DOS BULLETIN - Dansk Ortopædisk Selskab
DOS BULLETIN - Dansk Ortopædisk Selskab DOS BULLETIN - Dansk Ortopædisk Selskab
2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 84 Corrective osteotomy for malunion of the distal radius fractures. A retrospective study I.A El-Mansour, G.H Kejlaa, H. Thromborg Department for Orthopedic Surgery, Odense University Hospital, Svendborg Background: Malunion is one of the most common complications of distal radius fractures which causes significant disturbance of wrest function due to limited wrest motion and pain. Corrective osteotomy of malunited distal radius is often registered postoperatively functional and radiological improving. Purpose: This study presents the clinical and radiological outcome in a case series of 20 patients with corrective osteotomy for malunion of the distal radius fractures which was performed in the period 1th January 2007 – 4th December 2007. Methods: Patients with pain, movement and functional problems were corrected with open wedge bi-or tri planner osteotomy of the radius, mostly radiopalmar approach and with interposition of corticocancellous bone autograft from the iliac crest. The osteotomy was fixed by AO-T plates and screws. At followup period, the objective pain status, joint movement and functional evaluation of the wrist were performed according to Fernandez Scale. The post surgical radiographs status and wrist complications were assessed. Findings: Pain: (Excellent – none, Good – none, Fair – moderate during exercise, poor – constant) 12 ptt. – none pain, 5 ptt. – moderate pain, 3 ptt. constant pain, total no – 20 Range of movement: (per cent of normal – full 100%, 65-100 %, 40- 64 %, 0-39 %) 4 ptt. – full, 7 ptt. > 65 %, 8 ptt. 40-64 %, 1 ptt. < 40 %, total no 20 Grip strength: (per cent of normal – 80-100 %, 70-80 %, 50-70 %) 4 ptt. > 80 %, 13 ptt. 70-80 %, 3 ptt. >50 %, total no 20 Deformity: 15 ptt. invisible, 5 ptt. slight. The average joint movement was improved in all cases . Average movement in degrees: DF - 59, VF - 58, RD - 17, UD - 30, P - 68, S – 67 Normal: DF – 80, VF – 80, RD – 30, UD – 40, P – 90, S – 90 The average radiographic appearance in degrees before and after correction. Before: DA 23,5, VA 23,7, UPV mm 10, RI 12,1 After: DA 10,0, VA 10,0, UPV mm
2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 85 Does Arthroscopic Release (AR) of the Subscapularis Muscle and open transfer of the Latissimus Dorsi Muscle improve daily function in Obstetrical Brachial Plexus Lesions (OBPL) K. Daubjerg, L. H. Frich, S. Jepsen Orthopaedic Dep., Odense University Hospital Background: OBPL is a traction neural injury sustained during the course of birth process. As is the case in any closed peripheral nerve injury, severity can fall within a wide spectrum and is the key determinant of prognosis and the need for intervention. These lesions leave secondary sequelae in the joints and muscles as contractions and muscles weakness. Purpose: The purpose of this study was to evaluate the clinical outcome after AR of the subscapularis muscle, and open transfer of the latissimus dorsi muscle. Methods: 21 ptt. (9 boys), aged 5,7 years (0 – 10) were operate on (2004 – 2007). 13 ptt. had AR with partial tenotomy of the subscapularis and decompression of the coracoid, and 8 patients also had a concomitant open transfer of the latissimus dorsi muscle. Evaluation was according to the Mallet score. Additionally, active ext. rot. of the upper arm was evaluated. Findings: Follow-up period was 23-66 months. AR was successful in achieving approx. 40° of ext. rot. (41.6° in the arthroscopy group and 38.1° in the second group). Mean improvement Mallet score was 3.2 (1.2-5.3) in the arthroscopic group and 2.9 (0.8-4.9) in the group which also had a muscle transfer. The mean post-OP Mallet Score (a scale from 5 – 15) and external rotation in adduction showed an improvement in daily function. No complications were recorded. Conclusion: Our technique of partial tenotomy of the subscapularis tendon and rotator interval decompression, gives results comparable to open techniques, and with a much lower morbidity. The improvements in Mallet score and active ext. rot. in adduction was significant in both groups. The indication of the concomitant muscle transfers is not clear and demands further investigation. 85
- Page 33 and 34: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 35 and 36: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 37 and 38: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 39 and 40: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 41 and 42: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 43 and 44: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 45 and 46: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 47 and 48: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 49 and 50: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 51 and 52: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 53 and 54: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 55 and 56: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 57 and 58: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 59 and 60: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 61 and 62: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 63 and 64: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 65 and 66: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 67 and 68: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 69 and 70: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 71 and 72: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 73 and 74: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 75 and 76: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 77 and 78: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 79 and 80: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 81 and 82: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 83: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 87 and 88: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 89 and 90: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 91 and 92: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 93 and 94: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 95 and 96: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 97 and 98: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 99 and 100: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 101 and 102: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 103 and 104: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 105 and 106: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 107 and 108: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 109 and 110: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 111 and 112: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 113 and 114: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 115 and 116: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 117 and 118: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 119 and 120: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 121 and 122: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 123 and 124: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 125 and 126: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 127 and 128: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 129 and 130: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 131 and 132: 2010-378_DOS nr. 3 2010 29/09/10 10
- Page 133 and 134: 2010-378_DOS nr. 3 2010 29/09/10 10
2010-378_<strong>DOS</strong> nr. 3 2010 29/09/10 10:08 Side 85<br />
Does Arthroscopic Release (AR) of the Subscapularis<br />
Muscle and open transfer of the Latissimus Dorsi<br />
Muscle improve daily function in Obstetrical Brachial<br />
Plexus Lesions (OBPL)<br />
K. Daubjerg, L. H. Frich, S. Jepsen<br />
Orthopaedic Dep., Odense University Hospital<br />
Background: OBPL is a traction neural injury sustained during the<br />
course of birth process. As is the case in any closed peripheral nerve<br />
injury, severity can fall within a wide spectrum and is the key determinant<br />
of prognosis and the need for intervention. These lesions leave secondary<br />
sequelae in the joints and muscles as contractions and muscles<br />
weakness.<br />
Purpose: The purpose of this study was to evaluate the clinical outcome<br />
after AR of the subscapularis muscle, and open transfer of the latissimus<br />
dorsi<br />
muscle.<br />
Methods: 21 ptt. (9 boys), aged 5,7 years (0 – 10) were operate on (2004<br />
– 2007). 13 ptt. had AR with partial tenotomy of the subscapularis and<br />
decompression of the coracoid, and 8 patients also had a concomitant<br />
open transfer of the latissimus dorsi muscle. Evaluation was according<br />
to the Mallet score. Additionally, active ext. rot. of the upper arm was<br />
evaluated.<br />
Findings: Follow-up period was 23-66 months. AR was successful in<br />
achieving approx. 40° of ext. rot. (41.6° in the arthroscopy group and<br />
38.1° in the second group). Mean improvement Mallet score was 3.2<br />
(1.2-5.3) in the arthroscopic group and 2.9 (0.8-4.9) in the group which<br />
also had a muscle transfer. The mean post-OP Mallet Score (a scale from<br />
5 – 15) and external rotation in adduction showed an improvement in<br />
daily function. No complications were recorded.<br />
Conclusion: Our technique of partial tenotomy of the subscapularis tendon<br />
and rotator interval decompression, gives results comparable to<br />
open techniques, and with a much lower morbidity. The improvements in<br />
Mallet score and active ext. rot. in adduction was significant in both<br />
groups. The indication of the concomitant muscle transfers is not clear<br />
and demands further investigation.<br />
85
Change language