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Results for “RADIUS FRACTURES”

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At least 217 records · Page 12Linked to original sources
PubMed2005

Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation.

PURPOSE: The purpose of this study was to compare the outcomes of 2 treatments for unstable distal radius fractures: open reduction internal fixation (ORIF) through a volar approach with a fixed-angle implant and a standard external fixation (EF) method. METHODS: This study included patients with comminuted unstable intra-articular and extra-articular distal radius fractures treated by a single surgeon. Data were gathered retrospectively on 11 patients treated with EF who had been followed up for an average of 47 months (range, 12-84 mo). Prospective data were gathered on 21 patients who were treated with ORIF through a volar approach with a fixed-angle implant. Follow-up evaluation for this group averaged 17 months (range, 12-24 mo). The 2 groups were compared for range of motion (ROM), strength, and functional outcome as measured by the Patient Rated Wrist Evaluation (PRWE) and the Disability of the Arm, Shoulder, and Hand Questionnaire (DASH). Fracture reduction was evaluated from radiographs taken at the last follow-up visit and compared between groups. RESULTS: The mean passive wrist ROM at the final follow-up evaluation in EF patients was 59 degrees extension and 57 degrees flexion, compared with 63 degrees extension and 64 degrees flexion in patients treated with ORIF. Passive pronation/supination arc of motion was similar for the 2 groups, as were the DASH and PRWE scores. Grip strength as a percentage of the opposite wrist was significantly greater in the external fixation group, a possible consequence of longer follow-up evaluation. Final radiographic measurements for the EF group averaged 5 degrees volar tilt and 25 degrees radial inclination, with 2.2-mm ulnar-positive variance. The ORIF with volar plating group averaged 10 degrees volar tilt and 22 degrees radial inclination, with .5-mm ulnar-negative variance. Radial length and volar tilt were significantly greater for the ORIF group. The average final intra-articular step-off was significantly different, with 1.4-mm step-off in the EF group and .4 mm in the ORIF group. CONCLUSIONS: The use of ORIF with a volar fixed-angle implant resulted in stable fixation of the distal articular fragments, allowing early postsurgical wrist motion. The PRWE and DASH scores for the groups were equivalent, whereas intra-articular step-off, volar tilt, and radial length were better in the ORIF group. There were few complications, implant removal was not necessary, and early postsurgical wrist ROM was initiated without loss of reduction.

Adult↗
PubMed2005

Ice and pulsed electromagnetic field to reduce pain and swelling after distal radius fractures.

OBJECTIVE: To examine the relative effectiveness of ice therapy and/or pulsed electromagnetic field in reducing pain and swelling after the immobilization period following a distal radius fracture. METHODS: A total of 83 subjects were randomly allocated to receive 30 minutes of either ice plus pulsed electromagnetic field (group A); ice plus sham pulsed electromagnetic field (group B); pulsed electromagnetic field alone (group C), or sham pulsed electromagnetic field treatment for 5 consecutive days (group D). All subjects received a standard home exercise programme. A visual analogue scale was used for recording pain; volumetric displacement for measuring the swelling of the forearm; and a hand-held goniometer for measuring the range of wrist motions before treatment on days 1, 3 and 5. RESULTS: At day 5, a significantly greater cumulative reduction in the visual analogue scores as well as ulnar deviation range of motion was found in group A than the other 3 groups. For volumetric measurement and pronation, participants in group A performed better than subjects in group D but not those in group B. CONCLUSION: The addition of pulsed electromagnetic field to ice therapy produces better overall treatment outcomes than ice alone, or pulsed electromagnetic field alone in pain reduction and range of joint motion in ulnar deviation and flexion for a distal radius fracture after an immobilization period of 6 weeks.

Adolescent↗
PubMed1990

[Sudeck's disease after radius fracture].

Clinical and radiological features of Sudeck's dystrophy following radius fracture are described. Peripheral and endogenous factors are pointed out. Therapy consists in preventing and alleviating pain by primary immobilisation combined with gentle physical therapy of the non-involved parts of both upper extremities. Calcitonin, non-steroid antirheumatic and anxiolytic drugs should be administered simultaneously. The physician's care and tolerance of the mentally upset and labile patient are essential. Physiotherapy plays a major role in the long-standing rehabilitation process.

Diagnostic Imaging↗
PubMed1996

External fixation for distal radius fractures: adverse effects of excess distraction.

External fixation is accepted treatment for some distal radius fractures. Ligamentotaxis is the basis for the technique, and failure to recognize its limitations can lead to excess distraction. This paper discusses potential complications of excess distraction as well as its effect on outcome. Supplemental fixation techniques and multiplanar ligamentotaxis are advocated to improve outcome when external fixation is used.

Fracture Fixation↗
PubMed2003

Impact of bone density on distal radius fracture patterns and comparison between five different fracture classifications.

OBJECTIVE: To investigate the impact of bone mineral density (BMD) and bone geometry on failure loads and fracture patterns of the distal radius and to compare 5 different fracture classifications. DESIGN: Biomechanical and radiologic in vitro study. SETTING: Research laboratory. MAIN OUTCOME MEASUREMENTS: A total of 118 intact human forearms from elderly donors were examined by means of conventional radiography and peripheral quantitative computed tomography (PQCT) to determine BMD and geometry. The forearms were subjected to a standardized biomechanical test simulating a fall on the outstretched hand. The distal radius fractures were classified from x-rays using the AO ( 33), Cooney ( 9), Fernandez ( 15), Frykman ( 17), and Melone ( 31) classifications. The grading was repeated after preparation and direct visual inspection of the fracture site and was correlated with radiographic results. Fracture patterns also were correlated with BMD and geometry. RESULTS: Correlations between bone properties and fracture patterns (r = 0.09-0.70) suggested an increase in the severity of fractures with decreasing bone quality. The highest correlation between failure load and bone properties was found for the cortical area (r = 0.70) and trabecular density (r = 0.60). Good correlations between radiographic and direct visual classification were obtained for the Cooney ( 9) (r = 0.70), the AO ( 33) (r = 0.68), and the Fernandez ( 15) (r = 0.65) classifications. Smaller values were found for the Frykman ( 17) (r = 0.44) and the Melone ( 31) (r = 0.27) classifications. CONCLUSIONS: With increasing osteopenia, the load to failure decreases, and the severity of fractures increases. Fracture patterns in this patient population can be adequately graded with the AO ( 33) and Cooney ( 9) classifications. The severity of distal radius fractures tends to be underestimated by conventional x-ray examination, which needs to be taken into account when a fracture treatment plan is selected.

Aged↗
PubMed1996

Early salvage reconstruction of severe distal radius fractures.

During an 8-year period from 1980 through 1988, 9 distal radius fractures could not be restored because of bone loss or extensive comminution and were, therefore, salvaged by early arthrodesis in 7 patients and Swanson silicone wrist arthroplasty in 2. At a mean of 3.7 years, 4 patients rated good, 2 satisfactory, and 3 poor according to a 100-point scoring system based on residual pain, motion, grip strength, and occupational recovery. Irreparable distal radial fractures with damage largely confined to the skeleton achieved satisfactory or good results. Poor results occurred when there was severe soft tissue damage, especially neurovascular injury, despite a successful skeletal reconstruction. When articular restoration could not be accomplished, early arthrodesis or arthroplasty resulted in wrist alignment, stability, and pain control, and optimized the opportunity for digital and upper extremity functional recovery.

Adult↗
PubMed2005

Fragment-specific fixation of distal radius fractures using the Trimed device.

Fragment-specific fixation of the distal radius represents a new technique for addressing complex distal radius fractures. It signifies a substantial shift in the thought process of open reduction and internal fixation; each fracture fragment is addressed independently with small plates or wire forms, allowing comminuted fractures to be anatomically restored and early motion started. Although the system is at first daunting, its modularity provides flexibility for the surgeon to modify the fixation to the individual needs of the patient's specific fracture pattern and the surgeon's level of expertise. Once the technique has been learned, the surgeon will have in his or her armamentarium a powerful new tool to treat fractures that had before been difficult to address satisfactorily with conventional techniques.

Fracture Fixation, Internal↗
PubMed2002

An analysis of bone stresses and fixation stability using a finite element model of simulated distal radius fractures.

A 3-dimensional finite element model was used to study pin fixation in simulated unstable extra-articular distal radius fractures. Bone geometry and material properties were generated from computed tomography. The model was validated in cadaver testing. The model is robust and an accurate predictor of bone stresses and fracture stability under pure axial load. Three different pinning configurations and 3 different pin materials were evaluated. Crossed pinning provided greater fracture stability and a broader distribution of bone stresses than pinning through the radius styloid alone. Steel pins provided greater fracture stability; however, bioabsorbable pins produced lower stress concentration in the bone near the pins. A finite element model is useful in showing differences between various pin constructs in the treatment of distal radius fractures.

Aged↗
PubMed2004

The 45 degrees pronated oblique view for volar fixed-angle plating of distal radius fractures.

Distinctive to volar fixed-angle plating of the distal radius, the optimal position of the distal fixed-angle support is in the subchondral bone immediately proximal to the articular surface. Standard intraoperative radiographic imaging of the distal radius during placement of a volar fixed-angle plate does not provide adequate visualization of the subchondral bone-distal support interface. A 45 degrees pronated oblique view is described to address this specific issue of whether volar hardware placed at the immediate subchondral bone level has effectively avoided the radiocarpal joint. This is a quite important radiographic consideration when pursuing the strategy of volar fixed-angle plating of distal radius fractures.

Adult↗
PubMed2003

[Angularly stable radius plate: progress in treatment of problematic distal radius fracture?].

Fractures of the distal radius represent one of the most common fractures and have high socioeconomic relevance. Using the volar approach to avoid the soft tissue problems associated with dorsal plating, we treated a consecutive series of 49 displaced intra-articular distal radius fractures with a new fixed-angle internal fixation device. According to the AO classification, there were 21 C1, 19 C2, and nine C3 fractures. A retrospective study was carried out to obtain the functional results after open reduction and plate osteosynthesis. Loss of correction between postoperative and follow-up radiography was 1 degrees in volar tilt and radial inclination. The radial shortening was 1 mm. Wrist motion at final follow-up examination had recovered to an average of 80% of that at the normal, contralateral site. Overall outcome according to the Gartland and Werley scales showed 35% excellent, 50% good, and 15% fair results. Using the Martini score, we obtained 85% excellent and good results. The DASH score represented high subjective satisfaction.

Adult↗
PubMed2007

Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving conservative treatment?

AIM: To investigate whether radiographic deformities suggesting inadequate reduction would be associated with adverse clinical outcomes. MATERIALS AND METHODS: Consecutive patients over 50 years of age (n=74) with non-operatively managed distal radius fractures were enrolled in a prospective cohort study. They had radiographs at cast removal ( approximately 6 weeks) and completed DASH (Disabilities of the Arm, Shoulder and Hand), SF-12 (health-related quality of life), and satisfaction surveys 6-months post-fracture. A reference-standard musculoskeletal radiologist, blinded to outcomes status, measured palmar (dorsal) tilt, radial angle, radial height, ulnar height, and intra-articular step and gap. Radiographic indices were correlated to each other and to the various patient-reported outcomes in univariate and multivariate regression analyses. DASH score was the primary study outcome. RESULTS: Of the cohort studied (n=74, mean age 68.5 years, primarily white women), 71% had at least one "unacceptable" radiographic deformity by traditional criteria. Acceptable reduction varied from 60-99% depending on which single index was reported, and 44% of patients had more than two indices reported as unacceptable. Despite these radiographic findings, 6-months post-reduction, self-reported disability was low (DASH=24+/-17), health-related quality of life was near normal, and 72% were satisfied with their care. No radiographic index of wrist deformity (alone or in combination) was significantly correlated to any of the patient-reported outcomes. CONCLUSION: Self-reported outcomes in older adults with conservatively managed wrist fractures were not related to the "acceptability" of radiographic fracture reduction. The proportion of acceptable reductions varied by 40% depending on which index was reported. Consequently, detailed reporting of these indices in older adults with distal radius fracture may be inefficient or perhaps even unnecessary.

Aged↗
PubMed2002

Primary bone grafting does not improve the results in severely displaced distal radius fractures.

We prospectively randomised 45 patients ages 20-70 years with distal radius fractures of Older type III and IV to one of two treatment groups. One group was treated with closed reduction, primary bone grafting, and external fixation for 3 weeks, followed by a plaster cast that allowed volar flexion, for an additional 3 weeks. The other group was treated with closed reduction and external fixation for 6 weeks. The functional and radiographic results were evaluated. There was no difference between the two groups in either clinical or radiographic outcome. We do not recommend external fixation and primary bone grafting as a routine method in these fractures.

Adult↗
PubMed2000

Results of transarticular fixator application in distal radius fractures.

From January 1989 until October 1993, 102 patients with 103 distal radius fractures were included in a prospective study with the Pennig wrist fixator (Orthofix, Srl, Italy). 90.5% of these patients were reviewed with a minimum follow-up of 12 months. Using the functional outcome score according to Gartland and Werley, we obtained 41% excellent, 46% good, 10% fair and 3% poor results. Additional procedures such as K-wires, bone grafting or radio-ulnar stabilizations were carried out in 61% of cases. The complications included five fixator displacements, four of which happened with the prototype used until the first half of 1990. Two major pin-track-infections required surgical intervention, three patients in the beginning of the series encountered irritations of the superficial radial nerve, one pin cut out of the second metacarpal bone and one patient sustained algodystrophy. The results show the significance of an anatomical reduction, the restoration of the radial length seems to be of special importance to obtain good functional outcome. This can not always be achieved with the fixator alone; often additional procedures are required in order to obtain an anatomical joint reconstruction. The advantage of this fixator lies in its lightweight and small-size design as well as in its easy application technique and the possibility to carry out the reduction after mounting the fixator with the double ball joint centered on the fracture level and the carpus.

Adolescent↗
PubMed2001

Radius fractures in the athlete.

With prompt and accurate diagnosis, a stable and anatomic distal radius fracture reduction, the detection and treatment of any associated intraarticular injuries with the use of wrist arthroscopy, and an early, comprehensive rehabilitation program, one usually can expect a favorable outcome. The treating physician never should compromise these basic principles solely for the sake of a speedy return to sports at the behest of the coach, the athlete, or his family. This could result in a less-than-favorable recovery, and a possible permanent loss of athletic skills.

Arthroscopy↗
PubMed2001

Limited incision open techniques for distal radius fracture management.

This article discusses recent innovations in the management of distal radius fractures. Clinical and biomechanical studies have shown that stable fixation can be achieved with small implants aligned in an orthogonal fashion. This technique greatly diminishes the necessary soft tissue dissection needed at surgery and allows for early mobilization of the wrist, which may lead to improved outcomes and fewer soft tissue complications.

Adult↗
PubMed2006

Fixation of distal radius fractures using a fragment-specific system.

UNLABELLED: Operative treatment for distal radius fractures continues to evolve, but small-fragment fixation has some advantages compared with previous methods. We assessed two groups of patients. Group 1 was an initial series of patients treated with small-fragment fixation at a large institution in the United States, and Group 2 was a review of patients treated in Lund, Sweden. The first group was evaluated for return to routine activity. Return to work or routine daily activity averaged 6 weeks (range, 3-16 weeks). The second group was evaluated for early grip strength and range of motion compared with the uninjured extremity. The grip strength at final followup averaged 67% compared with the uninjured extremity. Wrist flexion averaged 46 degrees, extension averaged 57 degrees, pronation averaged 80 degrees, and supination averaged 73 degrees. LEVEL OF EVIDENCE: Therapeutic study, level IV.

Adult↗
PubMedDate not supplied

Radiographic assessment of pediatric proximal radius fractures: interrater and intrarater reliability.

Three methods of measuring pediatric proximal radius fracture radiographs were compared using injury films of 32 patients. Angulation and displacement were independently measured by four physicians. One physician measured the films by each method a second time 2 months later. Values for interrater and intrarater reliability were determined using inter- and intra-class coefficients (ICC). Interrater reliability was poor for methods using the axis of the proximal radial fragment or the proximal radial physis as a reference (ICC = 0.47 and 0.42, respectively). Measurement of the angle between a line parallel to the proximal radius articular surface and the radial shaft had the highest interrater reliability (0.76); measurement of displacement had the lowest interrater reliability (0.09). The intrarater reliability was excellent for all methods (0.93-0.99) and was also highest when the proximal articular surface reference was used. Of described methods, use of the proximal radius articular surface and the radial shaft as references had the highest interrater and intrarater reliability.

Adolescent↗