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At least 685 records · Page 38Linked to original sources
PubMed1993

[Morphologic causes and consequences of fracture of the distal radius].

Age and stress related changes in the distal epiphysis of the radius are viewed as cause and effect of losses in stability due to pathological stress. 15 in 97 distal radii show typical osseous alterations which can be evidenced after healing of a radial fracture by means of determining the subchondral cortex density. A dorsally directed inclination of the distal radius epiphysis following a healed fracture often be observed. This inclination leads to a redirecting of the resultant force vector which in turn results in a thickening of the subchondral corticalis directed towards the palmar socket margin. The densitometric evaluation based on X-ray depictions enables the morphological characterisation of the restructuring of corticalis and spongiosa in long bones as cause and effect of a fracture.

Aged↗
PubMed1994

[Prosthesis of the head of the radius in long-term follow-up--vitallium versus silastic].

At the Graz Hospital for Accident Surgery, seven Vitallium prostheses were implanted in the period from 1964 to 1968, and nine Silastic prostheses in the period from 1984 to 1991. In January 1993 we were able to do control examinations in eleven patients. Five of them with fractures of type B2.3, five of B3.3 and one of C3.3 according to the AO-Classification. Secondary treatment was done in four patients by prosthetic substitution. All patients had to wear a cast postoperatively for two to eight weeks. Our results--like those already described in relevant literature--clearly confirm the markedly poorere outcome of secondary treatment by prosthetic substitution of the head of the radius. On the basis of our results we therefore recommend in all cases where resection seems to be unavoidable to perform primary atraumatic resection with complete removal of all bone splinters and subsequent prosthetic substitution of the head of radius, if it is not possible to an osteoynthetic operation without immobilisation. We did not find any correlation to the classivication of the fracture types.

Adult↗
PubMed1990

[The density of cortical bone of the distal radius].

The rigid fixation of distal radius fractures by T plates needs a bone substance of sufficient strength to insert screws. In case of advanced osteoporosis only the cortical cone will provide a secure fixation. In this investigation the results of measurement concerning the thickness of palmar and dorsal cortical bone of the distal radius are reported relating to age and sex.

Adult↗
PubMed1993

A computer-assisted method for the study of the trabecular bone of the distal radius on conventional radiographs.

The procedure described is based on the acquisition and processing of x-rays of the distal radius obtained under standard conditions. An x-ray was obtained of the forearm together with an aluminum step wedge to automatically normalize the photometric values of the bone with respect to the photometric values of the reference aluminum wedge. Densitometric values for thickness (T) and a coarseness parameter (C) that depends on the trabecular bone pattern are measured on interactively selected rows and regions of interest (ROIs) of the digital image. Twenty-five women were examined and two different measurements were performed. The first measurement considers C in three sites of the radial epiphisis. The trabecular bone coarseness appears to increase from the distal to the very-very distal site and the value of C in the very distal site, which is located 1 cm distally to the distal one tenth of the radius, seems to be related to the pathological variations more than the value of C in the other sites. The second measurement is the C/T ratio of eight ROIs of 15 patients: five healthy and 10 osteoporotic women. This ratio is significantly different for the two groups in all the eight ROIs and the variations are particularly significant at 6 to 12 mm from the subchondral line.

Absorptiometry, Photon↗
PubMed2003

[Fractures of the distal radius. Minimally invasive pin fixation: indications and results].

Therapy of distal radius fractures in the elderly is increasingly subject to higher demands on functional results, especially in terms of patient comfort, load-bearing, tissue atrophy, and osteoporosis. From 1 January 1998 until 30 June 1999, 215 patients with distal radius fractures were treated at our hospital. One hundred eighteen of them had follow-up examinations after an average of 33 months. Using objective criteria (X-ray and functional), results were very good in 68.9% of the cases and good in 28.6%. Under subjective criteria, too, most of the patients had very little or no complaints (68%). These results underline the need and usefulness of differentiating operative therapies according to the fracture type in the AO classification system.

Adolescent↗
PubMed2003

[Distal radius fractures. 2.4 mm locking compression plates. Are they worth the effort?].

Fracture of the distal radius has a second peak of incidence in the second half of life. Because complex injuries are seen frequently, there is a need for differentiated treatment to achieve good results. The aim of our study was to evaluate the treatment of distal radius fractures with 2.4-mm locking compression (LC) plates in patients older than 65 years suffering from osteoporosis to determine the complications and compare costs of treatment with different interventions. Thirty-seven patients were included in this prospective study. The distribution of fractures according to AO classification was: nine type A, one type B, and 27 type C. The mean age was 76 years. Twenty-six volar plates, seven dorsal and four "sandwich" procedures were applied. The mean follow-up for 33 patients was 11.1 months. Using the functional Lidström score, we found 13 very good results, 15 good, four fair, and one poor, the radiologic Lidström scores were: 15 very good, 13 good, four fair, and one poor results. With the application of 2.4-mm LC plates, findings were good or very good in over 80%of osteoporotic distal radial fractures. Compared to other treatments, the real costs of intervention for LC plates is much higher.

Age Factors↗
PubMed2004

[Do fixed-angle T-plates offer advantages for distal radius fractures in elderly patients?].

In the treatment of distal radius fractures, plate osteosynthesis using fixed-angle T-plates has become more common. Higher stability often allows functional aftertreatment in metaphyseal and articular fractures. So far it remains unclear whether these advantages also apply to elderly patients who commonly suffer from osteoporosis and reduced cooperativeness. Therefore, we evaluated the radiological loss of correction during fracture consolidation in patients aged more than 70 years. Fixed-angle plates were used in 44 patients (mean age: 79.4 years) while conventional T-plates were used in 30 patients (mean age: 78.2 years). Postoperative immobilization for 6 weeks by plaster or external fixator was performed in all patients. The loss of correction was significantly lower for fixed-angle plates (4.6% vs 40.0%). As a result of this study, we have gradually reduced immobilization in favor of early functional treatment. In a recent study fixed-angle plates so far seemed to permit stable fracture fixation. Our results underline the advantage of stable fixation in displaced fractures of the distal radius even in osteoporotic bone of elderly patients.

Aged↗
PubMed2007

[Comparison of C-arm CT and standard imaging in osteosyntheses of fractured distal radius specimens].

BACKGROUND: The purpose of this study was to evaluate the value of C-arm CT imaging of the distal radius with standard patient positioning in intraoperative assessment of plate osteosynthesis. MATERIALS AND METHODS: Four complete distal radius specimens from human cadavers were fractured (type C), and internal fixation with palmar plates (stainless steel) was then carried out in each. On the basis of C-arm fluoroscopy, radiography and C-arm CT (Siremobil Iso-C3D, scans with forearm bones positioned parallel to the z-axis), 19 observers subsequently evaluated the positions of screws near the joint and any steps within the joint, after which the bones were surgically exposed and the imaging results checked against direct visual observations. RESULTS: No statistically significant differences were detected either between the modalities or between the evaluator groups. CONCLUSION: With standard patient positioning, the performance of C-arm CT was equivalent to and not better than that of current standard procedures, i.e. intraoperative fluoroscopy and postoperative radiography. Further studies should examine whether this holds true in clinical practice with representative patient collectives when titanium implants are used and/or optimized patient positioning is practised.

Cadaver↗
PubMed2001

[Correction of malunited distal radius fractures by osteotomy and interposition of iliac crest bone spain in the radio-palmar position. A retrospective study of 42 patients].

The retrospective study included 42 patients who have been treated with a palmar opening wedge osteotomy after malunion of distal radius fracture. 31 patients could be reexamined clinically and radiologically. The corrective osteotomy on the distal radius was done only radiopalmar with an insertion of a corticocancellous iliac graft. Radiological and functional findings as well as the subjective judgement of the patient have been commented pre- and after surgically according to the assessment scheme of Pechlaner and were then compared with the contra lateral wrist. The evaluation of the x-ray pictures showed an improvement from 3.7 to 1.9 points, the functional improvement from 3.7 to 2.6 points. The improvement of the subjective complaints results in a diminution of 3.3 to 2.2 points.

Adult↗
PubMed2006

Wrist arthroscopy and intra-articular fractures of the distal radius in young adults.

UNLABELLED: The difficulty on treatment of articular fractures of the distal radius comes from their comminutive character and frequency of ligamentous lesions associated, turning diagnosis and assessment always subject to discussion. Fracture reduction and fixation under arthroscopic control, along with ligamentous injury treatment, provides the Surgeon with a valuable tool in order to achieve best results on follow-up. Eighteen fractures of the distal radius on 18 young adults (average age of 28.6 years), all intra-articular and 9 with ligamentous lesions associated, were operated on under arthroscopic control. Results from an average distance of 12.2 months were appraised following the score of Green and O'Brien modified by Cooney. They were excellent in five cases, good in eight cases, average in four cases and bad in one case. Recovery was best for fractures with weak comminution and when articular congruence was restored. Arthroscopy, allowing control of fracture reduction, to diagnose and possibly treat associated ligamentous lesions, constitutes a good alternative to open surgical treatment. LEVEL OF EVIDENCE: case series (level IV).

Adolescent↗
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↗
PubMed1999

Image analysis of the distal radius trabecular network using computed tomography.

Bone texture analysis might provide information about bone structure in a noninvasive manner. In a prospective case-control cross-sectional study we investigated the value of computed tomography (CT) image analysis of the distal radius in the assessment of osteoporosis. Twenty patients suffering from postmenopausal osteoporosis were studied and compared with 21 age-matched controls. Eight slices were selected in each patient: four consecutive coronal slices and four consecutive cross-sectional slices. Bone texture analysis was performed using statistical, fractal and structural methods leading to the measurement of 32 features. Structural variables derived from histomorphometric parameters were measured after segmentation from a binary or a skeletonized image. Bone mineral density was measured by dual-energy X-ray absorptiometry both at the lumbar spine and the femoral neck. Eight of the 9 statistical features were significantly different in osteoporotic women as compared with controls (coronal slices, p < 0. 05). Seven structural variables were statistically different between the two groups on coronal slices (p < 0.05): valley surface area, bone volume/tissue volume, trabecular partition, Euler's number, trabecular bone pattern factor, node-to-node strut count and terminus-to-terminus strut count. The most significant results on coronal slices (p < 0.01) concerned 4 structural features: trabecular partition, Euler's number, trabecular bone pattern factor and terminus-to-terminus strut count. Three features were statistically different (p < 0.01) between the two groups on cross-sectional slices (skeletonization from gray levels). A few features yielded by texture analysis were correlated with both lumbar spine and femoral neck bone mineral density, but the level of these correlations was weak (r < 0.5). In conclusion, CT image analysis of the distal radius is a useful tool for characterizing bone texture alterations in osteoporotic women. These findings are in keeping with microarchitectural osteoporosis-related changes diagnosed on bone biopsies.

Aged↗
PubMed1997

Dedifferentiated parosteal osteosarcoma of the radius.

A 35-year-old woman presented with a painful swelling in the left distal radius that had been present for 1 year. Radiography and computerized tomography revealed a sclerotic surface lesion that had grown over the year and eroded the cortex. Histological examination demonstrated two distinct components: a cartilaginous low- to moderate-grade osteosarcoma on the surface and a high-grade osteosarcoma in the intramedullary component. This case is uncommon in two aspects: the radius is a rare site for such a tumor and the dedifferentiation was revealed at the time of the first surgery and was not secondary to recurrence.

Adult↗
PubMed2001

The Kapandji technique for fixation of distal radius fractures--a biomechanical comparison of primary stability.

The goal of this study was to compare Kapandji-K-wiring and established K-wiring techniques of the distal radius fracture for primary stability in a biomechanical model: dorsal K-wiring according to Kapandji using different angles of the K-wire, parallel and diagonal alignment of the K-wires. A new testing system which uses a synthetic material enabled us to carry out the cantilever bending test. By application of a lower load, the Kapandji procedure shows a higher reactive torque and stiffness. A higher reaction force of the other techniques, especially of the parallel wiring, are only observable under high-grade bending stress. Application of the Kapandji procedure with K-wires at a smaller angle to the axis of the radius results in the highest primary stability of the procedures investigated in the essential range of initial deformation.

Biomechanical Phenomena↗
PubMed1999

Intra-focal fixation for treating distal radius fracture: results of 104 cases.

Intra-focal fixation for a displaced distal radius fracture is a surgical option that achieves early functional recovery. We report a retrospective evaluation of the results with various types of distal radius fracture, using various fixation materials in 104 patients (69 women and 35 men; average age, 51.4 years; range, 4-91 years). Fracture types classified according to Frykman were: 14 type I, 15 type II, 6 type III, 16 type IV, 10 type V, 16 type VI, 9 type VII, and 18 type VIII. Fixation materials used were: conventional Kirschner wire in 6 patients, threaded Kirschner wire in 38, arum pins in 38, and conehead wedging screws in 22. The results for patients with Frykman types V-VIII fractures were not as good as those for patients with types I-IV. The arum pin and conehead wedging screw were each superior to either Kirschner wire or threaded Kirschner wire in reducing the fracture and in maintaining fixation. Our evaluation suggested that intra-focal fixation was also suitable for treatment of an intra-articular fracture. In elderly patients, we recommend the arum pin and conehead wedging screw as fixation materials, and suggest short-term postoperative immobilization.

Adolescent↗
PubMed2000

Increasing incidence of distal radius fractures in Japanese children and adolescents.

To investigate recent trends in the incidence of fractures in children and adolescents, we conducted a survey of distal radius fractures in 1992 and 1995 in Tottori Prefecture, Japan. Seven-hundred and forty-five patients under age 20 years were registered (562 males and 183 females). The age and sex-specific incidences of fractures in patients under 20 years of age were higher in males than in females, showing peaks at age 12-13 years for males and at age 10-11 years for females. The incidences had an obvious monthly variation, with peaks in spring and autumn. The age and sex-specific incidences were compared with those in the period 1986-1988, which we reported previously. The incidence in each year showed a significant increase with time for males but not for females. We conclude that the incidence of distal radius fractures in children and adolescents has a prominent peak matched by the age of the growth spurt, and the incidence of the fracture has increased in males during the past decade in Tottori Prefecture.

Adolescent↗
PubMed2000

Handgrip strength is an independent predictor of distal radius bone mineral density in postmenopausal women.

Several cross-sectional studies have reported a positive correlation between muscle strength and local bone mineral density. However, very few studies have evaluated the possible role of confounding variables, which may be substantial as both bone mineral density and muscle strength are multifactorial variables. We studied 140 postmenopausal women who underwent their first osteodensitometry in our hospital. Of these, 102 women affected neither by bone diseases apart from primary osteoporosis nor treated with drugs affecting bone mass were selected. Distal radius bone mineral density of the non-dominant arm was assessed by dual photon absorptiometry. Handgrip strength was measured by a handheld dynamometer. The following factors influencing bone mass were also considered: age, years since menopause, years of cyclic ovarian activity, body weight, body height, body mass index, and both calcium and alcohol dietary intake. Statistical evaluation was performed by stepwise multiple regression analysis. This showed that only two variables were independently related to bone mineral density: handgrip strength (which was the best bone density predictor among the studied independent variables) and years since menopause. R2 value was 0.43 (F=38.04, p < 0.001). All the other variables studied were not significantly related to bone density when the effects of both strength and years since menopause were considered. In conclusion, the data showed that handgrip strength was a strong independent predictor of distal radius bone mineral density in postmenopausal women. Clinical assessment of osteoporosis risk factors, including muscle strength, is recommended: although it is not an adequate substitute for bone densitometry, it can help clinicians to identify the risk groups at which to direct bone density measurement.

Adult↗
PubMed1980

Tension band wiring for fixation of comminuted fractures of the distal radius.

In the treatment of unstable comminuted and intra-articular fractures of the lower end of the radius, we have found that is is essential to reconstitute the normal anatomical relationship of the radius to the carpus and to the ulna. This is possible by performing an open reduction and by maintaining the fractured fragments by Kirschner wires and adding a tension band. Patients treated thus are reported. There have been no complications and the patients regained full function of the wrist without unsightly deformity.

Adult↗