scholarly journals Local Osteopenia Associated with Management of Intra-Articular Distal Radial Fractures by Insertion of External Fixation Pins in the Distal Fragment: Prospective Study

2002 ◽  
Vol 10 (2) ◽  
pp. 179-184 ◽  
Author(s):  
JA Mehta ◽  
JP Slavotinek ◽  
J Krishnan
Keyword(s):  
Bone Density ◽  
Distal Radius ◽  
Distal Radial Fracture ◽  
Distal Fragment ◽  
Radial Fracture ◽  
Distal Radial Fractures ◽  
Density Measurements ◽  
Articular Fractures ◽  
The Mean

Purpose. To assess the restoration of the bone mass of the distal radius following the use of implants in the distal radial fragment. Highly comminuted Frykman type 7 and 8 fractures were studied to determine whether the use of fixation pins in the comminuted distal radial fragment leads to osteopenia in the distal radial fragment after healing of the fracture. Methods. As part of a clinical trial, 30 patients with comminuted intra-articular fractures of the distal radius were treated with closed reduction, external non-bridging fixation, and early postoperative mobilisation. To detect local osteopenia, bone density measurements were taken at the distal metaphysis and mid-diaphysis following healing of the fractured radius and the contralateral unaffected radius in 12 patients. Results. The mean age of the 12 patients for whom bone density measurements were recorded was 52.5 years (range, 39–87 years). There were 9 females and 3 males included in the study. Seven patients had a Frykman type 8 fracture and 5 patients had a Frykman type 7 fracture. Significant osteopenia was absent despite the use of four 2.5-mm fixation pins in the distal fragments of the healed distal radial fracture. The median value of the maximal step was 2.8mm (range, 0–9.1mm). The median value of the intra-articular interfragmentary gap was 1.8 mm (range, 0–13.4mm). Conclusion. The findings of this study do not suggest long-term osteopenia following the use of four 2.5-mm pins in the distal fragments. The non-bridging fixator, by allowing early physical activity, possibly led to satisfactory functional and structural results.

Association of scapholunate dissociation and two-part articular fractures of the distal radius

2019 ◽  
Vol 44 (5) ◽  
pp. 468-474 ◽  
Author(s):  
Grace T.W. Sun ◽  
Simon B.M. MacLean ◽  
Justin J. Alexander ◽  
Richard Woodman ◽  
Gregory I. Bain
Keyword(s):  
Distal Radius ◽  
Ct Scans ◽  
Distal Radial Fracture ◽  
Fracture Type ◽  
Radial Fracture ◽  
Scapholunate Dissociation ◽  
Distal Radial Fractures ◽  
Level Of Evidence ◽  
Articular Fracture ◽  
Articular Fractures

Scapholunate dissociation may occur in association with distal radial fractures and is easily missed at initial presentation. The aim of this study was to examine variances in the scapholunate distance with respect to subtypes of two-part partial articular distal radial fractures. Axial computed tomography (CT) scans of acute two-part intra-articular radial fractures were assessed retrospectively from 80 patients and compared to 20 controls. From each scan, two images were analysed to identify the scaphoid, lunate and articular fracture line in the distal radius for fracture type categorization. The images were overlaid on a standardized distal radius template and the scapholunate distance measured. Significant increase in the scapholunate distance was noted in fracture subtypes: radial styloid oblique; dorsal ulnar column; sagittal ulnar column; and volar coronal. We conclude that these findings support the need for a higher index of suspicion for scapholunate dissociation in these distal radial fracture subtypes. Level of evidence: III

scholarly journals Volar Fixation of Dorsally Displaced Distal Radial Fracture Using Locking Compression Plate

2005 ◽  
Vol 13 (2) ◽  
pp. 153-157 ◽  
Author(s):  
KK Wong ◽  
KW Chan ◽  
TK Kwok ◽  
KH Mak
Keyword(s):  
Distal Radius ◽  
Locking Plate ◽  
Locking Compression Plate ◽  
Distal Radial Fracture ◽  
Radial Fracture ◽  
Distal Radial Fractures ◽  
Compression Plate ◽  
One Year ◽  
Compression Plating ◽  
Unstable Fractures

Purpose. To evaluate the functional and radiological results of treating unstable fractures of the dorsal distal radius with a volar locking plate. Methods. Dorsally displaced distal radial fractures in 30 patients (11 men and 19 women; mean age, 58.6 years) were fixed by volar locking compression plate and followed up for a minimum of one year. Results. At final functional assessment, 24 patients achieved excellent and 5 achieved good outcomes, with one patient exhibiting fair results. Radiological scores demonstrated 22 excellent and 8 good outcomes. No nonunion or infection occurred. Conclusion. Volar locking compression plating is a safe and effective treatment for unstable fractures of the dorsal distal radius.

Cost minimization analysis of the treatment of distal radial fractures in the elderly

2018 ◽  
Vol 100-B (2) ◽  
pp. 205-211 ◽  
Author(s):  
E. Q. Pang ◽  
J. Truntzer ◽  
L. Baker ◽  
A. H. S. Harris ◽  
M. J. Gardner ◽  
...  
Keyword(s):  
Cost Minimization ◽  
Secondary Analysis ◽  
The Elderly ◽  
Distal Radial Fracture ◽  
Radial Fracture ◽  
Distal Radial Fractures ◽  
Payer Perspective ◽  
Chi Squared ◽  
The Mean ◽  
The Cost

Aims The aim of this study was to test the null hypothesis that there is no difference, from the payer perspective, in the cost of treatment of a distal radial fracture in an elderly patient, aged > 65 years, between open reduction and internal fixation (ORIF) and closed reduction (CR). Materials and Methods Data relating to the treatment of these injuries in the elderly between January 2007 and December 2015 were extracted using the Humana and Medicare Advantage Databases. The primary outcome of interest was the cost associated with treatment. Secondary analysis included the cost of common complications. Statistical analysis was performed using a non-parametric t-test and chi-squared test. Results Our search yielded 8924 patients treated with ORIF and 5629 patients treated with CR. The mean cost of an uncomplicated ORIF was more than a CR ($7749 versus $2161). The mean additional cost of a complication in the ORIF group was greater than in the CR group ($1853 versus $1362). Conclusion These findings show that there are greater payer fees associated with ORIF than CR in patients aged > 65 years with a distal radial fracture. CR may be a higher-value intervention in these patients. Cite this article: Bone Joint J 2018;100-B:205–11.

scholarly journals Treatment of Comminuted Intra-articular Fractures of Distal Radius by External Fixator

2014 ◽  
Vol 1 (2) ◽  
pp. 30-34
Author(s):  
MH Mohammad Alamgir ◽  
Md. Monowarul Islam ◽  
M Ershadul Haque ◽  
M Nazrul Islam ◽  
Abdul Kader
Keyword(s):  
Distal Radius ◽  
External Fixator ◽  
Case Series ◽  
Distal Radial Fractures ◽  
Medical College ◽  
Articular Fractures ◽  
Satisfactory Outcome ◽  
The Mean ◽  
Plexus Block

Background: Treatment of comminuted intra-articular fractures of distal radius by external fixator is an important. Objective: The aim of study was to investigate the usefulness of external fixator as a treatment option for displaced comminuted intra-articular fractures of distal radius. Methodology: This case series was conducted in the Department of orthopaedic Surgery at Shaheed Suhrawardy Medical College& Hospital, Dhaka during the period of November 2011 to July 2013.  All the patients having comminuted intra-articular distal radial fractures were being treated with mini uniaxial external fixator under brachial plexus block. The average follow up was performed in about 6 month.Result: A total number of fifteen patients were enrolled for this study. The mean age with SD was 50.21±9.473. Patient outcomes were measured by modified Knirk and Jupiter score and were categorized as satisfactory and unsatisfactory groups. In this study satisfactory outcome was found in 86.0%. All fractures (100.0%) were united nicely. Few complications were encountered. Postoperative osteoarthritis was not found during follow up.Conclusion: The use of external fixator for treating the comminuted intra-articular distal radial fractures produces satisfactory result.DOI: http://dx.doi.org/10.3329/jcamr.v1i2.20516 Journal of Current and Advance Medical Research Vol.1(2) 2014: 30-34

Fractures of the Distal Radius and Scaphoid

1996 ◽  
Vol 21 (6) ◽  
pp. 772-774 ◽  
Author(s):  
J. OSKAM ◽  
J. S. DE GRAAF ◽  
H. J. KLASEN
Keyword(s):  
Conservative Treatment ◽  
Operative Treatment ◽  
Distal Radius ◽  
Functional Results ◽  
Distal Radial Fracture ◽  
Radial Fracture ◽  
Wrist Injury ◽  
Distal Radial Fractures ◽  
Scaphoid Fractures

Simultaneous fractures of the distal radius and scaphoid is an uncommon wrist injury. During the period 1980 to 1993, 23 patients with a median age of 39 years were treated for this injury. The median follow-up period was 7 years. All scaphoid fractures were undisplaced and located in the waist or distal third. An extraarticular distal radial fracture was observed in 15 wrists. A below elbow cast including the thumb was applied in 18 wrists for a mean duration of 9 weeks, and operative treatment was used in only 5 patients. All scaphoid fractures healed without complications. During conservative treatment there were three redisplacements of distal radial fractures. The final functional results were good in 18, fair in four, and poor in one patient. Because complications occurred at the distal radius we have changed our conservative treatment policy from a below elbow cast including the thumb to a dorsal splint for 6 weeks.

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 Development of Algorithm for Clinical Management of Sickle Cell Bone Disease: Evidence for a Role of Vertebral Fractures in Patient Follow-up

2020 ◽  
Vol 9 (5) ◽  
pp. 1601 ◽  
Author(s):  
Lucia De Franceschi ◽  
Daniele Gabbiani ◽  
Andrea Giusti ◽  
Gianluca Forni ◽  
Filippo Stefanoni ◽  
...  
Keyword(s):  
Bone Density ◽  
Sickle Cell ◽  
Bone Disease ◽  
Vertebral Fractures ◽  
Cell Disease ◽  
High Incidence ◽  
The Mean

Sickle-cell disease (SCD) is a worldwide distributed hemoglobinopathy, characterized by hemolytic anemia associated with vaso-occlusive events. These result in acute and chronic multiorgan damage. Bone is early involved, leading to long-term disability, chronic pain and fractures. Here, we carried out a retrospective study to evaluate sickle bone disease (SBD) in a cohort of adults with SCD. We assessed bone density, metabolism and turnover. We also evaluated the presence of fractures and the correlation between SCD severity and skeletal manifestations. A total of 71 patients with SCD were analyzed. The mean age of population was 39 ± 10 years, 56% of which were females. We found osteoporosis in a range between 7% and 18% with a high incidence of vertebral fractures. LDH and AST were predictive for the severity of vertebral fractures, while bone density was not. Noteworthy, we identified -1.4 Standard Deviations T-score as the cutoff for detecting the presence of fractures in patients with SCD. Collectively our data allowed us to develop an algorithm for the management of SBD, which may be useful in daily clinical practice to early intersect and treat SBD.

The incidence of ulnocarpal complaints after distal radial fracture in relation to the fracture of the ulnar styloid

2012 ◽  
Vol 38 (7) ◽  
pp. 710-717 ◽  
Author(s):  
S. Krämer ◽  
H. Meyer ◽  
P. F. O’Loughlin ◽  
B. Vaske ◽  
C. Krettek ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Grip Strength ◽  
Distal Radial Fracture ◽  
Radial Fracture ◽  
Ulnar Styloid ◽  
Distal Radial Fractures ◽  
Pain Scores ◽  
Ulnar Styloid Fracture ◽  
Loss Of Motion

Two hundred distal radial fractures, with a mean follow up of 20 months (range 6–49), were divided into three groups according to the presence and healing status of an ulnar styloid fracture. The patients underwent both clinical and radiological examination and completed two different questionnaires. One hundred and one, of 200 distal radial fractures, were associated with an ulnar styloid fracture. Forty-six of these developed an ulnar styloid nonunion. The authors encountered significantly higher pain scores (ulnar sided pain p = 0.012), a higher rate of DRUJ instability ( p = 0.032), a greater loss of motion and grip strength ( p = 0.001), and a poorer clinical outcome in cases with an ulnar styloid fracture, but no differences were apparent when those with healed ulnar styloid fractures or ulnar styloid nonunions were compared ( p > 0.05). The investigators propose that the incidence of ulnocarpal complaints following distal radial fracture depends on the presence but not the healing status of an ulnar styloid fracture.

Prospective investigation of the relationship between dorsal tilt, carpal malalignment, and capitate shift in distal radial fractures

2020 ◽  
Vol 102-B (1) ◽  
pp. 137-143
Author(s):  
Rachel Dias ◽  
Nick A. Johnson ◽  
Joseph J. Dias
Keyword(s):  
Operating Characteristic ◽  
Distal Radial Fracture ◽  
Radial Fracture ◽  
Roc Curve Analysis ◽  
Distal Radial Fractures ◽  
Initial Radiograph ◽  
Interval Linear ◽  
Adverse Influence ◽  
The Relationship ◽  
Prospective Investigation

Aims Carpal malalignment after a distal radial fracture occurs due to loss of volar tilt. Several studies have shown that this has an adverse influence on function. We aimed to investigate the magnitude of dorsal tilt that leads to carpal malalignment, whether reduction of dorsal tilt will correct carpal malalignment, and which measure of carpal malalignment is the most useful. Methods Radiographs of patients with a distal radial fracture were prospectively collected and reviewed. Measurements of carpal malalignment were recorded on the initial radiograph, the radiograph following reduction of the fracture, and after a further interval. Linear regression modelling was used to assess the relationship between dorsal tilt and carpal malalignment. Receiver operating characteristic (ROC) analysis was used to identify which values of dorsal tilt led to carpal malalignment. Results A total of 250 consecutive patients with 252 distal radial fractures were identified. All measures of carpal alignment were significantly associated with dorsal tilt at each timepoint. This relationship persisted after adjustment for age, sex, and the position of the wrist. Capitate shift consistently had the strongest relationship with dorsal tilt and was the only parameter that was not influenced by age or the position of the wrist. ROC curve analysis identified that abnormal capitate shift was seen with > 9° of dorsal tilt. Conclusion Carpal malalignment is related to dorsal tilt following a distal radial fracture. Reducing the fracture and improving dorsal tilt will reduce carpal malalignment. Capitate shift is easy to assess visually, unrelated to age and sex, and appears to be the most useful measure of carpal malalignment. The aim during reduction of a distal radial fracture should be to realign the capitate with the axis of the radius and prevent carpal malalignment. Cite this article: Bone Joint J 2020;102-B(1):137–143

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