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At least 307 records · Page 17Linked to original sources
PubMed1993

External fixation of distal radius fractures. Indications and technical principles.

External fixation of unstable intra-articular fractures of the distal radius has become an effective tool in the management of these difficult injuries. Careful assessment of the fracture pattern, appropriate patient selection, meticulous surgical technique, the appropriate choice of fixation device and pins, recognition of the need for augmentation with limited internal fixation or bone grafting, and aggressive postoperative rehabilitation provide the foundation for successful management of these fractures while minimizing complications. The surgeon must remember that the pin-bone interface is the link between the patient and the fixator. He or she must ensure a stable environment for this interface by providing a clean, tight purchase of the pin in bone with minimal damage to the bone and its surrounding soft tissues at the time of operation. Postoperatively, the surgeon must convey to the patient the importance of maintaining a healthy environment for this pin-bone interface. An appropriately chosen external fixation device can be expected to provide overall stability while maintaining length as well as angular and rotational alignment. However, it cannot be expected to provide precise small fragment control and restoration of articular congruity. This must be achieved by precise reduction and limited internal fixation using Kirschner wires while prevention of late collapse is afforded by subarticular bone grafting of the metaphyseal defect. Adherence to these principles should provide a satisfactory outcome with a significant reduction in the rate of complications when external fixation is used for the management of complex fractures of the distal radius.

Bone Nails↗
PubMed2005

Entrapment of the flexor digitorum superficials in the radius fracture site.

Entrapment of the flexor tendon after fracture of both forearm bones is very rare. This report describes entrapment of the middle finger flexor digitorum superficialis (FDS) tendon alone in the radius fracture site. A 13-year-old boy fractured both forearms and had closed reduction and a long-arm cast. After the cast was removed he had full middle finger motion with the wrist flexed but was unable to extend the proximal interphalangeal or metacarpophalangeal joints and could extend only the distal interphalangeal joint of the middle finger with the wrist in the neutral or extension position. Entrapment of the middle finger FDS tendon was suspected. After surgical release of the FDS tendon at the fracture site the patient had good functional results.

Adolescent↗
PubMed1991

[Indications for surgery in distal radius fractures].

In this retrospective study, the results of conservative treatment of 406 fractures of the distal radius are analysed and the limitations of conservative therapy indicated. In all, 107 male patients (average age 45 years) and 299 women (average age 65 years) were examined. In only one-third of these cases were both radiographically and clinically. Of the primarily dislocated fractures, 19% healed in the correct anatomical position with satisfactory to good clinical results. Up to now, treatment of fractures of the distal radius with dorsal tilting has been regarded as a form of conservative therapy. Although certain types of fracture, in particular unstable ones, have always been regarded as cases for operative treatment, no attempt has ever been made to define the limits between conservative and operative treatment. Evaluation of the results clearly indicates that the classification according to Frykman, the one most commonly in use, cannot be used as a primary criterion for operative treatment. In the course of a meticulous statistical evaluation, we defined the radiological parameters precisely with reference to shortening, dorsal tilt and instability and drew up a classification to define the primary indications for operation in cases of fracture of the distal radius. Shortening by over 3mm, dorsal tilting by over 10 degrees, presence of a dorsal debris zone, rupture, or osseous avulsion of the radioulnar syndesmosis as a further instability factor show the limits of conservative therapy and are clear indications for operative treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2003

[Combined palmar and dorsal approach for complex distal radius fractures].

PURPOSE: The purpose of this paper was to describe our management of complex fractures of the distal radius using a combined dorsal and palmar approach and to evaluate the radiological and clinical outcome. PATIENTS AND METHODS: Twenty out of 26 patients with complex fractures of the distal radius, which were operated on from 1996 to 2000 using a combined dorsal and palmar approach, were followed-up on an average of 28 months. According to AO fracture classification, there were one A3, two B3, three C1, two C2 and twelve C3 fractures. Six patients had associated injuries. The treatment was standardized: closed reduction on the day of injury; depending on the soft-tissue situation an external fixator or a forearm splint was applied; every patient underwent a computed tomography before the definitive surgical procedure, which was performed between one and 28 days after the injury when the swelling had subsided. According to the fracture patterns, the distal radius was stabilized using double plates (3), a palmar plate (11) or a dorsal plate (4), screws (1) or K-wires (1) combined with the initially applied external fixator (6). Follow-up included a radiological and clinical examination. The results were graded with use of the modified Mayo Wrist Score. Disability was assessed using the DASH score. RESULTS: All fractures healed, some with minor malunion. Fourteen of the 20 patients had osteoarthrotic changes. Compared to the opposite wrist, range of motion for flexion/extension was reduced by 25 %, radial/ulnar deviation by 20 % and forearm rotation by 5 %. Grip strength averaged 15 % less than that of the opposite side. Modified Mayo Wrist Score revealed 65 % excellent, 30 % good and 5 % poor results. DASH score averaged 18 points.

Adult↗
PubMed2006

Three-dimensional computer simulation of radiostereometric analysis (RSA) in distal radius fractures.

Physical phantom models have conventionally been used to determine the accuracy and precision of radiostereometric analysis (RSA) in various orthopaedic applications. Using a phantom model of a fracture of the distal radius it has previously been shown that RSA is a highly accurate and precise method for measuring both translation and rotation in three-dimensions (3-D). The main shortcoming of a physical phantom model is its inability to mimic complex 3-D motion. The goal of this study was to create a realistic computer model for preoperative planning of RSA studies and to test the accuracy of RSA in measuring complex movements in fractures of the distal radius using this new model. The 3-D computer model was created from a set of tomographic scans. The simulation of the radiographic imaging was performed using ray-tracing software (POV-Ray). RSA measurements were performed according to standard protocol. Using a two-part fracture model (AO/ASIF type A2), it was found that for simple movements in one axis, translations in the range of 25microm-2mm could be measured with an accuracy of +/-2microm. Rotations ranging from 16 degrees to 2 degrees could be measured with an accuracy of +/-0.015 degrees . Using a three-part fracture model the corresponding values of accuracy were found to be +/-4microm and +/-0.031 degrees for translation and rotation, respectively. For complex 3-D motion in a three-part fracture model (AO/ASIF type C1) the accuracy was +/-6microm for translation and +/-0.120 degrees for rotation. The use of 3-D computer modelling can provide a method for preoperative planning of RSA studies in complex fractures of the distal radius and in other clinical situations in which the RSA method is applicable.

Computer Simulation↗
PubMed1999

[Bowers hemi-resection-interposition arthroplasty for treatment of post-traumatic arthrosis of the distal radio-ulnar joint after distal radius fractures].

UNLABELLED: Arthrosis of the distal radioulnar joint (DRUJ) is a common problem following fractures of the distal radius. The treatment options include the hemiresection-interposition technique (Bowers procedure) or Kapandji-Sauvé procedure. In a retrospective study, we assessed the results of the Bowers procedure. MATERIAL AND METHODS: From 1992 to 1997, 24 patients were treated by the hemiresection-interposition technique (Bowers procedure) for arthrosis of the DRUJ following fracture of the distal radius. The average follow-up time was 30.5 (9 to 55) months. RESULTS: The average preoperative pronation was 67 degrees, the supination 45 degrees. Postoperatively, we found a pronation of 80 degrees and a supination of 62 degrees. Grip-strength compared to the opposite site could be improved from 38 to 57% postoperatively. Pain was reduced markedly in 78% of the patients. However, ten patients developed a postoperative instability of the distal ulna. In only two patients did painful instability necessitate revision procedures. CONCLUSION: The hemiresection-interposition technique is a salvage procedure for the destroyed DRUJ, leading to good clinical results in most patients. Painful instability of the distal ulna and remaining functional deficits can be the reasons for failure. Therefore, adequate primary reduction of fractures of the distal radius or secondary reconstruction of the anatomy is necessary to prevent secondary arthrosis of the DRUJ.

Adult↗
PubMedDate not supplied

The relationship between adherence to hand therapy and short-term outcome after distal radius fracture.

This study aimed to examine the relationship between adherence to hand therapy and short-term outcome after fracture of the distal radius. Attendance at hand therapy appointments, therapist-rated adherence during appointments, and home-exercise diaries were used to monitor adherence in 15 people undertaking rehabilitation after a wrist fracture. Outcome measures were change in impairment (wrist extension, grip strength, and pain rating) and change in activity (modified Levine questionnaire, Jebsen Test of Hand Function) from initial assessment (after cast removal) to follow-up (six weeks later). Multiple regression analysis found over 50% of variance in wrist extension change, Levine questionnaire change, and change on the simulated feeding item of the Jebsen Test of Hand Function to be predicted by adherence. Home exercise adherence was the most important predictor of the adherence measures. These results highlight the importance of adherence to home exercises prescribed by a hand therapist after fracture of the distal radius.

Aged↗
PubMed1993

[Distal radius fractures: conservative or surgical treatment?].

The "classical" Colles fracture of the distal radius is the most common fracture in the adult. In order to reduce the still rather high rate of permanent disability, this fracture involving a functionally important joint requires accurate reduction. The AO-fracture classification introduced by Müller not only defines the severity of an injury, but also allows for decision-making as to the most adequate treatment. Besides the purely conservative management by closed reduction and plaster cast for the type-A fractures, we have a number of other treatment modalities for the more complex-B and C-type fractures, such as closed reduction and percutaneous K-wire application or the use of the small external fixator as well as open reduction and internal fixation by plates and screws for a few selected indications.

Adolescent↗
PubMed2002

Sigmoid notch reconstruction using osteoarticular graft in a severely comminuted distal radius fracture: a case report.

A case of a young patient with a severely comminuted intra-articular distal radius fracture dislocation and severe injury of the distal radioulnar joint is presented. Early reconstruction of the sigmoid notch and radioulnar ligaments was performed using the remaining scaphoid facet of the distal radius articular surface, an autogenous tendon graft for ligament reconstruction, and radioscapholunate arthrodesis. The patient was able to return to his manual work without limitations. We present additional information on the comparative anatomy of the sigmoid notch and scaphoid facet that may guide surgeons in treating this severe injury.

Adult↗
PubMed1990

[Percutaneous drill wire fixation in treating distal radius fractures at risk of dislocation].

We are presenting an investigation of 47 cases treated with Kirschner wire fixation using drill wires for distal radius fractures. The average study period was 18 months after the fixation (13-25 months). Using Sarmiento's ratings we obtained the following results: 21 patients were rated as excellent, 19 as good, 6 as fair and 1 as poor. In contrast to a good reduction with a stepless joint surface, the initial fracture form and displacement does not influence the functional end results.

Adult↗
PubMed2002

[Vitamin C and prevention of reflex sympathetic dystrophy following surgical management of distal radius fractures].

Reflex sympathetic dystrophy is a major complication following surgical treatment of fractures of the distal radius. Its pathogenesis is related to lipid peroxidation which damages vascular endothelial cells, increasing capillary permeability. Vitamin C is a natural antioxidant. The authors have made a comparative study of two groups of patients with isolated closed displaced fractures of the distal radius, which were reduced and stabilized by intrafocal pinning. Group 1 included 100 patients who were treated from 1995 until 1998 and who did not receive any vitamin C supplementation; group 2 included 95 patients who were treated from 1999 to 2002 and who received daily administration of one gram vitamin C orally during 45 days, starting on the day of fracture. The incidence of reflex sympathetic dystrophy was five time times lower in group 2 (2.1% versus 10%). This is in line with previous observations and lends credit to the value of vitamin C administration as a prophylactic measure to prevent the occurrence of reflex sympathetic dystrophy in patients who undergo surgical treatment of a displaced fracture of the distal radius.

Adolescent↗
PubMed1994

Unstable distal radius fractures treated by modified Kirschner wire pinning: anatomic considerations, technique, and results.

A modified technique of percutaneous Kirschner-wire pinning for unstable distal radius fractures is presented. Three to four pins are placed from the radial styloid process toward and through the dorsal, volar, and ulnar cortices of the proximal fracture fragment, respectively. Rotational stability is achieved by bending and counterblowing of the wire ends in the styloid process. Anatomic studies of cadaver wrists revealed possible lesions of the superficial radial nerve, the cephalic vein, and the tendons of the brachioradialis muscle or the thumb and wrist extensors, respectively. Nevertheless, in a follow-up of 80 patients after 1 year, no tendinous lesions nor any other serious complications were seen. Using the criteria of Green and O'Brien, the results were excellent in 66.25%, good in 20%, and fair in 8.75%.

Arthritis↗
PubMed1989

Stability assessment of distal radius fractures.

A total of 112 consecutive cases of fractures of the distal radius managed conservatively were graded according to radiological criteria using the first radiograph. These criteria, as well as age over 60 years, were considered as gravity factors. A strong correlation was found between these criteria and the risk of secondary displacement, despite a correct initial reduction.

Adolescent↗
PubMed1999

The Monteggia lesion and ipsilateral supracondylar humerus and distal radius fractures.

Ipsilateral elbow and forearm fractures are quite rare in children. We present a Monteggia lesion with ipsilateral supracondylar humerus fracture in a 13-year-old girl. Through early surgical management, a successful result was achieved. We believe that, to minimize any initial or subsequent complications in such fractures, early surgical management should be the first treatment choice.

Adolescent↗
PubMed1990

Early clinical experience with Orthofix external fixation of complex distal radius fractures.

Twelve patients with complex fractures of the distal radius were treated with the Orthofix external fixation system (EBI Medical Systems, Fairfield, NJ). On follow up physical examination, the average wrist dorsiflexion was 46 degrees, and the average volar flexion was 55 degrees. The average grip strength in the involved hand was 38 lb force. The average final radial angle was 18 degrees, and the average residual radial height was 12 mm. Average volar tilt was 3 degrees. The complication rate was 42%. Very rigid axial stability is afforded by the fixator, but the large 3.5 mm tapered bone screw diameter precludes redrilling for screw adjustment. The apparatus needs frequent monitoring to reconfirm the security of the locking nuts and cam mechanisms, and the Orthofix system can be reused only four times.

Adolescent↗
PubMedDate not supplied

Use of bone-graft substitutes in distal radius fractures.

The development of bone-graft substitutes potentially provides the benefits of bone grafting without the risks of autograft harvest. During the past few years, the US Food and Drug Administration has approved several different types of products. These vary considerably in composition, structural strength, osteoinductive and osteoconductive potential, and mechanisms and rates at which they are resorbed or remodeled. The products now approved for orthopaedic applications in the United States include those based on naturally occurring materials (e.g., demineralized human bone matrix, bovine collagen mineral composites, and processed coralline hydroxyapatite) as well as synthetic materials (e.g., calcium sulfate pellets, bioactive glass, and calcium phosphate cement). Materials in development include variations on available products and a new generation of biologically active materials employing growth factors. Rigorous comparison of the products is difficult, as there are no universally accepted preclinical assays and comparable clinical studies. Despite the limitations of the data now available, controlled studies and anecdotal reports suggest that use of bone-graft substitutes may result in improved treatment outcomes for patients with fractures of the distal radius.

Animals↗