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A stress fracture of the radius occurred in a 22-year-old pool player who was well known for his unique style of putting 'English' on the billiard ball. Typical radiographic findings were seen, and the fracture subsequently healed. Only a few cases of stress fracture of the radius have been previously reported.
Twenty-eight unstable distal fractures of the radius have been treated with pins incorporated into a forearm plaster. The wrist is maintained in a neutral position permitting early use of the hand. Secondary displacement has been decreased. It is a safe and effective method of treating unstable distal fractures of the radius suitable for regular use in a busy district general hospital without the need of expensive specialized equipment.
Fractures of the distal radius in young adults are not uncommon, but have received little attention in the literature. This paper reports a series of 40 fractures of the distal radius. The quality of reduction was found to relate directly to the final result. The authors suggest that open reduction and internal fixation be used more frequently in the management of this fracture.
We present five cases of acute volar compartment syndrome developing as a complication of fractures of the distal radius. The patients were all males under the age of 50 years who sustained comminuted or displaced fractures of the distal radius. We suggest that this indicates an 'at risk' group. The interval between injury and the onset of symptoms of volar compartment syndrome varied between 12 and 48 hours. The diagnosis of each case was made clinically and confirmed at operation. With early extensive decompression full neurovascular recovery can be expected.
From 1977 to 1982 a total of 55 patients suffering comminuted fracture of the distal radius were treated with the external fixator. Fifty of these were followed up in 1983/85 and 32 of them were available for assessment in this study (1992). The follow-up period was 11.6 years on average. All patients had suffered an intra-articular fracture (91% a C-fracture, 9% a B-fracture according to the AO classification), 27 patients had also fractured the ulnar styloid process and in 11 a dye-punch fragment was present. Both wrists were assessed on the basis of case history, clinical examination, radiographs in two planes and visual analogue scales (VAS). The results were evaluated using established scoring systems. On the Gartland and Werley scale 75% of the results were good or very good, 63% according to Castaing. In general, there was no statistically significant difference between the results of this study and those of 1983/85. It could be demonstrated that there was a relationship between arthritis as a late complication and the existence of an intra-articular step-off of at least 2 mm at implant removal. This also has a negative influence on the range of motion and strength. Radial shortening affects the functional result whereas a die-punch fragment does not. On VAS patients identified performance restriction and disability as the worst consequences of the accident; these criteria correlated best with the results of objective evaluations. In contrast, patients were more satisfied with the result of treatment than would be expected from the objective analyses. The overall results indicate that exact reduction was extremely important. Long-term follow-up showed that the use of the external fixator in the treatment of comminuted intra-articular fractures of the distal radius was an adequate method. Prospective and possibly multicentric studies would be required to investigate more detailed relationships between treatment and long-term results.
Specific gravity, porosity index (physical parameters), hydroxyproline, calcium, magnesium, and phosphorus (chemical parameters) were determined in iliac crest trabecular bone of normal and osteoporotic subjects. These physical and chemical parameters were compared to bone mineral contents (BMC) measurements by x-ray photodensitometry of the radius. BMC values correlated negatively with porosity index, specific gravity, and degree of mineralization of trabecular bone matrix, which all increase with osteoporosis. There was a negative correlation between calcium and magnesium contents per net bone volume. "Distal" scans of the radius reflected better the axial skeleton mass than "proximal" scans, and physicochemical data correlated better with bone mineral content values than with bone mineral mass (BMM) values.
Rates of change in bone mineral density (BMD) at four skeletal sites were measured in 288 healthy postmenopausal women (41-71 years) who were participants in a 2-year calcium supplement trial. Mean calcium intake from food and supplements was 719 +/- 299 (sd) mg/day during the study. Annualized change in spine (L2-4) BMD, adjusted for body size, dietary calcium intake, treatment group and smoking was -2.24% +/- 2.07% (sd) in women who were 1 to 2 years postmenopausal and declined in women through 5 years after menopause. The rate of change in women who were 6 or more years postmenopausal was -0.96% +/- 2.96%. Mean adjusted change in heel BMD in all women was -1.16% +/- 3.26%. At the femoral neck and radius there was no significant adjusted change in BMD in the group as a whole (femoral neck -0.24% +/- 2.55%; radius -0.14% +/- 2.24%), and the rate of bone loss was not detectably accelerated in women closest to menopause. Rates of bone loss in the subset of subjects who received no calcium supplementation tended to be greater at all skeletal sites.
External fixation is a useful method of treating unstable fractures of the distal radius. There is a lack of information regarding the behaviour of mini-fixation systems, particularly under cyclical loading, which would be expected to occur at the wrist. This laboratory study was designed to investigate the mechanical characteristics of nine current fixation systems. A programme of loading was devised to mimic forces acting on the distal radius. Wooden dowel was used to mount the fixator. Distraction and compression forces were applied in an Instron rig. Displacement was monitored throughout the load programme. No fixator failed at the loads tested. The small Hoffman rectangular frame proved stiffest in compression and extension, but was heavier than other devices. A trend of progressive, permanent deformation became apparent in those fixators which contain plastic or composite materials. This feature has implications for loss of fracture reduction in the clinical setting.
The interosseous membrane of the forearm of 12 fresh cadaver specimens was studied anatomically and mechanically to better understand its role in stabilization of the radius after radial head excision. A central band of ligamentous tissue, approximately twice the thickness of the membrane on either side was identified in all specimens. Mechanical studies determined the relative contribution to longitudinal stiffness of the forearm. The central band was responsible for 71% of the longitudinal stiffness of the interosseous membrane after radial head excision. The contribution of the triangular fibrocartilage complex was 8%. Silicone radial head implants were much less stiff than the intact interosseous membrane. Injury to the central band of the interosseous membrane may be crucial to the development of proximal migration of the radius after radial head excision.
Three patients with advanced giant cell tumors of the distal radius received a frozen allograft replacement of the distal radius, accompanied by a distal radioulnar arthrodesis with ulnar osteotomy proximal to the wrist. Follow-up ranged from 2 to 4 years. During this time this combined procedure provided the following advantages: complete tumor resection, no donor site morbidity, retention of pronation-supination, and avoidance of pain or subluxation at the distal radial ulnar joint.
An experimental model using a static positioning frame, pressure-sensitive film (Fuji), and a microcomputer-based videodigitizing system was used to measure contact areas and pressures in the wrist. Contact areas and pressures were compared in a group of wrists between the normal state and with simulated distal radius fracture malunions of varying degrees. In simulated malunions, radial shortening to any degree slightly increased the total contact area in the lunate fossa, and was significant at 2 mm of shortening. By angulating the distal radius more than 20 degrees either palmar or dorsal, there was a dorsal shift in the scaphoid and lunate high pressure areas, and the loads were more concentrated, but there was no change in the load distribution between the scaphoid and lunate. Decreasing the radial inclination shifted the load distribution so that there was more load in the lunate fossa and less load in the scaphoid fossa.
Functional disability after a Colles' fracture was correlated to the degree of axial shortening of the radius measured at the site of distal radioulnar joint. According to the sum of demerit points, the functional end result was unsatisfactory (fair or poor) in 4% of the patients with an acceptable anatomic result, in 25% of the patients with grade 1 shortening (corresponding to a shortening of 3 to 5 mm), and in 31% of the patients with grade 2 shortening (shortening of more than 5 mm). The results suggest that even a minor axial shortening of the radius, without concomitant malalignment of the articular surface, carries an increased risk of permanent disability.
From a series of 650 dorsally angulated fractures of the distal radius, 32 intra-articular fractures were treated by open reduction and internal fixation. The 32 fractures were classified according to the Frykman criteria as type VII (5) or type VIII (27). On the basis of the location of intra-articular involvement, the fractures were further subdivided into Mayo type II (4), type III (18), and type IV (10). Results were analyzed by the methods of Gartland and Werley (functional) and Lidström (radiographic). After open reduction and internal fixation, 90% of the patients had satisfactory results on the basis of the subjective criteria of minimal deformity, absence of pain, and good strength. Objective assessment demonstrated that the patients had 80% of normal motion and 73% of normal grip strength at a minimum of 2 years after the operation. On the basis of radiographic and functional evaluation, results were good to excellent in 87%. When intra-articular step-off exceeded 2 mm or the radius was shortened more than 5 mm, the results were only fair and posttraumatic arthritis was evident.
Two unique cases of complex nonunions of the radius are presented. Each was characterized by bone loss, disruption of the distal radioulnar joint, and loss of axial alignment. Indirect reduction and lengthening of the radius were accomplished intraoperatively with the use of a femoral distractor, and the nonunion was treated with autogenous iliac crest graft and a long AO/ASIF dynamic compression plate. A functional result occurred in each case.
From 1985 to 1990, six patients were treated for ipsilateral fractures of the scaphoid and radius. All these injuries resulted from falls from a substantial height, with multiple injuries occurring in all patients. Two of the patients had minimally displaced fractures (1.0 mm), whereas the other four patients had moderately displaced scaphoid fractures (2.0 mm). The treatment for fracture of the distal radius was dependent on the fracture type, but all the scaphoid fractures were treated with internal fixation. All the fractures united, with the radial fractures healing in 6 weeks and the scaphoid fractures healing in an average of 13 weeks. The follow-up time averaged 2.9 years (range, 1.0 to 4.6 years). Internal fixation of the scaphoid in these combined injuries allowed for earlier and more aggressive therapy to maximize wrist and forearm motion.
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.
Insertion of a dorsal fixation pin was performed in 10 patients treated for distal radius fractures associated with dorsal angulation of the distal fragment. These fractures did not improve position with direct traction. Reduction was achieved with the use of a dorsal pin, used as a lever, to correct dorsal tilt of the fracture and to reestablish anterior angulation of 10 degrees in the distal joint surface of the radius. The dorsal pin was then fixed to an external fixator bar. All of these fractures healed in good position with appropriate alignment and without complications.
This paper addresses two important issues of three-dimensional (3D) natural shape analysis. The first concerns the segmentation of these shapes into 3D primitives and the second deals with their geometric characterisation by means of intrinsic features. Restricting ourselves to 3D objects formed from two-dimensional (2D) cross-sectional adjacent slices (i.e., long bones), we present a method of contextual classification and results concerning the ulnar bone. With respect to the second issue, a curvature-torsion analysis of the medullar axis is introduced and the results are represented by means of torsion images. A first application to ulnar structures is given. It is shown that radius bones have zero torsion and that their curvatures can be studied in 2D. A preliminary statistical study of the 2D curvature of the radius is also presented.