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Results for “RADIUS FRACTURES”

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At least 55 records · Page 3Linked to original sources
PubMed2005

Carpal canal pressures after volar plating of distal radius fractures.

Elevated pressures within the carpal canal are known to occur after distal radius fractures. Controversy exists regarding prophylactic carpal tunnel release after open reduction with internal fixation of distal radius fractures. The purpose of this study was to determine the tissue pressures within the carpal canal after volar plating of distal radius fractures. This study was a prospective, observational, IRB approved research study. Ten consecutive patients undergoing volar plating of distal radius fractures were enrolled. After the distal radius fractures were reduced and fixed with volar plates, slit catheters were inserted into the carpal canals for continuous postoperative pressure monitoring for 24 hours. The maximum recorded pressure was 65 mmHg, which occurred in the only patient with fracture blisters. Peak pressures remained at 40 mmHg or less (range 16-40, mean 29) in all patients without fracture blisters. At the conclusion of data collection, all pressures were at 31 mmHg or less. No patient complained of median nerve dysfunction during the study period. Routine prophylactic carpal tunnel release is not recommended after volar plating of distal radius fractures based on these pressure recordings.

Adult↗
PubMed2004

Nonunion of distal radius fractures.

Nonunion of a distal radius fracture is extremely uncommon. Healing problems in the distal radius seem to be related to unstable situations, such as concomitant fracture of the distal radius and ulna, and to an inadequate period of immobilization. Nonunion should be suspected if there is continuing pain after remobilization of the wrist in combination with a progressing deformity. The diagnosis may be confirmed by showing movement at the fracture site on lateral radiographs of the wrist in flexion and extension. Because of the rarity of distal radius fracture nonunion, it is not surprising that there is no consensus on the optimum mode of operative treatment. Based on our experience with reconstruction surgery in 23 patients, we think that most nonunions of the distal radius are amenable to attempts to re-align and heal the fracture even when the distal fragment is small. Therefore, surgeons should try to preserve even a small amount of wrist motion and reserve wrist fusion as a final resort.

Female↗
PubMed2004

Treatment of osteoporotic distal radius fractures.

Fracture of distal radius is most commonly an injury of the fit osteoporotic patient. As the population and health of older individuals continue to expand, osteoporotic distal radius fractures will become increasingly common. While many older patients have limited functional demands and can accept some deformity and wrist dysfunction, others remain very active into older age and desire optimal wrist alignment and function. The difficulty obtaining reliable fixation in osteoporotic bone presents a challenge to the surgeon that has been partially addressed by newer implants with screws that directly engage the plate, creating fixed angle bolts that have better fixation in osteoporotic bone. Decision-making is based upon a balance of the goals of the individual patient with the risks of intervention.

Aged↗
PubMed2002

[Acute carpal tunnel syndrome after distal radius fractures--long term results of surgical treatment with decompression and external fixator application].

Acute Carpal Tunnel Syndrome (ACTS) is a relatively rare sequel of distal fractures of the radius. This paper is an analysis of the causes of ACTS and of long-term results of treatment by surgical decompression combined with use of external fixators. Out of 128 patients with distal radius fractures treated in our department 11 cases required surgical treatment because of ACTS. Fractures were classified according to the AO classification as C2 and C3. CTSA was diagnosed basing on typical clinical signs: pain numbness over the radial three and a half fingers. All patients were treated surgically by reduction of the fracture, external fixation and decompression of the median nerve, all performed simultaneously. The results were assessed within 11 months (on average) postoperatively. It was found that ACTS depends on the severity of the fracture (comminuted, dislocated) and on method of treatment (local anaesthesia, multiple reductions, Cotton-Loder position). Long term results: pain was absent the two-point discrimination test was within norm, light sensation was within norm in 9 cases and slightly decreased in 2 cases. There were no positive Phalen tests and no Tinel signs. Grip strength raged from 17 to 120 kg (mean: 38 kg). According to Gartland-werley classification 5 excellent, 3 good, and 3 acceptable results were obtained. This indicates that early recognition and prompt treatment by surgical decompression and external fixation results in significant improvement of symptoms and prevents persistence of symptoms.

Acute Disease↗
PubMed2005

Treatment of distal radius fractures with intrafocal (kapandji) pinning and supplemental skeletal stabilization.

The technique of intrafocal pinning was originally described by Kapandji. This technique, along with the addition of supplemental external or internal bridging fixation, can be performed quickly with minimal soft tissue damage. This technique is indicated for the treatment of unstable extra-articular or minimally displaced intra-articular fractures of the distal radius. Studies demonstrate that young patients with displaced extra-articular distal radius fractures and minimal comminution can be treated by percutaneous intrafocal pin fixation alone, whereas, patients over 55 years of age and younger patients with comminution involving two or more surfaces of the radial metaphysis (or > 50% of the metaphyseal diameter) require bridging fixation besides percutaneous pin fixation. The use of this technique achieves the goal of surgical treatment of distal radius fractures: restoration of hand and wrist function through the restoration of alignment and articular surface congruity.

Bone Nails↗
PubMed1996

[Carpal ligament lesions associated with fresh distal radius fractures: arthroscopic study of 54 cases].

AIM: Intracarpal ligamentous tears and fractures of the distal radius may have a similar injury mechanism. We performed arthroscopy of the wrist in 54 patients with distal radius fracture to find out the frequency of associated ligamentous tears. RESULTS: 41% of the patients with an extraarticular fracture of the distal radius had at least one severe ligamentous tear of a carpal ligament. In the group of patients with intraarticular fracture we detected ligamentous tears even in 89%. Most frequent were tears of the lunotriquetral ligament. DISCUSSION: Associated ligamentous tears are more common than expected. These tears may be of importance in the outcome of treatment of distal radius fractures.

Adolescent↗
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↗
PubMed1999

Treatment of unstable distal radius fractures with cancellous allograft and external fixation.

Unstable fractures of the distal radius continue to pose a challenge to the hand surgeon. Adjunctive bone grafting is often required to augment structural integrity and aid healing. Because of the risks inherent to bone autograft harvest, however, freeze-dried, irradiated cancellous bone allograft has been used to treat unstable distal radius fractures with severe metaphyseal comminution. Seventeen patients with such fractures (mean age, 70 years; 2 males and 15 females) were treated with bone allograft and external fixation with or without internal fixation. The outcome was evaluated using the modified Mayo wrist score, demonstrating 3 excellent, 8 good, 6 fair, and no poor results on follow-up examination (mean follow-up period, 23 months; range, 7-43 months). The patients were requested to return for follow-up review between 1997 and 1998. These results show that cancellous bone allograft is a useful adjunct to external fixation in the treatment of unstable distal radius fractures.

Aged↗
PubMedDate not supplied

Forearm and distal radius fractures in children.

Pediatric forearm and distal radius fractures are common injuries. Resultant deformities are usually a product of indirect trauma involving angular loading combined with rotational displacement. Fractures are classified by location, completeness, angular and rotational deformity, and fragment displacement. Successful outcomes are based on restoration of adequate pronation and supination and, to a lesser degree, acceptable cosmesis. When several important concepts are kept in mind, these goals are usually met with conservative treatment by reduction and immobilization. Greenstick fractures are reduced by rotating the forearm such that the palm is directed toward the fracture apex. Complete fractures are manipulated and reduced with traction and rotation; extremities are then immobilized in well-molded plaster casts until healing, which usually takes about 6 weeks. Radiographs should be obtained between 1 and 2 weeks after initial reduction to detect early angulation. In fractures in any level in children less than 9 years of age, complete displacement, 15 degrees of angulation, and 45 degrees of malrotation are acceptable. In children 9 years of age or older, 30 degrees of malrotation is acceptable, with 10 degrees of angulation for proximal fractures and 15 degrees for more distal fractures. Complete bayonet apposition is acceptable, especially for distal radius fractures, as long as angulation does not exceed 20 degrees and 2 years of growth remains. Operative intervention is used when the fracture is open and when acceptable alignment cannot be achieved or maintained. Single-bone intramedullary fixation has proven useful.

Anesthesia↗
PubMed1996

[Algodystrophy after distal radius fractures].

Algodystrophy is a severe complication of distal radius fractures; its incidence balances from 0.02% to 37% reported from various papers. In order to ascertain its incidence and clinical picture, the following features in 100 patients 2-4 months after distal radius fracture were examined: pain in the hand, swelling, vasomotor and sudomotor instability, stiffness, trophic changes, shoulder complaints and changes on X-ray picture; the presence and intensity of each feature were noticed. There were 87 female and 13 male patients, aged from 36 to 88 years (average 60.6 years) in the group; 79% of patients complained of pain in affected hand (spontaneous or after loading) and 20% complained of pain and limitation of movement in the shoulder joint. Algodystrophy, diagnosed by the presence of at least 4 strongly expressed features was noted in 14% of patients. The syndrome developed more frequently in women than in men, in patients with displaced and manipulated fractures (particularly with fragmentation of the epiphysis) and in individuals wit poorly reduced fractures. The most specific for algodystrophy features were: deficiency of finger flexion greater than 3 cm, severe spontaneous pain, severe swelling and permanent redness of the hand; the author suggests, that algodystrophy after distal radius fracture is far more common condition than it is generally believed.

Adult↗
PubMed1999

[Diagnostic and therapeutic significance of arthroscopy in distal radius fracture].

Non-operative and minimal-invasive treatment of distal radius fractures have still a poor outcome. Although bony structures often heal acceptable, additional lesions of intraarticular ligamentous structures cause persistent pain and disability. Aim of the study was to present the diagnostic and therapeutic possibilities of arthroscopically assisted treatment of distal radius fractures. Diagnostic wrist arthroscopy found in 6 of 30 patients with distal radius fractures (23 AO type C fractures) a scapho-lunate ligament tear (20%) of which 3 had to be stabilized operatively. 18 patients (60%) presented with tears of the triangular fibrocartilage complex [Palmer classification: 1A (1); 1B (5); 1D (2); 1A, 1B (2); 1A, 1D (6); 1B, 1D (2)], which were repaired by arthroscopic shaving (n = 12), Kirschner wire stabilization of ulna head (n = 2) or arthroscopic suture (n = 3). Fractures were stabilized in most cases by combinations of canulated titan screws (3.0 mm) and Kirschner wires (n = 12). In 27 patients, the radial joint surface and the distal radio-ulnar joint could be reconstructed without any specific complications. Arthroscopic reduction of distal radius fractures allows minimal-invasive reconstruction of the joint surface, diagnoses relevant ligamentous tears and should applied with incongruencies of the joint surface greater than 2 mm and in widely dislocated fractures.

Adult↗
PubMed1994

Factors affecting functional outcome of displaced intra-articular distal radius fractures.

Open reduction and internal fixation is often required in comminuted, displaced intra-articular fractures of the distal radius when closed manipulation has failed to restore articular congruity. Results of surgical stabilization and articular reconstruction of these injuries are reviewed in this retrospective study of 49 patients with 52 displaced, intra-articular distal radius fractures. Forty-three patients with a mean age of 37 years (range, 17-79 years) were available for evaluation. The mean follow-up time was 38 months (range, 22-69 months). When rated by the system proposed by the Association for the Study of Internal Fixation (ASIF), 19 were ASIF type C2 and 21 were ASIF type C3. An injury score system based on the initial injury x-ray films was used to classify severely comminuted intra-articular fractures and to identify those associated with carpal injury. Postoperative fracture alignment, articular congruity, and radial length were significantly improved following surgery. Grip strength averaged 69 +/- 22% of the contralateral side, and range of motion averaged 75 +/- 18% of the contralateral side after surgery. A combined outcome rating system that included grip strength, range of motion, and pain relief averaged 76 +/- 19% of the contralateral side. Using regression analysis, a significant decrease was found in the combined rating with more severe fracture patterns as defined by the ASIF system, Malone classification, and the injury score system. The injury score system presented here and, in particular, the number of fracture fragments correlated most closely with the outcome of all classification systems examined. Operative treatment of complex distal radius fractures with reconstruction of articular congruity with internal fixation and/or external fixation can significantly improve functional outcome. The degree to which articular step-off, gap between fragments, and radial shortening are improved by surgery is strongly correlated with improved outcome, even when the results are corrected for severity of initial injury, whereas correction of radial tilt or dorsal tilt did not correlate with improved outcome.

Adult↗
PubMed2002

Static scapholunate dissociation diagnosed by scapholunate gap view in wrists with or without distal radius fractures.

This prospective study investigated static scapholunate dissociation (SLD) in wrists associated with distal radius fractures. SLD was detected as a widening of the scapholunate (SL) joint interval by SL gap view. Ninety-six distal radius fractures and 154 normal wrists were investigated by SL gap view, which is better for detecting SLD than the standard posteroanterior (PA) view. Incidences of non-symptomatic SLD detected by SL gap view in normal wrists increased by age. In the young age bracket, incidences of SLD in distal radius fractures were significantly higher than in normal wrists. Our results indicated that in patients younger than 30 years old, SLD in distal radius fractures was a fracture-caused abnormality. In those over 30, ascribing SLD to the fracture was difficult. Close examinations, like arthroscopy and dynamic cineradiography, need to be made in patients with SLD associated with distal radius fractures, especially in those younger than 30.

Adolescent↗
PubMed1994

Computed tomography scanning with image reconstruction in evaluation of distal radius fractures.

Seventeen patients with 18 intraarticular distal radius fractures underwent computed tomography (CT) scanning and image reconstruction to evaluate their distal radius fractures. All patients were selected prospectively because of intraarticular extension and/or displacement of their fractures on pre- or post reduction plain films. Patients who were not surgical candidates for open reduction and internal fixation of their fracture were not included in the study. X-ray films and CT scans were viewed separately and in random order by a senior radiologist not familiar with the cases. Both x-ray films and CT scans readily showed extension of fracture lines into the radiocarpal joint, radial shaft, and the ulnar styloid, but CT scans were better than x-ray films at demonstrating fracture involvement of the distal radioulnar joint, the extent of articular surface depression, and the amount of comminution. Due to the cost, it is recommended that the test only be used for patients who are surgical candidates for open reduction and internal fixation or when more information about the extent of comminution and joint depression is required.

Adolescent↗
PubMedDate not supplied

[Radiological findings in distal radius fractures].

X-ray examination in distal radius fractures is very important for the management and prognostic of these fractures. Anterior and lateral radiographs must be taken in standardised position to avoid errors in measurements. On antero-posterior x-ray of the distal radius the important parameters are: radial length (N = 11-12 mm), radial angle (N = 22 degrees-25 degrees) and radial width. For the radial length three methods of measurements (Gartland, Gelberman and Palmer) are presented. On the lateral x-ray the palmar inclination of the distal radius may be measured (N = 10 degrees-12 degrees). Modifications of these parameters associated with distal radius fractures are presented.

Humans↗
PubMed2005

Avoidance and treatment of complications of distal radius fractures.

The treatment of distal radius fractures continues to be fraught with complications. The more widespread use of internal fixation and supple-mental bone grafting with external fixation has decreased the incidence of malunions from closed-cast treatment and percutaneous pinning, but increased the risk of the complications specific to surgical intervention. Careful diagnosis, surgical planning, surgical technique, and postoperative rehabilitation can help optimize outcome in these difficult fractures.

Casts, Surgical↗
PubMed2004

Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient.

PURPOSE: Increased incidence of falls and osteoporosis combine to make distal radius fractures a major cause of morbidity for the elderly patient. This report presents our experience treating distal radius fractures in the elderly population using a volar fixed-angle internal fixation plate. METHODS: We reviewed retrospectively all patients older than 75 years treated during a period of 4 years and 7 months at our centers for unstable distal radius fractures using a volar fixed-angle plate. Postoperative management included immediate finger motion, early functional use of the hand, and a wrist splint used for an average of 3 weeks. Standard radiographic fracture parameters were measured and final functional results where assessed by measuring finger motion, wrist motion, and grip strength. RESULTS: Of 26 patients that fit the inclusion criteria, we were able to evaluate 23 patients with 24 unstable distal radius fractures for an average of 63 weeks. Final volar tilt averaged 6 degrees and radial tilt 20 degrees, and radial shortening averaged less than 1 mm. The average final dorsiflexion was 58 degrees, volar flexion 55 degrees, pronation 80 degrees, and supination 76 degrees. Grip strength was 77% of the contralateral side. There were no plate failures or significant loss of reduction, although there was settling of the distal fragment in 3 patients (1-3 mm). CONCLUSIONS: The treatment of unstable distal radius fractures in the elderly patient with a volar fixed-angle plate provided stable internal fixation and allowed early function. This technique minimized morbidity in the elderly population by successfully handling osteopenic bone, allowed early return to function, provided good final results, and was associated with a low complication rate.

Aged↗
PubMed1989

[Corrective osteotomy following peripheral radius fractures. Method and results].

Malunion of distal radius fractures leads, especially in those patients who are manually employed, to functional disability of the hand. Painful impingement on the ulnar side of the wrist results in decreased range of motion in pronation/supination and loss of strength. By reconstructing as precisely as possible the axial and longitudinal relationship of the forearm bones, the desired congruence of the distal radioulnar joint can be achieved, this improving greatly the strength and function of the hand. Indications, point of time, as well as technique in operating will be presented in short form in 42 of our own cases: complications will also be discussed. The roentgenographic and functional results, as well as the subjective evaluation from 33 patients whose operations took place longer than a year ago, before and after the malunion correction, will be listed according to our postoperative examination protocol for radius fractures. In all three parameters positive results could be shown, especially in the patient's subjective analysis. Notice will be taken on the special difficulties in position corrections in cases in which the ulnar side fragment is dislocated.

Adult↗