Thinking Cap

Author Subject: Thinking Cap
Robert Seelig Posted At 21:02:06 02/08/2001
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Symptomatic proximal translation of the radius following radial head resection.
Sowa DT. Hotchkiss RN. Weiland AJ.
All Sports Clinic of Delaware, University of Delaware, USA.
Clinical Orthopaedics & Related Research. (317):106-13, 1995 Aug.
Eight patients with symptomatic proximal translation of the radius after
having radial head resection for trauma were treated with a combination of
immediate pinning of the radius to the ulna, silicone radial head
replacement, or some form of ulnar shortening, including the Darrach
procedure, formal ulnar shortening, or Suave-Kapandji fusion. Despite
these techniques, all patients did not maintain effective relative length
of the radius, exhibiting 3 mm or greater positive ulnar variance after
treatment. Injuries to the central band of the interosseous membrane of
the forearm probably do not heal with mechanical integrity. Without this
structure, conventional methods of equalization of the radius and ulnar do
not appear to be reliable. Current methods of treatment of acute
longitudinal dissociation of the radius and ulna are inadequate.

I. Knoit Re: Thinking Cap (Currently 0 replies)
Posted At 14:32:20 02/09/2001

Where did you get this stuff? I would like to know more. I heard that this study was accurate.
Robert Seelig Re: Thinking Cap (Currently 0 replies)
Posted At 17:43:36 02/09/2001
S.J. Re: Thinking Cap (Currently 0 replies)
Posted At 13:33:14 02/14/2001

This is related to what kind of injury? Lots of medical terms I would like to know, more. In a less medical term.
Robert Seelig Re: Thinking Cap (Currently 0 replies)
Posted At 21:55:43 02/20/2001

A Fall on the Outstretched Hand. Most of the medical terms can be found in the dictionary, think about Greak and Latin, preffix and suffix.

Subluxtion (Under) (Loose or lax) As in tendon snapping over bone.

The radial head resection, done by an act of God. A moment in time. Think of putting a piece of glass wrapped in a towel, hit it with a hammer, and melt it back together again, probably won't be shaped as it once was????

Ulnar Variation.
Brian Robinson Re: Thinking Cap (Currently 0 replies)
Posted At 01:01:33 05/03/2001

In September, 1999 I sustained a left distal radius intra-articular fracture with significant comminution as well as dislocation of the distal radial ulnar joint (Galeazzi). An ao pi plate was utilized to internal fixate the fracture, and synthetic bone graft was utilized to reconstruct the radius. I also have a loss of radial length and incline with a corresponding ulnar variance. This past this past January, 2001 I had the ao pi plate removed in an attempt to resolve my pain.

After 19 months my pain is essentially unchanged. My chief complaint is the tremendous pain on the dorsum of the wrist with both dorsiflexion and palmar flexion. I also experience a "stabbing" type pain with supination and ulnar deviation, and still have a tremendous amount of baseline pain even when it is immobilized. My strength and range of motion are 80% of my uninvolved wrist, although it is not a fluid, pain free type of motion, and I still have a great deal of stiffness. My nerve conduction studies are normal, my radius has healed with a reasonably straight radial carpal surface, but with incongruity in the sigmoid fossa. And I have had nerve blocks that seem to have ruled out RSD.

The bottom line is that this injury has destroyed my quality of life, and I have become nearly housebound due to the pain. I have consulted with highly regarded physicians, including Julio Tuleznik (sp?), Dr. David Green in San Antonio and Dr. Amit Gupta in Louisville as well as local surgeons. Many options have been discussed including ulnar shortening, radial osteotomy/lenthening, denervation, radial chelectomy (sp?), fusion, etc.

1) Are there other surgeons on the "cutting edge" for this type of problem I should consult with?

2) What procedures would you recommend in this situation?

3) What are the risks of the procedures mentioned above?
Tarzan Re: Thinking Cap (Currently 0 replies)
Posted At 20:37:44 05/22/2001

After a crushed radial head on the right and an undiagnosed radial head fracture, and unaccepted at that, distal ulna resection combined with carpal tunnel both sides at once, paid for by me, and starved to recovery to boot. Seemed to do the most good addressing ulnar variation, and numbness, and excruciating pain at night, or when I took a nap.

Now a year and four months after the above surgery.

I don't think I'll ever be pain free, but my capacity is good enough to return to work as a carpenter. I've been working about a month now, and seem to be getting better all the time.

I tape my wrists up tight, with sports tape. Some times I use an Ace Wrap on my elbows. I have lots of extra motion in my wrists, combined with pops, snaps, and grinding of both elbows and wrists.

Although not as good as I was 5 minutes before I fell off the bridge, I am quite happy with my function.

I attached a link to the Wheeless Text of Orthopaedics, it talks in detail about different fixes, and study groups of out come of different techniques.

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