OBJECTIVE This paper is aimed to observe the long-term result of reconstruction of wrist joint by replacing distal end of radius with vascularized fibular head in patient of giant tumor. METHODS From July 1978 to November 1993, 12 cases of giant tumor of distal end of radius were treated by this procedure and followed up for 6 months to 15 years, and the movement range of wrist, grip strength, and pain were evaluated. RESULTS The painful wrist released in 11 cases, only one case still existed mild pain and felt discomfortable. The average range of movement of wrist joint was 34.05 degree in volar flexion, 52.80 degree in dorsal extension, 26.25 degree in ulnar deviation, and 19.75 degree in radial deviation, and average grip strength was 44.6 kg. Compared with the contralateral side, there were accounted for 46.2%, 72.7%, 76.1%, 80.6%, and 76.7% respectively. CONCLUSION Replacement of distal end of radius with fibular head to reconstruct wrist joint can restore function of carpal joint, which is proved to be a safe and effective method.
OBJECTIVE To review the history and current status of total wrist arthroplasty. METHODS The original articles about wrist arthroplasty in recent years were reviewed. RESULTS The properties of wrist prosthesis of different generations were reviewed, with the emphasis on the prosthesis design and biomechanical behaviours. The surgical techniques, complications and salvage procedures were also discussed. CONCLUSION Although wrist arthrodesis is highly successful in treating the end-stage wrist arthritis, total wrist arthroplasty using well-designed prosthesis remains an alternative for the patients with special demands of hand functions.
ObjectiveTo investigate the clinical application of the forearm interosseous dorsal artery perforator sublobe flaps in repairing two wounds in dorsal hand or wrist. MethodsBetween October 2009 and October 2012, 12 patients with two wounds in the dorsal hand or wrist were included in the study. There were 4 cases of skin defects (grade IV) and bone exposure caused by machine injury, 3 cases of skin defects with bone and tendon exposure caused by traffic accident, and 3 cases of skin defect and tendon exposure caused by crash injury of heavy object, with a duration of 3-12 hours (mean, 6 hours) between injury and admission; defects in the wrist and tendon exposure were caused by tumor resection in 2 cases. Four cases had metacarpal fractures. The size of larger skin and soft tissue defects ranged from 4.0 cm×3.5 cm to 5.0 cm×3.0 cm, and the size of smaller defects was from 2.5 cm×2.0 cm to 4.0 cm×3.0 cm. The flap size was from 6 cm×4 cm to 8 cm×3 cm and 3.0 cm×2.5 cm to 5.0 cm×3.0 cm. The donor sites were directly sutured or repaired with free skin graft. ResultsAll the flaps survived, and wound healed in first stage. All the cases were followed up 6-36 months (mean, 20 months). The flaps had good color and texture. Three cases underwent secondary surgery of thinning the flaps. At last follow-up, two-point discrimination of flaps was 10-14 mm, 12 mm on average. According to function standard for evaluation of upper extremity with total active motion of the fingers from the Hand Surgery Society of Chinese Medical Association, the results were excellent in 10 cases, and good in 2 cases. ConclusionForearm interosseous dorsal artery perforators sublobe flaps can be used to repair two wounds in the dorsal hand or wrist simultaneously, and it has the advantages of simple operation, less injury at donor site, and reliable blood supply.
The influence on the wrist stability following ulnar head resection (Darrach s procedure)was studied. A series of X-ray films and arthrography of the wrist joint were taken before and after ulnar head re- section. The results showed that after ulnar head resection the radial deviation increased 3 degree(Plt;0.01). and the ulnar deviation 11.92 degree (Plt;0.001). The position of the lunate remained unchanged. Arthrography of the wrist joint demonstrated that 11 specimens had injury of the triangular fibrocartilage.The stability of the wrist joint would no doubt be certainly affected following the ulnar head resction.
Objective To study the blood supply of the distally pediceled composite vascular net flap of forearm and its clinical effect. Methods From February 2000 to December 2003, the distally pediceled composite vascular net flap of forearm was used to repair a series of 26 skin defects with bone or tendon exposure on the hand and wrist.Of 26 patients, there were 17 males and 9 females at ages of 18 to 56 years; 16 received emergency operation and 10 received selective operation. The flap sizes ranged for 10 cm ×5 cm to 18 cm×7 cm. Results Allof the flaps survived. At followup of 3 to 8 months, there was no flap loss, even partial and the outcome was satisfactory in all patients.Twopoint discrimination was 6 to 10 mm. Conclusion Plexus around the cutaneous nerves and the superficial vein are connected with the superficial subdermal plexus and the deep facial plexus by perforators from the underling main arteries, forming a threedimensional vascular network and in a sort of longitudinal axiality, which is the anatomic base of blood supply for the flaps. Blood supply to the flap is provided by the perforators arising from the deeply situated radial or ulnar arteries in the distal pedical. The advantage of this flap is its constant and reliable blood supply without sacrifice of the main artery. The elevation of the flapis simple and rapid, and the flap has a higher survival rate.
wenty-one cases with injurys of upper trunk of brachial plexus in 18 and poliomyelitis in 3were treated by transfer of flexor carpi ulnaris muscle to restore flexion of elbow from may, 1981through November, 1992. There were 16 males and 5 females with an average age of 28 years old(ranged 17-60 years). All of the patients was combined with incompetence of abduction function ofshoulder, 6 cases with incompotence of extenxor function of elbow and 11 cases with incompotence ofsupifiation fu...
OBJECTIVE: To reduce amputation rate of severe electrical burn of wrist and to promote partial recovery of the injuried hand. METHODS: From 1987 to 1999, 44 cases, with 55 limbs of severe electrical burn were classified into 4 types, according to criteria of Dr Shen Zuyao, and were all treated by primary adequate decompression, timely debridement, reconstruction of blood circulation in cases complicated with blood vessel injury, and skin flap grafting from chest, abdomen or inguinal area, followed by treatment of anti-coaggluation and anti-infection. Once the wound healed, auto- or allo-transplantation or transferring of tendons were performed to repair tendon defect, and auto-nerve or fetal nerve transplantation performed for nerve defect. RESULTS: After the primary treatment of the 55 burned limbs, all limbs of type IV were amputated, and most of other 3 types survived. The function, including sensation and movement, of survived hands partially recovered. CONCLUSION: Primary reconstruction of blood circulation, cover of wound with skin flap, and timely repair of sensation and motor function are very crucial approach to reduce amputation rate and to promote the survived hand function of severe electrical burns of wrists.
OBJECTIVE: To introduce the operation method of treatment of nonunion of scaphoid bone by transfer of pedicled radial periosteal bone flap. METHODS: From Match 1986, 26 cases with old nonunion of scaphoid bone were treated by transfer of radial periosteal bone flap pedicled with recurrent branch of radial artery, the size of bone flap was 1.0 cm x 0.4 cm x 0.5 cm. RESULTS: All patients with old nonunion of scaphoid bone were healed by first intention, bone union was occurred after 2 to 3 months of operation, and wrist joint almost recovered normal function. CONCLUSION: It is an effective operation method to treat nonunion of scaphoid bone.