POST TRAUMATIC RADIO ULNAR SYNOSTOSIS

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CHERRY KOVOOR

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Jan 22, 2022, 12:24:36 PM1/22/22
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Dear friends

Kindly give your opinions

Pt a lady entrepaneur running a small industrial unit

While repairing one of the machines her R hand got caught in the machine and completely crushed with loss of all fingers at MCP JOINT level and fracture both bone forearm[ open]

TREATMENT GIVEN

External fixation debridement and skin grafting

Later after 4 weeks ext fix removal and after pin tract healing ORIF and bone grafting both radius and ulna- volar approch

At present [3 months] post ORIF, wrist joint has 40 degrees of dorsiflexion and 20 degree of palmar flexion, full ROM elbow and with forearm in mid-prone position no further pronation supination possible which she finds quite disabling

Present x-ray shows union of both radius and ulna but with synostosis

What can be done- My plan is to go mid dorsal approach expose the synostosis resect it and interposition fat graft.

I would be obliged if the members could tell their expieiences as to the result of excision and fat pad grafting  and any technical points that will be of help

Attaching x-rays

 

Regards

 

DR C CHERIYAN KOVOOR

sindaug12weeks.pn.png

Sudhir Warrier

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Jan 23, 2022, 8:49:04 PM1/23/22
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Hi Cherry,
I agree with Bijay. Too early to intervene. I'd wait another three months. Monthly x-rays and levels of alkaline phosphatase. 
Once it's established that no new heterotopic bone is getting formed, I would plan the excision. In the past, I have used prolene mesh as an interposition to good effect. 

A prosthetic hand may be fitted if the stump is stable, painless and free of any edema.

Sudhir Warrier


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