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Many salamanders can completely regenerate a fully functional limb. Limb regeneration is a carefully coordinated process involving several defined stages. One key event during the regeneration process is the patterning of the blastema to inform cells of what they must differentiate into. Although it is known that many genes involved in the initial development of the limb are re-used during regeneration, the exact molecular circuitry involved in this process is not fully understood. Several large-scale transcriptional profiling studies of axolotl limb regeneration have identified many transcription factors that are up-regulated after limb amputation. Sall4 is a transcription factor that has been identified to play essential roles in maintaining cells in an undifferentiated state during development and also plays a unique role in limb development. Inactivation of Sall4 during limb bud development results in defects in anterior-posterior patterning of the limb. Sall4 has been found to be up-regulated during limb regeneration in both Xenopus and salamanders, but to date it function has been untested. We confirmed that Sall4 is up-regulated during limb regeneration in the axolotl using qRT-PCR and identified that it is present in the skin cells and also in cells within the blastema. Using CRISPR technology we microinjected gRNAs specific for Sall4 complexed with cas9 protein into the blastema to specifically knockout Sall4 in blastema cells only. This resulted in limb regenerate defects, including missing digits, fusion of digit elements, and defects in the radius and ulna. This suggests that during regeneration Sall4 may play a similar role in regulating the specification of anterior-proximal skeletal elements. • Sall4 is re-expressed in many cell after injury to the limb. • Knock-down or knock-out of Sall4 during regeneration results in defects in patterning of the regenerate. • Knock-down or knock-out of Sall4 results in defects in expression of key fgf and wnt genes during limb regeneration. [ABSTRACT FROM AUTHOR]

The term ‘Ubiquitous name’ is created and discussed. A ‘ubiquitous name’ is a taxon name that is used for any specimens that are superficially classified with a ‘commonly adopted name’ such as Synedra acus (Ulnaria acus) and Synedra ulna (Ulnaria ulna). Two examples are provided. The first, from 1923, is Joaquin Frenguelli and his use of the name Synedra acus for the diatoms of Argentina. The second, 100 years later, from 2023, Kochoska et al.’s use of the name Synedra goulardii. With reference to historical biogeography, ‘ubiquitous names’ can only be successfully eliminated with revisionary monographic treatments of the geographical spread of taxa within some specific area. Historical biogeography requires schemes of taxon relationships so that one might be able to understand how, specifically, species relate in these different areas. [ABSTRACT FROM AUTHOR]

Background: Forearm shaft fractures are common injuries, often caused by falling from a fully-upright position or falling off a bike. They can be treated nonoperatively or surgically with intramedullary nailing or plates. The method of choice for treating pediatric forearm shaft fractures is the application of elastic stable intramedullary nailing (ESIN)|. The aim of the study was to evaluate ESIN in pediatric patients with forearm shaft fractures based on radiological images, and determine the etiology and complication rate associated with the injury. Methods: The study included 201 patients, 30.5% female 69.5% male, aged 1 to 17 years (mean 9.1 years; SD = 3.2), all had been diagnosed with a fracture of the forearm shaft and had been treated surgically with ESIN. In addition, all possessed a complete set of X-ray images and had attended a minimum six-month follow-up examination of the forearm. Axial alignment was evaluated retrospectively in the anatomical (AP) and lateral (LAT) positions. In total, 402 radiographs were examined. Of the injuries, 68% occurred during sports activity and 75% involved both the radius and the ulna. Results: Union was observed in all cases. Mean axial alignment values in AP and LAT X-ray or both the ulna and radius were satisfactory. Axial alignment values were not influenced significantly by age, type of surgery, type of fracture or etiology. Plaster cast application (9.8% of cases) significantly influenced radius axial alignment. The complication rate was 11.4% (n = 23). Significantly more complications were observed in patients receiving open reduction internal fixation (ORIF) (p = 0.0025). Conclusion: The ESIN technique is an effective treatment for forearm diaphyseal fractures in children, with good results regarding reduction and bone healing, indicated by x-ray. [ABSTRACT FROM AUTHOR]

Orthosuchus stormbergi was a small‐bodied crocodyliform, representative of a diverse assemblage of Early Jurassic, early branching crocodylomorph taxa from the upper Elliot Formation of South Africa. The life history of these early branching taxa remains poorly understood, with only sparse investigations into their osteohistology, yet species like Orthosuchus have potential to inform about the macroevolution of growth strategies on the stem leading to crown crocodilians. In order to elucidate the growth patterns of Orthosuchus, we used propagation phase contrast X‐ray synchrotron micro‐computed tomography to virtually image the osteohistology of the postcrania of two specimens, including multiple elements from the type (SAM‐PK‐K409), and the femur of a referred specimen (BP/1/4242). In total, we scanned nine mid‐diaphyseal sections of the humerus, radius, ulna, radiale, femur, tibia, fibula, and a rib. We then compared our results to osteohistological sections of crocodylomorph taxa from the published literature. Our results show that the most predominant bone tissue type in Orthosuchus is lamellar, with a few patches of woven and parallel‐fibred bone. The type specimen contains four to five lines of arrested growth and the hindlimb elements present outer circumferential lamellae, whereas the referred specimen contains six to seven. Both specimens grew at similar rates, reaching adult skeletal body size at year four or five. The sectioned bones, most notably the radius and ulna, are comparatively thick walled and compact. Our virtual osteohistological sections are one of the first for an early branching crocodyliform, and the broad sample of skeletal elements makes Orthosuchus a key anchor point for understanding the plesiomorphic life history traits of the clade. [ABSTRACT FROM AUTHOR]

Background: Distal radioulnar joint (DRUJ) instability is a common post-traumatic complication, often leading to chronic pain and dysfunction. Current reconstructive techniques, such as the single suture button construct, offer suboptimal stabilization in certain motions. This study aimed to evaluate whether a double suture button construct provides greater stability than the single construct in a cadaver model of DRUJ instability. We hypothesized that the double suture button construct would more effectively minimize dorsal translation of the radius relative to the ulna. Methods: We used nine freshly frozen human cadaver upper extremities, destabilized the DRUJ, and then reconstructed the joint using three different suture button constructs: single transverse, double (transverse + oblique), and single oblique. The specimens were secured in a custom-designed testing apparatus to measure dorsal translation of the radius. The study proceeded in five stages: stable DRUJ, unstable DRUJ, and reconstruction using a single transverse, double (transverse + oblique), and single oblique suture button construct. Dorsal translation was measured at neutral, 45° pronation, and 45° supination. Statistical comparisons of mean values were conducted for each stage. Results: Reconstruction with the transverse, transverse plus oblique, and oblique suture button constructs resulted in statistically significant reductions in dorsal translation compared to the unstable DRUJ (p < 0.001 for all). The double-suture button construct significantly minimized dorsal translation in all positions, restoring stability comparable to a stable DRUJ: neutral (p = 1.000), pronation (p = 0.963), and supination (p = 1.000). In contrast, single constructs failed to fully restore stability in pronation and supination. Conclusion: The double suture button construct provides significantly greater stabilization of the DRUJ compared to the single construct. These findings suggest that the double construct could be a more effective option for treating DRUJ instability, particularly in restoring normal joint function during various motions. Further research is warranted to confirm these results in clinical settings. [ABSTRACT FROM AUTHOR]

Purpose: To observe the effect of the forearm rotation function reconstruction with an external fixator in treating congenital radioulnar synostosis. Methods: From July 2017 to July 2023, 6 patients (9 sides) with congenital radioulnar synostosis who underwent reconstruction of the forearm rotation with the external fixator were retrospectively analyzed. The extent of flexion and rotation, the Modified An and Morrey functional rating index, and the grade according to the classification system proposed by Failla et al. were compared before and after the operation. Results: All patients were followed up for an average of 12.00 (8.00, 38.50) months. The average range of rotation, the Modified An and Morrey functional rating index increased from 0°, 64.56 ± 1.33 points to 85.00° ± 25.86°, 83.71 ± 5.50 points, respectively. The differences were statistically significant (t = 9.86, P < 0.01, t = 11.20, P < 0.01). There was no significant difference in forearm flexion before and after the operation (Z = 1.34, P = 0.18). According to the Failla classification system, 2 forearms were classified as poor preoperatively, 6 as fair and 1 as good. 2 forearms were assessed as excellent, 6 as good and 1 as fair during the last follow-up. Conclusion: Reconstruction of the forearm rotation function with an external fixator is safe and effective for treating congenital radioulnar synostosis. This technique can restore the partial rotational function of the forearm. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study is to establish the correlation of clinically measured carrying angle with four radiological angles, i.e., Humerus–Elbow–Wrist angle (HEWA), Humero-ulnar angle, Metaphyseal–Diaphyseal angle, and Baumann's angle, and to find out which of the above-mentioned angles co-relates best with the clinically measured carrying angle. Methods: We studied 100 patients in the age group of 2–12 years after Ethics committee approval and informed consent from parents. Clinical angle was measured using goniometer and radiological angles marked on antero-posterior elbow X-ray using a standard method. Collected data were studied using statistical tests to find out correlation. Results: Pearson correlation coefficient for humerus–elbow–wrist angle found to be 0.674 followed by Humero-Ulnar angle (r = 0.417). Regression coefficient for humerus–elbow–wrist angle is 0.635 (p value < 0.001). Conclusion: Humerus–Elbow–Wrist angle correlates better compared to other radiological angles in assessment of varus–valgus angulations of elbow & will not only play a vital role in pre- operative planning of deformity corrections but also in the evaluation & comparison of the post-operative functional outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the clinical efficacy of endoscopic debridement combined with compression suture in the treatment of aseptic olecranon bursitis. Methods: A retrospective analysis was conducted on 28 patients, including 25 males and 3 females, who underwent endoscopic debridement combined with compression suture for the treatment of aseptic olecranon bursitis at Huzhou Central Hospital from February 2017 to January 2024. Visual analogue scale (VAS) scores, Mayo elbow function scores, complications, recurrence rates and wound scars were evaluated to assess the treatment efficacy. Results: The average follow-up time was 12 ± 5 months (range: 5–22 months). The VAS score was slightly greater on postoperative day 1 than preoperatively, but this difference was not statistically significant. Compared with the preoperative level, the VAS score was significantly lower at 2 weeks post-surgery, and the patients were generally free of pain. The patients' Mayo elbow function score was significantly improved at 2 weeks after the operation, and their elbow function was generally normal at 1 month after the operation. At the final follow-up, no recurrence or obvious scarring was found in any of the patients, and all of them exhibited normal elbow function without any reported pain. Conclusion: Endoscopic debridement combined with compression suture for the treatment of aseptic olecranon bursitis has several advantages: simple operation, minimal invasiveness, minimal postoperative pain, rapid recovery, a low recurrence rate, and satisfactory overall efficacy. Level of evidence Level IV [ABSTRACT FROM AUTHOR]

Background: Stress injuries are often missed secondary to their insidious onset, milder symptoms, and subtle or initially absent findings when imaged. Main Body: This review aims to provide strategies for evaluating and treating upper extremity stress fractures. This article outlines the classic presentation of each fracture, the ages during which these injuries often occur, the relevant anatomy and biomechanics, and the mechanism of each injury. Diagnostic imaging and management principles are also discussed, including the use of conservative versus surgical management techniques. Short Conclusion: Upper extremity stress fractures are often mild injuries that resolve with conservative management but can lead to more serious consequences if ignored. Given their increasing incidence, familiarity with diagnosis and management of these injuries is becoming increasingly pertinent. Key Points: Stress injuries are often missed secondary to their insidious onset, milder symptoms, and subtle or initially absent findings when imaged. This review aims to provide strategies for evaluating and treating upper extremity stress fractures. [ABSTRACT FROM AUTHOR]

Ulnar mammary syndrome (UMS) results from heterozygous variants in the TBX3 gene and impacts limb, tooth, hair, apocrine gland, and genitalia development. The expressivity of UMS is highly variable with no established genotype–phenotype correlations. TBX3 belongs to the Tbx gene family, which encodes transcription factors characterized by the presence of a T‐box DNA‐binding domain. We describe a fetus exhibiting severe upper limb defects and harboring the novel TBX3:c.400 C > T (p.P134S) variant inherited from the mother who remained clinically misdiagnosed until prenatal diagnosis. Literature revision was conducted to uncover the TBX3 clinical and mutational spectrum. Moreover, we generated a Drosophila humanized model for TBX3 to study the developmental consequences of the p.P134S as well as of other variants targeting different regions of the protein.Phenotypic analysis in flies, coupled with in silico modeling on the TBX3 variants, suggested that the c.400 C > T is UMS‐causing and impacts TBX3 localization. Comparative analyses of the fly phenotypes caused by the expression of all variants, demonstrated that missense changes in the T‐box domain affect more significantly TBX3 activity than variants outside this domain. To improve the clinicians' recognition of UMS, we estimated the frequency of the main clinical features of the disease. Core features often present pre‐pubertally include defects of the ulna and/or of ulnar ray, hypoplastic nipples and/or areolas and, less frequently, genitalia anomalies in young males. These results enhance our understanding of the molecular basis and the clinical spectrum of UMS, shedding light on the functional consequences of TBX3 variants in a developmental context. [ABSTRACT FROM AUTHOR]

Background: Patients with hereditary multiple exostosis (HME) usually present with forearm deformity with or without radial head dislocation. Ulna lengthening has been proposed to address this condition. Exostosis resection plus ulna lengthening has been adopted in our hospital since 2008, and patients with this condition were retrospectively reviewed. Herein, we aimed to investigate the optimal timing and clinical outcomes of this surgical approach. Methods: In all, thirty-five patients (40 forearms), including 22 boys and 13 girls, were enrolled in our study from July 2014 to September 2020. We divided the patients into 4 groups based on the age when they received surgery and the status of the radial head. Pronation and supination of the forearm, flexion and extension of the elbow, wrist ulnar deviation and wrist radial deviation, and radiological parameters including ulnar length (UL), ulnar variance (UV), the percentage of radial bowing (RB/RL), radio articular angle (RAA) and carpal slip (CS), were assessed and recorded. Results: The mean UL was significantly improved after surgery in four Groups (P<0.05). In patients with radial head dislocation, we found significant improvement in forearm, wrist function and elbow flexion (p < 0.05). For the patients with radial head dislocation, the juniors demonstrated better improvement in % RB and RAA (p<0.05, p = 0.003 and 0.031). Conclusion: Exostosis resection and ulna lengthening with unilateral external fixation can effectively improve the function and radiological parameters of forearm deformity in HME children. For patients with radial head dislocation, early surgery can achieve better results. For patients not associated with radial head dislocation, we recommend regular follow-up and surgical treatment after 10 years of age. [ABSTRACT FROM AUTHOR]

The denomination of the "ulna" bone as "cubitus" bone is an error in terminology still observed in anatomy study texts and Chilean school textbooks, even though the term ulna was established as the official term in the 20th century. This problem is a reflection of the slow progressive change in academic communities and the population in general, through the traditional transfer of knowledge. Scientific dissemination allows for accelerating such a process, and in recent years, it has been enhanced through social networks and virtual platforms such as TikTok. Few studies relate the use of TikTok with anatomical learning. This research describes school students' perception of an informative video on correctly using the term "ulna." It analyzes the possible scope as a complementary activity to anatomical teaching for the school community and society. A TikTok video was developed and published four months before showing it to 17 11th-grade students from Viña del Mar, and then they were asked to complete a perception survey. In addition, statistical data provided by the TikTok platform itself was recorded. The results revealed a favorable reception of the informative content among the participating students, with a high percentage expressing total or partial agreement in all the statements evaluated (up to 82.4 %). The metrics delivered by the platform show an international reach, the main viewers being people from Chile (35.5 %), Mexico (25.3 %), and Colombia (7.2 %). Among the aspects mentioned by the students that need improvement, are the quality of visual editing and the fluency of the explanation. Given thepositive perception obtained from the video, we consider that using these complementary tools can improve human anatomy's teaching and learning processes and broaden our practices' impact on the educational community and society. [ABSTRACT FROM AUTHOR]

Maffucci syndrome is a rare, congenital, and nonhereditary syndrome characterized by the occurrence of multiple enchondromas and hemangiomas. According to previous studies, patients diagnosed with Maffucci syndrome have a higher risk of developing malignant tumors, such as ovarian cancer, pancreatic cancer, breast cancer, and central nervous system cancer, in addition to malignant transformations of enchondromas. The authors report a case of a 37-year-old male patient with Maffucci syndrome who presented with multiple enchondromas and hemangiomas. This patient's presentation and management are discussed, along with a review of the literature. Maffucci syndrome should be expected when encountering a patient with multiple enchondromas and suspected hemangiomas in the limbs. Even if benign lesions such as enchondromas or hemangiomas are diagnosed, regular follow-up is required to monitor for malignant transformations and the development of malignant tumors in other organs. [ABSTRACT FROM AUTHOR]

Background: Monteggia-equivalent fractures are similar to Monteggia fractures but involve different patterns and locations. When these fractures include a severe radial head fracture, radial head arthroplasty (RHA) should be considered. RHA can be performed using Kocher's approach or the less commonly used trans-olecranon approach, which has been less studied. This study evaluates the clinical and radiological outcomes of the trans-olecranon approach for RHA over 15 years. Methods: In this retrospective study, 45 cases of Monteggia-equivalent fractures were analyzed, focusing on patients over 18 with radial head fractures, treated by the same surgeon with RHA and open reduction and internal fixation (ORIF) of the proximal ulna via the trans-olecranon approach. Results: The cohort of 45 patients showed a mean flexion of 112.37° ± 13.7°, mean extension of 24.27° ± 17.9°, mean supination of 57.63° ± 28.9°, and mean pronation of 62.16° ± 29.07°. Clinical and radiographic measurements indicated satisfactory results, with acceptable complication and secondary procedure rates. Conclusion: The trans-olecranon, single-incision approach is effective for managing fractures involving the proximal ulna and radial head, offering adequate access to lateral elbow structures while minimizing damage to surrounding soft tissue. Therefore, this approach should be considered for patients presented with a Monteggia-equivalent fracture and an indication for RHA. [ABSTRACT FROM AUTHOR]

Introduction: Reconstructing long bone defects in the upper limbs, particularly the radius and ulna, poses significant challenges. These defects, resulting from trauma, tumors, infections, or congenital anomalies, require precise surgical intervention for functional restoration. Traditional non-vascularized autogenous bone grafts have limitations, such as resorption and limited biological activity. To address these challenges, free vascularized fibular grafts (FVFGs) have been developed, offering enhanced recovery by supplying nutrients and structural support, particularly in large defects or compromised vascularity. Materials and Methods: This retrospective study reviewed patients with significant forearm skeletal defects treated with FVFGs at our institution from January 2008 to January 2019. Included were patients with radius or ulna defects exceeding 8 cm due to trauma, tumor excision, or non-union fractures. Data on demographics, clinical details, surgical techniques, and outcomes—including graft union time, complications, range of motion, and the disabilities of the arm, shoulder and hand (DASH) scores—were analyzed. Results: Eight patients, with a mean age of 27.6 years and an average defect length of 9.8 cm, were included. All patients achieved graft union within an average of 4 months, with no tumor recurrence or significant complications. Functional outcomes showed mean forearm pronation of 56.9 degrees, supination of 52.5 degrees, and a mean DASH score of 17.7. Conclusions: FVFG is a safe and effective technique for managing complex forearm bone defects, providing high union rates and good functional outcomes. It should be considered a primary option for large forearm skeletal defects. [ABSTRACT FROM AUTHOR]

Objective: To compare performance in baseball pitchers before and after revision ulnar collateral ligament (UCL) surgery using performance metrics. Design: Case series. Setting: Public online database. Patients (or Participants): Players who underwent revision UCL surgery between 2015 and 2021 were identified. Players were included if they were Minor League (MiLB) or Major League (Major League baseball [MLB]) pitchers. Players were excluded if they were not pitchers, if they underwent their revision surgery as an amateur, or if there is no record of their primary reconstruction surgery. Interventions: Revision UCL surgery (repair or reconstruction). Main Outcome Measures: Return to sport (RTS) rate, RTS time, pitch velocity, and pitch spin rate. Results: Sixty-five pitchers underwent revision UCL surgery. MiLB pitchers had a shorter RTS time after their primary surgery (15.62 vs 20.77 months, P, 0.01) compared with MLB pitchers but similar RTS times after their revision reconstruction (19.64 vs 18.48 months, P 5 0.44). There was also no difference in return to play (RTP) rate overall after primary versus revision reconstruction (P 5 1.00). Major League baseball pitchers also had decreased RTS time after primary compared with revision reconstruction (15.62 vs 19.64 months, P, 0.01) but similar RTP rates (P 5 0.28). Finally, MLB pitchers had similar pitch breakdowns, velocities, and spin rates before and after their primary and revision repair or reconstruction. Conclusions: Both revision UCL repair and reconstruction can return pitchers to preinjury performance levels. Pitchers and teams should be properly counseled on realistic RTP times and postsurgery performance when discussing revision UCL surgeries. [ABSTRACT FROM AUTHOR]

Purpose: A deep knowledge of the variations of the posterior forearm musculature is crucial for assessing and diagnosing conditions in this region. Extensor indicis (EI) is one of the muscles in this region, which exhibits diverse anatomical variations. This report documents an extremely unusual form of the EI with an accessory head on the dorsum of the hand. Methods: During routine dissection, an extremely rare presentation of the EI was found in the left forearm of a 94-year-old female cadaver. Results: This unusual EI consisted of two muscle bellies. The traditional belly originated from the distal two-thirds of the ulna. The muscle became tendinous around the carpal area, distal to the extensor retinaculum. The tendon was subsequently joined by an accessory muscle belly originating from the distal radioulnar ligament. The EI tendon inserted onto the dorsal expansion of the index finger, ulnar to that of the extensor digitorum. The posterior interosseous nerve innervated the muscle. Conclusion: Herein, we report an extremely rare form of the EI. To our knowledge, EI with an accessory head has only been reported rarely over the past 200 years. Moreover, our report appears to be the first case with photographic details of this anatomical variation. Clinicians should be aware of this variation for proper diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Purpose: Depending on its axis, pronation varies from the radius rotation around the steady ulna to the reciprocal adduction of the radius and abduction of the ulna. While there is no question that pronator teres is a central pronation agonist, anconeus's role is not settled. The current investigation comparing palpation and ultrasonography in these two muscles during pronation along the axis capitulum-second digit evolved from a serendipitous finding in a clinical anatomy seminar. Methods: Single-hand palpation and two-transducer ultrasonography over anconeus and pronator teres were used on ten normal subjects to investigate their contraction during pronation around the capitulum-second digit axis. These studies were done independently and blind to the results of the other. The statistical analysis between palpation and ultrasonography was performed with Cohen's kappa coefficient and the χ2 test. Results: On palpation, on resisted full pronation, anconeus contracted in 8/10 subjects and pronator teres in 10/10 subjects. Without resistance, the corresponding ratios were 5/10 and 9/10. On two-transducer ultrasonography, the comparable ratios were 7/10 and 10/10, and 3/10 and 10/10. A fair concordance (Cohen's kappa = 0.21) between palpation and ultrasonography in detecting the simultaneous status of anconeus and pronator teres during resisted full pronation. Anatomic dissection illustrated the elements involved. Conclusions: Plain palpation confirmed by ultrasonography showed the simultaneous contraction of anconeus and pronator teres during resisted pronation in most of the studied subjects. The study suggests that palpation can be helpful in directly studying muscle activity during movement. [ABSTRACT FROM AUTHOR]

In sports practices, the intensity and type of forces exerted on the human body are totally different from everyday living. Harsh movements and impact loadings are very common in sports and sometimes cause severe injuries to both muscles and bones. In a specific case, in volleyball games, the lower arm of the player is continuously exposed to heavy impacts by the ball. The main part of the body enduring these impact loads are the two ulna and radius bones in the lower arm. Therefore, in this type of ball impacts it is important to investigate the effect of ball movement and condition on the stress-induced in bones. In the present study, using numerical finite element and generalized differential quadrature (GDQ) methods, stability conditions in the ulna and radius bones in volleyball players under several static and harmonic loading types are investigated. Furthermore, change in the ball mass in the standard range is also considered in analyses. The bone structure is modeled as a cylindrical shell with classical elasticity theory and for inhomogeneous material properties. The results obtained using the numerical method are presented with a focus on the state of stability of the both ulna and radius bones. [ABSTRACT FROM AUTHOR]

Isolated volar distal radioulnar joint (DRUJ) dislocation is a rare condition with only a few cases reported in the literature. Its diagnosis is often overlooked in the acute phase, and there is no consensus in its management. We present the case of a 20-year-old male patient with an isolated volar radioulnar dislocation, together with a review of the literature. The aim is to present and summarize the acute management of this condition and propose a therapeutic algorithm. [ABSTRACT FROM AUTHOR]

Whether the forelimb‐digging apparatus of tooth‐digging subterranean mammals has similar levels of specialization as compared to scratch‐diggers is still unknown. We assessed the scapular morphology and forelimb musculature of all four solitary African mole rats (Bathyergidae): two scratch‐diggers, Bathyergus suillus and Bathyergus janetta, and two chisel‐tooth diggers, Heliophobius argenteocinereus and Georychus capensis. Remarkable differences were detected: Bathyergus have more robust neck, shoulder, and forearm muscles as compared to the other genera. Some muscles in Bathyergus were also fused and often showing wider attachment areas to bones, which correlate well with its more robust and larger scapula, and its wider and medially oriented olecranon. This suggests that shoulder, elbow, and wrist work in synergy in Bathyergus for generating greater out‐forces and that the scapula and proximal ulna play fundamental roles as pivots to maximize and accommodate specialized muscles for better (i) glenohumeral and scapular stabilization, (ii) powerful shoulder flexion, (iii) extension of the elbow and (iv) flexion of the manus and digits. Moreover, although all bathyergids showed a similar set of muscles, Heliophobius lacked the m. tensor fasciae antebrachii (aiding with elbow extension and humeral retraction), and Heliophobius and Georychus lacked the m. articularis humeri (aiding with humeral adduction), indicating deeper morphogenetic differences among digging groups and suggesting a relatively less specialized scratch‐digging ability. Nevertheless, Heliophobius and Bathyergus shared some similar adaptations allowing scratch‐digging. Our results provide new information about the morphological divergence within this family associated with the specialization to distinct functions and digging behaviors, thus contributing to understand the mosaic of adaptations emerging in phylogenetically and ecologically closer subterranean taxa. This and previous anatomical studies on the Bathyergidae will provide researchers with a substantial basis on the form and function of the musculoskeletal system for future kinematic investigations of digging behavior, as well as to define potential indicators of scratch‐digging ability. [ABSTRACT FROM AUTHOR]

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The ulnar collateral ligament (UCL) of the elbow plays a crucial role in elbow stability, specifically as a valgus and rotational constraint. Injuries to the UCL are common in overhead‐throwing athletes resulting in elbow instability. A timely diagnosis of early ulno‐humeral joint space widening in the overhead‐throwing athlete is required, to inform patient management and return to play. Sonographic assessment and measurement of the ulno‐humeral joint space with and without stress, and comparison to the contralateral uninjured side provides a quantitative assessment of instability. A systematic sonographic technique for single operator stress ultrasound is outlined to improve consistency of assessment and reporting of findings. [ABSTRACT FROM AUTHOR]

Background: Coronoid fracture size is one important factor in decision-making on surgical vs. nonsurgical management. There is currently no reliable, standardized technique to measure coronoid fracture size or bone loss. Hence, decision-making remains arbitrary, and recommendations made in the literature are unreliable. The aim of the study was to develop and assess a simple, reliable computed tomography (CT)-based technique that allows measurement of apical and anteromedial facet (AMF) coronoid height and bone loss. To achieve this, we sought to understand normal coronoid height across a large patient cohort, and whether the new technique was sensitive at detecting bone loss in patients with a fracture. Methods: 163 CT scans were manually formatted in the plane of the proximal ulna. A best fit circle was drawn in the greater sigmoid notch on the sagittal section. The coronoid coverage height (CCH) was defined as the distance (in mm) measured at 90° from the greater sigmoid notch floor to a line between the olecranon and coronoid tips (or fracture base in fractured coronoids), bisecting the center of the circle. The coronoid height index (CHI) was calculated as a % by dividing the CCH by the diameter of the circle. The measurements were performed at the coronoid apex and the center of the AMF in 108 intact coronoids to understand normative values and 55 fractured coronoids to assess the sensitivity of the technique at detecting bone loss. Measurements were independently performed by two investigators, and interobserver reliability was assessed with weighted Cohen’s kappa (ĸ) and intraclass correlation coefficient. Results: For intact coronoids, the mean CCH was 11.4 ± 1.4 mm at the apex and 11.6 ± 1.3 mm at the AMF. The mean CHI was 56.7 ± 4.9% at the apex and 41.1 ± 3.6% at the AMF. For fractured coronoids, the mean CCH and CHI were significantly lower (P

Aims: The ulna is an extremely rare location for primary bone tumours of the elbow in paediatrics. Although several reconstruction options are available, the optimal reconstruction method is still unknown due to the rarity of proximal ulna tumours. In this study, we report the outcomes of osteoarticular ulna allograft for the reconstruction of proximal ulna tumours. Methods: Medical profiles of 13 patients, who between March 2004 and November 2021 underwent osteoarticular ulna allograft reconstruction after the resection of the proximal ulna tumour, were retrospectively reviewed. The outcomes were measured clinically by the assessment of elbow range of motion (ROM), stability, and function, and radiologically by the assessment of allograft-host junction union, recurrence, and joint degeneration. The elbow function was assessed objectively by the Musculoskeletal Tumor Society (MSTS) score and subjectively by the Toronto Extremity Salvage Score (TESS) and Mayo Elbow Performance Score (MEPS) questionnaire. Results: The mean follow-up of patients was 60.3 months (SD 28.5). The mean elbow flexion-extension ROM was 95.8° (SD 21). The mean MSTS of the patients was 84.4 (SD 8.2), the mean TESS was 83.8 (SD 6.7), and the mean MEPS was 79.2 (SD 11.5). All the patients had radiological union at the osteotomy site. Symptomatic osteoarthritic change was observed in three patients (23%), one of whom ended up with elbow joint fusion. Two patients (15.4%) had recurrence during the follow-up period. Surgical complications included two allograft fractures, two plate fractures, three medial instabilities, and two infections. Conclusion: Osteoarticular ulna allograft reconstruction provides acceptable functional outcomes. Despite a high rate of complications, it is still a valuable reconstruction method, particularly in skeletally immature patients who need their distal humerus physis for the rest of hand growth. Cite this article: Bone Jt Open 2024;5(9):749–757.

Abstract Background Stress injuries are often missed secondary to their insidious onset, milder symptoms, and subtle or initially absent findings when imaged. Main Body This review aims to provide strategies for evaluating and treating upper extremity stress fractures. This article outlines the classic presentation of each fracture, the ages during which these injuries often occur, the relevant anatomy and biomechanics, and the mechanism of each injury. Diagnostic imaging and management principles are also discussed, including the use of conservative versus surgical management techniques. Short Conclusion Upper extremity stress fractures are often mild injuries that resolve with conservative management but can lead to more serious consequences if ignored. Given their increasing incidence, familiarity with diagnosis and management of these injuries is becoming increasingly pertinent.

Objective: To determine which bones and which grades had the highest inter-rater variability when employing the Tanner–Whitehouse (T-W) method. Materials and methods: Twenty-four radiologists were recruited and trained in the T-W classification of skeletal development. The consistency and skill of the radiologists in determining bone development status were assessed using 20 pediatric hand radiographs of children aged 1 to 18 years old. Four radiologists had a poor concordance rate and were excluded. The remaining 20 radiologists undertook a repeat reading of the radiographs, and their results were analyzed by comparing them with the mean assessment of two senior experts as the reference standard. Concordance rate, scoring, and Kendall's W were calculated to evaluate accuracy and consistency. Results: Both the radius, ulna, and short finger (RUS) system (Kendall's W = 0.833) and the carpal (C) system (Kendall's W = 0.944) had excellent consistency, with the RUS system outperforming the C system in terms of scores. The repeatability analysis showed that the second rating test, performed after 2 months of further bone age assessment (BAA) practice, was more consistent and accurate than the first. The capitate had the lowest average concordance rate and scoring, as well as the lowest overall concordance rate for its D classification. Moreover, the G classifications of the seven carpal bones all had a concordance rate less than 0.6. The bones with lower Kendall's W were likewise those with lower scores and concordance rates. Conclusion: The D grade of the capitate showed the highest variation, and the use of the Tanner–Whitehouse 3rd edition (T-W3) to determine bone age (BA) was frequently inconsistent. A more comprehensive description with a focus on inaccuracy bones or ratings and a modification to the T-W3 approach would significantly advance BAA. [ABSTRACT FROM AUTHOR]

Chronic recurrent multifocal osteomyelitis (CRMO), an autoinflammatory bone disorder characterized by non-bacterial osteomyelitis causing recurrent multifocal bone lesions, is a well-known, yet uncommon pediatric condition that rarely affects adults; to date, it has never been diagnosed over the age of 75. The following report will discuss the first octogenarian diagnosed with CRMO and therefore represents an exceptionally rare presentation of a rare disease. An 83-year-old woman presented with progressive right shoulder, forearm, and hip pain, with associated weight loss and global weakness, requiring a wheelchair for mobility. Imaging revealed a pathologic right ulna fracture in addition to lytic lesions of the right proximal humerus and proximal femur. The clinical picture was thus that of a patient with probable multiple myeloma versus metastatic disease. After an extensive workup, however, the lesions were not malignant; histologic findings were instead suggestive of chronic osteomyelitis with negative cultures. Given the multifocal nature of this condition, combined with a lack of clinical symptoms of infection, a diagnosis of CRMO was rendered. The patient underwent intramedullary nailing of the right femur and splinting of the ulna, with a subsequent remarkable recovery to painless ambulation, complete union of the right ulna fracture, and resolution of the lytic lesions without receiving any targeted medical treatment. This case highlights the importance of maintaining CRMO on the differential for multifocal skeletal lesions, regardless of age. Performing a thorough workup with necessary imaging, biopsy, and culture are critical to establishing this diagnosis, which can only made as a diagnosis of exclusion. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the clinical and functional outcomes of children with distal both-bone forearm fractures treated by fixation of the radius only compared to fixation of both the radius and ulna. Methods: A total of 71 patients from two centres with distal both-bone forearm fractures (30 in the ulna-yes group, 41 in the ulna-no group) who underwent closed reduction and percutaneous pinning treatment were retrospectively analysed. Operation duration, number of fluoroscopic exposures, loss of reduction rate and angulation based on radiographic assessment were compared between the two groups. Evaluation of wrist function including Gartland-Werley Score and Mayo Wrist Score were compared at the last follow-up. Results: Ulna angulation upon bone healing on the posteroanterior and the lateral plane of ulna-no group (6.11 ± 1.56°; 6.51 ± 1.69°) was significantly greater than that of ulna-yes group (4.49 ± 1.30°; 5.05 ± 2.18°) (p < 0.05). No significant difference was found in the loss of reduction rate between ulna-yes group (6.67%, 2/30) and the ulna-no group (4.88%, 2/41) (p > 0.05). At last follow-up, no significant difference was found between the Gartland-Werley Scores of the ulna-yes group (1.83 ± 3.25, range: 0–16) and ulna-no group (1.85 ± 2.72, range: 0-11.5) (p > 0.05). No significant difference was found between the Mayo Wrist Scores of the ulna-yes group (92.60 ± 6.20) and ulna-no group (92.15 ± 7.58) (p > 0.05). Conclusions: For distal both-bone forearm fractures in children, fixation of only the radius appears to be a viable method with equivalent clinical outcomes compared to fixation of both the radius and ulna. [ABSTRACT FROM AUTHOR]

The Forkhead box transcription factors FOXC1 and FOXC2 are expressed in condensing mesenchyme cells at the onset of endochondral ossification. We used the Prx1-cre mouse to ablate Foxc1 and Foxc2 in limb skeletal progenitor cells. Prx1-cre;Foxc1Δ/Δ; Foxc2Δ/Δ limbs were shorter than controls, with worsening phenotypes in distal structures. Cartilage formation andmineralization was severely disrupted in the paws. The radius and tibia were malformed, whereas the fibula and ulna remained unmineralized. Chondrocyte maturation was delayed, with fewer Indian hedgehog-expressing, prehypertrophic chondrocytes forming and a smaller hypertrophic chondrocyte zone. Later, progression out of chondrocyte hypertrophy was slowed, leading to an accumulation of COLX-expressing hypertrophic chondrocytes and formation of a smaller primary ossification center with fewer osteoblast progenitor cells populating this region. Targeting Foxc1 and Foxc2 in hypertrophic chondrocytes with Col10a1-cre also resulted in an expanded hypertrophic chondrocyte zone and smaller primary ossification center.Our findings suggest that FOXC1 and FOXC2 direct chondrocyte maturation towards hypertrophic chondrocyte formation. At later stages, FOXC1 and FOXC2 regulate function in hypertrophic chondrocyte remodeling to allow primary ossification center formation and osteoblast recruitment. [ABSTRACT FROM AUTHOR]

The locoregional distribution patterns of lymphatic malformations (LM) in the upper extremity have not been described in the scientific literature. Twelve patients were diagnosed with a LM in their upper extremities between 1998 and 2021 at our center. In all cases, these were isolated malformations. Nine patients (75%) presented an ulnar distribution pattern of the LM, two (16.7%) presented a radial distribution pattern, and one (8.3%) presented involvement of both territories. We found no statistically significant differences in any sociodemographic or clinical variable between patients with ulnar or radial LM distribution patterns. In this work, we found that the ulnar distribution pattern was more frequent than the radial distribution pattern in upper extremity LM. Furthermore, we observed that LM in the radial territory appeared as lesions limited to the distal segment of the upper limb (thumb and distal radius). This is a small retrospective case series and therefore, these findings should be interpreted with caution. Larger sample size studies are necessary to validate and characterize this finding. [ABSTRACT FROM AUTHOR]

Objective The aim of this study is to create clinical normative data for ulnar length in the pediatric population and to demonstrate the usefulness of such data. Materials and Methods A nationally representative sample of healthy children aged 1 day to 18 years from five centers across India was collected. The percutaneous length of the ulna was measured by using a certified calibrated measuring tape across all centers. Other variables such as geographical domicile, dominance of the hand, age, body mass index (BMI), and sex of the child were also recorded. Results In total, 1,300 children (883 males and 417 females) with age ranging from 1 day to 18 years were included in the study. Gradual lengthening of the ulna was seen in both male and female children with increasing age without a significant difference; however, at 8, 9, and 14 years, there was significant lengthening of the ulna in males compared with females although the difference was statistically insignificant at 17 years. Apropos BMI at 16 years of age, a longer ulna was observed in obese children. Later on, at 18 years, the difference in ulnar length was insignificant. South Indian children had a significantly longer ulna up to the age of 11 years, but after the age of 11 years there was no difference in ulnar length in all zones. The length of the ulna was not affected by hand dominance. There was good inter-observer agreement and reliability between different centres. Age, zone, and gender, had statistically significant effect on the length of ulna but BMI and hand dominance was not significant. Conclusion This multicentric study provides normative data on the percutaneous length of the ulna in the Indian pediatric population. Gradual lengthening of the ulna was seen in all children with increasing age. The length of the ulna was significantly more in male, obese, and in South Indian children. However, except for age, other factors become insignificant at maturity. [ABSTRACT FROM AUTHOR]

Background: The elbow joint formed between the humerus within the arm,and the ulna and radius in the forearm permits the hand to be moved toward and far from the body.While the elbow joint is extended, the arm and forearm are not perfectly aligned,a deviation occurs laterally closer to the long axis of the arm, which is known as the “carrying angle”. Aim and objective: i)To measure the variation of carrying angle between rural and urban region of Haryana population between age group of 12-40 years. ii)To estimate the variation of carrying angle between male and female of age group of 12-40 year population of Haryana. Material and Methods: The present study consists of 230 (one hundred fifteen rural and one hundred fifteen urban subject) asymptomatic,healthy humans from urban and rural areas of the Haryana location within the age group of 12-40 years.Carrying angle was measured by using a physical goniometer made out of flexible clear plastic having each fixed and movable arm. Results: our study observed that mean of the carrying angle is 12.68º±2.14º in adult males and 15.34º±2.17º in females in rural regions. The mean carrying angle is 11.13º±1.89º in adult males and 13.50º±2.24º in females in urban areas respectively. Mean of carrying angle of males & females is larger in rural regions than in urban areas.Differences are statistically significant (p<0.001). Conclusion carrying angle is larger in male and female of rural region as compared to male and female of urban regions. Knowledge of measuring of the carrying angle and its differences are important even in assessing stressful elbow injuries in adults of rural and urban regions and other elbow deformities that require arthroplasties or reconstruction. The information in the present study may be useful for the evaluation in comparison to pathologic conditions as well as inside the management of disorders of the elbow,and is additionally beneficial as a forensic tool for sex determination. Our data may be beneficial in anthropological studies, Genetic studies, Forensics, and clinical practice. [ABSTRACT FROM AUTHOR]

The study aimed to provide a detailed anatomical description of the forelimb of the capybara using gross anatomy, radiography images, and three-dimensional reconstruction. Four adult animals were used for macroscopic dissections, one for the acquisition of radiographic images and reconstructions, and one specimen for bone descriptions. The results showed the anatomical details of the scapula with a developed hamate process and the absence of a clavicle. Radius and ulna do not fuse. The hand has five metacarpal bones, and the first digit is rudimentary. The proximal row of the carpal comprises the intermedioradial, ulnar, and accessory carpal bones, and the distal row comprises four carpal bones. The muscles present a general pattern similar to other groups of domestic animals; however, the absence of the accessory head of the triceps brachii muscle has been demonstrated. The resulting images provided excellent detail of the main anatomical structures of the capybara's thoracic limb. The illustrations in the present study are a valuable reference for the interpretation of normal and pathological imaging studies in the species in the present study. [ABSTRACT FROM AUTHOR]

Background: Distal forearm fractures were defined as distal radius fractures with concomitant distal ulna fractures, except ulna styloid fractures. Distal forearm fractures are common among geriatric populations, particularly those with osteoporosis. Conventionally, distal forearm fractures are reduced by a double incision approach; however, malreduction and instability of the distal radioulnar joint were not uncommon. We introduced a modified volar dual window approach to treat the distal forearm fracture and evaluate the functional outcomes and complications. Methods: From January 2020 to June 2023, 13 patients with distal forearm fractures underwent open reduction by the modified dual window approach with locking plate fixation. After surgery, splints were applied for two weeks, and the patients underwent postoperative hand therapy for three months. The mean Quick Disabilities of the Arm, Shoulder, and Hand scores, range of motions, grip strength, postoperative radiographic parameters, and complications data were collected. Results: The mean follow-up period was 12.1 months, and the mean age was 52.3 years. Average wrist flexion was 67°, extension 69°, pronation 81°, and supination 79°. Grip strength was 28.3 ± 11.5 kg, which was 88% of the uninjured opposite side. The Visual Analog Scale score during activities was recorded as 0.5 ± 0.9. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 14 ± 11.5. The postoperative radiographic parameters were as follows: radial height: 10.8 ± 1.7 mm, radial inclination: 22.6 ± 3.7°, volar tilting: 4.0 ± 3.9°, and ulnar variance: −0.4 ± 1.4 mm. All the patients achieved bone union at the final follow-up. Two patients underwent ulnar implant removal due to irritation symptoms. Neither infection, nor neurovascular injury, nor malreduction developed in these patients. Conclusions: The modified volar dual window approach can achieve good wrist function and distal forearm fracture reduction without increasing neurovascular or wound healing complications. This method is an alternative approach for distal forearm fracture, especially in comminuted distal ulna fracture or distal radioulnar joint incongruity. [ABSTRACT FROM AUTHOR]

Introduction: Complex distal humerus coronal shear fractures are rare injuries. These fractures involve small articular fragments and are challenging to fix. Design: Aprospective case series of 10 patients was done at a level 1 trauma centre between February 2017 and July 2021. Dubberley type 3 fractures were included in the study. Intervention: All patients underwent ORIF using posterior approach with olecranon osteotomy by a single surgeon. Patients were followed up for a minimum of 12 months postoperatively. Outcome Measures: The primary outcome measures were radiographic union and functional status of the limb (DASH score and MEPI score). Results: All patients achieved radiographic union of fracture as well as the osteotomy. The mean DASH score as measured on the final follow-up was 12.6 ± 10.2 and the mean MEPI score was 90 ± 8.2. None of the cases needed reoperation. Conclusion: Consistently good functional outcomes can be obtained in complex coronal shear fractures by posterior approach with olecranon osteotomy. Dubberley type 3b patients should undergo additional plate fixation. [ABSTRACT FROM AUTHOR]

Heavy animals incur large forces on their limb bones, due to the transmission of body weight and ground reaction forces, and the contractions of the various muscles of the limbs. This is particularly true for rhinoceroses, the heaviest extant animals capable of galloping. Several studies have examined their musculoskeletal system and the forces their bones incur, but no detailed quantification has ever been attempted. Such quantification could help understand better the link between form and function in giant land animals. Here we constructed three‐dimensional musculoskeletal models of the forelimb and hindlimb of Ceratotherium simum, the heaviest extant rhino species, and used static optimisation (inverse) simulations to estimate the forces applied on the bones when standing at rest, including magnitudes and directions. Overall, unsurprisingly, the most active muscles were antigravity muscles, which generate moments opposing body weight (thereby incurring the ground reaction force), and thus keep the joints extended, avoiding joint collapse via flexion. Some muscles have an antigravity action around several joints, and thus were found to be highly active, likely specialised in body weight support (ulnaris lateralis; digital flexors). The humerus was subjected to the greatest amount of forces in terms of total magnitude; forces on the humerus furthermore came from a great variety of directions. The radius was mainly subject to high‐magnitude compressive joint reaction forces, but to little muscular tension, whereas the opposite pattern was observed for the ulna. The femur had a pattern similar to that of the humerus, and the tibia's pattern was intermediate, being subject to great compression in its caudal side but to great tension in its cranial side (i.e. bending). The fibula was subject to by far the lowest force magnitude. Overall, the forces estimated were consistent with the documented morphofunctional adaptations of C. simum's long bones, which have larger insertion areas for several muscles and a greater robusticity overall than those of lighter rhinos, likely reflecting the intense forces we estimated here. Our estimates of muscle and bone (joint) loading regimes for this giant tetrapod improve the understanding of the links between form and function in supportive tissues and could be extended to other aspects of bone morphology, such as microanatomy. [ABSTRACT FROM AUTHOR]

Purpose: The epidemiology of paediatric fractures has been previously described, however there is limited data available on open fractures in this population. The purpose of this study was to investigate trends, mechanism of injury (MOI) and severity of paediatric open fractures and undertake an epidemiological study. Methods: All children ≤ 16.0 years presenting with open fractures were identified between 01/04/2013 and 01/04/2023. Those with craniofacial, thoracic and distal phalangeal fractures were excluded. Incidence was calculated based on those presenting within the local geographical region. Social deprivation was measured using the Index of Multiple Deprivation (IMD). Results: There were 208 open fractures with a median age of 11.0(q1 7.4-q3 13.4) years, and 153(74.6%) were in males. The MOIs were road traffic collisions 73(35.1%), sports/play 45(21.6%), fall > 2m 29(13.9%), simple fall 25(12.0%), crush 16(7.7%), bites 8(3.8%), assault 6(2.9%), and other 6(2.9%). Nineteen children (9.1%) presented with polytrauma. Gustilo-Anderson grade for long bone fractures were I-61(29.3%), II-24(11.5%), IIIa-36(17.3%), IIIb-30(14.4%) and IIIc-7(3.4%). There were 129 children presenting within the local geographical region providing an annual incidence of 8.0/100,000. Radius and ulna were the most frequently injured 49(38.0%) followed by tibia and fibula 44(34.1%). There were 69(53.5%) children presenting from an IMD quintile 1 with open fractures. Conclusion: Paediatric open fractures are commonly seen in the adolescent male and affect those who are from a more socially deprived background. These injuries account for 3.2% of fractures admitted to a MTC. Data suggests children principally sustain open fractures through two distinct injury patterns and ten-year trends suggests that there is a gradual decline in the annual incidence. [ABSTRACT FROM AUTHOR]

Background: Bizarre parosteal osteochondromatous proliferation (BPOP) is a rare benign bone tumor, it is also called "Nora's lesion". The lesion is characterized by heterotopic ossification of the normal bone cortex or parosteal bone. The etiology of BPOP is unclear and may be related to trauma. In most BPOPs, the lesion is not connected to the medullary cavity. Here we report an atypical case, characterized by reversed features compared to the typical BPOP, which demonstrated continuity of the lesion with the cavity. Case presentation: An 11-year-old female child had a slow-growing mass on her right wrist for 8 months with forearm rotation dysfunction. Plain X-rays showed an irregular calcified mass on the right distal ulna, and computed tomography (CT) showed a pedunculated mass resembling a mushroom protruding into the soft tissue at the distal ulna. The medulla of this lesion is continuous with the medulla of the ulna. A surgical resection of the lesion, together with a portion of the ulnar bone cortex below the tumor was performed, and the final pathology confirmed BPOP. After the surgery, the child's forearm rotation function improved significantly, and there was no sign of a recurrence at 1-year follow-up. Conclusion: It is scarce for BPOP lesions to communicate with the medullary cavity. However, under-recognition of these rare cases may result in misdiagnosis or inappropriate treatment thereby increasing the risk of recurrence. Therefore, special cases where BPOP lesions are continuous with the medulla are even more important to be studied to understand better and master these lesions. Although BPOP is a benign tumor with no evidence of malignant transformation, the recurrence rate of surgical resection is high. We considered the possibility of this particular disease prior to surgery and performed a surgical resection with adequate safety margins. Regular postoperative follow-up is of utmost importance, without a doubt. [ABSTRACT FROM AUTHOR]

The cellular and genetic networks that contribute to the development of the zeugopod (radius and ulna of the forearm, tibia and fibula of the leg) are not well understood, although these bones are susceptible to loss in congenital human syndromes and to the action of teratogens such as thalidomide. Using a new fate-mapping approach with the Chameleon transgenic chicken line, we show that there is a small contribution of SHH-expressing cells to the posterior ulna, posterior carpals and digit 3. We establish that although the majority of the ulna develops in response to paracrine SHH signalling in both the chicken and mouse, there are differences in the contribution of SHHexpressing cells between mouse and chicken as well as between the chicken ulna and fibula. This is evidence that, although zeugopod bones are clearly homologous according to the fossil record, the gene regulatory networks that contribute to their development and evolution are not fixed. [ABSTRACT FROM AUTHOR]

Background: Epidemiological research on fractures in children under the age of two is of great importance to help understand differences between accidental and abusive trauma. Objective: This systematic review aimed to evaluate studies reporting on the incidence of fractures in children under two years of age, excluding birth injuries. Secondary outcome measures included fracture location, mechanisms of injury and fracture characteristics. Methods: A systematic literature review (1946 to February 7th 2024), including prospective and retrospective cohort studies and cross-sectional cohort studies, was performed. Studies including children from other age groups were included if the actual measures for those aged 0–2 years could be extracted. We also included studies restricted to infants. Annual incidence rates of fractures were extracted and reported as the main result. Critical appraisal of was performed using the Appraisal tool for Cross-Sectional Studies. Results: Twelve moderate to good quality studies met eligibility criteria, of which seven were based on data from medical records and five were registry studies. Studies investigated different aspects of fractures, making comprehensive synthesis challenging. There was an overall annual fracture incidence rate of 5.3 to 9.5 per 1,000 children from 0–2 years of age; with commonest sites being the radius/ulna (25.2–40.0%), followed by tibia/fibula (17.3–27.6%) and the clavicle (14.6–14.8%) (location based on 3 studies with a total of 407 patients). In infants, the reported incidence ranged between 0.7 to 4.6 per 1,000 (based on 3 studies), with involvement of the clavicle in 22.2% and the distal humerus in 22.2% of cases (based on 1 study). Only a single metaphyseal lesion was reported (proximal humerus of an 11-month-old infant). Fracture mechanisms were detailed in four studies, with fall from chair, bed, table, own height or fall following indoor activities causing 50–60% of fractures. Conclusions: There is a paucity of good quality data on fracture incidence in children under the age of two. Larger, prospective and unbiased studies would be helpful in determining normal pattern of injuries, so that differences from abusive trauma may be better understood. [ABSTRACT FROM AUTHOR]

Background: For the treatment of coronoid process fractures, medial, lateral, anterior, anteromedial, and posterior approaches have been increasingly reported; however, there is no general consensus on the method of fixation of coronal fractures. Here, we present a highly-extensile minimally invasive approach to treat coronoid process fractures using a mini-plate that can achieve anatomic reduction, stable fixation, and anterior capsular repair. Further, the study aimed to determine the complication rate of the anterior minimally invasive approach and to evaluate functional and clinical patient-reported outcomes during follow-up. Methods: Thirty-one patients diagnosed with coronoid fractures accompanied with a "terrible triad" or posteromedial rotational instability between April 2012 and October 2018 were included in the analysis. Anatomical reduction and mini-plate fixation of coronoid fractures were performed using an anterior minimally invasive approach. Patient-reported outcomes were evaluated using the Mayo Elbow Performance Index (MEPI) score, range of motion (ROM), and the visual analog score (VAS). The time of fracture healing and complications were recorded. Results: The mean follow-up time was 26.7 months (range, 14–60 months). The average time to radiological union was 3.6 ± 1.3 months. During the follow-up period, the average elbow extension was 6.8 ± 2.9° while the average flexion was 129.6 ± 4.6°. According to Morrey's criteria, 26 (81%) elbows achieved a normal desired ROM. At the last follow-up, the mean MEPI score was 98 ± 3.3 points. There were no instances of elbow instability, elbow joint stiffness, subluxation or dislocation, infection, blood vessel complications, or nerve palsy. Overall, 10 elbows (31%) experienced heterotopic ossification. Conclusion: An anterior minimally invasive approach allows satisfactory fixation of coronoid fractures while reducing incision complications due to over-dissection of soft tissue injuries. In addition, this incision does not compromise the soft tissue stability of the elbow joint and allows the patient a more rapid return to rehabilitation exercises. [ABSTRACT FROM AUTHOR]

Post axial deficiency of the upper limb is also known as ulnar hemilmelia. It is an extremely rare anomaly which is characterized by the partial or complete absent ulna. Most cases are sporadic, with a higher prevalence in male gender. The condition is typically unilateral, affecting the right side. Commonly associated anomalies include short forearm, bowed radius, and ulnar deviation of wrist joint, complex wrist and hand anomalies. This case report describes a rare presentation of unilateral ulnar hemimelia with class I humeroradial synostosis in a 3-year-old child with an abnormally shortened left forearm and a non-functional left elbow. This case aims to contribute to the limited literature on isolated humeroradial synostosis underscoring the importance of imaging investigation. [ABSTRACT FROM AUTHOR]

Case: A 32-year-old man presented with a type II open both-bone forearm fracture and segmental bone loss because of complete extrusion of a diaphyseal fragment (3 cm) of ulna. The patient presented to our level 1 trauma center after a motor vehicle collision. The extruded segment underwent sterilization and immediate reimplantation with internal fixation approximately 6 hours after arrival. Our patient achieved union by 7-month follow-up, demonstrated excellent functional outcomes, and was free from infection at 1-year follow-up. Conclusion: In select cases, successful reimplantation can be achieved by meticulous debridement, sterilization, and immediate reimplantation with internal fixation. [ABSTRACT FROM AUTHOR]

Case: A 32-year-old woman with bilateral Madelung deformity presented with severe pain and arthritis of the radiocarpal and distal radioulnar joints. At final follow-up, 17 months for the left and 12 months for the right wrist, she had excellent functional results with no pain. Range of motion was 30° of flexion and 30° of extension with full pronosupination. Conclusion: There is paucity in the literature regarding salvage procedures in adults with this deformity. We demonstrate treatment with distal ulna excision and an radioscapholunate arthrodesis. This procedure may be indicated in Madelung deformity and proximal radiocarpal and distal radioulnar joint arthritis. [ABSTRACT FROM AUTHOR]

Case: A 12-year-old girl presented with significant right elbow pain following a fall during soccer which caused an osseous triceps avulsion injury and nondisplaced type II Salter-Harris radial neck fracture. The patient was treated with successful open repair utilizing suture anchor fixation, resulting in full return of function and return to previous activities. Conclusion: Timely and accurate diagnosis and treatment of displaced triceps sleeve avulsion injuries is critical and can result in excellent patient outcomes and return to previous functional level. This unique case contributes to the diagnosis and management of this rare condition in pediatric populations. [ABSTRACT FROM AUTHOR]

The addition of aromatase inhibitors has improved cancer-related outcomes in postmenopausal patients with estrogen receptor-positive breast cancer. However, aromatase inhibitor can be associated with a constellation of adverse musculoskeletal effects that comprises bone loss, arthralgia, myalgia, and tendinopathy. This medication complication, known as aromatase inhibitor-associated musculoskeletal syndrome, can limit treatment tolerability in many patients because of the high prevalence of aromatase inhibitor-associated musculoskeletal syndrome among those on aromatase inhibitor. The hand and wrist are the most affected joints in aromatase inhibitor-associated musculoskeletal syndrome, with patients presenting with symmetric arthralgia, stiffness, and tendinopathy. Radioulnar joint subluxation with extensor tendon tear has not been previously reported in patients with aromatase inhibitor-associated musculoskeletal syndrome. This is a case report of a 72-yr-old breast cancer survivor on an aromatase inhibitor presenting with chronic dominant wrist pain, weakness, and 5th digit finger drop. An extensor digitorum minimi tendon tear and radioulnar instability were identified using diagnostic musculoskeletal ultrasonography. This case illustrates the utility of in-office ultrasonography combined with dynamic examination for the often underrecognized pathology associated with aromatase inhibitor-associated musculoskeletal syndrome in breast cancer survivors. [ABSTRACT FROM AUTHOR]

Elbow computerized tomography (CT) scans have been widely applied for describing elbow morphology. To enhance the objectivity and efficiency of clinical diagnosis, an automatic method to recognize, segment, and reconstruct elbow joint bones is proposed in this study. The method involves three steps: initially, the humerus, ulna, and radius are automatically recognized based on the anatomical features of the elbow joint, and the prompt boxes are generated. Subsequently, elbow MedSAM is obtained through transfer learning, which accurately segments the CT images by integrating the prompt boxes. After that, hole-filling and object reclassification steps are executed to refine the mask. Finally, three-dimensional (3D) reconstruction is conducted seamlessly using the marching cube algorithm. To validate the reliability and accuracy of the method, the images were compared to the masks labeled by senior surgeons. Quantitative evaluation of segmentation results revealed median intersection over union (IoU) values of 0.963, 0.959, and 0.950 for the humerus, ulna, and radius, respectively. Additionally, the reconstructed surface errors were measured at 1.127, 1.523, and 2.062 mm, respectively. Consequently, the automatic elbow reconstruction method demonstrates promising capabilities in clinical diagnosis, preoperative planning, and intraoperative navigation for elbow joint diseases. [ABSTRACT FROM AUTHOR]

This study aimed to assess the fusion of growth plates and the development of secondary ossification centres in the forelimb bones of maned wolves (Chrysocyon brachyurus), contrasting the findings with established data from domestic dogs. Three maned wolves, comprising one male and two females, initially aged between 3 and 4 months, were subjected to monthly radiographic evaluations until 10–11 months of age, followed by bimonthly assessments until 18–19 months of age, encompassing both forelimbs. The closure times of growth plates were observed as follows: supraglenoid tubercle (7–8 months), proximal humerus (17–19 months), distal humerus (8–9 months), medial epicondyle of the humerus (8–9 months), proximal ulna (9–10 months), proximal radius (13–15 months), distal ulna (13–15 months) and distal radius (17–19 months). Statistical analysis revealed significant differences in the areas of secondary ossification centres in the proximal epiphyses of the humerus and radius, respectively, observed from the initial evaluation at 8–9 months and 6–7 months. Conversely, the epiphyses of the supraglenoid tubercle, distal humerus, proximal ulna, distal ulna, medial epicondyle of the humerus and distal radius did not exhibit significant area differences between 3–4 months and 4–5 months, yet notable distinctions emerged at 5–6 months. In summary, while the radiographic appearance of epiphyseal growth plates and secondary ossification centres in maned wolves resembles that of domestic dogs, closure times vary. These findings contribute to understanding the dynamics of epiphyseal growth plates in this species. [ABSTRACT FROM AUTHOR]

Although the important roles of proprioception and neuromuscular control in carpal instabilities under laboratory conditions have been recognized, only a few studies have translated this knowledge into a routine clinical practice. This study aimed to evaluate the results of a personalized rehabilitation in patients with carpal instability on functionality and pain intensity. This was a case series study. This case series included 39 adults (mean age: 38.2 ± 14.0 years; 16/23 females/males) diagnosed with carpal instability (radial or ulnar) with indication for orthopedic treatment. The disabilities of the arm, shoulder, and hand questionnaire was used to assess upper limb functionality. Pain perception was assessed using a visual analog scale. Exercise-based physiotherapy interventions were performed according to the clinical needs of the patients for at least 6 weeks (2-3 sessions per week). For the treatment of radial instability (n = 13), strengthening exercises of the abductor pollicis longus, extensor carpi radialis longus, flexor carpi radialis, and pronator quadratus muscles were prescribed. For the treatment of ulnar instability (n = 24), extensor carpi ulnaris and pronator quadratus were trained. All patients underwent proprioceptive training in open kinetic chain and closed kinetic chain, as well as strengthening of the unaffected hand. Changes before and after treatment were compared using the nonparametric Wilcoxon signed rank test. A significant improvement with a large effect size in disabilities of the arm, shoulder, and hand (P <.001; d = 2.9) and visual analog scale (P <.001; d = 3.2) scores were obtained after treatment. Moreover, the changes were greater than the minimal clinically important difference of 10.8 and 1.4, respectively. Similar results were found when patients with radial instability and ulnar instability were analyzed separately. Personalized training with specific proprioception and strengthening exercises produces improvements in functionality and pain perception in our cohort of people with carpal instability. These results highlight the importance of multicomponent exercise in the treatment of wrist instability. Future randomized clinical trials should further investigate the effectiveness of this protocol. • The protocol included strength training exercises combined with proprioceptive and cross-education training. • The combined exercise program showed benefits for function and pain in patients with carpal instability. • This protocol could be a valid alternative as a nonsurgical treatment for carpal instabilities. [ABSTRACT FROM AUTHOR]