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PubMed1989

Repair of the triangular ligament in Colles' fracture. No effect in a prospective randomized study.

We present a prospective and randomized study of two different treatments of extraarticular Colles' fracture with a fractured ulnar styloid. The study comprised 41 patients with 2 years' follow-up; 22 patients were treated with closed manipulation and an above-the-elbow plaster cast, whereas in 19 patients the avulsed ulnar styloid was transfixed and/or the triangular ligament was repaired after closed reduction of the fractured radius. In all the operated on patients, a complete rupture of the triangular ligament was found. Good reduction of all the fractures was achieved primarily according to the radiographic examination. At follow-up the alignment had deteriorated, with no difference between the two treatment groups. Neither did the findings in the wrist arthrograms differ between the two groups nor did the subjective complaints of the patients. We conclude that repair of the ruptured triangular ligament in extraarticular fractures of the distal radius is not better than conventional treatment.

Adolescent↗
PubMed1994

[Differential treatment of fractures of the distal radius].

Treatment of distal fractures of the radius has undergone considerable change during recent years. The cause for this lies primarily in the poor results of conservative treatments. In addition to osseous instability, the fractures of the radius are frequently combined with ligamentary instability as well, thereby exceeding the ability of conservative treatment. Among the many classifications, the AO classification of these fractures has proven to be the best and most widely accepted. This classification allows the recommendation of suitable procedures of treatment. The problem with inadequately healed fractures of the radius lies in the inherent unphysiological loading of the joint in the characteristic dorsal tilted position. This leads to a pathological displacement of the radius of flexion and extension and thereby to an overloading of the dorsal joint cartilage. The shortening of the radius leads to a mechanical impingement of the triangular fibrocartilagenous complex. The Kirschner wire fixation is particularly indicated in type A and type C fractures when combined with an external fixator. Of great importance here is the crossing of the K-wires, best accomplished by inserting an additional wire in a proximal to distal direction to achieve maximal mechanical stability. Biodegradable fixation devices are not yet in widespread use, as high costs and possible foreign body reactions have prevented their acceptance. The plate osteosynthesis has its domain in the treatment of volar luxation fractures (B3) and the partially articular fractures of the radius (B2). The domain of the external fixator, on the other hand, lies in the C2 and C3 fractures in combination with the K-wire osteosynthesis. Changing the mode of treatment to a plate osteosynthesis after two to three weeks allows a functional postoperative treatment. By use of a differentiated treatment regimen, the complication rate can be significantly reduced whose cause frequently lies in repeatedly attempted repositions. Nevertheless, a rupture of the tendon of the M. extensor pollicis longus takes place in a certain percentage of cases (less than 0.2%) due to the unusual vascularization of this tendon. The dystrophy of Sudeck has become a relatively rare occurrence. A connection between a compression syndrome of the median nerve and the dystrophy of Sudeck has been discussed. The differentiated management has led to a change from a purely conservative treatment to a more varied treatment of the fractures of the distal radius. In our own patients conservative treatment was carried out in 27.5%.

Bone Wires↗
PubMed1998

Controversies regarding radial neck fractures in children.

Fractures of the radial neck in children are not uncommon, yet several aspects of their management remain controversial. Until a consensus is reached regarding the determination of displacement, acceptability of initial angulation, treatment, and outcome, the complication rate of these fractures will remain high. The authors recommend measuring the displacement as the angle between a line perpendicular to the articular surface of the radial head with a line down the shaft of the proximal radius. Fractures that are angulated less than 30 degrees require immobilization alone. Fractures angulated more than 30 degrees should be treated with an attempt at closed reduction. If closed reduction fails, a percutaneous reduction should be attempted before open reduction. Internal fixation should be performed using an oblique extraarticular Kirshner wire for all unstable fractures. Grading outcome based on range of motion and the presence or absence of pain is recommended. It is hoped that once the controversies surrounding these fractures are resolved, the long term results of these troublesome injuries will improve.

Adolescent↗
PubMed2006

The flexor carpi radialis brevis muscle: an anomalous flexor of the wrist and hand. A case report.

The incidental finding of an aberrant wrist flexor is reported. This anomalous muscle was identified during surgical reconstruction for a distal radius fracture malunion. Distal and proximal dissection showed an independent, well-formed muscle belly with no interconnections to adjacent structures. A review of the literature yielded a report of these findings in cadaveric specimens; here we give a description in a living person.

Fractures, Malunited↗
PubMed2000

External fixation of the distal radius: to predrill or not to predrill.

Using both clinical and laboratory studies we investigated whether predrilling before insertion of external fixation pins is necessary for use in treating distal radius fractures. Our clinical study included 50 consecutive external fixators (4.0- and 2.5-mm pins) using 100 predrilled and 100 direct-drilled pins placed in a randomized manner. There was no increased incidence of pin track infection or other pin problem with the direct-drilled technique. There were, however, significantly elevated temperatures with the direct-drilled technique. We therefore recommend predrilling even though the temperature differences in this bone with this fixator were not clinically evident.

Adolescent↗
PubMed1996

Reconstructive osteotomy for malunion of the distal radius.

Common misconceptions about distal radius fractures result in undertreatment of many fractures, particularly in an active population. Loss of reduction of the fracture may cause a symptomatic malunion. Fourteen patients with an average age of 39 years (range, 21-65 years) underwent reconstructive procedures for radial malunions. The common malunion healed in a position of dorsal angulation, loss of radial inclination, and radial shortening. Ten patients had been treated by closed means, and 4 had undergone earlier surgical procedures without acceptable healing position of the fracture. Seven patients underwent a radial osteotomy alone, 5 patients had an osteotomy with an ulnar leveling procedure, and 2 patients had a Sauvé-Kapandji procedure alone. The average improvement in radial inclination was 14 degrees (range, 0 degrees-34 degrees), volar tilt 21 degrees (range, 2 degrees-33 degrees), and improvement in a positive ulnar variance by 6.8 mm (range, 0-48 mm). The complication rate was 29%, with a followup of 29 months (range, 12-43 months). Functional improvement was notable in 12 of 14 patients. Surgical reconstruction for malunions is technically difficult and may not completely restore the anatomy. Patient satisfaction, however, in terms of increased function, decreased pain, and decreased deformity is sufficiently high to warrant reconstructive treatment.

Adult↗
PubMed1992

[Technique and results of modified percutaneous bore wire osteosynthesis of the distal radius].

A modified technique for percutaneous K-wire pinning of distal radius fractures is presented. With this method, three to four K-wires are introduced from the radial styloid process towards and through the dorsal, volar and ulnar proximal cortical wall, respectively. After the fracture fragments have been demonstrated to be stable, the wires are cut, bent over and fixed. Then a dorsal plaster splint is applied, which should be worn for 4-6 weeks, depending on whether or not there is a dorsal comminution zone. Fifty-five patients have been operated on by this method. At follow-up 6 months after the operation, no secondary dislocation, wire migration, infection, Sudeck syndrome or functional disturbance was seen. The advantage of this method is emphasized as compared with the usual, previously published method.

Adult↗
PubMedDate not supplied

Traumatic ulnar physeal arrest after distal forearm fractures in children.

A review of the orthopaedic literature suggests that traumatic ulnar physeal arrest associated with radial fracture is a rare occurrence. Twenty-three cases of traumatic ulnar physeal arrest have been reported in patients with distal radius fractures, and we report five additional cases. A classification system for the distal ulnar growth deformities is proposed, and the compensatory radial changes are reviewed. Surgical indications for treatment include cosmetic deformity, progressive carpal subluxation, and decreased range of motion. Surgical options for treatment are discussed and include epiphysiodesis, ulnar lengthening, radial osteotomy, and the Suave-Kapandji procedure.

Adolescent↗
PubMed1993

Limb fracture pattern in different pediatric age groups: a study of 3,350 children.

The fracture patterns of 3,350 children with 3,413 limb fractures admitted to one center from 1986 to 1990 were analyzed retrospectively. The overall boy-to-girl ratio was 2.7:1, rising to 5.5:1 in the adolescent group. Distal radius fracture was the most common fracture (19.87%), followed by supracondylar fracture of the humerus (16.64%) and forearm shaft fracture (13.36%). Specific age group breakdown showed that supracondylar fracture of the humerus was the most common fracture occurring in the age groups 0 to 3 years and 4 to 7 years, accounting for 28.94 and 31.18% of all limb fractures, respectively. Fracture of the distal radius occurred in 27.06% of the 8 to 11 year age group and 23.31% of the 12 to 16 year group. Open fractures were uncommon (2.17%), and greenstick fractures were found only in 5.27% of this hospital series. The nondominant arm was found to have more fractures although the number was not statistically significant. Seasonal variation in incidence occurred, with more cases in the summer and autumn months. The open reduction rate in the treatment varied from 10.15% in the 0 to 3 year age group to 33.95% in the 12 to 16 year group. Forty-five percent of the 0 to 3 year age group were discharged from hospital within 24 h, contrasting with 30% in the other age groups. Overall incidence of fractures requiring hospital treatment was estimated to range from 35 per 10,000 in the 0 to 3 year age group to 62, 60, and 57 per 10,000 in the 4 to 7, 8 to 11, and 12 to 16 year groups, respectively.

Adolescent↗
PubMed2006

Graft-supplemented, augmented external fixation in the treatment of intra-articular distal radial fractures.

This article compares the functional and radiographic outcomes of intraarticular distal radial fractures treated with augmented external fixation in which autologous cancellous bone grafting or Norian SRS (Norian Corp, Cupertino, Calif) was used for filling the metaphyseal void. Thirty non-randomized patients, 15 in each group, with AO type C distal radius fractures (20 men and 10 women; average age: 48 years) were operatively treated between 1998-2000 and retrospectively evaluated. Radial inclination, radial length, volar tilt, and Modified Mayo Wrist Score were assessed at the most recent follow-up evaluation (average: 33.3 months). Overall, 12 (80%) patients in the Norian group had an excellent or good result, 2 had fair, and 1 had poor. In the autologous iliac bone graft group, the results were excellent or good in 11 (73.3%) patients, fair in 1, and poor in 2. No statistical difference between the two types of grafting was noted. Norian SRS is equally effective to cancellous bone as supplementary graft in comminuted distal radial fractures treated by external and Kirschner-wire fixation.

Adult↗
PubMed1992

Earlier wrist fracture: a confounding factor in distal forearm bone screening.

Thirty-six women aged 60, 70 or 80 years who had fractured one of their distal radii (Colles' fracture) 0 to 35 (median 10) years earlier were examined in this population-based study. Single photon measurements (SPA) were performed on both arms 1 cm and 6 cm proximal to the styloid process of the ulna. All women were questioned about earlier wrist fractures and which, if any, side had been affected. Information about the type and site of the fracture was also gathered from the hospital records. The bone mineral content (BMC) was found to be increased by almost 20% in the once-fractured radius at the distal measuring site (1 cm) when compared with the unaffected side. This difference did not seem to diminish with time. At the proximal measuring site there was no difference between the once-fractured and the non-fractured side. There was a progressive loss of bone mineral in the once-fractured arm during the first years after the fracture however. This appeared to be reversed after about 10 years to a relative gain, even though the correlation was weak. Six of the 36 women could not remember which side had been fractured and five could not remember having had such a fracture at all. Determination of osteoporosis by measuring forearm BMC with single photon densitometry is therefore of limited value in some women of the oldest age groups.

Age Factors↗
PubMed2003

[The hemiresection-interposition arthroplasty as a salvage procedure for the arthrotically destroyed distal radioulnar joint].

The arthrotically destroyed distal radioulnar joint will lead to painful limitation of forearm rotation. Alternative treatment options are the hemiresection-interposition arthroplasty or the Kapandji-Sauvé procedure. The aim of our study was to evaluate the clinical and functional results following the hemiresection-interposition arthroplasty in non-rheumatoid patients. The most common posttraumatic cause of the arthrosis was the malunited distal radius fracture. In a retrospective study we examined 36 of 51 patients with a mean age of 53 years after an average follow up of 34 months clinically, radiologically and using the DASH questionnaire. The average preoperative pain measured 7.8 on the visual analog scale and was reduced statistically highly significant (p < 0.01) to 3.9. Whilst pronation increased statistically not significantly from a mean of 74 degrees to 76 degrees (p = 0.428), supination improved significantly from 54 degrees to 69 degrees (p - 0.012). The average grip strength increased statistically highly significant (p<0.001) from 40% to 64% compared to the unaffected side. Patients' satisfaction with the result averaged 6.9 on a visual analog scale. Using a modified Mayo-wrist score, six patients were rated to have an excellent, eleven patients a good, ten patients a satisfactory and four patients a poor result. The average DASH score measured 35. In 21 patients radioulnar impingement was found. This appeared to be painful in 14 patients and required revision surgery using the ulnar head prosthesis in five patients. In three patients, secondary ulnar shortening had to be performed due to a remaining painful impaction of the distal ulna against the lunate and triquetrum. Comparing our clinical results with the reported results following the Kapandji-Sauvé procedure from the literature, there was no evident superiority of either of the procedures. There is a need for a functional evaluation following the Kapandji-Sauvé procedure to compare the remaining functional impairment following both procedures. In conclusion both procedures have to be classified salvage procedures and therefore the indication should be limited to the arthrotically destroyed distal radioulnar joint.

Adult↗
PubMed1999

Kirschner wire embolization to the heart: an unusual cause of pericardial tamponade.

A 50-year-old man presented with an abrupt onset of sharp, pleuritic, right-sided chest pain. A chest radiograph revealed a metallic foreign body over the cardiac silhouette; a chest CT scan localized the object to within the wall of the right ventricle. The patient subsequently developed pericardial tamponade necessitating pericardiocentesis. A 25-mm-long Kirschner wire protruding through the wall of the right ventricle was removed via thoracotomy. Forty-two months previously, the patient had undergone open reduction and fixation of a left radius fracture with two Kirschner wires. Clinicians caring for patients with orthopedic wires in place should be aware of wire migration with cardiac embolization as a potential complication.

Bone Wires↗
PubMed1989

Distal radial osteotomy.

Malunions of distal radius fractures are commonplace. Patients are decreasingly willing to accept the disability that may be associated with them. While the first line of treatment is initial good fracture care, corrective osteotomies offer later opportunity for pain relief and improved function.

Adult↗
PubMedDate not supplied

Volar fixed-angle plating of the distal radius.

The treatment of unstable distal radius fractures continues to improve as better methods of skeletal fixation and soft-tissue management are developed. Apart from closed reduction and percutaneous pinning of simpler fracture patterns, the three main methods of management are external fixation, dorsal plating, and volar fixed-angle plating. Specific advantages of volar fixed-angle plating include stable fixed-angle support that permits early active wrist rehabilitation, direct fracture reduction, and fewer soft-tissue and tendon problems. Volar fixed-angle plating also avoids the complications often associated with external fixation and dorsal plating. Biomechanical data indicate that, when loaded to failure, volar fixed-angle plates have significant strength advantages over dorsal plating. Volar fixed-angle plating is advantageous in elderly osteopenic patients and for high-energy comminuted fractures and malunions requiring osteotomy.

Bone Plates↗
PubMed2005

Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius.

BACKGROUND: Fractures of the distal part of the radius that are associated with complex comminution of both the articular surface and the metaphysis (subgroup C3.2 according to the Comprehensive Classification of Fractures) are a challenge for surgeons using standard operative techniques. METHODS: Twenty-five patients with subgroup-C3.2 fractures that had been treated with combined dorsal and volar plate fixation were evaluated at an average of twenty-six months after the injury. Subsequent procedures included implant removal in twenty-one patients and reconstruction of a ruptured tendon in two patients. RESULTS: An average of 54 degrees of extension, 51 degrees of flexion, 79 degrees of pronation, and 74 degrees of supination were achieved. The grip strength in the involved limb was an average of 78% of that in the contralateral limb. The average radiographic measurements were 2 degrees of dorsal angulation, 21 degrees of ulnar inclination, 0.8 mm of positive ulnar variance, and 0.7 mm of articular incongruity. Seven patients had radiographic signs of arthrosis during the follow-up period. A good or excellent functional result was achieved for twenty-four patients (96%) according to the rating system of Gartland and Werley and for ten patients (40%) according to the more stringent modified system of Green and O'Brien. CONCLUSIONS: Combined dorsal and volar plate fixation of the distal part of the radius can achieve a stable, mobile wrist in patients with very complex fractures. The results are limited by the severity of the injury and may deteriorate with longer follow-up. A second operation for implant removal is common, and there is a small risk of tendon-related complications.

Bone Plates↗