ROENTGEN OSTEODENSYTOMETRY IN THE EVALUATION OF STRUCTURAL AND FUNCTIONAL STATE OF BONE TISSUE IN WOMEN WITH THE 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.

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

BMC Geriatrics ◽

10.1186/s12877-021-02157-2 ◽

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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Comparison of operating time, fluoroscopy exposure time, and functional and radiological results of two surgical methods for distal forearm fractures of both-bones in pediatric patients: Is it necessary to fix both bones?

Acta Orthopaedica et Traumatologica Turcica ◽

10.5152/j.aott.2020.02.10 ◽

2020 ◽

Vol 54 (2) ◽

pp. 155-160

Author(s):

Hakan Kocaoglu ◽

◽

Mahmut Kalem ◽

Mustafa Kavak ◽

Ercan Sahin ◽

...

Keyword(s):

Exposure Time ◽

Pediatric Patients ◽

Operating Time ◽

Distal Forearm ◽

Forearm Fractures ◽

Radiological Results ◽

Surgical Methods ◽

Both Bones ◽

Distal Forearm Fractures ◽

Functional And Radiological Results

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Distal Forearm Fractures

Textbook of Orthopedics (Includes Clinical Examination Methods in Orthopedics) ◽

10.5005/jp/books/13033_45 ◽

2017 ◽

pp. 619-619

Author(s):

John Ebnezar ◽

Rakesh John

Keyword(s):

Distal Forearm ◽

Forearm Fractures ◽

Distal Forearm Fractures

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Short and long-arm fiberglass cast immobilization for displaced distal forearm fractures in children: a randomized controlled trial

International Orthopaedics ◽

10.1007/s00264-020-04800-w ◽

2020 ◽

Author(s):

Michelle Seiler ◽

Peter Heinz ◽

Alessia Callegari ◽

Thomas Dreher ◽

Georg Staubli ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Range Of Motion ◽

Daily Life ◽

Controlled Trial ◽

Distal Forearm ◽

Forearm Fractures ◽

Normal Range ◽

Randomized Controlled ◽

Loss Of Reduction ◽

Distal Forearm Fractures

Abstract Purpose The aim of this study was to investigate whether short-arm fiberglass cast (SAC) immobilization provides fracture stabilization comparable to that of long-arm cast (LAC) treatment of displaced distal forearm fractures after closed reduction in paediatric patients. Methods A prospective, randomized, controlled trial of children aged four to 16 years (mean 9.9 years) was designed with a sample of 120 children, whose size was set a priori, with 60 treated with SAC and 60 with LAC. The primary outcome was fracture stability and rate of loss of reduction. The secondary outcome analysis evaluated duration of analgesic therapy, restriction in activities of daily life, and the duration until patients regained normal range of motion in the elbow. Results No statistically significant differences were found between the two groups in loss of reduction or duration of analgesic therapy. In contrast, the duration until normal range of motion in the elbow was regained was significantly longer in the LAC group (median 4.5 days, P < 0.001). Restriction in activities of daily life did not differ significantly between the two groups except for the item “help needed with showering in the first days after trauma” (SAC 60%, LAC 87%, P = 0.001). Conclusion Fracture immobilization with short-arm fiberglass cast in reduced distal forearm fractures is not inferior to long-arm casts in children four years and older, excluding completely displaced fractures. Furthermore, short-arm casting reduces the need for assistance during showering. Trial registration NCT03297047, September 29, 2017

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Plaster cast treatment for distal forearm fractures in children

Journal of Pediatric Orthopaedics B ◽

10.1097/bpb.0000000000000678 ◽

2020 ◽

Vol 29 (2) ◽

pp. 179-186

Author(s):

Domenico Ravier ◽

Ilaria Morelli ◽

Valentina Buscarino ◽

Chiara Mattiuz ◽

Luca M. Sconfienza ◽

...

Keyword(s):

Plaster Cast ◽

Distal Forearm ◽

Forearm Fractures ◽

Fractures In Children ◽

Distal Forearm Fractures

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Reply to “Displaced distal forearm fractures in children with an indication for reduction under general anesthesia should be percutaneously fixated” by van Egmond PW, Schipper IB, van Luijt PA in Eur J Orthop Surg Traumatol. 2012 Apr;22(3):201–207

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-012-1003-2 ◽

2012 ◽

Vol 22 (6) ◽

pp. 527-527

Author(s):

Georg Singer ◽

Tanja Peschaut ◽

Tanja Kraus ◽

Robert Eberl

Keyword(s):

General Anesthesia ◽

Distal Forearm ◽

Forearm Fractures ◽

Fractures In Children ◽

Distal Forearm Fractures

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Reduction versus remodeling in pediatric distal forearm fractures: a preliminary cost analysis

Journal of Pediatric Orthopaedics B ◽

10.1097/01202412-200303000-00007 ◽

2003 ◽

Vol 12 (2) ◽

pp. 109-115

Author(s):

Twee T. Do ◽

William M. Strub ◽

Susan L. Foad ◽

Charles T. Mehlman ◽

Alvin H. Crawford

Keyword(s):

Cost Analysis ◽

Distal Forearm ◽

Forearm Fractures ◽

Distal Forearm Fractures

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Point-of-care ultrasound compared with conventional radiographic evaluation in children with suspected distal forearm fractures in the Netherlands: a diagnostic accuracy study

Emergency Medicine Journal ◽

10.1136/emermed-2018-208380 ◽

2019 ◽

Vol 36 (10) ◽

pp. 613-616 ◽

Cited By ~ 3

Author(s):

Anniek C Epema ◽

Mariëlle J B Spanjer ◽

Lieselotte Ras ◽

Johannes C Kelder ◽

Marieke Sanders

Keyword(s):

The Netherlands ◽

Diagnostic Accuracy ◽

Conventional Radiography ◽

Point Of Care Ultrasound ◽

Distal Forearm ◽

Forearm Fractures ◽

Predictive Values ◽

Pain Scores ◽

Fractures In Children ◽

Distal Forearm Fractures

BackgroundDistal forearm fractures are common in children. The reference standard to diagnose these fractures is by conventional radiography, which exposes these patients to harmful radiation. Ultrasound (US) seems to be a good alternative. However, emergency physicians (EPs) in the Netherlands have limited experience in using US for diagnosing fractures in children.ObjectiveThe primary objective was to determine the accuracy of US, performed by a Dutch EP, compared with conventional radiography, in diagnosing distal forearm fractures in children. As a secondary objective, differences in pain scores during the performance of both US and plain radiography were determined.MethodsChildren, aged between 0 and 14 years old, suspected of having a distal forearm fracture were enrolled at the Emergency Department. US and radiographic findings were compared. Statistics for accuracy were calculated. Pain scores were recorded during US and radiography and compared as well. All participating operators received an hour-long pretrial training.Results100 patients were enrolled. The mean age was 9.5 years (SD, 3.6), and 50% were women. Overall diagnostic accuracy was 92% (95% CI 85%-96%). The sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios for US were 95% (95% CI 87% to 99%), 86% (95% CI 71% to 95%), 92% (95% CI 83% to 97%), 91% (95% CI 76% to 98%), 6.86 (95% CI 3.04 to 15.51) and 0.05 (95% CI 0.02 to 0.17), respectively. The pain scores during US and radiographic imaging were 3.3 and 4.6, respectively (p<0.01).ConclusionsIn this study, we showed that US is an accurate method for diagnosing distal forearm fractures in children. The main advantages are that it is radiation-free and rapidly practicable, and that patients experience it as less painful than radiography. Moreover, this study has proven that with minimal experience in US, good diagnostic accuracy can be achieved after brief training.

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