Masato Okazaki

Tendon Entrapment in Distal Radius Fractures

We retrospectively defined the rate and clinical features of tendon entrapment in 693 consecutive patients with 701 distal radius fractures treated in a single hospital. Eight extensor tendons and one flexor tendon were entrapped. All fractures with extensor tendon entrapment were palmarly displaced (Smith type) or epiphyseal. Flexor tendon entrapment was seen in dorsally angulated (Colles type) epiphyseal fracture. The rate of tendon entrapment in acute distal radius fractures was 1.3%. Extensor tendon entrapment in palmarly displaced fractures is more common.

Costo-osteochondral graft for post-traumatic osteonecrosis of the radial head in an adolescent boy

We present a case of post-traumatic osteonecrosis of the radial head in a 13-year-old boy which was treated with costo-osteochondral grafts. A satisfactory outcome was seen at a follow-up of two years and ten months. Although costo-osteochondral grafting has been used in the treatment of defects in articular cartilage, especially in the hand and the elbow, the extension of the technique to manage post-traumatic osteonecrosis of the radial head in a child has not previously been reported in the English language literature. Complete relief of pain was obtained and an improvement in the range of movement was observed. The long-term results remain uncertain.

DOUBLE PLATE FIXATION FOR CORRECTION OF THE MALUNITED DISTAL ULNA FRACTURE: A CASE REPORT

A 62-year-old woman visited our hospital one year after a motor vehicle accident complaining of ulnar wrist pain and restricted pronation and supination. Radiographs showed a 35° angular deformity at the ulnar neck. Closing wedge osteotomy was performed using two plates for stabilization. Twenty-four months postoperatively, the osteotomy site united without correction loss and the patient gained adequate pronation and supination. To the best of our knowledge, this represents the first report of corrective osteotomy for the treatment of malunited ulnar neck fracture. Although salvage operations such as ulnar head resection and the Sauvé-Kapandji procedure may provide reasonable results, anatomical repair can be considered as an option.

Extensor tendon entrapment in volarly displaced distal radial fracture

A 37 year-old right hand dominant man fell down a staircase and injured his left wrist. When he attended our hospital the day after the injury, his wrist was grossly swollen and deformed. Although he complained of pain when the digits were fully flexed, he could still actively extend and flex his thumb and fingers. Radiographs showed a volarly displaced distal radial fracture associated with dorsal dislocation of the ulnar head. Because the fracture was dislocated and had a gap between the fragments, MRI was carried out in order to assess soft tissue interposition at the fracture site. Axial MRI indicated that the EPL, EIP, EDCs and EDM tendons had passed between the radius and the ulna onto their volar aspect (Fig 1). After failed closed reduction under general anaesthesia, the dorsal aspect of the wrist was explored. The proximal stump of the radius was found extruding through the extensor retinaculum with no tendons on the dorsal aspect: the extensor tendons had passed through the disrupted forearm interosseous membrane onto the volar aspect of the radius proximal stump. Application of traction and extension force to the wrist, as for closed reduction of a Smith’s fracture, exacerbated the trapping and damage to the tendons. After the tendons had been relocated, the distal radial fracture was reduced easily and internally fixed with a buttress plate through a volar approach. The triangular fibro-cartilage complex was then reattached to the fovea of the ulna. On review, 2 years after the operation, the patient had obtained satisfactory wrist function without pain and full range of digital motion. He returned to his original job as an electrician. Entrapment of extensor tendons in association with Smith’s fracture has been reported (El-Kazzi and Schuind, 2005; Itoh et al., 1987). In previous reports, tendon entrapment has been suspected because of failure of closed reduction, loss of active extension in digits, positive tenodesis effect and/or residual dorsal wrist pain. If there are few symptoms, it is very difficult to diagnose the tendon entrapment pre-operatively. The case presented here is unusual in that MRI was used primarily because of the severe displacement of the fracture, although there was no restriction of active motion of the digits. We presume that the patient could move the digits because the fracture was displaced and the tendons were loosely interposed, not crushed, at the fracture site. We believe MRI is effective in identifying interposition of the extensor tendons pre-operatively. As it costs more than a simple X-ray, MRI being approximately 22,000 yen (approx. £100, 150h) and a plain X-ray 2500 yen (approx. £11, 17h), we suggest MRI only be used when there is a gap between the radial shaft and the displaced volar fragment. When an MRI cannot be obtained, the dorsal aspect of the wrist should be explored to check for tendon entrapment.

Radial and volar perilunate trans-scaphoid fracture dislocation: a case report.

A case of radial and volar perilunate trans-scaphoid fracture dislocation in which the proximal fragment of the scaphoid was dislocated dorsally is presented.

The "docking" method for periprosthetic humeral fracture after total elbow arthroplasty: A case report

Treatment of a humeral shaft fracture following total elbow arthroplasty is a challenging problem, especially in the presence of a large bone defect and osteoporosis1-5. Periprosthetic humeral fractures usually require surgical repair. This can involve revision of the humeral component, fixation of the fracture with a plate or cerclage wires, use of a strut allograft, or revision with use of an allograft-prosthesis composite1. We used a customized intramedullary nail and supplemental autologous cancellous bone graft to treat a periprosthetic humeral fracture in a woman with rheumatoid arthritis who had a massive bone defect and poor bone quality. The patient was informed that data concerning the case would be submitted for publication, and she consented. A fifty-three-year-old woman presented with pain and deformity of the left elbow. She had rheumatoid arthritis and had been treated with oral prednisolone and methotrexate for more than fifteen years. The range of flexion of the elbow was from 30° to 90°. Radiographic findings were compatible with severe rheumatoid arthritis. Because the pain, deformity, and instability were intolerable to the patient, total elbow arthroplasty was carried out with a Gschwend-Scheier-Bahler (GSB)-III prosthesis (Zimmer, Warsaw, Indiana). Postoperatively, the wound did not heal, and, after four weeks, Enterobacter cloacae was grown on culture of specimens from a fistula. The infection was controlled, without removing the implant, by debridement, continuous irrigation, coverage of the fistula with an anconeus muscle flap, and administration of culture-specific intravenous antibiotics. After one year without additional problems, the patient fell and sustained a fracture of the humerus just proximal to …

A CASE REPORT OF A GIANT FOREARM LIPOMA CAUSING ANTERIOR INTEROSSEOUS NERVE PALSY AFTER FRACTURE OF THE DISTAL RADIUS

To the best of our knowledge, there are no previous reports on anterior interosseous nerve palsy (AINP) caused by a soft tissue tumor after fracture of the distal radius. We treated a case of giant forearm lipoma that caused AINP one day after internal fixation of a distal radius fracture.