Radial fractures

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Study protocol: non displaced distal radial fractures in adult patients: three weeks vs  five weeks of cast immobilization: a randomized trial

Study protocol: non displaced distal radial fractures in adult patients: three weeks vs five weeks of cast immobilization: a randomized trial

Background: Up to 30% of patients suffer from long-term functional restrictions following conservative treatment of distal radius fractures. Whether duration of cast immobilisation influences functional outcome remains unclear. Methods/Design: The aim of the study is to evaluate whether the duration of immobilization of non or minimally displaced distal radial fractures can be safely reduced. We will compare three weeks of plaster cast immobilization with five weeks of plaster cast immobilization in adult patient with non or minimally displaced distal radial fractures. Study design: a prospective randomized clinical trial.
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Biologic plating of unstable distal radial fractures

Biologic plating of unstable distal radial fractures

Despite the proven benefits of direct reduction and anatomic fixation for distal radial fracture, the authors have adopted the concept of extra-articular realignment during prospective enrollment, especially for indirect re- duction of metaphyseal fragments in accordance with MIPO technique. Compared with the concept of con- ventional anatomical reduction, extra-articular realign- ment is more focused on realignment of the injured limb by restoring the alignment index (length, rotation, and axis) rather than by anatomic reduction of the frac- ture fragments (Fig. 4). The reduction of distal radial fractures should focus on the restoration of radial length because most problems occurred in patients who achieved fair or poor restoration of radial length after conservative management [14]. Radial length was found to be automatically re-established upon restoration of anatomic continuity of the volar cortex through direct reduction [22]. Automatic restoration should not be ex- pected, however, if a volar cortex is comminuted at the metadiaphyseal area or the fracture surfaces could not be opened, such as in the PQ-sparing approach, and an additional procedure might be needed to achieve the ori- ginal length. A distractive technique using a spreader could be easily applied, similar to a femoral distractor Table 2 Complications related with bridge plating through pronator-sparing approach in distal radius fractures
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Efficacy of radial styloid targeting screws in volar plate fixation of intra-articular distal radial fractures: a biomechanical study in a cadaver fracture model

Efficacy of radial styloid targeting screws in volar plate fixation of intra-articular distal radial fractures: a biomechanical study in a cadaver fracture model

New developments in vloar plate and locking screw design have improved results of surgical treatment of distal radial fractures, [2-6] and several biomechanical studies have shown that a volar plate and locking screw system is efficient in the stabilizing of fractures against axial force [7-10]. Recently, the Acu-Loc® Targeted Dis- tal Radius system was designed as a best fit at the watershed line with 2 rows of distal locking screws and 1 or 2 screws targeting the radial styloid which theoreti- cally provides greater stability against radial styloid frag- ments [11]. We undertook biomechanical testing to determine the efficacy of the distinctive screws targeting radial styloid in the stable fixation of entire distal radial fractures using a fresh-frozen human cadaver fracture model.
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Carpal alignment in distal radial fractures

Carpal alignment in distal radial fractures

Patients with malunited distal radial fractures were report- ed to develop gradual progression of the midcarpal mala- lignment after the healing of the fracture, which worsened with the continued loading of the wrist [5]. Patients have also been reported to develop adaptive carpal realignment during evolution of the malunion itself, during and after the immobilization rather than after fracture healing [3]. They also described the carpal malalignment as not sim- ply a complication but the inevitable response of the car- pus to the altered mechanics caused by the malunion with dorsal radial tilt. However, it was our observation that the so described inevitable carpal realignment does not fol- low malunions of those fractures which are associated with dorsal subluxation of the radio-carpal joint. These fractures form nearly 11% of the total displaced distal ra- dial fractures [4]. With such controversial reports regard- ing carpal malalignment following the distal radial fractures, we thought it worthwhile to study the incidence and the natural course of the various carpal malalignment patterns occurring secondary to the displaced distal radial fractures. The present study, therefore proposed to meas- ure various radial and wrist radiological parameters fol- lowing distal radial fractures in pre-reduction, post- reduction and the serial follow-up films with a view to quantify accurately the displacement of the fracture and the associated carpal malalignment.
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Clinical outcomes in distal radial fractures with ipsilateral arteriovenous fistulas

Clinical outcomes in distal radial fractures with ipsilateral arteriovenous fistulas

All 13 patients had been injured in a simple fall. Twelve of the fractures were in the non-dominant limb, and one was in the dominant. All fractures were intraarticular and, based on the AO/OTA Classification of Fractures and Dislocations (formerly the Müller/AO Classifica- tion), were classified as partially articular type B (B2 in two cases, B3 in one case) or completely articular type C (C1 in two cases, C2 in seven cases, and C3 in one case). Four patients had undergone VLPF; four, ESF; and the other five, cast fixation. Six patients had brachiocephalic shunts, and seven had radiocephalic shunts (Table 1). At the follow-up, all AVFs were preserved, and adequate hemodialysis was achieved using a urea reduction ratio (URR) > 65%, and a Kt/V > 1.2 (K, dialyzer clearance
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EFFECT OF ALENDRONATE ON THE HEALING TIME OF DISTAL RADIAL FRACTURES TREATED CONSERVATIVELY: AN OBSERVATIONAL STUDY

EFFECT OF ALENDRONATE ON THE HEALING TIME OF DISTAL RADIAL FRACTURES TREATED CONSERVATIVELY: AN OBSERVATIONAL STUDY

Although the beneficial reasons for bisphosphonates may be justified from the improvements seen in patients, it is necessary to put in a word about the possible consequences of their usage. Bisphosphonates suppress the process of bone resorption by inhibiting osteoclast formation, which could in turn cause changes in remodeling, bone mineral content as well as affect the tensile strength of the healing bone [18]. In addition, a preferential deposition of oral and intravenous bisphosphonates at the site of an acute fracture has been noticed in many cases, and this could significantly affect clinical healing of these fractures [18]. Case studies performed by Odvina et al. [6], Goh et al. [19], and Kwek et al. [20] which looked into sets of atypical nonspine fractures of patients who have been on bisphosphonate therapy for a long period of time raised concerns about its usage. It was observed that fracture healing was delayed or absent for 3 months up to 2 years for a significant number of these patients while they were on therapy. Atypical femoral fractures and osteonecrosis of the jaw are some of the consequences of the use of bisphosphonates on a long duration basis, and thus, the exact duration of administration has been a topic of dispute in the field of orthopedics [12]. It was seen that inhibition of the hard callus remodeling to mature lamella bone occurs as a result of bisphosphonate use in several animal studies which have been conducted [7,8]. While the risk of using bisphosphonates has been found to be statistically significant in many of these studies, it is a worthy point that the clinical significance is still unclear. Bisphosphonates are seen to be highly beneficial in decreasing fracture risk and it is a fact that the anguish and fatality associated with a new fracture occurrence is higher than that of nonunions which have been seen [15]. Hence, a proper evaluation of when to start the treatment following a fracture requires in-depth analysis as a delayed start must not result in initiation issues with these agents.
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The titanium elastic nail serves as an alternative treatment for adult proximal radial shaft fractures: a cohort study

The titanium elastic nail serves as an alternative treatment for adult proximal radial shaft fractures: a cohort study

The methodology of our study is a retrospective cohort study. The institutional review board of Kaohsiung Gen- eral Veterans Hospital approved this retrospective study and informed consents were taken from all the patients. This study assessed patients with proximal radial shaft fractures who underwent fixation with TENs (DePuy Synthes, Johnson & Johnson Family of Companies, MA, USA) from November 2013 to April 2015. In total, five patients (six radial fractures) were included and antero- posterior (AP) and lateral forearm radiographs were obtained on first admission following trauma. All fracture patterns were recorded according to the Arbeitsgemeinschaft für Osteosynthesefragen/Ortho- paedic Trauma Association (AO/OTA) fracture classifi- cation system.
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WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet

WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet

There were 17 patients with concomitant injuries need- ing further operative procedures. Nineteen patients were offered WALANT procedure but refused, and the reason for not participating in the study group included the pa- tient is willing for general anesthesia (n = 15) and the pa- tients who felt lots of anxiety ( n = 4). Finally, 24 patients (40%) with distal radial fractures consented to WALANT surgery via fixation with volar plating or dorsal plating, and the other 36 patients were treated under general anesthesia (Fig. 1). The institutional review board of Kao- hsiung General Veterans Hospital approved this retro- spective study (IRB number: VGHKS17-CT8-13), and informed consent was obtained from all patients.
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Ligamentotaxis versus Open Reduction and Internal Fixation for Distal Radius Intra Articular  Fractures

Ligamentotaxis versus Open Reduction and Internal Fixation for Distal Radius Intra Articular Fractures

Objectives: This study compared the clinical and radiological outcomes of two different methods for the treatment of distal radial intra-articular frac- tures. Patients and Methods: Forty-six patients with distal radius intra-arti- cular fractures were divided into two groups. Group I included 24 patients with type C fracture treated by external fixator augmented by percutaneous K-wires. Group II included 22 patients with type C fracture treated by volar locked distal radial plate augmented by K-wires. Two patients had complex injuries necessitating double plating (sandwich). All patients were evaluated clinically by Mayo Wrist Score and radiologically by Sarmiento’s radiological score. Results: Both groups reported good personal satisfaction according to Mayo Wrist Score, and the results were not statistically different between the two groups. In Group I, 19 patients (79.2%) had excellent radiological out- come and five patients (20.9%) had good radiological outcome according to Sarmiento’s radiological score. In Group II, 20 patients (90.9%) had excellent outcome, and two (9.1%) had good radiological outcome; there was no or in- significant deformity. Conclusions: Complex distal radial fractures can be treated either by external fixation (ligamentotaxis) or by locked pre-contoured plating. The clinical outcome of plating and external fixator in our study did not show any statistically significant difference. The radiological outcome had no correlation with the clinical outcome.
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Clinical study of the Pronator Quadratus muscle: anatomical features and feasibility of Pronator Sparing Surgery

Clinical study of the Pronator Quadratus muscle: anatomical features and feasibility of Pronator Sparing Surgery

The space between PQ muscle and bone was created by an elevator and the plate was inserted beneath PQ muscle. Distal fixation was obtained first with one 3.5 mm screw inserted just beneath the subchondral bone at a convergent angle of 10° to the articular surface. Then, the longitudinal limb of the plate was lined up with the radial shaft, and the position of the plate was adjusted under fluoroscopy. The most proximal screw of the plate may be inserted through PQ under blunt dissection. The distal and middle screws of longitudinal limb of the plate were inserted easily with retraction of PQ muscle (shown in Figure 2). Other
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Radial and ulnar fracture treatment with paraosseous clamp-cerclage stabilisation technique in 17 toy breed dogs

Radial and ulnar fracture treatment with paraosseous clamp-cerclage stabilisation technique in 17 toy breed dogs

Methods Clinical records of small breed dogs with fractures of the radius and ulna were reviewed between January 2011 and January 2016. Inclusion criteria were bodyweight of ≤3.5 kg, fracture of the radius and ulna of one or two limbs without previous repair attempts, available follow-up information, and the use of PCCS for repair of the fracture as the sole method of fixation. Results Seventeen fractures in 17 dogs were included in the study. Radiographic union was documented in 13/17 cases. Median time to radiographic union was 13 weeks (range: 5–53 weeks). Major complications occurred in 24 per cent (4/17) due to implant failure, and for revision surgery the PCCS method was chosen in all four cases. Three of four revised fractures healed radiographically. One of the four dogs was lost for radiographic follow- up, but the owner could be contacted for a telephone questionnaire. Eleven of 17 dogs achieved an excellent return to function without any lameness during clinical examination, but 5/17 dogs showed an intermittent mild lameness despite full radiographic union. Routine implant removal was performed in 9/17 dogs. The owners of 15/17 dogs could be contacted for a telephone questionnaire for a long-term follow-up. No further complications were reported.
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Evaluation of Functional Outcome of Prosthetic Replacement of Comminuted Radial Head and Neck Fracture

Evaluation of Functional Outcome of Prosthetic Replacement of Comminuted Radial Head and Neck Fracture

insertion. Stiffness is prevented by encouraging early active motion. Indomethacin can be used in an effort to prevent heterotopic ossification in patients without contraindications; however, its effectiveness remains unproven. Posterior interosseous nerve injuries can be avoided by maintaining the forearm in pronation during the surgical approach and avoidance of Homan retractors placed anterior to the radial neck. Capitellar wear or erosions can occur, particularly with over lengthening of a radial head prosthesis or maltracking of implant. Management can include revision or removal of the implant if the elbow is stable. Mechanical failure of the prosthesis can arise from failure to link the modular implant correctly, or a failure of the coupling mechanism such as a screw or polyethylene in the setting of a bipolar device. Revision should be corrective. Polyethylene wear with secondary osteolysis and implant at the head–neck junction.
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Open reduction and internal fixation with bone grafts for comminuted mason type II radial head fractures

Open reduction and internal fixation with bone grafts for comminuted mason type II radial head fractures

in the literature [7, 29–31]. Ring et al. [7] applied ORIF with an autogenous bone graft to 1 of 30 patients with Mason type II fractures. Oztürk et al. [29] reported that 15 patients with radial head fractures underwent ORIF, and bone grafts from the distal part of the radius were used in 5 patients. Patel et al. [30] treated a severe comminuted fracture of the radial neck by ORIF with a tricortical iliac crest bone graft. Luenam et al. [30] reported that union was achieved in 9 of 10 patients who underwent an operation using an iliac crest bone graft for partial radial head reconstruction in the treat- ment of complex dislocation of the elbow. We prefer autografting from the lateral epicondyle of the humerus. The reasons for this choice are as follows: (1) taking bone chips from the same incision is convenient and induces less iatrogenic damage; (2) preparation of another sterile
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Severe traumatic valgus instability of the elbow: pathoanatomy and outcomes of primary operation

Severe traumatic valgus instability of the elbow: pathoanatomy and outcomes of primary operation

Richard et al. [14] reported complete avulsion of the MCL from its humeral footprint and disruption of the FPT leading to acute traumatic valgus instability in 11 collegiate athletes. Cho et al. [10] reported 7 patients with acute gross valgus instability without elbow disloca- tion suffered from complete disruption of the MCL and FPT, with variable degrees of tears of the anterior cap- sule and bone contusion of the radial head and capitel- lum. Those authors believed that acute valgus instability is probably the initial phase of posterolateral dislocation of the elbow [10]. Davidson et al. [15] reported varying degrees of acute valgus instability of the elbow due to avulsion of the MCL in 22 of 50 cases of radial head fractures. In terms of traumatic mechanism and pathoa- natomy, our results are extremely similar to those clin- ical studies mentioned above. In this study, all patients suffered from radial head fractures and complete avul- sion of the MCL from the humeral footprint, of which 64.5% (20/31) were accompanied by disruption of the FPT and 45.2% (14/31) were accompanied by tears of the anterior capsule. We believe that the deforming forces consisting of valgus strain and axial compression to an extended elbow may lead to a sequence of disrup- tion of the stabilizing structures from medial to lateral, thereby facilitating traumatic valgus instability. The aver- age difference in the medial joint angulation was 9.8° on valgus stress radiographs when the injured elbow was compared with the contralateral elbow, which met the criterion of gross valgus instability [29].
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Long-term outcomes of modular metal prosthesis replacement in patients with irreparable radial head fractures

Long-term outcomes of modular metal prosthesis replacement in patients with irreparable radial head fractures

Between 2004 and 2011, we identified 61 patients from our surgical database who underwent surgery for irreparable ra- dial head fractures. Radial head excision was performed in 20 elbows of 20 patients who failed to respond to nonsurgi- cal treatment for at least 1 month. RHR was performed in the other 41 elbows of 41 patients. All replacement surger- ies were preoperatively approved by at least two orthopedic surgeons in our department, and the surgical indication was well documented in the medical records. Because one single type of radial prosthesis was used for all replacement surgery in our institute from 2004 through 2011, this study only enrolled the surgeries performed during this period to avoid implant-selecting bias. Of 41 patients, 32 with more than 7-year follow-up were enrolled in this study, whereas the remaining 9 patients either had short-term follow-up or were lost to follow-up (Fig. 1). All patient and injury char- acteristics summarized in Table 1. There were 18 men and 14 women with an average of 43.91 ± 13.70 years (range, 14 to 75 years). The right and the left elbows were involved in 17 and 15 patients, respectively. The mean time from trauma to surgery was 10.13 ± 29.21 months (range, 0 to 120 months); 17 patients had acute injuries within 1 month, whereas 15 patients that were referred from other clinics had subacute or chronic injuries. Those referred patients were treated either non-operatively or failed to previous open reduction surgery. The diagnoses were valgus-type in- juries (14 patients: 4, acute injury; 10, chronic injury), ter- rible triad injury (14 patients), Monteggia fracture (3 patients), and supraintercondylar fracture of the distal hu- merus (1 patient). Previous surgery (1 to 3 times) before re- placement surgery was noted in 8 patients. All 32 patients had regular follow-up of more than 2 years. The latest sur- vey was performed at 7 to 15 years postoperatively.
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Comparison of Radial Head Resection With Radial Head Fixation in the Terrible Triad Injury of the Elbow

Comparison of Radial Head Resection With Radial Head Fixation in the Terrible Triad Injury of the Elbow

Objectives: Comparison of radial head resection with radial head fixation in terrible triad. Methods: In the present retrospective study, the outcome of terrible triad injury in 41 patients, in whom the radial head component was managed with either radial head resection (n=28) or open reduction and internal fixation (n=13), was compared. The subjective assessments of the outcome included Visual Analog Scale (VAS) for pain, the Mayo Elbow Performance Score (MEPS), and the Disabilities of the Arm, Shoulder, and Hand (DASH) score. The objective assessment of outcome included the evaluation of elbow Range of Motion (ROM) and elbow stability. Results: The Mean±SD age of the patients was 39.2±10.2 years. The demographic characteristics of the patients of the two study groups were not statistically different. The mean supination/pronation arc of motion was not significantly different between the two study groups (P=0.11). The mean flexion/extension arc of motion was significantly more in the fixation group (P=0.001). The mean MEPS and DASH scores were not significantly different between the study groups (P=0.22 and P=0.49, respectively). The mean VAS was significantly more in the fixation group (P=0.04). All the elbows were stable at the last follow-up. The postoperative complications (arthrosis and heterotopic ossification) were considerably more in the resection group.
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Monteggia-like lesions in adults treated with radial head arthroplasty—mid-term follow-up of 27 cases

Monteggia-like lesions in adults treated with radial head arthroplasty—mid-term follow-up of 27 cases

In agreement with the literature, a high number of patients with heterotrophic ossifications (44%) were ob- served in the current study. In a similar study, colleagues Antonio et al. reported a rate of 37% for proximal fore- arm fractures treated surgically [26]. Distal humeral frac- ture, terrible triad injury, Monteggia-like lesion, open injury, instability, severe breast trauma, or delayed final surgical treatment have been identified as risk factors for the development of heterotopic ossifications. Egol et al. carried out a retrospective evaluation of the clinical out- comes of 20 patients with a fracture of the proximal ulna, radial head or neck, and dislocation of the radial head [5]. At a mean follow-up of 2.3 years, the mean Broberg-Morrey score was 79 and the mean DASH score was 64. This accounted for only 11 (55%) of the patients with good or excellent results. Heterotopic ossification
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Pyrocarbon arthroplasty in acute unreconstructable radial head fractures: mid-term to long term results

Pyrocarbon arthroplasty in acute unreconstructable radial head fractures: mid-term to long term results

Another radiological finding frequent in patients with radial head prostheses is that of changes in the capitellum. First described by Van Riet [34] in 2004, its presence can be attributed to initial trauma or factors related to the actual prosthesis, such as different elas- ticity module as regards the bone. There has been an attempt to improve the transmission of load bearing to the radial head by using pyrocarbon, because its elas- ticity module is lower than that of metallic prostheses and more similar to the bone [6]. However, in our series there are capitellum changes in 88% of cases, which is too high a figure to put into question whether the elas- ticity module of this prosthesis, with its special compo- sition, is similar to that of the native bone (Fig. 3). If we
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Long-term results after non-operative and operative treatment of radial neck fractures in adults

Long-term results after non-operative and operative treatment of radial neck fractures in adults

The available literature often analyses the outcome of radial neck fractures together with fractures of the radial head. Duckworth et al. published a larger series of 237 patients who were suffering from a radial head or radial neck fracture and analysed the clinical outcome accord- ing to the MEPS after a mean follow-up of 6 months [8]. They recorded an excellent mean MEPS of 92 points, which is better than the results of the current study. They also reported of only two complications, which might be due to the rather short follow-up time. The revision surgery in our patients was performed after an average of 9.6 months. Most patients in this study were treated non-operatively.
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Bilateral Elbow Dislocation with Radial Head Fractures in a 33 Year Male – A Rare Case Report

Bilateral Elbow Dislocation with Radial Head Fractures in a 33 Year Male – A Rare Case Report

In our case report left side radial head was treated conservatively while right side was treated with open reduction and internal fixation. In a case like ours Raman et reported bilateral elbow dislocation and radial head fractures which were managed by closed reduction and ORIF of radial heads with plates. In their article they reported other modalities of fixation for radial head like polyglycolide pins [27], K wires [28], AO small fragment screws [28-29], fibrin adhesive system [29], AO thin screws [30] and transfixing wires [31]-each should be chosen based on surgeon’s relevant experience. In our case we used the headless screws and combined with a buttress plate based on familiarity and experience.
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