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At least 667 records · Page 37Linked to original sources
PubMed2006

Underutilization of antiosteoporotic drugs by orthopedic surgeons for prevention of a secondary osteoporotic fracture.

BACKGROUND: Despite the availability of effective treatment and well-publicized treatment guidelines for preventing osteoporotic fractures, there are significant gaps in implementing the recommendations, and it is unknown how many patients are treated for prevention of secondary osteoporotic fractures. In this study, we investigate what percentage of osteoporosis patients were treated with antiosteoporotic drugs after osteoporotic fractures of the hip, wrist, and proximal humerus, and we discuss here the need for improvement in the treatment of osteoporosis following fracture. METHODS: We studied 422 patients with osteoporotic fractures, 91 men and 331 women, with an average age of 77.1 years (range, 52-102 years). The 422 cases consisted of 299 hip fractures, 97 distal radius fractures, and 26 proximal humerus fractures. All patients underwent surgical intervention. The variables were examined to ascertain whether osteoporosis patients were medicated with antiosteoporotic drugs at postfracture. RESULTS: Fifty-five (13%) of the 422 patients received antiosteoporotic medication at postfracture. Pharmaceutical treatment was given in 44 cases (14.7%) of hip fractures, 8 cases (8.2%) of distal radius fractures, and 3 cases (11.5%) of proximal humerus fractures. Thirty-one (7.3% of total) of the 55 patients were taking the same medication pre- and postfracture. Seven (1.7%) of the 55 were administered a different drug compared to before the fracture, and 17 (4%) started to take an antiosteoporotic drug for the first time subsequent to the fracture. CONCLUSIONS: The present rate of treatment is insufficient given the high risk of secondary fractures and the availability of appropriate drugs that would reduce that risk.

Aged↗
PubMed1992

[Results of a volar approach to plate osteosynthesis of radius shaft fractures. Theoretical basis--clinical results].

This retrospective study analyses the results of 80 shaft fractures of the radius treated by open reduction and plating by a volar approach. Studies about strain distribution on the radius shaft worked out a varying pattern of tensile forces and a continuously change of the tension bend side through full range of motion. So from the biomechanical aspect an ideal position for compression plating is not determined and dorsal or volar plating brings the same stability. The advantage of the volar approach by Henry is the possibility of an easy extension of the approach to the distal or proximal part of the forearm and an optimal covering of the plate by soft tissue. To expose the superficial radial nerve is obligate, if necessary the deep radial nerve should be exposed too in proximal fractures. From 1973 to 1987 80 fractures of the shaft of the radius were treated by plating using the volar approach, since 1977 3.5 dynamic compression plate of the AO was used exclusively. Only two non-unions occurred in the beginning when the AO's third tube plate was used routinely. One massive callus formation had to be noticed with a complete loss of pronation and supination. One infection occurred, but normal wound healing and bone union could be achieved after early reoperation. Two incomplete lesions of the superficial radial nerve were seen, but normal sensibility occurred spontaneously. No other neural or vascular complication had to be noticed using this approach. In the follow-up 56 patients were seen two to 14 years postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1980

[Surgical treatment results in radius head fractures (author's transl)].

The operative treatment of radius head fractures represents only one method. Indication for surgical treatment and the method (resection or reconstruction of the radius head) is elucidated based on 30 surgically treated radius head fractures. Postsurgical examinations show better results for the reconstruction method in the limitation of movement and post-traumatic arthrosis than the resection, even though the difference between them shows no significance regarding the small number of cases. Cubitus valgus or changes on the distal radioulnar joint after resection were not found. If there is indication for surgical treatment of a radius head fracture, one should consider using the reconstruction method first.

Adolescent↗
PubMed1991

[The external fixator in unstable fractures of the distal end of the radius. Current literature review].

A recent review of the literature concerns instability of distal radius fractures and their treatment by external fixation. Redisplacement of distal radius fractures most often occurs chronically, and the severity can be predicted by initial deformity, axial shortening and dorsal comminution of the radius. The need for an anatomical reduction of these fractures is emphasized by different clinical and biomechanical studies. For many authors, external fixation provides good to excellent results in more than 75% of cases, both clinically and anatomically. Most of the complications are benign and do not affect long-term results. This study also discusses the different techniques and the best indications for external fixation.

External Fixators↗
PubMed2006

Biomechanical stability of a fixed-angle volar plate versus fragment-specific fixation system: cyclic testing in a C2-type distal radius cadaver fracture model.

PURPOSE: To compare the biomechanical stability of 2 recently introduced fixation systems in an intra-articular, dorsal comminution distal radius fracture model. METHODS: AO/ASIF type C2 fractures were simulated in 10 matched pairs of fresh-frozen cadaveric arms randomized between fixed-angle volar plate and fragment-specific fixation systems. Specimens were loaded in extension cyclically for 2,000 repetitions followed by a single cycle to failure. Initial, intermediate, and final stiffness values and failure load values were obtained and compared. RESULTS: Both systems were able to sustain physiologic cyclic loading. The fragment-specific system was significantly stiffer than the fixed-angle volar plate system for the ulnar segment in both the precycle and postcycle values. No other comparisons were significant with respect to stiffness. No significant difference in load to failure was found between the systems with respect to ulnar, radial, or overall fragment displacement. CONCLUSIONS: Both fixed-angle volar plate and fragment-specific fixation systems performed comparably in a simulated early postoperative motion protocol. Fragment-specific fixation had improved stiffness characteristics only with respect to the smaller ulnar-sided fragment.

Aged↗
PubMed1982

Simultaneous fracture of the scaphoid and radius in a child.

A 15-year-old boy sustained an ipsilateral scaphoid and radius fracture, a combination of injuries that has only received brief mention in previous reports. Closed reduction and cast immobilization produced a satisfactory result. The distal radius injury was a comminuted fracture with a vertical component that extended to the physis without involvement of the epiphysis. The mechanism of injury may have been a severe impact delivered to the base of the hand with the wrist fixed in dorsiflexion, a force that would make a distal radial epiphyseal fracture unlikely.

Adolescent↗
PubMed1997

Surgical Correction of Malunited Fractures of the Distal Radius.

Malunion of a distal radius fracture may result in functional limitation and pain. Reestablishing the geometry of the metaphysis and the alignment of the articular surface, restoring the relationship at the distal radioulnar joint, and respecting the soft-tissue envelope are elements of a successful reconstruction. The author describes a systematic approach to evaluation and treatment, including the indications for surgical correction, techniques of reconstruction, and potential complications. Salient aspects of postsurgical rehabilitation and salvage procedures are discussed.

Journal Article↗
PubMed2006

[What advantages does volar plate fixation have over K-wire fixation for distal radius extension fractures in the elderly?].

PURPOSE: The purpose of this retrospective study was to compare the outcome of open reduction and internal fixation (ORIF) followed immediately by physiotherapy and of percutaneous K-wire-fixation and casting for unstable distal radius fractures in elderly patients, considering the results both in general, for all such fractures, and selectively for A3 and C2 fractures. METHODS: Follow-up examinations were performed 26 (18-48) months after surgery in 43 patients (median age 67 (60-83) years) treated with K-wire fixation and 9 (5-17) months after surgery in 46 patients (median age 76 (60-90) years) treated with ORIF, and the outcome of each was recorded as Disabilities of the Arm, Shoulder and Hand (DASH), Gartland-Werley and Castaing scores; the radiological loss of correction was also assessed. Statistical analysis was performed first without reference to the specific type of fracture for the K-wire- and the total ORIF -groups, and then selectively for A3 and C2 -fractures only; in the second analysis the patients were divided into three groups: KD, ORIF with and ORIF without angular stability. RESULTS: The Garland-Werley and Castaing scores do not indicate any significant difference between the procedures specified. According to the Garland-Werley score 37 patients (86%) treated by K-wire fixation and 39 (85%) treated by ORIF achieved "excellent" and "good" results; according to the Castaing score there were 33 (77%) "good" results after K-wire fixation and 34 (74%) good results after ORIF. The radiological loss of correction (K-wire fixation/ORIF) as measured by the radial inclination (median 2/2.5 degrees), the palmar tilt (median 3/5 degrees) and the radial shortening (median 1/1 degrees mm) do not differ significantly. Suboptimal radiological results do not always correlate with results that are only "fair" or "poor". The non-fracture-specific DASH score suggests a higher degree of patient satisfaction after K-wire fixation (7 [0-87] points) than after ORIF (17 [0-82] points), which is not confirmed by fracture-specific evaluation. There is a significantly earlier return to the "activities of daily living" (4 as against 8 weeks) after ORIF. CONCLUSION: All the treatments compared are suitable for the treatment of A3 and C2 fractures. The important advantages of ORIF are the early functional physiotherapy without casting and without obligatory second surgery and the earlier return to "activities of daily living", which are all of decisive importance for older patients, who are the ones most frequently affected.

Aged↗
PubMedDate not supplied

Effect of early mobilisation on grip strength, pinch strength and work of hand muscles in cases of closed diaphyseal fracture radius-ulna treated with dynamic compression plating.

AIMS: The purpose of the study was to objectively determine the effects of early mobilisation in terms of grip strength and work of hand muscles in cases of closed diaphyseal fracture radius - ulna treated with dynamic compression plating. SUBJECTS AND METHODS: Fifty normal subjects and Twenty-one patients, (Eleven patients treated with early active and resistive goal directed mobilisation and Ten control group) were assessed for pinch strength and grip strength on Pinch Dynamometer and Jamar Dynamometer and work of hand muscles on Ergograph. Standardised positions of the equipments and patients were maintained throughout the study. RESULTS: Results showed highly significant reduction in performance in patients treated with early mobilisation as compared to normal subjects in their first assessment (Fourth week post operatively). These patients showed significant improvement in successive assessments (sixth & eighth post operative week) on exercising in between these assessments. CONCLUSIONS: There are significant effects on grip strength and work of hand muscles in patients treated with that early active and resistive goal directed mobilisation.

Adult↗
PubMed1996

Dynamic external fixation versus non-operative treatment of severe distal radial fractures.

Severe distal radius fractures often lead to impairment of wrist function, particularly in younger patients. This paper reports 55 consecutive patients younger than 65 years with displaced intra-articular fractures of the distal radius. Twenty-nine were treated with dynamic external fixation, and 26 with closed reduction and plaster cast immobilization. At least 1 year after the injury the anatomical and functional results were assessed using the scoring system of Lidstrom. In a retrospective analysis, both the anatomical and functional end score were significantly better in the dynamic external fixation group than in the group treated non-operatively (0.02 P < 0.05 using chi 2 analysis with Yates' correction). We conclude that dynamic external fixation is a good alternative for non-operative treatment in younger patients with severe distal radial fractures. Prospective evaluation of this subject is necessary.

External Fixators↗
PubMed1994

[Carpal instability associated with fracture in distal radius].

Among 197 fractures in distal radius, 65 fractures were found accompanied with carpal instability, with an incidence of 32.9 percent. Six patterns of the instability were observed, in which dorsiflexion instability and scapholunate dissociation were predominant. The occurrence and patterns of instability were related to the types of the fractures, curve and palmar tilt angle of the distal radial articular surface. 64.9 percent of the instability was corrected during reduction of the fracture, but 35.1 percent remained. Compared with the fractures without carpal instability, functions of the wrists were worse in the fractures with the instability. The pathogenesis of these injuries and clinical significance of this study were discussed.

Adolescent↗
PubMed2006

Volar fixed-angle plating of distal radius extension fractures: influence of plate position on secondary loss of reduction--a biomechanic study in a cadaveric model.

PURPOSE: Treatment of extension fractures of the distal radius with volar fixed-angle plates has become increasingly popular in the past 2 years. It has been observed clinically that placement of the distal screws as close as possible to the subchondral zone is crucial to maintain radial length after surgery. The purposes of this study were (1) to evaluate radial shortening after plating with regard to plate position and (2) to evaluate whether plate position has an influence on the strength and rigidity of the plate-screw construct. METHODS: An extra-articular fracture (AO classification, A3) was created in 7 pairs of fresh-frozen human cadaver radiuses. The radiuses then were plated with a volar distal radius locking compression plate. Seven plates were applied subchondrally; 7 plates were applied 4.5 mm to 7.5 mm proximal to the subchondral zone. The specimens were loaded with 800-N loads for 2,000 cycles to evaluate radial shortening in the 2 groups. Each specimen then was loaded to failure. RESULTS: Radial shortening was significantly greater when the distal screws were placed proximal to the subchondral zone. The amount of shortening after cyclic loading correlated significantly with the distance the distal screws were placed from the subchondral zone. Rigidity of the plate systems was significantly higher in radiuses in which the distal screws were placed close to the subchondral zone. CONCLUSIONS: To maintain radial length after volar fixed-angle plating, placement of the distal screws as subchondral as possible is essential. The subchondral plate-screw-bone constructs showed significantly greater rigidity, indicating higher resistance to postoperative loads and displacement forces.

Aged↗
PubMed2007

[Comparison of C-arm CT and standard imaging in osteosyntheses of fractured distal radius specimens].

BACKGROUND: The purpose of this study was to evaluate the value of C-arm CT imaging of the distal radius with standard patient positioning in intraoperative assessment of plate osteosynthesis. MATERIALS AND METHODS: Four complete distal radius specimens from human cadavers were fractured (type C), and internal fixation with palmar plates (stainless steel) was then carried out in each. On the basis of C-arm fluoroscopy, radiography and C-arm CT (Siremobil Iso-C3D, scans with forearm bones positioned parallel to the z-axis), 19 observers subsequently evaluated the positions of screws near the joint and any steps within the joint, after which the bones were surgically exposed and the imaging results checked against direct visual observations. RESULTS: No statistically significant differences were detected either between the modalities or between the evaluator groups. CONCLUSION: With standard patient positioning, the performance of C-arm CT was equivalent to and not better than that of current standard procedures, i.e. intraoperative fluoroscopy and postoperative radiography. Further studies should examine whether this holds true in clinical practice with representative patient collectives when titanium implants are used and/or optimized patient positioning is practised.

Cadaver↗
PubMed1992

Fractures of the forearm resulting from low-velocity gunshot wounds.

Thirty-seven extraarticular fractures of the forearm resulting from low-velocity gunshot injuries were treated by cast immobilization or open reduction and internal fixation with dynamic compression plates. All patients received 72 h of intravenous antibiotics. There were 14 isolated ulna fractures, 17 isolated radius fractures, and six both-bone (radius and ulna) fractures. Cast immobilization was used in 22 of 23 nondisplaced or minimally displaced fractures and eight of 14 displaced fractures. The remaining seven fractures were treated by open reduction and internal fixation. All fractures united within 16 weeks of injury regardless of the method of treatment. Poor clinical results related to the fracture occurred in six patients, five of whom were treated by cast immobilization. Fourteen patients had nerve palsies; eight resolved spontaneously and six had permanent neurologic deficits. There were two compartment syndromes and one ulnar artery transection. There were no infections. We conclude that displaced fractures of the radius, and both bone fractures, are best treated by open reduction and internal fixation. All patients should be closely monitored for 24 h for compartment syndrome, regardless of the fracture type or pattern. Early dynamic splinting is important when associated nerve injuries are present.

Academic Medical Centers↗