Objectiveto demonstrate a surgical technique for treating neck fractures of the fifth metacarpal, by means of reduction through intra-focal manipulation and percutaneous fixation using Kirschner wires, with the aims of making it easier to achieve and maintain the reduction during the operation and enabling reduction of these fractures even if a fibrous callus has formed.Methodsa series of ten patients with neck fractures of the fifth metacarpal presenting palmar angles greater than 30° underwent the surgical technique described, as examples, and their results were evaluated through postoperative radiographs and clinical examinations.Resultsall the patients achieved reductions that were close to anatomical and evolved to consolidation of the fracture in the position obtained.Conclusionthe surgical technique described is effective, easy to carry out, minimally invasive and low-cost, thereby enabling adequate clinical and radiographic reduction, even in subacute fractures already presenting a fibrous callus.
ResumoDois casos de falha óssea após fratura da região distal do fêmur tratados pela técnica de Masquelet são apresentados. O primeiro caso envolve uma perda óssea aguda, e o segundo, uma pseudoartrose. O manejo adequado dessas lesões levou à consolidação e a um bom resultado funcional.
Purpose
This study aims to describe and biomechanically evaluate a novel technique using a strip of the flexor carpi ulnaris tendon for distal radioulnar joint reconstruction.
Methods
Surgical technique was thoroughly detailed, and a cadaveric biomechanical test was conducted to evaluate sagittal plane stability. Pronosupination range of motion was measured before and after the procedure. Dorsal and volar translation resistances were checked in three situations: with the uninjured triangular fibrocartilage complex, after its complete resection and after the surgical procedure.
Results
For distal radioulnar joint translation, higher values were found both in dorsal and volar translation in situations with an injured triangular fibrocartilage complex, with means equal to 25.4 mm (SD: 9.4 mm) and 26.1 mm (SD: 8.0 mm), respectively. For intact triangular fibrocartilage complex, both dorsal and volar translations averages were 3.4 mm (SD: 0.9 mm) and 4.5 mm (SD: 1.8 mm), respectively. Finally, when evaluating dorsal and volar translations after surgical reconstruction, means were 6.3 mm (SD: 1.3 mm) and 6.8 mm (SD: 0.9 mm), respectively. Regarding supination and pronation range of motion, which ranged from 57.9 to 63.4o, there were no differences in mean and median measures, when the cadavers with intact and reconstructed triangular fibrocartilage complex were compared (p > 0.05).
Conclusion
Promising mechanical evaluations encourage us to hypothesize that the technique effectively reconstructs the dorsal and volar radioulnar ligaments, preserving pronosupination and maintaining the physiological characteristics of the wrist joint. Clinical comparative studies are still necessary to fully validate this procedure.
Level of evidence
Therapeutic - Level V.
The aim of the study was to determine the correlation of patterns of distal radius fractures with the triangular fibrocartilage complex (TFCC) injures. Methods: Sixty adult patients (mean age, 43 years) with distal radius fractures were included. The patients were analyzed according to the fracture character at the time of injury and classified with an Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification system. Wrist arthroscopy was performed for all cases to identify and classify TFCC injuries according to Palmer's classification system. Results: TFCC lesion of varying severity was present in 39 fractures. Statistical analysis yielded a correlation with any patterns of the distal radius fractures with the associated TFCC injuries. The comminution or dorsal angulation of the distal radius, ulnar styloid fracture, and AO classification system have no correlation with associated TFCC injuries. Conclusions: The patterns of a distal radius fracture do not predict a TFCC injury. TFCC injury should be considered with all distal radial fractures.
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