Radiographic changes after resection of the distal ulna in rheumatoid arthritis

Progressive ulnar translocation of the carpus and problems with the ulnar stump have been reported after resection of the distal ulna in rheumatoid arthritis (RA). However this has only occasionally been quantitatively assessed. In this study 24 wrists in 21 patients with RA were followed up for an average of 100 months after resection of the distal ulna. An additional 24 wrists in 14 non-operated RA patients were followed up for 92 months. In a retrospective radiographic analysis we demonstrate similar increases in ulnar translocation and ulnar-carpal distances in both groups.     

Radiographic changes after resection of the distal ulna in patients with rheumatoid arthritis.

Radiographic changes in the wrist after resection of the distal ulna in 61 rheumatoid patients (63 wrists) were evaluated more than five years after operation. The wrists were classified on preoperative radiographs into stable or unstable forms as defined by Simmen and Huber. Of 63 wrists, 52 were classified as stable and the remaining 11 were classified as unstable. At follow up, 50 of 52 wrists (96%) that were stable before operation had remained stable. Five of the 11 wrists that were unstable before operation had bony ankylosis or partial radiocarpal ankylosis, and in the remaining six cases there was carpal collapse. Resection of the distal ulna yields good results in stable wrists but operation is not indicated for unstable ones.     

Synovectomy with resection of the distal ulna in rheumatoid arthritis of the wrist

Wrist synovectomy with resection of the distal ulna was performed in 47 cases, where rheumatoid affection in the wrist joint caused visible capsular swelling, pain and reduced range of motion. At follow-up after a mean observation time of 33 months, 31 cases had complete pain relief, eight cases had moderate pain relief. In eight cases pain during wrist motion was unchanged at follow-up and in five of these, recurrence of capsular swelling was noted. The range of motion (both supination/pronation and vola- and dorsiflection) was significantly improved, as was the subjective assessment of function. The radiographic findings showed progression in 41 cases. Deviation in the wrist was unchanged. In three cases reoperations were performed and one case had spontaneous rupture of the 4th and 5th extensor tendons 1 month postoperatively. In 15 cases dislocation of the extensor carpi ulnaris tendon in volar direction by rotational movement was noted. Stability was good in all cases and no serious postoperative complications occurred. Wrist synovectomy with resection of the distal ulna is recommended in cases where regular medical treatment has been attempted for a minimum of 6 months without successful results.     

Excision of the distal ulna in rheumatoid arthritis

Resection of the ulna is an effective operation in the treatment of rheumatoid disorders of the distal radioulnar joint. Tenosynovectomies of the overlying extensor tendons and synovectomy of the joint are integral parts of the procedure. Following resection, the ulna usually remains in alignment with the radius, although some dorsal displacement is common. Restoring stability to the ulna as well as reconstructing a new sheath for the extensor carpi ulnaris can be accomplished in most cases by using the extensor retinaculum. In those cases where the retinaculum has been destroyed by the disease process or when the distal ulna is severely displaced, stability can be restored using the extensor carpi ulnaris for a tenodesis.     

Comparative results of resection of the distal ulna in rheumatoid arthritis and post-traumatic conditions

The purpose of this study was to determine whether the results of resection of the distal ulna differed depending upon the underlying aetiology of the condition. Patients with rheumatoid arthritis were compared with patients with post-traumatic wrist complaints. Fifty resections in 40 patients (eight male, 32 female) were assessed with respect to pain, range of motion, and grip strength. Of the 23 rheumatoid wrists, 86% were pain-free following surgery; however, only 36% of the patients in the trauma group reported pain relief postoperatively. Pain relief in post-traumatic patients was more predictable when distal radioulnar joint arthrosis was identified as the sole cause of wrist pain.     

Excision of the distal ulna in patients with rheumatoid arthritis

The results of excision of the distal ulna in 34 wrists of 25 patients with chronic rheumatoid arthritis of the distal radio-ulnar joint were reviewed. Rest pain had been cured or relieved in 77%, pain on pronation-supination in 86%, and limitation of pronation-supination in 90%, while 88% of the patients graded the result as excellent or fair. Despite this marked relief of symptoms, function of the upper limb was improved in only 25% of patients and remained unchanged in 60%. Ulnar subluxation of the carpus had occurred in 24% but seemed to be related to the destructive disease process rather than to the operation itself. The length of ulna resected was not related to the outcome of the operation.     

Three epiphyseal fractures (distal radius and ulna and proximal radius) and a diaphyseal ulnar fracture in a seven-year-old child's forearm.

SUMMARY: The authors report a rare case of fracture separations at both ends of the radius combined with an epiphyseal and diaphyseal fracture of the ipsilateral ulna. A seven-year-old girl fell one story and sustained a closed injury of her forearm. A closed reduction was unsuccessful, and an open reduction was performed with three of the four fractures being secured with Kirschner wires. These wires were removed one month later, and range-of-motion exercises were started. Thirty months after surgery, both forearms were equal in length, although the proximal radial epiphyseal line appeared partially closed. Joint motions, including forearm rotation, were normal. Radiologically, the ulnar diaphysis and the radial neck were posteriorly convex 20 degrees and 18 degrees, respectively.     

Radius neck-to-humerus trochlea transposition for elbow reconstruction after resection of the proximal ulna: report of 2 cases

The structural and functional deficit created after wide excision of the proximal ulna for malignant bone tumors presents a difficult reconstructive challenge. The purpose of our report was to retrospectively review the outcome of the radius neck-to-humerus trochlea transposition after wide resection of malignant forearm tumors in 2 patients. Good function was obtained using this surgical technique. This surgical option provides a durable biologic solution to a complex reconstructive problem.     

Derotational osteotomy of the proximal radius and the distal ulna for congenital radioulnar synostosis

Objective  To evaluate the clinical and functional results of a technical procedure in the surgical treatment of congenital radioulnar synostosis in children. Materials and methods  A prospective study had been undertaken from January 1992 to December 2004. Thirty-four patients with congenital radioulnar synostosis that are fixed in pronation were recruited. Congenital radioulnar synostosis was classified for two types according to Tachdjian’s criteria. All patients were treated by resection of the proximal radius and the distal ulna to remove a segmental bone of both parts of the forearm. After K-wires are inserted intramedullarly into both bones, the forearm is derotated manually, followed by cast immobilization. Results  There were 34 patients (52 forearms) with congenital radioulnar synostosis, whom the average age at surgery was 6 years and 3 months. There were two types of congenital radioulnar synostosis: Type 1 in six forearms (11.6%) and Type 2 in 46 forearms (88.4%). The preoperative forearm rotation ranged from 65° to 85° pronation. The postoperative forearm rotation angle was corrected from 0° to 30°; the best end position appears to be 70–100% of pronation. Of the patients, 78.8% had good or excellent results. All patients were operated on without complications; five patients had loss of correction during cast immobilization. Overall, the patient’s ability to perform daily activities showed a marked improvement after surgery. Conclusion  This method is a simple and safe technique to derotate the forearms of patients with congenital radioulnar synostosis that are fixed in pronation.     

Fracture of the distal radius associated with an articular comminutive fracture of the distal ulna: treatment in emergency by osteosynthesis of the radius by volar locking plate for the radius and a resection of the distal end of the ulna: report of one case

The authors present a case of a distal radius fracture associated with a comminutive fracture of the ulna head, treated by volar locking plate for the radius fracture and ulnar head resection. We obtain an early good objective and subjective functional result, whereas this type of fracture is classically associated with bad results in the series published with other treatments. This result needs to be confirmed by a more exhaustive series.     

Resection of the distal ulna with and without implant arthroplasty in rheumatoid arthritis

Eighteen patients who had rheumatoid wrist surgery with resection of the distal ulna, with or without implant arthroplasty, were reviewed at an average follow-up of 32 months. Subjective and objective clinical findings did not confirm any advantage to the routine use of implant arthroplasty of the distal ulna. Moreover, a bone resorptive process, which was identified in all implant cases, may cause clinical symptoms and prosthetic instability and may warrant reoperation. The histologic findings supported a granulomatous reaction to a foreign body as a cause of the resorptive process. Histologic examination showed a synovial type of membrane and the feasibility was raised of an enzymatic cause.     

自体腓骨近端移植重建桡骨远端肿瘤切除后的缺损

目的 通过对桡骨远端切除、功能重建后的腕关节功能的评价,寻求更好的重建方式和重建材料.方法 本组病例17例,平均年龄31.9岁(13～54岁).病理学分类骨巨细胞瘤16例、恶性肿瘤1例(Ⅱb期骨肉瘤),其中合并病理骨折4例;外科边界为广泛切除5例,边缘切除8例,囊内切除3例.重建方法 均为自体对侧腓骨近端移植.术后功能评价包括:腕关节活动度和前臂旋转、MSTS评分和DASH评分.结果 本组病例随访平均63个月(9～135月),复发2例,手术并发症3例.本组骨愈合病例13例,平均愈合时间13.8个月(6～22月).下尺桡关节分离现象较多见(10/15).功能评定中腕关节总活动度平均为57.67°,前臂旋转总活动度平均为68.33°,MSTS评分平均为86.89%,DASH评分平均为13.11.优势侧组和非优势侧组各项功能评定均无显著性差异.结论 本组选取自体腓骨近端重建,避免了异体骨和人工关节的高并发症,虽然腕关节总活动度损失较大,但前臂旋转功能尚佳,且术后功能评分良好,对优势侧和非优势侧同样适用.     

Management of bilateral complex fracture-dislocation of proximal ulna and radius: a case report

Complex fracture-dislocation of proximal ulna and radius (FDUR) are rare, representing only 2-5 % of elbow injuries. Monteggia-like lesions and transolecranon fractures include various patterns of complex FDUR, which are not well defined. The management of these injuries is considered extremely difficult, and clinical results are often poor. In this report, we present a case of a 66-year-old woman with bilateral complex FDUR. This pattern of injury is very rare and little information is available about its management. Diagnosis, surgical technique, rehabilitation programme and clinical results are reported. The bilaterality of the condition does not appear to influence the treatment and results.     

Management of bilateral complex fracture-dislocation of proximal ulna and radius: a case report

Complex fracture-dislocation of proximal ulna and radius (FDUR) are rare, representing only 2–5 % of elbow injuries. Monteggia-like lesions and transolecranon fractures include various patterns of complex FDUR, which are not well defined. The management of these injuries is considered extremely difficult, and clinical results are often poor. In this report, we present a case of a 66-year-old woman with bilateral complex FDUR. This pattern of injury is very rare and little information is available about its management. Diagnosis, surgical technique, rehabilitation programme and clinical results are reported. The bilaterality of the condition does not appear to influence the treatment and results.