Objective To investigate the effectiveness of ulnar shortening osteotomy combined with elastic suspension fixation for ulnar impaction syndrome caused by relatively long ulna. Methods Between October 2015 and August 2016, 3 cases of ulnar impaction syndrome were treated. One patient was male and 2 patients were females. The age was 32, 29, and 59 years, respectively. One patient was dislocation and impaction of distal radioulnar joint for more than 1 year after internal fixation due to ulnar and radial open fractures. Other patients had no trauma and surgery, but long-term manual history. The visual analogue scale (VAS) scores were 7, 5, and 5, respectively. Cooney wrist function scores were rated as poor. Preoperative X-ray measurements of the ulnar variance was 12.7, 9.0, and 8.7 mm, respectively. The ulna was transversely osteotomy and fixed with plate and screws. The distal radioulnar joint was elastic suspension fixed with mini plate. Results Postoperative X-ray film showed that the matching of the distal radioulnar joint had no significant difference compared with the contralateral side. All the incisions healed by first intention without complication such as neurovascular injury, infection, and dislocation of the distal radioulnar joint. The patients were followed up 27, 17, and 23 months, respectively. At last follow-up, X-ray film showed that all osteotomy segments achieved bony union without internal fixation failure. The VAS scores were 2, 0, and 1, respectively, and the Cooney wrist function scores were rated as excellent. Conclusion The ulnar shortening osteotomy combined with elastic suspension fixation can correct the ulna variation, avoid the instability of the distal radioulnar joint caused by the extensive dissection of the tissue around the ulnar, and avoid stiffness of the joints caused by rigid fixation. It is an ideal treatment for ulna impaction syndrome.
ObjectiveTo evaluate the risk factors for central lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC) of cN0 staging. MethodsClinical data of 94 patients with cN0 PTC in Guangdong General Hospital who underwent thyroidectomy with prophylactic central node dissection (pCND) from March to July in 2014 were collected to analyze the risk factors of CLNM by using univariate and multivariate analysis methods. ResultsCLNM was found in 43 patients (45.7%). Multivariate analysis results showed that, the CLNM rate of patients with age < 45 years, tumor located in front of lobe by ultrasound, diameter of tumor > 2 cm, capsular invasion, and total number of central lymph node dissected > 3 were significantly higher (P < 0.05). ConclusionAge < 45 years, tumor located in front of lobe by ultrasound, and diameter of tumor > 2 cm are the risk factors of CLNM in patients with cN0 PTC, pCND should be performed for patients with some of the above risk factors.