scholarly journals Technique for Intramedullary Stabilization of Ulnar Neck Fractures

Hand ◽  
2017 ◽  
Vol 13 (5) ◽  
pp. 563-571
Author(s):  
Jack Abboudi ◽  
Scott M. Sandilands ◽  
C. Edward Hoffler ◽  
William Kirkpatrick ◽  
William Emper
Keyword(s):  
Distal Radius ◽  
Kirschner Wire ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Distal Radial Fractures ◽  
Percutaneous Approach ◽  
Intramedullary Stabilization ◽  
Ulna Fractures ◽  
Neck Fracture ◽  
Reproducible Method

Background: Distal ulna fractures at the ulnar neck can be seen in association with distal radius fractures, and multiple techniques have been described to address the ulnar neck component of these injuries. We have found that treatment of ulnar neck fractures can be challenging in terms of anatomy and fracture fixation. We present a new percutaneous fixation technique for ulnar neck fractures commonly seen with distal radius fractures. Technique: Fixation of the ulnar neck fracture is performed after fixation of the distal radius fracture. Our technique uses anterograde intramedullary fixation to stabilize the fracture with a 1.6-mm (0.062 inch) Kirschner wire or a commercially available metacarpal fixation intramedullary nail. The fixation is introduced into the intramedullary space of the ulnar shaft 4 to 6 cm proximal to the fracture at a separate surgical site along the subcutaneous border of the ulna. The fixation is also supported with a sugar-tong splint for the first few weeks after surgery and requires removal of the ulnar implant approximately 10 weeks after implantation. Conclusion: Our technique utilizes a percutaneous approach with minimal fracture exposure. It provides a relatively simple and reproducible method to address ulnar neck fractures commonly seen in association with distal radial fractures.

scholarly journals Perfil epidemiológico das fraturas radiais distais em hospital de referência em Ribeirão Preto, Brasil

2020 ◽  
Vol 9 (3) ◽  
Author(s):  
Felipe Azevedo Mendes de Oliveira ◽  
Thiago Agostini Pereira Albeny ◽  
Luis Guilherme Rosifini Alves Rezende ◽  
Filipe Jun Shimaoka ◽  
Amanda Favaro Cagnolati ◽  
...  
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Case Series ◽  
High Energy ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Distal Radial Fracture ◽  
Fracture Treatment ◽  
Radius Fractures ◽  
Distal Radial Fractures

Objetivo: Avaliar o perfil epidemiológico das fraturas do rádio distal em hospitais de referência em Ribeirão Preto(SP), Brasil. Não existem dados suficientes na literatura nacional que corroborem com o perfil epidemiológico das fraturas do rádio distal. Métodos: 245 pacientes apresentaram 254 fraturas do rádio distal, ocorridas entre 2014 a 2017 foram avaliadas retrospectivamente para obtenção do perfil epidemiológico. Os fatores analisados foram idade e sexo, mecanismo do trauma, sazonalidade, tipo de fratura baseada na Classificação AO, presença de exposição óssea, lesões associadas, tipo de tratamento realizado (conservador ou cirúrgico) e o tipo de implante utilizado nos tratamentos cirúrgicos. Resultados: 60,2% dos pacientes participantes eram do sexo masculino e 39,8% do sexo feminino, distribuídos de forma bimodal. A média de idade foi 45,4 anos. Fraturas expostas corresponderam a 92,1% das fraturas e 7,9% representaram as expostas. Pacientes politraumatizados representaram 62,6%. O tempo médio de internação foi 8,09 dias. Conclusão: Apesar do padrão de fraturas mostrar semelhanças com outros estudos, o padrão apresentado pode não traduzir, de forma homogênea, o padrão obtido em outras metrópoles e grandes centros.Descritores: Fraturas do Rádio; Traumatismos do Punho; Epidemiologia; Hospitais Especializados.ReferênciasBruce KK, Merenstein DJ, Narvaez MV, Neufeld SK, Paulus MJ, Tan TP et al. Lack of Agreement on Distal Radius Fracture Treatment. J Am Board Fam Med. 2016;29(2):218-25.MacIntyre NJ, Dewan N. Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther. 2016;29(2):136-45.Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-97.Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012;28(2):113-25. Flinkkilä T, Sirniö K, Hippi M, Hartonen S, Ruuhela R, Ohtonen P et al. Epidemiology and seasonal variation of distal radius fractures in Oulu, Finland. Osteoporos Int. 2011;22(8):2307-312.Lindau TR, Aspenberg P, Arner M, Redlundh-Johnell I, Hagberg L. Fractures of the distal forearm in young adults. An epidemiologic description of 341 patients. Acta Orthop Scand. 1999;70(2):124-28.Diamantopoulos AP, Rohde G, Johnsrud I, Skoie IM, Hochberg M, Haugeberg G. The epidemiology of low- and high-energy distal radius fracture in middle-aged and elderly men and women in Southern Norway. PLoS One. 2012;7(8):e43367.Wilcke MK, Hammarberg H, Adolphson PY. Epidemiology and changed surgical treatment methods for fractures of the distal radius: a registry analysis of 42,583 patients in Stockholm County, Sweden, 2004–2010. Acta Orthop. 2013;84(3):292-96.Sigurdardottir K, Halldorsson S, Robertsson J. Epidemiology and treatment of distal radius fractures in Reykjavik, Iceland, in 2004. Comparison with an Icelandic study from 1985. Acta Orthop. 2011;82(4):494-98.Solgaard S, Petersen VS. Epidemiology of distal radius fractures. Acta Orthop Scand. 1985;56(5):391-93.Brogren E, Petranek M, Atroshi I. Incidence and characteristics of distal radius fractures in a southern Swedish region. BMC Musculoskelet Disord. 2007;8:48. Tsai CH, Muo CH, Fong YC, et al. A population-based study on trend in incidence of distal radial fractures in adults in Taiwan in 2000-2007. Osteoporos Int. 2011;22(11):2809-815.Koo OT, Tan DM, Chong AK. Distal radius fractures: an epidemiological review. Orthop Surg. 2013;5(3):209-13. Dóczi J, Renner A. Epidemiology of distal radius fractures in Budapest. A retrospective study of 2,241 cases in 1989. Acta Orthop Scand. 1994;65(4):432-33.Chen NC, Jupiter JB. Management of distal radial fractures. J Bone Joint Surg Am. 2007;89(9):2051-62.Pagano M, Gauvreau K. Princípios de Bioestatística. 2. ed. São Paulo: Pioneira Thompson Learning; 2004.                                  Court-Brown CM. Epidemiologia das fraturas e luxações. In: Court-Brown CM et al. (ed.); Fraturas em adultos de Rockwood Green. 8. ed. Barueri, SP: Manole; 2016.Fanuele J, Koval KJ, Lurie J, Zhou W, Tosteson A, Ring D. Distal radial fracture treatment: what you get may depend on your age and address. J Bone Joint Surg Am. 2009;91(6):1313-19.Jupiter JB, Marent-Huber M; LCP Study Group. Operative management of distal radial fractures with 2.4-millimeter locking plates: a multicenter prospective case series. Surgical technique. J Bone Joint Surg Am. 2010;92(Suppl 1 Pt 1):96-106.

scholarly journals Extensor Tendon Entrapment on Computed Tomography Imaging of Distal Radius Fractures

2019 ◽  
Vol 09 (02) ◽  
pp. 129-135
Author(s):  
Evan D. Nigh ◽  
Christopher P. Emerson ◽  
David To ◽  
Spencer Barnhill ◽  
Michael G. Rizzo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Distal Radius ◽  
Motor Vehicle ◽  
Ct Imaging ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Distal Radial Fractures ◽  
Level Of Evidence ◽  
Extensor Pollicis Longus ◽  
Tendon Entrapment

Abstract Objective To examine the association between distal radius fractures and tendon entrapment identified on computed tomography (CT) imaging. Patients and Methods After Institutional Review Board approval, we retrospectively reviewed distal radius fractures that underwent CT imaging from an electronic database between January 2006 to February 2018 at a single level 1 hospital trauma center. We categorized all distal radial fractures according to the AO-OTA (AO Foundation/Orthopaedic Trauma Association) classification. Distal upper extremity tendons were assessed for entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. Results A total of 183 distal radius fractures were identified in 179 patients. A total of 16 fractures (13 males and 3 females) were associated with tendon entrapment. Mechanism of injury included falls (n = 7), motor vehicle accidents (n = 6), dog bites (n = 2), and gunshot wound (n = 1). Entrapped tendons were limited to the extensor compartment and included the extensor pollicis longus (EPL; n = 11), extensor pollicis brevis (n = 1), extensor carpi ulnaris (n = 1), extensor carpi radialis longus (n = 1), and extensor digitorum communis (n = 2). The most commonly associated AO-OTA fracture pattern with tendon entrapment was complete articular radial fractures (2R3C; 69%), eight of which were simple articular with metaphyseal multifragmentary fractures (2R3C2). Of the distal radius fractures, 81% were associated with additional ulnar fractures of varying severity and displacement. Conclusion Approximately 8.7% of distal radius fractures were retrospectively identified to have tendon entrapment compared with a previously reported incidence of 1.3%. Wrist surgeons and radiologists should have higher suspicion for tendon entrapment and carefully review preoperative CT imaging for tendon entrapment in distal radius fractures especially if there is an intra-articular, multifragmentary injury pattern. Wrist surgeons and radiologists should also have increased suspicion for EPL tendon entrapments given its high incidence in association with distal radius fractures. Level of Evidence This is a Level III, retrospective cross-sectional study.

scholarly journals Below-elbow or above-elbow cast for conservative treatment of extra-articular distal radius fractures with dorsal displacement: a prospective randomized trial

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Gaetano Caruso ◽  
Francesco Tonon ◽  
Alessandro Gildone ◽  
Mattia Andreotti ◽  
Roberto Altavilla ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Clinical Outcomes ◽  
Distal Radius ◽  
Randomised Trial ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Distal Radial Fractures ◽  
Radiological Parameters ◽  
Cast Group

Abstract Background Distal radial fractures are common traumatic injuries, but their management remains controversial also in case of conservative treatment regarding the type of immobilisation. Hence, we conducted a two-arm, parallel-group, prospective randomised trial to compare the capacity of long casts (above-elbow) and short casts (below-elbow) to maintain the reduction of extra-articular distal radius fractures with dorsal displacement (AO/OTA classification: 2R3A2.2). Methods Seventy-four eligible patients with AO/OTA 2R3A2.2 fractures treated with closed reduction and cast immobilisation were randomised to the long cast group (n°= 37) or to the short cast group (n°= 37). Baseline radiological parameters, radial inclination (RI), radial height (RH), ulnar variance (UV) and palmar tilt (PT) were taken, and compared with clinical (DASH, Mayo Wrist and Mayo Elbow) and radiological scores taken at 7–10 days, 4 weeks and 12 weeks. Furthermore, to evaluate correlations between radiological parameters and functional outcomes, patients were divided into two groups according to whether or not their radiological parameters at Follow-ups 2 and 3 were acceptable, i.e. within the range 11–12 mm for RH, 16°–28° for RI, − 4–+ 2 mm for UV and 0°–22° for PT. Results Patient demographic and baseline radiological parameters were similar between groups. At follow-up, there were no statistically significant differences between the two types of cast in terms of RI, RH, UV or PT, or Mayo wrist or DASH scores. Short cast group patients displayed better Mayo elbow score at follow-up 2 (4 weeks), but this difference was no longer statistically significant at follow-up 3 (12 weeks). No statistically significant differences in clinical outcomes were found between patients who presented acceptable radiographic parameters at follow-up and those who did not. Conclusion As there were no significant differences between short casts and long casts in terms of fracture reduction maintenance or clinical outcomes, short casts are an effective method of post-reduction immobilisation in AO/OTA 2R3A2.2 fracture of the radius. Radiological parameters outside the range conventionally considered acceptable do not preclude a satisfactory clinical outcome. Trial registration ClinicalTrials.gov PRS, NCT04062110. Registred 20 August 2019.

scholarly journals Correlação clínico-radiográfica das fraturas articulares completas do rádio distal tratadas cirurgicamente

2020 ◽  
Vol 9 (3) ◽  
Author(s):  
Thiago Agostini Pereira Albeny ◽  
Breno Alves de Souza Vaz ◽  
Luis Guilherme Rosifini Alves Rezende ◽  
Filipe Jun Shimaoka ◽  
Amanda Favaro Cagnolati ◽  
...  
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Outcome Evaluation ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Distal Radial Fractures ◽  
Articular Fractures ◽  
Intraarticular Fractures ◽  
Anatomic Reduction

Introdução: As fraturas da extremidade distal do rádio representam uma das fraturas mais comuns. Diversos fatores descritos na literatura influenciam nos seus resultados após manejo cirúrgico; como a fragmentação articular, a restauração cirúrgica da anatomia do rádio, a reabilitação pós-operatória, entre outros. Objetivo: analisar o resultado funcional dos pacientes operados de fraturas articulares completas da extremidade distal do rádio e correlacionar estes resultados com os parâmetros radiológicos comumente utilizados. Métodos: 18 pacientes entre 18 a 65 anos, submetidos ao tratamento cirúrgico das fraturas do rádio distal do tipo AO 23C, no período de janeiro de 2014 a julho de 2016. Os seguintes parâmetros clínicos e radiográficos foram avaliados e submetidos a análise estatística: ADM (amplitude de movimento) do punho e antebraço, força de pinças e de preensão, PRWE (Patient Rated Wrist Evaluation), classificação AO da fratura e parâmetros radiográficos pós-operatórios. Resultados: A análise de regressão linear mostrou correlação estatisticamente significativa considerando a inclinação radial e o desvio ulnar. Conclusão: Correlação estatisticamente significativa entre os parâmetros radiográficos e resultados funcionais é de difícil determinação. Novos estudos com maior amostragem e que correlacionem os parâmetros radiográficos e idade são necessários para melhor estudo do tema abordado.Descritores: Fraturas do Rádio; Traumatismos do Punho; Fraturas Intra-Articulares.ReferênciasCourt-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-97. Wolf WS. Distal Radius Fracture. In: Green’s Operative Hand Surgery 7. ed. Philadelphia, PA: Elsevier.Alluri RK, Hill JR, Ghiassi A. Distal Radius Fractures: Approaches, Indications, and Techniques. J Hand Surg Am. 2016;41(8):845-54.McQueen MM. Fractures oh the distal radius and ulna. In: Rockwood and Green's fractures in adults 8. ed. Philadelphia, PA: Wolters Kluwer Health.Brogren E, Petranek M, Atroshi I. Incidence and characteristics of distal radius fractures in a southern Swedish region. BMC Musculoskelet Disord. 2007;8:48. Flinkkilä T, Sirniö K, Hippi M, Hartonen S, Ruuheia R, Ohtonen P  et al. Epidemiology and seasonal variation of distal radius fractures in Oulu, Finland. Osteoporos Int. 2011;22(8):2307-12.Róbertsson GO, Jónsson GT, Sigurjónsson K. Epidemiology of distal radius fractures in Iceland in 1985. Acta Orthop Scand. 1990;61(5):457-59.Sigurdardottir K, Halldorsson S, Robertsson J. Epidemiology and treatment of distal radius fractures in Reykjavik, Iceland, in 2004. Comparison with an Icelandic study from 1985. Acta Orthop. 2011;82(4):494-98.Meena S, Sharma P, Sambharia AK, Dawar A. Fractures of distal radius: an overview. J Family Med Prim Care. 2014;3(4):325-32.Metz VM, Gilula LA. Imaging techniques for distal radius fractures and related injuries. Orthop Clin North Am. 1993;24(2):217-28.Reis FB, Faloppa F, Saone RP, Boni JR, Corvlo MC. Fraturas do terço distal do rádio: classificação e tratamento. Rev Bras Ortop. 1994;29(5):326-30.Isani A, Melone CP Jr. Classification and management of intra-articular fractures of the distal radius. Hand Clin. 1988;4(3):349-60.AO Surgery Reference. Disponível em: https://surgeryreference.aofoundation.org/. Acesso em: 04 de janeiro de 2020.Lafontaine M, Hardy D, Delince P. Stability assessment of distal radius fractures. Injury. 1989;20(4):208-10.Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986;68(5):647-59.Szabo RM, Weber SC. Comminuted intraarticular fractures of the distal radius. Clin Orthop Relat Res. 1988;(230):39-48.Trumble TE, Culp RW, Hanel DP, Geissler WB, Berger RA. Intra-articular fractures of the distal aspect of the radius. Instr Course Lect. 1999;48:465-80.Lipton HA, Wollstein R. Operative treatment of intraarticular distal radial fractures. Clin Orthop Relat Res. 1996;(327):110-24.Bradway JK, Amadio PC, Cooney WP. Open reduction and internal fixation of displaced, comminuted intra-articular fractures of the distal end of the radius. J Bone Joint Surg Am. 1989;71(6):839-47.Melone CP Jr. Distal radius fractures: patterns of articular fragmentation. Orthop Clin North Am. 1993;24(2):239-53.Xavier CRM, Molin DCD, Santos RMM, Santos RDT, Ferreira Neto JC. Tratamento cirúrgico das fraturas do rádio distal com placa volar bloqueada: correlação dos resultados clínicos e radiográficos. Rev Bras Ortop. 2011;46(5):505-13.Karnezis IA, Panagiotopoulos E, Tyllianakis M, Megas P, Lambiris E. Correlation between radiological parameters and patient-rated wrist dysfunction following fractures of the distal radius. Injury. 2005;36(12):1435-39.Schneiders W, Biewener A, Rammelt S, Rein S, Zwipp H, Amlang M. Die distale Radiusfraktur. Korrelation zwischen radiologischem und funktionellem Ergebnis [Distal radius fracture. Correlation between radiological and functional results]. Unfallchirurg. 2006;109(10):837-44Trumble TE, Schmitt SR, Vedder NB. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg Am. 1994;19(2):325-40. Fernandez DL. Should anatomic reduction be pursued in distal radial fractures?. J Hand Surg Br. 2000;25(6):523-27.Kasapinova K, Kamiloski V. Outcome evaluation in patients with distal radius fracture. Prilozi. 2011;32(2):231-46.Paranaíba VF, Santos JBG, Raduan Neto J, Moraes VY, Belotti JC, Faloppa F. Aplicação do PRWE na fratura da extremidade distal do rádio: comparação e correlação dos desfechos consagrados.  Rev bras ortop. 2017;52(3):278-83.da Silva Rodrigues EK, de Cássia Registro Fonseca M, MacDermid JC. Brazilian version of the Patient Rated Wrist Evaluation (PRWE-BR): Cross-cultural adaptation, internal consistency, test-retest reliability and construct validity. J Hand Ther. 2015;28(1):69-76.

The Reliability of Measurements Taken from Computer-Stored Digitalised X-Rays of Acute Distal Radius Fractures

2008 ◽  
Vol 33 (3) ◽  
pp. 369-372 ◽  
Author(s):  
K. THOMASON ◽  
K. L. SMITH
Keyword(s):  
Distal Radius ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Distal Radius Fractures ◽  
X Rays ◽  
Tolerance Limits ◽  
Radius Fractures ◽  
Distal Radial Fractures ◽  
Intraclass Correlation Coefficients ◽  
Anatomical Parameters

Sixteen observers measured eight anatomical parameters on digitalised images of six acute distal radial fractures using the Patient Archiving Communication System software and repeated the measurements at least 2 weeks later. Inter- and intraobserver reliability was calculated using intraclass correlation coefficients and tolerance limits. The highest interobserver agreement was demonstrated in the dorsal tilt (intraclass correlation coefficient 0.858; tolerance limit 14.2°). When compared with the results of a study looking at observer reliability in measurement of healed distal radial fractures, the reliability of computerised measurements is not significantly different from those achieved by manual techniques (dorsal tilt interobserver tolerance limits on computer system 16°, compared to 15° using ruler and protractor). These results suggest that the recommended radiological reduction limits for distal radius fractures of <10° change in palmar tilt, <2 mm radial shortening, <5° change in radial angle and a <1 to 2 mm articular step cannot be reliably measured.

High rate of complications associated with extrafocal kirschner wire pinning for distal radius fractures

2008 ◽  
Vol 27 (4) ◽  
pp. 160-166 ◽  
Author(s):  
J. van Aaken ◽  
J.-Y. Beaulieu ◽  
D. Della Santa ◽  
O. Kibbel ◽  
C. Fusetti
Keyword(s):  
Distal Radius ◽  
Kirschner Wire ◽  
Distal Radius Fractures ◽  
High Rate ◽  
Radius Fractures

UNSTABLE DISTAL RADIUS FRACTURES TREATED BY MODIFIED KIRSCHNER WIRE PINNING

1994 ◽  
Vol 36 (1) ◽  
pp. 83-88 ◽  
Author(s):  
Hans Habernek ◽  
Reinhard Weinstabl ◽  
Christian Fialka ◽  
Lothar Schmid
Keyword(s):  
Distal Radius ◽  
Kirschner Wire ◽  
Distal Radius Fractures ◽  
Radius Fractures

scholarly journals Strain as a Function of Time in Extrinsic Wrist Ligaments Tensioned Through External Fixation

Hand ◽  
2017 ◽  
Vol 13 (1) ◽  
pp. 60-64
Author(s):  
Joseph P. Rectenwald ◽  
K. Ashley Bentley ◽  
Peter M. Murray ◽  
Subrata Saha
Keyword(s):  
Stress Relaxation ◽  
External Fixation ◽  
Distal Radius ◽  
Kirschner Wire ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Fracture Length ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Average Loss

Background: The objective of this study is to determine the time-dependent dissipation of extrinsic wrist ligament tension following the application external fixation with axial distraction of the wrist in a cadaveric model. Methods: Six paired fresh-frozen cadaveric specimens underwent mechanical testing simulating external fixation with 1 arm of each pair osteotomized to simulate a distal radius fracture. The change in tension was then recorded over 24 hours. Results: The rate of stress relaxation decreased with time. The average loss in tension in the control arms and osteotomized arms was 55% and 59%, respectively, over a 24-hour period. There was no statistically significant difference in the stress relaxation behavior between the 2 groups. Conclusion: This study further supports the recommendation that comminuted distal radius fractures treated with an external fixator should have Kirschner wire augmentation or other additional means of fixation to help maintain fracture length and alignment. The results of this study call in to question the efficacy of ligamentotaxis alone through external fixation as the sole means of maintaining reduction of displaced, unstable distal radius fractures.

Sign in / Sign up

Export Citation Format

Share Document