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At least 811 records · Page 45Linked to original sources
PubMed2006

[Plate fixation with locking screw for distal fractures of the radius].

PURPOSE OF THE STUDY: Fractures of the distal radius are common. No one implant has demonstrated superior efficacy in terms of maintaining the reduction over time. We report our experience with plate fixation using a locking screw. MATERIAL AND METHODS: Between September 2003 and June 2004, 67 displaced fractures of the distal radius were treated by plate fixation using the LCP-DRP 2.4 (Synthès). Three different plates (anterior, posterior, and external) were used. The patients wore a removable anatomic brace for three weeks. Self-controlled rehabilitation exercises began directly after surgery with mobilization of the digital chains. The Fernandez, Castaing and AO classifications were noted. Ulnar variance, anteversion of the radial glenoid, radial slope and the alpha angle were measured intraoperatively and at last follow-up to assess maintenance of reduction over time. The DASH test and Green and O'Brien and PRWE scores were used to assess clinical outcome. RESULTS: Mean follow-up was eight months. Mean age was 55.8 years. Eight patients were lost to follow-up. The analysis included 59 patients who could respond to the questionnaires. Bone healing was achieved at six weeks. There were no cases of secondary displacement nor loss of reduction. The Green and O'Brien score was good or very good for 85%. The mean DASH was 20.6 and the mean PRWE 32.8. DISCUSSION: The appropriate fixation method for distal fractures of the radius remains a controversial issue, leading to a variety of materials and fixation methods. Primary stability achieved with the locking screw in a plate enables early mobilization associated with more rapid recovery of function. The absence of secondary displacement, irrespective of the quality of the underlying bone enabled us to achieve equivalent results in young patients and older patients with osteoporotic bone. This study also confirmed the preference for the anterior approach, irrespective of the direction of the displacement. To date, no other material has enabled equivalent results. This is a major achievement in terms of fixation stability.

Adult↗
PubMed2005

Segmental radius and ulna fracture with epiphyseal involvement: a case report.

Segmental fractures of the radius and ulna are relatively common in adults, often occurring after high energy trauma. Segmental forearm fractures in children have not previously been reported, and their optimal management is unclear. We report a child of eight years of age who underwent fixation of these injuries with a good outcome.

Bone Plates↗
PubMed1989

The use of Kirschner wires in diaphyseal fractures of the forearm.

This paper reports a case history in which a diaphysial radius fracture was treated by internal fixation with a spade tipped Kirschner wire. After one year, attempted removal of the spade tipped K-wire was unsuccessful. It is recommended that trocar tipped K-wire be used in patients with delicate bones and in bones of children.

Adult↗
PubMed2006

Long-term follow-up evaluation of denervation of the wrist.

PURPOSE: To evaluate the indications and results of complete wrist denervation and to focus on the correlation between results and length of follow-up evaluation. METHODS: A retrospective review was performed of 71 complete denervations of the wrist joint in 70 patients with an average follow-up period of 9.6 years (range, 1-23 y) using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. The denervations were performed according to the description by Wilhelm. All patients were asked to provide a DASH score. The indications for surgery were degenerative changes caused by scaphoid nonunions (25), distal radius fracture (11), Kienböck's disease (11), primary degenerative arthritis (9), scapholunate dissociation (8), and others (7). RESULTS: The average DASH score was 26 (range, 0-88). Thirty-nine patients (40 wrists) reported considerable improvement, 8 reported little improvement, and 10 reported temporary improvement after surgery. Seven experienced no change and 6 experienced worsening after surgery. Twenty-two patients were completely free of pain and 13 (14 wrists) had little, 20 had moderate, 11 had considerable, and 4 had severe pain. Forty-eight patients (49 wrists) stated that they would repeat the denervation and 61 (62 wrists) were able to keep their former occupations. There was a trend toward lower (improved) DASH scores in patients with longer follow-up periods but this did not reach statistical significance. The best results were achieved in patients with scapholunate dissociations and the worst results occurred in old distal radius fractures. Patient age did not influence the results. Nine patients with unsatisfactory results needed a second procedure. CONCLUSIONS: Complete wrist denervation resulted in subjective long-term improvement in two thirds and in a complete or marked pain relief in half of the patients. Patients with longer postoperative time and younger age did not affect the results adversely. This procedure is simple and fast, does not decrease range of motion, and leaves all other surgical options open. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adult↗
PubMed1987

A biomechanical study of distal radial fractures.

In an attempt to explain disability in dorsally angulated malunited distal radius fractures, an experiment was designed to evaluate load patterns about the wrist with varying degrees of dorsal angulation of the distal radius. Osteotomies were made in the distal radius of fresh cadaver arms after a modified external fixator was applied to the radius and load cells applied to the proximal radius and ulna. Pressure-sensitive film was inserted into the radioulnar carpal joint. After a predetermined load was applied to the wrist it was found that the load through the ulna increased from 21% to 67% of the total load as the angulation of the distal radial fragment increased from 10 degrees of palmar tilt to 45 degrees of dorsal tilt. The pressure distribution on the ulnar and radial articular surfaces changed in position and became more concentrated as dorsal angulation increased.

Biomechanical Phenomena↗
PubMed2005

Extra-articular distal radial fracture malunion.

With the increase in surgical options for the treatment of distal radius fractures, the authors anticipate that distal radial fracture malunions will be a less frequently seen problem. Nevertheless, they will still occur. Although patient selection has been weighted toward the younger patient, we believe that surgery should be based on patient activity level, functional needs, and disability related to the malunion. With advances in biotechnology and improved anesthetics, surgical intervention even in the older and osteopenic population is now more promising. Surgical intervention still requires appropriate patient selection, careful preoperative planning, and meticulous surgical technique. The appropriate surgical procedure should be tailored to the patient's symptoms, age, needs, and radiographic findings.

Fracture Fixation, Internal↗
PubMed1992

Radiolunate and radioscapholunate arthrodesis.

Eleven patients underwent radiocarpal arthrodesis for a wrist disease other than rheumatoid arthritis. Operations included seven radiolunate fusions and four radioscapholunate fusions. The indication for surgery was posttraumatic changes secondary to radius fracture (five), Kienböck's disease (three), localized arthritis secondary to sepsis (two) and acute comminuted fracture of the distal radius (one). All patients had arthritis or post-traumatic changes limited to the articulation between the radius and carpus. Follow-up ranged from 24 months to 7 years, with an average of 41 months. Postoperatively, average range of motion of the wrist was 30.9 degrees of extension, 22.7 degrees of flexion, 10 degrees of radial deviation, and 19.3 degrees of ulnar deviation, and grip strength averaged 81.8% of that for the uninvolved hand. Pain relief was achieved in all patients, and they were able to return to their previous occupation. Bony union was achieved in all cases. Degenerative changes in the midcarpal joint were not seen.

Adult↗
PubMed1999

[Temporary external fixation in the correction of non articular mal-unions of the distal radius].

PURPOSE OF THE STUDY: The authors reviewed 21 cases of extra articular malunions of the distal radius treated by osteotomy, temporary external fixation, then osteosynthesis. Two groups were studied: Group A of 14 patients with dorsal tilt of the distal radius and Group B of 7 patients with palmar tilt of the distal radius. Mean follow-up of this series was 69 months ranged from 12 to 109 months. MATERIAL AND METHODS: In Group A, after exposure of the distal radius through a dorsal approach, the site of osteotomy, proximal to the distal radio-ulnar joint, was determined by fluoroscopy. The angular correction was done by progressive opening using a small external fixator. After checking on the correction, the bone graft was harvested 7 times on the radius as described by Watson et Castle, 7 times on the iliac crest. Bone fixation was done by two K-wires and a cast for 8 to 10 weeks. Three Sauvé-Kapandji procedures was done at the same time. In Group B, the approach was palmar, extended distally to open the carpal tunnel. The distraction was done with a distal T-shaped external fixator. The bone graft was always harvested on the iliac crest. Bone fixation was done with a T-shaped palmar plate. Two Sauvé-Kapandji procedures was done at the same time. RESULTS: Group A: Flexion-extension arc was improved of 15.5 p. 100, pronation-supination of 83.7 p. 100 and grip strength of 80 per cent of the pre-operative values. Radiological evaluation showed good correction except one case of undercorrection of the dorsal tilt (-7 degrees) and one case of undercorrection of the radial inclination (+6 degrees). The distal radio-ulnar index was measured at the mean of 0mm postoperatively compared to +5 mm pre-operatively. One patient developed a postoperative radiocarpal arthritis. Group B: Flexion-extension arc was improved of 96.2 p. 100, pronation-supination of 76.9 p. 100 and grip strength of 108.3 p. 100 of the preoperative values. Radiological evaluation showed good correction except one case of overcorrection of the palmar tilt (-10 degrees) and one case of undercorrection of the radial inclination (+7 degrees). The distal radio-ulnar index was measured at the mean of 0mm postoperatively compared to +7 mm pre-operatively. DISCUSSION: The functional consequences of malunions of the distal radius have been stressed by others for more than sixty years. Since, many authors have contributed to refine and improve their surgical correction. Several displacements should be taked into account for the preoperative planning. They are sagittal tilt, frontal horizontalisation, shortening, sagittal and frontal translation, and axial rotation. Many types of osteotomies could be done; closing wedge, opening wedge or reorientation. In some cases, an operative procedure of the distal radio-ulnar joint should be done at the same time. We chose an opening-wedge osteotomy and the use of a temporary external fixator to ensure progressive distraction and good adjustment in the correction of angular deformities. In the dorsal tilt group we were satisfied in using on 7 patients a trapezoidal cortico-cancellous bone graft harvested on the radius. CONCLUSION: The authors would like to stress two points: The technical interest of using a temporary external fixator to adjust the angular correction of the distal radius. The importance of an adequate treatment of distal radius fractures in emergency situation, considering the functional and cosmetic alterations due to malunions and their need for surgical corrections in main instances.

Colles' Fracture↗