RESUMO
The Madelung deformity can result in pain and decreased function of the wrist and hand. None of the surgical techniques available has been shown consistently to improve grip strength, range of movement or relieve pain. In this prospective study we have treated 18 patients with the Madelung deformity (25 wrists) by wedge subtraction osteotomy of the radius and shortening of the ulna. Our results show statistically significant improvement in grip strength and range of movement of the wrist and forearm. Pain improved in 80% of the patients and 88% were satisfied with the appearance. One patient had a wound infection and another developed reflex sympathetic dystrophy. Two had some recurrence due to continued growth of the ulna and it is recommended that the procedure be delayed until skeletal maturity, or else combined with epiphysiodesis of the ulna.
Assuntos
Osteotomia , Rádio (Anatomia)/cirurgia , Ulna/cirurgia , Articulação do Punho/anormalidades , Adolescente , Adulto , Feminino , Força da Mão , Humanos , Complicações Pós-Operatórias , Estudos Prospectivos , Amplitude de Movimento Articular , Recidiva , Articulação do Punho/fisiopatologiaRESUMO
This prospective study reports on the use of the Herbert screw for fixation of fractures and nonunions of the scaphoid through a dorsal approach. In cases of delayed union and nonunion, screw fixation was combined with bone grafting. Twenty-five patients were treated in this manner, and union rates of 100% for acute fractures and 87% for delayed union and nonunion were achieved. We believe that the dorsal approach provides ready access to the scaphoid, enabling placement of the screw in the best possible position to provide fracture fixation.