Wrist-Centric Surgery

Centralized wrist surgery is used for surgical treatment of congenital absence of the humerus. Curing disease: Indication 1. Congenital distal 1/3 of the distal humerus is absent and completely absent. 2. The sick child is over 6 months old. 3. The elbow joint activity is basically normal. Contraindications 1, the disease often combined with systemic malformations, such as Fanconi whole blood cell deficiency, there is no need for surgical orthopedics. 2, combined with elbow deformity, that is, the distal end of the humerus and the proximal ulnar bone connector, this hand can not make the hand touch the head and face after the operation, so no practical significance. 3, adolescent patients often have ulnar flexion and severe soft tissue contracture, and have been adapted to this deformity. Surgical procedure 1. Incision From the temporal side of the distal 1/3 of the distal metacarpal of the hand, extending to the proximal ulnar side, passing through the ulnar head to the volar side of the forearm, and then extending proximally along the lateral edge of the iliac crest, ending at the lower third of the forearm . 2. Exposing and loosening soft tissue The skin and subcutaneous tissue were cut along the incision line, and the flap was freely detached to both sides, and the thickened deep fascia was extensively cut. First find the median nerve on the volar side, and then fully free, then protect. Due to the variation of neurovascularity, the median nerve may be located deep in the longissimus dorsi and flexor digitorum, and may also be under the superficial fascia, and often divided into two large terminal branches, with the lateral branch replacing the missing The phrenic nerve is in the deep side of the diaphragm. Therefore, careful operation should be performed to sharply separate the fibrous tissue around it and do not damage the median nerve. It is worth emphasizing that it is one of the key steps in this operation to completely cut open the fibrous tissue of the lateral deep fascia and lateral muscle. On the lateral edge of the incision ruler, the ulnar wrist extensor muscle and wrist are separated. 3, ulnar wrist reconstruction On the dorsal side of the incision, an extra-periosteal separation reveals the ulnar and carpal bones. The surface of the ulnar head is covered with a thickened joint capsule, which is cut and peeled from the distal attachment of the ulna, revealing the ulnar head and the proximal row of the wrist bone, and retaining the attachment point of the joint capsule on the ulnar side and the dorsal side of the wrist. Then, in the proximal carpal bone corresponding to the third metacarpal bone, which is equivalent to the lunate bone, a part of the proximal carpal bone is cut with an osteotome to form a bone groove having the same width and depth as the ulnar head. The ulnar styloid process was resected, and the ulnar head was placed in the carpal bone groove, so that the hand was rotated about 30°, and a K-wire was used to fix the medullary cavity of the third metacarpal, carpal and distal 1/3 of the ulna. Then, the joint capsule is tightly sutured to the bone hole at the distal end of the ulna, and a bone attachment point is established, and the ulnar wrist extensor muscle and the wrist flexor muscle are placed in front, and the suture is fixed on the dorsal side of the fifth metacarpal Inside the bone hole. 4, closed the incision If the sick child has obvious ulnar bending deformity, the middle and lower 1/3 osteotomy of the ulna can be performed at the same time. Two Kirschner wires or plates are used for fixation, then the tourniquet is relaxed, the bleeding is completely stopped, and the incision is sutured in layers.

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