PURPOSE OF THE STUDY The preferred treatment of giant cell tumor of bone is curettage with the use of local adjuvant. If the tumor spreads beyond the bone into soft tissues, en bloc excision should be performed. Intralesional curettage allows joint preservation, but it is associated with a high recurrence rate. The purpose of the study was to identify the risk factors for local recurrence and to compare the functional outcomes after both types of surgical procedures. MATERIAL AND METHODS The group included 16 patients (5 women, 11 men) with giant cell tumor of bone in distal forearm treated at the First Department of Orthopedic Surgery, St. Anne s University Hospital Brno in 2005-2019. The mean age of patients was 38 years (22-53). The follow-up period was 6.75 years (2-15) on average. The most common location of the tumor was distal radius (14). In 6 patients denosumab treatment was indicated. Based on the obtained data, we compared the effects of gender, Campanacci grade, type of surgery and administration of denosumab on the risk of local recurrence. The functional outcomes were evaluated retrospectively based on the Musculoskeletal Tumor Society scoring system for upper limb salvage surgeries. RESULTS Resection and reconstruction using an osteocartilaginous allograft was performed in 9 patients. Seven patients were treated with tumor curettage with bone cement used to fill the cavity. The group of patients who underwent curettage showed a significantly higher mean MSTS score 89% compared to the group of patients with resection with the mean MSTS score 66% (P < 0.05). Local tumor recurrence was reported in 3 patients (18.75%). No statistically significant difference was found in gender, tumor grade, radicality of surgery or administration of targeted therapy with respect to the incidence of local recurrence. Altogether 6 complications (37.5%) were observed in the group. DISCUSSION The treatment of a giant cell tumor of bone aims to completely remove the tumor and to preserve the best possible function of the limb. The complications in distal forearm involve particularly an increase incidence of local recurrence and painful or limited range of motion of the wrist. Whereas curettage with the use of local adjuvant is burdened with a higher recurrence rate, resection with allograft reconstruction of bone defect is usually associated with poorer functional outcomes. CONCLUSIONS Tumor curettage using local adjuvant is preferred in a well-circumscribed tumor and offers an excellent functional outcome. En bloc tumor resection and reconstruction using an osteocartilaginous allograft is a suitable treatment option for a locally advanced tumor with a low risk of local recurrence. Key words: giant cell tumor of bone, distal radius, distal ulna, curettage, osteocartilaginous allograft.
- MeSH
- denosumab MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- nádory kostí * patologie MeSH
- následné studie MeSH
- obrovskobuněčný nádor kosti * patologie chirurgie MeSH
- radius chirurgie MeSH
- retrospektivní studie MeSH
- ulna patologie chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- Collesova fraktura * chirurgie diagnostické zobrazování komplikace MeSH
- diafýzy abnormality chirurgie diagnostické zobrazování MeSH
- dospělí MeSH
- fraktury vřetenní kosti chirurgie diagnostické zobrazování komplikace MeSH
- lidé MeSH
- osteotomie metody MeSH
- počítačová rentgenová tomografie metody přístrojové vybavení MeSH
- pronace MeSH
- rozsah kloubních pohybů MeSH
- supinace MeSH
- ulna abnormality chirurgie diagnostické zobrazování MeSH
- získané deformity ruky chirurgie diagnostické zobrazování MeSH
- zobrazování trojrozměrné MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- MeSH
- lidé MeSH
- osteotomie metody MeSH
- regenerace kostí MeSH
- rekonstrukce postranních vazů loketních metody MeSH
- retrospektivní studie MeSH
- ulna chirurgie MeSH
- vnitřní postranní vaz chirurgie zranění MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
Úvod: Abutment syndrom ulny, kdy distální část této kosti naráží na kosti karpu, je jednou z příčin bolestí na ulnární straně zápěstí. Příčina může být z vrozené plus varianty ulny či získaná například po zlomeninách distálního radia a nedostatečné korekci jeho délky. Materiál a metoda: Autoři hodnotili výsledky zkracovací osteotomie ulny u 22 pacientů průměrného věku 45,5 roku (16–84 let), kdy se jednalo o 12 žen a 10 mužů. Dominantní končetina byla poškozena u 13 pacientů a nedominantní u 9 pacientů. Pacienti byli zhodnoceni DASH dotazníkem před operací a s odstupem v průměru 82,4 měsíce (48–328 měsíců). Výsledky: Při hodnocení pacientů pomocí DASH skóre bylo předoperačně DASH skóre v průměru 44,6 bodu a po operaci 16,6 bodu. Nejhorší nález po operaci byl u pacienta po poškození předloktí typu Essex-Lopresti, kde po 8 letech od operace se stav výrazně zhoršil (o 27 bodů) oproti stavu před operací. Stav byl komplikován ve 3 případech nezhojením osteotomie a nutností reosteosyntézy a spongioplastiky. Jeden z těchto pakloubů byl komplikován infektem, kde bylo k sanaci lokálně použito nejprve vložení kostního cementu s antibiotikem a po zklidnění provedena spongioplastika. Diskuze: Zkracovací osteotomie ulny má dobré výsledky, pokud jsou dodrženy správné indikace. I když jde o technicky jednoduchý výkon, může být komplikován vznikem pakloubu, který je třeba aktivně řešit.
Introduction: Abutment syndrome of the ulna, where the distal part of the bone hits carpal bone, is one of the possible causes pain on the ulnar side of the wrist. The cause may be congenital plus-variants ulna, or developed after, for example, distal radius fractures and inadequate correction of its length. Material and methods: The authors evaluated the results of ulnar shortening osteotomy in 22 patients, average age 45.5 years (16-84 years); there were 12 women and 10 men. The dominant limb was damaged in 13 patients and non-dominant in 9 patients. Patients were evaluated using the DASH questionnaire preoperatively at an average interval of 82.4 months (48-328 months). Results: When evaluating patients using the DASH score, the preoperative averaged at 44.6 points preoperatively and 16.6 points postoperatively. The worst postoperative result was in the case of surgery to the patient's forearm, after damage of the Essex-Lopresti type, where 8 years after the operation, condition deteriorated significantly (by 27 points), compared to the situation before the operation. The condition was complicated in 3 cases by non-healing after osteotomy and the need for re-osteosynthesis and bone grafts. One of these non-unions was complicated by infections, which required local use of antibiotics delivered via bone cement insertion and a bone graft after soothing. Discussion: Butt ulnar osteotomy has good results if it follows the correct indication. Although it is a technically simple procedure, it can be complicated by non-unions, which need to be actively addressed.
- Klíčová slova
- bolesti zápěstí, abutment syndrom ulny, impaction syndrom ulny,
- MeSH
- bolest etiologie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- následné studie MeSH
- osteotomie * MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- spokojenost pacientů MeSH
- syndrom * MeSH
- ulna * chirurgie MeSH
- výsledek terapie MeSH
- zápěstí anatomie a histologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- senioři nad 80 let MeSH
- senioři MeSH
The main objective is to present two case reports of rare congenital differences of the upper extremity that belong to Category II of the modified classification of congenital hand deformities by Ogino et al. (1986). This classification was adopted by the Japanese Society for Surgery of the Hand in 1996. Category II includes incomplete formation of the joint, contracture and deformities due to failure of differentiation of parts and tumor-like conditions including hamartomas. Incomplete formation of the joint may result in synostosis, congenital dislocation and ankylosis of digital joints. We present an individual comprehensive treatment of two children, Proximal radioulnar synostosis and ulnar hypoplasia in one and Partial ulnar aplasia associated with dislocation of radial head and humeroulnar synchrondrosis in the other.
- MeSH
- dítě MeSH
- kontraktura diagnóza etiologie chirurgie MeSH
- kosti paže a předloktí chirurgie patologie MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony MeSH
- mladiství MeSH
- osteochondrodysplazie diagnóza etiologie chirurgie rehabilitace MeSH
- plod patologie MeSH
- poruchy růstu diagnóza etiologie chirurgie rehabilitace MeSH
- předškolní dítě MeSH
- synostóza diagnóza etiologie chirurgie rehabilitace MeSH
- ulna chirurgie patologie MeSH
- vrozené deformity horní končetiny * diagnóza etiologie chirurgie rehabilitace MeSH
- vrozené deformity ruky diagnóza etiologie chirurgie rehabilitace MeSH
- výsledek terapie MeSH
- zákroky plastické chirurgie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE OF THE STUDY To review the current methods of operative management of post-traumatic chronic radial head dislocation in chronic Monteggia lesions in children. MATERIAL AND METHODS Post-traumatic chronic dislocation of the proximal radius usually occurs following missed or ineffectively treated Monteggia fractures. The radial head is usually dislocated anteriorly. We performed open reduction of the radial head, reconstruction of the annular ligament and corrective osteotomy of the ulna in eleven patients. Three of our patients underwent ulnar lengthening via gradual distraction using an llizarov external fixator. This procedure was used in nine boys and five girls who were treated for complications following Monteggia lesions between 2000 and 2009. The average age at the time of surgery was 8 years and 4 months, the average injury-to-surgery interval was 19 months, and a prerequisite for surgery was a normal concave articular surface of the proximal radius. The patients were followed up for an average of 28 months and, at final follow-up, all were fully active and had no pain or instability. RESULTS The complications included: non-union of the ulnar osteotomy site in two patients, residual radiocapitellar subluxation in two patients, and one patient had revision surgery. Nine patients showed a full range of motion, two had a loss of extension, and three had a mean loss of pronation of 20 degrees and a mean loss of supination of 20 degrees. DISCUSSION The Monteggia lesion is a rare fracture in childhood, but its sequelae can be serious. So far a unified therapeutic approach has not been proposed. Most authors prefer reconstruction surgery. Our results are in full agreement with the published data. CONCLUSIONS The operative treatment of consequences after Monteggia fractures in children has a relatively high rate of complications and unpredictable results. Indications for reconstruction involve a normal articular surface of the radial head and a normal alignment of the radius and ulna.
- MeSH
- časové faktory MeSH
- dislokace kloubu chirurgie klasifikace MeSH
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- Monteggiova fraktura klasifikace komplikace MeSH
- obnova funkce MeSH
- předškolní dítě MeSH
- radius chirurgie MeSH
- ulna anatomie a histologie chirurgie MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
Distal radioulnar joint (DRUJ) instability often develops after distal forearm fracture or severe dislocation of the wrist with damage to its stabilising structures. The instability is usually diagnosed as a chronic condition and only rarely at the time of injury. When the stabilising structures are not treated adequately soon after injury, instability develops and is accompanied with pain, restricted range of motion and reduced grip strength. This study presents the option of chronic instability treatment by tenodesis with use of the palmaris longus tendon. Its aim is to remind the broad medical community of this issue. MATERIAL Between July 1994 and November 2000, tenodesis was performed in 15 patients with chronic DRUJ instability. The right and left sides were affected in 10 and five patients, respectively; of them 12 were dominant extremities. All injuries were diagnosed as dorsal subluxation of the ulnar head, with side dislocation in three patients. METHODS The diagnosis was based on a thorough medical history, and clinical and radiographic examination, including projections in forced maximum radial and ulnar duction, as recommended by Geyer and Luzius as early as in 1964. Tenodesis was done by the Jäger and Wirth method using the palmaris longus tendon. The patients were scored according to the Modified Mayo Wrist System. RESULTS Of the 15 patients treated by this method, 14 were evaluated. Eight patients regarded the results as very good, with no pain at maximal physical activity, and five considered them good, experiencing pain only at maximal but not at everyday activities. One patient reported a poor outcome. The average score increased from pre-operative 40 to 60 points post-operatively. All patients had a slight restriction of rotation movements of the forearm. Residual instability was found in one patient. DISCUSSION It is a common view that this condition is caused by subluxation or dislocation of the ulnar head, while in fact it is subluxation or dislocation of the radius turning around the ulna. As reported in the literature, dorsal dislocation is three-times as frequent as volnar dislocation, and this is in agreement with our findings. There is a wide variety of the operative methods for tenodesis which differ in the distribution of tunnels in bone. Restriction of the range of motion in our patients also agreed with the literature data. No effect of a distal radius fracture on the results of surgery was recorded. CONCLUSIONS Our results show that tenodesis is a method suitable to treat chronic DRUJ instability if the indication criteria are observed, i. e., if no arthritic lesions are present in the joint.
THE AIM OF THE STUDY: The aim of our study was to assess treatment results of angular deformities in distal radius by a system of the locking compression plates (LCP) at our clinic. METHODS: Our source data was collected prospectively from the records of patients where the locking compression plate was used for angulation correction of distal forearm between 2006 and 2007. The patients were divided by sex, the age range was defined and two groups were formed based on the initial diagnosis: the group of posttraumatic deformities (2 patients; 29 %) and the group of no traumatic deformities (3 patients with congenital shortening of ulna, valgus deformity and overgrowth of radius and 2 patients with exostoses multiplices with shortening of ulna and overgrowth of radius with ulnar angulation). The following parameters were set: radial articular angle and carpal slip prior to and after angulation correction, the healing period, the range of movement of the surrounding joints and occurrence of complications. RESULTS: We recorded only one case of delayed healing which was subsequently sustained by autospongioplastics and adjusted to normal. In the rest of the cases deformity correction occurred and the defined parameters were then corrected to normal. We observed no postoperative complications or permanent consequences. CONCLUSIONS: A two-year follow-up period monitoring treatment and therapeutic results of deformities in the forearm bones at our clinic, confirmed a minimal incidence of complications and a high percentage of successfully treated cases.
- MeSH
- dítě MeSH
- fraktury ulny komplikace MeSH
- fraktury vřetenní kosti komplikace MeSH
- hojení fraktur MeSH
- interní fixátory MeSH
- kostní destičky MeSH
- lidé MeSH
- mladiství MeSH
- radius abnormality chirurgie MeSH
- ulna abnormality chirurgie MeSH
- vrozené deformity končetin chirurgie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
