proximal radioulnar external rotation osteotomy

The ulnar ulnar external rotation osteotomy is used for the surgical treatment of congenital ulnar and ulnar fusion. Congenital ulnar and ulnar connection is a relatively rare upper limb deformity. The incidence of male and female is almost the same, and a few children have a family history. This deformity is about 60% involving both sides. It is characterized by the fact that the ulnar joint of the proximal ulna and the ulnar joint has ceased to exist. In addition to the bone deformity, there are also soft tissue contractures such as the forearm interosseous membrane. The development of the affected limb is poor, and it is thinner than the healthy side. There are other malformations, such as multiple fingers and fingers. Wilkei divides this malformation into two types: 1 The upper end of the ulna has a large connection range and the proximal bone marrow cavity is connected, the proximal humerus is stunted, and even the humeral head is dislocated backward or integrated with the proximal end of the ulna; 2 The proximal skeletal connection range is small, the bone marrow cavity between the two bones is not connected, and the proximal deformity of the two bones is not obvious. Although there are performances after birth, they often do not attract the attention of parents. When the sick child grows up, he uses the affected limb to take things, use chopsticks, and end bowls to find that the upper limbs are inflexible and the posture is special. Clinical manifestations: The affected side of the forearm is slightly shorter and thinner, and the forearm has no rotation function (the elbow is 90° and the upper limbs are measured against the torso posture) and is fixed at a certain position. There is no limitation in the movement of the shoulder and wrist joints, and there is no damage to the forearm nerves. X-ray films can confirm the proximal joints and extent of the ulna. Treatment of diseases: congenital ulnar and ulnar fusion Indication The proximal ulnar osteotomy is suitable for: 1. Congenital unilateral or bilateral ulnar ulnar fusion, with a forearm pronation deformity of more than 60 °. 2. Congenital unilateral ulnar ulnar bone connection, superior side, its forearm pronation deformity <60 ° can also be surgically corrected. Surgical procedure Incision Along the flank of the 1/3 dorsolateral epiphysis of the proximal ulna, the skin and deep fascia were longitudinally cut, and the length was about 5-7 cm. 2. Exposing and osteotomy The elbow muscle, the ulnar wrist extensor muscle space and the supinator muscle were separated, the periosteum was cut longitudinally, and the subperiosteal dissection was revealed to expose the ulnar bone fusion. Then, at the distal end portion of the ulnar and ulna fusion, the ulnar bone osteotomy line parallel to each other and 1 cm apart was designed. Using a bone knife or an electric bone saw, the ulnar bone was cut along the osteotomy line and the 1 cm long bone was removed to relax the forearm vascular nerve, which prevented the vascular nerve from being pulled and torsionally injured when the distal end of the osteotomy was rotated. Then, the ulnar bone at the distal end of the osteotomy is rotated together, and the unilateral person retains the pronation position of 10°-20°, while the bilateral side deformity retains the pronation side of the superior side of 20°-25°, and selects one. A thick Kirschner wire is fixed through the ulnar olecranon, the osteotomy end and the ulnar stem. If it is impossible or impossible to cut off a ulnar bone, only when the ulnar bone is cut off, it is not advisable to rotate the forearm to the ideal position immediately after surgery. The forearm should be gently rotated to the ideal position after 7-10 days after the operation. 3. Close the incision Relax the tourniquet, stop the bleeding completely and suture the incision layer by layer. complication Vascular nerve injury is a serious complication of this operation and a major obstacle to correcting deformity. Once present, the forearm should be immediately advanced to the preoperative level to prevent serious consequences. Taking a shortened osteotomy helps prevent this complication.

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