lectrophysiological examination was used in 15 cases of cubital tunnel syndrome before andduring opcration. The velocity, latency and amplitude of the conduction of the ulnar nerve 5cm aboveand below the elbew joint were measured by surface electrodes and direct stimulation. There is nosignificant difference(Pgt; 0.5 )between the results from the two kinds of testing. After the ulnarnerve was decompressed from the cubital tunnel, the conduction velocity increased by 50%, latency shortenee by 40%, the improvement in conduciton velocity being particularly significant(P lt; 0.02). which show that conduction velocity is a relatively sensitive testing parameter. Electrophysiological examination plays a monitoring role during cubital tunnel syndrome decompression.
ObjectiveTo study the effectiveness of anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle in the treatment of severe cubital tunnel syndrome. MethodsBetween March 2006 and May 2015, 22 cases (23 hands) of severe cubital tunnel syndrome were treated by use of anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle. There were 15 males and 7 females, aged 45-60 years (mean, 55 years). The causes were valgus deformity of elbow joint in 12 cases, ulnar nerve subluxation in 4 cases, and osteoarthritis in 6 cases. The disease duration was 10 months to 3 years (mean, 17 months). According to Akahori classification, 14 cases were rated as type 4 and 9 cases as type 5. The ring/little finger's numbness, hand intrinsic muscle atrophy, recovery of thumb adduction function, and improvement of claw hand deformity were observed after operation. Thumb and index finger's pinch strength was measured by use of pinch device; postoperative hand function was evaluated by the standards of Chinese Medical Society of Hand Surgery of upper limb assessment protocol. ResultsAll incisions healed well and all cases were successfully followed up 8 to 24 months (mean, 14 months). Numbness of ring/little finger was significantly reduced at 1 day after operation in 10 hands; numbness disappeared completely at 1 month after operation in 12 hands; mild numbness remained at 14 months after operation in 11 hands. At last follow-up, hand intrinsic muscle atrophy partially improved (+++) in 1 hand, no improvement in 22 hands; improvement of claw hand deformity was achieved in 17 hands, no improvement in 6 hands; pinch strength of thumb and index finger was significantly improved to (5.07±1.11) kg from preoperative (2.91±0.63) kg (t=-12.340, P=0.032). At last follow-up, the results were excellent in 11 hands, good in 8 hands, fair in 3 hands, and poor in 1 hand, and the excellent and good rate was 82.6%. ConclusionAnterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle is a simple, effective, and reliable surgical treatment for severe cubital tunnel syndrome.
ObjectiveTo explore the surgical method and its clinical efficacy for complicated proximal ulnar fracture. MethodsFrom February 2006 to July 2014, 22 patients with complicated proximal ulnar fracture were treated by open reduction with internal fixation. There were 17 males and 5 females with an average age of 32 years. According to AO classification, there were 4 cases of type C1, 13 of type C2, and 5 of type C3. Among the, there were 4 cases combined with posterior elbow dislocation, 2 cases combined with anterior elbow dislocation, and there were 2 Monteggia Ⅳ cases. Nineteen cases were close fractures, and the other 3 were open fractures. Nerve and vessel injury was not found in all cases. The time before operation was 7 to 12 days, with an average of 8 days. All patients were treated with open reduction and internal fixation. Mayo standard for evaluation of elbow joint was used to evaluate the therapeutic effect after operation. ResultsAll the patients were followed up from 8 to 18 months, with an average of 14 months. All fractures were completely healed. The healing time ranged from 12 to 30 weeks averaging 16 weeks. No failure of internal fixation occurred; no elbow anchyloses or instability occurred. The range of motion of elbow joint was between 120° and 140°, with an average of 135°. Mayo elbow score showed that 16 cases were excellent, 4 good, and 2 fair with an excellent and good rate of 90.9%. ConclusionEarly surgical treatment and rehabilitative training can facilitate satisfactory effects on complicated proximal ulnar fracture.
ObjectiveTo systematically review the effects of associated ulnar styloid fracture on the prognosis of distal radius fracture. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 5 2013), CNKI, CBM and WanFang Data were searched up to May 2013 for collecting cohort studies about the effects of associated ulnar styloid fracture on the prognosis of distal radius fracture. According to the inclusion and exclusion criteria, related cohort studies were screened, data were extracted and cross-checked, and quality of included studies was independently evaluated by two reviewers. Meta-analysis was then conducted using RevMan 5.2 software. ResultsA total of 9 studies involving 1 020 patients were included. The results of meta-analysis showed that there was no significant difference in GartlandWerley score between patients with ulnar styloid fracture or not. Statistical significant difference was found in DASH score between the two groups (MD=2.71, 95% CI 0.26 to 5.16, P=0.03), which indicated that patients with ulnar styloid fracture got higher score in DASH score. ConclusionCurrent evidence shows that ulnar styloid fracture may affect the prognosis of patients with distal radius fracture. Due to the quality and quantity limitation of the included studies, the above conclusion needs to be further verified by more high quality studies in future.
Objective To investigate the anatomical evidence of low end-to-side anastomosis of median nerve and ulnar nerve in repair of Dejerine Klumpke type paralysis or high ulnar nerve injury. Methods Twelve formaldehyde anticorrosion specimens (24 sides) and 3 fresh specimens (6 sides) were observed. There were 9 males (18 sides) and 6 females(12 sides). The specimen dissected under the microscope. S-shape incision was made at palmar thenar approaching ulnar side, the profundus nervi ulnaris and superficial branch of ulnar nerve were separated through near end of incision, and the recurrent branch of median nerve and comman digital nerve of the ring finger were separated through far end of incision. The distances from pisiform bone to the start point of the recurrent branch of median nerve, and to the start point of comman digital nerve of the ring finger were measured. The width and thickness of the profundus nervi ulnaris and superficial branch of ulnar nerve, and the recurrent branch of median nerve and comman digital nerve of the ring finger were measured, and the cross-sectional area was calculated. The number of nerve fiber was determined with HE staining and argentaffin staining. Results The crosssectional area and the number of nerve fiber were (2.46 ± 1.03) mm2 and 1 305 ± 239 for the profundus nervi ulnaris, (2.62 ± 1.75) mm2 and 1 634 ± 343 for the recurrent branch of median nerve, (1.60 ± 1.39) mm2 and 1 201 ± 235 for the superficial branch of ulnar nerve, and (2.19 ± 0.89) mm2 and 1 362 ± 162 for the comman digital nerve of the ring finger. There were no significant differences (P gt; 0.05) in the cross-sectional area and the number of nerve fiber between the profundus nervi ulnaris and the recurrent branch of median nerve, between the superficial branch of ulnar nerve and the comman digital nerve of the ring finger; and two factors had a l inear correlation (P lt; 0.05) with correlation coefficients of 0.68, 0.66 and 0.56, 0.36. The distances were (36.98 ± 4.93) mm from pisiform bone to the start point of the recurrent branch of median nerve, and (28.35 ± 6.63) mm to the start point of comman digital nerve of the ring finger. Conclusion Low end-to-side anastomosis of median nerve and ulnar nerve has perfect match in the cross-sectional area and the number of nerve fiber.
ObjectiveTo investigate the effectiveness of a modified anteromedial approach in the treatment of ulnar coronoid process fracture.MethodsBetween February 2017 and July 2018, 15 patients with ulna coronoid process fracture were reviewed. There were 9 males and 6 females, with an average age of 42.3 years (range, 24-60 years). The causes of injury included falling in 10 cases and traffic accidents in 5 cases, all cases were closed injury. According to the O’Driscoll classification, there were 4 cases of type Ⅰ, 6 cases of type Ⅱ, and 5 cases of type Ⅲ. The time from injury to operation was 2-8 days (mean, 3.7 days). All fractures were treated via a modified anteromedial approach between the pronator teres and the flexor carpi radialis plus with partial incision of flexor tendon aponeurosis. The fracture healing, muscle strength of forearm, postoperative complications were observed. At last follow-up, the elbow mobility were measured, the function of elbow was evaluated by Mayo elbow performance score (MEPS).ResultsAll cases were followed up 10-18 months (mean, 13.3 months). Fracture union was achieved in all patients with a mean time of 10 weeks (range, 8-14 weeks). No obvious decrease of hand grip strength, nerve injury, and infection occurred. One patient had slight heterotopic ossification without special treatment. At last follow-up, all patients had stable elbows with good flexion-extension and varus-valgus stability, the mean flexion was 123.3° (range, 100°-140°), mean extension loss compared with that before operation was 6.7° (range, 0°-20°), mean pronation was 76.0° (range, 60°-85°), and mean supination was 75.8° (range, 55°-90°). The MEPS score was 65-100 (mean, 90.3) with the result of excellent in 10 cases, good in 4 cases, and fair in 1 case.ConclusionThe treatment of ulnar coronoid process fracture via the modified anteromedial approach provides excellent exposure, minimal invasion, fewer complications, and satisfactory prognosis, which is conducive to elbow joint function recovery.
ObjectiveTo explore the effectiveness of modified Ilizarov semi-ring external fixator combined with an ulnar osteotomy lengthening in the treatment of old dislocation of the radial head in children. MethodsA retrospective analysis was made on the data of 14 patients with old dislocation of the radial head treated by the modified Ilizarov semi-ring external fixator combined with ulnar osteotomy lengthening between March 2012 and January 2015. The age ranged from 2 to 13 years (mean, 7.2 years), including 12 boys and 2 girls. There was 1 case of congential dislocation of the radial head and 13 cases of old Monteggia fracture. According to the Bado's classification, dislocation was rated as grade Ⅰ in 12 cases and grade Ⅲ in 2 cases. The elbow flexion-extension and forearm pronation and supination were compared between at pre- and post-operation; Mackay evaluation standard of elbow joint function was used to evaluate the effectiveness. ResultsThe operation time ranged from 50 to 65 minutes (mean, 58 minutes). All patients were followed up 6-33 months (mean, 21 months). No complication of infection, myositis ossificans, or redislocation occurred. X-ray film showed bony healing at ulnar osteotomy site within 82-114 days (mean, 90 days). The elbow flexion-extension and forearm pronation and supination were significantly improved at postoperation when compared with preoperation (P<0.05). The results of Mackay function assessment were excellent in 12 cases and good in 2 cases. ConclusionThe modified Ilizarov semi-ring external fixator combined with an ulnar osteotomy lengthening has the advantages of small incision, easy removal of fixator, satisfactory reduction, and no nonunion at ulnar osteotomy site in the treatment of old dislocation of the radial head, but the long-term effectiveness still needs to be followed up.
Objective To investigate the blood supply of the ulnar nerve in the elbow region and to design the procedure of anterior transposition of ulnar nerve accompanied with arteries for cubital tunnel syndrome.Methods The vascularity of the ulnar nerve was observed and measured in20adult cadaver upper limb specimens. And the clinical surgical procedure was imitated in 3 adult cadaver upper limb specimens. Results There were three major arteries to supply the ulnar nerve at the elbow region: the superior ulnar collateral artery, the inferior ulnar collateral artery and the posterior ulnar recurrent artery. The distances from arterial origin to the medial epicondyle were 14.2±0.9, 4.2±0.6 and 4.8±1.1 cm respectively. And the total length of the vessels travelling alone with the ulnar nerve were 15.0±1.3,5.1±0.3 and 5.6±0.9 cm. The external diameter of the arteries at the beginning spot were 1.5±0.5, 1.2±0.3 and 1.4±0.5 mm respectively. The perpendicular distance of the three arteries were 1.2±0.5,2.7±0.9 and 1.3±0.5 cm respectively.Conclusion It is feasible to perform anterior transposition of the ulnar nerve accompanied with arteries for cubital tunnel syndrome. And the procedure preserves the blood supply of the ulnar nerve following transposition.
Objective To observe the effectiveness of reduction and fixation by the improved elbow anteromedial approach in treatment of ulna coronoid process fracture. Methods Between January 2010 and December 2014, 13 patients with the ulna coronoid process fracture were treated with reduction and fixation by the improved elbow anteromedial approach. There were 10 males and 3 females with an average age of 37.2 years (range, 18-57 years). Five cases were caused by traffic accident, 7 cases by falling injury from height, and 1 case by object impact injury. Seven cases were the terrible triad of the elbow, 4 cases were the ulna coronoid process and radial head fractures, 1 case was the proximal radius and ulna fractures, and 1 case was the ulna coronoid process and distal radius fractures. According to Regan-Morrey classification criteria, the ulna coronoid process fracture was rated as type Ⅱ in 2 cases and as type Ⅲ in 11 cases. According to O’Driscoll classification criteria, 10 of the 13 cases were anterior coronoid fracture (8 cases of type Ⅱb, 2 of type Ⅱc), and 3 of basal fracture. The operation time, amount of intraoperative bleeding, postoperative complications, range of motion (ROM) of the elbow joint, Mayo elbow function index (MEPI) score and fracture healing time were recorded. Results The average operation time was 38.7 minutes (range, 30-55 minutes), and the average amount of intraoperative bleeding was 109.3 mL (range, 90-160 mL). All incisions healed at stage Ⅰ. There was no iatrogenic vascular or nerve injury. All patients were followed up 13-24 months (mean, 16.9 months). All fractures achieved clinical healing. The average healing time was 11.2 weeks (range, 8-16 weeks). There were 2 cases of heterotopic ossification. At last follow-up, the ROM of elbow flexion was 119-145° (mean, 132.4°); the ROM of elbow extension was –8-15° (mean, 7°). The ROM of forearm pronation was 68-90° (mean, 78.6°), and the ROM of forearm supination was 76-90° (mean, 84.3°). At last follow-up, the MEPI score was 70-100; and 9 cases were excellent, 3 cases were good, and 1 case was fair. The excellent and good rate was 92.3%. Conclusion Improved elbow anteromedial approach for the ulna coronoid process fracture can not only avoid the injuries of surrounding blood vessels and nerves, but also perform fracture reduction and fixation under direct vision. It is a safe, simple, and effective treatment method for the ulna coronoid process fracture.
In the repair of the defect of peripheral nerve, it was necessary to find an operative method with excellent therapeutic effect but simple technique. Based on the experimental study, one case of old injury of the ulnar nerve was treated by end-to-side neurorraphy with the intact median nerve. In this case the nerve defect was over 3 cm and unable to be sutured directly. The patient was followed up for fourteen months after the operation. The recovery of the sensation and the myodynamia was evaluated. The results showed that: the sensation and the motor function innervated by ulnar nerve were recovered. The function of the hand was almost recovered to be normal. It was proved that the end-to-side neurorraphy between the distal stump with the intact median nerve to repair the defect of the ulnar nerve was a new operative procedure for nerve repair. Clinically it had good effect with little operative difficulty. This would give a bright prospect to repair of peripheral nerve defect in the future.