Radius In Young Adults Research Articles

Intra-Articular Fractures of the Distal End of the Radius in Young Adults: Reexamined as Evidence-Based and Outcomes Medicine

The article “Intra-Articular Fractures of the Distal End of the Radius in Young Adults,” by Knirk and Jupiter, published in The Journal of Bone and Joint Surgery1 in 1986, in its day, was arguably one of the most important works on the management of intra-articular fractures of the distal end of the radius. Prior to the publication of that study, the critical factors that determined successful long-term management of intra-articular distal radial fractures in young patients had not been determined. The finding with the greatest impact on treatment algorithms was that accurate articular restoration was the most critical factor in preventing long-term arthritis in young patients with intra-articular distal radial fractures. However, twenty-three years of advancements in orthopaedic surgery and technology have exposed the methodological flaws of that study. The radiographic analysis incorrectly interpreted fracture lines, and the study failed to use intraobserver and interobserver validation in its analysis. The study also was conducted before the popularization of computerized tomography and wrist arthroscopy. Despite these shortcomings, an updated critical analysis reveals that its conclusions are still germane in today's treatment of distal radial fractures in young adults. The study by Knirk and Jupiter1 has been cited in 330 research and scholarly articles. Although it is sometimes inaccurately referenced2, it ranks among the most cited manuscripts in the orthopaedic surgery literature. Today, its conclusions not only direct the treatment of distal radial fractures but they also continue to generate hypotheses for outcome studies. Given the impact of the study on the standard of care and orthopaedic research, it is appropriate to critically review its methodology to determine whether the findings remain relevant today. Intra-articular fractures of the distal end of the radius in the young adult are a distinct group of fractures that can lead to accelerated …

Misquotation of a Commonly Referenced Hand Surgery Study

Novel clinical studies often define how we practice hand surgery. Proper referencing of these articles is therefore critical. Since the publication of Knirk and Jupiter's 1986 study analyzing intra-articular distal radius fractures in young adults, citations of this article have appeared to be inconsistent in the biomedical literature. We believe that analysis of studies referencing the Knirk and Jupiter article will reveal notable discrepancies with respect to the original data. We carefully reviewed Knirk and Jupiter's original article, "Intra-articular Fractures of the Distal End of the Radius in Young Adults" (J Bone Joint Surg 1986;68A:647-659) and formulated a comprehensive tabular outline of results and conclusions made in the article for reference. An electronic search was performed using the Institute for Scientific Information Scientific Citation Index for all articles written in English referencing the Knirk and Jupiter article from 1986 through 2002. Of the 159 articles found in the ISI database, 154 were retrieved and reviewed by 2 hand surgeons. Each article referencing the work was classified into 1 or more of 12 separate categories and rated as accurate, inaccurate, or equivocal with respect to Knirk and Jupiter's original data. Of the 154 articles examined, 63 have at least 1 inaccurate reference of the Knirk and Jupiter article. In general, articles referencing Knirk and Jupiter's classification system, protocol, or tables are accurate (59 of 63), whereas a majority of the articles addressing the value of 2 mm of articular incongruity after a distal radius fracture are inaccurate (43 of 57). Conclusions drawn from the Knirk and Jupiter article, especially regarding the value of 2 mm of articular incongruity of the radiocarpal joint at the time of fracture union, vary from one author to the next. Care must be taken in referencing biomedical literature, particularly articles that have a potentially profound impact on clinical patient management.

External fixators combined with limited internal fixation for serious comminuted fractures of distal radius in young adults

目的 探讨外固定支架加克氏针内固定治疗青壮年桡骨远端粉碎骨折的临床疗效.方法 2000年1月～2005年8月采用外固定支架加有限内固定治疗桡骨远端粉碎性骨折30例,外固定支架在术后6～8周拆除,术后进行腕关节功能锻炼.结果 所有患者获得14～24个月(平均16个月)随访.所有患者2个月均达骨性愈合,关节功能评定:优24例,良4例,差2例,优良率为93.3%.结论 外固定支架固定加有限克氏针内固定对治疗青壮年桡骨远端粉碎性骨折,固定牢固、可靠,可有效防止骨折的再移位和丢失,但不能过早进行腕关节功能锻炼,必须选择合适的时机拆除外固定支架,便于早期腕关节功能锻炼。

Wrist arthroscopy and intra-articular fractures of the distal radius in young adults

The difficulty on treatment of articular fractures of the distal radius comes from their comminutive character and frequency of ligamentous lesions associated, turning diagnosis and assessment always subject to discussion. Fracture reduction and fixation under arthroscopic control, along with ligamentous injury treatment, provides the Surgeon with a valuable tool in order to achieve best results on follow-up. Eighteen fractures of the distal radius on 18 young adults (average age of 28.6 years), all intra-articular and 9 with ligamentous lesions associated, were operated on under arthroscopic control. Results from an average distance of 12.2 months were appraised following the score of Green and O'Brien modified by Cooney. They were excellent in five cases, good in eight cases, average in four cases and bad in one case. Recovery was best for fractures with weak comminution and when articular congruence was restored. Arthroscopy, allowing control of fracture reduction, to diagnose and possibly treat associated ligamentous lesions, constitutes a good alternative to open surgical treatment. case series (level IV).

Intra-articular fractures of the distal end of the radius in young adults

Intra-articular fractures of the distal part of the radius in young adults comprise a distinct subgroup of fractures that are difficult to manage and are associated with a high frequency of post-traumatic arthritis. The effect of residual radiocarpal incongruity after this fracture has not been investigated previously. A retrospective study of forty-three fractures in forty young adults (mean age, 27.6 years) was done to determine the components that are critical to the outcome. Treatment included application of a cast alone in twenty-one fractures, insertion of pins and application of a plaster cast in seventeen, external fixation in two fractures, and open reduction and internal fixation in three fractures. At a mean follow-up of 6.7 years, 26 per cent were rated as excellent; 35 per cent, as good; 33 per cent, as fair; and 6 per cent, as poor. There was radiographic evidence of post-traumatic arthritis in twenty-eight (65 per cent) of the fractures. Accurate articular restoration was the most critical factor in achieving a successful result. Of the twenty-four fractures that healed with residual incongruity of the radiocarpal joint, arthritis was noted in 91 per cent, whereas of the nineteen fractures that healed with a congruous joint, arthritis developed in only 11 per cent. A depressed articular surface (a so-called die-punch fragment) was reduced anatomically by closed means in only 49 per cent and was responsible for residual incongruity in 75 per cent of the incongruous joints at late follow-up. Non-union of the ulnar styloid process adversely affected the results. Restoration and maintenance (extra-articular reduction) of the dorsal tilt and radial length did not prove critical except when severe radial shortening occurred.

Conservative treatment of intra-articular fractures of the distal radius--factors affecting functional outcome.

One hundred and eleven intra-articular fractures of the distal radius in young adults that were conservatively treated were studied. At two years, 80% of fractures were rated as excellent or good by the modified Green and O'Brien scoring system. The rate of re-displacement within casts was 28%. Sixty five per cent of re-displaced fractures were treated with surgical fixation. Those re-displaced fractures treated with repeated manipulation had only 33% excellent or good result. Moreover, their initial alignment could not be preserved. Axial compression (>2 mm) and dorsal angulation (>15 degrees ) were directly related to worse functional outcome and diminished range of motion.

Intraarticular lesions in distal fractures of the radius in young adults: A descriptive arthroscopic study in 50 patients

We examined the frequency of associated chondral and ligament lesions in distal fractures of the radius in young adults (men 20-60 years, women 20-50 years). Fifty initially displaced fractures were examined arthroscopically. Chondral lesions were found in 16 patients (32%). All patients but one were found to have a ligamentous injury in the wrist. No major instability was found. The most frequent ligament tear was the triangular fibrocartilage complex in 39 cases (78%), with a statistical correlation to ulnar styloid fractures. The scapholunate ligament was partially or totally torn in 27 cases (54%). No correlation was found between specific fracture type and pattern of ligament injury. Chondral and ligamentous lesions were frequent and may explain poor outcomes after seemingly well-healed distal fractures of the radius. The ligament lesions should also be kept in mind when early mobilization of the distal fracture of the radius is considered.

Extra-articular fractures of the distal radius in young adults a technique of closed reposition and stabilisation by mono-segmental, radio-radial external fixator

Some fractures of the distal radius need an operative treatment in order to restore and maintain both length and anatomical angles of the distal joint surfaces. We present a technique of closed reposition and stabilisation by external fixator on the distal radius, without any bridging of the wrist joint, allowing for active and passive motion of the wrist during bone healing. Two cases are illustrated as examples.

Fractures of the distal end of the radius in young adults: A 30-year follow-up

76 patients were examined clinically and radiologically 27 to 36 years after a fracture of the distal radius. The average age was 31 years at the time of injury and 63 years at follow-up. In 81% of the patients there was no difference between the fractured and the non-fractured side. No patient had to change his or her occupation or leisure activities because of the fracture. There were more degenerative changes in the fractured wrist than in the non-injured side. A statistically significant correlation was found between axial compression and the presence of degenerative changes in the radio-carpal and distal radio-ulnar joints. Treatment of the fracture of the distal end of the radius in the young adult should aim to conserve the length of the radius. However, after 30 years, complaints are few and correlate with degenerative changes in the radio-carpal joint only. 47 patients with articular fractures of the distal end of the radius were examined in the same way. The average age at the time of injury was 32 years and 58% of the patients were men. In 87% of the patients there was no difference between the fractured and the non-fractured side. However 37% had minor complaints. A higher proportion of patients with articular fractures developed degenerative changes than those with non-articular fractures. The existence of radiographic signs of osteoarthritis is directly related to axial compression and the persistant incongruity, after reposition, in either the radio-carpal or the distal radio-ulnar joints.

Intraarticular fractures of the distal end of the radius in young adults: A 16 (2–26) year follow-up of 42 patients

Forty-two patients, aged 29 (17-42) years when they sustained an intraarticular fracture of the distal end of the radius, were reexamined after 16 (2-26) years. More than two thirds of the fractures were caused by high-energy trauma. Subjectively, 34 patients had excellent or good results, while only 8 had fair or poor results; 6 patients had changed their occupation owing to disability from the wrist. Almost half of the patients had residual deformity at the follow-up clinical examination. Slightly more than half of the patients had radiographic arthrosis. Subjective evaluation correlated with residual deformity and arthrosis, but not with radiographic displacement or intraarticular step off. Arthrosis correlated with residual deformity and intraarticular step off, but not with radiographic displacement. Clinical residual deformity included soft-tissue changes in contrast to radiographic displacement. More interest should be directed to soft-tissue changes following this type of fracture.

External fixation and recovery of function following fractures of the distal radius in young adults

The functional recovery from Colles' fracture was studied prospectively over a 1-year period in 106 patients randomized to treatment by plaster or external fixation. Although external fixation allows immediate mobilization of the wrist and leads to a much better anatomical result, these factors did not permit any improvement in the wrist's early functional recovery. One year following injury the grip strength of the fixatortreated group was significantly superior to that of the plastertreated patients.

The outcome of fractures of the distal radius in young adults

Fractures of the distal radius in young adults are not uncommon, but have received little attention in the literature. This paper reports a series of 40 fractures of the distal radius. The quality of reduction was found to relate directly to the final result. The authors suggest that open reduction and internal fixation be used more frequently in the management of this fracture.

Intra-articular fractures of the distal end of the radius in young adults.

Intra-articular fractures of the distal end of the radius in young adults.

Intra-articular fracture of radius : Knirk J. L. and Jupiter J. B. (1986) Intra-articular fracture of the distal end of the radius in young adults. J. Bone JointSurg.68A, 647

Intra-articular fracture of radius : Knirk J. L. and Jupiter J. B. (1986) Intra-articular fracture of the distal end of the radius in young adults. J. Bone JointSurg.68A, 647

Intra-articular fractures of the distal end of the radius in young adults.

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