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PubMed2004

Measurement of bowing of the radius.

Fractures and plastic deformities of the forearm are common in children. While axial deformities are easily recognised and treated, bowing of the radius may be overlooked. Physiological bowing is essential for full rotation of the forearm. We have used the method of Schemitsch and Richards to estimate the degree of bowing in 100 children who had not suffered a fracture of the forearm. The site of maximum bowing remained constant at 60.39% of the length of the radius (95% CI 59.65 to 61.14). The value of maximum bowing did not exceed 10% of the total length (mean value 7.21%; 95% CI 7.00 to 7.41). This study provides information that can be useful for the diagnosis of bowing and for the evaluation of post-traumatic deformities.

Adolescent↗
PubMed1986

[Secondary arthrosis of the wrist joint in malposition of healed and un-corrected fracture of the distal radius].

Basal fracture of the radius (traumatic manus radioflex) healed in the typical false position appreciable impairs the biomechanics of the wrist. Development of secondary arthrosis is to be feared in this condition. We report on the result of a follow-up investigation of 24 patients with a false position of the distal end of the radius requiring correction. The observation period is five to 40 years. The clinical and radiological follow-up examination shows that even highly deformed wrists can retain good mobility and remain free of pain for years. The most prominent symptoms are strain pain on ulnar side of the wrist and in the region of the distal radioulnar joint. It is less the tilting of the base of the radius which is responsible for the symptoms and for the development of the arthrosis. On the contrary, the shortening of the radius plays the major role here, causing an incongruence or even luxation of the distal radioulnar joint.

Adolescent↗
PubMed1989

[Instability of fractures of the lower end of the radius: apropos of a series of 167 cases].

One-hundred-sixty-seven consecutive cases of distal radius fracture have been treated in our department from October 1985 until November 1987. All cases were rated according to anatomical criteria defined on the first radiogram. These criteria were the presence of a dorsal tilt greater than 20 degrees, dorsal comminution, intra-articular radiocarpal involvement, an associated fracture of the ulna and comminution of the distal radius. Age greater than 60 years was also considered as a factor in determining severity. With regard to fractures treated conservatively (from which comminuted fractures were excluded), a strong correlation was found between the sum of these factors and the risk of secondary displacement. This complication occurs despite a satisfactory initial reduction. Although the surgically treated cases were more severe, significantly better radiological results were observed following surgical management. This mode of classification of distal radius fractures is helpful for determining prognosis and evaluating the risk of secondary displacement and in the course, should help in the selection, perhaps earlier of the most appropriate treatment.

Adolescent↗
PubMed1992

[Lesions of the ligaments associated with distal fractures of the radius. 58 intraoperative arthrographies].

Intracarpal ligamentous tears and fractures of the radius often have a similar mechanism. For instance, no prospective studies have defined the real incidence of such associations, which are not antagonistic. The authors performed a systematic operative wrist arthrogram during distal radius fractures in a group of 58 patients with a mean age less than 50 years. Such a population was at low risk of degenerative ligamentous tears. Triangular fibrocartilage complex was torn in two-thirds of all types fractures. Extra-articular radius fractures were associated with an intracarpal ligamentous tear in 25% and always a luno-triquetral lesion type. In contrast, intra-articular and radius styloid fractures were frequently associated with a scapho-lunate lesion.

Adolescent↗
PubMed2003

Fracture risk in people with celiac disease: a population-based cohort study.

BACKGROUND & AIMS: People with celiac disease are at risk of developing osteoporosis, but the extent of any increased fracture risk is unclear. We performed a population-based cohort study by using the General Practice Research Database to quantify the fracture risk in people with celiac disease compared with the general population. METHODS: We identified 4732 people with celiac disease, of whom 1589 were "incident" cases, and 23,620 age- and sex-matched control subjects. We used Cox regression to estimate the hazard ratios for any fracture, hip fracture, and ulna or radius fracture in the celiac disease cohort compared with the general population. RESULTS: In the incident subjects with celiac disease, the mean age at diagnosis was 44 years, and 67% were women. The overall hazard ratio for any fracture was 1.30 (95% confidence interval, 1.16-1.46), for hip fracture was 1.90 (95% confidence interval, 1.20-3.02), and for ulna or radius fracture was 1.77 (95% confidence interval, 1.35-2.34). The absolute difference in the overall fracture rate was 3.20 per 1000 person-years and for hip fracture it was 0.97 per 1000 person-years in those older than 45 years. In 1589 incident subjects, the excess fracture risk was slightly lower compared with the "prevalent" subjects (hazard ratio for any fracture, 1.19 vs. 1.40, respectively). CONCLUSIONS: There were small increases in both the absolute and relative fracture risks in people with celiac disease; the excess risks were slightly lower in those with a more recent diagnosis. Our data indicate that concerns regarding a markedly increased fracture risk in celiac disease are unwarranted.

Adolescent↗
PubMed2007

A comparison between subjective outcome score and moderate radial shortening following a fractured distal radius in patients of mean age 69 years.

Radial shortening has been associated with a poor functional outcome following a fractured distal radius. This paper reports the results of evaluation by the patient rated wrist evaluation (PRWE) score of 60 patients (mean age 69) who underwent closed reduction and K-wire fixation of distal radial fractures. In this patient group, no association was found between moderate radial shortening, either at injury or fracture union, and this subjective outcome score. A significant association was found between the assessment of these fractures by the Frykman classification and the PRWE score (P=0.01).

Aged↗
PubMed2005

Dorsal double-plate fixation of the distal radius.

OBJECTIVE: Restoration of the intra- and extraarticular anatomy of the distal radius. Stable internal fixation of fragments, with the possibility of early functional rehabilitation. INDICATIONS: Distal intraarticular radius fractures with impacted articular fragments and displaced dorsoulnar fragment. Distal intraarticular radius fractures with bony or ligamentous injury of the proximal carpal row. CONTRAINDICATIONS: General medical contraindications for surgical intervention. Distal radius fractures with palmar tilt of the distal fragment. SURGICAL TECHNIQUE: Dorsal longitudinal incision. Approach to the intermediate column via the third extensor compartment by detaching the extensor pollicis longus (EPL) tendon. Arthrotomy and revision of the proximal carpal row. Reconstruction of the radiocarpal articular surface and support with a plate applied to the dorsoulnar aspect. Approach to the radial column by subcutaneous preparation between skin flaps (cave: superficial branch of the radial nerve) and retinaculum, incision of the first extensor compartment and support of the radial column with a preshaped plate, which is pushed through under the tendons of the first compartment. Cancellous bone grafting is usually not necessary. Subcutaneous displacement of the EPL tendon with the aid of a small retinacular flap. MANAGEMENT RESULTS: Application of a removable velcro cuff. Immediate functional postoperative physiotherapy, without the cuff. No straining or forcing until first radiographic examination at 6 weeks after the operation. RESULTS: 25 consecutive patients were monitored following a double-plate fixation, with a minimum follow-up of 12 months. In all cases the reduction, in accordance with the Stewart Score, was very good, a loss of reduction was not observed. The range of motion was between 100 degrees and 160 degrees for flexion/extension and between 160 degrees und 180 degrees for pronation/supination. The average DASH Score was 7.2 points, the PRWE Score 8.0 points. No relevant loss of strength (JAMAR dynamometer) was found in any of the patients in comparison with the healthy side. Complications noted were a muscle adhesion in the region of the first extensor compartment as well as a mild reflex sympathetic dystrophy, which healed without consequences. Implants were removed from six of the patients.

Adolescent↗
PubMed2003

Scaphoid and pronator fat stripes are unreliable soft tissue signs in the detection of radiographically occult fractures.

AIM: To determine the clinical value of scaphoid and pronator fat stripes in identifying occult underlying scaphoid and distal radius fractures, respectively. MATERIALS AND METHODS: In our department, all patients with clinically suspected scaphoid fractures and normal scaphoid series of radiographs undergo magnetic resonance imaging (MRI) of the wrist. We selected 50 cases with unequivocal MRI evidence of scaphoid fracture, 50 cases with distal radius fracture and 50 cases with no MRI evidence of bony injury. All 150 initial plain radiographs were examined retrospectively in random order without knowledge of the MRI findings and the scaphoid and pronator fat stripes scrutinized. RESULTS: The scaphoid fat stripe was abnormal in only 25 cases (50%) with confirmed scaphoid fracture on MRI. The pronator fat stripe was abnormal in 13 cases (26%) with confirmed distal radius fracture. In the 50 cases with no MRI evidence of bony injury, the scaphoid fat stripe and pronator fat stripe were abnormal in 25 (50%) and 15 (30%) cases, respectively. The sensitivity and specificity for an abnormal scaphoid fat stripe was 50%. The sensitivity and specificity for an abnormal pronator fat stripe was 26 and 70%, respectively. CONCLUSION: Scaphoid and pronator fat stripes are poor predictors of the presence or absence of underlying occult fractures.

Adipose Tissue↗
PubMed2005

[Fracture of the distal radius].

Distal fracture of the radius is an injury to a complex joint that is comprised functionally of four partial joints and makes it possible for the hand to move in all directions. The injuries to bone and cartilage and to the stabilizing ligamentous structures and the surrounding soft tissue vary as functions of the impact responsible, the mechanism of injury, and any previous illnesses. The objectives of treatment are restoration of pain-free, unrestricted and lasting function of the wrist and lower arm and avoidance of the typical complications. Stable fractures are treated by conservative means, while unstable fractures with fragmentation are realigned in a closed procedure and then stabilized by internal or external fixation. In the case of fractures in bones affected by osteoporosis it is usually not necessary to make good a metaphyseal defect when specially adapted fixed-angle plates are used. Complex intraarticular AO type C3 fractures with multiple fragments frequently require a two-step procedure with primary closed realignment, an external fixator spanning the joint, and subsequent extensive diagnostic examinations to ascertain any concomitant injuries and allow a decision on the definitive treatment that is most suitable for the type of injury present.

Fracture Fixation↗
PubMed2006

[Fracture of the distal radius].

Distal fracture of the radius is an injury to a complex joint that is comprised functionally of four partial joints and makes it possible for the hand to move in all directions. The injuries to bone and cartilage and to the stabilizing ligamentous structures and the surrounding soft tissue vary as functions of the impact responsible the mechanism of injury, and any previous illnesses. The objectives of treatment are restoration of pain-free, unrestricted and lasting function of the wrist and lower arm and avoidance of the typical complications. Stable fractures are treated by conservative means, while unstable fractures with fragmentation are realigned in a closed procedure and then stabilized by internal or external fixation. In the case of fractures in bones affected by osteoporosis it is usually not necessary to make good a metaphyseal defect when specially adapted fixed-angel plates are used. Complex intraarticular AO type C3 fractures with multiple fragments frequently require a two-step procedure with primary closed realignment, an external fixator spanning the joint, and subsequent extensive diagnostic examinations to ascertain any concomitant injuries and allow a decision on the definitive treatment that is most suitable for the type of injury present.

Adolescent↗
PubMed1989

[Fractures of the radius neck associated with ulna fractures in children].

The author has described one of the typical combinations of injuries in the elbow joint area in children, i.e. fractures of the neck of the radius with a simultaneous fracture of the ulna. The study is based on 37 cases observed by the author. Two types of the above-mentioned fractures have been distinguished: abduction (32) and extension (5) fractures. The methods of closed reposition of each type have been presented. These methods allow to reach the desired results even in major dislocations (60-90 degrees) of the head of the radius.

Adolescent↗
PubMed1997

[Scapholunar ligament injuries in acute wrist trauma. Arthroscopic diagnosis and minimally invasive surgery].

The final result of the treatment of distal intraarticular radius fractures depends both on the accuracy of the fracture reduction and on the presence or absence of additional carpal injuries. In particular, lesions of the intrinsic ligaments usually cause severe degenerative damage of the wrist joint if they are missed primarily. With the introduction of wrist arthroscopy these tears can be evaluated and treated earlier. Since 1993 arthroscopically assisted treatment has been performed in 23 patients with distal intraarticular fractures of the radius (mainly C fractures according to the AO classification system or group VII and VIII fractures according to Frykman). SL tears have been found in 11 patients (47.8%), 7 of whom showed marked instability and were stabilised at the time of surgery.

Adolescent↗
PubMed2003

Oblique shear fractures of the lunate.

Traumatic fractures of the lunate are rare. This article presents two patients who had displaced oblique lunate fractures and distal radius fractures. Both fractures achieved union; however, transient avascular necrosis occurred in the proximal healing of one patient.

Adult↗