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PubMed2000

Risk factors for perimenopausal distal forearm fracture.

This prospective population-based cohort study investigated factors predicting distal forearm fracture (DFF) in perimenopausal women. The study population consisted of 11,798 women from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) Study in Finland. Mean baseline age of these women was 52.3 (SD 2.9) years (range 47-56 years) and 68% were postmenopausal. Three hundred and sixty-eight women (3.1%) had a validated DFF during the 5-year follow-up. Previous wrist fracture, postmenopausal state, age and nulliparity were independent predictors of DFF, while hormone replacement therapy (HRT), dairy calcium and overweight protected against it in multivariate Cox regression analysis: previous wrist fracture increased the DFF risk by 158% (p < 0.0001), menopause by 69% (p = 0.002) and age by 6% per year (p = 0.010), whereas the continuous use of HRT decreased the risk by 63% (p = 0.0001), the use of dairy calcium at 1000-1499 mg/day (vs < 500 mg/day) by 39% (p = 0.004), overweight (BMI > 25 kg/m2) by 36% (p = 0.0002) and parity by 29% (p = 0.031). Combining dichotomous low weight, low use of calcium, non-use of HRT and previous wrist fracture into a risk score gave a dose-response effect by score level: the presence (vs absence) of all four risk factors resulted in a 12-fold DFF risk. Nevertheless, the sensitivity and specificity of the score for detecting DFF remained low. It was concluded that HRT, high nutritional calcium intake and overweight protect against but a history of wrist fracture predisposes to perimenopausal distal forearm fracture. A simple risk factor inquiry would help to identify perimenopausal women at high risk of distal forearm fracture.

Cohort Studies↗
PubMed2001

Ability of peripheral DXA measurements of the forearm to predict low axial bone mineral density at menopause.

The aim of this study was to evaluate the ability of peripheral dual-energy X-ray absorptiometry (pDXA) measurement of the forearm to predict low axial bone mineral density (BMD) as defined according to the WHO classification. Two hundred and thirty-four healthy women aged 45-60 years were investigated. BMD was measured at the proximal and distal radius + ulna by pDXA and at the lumbar spine and femoral neck by DXA. There was a significant but moderate correlation between peripheral and axial BMD measurements, with r values ranging from 0.4 to 0.6 (SEE: 13.5-17%). The cutoff values for the proximal and distal radius BMD that allow the identification with 95% sensitivity of postmenopausal women with either a lumbar spine or femoral neck T-score < -1, corresponded to a T-score of +0.5 (proximal radius) and +1 (distal radius). More than 90% of the whole population had a peripheral T-score below these thresholds. Using an axial T-score < or = -2.5 as the definition of abnormality reduced to 48% (proximal radius) to 66% (distal radius) the number of women who would have required DXA axial measurements (i.e., with a pDXA T-score below the cutoff value of -0.7). Of the 33 women (14%) with a proximal radius T-score < or = -2.5 (osteoporosis), only 1 had a lumbar spine and femoral neck T-score > or = -1 (normal). Conversely, of the 50% (proximal radius) to 65% (distal radius) of the women with normal forearm measurement, 5% (proximal radius) to 9% (distal radius) were found to be osteoporotic and an additional 57% (proximal radius) to 59% (distal radius) could be classified as osteopenic (T-score between -1 and -2.5) at either the lumbar spine or femoral neck. In conclusion, use of pDXA forearm measurement as a prescreening tool in early postmenopausal women should allow the direct identification of about 50% of the women with no axial osteoporosis. However, this study highlights the difficulties in using a unique T-score that could be applied to different sites to diagnose osteoporosis.

Absorptiometry, Photon↗
PubMed2006

Effects produced in human arm and forearm motoneurones after electrical stimulation of ulnar and median nerves at wrist level.

Effects of electrical stimulation of ulnar and median nerves at wrist level were investigated in post-stimulus time histograms (PSTHs) of single motor units from both flexors and extensors in human arm and forearm. Stimulation of ulnar nerve produced late (mean extra time-after monosynaptic group Ia excitation-10.7 +/- 0.1 ms) high-threshold (>1.2 x motor threshold, MT) excitation, which was not reproduced by purely cutaneous stimulation, in all the investigated motor nuclei except in Extensor Carpi Radialis. Stimulation of median nerve, and of the skin of fingers II and III (at palmar side level), produced short latency inhibition (mean extra time 3.8 +/- 0.3 ms), which was most often truncated or followed by late excitation (mean extra time 11.8 +/- 0.3 ms); both effects were of low threshold (0.8 x MT). Short latency inhibition was very strong, and late excitation was rare and weak in almost all the investigated motor units except in those supplying flexors in forearm, in which the main effect was the late facilitation (stronger than in other motoneurones). Since extra time was not more than 13 ms, it is suggested that the late effects may be mediated through spinal pathways, at least during their 3-5 first ms. Based on the electrophysiological results and on the anatomical characteristics of ulnar and median nerves, it is assumed that ulnar-induced late high-threshold peak in PSTHs might reflect group II excitation in spinal motoneurones, and median-induced modifications in motor unit discharge, mainly cutaneous control of motoneurone discharge. Since the central delay of median-induced inhibition is longer the more caudal the motoneurone, inhibitory propriospinal-like interneurones are supposed to mediate cutaneous inhibitory control from hand upon muscles in arm and forearm. Potential roles of proprioceptive and cutaneous control from hand to more proximal musculature, provided by ulnar and median nerve, respectively, during precise hand movements are discussed.

Adult↗
PubMed2001

Forearm bone mineral density in postmenopausal women with rheumatoid arthritis.

Osteoporosis in cases of rheumatoid arthritis (RA) is multifactorial, and the pathogenesis of bone loss induced by RA in postmenopausal women is not fully understood. The purpose of the present study was to determine the factors that affect forearm bone mineral density (BMD) in postmenopausal women with RA. In total, 839 postmenopausal women aged 46-90 years, were enrolled in the study; 470 patients with RA and 369 healthy controls (CON). Forearm (distal radius) BMD, measured by DXA using a DTX-200 (Osteometer, MediTech, CA, USA), was significantly lower in the RA group than in the CON group (P < 0.0001), even when adjusted for age, height, body weight, body mass index, and years since menopause (YSM) (P < 0.01). On multiple regression analysis, in the CON group, age and YSM were significantly correlated with BMD (P < 0.01 and P < 0.05, respectively). On the other hand, in the RA group, in addition to YSM, anatomic grade in the wrist, modified health assessment questionnaire (HAQ) score for the upper extremities, and erythrocyte sedimentation rate were each significantly correlated with BMD (P < 0.0001, P < 0.001, P < 0.0001, and P < 0.001, respectively), whereas functional class, duration of disease, dose of prednisolone used, modified HAQ score for the lower extremities, and the levels of c-reactive protein and rheumatoid factor were not. The present study with a large number of subjects shows that in addition to YSM, disuse (anatomic grade) of the wrist, arm function, and disease activity appear to be significant determinants of forearm BMD in postmenopausal women with RA.

Absorptiometry, Photon↗
PubMed2005

Towards standardization of dual X-ray absorptiometry (DXA) at the forearm: a common region of interest (ROI) improves the comparability among DXA devices.

Manufacturer-implemented regions of interest (ROIs) to determine the bone mineral density (BMD) at the forearm are currently not standardized across dual X-ray absorptiometry (DXA) devices. We hypothesized that their differences introduce considerable variation in measurement results for forearm BMD when taken on different devices, and that a ROIs common to all devices with standardized placement and size significantly improve device comparability. The common ROI was defined to have a fixed length of 2 cm and to extend proximally from the location where the ulna and radius bones superimpose on the DXA image. The effects of universal standardization of forearm BMD were combined with and compared to those of the common ROI. They were drawn on 91 female study participants (ages 20-80 years, 10 per decade) who were scanned on Hologic QDR-4500, Aloka DCS-600EX, GE Lunar PIXI and Norland pDEXA DXA scanners. For all device combinations, manufacturer-implemented ROI root mean-square errors were significantly higher than for the common ROI, suggesting that implementing an ROI with common design on all scanners is a good way to reduce interdevice variability. When manufacturer-implemented ROIs were universally standardized root mean-square error (RMSE) values were less different from that of the nonstandardized Common ROI, suggesting that universal standardization can further improve interdevice comparability even when a common ROI such as the one implemented here is used. ROI standardization dramatically improves interdevice comparability.

Absorptiometry, Photon↗
PubMed1998

MR imaging of the major nerves about the elbow: cadaveric study examining the effect of flexion and extension of the elbow and pronation and supination of the forearm.

Magnetic resonance (MR) imaging provides useful information in the evaluation of peripheral nerves. Recent advances in MR imaging allow for detailed depiction of the soft tissue structures of the elbow joint. Three major nerves are present about the elbow. Six cadaveric elbows were imaged to depict the normal anatomy of these nerves and to determine the best plane and position of the elbow for optimal visualization of each nerve. Axial images of the elbow in full extension with the forearm in supination allow identification of all major nerves. Axial images with the elbow in full flexion allow accurate assessment of the cubital tunnel and the ulnar nerve. Axial images of the elbow in full extension with the forearm in pronation are helpful for assessment of the median and radial nerves in the forearm.

Aged↗
PubMed2004

Distal forearm tourniquet for hand surgery.

To evaluate the usefulness of the tourniquet placed at the distal forearm, 30 patients were operated with the tourniquet set at the distal forearm using nerve-block anaesthesia. Pain during surgery, flexion of the fingers, bloodless field, and general complications during surgery and 18 months thereafter were recorded. The mean time of ischemia was 19.6+/-7.5 (10-50) min. A bloodless field was achieved in all cases, and pain during operation was low. Flexion of the fingers were found in most cases but was reducible and not annoying for the surgeon. There were no serious complications during surgery or at follow-up. The tourniquet placed at the distal forearm is painless, safe, and useful in hand surgery.

Adult↗
PubMed2005

The crisscross injury mechanism in forearm injuries.

INTRODUCTION: A new mechanism of injury of the forearm bones, crisscross injury, is described. It is more common than the Essex-Lopresti fracture dislocation. The old concept of isolated injury of one side of the radioulnar joint may be challenged. It often occurs in Mason type II fracture dislocation of the radial head or dislocation of radioulnar joints. MATERIALS AND METHODS: The first part was a cadaveric study of the crisscross injury of forearms. The second part was a clinical study of the crisscross injury in some cases of Mason type II fracture radial head and double dislocation of the radioulnar joint. RESULTS: The cadaveric study confirmed a stable crisscross fracture dislocation injury with intact interosseous membrane. The clinical study echoed the presence of this injury by imaging techniques. CONCLUSION: The crisscross injury mechanism explains the mirror pathogenesis of the traumatic fracture dislocation of the distal and proximal radioulnar joints with intact shaft of the radius and ulna. Co-existing subluxation or dislocation of the other radioulnar articulation must not be overlooked in cases of fracture dislocation of one radioulnar joint. Two types of crisscross injury of forearm bones are proposed.

Adult↗
PubMed1998

Traumatic forearm amputation with avulsions of the ulnar and median nerves from the brachial plexus.

A case of a traumatic forearm amputation and associated complete avulsions of the ulnar and median nerves from the brachial plexus due to a crush-traction injury of the distal part of the right forearm is reported. The patient also suffered a traumatic head injury. The injury of the upper limb and the general condition of the patient were so serious that an amputation at the 1/3 middle part of the forearm had to be performed.

Accidents, Traffic↗
PubMed2006

Correction and lengthening for deformities of the forearm in multiple cartilaginous exostoses.

BACKGROUND: Multiple cartilaginous exostoses cause various deformities of the epiphysis. In exostoses of the ulna, the ulna is shortened and the radius acquires varus deformity, which may lead to dislocation of the radial head. In this study, we present the results of exostoses resection, with correction and lengthening with external fixators for functional and cosmetic improvement, and prevention of radial head dislocation. METHODS: We retrospectively reviewed seven forearms of seven patients who had deformities of the forearm associated with multiple cartilaginous exostoses. One patient had dislocation of the radial head. Operative technique was excision of osteochondromas from the distal ulna, correction of the radius, and ulnar lengthening with external fixation up to 5 mm plus variance. We evaluated radiographs and the range of pronation and supination. Furthermore, we conducted a follow-up of ulnar length after the operation. RESULTS: Dislocation of the radial head of one patient was naturally reduced without any operative intervention. At the most recent follow-up, six of the seven patients showed full improvement in pronation-supination. Ulnar shortening recurred with skeletal growth of four skeletally immature patients; however, it did not recur in one skeletally mature patient. Overlength of 5 mm was negated by the recurrence of ulnar shortening about 1.5 years after the operation. CONCLUSIONS: We treated seven forearms of seven patients by excision of osteochondromas, correction of radii, and gradual lengthening of ulnas with external fixators. The results of the procedure were satisfactory, especially for function of the elbow and wrist. However, we must consider the possible recurrence of ulnar shortening within about 1.5 years during skeletal growth periods in immature patients.

Adolescent↗
PubMed2002

Early result of arteriovenous graft with deep forearm veins as an outflow in hemodialysis patients.

The purpose of this study was to evaluate the result of arteriovenous (A-V) grafting with the deep forearm veins as an outflow system in hemodialysis patients. Between June 1999 and July 2001, 27 A-V grafts consisting of ePTFE and deep forearm veins were constructed in 26 patients. All patients followed up for assessment of all relevant values, and the median follow-up period was 17.3 months. Seven grafts (26%) failed during the follow-up. The patency rates were 93% and 80% at 3 months and 12 months, respectively. No difference in patency rate was found between males and females, or between diabetics and nondiabetics. Graft-related complications, excluding graft thrombosis, occurred in five patients. These included operative wound dehiscence in two cases, a graft infection, a seroma, and a mild hypoperfusion in the hand. We conclude that the early patency rate of A-V graft using the forearm deep veins as an outflow system is very good and that this technique may be a recommended surgical modality for vascular access in patients with exhausted superficial veins.

Adult↗
PubMed2003

Comparison of autologous basilic vein transpositions between forearm and upper arm regions.

Arteriovenous fistulas are crucial for hemodialysis performances in patients with end-stage renal disease. In this report, we compare the results of basilic vein transposition in the forearm and upper arm regions. Autologous basilic vein transpositions were used in 20 patients with end-stage renal failure between May 2000 and January 2002. In 10 cases the basilic vein transposition was in the upper arm region for construction of a brachiobasilic fistula (group 1); in the remaining 10 cases it was in the forearm region for creation of a radiobasilic fistula (group 2). The mean age of the patients in group 1 was 53.6 years, and in group 2 it was 47.3. At the end of the follow-up period (mean, 10 months) patency rates in group 1 were 80% and in group 2, 90%. In group 2, early-term thrombosis, which could be treated easily with second intervention and anticoagulation treatment (low-molecular-weight heparin), was the most common complication (10%). For patients who have unsuitable cephalic vein and require long-term hemodialysis, transposition of the basilic vein in the forearm region (under the elbow) can be a good secondary choice for access, as can a brachiobasilic fistula in the upper arm region.

Adolescent↗
PubMed2006

Beta-2 adrenergic receptor polymorphisms and the forearm blood flow response to mental stress.

Circulating epinephrine plays an important role in skeletal muscle vasodilation during mental stress. Normotensive adults homozygous for glycine (Gly) of the Arg16/Gly beta2-adrenergic receptor polymorphism have a greater forearm beta2-receptor mediated vasodilation and a higher cardiac output response to isometric handgrip than arginine (Arg) homozygotes. To test the hypothesis that the Arg16/Gly beta2-adrenergic receptor polymorphism affects the forearm blood flow (FBF) and hemodynamic response to mental stress, and whether venous catecholamine concentrations predicted these responses, we measured venous epinephrine, norepinephrine, heart rate (HR), arterial pressure (Finapres), and FBF during mental stress in healthy subjects homozygous for Gly16 (n = 30; mean age +/- SE: 30 +/- 1.2, 13 women) and Arg16 (n = 17, age 30 +/- 1.6, 11 women). Resting HR, blood pressure, and FBF responses to mental stress were similar between genotype groups. There were positive correlations between epinephrine and peak FBF (r = 0.694, P < 0.001), peak forearm vascular conductance (r = 0.677, P < 0.001) and the change in epinephrine to the change in HR (r = 0.456, P = 0.002) in all subjects. These correlations were not significantly different in the Gly16 and Arg16 groups. We conclude that venous epinephrine predicts the FBF response to mental stress, and the increase in epinephrine is also correlated with the increase in HR. Furthermore, the Arg16/Gly beta2-receptor polymorphism has no significant influence on the FBF or cardiovascular responses to mental stress.

Adult↗
PubMed1991

Heterogeneous interference of nicardipine, verapamil, and diltiazem with forearm arteriolar responsiveness to adrenergic stimulation in hypertensive patients.

The interference of intraarterial nicardipine, verapamil, and diltiazem with the forearm vascular response to graded exogenous norepinephrine was evaluated in hypertensive patients. Nicardipine antagonized the vasoconstrictor effect of norepinephrine in a dose-dependent manner, whereas verapamil was ineffective, suggesting that functional alpha-adrenergic antagonism may participate in the vasodilatory and possibly the antihypertensive effect. Nicardipine also blunted the vasoconstriction to lower-body negative pressure and the action of angiotensin II administered intraarterially. Despite a comparable increase in basal forearm flow, verapamil was less potent than nicardipine in inhibiting vasoconstriction after both stimuli. Therefore nicardipine suppressed preferentially regional vascular reactivity, probably by blockade of the influx of extracellular calcium in response to receptor activation, because both alpha-adrenergic and angiotensin II receptor-mediated vasoconstrictor responses were attenuated. At variance with both nicardipine and verapamil was potentiation of the responses to norepinephrine after the administration of diltiazem. Because intraarterial propranolol abolished that potentiating action and the local vasodilatation to isoproterenol was clearly reduced, diltiazem probably interfered also with beta-adrenergic receptor-mediated vasorelaxing mechanisms in human forearm arterioles. The data further stress the heterogeneity of calcium channel blockers in humans.

Arterioles↗
PubMed1989

Effects of alpha- and beta-adrenergic antagonists on plasma apolipoproteins and forearm blood flow in patients with mild hypertension.

To study the mechanisms by which adrenergic antagonists affect blood pressure and plasma lipid levels, the effects of alpha-blockade with prazosin were compared with those of beta-blockade with propranolol in 23 normolipidemic, mildly hypertensive patients. Plasma lipoprotein composition, apolipoproteins, and some of the processes involved in lipid synthesis and clearance from plasma were investigated also. Patients entered an eight-week placebo period during which they were free of all antihypertensive medications. They were then randomly assigned under double-blind conditions to treatment with either prazosin (mean dose, 5 mg per day) or propranolol (mean dose, 133 mg per day) for eight weeks. Doses of both drugs were titrated to achieve either a decrease in diastolic blood pressure of 10 mm Hg or more or a reduction of diastolic blood pressure to less than 85 mm Hg, whichever was lower. Total plasma cholesterol decreased by 9 percent during prazosin treatment and increased by 7 percent during propranolol treatment (p less than 0.005 between treatments). Low-density lipoprotein cholesterol decreased by 12 percent with prazosin and increased by 12 percent with propranolol (p less than 0.005). Apolipoprotein B decreased by 17 percent with prazosin and increased by 15 percent with propranolol (p less than 0.005). There were no significant changes in total high-density lipoprotein cholesterol, its subfractions high-density lipoprotein2 or high-density lipoprotein3, or in apolipoprotein A1 and apolipoprotein A2. Plasma very low-density lipoprotein and low-density lipoprotein triglycerides were not significantly affected by either treatment. Plasma post-heparin lipase activities, which clear triglyceride and high-density lipoprotein cholesterol from plasma, were not altered significantly. Since regional blood flow could affect the clearance of plasma lipoproteins, measurements were taken of forearm blood flow, forearm vascular resistance, and maximal forearm vasodilatory potential during reactive hyperemia. The adrenergic antagonists had no effect on these measurements, nor did they affect cellular cholesterol synthesis as measured by the activity of 3-hydroxy-3-methylglutaryl coenzyme A reductase in blood mononuclear cells. The results of this study demonstrate differing actions between alpha- and beta-adrenergic antagonism. Alpha-blockade produced significantly lower levels of plasma low-density lipoprotein cholesterol and apolipoprotein B than beta-adrenergic antagonism without changes in high-density lipoproteins.

Adult↗
PubMed1989

Forearm and finger hemodynamics, blood pressure control, and lipid changes in diabetic hypertensive patients treated with atenolol and prazosin. A brief report.

Hypertension and diabetes mellitus frequently coexist and are independent risk factors for reduced peripheral perfusion. Antihypertensive medications that reduce blood pressure and improve peripheral perfusion would have advantages in diabetic hypertensive patients. In a randomized, two-placebo-period, single-blind, two-way, crossover study, finger and forearm blood flow, lipid levels, and blood pressure control were determined in 19 diabetic hypertensive patients given prazosin and atenolol, with each drug and placebo period lasting four weeks. Both drugs reduced blood pressure (sitting, 157/95 to 142/84 mm Hg for atenolol and 155/95 to 138/82 mm Hg for prazosin; standing, 154/94 to 144/84 mm Hg for atenolol and 154/94 to 133/81 mm Hg for prazosin). Lipid levels did not change, except that low-density lipoprotein levels decreased from 148 to 127 mg/dl with prazosin. Atenolol did not change forearm or finger blood flow or vascular resistance. Prazosin increased blood flow and reduced vascular resistance in both finger and forearm. In conclusion, prazosin demonstrated a potentially more appropriate hemodynamic profile than atenolol in diabetic hypertensive patients in this study.

Adult↗
PubMed1990

Reconstruction of palate with radial forearm flap; a report of 3 cases.

A prosthesis is the preferred method for the closure of a palatal defect following maxillectomy, with fairly satisfactory results. However, some patients suffer from symptoms due to mismatch of the prosthesis. We have reconstructed palatal defects using radial forearm flaps in 3 cases. The forearm flap is utilised for palatal reconstruction in the double-folded form. The flap is thin and pliable, there are no problems in regard to bulk and drooping of the flap, and the patients can wear the denture with minimal discomfort. We believe that reconstruction of the palate with a forearm flap is a useful procedure, especially for patients suffering from symptoms due to mismatch of the prosthesis.

Female↗
PubMed1995

Facial reconstruction after a burn injury using two circumferential radial forearm flaps, and a dorsalis pedis flap for the nose.

A 21-year-old man is reported in whom flap tissue was required to reconstruct the face and nose following burns. The whole of both forearms were used as radial forearm flaps for both cheeks, both lower eyelids, the right upper eyelid, upper and lower lips and chin. A Tagliacozzi arm flap and a dorsalis pedis flap were used for the nose. The ears were resurfaced using grafted skin along the line of the superficial temporal arteries. No thinning of the flaps was required and some facial muscle attachments to the forearm deep fascia led to more recovery of facial movement than might be expected with a flap reconstruction.

Accidents, Traffic↗