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PubMed2003

[The treatment and complications of intraarticular fractures of the distal radius].

UNLABELLED: The purpose of this trial was to determine the rate of complications and the cause of complications after intraarticular fractures of the distal radius. We examined those patients, who had intraarticular fractures of the distal radius and who were treated in Kaunas University of Medicine Hospital and Kaunas Red Cross hospital in 1998-2000. The evaluation of results was made by movement of the joint and pain in the wrist, which was evaluated by pain scale and McGill pain questionnaire. Palmar slope, radial inclination and radial length were evaluated rentgenologically. Distal radioulnar joint was evaluated as well (with evaluation of scapholunate ligament condition). Patients were investigated 1.5 and 2 years after fracture. RESULTS: There are more secondary dislocations and the shortening of radius in group that was treated by gypsum bandage. Good distraction of fracture ends is seen using external fixation, but strain of soft tissue gives complications: contraction of fingers, and instability of wrist. The incongruence of joint surface causes early arthrosis and pain. The injury of ligaments in the wrist, which can be seen by X-ray examination, causes instability of wrist and chronic pain.

Adult↗
PubMed1992

[Roentgen diagnosis of post-traumatic radius torsion].

Especially the identification of rotational malunions on the distal radius is difficult by routine diagnosis. Long-time effects like a chronic loss of articular surface of the posttraumatic rotation on the distal radioulnar joint are of clinical importance. Evading expensive diagnostic methods like CT simulated rotational malunions of the radius are quantitatively investigated on the basis of routine X-ray pictures only. The geometrical relation between the rotational angle of the radius and the two-dimensional distance from the dorsal to the volar border of the radial notch is described by a simple trigonometrical function. Considering morphological individualities of the radial notch and the rotational angles of right and left radii rotational malunions below 10 degrees are discovered and their effects on the forearm skeleton are assessed.

Aged↗
PubMed2003

[Repair of segmental bone defects in rhesus monkeys' radius with allogeneic tissue engineered bones].

OBJECTIVE: To construct tissue engineering bone with bio-derived materials and bone marrow stromal cells (MSCs), and to investigate the effect of allogeneic engineering bone implants on healing of segmental bone defects. METHODS: MSCs being aspirated aseptically from tibial tuberosities of young rhesus monkeys were induced into osteoblasts in vitro and then were cultured and marked with 5-bromo-2-deoxyuridine (BrdU). Tissue engineering bones were constructed with these labeled osteoblasts being seeded onto bio-derived materials made from fresh human bones which were treated physically and chemically, Then the constructs were implanted in 15 allogeneic monkeys to bridge 2.5 cm segmental bone defects of left radius as experimental groups, bio-derived materials only were implanted to bridge same size defects of right radius as control group. and, 2.5 cm segmental bone defects of both sides of radius were left empty in two rhesus monkeys as blank group. Every 3 monkeys were sacrificed in the 1st, 2nd, 3rd, 6th and 12th weeks postoperatively and both sides of the implants samples were examined macroscopically, histologicaly, and immunohistochemicaly. The two monkeys in blank group were sacrificed in the 12th week postoperatively. RESULTS: Apparent inflammatory reactions were seen around both sides of the implants samples in the 1st, 2nd, 3rd weeks, but it weakened in the 6th week and disappeared at the 12th week. The labeled osteoblasts existed at the 6th week but disappeared at the 12th week. The bone defects in experimental group were repaired and the new bone formed in multipoint way, and osteoid tissue, cartilage, woven bone and lamellar bone occurred earlier when compared with control group in which the bone defects were repaired in 'creep substitution' way. The bone defects in blank group remained same size at the 12th week. CONCLUSIONS: Engineering bones constructed with bio-derived materials and MSCs were capable of repairing segmental bone defects in allogeneic monkeys beyond 'creep substitution' way and making it healed earlier. Bio-derived materials being constituted with allogeneic MSCs may be a good option in construction of bone tissue engineering.

Animals↗
PubMed2003

[Arthroscopy-guided treatment of fractures of the distal radius: 16 wrists].

PURPOSE OF THE STUDY: We report our experience with arthroscopy-guided treatment of fractures of the distal radius. MATERIAL AND METHODS: Between November 2001 and June 2002, 16 patients (10 men, 6 women, mean age 51 years, age range 24-75 years) underwent arthroscopy-guided treatment of articular fractures of the distal radius. Patients were installed with the arm held in a horizontal position with a brace, the wrist under traction. The same procedure was used in all cases: introduction of the arthroscope, joint cleaning and shaving, search for lesions, arthroscopy-guided treatment. Kirschner 2-mm pins were used for fixation in all cases, combined with 1.2-mm pins in the event of ligament injury. RESULTS: Arthroscopic exploration revealed cartilage impaction in 25% of the wrists and ligament injuries in 30%. One fixation disassembled and was not remounted. There were two cases of reflex dystrophy. There were no arthroscopy-related complications. Bone healing was achieved in eight weeks in all cases. The mean DASH score was 22.5 at six months follow-up (range 3-10). DISCUSSION CONCLUSION: Arthroscopy-guided treatment of fractures of the distal radius was attempted for the first time in the early 90s. Per-operative arthroscopy enables a good view of the fracture and associated lesions (cartilage impaction, scapholunate, lunotriquetral ligament injury) and facilitates control of the reduction. Arthroscopy is technically simple and is the technique of choice due to the lack of morbidity. Several authors have reported their experience in more or less extensive series. Two notions should be emphasized. First, defective intra-articular reduction greater than 1 mm may lead to osteoarthritis of the wrist in 90% of the cases. Secondly, intra-operative imaging (fluoroscopy) does not provide sufficient precision to visualize a 1-mm stairstep in the articular surface, raising the risk of radiocarpal degeneration at mid term despite often satisfactory postoperative x-rays. We thus propose intra-operative arthroscopy to control the treatment of all articular wrist fractures, with or without displacement, in order to ensure satisfactory reduction with less than 1-mm defect in the articular surface and to search for and treat any associated bone or ligament injuries not diagnosed before surgery.

Adult↗
PubMed1992

[Plate osteosynthesis of the radius. Own implant and technique].

In 1989 and 1990, 46 acute distal radius fractures with die-punch compression cavities underwent open reduction and internal fixation using a new compression plate and surgical technique. In 34 of these patients, functional and radiological results after plate removal were studied. Surgical exposure was palmar or dorsal, or combined palmar with a supplementary dorsal incision, depending on the location of the compression cavity and the extent of fracture dislocation. A cortico-cancellous graft from the iliac crest was fitted into the compression cavity, thus supporting the reduced joint surface against the radius shaft. Superior maintenance of the reduction was achieved using cortico-cancellous instead of simple cancellous graft. A new titanius radius reconstruction plate was used for internal fixation. This two-fold support of the fracture allowed for earlier wrist mobilization.

Adolescent↗
PubMed1992

Comminuted intra-articular fracture of the distal radius--results of early open reduction and internal fixation.

Comminuted intra-articular fracture of the distal radius remains a challenging problem. This article reviews the results of 15 consecutive cases which were treated with open reduction and internal fixation with T-plate after failing to achieve articular congruency with closed reduction. The follow-up ranges from 20 months to 28 months. In thirteen cases, articular congruency was restored. However, 4 of these 13 cases later lost some of the articular congruency. This suggests the need for supplementary bone grafting. Reduction of the extra-articular portion of distal radius was generally well maintained. There was an average of 2.4 mm loss in styloid height, an increase of 1.2 mm in ulnar variance and loss of 12.5 degrees of volar tilt. Seven patients (46%) were completely pain-free, with the remaining 8 patients (53%) experiencing mild pain associated with forceful activities involving the wrist. All patients achieved a functional range of motion. Grip strength averaged 81% of the uninjured side. Of the 12 patients who were engaged in active employment, 10 returned to their previous job within 4 months of injury (average 8.5 weeks). The only complication in this series was the development of reflex sympathetic dystrophy in a 68-year-old housewife. We recommend open reduction and internal fixation if closed reduction fails to achieve articular congruency in comminuted distal radius fractures.

Adult↗
PubMed2004

Complications of treating distal radius fractures with external fixation: a community experience.

OBJECTIVE: To analyze the immediate postoperative complications associated with treating distal radius fractures with external fixation. DESIGN: A retrospective chart review of data obtained from 24 consecutive patients who were treated with small AO external fixators in 1997. SETTING: Two community medical centers. INTERVENTION: Preoperative and postoperative radiograph measurements were taken of radial inclination, radial tilt, and radial length, and fractures were classified according to the AO system. Patient charts were reviewed to document demographics, type of fixator used, open or percutaneous technique for pin placement, use of augmentation, additional operations, and complications. MAIN OUTCOME MEASUREMENTS: Complications associated with treating distal radius fractures with one type of external fixator. RESULTS: Sixteen of the 24 patients had complications: 5 with neuropathies of the median or superficial radial nerve, 9 with pin track infections, 2 with pin loosening, one with a nonunion, 2 with malunion, and 4 patients each with radial shortening, loss of radial tilt, collapse of ulnar border or volar intercalated segment instability (VISI) of the lunate and rotatory subluxation of the scaphoid. CONCLUSIONS: Postoperative complications following distal radius fractures treated with external fixation are common. Their effect, however, on long term functional results and patient satisfaction is negligible, with the exception of those patients with complications intrinsic to the fracture itself, i.e., nonunion, malunion or carpal malalignment.

Adult↗
PubMed2004

[Clinical results after surgeries of intraarticular distal radius fractures].

UNLABELLED: The aim of the study was to evaluate treatment results of intraarticular distal radius fractures using the combined method and to compare it to other methods. MATERIAL AND METHODS: Between 2000 and 2003 we evaluated clinical results of 105 patients with intraarticular fracture of distal radius. Thirty-five patients underwent the repair of intraarticular fracture according to combined method (using Kirschner wires and external fixator), 30 patients - only with Kirschner wires and 40 patients - only with external fixator. Results were evaluated clinically and rentgenologically. The evaluation was made by scoring system according to J. J. Gartland and C. W. Werley (modified by A. Sarmiento). X-ray pictures were evaluated every 2 weeks till the 6(th) week ant after 6 months. RESULTS: Using combined method, treatment results were good and very good for 28 patients, and satisfactory for 7 patients. In case when Kirschner wires were used, good and very good results were found in 17 patients, and satisfactory - in 13 ones. When only external fixators were used, good and very good results were observed in 26 patients and satisfactory - in 14 patients. There was statistically significant difference between the groups (p<0.05). CONCLUSIONS: Better clinical treatment results of intraarticular distal radius fractures were achieved when combined method (using Kirschner wires and external fixator) was applied. Using other methods of treatment we observed more cases of secondary dislocations.

Adult↗
PubMed1992

[Complex disorders of radius and ulna in childhood].

Treatment of congenital or acquired disturbances of the radius or ulna always requires recognition of the complex biomechanics of the forearm. In particular trauma, seemingly restricted to one of the bones, should caution against concomitant lesions to the other bone. The typical example is unfortunately the often missed dislocation of the capitulum radii in Monteggia-type lesions. Additional examples are deranged growth of the distal epiphysis of the radius after a fracture of the ulna, in association with multiple osteochondromas and of the proximal epiphysis of the radius in presumptively congenital dislocation of the capitum radii. Lesions encountered in children have to be analyzed carefully with respect to dynamics of maldevelopment. Corrections that have implications for neighbouring articulations should be undertaken with the intent to fully exploit the potential for remodelling by forthcoming growth processes.

Adolescent↗
PubMed2005

Complications and functional outcome following fixation of complex, intra-articular fractures of the distal radius with the AO Pi-Plate.

This study investigates the efficacy of the AO Pi-plate in the treatment of complex, intra-articular fractures of the distal radius. We retrospectively analysed the clinical and radiological results of 19 consecutive patients who underwent open reduction and internal fixation for dorsally displaced, intra-articular fractures of the distal radius using the AO Pi-plate. The final functional outcome was assessed using the Gartland & Werley scoring system. The average follow-up period was 34.3 months. Wrist movement was restored to a near normal range in all the patients. The functional outcome as measured by the Gartland & Werley scoring system showed excellent and good results in 15 (88%) of the patients. The implant was removed in 4 (23%) of the patients due to extensor tenosynovitis and restriction of flexion. This study demonstrates that although the functional outcome following fixation of complex distal radius fractures with the AO Pi-plate is good, there is a risk of developing extensor tenosynovitis and limitation of flexion. We recommend that the implant be used sparingly and if used then elective removal of the implant should be considered after fracture union.

Adult↗
PubMed2006

[Treatment of comminuted intra-articular fractures of the distal radius by open reduction and volar plating in adults].

BACKGROUND: We herein present the mid-term results of the adult patients with comminuted intra-articular fractures of the distal radius who were treated by palmar plating. METHODS: Between 1999 and 2003, open reduction and palmar plating were performed in 23 of the patients who had surgical treatment for comminuted intra-articular fractures of the distal radius. Nineteen patients (11 females, 8 males; mean age 34; range 22 to 54 years) with regular follow-up were included in the study. In the majority of patients only one wrist was involved (7 dominant - 12 nondominant). Preoperative evaluation included patient's history, physical examination, and radiological studies (plain radiographs, computed tomography). The patients were classified according to AO classification as 7 type B [B1 (1); B2 (3); B3 (3)] and 12 type C [C1 (7); C2 (5)]. The surgical procedure included internal fixation by using plates and screws with palmar approach. Range of motion exercises were started immediately after the operations. The patients were followed clinically and radiographically, with an average follow-up time of 28 months (range, 13-47 months). Complications were recorded. RESULTS: Union was achieved in all patients. Radiographic parameters including the radial height, radial inclination, palmar tilt, and articular congruency have been corrected in the operation and remained unchanged until the last follow-up. According to the Gartland and Werley's classification, there were 9 (47%) excellent, 7 (37%) good, and 3 (16%) fair results. No perioperative and postoperative complications were recorded, except for three wound problems and one prolonged scar tenderness. CONCLUSION: Palmar plating is a safe and effective treatment for comminuted intraarticular fractures of the distal radius, regardless of direction of displacement of the distal fragment.

Adult↗
PubMed2006

[Intraarticular distal radius fractures--arthroscopic assessment of injuries].

Intraarticular distal radius fractures affect predominantly young people by contrary to "loco typico" fractures concerning old patients with osteoporosis. They are usually caused by high energy trauma and their treatment needs anatomic reposition. Between August and December 2004 there were performed 10 wrist arthroscopies in distal intraarticular radius fractures: 3 women and 7 men, age from 20 to 63 years, average 41. In all cases arthroscopy revealed larger displacement than assessed by standard radiographs and multiple associated soft tissue injuries were detected: lesions of TFCC in 5 patients, cartilage lesions of carpal bones in 6 and I degree SL interosseous ligament lesion in 4 patients. Arthroscopy in distal radius fractures allows detailed articular surface displacement assessment and reposition under "eye control". Additionally associated soft tissue injuries, which are not visible in standard X-ray examination are detected and treated.

Adult↗
PubMed2006

External fixation in patients with age over 65 years with distal radius fracture.

AIM: This study evaluates the final outcome of the treatment of the distal radius fractures with external fixation in patients older than 65 years. PATIENTS AND METHODS: Thirteen patients over the age of 65 years with a distal radius fracture were treated with external fixation. The fracture type was determined according the Frykman classification. For evaluation of the outcome six months after the operation were used: Stewart Score System; Gartland and Werley; and PRWE (Patient-rated wrist evaluation). RESULTS: According to the Stewart score system one patient has excellent; nine good; and tree have fair result. Gartland and Werley score showed that four patients have excellent; six good; and three have fair result. According to the PRWE two patients have no pain and no functional disability; five have minimal; five have mild pain and functional disability; and one has moderate degree and frequency of pain and moderate functional disability. Statistically there is strong correlation between Gartland and Werley score and PRWE score (r=0.657) and weak correlation between Stewart score and PRWE score (r=0.431). CONCLUSION: The external fixation of the distal radius fractures in the patients with advanced age enables high degree of functioning of the injured wrist and high level of daily activity. Judging from the benefit of enabling an "independence" of these persons, the risk for the operative treatment is sustained.

Aged↗
PubMed1991

[Diagnosis of torsion malposition of the radius and ulna after healed distal fracture].

Assessing radial and ulnar rotational deformities quantitatively by routine diagnosis after healed distal forearm fractures is very difficult. A method to obtain information about direction and graduation of malrotation is described. This method is based on discovering topographic changes of skeletal points by CT. Rotational angles of intact forearm bones are measured on anatomic specimen and in vivo using epiphyseal and diaphyseal axes of the radius and the ulna. Normal rotation of intact forearm bones varies in a specific manner. The radius presents less variations than the ulna. A morphological index of radial and ulnar rotation is not given because of the great individuality of diaphyseal rotation. Both radii of a single individuum show a very small rotational difference. Therefore a verification of malrotation is indicated by comparison to the intact opposite radius. Higher rotational graduations on the left side have to be noted.

Follow-Up Studies↗
PubMed1991

[Secondary arthrosis of the wrist joint in malposition of healed and uncorrected distal radius fracture].

The authors report on long-term results of thirty-five unreduced distal radius fractures with malunion. The mean observation period was 11.5 years (5 to 45 years). It was found malalignment of the carpal articular surface of the radius with a resulting decrease in range of motion of the wrist, well tolerated by the patients and apparently not very painful. Much more evident was pain and decreased motion in the distal radio-ulnar joint for pronation and supination, which paralleled the extent of osteoarthrosis of this joint. This reduced forearm rotation was due to shortening of the radius, leading to incongruency and even dislocation of the distal radio-ulnar joint.

Adult↗
PubMed1991

[The external fixator in unstable fractures of the distal end of the radius. Current literature review].

A recent review of the literature concerns instability of distal radius fractures and their treatment by external fixation. Redisplacement of distal radius fractures most often occurs chronically, and the severity can be predicted by initial deformity, axial shortening and dorsal comminution of the radius. The need for an anatomical reduction of these fractures is emphasized by different clinical and biomechanical studies. For many authors, external fixation provides good to excellent results in more than 75% of cases, both clinically and anatomically. Most of the complications are benign and do not affect long-term results. This study also discusses the different techniques and the best indications for external fixation.

External Fixators↗
PubMed1991

[Indications for surgery in distal radius fractures].

In this retrospective study, the results of conservative treatment of 406 fractures of the distal radius are analysed and the limitations of conservative therapy indicated. In all, 107 male patients (average age 45 years) and 299 women (average age 65 years) were examined. In only one-third of these cases were both radiographically and clinically. Of the primarily dislocated fractures, 19% healed in the correct anatomical position with satisfactory to good clinical results. Up to now, treatment of fractures of the distal radius with dorsal tilting has been regarded as a form of conservative therapy. Although certain types of fracture, in particular unstable ones, have always been regarded as cases for operative treatment, no attempt has ever been made to define the limits between conservative and operative treatment. Evaluation of the results clearly indicates that the classification according to Frykman, the one most commonly in use, cannot be used as a primary criterion for operative treatment. In the course of a meticulous statistical evaluation, we defined the radiological parameters precisely with reference to shortening, dorsal tilt and instability and drew up a classification to define the primary indications for operation in cases of fracture of the distal radius. Shortening by over 3mm, dorsal tilting by over 10 degrees, presence of a dorsal debris zone, rupture, or osseous avulsion of the radioulnar syndesmosis as a further instability factor show the limits of conservative therapy and are clear indications for operative treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

The surgical treatment of severe comminuted intraarticular fractures of the distal radius with the small AO external fixation device. A prospective three-and-one-half-year follow-up study.

Although fractures of the distal radius are very common, an optimal treatment has not been clearly delineated. This is a prospective study of 40 patients, mainly young and active adults, with comminuted and unstable intraarticular fractures of the distal radius. The end results of closed reduction and rigid fixation with the small AO external fixator includes 36 patients (90%) with excellent and good results. Roentgenograms of 33 of these patients showed accurate alignment of the healed fractures. Four patients (10%) had a fair functional result, with a partial restriction of the range of movement, although roentgenograms demonstrated good alignment of the healed fractures. The small AO external fixator is both a useful and convenient method for the reconstruction and treatment of comminuted intraarticular fractures of the distal radius.

Adult↗