Ulnar impaction syndrome occurs when excessive load across the ulnocarpal joints results in pathologic changes, especially over the articular surface of the ulnar head and proximal ulnar corner of the lunate. The 2 main surgical options in ulnar impaction syndrome are ulnar shortening osteotomy and wafer procedure, whether open or arthroscopically, to decompress the ulnocarpal joint load. However, all of these techniques have their shortcomings and drawbacks. The current study demonstrates a novel technique to decompress the ulnocarpal joint load: the "reverse wafer procedure" for ulnar impaction syndrome. In this surgical technique, we resected the proximal ulnar side of the lunate instead of partial resection of the thin wafer of the distal ulnar head dome in the standard wafer procedure. This technique avoids iatrogenic central tear of triangular fibrocartilage and distal radioulnar joint portal arthroscopy, which is technically demanding while preserving the distal radioulnar joint.
Avian demineralized bone matrix (ADBM) powder prepared from chicken, pigeon, and turkey sources induced bone formation via endochondral and intramembranous processes, as in mammalian studies. There were no significant differences in percentage of new bone, percentage of cartilage, surface-forming osteoblast area, or osteoclast count between gaps treated with chicken, pigeon, and turkey DBM. However, there was a significantly (p<0.05) higher percentage of inflammatory area in gaps treated with chicken DBM than in gaps treated with pigeon DBM.
Open reduction of the radial head and reconstruction of the annular ligament has been advocated for the Monteggia fracture dislocation in children who present more than a month after injury. Three patients with an anterior Monteggia lesion were treated by open reduction of the radial head which was held in place by a Kirschner wire passed from the humerus to the radius. No attempt was made either to repair or reconstruct the annular ligament. The patients were aged between 2 and 6 years, the delay between injury and reduction was between 6 and 8 weeks, and the length of follow up was 5 years for two patients and 1 year for the third. All three patients were free of pain, had no deformity and the radial head had not subluxated. All had nearly full flexion at the elbow. The forearm had full supination but restricted pronation.
Long bone reconstruction using vascularized fibula graft is becoming more popular despite the difficulties and its post-operative complications. We reviewed our early experience dealing with vascularized fibula graft for the management of massive long bone defect. Thirteen patients had undergone long bone reconstruction using vascularized fibula graft. Early complications that had been encountered include superficial wound infection (23%), transient common peroneal nerve palsy (23%), stage 1 bed sore (7.7%), anastomotic venous thrombosis (30.8%), DIVC (15.4%), flap loss and amputation (7.7%), and reactive psychiatric problem (7.7%). The early complications following this procedure are comparable with other major orthopaedic surgery and most of them are minor and treatable. The complication rates are also comparable with similar surgery done elsewhere.