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At least 415 records · Page 23Linked to original sources
PubMed2005

Reconstruction of the distal radius facet by a free vascularized osteochondral autograft: anatomic study and report of a patient.

PURPOSE: Large chondral defects of the distal radius after fractures present a reconstructive challenge. The purpose of this study was to present the anatomic findings from a cadaver of a vascularized osteochondral autograft taken from the third metatarsal appropriate for reconstructing the distal radius articular facet. A patient is presented in whom 70% of the scaphoid fossa was reconstructed with this technique. METHODS: The base of the third metatarsal was studied in the feet of 20 cadavers. The size and shape of the cartilage were measured. Additionally vessel distribution was recorded and the diameters of vascular foramina were measured with Juch's method. RESULTS: The base of the third metatarsal is pear shaped and is wider dorsally than plantarly. It averages 19.2 mm long on its main axis. Its cartilaginous surface is minimally concave or flat and it is slanted slightly proximal-dorsal to distal-plantar and proximal-peroneal to distal-tibial. Nutrient foramina were found in every case in the dorsum and on both sides of the proximal shaft. At least 1 nutrient vessel could be tracked back to the dorsalis pedis in every dissected specimen. CONCLUSIONS: The anatomic features of the base of the third metatarsal make it a potential vascularized autograft to consider for osteochondral defects of the distal radius.

Adult↗
PubMed2005

A meta-analysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures.

PURPOSE: External fixation and open reduction and internal fixation have been the traditional techniques for surgical fixation of unstable distal radius fractures. The existing literature has not identified which is superior, primarily because of the lack of comparative trials. We performed a comprehensive systematic review and meta-analysis of the current literature on external fixation and internal fixation of distal radius fractures to determine the dominant strategy based on available scientific evidence. METHODS: We searched MEDLINE and EMBASE for English-language articles published between 1980 and 2004 that satisfied predetermined inclusion and exclusion criteria. The outcomes of internal and external fixation were compared using continuous measures of grip strength, wrist range of motion, and radiographic alignment and categoric measures of pain, physician-rated outcome scales, and complication rates. Outcomes were pooled by random-effects meta-analysis and meta-regression analysis was used to control for patient age, presence of intra-articular fracture, duration of follow-up period, and date of publication. Sensitivity analyses were used to test the stability of the meta-analysis results under different assumptions. RESULTS: Forty-six articles were included in the review with 28 (917 patients) external fixation studies and 18 (603 patients) internal fixation studies. Meta-analysis did not detect clinically or statistically significant differences in pooled grip strength, wrist range of motion, radiographic alignment, pain, and physician-rated outcomes between the 2 treatment arms. There were higher rates of infection, hardware failure, and neuritis with external fixation and higher rates of tendon complications and early hardware removal with internal fixation. Considerable heterogeneity was present in all studies and adversely affected the precision of the meta-analysis. CONCLUSIONS: The current literature offers no evidence to support the use of internal fixation over external fixation for unstable distal radius fractures. Comparative trials using appropriately sensitive and validated outcome measurements are needed to guide treatment decisions.

Bone Plates↗
PubMed2006

Volar versus dorsal plating in the management of intra-articular distal radius fractures.

PURPOSE: To compare the complications and functional and radiographic outcomes of volar and dorsal plating of intra-articular distal radius fractures. METHODS: This retrospective review included 34 patients found by searching a database of 350 patients treated for distal radius fractures. Inclusion criteria were (1) at least 1 year of follow-up data and (2) open reduction and internal fixation of a multifragmentary fragment intra-articular distal radius fracture with either a nonlocking volar or dorsal plate. Twenty patients were treated with a dorsal plate and 14 patients were treated with a volar nonlocking plate. Objective and subjective outcome parameters were compared between the 2 groups. Objective evaluations included wrist range of motion, grip strength, and preoperative and postoperative radiographic parameters (radial inclination, palmar tilt, ulnar variance, fracture pattern). Subjective evaluations were performed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score and the Gartland and Werley score. RESULTS: Volar plating resulted in a significantly better Gartland-Werley score compared with dorsal plating. There were no significant differences in the DASH score. Volar collapse was documented in 5 of the 20 patients in the dorsal plating group, which resulted in a mild loss of pronation compared with the volar plating group. No collapse occurred in the volar plating group. In addition the difference in the percentage of wrist range of motion compared with the contralateral wrist was not significant. Dorsal plating was associated with a ruptured extensor indicis tendon in 1 patient; secondary surgical procedures were required in 4 patients (tenolyses and radial styloidectomy). Volar plating was associated with median nerve neuropathy in 2 patients and intersection syndrome in one. CONCLUSIONS: Although both groups of patients had similar DASH scores the functional outcome in terms of Gartland and Werley scores was better in the volar plating group. In addition there was a higher rate of volar collapse and late complications in the dorsal plating group compared with the volar plating group. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level III.

Bone Plates↗
PubMed2006

A capsular-based vascularized distal radius graft for proximal pole scaphoid pseudarthrosis.

PURPOSE: To evaluate the clinical results of the application of a capsular-based dorsal distal radius vascularized bone graft in scaphoid proximal pole nonunions. METHODS: Thirteen patients with symptomatic nonunion at the proximal pole of the scaphoid (10 with avascular necrosis) were treated and reviewed retrospectively. The vascularized bone graft was harvested from the distal aspect of the dorsal radius and was attached to a wide distally based strip of the dorsal wrist capsule. It was inserted press-fit into a dorsal trough across the nonunion site after scaphoid fixation with a Herbert screw. RESULTS: After a mean follow-up period of 19 months 10 of the 13 nonunions (8 of the 10 with avascular necrosis) achieved solid bone union. No complications other than the 3 persistent nonunions occurred. CONCLUSIONS: Results of the use of a capsular-based vascularized bone graft from the distal radius for proximal pole scaphoid nonunions compare favorably with the results of pedicled or free vascularized grafts. It is a simple technique that eliminates the need for dissection of small-caliber pedicle or microsurgical anastomoses. No donor site morbidity was observed. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adult↗
PubMedDate not supplied

Volar fixation for dorsally angulated extra-articular fractures of the distal radius: a biomechanical study.

PURPOSE: To compare the biomechanical properties of 10 volar plate-fixation designs in 2 fracture models (dorsal wedge osteotomy, segmental resection osteotomy models). METHODS: Forty-eight radiuses were used in this study including 8 pairs. In 40 specimens a 15-mm dorsally based wedge osteotomy was performed and the volar cortex was fractured manually. They were arranged into 10 fixation groups with 5 different fixation designs (test 1). In the contralateral specimens of 8 paired radiuses a 10-mm segment of bone was excised (test 2). Four of the 10 fixation systems were chosen for these specimens. Cadaver hands and the proximal radiuses were potted in polymethylmethacrylate and tested with a servohydraulic materials testing machine with 300 N of axial compression load at 1 N/s initially and after each 1,000 cycles up to 5,000 cycles. After cyclic loading the specimens were loaded to failure in axial compression at 2 mm/min. The stiffness, failure peak load, and failure mode of each specimen were recorded. RESULTS: In test 1 in the wedge osteotomy specimens the T plate was the stiffest and the Synthes titanium plate was the least stiff; however, all specimens completed the 5,000 cycles of loading with no failures. There was no significant difference between the 10 fixation groups in failure peak load and only 7 of 40 failed at the distal portion of the hardware in the final load to failure testing. In test 2 the resection osteotomy specimens were less stiff and failed at a lower failure peak load compared with the wedge osteotomy specimens. Failure at the distal portion of the fixation system was seen in 7 of 8 specimens; nonlocking screws loosened and tines compressed the surrounding bone, resulting in tine-hole enlargement. CONCLUSIONS: All of the plate-fixation systems delivered sufficient stability to permit the simulated postoperative regimen of 1 week of immobilization followed by 5 weeks of early mobilization until expected union at 6 weeks after surgery. Based on these results a preferable volar fixation system would appear to benefit from the following: (1) sufficient plate strength to support the distal fragment from the volar side, (2) a locking system with sufficient strength to remain locked during the healing process, and (3) a distal design that does not affect the bone adversely. The anatomic reduction of the volar cortex in the wedge osteotomy specimens added stability to the construct.

Adult↗
PubMed2006

The outcome of intra-articular distal radius fractures treated with fragment-specific fixation.

PURPOSE: To assess the clinical, radiographic, and functional outcome of treating intra-articular distal radius fractures with fragment-specific fixation. METHODS: A retrospective review of 81 patients with 85 intra-articular distal radius fractures who were treated with fragment-specific fixation was performed. Minimum time to follow-up evaluation was 1 year, with a mean time of 32 months. The immediate postoperative films were compared with those taken at the final follow-up evaluation. Radiographs of the uninjured wrist were also obtained at the final follow-up evaluation for comparison. Patients were examined for wrist and finger range of motion, deformity, and grip strength, and they completed a standard Disabilities of the Arm, Shoulder, and Hand outcome survey. RESULTS: According to Gartland and Werley scoring there were 61 excellent and 24 good results. Flexion and extension of the surgically treated wrist at the final follow-up evaluation averaged 85% and 91%, respectively, of the uninjured wrist; grip strength averaged 92% compared with the uninjured side. The average Disabilities of the Arm, Shoulder, and Hand outcome score for the injured wrist was 9. Sixty-two percent of patients achieved a 100 degrees arc of flexion and extension and normal forearm rotation by postoperative week 6. Radiographic alignment was maintained between immediate postoperative and final follow-up films, and there were no cases of symptomatic arthritis at the final follow-up evaluation. CONCLUSIONS: Fragment-specific fixation is a reasonable alternative for treating intra-articular fractures of the distal radius. At final follow-up evaluations, patients had good to excellent results with respect to range of motion, grip strength, radiographic alignment, and satisfaction scores. Stable fixation allowed starting active and passive motion of the wrist without compromising postoperative alignment. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Adolescent↗
PubMed2006

Volar versus dorsal locking plates with and without radial styloid locking plates for the fixation of dorsally comminuted distal radius fractures: A biomechanical study in cadavers.

PURPOSE: To compare the stability and stiffness of dorsal and volar fixed-angle distal radius constructs in a cadaveric model. METHODS: A locking distal radius system was used in a combination of a dorsal and styloid plate (group 1), a single volar plate (group 2), and a combination of a volar and styloid plate (group 3) configuration. In addition a single volar 3.5-mm steel locking plate was used in group 4. Each construct was tested on 6 fresh-frozen radii with simulated unstable dorsally comminuted extra-articular distal radius fractures. Specimens were tested on a material testing machine with an extensometer and subjected to axial compression fatigue and load-to-failure testing. RESULTS: No construct failed in fatigue testing of 250 N for 5,000 cycles. Two specimens in each group were tested for 20,000 cycles without failure. The plastic deformation in the double-plate groups was lower compared with the single-plate groups, although the difference was not statistically significant. Group 1 had the highest and group 4 the lowest failure load and stiffness, respectively. The differences between group 1 and the other groups, except failure load compared with group 3, were statistically significant. Groups 2 and 3 had a significantly higher load to failure and group 3 had a significantly higher stiffness compared with group 4. CONCLUSIONS: All constructs offer adequate stability with minimal deformation on fatigue testing under physiologic conditions. Dorsal fixed-angle constructs are stiffer and stronger than volar constructs. The addition of a styloid plate to a volar plate did not significantly improve stability in this model of simulated extra-articular dorsal comminution loaded in axial compression.

Aged↗
PubMed2005

Sagittal wrist motion of carpal bones following intraarticular fractures of the distal radius.

Forty patients (mean age, 37 years) with intraarticular C2 and C3 Colles fractures were treated by open reduction, internal fixation and bone grafting. At a mean follow-up of 8 years radiocarpal and midcarpal motion was evaluated, the depth of the articular surface of the distal radius in the sagittal plane was measured and the presence of arthritis was noted. The fractures healed with a mean palmar tilt of 6 degrees , a mean ulnar tilt of 18 degrees and ulna variance within 1 mm of the contralateral side. The depth of the articular surface of the distal radius was 1.3 mm greater than the uninvolved side. Measurement of carpal bone angles relative to the radius in maximum flexion and extension revealed lunate extension of 23 degrees , lunate flexion of 15 degrees , capitate extension of 62 degrees , capitate flexion of 40 degrees . There was a significant correlation between articular surface depth and radiocarpal motion.

Adolescent↗
PubMed2006

Immediate mobilisation following corrective osteotomy of distal radius malunions with cancellous graft and volar fixed angle plates.

The purpose of the study was to examine the reliability with which a specific technique of corrective osteotomy of malunions of the distal radius combined with early mobilisation could both restore the normal anatomic parameters of the radius and achieve a functional range of motion with good strength. Corrective osteotomy of the distal radius was performed through a volar approach using a fixed angle volar plate and cancellous bone graft from the iliac crest in 19 patients of mean age 50 years with initial malunions with a mean dorsal tilt of 36 degrees and 7 mm of ulnar variance. An immediate mobilisation programme was started. All healed at a mean of less than 12 weeks (including two heavy smoking patients who required repeat cancellous bone grafting to achieve final union) to achieve a total arc of wrist motion around 120 degrees, forearm rotation of 158 degrees and grip strength which was 80% of contralateral. This treatment strategy was judged to be straightforward and effective.

Adult↗
PubMed2005

Accuracy and precision of radiostereometric analysis in the measurement of three-dimensional micromotion in a fracture model of the distal radius.

The purpose of the current study was to verify the feasibility of radiostereometric analysis (RSA) in monitoring three-dimensional fracture micromotion in fractures of the distal radius. The experimental set-up consisted of a simulated model of an extra-articular Colles' fracture, including metallic beads inserted into the bone on either side of the fracture site. The model was rigidly fixed to high precision micrometer stages allowing controlled translation in three axes and rotation about the longitudinal and transverse axes. The whole construct was placed inside a RSA calibration cage with two perpendicular radiographic film cassettes. Accuracy was calculated as the 95% prediction intervals from the regression analyses between the micromotion measured by RSA and actual displacements measured by micrometers. Precision was determined as the standard deviation of five repeated measurements of a 200 microm displacement or a 0.5 degrees rotation along a specific axis. Translations from 25 microm to 5mm were measured with an accuracy of +/-6 microm and translations of 200 microm were measured with a precision of 2-6 microm. Rotations ranging from 1/6 degrees to 2 degrees were measured with an accuracy of +/-0.073 degrees and rotations of 1/2 degrees were measured with a precision of 0.025 degrees -0.096 degrees . The number of markers and their configuration had greater impact on the accuracy and precision of rotation than on those of translation. Aside from the unknown rate of clinical marker loosening, the current results favor the use of at least four markers in each bone fragment in distal radius fractures. These results suggest a strong rationale for the use of RSA as an objective tool for comparing different treatment modalities and novel bone graft substitutes aimed at stabilization of fractures of the distal radius.

Humans↗
PubMed2000

Principles of external fixation and supplementary techniques in distal radius fractures.

External fixation for fractures of the distal radius has been used for almost 80 years. The main objective is to gain reduction and maintain the reduction throughout the treatment period. Several fixator concepts are available and selection is based on the complexity of the injury to be treated as well as the surgeon's experience. Periarticular application of the fixator with immediate use of the wrist joint is recommended whenever possible. For intra-articular fractures, transarticular application is advisable. External fixtion in complex fractures has to be supplemented by bone grafting, fixation wires and stabilization of the radioulnar joint. Associated injuries in distal radius fractures need to be identified and treated. The possible complications of external fixation and the means to prevent them are discussed. External fixation of the distal radius has found its place as an established method in treating certain types of this common fracture.

Adolescent↗
PubMed2002

Characterization of dynamic three-dimensional strain fields in the canine radius.

This note describes a method to approximate the 3-D mechanical environment of a long bone during a normal daily activity. Our specific goal was to characterize the temporal and spatial strain distributions in the mid-shaft region of the canine radius during gait. Direct measurement of strains along the entire surface of in vivo bone is not feasible, so we employed a combination of experimental measurements and numerical interpolation techniques to approximate the time-varying longitudinal strain distribution. Using standard in vivo strain gauging techniques, we measured dynamic strains at nine locations (three locations on each of three cross sections, data pooled from two experimental animals) on the canine radius during trotting gait. These in vivo strain measurements were then used to approximate the time course of the strain field for the entire radius mid-shaft region using a 3-D numerical interpolation scheme using finite element basis functions. Despite limitations in the present implementation of the method, the results show that there are considerable time-dependent variations in the strain distribution occurring at different transverse sections along the length of the diaphysis with substantial anteroposterior bending and rotation of neutral axis locations during the gait cycle.

Activities of Daily Living↗
PubMed1999

Load transfer analysis of the distal radius from in-vivo high-resolution CT-imaging.

Prevention of osteoporotic bone fractures requires accurate diagnostic methods to detect the increase in bone fragility at an early stage of osteoporosis. However, today's bone fracture risk prediction, primarily based on bone density measurement, is not sufficiently precise. There is increasing evidence that, in addition to bone density, also the bone microarchitecture and its mechanical loading conditions are important factors determining the fracture risk. Recently, it has been shown that new high-resolution imaging techniques in combination with new computer modeling techniques based on the finite-element (FE) method can account for these additional factors. These techniques might provide information that is more relevant for the prediction of bone fracture risk. So far, however, these new imaged-based FE techniques have not been feasible in-vivo. The objectives of this study were to quantify the load transfer through the trabecular network in a distal radius using a computer model based on in-vivo high-resolution images and to determine if common regions of fractures can be explained as a result of high tissue loading in these regions. The left distal radius and the two adjacent carpal bones of a healthy volunteer were imaged using a high-resolution three-dimensional CT system providing an isotropic resolution of 165 microm. The bone representation was converted into a FE-model that was used to calculate stresses and strains in the trabecular network. The two carpal bones were loaded using different load ratios (for each load case 1000 N in total) representing impact forces on the hand either in near-neutral position or ulnar/radial deviation. The load transfer through the trabecular network of the radius was characterized by the tissue strain energy density (SED) distribution for all load cases. It was found that the distribution of the tissue loading depends on the ratio of the forces acting on the carpal bones. For all load cases the higher SED values (on average: 0.02 +/- 0.08 (S.D.) N mm(-2)) are found in a 10 mm region adjacent to the articular surface which corresponds well with the region where Colles- or Chauffeur-fractures occur. We expect that, eventually, this new approach can lead to a better prediction of the fracture risk than methods based on bone density alone since it accounts for the bone microstructure as well as its loading conditions.

Carpal Bones↗
PubMed2001

Treating fractures of the distal radius with arthroscopic assistance.

The role and technique of arthroscopy when used in the treatment of fractures of he distal radius are reviewed. Arthroscopy, if properly modified, assists in the evaluation and reduction of displaced intra-articular fractures of the distal radius in treating associated injuries within the carpus. Technical details important to the successful use of this technique are discussed. Favorable outcomes have been reported after the use of this technique for the reduction of displaced intra-articular fractures of the distal radius.

Arthroscopy↗
PubMed2004

[Distal radius anterior marginal fractures treated with anterior plating. Mid-term results].

PURPOSE OF THE STUDY: We report a retrospective series of anterior marginal fractures of the distal radius treated by anterior plating in order to analyze results and identify prognostic factors. MATERIAL AND METHODS: This continuous series included 22 patients with an anterior marginal fracture of the distal radius treated between 1993 and 1999. Three patients were lost to follow-up. This analysis thus concerned 19 fractures in 15 men and 4 women, mean age 39 years. Surgical reduction and T-plate anterior fixation was used in all cases. RESULTS: Mean follow-up was 26 months. Anatomic results were satisfactory in 15 patients and poor in one. Function was satisfactory in 17 patients and poor in one. We noted two types of complication: spontaneously regressive reflex dystrophy (n=2) and osteoarthritis which developed in two patients after incomplete reduction. DISCUSSION: Anterior plating can provide satisfactory results for anterior marginal fractures of the distal radius if anatomic reduction is achieved. This method remains our preferred therapeutic approach with special attention being required for anatomic reduction.

Adolescent↗
PubMed2006

[Plate fixation with locking screw for distal fractures of the radius].

PURPOSE OF THE STUDY: Fractures of the distal radius are common. No one implant has demonstrated superior efficacy in terms of maintaining the reduction over time. We report our experience with plate fixation using a locking screw. MATERIAL AND METHODS: Between September 2003 and June 2004, 67 displaced fractures of the distal radius were treated by plate fixation using the LCP-DRP 2.4 (Synthès). Three different plates (anterior, posterior, and external) were used. The patients wore a removable anatomic brace for three weeks. Self-controlled rehabilitation exercises began directly after surgery with mobilization of the digital chains. The Fernandez, Castaing and AO classifications were noted. Ulnar variance, anteversion of the radial glenoid, radial slope and the alpha angle were measured intraoperatively and at last follow-up to assess maintenance of reduction over time. The DASH test and Green and O'Brien and PRWE scores were used to assess clinical outcome. RESULTS: Mean follow-up was eight months. Mean age was 55.8 years. Eight patients were lost to follow-up. The analysis included 59 patients who could respond to the questionnaires. Bone healing was achieved at six weeks. There were no cases of secondary displacement nor loss of reduction. The Green and O'Brien score was good or very good for 85%. The mean DASH was 20.6 and the mean PRWE 32.8. DISCUSSION: The appropriate fixation method for distal fractures of the radius remains a controversial issue, leading to a variety of materials and fixation methods. Primary stability achieved with the locking screw in a plate enables early mobilization associated with more rapid recovery of function. The absence of secondary displacement, irrespective of the quality of the underlying bone enabled us to achieve equivalent results in young patients and older patients with osteoporotic bone. This study also confirmed the preference for the anterior approach, irrespective of the direction of the displacement. To date, no other material has enabled equivalent results. This is a major achievement in terms of fixation stability.

Adult↗
PubMed2003

Palmar plate fixation of AO type C2 fracture of distal radius using a locking compression plate--a biomechanical study in a cadaveric model.

The stability of palmar plate fixation using a locking compression T-plate was compared with that of a conventional palmar T-plate and a dorsal T-plate in a cadaveric model of an AO type C2 fracture of distal radius. The wrist axial load transmission through the radius was tested for each fixation. The results show that, under 100N axial load, the palmar locking compression T-plate restores stability comparable to that of the intact radius, and is superior to conventional palmar or dorsal T-plates.

Biomechanical Phenomena↗
PubMed1997

Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients.

We examined the frequency of associated chondral and ligament lesions in distal fractures of the radius in young adults (men 20-60 years, women 20-50 years). Fifty initially displaced fractures were examined arthroscopically. Chondral lesions were found in 16 patients (32%). All patients but one were found to have a ligamentous injury in the wrist. No major instability was found. The most frequent ligament tear was the triangular fibrocartilage complex in 39 cases (78%), with a statistical correlation to ulnar styloid fractures. The scapholunate ligament was partially or totally torn in 27 cases (54%). No correlation was found between specific fracture type and pattern of ligament injury. Chondral and ligamentous lesions were frequent and may explain poor outcomes after seemingly well-healed distal fractures of the radius. The ligament lesions should also be kept in mind when early mobilization of the distal fracture of the radius is considered.

Adult↗