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The accuracy of BMD at distal radius was evaluated in terms of sensitivity, specificity, false negative, false positive, predictive value of a positive (osteoporosis) and a negative (normal) test for non-forearm osteoporosis. 278 women (150 osteoporotic and 128 normal) were measured for both distal radius bone mineral density (BMD) using Panasonic (DXA-70) dual energy X-ray absorptiometry (DEXA) and non-forearm BMD using Hologic (QDR-4500) DEXA on the same day. The results showed that mean age, menopause age, height and weight in the osteoporotic group were not different from the healthy group (p=0.168, 0.091, 0.274 and 0.097, respectively). Mean BMD of both distal radius and lumbar spine in the normal women was significantly higher than that in the osteoporotic group (p<0.001, = 0.002, <0.001, respectively). While mean BMD of the hip, femoral neck and Ward's triangle in both groups was not different (p = 0.330, 0.874, 0.847, respectively). The sensitivity of BMD of the right radius was very high (90.00-95.45%) and specificity was moderately high (53.85-73.68%). While false negative (4.55-10.00%) was less than false positive (26.32-46.15%). The accuracy of right radius BMD when compared with spine, hip, femoral neck and Ward's triangle was 82.35, 66.66, 80.00 and 86.49 per cent, respectively. The sensitivity (85.00-96.67%), specificity (57.69-81.58%), false negative (3.33-15.00%) and false positive (18.42-42.31%) of left radius BMD had the same trend as right radius BMD. Accuracy of the left radius when compared with non-forearm BMD was 88.24, 66.67, 75.71 and 86,49 per cent, respectively. The predictive value of right radius osteoporosis was 73.68, 47.37, 77.78 and 89.66 per cent for detecting osteoporosis at spine, hip, femoral neck and Ward's triangle, respectively. The predictive value of normal right radius BMD was 93.33, 92.86, 87.50 and 75.00 per cent, respectively for normal non-forearm BMD. Moreover, the predictive value of left radius osteoporosis for identifying spinal, hip, femoral neck and Ward's triangle osteoporosis was (80.56, 47.22, 77.55 and 91.07%, respectively) and the predictive value of normal left radius BMD for identifying normal BMD at non-forearm sites (96.88, 90.00, 71.43 and 72.22%, respectively) was revealed. It indicated that forearm DEXA provides adequate accuracy for in vivo determination of spinal, femoral neck and Ward's triangle osteoporosis. However, there was inadequate accuracy and very low predictive ability for identifying hip osteoporosis.
The proximal isovelocity surface area (PISA) color Doppler method with use of a hemielliptic formula is reported to be accurate for quantitating regurgitant volume (RV). However, this formula ideally requires the measurement of 2 or 3 radii and therefore is not widely used clinically. The purpose of this in vitro study was to derive a simple PISA formula for estimating RV with use of a single radius axial to the valve orifice and to compare it with the clinically used single-radius hemispherical formula (2 x pi R(2) x AV x TVI/Vp), where AV is the apparent color Doppler aliasing velocity, R is the PISA color Doppler aliasing radius, TVI is time-velocity integral of the jet by continuous wave Doppler, and Vp is the peak velocity of the jet by continuous wave Doppler. Pulsatile flow studies were performed across a convex curvilinear surface, which more closely approximates the shape of the mitral valve than does a planar surface. Pulse rates (60 to 80 bpm), peak flow velocities (4.0 to 6.0 m/s), and regurgitant orifice areas (0.2 to 1.0 cm(2)) were varied to simulate mitral regurgitation. The AVs were varied from 11 to 39 cm/s, and a single PISA aliasing radius was measured at each AV. Excellent linear correlations were obtained between the PISA radius and the actual RV measured with use of a beaker (r = 0.94 to 0.97, P <.0001). A series of simplified formulas was derived from the regression line of the PISA radius versus the RV. For example, with an AV of 21 cm/s, RV was estimated by a simplified PISA formula (where RV[mL] = 10 x R [mm] - 30) with an accuracy of 3.3 +/- 6.3 mL versus -20.3 +/- 8.7 mL for the standard single-radius PISA method (P <.0001). By using the standard single-radius hemispherical PISA formula, RV was underestimated if the radius was <20 mm. By using simplified regression equations, the PISA radius accurately estimated RV at a PISA radius <20 mm. Clinical studies are necessary to validate this concept.
To determine how well mineralization correlates in the radius and humerus of neonates, we have measured with photon absorptiometry the bone mineral content (BMC) and bone width (BW) in the humerus and radius of well premature neonates and in the radius alone of well term neonates at birth, 8 and 16 weeks of age. These data allow (1) the correlation of bone mineralization in the humerus and radius at birth and over the first 4 months of life and (2) the correlation between bone mineralization in the radius or humerus at birth and that measured at 8 and 16 weeks in the same bone site. The BMC of the radius was significantly (P less than 0.02) correlated with the BMC of the humerus at birth, 8 and 16 weeks, but the BW of the radius was significantly correlated with the BW of the humerus only at 16 weeks. On the other hand, the BMC of the radius at birth in both term and premature neonates failed to correlate significantly (P = ns) with the BMC of the radius at 8 or 16 weeks. In the humerus, the BMC at birth was significantly (P less than 0.001) correlated with that measured at 8 but not at 16 weeks. These data indicate that the humerus and radius increase in mineral content at a similar rate over the first 4 months of life but that one cannot accurately predict from the BMC at birth what the bone mineral content will be at 8 and 16 weeks of age.
BACKGROUND: Measurement of variceal wall tension theoretically provides the most accurate method of predicting future variceal bleeding. Using high-resolution endoluminal sonography in 45 patients with known portal hypertension, we measured and correlated the two previously unmeasured variables involved in the calculation of variceal wall tension (radius and wall thickness) by the Laplace equation. METHODS: A 20 MHz 6.2F ultrasound transducer was used to image esophageal varices during standard esophagoscopy. All images were captured on videotape and later reviewed by two blinded investigators. Outer and inner variceal wall circumferences were measured at a cross section of each varix. The radius of each varix and the variceal wall thickness were calculated. The radius of each varix was then correlated with its wall thickness. The interobserver and intraobserver variabilities were measured. RESULTS: The mean variceal radius was .86 +/- .34 cm for the inner radius and 1.48 +/- .41 cm for the outer radius; mean variceal wall thickness was .099 +/- 0.037 cm. Intraobserver and interobserver correlation for the radius was r = .98 and r = .97, respectively. The intraobserver and interobserver correlations for the wall thickness were r = .92 and r = .91, respectively. Variceal radius did not correlate with the wall thickness of the varix. CONCLUSIONS: High-resolution endoluminal sonography provides a method for the accurate measurement of esophageal variceal radius and wall thickness. Variceal radius does not correlate with variceal wall thickness, implying that variceal wall tension cannot be accurately estimated by measurement of variceal size alone. Combining these data with measurements of variceal pressure should allow for the direct determination of wall tension and, subsequently, identification of patients at risk for variceal bleeding.
PURPOSE OF THE STUDY: Mal-union of distal radius fractures cause functional limitation and progressive degenerative changes of the wrist. The authors evaluate both radiograph and functional outcomes in a group of patients with a post-traumatic deformation of the distal radius treated by corrective osteotomy and fixation by a newly developed T-plate. MATERIAL: A retrospective evaluation covered a group of 13 patients of the average age of 51 years (range, 35-60 years) operated on in 2001 for post-trauma symptomatic mal-union of the distal radius of the Colles type. The group included only patients in which a new implant was used. The time interval between the primary fracture and corrective osteotomy was on average 11 months. METHODS: Corrective osteotomy for Colles deformations was performed in all patients from the dorsal approach with the application of a cortico-cancellous bone graft. Stabilisation was performed by the mentioned plate. Radiograph and functional outcomes were evaluated statistically. RESULTS: The radiographic evaluation proved the restoration of the normal anatomic relationship between the distal radius and ulna as well as statistically significant improvement of the function of the hand as concerns the range of motion and muscular strength Except for one patient, all involved evaluated the outcome as a subjective improvement. DISCUSSION: Corrective osteotomy of the distal radius is a standard surgery performed routinely by plate fixation with the application of a cortico-cancellous bone graft. Despite a perfect coverage of the issues relating to potential consequences resulting from non-anatomic position of the articular surface of the distal radius, this surgery was not very frequent in the past. Nevertheless, recently, there is a growing number of works in the literature dealing with corrective osteotomies for mal-union of the distal radius after fractures not only for the Colles but also Smith type. CONCLUSIONS: Treatment of deformation of the distal radius is a rewarding procedure which brings the patients a significant improvement of the function of the hand. The implant used by the authors proved useful for a plate fixation on the distal radius.
The changes in strain distribution along the radius and ulna with loading and interosseous membrane (IOM) section were analyzed in this biomechanical study. Four cadaveric upper extremities were dissected and strain gauges applied. The forearm was loaded at the distal radius with a carpal implant after being positioned upright in neutral forearm rotation. Strain measurements were recorded before and after transection of the IOM. Before IOM transection, increased compressive strain was measured on the ulnar border of the ulna, while increased tensile strain was recorded on the dorsal aspect of the ulna, the dorsal aspect of the radius, and the lateral border of the radius when compared with the unloaded forearm. This suggests bowing of the radius and ulna with the convex side dorsally and bowing of the radius with the convex side radially. After IOM transection, increased tensile strain on the lateral border of the radius and the ulnar border of the ulna was measured when compared with the loaded forearm with an intact IOM. No change in strain patterns was measured by the strain gauges located on the dorsal aspect of the radius or ulna after IOM transection. The increased tensile strain during constant load application suggests increased bending moments acting on the radius and ulna after IOM transection.
OBJECTIVE: To compare the accuracy of radiography, nuclear scintigraphy, and histopathology for determining the proximal extent of distal radius osteosarcoma in dogs. STUDY DESIGN: Retrospective clinical study. SAMPLE POPULATION: Twenty client-owned dogs taken to Colorado State University with osteosarcoma of the distal radius. METHODS: Medical records of 20 dogs with confirmed osteosarcoma that underwent a limb-salvage procedure were reviewed. Measurements were performed directly from the lateral view of each radius, from both the scintigram and the radiograph, to determine the length of the radius and the distance from the proximal extent of the tumor to the distal radiographic or scintographic extent of the radius. The ratio of distal radial involvement to total radius length was calculated. A similar ratio was also determined using the macroslide, which included the entire portion of bone that was excised during the limb-salvage procedure. All 3 methods of measurement were compared. RESULTS: Nuclear scintigraphy significantly overestimated tumor length when compared with macroslide specimen measurements. Radiography also overestimated tumor length, but these results were not significantly different from macroslide specimen measurements. CONCLUSIONS: Both radiography and nuclear scintigraphy overestimate the extent of distal radius osteosarcoma in dogs when compared with histopathologic macroslides of the same lesions. Nuclear scintigraphy overestimated tumor extent to a larger degree than did radiography. CLINICAL RELEVANCE: Although radiography is a more accurate method of measurement of the extent of distal radius osteosarcoma, because nuclear scintigraphy overestimates tumor length to a greater degree, scintigraphy may provide a larger margin of safety for determining the site of proximal osteotomy during a limb-salvage procedure. However, caution should be taken when utilizing scintigraphy, because this method may overestimate length of radius involved to such an extent as to cause the surgeon to believe that a patient is not a suitable limb-salvage candidate.
PURPOSE OF THE STUDY: The authors reviewed 21 cases of extra articular malunions of the distal radius treated by osteotomy, temporary external fixation, then osteosynthesis. Two groups were studied: Group A of 14 patients with dorsal tilt of the distal radius and Group B of 7 patients with palmar tilt of the distal radius. Mean follow-up of this series was 69 months ranged from 12 to 109 months. MATERIAL AND METHODS: In Group A, after exposure of the distal radius through a dorsal approach, the site of osteotomy, proximal to the distal radio-ulnar joint, was determined by fluoroscopy. The angular correction was done by progressive opening using a small external fixator. After checking on the correction, the bone graft was harvested 7 times on the radius as described by Watson et Castle, 7 times on the iliac crest. Bone fixation was done by two K-wires and a cast for 8 to 10 weeks. Three Sauvé-Kapandji procedures was done at the same time. In Group B, the approach was palmar, extended distally to open the carpal tunnel. The distraction was done with a distal T-shaped external fixator. The bone graft was always harvested on the iliac crest. Bone fixation was done with a T-shaped palmar plate. Two Sauvé-Kapandji procedures was done at the same time. RESULTS: Group A: Flexion-extension arc was improved of 15.5 p. 100, pronation-supination of 83.7 p. 100 and grip strength of 80 per cent of the pre-operative values. Radiological evaluation showed good correction except one case of undercorrection of the dorsal tilt (-7 degrees) and one case of undercorrection of the radial inclination (+6 degrees). The distal radio-ulnar index was measured at the mean of 0mm postoperatively compared to +5 mm pre-operatively. One patient developed a postoperative radiocarpal arthritis. Group B: Flexion-extension arc was improved of 96.2 p. 100, pronation-supination of 76.9 p. 100 and grip strength of 108.3 p. 100 of the preoperative values. Radiological evaluation showed good correction except one case of overcorrection of the palmar tilt (-10 degrees) and one case of undercorrection of the radial inclination (+7 degrees). The distal radio-ulnar index was measured at the mean of 0mm postoperatively compared to +7 mm pre-operatively. DISCUSSION: The functional consequences of malunions of the distal radius have been stressed by others for more than sixty years. Since, many authors have contributed to refine and improve their surgical correction. Several displacements should be taked into account for the preoperative planning. They are sagittal tilt, frontal horizontalisation, shortening, sagittal and frontal translation, and axial rotation. Many types of osteotomies could be done; closing wedge, opening wedge or reorientation. In some cases, an operative procedure of the distal radio-ulnar joint should be done at the same time. We chose an opening-wedge osteotomy and the use of a temporary external fixator to ensure progressive distraction and good adjustment in the correction of angular deformities. In the dorsal tilt group we were satisfied in using on 7 patients a trapezoidal cortico-cancellous bone graft harvested on the radius. CONCLUSION: The authors would like to stress two points: The technical interest of using a temporary external fixator to adjust the angular correction of the distal radius. The importance of an adequate treatment of distal radius fractures in emergency situation, considering the functional and cosmetic alterations due to malunions and their need for surgical corrections in main instances.
OBJECTIVE: To determine the effect of pin hole size and number on the breaking strength of the adult equine radius when loaded in torsion to failure. SAMPLE POPULATION: 54 pairs of equine radii from adult horses. PROCEDURE: For test one, 12 pairs of radii were used to determine the effect of pin hole size on torsional breaking strength. A 6.35-mm hole was drilled in 1 radius, and a 9.5-mm hole was drilled in the contralateral radius. For test two, 36 pairs of radii were randomly assigned to 1 of 3 treatment groups (n = 12) to determine the effect of pin hole number on the torsional breaking strength of the equine radius. One radius of each pair served as a control, and one, three, or six 6.35-mm transcortical holes were drilled in the contralateral radius. For test three, 6 pairs of radii had torsional forces applied directly to the transfixation pins, as opposed to the bone itself. One radius of a pair served as a control, and three 6.35-mm smooth Steinman pins were placed in the contralateral radius. All radii were loaded in torsion to failure, and the breaking strengths were recorded. RESULTS: Compared with the 6.35-mm hole, the 9.5-mm hole significantly decreased torsional strength of the radius. There was no significant difference in mean torsional strength between the control radii and the radii with 1, 3, or 6 transcortical holes or when the transfixation pins were loaded. CONCLUSION: Use of up to three 6.35-mm transfixation pins can be used in a full-limb transfixation pin cast to optimize stiffness without a significant decrease (12%) in bone strength.
Our purpose in this study was (i) to measure trabecular bone structure using fractal analysis of distal radius radiographs in subjects with and without osteoporotic hip fractures, and (ii) to compare these measures with bone mineral density (BMD) as well as with measures of trabecular bone structure derived from high resolution magnetic resonance (MR) images. Distal radius radiographs were obtained using semi-industrial films (55 kVp, 400 mAs) in 30 postmenopausal patients, who had suffered osteoporotic hip fractures (74.8+/-8.2 years) in the last 24 months and 27 postmenopausal age-matched (74.6+/-6.6 yr) normal volunteers. Radiographs were digitized at 50 microm. A Fourier power spectrum-based fractal dimension (FD) characterizing the trabecular pattern was measured in a region of interest proximal to the joint line. The fractal dimension was calculated over two spatial frequency (f) ranges: FD1 was calculated over 0.5<log(f)<l.0, FD2 over the higher range 1.0<log(f)<1.5. Trabecular BMD in the radius was obtained using peripheral quantitative computed tomography (pQCT) (Stratec GmbH, Germany). In addition BMD of the proximal femur was determined using dual x-ray absorptiometry (DXA) (QDR 2000, Hologic, MA). In a subset of patients (16 controls and 18 with hip fractures), high resolution MR imaging of the distal radius (spatial resolution of 156 x 156 x 500 microm) was used to obtain measures analogous to bone histomorphometry. There were significant differences (p<0.05) between the fracture and nonfracture groups in the total femur BMD (13%), trabecular BMD in the distal radius (4%), and the fractal dimension in the radiographs (FD2) (3%). The correlations between FD2 and the total femur BMD as well as trabecular bone BMD in the distal radius were -0.48 (p<0.006) and -0.22 (p<0.33); respectively; FD1 increased with BMD and showed lower correlations. FD2 showed good correlations with App. Tb.N (-0.71) and App. Tb.Sp (0.69) (p<0.01), moderate correlation with App BV/TV (-0.53) (p<0.05), and no significant correlation with App. Tb.Th. The correlations between structural measures and FD1 showed the inverse trend and were typically lower. The odds ratios for a hip fracture were 2.44 for total femur BMD, 1.5 for trabecular BMD (radius), and 1.5 for FD2, respectively. In summary, the fractal measures derived from radiographs of the radius show differences between subjects with and without hip fractures, the predictive power of measures in the distal radius are comparable to radial trabecular BMD but lower than that of total hip BMD.
BACKGROUND: At end diastole, the position and shape of the ventricular septum depend on the transseptal pressure gradient. It is not clear, however, how the septal radius of curvature changes in response to the gradual change in transseptal pressure gradient during progressive pulmonary arterial constriction (PAC) and aortic constriction (AC). METHODS AND RESULTS: In 11 anesthetized open-chest dogs, the septal radius of curvature was measured from the short-axis two-dimensional echocardiogram, and the transseptal pressure gradient (left ventricular [LV] pressure minus right ventricular [RV] pressure) was calculated from ventricular pressures measured with micromanometers. Seven dogs were studied with both PAC and AC (group 1) and four dogs only with PAC, which was initiated before and after volume loading (group 2). The transseptal pressure gradient decreased during PAC. As the transseptal pressure gradient decreased, the septum shifted continuously leftward with decreases in the LV septum-free wall diameter and in LV cross-sectional area. The septal radius of curvature (Rs) increased until the septum became flat. The flat septum (i.e., Rs = infinity) occurred at a relatively constant value of transseptal pressure gradient (-4.6 +/- 1.4 mm Hg) independently of the absolute values of LV pressures when between 2 and 9 mm Hg, although necessarily a greater RV pressure was needed to make the septum flat when LV pressure was higher. After inversion, the septum again became curved, with a decrease in the absolute value of septal radius of curvature as the transseptal pressure gradient became increasingly negative. The septum was still concave to the LV cavity at zero transseptal pressure gradient, and its curvature decreased (i.e., its radius of curvature increased) with increases in ventricular pressures. During AC, the septal radius of curvature also increased, but with an increase in transseptal pressure gradient accompanied by increases in LV septum-free wall diameter and in LV area. In group 2 animals, at zero transseptal pressure gradient, the normalized septal radius of curvature was greater (p less than 0.005) at high LV pressure than at low LV pressure. The transseptal pressure gradient required to make the septum flat was not significantly different between low and high LV pressure, which confirmed the results of group 1. CONCLUSIONS: The results of the present study show that the shape and position of the ventricular septum are determined by the transseptal pressure gradient but that the shape of the septum is also affected by the ventricular pressures. The septum was not flat but rather still concave to the LV cavity at zero transseptal pressure gradient. Approximately 5 mm Hg of negative transseptal pressure gradient was required to displace the septum farther leftward and make it flat. The septal radius of curvature increased during both PAC (which decreased transseptal pressure gradient) and AC (which increased transseptal pressure gradient), indicating that the mechanisms involved in changing septal radius of curvature are different during PAC and AC.
OBJECTIVE: Rheumatoid Arthritis (RA) Disease-Modifying Anti-Rheumatic Drug (DMARD) Intervention and Utilization Study (RADIUS) is a unique, real-world, prospective, 5-year, observational study of over 10 000 patients with RA. RADIUS provides a snapshot of use patterns, effectiveness, and safety of DMARDs, biologics, and combination therapies used to manage RA in clinical practice. RESEARCH DESIGN AND METHODS: Patients with RA requiring a new DMARD or biologic (addition or switch) were eligible for the RADIUS study. Two separate patient cohorts were enrolled; RADIUS 1 patients initiated any new therapy at entry, and RADIUS 2 patients initiated etanercept at entry. Patient demographics and disease activity measures were collected at study entry, and baseline characteristics were summarized for various subgroups. Effectiveness, safety, and patterns of use will be tracked for therapies utilized during the 5-year study. RESULTS: RADIUS 1 enrolled 4959 patients, and RADIUS 2 enrolled 5102 patients, mostly at community private practices (88%). In RADIUS 1, most patients initiated methotrexate (MTX) monotherapy, followed by MTX in combination with a biologic (e.g. infliximab plus MTX) or other DMARD. In RADIUS 2, most patients initiated etanercept in combination with MTX, followed by etanercept monotherapy. When a new therapy was required, physicians tended to add another therapy versus switching therapies. Patients initiating a biologic had a longer duration of RA and more severe disease compared with patients initiating non-biologic therapy. CONCLUSIONS: These real-world data provide evidence of the prescribing practices of rheumatologists in 2001-2003. Future analyses will allow evidence-based comparisons of the long-term safety and effectiveness of DMARDs, biologics, and combination therapies to assist physicians in clinical decision-making.
To determine whether magnetic resonance (MR)-derived measures of trabecular bone architecture in the distal radius are predictive for prevalent hip fractures, 20 subjects with hip fractures and 19 age-matched postmenopausal controls were studied. Bone mineral density (BMD) measures at the hip (dual-energy X-ray absorptiometry, DXA) and the distal radius (peripheral quantitative computed tomography, pQCT) were also obtained. We compared the MR-based structural measures derived in the radius with those in the calcaneus of the same patients. In the radius, images were acquired at an in-plane resolution of 156 microm and a slice thickness of 0.5 mm. Stereologic measures such as the apparent trabecular thickness (app. Tb.Th), fractional trabecular bone volume (app. BV/TV), trabecular spacing (app. Tb.Sp) and trabecular number (app. Tb.N) were derived from the images. Measures of app. Tb.Sp and app. Tb.N in the distal radius showed significant (p<0.05) differences between the two groups, as did hip BMD measures. However, radial trabecular BMD measures showed only a marginal difference (p = 0.05). Receiver operating curve analysis was used to determine the diagnostic efficacy of BMD, structural measures and a combination of the two. The area under the curve (AUC) for total hip BMD was 0.73, and for radial trabecular BMD was 0.69. AUC for most of the measures of trabecular bone structure at the distal radius was lower than for hip BMD measures; however, AUC for app. Tb.N at the radius was 0.69, comparable to trabecular BMD using pQCT. The AUC for combined BMD (hip) and structure measures was higher (0.87) when radius and calcaneus structure was included. Measures of trabecular architecture derived from MR images combined with BMD measures improve the discrimination between subjects with hip fractures and normal age-matched controls.
Our objective was to evaluate the usefulness of CT virtual preoperative planning in the surgical repositioning of malunited distal radius fracture. Eleven patients with malunited distal radius fracture underwent multislice CT of both wrists. A preoperative workup was performed in a virtual reality environment created from the CT data sets. Virtual planning comprised three main procedures, carrying out the virtual osteotomy of the radius, prediction of the final position of the distal radius after osteotomy and computer-assisted manufacturing of a repositioning device, which was later placed at the surgical osteotomy site to reposition objectively the distal radius fragment before fixation with the osteosynthesis. All patients tolerated the surgical procedure well. During surgery, the orthopedic surgeons were not required in any of the cases to alter the position of the distal radius that was determined by the repositioning device. At postoperative follow-up, the anatomic relationship of the distal radius was restored (radial inclination, 21.4 degrees ; volar tilt, 10.3 degrees ; ulnar variance, 0.5 mm). Clinically, a significant improvement of pronation (P=0.012), supination (P=0.01), flexion (P=0.001) and extension (P=0.006) was achieved. Pain decreased from 54 to 7 points. CT virtual reality is a valuable adjunct for the preoperative workup and surgical reposition of malunited distal radius fractures.
PURPOSE: We performed radius lengthening to treat radial deviation of the wrist in patients with Bayne and Klug type II and type III radial longitudinal deficiencies. The purpose of this investigation was to review our results of radius lengthening for radial longitudinal deficiency. METHODS: Beginning in 1991 radius lengthening was performed to treat 4 patients with radial longitudinal deficiency whose mean age at the initial lengthening was 16 months. The corrections for radial deviation of the wrists were performed simultaneously by soft-tissue distraction of the wrist. According to Bayne and Klug's classification 2 patients had type II and 2 patients had type III deficiencies. All but 1 patient had lengthening several times to correct the recurring discrepancy between the radius and the ulna. RESULTS: The corrections were achieved just after the lengthening but deformities recurred because of growth discrepancies between the radius and the ulna as the children grew. The radius was lengthened by a mean of 28 mm, with a mean length gain of 79%. The mean period in the fixator was 136 days. Two patients had both functionally and cosmetically acceptable correction after several lengthening procedures. In the other patient we abandoned this treatment method because of severe bone absorption at the distal end of the lengthened radius. One patient died of cardiac disease after one lengthening. CONCLUSIONS: Radius lengthening for Bayne and Klug type II and type III deficiencies may be accomplished successfully with the primary benefit of maintaining wrist and forearm motion. It is likely that at least 3 lengthenings may be required and this may need to be accompanied by a soft-tissue distraction at the ulnar carpal joint as well. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.
We have assessed the influence of isolated and combined rotational malunion of the radius and ulna on the rotation of the forearm. Osteotomies were made in both the radius and the ulna at the mid-diaphyseal level of five cadaver forearms and stabilised with intramedullary metal implants. Malunion about the axis of the respective forearm bone was produced at intervals of 10 degrees. The ranges of pronation and supination were recorded by a potentiometer under computer control. We examined rotational malunions of 10 degrees to 80 degrees of either the radius or ulna alone and combined rotational malunions of 20 degrees to 60 degrees of both the radius and ulna. Malunion of the ulna in supination had little effect on rotation of the forearm. Malunion of either the radius or of the ulna in pronation gave a moderate reduction of rotation of the forearm. By contrast, malunion of the radius in supination markedly reduced rotation of the forearm, especially with malunion greater than 60 degrees. Combined rotational malunion produced contrasting results. A combination of rotational malunion of the radius and ulna in the same direction had an effect similar to that of an isolated malunion of the radius. A combination in the opposite direction gave the largest limitation of the range of movement. Clinically, rotational malunion may be isolated or part of a complex angular/rotational deformity and rotational malunion may lead to marked impairment of rotation of the forearm. A reproducible method for assessing rotational malunion is therefore needed.
In 105 postmenopausal women with clinical suspicion of osteoporosis single photon absorptiometry (SPA) of the forearm and fracture percentage of the thoracic and lumbar spine were estimated. SPA was performed on the commonly used mid-radius site as well as on a modified distal radius site where radius and ulna are separated by five mm. Spine fracture percentage was inversely correlated with mid-radius SPA (r = -0.49) but more closely with distal radius SPA (r = -0.61). With bone mineral density values above 0.400 g/cm2 on the distal radius, no fractures were found. Between 0.325 and 0.400 g/cm2, 35% of the patients showed vertebral fractures but only up to a maximum of 30%. Below 0.325 g/cm2, 89% of the women had crushed vertebrae, often more than 30% of those measured. In conclusion, these results indicate that modified distal radius densitometry is superior to the commonly used mid-radius measurement and has some predictive value for the presence of vertebral fractures.