ObjectiveTo evaluate the long-term effectiveness of lunate excision and vascularized capitate osteotomy transposition for advanced Kienböck's disease. MethodsBetween June 2004 and January 2008,16 patients with Kienböck disease in Lichtman stages ⅢB-IV were treated with lunate excision and vascularized capitate osteotomy transposition.There were 10 males and 6 females at the age of 27-59 years (mean,38.8 years).The disease was caused by trauma in 10 cases,and unknown reason in 6 cases.The main clinical symptoms were pain and limited activity of the wrist joint,and the disease duration was 5-32 months (mean,26.5 months).The carpal height index was 0.88±0.05; the radioscaphoid angle was (63.8±9.1)°.The visual analogue scale (VAS) score,range of motion (ROM),grip strength,Evans score,and radiographic changes were used to assess the effectiveness during follow-up. ResultsAll patients obtained healing of incision by first intention and were followed up 5 years and 4 months to 9 years (mean,5.8 years).VAS score was 2.0±1.5 at the final follow-up.The ROM of the flexion and extension of the wrist joint at the affected side were significantly less than those at the normal side (P<0.05).However,no significant difference was found in the grip strength and Evans score between the affected side and normal side (t=-0.997,P=0.327; t=-1.852,P=0.077).Postoperative radiographs showed that the carpal height index was 0.94±0.03,and the radioscaphoid angle was (48.4±4.8)°,which were improved significantly when compared with preoperative ones (t=-3.927,P=0.000; t=5.987,P=0.000).Osteophyte at the dorsal side of the radius and scaphoid rotation occurred in 6 cases and 2 cases,respectively. ConclusionLunate excision and vascularized capitate osteotomy transposition is a reliable method for advanced Kienböck's disease,with favorable improvement in wrist pain and grip strength for long-term follow-up.
ObjectiveTo explore the therapeutic effect of Masquelet technique combined with tissue flap grafting for bone defect and soft tissue defect. MethodsBetween August 2012 and April 2015, 18 cases of bone defect and soft tissue defect were treated by using Masquelet technique combined with tissue flap grafting. There were 11 males and 7 females, aged from 23 to 59 years (mean, 37.1 years). The time between injury and treatment was 15 days to 39 months (mean, 0.9 months). Defect located at the proximal tibia in 4 cases, at the middle tibia in 8 cases, at the distal tibia in 4 cases, and at the lateral heel in 2 cases. All patients were treated with debridement. After debridement, the bone defect was (5.7±1.8) cm in length, and the soft tissue defect was 5 cm×4 cm to 13 cm×11 cm in size. In one-stage operation, bone defect was repaired with the antibiotic cement and fracture was fixed by temporary external fixation. The surfaces of wound were repaired with tissue flap. After 6 to 8 weeks when wounds healed with no sign of infection, bone grafting from iliac bone and/or fibula was performed in two-stage operation. ResultsEighteen patients followed up 10-38 months (mean, 24.3 months). After one-stage operation, 6 cases had pin track infection, which was cured by strengthened disinfection and oral antibiotics. All the tissue flaps survived. Bone healing was observed on X-ray film at 15-57 weeks (mean, 25.3 weeks) after two-stage operation. The function of the knee and ankle joint recovered well. According to the American Orthopaedic Foot and Ankle Society (AOFAS) score for the ankle joint, the scores of ankle function ranged from 74 to 98, with an average of 89.7; the results were excellent in 7 cases, good in 10 cases, and fair in 1 case. ConclusionThe Masquelet technique combined with tissue flap grafting is an effective method to treat bone defect and soft tissue defect.
Objective To evaluate the effectiveness of Sauvé-Kapandji procedure in the treatment of traumatic ulnar styloid impaction syndrome. Methods Between June 2010 and January 2013, 12 patients with traumatic ulnar styloid impaction syndrome were treated by Sauvé-Kapandji procedure. There were 4 men and 8 women, with an average age of 58.9 years (range, 50-69 years). The disease was caused by traffic accident in 1 case, and by falling from height in 11 cases. All patients had dislocation of the distal radioulnar joint, and 7 patients also had old fractures of the distal radius. The main clinical symptoms were pain and limited activity of the wrist joint, and the disease duration was 2-4 months (mean, 3.5 months). The visual analogue scale (VAS) was 6.2±1.4. The clinical outcomes were assessed by VAS, range of motion (ROM) of the wrist, grip strength, Evans score, and X-ray film of wrist joint during follow-up. Results All patients obtained healing of incision by first intention and were followed up 37-73 months (mean, 58.4 months); no complication of infection, blood vessel injury, or nerves injury occurred. VAS was 1.2±1.0 at the final follow-up, showing significant difference when compared with preoperative one (t=9.950,P=0.000). The ROM of the affected wrist joint in flexion, extension, ulnar deviation, forearm pronation and supination were improved, but the ROM of the affected side were significantly less than those of normal side (P<0.05). No significant difference was found in the grip strength and Evans score between the affected side and normal side (t=–0.885,P=0.386;t=–1.969,P=0.062). According to Evans scores, the results were excellent in 8 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate of 91.7%. Postoperative radiographs showed bony healing in all patients, with the average healing time of 3.5 months (range, 3-6 months). The instability of proximal ulna occurred in 3 cases. Conclusion Sauvé-Kapandji procedure is a reliable remedy method for traumatic ulnar styloid impaction syndrome, with favorable improvement in wrist pain and forearm rotation. However, the surgical indications for Sauvé-Kapandji procedure should be strictly controlled.