Ulnar variance in distal radial fractures: assessment and interpretation

2022 ◽  
pp. 175319342110703
Author(s):  
Nick A. Johnson ◽  
Rachel Dias ◽  
Joseph J. Dias
Keyword(s):  
Distal Radius ◽  
Articular Surface ◽  
Ulnar Variance ◽  
The Other ◽  
Initial Assessment ◽  
Distal Radial Fractures ◽  
Distal Ulna ◽  
Level Of Evidence ◽  
Number Of Patients

We explored patterns of shortening of the distal radius and investigated the effect of displacement on ‘ulnar variance’ in 250 patients with distal radial fractures. A small number of patients (5%) had a fracture that resulted in true shortening. Thirty-two per cent had fractures that appeared short, but lateral radiographs revealed that the articular surface was tilted, with either the anterior or dorsal rim of the articular surface being proximal to the distal ulna but the other rim was distal to it. We recommend initial assessment of variance on lateral radiographs. If the anterior and dorsal rims of the distal radial articular surface are proximal to the distal ulna, then true shortening is present and lengthening and stabilization, to hold the radius distracted, should be considered. If only one rim is proximal to the distal ulna, then correction of the tilt will lessen the apparent positive variance. Level of evidence: IV

Analysis of variation in the surgical treatment of patients with distal radial fractures in the Netherlands

2016 ◽  
Vol 42 (1) ◽  
pp. 39-44 ◽  
Author(s):  
M. M. J. Walenkamp ◽  
M. A. M. Mulders ◽  
J. C. Goslings ◽  
G. P. Westert ◽  
N. W. L. Schep
Keyword(s):  
Surgical Treatment ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Distal Radial Fractures ◽  
Level Of Evidence ◽  
Explanatory Variables ◽  
Therapeutic Decisions ◽  
Number Of Patients ◽  
Analysis Of Variation

The purpose of this study was to examine the variation in surgical treatment rates of patients with distal radius fractures across Dutch hospitals. We obtained all reimbursement data for the treatment of distal radius fractures for 2012 and 2013 categorized by hospital. The surgical rate across hospitals was corrected for possible explanatory variables using linear regression analyses. We analysed a total of 95,754 reimbursements. The operative rate ranged from 0% to 23%, with a mean of 9.6%. Hospital type, the percentage of females, the percentage of patients over 65, the mean age, average socioeconomic status and the total number of patients treated explained only 2.6% of the observed differences in the operative rate among hospitals in 2012 and 11.6% in 2013. Our results suggest that subjective factors, such as surgeon’s opinions and preferences, significantly influence therapeutic decisions in patients with distal radius fractures. Level of evidence: III

Three-dimensional analysis of displacement characteristics of dorsally angulated intra-articular distal radial fractures

2019 ◽  
Vol 45 (4) ◽  
pp. 339-347
Author(s):  
Atsuo Shigi ◽  
Kunihiro Oka ◽  
Kohji Kuriyama ◽  
Hiroyuki Tanaka ◽  
Hideki Yoshikawa ◽  
...  
Keyword(s):  
Dimensional Analysis ◽  
Articular Surface ◽  
Three Dimensional ◽  
Anatomical Reduction ◽  
Distal Radial Fractures ◽  
Level Of Evidence ◽  
Dorsal Wall ◽  
Wall Displacement ◽  
Sigmoid Notch ◽  
Displacement Patterns

Understanding the complex fragmentation of intra-articular distal radial fractures contributes to achieving anatomical reduction during surgery. This study aimed to clarify three-dimensional displacement patterns of intra-articular fragmentation in dorsally angulated, intra-articular distal radial fractures. We identified five characteristic intra-articular fragments: a key fragment, dorsal ulnar corner, dorsal wall, radial column and anterior radial column. The key fragment was displaced with radial deviation, pronation and extension and with dorsal, proximal and radial translations. The dorsal ulnar corner displacement resulted in a gap, a step-off and a deepened concavity for the lunate facet and sigmoid notch. The dorsal wall displacement resulted in a deepened concavity, a gap and a step-off of the dorsal scaphoid facet. The displacements of the radial column and anterior radial column caused a step-off between the scaphoid and lunate facets. The five characteristic intra-articular fragments each created a characteristic gap and step-off in the articular surface. Level of evidence: IV

Intra-articular distal radius fractures in elderly patients: a randomized prospective study of casting versus volar plating

2017 ◽  
Vol 43 (2) ◽  
pp. 142-147 ◽  
Author(s):  
Daniel Martinez-Mendez ◽  
Alejandro Lizaur-Utrilla ◽  
Joaquin de-Juan-Herrero
Keyword(s):  
Conservative Treatment ◽  
Elderly Patients ◽  
Distal Radius ◽  
Articular Surface ◽  
Distal Radius Fractures ◽  
Volar Plating ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Loss Of Reduction

We compared outcomes in elderly patients with intra-articular distal radius fractures treated by closed reduction and plaster immobilization or open reduction and internal fixation with a volar plate. Ninety-seven patients older than 60 years were randomly allocated to conservative (47 patients) or surgical (50 patients) treatment. Over a 2-year period, we assessed patient-rated wrist evaluation score, DASH (disability arm, shoulder and hand) questionnaire, pain, wrist range of motion, grip strength, and radiological parameters. The functional outcomes and quality of life were significantly better after volar plating fixation compared with conservative treatment. We found that restoration of the articular surface, radial inclination, and ulnar variance affected the outcomes, but the articular step-off did not. Twenty-five per cent of the patients with conservative treatment had secondary loss of reduction. We conclude that surgical plating leads to better outcomes than conservative treatment for elderly patients with intra-articular distal radius fractures. Level of evidence: I

The assessment of cognitive function in the elderly using videoconferencing

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 36-38 ◽  
Author(s):  
Chris Ball ◽  
Alison Puffett
Keyword(s):  
Cognitive Function ◽  
Inner City ◽  
The Elderly ◽  
Structured Interview ◽  
The Other ◽  
Initial Assessment ◽  
Face To Face ◽  
Number Of Patients ◽  
Old Age Psychiatry ◽  
Videoconferencing System

People over the age of 65 were recruited from an inner-city old-age psychiatry service. Subjects had a structured interview (the CAMCOG test) by videoconferencing, and also face to face, by an investigator blind to the results of the test in the other mode. Reassessments were carried out within one week of the initial assessment. Eleven subjects were initially enrolled in the study and eight completed both modes. The number of patients in this study is very small but the results suggest that the CAMCOG test can be used reliably over a videoconferencing system without major modification.

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.

The Value of Plain X-Rays in Predicting TFCC Injury after Distal Radial Fractures

2008 ◽  
Vol 33 (3) ◽  
pp. 322-326 ◽  
Author(s):  
H. BOMBACI ◽  
A. POLAT ◽  
G. DENIZ ◽  
O. AKINCI
Keyword(s):  
Distal Radius ◽  
Articular Surface ◽  
Random Order ◽  
Distal Radioulnar Joint ◽  
X Rays ◽  
Distal Radial Fractures ◽  
Ulnar Styloid Fracture ◽  
Significant Difference ◽  
Mri Scans ◽  
Triangular Fibrocartilage

In this prospective study, the plain X-rays and MRI scans of 60 patients with intraarticular distal radius fractures were examined in random order. MRI evaluation revealed that 27 of the 60 patients (45%) had triangular fibrocartilage lesions. No correlation was found between triangular fibrocartilage injury and the Melone classification system, the presence of an ulnar styloid fracture, comminution of the articular surface of the distal radius, >20° dorsal angulation of the distal radius or subluxation/dislocation of the distal radioulnar joint on the plain X-rays. When Frykman Type VI and VIII fractures were compared with all the other Frykman subtypes, a significant difference in the incidence of triangular fibrocartilage complex tears was observed. We conclude that triangular fibrocartilage injury should be considered with all distal radial fractures, especially the Frykman Types VI and VIII.

Outcome of Distal Radial Fractures in Young Adults

2000 ◽  
Vol 25 (6) ◽  
pp. 535-543 ◽  
Author(s):  
J. D. GLIATIS ◽  
S. J. PLESSAS ◽  
T. R. C. DAVIS
Keyword(s):  
Young Adults ◽  
Distal Radius ◽  
Articular Surface ◽  
Wrist Pain ◽  
Outcome Questionnaire ◽  
Fracture Union ◽  
Distal Radial Fractures ◽  
Everyday Activities

The outcome of 169 fractures of the distal radius in adults under the age of 50 were assessed at least 18 months after injury (mean follow-up, 4.9 years) using a validated, patient-based outcome questionnaire. The questionnaire responses demonstrated that neither the Frykman nor the Mayo classifications of distal radial fractures predicted outcome. Fracture union with more than 10° of dorsal tilt was associated with increased difficulty with everyday activities and work, while union with a step in the radiocarpal articular surface was associated with loss of wrist mobility and difficulty with fine dextrous tasks. No measure of either intra- or extra-articular malunion influenced the severity or frequency of persistent wrist pain.

scholarly journals Reconstruction of Distal Radius Osteochondral Defects Using Metatarsal Autografts: a Multi-case Series

2019 ◽  
Vol 47 (01) ◽  
pp. 003-009
Author(s):  
Patrick K.Y. Goon ◽  
Shirley D. Stougie ◽  
Kalpesh R. Vaghela ◽  
J. Henk Coert
Keyword(s):  
Distal Radius ◽  
Free Flap ◽  
Articular Surface ◽  
Donor Site ◽  
Case Series ◽  
Donor Site Morbidity ◽  
Difficult Problem ◽  
Prospective Clinical Study ◽  
Level Of Evidence

Objective Delayed reconstruction of the articular surface of the distal radius after trauma is a difficult problem for hand surgeons, and the common solution is usually partial or total wrist fusion, relieving pain but sacrificing motion. A relative novel reconstructive technique addresses the problem with a free microvascular osteochondral flap, using the 3rd metatarsal (3MT) bone. We investigate the possibility of using the same donor as a graft rather than a free flap. Methods This was a prospective clinical study of patients with isolated lunate facet damage following trauma who underwent surgery to remove the damaged articular surface and in whom the defect was reconstructed with an osteochondral graft from the base of the 3MT. All of the patients were followed-up at specific time intervals, with pre- and postoutcome measures taken, including pain, grip strength, range of motion (ROM), and postoperative radiographs and computed tomography (CT) scans to evaluate graft resorption and union. Only patients with isolated distal radius defects were included. Results The average follow-up period was of 51 months (range: 14–73 months). The results of 7 patients included an average improvement of the pain score in the visual analogue scale (VAS) by 3 points, with an average arc of motion of 135°. In all, there was radiographic evidence of full incorporation of the graft, with no resorption. Donor site morbidity was minimal. Conclusions The current gold standard for distal radius articular surface reconstruction remains a free 3MT osteochondral flap. However, our results using the base of the 3MT as a graft shows promise, and if further follow-up confirms comparable results to the free flap technique, this would mean an easier and equally robust reconstruction without complicated microsurgery. Level of Evidence Therapeutic, Level V case series.

scholarly journals IMPORTANCE OF RADIOGRAPHY IN ORTHOSTATISM IN THE CONDUCT OF THORACOLOMBAR TRANSITION FRACTURES

2021 ◽  
Vol 20 (1) ◽  
pp. 60-63
Author(s):  
Victor Caponi Borba ◽  
Nilo Carrijo Melo ◽  
Pedro Felisbino Junior ◽  
Vinicio Nunes Nascimento ◽  
Wender Gonçalves Moura ◽  
...  
Keyword(s):  
Supine Position ◽  
Case Series ◽  
Wilcoxon Test ◽  
Surgical Indication ◽  
Initial Assessment ◽  
Level Of Evidence ◽  
X Ray ◽  
Number Of Patients ◽  
Case Series Study ◽  
Thoracolumbar Transition

ABSTRACT Objective: To evaluate the importance of radiography in the orthostatic position in the initial assessment of patients with thoracolumbar transition fractures and whether this image changes the surgical indication. Methods: Medical records and imaging tests of patients treated for thoracolumbar transition fractures from June 2018 to June 2019 were evaluated. Trauma patients between 18 and 60 years of age with fractures of T10 to L3 who had been indicated for conservative treatment were included. Cases of fractures considered unstable were excluded. Radiographs were taken with the patient in the supine position (supine X-ray), computed tomography (CT), and orthostatic radiography (orthostatic X-ray). Segmental kyphosis and degree of wedging were evaluated. The measurements were compared using the Wilcoxon test. The McNemar test was used to assess changes in conduct according to the criteria for surgical indication (kyphosis ≥ 25 ° and wedging ≥ 50%). Results: Fifty patients were evaluated, nine of whom (18%) were indicated for a change of conduct according to the orthostatic examinations and were submitted to surgical treatment. Vertebral kyphosis increased by 40.6% (p <0.001). The wedging increased by 25.62% (p <0.0001). Conclusion: Eighteen percent of the total number of patients who did not present instability criteria in radiographs in the supine position satisfied at least one of these criteria when the orthostatic X-ray was performed. Level of evidence 3B; Retrospective case series study.

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