Fracture in Humeroradial Synostosis: Description of Two Clinical Cases.

Synostosis is a generic term to indicate the union of two originally separated bones. At the elbow, humeroradial or longitudinal synostosis causes significant disability, which varies depending on hand function, elbow positioning, adjacent joints mobility and contralateral limb function. It is estimated that, to date, a little more than 150 patients have been described with this deformity, which is more common in subjects with deficient ulnar formation or affected by conditions such as Antley-Bixler and Hermann syndromes. The lack of the elbow joint, with the formation of a longer bone due to humerus-radius fusion, results in stiffness. As such, it is assumed that fractures in this topography are not uncommon. However, since synostosis is rare, this lesion was only described twice in the literature. We report two patients with a fracture of the single bone formed by a humeroradial synostosis and Bayne type-IV ulnar formation failure. Both patients were treated surgically with success. We emphasize the need for adequate treatment to not compromise the daily activities of patients who are adapted to their deformity, thus avoiding worsening the function of a previously affected limb.

The Flexor Carpi Radialis Portal for Arthroscopy-Assisted Reduction of the Dorsal Ulnar Fragment in Distal Radius Fractures.

Background The importance of the dorsal ulnar fragment (DUF) for stability and articular congruence of the radius is widely recognized, and standard surgical techniques often fail to ensure its reduction. Description of Technique We describe a modification of volar wrist portals for arthroscopic management of the DUF of the distal radius. It is made in an outside-in fashion in line with the flexor carpi radialis (FCR) approach for the distal radius. Through this volar portal, we achieve wide and direct visualization of the DUF, with the advantage of protecting important anatomic structures such as the FCR tendon, the radial artery, and the median nerve; all protected with the previously made volar approach for the distal radius. In addition, easy manipulation and reduction of the DUF is obtained with instrumentation through standard dorsal portals. Patients and Methods We performed this procedure in 23 patients with distal radius fractures (DRF) with displaced DUF. Results Early and late postoperative evaluation demonstrated intraoperative reduction maintenance and adequate range of motion, compatible with the usual findings of standard volar plating, with the benefit of anatomic reduction of the DUF. Conclusion With our technique, volar plating associated with arthroscopy-assisted dorsal fragment specific fixation with dorsal standard and the FCR portals permits optimal surgical treatment of most DRFs.