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
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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