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At least 235 records · Page 13Linked to original sources

PubMed2000

Self-reported disability following distal radius fractures: the influence of hand dominance.

The purpose of this study was to record the spectrum of self-reported disability following distal radius fractures and to gauge for differences in hand dominance in the use of subjective outcome data. Items were generated through patient interviews, literature review, and peer consultation. Fifty-three items were evaluated by a group of 55 patients recovering from a fracture of the distal radius, which established the prevalence, mean severity score, and overall severity score (or impact) of each item as it related to physical function and social/emotional impact. Hand dominance, age, and gender were also recorded. The results confirm that many patients who sustain distal radius fractures experience substantial impairment across a spectrum of quality of life domains. Because patients who sustain a dominant wrist injury are likely to report greater functional impairment across a wider range of activities, they also possess a greater potential for improvement. The practical implication is that outcome studies for the treatment of distal radius fractures should take hand dominance into account.

Activities of Daily Living↗

PubMed2003

Computer-assisted distal radius osteotomy.

PURPOSE: To establish the accuracy, precision, and clinical feasibility of a novel technique of computer-assisted distal radius osteotomy for the correction of symptomatic distal radius malunion. METHODS: Six patients underwent a computer-assisted distal radius osteotomy and were followed-up for an average of 25 months. Objective radiographic measurements and functional outcomes, as measured by clinical examination including grip strength and range of motion, and Disability of the Arm, Shoulder and Hand (DASH) questionnaires, were used. RESULTS: The mean radiographic parameters included an increase of radial inclination to 21 degrees from 12 degrees (normal, 23 degrees ). Dorsal and volar tilt (malunion) were corrected to 9 degrees from -30 degrees and 21 degrees, respectively (normal, 10 degrees ). Ulnar variance was corrected to 1.9 mm from 7.5 mm (normal, +1.5 mm). Normal is defined as the average of the contralateral limb radiographs. The mean clinical outcome measures at an average of 25 months included a DASH global score of 14, a DASH individual item average score of 1.6, and an average affected side grip strength of 79% when compared with the unaffected side. CONCLUSIONS: The results of the computer-assisted technique were comparable with published results of traditional non-computer-assisted opening wedge osteotomy techniques. This technique allows a surgeon to accurately and precisely recognize and correct 3-dimensional deformities of the distal radius including axial malalignment (supination). The technique has the added benefit of reducing radiation exposure to the patient and surgical team because fluoroscopy is not used during the procedure. Additional benefits of the computer-assisted technique include the ability to perform multiple surgical simulations to optimize the alignment plan, and it serves as an excellent teaching tool for less-experienced surgeons.

Adult↗

PubMed1995

Giant cell tumor of the distal radius.

We compared the outcome of patients with giant cell tumor of the distal radius treated by curettage/cryosurgery and en bloc resection, evaluating oncologic success, functional results, and complications. Thirty consecutive cases of giant cell tumor of the distal radius were treated at our institution between 1958 and 1988. Twenty-six patients were available for follow-up examination, with a minimum follow-up period of 3 years and median follow-up period of 9 years. Primary curettage/cryosurgery had a local recurrence in 3 of 12, and repeat curettage/cryosurgery achieved local control in in 16 of 18 primary and recurrent cases. The major complications in this group included skin necrosis, transient nerve palsies, and fragmentation with carpal collapse. An average of 60% of contralateral range of wrist motion was preserved. Ten patients underwent en bloc excision and arthrodesis for either primary or recurrent tumor; none developed local recurrence. The main complication in this group was failure of internal fixation and non-union at the graft-radius junction. Resultant strength and function were similar in both groups. Intralesional excision with adjunctive cryosurgery is an effective alternative to en bloc excision with the advantage of preserving the distal radius and wrist joint function, but with a notable complication rate. En bloc excision with arthrodesis is more suitable for extensive local disease with poor residual bone stock and as salvage for failed intralesional excision.

Adolescent↗

PubMed1992

Parosteal lipoma of the proximal radius: a report of five cases.

Parosteal lipoma of the proximal radius is a benign, slow-growing tumor. It may cause compression of either the posterior interosseous or the superficial branch of the radial nerve. Surgical excision usually leads to complete recovery. Five cases of parosteal lipoma of the proximal radius are presented. X-ray films demonstrated a radiolucent mass in contact with the radius. Two patients had signs of posterior interosseous nerve compression, and two showed signs of superficial radial nerve compression. In one case the lipoma surrounded an exostosis arising from the proximal radius. The tumors were excised in four patients. The three patients with neurologic involvement recovered fully. One patient refused surgery, and posterior interosseous nerve paralysis developed.

Adult↗

PubMed1996

Anatomic and X-ray film studies of the distal articular surface of the radius.

Knowledge of the surgical and topographic anatomy of the distal articular surface of the radius is valuable during diagnostic and operative procedures involving the distal radius. The aim of this study is to assist the surgeon in determining the location, displacement, and angulation of acute or healed distal radius articular fractures. Measurements were taken of the distal articular surface of 50 dry radii. Also, the margins and surfaces of the distal articular surface of 12 adult cadaver radii were marked by solder and radiopaque dye, respectively. X-ray films were then taken to define the margins and bony landmarks. The lunate facet surface area (53%) was found to be slightly larger than the scaphoid facet surface area (47%). Both the palmar tilt and the radial inclination were demonstrated on the marked x-ray films. Using the 30 degrees cephalad angled anteroposterior projection of the distal radius can help assess the dorsomedial fragment of the lunate fossa in a die-punch fracture.

Adult↗

PubMed1996

Anatomic considerations for the anterior exposure of the proximal portion of the radius.

The rate of posterior interosseous nerve injury is still of major concern during surgical exposure of the proximal portion of the radius. The objective of this study was to find the best way to protect the important neurovascular structures during anterior exposure of the proximal radius and to define the safest anatomic orientation for plate and screw placement during open reduction and internal fixation of the proximal radius. In 30 cadaveric upper limbs, the proximal portion of the radius was exposed through a modified anterior Henry approach. The important anatomic structures were localized and demonstrated on radiographs. Plates and screws were applied anterolaterally (in five specimens) and laterally (in another five specimens), and the locations of the safe and danger zones were noted. Lateral placement of the plate is preferred over the more commonly used anterolateral plating, because it carries less risk of injuring the posterior interosseous nerve during screw application and it does not impinge on the biceps tendon and block pronation.

Bone Plates↗

PubMed1992

[Lesions of the ligaments associated with distal fractures of the radius. 58 intraoperative arthrographies].

Intracarpal ligamentous tears and fractures of the radius often have a similar mechanism. For instance, no prospective studies have defined the real incidence of such associations, which are not antagonistic. The authors performed a systematic operative wrist arthrogram during distal radius fractures in a group of 58 patients with a mean age less than 50 years. Such a population was at low risk of degenerative ligamentous tears. Triangular fibrocartilage complex was torn in two-thirds of all types fractures. Extra-articular radius fractures were associated with an intracarpal ligamentous tear in 25% and always a luno-triquetral lesion type. In contrast, intra-articular and radius styloid fractures were frequently associated with a scapho-lunate lesion.

Adolescent↗

PubMed1985

[Radiological study of the height of the cubitus in relation to the radius. Measures of 2 comparative series].

It has been postulated that cubitus altus promotes Kienböck's disease. The inconstant value of the radioulnar index must be underlined. Our index is measured on sagittal X-rays. This study showed that the angle formed between the horizontal line which passes through the junction of the lower and ulnar borders of the radius and the line drawn from this same ulnar pole of the radius to the lower ulnar styloid (Fischer's angle) on posteroanterior projections was not reliable. In an initial study of 41 men and 36 women, the following mean values were found : 1.06 for men ; 0.65 for women. The minus sign indicates that the ulna was shorter than the radius. A second study showed that there was in fact very little difference between men (-2.08 mm) and women (-1.91 mm). Based on the study of 150 normal wrists, it seems possible to state that the physiological radioulnar index ranges from 0.5 mm to 2 mm on sagittal X-rays. The ulna was always shorter thant the radius, was slightly shorter in men than in women. We suggest that values of greater than 2.5 mm are necessary to define cubitus altus.

Female↗

PubMed1996

[Reconstruction of the loss of bone substance of the forearm by cubitalization of the radius (one bone forearm). Apropos of 6 cases].

Extensive forearm bone loss, whatever its etiology, presents a difficult reconstruction problem. This is mainly the case in the presence of lesions of the interosseous membrane associated with the radio-ulnar joint. When preservation of forearm rotation is not possible, cubitalization of the radius and reconstruction of the forearm by creation of a "one bone forearm" seems to be an excellent salvage technique both functionally and cosmetically. Our experience concerns six clinical cases; two of these cases are original and give the authors the opportunity to describe a new reconstructive technique of the distal humerus and elbow by vascularized transfer of the radius onto the radial artery (with a cutaneo-osseous transfer in one case). The etiology of the bone defect included severe trauma in three cases, and a Volkman's syndrome complicated by osteomyelitis in one case. Two cases represent an original technique of reconstruction of the distal humerus by a vascularised transfer of the radius onto the radial artery. Forearm reconstruction is performed by cubitalization of the radius. The etiology was traumatic in one case and neoplastic in another, and a cutaneo-osseous transfer was performed in the latter case. In this difficult problem of bone reconstruction, a favorable functional and cosmetic result was obtained in our series.

Adult↗

PubMed1996

Bony markers at the distal end of the radius for estimating handedness and radial length.

Measurements of the size of the bony markers at the distal end of the radius as well as the length of the radius in 61 left and 64 right dry radii were statistically analyzed. Since 90-95% of the general population is right-handed, as based on differences in the size of the right sided markers relative to the left, it is proposed that the greater distance between the dorsal tubercle and styloid process and the greater dorso-palmar diameter of the carpal articular surface opposite the dorsal tubercle are indicative of right-handedness. The length of the radius correlated with: the radio-ulnar transverse diameter at the distal end; the distance between the dorsal tubercle and the styloid process; the dorso-palmar diameter of the distal end opposite the dorsal tubercle; the dorso-palmar diameter of the carpal articular surface opposite to the dorsal tubercle; the dorso-palmar diameter of the distal end opposite the medial margin of the groove for the extensor pollicis longus; the dorso-palmar diameter of the distal end opposite the floor of the groove for the extensor pollicis longus and, finally, the height of the dorsal tubercle in relation to the posterior margin of the carpal articular surface (P < 0.001). Regression equations of the length of the radius for these markers have been derived.

Carpal Bones↗

PubMed2000

Prediction of bone strength of distal forearm using radius bone mineral density and phalangeal speed of sound.

This investigation compares quantitative ultrasound (QUS) measurement of the phalanges with peripheral quantitative computed tomography (pQCT) and dual X-ray absorptiometry (DXA) measurement of the forearm, to estimate the strength of the distal radius in 13 cadaveric forearms. The cadavers were scanned at the distal radius by pQCT and DXA for bone mineral density (BMD) and at the approximate phalanges by QUS for speed of sound (SOS). The distal radii were subjected to a simulated Colles fracture produced with a materials testing machine. The load at which the distal radius was fractured was considered as a representation of bone strength. The bone strength correlated significantly with SOS at different phalanges (r = 0.63-0.72), BMD at different regions of interest by DXA (r = 0.67-0.75), and cortical BMD at different sites by pQCT (r = 0.61-0.67). Standard stepwise regression analysis showed that adding phalangeal SOS into forearm densitometric variables significantly enhanced the statistical power for prediction of the strength of the distal radius. Our results suggest that, for assessment of site-specific distal forearm strength, QUS measurement of the phalanges is comparable to forearm densitometry. Phalangeal QUS may add clinical value if distal forearm strength has a high priority.

Aged↗

PubMed2005

Long-term changes in the tibia and radius bone mineral density following spinal cord injury.

DESIGN: A prospective inception cohort study with an observational analytic design in a spinal cord injury (SCI) centre hospital. OBJECTIVE: To assess changes in trabecular and compact bone of the tibia and radius prospectively in subjects with SCI. SUBJECTS: In total, 10 individuals with an acute SCI. METHODS: Trabecular and compact bone density of the tibia and radius by peripheral quantitative computerised tomography. RESULTS: Analysis of the individual gradients of the curve coefficient showed changes in trabecular bone between -0.19 and -2.46 and in cortical bone between +0.07 and -0.93 in the tibia within 34 months after the SCI. Both trabecular and cortical bone showed a group mean loss of 99 mg/cm(3). No changes were observed in the radius. CONCLUSION: There is a major decrease in tibia mineral density over 3 years; however, no change is observed for the radius mineral content. Large interindividual differences existed in the patterns of loss in the tibia bone substance after SCI. These patterns indicate that there is no steady state of bone mineral density following 3 years of spinal cord injury.

Absorptiometry, Photon↗

PubMedDate not supplied

Results of acute arthroscopically repaired triangular fibrocartilage complex injuries associated with intra-articular distal radius fractures.

PURPOSE: This study reviews the results of acute repair of peripheral ulnar-sided triangular fibrocartilage complex (TFCC) detachment associated with intra-articular distal radius fractures. TYPE OF STUDY: Two-year follow-up of patients who had undergone acute TFCC repair. METHODS: Fifty-six patients underwent arthroscopically assisted treatment of intra-articular distal radius fractures using external fixation and adjunctive percutaneous pinning between 1994 and 1998. Thirteen patients with an acute, complete tear of the ulnar attachment of the TFCC were treated using arthroscopic repair of the TFCC in addition to stabilization of the radius fracture. All patients were evaluated at a mean of 24 months (range, 17 to 35 months) with a physical examination, wrist radiographs, and a Disability of Arm, Shoulder, and Hand (DASH) module outcome assessment questionnaire. RESULTS: Average wrist flexion, extension, pronation, and supination were 67.3, 61.8, 79.1, and 86.8, respectively. The average grip strength was 78% of the uninjured side. The results of the Gartland and Werley grading system were good to excellent in 12 patients and fair in 1 patient. The DASH outcome scores revealed a mean functional score of 13 and a mean athletic score of 12. None of the patients reported ulnar-sided pain at follow-up. CONCLUSIONS: Arthroscopically assisted TFCC repair in conjunction with distal radius fixation resulted in a high degree of patient satisfaction and good to excellent clinical outcomes.

Adolescent↗

PubMed2001

Evaluation of the sigmoid notch with computed tomography following intra-articular distal radius fracture.

A classification system for disruption patterns of the sigmoid notch of the radius associated with distal radius fractures has not been established. Using plain x-rays and corresponding computed tomography (CT) scans we characterized and quantified the types of sigmoid notch involvement in 20 consecutive distal radius fractures with radiocarpal joint extension. Plain radiographs revealed fracture extension into the sigmoid notch in only 7 cases (35%) and the CT scans demonstrated fracture extension into the sigmoid notch in 13 cases (65%). Of the 13 fractures with sigmoid notch involvement, 9 (69%) were displaced and 4 (31%) were nondisplaced. Sigmoid notch articular step-off (n = 7) and gapping (n = 9) were detectable on the CT scans but not on the x-rays. Plain x-rays appear to underestimate sigmoid notch involvement following distal radius fractures. In addition, CT appears to be a superior diagnostic modality for quantifying sigmoid notch fracture step-off and articular gapping.

Adult↗

PubMed2002

Functional outcome following excision of tumours of the distal radius and reconstruction by autologous non-vascularized osteoarticular fibula grafting.

The distal radius and its articulations clearly have a vital role in the functional abilities of the hand and wrist. The treatment of tumours of the radius, therefore, needs to achieve satisfactory clearance of the lesions while also preserving as much wrist function as possible. We have employed osteoarticular autologous fibula grafts to reconstitute the distal radius after tumour excision. Since 1992, 13 patients have been treated by this technique for tumours of the distal radius. The group comprised patients with primary and recurrent giant cell tumours of bone, osteosarcoma, chondrosarcoma and Ewing's tumour. This technique achieves a satisfactory functional result without compromise of the prognosis for the tumour.

Adult↗

PubMedDate not supplied

[Epidemiology and chrono-epidemiology of distal radius fractures].

The frequency of distal radius fractures of patients treated in the outpatient clinic of the Herz-Jesu-Krankenhaus between Jan. 1997 and Dec. 1999 were evaluated retrospectively. Records of 366 patients (m: 132, f: 234) were assessed. The frequency of distal radius fractures was fitted to a cosine model using non-linear regression in order to detect a circadian or circannual rhythm. The goodness of fit was assessed by means of the F statistics and the coefficient of determination r2. Moreover, spectral analysis was performed. In 1997 135, in 1998 119, and in 1999 112 distal radius fractures were treated. The mean age of the patients was 40.3 ys. (women: 48.8; men: 25.3). The extended wrist was the most common position during Trauma, Accidents at home (41%), during spare time activities (23.8%), and during physical activities (21.6%) were more frequent than accidents during working hours (12.5%) or traffic accidents (1.1%). The latency for definite surgical treatment in our clinic was 8.5 hours (minimum: 15 min; maximum: 7 days and 14 hours). A significant cosine model could be fitted for a period of 24 hours (r2 = 0.82) with a maximum at 15.00 hours. Spectral analysis revealed an ultradian rhythm of approximately 12 hours in addition to the circadian periodicity. No significant circannual model could be fitted (r2 = 0.2), although a slight increase of frequency was found during May and June. In conclusion, the frequency of distal radius fractures shows a clear circadian but no circannual periodicity.

Accidents↗

PubMed2002

[Distal radius fractures and concomitant lesions. Experimental studies concerning the pathomechanism].

Since Colles (1814) first described a distal radius fracture and the publication by Dupuytren (1834), the frequency of and problems surrounding these fractures were increasingly recognised. Not only the treatment but also the formation and type of fracture were repeatedly analysed. The various theories concerning the pathomechanism led to names such as: "tear fracture", "bend fracture", "thrust fracture", "compression fracture", "snap fracture" and others. In our experimental studies we attempted to simulate the pathomechanism of distal radius fractures and present them pictorially. With the help of a materials testing machine, 63 prepared cadaver arms were hyperextended in the wrist joint until a radius fracture occurred. The concomitant lesions were registered radiologically and by dissection. Moreover, additional cadaver arms were deep-frozen and examined by means of computer tomography and cryosection according to Kathrein. Through experimental hyperextension it was possible to generate dorsal, central, and palmar types of fractures. We produced 42 dorsal, 14 central and 7 palmar fractures. Fundamentally, it seems that the fracture depends on the extent in which the carpal bones of the proximal row are pressed against the dorsal, central or palmar part of the articular surface of the distal radius. The subsequent dissection showed in 40 cases (63 %) mostly multiple concomitant lesions and in 23 cases (37 %) none of these. The reason for concomitant lesions may be the proportion of bone stability to the strength of ligaments. Most frequently (27 cases, i.e. 43 %), we found a destabilisation of the articular disk with or without a bony avulsion fragment (fracture of the ulnar styloid). We also commonly found ruptures of the interosseous ligaments between scaphoid and lunate (20 cases, i.e. 32 %) and lunate and triquetrum (11 cases, i.e. 18 %). It is difficult to apply knowledge gained from experimental studies on preserved cadaver arms clinically. There are of course no physiological reflexes and the slow fracture process must be taken into consideration. This holds true not only for concomitant lesions but also for the type of fracture. On the other hand, in these experimental studies it was possible to generate many realistic types of fractures with their concomitant lesions.

Biomechanical Phenomena↗

PubMed2003

[Radio-radial external fixation in the treatment of distal radius fractures allows for free wrist motion].

INTRODUCTION: Joint bridging external fixation in the treatment of distal radius fractures restores radial length, whereas anatomic reduction of articular fragments is difficult. Immobilisation of the wrist joint is a further disadvantage. An extraarticular hybrid fixation of distal radius fractures was introduced that facilitates fracture reduction, safe retention and allows for free wrist movement. METHODS: 30 consecutive patients with extra- and intraarticular comminuted fractures of the distal radius were treated with an extraarticular radio-radial external fixation employing a modified Ilizarov hybrid fixation technique. The operative procedure is described in detail. A clinical and radiological evaluation was carried out on the first and seventh day as well as 6 weeks postoperatively after implant removal. RESULTS: Anatomic reduction was achieved in 24 cases (80%). On the first postoperative day dorsiflexion was 30%, palmar flexion was 51% and pronation/supination was 60%/70% of the uninjured side. Six weeks postoperatively all fractures united. Wrist motion of the affected side was more than 80% of the unaffected side. Neither extensor tendinitis nor pin loosening in the distal fragment did occur. CONCLUSION: The technique of extraarticular hybrid fixation is safe and reliable in the treatment of comminuted fractures of the distal radius. It allows for early wrist movement in the immediate postoperative period.

Adult↗