scholarly journals Factors associated with Distal Radio-Ulnar Joint (DRUJ) instability in patients with Distal Radius Fractures

2018 ◽  
Vol 9 (5) ◽  
pp. 62-66
Author(s):  
Niraj Ranjeet ◽  
Krishna Sapkota ◽  
Pratyenta Raj Onta ◽  
Pabin Thapa ◽  
Krishna Wahegoankar ◽  
...  
Keyword(s):  
Distal Radius ◽  
Young Male ◽  
High Energy ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Ulnar Styloid ◽  
High Energy Trauma ◽  
Factors Associated ◽  
Sigmoid Notch ◽  
Druj Instability

Background: Distal Radius Fractures (DRF) are common fractures with variety of complications if treated inadequately. Among them, Distal Radio-Ulnar Joint (DRUJ) instability is one of the common residual disabilities leading to chronic and persistent subluxation or dislocation of the DRUJ which causes arthritis, pain and limitation of the hand functions. Aims and Objectives: This study aims to identify the factors either clinical of radiographic, indicative of DRUJ instability patients in acute DRF which may help the orthopedic surgeons to correctly diagnose and allow proper treatment.Materials and Methods: All patients from Aug 1, 2016-July 31, 2017 with acute DRF who were treated at Manipal Teaching Hospital were examined and evaluated for DRUJ instability. The demographic, clinical and radiological parameters of all the patients were analyzed and compared with those with stable DRUJ. Preoperatively all the fractures were classified using AO classification. Based on the classification, the association of fracture comminution, and intra-articular involvement with DRUJ instability, as well as its relation to the osteoporotic age was analyzed. Associated ulna styloid fracture and sigmoid notch involvement if present was noted with its size and displacement.Results: Out of 74 wrists, there were 30 males and 44 females, with a mean age of 44 (range 18-79). Most of the females (72%, n=32/44) sustained low energy trauma, while most of the males (77%, n=23/30) sustained high energy trauma. Irrespective of the sex, it was noted that DRUJ instability was significantly higher in males (p<0.0001) and in the non-osteoporotic age group (p=0.05). In our study 72.72% of DRF was associated with unstable DRUJ in patients with high energy trauma. AO types A3/B3/C3 (81.25%, n=26/32) was associated with more DRUJ instability compared to less comminuted fractures as AO type A2/B2/C2 (56%, n=14/25) or A1/B1/C1 (29.41%, n=5/17) (p<0.001). AO type C (43.24%, n=32) were associated with more DRUJ instability as compared to AO type B (25.67%, n=19) or AO type A (31.08%, n=23) (p=0.009). Ulnar styloid fractures was noted in 37.83% (28/74) of DRF and 35 (47.29%) patients had involvement of the sigmoid notch out of which 7 (20%) was displaced > 2mm and 28 (80%) was undisplaced.Conclusion: Factors associated with DRUJ instability in DRF were young male patients, high energy trauma, displaced ulnar styloid base fractures, sigmoid notch involvement, AO type C.Asian Journal of Medical Sciences Vol.9(5) 2018 62-66

Distal radius fracture with ipsilateral elbow dislocation: a rare but challenging injury

2021 ◽  
Author(s):  
Henrik Constantin Bäcker ◽  
Kathi Thiele ◽  
Chia H. Wu ◽  
Philipp Moroder ◽  
Ulrich Stoeckle ◽  
...  
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Elbow Dislocation ◽  
High Energy ◽  
Low Energy ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Associated Injuries ◽  
Radius Fractures ◽  
High Energy Trauma

Abstract IntroductionDistal radius fractures are common and account for approximately 14% to 18% of all adult extremity injuries. On rare occasions, ipsilateral elbow dislocation can be observed additionally. The aim of this study was to analyse the mechanism and level of injury, demographics, and associated injuries in distal radius fractures with ipsilateral elbow dislocations.Methods:Between 2012 and 2019, we searched our trauma database for distal radius fractures with ipsilateral elbow dislocations. All patients older than 18 years old were included. Data on demographics, mechanism of injury, level of energy, and subsequent treatments were collected. ResultsA total of 7 patients were identified. The mean age was 68.7 ± 13.3 years old and the left side was involved in 71.4% of cases. Females were affected in 85.7% (n=6/7) of cases. All suffered from low-energy mechanism without other orthopaedic injuries at a mean age of 71.5 ± 12.3 years old. The one male patient that was included suffered from high-energy trauma at 52 years of age. Most commonly, posterior elbow dislocations were observed (66.7%; n=4/6). Distal radius fracture patterns include two C2, two C3, and one case each of C1-type and B1-type fracture pattern in the low energy group. In the group of patients who sustained high energy trauma, associated injuries include a concomitant open elbow dislocation, an ulnar artery rupture and damage to the flexor digitorum superficialis muscle.ConclusionAlthough distal radius fracture with ipsilateral elbow dislocation is thought to be resulting from high energy injuries, this study shows that most patients were elderly females suffering from low energy mechanisms. If not suspected, this could be missed especially in the setting of altered mental status. Careful physical examination of one joint proximal and one joint distal to the presumed site of injury is recommended.

Strategies for Specific Reduction in High-Energy Distal Radius Fractures

Hand Clinics ◽  
2021 ◽  
Vol 37 (2) ◽  
pp. 267-278
Author(s):  
Nicholas Pulos ◽  
Alexander Y. Shin
Keyword(s):  
Distal Radius ◽  
High Energy ◽  
Distal Radius Fractures ◽  
Radius 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.

Wound Complications with Multiple Wrist Incisions in Distal Radius Reconstruction

2021 ◽  
Author(s):  
Joshua J. Meaike ◽  
Christian Athens ◽  
Nicole Sgromolo ◽  
Alexander Y. Shin ◽  
Peter C. Rhee
Keyword(s):  
Wound Healing ◽  
Soft Tissue ◽  
Surgical Management ◽  
Distal Radius ◽  
High Energy ◽  
Distal Radius Fractures ◽  
Wound Complications ◽  
Radius Fractures ◽  
Increased Risk ◽  
Delayed Healing

Abstract Background Placement and spacing of skin incisions are important for maintaining soft tissue perfusion and viability, particularly in the setting of local trauma. Question/Purpose The aim of this article is to determine if multiple skin incisions in the surgical management of distal radius fractures result in an increased risk of postoperative wound complications, particularly in the setting of high-energy mechanisms of injury with substantial initial displacement and associated soft-tissue insult that require multiple incisions for distal radius reconstruction. Patients and Methods A multicenter, retrospective chart review was performed for all adult patients who underwent open reduction, internal fixation of a closed distal radius fracture with multiple (≥2) hand, and wrist incisions with minimum follow-up of 6 weeks. Primary outcome measures included wound healing complications such as partial or complete skin necrosis, dehiscence, delayed healing, and superficial or deep infections. Results For 118 wrists, a total of 305 incisions were utilized, averaging 2.6 incisions per patient (range: 2–6) with the flexor carpi radialis and dorsal distal radius approaches occurring in 86 and 78% of cases, respectively. One patient was identified as having a pyogenic granuloma along an incision. However, two patients were identified as having wound concerns, including fracture blisters (n = 1) and wound margin epidermolysis (n = 1) along the incision. There were no cases of skin bridge necrosis, delayed healing, wound dehiscence, or infection. Conclusions There is no increased risk of wound healing complications with the use of multiple skin incisions (≥2) in the surgical management of distal radius fractures, afforded by the abundant and robust angiosomes around the wrist. Surgeons should have the confidence to utilize the necessary number of skin incisions to effectively reconstruct distal radius fractures.

scholarly journals Prevalence of triangular fibrocartilage complex injuries in patients with distal radius fractures: a 3.0T magnetic resonance imaging study

2019 ◽  
Vol 47 (8) ◽  
pp. 3648-3655
Author(s):  
Bingshan Yan ◽  
Zhaoning Xu ◽  
Yanchao Chen ◽  
Wangping Yin
Keyword(s):  
Distal Radius ◽  
Distal Radioulnar Joint ◽  
Distal Radius Fractures ◽  
Resonance Imaging ◽  
Radius Fractures ◽  
Ulnar Styloid ◽  
Radioulnar Joint ◽  
Ulnar Styloid Fracture ◽  
Triangular Fibrocartilage ◽  
3.0T Mri

Objective This study was performed to determine the prevalence of triangular fibrocartilage complex (TFCC) injuries as shown by 3.0T magnetic resonance imaging (MRI) in patients with distal radius fractures. Methods In total, 57 patients with distal radius fractures underwent 3.0T MRI examinations to observe the incidence of TFCC injuries after manual reduction and cast fixation. The fracture type was categorized by the AO classification, and the TFCC injury pattern was evaluated using the Palmer classification. The correlation between the location of the TFCC injury and the distal radius fracture pattern, distal radioulnar joint instability, or ulnar styloid fracture was analyzed. Results Fifty-five TFCC injuries were diagnosed. There was no significant relationship between the TFCC injury pattern and the type of distal radius fracture, distal radioulnar joint instability, or ulnar styloid fracture. Conclusions This study revealed a high prevalence of TFCC injuries in patients with distal radius fractures. The 3.0T MRI examination helps to assess TFCC injuries in patients with distal radius fractures. Clinical Trial Registration ChiCTR1800017101.

scholarly journals The Sigmoid Notch View for Distal Radius Fractures

2018 ◽  
Vol 43 (11) ◽  
pp. 1038.e1-1038.e5
Author(s):  
Robin N. Kamal ◽  
Fraser Leversedge ◽  
David S. Ruch ◽  
Suhail K. Mithani ◽  
Ilvy H.F. Cotterell ◽  
...  
Keyword(s):  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Sigmoid Notch

Management of Distal Ulnar Fracture Combined with Distal Radius Fracture

2016 ◽  
Vol 21 (02) ◽  
pp. 155-160 ◽  
Author(s):  
Jae Kwang Kim ◽  
Jong-Oh Kim ◽  
Yong-Do Koh
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Surgical Approaches ◽  
Radius Fractures ◽  
Ulnar Styloid ◽  
Cast Immobilization ◽  
Distal Ulna ◽  
Ulnar Styloid Fracture

The distal ulna is composed of the ulnar styloid, ulnar head, and distal ulnar metaphyseal area. Most of distal ulnar metaphyseal fractures are associated with distal radius fractures and this incidence tends to be greater in osteoporotic elderly. Consideration of the treatment of distal ulna metaphyseal fracture should be addressed after treating a distal radius fracture. If it is stable, cast immobilization is preferred, however, if it shows malalignment or instability, an operative method should be considered. More than half of distal radius fractures are combined with an ulnar styloid fracture, and considerable cases of ulnar styloid fractures result in nonunion. However, ulnar styloid nonunion usually does not cause any problems on the wrist. Recent studies of distal radius fractures treated using a volar locking plate have reported that neither the initial displacement nor the size of a concomitant ulnar styloid fracture affects clinical outcome, which suggests surgical approaches may usually not be indicated for ulnar styloid fractures.

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