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At least 883 records · Page 49Linked to original sources
PubMed2001

Geometric properties of distal radius and pathogenesis of Colles fracture: a peripheral quantitative computed tomography study.

It is well known among clinicians that Colles fracture patients may have normal projected axial bone mineral density and that bone mass is not synonymous with bone strength. The aim of this work was to investigate whether cross-sectional properties of the distal radius in female patients with recent Colles fracture differ from those of a younger group of normal women without fracture. It was hypothesized that patients with Colles fracture had petite distal radii and that cortical thinning and reduced cortical and trabecular volumetric density are dominant features of this fracture type. We used a multilayer high-precision peripheral quantitative computed tomography (pQCT) device with a long-term precision error of 0.1% for a dedicated phantom during the measurement period (152 d). Clinical measurements were made at an ultradistal site rich in trabecular bone and a less ultradistal site rich in cortical bone. The results show that the following pQCT variables were significantly reduced in the nonfractured radius of the Colles fracture cases: mean ultradistal trabecular volumetric density, mean ultradistal and distal cortical volumetric density, mean ultradistal and distal cortical thickness (p < 0.001 for all differences). The outer cortical diameter, cross-sectional bone area, and cortical bending moment of inertia were not statistically different in the two groups. Thus, it would appear that Colles fracture cases did not have petite distal radii. The results suggest that the deforming force of Colles fracture has a transaxial direction (fall on outstretched arm), resulting in a crush fracture, and that it is not a bending force. We suggest that Colles fracture occurs as a result of the combined effect of a fall on the out-stretched arm, low trabecular and cortical volumetric bone density, and reduced cortical thickness.

Adult↗
PubMed2001

Analysis of cancellous bone turnover by multiple slice analysis at distal radius: a study using peripheral quantitative computed tomography.

We compared the results of peripheral quantitative computed tomography (pQCT) measurements (XCT-900; Stratec) at the 4% site of the distal radius (section 1; slice thickness of 2 mm) and in two proximally adjacent sections (sections 2 and 3). The study population consisted of 138 ambulatory patients (age 16.4 +/- 5.6 yr; mean +/- SD; 71 female) who were referred to a pediatric densitometry unit. Total volumetric bone mineral density (BMD) increased, whereas the area of the radial cross-section decreased in a proximal direction. There was a decrease in bone mineral content between sections 1 and 3, which was more pronounced in subjects under age 16. Cancellous BMD significantly decreased from section 1 to 3 only under the age of 16. In 12 patients under age 17 who suffered from increased bone fragility, cancellous BMD decreased about 2.5 times more between sections 1 and 3 than in age-matched patients who received anticonvulsant therapy but had a normal neurologic and musculoskeletal status (-21.4% +/- 16.9 vs -8.1% +/- 6.3; p = 0.02). This suggests that in the bone fragility group, trabeculae were removed faster during longitudinal growth of the radius. In conclusion, multiple slice analysis may provide information on the dynamic turnover of metaphyseal trabeculae during growth.

Adolescent↗
PubMedDate not supplied

[Distal radius fractures: consistency of the classifications].

OBJECTIVE: The purpose of this study was to determine the intra-observer and interobserver reproducibility of Frykman, AO and Universal classifications for the fractures of the distal radius. METHODS: In this study, 40 radiographs of fractures of the distal radius were selected and classifed by orthopedists of different centers and levels of experience, determining the intra-observer and interobserver reproducibility of the classifications using Kappa statistic method. RESULTS: The medium intra-observer concordance observed was moderate to Frykman and Universal classifications and light to the AO system. The medium interobserver reproducibility was light in the two readings to Frykman and Universal classifications and despicable in the second reading of the AO classification. CONCLUSION: All the classifications used presented questionable interobserver reproducibility compromising the use of the three evaluated systems.

Humans↗
PubMed1993

The treatment of giant-cell tumors of the distal part of the radius.

We reviewed the results of the treatment of giant-cell tumors of the distal part of the radius in twenty-three patients, to identify criteria that could assist in the selection of the most effective option for treatment or reconstruction. The treatment was chosen on the basis of the preoperative roentgenographic assessment of the extent of the tumor. Seven patients, who had received previous treatment elsewhere, were referred to us because of a local recurrence. An extended curettage followed by packing of the cavity with cement was effective in preserving the normal function of the extremity and in eradicating the lesion in five patients who had a lesion that was intraosseous or that involved minimum cortical perforation. Of the eighteen remaining patients, who had extraosseous extension of the tumor, seventeen had a resection of the distal part of the radius and one had a below-the-elbow amputation. After resection of the involved segment of bone, the best functional result was seen in the patients who had been managed with a radiocarpal arthrodesis and use of an intercalary bone graft that was stabilized with a long plate. At the most recent follow-up examination (range, two to nineteen years after the curettage or resection), there had been no local recurrences.

Adolescent↗
PubMed1994

Dynamic external fixation of unstable fractures of the distal part of the radius. A prospective, randomized comparison with static external fixation.

A prospective, randomized study was done to compare the results of dynamic external fixation (the Clyburn device) with those of static external fixation (the AO/ASIF device) in the treatment of fifty unstable fractures of the distal part of the radius. Mobilization of the wrist from neutral to 30 degrees of flexion was begun in the dynamic-fixator group at approximately two weeks, and full motion, allowing 30 degrees of extension, was started at approximately four weeks. The external fixation frames in both groups were kept in place for approximately ten weeks. Mobilization of the wrist in the dynamic-fixator group provided little gain in the mean motion of the wrist at the time of the removal of the fixator or at the one, six, or twelve-month evaluation. The static-fixator group had greater flexion of the wrist and radial deviation at the early and late follow-up examinations, while the dynamic-fixator group demonstrated only greater ulnar deviation one month after the fixator had been removed. Motion of the wrist in the dynamic-fixator group resulted in a statistically significant loss of radial length compared with that in the static-fixator group (four millimeters compared with one millimeter, p < 0.001). Complications were more frequent in the dynamic-fixator group. As evaluated with a modification of the scoring system of Gartland and Werley, 92 percent of the results at one year were excellent or good in the static-fixator group and 76 percent, in the dynamic-fixator group. The results of this study cannot support the concept of early mobilization with a dynamic external fixator for the treatment of unstable fractures of the distal part of the radius.

Adult↗
PubMed1996

Operative treatment of volar intra-articular fractures of the distal end of the radius.

We retrospectively reviewed the results of operative treatment of forty-nine volar marginal intra-articular fractures of the distal end of the radius. According to the Comprehensive Classification of Fractures, there were two B3.1 fractures (characterized by a small volar fragment, with the sigmoid notch intact), three B3.2 fractures (characterized by a large volar fragment that included the sigmoid notch), and forty-four B3.3 fractures (characterized by comminution of the volar fragment). Although all fractures healed and only nine patients had evidence of osteoarthrosis on follow-up radiographs, there were six early and fourteen late complications, some of which adversely influenced the over-all outcome. After an average of fifty-one months (range, twenty-four to 117 months), there were thirty-one excellent, ten good, and eight fair results according to the system described by Gartland and Werley, and thirty-two excellent, nine good, five fair, and three poor results according to the modified system of Green and O'Brien. Two factors were found to have a significant association with a fair or poor outcome: evidence of osteoarthrosis on the most recent follow-up radiographs and reversal of the normal volar tilt of the distal end of the radius. The age of the patient, the interval from the injury to the operation, a concomitant injury of the ipsilateral upper extremity, an associated fracture of the ulnar styloid process, the radio-ulnar index, ulnar angulation, the classification of the fracture, comminution of the volar fragment, and articular incongruity were not significantly associated with the outcome.

Adolescent↗
PubMed1997

Treatment of displaced intra-articular fractures of the distal end of the radius with plates.

Thirty-four displaced intra-articular fractures of the distal aspect of the radius in thirty-four patients were treated with open reduction and internal fixation with plates and screws. Although there was a high rate of complications (nine [26 per cent] of thirty-four fractures), twenty-eight patients (82 per cent) had a good or excellent result according to the system of Gartland and Werley and twenty patients (59 per cent) had a good or excellent result according to the modified system of Green and O'Brien at the most recent evaluation. Immediately postoperatively, the articular surface of the distal aspect of the radius was restored to a mean of 2 degrees of volar tilt and 20 degrees of radial angulation and radial length was improved by a mean of ten millimeters compared with the preoperative length. The articular surface was restored to congruity or to at most one millimeter of step-off in twenty-six patients (76 per cent). By the time of the most recent evaluation, the initial postoperative alignment had changed markedly in three patients (9 per cent) and degenerative osteoarthrosis (grade II or III) had developed in six patients (18 per cent). We considered that the initial postoperative alignment had changed markedly when the articular surface was displaced by two millimeters or more, when the extra-articular alignment had changed by more than 10 degrees of radial tilt, or when there was more than five millimeters of radial shortening. The potential for restoration of normal alignment and the stability of the fixation are the main advantages of internal fixation with plates. Restoration of congruity to the joint was the major difficulty in this group of patients.

Adolescent↗
PubMed2003

Functional outcome and complications following two types of dorsal plating for unstable fractures of the distal part of the radius.

BACKGROUND: There is a paucity of data in the literature documenting the functional outcomes for patients who have been managed with a dorsal plate because of a distal radial fracture. The purpose of the present study was to determine the functional outcome and complications following dorsal plating for dorsally displaced, unstable fractures of the distal part of the radius. METHODS: The records of all patients who had been managed at our institution with dorsal plating because of a comminuted, dorsally displaced fracture of the distal part of the radius were reviewed. Patients with less than twelve months of follow-up were excluded from the study. Outcomes were evaluated at the time of the latest follow-up with use of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Gartland and Werley scoring system. RESULTS: Twenty-eight patients (nineteen women and nine men) with a mean age of forty-two years formed the basis of the study. The mean duration of follow-up was twenty-one months. Nineteen patients had been treated with a Synthes pi plate, and nine had been treated with a low-profile plate. There were no instances of loss of reduction, malunion, or nonunion. The mean score on the DASH questionnaire was 14.5 points. All patients had an excellent (nineteen patients) or good (nine patients) result according to the scoring system of Gartland and Werley. Nine patients had postoperative complications requiring repeat surgical treatment for hardware removal or extensor tendon reconstruction. All nine reoperations were performed in patients who had been treated with a Synthes pi plate, while none were performed in patients who had been treated with a low-profile plate (p < 0.025). Four complications occurred in patients who had been treated with a titanium plate, and five complications occurred in patients who had been treated with a stainless-steel plate (p = 0.71). CONCLUSIONS: Patients in whom a dorsally displaced distal radial fracture is treated with a titanium or stainless-steel Synthes pi plate have a significantly increased risk of complications compared with those in whom such a fracture is treated with a low-profile plate. Regardless of the type of plate used, all of the patients in the present study had a good or excellent long-term functional outcome.

Adolescent↗
PubMed2004

Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius.

BACKGROUND: Fractures of the distal part of the radius that are associated with complex comminution of both the articular surface and the metaphysis (subgroup C3.2 according to the Comprehensive Classification of Fractures) are a challenge for surgeons using standard operative techniques. METHODS: Twenty-five patients with subgroup-C3.2 fractures that had been treated with combined dorsal and volar plate fixation were evaluated at an average of twenty-six months after the injury. Subsequent procedures included implant removal in twenty-one patients and reconstruction of a ruptured tendon in two patients. RESULTS: An average of 54 degrees of extension, 51 degrees of flexion, 79 degrees of pronation, and 74 degrees of supination were achieved. The grip strength in the involved limb was an average of 78% of that in the contralateral limb. The average radiographic measurements were 2 degrees of dorsal angulation, 21 degrees of ulnar inclination, 0.8 mm of positive ulnar variance, and 0.7 mm of articular incongruity. Seven patients had radiographic signs of arthrosis during the follow-up period. A good or excellent functional result was achieved for twenty-four patients (96%) according to the rating system of Gartland and Werley and for ten patients (40%) according to the more stringent modified system of Green and O'Brien. CONCLUSIONS: Combined dorsal and volar plate fixation of the distal part of the radius can achieve a stable, mobile wrist in patients with very complex fractures. The results are limited by the severity of the injury and may deteriorate with longer follow-up. A second operation for implant removal is common, and there is a small risk of tendon-related complications.

Adult↗
PubMed2005

Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius.

BACKGROUND: Fractures of the distal part of the radius that are associated with complex comminution of both the articular surface and the metaphysis (subgroup C3.2 according to the Comprehensive Classification of Fractures) are a challenge for surgeons using standard operative techniques. METHODS: Twenty-five patients with subgroup-C3.2 fractures that had been treated with combined dorsal and volar plate fixation were evaluated at an average of twenty-six months after the injury. Subsequent procedures included implant removal in twenty-one patients and reconstruction of a ruptured tendon in two patients. RESULTS: An average of 54 degrees of extension, 51 degrees of flexion, 79 degrees of pronation, and 74 degrees of supination were achieved. The grip strength in the involved limb was an average of 78% of that in the contralateral limb. The average radiographic measurements were 2 degrees of dorsal angulation, 21 degrees of ulnar inclination, 0.8 mm of positive ulnar variance, and 0.7 mm of articular incongruity. Seven patients had radiographic signs of arthrosis during the follow-up period. A good or excellent functional result was achieved for twenty-four patients (96%) according to the rating system of Gartland and Werley and for ten patients (40%) according to the more stringent modified system of Green and O'Brien. CONCLUSIONS: Combined dorsal and volar plate fixation of the distal part of the radius can achieve a stable, mobile wrist in patients with very complex fractures. The results are limited by the severity of the injury and may deteriorate with longer follow-up. A second operation for implant removal is common, and there is a small risk of tendon-related complications.

Bone Plates↗
PubMed1978

Congenital pseudarthrosis of the radius.

Five children with six congenital pseudarthroses of the long bones of the forearm are described. Four cases were the result of neurofibromatosis, one was related to fibrous dysplasia, and one appears to be idiopathic. Whereas congenital pseudarthrosis of the leg primarily involves the tibia, congenital pseudarthrosis of the forearm primarily involves the radius. Four of the children were treated with bone grafts of the radius, three requiring repeated grafting. The etiology, differential diagnosis, long term prognosis, and treatment correlate with the data of similar lesions in the tibia. Thus the reason for poor fusion is probably unrelated to weight bearing but is rather the result of underlying bone pathology.

Child, Preschool↗
PubMed1980

Assessment of bone mass in the radius by computed tomography.

A reproducible method for quantitative analysis of computed tomographic cross-sections of the distal radius of patients with various metabolic bone diseases is described. A statistically significant correlation between the CT measurements in the radius and quantitative histomorphometric measurement of the trabecular bone volume of corresponding transilial bone biopsies is demonstrated. Selected longitudinal studies are presented to demonstrate the possible clinical applications of this type of CT analysis.

Adult↗
PubMed2003

MR imaging of ulnocarpal impaction after fracture of the distal radius.

OBJECTIVE: The purpose of our study was to evaluate the incidence of ulnocarpal impaction after distal radius fracture using MR imaging and to correlate imaging findings with those of radiography and clinical findings. CONCLUSION: Ulnocarpal impaction is a common finding after distal radius fracture. MR imaging can detect characteristic bone marrow changes of the lunate early after the trauma. A significant correlation exists between MR imaging findings and the extent of posttraumatic ulnar variance and pain levels.

Female↗
PubMed2003

Use of a dynamic compression plate and a cable cerclage system for repair of a fracture of the radius in a horse.

A pregnant 9-year-old Peruvian Paso mare was evaluated because of a fracture involving the left radius. On examination, grade IV/V lameness of the left forelimb was observed; radiography of the limb revealed a longitudinal oblique displaced fracture that extended from the caudal cortex of the radial mid-diaphysis into the humeroradial joint. To minimize the development of degenerative joint disease in the humeroradial joint, repair with internal fixation was recommended. A dynamic compression plate was applied to the cranial aspect of the radius; three 2-mm stainless steel cable cerclages were positioned around the mid- and proximal diaphysis. The horse was maintained in a sling for 8 to 12 hours daily for 3 weeks after surgery. Five months after surgery, the mare had foaled without complications, and grade I/V lameness during trotting only was observed. The combination of 1 dynamic compression plate and cable cerclage may provide satisfactory stabilization of this type of fracture in small to medium-sized horses.

Animals↗
PubMed2000

Postexercise and positional variation in mechanical properties of the radius in young horses.

The metacarpal of the horse is severely loaded during vigorous exercise. Metacarpal specimens have a greater impact strength in young horses that have been exercised than in those that have only been walked. We did not find a corresponding difference in the radius of the same horses. We show that cranial (anterior) cortical bone from the radius, which is loaded in tension during locomotion, has a greater Young's modulus, and tensile and bending strength, than bone from the caudal (posterior) cortex, which is loaded in compression. Caudal bone is, however, stronger in compression. The differences can be explained by differences in the histological structure developed by the 2 cortices and are presumably adaptive. This work confirms the work of others. Furthermore, we demonstrate that the impact energy absorption of cranial bone is nearly twice as great as that of caudal bone. The caudal cortex has apparently paid a heavy price in its reduction in resistance to accidental impact loading for being stronger than the cranial cortex in compressive loading.

Animals↗
PubMed1980

Radius shortening in malacia of the lunate.

Eight patients with malacia of the lunate treated by shortening of the radius have been reviewed after follow-up ranging from 2 to 7 years. The results were highly satisfactory and only one patient with fragmentation and collapse of the diseased bone did not obtain long-lasting pain relief. In all cases the progressive collapse of the lunate was arrested, an effect which is considered to be the result of reduced pressure on the lunate obtained by the radius shortening procedure.

Adult↗
PubMed1982

Results from resection of the distal end of the ulna after fractures of the lower end of the radius.

Pain, impaired mobility and weakness in the wrist are common complications after fractures of the lower end of the radius. When these symptoms persist, resection of the distal end of the ulna has been the surgical treatment of choice. 24 patients who had undergone this procedure were reviewed. 50% stated they were not improved by the operation. Of 11 patients with degenerative changes in the distal radio-ulnar joint on preoperative X-ray, 8 stated they were helped by the operation, while of 13 patients without any signs of arthrosis in the distal radio-ulnar joint, only 4 experienced relief of their discomfort. A more discriminating approach to the treatment of the sequelae of fractures to the lower end of the radius is required. Resection of the distal end of the ulna is probably only indicated when the distal radio-ulnar joint shows sings of arthrosis.

Adult↗
PubMed1982

Osteogenetic properties of reimplanted decalcified and undecalcified autologous bone in the rabbit radius.

In facial reconstructive surgery extensive studies have been performed to find substitutes to autologous vital bone as grafting material. Decalcified homologous compact bone has been found to possess a capacity of inducing new bone formation in rabbits whereas the application in man has not been successful thus far. In order to investigate the osteogenetic properties in autologous devitalized bone, the difference in bone forming capacity between decalcified and undecalcified devitalized autologous bone was studied. In rabbits, from the radius of each foreleg a piece of bone was resected, rinsed from periosteum and marrow whereupon one was decalcified in 0.6 N HCl. Both pieces were reimplanted in the radial defects 3 days later. The healing process was examined by radiography, light- and fluorescence microscopy. Decalcification seems to accelerate the osteogenetic process when bone is reimplanted to a defect in the rabbit radius.

Animals↗