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.
A paralisia de Erb-Duchenne é a mais frequente paralisia neonatal do plexo braquial, correspondendo a mais de 60% dos casos. Para o tratamento têm-se os procedimentos cirúrgicos convencionais e os complementares. Diante do prejuízo de qualidade de vida, da constância dos casos e da ausência de um protocolo que guie as escolhas terapêuticas da patologia, este estudo visa orientar a utilização de cada método de tratamento. METODOLOGIA: O estudo consistiu em uma revisão sistemática com busca nas bases de dados BVS e PubMed utilizando os descritores "Erb-Duchenne", "neonatal", "treatment" e "plexus brachial". RESULTADOS: As opções de tratamento são definidas pela avaliação clínica e pelo tipo de lesão. É consenso que a abordagem conservadora seja iniciada precocemente. DISCUSSÃO: Os estudos apresentam divergências no que se refere às alternativas terapêuticas. Muitos evidenciam a relevância do acompanhamento multidisciplinar e a inclusão de técnicas complementares como a injeção de toxina botulínica. Sobre o tratamento cirúrgico destaca-se as cirurgias primárias, comumente indicadas para crianças que não apresentam nenhum tipo de recuperação espontânea dentro de um espectro entre três a nove meses; e as cirurgias secundárias. CONCLUSÃO: Ressalta-se a necessidade de mais estudos nesta área, a fim de se direcionar a seleção terapêutica de forma mais assertiva, no fito de se priorizar a reabilitação e recuperação dos bebês e crianças.
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