Fracture Fixation ; instrumentation ; methods ; Fractures, Bone ; surgery ; Humans ; Scaphoid Bone ; injuries ; surgery ; Wrist Injuries ; surgery ; Wrist Joint ; surgery

OBJECTIVEFracture of either radius or ulna with a dislocation either at the proximal or distal radioulnar joint (DRUJ) is not a common injury and is inherently unstable. Here we report a case series, with both-bone forearm fractures associated with dislocation of DRUJ, as a Galeazzi-variant type fracture-dislocation, and try to analyze this injury pattern.

METHODSThe study was based on 6 patients having Galeazzi-variant type fracture-dislocation of different age (20 to 45 years). All fractures were closed type. Two fractures involved the same level and three fractures were at different levels of radius and ulna shaft. After thorough examination and investigations they were treated with limited contact dynamic compression plate without additional fixation for DRUJ.

RESULTSAll cases were followed up for 24 weeks. The maximum incidence occurred in age group between 31 and 40 years. All the fractures of both radius and ulna were united in average time of 12 weeks. Range of motion of wrist and elbow, supination and pronation at final follow-up were normal. There was no subsequent re-subluxation or dislocation of the DRUJ in any of the cases.

CONCLUSIONGaleazzi variant in adult is a new undescribed pattern of forearm with wrist injury. Stable open reduction and internal fixation of both-bone forearm fractures is mandatory, followed by 3 to 4 weeks of immobilization in a cast for the healing of disrupted DRUJ.

Adult ; Fracture Fixation, Internal ; Humans ; Joint Dislocations ; surgery ; Radius Fractures ; Wrist Injuries ; surgery ; Wrist Joint

Volar perilunate fracture dislocation is an extremely rare carpal injury, but associated with metacarpophalangeal joint dislocation of both the ipsilateral index and middle finger has never been reported. We report one case of a 28-year-old man following a high-energy trauma. After performing closed reduction of the metacarpophalangeal joint injury, open reduction of the wrist injury through volar approach was done, and a K-wire fixation was used to stabilize the scaphoid fracture and lunotriquetral joint. After a 16 months?follow-up period, the wrist regained a full range of motion without symptoms, and the fractured bone was strengthened in a good position.
Adult ; Fractures, Bone ; surgery ; Humans ; Joint Dislocations ; surgery ; Male ; Metacarpophalangeal Joint ; injuries ; Wrist Injuries ; surgery

Perilunate dislocations are rare injuries of the wrist and complete dislocation of the lunate is also rare. There is controversy in literature regarding the optimal management of such injuries. Complete lunate enucleation is associated with high rate of osteonecrosis of lunate thus wrist arthrodesis or proximal row carpectomy has been advocated as primary treatment for such injuries. We report a case of transradial styloid complete palmar lunate enucleation in a 25-year-old male patient who sustained injury to the left wrist due to fall on outstretched hand. Carpal row salvage surgery initially by closed reduction and wrist distractor application followed by open reduction and internal fixation with K-wires along with ligamentous repair resulted in restoration of normal wrist anatomy and good functional outcome. As many of these injuries are missed on initial presentation and outcome is poor for missed injuries, prompt diagnosis and early surgical management to restore vascularity of lunate is recommended.
Adult ; Arthrodesis ; Humans ; Joint Dislocations ; surgery ; Lunate Bone ; injuries ; surgery ; Male ; Wrist Injuries ; surgery

Fracture Fixation ; Fractures, Bone ; surgery ; Humans ; Scaphoid Bone ; injuries ; surgery ; Wrist Injuries ; surgery

OBJECTIVETo provide anatomical basis for the internal fixation of scaphoid fractures.

METHODSThe shape and vascular lake of 48 dry scaphoids and 36 wet scaphoids were observed.

RESULTSThe data of dry bone group and wet bone group were as follows: the height of scaphoid tubercle were (11.28+/-0.94) mm and (10.35+/-1.54) mm; the thickness of scapoid waist were (12.02+/-1.90) mm and (11.21+/-1.20) mm; the width of scapoid waist were (10.59+/-1.11) mm and (11.34+/-1.47) mm; the minimal thickness of the body of scapoid were (6.51+/-1.22) mm and (8.54+/-1.07) mm; the axis length of scapoid were (25.68+/-2.21) mm and (26.50+/-2.56) mm; the width of epicondyle of scaphoid of distal portion, waist and proximal portion were (6.50+/-1.06) mm, (5.14+/-1.01) mm, (4.42+/-1.16) mm and (6.64+/-1.18) mm, (6.01+/-0.75) mm and (5.71+/-0.78) mm, respestively. The main blood vessels came from the dorsal and the radial of wrist and passed through the whole scaphoid along the crest of scaphoid.

CONCLUSIONThe internal fixation of scaphoid can be designed according to the anatomical data without damaging the articular surface and blood supply.

Adult ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Wrist ; anatomy & histology ; blood supply ; Wrist Injuries ; surgery

OBJECTIVETo introduce a new free composite flap for the treatment of electric injuries of hands, which can repair the skin, blood vessels, tendons and nerves injuries in just one operation. It may improve the prognosis of electric hand injuries.

METHODS5 patients with electric injuries at wrist were treated by the free composite flap. The procedure is followed: The composite flap was harvested from medial lateral crural skin flap. Its blood supply was from tibial posterior vessels. The perforans arteries to flap and the branches to plantaris were preserved, and the nerve suralis and tendon plantaris were compound into the flap by carefully dissection of crural fascia. At the same time, 3-4 tendons of extensor digitorum longus were inserted into the superficial crural fascia. Thus, blood vessels, nerves and tendons were combined into the flap before transplantation. The composite flap was then transplanted into the recipient site of the electric injuries of hand to repair the long defects of the skin, blood vessels,nerves and tendons in one operation. The evaluation methods of the prognosis are the follows: the active motion function of finger was assessed by flexion and extension function of the fingers. The sensibility function was tested by the standards recommended by British Medical Association.

RESULTSThe patients were followed up from 3 to 12 months. All the flaps were survived. Six months after operation, the flexion distance from tip to palmar crease and extension distance from tip to horizontal level of 3 patients were 4-5 cm and 3-4 cm respectively, and the other 2 patients were recovered from 6 cm and 5 cm to 4 cm and 4 cm respectively. The sensibility of finger skin reached to S2 level, and skin temperature rose.

CONCLUSIONThe free medial lateral crural composite flap was an ideal one to cure electric injuries at wrist, for it repairs skin, nerves, vessels and tendons defects in just one operation.

Adult ; Electric Injuries ; surgery ; Hand Injuries ; surgery ; Humans ; Male ; Middle Aged ; Skin Transplantation ; Surgical Flaps ; Wrist ; surgery ; Wrist Injuries ; surgery ; Young Adult

OBJECTIVETo explore the therapeutic effects of arthroscopy for post-traumatic chronic wrist pain.

METHODSFrom February 2007 to June 2010, 12 patients with post-traumatic chronic wrist pain treated with arthroscopy were reviewed. Among the patients, 9 patients were male and 3 patients were female, ranging in age from 19 to 47 years, with a mean of 35.6 years. After physical examinations or MR abnormal findings, all the patients underwent wrist arthroscopic examination and treatment. Eight patients with tear in the central area of the triangular fibrocartilage complex (TFCC) underwent endoscopic partial resection. Two patients with relaxation of inter-carpal ligament after injury underwent radiofrequency shrinkage. One patient with distal radioulnar joint instability was treated with Kirschner fixation through distal radius and ulna in the neutral forearm rotation after clean-up of wrist joint, and also fixed with long arm cast immobilization for 6 weeks. One patient with ulnar impaction syndrome was treated with wrist clean, border modeling of triangular cartilage plate, partial resection of distal ulna.

RESULTSAll the patients were followed up with an average duration of 10 months. Modified Mayo wrist score were evaluated from preoperative mean of (51.67 +/- 15.27) ( 25 to 75 scores) to postoperative mean of (77.92 +/- 10.54) (65 to 95 scores). Eleven patients recovered to normal work.

CONCLUSIONArthroscopy is an effective method for patients with post-traumatic chronic wrist pain which can diagnosis and cure the injuries under arthroscopy.

Adult ; Arthroscopy ; methods ; Female ; Humans ; Male ; Middle Aged ; Pain ; surgery ; Wrist Injuries ; pathology ; surgery ; Wrist Joint ; pathology ; surgery ; Young Adult

OBJECTIVETo explore a new method for repair of concurrent skin and nerve defect at palm and carpal on ulnar side.

METHODSFrom April 2000 to August 2009, five cases with concurrent skin and nerve defect at palm and carpal on ulnar side were reconstructed with free medial plantar flaps. Palmar nervous proprii defect at ulnar side of little finger was repaired by the first toe tibia nervous proprii in one case. The superficial branch of radial nerve was applied to repair the defect of ulnar nerve, as well as its deep or superficial branch in two cases. The superficial branch of radial nerve was also used to repair the defect of superficial branch of ulnar nerve, common palmar digital nerve of the fourth finger, Little finger ulnar palmar nervous proprii in one case. The dorsal branch of ulnar nerve was applied to repair the defect of superficial branch of ulnar nerve, common palmar digital nerve of the fourth finger, little finger ulnar palmar nervous proprii in one case. The vascular bundle of medial plantar flap was anastomosed with ulnar vascular bundle. The wounds at donor sites were covered with free skin grafts which were obtained from upper leg.

RESULTSAll the flaps and skin grafts were survived completely. The five patients were followed up for six months to four years with no muscular atrophy or claw hand deformity. The esthetic result was satisfied. The Sensory of flaps and fingers recovered to S3 to S3+. The two-point discrimination distance on flaps was range from 7 mm to 10 mm. The postoperative comprehensive evaluation was excellent in the cases whose superficial and deep branches of ulnar nerve were repaired.

CONCLUSIONSFree medial plantar flap is an effective method to repair concurrent skin and nerve defect at palm and carpal on the ulnar side.

Adult ; Female ; Foot ; surgery ; Free Tissue Flaps ; Hand Injuries ; surgery ; Humans ; Male ; Skin ; injuries ; Ulnar Nerve ; injuries ; surgery ; Wrist Injuries ; surgery ; Young Adult

Adult ; Elbow Joint ; injuries ; Female ; Fractures, Bone ; surgery ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Wrist Injuries ; surgery