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PubMed2001

The role of bone graft and alternatives in unstable distal radius fracture treatment.

The increased prevalence of unstable fractures of the distal radius has stimulated the development of new technologies and new surgical techniques for treating these complex injuries. New developments also contribute to the expectation that orthopedic surgeons should be able to treat the fractured distal radius more successfully by achieving early stability, early function, and better outcomes. The continuous introduction of commercial bone graft substitutes and graft extenders has provided a large array of implantable materials. Rigorous comparison of the commercially available bone graft substitutes is difficult not only because of their diversity but also because uniformly accepted preclinical assays and comparable clinical studies have not been performed. Despite the lack of complete data, however, available data and collective experience suggest that bone graft substitutes can provide improved treatment methods and outcomes.

Biocompatible Materials↗
PubMed1993

Distal radius fractures: patterns of articular fragmentation.

Distal radius articular fractures principally result from the die-punch mechanism of injury that leads to consistent patterns of articular disruption with readily identifiable radiographic signs of instability and reducibility. In the vast majority of articular fractures, prompt recognition of these key radiographic features serves as a sound basis for optimal management. Whereas the type I stable injury can be managed by short-term immobilization, the most frequently encountered type II unstable die-punch fracture requires stabilization provided by external fixation, frequently coupled with percutaneous internal fixation, to maintain an accurate reduction. Restoration of articular congruity in an irreducible type IIB dorsal die-punch fracture, in contrast, can only be accomplished by open treatment, usually comprising a limited exposure for reduction and internal fixation of the radiocarpal articular surface, supplementary external fixation, and adjunctive iliac bone grafting. The irreducible type IIB articular fracture with volar displacement is most suitable for stabilization by plate and screw fixation; however, in patients with excessive comminution, Kirshner wires provide a satisfactory alternative method of fixation. The type III spike fragment is secured with either small screws or wires in conjunction with closed or limited open articular restitution and appropriate nerve and tendon surgery. The irreducible type IV fracture demonstrating wide separation of articular components always requires extensive open treatment for restoration of articular congruity as well as repair of associated skeletal and soft tissue injuries. In the type V explosion injury, provisional stabilization employing, external fixation provides a sturdy framework for critical revascularization or resurfacing procedures and serves to maintain radial alignment before definitive articular reconstruction. In more severe injuries, early detection and repair of frequent periarticular injuries are essential for a favorable recovery. In those fractures requiring open reduction with internal fixation, supplementary external fixation and iliac bone grafting have proved to be increasingly beneficial adjuvants to management. In all cases, preservation of articular congruity with precise restoration of key medial fragments is the principal prerequisite for a successful outcome.

External Fixators↗
PubMed2002

A biomechanical comparison of fragment-specific fixation and augmented external fixation for intra-articular distal radius fractures.

The biomechanical stability of an internal fixation system that uses low-profile modular implants to stabilize individual fracture components was studied in a validated cadaver fracture model that incorporated physiologic muscle forces and wrist motion. Fragment-specific fixation with immediate range of motion was compared with static augmented external fixation in simulated, unstable 3- and 4-part intra-articular distal radius fractures (n = 20). Fixation was applied and specimens were loaded via their major wrist tendons. Because the wrist joint was not constrained in the internal fixation group, full wrist motion occurred during load application in these specimens. A 3-dimensional motion tracking system calculated individual fracture fragment motion in both groups. In the 3-part fracture pattern fragment-specific fixation showed comparable stability to static augmented external fixation despite the full wrist range of motion that occurred during application of load in these specimens. In the 4-part fracture pattern fragment-specific fixation was shown to be significantly more stable when compared with static augmented external fixation in 4 of 6 axes of motion. Our findings confirm the stability of this low-profile plating system and support the consideration of early wrist motion when treating complex, intra-articular distal radius fractures with fragment-specific fixation.

Biomechanical Phenomena↗
PubMed1994

Distal radius fracture and the distal radioulnar joint--anatomical considerations.

The ulna represents the non-rotating, stable and weightbearing part of the forearm around which the radius rotates in pronation and supination. The distal radioulnar joint is the distal half of an articulation, the proximal half of which is the proximal radioulnar joint. In spite of the distance between the two, the distal and proximal radioulnar joints together form a bi-condylar joint, the "forearm joint", with the axis of rotation running from the centre of the radial head out distally into the interosseous space towards the centre of the ulnar head. The end of the radius together with the hand and what is held in the hand will rest against the stable, immobile ulnar head, which acts as the keystone of the wrist. Mobility and stability of the distal radioulnar joint is accomplished by the combined action between fully congruent articulating surfaces and intact radioulnar ligaments. Following a distal radius fracture, the semilunar notch of the radius will no longer be congruent to the ulnar head due to the displacement of the distal fracture fragment of the radius into either dorsal angulation, radial angulation, or both. The stabilizing ligaments will tear. Any posttraumatic disabling dysfunction of the distal radioulnar joint should accordingly be treated by a corrective osteotomy of the radius at the fracture site in order to achieve full congruity between the semilunar notch and the ulnar head. Resection of the ulnar head deprives the wrist its keystone and should therefore be avoided.

Biomechanical Phenomena↗
PubMed1992

[Initial experiences with a new wrist joint fixator in treatment of distal radius fractures].

Between January 1989 and October 1991, 56 patients with 57 distal radius fractures were treated with the new Orthofix wrist fixator. This review of 43 patients consists of cases with follow-ups of at least 12 months. One patient had died, and 38 (90.5%) of the remaining 42 fractures were examined 20.3 months after surgery, on average. Radiological findings were classified according to Lidström, and the functional results according to Gartland and Werley in the Sarmiento modification. Functional analysis demonstrated excellent and good results in 73% of the fractures. Although the number of cases studied is too small for statistical analysis, the results do show a trend emphasizing the importance of subtle anatomical restoration, particularly of the radial length. Since this cannot always be obtained by external fixation alone, supplementary Kirschner-wires, screws and bone-grafting can be necessary. The main advantages of the new Orthofix fixator are its light-weight design, simple application, and the possibility of fracture reduction even after the device has been mounted. Early mobilisation has not been evaluated sufficiently, so no general recommendations can be made yet.

Adolescent↗
PubMed2001

[Carpal injuries associated with distal radius fractures. Diagnosis and therapy].

The frequency of carpal injuries associated with distal radius fractures is often underestimated. Diagnosis of such lesions can be difficult. Important diagnostic steps include conventional X-rays, cinematography of the wrist, MRI, and arthroscopy. Different procedures such as wrist arthrography and CT are of secondary value. An early diagnosis of ligament injuries and instabilities can be obtained through cinematographic examination, whereas injuries to the TFCC are mainly diagnosed by MRI. Arthroscopy provides exact diagnosis as well as therapy, including arthroscopically controlled reposition of centrally depressed fragments of the articular surface of the radius and even treatment of TFCC lesions.

Arthroscopy↗
PubMed1997

Percutaneous pinning of distal radius fractures: a biomechanical study.

Mechanical testing of extra-articular distal radius fractures stabilized with percutaneous pins was performed. Twelve fresh-frozen unembalmed radii stripped of all soft tissues were used. An osteotomy with dorsal comminution was made 2.5 cm proximal to the radial styloid. Three pin sizes and four pin configurations were used to fix the fracture, and the constructs were mechanically tested. Results show that at least a .062-inch pin was required for any significant changes in rigidity of the four pin configurations tested to be discerned. Cross-pinning with two radial styloid pins and placement of a pin from the ulnar corner of the radius as the most rigid construct in both torsion and cantilever bending.

Aged↗
PubMed1988

Function after distal radius fracture.

Follow-up of 154 patients 3.5 years after a distal radius fracture treated by reduction and immobilization in plaster demonstrated that the initial displacement influenced their function. The classification of Older et al. (1965) was prognostic for the outcome. Residual deformity had the greatest influence on the function. The most frequent late problem was instability and tenderness in the distal radioulnar joint.

Female↗
PubMed2002

Interscalene and infraclavicular block for bilateral distal radius fracture.

UNLABELLED: Brachial plexus blockade is a suitable technique for surgery of the forearm, because it provides good intraoperative anesthesia as well as prolonged postoperative analgesia when long-acting local anesthetics are used. However, simultaneous blockade of both upper extremities has rarely been performed (1), because local anesthetic toxicity caused by the amount of drug needed to achieve an efficient block on both sides may be a problem. We report a case of successful bilateral brachial plexus block with ropivacaine in a patient with bilateral distal radius fracture, with each fracture requiring an open osteosynthesis. IMPLICATIONS: This case report presents the performance of a simultaneous blockade of both upper extremities in a patient who sustained a bilateral distal radius fracture. The patient was known to be difficult to intubate and to have a severe hypersensitivity to opioids.

Adult↗
PubMed2005

Predicting the outcome of distal radius fractures.

There are myriad factors that affect patient satisfaction following a distal radius fracture, including anatomic alignment, age, motion, pain,and hand dominance to name a few. The seeming contradictions in the literature serve to illustrate that individual outcomes are not entirely predict-able because of the different functional demands,expectations, and pain tolerance for each patient. Elderly populations may tolerate greater degrees of residual deformity because of a more sedentary lifestyle. Unrecognized intracarpal pathology may account for poor results despite acceptable radiographic alignment. Possessing a knowledge of the predictive factors that affect adversely the functional outcome, however, does allow the surgeon to manage complications proactively to maximize the potential for an acceptable end result.

Disability Evaluation↗
PubMedDate not supplied

Distal radius fractures: therapy practice patterns.

Identifying practice patterns for therapy interventions following distal radius fractures (DRFs) is necessary to define the most frequently used examination and intervention techniques. The purpose of this study was to identify preferred practice patterns and physical and functional outcome measures used during DRF management. Two hundred forty-two therapists (PTs, OTs, and CHTs) were surveyed by questionnaire at an annual hand therapy meeting. A descriptive analysis of data was performed. Preferred practice patterns during the immobilization and the post-immobilization periods were identified. More than 75% of the surveyed therapists used upper extremity range-of-motion exercises and compressive wrap with retrograde massage during the immobilization phase. More than 90% of therapists included range-of-motion exercises and heat/cold modalities in the post-immobilization treatment plans. Physical impairment measures of outcome were used much more frequently than functional outcome questionnaires in assessing progress during treatment. This study advances the evidence-based practice of therapy by establishing a foundation for future research.

Evidence-Based Medicine↗
PubMed1991

Reduction of treatment-related complications in the external fixation of complex distal radius fractures.

Treatment-related complications in the external fixation of complex distal radius fractures may be diminished by the insertion of 4-mm, self-tapping half-pins after predrilling. The pins are placed proximally in the radius and distally through six cortices of the second and third metacarpals. An adaptable fixation device that allows reduction after pin insertion and assembly is recommended. It must allow enough mobility to completely reduce a very unstable fracture after its application. A limited open surgical approach allows direct visualization of the bone where the fixator pins will be placed, as well as central insertion of the pins. It avoids eccentric drill placement, open section defects, redrilling, and damage to soft-tissue structures.

Biomechanical Phenomena↗
PubMed1997

Anaesthesia for the management of distal radius fractures in adults in Scottish hospitals.

The objective of this study was to determine the methods of anaesthesia used for the reduction of distal radius fractures in adults in Scotland and to compare this with the UK situation. The method used was a telephone questionnaire of accident and emergency doctors in 25 Scottish hospitals dealing with trauma. Thirty-two per cent still use general anaesthesia routinely for these procedures despite its cost, complexity and need for admission in the majority of cases. Forty-four per cent now use the Bier's block technique of regional anaesthesia, with the attendant advantages of ease of use, rapid recovery and no need for admission in the majority of patients. Twelve per cent use intravenous sedation and 12% use haematoma blocks for manipulations. It is concluded that Bier's block may be the anaesthetic method of choice for the management of distal radius fractures both in efficiency and economic terms in Scotland. However, training for Bier's blocks needs to be standardized and improved.

Adult↗
PubMed2000

[The analysis of causes of divergence between clinical and radiological results of conservative treatment for distal radius fracture in patients over 50 years of age].

A series of 231 distal radius fractures treated with closed manipulation and cast immobilization has been retrospectively evaluated. Excellent and good results were reported in 69.7% (according to patient's evaluation), in 67.1% according to Gartland-Werley clinical criteria and in 52.4% according to Sarmiento radiologic scale. Fair and poor results constitute circa 30% of results; their share increases as the Frykman fracture type increases and so increases the divergence between clinical and radiologic results.

Female↗
PubMed1997

Acceleration of tibia and distal radius fracture healing in patients who smoke.

A low intensity ultrasound device was investigated as an accelerator of cortical and cancellous bone fracture healing in smokers and nonsmokers. Statistically significant reductions in healing time for smokers and nonsmokers were observed for tibial and distal radius fractures treated with an active ultrasound device compared with a placebo control device. The healing time for a tibial fracture was reduced 41% in smokers and 26% in nonsmokers with the active ultrasound device. Similarly, distal radius fracture healing time was reduced by 51% in smokers and 34% in nonsmokers with the active device. Treatment with the active ultrasound device also substantially reduced the incidence of tibial delayed unions in smokers and nonsmokers. The use of the active ultrasound device accelerates cortical and cancellous bone fracture healing, substantially mitigates the delayed healing effects of smoking, speeds the return to normal activity, and reduces the long-term complication of delayed union.

Adult↗
PubMed2002

[Evaluation of carpal instability after distal radius fracture].

In this study carpal stability was assessed in a group of patients with distal fractures of the radius. The aim of this study was to: assess the frequency of carpal instability as a concomitant lesion to fractures of the distal radius, determine the type of instability and its correlation to fracture type and patient age, assess the influence of bone fragment dislocation on the type of instability. For a clinical evaluation of carpal instability results of physical examination and X-ray examination performed in both static and dynamic conditions were taken into account. In 33% of the examined cases different types of instability were noted. Carpal instability was found more often among younger patients, predominantly of the dorsal type. The type of observed instability depended mainly on the injury mechanism and fracture type of the distal radial epiphysis. Fracture type did not influence the frequency of carpal instability, whereas direction and degree of bone fragment displacement did correlate to the type of primary or secondary instability.

Adult↗