centralization of ulna, rare case presentation

1. CENTRALIZATION OF ULNA FOR
INFECTED NONUNION RADIUS
WITH EXTENSIVE BONE LOSS
Dr. CHIRANJEEVI
PG IN ORTHOPAEDICS
RANGARAYA MEDICAL COLLEGE
KAKINADA,ANDHRA PRADESH
UNDER THE GUIDENCE OF
DR Y NAGESWARA RAO PROFESSOR AND HOD
DR B S S S VENKATESWARLU (M.S)
PROFESSOR OF ORTHOPAEDICS
RANGARAYA MEDICAL COLLEGE
Kakinada, Andhra Pradesh

2. INTRODUCTION
 Infected nonunion with extensive bone
loss remains a challenging problem in
orthopaedic traumatology.
 Acquired Radial club hand deformity, post
osteomyelitis of radius bone is a very rare
disease.
 It results in functional and cosmetic deficit
of upper limb which is similar to congenital
cases.

3. WHAT ARE THE VARIOUS METHODS TO
RECONSTRUCT THE DEFORMITY
1. Bone grafting, plating,
2. Ilizarov,
3. Monorail external fixator,
4. Callus distraction etc

4. WHAT WE DID………?
 Keeping this in mind, to create a single bone
forearm we planned for centralization of ulna
on wrist to correct the deformity.
 This was originally devised by Hey-Groves in
1921, modified by Greenwood in 1932

5. CASE REPORT
 A 15years old boy came to OPD with
deformity of left forearm since childhood.
 He had h/o trauma during childhood at the
age of 8yrs managed conservatively with pop
cast . Later he had purulent discharge from
the same limb.

6. ON EXAMINATION
I. Patient had marked atrophy of the both hand
and forearm.
II. No active infection and sinus tracts but old
healed sinus tracts present.
III. He had complete pronation movements but
supination upto 90 degrees.
IV. Fixed radial deviation 50 degrees.
V. Fixed volar deviation 30 degrees.
VI. No neurovascular deficit.

8. RADIOLOGICAL EXAMINATION
Forearm AP and lateral
views
 Showing distal radial
metaphysis and distal
3rd diaphysis.
 No signs of active
osteomyelitis
 Positive ulnar variance

9. PROCEDURE
 ‘C’-shaped dorsal midline incision given.
 Branches of superficial sensory radial
nerve are preserved.
 The extensor tendons were identified, and
a thorough dissection was done to release
any tight radial structure.
 Distal end of ulna was osteotomised 1cm
proximal to the distal physis.

10. INTRA OPERATIVE

11.  The distal stump of the radius was exposed,
freshened and a trough created in its proximal
surface to accommodate the proximal ulnar
fragment.
 The latter was translated radially and impacted
into the distal radial remnant.
 This construct was held in place by k wires
passed through the 3rd metacarpal.
 Above elbow pop cast was applied for 3
months. Later k-wires were removed and wrist
movements were allowed.

12. RESULTS
 At 8months follow up 15-year-old boy had an
infection free, cosmetically acceptable
forearm with a stable wrist joint and a good
hand grip.
 He lacked the last 10 degrees of palmar and
dorsiflexion .
 The left forearm was 3 inches shorter than
the right. It was also smaller in girth by 1 inch
at mid-level and by 0.5 inch at wrist level.

13.  Radiographs showed consolidation of the
union between the hypertrophied centralized
ulna and distal radius,
 A good wrist joint space with a mild ulnar
negative variance and normal palmar tilt of
the distal radial articular surface.

14. POST OPERATIVE

18. CONCLUSION
 We conclude that centralization of ulna
showed good result in correcting the
deformity and producing wrist stability
reasonably.
 There was no detrimental effect on the
growth of the distal ulnar epiphysis. The
finding of the study need further follow-up, as
a short follow-up period for evaluating such
rare cases is not appropriate.

19. THANK YOU