The number of secondary feathers varies among orders of birds with some orders exhibiting a positive relationship with ulna length,whereas in other orders secondary number is invariant.This difference has implications...The number of secondary feathers varies among orders of birds with some orders exhibiting a positive relationship with ulna length,whereas in other orders secondary number is invariant.This difference has implications for scaling of the width of the feather vane within orders.In those species where the number of secondary remiges is invariant with ulna length,vane width should scale isometrically with ulna size to maintain an aerodynamic flight surface.Where feather count increases with increasing ulna length then vane width should exhibit negative allometry.Vane length should also correlate with ulna length,irrespective of the number of feathers.Data were compiled from an online library of images for the vane length and the width of the vane at 50%of the vane length for the fifth secondary feather for 209 bird species from 24 different orders.The results supported the hypotheses that vane width is a function of ulna size,and the number of secondary feathers as associated with different orders.Vane length was unaffected by the number of secondaries but varied between orders.The results suggest that birds have solved the problem of maintaining the aerodynamic surface of the proximal wing in two ways.Hence as ulna length increases the first solution involves more feathers that exhibit negative allometry for vane width,or in the second where feather count doesn't change,the vane width simply scales isometrically.The implications for the mechanical properties of the vane,and how it affects wing function,have not yet been explored in a range of birds.展开更多
BACKGROUND Pulmonary thromboembolism(PTE)is a serious postoperative complication that can occur after a fracture.Generally,PTE is caused by the falling off of lower extremity deep vein thrombosis(LEDVT)after lower lim...BACKGROUND Pulmonary thromboembolism(PTE)is a serious postoperative complication that can occur after a fracture.Generally,PTE is caused by the falling off of lower extremity deep vein thrombosis(LEDVT)after lower limb fracture surgery.LEDVT and PTE after upper extremity fracture surgery are very rare.PTE is one of the most common clinical causes of sudden death.Venous thromboembolism includes PTE and DVT.We experienced one case of LEDVT and PTE after distal ulna and radius fracture surgery.The purpose of our report is to raise awareness for orthopedic surgeons that PTE can occur after distal ulna and radius fracture surgery,and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.CASE SUMMARY We report a 51-year-old Chinese male who had severe fractures of the left distal ulna,radius and little finger after a motorcycle accident.The patient underwent external fixation,open reduction and internal fixation.On the third post-operative day,computed tomographic pulmonary angiography showed PTE.Doppler ultrasonography showed thrombus formation in the bilateral posterior tibial veins.After a period of anticoagulation therapy,on the 25th d after the PTE,computed tomographic pulmonary angiography showed that thrombus in both sides of the pulmonary artery disappeared.Furthermore,about 4 mo after the PTE,thrombosis in the deep veins of the lower limbs disappeared.About 1 year after the surgery,X-rays showed good fracture healing,and the function of the wrist joint recovered well.CONCLUSION Though rare,PTE can occur after distal ulna and radius fracture surgery and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.展开更多
60% of a dog's body weight is supported by its fore limbs, while the hind limbs mainly play the role of power, so the probability of dog's radius and ulna fracture is greatly increased. This paper mainly intro...60% of a dog's body weight is supported by its fore limbs, while the hind limbs mainly play the role of power, so the probability of dog's radius and ulna fracture is greatly increased. This paper mainly introduced the diagnosis and treatment of a case of radius and ulna fracture in dog, with an attempt to provide reference for clinical practice.展开更多
According to the specimens of ulna-radius of the Cape Hare (Lepus capensie) shot in fall and winter in Shanxi province, China, the ossifications of epiphyses cartilage of ulna-radius are divided into 4 stages. With we...According to the specimens of ulna-radius of the Cape Hare (Lepus capensie) shot in fall and winter in Shanxi province, China, the ossifications of epiphyses cartilage of ulna-radius are divided into 4 stages. With weight of eye lens as a reference, it is proved that the age criterion could be used to distinguish young less than 6–7 months old from those older. This is a pragmatic method to analyze age composition of game-bag in the early period of shooting season when younger holds a large proportion in the hare population. It also is useful in judging the age of hares trapped and estimating the effects of predation on the hare population structure.展开更多
BACKGROUND Cryptococcal osteomyelitis is a bone infection caused by cryptococcus.As an opportunistic infection,bone cryptococcosis usually occurs in patients with immunodeficiency diseases or in those undergoing immun...BACKGROUND Cryptococcal osteomyelitis is a bone infection caused by cryptococcus.As an opportunistic infection,bone cryptococcosis usually occurs in patients with immunodeficiency diseases or in those undergoing immunosuppressive therapy and often displays characteristics of disseminated disease.Isolated cryptococcal osteomyelitis is extremely unusual in immunocompetent person.The pathogenic fungus often invades vertebrae,femur,tibia,rib,clavicle,pelvis,and humerus,but the ulna is a rare target.CASE SUMMARY A 79-year-old woman complaining of chronic pain,skin ulceration and a sinus on her right forearm was admitted,and soon after was diagnosed with cryptococcal osteomyelitis in the right ulna.Unexpectedly,she was also found to have apparently normal immunity.After treatment with antifungal therapy combined with surgery debridement,the patient’s osteomyelitis healed with a satisfactory outcome.CONCLUSION Although rare,cryptococcal osteomyelitis should be considered in the differential diagnosis of osteolytic lesions even in immunocompetent patients,and good outcomes can be expected if early definitive diagnosis and etiological treatment are established.展开更多
Synedra ulna var, repanda Q. X. Wang ＆ Q. M. You, a new variety of Synedra （Bacillariophyta） from Xinjiang, China, is described and illustrated, and the characteristic of the variety： includes undulate-linear valv...Synedra ulna var, repanda Q. X. Wang ＆ Q. M. You, a new variety of Synedra （Bacillariophyta） from Xinjiang, China, is described and illustrated, and the characteristic of the variety： includes undulate-linear valves and straight pseudoraphe, differs from other species of Synedra.展开更多
Madelung deformity is rare, accounting for 1.7% of congenital anomalies. The treatment is essentially surgical and several techniques have been described. We report the result of a case treated in an adult patient by ...Madelung deformity is rare, accounting for 1.7% of congenital anomalies. The treatment is essentially surgical and several techniques have been described. We report the result of a case treated in an adult patient by a double osteotomy of the radius and ulna. The patient is satisfied.展开更多
<p style="text-align:justify;"> <span style="font-family:Verdana;">Chronic osteomyelitis is serious because of the orthopedic sequels that they could cause. Extended diaphyseal sequestr...<p style="text-align:justify;"> <span style="font-family:Verdana;">Chronic osteomyelitis is serious because of the orthopedic sequels that they could cause. Extended diaphyseal sequestrations could cause bone loss and their management is delicate. Here we report a case of right ulnar diaphyseal reconstruction by non-vascularized fibula transfer. This was a three-year-old girl, non-sickle cell, who had chronic osteomyelitis of the right ulna. The evolution was towards an almost total ulnar diaphyseal sequestration with externalization of the distal extremity. The removal of this large sequestrum occurred almost spontaneously, leaving a significant bone loss over a length of about 6 cm. Secondarily, we reconstructed the right ulnar diaphysis by transfer of a free non-vascularized graft of the left fibula, maintained by a pin. </span><span style="font-family:Verdana;">The follow up was favorable with almost complete recovery of pro</span><span style="font-family:Verdana;">no-supination. Fibular ossification has evolved as well and we did not notice any complications at the graft collection site. Non-vascularized fibula graft transfer is a useful therapeutic option in the management of significant bone defect</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> secondary to chronic osteomyelitis of one of the two forearm bones.</span> </p>展开更多
Giant cell tumour (GCT) or osteoclastoma is a very rare locally invasive bone tumour that occurs close to the joint. The ulnar metaphysis is an unusual site for an Osteoclastoma with occurrence rate of 0.45% to 3.2% a...Giant cell tumour (GCT) or osteoclastoma is a very rare locally invasive bone tumour that occurs close to the joint. The ulnar metaphysis is an unusual site for an Osteoclastoma with occurrence rate of 0.45% to 3.2% as reported in literature [1]. Most of the patients seek traditional methods of treatment before orthopaedic consultation and present lately with extensive involvement of the tumour into soft tissues and articular surface, making the joint preservation difficult or impossible. For reconstruction, several options have been described, which include fibular autografts, allografts and cement augmentation. Inherent to all these procedures is the risk of delayed union of the graft and preserving functional mobility of the joint. We report a rare case of a proximal ulna GCT diagnosed in a 13-year-old girl. It was treated with intralesional curettage, and autologous maternal iliac crest bone grafting augmented with bone cement reconstruction.展开更多
<p style="text-align:justify;"> <span style="font-family:Verdana;">Giant cell tumor of the wrist is a rare, benign and usually symptomatic condition. The discovery is sometimes made fol...<p style="text-align:justify;"> <span style="font-family:Verdana;">Giant cell tumor of the wrist is a rare, benign and usually symptomatic condition. The discovery is sometimes made following a medical imaging examination or a painful symptomatology or more often a visible or palpable swelling with or without vascular and/or nerve compression. At an advanced stage, the X-ray is of paramount importance. The well codified complete surgical resection is part of the therapeutic arsenal.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We present a clinical case report of a young woman with a giant cell tumor localized in the wrist in N’Djamena, Chad. This case concerns a 25-year-old patient who presented in July 2020 of a painful swelling lateral to her left wrist bone and whose X-ray radiography showed lysis of the cortical bone in the lower third of the ulna. After the operative resection of the tumor mass, the pathological examination of the operative specimen revealed the diagnosis of a giant cell tumor.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">A giant cell tumor is a benign condition, with a few symptoms and the location at the ulna is exceptional. Complete surgical resection is a viable treatment option.</span> </p>展开更多
Squamous cell carcinomas are the commonest malignancies of the head and neck. Metastases from stage III and stage IV tumors occur most commonly in the cervical lymph nodes. The incidence of distant metastases occurrin...Squamous cell carcinomas are the commonest malignancies of the head and neck. Metastases from stage III and stage IV tumors occur most commonly in the cervical lymph nodes. The incidence of distant metastases occurring from such advanced tumors is anywhere between 10% and 40%. Distant metastases occur most commonly to the lungs followed by the bone and liver. The bone metastasis occurs commonly in the axial skeleton. We report a rather unusual case of squamous cell carcinomas from the Head and Neck region in a 77-year-old male metastasizing to the ulna. This case is even more interesting because the presenting symptom was a pathological fracture of the ulna for which he had reported to the orthopedic department. The immunohistochemistry of the metastatic tumor had shown an unmistakable squamous cell carcinoma with positive cytokeratin elements within the tumor. He referred to the ENT department where he was diagnosed with T2N0M1 squamous cell carcinoma of the oropharynx. The patient was treated with internal fixation and bone cementing for the metastatic lesion, and primarily treated with chemoradiation.展开更多
Objective: To investigate the anatomic basis of vascularized ulnar nerve graft by the pedicle of the superior collateral ulnar artery (SCUA). Methods: Twenty-two fresh cadaver upper extremities injected intra-arterial...Objective: To investigate the anatomic basis of vascularized ulnar nerve graft by the pedicle of the superior collateral ulnar artery (SCUA). Methods: Twenty-two fresh cadaver upper extremities injected intra-arterially with latex were dissected to study the extrinsic blood supply of the ulnar nerve. Other 6 fresh upper extremities were used to analyze the blood supply range of SCUA inside the ulnar nerve by microangiographic and histological methods. Results: The ulnar nerve was supplied by a branch of the lateral thoracic artery or directly by the axillary artery in the axillary section, by branches of SCUA in the upper arm, and by branches from the anastomosis of the collateral arteries and the posterior branch of the recurrent ulnar artery in the elbow. SCUA could supply the whole ulnar nerve from the axilla to the wrist. Conclusions: The ulnar nerve can be used as a vascularized nerve graft by the pedicle of SCUA in treatment of brachial plexus roots avulsion by C7 transfer from healthy side.展开更多
目的:探讨不同固定方式对尺骨鹰嘴骨折患者的影响。方法:回顾性收集2022年1月—2024年9月至上饶市人民医院就诊的80例尺骨鹰嘴骨折患者的临床资料,根据不同固定方式分为A组(n=27)、B组(n=29)、C组(n=24),A组行新型张力带固定方式治疗,B...目的:探讨不同固定方式对尺骨鹰嘴骨折患者的影响。方法:回顾性收集2022年1月—2024年9月至上饶市人民医院就诊的80例尺骨鹰嘴骨折患者的临床资料,根据不同固定方式分为A组(n=27)、B组(n=29)、C组(n=24),A组行新型张力带固定方式治疗,B组行钢丝克氏针张力带治疗,C组行锁定接骨板治疗。比较三组手术相关指标、肘关节功能、术后疼痛程度、术后并发症。结果:A组手术时间、骨折愈合时间、术后住院时间短于其他两组,术中出血量少于其他两组(P<0.05);治疗后3个月,三组Mayo肘关节功能评分(MEPS)中各维度评分及总分均较治疗前上升,A组、B组关节活动度维度评分高于C组(P<0.05),A组关节稳定性、日常功能、MEPS总分均高于B组、C组(P<0.05),B组关节稳定性、日常功能、MEPS总分均高于C组(P<0.05);术后3、7 d,A组VAS评分低于其他两组,B组术后3 d VAS评分低于C组(P<0.05);三组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论:相较于锁定接骨板、钢丝克氏针张力带,新型张力带系统更有助于尺骨鹰嘴骨折患者术后肘关节功能恢复,缩短手术时间与住院时间,减少术中出血量,缓解术后疼痛。展开更多
AIM: To define the optimum safe angle of use for an eccentrically aligned proximal interlocking screw(PIS) for intramedullary nailing(IMN).METHODS: Thirty-six dry cadaver ulnas were split into two equal pieces sagital...AIM: To define the optimum safe angle of use for an eccentrically aligned proximal interlocking screw(PIS) for intramedullary nailing(IMN).METHODS: Thirty-six dry cadaver ulnas were split into two equal pieces sagitally. The following points were identified for each ulna: the deepest point of the incisura olecrani(A), the point where perpendicular lines from A and the ideal IMN entry point(D) are intersected(C) and a point at 3.5 mm(2 mm safety distance from articular surface + 1.5 mm radius of PIS) posterior from point A(B). We calculated the angle of screws inserted from point D through to point B in relation to D-C and B-C. In addition, an eccentrically aligned screw was inserted at a standard 20° through the anterior cortex of the ulna in each bone and the articular surface wasobserved macroscopically for any damage.RESULTS: The mean A-C distance was 9.6 mm(mean ± SD, 9.600 ± 0.763 mm), A-B distance was 3.5 mm, C-D distance was 12.500 mm(12.500 ± 1.371 mm) and the mean angle was 25.9°(25.9°± 2.0°). Lack of articular damage was confirmed macroscopically in all bones after the 20.0° eccentrically aligned screws were inserted. Intramedullary nail fixation systems have well known biological and biomechanical advantages for osteosynthesis. However, as well as these well-known advantages, IMN fixation of the ulna has some limitations. Some important limitations are related to the proximal interlocking of the ulna nail. The location of the PIS itself limits the indications for which intramedullary systems can be selected as an implant for the ulna. The new PIS design, where the PIS is aligned 20°eccentrically to the nail body, allows fixing of fractures even at the level of the olecranon without disturbing the joint. It also allows the eccentrically aligned screw to be inserted in any direction except through the proximal radio-ulnar joint. Taking into consideration our results, we now use a 20° eccentrically aligned PIS for all ulnas. In our results, the angle required to insert the PIS was less than 20° for only one bone. However, 0.7° difference corresponds to placement of the screw only 0.2 mm closer to the articular surface. As we assume 2.0 mm to be a safe distance, a placement of the screw 0.2 mm closer to the articular surface may not produce any clinical symptoms.CONCLUSION: The new PIS may give us the opportunity to interlock IMN without articular damage and confirmation by fluoroscopy if the nail is manufactured with a PIS aligned at a 20.0° fixed angle in relation to the IMN.展开更多
文摘The number of secondary feathers varies among orders of birds with some orders exhibiting a positive relationship with ulna length,whereas in other orders secondary number is invariant.This difference has implications for scaling of the width of the feather vane within orders.In those species where the number of secondary remiges is invariant with ulna length,vane width should scale isometrically with ulna size to maintain an aerodynamic flight surface.Where feather count increases with increasing ulna length then vane width should exhibit negative allometry.Vane length should also correlate with ulna length,irrespective of the number of feathers.Data were compiled from an online library of images for the vane length and the width of the vane at 50%of the vane length for the fifth secondary feather for 209 bird species from 24 different orders.The results supported the hypotheses that vane width is a function of ulna size,and the number of secondary feathers as associated with different orders.Vane length was unaffected by the number of secondaries but varied between orders.The results suggest that birds have solved the problem of maintaining the aerodynamic surface of the proximal wing in two ways.Hence as ulna length increases the first solution involves more feathers that exhibit negative allometry for vane width,or in the second where feather count doesn't change,the vane width simply scales isometrically.The implications for the mechanical properties of the vane,and how it affects wing function,have not yet been explored in a range of birds.
基金Shanghai Fengxian District Osteoarthropathy Clinical Diagnosis and Treatment Center,China,No.fxlczlzx-a-201704.
文摘BACKGROUND Pulmonary thromboembolism(PTE)is a serious postoperative complication that can occur after a fracture.Generally,PTE is caused by the falling off of lower extremity deep vein thrombosis(LEDVT)after lower limb fracture surgery.LEDVT and PTE after upper extremity fracture surgery are very rare.PTE is one of the most common clinical causes of sudden death.Venous thromboembolism includes PTE and DVT.We experienced one case of LEDVT and PTE after distal ulna and radius fracture surgery.The purpose of our report is to raise awareness for orthopedic surgeons that PTE can occur after distal ulna and radius fracture surgery,and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.CASE SUMMARY We report a 51-year-old Chinese male who had severe fractures of the left distal ulna,radius and little finger after a motorcycle accident.The patient underwent external fixation,open reduction and internal fixation.On the third post-operative day,computed tomographic pulmonary angiography showed PTE.Doppler ultrasonography showed thrombus formation in the bilateral posterior tibial veins.After a period of anticoagulation therapy,on the 25th d after the PTE,computed tomographic pulmonary angiography showed that thrombus in both sides of the pulmonary artery disappeared.Furthermore,about 4 mo after the PTE,thrombosis in the deep veins of the lower limbs disappeared.About 1 year after the surgery,X-rays showed good fracture healing,and the function of the wrist joint recovered well.CONCLUSION Though rare,PTE can occur after distal ulna and radius fracture surgery and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.
基金Supported by Top-notch Academic Programs Project of Jiangsu Higher Education Institutions(PPZY2015C230)
文摘60% of a dog's body weight is supported by its fore limbs, while the hind limbs mainly play the role of power, so the probability of dog's radius and ulna fracture is greatly increased. This paper mainly introduced the diagnosis and treatment of a case of radius and ulna fracture in dog, with an attempt to provide reference for clinical practice.
文摘According to the specimens of ulna-radius of the Cape Hare (Lepus capensie) shot in fall and winter in Shanxi province, China, the ossifications of epiphyses cartilage of ulna-radius are divided into 4 stages. With weight of eye lens as a reference, it is proved that the age criterion could be used to distinguish young less than 6–7 months old from those older. This is a pragmatic method to analyze age composition of game-bag in the early period of shooting season when younger holds a large proportion in the hare population. It also is useful in judging the age of hares trapped and estimating the effects of predation on the hare population structure.
文摘BACKGROUND Cryptococcal osteomyelitis is a bone infection caused by cryptococcus.As an opportunistic infection,bone cryptococcosis usually occurs in patients with immunodeficiency diseases or in those undergoing immunosuppressive therapy and often displays characteristics of disseminated disease.Isolated cryptococcal osteomyelitis is extremely unusual in immunocompetent person.The pathogenic fungus often invades vertebrae,femur,tibia,rib,clavicle,pelvis,and humerus,but the ulna is a rare target.CASE SUMMARY A 79-year-old woman complaining of chronic pain,skin ulceration and a sinus on her right forearm was admitted,and soon after was diagnosed with cryptococcal osteomyelitis in the right ulna.Unexpectedly,she was also found to have apparently normal immunity.After treatment with antifungal therapy combined with surgery debridement,the patient’s osteomyelitis healed with a satisfactory outcome.CONCLUSION Although rare,cryptococcal osteomyelitis should be considered in the differential diagnosis of osteolytic lesions even in immunocompetent patients,and good outcomes can be expected if early definitive diagnosis and etiological treatment are established.
基金Supported by the National Natural Science Foundation of China (No.30670154 & 30870162)the Leading Academic Discipline Project of Shanghai Municipal Education Commission (No.J50401)
文摘Synedra ulna var, repanda Q. X. Wang ＆ Q. M. You, a new variety of Synedra （Bacillariophyta） from Xinjiang, China, is described and illustrated, and the characteristic of the variety： includes undulate-linear valves and straight pseudoraphe, differs from other species of Synedra.
文摘Madelung deformity is rare, accounting for 1.7% of congenital anomalies. The treatment is essentially surgical and several techniques have been described. We report the result of a case treated in an adult patient by a double osteotomy of the radius and ulna. The patient is satisfied.
文摘<p style="text-align:justify;"> <span style="font-family:Verdana;">Chronic osteomyelitis is serious because of the orthopedic sequels that they could cause. Extended diaphyseal sequestrations could cause bone loss and their management is delicate. Here we report a case of right ulnar diaphyseal reconstruction by non-vascularized fibula transfer. This was a three-year-old girl, non-sickle cell, who had chronic osteomyelitis of the right ulna. The evolution was towards an almost total ulnar diaphyseal sequestration with externalization of the distal extremity. The removal of this large sequestrum occurred almost spontaneously, leaving a significant bone loss over a length of about 6 cm. Secondarily, we reconstructed the right ulnar diaphysis by transfer of a free non-vascularized graft of the left fibula, maintained by a pin. </span><span style="font-family:Verdana;">The follow up was favorable with almost complete recovery of pro</span><span style="font-family:Verdana;">no-supination. Fibular ossification has evolved as well and we did not notice any complications at the graft collection site. Non-vascularized fibula graft transfer is a useful therapeutic option in the management of significant bone defect</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> secondary to chronic osteomyelitis of one of the two forearm bones.</span> </p>
文摘Giant cell tumour (GCT) or osteoclastoma is a very rare locally invasive bone tumour that occurs close to the joint. The ulnar metaphysis is an unusual site for an Osteoclastoma with occurrence rate of 0.45% to 3.2% as reported in literature [1]. Most of the patients seek traditional methods of treatment before orthopaedic consultation and present lately with extensive involvement of the tumour into soft tissues and articular surface, making the joint preservation difficult or impossible. For reconstruction, several options have been described, which include fibular autografts, allografts and cement augmentation. Inherent to all these procedures is the risk of delayed union of the graft and preserving functional mobility of the joint. We report a rare case of a proximal ulna GCT diagnosed in a 13-year-old girl. It was treated with intralesional curettage, and autologous maternal iliac crest bone grafting augmented with bone cement reconstruction.
文摘<p style="text-align:justify;"> <span style="font-family:Verdana;">Giant cell tumor of the wrist is a rare, benign and usually symptomatic condition. The discovery is sometimes made following a medical imaging examination or a painful symptomatology or more often a visible or palpable swelling with or without vascular and/or nerve compression. At an advanced stage, the X-ray is of paramount importance. The well codified complete surgical resection is part of the therapeutic arsenal.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We present a clinical case report of a young woman with a giant cell tumor localized in the wrist in N’Djamena, Chad. This case concerns a 25-year-old patient who presented in July 2020 of a painful swelling lateral to her left wrist bone and whose X-ray radiography showed lysis of the cortical bone in the lower third of the ulna. After the operative resection of the tumor mass, the pathological examination of the operative specimen revealed the diagnosis of a giant cell tumor.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">A giant cell tumor is a benign condition, with a few symptoms and the location at the ulna is exceptional. Complete surgical resection is a viable treatment option.</span> </p>
文摘Squamous cell carcinomas are the commonest malignancies of the head and neck. Metastases from stage III and stage IV tumors occur most commonly in the cervical lymph nodes. The incidence of distant metastases occurring from such advanced tumors is anywhere between 10% and 40%. Distant metastases occur most commonly to the lungs followed by the bone and liver. The bone metastasis occurs commonly in the axial skeleton. We report a rather unusual case of squamous cell carcinomas from the Head and Neck region in a 77-year-old male metastasizing to the ulna. This case is even more interesting because the presenting symptom was a pathological fracture of the ulna for which he had reported to the orthopedic department. The immunohistochemistry of the metastatic tumor had shown an unmistakable squamous cell carcinoma with positive cytokeratin elements within the tumor. He referred to the ENT department where he was diagnosed with T2N0M1 squamous cell carcinoma of the oropharynx. The patient was treated with internal fixation and bone cementing for the metastatic lesion, and primarily treated with chemoradiation.
文摘Objective: To investigate the anatomic basis of vascularized ulnar nerve graft by the pedicle of the superior collateral ulnar artery (SCUA). Methods: Twenty-two fresh cadaver upper extremities injected intra-arterially with latex were dissected to study the extrinsic blood supply of the ulnar nerve. Other 6 fresh upper extremities were used to analyze the blood supply range of SCUA inside the ulnar nerve by microangiographic and histological methods. Results: The ulnar nerve was supplied by a branch of the lateral thoracic artery or directly by the axillary artery in the axillary section, by branches of SCUA in the upper arm, and by branches from the anastomosis of the collateral arteries and the posterior branch of the recurrent ulnar artery in the elbow. SCUA could supply the whole ulnar nerve from the axilla to the wrist. Conclusions: The ulnar nerve can be used as a vascularized nerve graft by the pedicle of SCUA in treatment of brachial plexus roots avulsion by C7 transfer from healthy side.
文摘目的:探讨不同固定方式对尺骨鹰嘴骨折患者的影响。方法:回顾性收集2022年1月—2024年9月至上饶市人民医院就诊的80例尺骨鹰嘴骨折患者的临床资料,根据不同固定方式分为A组(n=27)、B组(n=29)、C组(n=24),A组行新型张力带固定方式治疗,B组行钢丝克氏针张力带治疗,C组行锁定接骨板治疗。比较三组手术相关指标、肘关节功能、术后疼痛程度、术后并发症。结果:A组手术时间、骨折愈合时间、术后住院时间短于其他两组,术中出血量少于其他两组(P<0.05);治疗后3个月,三组Mayo肘关节功能评分(MEPS)中各维度评分及总分均较治疗前上升,A组、B组关节活动度维度评分高于C组(P<0.05),A组关节稳定性、日常功能、MEPS总分均高于B组、C组(P<0.05),B组关节稳定性、日常功能、MEPS总分均高于C组(P<0.05);术后3、7 d,A组VAS评分低于其他两组,B组术后3 d VAS评分低于C组(P<0.05);三组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论:相较于锁定接骨板、钢丝克氏针张力带,新型张力带系统更有助于尺骨鹰嘴骨折患者术后肘关节功能恢复,缩短手术时间与住院时间,减少术中出血量,缓解术后疼痛。
文摘AIM: To define the optimum safe angle of use for an eccentrically aligned proximal interlocking screw(PIS) for intramedullary nailing(IMN).METHODS: Thirty-six dry cadaver ulnas were split into two equal pieces sagitally. The following points were identified for each ulna: the deepest point of the incisura olecrani(A), the point where perpendicular lines from A and the ideal IMN entry point(D) are intersected(C) and a point at 3.5 mm(2 mm safety distance from articular surface + 1.5 mm radius of PIS) posterior from point A(B). We calculated the angle of screws inserted from point D through to point B in relation to D-C and B-C. In addition, an eccentrically aligned screw was inserted at a standard 20° through the anterior cortex of the ulna in each bone and the articular surface wasobserved macroscopically for any damage.RESULTS: The mean A-C distance was 9.6 mm(mean ± SD, 9.600 ± 0.763 mm), A-B distance was 3.5 mm, C-D distance was 12.500 mm(12.500 ± 1.371 mm) and the mean angle was 25.9°(25.9°± 2.0°). Lack of articular damage was confirmed macroscopically in all bones after the 20.0° eccentrically aligned screws were inserted. Intramedullary nail fixation systems have well known biological and biomechanical advantages for osteosynthesis. However, as well as these well-known advantages, IMN fixation of the ulna has some limitations. Some important limitations are related to the proximal interlocking of the ulna nail. The location of the PIS itself limits the indications for which intramedullary systems can be selected as an implant for the ulna. The new PIS design, where the PIS is aligned 20°eccentrically to the nail body, allows fixing of fractures even at the level of the olecranon without disturbing the joint. It also allows the eccentrically aligned screw to be inserted in any direction except through the proximal radio-ulnar joint. Taking into consideration our results, we now use a 20° eccentrically aligned PIS for all ulnas. In our results, the angle required to insert the PIS was less than 20° for only one bone. However, 0.7° difference corresponds to placement of the screw only 0.2 mm closer to the articular surface. As we assume 2.0 mm to be a safe distance, a placement of the screw 0.2 mm closer to the articular surface may not produce any clinical symptoms.CONCLUSION: The new PIS may give us the opportunity to interlock IMN without articular damage and confirmation by fluoroscopy if the nail is manufactured with a PIS aligned at a 20.0° fixed angle in relation to the IMN.
