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At least 19 recordsLinked to original sources
PubMed2001

[Treatment of united or malunited fractures of the elbow].

Nonunions and malunions around the elbow are often due to incorrect initial treatment of a fracture. We have to differentiate between nonunions and malunion of adults and children. There are general principles for the treatment of nonunions and malunions of the distal humerus. They should not always be treated by decortication, internal fixation and bone graft. Removal of non-united fragments or a correction osteotomy may be good alternatives. A correct surgical approach and a biologically accurate osteosynthesis are necessary for good joint mobility, whereby the most difficult problem is to regain extension. An arthrolysis is not normally necessary during the first operation of a non- or malunion. It can be carried out, if necessary, on removal of implants. If these principles are followed, then the operation is usually successful and the patient satisfied. If treatment fails, the possibility of a joint replacement or an arthrodesis should not be forgotten.

Adult↗
PubMed2002

Articular impingement in malunited fracture of the humeral head.

We report on the case of a fracture of the humeral metaepiphysis, surgical neck, and greater tuberosity treated conservatively. Malunion of a fracture of the greater tuberosity developed an impingement on the glenoid surface, causing an articular locking in internal rotation that resolved with slight pressure and a painful "click." The impinging bone was removed arthroscopically. Its extreme posterior position required opening a second, novel portal close to the posterior edge of the acromion for instrument access. Complete removal of the impinging bone restored free internal rotation without signs of impingement on the glenoid surface. Passive motion was initiated immediately postoperatively, and active motion in a water pool was initiated after 2 weeks. After 1 year, the patient has no pain, has maintained complete range of motion, and experiences no limitations in daily or sports activities. The peculiar features of this case are the absence of soft tissue scar stiffness and deficiency of the rotator cuff, because malunion of the bone fragment to the posterior edge of the humeral head produced a mechanical block of internal rotation, and the arthroscopic treatment of the impingement through an atypical superoposterior portal, which has not been described in the literature before.

Adult↗
PubMed2001

[Problems of malunited fractures of the distal radius].

The essential problematic of the distal fracture of the radius lies in the quality of its reduction and retention. 35 patients with distal fractures of the radius and strain fractures of the styloid process of the ulna were followed up with regard to their functional and radiological results and their subjective symptoms. Patients with intra-articular fractures were found to have significantly poorer functional results compared to those with extra-articular fractures. 29 out of 35 patients developed a nonunion of the styloid process of the ulna in the form of a compensatory false position with a significant dorsal tilt of the articular surface of the radius. Their functional results were also significantly poorer than those of the other 6 patients. The patients whose radii were shortened by more than 2 mm also had significantly poorer functional results and a median dorsal tilt of 5 degrees of the articular surface. Where the dorsal inclination of the articular surface of the radius exceeded 5 degrees, a significant increase in the scapholunar angle, which averaged 62 degrees, was found. On the basis of these figures, we conclude that in the reduction of the distal fracture of the radius, shortening by not more than 2 mm and a dorsal inclination of the articular surface of the radius, taken laterally, of not more than 5 degrees should be tolerated in order to minimise functional impairments of the wrist.

Fractures, Malunited↗
PubMed2000

[Malunited fractures of the forearm during the growth period with special reference to the forearm longitudinal axis. Case reports].

Malunion of forearm fractures located in the distal third will remodel satisfactorily providing the child is less than twelve years of age. Complete correction of gross deformity cannot be anticipated in diaphysial fractures when the child is over five years of age. Malunion of fractures of the forearm in children can lead to permanent functional disability with limitation of forearm rotation. In the case of functional disability, there is an indication for corrective osteotomy at the age over twelve in malunion of a fracture located in the distal third and already after age five in gross deformity of fractures to the midshaft of the forearm.

Adolescent↗
PubMed2004

Rotational deformity in malunited fractures of the distal radius.

PURPOSE: To evaluate rotational deformity in malunited fractures of the distal radius and its effect on forearm rotation. METHODS: Thirty-seven patients with a symptomatic malunion of the distal radius (25 with dorsal angulation and 12 with volar angulation) were assessed for rotational deformity of the distal fragment. Spiral computed tomographic scans were taken of both wrists. Rotational deformity was evaluated by comparing the radial torsion angle of the injured and uninjured sides according to Frahm. Multivariable regression analyses were used to identify the radiologic parameter that had the most important influence on forearm rotation. RESULTS: Of the 37 patients, 23 showed a rotational deformity of the distal radius. In both dorsally and volarly angulated malunions, pronation and supination deformities were identified. There was a tendency toward more pronation deformities with volar malunion. Volar angulated malunion with a rotational deformity of less than 10 degrees showed the smallest amount of forearm supination. Losses of pronation-supination did not correlate with the amount of rotational deformity. CONCLUSIONS: This study showed that rotational deformity is common with angulated malunions of the distal radius. The effect on forearm rotation should not be overestimated. Pretreatment computed tomographic scanning of both wrists to identify and measure malrotation of the distal radius may be helpful to improve the outcome after corrective osteotomy.

Adult↗
PubMed1999

[Lisfranc arthrodesis after malunited fracture healing].

The causes of residual deformity with posttraumatic painful arthritis after tarsometatarsal (Lisfranc) fracture-dislocation with the need for correctional arthrodesis are in our experience (22 cases over 5 years) overseen injuries in one third, closed reduction and immobilisation or inadequate fixation technique with K-wires in another two thirds of cases. Foot malalignment and residual instability is assessed with weight-bearing radiographs of both feet, adduction/abduction stress films and CT scans for complex deformity. Correction is carried out via two longitudinal dorsal incisions, strict epiperiosteal preparation and debridement of the Lisfranc joint of all remaining cartilage, sclerosis and fibrous tissue. Reorientation begins, in the same manner as primary open reduction, with anatomical alignment of the second metatarsal base to the second cuneiform. Defects are filled with autologous bone grafting, stable fusion can be achieved with 3.5 mm cancellous compression screws. Full weight bearing is allowed in a modelled plaster shoe for 6 to 8 weeks. The functional medium-term results are convincing with 15 of 17 patients seen after 13 months of follow-up working full time. The Maryland Foot Score improved from 38.9 to 76.8 points in these patients.

Adult↗
PubMed2000

Corrective osteotomy of malunited fractures of phalanges and metacarpals.

We have retrospectively reviewed our experience of corrective osteotomies for phalangeal and metacarpal malunions in eleven patients over a 5-year period. Rotational metacarpal malunion treated by metacarpal osteotomy and AO plate fixation can be performed with confidence of achieving a good or excellent result. Phalangeal osteotomy remains a daunting undertaking for most hand surgeons. Our indifferent results are probably due to the inclusion of three intraarticular malunions treated by extraarticular osteotomy. An alternative approach to these malunions may be appropriate.

Adult↗