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A small series of patients with distal radius fractures were subjected to nerve conduction studies after healing of their fractures. A large number (52%) were found to have slowing of nerve conduction across the wrist, predominantly median. The age of those who were abnormal was significantly higher than those who were normal. No other factors appeared to influence the results.
Extra-articular distal radius fractures frequently are undertreated. Results correlate directly with restoration of anatomy. Immobilization in plaster is an inferior method of preserving radial length and palmar tilt. Failure to maintain reduction with plaster can be predicted by the initial injury, if reduction is lost, closed reduction of the redisplaced fracture should be accompanied by external fixation.
This retrospective study compares 94 distal radius fractures. Sixty one women (median age 66) and 33 men (median age 42) were reviewed clinically and radiologically by a surgeon not involved in treatment. Fractures were classified into three AO groups. Standard X-rays were used for radiological evaluation. Fractures of the distal ulna were evaluated separately. Chi-square tests, Wilcoxon, Mann-Whitney and Fisher's tests were used for statistical evaluation. Women presented mainly "A" type fractures. They were treated by intramedullary pinning. Forty two fractures were grafted, using autogenous bone for young patients and bone substitute for the elderly. Twelve scapholunate dissociations were recorded, all but one were detected in women, 50 years of age or more. Four were painfree, two presented climatic pain and six claimed pain during effort; none had snapping. Radio-ulnar laxity was similar with or without styloid fractures. External fixator and autogenous grafts appeared the most efficient technique for maintaining radial length. Ulnar head fractures were related to a significant higher incidence of sympathetic dystrophy with reduced prono-supination, a correlation not previously noted to your knowledge. This suggests that radius and ulnar head fracture should be classified independently. The amount of pain was not related to classification, internal fixation or gender.
Fractures of the distal radius are common, especially in postmenopausal women, and their prevalence increases with age. Knowledge of the factors that increase the risk of fracture in this metaphyseal region would have predictive and therapeutic implications. Of particular interest in this study were (a) the relative contributions of cortical and trabecular bone to the strength of the distal radius and (b) the best radiographic features to use as strength indicators. In 21 forearms from fresh cadavera (median age at the time of death, 75 years), single photon absorptiometry and quantitative computed tomography were used to determine bone mineral content (BMC), density (BMC/W), and cross-sectional properties of the radius at distal and midshaft sites. Mechanical testing of the forearms then was used to determine the ultimate force and energy to cause the type of fracture that might be caused by a fall on the outstretched hand. Twelve of the 17 tested specimens sustained a fracture of the distal radius, and five sustained a fracture of the scaphoid. In the group of fractures of the distal radius, we found the cross-sectional area and moment of inertia of the cortical shell at the metaphyseal site to be better correlates of strength than the trabecular area and trabecular moment. In contrast, strength correlated much better with trabecular density than with cortical density. Overall, the best correlates of strength were the BMC and BMC/W at either the distal or proximal site. On balance, these results suggest that the thin cortical shell contributes substantially more to the mechanical strength of the distal radius than has been commonly appreciated.
PURPOSE: The purpose of this study was to determine the accuracy and reproducibility of intra-articular step-off and gap displacements measured on plain radiographs using a standard cadaver model. METHODS: Twenty-two physicians, in a blinded randomized fashion using a standard technique, examined the radiographs of 12 unique combinations of step and gap displacement created by a 3-part intra-articular osteotomy of the distal radius. Observer accuracy, inter- and intraobserver agreement, and tolerance limits were calculated. RESULTS: The results of this study suggest that observers, independent of skill level, may measure step-off and gap displacements accurately to within .62 +/- .53 mm (95% confidence interval = .59-65). The accuracy of measurement was influenced by the quality of the radiograph. Intraclass correlation coefficient scores showed "substantial" (.78) to "almost perfect" (.81) inter- and intraobserver agreement. CONCLUSIONS: These data can aid in the interpretation of clinical studies of acute distal radius fractures that are based on plain radiography.
A Salter-Harris Type I distal radius fracture was sustained by a skeletally immature adolescent while performing a supine bench press during weight training. Closed reduction was accomplished without difficulty. Fractures in adolescence due to weightlifting are rare but illustrate the need for proper instruction and supervision.
Sixty patients with unilateral distal radius fractures were managed conservatively. Clinical assessment included objective and subjective evaluations of the outcome of treatment. Radiographic evaluation included fracture classification using the AO/ASIF system and measurement of volar tilt, radial inclination and radial height shortening at the end of treatment. Clinical signs of carpal tunnel syndrome were confirmed electrodiagnostically in 12 patients (20%) during the recovery period. Each patient had electrodiagnostic studies of both upper limbs performed to confirm the diagnosis. The mean time between injury and the onset of symptoms was 10 months (range 6.5 weeks-27 months). A statistically significant correlation between the final clinical results of treatment and post-traumatic median nerve compression neuropathy was found, but the occurrence of the neuropathy correlated with neither fracture type nor with the final radiographic findings. No clinical signs of ulnar or radial nerve compression occurred in this study.
This article describes a 6-year study of use of volar plating in treating unstable dorsally comminuted distal radius fractures. Forty-six fractures treated with volar plating were reviewed. All cases were followed for at least 6 months; 35 were followed for more than 1 year. Fractures treated with adjunctive protruding pins were excluded. Bone graft was used in 4 cases. Anatomical results were rated excellent or good in 39 cases (85%). Subsidence occurred in 9 fractures, 4 of which malunited. Flexor pollicis longus tendon attrition occurred in 2 cases. Mean operative time was less than 1 hour (range, 30-90 minutes). Study results support continued use of volar plating in treating selected unstable dorsally displaced fractures of the distal radius. Prominent plates and sharp-edged screws may imperil deep flexor tendons and should be removed. More liberal use of bone graft and improvements in plate design should reduce complications.
This retrospective study addressed two basic questions important to hand therapists: what are the expectations of therapy vis-a-vis range of motion and strength among patients with distal radius fractures, and do patients treated by different therapists within a center experience substantially similar or dissimilar outcomes? Differences between patient groups were tested using ANOVA, and changes in performance were tested using the Student's t-test; significant differences between patient groups treated by different therapists were lacking and patients demonstrated significant changes in active motion and strength. Data were used to derive regression equations that yielded good estimates of active motion at discharge from therapy. Patients were treated an average of ten times; at discharge, they demonstrated active wrist and forearm motion compatible with the performance of activities of daily living.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
OBJECTIVE: We planned this study to evaluate the role of bone scintigraphy in patients with suspected carpal fracture and normal or suspicious radiographs following carpal injury. METHODS: Three-phase bone scintigraphy using Tc-99m-MDP was performed on 32 patients with negative radiographs but clinically suspected fracture at two weeks after the trauma. Focally increased radiopharmaceutical uptake was interpreted as a fracture. The final diagnosis was established with clinical follow-up. RESULTS: Twelve (38%) patients had a normal scan excluding fracture. Twelve patients had a single fracture. Multifocal fracture was present in 8 (25%) patients. Eight patients showed scaphoid fractures; of these three showed single scaphoid fracture, and the other five patients revealed accompanying fractures. Distal radius fractures and carpal bone fractures other than scaphoid were both observed in 12 patients. These were eleven fractures of distal radius; three fractures of pisiform; two fractures of hamate; and single fractures of lunate, trapezium and triquetrum. In one patient there was fracture of a first metacarpal bone. CONCLUSION: In patients with suspected carpal bone fracture and normal or suspicious radiographs, bone scintigraphy can be used as a reliable method to confirm or exclude the presence of a scaphoid fracture and to detect clinically unsuspected fractures of distal radius and other carpal bones.
Fractures of the distal radius are common injuries. Acceptable results typically can be obtained with appropriate surgical or nonsurgical management. However, a small percentage of these fractures can progress to symptomatic malunion, which traditionally has been treated with osteotomy of the distal radius. Proper understanding of anatomy, biomechanics, indications, and contraindications can help guide patient selection for surgery. In formulating a treatment plan, the surgeon also must consider such technical variables as the type of osteotomy, the use of bone graft or bone-graft substitute, and the means of fixation to stabilize the osteotomy. Simultaneous implementation of an ulnar-side procedure, an intra-articular osteotomy, and soft-tissue releases also may be necessary. Some cases may be more appropriate for wrist fusion or other salvage procedures.
Insertion of a dorsal fixation pin was performed in 10 patients treated for distal radius fractures associated with dorsal angulation of the distal fragment. These fractures did not improve position with direct traction. Reduction was achieved with the use of a dorsal pin, used as a lever, to correct dorsal tilt of the fracture and to reestablish anterior angulation of 10 degrees in the distal joint surface of the radius. The dorsal pin was then fixed to an external fixator bar. All of these fractures healed in good position with appropriate alignment and without complications.
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As suggested by Muller, a useful classification system for distal radius fractures must consider the severity of the bone lesion and serve as a basis for treatment and for evaluation of outcome. Although these fractures have long been considered to be Colles or Smith's fractures, they have been subjected to extensive scrutiny in order to define fracture morphology and treatment considerations. This review highlights a number of contemporary classification systems for distal radius fractures, including the systems of Older et al., the Comprehensive Classification of fractures, the Melone intra-articular classification system, and that of Fernandez.