Background This study created an anatomic reconstruction of the distal oblique bundle (DOB) of the interosseous membrane to determine its effect on distal radioulnar joint (DRUJ) instability and compare this technique with distal radioulnar ligament (DRUL) reconstruction. Questions/Purposes We hypothesized that this reconstruction would provide equivalent stability to DRUL reconstruction and that combining the two techniques would enhance stability. Methods Six cadaveric upper limbs were affixed to a custom frame. The volar/dorsal translation of the radius relative to the ulna was measured in 60° pronation, neutral, and 60° supination. Translation was sequentially measured with the DRUJ intact, with sectioned DRULs and triangular fibrocartilaginous complex (TFCC), and with sectioned DOBs. Reconstructions were performed on the DRULs, on the DOB tensioned in both neutral and supination, and employing both techniques. Results The DOB reconstruction, tensioned both in the neutral position and in 60° supination, was more stable than the partial and complete instability in 6/6 specimens in pronation and the neutral position and in 5/6 specimens in supination. The DOB reconstruction and the DOB reconstruction tensioned in supination were more stable than the DRUL reconstruction in 4/6 patients. Combining the two techniques did not further reduce translation. Conclusions The DOB reconstruction is capable of improving stability in the unstable DRUJ.
Background:Biologic augmentation with allograft has shown equivalent healing rates to autograft in several nonunion models. No literature exists clearly demonstrating this in the clavicle. The purpose of this study was to evaluate the healing and complication rates of clavicle nonunions treated solely with open reduction and internal fixation (ORIF) and allograft.Materials and Methods:Nineteen clavicle nonunions treated with ORIF and allograft were evaluated retrospectively to assess healing rates and complications based on clinical symptoms and radiographic findings.Results:For the 19 patients included and treated with ORIF and allograft, clinical follow-up averaged 15 months. Seven patients were smokers. Although complete radiographic healing was achieved in only 68% of patients, clinical success occurred in 16 (84%) patients who demonstrated full range of motion and strength without pain. The three patients who did not demonstrate full radiographic healing were completely pain free. Five patients experienced complications (26%). Two underwent hardware removal due to persistent irritation after union. Three had a persistent painful nonunion. Each of these three patients was a smoker (P=0.08). Two proceeded to union after revision fixation. The other had hardware failure, which was removed, with a persistent nonunion and did not wish any further treatment.Conclusion:ORIF with allograft bone substitute is an acceptable treatment alternative to iliac crest bone graft for clavicle nonunions. However, we did not demonstrate equivalent healing rates to published results utilizing autograft. Smokers were identified to have a trend toward higher failure rates with ORIF augmented with allograft and therefore these patients may be better served by augmenting fixation with autograft.Level of Evidence:IV; retrospective comparative study.
This article describes the case of a 77-year-old man with a recurrent posterior shoulder dislocation, treated with humeral hemiarthroplasty and reconstruction of a large posteroinferior glenoid defect with a bone block created from humeral head autograft. On examination, the patient's left arm was held in internal rotation against his stomach, with minimal swelling about the deltoid. His shoulder was nontender to palpation; however, he had substantial motion restrictions, and attempted motion was painful. He could forward elevate to 30°, extend to 0°, internally rotate to belly, and passive external rotation was limited to -30°. He maintained full elbow, wrist, and hand range of motion, and his neurovascular examination was intact. Radiographs revealed a recurrent posterior glenohumeral dislocation, with a large reverse Hill-Sachs defect involving the lesser turberosity and humeral head. Computed tomography with 3-D reconstruction revealed the humeral head defect involving the lesser tuberosity and approximately 40% of the humeral head and a large comminuted posteroinferior glenoid fracture measuring 2.7×0.8 cm, encompassing approximately 30% of the posteroinferior glenoid surface. Standard fixation was not possible; therefore, the resected humeral head was fashioned into an elliptical piece mirroring the size of the defect of the posteroinferior glenoid. Rough measurements of the defect were made and marked on the humeral head, which was then cut with an oscillating saw to approximate the size and shape of the defect. The glenoid graft provided an extension to the glenoid and prevented posterior subluxation with no block to motion. One year postoperatively, he had full strength (5/5) with external rotation, forward elevation, and internal rotation, 140° of active forward elevation, 30° of external rotation, internal rotation to T7, and no episodes of instability. To our knowledge. this is the first report of this technique in the literature. It is an alternative to total shoulder arthroplasty.
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