Denju Osada

Dorsal plating for comminuted intra-articular fractures of the distal end of the radius.

Forty-one dorsally displaced intra-articular fractures of the distal radius were treated by open reduction and internal fixation with the dorsal Symmetry plates. The average age at the time of the injury was 49 years. An average follow-up period was 15 months. The final radial length averaged 11 mm, radial inclination 23 degrees, volar tilt 7 degrees, ulnar variance 1.5 mm, and articular incongruity 0.3 mm. According to the Gartland and Werly scales, 36 fractures were excellent and five were good. However, ulnar variance increased more than 3 mm during follow-up in eight patients, and volar tilt increased more than 5 degrees during follow-up in ten patients. Use of dorsal Symmetry plate is effective for unstable comminuted intra-articular distal radius fractures, but severely comminuted fractures may possibly undergo re-displacement post-operatively.

MALUNITED FRACTURES OF THE DISTAL RADIUS TREATED WITH CORRECTIVE OSTEOTOMY USING VOLAR LOCKING PLATE AND A CORTICOCANCELLOUS BONE GRAFT FOLLOWING IMMEDIATE MOBILISATION

We describe our experience of using a volar locking plate for corrective osteotomy and bone grafting combined with early mobilisation in the treatment of distal radius malunions. Corrective osteotomy of the distal radius was performed through a volar approach, and fixated by a volar locking plate associated with corticocancellous iliac bone grafting in three patients aged 16, 71 and 75 years. Two patients had had volarly displaced malunion and one dorsally displaced malunion. Wrist motion was started immediately after surgery. The average follow-up was 15 months (range, 12-20 months). All osteotomies healed at an average 5.7 weeks post-operatively, resulting in a total arc of wrist motion of 133 degrees, forearm rotation of 167 degrees, and grip strength of 70% of that of the contralateral side. This treatment method proved to be effective and safe.

Subdeltoid approach for removal of large soft-tissue lesions beneath the deltoid muscle: report of two cases.

Lesions that develop beneath the deltoid muscle are rare but may occasionally be large and difficult to excise by a standard surgical approach to the shoulder. Martini 2-4 reported that the subdeltoid approach was useful to obtain wide exposure of the proximal metaphyseal region of the humerus. We describe two patients, one with a subdeltoid lipoma and the other with chronic subdeltoid bursitis, who underwent surgery by the subdeltoid approach and discuss the indications of this surgical exposure. Our operative procedure was based on that described by Martini. 4 In brief, the patient was placed in the lateral decubitus position and the arm was draped free. A V-shaped skin incision was made, starting from the deltoid tuberosity, with the anterior and posterior limb of incision along the anterior and posterior margins of the deltoid muscle (Figure 1). The distal tendon of the deltoid muscle was exposed and incised with the periosteal tissue adjacent to the tendon. The anterior and posterior margins of the deltoid muscle were bluntly dissected to expose the subdeltoid lesion while the distal tendon was lifted and reflected cranially with the overlying skin (Figure 2). Branches of the cephalic vein entering the deltoid muscle were ligated. The axillary nerve was carefully identified and protected from damage while separating the lesion from the deepest layer of the deltoid muscle. The subdeltoid lesion was also dissected from the surface of the humerus and removed en bloc. Finally, the distal tendon of the deltoid muscle was reattached securely with 6 to 8 thick nonabsorbable sutures passed through the holes made in the humeral cortex. Postoperatively, the arm was immobilized for 3 weeks in a sling and swathe with the shoulder at 20° of abduction. Self-assisted range-of-motion exercises of the shoulder were then started. Antigravity motions were encouraged 6 weeks after surgery.

PERSISTENT POSTEROLATERAL ROTATORY SUBLUXATION OF THE ELBOW IN CUBITUS VARUS: A CASE REPORT

A 23-year-old woman who had an episode of elbow injury which was treated cast immobilisation in childhood with residual cubitus varus sustained a posterior fracture dislocation of the same elbow. She was treated with closed reduction. Six months later, however, her elbow became stiff, and a persistent posterolateral rotatory subluxation was noted. Operations were performed in two steps; first, the radial head, which was subluxed posteriorly, was reduced and the lateral collateral ligament complex was reconstructed, and second, the stiff elbow was mobilised. Two years after the first surgery, the function of the elbow was satisfactorily recovered.

Three epiphyseal fractures (Distal Radius and Ulna and Proximal Radius) and a diaphyseal ulnar fracture in a seven-year-old child's forearm

SUMMARY The authors report a rare case of fracture separations at both ends of the radius combined with an epiphyseal and diaphyseal fracture of the ipsilateral ulna. A seven-year-old girl fell one story and sustained a closed injury of her forearm. A closed reduction was unsuccessful, and an open reduction was performed with three of the four fractures being secured with Kirschner wires. These wires were removed one month later, and range-of-motion exercises were started. Thirty months after surgery, both forearms were equal in length, although the proximal radial epiphyseal line appeared partially closed. Joint motions, including forearm rotation, were normal. Radiologically, the ulnar diaphysis and the radial neck were posteriorly convex 20 degrees and 18 degrees, respectively.

TREATMENT OF HOOK OF THE HAMATE FRACTURES IN ADULTS USING LOW-INTENSITY PULSED ULTRASOUND

Two delayed unions and one nonunion of hook of the hamate fractures in adults aged 31-, 40-, and 41-years-old were treated with low-intensity pulsed ultrasound (LIPUS). Ultrasound treatment was started at three, four, and six months after injury and ultrasound exposure at the hook of the hamate in the hypothenar eminence was carried out for four to five months. During the management period, there was no immobilisation with a cast or brace and limited strain with only routine daily activities allowed. In all cases, bony union was confirmed on carpal tunnel radiographs or computed tomography at the final follow-up time of eight and 36 months after injuries.

T-CONDYLAR FRACTURE OF THE DISTAL HUMERUS IN A THREE-YEAR-OLD CHILD

A three-year-old girl suffered a T-condylar fracture of the distal humerus. Open reduction and pinning were performed. Three years after injury, there was no functional disturbance or radiographic evidence of avascular necrosis or epiphyseal growth arrest.