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PubMed1979

Remodelling after distal forearm fractures in children. II. The final orientation of the distal and proximal epiphyseal plates of the radius.

In 39 children the steric orientation of both the distal and the proximal epiphyseal plates of the radius was evaluated 4 months to 10 years after distal forearm fractures that had healed with residual angulation. A residual fracture angulation was found to induce a change in orientation of both the distal and proximal epiphyseal plates. The final result of the reorientation was a normalization of the inclination of the plates in relation to the long axis of the bone. The proximal epiphyseal plate attained practically a normal orientation. The distal epephyseal plate tended towards overcorrection. In two of the four cases with a primary angulation exceeding 20 degrees considerable normalization occurred, but a "normal" state was not reached. This indicates an upper limit for angulations permitting normalization of the orientation of the distal epiphyseal plate of the radius.

Adolescent↗
PubMed1985

Classification of distal radius fractures.

We analysed retrospectively a series of 269 distal radius fractures in adults in order to determine which of five different classification systems gave the best information about the radiographical prognosis of a fracture. The result after reduction in 195 cases was influenced mainly by the primary shortening, whereas dorsal angulation, radial displacement, and the age and sex of the patient were of minor importance. The system described by Older et al. in 1965, was superior to the others. In the analysis of the radiographical result after fracture union, the quality of the reduction, the Older classification system, and the age of the patient were the most important prognostic factors. We conclude that reduction of a distal radius fracture should primarily aim at correcting the shortening.

Adult↗
PubMed1987

Treatment of giant cell tumor of the distal radius by ulnar translocation. A case report and review of the literature.

Presented is a case of giant cell tumor of the distal radius treated successfully by en bloc resection and translocation of the ipsilateral distal ulna. A good functional result was achieved with near full range of pronation and supination and 5 degrees of flexion at the wrist. The advantage of this technique is that the ulna provides a locally available vascularized graft to bridge the gap created by resection of the radius.

Adult↗
PubMed2002

Use of injectable calcium phosphate in the treatment of intra-articular distal radius fractures.

This study reviewed 19 patients with intra-articular fractures of the distal end ofthe radius treated with augmented external fixation and injectable calcium phosphate (Norian SRS; Norian Corp, Cupertino, Calif) between November 1997 and July 2000. Average patient age was 52 years, and average follow-up was 16.3 months. Patients were evaluated clinically and radiographically using the modified Mayo Wrist Score and Knirk and Jupiter's criteria, respectively. Overall results are comparable to those from other studies of intra-articular distal radius fractures in which other grafts have been used.

Adult↗
PubMed2006

A biomechanical comparison between two volar locking plate systems for distal radius fractures.

The biomechanical properties of two distal radius volar locking plate systems were investigated. A cadaveric model simulating distal radius fractures with dorsal comminution was selected. The biomechanical properties of fracture fixation using the Synthes volar locking T-plate and the Hand Innovation DVR plate were characterized. The average stiffness was 137.1 +/- 19.9 N/mm for the DVR group and 119.1 +/- 9.9 N/mm for the Synthes group (P = .49), and the average changes of the opening angle describing plastic deformation were 10.1 degrees +/- 4.0 degrees and 8.6 degrees +/- 13.2 degrees, respectively (P = .23). This study demonstrates that both the Synthes T-plate and Hand Innovations DVR plate fixation systems show comparable biomechanical characteristics.

Biomechanical Phenomena↗
PubMed2006

Ipsilateral vascularised ulnar transposition autograft for limb-sparing surgery of the distal radius in 2 dogs with osteosarcoma.

Canine osteosarcoma is the most commonly diagnosed primary bone tumour in the dog, affecting mainly large and giant breed dogs with the predilection site being the metaphysis of long bones, specifically the distal radius, proximal humerus, distal femur and proximal tibia and fibula. Treatment options are either palliative or curative intent therapy, the latter limb amputation or limb-sparing surgery together with chemotherapy. This article describes the use of an ipsilateral vascularised ulnar transposition autograft as well as chemotherapy in 2 dogs with osteosarcoma of the distal radius. Both dogs showed minimal complications with the technique and both survived over 381 days following the surgery. Complications seen were loosening of the screws and osteomyelitis. The procedure was well tolerated with excellent limb use. This technique is indicated for use in cases with small tumour size that have not broken through the bone cortex.

Animals↗
PubMed2007

Malunion of the distal radius.

Fractures of the distal radius are common injuries. Acceptable results typically can be obtained with appropriate surgical or nonsurgical management. However, a small percentage of these fractures can progress to symptomatic malunion, which traditionally has been treated with osteotomy of the distal radius. Proper understanding of anatomy, biomechanics, indications, and contraindications can help guide patient selection for surgery. In formulating a treatment plan, the surgeon also must consider such technical variables as the type of osteotomy, the use of bone graft or bone-graft substitute, and the means of fixation to stabilize the osteotomy. Simultaneous implementation of an ulnar-side procedure, an intra-articular osteotomy, and soft-tissue releases also may be necessary. Some cases may be more appropriate for wrist fusion or other salvage procedures.

Biomechanical Phenomena↗
PubMed1998

Surgical plating of a fractured radius and ulna in a wild Canada lynx.

A free-ranging, adult male Canada-lynx (Lynx canadensis) experienced a closed, complete, non-comminuted transverse fracture of the left radius and ulna when captured in a leg snare. A dynamic compression plate (DCP) attached to the anterior surface of the radius was used to stabilize the fracture. Radiographs 44 days post-surgery indicated advanced primary bone healing. The lynx was released 46 days post-surgery near the site of capture. Radiotelemetry indicated long-term survival and movements similar to other males monitored during the same period.

Anesthetics↗
PubMed1976

[Behavior of reactive shaft pseudarthroses of the canine radius in the electric and electromagnetic fields].

In 27 beagles, 19 radius shaft pseudarthroses and 8 tibia were stimulated either by directly applied alternating current of low frequency and strength, delivered from an implanted battery source, or by a pulsing electromagnetic field inductively coupled to bone. Increase of periosteal callus was only found beneath parallel sling electrodes placed on pseudarthroses parallel to the radius shaft. Stimulation by transverse electrodes implanted into bone produced no significant increase of osteogenesis and bone healing, evaluated by x-rays, scintigrams, and morphometry when compared with contralateral leg controls.

Animals↗
PubMedDate not supplied

Management of thrombocytopenia-absent radius (TAR) syndrome.

Thrombocytopenia-absent radius (TAR) syndrome is defined by bilateral absence of the radius and hypomegakaryocytic thrombocytopenia (<150,000/mm3). Lower extremity and nonorthopaedic anomalies also are frequently present. Charts and radiographs of 23 patients with TAR syndrome were reviewed, with extremity and other anomalies documented. Upper and lower extremity management, which included surgery and multiple attempts at orthotic and prosthetic fitting, was evaluated. Upper extremity prostheses were generally rejected, as most patients were able to perform tasks by approximating themselves closely enough to an object to use their own hands. Adaptive devices for feeding, dressing, and toileting were well tolerated. In the lower extremity, most affected patients either rejected any lower extremity intervention or had involvement that eventually precluded functional ambulation, necessitating power wheelchair or motorized cart use. The greatest degree of independence for these patients comes not from surgical, prosthetic, or orthotic intervention, but from the use of simple adaptive devices and powered mobility aids if required.

Child, Preschool↗
PubMed1999

[The influence of the traction on the wrist in the course of healing of the radius distal part comminuted fractures].

Traction and external fixation are the methods of choice by treating the comminuted fractures of the distal part of the radius. Bringing in two screws into the second metacarpal bone and the radius proximity from the fracture makes possible the traction and fixate the fractured bone splinters. The reposition of the comminuted fractures needs a very strong traction and provides to expand the ligaments and the wrist articular capsula. The aim of our study is to explain the mechanical influence of the external stabilization on the wrist and the wrist function after the immobilisation with the distraction. In 15 patients the examination was performed. The wrist was estimated on the base of clinical examination and rentgenography. Those examinations were performed within the moment of reduction of the dislocation, than 6 weeks and after next 6 weeks. All results are illustrated on graphics and x-ray pictures. The results of our study prove the profitable influence of the traction on the healing of the damaged articular surface in good clinical and functional position. Even a strong traction has in comparison to the control group (healing conservatively or by using various methods of the internal fixation) no influence on the wrist function.

Adult↗
PubMed1999

Arthroscopic management of intra-articular distal radius fractures.

Wrist arthroscopy is increasingly becoming recognized as an important adjunct in the management of displaced intra-articular fractures of the distal radius. Anatomic restoration of the articular surface is possible under bright, magnified conditions. Osteochondral loose bodies and associated intracarpal soft tissue injuries that may not be apparent on plain radiographs are detected and simultaneously managed. A method of management for displaced distal radius fractures using wrist arthroscopy and a combination of percutaneous and limited open reduction techniques are described.

Arthroscopy↗
PubMed2000

Adult monteggia fracture with ipsilateral distal radius fracture: case report.

Although the adult Monteggia fracture is a well-known injury, the combination of a Monteggia fracture and an ipsilateral distal radius fracture is extremely rare. It is important for the treating physician to recognize that this injury involves not only the bone elements but also their articulations. The distortion of the integrity of both the elbow and the wrist results in the potential for functional compromise, if inadequately treated. The case report presented here describes a 21-year-old woman with this complex injury resulting from a fall. The injury included a Monteggia type II fracture and an ipsilateral distal radius intra-articular fracture in the left forearm. An excellent result was obtained by surgical intervention in both the radial and ulnar bones. The factors we believe contributed to the excellent result were early diagnosis, anatomic reduction, stable fixation, and early physical exercise. The mechanism of injury giving rise to this rare combination of fractures is discussed, as well as a review of the literature.

Adult↗
PubMed2000

[Results of diaphyseal shortening of the radius in the treatment of Kienböck's disease: a series of 31 cases].

PURPOSE OF THE STUDY: Several therapeutic options have been proposed for the treatment of Kienbock's disease, including shortening of the radius. We report results in a series of 31 cases treated by diaphyseal radial shortening with a mean 6-year follow-up (range 1 - 18 years). MATERIAL AND METHODS: The series included 19 women and 12 men, mean age, 26 years (range 17 - 47 years). According to the Lichtmann classification there were 7 grade II, 23 grade IIIa and 1 grade IIIb. Mean shortening was 4.5 mm, ranging from 3 to 6 mm. Pain, mobility, muscle force and radiological presentation were assessed. RESULTS: Pain relief was achieved in all patients; 20 patients were entirely pain free and 11 had exceptional minor pain at exertion. Mean gain in mobility was 22 p. 100 both for palmar flexion and for dorsal flexion. Muscle force was improved in 30 cases with normal force in 18 and slightly less than normal force in 12. Muscle force remained insufficient in one case. According to the Michon criteria, there were 80 p. 100 excellent and good results. The radiographic assessment showed 14 improvements, 16 stabilizations, and 1 aggravation. Overall clinical ouctcome was independent of age, and preoperative radiographic aspect and length of the ulna. In addition, there was no correlation betwen radiological changes of the lunatum and the clinical result. CONCLUSION: Osteotomy for diaphyseal shortenig of the radius is a reliable simple procedure which does not require supplementary immobilization and which avoids complications encountered with self-compressive paltes.

Adolescent↗
PubMed2000

[Distal radius fracture. Surgery or plaster cast?]].

Fractures of the distal radius are most commonly seen in women in the sixth and seventh decade of life. These fractures range in severity from simple, stable non-dislocated metaphyseal transverse fractures of the distal radius to complex, intra-articular fractures of the wrist with involvement of the carpus. This means that individual consideration of the appropriate therapeutic approach that needs to be adopted is required. A decisive role for surgical treatment is played by the anatomical angles at the radiocarpal articular surface, and the congruence of the distal radio-ulnar joint. If care is not taken to establish proper anatomical relationships, persistent problems must be expected.

Casts, Surgical↗
PubMed2001

Fractures of the distal radius. Current concepts for treatment.

The authors review the treatment of fractures of the distal radius, based on their experience and from data in the literature. The choice of a treatment for any given fracture must take into account first of all the stability of the fracture. The best results are achieved in stable fractures. Only minimally displaced distal radius fractures can be treated functionally. However, a plaster cast for one week is indicated for the comfort of the patient. In displaced but stable fractures both closed reduction and percutaneous fixation are indicated. In case of closed reduction, the plaster cast should be applied for 5 to 6 weeks with an above-elbow cast for 3 weeks. Percutaneous fixation gives the best results in extraarticular fractures in younger patients. Because of its simplicity however, it should not be ignored in the elderly osteoporotic patients. In the authors' experience, both techniques were only used for extraarticular fractures. Good and excellent results were found in the closed reduction and plaster cast group in 74% of the patients; the Kapandji technique gave 75% good and excellent results. These results are in line with other findings which show that, for simple fracture types, the Kapandji technique and closed reduction seem to give similar results. External fixation is widely used for intra-articular comminuted fractures. Dynamic external fixation does not show any advantage over static devices. Additional K-wires or bone grafting may be necessary. External fixation gives superior results to plate and screw fixation. Internal fixation should be reserved for fractures with ventral comminution or severe displacement with unacceptable reduction by closed or minimally invasive techniques.

Adolescent↗
PubMed2001

[Paget disease or fibrous dysplasia of the radius?--A case report].

A 46 years old man, who showed a painful and progressive deformity of the left radius, is presented. After some months a fracture within the affected bone area occurred. The diagnostic procedures including X-ray, MRI, scintigraphy and histology were controversial. Both fibrous dysplasia and Paget's disease of bone were suspected. The critical analysis of all results concluded that the most likely diagnosis was fibrous dysplasia. Unaware of the diagnostic discrepancies, the patient received a therapy with pamidronate 3 x 60 mg intravenously, which improved symptoms. After 14 months, the patient complained again about pain in the left radius. After a second therapy with pamidronate the patient currently exhibits no symptoms. The controversial diagnostic results and the applied therapeutic procedure are discussed.

Diagnosis, Differential↗