Fractures of the Distal Radius and Ulna

Associated fractures of the distal ulnar metaphysis were present in 19 of 320 distal radial fractures requiring either closed manipulation or surgical treatment over a 2-year period. Four morphological patterns of ulnar fracture were encountered, the commonest being the type 1 simple extra-articular fracture of the distal end of ulna with minimal comminution (eight out of 19). 15 patients were treated conservatively and two each were treated by internal and external fixation. 15 patients were reviewed after a mean follow-up of 23.8 months and there were four excellent, five good, five fair clinical results and one poor result. Radiographically the distal radio-ulnar joint (DRUJ) was normal in eight wrists, but longitudinal or horizontal disruption of the DRUJ was present in seven wrists. Fracture callus encroached on the DRUJ in three patients, who also had limitation of forearm rotation. Two comminuted ulnar fractures (type 4) developed non-union, but both patients had full forearm rotation, in contrast to restriction of forearm rotation in four out of five patients with type 1 fractures.

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Complications after Displaced Talar Neck Fracture: Results from a Case Series and a Critical Review of Literature

The Open Orthopaedics Journal ◽

10.2174/1874325001812010567 ◽

2018 ◽

Vol 12 (1) ◽

pp. 567-575

Author(s):

D. Leonetti ◽

B. Di Matteo ◽

P. Barca ◽

S. Cialdella ◽

F. Traina ◽

...

Keyword(s):

Functional Performance ◽

Case Series ◽

Clinical Results ◽

Fracture Dislocation ◽

Review Of Literature ◽

Non Union ◽

Fracture Dislocations ◽

Neck Fracture ◽

Talar Fractures

Introduction: Talar fractures are uncommon injuries, whose outcome is often characterized by the onset of serious complications. The aims of the present study are: 1) to review the available evidence concerning the outcome and complications of talar neck fractures; 2) to describe the clinical results and the rate of post-op complications in a series of patients treated surgically after talar fracture-dislocations. Materials and methods: The review of the literature was performed on the Pubmed, Embase and Web of Science databases and aimed at identifying clinical trials with at least 10 patients and dealing with surgical management of talar fracture-dislocation (Hawkins grade II to IV). All the papers were analyzed to extract data concerning common complications such as non-union, mal-union, infection, osteonecrosis and osteoarthtritis. The clinical arm of this paper included 26 patients (19 men and 7 women), who underwent fixation of displaced talar fracture by cannulated screws and were retrospectively evaluated, both clinically and radiographically, at a mean 51.2 ± 23.4 months of follow-up. Results: The evaluation through the AOFAS score revelead a loss of functional performance with respect to the pre-injury status. Four patients were re-operated within final follow up, whereas the remaining 22 presented excellent results in 2 cases, good results in 4 cases, fair results in 11 cases and poor results in 5 cases. Osteoarthritis and osteonecrosis incidence were 51.9% and 25.9% respectively. Sixteen studies were included in the review and it was confirmed that the most frequent complication was post-traumatic OA, followed by osteonecrosis and mal-union. A variable range in percentage of complications described should be ascribed to the low quality of trials currently available. Conclusion: Displaced talar fracture are challenging to treat and the outcomes at middle-term are often modest. Looking at complications, the present case series and the review of literature revealed that the most common one is peritalar OA. Osteonecrosis, traditionally regarded as the most fearsome adverse event, is relevant but less frequent than OA.

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Dorsal (AO/ASIF) Pi-Plate Osteosynthesis in the Treatment of Distal Intraarticular Radius Fractures

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2006.08.007 ◽

2006 ◽

Vol 31 (6) ◽

pp. 673-679 ◽

Cited By ~ 17

Author(s):

A. SUCKEL ◽

S. SPIES ◽

P. MÜNST

Keyword(s):

Plate Osteosynthesis ◽

Extensor Tendon ◽

Radius Fractures ◽

Distal Radial Fractures ◽

Tendon Ruptures ◽

Tunnel Syndrome ◽

Poor Outcomes ◽

A Prospective Study

The results and complications using the dorsal 2.4 mm 2.7 mm (AO/ASIF) pi-plate for the treatment of distal radius fractures were evaluated in a prospective study of 42 patients followed up clinically and radiologically and seven patients followed up with telephone call and radiological follow-up for an average time of 12.1 (range 4–32) months in a group of 50 patients with intraarticular distal radial fractures treated consecutively using this method. Twelve complications occurred in 10 patients including two extensor tendon ruptures, two transient cases of CRPS Type 1 (Reflex Sympathetic Dystrophy, Algodystrophy), two instances of screw loosening, three cases of posttraumatic carpal tunnel syndrome and three permanent sensory irritations on the dorsum of the hands. Using the AO score, there were 37 successful and 12 tolerable results, with no unsatisfactory outcomes. Using the NYOWR scale, there were 17 very good and 25 good results, with no satisfactory or poor outcomes. These results suggest that this osteosynthesis provides adequate fixation of comminuted distal intraarticular radius fractures with a reasonable incidence of complications.

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Evaluation of Results of Fixation of Unstable Distal Radial Fractures by Volar Locking Plating System

Faridpur Medical College Journal ◽

10.3329/fmcj.v11i2.32887 ◽

2017 ◽

Vol 11 (2) ◽

pp. 62-66

Author(s):

Md Maiyeen Uddin ◽

Anadi Ranjan Mondal ◽

Narayan Chandra Karmakar ◽

Md Masudur Rahman ◽

Syed Asif Ul Alam

Keyword(s):

Locking Plate ◽

Volar Locking Plate ◽

Wrist Flexion ◽

Distal Radial Fractures ◽

Surgical Fixation ◽

Single Bone ◽

Trauma Surgeons ◽

Type 3

Distal radial fractures are most common fractures accounts 15% of whole skeletal injuries, as high as 40% to 49% are considered to be unstable that requires surgical fixation. The purpose of the study was to ascertain good functional hand by using volar locking plate & screws, as with locking system, distal screws are locked to the plate, which stabilized the screws against lateral movement (toggle effect), thus providing a "single bone-plate-screws construct" which producing a scaffold in the mostly cancellous distal radial metaphysis, so preventing from collapse. This study was done from January 2007 to December 2008 at National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR). Total numbers of cases were 17. All patients were admitted in hospital & most of them returned home within 4 days. Most patients were managed early within 1-10 days of injury. Most patients were Fernandez type 1, type 2, and type 3. Most patients were in the age group of 4th decade. All patients were followed up for a period of at least 3 months, mean follow up period was 6 months. Results showed that wrist pain, wrist stiffness, reduced grip strength were minimum with volar locking plate & screws as there is minimal radial shortening, radial angulation, volar tilt & ulnar variance and wrist flexion, wrist extension, ulnar deviation, supination, pronation were very good. So, the trauma surgeons can safely use this procedure.Faridpur Med. Coll. J. Jul 2016;11(2): 62-66

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CLASSIFICATION AND TREATMENT OF HAMATE FRACTURES

Hand Surgery ◽

10.1142/s0218810405002747 ◽

2005 ◽

Vol 10 (02n03) ◽

pp. 151-157 ◽

Cited By ~ 42

Author(s):

Kenichi Hirano ◽

Goro Inoue

Keyword(s):

Soft Tissue ◽

Closed Reduction ◽

Open Reduction ◽

Functional Results ◽

Non Union ◽

Cast Immobilisation ◽

Classification And Treatment

Twenty-nine patients with hamate fractures were treated. The two main types of hamate fractures are hook fractures (type 1) and body fractures (type 2). We sub-divided type 2 fractures according to the fracture line into coronal, type 2a and transverse, type 2b. There were 15 type 1, 11 type 2a and three type 2b fractures. For type 1, nine were treated with excision, one with open reduction and internal fixation (ORIF) and five with cast immobilisation, in which two resulted in non-union followed by excision. For type 2, five type 2a cases were treated with ORIF and the others with closed reduction and pinning. Most of the patients had satisfactory results at the seventh month follow-up. However, those with associated neurovascular and musculotendinous injuries were likely to have unfavourable results. On the basis of study findings, it appears that functional results are influenced mainly by the associated soft tissue damage.

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Non-restricted weight-bearing after modified Lapidus arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000322 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Manuel Pellegrini ◽

Giovanni Carcuro ◽

Natalio Cuchacovic ◽

Gerardo Muñoz ◽

Marcelo Somarriva

Keyword(s):

Hallux Valgus ◽

Weight Bearing ◽

Clinical Results ◽

Delayed Union ◽

Rigid Fixation ◽

X Rays ◽

Non Union ◽

Fixation Methods ◽

First Ray

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Modified lapidus arthrodesis is performed in the treatment of different pathologies, including hallux valgus and osteoarthritis of the first cuneo-metatarsal joint. Complications of this procedure include delayed union and non-union, reported to be between 5 to 20%. To prevent them, prolonged foot unloading and rigid fixation methods have been proposed. We sought to investigate our clinical results and complications in patients operated on with a modified Lapidus arthrodesis and inmediate weight bearing in a rigid post-operative shoe. Methods: After IRB approval, we conducted a retrospective patient chart review in a single center. Dedicated foot and ankle orthopaedic surgeons performed all procedures. Patients were included if they were older than 18 years, had a minimum follow up of one year and agreed to participate in the study. Patients with neuropathy, revision arthrodesis or those with concomitant midfoot/hindfoot procedures were excluded. All patients were operated on with an inter-articular lag screw and a locking neutralization plate. Patients were allowed to weight bear without restriction in a rigid post-operative shoe from postoperative day one. An independent musculoskeletal radiologist evaluated bone consolidation of the arthrodesis in x-rays or CT scan, when available. Results: Fifteen patients (18 feet) with an average age of 47 years (15-66) met inclusion criteria. All patients were female. Mean follow up was 19 months (12-24). Surgical indications were: hallux valgus in 14 cases and cuneo-metatarsal osteoarthritis in one case. Consolidation rate was 94% (14/15). Average time for radiological consolidation was 11 weeks (7-27). One patient (6%) developed non-union and required a revision arthrodesis with bone grafting. No loss of radiological correction or malalignment of the first ray was observed at last follow-up. Conclusion: Our results suggest that modified lapidus arthrodesis with rigid fixation methods and non restricted weight bearing is a safe and effective alternative to manage first ray pathology. This approach may not increase non-union rates or affect the reduction obtained.

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The Swanson Ulnar Head Prosthesis for Post-Traumatic Disorders of the Distal Radio-Ulnar Joint

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(92)90201-c ◽

1992 ◽

Vol 17 (6) ◽

pp. 682-688 ◽

Cited By ~ 71

Author(s):

D. STANLEY ◽

T. J. HERBERT

Keyword(s):

Bone Resorption ◽

Clinical Results ◽

Carpal Instability ◽

Forearm Rotation ◽

Indication For Surgery ◽

Distal Radial Fractures ◽

Ulnar Head ◽

Post Traumatic ◽

Ulnar Head Prosthesis

20 Swanson ulnar head prostheses inserted for post-traumatic disorders of the distal radio-ulnar joint were reviewed at a mean of 44.2 months post-operatively (range 12–104 months). The indication for surgery was painful loss of forearm rotation with or without ulno-carpal impingement and ulno-carpal instability. Symptoms in 16 patients were the result of malunion following severe distal radial fractures (two Frykman 7 fractures and 14 Frykman 8 fractures), and in the remainder were due to unreduced dislocations in the distal radio-ulnar joint (two patients) or unsatisfactory Darrach procedures (two patients). 70% of patients achieved excellent or good clinical results despite the fact that radiographs showed bone resorption in all cases, tilting of the prosthesis in 40% and implant fractures in 15%.

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Fixation of Hammertoes with a Permanent Intramedullary K-Wire: A Low-Cost Alternative for a Common Procedure

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00425 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0042

Author(s):

V. James Sammarco ◽

Josika A. Sammarco ◽

Allegra L. Delman

Keyword(s):

Low Cost ◽

Cost Savings ◽

Clinical Results ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Potential Cost ◽

Common Procedure ◽

Non Union ◽

Wire Fixation

Category: Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Traditional K-Wire fixation of the proximal interphalangeal joint during correction of hammertoes is associated with various complications including loss of fixation, recurrence of deformity, pin tract infection and patient dissatisfaction due to the pin. At least 20 devices designed expressly for the purpose of fusing the interphalangeal joint of the lesser toes exist. Cost of the implants can range from $450 to $2000 per implant (when disposable instruments are included in the cost.) We hypothesized that a permanent intraosseous K-Wire bridging the proximal and middle phalanx would perform in an equivalent manner to many commercially available implants with a large potential for cost savings. Methods: A modified DuVries hammertoe correction procedure through a dorsal approach including resection of both joint surfaces. A 2mm or 1.6mm K-wire is then cut and placed into the intramedullary canals of the phalanges bridging the PIP joint (IP). A snug extensor mechanism repair affords compression and rotational control. External pins (EP) were used if the diaphyseal canal was less than 1.6mm. A retrospective review of medical records and radiographs of all patients undergoing hammertoe correction over three years by a single surgeon. 50 patients (28 Women, 12 Men) and 53 feet (2 bilateral) with mean age 66 (range 34 – 84) who had a minimum 6-month follow-up were available for study. 112 toes were corrected. Osseous union or stable fibrous union were the desired results with non-union, deformity recurrence and/or the need for revision being noted as failure. Average follow-up was 21.7 months (6 – 54). Results: Results: Of the 93 IP fixations, there were 68 fusions, 22 stable fibrous unions, and 3 non-unions. Of the 19 External pins there were, 11 fusions, 3 stable fibrous unions and 5 non-unions. 5 Patients required revision which was done by bone grafting and compression with an intramedullary screw. Success was noted in 96% of IP fixation and 74% of external pin fixations. Conclusion: Permanent internal K-Wire fixation for hammertoe correction is a viable option for fixation of hammertoe deformity outperforming traditional temporary K-wire fixation and resulting in good clinical results comparable to other commercially available implants. Given the negligible cost of this implant, the potential cost savings to the medical system is great. K-Wires are readily available worldwide and this technique may useful in countries where resources do not allow use of expensive implants.

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Klinische Langzeitergebnisse der perkutanen transluminalen Angioplastie bei Patienten mit peripherer arterieller Verschlusskrankheit

VASA ◽

10.1024/0301-1526.31.1.36 ◽

2002 ◽

Vol 31 (1) ◽

pp. 36-42 ◽

Cited By ~ 3

Author(s):

. Bucek ◽

Hudak ◽

Schnürer ◽

Ahmadi ◽

Wolfram ◽

...

Keyword(s):

Success Rate ◽

Clinical Stage ◽

Ankle Brachial Index ◽

Clinical Situation ◽

Clinical Results ◽

Transluminal Angioplasty ◽

Term Outcome ◽

Long Term Outcome

Background: We investigated the long-term clinical results of percutaneous transluminal angioplasty (PTA) in patients with peripheral arterial occlusive disease (PAOD) and the influence of different parameters on the primary success rate, the rate of complications and the long-term outcome. Patients and methods: We reviewed clinical and hemodynamic follow-up data of 166 consecutive patients treated with PTA in 1987 in our department. Results: PTA improved the clinical situation in 79.4% of patients with iliac lesions and in 88.3% of patients with femoro-popliteal lesions. The clinical stage and ankle brachial index (ABI) post-interventional could be improved significantly (each P < 0,001), the same results were observed at the end of follow-up (each P < 0,001). Major complications occurred in 11 patients (6.6%). The rate of primary clinical long-term success for suprainguinal lesions was 55% and 38% after 5 and 10 years (femoro-popliteal 44% and 33%), respectively, the corresponding data for secondary clinical long-term success were 63% and 56% (60% and 55%). Older age (P = 0,017) and lower ABI pre-interventional (P = 0,019) significantly deteriorated primary clinical long-term success for suprainguinal lesions, while no factor could be identified influencing the outcome of femoro-popliteal lesions significantly. Conclusion: Besides an acceptable success rate with a low rate of severe complications, our results demonstrate favourable long-term clinical results of PTA in patients with PAOD.

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