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Annals of the Royal College of Surgeons... May 2016A chordoma is a slow growing malignant tumour of notochordal origin. A tumour with histological features that are identical to those of a chordoma may arise outside the...
INTRODUCTION
A chordoma is a slow growing malignant tumour of notochordal origin. A tumour with histological features that are identical to those of a chordoma may arise outside the axial skeleton. To date, there is little in the literature documenting their clinical course.
METHODS
Our large orthopaedic oncology database was used to document the clinical course of extra-axial chordoma.
RESULTS
Over a 30-year period, 131 patients diagnosed with a chordoma were treated at our unit. Only three (2.3%) of these cases were extra-axial chordomas: one in the femur, one in the ulna and one in the proximal fibula. All underwent surgical resection.
CONCLUSIONS
In view of the rarity of this tumour and the difficulty in confirming its diagnosis, we suggest that any suspected case is discussed with a specialist sarcoma multidisciplinary team so that the correct diagnosis can be achieved and treatment tailored accordingly.
Topics: Adult; Aged; Bone Neoplasms; Chordoma; Fibula; Humans; Male; Middle Aged; Radiography; Ulna
PubMed: 27087325
DOI: 10.1308/rcsann.2016.0138 -
Orthopaedics & Traumatology, Surgery &... Feb 2018The Monteggia injury is defined as radial head dislocation with a fracture of the ulnar shaft. This combination should be sought routinely in patients with ulnar... (Review)
Review
The Monteggia injury is defined as radial head dislocation with a fracture of the ulnar shaft. This combination should be sought routinely in patients with ulnar fractures, even when the displacement is small. The emergent management is simple, as reducing the ulnar fracture is usually sufficient to stabilise the radial head. Internal fixation of the ulna deserves to be widely used to fully stabilise the radial head. Irreducibility of the radial head at the acute stage may indicate an interposition, which requires open surgery on the joint. Radial head dislocation may occur even with minimal displacement of the ulnar fragment. Chronic Monteggia fractures are more challenging to treat and their outcomes are more variable. The radial head becomes irreducible after 2 to 3 weeks. When a simple surgical approach fails to ensure stable reduction, the most widely used method at present is open reduction of the radial head and proximal osteotomy of the ulnar shaft. Stability must be obtained intra-operatively. Without treatment, radial head dislocation may be well tolerated for several months or even years. In the long term, however, osteoarticular remodelling results in loss of joint congruence, pain and, eventually, osteoarthritis. Radiographs must therefore be obtained on an emergency basis and analysed with great care to avoid missing a Monteggia fracture.
Topics: Diagnosis, Differential; Diaphyses; Elbow Joint; Fracture Fixation, Internal; Humans; Monteggia's Fracture; Osteotomy; Radiography; Treatment Outcome; Ulna
PubMed: 29174872
DOI: 10.1016/j.otsr.2017.04.014 -
Veterinary Medicine and Science Nov 2021The forearms of dogs and cats do not only differ anatomically from each other, but there are also differences in prevalence of radius and ulna fractures between the two...
The forearms of dogs and cats do not only differ anatomically from each other, but there are also differences in prevalence of radius and ulna fractures between the two species. The prevalence of antebrachial fractures is 18.0% in dogs and 2.0-8.0% in cats. Many studies focus solely on the trabecular and cortical bone structure of dogs and the characteristics of the cat are often disregarded. The aim of this study was to evaluate the trabecular structure parameters [bone volume fraction per total volume (BV/TV), bone surface per total volume (BS/BV), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), connectivity density (Conn. D), degree of anisotropy (DA)] and the diaphyseal cortical bone density (Mean Density) of the antebrachium in cats and small dogs to visualise their differences. For this purpose, a total of 32 forearms of cats (n = 8) and small dogs (n = 8) were evaluated using microcomputed tomography and the findings were compared. The results of the study showed that cats had higher values for BV/TV, Tb.Th, Tb.Sp, DA and Mean Density and lower values for BS/BV, Tb.N and Conn.D at radius and ulna compared to dogs. According to the results of this study, the higher bone volume fraction (BV/TV), thicker trabeculae (Tb.Th), increased anisotropy (DA) and significantly higher diaphyseal cortical density (Mean Density) could contribute to the lower fracture risk of the antebrachium in cats compared to small dogs.
Topics: Animals; Cat Diseases; Cats; Cortical Bone; Dog Diseases; Dogs; Radius; Ulna; X-Ray Microtomography
PubMed: 34453415
DOI: 10.1002/vms3.619 -
Acta Medica Portuguesa Sep 2021
Topics: Fracture Fixation, Internal; Fractures, Bone; Humans; Ulna; Upper Extremity
PubMed: 34863325
DOI: 10.20344/amp.13444 -
Orthopaedics & Traumatology, Surgery &... Feb 2023Elbow fracture is frequent in children, and often requires surgery. There are many potential sequelae: neurovascular, ligamentous and osseous. Some are liable to be... (Review)
Review
Elbow fracture is frequent in children, and often requires surgery. There are many potential sequelae: neurovascular, ligamentous and osseous. Some are liable to be overlooked, due to young age and the cartilaginous nature of the joint. There is little bone remodeling in the elbow and displacement fracture, and especially supracondylar or lateral condyle fracture, has to be corrected rigorously, notably in older children. In case of lateral tilt in fracture of the neck of the radial head, on the other hand, remodeling is effective. Deformity in cubitus varus and cubitus valgus leads to neurological lesions and instability. Treatment should be early, with adapted surgery in expert hands. Post-traumatic stiffness is rare. Early intensive physiotherapy is unsuited to children and could worsen the stiffness due to inflammation. Lateral condyle non-union is a classic complication of fracture. Simple percutaneous screwing is a useful option. The equivalent in the medial epicondyle is well-tolerated, and simple monitoring now suffices. Late posterolateral rotational instability is a poorly known complication. It should be considered in case of cubitus varus that becomes painful after a long asymptomatic course. Radiocapitellar subluxation is seen on X-ray. Residual radial head dislocation after primary treatment (Monteggia lesion) responds well to the Bouyala technique of ulnar flexion osteotomy associated to annular ligament repair, without requiring ligament reconstruction.
Topics: Child; Humans; Elbow Fractures; Fractures, Bone; Elbow Joint; Ulna; Joint Dislocations
PubMed: 36302449
DOI: 10.1016/j.otsr.2022.103454 -
Hand (New York, N.Y.) Sep 2020The primary purpose of our study was to identify factors associated with reoperation after ulna shortening osteotomy. Our secondary aims were to determine the rate and...
The primary purpose of our study was to identify factors associated with reoperation after ulna shortening osteotomy. Our secondary aims were to determine the rate and type of reoperation procedures. In this retrospective study, we included patients older than 18 years of age who underwent an ulna shortening osteotomy between January 2003 and December 2015. Medical records of patients were assessed for our explanatory variables, reoperations, and reporting of symptoms. We used bivariate and multivariable analyses to identify factors associated with reoperation after ulna shortening osteotomy. Among 94 patients who underwent 98 ulna shortening osteotomies, there were 34 reoperations (35%). Nineteen patients (19%) underwent removal of hardware, 6 (6.1%) had a nonunion, and 9 (9.2%) underwent additional surgeries. Surgery on their dominant limb, trauma, and prior surgery to the ipsilateral wrist were associated with reoperation. In multivariable analysis, factors independently associated with reoperation were the dominant side being affected (odds ratio = 3.9; 95% confidence interval [CI] = 1.36-11) and traumatic origin (odds ratio = 3.4; 95% CI = 1.1-11). Bivariate analysis identified younger age and prior surgery of the affected wrist as factors associated with hardware removal. More operations for refixation due to nonunion of osteotomy were performed in patients with a transverse osteotomy compared with patients with an oblique osteotomy. One in 3 patients will undergo a reoperation after ulna shortening osteotomy, most often due to hardware irritation or nonunion of osteotomy. Awareness of these rates and predictive factors may be helpful for preoperative discussions and surgical decision making.
Topics: Humans; Osteotomy; Reoperation; Retrospective Studies; Ulna; Wrist Joint
PubMed: 30845843
DOI: 10.1177/1558944719828004 -
Current Osteoporosis Reports Feb 2020This review updates readers on recent developments in the assessment of cortical bone fragility in vivo. The review explains the clinical need that motivated the... (Review)
Review
PURPOSE OF REVIEW
This review updates readers on recent developments in the assessment of cortical bone fragility in vivo. The review explains the clinical need that motivated the development of Cortical Bone Mechanics Technology™ (CBMT) as a scientific instrument, its unique capabilities, and its necessary further development as a medical device.
RECENT FINDINGS
Clinical experience with dual-energy X-ray absorptiometry has led to calls for new clinical methods for assessing bone health. CBMT is a noninvasive, dynamic 3-point bending test that makes direct, functional measurements of the mechanical properties of cortical bone in ulnas of living people. Its technical validity in accurate measurements of ulna flexural rigidity and its clinical validity in accurate estimations of quasistatic ulna bending strength have been demonstrated. Because CBMT is a whole bone test, its measurements reflect the influences of bone quantity and bone quality at all hierarchical levels.
Topics: Absorptiometry, Photon; Biomechanical Phenomena; Cortical Bone; Flexural Strength; Humans; Ulna; Weight-Bearing
PubMed: 32088857
DOI: 10.1007/s11914-020-00558-7 -
The Journal of Hand Surgery, European... Dec 2023Ulnar dimelia is a very rare unilateral congenital upper limb anomaly (CULA) affecting the whole extremity. Treatment remains difficult because of the complexity and... (Review)
Review
Ulnar dimelia is a very rare unilateral congenital upper limb anomaly (CULA) affecting the whole extremity. Treatment remains difficult because of the complexity and multi-level involvement. Twenty-four cases with duplicated ulna, absent radius and polydactyly from seven European centres were reviewed according to a structured list of parameters. At first consultation, median age 8 months (1-178), the shoulder movement was good in 17 patients or poor in six, and the median passive elbow range of motion was 20° (0°-90°). The resting wrist position was flexed in 22/24 patients. Following stretching and splinting, elbow surgery included resection of the lateral proximal ulna in 11 patients and muscle transfers in six to improve passive movement and increase active elbow motion, respectively. Tendon transfers were performed in eight wrists and a pollicization or pseudo-pollicization in 23 patients. Overall, patients demonstrate acceptable function postoperatively. Guidelines for treatment of this severe CULA are presented. IV.
Topics: Humans; Hand Deformities, Congenital; Ulna; Polydactyly; Wrist Joint; Upper Extremity; Radius
PubMed: 37684016
DOI: 10.1177/17531934231196418 -
Acta Orthopaedica Et Traumatologica... Jan 2019The aim of this study was to discuss the diagnosis and surgical management and their results according to stage of primary bone tumors at ulna and to share our...
OBJECTIVE
The aim of this study was to discuss the diagnosis and surgical management and their results according to stage of primary bone tumors at ulna and to share our experience on this exceptional location for bone tumors.
METHODS
We have retrospectively reviewed our clinics database and identified 23 cases (14 males and 9 females, mean age was 28.9 (range 4-77)) with primary bone tumors and tumor like lesion involvement of ulna. The patients were evaluated according to complaints, type and grade of tumor, treatment, recurrence and functional status.
RESULTS
The most common first referral complaint was constrictive pain in 52.1% of the cases, benign tumors and tumor like lesions of the bone constituted 73.9% whereas malignant bone tumors were 26.1%, 39.1% of the lesions were located in distal end of ulna and the mean follow up was 33.8 months (range 8-172 months). Local recurrence has unexpectedly occurred in 3 benign lesions (13.1%).
CONCLUSION
Benign bone lesions tend to involve distal and proximal ends, malign bone lesions involve diaphysis mostly. Both benign and malignant diaphyseal lesions of the ulna have better postoperative results regarding the lesions at both ends of ulna. One should also take care of recurrences even after a decade from the primary surgery.
LEVEL OF EVIDENCE
Level IV, Therapeutic study.
Topics: Adult; Bone Neoplasms; Diaphyses; Female; Humans; Male; Neoplasm Recurrence, Local; Neoplasm Staging; Orthopedic Procedures; Postoperative Complications; Retrospective Studies; Turkey; Ulna
PubMed: 29773449
DOI: 10.1016/j.aott.2018.04.005 -
Journal of Orthopaedic Surgery and... Sep 2016Hand and wrist injuries are common during athletics and can have a significant impact especially if initially disregarded. Due to their high level of physical demand,... (Review)
Review
BACKGROUND
Hand and wrist injuries are common during athletics and can have a significant impact especially if initially disregarded. Due to their high level of physical demand, athletes represent a unique subset of the population.
MAIN BODY
The following is an overview of hand and wrist injuries commonly seen in athletics. Information regarding evaluation, diagnosis, conservative measures, and surgical treatment are provided.
CONCLUSION
Knowledge of these entities and special consideration for the athlete can help the team physician effectively treat these players and help them achieve their goals.
Topics: Athletic Injuries; Cartilage, Articular; Fractures, Bone; Hand Injuries; Humans; Ligaments, Articular; Metacarpal Bones; Return to Sport; Rupture; Scaphoid Bone; Tendinopathy; Ulna; Wrist Injuries
PubMed: 27633260
DOI: 10.1186/s13018-016-0432-8