Objective To investigate the treatment of ulnar coronoid process fracture with mini-plate and to evaluate the cl inical results. Methods Between September 2006 and March 2009, 14 patients with ulnar coronoid process fracture were treated with open reduction and internal fixation of mini-plate. There were 10 males and 4 females with an average age of 29 years (range, 14-51 years). Fracture was caused by fall ing from height in 4 cases and traffic accident in 10cases. The locations were left side in 6 cases and right side in 8 cases. According to Regan-Morrey classification, there were 2 cases of type I, 6 of type II, and 6 of type III. The flexion-extension arc of the elbow was (60 ± 10)° and the forearm rotation was (70 ± 10)°. The disease duration was 30 minutes to 11 days, and CT scan was used for definite diagnosis. Patients received early functional exercise 1 week postoperatively. Results All incisions healed by first intention. Fourteen cases were followed up 12-25 months (17 months on average). All fractures healed well, and the average union time was 10 weeks with a range of 7-12 weeks. No 1oosening or breakage of the internal fixation occurred except for 2 patients who had heterotopic ossification. The flexion-extension arc of the elbow was (110 ± 10)° and the forearm rotation was (130 ± 15)°, showing significant difference when compared with that before operation (P lt; 0.05). The cl inical results were evaluated according to Morrey’s scale, 8 cases were rated as excellent, 4 as good, and 2 as fair; the excellent and good rate was 85.7%. Conclusion Fixation of ulnar coronoid process fracture with mini-plate provides sufficient stabil ity to do early functional exercise and it can enhance functional outcome.
Objective To compare the short-term effectiveness of arthroscopic suture of triangular fibrocartilage complex (TFCC), arthroscopic suture of TFCC combined with open reduction and internal fixation, and simple open reduction and internal fixation in the treatment of distal radius fractures combined with ulnar styloid base fractures and TFCC injury. Methods A clinical data of 97 patients with distal radius fractures combined with ulnar styloid base fracture and TFCC injury, who were admitted between September 2019 and September 2022 and met the selective criteria, was retrospectively analyzed. After reduction and internal fixation of distal radius fractures, 37 cases underwent arthroscopic suture of TFCC (TFCC group), 31 cases underwent arthroscopic suture of TFCC combined with open reduction and internal fixation of ulnar styloid base fractures (combination group), and 29 cases underwent simple open reduction and internal fixation of ulnar styloid base fractures (internal fixation group). There was no significant difference in baseline data between groups (P>0.05), such as gender, age, injury side, time from injury to operation, and preoperative radius height, palm inclination, ulnar deviation, grip strength, wrist range of motion (ROM) in rotation, ulnar-radial deviation, and flexion-extension. The differences (change value) in radius height, metacarpal inclination angle, ulnar deviation angle, grip strength, and wrist ROM in rotation, ulnar-radial deviation, and flexion-extension between preoperative and 12 months after operation in 3 groups were compared. The effectiveness was evaluated according to the modified Gartland-Werley score at 12 months after operation. Results All incisions healed by first intention. All patients were followed up 12-18 months (mean, 14 months). X-ray films showed that there were 4 patients with non-union of ulnar styloid base fracture in TFCC group, and the remaining patients had fracture healing at 3 months after operation. The radius height, palm inclination, and ulnar deviation of 3 groups at 12 months after operation were significantly better than those before operation (P<0.05); however, the differences in the change values of the above indexes between groups was not significant (P>0.05). At 12 months after operation, the change values of wrist ROM in rotation, ulnar-radial deviation, and flexion-extension in the TFCC group and the combination group were significantly greater than those in the internal fixation group (P<0.05), and there was no significant difference between the TFCC group and the combination group (P>0.05). The change values of grip strength was significantly greater in the combination group than in the internal fixation group (P<0.05); there was no significant difference between the other groups (P>0.05). The excellent and good rates according to the modified Gartland-Werley score were 91.89% (34/37), 93.54% (29/31), and 72.41% (21/29) in the TFCC group, the combination group, and the internal fixation group, respectively. The excellent and good rates of the TFCC group and the combination group were significantly higher than that of the internal fixation group (P<0.05); there was no significant difference between the TFCC group and the combination group (P>0.05).ConclusionFor ulnar styloid base fractures with TFCC injury, compared with simple open reduction and internal fixation, arthroscopic suture of TFCC or suture TFCC combined with internal fixation treatment are both beneficial for wrist function recovery, and their short-term effectiveness are similar. Therefore, arthroscopic suture of TFCC may be a better choice.
ObjectiveTo study the effectiveness of anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle in the treatment of severe cubital tunnel syndrome. MethodsBetween March 2006 and May 2015, 22 cases (23 hands) of severe cubital tunnel syndrome were treated by use of anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle. There were 15 males and 7 females, aged 45-60 years (mean, 55 years). The causes were valgus deformity of elbow joint in 12 cases, ulnar nerve subluxation in 4 cases, and osteoarthritis in 6 cases. The disease duration was 10 months to 3 years (mean, 17 months). According to Akahori classification, 14 cases were rated as type 4 and 9 cases as type 5. The ring/little finger's numbness, hand intrinsic muscle atrophy, recovery of thumb adduction function, and improvement of claw hand deformity were observed after operation. Thumb and index finger's pinch strength was measured by use of pinch device; postoperative hand function was evaluated by the standards of Chinese Medical Society of Hand Surgery of upper limb assessment protocol. ResultsAll incisions healed well and all cases were successfully followed up 8 to 24 months (mean, 14 months). Numbness of ring/little finger was significantly reduced at 1 day after operation in 10 hands; numbness disappeared completely at 1 month after operation in 12 hands; mild numbness remained at 14 months after operation in 11 hands. At last follow-up, hand intrinsic muscle atrophy partially improved (+++) in 1 hand, no improvement in 22 hands; improvement of claw hand deformity was achieved in 17 hands, no improvement in 6 hands; pinch strength of thumb and index finger was significantly improved to (5.07±1.11) kg from preoperative (2.91±0.63) kg (t=-12.340, P=0.032). At last follow-up, the results were excellent in 11 hands, good in 8 hands, fair in 3 hands, and poor in 1 hand, and the excellent and good rate was 82.6%. ConclusionAnterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle is a simple, effective, and reliable surgical treatment for severe cubital tunnel syndrome.
Objective To investigate the effectiveness of Kirschner wire combined with silk tension band in the treatment of ulnar collateral ligament avulsion fracture of the thumb metacarpophalangeal joint. Methods Between September 2008 and October 2011, 14 patients with ulnar collateral ligament avulsion fracture of the thumb metacarpophalangeal joint were treated using a combination of Kirschner wire and silk tension band. There were 8 males and 6 females, aged 23-55 years (mean, 40.8 years). The causes of injury were machinery twist injury in 5 cases, manual twist injury in 4 cases, falling in 4 cases, sports injury in 1 case. The time from injury to operation was 2 hours-14 days. All the patients presented pain over the ulnar aspect of the metacarpophalangeal joint of the thumb, limitation of motion, and joint instability with pinch and grip. The lateral stress testing of the metacarpophalangeal joint was positive. Function training was given at 2 weeks after operation. Results All incisions healed by first intention. The lateral stress testing of the metacarpophalangeal joint was negative. All the patients were followed up 6-18 months (mean, 13.1 months). The X-ray films showed good fracture reduction and healing with an average time of 7 weeks (range, 4-10 weeks). At last follow-up, the thumbs had stable flexion and extension of the metacarpophalangeal joint, normal opposition function and grip and pinch strengths. According to Saetta et al. criteria for functional assessment, the results were excellent in 11 cases and good in 3 cases; the excellent and good rate was 100%. Conclusion It is an easy and simple method to treat ulnar collateral ligament avulsion fracture of the thumb metacarpophalangeal joint using Kirschner wire combined with silk tension band, which can meet the good finger function.
ObjectiveTo discuss the imaging manifestations of ulnar impaction syndrome, and to evaluate the diagnostic value of MR imaging. MethodsThe clinical data of 18 patients with clinical standard-proved ulnar impaction syndrome between January 2010 and June 2013 were retrospectively reviewed. ResultsSeventeen cases were diagnosed as ulna positive variation (94.6%), and the range of ulnar variance was 1.5 to 3.8 mm and the average ulnar variance was 2.6 mm. Neutral variance was found in one case. Fourteen cases had avascular necrosis or bone sclerosis of semilunar bone, and avascular necrosis or bone sclerosis of the triquetrum and ulnar was presented in 12 cases and 3 cases respectively on X-ray detection. CT scan showed that 16 cases of semilunar bone abnormalities (6 with ischemic necrosis), triquetrum osteonecrosis in 4 cases, and both necrosis of semilunar bone and triquetrum in 3 cases. On MRI, all cases had different degrees of damage, degeneration of semilunar bone, triquetrum, ulnar and triangular fibocartilage complex (ulnar side of the proximal end of the lunate in 18, radial side of the triquetrum in 17, distal joint surface of ulnar in 12, and triangular fibocartilage complex in 15). In the early stage, lesions were presented as edema of bone marrow and followed as different sizes of cystic change. Articular surface was collapsed later. ConclusionUlnar positive variance has important reference value in the diagnosis of ulnar impaction syndrome. MRI can show the early change of ulnar impaction syndrome, and provide reliable decision basis for clinical diagnosis and treatment.
Objective To compare the effectiveness of anterior subcutaneous transposition and anterior submuscular transposition of the ulnar nerve in the treatment of cubital tunnel syndrome. Methods Between June 2006 and October 2008, 39 patients with cubital tunnel syndrome were treated separately by anterior subcutaneous transposition (anterior subcutaneous transposition group, n=20) and anterior submuscular transposition (anterior submuscular transposition group, n=19). There was no significant difference in gender, age, duration, and cl inical classification between 2 groups (P gt; 0.05). Results All incisions healed by first intention in 2 groups. In anterior submuscular transposition group, 17 patients (89.5%) had abruptly deteriorated symptoms after the symptom of ulnar nerve compression was abated, and 1 patient (5.3%) had cicatrix at elbow; in the anterior subcutaneous transposition group, 10 patients (50.0%) had disesthesia at cubital anterointernal skin after operation; and there was significant difference in the complication between 2 groups (χ2=9.632, P=0.002). The patients were followed up 24 to 36 months, 28 months on average. There was no significant difference in grip strength, pinch power of thumb-to-ring finger and thumb-to-little finger, or two-point discrimination of distal l ittle fingers between 2 groups (P gt; 0.05), but significant differences were found between before operation and after operation in 2 groups (P lt; 0.05). According to the Chinese Medical Society of Hand Surgery Trial upper part of the standard evaluation function assessment, the results were excellent in 5 cases, good in 12 cases, fair in 1 case, and poor in 2 cases in the anterior subcutaneous transposition group; the results were excellent in 6 cases, good in 10 cases, fair in 2 cases, and poor in 1 case in the anterior submuscular transposition group; and there was no significant difference between 2 groups (u=0.346, P=0.734). According to disabil ity of arm-shoulder-hand (DASH) questionnaires, the score was 22 ± 7 in anterior subcutaneous transposition group and was 19 ± 6 in anterior submuscular transposition group, showing no significant difference (t=1.434, P=0.161). Conclusion Both anterior subcutaneous transposition and anterior submuscular transposition have good effectiveness in treating cubital tunnel syndrome; and anterior submuscular transposition has less complication than that of submuscular transposition.
Objective To provide anatomy evidence of the simple injury of the deep branch of the unlar nerve for cl inical diagnosis and treatments. Methods Fifteen fresh samples of voluntary intact amputated forearms with no deformity were observed anatomically, which were mutilated from the distal end of forearm. The midpoint of the forth palm fingerweb wasdefined as dot A , the midpoint of the hook of the hamate bone as dot B, the ulnar margin of the flexor digitorum superficial is of the l ittle finger as OD, and the superficial branch of the unlar nerve and the forth common finger digital nerve as OE, dot O was the vertex of the triangle, dot C was intersection point of a vertical l ine passing dot B toward OE; dot F was the intersection point of CB’s extension l ine and OD. OCF formed a triangle. OCF and the deep branch of the unlar nerve were observed. From May 2000 to June 2007, 3 cases were treated which were all simple injury of the deep branch of the unlar nerve by glass, diagnosed through anatomical observations. The wounds were all located in the hypothenar muscles, and passed through the distal end of the hamate bone. Muscle power controlled by the unlar nerve got lower. The double ends was sewed up in 2 cases directly intra operation, and the superficial branch of radial nerve grafted freely in the other 1 case. Results The distance between dot B and dot O was (19.20 ± 1.30) mm. The length of BC was (7.80 ± 1.35) mm. The morpha of OCF was various, and the route of profundus nervi ulnaris was various in OCF. OCF contains opponens canales mainly. The muscle branch of the hypothenar muscles all send out in front of the opponens canales. The wounds of these 3 cases were all located at the distal end of the hook of the hamate bone, intrinsic muscles controlled by the unlar nerve except hypothenar muscles were restricted without sensory disorder or any other injuries. Three cases were followed up for 2 months to 4 years. Postoperation, the symptoms disappeared, holding power got well, patients’ fingers were nimble. According to the trial standard of the function of the upper l imb peripheral nerve establ ished by Chinese Medieal Surgery of the Hand Association, the synthetical evaluations were excellent.Conclusion Simple injuries of the deep branch of the unlar nerve are all located in OCF; it is not easy to be diagnosed at the early time because of the l ittle wounds, the function of the hypothenar muscles in existence and the normal sense .
Objective To discuss the concept of ulnar tunnel at thewrist, the types, causes, traits of compression, diagnosis, and clinical significance of ulnar tunnel syndrome(UTS). Methods Thirty-nine cases diagnosed as having UTS from 1986 were retrospectively reviewed combined with previous relevant literature. Results Ulnar tunnel included Guyon’s canal, pisohamate tunnel and hypothenar segment. There were 8 types andmany causes of UTS. Some patients had compression in more than one zones and might be associated with carpal tunnel syndrome or cubital tunnel syndrome. UTS could be diagnosed through clinical manifestations and electrophysiological examination. Conclusion Defining the concept of ulnar tunnel and the knowledge of the complexity and rarity of UTS can effectively guide diagnosis and treatment.
Objective To investigate the methods and outcome of endoscopic ulnar neurolysis and minimal medial epicondylectomy in treatment of cubital tunnel syndrome with ulnar nerve subluxation. Methods Between June 2004 and June 2009, 11 cases of cubital tunnel syndrome with ulnar nerve subluxation were treated with endoscopic ulnar neurolysis andminimal medial epicondylectomy. There were 7 males and 4 females with an average age of 36 years (range, 18-47 years). All cases had numbness in l ittle finger and ring finger. The disease duration varied from 3 to 18 months (7 months on average). Nine cases had atrophy in the first dorsal interosseous muscle and hypothenar muscles. The preoperative electromyography showed that the ulnar nerve conduction velocity (NCV) were slowed down at elbow, which was (27.0 ± 1.5) m/s. Results All incisions healed by first intention, and no compl ication occurred. Eleven cases were followed up 6-37 months (19 months on average). All cases had normal sensation after 1 month of operation. The muscle strength was obviously improved in 11 cases after 3 months postoperatively (grade 4 in 7 cases and grade 3-4 in 4 cases). The postoperative electromyography showed that the NCV was obviously improved, which was (43.5 ± 9.5) m/s, showing significant difference when compared with preoperative one (P lt; 0.05). According to Amadio’ efficacy appraisal standard, the results were excellent in 7 cases and good in 4 cases. Conclusion The method of endoscopic ulnar neurolysis and minimal medial epicondylectomy has the advantages of safety, convenient manipulation, small incision, and early recovery for cubital tunnel syndrome with ulnar nerve subluxation.
Objective To produce anatomical theory evidence for treatment of cubital tunnel syndrome with anterior submuscular transposition.Methods Of 32 patients with cubital tunnel syndrome, there were 22 males and 10 females, aged 17-73 years. The distribution of the branches of superior ulnar collateral arteryand the relationship between superior ulnar collateral artery and ulnar nerve were observed; the position, scope and diameter of ulnar nerve lesion were also observed; the volume of new cubit tunnel was measured with dilator. Twenty cubituses of adult cadavers were made the models of anterior subcutaneous transposition and anterior submuscular transposition of ulnar nerve. Length changes of ulnar nerve in different situations were observed.Results Superior ulnar collateral artery could be transposed with ulnar nerve, and new cubit tunnel was wide enough to contain ulnar nerve. In the context of anterior subcutaneous transposition, the ulnar nerve was lengthened by 7.55%±0.52% when compared with that of preoperation in the case of elbow extension, there was significant difference (P＜0.05). In the context of anterior submuscular transposition, there was nosignificant difference in length of the ulnar nerves between preoperation and postoperation(P＞0.05).Conclusion Anterior submuscular transposition can overcome compression and pull of elbow on the ulnar nerve and has sufficient blood supply. New cubital tunnel is wide enough to contain ulnar nerve. Ulnar nerve anterior submuscular transposition is a useful method in treating cubital tunnel syndrome.