Congenital radio-ulnar synostosis
Benjamin Joseph, Selvadurai Nayagam, Randall Loder, Ian Torode in Paediatric Orthopaedics, 2016
Although resection of the synostosis makes considerable sense, the procedure is technically demanding and results are often unsatisfactory. One reason for failure is reformation of the synostosis. Interposition of various materials in the resection gap have been tried and of these vascularised fat graft seems to be the most promising.7 Kanaya8 reported gratifying short-term results in 12 children on whom he had performed resection of the synostosis and interposed vascularised fat graft and the anconeus muscle. He also performed a shortening angulation osteotomy of the radius to align the radial head towards the capitellum (Figure 50.3). The average motion regained at the radio-ulnar joint was 80°. However, there are no good long-term reports of this method and so most surgeons do not choose this procedure.
Individual conditions grouped according to the international nosology and classification of genetic skeletal disorders*
Christine M Hall, Amaka C Offiah, Francesca Forzano, Mario Lituania, Michelle Fink, Deborah Krakow in Fetal and Perinatal Skeletal Dysplasias, 2012
Other conditions with marked rhizo-mesomelic shortening in the second trimester of pregnancy: Mesomelic dysplasia Reinhardt-Pfeiffer type – very similar to LMD, but the inheritance is autosomal dominant; mesomelic dysplasia Kantaputra type – the ulnae are shorter than the bowed radii. There is milder shortening in the lower limbs with complete synostosis of the ankles. The fibulae are fused to the calcanea and tibiae to the talar bones. There is a prominent triangular protrusion of the fibulocalcaneal complex. There is also synostosis of the tarsal bones and of the distal tibiae and fibulae. Ferraz dysplasia: short metacarpals and metatarsals; achondroplasia (p. 47); Desbuquois dysplasia (p. 269); mesomelic dysplasia Robinow type: prominent forehead, hypertelorism, a wide mouth, small nose with anteverted nostrils. Mesomelic limb shortening is usually present and there may be vertebral anomalies. Osebold-Remondini dysplasia: hypoplastic or absent middle phalanges of hands and feet, carpal fusion, delayed coalescence of the calcaneal ossification centres, abnormalities of other tarsal bones and shortening of the radii, ulnae, tibiae and fibulae; Grebe dysplasia (p. 232).
The Anatomy of Joints Related to Function
Verna Wright, Eric L. Radin in Mechanics of Human Joints, 2020
The anatomic classification of joints is based upon the nature of the intervening tissues, which may be collagenous fibers or cartilage (both synarthroses) or the familiar complex of structures that together form a synovial (diarthrodial) joint. Additionally, bones that are initially separate may become joined by a continuation of their matrix to form a synostosis. This is usually the result of a normal developmental, growth, or aging process (as in the fusion of ilium, ischium, and pubis to form a single innominate bone), or it may be the result of a pathological process, such as fusion across the sacroiliac joints in ankylosing spondylitis.
In search of a single standardised system for reporting complications in craniofacial surgery: a comparison of three different classifications
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Anna Paganini, Madiha Bhatti-Söfteland, Sara Fischer, David Kölby, Emma Hansson, Justine O’Hara, Giovanni Maltese, Peter Tarnow, Lars Kölby
At our centre, sequential operations for syndromic cases, such as Crouzon and Pfeiffer, include frontal advancement combined with posterior springs at an early age, followed by ‘spectaclesplasty’ to correct exorbitism, and finally, Le Fort I or III to correct the midface and occlusion in adolescence. Such an approach spreads out the surgical trauma and makes the surgery less extensive than when all procedures are performed in a single operation. Our conservative use of Le Fort III and monobloc procedures might also have contributed to a lower CR than that seen in other centres [19,20]. In our material, there was no mortality. However, this has been reported [1,21]. A particular complication (i.e. prolonged wound healing), was relatively frequent in metopic synostosis as compared with other single-suture synostoses; however, this has not been previously described. One possible explanation could be the relatively tense skin closure after increase in the frontal volume achieved by frontal remodelling.
Brachial distal biceps injuries
Published in The Physician and Sportsmedicine, 2019
Drew Krumm, Peter Lasater, Guillaume Dumont, Travis J. Menge
The LABCN is the most commonly injured structure during both single-incision and dual-incision techniques. The nerve should be retracted laterally during each approach, as paresthesias or neuromas may develop 5–7% of time during the superficial dissection [6]. Another study by Bisson et al. showed 16% of patients with the two-incision technique had nerve complications, with the LABCN being the most common injury [26]. Injury to the radial and/or posterior interosseous nerve is more common with a single-incision approach. It has been reported in 5% of cases, most commonly due to improper retractor placement around the radial tuberosity [6]. This can be avoided by keeping the forearm fully supinated. Kelly et al. studied complications of patients undergoing the dual-incision distal bicep repair and found 4% of patients developed lateral antebrachial cutaneous paresthesias and 3% of patients had superficial radial nerve paresthesias. Furthermore, the single-incision technique resulted in a lower incidence of heterotopic ossification and synostosis compared to the dual-incision technique. Synostosis may lead to decreased pronation and supination of the forearm. This risk can be reduced by avoiding dissection between the radius and ulna and copious irrigation [27].
Initial UK series of endoscopic suturectomy with postoperative helmeting for craniosynostosis: early report of perioperative experience
Published in British Journal of Neurosurgery, 2023
Jonathan Halim, Adikarige Silva, Curtis Budden, David J. Dunaway, N. U. Owase Jeelani, Juling Ong, Greg James
All children referred with craniosynostosis were assessed in multidisciplinary fashion by the craniofacial team consisting of craniofacial plastic and neurosurgeons. The diagnosis was made based on clinical examination and radiographic imaging such as plain film radiograph or three-dimensional computed tomographic reconstruction, where needed. We have previously published evidence that radiological investigations do not aid diagnosis or management in ‘classical’ single suture synostosis presentations.15 Treatment options, including non-surgical surveillance, and their associated risks and benefits were discussed with the parents once the diagnosis was established.
Related Knowledge Centers
- Ankylosis
- Craniosynostosis
- Dysostosis
- Epiphyseal Plate
- Syndactyly
- Tarsal Coalition
- Joint
- Epiphyseal Line
- Radioulnar Synostosis
- Pulled Elbow