Radial Bone Fractures Research Articles

Comparative evaluation of methods for osteosynthesis of diaphyseal radial fractures by the method of mathematical modeling

RELEVANCE. The surgical treatment of patients with diaphyseal forearm fractures has a variety of methods and requires a precision technique. The need for postoperative immobilization after osteosynthesis of diaphyseal fractures remains a controversial issue, since osteosynthesis failure and the formation of a pseudoarthrosis are sometimes observed.In addition, very little information about the role of the interosseous membrane in the rotational function of the forearm during osteosynthesis is available in the literature.The OBJECTIVE was to determine the forces occurring during rotational movements of the forearm that lead to the above complications.METHODS AND MATERIALS. The clinical part included the results of surgical treatment of 330 patients with diaphyseal fractures of the forearm; it consisted of the main group (170 - interlocking osteosynthesis) and the comparison group (138 - plate osteosynthesis). The third group consisted of 22 patients with complications of surgical treatment of diaphyseal fractures of the forearm. We performed a comparative assessment of plate and interlocking osteosynthesis of radial bone fractures by mathematical modelling to determine the forces occurring during forearm rotation that lead to nonunion, instability and plate fractures.RESULTS. In the main group, healing was achieved in all (170 patients), in the comparison group, healing was achieved in 128 (92.8 %), consolidation was achieved in all 22 patients with fracture complications who underwent reconstruction. A comparative assessment revealed that during plate osteosynthesis, zones of high stress concentration were located around the plate opening above the area of fracture and the nearest to it holes from both sides. In interlocking osteosynthesis of the radius, the stresses are evenly distributed around the nail. Pronation-supination movements with an amplitude of (±90)°, according to the experimental results, should lead to the destruction of the cortical plate fairly soon after implantation, while the nail made of ultra-fine Ti-6Al-7Nb alloy will maintain its integrity.CONCLUSION. Based on these findings, external immobilization is advisable to avoid complications such as osteosynthesis instability or plate fracture.

Indicators of Intratissue Pressure in the Carpal Tunnel in Fractures of the Distal Radius

Summary. According to the literature, the pathogenesis of the secondary carpal tunnel syndrome in distal radius fractures remains poorly studied; local post-traumatic compartment syndrome is one of the possible mechanisms of its development.
 Objective: to study the indicators of subfascial pressure in the carpal tunnel in fractures of the distal radius in the acute period of injury and their relationship with the severity of the fracture, skialogic indicators of displacement, the severity of pain syndrome, the patient's age, and time since the injury.
 Materials and Methods. The study included 24 patients with acute fractures aged 48.4±19.0 years, among them 8 males and 16 females. The time from the moment of injury to the measurement of pressure with the “Stryker monitor pressure system” device was 10.5±9.8 hours; the indicators were correlated with pain syndrome according to the VAS scale, skialogic indicators of distal epimetaphysis deformity, and the severity of fractures according to the classification of fractures of the Association of Osteosynthesis (AO). By interviewing patients in a long-term period, the complaints which are a characteristic of lesions of the median nerve at the level of the carpal canal were determined.
 Results. In distal radius fractures in the acute period of injury, the level of subfascial pressure is on average 26.5±12.3 mm Hg; however, more than a third of patients (37.5%) reach critical values, 30 mm Hg and more, which can lead to ischemic damage to the soft tissues of the hand, including the median nerve. A moderate reliable relationship between the subfascial pressure parameters in the carpal canal and the severity of the fracture according to the AO classification, the level of pain syndrome according to the VAS scale, the age of patients, and a weak probable relationship with the period after injury, the degree of relative shortening of the radius, indicators of intra-articular displacement and loss of ulnar inclination of the distal epimetaphysis were determined. No significant and reliable correlation between the indicators of intra-tissue pressure in the carpal tunnel and the angle of the palmar inclination of the articular facet in distal epimetaphysis of the radial bone fractures was found. None of the examined patients developed carpal tunnel syndrome, so there is no direct correlation between increased subfascial carpal tunnel pressure in the acute period after the injury and the incidence of median nerve compression neuropathy.
 Conclusions. A moderate reliable relationship between the subfascial pressure parameters in the carpal canal and the severity of the fracture according to the AO classification, the level of pain syndrome according to the VAS scale, and the age of the patients, as well as a weak reliable correlation with the post-injury period, the degree of post-traumatic deformity of distal epimetaphysis of the radial bone in the form of its relative shortening and loss of inclination, and indicators of intra-articular displacement were determined. In this study, no correlation was found between increased subfascial pressure in the carpal canal in the acute period after trauma and the occurrence of compression neuropathy of the median nerve.

Characteristics of lower limb injuries in non-fatal road traffic accidents: a retrospective analysis of forensic medical examinations

Background. Fractures of the lower limbs are one of the most common injuries in road traffic accidents, however, the frequency and localization of fractures, as well as associated trauma, are not well understood. The purpose of the study was to conduct a retrospective analysis of forensic medical examinations of victims with the road traffic injuries of the lower limbs. Results. The research material was 100 reports of forensic medical examinations of victims with fractures of the femur and/or shin bones resulting from a non-fatal road traffic accidents. The study found that the average age of the victims was 41.5 ± 18.8 years (18 - 81 years). The main contingent of those injured was pedestrians (82%). In victims, the most common injury was polytrauma; closed limb fractures were more common. Hip fractures of various localization were found in 39%, shin fractures - in 59%, ankle fractures - in 12%. Closed head injury with a concussion of the brain of a mild degree (23%), closed fractures of the ribs (3%), self-healing dislocation of the humerus (1%), diaphyseal fractures of the forearm (3%), distal radial bone fractures (7%), and fractures of styloid process of the ulna (2%) were also noted. Conclusions. The main victims of road traffic accidents are pedestrians with polytrauma. The most common localization of fractures of the lower extremities is the diaphysis of the femur and the diaphysis of the shin bones.

Effect of low-level laser therapy on fracture healing in rabbits.

The purpose of this study was to investigate the effect of low-level laser therapy (LLLT) on radial bone fracture gap healing in a rabbit model. Thirty male white New Zealand rabbits under general anesthesia had a 3mm slice of radial bone surgically removed. Fifteen rabbits were treated by 830 nm laser at 4 J/cm2 and 15 were used as non-treated controls. Callus development was assessed by X-ray and radiographs every 7 days for 3 weeks. Significant radiologic changes were observed in both groups against time (P > 0.001) or from week to week (P > 0.05). However, there was no statistical difference in radiologic scores after week 2 (P = 0.087) or week 3 (P = 0.077) between control and laser treated bone. Findings suggest that in this study, laser treatment did not enhance callus formation nor reduce repair time of complete fracture of the radius in rabbits.

How post-operative rehabilitation exercises influence the healing process of radial bone shaft fractures fixed by a composite bone plate

Radial bone shaft fractures are commonly treated with bone plates. Flexible bone plates made of fiber-reinforced polymer composites have advantages over complications, such as stress shielding, corrosion, harmful ions, X-ray artifacts, resulting from metallic bone plates. Postoperative rehabilitation exercise is an important factor influencing the healing outcomes of radial bone fractures. A finite element model of radial shaft fracture was treated with Twintex [0]2nT composite bone plate and six stainless steel bicortical screws. Axial compression (10N), bending moment (0.1Nm), and torsion (0.1Nm) as single, combined, and alternative loads (10% loads of daily activities) were used in the finite element study. A mechano-regulation algorithm based on deviatoric strain was used to predict the healing of bone fractures. The healing performance and bending stiffness were evaluated and compared to estimate the healing status of bone fractures. The best exercise mode, which gave the highest healing performance (68%) and bending stiffness (89%), was suggested. These results can be successfully utilized for the design of healing devices for the rehabilitation of fractured bones.

Outcomes of the Osteocutaneous Radial Forearm Free Flap for Mandibular Reconstruction

Limited donor and recipient site complications support the osteocutaneous radial forearm free flap (OCRFFF) for mandibular reconstruction as a useful option for single-stage mandibular reconstruction. To examine and report long-term outcomes and complications at the donor and recipient sites for patients undergoing the OCRFFF for mandibular reconstruction. Retrospective review. Academic, tertiary care medical center. The study population comprised 167 consecutive patients who underwent single-staged mandibular reconstruction with an OCRFFF. Rates of complications at the donor and recipient sites. The mean patient age was 61 years (range, 20-93 years). Men compromised 68% of the population. Follow-up interval ranged from 2 to 99 months (mean, 25.9 months). The median length of bone harvested was 7 cm (range, 2.5-12.0 cm). Prophylactic plating was completed for each of the radii at the time of harvest. Donor site complications included radial fracture (1 patient [0.5%]), tendon exposure (47 patients [28%]), and donor hand weakness or numbness (13 patients [9%]). Recipient site complications included mandible hardware exposure (29 patients [17%]), mandible nonunion or malunion (4 patients [2%]), and mandible bone or hardware fracture (4 patients [2%]). Using regression analysis, we found that patients were 1.3 times more likely to have plate exposure for every increase of 1 cm of bone harvest length; this was statistically significant (P = .04). This is the largest single study reporting outcomes and complications for patients undergoing OCRFFF for mandibular reconstruction. Prophylactic plating of the donor radius has nearly eliminated the risk of pathologic radial bone fractures. Limited long-term donor and recipient site complications support the use of this flap for single-stage mandibular reconstruction.

Operative treatment of radial neck fractures in children

Injuries to the ulnar joint area are common musculoskeletal injuries in children. Among them, proximal radial bone fractures are characterized by a variety of treatment methods applied and a risk of complications. The aim of the present paper is to present the types and treatment results of proximal radial bone fractures in children. The present study is based on data obtained from the medical histories of 28 patients treated in the years 2006-2010. The clinical parameters analysed included the extent of bone fragment displacement, age and sex of the patient, and type and result of the operative treatment. Types and results of the operative treatment are presented based on post-operative clinical follow-up of 2 to 5 years. 1. Paediatric radial neck fractures occur primarily in adolescents and children at early school age, and the fracture line extends within the growth plate area. 2. The treatment results allow us to conclude that closed reduction of a radial neck fracture with intramedullary stabilization (ESIN) eliminates complications and provides for earlier restoration of the range of motion in the ulnar joint.

Zygomaticomaxillary buttress reconstruction of midface defects with the osteocutaneous radial forearm free flap

The purpose of this study was to evaluate morbidity, functional, and aesthetic outcomes in midface zygomatic-maxillary buttress reconstruction using the osteocutaneous radial forearm free flap (OCRFFF). A retrospective review of 24 consecutive patients that underwent midface reconstruction using the OCRFFF was performed. All patients had variable extension of maxillectomy defects that requires restoration of the zygomatic-maxillary buttress. After harvest, the OCRFFF was fixed transversely with miniplates connecting the remaining zygoma to the anterior maxilla. The orbital support was given by titanium mesh when needed that was fixed to the radial forearm bone anteriorly and placed on the remaining orbital floor posteriorly. The skin paddle was used for intraoral lining, external skin coverage, or both. The main outcome measures were flap success, donor-site morbidity, orbital, and oral complications. Facial contour, speech understandability, swallowing, oronasal separation, and socialization were also analyzed. There were 6 women and 18 men, with an average age of 66 years old (range, 34-87). The resulting defects after maxillectomy were (according to the Cordeiro classification; Disa et al, Ann Plast Surg 2001;47:612-619; Santamaria and Cordeiro, J Surg Oncol 2006;94:522-531): type I (8.3%), type II (33.3%), type III (45.8%), and type IV (12.5%). There were no flap losses. Donor-site complications included partial loss of the split thickness skin graft (25%) and 1 radial bone fracture. The most significant recipient-site complications were severe ectropion (24%), dystopia (8%), and oronasal fistula (12%). All the complications occurred in patients with defects that required orbital floor reconstruction and/or cheek skin coverage. The average follow-up was 11.5 months, and over 80% of the patients had adequate swallowing, speech, and reincorporation to normal daily activities. The OCRFFF is an excellent alternative for midface reconstruction of the zygomatic-maxillary buttress. Complications were more common in patients who underwent resection of the orbital rim and floor (type III and IV defects) or external cheek skin.

Latent Hypoparathyroidism in an Osteoporotic Patient with Multiple Endocrinopathies and Secondary Hemochromatosis due to Multiple Blood Transfusions, Unmasked by Alendronate and Glucocorticoid at Adrenal Crisis

A 30-year-old normocalcemic man with hypopituitarism, hypogonadism, diabetes mellitus, and secondary hemochromatosis due to multiple blood transfusions was admitted because of adrenal crisis. After intravenous administration of saline and cortisol, the corrected serum level of calcium decreased to 7.3 mg/dl. This osteoporotic patient had been prescribed alendronate for radial bone fracture. Since the increase in intact PTH (68 pg/ml) was impaired compared to that seen in hypocalcemic patients with secondary hyperparathyroidism, we presume that the patient has had latent hypoparathyroidism, which was unmasked by the administration of glucocorticoid and bisphosphonate. With a supplemented dose of 1alpha-OHD3, the patient has been eucalcemic.

Alendronate Improves Vitamin D–Resistant Osteopenia Triggered By Gastrectomy in Patients With Gastric Cancer Followed Long Term

Gastrectomy/gastric bypass has been used for patients with gastric cancer, and its application is now expanding to treating patients with morbid obesity, the prevalence of which is increasing worldwide. It is well known that gastrectomy leads to osteopenia, but the underlying pathophysiology and optimum treatments for this disorder have not been delineated. We followed 13 patients who showed progressive osteopenia (bone mineral density T-score<-2.4 SD) after gastrectomy/gastric bypass due to gastric cancer and who were resistant to long-term treatment (mean, 6 years) of active vitamin D3 and prospectively studied the effects of alendronate, a bisphosphonate, on osteopenia-related parameters for 2 years. Oral administration of alendronate in addition to vitamin D3 led to remarkable improvement within 2 years, not only in clinical symptoms, such as radial bone fractures and lumbar pain, but also in parameters for osteopenia, including decreased bone mineral density of the lumbar spine (P<0.01), decreased concentrations of calcium (P<0.05), increased urine levels of deoxypyridinoline (P<0.01), increased serum levels of bone-specific alkaline phosphatase (P<0.01), increased serum levels of osteocalcin (P<0.01), and increased serum levels of intact parathyroid hormone (P<0.05), although body weight did not alter. These results suggest that bisphosphonate may improve osteopenia after gastrectomy/gastric bypass.

ステロイド注入が原因と思われる長母指伸筋けん皮下断裂の経験

There are many reports about ruptures of the extesor pollicis longus tendon, caused by RA, by trauma, by radial bone fracture etc. We experienced a case of steroid induced rupture of the tendon. Case report; a 16-year-old, female. Chief complaint; disorder of the right thumb. She began working for a stocking manufacturing plant in April 1983. In August she complained of right wrist pain. She was diagnosed as having tendonitis, and was infitrated with steroid four times during two months without immobilization. In October, shee noticed a disorder of the right thumb suddenly when she was washing dishes. Immediately she consulted our hospital. There she was diagnosed as having a rupture of E. P. L. tendon. She was treated surgically. Duving surgery, E. P. L. tendon was ruptured completely and the ends were split finely. They were sutured end-to-end, and immobilised in plaster. The plaster was removed eight weeks after the operation. She could return to the same co pany. We consider the causes of rupture to be delayed healing following steroid injection and mechanical stress over this. We have had a new appreciation of an adverse reactionof steroid and the need for immobilization.