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The significance of the restoration of DRUJ anatomy in the treatment of intraarticular fractures of the distal radius
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SESSION4
SESSION 4: FREE PAPERS
Conclusion
Reconstruction of the distal radioulnar joint using an ulnar head prosthesis
Primary operative reduction of intraarticular fractures of the distal radius and restoration of the overall alignment, especially at the DRUJ, with the use of external fixator is worth the effort in reducing wrist disability in these severe injuries, especially pain and stiffness of the DRUJ.
J. van S c h o o n h o v e n T. J. H e r b e r t
Bad NeustadtlSaale, Germany; Sydney, Australia Disorders of the distal radioulnar joint (DRUJ) are common and can be of different origins. Clinically patients present with pain, weakness, instability and limitation of forearm rotation. Various operative techniques are described but weakness and painful instability following these procedures still remain a problem. To solve these problems a new ulnar head prosthesis has been designed consisting of a titanium stem and a ceramic head. Three stem designs include a special revision stem to correct length discrepancies in patients with excessive ulnar shortening following previous surgery. The operative technique with insertion of the ulnar head prosthesis includes the soft tissue reconstruction of the natural stabilizers of the DRUJ. To date this prosthesis has been used in 25 patients in three different hand centres. So far results are excellent. Nearly full forearm rotation was restored in all patients. Grip strength improved to a n average of 87% compared with the contralateral side and there is only one patient with persisting dorsal instability due to the wrong indication for the procedure that will be discussed. To be able to present as long term results as possible, reexamination of all patients is planned and will then cover a 2-year period of experience for the first patients treated with ulnar head prosthesis.
The significance of the restoration of DRUJ anatomy in the treatment of intraarticular fractures of the distal radius S. Frenyo, F. Cserkuti, G. A r v a
Budapest, Hungary Residual wrist disability after fractures of the distal radius is most often caused by undertreatment of these "injuries. Pain and limitation of movement at the DRUJ is the most frequent cause of these disabilities. In fact, this is the main cause of invalidity after Sudeck's dystrophy in distal fractures of the radius. We reviewed a 3 year series (01.01.93-31.12.95) of intraarticular fractures of the distal radius (AO type B3, C1-2-3) treated at a major trauma centre by primary reduction and fixation with a unilateral external fixation and K-wires (103 cases). Age: 37 to 78 yrs (mean: 63.4 yrs). Attention was given to the restoration of the overall alignment o f the radius and the joint congruity especially at the DRUJ. In five cases bone graft was used 2 weeks later. The fixator was removed at 6 weeks. Follow-up was at 1 year.
Radiological results In 60'/,, cases 0 to 3 mm shortening of the radius was noted at the DRUJ, in 29% 3 to 5 mm, and above 5 mm in 10%. Functional results: no pain in 37%, mild pain, not interfering with function in 34% and moderate pain, while carrying weight in 29%. Pro-supination was <50% in 39%, between 50 to 70% in 39% and >70% in 21%. RSD was not found in this series. In no case was any further reconstructive procedure (e.g. resection of distal ulna) necessary.
Chondral and ligamentous wrist lesions in young adults with distal radial fractures. A descriptive, arthroscopie study in 50 patients. T. L i n d a u , L. H a g b e r g , M A r n e r
Lund, Malmt, Sweden Introduction Although the distal radial fracture is the most common fracture in the upper extremity, few authors have paid attention to high energy fractures in young adults. The aim of this study was to examine the frequency of associated chondral and ligament lesions.
Material and methods In a descriptive study, including two centres and two surgeons, 50 patients with mean age of 39 years (20-58 years) with dislocated and/or intra-articular distal radial fractures were examined with wrist arthroscopy at mean 5 days (1-17 days) after injury.
Results Thirty-five chondral lesions in 16 patients (32%) were found and five patients with degenerative osteoarthritic changes. Forty-nine patients had ligament lesions, with 39 combined injuries, seven isolated SL-tears and three isolated T F C C tears. Nineteen of 23 partial or total tears (83%) in the radioscapholunate ligament were combined with a grade 2A and 2B instability in the SL ligament. The interosseous carpal ligament instability, as found during arthroscopy, was described in a classification system modified from Geissler (Hand Clinics, 1995). Thirty-seven of the 43 cases (86%) with SL lesions had instability grade 2A and grade 2B. Fifteen of the 17 cases (88%) with LT lesions had instability grade 2A and grade 2B. No patients had instability grade 3. Forty-one patients had TFCC-lesions, more often if the ulnar styloid was fractured or if an unstable ulna head was seen at preoperative clinical examination.
Conclusion Chondral and ligament lesions were found very frequently in the present study. Even if most lesions were found to be partial, they could possibly explain a poor outcome in a seemingly well healed distal radius fracture.
E.C.U. tenodesis in chronic unstable distal ulna C. Grandis, C. Cerizza, E Bassi
Milano, Italy To treat injuries of C.EC.T. different operations have been suggested over the years by many authors. These were related to the anatomical damage, and the importance of both soft tissues and joint surfaces of this zone.
SESSION4
SESSION 4: FREE PAPERS
Conclusion
Reconstruction of the distal radioulnar joint using an ulnar head prosthesis
Primary operative reduction of intraarticular fractures of the distal radius and restoration of the overall alignment, especially at the DRUJ, with the use of external fixator is worth the effort in reducing wrist disability in these severe injuries, especially pain and stiffness of the DRUJ.
J. van S c h o o n h o v e n T. J. H e r b e r t
Bad NeustadtlSaale, Germany; Sydney, Australia Disorders of the distal radioulnar joint (DRUJ) are common and can be of different origins. Clinically patients present with pain, weakness, instability and limitation of forearm rotation. Various operative techniques are described but weakness and painful instability following these procedures still remain a problem. To solve these problems a new ulnar head prosthesis has been designed consisting of a titanium stem and a ceramic head. Three stem designs include a special revision stem to correct length discrepancies in patients with excessive ulnar shortening following previous surgery. The operative technique with insertion of the ulnar head prosthesis includes the soft tissue reconstruction of the natural stabilizers of the DRUJ. To date this prosthesis has been used in 25 patients in three different hand centres. So far results are excellent. Nearly full forearm rotation was restored in all patients. Grip strength improved to a n average of 87% compared with the contralateral side and there is only one patient with persisting dorsal instability due to the wrong indication for the procedure that will be discussed. To be able to present as long term results as possible, reexamination of all patients is planned and will then cover a 2-year period of experience for the first patients treated with ulnar head prosthesis.
The significance of the restoration of DRUJ anatomy in the treatment of intraarticular fractures of the distal radius S. Frenyo, F. Cserkuti, G. A r v a
Budapest, Hungary Residual wrist disability after fractures of the distal radius is most often caused by undertreatment of these "injuries. Pain and limitation of movement at the DRUJ is the most frequent cause of these disabilities. In fact, this is the main cause of invalidity after Sudeck's dystrophy in distal fractures of the radius. We reviewed a 3 year series (01.01.93-31.12.95) of intraarticular fractures of the distal radius (AO type B3, C1-2-3) treated at a major trauma centre by primary reduction and fixation with a unilateral external fixation and K-wires (103 cases). Age: 37 to 78 yrs (mean: 63.4 yrs). Attention was given to the restoration of the overall alignment o f the radius and the joint congruity especially at the DRUJ. In five cases bone graft was used 2 weeks later. The fixator was removed at 6 weeks. Follow-up was at 1 year.
Radiological results In 60'/,, cases 0 to 3 mm shortening of the radius was noted at the DRUJ, in 29% 3 to 5 mm, and above 5 mm in 10%. Functional results: no pain in 37%, mild pain, not interfering with function in 34% and moderate pain, while carrying weight in 29%. Pro-supination was <50% in 39%, between 50 to 70% in 39% and >70% in 21%. RSD was not found in this series. In no case was any further reconstructive procedure (e.g. resection of distal ulna) necessary.
Chondral and ligamentous wrist lesions in young adults with distal radial fractures. A descriptive, arthroscopie study in 50 patients. T. L i n d a u , L. H a g b e r g , M A r n e r
Lund, Malmt, Sweden Introduction Although the distal radial fracture is the most common fracture in the upper extremity, few authors have paid attention to high energy fractures in young adults. The aim of this study was to examine the frequency of associated chondral and ligament lesions.
Material and methods In a descriptive study, including two centres and two surgeons, 50 patients with mean age of 39 years (20-58 years) with dislocated and/or intra-articular distal radial fractures were examined with wrist arthroscopy at mean 5 days (1-17 days) after injury.
Results Thirty-five chondral lesions in 16 patients (32%) were found and five patients with degenerative osteoarthritic changes. Forty-nine patients had ligament lesions, with 39 combined injuries, seven isolated SL-tears and three isolated T F C C tears. Nineteen of 23 partial or total tears (83%) in the radioscapholunate ligament were combined with a grade 2A and 2B instability in the SL ligament. The interosseous carpal ligament instability, as found during arthroscopy, was described in a classification system modified from Geissler (Hand Clinics, 1995). Thirty-seven of the 43 cases (86%) with SL lesions had instability grade 2A and grade 2B. Fifteen of the 17 cases (88%) with LT lesions had instability grade 2A and grade 2B. No patients had instability grade 3. Forty-one patients had TFCC-lesions, more often if the ulnar styloid was fractured or if an unstable ulna head was seen at preoperative clinical examination.
Conclusion Chondral and ligament lesions were found very frequently in the present study. Even if most lesions were found to be partial, they could possibly explain a poor outcome in a seemingly well healed distal radius fracture.
E.C.U. tenodesis in chronic unstable distal ulna C. Grandis, C. Cerizza, E Bassi
Milano, Italy To treat injuries of C.EC.T. different operations have been suggested over the years by many authors. These were related to the anatomical damage, and the importance of both soft tissues and joint surfaces of this zone.