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PubMed1988

Fractures and dislocations of the distal radioulnar joint.

Fractures and dislocations of the distal radioulnar joint are frequently visualized as a secondary problem in comparison to the more apparent radius fractures. Frequently, in the long-term follow-up of patients with radius fractures, ulnar wrist pain secondary to distal radioulnar joint incongruity is the final outcome. Therefore, in the evaluation of the injured forearm the distal radioulnar joint must be assessed clinically and radiographically. In this assessment if distal radioulnar joint instability or incongruity is present then joint stabilization or reduction, respectively, must be attained.

Adolescent↗
PubMedDate not supplied

Results of autogenous trephine biopsy needle bone grafting in fractures of radius and ulna.

Cortico-Cancellous bone graft harvested from the anterior iliac crest by the conventional open method is associated with more morbidity and is more time consuming as compared to the percutaneous method using trephine biopsy needle. The aim of the study was to determine whether cancellous bone graft harvested from anterior iliac crest using trephine biopsy needle consistently achieved bone union in comminuted fractures and fractures of more than 3 weeks duration of radius and ulna and also to determine the morbidity at the donor site. Autogenous cancellous bone graft was harvested percutaneously from 28 iliac crests in 16 patients and applied at fracture sites of 30 forearm bones using a 4mm trephine biopsy needle after the fractures had been fixed with plate and screws. The patients were followed up regularly upto 6 to 9 months post - operatively in the OPD to determine the union status of the fractured bones and the morbidity at the donor site. 29 of the 30 fractures of the forearm bones united without any problems. The shaft of a trephine got bent during the harvesting procedure at the beginning of the study due to improper technique. Cancellous bone graft harvested from the anterior iliac crest results in predictable good union results in comminuted fractures of forearm bones and also fractures presenting after 3 weeks of injury. It is also an easier and quicker way of harvesting bone graft and is associated with lesser morbidity and earlier recovery as compared to conventional open method.

Biopsy, Needle↗
PubMed1999

Intra-articular fractures of the distal aspect of the radius.

Intra-articular distal radius fractures are a heterogeneous group of injuries with different fracture patterns. The existing classification systems are helpful for describing the fractures but not for assessing their stability or for deciding which surgical approach to use. Patients who have a fracture with at least 1.0 mm of displacement of the articular surface may benefit from open surgical treatment. Improved diagnostic imaging with CT is helpful for fracture classification and surgical planning. The options for surgical treatment include limited open reduction and internal fixation, arthroscopically assisted internal fixation, and open reduction and internal fixation. The surgical approach is determined on the basis of the initial displacement of the fracture. Patients who have a displaced fracture of the volar rim may benefit from a volar approach; those who have a dorsally displaced fracture, from a dorsal approach; and those who have an impacted fracture such as a die-punch fracture, from a dorsal approach that provides better visualization of the articular surface. The long-term functional outcome is determined in part by the severity of the fracture as defined by the amount of comminution, the initial severity of displacement, and the number of fracture fragments. The accuracy of the reconstruction of the articular surface, with the goal of establishing congruency to within 1.0 mm, is also important in order to minimize the risk of late osteoarthrosis. Of all of the extra-articular parameters, restoration of the length of the radius is the most important for enhancing recovery of motion and grip strength and for preventing problems involving the distal radioulnar joint--the so-called forgotten joint in distal radial fractures.

Arthroscopy↗
PubMed2002

Survival among elderly patients after fractures of the distal radius.

Studies have documented increased mortality rates in patients sustaining hip and vertebral fractures. Distal radius fractures are common injuries among the elderly and are a significant source of disability. This study analyzed survival rates in an elderly patient cohort after distal radius fractures and determined mortality risk factors. In addition, the mortality rates in our patient cohort were compared with those of the general population of the United States matched for age and gender. The records of 325 elderly patients (250 women, 65 men) treated for distal radius fractures between 1992 and 1999 were reviewed and submitted to the national death registry maintained by the National Death Index and the Center for Disease Control and Prevention. The mortality experience of the patient cohort was analyzed by using bivariate statistical tests and multivariate regression. Average age at diagnosis was 77.4 years (range, 65-106 y). A total of 21% of patients (29% of men, 19% of women) died during the study period. After accounting for variations in age, total number of comorbidities, and Charlson comorbidity index, men were 2.65 times more likely to die than women (95% CI, range, 1.31-5.36) and their hazard of death was 1.83 times that of women (95% CI, range, 1.07-3.14). After accounting for variations in age and gender, patients with comorbidities were 5.23 times more likely to die (95% CI, range, 1.80-15.23) and did not survive as long as those without comorbidities. At 7 years after radius fracture, the cumulative estimated survival in the cohort under study was 57% compared with an expected value of 71% for the US population. Survival rates after distal radius fractures were notably lower than those expected for individuals of the same age and gender in standard populations. Men were twice as likely to die as women and did so almost twice as quickly.

Aged↗
PubMed1996

Displaced intra-articular fractures of the distal radius: the effect of fracture displacement on contact stresses in a cadaver model.

Contact stresses in the wrist were measured after simulating displaced fractures of the lunate fossa in the distal radius of eight human cadaver arms. Osteotomies created displaced lunate fossa fractures of 0, 1, 2, and 3 mm. Contact stresses were measured with Fuji pressure-sensitive film after loads of 100 N were applied to the wrist through wrist flexor and extensor tendons. Mean contact stresses were significantly increased with step-offs of 1 mm or more. Maximum stresses and overloaded areas were significantly increased with step-offs of 2 mm or more. As the magnitude of the fracture displacement increased, there was a shift in the focus of the maximum stresses toward the fracture line. In this model, simulated displaced die-punch fractures created alterations in both the magnitude and location of contact stresses in the wrist joint.

Biomechanical Phenomena↗
PubMed2000

Ipsilateral distal radius and scaphoid fractures.

Simultaneous fractures of the distal radius and scaphoid are uncommon. Previous reports have outlined a variety of treatment methods for this condition. We describe the results in eight patients with simultaneous fractures of the distal radius and scaphoid, who were treated at National Taiwan University Hospital from 1987 to 1998. Treatments for the distal radius fractures included pin-in-cast in one patient, casting in one, external fixation in one, external fixation after pinning in three, and open reduction with internal fixation in two. All scaphoid fractures occurred at the scaphoid waist, and were treated with long-arm thumb spica in three patients, Herbert screw fixation in two, and percutaneous pinning in three. All of the fractures united, and none of the patients developed scaphoid avascular necrosis. One patient suffered from superficial radial nerve injury during external fixation. The functional results of the wrist were good in five patients and fair in three. To prevent the possible over-distraction of the scaphoid fracture, fixation of the scaphoid should be performed if a distraction force is to be applied during the treatment of the distal radius fracture. If no distraction force is to be applied, a thumb spica may provide adequate fixation for the scaphoid fracture.

Adult↗
PubMed1991

Older's classification of Colles' fractures. Good intraobserver and interobserver reproducibility in 185 cases.

To evaluate the reliability of the Older classification, 4 observers classified 185 distal radius fractures twice with 1 month's interval. Both the intraobserver agreement and the interobserver agreement were high, with kappa values of 0.75 (0.69-0.79) and 0.69 (0.60-0.77), respectively. The agreement was especially high for type 1 and type 4 fractures. Older's method of classifying distal radius fractures can thus be recommended for clinical use.

Colles' Fracture↗
PubMed1997

[Injuries due to inline skating].

In order to elucidate the patterns of injuries associated with in-line skating all patients with a inlineskate injury have been sampled prospectively during summer 1996. 58 patients were included in the study, aged 8 to 54 years (mean 22.2 years). The total number of injuries was 63, that is 1.1 injury in every injured skater. The upper extremity was the region most commonly injured (63.5%), with the distal radius fracture being the most common single fracture (25.4%). The most severe injuries, however, could be found in the lower extremity, including two femoral neck fractures and one pertrochanteric fracture in three patients aged more than 35 years. 22.4% of patients required hospitalization up to 54 days, and 36.2% of injuries had to be treated operatively. The most common single procedure was closed reduction and percutaneous wire fixation of displaced radius fractures. It is concluded that in-line skating imposes a risk of severe injuries especially on first-time skaters aged 35 years and up. The typical skating injury is the fracture of the wrist, a fact pointing out the necessity of the use of appropriate safety gear.

Adolescent↗
PubMed1999

A biomechanical comparison of different wrist external fixators with and without K-wire augmentation.

To compare stability of wrist external fixation, simulated unstable extra-articular distal radius fractures were created in 7 fresh-frozen cadaveric upper extremities and stabilized using 4 different external fixators. Physiologic muscle tension across the wrist was simulated by application of 40-N load distributed among the wrist tendons. Alternating loads of up to 100 N in flexion and extension of the wrist were applied during stability testing and 3-dimensional kinematics of the proximal and distal fracture fragments were determined using attached infrared light-emitting diodes and a 3-dimensional motion tracking system. Fracture stability was reassessed for each of the constructs after augmentation of the fracture fragments with a single dorsal transfixion K-wire. K-wire augmentation demonstrated a significant reduction in motion of the distal radial fragment of at least 40% in all 3 rotational planes. For flexion/extension, the reduction in motion was from 4.5 degrees to 2.6 degrees. For radial/ulnar deviation, the range of motion decreased from 3.0 degrees to 1.5 degrees. Rotational motion declined from an average of 3.2 degrees to 1.2 degrees. The addition of the single dorsal transfixion K-wire significantly improved stability of each of the 4 fixators in at least 1 of the 3 planes in which motion was measured. While we compared the most rigid with some of the least rigid external fixators, the data do not support an important difference in fracture fragment stability among the 4 fixators. The data much more strongly support the concept of K-wire augmentation for increasing stability of an unstable extra-articular distal radius fracture regardless of the type of external fixator that is used.

Biomechanical Phenomena↗
PubMed1989

Rotational stability of diaphyseal fractures of the radius and ulna fixed with Rush pins and/or fracture bracing.

The rotational stability of fractures of the radius and ulna treated with Rush pins and/or fracture bracing was studied in six fresh cadaver forearms. Forearm rotation and fracture site motion (rotation) were measured as functions of applied forearm torque and rotation (pronation-supination). Values were obtained from the forearm: (1) intact and with both bones fractured; (2) without fixation; (3) with a fracture brace; (4) with Rush pins; and (5) with a combination of Rush pins and a fracture brace. A brace was ineffectual in reducing fracture site motion when the wrist was rotated to specified angles compared to fracture site motion for the forearm with no fixation treatment rotated to the same angles. When loading to specific torque levels, however, the brace reduced fracture site motion to one-half the motion with no fixation treatment. Under both loading conditions, Rush pin fixation significantly and markedly reduced the fracture site motion (to approximately one-eighth of the motion with no fixation treatment), whereas a brace in conjunction with Rush pins did not significantly further reduce the fracture site motion. The radius showed more motion at fracture site than the ulna.

Bone Nails↗
PubMed1994

The epidemiology of osteoporotic fractures in a Mediterranean country.

A population study was carried out over a period of 3 years (1987-1989) to determine the incidence of osteoporotic fractures. Fractures diagnosed in the two acute hospitals of the Maltese Islands were collected and classified according to the fracture site, age, sex, and patient's residence. Fractures in the Maltese Islands can only be diagnosed and adequately treated in these two general hospitals. A total of 8780 fractures were examined. Fracture of the neck of the femur was the most common fracture for which patients were admitted to the hospital. There were twice (1.96) as many females as males hospitalized for this fracture, giving an annual incidence of 262/100,000 females to 134/100,000 males over the age of 45. The fracture incidence was 2-3 times less than that found in North European countries, but was similar to the fracture rates obtained in Mediterranean studies. Fracture radius was the most frequent fracture treated on an outpatients basis. In over 45-year-olds, the female predominance persisted, giving a ratio of 3.65:1. This gave an annual incidence of 452/100,000 females to 150/100,000 males. Again, the fracture incidence obtained was significantly lower than that of Northern European countries. Other long bones showed a similar female to male (F:M) ratio in the cohort over 45 years of age. The bones showing this F:M ratio were the humerus (3.9:1), fibula (1.89:1), and tibia (1.6:1). Below 45 years of age males had more fractures than females for any bone studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Internal fixation of the distal radius. A comparative, experimental study.

In a comparative, experimental examination of 60 human cadaver radii, the stability of various, widely used internal fixation procedures of a distal radius fracture loco typico using a dorsal wedge was determined. The use of 2.5-mm Kirschner wires (K-wires) delivered a 10% greater stability than 1.8-mm K-wires. The 2.7-mm polylactide rods achieved a slightly greater stability than 1.8-mm K-wires under accurate pinning conditions. Polylactide rods (35 mm length, 2 mm diameter) and polyglycolide rods (60 mm length, 2 mm diameter) proved to be 20% less solid than 1.8-mm K-wires and almost 45% less than plate fixation. The short polylactide pins, however, did not have enough hold in the proximal cortical bone. The 2.7-mm polylactide rods (60 mm length) complied with the stability prerequisites necessary for comparable substitution for K-wires in distal radius fractures.

Bone Nails↗
PubMed2001

Diagnosis of occult scaphoid fractures and other wrist injuries. Are repeated clinical examinations and plain radiographs still state of the art?

To examine the efficacy of repeated clinical examinations and follow-up radiographs, 121 patients were prospectively and consecutively randomised and clinically followed until a final diagnosis was achieved. All of these patients additionally underwent magnetic resonance imaging (MRI) scans within an average of 3 days after trauma to control the results of this study. MRI detected 112 injuries in 82 patients (67%). Twenty-eight (25%) of these injuries were scaphoid fractures. There were 15 fractures of other carpal bones, 14 avulsion fractures of extrinsic ligaments (AFL), 26 other bone injuries (fractures of distal radius, fractures of radial styloid, ulnar head fracture metacarpal fracture, bone bruises), and 29 soft tissue injuries (triangular fibro-cartilaginous complex injuries, complete or partial ruptures of the scapholunate ligament, ruptures of the radial collateral ligament, hemarthrosis). By means of repeated clinical examinations and plain scaphoid views, experienced observers were able to detect all the occult scaphoid fractures within 38 days, as well as most of the other fractures about the wrist except one fracture of the triquetrum. Soft tissue injuries, however, were diagnosed only in two cases of complete scapholunate ligament tears. It was further obvious that 70% of all scaphoid fractures and 60% of the AFLs were detected in a review of the initial X-rays by experienced surgeons. Only 30% of all scaphoid fractures detected were really occult and all of these were diagnosed correctly. This prospective study demonstrates that clinical and radiological standard procedures are reliable in the diagnosis of occult fractures of the carpus and wrist when performed by experienced observers. MRI scans are indicated for early diagnosis of occult fractures and soft tissue injuries about the wrist.

Adult↗
PubMedDate not supplied

The utility of a bone scan in the diagnosis of clinical scaphoid fracture.

The incidence of true scaphoid fracture and the value of radionuclide scan was evaluated in a 1-year retrospective review of 54 emergency department patients with a preliminary diagnosis of clinical scaphoid fracture (snuff box tenderness and negative initial X-ray study). All emergency department charts of patients with a discharge diagnosis of clinical scaphoid fracture were reviewed to determine the number ultimately found to have a true scaphoid fracture and to ascertain how the diagnosis was actually achieved. All patients were managed by immobilization in a thumb spica cast for a period of 10-14 d, with repeat clinical assessment and radiographs at that time. The diagnosis of true scaphoid fracture was confirmed radiographically at the time of reassessment or, in the case of persistent tenderness and negative repeat radiographs, by the use of a technetium bone scan. In our study group, only 8 of 54 patients (14.8%) were found to have a final diagnosis of true scaphoid fracture. In 75% (6/8) of these patients, the diagnosis was made by technetium bone scans, as the radiographs remained negative at the time of reassessment. In addition, a bone scan revealed the presence of two previously unsuspected fractures (one distal radius fracture and one triquetral fracture) in two patients with continued clinical tenderness. This study confirms the previously reported low incidence of scaphoid fractures in patients with a diagnosis of clinical scaphoid fracture. It also demonstrates the importance of technetium bone scan as a diagnostic tool of increased sensitivity, as compared to traditional radiographs, in detecting the presence of scaphoid fractures and in detecting other clinically unsuspected fractures in this group of patients.

Adolescent↗
PubMed1977

Denervation of the wrist joint.

A collective review was made of the results of denervation of the wrist joint for painful restrictiorn of motion done in 313 patients and follow-up studies on 195 (average 4.1 years, ranging from 9 months to 14 years). Complete denervation was done in only 30, partial denervation in the others being done after testing with local anesthetic blocks. Sixty-nine of the patients retained a moble wrist without pain or with slight pain with heavy work. No evidence of Charcot-like joints was seen. Poorest results followed when the operation was done for sequelae of intra-articular fracture of the radius, fracture dislocations, unstable ligamentous support, joint surface destruction, or for those required to do heavy manual labor. Arthrodesis was done secondarily in nine patients.

Arthrodesis↗