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PubMedDate not supplied

Three epiphyseal fractures (distal radius and ulna and proximal radius) and a diaphyseal ulnar fracture in a seven-year-old child's forearm.

SUMMARY: The authors report a rare case of fracture separations at both ends of the radius combined with an epiphyseal and diaphyseal fracture of the ipsilateral ulna. A seven-year-old girl fell one story and sustained a closed injury of her forearm. A closed reduction was unsuccessful, and an open reduction was performed with three of the four fractures being secured with Kirschner wires. These wires were removed one month later, and range-of-motion exercises were started. Thirty months after surgery, both forearms were equal in length, although the proximal radial epiphyseal line appeared partially closed. Joint motions, including forearm rotation, were normal. Radiologically, the ulnar diaphysis and the radial neck were posteriorly convex 20 degrees and 18 degrees, respectively.

Child↗
PubMed1999

[Results of corrective osteotomy of malunited extension fractures of the radius at the usual site].

BACKGROUND: There is an increasing interest in the corrective osteotomy for the malunited distal radius fracture. Already in the seventies we developed an operative technique for the correction of the malunited Colles' fracture. The technique is based on a special plate, which facilitates precise restoration of the angulation of the joint surface and the length of the radius. The purpose of our study is to investigate the results of our method and to compare them with results in the literature. PATIENTS AND METHODS: We examined retrospectively the patients with a malunited Colles' fracture corrected by our technique until August 1996. The investigated criteria were range of motion, grip strength, pain relief, and X-ray findings. RESULTS: Until August 1996, we have performed 124 corrective osteotomies for malunited Colles' fractures; 115 were carried out by our technique; 91 of them could be examined. The mean follow-up time was 4.5 years. The range of motion has improved in all planes, especially for flexion. Grip strength increased but still remained below the level of the opposite side. On X-ray, average dorsal tilt of the radiocarpal joint was 24 degrees preoperatively and was reduced to an almost normal palmar tilt of 7 degrees. Ulnar-plus variance was reduced from 6 mm to less than 1 mm. CONCLUSION: Corrective osteotomy of the distal radius is of great benefit and leads to improved hand function and diminished pain. The use of our special plate facilitates this ambitious operation considerably.

Adult↗
PubMed1995

Results of combined internal and external fixation for the treatment of severe AO-C3 fractures of the distal radius.

Combined internal and external fixation for distal radius fractures has been previously reported, but the indications, technique, and results are not defined. This study reviews an experience with a specific surgical strategy for the treatment of a homogeneous population of AO-C3 fractures of the distal radius. The technique is composed of combined palmar and dorsal surgical approaches for open reduction and internal fixation of fracture fragments after neutralizing the wrist with a rigid external fixator. Thirteen fractures in 12 patients were followed an average of 27 months. Wrist motion averaged 60 degrees of flexion and 45 degrees of extension. The injured extremities had a mean grip strength that was 83% of the uninjured side. Follow-up x-ray films showed a dorsal tilt of 1 degree, radial inclination of 18 degrees, and radial length of 12 mm. Using the rating system of Green and O'Brien, the results were excellent or good in 10 wrists. The results indicate that this surgical strategy, though technically demanding, can be successfully used in this specific subset of difficult to treat distal radius fractures.

Adult↗
PubMed2001

[Primary arthroscopic treatment of TFCC tears in fractures of the distal radius].

The primary simultaneous diagnosis and therapy of TFCC tears in distal radius fractures is still the exception. We present our results of arthroscopic treatment of these injuries. From January 1998 until September 1999, we treated 21 patients with a type C fracture (AO classification) of the distal radius and one patient with a scaphoid fracture and TFCC tears. The Palmer 1A (n = 5) and 1 C (n = 4) tears have been arthroscopically shaved as well as the meniscal tear (n = 1). The Palmer 1B tears were refixed either in an outside-inside technique (n = 6) or in a new all-inside technique (n = 6). Palmer 1D tears were refixed in the Fellinger technique (n = 5). In the clinical follow-up examination six to fifteen months later, we saw symptoms of ulnar-sided wrist pain only in one case of a Palmer 1B tear treated in an outside-inside technique. Especially the patients treated by the new all-inside technique were free from symptoms of TFCC instability. We conclude, that arthroscopic treatment of TFCC tears in acute radius fractures is possible with good results. The new technique of all-inside repair is minimally invasive and shows good results.

Adolescent↗
PubMed1985

[Compression/flexion fractures of the radius base (Smith fractures)].

Out of 416 Colles-fractures we observed 18 of the Smith-type. The Smith fracture is a rare injury, it will generally occur in consequence of a fall on the supinated hand which is forced in pronation. The dislocation of the carpus and peripheral fragment is in the volar and proximal direction. It should be treated operatively, especially in intraarticular fractures. Surgical treatment of patients will result in better movability of he wrist and intact distal joint surfaces.

Adult↗
PubMed2000

Acute fractures of the distal radius.

Distal radius fractures commonly are sustained by athletes during competition. Typically, these are high energy injuries with severe displacement, metaphyseal comminution, and articular surface disruption. Each fracture is distinguished by its degree of articular displacement, stability, and reducibility. Management is contingent on recognition of the variable magnitude of articular disruption and skillful treatment based on specific fracture configuration.

Athletic Injuries↗
PubMed2003

Biomechanical evaluation of plate osteosynthesis for AO type C2 fracture of the distal radius--a cadaver study.

An AO type C2 distal radius fracture was simulated in a cadaver model by creating a metaphyseal defect of 5 mm and an intra-articular defect of 2 mm. Five different methods of plate osteosynthesis were tested biomechanically in each of six fresh cadaveric hands. Biomechanical testing suggested that cement augmented plating plus screws in the distal fragment was the strongest. Dorsal and volar plating plus screws on both sides of the distal fragment had the same effect of restoring stiffness and load transmission pattern as fixation with double plating plus volar screws alone. Fixation with plating plus dorsal screws was significantly weaker than these three methods, and double buttress plating with no screws in the distal fragments was the weakest.

Analysis of Variance↗
PubMed2003

[Dorsal double plating for fractures of the distal radius--a biomechanical concept and clinical experience].

This article describes the anatomical and biomechanical rationale for stable internal fixation of distal radius fractures using a dorsal approach. The three column biomechanical model is illustrated. Advances in the understanding of the anatomy, the biomechanical model of the three columns and our clinical experience with dorsal double plating have lead to the development of a new set of precontoured 2.4 mm Titanium plates with the option for head locking screws.

Biomechanical Phenomena↗
PubMed2001

[Interest in wrist arthroscopy for treatment of articular fractures of the distal radius: report of 27 cases].

We report our results of treatment of intra articular distal radius fracture assisted by wrist arthroscopy. Twenty six patients (15 men and 11 women) were treated using this technique. All the patients were operated on under regional anaesthesia, the elbow flexed to 90 degrees, and in-line traction applied using "Japanese" fingers traps (4 to 6 kgs). After articular cleansing, reduction under arthroscopic and fluoroscopic control was carried out using K-wires. All fractures were intra articular and in four cases of fractures with four fragments, it was necessary to combine a volar plate with the K-wires. There were 21 associated ligament injuries (seven TFCC tears, four lunotriquetral ligament injuries and ten scapholunate injuries of which four necessitated pinning). Our average follow-up time was 16 months (6-26 months). There was absence of pain in 23 cases and the results were good for wrist motion and strength. We did not experienced any severe secondary displacement. Eighteen excellent, seven good results and one average result were obtained. The quality of these functional and anatomical results seems to be directly linked to the quality of reduction obtained under arthroscopy and the quality of internal fixation carried out under traction.

Adult↗
PubMed2002

Open fractures of the distal radius.

A review of 18 patients treated at our institution for open distal radius fractures was performed. The patients were followed up for an average of 32 months (range, 12 months to 5.3 years). Wounds were classified according to Gustilo and Anderson with 9 type I (50%), 3 type II (17%), and 6 type III (34%) (3 IIIa, 2 IIIb, 1 IIIc) injuries. Seven patients underwent a total of 2 to 4 procedures to treat their injuries, and 3 patients required 5 or more procedures. Eleven (61%) patients had postoperative complications. Patients were evaluated with the Disabilities of the Arm, Shoulder, and Hand questionnaire and scored an average of 33. Wound severity was associated with an increased number of postoperative complications (p =.012), an increased number of complications per patient (p =.015), a higher number of surgical procedures (p =.003), a decreased average range of motion (p =.235), and fair or poor results at the latest follow-up (p =.03). Although type I injuries may be similar to their closed counterparts, patients with type III injuries experienced a much greater number of initial complications and had worse long-term clinical outcomes.

Adolescent↗
PubMed1988

[Radiologic diagnosis following compound fracture of the distal radius with special reference to computed tomography].

After complicated distal radius fractures with persistent symptoms, a variety of radiological methods may be indicated, including plain films, magnification views, examination under stress and arthrography. CT accurately differentiates abnormalities of the distal radio-ulnar joint and aids in deciding on surgical treatment. Demonstration of degenerative changes and of subluxations is much more satisfactory in the third plane, since there is no superimposition.

Elbow Joint↗
PubMed2006

Arthroscopic management of volar lunate facet fractures of the distal radius.

The clinical outcome of an intraarticular distal radius fracture is generally thought to be associated with the following factors: amount of radial deformity, joint congruity, and associated soft-tissue injuries. The proposed technique to manage this fracture pattern that involves a displaced volar lunate facet fragment uses wrist arthroscopy and pinning. Distraction of the fracture before arthroscopy is accomplished either by external fixation or by the arthroscopy tower. A freer elevator is introduced dorsally to disimpact the fragments, and next, a nerve hook is used to reduce the volar lunate facet, which is subsequently pinned to the radial styloid. The remaining fragments are reduced with interfragmentary pin fixation, and this anatomical articular construct is fixed to the radial metaphysis. The advantages of this technique are: (a) accurate assessment of articular congruency by direct visualization, (b) identification and repair of associated lesions, and (c) minimal soft tissue disruption. Potential disadvantages of external fixation supplemented by interfragmentary pins may be that it does not provide for rigid stable fixation, and therefore, does not allow for early motion compared to open reduction and internal fixation. Furthermore, it is technically challenging, and is therefore suggested as an alternative for the aforementioned fracture pattern.

Arthroscopy↗
PubMed1994

[Surgical treatment of fractures of the distal radius--a closed therapy concept. Initial results with the bowl osteosynthesis].

We present our treatment strategy for distal radius fractures, based on intrafocal pinning (Kapandji) and further combination with a palmar plate resulting in bowl osteosynthesis (Nonnenmacher). Even with a changing surgical team, we got more than 80% good results and rapid revalidation. We thus favor dynamic minimal osteosynthesis close to the fracture physiopathology. Indication for external fixation becomes limited to open or comminutive fractures.

Adolescent↗
PubMed2002

Modified Desmanet's intramedullary pinning for fractures of the distal radius.

The purpose of this article is to present the results of Desmanet's intramedullary pinning for distal radius fractures, and also to present modifications of the cut-end management of pins; the cut-ends were shaped like a tear-drop for the radial pin and like a curtain-hook for the ulnar pin. One hundred and two operated patients (23 men and 79 women; mean age at operation, 61.0 +/- 17.5 years) were followed up for 9.6 +/- 12.9 months. The clinical results were satisfactory according to the demerit point system of Saito; 83 were assessed as excellent and 19, as good. On the X-ray measurements, the mean values for radial inclination angle, volar tilting angle, and ulnar variance were 23.5 degrees +/- 5.1 degrees, 8.8 degrees +/- 7.1 degrees, and 1.0 +/- 1.6 mm, respectively. Eighty-three patients (81.4%) showed no deformities. The results of 23 aged patients (older than 75 years) were also satisfactory, and this method thus appears to be a good choice for aged patients with osteoporosis. Modifications of the cut-ends of pins reduced the extensor tendon complications that occur with Desmanet's original method. The present method is also good for extra-articular Colles' fracture. Concerning intraarticular Colles' fractures, the undisplaced type and the ulnar split type are good indications for this method. This method can also be used for the dorsal split depression type, but the ulnodorsal split type is not a good indication.

Adolescent↗
PubMedDate not supplied

Management of fractures of the distal radius: surgeon's perspective.

The new millennium represents a time for expanding our present knowledge of the treatment of distal radius fractures, based on the foundation of information that has been gathered over the past century. Treatment-oriented classifications have replaced the prior generalization applied to all "Colles fractures" and have directed preoperative planning. Newer external fixation frames, improved surgical technique, and superior instrumentation allow for safer reproducible ligamentotaxis. These current concepts of treatment along with a comprehensive therapy plan have provided the basis for enhanced recovery from these challenging injuries.

Bone Nails↗