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Results of treatment of 19 children with radial neck fracture and 1 with head fracture have been presented. In the group of 12 children managed with an open reduction 50% results were poor. In all children treated conservatively good results have been achieved. The technique for percutaneous reduction of the fracture with the use of Kirschner wires has been discussed.
Fractures of the radius and ulna are common in the dog and cat. If treated inappropriately, complications may result. These include delayed union, nonunion, malunion, and growth deformities. ESF is a versatile method of fixation for fractures of the radius and ulna. Types that are applicable range from the simple type I to the complex type III fixator. In general, the more unstable the fracture, the more rigid the assembly must be to counteract fracture forces. There are three basic phases to consider when using ESF: (1) preoperative planning, (2) application of the ESF, and (3) long-term management. A deficiency in any one of these phases can lead to complications and an unsatisfactory clinical outcome. Although ESF can be used on many types of fractures, the technique is especially well suited for open or highly comminuted fractures when internal fixation is not applicable. In these cases, close attention must be paid to the integrity of the soft tissues. In addition, cancellous bone grafts should be placed either at the time of initial repair or in a delayed fashion after adequate vascularity has been established. Staged or complete removal of the ESF should be individualized to each fracture case. In general, staged disassembly or "dynamization" can begin when the bone and fixator begin to function as a composite as determined by radiographs. Complete fixator removal should be considered when the fracture exhibits clinical and radiographic evidences of union.
Twenty children with fractures of both bones in the middle third of the forearm were immobilized in extension after closed reduction. Unlike distal-third fractures, these fractures are prone to develop rotary and angular deformities that may lead to permanent functional impairment and visible deformity. Mid-third forearm fractures with the radius fracture proximal to the ulnar fracture are even more troublesome. Nineteen patients had no clinical deformity at cast removal, and by 1 year, there was no difference in forearm rotation. Extension casting can be used initially for proximal fractures or to salvage forearms that lost reduction in flexed elbow casts. Extension cast application is easy while the reduction is maintained, whereas the problems are often encountered while applying a flexed elbow cast. This unorthodox treatment is safe and effective and may alleviate the need for surgical intervention.
In fractures of the elbow with an associated fracture of the coronoid process, the size of the coronoid fragment determines the stability of the joint. A diminution of the arch of the incisura semilunaris by about 30 degrees causes instability of the elbow. We present an alternative way of treating the special case of a fracture of the coronoid process combined with comminuted fracture of the proximal end of the radius. A suitable fragment of the head of the radius is used to reconstruct the coronoid process. The stability achieved allows early functional postoperative treatment with a good range of movement at the elbow joint.
OBJECTIVE: This study evaluates the technique of medial bone plating in the repair of radius fractures in dogs and cats. STUDY DESIGN: A retrospective study was made of patients diagnosed with fractures of the radius that were stabilized by application of a bone plate to the medial side of the bone. ANIMAL POPULATION: Sixteen client-owned dogs and 4 client-owned cats. The animals' ages varied from 5 months to 8 years, and their weight varied from 1.3 to 49 kgs. METHODS: Animals were evaluated using radiography or client assessment, or both. RESULTS: Medical plate application was technically easier to do than cranial plate application, the technique avoided the extensor tendons, and permitted greater versatility in the selection of smaller plates for the fixation of distal radius fractures. All fractures repaired by this method healed with no postoperative complications. CONCLUSIONS: Medial plate application may be used for osteosynthesis of distal or middiaphyseal radius fractures. Further studies are needed to evaluate the use of this technique in morphologically complex fractures. In patients with fractures of the proximal radius, cranial plate application is considered more appropriate. CLINICAL RELEVANCE: Medial plating of radial fractures has significant advantages compared with conventional plate application; it provides the surgeon with an alternative method of fixation for selected radius fractures in dogs and cats.
In order to help provide care for acute orthopedic injuries to a portion of a military patient population and to add simultaneously a new aspect to the orthopedic rotation of family practice residents, a family practice orthopedic trauma clinic, staffed solely by family physicians, was initiated, and the records for six months were examined and summarized. A total of 540 patient visits, 286 (52.9 percent) of whom were adults during 45 sessions of this clinic were noted. Fractures accounted for 79.2 percent of the injuries, while sprains and contusions accounted for 17.7 and 3.1 percent, respectively. The most frequent injuries were fractures of the radius, fractures of hand phalanges, and ankle sprains. Orthopedic consultation was obtained at 88 (16.2 percent) of the patient visits. The results of this study indicate that family physicians can effectively manage the majority of nonsurgical, acute orthopedic injuries and that a clinic of this type may be a valuable addition to the orthopedic rotation of a family practice residencies.
Except for subjective clinical criteria, there is no formal definition of distal radius fracture instability in the literature. The purposes of this ex vivo biomechanical study were (1) to provide an objective mechanical definition of fracture instability and (2) to demonstrate a noninvasive method that allows for direct measurement of instability. The following 3 questions are addressed: (1) Can the stability of distal radius fractures be measured using computed tomography (CT)? (2) Are the stability measurements reproducible? (3) How does external fixation change stability? A CT technique is described that was used to measure displacement of fracture fragments and measure the compliance of ex vivo distal radius fractures before and after external fixation. Validation studies of the CT technique revealed a mean coefficient of variation of 0.38. There was a linear relationship between measured and known displacements for all 3 orthogonal planes (coefficient of determination 0.99; p < .01). There was significant fracture displacement with loads as small as 20 N. The slope of the load-displacement curve (structural compliance) provided a quantitative measure of fracture instability. Fracture compliance decreased up to 69% after application of an external fixator.
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We report the incidence of proximal femur and distal radius fractures in Tottori prefecture, Japan. In 1986 and 1987, 573 proximal femoral fractures and 1576 distal radial fractures were registered in this district. The age- and sex-specific incidence rates of these two fractures are lower among Japanese than among European or North American whites, according to previous reports. Thus, it was concluded that the incidence rates of these two fractures are lower in Japanese than in Caucasians.
The final result of the treatment of distal intra-articular radius fractures depends both on the accuracy of the fracture reduction and on the presence of additional carpal injuries. In particular, lesions of the intrinsic ligaments usually lead to 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 intra-articular fractures of the radius (mainly C-fractures according to the AO classification system or group VII and VIII fractures according to Frykman). Scapholunate (SL) tears were found in 11 patients (47.8%), 7 of whom showed marked instability intraoperatively and were stabilised at the time of surgery.
PURPOSE: A new fixed-angle volar plate for a dorsally displaced distal radius fracture was designed with the aim of avoiding soft tissue problems due to dorsal plating. The purpose of this study was to compare the biomechanical properties of this new plate with 2 existing volar plates in a cadaver model. METHODS: Three different plates were applied on surgically simulated unstable extra-articular distal radius fractures in formalin-fixed cadaver radiuses. Group 1 (volarly placed AO titanium Distal Radius plates [Synthes Ltd, Paoli, PA]; n = 6), group 2 (volarly placed titanium Symmetry plates [DePuy ACE Co, El Segundo, CA]; n = 6), and group 3 (volarly placed newly designed titanium plates; n = 6) were tested to failure under axial compression with a materials testing machine. Specimens of all 3 groups had similar bone mineral density. RESULTS: Group 3 specimens had significantly greater elastic limit and ultimate strength than the other 2 groups. Specimens of group 3 had the greatest rigidity, although this was statistically insignificant compared with the other 2 groups. All plates (groups 1, 2, 3) failed in apex volar angulation. CONCLUSIONS: The newly designed plate fixation system is the strongest of the systems tested and may offer adequate stability for the treatment of a distal radius fracture in which the dorsal and/or volar metaphyseal cortex is comminuted severely.
The inherent ability of pediatric metaphyseal radius fractures to heal and remodel made us question the need for immediate anatomic reduction under conscious sedation. We believe that isolated closed distal radius fractures with 15 degrees of angulation and 1 cm of shortening will heal well and remodel completely without clinical or functional sequelae. Time and expense can be decreased by splinting and follow-up without the need for immediate anatomic reduction in the emergency room. In order to answer this question, we retrospectively evaluated 34 pediatric metaphyseal wrist fractures that lost position after attempted reduction and healed in their angulated or shortened position. We looked at the time to healing, time to remodeling and any residual clinical or functional deficits. We then did a comparison cost analysis with time matched patients who had complete but minimally displaced fractures of the distal radius that were treated by immediate splinting with orthopaedic follow-up. Our results showed that skeletally immature patients with open physes, isolated injuries, dorsovolar and radioulnar angulations less than 15 degrees and less than 1 cm of shortening will heal and be out of cast within an average of 6 weeks and completely remodel within an average of 7.5 months. The average time in the emergency room was 2 h less with no reduction. The cost of the emergency room visit with attempted reduction was 50% more than splinting with early referral (US dollars 536 versus US dollars 270). None of our patients had significant clinical deformities or residual functional deficits.
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The primary prerequisites for optimal management of the athlete's fractured wrist are prompt diagnosis, anatomic and stable reduction, effective immobilization until healing is thorough, and comprehensive rehabilitation of the injured parts. Fulfillment of these fundamental criteria consistently leads to a highly favorable outcome with minimal risk of re-injury. In contrast, a compromise of these principles, especially for the sake of a speedy return to sports, invariably results in suboptimal recovery and, not infrequently, a permanent loss of skills. The exceptions to the cardinal rule that successful treatment of wrist fractures requires precise restoration of anatomic relationships are specific: displaced hamate hook fractures, displaced trapezial ridge fractures, and comminuted pisiform fractures. In such instances, successful union essentially is precluded, and early excision of the displaced fragments is the logical means of facilitating an uncomplicated recovery. For the more complex fractures requiring stabilization, continual refinements in methods of fixation are considerably diminishing fracture morbidity. The availability of small screws that provide rigid fixation of the carpus is, with increasing consistency, promoting accelerated union and rapid rehabilitation. Well-conceived combinations of low-profile, mechanically efficient external fixators and precisely used Kirschner wires achieve highly secure fracture stability for the distal radius that similarly enhances recovery with a minimum of complications. Improvements in both design and application of internal and external fixation techniques undoubtedly constitute a major advance in the management of wrist fractures among athletes. For some athletes, the return to competition can be safely expedited by the use of custom-fit protective gloves, splints, or casts. For most, however, the treatment regimen usually entails a minimum of 3 to 4 months. Although the healing and rehabilitation process is often lengthy and may seem costly, particularly in terms of time lost from competition, seldom do athletes regret the investment once they return to their highly skillful activities unencumbered by wrist impairment. Never does the sports medicine physician regret compliance with the principles of optimal care.
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Patients presenting with an osteoporosis-related fracture are at increased risk of further fractures. We performed a retrospective survey to determine if elderly patients presenting to the orthopaedic unit at Manchester Royal Infirmary with low energy hip or distal radius fractures were being managed appropriately with regards to assessment, investigation and treatment for possible osteoporosis. The initial survey demonstrated that only 16% of elderly female patients with low energy hip fractures and none of those (0%) with distal radius fractures were started on treatment or referred for further investigations for possible osteoporosis. After changes in our practice, 76% (p < 0.00001) of patients with hip fractures and 81% (p < 0.00001) of those with distal radius fractures were investigated, started on treatment or referred to a consultant physician for the management of osteoporosis.