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At least 271 records · Page 15Linked to original sources
PubMed2004

Image-based micro-finite-element modeling for improved distal radius strength diagnosis: moving from bench to bedside.

Although osteoporosis is characterized by quantitative (mass) and qualitative (structural) changes, standard clinical techniques (dual-energy X-ray absorptiometry, DXA) only measure the former. Three-dimensional micro-finite-element (micro-FE) models based on high-resolution images can account for structural aspects as well, and it has recently been shown that an improved prediction of distal radius strength is possible with micro-FE analysis. A clinical application of this technique, however, is limited by its high imaging and computational demands. The objective of this study is to investigate if an improved prediction of bone strength can be obtained as well when only a small part of the radius is used for micro-FE modeling. Images of a 1-cm region of the metaphysis of the distal radius of 54 cadaver arms (mean age: 82 +/- 9 SD) made with a three-dimensional peripheral quantitative computed tomography (pQCT) device at 165- micro m resolution formed the basis for micro-FE models that were used to predict the bone failure load. Following imaging, specimens were experimentally compressed to failure to produce a Colles'-type fracture. Failure loads predicted from micro-FE analyses agreed well with those measured experimentally (R2 = 0.66, p < 0.001). Lower correlations were observed with bone mass (R2 = 0.48, p < 0.001) and microstructural parameters (R2 = 0.47, p < 0.001). Hence, even when only a small region is modeled, micro-FE analysis provides an improved prediction of radius strength.

Absorptiometry, Photon↗
PubMed1999

Intra-articular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared with open reduction and internal fixation.

BACKGROUND: There is no consensus that an arthroscopically guided operation can improve the anatomical and functional results of treatment of intra-articular fractures of the distal aspect of the radius. The purpose of the present prospective study was to determine the usefulness of arthroscopically assisted reduction of displaced intra-articular fractures of the distal aspect of the radius by comparing the results of that procedure with those of conventional open reduction and internal fixation. METHODS: Thirty-four fractures were treated with arthroscopically guided reduction with use of one volar and two dorsal arthroscopic portals. The fractures were pinned, and external fixation was used with or without autogenous bone graft. Intraoperative fluoroscopy was not used. Forty-eight fractures were treated with conventional open reduction and internal fixation with a plate and screws or with pinning, with or without external fixation. The average duration of follow-up for all fractures was thirty-one months. RESULTS: The scores for overall outcome, assessed with use of the system of Gartland and Werley and that of Green and O'Brien as modified by Cooney et al., demonstrated that the group that had had an arthroscopically assisted procedure had better outcomes than the group that had had conventional open reduction and internal fixation. The group that had had an arthroscopically assisted procedure also had significantly better ranges of flexion-extension and radial-ulnar deviation of the wrist and grip strength (p<0.05). We detected an association between the maximum step and gap displacement and evidence of osteoarthritis of the radiocarpal joint (p<0.001), but we did not find a significant association, with the numbers available, between the scores for osteoarthritis, graded according to the scale of Knirk and Jupiter, and the scores for overall outcome, assessed with the scale of Gartland and Werley and the modified system of Green and O'Brien, in either group (p = 0.376). The radiographic results showed that the patients who had had an arthroscopically assisted procedure had better reduction of volar tilt, ulnar variance, and articular (gap) displacement than did those who had been managed with conventional open reduction and internal fixation (p<0.05 for each comparison). CONCLUSIONS: An arthroscopically guided operation achieved an accurate reduction of intra-articular fractures of the distal aspect of the radius. Minimum capsular and adjacent soft-tissue scarring reduced postoperative contracture, which improved the overall functional results. We recommend arthroscopically guided reduction and internal fixation not only for young adults but for all patients who are less than seventy years old and have an intra-articular fracture of the distal part of the radius with more than one millimeter of displacement on plain radiographs.

Adolescent↗
PubMed2004

Loss of fixation of the volar lunate facet fragment in fractures of the distal part of the radius.

BACKGROUND: The purpose of the present study is to report on a cohort of patients with a volar shearing fracture of the distal end of the radius in whom the unique anatomy of the distal cortical rim of the radius led to failure of support of a volar ulnar lunate facet fracture fragment. METHODS: Seven patients with a volar shearing fracture of the distal part of the radius who lost fixation of a volar lunate facet fragment with subsequent carpal displacement after open reduction and internal fixation were evaluated at an average of twenty-four months after surgery. One fracture was classified as B3.2 and six were classified as B3.3 according to the AO comprehensive classification system. All seven fractures initially were deemed to have an adequate reduction and internal fixation. Four patients required repeat open reduction and internal fixation, and one underwent a radiocarpal arthrodesis. At the time of the final follow-up, all patients were assessed with regard to their self-reported level of functioning and with use of Sarmiento's modification of the system of Gartland and Werley. RESULTS: At a mean of two years after the injury, six patients had returned to their previous level of function. The result was considered to be excellent for one patient, good for four, and fair for two. The average wrist extension was 48 degrees, or 75% of that of the uninjured extremity. The average wrist flexion was 37 degrees, or 64% of that of the uninjured extremity. The one patient who underwent radiocarpal arthrodesis had achievement of a solid union. The four patients who underwent repeat internal fixation had maintenance of reduction of the lunate facet fragment. The two patients who declined additional operative intervention had persistent dislocation of the carpus with the volar lunate facet fragment. CONCLUSIONS: The stability of comminuted fractures of the distal part of the radius with volar fragmentation is determined not only by the reduction of the major fragments but also by the reduction of the small volar lunate fragment. The unique anatomy of this region may prevent standard fixation devices for distal radial fractures from supporting the entire volar surface effectively. It is preferable to recognize the complexity of the injury prior to the initial surgical intervention and to plan accordingly.

Adult↗
PubMed2006

Fractures of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation.

BACKGROUND: Fractures of the volar articular margin of the distal part of the radius with volar radiocarpal subluxation (Barton fractures) are well recognized, and substantial data are available to guide their treatment. In contrast, fractures of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation (sometimes referred to as dorsal or reverse Barton fractures) are rarely mentioned, and there are very little data to guide their treatment. METHODS: Twenty patients with a fracture of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation were evaluated. A spectrum of volar injuries was observed: two patients had torn volar ligaments; ten had a displaced, rotated volar marginal lip fracture; six had impaction of the volar aspect of the articular surface; and two had no appreciable volar injury. Fourteen of the twenty patients also had impacted central articular fragments. Eighteen patients underwent surgical reconstruction of the articular surface and application of dorsal buttress plates with use of a variety of surgical approaches. At the time of follow-up, the outcome was assessed radiographically and with use of the modified Mayo wrist score and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS: At an average of thirty months postoperatively, nineteen fractures had healed without substantial loss of alignment and one patient had recurrent dorsal subluxation after plate removal. The final average amount of wrist and forearm motion was 59 degrees of flexion, 56 degrees of extension, 87 degrees of pronation, and 85 degrees of supination. The average grip strength was 85% of that of the contralateral, uninjured hand. The final functional result according to the system of Gartland and Werley was rated as excellent or good for eighteen patients and as fair for two. The average modified Mayo wrist score was 75 points, and the average DASH score was 15 points. CONCLUSIONS: Fractures of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation are accompanied by a spectrum of volar injuries, including ligament injuries, avulsion fractures, and impaction of the articular surface. Despite the relative complexity of these injuries, satisfactory wrist function can be achieved with operative treatment in most patients. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Adult↗
PubMed1996

Quantitative CT assessment of the lumbar spine and radius in patients with osteoporosis.

OBJECTIVE: We undertook this study to quantify the relationship between bone mineral assessments of the lumbar spine using quantitative CT (QCT) and of the radius using peripheral QCT (pQCT) and to test the sensitivity of both techniques in detecting changes in bone mass that are related to age and osteoporosis. SUBJECTS AND METHODS: Forty-two healthy premenopausal, 38 healthy postmenopausal, and 97 osteoporotic postmenopausal women were examined with pQCT of the distal radius and with QCT of the lumbar spine (L1-L4). The bone mineral density (BMD), bone mineral content (BMC), and a cross-sectional area of cortical bone were assessed at the distal radius. The BMD of trabecular and total bone and the BMC of total bone were assessed at the midvertebral bodies of the lumbar spine. RESULTS: In the healthy women, correlations of radial BMD with spinal trabecular and total BMD were modest (r = .39 and r = .49, respectively) but were higher for total BMC (r = .79). All correlations in osteoporotic women (r = .19 for trabecular BMD, r = .31 for total BMD, and r = .47 for total BMC) were lower than those in healthy women. For measurement of spinal bone mass in healthy women, trabecular BMD showed a higher correlation with age (r = .81) and a larger relative annual decrease (1.2%) than did total BMD (r = .75, .78%) or total BMC (r = .54, .55%). At the radius, the highest correlations with age were found for total BMC (r = .57, .53%), cortical area (r - .52, .67%), and cortical BMC (r = .48, .78%). Age-adjusted odds ratios for prevalent vertebral fractures were highest for total (4.5) and trabecular (4.4) spinal BMD. For radial measurements, odds ratios were highest for both total BMD (2.3) and cortical area (2.3). CONCLUSION: QCT of spinal trabecular bone showed the strongest capability for assessment of age-related bone loss and for discrimination of osteoporotic vertebral fractures. In comparison, pQCT of radial trabecular bone showed the weakest capability for these applications, and pQCT of radial cortical or total bone showed intermediate capability.

Aged↗
PubMed2003

Osteomyelitis secondary to trauma involving the proximal end of the radius in horses: five cases (1987-2001).

OBJECTIVE: To determine clinical, radiographic, and scintigraphic abnormalities in and treatment and outcome of horses with trauma-induced osteomyelitis of the proximal aspect of the radius. DESIGN: Retrospective study. ANIMALS: 5 horses. PROCEDURE: Data collected from the medical records included signalment; history; horse use; degree of lameness; radiographic, ultrasonographic, and scintigraphic findings; treatment; and outcome. RESULTS: Duration of lameness prior to referral ranged from 14 to 60 days. Mean severity of lameness was grade 3 of 5, and all horses had a single limb affected. All horses had signs of pain during elbow joint manipulation and digital palpation over the lateral aspect of the proximal end of the radius. Radiographic lesions consisted of periosteal proliferation, osteolysis, and subchondral bone lysis. Scintigraphy in 3 horses revealed intense pharmaceutical uptake diffusely involving the proximal end of the radius. Two horses had sepsis of the elbow joint. All horses were treated with antimicrobials long-term; 1 horse was also treated by local perfusion of the radial medullary cavity through an indwelling cannulated screw. At follow-up, all horses had returned to their previous function. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that osteomyelitis of the proximal end of the radius can result from a traumatic injury to the antebrachium. Because lesions may be an extension of septic arthritis, a thorough examination of the wound area and elbow joint is recommended. Prolonged systemic antimicrobial treatment can result in a successful outcome.

Animals↗
PubMed1989

Bone strength of the radius and ulna in the non-human primate.

The technique and measurement of the bone strength of the radius and ulna in the non-human primate are presented. The aim of this study was to find a relationship between the mechanical strength of an intact radius and ulna forearm and its collateral isolated radius and isolated ulna which would be of assistance in the studies on mechanical bone strength and bone healing. The findings include: (1) bone strength is significantly influenced by factors such as age, sex, and body weight; (2) wide variation in normal bone-tissue strength exists among similar individuals; (3) there are differences in bone strength in the same individual if contralateral sides are compared; (4) growing bones are very elastic and are able to bend to an angle of up to 90 degrees before a fracture occurs; (5) soft tissue structures (such as muscle, interosseous membrane, and tendons) do not contribute to the strength of a diaphysis in low velocity injuries; and (6) the midshaft area of the radius is approximately 10% stronger than that of the ulna in the adult.

Aging↗
PubMedDate not supplied

Plating of the distal radius.

Distal radius fractures are common injuries that can be treated by a variety of methods. Restoration of the distal radius anatomy within established guidelines yields the best short- and long-term results. Guidelines for acceptable reduction are (1) radial shortening < 5 mm, (2) radial inclination > 15 degrees , (3) sagittal tilt on lateral projection between 15 degrees dorsal tilt and 20 degrees volar tilt, (4) intra-articular step-off < 2 mm of the radiocarpal joint, and (5) articular incongruity < 2 mm of the sigmoid notch of the distal radius. Treatment options range from closed reduction and immobilization to open reduction with plates and screws; options are differentiated based on their ability to reinforce and stabilize the three columns of the distal radius and ulna. Plating allows direct restoration of the anatomy, stable internal fixation, a decreased period of immobilization, and early return of wrist function. Buttress plates reduce and stabilize vertical shear intra-articular fractures through an antiglide effect, where-as conventional and locking plates address metaphyseal comminution and/or preserve articular congruity/reduction. With conventional and locking plates, intra-articular fractures are directly reduced; with buttress plates, the plate itself helps reduce the intra-articular fracture. Complications associated with plating include tendon irritation or rupture and the need for plate removal.

Bone Plates↗
PubMed1999

[Reflex sympathetic dystrophy (Sudeck's disease). An unavoidable complication of distal radius fracture?].

OBJECTIVE: Reflex sympathetic dystrophy after a distal radius fracture is judged as a complication, which cannot be avoided in every case. The aim of the present study is to find out whether this assumption also holds with respect to the actual technique of treatment of the radius fracture. METHODS: 50 cases are analyzed, in which (between 1975 and 1996) an expert opinion was given about the question of malpractice. RESULTS: In 3 of 50 cases malpractice due to healing of fracture in malposition was proven. Only in one case malpractice was seen in development of reflex sympathetic dystrophy itself. Although two thirds of the fractures were classified as instabile, 47 of them were treated conservatively. 30 of 40 repositions were incomplete from the beginning. In ten cases a second reposition was necessary, in 19 cases a secondary dislocation happened, 24 of 40 repositions were done without a sufficient analgesia. Most of the treatments would not follow the latest treatment principles of distal radius fracture. CONCLUSION: The estimation of development of reflex sympathetic dystrophy has to be changed: This complication is to be regarded as inevitable only if the two most important triggers (instability and pain) are avoided by following the actual rules of treatments of the distal radius fracture.

Female↗
PubMed1999

Changes in spine and radius bone density during long-term hormone replacement.

Lumbar spine and mid-radius bone mineral density was measured repeatedly in 48 postmenopausal women who completed 7 years of taking either a 500 mg x day(-1) calcium supplement (n = 22) or calcium supplementation with hormone replacement therapy. The hormone replacement was either a low dose (n = 15) or a moderate dose (n = regime. The purpose of the measurements was to establish the long-term pattern of change in bone mineral mass produced by continued hormone replacement. The calcium-only group lost bone mineral mass at the radius, while the spine, bone was preserved. Low dose hormone replacement preserved radius bone. Moderate dose replacement increased bone mineral mass at the spine and preserved radius bone.

Aged↗
PubMed1999

[The operative therapy of distal unstable radius fractures with dorsal and palmar plates. A retrospective study with respect to the DASH-score system].

The distal radius fracture is the most common human skeletal injury. Predominantly woman in the 6th to 7th decade are found. There is a high correlation to the post menopause high turn over osteoporosis and its negative calcium balance. Due to the various multifactoral radius fracture combinations is a detailed classification with its correlated treatment important. The operative intervention in the past played a secondary roll. The newest concepts demand an exact reconstruction of the articulating surfaces through closed reposition and K-wire support, screw osteosynthesis, external fixation and its combinated forms. The posttraumatical joint changes with secondary palmar and dorsal dislocation of the radius base after reduction caused the exact therapy scheme with respect to the AO-classification to be developed. In the clinic and policlinic Oskar-Helene-Heim of the Free University in Berlin 213 patients were surgicly treated on distal radius fractures either from volar or dorsaly with a plate osteosynthesis between 1988-1998. In cases of multidirectionional fractures with compression of the articular surfaces we combined a bicortal bone block or spongiosa to support and to avoid the secondary dislocation and thus arthrosis. The study was divided in three sections, beginning with the clinical inspection. Further followed the X-ray evaluation and the assessment of the DASH-scores.

Aged↗
PubMed1999

[Diagnostic and therapeutic significance of arthroscopy in distal radius fracture].

Non-operative and minimal-invasive treatment of distal radius fractures have still a poor outcome. Although bony structures often heal acceptable, additional lesions of intraarticular ligamentous structures cause persistent pain and disability. Aim of the study was to present the diagnostic and therapeutic possibilities of arthroscopically assisted treatment of distal radius fractures. Diagnostic wrist arthroscopy found in 6 of 30 patients with distal radius fractures (23 AO type C fractures) a scapho-lunate ligament tear (20%) of which 3 had to be stabilized operatively. 18 patients (60%) presented with tears of the triangular fibrocartilage complex [Palmer classification: 1A (1); 1B (5); 1D (2); 1A, 1B (2); 1A, 1D (6); 1B, 1D (2)], which were repaired by arthroscopic shaving (n = 12), Kirschner wire stabilization of ulna head (n = 2) or arthroscopic suture (n = 3). Fractures were stabilized in most cases by combinations of canulated titan screws (3.0 mm) and Kirschner wires (n = 12). In 27 patients, the radial joint surface and the distal radio-ulnar joint could be reconstructed without any specific complications. Arthroscopic reduction of distal radius fractures allows minimal-invasive reconstruction of the joint surface, diagnoses relevant ligamentous tears and should applied with incongruencies of the joint surface greater than 2 mm and in widely dislocated fractures.

Adult↗
PubMed1975

Compression-plate fixation in acute diaphyseal fractures of the radius and ulna.

At the Campbell Clinic and City of Memphis Hospital from 1960 to 1970, 244 patients (216 with closed and twenty-eight with open fractures) had 330 acute diaphyseal fractures of the radius and ulna which were treated with ASIF compression plates and followed for from four months to nine years. One hundred and twelve patients had fractures of both bones of the forearm; fifty, single fractures of the ulna; and eighty-two, single fractures of the radius. In all, 193 fractures of the radius and 137 fractures of the ulna were treated by compression plating. Sixty-three patients (25.9 per cent) with severely comminuted fractures also had iliac-bone grafts. The over-all rate of union for the radius was 97.9 per cent and for the ulna, 96.3 per cent. ASIF compression plates, therefore, provided a successful method for obtaining union and restoring optimum function after acute diaphyseal fractures of the forearm.

Acute Disease↗
PubMed2000

Ipsilateral distal radius and scaphoid fractures.

Simultaneous fractures of the distal radius and scaphoid are uncommon. Previous reports have outlined a variety of treatment methods for this condition. We describe the results in eight patients with simultaneous fractures of the distal radius and scaphoid, who were treated at National Taiwan University Hospital from 1987 to 1998. Treatments for the distal radius fractures included pin-in-cast in one patient, casting in one, external fixation in one, external fixation after pinning in three, and open reduction with internal fixation in two. All scaphoid fractures occurred at the scaphoid waist, and were treated with long-arm thumb spica in three patients, Herbert screw fixation in two, and percutaneous pinning in three. All of the fractures united, and none of the patients developed scaphoid avascular necrosis. One patient suffered from superficial radial nerve injury during external fixation. The functional results of the wrist were good in five patients and fair in three. To prevent the possible over-distraction of the scaphoid fracture, fixation of the scaphoid should be performed if a distraction force is to be applied during the treatment of the distal radius fracture. If no distraction force is to be applied, a thumb spica may provide adequate fixation for the scaphoid fracture.

Adult↗
PubMed2001

[Non-articular malunions of the distal radius: evaluation and techniques of correction].

Malunion remains the most common complication following fracture of the distal radius. Deformities can be observed in all three planes with displacement in dorsal or palmar tilt, translation, shortening and axial rotation. Preoperative evaluation requires a comparative analysis with clinical, radiological and scanographic assessment. The functional consequences affect the radiocarpal and distal radio-ulnar joints and the carpus. Biomechanical aspects include changes in pressure forces on the distal radius and ulna, and displacement of the centers of rotation. If present, associated lesions should be evaluated. The degree of clinical acceptance depends on each patient, but generally functional outcome is closely correlated with the anatomic result. Limits of radiological acceptance should be defined at 20 degrees dorsal tilt, 5 degrees radial inclination, and a - 4 mm distal radio-ulnar index. Corrective osteotomy is performed on the radius, with or without a complementary ulnar procedure. Closing wedge and re-orientation osteotomies are no longer used. Opening wedge osteotomy with or without lengthening is preferred, generally with an access on the same side as the sagittal tilt. The osteotomy should be performed just above the distal radio-ulnar joint. A temporary external fixator provides the best way to check peroperative corrections. Bone grafts may be harvested from the radius or the iliac crest. Pins and cast are sufficient to immobilize the dorsal tilt corrections. In case of volar tilt, an internal plate fixation is best. Depending on the status of the distal radio-ulnar joint, a conservative (shortening osteotomy, wafer procedure) or non-conservative (Darrach-Moore, Kapandji-Sauvé.) procedure should be performed on the ulna. If needed, associated lesions of the carpus must be treated. Surgical correction is mainly indicated in case of a functionally unacceptable deformation, but should be discussed if the radiographical limits have been overrun. The goal of such corrective procedures is to recover anatomical restitution.

Activities of Daily Living↗
PubMed2001

[Complex fractures of the proximal end of the radius and ulna in adults: a new classification].

Unlike injuries involving only one of the forearm bones, complex lesions of the proximal end of the radius and the ulna are particularly unstable. Various situations-Monteggia fracture, transolecraneal dislocation, or fracture-dislocation-are encountered. The classification systems proposed to date and recalled here are insufficient, making it difficult to provide optimal therapy and also hindering comparison between published series. We propose a descriptive classification including all the anatomic varieties of complex fractures of the proximal end of the radius and the ulna. This classification is based on our experience with 38 cases and takes into account 4 basic elements: the height of the ulnar fracture line, the direction of the displacement of the proximal radius, the association of a fracture of the proximal radius and/or of the coronoid process.

Adult↗
PubMedDate not supplied

[Radiological findings in distal radius fractures].

X-ray examination in distal radius fractures is very important for the management and prognostic of these fractures. Anterior and lateral radiographs must be taken in standardised position to avoid errors in measurements. On antero-posterior x-ray of the distal radius the important parameters are: radial length (N = 11-12 mm), radial angle (N = 22 degrees-25 degrees) and radial width. For the radial length three methods of measurements (Gartland, Gelberman and Palmer) are presented. On the lateral x-ray the palmar inclination of the distal radius may be measured (N = 10 degrees-12 degrees). Modifications of these parameters associated with distal radius fractures are presented.

Humans↗
PubMed2003

[Selection of dorsal or volar internal fixation for unstable distal radius fractures].

OBJECTIVE: To assess the results of T-plate in the treatment of unstable distal radius fractures. METHODS: Dorsal or volar T-plate fixation was used for unstable distal radius fractures according to different types of fracture. For comminuted fractures with severe cortex destruction and insufficient buttress, artificial bone graft or autograft was adopted to restore local stability. RESULTS: Satisfactory reduction was achieved after surgery. Functional rehabilitation under surveillance began from the 2nd or 3rd post-operative day. The overall excellent or good recovery rate was 90.77% after a mean follow-up of 29.63 months. For the 55 sides of volar fixation (30 sides with a dorsal displacement fragment), excellent or good recovery rate was 92.72%. Dorsal fixation was used in delayed cases (> 6 weeks) or certain fracture patterns unsuitable for volar approach. The excellent on good recovery rate was 77.77%. CONCLUSIONS: Volar approach is an ideal option not only for distal radius fracture with a volar displaced fragment but also for dorsal displaced fractures (Colles' fracture). The advantages of this approach include flat cortex for easy plate fixation, better tension band effect, less soft tissue destruction, leaving dorsal soft tissue hinge intact, and avoiding bone graft leakage. Satisfactory results can be obtained in those patients with unstable distal radius fracture through volar approach plate fixation, especially in those with fresh fractures. If possible, volar approach can also be used in delayed fractures within 6 weeks. The results of dorsal fixation is a little bit inferior.

Adolescent↗