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At least 613 records · Page 34Linked to original sources
PubMed2003

Injectable calcium phosphate bone cement Norian SRS for the treatment of intra-articular compression fractures of the distal radius in osteoporotic women.

BACKGROUND: Distal radius fracture often presents a metaphyseal void which is more extended in elderly, osteoporotic patients. Bone graft and bone substitutes are reported to be beneficial in maintaining metaphyseal reduction. METHODS: We performed a prospective study on 52 menopausal, osteoporotic women with unstable intra-articular distal radius fractures to compare the outcome of percutaneous pinning and immobilisation in a cast for 6 weeks with that using injectable calcium phosphate bone cement (Norian Skeletal Repair System, SRS) to supplement pin and screw fixation and immobilisation in a cast for 3 weeks. All patients were reviewed 2 years (range 21-29 months) after surgery. RESULTS: Patients treated with SRS had better functional outcome, restoration of movement and grip strength ( p<0.001). In this group there was 1 mm loss of radial length, 3 degrees loss of radial inclination and 7 degrees loss of palmar tilt. In the control group radial length decreased 3 mm, radial inclination decreased 11 degrees and palmar tilt 12 degrees. Loss of reduction was significantly higher in the control group ( p<0.001). CONCLUSION: We conclude that the use of Norian SRS to supplement pin and screw fixation is effective in maintaining the reduction of unstable intra-articular distal radius fractures in osteoporotic patients and provides a better clinical outcome than percutaneous pinning.

Aged↗
PubMed2005

Fractures of the distal radius treated with a nonbridging external fixation technique using multiplanar k-wires.

PURPOSE: Joint-bridging external fixation is a minimally invasive treatment option for distal radius fractures. Although radial length can be restored easily the anatomic reduction of articular fragments and restoration of the normal volar tilt proves to be more difficult. A method of nonbridging hybrid fixation of distal radius fractures facilitates fracture reduction and allows for free wrist movement. METHODS: Twenty-five consecutive patients with fractures of the distal radius were treated with nonbridging external fixation for 6 weeks. The stepwise surgical technique comprised a preliminary joint-bridging construction for reduction purposes, the subsequent insertion of 3 to 4 K-wires in the distal fragment, the assembling of wires to a bar nearly parallel to the fracture line, and lastly the removal of the joint-bridging part. Clinical and radiologic evaluation was performed on the first and seventh days and at 6 weeks and 2 years after surgery. RESULTS: All fractures united. Palmar tilt (> or =0 degrees ) and articular surface (articular step-off < 2 mm) were restored in all patients whereas loss of radial length occurred in 4 patients having the distal fracture fragment secured with 3 K-wires. No radial shortening was seen in fractures with 4 K-wires inserted in the distal fragment. Functional results at 2 years after surgery showed an average extension of 55 degrees and flexion of 64 degrees without significant differences between extra-articular and intra-articular fractures. There was no extensor tendinitis or pin loosening in the distal fragment; however, 3 pin track infections of proximal pins occurred. CONCLUSIONS: This surgical technique of nonbridging external fixation is a good treatment option for distal radius fractures: it permits wrist movement. We recommend the insertion of 4 K-wires in the distal fracture fragment.

Aged↗
PubMed2005

Condylar stabilizing technique for intra-articular fracture of distal radius.

I previously reported a new reduction and fixation technique for extra-articular distal radius fracture associated with osteoporosis. I developed the technique and applied it to intra-articular fracturea. I present here the technique and verify its reliability, comparing the functional results of intra-articular fracture cases to those of extra-articular cases.

Bone Plates↗
PubMed2006

[Open reduction and internal fixation of distal radius extension fractures in women over 60 years of age with the dorsal radius plate (pi-plate)].

PURPOSE: The goal of this study was to review the clinical and radiological results and to correlate them with the functional outcome score DASH in women over 60 years who underwent open reduction and internal fixation with a pi-plate for displaced distal radius fractures. METHOD AND CLINICAL MATERIAL: In this retrospective study, forty-nine women over 60 years old with mainly intra-articular distal radius fractures underwent open reduction and internal fixation with a pi-plate. The dorsal approach was used permitting an anatomical reduction of the articular surface under direct vision of the radio-carpal joint. Patient follow-up was for a minimum of twelve months with a mean of 32 months. RESULTS: For 71 % of patients, there were no limitations in their daily activities and only one patient complained of a major disability. Overall, the flexion of the wrist was reduced by 15 degrees compared to the opposite side (mean 50 degrees). The DASH score (14.4) was not higher than that of a comparable age controlled group without radius fracture. The pi-plate was demonstrated to be a stable implant in osteoporotic bone and there was only one secondary dislocation. Most patients were painfree with two patients describing tolerable pain, one because of a progressing radio-carpal osteoarthritis and the second due to a neuroma of the superficial branch of the radial nerve. The other major complication was a late rupture of the extensor tendon of the index finger in one of the twelve patients where the pi-plate had not been removed. CONCLUSION: We recommend anatomical reduction and internal fixation for displaced intra-articular distal radius fractures using a dorsal approach to achieve a good wrist function including painless load bearing with the implant removed four months after surgery.

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PubMed2006

Open reduction and palmar plate-osteosynthesis in combination with a nanocrystalline hydroxyapatite spacer in the treatment of comminuted fractures of the distal radius.

In a prospective study, we used the nanocrystalline hydroxyapatite paste Ostim (Osartis, Obernburg, Germany) in combination with a palmar plate to treat comminuted radius fractures with a metaphyseal and articular component in order to examine the clinical use of Ostim as a bone substitute. Twenty-one patients with 22 radius fractures of AO types C2 and C3 were included in the study. The measurements, taken 10.2+/-1.3 months after the initial treatment, revealed a dorsopalmar tilt of 8.8+/-3.7 degrees , a radioulnar inclination of 18.8+/-2.8 degrees and an ulnar variance of 0.8+/-1.8mm. According to the Gartland and Werley evaluation, eight of the treated fractures attained an excellent, 11 a good and the remaining three a fair result. The study demonstrates that Ostim, in combination with angularly stable osteosynthesis, can be used as an acceptable bone substitute for the treatment of type C2 and C3 radial fractures.

Adult↗
PubMed1997

Plaster cast versus percutaneous pin fixation for comminuted fractures of the distal radius in patients between 46 and 65 years of age.

OBJECTIVE: To compare the results of treating unstable distal radius fractures either by percutaneous pinning and casting, or by traditional closed reduction and casting. DESIGN: Prospective, randomized. SETTING: University hospital. PATIENTS: Forty patients with unstable Frykmann III-VIII distal radius fractures resulting from a fall. INTERVENTIONS: Twenty patients were treated with closed reduction, consisting of manipulation, under local anesthesia, followed by casting. Twenty patients were treated with percutaneous fixation using K-wires, followed by casting. MAIN OUTCOME MEASUREMENTS: Initial displacement, quality of reduction, carpal malalignment, articular step-off. Range of motion and grip strength were measured using a scoring system reported by Home et al. (10). RESULTS: Functional results in the pinning group were better (excellent, 12; good, 6; fair, 2) than in the plaster group (excellent, 3; good, 8; fair, 5; poor, 4). Anatomic results also were better in the pinning group. CONCLUSION: The best anatomic and functional results were obtained by percutaneous pinning. Although the cost of pins and plaster treatment is significantly greater than plaster treatment, the author believes that the positive end result justifies the cost.

Aged↗
PubMed2002

Surgical treatment of redisplaced fractures of the distal radius in patients older than 60 years.

Twenty patients aged 60 years or older (average age, 68 y) presented to our institution with a distal radius fracture made complex by virtue of displacement after a closed reduction and cast or external fixation immobilization. Ten of the fractures were volarly angulated and 10 were dorsally angulated. Fifteen patients' hands had associated soft-tissue swelling. Surgical exposure and stable internal fixation were undertaken to both realign the fracture as well as enable functional rehabilitation. The final functional result and radiographic results were physician rated and patient rated by using the Patient Rated Wrist Evaluation (PRWE). The patients' overall activity level was quantified and compared with population norms by using the Physical Activity Scale for the Elderly (PASE). At an average follow-up visit of 38 months, all the fractures healed and none of the implants loosened or broke. The functional results were excellent in 7, good in 11, and fair in 2. The average PRWE score was 14, which compares favorably with prior studies of adult patients of all ages treated for a distal radius fracture. The PASE score averaged 177, representing a return to preoperative activity levels in 17 of 20 patients. Complications included loss of alignment, tendon rupture, transient radial sensory neuritis, and nonfatal pulmonary embolism in 1 patient each. Six plates were removed because of soft-tissue irritation.

Aged↗
PubMed2003

[Fractures of the distal radius. Minimally invasive pin fixation: indications and results].

Therapy of distal radius fractures in the elderly is increasingly subject to higher demands on functional results, especially in terms of patient comfort, load-bearing, tissue atrophy, and osteoporosis. From 1 January 1998 until 30 June 1999, 215 patients with distal radius fractures were treated at our hospital. One hundred eighteen of them had follow-up examinations after an average of 33 months. Using objective criteria (X-ray and functional), results were very good in 68.9% of the cases and good in 28.6%. Under subjective criteria, too, most of the patients had very little or no complaints (68%). These results underline the need and usefulness of differentiating operative therapies according to the fracture type in the AO classification system.

Adolescent↗
PubMed2004

An evaluation of two scoring systems to predict instability in fractures of the distal radius.

BACKGROUND: Various scoring scales have been introduced in the management of patients with multiple injuries and lower extremity injuries. Two scoring systems have been introduced to predict instability in distal radius fractures. The purpose of this investigation was to evaluate the accuracy of these two models in predicting instability. METHODS: A prospective study of 105 consecutive patients sustaining unilateral closed distal radius fractures was performed. Two scoring systems--the MacKenney formula and the Adolphson formula--were used to calculate the probability of fracture instability on the basis of initial presentation and injury films. The predicted probability of instability calculated from both models was then compared with actual results of instability on the basis of specific radiographic criteria at follow-up. RESULTS: Final follow-up information was available on 80 patients. There were 44 unstable fractures and 36 stable fractures at final follow-up. Using the MacKenney formula, of the 38 fractures predicted to have a low probability of instability (Pinstability < 30%), 18 (47.4%) were found to be unstable. Using the Adolphson formula, of the 28 fractures predicted to have a low probability of instability (Pstability > 70%), 14 (50%) were actually unstable. CONCLUSION: Both scoring systems were found to underestimate the degree of fracture instability and to have a negative predictive value between 47 and 50% in a prospective series of patients. In fractures predicted to have a low probability of instability in both models, we found a poor correlation between predicted instability and actual instability. Our results demonstrate the limitations of two scoring systems in predicting fracture stability and in making clinical decisions on the basis of their results.

Adult↗
PubMed2003

MR imaging of ulnocarpal impaction after fracture of the distal radius.

OBJECTIVE: The purpose of our study was to evaluate the incidence of ulnocarpal impaction after distal radius fracture using MR imaging and to correlate imaging findings with those of radiography and clinical findings. CONCLUSION: Ulnocarpal impaction is a common finding after distal radius fracture. MR imaging can detect characteristic bone marrow changes of the lunate early after the trauma. A significant correlation exists between MR imaging findings and the extent of posttraumatic ulnar variance and pain levels.

Female↗
PubMed1993

Intrafocal (Kapandji) pinning of unstable fractures of the distal radius.

Intrafocal pinning of distal radius fractures was described first by Kapandji in 1976. The technique has been used widely in Europe but remains relatively unknown in the United States. It is indicated in unstable distal radius fractures without significant intra-articular displacement. This article provides a review of the European experience, a description of the surgical technique, and an analysis of our own clinical series. Intrafocal pinning works best in patients less than 65 years of age, for the fracture patterns described previously. It provides the surgeon with a simple and effective, minimally invasive method of improving alignment and stability of unstable fractures.

Adolescent↗
PubMed2001

Ilizarov hybrid external fixation for fractures of the distal radius: Part II. Internal fixation versus Ilizarov hybrid external fixation: Stability as assessed by cadaveric simulated motion testing.

The in vitro stability of an Ilizarov hybrid external fixator was compared with that of a dorsal 3.5-mm AO T-plate in 8 unpaired, fresh-frozen upper extremities. A specially designed testing device that used computer-controlled pneumatic actuators was used to simulate active finger, wrist, and forearm motions by applying loads to relevant tendons. A comminuted extra-articular distal radius fracture was modelled using a dorsally based wedge osteotomy. Fracture stability was assessed using an electromagnetic tracking device to measure motion across the fracture site after randomized application of the plate and the hybrid fixator. During simulated finger and wrist motions with the forearm pronated or supinated, motion of the distal fragment with the hybrid fixator applied was comparable to or statistically less than with the AO plate applied. During simulated forearm rotation, the stability provided by the 2 fixation types was similar, although the plate allowed statistically less radial-ulnar deviation of the fragment. In this model of a 2-part extra-articular distal radius fracture, the clinically meaningful stability of the Ilizarov hybrid external fixator was comparable to that of the dorsal AO plate.

Aged↗
PubMed1997

A prospective trial to compare three anaesthetic techniques used for the reduction of fractures of the distal radius.

The aim of this study was to compare prospectively haematoma blocks alone and haematoma blocks with sedation with general anaesthesia for the reduction of distal radius fractures in adult patients, with respect to pain perception before, during and after manipulation using a visual analogue scale, radiological position, waiting time, procedure time and cost. Fifty-eight adult patients with closed, displaced distal radius fractures were included in the study. Pain experienced during manipulation was greatest in patients who received haematoma blocks alone compared with the other two groups. Post-manipulation pain was significantly greater in patients who received a general anaesthetic. Radiological correction was as good in those patients receiving a haematoma block with or without sedation as a general anaesthetic. The waiting and manipulation times and resource costs were greater in those receiving a general anaesthetic. There were no complications related to any of these anaesthetic methods. Patient acceptance is greater with a correctly performed haematoma block and sedation technique compared to general anesthesia. It is also more efficient with regard to time and the resources required. This is particularly important for a progressively increasing ambulatory, elderly population who require prompt, safe, effective and painless management.

Adolescent↗
PubMed2006

Fifteen-year outcome of displaced intra-articular fractures of the distal radius.

PURPOSE: We previously reported the functional and radiographic outcomes of 21 young adults at an average of 7 years after open reduction and internal fixation of an intra-articular distal radius fracture (original study). The purpose of the current investigation was to evaluate the same cohort at an average of 15 years after surgery to evaluate the effect of additional time on both function and radiographic appearance. METHODS: We re-evaluated 16 of the original patients at an average of 15 years after surgery. Subjective assessment was performed with the Musculoskeletal Functional Assessment and the Hand Function Sort questionnaires. Objective assessment included a detailed physical examination and strength measurement. Standardized radiographs and computed tomography were used to assess wrist morphology, residual articular step and gap displacement, and the presence and degree of arthrosis. RESULTS: Subjectively patients continued to function at a high level at the last follow-up evaluation: the average Musculoskeletal Functional Assessment score was 10 and 14 of the 16 patients functioned at a high level according to the Hand Function Sort. Strength and range of motion remained essentially unchanged from the original report. Radiocarpal arthrosis was noted in 13 of the 16 wrists and joint space was reduced an additional 67% compared with the 7-year follow-up evaluation. Nonetheless there continued to be no correlation between the presence or degree of arthrosis and upper-extremity function. CONCLUSIONS: Radiocarpal arthrosis after intra-articular distal radius fractures can be expected to worsen over time. Despite joint space narrowing and evidence of advanced arthrosis, however, patients maintained a high level of function at the long-term follow-up evaluation. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic, Level II.

Activities of Daily Living↗
PubMed1997

Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography.

This study evaluated the reliability of plain radiography versus computed tomography (CT) for the measurement of small (< 5 mm) intra-articular displacements of distal radius fracture fragments. The plain radiographs and CT scans of 19 acute intra-articular distal radius fractures were used by 5 independent observers, using 2 standardized techniques, to quantify incongruity of the articular surface in a blinded and randomized fashion. Repeat measurements were performed by the same observers 2-4 weeks later, allowing determination of intraclass correlation coefficients (ICC) as a measure of intraobserver and interobserver agreement. The average maximum gap displacement on plain radiographs was 2.1 mm (range, 0.0-15.0 mm, lateral view) and on CT images was 4.9 mm (range, 0.7-17.3 mm, axial view). The average maximum step displacement on plain radiographs was 0.9 mm (range, 0.0-6.4 mm, lateral view) and on CT images was 1.2 mm (range, 0.0-6.0 mm, sagittal view). More reproducible values determining step and gap displacement were obtained when the arc method of measurement was used on CT scans (ICC values, .69-.97) as compared to the longitudinal axis method for plain radiographs (ICC values, .30-.50). For measured displacements of 2 mm or more, our data demonstrated poor correlation between measurements made on CT images and those made on plain radiographs (gap or step displacement > 2 mm, K = 0.21; step displacement > 2 mm, K = 0.21). Thirty percent of measurements from plain radiographs significantly underestimated or overestimated displacement compared to CT scan measurements. From these data, we conclude that CT scanning data, using the arc method of measurement, are more reliable for quantifying articular surface incongruities of the distal radius than are plain radiography measurements.

Fracture Healing↗
PubMed1999

[The treatment of unstable fractures of the distal radius using a bridging external fixator. Results from a long-term evaluation].

INTRODUCTION: The aim of our study was to evaluate external fixation in the treatment of unstable distal radius fractures in a long-term follow-up. METHODS: Within 8 years 174 patients with severely displaced distal radius fractures were included in a prospective study and treated with an external wrist fixator (Orthofix Srl, Italy). A total of 148 patients were reviewed with an average follow-up time of 28 months. RESULTS: Using the functional outcome score according to Gartland and Werley, we obtained 29.3 % excellent, 42.5 % good, 10.3 % fair and 2.9 % poor results; 14.9 % of the patients were not available for follow-up. Additional procedures were carried out in 54.1 % to obtain dorsal stabilization. The list of complications included two major pin-tract infections requiring surgical intervention, one pin cut out of the second metacarpal bone, one fixator dislocation, and one patient had algodystrophy. The length of the radius and joint congruity did not significantly from the situation when the fixator has been removed at the end of the treatment. CONCLUSION: The results show the importance of anatomical reduction, and especially restoration of radial length, in order to obtain good functional outcome.

Adolescent↗
PubMedDate not supplied

Stress fracture of the radius following a fracture of the ulna diaphysis.

A 70-year-old woman incurred a stress fracture of the radius following a fracture of the ulna. The patient had osteomalacia secondary to a Billroth II procedure. The primary reasons for the development of osteomalacia following a Billroth II procedure are: decreased transit time through the gut, which causes less Vitamin D and calcium absorption, and bypassing of the duodenum, where calcium absorption is highest. After treatment of the osteomalacia with calcium and Vitamin D, the fracture healed uneventfully. The present case report emphasizes the need to identify and treat diseases associated with fractures. Patients with severe osteomalacia and ulnar shaft fractures should have the forearm immobilized because motion at the fracture site may lead to a stress fracture of the radius.

Aged↗