scholarly journals Management of intra-articular fractures of distal end radius in adults

2016 ◽  
Vol 2 (4) ◽  
pp. 220
Author(s):  
Satish R. Gawali ◽  
Hardikar S. M. ◽  
S. Prakash ◽  
Sunil Nadkarni
Keyword(s):  
Treatment Plan ◽  
Plaster Cast ◽  
Fracture Pattern ◽  
Distal Radial Fractures ◽  
Fracture Geometry ◽  
Articular Fracture ◽  
Articular Fractures ◽  
Orthopaedic Community ◽  
Almost All ◽  
End Results

<p class="abstract"><strong>Background:</strong> Incidence of intra articular fracture L/3rd radius is significantly on rise due to high velocity accidents in young and adults. Painless wrist function is of vital importance for functioning of upper extremity in almost all activities of daily living and precise function of hand. Intra articular fracture of L/3rd radius has generally gross comminution and so also small articular fragments. Orthopaedic community differ about specific implants to fix this complex injury. The present study was undertaken to know efficacy of different modalities of treatment for different fracture pattern. Comminuted intra articular fracture geometry varies widely, to fix these small fragments to achieve stable anatomical reduction is a challenging task.   </p><p class="abstract"><strong>Methods:</strong> It is a combined i.e. retrospective and prospective study conducted at Hardikar Hospital, Pune, India from 1999 to December 2000. Patients of intra-articular fracture of distal end radius by different modes of treatment are included in the study. 1 patient with unilateral fracture was lost for follow-up. Thus 50 fractures, in 49 patients. were included in study. Clinico-radiological assessment was carried out by Lidstrom's (1959) criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> Satisfactory early functional end results with plaster treatment is 72.2% whereas with other modality of treatment it rises to 87.5%, indicating superiority of other modalities of treatment as far as early functional end results are concerned.</p><strong>Conclusions:</strong> Manipulation and plaster cast method continues to be the treatment of choice in the stable intra articular distal radial fractures. Hence there is a need for a "differentiated therapy for distal radial fractures". The treatment plan for patients must be based not only on fracture pattern identified on plain radiographs but also on factors such as bone quality, bone comminution, energy of injury and associated soft tissue damage. Additional factors to be considered in individual patient are-life style associated medical conditions and compliance.

scholarly journals An analysis of functional outcome following conservative versus surgical management in fractures of the distal radius

2017 ◽  
Vol 4 (1) ◽  
pp. 99
Author(s):  
Yeshwanth Subash ◽  
Ravikrishna R. ◽  
Jagadeesh B.
Keyword(s):  
Surgical Management ◽  
Distal Radius ◽  
Treatment Method ◽  
Fracture Pattern ◽  
Distal Radial Fractures ◽  
Orthopaedic Department ◽  
Conservative Group ◽  
Advantages And Disadvantages ◽  
Articular Fractures ◽  
Type 3

<p class="abstract"><strong>Background:</strong> <span lang="EN-GB">Distal radial fractures are one of the most common injuries seen in the orthopaedic department, which can be managed both conservatively and surgically. There are advantages and disadvantages in each method of management. The aim of this study was to compare the functional and radiological outcomes of intra-articular fractures of the distal end of the radius with conservative and surgical management</span><span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-GB">80 cases of intra articular fractures of the distal radius managed by both conservative and surgical means were studied between January 2011 to January 2013 and were followed up for a minimum period of two years</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-GB">In our series of 80 patients, there 53 males and 27 females. Most of the patients were between 20-30 years of age with the mean age being 40.35 years. RTA was the most common mode of injury (45%). Frykman’s type 3 (41.7%) was the most common fracture type seen followed by type 8. All fractures united by the end of 6 months. Excellent results were seen in 47.5% of cases in the surgical group and 30% of cases in the conservative group</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-GB">From this study, we conclude that surgical management is better than conservative in the treatment of intra articular fractures of the distal end of radius. Therefore, one treatment method of treatment cannot be generalized for all types of fractures and treatment should be individualized to a particular fracture in terms of age, fracture pattern, degree of displacement and amount of communition present</span><span lang="EN-IN">.</span></p><p class="abstract"> </p>

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

Minimally Displaced Colles’ Fractures: A Prospective Randomized Trial of Treatment With a Wrist Splint or a Plaster Cast

2003 ◽  
Vol 28 (1) ◽  
pp. 50-53 ◽  
Author(s):  
D. O’CONNOR ◽  
H. MULLETT ◽  
M. DOYLE ◽  
A. MOFIDI ◽  
S. KUTTY ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Outcome Assessment ◽  
Functional Assessment ◽  
Plaster Cast ◽  
Adult Patients ◽  
Prospective Randomized Trial ◽  
Radiological Evaluation ◽  
Distal Radial Fractures ◽  
Assessment Score ◽  
Wrist Splint

Sixty-six adult patients with minimally displaced distal radial fractures were randomly assigned to treatment with either a plaster cast or a lightweight removable wrist splint. Outcome assessment was by clinical and radiological evaluation and an independent physiotherapy assessment. There were significant differences between the treatments for cast satisfaction, cast problems and the functional assessment score at 6 weeks, with the removable splint scoring better in all cases.

scholarly journals Closed Reduction and Percutaneous Kirschner Wire Fixation Combined with Plaster Cast versus Conventional Plaster Cast immobilization in the Treatment of Colles' Fracture – A Prospective Randomized Comparative Study

1970 ◽  
Vol 17 (2) ◽  
pp. 98-105 ◽  
Author(s):  
KS Uzzaman ◽  
KA Awal ◽  
MK Alam
Keyword(s):  
Comparative Study ◽  
Closed Reduction ◽  
Kirschner Wire ◽  
Plaster Cast ◽  
Cast Immobilization ◽  
Fixation Group ◽  
Wire Fixation ◽  
Colles Fracture ◽  
End Results

Purpo'e: To evaluate functional & anatomical results of the Colles’ fracture treated by two methods- i) Closed reduction & precutaneous kirschner wire (K- wire) fixation combined with plaster cast & ii) Conventional plaster cast immobilization after closed reduction.Methods: A randomized prospective comparative study was done from July 2003 to June 2005 on 52 patient with Colles' fracture in NITOR, Dhaka. 12 patients lost from follow up. Twenty patient (20) in each group were finally available for evaluation. The group treated by closed reduction & percutaneous K-wire fixation combined with plaster cast- designated as "Arm A" & another group treated conventionally by plaster cast only designated by "Arm-B". Male Female ratio was 1:3, Age range was 35 to 70 years (Mean age 52.5 years) Distribution of limbs side involvement almost equal. Mode of injuries were domestic fall & RTA (4:1) According to AO classification fracture were in both groups- A2 = 13, A3 = 10, C1 = 6, C2 = 8 & C3 = 3 (Total- 40). Follow up period was 6-14 months (mean = 6 month)Results: Union time for most of the fractures was 6-8 weeks. At final follow up Satisfactory Anatomical end results of percutuneous fixation group (Arm-A) were 80% and in conventional plaster cast group (Arm-B) were 35%. (P<0.01). Satisfactory functional end results in Arm-A group were 70% and in Arm-B group were 30% (P<0.01) Complications seen much more in conventional group (Arm-B) than percutaneous K-wire fixation group (Arm-B). Sarmiento & Latta’s criteria was used to evaluate the progress.Conclusion: The coventional plaster cast method for treatment of colles’ fracture usually can't maintain radial length & angulation in many instances and results significant anatomical difficultly and functional disability. On the other hand after close reduction additional fixation in the form of percutaneous crossed K-wire can maintain the reduction till bony union & prevent late collapse at fracture site & provides better result. Key Words: Colles' fracture; closed reduction; Plaster cast & Kirschner wire (K-wire) fixationDOI: 10.3329/jdmc.v17i2.6591J Dhaka Med Coll. 2008; 17(2) : 98-105

scholarly journals Clinical efficacy of treating the first metacarpal base fracture by closed reduction and percutaneous parallel  K-wire  interlocking fixation

2021 ◽  
Author(s):  
Wu Wang ◽  
Min Zeng ◽  
Junxiao Yang ◽  
Long Wang ◽  
Jie Xie ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Closed Reduction ◽  
Fracture Group ◽  
Articular Fracture ◽  
Articular Fractures ◽  
Injured Side ◽  
Uninjured Side ◽  
Flexion Extension ◽  
The Mean

Abstract Objective: To explore the clinical efficacy of treating a first metacarpal base fracture by closed reduction and percutaneous parallel K-wire interlocking fixation between the first and second metacarpals.Methods: Twenty patients treated by the above technique from October 2015 to December 2018 at our institution were retrospectively reviewed. The patients’ average age was 36 years (range, 16–61 years). Eleven patients were extra-articular fractures and nine were intra-articular fractures. The mean follow-up period was 12 months (range, 10–18 months). At the final follow-up, the functional recovery of the injured hand was assessed and compared with that of the uninjured hand.Results: All patients recovered well with no complications. In the extra-articular fracture group, the mean hand grip strength, pinch strength, and Kapandji score were 43.4 ± 7.0 kg, 9.1 ± 1.4 kg, and 9.5 ± 0.7 on the injured side and 41.7 ±6.8 kg, 8.7 ± 0.8 kg, and 9.7 ± 0.5 on the uninjured side, respectively, with no significant differences. In the intra-articular fracture group, the above indexes were 43.0 ± 6.5 kg, 9.0 ± 1.1 kg, and 9.3 ± 0.7 on the injured side and 42.1 ± 6.6 kg, 8.6 ± 1.1 kg, and 9.7 ± 0.5 on the uninjured side, respectively, also with no significant differences. The abduction and flexion-extension arc of the thumb on the injured hand were lower than those on the uninjured hand in both the extra-articular and intra-articular fracture groups, but the patients felt clinically well with respect to daily activities and strength.Conclusion: The percutaneous parallel K-wire and the interlocking fixation technique is simple, effective, and economic for first metacarpal base fractures.

Extra-articular Medial Impression Fracture of the Talus: A Previously Undescribed Injury

2018 ◽  
Vol 11 (6) ◽  
pp. 553-558
Author(s):  
Olivier Wijers ◽  
Rosa C. Looijen ◽  
Jens A. Halm ◽  
Tim Schepers
Keyword(s):  
Correct Diagnosis ◽  
Case Series ◽  
Patient Characteristics ◽  
Trauma Mechanism ◽  
Retrospective Case ◽  
Articular Fractures ◽  
First Case ◽  
Impression Fracture ◽  
Talar Fractures ◽  
Almost All

Background: Peripheral fractures of the talus are uncommon. Almost all the literature regarding talar fractures consists of central intra-articular fractures, whereas studies about peripheral talar fractures are lacking. The aim of this study is to increase awareness in diagnosing an unusual peripheral extra-articular medial impression fracture of the talus. Methods: This study includes a retrospective case series of patients with an extra-articular medial impression fracture of the talus. Patient characteristics, trauma mechanism, diagnostics, fracture characteristics, and treatment were reported. Results: Eight consecutive patients with an extra-articular medial impression fracture of the talus were identified. In 80%, the trauma mechanism was a supination or inversion injury of the ankle and foot. An X-ray was obtained in all patients; in 7 (88%) patients, a computed tomography scan was done, and an additional magnetic resonance imaging was done in 3 (38%) patients. In 4 patients (50%), the correct diagnosis was missed at first presentation. The delay between injury and diagnosis was 0 to 180 days (of 36 days on average). Conclusion: This is the first case series to describe patients with a peripheral extra-articular medial impression fracture of the talus. Good clinical examination and judicious use of diagnostic imaging are a necessity to find the talar impression fractures in a timely manner, and treatment can be started immediately. Levels of Evidence: Level V

scholarly journals Patient-related QA for helical TomoTherapy with Delta4: analysis of the results

2017 ◽  
Vol 3 (2) ◽  
pp. 635-638 ◽  
Author(s):  
Henning Salz ◽  
Simon Howitz ◽  
Tim Brachwitz ◽  
Tilo Wiezorek
Keyword(s):  
Standard Deviation ◽  
Helical Tomotherapy ◽  
Treatment Plan ◽  
Measurement Procedure ◽  
Separate Analysis ◽  
Gamma Analysis ◽  
Treatment Plans ◽  
Cross Calibration ◽  
Almost All ◽  
Chamber Measurements

AbstractThe biplanar diode arrays Delta4PT and Delta4+ has been used in our hospital since the introduction of the TomoTherapy in 2013 to ensure a good agreement between the calculated and the measured dose distributions in patient-related QA with helical TomoTherapy. The aim of this presentation is to evaluate the quality of the measurement procedure with the Delta4 phantoms Delta4PT and (since January 2016) Delta4+. This includes the influence of a cross calibration with a treatment plan with low modulation.Two analyses were performed: (i) All treatment plans in a period of three months (n=86) were not only calculated and measured with Delta4PT or Delta4+ but also with an ionization chamber (Exradin A1SL) in the homogeneous “cheese phantom”. (ii) All data measured from January 2016 to April 2017 (Delta4+, n=132) were analyzed regarding median dose deviation, Gamma analysis and others.The comparison with chamber measurements shows that all measurements with Delta4 and almost all with the ionization chambers (79 of 86) yield a deviation of measured vs. planned dose in the PTV of less than 2.5%, but with a lower variation of the Delta4 measurements. However, a strong correlation between both was not observed.The separate analysis of the measurements with the newer Delta4+ (since January 2016) shows a mean dose deviation in the PTVs of only 0.14% with a standard deviation (S.D.) of 0.69%. Before every measurement a cross calibration has been performed. Without this cross calibration, the deviation would be 0.96% with an increased standard deviation of 0.93%.It is concluded that the Delta4 systems are well suited for patient-related QA for helical TomoTherapy treatment plans. The comparison with chamber measurements shows a plausible accordance between both systems whereas the variation of single measurements is quite different.With the help of a daily cross calibration the variability of the Delta4 results is further decreased and the results show higher accuracy and reliability. According to our experience, a daily cross calibration is mandatory for a reliable patient-related QA.

scholarly journals Dentigerous cyst in the maxilla: case report in a pediatric patient

2021 ◽  
Vol 10 (16) ◽  
pp. e143101623293
Author(s):  
Bianca de Fatima Borim Pulino ◽  
Raphael Capelli Guerra ◽  
Gabriel Cunha Collini ◽  
Marcello Cheloti ◽  
Eduardo Hochuli Vieira
Keyword(s):  
Pediatric Patient ◽  
Alveolar Bone ◽  
Treatment Plan ◽  
Dentigerous Cyst ◽  
Odontogenic Cysts ◽  
Long Period ◽  
Unerupted Tooth ◽  
Dentigerous Cysts ◽  
Male Patients ◽  
Almost All

Dentigerous cysts are the second most common odontogenic cysts of the jaws, and sometimes inhibit the eruption of teeth. Almost all of the dentigerous cyst encloses the crown of an unerupted tooth and the radiolucent area is attached to the tooth at the cementoenamel junction. Dentigerous cyst is more common in male patients and most commonly develop in the second and third decades of life. Clinically, a localized swelling of the alveolar bone can be detected, however, dentigerous cysts can be asymptomatic during a long period of time, leading to a significant destruction of bone. The conventional treatment plan is cyst removal and marsupialization. Marsupialization therapy can be useful to promote the spontaneous eruption of the involved tooth within the cyst. However, tooth eruption does not always occur spontaneously after marsupialization. This article aims to report a clinical case of the diagnosis and treatment of a dentigerous cyst in the maxilla associated with an unerupted canine in a pediatric patient and discussion of the treatment performed.

scholarly journals Management of intra-articular fracture of distal femur with LCP and Lag screws in adults

2017 ◽  
Vol 5 (4) ◽  
pp. 1434 ◽  
Author(s):  
Manjit S. Daroch ◽  
Deepak Vashisht ◽  
Sanjeev Sreen
Keyword(s):  
Elderly Patients ◽  
Range Of Motion ◽  
Distal Femur ◽  
Articular Surface ◽  
Poor Quality ◽  
Osteoporotic Bone ◽  
Bony Union ◽  
Articular Fracture ◽  
Articular Fractures ◽  
Stable Osteosynthesis

Background: Accurate reconstruction of articular surface of distal femur by closed manipulation is not possible. The recent trend for displaced intra-articular fractures of the distal femur is open reduction and stable osteosynthesis with early rehabilitation. The best exposure is achieved through Swashbuckler approach with good results. Purpose of the study was to review the surgical management with LCP and lag screws of complex and most challenging intra-articular fracture of distal femur.Methods: 30 cases of intra-articular fractures of distal femur were treated with LCP and Lag screws in adults. Regular follow-up with all records was carried out for a period of 36 months. Most of patients were treated with Swashbuckler approach. Final outcome was carried based on Neer’s criteria.Results: Union was achieved in all the cases and mean time was 15 weeks. Patients have more range of motion in C1 and C2 types of fracture as compare to C3 Types. Mean range of motion was 1140. Early physiotherapy has big role to achieve good range of motion.Conclusions: LCP is better implant in comminuted I/A fractures of distal end of femur and in elderly patients with osteoporotic bone. In spite of the worst fracture anatomy of the comminuted fracture of distal femur and the poor quality of bone in elderly patients, this can provide better post-operative range of knee motion with overall better Knee score, achieving bony union in all the cases with early physiotherapy.

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