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At least 163 records · Page 9Linked to original sources

PubMed2002

Distal radius fractures in older women: a 10-year follow-up study of descriptive characteristics and risk factors. The study of osteoporotic fractures.

OBJECTIVES: To determine the incidence of distal radius fractures and the characteristics of those fractures and to identify the key risk factors. DESIGN: Prospective cohort study, mean follow-up of 9.8 years. SETTING: Four clinical centers, one each in Baltimore, Maryland; Minneapolis, Minnesota; Pittsburgh, Pennsylvania; and Portland, Oregon. PARTICIPANTS: Nine thousand seven hundred four white women aged 65 and older, enrolled in the multicenter Study of Osteoporotic Fractures. METHODS: Five hundred twenty-seven distal radius fractures were confirmed by physician review of radiology reports; characteristics of the fractures were noted. Information was also collected on lifestyle, demographics, bone mineral density (BMD), and clinical and performance measures. RESULTS: The overall incidence of fracture was 7.3/1,000 person-years. Twenty-seven percent of the fractures were intra-articular; 73% were extra-articular. The independent predictors of fracture were decreased BMD (per 0.1 g/cm(2)) at the distal radius ( relative risk ( RR)=1.8, 95% confidence interval ( CI)=1.6-2.1), a history of recurrent falls ( RR=1.6, 95% CI=1.2-2.0), and having had a previous fracture since age 50 ( RR=1.3, 95% CI=1.1-1.6). Current use of oral estrogen was protective ( RR=0.6, 95% CI=0.4-0.8). For women aged 75 and older, poor cognitive status was also a predictor of wrist fracture. Intra-articular fractures occurred more than twice as frequently in women with diabetes mellitus. CONCLUSIONS: This is the first large long-term comprehensive study of distal radius fractures in older people. The results indicate that factors predictive of distal radius fractures can easily be assessed in routine clinical practice and can identify women at high risk for fracture. Selected preventive strategies could be designed to reduce the incidence of these fractures.

Aged↗

PubMed2002

The effects of dorsally angulated distal radius fractures on carpal kinematics.

A cadaver model was used in a biomechanical study of dorsally angulated distal radius fractures to evaluate alterations in carpal kinematics. Distal radius fractures were simulated by dorsal closing-wedge osteotomy and fixed with a custom-designed external fixator. A magnetic tracking device measured the carpal bone motions in several positions of dorsal angulation from neutral tilt to 30 degrees dorsal tilt. Changes in carpal alignment showed different patterns between each specimen consisting of a spectrum from dorsal subluxation of the entire carpus to adaptive dorsal carpal instability (DISI deformity). Components of carpal bone motion were altered markedly at all positions of dorsal angulation of the distal radius. The severity of the DISI deformity and related carpal instability correlated well with the alterations of carpal kinematics during wrist flexion and extension, whereas dorsal subluxation alone had a poor relationship with changes in carpal kinematics. The amount of DISI deformity and the degree of dorsal angulation of the radius may be prognostic factors when considering whether to perform a corrective osteotomy of the distal radius.

Aged↗

PubMed2002

Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability.

Ulnar-sided injuries of the wrist have received more attention recently for their potential negative impact on the outcome of distal radius fractures. Radiographs and medical records were retrospectively reviewed for 166 distal radius fractures treated during a 1-year interval. Distal radius fractures were classified according to the AO system, and accompanying ulnar styloid fractures were evaluated for both size and displacement. Each distal radius fracture was also evaluated for radiographic and clinical evidence of distal radioulnar joint instability. The distribution of ulnar styloid fractures was not random; greater than one third involved the base. All distal radius fractures complicated by distal radioulnar joint instability were accompanied by an ulnar styloid fracture. A fracture at the ulnar styloid's base and significant displacement of an ulnar styloid fracture were found to increase the risk of distal radioulnar joint instability.

Adolescent↗

PubMed2002

Survival among elderly patients after fractures of the distal radius.

Studies have documented increased mortality rates in patients sustaining hip and vertebral fractures. Distal radius fractures are common injuries among the elderly and are a significant source of disability. This study analyzed survival rates in an elderly patient cohort after distal radius fractures and determined mortality risk factors. In addition, the mortality rates in our patient cohort were compared with those of the general population of the United States matched for age and gender. The records of 325 elderly patients (250 women, 65 men) treated for distal radius fractures between 1992 and 1999 were reviewed and submitted to the national death registry maintained by the National Death Index and the Center for Disease Control and Prevention. The mortality experience of the patient cohort was analyzed by using bivariate statistical tests and multivariate regression. Average age at diagnosis was 77.4 years (range, 65-106 y). A total of 21% of patients (29% of men, 19% of women) died during the study period. After accounting for variations in age, total number of comorbidities, and Charlson comorbidity index, men were 2.65 times more likely to die than women (95% CI, range, 1.31-5.36) and their hazard of death was 1.83 times that of women (95% CI, range, 1.07-3.14). After accounting for variations in age and gender, patients with comorbidities were 5.23 times more likely to die (95% CI, range, 1.80-15.23) and did not survive as long as those without comorbidities. At 7 years after radius fracture, the cumulative estimated survival in the cohort under study was 57% compared with an expected value of 71% for the US population. Survival rates after distal radius fractures were notably lower than those expected for individuals of the same age and gender in standard populations. Men were twice as likely to die as women and did so almost twice as quickly.

Aged↗

PubMed2000

[Pseudarthroses after distal radius fractures. What is the role of the distal radioulnar joint?].

Non-union following distal radial fracture is extremely rare. Therefore, the patterns are not completely understood. Recently, it was suggested that an associated distal ulna shaft fracture increases the risk to develop a non-union for comminuted fractures of the distal radius. The purpose of this study was to review our 15 cases with this condition to investigate the role of an associated distal ulna shaft fracture and/or an associated lesion of the distal radioulnar joint. The second goal was to evaluate the success of the surgical treatment in relation to the extent of the metaphyseal subchondral bone supporting the articular surface distal to the site of the non-union. We reviewed our 15 cases which were operated on for non-union of the distal radius since 1992. In all cases, the radiographs could be reviewed. Twelve patients could actually be re-examined. The investigated criteria were: initial, pre- and postoperative X-ray findings, other medical conditions, range of motion, grip strength, and pain relief. Clinical outcome was evaluated using the DASH-questionnaire. According to the AO classification system, there were two type A3 and 13 type C3 fractures. There were seven associated distal ulna fractures. The distal radioulnar joint was involved in twelve cases. The other medical conditions in the patients with non-union after distal radial fracture included allergy, hypothyroidism, diabetes mellitus, peripheral neuropathy, and bronchial asthma. Four patients were tobacco smokers. Only one patient was initially treated non-operatively. In all cases, the distal radius was restored preserving wrist motion. Bony union was achieved in 14 cases. The range of motion has improved in all planes. Grip strength increased but still remained over 50% below the level of the opposite side. Postoperatively, the majority of patients was pain free. In four cases, complications were seen postoperatively. Three of these patients had less than 6 mm of metaphyseal subchondral bone beneath the articular surface. Three of the four patients were tobacco smokers. Inadequate treatment of a comminuted distal radial fracture associated with a special local situation--such as an additional distal ulna shaft fracture and/or an associated lesion of the distal radioulnar joint--combined with a general medical condition, adversely affects fracture healing, increasing the risk for non-union. From the review of the records of these 15 cases, we recommend that non-union with more than 5 mm of subchondral bone supporting the articular surface distal to the non-union site undergo reconstruction of the radius. Non-union with less than 5 mm subchondral bone supporting the articular surface requires an individual decision. A good bone stock and stable fixation allows for reconstruction of the radius, otherwise wrist fusion is a useful salvage procedure.

Adult↗

PubMed2003

[Computer-assisted planning and corrective osteotomy in distal radius malunion].

Corrective osteotomy of the malunited distal radius following fracture was performed in six patients using virtual planning and computer-assisted surgery. Radius joint angles and ulnar variance were assessed by CT scan and compared with the uninvolved wrist. Dorsal tilt was improved by 6 degrees, radial inclination by 3 degrees, radius rotation by 7 degrees and ulnar variance by 4.6 mm. Results were almost equivalent to the noninvolved radius. Corrective osteotomy in extraarticular malunited distal radius fracture was optimized by computer-assisted planning and surgery.

Adult↗

PubMed2003

[Palmar plating with the locking compression plate for dorsally displaced fractures of the distal radius--first clinical experiences].

Injuries and irritation of extensor tendons are common problems in the treatment of fractures of the distal radius when plating is used via a dorsal approach. By the development of locking compression plates the possibility of palmar plating for dorsally displaced fractures of the distal radius is available. In this study our first clinical experiences using the 3.5 mm radius locking compression plate (LCP) are reported. Between February 2002 and September 2002 24 patients with dorsally displaced fractures of the distal radius were treated using a palmar approach with the LCP and included in a prospective study. The mean age of the patients was 52 years (28-87 years). Six weeks and six months after surgery a clinical assessment was done, the range of motion of the injured wrist was measured, and an X-ray control of the injured joint was performed. The preliminary results demonstrate the option of early functional treatment using the locking compression plate. Most of the patients had a good to excellent range of motion of the injured wrist which resulted in an early return to former activity. There were few intra- and postoperative complications. No irritation of the median nerve, no infection was observed. In one case a screw which was placed intraarticularly was removed prematurely. The palmar locking compression plate has been proven as a safe and effective implant for the treatment of dorsally displaced fractures of the distal radius.

Adult↗

PubMed2000

Torsional strength of the radius after osteofasciocutaneous free flap harvest with and without primary bone plating.

The osteocutaneous radial forearm free flap (OCRFFF) has not gained widespread popularity in mandibular reconstruction, primarily because of concerns about pathologic fracture of the weakened radius. This study examines the effectiveness of plate fixation of the radius bone after harvest of the OCRFFF as a mechanism to minimize donor-site morbidity and increase the usefulness of the OCRFFF. Matched pairs of fresh human cadaveric radius bones were used in this study. Two study groups were designed. The first group was used to define the amount of strength lost after a typical bone graft harvest. The second group was designed to demonstrate how much torsional strength was regained by the application of an orthopedic reconstruction plate. Statistically significant results were obtained for both groups. In group 1, the strength of the cut bones compared with that of the unaltered bones was significantly decreased by 82% (P = 0.016). In group 2, the cut bones reinforced with a plate were 75% stronger (P = 0.002) than the bones that were only cut. Although the radius bone is significantly weakened by the harvest of a graft, much of this strength can be regained with plate fixation of the radius.

Biomechanical Phenomena↗

PubMed2004

Nonunion of distal radius fractures.

Nonunion of a distal radius fracture is extremely uncommon. Healing problems in the distal radius seem to be related to unstable situations, such as concomitant fracture of the distal radius and ulna, and to an inadequate period of immobilization. Nonunion should be suspected if there is continuing pain after remobilization of the wrist in combination with a progressing deformity. The diagnosis may be confirmed by showing movement at the fracture site on lateral radiographs of the wrist in flexion and extension. Because of the rarity of distal radius fracture nonunion, it is not surprising that there is no consensus on the optimum mode of operative treatment. Based on our experience with reconstruction surgery in 23 patients, we think that most nonunions of the distal radius are amenable to attempts to re-align and heal the fracture even when the distal fragment is small. Therefore, surgeons should try to preserve even a small amount of wrist motion and reserve wrist fusion as a final resort.

Female↗

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↗

PubMed2005

Temporary fixation with the Agee-Wristjack during correctional osteotomies for malunions and nonunions of the distal radius.

Upper extremity surgeons are often responsible for managing complex malunions and nonunions of distal radius fractures. Studies have demonstrated that corrective osteotomies of the malunited distal radius with placement of sculpted bone grafts produce the best functional and cosmetic results in patients. We describe a technique for providing provisional stabilization of the osteotomy site for treatment of distal radius malunions and nonunions using the Agee-Wristjack external fixator device. The Agee-Wristjack has several features that make it superior to other available small external fixators. Its gear mechanisms confer stable distraction of the distal radius following osteotomy and greatly facilitate appropriate positioning of the distal fragment. Iliac crest bone graft may be harvested and shaped precisely to fit the osteotomy defect. Placement of the Agee-Wristjack's distal fixator pins into the index metacarpal instead of the distal radius fragment facilitates application of a plate, with minimal interference from the distal pins. Finally, the Agee-Wristjack may be maintained following surgery to supplement the internal fixation.

Contraindications↗

PubMed1994

Stabilisation of fractures of the proximal radius and ulna in a dog by application of a single plate to the ulna.

If a plating technique is used, fractures of the radius and ulna are usually stabilised by the application of a plate to the radius, or by the placement of plates on both the radius and ulna. This report describes the treatment of comminuted fractures of the proximal radius and ulna in a young dog by the application of a single plate to the caudal surface of the ulna. Satisfactory healing of both fractures occurred by five weeks after surgery. This approach avoided the difficult surgical approach to the proximal radius, and simplified the management of a dog with multiple fractures in one limb.

Animals↗

PubMed2002

Static scapholunate dissociation diagnosed by scapholunate gap view in wrists with or without distal radius fractures.

This prospective study investigated static scapholunate dissociation (SLD) in wrists associated with distal radius fractures. SLD was detected as a widening of the scapholunate (SL) joint interval by SL gap view. Ninety-six distal radius fractures and 154 normal wrists were investigated by SL gap view, which is better for detecting SLD than the standard posteroanterior (PA) view. Incidences of non-symptomatic SLD detected by SL gap view in normal wrists increased by age. In the young age bracket, incidences of SLD in distal radius fractures were significantly higher than in normal wrists. Our results indicated that in patients younger than 30 years old, SLD in distal radius fractures was a fracture-caused abnormality. In those over 30, ascribing SLD to the fracture was difficult. Close examinations, like arthroscopy and dynamic cineradiography, need to be made in patients with SLD associated with distal radius fractures, especially in those younger than 30.

Adolescent↗

PubMed2003

Pain and disability reported in the year following a distal radius fracture: a cohort study.

BACKGROUND: Distal radius fractures are a common injury that cause pain and disability. The purpose of this study was to describe the pain and disabilities experienced by patients with a distal radius fracture in the first year following fracture. METHODS: A prospective cohort study of 129 patients with a fracture of the distal radius was conducted. Patients completed a Patient-rated Wrist Evaluation at their baseline clinic visit and at 2, 3, 6 and 12 months following their fracture. The frequency/severity of pain and disabilities reported was described at each time point. RESULTS: The majority of patients experienced mild pain at rest and (very) severe high levels of pain with movement during the first two-months following distal radius fracture. This time is also associated with (very) severe difficulty in performing specific functional activities and moderate to severe difficulty in four domains of usual activity. The majority of recovery occurred within six-months, but symptoms persisted for a small minority of patients at one-year following fracture. Patients had the most difficulty with carrying ten pounds and pushing up from a chair. Resumption of usual personal care and household work preceded, and was more complete, than work and recreational participation. CONCLUSIONS: This study demonstrated that the normal course of recovery following a distal radius fracture is one where severe symptoms subside within the first two-months and the majority of patients can be expected to have minimal pain and disability by six-months following fracture. This information can be used when planning interventions and assessing whether the progress of a patient is typical of other patients.

Activities of Daily Living↗

PubMed2004

Management of the giant-cell tumours of the distal radius.

BACKGROUND: Giant-cell tumour of the distal radius is a rare neoplasm that affects the peri-articular metaphysial region of the bone. Curettage alone or with bone grafting has been reported to be associated with high incidence of local recurrence in these tumours. In the present series, we report the results of curettage only as the treatment for primary giant-cell tumour of the distal radius carried out at a single centre. PATIENTS AND RESULTS: A total of 287 patients with giant-cell tumour have been referred to us for treatment over the last 28 years; 24 of these were found to have lesion in the distal radius. One patient underwent endoprosthetic replacement of the distal radius. The remaining 23 patients underwent curettage of the primary neoplasm. Four out of the 23 (17%) patients developed local recurrence of disease, The mean time to local recurrence was 17 months (range, 9-27 months). Complications such as collapse of the articular cartilage are more common in patients with an extensive soft tissue component of the tumour. CONCLUSIONS: Curettage alone is adequate treatment for the majority of patients with giant-cell tumours of the distal radius but some form of stabilisation may be required in the presence of extensive bone destruction.

Adolescent↗

PubMed1999

Alendronate increases bone density and bone strength at the distal radius in postmenopausal women.

In addition to the alendronate Osteoporosis Intervention Trial (FOSIT) core protocol 901-0A of 1908 enrolled patients, the use of peripheral quantitative computed tomography (pQCT) was explored for the assessment of response to therapy. Bone mineral and strength related parameters at two different sites at the distal radius were explored in a subset of the multicenter core study. One hundred and three patients were entered into the substudy and given either a daily dose of 10 mg of alendronate or placebo for 1 year. Measurements were done at months 0, 3, 6, and 12. Inclusion criteria were bone mineral density (BMD) measurements at the lumbar spine of -2 SD. The response to therapy was assessed by dual-energy X-ray absorptiometry in the lumbar spine and the hip, and by pQCT in the ultradistal and the shaft sites of the radius. In line with the FOSIT core study, alendronate increased BMD at the lumbar spine and the hip, and it decreased the serum biochemical markers of bone turnover. The substudy showed differences between the therapy and placebo group in trabecular bone density (8.4%, p = 0.095), in total density (6.8%, p = 0.009), and in the bone strength index (BSI) (15. 6 mm3, p = 0.037) at the ultradistal site due to treatment and no changes at the radius shaft. A significant correlation was observed between percentage changes from baseline in BMD of the lumbar spine, and in total density and bone strength at the ultradistal radius site in the treatment group, but not in the placebo group. Thus, the ultradistal radius site did respond to alendronate therapy. The increased bone density accompanied a significant gain in the BSI at the ultradistal site, a finding that might help explain the reduced wrist fractures in the alendronate Fracture Intervention Trial.

Aged↗

PubMed2004

Impact of using the ultradistal radius region of interest on diagnostic classification.

World Health Organization (WHO) criteria using T-scores for classifying patients as normal, osteopenic, or osteoporotic are based on bone mineral density (BMD, g/cm2) of the lumbar spine and hip and bone mineral content (BMC) (BMC, g) at the distal and midradius. There is no consensus on whether other forearm regions of interest (ROIs) can be used with the WHO criteria. Because the ultradistal radius region of interest (UDR) has a greater ratio of trabecular to cortical bone than midshaft portions of the radius, it is possible that more patients would be classified as osteoporotic if the UDR is measured. The objective of this study was to determine the prevalence of osteoporosis when using T-scores from the UDR in addition to PA lumbar spine, proximal femur (hip), and the radius 33% ROI. Retrospective data were obtained from three centers with differing patient demographics, thus reducing bias as a result of patient characteristics. Data were used only from patients who had a spine, hip, and forearm scan on the same day. Central dual-energy X-ray absorptiometry (DXA) systems included a GE Lunar DPX-L, DPX IQ, and Prodigy and a Hologic Delphi. Hologic data were for the ultradistal radius + ulna ROI (UDRU). Diagnostic classification (using the WHO T-score criteria) was made excluding and including the UDR and UDRU T-scores, in addition to lumbar spine (L2-L4 or L1-L4), hip (femoral neck, greater trochanter, or total), and the radius 33% ROI. The lowest T-score from any ROI determined the classification. For all GE Lunar patients (n = 409 women; age range: 20-96 yr), the distribution of normal, osteopenic, osteoporotic not using the UDR was 94 (23%), 170 (42%), and 145 (36%), respectively. The distribution when using the UDR was 67 (16%), 137 (33%), and 205 (50%), respectively. The difference in the ratio of normal + osteopenic versus osteoporotic when excluding and including the UDR T-scores was significant (p < 0.0001; two-tailed Fisher's exact test). For all Hologic patients (n = 153 women; age range: 44-93 yr), the distributions were 32 (21%), 66 (43%), and 55 (36%) not using and 31 (20%), 64 (42%), and 58 (38%), respectively, using the UDRU (not statistically significantly different). The group mean T-scores were lowest for the UDR compared to the spine and hip with GE Lunar but not Hologic patients.

Absorptiometry, Photon↗

PubMed2002

Effects of exercise practice on the maintenance of radius bone mineral density in postmenopausal women.

The effect of exercise practice on the radius bone mineral density (BMD) was investigated on 480 women at the age of perimenopause and later. The BMD at the 1/3 distal site of the radius on a non-dominant hand was measured using the Dual Energy X-ray Absorptiometry method. The subjects were divided into group E with regular exercising and group C without regular exercising. The difference of mean radius BMD values was not statistically significant between groups E and C. Each of the groups E and C was further classified into a perimenopause group and groups with stratified postmenopausal years (postmenopausal years less than 5, less than 10 and more than 10). Then, the mean radius BMD value of the perimenopause subgroup was taken as 100% for each of the groups E and C, and the relative radius BMD values of subgroups were compared between groups E and C. The relative BMD values for the subgroup of postmenopausal years more than 10 were higher in E group than those in C group, while no difference was observed in below postmenopausal 10 years between the two groups. To clarify the BMD difference among exercise events, group E was further divided into the following three subgroups: the subgroup practising events which give high-impact to arm (HI group), such as tennis, ping-pong, golf and volleyball, the subgroup practising swimming (SW group), and the subgroup practising events which give low-impact to arm (LI group), such as walking, running, aerobic dance and light gymnastics. No significant differences were observed in BMD values among the above sports event-stratified subgroups when postmenopausal years were less than 10 years, but the relative BMD values for the subgroup of postmenopausal years more than 10 were higher in HI and LI group than those in control group. These results suggest the possibility that exercise practice suppresses a postmenopausal decline in bone density for preventing osteoporosis from developing.

Adult↗