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Niemann MJ, Lese AB, Sraj S, Taras JS. Distal Ulna Fracture Fixation with the Specialized Threaded Pin. J Hand Surg Glob Online 2023; 5:426-429. [PMID: 37521552 PMCID: PMC10382881 DOI: 10.1016/j.jhsg.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/25/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose Distal ulna fractures can often be treated nonsurgically; however, many surgeons consider significant displacement or instability, especially following fixation of an associated distal radius fracture, an indication for surgical fixation because of potential problems associated with malunion of these fractures. Traditionally, these fractures have been addressed with plate fixation but hardware in this location is often prominent and associated with a high rate of symptomatic hardware and subsequent hardware removal. We proposed a method of intramedullary fixation using a specialized threaded pin. As this fixation is intramedullary, it avoids many of the problems associated with traditional surgical treatment methods for this fracture. We present a series of nine patients treated in this manner, all of whom had associated distal radius fractures. Methods Preoperative and postoperative radiographs were reviewed, after which patients were contacted via phone. Patient-reported outcome measures, including QuickDASH and visual analog scale scores, were assessed. Results The average QuickDASH score was 13.6 (range, 0-100), with a median of 9.1. Three patients reported occasional ulnar-sided wrist pain, with an average visual analog scale score of 1.3 (range, 0-10) and a median of 0.5. All patients returned to all activities except one patient who could not resume playing musical instruments because of stiffness. No patient required removal of the threaded pin, but one patient underwent removal of the radial volar plate. No other patients underwent secondary procedures. Conclusions Threaded pin fixation is a viable alternative to existing options for distal ulnar neck fractures and may have an advantage over plate fixation because of a lack of hardware prominence. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
| | - Andréa B. Lese
- Department of Orthopaedics, West Virginia University, Morgantown, WV
| | - Shafic Sraj
- Department of Orthopaedics, West Virginia University, Morgantown, WV
| | - John S. Taras
- Department of Orthopaedics, West Virginia University, Morgantown, WV
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2
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O’Malley O, Brown OC, Duncan L, Cheung G, Stevenson HL, Brown DJ. Isolated volar dislocation of the distal radioulnar joint: a case series and systematic review. Ann R Coll Surg Engl 2023; 105:196-202. [PMID: 35617051 PMCID: PMC9974347 DOI: 10.1308/rcsann.2022.0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Isolated volar dislocations of the distal radioulnar joint are reported as rare. We observed three such cases over a 12-month period. Literature to date consists of multiple case reports and case series with no structured reviews. There is debate as to incidence, mechanism, investigation, treatment and prognosis. METHODS A case series and formal systematic review was performed. This included an analysis of the demographics, mechanism, presentation, investigation, treatment and outcome of the cases identified from the wider published series. FINDINGS In total 99 cases of this injury were identified from 59 papers, with a further 9 cases having an associated ulna styloid fracture. CONCLUSIONS This is a rare injury, representing up to 0.02% of all bony injuries, which is diagnosed late in 36% of cases. Inability to obtain a true lateral radiograph may contribute to the diagnosis being missed. Computed tomography scans are useful in suspected cases without radiographic confirmation. Acute cases are successfully treated with closed reduction in 78% of cases; however associated soft tissue injuries may need to be surgically addressed. Delayed presentation is more likely to require open surgery and preoperative MRI scans are indicated to aid surgical planning. Chronic instability rarely occurs and may need treatment with reconstruction or salvage. A good, subjective, result is reported in the majority of patients.
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Affiliation(s)
- O O’Malley
- Liverpool University Hospitals NHS Foundation Trust, UK
| | - OC Brown
- Liverpool University Hospitals NHS Foundation Trust, UK
| | - L Duncan
- University of Liverpool School of Medicine, UK
| | - G Cheung
- Liverpool University Hospitals NHS Foundation Trust, UK
| | - HL Stevenson
- Liverpool University Hospitals NHS Foundation Trust, UK
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Moloney M, Farnebo S, Adolfsson L. Distal ulna fractures in adults-subcapitular, transverse fractures did not benefit from surgical treatment. Arch Orthop Trauma Surg 2023; 143:381-387. [PMID: 35064293 PMCID: PMC9886608 DOI: 10.1007/s00402-022-04336-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 01/03/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Fractures of the distal ulna, excluding the styloid, are rare. The cause of injury is often a fall on an outstretched hand with an extended wrist, and in most cases there is a concomitant distal radius fracture. The aims of this retrospective study were to investigate the results of the current treatment of distal ulna fractures in adults, with or without a concomitant distal radius fracture, and if a recently presented fracture classification could predict outcome. MATERIALS AND METHODS Patients, 18 years or older, treated for a fracture of the distal third of ulna in our county, were included. Fractures of the styloid tip were excluded. The radiographs of the fractures were independently classified by two specialists in radiology according to the 2018 AO/OTA classification. Follow-up was performed 5-7 years after the injury, through the questionnaire Patient-Rated Wrist Evaluation (PRWE) and new radiographs of both wrists. RESULTS Ninety-six patients with 97 fractures were included and filled out the PRWE. 65 patients also had new radiographs taken. 79 patients were women and the mean age at the time of injury was 63 years (SD 14.5). The most common fracture class was the extra-articular transverse fracture, 2U3A2.3 (42%). We found that 40% of the fractures had been treated by internal fixation and only 2 fractures had not healed, one conservatively treated and one operated. The median PRWE was 15 (IQR 33.5). The PRWE score was significantly worse in the operated ulna fractures (p = 0.01) and this was also true for extra-articular transverse fractures 2U3A2.3 (p = 0.001). Initial displacement was more common in operated transverse fractures, but it could not be proven that this was the reason for the inferior result. CONCLUSIONS Distal ulna fractures almost always unite and the result is comparable to that of isolated distal radius fractures when measured by PRWE. Based on the opinions of the radiologists and how often a consensus discussion was needed for classification, we found the updated AO classification system difficult to use, if dependent only on standard radiographic views. In the present study, transverse extra-articular ulna fractures did not benefit from internal fixation regardless if associated with a distal radius fracture or isolated.
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Affiliation(s)
- Maria Moloney
- Department of Plastic Surgery, Hand Surgery and Burns, Faculty of Health Sciences, Linköping University, 58185, Linköping, Sweden.
| | - Simon Farnebo
- Department of Plastic Surgery, Hand Surgery and Burns, Faculty of Health Sciences, Linköping University, 58185, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lars Adolfsson
- Department of Orthopaedics, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Sahito B, Ali SME, Qamar J, Katto MS, Ahmed MW, Jamil M. A Comparison of Outcomes of 'Extensor Carpi Ulnaris Tenodesis' versus 'No Tenodesis' after Resection of the Distal Ulna in Patients with Giant Cell Tumor. J Hand Surg Asian Pac Vol 2022; 27:110-116. [PMID: 35037577 DOI: 10.1142/s2424835522500102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: One of the methods of stabilizing the stump of the ulna following resection of the distal ulna is tenodesis of the extensor carpi ulnaris (ECU). Some studies have recommended stabilization, whereas others have not found it useful. Most of these studies have a mix of different pathologies and often do not have a control group. The aim of this study is to compare the outcomes of ECU tenodesis versus no tenodesis after resection of the distal ulna in patients with grade III giant cell tumor (GCT) of the distal ulna. Methods: The retrospective study included 10 patients with Campanacci grade III GCT of the distal ulna treated by resection of the distal ulna between 2014 and 2019. Patients were stratified into two groups based on whether they underwent ECU tenodesis (n = 5) or no tenodesis (n = 5). The patients were assessed at 6 weeks, 6 months, and 12 months for complications and outcomes using the Mayo wrist score (MWS) and the revised musculoskeletal tumor society score (MSTS). Results: The MWS and the MSTS were significantly better in the ECU tenodesis group at 6 weeks. At 6 months, MWS was similar in both groups, but MSTS continued to be significantly better in ECU tenodesis group. At 12 months, both groups reported similar MWS and MSTS. There were no recurrences in either groups. One patient in the ECU tenodesis group developed ECU tendonitis that resolved with conservative treatment. Conclusions: The outcomes of ECU tenodesis were better in the short term (6 months), although both groups reported similar outcomes at 12 months. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Badaruddin Sahito
- Dow University of Health Sciences, Karachi, Pakistan.,Dr. Ruth KM Pfau Civil Hospital Karachi, Karachi, Pakistan
| | | | - Javeria Qamar
- Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Soughat Katto
- Dow University of Health Sciences, Karachi, Pakistan.,Dr. Ruth KM Pfau Civil Hospital Karachi, Karachi, Pakistan
| | - Malik Wasim Ahmed
- Dow University of Health Sciences, Karachi, Pakistan.,Dr. Ruth KM Pfau Civil Hospital Karachi, Karachi, Pakistan
| | - Muhammad Jamil
- Dow University of Health Sciences, Karachi, Pakistan.,Dr. Ruth KM Pfau Civil Hospital Karachi, Karachi, Pakistan
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Tsujisaka R, Nakayama R, Sekita T, Asano N, Kikuta K, Oguro S, Takeuchi K, Sasaki A, Okita H, Nakamura M, Matsumoto M. Dedifferentiated Osteosarcoma of the Distal Ulna: A Case Report. Case Rep Oncol 2021; 14:1228-1236. [PMID: 34703440 PMCID: PMC8460975 DOI: 10.1159/000518266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022] Open
Abstract
Osteosarcoma is the most common malignant primary bone tumor that occurs most frequently in the second decade of life but rarely in patients over 40 years of age. The most common primary sites of osteosarcoma are the distal femur followed by proximal tibia and proximal humerus, and involvement of the wrist is extremely rare. Moreover, dedifferentiated osteosarcoma is also a rare condition that progresses to high-grade osteosarcoma from low-grade osteosarcoma, usually central low-grade osteosarcoma or parosteal osteosarcoma that bears MDM2 and/or CDK4 gene amplifications. We herein report an extremely rare case of dedifferentiated osteosarcoma arising in the distal ulna of an adult over 40 years of age. The patient was a 46-year-old man with a 2-month history of pain in his left swollen wrist. The initial radiological findings suggested a benign bone tumor in the distal ulna, and the lesion was marginally excised at the nearby hospital. Although the pathological diagnosis at the nearby hospital suggested a benign cartilaginous tumor, the tumor recurred in an aggressive manner 8 months after the initial surgery. The patient was referred to our hospital, and an incisional biopsy showed a high-grade osteosarcoma. The primary tumor was retrospectively re-evaluated at our hospital and diagnosed as low-grade osteosarcoma. Since neoadjuvant chemotherapy failed to shrink the tumor, the patient had to undergo below the elbow amputation to cure the disease. Although the tumor was negative for MDM2 nor CDK4, the definitive diagnosis of dedifferentiated osteosarcoma was made according to the clinical course and the histological findings. Lung metastases were found 10 months after the amputation, which were successfully treated by neoadjuvant chemotherapy and surgery. The patient has been doing well with no evidence of disease for 1 year and 6 months. Surprisingly, the literature review revealed that many low-grade osteosarcomas of the distal ulna progressed to high-grade dedifferentiated osteosarcomas. One should bear in mind that the diagnosis and treatment for bone-forming tumors of the distal ulna should be made very carefully because, although rare, it is possible that the tumor may initially appear as a benign or low-grade malignant tumor and may progress to high-grade osteosarcoma.
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Affiliation(s)
- Ryosuke Tsujisaka
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Robert Nakayama
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuya Sekita
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Naofumi Asano
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazutaka Kikuta
- Department of Musculoskeletal Oncology and Orthopaedic Surgery, Tochigi Cancer Center, Tochigi, Japan
| | - Sota Oguro
- Department of Diagnostic Radiology, Tohoku University Hospital, Miyagi, Japan
| | - Katsuhito Takeuchi
- Division of Orthopaedic Surgery, Kawasaki Municipal Ida Hospital, Kanagawa, Japan
| | - Aya Sasaki
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan.,Department of Pathology and Laboratory Medicine, Tokyo Dental College Ichikawa General Hospital, Tokyo, Japan
| | - Hajime Okita
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Cha SM, Shin HD, Lee SH, Ga IH. Factors predictive for union of basal fracture of the ulnar styloid process after distal radial fracture fixation using a volar locking plate. Injury 2021; 52:524-531. [PMID: 33268076 DOI: 10.1016/j.injury.2020.10.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/11/2020] [Accepted: 10/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Some basal ulnar styloid fractures (USFs) achieve union without surgical fixation when accompanying distal radius fractures (DRFs) are treated via placement of volar locking plates (VLPs). The purpose of this study was to seek factors predictive of such healing through the retrospective case-control study. METHODS We evaluated 203 patients who received VLPs to treat DRFs in our institute from March 2010 to February 2018; Group 1 contained "union" patients and Group 2 contained "nonunion" patients. Basic demographic, radiological, and operative variables were compared. At the final follow-up (at least 2 years postoperatively), pain was scored using a visual analog scale (VAS). Scores on the Disabilities of the Arm, Shoulder, and Hand (DASH) instrument; grip strengths; and demerit points of the Gartland and Werley system were compared between groups. RESULTS Group 1 consisted of 58 patients and Group 2 consisted of 147 patients. Univariate analysis showed that age, bone mineral density (BMD), and Gaulke USF classification significantly differed between groups (all p < 0.05). Multivariate analysis showed that BMD (p < 0.001, odds ratio [OR] = 0.214, 95% confidence interval [95% CI] = 0.126-0.363) and Gaulke classification (p < .001, OR = 0.092, 95% CI = 0.034-0.250) were significantly associated with USF union, which was significantly higher in patients with mean BMD ≥ -0.12 (the cutoff value) and type IIC USFs. However, postoperative clinical outcomes at the final follow-up did not differ significantly between groups (all p > 0.05). CONCLUSIONS Approximately 30% (58/205) of basal USFs associated with DRFs united after VLPs alone were placed to treat the DRFs. BMD ≥ -0.12 independently predicted union. Type IIC USFs exhibited more union than other fracture types. Additional surgical fixation of a basal USF accompanied by a DRF treated via VLP placement may be unnecessary, especially if BMD is good and fracture type is IIC. LEVEL OF EVIDENCE Level III, Case-control study.
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Affiliation(s)
- Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hyun Dae Shin
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
| | - Seung Hoo Lee
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - In Ho Ga
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
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Sharma V, Sharma K, Sharma S, Kanwar S, Soni RK, Katoch P. Resection and Stump Stabilization in Giant Cell Tumor Distal Ulna: A Case Report. J Orthop Case Rep 2021; 10:45-48. [PMID: 33623766 PMCID: PMC7885650 DOI: 10.13107/jocr.2020.v10.i04.1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Giant cell tumors (GCTs) of distal ulna are extremely rare accounting for 0.45%–3.2% of all the cases of GCTs. These are locally aggressive and have a higher rate of recurrence of up to 40% with conservative modality of treatment. Proximity to carpus and diminished range of motion makes their treatment a challenge. Case Report: A 27-year-old male presented to us with swelling right distal ulna. X-ray and MRI were suggestive of GCT. The diagnosis was confirmed by core needle biopsy. The patient was managed by wide resection ulna with extensor carpi ulnaris tenodesis. Conclusion: GCT ulna although very rare in presentation is a possible diagnosis. Wide resection of ulna is a viable treatment option to achieve disease free status. Extensor carpi ulnaris tenodesis helps stabilization of ulnar stump.
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Affiliation(s)
- Vipin Sharma
- Department of Orthopaedics, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Kavya Sharma
- MM Medical College, Solan, Himachal Pradesh, India
| | - Seema Sharma
- Department of Orthopaedics, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Sachin Kanwar
- Department of Orthopaedics, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Ravi K Soni
- Department of Orthopaedics, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Punit Katoch
- Department of Orthopaedics, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
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8
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Solichin I, Martika W, Wikanjaya R. Giant cell tumor of distal ulna treated using en-bloc resection combined with extensor carpi ulnaris and flexor carpi ulnaris tendon stabilization: A case report. Int J Surg Case Rep 2021; 79:362-367. [PMID: 33516051 PMCID: PMC7847819 DOI: 10.1016/j.ijscr.2021.01.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/16/2021] [Accepted: 01/16/2021] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Giant Cell Tumor (GCT) is a form of bone tumor which is rare, benign, and locally invasive. To date, there have not been many case reports regarding cases of GCTs on the distal ulna which made the optimum strategy in management remain controversial. In some reported cases, the patient was treated with wide excision followed by reconstructive procedure resulting in ulnar translation of the carpal bones and dynamic convergence of the ulna towards the radius. PRESENTATION OF CASE We documented a case of 29-year-old male with distal ulna GCT, treated with en-bloc resection combined with extensor carpi ulnaris and flexor carpi ulnaris tendon stabilization. The key objectives of GCT treatments are to avoid local recurrence with sufficient resection and to maintain the function of the limbs. Specific treatment options have been suggested for en-bloc resection with or without the need for ulnar reconstruction or stabilization, even prothesis. In this case, we excised the distal portion of the ulna with some soft tissue procedure for added stability. CLINICAL DISCUSSION Three weeks after the surgery, the patient was able to perform wrist flexion and extension, fingers abduction, adduction, and opposition with slight limitation. The DASH and PRWE score had improved gradually within 3 weeks and 6 months after the surgery. CONCLUSION In the subsequent evaluation after six months of the surgery, the patient achieved full restoration of forearm function without any limitation.
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Affiliation(s)
- Iman Solichin
- Department of Orthopaedics and Traumatology, Purwokerto Orthopaedics Hospital, Purwokerto, Central Java, Indonesia
| | - Windi Martika
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo National Central General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
| | - Rio Wikanjaya
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo National Central General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Mujaddid I, Pamudji U, Savero I, Handry T, Brian W. Wide resection giant cell tumor of distal ulna and stabilization ulnar stump with extensor Carpi ulnaris tendon (2 case reports). Int J Surg Case Rep 2020; 74:58-62. [PMID: 32799053 PMCID: PMC7453115 DOI: 10.1016/j.ijscr.2020.07.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 11/18/2022] Open
Abstract
The distal Ulna is an unusual site (0.45%–3.2%) for a primary bone GCT. The functional reconstruction of the defect after resection has been a challenge. Many surgeons try to retain the ulna and perform the only curettage and packing with polymethylmethacrylate. Unfortunately, there is a high recurrence rate of up to 40% when treated in such a manner. Wide resection of the distal ulna with or without reconstruction or stabilization of the ulnar stump is the recommended treatment for GCTs in such locations. We present two patients with GCT of the distal ulna, all of them treated by wide resection of the distal ulna followed by stabilization of the remaining ulna using one half of the extensor carpi ulnaris (ECU) tendon. All the patient satisfied with the treatment.
Introduction Giant-cell tumor (GCT) of bone occurred in the distal end of the ulna is extremely uncommon. Wide resection is usually indicated in such cases and at times it may be necessary to remove a long segment of the distal ulna. The functional reconstruction of the defect after resection has been a challenge. Wide resection of the distal ulna with or without reconstruction or stabilization of the ulnar stump is the recommended treatment for GCTs in such locations. Presentation of case There were 2 cases of giant cells tumor of the distal ulna. They treated with wide resection and stabilization of ulnar stump by extensor carpi ulnaris tendon. We were evaluating outcomes using the Musculoskeletal Tumor Society (MSTS) Score for the upper extremity. The results from the evaluation of the MSTS Score were an average of 24 points. Discussion There were 2 patients. All of them present with lumps of their wrist and the pain over the lump. Patients treated with wide resection and stabilization of ulnar stump by extensor carpi ulnaris. The result from the evaluation of the Musculoskeletal Tumor Society (MSTS) score were 24 points. Conclusion Giant cell tumor of bone is a rare, generally benign, locally invasive tumor. The ulna distal extremity is an unusual site for a primary bone GCT. Any ulnar resection proximal to the insertion of the pronator quadratus can lead to instability in the form of radio-ulnar convergence and dorsal displacement (winging) of the ulnar stump. This can result in a diminution of forearm rotation and weakness with grasp. The main goal of stabilization is the stable, pain-free, and functional outcome of the wrist. In this cases report our patient with giant cell tumor were treated with wide resection and stabilization of ulnar stump by extensor carpi ulnaris. All of the patients satisfied with our treatment.
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Affiliation(s)
- I Mujaddid
- Orthopaedic & Traumatology Department Faculty of Medicine Sebelas, Maret University, Orthopaedic Hospital Prof. Dr. R. Soeharso Surakarta, Indonesia.
| | - U Pamudji
- Orthopaedic & Traumatology Department Faculty of Medicine Sebelas, Maret University, Orthopaedic Hospital Prof. Dr. R. Soeharso Surakarta, Indonesia
| | - I Savero
- Orthopaedic & Traumatology Department Faculty of Medicine Sebelas, Maret University, Orthopaedic Hospital Prof. Dr. R. Soeharso Surakarta, Indonesia
| | - Th Handry
- Radiology Department Faculty of Medicine Sebelas, Maret University, Orthopaedic Hospital Prof. Dr. R. Soeharso Surakarta, Indonesia
| | - W Brian
- Pathology Anatomy Department Faculty of Medicine Sebelas, Maret University Surakarta, Indonesia
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10
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Abstract
Painful radioulnar convergence following resection of the distal ulna can produce substantial disability and prove a challenging surgical problem, particularly in the revision setting. The purpose of this study was to evaluate the outcome of a series of patients with chronic distal radioulnar joint instability or multiple prior procedures treated with linked distal radioulnar joint arthroplasty with the APTIS prosthesis. A series of ten patients were identified with a mean follow up of 4.0 years. At final follow-up nine of ten implants survived free from revision or removal, with patients experiencing good pain relief and functional outcomes, with reasonable overall satisfaction in all seven patients who returned the questionnaires. Despite the medium-term follow-up and small number of patients, our results suggest the linked distal radioulnar joint arthroplasty may be a viable option for treating painful radioulnar convergence following multiple failed procedures at the distal radioulnar joint.
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Affiliation(s)
- S Kakar
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester MN, USA
| | - T Fox
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester MN, USA
| | - E Wagner
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester MN, USA
| | - R Berger
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester MN, USA
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11
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Abstract
In isolation, distal ulna fractures are rare. They are often found in conjunction with distal radius fractures, and the complexity of the interaction of the distal ulna with the radioulnar joint and triangular fibrocartilage complex makes understanding and treatment of distal ulna fractures challenging. Fixation of distal ulna fractures can be problematic owing to comminution making reduction challenging. A thin soft tissue can lead to hardware prominence and necessitate implant removal. In this Current Concepts article, we review the anatomy, pathology, and treatment of distal ulna fractures as well as potential complications and salvage procedures.
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Affiliation(s)
- Todd A Richards
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, Virginia
| | - D Nicole Deal
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, Virginia.
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12
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Abstract
Enbloc resection with or without ulnar stump stabilization is the recommended treatment for giant cell tumors (GCT) of the distal ulna. A few sporadic reports are available where authors have described various procedures to prevent ulnar stump instability and ulnar translation of carpal bones. We report a GCT of the distal ulna in a 43-year-old male which was resected enbloc. The distal radioulnar joint was reconstructed by fixing an iliac crest graft to the distal end of the radius (ulnar buttress arthroplasty) and the ulnar stump was stabilized with extensor carpi ulnaris tenodesis. After a followup at three years, there was no evidence of tumor recurrence or graft resorption; the patient had a normal range of movement of the wrist joint and the functional outcome was excellent as per the score of Ferracini et al.
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Affiliation(s)
- Monappa A Naik
- Department of Orthopaedics, KMC, Manipal, Karnataka, India
| | - Premjit Sujir
- Department of Orthopaedics, KMC, Manipal, Karnataka, India
| | - Sharath K Rao
- Department of Orthopaedics, KMC, Manipal, Karnataka, India
| | - Sujit K Tripathy
- Department of Orthopaedics, KMC, Manipal, Karnataka, India
- Address for correspondence: Dr. Sujit Kumar Tripathy, Department of Orthopaedics, KMC, Manipal, Karnataka – 576 104, India. E-mail:
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