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The solitary shortening of radius or ulna gives rise to malalignment of the wrist or elbow. Shortening of the ulna causes dislocation of the head of radius, shortening of the radius leads to a clubhand with disorders of the wrist. The disphyseal lengthening osteotomy of the radius or ulna corrects these deformities.
Displaced intra-articular distal radius fractures are difficult to treat, with numerous associated complications. The potential onset of post-traumatic osteoarthritis (OA) is a major concern. The relationship between malreduced intra-articular fracture of the distal radius and subsequent early onset of radiocarpal OA is clinically important, yet poorly understood. To better understand this presumed mechanical relationship, detailed information regarding joint loading, kinematics and associated stress distributions must be obtained. Toward this end, a three-dimensional finite element (3D FE) contact model of the radiocarpal joint has been developed, including the radius, lunate, scaphoid, articulations between these bones and selected soft tissues near the joint. FE model geometry was derived from cryomicrotome sections of a cadaver wrist. Radiocarpal contact stress distributions in the intact and simulated malreduced fracture conditions, previously collected using a cadaveric intra-articular fracture model, are used to establish validity of the computational model. Finally, a section of the distal radius constituting the entire lunate fossa was displaced 1,2 and 3 mm to represent a depressed lunate die-punch fracture.
Typical complications of distal radius fractures include post-traumatic malalignment in about 20%. This is associated with ulno-carpal pain and impaired wrist function. Various corrective procedures have been recommended. Between 1972 and 1986, 96 patients with posttraumatic disorders after distal radius fractures underwent surgical treatment. Three different procedures were carried out: simple corrective osteotomy of the distal radius, combined correction of the radius and ulna, as well as isolated correction of the ulna (distal resection, step-cut osteotomy, hemiresection arthroplasty). 83 (86.5%) of the patients were followed up for an average of 7 years postoperatively. The functional results were evaluated according to Lidström. Excellent and good results were found in 58 (69.9%), fair in 20 (24.1%) and bad results in 5 (6.0%). The best results were mostly seen in cases with a short interval between trauma and corrective procedure. Distal ulna resection has not been performed in our department since 1986 because of poor results and concommitant wrist-instability. We recommend combined correction procedures in those patients with painful deformities within a period of no more than six to nine months after trauma. The indication should also take individual aspects such as profession, age, activities, complaints, and radiological findings into account. Signs of osteoarthrosis and wrist disorders due to severe soft tissue problems are contra-indications to any of the aforementioned correction procedures.
OBJECTIVE: To find out an ideal method of internal fixation for the treatment of fractures of proximal radius. METHODS: From August 2001 to April 2004, 24 patients suffering from fractures of proximal radius were treated with Ni-Ti shape memory alloy embracing fixator. Of 24 patients, there were 19 males and 5 females, aging from 16 to 48 years; there were 9 cases of wrestling injury, 5 cases of crush injury, 4 cases of traffic accident injury, 3 cases of direct violence impact injury and 3 cases of high falling injury. All patients were given operation according to fix method of the shape memory alloy embracing fixator. All cases were regularly followed up to observe the fracture healing and functional recovery. RESULTS: All cases were followed up postoperatively from 4 months to 21 months with an average of 10 months. No complication occurred during operation and after operation. Healing by first intention was achieved. X-ray showed that all cases achieved clinical union 8-12 weeks after operation. According to Anderson's criteria and the results were excellent in 18 cases, good in 5 cases, and fair in 1 case. The excellent and good rate was 95.83%. CONCLUSION: The internal fixation with shape memory alloy embracing fixator has as follows advantages: less trauma, esay-to-do, stable fixation, better tissue compatibility and less complication in treating fractures of proximal radius. This method can enhance the fracture healing and functional recovery. So it is a better method to treat fractures of proximal radius.
OBJECTIVE: We recently reported enhanced arterial thickening in patients with rheumatoid arthritis (RA) and the importance of increased bone resorption in this process. Our aim was to examine whether arterial stiffening, another aspect of atherosclerosis, is also increased in patients with RA, and to determine if it is an important risk factor. METHODS: The subjects were 47 patients with RA and 49 healthy controls, all postmenopausal women. Subjects having risk factors for atherosclerosis were excluded. Femoral-ankle (fa) pulse wave velocity (PWV) and brachial-ankle (ba) PWV were measured in all patients using a waveform analyzer. Bone mineral density (BMD) at the ultradistal radius was assessed by peripheral quantitative computed tomography. Inflammation markers (C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor, platelet count) and bone resorption markers (urinary excretion of deoxypyridinoline and N-terminal telopeptide) were also measured. RESULTS: The median values of faPWV and baPWV in RA patients were 1124 cm/s [interquartile range (IQR) 1040-1175] and 1539 cm/s (IQR 1297-1738), respectively, which were significantly greater than the respective values of 982 cm/s (IQR 819-1054; p < 0.001) and 1322 cm/s (IQR 1112-1398; p = 0.004) in controls. In multiple regression analysis, the presence of RA emerged as an independent factor associated with the greater faPWV and baPWV when adjusted for age, blood pressure, and smoking. In RA patients alone, BMD in the trabecular bone component, but not for the total bone (cortical plus trabecular), at the ultradistal radius correlated significantly with both faPWV and baPWV. Multiple regression analysis showed that trabecular BMD at the distal radius was a significant factor independently associated with greater faPWV and baPWV when adjusted for age, blood pressure, and smoking. None of the measured inflammation markers or bone resorption markers correlated with either faPWV or baPWV in patients with RA. CONCLUSION: Patients with RA show increased arterial stiffening, in addition to the arterial thickening we have previously reported, supporting the notion of enhanced atherosclerosis in RA patients. Paraarticular bone loss in the trabecular bone component at the ultradistal radius is a factor significantly associated with increased arterial stiffening in RA patients.
OBJECTIVES: To evaluate the effect of conservative treatment on stability of different types of distal radius fracture so as to help select the optimal treatment of different distal radius fracture and verify the exact time when the patient need careful. METHODS: During the period of one year 103 consecutive patients of distal radius fracture were treated by closed reduction and below-elbow cast immobilization and standard PA in the emergency room and were followed up 1, 2, and 4 weeks after the initial visit until the casts were removed. Lateral radiographic examination was conducted before and after reduction and during the reexamination. All the images were saved in a working server in hospital. The patients were classified according to the Cooney classification system, then the displacement, palmar tilt, radial inclination and radial shortening in every film were measured accurately and involvement of radiocarpal joint surface was noted. Combined with the assessment by the Lindstrom grading system, the radiographic results were divided into 2 groups: accepted and unaccepted. Finally, Pearson Chi-square test, likelihood ratio test, and Kendall correlation analysis were used to testify the radiographic results of different Cooney types. RESULTS: Fractures of Cooney type 1, 2 and 3 achieved good results after non-operative treatment with the rates of accepted results of 90%, 88.5%, and 88.9% respectively. Only 28.1% of the type 4 fractures reached the accepted criteria. The general rate of accepted results among the 103 fracture patients was 69.9%. The general rate of accepted results of the 103 patients was 69.9%. The rates of accepted results of the Cooney type 1, 2, 3, and 4 fractures were 90.0%, 88.5%, 88.9%, and 28.1% respectively. The radiographic result was significantly correlated with the Cooney classification with a large Kendall coefficient. Displacement after closed reduction was found in 36.5% of the type 2 fractures and 65.6% of the type 4 fractures and a large majority of them displayed instability within a week after the closed reduction and cast immobilization. CONCLUSION: A large majority of the distal radius fractures can achieve good results after treatment by closed reduction and cast immobilization, especially those of type 1, 2, and 3, for which conservative treatment should be the first choice. However, type 4 fracture is extremely unstable and a large percentage of it fails to get satisfactory result by non-operative treatment, so operative treatment is better for it. Reexamination 1 - 2 weeks after the manipulation should be emphasized so as to adopt effective treatment in time.
Posttraumatic angular and rotatory deformities of radius or ulna or both frequently cause a restriction of supination-pronation. The loss of motion is determined by the direction and the degree of angulation and by location of fracture. The dorsopalmar angulation and radioulnar deviation of the radius in an anatomic forearm specimen are simulated and the motions of the radius during supination-pronation are investigated. Dorsal angulation and radial deviation produce a considerable loss of pronation. However, supination losses are much less affected. The reduction of the interosseous gap is an important morphological reason of this effect. The angle of torsion is measured in left and right intact radii between transversal epiphyseal and diaphyseal axes. The torsion of the distal radial epiphysis varies from 0 to 16 degrees. Left and right radius of a single individual show very small differences in their torsion; therefore a comparison to the intact contralateral bone is indicated.
Bone mineral content (BMC), density (BMD), and size were measured in 202 subjects ranging from 3 to 25 years of age (106 males and 96 females), half of which were children and half young adults. BMC and BMD were measured using single photon absorptiometry at the proximal and distal radius and dual photon absorptiometry at the lumbar spine and the total body. In the pre-pubertal age group (3-9 yrs), no differences were found in BMC nor BMD between males and females at any site. Growth of bone during puberty was characterized by an increase in BMC, bone size and BMD. The percent increase in BMC was greater at the lumbar spine and the total body (+200 to +390 %) than at the radius (+90 to +270 %). The increase in BMC was higher than the increase in BMD (+50 to +90 %). Overall bone growth in the total body was not reflected by changes in BMC of the appendicular skeleton. The increase in BMD was heterogeneous and was higher in the legs than in the arms. In males, the increase in BMC and size during growth was greater than in females resulting in a higher peak bone mass and size in males. The increase in BMD was similar between males and females at the distal radius, the lumbar spine and the total body, but higher at the proximal radius, the arms and the legs in males.(ABSTRACT TRUNCATED AT 250 WORDS)
Thirteen patients with neglected luxation of the proximal radius who were treated with different surgical procedures at the Orthopaedic Department of the Kantonsspital in St. Gallen (Switzerland) returned for evaluation at an average of 7 years postoperatively. The luxation was traumatic in 11 cases (7 Monteggia-fractures) and in 2 cases due to a dysplasia of the forearm. In 7 patients the deformity recurred and in 1 a synostosis between radius and ulna was noticed. In 4 cases the wrist showed a relative overlength of the ulna. Proximal osteotomy of the ulna in combination with open reduction of the proximal radius gave better results than the other procedures. Congenital luxation of the proximal radius does not cause much symptoms but surgical treatment often results in recurrence of the deformity. Therefore, we only occasionally advocate operative therapy in these cases.
The radius location of a giant-cell tumor is not rare. Treatment sets the surgeon with the reconstruction procedure after block excision, specially when localized in the distal end of the bone. The authors present one case of a grade I giant-cell tumor of the distal radius, treated after a first recurrence. A block excision was done and the distal end of the radius was reconstructed by a free vascularized fibular transplant. Healing succeeded in 2 months and a half. The wrist motion recovery was good. No recurrence was observed for eighteen months after surgery. Radius reconstruction after block excision can be done by using free vascularized bone transfers. Healing occurs after a shorter period due to the graft's living characteristics.
The forearm and wrist radiographs in 400 children with age ranging from 2 months to 2 1/2 years were analyzed. Comparatively, x-ray films and their correlated macrosections of the wrist of 14 children's cadavers about the same age were studied. Alternate lines of increased, decreased, and increased density at the distal metaphysis of the ulna and radius were accountable. All these are normal variants of the development of the ulna and radius of infants. A series of abnormal x-ray signs were demonstrated in children administered over 100,000 IU of vitamin D every month on the average. These signs are blurred cortical bone with linear periosteal reaction, disorganization of the cortical bone, osteoporosis, cortical thickening and sclerosis of the ulna and radius, dense and thick calcified ring of ossification nuclei of the carpale, and dense metaphyseal band of the ulna and radius. The more vitamin D was administered, the more frequently abnormal x-ray signs occurred. These signs coincide with the results of radiopathologic and microangiographic correlations of hypervitaminosis D in animals, an experiment we had made before. The x-ray findings of hypervitaminosis D are very complicated. Only based on a series of x-ray signs rather than a single dense metaphyseal band could a radiologic diagnosis of hypervitaminosis D be made.
K-wire stabilization and casting of unstable or intraarticular fractures of the distal radius has proven to be an effective method of treatment since many years. However the need of implant removal after fracture healing is a disadvantage of this method. For this reason we investigated on the use of biodegradable implants in a fracture model of the distal radius. The biomechanical testing with Polydioxanon-(PDS)-pins (Ethipin) showed too small primary stability for the use in vivo. Osteosyntheses with three Polyglycolacid-(PGA)-rods Biofix compared with three K-wires 1.6 mm on the other hand showed 82% initial stability. From May to September 1988 typical distal radius fractures in 11 patients have been stabilized with Biofix-rods. The result of primary reduction could be obtained in all cases. These first experiences suggested, that stabilization of distal radius fractures with Biofix-rods might alternatively be performed instead of K-wire pinning.
Growth arrest of the distal radius may follow a severe injury to the growth plate. When the growth of the distal radius ceases in the child, continuing ulnar growth results in radial deviation of the hand and dislocation of the distal radioulnar joint. Treatment options in such a limb-length discrepancy are resection of the physeal bony bridge, lengthening of the shaft of the radius with bone graft using the principle of the Wagner technique, resection or epiphysiodesis of the distal ulna, and lengthening through a metaphyseal corticotomy without the use of bone graft. We report a case of metaphyseal lengthening of the radius employing the Ilizarov external fixator for controlled distraction osteogenesis.
Basal fracture of the radius (traumatic manus radioflex) healed in the typical false position appreciable impairs the biomechanics of the wrist. Development of secondary arthrosis is to be feared in this condition. We report on the result of a follow-up investigation of 24 patients with a false position of the distal end of the radius requiring correction. The observation period is five to 40 years. The clinical and radiological follow-up examination shows that even highly deformed wrists can retain good mobility and remain free of pain for years. The most prominent symptoms are strain pain on ulnar side of the wrist and in the region of the distal radioulnar joint. It is less the tilting of the base of the radius which is responsible for the symptoms and for the development of the arthrosis. On the contrary, the shortening of the radius plays the major role here, causing an incongruence or even luxation of the distal radioulnar joint.
Osteosynthesis n comminuted fracture of the head of the radius is extremely difficult because of the small size of the bone fragments. The particularly rich innervation of the elbow explains the violent vasomotor reaction that accompanied injuries of the elbow, reaction responsible in the last instance of the onset of biological alterations the articulation. For this reason, the therapeutical solutions must have in view rapid restoring of the passive and active movements of the elbow. Reactions of the radius head is often followed by ossification around the radius stump, subluxation of the inferior articulation and valgus of the ulna. Osteosynthesis is only possible if there is a single detached bone fragment in posterioexternal position with respect to the radius head circumference. The authors describe an original technique, i.e. reducing the fractured bone fragments which are then fixed with a Kirschner rod, brought out percutaneously. A description is given of the operative procedure and postoperative care in the first eight patients operated. Very good results were obtained in 4 case, good results in 3 and poor results in one case.
Rosette strain gauges were applied to the equine radius and tibia. Three sites were examined on each bone on separate occasions (proximal metaphysis, middiaphysis, and distal metaphysis). At each site, 4 rosette gauges were applied around the bone (ie, cranial, caudal, medial, and lateral). Strain recordings were made while walking the horse with and without a full-limb plaster cast. The principal axis of tensile strain was on the craniolateral aspect of the radius. Distally, on the radius, the largest strains were torsional. The cast changed the principal axis of tensile strain on the radius from the craniolateral surface to the caudal surface. The principal tensile strain of the tibia was just to the lateral side of cranial in the proximal and diaphyseal regions. Distally, the principal axis of tensile strain was craniolateral; however, the largest strains measured here were torsional. The cast changed the principal axis of tensile strain on the distal metaphysis of the tibia, but it did not reduce the magnitude of the strains measured. Casts may not aid stabilization of radial or tibial fractures repaired with internal fixation and may in fact place additional stress on the fracture site.
A digital image processing system was used to study changes in orientation of the radiographic trabecular pattern of bone in children aged 4-14 years. The radiographs originated from a mixed-longitudinal growth study (The Nijmegen Growth Study), which comprised of three birth cohorts and which was carried out between 1971 and 1975. Of 3075 left hand-forearm radiographs of 426 children, the orientation of the trabecular pattern of the radius was analysed in twelve directions on a standard area of 10 x 10 millimetres. It was demonstrated that the trabecular pattern of the radius shows two predominant directions of orientation: along and perpendicular to the long axis of the radius. Spearman's Rank Correlations were calculated between direction of orientation and age of the children for the total population as well as for the cohorts separately, because the existence of cohorts-effects. The cohort of the youngest children showed more and higher significant correlations than the other cohorts, indicating that the trabecular pattern of young children is more subjected to changes. The results indicate that the prevalence of trabeculae orientated perpendicular to the long axis of the radius decreases. We speculate that this development reflects the effects of changes in mechanical loading in that direction during growth and development resulting in functional adaptation of the trabecular bone.
An unusual case of wringer injury in a 29-month-old child demonstrates extensive loss of the diaphysis of both the radius and ulna. Reconstruction consisted of cortico-cancellous autogenous tibial bone grafting of the radius and ulna in two stages. Follow-up of 24 years showed remodeling and good alignment of the entire radius and ulna, culminating in a good functional and cosmetic result. Extensive soft tissue damage and decreased blood supply result in bone necrosis. There is no reason to bone graft the radius and ulna at the same time.