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PubMed2006

Bridge plating of distal radius fractures: the Harborview method.

UNLABELLED: High-energy comminuted distal radius fractures treated at Level 1 trauma centers represent unique treatment challenges. In particular, two groups of patients require special consideration: patients with high-energy injuries that have fracture extension into the radius and ulna diaphysis and patients with multiple injuries that require load bearing through the injured wrist to assist with mobilization. We report our experiences treating these injuries with a bridge plating technique. The bridge plate acts as an "internal fixator" and depends on ligamentotaxis for fracture reduction. The technique has been found to be performed easily and achieves the goals of maintenance of fracture reduction, allows weightbearing through the injured extremity, and is associated with few complications. We describe the technique and review our experience with a retrospective chart review of 62 consecutive patients. LEVEL OF EVIDENCE: Therapeutic study, level IV (case series).

Adult↗

PubMed2005

Vascularized bone grafting from the base of the second metacarpal for persistent distal radius nonunion: a case report.

Although fractures of the distal radius are relatively common, nonunion is a rare complication. We report a case of a distal radius nonunion in a healthy 51-year-old woman who was involved in a motor vehicle accident. Initial attempts to treat the nonunion with open reduction and internal fixation and corticocancellous bone grafting from the iliac crest failed. Preservation of wrist motion was of considerable importance and wrist arthrodesis was deferred. Treatment of the nonunion with a vascularized bone graft from the base of the second metacarpal, combined with biplanar stable fixation and allogenic bone graft, resulted in union of the fracture and a good functional outcome.

Bone Transplantation↗

PubMed2007

Stacked plating for metadiaphyseal fractures of the distal radius: a technique report.

Combined injuries of the distal radius and shaft are rare, are usually caused by high energy, and pose a surgical dilemma. Surgical tactics and implants that are routinely used either for isolated fractures of the distal radius or for fractures of the radial shaft are often not applicable for this combined injury. We describe a technique of dual-stacked plating for these metadiaphyseal fractures and its use in two patients.

Bone Plates↗

PubMedDate not supplied

Rotational osteotomy at the diaphysis of the radius in the treatment of congenital radioulnar synostosis.

Four cases of congenital radioulnar synostosis in three patients were treated by rotational osteotomy of the distal radius. The diaphysis of the radius was osteotomized transversely, and then the forearm was supinated manually. Following surgery, the palm was immobilized in a fully supinated position by a long-arm cast. The average age at surgery was 4 years 5 months old (range 3 years 11 months to 4 years 11 months), and the average follow-up was 21 months (range 12-36 months). Bone union was obtained in all patients without any complications or correction loss. Functional improvements were achieved in all patients. This procedure is simple and safe in the treatment of congenital radioulnar synostosis.

Child, Preschool↗

PubMed2005

Internal distraction plating of distal radius fractures.

Internal distraction plating can be used for the treatment of highly comminuted distal radius fractures especially in elderly patients. The technique involves the use of 3.5, 2.7, or 2.5 dynamic compression plates. The instrumentation is applied in distraction dorsally from the radial diaphysis, bypassing the comminuted segment, and fixed distally to the long metacarpal. The advantages of this technique are: a) it can be used as an alternative for managing difficult fractures in the elderly population; b) it is indicated in patients with osteoporotic bone; c) complications associated with external pins are avoided; and d) the stability of the plate allows patients to use the extremity for transfer and activities of daily living. On the other hand, possible disadvantages to be considered are: a) the need of a second operation to remove the plate; and b) the prolonged duration of immobilization. Elderly patients with osteoporotic bone who undergo treatment of comminuted distal radius fractures may result in poor outcomes with high rates of complications if external fixation or standard internal fixation is used. The current approach represents an alternative that provides union of the fracture with excellent alignment, functional range of motion, and minimal functional disability.

Bone Plates↗

PubMed2005

Fragment-specific fixation of distal radius fractures using the Trimed device.

Fragment-specific fixation of the distal radius represents a new technique for addressing complex distal radius fractures. It signifies a substantial shift in the thought process of open reduction and internal fixation; each fracture fragment is addressed independently with small plates or wire forms, allowing comminuted fractures to be anatomically restored and early motion started. Although the system is at first daunting, its modularity provides flexibility for the surgeon to modify the fixation to the individual needs of the patient's specific fracture pattern and the surgeon's level of expertise. Once the technique has been learned, the surgeon will have in his or her armamentarium a powerful new tool to treat fractures that had before been difficult to address satisfactorily with conventional techniques.

Fracture Fixation, Internal↗

PubMed2004

An evaluation of two scoring systems to predict instability in fractures of the distal radius.

BACKGROUND: Various scoring scales have been introduced in the management of patients with multiple injuries and lower extremity injuries. Two scoring systems have been introduced to predict instability in distal radius fractures. The purpose of this investigation was to evaluate the accuracy of these two models in predicting instability. METHODS: A prospective study of 105 consecutive patients sustaining unilateral closed distal radius fractures was performed. Two scoring systems--the MacKenney formula and the Adolphson formula--were used to calculate the probability of fracture instability on the basis of initial presentation and injury films. The predicted probability of instability calculated from both models was then compared with actual results of instability on the basis of specific radiographic criteria at follow-up. RESULTS: Final follow-up information was available on 80 patients. There were 44 unstable fractures and 36 stable fractures at final follow-up. Using the MacKenney formula, of the 38 fractures predicted to have a low probability of instability (Pinstability < 30%), 18 (47.4%) were found to be unstable. Using the Adolphson formula, of the 28 fractures predicted to have a low probability of instability (Pstability > 70%), 14 (50%) were actually unstable. CONCLUSION: Both scoring systems were found to underestimate the degree of fracture instability and to have a negative predictive value between 47 and 50% in a prospective series of patients. In fractures predicted to have a low probability of instability in both models, we found a poor correlation between predicted instability and actual instability. Our results demonstrate the limitations of two scoring systems in predicting fracture stability and in making clinical decisions on the basis of their results.

Adult↗

PubMed2005

Pisiform bone fracture-dislocation and distal radius physeal fracture in two children.

We report two children with a Salter-Harris type 1 and 2 distal radius physeal fracture associated with a fracture-dislocation of the pisiform bone. The two patients were treated with closed reduction of both the distal radius and dislocated pisiform under general anaesthesia. Then a long-arm cast was applied for 30 days resulting in full healing of the fractures. The patients were re-evaluated after 30 years, and the wrists did not show any functional impairments. On radiographic evaluations, there were no signs of osteoarthritis or misalignment between the pisiform and the triquetral, in contrast to what has been reported in adult carpal fractures.

Adolescent↗

PubMed2006

Triplane fracture of the distal radius.

A case of triplane fracture of the distal radius is reported in a 13-year-old boy. This exceptional fracture showed displacement, and was healed by closed reduction and 6 weeks of external immobilization. Eighteen months later, the patient showed complete physeal arrest of the distal radius, with radio-ulnar length discrepancy but without any repercussion on wrist mobility. The patient was declared asymptomatic 3 years after the injury. Prompt, physiological physeal arrest reduces the potential of growth deformity. These fractures must be treated conservatively by closed reduction (if displacement exists) and external immobilization, just like a normal one-plane fracture. We may suppose that final radio-ulnar discrepancy could lead to a painful and symptomatic ulno-carpal conflict in adult life. The following characteristics can be associated with this rare fracture: (1) occurrence close to the end of the growth period, as in other types of triplane fractures; (2) evolution towards partial or complete growth arrest of the physis, not requiring treatment and (3) stability of the fracture after closed reduction. In the present case, as in the other reported cases, it may also be added that orthopaedic treatment has been the rule, in contrast with triplane fractures occurring in the distal tibia, in which surgical treatment is indicated.

Accidents, Traffic↗

PubMed1982

Simultaneous fracture of the scaphoid and radius in a child.

A 15-year-old boy sustained an ipsilateral scaphoid and radius fracture, a combination of injuries that has only received brief mention in previous reports. Closed reduction and cast immobilization produced a satisfactory result. The distal radius injury was a comminuted fracture with a vertical component that extended to the physis without involvement of the epiphysis. The mechanism of injury may have been a severe impact delivered to the base of the hand with the wrist fixed in dorsiflexion, a force that would make a distal radial epiphyseal fracture unlikely.

Adolescent↗

PubMed2026

Non-Coding c.*6C>T Variant in RBM8A Associated With Thrombocytopenia-Absent Radius (TAR) Syndrome in Three Indian Patients.

Thrombocytopenia-absent radius (TAR) syndrome is a rare genetic disorder characterized by the absence of radius in the forearms and a decrease in platelet count. The molecular basis of TAR syndrome is linked to a heterozygous minimal deletion within the 1q21.1 region spanning 200 k bases (kb), resulting in a null allele and a nucleotide variation in RBM8A resulting in a hypomorphic allele. Previous studies have identified pathogenic variants in the coding regions of the RBM8A gene as the cause of TAR syndrome. However, the involvement of non-coding variants in disease pathogenesis remains largely unexplored. We investigated the association of a non-coding 3' UTR variant, c.*6C>T, in RBM8A with TAR syndrome in three individuals from two unrelated families of Indian origin. Our study provides evidence that this variant is associated with decreased stability of the transcript and is a hypomorphic allele with disease-causing impact when in trans with a null allele (1q21.1 deletion). The present work is the first application of an mRNA stability assay to directly detect RNA degradation in patients with non-coding RBM8A variants causing TAR syndrome.

Humans↗

PubMedDate not supplied

Repair of fractures of the distal aspect of the radius in two horses.

Fractures of the distal radius in two horses were repaired by open reduction and interfragmentary compression using screws placed in a lag fashion. One horse had a complete oblique fracture of the medial aspect of the epiphysis of the distal radius and was sound for riding 32 months after surgery. The other horse had an open spiral comminuted fracture with medial displacement of the distal radial fragment. Laminitis developed in the contralateral limb and this horse was euthanatized 5 weeks after surgery.

Animals↗

PubMed1983

Longitudinal study of body height, radius length and skeletal maturity in Danish boys with cleft lip and palate.

Body height, radius length and skeletal maturity were registered longitudinally in 48 boys with combined cleft lip and palate (CLP) and compared with measurements in a non-cleft control group. Age range was from 6 to 20 yr. Skeletal maturity was evaluated according to the TW2 method. Distance and velocity curves for radius length and body height were determined by means of a computer program which for each month calculated the median and percentiles of the distribution. Compared to the control group the CLP boys were slightly shorter from 6 to 18 yr of age. The velocity curves revealed that pubertal growth maximum occurred on an average 6 months later in the CLP boys and that the pubertal growth spurt was less marked. However, the total growth period was prolonged thus enabling the CLP group to catch up with the control group. Skeletal maturity was retarded during the whole period when compared to normal children. It is suggested that the early feeding problems and recurrent infections of the upper airways combined with the surgical procedures account for an essential part of the delay in the present CLP group.

Adolescent↗

PubMed1986

Radius fractures in the horse: a retrospective study of 47 cases.

The case records, radiographs and treatment results of 47 consecutive equine radius fractures presented to The Ohio State University Veterinary Hospital from 1975 to 1985 were examined retrospectively. Chip fractures and incomplete fractures were not considered. Both diaphyseal fractures and fractures involving the physes were included. Diaphyseal fractures were placed into three major categories: comminuted, oblique and transverse; and subclassified as proximal, mid-diaphyseal, or distal. Fractures involving a physis were classified using the Salter-Harris classification system. The horses ranged in age from one day to 19 years old. Nineteen of the patients were destroyed humanely on presentation, and 28 were treated. Twenty-four of the 28 fractures treated were repaired by open reduction and internal fixation. Success rate was related to the age of the horse and the type of fracture. Adult radius fractures have a poor prognosis. Most fractures in foals are either physeal fractures or transverse or oblique diaphyseal fractures and have an excellent to good prognosis when repaired adequately.

Animals↗

PubMed1997

In vivo assessment of trabecular bone structure at the distal radius from high-resolution magnetic resonance images.

In this study a method of assessing trabecular bone structure at the distal end of the radius from high-resolution magnetic resonance images is described. Trabecular bone is segmented from the marrow and soft tissue background using an adaptive threshold, a region growth, and a skeletonization step. From the processed image we measured the connectivity and orientation of the trabecular bone network. Connectivity was assessed by a proposed connectivity index (CI) and marrow space was quantitated by a mean hole area (HA). Significant age-related changes in CI and HA were observed in a mixed group of normal volunteers. CI decreased at a rate of 0.18 yr-1 (r = 0.72, n = 14, p < 0.05) and HA increased at a rate of 0.018 mm2 yr-1 (r = 0.69, n = 14, p < 0.05). Gradient analysis was used to examine trabecular orientation, and revealed that the individual trabeculae at the distal end of the radius are organized anisotropically along the bone. These findings suggest that clinical magnetic resonance scanners can be used to assess trabecular bone structure in vivo.

Adolescent↗

PubMed1975

Fibrillation of head of radius as one cause of tennis elbow.

Twenty-five patients with resistant tennis elbow were treated by exploration of the radio-humeral joint. Twenty cases showed abnormalities of the cartilage of the head of the radius. Division of the orbicular ligament and excision of the abnormal cartilage gave good results in 19 to 20 cases seen recently. We believe fibrillation of the head of the radius is an important cause of tennis elbow, and the arguments to support this theory are enumerated.

Cartilage, Articular↗

PubMed2000

The treatment of unstable distal radius fractures with volar fixation.

Stable internal fixation and early motion has not been routinely available for distal radius fractures. Difficulties with the dorsal approach discourage surgeons from internally fixing the most common fracture types. The introduction of a new volar plate with subchondral support fixation allows the treatment of most distal radius fractures with stable internal fixation and early motion while avoiding the complications inherent in the dorsal approach.

Adult↗

PubMed2001

Lunate plasty for Kienböck's disease: use of a pedicled vascularised radial bone graft combined with shortening of the capitate and radius.

We treated eight patients with Kienböck's disease (two patients each with stage 1, 2, 3a and 3b disease by Lichtman's classification) by removing a pedicled, vascularised bone segment from the dorsal aspect of the distal radius and engrafting it into the lunate. Additional shortening of the radius was performed in patients with the ulna-minus or null variant. Shortening of the capitate and capito-hamate fusion were also performed in patients with stage 3 disease. All patients were relieved of their wrist pain at rest and during movement, and the mean grip strength increased from 37% of that in the contralateral hand before surgery to 80% after surgery. The mean post-operative range of motion in the affected wrist was 92% of that in the opposite wrist in patients with stage 1 and 2 disease, and 53% in patients with stage 3 disease. Post-operative assessment revealed that four patients had excellent results, three had good results, and one had a fair result.

Adult↗