Objective To analyze the therapy and effectiveness of ulnar styloid fracture complicated with wrist dorsal branch of ulnar nerve injury. Methods Between October 2005 and October 2012, 16 cases of ulnar styloid fracture complicated with wrist dorsal branch of ulnar nerve injury were treated. There were 14 males and 2 females with an average age of 42 years (range, 22-58 years). Fracture was caused by traffic accident in 8 cases, by mechanical crush in 5 cases, and by falling in 3 cases. According to the anatomical features of the ulnar styloid and imaging findings, ulnar styloid fractures were classified as type I (ulnar styloid tip fracture) in 1 case and type II (ulnar styloid base fracture) in 15 cases. The skin sensation of ulnar wrist was S0 in 5 cases, S1 in 1 case, S2 in 7 cases, and S3 in 3 cases according to the criteria of the British Medical Research Council in 1954 for the sensory functions of the ulnar wrist. The time from injury to operation was 6-72 hours (mean, 18 hours). Fracture was treated by operative fixation, and nerve was repaired by epineurium neurolysis in 13 cases of nerve contusion and by sural nerve graft in 3 cases of complete nerve rupture. Results All incisions healed by first intention. Sixteen patients were followed up for an average time of 14 months (range, 6-24 months). The X-ray films showed that all of them achieved bone union at 4-10 weeks after operation (mean, 6 weeks). No patient had complications such as ulnar wrist chronic pain and an inability to rotate. According to Green-O’Brien wrist scoring system, the results were excellent in 13 cases and good in 3 cases; according to the criteria of the British Medical Research Council in 1954 for the sensory functions of the ulnar wrist, the results were excellent in all cases, including 11 cases of S4 and 5 cases of S3+. Two-point discrimination of the ulnar wrist was 5-9 mm (mean, 6.6 mm). Conclusion For patients with ulnar styloid fracture complicated with wrist dorsal branch of ulnar nerve injury, internal fixation and nerve repair should be performed. It can prevent ulnar wrist pain and promote sensory recovery.
Objective To evaluate the effect of associated ulnar styloid fracture on wrist function after distal radius fracture by comparing the cl inical data between the cases of distal radius fracture with or without ulnar styloid fractures. Methods The cl inical data of 182 patients with distal radius fracture between February 2005 and May 2010 were retrospectively analyzed, including 75 with ulnar styloid fracture (group A), and 107 without ulnar styloid fracture (group B). There was no significant difference in sex, age, disease duration, and fracture classification between 2 groups (P gt; 0.05). In groups A and B, closed reduction and spl intlet or cast fixation were performed in 42 and 63 cases respectively, and openreduction and internal fixation in 33 and 44 cases respectively. All ulnar styloid fractures were not treated. Results Thepatients were followed up 21 months on average in group A and 20 months on average in group B. All incisions healed by first intention after operation. Ulnar wrist pain occurred in 4 patients (5.3%) of group A and 6 patients (5.6%) of group B, showing no significant difference (χ2=0.063, P=0.802). The fracture heal ing time was (10.9 ± 2.7) weeks in group A and (11.6 ± 2.3) weeks in group B, showing no significant difference (t=1.880, P=0.062). There was no significant difference in the palmar tilt angle, the ulnar incl ination angle, and the radial length between groups A and B when fracture healing (P gt; 0.05). At last follow-up, there was no significant difference in wrist flexion-extension, radial-ulnar deviation, pronation-supination, and grip and pinch strength between 2 groups (P gt; 0.05). According to the Gartland-Werley score in groups A and B, the results were excellent in 24 and 35 cases, good in 43 and 57 cases, fair in 5 and 10 cases, and poor in 3 and 5 cases with execllent and good rate of 89.3% and 86.0%, respectively, showing no significant difference between 2 groups (Z= —0.203, P=0.839). There were significant differences in the above indexes between patients undergoing closed reduction and open reduction in group A (P lt; 0.05). Conclusion Associated ulnar styloid fracture has no obvious effect on the wrist function after distal radius fracture. The anatomical reduction of distal radial fracture is the crucial importance in the treatment of distal radial fracture accompanying ulnar styloid fracture.
Objective To evaluate the treatment and effects of wrist arthroscopy in tear of triangular fibrocartilage complex (TFCC). Methods Between January 2006 and December 2008, 16 patients with tear of TFCC were treated. Of 16 patients, 11 were male and 5 were female with an average age of 32.5 years (range, 25-51 years). Injury was caused by sprain in 12cases, and by fall ing in 4 cases. The locations were the left side in 10 cases and the right side in 6 cases. The mean injury duration was 3 months to 6 years and 2 months. The main cl inical symptoms included wrist powerlessness and ulnar-sided wrist pain which was aggravated with clench fist and l ifting heavy things. The results of the ulnar-sided wrist stress test were positive in 14 cases and negative in 2 cases. The preoperative values of wrist range of motion (ROM) were (45.58 ± 5.18)° at volar flexion, (41.22 ± 3.83)° at dorsal extension, (17.82 ± 2.48)° at radial deviation, (21.35 ± 4.61)° at ulnar deviation, (69.85 ± 8.36)° at pronation, and (70.13 ± 6.34)° at supination. According to Palmer standard, 10 cases of IA were treated with debridement; 3 cases of IB with suture and 1 of them failed and was partially excised; 2 cases of IC with debridment on triangular fibrocartilage disc, ulnolunate l igament, and ulnotriguetrum l igament; and 1 case of ID with trimming plastic operation. Results All incisions healed by first intention, and no compl ications of joint infection or neurovascular injury was found. All patients were followed up 14-38 months (mean, 18.5 months). Fifteen patients were restored to normal l ife and work without ulnar-sided wrist pain. One patient had no pain, but he had wrist powerless. The values of ROM at last follow-up were (50.16 ± 6.21)° at volar flexion, (45.37 ± 4.65)° at dorsal extension, (18.95 ± 3.56)° at radial deviation, (26.28 ± 5.09)° at ulnar deviation, (78.87 ± 7.69)° at pronation, and (76.46 ± 8.31)° at supination; showing significant differences when compared with preoperative values(P lt; 0.05). According to Green-O’Brien standard, the results were excellent in 9 cases, good in 6 cases, fair in 1 case, and the execellent and good rate was 93.75%. Conclusion The wrist arthroscopy not only can definitely diagnose tear of TFCC, but also is useful for treatment. In addition, the incision is small and the function is easy to recover, and the occurence of chronic ulnar-sided wrist pain can be effectively avoided.
Objective To summarize the therapeutic effectinevess of incorporating pedicled retrograde flap of forearm transplantation for reconstructing severe contracture of the first web space and wrist. Methods Between November 2005 and February 2010, 26 patients with severe contracture of the first web and wrist were treated. There were 18 males and 8 females with an average age of 27 years (range, 12-45 years). The locations were the right sides in 15 cases and the left sides in 11cases. The injury reason included hot water scald in 7 cases, explosion hurt in 5 cases, traffic accident in 3 cases, hot pressing in 5 cases, and flame burns in 6 cases. The duration of scar contracture ranged from 6 to 26 months with an average of 11 months. According to the evaluation standard by GU Yudong et al., all had severe contracture of the first web space, and concomitant injuries included adduction deformity thumb, l imitation of the thumb extension and opposition function, and carpometacarpal flexion joint deformity. After scar contracture was released, the defect size ranged from 5.8 cm × 4.5 cm to 11.3 cm × 7.2 cm, which were repaired by the incorporating pedicled retrograde flap of forearm of 6.5 cm × 5.0 cm to 12.5 cm × 8.0 cm at size. The donor sites were directly sutured or repaired with skin graft. Results Bl ister and partial necrosis occurred at the distal end of the flaps in 2 cases, which were cured after dressing change. The other flaps survived and wounds healed by first intention. Incisions at donor sites healed by first intention. Twenty-six patients were followed up 6 to 24 months (mean, 15 months). The patients had functional recovery in thumb adduction and opposition at different degrees. At 6 months after operation, according to the Swanson et al. AMA system for total thumb activity, the total thumb function was improved significantly, and according to Jensen et al. measurement, the width and angle of the first web space were significantly increased, all showing significant differences (P lt; 0.05). Conclusion Incorporating pedicled retrograde flap of forearm transplantation for repairing severe contracture of the first web space and wrist could augment the first web space and improve the wrist flexible function.
Objective To review the progress in the treatment method of carpal tunnel syndrome (CTS). Methods Recent l iterature concerning the treatment method of CTS was extensively reviewed, analyzed, and summarized. Results Wrist spl inting and local steroid injection are effective in patients with mild to moderate CTS in the short-term. however, patients with recurrent CTS have to accept surgical treatment. The main operative patterns include open carpal tunnel release (OCTR), mini-OCTR, and endoscopic carpal tunnel release. Conclusion The final conclusion of the most effective method to treat CTS needs more cl inical researches, and surgical treatment is one method recommended by some scholars.
Objective To discuss the relationship between recovery of anatomical integrity and functional outcome in elderly patients with distal radius fractures by comparing the effects of open reduction and closed reduction. Methods The cl inical data were retrospectively analyzed from 78 elderly patients with distal radius fractures treating with nonoperation andoperation from February 2005 to March 2009. Thirty-seven patients underwent closed reduction and spl intlet fixation or cast appl ication (non-operation group), and forty-one patients underwent open reduction and internal fixation (operation group). In non-operation group, there were 15 males and 22 females with an average age of 73 years (60-83 years). According to the AO classification system for fracture, there were 8 cases of type A2, 7 cases of type A3, 7 cases of type B1, 4 cases of type B2, 2 cases of type B3, 4 cases of type C1, 2 cases of type C2, and 3 cases of type C3. The time from injury to admission was between 30 minutes and 3 days with a mean time of 1 day. In operation group, there were 18 males and 23 females with an average age of 71 years (62-80 years). According to the AO classification system for fracture, there were 5 cases of type A2, 7 cases of type A3, 7 cases of type B1, 6 cases of type B2, 3 cases of type B3, 4 cases of type C1, 5 cases of type C2, and 4 cases of type C3. The time from injury to admission was between 30 minutes and 7 days with a mean time of 1 day. There were no significant differences (P gt; 0.05) in sex, age, disease course and fracture classification between two groups. Results All incisions obtained heal ing by first intention after operation in operation group. All patients were followed up for 9-36 months (20 months on average). Fracture heal ing was achieved within 8 to 15 weeks, with an average of 11 weeks. There were no significant differences (P gt; 0.05) in fracture heal ing time between non-operation group [(10.8 ± 2.0) weeks] and operation group [(11.7 ± 2.5) weeks]. At last follow-up, thepalmar tilt angle was (5.6 ± 2.0)° and (8.6 ± 3.0)°, the radial incl ination angle was (19.1 ± 4.9)° and (21.8 ± 2.0)°, and the radial length was (8.3 ± 1.3) mm and (10.4 ± 1.4) mm in non-operation group and operation group, respectively; showing significant differences (P lt; 0.05) between two groups. According to the Gartland-Werley score, the results were excellent in 9 cases, good in 21 cases, fair in 5 cases, and poor in 2 cases in non-operation group, the excellent and good rate was 81.1%; in operation group, the results were excellent in 13 cases, good in 25 cases, fair in 2 cases, and poor in 1 case, the excellent and good rate was 92.7%, showing no significant difference (P gt; 0.05) between two groups. There were no significant differences (P gt; 0.05) in flexion and extension activity of wrist, radioulnar partial activity, pronation-supination activity, grip and pinch strength between two groups. Conclusion Open reduction and closed reduction can achieve satisfactory functional outcomes, but closed reduction was inferior to open reduction in anatomic reduction for treating distal radius fractures in elderly patients.
Objective To observe the effectiveness of wrist joint reconstruction with vascularized fibular head graft after resection of distal radius giant cell tumor. Methods Between March 2000 and March 2009, 31 cases of distal radius giant cell tumor were treated with extended resection and vascularized fibular head graft for repairing defects of the distal radius, and reconstructing wrist joint. There were 14 males and 17 females with an average age of 37.2 years (range, 15-42 years). The disease duration ranged from 1 month to 2 years and 3 months with an average of 8 months. The size oftumor was 6.5 cm 3.5 cm-8.0 cm 4.5 cm. The range of motion (ROM) of wrist joint was as follows: extension 5-15° (mean, 10.7°), flexion 9-21° (mean, 14.2 ), radial incl ination 0-10 (mean, 8.6 ), and ulnar incl ination 0-15° (mean, 7.9°). The ROM of forearm was as follows: pronation 15-50 (mean, 28.7 ) and supination 10-25° (mean, 16.5°). The histopathological examination revealed that there were 5 cases of stage I, 17 of stage II, and 9 of stage III. Results All patients achieved primary heal ing of incision and were followed up 1-9 years with an average of 4.5 years. The X-ray films showed that bone heal ing time was 12-16 weeks with an average of 13 weeks. No tumors recurrence was observed. The ROM of wrist joint was as follows at 1 year after operation: extension 20-50 (mean, 29.0 ), flexion 30-50° (mean, 35.0°), radial incl ination 10-20° (mean, 16.5°), and ulnar incl ination 20-25 (mean, 23.5 ). The ROM of forearm was as follows: pronation 40-90° (mean, 68.3°) and supination 30-80 (mean, 59.6 ). There were significant differences in the ROM between before operation and after operation (P lt; 0.05). According to the Krimmer et al wrist score, the results were excellent in 17 cases, good in 12, and fair in 2. Conclusion Wrist joint reconstruction with vascularized fibular head graft can restore function of wrist joint. The operation is proved to be safe and effective in treating distal radius giant cell tumor.
Objective To explore the anatomical features of some major dorsal wrist interosseous l igaments, and to measure their biomechanical properties to screen a suitable donor site for the repair of scapholunate dorsal l igament. Methods Sixteen wrist joints from 8 frozen fresh male adult cadavers were selected, whose age was 20-38 years and whose height was 165-178 cm. There were no injuries to their wrists. The follow l igaments were observed and measured for the interosseous l igaments: volar and dorsal scapholunate l igaments (SL-v, SL-d), lunotriquetral dorsal l igament (LT), trapezoidcapitate dorsal l igament (TC), capitohamate l igament (CH) and the 2nd-4th carpometacarpal l igaments (CMC-2-4). The bone-l igament-bone samples of the above l igaments were prepared for further biomechanical measurements. Ligament extension testing was performed for each bone-l igament-bone sample on a material testing system. The broken load and length were measured and statistically analyzed. Results The SL and the LT were both “C” shape, attaching to the volar, proximal and dorsal joint surface. The TC and CH l igaments were mainly transverse fibers, which connected with each other at the dorsal side of capitate. The CMC-2-4 l igaments were obl iquitous fibers. Within these wrist interosseous l igaments, the SL-v and CMC-4 were relatively long. The l igament length differences were significant between SL-v and TC and between CMC-4 and TC (P lt; 0.05). TC and CMC-2 were fairly thick. But there was no significant difference among the l igaments (P gt; 0.05). SL-d had the highest broken load of (73.6 ± 9.6) N. The broken load differences were all significant between SL-d and other l igaments (P lt; 0.05). SL-v had largest broken length of (5.24 ± 1.65) mm. The broken length differences were all significant between SL-v and other l igaments (P lt; 0.05). Conclusion The anatomical structures and biomechanical features of the wrist interosseous l igaments were closely related with their physiological functions. CMC-2 and CH are both suitable to be used for the repair of scapholunate dorsal l igament.
To evaluate the changes in stabil ity of the wrist after experimental traumatic triangular fibrocartilage complex (TFCC) lesions, and to provide basic theoretical criteria for cl inical treatment. Methods Fourteen adult cadaver upper extremities specimens were included. Two of 14 specimens were tested in pre-experiment. The specimens were tested in a INSTRON 8874 biomechanics measuring instrument. First a dorsal arthrotomy (ART) was performed, and second test was with 1 of 4 different experimental lesions according to Palmer’s classification of traumatic TFCC lesions (n=3). 1A: central perforation; 1B: ulnar avulsion with or without fracture of processus styloideus ulnae; 1C: distal avulsion with l igament injury; 1D: radial avulsion. Forced internal∕external rotation torque were recorded in the interval — 60° to 60° of flexion. Results The average torque of the dorsal ART was (0.713 ± 0.121) Nm, and the 1B-1 lesion (ulnar avulsion without ulnar styloid fracture) was (0.709 ± 0.134) Nm, the 1B-2 lesion (ulnar avulsion with ulnar styloid fracture) was (0.409 ± 0.113) Nm. The difference between the 1B-1 lesion and the dorsal ART was not significant but the difference between the 1B-2 lesion and the dorsal ART was significant (P lt; 0.05). The average torque of the 1C lesion in about 45° of wrist extention and flexion were (0.878 ± 0.184) Nm and (0.988 ± 0.197) Nm, and the dorsal ART were (1.510 ± 0.173) Nm and (1.540 ± 0.093) Nm. The difference between the two groups was significant (P lt; 0.05). The 1A lesion and 1D lesion did not alter significantly wrist stabil ity. Conclusion The 1B-2 lesion and 1C lesion alter significantly the stabil ity of the wrist.
【Abstract】 Objective To investigate the effect of the volar capsular l igament complex on stabil ity of the wrist jointand to provide basic biomechanical theoretical criteria for cl inic appl ication of the external fixator. Methods Nine upperl imbs specimens (left 6, right 3) were taken from fresh adult cadavers to make wrist joint-bone capsular l igament complex specimens. Firstly, soft tissues of forearms and hands were resected and capsular membranes and l igaments were reserved to make the bone-articular l igament complex (normal specimen). Secondly, the volar capsular l igament complex was cut off from radial malleolus to ulnar malleolus (impaired specimen). Thirdly, the impaired volar capsular l igament complex was interruptedly sutured by the use of 4# suture silk (repaired specimen). To simulate cl inical operation with external fixator, the biomechanical test was done according to the sequence (normal, impaired, repaired, repaired and fixed, impaired and fixed). Statistical significance was analyzed through selected loads at the three different shifts (1.5, 2.0, 2.5 cm). Results According to the sequence (normal, impaired, repaired, repaired and fixed, impaired and fixed), when the shift was 1.5 cm, the different respective loads were (60.74 ± 20.60), (35.23 ± 13.88), (44.36 ± 20.78), (168.40 ± 29.21) and (139.00 ± 33.18) N, respectively. When the shift was 2.0 cm, the different loads were (138.46 ± 12.93), (87.17 ± 24.22), (97.52 ± 23.29), (289.00 ± 54.29) and (257.98 ± 55.74) N, respectively. When the shift was 2.5 cm, the different loads were (312.87 ± 37.15), (198.16 ± 37.14), (225.66 ± 30.96), (543.15 ± 74.33) and (450.35 ± 29.38) N, respectively. There was no statistically significant difference between the impaired and repaired specimens (P gt; 0.05). Similarly, there was statistically significant difference among the rest specimens (P lt; 0.05). The same statistical results were obtained when the two different shifts were compared. There was statistically significant difference at the three different shifts for the same specimen (P lt; 0.05). Conclusion Volar capsular l igament complex is an important anatomic structure to keep stabil ity of the wrist joint. The carpal instabil ity arises out of the injured complex. Repairing the injured complex only can not immediately restore stabil ity of the wrist joint. The external fixator can effectively help to diminish the relative shift of the impaired capsular l igament complex, to reduce the load of the repaired complex and to protect the complex accordingly. The device plays an important role in maintaining stabil ity of the wrist joint.