ANTHROPOMETRIC ANATOMIZATION OF DISTAL RADIUS USING DIGITAL XRAYS IN SOUTH INDIAN POPULATION

Background: Population specic understanding of distal radius athropometry is indeed an essential factor for managing fractures of distal radius which is most commonly encountered. The primary goal of treatment of distal radius fracture is to obtain an well functioning wrist joint with restored normal anatomy, for which reduction criteria based on western population is being used till now . Hence in this study we analyse the anthropometry of distal end of radius using digital xrays in south Indian population. Hundred pat Materials and Methods: ients with a normal wrist joint attending the Department of Orthopaedics and Traumatology unit of Government Medical College and ESI Hospital, Coimbatore were included in this study. Plain Radiographs were taken to measure the Radial Inclination, Palmer Tilt, Radial Height and Ulnar Variance and the values were compared with data reported in the literature. The mean value of Radial Inclination(22.54 Results: °±2.18°), Palmer Tilt(12.01°±1.88°), Radial Height(11.30mm±0.30mm), and Ulnar Variance(0.44mm±1.03mm) in our study population differed on comparing with data reported in the literature for Western and other Indian population. This study concludes Conclusion: that signicant differences exist between the values observed in our study population and the values reported in the literature for western population and other Indian population, which can be used as a reference criteria in managing the fracture distal radius among south Indian population.

Comparison of extra-articular radiographic parameters of distal radius fractures on plain radiographs and CT scans

The aim of this study was to compare extra-articular radiographic parameters of distal radial fractures measured on plain radiographs and CT scans. Two researchers independently measured four extra-articular radiographic parameters (dorsal tilt, carpal alignment, radial inclination and ulnar variance) on both radiographs and CT scans in 85 patients. Inter-observer reliability for both techniques was assessed, along with the agreement between CT scans and radiographs using the intraclass correlation coefficient and Bland–Altman plots. The results showed that dorsal tilt, carpal alignment, radial inclination and ulnar variance can be measured reliably on both radiographs and CT scans. At a patient level, carpal alignment, radial inclination and ulnar variance CT scan measurements are an acceptable alternative to plain radiograph measurements in the vast majority of patients. In contrast, dorsal tilt CT scan measurements are not comparable with radiographs in 40% of the cases. Therefore, caution should be taken in measuring dorsal tilt on CT scans.

The Usefulness of Radial Column Plate in Distal Radius Fracture: Indications and Results

Purpose: The most common surgical treatment for distal radius fracture is internal fixation using volar locking plates, but it is sometimes difficult to maintain reduction with them. Therefore, this research reports the results of surgical treatment with additional radial column plates.Methods: We analyzed 12-month follow-up results in 100 cases. The patients had the B or C types of distal radius fractures, in accordance with AO classification, and underwent surgical treatment at our hospital from May 2013 to December 2019. There were 16 cases of B-type and 84 cases of C-type fractures. Out of these, 87 were treated with volar locking plates (V group) and 13 had additional radial column plates (VR group). The results of surgical treatment were examined clinically by measuring the disabilities of the arm, shoulder and hand (DASH) and Mayo wrist score, and radiologically by measuring the radial length, radial inclination, and volar tilt, before and after surgery.Results: After treatment, the radiographic average in the V group showed a radial length of 12.3 mm, radial inclination of 20.2°, and volar tilt of 5.8°, while the VR group showed 11.6 mm, 22.3°, and 9.0° respectively. A statistically significant difference was found in the DASH score, and the DASH score showed good results in the VR group.Conclusion: Additional radial column plate fixation is worth considering because it provides clinically and radiologically satisfactory results in treatment of B and C types distal radius fracture involving articular surface.

Single-stage Distal Radius Dome Osteotomy with Ulnar Diaphyseal Shortening and Distal Ulnar Epiphysiodesis in A Case of Manus Valgus Deformity Secondary to Post-Traumatic Physeal Growth Arrest – A Case Report

Introduction: Distal radius physeal growth arrest in children secondary to trauma is a rare complication. Various modalities of surgical treatment exist. Correction of severe deformity by a single-stage surgery is rare in current literature. We describe a case of surgically treated post-traumatic manus valgus deformity in an adolescent female with a satisfactory surgical outcome. Case Report: A 13-year-old right-hand dominant girl presented to us with a painless, gradually progressive left wrist deformity for the past 3 years. She sustained a left wrist injury 3.5 years back for which she received native treatment. She was able to do most of her daily activities and cosmetic disability was her primary concern. She had a 20° fixed radial deviation deformity with further radial deviation up to 60°. Forearm rotation was from 70° supination to 60° pronation. Her pre-operative Mayo Modified Wrist Score was 25/10/10/25/70 (Pain/Satisfaction/Range of motion/Grip strength/Total). Radiologically, there was the obliteration of lateral distal radial physis with overgrowth of medial physis. Distal ulnar physeal overgrowth led to positive ulnar variance. Radiologically, the magnitude of deformity was 43° manus valgus (+24° radial inclination). We performed dome osteotomy at distal radius metaphysis with distal radius plating through modified Henry approach. Simultaneous ulnar diaphyseal shortening osteotomy with plate fixation was done through a dorsal approach and distal ulnar epiphysiodesis was done by physeal drilling to prevent future overgrowth. At 13 months follow-up, the wrist has clinically no deformity and radiologically 5° manus valgus (+24° radial inclination). Both the osteotomy sites have united and ulnar variance is restored. Now, her ulnar deviation was 20° and radial deviation was 30°. Her forearm rotational arc was maintained. Mayo Modified Wrist Score was 25/25/10/25/85 (Pain/Satisfaction/Range of motion/Grip strength/Total) with no hindrance of daily activity.

A modified intrafocal pinning technique with three‐dimensional planning to facilitate volar plating in dorsally comminuted AO/OTA C2 and C3 distal radius fractures

Backgrounds Theaim of this study was to assess the efficacy of a modified intrafocal pinningtechnique with three-dimensional (3D) planning to facilitate volar plating in dorsally comminuted intra-articular distal radius fractures. Methods Intotal 35 AO/OTA type C2 and C3 fractures were finally included.The 3D digital model of the fracture was reconstructed based on preoperative computedtomographic (CT) images, with the displacement of the comminuted dorsalfragment and the intra-articular fragment analyzed for preoperative planning. During operation, amodified intrafocal pinning technique was applied percutaneously from thedorsal aspect of the radius to reduce the collapsed intra-articular fragmentfollowing volar plating. Adequate reduction was confirmed in all of patientsconsidering radial height, radial inclination and volar tilt in postoperativeradiographs. Results No significant fracture re-displacement wasobserved in most of the cases during a mean follow-up period of 17.4 months, exceptfor two patients withthe C3 fracture. All of the patients achieved adequate clinicalROMs at 12 months postoperatively, with a mean DASH score of 12.0. Most of the patients achievedan excellent (n = 21) or good (n = 12) Gartland and Werley wrist score. Conclusions Ourmodified intrafocal pinning technique with 3D planning contributes to a satisfactoryclinical and radiological outcome in dorsally comminuted intra-articular distalradius fractures fixed with a volar locking plate. Trialregistration Notapplicable because the design of the study is retrospective.

The effect of forearm rotation on radiographic measurements of the wrist: an experimental study using radiostereometric analyses on cadavers

Background Although dorsal/palmar tilt, radial inclination (RI), and ulnar variance (UV) are measurements commonly performed in wrist radiographs, the impact of forearm rotation on those measurements during the radiographic procedure is uncertain. Our aim was to determine the impact of supination and pronation on the reliability of measurements of tilt, RI, and UV. Methods Tantalum markers were inserted into the distal radius of 21 unfractured cadaver forearms. The forearms were radiographed in different degrees of supination and pronation. The exact degree of rotation was calculated with radiostereometric analyses. Tilt, RI, and UV were measured by two independent readers in a random and anonymised fashion. Association between forearm rotation and radiographic measurements was examined using linear regression. Results Forearm rotation significantly impacted the radiographically measured tilt. One degree of supination and pronation respectively increased and decreased palmar tilt with 0.68° and 0.44°, observers 1 and 2, respectively. As opposed to observer 1, observer 2 found that RI was significantly impacted by rotation with a slope of 0.08. Ulnar variance was not significantly impacted by rotation with linear regression slopes of 0.01° (95% confidence interval [CI] − 0.02–0.05, p = 0.490) and 0.02° (95% CI − 0.02–0.07; p = 0.288), observer 1 and observer 2, respectively. Conclusion In unfractured forearms, the radiographically measured tilt was significantly affected by rotation. Palmar tilt increased with supination and decreased with pronation. Rotation significantly affected radial inclination, although of a magnitude that is probably not clinically relevant. No significant impact on UV was found.

Functional and radiological outcome after forearm plating in children and adolescent fracture

The literature on forearm overgrowth after plating in traumatic conditions is relatively poor though this technique can be useful when intra-medullary nailing is not sufficient in pediatric cases. The goal of this study was to assess a potential overgrowth after plating and identify impact on function. We conducted a retrospective study of all pediatric patients who underwent open surgery of the radius and/or ulna diaphysis with internal fixation by plating, in our institution, between October 2013 and July 2019. At last follow-up, functional and radiological outcomes were compared between the operated and uninjured forearm. Range of motion (ROM) of the wrist and elbow, clinical scores, radial and ulnar length were measured. A positive bone length discrepancy of more than 2mm was considered as an overgrowth. Were also studied the radio-ulnar index, radial inclination and radiocarpal angle. Thirteen patients were included. The mean age was 12.1 years old (±3.0 years), they were plated on the radius (10 cases) or on the ulna (3 cases). Mean follow- up was 4.4 years (± 1.8). In two cases, the plated bone (radius) was significantly longer than the uninjured one. There was no significant difference regarding radio-ulnar index, radial inclination and radiocarpal angle. The only statistically significant difference between the operated and uninjured forearm was the pronation/supination range, which was greater in the uninjured forearm (mean 160 ±48° versus 175 ±49°, p=0.01). This study confirms the good functional and radiological outcomes after plating even in a skeletally immature forearm. Level of evidence : IV.

Three-dimensional evaluations of preoperative planning reproducibility for the osteosynthesis of distal radius fractures

Background Three-dimensional preoperative planning was applied for the osteosynthesis of distal radius fractures. The objective of this study was to evaluate the reproducibility of three-dimensional preoperative planning for the osteosynthesis of distal radius fractures with three-dimensional reference points. Methods Sixty-three wrists of 63 distal radius fracture patients who underwent osteosynthesis with three-dimensional preoperative planning were evaluated. After taking preoperative CT scans of the injured wrists, 3D images of the distal radius were created. Fracture reduction, implants choices, and placements simulation were performed based on the 3D images. One month after the surgery, postoperative CT images were taken. The reproducibility was evaluated with preoperative plan and postoperative 3D images. The images were compared with the three-dimensional coordinates of radial styloid process, volar and dorsal edges of sigmoid notch, and the barycentric coordinates of the three reference points. The reproducibility of the preoperative plan was evaluated by the distance of the coordinates between the plan and postoperative images for the reference points. The reproducibility of radial inclination and volar tilt on three-dimensional images were evaluated by intra-class correlation coefficient (ICC). Results The distances between the preoperative plan and the postoperative reduction for each reference point were (1) 2.1±1.3 mm, (2) 1.9±1.2 mm, and (3) 1.9±1.2 mm, respectively. The distance between the preoperative plan and postoperative reduction for the barycentric coordinate was 1.3±0.8 mm. ICCs were 0.54 and 0.54 for the volar tilt and radial inclination, respectively (P<0.01). Conclusions Three-dimensional preoperative planning for the osteosynthesis of distal radius fracture was reproducible with an error of about 2 mm for each reference point and the correlations of reduction shapes were moderate. The analysis method and reference points may be helpful to understand the accuracy of reductions for the three-dimensional preoperative planning in the osteosynthesis of distal radius fractures. Trial registration Registered as NCT02909647 at ClinicalTrials.gov

Morphometric Study of Distal End of Human Dry Radii

Introduction: Radius is the lateral bone of forearm. Important parameters of its distal end include angle of radial inclination, palmar tilt, and length of radial styloid process. Morphometry of the distal end of radius is important in various clinical orthopaedic procedures such as reduction of distal radius fractures, design of distal radius prosthesis, and kinematics of the wrist joint. The aim of this study is to determine the angle of radial inclination, palmar tilt, length of styloid process, oblique width, transverse and anteroposterior diameter of distal end of human dry radii in Nepalese population. Methods: This is a descriptive cross-sectional study conducted in the dissection hall of Department of Human Anatomy, Nepalese Army Institute of Health Sciences, Sanobhyrang, Kathmandu, Nepal from October 2019 to November 2019 after obtaining ethical approval. Total 76 human dry radii were included in the study by convenience sampling method. Angle of radial inclination, palmar tilt, length of styloid process, oblique width, transverse and anteroposterior diameter of distal end of human dry radii were studied. Data was collected and analysed by SPSS version 24. Results: Mean length of styloid process was 1.09 cm. Mean anteroposterior and transverse diameter of distal end of radius was 1.88 cm and 2.85 cm respectively. Mean oblique width of distal radius was 2.82 cm. The mean palmar tilt and angle of inclination of radius were 9.72 and 23.62 degree respectively. Conclusions: This study provides the reference data for the anatomical alignment while treating the injuries of the distal end of radius in Nepalese population.

Distal Radius Measurements in Indian Population-An comprehensive Morphometrical Analysis

The four basic morphometrical parameters regarding the anatomy of the distal end of radius bone are radial inclination, palmar tilt/volar tilt, radial height (length) and ulnar variance. The management of various conditions such as fracture of the distal radius bone, designing of the distal radius plates and kinesiology utilize the parameters in the morphometrical measurement of the distal end radius. The goal of our study is to bring about the normalized values of the morphometrical parameters of the DER among the general Indian population for helping in designing the distal radius plates. The study was conducted in a tertiary care hospital in India. It was a single hospital based study. The views considered for the study were the true posteroanterior (PA) and the lateral view (with neutral rotation). The posteroanterior view was used for the measurement of radial inclination, radial length (height) and the ulnar variance. The lateral view helped in the accomplishment of the measurement of the palmar/volar tilt. The statistical analysis was done by Microsoft Excel 2007 (Data add in function was installed for the analysis of the collected data). The means of the morphometrical parameters was compared with the help of T-test. Two hundred (n=200) radiographs were included for analysis under this study. The mean value of radial inclination was 20.7 8 ° ± (SD) 3.45° [Range: 14.9-29.1°], palmar/volar tilt 10.99° ± (SD) 3.87° [Range: 1.8-18.6°], radial length/height 11.39 mm ± (SD) 1.97 mm [Range: 8.3-27.7 mm], and ulnar variance 0.90 mm ± (SD) 3.14 mm [Range: +0.70 to +3.70]. This study will lead for further researches in the analysis of the morphometrical parameters of the distal end of radius bone in the Indian population. For the clinical management of the injuries around the wrist joint the results of this study can be used as a reference standard to anatomically align the bones and the affected structures.