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PubMed2004

[Arthroscopy in the diagnosis and therapy of wrist disorders].

PURPOSE OF THE STUDY: Arthroscopy of the wrist is a method facilitating the establishment of diagnosis in patients with wrist complaints which may also serve for surgical management of some of the causes of wrist pathology. The author presents his first experience with carpal arthroscopy as a diagnostic method as well as a therapeutic technique performed in one or two stages. MATERIAL: A total of 34 patients, 12 women and 22 men, in the age range of 14 to 64 years, underwent carpal arthroscopy. This was performed to treat acute or chronic conditions in 16 and 18 patients, respectively. METHODS: Arthroscopy was carried out with the hand in vertical traction, using distraction forces of 50 to 70 N, from the approach between the third and fourth or/and the fourth and fifth extensor compartments, in order to inspect the mediocarpal joint by an arthroscope with a diameter of 2.4 mm. Neither a tourniquet nor a pump was employed. When a lesion was detected, it was treated by arthroscopy or an open procedure in one surgical procedure. When indicated, further surgical intervention followed. RESULTS: The arthroscopic inspection revealed triangular fibrocartilagenous complex (TFCC) lesions in 18 patients. Injury to the scaphoid-lunate (SL) ligament was found in 16 patients. One patient had a combined lesion of the triquetral-lunate and SL ligaments, two showed a SL lesion together with a distal radius fracture, three were diagnosed with pseudoarthrosis of the scaphoid bone and one with synovitis after rheumatoid arthritis. In two patients, adhesions in the radiocarpal joint following a fracture of the distal radius were found and shaved. A total of 22 patients were treated by arthroscopic surgery; 19 underwent open procedures in one stage and five were indicated for secondary surgery. DISCUSSION: Wrist arthroscopy has been reported in the literature as the only method that can reveal damage to SL ligaments not shown by X-ray or magnetic resonance imaging examination. During arthroscopy, several interventions can directly be carried out by this procedure, such as treatment of the TFCC, and thus relieve the patient's complaints. Arthroscopy is irreplaceable in the diagnosis of dynamic carpal instability or injury to TFCC in ulnar-carpal impingement. Our experience suggests that arthroscopically-guided osteosynthesis of the distal radius has great prospects. CONCLUSIONS: In our hospital acute arthroscopy is indicated when carpal connective tissue lesions, potentially leading to wrist instability, are suspected, when damage to carpal ligaments is found by X-ray examination or when an acute TFCC lesion is suspected. Arthroscopically-guided osteosynthesis of the distal radius appears to be a prospective method. In patients with chronic complaints, wrist arthroscopy is indicated in suspected TFCC lesions with ulnar-carpal impingement, in chronic carpal synovitis, and before sperious operations on the carpal bones in order to ascertain the state of cartilage and plan the appropriate surgery.

Adolescent↗
PubMed1997

Predilection for supracondylar fractures in children with cubital recurvatum.

It has been a common observation that children with supracondylar fracture of the humerus tend to demonstrate hyperextensibility of their elbow joints. In this study, we measured and compared the degree of hyperextension of the uninjured elbow of children less than sixteen years old who sustained either a supracondylar or a distal radial fracture. We concluded that children with higher degree of hyperextension in the elbow are more likely to sustain a supracondylar fracture than a distal radius fracture during a fall on the outstretched hand.

Accidental Falls↗
PubMed2005

Treatment of distal radial fractures with grafting and K-wiring.

We present a series of 10 distal radius fractures treated with either bone substitute or xenograft, and Kapandji's technique (intra-focal threaded Kirschner wires which lever on the graft before penetrating the opposite diaphyseal cortex). The Kirschner wires are buried. Long-term follow-up (one to five years, mean 2.8 years) shows very little secondary displacement (up to 3 mm loss of radial height on the antero-posterior views and none on the sagittal views), excellent tolerability and integration of substitute and good function. The above operative technique has the advantage to allow immediate mobilisation of the wrist.

Aged↗
PubMed2002

Use of injectable calcium phosphate cement for fracture fixation: a review.

Injectable osteoconductive calcium phosphate cements have been introduced as an adjunct to internal fixation for treating selected fractures. These cements harden without producing much heat, develop compressive strength, and are remodeled slowly in vivo. The main purpose of the cement is to fill voids in metaphyseal bone, thereby reducing the need for bone graft, but cements also may improve the holding strength around metal devices in osteoporotic bone. Several bioactive cements are being developed. One of these cements, Skeletal Repair System, is available in Europe and has been approved by the United States Food and Drug Administration for use in selected distal radius fractures. Cadaveric studies have shown that using Skeletal Repair System cement with conventional metal fixation in certain fractures of the distal radius, tibial plateau, proximal femur, and calcaneus can produce better stability, stiffness, and strength than metal fixation alone. Early clinical results have shown reduced time to full weightbearing when cement has been used for augmentation of tibial plateau and calcaneal fractures, more rapid gain of strength and range of motion when used in distal radius fractures, and improved stability in certain hip fractures. Bioactive cements in general also may prove useful in vertebroplasty.

Animals↗
PubMed1991

Treatment of displaced articular fractures of the radius.

Forty patients with articular fractures of the distal radius in which anatomic reduction of the joint surface could not be obtained by closed manipulation or by ligamentotaxis with external fixators had a combination of percutaneous and/or open reduction techniques to restore articular congruity. X-ray films taken after treatment with an average follow-up of 4 years showed satisfactory extraarticular alignment in 85% of the cases, and 37 (92.5%) patients demonstrated an articular step-off of 1 mm or less at late follow-up examination. Radiographic evidence of radiocarpal arthritis was present in 5% of the cases at follow-up examination.

Adolescent↗
PubMedDate not supplied

Monteggia and equivalent lesions in childhood.

One hundred two children with acute Monteggia lesions treated over a 25 year period were reviewed. Using the Bado classification system, type 1 (53%) and type 3 (26%) fractures were the most common. The type 1 equivalent injury associated with a proximal radius fracture is more common in children than previously reported. The majority of injuries could be treated with closed reduction, except the type 1 equivalent lesions, which required operative treatment in 10 of 14 children. Varus angulation of the ulna was the most common deformity after closed treatment. Nerve injuries occurred in 11% of the injuries, and resolved in all cases without operative treatment.

Adolescent↗
PubMed2000

[Indication and results of ulna shortening osteotomy in ulnocarpal wrist joint pain].

The ulnar impaction syndrome is proven to be a common source of ulnar sided wrist pain. Ulna-shortening osteotomy represents a successful therapy for this kind of problem, both congenital or posttraumatic positive ulnar variance. Positive variance resulting from a distal radius fracture needs correct dorsal and radial angulation of the radius. In case of congenital positive variance arthroscopic debridement for decompression of the TFCC should be performed first. The adequate correction of the length is the major problem. Disorders of the distal radioulnar joint may result due to overcorrection. Oblique osteotomy using 7-hole-plates is our preferred treatment.

Adult↗
PubMed1990

Open reduction and internal fixation of comminuted, intraarticular fractures of the distal radius.

Comminuted intraarticular fractures of the distal radius present a difficult problem in management. It is well established that unreduced significant articular incongruency will result in early degenerative osteoarthritis. The technical demands of, and the results to be expected from, formal open reduction and internal fixation of these comminuted articular fractures have not been addressed in the current literature. From 1981 to 1986, 20 patients were treated by open reduction after failure of closed means. Seventeen patients were personally reviewed at an average follow-up of 3.25 years. The results indicate that the procedures are technically demanding and have high early (15%) and late (35%) complication rates. This gives an overall complication rate of 50%, including the need for further operative procedures. However, patient satisfaction is very high, most patients (89%) returning to previous occupations. Function and radiographic results are excellent. Articular congruency was restored in 88%.

Adult↗
PubMedDate not supplied

Longitudinal growth pattern of the radius after forearm fractures conservatively treated in children.

In a 3-year prospective study, the growth pattern of the radius following fracture was analyzed in 64 children < 15 years old with forearm fractures treated by conservative methods. Comparative radiographic studies of the fractured and the uninjured radius were carried out in all patients at 3, 6, 12, and 18 months after fracture. Only 40 patients, 28 boys and 12 girls, with an average age of 9 years, completed the follow-up period. The series included 19 buckle fractures of the radius, 11 green-stick, and 10 complete fractures. Fracture of the ulna was associated in 11 cases. Maximal average radial growth rate was observed from age 9 through 12 years. Overall, the length discrepancy between the fracture and the healthy radius at the end of the follow-up period averaged 0.03 cm (range -0.50 to +1). In nine cases (21%), the fractured radius showed an average overgrowth of +0.44 cm. In 10 other patients (25%), a radial shortening could be detected (average discrepancy -0.29). Five of the nine cases with radial overgrowth had an associated fracture of the ulna. This association was not found in any of the 10 patients with radial shortening. These observations allow us to reconsider the classic etiopathogenic theories concerning overgrowth in the long bones of children following fracture. Factors other than the increased vascularity of the growth plate--as is postulated for the femur and tibia--must be investigated further to explain the frequent absence of radial overgrowth following fracture.

Adolescent↗
PubMed1997

[New developments in the application of resorbable implants].

The application of biodegradable implants is combined with advantages and disadvantages. They offer a great deal of innovative ideas. Best evaluation has been done with pins for the fixation of low loaded osteochondral fractures. When using 2.7 mm Polypin primary mechanical stability of distal radius fractures is comparable with the fixation by 1.8 mm K-wires. A prospective and randomised study with two years follow up, including 183 radial head fractures, showed no significant difference in results and complications in metal and polyactide implants. For this localisation and other comparable indications the implant can be recommended. Despite the more extensive degradable device overall costs can be reduced with the polymer implant. Orientruded polyactide screws showed good clinical results, newetheless resorption was extremely late within 5 to 7 years.

Adolescent↗
PubMed2003

Surgical correction of deformities of the distal radius due to fractures in pediatric patients.

INTRODUCTION: The indication and treatment of malunited fractures of the distal radius in the growing skeleton differ from those for adults. The literature results are scarce. In this study we examined the results of surgical correction following fractures of the distal radius in infants. MATERIALS AND METHODS: Seven infant patients with malaligned fractures of the distal radius that demonstrated significant functional deficit and poor prognosis for spontaneous recovery were treated with surgical correction. Two of them were treated because of growth disturbance from post-traumatic closure of the distal radial physis. RESULTS: All seven osteotomies healed with acceptable radiologic alignment. After an average follow-up period of 3 years and 1 month (range 10 months to 8 years and 4 months), patients had an average range of wrist motion (ROM) of 131 deg in extension and flexion (93% of the contralateral side, 130% of presurgical situation); 65 deg in ulnar and radial deviation (94% of the contralateral side, 122% of presurgical situation); and 177 deg in pronation and supination of the forearm (97% of the contralateral side, 115% of presurgical situation). The average grip strength of 71.4 kPa was nearly equal to the other side with 72.8 kPa. The average postoperative angulation of the distal radius was 12 (range 10-17) deg, the radial inclination 20 (range 12-30) deg, and the ulnar variance was -0.6 (range -3 to +2) mm. According to the Fernandez point score system as well as the scale of Fernandez, there were five excellent results and two good results. The patients described low disability on the DASH scores, with a median of 4 (range 0-41) points. CONCLUSIONS: Surgical correction for malunited fractures of the distal radius provides good and excellent radiological and functional results in the growing skeleton. It should be considered immediately if there is poor remodeling capacity and disabling loss of function.

Adolescent↗
PubMed1999

Entrapment of the index flexor digitorum profundus tendon after fracture of both forearm bones in a child.

Entrapment of the index FDP tendon in a radius fracture callus occurred after fracture of both forearm bones in a 4-year-old boy. Surgical release of the FDP tendon, three months after fracture, resulted in normal index finger motion. This clinical problem can be avoided by a detailed physical examination of children with forearm fractures, verifying full passive range-of-motion of the hand after cast immobilization. Prompt supervised active range-of-motion should be done to prevent adhesions at the fracture site.

Child, Preschool↗
PubMed1993

[Correction of distal radial malunion by forward-sliding osteotomy. 3 case reports].

The "forward-sliding autograft" osteotomy is designed for the correction of malposition of the distal radius following distal radius fracture of which more than 70% (of 122 fractures) appear to unite with a dorsal tilt. The osteotomy technique described seems to be effective, maintaining identical length of both arms, and only needs local anesthesia. A local autologous graft is used instead of the iliac graft. Only minimal internal fixation material is required and removal of metal is not necessary. The dorsal approach is safe and free of nerve endings. The procedure is ideal for outpatient surgery and can be performed in a one day surgery center, ie on an outpatient basis. Osteopororis appears to have no effect on the results. However the technique is demanding and preoperative planning is mandatory. The surgeon should be familiar with the use of the external fixator in the case of secondary instability.

Adult↗