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PubMed2006

[Distal radius fracture. Correlation between radiological and functional results].

BACKGROUND: The purpose of the present study was to investigate the influence of the radiological parameters on the functional outcome of patients with a fracture of the distal radius and to find out to which extent a deformity can be tolerated. PATIENTS AND METHODS: A total of 344 patients with an isolated fracture of the distal radius were treated during a 3-year period; 211 of them were evaluated at an average of 16 months after the accident according to the score of Gartland and Werley as modified by Sarmiento. Furthermore, we developed our own score for evaluating the influence of radiological parameters on the functional outcome. RESULTS: According to the AO classification, there were 20 patients with an A2, 71 an A3, 11 a B, 35 a C1, 44 a C2, and 30 a C3 fracture. Of 211 patients, 28 (13%) had a step-off in the articular surface of over 1 mm, resulting in a 24% reduction of the range of motion compared to the non-injured wrist (p<0.05). Patients with a radial shortening of more than 3 mm (n=12) had a 21% reduction of pro- and supination compared to the non-injured side (p<0.05). The radial tilt and the palmar inclination did not have a direct influence on the functional outcome. Patients treated with K-wire pinning and with an initial palmar inclination of less then -15 degrees had a significantly higher secondary loss of palmar inclination of 9 degrees compared to all others (p<0.05) at the final follow-up. CONCLUSION: The main radiological factors influencing the functional outcome of fractures of the distal radius are radial shortening and a step-off in the articular surface.

Adolescent↗
PubMed2006

[Fracture of the distal ulna accompanying fracture of the distal radius. Minimally invasive treatment with elastic stable intramedullary nailing (ESIN)].

The distal radius is one of the commonest sites of fracture, and this injury is sometimes associated with fracture of the distal ulna. In recent years, surgical treatment of distal radius fractures has consisted increasingly in internal fixation with locking plates followed by early functional postoperative treatment. The associated injury to the distal ulna has so far not received much attention in the literature. Various techniques have veen described for its treatment: Kirscher wire fixation, tension band wiring, and internal fixation with screws and plates. Following positive results with elastic stable intramedullary nailing (ESIN) in the treatment of shaft fractures in children this technique was also applied in in fractures in adults (forearm, clavicle). Use of this technique for stabilisation of distal ulnar fractures has not previously been reported. In the course of a prospective longitudinal study (EBM level II), in 26 patients with an average age of 73.6 (42-88 years), bone healing in anatomical position was achieved in all cases within 6-12 weeks after closed reduction and anterograde ESIN with subsequent treatment that did not involve immobilization. No length differences of more than 2 mm and no functionally relevant deviations of the ulnar axis were observed. Apart from 3 cases of nail perforation at the distal end of the ulna, which had no clinical manifestations, there were no complications. ESIN offers a minimally invasive option for the treatment of unstable fractures of the distal ulna associated with distal radius fractures; it allows functional aftertreatment and can be regarded at least as an alternative to open reduction with internal fixation.

Adult↗
PubMed1998

[Prognosis of proximal radius fractures in the growth period].

Fractures of the proximal radius in children may lead to deformities of the radial head and functional disturbance of pro- and supination. However, traumatization is not only caused by the injury itself, but may also occur secondary to surgical reduction, manipulation of fracture fragments and excessive physiotherapy. In a prospective long-term follow-study (2-20 years after trauma) of 38 children with displaced proximal radius fractures we found functional disturbances in 11% of children only. These were not caused by radial head deformities, which were present on 83% of follow-up radiographs. Functional impairment was mainly seen after open reduction or secondary growth disturbances. On follow-up radiographs all conservatively treated fracture angulations up to 60 degrees had corrected themselves spontaneously. In view of the high complication rates after open reduction and the poor functional results, as well as the inconvenience for the pediatric patient and the economic aspects, we recommend a primary conservative treatment concept of proximal radius fractures in children.

Adolescent↗
PubMed1998

[Distal, metaphyseal compression fractures of the radius. Results of open reposition, stable defect replacement with cortico-cancellous iliac crest bone and plate osteosynthesis].

Conservative treated distal radius fractures with extended metaphyseal void and missing cortical support resulted in loss of reduction. From 1988 till 1994 117 fractures of the distal radius were treated by open reduction, filling the metaphyseal void with a corticocancellous iliac bone graft and plate fixation. In this retrospective study results after surgical reconstruction were evaluated radiologically and clinically and were discussed to conservative treatment. 30 patients suffering from extraarticular metaphyseal distal radius fracture were evaluated after a mean of 42 months (minimum 20, maximum 68 months) after surgery. Ulnar variance was restored in 70% to the uninvolved side. Ulnar minus variance up to 2 mm persisted in 30%. Radial joint angles were restored to normal in 53%. In 40% of the patients a loss of reduction up to 10 degrees and in 7% up to 25 degrees occured. Active range of motion in the sagittal and frontal plane was equivalent to the non involved side in 30%. 70% of the patients showed reduced range of motion up to 20%. Rotation was unlimited in 77%, reduced up to 10% in 23%. Subjective results were excellent in 90%, good in 10%. Compared to conservative therapie, surgery showed superior results.

Adolescent↗
PubMed2002

[Treatment of complicated fracture of the distal radius with external fixator. Follow-up--complications--outcomes].

The performance of the external fixation regarding severe fractures of the distal radius was evaluated by means of a very detailed retrospective study. Between 1989 and 1994 74 Patients with 76 fractures of the distal radius with a mean age of 69 years for female and 39 years for male patients were treated with the external fixator. 37% were open fractures. Using the ASIF classification, 21% were type A-fractures, 8% were type B-fractures and 71% were type C-fractures. In 44 cases the external fixator was used primarily, in 32 cases secondarily after failed conservative treatment. Additional procedures were partially necessary (K-wires, screws, bone grafts etc.). 32 complications had to be noted, the lesion of the superficial branch of the radial nerve being the most common (16%). After a mean follow up of 36 months 60 patients with 61 fractures could be evaluated clinically and radiologically. With the Sarmiento score as well as the Castaing score, 84% could be classified as very good or good, 16% as fair, no poor results were recorded. From this study we conclude that the primary treatment of complex fractures of the distal radius can be performed with external fixation along with the additional procedures necessary (K-wires etc.). Because of the reliable elimination of pain caused by the fracture, it forms a preventive measure against reflex sympathic dystrophy.

Adult↗
PubMed2005

Gender differences in trabecular bone architecture of the distal radius assessed with magnetic resonance imaging and implications for mechanical competence.

High-resolution magnetic resonance imaging (hrMRI) has recently made it possible to evaluate trabecular bone structure in vivo. Despite obvious gender differences in fracture incidence at the distal radius, little is known about gender differences in trabecular bone microarchitecture and its relationship to the structural strength of the forearm. The aim of this study was to determine trabecular bone structure in the distal radius of elderly women and men and its correlation with failure loads of the distal radius as determined in a fall configuration. Specifically, we tested the hypotheses that structural indices differ between women and men and that they offer information that is independent from BMD for predicting structural strength. Intact right arms were obtained from 73 formalin-fixed cadavers (age 80+/-11 years, 43 women, 30 men). Trabecular structural indices (apparent bone volume fraction [app. BV/TV], trabecular number [app. Tb.N], trabecular separation [app. Tb.Sp], trabecular thickness [app. Tb.Th] and fractal dimension [Frac.Dim]) were assessed in the distal metaphysis, using hrMRI with 156 microm in-plane resolution and proprietary digital image analysis, while BMD was measured with dual X-ray absorptiometry (DXA). Women displayed significantly lower BMD (-29.8%, p <0.001), app. BV/TV (-8.2%, p <0.05) and app. Tb.Th (-10.2%, p <0.001) than men, whereas app. Tb.N, app. Tb.Sp. and fractal dimension did not differ significantly. Structural parameters differed between normal and osteopenic women (BV/TV: -11%, p <0.01; Tb.Th: -8%, p <0.001) and between normal and osteoporotic women BV/TV: -21%, p <0.001; Tb.Th: -16%, p <0.001). App. BV/TV, app. Tb.Th and fractal dimension provided information independent from BMD in the prediction of radial failure loads in multiple regression models. These findings imply that it should be of clinical interest to monitor both bone mass and trabecular microstructure for predicting osteoporotic fracture risk.

Absorptiometry, Photon↗
PubMed2006

Accuracy of pQCT for evaluating the aged human radius: an ashing, histomorphometry and failure load investigation.

INTRODUCTION: Quantifying the determinants of bone strength is essential to understanding if or how the structure will fail under load. Determining failure requires knowledge of material and geometric properties. However, characterizing the relative contributions of geometric parameters of bone to overall bone strength has been difficult to date because of limitations in imaging technology. Peripheral quantitative computed tomography (pQCT) uses digital images to derive estimates of bone strength in the peripheral skeleton and is a relatively safe technique to differentiate cortical from trabecular bone and assess bone geometry and density. However, in a compromised osteoporotic bone, thin cortices and low scan resolution can limit accurate analysis. METHODS: Therefore, in this two-part investigation we scanned ten pairs (n=20) of fresh-frozen radial specimens [female, mean (SD) age 79(6) years] using pQCT (XCT 2000) at the 4 and 30% sites of the distal radius. We investigated the accuracy of four different acquisition resolutions (200, 300, 400, 500 microm) and several analysis modes and thresholds. We evaluated (1) the accuracy of the Norland/Stratec XCT 2000 pQCT in assessing low-density bones by comparing pQCT outcomes to ashing and histomorphometry and (2) the association of geometric parameters by pQCT and areal bone mineral density (aBMD) by dual-energy X-ray absorptiometry (DXA) to failure load at the distal radius. RESULTS: Using histomorphometry and ashing as reference standards, we found that pQCT scans varied systematically and underestimated or overestimated total area and mineral content at the radial midshaft depending on the analysis algorithm and selected threshold. Overall, most pQCT analysis modes were accurate. In the mechanical testing studies, bone mineral content and cortical bone content at the midshaft were strongly associated with failure load. The pQCT parameters that best accounted for failure load were total content at the 4% site and cortical thickness at the 30% site and they accounted for up to 81% of the variance. The best DXA predictor of failure load was total density at the distal third site and it explained 75% of the variance. CONCLUSIONS: In summary, analysis mode, resolution and thresholding affected pQCT outputs at the radial midshaft. This study extends our understanding of pQCT analysis and provides important data regarding determinants of bone strength at the distal radius.

Aged↗
PubMed2000

Discrimination of proximal hip fracture by quantitative ultrasound measurement at the radius.

Osteoporosis is a disease that culminates in fragility fractures and, therefore, imposes major burden on the health economy. In dealing with this worldwide condition, it is prudent to use a reliable, inexpensive, portable diagnostic means that does not use ionizing radiation and is capable of measuring bone properties at several sites. Recently, a quantitative ultrasound device (Omnisense) that measures speed of sound (SOS) at multiple skeletal sites was introduced. The Omnisense combines the 'axial transmission' mode and the critical angle concept. Preliminary reports suggested that of the different skeletal sites measured by this device, the distal third of the radius is the preferred measurement site for osteoporosis. In this cross-sectional study, SOS was determined at the radius using Omnisense in 50 hip-fractured elderly women (group F, age 76.1 +/- 6.0 years), 130 elderly controls (group NF, age 71.5 +/- 5.2 years) and 185 young healthy controls (group YH, age 40.6 +/- 3.0 years). Actual SOS was significantly lower in group F compared with group NF (p = 0.0001). Whereas SOS T-scores calculated for each woman and stratified into age subgroups within each of the study groups indicate decline from -2.22 to -3.56 in group F and from -1.56 to -3.17 in group NF, there was an increase from -0.02 to 0.03 in group YH. Age- and BMI-adjusted logistic regression for hip fracture discrimination indicated an area under the receiver operating characteristic curve for hip fracture of 0.79 (95% CI, 0.73-0.86; p = 0.005) and an odds ratio of 1.92 (95% CI, 1.22-3.02; p = 0.005). We conclude that SOS measured at the radius by Omnisense discriminates subjects with hip fracture. from controls. Prospective studies are needed to support the role of Omnisense in assessing the risk of hip fracture.

Adult↗
PubMed2003

Measurements of bone mineral density of the radius in a medieval population.

The current morbidity in the elderly as a result of osteoporotic fractures has led to interest in the incidence of this condition in past populations. The purpose of this study was to evaluate the technique of scanning of the distal radius with DXA in archaeological bone. The radius is often better preserved in archaeological contexts than bone with higher trabecular content such as the femoral neck or vertebrae. Adult radii (101) from the deserted medieval village site of Wharram Percy were scanned. These skeletal remains represent an homogenous rural population. The scanned individuals were divided into 3 age groups; 18-29, 30-49, and 50+. In both males and females bone loss was statistically significant in the highly trabecular ultra-distal region and the more cortical mid-region after age 50. Only females lost bone in the largely cortical one-third site before age 50. This is in accordance with modern clinical studies in which this loss is attributed to the effects of menopause. In order to assess whether there were differences in bone loss between weight and non-weight-bearing bones, the results were also compared with those from an earlier study of the femoral neck. In both sexes trabecular bone was lost at both anatomical sites after age 50. However, scanning the radius also had the advantage of assessing cortical bone loss. Additionally, despite demonstrable bone loss, there were no Colles or hip fractures in this paleopopulation, suggesting that although an active lifestyle such as that spent in agricultural activity, does not prevent bone loss, it may protect against osteoporotic fracture.

Absorptiometry, Photon↗
PubMed1998

Posterior interosseous nerve palsy caused by parosteal lipoma of proximal radius.

Lipomas are common benign soft tissue tumors which tend to be indolent, and symptoms caused by nerve compression are unusual. However, a parosteal lipoma, occurring adjacent to the proximal radius may easily cause paralysis of the posterior interosseous nerve because of a specific anatomical relationship of these structures in that area. Two cases of parosteal lipoma of the proximal radius causing paralysis of the posterior interosseous nerve are reported. CT and MR imaging demonstrate the characteristic fatty mass around the radius and are specific in making the diagnosis. Surgical excision should be promptly performed to ensure optimal recovery from the nerve paralysis.

Bone Neoplasms↗
PubMed1998

Fracture of the upper radius with ipsilateral dislocations of the elbow and superior radio-ulnar joints. A case report.

We report the rare combination of a closed fracture of the upper third of the radius with ipsilateral posterior dislocation of the elbow joint and disruption of the superior radio-ulnar joint. Although in the Bado classification there is a fourth type that describes fractures of both radius and ulna with dislocation of the superior radio-ulnar joint, it does not include the injury we report. We review of the literature and put forward an extension of Bado's classification so that fractures of either, or both, the radius and ulna associated with pericubital dislocations will be included.

Adult↗
PubMed2001

Bone structure of the distal radius and the calcaneus vs BMD of the spine and proximal femur in the prediction of osteoporotic spine fractures.

The aim of this study was to compare structure measures obtained from high-resolution MR images of the calcaneus and the distal radius with bone mineral density (BMD) of the spine and hip in the prediction of osteoporotic spine fracture status. High-resolution MR images of the calcaneus and radius were obtained in 24 post-menopausal women with spine fractures and 22 age-matched controls. Imaging was performed at 1.5 T using a T1-weighted spin-echo sequence (slice thickness 1 mm, in-plane spatial resolution 195 x 195 microm(2)). Structure analysis was performed using parameters analogous to standard histomorphometry. Bone mineral density of the spine was obtained using quantitative CT and of the hip with dual-energy X-ray absorptiometry. Significant differences between both patient groups were obtained with BMD and all structure parameters ( p<0.05). Using receiver operating characteristic analysis to determine the diagnostic performance in differentiating both groups, the best results were found for BMD of the spine, one of the radial structure measures and a combination of the calcaneal structure measures. In this study BMD of the spine and structure measures of the distal radius were best suited to predict the osteoporotic fracture status of the spine. A combination of BMD and structure measures did not yield any additional information on fracture status.

Absorptiometry, Photon↗
PubMed2003

Injectable calcium phosphate bone cement Norian SRS for the treatment of intra-articular compression fractures of the distal radius in osteoporotic women.

BACKGROUND: Distal radius fracture often presents a metaphyseal void which is more extended in elderly, osteoporotic patients. Bone graft and bone substitutes are reported to be beneficial in maintaining metaphyseal reduction. METHODS: We performed a prospective study on 52 menopausal, osteoporotic women with unstable intra-articular distal radius fractures to compare the outcome of percutaneous pinning and immobilisation in a cast for 6 weeks with that using injectable calcium phosphate bone cement (Norian Skeletal Repair System, SRS) to supplement pin and screw fixation and immobilisation in a cast for 3 weeks. All patients were reviewed 2 years (range 21-29 months) after surgery. RESULTS: Patients treated with SRS had better functional outcome, restoration of movement and grip strength ( p<0.001). In this group there was 1 mm loss of radial length, 3 degrees loss of radial inclination and 7 degrees loss of palmar tilt. In the control group radial length decreased 3 mm, radial inclination decreased 11 degrees and palmar tilt 12 degrees. Loss of reduction was significantly higher in the control group ( p<0.001). CONCLUSION: We conclude that the use of Norian SRS to supplement pin and screw fixation is effective in maintaining the reduction of unstable intra-articular distal radius fractures in osteoporotic patients and provides a better clinical outcome than percutaneous pinning.

Aged↗
PubMed2005

Outcome after surgery of distal radius fractures: no differences between external fixation and ORIF.

The purpose of this study was to determine the most appropriate surgical treatment from three procedures used for fractures of the distal radius. In a retrospective comparative study, 166 out of 237 patients who underwent surgery for AO/ASIF A3 or C2 distal radius fractures were evaluated. Surgical procedures were external fixation or open reduction and internal fixation with either palmar or dorsal plates. Radiological outcomes were palmar tilt, radial angle, radial length and ulnar variance. Functional outcomes were range of motion and grip strength. In addition, outcomes according to Gartland and Werley and the Disabilities of the Arm, Shoulder and Hand questionnaire were compared. Further outcome criteria were the treatment time and the number of complications. Data were analysed using an analysis of variance statistical procedure respective of the chi2-test. Open reduction and internal fixation, in particular palmar plate fixation, demonstrated the best radiological and functional results. Subjective assessment of ORIF proved better than that of external fixation as treatment time was shorter and complications were more rarely seen. However, most of the differences between groups were not significant. Although there were no significant differences between groups, our data indicates that most dorsally displaced distal radius fractures can be treated successfully by open reduction and internal fixation. Palmar plate fixation seems to have slight advantages compared to both the external fixation and dorsal plate fixation surgical procedure.

Adult↗
PubMed2005

A randomised clinical trial of activity-focussed physiotherapy on patients with distal radius fractures.

INTRODUCTION: Physiotherapy is considered by some authorities to be an important aspect of management in patients following distal radius fractures. There is evidence of improvement in impairment with physiotherapy; however, there is no evidence to support early return of functional activity. Traditional physiotherapy management has focussed on improving impairment; however, there are no trials with emphasis on skill acquisition via motor re-learning principles. MATERIALS AND METHODS: Forty-one participants with conservatively managed distal radius fractures were studied in a randomised, single-blinded, prospective trial. Two treatment options were compared: exercise and advice versus activity-focussed physiotherapy with measurement periods of 6 weeks after removal of cast and follow-up at 24 weeks. RESULTS: Participants allocated to the exercise and advice group consulted a physiotherapist an average of 0.9 (SD 0.4) times, while the participants allocated to the more intensive activity-focussed group consulted with physiotherapy a mean of 4.4 (SD 2.3) times. At both 6 and 24 weeks there were no significant differences between the groups for change in impairment (as measured by grip strength, range of motion of wrist flexion and extension and pain intensity), activity limitation and participation restriction, as measured by the Patient-Rated Wrist Evaluation (PRWE). Exercise and advice given by a physiotherapist were equally as effective as activity-focussed physiotherapy in recovery both at 6 and 24 weeks. CONCLUSION: The results suggest that after removal of cast from fracture of distal radius, patients may routinely require no more than a single session of advice and exercise provided by a physiotherapist.

Activities of Daily Living↗
PubMed2006

Surgical treatment of distal radius fractures with an angle fixed bar palmar plating system: a single center study of 102 patients over a 2-year period.

INTRODUCTION: Most fractures of the distal radius can be treated by conservative means; however, unstable distal radius fractures (DRFs) require surgical fixation. The purpose of this study was to evaluate functional and radiographic results of DRFs treated with a palmar plating system regarding patient's quality of life. METHODS: This study reports a total number of 104 DRFs in 102 patients, operatively treated, over a 2-year period with a mean follow up time of 15.6 +/- 7.2 months The patient's average age was 59.9 +/- 18.0 years. The results were evaluated according to the scores of Gartland and Werley, Castaing and the disabilities of the arm, shoulder, and hand (DASH) outcome questionnaire. RESULTS: Ninety-three patients were evaluated at final examination. Excellent and good results were achieved for 92 (98.9%) patients according to score of Gartland and Werley and for 86 (92.5%) patients regarding the scoring system of Castaing. The DASH outcome questionnaire averaged 8.0 +/- 13.7 points. INTERPRETATION: This study shows, in a representative number of cases, that palmar plating of unstable fractures of the distal radius is a safe and effective treatment modality. Early surgical treatment results in optimal outcome regarding patient's quality of life.

Adolescent↗
PubMed2001

Simultaneous ipsilateral fractures of distal and proximal ends of the radius.

We treated a patient with a rare combination of ipsilateral fractures of the distal and proximal ends of the radius. A woman aged 52 years had simultaneous fractures of the distal and proximal ends of the radius (radial head and neck) after she fell from a high place. The fracture of the radial head was treated by open fixation with a cancellous bone screw, and the fractured distal end of the radius was treated by bone graft, with the subsequent application of an external fixator. At the 1-year follow up, the patient had minor residual limitation of forearm pronation and elbow joint extension, but she had no pain on movement, and had a good result based on Cooney's score (90 points).

Accidental Falls↗
PubMed2002

Calcium phosphate bone cement for treatment of distal radius fractures: a preliminary report.

Distal radius fractures in osteoporotic patients are often complicated with a residual deformity and a subsequent stiff and painful wrist. The aim of this study was to evaluate the usefulness of calcium phosphate bone cement (CPC95) in the treatment of these fractures. Seven Colles type fractures in seven patients (all female; average age, 58 years) were treated. After a closed reduction, the fractures were fixed either by percutaneous pinning or by external skeletal fixation. The CPC95 was then injected into the cancellous bone defect through a small dorsal incision. The functional and radiological results were evaluated for up to 1 year. All patients were graded as good or excellent within 3 months, and all were graded as excellent at the final follow-up. The average duration of immobilization was 3.5 weeks. The overall shortening of the radius was 2.3 mm. In one patient, CPC95 extruded into the extensor tendon sheath and was surgically removed. Injection of CPC95 is a promising augmentation of osteosynthesis for distal radius fractures, although a prospective control study is mandatory to prove the usefulness of this material. The equipment and surgical technique should be refined to avoid the extrusion of CPC95.

Biocompatible Materials↗