PURPOSE: Multiple hereditary exostoses of the forearm typically form in the distal ulna, causing disturbances in the growth of the ulna and functional disability. Multiple hereditary exostoses inhibit the growth of the ulna, leading to an acquisition of a varus deformity in the radius, which sometimes leads to dislocation of the radial head, the development of limitations in the pronation-supination of the forearm, and cosmetic problems. MATERIALS AND METHODS: We retrospectively reviewed the cases of four patients who had deformities of the forearm with radial head dislocation associated with multiple hereditary exostoses, and evaluated the radiologic and clinical results of excision of the osteochondromas from the distal ulna and gradual ulnar lengthening with an Ilizarov external fixator. RESULTS: Good clinical and radiological results were obtained after a mean follow-up of 25 months. At the most recent follow-up, radial bowing, ulnar shortening, carpal slip, and the pronation/supination arch of the forearm had improved. There was little change in terms of preoperative radial articular angle and the flexion/extension arch of the elbow by the most recent follow-up. CONCLUSION: Treatment of four forearms from four patients by excision of osteochondromas and gradual lengthening of the ulna with an Ilizarov external fixator spontaneously reduced dislocations of the radial heads without the need for any additional operative intervention. All patients were satisfied with the final results.
Adolescent ; Child ; Child, Preschool ; Exostoses, Multiple Hereditary/*radiography/surgery ; Female ; Humans ; Male ; Radius/radiography ; Retrospective Studies ; Ulna/radiography ; Young Adult

Cubitus varus, which includes deformities of varus, hyperextension and internal rotation, is the most common complication of supracondylar fracture of the humerus in children. For correction of cubitus varus deformity, many operative methods have been reported but postoperative results are not always satifactory. For the purpose of detection of the reason of postoperative residual deformity, we reviewed AP roentgenography of 22 patients of cubitus varus deformity in the view point that change of longitudinal axis of forearm contribute the residual deformity. The results are summerized as follows: 1. Degree of cubitus varus deformity was more severe in the patients whose interval between the injured time and visiting hospital for cubitus varus was longer. 2. Average proximal radial shaft angle was 10.99degrees +/-3.48degrees in normal limb and 15.72degrees+/-4.03degrees in affected limb and average ulnar shaft angle was 7.86degrees+/-3.60degrees, 10.54degrees +/-4.02degrees (P<0.05), respectively which were all significant value statistically (P<0.05). Average distal radial shaft angle was 10.21degrees 2.37 in normal limb and 11.21degrees +/-1.51degrees in affected limb and statistically insignificant (P>0.05). 3. More severe cubitus varus deformity revealed more change of proximal radial shaft angle of attected limb compare to normal limb. Based on these results, we concluded that correction of the cubitus varus deformity should not be delayed in order to minimize the secondary change of longitudinal axis of foream bones and to obtain satisfacotry cosmetic outcome.
Axis, Cervical Vertebra* ; Child ; Congenital Abnormalities* ; Extremities ; Forearm ; Humans ; Humerus ; Radiography ; Radius* ; Ulna*

We evaluated abnormalities in medial portion of elbow in high-school weightlifter compared with the non weightlifter using a stress radiography and ultrsonography. The experimental group(G1) was 26 high school weightlifters with an average age of 17 years old (range, 16.18 years). The control group (G2) were comprised of 25 age matched general students. Both groups received physical examination, simple and valgus stress radiography and ultrasonography on both side of elbow. Physical examination showed 26.9% (14/52 elbows) tenderness and 19.2% (10/52 elbows) valgus laxity in G1, no tenderness and laxity in G2. There were no differences in medial joint gaps on simple radiography (G1, 3.3 mm, G2, 2.7 mm; p>0.05), but the valgus stress view showed 5.6+/-0.8 mm medial joint gap in G1 and 3.8+/-0.8 mm in G2 (p<0.001). Ultrasonography in G1, angular deformity was found in 67.3% (36/52) and G2 all in normal (p<0.01). The horizontal distance was an average 4.9+/-1.23 mm for the G1 and 3.1+/-0.78 mm for the G2 (p<0.001). Vertical distance of the proximal portion of the ulna was average 0.58+/-0.94 mm for the G1 and 1.59+/-0.49 mm for the G2 (p<0.001). In G1, angular deformity of male was 50% (15/30 elbows) and female was 95% (21/22 elbows) (p<0.001). Change of horizontal and vertical distance were larger in female (p<0.05). In conclusion, there were increased incidence of medial elbow joint laxity in high school weightlifter, especially in female, regardless of career. Sustained valgus laxity could be prone to ulnar collateral ligament injury and should be evaluated with ultrasonography-assisted dynamic study.
Collateral Ligaments ; Congenital Abnormalities ; Elbow Joint* ; Elbow* ; Female ; Humans ; Incidence ; Joints ; Male ; Physical Examination ; Radiography ; Ulna ; Ultrasonography

PURPOSE: Ultrasound is of proven accuracy in abdominal and thoracic trauma and may be useful for diagnosing extremity injury in situations where radiography is not available, such as disasters and military and space applications. However, the diagnosis of fractures is suggested by history and physical examination and is typically confirmed with radiography. As a alternative to radiography, we prospectively evaluated the utility of extremity ultrasound performed by trained residents of emergency medicine (EM) one patient with wrist and ankle extremity injuries. METHODS: Initially, residents of EM performed physical examinations for fractures. The emergency ultrasound (EM US) was performed by trained residents, who used a portable ultrasound device with a 10- to 5-MHz linear transducer, on suspected patients before radiography examination. The results of emergency ultrasound and radiography and the final diagnosis were recorded, and correlations among them were determined by using Kappa`s test. RESULTS: Thirty-nine patients were enrolled in our study. The average age was 36.6+/-19.3 years. There were radius Fx. (n=21), radius-ulna Fx. (n=1), ulna Fx. (n=1), and contusion (n=2) injuries among the wrist injury and lat.-med. malleolar Fx. (n=13), lat. malleolar Fx. (n=6), and med. malleolar Fx. (n=3) injuries among the ankle injury. Comparing EM US with radiography, we found the sensitivity, specificity, positive predictive value, and negative predictive value of EM US for Fx. diagnosis to be 100%, 66.7%, 97.3%, 100% and those of radiography to be 97.2%, 100%, 100%, and 75%, respectively. Kappa`s test for a correlation between the Fx. diagnosis of EM US and the final diagnosis of Fx was performed, and Kappa`s value was 0.787 (P = 0.004). CONCLUSION: EM US for Fx. can be performed quickly and accurately by EM residents with excellent accuracy in remote locations such as disaster areas and in military and aerospace applications. EM US was as useful as radiography in our study and had a high correlation to the final diagnosis of Fx. Therefore, ultrasound should performed on patients with extremity injury to determine whether extremity evaluation should be added to the FAST (focused abdominal sonography trauma) examination.
Ankle Injuries* ; Ankle* ; Contusions ; Diagnosis ; Disasters ; Emergencies* ; Emergency Medicine ; Extremities ; Humans ; Military Personnel ; Physical Examination ; Prospective Studies ; Radiography ; Radius ; Sensitivity and Specificity ; Transducers ; Ulna ; Ultrasonography* ; Wrist Injuries ; Wrist*

A patient with a 2-year history of pain in the left arm, and decreased strengths unrelieved by non-steroidal anti-inflammatory therapy, was being referred for repeating radiography. The radiologic examinations have demonstrated a unique pattern of non-contiguous osteolysis in the left elbow, proximal and distal radius, ulna, wrist, carpal bones, proximal and distal metacarpals and phalanges. Multi-site biopsies were being performed and confirmed the diagnosis of massive osteolysis. To our knowledge, this is the first case in which multifocal, non-contiguous osteolysis with skip lesions without associated nephropathy and without a hereditary pattern is being described in one extremity.
Adult ; Biopsy, Fine-Needle ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Male ; Osteolysis, Essential/*diagnosis ; Tomography, X-Ray Computed/*methods ; Ulna/*pathology/radiography

OBJECTIVE: To assess the maturation disparity of hand-wrist bones using the BoneXpert system and Greulich and Pyle (GP) atlas in a sample of normal children from China. MATERIALS AND METHODS: Our study included 229 boys and 168 girls aged 2-14 years. The bones in the hand and wrist were divided into five groups: distal radius and ulna, metacarpals, proximal phalanges, middle phalanges and distal phalanges. Bone age (BA) was assessed separately using the automatic BoneXpert and GP atlas by two raters. Differences in the BA between the most advanced and retarded individual bones and bone groups were analyzed. RESULTS: In 75.8% of children assessed with the BoneXpert and 59.4% of children assessed with the GP atlas, the BA difference between the most advanced and most retarded individual bones exceeded 2.0 years. The BA mean differences between the most advanced and most retarded individual bones were 2.58 and 2.25 years for the BoneXpert and GP atlas methods, respectively. Furthermore, for both methods, the middle phalanges were the most advanced group. The most retarded group was metacarpals for BoneXpert, while metacarpals and the distal radius and ulna were the most retarded groups according to the GP atlas. Overall, the BAs of the proximal and distal phalanges were closer to the chronological ages than those of the other bone groups. CONCLUSION: Obvious and regular maturation disparities are common in normal children. Overall, the BAs of the proximal and distal phalanges are more useful for BA estimation than those of the other bone groups.
Age Determination by Skeleton ; Asian Continental Ancestry Group* ; Bone and Bones ; Child* ; China ; Developmental Disabilities ; Female ; Hand ; Humans ; Metacarpal Bones ; Pattern Recognition, Automated ; Radiography ; Radius ; Ulna ; Wrist

PURPOSE: Rupture of a collateral ligament of the metacarpophalangeal joint is rare except in the thumb. The injured digit became flexed and deviated toward ulna side by the hypothenar intrinsic musculature. Incomplete rupture of a collateral ligament of the metacarpophalangeal joint can be often managed by splinting the affected digit in flexion position, however, in the case of complete tears that distraction of the ends of the ruptured collateral ligament is too great to allow repositioning by splinting. Primary repair of the ruptured collateral ligament or reattachment to bone by a pull-out wire, or tendon graft technique appears to be adequate. METHODS: We report a case of instability of fifth metacarpophalangeal joint due to complete rupture of radial collateral ligament. This 18-year-old male presented pain in his right outstretched hand after trauma. The diagnosis was obtained by physical examination and simple radiography. Because of persistent instability after the initial conservative treatment, open reduction and repair surgical treatment was required. RESULTS: The fifth metacarpophalangeal joint became free of pain and stable under forced lateral deviation. Postoperative results showed good metacarpophalangeal joint function and stability during 8 months follow-up period. CONCLUSION: Because of the interposition of the sagittal band between the ruptured ends of radial collateral ligament such as Stener-like lesion of the thumb, surgical repair of metacarpophalangeal joint collateral ligament of the finger was justified in case of complete laxity in full flexion.
Adolescent ; Collateral Ligaments* ; Diagnosis ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Male ; Metacarpophalangeal Joint* ; Physical Examination ; Radiography ; Rupture* ; Splints ; Tendons ; Thumb ; Transplants ; Ulna

Adolescent ; Child ; Child, Preschool ; Combined Modality Therapy ; External Fixators ; Female ; Humans ; Male ; Manipulation, Orthopedic ; methods ; Radiography ; Radius Fractures ; diagnostic imaging ; therapy ; Splints ; Ulna Fractures ; diagnostic imaging ; therapy

BACKGROUND: The goal of this study was to compare simple radiographic findings and clinical results according to residual ulnar variance following ulnar shortening for ulnar impaction syndrome. METHODS: Forty-five cases of ulnar impaction syndrome, which were treated with ulnar shortening from 2005 to 2008, were studied retrospectively. Group I included 13 cases with positive residual variance after ulnar shortening and group II included 32 cases with negative variance after shortening. The presence of a lunate cystic lesion both preoperatively and at final follow-up and assessments of wrist function based on the modified Mayo wrist score, the disabilities of the arm, shoulder, and hand (DASH) score, as well as the Chun and Palmer score were evaluated. RESULTS: A cystic lesion of the lunate was present in 4 cases preoperatively and the size decreased in 2 cases at final follow-up in group I, and in 10 and 5 cases, respectively, in group II. No statistical difference was observed between the groups. The modified Mayo wrist score, DASH score, as well as the Chun and Palmer score improved significantly in both groups. No significant differences were observed between the two groups in terms of the proportion of positive cystic lesions at final follow-up or the functional scores. CONCLUSIONS: After ulnar shortening, the degree of radiological change in the cystic lunate lesions and clinical improvement did not differ significantly between the groups with unintended residual positive and negative variance after shortening.
Adult ; Aged ; Bone Cysts/surgery ; Bone Diseases/*radiography/*surgery ; Female ; Health Status Indicators ; Humans ; Lunate Bone/surgery ; Male ; Middle Aged ; Osteotomy/*methods ; Retrospective Studies ; Statistics, Nonparametric ; Ulna/*radiography/*surgery

OBJECTIVETo investigate three-dimensional kinematics of the superficial and deep portion of triangular fibrocartilage complex (TFCC) in different parts of the forearm rotation.

METHODSSix wrists of 6 volunteers were used to obtain CT scans at different positions of the wrist. The wrists were scanned from 90 degrees of pronation to 90 degrees of supination at an interval of 30 degrees. The 3-dimensional radius and ulna were reconstructed with customized software and changes in length of the superficial and deep portion of TFCC during forearm rotation.

RESULTSIn forearm pronation, the superficial dorsal portion and the deep palmar portion of the TFCC were tight. While the superficial palmar portion and the deep dorsal potion of the TFCC were lax. In supination, the changes in length of all these fibers were reverse.

CONCLUSIONSIn forearm rotation one portion fibers of dorsal TFCC and one portion fibers of palmar TFCC are tight, and this mechanism controls stability during DRUJ rotation.

Adult ; Biomechanical Phenomena ; Female ; Forearm ; physiology ; Humans ; Imaging, Three-Dimensional ; Male ; Pronation ; Radiography ; Radius ; diagnostic imaging ; Supination ; Triangular Fibrocartilage ; diagnostic imaging ; Ulna ; diagnostic imaging ; Wrist Joint ; diagnostic imaging ; Young Adult