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At least 667 records · Page 37Linked to original sources
PubMed1995

Malunions of the distal radius: treatment options.

Approaches to malunion of the distal radius may be viewed as a hierarchy of surgical options with increasing complexity and potential surgical morbidity. Choice of an appropriate surgical approach requires consideration of the patient's activity level, as well as the anatomic distortion that is present. In the posttraumatic situation, there is lack of agreement as to management of the distal ulna. Relative increased ulnar length and triangular fibrocartilage insufficiency make use of partial resection techniques more difficult. Osteotomy of the distal radius with or without a concomitant distal ulna procedure most nearly re-creates the preinjury situation anatomically and is seeing increasingly widespread application. It continues to be a challenging procedure from a technical standpoint. The need for procedures discussed in this review could be drastically reduced by a more aggressive approach to the initial fracture.

Arthrodesis↗
PubMed1997

Evaluation of cancellous structure in the distal radius using spectral analysis.

A preliminary study was conducted to analyze trabecular patterns in digitized wrist radiographic images from 68 patients (31 males and 37 females), aged from 7 to 93 years. The fast Fourier transform was used to perform the spectral analysis of the distal radius. Three indices were defined to permit quantification of the cancellous structure in terms of the spacing and orientation of bone trabeculae (periodicity): a spectral trabecular index, a longitudinal trabecular index, and a transverse trabecular index. The spectral trabecular index reflects the periodicity of the trabeculae (spacing and orientation), while the other 2 selectively reflect the periodicity of longitudinally and transversely oriented ones. The ratio of the longitudinal and transverse trabecular indices was also studied. The shape of the high magnitude frequencies in the spectrum was crosslike for all patients, implying a preferentially orthogonal 2-dimensional structure for the cancellous bone in the distal end of the radius. The variation of the defined trabecular bone indices with age corresponded with the formation of bone through infancy and adolescence, reaching a peak in adulthood and gradual loss thereafter. This quantification detects structural changes that occur with aging and may therefore be useful in the study of osteoporosis.

Adolescent↗
PubMed1998

[Giant cell tumors of the distal end of the radius treated by resection-arthrodesis].

The distal end of the radius is one of the sites commonly affected by giant-cell tumor of bone; it poses problems of reconstruction after resection of the distal radius. The authors present a retrospective study of 5 giant cells tumors treated by resection-arthrodesis of the wrist. These tumors were seen in 3 men and 2 women. From the radiological point of view, all tumors were extensive and lytic lesions centered in the epiphysis and involving the metaphysis; the wrist joint was respected. From the histological point of view, the tumors were grade I in 3 cases and grade II in 2 cases. With a mean follow up of 8 years, the results were considered good in 3 cases, fair in 1 case and poor in 1 case. A high incidence of bone complications was noted: delayed union (up to 11 months) and fracture of the graft, which occurred in 3 patients.

Adult↗
PubMedDate not supplied

Immediate reconstruction of the mandible using a vascularized segment of radius.

Resection of a segment of mandible, particularly when associated with malignant disease, carries a high morbidity and mortality. Traditional methods of autogenous bone grafting have proved unreliable in immediate reconstruction of such mandibular defects because of the variability of the recipient bed. These unfavorable conditions for bone graft survival can be largely overcome using vascularized bone and vascularized soft tissue reconstruction. The radial forearm free flap has proved a versatile and useful method in intraoral reconstruction and can be used together with a segment of radius as a composite flap. The technique of raising a segment of vascularized radius is described and its use in immediate reconstruction of the mandible at the time of resection illustrated in a series of 14 consecutive cases. There was one microvascular failure in this series and one postoperative death. The remaining 12 cases have had a successful outcome and show clinical union in the follow-up period varying from 11-36 months. There is evidence indicating that the bone maintains its viability even in the presence of preoperative or early postoperative radiotherapy.

Adult↗
PubMedDate not supplied

In vivo comparison of MR phase distribution and 1/T2* with morphologic parameters in the distal radius.

A new approach based on the calculation of the phase variance in a region of interest on the phase images of a simple gradient echo sequence, was used to assess the properties of trabecular bone in the distal radius. The phase variance reflects the distribution of field inhomogeneities due to the difference in magnetic susceptibility between bone and marrow in a way similar to T2*. However, the phase variance monitors the intervoxular differences, whereas T2* studies the intravoxular inhomogeneities. In this study of the radius of seven volunteers, both techniques were compared with parameters characterizing trabecular bone structure derived from high resolution MR images. Parameters such as the apparent bone area fraction, trabecular number, thickness and spacing, and box-counting fractal dimension were determined.

Adult↗
PubMed1981

Free vascularized fibular graft for replacement of the radius after excision of giant cell tumor: case report.

A case is reported in which a giant cell tumor of the distal end of the radius was treated by massive resection and reconstruction with a free vascularized bone graft taken from the fibula. The postoperative course was uneventful. Angiograms made eight weeks after surgery showed patent anastomoses. One year after surgery there was no evidence of recurrence of the tumor, and roentgenograms showed no degenerative changes and bony union with hypertrophy at the junction of the radius and the graft. An excellent clinical result was obtained, and the patient was able to return to his original occupation as an illustrator.

Bone Neoplasms↗
PubMed1991

Thrombocytopenia and absent radius (TAR) syndrome.

We give details of seven children with the TAR syndrome, Thrombocytopenia with absence of the radius. Two of the children were siblings. The TAR syndrome is characterised by hypomegakaryocytic thrombocytopenia and bilateral absence of the radius. It is inherited as an autosomal recessive trait.

Child, Preschool↗
PubMed1992

[Malunion of the distal radius and its treatment. Apropos of 122 radii].

We have reviewed 109 out of 122 operations performed for malunion of the distal radius. An excellent or good result was achieved in 80%, with 3% poor and 7% mediocre. Complications occurred in 12.6%. Accurate assessment of the frontal and sagittal angles of the articular surface of the distal radius was necessary in planning the operation, and correct realignment was required to achieve a proper result. Some cases in which an excellent correction was achieved did not produce a satisfactory outcome because of residual problems with soft tissue or ligaments. No patient with carpal instability had a good result. The morphology of the fracture and the sex or activity level of the patient did not influence the result.

Adolescent↗
PubMed1979

Bipolar fixation of fractures of the distal end of the radius.

The frequency fo secondary displacement in fractures of the distal end of the radius is very high and varies from 40 to 60% in various series. This results from the void in the epiphysis after reduction due to crushing of the cancellous bone. Secondary displacement can be easily avoided by the bipolar fixation method. This method is quite simple. Two strong Kirschner wires are driven into the radius and into the first metacarpal, and then incorporated in the cast after the reduction of the fracture. In this study we have followed 102 out of 250 patients treated by this method. The number of secondary displcements has been negligible. The functional results are excellent and we did not find any untoward effects attributable to our technique.

Adult↗
PubMed1992

Influence of body weight on rates of change in bone density of the spine, hip, and radius in postmenopausal women.

Interrelationships between percent of ideal body weight (%IBW), serum estrogen levels, and change in bone mineral density (delta BMD) and bone mineral content (delta BMC) were studied in 288 postmenopausal women aged 41-71 years who participated in a 2-year calcium supplement trial. The spine (L2-L4) and femoral neck were measured by dualphoton absorptiometry, and the radius was measured by single-photon absorptiometry. Years since menopause, calcium intake, and initial BMD or BMC were included as independent variables in two-phase regressions of delta BMD and delta BMD on %IBW. Increased %IBW protected against loss of spine BMD [regression slope estimate = 0.05, 95% C.I.: (0.03, 0.26)] and BMC in women up through about 106 %IBW but not in heavier women. Increased %IBW was not significantly related to delta BMD or delta BMC at the femoral neck or radius. Women above 106 %IBW had significant gains in spine and femoral neck area (P less than 0.05). Serum estrone and estradiol were positively correlated with delta BMD and delta BMC at the femoral neck only.

Absorptiometry, Photon↗
PubMed1994

Densitometry of the radius using single and dual energy absorptiometry.

Though spinal and femoral measurements are typically preferred for evaluating skeletal density, an abundance of forearm data exists, primarily from single photon absorptiometry (SPA) devices. Most dual X-ray absorptiometry (DXA) scanners are capable of scanning the forearm and provide analysis tools to duplicate conventional SPA measurements. In this study, we have compared the radius density measurements from three commonly available densitometers: a Norland 278 SPA, a Lunar DPX-L, and a Hologic 1000/W. Radius bone mineral density (BMD) on the nondominant forearm was measured in 28 volunteers (21 women and 7 men) aged 24-78, with an average age of 51 +/- 17 years. Values were compared and regression relationships derived at corresponding measurement sites. SPA and DXA BMD values were found to be highly correlated (r = 0.99) with small standard errors (0.014 g/cm2-0.021 g/cm2), though significant absolute differences were observed at most measurement regions. Correlation slopes ranged from 0.85 to 1.04, with intercepts from 0.01 to 0.08 g/cm2. Using the resultant regression equations, SPA BMD values can be converted to DXA values with an expected error of roughly 3%. DXA BMD can also be interconverted between Lunar and Hologic with a similar expected error. In situations where this level of imprecision is acceptable, patient forearm measurements obtained on different systems can be interconverted.

Absorptiometry, Photon↗
PubMed1995

Internal fixation of the distal radius. A comparative, experimental study.

In a comparative, experimental examination of 60 human cadaver radii, the stability of various, widely used internal fixation procedures of a distal radius fracture loco typico using a dorsal wedge was determined. The use of 2.5-mm Kirschner wires (K-wires) delivered a 10% greater stability than 1.8-mm K-wires. The 2.7-mm polylactide rods achieved a slightly greater stability than 1.8-mm K-wires under accurate pinning conditions. Polylactide rods (35 mm length, 2 mm diameter) and polyglycolide rods (60 mm length, 2 mm diameter) proved to be 20% less solid than 1.8-mm K-wires and almost 45% less than plate fixation. The short polylactide pins, however, did not have enough hold in the proximal cortical bone. The 2.7-mm polylactide rods (60 mm length) complied with the stability prerequisites necessary for comparable substitution for K-wires in distal radius fractures.

Bone Nails↗
PubMed1993

Ulnar-shortening osteotomy after fracture of the distal radius.

The ulnar impingement syndrome due to a relatively long ulna is one of the complications of a fracture of the distal radius. We performed ten ulnar-shortening osteotomies to restore distal radioulnar joint congruity. The mean relative ulna length was 4-5 mm. Insufficient bone healing was encountered in four osteotomies. Replating and cancellous bone grafting was necessary in two cases because of nonunion. The functional outcomes were good in six, fair in two, and poor in two cases. Nonunion and poor functional outcome were related to a malunion of the radius with a volar radiocarpal angle of 20 degrees or 25 degrees. It appeared that incongruity of the distal radioulnar joint favored nonunion.

Adult↗
PubMed1995

Cortical thickness assessed by peripheral quantitative computed tomography: accuracy evaluated on radius specimens.

The purpose of the present study was to evaluate the accuracy of peripheral quantitative computed tomography (pQCT) in measuring the thickness of the radial cortex. Thirty left forearm specimens were scanned on an XCT 960 Stratec pQCT device using a 2.5 mm thick slice at the junction of the middle and the distal third of the radius. Cortical and trabecular areas were assessed using a threshold procedure; cortical thickness was subsequently calculated assuming a circular ring model for the radius. Cortical thickness was also measured on the true shape of bone using an iterative contour detection procedure. Subsequently 2.5 mm thick resin-embedded cylindrical radial specimens, matched with the site of pQCT examination, were obtained and contact radiographs were performed. After tenfold magnification, the cortical and trabecular areas of the specimens were measured using computerized planimetry and cortical thickness was calculated assuming a circular ring model. The cortical thickness could be assessed by pQCT in all cases using the threshold algorithm (mean (SD) 2.51 (0.58) mm) and in 21 cases could be directly measured on the true shape of bone (2.62 (0.32) mm). The cortical thickness of the specimens showed good correlation and high proportionality with that measured using pQCT with either the threshold algorithm (r = 0.941, slope = 0.976) or the iterative contour detection procedure (r = 0.883, slope = 0.987). In conclusion, pQCT is able to assess the thickness of the radial cortex, at the junction of the middle and the distal third, with high accuracy.

Aged↗
PubMed1980

Effect of intraosseous fat on the measurements of bone mineral of distal radius.

Intraosseous fat is one of the main sources of error in 241Am bone mineral densitometry of distal radius. In this work we have calculated the magnitude of errors which are possible if the influence of fat is not taken into consideration. Without the fat correction the mineral density of distal radius is underestimated 50-60% with low-density osteoporotic bones.

Adipose Tissue↗
PubMed1994

Early and late displacement of fractures of the distal radius. The prediction of instability.

One hundred fractures of the distal radius with dorsal displacement were treated by closed reduction and a plaster cast. The mean age of the patients was 55 years. Radiographs were taken after 1, 2 and 5 weeks to evaluate the frequency of early and late displacement. Dorsal angulation occurred in 71 patients, shortening of the radius in 47 and flattening of the radial angle in 32. Late displacement was more frequent than early. Statistical analysis showed a greater incidence of secondary shortening in Older's types III and IV fractures. The severity of the initial radial shortening was the most reliable indication of instability.

Chi-Square Distribution↗
PubMed1976

The distribution of cortical and trabecular bone mass along the lengths of the radius and ulna and the implications for in vivo bone mass measurements.

The amounts of cortical and trabecular bone mineral mass were measured by means of microdissection and an ashing technique at approximately 2.5 mm intervals along the most distal 12 cm of radii and ulnae from four women aged 21, 43, 63, and 85. The data show that the distributions of mineral mass and percentage of trabecular bone are similar in both bones. At sites in the radius and ulna commonly used in the photon absorptiometric method of bone mineral mass measurement the percentage of trabecular bone varies between 10% and 50%. The percentage of trabecular bone in the most distal 10% of the length of the radius and ulna remains approximately constant with age but the percentage in the segment which lies between 30% and 40% of the length, measured from the styloid process, increases with age.

Adult↗
PubMed1993

[Resection of the radius head in multiple and comminuted fractures. Clinical results and critical evaluation compared with the literature].

Between 1974 and 1989 39 patients with multi-fragmentary fractures of the head of the radius or radial neck fractures were treated by resection of the radial head at the Department of Trauma and Reconstructive Surgery (UKE-University Hospital Hamburg). Follow-up of 22 patients after 0.5 to 15 years (average 7.8 years) by means of patient documents, actual condition, functionally re-examination of the upper limb and evaluation of the roentgenological changes revealed 22.8% good, 63.6% acceptable and 13.6% poor results according to a modified scoring system. Characteristic complications after excision of the radial head are the increase of the carrying angle of the elbow, the proximal migration of the radius and the loss of grip strength. Due to a critical review of the international literature prosthetic replacement by now does not lead to convincing better results. Reoperations may be mandatory to remove the implant because of tissue reactions or failure of the implant.

Adult↗