Objective To summarize operative procedure and the effectiveness of open reduction with internal fixation or radial head replacement for the treatment of Essex-Lopresti injury. Methods Between November 2002 and October 2010, 10 patients with Essex-Lopresti injury were treated. There were 8 males and 2 females with a mean age of 36 years (range, 20-56 years). Eight cases were fresh closed fracture within 2 days. According to Mason classification, 5 fracture were typeII, 3 were type III. The other 2 cases were old fracture within 3 months. Wrist joint X-ray revealed that all the patients had distal radioulnar joint dislocation. Open reduction with internal mini-plate or absorbable screw fixation was performed in 5 cases, and radial head replacement in 5 cases; meanwhile, the distal radioulnar joint was reducted and fixed. Results All incisions healed by first intention without infection or bone nonunion. The patients were followed up 7 to 24 months with an average of 14.7 months. The X-ray films showed fracture heal ing at 9-20 weeks (mean, 16.3 weeks); distal radioulnar joint was stable without shortening or shift of proximal radius. According to elbow cl inical evaluation system, the results were excellent in 5 cases, good in 3 cases, and fair in 2 cases. According to wrist cl inical evaluation, the results were excellent in 7 cases, good in 2 cases, and fair in 1 case. All patients had good elbow stabil ity, and recovered quickly. Conclusion Early diagnosis, operation, and functional exercises are important to obtain an excellent result in treating Essex-Lopresti injury.
ObjectiveTo evaluate the effectiveness of intra-articular radioulnar ligament reconstruction in the treatment of chronic instability of the distal radioulnar joint. MethodsBetween January 2006 and June 2012, the intra-articular radioulnar ligament reconstruction was used to treat chronic instability of the distal radioulnar joint in 12 patients. Of 12 cases, 8 were males and 4 were females with an average age of 37.3 years (range, 22-54 years). The causes of injury were tumble in 9 patients, traffic accident in 2 patients, and sprain in 1 patient. The average time from initial injury to operation was 6.2 months (range, 2-13 months). The pain and function of the wrists were assessed with Patient-Rated Wrist Evaluation (PRWE) (27.5±4.7). Broadening of the distal radioulnar joint space was seen on the anteroposterior radiograph in all the patients. Lateral view showed dorsal instability in 10 patients and palmar instability in 2 patients. There was no radial fracture, ulnar fractures or degeneration of the distal radioulnar joint. ResultsAll patients achieved primary healing of incision. No complication of deep infection or nerve injury occurred. They were followed up from 12 to 30 months (mean, 20.6 months). Pain and the clicking sound of the wrists disappeared; grip strength increased; the range of motion values of the wrist and forearm were restored. PRWE score was 5.8±2.1 at last follow-up, showing significant difference when compared with preoperative score (t=14.215, P=0.000). Imaging examination showed good appositions of the distal radioulnar joint, with no dislocation or subluxation. ConclusionIntra-articular radioulnar ligament reconstruction can rebuild the anatomic stability of the distal radioulnar joint, which does not damage the adjacent structures of the joints and can obtain satisfactory function of the reconstructed joint. It is a good choice for chronic instability of the distal radioulnar joint without articular degeneration.
ObjectiveTo discuss the clinical result of extrinsic radioulnar tether combined with anchoring nail fixation for treating chronic dorsal instability of the distal radioulnar joint (DRUJ). MethodsBetween July 2011 and December 2012, 6 patients with chronic dorsal instability of the DRUJ were treated with extrinsic radioulnar tether combined with anchoring nail fixation. There were 1 male and 5 females with the average age of 27.3 years (range, 22-35 years). All of 6 patients had a wrist trauma history. The average disease duration was 4.8 years (range, 6 months to 15 years). Radiographs were taken postoperatively to observe the anchoring nail loosening. The stress test and forearm rotation test were used to evaluate the function of DRUJ. The complications, the grip power, range of motion, and visual analogue scale (VAS) scores were recorded at last follow-up. And the joint function was evaluated by disability of arm, shoulder, and hand (DASH) score. ResultsPrimary healing of incision was obtained in all cases, without any complications such as infection and ulnar neck fracture. All 6 patients were followed up 6-24 months (mean, 13.7 months). Stability was achieved in all patients. Radiographs showed that the joint space was widened and dislocation of the ulnar head was improved at 3 and 6 months after operation. The results of the stress test and forearm rotation test were negative. At last follow-up, the grip power, DASH score, VAS score, and range of motion of the wrist were significantly improved when compared with preoperative ones (P<0.05). ConclusionExtrinsic radioulnar tether combined with anchoring nail fixation is an easy method of surgical revision to treat chronic dorsal instability of DRUJ, which can maintain the stability and protect the blood supply of triangular fibrocartilage complex.