Ultrasonography-assisted assessment of the influence of the volar prominence of the plate on the median nerve in distal radius fractures.

OBJECTIVE: The study aimed to explore the effect of differing volar locking plate (VLP) prominence on the median nerve (MN) in distal radius fracture (DRF) with ultrasound assistance to guide clinical treatment. METHODS: Forty-four patients who received VLP for DRF at our department were admitted and followed-up between January 2019 and May 2021. Different plate positions were graded using Soong classification; 13 were Grade 0, 18 were Grade 1, and 13 were Grade 2. The MN parameters at different wrist positions in patients with different Soong grades were measured with ultrasound assistance, including the median nerve cross-sectional area (MNCSA), diameter in the radial-ulnar direction (D1), and diameter in the dorsal-palmar direction (D2). The sensation in the affected finger and grip strength were collected at follow-up, scored using the Disabilities of the Arm, Shoulder, and Hand (DASH) scale to determine function, and statistically analysed. RESULTS: The MNCSA differed significantly across Soong grades. The MNCSA at the flexed, neutral, and extended wrist positions was smallest at Grade 0 and largest at Grade 2 (P < 0.05), and that at the neutral position was not significantly different between Grades 1 and 2 (P > 0.05). There was no significant interaction between the wrist positions and Soong grade (P > 0.05). The differences in D1 and D2 among different Soong grades were not statistically significant (P > 0.05). There were no statistical differences in grip strength, DASH, and sensation among different Soong grades (P > 0.05). CONCLUSIONS: Differing plate protrusions in DRF treatment did not cause clinical symptoms during follow-up; however, excessive plate protrusion (Soong Grade 2) increased the cross-sectional area of the MN. We recommend placing the plate as proximal as possible during VLP treatment of DRFs to avoid excessive bulges affecting the MN.

An intraneural ganglion cyst of the ulnar nerve at the wrist: a case report and literature review.

BACKGROUND: Intraneural ganglion cysts of the ulnar nerve at the wrist are rare and poorly understood. We report a case of an intraneural ganglion cyst at the level of the wrist.Case presentation: A 48-year-old man presented with the complaints of weakness for 6 months and serious aggravation for 1 month in his right hand. After examinations, including ultrasound, the patient was diagnosed with an intraneural ganglion cyst. Intraoperatively, with exposure of the ulnar nerve, we found that the intraneural ganglion cyst was at the level of Guyon's canal and extended approximately 6 cm proximally. Postoperatively, sensation of the fingers was normal, but atrophy of his muscles and limited straightening of his ring and little fingers were similar to those preoperatively. CONCLUSIONS: Diagnosis of an intraneural cyst before surgery is mostly based on ultrasound and magnetic resonance imaging. Transection of the articular branch is an important measure to prevent recurrence of this cyst. If the ulnar nerve is compressed and causes symptoms, nerve decompression, including removal/aspiration of the cyst, and sometimes external neurolysis of the nerve, are necessary to relieve the symptoms and allow regeneration of the nerve. However, these should be performed without damaging the nerve fascicles.

Functional reconstruction of severe hand injuries using allogeneic tendons: a retrospective study.

OBJECTIVE: To evaluate the effectiveness and safety of allogeneic tendons for functional reconstruction of severe hand injuries. METHODS: From August 2007 to July 2014, we performed functional reconstruction with tendon allografts for severe hand injuries affecting two or more tendons. At the final follow-up, we assessed total active motion (TAM); pincer pinch strength; grip strength; Disabilities of the Arm, Shoulder, and Hand (DASH) score; degree of satisfaction; and adhesion. We measured the white blood cell count, C-reactive protein concentration, erythrocyte sedimentation rate, total T-cell count, and CD4+T/CD8+T ratio to evaluate the immune response and check for infection. RESULTS: Ten patients received 26 allogeneic tendons to reconstruct hand function. The average follow-up period was 50.0 months (range, 24-82 months). The TAM was 126.4° (12°-253°), pincer pinch strength was 0.83 kg (0-4.5 kg), and grip strength was 13.69 kg (4-41.5 kg). The DASH score was 14.25 (3.3-30.8), and seven and three patients were satisfied and partially satisfied, respectively. One patient developed tendon adhesion. All immune and infectious parameters were within the reference range. CONCLUSION: Functional reconstruction using allogeneic tendons for severe hand injuries with multiple tendon defects was effective and safe; however, more research is needed.

Melone's concept revisited in comminuted distal radius fractures: the three-dimensional CT mapping.

BACKGROUND: There is no consensus in the literature about the ideal classification of the distal radius fracture for the clinical practice. The traditional Melone classification system divides the distal radius into four basic components, the shaft, radial styloid, dorsal medial fragment, and volar medial fragment. The aim of this study was to identify fracture lines in comminuted distal radius fractures using three-dimensional mapping of computed tomography (CT) images to test the hypothesis that fracture fragments can be divided according to the Melone classification. METHODS: Fifty-nine consecutive OTA/AO 23C3 fractures presented at the hospital between January 2018 and October 2019 were retrospectively reviewed. The fracture lines were characterized in the axial, sagittal, and coronal CT planes. After reducing the fractures in a three-dimensional (3D) model, the fracture lines were plotted from the CT images and were then superimposed on one another and oriented to fit a standard template. The area of articular surfaces was measured and compared to quantify the differences between the radial bone fragments. RESULTS: Thirty-five cases (59.3%) in this study fit the Melone classification and 24 cases (40.7%) did not. On the radiocarpal surface, there was a greater concentration of fracture lines in the dorsal area of the radius than in the volar area. On the distal radioulnar joint (DRUJ), the fracture lines were focused around two specific concentrated regions. For the articular surface area, the mean area of the radial styloid, volar medial fragment, and dorsal medial fragment was 141.13 ± 90.16 mm2, 147.79 ± 75.94 mm2, and 79.05 ± 70.73 mm2, respectively. There was a significant difference in articular surface area for the Melone fragments (P = 0.002). CONCLUSIONS: The Melone classification system is not suitable for characterizing all C3 fractures. The findings of this study confirm that the dorsal medial fragments are relatively comminuted and small. Extra care should be given to these small fragments when reducing the fracture.

Effect of A2 pulley release on repaired tendon gliding resistance and rupture in a chicken model.

PURPOSE: Release of part of the A2 pulley has been suggested to improve function after zone II primary flexor tendon repairs. The purpose of this study was to measure the effect of A2 pulley release compared with pulley preservation on repaired tendon gliding resistance and rupture in the early postoperative period in a chicken model. METHODS: We divided 104 long toes from 52 Leghorn chickens into 2 experimental groups. In group 1, the flexor digitorum profundus tendons were cut completely and repaired surgically with either release or preservation of the A2 pulley. The tendon laceration was positioned so that the repair had to glide through the pulley with toe flexion. The toes were subjected to simulated active flexion at the end of the 2nd and 4th postsurgical weeks. The rupture rates of the tendons were recorded. In group 2, the volar two thirds of the tendons were cut and repaired, also in the region of the A2 pulley, with the pulley released or preserved. The force resisting tendon motion and the work of digital flexion with simulated active digital flexion were tested 3, 5, 7, and 14 days after surgery. RESULTS: At the end of the 2nd and 4th weeks, the tendon repairs showed significantly higher rates of rupture in the presence of an intact A2 pulley compared with those with the pulley released. Tendon gliding resistance was significantly increased with preservation of the pulley on postsurgical days 3, 5, 7, and 14; these toes required a greater number of motion cycles to reach steady levels of resistance and showed significantly higher steady resistance after digital motion. CONCLUSIONS: Release of the A2 pulley decreases the rate of repair rupture and the resistance to tendon gliding when the site of tendon repair has to glide through the pulley in the early postsurgical period. The findings of this study support partial release of the A2 pulley to favor successful tendon repair.

[Measurements of parameters of posteroanterior X-ray films of distal radial fracture and their significance].

OBJECTIVE: To provide the basic knowledge of wrist joint for diagnosing of these morphological change in pathological condition by measuring the posteroanterior X-ray films of different types of distal radius fracture by AO classification. METHODS: Eleven radiographic indexes were measured including following 7 new parameters of 83 cases of distal radius fracture: ulnar styloid length (USL), ulnar head length (UHL), ulnar head diameter (UHD), maximal distal radius width (MDRW), proximal distal radius width (PDRW), sigmoid notch length (SNL) and sigmoid notch width (SNW) by Pacs system in standard X-ray films. The indexes were defined by the ratio of these parameters to the length of the third metacarpal. Statistical significance of indexes and correlations of parameters were analyzed by SPSS 16.0. RESULTS: It was found that indexes of 11 parameters and 27 pairs of indexes had significantly different. Compared the indexes of 14 groups with normal group existed statistical significance, 62 pairs value of 11 parameters had correlations. CONCLUSION: The study provides additional radiographic index that will be helpful to more careful diagnosis and treatment of the distal radius fractures and their associated injuries such as ulnar wrist injuries or carpal instability.