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At least 793 records · Page 44Linked to original sources
PubMed2000

Prenatal diagnosis of thrombocytopenia-absent-radius (TAR) syndrome.

The prenatal diagnosis of thrombocytopenia-absent-radius (TAR) syndrome using ultrasound and cordocentesis in the 16th week of gestation is established. The sonographic findings detected in this case included bilateral absence of the radius and club hands with normal thumbs and metacarpals. Because of a high index of suspicion for the syndrome, cordocentesis for fetal blood analysis was performed. Thrombocytopenia, with a platelet count of 14,000/mm3, was identified. The pregnancy was electively terminated and subsequent findings confirmed the sonographic diagnosis. This report, to our knowledge, is one of a very limited number of cases published in the literature, in which the prenatal diagnosis of TAR syndrome was made.

Abortion, Therapeutic↗
PubMed1999

Tilted lateral radiographs in the evaluation of intra-articular distal radius fractures.

The anatomy of the distal radius confounds the assessment of fracture displacement of the lunate facet. Since reduction of the articular surface is paramount to obtaining good clinical results, this study was designed to evaluate whether a radiograph taken 22 degrees from true lateral (forearm held at a 22 degrees angle from the horizontal film cassette) would enhance the accuracy of measuring displacement. Fifteen lunate facet fractures of varying depression were produced in 7 fresh cadaveric wrists. Posteroanterior (PA), standard lateral, and 22 degrees tilted lateral radiographs were obtained of each fracture pattern. Four observers reviewed the films and measured the depression of the fragments from their anatomic position. Measurement error from actual depression averaged 1.1 mm when the evaluators evaluated the 22 degrees lateral and PA films, 1.5 mm for the standard lateral and PA views, and 0.8 mm for the standard lateral, 22 degrees lateral, and PA radiographs (combined group). The decrease in measurement error obtained from all 3 groups was statistically significant. The results of this study suggest that the 22 degrees tilted lateral, either in combination with the standard lateral radiograph or just with the PA view, may help the hand surgeon better understand the intra-articular depression of lunate facet fractures of the distal radius.

Cadaver↗
PubMed1999

The evaluation of tension in an experimental model of external fixation of distal radius fractures.

A cadavaric model was used to evaluate the previously reported methods of determining excessive tension when applying an external fixator across the wrist. An osteotomy of the distal radius was performed and tension was applied incrementally across the joint in 9 cadaveric specimens. The fingers of each specimen could fully flex to the palm at all levels of tension tested. Although the radiocarpal and midcarpal joint spaces did lengthen with incremental changes in the amount of tension, there was no statistically significant correlation that could be made about the difference between the radiocarpal and midcarpal spaces and tension applied across the wrist. Although the carpal height ratio increased significantly from 0 to 10 lb of traction, the carpal height ratio appeared to plateau after further increases in tension. In conclusion, surgeons need to be careful when using any of these previously reported techniques for determining the optimal tension to be applied with an external fixator across the wrist. These techniques may not reproducibly allow the surgeon to detect whether there is excessive distraction across the distal radius fracture.

External Fixators↗
PubMed2000

Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years.

Twenty-five sedentary, low-demand patients older than 60 years were retrospectively evaluated for function and radiographic results following nonoperative treatment of displaced distal radius fractures. The mean age was 72 years and the average follow-up period was 34 months. All patients had radiographic and functional evaluations. The radiographic assessment included a scoring system based on measurements of the final dorsal angle, loss of radial length, and the final radial inclination. The development of radiocarpal and distal radioulnar joint arthrosis was also investigated. The functional assessment included subjective and objective criteria. Overall satisfaction, ability to return to previous activity level or occupation, concern over wrist appearance, and a functional task questionnaire were part of the subjective assessment. Objective assessment included neuromuscular evaluation and measurements of range of motion and grip strength. The final radiographic scores revealed that 6 patients (24%) had excellent results, 11 (44%) had good results, 2 (8%) had fair results, and 6 (24%) had poor results. Six of 10 patients with intra-articular fractures developed progressive wrist arthrosis. Two of 6 patients with radiographic arthrosis had unsatisfactory functional outcome. Five of 8 patients with intra-articular fractures that healed with a residual stepoff >/=2 mm had satisfactory functional outcome; 3 of these 8 patients had unsatisfactory functional outcome. The functional assessment revealed that 22 patients (88%) had excellent or good results and 3 (12%) had fair or poor results. The radiographic outcome did not correlate with the functional outcome. Twenty-three of 25 patients (92%) were satisfied with the overall outcome of the treatment and 22 (88%) were able to return to their previous activity level or occupation. Despite an obvious clinical deformity in over half of the patients, none were unhappy with the clinical appearance of the wrist. According to the functional task questionnaire, jar opening was by far the most difficult task to perform after fracture healing. Functional outcome was satisfactory in most cases; a high level of personal satisfaction and return to previous activity level was observed, regardless of the radiographic result. Nonoperative treatment of distal radius fractures yields satisfactory outcome, especially in those with low functional demands. It also is indicated in poor operative candidates. (J Hand Surg 2000; 25A:19-28.

Activities of Daily Living↗
PubMed2000

Responsiveness of the short form-36, disability of the arm, shoulder, and hand questionnaire, patient-rated wrist evaluation, and physical impairment measurements in evaluating recovery after a distal radius fracture.

We evaluated the responsiveness of patient questionnaires and physical testing in the assessment of recovery after distal radius fracture. Patients (n = 59) were assessed at their baseline clinic visit and again 3 and 6 months after injury. At each visit patients completed a short form-36, Disability of the Arm, Shoulder, and Hand questionnaire, and patient-rated wrist evaluation (PRWE). At 3 and 6 months grip strength, range of motion, and dexterity were analyzed. Standardized response means (SRM) and effects sizes were calculated to indicate responsiveness. The PRWE was the most responsive. Both the PRWE (SRM = 2.27) and the Disability of the Arm, Shoulder, and Hand (SRM = 2.01) questionnaire were more responsive than the short form-36 (SRM = 0.92). The physical component summary score of the short form-36 was similar to that of the physical component subscales. Questionnaires were highly responsive during the 0- to 3-month time period when physical testing could not be performed. Of the physical tests, grip strength was most responsive, followed by range of motion. Responsive patient-rating scales and physical performance evaluations can assist with outcome evaluation of patients with distal radius fracture.

Adolescent↗
PubMed2001

Ilizarov hybrid external fixation for fractures of the distal radius: Part II. Internal fixation versus Ilizarov hybrid external fixation: Stability as assessed by cadaveric simulated motion testing.

The in vitro stability of an Ilizarov hybrid external fixator was compared with that of a dorsal 3.5-mm AO T-plate in 8 unpaired, fresh-frozen upper extremities. A specially designed testing device that used computer-controlled pneumatic actuators was used to simulate active finger, wrist, and forearm motions by applying loads to relevant tendons. A comminuted extra-articular distal radius fracture was modelled using a dorsally based wedge osteotomy. Fracture stability was assessed using an electromagnetic tracking device to measure motion across the fracture site after randomized application of the plate and the hybrid fixator. During simulated finger and wrist motions with the forearm pronated or supinated, motion of the distal fragment with the hybrid fixator applied was comparable to or statistically less than with the AO plate applied. During simulated forearm rotation, the stability provided by the 2 fixation types was similar, although the plate allowed statistically less radial-ulnar deviation of the fragment. In this model of a 2-part extra-articular distal radius fracture, the clinically meaningful stability of the Ilizarov hybrid external fixator was comparable to that of the dorsal AO plate.

Aged↗
PubMed2001

Computed tomography scanning of intra-articular distal radius fractures: does it influence treatment?

The purpose of this study is to determine whether the addition of computed tomography (CT) results in changes in the evaluation and treatment of intra-articular distal radius fractures. Fifteen intra-articular distal radius fractures were evaluated independently by 4 hand surgeons. Plain x-rays were reviewed initially followed by the corresponding CT scans for comparison of articular step-off and gapping, comminution, and treatment. Kappa coefficients (kappa) of intraobserver and interobserver reliability for treatment plans were generated. Computed tomography scans improved the sensitivity of measurement of articular surface gapping, improved the accuracy of detection of comminution and distal radioulnar joint involvement, and altered proposed treatment plans within observers (intraobserver agreement: kappa =.54, moderate) and improved agreement of proposed treatment plans between observers (kappa =.34 to kappa =.44, fair to moderate). Computed tomography scanning influenced observers to change treatment plans and resulted in increased interobserver reliability in the proposed management of these injuries.

Humans↗
PubMed2001

Treatment of the unstable distal radius fracture with external fixation and a hydroxyapatite spacer.

A prospective study was performed on 25 patients (15 women, 10 men) with unstable fractures of the distal radius selectively treated with a dynamic type of external fixation combined with a hydroxyapatite spacer. The fractures ranged from type VI to type VIII according to Frykman's classification. The patients' mean age at surgery was 49 years (range, 19-75 years). The mean follow-up period was 2.5 years, and overall outcome was assessed using Gartland and Werley's demerit point system as modified by Sarmiento. Radial inclination was 26 degrees +/- 4 degrees at the time of reduction and 26 degrees +/- 5 degrees at follow-up, palmar tilt was 9 degrees +/- 2 degrees at reduction and 8 degrees +/- 3 degrees at follow-up, and ulnar variance was 1.4 +/- 0.6 mm at reduction and 2.1 +/- 0.9 mm at follow-up. The mean range of motion at follow-up was 80 degrees +/- 10 degrees in flexion, 80 degrees +/- 10 degrees in extension, 85 degrees +/- 10 degrees in supination, and 80 degrees +/- 5 degrees in pronation. The outcome in 24 of 25 patients was evaluated as excellent. In the surgical treatment of unstable fractures of the distal radius using external fixator, the fracture reduction should be supported with bone graft or a bone substitute, and a hydroxyapatite spacer was considered to be a useful substitute for a bone graft.

Adult↗
PubMed2002

Osteosarcoma of the distal radius treated by intraoperative extracorporeal irradiation.

Osteoblastic osteosarcoma in the distal radius of a 50-year-old woman was treated by en bloc resection, intraoperative extracorporeal irradiation, and reimplantation. Twenty-three months after surgery finger function was good. No tumor recurrence or distant metastasis was found at the final follow-up examination. Intraoperative extracorporeal irradiation and reimplantation is an easy and convenient reconstructive surgical procedure after en bloc excision of a tumor in the distal radius. A biologic reconstruction with a precise anatomic fit is possible, and long-term endoprosthetic problems and maintenance of bone-banking facilities for allografts are avoided.

Bone Neoplasms↗
PubMed2002

Wedge osteotomies of the radius for Kienböck's disease: a biomechanical analysis.

We compared changes in lunate cortical strain with an applied physiologic load by altering radial inclination to simulate opening and closing wedge osteotomies of the distal radius. Nineteen fresh-frozen cadaver arms were mounted in neutral position and tested under axial compression at a physiologic load by means of a repeated-measures design. Principal compressive strains were measured with rosette strain gauges mounted on the lunate's palmar and dorsal cortices. Distal radius osteotomy and custom external fixator allowed for altering radial inclination in progressive 3 degrees increments both by increasing and decreasing radial inclination in each specimen. Maximum principal strain was recorded for each inclination increment and compared with control. Comparison of all data showed a 26% decrease on lunate cortical strain for the radial opening wedge osteotomy and a 24% increase for the radial closing wedge osteotomy. This difference was statistically significant. No significant differences were found between individual angular increments (3 degrees to 15 degrees). The radial opening wedge osteotomy was more effective than the radial closing wedge osteotomy at diminishing lunate strain. The results validate the biomechanical effectiveness of this extra-articular osteotomy, which is intended to minimize alteration of ulnar variation.

Analysis of Variance↗
PubMed2002

Lateral closing wedge osteotomy of the distal radius for advanced stages of Kienböck's disease.

Seven patients with advanced Kienböck's disease, stage III-B and IV by Lichtman classification, who were treated with lateral closing wedge osteotomy of the distal radius were evaluated clinically and radiographically. The clinical results were correlated with radiographic changes. Five patients had stage III-B and 2 had stage IV disease; average follow-up period was 50 months (range, 24-93 months). Clinical results were good in 4 patients, fair in 2 patients, and poor in 1 patient based on Nakamura's postoperative clinical scoring system. The carpal-ulnar distance ratio and lunate-covering ratio increased and the radioscaphoid angle improved significantly. The improvements in radioscaphoid angle and Nakamura's postoperative clinical score showed a significant correlation. The satisfactory clinical outcome of lateral closing wedge osteotomy of the distal radius for advanced-stage Kienböck's disease can be attributed to the effects of the increased lunate-covering ratio and the improved radioscaphoid angle on carpal alignment.

Aged↗
PubMed2002

Failure of a retinacular flap to prevent dorsal wrist pain after titanium Pi plate fixation of distal radius fractures.

Patients with distal radius fractures that had been treated with a dorsal Pi plate and retinacular flap covering the transverse limb of the Pi plate were evaluated clinically and radiographically. Nine of 20 patients (45%) required plate removal for dorsal wrist pain. Three of the remaining 11 who retained the plate had dorsal tenderness over the wrist extensors. There were no differences evident between the 2 groups in plate size, position, or number of screws used. In addition there were no significant differences between the groups in either radial height or inclination. The palmar tilt did show a trend toward statistical significance: those patients who required plate removal had an average of 4.1 degrees of dorsal tilt, patients whose plate was not removed averaged 2.8 degrees of palmar tilt. Our results show that the retinacular flap covering the distal transverse limb of the Pi plate did not prevent the occurrence of dorsal wrist pain. Dorsal wrist pain remained a problem with dorsal plating of distal radius fractures.

Adult↗
PubMed2002

Surgical treatment of redisplaced fractures of the distal radius in patients older than 60 years.

Twenty patients aged 60 years or older (average age, 68 y) presented to our institution with a distal radius fracture made complex by virtue of displacement after a closed reduction and cast or external fixation immobilization. Ten of the fractures were volarly angulated and 10 were dorsally angulated. Fifteen patients' hands had associated soft-tissue swelling. Surgical exposure and stable internal fixation were undertaken to both realign the fracture as well as enable functional rehabilitation. The final functional result and radiographic results were physician rated and patient rated by using the Patient Rated Wrist Evaluation (PRWE). The patients' overall activity level was quantified and compared with population norms by using the Physical Activity Scale for the Elderly (PASE). At an average follow-up visit of 38 months, all the fractures healed and none of the implants loosened or broke. The functional results were excellent in 7, good in 11, and fair in 2. The average PRWE score was 14, which compares favorably with prior studies of adult patients of all ages treated for a distal radius fracture. The PASE score averaged 177, representing a return to preoperative activity levels in 17 of 20 patients. Complications included loss of alignment, tendon rupture, transient radial sensory neuritis, and nonfatal pulmonary embolism in 1 patient each. Six plates were removed because of soft-tissue irritation.

Aged↗
PubMed2002

Sigmoid notch reconstruction using osteoarticular graft in a severely comminuted distal radius fracture: a case report.

A case of a young patient with a severely comminuted intra-articular distal radius fracture dislocation and severe injury of the distal radioulnar joint is presented. Early reconstruction of the sigmoid notch and radioulnar ligaments was performed using the remaining scaphoid facet of the distal radius articular surface, an autogenous tendon graft for ligament reconstruction, and radioscapholunate arthrodesis. The patient was able to return to his manual work without limitations. We present additional information on the comparative anatomy of the sigmoid notch and scaphoid facet that may guide surgeons in treating this severe injury.

Adult↗
PubMed2002

A biomechanical comparison of fragment-specific fixation and augmented external fixation for intra-articular distal radius fractures.

The biomechanical stability of an internal fixation system that uses low-profile modular implants to stabilize individual fracture components was studied in a validated cadaver fracture model that incorporated physiologic muscle forces and wrist motion. Fragment-specific fixation with immediate range of motion was compared with static augmented external fixation in simulated, unstable 3- and 4-part intra-articular distal radius fractures (n = 20). Fixation was applied and specimens were loaded via their major wrist tendons. Because the wrist joint was not constrained in the internal fixation group, full wrist motion occurred during load application in these specimens. A 3-dimensional motion tracking system calculated individual fracture fragment motion in both groups. In the 3-part fracture pattern fragment-specific fixation showed comparable stability to static augmented external fixation despite the full wrist range of motion that occurred during application of load in these specimens. In the 4-part fracture pattern fragment-specific fixation was shown to be significantly more stable when compared with static augmented external fixation in 4 of 6 axes of motion. Our findings confirm the stability of this low-profile plating system and support the consideration of early wrist motion when treating complex, intra-articular distal radius fractures with fragment-specific fixation.

Biomechanical Phenomena↗
PubMed2003

Comparison of different distal radius dorsal and volar fracture fixation plates: a biomechanical study.

PURPOSE: To compare the biomechanical properties of 6 dorsal and volar fracture fixation plate designs in a cadaver model. METHOD: Six different plating techniques were used on surgically simulated, unstable, extra-articular distal radius fractures in fresh-frozen cadavers. Specimens were tested to failure in axial compression with the Materials Testing System machine, and were analyzed with a motion analysis system. The 6 different fixation systems studied included an AO stainless steel Pi plate (group 1), an AO titanium Pi plate (group 2), a Forte plate (group 3), a dorsally placed Symmetry plate (group 4), a volarly placed Symmetry plate (group 5), and a volarly placed SCS/V plate (group 6). RESULTS: All dorsal plates (groups 1, 2, 3, 4) failed in apex dorsal angulation and all volar plates (groups 5, 6) failed in apex volar angulation. No group developed an average angular deformity greater than 5 degrees with a load of 100 N, which compares with the physiologic loads expected with active wrist motion. Only the volarly placed SCS/V plated specimens (group 6) resisted deformation of 5 degrees or more at loads up to 250 N, which compares with the physiologic loads expected with active finger motion, and was significantly stronger and more rigid than the other 5 plate groups. CONCLUSIONS: The SCS/V plate fixation system is the most rigid of the systems tested and may offer adequate stability for the treatment of the distal radius fracture in which the anterior and/or posterior metaphyseal cortex is comminuted severely.

Adolescent↗