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PubMed1994

[Angioarchitecture of the ulna and radius and their practical relevance].

The periosteal and endosteal blood supply of the human ulna and radius was investigated by anatomical dissection. The main artery concerned is the anterior interosseous artery. It supplies the diaphysis of ulna and radius; its branches feed the distal one-fourths of both the ulna and the radius. The proximal one-fourth of the ulna is supplied by the ulnar artery, the ulnar recurrent artery and the recurrent interosseous artery. Periosteal branches of the common interosseous artery, the ulnar artery and the recurrent interosseous artery supply the proximal one-fourth of the radius. In both bones the main branch of the nutrient artery has an ascending course. The anterior interosseous artery, as the main artery of the periosteal and endosteal supply of the human ulna and radius, is important in transplantation and reconstruction, especially with a view to reducing the rate of pseudarthrosis. When osteosynthesis is planned so-called LC-DC plates should be chosen to preserve the periosteal branches. When a vascularized bone graft is taken from the forearm the vascularization of the remaining bones has to be considered. The vascularity of this area allows various options in grafting.

Arteries↗

PubMed2006

Buttressing angle of the double-plating fixation of a distal radius fracture: a finite element study.

Treatment of a distal radius fracture should consider principles including stable fixation and early motion. The aim of this study was to investigate the biomechanical interactions of plate-fixation angles in the internal double-plating method coupled with various load conditions using non-linear finite element analysis (FEA). A 3D finite element distal radius fracture model with three separation angles (50, 70, and 90 degrees ) between the buttressed L- and straight plates was generated based on computed tomography data. After model verification and validation, frictional (contact) elements were used to simulate the interface condition between the fixation plates and the bony surface. The stress/strain distributions and displacements at the radius end were observed under axial, bending, and torsion load conditions. The simulated results indicated that the bending and torsion increased the stress values more than the axial load. The radius and straight plate stress values decreased significantly with increasing fixation angles for all load conditions. However, the L-plate stress values increased slightly under the bending buckling effect. The displacements at the radius end and strains at the fracture healing interface decreased with increasing fixation angles for axial and torsion conditions but displayed a slight difference for the bending condition. The findings using FEA provide quantitative evidence to identify that much larger plate fixation angles could provide better mechanical strength to establish favorable stress-transmission and prevent distal fragment dislocation.

Biomechanical Phenomena↗

PubMed1989

Radiographic definition of the dorsal and palmar edges of the distal radius.

The dorsal and palmar edges of the distal radius, as well as the concavity of the articular surface were labeled with wire and radiographs taken from neutral to 30 degrees of added dorsal tilt. The dorsal edge was identified as the structure that protrudes distally in neutral. The palmar edge was found to overlap with the sclerotic subchondral bone of the radius in neutral. With increasing dorsal tilt the profile of the palmar edge appeared as it protruded distal to the sclerotic subchondral line of the radius. The profile of the palmar edge could be distinguished from that of the dorsal edge on the anteroposterior view. The wire, which was placed midway between the dorsal and palmar edges and the concavity of the articular surface corresponded to the prominent sclerotic subchondral bone line of the distal radius. This did not change in position with increasing dorsal tilt. This clarification of the radiologic anatomy is helpful in extending the use of the anteroposterior radiograph for the interpretation of fractures and malunions of the distal radius.

Humans↗

PubMed2006

Anatomy of the distal brachioradialis and its potential relationship to distal radius fracture.

PURPOSE: To describe the anatomy of the brachioradialis (BR), paying special attention to its insertion in relation to the surrounding structures in cadavers and evaluating and correlating this information with a distal radius fracture pattern in a clinical population. METHODS: Eighteen fresh-frozen cadaver arms were dissected to observe the gross anatomy of the BR. The dimensions of the insertion were measured using a caliper and a 3-dimensional digitizer. The radiographs of 34 patients with 35 distal radius fractures were reviewed and the fracture pattern was compared with the normalized location of the BR insertion based on the cadaver measurements. RESULTS: On average the BR tendon inserted onto the proximal base of the first dorsal compartment 17 mm from the radial styloid tip and extended 15 mm proximally; the insertion was 11 mm wide. The BR insertion was bordered consistently by both septa of the first dorsal compartment, forming a tunnel-like structure of thick fibrous tissue on the radial aspect of the distal radius. The whole length of the tendon attached firmly to the underlying antebrachial fascia, which limited excursion. In 18 of the fractures the fracture line deviated from transverse to proximal at the radial side, forming a radial beak. The proximal tip of the beak correlated with the expected location of the proximal end of the BR tendon insertion. CONCLUSIONS: The BR distal tendon insertion is a consistent, distinct insertion at the base of the first dorsal compartment, which correlates with the radial-beak fracture pattern in approximately 50% of distal radius fractures. Cutting the BR tendon disconnects the distal fragment from the BR muscle and the forearm fascia, which may facilitate reduction of the distal radial fragments during open reduction of the distal radius fracture.

Adult↗

PubMedDate not supplied

The volar extension of the lunate facet of the distal radius: a quantitative anatomic study.

PURPOSE: To describe quantitatively the protrusion of the volar part of the lunate facet of the distal radius articular surface anterior to the volar metaphyseal cortex, which is susceptible to fracture and can be difficult to control with plates and screws alone. METHODS: Quantitative anatomic measurements of 48 3-dimensional computed tomography scans of the distal radius were analyzed to quantify the anatomy of the volar part of the lunate facet of the distal radius. The measurements were scaled to account for overall bone size. Male and female anatomies were compared. RESULTS: The height and width of the volar extension of the lunate facet were 3 +/- 1 mm and 19 +/- 4 mm, respectively. The mean height of the lunate facet was 19 +/- 3 mm. An average of 16% of the lunate facet projects anterior to the flat volar surface of the distal radius. The thickness of the volar extension of the lunate facet averaged 5 +/- 1 mm. There were no statistically significant differences between men and women for any of the scaled measurements. CONCLUSIONS: The observation that the volar lunate facet projects approximately 3 mm (or 16% of the dorsal-volar height of the lunate facet) anterior to the flat volar surface of the distal radius and is approximately 5 mm thick helps explain its relative vulnerability to injury and the difficulty encountered when trying to secure it with a plate and screws.

Adult↗

PubMed1984

Midcarpal instability caused by malunited fractures of the distal radius.

Thirteen patients with malunited fractures of the distal radius developed symptoms of pain and instability of the midcarpal joint. In six cases, a recurrent voluntary midcarpal subluxation was also present during ulnar deviation. These symptoms were first noticed several weeks, and at times several months, after all immobilization for the treatment of the original fracture had been discontinued. We believe that the loss of the normal palmar tilt of the distal articular surface of the radius prepositions the carpus in a dorsal collapse alignment, which enables this instability to develop. Although the instability is localized to the midcarpus , it is treated best, in our opinion, by a corrective osteotomy of the distal radius. In nine patients, osteotomies resulted in relief of preoperative symptoms and correction of midcarpal instability. In one patient, osteotomy of the radius was deemed unnecessary because the loss of palmar tilt of the radius was minimal. Instead the midcarpal ( triquetrohamate ) joint was stabilized by ligament reconstruction. Only transient correction was obtained, with later recurrence of the voluntary midcarpal subluxation.

Adolescent↗

PubMed2002

Open reduction and internal fixation of un-united fractures of the distal radius: does the size of the distal fragment affect the result?

Two cohort populations consisting of 13 patients with an un-united fracture of the distal radius in whom the distal fragment had more than 5 mm of subchondral bone supporting the articular surface distal to the site of the nonunion and ten patients with an un-united fracture of the distal radius with a smaller distal fragment were compared. There were no preoperative differences with respect to age, gender, interval between injury and index procedure, preoperative amount of radius tilt, ulnar inclination and ulnar variance, or the preoperative function. Independent of the size of the distal fragment in all patients the distal radius was restored to gain bony union and realignment with preservation of some wrist motion. The length of the follow-up period averaged 30 months for the small fragment group compared with 22 months for the large fragment group. Bony union was achieved in 22 patients. One patient out of the large fragment group failed to heal the fracture and had wrist fusion. At the follow-up examination there were no significant differences in the radiological and clinical outcome between the two groups. No differences were seen on total range of motion of forearm supination and pronation with an average of 135 degrees in the large fragment group and 145 degrees in the small fragment group. Wrist motion revealed no significant differences in the flexion-extension arc, averaging 90 degrees in the large fragment group and 83 degrees in the small fragment group. Total range of motion of radial and ulnar deviation of the wrist was similar, averaging 39 degrees in the large fragment group and 43 degrees in the small fragment group. Grip strength averaged 59% compared with the opposite limb for the large fragment group and 67% for the small fragment group. We believe that the results of reconstruction of un-united fractures of the distal end of the radius for patients in whom the distal fragment had less than 5 mm of subchondral bone supporting the articular surface distal to the site of the nonunion are comparable to the results for patients with a larger distal fragment. Therefore, we believe that surgeons should try to preserve even a small amount of wrist motion and reserve wrist fusion as a final resort.

Adult↗

PubMed2002

Three-dimensional in vivo kinematics of the distal radioulnar joint in malunited distal radius fractures.

How malunion of the distal radius affects the kinematics of the distal radioulnar joint in vivo was evaluated. A novel computed tomography image-based technique was used to quantify radioulnar motion in both wrists of 9 patients who had unilateral malunited distal radius fractures. In the injured wrists dorsal angulation averaged 21 degrees +/- 6 degrees, radial inclination averaged 18 degrees +/- 5 degrees, and radial shortening averaged 21 +/- 3 mm. Clinically, the average range of motion of the injured wrists was 75 degrees +/- 25 degrees pronation and 73 degrees +/- 23 degrees supination. Kinematics of the radius during pronation and supination in the malunited forearms was indistinguishable from that in the uninjured forearms. In both the axis of rotation of the radius passed through the center of the ulnar head, although it shifted slightly ulnar and volar in supination and radial and dorsal during pronation. In contrast to previous in vitro biomechanical findings, there was no dorsovolar radial translation at the extremes of pronation or supination and no translation of the radius along the rotation axis. Soft tissues may play a larger role in limiting function than previously appreciated, and treatment may require correction of altered soft tissue structures as well as any abnormal bone anatomy.

Adolescent↗

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↗

PubMed1982

[Radius head resection as a reconstructive measure of the elbow joint].

The authors followed up 55 patients to check on the clinical manifestations prevailing ten years after resection of the head of the radius with particular reference to the pattern presented in the radiocarpal joint. Particular attention was paid to functional and roentgenological changes in the regions of the elbow and wrist. Overall results were unsatisfactory, although a clear improvement in function could be seen in old fractures of the head of the radius, although the function did not improve beyond that achieved by primary resection of the head. No convincing improvement was obtained in old dislocations of the radial head (most of them being accompanied by additional injuries) by a resection of the head of the radius. With the progress of time after the operation, the overall result deteriorated, depending on the likewise slowly progressing proximal dislocation of the radius and hence negative influence exercised on the biomechanics in the distal radioulnar or wrist joint. On the basis of these results it is recommended to attempt radial head preserving treatment as the initial measure in fractures of the head of the radius, i.e. to promote osteosynthesis as far as ever possible.

Adolescent↗

PubMed1995

Symptomatic proximal translation of the radius following radial head resection.

Eight patients with symptomatic proximal translation of the radius after having radial head resection for trauma were treated with a combination of immediate pinning of the radius to the ulna, silicone radial head replacement, or some form of ulnar shortening, including the Darrach procedure, formal ulnar shortening, or Suave-Kapandji fusion. Despite these techniques, all patients did not maintain effective relative length of the radius, exhibiting 3 mm or greater positive ulnar variance after treatment. Injuries to the central band of the interosseous membrane of the forearm probably do not heal with mechanical integrity. Without this structure, conventional methods of equalization of the radius and ulnar do not appear to be reliable. Current methods of treatment of acute longitudinal dissociation of the radius and ulna are inadequate.

Adult↗

PubMed1993

Imaging techniques for distal radius fractures and related injuries.

In patients with distal radius fractures, routine roentgenographic examination in at least two or three planes should be performed first and is usually sufficient for correct diagnosis and adequate treatment. A careful examination of the soft tissues of the forearm and wrist on conventional roentgenograms may be key for correct diagnoses. Routine roentgenographic examination of the wrist, preferable in four views, should be performed in every patient with a distal radius fracture acutely as well as at follow-up. The technique is easy to perform, universally available, and inexpensive. Advanced imaging techniques such as radionuclide bone imaging, CT, or MR imaging should not be first choice modalities in patients with distal radius fractures and should be used only when conventional roentgenograms are inconclusive. Scintigraphy can be helpful for diagnosing occult fractures, for documenting fracture healing and ligamentous or cartilaginous post-traumatic disorders, as well as for diagnosis and follow-up of reflex sympathetic dystrophy. A disadvantage of scintigraphy is its poor specificity. Indications for CT include the confirmation of occult fractures suspected on the basis of the findings of physical examination and focally hot bone scintigrams when plain films are normal or inconclusive. In comparison with conventional radiography, CT is superior for the preoperative evaluation of complex comminuted distal radius fractures, depicting the distal radial articular surface and size and position of fracture fragments, as well as for the assessment of fracture healing. Additionally, CT is the imaging technique of choice for the correct diagnosis of subluxations of the distal radioulnar joint. Magnetic resonance imaging is an important diagnostic technique for the evaluation of suspected injuries of soft tissues related to distal radius fractures, such as to the flexor and extensor tendons or the median nerve, and for the early diagnosis of necrosis of the scaphoid or lunate. Other indications include identification of triangular fibrocartilage complex perforations, ruptures of carpal ligaments, and demonstration of contents of the carpal tunnel.

Follow-Up Studies↗

PubMed2004

Anatomical considerations of the radius.

Most radial head prostheses do not seem to be based on anatomic data. This may be due partly to the great variation of radial morphology. More importantly, few articles report on the dimensions of the radius. Authors have mainly studied dimensions of the radial head, with less emphasis to the relationship with the rest of the radius. Dimensions of, and relationship between, the proximal and the rest of the radius were measured on 27 fresh-frozen cadaveric upper extremities. Radial head, articulating surface, diaphysis, and distal radius were measured. Angles between the radial neck and diaphysis were defined and calculated. Axes of the distal and proximal radius were defined and radial torsion was calculated. Repeated measures were done by two observers in ten specimens. Inter- and intra-class correlation coefficients were very acceptable. Radial dimensions were found to be highly variable. Calculation of radial torsion showed the largest range. The average torsion was 54 degrees (range = 23-78 degrees). Radial length was 235 mm (range = 207-269 mm). Radial neck length was 13 mm (range = 9-19 mm). We found an average proximal diaphysis-neck angle of 17 degrees (range = 6-28 degrees). End to end-neck angle was 13 degrees (range = 4-22 degrees). Our findings indicate that even with a perfectly anatomical prosthesis, restoration of the anatomical situation can only be achieved when the implant is placed in the correct position. Instrumentation should be developed to allow accurate and reproducible implantation. The measurements we provide may aid this development.

Aged↗

PubMed1996

Effect of aging on trabecular and compact bone components of proximal and ultradistal radius.

Bone densitometry has become a major tool for osteoporosis risk assessment. The traditional dual-energy X-ray absorptiometry (DXA) methods are able to evaluate the bone mineral content (BMC; mg/cm) and the areal density (BMD; mg/cm2), but only quantitative computed tomography (QCT) has the potential to measure the true volumetric bone density in the sense of mass per unit volume (mg/cm3). Peripheral QCT (pQCT) measurements were carried out at the nondominant radius using a Stratec XCT 960 (Unitrem, Roma) in 241 postmenopausal and 29 premenopausal women. The sites of evaluation were both the ultradistal and the proximal radius. The technique used has a coefficient of variation of 2% and it allows separation of the bone section into trabecular and cortical bone on the basis of density threshold. Bone mass of radius, hip and spine was also evaluated by DXA procedures. The bone density data obtained by pQCT were significantly correlated with all DXA measurements. The correlation coefficients between their respective BMD values ranged from 0.48 to 0.75, but for the BMC values of the radius the correlation coefficients ranged from 0.82 to 0.93. The BMD values measured by DXA, but not by pQCT, were positively related with patient heights. All pQCT density measurements, including those obtained at the proximal radius and containing exclusively cortical bone, where negatively related with age and years since menopause. A partial volume effect, which is increasingly relevant the thinner are the bone cortices, might explain that. However, by applying increasing density thresholds, cortical bone density seems to decrease with age as a consequence of a gradual density diminution from the inner part of the bone cortex outwards. Trabecular bone density decreases with aging, but its overall mass does not change as a consequence of an age-related enlargement of trabecular area. Thus, the proportion of trabecular bone over total bone rises, and this might be relevant for our understanding of the age-related changes in bone turnover and rate of bone loss.

Absorptiometry, Photon↗

PubMed2003

Preferential reductions of paraarticular trabecular bone component in ultradistal radius and of calcaneus ultrasonography in early-stage rheumatoid arthritis.

Rheumatoid arthritis (RA) is a major cause of secondary osteoporosis and is frequently associated with both paraarticular and generalized osteoporosis. The present study was designed to investigate the preferential sites of reduction of bone mineral density (BMD), in the early stage of RA, with special emphasis on the differential effect of RA on BMD in trabecular and cortical components. The participants (30 RA patients and 26 healthy participants) were all female with disease duration of less than 1 year. BMD in the radius was measured at 4% (ultradistal site) and 20% (midshaft) to the ulnar length proximal to the end of radius by peripheral quantitative computed tomography. BMD in lumbar spine was measured by dual X-ray absorptiometry and the osteo-sono assessment index (OSI) of the calcaneus by ultrasound. RA patients showed lower BMD preferentially in the trabecular component, but not in cortical bone component of the ultradistal radius than age-matched normal controls. Calcaneus OSI was also significantly reduced. The radial midshaft and lumbar spine did not differ significantly between RA patients and normal controls. Trabecular BMD in the ultradistal radius exhibited negative correlations with serum CRP, ESR, and RF, and calcaneus OSI with M-HAQ score. In conclusion, it was suggested that disease activity of RA and impairment of daily physical activity might be a significant determinant of deterioration of bone structure in paraartciular distal radius and calcaneus, respectively, in early-stage RA patients.

Activities of Daily Living↗

PubMed2004

Prevalence and risk factors of distal radius and calcaneus bone mineral density in Korean population.

To estimate the prevalence and the related risk factors of low bone mineral density of the calcaneus and the distal radius, a community-based study was conducted in three rural areas of Korea. A total of 1420 women and 732 men aged 40 years and older participated in this study. Information on sociodemographic characteristics and the potential risk factors for osteoporosis were collected by an interviewer-administered standardized questionnaire. Bone mineral density (BMD) of the calcaneus and the distal radius were measured by dual-energy X-ray absorptiometry (DXA). Three hundred and seventeen women and 183 men aged 20-29 years who participated in a regular health check-up were used as a reference population. Osteoporosis was defined using WHO criteria. Odds ratios of the risk factors of osteoporosis were calculated by the unconditional logistic regression model. The standardized prevalence of osteoporosis of the calcaneus was 8.4% for males and 27.3% for females using the Korean population of year 2000 as a standard population. The standardized prevalence of osteoporosis of the distal radius was 4.2% for males and 18.8% for females. Older age and lower body mass index (BMI) were related with low BMD in both the calcaneus and distal radius in males and females. The duration after menopause and the number of live births were an independent risk factor for osteoporosis of the calcaneus (OR = 1.1, 95% CI = 1.00-1.11; the duration after menopause; OR = 2.0, 95% CI = 1.20-3.35, the number of live birth) and a familial history of non-traumatic fractures or osteoporosis among the first-degree relatives was significantly related to a increased risk of osteoporosis of the distal radius in females (OR = 2.9, 95% CI = 1.36-6.31).

Adult↗

PubMed2004

Decreased bone mineral density at the distal radius, but not at the lumbar spine or the femoral neck, in Japanese type 2 diabetic patients.

The purpose of this study is to assess the association between type 2 diabetes and bone mineral density. This study included 145 Japanese patients (64 men and 81 women) with type 2 diabetes and 95 non-diabetic control subjects (41 men and 54 women) of similar age. We measured bone mineral density (BMD) at the sites with different cortical/cancellous bone ratio (lumbar spine, femoral neck, and distal radius) using dual-energy X-ray absorptiometry. BMD and Z score at the distal radius were significantly lower in type 2 diabetic patients than those in control subjects, and in type 2 diabetic patients, the Z score at the distal radius was lower than that at their own lumbar spine and femoral neck. In type 2 diabetic patients, negative correlation between BMD and the mean HbA1c during the previous 2 years was found significantly at the distal radius in both genders and at the femoral neck in women. These results indicate the selective cortical bone loss in type 2 diabetes and suggest the importance of also determining BMD at the radius and keeping good metabolic control to prevent bone loss in type 2 diabetic patients.

Absorptiometry, Photon↗

PubMed1998

MRI of fractures of the distal radius: comparison with conventional radiographs.

OBJECTIVE: To compare the evaluation of fractures of the distal radius with MRI and conventional radiographs. To demonstrate the ability of MRI to detect unsuspected soft tissue derangement accompanying this common injury. DESIGN AND PATIENTS: Twenty-one consecutive inpatients admitted following fracture of the distal radius underwent preoperative evaluation with both conventional radiographs and MRI. In each case, analysis was made of both the osseous and soft tissue injury. MRI findings were compared with those identified on conventional radiographs and at subsequent surgical fixation. RESULTS: Of 21 patients with fractures of the distal radius, 20 had extension to the radiocarpal articulation, 14 had distal radio-ulnar joint extension and 5 had avulsion of the ulnar styloid. Occult carpal bone fractures accompanying fracture of the distal radius were identified in two patients: one of the capitate and the other of the second metacarpal base. Ten patients (48%) had associated soft tissue injury: six patients had scapholunate ligament rupture, two patients had disruption of the triangular fibrocartilage, one patient had extensor carpi ulnaris tenosynovitis and one patient had a tear of a dorsal radiocarpal ligament. Of five patients with ulnar styloid avulsions, none had evidence of triangular fibrocartilage tears. CONCLUSION: MRI affords better evaluation of osseous injury accompanying distal radial fractures than conventional radiographs. Intra-articular soft tissue injury accompanies distal radial fractures in almost 50% of cases. Scapholunate ligament disruption commonly accompanies intraarticular fracture through the lunate facet of the distal radius. Fracture of the ulnar styloid is infrequently associated with tear of the triangular fibrocartilage.

Adult↗