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PubMed1962

Action of antidiuretic hormone on the equivalent pore radius at both surfaces of the epithelium of the isolated toad skin.

A previously described method (1) allows the observation of swelling and shrinking of the epithelial cells of the isolated toad skin, when the solution bathing either the outer or inner side of the skin is modified. Thus, the concentration of probing molecules of graded size, isotonic to the epithelial cells, across each face of the isolated toad skin can be determined. These concentrations have been used for the estimation of the equivalent pore radius at the outer and inner face of the skin epithelium, following the approach of Goldstein and Solomon for red cells (3). An equivalent pore radius of 4.5 A for the outer surface, and one of 7 A for the inner surface have been obtained. Antidiuretic hormone had an effect only when added to the inner side. This effect was only at the outer surface and is interpreted as widening of the 4.5 A pores to about 6.5 A. A model membrane, formed by narrow and wide pores in series, may explain some of the apparent inconsistencies previously observed.

Animals↗

PubMed1985

Normal values for trabecular and cortical bone in the radius measured by computed tomography.

Quantities related to the amount of trabecular bone in the distal radius and cortical bone in the radius mid-shaft have been measured in 262 normal adults of both sexes aged 21-89 years by computed tomography (CT). A special-purpose CT system (ISOTOM) which incorporated a source of 125I (29 keV) was used to make the measurements. The relationships between these quantities and age, weight, height and surface area have been evaluated, and the results have been used to draw conclusions on the significance of values measured in female patients with osteoporosis, Colles' fracture of the wrist and generalised osteoarthritis.

Absorption↗

PubMed1987

Comparison of broadband ultrasonic attenuation of the os calcis and quantitative computed tomography of the distal radius.

The measurement of broadband ultrasonic attenuation (BUA) in the os calcis, which consists of predominantly trabecular bone, has been compared by others with single photon absorptiometry of forearm cortical bone. We have compared BUA in 24 female subjects with the separate measurement of trabecular and cortical bone in the distal radius using quantitative computed tomography (QCT). BUA was highly significantly correlated with each of the measurements in the radius (P less than 0.001). Paradoxically, BUA was found to be best correlated with the bone mass per unit length in the radial shaft (r = 0.85) rather than with radial trabecular bone (r = 0.66). The degree of correlation was not sufficient to predict radial bone mass accurately in individuals. Broadband ultrasonic attenuation, however, appears to be a useful measurement of bone in the appendicular skeleton.

Adult↗

PubMed1985

Correlates of mid-radius bone density among postmenopausal women: a community study.

We surveyed mid-radius bone density in a geographically-defined population of 324 women, 55-80 years old from two small, demographically-similar communities whose water supply provided 60 mg/l and 375 mg/l of elemental calcium. Mean community calcium intakes were 964 mg/day and 1329 mg/day respectively. Bone density, measured by photon densitometry, was correlated with physical measurements, medical history, and reported nutritional intake. Mid-radius bone density decreased with age while the following additional factors were independently and positively associated with bone density: humeral muscle area (p = 0.0001), extended estrogen use (p = 0.0004), thiazide use (p = 0.0029), and vitamin D intake (p = 0.0104). Estimated total calcium intake alone did not significantly correlate with bone density; however, mean bone density was significantly greater in persons whose calcium intake was greater than 800 mg/day, consumed concurrently with vitamin D in amounts greater than 400 IU (p = 0.0342), the Recommended Daily Allowance of these two nutrients.

Aged↗

PubMed2002

Interscalene and infraclavicular block for bilateral distal radius fracture.

UNLABELLED: Brachial plexus blockade is a suitable technique for surgery of the forearm, because it provides good intraoperative anesthesia as well as prolonged postoperative analgesia when long-acting local anesthetics are used. However, simultaneous blockade of both upper extremities has rarely been performed (1), because local anesthetic toxicity caused by the amount of drug needed to achieve an efficient block on both sides may be a problem. We report a case of successful bilateral brachial plexus block with ropivacaine in a patient with bilateral distal radius fracture, with each fracture requiring an open osteosynthesis. IMPLICATIONS: This case report presents the performance of a simultaneous blockade of both upper extremities in a patient who sustained a bilateral distal radius fracture. The patient was known to be difficult to intubate and to have a severe hypersensitivity to opioids.

Adult↗

PubMed1997

Dynamic external fixation for distal radius fractures.

Thirty adult patients with closed comminuted and mostly intraarticular fractures of the distal radius were treated by closed reduction and immobilization with a dynamic external wrist fixator during a 2-year period. In 13 patients with severely comminuted and unstable fractures, additional Kirschner wires were used. After 10 to 14 days of rigid fixation in neutral position, the motion element was unlocked to allow up to 30 degrees flexion. Six weeks later, the fixator was removed. The patients then were observed for an average of 24 weeks. An excellent functional outcome was seen in 6 patients (20%), a good outcome in 20 patients (67%), and a fair outcome in 4 patients (13%). Anatomically, 15 patients (50%) had an excellent result, 14 (47%) a good outcome, and 1 (3%) a fair outcome. Only minimal loss of reduction averaging 1 degree palmar tilt was seen during mobilization. There were 2 major complications: 1 deep Kirschner wire tract infection and 1 index metacarpal fracture. Minor complications such as sensory disturbances and pin tenderness were present but recovered completely after removal of the fixator. This study provides promising data and offers an alternative method in the treatment of distal radius fractures with severe comminution. In cases with postreductive unstable fragments, additional Kirschner wires should be used to allow early mobilization of the wrist.

Adult↗

PubMed2000

Extensile posterior approach to the radius.

An extensile posterior approach to the radius was studied on 20 forearm anatomic specimen upper limbs. The skin incision followed a line from the lateral epicondyle of the humerus to a point corresponding to the middle of the posterior aspect of the wrist. Dissection was done between the extensor digitorum communis and the extensor carpi radialis brevis. The posterior interosseous nerve was identified, and the muscle fibers of the superficial head of the supinator were divided from distal to proximal to the posterior interosseous nerve, which was dissected and carefully retracted laterally. The muscle fibers of the deep head of the supinator were divided to the bone. An incision was made along the superior and inferior margins of the abductor pollicis longus and extensor pollicis brevis. A nerve tape was placed around the two muscles, and they were retracted proximally and medially or distally and laterally, as necessary. To expose the distal third of the radius, the obliquely placed muscles, abductor pollicis longus, and extensor pollicis brevis were retracted proximally and medially. Dissection was done between the extensor carpi radialis brevis and extensor pollicis longus. Anatomic study of the posterior interosseous nerve branches was done to understand the vulnerability of such branches seen in this approach.

Forearm↗

PubMed2001

Vascular anatomy of the distal radius: implications for vascularized bone grafts.

The vascular anatomy of the distal radius and ulna is complex with a series of longitudinal vessels anastomosing with a series of arches. This complex anastomotic network of vessels has a consistent spatial relationship to surrounding anatomic structures and is constant in nature. Knowledge of the vascular anatomy of the distal radius and ulna has allowed the creation of numerous reverse flow pedicled vascularized bone grafts, which can be applied to carpal pathologic features to assist in the healing of difficult fractures or avascular necrosis. The anatomy and terminology of the vascular network and the implications, indications, and applications of this anatomy to carpal pathologic features is reviewed.

Bone Transplantation↗

PubMed1988

Open reduction and internal fixation of volar lip fractures of the distal radius.

Fractures of the volar lip of the distal radius are relatively uncommon injuries. However, controversy exists concerning the treatment of these fractures. We reviewed our experience with open reduction and internal fixation through a volar approach using buttress plates. Sixteen patients with 17 fractures were treated by this method. Their ages ranged from 16 to 65 years (average 38 years). Eight fractures occurred secondary to motor vehicle accidents, while the remaining patients sustained falls. Mean follow-up time was 19.5 months. All fractures healed with no infections. Sixteen of the fractures were treated primarily with open reduction and internal fixation, while one patient was treated 6 weeks after injury for a malunion. Ranges of motion averaged 71 degrees dorsiflexion, 60 degrees palmar flexion, 79 degrees pronation, 78 degrees supination, 22 degrees radial deviation, and 32 degrees ulnar deviation. Analysis of results demonstrated 12 excellent, 2 good, and 3 fair results. Two patients with fair results had nonanatomic restoration of the joint surface at surgery, while the other patient with a fair result was treated late. We recommend early open reduction and internal fixation of displaced or unstable volar lip fractures of the distal radius. Accurate anatomic alignment and stable fixation are achieved with the volar buttress plate. Motion can begin 2-3 days after surgery to aid in obtaining excellent functional results.

Adult↗

PubMed1991

Percutaneous and limited open reduction of the articular surface of the distal radius.

Between 1979 and 1986, 40 patients with intraarticular fractures of the distal radius, in which anatomic reduction could not be obtained by closed manipulation or external fixation, underwent a combination of percutaneous and/or limited open reduction techniques to restore articular congruity. All 40 patients' radiographs that were retrospectively reviewed with an average follow-up of 4 years showed satisfactory extraarticular alignment in 85% of cases, and 37 patients (92.5%) demonstrated an articular step-off of less than or equal to 1 mm. Thirty-one patients retrieved for follow-up had a good functional result. The treatment goals of intraarticular fractures of the distal radius are anatomic restoration of the joint surface and optimal fixation to maintain reduction in an effort to prevent posttraumatic arthrosis of the wrist.

Adolescent↗

PubMedDate not supplied

Repair of five distal radius fractures with an investigational cancellous bone cement: a preliminary report.

OBJECTIVE: The purpose of the study was to evaluate the feasibility of Norian SRS bone cement injected percutaneously into a distal radius following reduction in both preventing loss of reduction as well as safety. DESIGN: The study was a prospective clinical study with an established protocol. SETTING: The study was conducted at the Massachusetts General Hospital following approval of the institutions Investigational Review Board. All patients were required to read and approve an informed consent document. PATIENTS: While twenty patients' radiographs fulfilled the requirement of a dorsally displaced extraarticular fracture to have occurred within 72 hours of presentation, only five consented to participate fully and one voluntarily withdrew after a six-month follow-up. INTERVENTION: All fractures were reduced under regional or general anesthesia, and the Norian SRS was introduced via a catheter system into the metaphyseal defect of the fracture. A short arm cast was applied and remained in place for six weeks. MAIN OUTCOME MEASUREMENTS: Radiographic parameters of fracture reduction were measured prospectively by an independent radiologist throughout the 12 months of the study. Clinical parameters of hand and wrist function were measured prospectively by an independent occupational therapist. RESULTS: At 12-month follow-up, radial length was a mean 9.9 mm with an average loss of < 1 mm; radial angle maintained at a mean 25.4 degrees; volar angle was within normal range (0-21 degrees) in 4; and 1 patient had a dorsal angle of 7 degrees. Wrist motion improved 50 percent between 6 weeks and 3 months and improved further by 12 months when grip strength reached a mean of 88 percent of the contralateral side. Dorsal and volar extrusion of injected Norian SRS in 4 patients resorbed over time. There were no clinically significant adverse effects or complications. CONCLUSIONS: Norian SRS proved to be clinically safe and effective as a cancellous bone cement to maintain fracture reduction of unstable extraarticular distal radius fractures.

Bone Cements↗

PubMed1997

Plaster cast versus percutaneous pin fixation for comminuted fractures of the distal radius in patients between 46 and 65 years of age.

OBJECTIVE: To compare the results of treating unstable distal radius fractures either by percutaneous pinning and casting, or by traditional closed reduction and casting. DESIGN: Prospective, randomized. SETTING: University hospital. PATIENTS: Forty patients with unstable Frykmann III-VIII distal radius fractures resulting from a fall. INTERVENTIONS: Twenty patients were treated with closed reduction, consisting of manipulation, under local anesthesia, followed by casting. Twenty patients were treated with percutaneous fixation using K-wires, followed by casting. MAIN OUTCOME MEASUREMENTS: Initial displacement, quality of reduction, carpal malalignment, articular step-off. Range of motion and grip strength were measured using a scoring system reported by Home et al. (10). RESULTS: Functional results in the pinning group were better (excellent, 12; good, 6; fair, 2) than in the plaster group (excellent, 3; good, 8; fair, 5; poor, 4). Anatomic results also were better in the pinning group. CONCLUSION: The best anatomic and functional results were obtained by percutaneous pinning. Although the cost of pins and plaster treatment is significantly greater than plaster treatment, the author believes that the positive end result justifies the cost.

Aged↗

PubMed1998

Optimal position for plate fixation of complex fractures of the proximal radius: a cadaver study.

OBJECTIVE: To determine the optimal postion for plate fixation in complex fractures of the proximal radius in which head and neck dissociation occurs. DESIGN: Technical study. SETTING: Tertiary referral center, teaching hospital, U.S. military. SUBJECTS: Five preserved cadavers. MAIN OUTCOME MEASURE: Radioulnar impingement and proximity to neurovascular structures were directly measured in elbows plated in each of three positions: neutral, full pronation, and full supination. RESULTS: Application of the 2.0-millimeter T-plate to the lateral aspect of the radial head and neck with the forearm in neutral position had no impingement, whereas application in full pronation resulted in loss of the last 30 degrees of supination. Plate application in full supination resulted in the loss of the last 10 degrees of pronation. In addition, there was no impingement when the 2.7-millimeter plate was applied similarily in the neutral position. None of these positions resulted in increased risk to neurovascular structures. CONCLUSIONS: The optimal position for plate fixation of complex proximal radius fractures is with the forearm in neutral position, with the plate applied directly lateral. A larger implant, 2.7 millimeters, may be used if this technique is followed without further risk of impingement and loss of motion.

Adult↗

PubMed2001

Distal radius epiphysiolysis associated with scaphoid fractures in immature patients: report of two cases and review of the literature.

Two cases of carpal scaphoid fractures associated with distal radius epiphysiolysis are presented. Only three cases of this unlikely combination were found in the English literature. One of the scaphoid fractures had to be confirmed by bone scan. Conservative treatment after gentle reduction of the radius fracture gave excellent results.

Accidental Falls↗

PubMed2005

A biomechanical comparison of a dorsal 3.5-mm T-plate and a volar fixed-angle plate in a model of dorsally unstable distal radius fractures.

OBJECTIVES: To compare the biomechanical stability of internal fixation of extra-articular, dorsally unstable distal radius fractures fixed by 1 of 2 methods, either a standard dorsal nonlocked T-plate or a volar locked fixed-angle plate. DESIGN: Biomechanical cadaveric study. SETTING: Biomechanical testing laboratory. INTERVENTION: In 6 matched pairs of fresh-frozen cadaveric specimens, a simulated unstable extra-articular distal radius fracture was created. The fractures were stabilized with either a dorsal 3.5-mm stainless steel T-plate or a titanium locked volar fixed-angle plate. Specimens were axially loaded at 5 points (centrally, volarly, dorsally, radially, and ulnarly) and then cyclically loaded for 5000 cycles with an 80 N central load. Postcyclical loading, specimens were once again axially loaded at the 5 points. MAIN OUTCOME MEASURES: Initial fixation stiffness and stiffness after midaxial cyclical loading was compared at the 5 points. RESULTS: With the volar locked fixed-angle plate, fixation was significantly stiffer than with the dorsal nonlocked T-plate for ulnar and volar loading in single-cycle testing. After cyclic loading, the locked volar fixed-angle plate maintained more of its initial stiffness than the dorsal nonlocked T-plate. The dorsal 3.5-mm stainless steel T-plate's stiffness when dorsally loaded significantly decreased after cyclical loading. CONCLUSIONS: The volar locked fixed-angle plate maintained a greater percentage of its initial stiffness after cyclic loading compared to the dorsal nonlocked plate. Also, the volar locked plate was stiffer than the dorsal nonlocked plate for all loading configurations tested except when subjected to a dorsally applied eccentric load.

Adult↗

PubMed1989

Use of the Clyburn External Fixator in fractures of the distal radius.

A study was organized to evaluate the use of a one-plane external fixation device to treat comminuted fractures of the distal radius. Clinical and roentgenographic data were obtained in 20 patients with a followup ranging from 12 to 20 months. The results were graded 14 excellent, 4 good, 2 fair, and none poor. The use of the Clyburn External Fixation Device with supplemental radial styloid Kirschner wire fixation achieved acceptable results in the treatment of comminuted distal radius fractures and proved to be easily applied.

Adult↗

PubMed2006

T-Pin for distal radius fracture.

Distal radius fractures are among the most common fractures treated by orthopedic surgeons. Numerous techniques have been devised to address these fractures and the factors associated with these injuries. The T-Pin (Union Surgical, LLC, Philadelphia, PA) is a novel instrumentation designed to use standard percutaneous techniques in the treatment of extra-articular distal radius fractures. The T-Pin allows for early active range of motion, as well as earlier return to functional activities. This article discusses the instrumentation, the techniques of insertion and extraction, and postoperative care.

Bone Nails↗

PubMed2004

Assessment of articular displacement of distal radius fractures.

Intraarticular step and gap displacements represent the most common indication for surgical treatment of distal radius fractures. Most often, treatment decision making relies only on good-quality plain radiographs taken before and after reduction with measurement accuracy maximized by using the longitudinal axis method. When plain radiographs alone prove insufficient, CT scans or tomograms will significantly improve interobserver and intraobserver reliability of measurements, especially when evaluated using the arc method. Tomography is an effective method for postoperative evaluation of fractures immobilized in splints or casts. The role of MRI in assessing intraarticular distal radius fractures is limited to confirming injuries to carpal ligaments or the triangular fibrocartilage complex. Intraoperatively, we use fluoroscopy to obtain 30 degrees cephalad posteroanterior views and as 22 degrees lateral views to best observe articular surface reduction. Our current operative indications include fractures with radiocarpal or distal radioulnar joint step or gap deformities greater than 1-2 mm, gross distal radioulnar joint instability, or those with extensive metaphyseal comminution rendering them particularly unstable after closed reduction. In general, we tend to lean toward operative fixation in younger, more active patients.

Arthroscopy↗