lectrophysiological examination was used in 15 cases of cubital tunnel syndrome before andduring opcration. The velocity, latency and amplitude of the conduction of the ulnar nerve 5cm aboveand below the elbew joint were measured by surface electrodes and direct stimulation. There is nosignificant difference(Pgt; 0.5 )between the results from the two kinds of testing. After the ulnarnerve was decompressed from the cubital tunnel, the conduction velocity increased by 50%, latency shortenee by 40%, the improvement in conduciton velocity being particularly significant(P lt; 0.02). which show that conduction velocity is a relatively sensitive testing parameter. Electrophysiological examination plays a monitoring role during cubital tunnel syndrome decompression.
Objective To provide anatomy evidence of the simple injury of the deep branch of the unlar nerve for cl inical diagnosis and treatments. Methods Fifteen fresh samples of voluntary intact amputated forearms with no deformity were observed anatomically, which were mutilated from the distal end of forearm. The midpoint of the forth palm fingerweb wasdefined as dot A , the midpoint of the hook of the hamate bone as dot B, the ulnar margin of the flexor digitorum superficial is of the l ittle finger as OD, and the superficial branch of the unlar nerve and the forth common finger digital nerve as OE, dot O was the vertex of the triangle, dot C was intersection point of a vertical l ine passing dot B toward OE; dot F was the intersection point of CB’s extension l ine and OD. OCF formed a triangle. OCF and the deep branch of the unlar nerve were observed. From May 2000 to June 2007, 3 cases were treated which were all simple injury of the deep branch of the unlar nerve by glass, diagnosed through anatomical observations. The wounds were all located in the hypothenar muscles, and passed through the distal end of the hamate bone. Muscle power controlled by the unlar nerve got lower. The double ends was sewed up in 2 cases directly intra operation, and the superficial branch of radial nerve grafted freely in the other 1 case. Results The distance between dot B and dot O was (19.20 ± 1.30) mm. The length of BC was (7.80 ± 1.35) mm. The morpha of OCF was various, and the route of profundus nervi ulnaris was various in OCF. OCF contains opponens canales mainly. The muscle branch of the hypothenar muscles all send out in front of the opponens canales. The wounds of these 3 cases were all located at the distal end of the hook of the hamate bone, intrinsic muscles controlled by the unlar nerve except hypothenar muscles were restricted without sensory disorder or any other injuries. Three cases were followed up for 2 months to 4 years. Postoperation, the symptoms disappeared, holding power got well, patients’ fingers were nimble. According to the trial standard of the function of the upper l imb peripheral nerve establ ished by Chinese Medieal Surgery of the Hand Association, the synthetical evaluations were excellent.Conclusion Simple injuries of the deep branch of the unlar nerve are all located in OCF; it is not easy to be diagnosed at the early time because of the l ittle wounds, the function of the hypothenar muscles in existence and the normal sense .
Objective To discuss the concept of ulnar tunnel at thewrist, the types, causes, traits of compression, diagnosis, and clinical significance of ulnar tunnel syndrome(UTS). Methods Thirty-nine cases diagnosed as having UTS from 1986 were retrospectively reviewed combined with previous relevant literature. Results Ulnar tunnel included Guyon’s canal, pisohamate tunnel and hypothenar segment. There were 8 types andmany causes of UTS. Some patients had compression in more than one zones and might be associated with carpal tunnel syndrome or cubital tunnel syndrome. UTS could be diagnosed through clinical manifestations and electrophysiological examination. Conclusion Defining the concept of ulnar tunnel and the knowledge of the complexity and rarity of UTS can effectively guide diagnosis and treatment.
ObjectiveTo systematically review the effects of associated ulnar styloid fracture on the prognosis of distal radius fracture. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 5 2013), CNKI, CBM and WanFang Data were searched up to May 2013 for collecting cohort studies about the effects of associated ulnar styloid fracture on the prognosis of distal radius fracture. According to the inclusion and exclusion criteria, related cohort studies were screened, data were extracted and cross-checked, and quality of included studies was independently evaluated by two reviewers. Meta-analysis was then conducted using RevMan 5.2 software. ResultsA total of 9 studies involving 1 020 patients were included. The results of meta-analysis showed that there was no significant difference in GartlandWerley score between patients with ulnar styloid fracture or not. Statistical significant difference was found in DASH score between the two groups (MD=2.71, 95% CI 0.26 to 5.16, P=0.03), which indicated that patients with ulnar styloid fracture got higher score in DASH score. ConclusionCurrent evidence shows that ulnar styloid fracture may affect the prognosis of patients with distal radius fracture. Due to the quality and quantity limitation of the included studies, the above conclusion needs to be further verified by more high quality studies in future.
In the repair of the defect of peripheral nerve, it was necessary to find an operative method with excellent therapeutic effect but simple technique. Based on the experimental study, one case of old injury of the ulnar nerve was treated by end-to-side neurorraphy with the intact median nerve. In this case the nerve defect was over 3 cm and unable to be sutured directly. The patient was followed up for fourteen months after the operation. The recovery of the sensation and the myodynamia was evaluated. The results showed that: the sensation and the motor function innervated by ulnar nerve were recovered. The function of the hand was almost recovered to be normal. It was proved that the end-to-side neurorraphy between the distal stump with the intact median nerve to repair the defect of the ulnar nerve was a new operative procedure for nerve repair. Clinically it had good effect with little operative difficulty. This would give a bright prospect to repair of peripheral nerve defect in the future.
ObjectiveTo discuss the imaging manifestations of ulnar impaction syndrome, and to evaluate the diagnostic value of MR imaging. MethodsThe clinical data of 18 patients with clinical standard-proved ulnar impaction syndrome between January 2010 and June 2013 were retrospectively reviewed. ResultsSeventeen cases were diagnosed as ulna positive variation (94.6%), and the range of ulnar variance was 1.5 to 3.8 mm and the average ulnar variance was 2.6 mm. Neutral variance was found in one case. Fourteen cases had avascular necrosis or bone sclerosis of semilunar bone, and avascular necrosis or bone sclerosis of the triquetrum and ulnar was presented in 12 cases and 3 cases respectively on X-ray detection. CT scan showed that 16 cases of semilunar bone abnormalities (6 with ischemic necrosis), triquetrum osteonecrosis in 4 cases, and both necrosis of semilunar bone and triquetrum in 3 cases. On MRI, all cases had different degrees of damage, degeneration of semilunar bone, triquetrum, ulnar and triangular fibocartilage complex (ulnar side of the proximal end of the lunate in 18, radial side of the triquetrum in 17, distal joint surface of ulnar in 12, and triangular fibocartilage complex in 15). In the early stage, lesions were presented as edema of bone marrow and followed as different sizes of cystic change. Articular surface was collapsed later. ConclusionUlnar positive variance has important reference value in the diagnosis of ulnar impaction syndrome. MRI can show the early change of ulnar impaction syndrome, and provide reliable decision basis for clinical diagnosis and treatment.
Objective To investigate the methods and outcome of endoscopic ulnar neurolysis and minimal medial epicondylectomy in treatment of cubital tunnel syndrome with ulnar nerve subluxation. Methods Between June 2004 and June 2009, 11 cases of cubital tunnel syndrome with ulnar nerve subluxation were treated with endoscopic ulnar neurolysis andminimal medial epicondylectomy. There were 7 males and 4 females with an average age of 36 years (range, 18-47 years). All cases had numbness in l ittle finger and ring finger. The disease duration varied from 3 to 18 months (7 months on average). Nine cases had atrophy in the first dorsal interosseous muscle and hypothenar muscles. The preoperative electromyography showed that the ulnar nerve conduction velocity (NCV) were slowed down at elbow, which was (27.0 ± 1.5) m/s. Results All incisions healed by first intention, and no compl ication occurred. Eleven cases were followed up 6-37 months (19 months on average). All cases had normal sensation after 1 month of operation. The muscle strength was obviously improved in 11 cases after 3 months postoperatively (grade 4 in 7 cases and grade 3-4 in 4 cases). The postoperative electromyography showed that the NCV was obviously improved, which was (43.5 ± 9.5) m/s, showing significant difference when compared with preoperative one (P lt; 0.05). According to Amadio’ efficacy appraisal standard, the results were excellent in 7 cases and good in 4 cases. Conclusion The method of endoscopic ulnar neurolysis and minimal medial epicondylectomy has the advantages of safety, convenient manipulation, small incision, and early recovery for cubital tunnel syndrome with ulnar nerve subluxation.
ObjectiveTo explore the surgical method and its clinical efficacy for complicated proximal ulnar fracture. MethodsFrom February 2006 to July 2014, 22 patients with complicated proximal ulnar fracture were treated by open reduction with internal fixation. There were 17 males and 5 females with an average age of 32 years. According to AO classification, there were 4 cases of type C1, 13 of type C2, and 5 of type C3. Among the, there were 4 cases combined with posterior elbow dislocation, 2 cases combined with anterior elbow dislocation, and there were 2 Monteggia Ⅳ cases. Nineteen cases were close fractures, and the other 3 were open fractures. Nerve and vessel injury was not found in all cases. The time before operation was 7 to 12 days, with an average of 8 days. All patients were treated with open reduction and internal fixation. Mayo standard for evaluation of elbow joint was used to evaluate the therapeutic effect after operation. ResultsAll the patients were followed up from 8 to 18 months, with an average of 14 months. All fractures were completely healed. The healing time ranged from 12 to 30 weeks averaging 16 weeks. No failure of internal fixation occurred; no elbow anchyloses or instability occurred. The range of motion of elbow joint was between 120° and 140°, with an average of 135°. Mayo elbow score showed that 16 cases were excellent, 4 good, and 2 fair with an excellent and good rate of 90.9%. ConclusionEarly surgical treatment and rehabilitative training can facilitate satisfactory effects on complicated proximal ulnar fracture.
Objective To explore the operation procedure and effectiveness of terrible triad of the elbow joint. Methods Between October 2006 and June 2010, 11 cases of closed terrible triad of the elbow joint were treated by operation. There were 8 males and 3 females with an average age of 32 years (range, 21-53 years). The mechanism of injury was fall ing from height in 4 cases and traffic accident in 7 cases. The time from injury to admission was 30 minutes to 9 days. According to Regan-Morrey classification for fractures of the ulnar coronoid, there were 5 cases of type I, 5 cases of type II, and 1case of type III; and according to Mason classification for fractures of the radial head, there were 4 cases of type I, 5 cases of type II, and 2 cases of type III. The elbow joint range of motion (ROM) was (63 ± 9)° at flexion and extension, and the forearm ROM was (71 ± 8)° at pronation and supination. All cases underwent reduction and fixation by lateral approach combined with medial approach according to McKeeps operation process. After operation, the affected l imb was immobil ized with plaster at elbow joint flexion of 90° and in forearm neutral position, then passive physical exercises were carried out, and finally active physical exercises were done after removing plaster at 4 weeks. Results All incisions healed by first intention. Eleven cases were followed up 7-27 months (14.5 months on average). The X-ray films showed good reduction, the cl inical heal ing time was 8-19 weeks with an average of 11 weeks. Mild ectopic ossification of the elbow joint occurred in 3 cases at 6 months after operation, mild degenerative change in 1 case at 18 months after operation. At last follow-up, the elbow joint ROM was (103 ± 14)° at flexion and extension, and the forearm ROM was (122 ± 13)° at pronation and supination, showing no significant difference when compared with the values of normal elbow joint (P gt; 0.05) and significant difference when compared with the preoperative values of affected elbow joint (P lt; 0.05). According to Mayo elbow performance score, the results were excellent in 5 cases, good in 5 cases, and fair in 1 case with an excellent and good rate of 90.9%. Conclusion The surgical treatment of terrible triad of the elbow joint can restore sufficiently elbow stabil ity, allow early motion postoperatively, and enhance the functional outcome.
Objective To investigate the clinical therapeutic effect of the ulnar neurolysis and nerve anterior transposition with an immediate range of motionfor the cubital tunnel syndrome in the aged. Methods Forty-three patients (24males and 19 females, aged 60-81 years, averaged 67) admitted for the cubital tunnel syndrome from January 1999 to December 2004 were randomly divided into 2groups: Group A (n=20) and Group B (n=23), with an illness course of 2-10 months. All the patients underwent the ulnar neurolysis and the nerve anterior transposition. After operation the patients’ elbows in group A were immobilized with the plaster slab for an external fixation for 3 weeks; the patients’ elbows in group B did not use the external fixation, but began an immediate range of motion on the 2nd day after operation. The Bishop scoring system was used to evaluate the patients’ functional recovery in the 2 groups. Results The follow-up for 1-5 years showed that the ulnar nerve function of all the patients were improved but no significant differences were found between the 2 groups (P＞0.05). The patients in Group A returned to daily activities or work at 45.2±5.1 days, but the patients in Group B required 15.5±3.8 days, with a significant difference between the 2 groups (P＜0.05). According to Bishop scoring system, the resutls were excellent in 14 cases, good in 4 cases, fair in 1 case and poor in 1 case in Group A, and 16, 4, 2 and 1 respectively in Group B. There was no significant difference between the two groups(P＞0.05). Conclusion The ulnar neurolysis and nerve anterior transposition with an immediate range of motion for the cubital tunnel syndrome can promote the ulnar function recovery of the oldaged patients. They can return to their daily activities or work at a more rapid speed when their elbows are mobilized immediately after operation.