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PubMed2001

[Indications criteria for treatment of distal radius fractures].

To achieve an optimal functional result after distal radius fractures the treatment has to orientate at different criteria. The bone destruction must be analysed. A fracture classification is necessary to use all the variable alternatives of treatment. With the AO classification we are able to describe most of the variable fracture types. Soft tissue damage and osteoporosis must be regarded additionally. The most important criteria however in fracture treatment is the fracture type.

External Fixators↗
PubMed2002

Use of injectable calcium phosphate in the treatment of intra-articular distal radius fractures.

This study reviewed 19 patients with intra-articular fractures of the distal end ofthe radius treated with augmented external fixation and injectable calcium phosphate (Norian SRS; Norian Corp, Cupertino, Calif) between November 1997 and July 2000. Average patient age was 52 years, and average follow-up was 16.3 months. Patients were evaluated clinically and radiographically using the modified Mayo Wrist Score and Knirk and Jupiter's criteria, respectively. Overall results are comparable to those from other studies of intra-articular distal radius fractures in which other grafts have been used.

Adult↗
PubMed2005

A biomechanical comparison of a dorsal 3.5-mm T-plate and a volar fixed-angle plate in a model of dorsally unstable distal radius fractures.

OBJECTIVES: To compare the biomechanical stability of internal fixation of extra-articular, dorsally unstable distal radius fractures fixed by 1 of 2 methods, either a standard dorsal nonlocked T-plate or a volar locked fixed-angle plate. DESIGN: Biomechanical cadaveric study. SETTING: Biomechanical testing laboratory. INTERVENTION: In 6 matched pairs of fresh-frozen cadaveric specimens, a simulated unstable extra-articular distal radius fracture was created. The fractures were stabilized with either a dorsal 3.5-mm stainless steel T-plate or a titanium locked volar fixed-angle plate. Specimens were axially loaded at 5 points (centrally, volarly, dorsally, radially, and ulnarly) and then cyclically loaded for 5000 cycles with an 80 N central load. Postcyclical loading, specimens were once again axially loaded at the 5 points. MAIN OUTCOME MEASURES: Initial fixation stiffness and stiffness after midaxial cyclical loading was compared at the 5 points. RESULTS: With the volar locked fixed-angle plate, fixation was significantly stiffer than with the dorsal nonlocked T-plate for ulnar and volar loading in single-cycle testing. After cyclic loading, the locked volar fixed-angle plate maintained more of its initial stiffness than the dorsal nonlocked T-plate. The dorsal 3.5-mm stainless steel T-plate's stiffness when dorsally loaded significantly decreased after cyclical loading. CONCLUSIONS: The volar locked fixed-angle plate maintained a greater percentage of its initial stiffness after cyclic loading compared to the dorsal nonlocked plate. Also, the volar locked plate was stiffer than the dorsal nonlocked plate for all loading configurations tested except when subjected to a dorsally applied eccentric load.

Adult↗
PubMed1989

[Concomitant carpal injuries in radius fractures. Nature and incidence, analysis of the last 10 years].

Carpal involvement was detected in 47 cases amongst 2828 radius fractures in the last ten years at the St. Gallen Cantonal Hospital. A radiological correlate of this carpal involvement was found retrospectively in 18 cases. The number is likely to be very much higher with increased attention to this injury! The significance of exact diagnosis is underscored by the observation that the concomitant carpal lesion predominates in the further course and determines the fate of the wrist a long time after the radius fracture has healed up.

Carpal Bones↗
PubMed2006

Prediction of distal radius fracture in children, using a biomechanical impact model and case-control data on playground free falls.

OBJECTIVES: To assess the ability of a biomechanical impact model to predict the likelihood of distal radius fracture in children using data gathered for a previous epidemiological case-control study of falls from playground equipment. METHODOLOGY: Factor of Risk (FR) values were generated for each of selected subjects from the case-control study using a biomechanical model. Logistic regression curves were fitted to examine the relationship between the FR values and the probability of radius fracture. RESULTS: Forty-five cases and thirty-one controls were selected. The logistic regression analyses showed a significant association between the probability of fracture and FR. CONCLUSIONS: The biomechanical model distinguished between children who fractured their distal radius and those who did not. The model can be used to test how risk factors, such as fall height and ground surface type, affect physical stresses transmitted through the arm and their relation to the fracture tolerance of the distal radius.

Accidental Falls↗
PubMed2001

Computed tomography scanning of intra-articular distal radius fractures: does it influence treatment?

The purpose of this study is to determine whether the addition of computed tomography (CT) results in changes in the evaluation and treatment of intra-articular distal radius fractures. Fifteen intra-articular distal radius fractures were evaluated independently by 4 hand surgeons. Plain x-rays were reviewed initially followed by the corresponding CT scans for comparison of articular step-off and gapping, comminution, and treatment. Kappa coefficients (kappa) of intraobserver and interobserver reliability for treatment plans were generated. Computed tomography scans improved the sensitivity of measurement of articular surface gapping, improved the accuracy of detection of comminution and distal radioulnar joint involvement, and altered proposed treatment plans within observers (intraobserver agreement: kappa =.54, moderate) and improved agreement of proposed treatment plans between observers (kappa =.34 to kappa =.44, fair to moderate). Computed tomography scanning influenced observers to change treatment plans and resulted in increased interobserver reliability in the proposed management of these injuries.

Humans↗
PubMed2002

[Treatment of intra-articular distal radius fractures by external radio-radial fixation--two case studies].

The paper presents two cases of the intra-articular distal radius fractures treated with good results by external radio-radial fixation. Techniques of the method are discussed. The advantages of the method are good stability and early function of the wrist after treatment. The indication for this method is distal radius fractures typ A3, C2 and C3 according the AO classification.

Adult↗
PubMed2000

Responsiveness of the short form-36, disability of the arm, shoulder, and hand questionnaire, patient-rated wrist evaluation, and physical impairment measurements in evaluating recovery after a distal radius fracture.

We evaluated the responsiveness of patient questionnaires and physical testing in the assessment of recovery after distal radius fracture. Patients (n = 59) were assessed at their baseline clinic visit and again 3 and 6 months after injury. At each visit patients completed a short form-36, Disability of the Arm, Shoulder, and Hand questionnaire, and patient-rated wrist evaluation (PRWE). At 3 and 6 months grip strength, range of motion, and dexterity were analyzed. Standardized response means (SRM) and effects sizes were calculated to indicate responsiveness. The PRWE was the most responsive. Both the PRWE (SRM = 2.27) and the Disability of the Arm, Shoulder, and Hand (SRM = 2.01) questionnaire were more responsive than the short form-36 (SRM = 0.92). The physical component summary score of the short form-36 was similar to that of the physical component subscales. Questionnaires were highly responsive during the 0- to 3-month time period when physical testing could not be performed. Of the physical tests, grip strength was most responsive, followed by range of motion. Responsive patient-rating scales and physical performance evaluations can assist with outcome evaluation of patients with distal radius fracture.

Adolescent↗
PubMed2000

[Simultaneous management of multi-fragment distal radius fractures with palmar and dorsal approach].

Reconstruction of the articular anatomy can be extremely difficult in distal radius fractures with severe comminution of both the dorsal and palmar cortices. In these cases, neither open reduction using an unilateral approach nor closed reduction with ligamentotaxis and fixateur externe will be successful. Reconstruction of both the dorsal and palmar cortical column is necessary. Sixteen of nineteen patients with unstable bicolumnar distal radius fractures treated by a combined plate osteosynthesis were studied retrospectively. Follow-up time averaged 32.5 months (8 to 74). At the time of re-examination the average grip strength and range of motion were reduced by 30% compared with the uninjured side. The average DASH-score was 11.2 points. Radiographic measurements revealed a satisfactory restoration of the radius concerning length and form. There were no signs of higher graded arthrosis.

Adult↗
PubMed2005

Fixed angle fixation of distal radius fractures through a minimally invasive approach.

Treating unstable distal radius fractures in osteoporotic patients remains a challenge for the surgeon. Fixed angle plate fixation requires ample surgical dissection but has been shown to improve stability, allow early functional use of the hand and facilitate rehabilitation. We herein describe a treatment method that provides the benefits of fixed angle fixation while utilizing a minimally invasive approach. Stability is achieved by the use of a new implant that is placed through a small dorsal incision and minimizes extensor tendon disruption. This method finds application in the unstable extra-articular fracture of the high risk patient where minimal surgical morbidity is desirable and when reduction can be obtained without the need of extensive dissection. Clinical examples are fractures in the elderly patient where confusion can follow prolonged anesthesia, fractures in the patient with a bleeding disorder where a small wound volume is desirable and fractures in the polytraumatized patient where surgical time must be kept to a minimum. This technique allows anatomic reduction and stable fixation to be achieved in a short operative time and with minimal surgical insult while providing the compromised patient with a rapid recovery.

Bone Plates↗
PubMed1998

[Alternative surgical method in malalignment of healed distal radius fracture: Kapandji-Sauvé procedure].

Malunion after distal radius fracture with subluxation of the distal radioulnar joint can considerably limit the function of the hand. If the malunion cannot be eliminated by the corrective osteotomy of the radius, care must be taken not to additionally impair the stability of the wrist joint and the carpus, in the event of any necessary salvage procedure. In the Kapandji-Sauvé procedure, an arthrodesis is carried out after repositioning of the distal radioulnar joint. By segment resection of the ulnar shaft, a new joint is made to permit forearm rotation. Between 1984 and 1995, a total of 96 patients were treated with this procedure in our hospital. It was possible to re-examine 87 of those patients after an average period of 4 1/2 (1 to 11) years. The average age of the patients was 59 (14 to 72) years. In 25 cases the results were very good and in 52 cases good. In nine cases the results were poor. In one case the result was unsatisfactory.

Adolescent↗
PubMed2005

Volar plate fixation of distal radius fractures.

Volar fixed angle fixation may be considered as the beginning of a new era in restoring wrist function to patients with dorsally displaced distal radius fractures even in the face of comminuted or osteopenic bone. A thorough understanding of the anatomy of the wrist is a prerequisite when volarly approaching dorsally displaced distal radius fractures. The demonstration of the device theoretical and practical advantages requires an appreciation of the basics of working length, principles of plate stability, and the effect of cantilever bending. Volar fixed angle fixation successfully improves wrist function and significantly prevents the complications of the dorsal approach previously intractable to treatment. The current advantages, indications, clinical results, and complications of this new technology are being reviewed.

Biomechanical Phenomena↗
PubMed1983

[Conservative and surgical treatment of radius fractures loco classico].

More and more distal fractures of the radius are treated surgically, thereby decreasing the treatment time and quickly restoring use of the arm. The rarely seen compound fractures of the radius and those involving circulation problems or loss of feeling in the hand will be treated as emergency cases. The most frequently used treatment is osteosynthesis using pins. In cases of Smith fracture, with young patients or corrective surgery the preferred method is osteosynthesis using metal plates. If, because of extensive fragmentation, a non-operative treatment would certainly lead to dislocation, or a secondary dislocation due to a non-operative treatment has already taken place, the surgical treatment should be discussed. Dislocated intraarticular fractures are increasingly being treated immediately surgically.

Adolescent↗
PubMed1985

Epidemiology of distal radius fractures.

In the county of Frederiksborg, Denmark, all distal radius fractures in inhabitants over 20 years of age were recorded throughout 1981; the population at risk was a quarter million, and fractures occurred in 394 women and 99 men. The age-specific incidence confirmed the rise in osteoporotic fractures over the past 20 years demonstrated recently in Malmö and Oslo.

Adult↗
PubMed1989

Completely displaced distal radius fractures with intact ulnas in children.

Completely displaced distal radius fractures with intact ulnas are uncommon, difficult-to-reduce fractures in children. Ten of these fractures were retrospectively reviewed from a series of more than 600 forearm fractures. Eight of ten patients were available for follow up clinically and radiologically at an average of 21 months. Considerable remodeling was noted including two fractures that were left in an overriding position of 10 mm. If angulation does not exceed 16 degrees of radial deviation and 20 degrees of dorsal angulation, repeat manipulations need not be performed. Stimulation of growth by the fracture restored radial length. Thus, reduction of the overriding is unnecessary.

Adolescent↗
PubMed1998

[Prognosis of proximal radius fractures in the growth period].

Fractures of the proximal radius in children may lead to deformities of the radial head and functional disturbance of pro- and supination. However, traumatization is not only caused by the injury itself, but may also occur secondary to surgical reduction, manipulation of fracture fragments and excessive physiotherapy. In a prospective long-term follow-study (2-20 years after trauma) of 38 children with displaced proximal radius fractures we found functional disturbances in 11% of children only. These were not caused by radial head deformities, which were present on 83% of follow-up radiographs. Functional impairment was mainly seen after open reduction or secondary growth disturbances. On follow-up radiographs all conservatively treated fracture angulations up to 60 degrees had corrected themselves spontaneously. In view of the high complication rates after open reduction and the poor functional results, as well as the inconvenience for the pediatric patient and the economic aspects, we recommend a primary conservative treatment concept of proximal radius fractures in children.

Adolescent↗