Ulnar Fracture Research Articles

Upper limb pediatric fractures in 22 tertiary children's hospitals, China: a multicenter epidemiological investigation and economic factor analysis of 32,832 hospitalized children

BackgroundFractures are the most common type of unintentional injury in children, with traumatic upper limb fractures accounting for approximately 80% of all childhood fractures. Many epidemiological investigations of upper limb fractures in children have been conducted, but with the development of society, the patterns of childhood fractures may have changed. This study aimed to analyze the epidemiology and economic cost factors of upper limb fractures in Chinese children.MethodsWe retrospectively reviewed children with upper limb fractures or old upper limb fractures hospitalized between December 1, 2015, and December 31, 2019, in 22 tertiary children’s hospitals, under China’s Futang Research Center of Pediatric Development. We used the ICD10 codes on the front sheet of their medical records to identify cases and extracted data on age, sex, injury cause, fracture site, treatment, the year of admission and discharge, visiting time, and various costs during hospitalization from the medical record.ResultsA total of 32,439 children (21,478 boys and 10,961 girls) were identified, of whom 32,080 had fresh fractures and 359 had old fractures. The peak age was 3–6 years in both sexes. A total of 4788 were infants, 14,320 were preschoolers, 10,499 were in of primary school age, and 2832 were adolescent. Fractures were most frequent in autumn (August to October). Admissions peaked at 0 o’clock. Among the 32,080 children with fresh upper limb fractures, the most common fracture site was the distal humerus, with a total of 20,090 fracture events including 13,134 humeral supracondylar fractures and 4914 lateral humeral condyle fractures. The most common cause of injuries was falling over. The most common joint dislocation accompanying upper limb fractures occurred in the elbow, involving 254 cases. Surgery was performed in 31,274 children, and 806 did not receive surgery. Among those with clear operative records, 10,962 children were treated with open reduction and 18,066 with closed reduction. The number of cases was largest in the East China region (Anhui Province, Shandong Province, Jiangsu Province, Zhejiang Province, and Fujian Province), with 12,065 cases overall. Among the 359 children with old fractures, 118 were admitted with a diagnosis of “old humerus fracture,” accounting for the highest proportion; 244 underwent surgical open reduction, 16.16% of whom had osteotomy. For the children with fresh fractures, the average total hospital cost was 10,994 yuan, and the highest average total hospital cost was 14,053 yuan, for humeral shaft fractures. For the children with old fractures, the average total hospital cost was 15,151 yuan, and the highest average total hospital cost was 20,698 yuan, for old ulna fractures. Cost of materials was the principle factor affecting total hospital cost, followed by surgery and anesthesia costs, both in children with fresh fractures and those with old fractures. Significant differences were observed in all hospital costs (P < 0.001) except treatment costs (P = 0.702), between children with fresh fractures and those with old fractures. Among the 32,439 children, full self-payment accounted for the highest proportion of all payment methods, involving 17,088 cases, with an average cost of 11,111 yuan.ConclusionInformation on the epidemiological characteristics of childhood fractures suggests that health and safety education and protective measures should be strengthened to prevent upper limb fractures in children. For both fresh and old fractures, the cost of materials was the principal factor affecting total hospital cost, followed by surgery and anesthesia costs. The overall average total hospital cost is higher in children with old fractures than in children with fresh fractures. Among all children, full self-payment, at 53% of children, accounted for the highest proportion of all payment methods. Hospital costs are a headache for those families who will pay on their own. It can lead to a delayed treatment and unhealed fractures or malunion in some children. Therefore, the child trauma care system and training on fractures need to be improved, to reduce the late presentation of fractures. These combined measures will improve children’s quality of life, reduce the expenditure of families, and decrease the public health burden. To provide better medical services for children, authorities must improve the allocation of health resources, establish a comprehensive medical security system for children, and set up more child trauma centers.

Comparison between volar plating and external fixation augmented by Kirshner wires in comminuted distal radial fractures

Background Volar locking plate (VLP) has gained the most popularity in the treatment of distal radius fractures due to its superior biomechanical property. In contrast, external fixation (EF) is not so extensively used. The aim of this study was to find what procedure is better in the management and achieves favorable outcomes in patients with comminuted distal radial fractures. Patient and methods This study included 30 patients with distal radial fractures AO types A3, C2, C3 in which 15 ubjects were managed with open reduction and internal fixation by volar plate, and another 15 were managed with external fixation augmented by K-wires. The minimum duration of follow-up in our study was six months. Results Patients treated with external fixation augmented by K-wires had grip strength range 15-27, patients treated with volar plating had grip strength range 8-27. There was no significant statistical difference between 2 groups regarding extension. In Group A Mann- Whitney test revealed that Gartland-Werely score had negative correlation with affected hand. In Group B the correlation was positive with AO/ OTA classification only and negative with affected hand and ulnar styloid fracture but also not statistically significant between Quick-DASH score with affected hand, AO/OTA classification and ulnar styloid fracture. Conclusion Both volar plating and external fixation augmented by K-wires are treatment choices for distal radius fractures. Whereas external fixation maintains a significant role in the treatment of distal radius fractures, ORIF with locked volar plating has changed the way many surgeons treat certain types of distal radius fractures.

Anatomical and Clinical Concepts in Distal Radius Volar Ulnar Corner fractures.

Background Volar ulnar corner fractures are a subset of distal radius fractures that can have disastrous complications if not appreciated, recognized, and appropriately managed. The volar ulnar corner of the distal radius is the "critical corner" between the radial calcar, distal ulna, and carpus and is responsible for maintaining stability while transferring force from the carpus. Description Force transmitted from the carpus to the radial diaphysis is via the radial calcar. A breach in this area of thickened cortex may result in the collapse of the critical corner. The watershed ridge (line) is clinically important in these injuries and must be appreciated during planning and fixation. Fractures distal to the watershed ridge create an added level of complexity and associated injuries must be managed. An osteoligamentous unit comprises bone-ligament-bone construct. Volar ulnar corner fractures represent a spectrum of osteoligamentous injuries each with their own associated injuries and management techniques. The force from the initial volar ulnar corner fracture can propagate along the volar rim resulting in an occult volar ligament injury, which is a larger zone of injury than appreciated on radiographs and computerized tomography scan. These lesions are often underestimated at the time of fixation, and for this reason, we refer to them as sleeper lesions. Unfortunately, they may become unmasked once the wrist is mobilized or loaded. Conclusions Management requires careful planning due to a relatively high rate of complications after fixation. A systematic approach to plate positioning, utilizing several fixation techniques beyond the standard volar rim plate, and utilizing fluoroscopy and/or arthroscopy is the key strategy to assist with management. In this article, we take a different view of the volar ulnar corner anatomy, applied anatomy of the region, associated injuries, and management options.

Predictors for nonunion of unrepaired ulnar styloid fracture associated with distal radius fractures in patients treated with volar locking plate fixation and their effect on functional outcomes

IntroductionNonunion of ulnar styloid fractures after radius stabilisation by volar locking plate (VLP) fixation without surgical fixation on ulnar styloid fractures is quite common. However, the factors affecting the nonunion of ulnar styloid fractures and their effect on functional outcomes in patients with distal radius fractures (DRFs) treated with VLP fixation are unclear. HypothesisThe purpose of this study was to investigate the predictors affecting nonunion of unrepaired ulnar styloid fractures in patients with DRFs and the effect of nonunion and its predictors on functional outcomes. Materials and methodsWe retrospectively reviewed data from 84 patients with DRF who underwent VLP fixation. None of the accompanying ulnar styloid fractures were manipulated during the surgery. Postoperative evaluation included the measurement of the grip strength, wrist range of motion, and Disabilities of the Arm, Shoulder, and Hand score at a minimum of one year postoperatively. Patients were divided into the nonunion and union groups according to the presence of union of ulnar styloid fracture. Demographic and radiologic parameters, including age, sex, bone mineral density, location and displacement distance of ulnar styloid fracture, and fracture pattern of DRFs, were analysed to identify predictors of nonunion. Functional outcomes were compared between the two groups and were compared according to the presence of predictors of nonunion. ResultsUnivariate analysis revealed that the nonunion rate was higher in ulnar styloid non-base fractures, substantial displacement (≥1.9mm) of ulnar styloid fracture, and AO/OTA C-type DRF. However, multivariate logistic regression analysis showed that non-base fractures and substantial displacement were significant predictors. Accompanying ulnar styloid fracture nonunion and its predictors were found not to influence functional outcomes. DiscussionSubstantial displacement and non-base fracture are predictive factors for nonunion of unrepaired ulnar styloid fractures after DRF treatment with VLP fixation. However, nonunion and its predictors do not influence the overall wrist function. These findings suggest that the ulnar styloid fracture accompanying DRF should not be considered a fracture affecting the wrist function when treating with VLP fixation. Level of evidenceIII, Retrospective, Case Control study.

Foveal Triangular Fibrocartilage Complex Tears: Recognition of a Combined Tear Pattern

Triangular fibrocartilage complex (TFCC) injuries are categorized most commonly by the Palmer and the Atzei and Luchetti classifications. Combined tears are reported less frequently, and the classification of these tears is unclear. In this study, we present a series of patients with combined central disc and foveal TFCC tears that do not fit into either of these classifications. Seventeen patients from 2 institutions presented with a combined central and foveal TFCC tear, confirmed by wrist arthroscopy between September 2017 and December 2020. Patient demographics, injury mechanism, associated injuries, clinical findings, magnetic resonance imaging results, surgeon description of tears, and treatment rendered were evaluated. Patients were predominantly female (76%). Mean age was 40 years with a bimodal age distribution (7/17 patients <35 and 10/17 >45 years). Eleven patients (65%) sustained the injury from a fall. All had some degree of distal radioulnar joint (DRUJ) instability on clinical examination and almost half (8/17) had a history of a distal radius or ulnar styloid fracture during the initial injury. The foveal tear was confirmed by direct visual assessment and a positive hook test result; a suction test result commonly was positive as well. All patients underwent debridement of the central tear, and 16 of 17 underwent foveal TFCC repair with 1 having an irreparable tear. We present a series of patients with combined central disc and foveal TFCC tears, a pattern that does not fit current classification schemes. All patients exhibited some degree of instability of the DRUJ and almost half had a history of distal radius or ulnar styloid fracture. Identification of a central tear of the TFCC, together with even subtle DRUJ instability, should lead to consideration of a coexistent foveal tear. Diagnostic IV.

Peri-Implant Distal Radius Fracture: Proposal of a New Classification

A peri-implant fracture near the volar plate of the distal radius represents a rarity and can be associated with a mechanical failure of the devices. A literature review was conducted including all fractures that occurred around a volar wrist plate, which could be associated with an ulna fracture. All articles published until December 2021 were considered according to the guidelines presented in the PRISMA Statement. The search was conducted with the PubMed electronic database, Cochrane Database of Systematic Reviews, Medline, Embase, and Google Scholar. Only nine cases of these fractures were reported in the literature. The causes could be due to delayed union/non-union of the old fracture after low energy traumas, high energy trauma in patients with poor bone quality, or hardware mechanical failure. Furthermore, the literature review of peri-implant radius fracture shows different level of radius fracture and types of implant failure. In accordance with these different cases, a new classification of peri-implant fracture of the distal radius is proposed.

Operative Stabilization of Distal Radius Fractures Presenting With Ulnar Head Subluxation/Dislocation Addresses Distal Radioulnar Joint Instability Without Further Stabilization Procedures.

To determine the prevalence of ulnar head subluxation/dislocation in distal radius fracture and to discuss management, surgical outcomes, and relevant anatomy. Urban tertiary care hospital. Two hundred seventy-one patients with displaced distal radius fractures undergoing surgical management were reviewed to determine the incidence of ulnar head subluxation or dislocation using the Mino criteria defined by Mino et al. Postoperative computed tomography and radiographs were assessed for sigmoid notch and distal radioulnar joint (DRUJ) reduction and fracture healing. Range of motion, functional limitation, and pain were documented at final outcome. Of the 271 cases, there were 8 cases of prereduction DRUJ subluxation/dislocation, including 2 frank dislocations and 6 subluxations (2.95%). All were treated with open reduction and internal fixation (ORIF) of the distal radius with a volar locked plate. In addition, 1 patient underwent ORIF of an associated distal ulnar shaft fracture and another, who had a grade 1 open fracture over the distal ulna, underwent open TFCC repair. The remaining 6 patients had closed reduction of the DRUJ without further stabilizing procedures. All had stable DRUJ joints following ORIF, both intra-operatively and at final follow-up. All ulnar heads were located within the DRUJ on post-op computed tomography; using the more sensitive radioulnar ratio there was residual ulnar head subluxation in 5/8 patients. Range of motion and functional outcome were excellent at an average of 133 weeks postoperatively. The DRUJ was stable at long-term follow-up in all patients. Ulnar head subluxation/dislocation is an uncommon injury in the setting of distal radius fracture. When present, it can usually be treated effectively with operative stabilization of the distal radius fracture without further stabilizing procedures. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Chronic non-bacterial osteomyelitis of distal ulna in a paediatric patient: a case report and review of literature

&lt;p class="abstract"&gt;Chronic non-bacterial osteomyelitis (CNO) is a rare disorder characterized by focal aseptic inflammation with a self-limiting, relapsing course of disease with female predominance and usually observed in paediatric age groups diagnosed by clinical, radiological and histopathological findings after ruling out all other differentials. We reported this rare case found in a 7 year old female with a history of greenstick fracture of distal ulna 3 years ago with flaring up of pain and swelling since trivial trauma to left wrist 1 month ago. We emphasize on the relevant data and findings to reach the conclusive diagnosis and treatment of the disease. CNO can present as benign unifocal non-relapsing to more severe form of multifocal relapsing inflammatory lesions involving metaphysis of long bones, vertebrae, clavicle and mandible. Diagnosis is made after excluding infection, malignancy, auto-immune and metabolic disorders. Treatment is mainly empirical to reduce pain and inflammation through NSAIDs, corticosteroids, bisphosphonates and sometimes TNF alpha inhibitors as no proper guidelines are available.&lt;/p&gt;

Does Surgery Improve Healing After Isolated Diaphyseal Ulna Fractures?

Isolated diaphyseal ulna fractures can be treated nonsurgically or with open reduction and internal fixation (ORIF). It is unclear whether ORIF provides quicker and/or more predictable healing. The purpose of this study was to compare the healing characteristics of isolated diaphyseal ulna fractures after surgical and nonsurgical treatment. All patients treated for an isolated diaphyseal (distal- or middle-third) ulna fracture between 2010 and 2018, with a minimum of 3 months of follow-up, were identified. Electronic medical records were reviewed to record patient demographics, assess the treatments used, and compare outcomes. We determined healing and nonunion rates, complications, reoperations, and final radiographic fracture alignment. Ninety-five patients were included with a median follow-up of 20 weeks. Of these, 56 patients were treated nonsurgically and 39 patients were treated with ORIF. At the time of the final follow-up, 51 of the 56 (91.1%) nonsurgically treated fractures had healed and 38 of the 39 (97.4%) surgically managed fractures had healed. There were 5 nonunions after nonsurgical treatment (8.9%) and 1 nonunion after ORIF (2.6%). Eleven patients (19.6%) treated nonsurgically required conversion to ORIF, whereas 4 patients (10.3%) treated with ORIF required reoperation. Middle-third fractures treated nonsurgically had a higher rate of nonunion (30.8%) compared with distal-third fractures treated nonsurgically (2.3%). The healing characteristics of isolated ulnar shaft fractures do not appear to differ substantially between surgical and nonsurgical treatment. However, nearly 20% of the patients treated nonsurgically may require eventual ORIF. Distal-third fractures may be at a higher risk of conversion to ORIF, and middle-third fractures may be at a higher risk of nonunion. Therapeutic IV.

Poor reliability and reproducibility of 3 different radiographical classification systems for distal ulna fractures.

Background and purposeClassification of fractures can be valuable for research purposes but also in clinical work. Especially with rare fractures, such as distal ulna fractures, a treatment algorithm based on a classification can be helpful. We compared 3 different classification systems of distal ulna fractures and investigated their reliability and reproducibility.Patients and methodspatients with 97 fractures of the distal ulna, excluding the ulnar styloid, were included. All fractures were independently classified by 3 observers according to the classification by Biyani, AO/OTA 2007, and AO/OTA 2018. The classification process was repeated after a minimum of 3 weeks. We used Kappa value analysis to determine inter- and intra-rater agreement.ResultsThe inter-rater agreement of the AO/OTA 2007 classification was judged as fair, ĸ 0.40, whereas the agreement of AO/OTA 2018 and Biyani was moderate at ĸ 0.42 and 0.43 respectively. The intra-rater agreement was judged as moderate for all classifications.InterpretationThe differences between the classifications were small and the overall impression was that neither of them was good enough to be of substantial clinical value. The Biyani classification, being developed specifically for distal ulna fractures, was the easiest and most fitting for the fracture patterns seen in our material, but lacking options for fractures of the distal diaphysis. Standard radiographs were considered insufficient for an accurate classification. A better radiographic method combined with a revised classification might improve accuracy, reliability, and reproducibility.

Casting Without Reduction Versus Closed Reduction With or Without Fixation in the Treatment of Distal Radius Fractures in Children: Protocol for a Randomized Noninferiority Trial.

BackgroundAcute treatment for distal radius fractures, the most frequent fractures in the pediatric population, represents a challenge to the orthopedic surgeon. Deciding on surgical restoration of the alignment or cast immobilization without reducing the fracture is a complex concern given the remodeling potential of bones in children. In addition, the lack of evidence-based safe boundaries of shortening and angulation, that will not jeopardize upper-extremity functionality in the future, further complicates this decision.ObjectiveThe authors aim to measure functional outcomes, assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Physical Function v2.0 instrument. The authors hypothesize that outcomes will not be worse in children treated with cast immobilization in situ compared with those treated with closed reduction with or without percutaneous fixation. The authors also aim to compare the following as secondary outcomes: ulnar variance and fracture alignment in the sagittal and coronal planes, range of motion, pressure ulcers, pain control, radius osteotomy due to deformity, pseudoarthrosis cure, and remanipulation.MethodsThis is the protocol of a randomized noninferiority trial comparing upper-extremity functionality in children aged 5 to 10 years, after sustaining a distal radius fracture, treated with either cast immobilization in situ or closed reduction with or without fixation in a single orthopedic hospital. Functional follow-up is projected at 6 months, while clinical and radiographic follow-up will occur at 2 weeks, 3 months, and 9 months.ResultsRecruitment commenced in July 2021. As of January 2022, 23 children have been randomized. Authors expect an average of 5 patients to be recruited monthly; therefore, recruitment and analysis should be complete by October 2024.ConclusionsThis experimental design that addresses upper-extremity functionality after cast immobilization in situ in children who have sustained a distal fracture of the radius may yield compelling information that could aid the clinician in deciding on the most suitable orthopedic treatment.Trial RegistrationClinicalTrials.gov NCT05008029; https://clinicaltrials.gov/ct2/show/NCT05008029International Registered Report Identifier (IRRID)DERR1-10.2196/34576

Neglected Monteggia fracture: a review.

Monteggia fracture is characterized by radial head dislocation combined with proximal ulnar fracture.If not diagnosed at an early stage, these lesions can gradually lead to forearm deformities and dysfunction, finally resulting in neglected Monteggia fracture. When the radial head is not reduced, several deformities develop at the humeroradial joint, including cubitus valgus and osteoarthritis.Adequate radiographs are crucial when the surgeons deal with forearm injuries.At present, proximal ulnar osteotomy and open reduction of chronic radial head dislocation provides satisfactory functional outcomes because of anatomic alignment reconstruction.Supplementary procedures, including transcapitellar pinning and repair or reconstruction of the annular ligament, which are performed in order to enhance stability of the humeroradial joint, should be thoroughly assessed based on joint rotational stability after reduction and on potential complications.

Residual stability of the distal radioulnar joint following ulnar styloid fracture: influence of the remnant distal radioulnar ligaments.

Clinical studies suggest that even untreated basal ulnar styloid fractures may not affect patient outcomes. This may be due to the remaining parts of the distal radioulnar ligament still attached providing sufficient residual stability of the distal radioulnar joint. We tested this hypothesis in a biomechanical cadaveric model. Dorsopalmar translation of the distal radioulnar joint and forearm rotation were measured. Seventeen specimens were tested after a simulated ulnar styloid fracture including the fovea, followed by transection of the remaining palmar (n = 9) or dorsal (n = 8) portions of the distal radioulnar ligament and finally with all remnants transected. Rotation and translation both increased significantly after the final transection compared with the foveal fracture. The increase in translation was larger after transection of the dorsal remnants. We conclude that in an ulnar styloid fracture including the fovea, some ligament components are still attached to the ulnar head, giving residual stability to the distal radioulnar joint.

Simulated Analysis Ti-6Al-4V Plate and Screw as Transverse Diaphyseal Fracture Implant for Ulna Bone

Transverse diaphyseal fracture is one of the most common fractures caused by accidents. The fracture treatment needs surgery to apply the fixations that matched the bone geometry. This paper aims to reverse engineering of a published bone plate and screw criteria into a three-dimensional (3D) model and analyze them using the finite element method (FEM) in several factors, the bone, the plate, the screw, the unification of plate and screw, and combination all components. This paper conducts two main activities of designing plate and screw based on literature for ulna bone implant and running the FEM to achieve the von Misses stress in the plate, screw, and bone by placing load and constrained area based on the actual use of the implant in the patient. The maximum number in von Misses stress are 5.01855 MPa for bone only, 0.00918 MPa for plate only, 193.304 MPa for screws only, 6.28160 MPa for the assembly screws and a plate, and 761.07 MPa for all unification. All simulation results meet the expectation that the bone analysis is less than the compressive strength of the ulnar bone. Moreover, when applied to the bone, the plate and screw analysis and the assembly also demonstrate a lower number than the yield strength of the properties of the Ti6Al4V materials. All this biomechanical assessment confirms that designs could withstand ulnar bone’s ultimate flexural load and pressure. The finite element analysis (FEA) on the proposed recreated dimension on ulnar plate and screw is expected to accelerate the rehabilitation process of radius ulnar fracture, particularly in the transverse diaphyseal fracture in ulna bone.

USE OF TENSION BAND WIRING TECHNIQUE IN PROXIMAL ULNAR FRACTURES: A FINITE ELEMENT BIOMECHANICAL ANALYSIS

Background: Tension band wiring is considered the standard treatment for olecranon fracture. A recentstudy proved that it can be used for the fracture as distal to the coronoid process.&#x0D; Objective: The study aimed to investigate whether tension band wiring can be used in proximal ulnarfracture fixation up to and distal to the coronoid process.&#x0D; Methods: Models of simple proximal ulnar fracture including 4 intraarticular and 2 extraarticularfractures were created. Fixation was completed using tension band wiring technique, and biomechanicalresponses were evaluated using finite element analysis. After a physiologic load was applied, thefracture displacement, von Mises stress, and stiffness were recorded.&#x0D; Results: All fracture models were able to withstand the load of daily activities with a maximumdisplacement of 50% of the articular surface. In addition, the von Mises stress was the highest in themiddle articular fracture. The mean transcortical K-wire tension band wiring stiffness of the intraarticular and extra-articular fractures was 1144.89 N/mm and 1231.45 N/mm, respectively.&#x0D; Conclusion: Tension band wiring is another option to treat proximal ulnar fractures with the ability towithstand immediate postoperative load.

Outcomes of Paediatric Distal Radius Metaphyseal Fractures

Background: Manipulation and cast immobilisation is the accepted gold standard for management of distal radius metaphyseal fractures in children, with the use of Kirschner wires (K-wires) in cases with potential instability. The primary aim of this study was to determine the outcome of these fractures treated with our current management protocol. We also sought to identify possible risk factors for redisplacement. Methods: A retrospective study was conducted on 61 children with displaced distal radius metaphyseal fractures under the age of 16 years. Fifty-three patients were treated with manipulation and casting only, while eight patients had K-wire fixation. The primary outcome measured was redisplacement during follow-up. Initial complete displacement, an associated ulna fracture, the quality of reduction, cast and padding indices were assessed as possible risk factors for redisplacement. Results: A redisplacement rate of 18.8% was reported. We found a statistically significant association between redisplacement and non-anatomical reduction (P = 0.001), cast index (P = 0.030) and padding index (P = 0.031). Non-anatomical reduction resulted in 23.6 times more likelihood of redisplacement (P = 0.008) compared to anatomical reduction. Complete displacement and the presence of an ulna fracture had no effect on redisplacement. Conclusions: Our current treatment protocol is safe and effective based on the redisplacement rate of 18.8% which is marginally lower than current standards reported in the literature. Poor casting technique and non-anatomical reduction were found to be significant predictors of redisplacement. We suggest that K-wires be used if anatomical reduction is not achieved in older children with limited remodelling capacity.

The factors affecting the redisplacement in distal radius fractures

Objectives: Many instability criteria have been described in the literature to predict loss of reduction in distal radius fractures. However, the effect of the column location of the fracture on loss of reduction has not been investigated. The aim of this study is to investigate the effect of fracture column location and other radiological parameters on the loss of reduction of the distal radius fractures. Methods: A total of 106 patients who were treated conservatively for displaced distal radius fractures were included in the study. The average age of the patients included in the study is 54.9 years (range: 18-91 years). Anteroposterior and lateral radiographs of the wrist were taken in each patient at the time of first admission, immediately after reduction and casting, and at the 1st, 2nd and 6th weeks. Intraarticular fracture were evaluated by computed tomography (CT). Radial length, volar tilt angle and column location of the fracture were obtained by evaluating the radiographs and CT. The effects of post-reduction radiological parameters and column location of the fracture on loss of reduction were analyzed. Results: Reduction loss was detected in 23 (21.7%) of 106 patients. Metaphyseal fracture in 83 (78.3%) patients, intermediate volar column fracture in 76 (71.7%) patients, intermediate dorsal column fracture in 86 (81.1%) patients, ulnar column fracture in 52 (49.1%) patients and radial column fracture in 25 (23.6%) patients were determined. It was observed that having a fracture in the ulnar column or radial column caused a significant loss in radial length (p &amp;lt; 0.05). Metaphyseal and the intermediate column fractures did not make a statistically significant difference in reduction loss. Conclusions: Column location of the fracture can also be used to predict loss of reduction in the conservative treatment of distal radius fractures.

Application of WALANT in Diaphyseal Plating of Forearm Fractures: An Observational Study

Wide-Awake Local Anesthesia No Tourniquet (WALANT) is a novel anesthesia technique in distal radius and ankle fracture fixation. However, to date, there are limited studies in diaphyseal plating of forearm fractures under WALANT. This research is to study the feasibility of the use of WALANT technique in plating of diaphyseal fractures of the forearm as well as peri-operative outcomes. Sixty-one adult patients who underwent diaphyseal plating of the forearm under WALANT between the period of January 2019 and January 2021. It consists of 31 radius fractures, 15 ulna fractures and 15 ipsilateral radius and ulna fractures. Outcomes evaluated were duration of stay, peri-operative numerical pain rating scale, peri-operative blood pressure and heart rate, visual analogue scale for anxiety, blood loss, surgery duration, adverse effect, patient's satisfaction and any complications at 6 months follow up. Fifty-four patients (88.5%) were male and 7 patients (11.5%) were female with a mean age of 31.7 years (SD = 13.564). Thirty-eight out of 61 patients were totally pain free throughout the surgery. Ten (13%) patients reported pain during muscle dissection, 14 (18%) patients reported pain during bone manipulation and 12 (16%) patients reported pain during bone drilling. There was no significant difference in pain score between radius and ulna bones (P > .05). There was a significant change in blood pressure after LA infiltration (P < .01). The mean estimated blood loss was 27.39 ml (SD = 11.44) and the mean duration of post-surgery hospital stay was 1 day (SD = 1.026). Fifty-six patients (92%) recommended diaphyseal plating of the forearm under WALANT. None of the patients required conversion to general anesthesia and had any adverse events or infection during 6 months follow up. Diaphyseal plating of the forearm under WALANT is a feasible alternative anesthesia technique and is well tolerated by patients. Therapeutic III.

A case report of surgical treatment of traumatic drop hand by quadruple tendons transfer.

IntroductionDrop hand is the case of inability to dorsiflexion of the hand and fingers according to radial nerve palsy (complete syndrome) or PIN (Posterior Interosseous Nerve) palsy (partial syndrome). Therefore, the patient loses part of the normal function of his/her hand causing life problems especially if it is the dominant hand. Tendon transfer is the main surgical treatment.Case reportWe present a case of a young male who sustained multiple traumatic war injuries especially in the left upper limb; open humerus fracture, open ulna fracture, open radius fracture with a clear drop hand syndrome. After quadruple tendons transfer, he got a very good result especially in thumb movements with good ROM (Range Of Motions) in the wrist.DiscussionSince it is difficult to restore full ROM and full muscular strength in the wrist and fingers of a drop hand with triple tendon transfer routinely, especially in the case of multiple injury to the upper extremity with the pronator teres being nonfunctional, we decided to perform quadruple tendon transfer depending on the tendons; FCR, PL, 3rdFDS, 4thFDS for stronger extension of the wrist, thumb, and other fingers.ConclusionOur aim here is to confirm that the drop hand does not have standard findings in all cases. It may be a challenge, and may have atypical findings especially in the case of ipsilateral multiple traumatic limb, which in turn may have weakness or restriction in some important movements, so, it is important to keep in mind alternatives of tendon transfer.

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.