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Discrepancies of Length in the Forearm
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
Christopher Prior, Nicholas Peterson, Selvadurai Nayagam
On examination, the forearm was short, the wrist was radially deviated, and the head of the ulna was unduly prominent. Ulnar deviation of the wrist and pronation and supination were reduced. X-rays confirmed relative shortening of the radius, loss of radial inclination of the distal articular surface and a physeal bar. CT images revealed an accessible central physeal bar of the distal radius involving 20% of the physis (Figure 40.2).
Physical Examination of the Hand
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
To begin with, the swan-neck deformity is reducible, but the deformity becomes fixed if neglected or untreated. Various factors contribute to the swan-neck deformities:Articular: Fractures, dislocations at the PIP joints.Interosseous muscle contractures (volar subluxation of the proximal phalanx brings the interosseous tendons dorsal to the MCP joint axis directing the extensor force to the extensor apparatus culminating in a swan-neck deformity).Chronic flexion wrist deformity.Extensor digitorum communis (EDC) injury proximal to MCP joint.Ulnar deviation of the fingers
Hands
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Ulnar deviation is caused by normal use/anatomical predispositions: Thumb pressure during pinch gripUlnar inclination of MC headsADM action as a strong ulnar deviator
Surgical fixation techniques in four-corner fusion of the wrist: a systematic review of 1103 cases
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Octavian Andronic, Raffael Labèr, Philipp Kriechling, Daniel Karczewski, Andreas Flury, Ladislav Nagy, Andreas Schweizer
All 29 studies reported ROM either as total flexion–extension arc or with single values for flexion and extension. Two studies reported their values as percentage of the contralateral side and were excluded in the calculation performed but reported in Table 3. Total flexion-extension arc in the locking plate group was 63° (range 48 − 79°), non-locking plates 62° (range 52 − 78°), compression screws 53° (range 49 − 57°), staples 64° (range 60 − 68°) and k-wire 68° (range 45 − 80°), respectively. Radial- and ulnar deviation was reported in 24 studies. Two of them reported values as percentage of contralateral side (Table 3). The mean arc was 31° (range 24 − 53°). Radio-Ulnar-Arc was 28° (range 25 − 30°), 31° (range 27 − 37°), 31° and 36° (range 24 − 53°) for locking plates, non-locking plates, staple fixation and k-wire fixation, respectively (Table 3).
Free latissimus dorsi flap for upper extremity reconstruction in a 9-month-old
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Ryan D. Wagner, Jacqueline S. Yang, Brittany E. Bryant, William C. Pederson, Shayan A. Izaddoost
Improvement was temporary and by 9 months of age, the patient developed ulnar deviation from a lack of growth at the ulna and restriction to wrist and finger extension likely secondary to scarring and adhesions (Figure 2). After a thorough discussion with the parents, the patient underwent complete scar excision, extensive tenolysis to the entire extensor compartment, and coverage with a latissimus dorsi free flap with a 9 × 5 cm split-thickness skin graft (Figures 3–6). Total operative time was just over 9 hours. The patient remained intubated in the NICU for 5 days postoperatively to allow for flap monitoring and initial healing. A continuous heparin infusion of 5 units/kg/h was administered for 10 days while in the hospital. The patient underwent a routine recovery from the operation without complication. The patient required several subsequent surgeries including distraction lengthening of the ulna at age 4, followed by a palmaris longus to extensor pollicis longus tendon transfer and z-plasty scar revision at age 6, and finally a flap debulking procedure at age 9 (Figure 7).
A new assessment tool for ulnar drift in patients with rheumatoid arthritis using pathophysiological parameters of the metacarpophalangeal joint
Published in Modern Rheumatology, 2019
Shogo Toyama, Ryo Oda, Daisaku Tokunaga, Daigo Taniguchi, Satoru Nakamura, Maki Asada, Hiroyoshi Fujiwara, Toshikazu Kubo
UD is the most common and difficult to manage deformity in the rheumatoid hand [8]; it is reported that 44% of patients develop UD within the first 10 years [6]. For UD to emerge, several factors are present in normal hands while others are present only in the arthritic joints of patients with adult-onset RA. Several common activities increase ulnar deviation force, such as turning a key, lifting a mug by the handle, and cutting food with a knife [9,10]. In addition, in the normal hand, the radial collateral ligament of the MP joint is longer than the ulnar collateral ligament, so arthritis at the MP joint initially elongates the radial collateral ligament [11–13]. Meanwhile, in arthritic joints, synovitis due to RA at the wrist joint induces radial rotation of the carpal bones [14] and carpometacarpal joint descent of the fourth and fifth metacarpal bones (so-called ‘metacarpal-descent’), and sagittal band loosening at the MP joint, in particular, induces extensor tendon dislocation at the MP joint level and dysfunction of the intrinsic muscles [15–17].