MyMedR

Paediatric forearm fractures: functional outcome of conservative treatment

Tarmuzi NA, Abdullah S, Osman Z, Das S

Bratisl Lek Listy, 2009;110(9):563-8.

PMID: 19827340

Forearm fractures are common in the paediatric age group. Closed reduction and casting are the primary means of treatment in over 90% of these fractures. Resultant deformities are usually a product of indirect trauma involving angular loading combined with rotational deformity and fragment displacement.

Matched MeSH terms: Ulna Fractures/radiography; Ulna Fractures/therapy*

Fulltext Morphological variant of pronator quadratus muscle: a case report

Ahmad Ruzain, S., Zar Chi, T., Syed Baharom, S.A.F.

Medicine & Health, 2018;13(2):164-169.

MyJurnal

Presented herein is a case of one different morphological anomaly of pronator quadratus (PQ) muscle. Here, the shape of PQ was not similar to the normal morphology of the muscle. The PQ muscle appeared to be in distinct triangular-shaped instead of quadrangular-shaped. In addition, this triangular-shaped was found in two sites i.e. proximal and distal. Significantly, the PQ muscle consisted of two fleshy red fibres and white aponeurosis. Proximally placed portion had a wide base and a narrower apex. The larger base was attached to the ulna and formed of fleshy red fibres which converged laterally to be continuous with aponeurosis ending on the radius. In contrast, the distal triangular portion had the fleshy fibres attached to the radius and converged medially to be continuous with aponeurotic portions on the ulna. Each portion were referred as pronator triangularis proximalis and pronator triangularis distalis. These variations might affect atypically in cases of forearm pronation. Information of these variations is important in hand surgeries and provide an additional knowledge on the relationship between morphology of PQ muscle and the limitation or the strength in the action of it.

Matched MeSH terms: Ulna

Fulltext Two-Year Outcome of Synthetic Annular Ligament Reconstruction in the Elbow: A Case Report

Kesu Belani L, Abdullah S, Harun MH, Narin Singh PSG, Sapuan J

Cureus, 2020 Nov 19;12(11):e11564.

PMID: 33364091 DOI: 10.7759/cureus.11564

Monteggia fracture is commonly treated with open anatomical reduction and fixation of the ulna fracture. The radial head will be automatically reduced once anatomical fixation of the ulna is achieved. However, it is occasionally associated with an irreducible radial head dislocation requiring an open reduction and reconstruction of the torn annular ligament. We describe a case of traumatic Monteggia fracture which underwent initial plating, however post-operative radiograph denoted an irreducible radial head secondary to a ruptured annular ligament. We reconstructed the annular ligament with a synthetic graft sling around the radial neck with an anchor suture. The radial head was stable in all directions after annular ligament reconstruction. A two-year follow-up shows full range of motion of the elbow joint with osteolysis of the radial head, no other operative morbidity was observed.

Matched MeSH terms: Ulna; Ulna Fractures

Fulltext Both-Bone Forearm Fractures in Children with Minimum Four Years of Growth Remaining: Can Cast Achieve a Good Outcome at Skeletal Maturity?

Hadizie D, Munajat I

Malays Orthop J, 2017 Nov;11(3):1-9.

PMID: 29326760 MyJurnal DOI: 10.5704/MOJ.1711.009

Introduction: Both-bone forearm fractures in children can be treated non-operatively with a cast. Most previous studies have shown favourable outcome; however, information on the functional outcome after skeletal maturity is still scanty. Therefore, this study was conducted to determine the functional outcome after skeletal maturity in fractures with at least four years of growth remaining. Materials and Methods: This retrospective study was conducted from March 2012 until March 2013. Age at the time of fracture was taken as until 10 years for females and until 12 years old for males with at least four years of growth remaining. Fractures occurring in the diaphysis were included in the study. Functional outcomes were assessed at or after skeletal maturity. Results: Forty-four children fulfilled the criteria. The ages of the youngest and the oldest at the time of fracture was five and 12 years old respectively. Follow-up of the male and female patients were 7.4 years and 5.5 years respectively. There was a significant difference between post-reduction angulation and angulation at skeletal maturity of the radius and ulna (p<0.001). Out of 44 patients, 39 had excellent and five had good functional outcomes. No patient had fair or poor functional outcome. There was no association between the functional outcome and the angulation of forearm bones after skeletal maturity. Age at the time of fracture had a significant association with the functional outcome. Conclusion: Non-operative treatment of both-bone diaphyseal forearm fractures in a cast has good to excellent functional outcomes in children who still have four years of growth remaining.

Matched MeSH terms: Ulna; Ulna Fractures

Reverse Wafer Procedure for Ulnar Impaction Syndrome

Ozcelik IB, Jusoh MH, Cavit A

Tech Hand Up Extrem Surg, 2024 Mar 01;28(1):16-18.

PMID: 37702374 DOI: 10.1097/BTH.0000000000000453

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.

Matched MeSH terms: Ulna/surgery

Fulltext Bilateral Olecranon Fracture in Adult. A Case Report

Zamzuri, Z., Nazri, M.Y., Amindudin, C.A., Azril, A., Shukrimi, A., Hafiz, A., et al.

International Medical Journal Malaysia, 2006;5(1):1-3.

MyJurnal

We report a case of a 14-year-old Malay male who fell at school and sustained bilateral olecranon fractures. He had undergone an open reduction and tension band wiring to stabilize the fracture. Three months after the surgery, the movement of both his elbows was satisfactory.

Matched MeSH terms: Ulna Fractures

Fulltext A Palmar Lipoma with Median and Ulnar Nerve Compressive Symptoms

Azwa, N., Shalimar, A., Jamari, S.

Malays Orthop J, 2007;1(2):33-35.

MyJurnal

Although lipoma is common in the upper limbs, it rarely occurs in the palm, and usually does not compress the surrounding structures. Here, we report a patient presenting with compressive neuropathy of the ulna and median nerves secondary to a palmar lipoma. Surgical excision led to full neurological recovery.

Matched MeSH terms: Ulna

Evaluation of Osteogenic Potentials of Avian Demineralized Bone Matrix in the Healing of Osseous Defects in Pigeons

Sanaei R, Abu J, Nazari M, Zuki MA, Allaudin ZN

Vet Surg, 2015 Jul;44(5):603-12.

PMID: 25656987 DOI: 10.1111/vsu.12292

To evaluate avian allogeneic demineralized bone matrix (DBM) in the healing of long bone defects as a function of geometry and time in a pigeon model.

Matched MeSH terms: Ulna Fractures/surgery; Ulna Fractures/veterinary*

The effect of chicken, pigeon, and turkey demineralized bone matrix (DBM) implanted in ulnar defects fixed with the intramedullary-external skeletal fixator (IM-ESF) tie-in in pigeons (Columba livia): histological evaluations

Jalila A, Redig PT, Wallace LJ, Ogema TR, Bechtold JE, Kidder L

Med J Malaysia, 2004 May;59 Suppl B:125-6.

PMID: 15468850

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.

Matched MeSH terms: Ulna/pathology; Ulna/surgery*

Fulltext The effect of strontium ranelate on the healing of a fractured ulna with bone gap in rabbit

Ibrahim MR, Singh S, Merican AM, Raghavendran HR, Murali MR, Naveen SV, et al.

BMC Vet Res, 2016 Jun 16;12(1):112.

PMID: 27307015 DOI: 10.1186/s12917-016-0724-6

Fracture healing in bone gap is one of the major challenges encountered in Orthopedic Surgery. At present, the treatment includes bone graft, employing either internal or external fixation which has a significant impact on the patient, family and even society. New drugs are emerging in the markets such as anabolic bone-forming agents including teriparatide and strontium ranelate to stimulate bone growth. Based on the mechanism of their actions, we embarked on a study on the healing of a fractured ulna with bone gap in a rabbit model. We segregated ten rabbits into two groups: five rabbits in the test group and five rabbits in the control group. We created a 5 mm bone gap in the ulna bone, removing the periosteum as well. Rabbits in the test group received 450 mg/kg of strontium ranelate via oral administration, daily, for six weeks. The x-rays, CT scans and blood tests were performed every two weeks. At the end of six weeks, the rabbits were sacrificed, and the radius and ulna bones harvested for histopathological examination.

Matched MeSH terms: Ulna Fractures/drug therapy*; Ulna Fractures/pathology

Fulltext Early remodeling in children's forearm fractures

Qairul IH, Kareem BA, Tan AB, Harwant S

Med J Malaysia, 2001 Dec;56 Suppl D:34-7.

PMID: 14569764

The forearm fracture is a fracture of the upper limb between the elbow and the wrist. It is a common injury in children, accounting for more than half of all children's fractures, and mostly occur when a child falls on the outstretched arm. A difficult clinical problem that often arises is how much angulation can be accepted in the child and how much remodeling will occur. One hundred consecutive cases of forearm fractures that were admitted at Childrens Orthopaedic Ward, Institute of Paediatrics at Hospital Kuala Lumpur between 1st January 1997 to 31st December 1998 were studied. We found that all fractures united 3 to 6 weeks, with a remodeling rate of about 2.5 degrees/month: the proximal fractures having the most potential to remodel. We conclude that the early remodeling potential of forearm fractures in children is 1.5 degrees/month in midshaft fractures and 2.5 degrees/month in distal and proximal fractures. We recommend accepting a 10-20 degree angulation in midshaft fractures, and a 20-30 degree angulation in metaphyseal fractures; based on our study of early remodeling potential.

Matched MeSH terms: Ulna Fractures/physiopathology*; Ulna Fractures/therapy

Fulltext Locking compression plate: a treatment option for diaphyseal nonunion of radius or ulna

Ling HT, Kwan MK, Chua YP, Deepak AS, Ahmad TS

Med J Malaysia, 2006 Dec;61 Suppl B:8-12.

PMID: 17600986

Treatment of radius or ulna nonunion requires both osteogenic environment and mechanical stability. We would like to report three radial and six ulnar diaphyseal nonunions treated with 3.5 mm locking compression plate (LCP) fixation. To assess the effectiveness of 3.5 mm LCP in treating diaphyseal nonunion of the forearm bones, we prospectively reviewed nine patients with the mean age of 33 years with diaphyseal nonunion of the radius or ulna. All patients were treated with 3.5 mm LCP. Bone grafting was only performed for atrophic nonunion. Surgical and functional outcome were evaluated. There were three atrophic nonunion of the radius, four atrophic nonunion of the ulna and two hypertrophic nonunion of the ulna. All nonunion united successfully with satisfactory functional outcome. 3.5 mm LCP is effective in the treatment of nonunion of ulna or radius.

Matched MeSH terms: Ulna Fractures/radiography; Ulna Fractures/surgery*

Assessment of articular cartilage and subchondral bone using EPIC-microCT in Labrador retrievers with incipient medial coronoid disease

Lau SF, Wolschrijn CF, Siebelt M, Vernooij JC, Voorhout G, Hazewinkel HA

Vet J, 2013 Oct;198(1):116-21.

PMID: 23846028 DOI: 10.1016/j.tvjl.2013.05.038

The aetiopathogenesis of medial coronoid disease (MCD) remains obscure, despite its high prevalence. The role of changes to subchondral bone or articular cartilage is much debated. Although there is evidence of micro-damage to subchondral bone, it is not known whether this is a cause or a consequence of MCD, nor is it known whether articular cartilage is modified in the early stages of the disease. The aim of the present study was to use equilibrium partitioning of an ionic contrast agent with micro-computed tomography (microCT) to investigate changes to both the articular cartilage and the subchondral bone of the medial coronoid processes (MCP) of growing Labrador retrievers at an early stage of the disease and at different bodyweights. Of 14 purpose-bred Labrador retrievers (15-27 weeks), six were diagnosed with bilateral MCD and one was diagnosed with unilateral MCD on the basis of microCT studies. The mean X-ray attenuation of articular cartilage was significantly higher in dogs with MCD than in dogs without MCD (P<0.01). In all dogs, the mean X-ray attenuation of articular cartilage was significantly higher at the lateral (P<0.001) than at the proximal aspect of the MCP, indicating decreased glycosaminoglycan content. Changes in parameters of subchondral bone micro-architecture, namely the ratio of bone volume to tissue volume (BV/TV), bone surface density (BS/TV), bone surface to volume ratio (BS/BV), trabecular thickness (Tb.Th; mm), size of marrow cavities described by trabecular spacing (Tb.Sp; mm), and structural model index (SMI), differed significantly by litter (P<0.05) due to the difference in age and weight, but not by the presence/absence of MCD (P>0.05), indicating that subchondral bone density is not affected in early MCD. This study demonstrated that cartilage matrix and not subchondral bone density is affected in the early stages of MCD.

Matched MeSH terms: Ulna/pathology*; Ulna/radiography

Fulltext Comparison of fracture patterns between rural and urban populations in a developing country

Saw A, Sallehuddin AY, Chuah UC, Ismail MS, Yoga R, Hossain MG

Singapore Med J, 2010 Sep;51(9):702-8.

PMID: 20938610

The pattern of fracture, including the anatomical location and age distribution, may differ among urban and rural populations due to various factors such as the inhabitants' occupation and living environment.

Matched MeSH terms: Ulna Fractures/diagnosis; Ulna Fractures/pathology

Fulltext Single-Bone Forearm Salvage Procedure for a Child with Acquired Radial Clubhand in a Resource Limited Centre: A Case Report

Sahdi H, Chan WH, Dollah NB, Entri A

Malays Orthop J, 2018 Nov;12(3):43-46.

PMID: 30555646 MyJurnal DOI: 10.5704/MOJ.1811.011

Acquired radial clubhand deformity can be a consequence of large bone gap left by premature extensive radius osteomyelitis sequestrectomy. Single-bone forearm reconstruction is a salvage procedure when other motion-preserving techniques are not feasible. Here we present a child who developed radial clubhand deformity after an untimely sequestrectomy of radius diaphysis. In view of limited microsurgical expertise in our centre, single-bone forearm procedure was done utilising simple Kirshner wires to achieve radio-ulnar fusion. The procedure resulted in pain-free stable wrist, restoration of hand function and improved cosmesis.

Matched MeSH terms: Ulna

Fulltext Hypertrophic nonunion of the ulna in a child: treatment with an elastic stable intramedullary nail without bone graft

Abd Rashid AH, Ibrahim S

Strategies Trauma Limb Reconstr, 2010 Dec;5(3):145-7.

PMID: 21286359 DOI: 10.1007/s11751-010-0089-5

Nonunion following diaphyseal forearm fracture is an uncommon complication in children. Compression plate fixation with bone grafting has been the standard method to treat this complication. We report a case of hypertrophic nonunion of the ulna in a child who was treated surgically using an elastic stable intramedullary nail (ESIN) without bone grafting. The nonunion healed 4 months after surgery.

Matched MeSH terms: Ulna

Fulltext Distal radius morphometry in the Malaysian population

Chan CYW, Vivek AS, Leong WH, Rukmanikanthan S

Malays Orthop J, 2008;2(2):27-30.

MyJurnal

The goal of treatment in distal radius fracture is to restore the anatomy of the distal radius, however the criteria currently used to evaluate the quality of eduction are based on Western based published figures. This goal of this study was to investigate whether there are variations in the morphology of the distal radius among the multiracial population of Malaysia. Consecutive normal wrist radiographs of patients who presented to the accident and emergency unit in three major hospitals in Malaysia were measured. The palmar tilt of the distal radius averaged 12.6o Â± 3.55o, and the radial inclination averaged 25.1o Â± 3.42o. The ulnar variance averaged â€“ 0.1 Â± 1.31mm, 38.4% of the patients had neutral ulnar variance, 28.8% have negative ulnar variance and 32.9% have positive ulnar variance. Our results indicate that distal radius morphometric parameters in the Malaysian population are comparable to Western figures.

Matched MeSH terms: Ulna

Fulltext Giant Solitary Forearm Exostosis in A Child

Faisham W.I., Zulmi, W.

Malays Orthop J, 2009;3(1):81-84.

MyJurnal

Forearm deformity secondary to giant solitary ulna exostosis is rare. We describe a rare presentation of symptomatic solitary giant exostosis involving the entire distal ulna resulting in ulnar bowing of the forearm in a five-year-old boy. The tumour was completely resected and the defect was reconstructed with an allograft wrapped with a free autogenous periosteal tubular sleeve to deliver fresh pluripotential cells for better incorporation and integration. The distal ulna physes was preserved. An osteotomy was performed on the radius to correct the deformity. One year after surgery, the deformity remains corrected with normal bone length and excellent hand function. There is no evidence of local recurrence and the allograft has fully incorporated.

Matched MeSH terms: Ulna

Fulltext Ulnar Osteotomy with 2-Pin Unilateral Gradual Distraction for Treatment of Chronic Monteggia Fracture: A Case Report

Gooi SG, Wang CS, Saw A, Zulkiflee O

Malays Orthop J, 2017 Mar;11(1):79-81.

PMID: 28435583 MyJurnal DOI: 10.5704/MOJ.1703.015

Missed Monteggia fracture leading to chronic radial head dislocation is a known complication. The surgical treatment options remain challenging. The aim of treatment is to reduce the radial head and to maintain the stability of the elbow in all ranges of motion. A few surgical techniques have been described with complications. We report the case of a 13 years old boy with chronic radial head dislocation as a result of an unrecognised Monteggia fracture-dislocation for eight years. We successfully reduced the radial head and corrected the cubital valgus from 45 degrees to 10 degrees with a proximal ulna osteotomy and gradual distraction with 2-pin Monotube external fixator. The correction was uneventful with good functional outcome.

Matched MeSH terms: Ulna

Fulltext Variants of Monteggia Type Injury: Case Reports

Kamudin N, Firdouse M, Han CS, M Yusof A

Malays Orthop J, 2015 Mar;9(1):23-27.

PMID: 28435591 MyJurnal DOI: 10.5704/MOJ.1503.001

BACKGROUND: Monteggia fracture-dislocation is rare in children. Various reports attest to its rarity, while recording the many variant of this injury. It is, therefore, easy to miss the diagnosis in the absence of proper clinical examination and radiographs.

CASE REPORT: This report highlights two rare variants of Monteggia fracture-dislocation seen in children. The first case was a 12-year old girl alleged to have fallen from a 15- feet tall tree and sustaining a combined type III Monteggia injury with ipsilateral Type II Salter-Harris injury of distal end radius with a metaphyseal fracture of the distal third of the ulna. The second case was a 13-year old who had sustained a closed fracture of atypical Type I Monteggia hybrid lesion, in a road traffic accident.

CONCLUSION: This report highlights the rare variants of Monteggia fracture dislocation which could have been missed without proper clinical examinations and radiographs.

Matched MeSH terms: Ulna

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