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PubMed1998

Bone mineral density in girls with forearm fractures.

In childhood, the most common site of fracture is the distal forearm. To determine whether young girls with these fractures have low bone density more commonly than fracture-free controls, we measured bone density at the radius, spine, hip, and whole body and total body bone mineral content, lean tissue mass, and fat mass by dual-energy X-ray absorptiometry in 100 Caucasian girls aged 3-15 years with recent distal forearm fractures and 100 age- and gender-matched controls. Bone density (age-adjusted ratios of all cases:controls with 95% confidence intervals) was lower in cases at the ultradistal radius 0.963 (0.930-0.996), 33% radius 0.972 (0.945-0.999), lumbar spine 0.945 (0.911-0.980), hip trochanter 0.952 (0.918-0.988), and total body 0.978 (0.961-0.995). Moreover, osteopenia (defined as Z score below -1), was more common in cases than controls (p < 0.05) in the forearm, spine, and hip, with one third of fracture cases having low spinal density. Odds ratios (95% confidence intervals) for low bone density were: ultradistal radius, 2.2 (1.1-4.6); lumbar spine, L2-L4, 2.6 (1.3-4.9); and femur trochanter, 2.0 (1.0-3.9). Fracture patients aged 8-10 years weighed more (mean +/- SD) than age-matched controls (37.2+/-8.0 kg vs. 32.5+/-6.6 kg, p < 0.01) while older patients reported lower current and past calcium intakes than matched controls (p < 0.05). We conclude that low bone density is more common throughout the skeleton in girls with forearm fractures than in those who have never broken a bone, supporting the view that low bone density may contribute to fracture risk in childhood.

Adolescent↗
PubMed2000

More broken bones: a 4-year double cohort study of young girls with and without distal forearm fractures.

Predictors of childhood fractures have not been investigated previously. This study was undertaken to determine whether a previous history of forearm fracture, low bone mineral density (BMD; both areal bone mineral density [aBMD, g/cm2] and volumetric bone mineral apparent density [BMAD, g/cm3]), or anthropometry, influence fracture risk in young girls. At baseline, two cohorts of girls, aged 3-15 years, were evaluated: 100 had recently broken a forearm (group 1) and 100 were fracture free (group 2). Four years later we restudied 170 of these girls (82 from group 1 and 88 from group 2). We now report the relationships of previous fracture history, baseline BMD (measured by dual-energy X-ray absorptiometry), baseline weight, and height to risk of new fracture. More new fractures occurred in group 1 (37 fractures in 24 girls) than in group 2 (8 fractures in 7 girls; p = 0.0007). The independent predictors for occurrence of a new fracture at any skeletal site in a multivariate model adjusting for age, weight, total body aBMD, and fracture history were previous fracture (hazard ratio [HR], 3.28; 95% CI, 1.41-7.64); age (HR per 1-year increase, 0.91; 95% CI, 0.84-0.99); total body aBMD (HR per 1 SD decrease, 1.92; 95% CI, 1.31-2.81); and body weight (HR per 1 SD increase, 1.49; 95% CI, 1.06-2.08). Girls with two risk factors together had substantially greater fracture risk: previous fracture and low spinal BMAD (HR, 9.4; 95% CI, 2.8-32.0), previous fracture and high body weight (HR, 10.2; 95% CI, 2.8-37.6), or previous fracture and low total body aBMD (HR, 13.0; 95% CI, 3.9-43.1). We conclude that previous forearm fracture, low total body aBMD, low spinal BMAD, and high body weight each increase risk of new fractures within 4 years in young girls. Interventions to reduce the risk of fractures, particularly forearm fractures, in girls warrant further study.

Absorptiometry, Photon↗
PubMed2001

Diagnostic discrepancies between two closely related forearm bone density measurement sites.

At the present time the diagnosis of osteoporosis is based on the use of T-scores. Measurements at different skeletal sites or of different regions of interest may result in diagnostic discrepancies. In this study, we tried to demonstrate that bone mineral density (BMD)values at the closely related forearm sites may lead to diagnostic uncertainty, and to assess the degree of site heterogeneity across different age groups. The study consisted of 2348 women (age 20-83) referred for bone densitometry. Forearm BMD was measured at the distal and ultradistal sites by single X-ray absorptiometry (DTX-100 device). T-scores were calculated from Bulgarian reference data. Diagnostic disagreement between sites was found in 19.3% of all women. In 7.7% of all cases, the difference between T-scores at the two sites exceeded 1. The discrepancies were more pronounced after age 60. This corresponds well to the different onset and rates of trabecular and cortical bone losses as well as to their different distribution along the forearm. We encourage the separate assessment of cortical and trabecular bone densities or measurements at axial sites in case forearm sites yield conflicting results or low-normal BMD values.

Absorptiometry, Photon↗
PubMed1980

Insulin-like activity of bradykinin on amino acid balances across the human forearm.

In order to investigate whether bradykinin which has been shown to improve carbohydrate metabolism of skeletal muscle exhibits also insulin-like activity on amino acid metabolism, balances of oxygen and 13 amino acids across the forearm and forearm blood flow were determined in normal subjects during the arterial infusion of insulin (n = 9, 250 mu-units x kg-1 x min-1), bradykinin (n = 7, 0.2 ng x kg-1 x min-1) and papverine (n = 5, 2 microgram x kg-1 x min-1). As expected, the infusion of insulin exhibited significant reduction of the release of glycine, proline, valine, phenylalanine, leucine, threonine and isoleucine. As insulin, bradykinin lessened the release of 9 amino acids: Glycine, serine, ornithin, valine, leucine, isoleucine and tyrosine. On the contrary, papaverine which exhibited almost identical accelerationof forearm blood flow as bradykinin, did not influence the amino acid release from forearm muscle. These findings further support the notion that kinins liberated during muscle work might be involved in the work-induced insulin-like action on carbohydrate- and also on amino acid metabolism.

Adult↗
PubMed1995

Operative treatment of malunited fractures of the forearm.

We conducted a retrospective review of the results of twenty-seven consecutive osteotomies for malunited fractures of the forearm performed at the Mayo Clinic from 1976 to 1991. There were seventeen male patients and ten female patients who were an average of nineteen years old (range, nine to forty-one years old) at the time of the osteotomy. The corrective osteotomy was performed an average of seventy-three months (range, two to 324 months) after the fracture. The indication for the procedure was functional loss of motion (average arc of pronation-supination, 74 degrees; range, 20 to 120 degrees) in twenty patients, an unstable and painful distal radioulnar joint in six, and an unacceptable appearance of the forearm in one. Twenty patients had a corrective osteotomy of the radius; two, of the ulna; and five, of both bones. Of the twenty patients who had a corrective osteotomy for loss of motion of the forearm, nine were managed within twelve months after the initial injury and eleven were managed more than twelve months afterward. The patients who were managed early gained an average of 79 degrees (range, 20 to 160 degrees) of rotation after the osteotomy. Those who were managed late gained an average of only 30 degrees (range, -25 to 95 degrees). A pain-free, stable wrist was achieved in three of the six patients who were managed for an unstable and painful distal radio-ulnar joint. However, these six patients lost an average of 7 degrees (range, -25 to 25 degrees) of rotation of the forearm.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Osteosynthesis with Kirschner wires in the treatment of dislocation fractures of the forearm in children].

INTRODUCTION: Forearm fractures make 13-18% of all injuries of the upper extremities in children. Most of them are older than 6 years. The degree of tolerance is different but children younger than 8 years can tolerate 15-20 degrees of angulation, 45 degrees of inadequate rotation and total displacement. Older children can tolerate angulation of 10 degrees, 30 degrees of inadequate rotation and complete dislocation. MATERIAL AND METHODS: Over a period of five years (1995-2000) 54 children with forearm fractures (22 stable and 32 unstable fractures) were treated at the Pediatric Surgery Clinic in Novi Sad. Closed reduction and percutaneous pinning were treatments of choice in 19 patients with unstable fractures: 7 kids with only radius pinning, three kids with isolated ulnar fixation, 9 kids with pinning of both bones. Open reposition and fixation with Kirschner wires was done in 13 kids. RESULTS: In the group of 22 children with stable fractures results were excellent in 17 (77%), good in 4 (18.5%), and satisfactory in one child (4.5%). In the group of 32 children with unstable fractures excellent results were noted in 24 (75%), good in 4 (12.5%), satisfactory in 3 (9.4%) and unsatisfactory in one child (3.1%). DISCUSSION: A large number of forearm fractures in children can be treated with manual reduction and plaster immobilisation into a tolerable position. However, in unstable fractures the method of choice is manual reduction with percutaneous pinning. Some authors prefer fixation of both bones, others fix only one. CONCLUSIONS: Based on our experience it is concluded that orthopedic reposition and percutaneous pinning of unstable forearm fractures in children is very easy to perform, duration of intramedullar fixation is relatively short, removal of pins is also very easy without anesthesia and it requires short period of plaster immobilisation. This provides faster rehabilitation and improves quality of life.

Bone Wires↗
PubMed2004

The immediate effects of tension of counterforce forearm brace on neuromuscular performance of wrist extensor muscles in subjects with lateral humeral epicondylosis.

STUDY DESIGN: Within-subject repeated-measures study. OBJECTIVES: To examine the immediate effects of counterforce forearm brace on isokinetic strenght stretch reflex, passive stretching pain threshold of the wrist extensors, and proprioception of the wrist in subjects with lateral humeral epicondylosis for different strap tensions of a forearm brace. BACKGROUND: Counterforce forearm bracing has been used for treating lateral humeral epicondylosis, but the effect of brace tension has not been well reported. METHODS AND MEASURES: Fifteen subjects diagnosed with lateral humeral epicondylosis on their dominant arm were tested under 4 randomized conditions: (1) no brace, (2) brace with minimal tension, (3) brace with 25-N tension, and (4) brace with 50-N tension. The tests included isokinetic wrist extensors strength, passive stretching force in wrist flexion to elicit pain in the wrist extensors, wrist proprioception, and stretch reflex latency of the extensor carpi ulnari. A repeated-measures MANOVA was used to analyze the data and significant results were further analyzed with post hoc linear contrasts (alpha = .05). RESULTS: Among the 4 conditions, significant differences were found in wrist proprioception P = .032) and pain threshold to passive stretching of the wrist extensors (P = .05), but were not found in wrist extension isokinetic strength and stretch reflex latency of the extensor carpi ulnaris. CONCLUSION: A forearm counterforce brace, as applied in this study, affects wrist joint proprioception and increases the pain threshold to passive stretching of the wrist extensors in subjects with lateral humeral epicondylosis, but it has no effect on wrist extensor strength and stretch reflex latency of the extensor carpi ulnaris.

Adult↗
PubMed1987

Internal fixation of forearm fractures in children.

Fourteen children with severely displaced diaphyseal fractures of both bones of the forearm treated with open reduction and internal fixation were reviewed; these operations represented 9 per cent of all the diaphyseal forearm fractures in children during a 9-year period. The mean age of the patients at the time of the injury was 12 (7-14) years; they were reexamined 8 (5-11) years later, all after cessation of growth. At follow-up, limited prosupination, observed in 8 patients, was associated with a fracture of the proximal third of the forearm; limited motion of the radiocarpal joint, in 2 patients, was associated with shortening of the ulna. Only 4 patients complained of pain or were aware of restricted motion, and the average function was good. Open reduction and internal fixation is indicated in displaced fractures of the forearm even in children.

Adolescent↗
PubMed1999

Remodeling of forearm fractures in children.

A prospective study of 42 children with forearm fractures, treated by closed reduction and plaster, was conducted to assess the remodeling capacity of the radial epiphyseal plate after union of fracture with angulation. The children's ages ranged from 3 to 15 years. The effect of residual angulation of the healed fracture on the distal radial epiphyseal plate was examined radiographically over a median follow-up time of 3 years and 2 months, to observe the behavior of the distal radial epiphyseal plate during remodeling and to identify the factors that influenced this process. On the basis of these findings, guidelines are proposed for the treatment of forearm fractures that have healed with residual angulation. The inclinations of the distal radial epiphyseal plate on the fractured and normal forearms were compared on anteroposterior and lateral radiographs, at union and at final follow-up, in both the radioulnar and the dorsovolar planes. An alteration of inclination was seen in all patients with dorsovolar angulation of the radial growth plate, which always tended toward a correction of the abnormal inclination. In diaphyseal fractures, the distal radial epiphyseal plate realigned well only in children aged < or = 10 years, whereas with distal radial fractures, realignment of the epiphyseal plate and restoration of function was uniformly good up to age 15. Diaphyseal fractures, with radioulnar angulation in the growth plate, did not seem to remodel completely and were associated with loss of motion, whereas in distal fractures, irrespective of the final inclination of the epiphyseal plate, the range of motion returned completely at the end of follow-up. Abnormal angulation in the radioulnar plane was poorly corrected in all patients. These results could be helpful in the treatment of forearm fractures that are positioned or have healed in residual angulation.

Adolescent↗
PubMed1999

Relationship between ligamentous laxity and the site of upper extremity fractures in children: extension supracondylar fracture versus distal forearm fracture.

Eighty children who had fallen on an outstretched hand and sustained either a displaced supracondylar fracture (group 1) or a displaced distal forearm fracture (group 2) were prospectively studied. Ligamentous laxity in these 80 patients was determined by four methods: (a) contralateral elbow hyperextension, (b) knee hyperextension, (c) the ability to touch the thumb to the ipsilateral forearm, and (d) the ability to extend the thumb past the ulnar border of the clenched fist. Elbow hyperextension averaged 10.5 degrees in group 1 and 4.4 degrees in group 2 (P < 0.0001). Knee hyperextension averaged 7.2 degrees in group 1 and 2.4 degrees in group 2 (P < 0.001). Twenty-one of 38 patients in group 1 (55%) compared with 8 of 42 patients in group 2 (19%) could touch the thumb to the ipsilateral forearm (P < 0.001). Twenty-seven of 38 patients in group 1 (71%) compared with 5 of 42 patients in group 2 (12%) could extend the thumb past the ulnar border of the clenched fist (P < 0.001). The authors conclude that a child who demonstrates ligamentous laxity is more likely to sustain an extension supracondylar humerus fracture than a distal forearm fracture when he or she falls on the outstretched hand to break the force of the fall.

Accidental Falls↗
PubMed2000

Increasing use of autogenous fistulas: selection of dialysis access sites by duplex scanning and transposition of forearm veins.

Although the autogenous radiocephalic fistula is considered to be the ideal access for hemodialysis, significant changes in the demographics of patients undergoing angioaccess have occurred since its initial description in the 1960s. Patients presenting for initial access evaluation in contemporary practice are less likely to have arteries and veins suitable for autogenous fistula (AF) formation in the classic location. Physical examination of the upper extremity alone may be inadequate for selection of arteries and veins that will mature into a functioning AF. The authors have used duplex ultrasound (DU) to assess upper-extremity vasculature for planning of dialysis access procedures. Criteria for selection of arteries and veins and a detailed description of our DU examination protocol are reviewed. Routine use of upper-extremity DU has identified many patients with forearm veins that are suitable for use, but in locations remote from the optimal arterial inflow or too deep to facilitate easy needle cannulation. Modifications to the single-incision radiocephalic fistula that allow for expanded use of forearm veins identified by DU are described, and the technique of superficial venous transposition of forearm veins in particular is reviewed in detail. On the basis of our experience, we recommend the combination of upper-extremity planning DU and superficial venous transposition in the forearm to increase use of AF and reduce reliance on prosthetic bridging grafts (BG) in patients requiring access for hemodialysis.

Arm↗
PubMed2000

Distal forearm fractures in New Zealand children: annual rates in a geographically defined area.

AIMS: To estimate the annual incidence of distal forearm fractures in New Zealand children and to describe circumstances associated with this fracture. METHODS: The ages and dates of fracture of all girls and boys aged three to fifteen years with distal forearm fractures treated at Fracture Clinic, Dunedin Public Hospital in one calendar year were recorded. RESULTS: The age-standardised annual incidence rates for Dunedin girls and boys aged three to fifteen years were 10.4 per 1000 (95% CI 8.3-12.4 per 1000), and 10.4 per 1000 (95% CI 8.3-12.6 per 1000), respectively. The peak incidence in girls was observed at ten years of age (23.5 fractures per 1000) and for boys at thirteen years of age (25.3 fractures per 1000). Extrapolation of these rates to all New Zealand suggest that in children aged three to fifteen years, 3659 (95% CI 2906-4413) distal forearm fractures occur per year in girls, and 3845 (95% CI 3087-4603) per year in boys, representing about 20 fractures per day. Many of the fractures for the girls and boys resulted from apparently slight trauma (62.2% and 61.6%, respectively). CONCLUSIONS: Distal forearm fractures are very common events in New Zealand children and adolescents, and are usually caused by apparently slight trauma.

Accidental Falls↗
PubMed2003

[One-bone forearm operation for defective ulna osteomyelitis: a case report].

A four-year-old boy with forearm instability secondary to defective ulna osteomyelitis underwent one-bone forearm operation in neutral supination-pronation position. A year after the operation, shortening (3 cm) of the forearm was detected. Radiographs showed delayed union; however, a stable and functional forearm was obtained. The patient was able to use his fingers.

Child, Preschool↗
PubMed2003

[Free anterolateral thigh flap for reconstruction of head and neck defects: preliminary results and a comparison with the radial forearm flap].

BACKGROUND: The authors present their personal preliminary experience with the free anterolateral thigh flap in the reconstruction of head and neck defects and compare these first cases with the radial forearm flaps. METHODS: Seventeen patients undergoing free flap reconstruction between December 1998 and September 2001 have been selected for this retrospective study and evaluated. In fourteeen patients reconstruction was performed with a radial forearm flap. In three patients an anterolateral thigh flap was used. Six dissections on cadavers have also been performed in order to study the anatomical variations of the perforators of the lateral circumflex femoral system. RESULTS: All flaps survived, without any major vascular impairment. CONCLUSIONS: Despite a laborious dissection of the pedicle the anterolateral thigh is a versatile flap, with a minimal morbidity of the donor area. Even if the radial forearm is overall accepted as the gold standard for head and neck reconstruction, the anterolateral thigh flap is suggested as a good and safe surgical option, especially when a large flap is requested or in female patients concerned with the cosmetic result in the forearm donor area.

Aged↗
PubMed2004

Ununited diaphyseal forearm fractures with segmental defects: plate fixation and autogenous cancellous bone-grafting.

BACKGROUND: With current techniques of plate-and-screw fixation, diaphyseal nonunions of the radius and ulna are unusual. The few reports that have been published have discussed the use of structural corticocancellous bone grafts for the treatment of atrophic nonunions that are associated with osseous defects. We reviewed the rate of union and the functional results in association with the use of plate-and-screw fixation and autogenous cancellous (nonstructural) bone grafts. METHODS: Thirty-five patients with an atrophic ununited diaphyseal fracture of the forearm were treated with 3.5-mm plate-and-screw fixation and autogenous cancellous bone-grafting. A segmental osseous defect with an average size of 2.2 cm (range, 1 to 6 cm) was present in each patient. Twenty of the original fractures had been open. Eleven patients had had treatment of a deep infection before referral to us. The nonunion involved both forearm bones in eight patients, the radius alone in sixteen patients, and the ulna alone in eleven patients. RESULTS: The atrophic nonunion was associated with an open fracture in twenty patients, suboptimal fixation in twenty-two, a fracture-dislocation of the forearm in nine, and infection in eleven. All fractures healed without additional intervention within six months. Two patients had a subsequent Darrach resection of the distal part of the ulna for the treatment of arthrosis of the distal radioulnar joint. After an average duration of follow-up of forty-three months, the final arc of motion averaged 121 degrees in the forearm, 131 degrees at the elbow, and 137 degrees at the wrist, with an average grip strength of 83% compared with that of the contralateral limb. According to the system of Anderson and colleagues, five patients had an excellent result, eighteen had a satisfactory result, eleven had an unsatisfactory result (because of elbow stiffness related to associated elbow injuries in three and because of wrist stiffness in eight), and one had a poor result (because of malunion). CONCLUSIONS: When the soft-tissue envelope is compliant, has limited scar, and consists largely of healthy muscle with a good vascular supply, autogenous cancellous bone-grafting and stable internal plate fixation results in a high rate of union and improved upper limb function in patients with diaphyseal nonunion of the radius and/or ulna.

Adult↗
PubMedDate not supplied

[Bone mineral density, milk intake and physical activity in boys who suffered forearm fractures].

OBJECTIVE: To compare boys with and without forearm fracture in terms of their bone mineral density, intake of milk and dairy products, and physical activity. METHODS: There were 23 boys in each group (aged between 7 and 13 years). They were submitted to bone densitometry with dual-energy x-ray absorptiometry (DEXA) of the forearm (opposite side of the fracture). Participants answered questionnaires about their intake of milk and dairy products, and about their physical activity. RESULTS: The mean+/-SD of the bone mineral density of the radial and ulnar distal diaphysis in the case group (0.430+/-0.038 g.cm(-2)) was significantly lower (p = 0.018) than that of the control group (0.458+/-0.039 g.cm(-2)). Likewise, the mean of the distal metaphysis of the forearm was 0.309+/-0.033 g.cm(-2) in the case group and 0.349+/-0.054 g.cm(-2) in the control group (p = 0.004). Milk intake (1.5+/-1.2 cups a day) was significantly lower in the case group (p = 0.001) than in the control group (2.7+/-1.2 cups a day). The number of boys who practiced after-school physical activity was significantly lower (p = 0.017) in the case group (six boys = 26%) than in the control group (15 boys = 53%). CONCLUSION: Boys who suffered forearm fracture showed lower bone mineral density compared with the control group. In the case group, milk intake and physical activity were lower than in the control group.

Absorptiometry, Photon↗
PubMed2006

[The anatomy lesson of Dr Nicolaes Tulp by Rembrandt (1632) and the findings during dissection of the forearm of a cadaver: anatomical discrepancies].

OBJECTIVE: To compare The anatomy lesson of Dr Nicolaes Tulp by Rembrandt (1632) with the findings during dissection of the forearm of a cadaver. DESIGN: Descriptive. METHOD: The left forearm of a 41-year-old white male cadaver was dissected, photographs being taken at every stage of dissection. The anatomical structures in the original painting and during dissection were described and compared. At dissection, several structures were displaced in an attempt to reproduce the anatomical structures as shown in the painting. RESULTS: Dissection revealed four anatomical differences in comparison with Rembrandt's painting: (a) the muscle belly seen at the proximal ulnar side of the forearm in the painting was not seen on dissection; section of the insertion of the M. flexor carpi radialis and transposition of this muscle to the location of the muscle belly created the possibility of lifting up the M. flexor digitorum superficialis and reproducing the muscle belly; (b) in the painting, Tulp lifted only the M. flexor digitorum superficialis, but the amount of muscle tissue found in the forceps was increased in the painting compared with the dissection; (c) the positions of the bellies of the M. flexor digitorum superficialis to the index finger and 5th digit and to the 3rd and 4th digits were found to be reversed; (d) the longitudinal white structure situated in the ulnar part of the 5th digit in the painting was not found on dissection. This may have been an anatomical variant of the ulnar nerve. CONCLUSION: The anatomical characteristics of the painting could not be reproduced by dissection of the forearm of a cadaver.

English Abstract↗
PubMed1986

Forearm bone mineral content does not decline with age in premenopausal women.

Forearm densitometry was performed on 77 normal premenopausal women aged 22-59 years. Bone mineral content (BMC) (arbitrary units) was converted into true forearm mineral content (FMC) (mg/cm) by measuring and ashing a sample radius and ulna. FMC was divided by width to yield surface density (mg/cm2) and divided by cross-sectional area to yield forearm mineral density (FMD) (mg/ml). The coefficient of variation of FMC was 12.3%, which was reduced to 10.1% after correction for width and 10.9% after correction for area. FMC was significantly related to height, bone width, and bone area but not to weight. The correlation with height was lost when FMC was corrected for bone width or bone area. None of the measured or derived bone variables was significantly related to age. Neither total bone mass nor bone density declines with age in premenopausal women. A comparison of normal and osteoporotic women will be required to establish whether bone width or bone area is the best referent for forearm mineral content.

Adult↗