Objective: To observe the effect of the joint injury of the distal radio-ulnar joint. Methods: 60 patients with Distal Radioulnar Joint (DRUJ) injury were divided into observation group and control group according to ...Objective: To observe the effect of the joint injury of the distal radio-ulnar joint. Methods: 60 patients with Distal Radioulnar Joint (DRUJ) injury were divided into observation group and control group according to random number method. 30 cases were included in each of the two groups.Before and after treatment in patients with Visual Analogue Scale (Visual Analogue Scale, VAS) score, forearm pronation and supination electromyographic activity, methods of electric integral value (integral electromyogram, iEMG) and Wrist in patients with self assessment Scale (Patient - Rated Wrist Evaluation, PRWE) score evaluation, comparison, and the clinical observation on diagnosis of disease and curative effect of traditional Chinese medicine standard (assessment process by blind method).Results: compared with the two groups before and after treatment, VAS score decreased, forearm pronation and postpronation activity increased, iEMG value increased, and PRWE scale score decreased (all P < 0.05), and the curative effect of the treatment group was better than that of the control group (P < 0.05). The total effective rate of the treatment group [93.3% (28/30)] was higher than that of the control group [50%(15/30), P < 0.05].Conclusion: the combined exercise training of muscle and bone setting technique can effectively alleviate the pain of patients with radial ulnar joint injury, improve the rotation of the forearm, increase the recruitment of the anterior rotatory muscle, and improve the wrist function of patients, and the effect is better than if combined with forearm support fixation.展开更多
Single bone forearm fractures are usually associated with dislocation of one radio-ulnar joint. The association of ulnar fractures with dislocation of proximal radio-ulnar joint and radius fractures with distal radio-...Single bone forearm fractures are usually associated with dislocation of one radio-ulnar joint. The association of ulnar fractures with dislocation of proximal radio-ulnar joint and radius fractures with distal radio-ulnar joint is well described. Classically they are better known as Monteggia and Galeazzi fracture dislocations respectively. These peculiar presentations are attributed to intricate relationship of the forearm bones joined together as a unit by two radio-ulnar joints at proximal and distal ends and the interosseous membrane in the middle part. However, simultaneous dislocation of the both radio-ulnar joints associated with fracture of single bone is a very rare event. Literature search does not reveal a single case of such type. We are presenting here a case of fracture shaft of radius associated with dislocation of both proximal and distal radio-ulnar joints. The patient was managed by open reduction and fixation of the radius by a compression plate and the dislocations were reduced by closed method and stabilized with small K wires.展开更多
The authors report their experience with the Sauvé-Kapandji procedure for the management of posttraumatic disorders of the distal radioulnar joint in 9 younger and active patients. The mean age of our series was ...The authors report their experience with the Sauvé-Kapandji procedure for the management of posttraumatic disorders of the distal radioulnar joint in 9 younger and active patients. The mean age of our series was 37 years. We operated patients for whom pain in the distal radioulnar joint was more relieved by usual analgesic medical treatment, and those with a limitation of wrist movements. Until the latest follow-up, patients have benefited from antero-posterior and profile radiographs of the wrist. Functional assessment was based on the Modified Mayo Wrist Score whose average value was around 77 points. Postoperatively all patients experienced relief of pain. Rotation of the forearm increased to near normal values. On a professional level, eight of nine employed patients had returned to work. There were no major complications.展开更多
Introduction: Intra-articular distal radial fractures in young patients occur in high energy trauma which can lead to a combination of bone and ligaments lesions. An articular step superior to 2 mm is pejorative, for ...Introduction: Intra-articular distal radial fractures in young patients occur in high energy trauma which can lead to a combination of bone and ligaments lesions. An articular step superior to 2 mm is pejorative, for that an adequate radiologic analysis is necessary accessing to the best surgical treatment. The purpose of our study was to investigate this type of fracture and expose radiologic analysis (radiograph and CT-scan) of bone and ligamentous associated lesions of this specific twisted lunate facet fracture for recognizing it and accessing to the best surgical treatment. Patients and Methods: Seven patients with severely displaced type 4 articular fractures of the distal radius whose wrists had been exposed to violent compression are reported in our series, they are required open treatment for the reduction and fixation of disrupted articular surfaces by using an antero-medial approach which allows direct access to the fragment of the lunate facet and easier visualization of the distal radio-ulnar joint. Results: All the patients were clinically examined with antero-posterior and lateral X ray, completed by a CT scan, all the fractures were type IV according to Melone classification. In all of our seven cases there was a lesion of the distal radioulnar joint (DRUJ) identified in the CT scan. The CT scan allowed us to individualize well the void of the lunate fossa and calculate his exact degree of rotation, which is very important for planning therapeutic management. Discussion: In all of our cases the CT scan was to expose all of the osseous and ligamentous injuries;in the sagittal reconstruction we were able to objectify and calculate the exact degree of the rotation of the lunate fossa fragment;in the frontal reconstruction the void of the lunate fossa is visible and in the axial reconstruction we can determine the incongruence of the distal radio-ulnar joint (DRUJ). Intra-articular involvement has long been recognized as a poor prognostic factor in fractures of the distal radius. However, despite early studies reporting poor results with non operative treatment for these injuries, most authors opposed operative intervention, due to lack of a good radiological analysis and the CT scan;knowledge that a number of studies have shown that inadequate reduction of intra-articular distal radius fractures leads to the development of arthritis.展开更多
Disruption of the distal tibiofibular syndesmosis is frequently accompanied by rotational ankle fracture such as pronation-external rotation and rarely occurs without ankle fracture.In such injury,not only inadequatel...Disruption of the distal tibiofibular syndesmosis is frequently accompanied by rotational ankle fracture such as pronation-external rotation and rarely occurs without ankle fracture.In such injury,not only inadequately treated or misdiagnosed cases,but also correctly diagnosed cases can possibly result in a chronic pattern which is more troublesome to treat than an acute pattern.This paper reviews anatomical and biomechanical characteristics of the distal tibiofibular joint,the mechanism of chronic disruption of the distal tibiofibular syndesmosis,radiological and arthroscopic diagnosis,and surgical treatment.展开更多
BACKGROUND Surgical treatment of complex fractures of the distal femur in the elderly is controversial.Osteoporosis and pre-existent osteoarthritis are common comorbidities in the elderly which add to the need for ear...BACKGROUND Surgical treatment of complex fractures of the distal femur in the elderly is controversial.Osteoporosis and pre-existent osteoarthritis are common comorbidities in the elderly which add to the need for early walking and rapid restoration of function and also pose significant obstacles to achievement of satisfactory results with standard fixation techniques.Recently,several authors have suggested that primary arthroplasty could be a viable alternative option to standard fixation techniques in selected patients with complex distal femur fractures.AIM To present our experience with 11 cases of distal femur fractures treated with knee arthroplasty and large femoral resection in a population of patients over the age of 85.METHODS Data from 11 consecutive patients(10 females,1 male)presenting with acute intra-articular supracondylar or intercondylar distal femur fractures and with pre-existent primary osteoarthritis who were treated with primary knee arthroplasty were recorded.We collected standard demographic data,comorbidities and patient reported outcomes including Visual Analogical Scale(VAS),Oxford Knee Score(OKS)and Barthel’s Index.Post-operative joint range of motion(ROM)and standard radiographic data were also collected.RESULTS At a mean follow-up of 23.2 mo,all of the implants were well-positioned and osteointegrated.Furthermore,all the patients were alive and walking either independently or with walking aids.There was a marked improvement in pain(VAS 4.5 postop vs 1.9 at the last follow-up),OKS score(29.5 postop vs 36.81 at the last follow-up),ROM(96.2°postop vs 102°at the last follow-up)and restoration of pre-injury ambulatory status(average Barthel Index 77.3).The radiographic evaluations showed good restoration of the articular geometry.No deaths and no complications were recorded.CONCLUSION In conclusion,we believe that knee megaprosthesis in the case of complex fractures of the distal femur is a valid surgical choice.This is particularly true in elderly patients with severe osteoporosis and pre-existing osteoarthritis.It is important to note that this surgery should be performed by surgeons with proven experience in prosthetic hip and knee surgery and that a scrupulous selection of the cases is completed.展开更多
基金Key project of nature fund of anhui department of education(No.KJ2018a0273).
文摘Objective: To observe the effect of the joint injury of the distal radio-ulnar joint. Methods: 60 patients with Distal Radioulnar Joint (DRUJ) injury were divided into observation group and control group according to random number method. 30 cases were included in each of the two groups.Before and after treatment in patients with Visual Analogue Scale (Visual Analogue Scale, VAS) score, forearm pronation and supination electromyographic activity, methods of electric integral value (integral electromyogram, iEMG) and Wrist in patients with self assessment Scale (Patient - Rated Wrist Evaluation, PRWE) score evaluation, comparison, and the clinical observation on diagnosis of disease and curative effect of traditional Chinese medicine standard (assessment process by blind method).Results: compared with the two groups before and after treatment, VAS score decreased, forearm pronation and postpronation activity increased, iEMG value increased, and PRWE scale score decreased (all P < 0.05), and the curative effect of the treatment group was better than that of the control group (P < 0.05). The total effective rate of the treatment group [93.3% (28/30)] was higher than that of the control group [50%(15/30), P < 0.05].Conclusion: the combined exercise training of muscle and bone setting technique can effectively alleviate the pain of patients with radial ulnar joint injury, improve the rotation of the forearm, increase the recruitment of the anterior rotatory muscle, and improve the wrist function of patients, and the effect is better than if combined with forearm support fixation.
文摘Single bone forearm fractures are usually associated with dislocation of one radio-ulnar joint. The association of ulnar fractures with dislocation of proximal radio-ulnar joint and radius fractures with distal radio-ulnar joint is well described. Classically they are better known as Monteggia and Galeazzi fracture dislocations respectively. These peculiar presentations are attributed to intricate relationship of the forearm bones joined together as a unit by two radio-ulnar joints at proximal and distal ends and the interosseous membrane in the middle part. However, simultaneous dislocation of the both radio-ulnar joints associated with fracture of single bone is a very rare event. Literature search does not reveal a single case of such type. We are presenting here a case of fracture shaft of radius associated with dislocation of both proximal and distal radio-ulnar joints. The patient was managed by open reduction and fixation of the radius by a compression plate and the dislocations were reduced by closed method and stabilized with small K wires.
文摘The authors report their experience with the Sauvé-Kapandji procedure for the management of posttraumatic disorders of the distal radioulnar joint in 9 younger and active patients. The mean age of our series was 37 years. We operated patients for whom pain in the distal radioulnar joint was more relieved by usual analgesic medical treatment, and those with a limitation of wrist movements. Until the latest follow-up, patients have benefited from antero-posterior and profile radiographs of the wrist. Functional assessment was based on the Modified Mayo Wrist Score whose average value was around 77 points. Postoperatively all patients experienced relief of pain. Rotation of the forearm increased to near normal values. On a professional level, eight of nine employed patients had returned to work. There were no major complications.
文摘Introduction: Intra-articular distal radial fractures in young patients occur in high energy trauma which can lead to a combination of bone and ligaments lesions. An articular step superior to 2 mm is pejorative, for that an adequate radiologic analysis is necessary accessing to the best surgical treatment. The purpose of our study was to investigate this type of fracture and expose radiologic analysis (radiograph and CT-scan) of bone and ligamentous associated lesions of this specific twisted lunate facet fracture for recognizing it and accessing to the best surgical treatment. Patients and Methods: Seven patients with severely displaced type 4 articular fractures of the distal radius whose wrists had been exposed to violent compression are reported in our series, they are required open treatment for the reduction and fixation of disrupted articular surfaces by using an antero-medial approach which allows direct access to the fragment of the lunate facet and easier visualization of the distal radio-ulnar joint. Results: All the patients were clinically examined with antero-posterior and lateral X ray, completed by a CT scan, all the fractures were type IV according to Melone classification. In all of our seven cases there was a lesion of the distal radioulnar joint (DRUJ) identified in the CT scan. The CT scan allowed us to individualize well the void of the lunate fossa and calculate his exact degree of rotation, which is very important for planning therapeutic management. Discussion: In all of our cases the CT scan was to expose all of the osseous and ligamentous injuries;in the sagittal reconstruction we were able to objectify and calculate the exact degree of the rotation of the lunate fossa fragment;in the frontal reconstruction the void of the lunate fossa is visible and in the axial reconstruction we can determine the incongruence of the distal radio-ulnar joint (DRUJ). Intra-articular involvement has long been recognized as a poor prognostic factor in fractures of the distal radius. However, despite early studies reporting poor results with non operative treatment for these injuries, most authors opposed operative intervention, due to lack of a good radiological analysis and the CT scan;knowledge that a number of studies have shown that inadequate reduction of intra-articular distal radius fractures leads to the development of arthritis.
文摘Disruption of the distal tibiofibular syndesmosis is frequently accompanied by rotational ankle fracture such as pronation-external rotation and rarely occurs without ankle fracture.In such injury,not only inadequately treated or misdiagnosed cases,but also correctly diagnosed cases can possibly result in a chronic pattern which is more troublesome to treat than an acute pattern.This paper reviews anatomical and biomechanical characteristics of the distal tibiofibular joint,the mechanism of chronic disruption of the distal tibiofibular syndesmosis,radiological and arthroscopic diagnosis,and surgical treatment.
文摘BACKGROUND Surgical treatment of complex fractures of the distal femur in the elderly is controversial.Osteoporosis and pre-existent osteoarthritis are common comorbidities in the elderly which add to the need for early walking and rapid restoration of function and also pose significant obstacles to achievement of satisfactory results with standard fixation techniques.Recently,several authors have suggested that primary arthroplasty could be a viable alternative option to standard fixation techniques in selected patients with complex distal femur fractures.AIM To present our experience with 11 cases of distal femur fractures treated with knee arthroplasty and large femoral resection in a population of patients over the age of 85.METHODS Data from 11 consecutive patients(10 females,1 male)presenting with acute intra-articular supracondylar or intercondylar distal femur fractures and with pre-existent primary osteoarthritis who were treated with primary knee arthroplasty were recorded.We collected standard demographic data,comorbidities and patient reported outcomes including Visual Analogical Scale(VAS),Oxford Knee Score(OKS)and Barthel’s Index.Post-operative joint range of motion(ROM)and standard radiographic data were also collected.RESULTS At a mean follow-up of 23.2 mo,all of the implants were well-positioned and osteointegrated.Furthermore,all the patients were alive and walking either independently or with walking aids.There was a marked improvement in pain(VAS 4.5 postop vs 1.9 at the last follow-up),OKS score(29.5 postop vs 36.81 at the last follow-up),ROM(96.2°postop vs 102°at the last follow-up)and restoration of pre-injury ambulatory status(average Barthel Index 77.3).The radiographic evaluations showed good restoration of the articular geometry.No deaths and no complications were recorded.CONCLUSION In conclusion,we believe that knee megaprosthesis in the case of complex fractures of the distal femur is a valid surgical choice.This is particularly true in elderly patients with severe osteoporosis and pre-existing osteoarthritis.It is important to note that this surgery should be performed by surgeons with proven experience in prosthetic hip and knee surgery and that a scrupulous selection of the cases is completed.
