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PubMed1995

[Treatment of radius fractures with a newly developed dynamic external fixator].

Ligamentotaxis first described by Vidal presented the opportunity to treat wrist fractures near to the joint with external fixation. The first published results with this technique were surprisingly successful. As a result, since 1980 the author began, as one of the first in the German speaking regions, to treat radius fractures with the Hoffmann C-series external fixator. With a newly developed dynamic wrist fixator device 4 clinics have treated 104 fractures in a prospective study. These fractures were followed up 6 months later. Using the Lidström classification, the x-ray results were very good and good for 98% and moderate for 2% of treated fractures. Clinically the results were very good and good for 91% and moderate for 2% of treated fractures. Poor results were not recorded. 92% of the patients had a shortening of the radius of less than 2 mm. The sooner motion was initiated, the better the results were during the follow up. All the parameters such as x-ray evaluation, clinical evaluation, pain, strength, and in particular motion were improved when compared to a static fixator or motion after 14 postoperative days. The treatment time with this new dynamic wrist fixator device was reduced by two weeks compared to a static fixator. Cancellous bone grafting was never necessary.

Equipment Design↗
PubMed1990

Limited open surgical approach for external fixation of distal radius fractures.

In an effort to reduce treatment-related complications, a surgical procedure has been developed for the insertion and application of an external fixation device in the management of unstable fractures of the distal radius. Clinical experience with this device has demonstrated its effectiveness in reducing complications associated with pin insertion. The surgical technique is presented together with a case example. Results of laboratory tests corroborate our clinical experience and demonstrate the effectiveness of this technique in minimizing complications. Clinical results in 66 cases document the efficacy and safety of this technique.

Adult↗
PubMed2001

Extraarticular external fixation in distal radius fractures pinplacement in osteoporotic bone.

External fixation is a well accepted treatment option in distal radial fractures. The fixator can be used in two different ways: joint bridging or extraarticular. The extraarticular technique presumes that the fracture does not involve the radio-carpal joint and that the distal fragment is broad enough to accommodate two fixator screws. Taking into account that the majority of distal radius fractures occur in elderly female patients the question arises whether osteoporotic bone is an obstacle to extraarticular external fixation. Bone slices of 2mm thickness were cut out of six human cadaver radii with a mean age of 76 years (from 65 to 94 years) in the saggital plane. A radiograph of each slice was digitized and the distribution of gray values measured. It was found that the radiographic density was highest at the palmar side of the distal radius in a triangular area built by the palmar lip of the radius. In this region, even in severe osteoporotic bone, strong trabeculae are visible running parallel to longitudinal axis of the radius. Fixator screws inserted into the distal radial fragment especially in an osteoporotic situation should be securely anchored in the palmar lip of the distal radius.

Adult↗
PubMed1993

The rationale for precise management of distal radius fractures.

Fractures of the distal radius continue to be one of the most common skeletal injuries treated by orthopedic or trauma surgeons. These injuries account for one sixth of all fractures seen and treated in emergency rooms. The rapid expansion of knowledge regarding the functional anatomy of the hand and wrist, the recognition by treating physicians of the ever increasing functional demands of senior citizens, and improved methodologies of achieving and maintaining anatomic restoration of these fractures have generated a renewed interest in addressing these fractures in a more precise manner.

Arthritis↗
PubMed2001

[Is there still a place for conservative treatment of distal radius fractures in the adult?].

Contrary to Colles'opinion which pretended the fracture of the distal radius would heal without sequellae, many studies devoted to this problem showed that complications will affect one third of the cases (malunion, nerve compression, dystrophy, tendon rupture). It is important for the surgeon to know well the different fracture types, the general condition of his patient as well as his osteoarticular state to make the good choice of treatment. Our study shows that the nonoperative treatment will be chosen for any fracture type as far as it concerns an old or crippled patient, especially if there is an osteoporosis. On the contrary, for a young and active patient with a good bone quality, non operative treatment will be chosen as far as the fracture will be reducible and stable. If it is not, an osteosynthesis has to be done. Many studies already published tend to demonstrate that there is a correlation between anatomical and functional results. However, concerning elderly, this correlation tend to disappear with time.

Adult↗
PubMed2000

Extensor tendon rupture after internal fixation of a distal radius fracture using a dorsally placed AO/ASIF titanium pi plate. Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation.

Extensor tenosynovitis has been reported as a complication of the Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) pi plate. The authors present a case of extensor tendon rupture after internal fixation with a pi plate after one of the screws in the distal limb loosened. This mechanism of extensor tendon rupture has not been reported previously. With appropriate prevention, monitoring, and intervention this complication could have been avoided. Schnur DP, Chang B. Extensor tendon rupture after internal fixation of a distal radius fracture using a dorsally placed AO/ASIF titanium pi plate.

Bone Plates↗
PubMed2000

[Malpractice in connection with radius fractures must be reduced. Clear guidelines for treatment and follow-up are required].

PSR handles the vast majority of malpractice injuries in Sweden. PSR is a claims handling company which settles claims for malpractice on behalf of the insurance company owned by the Swedish county councils: the County Councils Mutual Insurance Company. A central issue in the law regulating patient injuries in Swedish health care is to define injuries that could have been avoided if a certain therapeutic/diagnostic procedure or a more appropriate method had been utilized. PSR arranged a multiprofessional conference regarding guidelines to decrease the number of malpractice injuries in the treatment of distal radius fractures. Among the most important issues defined were: To improve and standardize diagnostic imaging Patient information Early decision making in surgery and physical/occupational therapy A more well-defined indication for surgery, in which type of trauma, biological age and functional demands are considered in addition to radiographs Less stereotyped thinking in follow-up Controlled randomized trials.

Clinical Competence↗
PubMed1988

Epidemiology of distal radius fracture in Stockholm 1981-82.

During 1981 and 1982, 1,536 fractures of the distal radius were treated within the catchment area of Södersjukhuset (Southern Hospital), Stockholm. The age-specific incidence did not differ from that of three other Scandinavian investigations, except for women over 75 years of age, among whom the incidence decreased in Stockholm and Oslo and increased in Malmö and Hillerød. Using Frykman's (1967) classification, extraarticular fractures dominated.

Adolescent↗
PubMed1990

Effects of distal radius fracture malunion on wrist joint mechanics.

An experimental model using a static positioning frame, pressure-sensitive film (Fuji), and a microcomputer-based videodigitizing system was used to measure contact areas and pressures in the wrist. Contact areas and pressures were compared in a group of wrists between the normal state and with simulated distal radius fracture malunions of varying degrees. In simulated malunions, radial shortening to any degree slightly increased the total contact area in the lunate fossa, and was significant at 2 mm of shortening. By angulating the distal radius more than 20 degrees either palmar or dorsal, there was a dorsal shift in the scaphoid and lunate high pressure areas, and the loads were more concentrated, but there was no change in the load distribution between the scaphoid and lunate. Decreasing the radial inclination shifted the load distribution so that there was more load in the lunate fossa and less load in the scaphoid fossa.

Adult↗
PubMed1998

Kapandji pinning or closed reduction for extra-articular distal radius fractures.

In a randomized prospective trial, closed reduction and plaster application was compared with Kapandji pinning. Closed reduction and plaster cast application was performed in 50 patients, Kapandji pinning in 48 patients. According to the Cooney score, good and excellent results were found in 74% of patients in the closed reduction and plaster cast group compared with 75% of patients in the Kapandji-pinning group. In terms of maintenance of reduction and functional outcome at 1-year follow-up, no statistically significant differences were found between the two groups. We conclude, therefore, that both techniques can be applied to extra-articular fractures of the distal radius according to the characteristics of the forearm and the surgeon's or the patient's need.

Aged↗
PubMed1994

Treatment of comminuted distal radius fractures: an approach based on pathomechanics.

Following dorsally displaced fractures of the distal radius, the classic position of immobilization is with the wrist flexed and in ulnar deviation. This is not the position of function and entails morbidity in the form of finger stiffness, which may require prolonged rehabilitation. We treated 20 consecutive, comminuted, intraarticular distal radial fractures using a new external fixation system with the wrist in a neutral to extended position, thereby promoting metacarpophalangeal joint flexion by relatively relaxing the finger extensor tendons. Supplemental pin fixation was used in eight cases. Most patients were performing active digital motion on the day of surgery and 95% maintained functional finger motion during treatment. All fractures healed uneventfully. Palmar tilt was restored in 55% of patients in spite of a wrist neutral or extended position. This method of fixing distal radial fractures allows restoration of anatomy while avoiding hand stiffness.

Adult↗
PubMed2005

Dorsal plating for distal radius fractures.

A dorsal approach to the distal radius for comminuted intra-articular fractures affords excellent exposure of the joint surface. Dorsal plating can reliably buttress the joint, leading to low rates of arthrosis, but at the expense of wrist stiffness and high rates of extensor tendon problems. New, smaller implants may prove capable of supporting the joint with lower rates of extensor irritation.

Bone Plates↗
PubMed1994

[Retrospective analysis of consecutively treated distal radius fractures with the external fixator].

The purpose of this study was to determine retrospectively some subjective and objective parameters following the operative treatment of 32 patients with "complex" (intraarticular and/or comminuted) fractures of the distal radius using the small AO external fixation device. The mean follow-up period was 20 months (minimum 4, maximum 48) and the mean age of the subjects was 62 years (minimum 27, maximum 91). Subjective results such as "general feeling", mobility, strength and pain, expressed with a scoring system (% of maximum obtainable points), showed an overall good result and ranged between 71% (pain), 81% (strength) and 91% (mobility and "general feeling"). Regarding the objective results, no major skin or soft tissue distress (Sudeck dystrophy) was noted. However, there was a general tendency towards a mobility deficit of the wrist operated on, which was statistically significant (P < 0.01) for flexion, extension, supination and abduction (respectively, -17.7%, -12.4%, -7.1% and -12.5%). The late standard radiological and lateral controls showed a mean radial angle of +2.13 degrees (B or lateral radial angle) and +23.13 degrees (A or AP angle), respectively. The analysis of data, as expressed by time after operation (< or > than 10 months), showed no relevant difference between the two groups (age of both similar), as expressed by age (< or > than 60 years); the data only showed differences in strength and pain (scores by 92% vs 82% for force and 92% vs 76% for pain) and in flexion and extension (-22.8% and -14%, P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Corrective osteotomy of malunited distal radius fractures].

The malunion of the distal radius may result in shortening, radial impaction, volar angulation, dorsal displacement or rotatory deformity. For restoration, the anatomy and kinematics of the distal radioulnar joint and the triangular fibrocartilaginous complex (TFCC) are of importance. This nonunion consists of the articular disk, a meniscus homologue, the ulnar collateral ligament, and the dorsal and palmar radioulnar ligaments. Malunion of the distal radioulnar joint leads to an increase in loading on the individual parts, as well as pain and a decrease in supination and pronation. Osteotomy is indicated if the angulation of the malunion is more than 20 degrees in the frontal or sagittal plane. Corrective osteotomy requires detailed preoperative planning with calculation of the correct position in all planes. The most common operation that has proved to be effective is osteotomy of the radius, insertion of a trapezoidal bone graft in place, and internal fixation with a dorsal or volar plate.

Elbow Joint↗
PubMed2003

Monteggia type I equivalent lesion: diaphyseal ulna and radius fractures with a posterior elbow dislocation in an adult.

BACKGROUND: A rare type I Monteggia equivalent lesion with a posterior dislocation associated with a diaphyseal radius and ulna fracture in an adult is described. The probable mechanisms of injury are speculated to include flexion of the elbow and pronation of the forearm. METHODS AND RESULTS: Early reduction of the dislocation and rigid fixation of the fractures helped to achieve excellent results.

Accidental Falls↗
PubMed2005

Treatment of the neglected distal radius fracture.

Operative treatment of inadequately or imperfectly treated fractures of the distal radius can improve wrist and hand function substantially, but rarely restores the limb to normal. Patients with malunion of the distal radius present either with poor radiographic alignment before complete healing of the fracture (nascent malunion) or with functional problems that may be related to inadequate alignment of a healed fracture (mature malunion). Corrective osteotomy is offered to patients who have sufficient malalignment that the surgeon thinks problems are inevitable or to patients in whom the functional deficit can be related clearly to the malunion. Ununited fractures are associated with painful instability of the wrist and very poor hand function. Operative treatment has proved successful even when the distal fragment is small. Operative treatment for reconstruction of the distal radius has been facilitated by the introduction of plates with angular stable screws (screws that lock into the plate). Painful arthritis is salvaged with arthrodesis.

Arthritis↗