Is splinting of distal radius torus fractures an acceptable alternative to casting?
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Adolescent↗
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Results for “RADIUS FRACTURES”
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Osteocutaneous radial forearm free flap: its use without significant donor site morbidity.
While the fasciocutaneous radial forearm free flap has gained increasing popularity, the osteocutaneous radial forearm free flap has been condemned because of a high rate of pathologic donor radius fracture. On the basis of studies that demonstrated increased strength in ostectomized radii after dynamic compression plating, we believed that internal fixation at the time of graft harvest would significantly reduce the incidence of donor radius fracture. This is a retrospective review of the first 54 patients undergoing osteocutaneous radial forearm free flap reconstruction of the head and neck at our institution; 52 underwent prophylactic plating of their donor radii. No clinically significant donor radius fractures have occurred in plated patients. Five asymptomatic fractures were discovered on routine radiographs and required no treatment. Objective evaluation of forearm range of motion and strength after graft harvest demonstrated excellent function compared with unoperated arms. Serial radiographs have shown remodeling and reconstitution of donor radii without localized osteopenia.
Adolescent↗
A scaphoid fracture associated with a displaced distal radial fracture in a child.
A hyperextension injury to the wrist caused a transverse scaphoid fracture associated with a displaced distal radial fracture in an 11-year-old boy. Anatomic reduction and immobilization in a long-arm cast for a period of 12 weeks resulted in subsequent healing of these fractures. The coexistence of a scaphoid fracture with a distal radius fracture in a child is important to recognize because reduction maneuvers are modified to effectively treat this combination of injuries. Patients with distal radial physeal injuries should be closely evaluated for clinical and roentgenographic signs of scaphoid fractures.
Carpal Bones↗
Nonbridging external fixation in the treatment of unstable fractures of the distal forearm.
INTRODUCTION: Unstable fractures of the distal forearm often require surgical treatment to restore the normal anatomy and function. We have used a relatively new technique, nonbridging external fixation, in the treatment of these fractures in our hospital during the past few years. Our results are presented here. MATERIALS AND METHODS: Fifty-two patients (41 female, 11 male) with an unstable fracture of the distal forearm were treated using nonbridging external fixation at Oulu University Hospital during 1996-1999. The patients' mean age was 57 years. There were 45 Colles-type fractures, and 7 distal radius fractures had a concomitant distal ulna fracture. Forty-three patients were reviewed after a mean of 16 months of follow-up to assess radiological, functional, and subjective results. RESULTS: The fixation device maintained reduction well during healing, and the final radiological result was good. Range-of-motion and grip strength were restored to levels of 87-98% compared with the uninjured forearm. The subjective result was rated as 8 (mean) on a scale of 0-10. Pin-tract infection was a common complication (19%), but such cases were easily treated with antibiotics. CONCLUSION: Nonbridging external fixation offers an easy, minimally invasive, and reliable technique in the treatment of unstable fractures of the distal forearm.
Adolescent↗
Management of non-union with pulsed low-intensity ultrasound therapy--international results.
In prospective, randomized, double-blind, placebo-controlled, multi-center clinical studies, pulsed, low-intensity ultrasound has been proven to be effective in decreasing the time to heal in both fresh diaphyseal (tibia) and metaphyseal (distal radius) fractures. It also decreases the likelihood of a delayed union (>150 days to heal) in tibia fractures and loss of reduction in distal radius fractures. World-wide clinical studies, using pulsed, low-intensity ultrasound for treatment of non-union in a self-paired control study design, have demonstrated a heal rate of 88% with an average treatment time of 4.5 months in non-unions and an average fracture age of 23 months. The therapy is safe and non-invasive, and is used by the patient at home for a 20-minute treatment session per day.
Fractures, Ununited↗
[Replacement-plasty of the coronoid process in unstable elbow joint dislocations with avulsion fracture of the coronoid process and radius head crush fracture].
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Fracture Fixation, Internal↗
Biomechanical testing of the fractured distal radius treated with a new bone cement--is it strong enough?
This study evaluates the in vitro ability of CAP, a bone graft substitute with osteointegration and osteoconductive properties, to restore the anatomy and strength of fractured distal radii. Ten pairs of cadaveric radii were imaged and tested to failure, simulating a fracture. The radii were reconstructed using CAP and were re-fractured and sequentially imaged. The deformities of the bones were determined through computerised evaluation of the radiographs. Radiographic analysis showed that CAP is capable of restoring the anatomy of the distal radius. The load and work required to fracture intact radii were compared to those required to fracture the reconstructed radii. The load to fracture was similar in the two situations. The work to fracture, however, was higher with reconstructed radii, suggesting that these are stronger than the original bones. Our study supports the hypothesis that CAP is capable of restoring the original anatomy and dimensions of the distal radius and re-establishing its mechanical strength.
Biomechanical Phenomena↗
Early MRI in the management of clinical scaphoid fracture.
The incidence of MRI detected scaphoid and other wrist fractures was determined in a clinical setting in patients with suspicion of scaphoid injury and negative initial radiographs. The influence on subsequent patient management was examined. Patients attending Accident and Emergency over a 25 month period with suspected scaphoid fracture and normal scaphoid series plain films were referred for wrist MRI. Scans comprising T(1) weighted spin echo and short tau inversion recovery (STIR) coronal sequences were performed in a dedicated extremity low field MRI scanner within 14 days of injury. Subsequent effects on patient management were ascertained by clinician completed questionnaire. 195 patients were scanned. There were 37 scaphoid fractures (19%), 28 distal radius fractures (14%), 9 fractures of other carpal bones (5%) and 119 studies with no fracture. The management of 180 patients (92%) was altered as a result of the MRI scan. Occult fractures are present in almost two fifths of patients with suspected scaphoid fracture and normal initial plain films. Half of these are scaphoid fractures. MRI allows an early definitive diagnosis to be made, changing patient management in over 90% of cases and should be regarded as the gold standard investigation in this population.
Adolescent↗
[The treatment of distal splinter fractures using an external fixator. Indications and technic].
To sum up we can say that only 10-20% of the distal radius fractures are treated by an external fixator. The combination with the percutaneous Kirschner wire-osteosynthesis is a must for us. About 80 to 90% of the cases are provided according to the category A, that means closed. For 10 to 20% the opened reposition and spongiosa bone graft is needed whereby here the fixator will be put primary for distraction and ligamental replacement. The results of 85% can be judged as good or very good. 15% only are satisfactory or insufficient. These experiences are corresponding to the results of Cooney (1980) and Vidal (1977). Contrary to the original opinion that the older patient is not suited for this treatment it was showed that the incidence of the dystrophy is not higher in an advanced age. The assumption for a successful use of the external fixator is the choice of a suitable fracture, the readiness of the patient for cooperation and the possibility of a regular after-care and control. In that sense the technic completes the normal therapeutical method in the treatment of the distal radius-fracture.
Fracture Fixation↗
How many clinic visits does it take to treat distal radial fractures?
The purpose of this study was to evaluate the changes in alignment during the course of treatment for extra-articular distal radius fracture and the relationship of initial and intermediate radiographs, with the final radiograph taken at fracture union. A cohort of 96 consecutive patients who were conservatively managed for extra-articular distal radius fracture in an 18-month period was undertaken. The radiographs analysed were taken at prereduction, postreduction, a week later and at fracture union. The radiological parameters analysed were radial tilt, radial length, radial inclination, dorsal comminution and ulnar styloid fracture. There was a significant change in radiographic alignment between initial and immediate postreduction radiographs, and between postreduction 1 week later radiographs (p < 0.05), but the number of patients in the 1 week later and fracture union groups remained similar (p > 0.05). All patients with poor radiological outcome had ulnar styloid fractures. This was also associated with dorsal comminution in 86% of patients. Patients with satisfactory radiological outcome had ulnar styloid fracture and comminution in 34% and 43% of patients respectively. The final radiological outcome was not found to be influenced by initial unsatisfactory alignment of radial tilt, radial length and radial inclination individually or in combination. We suggest that two clinic visits after initial reduction of the fracture should be sufficient to manage such injuries; the first visit 1 week after manipulation to detect unacceptable displacement and if found satisfactory, the last visit at fracture union for final review, advice and referral to physiotherapy.
Adult↗
Marked initial displacement predicts complications in physeal fractures of the distal radius: an analysis of fracture characteristics, primary treatment and complications in 109 patients.
BACKGROUND: Factors predicting redisplacement in the cast and early complications in distal radial physeal injuries have not been analyzed before. PATIENTS AND METHODS: We analyzed 109 consecutive children with displaced physeal fractures of the distal radius treated by manipulation under anesthesia RESULTS: Acute carpal tunnel syndrome developed in 2 patients. Posttraumatic swelling necessitating trimming, splitting or removal of the primary circular cast occurred in one-sixth of the patients. Half of the fractures healed in malunion despite an anatomic primary reduction in 85% of the cases. According to logistic regression models, marked initial malposition of the fracture (< 50% displacement or < 20% angulation) was an independent risk factor for complications and redisplacement. Non-anatomic reduction of the fracture was an additional independent risk factor for redisplacement. INTERPRETATION: The risk of an acute carpal tunnel syndrome should be remembered in patients with marked primary displacement of the fracture. To avoid redislocation, pin fixation of the fracture in patients close to skeletal maturity should be considered if there is a marked initial malposition of the fracture, or if fully anatomic reduction cannot be achieved.
Adolescent↗
Effect of radial shortening on muscle length and moment arms of the wrist flexors and extensors.
The purpose of this study was to determine the effect of distal radial shortening on muscle length and moment arm of the wrist flexors and extensors. In eight cadaveric upper extremities, distal radius fractures were simulated by an ostectomy. The distal radius was progressively shortened by 2.5, 5.0, 7.5, and 10 mm. Changes in the resting length of the flexor carpi radialis and ulnaris, extensor carpi radialis longus and brevis, and extensor carpi ulnaris muscles were measured with rotary potentiometers at neutral position, flexion, extension, and radial and ulnar deviation of the wrists. The wrists were passively moved through flexion-extension and radioulnar deviation, and tendon excursions and wrist joint angulation were recorded simultaneously. Tendon moment arms were derived from tendon excursions and joint motion. The results showed that either muscle length or moment arm of the principal wrist flexors and extensors was significantly affected by the radial shortening. Muscle length decreased significantly after radial shortening in all the wrist flexors and extensors except for the extensor carpi ulnaris. The moment arm of the extensor carpi ulnaris tendon decreased significantly during either wrist flexion-extension or radioulnar deviation. The extensor carpi radialis brevis and flexor carpi ulnaris tendons also showed a significant decrease in their moment arms during radioulnar deviation of the wrist. Radial shortening of only 2.5 mm caused statistically significant changes in muscle length and moment arm of the wrist flexors and extensors. Increasing the extent of radial shortening exaggerated the biomechanical changes in the wrist motors. These results validate the importance of normal radial length for wrist kinetics and, from a biomechanical perspective, support complete correction of radial shortening after distal radius fractures.
Aged↗
[Conservative therapy of isolated radius head fracture--immobilization or early functional movement treatment?].
We reviewed 95 patients with isolated fractures of the radial head. 33 of them were treated by plaster cast fixation for three weeks, 62 by immediate active motion. No difference in frequency of arthrosis and periarticular ossification in both groups could be observed. Examination of the patients two to four years after trauma showed excellent functional results in 61% of the 33 patients and in 77% of the 62 patients. The average duration of treatment is shorter by two weeks in the group of immediate active motion. The clinical results of this group, although not statistically significant, seem to be better than after immobilization.
Adolescent↗
[Smith's fracture. A radiological and functional follow-up study of 62 primary and post-primary surgically treated fractures].
The reversed Barton fracture of the distal radius is rare. In the literature there is a rate of 3 to 20.5% of all distal radius fractures. Whereas the reposition is simple, the reduction is difficult. This retrospective report about the treatment by osteosynthesis in the years between 1977 to 1987 in the "Berufsgenossenschaftliche Unfallklinik" Tübingen demonstrates a direct correlation between radiological and functional results. That means in consequence that internal fixation by using a small palmar T-plate is the favorable therapy.
Adult↗
[Remodelling ability of the distal radius in fracture healing in childhood].
INTRODUCTION: Distal forearm fractures are among the commonest skeletal injuries in childhood. The aim of this work is to analyze factors determining remodelling abilities of the distal radial metaphysis in dislocated fractures, considering a requirement for eventual non-operative repositioning. MATERIAL AND METHODOLOGY: The primary patient group included a group of patients treated in 2004 for distal radial metaphysis fractures, left to heal in a dislocated position. The angle of dislocation ranged from 8 to 30 degrees. All patients underwent a follow up x-ray examination 2, or more, years later and a clinical examination of the wrist joint range of motion. The extent of remodellation was studied, considering duration of the healing process, patient's age and the fracture line distance from the growth plate. RESULTS: The results show that in the majority of the patients included in the study, complete remodellation of the radius nearly to its anatomical position (86%) occurred. The results were significantly better in the patient group aged 0-12 years. Furthermore, significantly less residual dislocations were recorded within 20 mm from the growth plate. Restriction of the wrist joint range of motion resulting from residual dislocation was not recorded. CONCLUSION: Based on the results, conservative treatment of the condition, especially in cases of multiple injuries or of a polytrauma, is recommended. Also, in cases of deterioration of the positioning or of redislocation after repositioning, repositioning need not be repeated in patients below 12 year of age.
Adolescent↗
Delayed rupture of flexor pollicis longus tendon after volar plating of the distal radius.
Flexor tendon rupture following distal radius fracture is rare. We described a case of flexor pollicis longus rupture, presented five years after volar plating of distal radius fracture.
Bone Plates↗
The effect of increasing distraction on digital motion after external fixation of the wrist.
PURPOSE: Although several factors have been related to the development of digital stiffness after external fixation of distal radius fractures, distraction can be considered one of the most important. This study determined a threshold for distraction during external fixation of distal radius fractures and documented the effect of distraction of the wrist on metacarpophalangeal (MCP) joint motion. METHODS: Eight fresh-frozen cadaveric forearms were mounted on a testing frame and the flexor digitorum superficialis (FDS) tendon of each finger was pulled individually until a 90 degrees flexion at the MCP joint was generated. A load cell was used to record the force applied on the tendons. Tendon displacement was calculated by using a linear potentiometer. Sequential distraction across the wrist was applied through a distraction outrigger on the external fixator and was measured both on the external fixator in millimeters and on fluoroscopic images. Finger motion was captured by using a 2-dimensional motion tracking system. The experiment was repeated at different levels of wrist distraction (increments of 2 mm to a maximum of 14 mm). RESULTS: There was a significant difference in the effect of distraction on the individual fingers. For the index finger the load required for the FDS to produce a 90 degrees flexion at the MCP joint was increased linearly between 0 and 8 mm of wrist distraction. For the other fingers a threshold of distraction was found. A significant increase in the load was noticed after 5 mm of wrist distraction. CONCLUSIONS: More than 5 mm of wrist distraction increases the load required for the FDS to generate MCP joint flexion for the middle, ring, and small fingers. For the index finger, however, as much as 2 mm of wrist distraction significantly increases the load required for flexion at the MCP joint.
Cadaver↗
[Salvage operations and their differential indication for the distal radioulnar joint].
The most common cause of an arthritically damaged distal radioulnar joint is a malunion of a distal radius fracture. Therapeutically, ulnar head resection, hemiresection-interposition-technique, Kapandji-Sauvé procedure and implantation of an ulnar head prosthesis have been described. None of these procedures is able to restore the complete function of the joint. Therefore, anatomical reconstruction of the joint in acute or secondary correction osteotomy for malunited fractures of the distal radius should be performed to avoid the development of the arthrosis. Numerous clinical studies have demonstrated a similar reduction of the clinical symptoms for all procedures. Therefore, classification of the different procedures has to consider the number of complications. Biomechanically, partial resection of the distal ulna will destabilize the distal radioulnar context and clinically may lead to painful radioulnar and/or dorsopalmar instability of the distal ulnar stump. Biomechanically and clinically, this complication, next to secondary extensor tendon ruptures, has to be expected far more often following complete resection of the ulnar head than in the alternative procedures. We do not see any remaining indication for complete resection of the ulnar head. Clinical results and the occurrence of painful instability of the distal ulnar stump have been reported almost identically for the hemiresection-interposition technique and the Kapandji Sauvé procedure. Therefore, both procedures appear to be equally suitable for the treatment of painful arthrosis of the distal radioulnar joint. In patients with a preexisting instability of the distal radioulnar joint, or a major deformity of the radius or the ulna, we prefer to perform the hemiresection-interposition-technique. In these conditions we consider the remaining contact of the triangular fibrocartilage complex with the distal end of the ulna a biomechanical advantage to reduce the risk of secondary instability. Biomechanically as well as clinically, replacement of the ulnar head using a prosthesis has been shown to either avoid or solve the problem of instability. We therefore consider ulnar head replacement the treatment of choice in secondary painful instability following resection procedures at the distal end of the ulna. Primary ulnar head replacement should be considered in special indications until long-term follow-up results are available.
Arthroplasty↗