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ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2009, Number 1

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Acta Ortop Mex 2009; 23 (1)

Treatment of distal radius non-union in a three-stage procedure. Case report

Arredondo GE, Vargas MR

Language: Spanish
References: 18
Page: 26-30
PDF size: 227.39 Kb.


ABSTRACT

Introduction: Non-union of the distal radius is an infrequent entity. Recently, it has been identified more often and it has been speculated that external fixation and other techniques used to maintain radial length, may create defects that favor the non-union. In chronic injuries, residual deformity and retraction of tissues are difficulties for treatment. Case presentation: We report the case of a 40-year-old male patient with a non-union after a Frykman VIII distal radius fracture managed unsuccessfully with external fixation with a Green-type cast, and with one year of evolution showing a serious «Z» deformity. The patient underwent a first surgical procedure with external fixation to achieve distraction for 30 days, then a second event with intramedullar nailing and autografting with 3 cm of iliac crest and finally a Sauvé-Kapandji procedure. We achieved consolidation of the lesion with graft integration. Satisfactory range of motion, including pronation and supination, were recovered. Discussion: The combination of these three surgical events allows joint rescue, in spite of the deformity and time of evolution. A first procedure based on ligamentotaxis allowed for gradual recovery of the joint relationships and prepared the area of bone loss to be restituted. On the second procedure it is possible to use an implant on the distal remain with enough osteogenic supply, and finally the third procedure will restore pronation and supination, usually lost during injuries in that area.


REFERENCES

  1. Ovidiou A: Management of complication of distal radius and ulna fractures. J Bone Joint Surg 2002; 84-B (SUPP III): 358-9.

  2. Sertorio GMA, Angelini LC, Tavares de Oliveira M, Trombini N, Martins FC, De Almeida PBSM: Treatment of nonunion in the third distal of the radius. Act Ortop Bras 2005; 13(2): 95-100.

  3. Ring D, Júpiter JB: Nonunion of the distal radius. Tech hand Upper Extrem Surg 2002; 6(1): 6-9.

  4. Venu KM, Forder J, Bommiready R, Skyrme AD, Compson JC, Groom AFG: Ilizarov method for management of chronic non union of distal radius causing a «Z» deformity of the wrist. Injury 2005; 36(8): 346-8.

  5. McKee MD, Waddell JP, Yoo, DR, Robin R: Nonunion of distal radial fractures associated with distal ulnar shaft fractures: A report of four cases. Orthop Traum 1997; 11(1): 49-53.

  6. Prommersberger KJ, van Schoonhoven J, Laubach S: Pseudoartroses after distal radius fractures. What is the role of the distal radioulnar joint. Handchir Mikrochir Plast Chir 2000; 32(6): 379-89.

  7. Anderson JT, Lucas GL, Buhr R: Complications of treating distal radius fractures with external fixation: A community experience. Iowa Orthop J 2004; 24: 53-9.

  8. Green DP: Pins and plaster treatment of comminuted fractures of the distal en of the radius. J Bone Joint Surg 1975; 3: 305-10.

  9. De la Garza-Alatorre, Nualart L, Capdevila R: Tratamiento de la deformidad de Madelung secundaria a fracturas y osteomielitis. Estudio en siete casos. Rev Mex Ortop Traum 2000; 14(5): 424-8.

  10. Houshian S, Schroder HA, Weeth R: Correction of Madelung’s deformity by the Ilizarov technique. J Bone Joint Surg 2004; 86-B: 536-40.

  11. Zhang X, Duan L, Li Z, Chen X: Callus distraction for the treatment of acquired radial club hand deformity after osteomyelitis. J Bone Joint Surg 2007; 89-B(11): 1515-8.

  12. Lubahn JD, Hood JM, Nechleba J, Williams DP, Green T: Gradual reduction of distal radial malunion using distraction osteogénesis. Hand Surg 2007; 32A(6): 796-9.

  13. Acartürk, TO, Krishnamurthy A, Lee AWP: The use of external skeletal fixation to facilitate the surgical release of wrist flexion and thumb web spaces contractures. Hand Surg 2006; 31A(10): 1619-25.

  14. Arredondo E: Tratamiento de las seudoartrosis de antebrazo con injerto de cresta ilíaca y clavo Hunec. Acta Ortop Mex 2004; 18(6): 245-50.

  15. Konrath GA, Bahler S: Open reduction and internal fixation of unstable distal radius fractures: results using the trimed fixation system. J Orthop. Trauma 2002; 16(8): 578-85.

  16. Apergis E, Tsampazis K, Palamidi A, Poulilios A, Garas G, Pavlakis D: Surgical treatment of delayed union or nonunion of the distal radius. J Bone Joint Surg Br 2004; 86-B: 166.

  17. Carter PB, Stuart PR: The Sauve-Kapandji procedure for post-traumatic disorders of the distal radio-ulnar joint. J Bone Joint Surg 2000; 82-B(7): 1013-8.

  18. Rosales RS, Scheker LR: Inestabilidad radio cubital distal ¿Cuál es la función de esta articulación? En: Gil L (ed) Tratado de Cirugía de la Mano. Valencia Esp. 1998.




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