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.
ObjectiveTo investigate the effectiveness of local subcutaneous pedicled fat flap filling and separation of the synostosis area associated with radial shortening osteotomy and plate internal fixation for the treatment of congenital radioulnar synostosis.MethodsBetween February 2014 and June 2018, 36 patients (41 sides) with congenital radioulnar synostosis were analyzed retrospectively, including 21 males and 15 females, aged 2.5-4.5 years with an average of 3.1 years. The fixed pronation deformity of the forearm ranged from 30° to 90° with an average of 71.6°, and the range of motion of the elbow flexion was 120°-135° with an average of 128.2°. According to the Cleary-Omer classification, there were 8 sides of type Ⅱ, 17 sides of type Ⅲ, and 16 sides of type Ⅳ. All patients were treated by local subcutaneous pedicled fat flap filling and separation of the synostosis area associated with radial shortening osteotomy and plate internal fixation. The range of motion of the elbow, muscle strength, joint stability, and patient discomfort were evaluated by using the Broberg and Morrey elbow scoring system preoperatively and postoperatively. In addition, the ability for daily living of the affected limb was evaluated by using the Failla grading standard.ResultsRadial nerve palsy occurred in 3 cases, and nerve function recovered at 2-4 weeks after operation. All the 36 cases were followed up 6-52 months, with an average of 38 months. All osteotomy sites healed, the healing time was 5-12 weeks (mean, 6.3 weeks), and the pedicled fat flap between the radius and ulna survived when the internal fixation was taken. At last follow-up, the flexion range of motion of elbow joint was not decreased, and the pronation and supination range of motion of forearm were improved. The elbow flexion range of motion was 125°-135° with an average of 132.4°. The pronation range of motion of forearm was 15°-45° with an average of 30.1°, and the supination range of motion of forearm was 10°-40° with an average of 22.6°. At last follow-up, the Broberg and Morrey elbow scores increased from the preoperative 85.6±1.0 to 91.8±1.8, showing significant difference (t=25.593, P=0.000). Moreover, the results were good in 3 sides, fair in 9 sides, and poor in 29 sides according to the Failla grading standard before operation, with an excellent and good rate of 7.3%. At last follow-up, the results were excellent in 6 sides, good in 28 sides, and fair in 7 sides, with an excellent and good rate of 82.9%, showing significant difference when compared with preoperative value (Z=−5.781, P=0.000).ConclusionThe application of local subcutaneous pedicled fat flap filling and separation of the synostosis area associated with radial shortening osteotomy and plate internal fixation is an effective surgical method for the treatment of congenital radioulnar synostosis. It can restore the partial rotation function of the forearm and improve the quality of life of children.
To provide the scientific theoretical basis for cl inical practice by comparing biomechanicalcharacteristics of single compressed plate with intramedullary pin, locking intramedullary nail and simple arm externalfixator with simple internal fixation devices. Methods Eighteen wet humeral bone specimens of adult cadaver were madecompl icated fracture models of humeral shaft and divided into 3 groups according to fixation methods. Fracture was fixed by single compressed plate with intramedullary pin in plate group, by locking intramedullary nail in intramedullary nail group and by external fixator with simple internal fixation devices in external fixator group. The intensity and rigidity of compl icated fracture models of humeral shaft was measured in compress test and torsion test. Results In compress test, the maximum load in plate group (6 162.09 ± 521.06) N and in intramedullary nail group (6 738.32 ± 525.89) N was significantly larger than that in external fixator group (2 753.57 ± 185.59) N (P lt; 0.05); but there was no significant difference between plate group and intramedullary nail group (P gt; 0.05). Under 600 N physiological compress load, the rigidity was (171.69 ± 6.49) N/mm in plate group, (333.04 ± 36.85) N/mm in intramedullary nail group and (132.59 ± 2.93) N/mm in external fixator group; showing no significant difference between plate group and external fixator group (P gt; 0.05), and showing significant difference between intramedullary nail group and plate, external fixator groups (P lt; 0.05). In torsion test, the maximum torque in plate group (38.24 ± 7.08) Nm was significantly larger than those in intramedullary nail group (17.12 ± 5.73) Nm and external fixator group (20.26 ± 6.42) Nm (P lt; 0.05), but there was no significant difference between intramedullary nail group and external fixator group (P gt; 0.05). Under 0.80 Nm physiological torque, the rigidity was (16.36 ± 2.07) Ncm/° in plate group and (18.79 ± 2.62) Ncm/° in external fixator group, which was significantly larger than that in intramedullary nail group (11.45 ± 0.22) Ncm/° (P lt; 0.05); but there was no significant difference between plate group and external fixator group (P gt; 0.05). Conclusion Those fracture models fixed by single compressed plate with intramedullary pin have better compress and torsion intensity, they also have better torsion rigidity but less compress rigidity. Those fracture models fixed by locking intramedullary nail have better compress intensity but less torsion intensity, they also have better compress rigidity but less torsion rigidity. Those fracture models fixed by external fixator with simple internal fixation device have less compress and torsion intensity, they also have less compress rigidity but better torsion rigidity.