Diaphyseal Fractures Of Radius Research Articles

Comparison of cranial versus medial minimally invasive plate osteosynthesis applications for the stabilization of simulated radius and ulna fractures in dog cadavers.

Minimally invasive plate osteosynthesis (MIPO) is an emerging fracture management modality in small animal orthopedics. Although cranial plate application has been consistently advocated when performing radial MIPO, medial plating affords several purported advantages including improved screw purchase through the wider medial-to-lateral dimension of the radius, the potential to use smaller plates allowing more screws per unit length, and avoidance of extensor tendons which can complicate cranial plate placement in distal diaphyseal or metaphyseal fractures. To compare cranial versus medial MIPO applications for the stabilization of diaphyseal radius and ulna fractures in dog cadavers. Simulated bilateral antebrachial fractures were stabilized with cranial MIPO on one forelimb and medial MIPO on the contralateral limb, facilitated by a two-ring circular fixator construct. Procedure times and ease, number of fluoroscopic images obtained, and post-procedural frontal and sagittal alignment and radial length were compared between plating groups. The ease of construct placement, fracture reduction, radial approach, and plate application, were subjectively scored 1-5 for each procedure. Paired t-tests were performed to identify significant differences (p < 0.05) between the two plating groups. There was no difference in total or incremental procedural times, subjective ease scores, or the number of fluoroscopic images obtained between plating groups. Both plating groups had comparable post-procedural frontal and sagittal plane alignment. There was a significant difference between plating groups for final radial length (p = 0.004) and change in radial length compared to the intact radii, (p = 0.002). Medial-plated radii measured longer than cranial-plated radii. The only outcome measure significantly different between plating groups was the post-procedural radial length. The change in length compared to intact radii was <1%, regardless of the plating group, and unlikely to be clinically relevant.

Treatment of diaphyseal forearm fracture with interlocking intramedullary nailing: A pilot study

IntroductionThe present study was done to assess the functional outcome and complications of interlocking intramedullary (IM) radius ulna nailing to treat radio-ulna fractures in adults. MethodologyThirty adult patients with diaphyseal or segmental fractures of radius and ulna were included and treated with IM nailing. Grace and Eversmann rating system was used to assess functional evaluation and grip strength was measured using grasp dynamometer. ResultsMean age of the 30 eligible patients was 33.5 years, and males comprised 77% of the study population. Intra-operative complications like nail impaction and proximal screw locking problem for radius was present in one patient each. Increased swelling in three patients (10%) and posterior interosseous nerve palsy in one patient (3%) were observed post-operatively. In the post-operative period, all patients were able to move fingers, had 100° elbow range of motion and good grip strength. Pronation and supination till 80° was present in 80% and 57% of the patients respectively. Wrist flexion and dorsiflexion till 90° was present in 80% and 57% of the patients. Fracture union was confirmed radiologically in all cases at a mean of 3.6 weeks. Functional outcome was excellent in 73% and good in 13%. Grip strength was judged to be excellent in all cases. ConclusionsExcellent and good functional outcomes were obtained in 86%, and no case developed mal-union or delayed union. Based on our results, IM nail for surgical treatment of radial and ulnar diaphyseal fractures can be used.

Dorsal or Lateral Approach for Intramedullary Nailing Using Kirschner Wire in Pediatric Radius Diaphyseal Fractures: Does it really matter?

Intramedullary nailing is the most preferred fixation method for diaphyseal radius and ulna fractures in the young age group. The aim of this study was to compare the dorsal and lateral entry points in the context of entry site-related complications, fracture union and functional results. This retrospective comparative study included pediatric patients who underwent surgery for isolated diaphyseal radius or both bone forearm fractures with intramedullary nailing using Kirschner wire between January 2013 and January 2019. K-wire was introduced from the distal radius through dorsal entry (Group A) in 19 patients and lateral entry (Group B) in 18 patients. The mean follow-up was 37months. Complications were noted and functional outcomes were evaluated according to the CHOP criteria. All fractures were healed. The functional results were determined to be excellent for 30, fair for 4, and poor for 3 patients. The overall complication rate was 18.9%, including distal radius fracture, mild pain in the wrist, and minor loss in ROM. No statistically significant differences were determined between the groups in respect of functional results and complication rates. Good functional results and similar complication rates can be obtained with both dorsal and lateral entry approaches. Stainless steel K-wire is an inexpensive intramedullary fixation implant option, which provides strong stabilization. Distal radius fracture is a newly reported complication for forearm intramedullary nailing. Leaving the implant out of the skin seems safe with the benefit of avoiding a further surgical intervention to extract the implant.

Retrospective analysis of diaphyseal fracture of radius fixation using modified lateral approach and lateral platting

Retrospective analysis of diaphyseal fracture of radius fixation using modified lateral approach and lateral platting - IJOS- Print ISSN No: - 2395-1354 Online ISSN No:- 2395-1362 Article DOI No:- 10.18231/j.ijos.2020.036, Indian Journal of Orthopaedics Surgery-Indian J Orthop Surg

A study of clinicoradiological and functional outcomes of intramedullary nailing in diaphyseal radius ulna fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of this study was to evaluate the results of intramedullary nailing in diaphyseal fractures of radius and ulna in age group of 10 to 49 years and to understand its clinicoradiological and functional results.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a retrospective case series study of forearm bone fractures and the selected management for the same over a period of 3 years. We chose the cases in which intramedullary nailing was the treatment modality which were followed up over a period of minimum 6 months. Patients with galeazzi variety, monteggia variety, pathological fracture or non-union after previous surgery were excluded. The outcomes were then evaluated with disabilities of the arm, shoulder and hand (DASH) score, Green and O’Brien score, and Grace and Eversmann functional outcome score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Of the 22 patients, 10 patients had excellent functional outcome according to Grace and Eversmann score, 7 patients had good outcome, 4 patients had acceptable while 1 was unacceptable. Green and O’Brien also had similar results, except that patients among fair category were 3 and poor category were 3. The mean DASH score was 16.2.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study shows that closed method for fixation by intramedullary nailing of both bone forearm fractures leads to excellent to good functional outcomes (according to DASH score, Green and O Brien, and Grace and Eversmann score) with less complications. In 6 months follow up x ray there is radiological union in all cases with no angulation, malunion or non-union. &lt;/p&gt;

Functional outcome of locking compression plating in diaphyseal fractures of radius and ulna

Background & Objectives: Forearm fractures are regarded as articular fractures as slight deviations in spatial orientation of the radius & ulna will significantly decrease the forearm’s rotational range thus disturbing positioning & functioning of the hand. Conservatively done reduction of these fractures results in a poor functional outcome. Hence perfect reduction is essential in maintaining the rotation which is achieved by open reduction & internal fixation with plate & screws. The present study is undertaken to learn the techniques assess the advantages, functional outcome and complication of the new method of internal fixation of diaphyseal fractures of radius & ulna.Materials & Methods: A prospective study involving 20 cases was carried out from September 2015 to September 2017 at Bapuji Hospital and Chigateri General Hospital attached to JJM Medical College, Davangere. These cases involving fracture both bone forearm was treated with open reduction & internal fixation using Locking Compression Plating. Functional outcome was assessed using Anderson et al. criteria scoring system (1975).Results: In this study, majority of the patients were males, middle aged, with road traffic accidents being the commonest mode of injury, involving middle third of both bones of forearm. Majority of our cases had fracture union within 14 weeks with no cases of failure or non-union and most of the patients returned to their routine activities within 16 weeks of surgery. There was no major complication in our study. Excellent or full range of mobility of elbow and wrist joints was present in 15 patients (75%) and 5 (25%) patients had good range of movements.Conclusion: The open reduction and internal fixation with LCP of forearm fractures produce excellent results, the advantage being early mobilization, early union but the complication, duration of surgery and surgical techniques remains unchanged.

A comparative study of both bone forearm fractures treated with intramedullary nailing vs plating in adults

Background: The aim of this paper was to study the diaphyseal fractures of radius and ulna treated with nail/plate in adults and to choose the best modality of treatment.Methods: From May 2017 to December 2018 in Department of Orthopaedics, Krishna institute of medical sciences, Karad, total of 30 patients of both bones forearm fractures were treated. 15 were treated with open reduction and internal fixation using DCP plating or 1/3rd tubular plate and 15 with intramedullary nailing with radius and ulna nail. 30 patients were available for the follow up. Follow up was done for one year. Functional results were assessed by using Anderson et al criteria.Results: The time required for surgery in plating group was 62 minutes, and 42 minutes for nailing group. Average time of radiological union for radius & ulna was 13 weeks in nailing group and 16 weeks in plating group. There was one case of radiological non union with ulna nailing and there was no other associated complications.Conclusion: We conclude that open reduction and internal fixation with plating is the gold standard procedure for the treatment of both bone forearm fractures in adults. Intramedullary nailing is a less attractive alternative compared to plating as the normal movements are hampered.

Comparative study of effectiveness of rush pin with long arm cast and dynamic compression plate in management of closed diaphyseal fracture of radius and ulna in adults

To compare the effectiveness of Rush pin with long arm cast and dynamic compression plate in the management of diaphyseal fracture of radius and ulna in adults. The randomised control study was conducted at the Mayo Hospital, Lahore, Pakistan, from December 2012 to December 2015, and comprised diaphyseal fracture of radius and ulna cases aged 15-45 years of either gender. The patients were divided randomly into two groups. Group A was managed with open reduction and internal fixation with Dynamic Compression Plate, while group B was managed with closed reduction and internal fixation with Rush pin and long arm cast. Groups were compared for age, gender, Orthopaedic Trauma Association fracture type distribution, surgery time, amount of blood loss, union achieved, time to union and functional outcome in terms of Grace-Eversmann criteria and the Disabilities of the Arm, Shoulder and Hand score. The complications in the two groups were also noted. SPSS 20 was used for data analysis. Of the 60 patients, 30(50%) each were in groups A and B. In group A, there were 23(76.67%) males and 7(23.33%) females, while in group B, there were 26(86.67%) males and 4(13.33%) females. The mean age in group A was 30.33} 4.26 years (range 21-37 years), and in group B it was 28.60}7.69 years (range 15-45 years). There was significant short time to union in group B compared to group A (p<0.0001). Frequency of union and functional outcome were not significantly different between the groups (p>0.05). Functional outcome and frequency of union was not significantly different between the groups, but there was a statistically significant earlier union in cases managed with Rush pin and long arm cast than those managed with open reduction and internal fixation with Dynamic Compression Plate.

A comparative study between plating &amp; intramedullary nailing for displaced diaphyseal fractures of radius and ulna in adults

Background: In the current era of industrialization and with mechanized farming in India, fractures of forearm bones have become more common. The forearm serves an important role in the functioning of the upper extremity. Hence aggressive management through good anatomical reduction and internal fixation of these fractures has become a necessity. The purpose of this study was to assess and compare functional results of plating and nailing in fracture stabilization. Methods: Retrospective and prospective study with the sample size of 20 patients with both bone forearm fractures. 10 patients were treated with dynamic compression plating and remaining 10 with intramedullary square nails. Results were assessed by time for union, type of fractures, range of motion of elbow and wrist joint, complications and functional assessment were done by Grace- Eversmann Criteria and DASH questionnaire. Results were statistically analysed with Mann- Whitney U-test. Results: Out of 20 cases 18 were males and 2 females, with average age of 38.5 years. 12 fractures were of A32 type according to AO classification. Good or full range of mobility of elbow and wrist joints with excellent & satisfactory results were present in 16 patients as per Grace-Eversmann criteria. 2 patients showed ulnar nail back out while other 2 had delayed union of fracture, all seen with intramedullary nailing. Conclusion: There was no statistically significant difference between results of nailing and plating. However, it is concluded that while good functional results can be obtained with intramedullary nailing of forearm fractures, open reduction and internal fixation offracture remains the treatment of choice for most forearm fractures with adherence to AO principles.

Postero-Lateral Elbow Dislocation With Ipsilateral Radius And Ulna Fracture: A Case Report

Elbow dislocation with ipsilateral diaphyseal fracture of both radius and ulna is a rare injury. How-ever, elbow dislocation with either radius or ulna diaphyseal fracture is commonly reported. We report an uncommon injury of a 33 years old male who had his elbow dislocation with ipsilateral both bones forearm fracture. Elbow dislocation was reduced and fracture both bones were fixed with low contact dynamic com-

Clinico: Radiological outcome of diaphyseal fractures of both bone forearm in adults treated with dynamic compression plates: A prospective study

The diaphyseal fractures of radius and ulna in adults can result in significant loss of function if inadequately treated. Hence, they are usually managed by internal fixation and dynamic compression plates are the most commonly used implant for this purpose. We report the clinico-radiological outcome of both bone forearm fractures treated with Dynamic Compression Plate, through a prospective study done at Government Medical College, Thrissur from December 2014 to November 2015. The final outcome evaluated by Anderson criteria showed 62.5% excellent, 33.33% good results and only one poor outcome. Our series had 95.83% union rates with mean union duration of 13.8 weeks. We concluded that open reduction and internal fixation of adult forearm shaft fractures can be appropriately treated with Dynamic Compression Plating, which will give an excellent to good results and the results are worthy of comparison with those of the expensive newer implants.

Diaphyseal Fracture of both Bone Forearm with Distal Radio-Ulnar Joint Dislocation: An Unusual Entity

Introduction: Diaphyseal fractures of both radius and ulna are a common entity. The indirect forces which can lead to diaphyseal fracture of radius and ulna are also responsible for injuring distal radio-ulnar joint (DRUJ). However, simultaneous occurrence of fractures of both forearm bones, along with DRUJ disruption, is an uncommon entity. Case report: We came across a patient, who sustained fractures of both forearm bones with DRUJ dislocation. He was treated with open reduction and internal fixation of both the forearm fractures. His DRUJ reduced spontaneously after anatomical reduction of both fractures and was found to be stable on intra-operative assessment. He was immobilized in long arm splint for healing of DRUJ for 4 weeks. The fracture healed and the patient attained full range of motion at 12 weeks follow up. Conclusion: Distal and proximal joints should be thoroughly examined in all the forearm fractures. Anatomical reduction of forearm bones is essential to obtain congruent DRUJ. Any instability of DRUJ should be assessed intra-operatively and dealt with accordingly for favorable functional outcome.

Intramedullary nailing as a treatment modality in diaphyseal radius and ulna fractures

Traumatic skeletal injuries are becoming very common with advent of modernization because of increased vehicles and increased industrialization. Radius and ulna fractures are among the most common long bone injuries admitted to any hospital. The management of Radius/ Ulna diaphyseal fractures has always held particular interest of orthopaedic surgeons. By virtue of its location Radius-Ulna are exposed to frequent injuries with elbow joint and wrist it forming the extinct boundaries with superior and inferior radio-ulnar joint and spanning interosseous membrane to control rotation in the forearm. Early treatment and proper stabilization gives a better functional outcome. Early fracture fixation either by closed reduction with nailing or open reduction internal fixation with compression plate reduce morbidity and mortality significantly. Intramedullary nailing can be excellent choice of treatment especially in compound injuries, poor skin condition, segmental fractures and grossly communited fractures. Excellent results were obtained using closed reduction with large snugly fit intramedullary nail in radius ulna fractures which provided both rotational and angular stability.

The Surgical Outcomes of Diaphyseal Fractures of Radius and Ulna treated by Plate and Screws Fixation in Vietnam

Objectives: 1) Study the clinical and radiographic characteristics of both bones forearm fractures in adults. 2) Evaluate the surgical outcomes of plate and screws fi xation for these fractures.

Rotational Corrective Osteotomy for Malunited Distal Diaphyseal Radius Fractures in Children and Adolescents.

To report our method of computer-planned rotational corrective osteotomy for malunited distal diaphyseal radius fractures in children and adolescents using a custom jig and to review the results of 4 cases. Four patients (mean age, 13 years; range, 11-16 years) underwent computer-planned rotational corrective osteotomy for malunited distal diaphyseal radius fracture using a custom jig. We retrospectively evaluated their radiographic and clinical data. In patients who had marked restriction of forearm supination before osteotomy, the mean arc of forearm supination improved from 5° before surgery to 79° after surgery. Angular deformity on x-ray, range of forearm rotation, and grip strength all improved after surgery. Mild and moderate pain reported by 1 and 2 patients, respectively, was resolved after surgery. Computer-planned rotational corrective osteotomy for malunited distal diaphyseal radius fracture in children and adolescents using a custom jig is a strategy that facilitates the surgical procedure by accurately correcting both rotational and angular deformities on 1 plane in a single procedure. Therapeutic V.

Reduced Incision Surgical Fixation of Diaphyseal Forearm Fractures in Adults through a Minimally Invasive Volar Approach: 通過微創前側進路來進行小切口手術固定成人的前臂骨幹骨折

PurposeThe study aimed to describe and evaluate the minimally invasive volar approach to the forearm for open reduction and internal fixation of diaphyseal radius fractures. MethodsThis is a matched case-control study involving patients with diaphyseal forearm fractures operated by one orthopaedic surgeon over 2 years. Cases underwent a minimally invasive volar approach, whereas controls underwent a standard Henry’s approach. In total, 17 cases and 17 controls were studied based on patient demographics, injury patterns, and surgical outcomes. ResultsThe duration of surgery was significantly shorter for cases than for controls in combined radius and ulna fracture fixation (58.8 minutes vs. 84 minutes; p=0.03). There was no significant difference in operative time for isolated radius fractures, hospitalisation duration, and time to return to work. No malalignment or complications were observed. ConclusionThe minimally invasive volar approach to the forearm is as safe and efficacious as traditional approaches in the fixation of diaphyseal radius fractures.

A prospective study of management of closed diaphyseal fractures of radius and/or ulna in children with intramedullary titanium elastic nail system

Background & Aim: Intra-medullary elastic nailing system is an ideal device for the treatment of pediatric forearm fractures. It is simple, safe, minimally invasive technique and has a fewer complications. The aim of the study was to evaluate and report our experiences regarding union rates, clinical and functional outcome and complications associated with this treatment modality in BBF between age group of 5 to 15 years. Material & Methods: 40 cases of pediatric diaphyseal both bone forearm in children of age group 5 to 15 years operated at National Institute of Medical Science and hospital, Jaipur meeting the inclusion and the exclusion criteria ( as given below) managed between January 2015 to December 2015 with TENS were prospectively reviewed. The final functional and clinical outcome & complications were assessed at 6 month of follow up by Andersons et al criteria. Results: Of all 40 patients had undergone close reduction in which 2 required open reductions. All fractures united at a mean of 7.95 weeks (range 6-10 weeks) with achievement of full R.O.M at elbow and wrist in majority with reported restriction in 3 cases. There were no major complications but encountered minor complications in 18 patients such as pain (22.5%), hardware skin irritation (12.5%), and pin track infection (10%). The final functional outcome evaluated by Andersons et al criteria showed 90% excellent results and remaining showed good outcome. Conclusion: TENS is an ideal device for the treatment of pediatric forearm fractures as it is a simple, safe, minimally invasive technique and has fewer complications. It also does not interfere with growth of the forearm and provides early union due to non interference of fracture hematoma and minimal periosteal stripping. It provides shorter hospital stay, rapid return to daily activity & school, avoids long & uncomfortable immobilization & cosmetically acceptable

Elbow dislocation with ipsilateral diaphyseal fractures of radius and ulna in an adult—is it type 1 or type 2 Monteggia equivalent lesion?

Elbow dislocation with concomitant diaphyseal fractures of radius and ulna has been reported rarely. This injury could be included in Monteggia equivalent lesions based on the mechanism of injury, radiographic pattern and method of treatment as described by Bado. We report a rare case of Monteggia equivalent lesion in an adult with unclear mechanism of injury. The possible mechanism of injury, its management and the follow-up results were described. An attempt to solve the controversy regarding whether labeling it as type 1 or type 2 was made.

Early clinical outcomes of isolated low velocity gunshot radius fractures treated with closed reduction and locked intramedullary nailing

BACKGROUND: The treatment goals in diaphyseal radius fractures are to regain and maintain length and rotational alignment and stability. Open reduction and plating carries the inherent problems of soft tissue disruption and periosteal stripping. Intramedullary nailing offers advantages of minimally invasive surgery and minimal soft tissue trauma. AIMS: To investigate the outcomes of locked intramedullary nailing for isolated gunshot diaphyseal radius fractures in adults. METHODS: A cross-sectional review of prospectively collected clinical and radiological data was performed. All adult patients with isolated gunshot radius fractures treated with closed reduction and locked intramedullary nailing between 2009 and 2013 were reviewed. Twenty-two nails were inserted in 22 patients, all males with a mean age of 28.9 years (range 19-40). All surgeries were performed between 2 and 12 days after injury (average 4 days). Follow-up was for an average of 11 weeks (range 8-24). RESULTS: All fractures united with the index procedure. Mean time to union was 10 weeks (range 8-24). Using the Anderson classification, the clinical outcome was excellent in 14 patients (64%), satisfactory in six (27%) and unsatisfactory in two (9%). CONCLUSION: Closed reduction and intramedullary nail fixation of gunshot radius fractures shows promising results without significant complications.

A Pronator Teres-sparing Volar Approach for Osteosynthesis of Midshaft Diaphyseal Radius Fractures.

Henry's approach is widely considered the "workhorse" for exposing the volar radius and has not really changed since his original description in 1945. We describe a pronator teres-sparing volar approach to the forearm, for osteosynthesis of midshaft diaphyseal radius fractures. We believe this approach is safe, simple, and reproducible, and has several practical and theoretical advantages over Henry's original description.