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At least 397 records · Page 22Linked to original sources
PubMed2006

Treatment of distal radius fractures with a low-profile dorsal plating system: an outcomes assessment.

PURPOSE: To evaluate objective functional and radiographic outcomes after internal fixation of acute, displaced, and unstable fractures of the distal aspect of the radius in adults by using a low-profile dorsal plating system. Our hypothesis was that the low-profile dorsal plating system would allow for a reduction of extensor tendon irritation and pain and provide stable osseous fixation. METHODS: Sixty consecutive unstable fractures in 59 patients were treated by open reduction internal fixation using a low-profile dorsal plating system. There were 29 type A, 14 type B, and 8 type C fractures (AO classification system). Fifty patients with 51 fractures returned for outcomes assessment by physical examination, plain radiographs, and completion of a validated musculoskeletal function assessment questionnaire. The minimum follow-up period was 1 year; the mean follow-up period was 24 months. Clinical evaluation was performed and plain radiographs were assessed for maintenance of immediate postoperative reduction and implant position. Objective functional assessment was obtained through the Disabilities of the Arm, Shoulder, and Hand questionnaire. RESULTS: Outcomes analysis showed no cases of extensor tendon irritation or rupture. Hardware removal was performed in 1 patient but no extensor tendon irritation or rupture was evidenced. The mean Disabilities of the Arm, Shoulder, and Hand score was 11.9; implant-related discomfort was minimal. All patients had an excellent (31 patients) or good (19 patients) result according to the scoring system of Gartland and Werley. The mean active range of motion was greater than 80% of that of the contralateral wrist in flexion/extension, pronation/supination, and ulnar/radial deviation. Extensor tendon function was unimpaired in all patients. Grip and pinch strength averaged 90% and 94% of the contralateral sides, respectively. Radiographic evaluation showed no change in fracture reduction or implant position. CONCLUSIONS: The treatment of distal radius fractures with a low-profile stainless steel dorsal plating system is a safe and effective method that provides stable internal fixation and allows for full extensor tendon glide and full metacarpophalangeal joint motion. Objective outcome testing showed uniformly good to excellent recovery of wrist and hand function in all patients. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adult↗
PubMed2005

Distal radioulnar joint instability in distal radius fractures: the role of sigmoid notch and triangular fibrocartilage complex revisited.

The stabilising effects of various structures of the distal radioulnar joint (DRUJ) have been heavily debated. This biomechanical cadaveric study examined the effects of the volar and dorsal lips of the sigmoid notch and the volar and dorsal aspects of the triangular fibrocartilage complex (TFCC) on DRUJ stability. Sequential fractures of the distal radius and sectioning of the TFCC were performed followed by measurements of ulnar translation with the forearm in pronation, neutral and supination. A dorsal lunate facet fracture created instability in pronation. Lunate facet fractures alone did not create instability in other forearm positions. Sectioning of the volar TFCC after loss of the dorsal TFCC by a dorsal lunate facet fracture caused DRUJ instability with the forearm in neutral position. Sectioning of the dorsal TFCC after loss of the volar TFCC due to a volar lunate facet fracture created instability in neutral and pronated positions.

Biomechanical Phenomena↗
PubMed1989

Intramedullary fixation of unstable distal radius fractures. A method of fixation allowing early motion.

During a four-year period, we have treated unstable fractures of the distal radius with closed anatomic reduction and insertion of a Rush intramedullary rod through a small dorsoradial wrist incision, followed by early controlled range of motion. In an attempt to reduce the stiffness commonly seen in the fingers, wrist, and elbow, a simple method of more stable fixation and early motion was instituted. Patient assessment using common anatomic and functional classification systems revealed good to excellent results in 35 of 36 patients (98%). Only three patients had complications, and these were all minor in nature. Three rods were removed, all because of prominence and irritation of the tip of the rod over the radial styloid. The procedure is technically reproducible, and has a very high rate of patient acceptance and satisfaction.

Adult↗
PubMed2003

[Management of complex distal radius fractures].

Complex injuries of the distal radius can be associated with articular comminution, severe soft tissue injury, large metaphyseal and/or diaphyseal bone defects, carpal ligament tears or its combinations. We recommend a standardized three step approach for the management of these severe injuries: external fixation as an emergency procedure; treatment of soft tissue damage and further diagnostics as needed; definitive adapted operative therapy after thorough analysis of the specific injury.

Bone Plates↗
PubMed1990

[Accident mechanisms and classification in distal radius fracture].

The form and severity of fracture of the distal radius as well as the concomitant injury of discoligamentary structures of the wrist depend on the position of the wrist at the moment of hitting the ground. The width of this angle influences the localization of the fracture. Pronation, supination and abduction determine the direction of force and the compression of the carpus and the different appearances of ligamentary injuries. The classifications of these fractures published by Frykman (1967) and M. E. Müller et al. (1989, AO-Group), incomplete, are useful for objective evaluation or documentation and may suggest indications for treatment when critically used.

Biomechanical Phenomena↗
PubMed2005

Dorsal plating of unstable distal radius fractures using a bio-absorbable plating system and bone substitute.

This study reports the results of open reduction and internal fixation of 26 unstable, intraarticular, dorsally displaced fractures of the distal radius using a bio-absorbable dorsal distal radius (Reunite) plate and calcium phosphate (Biobon) bone substitute. The bio-absorbable plate has the advantage of being low profile, easily contourable and angularly stable. In the majority of cases, this plate produces functional results comparable with metal plates. The Gartland and Werley score was excellent or good in 21 patients. The theoretical advantage over metal plates is in eliminating the need to remove the plate and hence the need for a second operation if implant-related extensor tenosynovitis occurs. Inflammatory tissue reaction to the degradation products of the plate is a potential concern, although the co-polymer ratio used in this plate appears to have reduced the severity of this reaction, which was seen in two patients in this series. The reduction was lost in five patients with severe dorsal comminution. Following this experience, we do not recommend this plating system for fractures with a metaphyseal gap of greater than 7 mm following reduction.

Absorbable Implants↗
PubMed1990

Epidemiology of distal radius fractures in Iceland in 1985.

Between March 1985 and March 1986, 249 fractures of the distal radius in patients over 15 years of age were treated in the Reykjavik area, which had a total at risk population of 100,154. The incidence pattern was similar to what has been reported in recent Nordic studies except that the fracture risk of women was lower than in Oslo in 1979 and Malmö in 1980-81, and for men higher than in Fredriksborg in 1981. Fifty-seven percent of the patients had employment at the time of accident. The majority of accidents happened outdoors, especially on sidewalks and in streets, and were more common during the winter months.

Accidental Falls↗
PubMed1992

Open reduction and internal fixation for distal radius fractures.

From a series of 650 dorsally angulated fractures of the distal radius, 32 intra-articular fractures were treated by open reduction and internal fixation. The 32 fractures were classified according to the Frykman criteria as type VII (5) or type VIII (27). On the basis of the location of intra-articular involvement, the fractures were further subdivided into Mayo type II (4), type III (18), and type IV (10). Results were analyzed by the methods of Gartland and Werley (functional) and Lidström (radiographic). After open reduction and internal fixation, 90% of the patients had satisfactory results on the basis of the subjective criteria of minimal deformity, absence of pain, and good strength. Objective assessment demonstrated that the patients had 80% of normal motion and 73% of normal grip strength at a minimum of 2 years after the operation. On the basis of radiographic and functional evaluation, results were good to excellent in 87%. When intra-articular step-off exceeded 2 mm or the radius was shortened more than 5 mm, the results were only fair and posttraumatic arthritis was evident.

Adolescent↗
PubMed1993

Distal radius fractures. Multiplanar ligamentotaxis.

Ligamentotaxis is the principle of molding fracture fragments into alignment as a result of tension applied across a fracture by the surrounding intact soft tissues. Uniplanar ligamentotaxis obtained by longitudinal traction does not always restore palmar tilt to the distal radius. Multiplanar ligamentotaxis extends the principle of uniplanar ligamentotaxis to include translation of the hand in the dorsal-palmar and the radial-ulnar planes to effect appositional and tilting alignment of the distal fragment(s) of a fractured radius. Use of an external fixator that allows adjustments in multiple planes helps restore anatomic alignment and maintain fracture reduction during healing.

Bone Lengthening↗
PubMed1994

Orthofix external fixation of distal radius fractures: complications associated with screw size.

We did a retrospective analysis of 28 patients who were treated with the Orthofix external fixation system for complex fractures of the distal radius to study complications associated with screw size. The 14 patients in group 1 had a 4.5/3.5-mm tapered screw placed in the metacarpal bone; the 14 patients in group 2 had a 3.5/3.3-mm tapered screw placed in the metacarpal bone. Both groups had 4.5/3.5-mm tapered screws placed in the radius. Two patients in group 1 had metacarpal pin tract infections; no patients in group 2 had a distal pin tract infection. Two patients in group 1 had a fracture of the metacarpal; only one patient in group 2 had a fracture of the metacarpal. In both groups two patients had proximal pin tract infections at the radius screw fixation site. There was no screw breakage in either group. The unique design of the tapered Orthofix screw allows it to be removed almost painlessly in the clinic. At installation in the operating room, however, the surgeon must remember not to back the threaded pin out for fine adjustment of bony penetration. Any reverse excursion of the threaded shaft will loosen the tapered screw and cause early failure of the fixation. We no longer use the 4.5/3.5-mm screw when managing wrist fractures with the Orthofix external fixation system. It is now our policy to use the 3.5/3.3-mm screw for fixation of the Orthofix external frame to both the metacarpal bone and the radius.

Adolescent↗
PubMed2004

Comparative study of nonbridging and bridging external fixators for unstable distal radius fractures.

The purpose of this study was to compare nonbridging external fixators (group NB) with bridging external fixators (group B) in the treatment for unstable distal radius fractures. The subjects consisted of 84 patients, 42 in each group. Mean patient age was 64.0 years in group NB and 59.6 years in group B. According to Saito's classification, most fractures were of the comminuted Colles type. No bone graft was made in group NB. Patients of group B showed serious reflex sympathetic dystrophy (RSD). On Saito's evaluation criteria, the proportion of patients evaluated as "good" or better was 100% in group NB and 95.6% in group B. This finding can be taken as evidence that group NB patients showed better results.

Adolescent↗
PubMed2003

[New principles in the surgical treatment of distal radius fractures -- locking implants].

The treatment goal for fractures of the distal end of the radius is full functional recovery of the wrist. Prerequisites are restoration of the anatomy and early functional after treatment in accordance to the treatment guidelines for other articular and juxta-articular fractures. A better understanding of the anatomy and new biomechanical models lead to the development of new implants and operative techniques. The LCP-concept with locking screws had a considerable impact on recent advances in the operative treatment of distal radius fractures.

Bone Plates↗
PubMed1998

Intrafocal (Kapandji) pinning of distal radius fractures with and without external fixation.

Seventy-three patients were treated with either intrafocal pinning (Kapandji technique) alone or in combination with external fixation between 1988 and 1993 for extra-articular fractures of the distal radius (with or without a nondisplaced extension into the radiocarpal articular surface) with inadequate alignment after initial closed reduction. Sixty-one patients were available for follow-up examination at an average of 34 months (range, 24-71 months). The average age was 52 years (range, 16-84 years). Thirty-three of the patients were female. The patients all had dorsally displaced extra-articular fractures, although 56% had a nondisplaced extension of the fracture into the radiocarpal joint and 46% had a nondisplaced fracture extending into the distal radioulnar joint. The patients were separated into groups based on age, degree of comminution, and whether external fixation was also used. In the older patients, range of motion, grip strength, and pain relief were significantly better when external fixation was used, even when only 1 cortex of the radius demonstrated comminution. In the younger patients, good results in terms of range of motion, grip strength, and pain relief were obtained when percutaneous intrafocal pins were used alone in patients with comminution of only 1 surface of the radius (<50% of the metaphyseal diameter). When > or = 2 sides of the radial metaphysis were comminuted, the patients with external fixation had better results than those without external fixation. Although the correction of palmar tilt and radial tilt did result in better functional results, the restoration of radial length had the most significant effect on range of motion and grip strength.

Adolescent↗
PubMed1995

Use of pharmacologically induced ejaculation to obtain semen from a stallion with a fractured radius.

Ejaculation was pharmacologically induced in a 13-year-old Quarter Horse stallion with a spiral fracture of the radius. The owners desired to have semen from the stallion frozen prior to euthanatizing the horse, but because of the debilitating injury, standard methods of semen collection could not be used. With the stallion standing quietly in a stall, a plastic collection bag was positioned over the stallion's penis, and clomipramine hydrochloride (2.2 mg/kg of body weight, IV) was administered. Fifty-five minutes later, xylazine hydrochloride (0.5 mg/kg, IV) was administered. The stallion ejaculated 2 minutes after xylazine administration. The semen sample was of low volume and had a high concentration of spermatozoa; however, motility of spermatazoa was poor and the semen was unacceptable for freezing. The stallion was euthanatized. Semen aspirated from the epididymis after euthanasia was of similar quality to that of the ejaculated sample. Pharmacologic induction of ejaculation can be useful for obtaining semen from stallions when standard techniques cannot be applied.

Animals↗