Radius Neck-to-Humerus Trochlea Transposition for Elbow Reconstruction After Resection of the Proximal Ulna: Report of 2 Cases
Department of Orthopedics, Mayo Clinic, Scottsdale, AZ 85259, USA. The Journal of hand surgery
(Impact Factor: 1.67).
11/2008; 33(8):1384-7. DOI: 10.1016/j.jhsa.2008.04.004
The structural and functional deficit created after wide excision of the proximal ulna for malignant bone tumors presents a difficult reconstructive challenge. The purpose of our report was to retrospectively review the outcome of the radius neck-to-humerus trochlea transposition after wide resection of malignant forearm tumors in 2 patients. Good function was obtained using this surgical technique. This surgical option provides a durable biologic solution to a complex reconstructive problem. (J Hand Surg 2008;33A:1384-1387. Copyright (C) 2008 by the American Society for Surgery of the Hand. All rights reserved.)
Available from: ncbi.nlm.nih.gov
- "In order to assess the 1-year effectiveness of radius neck-to-humerus trochlea transposition, the rare case of an 80-year-old Chinese Han male undergoing the procedure after wide excision of an advanced metastatic ulnar tumor is examined in detail, providing a powerful precedent for the potential long-term success of this procedure in stabilizing the elbow with minimal impact on the sensitivity and minimal mobility impairment. Few cases have reviewed both the immediate postsurgical and long-term outcomes of this technique [7,8], suggesting the need for formal evaluation of such cases in order to improve clinical treatments choices and overall patient outcomes. "
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ABSTRACT: Wide en bloc excision of proximal ulna sections is used to treat traumatic and pathological fractures of the ulna, though poor standardization of clinical treatment often results in long-term failure of such reconstructed biomechanical structures. In order to provide insight into effective ulnar reconstructive treatments, the case of an 80-year-old Chinese Han male presenting with pathological fracture caused by a proximal ulnar metastatic tumor concurrent with metastatic renal cancer complicated by occurrence in the brain and lungs is reported and contrasted with alternative treatment techniques. Wide resectioning of the proximal ulna and reconstruction with local radius neck-to-humerus trochlea transposition resulted in preservation of functionality, sensitivity, and biomechanical integrity after postsurgical immobilization, 6 weeks of passive- and active-assisted flexion, and extension with a hinged brace. The resultant Musculoskeletal Tumor Society rating score was 25 of 30 (83 %). Full sensitivity and mobility of the left hand and elbow (10° to 90° with minimally impaired supination and pronation) was restored with minimal discomfort. No evidence of local recurrence or other pathological complications were observed within a 1-year follow-up period. Efficient reconstruction of osseous and capsuloligamentous structures in the elbow is often accomplished by allografts, prosthesis, and soft tissue reconstruction, though wide variations in risk and prognosis associated with these techniques has resulted in disagreements regarding the most effective standards for clinical treatment. Current findings suggest that radius neck-to-humerus trochlea transposition offers a superior range of elbow movement and fewer complications than similar allograft and prosthetic techniques for patients with multiple metastatic cancers.
Available from: PubMed Central
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ABSTRACT: Ewing's sarcoma of the bone is the second most frequently occurring malignant bone tumor in children and adolescents. Ewing's sarcoma in the ulna are extremely rare. Thus, the surgical options for reconstruction of the elbow are limited and technically challenging. In the current study, a 29-year-old male with Ewing's sarcoma of the ulna was treated with a sub-total resection and reconstruction using a non-vascularized, autogenous fibular graft and hernia mesh. At the 2-year follow-up, the patient had returned to his previous occupation with no evidence of local recurrence or distant metastasis. The functional recovery was satisfactory, and the patient could perform active movement of the elbow from 0° to 135°, forearm pronation to 30°, supination to 85° and had full hand function. The grip power of the left hand was 36 kg, which was 86% of the contralateral side (42 kg).
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