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PubMed1985

Corrective osteotomy of malunited fractures of the distal end of the radius.

Thirty-nine patients with painful impaired forearm rotation and reduced grip strength after malunited fracture of the distal radius were treated with corrective osteotomy of the distal radius, bone grafting and internal fixation and followed for an average of 1.5 years. All patients stated that they were improved by the procedure. At follow-up 36 patients were graded as excellent or good, implying no pain, moderate limitation of motion and grip strength not less than 70% of the uninjured hand. Two patients were graded as fair and one as poor. It is concluded that surgical correction of the deformity is a good procedure when treating disabilities in the distal radio ulnar joint following malunited fractures of the distal end of the radius.

Adult↗
PubMed1982

Incidence of fractures on the distal radius and proximal femur: comparison of patients in a mental hospital and the general population.

A statistically significant increase in the incidence of fractures of the distal radius was found in the general population of southern Sweden during recent decades. As regards fractures of the proximal femur, an increase in the incidence of trochanteric fractures was observed only in women. In male patients at a mental hospital the fracture rate of the distal radius was the same as in the general population but the fracture rate of the proximal femur was about twelve times higher. In female patients at the same mental hospital the fracture rate of the distal radius was three times greater and that of proximal femur about seven times greater than that of the general population. This difference may not only be due to an increased skeletal fragility in patients in mental institutions but may also suggest poorer protective mechanisms against falls. Undiagnosed cardiovascular or neurological diseases, for example intermittent cardiac arrhythmia or transient cerebral ischaemic attacks, may cause falls. Early diagnosis and treatment of such diseases may reduce the number of fractures of the proximal femur.

Adult↗
PubMed1990

Cast or external fixation for fracture of the distal radius. A prospective study of 126 cases.

In a prospective 4-year study, 126 consecutive patients with a fracture of the distal radius were followed. Functional, anatomic, and radiographic final results of fixation with above-the-elbow cast immobilization were compared with the results obtained with external fixation. The results following external fixation of comminuted intraarticular fractures were better than those of similar fractures treated in a cast. Aged osteoporotic patients tolerated better residual deformities, and the clinical results had a relatively low correlation with the final anatomic alignment. We suggest that extraarticular fractures of the distal radius should be treated with cast immobilization. Comminuted intraarticular fractures of the distal radius should be treated with external fixation, which maintains accurate anatomic position until solid fracture healing is achieved.

Adult↗
PubMed2005

Fractal analysis of bone architecture at distal radius.

Bone strength depends on bone quality (architecture, turnover, damage accumulation, and mineralization) as well as bone mass. In this study, human bone architecture was analyzed using fractal image analysis, and the clinical relevance of this method was evaluated. The subjects were 12 healthy female controls and 16 female patients suspected of having osteoporosis (age range, 22-70 years; mean age, 49.1 years). High-resolution CT images of the distal radius were acquired and analyzed using a peripheral quantitative computed tomography (pQCT) system. On the same day, bone mineral densities of the lumbar spine (L-BMD), proximal femur (F-BMD), and distal radius (R-BMD) were measured by dual-energy X-ray absorptiometry (DXA). We examined the correlation between the fractal dimension and six bone mass indices. Subjects diagnosed with osteopenia or osteoporosis were divided into two groups (with and without vertebral fracture), and we compared measured values between these two groups. The fractal dimension correlated most closely with L-BMD (r=0.744). The coefficient of correlation between the fractal dimension and L-BMD was very similar to the coefficient of correlation between L-BMD and F-BMD (r=0.783) and the coefficient of correlation between L-BMD and R-BMD (r=0.742). The fractal dimension was the only measured value that differed significantly between both the osteopenic and the osteoporotic subjects with and without vertebral fracture. The present results suggest that the fractal dimension of the distal radius can be reliably used as a bone strength index that reflects bone architecture as well as bone mass.

Absorptiometry, Photon↗
PubMed1976

[A new technic for the correction of malunited distal radius fractures].

After malunited fractures of the distal radius the original anatomy of the wrist joint can be restored only by osteotomy of the radius and interposition of a cortico-cancellous bone block. This procedure has been shown to be much easier using a new bone plate for internal fixation. The plate is applied to the radius volarly through a radio-volar approach. The correcting angles can be adjusted easily. The stable osteosynthesis allows early postoperative motion. In cases of osteoarthritic changes the procedure may be combined with a denervation of the wrist joint (A. WILHELM).

Bone Plates↗
PubMed1999

[The importance of the distal radioulnar joint for reconstructive procedures in malunited distal radius fracture].

Clinically most patients complain about ulnar sided wrist pain and limited forearm rotation following malunited distal radius fractures. Possible bony reasons consist of intraarticular incongruency, malalignment of the sigmoid notch of the distal radius or the ulna-plus-situation at the wrist level. A persisting luxation of the distal radioulnar joint (DRUJ) will present itself with complete loss of forearm rotation. The ligamentous or bony detachment of the triangular fibrocartilage complex (TFCC) will lead to instability of the DRUJ. Uncorrected, each of these components will lead to arthrosis of the DRUJ. The presence of arthrosis only allows salvage procedures for the DRUJ and will lead to functional loss. Reconstructive options consist of radius correction osteotomy, ulnar shortening osteotomy, reposition of a luxation and refixation of the TFCC. To chose the necessary reconstructive procedure, the individual pathological situation has to be analysed.

Fractures, Malunited↗
PubMed1999

[Postero-medial elastic stable intramedullary nailing for anteriorly displaced distal diaphyso-metaphyseal fractures of the radius in children].

PURPOSE: To suggest a mechanically satisfying method to stabilize the unfrequent distal diaphyso-metaphyseal fractures of the radius, when they are anteriorly displaced, avoiding the classical use of an anterior osteosynthesis by plate and screws. MATERIAL AND METHODS: Ten cases of postero medial Elastic Stable Intramedullary Nailing are presented. Technically, a small postero medial approach with gentle retraction of extensors tendons is used. Then a hole is drilled through the postero medial metaphysis of the distal radius. A present wire is introduced intramedullary, directing its elastic forces in a postero lateral way, fighting against the displacement. DISCUSSION: The instability of this fracture often requires an osteosynthesis. Plating needs a larger incision and a direct control of the fracture (danger of injure of the growth plate, scar). Retrograd nailing through the proximal end of the bone can injure nerves. Then, postero medial Elastic Stable Intramedullary Nailing can be useful for stabilization of the diaphysometaphyseal fractures of the radius.

Adolescent↗
PubMedDate not supplied

Distal radius fracture in adults: self-reported physical functioning, role functioning, and meaning of injury.

PURPOSE: To identify physical function, role function, and meaning of injury in adults with a distal radius fracture. SAMPLE: Convenience sample of 60 adults with an isolated distal radius fracture. METHOD: Repeated measures of analysis of variance were used to test the relationship of gender, age, education, hand dominance, preinjury physical health, and treatment modality to physical function, role function, and meaning of illness/injury. The independent variable is time and the dependent variables are physical function, role function, and meaning of illness/injury. FINDINGS: Although improvement occurred with time, older adults had significantly lower physical functioning than younger adults while their wrist was immobilized, and middle-age adults had significantly lower role functioning compared to younger and older adults. Physical function was influenced by age, and role function was influenced by both age and education. CONCLUSION: The identified need for additional guidance and physical and emotional support with the standard treatment of distal radius fractures highlights the need for nursing care during the early recovery period.

Activities of Daily Living↗
PubMed2001

[Complex fractures of the proximal end of the radius and ulna in adults: a retrospective study of 38 cases].

PURPOSE OF THE STUDY: Complex lesions of the proximal end of the radius and ulna are uncommon and generally associate a fracture of the proximal ulna and a dislocation of the radial head, which also may be fractured. We assessed the effect of the type of fracture and treatment on functional outcome and complications. MATERIAL AND METHODS: Thirty-eight adults (25 men and 13 women) were treated for complex fractures of the proximal end of the radius and ulna. For 25 of them, mean follow-up was 2.4 years. For the ulna, there was an epiphyseal fracture in 10 cases, a metaphyseal-epiphyseal fracture in 16 and a diaphyseal fracture in 12. The coronoid process was fractured in 20 cases and the proximal radius in 19. There was an anterior displacement in 24 cases. There were 9 open fractures and 13 patients had another injury of the upper limb. Functional outcome was assessed with a 100 point scale using subjective (pain) and objective (active motion, muscle force, stability) criteria. RESULTS: For the 25 fractures with more than 1 year follow-up, outcome was very good in 8, good in 6, fair in 8 and poor in 3. The pain and muscle force scores followed a similar pattern. Motion appeared as the determining factor for good outcome. Seven early revisions (2 for deep infections, 2 for disassembly of the fixation system, 3 for insufficient fixation) were required among the 38 patients. Among the late complications, there were 3 nonunions, 5 misalignments, and 4 proximal radio-ulnar synostoses. Six elbows required revision to restore motion. DISCUSSION: Certain characteristics of the fractures were predictive of poor outcome: skin opening, association with a lesion of the homolateral upper limb, mirror lesion of the lateral condyle, metaphyseal-epiphyseal fractures, communitive fractures, presence of a fracture of the radial head or the coronoid process. CONCLUSION: Complex proximal fractures of both bones of the forearm threaten the functional prognosis of the upper limb due to the risk of stiffness. Successful treatment depends on three factors: stable anatomic reconstruction of the ulnar articulation, and reconstruction of the lateral column and the coronoid process, necessary for a stable elbow. In addition, early mobilization, possible with a stable osteosynthesis, is indispensable for recovering useful joint movement.

Adolescent↗
PubMed2002

[Using unstable fractures of the distal end of the radius: open reduction and internal fixation with T - type plate].

OBJECTIVE: To treat unstable fractures of the distal end of the radius with open reduction and internal fixation with T-type plate. METHODS: 45 patients were treated with T-type plate. Bone graft was used in fifteen patients with severe bone defect. Clinical findings of 45 patients with fractures of the distal end of the radius (one is bilateral fractures) showed fairly good results. RESULTS: The patients were followed up for an average period of 25.36 months. 41 patients showed excellent or good results with a rate of 91.11%. CONCLUSION: It is difficult to reduce unstable fracture of the distal end of the radius in the way of close reduction. Re-displacement is frequent for external fixation and is not reliable in maintaining reduction. These fractures should be treated with early open reduction and internal fixation, and reasonable exercise should be taken after the operation. Good results can be predicted. The most important factors affecting final outcome include radial shortening and reduction of articular surface.

Adolescent↗
PubMed1999

[Observation of reconstruction of wrist joint by replacement of distal end of radius with vascularized fibular head].

OBJECTIVE: This paper is aimed to observe the long-term result of reconstruction of wrist joint by replacing distal end of radius with vascularized fibular head in patient of giant tumor. METHODS: From July 1978 to November 1993, 12 cases of giant tumor of distal end of radius were treated by this procedure and followed up for 6 months to 15 years, and the movement range of wrist, grip strength, and pain were evaluated. RESULTS: The painful wrist released in 11 cases, only one case still existed mild pain and felt discomfortable. The average range of movement of wrist joint was 34.05 degree in volar flexion, 52.80 degree in dorsal extension, 26.25 degree in ulnar deviation, and 19.75 degree in radial deviation, and average grip strength was 44.6 kg. Compared with the contralateral side, there were accounted for 46.2%, 72.7%, 76.1%, 80.6%, and 76.7% respectively. CONCLUSION: Replacement of distal end of radius with fibular head to reconstruct wrist joint can restore function of carpal joint, which is proved to be a safe and effective method.

Adult↗
PubMed2002

[Juxtacortical osteosarcoma of the radius in a child].

The authors report a rare case of juxtacortical osteosarcoma of the radius in a child. The diagnosis and treatment were delayed because of misleading and wrongly reassuring radiological and histological aspects. The 12-year-old boy was admitted for a tumefaction of the proximal extremity of the right radius noticed after trauma. Physical examination showed a hard and slightly painful swelling. Xrays showed an irregular osseous mass developed from the superior metaphysis of the radius and encircling it. MRI showed a juxtacortical tumor with medullary involvement. A biopsy concluded to a fracture callus. Ten months later, the tumor became painful and homogeneous, regular and well defined on Xrays. A repeat biopsy showed juxtacortical osteosarcoma. Enbloc resection of the tumor was done. After a follow-up of 2 years, the child is alive without recurrence and metastasis and with a satisfactory function of the upper limb.

Biopsy↗
PubMed2002

Distal radius bone mineral density and grip strength in peri/postmenopausal Thai women.

To determine the relationship between distal radius bone mineral density (BMD) and grip strength (GS) in peri/post menopausal Thai women. 177 healthy volunteers, > or = 40 years old, were included. Distal radius BMD of the non-dominant side was measured using dual energy X-ray absorptiometry. GS of both dominant and non-dominant sides was measured using a Jamar dynamometer. The association between BMD and GS was determined by correlation analysis. Other factors possibly affecting the BMD or GS including age, years since menopause (YSM), body weight (BW), height (Ht) and body mass index (BMI) were analyzed by the multiple regression method. It was found that BMD had statistically significant but weak, positive correlation to GS (r = 0.262, p < 0.001 for the dominant side, r = 0.193, p < 0.001 for non-dominant side). Age and YSM had a negative correlation, whereas, BW and Ht had a positive correlation to either BMD or GS. After multiple regression analysis, the significant predictors of BMD were age and BW, of dominant GS were age and Ht, and of non-dominant GS was YSM. In conclusion, decrements in distal radius BMD and in GS were found in peri/postmenopausal women. Aging seems to be the most important factor for these features. Although the GS has statistically significant correlation to the corresponding BMD, the clinical significance might not be obvious. Furthermore, the stronger correlation of BMD to the contralateral dominant GS than to the ipsilateral non-dominant GS implies that the influence of muscular strength on BMD, if present, is not due to a direct effect in this age group.

Adult↗
PubMed2002

[Treatment of childhood unstable radius distal methaphysis fractures with closed reduction and percutaneous Kirschner wires].

OBJECTIVES: We evaluated the results of treatment with closed reduction and percutaneous Kirschner wires in childhood unstable radius distal methaphysis fractures. METHODS: Forty-four fractures of radius distal methaphysis of 43 children (33 boys, 10 girls; mean age 11.7 years; range 8.6 to 16 years) were treated with immediate closed reduction and percutaneous Kirschner wires. Fractures with more than 50% displacement were considered unstable. A satisfactory reduction was defined as the presence of 80% cortical contact on anteroposterior and lateral x-rays, an angulation of less than 20 degrees and 15 degrees at ages below and over 10 years, respectively, and the absence of malrotation. Clinically, the range of motion of the elbow and wrist, forearm rotation, and grip strength were measured and compared with those of the other side in the 12th postoperative week. A restriction of 10 degrees or more in relation to the other side was regarded as failure. Radiologic indications of failure in the postoperative sixth week were residual angulations of more than 15 degrees and 10 degrees at ages below and above 10 years, respectively, and malrotation. RESULTS: Forty-one patients (93.2%) achieved a successful outcome. Failure was encountered in three patients (6.8%). Two patients developed type 1 pin tract infection, which resolved with antibiotic therapy and wound care. Patients returned to their normal activities in a mean of 10 weeks. CONCLUSION: Closed reduction and the use of percutaneous Kirschner wires proved to be the choice of treatment in unstable radius distal methaphysis fractures in children.

Adolescent↗
PubMed2002

[Vitamin C and prevention of reflex sympathetic dystrophy following surgical management of distal radius fractures].

Reflex sympathetic dystrophy is a major complication following surgical treatment of fractures of the distal radius. Its pathogenesis is related to lipid peroxidation which damages vascular endothelial cells, increasing capillary permeability. Vitamin C is a natural antioxidant. The authors have made a comparative study of two groups of patients with isolated closed displaced fractures of the distal radius, which were reduced and stabilized by intrafocal pinning. Group 1 included 100 patients who were treated from 1995 until 1998 and who did not receive any vitamin C supplementation; group 2 included 95 patients who were treated from 1999 to 2002 and who received daily administration of one gram vitamin C orally during 45 days, starting on the day of fracture. The incidence of reflex sympathetic dystrophy was five time times lower in group 2 (2.1% versus 10%). This is in line with previous observations and lends credit to the value of vitamin C administration as a prophylactic measure to prevent the occurrence of reflex sympathetic dystrophy in patients who undergo surgical treatment of a displaced fracture of the distal radius.

Adolescent↗
PubMed2003

Repair of radius defect with bone-morphogenetic-protein loaded hydroxyapatite/collagen-poly(L-lactic acid) composite.

OBJECTIVE: To explore the method to repair bone defect with bone-morphogenetic-protein loaded hydroxyapatite/collagen-poly(L-lactic acid) composite. METHODS: 18 adult beagle dogs were randomly divided into 3 groups. In Group A, bone-morphogenetic-protein (BMP) loaded hydroxyapatite/collagen-poly(L-lactic acid) (HAC-PLA) scaffold was implanted in a 2 cm diaphyseal defect in the radius. In Group B, unloaded pure HAC-PLA scaffold was implanted in the defects. No material was implanted in Group C (control group). The dogs were sacrificed 6 months postoperatively. Features of biocompatibility, biodegradability and osteoinduction were evaluated with histological, radiological examinations and bone mineral density (BMD) measurements. RESULTS: In Group A, the radius defect healed after the treatment with BMP loaded HAC-PLA. BMD at the site of the defect was higher than that of the contralateral radius. Fibrous union developed in the animals of the control group. CONCLUSIONS: BMP not only promotes osteogenesis but also accelerates degradation of the biomaterials. Optimized design parameters of a three-dimensional porous biomaterial would give full scope to the role of BMP as an osteoinductive growth factor.

Animals↗
PubMed2003

Palmar tilt changes due to distal radius fractures and radiocarpal instability: a biomechanical study.

OBJECTIVE: To investigate the impact of dorsally angulated malunited distal radius fractures on the stability of the radiocarpal joint. METHODS: Eight fresh upper limb specimens from 4 human cadavers were obtained, in which radial osteotomy was performed to prepare models of Frykman I distal radius fracture. Pressure-sensitive film was applied to study the changes in the contact area distribution and the pressure load across the radiocarpal joint in response to palmar tilt variation, and the lateral radiograph of the wrist was taken at the end of pressure loading. RESULTS: When the dorsal tilt exceeded 10 degrees, the radioscaphoid and radiolunate articular contact areas were markedly decreased (P<0.01) and shifted to the dorsal aspect of the radiocarpal joint, where the pressure load was significantly increased (P<0.01). A dorsal radiocarpal subluxation was liable to occur on the sagittal plane when the dorsal tilt exceeded 40 degrees. CONCLUSION: A dorsal tilt over 10 degrees is the most primary cause of radiocarpal instability after a dorsal deformity due to distal radius fractures.

Adult↗