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PubMedDate not supplied

The intraosseous blood supply of the canine radius: implications for healing of distal fractures in small dogs.

The intraosseous vascular anatomy of the radius was studied in 12 pairs of canine cadaver limbs. Six pairs of specimens were obtained from small-breed dogs (less than 6 kg) and six pairs were obtained from large-breed dogs (18 to 30 kg). All specimens were studied after arterial injection with India ink. Samples were fixed, frozen, then sectioned and processed using a modified Spalteholz technique. In all specimens, the intraosseous blood supply arose from the nutrient artery with its associated branches and the metaphyseal arteries. In small-breed dogs, there was decreased vascular density at the distal diaphyseal-metaphyseal junction compared with large-breed dogs. The reduced vascularity corresponded to the region associated with a poor prognosis for fracture healing in small-breed dogs. This regional association suggests that a decreased vascular supply in the distal radius may contribute to a higher frequency of delayed union and nonunion in smaller dogs.

Animals↗
PubMed2004

Radiocarpal arthrodesis for osteoarthritis following fractures of the distal radius.

To compare the radioscapholunate (RSL) arthrodesis and radiolunate (RL) arthrodesis as a treatment for radiocarpal osteoarthritis following fractures of the distal radius, nine patients, 23 to 70 years old (average 41) at the time of surgery, were assessed two to 33 years after surgery. The periods between injury and surgery ranged from four months to 30 years. RSL arthrodesis was performed in three cases and RL arthrodesis in six. Post-operative wrist pain disappeared in six and was decreased in the other three. In the RSL group, the total arc of wrist flexion and extension was reduced from 50 degrees pre-operatively to 35 degrees post-operatively. In the RL group, it was increased from 72 degrees to 76 degrees after surgery. Grip strength improved in most patients, from 7 to 18 kg in the RSL group, and from 16 to 27 kg in the RL group. On roentogenogram, three patients showed arthritic changes in the adjacent joints, but there were no symptoms in two of the three patients. We concluded that partial radiocarpal arthrodesis (preferably RL arthrodesis) is a reliable procedure for radiocarpal osteoarthritis following fractures of the distal radius.

Adult↗
PubMed2026

CL16019, A Combination of Cissus quadrangularis and Boswellia serrata Extracts Promotes the Healing of Distal Radius Fractures: A Multicentric, Randomized, Open-Label Study.

OBJECTIVE: Distal radius fracture (DRF) is the most frequent injury to the upper limb. Complications include nonunion, wrist stiffness and instability, local discomfort, and tendon irritation. The purpose of the current open-label clinical study was to evaluate the safety, efficacy, and tolerability of CL16019, an herbal formulation of Cissus quadrangularis and Boswellia serrata extract, in accelerating fracture healing in volunteers with DRFs. METHODS: Fifty participants (both male and female; age: 30-50 years) with type I, IIA, or IIB DRFs (as per Lidstrom classification) were equally randomized and treated with standard treatment (ST) or ST + CL16019 for 60 days. The primary efficacy outcome was the radiographical bone fracture healing rate as scored by the Radius Union Scoring System (RUSS). Pain, swelling, and tenderness were among the clinical characteristics evaluated using the visual analog scale (VAS). Wrist function improvements were assessed using the Patient-Rated Wrist Evaluation Questionnaire (PRWEQ). The intergroup and intragroup results were analyzed using a paired t-test and an analysis of covariance model, respectively. RESULTS: The RUSS scores for the ST and ST + CL16019 groups at the end of the trial were 5.54 &#xb1; 1.77 and 7.96 &#xb1; 0.20, respectively, with a p-value <0.0001. In addition, the CL16019 volunteers showed substantial (p < 0.05) declines in their VAS and PRWEQ scores. The ST + CL16019 group demonstrated higher Physician Global Assessment and Subject Global Assessment scores. CONCLUSIONS: Supplementation of CL16019 along with standard therapy was found to enhance the bone fracture healing rate, possibly by accelerating the callus formation rate and enhancing cortical bridging. These findings imply that CL16019 might be a good adjunctive in addition to ST for the faster healing of DRFs. The trial was registered with the Clinical Trial Registry of India (CTRI) with the registration number CTRI/2021/12/039006, on December 29, 2021.

Humans↗
PubMed1986

Angulation of the radius in children's fractures.

A study of 79 children with malunion of forearm fractures is presented. Age at the time of injury, the site of the fracture and the degree and direction of angulation at union were correlated with loss of forearm rotation at review 3.5 to 6 years later. Some guidelines are proposed for the acceptability of angular deformity at union, importance being placed on the avoidance of radial deviation of the radius, and the maintenance of the interosseous gap between the shafts of the radius and ulna.

Adolescent↗
PubMed1989

Ligamentotaxis and bone grafting for comminuted fractures of the distal radius.

The conventional treatment of comminuted fractures in the distal radius has been unsatisfactory. We therefore made a prospective study using the principle of ligamentotoxis and primary cancellous bone grafting as the uniform method of treatment. Ligamentotaxis was maintained by using an external fixator for three weeks only, after which a carefully monitored programme of rehabilitation was given. We have reviewed 72 consecutive distal radial fractures after a follow-up of 7 to 40 months (average 11 months). Reduction had been maintained during healing and over 80% of patients regained full range of movement in hands, wrists and forearms with strong and pain-free wrist function. Complications were infrequent and gave no real problems. We conclude that distraction, external fixation and bone grafting appears to be an excellent method of treating comminuted fractures of the distal radius.

Adolescent↗
PubMed2002

Management of completely displaced metaphyseal fractures of the distal radius in children. A prospective, randomised controlled trial.

In a prospective, randomised controlled trial, 68 children who had a completely displaced metaphyseal fracture of the distal radius were treated either by manipulation (MUA) and application of an above-elbow cast alone or by the additional insertion of a percutaneous Kirschner (K-) wire. Full radiological follow-up to union was obtained in 65 children and 56 returned for clinical evaluation three months after injury. Maintenance of reduction was significantly better in the K-wire group and fewer follow-up radiographs were required. There was no significant difference in the clinical outcome measured three months after injury. Seven of 33 patients in the MUA group had to undergo a second procedure because of an unacceptable position compared with none of the 35 in the K-wire group (chi-squared test, p < 0.01). One patient in the K-wire group required exploration for recovery of a migrated wire. We conclude that the use of a percutaneous K-wire to augment the reduction of the fracture in children who have a completely displaced metaphyseal fracture of the distal radius is a safe and reliable way of maintaining alignment of the fracture.

Adolescent↗
PubMed2004

Measurement of bowing of the radius.

Fractures and plastic deformities of the forearm are common in children. While axial deformities are easily recognised and treated, bowing of the radius may be overlooked. Physiological bowing is essential for full rotation of the forearm. We have used the method of Schemitsch and Richards to estimate the degree of bowing in 100 children who had not suffered a fracture of the forearm. The site of maximum bowing remained constant at 60.39% of the length of the radius (95% CI 59.65 to 61.14). The value of maximum bowing did not exceed 10% of the total length (mean value 7.21%; 95% CI 7.00 to 7.41). This study provides information that can be useful for the diagnosis of bowing and for the evaluation of post-traumatic deformities.

Adolescent↗
PubMed2005

Corrective osteotomy for intra-articular malunion of the distal part of the radius.

BACKGROUND: Corrective osteotomy is an appealing treatment for malunited articular fractures of the distal part of the radius since articular incongruity may be the factor most strongly associated with arthrosis and diminished function after such fractures. Enthusiasm for osteotomy has been limited by concerns regarding the difficulty of the technique and the potential for additional injury, osteonecrosis, and nonunion. METHODS: Twenty-three skeletally mature patients were evaluated at an average of thirty-eight months after corrective osteotomy for an intra-articular malunion of the distal part of the radius. The indication for the osteotomy included dorsal or volar subluxation of the radiocarpal joint in fourteen patients and articular incongruity of > or =2 mm as measured on a posteroanterior radiograph in seventeen patients. Six patients had combined intra-articular and extra-articular malunion. The average interval from the injury to the osteotomy was six months. The average maximum step-off or gap of the articular surface prior to the operation was 4 mm. RESULTS: One patient had a subsequent partial wrist arthrodesis because of radiocarpal arthrosis, and three patients had additional surgery because of dysfunction of the distal radioulnar joint. One patient had a rupture of the extensor pollicis longus, which was treated with a tendon transfer. The final articular incongruity averaged 0.4 mm, and the final grip strength averaged 85% of that on the contralateral side. The rate of excellent or good results was 83% according to the rating systems of Fernandez and of Gartland and Werley, and 43% according to a modification of the rating system of Green and O'Brien. CONCLUSIONS: The results of corrective osteotomy for the treatment of intra-articular malunion are comparable with those of osteotomy for the treatment of extra-articular malunion. Intra-articular osteotomy can be performed with acceptable safety and efficacy, it improves wrist function, and it may help to limit the need for salvage procedures such as partial or total wrist arthrodesis.

Adolescent↗
PubMed2006

Corrective osteotomy for intra-articular malunion of the distal part of the radius. Surgical technique.

BACKGROUND: Corrective osteotomy is an appealing treatment for malunited articular fractures of the distal part of the radius since articular incongruity may be the factor most strongly associated with arthrosis and diminished function after such fractures. Enthusiasm for osteotomy has been limited by concerns regarding the difficulty of the technique and the potential for additional injury, osteonecrosis, and nonunion. METHODS: Twenty-three skeletally mature patients were evaluated at an average of thirty-eight months after corrective osteotomy for an intra-articular malunion of the distal part of the radius. The indication for the osteotomy included dorsal or volar subluxation of the radiocarpal joint in fourteen patients and articular incongruity of >/=2 mm as measured on a posteroanterior radiograph in seventeen patients. Six patients had combined intra-articular and extra-articular malunion. The average interval from the injury to the osteotomy was six months. The average maximum step-off or gap of the articular surface prior to the operation was 4 mm. RESULTS: One patient had a subsequent partial wrist arthrodesis because of radiocarpal arthrosis, and three patients had additional surgery because of dysfunction of the distal radioulnar joint. One patient had a rupture of the extensor pollicis longus, which was treated with a tendon transfer. The final articular incongruity averaged 0.4 mm, and the final grip strength averaged 85% of that on the contralateral side. The rate of excellent or good results was 83% according to the rating systems of Fernandez and of Gartland and Werley, and 43% according to a modification of the rating system of Green and O'Brien. CONCLUSIONS: The results of corrective osteotomy for the treatment of intraarticular malunion are comparable with those of osteotomy for the treatment of extra-articular malunion. Intra-articular osteotomy can be performed with acceptable safety and efficacy, it improves wrist function, and it may help to limit the need for salvage procedures such as partial or total wrist arthrodesis.

Adolescent↗
PubMed2000

Microcrack density and length in the proximal and distal metaphyses of the humerus and radius in dogs.

OBJECTIVE: To compare microcrack density and length in the proximal and distal metaphyses of the humerus and radius in dogs. SAMPLE POPULATION: Left humerus and radius from each of 10 dogs of medium to large size. PROCEDURE: Metaphyseal specimens were bulk stained in 1% basic fuchsin in graded alcohols and embedded in methylmethacrylate. For quantification of fatigue-induced microscopic damage, transverse sections were prepared from proximal and distal metaphyseal regions, and length and density of microcracks were determined, using light microscopy. RESULTS: Bone region, age, and body weight were not significantly associated with microcrack density or length. CONCLUSIONS AND CLINICAL RELEVANCE: The hypothesis that fatigue-induced injury (increased microcrack density and length) caused by cyclic loading associated with daily activity is greater in bone regions prone to development of osteosarcoma was not supported by data from this study.

Animals↗
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↗
PubMed1991

[Long term treatment results for acute hematogenous osteomyelitis of the radius].

The 37 years follow up of hematogenous osteomyelitis of the radius with the whole shaft sequestrum is presented. The treatment consisted of surgical removal of the sequestrum and administration of both local and systemic antibiotics. One year after surgery and subsiding of the flare the fragments were united with an autogenic bone graft. After trauma related fracture the incorporated graft has united in usual period of time. Clinical and radiological examination carried out after 37 years revealed full remodeling of the shaft with features of growth disturbances of the radius.

Anti-Bacterial Agents↗
PubMed1991

[Rehabilitation treatment of inveterate meta-epiphyseal deformities of the radius].

Unilateral separate anchor--wiring osteosynthesis of the forearm bones has essential advantages over the accepted methods for osteosynthesis of metaepiphyseal fractures of the radius. For adaptation to modern requirements an apparatus is suggested with external fixation of the radial diaphysis and the second metacarpal bone by means of bundles of short Kirschner wires with Y-shaped insertion of the pointed ends. The apparatus provides for longitudinal and transverse movement with fixation of the fragments at any level of the forearm and maintenance of rotational movements and movements at the interphalangeal joints. The method was applied in operations on 18 patients with neglected metaepiphyseal deformities of the radius; the outcome was positive.

Equipment Design↗
PubMed1991

[Corrective osteotomy for the treatment of carpal tunnel syndrome in malaligned healed fractures of the distal radius].

This report deals with 12 patients with fractures of the distal radius that healed with malpositioning with dorsal sinking of the articular surface. This malalignment was followed in all patients by a compression syndrome of the median nerve. All patients underwent an osteotomy by the dorsal approach to correct this malalignment of the distal radius. The carpal ligament was not released simultaneously. In 11 patients a significant reduction in the typical night pain was noticed. Normal or almost normal sensitivity was achieved within the first 2 months (2 weeks to 4 months). Only in one patient was release of the carpal ligament necessary after 6 months, because the osteotomy had no effect on the pain. In the follow-up examination after 6 years, significantly better wrist function was noticed in all patients, and 11 had normal function of the median nerve. In only one patient with moderate loss of sensitivity still present, although these was an obvious significant reduction in pain. In this patient the osteotomy was performed very late (after 10 months). Thus, an osteotomy by the dorsal approach has the advantage of restoring normal function of both the wrist and median nerve.

Aged↗
PubMed1990

[Corrective osteotomy of malunited distal radius fractures].

The malunion of the distal radius may result in shortening, radial impaction, volar angulation, dorsal displacement or rotatory deformity. For restoration, the anatomy and kinematics of the distal radioulnar joint and the triangular fibrocartilaginous complex (TFCC) are of importance. This nonunion consists of the articular disk, a meniscus homologue, the ulnar collateral ligament, and the dorsal and palmar radioulnar ligaments. Malunion of the distal radioulnar joint leads to an increase in loading on the individual parts, as well as pain and a decrease in supination and pronation. Osteotomy is indicated if the angulation of the malunion is more than 20 degrees in the frontal or sagittal plane. Corrective osteotomy requires detailed preoperative planning with calculation of the correct position in all planes. The most common operation that has proved to be effective is osteotomy of the radius, insertion of a trapezoidal bone graft in place, and internal fixation with a dorsal or volar plate.

Elbow Joint↗
PubMed1989

[Treatment of extra-articular malunited fractures of the distal radius using osteotomy with interposition of a graft].

Malunited fractures of the distal end of the radius are corrected by an osteotomy transversely oriented at the level of the angulation (15 cases reported). After correction of the deformation (length and angulation) compact iliac bone graft is inserted. 5 malunited fractures with a volar deformation were corrected by a palmar surgical approach and AO-T-plate fixation. 8 cases with a dorsal displacement were corrected by a dorso-lateral surgical approach and fixed with K-wires (7 cases) and without any internal fixation (1 case). 2 cases with dorsal displacement were corrected by a palmar approach and AO-plate fixation. Clinical and radiological results are good, except one case with secondary displacement and malunion which needed an ulnar head resection and the other, in which the radius was not enough lengthened, and needed the ulnar to be shortened.

Adult↗
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↗
PubMed1987

Median nerve compression by volarly displaced fragments of the distal radius.

Median nerve compression may occur acutely, subacutely, or late following fractures of the distal radius. Hematoma and swelling at the mouth of the carpal tunnel are the likely cause in acute cases. A contributing factor generally not recognized initially is a volarly displaced fragment of distal radius compressing the median nerve against the proximal edge of the flexor retinaculum. In nine such fractures, median nerve compression occurred in eight. Lack of recognition led to the delay in diagnosis and treatment of two patients. The volar fragment could always be seen on the first postreduction roentgenogram. Carpal tunnel release and removal or reduction of the displaced volar fragment should be carried out as early as possible to avoid the complications of reflex sympathetic dystrophy. Removal of the bony fragment alone, without carpal tunnel decompression, may be insufficient.

Carpal Tunnel Syndrome↗