X-ray Follow-up after Open Reduction Internal Fixation of Distal Forearm Fracture

2020 ◽  
Author(s):  
Henrik Johan Sjølander ◽  
Sune Jauffred ◽  
Michael Brix ◽  
Per H. Gundtoft
Keyword(s):  
Diagnostic Imaging ◽  
Forearm Fracture ◽  
Minimal Risk ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Distal Forearm Fracture ◽  
Standard Regimen ◽  
Prolonged Immobilization ◽  
Distal Forearm Fractures

Abstract Background Following surgery, the standard regimen for fractures of the distal forearm includes radiographs taken 2-weeks postoperatively. However, it is unclear whether these radiographs have any therapeutic risks or benefits for patients. Objective The purpose of this study is to determine the importance of radiographs taken 2-weeks after surgery on distal forearm fractures, especially if it leads to further operations, and to establish whether this practice should be continued. Materials and Methods This is a retrospective cohort study of patients with a distal forearm fracture treated surgically with a volar locking plate at two university hospitals in Denmark. Standard aftercare at both departments is 2 weeks in a cast. Patients attend a 2-week follow-up, at which the cast is replaced with a removable orthosis and radiographs are taken. It was recorded whether these radiographs had resulted in any change of treatment in terms of further operations, prolonged immobilization, additional clinical follow-up, or additional diagnostic imaging. Results A total of 613 patients were included in the study. The radiographs led to a change of standard treatment for 3.1% of the patients. A second operation was required by 1.0%; 0.5% were treated with prolonged immobilization, and 1.6% had additional outpatient follow-up due to the findings on the radiographs. Additional diagnostic imaging was performed on 1.9% of the patients. Conclusion The radiographs taken at the 2-weeks follow-up resulted in a change of treatment in 3.1% of the cases. Given the low cost and minimal risk of radiographs of an extremity, we concluded that the benefits outweigh the costs of routine radiographs taken 2 weeks after surgical treatment of distal forearm fractures.

First Experience in one-step Surgical Treatment of Distal Forearm Bones Fractures Complicated by Regional Pain Syndrome

2011 ◽  
Vol 18 (2) ◽  
pp. 32-37
Author(s):  
I O Golubev ◽  
A I Krupatkin ◽  
Il'ya Aleksandrovich Kutepov ◽  
O M Bushuev ◽  
M V Merkulov ◽  
...  
Keyword(s):  
Pain Syndrome ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Treatment Results ◽  
Doppler Flowmetry ◽  
Bone Fragments ◽  
Forearm Bones ◽  
One Step ◽  
Distal Forearm Fractures

Treatment results for 9 patients with distal forearm fractures complicated by sympathetically dependant type of complex regional pain syndrome were analyzed. After clinical, radiologic examination, laser Doppler flowmetry, computer thermography one-step open reposition of bone fragments with osteosynthesis and perivascular sympathectomy was performed in all patients. Follow-up period made up from 4 to 7 months. Excellent results was achieved in 1 (11%) patient, good - in 7 (78%), satisfactory - in 1 (11%) patient.

scholarly journals ChASTOTA PERELOMOV BEDRA I PREDPLECh'Ya I ZATRATY NA IKh LEChENIE V MOSKOVSKOY OBLASTI

2005 ◽  
Vol 8 (2) ◽  
pp. 8-13
Author(s):  
A V DREVAL' ◽  
L A MARChENKOVA ◽  
I V KRYuKOVA
Keyword(s):  
Retrospective Study ◽  
Medical Care ◽  
Hip Fractures ◽  
Forearm Fracture ◽  
Moscow Region ◽  
Medical Care Cost ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Medical Aid ◽  
Distal Forearm Fractures

The aim of the study was to assess incidence of hip and distal forearm fractures and quality of the early medical aid and direct financial expenses for treatment those fractures in Moscow Region in the period of 1998-2002. Methods: For performing retrospective study among population aged 50 years Kolomensky area of Moscow Region was chosen. Source documents about patients with hip and distal forearm fractures were obtained from traumatologic hospital and traumatologic station of Kolomensky area. Cost of medical aid was calculated on the basis of the prices of the State Obligatory Medical Insurance of Russian Federation. Results: 527 hip fractures and 2420 distal forearm fractures were registered during 1998-2002. Hip fractures incidence varied from 77.1/100 000 to 156.6/100 000 among males (p0.05). Distal forearm fractures incidence changed from 247.1/100 000 to 309.3/100 000 among males (p>0.05) and from 1213.0/100 000 to 1025.0/100 000 among females (p>0.05). Incidence of both fractures was significantly higher (p70 years old and there was no any dependence of distal forearm fractures incidence on age. Only 4% of hip fractures were surgically operated at the first 2 months after fracture. Direct financial expenses for treatment of patients with hip fracture for first the 2 months after fracture had made was over 582 - in average and early medical care cost for all hip fractures was about 104 714 - in Kolomensky area in the period of 1998-2002. Medical aid to patients with distal forearm fracture cost over 10- in average and financial expenses for treatment of all distal forearm fractures had made about 25 180 - in Kolomensky area for 5 years. We consider provisional amount of hip fractures may be about 23 500 and amount of distal forearm fractures may be about 105 300 during 1998-2002 in Moscow Region. Early medical care cost for all hip fractures was about 3 644 047- and for all distal forearm fractures about 876 264- in total in the period of study. Conclusions: Retrospective study among Moscow Region population aged 50 years revealed high incidence of hip and distal forearm fractures both in males and females in the period of 1998-2002. The investigation revealed that patients with hip fractures did not receive an adequate qualified medical aid and very high financial assets were spent for early medical care to fractures in Moscow Region.

Sokrat II – An International, Prospective, Multicenter, Phase IV Diagnostic Trial to Evaluate the Efficacy of the Wrist SAFE Algorithm in Fracture Sonography of Distal Forearm Fractures in Children

2019 ◽  
Vol 40 (03) ◽  
pp. 349-358 ◽  
Author(s):  
Ole Ackermann ◽  
Piotr Wojciechowski ◽  
Maria Dzierzega ◽  
Kay Grosser ◽  
Ansgar Schmitz-Franken ◽  
...  
Keyword(s):  
Clinical Findings ◽  
X Rays ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Clinical Predictors ◽  
Sonographic Diagnosis ◽  
Fractures In Children ◽  
Study Sites ◽  
Distal Forearm Fractures

Abstract Background Distal forearm fractures are the most common fractures in childhood and can be diagnosed with ultrasound. The aim of this study was to demonstrate the eligibility of Wrist SAFE for clinical use and the avoidance of X-ray application in children. Methods We enrolled patients from 0 – 12 years with suspected distal forearm fractures. They were treated according to the Wrist SAFE algorithm, a detailed pathway for ultrasound fracture diagnosis, treatment decisions and control options. Additionally, 9 clinical predictors were tested. Depending on sonographic and clinical findings, patients were treated with functional movement, immobilization or surgery. Follow-up was conducted after 5 days and 3 months. Results 16 physicians (6 specialists, 10 assistants) at 5 study sites examined 498 (234 boys, 251 girls, 13 not specified) patients with ultrasound, age 8.4 (0 – 12) years. 321 (64 %) patients were diagnosed with a fracture, 5 (0.8 %) with suspected fracture; X-rays were conducted in 58 cases (12 %), 9 (1.8 %) of them on day 1 and 49 (9.8 %) on day 5; sonographic diagnosis was confirmed in 57 of 58 (98 %) cases; in one case, the sonographic diagnosis of “contusion” was revised to “radius fracture”. 381 patients (77 %) underwent final follow-up after an average of 96 (62 – 180) days. All patients were symptom-free at that time. Palpatory bone pain over the radius/ulna and swelling were identified as clinical predictors. 81 % of X-rays were avoided. Conclusion Wrist SAFE enables the safe diagnosis and therapy of distal forearm fractures in children. Findings can be reviewed safely, also enabling physicians in training to use the method. 81 % of X-rays can be avoided, a figure that corresponds to 2.8 million X-rays in the G10 member states. After performing 100 examinations, physician have acquired the necessary sonography skills.

scholarly journals The Concentration of Selected Inflammatory Cytokines (IL-6, IL-8, CXCL5, IL-33) and Damage-Associated Molecular Patterns (HMGB-1, HSP-70) Released in an Early Response to Distal Forearm Fracture and the Performed Closed Reduction With Kirschner Wire Fixation in Children

2021 ◽  
Vol 12 ◽  
Author(s):  
Marzena Tylicka ◽  
Tomasz Guszczyn ◽  
Michał Maksimowicz ◽  
Joanna Kamińska ◽  
Ewa Matuszczak ◽  
...  
Keyword(s):  
Forearm Fracture ◽  
Kirschner Wire ◽  
Control Group ◽  
Distal Forearm ◽  
Hsp 70 ◽  
Distal Forearm Fracture ◽  
Kirschner Wire Fixation ◽  
Wire Fixation ◽  
Molecular Patterns ◽  
Distal Forearm Fractures

The evaluation of trauma after surgery through objective analysis of biochemical markers can help in selecting the most appropriate therapy. Thus the aim of the study was the evaluation of the concentration of selected inflammatory cytokines (IL-6, IL-8, CXCL5, IL-33), C-reactive protein (CRP), and damaged-associated molecular patterns (DAMPs): HMGB-1, HSP-70 in the plasma of children in response to bone fracture and 12-14 hours after subsequent surgery performed by closed reduction with percutaneous Kirschner wire fixation (CRKF). The study will answer the question if the CRFK procedure leads to excessive production of inflammatory and damage markers. Blood samples from 29 children with distal forearm fractures were collected 30 min. before CRKF procedure and 12-14 hours after performance of the procedure. The control group was composed of 17 healthy children. IL-6 and CRP concentrations were analyzed using routinely performed in vitro diagnostics tests; the remaining proteins were analyzed with the use of the ELISA method. Increased values of IL-6, CRP, and HSP-70 represented an early inflammatory response to distal forearm fractures classified as SH-II type according to the Salter-Harris classification system. However, the median CRP concentration was within the reference values not indicative of inflammation. The CRKF procedure may be a good solution for the treatment of bone fractures, as damaged associated molecular patterns – HMGB-1 and HSP-70 – did not significantly differ 12-14 hours after the approach was applied as compared to the control group. Moreover, the increase in IL-6 concentration after the CRKF procedure was 1.5-fold to the level before CRKF, while the increase of this marker in response to the distal forearm fracture was 4.3-fold compared to the control group. Based on this data, it appears reasonable to suggest that the CRKF approach caused less damage and inflammatory response in comparison to the response to the fracture itself.

Distal forearm fractures in children: the role of radiographs during follow up

Injury ◽  
1998 ◽  
Vol 29 (4) ◽  
pp. 309-312 ◽  
Author(s):  
J.S. Green ◽  
S.C. Williams ◽  
D. Finlay ◽  
W.M. Harper
Keyword(s):  
Distal Forearm ◽  
Forearm Fractures ◽  
Fractures In Children ◽  
Distal Forearm Fractures

scholarly journals DISTAL ULNA PHYSEAL ARREST FOLLOWING DISTAL FOREARM FRACTURES IN CHILDREN

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0019
Author(s):  
Trevor J. Shelton ◽  
J. Ryan Taylor ◽  
Lauren Agatstein ◽  
Andrea Bauer ◽  
Brian Haus
Keyword(s):  
Distal Radius ◽  
Common Mechanism ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Post Injury ◽  
Distal Ulna ◽  
Physeal Fracture ◽  
Distal Forearm Fractures

Background: Pediatric forearm fractures are a common injury with only a small subset of these involving the distal physes of the radius and ulna. A common mechanism of injury in these fractures are from sports related injuries or fall on outstretch hand. Physeal fractures of the distal radius are well-studied, with varying rates of growth arrest and potential for deformity depending on the type of physeal fracture. The incidence and long-term complications of pediatric forearm fractures involving the distal ulna physis remains largely unknown. Distal ulnar physeal arrest can lead to the development of radioulnar length discrepancy and angular deformities. Two previous studies of limited sample size report a 50-55% of physeal arrest when the ulnar physiss was involved in the fractur, which seems higher than what is seen at our institution. The purpose of this study was to investigate the demographic distribution, as well as the incidence of physeal arrest following a physeal fracture of the distal ulna. Methods: After institutional review board approval, a retrospective study was performed of all patients with distal forearm fractures treated at our institution from January 2003 until December 2017. We included patients < 18 years of age who presented to our level-1 emergency department or to our orthopaedic department and excluded those with extra-physeal fracture and closed physis. Wrist x-rays of 1,618 patients with distal forearm fractures were reviewed revealing a total of 52 patients with distal ulna physeal fracture. Patient demographics including age, gender, height, weight, mechanism of injury, and age at follow up was recorded. Each injury x-ray was reviewed and the distal ulna physeal fracture was categorized using the Salter-Harris (SH) classification system. Concomitant injuries were also recorded and if there was a radial physeal injury the SH classification system was used again. All follow up radiographs > 6 months post-injury were reviewed to assess for physeal arrest. Results: There were a total of 11 patients (average age at injury 10 ± 2 years; 5 males, 6 females; average height 1.5 0.2 m, average weight 47 ± 23 kg) with at least 6 months follow up post injury (average follow up time 2.4 ± 2.2 years. Of these, the most common mechanism was fall on outstretch hand occurring 64% of the time (n = 7), followed by sports in 18% (1 football, 1 baseball), and 9% fall from bike (n = 1), and 9% from ATV accident (n = 1). The most frequent distal ulna physeal fracture was SH type 2 occurring 55% of the time (n = 6), while 36% had a SH type 3 (n = 4), and 9% had a SH type 1 (n = 1). Eight patients had an ipsilateral radius fracture with 45% having a metaphyseal fracture (n = 5) and 27% having a distal radius physeal fracture (n = 3; one SH type 1, and two SH type 2). One patient had an ipsilateral supracondylar fracture and another patient had a Galeazzi fracture. Casting was the most frequent treatment occurring 64% of the time (n = 7), followed by closed reduction and casting in 18% (n = 2). Closed reduction and percutaneous pinning was done in 9% (n = 1), and open reduction and internal fixation (ORIF) was done in 9% (n = 1). None of these patients developed distal ulna physeal arrest (while one of them developed a distal radius physeal arrest. The one patient with the Galezzi fracture did go on to develop a malunion with clicking of his wrist despite being treated with ORIF and required a revision osteotomy 7 months later. The remainder of patients had no complications. Conclusion/Significance: The most important finding of this study is that the rate of distal ulna physeal arrest following fracture was 0%. This is in contrast to previous studies of limited sample size that reported a rate of 50-55%. Our results demonstrate a much lower incidence of distal ulnar physeal arrest than previously thought in the pediatric population with distal forearm fractures. These findings suggest that the majority of patients with distal ulna physeal fractures do well with conservative management, and may only require routine clinical and radiographic follow up.

scholarly journals Variations in situational risk factors for fractures of the distal forearm, hip, and vertebrae in older women

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wen-Yu Yu ◽  
Hei-Fen Hwang ◽  
Mau-Roung Lin
Keyword(s):  
Risk Factors ◽  
Soft Tissue ◽  
Older Women ◽  
Individual Characteristics ◽  
Situational Factors ◽  
Control Group ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Protective Response ◽  
Distal Forearm Fractures

Abstract Background Situational factors during a fall among three common types of fractures of the distal forearm, hip, and vertebrae among older women in Taiwan were investigated. Methods In 2016 ~ 2017, study participants were identified from those aged ≥65 years who visited emergency departments due to a fall in two university-affiliated hospitals in Taipei. In addition to individual characteristics, situational factors during the fall (location, activity, change of center of mass, fall mode, fall direction, initiating a protective response, and being hit) were collected. A sample of 203 distal-forearm fractures, 189 vertebral fractures, and 375 hip fractures was recruited, while 717 women with a soft-tissue injury were used as a control group. The identification of situational risk factors for each type of fracture was validated by using those who sustained one of the other two types of fracture as a control group. Results After adjusting for age and other individual characteristics, compared to soft-tissue injuries, distal-forearm fractures were significantly more likely to occur with slips (odds ratio [OR] = 11.0; 95% confidence interval [CI] = 4.76 ~ 25.4), trips (OR = 3.40; 95% CI = 1.42 ~ 8.17), step-downs (OR = 4.95; 95% CI = 2.15 ~ 11.4), and from sideways falls (OR = 1.73; 95% CI = 1.12 ~ 2.67) and significantly less likely to occur indoors (OR = 0.62; 95% CI = 0.42 ~ 0.90) or from backwards falls (OR = 0.62; 95% CI = 0.41 ~ 0.95). Hip fractures were significantly more likely to occur with step-downs (OR = 1.76; 95% CI = 1.13 ~ 2.75) and from backwards (OR = 3.16; 95% CI = 2.15 ~ 4.64) or sideways falls (OR = 5.56; 95% CI = 3.67 ~ 8.41) and significantly less likely when hitting an object (OR = 0.26; 95% CI = 0.13 ~ 0.52) or initiating a protective response (OR = 0.58; 95% CI = 0.36 ~ 0.93). Vertebral fractures were significantly more likely to occur with slips (OR = 2.42; 95% CI = 1.30 ~ 4.50), step-downs (OR = 2.53; 95% CI = 1.43 ~ 4.48), and backwards falls (OR = 2.15; 95% CI = 1.39 ~ 3.32). Similar results were found in the validation analyses. Conclusions Large variations in situational risk factors for the three types of fracture in older women existed. A combination of individual and situational risk factors may display a more-comprehensive risk profile for the three types of fracture, and an intervention that adds training programs on safe landing strategies and effective compensatory reactions may be valuable in preventing serious injuries due to a fall.

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