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Ulnar instability

Brent H Foster, Calvin B Shaw, Robert D Boutin, Anand A Joshi, Christopher O Bayne, Robert M Szabo, Abhijit J Chaudhari
We present a method for the statistical modeling of the displacements of wrist bones during the performance of coordinated maneuvers, such as radial-ulnar deviation (RUD). In our approach, we decompose bone displacement via a set of basis functions, identified via principal component analysis (PCA). We utilized MRI wrist scans acquired at multiple static positions for deriving these basis functions. We then utilized these basis functions to compare the displacements undergone by the bones of the left versus right wrist in the same individual, and between bones of the wrists of men and women, during the performance of the coordinated RUD maneuver...
January 24, 2019: Journal of Biomechanics
Sheena K Sikora, Stephen K Tham, Jason N Harvey, Marc Garcia-Elias, Tony Goldring, Andrew H Rotstein, Eugene T Ek
Background  Scapholunate instability (SLI) is the most common form of carpal instability. Early detection of SLI is imperative as early reconstructive procedures can potentially prevent the natural history of progressive degenerative arthritis. After wrist arthroscopy, magnetic resonance imaging (MRI) remains the next best noninvasive diagnostic option; however, access still remains costly and is often limited in many health care systems worldwide. In this article, we describe a novel device that allows for dynamic X-rays to be taken, accentuating the scapholunate (SL) widening...
February 2019: Journal of Wrist Surgery
Jung-In Shim, Jin-Hyung Im, Joo-Yup Lee, Han-Vit Kang, Sung-Hyun Cho
Purpose  The relationship between triangular fibrocartilage complex (TFCC) tear and ulnar impaction syndrome has not been fully understood. We hypothesized that a TFCC tear could change the ulnar variance, which may be the cause of ulnar impaction syndrome. Patients and Methods  A total of 72 patients who underwent TFCC foveal repair between January 2011 and June 2016 were included in this retrospective study. Among them, 44 patients diagnosed with TFCC foveal tear with distal radioulnar joint instability and no ulnar impaction syndrome underwent TFCC foveal repair only (group A) and 28 patients diagnosed with TFCC foveal tear with ulnar impaction syndrome underwent TFCC foveal repair and ulnar shortening osteotomy simultaneously (group B)...
February 2019: Journal of Wrist Surgery
Michael Hackl, Kilian Wegmann, Boris Hollinger, Bilal F El-Zayat, Dominik Seybold, Thorsten Gühring, Marc Schnetzke, Kay Schmidt-Horlohé, Stefan Greiner, Helmut Lill, Alexander Ellwein, Michael C Glanzmann, Sebastian Siebenlist, Martin Jäger, Jörg Weber, Lars P Müller
BACKGROUND: Radial head fractures lead to persisting disability in a considerable number of cases. This study aimed to investigate their most common revision causes and procedures. METHODS: This multicenter retrospective study reviewed the cases of 466 adult patients who had undergone surgical revision after operative or nonoperative treatment of a radial head fracture. The initial diagnosis was a Mason type I fracture in 13.0%, Mason type II fracture in 14.6%, Mason type III fracture in 22...
February 1, 2019: Journal of Shoulder and Elbow Surgery
Michael S Guss, Lindsay K Hess, Mark E Baratz
HYPOTHESIS: This study's purpose was to provide a reproducible way for surgeons to intraoperatively assess the elbow's lateral ulnar collateral ligament origin and determine whether there is posterolateral rotatory instability (PLRI) despite an intact common extensor origin (CEO). We hypothesized that we could re-create clinically relevant disruption of lateral supporting structures despite an intact CEO and illustrate progressive elbow PLRI. METHODS: The relationship of the lateral capsule to the capitellum articular surface was noted in 8 cadaveric upper extremities...
February 1, 2019: Journal of Shoulder and Elbow Surgery
S Hassan, R Shafafy, A Mohan, P Magnussen
INTRODUCTION: Isolated ulnar shortening osteotomies can be used to treat ulnocarpal abutment secondary to radial shortening following distal radius fractures. Given the increase of fragility distal radius fractures awareness of treating the sequelae of distal radius fractures is important. We present the largest reported case series in the UK of ulnar shortening osteotomies for this indication. MATERIALS AND METHODS: Twenty patients with previous distal radial fractures were included, who presented with wrist pain and radiologically evident positive ulnar variance secondary to malunion of the distal radius with no significant intercalated instability...
January 30, 2019: Annals of the Royal College of Surgeons of England
Jeremi Leasure, Kerisimasi Reynolds, Marc Thorne, Rafael Escamilla, Ken Akizuki
BACKGROUND: Throwing athletes with ulnar collateral ligament (UCL) injury and symptomatic valgus instability can expect to return to the same or higher level of play. Reconstruction with tendon graft is the dominant method of surgical treatment. Recent evidence suggests that spanning the joint with a suture anchored on both sides is biomechanically equivalent to reconstruction, with faster time to return to play. The authors developed a hybrid UCL reconstruction technique augmented with a suture brace to improve joint stability...
January 28, 2019: American Journal of Sports Medicine
Takehiko Takagi, Masahiko Watanabe
Injuries to the ulnar collateral ligament (UCL) of the thumb are common and require prompt attention. Diagnostic findings and treatment options differ in acute and chronic injuries of the UCL. Pain and weakness of pinch and grip occur with chronic UCL instability. Various surgical techniques have been described for the treatment of chronic ligament insufficiency at the metacarpophalangeal (MCP) joint of the thumb. These include refashioning of the ligament from capsular remnants, dynamic tendon transfers, tendon advancement, free tendon grafts, and MCP joint fusion...
January 23, 2019: Journal of Hand Surgery
Vanessa Robba, Andrew Fowler, Alexia Karantana, Douglas Grindlay, Tommy Lindau
BACKGROUND: Peripheral 1B tears of the triangular fibrocartilage complex (TFCC) can result in distal radioulnar joint (DRUJ) instability. In the context of associated DRUJ instability, combined evidence supports successful outcomes for peripheral tear repair. METHODS: The aim of this systematic review (SR) was to compare the surgical treatment of 1B TFCC tears via arthroscopic versus open methods of repair. The primary outcome measure was restored DRUJ stability...
January 22, 2019: Hand: Official Journal of the American Association for Hand Surgery
Eric Abehsera, Elvire Guerre, Pauline Duriez, Mazen El Rafei, Christian Fontaine, Christophe Chantelot
INTRODUCTION: Elbow dislocation can lead to instability and stiffness of the elbow. The main goal of this study was to list the initial elbow ligaments injuries caused by simple posterolateral elbow dislocations. The secondary goals were to assess ligament healing 2 months after the initial dislocation, to research a correlation between ligaments injuries and clinical course, and to search for predictive factors of instability. PATIENTS AND METHODS: Patients who had simple posterolateral elbow dislocation for the first time between January 2015 and May 2016 were included...
January 16, 2019: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Fabrice Duparc, Marie-Caroline Merlet
The appropriate management of early treatment failures in patients with elbow injuries requires the identification of the cause of failure. In this work, six types of elbow injury are considered: (i) identification of early failed reduction of a dislocation or fracture-dislocation of the elbow should lead to a repeat reduction procedure, testing for elbow instability, and ligament repair, followed by the use of a hinged external fixator to allow early mobilisation. Differentiating an isolated dislocation from a dislocation combined with a fracture of the coracoid process is crucial...
December 24, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
William T Wilson, Graeme P Hopper, Paul A Byrne, Gordon M MacKay
The ulnar collateral ligament (UCL) is the primary restraint to valgus angulation at the elbow. Injury to the UCL is increasingly common and can lead to instability, especially in athletes involved in overhead throwing. Conventional treatment is reconstruction using tendon autograft but performance levels are often restricted after long periods of rehabilitation. Modern surgical techniques have led to renewed interest in repair of the ligament, with the aim of restoring native anatomy. This has the benefit of retained proprioception and no graft harvest morbidity...
December 19, 2018: BMJ Case Reports
Gokhan Karademir, Daniel R Bachman, Antonis P Stylianou, Akin Cil
BACKGROUND: Our objective was to analyze the effect of different anteromedial coronoid fracture patterns with different combinations of ligamentous repairs. We hypothesized that smaller fractures would be sufficiently treated with ligamentous repair alone but that larger fragments would require a combination of ligament and bony repair versus reconstruction. METHODS: Two multibody models were created from cadaveric specimens in the ADAMS program. Four different conditions were simulated: (1) no fracture, (2) O'Driscoll anteromedial subtype I (2...
December 12, 2018: Journal of Shoulder and Elbow Surgery
Ji Hun Park, Jong Woong Park
Background: Tears of the triangular fibrocartilage complex (TFCC) can result in instability of the distal radioulnar joint (DRUJ) and ulnar-sided wrist pain. This study evaluates clinical results of arthroscopic transosseous repair for both proximal and distal components of TFCC tear with DRUJ instability. Materials and Methods: Ten patients who underwent both proximal component and distal component of TFCC repair were retrospectively reviewed. The proximal component of TFCC was repaired through arthroscopic one-tunnel transosseous suture technique, and the combined distal component tear was repaired to the ulnar capsule using same transosseous tunnel in all cases...
November 2018: Indian Journal of Orthopaedics
Jamil F Soni, Weverley R Valenza, Anna Carolina Pavelec
PURPOSE OF REVIEW: The chronic Monteggia may lead to pain, mobility limitation, progressive valgus deformity, lateral elbow instability, late ulnar nerve paralysis, and degenerative changes. In this review, we discuss the current procedures in the literature focused on correcting chronic Monteggia to avoid these complications. RECENT FINDINGS: Correction of the ulnar deformity with elongation and angulation of the ulna in the opposite direction of the dislocation of the radial head is the most important factor for the reduction and consequent preservation of the radial head...
February 2019: Current Opinion in Pediatrics
Christopher L Camp, Michael Fu, Hamidreza Jahandar, Vishal S Desai, Alec M Sinatro, David W Altchek, Joshua S Dines
BACKGROUND: Injury to the lateral ulnar collateral ligament (LUCL) complex of the elbow often results in posterolateral rotatory instability. Although surgical reconstruction of the LUCL is often required, gaps in our understanding of the LUCL complex remain. The purpose of this study was to provide a robust and accurate characterization of the lateral elbow ligamentous complex. METHODS: The LUCLs, radial collateral ligaments, and annular ligaments in 10 cadaveric elbows were 3-dimensionally digitized and reconstructed using computed tomography...
December 6, 2018: Journal of Shoulder and Elbow Surgery
John B Fuller, John C Dunn, Nicholas A Kusnezov, Leon J Nesti, Kelly G Kilcoyne
BACKGROUND: Medial ulnar collateral ligament (MUCL) reconstruction outcomes are well described in competitive throwers but not in nonthrowers. This investigation elucidated epidemiologic variables, functional outcomes, and prognostic factors after MUCL reconstruction in young active patients. METHODS: United States military service members undergoing MUCL reconstruction were isolated using the Management Analysis and Reporting Tool (M2) database from 2009 to 2016...
November 28, 2018: Journal of Shoulder and Elbow Surgery
Michael Rutter, Louis C Grandizio, W James Malone, Joel C Klena
PURPOSE: To assess the use of preoperative, dynamic ultrasound to predict ulnar nerve instability following in situ decompression for cubital tunnel syndrome. METHODS: Prior to undergoing in situ decompression, 43 consecutive patients underwent dynamic ultrasound to assess the stability of the ulnar nerve during elbow flexion. The dynamic ultrasound findings were compared with the intraoperative assessment of nerve stability following in situ decompression. RESULTS: The preoperative dynamic ultrasound agreed with intraoperative findings in 38 of 43 patients (88%)...
November 27, 2018: Journal of Hand Surgery
Ryan M Greene, Jacqueline E Bader, Libby Mauter, Benjamin W Sears, Conrad J Tirre, Armodios M Hatzidakis
CASE: A 49-year-old right-hand-dominant man sustained an auger-related injury that resulted in open dislocation at the left wrist and palm, with complete amputation of the distal aspect of the forearm and the hand. The injury at the elbow included instability with an ulnar coronoid fracture, posterior dislocation of the ulna, and posterolateral dislocation of the radius. To restore stability of the forearm stump and elbow, we performed a complete resection of the radius, open reduction and internal fixation of the coronoid tip, a repair of the lateral collateral ligament, and transfer of the distal biceps tendon to the coronoid...
November 28, 2018: JBJS Case Connector
Joon Kyu Lee, Jae-Yeon Hwang, Suk Yoon Lee, Bong Cheol Kwon
BACKGROUND: The triangular fibrocartilage complex (TFCC) tear is a common cause of ulnar-side wrist pain; however, its natural course is not well understood. QUESTIONS/PURPOSES: We sought (1) to determine the natural course of TFCC tears without distal radioulnar joint (DRUJ) instability, and (2) to identify the factors associated with poor prognosis after nonsurgical treatment of TFCC tears. METHODS: Over a 3-year period, we treated 117 patients with TFCC tears who did not have DRUJ instability...
October 22, 2018: Clinical Orthopaedics and related Research
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