Ulnar Variance Research Articles

Magnitude, Direction, Temporal Patterns, and Frequency of Loss of Distal Radius Fracture Reduction in Women 50 Years and Older

To determine the magnitude, direction, temporal patterns, and frequency of reduction loss following nonsurgical, closed treatment of distal radius fractures in women 50 years and older and correlate these observations with bone mineral density and age. We reviewed registry data on 1,148 patients 50 years and older with distal radius fractures managed by closed reduction and cast immobilization. Radial inclination (RI), ulnar variance (UV), and radial tilt (RT) were measured immediately and at 1, 2, 3, 6, 9, and 12 weeks after reduction. Magnitude, direction, frequency, and patterns of change were compared at each time point and correlated with bone mineral density T-scores and age using paired t tests in a mixed effects model. Over 12 weeks, RI decreased by 3° ± 5°, the majority occurring in the first 2 weeks and significantly correlated with bone mineral density T-score and age. Unexpectedly, RI increased over time in 5% of patients. Ulnar variance increased by 2.3 ± 1.7 mm, the majority occurring in the first 3 weeks and correlated with age. Radial tilt changed by 7° ± 11° in those displacing dorsally and 8° ± 12° in those displacing volarly at 12 weeks, with the majority occurring in the first 3 weeks and significantly correlating with age. Ulnar variance and RT continued to change by small increments between weeks 3 and 6. Nearly 90% of our cohort experienced measurable loss of reduction and 50% changed at least 5° RI, 11° RT, and 2 mm UV. Most distal radius fracture managed with closed reduction and casting have some loss of reduction, the majority occurring in the first 3 weeks and correlated with increased age and osteoporosis. This guides clinicians in informing patients about expected reduction loss, frequency of clinical and radiographic follow-up, and timing of discussions regarding the need for surgery. Prognostic II.

Ulnar variance and triangular fibrocartilage thickness in adolescents: a cross-sectional MRI study of healthy participants.

Skeletally immature wrists are considered at risk of injury due to increased axial loading through a relatively shorter ulna. The aim of this study was to determine whether triangular fibrocartilage thickness relates to ulnar variance and age in adolescents. The radiographs and MRIs of 24 healthy adolescents were retrospectively assessed. Four observers assessed bone age and ulnar variance on radiographs and measured triangular fibrocartilage thickness on MRIs. Median calendar and bone age was 13years and ulnar variance was -0.7 mm. Median triangular fibrocartilage thickness was 1.4 mm, with excellent inter-observer agreement (r = 0.86). It was moderately correlated with ulnar variance (ρ = -0.46) as well as with bone age (ρ = -0.49). Both variables were statistically significant predictors in a multivariate analysis. This suggests that triangular fibrocartilage thickness changes during skeletal maturation, which might influence axial load distribution in skeletally immature wrists.

Factors Affecting Functional Recovery After Volar Locking Plate Fixation for Distal Radius Fractures.

There is still no certainty about factors delaying functional recovery after surgery, although volar locking plate (VLP) fixation is the mainstay of treatment for distal radius fractures (DRFs), and several good postoperative recoveries have been reported. The purpose of this study was to investigate factors affecting functional recovery after VLP fixation for DRF. The subjects included 104 patients (84 females, 20 males, mean age: 63.2 ± 13.8 years) treated with VLP fixation for DRF, who could be followed for 1 year. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, grip strength, and range of motion of the wrist joint were measured at 3, 6, and 12 months postoperatively, and the primary outcome was the QuickDASH score. A multiple regression analysis adjusted for age and sex was used to analyze factors affecting functional recovery at 12 months. A multiple regression analysis showed that the factors that significantly influenced the QuickDASH score at 1 year postoperatively were the grip strength ratio to the uninjured side, dominancy of the injured hand, and postoperative ulnar variance, in descending order of involvement. Trauma energy, history of diabetes, fracture type, complications, and range of motion were not included in the model. Smaller grip strength, dominant-hand injury, and larger postoperative ulnar variance significantly worsened the QuickDASH score at 1 year postoperatively. In order to achieve satisfactory functional recovery at 1 year after surgery, we confirmed that it is important to surgically achieve smaller postoperative ulnar variance and increase grip strength.

MORPHOMETRY OF DISTAL RADIUS – A RADIOGRAPHIC STUDY IN NEPALESE POPULATION

Background: Distal radius fractures are common injuries. The outcome of the fractures depends upon the post reduction morphometric parameters. This study was aimed to assess the normal morphometric parameters of distal radius in Nepalese population. Methods: This was a prospective cross-sectional study of morphometric measurements of 150 distal radius on x rays of wrist joints of patients presenting to department of orthopedics at CMCTH from October 2020 to September 2021. Radial height, Radial inclination, Palmer tilt, Ulnar variance and Radial width in posteroanterior (PA) and lateral views were measured. The data obtained was analyzed to see the difference according to age, sex, side, dominance and ethnicity. Results: The mean values of Radial height, Radial inclination, Palmer tilt, Ulnar variance and Radial width posteroanterior and lateral were 11.75+-0.94mm, 22.75+-1.50 degrees, 10.51+-1.04 degrees, -0.51 to+-1.15 mm, 27.05+-1.16 mm and 18.7+-1.12 mm respectively. Conclusions: The distal radius morphometry of Nepalese population is comparable to other national, regional and western similar studies. There were no any statistically significant differences of all the morphometric parameters of distal radius according to age, sex, side, dominance and ethnicity except Radial inclination, according to ethnicity; and Radial width, according to ethnicity and dominance.

Elderly unstable distal radius fractures a prospective cohort study of bone substitutes-augmented percutaneous pinning

BackgroundBased on debatable recommendations of using bone substitutes for filling of metaphyseal void in elderly unstable distal radius fractures; this study investigated the following question “Do bone substitutes effectively contribute to postoperative stability of k-wire fixation construct and accelerate healing in elderly unstable distal radius fractures?”.MethodsThis prospective cohort study was conducted from October 2014 to April 2021. According to use of bone substitutes, 40 patients of elderly unstable distal radius fractures were alternately allocated into; group-(A) of bone substitutes-augmented percutaneous pinning (19 patients); and group-(B) of non-augmented percutaneous pinning (21 patients). Groups were compared for preoperative patients’ demographics and postoperative ROM, Quick-DASH and Mayo Wrist scores, radiographic parameters (palmar tilt, radial height and inclination, ulnar variance and intra-articular step-off) and duration until radiographic fracture healing.ResultsStatistically, augmented and non-augmented groups were matched in terms of patients’ demographics (mean age; 58.7 vs. 62.0 years respectively, P-value = 0.25). All included fractures have healed with insignificantly longer duration in augmented group (7.1 vs. 6.8 weeks, P-value = 0.26). At 12-week postoperative evaluation, radiographic parameters of both groups were comparably well-maintained except for intra-articular step-off which showed significantly less secondary displacement in augmented group (0.1 vs. 0.4 mm, P-value = 0.01). There were insignificant differences in 6-month postoperative ROM, and Quick-DASH and Mayo Wrist scores.ConclusionCompared to its bone substitutes-augmented counterpart; non-augmented percutaneous pinning of elderly unstable distal radius fractures can offer advantages of comparable healing rates and functional and radiographic outcomes, less-invasive approach, shorter operative time and lower cost.Level of evidenceIII

Effect of the Articular Surface Incongruency on Surgical Outcome of the Distal Radius Fracture.

Purpose The aim of this study was to demonstrate the joint fragment that mostly affects the outcome of the distal radius fracture surgically treated with a volar locking plate (VLP). Methods The outcomes of 69 patients with the distal radius fractures were evaluated at their final follow-up. The articular surface was divided into six specific fragments, and computed tomography (CT) was used to evaluate the degree of mismatch of each fragments. A plain radiograph was also obtained for evaluation of the distal radius alignment. Clinical outcomes were measured by using the Disabilities of the Arm, Shoulder and Hand (DASH) and Modified Mayo Wrist Score (MMWS). Univariate analyses were performed, with subsequent multiple logistic regression analyses. Results The mean follow-up period was 14.8 (range, 12 to 52) months. The group with a worse DASH score showed significantly greater mismatch in the volar and dorsal lunate facets, as well as the central depression of the distal radius (p = 0.042, 0.031, and 0.023, respectively). There was a significant positive correlation between the DASH score and degree of mismatch of the dorsal lunate facet and central depression of the distal radius (p = 0.040 and 0.011, respectively). Groups with worse MMWS showed significantly greater mismatch in the dorsal lunate facet (p = 0.025). There was a significant negative correlation between MMWS and abnormal ulnar variance and mismatch of the dorsal lunate facet and central depression of the distal radius (p = 0.041, 0.004, and 0.018, respectively). The result of multiple logistic regression analysis demonstrated that a mismatch of the dorsal lunate facet is a significant predictor for a worse MMWS (odds ratio = 3.072, p = 0.043). Conclusions Articular surface mismatch of the dorsal lunate facet appears to mostly affect the surgical outcomes of the distal radius fractures using VLP. In cases where the dorsal lunate facet is heavily involved, surgeons should be cautious about its reduction and fixation.

Order of importance of anatomical risk factors in Kienböck’s disease: An artificial neural network study

Anatomical variations in bony structures around the wrist have been considered as risk factors for Kienböck’s disease: ulnar variance, Nattrass index, ulnar variance/capitate height ratio and presence of a lunohamate joint. This study aimed to assess the order of importance of these variations as risk factors for Kienböck's disease. Two groups were formed: patients (n = 58) and controls (n = 235). On posteroanterior radiographs in the two groups, these risk factors were examined by four raters. After inter-rater correlation analysis, an artificial neural network was used to estimate their relative importance. All parameters showed statistically significant inter-rater correlation (p < 0.05). The artificial neural network study showed that the three most important risk factors, in descending order, were: Nattrass index, ulnar variance/capitate height ratio and negative ulnar variance. The study determined the order of importance of the anatomical risk factors for Kienböck’s disease measurable on posteroanterior wrist radiographs. Although these findings seem to be useful in the diagnostic algorithm of Kienböck’s disease, multivariate analysis of all measurable risk factors is still needed. The artificial neural network approach could contribute to such a comprehensive study.

Radius distraction during volar plating of distal radius fractures may improve distal radioulnar joint stability at minimum 3-year follow-up: a retrospective case series study

BackgroundThe surgical technique of radius distraction for stabilization of distal radioulnar joint (DRUJ) if intraoperative DRUJ instability was found after the fixation of distal radius fracture has been previously described, but this surgical technique lacks clinical and radiographic effect in minimal 3 years follow-up. We therefore evaluated the clinical outcome and radiographic results of radius distraction in minimal 3 years follow-up as long-term evaluation.MethodsWe reviewed the case series of distal radius fracture with concomitant DRUJ instability receiving radius distraction from the senior author over a 5-year period (January 1st, 2013, to June 30th, 2017) retrospectively. Radius distraction during volar plating was performed by moving the volar plate distally via compression screw loosening/fastening to achieve firm endpoint on the dorsopalmar stress test. The evaluations of radiographic, including bone union time and ulnar variance, and clinical outcomes, including grading of DRUJ instability, NRS of wrist pain, DASH score, MMWS score, and range of motion of operated wrist at final follow-up, were performed at clinic as minimum 3-year follow-up; a total 34 patients had been evaluated.ResultsAt minimal post-operative 36 months follow-up, all cases demonstrated acceptable wrist range of motion with stable DRUJs, low NRS of wrist pain (0.6, SD 0.7), and satisfactory DASH score (mean 9.1, SD 6.2) and MMWS score (mean 87, SD 10). There were no cases suffering from nonunion of distal radius. The mean ulnar variance of injured wrist and uninjured wrist were -1.2 mm and 0.2 mm, respectively (SD 1.0 and 0.6) with significant statistical difference.ConclusionsRadius distraction during volar fixation of distal radius fracture should be considered if DRUJ instability was found by the dorsopalmar stress test intraoperatively, and the long-term DRUJ stability could be achieved by maintenance of normal-to-negative ulnar variance, with decreased wrist pain and satisfactory function outcome.Level of EvidenceTherapeutic Level IV

A Retrospective Cohort Study Comparing the Outcomes of Conservative Versus Operative Fixation of Distal Radius Fractures in Children.

ObjectivesDistal radius fractures are common pediatric orthopedic injuries accounting for 25% of all fractures with a significant incidence in the age group 10-14 years. This study aims to evaluate the operative and non-operative methods of treating distal radius fractures in children.MethodsThis is a retrospective cohort study conducted on 176 children with distal radius fracture. We studied the operative and non-operative treatments of all children presented with distal radius fracture to the emergency department of the Bahrain Defense Force (BDF) Hospital from January 1, 2015, to February 1, 2022. The inclusion criteria were as follows: age of 17 years or younger, distal radius fracture with or without complete displacement and skeletal immaturity managed as of non-operative or operative groups. Patients who did not have follow-up data after the date of surgery were excluded. The statistical analysis was performed using the software SPSS version 23.0 (IBM Corp., Armonk, NY). Continuous data expressed as mean, standard deviation and discrete variables were expressed as frequency and percentages. One-way Analysis of Variance (ANOVA) was used to compare the continuous variables between groups. The Student’s t-test was used for the two-group comparison. For the comparison of discrete variables, a Chi-Square test or Fisher’s exact test was used.ResultsSeventy-seven patients were conservatively managed with cast immobilization (“non-operative” group) in comparison to 99 patients who were surgically managed (“operative” group) with either percutaneous pinning (n=56) or flexinail (n=43). Fewer patients underwent physiotherapy in the operative group with 14 (25.0%) patients for percutaneous pinning and seven (16.3%) patients for flexinail versus 31 (40.3%) patients in the non-operative group (p<0.015). There were statistically significant differences in radial inclination (p<0.001) between conservative and percutaneous pinning (22.22±2.86 vs 18.76±3.33 degrees) and percutaneous pinning and flexinail (18.76±3.33 vs 22.37±3.44 degrees). Likewise, there was a significant difference found in ulnar variance between conservative and percutaneous pinning (-0.45±2.14 mm vs -1.47±1.93 mm, p=0.012) and conservative and flexinail (-0.45±2.14 mm vs -1.59±1.90 mm, p=0.009). There were a total of 25 documented complications. Nineteen (19.8%) complications occurred in the non-operative group versus five (7.2%) and one (2.3%) complications in percutaneous pinning and flexinail groups, respectively (p=0.003). The most common complication in the non-operative group was loss of reduction while in cast and subsequent need for surgical intervention. Ten of these patients underwent percutaneous pinning whereas nine were fixed by flexinail.ConclusionThis study illustrated an overall similar success between the surgical and the conservative treatments of distal radius fractures in children. Due to the higher complication rate reported in the conservative group, the conservative treatment cannot be considered safer than the surgical treatment.

Prospective Descriptive Study of Radiological and Functional Outcomes of Volar Barton’s Fracture Fixed by Volar Locked Plate

BACKGROUND: Volar Barton’s fracture is a shearing mechanism of injury that results in fracture and subluxation of distal end radius in which volar rim of the distal radius is displaced with hand and carpus. Open reduction and volar plate fixation ensure more stable change of displacement, preservation of reduction, and early mobilization. AIM: This study aims to assess the functional and radiological outcome results of volar Barton’s fracture treated by volar buttress plate using the demerit points system of Gartland and Werley. PATIENTS AND METHODS: This study is a prospective descriptive observational study on 32 patients who were treated with ORIF by volar buttress plate for isolated volar Barton’s fractures between February 2018 and June 2020 in Alkindy teaching hospital/Baghdad/Iraq. All volar Barton’s fracture cases satisfying the inclusion criteria which included patient over 18 years, isolated fracture, medically fit, and &lt;5 days old injuries, while fractures extend to radius shaft, compound fractures, and associated with other injuries were excluded from the study. All fractures are fixed by volar locked plate followed up for 12 week’s duration for functional and radiological assessment using the Demerit points system of Gartland and Werley. RESULTS: Most cases were in the age group below 40 years, average age 38 years (range 19–64 years), male patient was 69%, side of involvement was right wrist in 75% of cases, falling on an outstretched hand account 50%, while roads traffic accidents in 37.5%, fall from a height in 6.25%, and direct trauma in 6.25%. The final sequel of the results was average volar tilt was 11.1°, the radial shortening average was 4 mm, the radial inclination average was 19.9°, and the ulnar variance was 0.3 mm. Functional outcomes depending on Gartland and Werley’s score were 50% as excellent results, 43.75% as good results, 6.25% as fair results, and no poor results in this study. CONCLUSIONS: Volar locking buttress plate provides fracture stability and early mobilization, therefore, recovery of daily live activity in a short time.

Radiological, Clinical, and Functional Outcomes of Combined Dorsal and Volar Locking Plate Osteosynthesis for Complex Distal Radius Fractures

The purpose of this study was to assess the short- to mid-term radiologic, clinical, and functional outcomes of patients treated with combined dorsal and volar locking plating for internal fixation of complex, comminuted, intra-articular, distal radius fractures. We performed a retrospective review of 34 patients treated with combined dorsal and volar locking plates for the internal fixation of complex, comminuted, intra-articular distal radius fractures. Radiographic and clinical parameters were recorded at a mean of 48 months after surgery. Activities of daily living and quality of life were assessed by the Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation questionnaires. Compared with the contralateral wrist, the treated wrist regained 73% of flexion, 81% of extension, 86% of ulnar deviation, 90% of radial deviation, 98% of pronation, 99% of supination, and 93% of grip strength. Mean Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores were 11 (range, 0-78) and 11 (range, 0-77), respectively. Radial height and radial inclination were restored anatomically in 24% and 41% of patients, respectively, while volar tilt and ulnar variance were restored in 68% of patients. The overall functional and radiologic outcome of patients with comminuted intra-articular complex distal radius fractures treated with the combined dorsovolar plate osteosynthesis was good to excellent. Therapeutic IV.

Outcomes of Arthroscopic-Assisted Distal Radius Fracture Volar Plating: A Meta-Analysis

The use of wrist arthroscopy to assist fixation of distal radius fractures with volar locking plates (VLPs) has been gaining popularity in recent years; however, there is no consensus on its benefits. This meta-analysis compares outcomes of arthroscopic-assisted VLP to fluoroscopic-assisted VLP in distal radius fractures through a systematic review of the published literature. A systematic search of publications from databases (Medline, EMBASE, Scopus, and Cochrane) was obtained from inception to May 2020. A random-effects meta-analysis was used to calculate effect sizes. Outcomes included postoperative radiographic reduction (gap, stepoff, radial inclination, volar tilt, and ulnar variance), procedural outcomes (operative time, additional soft tissue injuries and complications), and functional outcomes (range of motion; visual analog scale score; Disabilities of the Arm, Shoulder, and Hand score; Patient-Rated Wrist Evaluation score; Mayo clinic score; and grip strength). Six studies, involving 280 patients, met the final inclusion criteria. The meta-analysis for postoperative stepoff was statistically significant, favoring arthroscopic-assisted VLP. In addition, there was greater identification of associated soft tissue injuries, increased wrist extension, and a longer operative duration when performing arthroscopic-assisted VLP fixation. There were no differences in other postoperative radiographic outcomes, complications, or functional outcomes. The current literature suggests that arthroscopic-assisted VLP is a useful adjunct to intra-articular reduction and treatment of associated soft tissue injuries in distal radius fractures. Considerations should include operative time, costs, and the additional training required. Further studies are needed to assess functional outcomes. Therapeutic II.

The association of three anatomical factors with ulnar-sided wrist pain: a radiological study.

Ulnar-sided wrist pain is associated with the development of multiple wrist pathologies. But the anatomical etiologies have not been fully understood. To determine the association of three anatomical factors with ulnar-sided wrist pain, including ulnar variance (UV), distal ulnar volar angle (DUVA), and pisiform-ulnar distance (PUD). A total of 64 patients who had ulnar-sided wrist pain associated with training injuries were retrospectively studied. A control group included 64 healthy athletes from the same unit. The UV, DUVA, and PUD of each individual was measured on radiographs. The average UV and DUVA of those in the ulnar-sided pain group were 0.84 mm and 174.65°, respectively; the control group values were 0.39 mm and 175.11°. The differences between the two groups had no statistical significance (P > 0.05). The average PUD of the ulnar-sided wrist pain group was shorter than that of the control group (2.37 cm vs. 2.65 cm); the difference had statistical significance (P < 0.05). PUD had a negative correlation with ulnar-sided pain; it was an anatomical protective factor (odds ratio = 0.01; P < 0.00; 95% confidence interval=0.00-0.05). Both UV and DUVA had no significant correlations with ulnar-sided wrist pain (P > 0.05). PUD has a significant correlation with ulnar-sided wrist pain. It is the anatomical protective factor. Both the UV and DUVA have no statistical association with ulnar-sided wrist pain, but we cannot ignore their potential pathogenic effects on wrists, and further studies are needed to confirm the results.

Evaluating Distal Radius Radiological Indices as Scaphoid Fracture Risk Factors

Background: Scaphoid fracture is the most common wrist injury with a high rate of misdiagnosis and subsequent complications. As the morphology of the distal radius affects the load transmission through the carpal bones, radiographic wrist indices may help prevent missing occult fractures. Objectives: The current retrospective case-control study compared the distal radius radiographic indices of patients with a scaphoid fracture with a control group. Methods: Wrist X-rays of 129 patients with scaphoid fractures (case group) and the contralateral uninjured side of 101 patients with distal radius fractures (control group) were assessed by two orthopedic surgeons. Anteroposterior and lateral radiographs were evaluated to measure the radial height (RH), radial inclination (RI), ulnar variance (UV), and volar tilt (VT). Results: The student t-test was used to compare the distal radius radiographic indices between the two groups. The average RI was 27.14 in the scaphoid fracture group and 24.35 in the control group (P&lt;0.05). Mean VT, RH, and UV of the case group were, 12.32, 15.01, and - 0.73, respectively; this is while in the control group, the above measures were 10.76, 13.52, and - 0.11, respectively (P&lt;0.05). Conclusion: High values of RH, RI, and VT, and negative amount of UV are significantly correlated with scaphoid fracture after a Fall Onto an Outstretched Hand (FOOSH) injury.

Recent Advances in Assessment and Treatment in Kienböck's Disease.

Kienböck’s disease is a rare disease described as progressive avascular osteonecrosis of the lunate. The typical manifestations include a unilateral reduction in wrist motion with accompanying pain and swelling. Besides recent advances in treatment options, the etiology and pathophysiology of the disease remain poorly understood. Common risk factors include anatomical features including ulnar variance, differences in blood supply, increased intraosseous pressure along with direct trauma, and environmental influence. The staging of Kienböck’s disease depends mainly on radiographic characteristics assessed according to the modified Lichtman scale. The selection of treatment options is often challenging, as radiographic features may not correspond directly to initial clinical symptoms and differ among age groups. At the earliest stages of Kienböck disease, the nonoperative, unloading management is generally preferred. Patients with negative ulnar variance are usually treated with radial shortening osteotomy. For patients with positive or neutral ulnar variance, a capitate shortening osteotomy is a recommended option. One of the most recent surgical techniques used in Stage III Kienböck cases is vascularized bone grafting. One of the most promising procedures is a vascularized, pedicled, scaphoid graft combined with partial radioscaphoid arthrodesis. This technique provides excellent pain management and prevents carpal collapse. In stage IV, salvage procedures including total wrist fusion or total wrist arthroplasty are often required.

Ulnar Epiphysiodesis: Success of the Index Procedure.

Premature radial physeal closure is a relatively rare occurrence in children. When isolated growth arrest of the radius with continued ulnar growth occurs, the resulting ulnar positive deformity leads to altered wrist mechanics and pain. Timely epiphysiodesis of the distal ulna with and without ulnar shortening osteotomy can address these issues, but continued ulnar overgrowth is a possible complication. We seek to evaluate the success rate of the primary epiphysiodesis of the ulna and associated clinical outcomes. A chart review was conducted at 2 children's hospitals from 2008 to 2019. Patients between the ages of 6 and 18 years old, with premature distal radius physeal closure, with or without positive ulnar variance, and >2 months follow-up were included. We evaluated the following characteristics for each patient: demographics, initial cause of premature radial physeal closure, ulnar variance, additional procedures performed during epiphysiodesis, preoperative and postoperative pain, range of motion, instability. Summary statistics were conducted and expressed as proportions, medians and means. A paired t test evaluated change in ulnar variance for those who had an ulnar shortening osteotomy performed. Thirty-one wrists among 30 patients were identified, and the median age at the time of surgery was 12.2 years (interquartile range: 3.4). Ulnar shortening osteotomies were performed in 53.1% of cases and distal radius osteotomy in 15.6%. Bone graft was utilized in 25.8% of the epiphysiodesis procedures. There were 2 failures of primary epiphysiodesis indicating an index success rate of 93.7%. The average ulnar variance correction was 3.1 mm (95% confidence interval: 1.9, 4.4). The mean physeal time to closure was 134 days. Preoperative symptoms were resolved for 90.6% cases at final follow-up. Ulnar epiphysiodesis successfully terminates ulnar physeal growth in 93.7% of cases. Preoperative symptoms were completely resolved with a median physeal closure of just over 4 months. Ulnar variance was corrected on average by 4.1 mm when a radial or ulnar shortening osteotomy was performed at the time of epiphysiodesis. Level IV-case series.

Ulnar variance in distal radial fractures: assessment and interpretation

We explored patterns of shortening of the distal radius and investigated the effect of displacement on 'ulnar variance' in 250 patients with distal radial fractures. A small number of patients (5%) had a fracture that resulted in true shortening. Thirty-two percent had fractures that appeared short, but lateral radiographs revealed that the articular surface was tilted, with either the anterior or dorsal rim of the articular surface being proximal to the distal ulna but the other rim was distal to it. We recommend initial assessment of variance on lateral radiographs. If the anterior and dorsal rims of the distal radial articular surface are proximal to the distal ulna, then true shortening is present and lengthening and stabilization, to hold the radius distracted, should be considered. If only one rim is proximal to the distal ulna, then correction of the tilt will lessen the apparent positive variance.Level of evidence: IV.

Evaluation of radiographic measurements of the wrist in the Turkish population

Background/Aim: Wrist parameters measured on direct radiography are essential in diagnosing distal radius fractures and many specific wrist disorders and determining prognosis after treatment. Previous studies have shown the intercommunity variability of these parameters in the literature. To our knowledge, no study in the literature reflects the normal values in the Turkish population. This study aimed to determine the distribution and normal limits of parameters measured in posteroanterior (PA) and direct lateral radiographs of the wrist in our population between age and gender groups. Methods: In this retrospective cohort study, patients who presented to 2 centers in our clinic between 2014-2020 and had PA and lateral wrist radiographs were retrospectively reviewed. Images from patients who had no significant osseous pathology and had not undergone wrist surgery were randomly selected, and 320 (201 female, 119 male) digital images were retrospectively analyzed. The mean age was 40.45 (13.71). The sample was divided into three groups (18-30, 31-50, over 51) according to age and into two groups according to gender. Radial inclination (RI), lunate fossa inclination (LFA), cord of radiocarpal arch (cord RC), radial shift (Radsh), radial height (RadH), ulnar variance (UV), third metacarpal height (3rd MH), carpal height (CH), capitate height (CapH), lunate transverse length (LL), lunate uncovering length (LUL), scapholunate joint distance (SLD), distal radioulnar joint distance (RUD), volar tilt on lateral radiographs (VT), scapholunate angle (SLA) were measured. The lunate uncovering ratio (LUR) was measured in proportion to the lunate uncovering length (LUL) / lunate transverse length (LL); carpal height ratio (CHR) by proportioning carpal height (CH) / third metacarpal height (3rd MH); revised carpal height ratio (rCHR) was calculated by proportioning the carpal height (CH) / capitate height (CapH). Results: Although the RI and SL values of angular parameters were similar between the gender groups, the LFI and VT values were significantly higher in the female group (P=0.014 and P=0.004, respectively). All metric parameters were significantly superior in the male group (P 0.05). While UV values of metric parameters increased in parallel with age, RUD values decreased significantly (P<0.001). The values of the metric parameters CH 3rd MH, CapH, and proportional parameters LUR values also differed between the groups without being correlated with age (P=0.011, P=0.003, P=0.009, P=0.019, respectively). Conclusion: In our study, we have given the measurement parameters that can be used as a reference for the Turkish population, the relationships between gender and age groups, and the variability. These parameters can be helpful in the diagnosis and treatment of wrist pathologies, the design and development of implants for the treatment of wrist pathologies for our population.

Radiological assessment of collapse of distal end radius fracture followed by close reduction and cross k wire fixation

Background: Distal end radius fractures are the commonest occurring fractures occurring in upper extremity. They represent one-sixth of all fractures treated in emergency department. The present study was conducted to assess collapse in distal end radius fracture following close reduction and cross K wire fixation using standard AP and lateral radiological parameters of reduction.Materials & Methods: A sample of 40 patients who underwent K wire fixation for unstable fractures of distal radius over a period of 18 months reporting serially to the orthopaedics OPD a single tertiary hospital were included.Results: The mean immediate postoperative volar tilt was 10.08°, while at 6 weeks postoperative, it was found to be 8.91° respectively. The mean immediate postoperative radial inclination was 24.02°, while at 6 weeks postoperative, it was found to be 22.67° respectively. The mean immediate postoperative Ulnar variance was 0.38 mm while at 6 weeks postoperative, it was found to be – 0.008 mm respectively. Significant results were obtained while comparing the Ulnar variance at different postoperative time intervals. Collapse in volar tilt after K wire removal was seen in 71.11 percent of the patients. Among these, 1°, 2° and 3° collapse of volar tilt was seen in 31.11 percent, 33.33 percent and 6.67 percent of the patients respectively.Conclusion: The closed reduction and percutaneous K-wire fixation is a least invasive, safer, and effective method to maintain the reduction, prevent significant collapse during healing, and maintain the stability of the distal radio-ulnar joint even when the fracture is grossly comminuted, intra-articular, or unstable.

Investigation of the Relationship Between Wrist Ganglion Cysts and the Ulnar Variance Using 3-Tesla Magnetic Resonance Imaging

Investigation of the Relationship Between Wrist Ganglion Cysts and the Ulnar Variance Using 3-Tesla Magnetic Resonance Imaging