to one year was assessed by strength, motion, pain (visual analog scale), and a subcutaneous ulna border palpation (SCUBP) test to assess hardware prominence. RESULTS: All fractures achieved union by 8 weeks. At 12 weeks postoperatively, all motion was within 10 degrees of the contralateral side in all directions. Of the 18 patients who underwent SCUBP testing, all 18 patients reported to have no pain at 12 weeks. At one-year follow-up, all patients had resumed normal activities, including work and athletics. All of the patients who underwent the SCUBP testing continued to have no pain. CONCLUSIONS: Multiplanar locked intramedullary nails offer effective management for proximal ulna fractures similar to those reported with plating techniques. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Epidemiology and health-care utilisation of wrist fractures in older adults in The Netherlands, 1997-2009.

INTRODUCTION: Wrist fractures are common in older adults and are expected to increase because of ageing populations worldwide. The introduction of plate and screw fixation has changed the management of this trauma in many patients. For policymaking it is essential to gain insight into trends in epidemiology and healthcare utilisation. The purpose of this study was to determine trends in incidence, hospitalisation and operative treatment of wrist fractures. METHODS: A population-based study of patients aged 50 years and older using the Dutch National Injury Surveillance System and the National Hospital Discharge Registry. Data on emergency department visits, hospitalisations and operative treatment for wrist fractures within the period 1997-2009 were analysed. RESULTS: In women, the age-standardised incidence rate of wrist fractures decreased from 497.2 per 100,000 persons (95% confidence interval, 472.3-522.1) in 1997 to 445.1 (422.8-467.4) in 2009 (P for trend < 0.001). In men, no significant trends were observed in the same time period. Hospitalisation rates increased from 30.1 (28.3-31.9) in 1997 to 78.9 (75.1-82.8) in 2009 in women (P < 0.001), and from 6.4 (6.0-6.8) to 18.4 (17.3-19.5) in men (P < 0.001). There was a strong increase in operative treatment of distal radius fractures, especially due to plate fixation techniques in all age groups. CONCLUSION: Incidence rates of wrist fractures decreased in women and remained stable in men, but hospitalisation rates strongly increased due to a steep rise in operative treatments. The use of plate and screw fixation techniques for distal radius fractures increased in all age groups.

Rehabilitation considerations in the management of terrible triad injury to the elbow.

An elbow dislocation associated with a radial head and coronoid fractures is termed a terrible triad. This injury almost always renders the elbow unstable requiring surgical intervention. The primary goal of surgery is to stabilize the elbow to permit early motion to prevent stiffness. Recent literature has improved our understanding of elbow anatomy and biomechanics as well as the pathoanatomy of this injury. This article reviews key concepts that will allow the surgeon and therapist to apply an systematic rehabilitation approach when managing such injuries.

Use of homologous bone graft in the treatment of aseptic forearm nonunion.

The dyaphyseal nonunion of forearm bones is a complication that changes the normal interaction between radius and ulna, which may lead to forearm malfunction. We reviewed 14 patients treated by surgical technique included a homologous bone graft in combination with a plate. The mean age was 31 years (range, 18-45 years) at the time of surgery. Minimum follow-up was 2 years (mean, 5 years; range, 2-13 years). There were no intraoperative or postoperative complications. At last follow-up, all forearm bones had remodelled. The mean visual analogue pain scale was 1 (range, 0-4). There was a high success rate regarding forearm alignment and functional results; all patients recovered daily and working activities quickly. This surgical technique in treatment of aseptic forearm nonunion by combining homologous bone graft with a plate led to bone healing, improved forearm function, and a durable outcome with long-term follow-up.

Resultados funcionales de la prótesis total radiocubital distal: caso clínico y revisión de la bibliografía / Functional outcomes of total distal radioulnar joint: a case report and review of the literature

La articulación radio cubital distal (ARCD) resulta imprescindible para poder elevar objetos contra gravedad. En las lesiones de dicha articulación, es necesario reconstruir todos los elementos articulares y estabilizadores para poder soportar la fuerzas de tensión en muñeca y antebrazo y evitar una importante pérdida de función de la extremidad. La prótesis total radiocubital distal promulgada por Scheker es una alternativa novedosa para reparar anatómica y biomecánicamente esta articulación, ya que los procedimientos previos (resección, artrodesis o hemiartroplastia) no han mostrado resultados satisfactorios. Se presenta el caso de una paciente con inestabilidad de muñeca por disfunción de la ARCD en la que se implantó dicho modelo protésico y se desarrolló un programa de rehabilitación posquirúrgico previamente no descrito, de 12 semanas de duración. Se exponen unos resultados funcionales excelentes y se comparan con los publicados en la bibliografía(AU)

The distal radioulnar joint (DRUJ) is very important for lifting objects. When the DRUJ is injured, all of the joint elements and stabilizing elements must be reconstructed in order to be able to support the tension forces on the wrist and forearm and avoid significant loss of limb functions. The total DRUJ prosthesis developed by Scheker is a new alternative to be taken into account. It seems to allow anatomical and biomechanical repair of the DRUJ. Moreover, it gives better results than previously published procedures (removal, arthrodesis and hemiarthroplasty of the DRUJ). We present the case of a woman with symptomatic wrist instability due to dysfunction of the DRUJ who underwent Scheker's arthroplasty. In the postoperative period, we designed a new 12-week rehabilitation program, which gave us an excellent result. Finally we discuss our case, comparing them with those previously reported in the literature(AU)

[Modern approach to the rehabilitation of children with fractured long tubular bones].

An optimized therapeutic rehabilitation program involved 393 patients with fractured long bones (humeral, radial/ulnar, femoral, crural) admitted to the Orthopedic Department of the Stavropol Regional Children's Clinical Hospital and the Rehabilitation Centre for Handicapped Children and Adolescents. Rehabilitation was performed in three consecutive stages, viz. immobilization, functional recovery and training. The proposed approach ensured rather fast functional recovery of the affected extremity even in cases with compound fractures. The rehabilitation program included polyenzyme therapy with wobenzym during 3-4 weeks after injury or surgical repositioning of bone fragments. Pain and oedema syndromes resolved twice as fast as after traditional treatment. The use of this program permitted to avoid development of contracture and disturbances of locomotary activity; moreover, it improved the quality of life in children with fractures of long tubular bones.

Olecranon fractures.

Several options exist for the management olecranon fractures. These include tension band, plate and intramedullary fixation techniques as well as fragment excision with triceps advancement and non-operative management. No one technique is suitable for the management of all olecranon fractures. In deciding how to treat this common trauma presentation, the surgeon needs a good understanding of the anatomy, different fracture morphologies, surgical options and potential complications. With appropriate management and early mobilisation good functional results can be expected in the majority of patients.