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      Reconstruction of malunited diaphyseal fractures of the forearm

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          Abstract

          The forearm is a complex anatomical and functional unit with unique osseous, soft tissue and articular relationships. Disruption of these important relations can have a significant impact, leading to pain, instability of the radio-ulnar articulation and reduced range of motion. The gold standard for treating forearm fractures in adults remains anatomic reduction, stable plate fixation and preservation of the surrounding blood supply. Failure to achieve these goals may lead to malunion, requiring reconstructive surgery, which can be technically challenging. In this review, we discuss the essential aspects of anatomy and pathomechanics, clinical and radiological assessment and the state of the art in pre-operative planning and deformity correction surgery.

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          Most cited references56

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          A biomechanical study of normal functional elbow motion.

          Maegan Askew, Chi-Yang Chao, B Morrey (1981)
          We studied thirty-three normal patients, eighteen women and fifteen men, for normal motion and the amount of elbow motion required for fifteen activities of daily living. The amounts of elbow flexion and forearm rotation (pronation and supination) were measured simultaneously by means of an electrogoniometer. Activities of dressing and hygiene require elbow positioning from about 140 degrees of flexion needed to reach the occiput to 15 degrees of flexion required to tie a shoe. Most of these activities are performed with the forearm in zero to 50 degrees of supination. Other activities of daily living (such as eating, using a telephone, or opening a door) are accomplished with arcs of motion of varying magnitudes. Most of the activities of daily living that were studied in this project can be accomplished with 100 degrees of elbow flexion (from 30 to 130 degrees) and 100 degrees of forearm rotation (50 degrees of pronation and 50 degrees of supination). These data, not previously recorded, may be used to provide an objective basis for the determination of disability impairment, to determine the optimum position for elbow splinting or arthrodesis, and to assist in the design of elbow prostheses. The motion needed to perform essential daily activities is obtainable with a successful total elbow arthroplasty.
          Article 0 comments Cited 159 times – based on 0 reviews     Review now
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            Three-dimensional corrective osteotomy of malunited fractures of the upper extremity with use of a computer simulation system.

            Hisao Moritomo, Akira Goto, Tsuyoshi Murase … (2008)
            Three-dimensional anatomical correction is desirable for the treatment of a long-bone deformity of the upper extremity. We developed an original system, including a three-dimensional computer simulation program and a custom-made surgical device designed on the basis of simulation, to achieve accurate results. In this study, we investigated the clinical application of this system using a corrective osteotomy of malunited fractures of the upper extremity. Twenty-two patients with a long-bone deformity of the upper extremity (four with a cubitus varus deformity, ten with a malunited forearm fracture, and eight with a malunited distal radial fracture) participated in this study. Three-dimensional computer models of the affected and contralateral, normal bones were constructed with use of data from computed tomography, and a deformity correction was simulated. A custom-made osteotomy template was designed and manufactured to reproduce the preoperative simulation during the actual surgery. When we performed the surgery, we placed the template on the bone surface, cut the bone through a slit on the template, and corrected the deformity as preoperatively simulated; this was followed by internal fixation. All patients underwent radiographic and clinical evaluations before surgery and at the time of the most recent follow-up. A corrective osteotomy was achieved as simulated in all patients. Osseous union occurred in all patients within six months. Regarding cubitus varus deformity, the humerus-elbow-wrist angle and the anterior tilt of the distal part of the humerus were an average of 2 degrees and 28 degrees, respectively, after surgery. Radiographically, the preoperative angular deformities were nearly nonexistent after surgery. All radiographic parameters for malunited distal radial fractures were normalized. The range of forearm rotation in patients with forearm malunion and the range of wrist flexion-extension in patients with a malunited distal radial fracture improved after surgery. Corrective osteotomy for a malunited fracture of the upper extremity with use of computer simulation and a custom-designed osteotomy template can accurately correct the deformity and improve the clinical outcome.
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              Compression-plate fixation in acute diaphyseal fractures of the radius and ulna.

              R Tooms, T D Sisk, Rozalyn Anderson … (1975)
              At the Campbell Clinic and City of Memphis Hospital from 1960 to 1970, 244 patients (216 with closed and twenty-eight with open fractures) had 330 acute diaphyseal fractures of the radius and ulna which were treated with ASIF compression plates and followed for from four months to nine years. One hundred and twelve patients had fractures of both bones of the forearm; fifty, single fractures of the ulna; and eighty-two, single fractures of the radius. In all, 193 fractures of the radius and 137 fractures of the ulna were treated by compression plating. Sixty-three patients (25.9 per cent) with severely comminuted fractures also had iliac-bone grafts. The over-all rate of union for the radius was 97.9 per cent and for the ulna, 96.3 per cent. ASIF compression plates, therefore, provided a successful method for obtaining union and restoring optimum function after acute diaphyseal fractures of the forearm.
              Article 0 comments Cited 43 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jesse B Jupiter: +1-617-7264700 , +1-617-7248532 , jjupiter1@partners.org
                Journal
                Journal ID (nlm-ta): Hand (N Y)
                Journal ID (iso-abbrev): Hand (N Y)
                Title: Hand (New York, N.Y.)
                Publisher: Springer US (Boston )
                ISSN (Print): 1558-9447
                ISSN (Electronic): 1558-9455
                Publication date (Electronic): 1 May 2014
                Publication date PMC-release: 1 May 2014
                Publication date (Print): September 2014
                Volume: 9
                Issue: 3
                Pages: 265-273
                Affiliations
                The Hand and Upper Extremity Service, Massachusetts General Hospital and Harvard Medical School, 55, Fruit Street, Boston, MA 02114 USA
                Article
                Publisher ID: 9635
                DOI: 10.1007/s11552-014-9635-9
                PMC ID: 4152429
                PubMed ID: 25191155
                SO-VID: 4006d025-9827-43a1-8c6b-062cbe221034
                Copyright © © The Author(s) 2014
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

                History
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © American Association for Hand Surgery 2014

                ScienceOpen disciplines: Orthopedics
                Keywords: forearm,fracture,malunion,malunited,diaphysis,diaphyseal,reconstruction,deformity,correction,osteotomy
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: forearm, fracture, malunion, malunited, diaphysis, diaphyseal, reconstruction, deformity, correction, osteotomy

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