Severely comminuted intraarticular distal radius malunion can significantly affect a patient's quality of life. To date, there is no ideal solution. We propose customized distal radius prosthesis replacement as a treatment option. A 33-year-old policeman presented with left wrist deformity and loss of motion for five months following a distal radius fracture AO (Arbeitsgemeinschaft für Osteosynthesefragen) type-C3 which had been fixed with a volar locking plate incorporate with external fixation and Kirschner wire (K-wire) augmentation for two months. He needed to rely on wrist motion for work. Therefore, we fabricated a customized distal radius prosthesis based on his contralateral normal anatomy to replace the malunion site. The patient was satisfied and able to return to work two months after the operation. Thirty months later, the range of motion had improved from fixed 40° flexion and fixed 70° pronation deformity to 73° flexion, 79° extension, 75° supination, and 85° pronation. His DASH (Disabilities of the Arm, Shoulder, and Hand) score had improved from 80 to 14.2. His pain score, as measured by the visual analog scale, improved from eight preoperatively to two. Unreconstructable intraarticular malunion of the distal radius is a challenging problem with no treatment consensus. Customized distal radius prosthesis may provide a successful treatment option. Future research should elucidate long-term outcomes.

Background: Volar locking plate (VP) and Kirschner wire (K-wire) fixations of distal end radius fractures are the most frequently used techniques that produce similar long term clinical results. However, inadequate fixation strength of the K-wire may cause pin loosening or migration. Although these complications can be prevented by immobilization, joint stiffness and a prolonged recovery period can occur. Objective: Herein, a technique that provided more stability, allowing immediate motion after fixation by linking the K-wires into a single system (locked K-wire system) was proposed. Methods: We evaluated biomechanical responses of the locked K-wire system and a VP in extraarticular distal radius fracture models AO/OTAa type 23A2 and 23A3 using three-dimensional finite element analysis. All models were tested under axial, bending, and torsional loads. Results: From the simulation results, the total displacement was greater in the dorsal wedge fracture than that from the simple fracture under all loads for both fixation systems. The locked K-wire system and the VP could withstand immediate physiologic load with maximum displacements of 1.15 mm and 1.39 mm, respectively. Conclusion: Considering the immediate physiologic load resistance and the ability to preserve its position during the bone-healing period, the locked K-wire system might be used as an alternative to fix distal radius fractures.

Background: Tension band wiring is considered the standard treatment for olecranon fracture. A recentstudy proved that it can be used for the fracture as distal to the coronoid process. Objective: The study aimed to investigate whether tension band wiring can be used in proximal ulnarfracture fixation up to and distal to the coronoid process. Methods: Models of simple proximal ulnar fracture including 4 intraarticular and 2 extraarticularfractures were created. Fixation was completed using tension band wiring technique, and biomechanicalresponses were evaluated using finite element analysis. After a physiologic load was applied, thefracture displacement, von Mises stress, and stiffness were recorded. Results: All fracture models were able to withstand the load of daily activities with a maximumdisplacement of 50% of the articular surface. In addition, the von Mises stress was the highest in themiddle articular fracture. The mean transcortical K-wire tension band wiring stiffness of the intraarticular and extra-articular fractures was 1144.89 N/mm and 1231.45 N/mm, respectively. Conclusion: Tension band wiring is another option to treat proximal ulnar fractures with the ability towithstand immediate postoperative load.

Cubital tunnel syndrome (CuTS) is a well-recognized compressive neuropathy worldwide. With technological advancement, endoscopy is introduced to facilitate the procedure. However, there are concerns about the excessive cost that comes with special instruments. This article aims to provide the results of the cost-saving endoscopic-assisted cubital tunnel release surgical technique that uses the normally available operating instruments.A retrospective review was performed of the nine patients that were diagnosed with CuTS and underwent minimal incision endoscopic-assisted cubital tunnel release in Police General Hospital. Patients were followed up to sixth month postoperation. The modified McGowan classification was used to determine the severity of symptoms. Surgical outcomes were evaluated by the modified Bishop classification, visual analog score (VAS), and patients' satisfaction. Other factors investigated were scar pain and peri-incisional numbness and hematomas.The incisions were measured as 7-9 mm. All patients reported having a pain score of 1 on the third day. Seven of nine patients were able to return to work one day after surgery. Modified Bishop score showed five excellence, three good, and one fair after two weeks. There was no surgical-related complication found. All patients noted the excellence satisfaction of the procedure.The minimal incision endoscopic-assisted cubital tunnel release has shown favorable outcomes with the cost-saving of simple instruments. However, a large prospective trial may be needed for further study.

Objectives To compare bone mineral density (BMD) in Thai postmenopausal women with and without distal radius fracture, and to investigate the role of vertebral fracture assessment (VFA) in diagnosing osteoporosis after distal radius fracture. Methods A cross-sectional study was conducted in Thai postmenopausal women with and without distal radius fracture. BMDs of the femoral neck (FN), total hip (TH), lumbar spine (LS), and VFA were obtained within 2 weeks of injury. BMD were compared between groups. Participants were classified into osteoporosis, osteopenia or normal using BMD alone, and BMD plus VFA, where a mere presence of vertebral compression fracture indicated osteoporosis. Results Fifty postmenopausal women with distal radius fractures and 111 non-fracture postmenopausal women participated. The mean BMD was significantly lower at all sites in the fracture group (FN BMD 0.590 ± 0.075 vs 0.671 ± 0.090, p = 0.007; TH BMD 0.742 ± 0.103 vs 0.828 ± 0.116, P = 0.009; LS BMD 0.799 ± 0.107 vs 0.890 ± 0.111, P = 0.009 in the fracture vs non-fracture group respectively). VFA increased the prevalence of osteoporosis from 16 (32%) to 23 (46%) in the fracture group, and 7 (6.31%) to 17 (16.22%) in the non-fracture group, with a number needed to treat 9. Conclusions Postmenopausal women with distal radius fractures had lower BMD. Incorporating VFA into diagnosis of osteoporosis increased the prevalence of osteoporosis in both fracture and non-fracture groups. Postmenopausal women aged 50 years or older with distal radius fracture are a good target for the investigation of osteoporosis.