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At least 361 records · Page 20Linked to original sources
PubMed2001

Palmar tilt of the distal radius: influence of off-lateral projection initial observations.

PURPOSE: To evaluate the effect of slight off-lateral positioning of the wrist on measurements of the palmar tilt of the distal radius on lateral views and to determine how this effect can be corrected quantitatively. MATERIALS AND METHODS: Seven cadaveric forearms in neutral and various oblique positions (5 degrees, 10 degrees, 15 degrees, 20 degrees ) of supination and pronation were examined with lateral radiography. The palmar tilt of the distal radius measured on the radiographs was correlated with each position of the wrist and the distance between the position of the palmar cortex of the pisiform bone (P) and a reference point (point 0), which was defined as the midpoint within the interval between palmar cortices of the distal scaphoid pole and of the capitate head (P0 distance). The same measurements were performed on 11 wrists during arthrography. RESULTS: The apparent palmar tilt of the distal radius increased with supination of the forearm. Regression analysis with the P0 distance as independent and palmar tilt as dependent variables resulted in a slope of 0.95 in the seven cadaveric wrists and of 0.92 in the 11 wrist arthrograms. The squares of the correlation coefficients (R(2)) were 0.89 in cadaveric wrists and 0.69 in 11 wrist arthrograms. CONCLUSION: Differences in the palmar tilt produced by off-lateral projections of the wrist can be estimated from the measured difference of the P0 distance. A 1-mm difference in the P0 distance corresponds to a difference in the palmar tilt of approximately 1 degrees.

Adult↗
PubMed1998

Redisplaced unstable fractures of the distal radius. A randomised, prospective study of bridging versus non-bridging external fixation.

A randomised, prospective study was carried out on 60 patients with unstable fractures of the distal radius to compare bridging with non-bridging external fixation using pins placed in the distal fragment of the radius. The radiological results showed significant improvement in the non-bridging group at all stages of review. In particular, normal volar tilt and carpal alignment were regained and maintained. The functional results at six weeks, three months, six months and one year showed statistically better grip strength and flexion in the non-bridging group at all stages of review. Other ranges of movement showed an early advantage in the non-bridging group. Non-bridging external fixation is the treatment of choice for unstable fractures of the distal radius which have sufficient space for the placement of pins in the distal fragment.

Adult↗
PubMed1997

Correlation of trabecular bone structure with age, bone mineral density, and osteoporotic status: in vivo studies in the distal radius using high resolution magnetic resonance imaging.

High resolution magnetic resonance (MR) images of the distal radius were obtained at 1.5 Tesla in premenopausal normal, postmenopausal normal, and postmenopausal osteoporotic women. The image resolution was 156 microm in plane and 700 microm in the slice direction; the total imaging time was approximately 16 minutes. An intensity-based thresholding technique was used to segment the images into trabecular bone and marrow, respectively. Extensions of standard stereological techniques were used to derive measures of trabecular bone structure from these segmented images. The parameters calculated included apparent measures of trabecular bone volume fraction, trabecular thickness, trabecular spacing, and trabecular number. Fractal-based texture parameters, such as the box-counting dimension, were also derived. Trabecular bone mineral density (BMD) and cortical bone mineral content (BMC) were measured in the distal radius using peripheral quantitative computed tomography (pQCT). In a subset of patients, spinal trabecular BMD was measured using quantitative computed tomography (QCT). Correlations between the indices of trabecular bone structure measured from these high-resolution MR images, age, BMD, and osteoporotic fracture status were examined. Cortical BMC and trabecular BMD at the distal radius, spinal BMD, trabecular bone volume fraction, trabecular thickness, trabecular number, and fractal dimension all decreased with age. Trabecular spacing showed the greatest percentage change and increased with age. In addition, significant differences were evident in spinal BMD, radial trabecular BMD, trabecular bone volume fraction, trabecular spacing, and trabecular number between the postmenopausal nonfracture and the postmenopausal osteoporotic subjects. Trabecular spacing and trabecular number showed moderate correlation with radial trabecular BMD but correlated poorly with radial cortical BMC. High resolution MR imaging, a potentially useful tool for quantifying trabecular structure in vivo, may have applications for understanding and evaluating skeletal changes related to age and osteoporosis.

Adult↗
PubMed2003

Distraction osteotomy for malunion of the distal end of the radius with radial shortening.

The treatment and outcomes of distraction osteotomy in 9 patients with malunion of the distal radius with radial shortening are presented. The patients had an average age of 32 years (range: 14 to 36 years) and comprised 7 males and 2 females. Ulnar inclination was below normal in all patients, volar inclination was below normal in 8 patients, and the average radial length discrepancy was 7.6 mm (range: 4 to 16 mm). Angulations in the distal radius were corrected by manipulation after osteotomy, and shortening by callus distraction. In order to achieve normal radial length, distraction was performed for an average of 10.2 days (range: 7 to 19 days), and union occurred in an average of 10.7 weeks (range: 9 to 13 weeks). During the waiting period between distraction and consolidation, impairment of ulnar and volar inclination recurred in 3 patients, and translation of the distal fragment necessitating correction occurred in 3 patients. No cases of nonunion or malunion were observed. In all patients, there was a decrease in cosmetic and pain-related complaints, and improvement in wrist movements. Distraction osteotomy is a simple and effective treatment for malunion of the distal radius with concurrent radial shortening. However, the position of the distal fragment should be followed up until consolidation.

Adolescent↗
PubMed2003

Fractures of the distal aspect of the radius: changes in treatment over the past two decades.

Fractures of the distal end of the radius are among the most common orthopaedic injuries, and treatment of these fractures has changed over the course of time. Many fractures of the distal radius are in fact relatively uncomplicated and are effectively treated by closed reduction and casting. However, fractures that are either unstable and/or involve the articular surfaces can jeopardize the integrity of the articular congruence and/or the kinematics of these articulations. The goal of the treating physician should then be to restore the functional anatomy by a method that does not compromise hand function. The fracture pattern, degree of displacement, the stability of the fracture, and the age and physical demands of the patient determine the best treatment option. Over the past 20 years, there has been a development of more sophisticated internal and external fixation techniques and devices for the treatment of displaced fractures of the distal radius. The use of percutaneous pin fixation, external fixation devices that permit distraction and palmar translation, low profile internal fixation plates and implants, arthroscopically-assisted reduction, and bone grafting techniques including bone graft substitutes all have contributed to improving fracture stability and outcome.

Arthroscopy↗
PubMed1992

Ipsilateral fractures of the distal radius and scaphoid treated by Herbert screw and external skeletal fixation. A report of two cases.

Two patients with comminuted, displaced fractures of the distal radius associated with ipsilateral, undisplaced scaphoid fractures were treated by internal fixation of the scaphoid fracture with a Herbert screw in association with external fixation of the distal radial fracture. One of the patients had a limited open reduction of the distal radius combined with bone grafting. Both patients had satisfactory results. Internal fixation of the scaphoid is indicated if distraction is applied to the carpus to treat an associated fracture of the distal radius, even if the scaphoid fracture is undisplaced.

Accidental Falls↗
PubMed2005

Quantification of changes in graft dimension after corrective osteotomy of the distal end of the radius.

PURPOSE OF THE STUDY: This is a cross section retrospective study which shows undertaken in order to determine the frequency and degree of postoperative alterations in size of cortico-cancellous autografts used in corrective osteotomies of the distal radius. PATIENTS AND METHOD: In the period from 1987 to 2002, 50 patients (21 females and 29 males, mean age 38 years, range 18-64, were treated with corrective osteotomy, bone grafting and internal fixation after mal-united Colles' fracture. The patients were followed up from 6 months to 5 years (average 15 months). Heights of volar, ulnar, dorsal and radial sides of the graft were determined from radiographs (preoperative, immediately after the surgery and at the late follow-up examination) according to the BIZCAD method and put into the computer program, which compared them in three dimensions. RESULTS: In sixteen patients (32 %) one or more sides of the graft decreased in height during the postoperative period by more than three millimeters. In five cases there was a complete resorption of the implanted graft. In the other thirty-four cases, an average decrease in all sides of graft was statistically significant. Unequal decrease led to an increase of volar inclination angle of the distal articular surface of the radius, averaging 3 degrees. Influence of age on the diminution of the graft size was found. More distally placed grafts had less incidence of significant resorption. A correlation between initial height of the side of the graft and its alterations was also found (r=0.49, p<0.001). CONCLUSION: Postoperative changes in the size of graft are frequent and represent a serious obstacle to the success of corrective osteotomies. We recommend that: 1. the use of a the higher bone graft for elongating of the radius, however with a greater chance of resorption; the alternative method of ulna shortening should be considered; 2. the osteotomy line and the grafts should be placed more distally to decrease the risk of resorption; 3. if osteotomy can't be performed distally enough, postoperative immobilization for about three weeks should be considered.

Adolescent↗
PubMed1993

Hominid radius from the middle Pliocene of Lake Turkana, Kenya.

A nearly complete left radius, KNM-ER 20419, was recovered from middle Pliocene sediments east of Lake Turkana, Kenya in 1988. Ape-like characteristics of the fossil include an eccentrically positioned articular fovea, relatively long radial neck, wide distal metaphysis, and large brachioradialis crest. The robustness of the radial neck in proportion to the radial head, and the semilunar shape of the distal diaphysis, however, clearly distinguish KNM-ER 20419 as hominid. The distal articular surface possesses a larger area for radius-lunate articulation than for radius and scaphoid, a radiocarpal arrangement that is associated with increased wrist adduction among quadrumanous climbers. Since this morphology is also found in hylobatids, Pongo, and other early australopithecines, it is argued to be plesiomorphic for hominoids. This further supports the argument that vertical climbing was an important locomotor behavior among both early hominoids and our more immediate prebipedal ancestors.

Animals↗
PubMed1984

Bone density in osteopenic women: a modified distal radius density measurement procedure to develop an "at risk" value for use in screening women.

This study measured radial and lumbar spine bone density in postmenopausal white female patients with nontraumatic fractures and their age-matched controls. Bone density measurements were made with a single-beam densitometer. Distal radial bone density measurements were made at the site at which the radius and ulna are separated by 5 mm, which is approximately 5 mm from the distal radioulnar joint. Lumbar spine density was obtained using a dual-beam densitometer. Density at the commonly used "2/3" site near the midradius was also measured. Forty-six crush fracture osteoporotic patients, 35 hip fracture patients, and 20 osteopenic patients referred to the clinic for back pain or excessive bone loss but with no history of nontraumatic fracture were studied. Bone density values at all sites in the patient populations were statistically reduced from control values (p less than 0.01). At a mean age of 62 years, density of the midradius was 12% below the control value. However, both vertebral and distal radial densities ("5 mm" site) were 25% below control values. The spine/distal radius ratio remained constant. It was demonstrated that bone density at the modified distal radial site could be used to predict vertebral density in osteopenic patients. An "at risk" value useful in screening procedures was determined as that distal radius density value greater than or equal to 95% of all values from fracture patients--325 mg/cm2. It is concluded that distal radial density at the new "5 mm" site can be used in conjunction with midradius density as a preliminary test for both generalized and trabecular bone mass loss in women.

Absorptiometry, Photon↗
PubMed2005

Microsurgical fibular graft for full-length radius reconstruction after giant-cell tumor resection: a case report.

In this article, we present the treatment of a recurrent giant-cell tumor of the radius with en bloc resection and full-length radius reconstruction with a 24-cm long microsurgical fibular graft. At time of 8-year follow-up, there was no evidence of tumor recurrence. A satisfactory range of motion of the elbow, wrist, and forearm was maintained. There was no instability in the joints, and grip strength measured 63% of the opposite side. With appropriate dynamic tendon transfer, this procedure can provide an alternative method for reconstruction of the full-length radius after tumor resection, with functional and durable results.

Adult↗
PubMed1995

MRI of bone marrow in the distal radius: in vivo precision of effective transverse relaxation times.

The effective transverse relaxation time T2* is influenced by the presence of trabecular bone, and can potentially provide a measure of bone density as well as bone structure. We determined the in vivo precision of T2* in repeated bone marrow measurements. The T2* measurements of the bone marrow of the distal radius were performed twice within 2 weeks in six healthy young volunteers using a modified water-presaturated 3D Gradient-Recalled Acquisition at Steady State (GRASS) sequence with TE 7, 10, 12, 20, and 30; TR 67; flip angle (FA) 90 degrees. An axial volume covering a length of 5.6 cm in the distal radius was measured. Regions of interest (ROIs) were determined manually and consisted of the entire trabecular bone cross-section extending proximally from the radial subchondral endplate. Reproducibility of T2* and area measurements was expressed as the absolute precision error (standard deviation [SD] in ms or mm2) or as the relative precision error (SD/mean x 100, or coefficient of variation [CV] in %) between the two-point measurements. Short-term precision of T2* and area measurements varied depending on section thickness and location of the ROI in the distal radius. Absolute precision errors for T2* times were between 1.3 and 2.9 ms (relative precision errors 3.8-9.5 %) and for area measurements between 20 and 55 mm2 (relative precision errors 5.1-16.4%). This MR technique for quantitative assessment of trabecular bone density showed reasonable reproducibility in vivo and is a promising future tool for the assessment of osteoporosis.

Adult↗
PubMed1981

Application of free autogenous fibular graft in the treatment of aggressive bone tumours of the distal end of the radius.

Long-term results of the application of free autogenous fibular graft in the treatment of aggressive bone tumours of the distal end of the radius are presented. Six patients underwent radical resection of the tumour including the articular surface of the distal radius during the period 1969 to 1978, the average follow-up time being 5 years. In one case the tumour was low grade chondrosarcoma, in three cases a giant cell tumour grade two to three and in the remaining two a hemangioma. Five to twelve cm of the distal radius was resected and the defect was replaced using the ipsilateral proximal part of the fibula as free graft. Osteosynthesis was performed end to end with a plate fixation, or side to side with screw fixation. At follow-up, the range of motion in the radiocarpal joint was normal or close to normal in each case and all patients had returned to work within 6 months of the operation. None of the patients presented a recidive of the tumour.

Adult↗
PubMed1987

The effects of walking on the cross-sectional dimensions of the radius in postmenopausal women.

This report deals with the analysis of data from a 3-year clinical trial on the effect of walking on postmenopausal bone loss. Two hundred fifty-five women, with an average age of 57 at entry, were randomized into two groups, a walking and a control group. Bone measures in the shaft of the radius were carried out with a CT scanner in search of generalized skeletal effects rather than effects localized to the bones of the leg. Although bone density losses were comparable in the two randomized groups, changes in the cross-sectional area of the radius were significantly greater in the walkers with high grip strength (greater than 25 Kg) than in the controls with comparable high grip strength which corresponded to the upper half range of the grip-strength distribution. It is concluded that the moderate activity of walking exerted systemically positive effects on the radius which, within the protocol of the study, could be substantiated only when synergized with inherent muscle strength.

Female↗
PubMed1987

Bone density of the radius, spine, and hip in relation to percent of ideal body weight in postmenopausal women.

Bone mineral content (BMC) and bone mineral density (BMD) of the spine (L2-L4) and hip (at femoral neck, Ward's triangle, and greater trochanter sites) were determined by dual-photon absorptiometry (DPA), and of the radius by single-photon absorptiometry (SPA) in healthy postmenopausal women aged 40-70 years. The relationships of BMC and BMD to years since menopause were examined separately in 97 women who were above 115% of ideal body weight (IBW) and in 128 women below. The heavier women had significantly greater mean BMC and BMD at each site than did the normal-weight women. In the normal-weight women, there was a significant negative correlation between BMD and years since menopause at each measurement site except the greater trochanter. In the obese women, BMD decreased with increasing years since menopause at the radius site only and BMC declined with increasing years after menopause at the hip (femoral neck and Ward's triangle region) as well as the radius. Thus, body size is a significant determinant of BMD in this population. The pattern of loss of BMD from Ward's triangle and femoral neck regions of hip are similar to that of the spine. The BMC and BMD findings in the hip suggest that remodeling occurs at this weight-bearing site which has a favorable effect on bone strength.

Adult↗
PubMed2003

[Occult scaphoid-lunate dissociation in distal radius fractures].

INTRODUCTION: The aim of this study was to investigate the clinical consequences of scapholunate dissociation associated with fractures of the distal radius and the impact on wrist function. Fractures of the distal radius and scapholunate dissociation overlap in pathomechanics. The diagnosis however is frequently missed initially. PATIENTS AND METHODS: We reviewed 45 consecutive patients with closed distal radius fractures with a mean follow up of 48 months. Ten patients underwent surgery and 35 patients were treated by fracture reduction and cast immobilization during 4.5 (range 3 to 8) weeks. All patients were re-examined clinically and radiographs of both wrists were compared. RESULTS: Four patients showed evidence of SLD in the scapholunate joint region based on specific criteria (scapholunate gaps > 2 mm on anterior-posterior radiograph and the scapholunate angle > 60 degrees on lateral radiograph). All patients with SLD showed a poor radioulnar deviation. Three patients reported mild to moderate pain. DISCUSSION: The difficulties in management of SLD may be avoided by early detection and treatment. In all investigated patients the diagnosis was missed after the initial trauma. Untreated SLD can lead to carpal collapse and arthrosis of the wrist, and ultimately to scapholunate advanced collapse.

Adolescent↗
PubMed1999

[The treatment of unstable fractures of the distal radius using a bridging external fixator. Results from a long-term evaluation].

INTRODUCTION: The aim of our study was to evaluate external fixation in the treatment of unstable distal radius fractures in a long-term follow-up. METHODS: Within 8 years 174 patients with severely displaced distal radius fractures were included in a prospective study and treated with an external wrist fixator (Orthofix Srl, Italy). A total of 148 patients were reviewed with an average follow-up time of 28 months. RESULTS: Using the functional outcome score according to Gartland and Werley, we obtained 29.3 % excellent, 42.5 % good, 10.3 % fair and 2.9 % poor results; 14.9 % of the patients were not available for follow-up. Additional procedures were carried out in 54.1 % to obtain dorsal stabilization. The list of complications included two major pin-tract infections requiring surgical intervention, one pin cut out of the second metacarpal bone, one fixator dislocation, and one patient had algodystrophy. The length of the radius and joint congruity did not significantly from the situation when the fixator has been removed at the end of the treatment. CONCLUSION: The results show the importance of anatomical reduction, and especially restoration of radial length, in order to obtain good functional outcome.

Adolescent↗
PubMed2003

[Results after palmar plate-osteosynthesis with angularly stable T-plate in 100 distal radius fractures: a prospective study].

In a prospective study a total of 124 unstable fractures of the distal radius were treated with a fixed angle palmar T-plate (Synthes Ltd., Switzerland). A total of 100 distal radius fractures were evaluated radiologically and clinically after a mean of 10 months after surgery. Loss of correction between postoperative and follow-up radiographs was assessed. The mean loss of the initial volar tilt was 3+/-4 degrees, the loss of radial inclination 0.4+/-2 degrees. The radial shortening was 1+/-1 mm. Flexion and extension of the injured wrist had recovered to an average of 81% of the normal, contralateral side. Radial and ulnar deviation were limited to 84%, pronation and supination reached 91%. Mass grip strength recovered to an average of 74% of the normal side. Using the functional outcome score according to Sarmiento,we obtained 15% excellent,56% good, 28% fair and 1% poor results. The complication rate was 10%. In conclusion, the operative treatment of unstable extra- and intraarticular fractures of the distal radius by fixed angle T-plateosteosynthesis shows good radiological and functional results.

Adult↗
PubMed2004

[Incorrect classification of extra-articular distal radius fractures by conventional X-rays. Comparison between biplanar radiologic diagnostics and CT assessment of fracture morphology].

Thirty-five displaced fractures of the distal radius, classified by standard radiographs as extra-articular type A2 and A3 fractures according to the AO classification, were investigated before operative treatment by computed tomography. The comparative analysis surprisingly revealed an involvement of the articular surface of the distal radius in 57%. The intra-articular fractures were classified after CT as C1 in 15%, C2 in 65%, and C3 in 20%. The distal radioulnar joint was involved in 80% of the type C injuries and showed a dorsal subluxation in 17% of all cases. Similar to the results of type A2 and A3 fractures, type B and C fractures of the distal radius also may be underestimated in standard radiographs. This concerns important components such as the involvement of the radiocarpal joint surface and concomitant injuries of the distal radioulnar joint. Since joint congruency is an important predictor of outcome, CT scanning should be used more generously for planning and controlling surgical therapy.

Adult↗