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PubMed2000

Extensor tendon rupture secondary to the AO/ASIF titanium distal radius plate without associated plate failure: a case report.

Complications with open reduction and internal fixation of distal radius fractures have led to the development of the AO/titanium Pi-plate. This was designed to be a low-profile plate to decrease its intrusion into surrounding soft tissues. Recent case reports are revealing an association of tendon ruptures with failures of this plate. This case report demonstrates extensor tendon rupture without plate failure or prominent screw heads.

Adult↗
PubMed1997

A prospective study of thiazide use and fractures in women.

Thiazide diuretics reduce urinary calcium and may inhibit bone resorption, and hence may help to attenuate age-related bone loss and to lower the risk of osteoporotic fracture. We followed 83728 women, who were 36-61 years of age at baseline in 1982, for 10 years with biennial mailed questionnaires on which they reported incident fractures, use of thiazide diuretics, and other medical behavioral information. From descriptions of fracture sites and circumstances, 251 hip (proximal femur) and 1594 forearm (distal radius) fractures were identified as low or moderate trauma events. After controlling for age, body mass index, menopausal status, postmenopausal hormone use, cigarette smoking and dietary factors, we observed a statistically significant 22% reduction in the risk of forearm fractures among current thiazide users compared with women who reported no thiazide use. Risk appeared to decline with longer duration of use, reaching a 37% reduction in risk among women who had been using thiazides for 8 or more years. For hip fractures, thiazide use was protective among the postmenopausal women (relative risk = 0.69, 95% confidence interval 0.48-0.99). We conclude that the potential benefit of thiazide diuretics for osteoporosis should be considered when prescribing antihypertensive treatment.

Adult↗
PubMed2001

Simple treatment for torus fractures of the distal radius.

Torus (buckle) fractures of the distal radius are common in childhood. Based on the results of a postal questionnaire and a prospective, randomised trial, we describe a simple treatment for this injury, which saves both time and money. Over a six-month period, we randomised 201 consecutive patients with this injury to treatment with either a traditional forearm plaster-of-Paris cast or a 'Futura-type' wrist splint. All patients were treated for a period of three weeks, followed by clinical and radiological review. There was no difference in outcome between the two groups, and all patients had a good result. Only one patient did not tolerate the splint which was replaced by a cast. The questionnaire showed a marked variation in the way in which these injuries are treated with regard to the method and period of immobilisation, the number of follow-up visits and radiographs taken. We suggest that a 'Futura-type' wrist splint can be used to treat these fractures. The patient should be reviewed on the following day to confirm the diagnosis and to give appropriate advice. There is no evidence that further follow-up is required. This simple treatment has major benefits in terms of cost and reduction of the number of attendances.

Adolescent↗
PubMed1999

Biomechanical evaluation of wrist motor tendons after fractures of the distal radius.

We conducted a biomechanical study of changes in parameters of wrist motor tendons in fractures of the distal radius in 7 cadaveric extremities. Extra-articular distal radius fractures were simulated by distal radius osteotomy and fracture angulation was maintained by external fixators. Eight positions of the distal radius fractures were studied: dorsal angulation of 10 degrees, 20 degrees, 30 degrees, and 40 degrees and radial angulation of 5 degrees, 10 degrees, 15 degrees, and 20 degrees. Dorsal and radial angulation of the fractures were measured with respect to the shaft of the radius. Excursions of 5 principal wrist motor tendons extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris were recorded simultaneously with wrist joint angulation using a computer-assisted recording system. Data were collected from intact wrists and from wrists with fractures at each of 8 positions of angulation during wrist flexion and extension and radical and ulnar deviation. Moment arm of the wrist motor tendons was derived from tendon excursion and joint angulation. The results demonstrated that excursions and moment arms of principal wrist motor tendons are significantly affected by dorsal and radial angulation of distal radius fractures. Amplitude of changes in moment arms increased as the deformities became more severe. Statistical analysis revealed that dorsal angulation of 10 degrees or more significantly affected moment arms of all the prime wrist motors. Dorsal angulation of 30 degrees or 40 degrees changed the moment arms greatly. Radial angulation of 5 degrees did not affect moment arms of the tendons and angulation over 10 degrees had a statistically significant effect on the tendons. We conclude that deformities of distal radius fractures have a significant influence on the biomechanics of the wrist motors.

Aged↗
PubMed2001

Orthopedic pitfalls in the ED: Galeazzi and Monteggia fracture-dislocation.

Occult dislocations at the wrist and elbow frequently accompany forearm fractures. When left unrecognized and untreated, these injuries lead to a high incidence of long-term functional disability and chronic pain. Emergency medicine practitioners need to be vigilant for both Galeazzi (distal radius fracture with radioulnar joint disruption), and Monteggia (proximal ulna fracture with radial head dislocation) fracture-dislocations. This review article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency practitioner.

Accidental Falls↗
PubMed2006

A convenient dynamic wire traction-fixation method for hand and forearm fractures.

We report on a convenient intraoperative distraction technique, called the modified Dynamic Wire-framed Traction (mDWT) method, that assists in fracture reduction and/or is used as an external fixator in patients with unstable distal radius fractures and in other hand and forearm fractures. The mDWT device is easily assembled with wires at the time of surgery, and its configuration produces sufficient longitudinal distraction force that makes reduction easier and facilitates additional fixation procedures. Furthermore, the device can be converted into a simple unilateral external fixator that can be retained postoperatively. Our experience with 13 patients shows that the mDWT method is easy to apply and is a cost-effective technique when used as an intraoperative distraction device or as an external fixator.

Adult↗
PubMed2004

[Distal radius anterior marginal fractures treated with anterior plating. Mid-term results].

PURPOSE OF THE STUDY: We report a retrospective series of anterior marginal fractures of the distal radius treated by anterior plating in order to analyze results and identify prognostic factors. MATERIAL AND METHODS: This continuous series included 22 patients with an anterior marginal fracture of the distal radius treated between 1993 and 1999. Three patients were lost to follow-up. This analysis thus concerned 19 fractures in 15 men and 4 women, mean age 39 years. Surgical reduction and T-plate anterior fixation was used in all cases. RESULTS: Mean follow-up was 26 months. Anatomic results were satisfactory in 15 patients and poor in one. Function was satisfactory in 17 patients and poor in one. We noted two types of complication: spontaneously regressive reflex dystrophy (n=2) and osteoarthritis which developed in two patients after incomplete reduction. DISCUSSION: Anterior plating can provide satisfactory results for anterior marginal fractures of the distal radius if anatomic reduction is achieved. This method remains our preferred therapeutic approach with special attention being required for anatomic reduction.

Adolescent↗
PubMedDate not supplied

Internal fixation of pilon fractures of the distal radius.

When closed manipulation fails to restore articular congruity in comminuted, displaced fractures of the distal radius, open reduction and internal fixation is required. Results of surgical stabilization and articular reconstruction of these injuries are reviewed in this retrospective study of 49 patients with 52 displaced, intra-articular distal radius fractures. Forty-three patients (87%) with a mean age of 37 years (range of 17 to 79 years) were available for evaluation. The mean follow-up time was 38 months (range 22-69 months). When rated according to the Association for the Study of Internal Fixation (ASIF), 19 were type C2 and 21 were type C3. We devised an Injury Score System based on the initial injury radiographs to classify severely comminuted intra-articular fractures and to identify those associated with carpal injury (3 patients). Post-operative fracture alignment, articular congruity, and radial length were significantly improved following surgery (p < .01). Grip strength averaged 69% +/- 22% of the contralateral side, and the range of motion averaged 75% +/- 18% of the contralateral side post-operatively. A combined outcome rating system that included grip strength, range of motion, and pain relief averaged 76% +/- 19% of the contralateral side. There was a statistically significant decrease in the combined rating with more severe fracture patterns as defined by the ASIF system (p < .01), Malone classification (p < .03), and the Injury Score System (p < .001). The Injury Score System presented here, and in particular the number of fracture fragments, correlated most closely with outcome of all the classification systems studied. Operative treatment of these distal radius fractures with reconstruction of the articular congruity and correction of the articular surface alignment with internal fixation and/or external fixation, can significantly improve the radiographic alignment and functional outcome. Furthermore, the degree to which articular stepoff, gap between fragments, and radial shortening are improved by surgery is strongly correlated with improved outcome, even when the results are corrected for severity of initial injury, whereas correction of radial tilt or dorsal tilt did not correlate with improved outcome.

Adolescent↗
PubMed1993

[The painful ulno-carpal joint. Diagnosis and therapy].

The ulnocarpal joint plays a critical role in hand and wrist function. It serves as part of forearm rotation as well as part of the carpal kinematics. The joint is comprised of the distal radio-ulnar articulation, triangular fibrocartilage complex, lunate, triquetrum, hamate, and pisiform, and the intra and extracapsular ligamentous and soft tissue constraints. Traumatic disruptions as well as chronic inflammatory conditions are commonplace. In addition to standard radiographs, arthrography, CT scanning, and MRI studies prove useful. Wrist arthroscopy is becoming of increasing importance in this region of the wrist. Ulnar impaction syndrome may occur associated with malunion of distal radius fracture, ulna positive variance, or chronic TFCC tears. Osteotomy of the distal radius or ulnar shortening osteotomy should be considered. Instability of the distal ulna can be treated with tenodesis procedures, hemi-resection arthroplasty, matched ulna resection or the Sauvé-Kapandji procedure.

Biomechanical Phenomena↗
PubMed2001

[Arthroscopic diagnosis of concomitant scapholunate ligament injuries in fractures of the distal radius].

To investigate the occurrence of carpal ligamentous injuries in patients with fractures of the distal radius, the results of 122 wrist arthroscopies were analysed within a retrospective study. Indications for arthroscopy included suspected carpal instability according to radiographic findings and/or the necessity for internal fixation of the radius fracture. Arthroscopy revealed acute scapholunate ligament tears in 84 patients. Scapholunate separation was found to be of prognostic value for ligament tears. There was no association between ligamentous lesions and carpal angles or fracture dislocation. Scapholunate ligament tears were most frequent in sagittal articular fractures. In these cases, wrist arthroscopy should be performed during operative treatment of the radius fracture to allow direct visualization and subsequent repair of ligamentous tears.

Adolescent↗
PubMed1995

[Osteosynthesis using intra-focal pins of anteriorly dislocated fractures of the inferior radial epiphysis].

The authors describe two anterior approaches to intra-focal pinning of distal radius fractures, with anterior tilt, Smith type and anterior margin type. They demonstrate that this fixation mode is as reliable as anterior plate osteosynthesis, with less anatomic cost. It allows immediate mobilization and affords good functional results. Performed with regular K. Wire or better with "Arum" Pins, this procedure was used in ten Smith's fractures, six anterior margin fractures, one two-margins fractures, and twelve multi-fragment fractures. Anterior pins are also used when excessive anterior reduction is feared in Colle's fractures. Secondary displacements are rare, except radius shortening which is possible with all types of fracture and treatment. As cast is prohibited, early rehabilitation provides good and excellent functional results. Complications are exceptional, occurring at the beginning of the authors' experience. Thanks to some precaution, such as the "open approach" and protecting the pin ends, this technique is simple, reliable, economic and effective.

Bone Nails↗
PubMed2000

[Influence of patient's age and fracture morphology on the final result of conservative treatment].

Three hundred and thirty-three cases of the distal radius fractures have been retrospectively analyzed. The patients were divided into 4 age groups (15-29, 30-49, 50-69 and above 70 years of age) and into 8 groups according to Frykman's classification of fracture morphology. Excellent and good results in the first and second age group were found in 84.3% (patients evaluation), in 85.3% (clinical evaluation according to Gartland-Werley criteria) and in 87.2% (radiologic Sarmiento scale). The scores in age groups III and IV were 69.7%, 67.1% and 52.4% respectively. Extraarticular fractures (Frykman I and II) were found in 69.7% in age groups II and I and in 37.3% in group III and IV. Excellent and good results in the extraarticular fractures group were found in 88% subjectively, 84.2% clinically and in 85.1% radiologically whilst in the intraarticular fractures group in 57.6%, 59.3% and 37.4% respectively. Clinical and radiologic results worsen as the fracture morphology gets more complicated and this occurs with increasing age of the patient.

Adolescent↗
PubMed1988

Simultaneous fractures of the distal radius and scaphoid.

Simultaneous fractures of the distal radius and scaphoid are uncommon injuries for which the treatment is controversial. Nine patients with these fractures are presented. Five patients were available for long-term followup. In the series, there were five Colles and four Smith's fractures of the distal radius. All scaphoid fractures occurred at the anatomic waist. All injuries resulted from falls of considerable force producing hyperextension at the wrist. The ages of the patients ranged from 21 to 90 years (median, 34). All fractures were placed in a thumb spica cast with the wrist in neutral position. Five fractures required a second reduction of the radius and were placed in external skeletal fixation. No scaphoid fracture was displaced by this treatment, and all scaphoid fractures progressed to union. The principal deformity at followup was an average 16 degrees loss of volar tilt. Residual pain or functional disability was not noted. We conclude that these fractures can be successfully treated by reduction of the radius and immobilization by whatever means necessary to maintain an acceptable position. Scaphoid reduction and healing seemed unaffected by the method of treatment used to treat the distal radius fracture in this series.

Adult↗
PubMed2002

[The VB system: a new modular osteosynthesis material involving both screws and wires].

VB is an osteosynthesis system for the stabilisation of small fragments, which combines the benefits of both wires and screws. It is a modular system comprising a threaded pin and a ring. The threaded pin is first positioned. Then a ring is grasped and opened by the progressive angulation of a screwdriver. Still anchored on the screwdriver, the ring slides easily on the pin. It is clamped on the pin by simply removing the screwdriver and the pin is then cut. This modular system includes 1.8 and 1.1 mm pins and different types of rings (threaded or non threaded, with or without collars). The system is easy to handle and can be introduced using an open or percutaneous technique, allowing compression or distraction. Our preliminary series, performed in accordance with National clinical trial protocol (Huriet) consisted of 50 cases in 24 patients (five women and 19 men) with an average age of 48 years, and a follow-up of more than six months. Fourteen cases of fractures (28 implants) were treated as emergencies (two radial heads, one capitellum, one trochlea of the humerus, seven distal radius fractures, one trapezium, two metacarpals) and 12 cases (22 implants) were elective cases: arthrodesis (one trapezo-metacarpal, one intermetacarpal, two interphalangeal, two carpal), non-union (six scaphoids, one phalangeal) and one phalangeal malunion. Hardware removal was performed in 16 cases. No implant failure has been detected. One case, a DIP arthrodesis, had a suspicion of sepsis which led to the removal of the implants at six weeks. The results of this study have convinced us of the merits of the system, which combines the advantages of both wires and screws. The system allows the user to perform either distraction or compression, and to adjust the force by hand. Compared to the fixed amount of compression produced by lag screws, this feature seems to be a real step forward.

Adult↗