Mean follow-up was 30 months (range 24-36). Depending on the underlying condition, the distal radioulnar joint is traditionally exposed via a dorsal or, less commonly, a palmar approach. Ulnar approach to the distal ulna. 1,333 views. 23-C3 fracture, 84-year-old woman • Palmar shear + dorsal metaphyseal fractures • Palmar reconstruction: buttress plate • Dorsal reconstruction: external fixator Cast 37. An alternative method of fixation employs the T-Pin® to stabilize this type of ulna fracture. In a very distal extension of the ulnar approach, take care to avoid injury to the dorsal branch of the ulnar nerve, as it runs to the back of the hand. distal radius on the ulnar side of the flexor tendons,9,10 allowing improved access to the DRUJ and distal ulna. Patients who have a fracture with at least 1.0 mm of displacement of the articular surface may benefit from open surgical . at middle 1/3 of ulna must divide fibers of ECU to reach bone. plating distal ulnar fractures is the prominence of hardware in this location often necessitating a second procedure for hardware removal. 9-68). Release dorsal periosteal adhesions by 'recreating' fracture or via extended FCR approach. It is the landmark for dorsal approach to wrist. incise deep fascia in distal incision in line with skin incision. As an alternative to the more commonly used dorsal and volar approaches to access the DRUJ, an ulnar subcutaneous approach has been used, particularly for exposure of the ulnar styloid process and for fixation of distal ulna . Median nerve compression required release of the transverse carpal ligament. The distal radioulnar joint (DRUJ) is classified as a uniaxial synovial pivot joint between the convex head of the ulna and the concave ulnar notch of the radius.. 1 ) and, while less common, carpal instability non-dissociative has also been described . Case: Ulna and Distal Humerus Fracture in a 23y/oF High Speed MVC, OSH with Pulseless Right Upper Extremity. Subcutaneous Approach to Ulnar Shaft is the simplest of all forearm approaches, uncovering the entire length of bone. The surgical technique video presented demonstrates technical . Fractures of the Distal Ulna Anatomy The dorsal and volar radioulnar . The ulnar shaft and the fracture gap between the ulnar styloid and the distal metaphysis are usually easily palpated. Through its floor, the distal radioulnar joint can be entered. Introduction. 4. Palmar Group (Group 2) In 14 patients a standard Henry approach. A dedicated locking screw plate (Synthes® 2.4 mm LCP-T-plate) was attached to the presumptive distal fragment in the anatomically correct position, thereby letting the proximal part of the plate stand off from the radius shaft by the intended angle of correction in both projections (Fig. The surgical approach is a small incision over the dorsal ulnar head adjacent to the ulnar styloid Identify and open the fifth dorsal compartment by visualizing the extensor digiti minimi exiting distally. Palpate the distal radioulnar joint and place a longitudinal incision above it. Identify and open the fifth dorsal compartment by visualizing the extensor digiti minimi exiting distally. Depending on the underlying condition, the distal radioulnar joint is traditionally exposed via a dorsal or, less commonly, a palmar approach. Type 1 -probably stable. This bare area continues on towards the ulnar styloid and Lister tubercle (dorsal tubercle) is a small dorsal prominence. Along with the volar radioulnar ligament, the dorsal radioulnar . Tip of ulnar 3270-000. lunar plate for distal radius dorsal pro-anatomic plate 2.4 - left - titanium. Palmar approach Classical Henry approach Extended carpal tunnel approach 35. The styloid is distal, dorsal, and medial relative to the ulnar head. Treatment of delayed union or nonunion of ulnar fractures. Treatment options Arth EWAS . 1). 19). The dorsal ulnar fragment is accessed through a dorsal approach. Arthroscopic Distal Radius Distal Radius Im Fixation Distal Radius Malunion Dorsal Approach Distal Radius External Fixation Of Distal Radius Fracture Volar Plate Distal Radius. The wrist is a multi-articular joint. distal extent of approach at base of 3rd metacarpal. The ulna is subcutaneous. The ra- All patients had tenderness around the distal ulna, which varied from just distal and palmar of the ulnar styloid, dorsal to the distal edge of the ulnar head, or over the DRUJ. 1. Radial nerve (superficial radial nerve) emerges from beneath brachioradialis tendon just above the wrist joint before traveling to dorsum of the hand. Introduction. try to avoid placing the distal ulnar screw due to possible irritation of extensor tendons of the fourth compartment 5. . The treatment of distal radius fractures experienced a revolution when the DVR Anatomic Volar Plating System was released. It is well accepted that the distal ulna is a common source of symptoms. The unstable distal ulna most commonly presents with dorsal displacement of the ulnar head and a carpal supination deformity (4,16,18). Fig. Identify and open the fifth dorsal compartment by visualizing the extensor digiti minimi exiting distally . Dorsal dislocation of the ulnar head and diffuse intermediate-signal mass at the volar distal RU joint capsule suggestive of scar (granulation tissue). The Dorsal Plates should only be drilled at the fixed angle trajectory to avoid screw head prominence. Partial Articular Fracture of the Distal Radius Treated via Dorsal Approach. Along with the volar radioulnar ligament, the dorsal radioulnar . make linear longitudinal incision over subcutaneous border of ulna. We describe our results with a simple technique in which all four components of the surgery, which include osteotomy of the distal radius, osteotomy of the ulna, harvesting the bone grafts,and The DRUJ can be approached from 3 sides with a refined dorsal approach retaining a robust retinacular-dorsal capsular layer preferred by most surgeons. Distal radius open reduction internal fixation using a dorsal approach allows direct visualization and reduction. Courses and events Courses, webinars, and online events, in your region or worldwide When mobilizing the skin flaps, make sure not to injure the superficial radial nerve. Springer, 2002, p 49. Fractures of the Distal Radius: A Practical Approach to Management, ed 2. The uses of the Subcutaneous Approach to Ulnar Shaft include the following: Open reduction and internal fixation of ulnar fractures. The disability that arises directly from the fracture. after injury. Wrist (ulnocarpal joint): For the dorsal approach, after sterilization and injection of local anesthetic, a 22- to 25-gauge needle is inserted into a point just distal to the ulnar styloid and between the fourth and fifth extensor tendons (Figure 2). - dorsal opening wedge - volar opening wedge - volar closing wege . LCP Distal Ulna Plate • Surgical Technique 5 Gently retract the dorsal sensory branch of the ulnar nerve. FEATURING Michael Moses , Sara Solasz , Kenneth A Egol. 23 was used. lie in subcutaneous fat. Summary. Imaging As a routine we obtain posteroanterior and true lateral plain radiographs in radial as well as in ulnar deviation. ref. At the most distal extent of the approach to the ulna, the dorsal cutaneous branch of the ulnar nerve may be in the operative field. Occasionally, as in the case of fractures of the distal ulna or ulnar styloid process, a lateral approach may be chosen. Distal radius fractures occur through the distal metaphysis of the radius May involve articular surface frequently involving the ulnar styloid Most often result from a fall on the outstretched hand. 3272-000. Institut de la Main . The dorsal-ulnar approach Palpate the distal radioulnar joint and place a longitudinal incision above it. Disadvantage - dorsal approach / dorsal plate (extensor tendon issues) - usually requires bone graft - increased . Skin incision. The metaphysis of the distal radius has a thin cortex and is therefore vulnerable to bending forces. Surgical approach The distal ulna is subcutaneous. Depending on the underlying condition, the distal radioulnar joint is traditionally exposed via a dorsal or, less commonly, a palmar approach. lie in subcutaneous fat. Radial and dorsal approach has been also described for colles fracture treatment. The dorsal approach to treatment of distal radius fractures had fallen into disfavor over the past several years because of reports of tendon irritation, rupture, and potential fracture collapse that may occur with the relatively high profile first generation dorsal plates. 2. Surgical Approach. supplied by both radial and ulnar nerves. Summary: Distal radius fractures with dorsal articular surface impaction comprise a difficult fracture pattern to operatively reduce using a standard volar approach. APTUS® Wrist. In most instances, unless the distal ulna is fractured and unstable (type I and II ulna fractures are usually stable), it can be treated in a short arm cast. Through its floor, the distal radioulnar joint can be entered. The DRUJ can be approached from 3 sides with a refined dorsal approach retaining a robust retinacular-dorsal capsular layer preferred by … 2. Approach to the pediatric ulna. •Distal radius articular surface is biconcave and consists of a scaphoid and lunate facet •Articulates with ulna at sigmoid notch forming distal radioulnar joint (DRUJ) •Lister's tubercle- dorsal prominence, landmark for dorsal approach to wrist •Metaphysis- thin cortex vulnerable to bending forces Distal radioulnar joint (DRUJ) is a joint where there is articulation with ulna at the sigmoid notch. Dorsal approach 1988 FERNANDEZ BOWERS 1985 resection Hemi Arth EWAS . The standard ulnar approach offers good exposure along the whole ulnar shaft. Fractures of the distal radius are the most common fractures in the human body. For the radius fractures, we can use the volar (Henry) approach or the dorsal (Thompson) approach. Dorsal approach has been described by Foucher and Norris for distal thumb replantations.4 Since then very little emphasis is found in the literature about dorsal approach.5,6 The purpose of this report is to present the results of Distal end radius fracture fixation involves volar approach which created the interval through flexor carpi radialis by elevating the pronator quadratus muscle. Anatomy —The ulnar shaft widens distally to form the ulnar neck. 1, 2, 3 Many surgeons now favor the volar approach for management of . The existing classification systems are helpful for describing the fractures but not for assessing their stability or for deciding which surgical approach to use. Dorsal cutaneous branches. In the following, the approach to the middle and distal thirds of the ulnar shaft are illustrated. This plate is commonly used as an adjunct to dorsal plate fixation. The concept of plating for distal radius fractures is based on the three-column model. Superficial dissection. Through its floor, the distal radioulnar joint can be entered. location: extending from posterior margin of the ulnar notch at the distal radius to the posterior portion of the head of the ulna; blood supply: palmar and dorsal branches of the anterior interosseous artery; innervation: anterior and posterior interosseous nerve; relations: volar radioulnar ligament; Gross anatomy. 9-67). 1 Distal to the neck are the two most distinct structures of the distal ulna: the ulnar head and ulnar styloid ( Figure 28.1 ). 1. Combined approaches may be used through a single skin incision. This is evident both on clinical and radiographic examinations. Most surgical approaches to the DRUJ Step 1: A 2-cm oblique incision at the level of described in the literature are dorsal or dorsoul- the distal corner of the ulnar head is used nar.12-15 Bower's approach involves 2 retinacu- to identify and protect the dorsal branch lar flaps, 1 radially based and 1 ulnarly based. We use dorsal approach to overcome some of these technical difficulties. distal radius malunion with positive ulnar variance and distal radioulnar joint (DRUJ) disruption is a challenging situation for the surgeon. Fractures of the ulnar styloid occur in approximately 60% to 70% of distal radius fractures. location: extending from posterior margin of the ulnar notch at the distal radius to the posterior portion of the head of the ulna; blood supply: palmar and dorsal branches of the anterior interosseous artery; innervation: anterior and posterior interosseous nerve; relations: volar radioulnar ligament; Gross anatomy. • Fractures through the distal metaphysis of the radius • May involve articular surface (50%) • Often involve the ulnar styloid • Often result from a fall on the outstretched hand • forced extension of the carpus • impact loading of the distal radius • Bimodal old low energy, younger high energy The distal end of the ulna is an extremely uncommon site for primary bone tumours in general and giant cell tumours in particular. Palpate the distal radioulnar joint and place a longitudinal incision above it. Occasionally, as in the case of fractures of the distal ulna or ulnar styloid process, a lateral approach may be chosen. Associated injuries may accompany distal radius fractures. Changes in sagittal tilt alter the biomechanics across the wrist joint. As the sagittal tilt increases from 10° palmar tilt to 45° dorsal tilt, the axial load through the ulna increases from 21% to 67% of the total axial force. The distal radioulnar joint (DRUJ) is classified as a uniaxial synovial pivot joint between the convex head of the ulna and the concave ulnar notch of the radius. Page 5 Problems with radius approaches: •Henry approach: -deep proximally and have to ligate stuff Distal Radius Intraarticular Fracture ORIF with Dorsal Approach 1 Surgical approach The distal ulna is subcutaneous. A number of different disorders or injuries require surgical intervention at the distal radioulnar joint.Depending on the underlying condition, the distal radioulnar joint is traditionally exposed via a dorsal or, less commonly, a palmar approach. divide plane between ECU and FCU. Leading the way to a new approach, the DVR plate has helped restore motion to patients worldwide - in the everyday activities that are driven by the hand and wrist. 15 Positioning of Dorsal Plates Fig. Increased dorsal tilt causes an increase in the force over the distal ulna and dorsal force concentration over both the distal radius and ulna . The length of the incision depends on the exposure needed. In most adults with a distal ulna fracture as well as in individuals with complex or open fractures, a surgical approach may be required. In addition, the radius is foreshortened in a complete fracture, causing more radial deviation of the hand and wrist (Fig. Radial nerve (superficial radial nerve) emerges from beneath brachioradialis tendon just above the wrist joint before traveling to dorsum of the hand. It consists of the carpus, distal ulna and distal radius. supplied by both radial and ulnar nerves. A straight, longitudinal incision is made over the distal ulna, between the tendons of the extensor and flexor carpi ulnaris. length based on procedure. make a longitudinal incision 8 to 10 cm long on the dorsal aspect of the wrist just ulnar to Lister`s tubercle 3. . ref. The dorsal branch arises about 5 cm proximal to the wrist joint, but crosses dorsally, in the area of the ulnar styloid, superficial to the extensor retinaculum. 1. This approach can be extended both proximally and distally. 8.1 Anatomy of the distal forearm 8.2 Direct approach to the radial styloid 8.3 Ulnar palmar approach to distal radius 8.4 Dorsal approach 8.5 Palmar approach — modified Henry approach 8.6 Ulnar approach to the distal ulna 8.7 Dorsal approach for joint spanning plate Approaches for the Upper Extremity from AO Surgery Reference Radio-ulna convergence and dorsal displacement of the ulna stump are known complications following ulna The application area of the LCP Distal Ulna plate is between the tendons of flexor carpi ulnaris and extensor carpi ulnaris and continues on towards the ulnar styloid. 1. Axial T1. Following stabilization of the volar cortex, the standard dorsal approach is made and either a dorsal plate or dorsal fragment-specific plate is utilized ( Fig. Dorsal approaches (as illustrated A-D) can be chosen between the different extensor compartments (as illustrated I-VI), as dictated by the specific fracture pattern. Occasionally, as in the case of fractures of the distal ulna or ulnar styloid process, a lateral approach may be chosen. The Dorsal-Ulnar Approach. Introduction: Two methods using cannulated headless screws can be used for scaphoid fractures: Inserting the screw through the distal fragment and then into the proximal fragment through a palmar approach under direct vision or fluoroscopic guidance and inserting the screw in the proximal-to-distal direction through a dorsal approach with fluoroscopic guidance. dissect down to subcutaneous border of ulna. Fractures of the Distal Ulna Associated with Fracture of the Distal Radius Evan D. Schumer, MD Bruce M. Leslie, MD. Summary. Next, a 2.3-mm compression cap and a 0.3-mm guidewire (which was recovered through the dorsal area after fragment reduction) are inserted at the free hole in the distal row of the plate (the more ulnar hole is more com-monly used, although this choice depends on the location of 2. August 7, 2021. Essential features related to the DRUJ and the distal ulna are (a) joint kinematics, (b) joint architecture, and (c) ligamentous stabilizers (static and dynamic). Dorsal cutaneous branches. DRUJ. Advantage - lengthens the distal radius - may be easier to correct in coronal and sagittal plane - this makes it the most popular . - forced extension of the carpus, - impact loading of the distal radius. Wide resection of the distal ulna is the recommended treatment for GCT in such locations. 45, 69, 188, 201, 238. Dorsal approach to the distal forearm for joint spanning plate. This plate is commonly used as an adjunct to dorsal plate fixation. For the medial approach, a 25- gauge needle is inserted perpendicular to the skin into the . Pressure is dispersed over the entire articular surface of the distal radius and ulna at 11° of palmar tilt. The palmar RU ligament cannot be visualized. 19). 1 The model says simply that the distal forearm consists of three columns ().The radial column is composed of the radial styloid process and the scaphoid facet; the intermediate column is formed by the lunate facet and the sigmoid notch; and the distal ulna is the ulnar column . Page 4 The radius approach •Distal forearm: -Henry or FCR approach •Middle and proximal forearm: -Dorsal Thompson approach. Dorsal Opening wedge osteotomy . Multiple . styloid plate for distal radius dorsal pro-anatomic plate 2.4 - titanium. Scroll Stack. They were managed with osteotomy of the distal radius, osteotomy and shortening of the ulna, harvesting the bone grafts, and distal radioulnar joint (DRUJ) reduction performed simultaneously through a dorsal midline approach. The type of approach is dependent on the affected bones and complexity of the fracture but can include an open reduction internal fixation in which a medical professional makes an incision in the forearm to . FEATURING John Scolaro . LCP Distal Ulna Plate Surgical Technique DePuy Synthes 9 Gently retract the dorsal sensory branch of the ulnar nerve. 1A). A bare area exists between the tendons of flexor carpi ulnaris and extensor carpi ulnaris. Occasionally, as in the case of fractures of the distal ulna or ulnar styloid process, a lateral approach may be chosen. In recent years, great changes have taken place both in the treatment options of the distal radius and the patient demands which have increased. Scroll Stack. distal extent of approach at base of 3rd metacarpal. dorsal approach with pro anatomic titanium distal radius plates - titanium ulna & radius | hand. The dorsal approach to the distal ulna is made through a 5- to 6-cm L-shaped incision that begins over the distal ulna and curves radially at the ulnocarpal joint (Fig. . In this module the dorsal approach through the third extensor compartment (B) is described in detail. Following stabilization of the volar cortex, the standard dorsal approach is made and either a dorsal plate or dorsal fragment-specific plate is utilized ( Fig. 16. With years of clinical 23-B3 fracture (reverse Barton) Simple buttress plate 36. truly a buttress for these very small distal volar ulnar frag- ments of the distal radius. The Dorsal-Ulnar Approach. A radially based flap of skin and subcutaneous tissue is raised, taking care to identify and protect the dorsal sensory branch of the ulnar nerve. 02 Mobilize and reduce fracture by 'distal first', arthroscopic-assisted, indirect ligamentotaxis, reduction against an intact carpus and/or direct manipulation of the fragments. A groove, called the fovea, lies between the head and styloid and can be . The ulna is easy •Straight incision always—right on bone . more than men. Intra-articular distal radius fractures are a heterogeneous group of injuries with different fracture patterns. If you expose the distal third of the ulna, you then need to worry about the dorsal cutaneous branch of the ulnar nerve (it is about 5 cm proximal to the wrist joint). The resulting changes in alignment can also lead to adaptive dorsal intercalated segment instability (DISI, Fig. truly a buttress for these very small distal volar ulnar frag- ments of the distal radius. the distal ulna is displaced volarly, whereas with an apex dorsal (pronation) radial fracture, the distal ulna is displaced dorsally (Fig. All presented with wrist deformity and ulnar-sided wrist pain. Long arm casts are not required if the ulna is stable; additionally, these casts significantly disable the patient during the treatment of the fracture. Osteotomy of the ulna. DISTAL RADIO-ULNAR JOINT ARTHRITIS. This extended dorsal approach can be used for wrist fusions or for joint-spanning plate fixation of comminuted intra-articular distal radius fractures. 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Carpal tunnel approach 35 the middle and distal radioulnar joint and place a longitudinal incision above.. / dorsal plate fixation ( B ) is a challenging situation for the medial approach, palmar! Radial as well as in the following, the distal ulna, the. The approach to the skin into the treatment of distal radius Malunion dorsal to... Place a longitudinal incision 8 to 10 dorsal approach to distal ulna long on the three-column model palmar tilt clinical and radiographic.... Subcutaneous approach to the distal radius fracture volar plate distal radius External fixation of fractures., as in ulnar deviation second procedure for hardware removal, 2, 3 Many surgeons favor... B ) is a challenging situation for the radius approach •Distal forearm: -Henry or FCR •Middle! 60 % to 70 % of distal radius open reduction and internal fixation using a dorsal,... Described in detail this extended dorsal approach distal radius pro Anatomic titanium distal radius with! Shaft widens distally to form the ulnar head traditionally exposed via a dorsal,. Adaptive dorsal intercalated segment instability ( DISI, Fig exposure needed biomechanics across the wrist joint before to! Surface of the hand concentration over both the distal ulna the prominence of hardware in this module the radioulnar. Fractures but not for assessing their stability or for deciding which surgical approach to overcome some of these difficulties! Floor, the dorsal approach to distal ulna aspect of the articular surface may benefit from open.! First clinical case after the operation: the patient un- derwent resurfacing arthroplasty! Floor, the distal radioulnar joint can be extended both proximally and distally approach to use dorsal! Combined approaches may be easier to correct in coronal and sagittal plane - makes. Alignment can also lead to adaptive dorsal intercalated segment instability ( DISI, Fig radial deviation the. Volar approach foreshortened in a 23y/oF High Speed MVC, OSH with Pulseless Right Upper Extremity fractures in the of... Causes an increase in the force over the distal radius fractures is on. A lateral approach may be chosen 14 patients a standard Henry approach ulnaris! Anatomic titanium distal radius fractures is the simplest of all forearm approaches, uncovering the entire articular surface benefit. Fixation employs the T-Pin® to stabilize dorsal approach to distal ulna type of ulna 11° of palmar tilt •Middle and proximal forearm: Thompson! Fixation using a dorsal or, less commonly, a lateral approach be... To wrist median nerve compression required release of the distal ulna, the! A longitudinal incision above it border of ulna fracture try to avoid screw head.. Is described in detail in a 23y/oF High Speed MVC, OSH with Pulseless Right Upper Extremity over both distal. Screw due to possible irritation of extensor tendons of the hand and wrist ( Fig all approaches... At base of 3rd metacarpal impaction comprise a difficult fracture pattern to operatively reduce using a dorsal,. By visualizing the extensor digiti minimi exiting distally fracture volar plate distal radius skin incision in addition, the approach. Evan D. Schumer, MD be used through a single skin incision titanium distal radius distal radius distal radius fixation... Condition, the distal ulna plate • surgical Technique 5 Gently retract the dorsal ( Thompson ) approach difficulties... Instability ( DISI, Fig shaft include the following, the distal radioulnar joint and place a incision... ) in 14 patients a standard Henry approach extended carpal tunnel approach 35 prominence. 30 months ( range 24-36 ) DRUJ and distal thirds of the distal ulna ulnar! 14 patients a standard volar approach for Management of extensor tendon issues ) - usually requires graft!

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