Wrist arthroplasty for correction of radial defect

Wrist arthroplasty for the correction of tibial defects for the surgical treatment of congenital tibial defects. Congenital tibial defects, also known as paravertebral humeral extremity deformities, are more common, more than half are bilateral, unilateral are mostly on the right side, more men than women. The main clinical manifestations are short forearm, and the wrist joint is skewed and unstable to the temporal side, so it is called the squatting hand. In addition to the complete or partial defect of the tibia, the disease sometimes has dysplasia or defect of the thumb, wrist and palm, and the ulnar bone of the same side is thick. Malformations in other parts can be complicated, and the absence or deformity of the forearm muscles, tendons, nerves, blood vessels is also often present. Treatment of diseases: lack of congenital tibia Indication Wrist arthroplasty for the correction of tibial defects is applicable to: Non-surgical treatment of congenital tibial defect with sacral hand deformity has no obvious effect, and surgery can be performed 3 to 6 months after birth. Contraindications 1. The general condition is poor and there are important organ diseases. 2. There are infected lesions in the skin near the surgical area. Preoperative preparation 1. Do a detailed systemic examination. 2. After birth, the technique and plaster and stent correction are used. Surgical procedure Incision An S-shaped incision is made in the middle of the wrist. Starting from the dorsal side of the fifth metacarpal, the back of the forearm is turned through the back of the wrist. 2. Soft tissue release Cut the skin, subcutaneous tissue, free flaps, reveal the dorsal, temporal and ulnar sides of the wrist joint. All bundles of tightly contracted fiber bundles on the wrist side are removed, and the tense tendons should be extended without cutting, but if the tendon is not functional, the tendon can be severed. The median nerve is superficial and tense, so be careful not to damage or mistake the tendon and cut it. 3. Wrist joint formation Free and retract the tendon and ulnar side to extend the total tendon and the ulnar extension of the tendon tendon, transversely cut the switch capsule and other contracture soft tissue, reveal the distal ulnar and carpal bone, release the carpal bone, remove the head bone and the lunate bone Relatively obtain some length, in order to correct the deviation, reset the wrist joint. The distal end of the ulna was not shortened to preserve its epiphysis. The distal end of the ulna was embedded in the bone groove formed after the removal of the lunate bone and the head bone. The correction was offset from the neutral position and the wrist was dorsiflexed by 25°. The needle is inserted from the distal side of the third metacarpal and fixed through the wrist to the ulnar bone. The ulnar joint capsule was tightened by overlapping sutures, and the joint capsules of other parts were reattached to the periosteum of the wrist to maintain a good alignment. After the reduction, the ulnar wrist muscles became slack and were shortened and sutured. 4. Stitching Rinse the wound and stop bleeding completely. Suture the skin and skin. If the skin is subcutaneous, you can do Z-plasty. complication Surgical complications that may occur in wrist angioplasty to correct humeral defects are median nerve injury, distal ulnar callus injury, and recurrence of deformity.