Distal Ulna Fractures Research Articles

Hand laterality recognition in distal radius and/or ulna fracture

Hand laterality, an important ability to determine the orientation of a limb is common to get affected after short term immobilization. Distal radius and/or ulna fracture is a commonly encountered fracture resulting from upper-limb trauma. Conservative treatment using closed reduction and plaster cast application to immobilize the joint remains choice of treatment over surgery in the treatment of these fractures. There is a paucity of literature reporting impairment in hand laterality after long term immobilization as commonly performed in patients with distal radius and/or ulna fractures. Understanding effect of immobilization on hand laterality in distal-end radius/ulna fractures warranted present investigation. To evaluate hand laterality based on the accuracy and response time for hand determination after plaster cast removal in distal radius and/or ulna fracture. Prospective cross sectional study. Subjects (n=60, age range=40-59 years, females (n)=28 and males (n)=32) were shown 24 real-hand images with various degrees of angular rotation and instructed to identify the hand as left and/or right. Accuracy (% correctly identified) and Response time (milliseconds to identify left or right hand in the image) of motor imagery during hand laterality task were recorded. Pain intensity before and after the hand laterality task were noted using Visual Analogue Scale. Repeated measures of ANOVA and t tests were used to analyze the accuracy and response times among two groups. The experimental group showed significantly (P < .05) lower accuracy and longer response time as compared to the control group. No significant difference in the accuracy and response time were noted in the immobilization of the dominant and the non-dominant hand within the experimental group (P > .05). Also, there was no change in pain pre- to post-hand laterality task. Findings of this study could aid in enhancing the understanding of post-immobilization effect on hand laterality and open new arenas for assessment and rehabilitation of distal-end radius and/or ulna fractures where immobilization is the principal treatment.

Distal ulna fractures in adults—subcapitular, transverse fractures did not benefit from surgical treatment

IntroductionFractures of the distal ulna, excluding the styloid, are rare. The cause of injury is often a fall on an outstretched hand with an extended wrist, and in most cases there is a concomitant distal radius fracture. The aims of this retrospective study were to investigate the results of the current treatment of distal ulna fractures in adults, with or without a concomitant distal radius fracture, and if a recently presented fracture classification could predict outcome.Materials and methodsPatients, 18 years or older, treated for a fracture of the distal third of ulna in our county, were included. Fractures of the styloid tip were excluded. The radiographs of the fractures were independently classified by two specialists in radiology according to the 2018 AO/OTA classification. Follow-up was performed 5–7 years after the injury, through the questionnaire Patient-Rated Wrist Evaluation (PRWE) and new radiographs of both wrists.ResultsNinety-six patients with 97 fractures were included and filled out the PRWE. 65 patients also had new radiographs taken. 79 patients were women and the mean age at the time of injury was 63 years (SD 14.5). The most common fracture class was the extra-articular transverse fracture, 2U3A2.3 (42%). We found that 40% of the fractures had been treated by internal fixation and only 2 fractures had not healed, one conservatively treated and one operated. The median PRWE was 15 (IQR 33.5). The PRWE score was significantly worse in the operated ulna fractures (p = 0.01) and this was also true for extra-articular transverse fractures 2U3A2.3 (p = 0.001). Initial displacement was more common in operated transverse fractures, but it could not be proven that this was the reason for the inferior result.ConclusionsDistal ulna fractures almost always unite and the result is comparable to that of isolated distal radius fractures when measured by PRWE. Based on the opinions of the radiologists and how often a consensus discussion was needed for classification, we found the updated AO classification system difficult to use, if dependent only on standard radiographic views. In the present study, transverse extra-articular ulna fractures did not benefit from internal fixation regardless if associated with a distal radius fracture or isolated.

Elastic stable intramedullary fixation using epibloc versus crossed kirschner wires fixation for distal forearm fractures in children: A retrospective analysis.

Background:Childrens' distal forearm fractures (DFFs) could be treated conservatively with closed reduction and immobilisation, but post-reduction displacements often occur. Displaced DFF should be surgically fixed, to avoid further displacement. Nevertheless, immobilisation after surgery is recommended. Epibloc system (ES), a system of stable elastic nail fixation, is widely used to stabilise adults extra-articular distal radius fractures, with advantages to not requiring post-surgical immobilisation. The present investigation represents a retrospective analysis of paediatric patients with DFF treated with ES applied with a minimal technical variation, to fix both ulna and radius fractures using a unique device.Materials and Methods:A retrospective analysis was performed on 44 children (age 6–11 years) who underwent closed reduction and internal fixation because of DFF (both ulna and radius). Group A (21 patients): ES fixation. Group B (23 patients): K-wires and short arm cast fixation. The primary outcome was the subsistence of reduction monitored through X-rays. The secondary outcome was the measurement of active range of motion (AROM) and the time of recovery.Results:No differences were observed comparing Group A and B in terms of the maintenance of reduction (P > 0.05). Seven days after the implant removal, patients in Group A reached significantly better results compared to patients in Group B in terms of AROM (P < 0.05). No differences were revealed in terms of complications between the two groups.Conclusion:ES applied with a minimal technical variation is safe and effective in treating distal ulna and radius fractures, with minimal requirement of post-surgical rehabilitation.

L’utilisation d’autogreffe avec ostéosynthèse à foyer ouvert des fractures isolées de l’ulna distal améliore les résultats cliniques à court terme : une expérience sur 11 ans

BackgroundMost of the studies on ulna fractures assess the treatment of fractures accompanied by other tissue injuries; thus, the number of studies focused directly on isolated distal ulna fractures are very few. In this study, it was aimed to evaluate the short-term results of open reduction internal fixation (ORIF) and autograft+ORIF approaches in the treatment of isolated distal ulna fractures. HypothesisUsing autograft in the surgical treatment of isolated distal ulna fractures with open reduction internal fixation improves short-term clinical outcomes. Patients and methodsThe records of isolated distal ulna fractures (distal one-third) operated at the Maltepe University Hospital Orthopedics and Traumatology Clinic between January 2009 and December 2019 were retrospectively reviewed. The cases were divided into two groups according to surgical approach, ORIF (n=40) or autograft+ORIF (n=34). ResultsThe mean age was 41.55±12.42 years. Among the cases, 52.7% were female, 67.6% of the fractures were right-sided, and 37.8% of the traumas causing the fracture were high-energy trauma. There was no significant difference between the ORIF and autograft+ORIF groups in terms of age, gender, side and severity of trauma (p>0.05). It was found that pseudoarthrosis development was significantly more prevalent in the ORIF group (25%) compared to the autograft+ORIF group (5.9%) (p=0.026). The median (1st quartile-3rd quartile) time to union was 16 (14–17) weeks in the ORIF group, and 9.5 (8.5–12) weeks in the autograft+ORIF group. Compared to ORIF, the time to union was significantly shorter with the autograft+ORIF procedure (p<0.001). At both the 3rd and 12th month follow-up examinations, the autograft+ORIF group was found to have significantly higher MAYO score and grip strength, and lower DASH score, compared to the ORIF group. DiscussionWhen an autograft is used in addition to ORIF in the surgical treatment of isolated distal ulna fractures, the bone heals faster, pseudoarthrosis develops less frequently, and short-term (3rd and 12th months) functional results are better. Level of evidenceIII; Therapeutic Study.

194 Challenging the Dogma of Radiographs a Joint Above and Below a Suspected Fracture: Quantification of Waste in Wrist Fracture Evaluation

The dogmatic teaching and practice to obtain X-ray imaging of the joint above and below every suspected wrist fracture is ingrained in emergency medicine and orthopedics. Originally recommended in a 1975 abstract, based on no data, this idea has been perpetuated to the present. In the interest of patient cost, resource management, and throughput we questioned the utility of this knee jerk radiographic exploration. We assessed the probability of identifying fractures outside of the wrist x-ray when no tenderness to palpation was elicited beyond the wrist. We performed a retrospective medical record review of patients diagnosed with wrist fractures at an urban public aid academic hospital. Inclusion criteria: was ICD diagnosis of distal radius, distal ulna, or carpal bone fractures at discharge between April 2019 and April 2020. Patients were excluded if they were <18 years of age, GCS <15, documented tenderness to the hand, proximal forearm, elbow, or humerus, or follow up visits. The documented physical exams performed by ED providers and Orthopedic consults were reviewed to identify location of tenderness both at the wrist and elsewhere. Undocumented tenderness was assumed to be negative. Analysis was performed with descriptive statistics including 95% confidence intervals. 716 patient encounters were identified. After exclusions, the cohort included 345 unique patients who presented with only wrist tenderness. Of the 345 patients, 113 were between the ages 18-40, 193 were between 40-65, and 39 patients were over 65. 177 (51%) were female. Based on our exclusion criteria, this sample had no tenderness outside of the wrist. Still, there were 268 hand x-rays, 284 forearm x- rays, 77 elbow x-rays, and 21 humerus x-rays performed. There were zero additional fractures identified in this imaging beyond the wrist. Analysing the frequency and outcome of these additional x-rays allowed estimation of the upper limit of the 95% CI as a way of estimating the probability of identifying an additional fracture. Forearm radiographs identified 0 % additional fractures, (95% CI (0.0 to 1.3%)). Hand x-rays 0% (95% CI (0.0 to 1.4%). Wrist x-rays alone identified 345 distal radial fractures, 184 distal ulna fractures, 14 carpal bone fracture/dislocations, and 1 proximal metacarpal fracture. The proportion of patients with additional radiographs that identified a fracture not identified on wrist x-ray in this sample was zero. Based on sample size the potential miss rate is likely less than 2%. This argues against default image ordering above and below tenderness and may provide savings on time, radiation, and cost.

Using autograft in the surgical treatment of isolated distal ulna fractures with open reduction internal fixation improves short-term clinical outcomes: 11 years of experience

BackgroundMost of the studies on ulna fractures assess the treatment of fractures accompanied by other tissue injuries; thus, the number of studies focused directly on isolated distal ulna fractures are very few. In this study, it was aimed to evaluate the short-term results of open reduction internal fixation (ORIF) and autograft+ORIF approaches in the treatment of isolated distal ulna fractures. HypothesisUsing autograft in the surgical treatment of isolated distal ulna fractures with open reduction internal fixation improves short-term clinical outcomes. Patients and methodsThe records of isolated distal ulna fractures (distal one-third) operated at the Maltepe University Hospital Orthopedics and Traumatology Clinic between January 2009 and December 2019 were retrospectively reviewed. The cases were divided into two groups according to surgical approach, ORIF (n=40) or autograft+ORIF (n=34). ResultsThe mean age was 41.55±12.42 years. 52.7% of the cases were female, 67.6% of the fractures were right-sided, and 37.8% of the traumas causing the fracture were high-energy trauma. There was no significant difference between the ORIF and autograft+ORIF groups in terms of age, gender, side and severity of trauma (p>0.05). It was found that pseudoarthrosis development was significantly more prevalent in the ORIF group (25%) compared to the autograft+ORIF group (5.9%) (p=0.026). The median (1st quartile–3rd quartile) time to union was 16 (14–17) weeks in the ORIF group, and 9.5 (8.5–12) weeks in the autograft+ORIF group. Compared to ORIF, the time to union was significantly shorter with the autograft+ORIF procedure (p<0.001). At both the 3rd and 12th month follow-up examinations, the autograft+ORIF group was found to have significantly higher MAYO score and grip strength, and lower DASH score, compared to the ORIF group. DiscussionWhen an autograft is used in addition to ORIF in the surgical treatment of isolated distal ulna fractures, the bone heals faster, pseudoarthrosis develops less frequently, and short-term (3rd and 12th months) functional results are better. Level of evidenceIII; therapeutic study.

Determining the Effectiveness of a New Device for Hand Therapy (The FEPSim Device): Feasibility Protocol for a Randomized Controlled Trial Study.

BackgroundImpairments of the forearm, wrist, and hand affect a sizable proportion of individuals and impose a significant economic burden on health care systems. FEPSim is a medical device for hand and wrist rehabilitation. The FEPSim device could be part of the standard of care for upper extremity rehabilitation during therapeutic activities to increase range of motion, dexterity, and strength. FEPSim has not yet been tested in a health care setting; therefore, a trial of the effectiveness of FEPSim in upper extremity rehabilitation is warranted.ObjectiveThis study aims to assess the feasibility of conducting a definitive trial in terms of recruitment, eligibility criteria, the type and number of diagnoses included, the length and dosage of the intervention, and data collection methods. This study also aims to gather clinical and statistical information as well as information related to the cost and usability, which allows for an economic evaluation of the device.MethodsThe trial will use a randomized controlled design comprising 47 intervention participants and 47 control group participants. Participants will be adults (age≥18 years) attending outpatient rehabilitation with limitations in their forearm, wrist, or hand function due to distal radial or ulnar fractures, stroke, or osteoarthritis. This study’s primary outcome variables are related to patients’ range of motion and strength, specifically active and passive wrist flexion and extension range of motion; active and passive forearm pronation and supination range of motion; grip strength; and pinch strength. The secondary outcome variables are related to patients’ perceived wrist pain and disability in activities of daily living. The patients’ perceived wrist pain and disability in activities of daily living will be measured using the patient-rated wrist evaluation questionnaire. The control group will receive the standard of care at each of the 2 hospital facilities (Glenrose Rehabilitation and Royal Alexandra Hospitals). The intervention group will receive the same standard of care as the control group at each facility and will use the FEPSim device for therapeutic activities to increase strength, range of motion, resistance, and dexterity. All the participants will be assessed at baseline (week 0); weeks 2, 4, and 8; and postintervention (week 10).ResultsThe FEPSim study was launched in April 2020. This study is currently on hold because of the global COVID-19 pandemic. The recruitment process is expected to resume by September 2020, and the primary impact analysis is expected to be conducted by December 2020.ConclusionsThis study will provide valuable information on the measurement of comparative intervention effects, technology acceptance by hand therapists, and how associated treatment and product costs will contribute to the evidence planning process, which will be crucial for the future adoption of FEPSim.Trial RegistrationInternational Standard Randomized Controlled Trial Number Registry ISRCTN13656014; https://www.isrctn.com/ISRCTN13656014International Registered Report Identifier (IRRID)PRR1-10.2196/22145

橈骨遠位端骨折に伴う尺骨遠位端骨折（茎状突起骨折単独を除く）の特徴と治療成績

橈骨遠位端骨折に伴う尺骨遠位端骨折（茎状突起骨折単独を除く）の特徴と治療成績

391 Multiple Unilateral Upper Limb Fractures in The Paediatric Setting – A Case Report

Abstract Introduction 5% of forearm fractures in children have associated supracondylar fractures, hence any forearm fractures warrant careful examination of the elbow, and radiographs taken should visualise the elbow and wrist joint for other injuries. We report a case of multiple upper limb fracture in a child, comprising of lateral condyle and both-bone forearm fracture. Case Presentation: A 5-year-old boy was admitted having fallen from a ladder approximately 1.5 metres high in a playground. The left limb was significantly deformed, with no open injury, and neurovascularly intact throughout. Radiographs demonstrated a minimally displaced lateral condyle fracture of the left elbow, a mid-shaft ulna fracture and a displaced off-ended distal third radius and ulna fracture of the left wrist. Any metabolic bone disease and non-accidental injury was ruled out. CT imaging was performed to completely assess the fracture pattern and discussion with our local regional trauma centre. Given the minimal displacement of the lateral epicondyle, conservative management was decided for this. The displaced distal radial fracture was managed with open reduction and internal fixation with a plate, and the ulna shaft fracture with manipulation and plaster cast application. By 12 weeks after surgery there was full range of movement of the elbow, wrist, and forearm, with complete radiological union.

A comparative study of distal third radius and ulna fractures treated with locking plate and non-locking plate in geriatric age group

Background: Fractures of radius and ulna are amongst the leading injuries in upper extremity in geriatric age group. Associated rotational instability of forearm bones in such fractures renders them suitable for operative fixation. Non-the less conservative management has also been employed in such injuries. We conducted this study to analyze and compare the outcomes of using Locking plate and Non-locking plates for internal fixation in geriatric population for distal 1/3rd shaft radius and ulna fractures in terms of fracture union, range of motion and functional outcome.Methods: Aprospective study of 20 patients with distal third radius and ulna fracture was conducted with 10 patients managed with locking 3.5 mm Dynamic Compression Plate and 10 with non-locking 3.5 mm Dynamic Compression Plate. All patients with extra-articular fractures were selected for this study and were randomly chosen for each procedure. They were followed up regularly at 3 weeks, 6 weeks and 12 weeks for time of union, wrist flexion, elbow flexion, supination, pronation and functional outcome.Results: There were a total of 13 males and 7 females. Mean time for radiological union was 5.8 weeks for Locking plate, 8 weeks for non-locking plate. Mean Flexion/Extension at elbow was 134o/140o for locking plate, 132o/139o for non-locking plate. Average supination/pronation was 61o/66.4o for locking plate, 57o/61.8o for non-locking plate. Mean duration for surgery was 75.25 minutes for locking plate, 75.70 minutes for non-locking plate.Conclusion: Open reduction and internal fixation with locking plating can be considered as the treatment of choice when considering fixation of distal third Radius and Ulna fractures in geriatric age group.

Acute Bony Injuries of Hand and Wrist.

Acute bony injuries to the hand and wrist are very common after a fall on an outstretched hand. In the wrist, distal radius fractures are the most common; isolated distal ulna fractures are uncommon. More serious injuries to the wrist include complicated fracture-dislocation injuries such as perilunate dislocations. At the carpal level, scaphoid fractures are the most common followed by fractures of the dorsal side of the triquetrum. The metacarpals often fracture, most commonly the base of the thumb and the subcapital region of the fifth metacarpal. In the fingers, we encounter many different types of fractures, often avulsions reflecting underlying soft tissue pathology (e.g., mallet finger). Dislocations are common in the fingers, predominantly in the distal interphalangeal joints. From an imaging standpoint, conventional radiography is always the initial examination. Complex (intra-articular) fractures, fracture-dislocation injuries, and a strong clinical suspicion of radiographically occult fractures need to be further evaluated for decision making regarding treatment. Computed tomography is the primary imaging modality of choice for the first two. In the latter, magnetic resonance imaging can be preferable, depending on clinical suspicion and the local situation in the associated hospital.

Pain Perception During the Phases of Manual Reduction of Distal End Radius Fracture With a Periosteal Block.

IntroductionClosed reduction is an effective method of treatment for distal end radius fractures. We present a case series of patients with distal end radius fractures who underwent closed manipulative reduction using the periosteal block. We describe the technique in detail and examine its efficacy in pain lowering effect during closed reduction.MethodsNineteen patients with distal end radial and ulnar fractures were included and grouped based on the Frykman classification. The reduction was performed using a periosteal block of 10 ml of 2% lignocaine injection. The severity of pain was recorded by utilizing the visual analog scale (VAS) in five phases: 1) before injection, 2) after 15 minutes of analgesia in a resting position, 3) during minimal motion, 4) during full manipulation and reduction, and 5) post-procedure. The VAS scoring was classified as painless (VAS score of 0), mild pain (VAS score between 1-3), and painful (VAS score of 4 and above).ResultsThe study included 19 patients [median age of 53 years (range: 18-88 years)]; there were 11 (58%) males and eight (42%) females. The mechanism of injury was a fall (n=12, 63%) or a motor vehicle accident (n=7, 37%). There was a statistically significant reduction of pain between phase one and all the other phases. Between the different fracture configurations, there was no significant difference in pain reduction. The most painful phase was expected to be phase four, ie, during full manipulation, in which four (21%) patients had a VAS score of 0, 12 (63%) patients had a VAS score between 1-3, and three (16%) patients had a VAS score of 4. Thus, 16 out of 19 patients (84%) had no or minimal pain during the most painful phase. There were no complications from the periosteal blocks.ConclusionsThe periosteal nerve block is an effective procedure providing satisfactory analgesia during the reduction of distal radial and ulnar fractures. It has no side effects and is free from complications associated with conventional sedation.

Does Simultaneous Fixation of Both Distal Radius and Distal Ulnar Fractures Improve Outcomes? A Retrospective Cohort Study.

Introduction: Distal metaphyseal ulnar fractures are often found in conjunction with distal radius fractures. However, there is no consensus on optimal management. The purpose of this study was to determine whether simultaneous fixation of both distal radius and distal ulnar fractures would improve outcomes. Materials and Methods: Patients treated for distal radial fractures over a 4-year period at our trauma center were identified, and their medical records were analyzed. Twenty-three patients met the inclusion criteria for this study. All radius fractures were fixed using a volar locking plate. Fourteen ulnar fractures were treated with surgical fixation, and nine were treated conservatively. Data were collected on patient demographics, mechanism of injury, whether it was a closed or open fracture, Gustilo classification, AO/OTA classification, immobilization period, follow-up period, and type of treatment. Physical findings comprising the active range of motion and grip strength and radiological findings, including the ulnar variance compared to the healthy side and bone union, were evaluated. Clinical outcomes were assessed using the quick Disabilities of the Arm, Shoulder, and Hand scores. Results: There was no significant difference between the groups in the quick Disabilities of the Arm, Shoulder, and Hand scores, but the arc of dorsi-palmar flexion was more restricted in the operative group than in the conservative group. Other results were not significantly different between the two groups. Discussion: Fixation of distal metaphyseal ulnar fractures can be challenging, and several studies have shown the validity of conservative treatments. This supports the view that if the distal radius fracture is anatomically and rigidly fixed, distal metaphyseal ulnar fractures can be successfully managed conservatively. Conclusion: Our results did not show any merit in the simultaneous fixation of both distal radius and distal ulnar fractures. Thus, needless surgery should be avoided.

Fixation of Distal Ulna Fractures by Distal Ulnar Locked Hook Plate

Background: Distal ulna fractures are often found in conjunction with distal radius fractures, and the complexity of the interaction of the distal ulna with the radio-ulnar joint and triangular fibrocartilage complex makes understanding and treatment of distal ulna fractures challenging. Objective: To determine the efficacy and analyze the results of Locking Compression Distal Ulna Hook Plate (LC-DUP) in patients suffering from distal ulnar fracture (either isolated or associated with distal radius fractures). Patients and methods: This prospective clinical trial study included 18 patients. The age of the studied group ranged from 22 to 58 years; half of the group had age ranged from 30 to 40 years. They were suffering from distal ulna fractures and were treated by locked compression distal ulnar hook plates during the period from November 2019 to July 2020. Results: All patients eventually achieved full union. Only two of them had delayed union. The radiological and clinical assessment of fracture site and DRUJ was promising. More than three quarters of patients had excellent outcome, while the rest quarter; half of them had good, and the other half had satisfactory outcome according to the Modified MAYO Score, which had mean of 90.5 ± 14.6. While, the mean of the Quick DASH score was 9.8 ± 5.8. Conclusion: The good outcomes achieved in this study suggest that the use of the distal ulna hook plate could be an alternative treatment method for intra-articular ulna neck or head fractures, as well as basal oblique ulnar styloid fractures.

Repair of a Divergent Elbow Dislocation with Distal Ulnar Fracture in a Dog Using TightRope and External Skeletal Fixation

AbstractThe aim of this study was to report the outcome in a 6-year-old male English Setter dog that suffered a combination of divergent elbow dislocation and open distal ulnar fracture. This study is a case report. After surgical reduction in the elbow luxation, the dog was treated with the TightRope fixation system used as replacement of the lateral collateral ligament, a radioulnar positional screw, and external skeletal fixation. Removal of all implants was performed 3 months postoperatively. The 6-month follow-up visit found the dog without lameness, displaying normal activity, and with normal elbow range of motion and normal Campbell's test. Successful surgical management was achieved with good long-term results using TightRope, a positional screw, and an external skeletal fixator.

Successful surgical management of radial and ulnar fracture by dynamic compression plating technique in a dog

Radius and ulna are paired bone. Radius/ ulna or both radius and ulnar fractures are common in small and large animals. Small and toy breeds of dog are more prone to distal radial fractures and have a high rate of complications even after surgical correction. The present case study was conducted for management of right distal radial and ulnar diaphyseal overriding transverse fracture in an eight-month-old, 8.4 kgs bodyweight male intact Samoyed breed of dog. The case was corrected by using a 2.7mm 8-hole dynamic compression plate applied in the cranial aspect of the radius. The patient was evaluated postoperatively at a different interval by clinical and radiographic examination up to 72 days of operation. Clinically, lameness grade was improved gradually and functional limb outcome was excellent on postoperatively day72. Postoperative day1 to day 72, X-ray revealed implant (plate and screw) in position and primary healing of the bone.

A Rare Cause of Diffuse Forearm Swelling in an Infant.

1. Matthew Baker, MD* 2. Stephanie Todd, MD, FAAP†,‡ 3. Narendra S. Shet, MD†,‡ 1. *Children’s Hospital Los Angeles, Los Angeles, CA 2. †George Washington University School of Medicine, Washington, DC 3. ‡Children’s National Hospital, Washington, DC A 10-month-old previously healthy girl presents to the emergency department with new-onset fevers and progressive right forearm swelling, pain, and irritability after a diagnosis of a distal forearm fracture in the same arm 2 weeks earlier. Per the parents’ report, they initially sought care 2 weeks earlier when the child refused to bear weight with the right arm while crawling without any known history of trauma. Outside imaging was reported to be notable for nondisplaced distal radial and ulnar fractures, for which the patient was splinted. Although the family denied a history of trauma, due to the unclear etiology of the fractures, an evaluation for possible nonaccidental trauma was performed that was unrevealing, except for the noted radius and ulna fractures. Follow-up 1 week later had revealed a swollen forearm with repeated plain radiographs that demonstrated abundant periosteal reaction along the distal radius and ulna, presumably representing evidence of healing nondisplaced fractures given the duration since the initial injury (Fig 1). The arm remained swollen but compressible and nontender on examination. Due to the fever, as well as continued swelling of the right distal arm with decreased mobility and worsening pain and irritability, the parents present to …

Management of Comminuted Distal Ulna Fracture with a Self-made Syringe External Fixator: A Case Report and Review of The Literature

Management of Comminuted Distal Ulna Fracture with a Self-made Syringe External Fixator: A Case Report and Review of The Literature

Incidence of Scaphoid Fractures and Associated Injuries at US Trauma Centers.

Backgound The scaphoid is the most commonly fractured carpal bone and often presents as a diagnostic challenge. Fractures can often go unnoticed on initial radiographic evaluation and clinical presentation can vary significantly among patients. Awareness of high-risk cohorts assists practitioners in making the appropriate clinical diagnosis of acute scaphoid fracture. Materials and Methods The National Trauma Data Bank is the world's largest trauma data repository. Utilizing the 2016 public use file, we isolated scaphoid fractures by anatomic fracture location by utilizing International Classification of Diseases, 10th revision coding. Reported cases of distal pole (S62.01), waist (S62.02), and proximal pole (S62.03) were included. This data was then queried to determine trends in mechanism of injury, demographic information, and associated injuries. Results There were a total of 968,665 patients with 2,769 cases of reported scaphoid fractures resulting in 286 scaphoid fractures per 100,000 person-years. Males were more likely to sustain a scaphoid fracture than females. The most commonly encountered associated injuries were distal radius fractures, distal ulnar fractures, and nonscaphoid carpal bone fractures, respectively. Conclusions Scaphoid fractures presenting to trauma centers are more commonly reported among males and those involved in motor vehicle accidents or falls. Appropriate scaphoid-specific radiographic imaging should be obtained as well as wrist and elbow images to evaluate for concomitant injuries, especially distal radius fractures.

A Cost-effective Technical Tip for Surgical Management of Pediatric Distal Radius and Ulna Fractures at Metadiaphyseal Junction

Significantly displaced paediatric distal radius and ulna fractures which occur at the meta-diaphyseal junction frequently require surgical fixation due to the highly unstable configuration. The location of the fracture is often too proximal for transfixing with K-wires and too distal for intra-medullary TEN (titanium elastic nailing). We describe a simple cost-effective technique to stabilise such an injury using a readily available 2mm stainless steel kirschner-wire.