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Sample records for acute distal radius

  1. Acute Ulnar Shortening for Delayed Presentation of Distal Radius Growth Arrest in an Adolescent

    PubMed Central

    Ellanti, Prasad; Harrington, Paul

    2012-01-01

    Distal radius physeal fractures are common in children and adolescents. However, posttraumatic growth arrest is uncommon. The management of posttraumatic growth arrest is dependent on the severity of the deformity and the remaining growth potential of the patient. Various treatment options exist. We present a 17-year-old male with distal radius growth arrest who presented four years after the initial injury. He had a symptomatic 15 mm positive ulnar variance managed with an ulnar shortening osteotomy with the use of the AO mini distractor intraoperatively. To the best of our knowledge, an acute ulnar shortening of 15 mm is the largest reported. PMID:23227397

  2. Acute ulnar shortening for delayed presentation of distal radius growth arrest in an adolescent.

    PubMed

    Ellanti, Prasad; Harrington, Paul

    2012-01-01

    Distal radius physeal fractures are common in children and adolescents. However, posttraumatic growth arrest is uncommon. The management of posttraumatic growth arrest is dependent on the severity of the deformity and the remaining growth potential of the patient. Various treatment options exist. We present a 17-year-old male with distal radius growth arrest who presented four years after the initial injury. He had a symptomatic 15 mm positive ulnar variance managed with an ulnar shortening osteotomy with the use of the AO mini distractor intraoperatively. To the best of our knowledge, an acute ulnar shortening of 15 mm is the largest reported.

  3. [Fractures of the distal radius].

    PubMed

    Rueger, J M; Hartel, M J; Ruecker, A H; Hoffmann, M

    2014-11-01

    The most prevalent fractures managed by trauma surgeons are those involving the distal radius. The injury occurs in two peaks of prevalence: the first peak around the age of 10 years and the second peak around the age of 60 years. Distal radius fracture management requires sensitive diagnostics and classification. The objectives of treatment are the reconstruction of a pain-free unlimited durable functioning of the wrist and avoidance of typical fracture complications. Non-operative conservative management is generally employed for stable non-displaced fractures of the distal radius with the expectation of a good functional outcome. Unstable comminuted fractures with intra-articular and extra-articular fragment zones are initially set in a closed operation and finally by osteosynthesis. An armament of surgical implants is available for instable fractures requiring fixation. Palmar locked plate osteosynthesis has been established in recent years as the gold standard for operative management of distal radius fractures. Complex Working Group on Osteosynthesis (AO) classification type 3 fractures require extensive preoperative diagnostics to identify and treat typical associated injuries around the wrist.

  4. [Distal radius fractures in children].

    PubMed

    Otayek, S; Ramanoudjame, M; Fitoussi, F

    2016-12-01

    Metaphyseal and physeal fractures of the distal radius are common in children. Most cases are best treated with closed reduction and cast immobilization. Long-term outcomes of these injuries are excellent when specific treatment principles of reduction and casting are followed. Surgical indications are limited and include open fractures, intra-articular fractures, non-reducible fractures, unstable fractures, and the presence of associated nerve injury. Closed reduction and percutaneous pin fixation is the most commonly used surgical option. The clinician should be aware of delayed complications such as growth disturbance of the distal radius, and understand how to manage these problems to ensure successful long-term outcomes. Epiphysiodesis is uncommon but growth plate injuries need to be followed for one year.

  5. Elbow dislocation with ipsilateral distal radius fracture

    PubMed Central

    Meena, Sanjay; Trikha, Vivek; Kumar, Rakesh; Saini, Pramod; Sambharia, Abhishek Kumar

    2013-01-01

    Elbow dislocation associated with ipsilateral distal radius fracture is a rare pattern of injury, although it is common for elbow dislocation and forearm fractures to occur separately. We report a rare case of a 20-year-old male who had a posterior elbow dislocation and ipsilateral distal radius fracture. Elbow dislocation was first reduced in extension and distal radius fracture was then reduced in flexion. Both the injuries were conservatively managed. At 6 months follow-up, the patient had no pain in his elbow and minimal pain in his wrist on heavy lifting and had resumed his work as a laborer. PMID:24082758

  6. Elbow dislocation with ipsilateral distal radius fracture.

    PubMed

    Meena, Sanjay; Trikha, Vivek; Kumar, Rakesh; Saini, Pramod; Sambharia, Abhishek Kumar

    2013-07-01

    Elbow dislocation associated with ipsilateral distal radius fracture is a rare pattern of injury, although it is common for elbow dislocation and forearm fractures to occur separately. We report a rare case of a 20-year-old male who had a posterior elbow dislocation and ipsilateral distal radius fracture. Elbow dislocation was first reduced in extension and distal radius fracture was then reduced in flexion. Both the injuries were conservatively managed. At 6 months follow-up, the patient had no pain in his elbow and minimal pain in his wrist on heavy lifting and had resumed his work as a laborer.

  7. Management of Complications of Distal Radius Fractures

    PubMed Central

    Chung, Kevin C.; Mathews, Alexandra L.

    2015-01-01

    Synopsis Treating a fracture of the distal radius may require the surgeon to make a difficult decision between surgical treatment and nonsurgical management. The use of surgical fixation has recently increased owing to complications associated with conservative treatment. However, conservative action may be necessary depending on certain patient factors. The treating surgeon must be aware of the possible complications associated with distal radius fracture treatments to prevent their occurrence. Prevention can be achieved with a proper understanding of the mechanism of these complications. This article discusses the most recent evidence on how to manage and prevent complications following a fracture of the distal radius. PMID:25934197

  8. Operative treatment of distal radius fractures.

    PubMed

    Vasenius, J

    2008-01-01

    The incidence of distal radius fractures is increasing together with the average age of population. Intra-articular incongruity is the most probable cause of unsatisfactory outcome of distal radius fractures in younger and more active patients. Thus, the main goal in the treatment of distal radius fractures should be restoration of articular congruence. A computed tomography (CT) is recommended to help surgeon in preoperative planning in the treatment of comminuted intra-articular fractures. New implants have been designed to provide stable enough fixation for early mobilisation after surgery and to lower rather high complication rates related to conventional fixation methods such as external fixation and dorsal plating. The most common complications related to volar fixed angle plating such as flexor and extensor tendon problems, median nerve neuropathy, and screw diplacement into the radiocarpal joint are surgeon related and are avoidable with proper education. More randomized prospective studies are needed to prove superiority of any fixation method to another.

  9. Topographic matching of distal radius and proximal fibula articular surface for distal radius osteoarticular reconstruction.

    PubMed

    Zhang, H; Chen, S; Wang, Z; Guo, Y; Liu, B; Tong, D

    2016-07-01

    During osteoarticular reconstruction of the distal radius with the proximal fibula, congruity between the two articular surfaces is an important factor in determining the quality of the outcome. In this study, a three-dimensional model and a coordinate transformation algorithm were developed on computed tomography scanning. Articular surface matching was performed and parameters for the optimal position were determined quantitatively. The mean radii of best-fit spheres of the articular surfaces of the distal radius and proximal fibula were compared quantitatively. The radial inclination and volar tilt following reconstruction by an ipsilateral fibula graft, rather than the contralateral, best resembles the values of the native distal radius. Additionally, the ipsilateral fibula graft reconstructed a larger proportion of the distal radius articular surface than did the contralateral. The ipsilateral proximal fibula graft provides a better match for the reconstruction of the distal radius articular surface than the contralateral, and the optimal position for graft placement is quantitatively determined.

  10. Fractures of Distal Radius: An Overview

    PubMed Central

    Meena, Sanjay; Sharma, Pankaj; Sambharia, Abhishek Kumar; Dawar, Ashok

    2014-01-01

    Fractures of distal radius account for up to 20% of all fractures treated in emergency department. Initial assessment includes a history of mechanism of injury, associated injury and appropriate radiological evaluation. Treatment options include conservative management, internal fixation with pins, bridging and non-bridging external fixation, dorsal or volar plating with/without arthroscopy assistance. However, many questions regarding these fractures remain unanswered and good prospective randomized trials are needed. PMID:25657938

  11. Physeal arrest of the distal radius.

    PubMed

    Abzug, Joshua M; Little, Kevin; Kozin, Scott H

    2014-06-01

    Fractures of the distal radius are among the most common pediatric fractures. Although most of these fractures heal without complication, some result in partial or complete physeal arrest. The risk of physeal arrest can be reduced by avoiding known risk factors during fracture management, including multiple attempts at fracture reduction. Athletes may place substantial compressive and shear forces across the distal radial physes, making them prone to growth arrest. Timely recognition of physeal arrest can allow for more predictable procedures to be performed, such as distal ulnar epiphysiodesis. In cases of partial arrest, physeal bar excision with interposition grafting can be performed. Once ulnar abutment is present, more invasive procedures may be required, including ulnar shortening osteotomy or radial lengthening.

  12. Triplane fracture of the distal radius.

    PubMed

    García-Mata, Serafín; Hidalgo-Ovejero, Angel

    2006-07-01

    A case of triplane fracture of the distal radius is reported in a 13-year-old boy. This exceptional fracture showed displacement, and was healed by closed reduction and 6 weeks of external immobilization. Eighteen months later, the patient showed complete physeal arrest of the distal radius, with radio-ulnar length discrepancy but without any repercussion on wrist mobility. The patient was declared asymptomatic 3 years after the injury. Prompt, physiological physeal arrest reduces the potential of growth deformity. These fractures must be treated conservatively by closed reduction (if displacement exists) and external immobilization, just like a normal one-plane fracture. We may suppose that final radio-ulnar discrepancy could lead to a painful and symptomatic ulno-carpal conflict in adult life. The following characteristics can be associated with this rare fracture: (1) occurrence close to the end of the growth period, as in other types of triplane fractures; (2) evolution towards partial or complete growth arrest of the physis, not requiring treatment and (3) stability of the fracture after closed reduction. In the present case, as in the other reported cases, it may also be added that orthopaedic treatment has been the rule, in contrast with triplane fractures occurring in the distal tibia, in which surgical treatment is indicated.

  13. [Vascularized iliac crest and distal radius reconstruction].

    PubMed

    Pic Gomis, L; Gomis, R

    2010-12-01

    The authors relate their experience concerning the vascularized iliac crest flap. In the first chapter, they detail the anatomic vascularized osteocutaneous iliac crest. Blood supply arises from the deep and superficial circonflexe iliac artery. Many anastomoses connect the two systems. In the second chapter, they detail the operative technique of free and pedicule hone iliac crest flap. Composite cutaneous bone flaps are also detailed. In the third chapter, they detail informations about treatment of distal radius bone defects with associated skeen flap if necessary.

  14. Distal radius fracture after proximal row carpectomy

    PubMed Central

    Igeta, Yuka; Naito, Kiyohito; Sugiyama, Yoichi; Obata, Hiroyuki; Aritomi, Kentaro; Kaneko, Kazuo; Obayashi, Osamu

    2015-01-01

    Introduction We encountered a patient with distal radius fracture (DRF) after proximal row carpectomy (PRC). The mechanism of the DRF after PRC is discussed in this report. Presentation of case The patient was a 73-year-old female who had undergone PRC due to Kienböck disease before. The wrist range of motion was: 45° on dorsiflexion and 20° on flexion. DRF has occurred at 3 years after PRC. The fracture type was extra-articular fracture. Osteosynthesis was performed using a volar locking plate. No postoperative complication developed, the Mayo score was excellent at 6 months after surgery, and the daily living activity level recovered to that before injury. Discussion Since the wrist range of motion decreased and the lunate fitted into the joint surface after PRC, making the forearm join with the hand like a single structure, pressure may have been loaded on the weak distal end of the radius from the dorsal side, causing volar displacement and fracture. Conclusion The pressure distribution and range of motion of the radiocarpal joint after PRC are different from those of a normal joint, and the mechanism of fracture also changes due to PRC. PMID:25623755

  15. Ultrasound-Assisted Distal Radius Fracture Reduction

    PubMed Central

    Socransky, Steve; Skinner, Andrew; Bromley, Mark; Smith, Andrew; Anawati, Alexandre; Middaugh, Jeff; Ross, Peter

    2016-01-01

    Introduction Closed reduction of distal radius fractures (CRDRF) is a commonly performed emergency department (ED) procedure. The use of point-of-care ultrasound (PoCUS) to diagnose fractures and guide reduction has previously been described. The primary objective of this study was to determine if the addition of PoCUS to CRDRF changed the perception of successful initial reduction. This was measured by the rate of further reduction attempts based on PoCUS following the initial clinical determination of achievement of best possible reduction. Methods  We performed a multicenter prospective cohort study, using a convenience sample of adult ED patients presenting with a distal radius fracture to five Canadian EDs. All study physicians underwent standardized PoCUS training for fractures. Standard clinically-guided best possible fracture reduction was initially performed. PoCUS was then used to assess the reduction adequacy. Repeat reduction was performed if deemed indicated. A post-reduction radiograph was then performed. Clinician impression of reduction adequacy was scored on a 5 point Likert scale following the initial clinically-guided reduction and following each PoCUS scan and the post-reduction radiograph. Results  There were 131 patients with 132 distal radius fractures. Twelve cases were excluded prior to analysis. There was no significant difference in the assessment of the initial reduction status by PoCUS as compared to the clinical exam (mean score: 3.8 vs. 3.9; p = 0.370; OR 0.89; 95% CI 0.46 to 1.72; p = 0.87). Significantly fewer cases fell into the uncertain category with PoCUS than with clinical assessment (2 vs 12; p = 0.008). Repeat reduction was performed in 49 patients (41.2%). Repeat reduction led to a significant improvement (p < 0.001) in the PoCUS determined adequacy of reduction (mean score: 4.3 vs 3.1; p < 0.001). In this group, the odds ratio for adequate vs. uncertain or inadequate reduction assessment using PoCUS was 12.5 (95% CI 3

  16. New concepts in the treatment of distal radius fractures.

    PubMed

    Taras, John S; Ladd, Amy L; Kalainov, David M; Ruch, David S; Ring, David C

    2010-01-01

    Fracture of the distal radius is the type of fracture most commonly seen in emergency departments. The understanding of nonsurgical and surgical care of distal radius fractures is evolving with recently developed methods of fixation. It is worthwhile to review some new methods of treatment, the role of bone grafting and synthetic substitutes, the principles of complex fracture management, and the treatment of common complications of distal radius fractures.

  17. An Asian Perspective on the Management of Distal Radius Fractures

    PubMed Central

    Sebastin, Sandeep J.; Chung, Kevin C.

    2012-01-01

    Synopsis There is little data with regards to the epidemiology, pathology, or management of distal radius fractures from centers in Asia. Asia includes five advanced economies, namely Hong Kong SAR, Japan, Korea, Singapore, and Taiwan and a number of emerging economies prominent among which are China, India, Malaysia, Philippines, and Thailand. This article examines the available epidemiological data from Asia, and compares the management of distal radius fractures in the advanced and emerging Asian economies and how they match up to the current management in the west. It concludes by offering solutions for improving outcomes of distal radius fractures in both the advanced and emerging economies of Asia. PMID:22554658

  18. Distal Radius Radiographic Indices and Perilunate Fracture Dislocation

    PubMed Central

    Bagherifard, Abolfazl; Jafari, Davod; Keihan Shokouh, Hassan; Motavallian, Ebrahim; Najd Mazhar, Farid

    2016-01-01

    Background Distal radius radiographic indices may play a role as risk factors in pathogenesis of Kienbock’s disease, scaphoid fracture and nonunion. Perilunate fracture dislocations are devastating wrist injuries, and their relationship and distal radius indices have not been addressed in the literature. Objectives The aim of this study was to evaluate the possible role of distal radius radiographic indices including radial height, radial inclination, ulnar variance and volar tilt as risk factors in the perilunate fracture dislocation injury of the wrist. Patients and Methods We studied distal radius radiographic indices including radial height, radial inclination, ulnar variance and volar tilt in 43 patients with perilunate fracture dislocations and compared them with 44 wrists in the control group. Results The mean values of the radial height, radial inclination, ulnar variance and volar tilt were 12.74 (5 - 18), 24.20 (7 - 35), -0.73 (-5 - 4) and 12.28 (2 - 20) in the patient group. These values were 12.68 (9 - 22), 23.22 (17 - 30), -0.11 (-4 - 3) and 11.05 (-3 - 20), respectively in the control group. There was no statistically significant difference between the two groups. Conclusions This study did not show that distal radius anatomical indices including the radial height, radial inclination, ulnar variance and volar tilt influence perilunate fracture dislocation as risk factors. PMID:27626004

  19. Accuracy of distal radius positioning using an anatomical plate.

    PubMed

    Vroemen, Joy C; Dobbe, Johannes G G; Sierevelt, Inger N; Strackee, Simon D; Streekstra, Geert J

    2013-04-01

    Over the past decade, several anatomical plates have been introduced to improve the result of open reduction and internal fixation of the distal radius. Using 3-dimensional imaging techniques, the authors studied the accuracy and reproducibility of distal radius positioning using anatomical plates.Distal radius fractures and the correction of these fractures were simulated with plastic bone models of radii. The authors simulated a defect by removing an arbitrary wedge shape from the artificial radii. Two surgeons corrected these fractures by placing 2 anatomical plate types according to the plate manufacturers' instructions. The residual positioning errors of the distal segment in relation to the unaffected radii were determined using 3-dimensional imaging and were compared with naturally occurring bilateral radius differences in healthy individuals. In many cases, positioning does not agree with differences based on bilateral asymmetry in healthy patients.This study indicated the accuracy of anatomical plates. Positioning an anatomical plate may lead to considerable residual errors in individual patients. Volar distal radius plate shapes differ among plate manufacturers. Therefore, one plate may perform better than another in an individual.

  20. Predicting the failure load of the distal radius.

    PubMed

    Muller, Monique E; Webber, Colin E; Bouxsein, Mary L

    2003-06-01

    The distal radius is an important site for the early detection of patients at risk for fracture. Since measuring bone strength in vivo is not possible, we evaluated which bone assessment method of the forearm would best predict failure load of the distal radius and computed a factor of risk for wrist fracture (Phi wrist). Thirty-eight cadaveric forearm specimens were measured by five different techniques to assess bone density, bone mineral content, geometry and trabecular structure at the distal forearm. The bone assessment techniques included dual-energy X-ray absorptiometry (DXA) of the radius, peripheral quantitative computed tomography (pQCT) of the 4% and 20% distal sites of the radius, DXA of the phalanges, digital X-ray radiogrammetry of the forearm (DXR-BMD), and quantitative ultrasound of the radius. The failure load of each excised radius was determined by simulating a fall on an outstretched hand. The pQCT measurements of polar stress-strain index and cortical content explained the greatest portion of variance in failure load (r2=0.82-0.85). Bone mineral content measures were generally better predictors of failure load (r2=0.53-0.85) than the corresponding volumetric or areal bone mineral density values (r2=0.22-0.69) measured by either pQCT or DXA. Multiple regression analysis showed that the addition of a bone geometry measure improved the ability of a bone density measure alone to predict failure load. There was high variability in the ability of different techniques and different variables within a given technique to predict failure load. Estimates of the factor of risk for wrist fracture (Phi wrist) revealed that the women in this study would have been likely to fracture their distal radius upon falling from a standing height (Phi wrist= 1.04), whereas the men would have likely withstood the impact without fracturing their wrist (Phi wrist= 0.79).

  1. A Unified Approach to Outcomes Assessment for Distal Radius Fractures.

    PubMed

    Waljee, Jennifer F; Ladd, Amy; MacDermid, Joy C; Rozental, Tamara D; Wolfe, Scott W

    2016-04-01

    Distal radius fractures are one of the most common upper extremity injuries. Currently, outcome assessment after treatment of these injuries varies widely with respect to the measures that are used, timing of assessment, and the end points that are considered. A more consistent approach to outcomes assessment would provide a standard by which to assess treatment options and best practices. In this summary, we review the consensus regarding outcomes assessment after distal radius fractures and propose a systematic approach that integrates performance, patient-reported outcomes, pain, complications, and radiographs.

  2. Future treatment and research directions in distal radius fracture.

    PubMed

    Jupiter, Jesse

    2012-05-01

    Whether or not they will have their lives dramatically extended in the next few decades, it is clear that people are living longer, healthier, and more active lives. The two peak incidences of distal radius fractures will remain within the pediatric and geriatric age groups, with the latter experiencing a substantial increase in the coming years. This article attempts to project future developments with regard to epidemiology, risk and prevention, fracture assessment, and treatment of distal radius fractures, and the ever increasing concern for the economic impact of this prevalent injury.

  3. Unstable Distal Radius Fractures Treated by Volar Locking Anatomical Plates

    PubMed Central

    Jose, Anto; Deniese, Pascal Noel; Babu, Abey Thomas; Rengasamy, Kanagasabai; Najimudeen, Syed

    2017-01-01

    Introduction Fracture of the distal end of radius represents the most common fracture of the upper extremity accounting for 16-20% of all fractures. Plating is now emerging as the gold standard for management of distal radius fractures due to increased rate of complications such as malunion, subluxation/dislocation of distal radio-ulnar joint or late collapse of fracture. Procedures such as closed reduction and cast immobilization, ligamentotaxis with external fixator and percutaneous pin fixation are no longer acceptable. Aim The purpose of the study was to evaluate the functional and radiological outcome of unstable distal radius fractures treated with the volar locking plate. Materials and Methods We reviewed 53 patients from January 2011 to December 2015, treated for unstable distal radius fractures using a volar locking compression plate. Standard radiographic and clinical assessment after 12 months (range 12-16 months) were measured and final functional and radiological outcome were assessed using the Modified Mayo wrist scoring system and Sarmiento’s modification of Lindstorm criteria respectively. Results There were 42 males and 11 females with an average age of 39.12±31.78 years (18-71 years). At the end of 12 months, 36 patients had an excellent radiological outcome and 10 patients had good radiological outcome as per Sarmiento’s modification of Lindstorm criteria. Eleven patients had an excellent functional outcome and 26 patients had a good functional outcome as per modified Mayo wrist scoring system. There was one case of superficial wound infection which subsided with intravenous antibiotics. Conclusion The volar locking plate fixation helps in early mobilization of the wrist, restores anatomy, allows early return to function, prevents secondary loss of reduction and hence is an effective treatment for unstable fractures of the distal radius. PMID:28274009

  4. Ultrasound-Guided Reduction of Distal Radius Fractures

    PubMed Central

    Sabzghabaei, Anita; Shojaee, Majid; Arhami Dolatabadi, Ali; Manouchehrifar, Mohammad; Asadi, Mahdi

    2016-01-01

    Introduction: Distal radius fractures are a common traumatic injury, particularly in the elderly population. In the present study we examined the effectiveness of ultrasound guidance in the reduction of distal radius fractures in adult patients presenting to emergency department (ED). Methods: In this prospective case control study, eligible patients were adults older than 18 years who presented to the ED with distal radius fractures. 130 consecutive patient consisted of two group of Sixty-Five patients were prospectively enrolled for around 1 years. The first group underwent ultrasound-guided reduction and the second (control group) underwent blind reduction. All procedures were performed by two trained emergency residents under supervision of senior emergency physicians. Results: Baseline characteristics between two groups were similar. The rate of repeat reduction was reduced in the ultrasound group (9.2% vs 24.6%; P = .019). The post reduction radiographic indices were similar between the two groups, although the ultrasound group had improved volar tilt (mean, 7.6° vs 3.7°; P = .000). The operative rate was reduced in the ultrasound groups (10.8% vs 27.7%; P = .014). Conclusion: Ultrasound guidance is effective and recommended for routine use in the reduction of distal radius fractures. PMID:27299141

  5. Intrafocal pinning for distal radius metaphyseal fractures in children.

    PubMed

    Parikh, Shital N; Jain, Viral V; Youngquist, Jeffrey

    2013-06-01

    The purpose of this retrospective case control study was to evaluate the results of intrafocal pinning for distal radius metaphyseal fractures in children and to compare these results with conventional pinning. Data were collected from medical records and radiographs from patients who underwent closed reduction and percutaneous pinning for distal radius fracture in a Level I trauma center at the authors' institution between 2008 and 2010. Inclusion criteria included a dorsally angulated metaphyseal fracture without physeal involvement, an open distal radius physis, and a follow-up to radiographic union. A total of 10 patients with intrafocal pinning were compared to 26 patients with conventional pinning. Preoperatively, angulation was greater in patients who received intrafocal pinning than conventional pinning based on anteroposterior radiographs. Postoperatively, the 2 groups did not differ in angulation on either anteroposterior or lateral radiographs. One malunion and 2 pin-related complications occurred in the conventional pinning group, and 1 pin-related complication occurred in the intrafocal pinning group. The 2 groups did not differ by age, sex, side of injury, days to surgery, or initial shortening. This study affirms that the intrafocal pinning technique is an alternative to the conventional pinning technique for the stabilization of displaced metaphyseal distal radius fractures in children. Intrafocal pinning can also be used as a reduction tool for fractures that cannot be reduced by closed manipulation. The complications are comparable between the 2 techniques.

  6. [Distal radius fractures: new concepts as basis for surgical treatment].

    PubMed

    Rikli, D A; Babst, R; Jupiter, J B

    2007-02-01

    New advances in the biomechanics and pathomechanics of distal radius fractures as well as new generations of plates and improved surgical approaches now make possible the stable management and early functional rehabilitation not only of simple but also of complicated distal radius fractures according to the principles for articular and juxta-articular fractures. Especially for complex articular fractures, the fracture patterns are so heterogeneous that an individual surgical treatment strategy must be developed for each case. The preoperative clarification of articular fractures with computed tomography is particularly useful for planning surgery. Mental exposition with the three-column model and pathomechanics is an important prerequisite for understanding this type of injury and the appropriate choice of operative technique. A decisive factor for success is the subtle surgical procedure in approaching and handling the fine plates.

  7. Medical management of fragility fractures of the distal radius.

    PubMed

    Morgan, Emily N; Crawford, David A; Scully, William F; Noce, Nicholas J

    2014-12-01

    Fragility fractures of the distal radius represent an opportunity to diagnose and treat osteoporosis before further fractures occur. The goal of this study was to determine the prevalence of prescriptions for calcium/vitamin D supplementation and the prevalence of dual-energy x-ray absorptiometry (DEXA) scans in patients who sustained fragility fractures of the distal radius. A further goal was to determine the prevalence of patients who received prescriptions for the treatment of osteoporosis after DEXA scans. The authors performed a retrospective review of all patients 50 years and older who sustained a fragility fracture of the distal radius and were treated by the orthopedic surgery service at the authors' institution from 2004 to 2010. After a fragility fracture of the distal radius, fewer than 25% of previously unidentified at-risk patients received a prescription for vitamin supplementation and underwent a DEXA scan. Women were 7 times more likely than men to receive calcium/vitamin D supplementation, 14 times more likely to undergo a DEXA scan for the evaluation of osteoporosis, and 25 times more likely to receive a prescription for bisphosphonates. Patients who underwent a DEXA scan were 9 times more likely to receive pharmacologic treatment than those who did not undergo this scan. More than half of patients did not receive a prescription for calcium/vitamin D supplementation and did not undergo DEXA scanning as recommended by current National Osteoporosis Foundation guidelines. Most patients who received prescriptions or underwent DEXA scans did so before rather than after fracture, indicating poor compliance with National Osteoporosis Foundation guidelines.

  8. Complications of pediatric distal radius and forearm fractures.

    PubMed

    Chia, Benjamin; Kozin, Scott H; Herman, Martin J; Safier, Shannon; Abzug, Joshua M

    2015-01-01

    Distal radius and forearm fractures represent a large percentage of pediatric fractures. The most common mechanism of injury is a fall onto an outstretched arm, which can lead to substantial rotational displacement. If this rotational displacement is not adequately addressed, there will be resultant loss of forearm motion and subsequent limitations in performing the activities of daily living. Good initial reductions and proper casting techniques are necessary when treating distal radius and forearm fractures nonsurgically; however, maintaining an acceptable reduction is not always possible. Atraumatic reduction of a displaced physeal fracture should occur within 7 days of the injury. If an impending malunion presents at 2 weeks or later after injury, observation is warranted because of concerns about physeal arrest with repeated attempts at manipulation, and it should be followed by a later assessment of functional limitations. Pediatric patients and their parents have higher expectations for recovery, which has contributed to an increase in the surgical management of pediatric distal radius and forearm fractures. In addition, surgical interventions, such as intramedullary nailing, have their own associated complications.

  9. Korean Type Distal Radius Anatomical Volar Plate System: A Preliminary Report

    PubMed Central

    Kim, Jeong Hwan; Kim, Jihyeung; Kim, Min Bom; Rhee, Seung Hwan; Gong, Hyun Sik; Lee, Young Ho

    2014-01-01

    Background Distal radius fracture is the most common fracture of the upper extremity, and approximately 60,000 distal radius fractures occur annually in Korea. Internal fixation with an anatomical volar locking plate is widely used in the treatment of unstable distal radius fractures. However, most of the currently used distal radius anatomical plate systems were designed based on the anatomical characteristics of Western populations. Recently, the Korean-type distal radius anatomical volar plate (K-DRAVP) system was designed and developed based on the anatomical characteristics of the distal radius of Koreans. The purpose of this study was to evaluate the preliminary results of the new K-DRAVP system, and to compare its radiologic and functional results with those of the other systems. Methods From March 2012 to October 2012, 46 patients with acute distal radius fractures who were treated with the K-DRAVP system at three hospitals were enrolled in this study. Standard posteroanterior and lateral radiographs were obtained to assess fracture healing, and three radiographic parameters (volar tilt, radial inclination, and radial length) were assessed to evaluate radiographic outcomes. The range of motion and grip strength, the Gartland and Werley scoring system, and the disabilities of the arm, shoulder and hand (DASH) questionnaire were used to assess clinical and functional outcomes. Results All radiologic parameters were restored to normal values, and maintained without any loosening or collapse until the time of final follow-up. Grip strength was restored to 84% of the value for the unaffected side. The mean range of motion of the wrist at final follow-up was restored to 77%-95% of the value for the unaffected side. According to the Gartland and Werley scoring system, there were 16 excellent, 26 good, and 4 fair results. The mean DASH score was 8.4 points. There were no complications after surgery. Conclusions The newly developed K-DRAVP system could be used to

  10. Three-dimensional in vivo kinematics of the distal radioulnar joint in malunited distal radius fractures.

    PubMed

    Moore, Douglas C; Hogan, Kathleen A; Crisco, Joseph J; Akelman, Edward; Dasilva, Manuel F; Weiss, Arnold-Peter C

    2002-03-01

    How malunion of the distal radius affects the kinematics of the distal radioulnar joint in vivo was evaluated. A novel computed tomography image-based technique was used to quantify radioulnar motion in both wrists of 9 patients who had unilateral malunited distal radius fractures. In the injured wrists dorsal angulation averaged 21 degrees +/- 6 degrees, radial inclination averaged 18 degrees +/- 5 degrees, and radial shortening averaged 21 +/- 3 mm. Clinically, the average range of motion of the injured wrists was 75 degrees +/- 25 degrees pronation and 73 degrees +/- 23 degrees supination. Kinematics of the radius during pronation and supination in the malunited forearms was indistinguishable from that in the uninjured forearms. In both the axis of rotation of the radius passed through the center of the ulnar head, although it shifted slightly ulnar and volar in supination and radial and dorsal during pronation. In contrast to previous in vitro biomechanical findings, there was no dorsovolar radial translation at the extremes of pronation or supination and no translation of the radius along the rotation axis. Soft tissues may play a larger role in limiting function than previously appreciated, and treatment may require correction of altered soft tissue structures as well as any abnormal bone anatomy.

  11. Post-traumatic osteonecrosis of the lunate after fracture of the distal radius.

    PubMed

    Nakanishi, Akito; Yajima, Hiroshi; Kisanuki, Osamu

    2014-12-01

    We present a case of post-traumatic osteonecrosis of the lunate after fracture of the distal radius. Post-traumatic osteonecrosis of the carpal lunate after a fracture of the distal radius has, to our knowledge, not been reported previously. We treated the patient with vascularised bone graft from the distal radius, with a satisfactory result.

  12. Biomechanics and biology of plate fixation of distal radius fractures.

    PubMed

    Freeland, Alan E; Luber, Kurre T

    2005-08-01

    The fracture management principles of anatomic or near anatomic reduction, fracture stabilization, minimal operative trauma, and early joint motion are paramount in man-aging unstable distal radial fractures. The operative approach and plate selection should correlate with the fracture configuration. Plates have the advantages of providing secure fixation throughout the entire healing process without protruding wires or pins and allowing early and intensive forearm, wrist, and digital exercises. Disadvantages include additional operative trauma, including fragment devascularization; some additional risk of wrist stiffness; occasional tendon rupture; and at times, the need for plate removal. New developments in plate and screw design and operative strategies, fragment specific fixation, and plate strength have improved results with plate fixation. Fixed angle blades and locking screws and pegs enhance overall plate stability, support the articular surface of the distal radius, and are effective in fractures occurring in osteopenic bone.

  13. Radiographic Outcomes of Volar Locked Plating for Distal Radius Fractures

    PubMed Central

    Mignemi, Megan E.; Byram, Ian R.; Wolfe, Carmen C.; Fan, Kang-Hsien; Koehler, Elizabeth A.; Block, John J.; Jordanov, Martin I.; Watson, Jeffry T.; Weikert, Douglas R.; Lee, Donald H.

    2013-01-01

    Purpose To assess the ability of volar locked plating to achieve and maintain normal radiographic parameters for articular stepoff, volar tilt, radial inclination, ulnar variance, and radial height in distal radius fractures. Methods We performed a retrospective review of 185 distal radius fractures that underwent volar locked plating with a single plate design over a 5-year period. We reviewed radiographs and recorded measurements for volar tilt, radial inclination, ulnar variance, radial height, and articular stepoff. We used logistic regression to determine the association between return to radiographic standard norms and fracture type. Results At the first and final postoperative follow-up visits, we observed articular congruence less than 2 mm in 92% of fractures at both times. Normal volar tilt (11°) was restored in 46% at the first follow-up and 48% at the final one. Radial inclination (22°) was achieved in 44% at the first follow-up and 43% at the final one, and ulnar variance (01 ± 2 mm) was achieved in 53% at the first follow-up and 53% at the final one. In addition, radial height (14 ± 1mm) was restored in 14% at the first follow-up and 12% at the final one. More complex, intra-articular fractures (AO class B and C and Frykman types 3, 4, 7, and 8) were less likely to be restored to normal radiographic parameters. However, because of the small sample size for some fracture types, it was difficult to discover significant associations between fracture type and radiographic outcome. Conclusions Volar locked plating for distal radius fractures achieved articular stepoff less than 2 mm in most fractures but only restored and maintained normal radiographic measurements for volar tilt, radial inclination, and ulnar variance in 50% of fractures. The ability of volar locked plating to restore and maintain ulnar variance and volar tilt decreased with more complex intra-articular fracture types. PMID:23218558

  14. Fractal analysis of bone architecture at distal radius.

    PubMed

    Tomomitsu, Tatsushi; Mimura, Hiroaki; Murase, Kenya; Sone, Teruki; Fukunaga, Masao

    2005-12-20

    Bone strength depends on bone quality (architecture, turnover, damage accumulation, and mineralization) as well as bone mass. In this study, human bone architecture was analyzed using fractal image analysis, and the clinical relevance of this method was evaluated. The subjects were 12 healthy female controls and 16 female patients suspected of having osteoporosis (age range, 22-70 years; mean age, 49.1 years). High-resolution CT images of the distal radius were acquired and analyzed using a peripheral quantitative computed tomography (pQCT) system. On the same day, bone mineral densities of the lumbar spine (L-BMD), proximal femur (F-BMD), and distal radius (R-BMD) were measured by dual-energy X-ray absorptiometry (DXA). We examined the correlation between the fractal dimension and six bone mass indices. Subjects diagnosed with osteopenia or osteoporosis were divided into two groups (with and without vertebral fracture), and we compared measured values between these two groups. The fractal dimension correlated most closely with L-BMD (r=0.744). The coefficient of correlation between the fractal dimension and L-BMD was very similar to the coefficient of correlation between L-BMD and F-BMD (r=0.783) and the coefficient of correlation between L-BMD and R-BMD (r=0.742). The fractal dimension was the only measured value that differed significantly between both the osteopenic and the osteoporotic subjects with and without vertebral fracture. The present results suggest that the fractal dimension of the distal radius can be reliably used as a bone strength index that reflects bone architecture as well as bone mass.

  15. Primary Combined Replacements for Treatment of Distal Radius Physeal Arrest

    PubMed Central

    Schmidt, Ingo

    2014-01-01

    This is a case report of a 59-year-old female patient with a posttraumatic growth arrest of the distal radius, leading to radioscaphoid osteoarthritis, carpal instability, and a symptomatic ulnocarpal impaction syndrome that was successfully treated with combined total wrist arthroplasty and ulnar head implant. One year postoperatively, there was no change in position without any signs of loosening of both implants. Both subjectively and functionally, all clinical parameters—Disabilities of the Arm, Shoulder, and Hand (DASH), visual analog scale (VAS), grip strength—had improved. Level of Evidence: IV PMID:25097815

  16. Stabilisation of distal radius fractures: Lessons learned and future directions.

    PubMed

    Horst, Taylor A; Jupiter, Jesse B

    2016-02-01

    Our understanding of the diagnosis and management of distal radius fractures has been a long developed over centuries. There has been a shift in treatment of these very common injuries from closed reduction and casting to internal fixation. The answer to the best method of treatment has yet to be found. Today, we have a multitude of treatment options available with varying degrees of evidence to support their use. This review helps to illustrate the lessons we have learned and future directions for treatment.

  17. Measurement of ulnar variance and radial inclination on X-rays of healed distal radius fractures. With the axis of the distal radius or ulna?

    PubMed

    Thuysbaert, Gilles; Ringburg, Akkie; Petronilia, Steven; Vanden Berghe, Alex; Hollevoet, Nadine

    2015-06-01

    Ulnar variance and radial inclination are radiological parameters frequently used to evaluate displacement of distal radius fractures. In most studies measurements are based on the long central axis of the distal radius, although the axis of the distal ulna can also be used. The purpose of this study was to determine which axis is more reliable. Four observers performed measurements on standard anteroposterior digital wrist X-rays of 20 patients taken 1 and 2 months after sustaining an extra-articular distal radius fracture. Intraobserver reliability was similar with both methods. No difference was found in interobserver reliability between both methods for ulnar variance, but for radial inclination it was better with the axis through the radius. Measurements on two X-rays of the same wrist taken at a different moment were similar with both methods. It can be concluded that the central axis of the distal radius can remain the basis to determine ulnar variance and radial inclination.

  18. Biomechanical Comparison of Osteoporotic Distal Radius Fractures Fixed by Distal Locking Screws with Different Length

    PubMed Central

    Liu, Xiong; Wu, Wei-dong; Fang, Ya-feng; Zhang, Mei-chao; Huang, Wen-hua

    2014-01-01

    Objectives To evaluate the postoperative stability of osteoporotic distal radius fractures fixed with distal locking screws with different length. Methods A comminuted extra-articular dorsally unstable distal radius fracture, treated with volar locking plate system, was created. The 18 specimens were randomized into 3 groups based on distal locked screws with different length: Group A had unicortical screws with 50% length to the dorsal cortex. Group B had unicortical screws with 75% length to the dorsal cortex. Group C had bicortical screws. Axial compression and bending loads were imposed on the models before and after cycling testing as well as load to clinical and catastrophic failure. Results Minimum change in stiffness was observed before and after fatigue for all groups. The final stiffness to bending forces was statistically similar in all groups, but stiffness to axial compression was statistically significant different: Group A approached significance with respect to groups B and C (P = 0.017, 0.009), whereas stiffness in group B and C was statistically similar (P = 0.93). Load to clinical failure was significantly less for group A (456.54±78.59 N) compared with groups B (580.24±73.85 N) and C (591.07±38.40 N). Load to catastrophic failure was statistically similar between groups, but mean values for Group A were 18% less than means for Group C. Conclusions The volar locking plate system fixed with unicortical locking screws with at least 75% length not only produced early stability for osteoporotic distal radius fractures, but also avoided extensor tendon complications due to dorsal screw protrusion. PMID:25080094

  19. Pediatric distal radius fractures and triangular fibrocartilage complex injuries.

    PubMed

    Bae, Donald S; Waters, Peter M

    2006-02-01

    Management of distal radius fractures is guided by the pattern and location of injury, degree of deformity, and expectations of bony remodeling based on the amount of remaining skeletal growth.Indications for surgical treatment include unstable or irreducible fractures, open fractures, floating elbow injuries, and neurovascular or soft-tissue compromise precluding cast immobilization. Patients and families should be counseled regarding the potential for post-traumatic distal radial growth arrest following physeal fractures. In these cases, epiphysiodeses, ulnar shortening osteotomies, or corrective radial osteotomies may be performed, depending on the pattern of arrest,degree of deformity, and remaining skeletal growth.TFCC tears may be the source of ulnar-sided wrist pain in children and adolescents, though symptoms and physical examination findings maybe subtle. Patients who have persistent pain and functional limitations despite activity modification and therapy are candidates for surgical treatment. Appropriate repair of peripheral TFCC tears with correction of concomitant wrist pathology restores normal wrist anatomy, alleviates pain, and allows for return to functional activities.

  20. A biomechanical approach to distal radius fractures for the emergency radiologist.

    PubMed

    Bunch, Paul M; Sheehan, Scott E; Dyer, George S; Sodickson, Aaron; Khurana, Bharti

    2016-04-01

    Distal radius fractures are the most common upper extremity fracture and account for approximately one sixth of all fractures treated in US emergency departments. These fractures are associated with significant morbidity and have a major economic impact. Radiographic evaluation of distal radius fractures is frequently performed in the emergency department setting, has a profound impact on initial management, and is essential to assessing the quality and relative success of the initial reduction. While the most appropriate definitive management of distal radius fractures remains controversial, overarching treatment principles reflect distal radius injury mechanisms and biomechanics. An intuitive understanding of the biomechanics of the distal radius and of common mechanisms of injury informs and improves the emergency radiologist's ability to identify key imaging findings with important management implications and to communicate the critical information that emergency physicians and orthopedic surgeons need to best manage distal radius fractures.

  1. Prevent Collapse and Salvage Failures of the Volar Rim of the Distal Radius

    PubMed Central

    Orbay, Jorge L.; Rubio, Francisco; Vernon, Lauren L.

    2016-01-01

    Background Articular fractures of the distal radius may include a small fragment from the volar margin of the lunate fossa: volar marginal fragments (VMFs); these fragments are prone to loss of fixation and avascular necrosis, and often result in wrist subluxation. We present our experience managing acute and delayed VMFs. The first is treated using a hook plate extension to a volar locking plate and the latter using a volar opening wedge osteotomy to redistribute loads on the remaining articular surface. Materials and Methods We retrospectively reviewed the records of all patients treated at our facility with a hook plate extension for a VMF and for patients treated with a volar opening wedge osteotomy. Medical charts were examined for complications and functional results. Technique A hook plate extension was used to fix the VMF when plate buttressing was insufficient. For patients who presented a collapsed and reabsorbed VMF, a volar opening wedge osteotomy was used to reorient the articular surface, restoring joint stability. Results The hook plate extension was successful in managing 19 of the 21 acute VMFs. The volar opening wedge osteotomy provided concentric reduction and improved pain and motion in all treated patients. Conclusion We demonstrated that hook plate fixation of the VMF is an effective means of fixing the acute VMF and that a volar opening wedge osteotomy can be used to salvage a distal radius fracture with a collapsed VMF. PMID:26855831

  2. Biomechanical analysis of distal radius fractures using intramedullary Kirschner wires.

    PubMed

    Tsai, Wen-Chi; Lin, Shang-Chih; Hsiao, Chun-Ching; Lu, Tung-Wu; Chao, Ching-Kong; Liu, Hwa-Chang

    2009-03-01

    Colles's fracture is the most common type of distal radius fracture. Surgically, it remains a challenge to restore radial height and volar tilt in order to regain optimal wrist function. Ulson's procedure provides a dynamic effect on fixing fractured fragments and restoring joint function using two wires. However, the biomechanical influences of bone and wire remain critical issues for fracture reduction and bone union in Ulson's procedure. Based on elastic beam and foundation theory, this study formulated a closed-form mathematical model to investigate the effects of bone and wire parameters on wire deflection and bony reaction. The wire deflection and bony reaction were chosen as the indices of wrist stability and reduction within the post-operative period. The predicted results showed that greater bone strength, higher wire stiffness, and longer wire contact length provide a more stable wire-bone construct, thus facilitating fracture reduction and bone union. The wire stiffness had a much more significant effect on the construct stability compared with bone quality and contact length. In terms of entry point and insertion angle, surgical planning for the contact length was more important than bony quality for stabilizing the whole wire-bone construct.

  3. Photogrammetric analysis of the articular surface of the distal radius.

    PubMed

    Ege, A; Seker, D Z; Tuncay, I; Duran, Z

    2004-01-01

    Three-dimensional measurements made using photogrammetry have recently gained popularity with the development of real-time detection facilities and up-to-date equipment. The modelling of human bones presents a particular challenge as the measurements required are difficult to obtain, especially from uneven surfaces. In this study, the articular surfaces of 12 radius bones were evaluated using photogrammetry to obtain three-dimensional coordinates of certain points. Morphometric characteristics of the digital topography of the articular surface were analysed using three-dimensional data from more than 200 points for each specimen. The coronal plane curve, from the tip of the styloid process to the centre of the distal radioulnar articular notch, was found to be similar to the fourth degree polynomial function. A mathematical expression representing the sagittal curve passing through scapholunate border could not be found. Close-range photogrammetry is a safe and precise technique that can provide reliable, reproducible and accurate data for evaluating complex morphological surfaces.

  4. AO Distal Radius Fracture Classification: Global Perspective on Observer Agreement.

    PubMed

    Jayakumar, Prakash; Teunis, Teun; Giménez, Beatriz Bravo; Verstreken, Frederik; Di Mascio, Livio; Jupiter, Jesse B

    2017-02-01

    Background The primary objective of this study was to test interobserver reliability when classifying fractures by consensus by AO types and groups among a large international group of surgeons. Secondarily, we assessed the difference in inter- and intraobserver agreement of the AO classification in relation to geographical location, level of training, and subspecialty. Methods A randomized set of radiographic and computed tomographic images from a consecutive series of 96 distal radius fractures (DRFs), treated between October 2010 and April 2013, was classified using an electronic web-based portal by an invited group of participants on two occasions. Results Interobserver reliability was substantial when classifying AO type A fractures but fair and moderate for type B and C fractures, respectively. No difference was observed by location, except for an apparent difference between participants from India and Australia classifying type B fractures. No statistically significant associations were observed comparing interobserver agreement by level of training and no differences were shown comparing subspecialties. Intra-rater reproducibility was "substantial" for fracture types and "fair" for fracture groups with no difference accounting for location, training level, or specialty. Conclusion Improved definition of reliability and reproducibility of this classification may be achieved using large international groups of raters, empowering decision making on which system to utilize. Level of Evidence Level III.

  5. The Unstable Distal Radius Fracture—How Do We Define It? A Systematic Review

    PubMed Central

    Walenkamp, Monique M. J.; Vos, Lara M.; Strackee, Simon D.; Goslings, J. Carel; Schep, Niels W. L.

    2015-01-01

    Background Unstable distal radius fractures are a popular research subject. However, to appreciate the findings of studies that enrolled patients with unstable distal radius fractures, it should be clear how the authors defined an unstable distal radius fracture. Questions In what percentage of studies involving patients with unstable distal radius fractures did the authors define unstable distal radius fracture? What are the most common descriptions of an unstable distal radius fracture? And is there one preferred evidence-based definition for future authors? Methods A systematic search of literature was performed to identify any type of study with the term unstable distal radius fracture. We assessed whether a definition was provided and determined the level of evidence for the most common definitions. Results The search yielded 2,489 citations, of which 479 were included. In 149 studies, it was explicitly stated that patients with unstable distal radius fractures were enrolled. In 54% (81/149) of these studies, the authors defined an unstable distal radius fracture. Overall, we found 143 different definitions. The seven most common definitions were: displacement following adequate reduction; Lafontaine's definition; irreducibility; an AO type C2 fracture; a volarly displaced fracture; Poigenfürst's criteria; and Cooney's criteria. Only Lafontaine's definition originated from a clinical study (level IIIb). Conclusion In only half of the studies involving patients with an unstable distal radius fracture did the authors defined what they considered an unstable distal radius fracture. None of the definitions stood out as the preferred choice. A general consensus definition could help to standardize future research. PMID:26649263

  6. Volar morphology of the distal radius in axial planes: a quantitative analysis.

    PubMed

    Oura, Keiichiro; Oka, Kunihiro; Kawanishi, Yohei; Sugamoto, Kazuomi; Yoshikawa, Hideki; Murase, Tsuyoshi

    2015-04-01

    To investigate the cause of rupture of the flexor pollicis longus (FPL) after volar plate fixation of distal radius fractures, previous studies have examined the shape of the distal radius in the sagittal plane or in the lateral view. However, there are no reports on the anatomical shape of the volar surface concavity of the distal radius in the axial plane. We hypothesized that this concavity might contribute to the mismatch between the plate and the surface of the radius. To test this hypothesis, we constructed three-dimensional models of the radius and FPL based on computed tomography scans of 70 normal forearms. We analyzed axial cross-sectional views with 2 mm intervals. In all cases, the volar surface of the distal radius was concave in the axial plane. The concavity depth was maximum at 6 mm proximal to the palmar edge of the lunate fossa and progressively decreased toward the proximal radius. FPL was closest to the radius at 2 mm proximal to the palmar edge of the lunate fossa. The volar surface of the distal radius was externally rotated from proximal to distal. These results may help to develop new implants which fit better to the radius and decrease tendon irritation.

  7. Outcomes Following Operative Treatment of open Fractures of the Distal Radius: A Case Control Study

    PubMed Central

    MacKay, Brendan J; Montero, Nicole; Paksima, Nader; Egol, Kenneth A

    2013-01-01

    Purpose To report radiographic, clinical, and patient-based functional outcomes following contemporary operative treatment of patients who sustained an open distal radius fracture and compare them to a similar group of patients treated operatively for closed distal radius fractures. Methods Over five years, 601 patients with a distal radius fracture presented to our academic medical center, including one Level 1 trauma hospital, and were prospectively enrolled in an upper extremity trauma database. Patients with open distal radius fractures underwent irrigation, debridement, and operative fixation within 24 hours of presentation. Closed distal radius fractures requiring operative fixation were treated electively. Retrospective review of the database identified eighteen open fractures of the distal radius (11 type I, 6 type II, 1 type IIIa). The open fracture patients were individually matched with eighteen closed distal radius fracture patients who underwent surgical fixation based on age, sex, injury to dominant extremity, fracture pattern, and method of fracture fixation. Clinical, radiographic, patient- based functional outcomes, and complications were recorded at routine postoperative intervals. Results Follow-up was greater than 77% in both groups at all time points. The open and closed groups were similar in regards to age, gender, BMI, race, tobacco use, income, employment status, hand dominance, injury to dominant extremity, mechanism of injury, fracture classification, method of fracture fixation, and presence of concomitant injury. Postoperative complications and reoperation rates were similar between the open and closed groups. Union rates and radiographic alignment one year postoperatively were similar between the open and closed fracture groups. At final follow-up, range of motion parameters, grip strengths, DASH indices, and subjective pain scores were similar between both groups. Discussion Open distal radius fractures treated with early debridement

  8. The Effect of Osteoporosis on Healing of Distal Radius Fragility Fractures.

    PubMed

    Tulipan, Jacob; Jones, Christopher M; Ilyas, Asif M

    2015-10-01

    Although the decision for operative versus nonoperative treatment of distal radius fractures remains subjective and is performed on a case-by-case basis, evaluation and treatment of patients with concomitant osteoporosis requires understanding of the behavior of this injury as a distinct subset of distal radius fractures. Age, infirmity, and osteoporosis affect every aspect of the fracture. Understanding what makes these fractures unique assists surgeons in more effective and efficient treatment. The authors present the current understanding of osteoporotic fragility fractures of the distal radius, focusing on epidemiology, biomechanics of bone healing, and its implication on strategies for management.

  9. Use of High-Speed X ray and Video to Analyze Distal Radius Fracture Pathomechanics.

    PubMed

    Gutowski, Christina; Darvish, Kurosh; Liss, Frederic E; Ilyas, Asif M; Jones, Christopher M

    2015-10-01

    The purpose of this study is to investigate the failure sequence of the distal radius during a simulated fall onto an outstretched hand using cadaver forearms and high-speed X ray and video systems. This apparatus records the beginning and propagation of bony failure, ultimately resulting in distal radius or forearm fracture. The effects of 3 different wrist guard designs are investigated using this system. Serving as a proof-of-concept analysis, this study supports this imaging technique to be used in larger studies of orthopedic trauma and protective devices and specifically for distal radius fractures.

  10. Double V-shaped cancellous osteotomy of the distal radius for Kienböck's disease.

    PubMed

    Aly, Tarek Ahmed

    2009-03-01

    Treatments of Kienböck's disease range from conservative measures-usually immobilization during the acute phase-to such procedures as joint leveling by radial shortening or ulnar lengthening, intercarpal fusion, silastic arthroplasty, and vascularized bone grafts. Joint-leveling procedures have many complications such as nonunion, hardware problems, and pain. In this study, 34 patients with Kienböck's disease, stage 1 through 3B in Lichtman's classification, were treated with a new technique: a double V-shaped metaphyseal osteotomy of the distal radius and dorsal tilt of the distal radius. The patients were evaluated clinically regarding pain, which decreased in 88% of patients; range of motion, which improved in all patients; and grip strength, which improved by 90%. Progression of the disease was assessed radiologically by determining the carpal height ratio and the carpal ulnar distance ratio. There were no cases with nonunion of the radial osteotomy at follow-up. This procedure is an effective treatment method for Kienböck's disease in wrists that do not have degenerative changes in the adjacent carpal joints.

  11. Physeal growth arrest of the distal radius treated by the Ilizarov technique. Report of a case.

    PubMed

    Aston, J W; Henley, M B

    1989-07-01

    Growth arrest of the distal radius may follow a severe injury to the growth plate. When the growth of the distal radius ceases in the child, continuing ulnar growth results in radial deviation of the hand and dislocation of the distal radioulnar joint. Treatment options in such a limb-length discrepancy are resection of the physeal bony bridge, lengthening of the shaft of the radius with bone graft using the principle of the Wagner technique, resection or epiphysiodesis of the distal ulna, and lengthening through a metaphyseal corticotomy without the use of bone graft. We report a case of metaphyseal lengthening of the radius employing the Ilizarov external fixator for controlled distraction osteogenesis.

  12. [Early corrective osteotomy after secondary displaced distal radius fractures in children].

    PubMed

    Boeckers, P; Gehrmann, S V; Wild, M; Schädel-Höpfner, M; Windolf, J

    2014-02-01

    Secondary fracture displacement before osseous consolidation of distal radius fractures in children occasionally leads to restricted forearm rotation. So far, there is no consistent treatment recommendation to correct this complication. We report on 5 children with an age of 8-13 years (mean age 12.3 years, 4 boys, 1 girl) with secondary displaced distal radius fractures and high functional deficits in forearm rotation (mean ROM for pro-/supination 70-0-30°) after osseous consolidation. We performed corrective osteotomies of the distal radius using a palmar approach after a mean of 38 days. Stabilisation was achieved with a fixed-angle plate system. At the final follow-up examination (mean 9 months) the forearm rotation was normal. No complications were observed. We consider corrective osteotomies of the distal radius in children with deficits of forearm rotation to be a possible strategy. Early corrective osteotomies can lead to a predictable increase of function through reestablishing normal articulation.

  13. Volar Locking Plate Breakage after Nonunion of a Distal Radius Osteotomy

    PubMed Central

    Rodríguez-Alabau, Sergi; Soldado, Francisco; Mir, Xavier

    2016-01-01

    We report a 38-year-old male with a nonunion followed by plate breakage after volar plating of a distal radius osteotomy. Volar locking plates have added a new approach to the treatment of distal radius malunions, due to a lower morbidity of the surgical approach and the strength of the final construction, allowing early mobilization and return to function. Conclusion. Plate breakage is an uncommon complication of volar locking plate fixation. To our knowledge, few cases have been described after a distal radius fracture and no case has been described after a distal radius corrective osteotomy. In the present case, plate breakage appears to have occurred as a result of a combination of multiple factors as the large corrective lengthening osteotomy, the use of demineralized bone matrix instead of bone graft, and the inappropriate fixation technique as an unfilled screw on the osteotomy site, rather than the choice of plate. PMID:28003828

  14. Secondary displacement of distal radius fractures treated by bridging external fixation.

    PubMed

    Farah, N; Nassar, L; Farah, Z; Schuind, F

    2014-05-01

    Loss of reduction remains an important problem after treatment of distal radius fractures, whatever the type of bone fixation. We assessed retrospectively the rate of secondary displacement after external fixation of distal radius fractures in order to identify possible risk factors for instability. We reviewed the pre-operative and serial post-operative radiographs of a retrospective series of 35 distal radius fractures treated by bridging external fixation. When classified according to the Société Française d'Orthopédie et Traumatologie (SOFCOT) criteria, the rate of secondary displacement was 48.5%. At final follow up, the reduction was anatomical in 12% and acceptable in 83%. There was malunion in 5%. The loss of reduction concerned primarily the distal radius palmar tilt and was moderate. No correlation was found with age, gender, type of fracture, degree of initial displacement, associated ulnar fracture, or seniority of the treating surgeon.

  15. Distal radius fracture after Sauvé-Kapandji procedure in a rheumatoid arthritis patient.

    PubMed

    Ochi, Kensuke; Horiuchi, Yukio; Matsumura, Takashi; Nakamura, Mitsukazu; Takei, Terue; Yabe, Hiroki

    2012-04-01

    We report a case of distal radius fracture after a Sauvé-Kapandji procedure combined with synovectomy and tendon transfer in a rheumatoid arthritis patient. This case shared several unusual features that were also seen in a previously reported case. Based on these features, we discuss favorable surgical treatment for the rheumatoid wrist with extensor tendon rupture, and also the optimal treatment for distal radius fracture after such procedures.

  16. Pathological fracture of the right distal radius caused by Enterobacter aerogenes osteomyelitis in an adult.

    PubMed

    Lin, Te-Yu; Chi, Hung-Wei; Wang, Ning-Chi

    2010-05-01

    A pathological fracture is a break in a diseased bone caused by weakening of the bone structure by a pathological process with no identifiable trauma. Acute bacterial osteomyelitis that results in pathological fractures in the extremities is rare in adults. To our knowledge, we report the first case of Enterobacter aerogenes osteomyelitis of the right distal radius, complicated with a pathological fracture, in a 79-year-old man with diabetes, which was diagnosed by radiological, microbiological, and histopathological examinations. He recovered well after an 8-week course of antibiotics and surgical debridement. This highlights the fact that radial osteomyelitis should be included in the differential diagnosis when an elderly diabetic patient with no history of trauma presents with pain in the forearm.

  17. Corrective distal radius osteotomy: including bilateral differences in 3-D planning.

    PubMed

    Dobbe, J G G; Vroemen, J C; Strackee, S D; Streekstra, G J

    2013-07-01

    After a fracture of the distal radius, the bone segments may heal in a suboptimal position. This condition may lead to a reduced hand function, pain and finally osteoarthritis, sometimes requiring corrective surgery. Recent studies report computer-assisted 3-D planning techniques in which the mirrored contralateral unaffected radius serves as reference for planning the position of the distal radius before corrective osteotomy surgery. Bilateral asymmetry, however, may introduce length errors into this type of preoperative planning that can be compensated for by taking into account the concomitant ulnae asymmetry. This article investigates a method for planning a correction osteotomy of the distal radius, while compensating for bilateral length differences using a linear regression model that describes the relationship between radii and ulnae asymmetry. The method is evaluated quantitatively using CT scans of 20 healthy individuals, and qualitatively using CT scans of patients suffering from a malunion of the distal radius. The improved planning method reduces absolute length deviations by a factor of two and markedly reduces positioning variation, from 2.9 ± 2.1 to 1.5 ± 0.6 mm. We expect the method to be of great value for future 3-D planning of a corrective distal radius osteotomy.

  18. Contact areas of the scaphoid and lunate with the distal radius in neutral and extension: correlation of falling strategies and distal radial anatomy.

    PubMed

    Chen, Y R; Wu, Y F; Tang, J B; Giddins, G

    2014-05-01

    The functional neutral of wrist movement is about 10° extension yet the distal radius has a volar tilt. This has not previously been explained. Assuming that the contact area between the carpus and the distal radius increased in wrist extension this would also help stabilize the carpus on the distal radius in positions where typically there is greater loading. To test this hypothesis we reconstructed three-dimensional structures of the carpal bones and distal radius using computed tomography scans of 13 normal wrists. The contact areas of the scaphoid with the distal radius were measured and were found progressively increased from flexion 20°, neutral, extension 20°, to extension 40°. The maximal increases in the contact area of the scaphoid and the distal radius was at full wrist extension. No significant changes in the contact areas of the lunate with the distal radius were found between the different positions. The contact characteristics provide greater stability to the carpus on the distal radius, and to help spread forces from impact to the wrist reducing the transmitted peak forces and thus the risk of distal radius and carpal injuries.

  19. Optimal Positioning for Volar Plate Fixation of a Distal Radius Fracture: Determining the Distal Dorsal Cortical Distance.

    PubMed

    Vosbikian, Michael M; Ketonis, Constantinos; Huang, Ronald; Ilyas, Asif M

    2016-01-01

    Distal radius fractures are currently among the most common fractures of the musculoskeletal system. With a population that is living longer, being more active, and the increasing incidence of osteoporosis, these injuries will continue to become increasingly prevalent. When operative fixation is indicated, the volar locking plate has recently become the treatment of choice. However, despite its success, suboptimal position of the volar locking plate can still result in radiographic loss of reduction. The distal dorsal cortical distance is being introduced as an intraoperative radiographic tool to help optimize plate position and minimize late loss of fracture reduction.

  20. The relationship between displacement and clinical outcome after distal radius (Colles') fracture.

    PubMed

    Finsen, V; Rod, O; Rød, K; Rajabi, B; Alm-Paulsen, P S; Russwurm, H

    2013-02-01

    We reviewed 260 patients who had been treated non-operatively for a dorsally displaced distal radius fracture a mean 6.3 (range 2.5-12.7) years earlier, in an attempt to find the limits of displacement compatible with a good clinical outcome. We excluded patients with previous or later injuries to the same limb. Bivariate analysis revealed a highly statistically significant relationship between radiographic displacement at review and clinical outcome scores. Correlation coefficients varied between 0.14 and 0.30. However, multiple linear regression analysis using most factors commonly thought to be of importance in determining the clinical outcome as independent variables explained only 23% of the variability of the clinical outcome. Dorsal angulation, ulnar variance, and radial inclination together accounted for only 11% of the variability. We conclude that the final alignment of the distal radius as shown radiologically has only a minor influence on the clinical outcome of Colles' type distal radius fractures.

  1. Reconstruction of the Distal Radius following Tumour Resection Using an Osteoarticular Allograft

    PubMed Central

    Maurer-Ertl, Werner; Pirker-Frühauf, Ulrike; Lovse, Thomas; Leithner, Andreas

    2013-01-01

    Reconstruction of the distal radius following tumour resection is challenging and various techniques are recorded. We retrospectively analysed the outcome of five patients (one male and four females) after reconstruction of the distal radius with osteoarticular allograft, following tumour resection. Mean followup was 32 months (range, 4–121). In three of the five patients the dominant limb was affected. Mean bone resection length was 6.5 centimetres (range, 5–11.5). Two grafts developed nonunion, both successfully treated with autologous bone grafting. No infection, graft fracture, or failure occurred. Mean flexion/extension was 38/60 degrees and mean pronation/supination was 77/77 degrees. The mean Mayo wrist score was 84 and the mean DASH score was 8, both representing a good functional result. Therefore we state the notion that osteoarticular allograft reconstruction of distal radius provides good to excellent functional results. PMID:23690732

  2. Treatment of distal radius fractures with intrafocal (kapandji) pinning and supplemental skeletal stabilization.

    PubMed

    Weil, Wayne M; Trumble, Thomas E

    2005-08-01

    The technique of intrafocal pinning was originally described by Kapandji. This technique, along with the addition of supplemental external or internal bridging fixation, can be performed quickly with minimal soft tissue damage. This technique is indicated for the treatment of unstable extra-articular or minimally displaced intra-articular fractures of the distal radius. Studies demonstrate that young patients with displaced extra-articular distal radius fractures and minimal comminution can be treated by percutaneous intrafocal pin fixation alone, whereas, patients over 55 years of age and younger patients with comminution involving two or more surfaces of the radial metaphysis (or > 50% of the metaphyseal diameter) require bridging fixation besides percutaneous pin fixation. The use of this technique achieves the goal of surgical treatment of distal radius fractures: restoration of hand and wrist function through the restoration of alignment and articular surface congruity.

  3. En bloc joystick reduction of a comminuted intra-articular distal radius fracture: a technical trick.

    PubMed

    Siegall, Evan; Ziran, Bruce

    2014-08-01

    A patient with a 1-month-old intra-articular distal radius fracture (treated closed in a splint) presented with an unacceptable degree of pain and stiffness caused by shortening and dorsal angulation of the distal radius. The fracture was comminuted with 4 or 5 distinct fragments, several involving the articular surface. Surgical correction was attempted. During the procedure, it was noted that, though the distal radius was shortened and angulated, there was actually acceptable congruity of the articular surface itself, despite the intra-articular nature of the fracture. Bone quality was poor and healing incomplete. Thus, we were concerned the currently congruous articular surface would fall apart with manipulation. Given this situation, we used a unique scaffolding technique with Kirschner wires placed in perpendicular fashion to both hold the articular surface intact and manipulate it en bloc. This technique is a simple way to turn a complex fracture into an easily reduced 2-part fracture.

  4. [Results of Kapandji-Sauvé operation after distal radius fractures].

    PubMed

    Borisch, N; Haussmann, P

    1998-11-01

    Incongruity of the distal radioulnar joint represents a major problem following malunited fractures of the distal radius. A useful solution is the arthrodesis of the distal radioulnar joint with distal ulnar pseudarthrosis as described by Kapandji-Sauvé. The results of this procedure are presented and the indication compared to alternative treatment options discussed. Between 1991 and 1997, 19 patients were treated with a Kapandji-Sauvé procedure, for rheumatoid arthritis in seven and for a malunited fracture of the distal radius in twelve patients. All of the patients with a malunion of the distal radius were followed up 5 to 70 months postoperatively by clinical and X-ray examination. For evaluation the protocol by Martini for malunited fractures of the distal radius was used. All but one patient agreed that the operation had been beneficial and would choose to undergo the same procedure again necessary. Mean forearm rotation improved from 99 to 166 degrees. Preoperative pain was reduced in eleven patients. Two patients were completely pain-free and seven noticed pain during heavy load only. Grip strength improved postoperatively in three patients, remained unchanged in four and was diminished in three. In two patients preoperative measurements were not available. Evaluation by the Martini protocol gave three very good, four good, four fair, and one poor result. In one patient, regeneration of the ulna across the resected segment occurred necessitating a secondary excision. This resulted in a return of forearm rotation of 140 degree and good patient satisfaction. Arthrodesis of the distal radioulnar joint with distal ulnar pseudarthrosis reliably reduces pain and improves forearm rotation after malunited fractures of the distal radius. However, it cannot influence pain originating from the radiocarpal joint. Therefore, patients with advanced radiocarpal arthrosis are not suitable for the operation. We consider the procedure to be indicated when the distal

  5. The primary Sauve-Kapandji procedure--for treatment of comminuted distal radius and ulnar fractures.

    PubMed

    Horii, E; Ohmachi, T; Nakamura, R

    2005-02-01

    We have performed primary Sauve-Kapandji procedures on four patients with severe open comminuted fractures of both the distal radius and ulna. The fragmented distal ulna was fixed to the sigmoid notch in order to stabilize the ulnar side of the carpus, and a proximal pseudoarthrosis was maintained for forearm rotation. All the distal radial fractures united without major complications. The mean wrist flexion/extension arc was 76 degrees , the mean pronation/supination arc was 135 degrees, and grip strength was 64% of the contralateral side. All patients returned to their work or daily activities within short time period without any additional surgical treatment, except for removal of implants in three patients. The primary Sauve-Kapandji procedure is effective for the reconstruction of severely combined distal radius and ulnar fractures.

  6. Preferential distal radius fracture in right-handed individuals presenting to an ED.

    PubMed

    Pesola, Gene R; Feinberg, Gary A; Ahsan, Habibul

    2003-11-01

    The purpose of this study was to determine whether there is a lateralizing predisposition toward injury in right hand-dominant (RHD) individuals. The distal radius fracture was used as the injury for evaluation because it is easily defined and can be objectively documented by roentgenography. A prospective case-series design was used to include consecutive RHD patients with a distal radius fracture. There were 86 women with an average age of 63.1 +/- 17.9 years and 41 men with an average age of 44.0 +/- 17.6 years with a significant difference between ages (P <.01). Overall, there were 50 right and 77 left distal radius fractures, which was significantly different than a 50:50 split (P <.025). Stratification and logistic regression analysis revealed that age (dichotomized into age greater than 57 or other) and not gender was a significant factor in the determination of left versus right distal radius fracture. No interaction between age and gender was found. After adjustment for gender, the odds of developing a left compared with right distal radius fracture was 2.3-fold greater for the older compared with the younger age group (95% confidence interval, 1.0-5.2). Preliminary evidence suggests a lateralizing predisposition for left distal radius fractures in older compared with younger individuals who are RHD. If this data holds up, finding the etiology/mechanism of this predisposition might help in designing environments to minimize the impact of this injury pattern in the slightly older individual.

  7. The persistence of epiphyseal scars in the distal radius in adult individuals.

    PubMed

    Davies, Catriona; Hackman, Lucina; Black, Sue

    2016-01-01

    The use of radiographic imaging in the estimation of chronological age facilitates the analysis of structures not visible on gross morphological inspection. Following the completion of epiphyseal fusion, a thin radio-opaque band, the epiphyseal scar, may be observed at the locus of the former growth plate. The obliteration of this feature has previously been interpreted as the final stage of skeletal maturation and consequently has been included as a criterion in several methods of age estimation, particularly from the distal radius. Due to the recommendations relating to age estimation in living individuals, accurate assessment of age from the distal radius is of great importance in human identification; however, the validity of the interpretation of the obliteration of the epiphyseal scar as an age-related process has not been tested. A study was undertaken to assess the persistence of epiphyseal scars in adults between 20 and 50 years of age through the assessment of 616 radiographs of left and right distal radii from a cross-sectional population. This study found that 86% of females and 78% of males retained some remnant of the epiphyseal scar in the distal radius. The relationships between chronological age, biological sex and the persistence of the epiphyseal scar were not statistically significant. The findings of this study indicate that the epiphyseal scars may persist in adult individuals until at least 50 years of age. No maximum age should therefore be applied to the persistence of an epiphyseal scar in the distal radius.

  8. OSTEOTOMY OF THE DISTAL RADIUS USING A FIXED-ANGLE VOLAR PLATE

    PubMed Central

    de Oliveira, Ricardo Kaempf; Binz, Mário Arthur Rockenbach; Ferreira, Marco Tonding; Ruschel, Paulo Henrique; Serrano, Pedro Delgado; Praetzel, Rafael Pêgas

    2015-01-01

    Objective: Skewed consolidation of the distal radius, due to sequelae of fractures, may cause functional incapacity, thus leading such patients to present pain, loss of strength and diminished mobility. Based on the excellent results obtained from surgical treatment of unstable fractures of the distal radius through a volar approach and use of rigid fixation with a fixed-angle volar plate, we started to use the same method for osteotomy of the distal radius. Methods: A retrospective review was conducted, and 20 patients treated between February 2002 and October 2009 were found. The mean length of follow-up was 43.9 months (range: 12 to 96 months). The surgical indications were persistent pain, deformity and functional limitation subsequent to a dorsally displaced fracture. Results: The mean preoperative deformity was 27° of dorsal tilt of the distal radius, 87° of ulnar tilt, and 7.3 mm of shortening of the radius. All the osteotomies consolidated and the final mean volar tilt was 6.2°, with ulnar tilt of 69.3° and shortening of 1 mm. The mean mobility of the wrist increased by 19.9° (flexion) and by 24° (extension). Mean forearm supination increased by 23.5° and pronation by 21.7°. Grip strength increased from 13.4 to 34.5 pounds. Conclusion: Use of a fixed-angle volar plate for a volar approach towards osteotomy of the distal radius enables satisfactory correction of the deformities and eliminates the need for removal of the synthesis material caused by tendon complications PMID:27042618

  9. Remodeling of Salter-Harris type II epiphyseal plate injury of the distal radius.

    PubMed

    Houshian, Shirzad; Holst, Anette Koch; Larsen, Morten S; Torfing, Trine

    2004-01-01

    The authors studied the relation between residual angulation at the time of healing and final orientation of the distal radius as well as the clinical outcome in patients after Salter-Harris type II epiphyseal plate injury of the distal radius. Eighty-five patients were reviewed with a median follow-up of 8.5 years. Anteroposterior and lateral radiographs were taken at follow-up. The mobility of both wrists and forearms was examined, together with grip strength. Pain with activities and sports was evaluated. At follow-up, 73 patients (86%) were anatomically normal on radiographs; the remaining 12 patients had an incomplete remodeling of the volar and/or radial inclination of the distal radius. Premature closure of the growth plate in the distal radius or ulna did not occur in any of these children. Complete remodeling was seen in children aged up to 10 years in all but one patient. Remodeling after Salter-Harris type II epiphyseal plate injury occurs in all age groups, but the potential is greater in children up to 10 years of age. The incomplete remodeling does not seem to have any substantial long-term negative effect on mobility of the wrist and grip strength.

  10. Characteristics of distal radius speed of sound data in Chinese mainland men and women.

    PubMed

    Huang, Ligang; Pan, Jiafei; Jin, Hongting; Xiao, Luwei; Tao, Jing; Tong, Peijian

    2015-01-01

    Quantitative ultrasound (QUS) assessment of bone health status, as a reliable method, is rapidly gaining popularity. Speed of sound (SOS) is one parameter of skeletal status provided by QUS assessment. The objective of the present study was first to determine the normative distal radius SOS data on healthy Chinese mainland men and women and second to investigate the effects of sex, age, and body size on this parameter. A study cohort consisting of 19,980 healthy Chinese women and 8722 men aged 20-89 yr participated in this investigation. They answered a detailed questionnaire on their healthy condition, and their anthropometric measurements were taken. Their distal radius SOS values were evaluated using the Sunlight ultrasound systems. The distal radius SOS values exhibited a characteristic rise-then-fall pattern with increasing age in both sexes. The peak SOS value occurred at the age of 40-49 both in males and females. Age-related differences were both pronounced among males and females. Pearson correlation and regression analysis showed that age was a major determinant of SOS in both sexes. In females, SOS values had a much stronger correlation with age than male subjects. Body weight was also correlated with SOS but not as well as age. The SOS values of distal radius at present study may be used as normal reference data for Chinese mainland population and will be useful for comparing the results of individual studies and determining diagnostic criteria of osteoporosis by QUS.

  11. Failure characteristics of the isolated distal radius in response to dynamic impact loading.

    PubMed

    Burkhart, Timothy A; Andrews, David M; Dunning, Cynthia E

    2012-06-01

    We examined the mechanical response of the distal radius pre-fracture and at fracture under dynamic impact loads. The distal third of eight human cadaveric radii were potted and placed in a custom designed pneumatic impact system. The distal intra-articular surface of the radius rested against a model scaphoid and lunate, simulating 45° of wrist extension. The scaphoid and lunate were attached to a load cell that in turn was attached to an impact plate. Impulsive impacts were applied at increasing energy levels, in 10 J increments, until fracture occurred. Three 45° stacked strain gauge rosettes were affixed along the length of the radius quantifying the bone strains. The mean (SD) fracture energy was 45.5 (16) J. The mean (SD) resultant impact reaction force (IRFr) at failure was 2,142 (1,229) N, resulting in high compressive strains at the distal (2,718 (1,698) µε) and proximal radius (3,664 (1,890) µε). We successfully reproduced consistent fracture patterns in response to dynamic loads. The fracture energy and forces reported here are lower and the strains are higher than those previously reported and can likely be attributed to the controlled, incremental, dynamic nature of the applied loads.

  12. Carpal Malalignment in Malunion of the Distal Radius and the Effect of Corrective Osteotomy

    PubMed Central

    De Smet, Luc; Verhaegen, Filip; Degreef, Ilse

    2014-01-01

    Introduction Malunions of the distal radius often induce carpal malalignment. Two different types can be distinguished: an adaptive midcarpal malalignment (so-called CIA wrist: carpal instability, adaptive) and a radiocarpal malalignment (dorsal translation of the whole carpus). The effect of distal radial osteotomy on the carpal alignment has hardly been studied. Material and Methods 31 wrists in 31 patients (mean age 44 years) with malunion of the distal radius after a Colles fracture were treated with a corrective osteotomy. The patients were divided on basis of effective radio-lunate flexion (ERLF) in the two patterns of carpal malalignment. The radiographic changes were evaluated. Results There were 20 patients with midcarpal malalignment (ERLF ≤ 25°) and 11 with radiocarpal malalignment (ERLF > 25°). There was a correction of radial tilt and ulnar variance in both groups. There was a significant improvement of the carpal alignment in the midcarpal malalignment group, up to normal parameters. Neither age nor delay between fracture and osteotomy correlated. In the radiocarpal malalignment group a significant effect on the ERLF was observed. In the patients with dorsal plating 70% of the hardware had to be removed. Conclusion Distal radial osteotomy is a reliable technique for correction of the deformity at the distal end of the radius and carpal malalignment. PMID:25097809

  13. Image-guided distal radius osteotomy using patient-specific instrument guides.

    PubMed

    Kunz, Manuela; Ma, Burton; Rudan, John F; Ellis, Randy E; Pichora, David R

    2013-08-01

    In this article, we describe a method for computer-assisted distal radius osteotomies in which computer-generated, patient-specific plastic guides are used for intraoperative guidance. Before surgery, the correction and plate location are planned using computed tomography scans for both radii and ulnae, and the planned locations of the distal and proximal drill holes for the plate are saved. A plastic, patient-specific instrument guide is created using a rapid prototyping machine into which a mirror image of intraoperative, accessible bone structure of the distal radius is integrated. This allows for unique positioning of the guide during surgery. For each planned drill location, a guidance hole is incorporated into the guide. During surgery, a conventional incision is made, and the guide is positioned on the radius. The surgeon drills the holes for the plate screws into the intact radius and performs the osteotomy using the conventional technique. Using the predrilled holes, the surgeon affixes the plate to the radius fragments. The guides are easy to integrate into the surgical workflow and minimize the need for intraoperative fluoroscopy for guidance of the procedure.

  14. Multivariate injury risk criteria and injury probability scores for fractures to the distal radius.

    PubMed

    Burkhart, Timothy A; Andrews, David M; Dunning, Cynthia E

    2013-03-15

    The purpose of this study was to develop a multivariate distal radius injury risk prediction model that incorporates dynamic loading variables in multiple directions, and interpret the distal radius failure data in order to establish injury probability thresholds. Repeated impacts with increasing intensity were applied to the distal third of eight human cadaveric radius specimens (mean (SD) age=61.9 (9.7)) until injury occurred. Crack (non-propagating damage) and fracture (specimen separated into at least two fragments) injury events were recorded. Best subsets analysis was performed to find the best multivariate injury risk model. Force-only risk models were also determined for comparison. Cumulative distribution functions were developed from the parameters of a Weibull analysis and the forces and risk scores (i.e., values calculated from the injury risk models) from 10% to 90% probability were calculated. According to the adjusted R(2), variance inflation factor and p-values, the model that best predicted the crack event included medial/lateral impulse, Fz load rate, impact velocity and the natural logarithm of Fz (Adj. R(2)=0.698), while the best predictive model of the fracture event included medial/lateral impulse, impact velocity and peak Fz (Adj. R(2)=0.845). The multivariate models predicted injury risk better than both the Fz-only crack (Adj. R(2)=0.551) and fracture (Adj. R(2)=0.293) models. Risk scores of 0.5 and 0.6 corresponded to 10% failure probability for the crack and fracture events, respectively. The inclusion of medial/lateral impulse and impact velocity in both crack and fracture models, and Fz load rate in the crack model, underscores the dynamic nature of these events. This study presents a method capable of developing a set of distal radius fracture prediction models that can be used in the assessment and development of distal radius injury prevention interventions.

  15. Growth arrest of the distal radius following a metaphyseal fracture: case report and review of the literature.

    PubMed

    Tang, Chris W; Kay, Robert M; Skaggs, David L

    2002-01-01

    We report a 12-year-old girl who developed growth arrest of the distal radius physis 9 months after sustaining a complete fracture of the distal radial and ulnar metaphysis with no involvement of the physis evident at time of injury. The girl sustained a fracture of the metaphysis of her right distal radius and ulna after a fall. Anterior-posterior, lateral and oblique radiographs at injury, and during subsequent healing show no evidence of the fracture involving the physis. She was treated with closed reduction and casting for 6 weeks and healed uneventfully. She returned 4 month later concerned about distal ulnar prominence. Radiographs revealed a loss of radial tilt and with suspicion of a physeal bar. Magnetic resonance imaging confirmed a physeal bar located in the dorsal radial region. A literature search of the Medline database was used to obtain prior case reports for review purpose. The patient underwent an epiphysiodesis of the distal radius and ulna along with an opening wedge osteotomy and bone grafting of the distal radius to restore radial height and inclination. She healed without complication and with restoration of the normal relationship of the distal radius and ulna. A review of the literature reveals five reported case of distal radial metaphyseal fractures not invloving the physis leading to growth arrest. By comparison, there are 31 reported cases of distal radius physeal arrest following fractures involving the physis. The physician should be aware that common distal radius metaphyseal fractures may rarely lead to growth arrest.

  16. Resection-reconstruction arthroplasty for giant cell tumor of distal radius

    PubMed Central

    Saikia, Kabul C; Borgohain, Munin; Bhuyan, Sanjeev K; Goswami, Sanjiv; Bora, Anjan; Ahmed, Firoz

    2010-01-01

    Background: Giant cell tumor (GCT) of the distal radius poses problems for reconstruction after resection. Several reconstructive procedures like vascularized and non-vascularized fibular graft, osteo-articular allograft, ceramic prosthesis and megaprosthesis are in use for substitution of the defect in the distal radius following resection. Most authors advocate wrist arthrodesis following resection of distal radius and non vascularized fibular graft. Here we have analyzed the results of aggressive benign GCTs of the distal radius treated by resection and reconstruction arthroplasty using autogenous non-vascularized fibular graft. Materials and Methods: Twenty-four cases of giant cell tumor of the distal radius (mean age 32 years, mean follow-up 6.6 years) treated by en-bloc resection and reconstruction arthroplasty using autogenous non-vascularized ipsilateral fibular graft with a minimum followup of two years have been included in this retrospective study. Nineteen cases were of Campanacci grade III and five were of Grade II recurrence. The mean resected length of the radius was 9.5 (8-12) cm. Routine radiographs and clinical assessments regarding pain, instability, recurrence, hand grip strength and functional status were done at regular intervals and functional results were assessed using (musculoskeletal tumor society) MSTS-87 scoring. Results: Early radiological union at host-graft junction was achieved at mean 12.5 weeks, (range 12-14 weeks) and solid incorporation with callus formation was observed in mean 29 weeks (range 28-32 weeks) in all the cases. Satisfactory range of motion (mean 63%, range 52-78%) of the wrist was achieved in 18 cases. Grip strength compared to the contralateral hand was found to be 67% (range 58-74%). Functional results were excellent in six cases (25%), good in 14 cases (58.3%) and four (16.7%) cases had fair results. Soft tissue recurrence was seen in one patient. The most commonly encountered complication was fibulo

  17. [Effect of age and anti-osteoporotic drugs on bone strength and structure of the distal radius].

    PubMed

    Uchiyama, Shigeharu

    2013-07-01

    The distal radius constitutes a proximal part of the wrist joint, which bears axial load from the carpal bones. Based on the biomechanical experiments, the load transmitted from the carpal bones to the distal articular surface of the radius is greater to the lunate fossa than the scaphoid fossa. The findings are consistent with the results obtained from HR-pQCT analysis of the distal radius. As ageing, bone mineral densities of the distal radius decrease, and structures of the cortical and trabecular bones also deteriorate. Such deterioration can be prevented by osteoporotic medicines such as PTH or bisphosphonate. Denosumab has been shown to increase mechanical indices of the bone structure of the distal radius. The distal radius of the individual is fractured when the load over approximately 5 times (2.5SD) of the weight is applied. It is possible to predict load of fracture in the distal radius from the results of DXA derived BMD or HR-pQCT derived bone parameters. We should not miss the opportunity of treatment for osteoporosis when the patients with fragility distal radius fracture are seen.

  18. Biomechanical Performance of Variable and Fixed Angle Locked Volar Plates for the Dorsally Comminuted Distal Radius

    PubMed Central

    Martineau, D; Shorez, J; Beran, C; Dass, A G; Atkinson, P

    2014-01-01

    Background The ideal treatment strategy for the dorsally comminuted distal radius fracture continues to evolve. Newer plate designs allow for variable axis screw placement while maintaining the advantages of locked technology. The purpose of this study is to compare the biomechanical properties of one variable axis plate with two traditional locked constructs. Methods Simulated fractures were created via a distal 1 cm dorsal wedge osteotomy in radius bone analogs. The analogs were of low stiffness and rigidity to create a worst-case strength condition for the subject radius plates. This fracture-gap model was fixated using one of three different locked volar distal radius plates: a variable axis plate (Stryker VariAx) or fixed axis (DePuy DVR, Smith & Nephew Peri-Loc) designs. The constructs were then tested at physiologic loading levels in axial compression and bending (dorsal and volar) modes. Construct stiffness was assessed by fracture gap motion during the different loading conditions. As a within-study control, intact bone analogs were similarly tested. Results All plated constructs were significantly less stiff than the intact control bone models in all loading modes (p<0.040). Amongst the plated constructs, the VariAx was stiffest axially (p=0.032) and the Peri-Loc was stiffest in bending (p<0.024). Conclusion In this analog bone fracture gap model, the variable axis locking technology was stiffer in axial compression than other plates, though less stiff in bending. PMID:25328471

  19. Type IIA Monteggia Fracture Dislocation with Ipsilateral Distal Radius Fracture in Adult – A Rare Association

    PubMed Central

    James, Boblee

    2016-01-01

    Monteggia fracture constitutes about 5-10% of the forearm fractures. Monteggia fracture by definition is proximal ulnar fracture with disruption of proximal radioulnar joint. Bado classified Monteggia fracture dislocation into four types and Jupiter subclassified type II Bado’s fractures into four types. The associated injury in the form of distal radial fractures and distal humerus fractures are rare though many cases of distal radial physeal injuries have been reported in paediatric population. Hereby we report a rare association of type IIA Monteggia fracture dislocation with ipsilateral distal radius fracture in an adult patient. This case report also highlights on proper examination and full length radiographs of forearm to avoid missing injury at wrist in cases of elbow injuries. Management of such complex injuries included open reduction and internal fixation of olecronon fracture, distal radius fracture and radial head resection. Functional outcome at six months was good at wrist whereas at elbow, stiffness was a major concern with elbow range of movement from 40°-110°. PMID:27656518

  20. A Comprehensive Study of Internal Distraction Plating, an Alternative Method for Distal Radius Fractures

    PubMed Central

    Mavani, Kinjal J

    2016-01-01

    Introduction The management of highly comminuted distal radius fractures still remains a major treatment challenge. Articular comminution and compromised bone quality are the culprits. One novel approach is the technique of Internal Distraction Plating which involves “bridging” the fracture with the use of a standard 3.5mm plate applied dorsally in distraction from the radius, proximal to the fracture, to the long finger metacarpal distally, bypassing the comminuted segment. The plate is removed once fracture union has been achieved. Aim The present study was conducted with the aim to evaluate the role of internal dorsal distraction plating as an alternative method in the treatment of fracture distal radius in terms of special indications, technique and outcome. Materials and Methods This study was a prospective longitudinal study on 20 patients (mean age 62 years) treated with internal distraction plating for comminuted distal radius fractures with specific indications. Regular follow-ups with standard radiographs and analysis were done upto 24 months. Functional outcome were assessed by DASH Score and the Gartland and Werley demerit score. Results At final follow-up, all fractures had united and X-rays showed mean palmar tilt of 7°, positive ulnar variance of 0.5mm, radial inclination of 18° and average loss of 2mm of radial height. Mean range of motion values for wrist flexion 46°, extension 50°, pronation 79° and supination 77° At final follow-up, the mean DASH score was 32. 85% patient had excellent to good result as per Gartland and Werley demerit score. This construct has yield satisfactory clinical and radiographic results with these very challenging injuries. Conclusion The purpose of this study was to report the radiographic and the functional outcomes of treatment with this technique. External fixator and volar plating in communited distal end radius fractures are not always satisfactory in old age with osteoporotic bone because of

  1. Triplane fracture of distal radius treated surgically: case report and review of the literature.

    PubMed

    Mingo-Robinet, Juan; Torres-Torres, Miguel; Gonzalez-Rodriguez, Manuel

    2014-05-01

    Only four cases of triplane distal radius fracture have been described in the literature. We report the first that has been treated with open reduction and internal fixation. A 15-year-old boy sustained a triplane fracture of the distal radius. After an unsuccessful attempt at closed reduction, open reduction and internal fixation were performed. Six months after injury, the patient is asymptomatic, but radiographs show a partial growth arrest. The goal of treatment is to achieve anatomic reduction of the articular surface. In this case interposed periosteum prevented anatomic reduction, requiring open reduction and internal fixation. Because of the patient's advanced age the partial physeal arrest should advance to complete arrest before length impairment or occurrence of angular deformity.

  2. Classification of Distal Radius Physeal Fractures Not Included in the Salter-Harris System

    PubMed Central

    Sferopoulos, Nikolaos K

    2014-01-01

    Introduction : The most commonly used classification for pediatric physeal fractures has been proposed by Salter and Harris. Among the most suitable classification schemes are those proposed by Ogden and Peterson who added several new types of injuries. The purpose of this study was to examine the value of both schemes to classify all different types of physeal injuries of the distal radius that are not included in the Salter-Harris system and to test a new nomenclature to classify and guide treatment for the whole spectrum of these injuries. Methods : A total of 292 children who were admitted for a physeal fracture of the distal radius that could not be classified according to the Salter-Harris system were identified from the hospital database. All radiographs were carefully examined and classified according to the existing classifications of Ogden and Peterson and a modified classification scheme. The results of the treatment were also evaluated. Results : Ninety-six physeal injuries could not be classified using the classification schemes of Ogden and Peterson. All injuries could be classified in five types using the new, modified nomenclature. Growth abnormalities of the distal radius were evaluated after an average follow-up time of 11 years. Growth arrest due to a physeal bar was detected only in one patient. Discussion : The proposed modified scheme is practical, incorporates all previous classification systems, allows classification of all physeal injuries of the distal radius that are not included in the Salter-Harris system and may assist comparison of treatment outcomes. PMID:25132871

  3. Analysis of Publication Bias in the literature for Distal Radius Fracture

    PubMed Central

    Sando, Ian C; Malay, Sunitha; Chung, Kevin C

    2013-01-01

    Purpose Distal radius fractures are the most commonly treated fracture, and their management remains complex. We aim to evaluate the presence of publication bias in the literature on distal radius fracture management and identify specific study variables that may influence the reporting of positive outcomes. Methods We conducted a systematic review on all available journal articles to find primary articles reporting on the management of distal radius fractures. Data collected included the direction of study outcome (positive, neutral, and negative) and various study characteristics including sample size, geographic origin of the study, clinical setting, study design, type of treatment, analysis for statistical significance, evaluation of wrist function, presence of subjective outcome measures, mean follow-up time, adequacy of reduction, complications, mean patient age, and the presence of any extramural funding. Results We reviewed 215 journal articles and found that 70% of articles reported positive outcomes, 25% reported neutral outcomes, and 5% reported negative outcomes. Funnel plot analysis suggested the presence of publication bias due to the asymmetric distribution of studies. In addition, we found statistically significant differences between study outcomes with respects to treatment type, presence of external funding, reduction adequacy, hand/wrist functional assessment, and patient questionnaires for subjective assessment. Conclusions Publication bias likely exists in the literature for distal radius fracture management. Several study characteristics influence the reporting of positive outcomes, but whether or not the presence of these characteristics portends a greater chance of publication remains unclear. A standardized approach to measure and track results may improve evidence-based outcomes. PMID:23566720

  4. Primary hyperparathyroidism associated with a giant cell tumor: One case in the distal radius.

    PubMed

    Ouzaa, M R; Bennis, A; Iken, M; Abouzzahir, A; Boussouga, M; Jaafar, A

    2015-10-01

    Hyperparathyroidism can present itself as brown tumors (or osteolytic expansive lesions) that usually disappear after normalization of calcium and phosphate levels. It rarely occurs simultaneously with a giant cell tumor. The authors report one case of a localized form at the distal radius in a patient being followed for primary hyperparathyroidism. The diagnostic challenges related to the clinical and radiological similarities of these two pathological entities are discussed, as they can lead to delays in therapeutic management.

  5. [New minimally invasive approach for palmar plating in distal radius fractures].

    PubMed

    Chmielnicki, M; Prokop, A

    2015-02-01

    Distal radius fractures are among the most common fractures. Types A3 and C2 make up almost half of these. Volar fixed-angle plate fixation is the gold standard of treatment today. We wanted to minimise the approach to the distal radius through a transverse 2-3 cm incision in the wrist flexor fold, tunnelling beneath the pronator muscle. The operative technique is demonstrated here. 11 patients, averaging 70 years of age, underwent surgery for 7 A3 and 4 C2 type fractures. Average operating time was 50 minutes. Length of admission averaged 2.9 days. Using a visual analogue scale, pain decreased from 6/10 preoperatively to 3/10 on post-op day one and 2/10 on post-op day three. After 6 weeks, flexion and extension averaged 45-0-45°, and radial and ulnar deviation 20-0-20°. Pronation and supination averaged 85-0-85°. Grip strength with manometer averaged 90 % compared to the contralateral side at 6 weeks and 96 % at 3 months. As comparison, from 1 January 2008 until 31 May 2013, we treated 908 patients with distal radius fractures with volar fixed-angle plates through a conventional longitudinal incision of 5-8 cm. The average skin to skin time was 46 minutes, with an average length of admission of 5.6 days. A minimally invasive approach to treat distal radius fractures with volar plate fixation and sparing of the pronator muscle is possible. The initial patients treated with this approach experienced minimal post-operative pain, shorter hospital admissions, and rapid grip strength recovery with almost undisturbed rotational motion.

  6. The Impact of Patient Activity Level on Wrist Disability after Distal Radius Malunion in Older Adults

    PubMed Central

    Nelson, Gregory N.; Stepan, Jeffrey G.; Osei, Daniel A.; Calfee, Ryan P.

    2014-01-01

    Objective To determine if high-activity older adults are adversely affected by distal radius malunion. Design Cross-sectional study. Setting Hand clinics at a tertiary institution. Participants 96 patients ≥60 years old at time of fracture evaluated at least 1 year following distal radius fracture. Intervention Physical Activity Scale of the Elderly (PASE) scores stratified participants into high- and low-activity groups. Malunions were defined radiographically by change of ≥20° of lateral tilt, ≥15° radial inclination, ≥4 mm of ulnar variance, or ≥4 mm intra-articular gap or step-off, compared to the uninjured wrist. Main Outcome Measure Patient-rated disability of the upper-extremity was measured by the QuickDASH and Visual Analog Scales (VAS) for pain/function. Strength and motion measurements objectively quantified wrist function. Results High-activity participants with a distal radius malunion were compared to high-activity participants with well-aligned fractures. There was no significant difference in QuickDASH scores, VAS function, strength, and wrist motion despite statistically, but not clinically relevant, increases in VAS pain scores (difference 0.5, p=0.04) between the groups. Neither PASE score (β= 0.001, 95%CI: −0.002 to 0.004) nor malunion (β=0.133, 95%CI: −0.26 to 0.52) predicted QuickDASH scores in regression modeling after accounting for age, sex, and treatment. Operative management failed to improve outcomes and resulted in decreased grip strength (p=0.05) and more frequent complications (26% vs 7%, p=0.01) when compared to nonoperatively management. Conclusion Even among highly active older adults, distal radius malunion does not impact functional outcomes. Judicious use of operative management is warranted provided heightened complication rates. PMID:25233158

  7. Mid-term functional outcome after the internal fixation of distal radius fractures

    PubMed Central

    2012-01-01

    Background Distal radius fracture is a common injury with a variety of operative and non-operative management options. There remains debate as to the optimal treatment for a given patient and fracture. Despite the popularity of volar locking plate fixation, there are few large cohort or long term follow up studies to justify this modality. Our aim was to report the functional outcome of a large number of patients at a significant follow up time after fixation of their distal radius with a volar locking plate. Methods 180 patients with 183 fractures and a mean age of 62.4 years were followed up retrospectively at a mean of 30 months (Standard deviation = 10.4). Functional assessment was performed using the Disabilities of the Arm, Shoulder and Hand (DASH) and modified MAYO wrist scores. Statistical analysis was performed to identify possible variables affecting outcome and radiographs were assessed to determine time to fracture union. Results The median DASH score was 2.3 and median MAYO score was 90 for the whole group. Overall, 133 patients (74%) had a good or excellent DASH and MAYO score. Statistical analysis showed that no specific variable including gender, age, fracture type, post-operative immobilisation or surgeon grade significantly affected outcome. Complications occurred in 27 patients (15%) and in 11 patients were major (6%). Conclusion This single centre large population series demonstrates good to excellent results in the majority of patients after volar locking plate fixation of the distal radius, with complication rates comparable to other non-operative and operative treatment modalities. On this basis we recommend this mode of fixation for distal radius fractures requiting operative intervention. PMID:22280557

  8. Distal radius fractures: Minimally invasive plate osteosynthesis with dorsal bicolumnar locking plates fixation

    PubMed Central

    Chen, Alvin Chao-Yu; Chou, Ying-Chao; Cheng, Chun-Ying

    2017-01-01

    Background: Controversy still exists regarding the current treatment modalities for unstable distal radius fractures. There are yet few articles investigating the efficacy of bicolumnar dorsal plating technique, which is designed to minimize tissue dissection while providing sufficiently secure fixation. A clinical study was performed to evaluate the feasibility of the minimally invasive plate osteosynthesis (MIPO) technique using a modified dorsal approach for the treatment of distal radius fractures. Materials and Methods: Thirty patients with unilateral distal radius fracture who underwent bicolumnar plate fixation with a minimally invasive dorsal approach between September 2008 and December 2010 were included in this retrospective study. Twenty four patients (8 men and 16 women) with a mean age of 53 years (range 18-85 years) were available for followup of at least 1 year or more were included in final study. Herein, we report the functional radiological outcomes of the study. There were three cases of AO Type A fracture, five cases of AO Type B fracture, and 16 cases of AO Type C fracture. Results: The union was achieved in all the patients. The functional results at one-year followup, assessed using the modified Gartland and Werley scoring system, were excellent in 14 patients, good in seven patients, and fair in three patients. The average correction of deformity was 4.1 mm for radial height, 7.6° for radial inclination, and 20.7° for volar tilt. Conclusions: MIPO with a dorsal approach is a feasible option for the management of displaced distal radius fractures and can result in favorable surgical outcomes. PMID:28216757

  9. Salter-Harris type-IV displaced distal radius fracture in a 5-year-old.

    PubMed

    Huntley, Samuel R; Summers, Spencer H; Stricker, Stephen J

    2016-03-01

    Displaced Salter-Harris type-IV fractures are rare in young children and can result in articular incongruity or premature physeal arrest. We describe a 5-year-old boy who sustained a displaced left distal radial Salter-Harris type-IV fracture. The patient had normal wrist function and physeal growth at the 3-year postoperative follow-up. Our patient is by far the youngest reported child with a displaced Salter-Harris type-IV fracture of the distal radius. Prompt anatomic reduction and fixation of a displaced distal radial Salter-Harris type-IV fracture can result in excellent short-term wrist motion with maintenance of physeal function.

  10. Treatment of Distal Radius Fracture Nonunion With Posterior Interosseous Bone Flap

    PubMed Central

    Saremi, Hossein; Shahryar-Kamrani, Reza; Ghane, Bahareh; Yavarikia, Alireza

    2016-01-01

    Background Nonunion of distal radius fractures is disabling. Treatment is difficult and the results are not predictable. However, posterior interosseous bone flap (PIBF) has been successful in treating forearm nonunion. Objectives To treat distal radius fracture nonunion with PIBF as a new procedure. Patients and Methods This prospective non-randomized cohort study was performed at two hospitals in Tehran between January 2011 and September 2015. PIBFs were applied in nine patients (10 nonunions) with a mean age of 55 years. Union success rate, grip strength, wrist range of motion, and forearm rotation were then evaluated. Results Although four of the patients had a history of infection, all participants achieved fracture union at a mean time of 3.8 months. Grip strength improved by 12.4 kg. There was also 36° improvement in wrist flexion, 20° improvement in wrist extension, 60° improvement in forearm supination, and 46° improvement in forearm pronation. The range of motion and grip strength improvements were significant. Conclusions Pedicled PIBF is a new option for treating distal radius fracture nonunion. The results are predictable in achieving union and good function, and this technique can be successfully used in cases with extensive soft-tissue damage or infection. PMID:27703802

  11. Corrective Osteotomy for Deformity of the Distal Radius Using a Volar Locking Plate

    PubMed Central

    Peterson, Brett; Gajendran, Varun

    2007-01-01

    Dorsally angulated malunions of the distal radius have historically been corrected with an opening wedge osteotomy fixed with a dorsal plate. Volar locking plates may facilitate a less morbid approach to corrective osteotomies of the wrist. Eight consecutive patients with an average age of 40 years (range, 15–52 years) underwent correction of a distal radius deformity through a volar approach. Clinical follow-up averaged 17.4 months (range, 7–41 months). Preoperative radiographs revealed an average of 24° of dorsal tilt in patients with dorsal deformity. Postoperatively, their average measurement was <3° of volar tilt. Patients were initially ulnar-positive with an average of 4 mm ulnar-positive variance (range, 2–7 mm). This corrected to less than 1 mm postoperatively. Postoperative disabilities of the arm, shoulder, and hand (DASH), SF-12, and Mayo Wrist scores averaged 10.8, 40.5, and 82.5, respectively. There were no nonunions, and no plates required removal. Distal radius deformity can be effectively addressed through a volar approach with the use of a locking plate. PMID:18780123

  12. [Vitamin C and prevention of reflex sympathetic dystrophy following surgical management of distal radius fractures].

    PubMed

    Cazeneuve, J F; Leborgne, J M; Kermad, K; Hassan, Y

    2002-12-01

    Reflex sympathetic dystrophy is a major complication following surgical treatment of fractures of the distal radius. Its pathogenesis is related to lipid peroxidation which damages vascular endothelial cells, increasing capillary permeability. Vitamin C is a natural antioxidant. The authors have made a comparative study of two groups of patients with isolated closed displaced fractures of the distal radius, which were reduced and stabilized by intrafocal pinning. Group 1 included 100 patients who were treated from 1995 until 1998 and who did not receive any vitamin C supplementation; group 2 included 95 patients who were treated from 1999 to 2002 and who received daily administration of one gram vitamin C orally during 45 days, starting on the day of fracture. The incidence of reflex sympathetic dystrophy was five time times lower in group 2 (2.1% versus 10%). This is in line with previous observations and lends credit to the value of vitamin C administration as a prophylactic measure to prevent the occurrence of reflex sympathetic dystrophy in patients who undergo surgical treatment of a displaced fracture of the distal radius.

  13. Trabecular and cortical microstructure and fragility of the distal radius in women.

    PubMed

    Bala, Yohann; Bui, Quang Minh; Wang, Xiao-Fang; Iuliano, Sandra; Wang, Qingju; Ghasem-Zadeh, Ali; Rozental, Tamara D; Bouxsein, Mary L; Zebaze, Roger M D; Seeman, Ego

    2015-04-01

    Fragility fractures commonly involve metaphyses. The distal radius is assembled with a thin cortex formed by fusion (corticalization) of trabeculae arising from the periphery of the growth plate. Centrally positioned trabeculae reinforce the thin cortex and transfer loads from the joint to the proximal thicker cortical bone. We hypothesized that growth- and age-related deficits in trabecular bone disrupt this frugally assembled microarchitecture, producing bone fragility. The microarchitecture of the distal radius was measured using high-resolution peripheral quantitative computed tomography in 135 females with distal radial fractures, including 32 girls (aged 7 to 18 years), 35 premenopausal women (aged 18 to 44 years), and 68 postmenopausal women (aged 50 to 76 years). We also studied 240 fracture-free controls of comparable age and 47 healthy fracture-free premenopausal mother-daughter pairs (aged 30 to 55 and 7 to 20 years, respectively). In fracture-free girls and pre- and postmenopausal women, fewer or thinner trabeculae were associated with a smaller and more porous cortical area (r = 0.25 to 0.71 after age, height, and weight adjustment, all p < 0.05). Fewer and thinner trabeculae in daughters were associated with higher cortical porosity in their mothers (r = 0.30 to 0.47, all p < 0.05). Girls and premenopausal and postmenopausal women with forearm fractures had 0.3 to 0.7 standard deviations (SD) fewer or thinner trabeculae and higher cortical porosity than controls in one or more compartment; one SD trait difference conferred odds ratio (95% confidence interval) for fracture ranging from 1.56 (1.01-2.44) to 4.76 (2.86-7.69). Impaired trabecular corticalization during growth, and cortical and trabecular fragmentation during aging, may contribute to the fragility of the distal radius.

  14. Geometric properties of distal radius and pathogenesis of Colles fracture: a peripheral quantitative computed tomography study.

    PubMed

    Nielsen, S P; Xie, X; Bärenholdt, O

    2001-01-01

    It is well known among clinicians that Colles fracture patients may have normal projected axial bone mineral density and that bone mass is not synonymous with bone strength. The aim of this work was to investigate whether cross-sectional properties of the distal radius in female patients with recent Colles fracture differ from those of a younger group of normal women without fracture. It was hypothesized that patients with Colles fracture had petite distal radii and that cortical thinning and reduced cortical and trabecular volumetric density are dominant features of this fracture type. We used a multilayer high-precision peripheral quantitative computed tomography (pQCT) device with a long-term precision error of 0.1% for a dedicated phantom during the measurement period (152 d). Clinical measurements were made at an ultradistal site rich in trabecular bone and a less ultradistal site rich in cortical bone. The results show that the following pQCT variables were significantly reduced in the nonfractured radius of the Colles fracture cases: mean ultradistal trabecular volumetric density, mean ultradistal and distal cortical volumetric density, mean ultradistal and distal cortical thickness (p < 0.001 for all differences). The outer cortical diameter, cross-sectional bone area, and cortical bending moment of inertia were not statistically different in the two groups. Thus, it would appear that Colles fracture cases did not have petite distal radii. The results suggest that the deforming force of Colles fracture has a transaxial direction (fall on outstretched arm), resulting in a crush fracture, and that it is not a bending force. We suggest that Colles fracture occurs as a result of the combined effect of a fall on the out-stretched arm, low trabecular and cortical volumetric bone density, and reduced cortical thickness.

  15. [Alternative surgical method in malalignment of healed distal radius fracture: Kapandji-Sauvé procedure].

    PubMed

    Pechlaner, S

    1998-11-01

    Malunion after distal radius fracture with subluxation of the distal radioulnar joint can considerably limit the function of the hand. If the malunion cannot be eliminated by the corrective osteotomy of the radius, care must be taken not to additionally impair the stability of the wrist joint and the carpus, in the event of any necessary salvage procedure. In the Kapandji-Sauvé procedure, an arthrodesis is carried out after repositioning of the distal radioulnar joint. By segment resection of the ulnar shaft, a new joint is made to permit forearm rotation. Between 1984 and 1995, a total of 96 patients were treated with this procedure in our hospital. It was possible to re-examine 87 of those patients after an average period of 4 1/2 (1 to 11) years. The average age of the patients was 59 (14 to 72) years. In 25 cases the results were very good and in 52 cases good. In nine cases the results were poor. In one case the result was unsatisfactory.

  16. Treatment of unstable extra-articular distal radius fractures by modified intrafocal Kapandji method.

    PubMed

    Ruschel, Paulo Henrique; Albertoni, Walter Manna

    2005-03-01

    The authors prospectively assess the results of surgically treated, unstable extra-articular distal radius fractures from 29 patients with good bone quality. Mean age was 49 years, ranging from 22 to 69 years; the female gender was the most frequently affected (58.6% of the cases). Surgical fixation was indicated for fractures presenting an angulation above 20 degrees , marked dorsal comminution, and radius shortening in excess of 10 mm on initial x-rays (anteroposterior and lateral views). The Kapandji technique, with intrafocal, nonthreaded Kirschner wires, was employed. Clinical data assessed anatomic aspects according to Scheck, functional aspect after Gartland and Werley, strength by Scheck's methods, and esthetic by Frykman's criteria. Functional assessment, according to Gartland and Werley, revealed 72.1% of excellent and good results at 3 months; 89.7% at 6 months; and 96.6% at 12 months. Immediate postoperative reduction was not maintained at the final follow-up at 12 months; however, that loss was not severe, and the anatomic outcome was good and excellent in 96.6% of the cases. Six patients presented complications. Four patients presented reflex sympathetic dystrophy; 1 patient had a superficial Kirschner wire infection, and another patient had radial nerve superficial branch paresthesia. The employed technique showed to be effective in the treatment of unstable, extra-articular fractures of the distal radius. It is easy to learn and to perform. The device employed has a low cost and is widely available in operation rooms.

  17. Difficulty in Fixation of the Volar Lunate Facet Fragment in Distal Radius Fracture

    PubMed Central

    Obata, Hiroyuki; Futamura, Kentaro; Obayashi, Osamu; Mogami, Atsuhiko; Tsuji, Hideki; Kurata, Yoshiaki; Kaneko, Kazuo

    2017-01-01

    Recent reports suggest the presence of a rare fracture type for which reduction and fixation cannot be achieved with volar locking plate (VLP). In particular, it is difficult to achieve reduction and fixation with volar lunate facet (VLF) fragments present on the volar ulnar aspect of the lunate facet, because of the anatomical structure and biomechanics in this region. Herein, we report two challenging cases of difficulty in fixation of the VLF fragment in distal radius fracture. For this fracture type, it is most important to identify the volar ulnar bone fragment before surgery; it may also be necessary to optimize distal placement of the VLP via a dual-window approach and to apply additional fixations, such as a small plate, anchor, and/or external fixation. PMID:28255487

  18. Automated Classification of Epiphyses in the Distal Radius and Ulna using a Support Vector Machine.

    PubMed

    Wang, Ya-hui; Liu, Tai-ang; Wei, Hua; Wan, Lei; Ying, Chong-liang; Zhu, Guang-you

    2016-03-01

    The aim of this study was to automatically classify epiphyses in the distal radius and ulna using a support vector machine (SVM) and to examine the accuracy of the epiphyseal growth grades generated by the support vector machine. X-ray images of distal radii and ulnae were collected from 140 Chinese teenagers aged between 11.0 and 19.0 years. Epiphyseal growth of the two elements was classified into five grades. Features of each element were extracted using a histogram of oriented gradient (HOG), and models were established using support vector classification (SVC). The prediction results and the validity of the models were evaluated with a cross-validation test and independent test for accuracy (PA ). Our findings suggest that this new technique for epiphyseal classification was successful and that an automated technique using an SVM is reliable and feasible, with a relative high accuracy for the models.

  19. MRI of bone marrow in the distal radius: in vivo precision of effective transverse relaxation times

    NASA Technical Reports Server (NTRS)

    Grampp, S.; Majumdar, S.; Jergas, M.; Lang, P.; Gies, A.; Genant, H. K.

    1995-01-01

    The effective transverse relaxation time T2* is influenced by the presence of trabecular bone, and can potentially provide a measure of bone density as well as bone structure. We determined the in vivo precision of T2* in repeated bone marrow measurements. The T2* measurements of the bone marrow of the distal radius were performed twice within 2 weeks in six healthy young volunteers using a modified water-presaturated 3D Gradient-Recalled Acquisition at Steady State (GRASS) sequence with TE 7, 10, 12, 20, and 30; TR 67; flip angle (FA) 90 degrees. An axial volume covering a length of 5.6 cm in the distal radius was measured. Regions of interest (ROIs) were determined manually and consisted of the entire trabecular bone cross-section extending proximally from the radial subchondral endplate. Reproducibility of T2* and area measurements was expressed as the absolute precision error (standard deviation [SD] in ms or mm2) or as the relative precision error (SD/mean x 100, or coefficient of variation [CV] in %) between the two-point measurements. Short-term precision of T2* and area measurements varied depending on section thickness and location of the ROI in the distal radius. Absolute precision errors for T2* times were between 1.3 and 2.9 ms (relative precision errors 3.8-9.5 %) and for area measurements between 20 and 55 mm2 (relative precision errors 5.1-16.4%). This MR technique for quantitative assessment of trabecular bone density showed reasonable reproducibility in vivo and is a promising future tool for the assessment of osteoporosis.

  20. Distal Radius Volar Rim Fracture Fixation Using DePuy-Synthes Volar Rim Plate

    PubMed Central

    Kachooei, Amir Reza; Tarabochia, Matthew; Jupiter, Jesse B.

    2016-01-01

    Background To assess the results of distal radius fractures with the involvement of the volar rim fixed with the DePuy-Synthes Volar Rim Plate. Case Description We searched for the patients with volar rim fracture and/or volar rim fractures as part of a complex fracture fixed with a volar rim plate. Ten patients met the inclusion criteria: three patients with type 23B3, six patients with type 23C, and one patient with very distal type 23A. The mean follow-up was 14 months (range: 2–26). Fractures healed in all patients. Of the three patients with isolated volar rim fractures (type 23B3), two patients had no detectable deficits in motion. These patients had an average Gartland and Werley score of 9 (range: 2–14). Of the other seven patients (six with type 23C and one with type 23A fracture), three patients healed with full range of motion and four had some deficits in range of motion. Two patients had excellent results, three had good results, and two had fair results using the Gartland and Werley categorical rating. One patient healed with a shortened radius and ulnar impingement requiring a second surgery for ulnar head resection arthroplasty. Literature Review Results after nonoperative treatment of volar rim fractures are not satisfactory and often require subsequent corrective osteotomy. Satisfactory outcomes are achieved when the fragments are well reduced and secured regardless of the device type. Clinical Relevance Volar rim plates give an adequate buttress of the volar radius distal to volar projection of the lunate facet and do not interfere with wrist mobility. Furthermore, the dorsal fragments can be fixed securely through the volar approach eliminating the need for a secondary posterior incision. However, patients should be informed of the potential problems and the need to remove the plate if symptoms develop. PMID:26855829

  1. A Simple 3-Dimensional Printed Aid for a Corrective Palmar Opening Wedge Osteotomy of the Distal Radius.

    PubMed

    Honigmann, Philipp; Thieringer, Florian; Steiger, Regula; Haefeli, Mathias; Schumacher, Ralf; Henning, Julia

    2016-03-01

    The reconstruction of malunited distal radius fractures is often challenging. Virtual planning techniques and guides for drilling and resection have been used for several years to achieve anatomic reconstruction. These guides have the advantage of leading to better operative results and faster surgery. Here, we describe a technique using a simple implant independent 3-dimensional printed drill guide and template to simplify the surgical reconstruction of a malunited distal radius fracture.

  2. Solid variant of aneurysmal bone cist on the distal extremity of the radius in a child.

    PubMed

    Ferreira, Adriano Jander; de Almeida Leitão, Sebastião; Rocha, Murilo Antônio; Nascimento, Valdênia das Graças; Lima, Giovanni Bessa Pereira; de Meneses, Antonio Carlos Oliveira

    2016-01-01

    The solid variant of aneurismal bone cysts (ABC) is considered rare. It occurs with greater frequency in pediatric patients and in the tibia, femur, pelvis and humerus. We present a case of a metaphyseal lytic lesion on the distal extremity of the radius in a child whose radiograph was requested after low-energy trauma. The hypothesis of a pathological bone fracture secondary to an aneurysmal bone cyst was suggested. After biopsy, the child underwent intralesional excision without bone grafting and the histopathological findings were compatible with the solid variant of aneurysmal bone cyst.

  3. An unusual cause of focal hand dystonia due to a retained implant of the distal radius.

    PubMed

    Vaishya, Raju; Agarwal, Amit Kumar; Vijay, Vipul

    2016-01-08

    Focal hand dystonia (FHD) is characterised clinically by a task-specific symptom and typical electromyography findings of a characteristic pattern of cocontraction of the agonist and antagonist muscles of the hand and forearm. The aetiopathogenesis of this condition is still not clear. We present a case of a patient with an unusual aetiology for this condition, in the form of retained hardware in the distal radius. This patient had complete resolution of symptoms after removal of a retained radial plate. Thorough history-taking, clinical examination and necessary investigations are the cornerstones for making a diagnosis of FHD.

  4. Radial osteotomy and Sauvé-Kapandji procedure for deformities of the distal radius.

    PubMed

    Schroven, I; De Smet, L; Zachee, B; Steenwerckx, A; Fabry, G

    1995-01-01

    We treated 12 patients with a posttraumatic or congenital deformity of the distal radius. A radial osteotomy and a Sauvé-Kapandji procedure were carried out. In 9 patients the deformity was caused by a malunited fracture; the other 3 patients were referred to us with a Madelung deformity. We performed 6 open wedge osteotomies and 6 closing wedge osteotomies. All but one patient rated the result of the operation as good or excellent. The reason for the only failure could be carpal instability.

  5. Surgery versus conservative treatment in patients with type A distal radius fractures, a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Fractures of the distal radius are common and account for an estimated 17% of all fractures diagnosed. Two-thirds of these fractures are displaced and require reduction. Although distal radius fractures, especially extra-articular fractures, are considered to be relatively harmless, inadequate treatment may result in impaired function of the wrist. Initial treatment according to Dutch guidelines consists of closed reduction and plaster immobilisation. If fracture redisplacement occurs, surgical treatment is recommended. Recently, the use of volar locking plates has become more popular. The aim of this study is to compare the functional outcome following surgical reduction and fixation with a volar locking plate with the functional outcome following closed reduction and plaster immobilisation in patients with displaced extra-articular distal radius fractures. Design This single blinded randomised controlled trial will randomise between open reduction and internal fixation with a volar locking plate (intervention group) and closed reduction followed by plaster immobilisation (control group). The study population will consist of all consecutive adult patients who are diagnosed with a displaced extra-articular distal radius fracture, which has been adequately reduced at the Emergency Department. The primary outcome (functional outcome) will be assessed by means of the Disability Arm Shoulder Hand Score (DASH). Secondary outcomes comprise the Patient-Rated Wrist Evaluation score (PRWE), quality of life, pain, range of motion, radiological parameters, complications and cross-overs. Since the treatment allocated involves a surgical procedure, randomisation status will not be blinded. However, the researcher assessing the outcome at one year will be unaware of the treatment allocation. In total, 90 patients will be included and this trial will require an estimated time of two years to complete and will be conducted in the Academic Medical Centre Amsterdam and

  6. A case of osteoid osteoma in the distal radius epiphysis with atypical onset.

    PubMed

    Deveci, Alper; Fırat, Ahmet; Bozkurt, Murat; Hücümenoğlu, Sema

    2014-01-01

    We present a 16-year-old male patient, with a history of wrist trauma 3 months prior to admission, presented with widespread swelling, limitation of motion and pain that was unresponsive to anti-inflammatory drugs in the left wrist. A lesion compatible with osteoid osteoma in the distal epiphysis of the left radius was detected radiologically. Diagnosis of osteoid osteoma was confirmed with pathological examination of the lesion. Differential diagnosis is important as the atypical lesion occurred after trauma, making it difficult to distinguish from synovitis and infection in consideration of its location.

  7. The Kapandji technique for fixation of distal radius fractures--a biomechanical comparison of primary stability.

    PubMed

    Mittelmeier, W; Braun, C; Schäfer, R

    2001-01-01

    The goal of this study was to compare Kapandji-K-wiring and established K-wiring techniques of the distal radius fracture for primary stability in a biomechanical model: dorsal K-wiring according to Kapandji using different angles of the K-wire, parallel and diagonal alignment of the K-wires. A new testing system which uses a synthetic material enabled us to carry out the cantilever bending test. By application of a lower load, the Kapandji procedure shows a higher reactive torque and stiffness. A higher reaction force of the other techniques, especially of the parallel wiring, are only observable under high-grade bending stress. Application of the Kapandji procedure with K-wires at a smaller angle to the axis of the radius results in the highest primary stability of the procedures investigated in the essential range of initial deformation.

  8. Wrist function in malunion: Is the distal radius designed to retain function in the face of fracture?

    PubMed Central

    Johnson, N

    2016-01-01

    Introduction Fractures of the distal radius are the most common fracture in humans and are the sempiternal hazard of 3.5 million years of bipedalism. Despite the antiquity of the injury, one of the most controversial topics in current orthopaedics is the management of distal radius fractures. It has been suggested that radiographic appearances rarely correlate with functional outcomes. As the success of the human species is predicated almost exclusively on its dexterity and intelligence, it is conceivable that the distal radius has evolved to preserve function even in the face of injury. We therefore hypothesise that the distal radius is designed to accommodate the possibility of fracture. Methods We conducted a review of studies comparing fracture pattern and form with function. We also explore the paleoanthropological evidence and comparative studies with other primates. Findings The evidence points to the human distal radius being highly tolerant of post-fracture deformity in terms of preservation of function. In addition, the distal radius appears to have apparently anatomically ‘redundant’ features that confer this capability. We believe these phenomena to be an evolved trait that developed with bipedalism, increasing the chances of survival for a species whose success depends upon its dexterity. PMID:27376442

  9. Clinical effects of three surgical approaches for a giant cell tumor of the distal radius and ulna

    PubMed Central

    Zhang, Jing; Li, Yi; Li, Dongqi; Xia, Junfeng; Li, Su; Yu, Shunling; Liao, Yedan; Li, Xiaojuan; Li, Huilin; Yang, Zuozhang

    2016-01-01

    The aim of the present study was to assess the curative effects of three surgical approaches for a giant cell tumor (GCT) of the distal radius and ulna. A total of 27 patients with GCT on distal radius and ulnas (7 and 20, respectively), confirmed by biopsy, were treated with individualized treatment regimens, according to the Campanacci's grade system: i) Curettage plus inactivated tumor bed and allogeneic bone graft/bone cement augmentation for Campanacci's grade I GCT of the distal radius and ulna (Group A); ii) simple en bloc resection for Campanacci's grade II and III GCT of the distal ulna (Group B); iii) en bloc resection and reconstruction with non-vascularized fibular autograft/allogeneic bone graft for Campanacci's II and III GCT of the distal radius (Group C). Postoperative recurrence and complications were recorded. The Musculoskeletal Tumor Society Score was used to assess functional results. The mean follow-up time was 25 months (range, 9–125 months). A total of 3 patients exhibited tumor recurrence at 9, 11 and 15 months following surgery (1 case succumbed to pulmonary metastasis at 27 months). Overall, the incidence of the postoperative recurrence of the GCT of the distal ulna and radius were 14.3 (1/7) and 10% (2/20), respectively, with a statistical P-value of 0.762. No statistically significant difference was observed regarding the incidence of the postoperative recurrence, postoperative complications and MSTS results among the three surgical approaches for the GCT on distal ulna and radius (all P>0.05). However, statistically significant differences were noted when the incidence of the postoperative recurrence of curettage (Group A) was compared with that of en bloc resection (Groups B and C) (P=0.024). In conclusion, in order to achieve the best clinical effects for patients with GCT on distal radius and ulna, individualized treatment regimens must be designed according to the different Campanacci's grades and tumor locations. PMID:27900098

  10. Nonunion of distal radius fracture and distal radioulnar joint injury: a modified Sauvé-Kapandji procedure with a cubitus proradius transposition as autograft.

    PubMed

    Villamor, Angel; Rios-Luna, Antonio; Villanueva-Martínez, Manuel; Fahandezh-Saddi, Homid

    2008-12-01

    The Sauvé-Kapandji (SK) procedure is indicated in distal radius nonunion or malunion and distal radioulnar joint (DRUJ) instability. It can also be used to treat the rheumatoid wrist with severe degenerative changes in the DRUJ. The main objective is to allow a pain-free range of movement. We present a patient with rheumatoid arthritis and distal radius nonunion who, after three operations, was treated with the SK procedure. The clinical and radiological results were excellent. A 53-year-old woman diagnosed with rheumatoid arthritis fell on her forearm at home 2 years ago. Examination at an outpatient clinic revealed a distal radius fracture classified as type V according to the Frykman classification. She had been operated three times with open reduction internal fixation using a plate, screws, and bone allograft. She came to our institution with a distal radius nonunion, positive post-traumatic ulnar variance, and ulnar nerve paresis. The range of movements was 20 degrees -10 degrees flexion-extension and 40 degrees -30 degrees pronation-supination, and she needed daily fentanyl. We performed a modified SK procedure with an autologous iliac crest bone graft and ulnar bone graft from the osteotomy area (cubitus proradius), bone morphogenetic protein, and a low profile distal radius plate. After 1 year of follow-up, the distal radius fracture has healed and the wrist is pain-free with a complete range of movement in flexion-extension and pronation-supination. The main indication for the SK procedure is post-traumatic positive ulnar variance and associated ulnocarpal impaction. The cubitus proradius bone graft transposition is an interesting technical note that makes this case a challenge for skilled orthopedic hand surgeons.

  11. Enhancement of fracture healing by electrical stimulation in the comminuted intraarticular fracture of distal radius.

    PubMed

    Kohata, Kazuhiro; Itoh, Soichiro; Takeda, Shu; Kanai, Misa; Yoshioka, Taro; Suzuki, Hiroyuki; Yamashita, Kimihiro

    2013-01-01

    Effectiveness of an alternating electric current (AC) stimulation in prevention of bone deformity for comminuted intraarticular fracture of distal radius were verified by comparing postoperative results treated with a wrist-bridging external fixator combined with or without an AC stimulator (EF and NEF, respectively), and a palmar locking plate (LP). This study evaluated 92 cases (mean age 67.9 ± 11.4 years) of type C2 and 60 cases (mean age 69.7 ± 9.5 years) of type C3 distal radius fractures, as classified by the Association for Osteosynthesis. In total, 55 and 24 cases were treated with EF and NEF, respectively; and 73 cases were treated with LP. Callus appeared 27.5 ± 4.6 days postoperatively and the external skeletal fixation period was significantly shorter in the EF group than in the NEF group. The decrease in radial length was significantly lower in the EF group when compared to the LP group. There were no significant differences among the groups for the other radiographic and functional parameters. AC stimulation combined to the external fixation may be a promising method to prevent postoperative deformity in the severely comminuted intraarticular fractures by accelerating callus maturation and facilitating new bone bridging across the gap of fracture site.

  12. Ulnar Shortening Osteotomy After Distal Radius Fracture Malunion: Review of Literature

    PubMed Central

    Barbaric, Katarina; Rujevcan, Gordan; Labas, Marko; Delimar, Domagoj; Bicanic, Goran

    2015-01-01

    Malunion of distal radius fracture is often complicated with shortening of the radius with disturbed radio- ulnar variance, frequently associated with lesions of triangular fibrocartilage complex and instability of the distal radioulnar joint. Positive ulnar variance may result in wrist pain located in ulnar part of the joint, limited ulnar deviation and forearm rotation with development of degenerative changes due to the overloading that occurs between the ulnar head and corresponding carpus. Ulnar shortening osteotomy (USO) is the standard procedure for correcting positive ulnar variance. Goal of this procedure is to minimize the symptoms by restoring the neutral radio - ulnar variance. In this paper we present a variety of surgical techniques available for ulnar shorthening osteotomy, their advantages and drawbacks. Methods of ulnar shortening osteotomies are divided into intraarticular and extraarticular. Intraarticular method of ulnar shortening can be performed arthroscopically or through open approach. Extraarticular methods include subcapital osteotomy and osteotomy of ulnar diaphysis, which depending on shape can be transverse, oblique, and step cut. All of those osteotomies can be performed along wrist arthroscopy in order to dispose and treat possibly existing triangular fibrocartilage complex injuries. At the end we described surgical procedures that can be done in case of ulnar shorthening osteotomy failure. PMID:26157524

  13. Non-union in 3 of 15 osteotomies of the distal radius without bone graft

    PubMed Central

    Scheer, Johan H; Adolfsson, Lars E

    2015-01-01

    Background and purpose Open-wedge osteotomies of the distal radius create a void that is usually filled with either iliac crest bone graft or bone substitute. Previous studies have suggested that this is unnecessary. We investigated the safety of omitting the filling procedure. Patients and methods We included 15 patients with a dorsal malunion of a distal radius fracture. A palmar approach and angle-stable plates were used. The patients were followed until there was radiographic and clinical healing. Results Non-union occurred in 3 of the 15 patients. The study, which had been planned to include 25 patients, was then discontinued. 6 osteotomies created a trapezoid void (no cortical contact); 3 of these did not unite after the index procedure (p = 0.04), but did subsequently, after autogenous bone grafting. A trapezoid void was significantly associated with non-union (p = 0.04). Interpretation When a trapezoid defect is created, one should consider bone substitute or autogenous bone graft. This has been shown to be safe in other studies. PMID:25619425

  14. The Use of a Custom-made Prosthesis in the Treatment of Chondrosarcoma of Distal Radius.

    PubMed

    Guzik, Grzegorz

    2016-01-01

    The most common neoplasms of the distal radius are primary tumors, of which aneurysmal bone cysts and giant cell tumors are seen almost exclusively. Chondrosarcomas are most commonly located in the pelvis, ribs and proximal segments of the extremities; they rarely occur in forearm bones. Bone defects after distal radial resection can be replaced with bone grafts, both autogenous and allogenic. There is always a risk of failure of the bones to mend or slower synostosis, which necessitates the search for new treatments. Recently, custom-made prostheses have been used with increasing frequency. In early 2015, a 25-year-old male patient was admitted to the Department of Orthopedic Oncology in Brzozów on account of a tumor involving the epiphysis and metaphysis of the right distal radius. Imaging studies confirmed that the lesion was a neoplasm and a biopsy revealed a chondrosarcoma. Radical resection of the tumor was attempted and a custom-made prosthesis was inserted in the place of the bone defect. The prosthesis was designed and manufactured over 4 weeks. No complications occurred during the surgery or in the postoperative period. After the surgery, the forearm and wrist were in a plaster splint for 6 weeks and then rehabilitation was started. The treatment outcome was good. Now, three months after the surgery, the patient has good wrist mobility and efficient grip. Surgical treatment of malignant tumors of the distal radius with extensive bone resection poses the challenge of bone replacement and recovery of fair hand function. Commonly known and practised, reconstructions with autogenous or allogenic bone grafts enable partial restoration of the radiocarpal joint surface and DRUJ. The use of large bone grafts is associated with a risk of non-union and limited hand function even if the grafts are vascularized. Arthrodesis of the radiocarpal joint is currently performed less and less frequently. Custom-made prostheses appear to be a good solution. This method makes

  15. Salmonella osteomyelitis of the distal radius in a healthy young adult patient: report of a rare case and literature review.

    PubMed

    Tonogai, Ichiro; Hamada, Yoshitaka; Hibino, Naohito; Sato, Ryosuke; Henmi, Tatsuhiko; Sairyo, Koichi

    2015-01-01

    Salmonella osteomyelitis of the radius in a healthy individual is very rare. We present such a case involving the distal radius of a healthy 23-year-old man without underlying disease or possible episode. He had right wrist pain for approximately 3 years, and osteolytic lesion was seen in the right distal radius. He underwent surgical treatment, and salmonella was isolated from pus in the lesion. Postoperative antibiotics successfully treated his infection. He had no sign of recurrence, but the point of entry for infection remains unknown.

  16. Sustentaculum Lunatum: Appreciation of the Palmar Lunate Facet in Management of Complex Intra-Articular Fractures of the Distal Radius.

    PubMed

    Paryavi, Ebrahim; Christian, Matthew W; Eglseder, W Andrew; Pensy, Raymond A

    2015-09-01

    Fracture of the distal radius is the most common wrist injury. Treatment of complex intra-articular fractures of the distal radius requires an accurate diagnosis of the fracture pattern and a thoughtful approach to fixation. We propose a new term, sustentaculum lunatum, for the palmar lunate facet. The sustentaculum lunatum deserves specific attention because of its importance in load transmission across the radiocarpal joint. It is also key to restoring the anatomy of the palmar distal radial metaphysis during internal fixation. We provide a review of the structure and function of the sustentaculum lunatum and describe fixation techniques. This article is intended to promote awareness of this fragment in the treatment of fractures of the distal radius.

  17. Computer-assisted planning and navigation for corrective distal radius osteotomy, based on pre- and intraoperative imaging.

    PubMed

    Dobbe, J G G; Strackee, S D; Schreurs, A W; Jonges, R; Carelsen, B; Vroemen, J C; Grimbergen, C A; Streekstra, G J

    2011-01-01

    Malunion after a distal radius fracture is very common and if symptomatic, is treated with a so-called corrective osteotomy. In a traditional distal radius osteotomy, the radius is cut at the fracture site and a wedge is inserted in the osteotomy gap to correct the distal radius pose. The standard procedure uses two orthogonal radiographs to estimate the two inclination angles and the dimensions of the wedge to be inserted into the osteotomy gap. However, optimal correction in 3-Dspace requires restoring three angles and three displacements. This paper introduces a new technique that uses preoperative planning based on 3-D images. Intraoperative 3-D imaging is also used after inserting pins with marker tools in the proximal and distal part of the radius and before the osteotomy. Positioning tools are developed to correct the distal radius pose in six degrees of freedom by navigating the pins. The method is accurate ( d 1.2 mm, ϕ 0.9°, m TRE = 1.7 mm), highly reproducible (SE (d) < 1.0 mm, SE (ϕ) ≤ 1.4°, SE (m) (TRE) = 0.7 mm), and allows intraoperative evaluation of the end result. Small incisions for pin placement and for the osteotomy render the method minimally invasive.

  18. Devising for a distal radius fracture fixation focus on the intra-articular volar dislocated fragment

    PubMed Central

    Sugiyama, Yoichi; Naito, Kiyohito; Obata, Hiroyuki; Kinoshita, Mayuko; Aritomi, Kentaro; Kaneko, Kazuo; Obayashi, Osamu

    2016-01-01

    Introduction Distal radius fracture (DRF) accompanied by intra-articular volar displaced fragment is difficult to reduce. This volar fragment remains when treated with a simple buttress effect alone, and V-shaped deformity may remain on the articular surface. We attempted to improve dorsal rotational deviation of volar fragment by osteosynthesis applying the condylar stabilizing technique. We report the surgical procedure and results. Materials and methods The subjects were 10 cases of DRF accompanied by intra-articular volar displaced fragments surgically treated (mean age: 69 years old). The fracture type based on the AO classification was B3 in 1 case, C1 in 4, C2 in 2, and C3 in 3 cases. All cases were treated with a volar locking plate. Reduction was applied utilizing the angle stability of the volar locking plate, similarly to the condylar stabilizing technique. On the final follow-up, we evaluated clinical and radiologic evaluation. To evaluate V-shaped valley deformity of the articular surface, the depth of the lunate fossa of the radius was measured using computed tomography (CT). Results The duration of postoperative follow-up was 11 (6–24) months. Mayo wrist score was 93 (Excellent in 10 cases). No general complication associated with a volar locking plate was noted in any case. Volar tilt on radiography were 11° (4–14). The depth of the lunate fossa on CT was 3.9 ± 0.7 mm in the patients. Conclusion This procedure may be useful for osteosynthesis of distal radius fracture accompanied by intra-articular volar displaced fragments. PMID:27144008

  19. Dorsal Plating of Distal Radius Fractures Historical Context and Appropriate Use.

    PubMed

    Ayalon, Omri; Paksima, Nader

    2017-01-01

    The management of distal radius fractures has evolved over time from a largely nonoperative paradigm to a more commonly performed operative procedures today. Surgical trends have similarly developed, with dorsal plating falling out of favor due to complications involving extensor tendon pathology as well as due to the ubiquity of the volar plate along with the advent of locking plate technology. However, with the improvement in design of newer generation dorsal plates, this technique should be used in the appropriate clinical situation, including dorsal comminution and angulation with concomitant carpal pathology. Outcome data supports dorsal plating and has been shown to be comparable to that of volar plating, with some unique advantages. As such, the technique of dorsal plating should have a role in surgical management of these injuries.

  20. Corrective distal radius osteotomy following fracture malunion using a fixed-angle volar locking plate.

    PubMed

    Opel, S; Konan, S; Sorene, E

    2014-05-01

    Post-traumatic distal radius deformity may cause severe morbidity, and corrective osteotomy is often necessary to realign the functional axis of the wrist to correct symptomatic malunion. The aim of this retrospective study was to review the short-term results of a single surgeon’s series of distalradius corrective osteotomies following fracture malunion using a fixed-angle volar locking plate for 20 patients(16 women) of an average age of 57 (range 19–83) years [corrected].At short-term follow up (average 14 months, range 12-15 months), no complications were noted and radiological union was confirmed in all cases at an average of 3 months. The average post-operative Disability of the Arm, Shoulder and Hand score was 13.48 (range 0-48.33) and an objective improvement was noted in movements at the wrist joint. A statistically significant improvement was achieved in ulnar variance, radial inclination, dorsal tilt, and supination.

  1. Retrospective Comparison of Percutaneous Fixation and Volar Internal Fixation of Distal Radius Fractures

    PubMed Central

    Lozano-Calderón, Santiago A.; Doornberg, Job N.

    2007-01-01

    A change in the practice of a single surgeon provided an opportunity for retrospective comparison of comparable cohorts treated with percutaneous fixation (17 patients) or a volar plate and screws (23 patients) an average of 30 months after surgery. The final evaluation was performed according to the Gartland and Werley and Mayo rating systems and the DASH questionnaire. There were no significant differences on the average scores for the percutaneous and volar plating groups, respectively: Gartland and Werley, 4 vs 5; Mayo, 82 vs 83; and DASH score 13 for both cohorts. Motion, grip, and radiographical parameters were likewise comparable. Volar internal plate and screw fixation can achieve results comparable to percutaneous fixation techniques in the treatment of fractures of the distal radius. PMID:18780085

  2. [Arthroscopically assisted osteosynthesis of dorsally tilted intraarticular distal radius fractures--technique and results].

    PubMed

    Lutz, M; Wieland, T; Deml, C; Erhart, S; Rudisch, A; Klestil, T

    2014-10-01

    The present paper describes the indication and application of an arthroscopically assisted osteosynthesis for distal radius fractures. Visualisation of articular incongruency is emphasised with special regard to articular fracture fragment reduction. In addition to that, classification of soft tissue injuries and treatment options are discussed. The final clinical and radiological results of 17 patients are presented: DASH and PRWE averaged 4.9 and 6.0 respectively. Active range of motion measured 123° for flexion/extension, 51° for radial and ulnar deviation and 163° for pronosupination, which is 87%, 98% and 97%, respectively, compared with the opposite wrist. Radial inclination at final follow-up was 23°, palmar tilt measured 6° and ulnar variance averaged -1.2 mm. The scapholunate gap at follow-up was 1.6 mm, and the scapholunate angle measured 57°.

  3. Kapandji pinning or closed reduction for extra-articular distal radius fractures.

    PubMed

    Stoffelen, D V; Broos, P L

    1998-10-01

    In a randomized prospective trial, closed reduction and plaster application was compared with Kapandji pinning. Closed reduction and plaster cast application was performed in 50 patients, Kapandji pinning in 48 patients. According to the Cooney score, good and excellent results were found in 74% of patients in the closed reduction and plaster cast group compared with 75% of patients in the Kapandji-pinning group. In terms of maintenance of reduction and functional outcome at 1-year follow-up, no statistically significant differences were found between the two groups. We conclude, therefore, that both techniques can be applied to extra-articular fractures of the distal radius according to the characteristics of the forearm and the surgeon's or the patient's need.

  4. Outcomes of Nonoperative Treatment of Salter-Harris II Distal Radius Fractures

    PubMed Central

    Larsen, Meredith C.; Bohm, Kyle C.; Rizkala, Amir R.; Ward, Christina M.

    2016-01-01

    Background: Despite the frequent occurrence of these injuries, we know little about the natural history of Salter-Harris II (SH II) distal radius fractures. We conducted a systematic review of studies examining the radiographic and clinical outcomes of nonoperatively managed SH II distal radius fractures. Methods: Systematic searches of the MEDLINE and Cochrane computerized literature databases and manual searches of bibliographies were performed. We reviewed both descriptive and quantitative data. Results: Seven studies including 434 SH II fractures were reviewed. Two studies reported clinical outcomes based on patient age, but neither study described a statistical correlation between patient age and outcome. Two studies discussed the effect of age on radiographic outcome and reported higher rates of anatomic remodeling in children 10 years or younger. Two studies with long-term (average follow-up greater than 8 years) clinical results reported complication rates of 5%. Long-term follow-up of radiographic outcomes appeared in 4 studies with variable results. Five studies reported the frequency of premature physeal arrest after SH II fractures, with results ranging from 0% to 4.3%. Conclusions: Based on this review, no recommendations can be made as to what defines an acceptable reduction or which fractures would benefit from surgical intervention. Angular deformity seems to correct to an acceptable alignment in patients less than 10 years of age, but these younger patients seem to be at higher risk for symptomatic shortening if a growth arrest occurs. Redisplacement after reduction is fairly common, and other more severe complications such as pain, loss of motion, and nerve injury can occur. PMID:27418886

  5. Opening Wedge Osteotomy for Distal Radius Malunion: Dorsal or Palmar Approach?

    PubMed Central

    Rothenfluh, Esin; Schweizer, Andreas; Nagy, Ladislav

    2013-01-01

    Background There are various technical variations to consider when performing a corrective osteotomy of a distal radius malunion. We chose two of the more commonly reported techniques and compared the results of volar (palmar) osteotomy and fixation with dorsal osteotomy and fixation. Method Within a continuous cohort of patients who had undergone corrective osteotomy for a malunited Colles fracture, two groups could be identified retrospectively. In 8 patients a dorsal approach was used. A structural trapezoidal graft, subtending the amount of correction, was inserted into the osteotomy gap and stabilization was performed with a thin round-hole mini-fragment plate. In 14 patients a palmar approach and a palmar fixed-angle plate was used for correction of the malunion and for angular stable rigid fixation of the two fragments. The osteotomy gap was loosely filled with nonstructural cancellous bone chips. A retrospective comparison of the two groups was performed to see whether the outcome was affected by the use of either operative technique.The demographics, the preoperative amount of deformity, range of motion, pain, and force were comparable for both groups. All osteotomies healed without loss of correction. After a minimal follow-up of one year, radiographic appearance, objective functional parameters were assessed and subjective data (Disabilities of the Arm, Shoulder, and Hand [DASH] score and special pain and function questionnaire) obtained. Results These data did not show statistical difference for the two groups except for the amount of final wrist flexion. This parameter was significantly better in patients who had palmar approaches and fixed-angle plates. Conclusion Corrective osteotomies of distal radius malunions can be done in either way. It might result in some better flexion, if performed volarly. PMID:24436789

  6. Routine Imaging after Operatively Repaired Distal Radius and Scaphoid Fractures: A Survey of Hand Surgeons

    PubMed Central

    Bohl, Daniel D.; Lese, Andrea B.; Patterson, Joseph T.; Grauer, Jonathan N.; Dodds, Seth D.

    2014-01-01

    Background There is currently no standard of care for imaging after hand and upper-extremity procedures, and current imaging practices have not been characterized. Questions/Purposes To characterize current imaging practices and to compare those practices to the best available evidence. Patients and Methods A survey was distributed to attending-level surgeons at a regional hand and upper-extremity surgery conference in the United States in 2013. 40 out of 75 surgeons completed the survey (53%). Results All results are presented for distal radius and scaphoid fractures, respectively. There was a high degree of variability between respondents in the number of radiographic series routinely ordered during follow-up of asymptomatic patients, with the number of series ranging from 1–6 and 1–6. On average, respondents did not order an excessive number of follow-up radiographs for asymptomatic patients, with means (± standard deviations) of 2.6 ± 1.0 and 3.3 ± 1.2 radiographic series. Radiographic series were taken at only 74% and 81% of postoperative visits with asymptomatic patients. Only 10% and 8% of respondents felt it was acceptable medical practice to save costs by ordering postoperative radiographs only when patients are symptomatic. Conclusions Among a sample of 40 fellowship-trained hand surgeons, these findings demonstrate a high degree of variability in number of radiographs obtained after operative repair of distal radius and scaphoid fractures. On average, respondents were relatively efficient with respect to total number of postoperative radiographs ordered. Level of Evidence Diagnostic study, level IV. PMID:25364636

  7. Limb Preservation in Recurrent Giant Cell Tumour of Distal End of Radius with Fibular Graft Fracture: Role of Ulnocarpal Arthrodesis.

    PubMed

    Kumar, Narinder

    2015-01-01

    Giant cell tumors of distal radius are locally aggressive tumors with a high rate of recurrence. Though surgery remains the mainstay of treatment, reconstruction remains a challenge in cases of recurrence. Recurrences of GCT in autogenous fibular grafts have been rarely reported and pathological fractures through such grafts are even rarer. Ulnocarpal arthrodesis has never been described as a limb preservation procedure in such a recurrent lesion in distal radius with pathological fracture through a well incorporated fibular graft. A case of pathological fracture in a well incorporated autogenous non-vascularized fibular bone graft in recurrent GCT of distal radius and its successful management with ulnocarpal arthrodesis is reported. In such a scenario where other reconstructive options like allograft or prosthetic reconstructions are not likely to succeed, ulnocarpal arthrodesis may be considered as a salvage procedure.

  8. [Validity of modified radiological views to detect screw protrusion at the distal radius. A comparative study with computerized tomography].

    PubMed

    Mora-Pascual, F E; Aguilella-Fernández, L

    2013-01-01

    Volar fixed-angle plates (VFAP) are currently widely used for the treatment of extra-articular distal radius fractures. Using these plates has a high risk of articular and dorsal screw protrusion due to their special configuration. The aim of this study is to assess the validity of the standard X-rays, performed with the help of wedged supports, in order to detect articular and dorsal screw protrusion. A comparison with computed tomography (CT) scan imaging has been made. The outcome of 26 patients with distal radius articular fracture, treated with a VFAP, is reported. Good correlation between modified X-rays and CT scan was observed. A sensitivity of 100% for articular protrusion and 66% for dorsal have been obtained. When detecting screw protrusion at the distal radius, the use of wedged supports to perform special X-rays intraoperatively is an effective tool.

  9. Mechanical consequences of different scenarios for simulated bone atrophy and recovery in the distal radius.

    PubMed

    Pistoia, W; van Rietbergen, B; Rüegsegger, P

    2003-12-01

    Metabolic bone diseases such as osteoporosis usually cause a decrease in bone mass and a deterioration of bone microarchitecture leading to a decline in bone strength. Methods to predict bone strength in patients are currently based on bone mass only. It has been suggested that an improved prediction of bone strength might be possible if structural changes are taken into account as well. In this study we evaluated which structural parameters (other than bone mass) are the best predictors for changes in bone mechanical properties of the human radius after different bone atrophy scenarios and whether the original strength of the affected bone can be recovered if bone loss is restored by thickening of the remaining structures. To answer these questions, a human radius was measured with a microcomputer tomography scanner to extract the full three-dimensional architecture of the distal radius at an isotropic resolution of 80 microm. Eight models with modified bone architecture were created and the mechanical variations due to these modifications were studied using microfinite element (micro-FE) simulations. In four models mass was lowered by 20%, either by reducing cortical thickness, trabecular thickness, or number of trabeculae or by overall thinning of structures. In the other four models bone mass was restored to the original value using a trabecular bone thickening procedure. The micro-FE analyses revealed that most load was carried by the cortical bone. For this reason, bone strength was affected most in the reduced cortical thickness model. For the same reason, the trabecular bone atrophy scenarios, all of which affected bone strength in a very similar way, resulted in less dramatic bone strength reduction. The restoration of bone mass did not recover the original bone strength. These findings demonstrate that the importance of different parameters for the prediction of bone strength also depends on the mechanical loading. This could explain why results of

  10. Pathologic fracture of the distal radius in a 25-year-old patient with a large unicameral bone cyst

    PubMed Central

    2014-01-01

    Background Distal radius fractures (DRF) are often referred to as osteoporosis indicator fractures as their incidence increases from age 45. In the group of young adults, distal radius fractures normally result from high-energy trauma. Wrist fractures in young patients without adequate trauma thus raise suspicion of a pathologic fracture. In this report we present the case of a fractured unicameral bone cyst (UBC) at the distal radius in a young adult. To the author’s best knowledge, this is the first detailed report in an UBC at the distal radius causing a pathologic DRF in an adult patient. Case presentation A 25-year-old otherwise healthy male presented to our Emergency Department after a simple fall on his right outstretched hand. Extended diagnostics revealed a pathologic, dorsally displaced, intra-articular distal radius fracture secondary to a unicameral bone cyst occupying almost the whole metaphysis of the distal radius. To stabilize the fracture, a combined dorsal and volar approach was used for open reduction and internal fixation. A tissue specimen for histopathological examination was gathered and the lesion was filled with an autologous bone graft harvested from the ipsilateral femur using a reamer-irrigator-aspirator (RIA) system. Following one revision surgery due to an intra-articular step-off, the patient recovered without further complications. Conclusions Pathologic fractures in young patients caused by unicameral bone cysts require extended diagnostics and adequate treatment. A single step surgical treatment is reasonable if fracture and bone cyst are treated appropriately. Arthroscopically assisted fracture repair may be considered in intra-articular fractures or whenever co-pathologies of the carpus are suspected. PMID:24925068

  11. [Postoperative morbidity in surgically treated extension fractures of the distal radius. A comparative study of dorsal and volar approach].

    PubMed

    Zettl, R P; Ruchholtz, S; Taeger, G; Obertacke, U; Nast-Kolb, D

    2001-08-01

    The aim of this study was to investigate perioperative morbidity in operative interventions in distal radiusfractures, comparing the operative approach from volar and dorsal. Only problems, resulting from the operative approach towards the distal aspect of the radius, were examined. In a Case-Control-Study, we investigated patients with operative by plate-osteosynthesis treated distal radius-extensions-fractures. During 3 years we investigated 92 patients. 49 were operated with a volar approach, and after changing the operative management, consecutive 43 patients with a dorsal approach to the distal radius. Indications for operative treatment were not changed. The approach to the distal aspect of the radius corresponded to the recent guidelines. Further perioperative procedures were identical, including procedures in anesthesiology. Datas of patients have been investigated for epidemiology, kind of operations, point of time in treatment, duration of operation, X-Ray, immobilisation and time of inhospital stay as well as all documented complications. It has been shown, that in respect of all criterias, concerning length of operation (106 vs. 83 min), intraoperative X-Ray (3.0 vs. 1.65 min) as well as postoperative immobilisation (33 vs. 25 days), and documented incidences of complications like secondary wound-healing (19/49 vs. 0/43) or nerval irritations (13/49 vs. 1/43), the dorsal osteosynthesis is definitively to be favored.

  12. A new building block: costo-osteochondral graft for intra-articular incongruity after distal radius fracture.

    PubMed

    Tang, Chris Yuk Kwan; Fung, Boris; Poon, T L; Fok, Margaret

    2014-01-01

    Even with the invention of locking plates, intra-articular fractures of distal radius with extreme comminution remain a challenge for orthopaedic surgeons. Osteochondral graft is a potential choice to reconstruct the articular defect. We report a patient who had a fracture of distal radius with costo-osteochondral graft for articular reconstruction which has not yet been described in the English literature. At nine-year follow-up, he was pain free and had full range of movement of the wrist. The authors suggest that costo-osteochondral graft could be an option with satisfactory result.

  13. Denosumab, a Potential Alternative to the Surgical Treatment of Distal Radius Giant Cell Tumor of Bone: Case Report.

    PubMed

    Park, Min Jung; Ganjoo, Kristen N; Ladd, Amy L

    2015-08-01

    Juxta-articular giant cell tumors can pose major surgical challenges. Aggressive distal radius giant cell tumors often require complex reconstructive procedures that are associated with numerous complications. We present a case of a 25-year old man with a Campanacci grade 3 giant cell tumor of the distal radius that was successfully treated with denosumab without complex reconstructive procedures. At 3.5-year follow-up and 1-year drug free period, the patient remained asymptomatic without histologic evidence of recurrent tumor. With denosumab therapy, patients can potentially avoid surgery and achieve a successful outcome.

  14. Relationship between distal radius fracture malunion and arm-related disability: A prospective population-based cohort study with 1-year follow-up

    PubMed Central

    2011-01-01

    Background Distal radius fracture is a common injury and may result in substantial dysfunction and pain. The purpose was to investigate the relationship between distal radius fracture malunion and arm-related disability. Methods The prospective population-based cohort study included 143 consecutive patients above 18 years with an acute distal radius fracture treated with closed reduction and either cast (55 patients) or external and/or percutaneous pin fixation (88 patients). The patients were evaluated with the disabilities of the arm, shoulder and hand (DASH) questionnaire at baseline (concerning disabilities before fracture) and one year after fracture. The 1-year follow-up included the SF-12 health status questionnaire and clinical and radiographic examinations. Patients were classified into three hypothesized severity categories based on fracture malunion; no malunion, malunion involving either dorsal tilt (>10 degrees) or ulnar variance (≥1 mm), and combined malunion involving both dorsal tilt and ulnar variance. Multivariate regression analyses were performed to determine the relationship between the 1-year DASH score and malunion and the relative risk (RR) of obtaining DASH score ≥15 and the number needed to harm (NNH) were calculated. Results The mean DASH score at one year after fracture was significantly higher by a minimum of 10 points with each malunion severity category. The RR for persistent disability was 2.5 if the fracture healed with malunion involving either dorsal tilt or ulnar variance and 3.7 if the fracture healed with combined malunion. The NNH was 2.5 (95% CI 1.8-5.4). Malunion had a statistically significant relationship with worse SF-12 score (physical health) and grip strength. Conclusion Malunion after distal radius fracture was associated with higher arm-related disability regardless of age. PMID:21232088

  15. [Possible applications of pedicled vascularized bone transplants of the distal radius].

    PubMed

    Sauerbier, M; Bishop, A T

    2001-11-01

    Reverse-flow pedicle vascularized bone grafts (VBGs) from the distal radius may be used for the surgical treatment of carpal fracture nonunions and avascular necrosis. Such grafts remain viable with quantifiable blood flow as demonstrated in a recent canine experiment. In this paper, the vascular anatomy of the distal radius is demonstrated and the surgical technique of VBG harvest is described. Our indications and results for treatment of scaphoid nonunion and Kienböck's disease are discussed and compared with the current literature. Fifteen patients with scaphoid nonunion and nine patients with Kienböck's disease stage IIIa were treated by reverse-flow pedicled VBG. Range of motion and grip strength were measured postoperatively and compared to the contralateral hand in all patients. An outcome questionnaire was used to measure patient's satisfaction and ADL's in the patients with Kienböck's disease. The radiologic diagnostic was performed with conventional X-rays, trispiral tomograms and MRI. In the scaphoid nonunion group, all patients were male, with an average age of 27.6 years. Five patients had prior attempts of autogenous bone grafting which failed. Six patients had a radiographic suggestion of proximal fragment avascular necrosis. All scaphoids healed. Time to union was 11.1 weeks on average. Average follow-up was 36.2 months. Pain relief, range of motion and grip strength were very promising. The treatment of Kienböck's disease was also promising in nine patients. Mean patient age was 31 years, and follow-up averaged 32 months. Six patients had complete pain relief, and three had occasional pain. Grip strength reached 86% of the contralateral side (a 25% improvement from preoperative values). Postoperative MRI demonstrated progressive revascularization with time. The results of treating scaphoid nonunions are promising. The use of vascularized bone graft facilitates rapid, reliable union of established scaphoid nonunion, even with proximal location

  16. Quantitative analyses of cross-sectional shape of the distal radius in three species of macaques.

    PubMed

    Kikuchi, Yasuhiro

    2004-04-01

    I conducted quantitative analyses of the cross-sectional shape of the distal radial shaft in three species of macaques, which differ in locomotor behavior: semi-terrestrial Japanese macaques ( Macaca fuscata), arboreal long tailed macaques ( M. fascicularis), and relatively terrestrial rhesus macaques ( M. mulatta). I took CT scans of the distal radial shafts of a total of 180 specimens at the level of the inferior radio-ulnar articulation. From each CT image, the periosteal outline of the radius was traced automatically by a digital imaging technique. I determined five points (landmarks) on the outline by developing a standardized morphometric technique. Bone surface lengths were measured by using these landmarks and their soft tissue correlates were investigated. The results of this study were as follows: (1) Semi-terrestrial M. fuscata has features that are approximately intermediate between those of the other two species. M. fuscata has a relatively small groove for M. abductor pollicis longus and a large groove for Mm. extensor carpi radialis longus et brevis. These characters resemble those of M. fascicularis. On the other hand, the ulnar notch of M. fuscata is relatively large, a character which is similar to that of M. mulatta. Moreover, compared to the other two macaques, the surface of the flexor muscles of M. fuscata is intermediate in size. (2) The more terrestrial M. mulatta has a relatively large groove for M. abductor pollicis longus and a small groove for Mm. extensor carpi radialis longus et brevis. Moreover, M. mulatta has a relatively large ulnar notch and a small surface for the flexor muscles. (3) The arboreal M. fascicularis has similar features to those of M. fuscata for the first and second relative size index. However, in the ulnar notch, M. fascicularis has a peculiar character and the surface for the flexor muscles is relatively large compared to those of the other two species. These results can be interpreted in terms of positional

  17. Single-incision open reduction and internal fixation of comminuted trapezium fractures with distal radius cancellous autograft.

    PubMed

    Matzon, Jonas L; Reb, Christopher W; Danowski, Ryan M; Lutsky, Kevin

    2015-03-01

    Trapezium fractures comprise approximately 3% to 5% of all hand fractures. Although operative management of intra-articular trapezium fractures can result in good functional outcomes, there is very little literature addressing specific operative techniques. We describe a technique for open reduction and internal fixation of severely comminuted, intra-articular trapezium fractures, utilizing autogenous cancellous bone graft from the distal radius.

  18. Early breakage of a titanium volar locking plate for fixation of a distal radius fracture: case report.

    PubMed

    Yukata, Kiminori; Doi, Kazuteru; Hattori, Yasunori; Sakamoto, Soutetsu

    2009-01-01

    This report presents a case demonstrating the early breakage of a titanium volar locking plate implanted for internal fixation of a dorsally displaced distal radius fracture in which the dorsal cortex was severely comminuted. Careful selection of the proper plate and appropriate surgical technique and postoperative management are necessary to avoid this complication.

  19. Comparison of conservative and operative treatment for distal radius fracture: a meta-analysis of randomized controlled trials

    PubMed Central

    Song, Jian; Yu, Ai-Xi; Li, Zong-Huan

    2015-01-01

    Background: The authors conducted a meta-analysis to compare the effectiveness and safety of conservative and operative treatment for distal radius fracture. Methods: PubMed, EMBASE, and the Cochrane Library were searched to identify the relevant studies published up to February of 2015. All randomized controlled trials published to compare the conservative and operative treatment were included in the study. Results were pooled using meta-analysis to compare the efficacy and safety of conservative and operative treatment for distal radius fracture. Results: The databases were derived from seven qualified studies that included a total of 523 patients in which 269 cases adopted conservative treatment while 253 cases adopted operative treatment. Overall, compared with the conservative treatment- treated the distal radius fracture, operative therapies resulted in significantly better radiographic (P<0.05), however, no significant differences of the functional outcomes and complication rate were observed between the two methods (P>0.05). Conclusion: Surgical treatment seems to be more effective distal radius fracture compared with conservative treatment when the radiographic outcomes were analyzed, and no significant differences were deteched in the functional outcomes and complication rate. PMID:26770293

  20. Structure and strength of the distal radius in female patients with rheumatoid arthritis: a case-control study.

    PubMed

    Zhu, Tracy Y; Griffith, James F; Qin, Ling; Hung, Vivian W Y; Fong, Tsz-Ning; Au, Sze-Ki; Tang, Xiao Lin; Kwok, Anthony W; Leung, Ping-Chung; Li, Edmund K; Tam, Lai-Shan

    2013-04-01

    The purpose of this work was to investigate the volumetric bone mineral density (vBMD), bone microstructure, and mechanical indices of the distal radius in female patients with rheumatoid arthritis (RA). We report a cross-sectional study of 66 middle-aged female RA patients and 66 age-matched healthy females. Areal BMD (aBMD) of the hip, lumbar spine, and distal radius was measured by dual-energy X-ray absorptiometry (DXA). High-resolution peripheral quantitative computed tomography (HR-pQCT) was performed at the distal radius, yielding vBMD, bone microstructure, and mechanical indices. Cortical and trabecular vBMD were 3.5% and 10.7% lower, respectively, in RA patients than controls, despite comparable aBMD. Trabecular microstructural indices were -5.7% to -23.1% inferior, respectively, in RA patients compared to controls, with significant differences in trabecular bone volume fraction, separation, inhomogeneity, and structural model index. Cortical porosity volume and percentage were 128% and 93% higher, respectively, in RA patients, with stress being distributed more unevenly. Fourteen RA patients had exaggerated periosteal bone apposition primarily affecting the ulnovolar aspect of the distal radius. These particular patients were more likely to have chronic and severe disease and coexisting wrist deformity. The majority of the differences in density and microstructure between RA patients and controls did not depend on menstrual status. Recent exposure to glucocorticoids did not significantly affect bone density and microstructure. HR-pQCT provides new insight into inflammation-associated bone fragility in RA. It detects differences in vBMD, bone microstructure, and mechanical indices that are not captured by DXA. At the distal radius, deterioration in density and microstructure in RA patients involved both cortical and trabecular compartments. Excessive bone resorption appears to affect cortical more than trabecular bone at distal radius, particularly

  1. [Outcomes of minimally invasive plate osteosynthesis (MIPO) with volar locking plates in distal radius fractures: A review].

    PubMed

    Liverneaux, P; Ichihara, S; Facca, S; Hidalgo Diaz, J J

    2016-12-01

    Minimally invasive plate osteosynthesis (MIPO) has been used in recent years to treat fractures of the distal radius with volar locking plates. Its advantages are the preservation of the pronator quadratus and good esthetics. The MIPO technique was described originally with two incisions: one distal transverse or longitudinal incision and one proximal longitudinal incision. The trend is now to use a single longitudinal incision less than 20mm long. Functional and radiological outcomes are comparable to those of conventional techniques. The MIPO technique is indicated for extra-articular and intra-articular fractures. Arthroscopy may be used concurrently in the latter case. When the distal radius fracture is associated with a proximal shaft fracture, a double incision is needed to introduce a longer plate. The relative contraindications of the MIPO technique are comminuted intra-articular fractures in osteoporotic elderly patients. If reduction is problematic, a larger incision can easily be made.

  2. Arthroscopic study of injuries in articular fractures of distal radius extremity

    PubMed Central

    Araf, Marcelo; Mattar, Rames

    2014-01-01

    OBJECTIVE: To analyze the incidence of wrist ligament and cartilage associated fractures of the distal radius, through arthroscopy, correlating with AO/ASIF classification. METHODS: Thirty patients aged between 20 and 50 years old, with closed fracture from groups B and C according to AO/ASIF classification were selected. All of them were submitted to wrist arthroscopy to address intra-articular injuries and reduction and osteosynthesis of the fracture. RESULTS: A high incidence of intra-articular injuries was noticed, and 76.6% of them presented injury of the triangular fibrocartilage complex, 36.6% of the intrinsic scapholunate ligament, 6.6% of the intrinsic triquetrolunate ligament, and 33% articular cartilage injury larger than three millimeters. Patients with fractures from type C according to AO/ASIF classification presented a higher incidence of ligament injuries. CONCLUSION: There is no relationship between the presence of chondral injury and the AO/ASIF classification of the fractures in the cases reported in this study. Level of Evidence III, Non Randomized Controlled Trial. PMID:25061421

  3. Variation in the Use of Therapy following Distal Radius Fractures in the United States

    PubMed Central

    Waljee, Jennifer F.; Zhong, Lin; Shauver, Melissa

    2014-01-01

    Background: Distal radius fractures (DRFs) are one of the most common injuries among the elderly, resulting in significant expense and disability. The specific aims of this study are (1) to examine rates of therapy following DRFs and (2) to identify those factors that influence utilization of therapy and time span between DRF treatment and therapy among a national cohort of elderly patients. Methods: We examined national use of physical and occupational therapy among all Medicare beneficiaries who suffered DRFs between January 1, 2007, and October 1, 2007, and assessed the effect of treatment, patient-related, and surgeon-related factors on utilization of therapy. Results: Overall, 20.6% of patients received either physical or occupational therapy following DRF. Use of therapy varied by DRF treatment, and patients who underwent open reduction and internal fixation were more likely to receive therapy compared with patients who received closed reduction. Patients who received open reduction and internal fixation were also referred to therapy earlier compared with patients who received external fixation, percutaneous pinning, and closed reduction. Surgeon specialization is associated with greater use of postoperative therapy. Patient predictors of therapy use include younger age, female sex, higher socioeconomic status, and fewer comorbidity conditions. Conclusion: Use of therapy following DRF varies significantly by both patient- and surgeon-related factors. Identifying patients who benefit from postinjury therapy can allow for better resource utilization following these common injuries. PMID:25289323

  4. How Should the Treatment Costs of Distal Radius Fractures Be Measured?

    PubMed

    Swart, Eric; Tulipan, Jacob; Rosenwasser, Melvin P

    Distal radius fractures (DRFs) are common, but the best way to measure the total cost of treating these injuries is not known. We conducted a study to measure the total treatment cost of DRFs to identify which items should be measured, and for how long, to capture all major cost-drivers. Eighty-two patients with DRFs were included in this prospective, observational study. All costs, both direct and indirect, were measured. Direct costs were measured for each patient from internal billing records. Indirect costs were obtained with a customized questionnaire. The major contributors to overall cost were physician fees, operating room costs, occupational therapy, and missed work, which together accounted for 92% of total cost. Recurring indirect costs largely resolved within 3 months for nonoperative management and within 6 months for operative management. Physician fees, operating room costs, occupational therapy, and missed work are the major cost-drivers for DRFs and should be measured for at least 6 months after injury. Indirect costs, particularly those associated with missed work, represent a significant amount of the total overall cost.

  5. Rate of Improvement following Volar Plate Open Reduction and Internal Fixation of Distal Radius Fractures

    PubMed Central

    Dillingham, Chris; Horodyski, MaryBeth; Struk, Aimee M.; Wright, Thomas

    2011-01-01

    Purpose. To determine recovery timeline of unstable distal radius fractures treated by open reduction and internal fixation with a locking volar plate. Methods. Data was collected prospectively on a consecutive series of twenty-seven patients during routine post-operative visits at 2 and 6 weeks, and 3, 6, 12 and 24 months. Range of motion measures and grip strength for both wrists were recorded. Results. Greatest gains were made within the first 3 months after surgery. Supination and pronation returned more quickly than flexion or extension, with supination and pronation both at 92% of the uninjured wrist at 3 months. Only flexion improved significantly between 3 and 6 months. All wrist motions showed some improvement until 1 year. Grip strength returned to 94% of the uninjured wrist by 12 months. Conclusions. Range of motion improvement will be greatest between 2 weeks and 3 months, with improvement continuing until 12 months. Grip strength should return to near normal by one year. Function and pain will improve, but not return to normal by the end of 12 months. Clinical Relevance. These results provide the surgeon with information that can be shared with patients on the anticipated timeline for normal recovery of function and strength. PMID:21991417

  6. Mortality after Distal Radius Fracture in Men and Women Aged 50 Years and Older in Southern Norway

    PubMed Central

    Øyen, Jannike; Diamantopoulos, Andreas P.; Haugeberg, Glenn

    2014-01-01

    Increased mortality rates in patients sustaining hip and vertebral fractures are well documented; however in distal radius fracture patients the results are conflicting. The aim of this study was to examine short- and long-term mortality in distal radius fracture patient in comparison with the background population. Patients aged ≥50 years with distal radius fracture living in Southern Norway who suffered a fracture in the two year period 2004 and 2005 were included in the study. The mortality risk of the standard Norwegian population was used to calculate the standardized mortality ratio (SMR). The number of distal radius fractures was 883 (166 men and 717 women). Mean age was 69 years (men 65 years and women 70 years). After one year the overall mortality rate was 3.4% (men 5.4% and women 2.9%) and after five years 4.6% (men 4.0% and women 4.8%). The SMR for men and women compared to the Norwegian population for the first year was 1.6 (95% confidence interval (CI): 0.6, 2.7) and 0.9 (95% CI: 0.4, 1.2), respectively, and after five years 1.7 (95% CI: 0.3, 3.0) and 2.0 (95% CI: 1.2, 2.7). Stratified on age groups (50–70 and >70 years) an increased SMR was only seen in female patients aged >70 years five years after the fracture (SMR: 1.9, 95% CI: 1.1, 2.6). In conclusion, increased SMR was found in female patients aged >70 years five years after the distal radius fracture, but not in men or in women younger than 70 years. PMID:25380128

  7. SURGICAL TREATMENT OF DISTAL RADIUS FRACTURES WITH A VOLAR LOCKED PLATE: CORRELATION OF CLINICAL AND RADIOGRAPHIC RESULTS

    PubMed Central

    Xavier, Claudio Roberto Martins; Dal Molin, Danilo Canesin; dos Santos, Rafael Mota Marins; dos Santos, Roberto Della Torre; Neto, Julio Cezar Ferreira

    2015-01-01

    Objectives: To analyze and correlate the clinical and radiographic results from patients with distal radius fractures who underwent surgical treatment with a fixed-angle volar locked plate. Methods: Sixty-four patients with distal radius fractures were evaluated. They all underwent surgical treatment with a volar locked plate for the distal radius, with a minimum of six months of postoperative follow-up. They underwent a physical examination that measured range of motion and grip strength, answered the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and underwent radiographic examination. Results: In the physical examination on the patients, all the range-of-motion measurements were reduced. Grip strength measured in kgf was on average 85.8% of the strength on the unaffected side. The mean DASH score was 15.99. A significant relationship was found between lower DASH scores and losses of extension and grip strength. On the radiographs, the mean values in relation to the unfractured side were 84.0% for radial inclination, 85.4% for radial length and 86.8% for volar deviation of the radius. Loss of radial length was correlated with losses of extension and grip strength. PMID:27027046

  8. STATISTICAL ANALYSIS ON FUNCTIONAL AND RADIOGRAPHIC RESULTS AFTER USE OF LOCKED VOLAR PLATE FOR FRACTURES OF THE DISTAL RADIUS

    PubMed Central

    Machado, Daniel Gonçalves; da Cruz Cerqueira, Sergio Auto; Rodarte, Rodrigo Ribeiro Pinho; de Souza Araújo Netto, Carlos Alberto; de Mathias, Marcelo Bezerra

    2015-01-01

    Objectives: To evaluate the functional results from using a fixed-angle locked volar plate for treating fractures of the distal extremity of the radius, using the DASH (disorders of the arm, shoulder and hand) questionnaire and its radiographic correlation with the Lidström classification. Methods: Thirty patients with unstable fractures of the distal extremity of the radius were evaluated after they had undergone a surgical procedure consisting of open reduction and internal fixation using a fixed-angle locked volar plate, at the Military Police Central Hospital of Rio de Janeiro between 2008 and 2009. The results were assessed based on range of motion, DASH protocol scores and radiographies with the Lidström classification. Results: The mean age of the patients in the study was 51 years. The mean DASH score was 11.9 points. It was observed that the radiographic findings did not influence the DASH score. It was found that flexion, pronation, supination and radial deviation correlated with the DASH score. Conclusions: The study showed that subjective functional outcomes using the DASH protocol, obtained from using a locked volar plate to treat fractures of the distal extremity of the radius, are influenced by the range of motion, and especially by the flexion, supination, pronation and radial deviation of the wrist after surgery. There is no correlation between the radiological parameters of either the normal or the operated radius, and the subjective functional outcomes assessed using the DASH protocol. PMID:27042637

  9. Comparing Morbidities of Bone Graft Harvesting from the Olecranon Process and the Distal Radius

    PubMed Central

    Micev, Alan J.; Slikker, William; Ma, Madeleine; Richer, Ross J.; Cohen, Mark S.

    2016-01-01

    Background: The aim of this study is to compare donor-site morbidities between patients who underwent bone graft harvesting from either the olecranon process (OP) or the distal radius (DR). Methods: We evaluated 44 patients who underwent bone graft harvesting from the OP (25 cases) or the DR (19 cases) for various procedures in the ipsilateral upper extremity. Follow-up averaged 14 (OP group) and 19 months (DR group). Outcome measures included visual analog scales (VAS) for graft harvest-site pain and scar appearance, joint motion, and x-rays of the graft harvest and recipient sites. The VAS scores ranged from 0 to 10 with a low score reflecting no pain and excellent satisfaction and a high score reflecting severe pain and poor satisfaction. Results: The VAS scores for pain averaged 0.4 (OP) and 0.5 (DR), and the VAS scores for scar appearance averaged 0.3 (OP) and 0.7 (DR). These differences were not significant. Within each group, there were no significant differences between the operative and nonoperative limbs for elbow or wrist motion. Early graft harvest-site complications involved 1 superficial wound infection (OP) and 1 wound dehiscence (DR). A graft harvest-site defect was detected by x-ray in 84% of OP cases and in 67% of DR cases. Bone healing at the graft recipient sites was observed in more than 87% of cases in both groups. Conclusions: Bone graft harvesting from either the OP or the DR led to comparable patient- and evaluator-determined outcomes with low risks of complications. Surgeons can safely use either option. PMID:27014552

  10. Morphometry of distal end radius in the Indian population: A radiological study

    PubMed Central

    Mishra, Pankaj Kumar; Nagar, Manoj; Gaur, Suresh Chandra; Gupta, Anuj

    2016-01-01

    Introduction: The morphometry of distal end radius (DER) comprises the four necessary parameters: radial inclination, palmer tilt, radial height, and ulnar variance. The unblemished intellect about the morphometry is urged for the management of fracture of DER. The goal of our study was to determine the values of morphometric parameters of the DER from the adult Indian. Materials and Methods: It was a single hospital- based observational cross-sectional, prospective study. Radial inclination, radial height, and ulnar variance were measured on posteroanterior view, and the measurement of palmer tilt was accomplished on the lateral view. All the statistical analysis was done by Microsoft XL 2007 (data add in function were installed for data analysis). T-test was used for comparing the means of the parameters. Results: Two hundred and forty two (n = 242) X-rays were included in this study to analyze. The mean value (n = 242) of radial inclination was 23.27°± (standard deviation [SD]) 7.42° (range: 11.3–42.1°), palmer tilt 10.07° ± (SD) 5.28° (range: 1–16.9°), radial height 11.31 mm ± (SD) 4.9 mm (range: 7.1–30.4 mm), and ulnar variance 0.66 mm ± (SD) 2.46 mm (range: −2.4 to +4.1). Conclusion: This study may provide an inauguratory plinth to prosecute the further analytical research in the Indian population. Moreover, the data may also be used as a reference data for the anatomical alignment while treating the injuries of the DER in the Indian population. PMID:27904215

  11. [An inveterate fracture of the barton type of the distal radius with dislocation in the radiocarpal joint--case history].

    PubMed

    Bednarenko, Marcin; Kotela, Ireneusz; Bołtuć, Witold; Jakubowski, Lukasz

    2006-01-01

    Barton's fracture was first described and isolated as a disease entity in 1839. It is a quite rare fracture constituting, according to various authors 1.5-2.3% of the distal radius fractures. It is usually accompanied with subluxation or luxation in the radiocarpal joint. In the study we present treatment, dealing with operative difficulties and rehabilitation in a 52-year-old patient with an inveterate fracture of the Barton type of the distal radius with dislocation in the radiocarpal joint. He was previously treated by a local quack. The patient underwent an operative treatment; fragments were anatomically repositioned and a stable fixation was applied. As a result of treatment and intensive rehabilitation, we achieved synostosis and functionality of the wrist and left hand.

  12. Open Reduction and Volar Plate Fixation of Dorsally Displaced Distal Radius Fractures: A Prospective Study of Functional and Radiological Outcomes

    PubMed Central

    Sadasivan, Anand Kumar; Hegde, Anoop; Shetty, Ashwin

    2016-01-01

    Introduction The fractures of the distal radius have always posed a unique challenge to the orthopaedic fraternity. The complex ligamentous and bony anatomy offers a wide variety of fractures to be dealt with around this zone. Over the years these injuries have become common especially in the elderly age group as well as the implants and surgical techniques have improved. Aim To assess the radiological and functional outcome after fixation of intra-articular dorsally displaced distal radius fractures with open reduction and volar Locking Compression Plate fixation (LCP). To study the complications occurring with this technique. Materials and Methods A prospective study was conducted in the Department of Orthopaedics at ARS Hospital, Tirupur, Tamil Nadu, from June 2015 to June 2016. A total of 20 skeletally mature patients with Lidstrom class 2D and 2E fresh closed distal radius fractures were enrolled in the study. All the patients underwent open reduction with locking compression plating with titanium LCPs using the volar approach. The patients were reviewed regularly at three, six, 12 and 24 weeks. Final assessment of radiographic fracture union was done and scored as per the ‘Radiographic Scoring System to Evaluate Union of Distal Radius Fractures {Radius Union Scoring System (RUSS)}’ and the functional assessment of the wrist was done using the Mayo wrist score. The final results were tabulated and calculated statistically using ‘frequency and proportions’ and ‘Chi-square tests’ were used to assess the test of association. Results Of the 20 patients reviewed, one patient had excellent Mayo wrist score, five had good scores, 12 had satisfactory and two patients had poor results. Seven patients had a RUSS score less than five points and four patients had RUSS score of five points, four patients had six points, two patients had seven points and three patients had eight points. One patient was noted to have dorsal collapse of the fracture during the

  13. Tendon and neurovascular injuries of the distal radius after pinning with Kirschner wires: A meta-analysis of cadaveric studies.

    PubMed

    Yammine, Kaissar; Rafi, Sidiqa M; Furhad, Sadia

    2015-05-01

    Tendon and nerve structures are at risk when displaced fractures of the distal radius are pinned using K-wires. The aim of this meta-analysis (MA) is to examine the published evidence of such complications in cadavers. Eight studies met our inclusion criteria. The meta-analytical results were as follows: (a) 2.87% and 30.5% tendon involvement at the radial styloid process (RSP) and the dorso-radial area of the distal radius, respectively; (b) 3.5% and 1.1% tendon involvement when the percutaneous pinning (PP) and the limited open pinning (LOP) techniques were used, respectively; (c) 16.1% and 3.4% nerve involvement at the RSP and the dorso-radial area of the distal radius, respectively; (d) in 35.7% the nerve was speared and in 64.3% it touched the K-wire at the styloid area; (e) 61.3% cephalic vein involvement in the styloid area; (f) the second branch of the sensitive branch of the radial nerve (SBRN) was the closest to a wire inserted into the RSP; (g) the mean (±SD) distance between a branch of the SBRN and a styloid wire was 2.17 ± 0.82 mm. Our results for nerve and tendon injury frequencies in the RSP were close to those in clinical meta-analytical studies, offering an excellent statistical model of evidence synthesis based on cadaveric studies to assess the frequency of such injuries in clinical practice. However, this cadaveric MA yielded more accurate data than the previously reported clinical MA in assessing the real risk of injury of such structures in the distal radius in terms of their proximity to the inserted K-wires.

  14. Surgical Treatment of Unstable Distal Radius Fractures With a Volar Variable-Angle Locking Plate: Clinical and Radiological Outcomes

    PubMed Central

    Khatri, Kavin; Sharma, Vijay; Farooque, Kamran; Tiwari, Vivek

    2016-01-01

    Background Unstable distal end radius fractures are difficult to manage and so various treatment modalities have been described. The use of variable-angle locking plates is promoted for the management of these fractures. Objectives This study aimed to evaluate the functional and radiological outcomes in unstable distal end radius fractures treated with variable-angle locking plates. Patients and Methods We reviewed 23 unstable distal end radius fractures that were treated at our institution with volar variable-angle locking plates. The mean age of the patients was 32.82 ± 11.81 years (range 19 to 62) and the mean duration of follow-up was 11.04 ± 2.47 months (range 6 to 15). All of the patients underwent open reduction and internal fixation with a variable-angle locking plate. Radiological parameters such as radial inclination, length, tilt, and ulnar variance were measured at six weeks and at the final follow-up. The functional evaluation was conducted by measuring the range of motion at the wrist joint as well as the grip strength. Gartland and Werley’s demerit scoring system was used to assess the final outcome. Results There were two cases of superficial infection that responded to oral antibiotics. One patient had developed a hypertrophic scar, while another had carpal tunnel syndrome that was conservatively managed. There was a significant improvement in the functional indices from six weeks to the final follow-up, while the radiological parameters were maintained. According to Gartland and Werley, excellent results were reported in 65.2% cases, while good results were present in 35% cases. Conclusions The use of variable-angle locking plates in treating unstable distal end radius fractures is associated with excellent to good functional outcomes with minimal complications. PMID:27679785

  15. Osteosynthesis in Distal Radius Fractures with Conventional Bridging External Fixator; Tips and Tricks for Getting Them Right

    PubMed Central

    Chilakamary, Vamshi Krishna; Koppolu, Kiran Kumar; Rapur, Shivaprasad

    2016-01-01

    Background Distal radius fractures are the commonest fractures occurring in the upper extremity, accounting for 15-20% of patients treated in emergency department. Although distal radial fractures were described 200 years ago, they still remain as unsolved fractures with no clear guidelines. It is often reported that anatomical reduction has a bearing on the functional outcome. Aim To study the management of distal end radius fracture by utilizing the principle of ligamentotaxis where in the reduction obtained by closed means is maintained by external fixator till solid bony union occurs. Materials and Methods A total of 26 cases were selected for study by scrutiny of the inclusion and exclusion criteria. Most of our cases were treated with external fixator within 8 hrs of injury. Small A.O external fixator (bridging ex-fix) with 2 pins each in radius and 2nd metacarpal percutaneously was used for all the cases. Selective k wire fixation was done in cases of instability. Fixator was removed after 6 weeks. Guided physiotherapy was ensured in all the cases. Patients were followed up for an average of 9 months. Results Modified Gartland and Werley scoring system was used to evaluate the overall functional results. Excellent to good results were achieved in 88.45% of our cases while fair result was in 11.54 %. One case had pin loosening and two other cases had malunion. Conclusion External fixator used for ligamentotaxis is an effective method of treating unstable extraarticular and complex intraarticular fractures of distal radius. Improved anatomical restoration with early rehabilitation has produced favourable functional outcome in our series. The complications like pin tract infection is rare due to the availability of superior antibiotics and sterile surgical technique. complications like wrist and finger stiffness has improved with physiotherapy. PMID:26894133

  16. Nonunion in a distal radius metaphyseal fracture in a child: Role of intact periosteal sleeve in management

    PubMed Central

    Sivashanmugam, Raju; Vijay, Sriram; Balakumar, Balasubramanian

    2015-01-01

    We present an adolescent with distal radius nonunion following an open fracture and failed surgery which eventually united when the length and stability was restored for eight weeks duration. The intact periosteal sleeve at the nonunion site formed new bone when its tension was restored by gradual differential distraction. This case report highlights the possibility of stimulating bony union in an established atrophic nonunion by distracting the minimally disturbed soft tissue and thick osteogenic periosteal envelope in the paediatric age group. PMID:25593362

  17. Bone Mineral Density and Prevalence of Osteoporosis in Postmenopausal Korean Women with Low-Energy Distal Radius Fractures.

    PubMed

    Jung, Hong Jun; Park, Ho Youn; Kim, Jin Sam; Yoon, Jun-O; Jeon, In-Ho

    2016-06-01

    The aim of this study was to evaluate the bone mineral density and the prevalence of osteoporosis in postmenopausal Korean women with low-energy distal radius fractures and compared with those of aged-matched normal Korean women. Two hundred and six patients with distal radius fractures between March 2006 and March 2010 were included in this study. Patients were divided into three groups by age; group 1 (50-59 years), group 2 (60-69 years), and group 3 (70-79 years). Controls were age-matched normal Korean women. The bone mineral density values at all measured sites, except for the spine, were significantly lower in group 1 than those of control. While the bone mineral density values in group 2 and 3 were lower than those of controls, these differences were not statistically significant. All groups had significantly higher prevalence of osteoporosis at the Ward's triangle; however, at the spine, femoral neck and trochanteric area it was not significantly different from those of age-matched controls. Although the prevalence of osteoporosis of the postmenopausal women with low-energy distal radius fractures may not be higher than that of the control, osteoporosis should be evaluated especially in younger postmenopausal patients to prevent other osteoporotic hip and/or spine fractures.

  18. FIXATION OF FRACTURES OF THE DISTAL EXTREMITY OF THE RADIUS USING THE MODIFIED KAPANDJI TECHNIQUE: EVALUATION OF THE RADIOLOGICAL RESULTS

    PubMed Central

    Neto, Antonio Piva; Lhamby, Fabio Colla

    2015-01-01

    To demonstrate a simple and efficacious option for treating fractures of the distal extremity of the radius using Kirschner wires. Methods: Between September 2008 and April 2009, 48 patients with fractures of the distal extremity of the radius, classified as A3 according to the AO classification, were treated surgically using a modification of the Kapandji technique. Results: Out of the 48 wrists operated, 42 (87.5%) presented postoperative measurements within the acceptable limits. We used the parameters of McQuenn and Caspers who considered that the radial angulation should be wider than 19° and the volar angulation should be narrower than -12°. All the postoperative volar inclination measurements were narrower than -3°. The mean preoperative radial inclination was 13.14° and the mean postoperative value was 21.18°. The mean preoperative volar inclination was 28.75° and the mean postoperative value was 3.31°. The mean preoperative radial height was 5.25 mm and the mean postoperative value was 9.48 mm. Conclusion: The technique described here had excellent stability for treating fractures of the distal extremity of the radius classified as A3. It was easy to implement and minimally invasive, with minimal surgical complications, and it was inexpensive. PMID:27027023

  19. Bone Mineral Density and Prevalence of Osteoporosis in Postmenopausal Korean Women with Low-Energy Distal Radius Fractures

    PubMed Central

    2016-01-01

    The aim of this study was to evaluate the bone mineral density and the prevalence of osteoporosis in postmenopausal Korean women with low-energy distal radius fractures and compared with those of aged-matched normal Korean women. Two hundred and six patients with distal radius fractures between March 2006 and March 2010 were included in this study. Patients were divided into three groups by age; group 1 (50-59 years), group 2 (60-69 years), and group 3 (70-79 years). Controls were age-matched normal Korean women. The bone mineral density values at all measured sites, except for the spine, were significantly lower in group 1 than those of control. While the bone mineral density values in group 2 and 3 were lower than those of controls, these differences were not statistically significant. All groups had significantly higher prevalence of osteoporosis at the Ward’s triangle; however, at the spine, femoral neck and trochanteric area it was not significantly different from those of age-matched controls. Although the prevalence of osteoporosis of the postmenopausal women with low-energy distal radius fractures may not be higher than that of the control, osteoporosis should be evaluated especially in younger postmenopausal patients to prevent other osteoporotic hip and/or spine fractures. PMID:27247508

  20. Statistical analysis on the concordance of the radiological evaluation of fractures of the distal radius subjected to traction☆

    PubMed Central

    Machado, Daniel Gonçalves; da Cruz Cerqueira, Sergio Auto; de Lima, Alexandre Fernandes; de Mathias, Marcelo Bezerra; Aramburu, José Paulo Gabbi; Rodarte, Rodrigo Ribeiro Pinho

    2016-01-01

    Objective The objective of this study was to evaluate the current classifications for fractures of the distal extremity of the radius, since the classifications made using traditional radiographs in anteroposterior and lateral views have been questioned regarding their reproducibility. In the literature, it has been suggested that other options are needed, such as use of preoperative radiographs on fractures of the distal radius subjected to traction, with stratification by the evaluators. The aim was to demonstrate which classification systems present better statistical reliability. Results In the Universal classification, the results from the third-year resident group (R3) and from the group of more experienced evaluators (Staff) presented excellent correlation, with a statistically significant p-value (p < 0.05). Neither of the groups presented a statistically significant result through the Frykman classification. In the AO classification, there were high correlations in the R3 and Staff groups (respectively 0.950 and 0.800), with p-values lower than 0.05 (respectively <0.001 and 0.003). Conclusion It can be concluded that radiographs performed under traction showed good concordance in the Staff group and in the R3 group, and that this is a good tactic for radiographic evaluations of fractures of the distal extremity of the radius. PMID:26962498

  1. Use of the volar fixed angle plate for comminuted distal radius fractures and augmentation with a hydroxyapatite bone graft substitute.

    PubMed

    Goto, Akira; Murase, Tsuyoshi; Oka, Kunihiro; Yoshikawa, Hideki

    2011-01-01

    Treatment of distal radius fractures with a volar fixed angle plate achieves sufficient stabilisation and permits early physical exercise. However, secondary displacement after surgery sometimes occurs in elderly patients with a metaphyseal comminution and/or cases in which the subchondral support pegs were not placed immediately below the subchondral zone. We treated elderly patients suffering from distal radius fractures with metaphyseal comminution, using both volar fixed angle plate with or without augmentation with a hydroxyapatite bone graft substitute to investigate the benefit of augmentation for maintaining a fracture reduction. We evaluated the differences among radiographic parameters including palmar tilt, radial inclination, and ulnar variance on immediate postoperative and final follow-up radiographs to analyse the maintenance of the initial reduction. There were no significant differences between the two groups in terms of palmar tilt (P = 0.80) and radial inclination (P = 0.17); however, ulnar variance increased significantly in the group treated with a volar fixed angle plate without augmentation (P < 0.05). It might be useful to use a combination technique of a locking plate system and the hydroxyapatite bone graft substitute as augmentation to treat distal radius comminuted fractures in elderly patients.

  2. The International Classification of Functioning as an explanatory model of health after distal radius fracture: A cohort study

    PubMed Central

    Harris, Jocelyn E; MacDermid, Joy C; Roth, James

    2005-01-01

    Background Distal radius fractures are common injuries that have an increasing impact on health across the lifespan. The purpose of this study was to identify health impacts in body structure/function, activity, and participation at baseline and follow-up, to determine whether they support the ICF model of health. Methods This is a prospective cohort study of 790 individuals who were assessed at 1 week, 3 months, and 1 year post injury. The Patient Rated Wrist Evaluation (PRWE), The Wrist Outcome Measure (WOM), and the Medical Outcome Survey Short-Form (SF-36) were used to measure impairment, activity, participation, and health. Multiple regression was used to develop explanatory models of health outcome. Results Regression analysis showed that the PRWE explained between 13% (one week) and 33% (three months) of the SF-36 Physical Component Summary Scores with pain, activities and participation subscales showing dominant effects at different stages of recovery. PRWE scores were less related to Mental Component Summary Scores, 10% (three months) and 8% (one year). Wrist impairment scores were less powerful predictors of health status than the PRWE. Conclusion The ICF is an informative model for examining distal radius fracture. Difficulty in the domains of activity and participation were able to explain a significant portion of physical health. Post-fracture rehabilitation and outcome assessments should extend beyond physical impairment to insure comprehensive treatment to individuals with distal radius fracture. PMID:16288664

  3. A prospective study of a modified pin-in-plaster technique for treatment of fractures of the distal radius

    PubMed Central

    Mirghasemi, S. A.; Rashidinia, S.; Sadeghi, M. S.; Talebizadeh, M.; Rahimi, N.

    2015-01-01

    Objectives There are various pin-in-plaster methods for treating fractures of the distal radius. The purpose of this study is to introduce a modified technique of ‘pin in plaster’. Methods Fifty-four patients with fractures of the distal radius were followed for one year post-operatively. Patients were excluded if they had type B fractures according to AO classification, multiple injuries or pathological fractures, and were treated more than seven days after injury. Range of movement and functional results were evaluated at three and six months and one and two years post-operatively. Radiographic parameters including radial inclination, tilt, and height, were measured pre- and post-operatively. Results The average radial tilt was 10.6° of volar flexion and radial height was 10.2 mm at the sixth month post-operatively. Three cases of pin tract infection were recorded, all of which were treated successfully with oral antibiotics. There were no cases of pin loosening. A total of 73 patients underwent surgery, and three cases of radial nerve irritation were recorded at the time of cast removal. All radial nerve palsies resolved at the six-month follow-up. There were no cases of median nerve compression or carpal tunnel syndrome, and no cases of tendon injury. Conclusion Our modified technique is effective to restore anatomic congruity and maintain reduction in fractures of the distal radius. Cite this article: Bone Joint Res 2015;4:176–180 PMID:26541833

  4. Reconstruction of Scaphoid Nonunion Fractures of the Proximal One Third With a Vascularized Bone Graft From the Distal Radius

    PubMed Central

    Jaminet, Patrick; Naegele, Beate; Pfau, Matthias; Schaller, Hans-Eberhard

    2014-01-01

    Objective: The treatment of proximal located scaphoid nonunion is a well-known and common problem. For these patients, we used a vascular pedicled bone graft of the distal radius. Methods: In the last 7 years, 75 patients were treated with the vascular pedicled bone graft. Retrospectively, patients’ data, healing rates, and factors influencing scaphoid healing were analyzed. Results: The overall healing rate in cases with proximal located nonunions (n = 54) was approximately 70%. Out of these 54 patients, 47 patients showed avascular proximal fragments. Multivariate analysis showed no significant impact for the factors age, smoking, duration of disease, or previous operation. Conclusions: In our negative selected patient group, we were able to achieve good results with the usage of a pedicled vascularized bone graft of the distal radius. Our results indicate a favorable outcome for the use of a pedicled vascularized distal radius bone graft in both scaphoid nonunion fractures of the proximal third, with or without an avascular proximal pole. PMID:25165493

  5. Effect and nursing study of traditional Chinese medicine preparation huayu zhitong powder in the treatment of distal radius fracture.

    PubMed

    Wang, Yun; Ning, Huaxiu; Wang, Zhigang

    2015-03-01

    This paper aims to discuss the effect of traditional Chinese medicine preparation Huayu Zhitong powder in the treatment of distal radius fracture. In this paper, 200 patients with distal radius fracture were randomly divided into treatment group and control group. Patients in treatment group orally took Huayu Zhitong powder, while patients in control group were treated with traditional Shangke Jiegu tablets with traditional Chinese medicine composition. After fixed in a cast plaster, patients in the two groups were supervised the disappearance time of pain by adopting NRS (Numerical rating scale) from scale 0 to 10. Besides, they returned at day 5 and day 8 respectively, and then they were observed the swelling affected part. At day 14, day 28, and day 56 after reduction they respectively took an x-ray. Then they would be graded according to the growth of osteotylus and the clinical effects were evaluated based on the grade. Finally, the treatment group worked better in relief effect than the control group. At day 8, the treatment group worked better in detumescence than the control group. At day 28, the recovery effect in treatment group was found to be better than the other. From these, it is shown that the traditional Chinese medicine works much better in the treatment of distal radius fracture than traditional treatment medicine. Thus it is of great worth spreading for use.

  6. Dorsally Comminuted Fractures of the Distal End of the Radius: Osteosynthesis with Volar Fixed Angle Locking Plates

    PubMed Central

    Selhi, Harpal Singh; Devgan, Ashish; Magu, Narender Kumar; Yamin, Mohammad

    2013-01-01

    Background. Dorsally comminuted distal radius fractures are unstable fractures and represent a treatment challenge. The objective of this study was to evaluate the functional and radiological outcome of dorsally comminuted fractures of the distal radius fixed with a volar locking plate. Patients and Methods. Thirty-three consecutive patients with dorsally comminuted fractures of the distal end of the radius were treated by open reduction and internal fixation with AO 2.4 mm (n = 19)/3.5 mm (n = 14) volar locking distal radius plate (Synthes, Switzerland, marketed by Synthes India Pvt. Ltd.). There were 7 type A3, 8 type C2, and 18 type C3 fractures. The patients were followed up at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Subjective assessment was done as per Disabilities Arm, Shoulder, and Hand (DASH) questionnaire. Functional evaluation was done by measuring grip strength and range of motion around the wrist; the radiological determinants were radial angle, radial length, volar angle, and ulnar variance. The final assessment was done as per Demerit point system of Saito. Results. There were 23 males and 10 females with an average age of 44.12 ± 18.63 years (18–61 years). Clinicoradiological consolidation of the fracture was observed in all cases at a mean of 9.6 weeks (range 7–12 weeks). The average final extension was 58.15° ± 7.83°, flexion was 54.62° ± 11.23°, supination was 84.23° ± 6.02°, and pronation was 80.92° ± 5.54°. Demerit point system of Saito yielded excellent results in 79% (n = 26), good in 18% (n = 6), and fair in 3% (n = 1) patients. Three patients had loss of reduction but none of the patients had tendon irritation or ruptures, implant failure, or nonunion at the end of an one-year followup. Conclusion. Volar locking plate fixation for dorsally comminuted distal radius fractures results in good to excellent functional outcomes despite a high incidence of loss of reduction and fracture collapse. PMID:24959352

  7. Early posttraumatic physeal arrest in distal radius after a compression injury.

    PubMed

    Valverde, J A; Albiñana, J; Certucha, J A

    1996-01-01

    Early posttraumatic arrest of the distal radial physis is an uncommon complication and usually appears after type II physeal injury. We report a 13-year-old boy who sustained an injury to his right wrist, incurring an avulsion fracture of ulnar styloid process. Twenty-one months later, a uniform closure of the distal radial physis was observed. An ulnar shortening osteotomy and distal ulnar epiphysiodesis were performed. We discuss different factors of this complication, but crush injury of germinal cells of the growthplate is considered the main etiology.

  8. Reproducibility of direct quantitative measures of cortical bone microarchitecture of the distal radius and tibia by HR-pQCT.

    PubMed

    Burghardt, Andrew J; Buie, Helen R; Laib, Andres; Majumdar, Sharmila; Boyd, Steven K

    2010-09-01

    Quantitative cortical microarchitectural end points are important for understanding structure-function relations in the context of fracture risk and therapeutic efficacy. This technique study details new image-processing methods to automatically segment and directly quantify cortical density, geometry, and microarchitecture from HR-pQCT images of the distal radius and tibia. An automated segmentation technique was developed to identify the periosteal and endosteal margins of the distal radius and tibia and detect intracortical pore space morphologically consistent with Haversian canals. The reproducibility of direct quantitative cortical bone indices based on this method was assessed in a pooled data set of 56 subjects with two repeat acquisitions for each site. The in vivo precision error was characterized using root mean square coefficient of variation (RMSCV%) from which the least significant change (LSC) was calculated. Bland-Altman plots were used to characterize bias in the precision estimates. The reproducibility of cortical density and cross-sectional area measures was high (RMSCV <1% and <1.5%, respectively) with good agreement between young and elder medians. The LSC for cortical porosity (Ct.Po) was somewhat smaller in the radius (0.58%) compared with the distal tibia (0.84%) and significantly different between young and elder medians in the distal tibia (LSC: 0.75% vs. 0.92%, p<0.001). The LSC for pore diameter and distribution (Po.Dm and Po.Dm.SD) ranged between 15 and 23 microm. Bland-Altman analysis revealed moderate bias for integral measures of area and volume but not for density or microarchitecture. This study indicates that HR-pQCT measures of cortical bone density and architecture can be measured in vivo with high reproducibility and limited bias across a biologically relevant range of values. The results of this study provide informative data for the design of future clinical studies of bone quality.

  9. Use of mineralized collagen bone graft substitutes and dorsal locking plate in treatment of elder metaphyseal comminuted distal radius fracture

    NASA Astrophysics Data System (ADS)

    Liu, Ke-Bin; Huang, Kui; Teng, Yu; Qu, Yan-Zheng; Cui, Wei; Huang, Zhen-Fei; Sun, Ting-Fang; Guo, Xiao-Dong

    2014-03-01

    Bone graft may be needed to fill bone defect in elderly patients with a metaphyseal comminuted distal radius fracture. In this retrospective, nonrandomized, single-surgeon study, we evaluated the clinical and radiologic outcomes of using both dorsal locking plates with or without augmentation with mineralized collagen (MC) bone graft for elderly patients with dorsally metaphyseal comminuted radius fractures. Patients in group 1 ( n = 12) were treated with dorsal locking plates with MC bone graft application into the metaphyseal bone defect, and those in group 2 ( n = 12) only with dorsal locking plates. Clinical and radiologic parameters were determined at three and 12 months after surgery. At final follow-up, no significant difference was noted between the 2 groups in terms of palmar tilt and radial inclination ( p = 0.80); however, ulnar variance increased significantly in the group 2 treated with dorsal locking plates without augmentation ( p < 0.05). Functionally, there was no significant difference between the groups. Our preliminary study suggests that combination of MC as bone-graft substitutes and dorsal locking plates may be a usefully alternative for elderly patients with metaphyseal comminuted distal radius fracture.

  10. Standing placement of transphyseal screw in the distal radius in 8 Thoroughbred yearlings

    PubMed Central

    Modesto, Rolf B.; Rodgerson, Dwayne H.; Masciarelli, Amanda E.; Spirito, Michael

    2015-01-01

    This retrospective study describes placement of distal radial transphyseal screws in Thoroughbred yearlings with carpal varus deformities while standing, and identifes short- and long-term complications following the procedure. Data gathered from 2009 to 2013 identified 8 yearlings that met the inclusion criteria. Horses were sedated intravenously and a single 4.5-mm cortical screw was placed in the distal lateral radial physis following application of local anesthetic and surgical preparation of a pre-placed hole. All horses were evaluated weekly after surgery and screw removal was performed standing and under sedation when correction of the angular limb deformity was achieved. The mean time for screw removal was 46 days. No short- or long-term complications were identified. Findings indicate that placing a single transphyseal screw in the lateral aspect of the distal radial physis with the horse standing is a viable option to treat varus angular limb deformity of the carpus in horses. PMID:26028683

  11. The outcomes of displaced paediatric distal radius fractures treated with percutaneous Kirschner wire fixation: a review of 248 cases.

    PubMed

    Ramoutar, D N; Shivji, F S; Rodrigues, J N; Hunter, J B

    2015-04-01

    This study aimed to evaluate the effect of manipulation under anaesthesia (MUA) and Kirschner wire (K-wire) fixation of displaced, paediatric distal radius fractures on residual radiological angulation, displacement, and shortening, as well as functional outcomes, including complication rates. A retrospective review was conducted of all paediatric patients undergoing MUA and K-wire fixation for an extra-articular distal radius fracture over a period of 5 years. A total of 248 patients were included in the study with a mean age of 9.9 years (3-15). Mean follow-up was 6.6 weeks (4-156). There was a statistically significant increase in median dorsal angulation (p<0.0001) between initial post-operative and follow-up radiographs at the time of K-wire removal. The number of K-wires used did not have a significant effect on dorsal angulation (p=0.9015) at time of K-wire removal, nor did the use of an above or below elbow cast (p=0.3883). Seventeen patients required a further general anaesthetic (5 revision operations, 12 removal of migrated K-wires). Eighty-seven percentage of (215 patients) of patients had normal function at follow-up post-K-wire removal. Angulation at time of K-wire removal of more than 15° was significantly associated with reduced functional outcome (p=0.0377). A total of 41 patients (17%) had complications associated with K-wire use. We conclude that though K-wire fixation is an effective technique, it does not prevent re-angulation of the fracture and is associated with a significant complication rate. Given the remodelling potential and tolerance to deformity in children, surgeons should give careful thought before utilising this technique for all displaced or angulated paediatric distal radius fractures. If used, 1 K-wire with immobilisation in a below elbow cast is sufficient in most cases.

  12. Titanium integration with bone, welding, and screw head destruction complicating hardware removal of the distal radius: report of 2 cases.

    PubMed

    Van Nortwick, Sara S; Yao, Jeffrey; Ladd, Amy L

    2012-07-01

    Increasingly, surgeons treat distal radius fractures with locking plate systems. Recent case reports have focused on technical insertion errors resulting in removal difficulties: poor drilling orientation or cross-threading, destruction of the screw head, and filling of the screw recess with tissue. We report 2 complications of titanium locked plate removal secondary to in vivo reactions including titanium integration with bone and mechanical binding between the titanium screw and plate. We clarify and discuss terminology relevant to implant removal, including cold-welding, galling, fretting, and anodization. Even with optimal technique, in situ reactions can complicate titanium implant removal.

  13. Displaced Intra-Articular Fractures of the Distal Radius: Open Reduction With Internal Fixation Versus Bridging External Fixation

    PubMed Central

    Fakoor, Mohammad; Fakoor, Morteza; Mohammadhoseini, Payam

    2015-01-01

    Background: Distal radius fracture is common in all ages. Mobility and wrist function is important. The choice of treatment should aim for optimal function with minimal complications. Objectives: In this study we compared two surgical approaches, open reduction and internal fixation (ORIF) and closed reduction with external fixation (CR + EF), for treatment of intra-articular distal radius fractures. Patients and Methods: Ninety-four patients with distal radius fracture (type 3, 4 and 5 Fernandez classification) were treated with two surgical methods (ORIF and CR + EF); 55 were treated with CR + EF and 39 were treated with ORIF by different surgeons. All patients were assessed at the end of the first, third and sixth week; and then after the third, sixth and 12th month. At the end of the follow-up, all patients completed the Michigan hand outcome questionnaire (MHOQ). We compared radiological parameters of distal radius, range of motion (ROM) of the wrist, duration of rehabilitation, complication and patient satisfaction of the methods. Results: In our study, radiological findings for the ORIF group were radial inclination (RI): 19.35, radial length (RL): 10.35, radial tilt (RT): 8.92, and ulnar variance (UV): 1.64, while for the CR + EF group these were RI: 15.13, RL: 8, RT: 4.78, and UV: 0.27. The ROM for ORIF were flexion/extension (F/E): 137, Radial/Ulnar deviation (R/U): 52, and Supination/Pronation (S/P): 141, while for the CR + EF group these were F/E: 117, R/U: 40 and S/P: 116. Michigan hand outcome score for ORIF was 75% and for Ext. fix was 60%. The rate of complication with the ORIF method was 58% and in Ext. fix this was 69%. The patients in CR + EF had more than the ORIF course of physiotherapy and rehabilitation. Conclusions: In comparison of ORIF and CR + EF, all results including functional score, clinical and radiologic criteria were in favor of the ORIF method while there were less complications with this method. We believe that ORIF is a better

  14. Radiological Outcomes of Distal Radius Fractures Managed with 2.7mm Volar Locking Plate Fixation-A Retrospective Analysis

    PubMed Central

    Kotian, Prem; Mudiganty, Srikanth; Annappa, Rajendra

    2017-01-01

    Introduction Distal radius fractures accounts for around 15% of all fractures diagnosed and treated in the emergency rooms. These fractures usually result secondary to high velocity injury such as a motor vehicle accident or fall on an out stretched hand. In the elderly, it is a common fragility fracture. Volar Locking Compression Plates (LCP) is effective devices for fixation of the distal radius fractures. There is a lacuna with regard to literature on the 2.7 mm volar LCP and the current study retrospectively assesses the postoperative radiological outcomes. Aim To measure the radiological outcomes in patients with displaced distal radius fractures managed with 2.7 mm volar LCP fixation using Sarmiento’s Modification of Lindstorm Criteria. Materials and Methods A retrospective study was conducted in the Department of Orthopaedic Surgery at Kasturba Medical College Allied Hospitals, Mangalore from May 2014 to July 2016. All displaced distal radius fractures of skeletally mature patients who underwent volar locking plate fixation between May 2014 to July 2016 and follow up with X-rays at six weeks and three months were included as part of the study. The study comprised of 20 patients and fractures were classified using the AO and Melone’s classification systems. The radiological outcome was scored based on Sarmiento’s Modification of Lindstorm Criteria. Results Post operative check X-rays were analysed at immediate post operative, six weeks and three months. The mean immediate post operative radial shortening, decrease in radial deviation and loss of palmar tilt were 4.08±2.23, 5.91±4.01and 4.11±3.29 respectively. The corresponding values at last follow up were 4.71±2.31, 7.9±5.13 and 4.91±3.32 respectively. No statistically significant difference (p=0.930;874;716) in radial shortening, decrease in palmar angulation and loss of radial deviation was seen till the final follow up. Sarmiento’s Modification of Lindstorm Criteria showed a good

  15. Image-based micro-finite-element modeling for improved distal radius strength diagnosis: moving from bench to bedside.

    PubMed

    Pistoia, W; van Rietbergen, B; Lochmüller, E-M; Lill, C A; Eckstein, F; Rüegsegger, P

    2004-01-01

    Although osteoporosis is characterized by quantitative (mass) and qualitative (structural) changes, standard clinical techniques (dual-energy X-ray absorptiometry, DXA) only measure the former. Three-dimensional micro-finite-element (micro-FE) models based on high-resolution images can account for structural aspects as well, and it has recently been shown that an improved prediction of distal radius strength is possible with micro-FE analysis. A clinical application of this technique, however, is limited by its high imaging and computational demands. The objective of this study is to investigate if an improved prediction of bone strength can be obtained as well when only a small part of the radius is used for micro-FE modeling. Images of a 1-cm region of the metaphysis of the distal radius of 54 cadaver arms (mean age: 82 +/- 9 SD) made with a three-dimensional peripheral quantitative computed tomography (pQCT) device at 165- micro m resolution formed the basis for micro-FE models that were used to predict the bone failure load. Following imaging, specimens were experimentally compressed to failure to produce a Colles'-type fracture. Failure loads predicted from micro-FE analyses agreed well with those measured experimentally (R2 = 0.66, p < 0.001). Lower correlations were observed with bone mass (R2 = 0.48, p < 0.001) and microstructural parameters (R2 = 0.47, p < 0.001). Hence, even when only a small region is modeled, micro-FE analysis provides an improved prediction of radius strength.

  16. Comparative clinical study of locking screws versus smooth locking pegs in volar plating of distal radius fractures.

    PubMed

    Boretto, J G; Pacher, N; Giunta, D; Gallucci, G L; Alfie, V; De Carli, P

    2014-09-01

    The present study was performed to test the null hypothesis on no difference in stability of fixation after volar plating of intra-articular distal radius fractures (AO C2-C3) with either locking smooth pegs or locking screws in a clinical setting. A retrospective evaluation included adult patients with C2-C3 AO fractures treated with a volar plate with locking smooth pegs or locking screws. Radiographic assessment was performed to evaluate extra- and intra-articular parameters in the early postoperative period and after bone union. Twenty-seven consecutive patients were included. Thirteen cases had fixation with locking screws and 14 had fixation with locking smooth pegs. Both groups had bone fragment displacement after fixation. However, there were no significant differences between the groups either in extra- or intra-articular parameters defined by Kreder et al. (1996). Our study shows that, in a clinical setting, there is no difference in stability fixation between locking screws or smooth locking pegs in C2-C3 distal radius fractures.

  17. [Complications of open reduction and internal fixation versus external fixation for unstable distal radius fractures: a meta-analysis].

    PubMed

    Yang, Z; Yuan, Z Z; Ma, J X; Ma, X L

    2016-12-20

    Objective: To make a systematic assessment of the complications of open reduction and internal fixation versus external fixation for unstable distal radius fractures. Method: A computer-based online search of PubMed, ScienceDirect, EMBASE, BIOSIS, Springer and Cochrane Library were performed.The randomized and controlled trials of open reduction and internal fixation versus external fixation for unstable distal radius fractures were collected.The included trials were screened out strictly based on the criterion of inclusion and exclusion.The quality of included trials was evaluated.RevMan 5.0 was used for data analysis. Result: A total of 17 studies involving 1 402 patients were included.There were 687 patients with open reduction and internal fixation and 715 with external fixation.The results of Meta-analysis indicated that there were statistically significant differences with regard to the postoperatively total complications, infection, malunion, tendon rupture (I(2)=8%, RR=0.77(95%CI 0.65-0.91, Z=3.10, P<0.05). There were no statistically significant differences observed between two approaches with respect to nounion, re-operation, complex regional pain syndrome, carpal tunnel syndrome, neurapraxia, tendonitis, painful hardware, scar(P>0.05). Conclusion: Postoperative complications are present in both open reduction and internal fixation and external fixation.Compared with external fixation, open reduction and internal fixation is lower in total complications postoperatively, infection and malunion, but external fixation has lower tendon rupture incidence.

  18. Treatment of Preiser disease with vascularized bone graft from the distal radius: a report of two cases.

    PubMed

    da Gama, Sérgio Augusto Machado; de Rezende, Marcelo Rosa; Ribak, Samuel

    2015-09-01

    The authors report two cases of women with Preiser disease treated with dorsal distal radius vascularized grafts. In the first case, after minor trauma, the patient had pain in the left wrist of insidious onset and evolution with significant worsening. The radiographic examination showed increased density of the proximal pole of the scaphoid, and magnetic resonance imaging (MRI) showed partial necrosis. Intraoperatively, as the integrity of the cartilage of the proximal pole of the scaphoid was observed, dorsal vascularized distal radius graft was performed using the 1,2 intercompartmental supraretinacular artery. In 4 months postoperatively, MRI showed almost total integration of the graft, and 1 year after surgery, the patient was asymptomatic, with normal mobility of the operated wrist and imaging showing a normal scaphoid. The second case had similar history and clinical picture, but the radiographs showed narrowing and diffuse sclerosis and also osteolytic areas in the proximal pole of the scaphoid; MRI showed diffuse necrosis. The same graft technique was used, considering that there was a good cartilaginous coverage of the scaphoid. After 9 years of follow-up, the patients remain free of pain or functional limitations. In such cases, the vascularized graft technique was effective and, therefore, a good therapeutic option, provided that there is no degenerative changes in the carpus and, especially, the cartilage of the proximal pole is viable.

  19. Reduction of multi-fragment fractures of the distal radius using atlas-based 2D/3D registration

    NASA Astrophysics Data System (ADS)

    Gong, Ren Hui; Stewart, James; Abolmaesumi, Purang

    2009-02-01

    We describe a method to guide the surgical fixation of distal radius fractures. The method registers the fracture fragments to a volumetric intensity-based statistical anatomical atlas of distal radius, reconstructed from human cadavers and patient data, using a few intra-operative X-ray fluoroscopy images of the fracture. No pre-operative Computed Tomography (CT) images are required, hence radiation exposure to patients is substantially reduced. Intra-operatively, each bone fragment is roughly segmented from the X-ray images by a surgeon, and a corresponding segmentation volume is created from the back-projections of the 2D segmentations. An optimization procedure positions each segmentation volume at the appropriate pose on the atlas, while simultaneously deforming the atlas such that the overlap of the 2D projection of the atlas with individual fragments in the segmented regions is maximized. Our simulation results shows that this method can accurately identify the pose of large fragments using only two X-ray views, but for small fragments, more than two X-rays may be needed. The method does not assume any prior knowledge about the shape of the bone and the number of fragments, thus it is also potentially suitable for the fixation of other types of multi-fragment fractures.

  20. A prospective comparison between Kapandji and percutaneous extra-focal fixation in extra articular distal radius fractures

    PubMed Central

    Mirhamidi, Seyed Mehdi; Bayat, Farzad Merrikh

    2013-01-01

    Introduction: there are multiple methods of distal radius fractures treatments. Of these percutaneous wire insertion has yielded popular acceptance. These percutaneous wire insertions can be done through many different ways with their own advantages and disadvantages. One of these methods is Kapandji method and because of its inherent stability in biomechanical examinations we suppose that we can begin the range of motion sooner than other methods with the hope of better outcome. Patients and methods: From 2010 to 2012 we studied 45 patients, of these 23 went under extra-focal technique and 22 went under Kapandji technique. After Kapandji we immobilized the limb in splint for 4 weeks and started partial motion thereafter and in the extra-focal group we immobilized them in for 6 weeks in long arm casts. Results: After 3 months and 6 months we assess the Gartland and Warley score and find 39% and 73% excellent and good result in extra-focal and 45% and 86% excellent and good result in Kapandji group after 3 and 6 months, respectively. Although there were about 0.22 mm collapse in both groups, here were no statistically significant differences in functional score or radiologic and anatomic parameters between groups. Conclusion: we have find Kapandji technique a suitable method of distal radius fracture fixation in cases with no articular involvement and we think it is better to immobilize the limb for at least 6 weeks after Kapandji fixation, in order to better control the pain. PMID:23386917

  1. Radiographic Outcomes of Percutaneous Pinning for Displaced Extra-Articular Fractures of the Distal Radius: A Time Course Study

    PubMed Central

    Yang, Tien-Yu; Shen, Shih-Hsun

    2014-01-01

    Introduction. Although not all malunited distal radius fractures are symptomatic, the goal of treatment for displaced extra-articular fractures of the distal radius should be to restore and to maintain the radial geometry until bone healing. However, the time course change after surgery for these fractures is unclear. Methods. We, therefore, performed a retrospective cohort study on patients who sustained such fractures treated with percutaneous pinning. The main outcome measures in this study included four radiographic measurements: radial height, radial inclination, radial tilt, and ulnar variance. Results. Assessment of the monthly changes in these measurements revealed that early fracture collapse with loss of the reduced radial tilt occurred. Besides, among the 4 measurements, the normal radial tilt was the most difficult to be achieved when repositioning and pinning the fractured fragments. Conclusions. Even though the modified Kapandji technique provided a superior ability to maintain the reduced position until bone healing over the Willenegger method, we recommended that refinement of surgical techniques and postoperative hand care program may be necessary to fulfill the treatment objectives of stable surgical fixation and early joint motion. PMID:24883316

  2. Prediction of bone mechanical properties using QUS and pQCT: study of the human distal radius.

    PubMed

    Muller, M; Mitton, D; Moilanen, P; Bousson, V; Talmant, M; Laugier, P

    2008-07-01

    The objective was to compare the prediction of bone mechanical properties provided by axial transmission to that provided by peripheral quantitative computed tomography (pQCT) at the distal radius. The distal radius is the location for Colles' fractures, a common osteoporosis related trauma situation. Measurements of the radial speed of sound were performed using three axial transmission devices: a commercial device (Sunlight Omnisense, 1.25 MHz), a bi-directional axial transmission prototype (1 MHz), both measuring the velocity of the first arriving signal (FAS), and a low frequency (200 kHz) device, measuring the velocity of a slower wave. Co-localized pQCT measurements of bone mineral density and cortical thickness were performed. Ultrasound and pQCT parameters were compared to mechanical parameters such as failure load and Young's modulus, obtained using quasistatic compressive mechanical testing and finite elements modelling (FEM). Correlations of the ultrasound and pQCT parameters to mechanical parameters were comparable. The best predictor of failure load was the pQCT measured cortical thickness. The best predictor of Young's modulus was the bi-directional SOS. The low frequency device significantly correlated to cortical thickness and failure load. The results suggest that different axial transmission approaches give access to different bone mechanical parameters. The association of different axial transmission techniques should be able to provide a good prediction of bone mechanical parameters, and should therefore be helpful for fracture risk prediction.

  3. Gender differences in trabecular bone architecture of the distal radius assessed with magnetic resonance imaging and implications for mechanical competence.

    PubMed

    Hudelmaier, Martin; Kollstedt, A; Lochmüller, E M; Kuhn, V; Eckstein, F; Link, T M

    2005-09-01

    High-resolution magnetic resonance imaging (hrMRI) has recently made it possible to evaluate trabecular bone structure in vivo. Despite obvious gender differences in fracture incidence at the distal radius, little is known about gender differences in trabecular bone microarchitecture and its relationship to the structural strength of the forearm. The aim of this study was to determine trabecular bone structure in the distal radius of elderly women and men and its correlation with failure loads of the distal radius as determined in a fall configuration. Specifically, we tested the hypotheses that structural indices differ between women and men and that they offer information that is independent from BMD for predicting structural strength. Intact right arms were obtained from 73 formalin-fixed cadavers (age 80+/-11 years, 43 women, 30 men). Trabecular structural indices (apparent bone volume fraction [app. BV/TV], trabecular number [app. Tb.N], trabecular separation [app. Tb.Sp], trabecular thickness [app. Tb.Th] and fractal dimension [Frac.Dim]) were assessed in the distal metaphysis, using hrMRI with 156 microm in-plane resolution and proprietary digital image analysis, while BMD was measured with dual X-ray absorptiometry (DXA). Women displayed significantly lower BMD (-29.8%, p <0.001), app. BV/TV (-8.2%, p <0.05) and app. Tb.Th (-10.2%, p <0.001) than men, whereas app. Tb.N, app. Tb.Sp. and fractal dimension did not differ significantly. Structural parameters differed between normal and osteopenic women (BV/TV: -11%, p <0.01; Tb.Th: -8%, p <0.001) and between normal and osteoporotic women BV/TV: -21%, p <0.001; Tb.Th: -16%, p <0.001). App. BV/TV, app. Tb.Th and fractal dimension provided information independent from BMD in the prediction of radial failure loads in multiple regression models. These findings imply that it should be of clinical interest to monitor both bone mass and trabecular microstructure for predicting osteoporotic fracture risk.

  4. Ten Years' Follow-Up on Combined Palmar and Dorsal Internal Fixation of Complex Distal Radius Fractures.

    PubMed

    Iselin, Lukas Daniel; Massy-Budmiger, Anne-Sophie; Droeser, Raoul A; Mett, Tobias R; Babst, Reto; Rikli, Daniel A

    2016-05-01

    Complex distal intra-articular radial fractures (AO Type C3) are rare, but are life-changing injuries. They are usually related to high-velocity trauma mechanisms in a working male population.We surveyed a cohort of these fractures treated in our institution to assess the functional long-term outcome.Twelve consecutive patients with comminuted intra-articular distal radial fractures were treated at our institution. Osteosynthesis was performed by a single senior surgeon with volar and dorsal extended approaches. The intermediate and final control included conventional X-ray, range of motion (ROM), grip strength, and the Disabilities of the Arm, Shoulder, and Hand index (DASH), as well as the Patient-rated Wrist Evaluation (PRWE) score for functional outcome at 1 and 10 years' of follow-up.At 10 years' follow-up, anatomic reconstruction with a step or gap of <1 mm was achieved in 10 of the 12 above-mentioned patients, whereas 2 patients were lost to follow-up. ROM was good to excellent in 8 patients. Median grip strength was 107% of the contralateral side. Median DASH-Index and PRWE were 2.3 and 6 respectively, at 10 years. Eight patients returned to premorbid heavy labor. One patient was retired at the time of injury.Combined volar and dorsal approaches allow achieving anatomical reconstruction in comminuted intra-articular distal radius fractures and reveal good functional outcomes at intermediate and long-time follow-up.

  5. Distinctive metaphyseal chondrodysplasia with severe distal radius and ulna involvement (upper extremity mesomelia) and normal height.

    PubMed

    Camera, Andrea; Camera, Gianni

    2003-10-01

    Metaphyseal chondrodysplasias (MCD) are skeletal disorders characterized by metaphyseal irregularities and, usually, by short stature. In MCD, wide heterogeneity exists with regard to clinical and radiological changes. We report on a patient with clinical and radiological findings of MCD who had coxa valga and normal height with metaphyseal involvement of the long bones. The short radii and ulnae showed a very severe change in their distal metaphyses, leading to mesomelic shortening confined to the upper limbs. Hematological, ophthalmological, and hearing examinations were normal. This type of MCD appears to represent a yet undescribed syndrome.

  6. Outcome Analysis of Intra-Articular Scapula Fracture Fixation with Distal Radius Plate: A Multicenter Prospective Study

    PubMed Central

    Panigrahi, Ranajit; Madharia, Divya; Das, Dibya Singha; Samant, Saswat; Biswal, Manas Ranjan

    2016-01-01

    Background Scapula fractures occur in approximately 1% of all fractures and constitute about 3% - 5% of all injuries of the shoulder joint. Objectives This study aimed to evaluate the clinical outcomes of 20 surgically treated patients with displaced glenoid fractures after stabilization with distal radius plate. Methods Between 2012 and 2015, at 2 centers (HMCH & SHCE) of Bhubaneswar Odisha, we stabilized 20 scapular intra-articular fractures surgically with distal radius locking plate and studied the outcome of the surgeries. The outcome of the 20 fractures was determined using the Constant and Murley score. Both shoulders were assessed and the score on the injured side was given as a percentage of that on the uninjured side. Results The median score was 88% (mean 65%, range 30 to 100). The median score for strength was 21/25 (mean 19, range 0 to 25) and that for pain 11/15 (mean 11, range 5 to 15). The median functional score was 16/20 (mean 15, range 0 to 20). The mean range of active abduction of the shoulder was 135° (20 to 180), the mean range of flexion 138° (20 to 180) and the mean range of external rotation 38° (0 to 100). Five patients showed excellent result; 11 patients showed good result; three patients showed fair result and one patient had poor outcome according to the Constant-Murley score. A superficial infection settled with antibiotics after operation in one patient whose score at final follow-up was 96%. In one patient, delayed healing was reported because of infection. One patient with stiffness of the shoulder at six weeks underwent manipulation under anesthesia with a follow-up score of 81%. Conclusions Various fixation modalities have been described in the literature, however fixation of intra-articular fracture of glenoid with distal radius locking plate for articular reconstruction in the presented series provides good functional outcome with early restoration of the range of motion of the shoulder. PMID:28144606

  7. External Fixation Versus Open Reduction With Locked Volar Plating for Geriatric Distal Radius Fractures

    PubMed Central

    Lee, Daniel J.

    2014-01-01

    The optimal management of displaced dorsal radius fractures (DRFs) in older patients remains an issue of debate. Bridging external fixation is a well-accepted treatment modality for severely comminuted DRFs, while open reduction and internal fixation with locked volar plating has emerged as a promising alternative in recent years. The current body of randomized trials supports the trend toward locked volar plating, as it allows for quicker improvement in subjective and functional outcomes. There is no clear evidence to suggest that one technique carries significantly less complications than the other. Locked volar plating should be considered in patients for whom an accelerated functional recovery would be advantageous. Otherwise, both external fixation and locked volar plating provide good long-term clinical outcomes. PMID:25360346

  8. Intraarticular fractures of the distal radius in young adults--a review of the outcome of treatment.

    PubMed

    Pan, K L; Masbah, O; Ali, M

    2001-06-01

    A retrospective review of 30 intraarticular fractures of the distal radius in 27 patients was done. Only young adults aged between 18 and 40 were included. Road traffic accidents accounted for 25 of the cases (23 motorcyclists). Fourteen fractures were treated by closed reduction and a plaster cast. Sixteen fractures were treated by open reduction with internal fixation using a buttress plate or multiple Kirschner wires. At a mean follow-up of 17 months, 63% of the wrists had a satisfactory result and 37% unsatisfactory result. The main adverse factor was intraarticular congruity. The grip strength on the injured side averaged 56% of that of the uninjured side and the pinch strength averaged 73%. Most of the patients were able to return to their former occupation in an average of four months.

  9. Surgical Technique of Corrective Osteotomy for Malunited Distal Radius Fracture Using the Computer-Simulated Patient Matched Instrument.

    PubMed

    Murase, Tsuyoshi

    2016-06-01

    The conventional corrective osteotomy for malunited distal radius fracture that employs dorsal approach and insertion of a trapezoidal bone graft does not always lead to precise correction or result in a satisfactory surgical outcome. Corrective osteotomy using a volar locking plate has recently become an alternative technique. In addition, the use of patient-matched instrument (PMI) via computed tomography simulation has been developed and is expected to simplify surgical procedures and improve surgical precision. The use of PMI makes it possible to accurately position screw holes prior to the osteotomy and simultaneously perform the correction and place the volar locking plate once the osteotomy is completed. The bone graft does not necessarily require a precise block form, and the problem of the extensor tendon contacting the dorsal plate is avoided. Although PMI placement and soft tissue release technique require some degree of specialized skill, they comprise a very useful surgical procedure. On the other hand, because patients with osteoporosis are at risk of peri-implant fracture, tandem ulnar shortening surgery should be considered to avoid excessive lengthening of the radius.

  10. Volar locking distal radius plates show better short-term results than other treatment options: A prospective randomised controlled trial

    PubMed Central

    Drobetz, Herwig; Koval, Lidia; Weninger, Patrick; Luscombe, Ruth; Jeffries, Paula; Ehrendorfer, Stefan; Heal, Clare

    2016-01-01

    AIM To compare the outcomes of displaced distal radius fractures treated with volar locking plates and with immediate postoperative mobilisation with the outcomes of these fractures treated with modalities that necessitate 6 wk wrist immobilisation. METHODS A prospective, randomised controlled single-centre trial was conducted with 56 patients who had a displaced radius fracture were randomised to treatment either with a volar locking plate (n = 29), or another treatment modality (n = 27; cast immobilisation with or without wires or external fixator). Outcomes were measured at 12 wk. Functional outcome scores measured were the Patient-Rated Wrist Evaluation (PRWE) Score; Disabilities of the Arm, Shoulder and Hand and activities of daily living (ADLs). Clinical outcomes were wrist range of motion and grip strength. Radiographic parameters were volar inclination and ulnar variance. RESULTS Patients in the volar locking plate group had significantly better PRWE scores, ADL scores, grip strength and range of extension at three months compared with the control group. All radiological parameters were significantly better in the volar locking plate group at 3 mo. CONCLUSION The present study suggests that volar locking plates produced significantly better functional and clinical outcomes at 3 mo compared with other treatment modalities. Anatomical reduction was significantly more likely to be preserved in the plating group. Level of evidence: II. PMID:27795951

  11. Assessment of volume fraction and fabric in the distal radius using HR-pQCT.

    PubMed

    Varga, P; Zysset, P K

    2009-11-01

    The aim of this study was to investigate the capabilities of the state of the art HR-pQCT technique to predict mineral content, volume fraction and fabric of trabecular bone structure compared to the gold standard microCT. Four cadaveric human forearms were scanned with HR-pQCT and the dissected radius epiphyses with microCT. After registering the images, bone mineral density (BMD), volume fraction (BV/TV) and fabric were computed on corresponding cubical regions of interest for both image sources. In particular, the effect of the segmentation procedure on BV/TV was analyzed. Assessment of fabric was performed with three different methods comparing their efficiency and robustness against resolution change. The results showed that in order to achieve optimal results at the lower image resolution, different filtering and thresholding approaches needed to be selected for different tasks. Therefore, to preserve BV/TV, the BMD-based volume fraction provided best match with the reference values of microCT, while in case of Mean Intercept Length (MIL) fabric a Gaussian filter and a histogram-based threshold were optimal. Using the latter, MIL was found to be more robust against resolution change than the other approaches. Additionally, we proposed a linear model for describing the mathematical transformation that the second order fabric tensor undergoes when the resolution of the input images changes. As a conclusion, we found that the investigated properties of trabecular bone structure can be adequately predicted from the lower resolution technique that is available in vivo for peripheral bones, when proper image processing and corrections are applied.

  12. External Fixator for Maintaining Reduction Before Volar Plating: A Simple Treatment Method for Association of Osteosynthesis Type C3 Distal Radius Fracture.

    PubMed

    Tsai, Chun-Hao; Hsu, Chin-Jung; Wang, Ta-I; Fong, Yi-Chin; Hsu, Horng-Chaung; Lin, Tsung-Li

    2016-03-01

    Volar plating for Association of Osteosynthesis type C3 distal radius fractures involves more time and more radiation exposure because it is extremely difficult to simultaneously maintain the reduction and restore the congruity of the articular surface. The authors present a technique of maintaining the acceptable reduction by using an external fixator followed by open volar plating for restoring articular congruity. A consecutive series of 96 Association of Osteosynthesis type C3 distal radius fractures treated with the technique were retrospectively reviewed between January 2004 and December 2012. The technique makes surgery simpler and more effective, and reduces radiation exposure.

  13. Elbow dislocation with ipsilateral fracture of the distal radius associated with a brachial artery injury: A new pathological condition of traumatic origin.

    PubMed

    Trigo Lahoz, L; Lamas Gomez, C; Sarasquete Reiriz, J; de Caso Rodriguez, J; Proubasta Renart, I

    2016-11-25

    Elbow dislocation associated with ipsilateral fracture of the distal radius and a brachial artery injury is an uncommon traumatic entity. The two references of this injury combination appeared in 2015, although both authors did not realise that they were the first two cases published in the medical literature. Although mentioned in the text of the articles, no mention was made of the fracture of the distal radius in the titles. The purpose of this paper is to present three cases with this new traumatic pathological entity, explaining its pathogenetic mechanism, the treatment used, and the results obtained.

  14. En bloc excision and autogenous fibular reconstruction for aggressive giant cell tumor of distal radius: a report of 12 cases and review of literature

    PubMed Central

    2011-01-01

    Introduction Giant cell tumor (GCT) of distal radius follows a comparatively aggressive behaviour. Wide excision is the management of choice, but this creates a defect at the distal end of radius. The preffered modalities for reconstruction of such a defect include vascularized/non-vascularized bone graft, osteoarticular allografts and custom-made prosthesis. We here present our experience with wide resection and non-vascularised autogenous fibula grafting for GCT of distal radius. Materials and methods Twelve patients with a mean age of 34.7 years (21-43 years) with Campanacci Grade II/III GCT of distal radius were managed with wide excision of tumor and reconstruction with ipsilateral nonvascularised fibula, fixed with small fragment plate to the remnant of the radius. Primary autogenous iliac crest grafting was done at the fibuloradial junction in all the patients. Results Mean follow up period was 5.8 years (8.2-3.7 years). Average time for union at fibuloradial junction was 33 weeks (14-69 weeks). Mean grip strength of involved side was 71% (42-86%). The average range of movements were 52° forearm supination, 37° forearm pronation, 42° of wrist palmerflexion and 31° of wrist dorsiflexion with combined movements of 162°. Overall revised musculoskeletal tumor society (MSTS) score averaged 91.38% (76.67-93.33%) with five excellent, four good and three satisfactory results. There were no cases with graft related complications or deep infections, 3 cases with wrist subluxation, 2 cases with non union (which subsequently united with bone grafting) and 1 case of tumor recurrence. Conclusion Although complication rate is high, autogenous non-vascularised fibular autograft reconstruction of distal radius can be considered as a reasonable option after en bloc excision of Grade II/III GCT. PMID:21385393

  15. Quantitative characterization of subject motion in HR-pQCT images of the distal radius and tibia.

    PubMed

    Sode, Miki; Burghardt, Andrew J; Pialat, Jean-Baptiste; Link, Thomas M; Majumdar, Sharmila

    2011-06-01

    Image quality degradation due to subject motion is a common artifact affecting in vivo high-resolution peripheral quantitative computed tomography (HR-pQCT) of bones. These artifacts confound the accuracy and reproducibility of bone density, geometry, and cortical and trabecular structure measurements. Observer-based systems for grading image quality and criteria for deciding when to repeat an acquisition and post hoc data quality control remain highly subjective and non-standardized. This study proposes an objective, quantitative technique for measuring subject motion in HR-pQCT acquisitions from raw projection data, using image similarity measures applied to parallelized projections at 0° and 180°. A total of 88 HR-pQCT exams with repeated acquisitions of the distal radius (N = 54) or distal tibia (N = 34) of 49 women (age = 59 ± 14 year) and 3 men (46 ± 2 year) were retrospectively evaluated. All images were graded from 1 (no visible motion artifacts) to 5 (severe motion artifacts) according to the manufacturer-suggested image quality grading system. In addition, to serve as the reference case without motion artifacts, two cadaveric wrist and two ankle specimens were imaged twice with repositioning. The motion-induced error was calculated as the percent difference in each bone parameter for the paired scans with and without visually apparent motion artifacts. Quantitative motion estimates (QMEs) for each motion-degraded scan were calculated using two different image similarity measures: sum of squared differences (SSD) and normalized cross-correlation (NCC). The mean values of QME(SSD) and QME(NCC) increased with the image quality grade for both radius and tibia. Quality grades were differentiated between grades 2 and 3 using QME(SSD), but not with QME(NCC), in addition to between grades 4 and 5. Both QMEs correlated significantly to the motion-induced errors in the measurements and their empirical relationship was derived. Subject motion had greater impact

  16. Success Rate and Complications of Comminuted Intra-Articular Distal Radius Fracture Treatment via Closed Reduction and Use of a Mini-External Fixator

    PubMed Central

    Karimi Nasab, Mohammad Hossein; Shayesteh Azar, Masoud; Fazel Moghaddam, Samira; Taghipour, Mehrdad

    2015-01-01

    Background: Intra-articular fracture of the distal radius is extremely common; however, the management of this fracture is controversial. Objectives: With regard to the importance of intra-articular fracture of the distal radius and the best treatment method for the fracture, we sought to assess the success rate following the treatment of comminuted intra-articular fractures of the distal radius via closed reduction and use of a mini-external fixator. Patients and Methods: This longitudinal retrospective study was undertaken at our department of orthopedics via assessment of radiographs and patient files of those referred from 2006 to 2013. Radiographic criteria included the degree of angulation and shortening of the radius. Data were analyzed using SPSS 18 software and were presented as mean ± standard deviation (SD). The significance level was set at P ≤ 0.05. Results: Overall, ≥ 2 mm shortening of the radius was seen in 28% of the patients, 53% had 2 - 5 mm radial shortening and 19% of the patients had more than 5 mm shortening of the radius. Most of the participants had acceptable outcomes. The mean angulation was 6.28 ± 2.85 degrees and the mean shortening was 3.92 ± 2.22. Thirty-nine percent of the patients had an angulation of less than 5 mm, 56% and 5% had an angulation of 5 - 10 mm and more than 10 mm, respectively. Conclusions: The results of our study showed that the mini-external fixator is a good and effective treatment option for obtaining radial length, angulation and bony union in intra-articular fractures of the distal radius. PMID:26839853

  17. Relationship between Bone Mineral Density and Serum Vitamin D with Low Energy Hip and Distal Radius Fractures: A Case-Control Study

    PubMed Central

    Tahririan, Mohammad Ali; Motififard, Mehdi; Omidian, Ali; Aghdam, Hossein Akbari; Esmaeali, Amir

    2017-01-01

    Background: The main purpose of this study was to determine the relationship between serum vitamin D and the status of bone mineral density in patients with low-energy hip and distal radius fracture. Methods: This retrospective case-control study was performed between January 2013 and January 2014. Participants aged 55 years or older were divided to case group including 85 patients with low-energy hip fracture and 83 patients with low-energy distal radius fractures, and 82 subjects as a matched control group. Bone mineral density was measured with dual energy X-ray absorptiometry and serum sample was obtained to check vitamin D, calcium, phosphorus, alkaline phosphatase, and protein. Results: Study subjects for final evaluation consisted of 78 in hip and distal radius fracture groups and 80 in control group. There were no significant differences in the mean serum levels of calcium, phosphorus and alkaline phosphatase between the three groups. The overall mean serum level of vitamin D3 was significantly different among the three groups. Similar results were observed with hip and spine t-score between the groups. Conclusion: There is not only a direct relation between serum vitamin D and the risk of low energy hip and distal radius fractures, but also a significant relation between low bone density in hip and spine area with low serum calcium was observed. PMID:28271083

  18. Use of the AO veterinary mini 'T'-plate for stabilisation of distal radius and ulna fractures in toy breed dogs.

    PubMed

    Hamilton, M H; Langley Hobbs, S J

    2005-01-01

    The use of the AO (Arbeitsgemeinschaft für Osteosynthesefragen) veterinary mini 'T'-plate for stabilisation of distal radius and ulna fractures in toy breed dogs was evaluated in a retrospective study. All of the 14 dogs in the study weighed 3.5 kg or less. The AO mini 'T'-plate was used as the final means of fixation in all cases. It was used as the primary form of stabilisation in ten dogs, and in four dogs it was used at revision surgery. In all cases, of the fractures healed. Return to function was graded 'as excellent' in six cases, 'good' in four and 'fair' in two. Two dogs were lost to long-term follow up. It was concluded that the AO veterinary mini 'T'-plate is a suitable choice of implant for stabilisation of distal radius and ulna fractures in toy breed dogs, especially when the distal fragment is very small.

  19. Alterations of bone density, microstructure, and strength of the distal radius in male patients with rheumatoid arthritis: a case-control study with HR-pQCT.

    PubMed

    Zhu, Tracy Y; Griffith, James F; Qin, Ling; Hung, Vivian W; Fong, Tsz-Ning; Au, Sze-Ki; Li, Martin; Lam, Yvonne Yi-On; Wong, Chun-Kwok; Kwok, Anthony W; Leung, Ping-Chung; Li, Edmund K; Tam, Lai-Shan

    2014-09-01

    In this cross-sectional study, we investigated volumetric bone mineral density (vBMD), bone microstructure, and biomechanical competence of the distal radius in male patients with rheumatoid arthritis (RA). The study cohort comprised 50 male RA patients of average age of 61.1 years and 50 age-matched healthy males. Areal BMD (aBMD) of the hip, lumbar spine, and distal radius was measured by dual-energy X-ray absorptiometry. High-resolution peripheral quantitative computed tomography (HR-pQCT) of the distal radius provided measures of cortical and trabecular vBMD, microstructure, and biomechanical indices. aBMD of the hip but not the lumbar spine or ultradistal radius was significantly lower in RA patients than controls after adjustment for body weight. Total, cortical, and trabecular vBMD at the distal radius were, on average, -3.9% to -23.2% significantly lower in RA patients, and these differences were not affected by adjustment for body weight, testosterone level, or aBMD at the ultradistal radius. Trabecular microstructure indices were, on average, -8.1% (trabecular number) to 28.7% (trabecular network inhomogeneity) significantly inferior, whereas cortical pore volume and cortical porosity index were, on average, 80.3% and 63.9%, respectively, significantly higher in RA patients. RA patients also had significantly lower whole-bone stiffness, modulus, and failure load, with lower and more unevenly distributed cortical and trabecular stress. Density and microstructure indices significantly correlated with disease activity, severity, and levels of pro-inflammatory cytokines (interleukin [IL] 12p70, tumor necrosis factor, IL-6 and IL-1β). Ten RA patients had focal periosteal bone apposition most prominent at the ulnovolar aspect of the distal radius. These patients had shorter disease duration and significantly higher cortical porosity. In conclusion, HR-pQCT reveals significant alterations of bone density, microstructure, and strength of the distal radius in

  20. [Stress osteotomy of the distal radius- and ulna metaphysis (Illarramendi procedure): an alternative treatment method in lunate necrosis].

    PubMed

    Schulz, C; De Carli, P; Anetzberger, H; Illarramendi, A

    1998-05-01

    The etiology of Kienböck's disease is still unknown. Many operative procedures, usually based on biomechanical considerations, are recommended. Based on known effects of core decompression procedures on bone, we present a technique of core decompression of the metaphysis of the distal radius and ulna (MCD) as an easy, alternative biologic treatment. Ten cases with a mean follow-up of 10.8 years are analyzed. All patients had significant postoperative pain relief and returned to their previous activities. At the time of follow-up, comparative motion of flexion-extension of the wrist averaged 74%, mean grip strength was 81% of the nonaffected side. Radiographic follow-up did not slow significant postoperative collapse of the lunate (p > 0.05). No correlation was observed between post-operative results and ulnar variance. MCD is a simple, low-risk procedure. Clinical and radiological outcome supports a theory of biologic rather than biomechanic mechanisms related to fracture healing, that stimulate regeneration of the avascular lunate and relieve symptoms. A primary vascular etiology of idiopathic avascular necrosis of the lunate seems to be likely.

  1. Distal radius bone mineral density estimation using the filling factor of trabecular bone in the x-ray image.

    PubMed

    Lee, Sooyeul; Jeong, Ji-Wook; Lee, Jeong Won; Yoo, Done-Sik; Kim, Seunghwan

    2006-01-01

    Osteoporosis is characterized by an abnormal loss of bone mineral content, which leads to a tendency to non-traumatic bone fractures or to structural deformations of bone. Thus, bone density measurement has been considered as a most reliable method to assess bone fracture risk due to osteoporosis. In past decades, X-ray images have been studied in connection with the bone mineral density estimation. However, the estimated bone mineral density from the X-ray image can undergo a relatively large accuracy or precision error. The most relevant origin of the accuracy or precision error may be unstable X-ray image acquisition condition. Thus, we focus our attentions on finding a bone mineral density estimation method that is relatively insensitive to the X-ray image acquisition condition. In this paper, we develop a simple technique for distal radius bone mineral density estimation using the trabecular bone filling factor in the X-ray image and apply the technique to the wrist X-ray images of 20 women. Estimated bone mineral density shows a high linear correlation with a dual-energy X-ray absorptiometry (r=0.87).

  2. Treatment of intra-articular distal radius fractures by the volar intrafocal Kapandji method: a case series.

    PubMed

    Rubin, Guy; Chezar, Avi; Rinott, Micha; Bor, Noam; Rozen, Nimrod

    2013-06-01

    At present, the most common treatment for intra-articular fractures with a volar fragment is open reduction and internal fixation with a volar locking plate. This manuscript describes and evaluates the safety and efficacy of a modified Kapandji technique with insertion of a volar Kirschner wire for osteosynthesis of intra-articular distal radius fractures with a volar fragment. Four patients treated with the "volar Kapandji technique" completed follow-up of at least 12 (12 to 54) months. The mean age was 43 (23 to 53) years. The mean Disability of the Arm, Shoulder, and Hand score was 21.7 (0 to 41) and the mean Patient-Rated Wrist Evaluation score was 12.9 (0 to 25.8). The mean loss of flexion was 13.7 (0 to 30) degrees, the mean loss of extension was 10 (0 to 30) degrees, the mean loss of supination was 0 degrees, and the mean loss of pronation was 10 (0 to 20) degrees. There was no loss in dorsal angulation, radial inclination, or radial length compared with the other hand. No early or late complications were recorded.

  3. Insufficiency fracture at the distal diaphysis of the radius after synovectomy combined with the Sauvé-Kapandji procedure in a patient with rheumatoid arthritis.

    PubMed

    Nagira, Keita; Hagino, Hiroshi; Yamashita, Yasutsugu; Kishimoto, Yuji; Teshima, Ryota

    2010-10-01

    We report here a rare case of insufficiency fracture at the distal diaphysis of the radius in a patient with rheumatoid arthritis (RA) after synovectomy combined with the Sauvé-Kapandji procedure. A 71-year-old woman who had been diagnosed with RA had been consecutively treated with several disease-modifying antirheumatic drugs. She had undergone synovectomy of the right wrist combined with the Sauvé-Kapandji procedure, due to a tendon rupture, 2 years before the current presentation (first visit). Although she had not experienced any recent trauma, the wrist pain had increased after she had lifted up the bedding at the funeral of her friend about 1 month prior to her first visit. Radiographs of her right wrist taken at the second visit showed a fracture at the distal diaphysis of the radius at the level of the excision osteotomy of the distal ulna; however, no displacement of the distal fragment was observed. We immobilized her forearm in a long-arm cast. However, after 3 weeks of cast immobilization, a displacement of the distal fragment was observed. A manual reduction of the displacement was performed and the arm was again immobilized in a long-arm cast. However, 1 week later, a displaced distal fragment was again observed. Subsequently, she received an open reduction and internal fixation using a volar locking plate and screws with an autologous iliac crest bone graft. Bone union was completed by 8 months following the operation.

  4. Clinical outcome of en-block resection and reconstruction with nonvascularized fibular autograft for the treatment of giant cell tumor of distal radius

    PubMed Central

    Taraz-Jamshidi, Mohammad H; Gharadaghi, Mohammad; Mazloumi, Seyed Mahdi; Hallaj-Moghaddam, Mohammad; Ebrahimzadeh, Mohammad H

    2014-01-01

    Background: Although giant cell tumor (GCT) is considered to be a primary benign bone tumor, its aggressive behavior makes its diagnosis and treatment, difficult and challenging. This is especially true in distal radius where GCT appears to be more aggressive and difficult to control locally. We report our clinical outcome of en-block resection and reconstruction with non-vascularized fibular autograft in 15 patients with distal radius GCT. Materials and Methods: We retrospectively reviewed 15 patients with GCT (Grade 2 and 3) of distal radius who were treated with en-block resection and non-vascularized fibular autograft. Five of 15 were recurrent GCT treated initially with extended curettage; local adjuvant therapy and filling the cavity with cement or bone graft. We followed the patients for mean 7.2 years post operation (range: 4-11 years). Patients were evaluated post operation with clinical examination, plain radiography of distal radius and chest X-ray and/or computed tomography scan. Furthermore pain, function, range of motion and grip strength of the affected limb were evaluated and mMayo wrist score was assessed. Results: A total of 11 patients were women and 4 were men. Mean age of patients was 29 years (range: 19-48). We had no lung metastasis and bony recurrence occurred in one patient (6.6%). Nearly 53.3% of patients had excellent or good functional wrist score, 80% of the patients were free of pain or had only occasional pain and 80% of patients returned to work. Mean range of motion of the wrist was 77° of flexion-extension and mean grip strength was 70% of the normal hand. Conclusion: En-block resection of distal radius GCT and reconstruction with non-vascularized fibular autograft is an effective technique for treatment in local control of the tumor and preserving function of the limb. PMID:24778664

  5. Treatment of reducible unstable fractures of the distal radius: randomized clinical study comparing the locked volar plate and external fixator methods: study protocol

    PubMed Central

    2014-01-01

    Background Various treatments are available for reducible unstable fractures of the distal radius, such as closed reduction combined with fixation by external fixator (EF), and rigid internal fixation using a locked volar plate (VP). Although there are studies comparing these methods, there is no conclusive evidence indicating which treatment is best. The hypothesis of this study is that surgical treatment with a VP is more effective than EF from the standpoint of functional outcome (patient-reported). Methods/Design The study is randomized clinical trial with parallel groups and a blinded evaluator and involves the surgical interventions EF and VP. Patients will be randomly assigned (assignment ratio 1:1) using sealed opaque envelopes. This trial will include consecutive adult patients with an acute (up to 15 days) displaced, unstable fracture of the distal end of the radius of type A2, A3, C1, C2 or C3 by the Arbeitsgemeinschaft für Osteosynthesefragen–Association for the Study of Internal Fixation classification and type II or type III by the IDEAL32 classification, without previous surgical treatments of the wrist. The surgical intervention assigned will be performed by three surgical specialists familiar with the techniques described. Evaluations will be performed at 2, and 8 weeks, 3, 6 and 12 months, with the primary outcomes being measured by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and measurement of pain (Visual Analog Pain Scale and digital algometer). Secondary outcomes will include radiographic parameters, objective functional evaluation (goniometry and dynamometry), and the rate of complications and method failure according to the intention-to-treat principle. Final postoperative evaluations (6 and 12 months) will be performed by independent blinded evaluators. For the Student’s t-test, a difference of 10 points in the DASH score, with a 95% confidence interval, a statistical power of 80%, and 20% sampling error

  6. Acute experimental distal colitis alters colonic transit in rats.

    PubMed

    Myers, B S; Dempsey, D T; Yasar, S; Martin, J S; Parkman, H P; Ryan, J P

    1997-04-01

    Data from humans with active distal colitis suggest that the proximal colon exhibits increased contractile activity and delayed transit, whereas the distal colon shows decreased contractile activity and rapid transit. The present study used the acetic acid rat model of experimental colitis to determine the effect of distal colitis on total and regional colonic transit in vivo and on the in vitro contractility of circular smooth muscle from the proximal and distal colon. Distal colitis was induced in rats by intracolonic administration of 4% acetic acid; sham control rats received saline enemas. Control and colitic rats were studied 2 days postenemas. Total colon transit was determined by calculating the geometric center of distribution of a radiolabeled marker (51Cr) instilled into the proximal colon. Regional transit was assessed by expressing the radioactivity in the cecum, proximal and distal colon, and excreted stool as a percent of total radioactivity. Muscle strips from the proximal and distal colon were stimulated with 100 microM acetylcholine (ACh) and 60 mM KCl and the tension was expressed as kilograms per square centimeter. Distal colitis was characterized by decreased total colon transit, increased retention of marker in the cecum and proximal colon, and decreased retention of marker in the distal colon. In vitro contractility studies revealed that distal colitis increased proximal colon circular smooth muscle contractility and decreased distal colon circular smooth muscle contractility to both ACh and potassium. Distal colitis is associated with regional differences in colonic circular smooth muscle contractility, which may contribute to delayed transit in the proximal colon and rapid transit in the distal colon.

  7. Acute compartment syndrome of the forearm caused by calcific tendinitis of the distal biceps.

    PubMed

    Garayoa, Santiago Amillo; Romero-Muñoz, Luis M; Pons-Villanueva, Juan

    2010-12-01

    Acute compartment syndrome of the forearm requires immediate treatment to avoid damage of the soft tissues and a poor functional outcome for the forearm. Muscular and bone lesions are the main causes of acute compartment syndromes. We report a case of acute compartment syndrome of the forearm caused by a calcific tendinitis of the distal biceps.

  8. Comparison of effects of seven treatment methods for distal radius fracture on minimizing complex regional pain syndrome

    PubMed Central

    Sun, Tao

    2016-01-01

    Introduction Using network meta-analysis, we evaluated the adverse effects of the seven most common treatment methods, i.e., bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating, by their associated risk of developing complex regional pain syndrome (CRPS) in distal radius fracture (DRF) patients. Material and methods Following an exhaustive search of scientific literature databases for high quality studies, randomized controlled trials (RCTs) related to our study topic were screened and selected based on stringent predefined inclusion and exclusion criteria. Data extracted from the selected studies were used for statistical analyses using Stata 12.0 software. Results A total of 17 RCTs, including 1658 DRF patients, were enrolled in this network meta-analysis. Among the 1658 DRF patients, 452 received bridging external fixation, 525 received non-bridging external fixation, 154 received K-wire fixation, 84 received plaster fixation, 132 received dorsal plating, 123 received volar plating, and 188 received dorsal and volar plating. When compared to bridging external fixation patients, there was no marked difference in the CRPS risk in DRF patients receiving different treatments (all p > 0.05). However, the surface under the cumulative ranking curves (SUCRA) for plaster fixation (77.0%) and non-bridging external fixation (71.3%) were significantly higher compared with the other five methods. Conclusions Our findings suggest that compared with bridging external fixation, K-wire fixation, dorsal plating, volar plating, dorsal and volar plating, plaster fixation and non-bridging external fixation might be the better treatment methods to reduce the risk of CRPS in DRF patients. PMID:28144268

  9. External fixation is more suitable for intra-articular fractures of the distal radius in elderly patients

    PubMed Central

    Ma, Chuang; Deng, Qiang; Pu, Hongwei; Cheng, Xinchun; Kan, Yuhua; Yang, Jing; Yusufu, Aihemaitijiang; Cao, Li

    2016-01-01

    The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius (IFDR) in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after 1 week and 3, 6 and 12 months. After 3 months, the plating group had better pronation (P=0.001), supination, (P=0.047) and extension (P=0.043) scores. These differences were somewhat attenuated by 6 months and disappeared at 1 year. The plating group had a greater occurrence of wound infection (P=0.043), tendonitis, (P=0.024) and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the “gross motor” category (walking upstairs, bending over, walking 500 yards; P=0.023). Internal fixation was more advantageous than external fixation in the early rehabilitation period; after 1 year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries. PMID:27408765

  10. Variation in the Incidence of Distal Radius Fractures in the US Elderly as Related to Slippery Weather Conditions

    PubMed Central

    Giladi, Aviram M.; Shauver, Melissa J.; Ho, Allison; Zhong, Lin; Kim, H. Myra; Chung, Kevin C.

    2014-01-01

    Background Distal radius fractures (DRFs) are costly and debilitating injuries, especially for the elderly. DRFs often occur from falls and more commonly occur outdoors. Inclement weather, especially in the winter, may increase the risk of fall-related injuries. Small community studies have reported increased risk of DRF due to inclement winter weather; however, larger studies are lacking. Methods We analyzed a sample of 2007 Medicare claims for DRF. Weather data were collected for the date and location of each DRF in our analysis cohort. A novel slipperiness score (0–7, 7 indicates the most slippery weather) was used as a measure of the severity of slippery outdoor conditions. Negative binomial regression models evaluated the correlation between slipperiness and DRF occurrence. Results Risk of DRF was higher in winter months (Incidence Rate Ratio=1.2, 95%CI 1.14–1.26, p<0.001). Days with average temperature ≤ 32°F (IRR=1.36, 95%CI 1.19–1.54, p<0.001), snow/ice on ground at the start of the day (IRR=1.45, 95%CI 1.25–1.68, p<0.001), and freezing rain (IRR=1.24, 95%CI 1.03–1.49, p=0.025) all had an increased risk of DRF. Risk of sustaining a DRF was increased 21% on days with a slipperiness score of 5 or above (IRR=1.21, 95%CI 1.08–1.20, p=0.007). Additionally, for each increase in slipperiness score above 4, the IRR of DRF increased as well. Conclusions Weather events that create slippery walking conditions, most often occurring in winter months, result in an increased risk of DRF in the US elderly. This finding can be used to support resource allocation as well as awareness and prevention campaigns. Level of Evidence IV; retrospective cohort PMID:24469166

  11. HR-pQCT based FE analysis of the most distal radius section provides an improved prediction of Colles' fracture load in vitro.

    PubMed

    Varga, Peter; Pahr, Dieter H; Baumbach, Sebastian; Zysset, Philippe K

    2010-11-01

    The remarkable performances of high-resolution peripheral quantitative computed tomography (HR-pQCT) make the distal radius a favorable site for early diagnosis of osteoporosis and improved Colles' fracture risk assessment. The goal of this study was to investigate if the HR-pQCT-based micro finite element (μFE) method applied on specific sections of the distal radius provides improved predictions of Colles' fracture load in vitro compared to bone mineral content (BMC), bone mineral density (BMD), or histomorphometric indices. HR-pQCT based BMC, BMD, histomorphometric parameters, and μFE models of 9-mm-thick bone sections were used to predict fracture load of 21 distal radii assessed in an experimental model of Colles' fracture reported in a previous study. The analysis was performed on two bone sections: a standard one recommended by the HR-pQCT manufacturer and a second one defined just proximal to the distal subchondral plate. For most of the investigated parameters, significant differences were found between the values of the two sections. Correlations with experimental fracture load and strength were higher in the most distal section, and the difference was statistically significant for μFE strength. Furthermore, the most distal section was computed to have significantly lower ultimate force and strength by 13% and 35%, respectively, than the standard section. BMC provided a better estimation of Colles' fracture load (R(2)=0.942) than aBMD or any other histomorphometric indices. The best prediction was achieved with μFE analyses of the most distal slice (R(2)=0.962), which provided quantitatively correct ultimate forces.

  12. Vascularized bone grafting from the dorsal distal radius for Kienböck's disease: technique, indications and review of the literature.

    PubMed

    Kakar, S; Shin, A Y

    2010-12-01

    The goals of surgical procedures in Kienböck's disease are to preserve wrist function, revascularize the necrotic lunate and maintain normal wrist kinematics when possible. Of the various treatment options, pedicled vascularized bone grafts from the dorsal distal radius permit the transfer of vascularized osseous tissue to the necrotic lunate in order to revascularize it. Vascularized bone grafting is an attractive alternative to conventional bone grafting by improving the local biological environment and thereby promoting revascularization. Recent advances in the anatomy and physiology of vascularized pedicled bone grafts have increased our ability to apply them to the treatment of Kienböck's disease. The purpose of this article is to describe the detailed vascular anatomy of the dorsal distal radius, the surgical technique, indications as well as contraindications of our preferred method of pedicled vascularized bone grafts of Kienböck's disease.

  13. Unicompartmental isoelastic resurfacing prosthesis for malignant tumor of the distal radius: A case report with a 3-year follow-up.

    PubMed

    Ichihara, S; Hidalgo-Diaz, J J; Facca, S; Liverneaux, P

    2015-12-01

    We report a case of 74-year-old man in whom a unicompartmental isoelastic resurfacing prosthesis was used to reconstruct the distal radius after en-bloc resection of a malignant tumor. Thirty-nine months after the operation, on a visual analogic scale, pain score was 0/10 and range of motion was 25° of flexion, 5° of extension, 70° of pronation, 45° of supination, 20° of radial deviation, and 30° of ulnar deviation. The Quick DASH functional score was 72.72/100. With radiographic finding, the prosthesis was well-aligned, with no evidence of loosening but with slightly implant conflict with the lunate. This case report indicates that unicompartmental isoelastic resurfacing prosthesis seems a simple and reliable technique for distal radius reconstruction after en-bloc resection of malignant tumor.

  14. Functional outcome of en bloc resection of a giant cell tumour of the distal radius and arthrodesis of the wrist and distal ulna using an ipsilateral double barrel segmental ulna bone graft combined with a modified Sauve-Kapandji procedure.

    PubMed

    Zhang, W; Zhong, J; Li, D; Sun, C; Zhao, H; Gao, Y

    2016-08-25

    Giant cell tumour of the distal radius is a locally aggressive lesion. In this study, we performed a wrist arthrodesis reconstruction with an ipsilateral double barrel segmental ulnar bone graft combined with a modified Sauve-Kapandji procedure for a giant cell tumour of the distal radius. From January 2007 to September 2013, we followed eight patients for a mean duration of 36 months. One patient developed a recurrence and was treated by amputation; the other seven patients achieved radiological union in about 8 months. There was no wrist instability, deformation or dislocation; the mean range of motion of the forearm achieved 75° of supination and 70° of pronation. The patients could recover reasonable grip strength. This new operative procedure can excise the tumour with a low rate of recurrence, fewer functional deficits and fewer complications than reported for other procedures.

  15. A distinctive type of metaphyseal chondrodysplasia with characteristic thickening of the distal ulna and radius: possible metaphyseal chondrodysplasia-Rosenberg.

    PubMed

    Lee, Yung-Seng; Elliott, Alison M; Loke, Kah-Yin; Lachman, Ralph S

    2003-05-15

    We report an 8-year-old boy with a distinctive form of metaphyseal chondrodysplasia (MCD). He presented with moderate disproportionate short stature and bony swelling of his wrists, knees, and ankles. There were severe metaphyseal abnormalities with a honeycomb appearance affecting the distal tibiae and fibulae, proximal tibiae, distal femurs, distal ulnae and radii, and both hands. His thoracolumbar spine was normal. Radiological examination of the mother's forearms revealed widening of the distal radii and short ulnae with hypoplastic distal ends. Rosenberg and Löhr [1986: Eur J Pediatr 145:40-45] reported a four-generational kindred in which affected members had thickening of the wrist proximal to the styloid process of the ulna and thickening of the dorsum sellae. Although many of the radiographic features of this patient are those of MCD-Rosenberg, the skeletal features of our patient do not appear to represent any known classified forms of MCD.

  16. Use of Relative vs Fixed Offset Distance to Define Region of Interest at the Distal Radius and Tibia in High-Resolution Peripheral Quantitative Computed Tomography.

    PubMed

    Shanbhogue, Vikram V; Hansen, Stinus; Halekoh, Ulrich; Brixen, Kim

    2015-01-01

    Although the region of interest in high-resolution peripheral quantitative computed tomography, defined based on the manufacturer's protocol for in vivo scanning, provides consistency and is practically convenient, it does not take into account possible variation in morphology in the regions adjacent to the measurement site. This study aimed at compare the morphologic variation in measurements using the standard fixed offset distance to define the distal starting slice against those obtained by using a relative measurement position scaled to the individual bone length at the distal radius and tibia in normal healthy adult subjects. A total of 40 healthy adult subjects (median height, 175.3 cm; range: 150.0-196.0 cm) were included in the study. High-resolution peripheral quantitative computed tomography at the distal radius and tibia was performed in all subjects, the region of interest defined by, first, the standard measurement protocol, where the most distal CT slice was 9.5 mm and 22.5 mm from the end plate of the radius and tibia, respectively, and second, the relative measurement method, where the most distal CT slice was at 4% and 7% of the radial and tibial lengths, respectively. Volumetric densities and microarchitectural parameters were compared between the 2 methods. Measurements of the total and cortical volumetric density and cortical thickness at the radius and tibia and cortical porosity, trabecular volumetric density, and trabecular number at the tibia were significantly different between the 2 methods (all p < 0.001). The predicted morphologic variation with varying measurement position was substantial at both the radius (up to 34%) and the tibia (up to 36%). A lack of consideration to height (and in turn the bone lengths) in the standard patient protocol could lead to the introduction of systematic errors in radial and tibial measurements. Although this may not be of particular significance in longitudinal studies in the same individual, it

  17. The prevalence of pain and disability one year post fracture of the distal radius in a UK population: A cross sectional survey

    PubMed Central

    Moore, Catherine M; Leonardi-Bee, Jo

    2008-01-01

    Background A fracture of the distal radius is a commonly occurring fracture and accounts for a third of all fractures in the elderly. Thus far, one year estimates of pain and disability following a fracture of the distal radius have been reported on Canadian populations. The primary aim of this study is to investigate the prevalence of pain and disability in a UK population one year post fracture of the distal radius. Methods A cross-sectional survey was undertaken, of all subjects suffering a fracture of the distal radius between October 2005 and February 2006 in Nottingham, UK. Primary outcomes used were the VAS for pain and the DASH for disability. Prevalence of pain and disability were calculated and odds ratios presented for associations between demographics, pain and disability. Results 93/264 (35%) subjects responded to the questionnaire. 6 subjects did not fulfill the inclusion criteria and were excluded from further analysis. 11% of subjects reported moderate to very severe pain. 16% of subjects reported moderate to very severe disability. Statistically significant associations were found between pain medication usage for the wrist fracture and moderate to very severe pain (OR 11.20, 95% CI 2.05 – 61.23). Moderate to very severe disability was associated with older age (OR 6.53, 95%CI 1.65 – 25.90) and pain medication usage for the wrist fracture (OR 4.75, 95% CI 1.38 – 16.37). Working was associated with a reduction in risk of moderate to very severe disability (OR 0.14, 95% CI 0.03 – 0.67). Conclusion This study demonstrates that there are a small proportion of patients who are still suffering moderate to very severe pain and disability one year post fracture of the distal radius. The study also demonstrates that there are significant associations between characteristics of the patients and the level of pain and disability. This highlights the need for further research into the most appropriate management of these patients in order to reduce this

  18. Cost effectiveness of treatment with percutaneous Kirschner wires versus volar locking plate for adult patients with a dorsally displaced fracture of the distal radius: analysis from the DRAFFT trial.

    PubMed

    Tubeuf, S; Yu, G; Achten, J; Parsons, N R; Rangan, A; Lamb, S E; Costa, M L

    2015-08-01

    We present an economic evaluation using data from the Distal Radius Acute Fracture Fixation Trial (DRAFFT) to compare the relative cost effectiveness of percutaneous Kirschner wire (K-wire) fixation and volar locking-plate fixation for patients with dorsally-displaced fractures of the distal radius. The cost effectiveness analysis (cost per quality-adjusted life year; QALY) was derived from a multi-centre, two-arm, parallel group, assessor-blind, randomised controlled trial which took place in 18 trauma centres in the United Kingdom. Data from 460 patients were available for analysis, which includes both a National Health Service cost perspective including costs of surgery, implants and healthcare resource use over a 12-month period after surgery, and a societal perspective, which includes the cost of time off work and the need for additional private care. There was only a small difference in QALYs gained for patients treated with locking-plate fixation over those treated with K-wires. At a mean additional cost of £714 (95% confidence interval 588 to 865) per patient, locking-plate fixation presented an incremental cost effectiveness ratio (ICER) of £89,322 per QALY within the first 12 months of treatment. Sensitivity analyses were undertaken to assess the ICER of locking-plate fixation compared with K-wires. These were greater than £30,000. Compared with locking-plate fixation, K-wire fixation is a 'cost saving' intervention, with similar health benefits.

  19. A Comparative Study between Closed Reduction and Cast Application Versus Percutaneous K- Wire Fixation for Extra-Articular Fracture Distal end of Radius

    PubMed Central

    Venkatesh, Raghu Begur; Narayanappa, Roshan Kumar Bangalore

    2016-01-01

    Introduction In extra-articular distal radius fractures closed reduction and casting has been the mainstay of treatment, difficulty lies in predicting and maintaining the proper reduction at final union. Percutaneous K-wire stabilization is also a widely accepted treatment option, but there is no consensus on its outcome in comparison to closed reduction and casting. Aim To evaluate the results of closed reduction and casting versus closed reduction with percutaneous K wire fixation and casting in the treatment of the distal radius extra-articular fracture with reference to the restoration of radial height, radial inclination, volar tilt of the distal articular surface and to assess the functional outcome of the same measured by the Gartland and Werley demerit scoring system. Materials and Methods Prospective study was conducted on 60 patients attending the Department of Orthopaedics, from December 2013 to May 2015 with extra-articular fractures (AO type 23-A2 and 23-A3) of distal radius and fulfilling all the inclusion and exclusion criteria. The cases were randomly divided into two equal groups of 30 patients, the first group treated by closed reduction and below elbow cast application, while the second group were treated by closed reduction percutaneous K-wire application and below elbow cast application. The radiological outcome of both groups were evaluated by measuring the Volar inclination, Radial inclination and Radial height, while the functional outcome was evaluated by the demerit scoring system of Gartland and Werley. Results The Cast application group had 13 excellent, 9 good, 7 fair and 1 poor result the mean outcome score of the group was 5.2. The K wiring group had 11 excellent, 13 good, 5 fair and 1 poor result, the mean score of the group was 5.17. The unpaired student’s t-test on the values obtained from both groups yielded a p-value of 0.9816. The mean radial height in the Cast application group was 8.033mm while the mean in the k wiring group

  20. The proximal and distal position of the radius relative to the ulna through a full range of elbow flexion and forearm rotation.

    PubMed

    Quigley, R J; Robicheaux, G W; Lee, T Q

    2014-06-01

    The purpose of this study was to measure the position of the radius relative to the ulna through a complete range of elbow flexion and forearm rotation. Twenty cadaveric upper extremities were mounted on a testing jig that allowed simultaneous control of elbow flexion and forearm rotation. The longitudinal position of the radius relative to the ulna was measured using a three-dimensional digitizer at full pronation, mid-pronation (45°), neutral (0°), mid-supination (45°) and full supination at 10°, 30°, 60°, 90° and 120° of elbow flexion. Our results showed that the radius is located distally when in supination and is located more proximally as it is rotated into pronation. The longitudinal position of the radius changes over 9 mm when moving through a complete arc of forearm rotation. The angle of elbow flexion had a secondary effect on the longitudinal position of the radius, causing changes of less than 0.8 mm.

  1. Ilizarov hybrid external fixation for fractures of the distal radius: Part II. Internal fixation versus Ilizarov hybrid external fixation: Stability as assessed by cadaveric simulated motion testing.

    PubMed

    Dunning, C E; Lindsay, C S; Bicknell, R T; Johnson, J A; King, G J; Patterson, S D

    2001-03-01

    The in vitro stability of an Ilizarov hybrid external fixator was compared with that of a dorsal 3.5-mm AO T-plate in 8 unpaired, fresh-frozen upper extremities. A specially designed testing device that used computer-controlled pneumatic actuators was used to simulate active finger, wrist, and forearm motions by applying loads to relevant tendons. A comminuted extra-articular distal radius fracture was modelled using a dorsally based wedge osteotomy. Fracture stability was assessed using an electromagnetic tracking device to measure motion across the fracture site after randomized application of the plate and the hybrid fixator. During simulated finger and wrist motions with the forearm pronated or supinated, motion of the distal fragment with the hybrid fixator applied was comparable to or statistically less than with the AO plate applied. During simulated forearm rotation, the stability provided by the 2 fixation types was similar, although the plate allowed statistically less radial-ulnar deviation of the fragment. In this model of a 2-part extra-articular distal radius fracture, the clinically meaningful stability of the Ilizarov hybrid external fixator was comparable to that of the dorsal AO plate.

  2. Initial shortening and internal fixation in combination with a Sauvé-Kapandji procedure for severely comminuted fractures of the distal radius in elderly patients.

    PubMed

    Arora, R; Gabl, M; Pechlaner, S; Lutz, M

    2010-11-01

    We identified 11 women with a mean age of 74 years (65 to 81) who sustained comminuted distal radial and ulnar fractures and were treated by volar plating and slight shortening of the radius combined with a primary Sauvé-Kapandji procedure. At a mean of 46 months (16 to 58), union of distal radial fractures and arthrodesis of the distal radioulnar joint was seen in all patients. The mean shortening of the radius was 12 mm (5 to 18) compared to the contralateral side. Flexion and extension of the wrist was a mean of 54° and 50°, respectively, and the mean pronation and supination of the forearm was 82° and 86°, respectively. The final mean disabilities of the arm, shoulder and hand score was 26 points. According to the Green and O'Brien rating system, eight patients had an excellent, two a good and one a fair result. The good clinical and radiological results, and the minor complications without the need for further operations related to late ulnar-sided wrist pain, justify this procedure in the elderly patient.

  3. Forced Arterial Suction Thrombectomy Using Distal Access Catheter in Acute Ischemic Stroke

    PubMed Central

    Lee, Ho-Cheol; Kang, Dong-Hun; Hwang, Yang-Ha; Kim, Yong-Sun

    2017-01-01

    Historical innovations in mechanical thrombectomy devices and strategies for ischemic stroke have resulted in improved angiographic outcomes and better clinical outcomes. Various devices have been used, but the two most common approaches are aspiration thrombectomy and stent-retrieval thrombectomy. Aspiration thrombectomy has advanced from the traditional Penumbra system to forced arterial suction thrombectomy and a direct aspiration first-pass technique. Newer generation aspiration catheters with flexible distal tips and a larger bore have demonstrated faster and better recanalization relative to older devices. Recently, several species of distal access catheters have similar structural characteristics to the Penumbra reperfusion catheter. Therefore, we used the distal access catheter for forced arterial suction thrombectomy in three patients with acute ischemic stroke. In each case, we achieved fast and complete recanalization without significant complications. Forced arterial suction thrombectomy using a distal access catheter might provide another option for mechanical thrombectomy in patients with acute ischemic stroke. PMID:28316869

  4. Correlation between dorsovolar translation and rotation of the radius on the distal radioulnar joint during supination and pronation of forearm.

    PubMed

    Lee, Sang Ki; Song, Young Dong; Choy, Won Sik

    2015-09-01

    This study aimed to describe the patterns of movements about radius and ulna in individual degrees of forearm rotation. And, we also determined the effect of forearm rotation on translation and rotation of the radius with reference to the ulna, and to measure the relationship between forearm rotation, translation and rotation of the radius. Computed tomography of multiple, individual forearm positions, from 90° pronation to 90° supination, was conducted in 26 healthy volunteers (mean age, 43.9 years) to measure dorsovolar translation and rotation of the radius in the DRUJ in each forearm position. The mean dorsovolar translations were within 1.99 mm at 90° pronation to -2.03 mm at 90° supination. The rotations of the radius were 71.20° at 90° pronation and -46.63° at 90° supination. There were strong correlations between degrees of forearm rotation and dorsovolar translation (r=0.861, p<0.001) and rotation of the radius (r=0.960, p<0.001), suggesting that the DRUJ, carpal joints, and rotatory laxity of the carpal ligament, especially in supination, contribute to forearm supination and pronation. These findings provide an understanding of wrist kinematics, are may be useful in reconstructive wrist surgery to achieve normal range of motion, and are may be helpful for the design of DRUJ reconstruction using prostheses.

  5. Significance of a Pronator Quadratus–Sparing Approach for Volar Locking Plate Fixation of Comminuted Intra-articular Fractures of the Distal Radius

    PubMed Central

    Itoh, Soichiro; Yumoto, Myu; Kanai, Misa; Yoshida, Wataru; Yoshioka, Taro

    2016-01-01

    Background: The preservation of the integrity of the pronator quadratus (PQ) muscle is expected to have many benefits, particularly in cases of highly comminuted intra-articular fractures of the distal radius. Therefore, we examined the significance of a PQ muscle–sparing approach for volar locking plate (VLP) fixation of these types of fractures. Methods: Sixty-five patients who sustained AO Foundation and Orthopaedic Trauma Association (AO/OTA) type C2 and C3 distal radius fractures were treated with VLP fixation using either a PQ muscle release and repair (PQ-releasing group, n = 30) or a PQ muscle–sparing approach (PQ-sparing group, n = 35). Radiographic parameters, active range of motion (ROM), percentage of the grip power of the injured hand compared with that of the opposite hand, wrist pain visual analog scale (VAS) score, and Quick Disability of the Arm, Shoulder, and Hand (DASH) score (disability/symptom) were evaluated monthly up to 12 months after surgery. Results: The mean VAS score was significantly lower in the PQ-sparing group at 2, 3, and 4 months postoperatively than in the PQ-releasing group. Furthermore, the mean Quick DASH score in the PQ-sparing group was significantly lower than that in the PQ-releasing group at 1 and 2 months postoperatively. There were no significant differences, however, in the other functional parameters in the groups through the observation period. Conclusions: The PQ muscle–sparing approach appears to achieve satisfactory results in patients undergoing VLP fixation of comminuted intra-articular fractures of the distal radius. PMID:27418895

  6. Evaluation of the Sigmoid Notch Involvement in the Intra-Articular Distal Radius Fractures: The Efficacy of Computed Tomography Compared with Plain X-ray

    PubMed Central

    Heo, Youn Moo; Roh, Jae-Young; Kim, Sang-Bum; Kim, Kwang Kyoon; Oh, Byung Hak; Oh, Hyeong-Tak

    2012-01-01

    Background The purpose of this study is to evaluate the efficacy of computed tomography (CT) scans compared with plain radiographs on detecting the involvement of the sigmoid notch. Methods This study involved 121 cases diagnosed as the intra-articular distal radius fracture and performed post-reduction CT scans. We determined the presence of the sigmoid notch involvement with both plain radiographs and CT scans and compared findings of plain radiographs with CT scans about the incidence and the pattern of injuries. And the differences of results between arbeitsgemeinschaft für osteosyntheses (AO) type C2 and C3 were compared. Results The incidences of sigmoid notch involvement detected in plain radiographs were 81 cases (66.9%), whereas CT scans were 99 cases (81.9%). The sensitivity of plain radiographs compared with CT scans was 74.7%, the specificity was 68.2%, the positive predictive value was 91.4%, the negative predictive value was 37.5%, the false negative value was 25.3%, and the false positive value was 31.8%. In comparison between AO type C2 and C3, the incidence of sigmoid notch involvement was not a significant difference, but the displacement of fracture fragment showed a significant difference. Conclusions The intra-articular distal radius fracture usually accompanies the sigmoid notch involvement. Considering that the evaluation of sigmoid notch involvement by plain radiography often results in misinterpretation or underestimation, performing CT scan in intra-articular distal radius fracture is thought to be beneficial. PMID:22379560

  7. Percutaneous fixation with Kirschner wires versus volar locking plate fixation in adults with dorsally displaced fracture of distal radius: randomised controlled trial

    PubMed Central

    Achten, Juul; Parsons, Nick R; Rangan, Amar; Griffin, Damian; Tubeuf, Sandy; Lamb, Sarah E

    2014-01-01

    Objectives To compare the clinical effectiveness of Kirschner wire fixation with locking plate fixation for patients with a dorsally displaced fracture of the distal radius. Design A multicentre two arm parallel group assessor blind randomised controlled trial with 1:1 treatment allocation. Setting 18 trauma centres in the United Kingdom. Participants 461 adults with a dorsally displaced fracture of the distal radius within 3 cm of the radiocarpal joint that required surgical fixation. Patients were excluded if the surgeon thought that the surface of the wrist joint was so badly displaced it required open reduction. Interventions Kirschner wire fixation: wires are passed through the skin over the dorsal aspect of the distal radius and into the bone to hold the fracture in the correct anatomical position. Locking plate fixation: a locking plate is applied through an incision over the volar (palm) aspect of the wrist and secured to the bone with fixed angle locking screws. Main outcome measures Primary outcome measure: validated patient rated wrist evaluation (PRWE). This rates wrist function in two (equally weighted) sections concerning the patient’s experience of pain and disability to give a score out of 100. Secondary outcomes: disabilities of arm, shoulder, and hand (DASH) score, the EuroQol (EQ-5D), and complications related to the surgery. Results The baseline characteristics of the two groups were well balanced, and over 90% of patients completed follow-up. The wrist function of both groups of patients improved by 12 months. There was no clinically relevant difference in the patient rated wrist score at three, six, or 12 months (difference in favour of the plate group was −1.3, 95% confidence interval −4.5 to 1.8; P=0.40). Nor was there a clinically relevant difference in health related quality of life or the number of complications in each group. Conclusions Contrary to the existing literature, and against the rapidly increasing use of locking plate

  8. A rare combined injury of dorsal fracture-dislocation of four carpometacarpal joints and trapezium, trapezoid and distal radius bone fractures.

    PubMed

    Touloupakis, Georgios; Stuflesser, Wilfried; Antonini, Guido; Ferrara, Fabrizio; Crippa, Cornelio; Lettera, Maria Gabriella

    2016-05-06

    Incorrect or delayed diagnosis and treatment of the carpometacarpal fracture-dislocations is often associated with poor prognosis. We present a rare case of unusual pattern of injury, involving dorsal dislocation of four ulnar carpometacarpal joints, associated with fracture of the trapezium, a burst fracture of the trapezoid  bone and an extra-articular fracture of the third distal  of the radius. The first surgical intervention was followed by unsatisfactory results, confirmed by the CT scans. A second surgery followed and an open reduction and pinning with K wires performed. Post-operative follow up lasting for nine months revealed a very good surgical outcome.

  9. Is minimally invasive application by intramedullary osteosynthesis in comparison with volar plating real benefit in the treatment of distal radius fractures?

    PubMed Central

    Vlček, Martin; Jaganjac, Edib; Pech, Jan; Jonáš, David; Kebrle, Radek

    2014-01-01

    Purpose of the study: Can minimally invasive intramedullary osteosynthesis of distal radius fractures provide better therapeutic results than multidirectional locking plates. Retrospective study of 68 patients operated for distal radius fractures, 18 were treated with intramedullary X-screw (XSCR) fixation and 50 with the multidirectional angle-stable plate system (APTUS). The evaluation at 1-year follow-up included functional status of the wrist and hand, and radiographic findings. In the XSCR group, the functional outcomes of the treated extremity did not achieve values comparable with those of the uninjured side in any of the parameters measured. The radiographic findings did not meet the requirements of successful healing due to failure to restore an anatomical volar tilt in 22.2% cases. In the APTUS group, comparable values of the injured and the uninjured side were achieved in radial deviation, ulnar deviation, pronation, supination and grip strength. The radiographic criteria of successful healing were met by all fractures treated by locking plate osteosynthesis. Implant migration associated with secondary displacement of bone fragments was recorded in 33.3 % of the XSCR patients and only in 4.0 % of the APTUS patients. The overall evaluation show that intramedullary osteosynthesis does not produce better treatment outcomes compared with plate osteosynthesis in indicated types of fractures. PMID:24856379

  10. A Critical Comparison Between Two Scanning Protocols of High-Resolution Peripheral Quantitative Computed Tomography at the Distal Radius in Adolescents.

    PubMed

    Cheuk, Ka-Yee; Tam, Elisa Man-Shan; Yu, Fiona Wai-Ping; Yip, Benjamin Hon-Kei; Hung, Vivian Wing-Yin; Wang, Xiaofang; Ghasem-Zadeh, Ali; Zhu, Tracy Y; Qin, Ling; Cheng, Jack Chun-Yiu; Lam, Tsz-Ping

    2016-01-01

    High-resolution peripheral quantitative computed tomography (HR-pQCT) is a unique technology for assessing bone mineral density and bone microarchitecture. Currently, no universally accepted protocol for selecting the region of interest (ROI) at the distal radius has been established for growing subjects. This study aimed (1) to investigate the differences in HR-pQCT measurements of 2 different ROI protocols applied to the distal radius of healthy adolescents and (2) to identify the least common area of ROI (the least common ROI) between the protocols. Twenty-six boys and 26 girls aged between 13 and 16 yr old were recruited. Nondominant distal radius was scanned by 2 HR-pQCT protocols, namely, the "5-mm protocol," where the distal end of ROI started at 5 mm proximal to a reference line, and the "4% protocol," where the ROI started at 4% of the ulnar length proximal to another reference line. The least common ROI between the 2 protocols was identified and the slice numbering within the common ROI was determined. Bland-Altman plots were used to check the agreement of the least common ROIs between the 2 protocols. Paired t-test and Wilcoxon signed-rank test were used for analysis. In boys, significant differences between protocols were found in most parameters with the maximum difference observed in the cortical area (25.0%, p < 0.001). In girls, differences were observed only for total volumetric bone mineral density (3.6%, p = 0.032). The number of slices in the least common ROI was 66 (60.0%) and 57 (51.8%) in boys and girls, respectively. Good agreements on all HR-pQCT parameters from the least common ROI between the 2 protocols were found. Significant differences in bone parameters were noted between the 2 protocols. When comparing the 2 protocols, observed gender differences could reflect the differences in skeletal growth at the peripubertal period between genders. Least common ROI could be useful for cross-center comparisons and when merging

  11. Can Total Wrist Arthroplasty Be an Option for Treatment of Highly Comminuted Distal Radius Fracture in Selected Patients? Preliminary Experience with Two Cases

    PubMed Central

    Schmidt, Ingo

    2015-01-01

    We present two case reports of successful primary shortening of the forearm and total wrist arthroplasty (TWA) using the new angle-stable Maestro Wrist Reconstructive System (WRS) for treatment of highly comminuted distal radius fracture in selected autonomous patients. In a 56-year-old male patient with adequate bone stock, insertion of the noncemented Maestro WRS was combined with ulnar shortening osteotomy. In an 84-year-old female patient with poor osteoporotic bone stock, insertion of the radial cemented Maestro WRS was combined with ulnar head resection. Both patients could resume their work without additional surgery after TWA. At the 1-year follow-up, there were no changes in position of either implant without signs of loosening, no impingement, and no instability of the distal radioulnar joint or the distal ulna stump. All clinical parameters (DASH score, pain through VAS, and grip strength) were satisfactory. Both patients reported that they would have the same procedure again. Further experience is needed to validate this concept. PMID:26491587

  12. Arthroscopically assisted reduction and immobilization of intraarticular fracture of the distal end of the radius: several options of reduction and immobilization.

    PubMed

    Guofen, Chen; Doi, Kazuteru; Hattori, Yasunori; Kitajima, Izuru

    2005-06-01

    On the basis of preoperative computerized tomography scanning and newly developed 3-dimensional reconstruction technique, Doi classified intraarticular distal radial fracture to 2-, 3-, and 4-part type, according to the number of main fracture fragments in distal radial aspect. This classification system simply, as well as perspicuously, describes the status of joint surface, thereby providing an intuitionist and practical guideline for arthroscopy procedure. Between 1992 and 2003, 91 patients ranged from 21 to 79 years of age with intraarticular distal radius fracture were treated with an arthroscopically assisted operation at our department. Among these patients, 42, 34, and 15 cases were 2-, 3-, and 4-part type, accounting for 46%, 37%, and 17% respectively. Wrist arthroscopy was applied individually according to the different type, with the purpose of achieving <1mm reduction. Role of arthroscopy was postreduction examination for 14 cases, as K-wire guider in 13 cases, assisting reduction, and immobilization in 61 cases. Four of the 61 cases changed to ORIF. Immobilization methods include external fixator combined with K-wire or plate combined with pullout wire or screw. K-wire without other implant was applied to 6 cases. In 1 case, a screw was the only implant.

  13. Osteosarcoma of the distal radius treated with segmental forearm resection, hand replantation, and subsequent limb lengthening: case report.

    PubMed

    Hatano, Hiroshi; Morita, Tetsuro; Kobayashi, Hiroto; Iwabuchi, Yasuhiro

    2014-06-01

    A 9-year-old girl with osteosarcoma of the radius was treated with segmental forearm resection and replantation followed by forearm lengthening of 11 cm. At 9-year follow-up, she had recovered sensory function, and her pinch and grasp were sufficient for performing daily activities. Functional outcomes evaluated by the Disabilities of the Arm, Shoulder, and Hand questionnaire and International Society of Limb Salvage functional score system were 4/100 and 23/30, respectively.

  14. Intra-articular Fractures of the Sigmoid Notch of the Distal Radius: Analysis of Progression to Distal Radial Ulnar Joint Arthritis and Impact on Upper Extremity Function in Surgically Treated Fractures.

    PubMed

    Vitale, Mark A; Brogan, David M; Shin, Alexander Y; Berger, Richard A

    2016-03-01

    Background Studies have established an increased risk of radiocarpal joint posttraumatic arthritis in patients with displaced intra-articular fractures of the distal radius, although this phenomenon has yet to be evaluated in the distal radioulnar joint (DRUJ). Purpose We hypothesized that patients with displaced intra-articular fractures of the sigmoid notch would have a higher prevalence of DRUJ arthritis and greater upper extremity dysfunction after operative treatment of distal radius fractures compared with fractures without sigmoid notch involvement. We also hypothesized that the degree of sigmoid notch incongruity would be correlated with the grade of DRUJ arthritis and the severity of upper extremity dysfunction. Patients and Methods A retrospective review was conducted on surgically treated patients with distal radius fractures with pre- and/or postoperative computed tomography (CT) scans. Patients were divided into groups based on presence or absence of fracture extension into the sigmoid notch. Within the sigmoid notch group, postoperative CT scans were used to measure sigmoid notch fracture step-off and diastasis (mm), as well as volar or dorsal DRUJ subluxation (%). Patients were administered Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires and radiographs were obtained to grade DRUJ arthritis using the Kellgren-Lawrence (KL) radiographic criteria. Results Thirty-three patients were included (19 with sigmoid notch involvement and 14 without) with an average radiographic follow-up of 6.3 years (range: 3.5-10.1 years). DASH scores were available for all patients, and radiographic follow-up was available in 24 patients (73%). A trend toward higher grade of DRUJ arthritis and poorer average DASH was found in those with sigmoid notch involvement, but was not statistically different. In the sigmoid notch group there were poorer DASH scores in patients with coronal step-off > 1.0-mm (p < 0.05). There were no significant

  15. A trans-ethnic genome-wide association study identifies gender-specific loci influencing pediatric aBMD and BMC at the distal radius.

    PubMed

    Chesi, Alessandra; Mitchell, Jonathan A; Kalkwarf, Heidi J; Bradfield, Jonathan P; Lappe, Joan M; McCormack, Shana E; Gilsanz, Vicente; Oberfield, Sharon E; Hakonarson, Hakon; Shepherd, John A; Kelly, Andrea; Zemel, Babette S; Grant, Struan F A

    2015-09-01

    Childhood fractures are common, with the forearm being the most common site. Genome-wide association studies (GWAS) have identified more than 60 loci associated with bone mineral density (BMD) in adults but less is known about genetic influences specific to bone in childhood. To identify novel genetic factors that influence pediatric bone strength at a common site for childhood fractures, we performed a sex-stratified trans-ethnic genome-wide association study of areal BMD (aBMD) and bone mineral content (BMC) Z-scores measured by dual energy X-ray absorptiometry at the one-third distal radius, in a cohort of 1399 children without clinical abnormalities in bone health. We tested signals with P < 5 × 10(-6) for replication in an independent, same-age cohort of 486 Caucasian children. Two loci yielded a genome-wide significant combined P-value: rs7797976 within CPED1 in females [P = 2.4 × 10(-11), β =- 0.30 standard deviations (SD) per T allele; aBMD-Z] and rs7035284 at 9p21.3 in males (P = 1.2 × 10(-8), β = 0.28 SD per G allele; BMC-Z). Signals at the CPED1-WNT16-FAM3C locus have been previously associated with BMD at other skeletal sites in adults and children. Our result at the distal radius underscores the importance of this locus at multiple skeletal sites. The 9p21.3 locus is within a gene desert, with the nearest gene flanking each side being MIR31HG and MTAP, neither of which has been implicated in BMD or BMC previously. These findings suggest that genetic determinants of childhood bone accretion at the radius, a skeletal site that is primarily cortical bone, exist and also differ by sex.

  16. Bone geometry, density, and microarchitecture in the distal radius and tibia in adults with osteogenesis imperfecta type I assessed by high-resolution pQCT.

    PubMed

    Folkestad, Lars; Hald, Jannie Dahl; Hansen, Stinus; Gram, Jeppe; Langdahl, Bente; Abrahamsen, Bo; Brixen, Kim

    2012-06-01

    Osteogenesis imperfecta (OI) is a hereditary disorder characterized by decreased biosynthesis or impaired morphology of type I collagen that leads to decreased bone mass and increased bone fragility. We hypothesized that patients with OI have altered bone microstructure and bone geometry. In this cross-sectional study we compared patients with type I OI to age- and gender-matched healthy controls. A total of 39 (13 men and 26 women) patients with OI, aged 53 (range, 21-77) years, and 39 controls, aged 53 (range, 21-77) years, were included in the study. Twenty-seven of the patients had been treated with bisphosphonates. High-resolution peripheral quantitative computed tomography (HR-pQCT) at the distal radius and distal tibia and dual-energy X-ray absorptiometry of total hip, femoral neck, trochanteric region, and the lumbar spine (L1-L4) were performed. The patients were shorter than the controls (159 ± 10 cm versus 170 ± 9 cm, p < 0.001), but had similar body weight. In OI, areal bone mineral density (aBMD) was 8% lower at the hip (p < 0.05) and 13% lower at the spine (p < 0.001) compared with controls. The trabecular volumetric bone mineral density (vBMD) was 28% lower in radius (p < 0.001) and 38% lower in tibia (p < 0.001) in OI compared with controls. At radius, total bone area was 5% lower in OI than in controls (p < 0.05). In the tibia, cortical bone area was 18% lower in OI (p < 0.001). In both radius and tibia the number of trabeculae was lower in patients compared to the controls (35% and 38%, respectively, p < 0.001 at both sites). Furthermore, trabecular spacing was 55% higher in OI in both tibia and radius (p < 0.001 at both sites) when compared with controls. We conclude that patients with type I OI have lower aBMD, vBMD, bone area, and trabecular number when compared with healthy age- and gender-matched controls.

  17. Late-onset distal polyneuropathy due to acute organophosphate intoxication case report.

    PubMed

    Genel, Ferah; Arslanoğlu, Sertaç; Uran, Nedret; Doğan, Mustafa; Atlihan, Füsun

    2003-01-01

    Intoxications due to organophosphate insecticides are common in our country, since agriculture has an important place. Besides the well known acute cholinergic toxicity, these compounds may cause late-onset distal polyneuropathy occurring two to three weeks after the acute exposure. An eight-year-old boy and a 13-year-old girl admitted to the hospital with gait disturbances. Beginning 15 and 20 days, respectively, after organophosphate ingestion. Neurologic examination revealed bilateral dropped foot, absent Achilles tendon reflexes and peripheral sensory loss. Electromyography demonstrated motor weighed sensory-motor polyneuropathy with axonal degeneration significant in the distal parts of bilateral lower extremities. Biochemical, radiological findings and magnetic resonance imagings were normal. The two cases were taken under a physiotherapy program. The two cases are presented here since organophosphate poisonings are common in our country, and since late-onset polyneuropathy is not a well known clinical presentation as acute toxicity.

  18. Local topological analysis at the distal radius by HR-pQCT: Application to in vivo bone microarchitecture and fracture assessment in the OFELY study.

    PubMed

    Pialat, J B; Vilayphiou, N; Boutroy, S; Gouttenoire, P J; Sornay-Rendu, E; Chapurlat, R; Peyrin, F

    2012-09-01

    High-resolution peripheral quantitative computed tomography (HR-pQCT) is an in-vivo technique used to analyze the distal radius and tibia. It provides a voxel size of 82μm. In addition to providing the usual microarchitecture parameters, local topological analysis (LTA) depicting rod- and plate-like trabeculae may improve prediction of bone fragility. Thirty-three women with prevalent wrist fractures from the OFELY cohort were compared with age-matched controls. Bone microarchitecture, including the structural model index (SMI), was assessed by HR-pQCT, and micro-finite element analysis (μFE) was computed on trabecular bone images of the distal radius (XtremeCT, Scanco Medical AG). A new LTA method was applied to label each bone voxel as a rod, plate or node. Then the bone volume fraction (BV/TV*), the rod, plate and node ratios over bone volume (RV/BV*, PV/BV*, NV/BV*) or total volume (RV/TV*, PV/TV*, NV/TV*) and the rod to plate ratio (RV/PV*) were calculated. Associations between LTA parameters and wrist fractures were computed in a conditional logistic regression model. Multivariate models were tested to predict the μFE-derived trabecular bone stiffness. RV/TV* (OR=4.41 [1.05-18.62]) and BV/TV* (OR=6.45 [1.06-39.3]), were significantly associated with prevalent wrist fracture, after adjustment for ultra distal radius aBMD. Multivariate linear models including PV/TV* or BV/TV*+RV/PV* predicted trabecular stiffness with the same magnitude as those including SMI. Conversion from plates into rods was significantly associated with bone fragility, with a negative correlation between RV/PV* and trabecular bone stiffness (r=-0.63, p<0.0001). We conclude that our local topological analysis is feasible for a voxel size of 82μm. After further validation, it may improve bone fragility description.

  19. Desmoplastic fibroma of the distal radius: an interesting case and a review of the literature and therapeutic implications

    PubMed Central

    Beebe, Kathleen S.; Ippolito, Joseph A.

    2016-01-01

    Desmoplastic fibromas are rare, benign, locally aggressive bone tumors, which arise primarily in patients younger than 30 years old. Historically, even with greater functional loss, en bloc or wide resection of the tumors to prevent local recurrence has been the method of choice in treatment. This article discusses the presentation of a 10-year-old male who presented with a mass in the distal forearm, after reporting difficulty in pronation and supination. The patient was ultimately treated with wide resection and allo-arthrodesis with allograft. Post-operatively, the patient has exhibited excellent recovery, including normal range of motion at the shoulder and elbow, and ability to perform all activities of daily livings despite reduced grip strength compared with the contralateral side. PMID:26767767

  20. Tuberculosis of Distal Radius Presenting as Cystic Lesion in a Nine-Month-Old Infant: A Rare Case Report

    PubMed Central

    Garg, Anant Kumar; Bandyopadhyay, Abhishek; Kumar, Sanjay; Pal, Sumanta

    2016-01-01

    Tuberculous osteomyelitis affecting long bones is a rare form of tuberculosis. Among infants born in endemic region, often it is difficult to diagnose owing to its subtle clinical features. Here, a case of tuberculous osteomyelitis affecting the distal radial metaphysis is reported, presenting as a cystic lesion in a nine-month-old male infant. Open biopsy with curettage was performed followed by filling of the cavity with synthetic bone substitute (beta tricalcium phosphate granules). The diagnosis was confirmed by histopathological examination and demonstration of acid fast bacilli. Further treatment with anti-tubercular drugs led to clinical and radiological improvement. This case report highlights the importance of keeping tuberculosis as a differential diagnosis while dealing with cases with similar presentation in an endemic region. PMID:27790537

  1. Percutaneous Kirschner Wire fixation in distal radius metaphyseal fractures in children: does it change the overall outcome?

    PubMed Central

    Ozcan, M; Memisoglu, S; Copuroglu, C; Saridogan, K

    2010-01-01

    Background and Objectives: The aim of this study was to determine the effect of Kirschner wire fixation after closed reduction of radial metaphyseal fractures with high risk of redisplacement. Patients and Methods: In this retrospective study 40 cases were studied in two groups. In group 1 (n=20, average age 11.2 years), K-wire fixation was performed after closed reduction. In group 2 (n=20 average age 10.1 years), only plaster immobilization was applied following closed reduction. The compared clinical and radiological parameters were, pain, limb deformitiy, range of motion of the wrist, angulation of the fracture site, radial distal epipihyseal angle and severity of translation. Results:Redisplacement rate was 10% in group 1 and 50% in group 2. This shows, Kirschner wire fixation has a positive effect in the maintanence of the initial reduction (p<0.05). Age, gender, reduction quality had no effect on redisplacement (p>0.05). Concerning the severity of translation, the risk of redisplacement increases in stage 3 (50%- 100%) and stage 4 (>100%) fractures (p<0,05). Concomitant complete ulnar fracture has also redisplacement risk (p<0.05). Redisplacement risk increases when the distance of fracture line to epiphyseal line was between 11-20 mm (p<0.05). There was no significiant difference between two groups after last evaluation based on radiological parameters and clinical results (p>0.05). Conclusions:This study shows that Kirschner wire fixation prevents redisplacement in early follow-up of first three weeks but there is no superiority after 20 months follow-up in distal metaphyseal fractures of children. PMID:21311635

  2. Correction of severe wrist deformity following physeal arrest of the distal radius with the aid of a three-dimensional computer simulation.

    PubMed

    Murase, Tsuyoshi; Oka, Kunihiro; Moritomo, Hisao; Goto, Akira; Sugamoto, Kazuomi; Yoshikawa, Hideki

    2009-11-01

    Growth arrest following physeal injury may result in severe limb deformity. We report a case of complex wrist deformity caused by injury to the distal radial physis resulting in radial shortening and abnormal inclination of the radial articular surface, which was successfully treated by gradual correction after computer simulation. The simulation enabled us to develop an appropriate operative plan by accurately calculating the axis of the three-dimensional (3D) deformity using computer bone models. In the simulative surgery with a full-size stereolithography bone model, an Ilizarov external fixator was applied to the radius such that its two hinges were located on the virtual axis of the deformity, which was reproduced in the actual surgery. This technique of 3D computer simulation is a useful alternative to plan accurate correction of complex limb deformities following growth arrest.

  3. Fast estimation of Colles' fracture load of the distal section of the radius by homogenized finite element analysis based on HR-pQCT.

    PubMed

    Hosseini, Hadi S; Dünki, Andreas; Fabech, Jonas; Stauber, Martin; Vilayphiou, Nicolas; Pahr, Dieter; Pretterklieber, Michael; Wandel, Jasmin; Rietbergen, Bert van; Zysset, Philippe K

    2017-04-01

    Fractures of the distal section of the radius (Colles' fractures) occur earlier in life than other osteoporotic fractures. Therefore, they can be interpreted as a warning signal for later, more deleterious fractures of vertebral bodies or the femoral neck. In the past decade, the advent of HR-pQCT allowed a detailed architectural analysis of the distal radius and an automated but time-consuming estimation of its strength with linear micro-finite element (μFE) analysis. Recently, a second generation of HR-pQCT scanner (XtremeCT II, SCANCO Medical, Switzerland) with a resolution beyond 61 μm became available for even more refined biomechanical investigations in vivo. This raises the question how biomechanical outcome variables compare between the original (LR) and the new (HR) scanner resolution. Accordingly, the aim of this work was to validate experimentally a patient-specific homogenized finite element (hFE) analysis of the distal section of the human radius for the fast prediction of Colles' fracture load based on the last generation HR-pQCT. Fourteen pairs of fresh frozen forearms (mean age = 77.5±9) were scanned intact using the high (61 μm) and the low (82 μm) resolution protocols that correspond to the new and original HR-pQCT systems. From each forearm, the 20mm most distal section of the radius were dissected out, scanned with μCT at 16.4 μm and tested experimentally under compression up to failure for assessment of stiffness and ultimate load. Linear and nonlinear hFE models together with linear micro finite element (μFE) models were then generated based on the μCT and HR-pQCT reconstructions to predict the aforementioned mechanical properties of 24 sections. Precision errors of the short term reproducibility of the FE analyses were measured based on the repeated scans of 12 sections. The calculated failure loads correlated strongly with those measured in the experiments: accounting for donor as a random factor, the nonlinear hFE provided a

  4. Fracture severity of distal radius fractures treated with locking plating correlates with limitations in ulnar abduction and inferior health-related quality of life

    PubMed Central

    Tsitsilonis, Serafim; Machó, David; Manegold, Sebastian; Krapohl, Björn Dirk; Wichlas, Florian

    2016-01-01

    Introduction/background: The operative treatment of distal radius fractures has significantly increased after the introduction of locking plates. The aim of the present study was the evaluation of health-related quality of life, functional and radiological outcome of patients with distal radius fractures treated with the locking compression plate (LCP). Materials and methods: In the present study 128 patients (130 fractures) that were operatively treated with the LCP (2.4 mm/3.5 mm, Synthes®) were retrospectively evaluated. Mean follow-up was 22.7 months (SD 10.6). The fractures were radiographically evaluated (radial inclination, palmar tilt, ulnar variance) pre-, postoperatively and at the last follow-up visit. Range of motion (ROM) was documented. Grip strength was assessed with the use of a JAMAR dynamometer. The score for disabilities of the arm, shoulder and hand (DASH) and the Gartland-Werley score (GWS) were evaluated. Health-associated quality of life was assessed with use of SF-36 Health Survey. Results: Postoperative reduction was excellent; at the last follow-up visit only minimal reduction loss was observed. Except for pronation, a statistically significant decrease of ROM was present; in most cases that was not disturbing for the patients. The injured side achieved 83.9% of grip strength of the intact side. Mean DASH was 18.9 and mean GWS was 3.5. Health-associated quality of life was generally not compromised. However, limitations in ulnar abduction correlated with inferior quality of life. Fracture severity correlated with inferior quality of life, despite the absence of correlation with the functional and radiological outcome. Complication rate was low. Conclusions: Fracture severity seems to affect ulnar abduction and therefore patient quality of life, despite almost anatomical reduction; the objective and subjective scores were in most cases excellent. Modern everyday activities, such as keyboard typing, could be associated with the present

  5. Early changes in bone density, microarchitecture, bone resorption, and inflammation predict the clinical outcome 12 weeks after conservatively treated distal radius fractures: an exploratory study.

    PubMed

    Meyer, Ursina; de Jong, Joost J; Bours, Sandrine G P; Keszei, András P; Arts, Jacobus J; Brink, Peter R G; Menheere, Paul; van Geel, Tineke A C M; van Rietbergen, Bert; van den Bergh, Joop P W; Geusens, Piet P; Willems, Paul C

    2014-09-01

    Fracture healing is an active process with early changes in bone and inflammation. We performed an exploratory study evaluating the association between early changes in densitometric, structural, biomechanical, and biochemical bone parameters during the first weeks of fracture healing and wrist-specific pain and disability at 12 weeks in postmenopausal women with a conservatively treated distal radius fracture. Eighteen patients (aged 64 ± 8 years) were evaluated at 1 to 2 and 3 to 4 weeks postfracture, using high-resolution peripheral quantitative computed tomography (HR-pQCT), micro-finite element analysis, serum procollagen type-I N-terminal propeptide (P1NP), carboxy-terminal telopeptide of type I collagen (ICTP), and high-sensitive C-reactive protein (hsCRP). After 12 weeks, patients rated their pain and disability using Patient Rated Wrist Evaluation (PRWE) questionnaire. Additionally, Quick Disability of the Arm Shoulder and Hand (QuickDASH) questionnaire and active wrist range of motion was evaluated. Linear regression models were used to study the relationship between changes in bone parameters and in hsCRP from visit 1 to 2 and PRWE score after 12 weeks. A lower PRWE outcome, indicating better outcome, was significantly related to an early increase in trabecular bone mineral density (BMD) (β -0.96 [95% CI -1.75 to -0.16], R(2)  = 0.37), in torsional stiffness (-0.14 [-0.28 to -0.004], R(2)  = 0.31), and to an early decrease in trabecular separation (209 [15 to 402], R(2)  = 0.33) and in ICTP (12.1 [0.0 to 24.1], R(2)  = 0.34). Similar results were found for QuickDASH. Higher total dorsal and palmar flexion range of motion was significantly related to early increase in hsCRP (9.62 [3.90 to 15.34], R(2)  = 0.52). This exploratory study indicates that the assessment of early changes in trabecular BMD, trabecular separation, calculated torsional stiffness, bone resorption marker ICTP, and hsCRP after a distal radius fracture provides

  6. Distal Radius Fracture (Broken Wrist)

    MedlinePlus

    ... is o en started to help improve the motion and function of the injured wrist. Surgical Treatment ... casting, it is important that you achieve full motion of your fingers as soon as possible. If ...

  7. Treatment of reducible unstable fractures of the distal radius in adults: a randomised controlled trial of De Palma percutaneous pinning versus bridging external fixation

    PubMed Central

    2010-01-01

    Background At present, there is no conclusive evidence regarding the best treatment method for reducible unstable fractures of the distal radius. This study compared the effectiveness of two methods used in surgical treatment of such fractures: percutaneous pinning and external fixation. Methods We randomly allocated 100 patients into two groups treated surgically with modified De Palma percutaneous pinning and bridging external fixation. Independent but not blinded evaluators administered the DASH quality-of-life questionnaire at postoperative months 6 and 24, performed functional assessment of pain, range of motion, and palm grip strength, and radiographic examinations (volar and radial angle, and height of the radius) before the operation, immediately afterwards, and at 6 and 24 months postoperative. Modified De Palma percutaneous pinning patients used an above-elbow cast whereas external fixation group had unrestricted elbow motion after surgery. Patients who for any reason demonstrated treatment failure or required additional interventions were followed up and their results were included in the group into which these patients had initially been randomised according to the intention-to-treat principle. A significance level of 5% (alpha = 0.05). was used for all statistical tests, such that tests presenting a p-value less than 0.05 were considered statistically significant. Results Ninety one (58.8 mean age and 66 participants were female) were included in the final assessment at 24 months. The DASH questionnaire evaluation showed a statistically significant result favouring the De Palma group (mean difference = -7.1 p = 0.044) after six months, but this was not maintained at 24 months. There were no statistically differences between the groups with respect to palm grip strength. Analysis of the range-of-motion limitation index (uninjured side minus affected side motion of) showed a statistical difference (mean difference = 2.4 p = 0.043) favoring the external

  8. Acute inhibition of NCC does not activate distal electrogenic Na+ reabsorption or kaliuresis

    PubMed Central

    Craigie, Eilidh; Homer, Natalie Z. M.; Mullins, John J.; Bailey, Matthew A.

    2014-01-01

    Na+ reabsorption from the distal renal tubule involves electroneutral and electrogenic pathways, with the latter promoting K+ excretion. The relative activities of these two pathways are tightly controlled, participating in the minute-to-minute regulation of systemic K+ balance. The pathways are interdependent: the activity of the NaCl cotransporter (NCC) in the distal convoluted tubule influences the activity of the epithelial Na+ channel (ENaC) downstream. This effect might be mediated by changes in distal Na+ delivery per se or by molecular and structural adaptations in the connecting tubule and collecting ducts. We hypothesized that acute inhibition of NCC activity would cause an immediate increase in Na+ flux through ENaC, with a concomitant increase in renal K+ excretion. We tested this using renal clearance methodology in anesthetized mice, by the administration of hydrochlorothiazide (HCTZ) and/or benzamil (BZM) to exert specific blockade of NCC and ENaC, respectively. Bolus HCTZ elicited a natriuresis that was sustained for up to 110 min; urinary K+ excretion was not affected. Furthermore, the magnitude of the natriuresis was no greater during concomitant BZM administration. This suggests that ENaC-mediated Na+ reabsorption was not normally limited by Na+ delivery, accounting for the absence of thiazide-induced kaliuresis. After dietary Na+ restriction, HCTZ elicited a kaliuresis, but the natiuretic effect of HCTZ was not enhanced by BZM. Our findings support a model in which inhibition of NCC activity does not increase Na+ reabsorption through ENaC solely by increasing distal Na+ delivery but rather by inducing a molecular and structural adaptation in downstream nephron segments. PMID:24402096

  9. A Comparative Outcomes Study Using the Volar Locking Plating System for Distal Radius Fractures in both Young Adults and Adults Older than 60 Years

    PubMed Central

    Chung, Kevin C.; Squitieri, Lee; Kim, H. Myra

    2015-01-01

    Purpose Despite the high prevalence and impact of distal radius fractures (DRFs) on older patients, the current available literature regarding DRFs in older adults lacks adequate comparative treatment data. The purpose of this prospective, controlled outcomes study is to compare outcomes using the volar locking plating system (VLPS) for DRFs in both older and younger adults. Methods Consecutive, eligible patients were enrolled into our prospective study over a two-year period on the basis of strict inclusion/exclusion criteria. Subjects were entered into two cohorts based on age: 20–40 years and ≥ 60 years. Patient outcomes and complication rates were evaluated at three, six and twelve months after surgery. Outcome measures included the Michigan Hand Outcomes Questionnaire (MHQ), grip strength, active wrist and forearm range of motion, the Jebsen-Taylor test, and radiographic parameters. Results 55 patients (30 young and 25 older adults) with unilateral, inadequately reduced DRFs were enrolled and received surgical treatment with the VLPS. We observed no statistically significant difference in any of the outcomes for all three follow-up periods. While older age patients continued to improve throughout their twelve month postoperative visits, younger patients achieved their maximum recovery during the six month follow-up period, suggesting different recovery patterns. At the twelve-month assessment, older patients were able to achieve a higher mean MHQ score than their younger counterparts (normalized mean: 85% and 82%, respectively). Complication rates were similar between the two groups for all three time periods, with most occurring on or before the three month postoperative visit. Conclusions This study indicates that the VLPS is successful in managing DRFs in older patients and without increased complications compared to younger patients. For the older patients without prohibitive surgical risks, internal fixation using the VLPS yields comparable outcomes

  10. Early Functional Postoperative Therapy of Distal Radius Fracture with a Dynamic Orthosis: Results of a Prospective Randomized Cross-Over Comparative Study

    PubMed Central

    Stuby, Fabian M.; Döbele, Stefan; Schäffer, Susanne-Dorothea; Mueller, Simon; Ateschrang, Atesch

    2015-01-01

    Introduction This study was conducted according to GCP criteria as a prospective randomized cross-over study. The primary goal of the study was to determine clinical findings and patient satisfaction with postoperative treatment. 29 patients with a distal radius fracture that was surgically stabilized from volar and who met the inclusion criteria were enrolled over a 12-month period. Each patient randomly received either a dorsal plaster splint or a vacuum-fit flexible but blocked orthosis applied postoperatively in the operating theatre to achieve postoperative immobilization. After one week all patients were crossed over to the complementary device maintaining the immobilization until end of week 2. After week 2 both groups were allowed to exercise wrist mobility with a physiotherapist, in the orthosis group the device was deblocked, thus allowing limited wrist mobility. After week 4 the devices were removed in both groups. Follow-up exams were performed after postoperative weeks 1, 2, 4 and 12. Results and Discussion Results were determined after week 1 and 2 using SF 36 and a personally compiled questionnaire; after weeks 4 and 12 with a clinical check-up, calculation of ROM and the DASH Score. Comparison of the two groups showed a significant difference in ROM for volar flexion after 4 weeks, but no significant differences in DASH Score, duration of disability or x-ray findings. With regard to satisfaction with comfort and hygiene, patients were significantly more satisfied with the dynamic orthosis, and 23 of the 29 patients would prefer the flexible vacuum orthosis in future. Trial Registration German Clinical Trials Register (DRKS) DRKS00006097 PMID:25822197

  11. Comparison and combination of scaling index method and Minkowski functionals in the analysis of high resolution magnetic resonance images of the distal radius in vitro

    NASA Astrophysics Data System (ADS)

    Sidorenko, Irina N.; Bauer, Jan; Monetti, Roberto; Mueller, Dirk; Rummeny, Ernst J.; Eckstein, Felix; Raeth, Christoph W.

    2008-03-01

    High resolution magnetic resonance (HRMR) imaging can reveal major characteristics of trabecular bone. The quantification of this trabecular micro architecture can be useful for better understanding the progression of osteoporosis and improve its diagnosis. In the present work we applied the scaling index method (SIM) and Minkowski Functionals (MF) for analysing tomographic images of distal radius specimens in vitro. For both methods, the correlation with the maximum compressive strength (MCS) as determined in a biomechanical test and the diagnostic performance with regard to the spine fracture status were calculated. Both local SIM and global MF methods showed significantly better results compared to bone mineral density measured by quantitative computed tomography. The receiver operating characteristic analysis for differentiating fractured and non-fractured subjects revealed area under the curve (AUC) values of 0.716 for BMD, 0.897 for SIM and 0.911 for MF. The correlation coefficients with MCS were 0.6771 for BMD, 0.843 for SIM and 0.772 for MF. We simulated the effect of perturbations, namely noise effects and intensity variations. Overall, MF method was more sensitive to noise than SIM. A combination of SIM and MF methods could, however, increase AUC values from 0.85 to 0.89 and correlation coefficients from 0.71 to 0.82. In conclusion, local SIM and global MF techniques can successfully be applied for analysing HRMR image data. Since these methods are complementary, their combination offers a new possibility of describing MR images of the trabecular bone, especially noisy ones.

  12. Treatment of unstable distal radius fractures: non-invasive dynamic external fixator versus volar locking plate – functional and radiological outcome in a prospective case-controlled series

    PubMed Central

    Bajwa, Ali S.; Rammappa, Manju; Lee, Ling; Nanda, Rajesh

    2015-01-01

    Introduction: Distal radius fracture (DRF) is a common injury and various treatment modalities including open reduction and internal fixation (ORIF) with volar locking plate are available. More recently, a non-invasive external fixator has been used. Aims: To prospectively compare the use of a non-invasive external fixator with early dynamisation for DRF against ORIF with volar locking plate control group. Methods: Consecutive patients with closed DRF were included in a prospective case-controlled study. Patients were assigned to non-invasive external fixator or ORIF. Minimum follow-up was two years. Follow-up was at weeks 2, 4, 6, 8, 12, 26 and at one and two-year post-operatively. The outcome measures included demographic details, injury mechanism, AO fracture type, risk factors, body mass index (BMI), ulnar styloid fracture and dorsal comminution, radiographs, grip strength and DASH score. Results: Consecutive 50 patients were treated either with non-invasive external fixator (25/50) or with ORIF (25/50) and the mean age of the two groups was 53 years (SD 17.1) and 49 years (SD 19.5), respectively. Demographics were matched in two groups. In the non-invasive external fixator group, there were 10 AO Type-A, 5 Type-B and 10 Type-C fractures. The ORIF group included 8 Type-A, 6 Type-B and 11 Type-C fractures. The mean DASH score at three-months and one-year post-injury in non-invasive fixator group was 12.2 (SD 3.1) and 3.5 (SD 0.7), respectively, significantly greater than those of ORIF group 14.5 (SD 5.6) and 11.2 (SD 4.4), respectively (p < 0.05). Conclusion: DRF treated with non-invasive external fixator can give functional results superior to ORIF at three-months and the trend is maintained at one and two-year post-operatively. PMID:27163089

  13. Reference values for digital X-ray radiogrammetry parameters in children and adolescents in comparison to estimates in patients with distal radius fractures.

    PubMed

    Renz, Diane M; Malich, Ansgar; Ulrich, Andreas; Pfeil, Alexander; Mentzel, Hans-Joachim; Streitparth, Florian; Maurer, Martin H; Teichgräber, Ulf K; Böttcher, Joachim

    2016-01-01

    The first objective of this study was to determine normative digital X-ray radiogrammetry (DXR) values, based on original digital images, in a pediatric population (aged 6-18 years). The second aim was to compare these reference data with patients suffering from distal radius fractures, whereas both cohorts originated from the same geographical region and were evaluated using the same technical parameters as well as inclusion and exclusion criteria. DXR-BMD and DXR-MCI of the metacarpal bones II-IV were assessed on standardized digital hand radiographs, without printing or scanning procedures. DXR parameters were estimated separately by gender and among six age groups; values in the fracture group were compared to age- and gender-matched normative data using Student's t tests and Z scores. In the reference cohort (150 boys, 138 girls), gender differences were found in bone mineral density (DXR-BMD), with higher values for girls from 11 to 14 years and for boys from 15 to 18 years (p < 0.05). Girls had higher normative metacarpal index (DXR-MCI) values than boys, with significant differences at 11-14 years (p < 0.05). In the case-control investigation, the fracture group (95 boys, 69 girls) presented lower DXR-BMD at 15-18 years in boys and 13-16 years in girls vs. the reference cohort (p < 0.05); DXR-MCI was lower at 11-18 years in boys and 11-16 years in girls (p < 0.05). Mean Z scores in the fracture group for DXR-BMD were -0.42 (boys) and -0.46 (girls), and for DXR-MCI were -0.51 (boys) and -0.53 (girls). These findings indicate that the fully digital DXR technique can be accurately applied in pediatric populations ≥ 6 years of age. The lower DXR-BMD and DXR-MCI values in the fracture group suggest promising early identification of individuals with increased fracture risk, without the need for additional radiation exposure, enabling the initiation of prevention strategies to possibly reduce the incidence of osteoporosis later in life.

  14. High-resolution peripheral quantitative computed tomography (HR-pQCT) can assess microstructural and biomechanical properties of both human distal radius and tibia: Ex vivo computational and experimental validations.

    PubMed

    Zhou, Bin; Wang, Ji; Yu, Y Eric; Zhang, Zhendong; Nawathe, Shashank; Nishiyama, Kyle K; Rosete, Fernando Rey; Keaveny, Tony M; Shane, Elizabeth; Guo, X Edward

    2016-05-01

    High-resolution peripheral quantitative computed tomography (HR-pQCT) provides in vivo three-dimensional (3D) imaging at the distal radius and tibia and has been increasingly used to characterize cortical and trabecular bone morphology in clinical studies. In this study, we comprehensively examined the accuracy of HR-pQCT and HR-pQCT based micro finite element (μFE) analysis predicted bone elastic stiffness and strength through comparisons with gold-standard micro computed tomography (μCT) based morphological/μFE measures and direct mechanical testing results. Twenty-six sets of human cadaveric distal radius and tibia segments were imaged by HR-pQCT and μCT. Microstructural analyses were performed for the registered HR-pQCT and μCT images. Bone stiffness and yield strength were determined by both HR-pQCT and μCT based linear and nonlinear μFE predictions and mechanical testing. Our results suggested that strong and significant correlations existed between the HR-pQCT standard, model-independent and corresponding μCT measurements. HR-pQCT based nonlinear μFE overestimated stiffness and yield strength while the linear μFE underestimated yield strength, but both were strongly correlated with those predicted by μCT μFE and measured by mechanical testing at both radius and tibia (R(2)>0.9). The microstructural differences between HR-pQCT and μCT were also examined by the Bland-Altman plots. Our results showed HR-pQCT morphological measurements of BV/TV(d), Tb.Th, and Tb.Sp, can be adjusted by correction values to approach true values measured by gold-standard μCT. In addition, we observed moderate correlations of HR-pQCT biomechanical and microstructural parameters between the distal radius and tibia. We concluded that morphological and mechanical properties of human radius and tibia bone can be assessed by HR-pQCT based measures.

  15. Open reduction and palmar plate-osteosynthesis in combination with a nanocrystalline hydroxyapatite spacer in the treatment of comminuted fractures of the distal radius.

    PubMed

    Huber, F-X; Hillmeier, J; Herzog, L; McArthur, N; Kock, H-J; Meeder, P J

    2006-06-01

    In a prospective study, we used the nanocrystalline hydroxyapatite paste Ostim (Osartis, Obernburg, Germany) in combination with a palmar plate to treat comminuted radius fractures with a metaphyseal and articular component in order to examine the clinical use of Ostim as a bone substitute. Twenty-one patients with 22 radius fractures of AO types C2 and C3 were included in the study. The measurements, taken 10.2+/-1.3 months after the initial treatment, revealed a dorsopalmar tilt of 8.8+/-3.7 degrees , a radioulnar inclination of 18.8+/-2.8 degrees and an ulnar variance of 0.8+/-1.8mm. According to the Gartland and Werley evaluation, eight of the treated fractures attained an excellent, 11 a good and the remaining three a fair result. The study demonstrates that Ostim, in combination with angularly stable osteosynthesis, can be used as an acceptable bone substitute for the treatment of type C2 and C3 radial fractures.

  16. Effects on bone geometry, density, and microarchitecture in the distal radius but not the tibia in women with primary hyperparathyroidism: A case-control study using HR-pQCT.

    PubMed

    Hansen, Stinus; Beck Jensen, Jens-Erik; Rasmussen, Lars; Hauge, Ellen M; Brixen, Kim

    2010-09-01

    Patients with primary hyperparathyroidism (PHPT) have continuously elevated parathyroid hormone (PTH) and consequently increased bone turnover with negative effects on cortical (Ct) bone with preservation of trabecular (Tb) bone. High-resolution peripheral quantitative computed tomography (HR-pQCT) is a new technique for in vivo assessment of geometry, volumetric density, and microarchitecture at the radius and tibia. In this study we aimed to evaluate bone status in women with PHPT compared with controls using HR-pQCT. The distal radius and tibia of 54 women--27 patients with PHPT (median age 60, range 44-75 years) and 27 randomly recruited age-matched healthy controls (median age 60, range 44-76 years)--were imaged using HR-pQCT along with areal bone mineral density (aBMD) by dual-energy X-ray absorptiomentry (DXA) of the ultradistal forearm, femoral neck, and spine (L1-L4). Groups were comparable regarding age, height, and weight. In the radius, patients had reduced Ct area (Ct.Ar) (p = .008), Ct thickness (Ct.th) (p = .01) along with reduced total (p = .002), Ct (p = .02), and Tb (p = .02) volumetric density and reduced Tb number (Tb.N) (p = .04) and increased Tb spacing (Tb.sp) (p = .05). Ct porosity did not differ. In the tibia, no differences in HR-pQCT parameters were found. Moreover, patients had lower ultradistal forearm (p = .005), spine (p = .04), and femoral neck (p = 0.04) aBMD compared with controls. In conclusion, a negative bone effect of continuously elevated PTH with alteration of HR-pQCT assessed geometry, volumetric density, and both trabecular and cortical microarchitecture in radius but not tibia was found along with reduced aBMD by DXA at all sites in female patients with PHPT. © 2010 American Society for Bone and Mineral Research.

  17. In Vivo Precision of Digital Topological Skeletonization Based Individual Trabecula Segmentation (ITS) Analysis of Trabecular Microstructure at the Distal Radius and Tibia by HR-pQCT.

    PubMed

    Zhou, Bin; Zhang, Zhendong; Wang, Ji; Yu, Y Eric; Liu, Xiaowei Sherry; Nishiyama, Kyle K; Rubin, Mishaela R; Shane, Elizabeth; Bilezikian, John P; Guo, X Edward

    2016-06-01

    Trabecular plate and rod microstructure plays a dominant role in the apparent mechanical properties of trabecular bone. With high-resolution computed tomography (CT) images, digital topological analysis (DTA) including skeletonization and topological classification was applied to transform the trabecular three-dimensional (3D) network into surface and curve skeletons. Using the DTA-based topological analysis and a new reconstruction/recovery scheme, individual trabecula segmentation (ITS) was developed to segment individual trabecular plates and rods and quantify the trabecular plate- and rod-related morphological parameters. High-resolution peripheral quantitative computed tomography (HR-pQCT) is an emerging in vivo imaging technique to visualize 3D bone microstructure. Based on HR-pQCT images, ITS was applied to various HR-pQCT datasets to examine trabecular plate- and rod-related microstructure and has demonstrated great potential in cross-sectional and longitudinal clinical applications. However, the reproducibility of ITS has not been fully determined. The aim of the current study is to quantify the precision errors of ITS plate-rod microstructural parameters. In addition, we utilized three different frequently used contour techniques to separate trabecular and cortical bone and to evaluate their effect on ITS measurements. Overall, good reproducibility was found for the standard HR-pQCT parameters with precision errors for volumetric BMD and bone size between 0.2%-2.0%, and trabecular bone microstructure between 4.9%-6.7% at the radius and tibia. High reproducibility was also achieved for ITS measurements using all three different contour techniques. For example, using automatic contour technology, low precision errors were found for plate and rod trabecular number (pTb.N, rTb.N, 0.9% and 3.6%), plate and rod trabecular thickness (pTb.Th, rTb.Th, 0.6% and 1.7%), plate trabecular surface (pTb.S, 3.4%), rod trabecular length (rTb.ℓ, 0.8%), and plate

  18. Single and dual incision technique for acute distal biceps rupture: clinical and functional outcomes

    PubMed Central

    Guglielmino, Claudia; Massimino, Paolo; Ioppolo, Francesco; Castorina, Sergio; Musumeci, Giuseppe; Di Giunta, Angelo

    2016-01-01

    Summary Background Distal bicep tendon injuries are a traumatic event though rather rare. The pathogenesis is not entirely clear. The most common cause for injury is an unexpected load on the biceps when the elbow is in an extended position. Although several studies have provided insight into the pathogenetic processes of the lesion, the literature suggests to treat all injuries surgically (whether partial or total) if there is high functional demand. Methods Between January 2006 and March 2016 were studied 20 patients surgically treated for a disconnected distal bicep, 15 with a total lesion and 5 with a partial lesion. The patients were divided into 2 groups. Surgical access with single incision was performed on 13 patients while a double surgical access was performed on 7 patients. The clinical and functional results were studied using an Ewald System Score (ESS). Results In both groups, the most rapid improvement was achieved for the parameters of pain and deformity with excellent results, while those of function and movement were normalized as gradual and progressive over next 2 months. Conclusion The clinical and functional outcomes during the follow-up examination after surgery showed excellent results in patients treated with both types of surgical procedures. PMID:28217566

  19. Functional outcomes and cost estimation for extra-articular and simple intra-articular distal radius fractures treated with open reduction and internal fixation versus closed reduction and percutaneous Kirschner wire fixation

    PubMed Central

    Dzaja, Ivan; MacDermid, Joy C.; Roth, James; Grewal, Ruby

    2013-01-01

    Background We sought to compare direct costs and clinical and radiographic outcomes for distal radius fractures (DRF) treated with open reduction internal fixation with volar locking plates (VLP) versus closed reduction and percutaneous pinning (CRPP). Methods We identified patients with AO-type A and C1 DRFs from a prospective database. Outcomes were assessed at 6 weeks and at 3, 6 and 12 months, and surgical care costs were estimated. Results Twenty patients were treated with CRPP and 24 with VLP. There were no significant differences in patient-rated wrist evaluation (PRWE) scores between the 2 groups at any time point (mean 16.2 ± 23.1 in the CRPP group v. 21.5 ± 23.6 in the VLP group, p = 0.91). Overall alignment was maintained in both groups; however, there was a greater loss of radial height over time with CRPP than VLP (0.97 mm v. 0.25 mm, p = 0.018). The mean duration of surgery was longer for VLP than CRPP (113.9 ± 39.5 min v. 86.5 ± 7.8 min, p = 0.029), but there were fewer clinic visits (5.2 ± 1.4 v. 7.8 ± 1.3, p < 0.001) and fewer radiographs (7.4 ± 2.7 v. 9 ± 2.4, p = 0.031). The total cost per case was greater for VLP than CRPP ($1637.27 v. $733.91). Conclusion Based on PRWE scores, VLPs did not offer any significant advantage over CRPP in patients with simple fracture types between 3 and 12 months, but they were much more costly. Whether VLP offers any functional advantage earlier in recovery, thereby justifying their expense, requires further investigation in the form of a prospective randomized trial with a detailed cost analysis. PMID:24284144

  20. Assessment of trabecular bone yield and post-yield behavior from high-resolution MRI-based nonlinear finite-element analysis at the distal radius of pre- and postmenopausal women susceptible to osteoporosis

    PubMed Central

    Zhang, Ning; Magland, Jeremy F.; Rajapakse, Chamith S.; Lam, ShingChun Benny

    2013-01-01

    Rationale and Objectives To assess the performance of a nonlinear micro-finite element model on predicting trabecular bone (TB) yield and post-yield behavior based on high-resolution in-vivo MR images via the serial reproducibility. Materials and Methods The nonlinear model captures material nonlinearity by iteratively adjusting tissue-level modulus based on tissue-level effective strain. It enables simulations of TB yield and post-yield behavior from micro-MR images at in-vivo resolution by solving a series of nonlinear systems via an iterative algorithm on a desktop computer. Measures of mechanical competence (yield strain/strength, ultimate strain/strength, modulus of resilience and toughness) were estimated at the distal radius of pre- and postmenopausal women (N=20; age 50–75) in whom osteoporotic fractures typically occur. Each subject underwent three scans (20.2±14.5 days). Serial reproducibility was evaluated via coefficients of variation (CV) and intra-class correlation coefficient (ICC). Results Nonlinear simulations were completed in an average of 14 minutes per 3D image data set involving analysis of 61 strain levels. The predicted yield strain/strength, ultimate strain/strength, modulus of resilience and toughness had a mean value of 0.78%, 3.09 MPa, 1.35%, 3.48 MPa, 14.30 kPa and 32.66 kPa, respectively, covering a substantial range by a factor of up to four. ICC ranged from 0.986 to 0.994 (average 0.991); CV ranged from 1.01% to 5.62% (average 3.6%), with yield strain and toughness having the lowest and highest CV values, respectively. Conclusion The data suggest that the yield and post-yield parameters have adequate reproducibility to evaluate treatment effects in interventional studies within short follow-up periods. PMID:24200486

  1. [Redo surgery for residual distal dissection after the limited proximal aortic replacement for Stanford type A acute aortic dissection].

    PubMed

    Ogino, Hitoshi

    2013-07-01

    Redo surgery for residual distal dissection after the limited proximal aortic repair for Stanford type A acute aortic dissection remains challenging with some difficulties. In essence, redo aortic repair predominantly depends on the significantly dilated parts of the residual dissection. According to that, the strategy including median or lateral approach and 1 or 2 staged repair would be determined with careful consideration for patients' age and function of the vital organs such as brain, heart, lung, liver, and kidney. Generally, for relatively young and low-risk patients, an aggressive 1 stage repair of the entire arch to descending aorta through a left thoracotomy is feasible. Meanwhile, 2 stage repair is beneficial for elderly high-risk patients, which consists of the 1st total arch replacement with elephant trunk through a median sternotomy followed secondly by the open descending aortic repair through a lateral thoracotomy or recently-advanced less-invasive endovascular aortic repair. In the initial repair, more aggressive total arch replacement with elephant trunk or frozen elephant trunk might be another useful option to potentially prevent such troublesome behaviors of the residual dissecting aorta requiring redo surgery in the late stage.

  2. Acute saline expansion increases nephron filtration and distal flow rate but maintains tubuloglomerular feedback responsiveness: role of adenosine A1 receptors

    PubMed Central

    Singh, Prabhleen; Deng, Aihua; Thomson, Scott C.; Vallon, Volker

    2012-01-01

    Temporal adaptation of tubuloglomerular feedback (TGF) permits readjustment of the relationship of nephron filtration rate [single nephron glomerular filtration rate (SNGFR)] and early distal tubular flow rate (VED) while maintaining TGF responsiveness. We used closed-loop assessment of TGF in hydropenia and after acute saline volume expansion (SE; 10% body wt over 1 h) to determine whether 1) temporal adaptation of TGF occurs, 2) adenosine A1 receptors (A1R) mediate TGF responsiveness, and 3) inhibition of TGF affects SNGFR, VED, or urinary excretion under these conditions. SNGFR was evaluated in Fromter-Wistar rats by micropuncture in 1) early distal tubules (ambient flow at macula densa), 2) recollected from early distal tubules while 12 nl/min isotonic fluid was added to late proximal tubule (increased flow to macula densa), and 3) from proximal tubules of same nephrons (zero flow to macula densa). SE increased both ambient SNGFR and VED compared with hydropenia, whereas TGF responsiveness (proximal-distal difference in SNGFR, distal SNGFR response to adding fluid to proximal tubule) was maintained, demonstrating TGF adaptation. A1R blockade completely inhibited TGF responsiveness during SE and made VED more susceptible to perturbation in proximal tubular flow, but did not alter ambient SNGFR or VED. Greater urinary excretion of fluid and Na+ with A1R blockade may reflect additional effects on the distal nephron in hydropenia and SE. In conclusion, A1R-independent mechanisms adjust SNGFR and VED to higher values after SE, which facilitates fluid and Na+ excretion. Concurrently, TGF adapts and stabilizes early distal delivery at the new setpoint in an A1R-dependent mechanism. PMID:22622464

  3. Performance of the MRI-based virtual bone biopsy in the distal radius: serial reproducibility and reliability of structural and mechanical parameters in women representative of osteoporosis study populations.

    PubMed

    Lam, Shing Chun Benny; Wald, Michael J; Rajapakse, Chamith S; Liu, Yinxiao; Saha, Punam K; Wehrli, Felix W

    2011-10-01

    Serial reproducibility and reliability critically determine sensitivity to detect changes in response to intervention and provide a basis for sample size estimates. Here, we evaluated the performance of the MRI-based virtual bone biopsy in terms of 26 structural and mechanical parameters in the distal radius of 20 women in the age range of 50 to 75 years (mean=62.0 years, S.D.=8.1 years), representative of typical study populations in drug intervention trials and fracture studies. Subjects were examined three times at average intervals of 20.2 days (S.D.=14.5 days) by MRI at 1.5 T field strength at a voxel size of 137×137×410 μm(3). Methods involved prospective and retrospective 3D image registration and auto-focus motion correction. Analyses were performed from a central 5×5×5 mm(3) cuboid subvolume and trabecular volume consisting of a 13 mm axial slab encompassing the entire medullary cavity. Whole-volume axial stiffness and sub-regional Young's and shear moduli were computed by finite-element analysis. Whole-volume-derived aggregate mean coefficient of variation of all structural parameters was 4.4% (range 1.8% to 7.7%) and 4.0% for axial stiffness; corresponding data in the subvolume were 6.5% (range 1.6% to 13.0%) for structural, and 5.5% (range 4.6% to 6.5%) for mechanical parameters. Aggregate ICC was 0.976 (range 0.947 to 0.986) and 0.992 for whole-volume-derived structural parameters and axial stiffness, and 0.946 (range 0.752 to 0.991) and 0.974 (range 0.965 to 0.978) for subvolume-derived structural and mechanical parameters, respectively. The strongest predictors of whole-volume axial stiffness were BV/TV, junction density, skeleton density and Tb.N (R(2) 0.79-0.87). The same parameters were also highly predictive of sub-regional axial modulus (R(2) 0.88-0.91). The data suggest that the method is suited for longitudinal assessment of the response to therapy. The underlying technology is portable and should be compatible with all general

  4. Use of MR-based trabecular bone microstructure analysis at the distal radius for osteoporosis diagnostics: a study in post-menopausal women with breast cancer and treated with aromatase inhibitor

    PubMed Central

    Baum, Thomas; Karampinos, Dimitrios C.; Seifert-Klauss, Vanadin; Pencheva, Tsvetelina D.; Jungmann, Pia M.; Rummeny, Ernst J.; Müller, Dirk; Bauer, Jan S.

    2016-01-01

    Summary Purpose Treatment with aromatase inhibitor (AI) is recommended for post-menopausal women with hormone-receptor positive breast cancer. However, AI therapy is known to induce bone loss leading to osteoporosis with an increased risk for fragility fractures. The purpose of this study was to investigate whether changes of magnetic resonance (MR)-based trabecular bone microstructure parameters as advanced imaging biomarker can already be detected in subjects with AI intake but still without evidence for osteoporosis according to dual energy X-ray absorptiometry (DXA)-based bone mineral density (BMD) measurements as current clinical gold standard. Methods Twenty-one postmenopausal women (62±6 years of age) with hormone-receptor positive breast cancer, ongoing treatment with aromatase inhibitor for 23±15 months, and no evidence for osteoporosis (current DXA T-score greater than −2.5) were recruited for this study. Eight young, healthy women (24±2 years of age) were included as controls. All subjects underwent 3 Tesla magnetic resonance imaging (MRI) of the distal radius to assess the trabecular bone microstructure. Results Trabecular bone microstructure parameters were not significantly (p>0.05) different between subjects with AI intake and controls, including apparent bone fraction (0.42±0.03 vs. 0.42±0.05), trabecular number (1.95±0.10 mm−1 vs 1.89±0.15 mm−1), trabecular separation (0.30±0.03 mm vs 0.31±0.06 mm), trabecular thickness (0.21±0.01 mm vs 0.22±0.02 mm), and fractal dimension (1.70±0.02 vs. 1.70±0.03). Conclusion These findings suggest that the initial deterioration of trabecular bone microstructure as measured by MRI and BMD loss as measured by DXA occur not sequentially but rather simultaneously. Thus, the use of MR-based trabecular bone microstructure assessment is limited as early diagnostic biomarker in this clinical setting. PMID:27252740

  5. Distal ulnar growth arrest.

    PubMed

    Nelson, O A; Buchanan, J R; Harrison, C S

    1984-03-01

    Four cases of arrest of distal ulnar physeal growth occurring in children ages 7 to 13 years had follow-up for 2 to 10 years. Each patient developed bowing of the radial diaphysis, ulnar translation of the distal radial epiphysis, and increased ulnar angulation of the distal radiocarpal joint surface. Growth discrepancies were documented in both the ulna (range 2.2 to 3.9 cm) and to a lesser extent the radius (range 0.2 to 1.6 cm) when compared to the opposite forearm in each patient. The progression of deformity appeared to be greatest during adolescence. Radial deviation and pronation were limited to varying degrees in each case. No patient had significant pain or functional impairment, but the cosmetic appearance was always displeasing. Indications for surgical treatment include increasing ulnar angulation of the distal radial articular surface, progressive loss of motion, and displeasing cosmetic appearance.

  6. DISTAL MYOPATHIES

    PubMed Central

    Dimachkie, Mazen M.; Barohn, Richard J.

    2014-01-01

    Over a century ago, Gowers described two young patients in whom distal muscles weakness involved the hand, foot, sternocleidomastoid, and facial muscles in the other case the shoulder and distal leg musculature. Soon after, , similar distal myopathy cases were reported whereby the absence of sensory symptoms and of pathologic changes in the peripheral nerves and spinal cord at postmortem examination allowed differentiation from Charcot-Marie-Tooth disease. In 1951, Welander described autosomal dominant (AD) distal arm myopathy in a large Scandanavian cohort. Since then the number of well-characterized distal myopathies has continued to grow such that the distal myopathies have formed a clinically and genetically heterogeneous group of disorders. Affected kindred commonly manifest weakness that is limited to foot and toe muscles even in advanced stages of the disease, with variable mild proximal leg, distal arm, neck and laryngeal muscle involvement in selected individuals. An interesting consequence of the molecular characterization of the distal myopathies has been the recognition that mutation in a single gene can lead to more than one clinical disorder. For example, Myoshi myopathy (MM) and limb girdle muscular dystrophy (LGMD) type 2B are allelic disorders due to defects in the gene that encodes dysferlin. The six well described distal myopathy syndromes are shown in Table 1. Table 2 lists advances in our understanding of the myofibrillar myopathy group and Table 3 includes more recently delineated and less common distal myopathies. In the same manner, the first section of this review pertains to the more traditional six distal myopathies followed by discussion of the myofibrillar myopathies. In the third section, we review other clinically and genetically distinctive distal myopathy syndromes usually based upon single or smaller family cohorts. The fourth section considers other neuromuscular disorders that are important to recognize as they display prominent

  7. Acute motor and sensory axonal neuropathy (AMSAN) in a 15-year-old boy presenting with severe pain and distal muscle weakness.

    PubMed

    Rostásy, K M; Huppke, P; Beckers, B; Brockmann, K; Degenhardt, V; Wesche, B; König, F; Gärtner, J

    2005-08-01

    Acute motor and sensory axonal neuropathy (AMSAN) is a recently described subtype of Guillain-Barré syndrome characterized by acute onset of distal weakness, loss of deep tendon reflexes and sensory symptoms. Electrophysiological studies show mildly reduced nerve conduction velocities combined with a marked reduction of muscle action and sensory nerve action potentials. Here, we report a 15-year-old boy who suffered from severe burning and knife-like pain that increased over a period of three months and resulted in a disrupted sleep pattern and suicidal intentions as well as marked loss of weight. In addition, he developed muscle weakness in his hands and feet. Neurophysiological and histopathological studies revealed AMSAN. Marked improvement of his condition was achieved by treatment with intravenous immunoglobulins, high-dose methylprednisolone, and a combination of gabapentin, antidepressants, and an oral morphine.

  8. Identification of a novel distal control region upstream of the human steroidogenic acute regulatory protein (StAR) gene that participates in SF-1-dependent chromatin architecture.

    PubMed

    Mizutani, Tetsuya; Yazawa, Takashi; Ju, Yunfeng; Imamichi, Yoshitaka; Uesaka, Miki; Inaoka, Yoshihiko; Matsuura, Kaoru; Kamiki, Yasue; Oki, Masaya; Umezawa, Akihiro; Miyamoto, Kaoru

    2010-09-03

    StAR (steroidogenic acute regulatory protein) mediates the transport of cholesterol from the outer to the inner mitochondrial membrane, the process of which is the rate-limiting step for steroidogenesis. Transcriptional regulation of the proximal promoter of the human StAR gene has been well characterized, whereas analysis of its distal control region has not. Recently, we found that SF-1 (steroidogenic factor 1) induced the differentiation of mesenchymal stem cells (MSCs) into steroidogenic cells with the concomitant strong induction of StAR expression. Here, we show, using differentiated MSCs, that StAR expression is regulated by a novel distal control region. Using electrophoretic mobility shift (EMSA) and chromatin immunoprecipitation (ChIP) assays, we identified novel SF-1 binding sites between 3,000 and 3,400 bp upstream of StAR. A luciferase reporter assay revealed that the region worked as a strong regulator to exert maximal transcription of StAR. ChIP analysis of histone H3 revealed that upon SF-1 expression, nucleosome eviction took place at the SF-1 binding sites, not only in the promoter but also in the distal SF-1 binding sites. Chromosome conformation capture analysis revealed that the region upstream of StAR formed a chromatin loop both in the differentiated MSCs and in KGN cells, a human granulosa cell tumor cell line, where SF-1 is endogenously expressed. Finally, SF-1 knockdown resulted in disrupted formation of this chromatin loop in KGN cells. These results indicate that the novel distal control region participate in StAR activation through SF-1 dependent alterations of chromatin structure, including histone eviction and chromatin loop formation.

  9. Impact of Distal Protection with Filter-Type Device on Long-term Outcome after Percutaneous Coronary Intervention for Acute Myocardial Infarction: Clinical Results with Filtrap®

    PubMed Central

    Teramoto, Ryota; Sakata, Kenji; Miwa, Kenji; Matsubara, Takao; Yasuda, Toshihiko; Inoue, Masaru; Okada, Hirofumi; Kanaya, Honin; Kawashiri, Masa-aki; Hayashi, Kenshi

    2016-01-01

    Aim: Although distal embolization during percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) deteriorates cardiac function, whether distal protection (DP) can improve prognosis is still controversial. We investigated whether a filter-type DP device, Filtrap®, could improve long-term outcomes after PCI for AMI. Method: We studied 164 patients (130 men, mean age: 65.7 years) who underwent PCI. Patients were divided into two groups based on the use of Filtrap®. The occurrence of congestive heart failure (CHF) and major adverse cardiac events (MACE) defined as cardiac death, recurrent AMI, and target vessel revascularization were compared. Result: Between DP (n = 53, 41 men, mean age: 65.5 years) and non-DP (n = 111, 89 men, mean age: 65.8 years) groups, although there was significantly greater plaque area in the DP group than in the non-DP group, there were no significant differences in coronary reperfusion flow after PCI. Interestingly, patients with CHF in the non-DP group exhibited a higher CK level than those in the DP group. During a 2-year follow-up period, cumulative CHF was significantly lower in the DP group than in the non-DP group (log-rank p = 0.018), and there was no significant difference in the MACE rate (log-rank p = 0.238). The use of DP device could not predict MACE, but could predict CHF by multivariate analysis (odds ratio = 0.099, 95% CI: 0.02–0.42, p = 0.005). Conclusion: These results demonstrate that favorable clinical outcomes could be achieved by the filter-type DP device in AMI, particularly in patients with CHF. PMID:27251330

  10. Distal radioulnar joint injuries

    PubMed Central

    Thomas, Binu P; Sreekanth, Raveendran

    2012-01-01

    Distal radioulnar joint is a trochoid joint relatively new in evolution. Along with proximal radioulnar joint, forearm bones and interosseous membrane, it allows pronosupination and load transmission across the wrist. Injuries around distal radioulnar joint are not uncommon, and are usually associated with distal radius fractures,fractures of the ulnar styloid and with the eponymous Galeazzi or Essex_Lopresti fractures. The injury can be purely involving the soft tissue especially the triangular fibrocartilage or the radioulnar ligaments. The patients usually present with ulnar sided wrist pain, features of instability, or restriction of rotation. Difficulty in carrying loads in the hand is a major constraint for these patients. Thorough clinical examination to localize point of tenderness and appropriate provocative tests help in diagnosis. Radiology and MRI are extremely useful, while arthroscopy is the gold standard for evaluation. The treatment protocols are continuously evolving and range from conservative, arthroscopic to open surgical methods. Isolated dislocation are uncommon. Basal fractures of the ulnar styloid tend to make the joint unstable and may require operative intervention. Chronic instability requires reconstruction of the stabilizing ligaments to avoid onset of arthritis. Prosthetic replacement in arthritis is gaining acceptance in the management of arthritis. PMID:23162140

  11. Genome Wide Mapping of NR4A Binding Reveals Cooperativity with ETS Factors to Promote Epigenetic Activation of Distal Enhancers in Acute Myeloid Leukemia Cells

    PubMed Central

    Duren, Ryan P.; Boudreaux, Seth P.; Conneely, Orla M.

    2016-01-01

    Members of the NR4A subfamily of orphan nuclear receptors regulate cell fate decisions via both genomic and non-genomic mechanisms in a cell and tissue selective manner. NR4As play a key role in maintenance of hematopoietic stem cell homeostasis and are critical tumor suppressors of acute myeloid leukemia (AML). Expression of NR4As is broadly silenced in leukemia initiating cell enriched populations from human patients relative to normal hematopoietic stem/progenitor cells. Rescue of NR4A expression in human AML cells inhibits proliferation and reprograms AML gene signatures via transcriptional mechanisms that remain to be elucidated. By intersecting an acutely regulated NR4A1 dependent transcriptional profile with genome wide NR4A binding distribution, we now identify an NR4A targetome of 685 genes that are directly regulated by NR4A1. We show that NR4As regulate gene transcription primarily through interaction with distal enhancers that are co-enriched for NR4A1 and ETS transcription factor motifs. Using a subset of NR4A activated genes, we demonstrate that the ETS factors ERG and FLI-1 are required for activation of NR4A bound enhancers and NR4A target gene induction. NR4A1 dependent recruitment of ERG and FLI-1 promotes binding of p300 histone acetyltransferase to epigenetically activate NR4A bound enhancers via acetylation at histone H3K27. These findings disclose novel epigenetic mechanisms by which NR4As and ETS factors cooperate to drive NR4A dependent gene transcription in human AML cells. PMID:26938745

  12. Acute cytotoxicity and apoptotic effects after l-Pam exposure in different cocultures of the proximal and distal respiratory system.

    PubMed

    Pohl, Christine; Hofmann, Helene; Moisch, Michaela; Papritz, Mirko; Iris Hermanns, M; Dei-Anang, Jasmin; Mayer, Eckhard; Kehe, Kai; Kirkpatrick, Charles James

    2010-07-01

    Sulphur and nitrogen mustard are strong alkylating agents which can cause after inhalation acute lung injury in the larynx, trachea and large bronchi and can lead to alveolar edema. In our study we tested the N-Lost l-Phenylalanine Mustard (l-Pam). Therefore we seeded the alveolar type II cell line NCI H441 on the upper membrane of a Transwell filter plate and the endothelial cell line ISO-Has-1 on the lower side of the membrane for the alveolar model and combined the human bronchial explant-outgrowth cells and fibroblasts in the bronchial model and exposed both models with various concentrations of l-Pam. Treatment with l-Pam led to a concentration-dependent decrease of the transepithelial electrical resistance and therefore impairment of barrier function in both models. Changes in morphology could be observed. In the bronchial model damaged cell organelles whereas in the alveolar model a widening of intercellular spaces could be seen. Loss of cell-matrix adhesion as well as apoptotic and necrotic cell death could be demonstrated. In conclusion, treatment with the nitrogen mustard in the coculture models showed comparable results to sulphur mustard treatment and thus this model could be useful to explore similarities and differences in signal transduction pathways after treatment with both sulphur and nitrogen mustard.

  13. Villous adenoma of the distal appendix.

    PubMed

    Taylor, J V; Thomas, M G; Kelly, S; Sutton, R

    1997-04-01

    Villous adenoma confined to the distal appendix has not been previously reported in conjunction with acute apendicitis. The presence of an adenoma indicates a need for further investigation due to an association with neoplasia elsewhere.

  14. Large mode radius resonators

    NASA Technical Reports Server (NTRS)

    Harris, Michael R.

    1987-01-01

    Resonator configurations permitting operation with large mode radius while maintaining good transverse mode discrimination are considered. Stable resonators incorporating an intracavity telescope and unstable resonator geometries utilizing an output coupler with a Gaussian reflectivity profile are shown to enable large radius single mode laser operation. Results of heterodyne studies of pulsed CO2 lasers with large (11mm e sup-2 radius) fundamental mode sizes are presented demonstrating minimal frequency sweeping in accordance with the theory of laser-induced medium perturbations.

  15. Distal splenorenal shunt

    MedlinePlus

    ... shunt; Cirrhosis - distal splenorenal; Liver failure - distal splenorenal; Portal vein pressure - distal splenorenal shunt ... vein from your spleen is removed from the portal vein. The vein is then attached to the ...

  16. Effective Cleaning Radius Studies

    SciTech Connect

    Churnetski, B.V.

    2001-10-15

    This report discusses results of testing done in the Savannah River Laboratory half tank and full tank mockup facilities using kaolin clay slurries and the relationship between cleaning radius and pump and slurry characteristics.

  17. The Proton Radius Puzzle

    NASA Astrophysics Data System (ADS)

    Downie, E. J.

    2016-03-01

    The proton radius puzzle is the difference between the proton radius as measured with electron scattering and in the excitation spectrum of atomic hydrogen, and that measured with muonic hydrogen spectroscopy. Since the inception of the proton radius puzzle in 2010 by the measurement of Pohl et al.[1], many possible resolutions to the puzzle have been postulated, but, to date, none has been generally accepted. New data are therefore necessary to resolve the issue. We briefly review the puzzle, the proposed solutions, and the new electron scattering and spectroscopy experiments planned and underway. We then introduce the MUSE experiment, which seeks to resolve the puzzle by simultaneously measuring elastic electron and muon scattering on the proton, in both charge states, thereby providing new information to the puzzle. MUSE addresses issues of two-photon effects, lepton universality and, possibly, new physics, while providing simultaneous form factor, and therefore radius, measurements with both muons and electrons.

  18. HEREDITARY DISTAL FORELEG CURVATURE IN THE RABBIT

    PubMed Central

    Pearce, Louise

    1960-01-01

    An inwardly directed curvature of the distal segment of both forelegs of the rabbit has been described. The condition was detected at 2 to 3 weeks of age, developed rapidly, and reached its final and permanent stage at 2 to 3 months of age. Only the distal epiphysis of the ulna was primarily affected and this in the form of a massive chondrodystrophic lesion accompanied by a progressive curvature of the shaft. The curvature of the growing radius was a secondary effect due to the firm, immovable, anatomical connection of the ulna and radius. The positional changes of the wrist and paw were likewise effects secondary to the changed form of the ulna and radius. The bowing abnormality occurred only in certain families of pure bred Beveren, Belgian, French Silver, and Dutch rabbits and was found to be inherited. The mode of inheritance was on the basis of a single recessive unit factor (5). PMID:13733755

  19. Pullout wire fixation together with distal interphalangeal joint Kirschner wire stabilization for acute combined tendon and bone (double level) mallet finger injury.

    PubMed

    Zhang, Xu; Shao, Xinzhong; Huang, Yong

    2015-02-01

    This article describes a previously unclassified type of combined tendon/bone mallet finger. This supplements the conventional Doyle classification. The article also describes the technique for surgical treatment of such mallet fingers, which involves the use of a pullout wire with K-wire stabilization of the distal interphalangeal joint.

  20. Two-wave propagation in in vitro swine distal ulna

    NASA Astrophysics Data System (ADS)

    Mano, Isao; Horii, Kaoru; Matsukawa, Mami; Otani, Takahiko

    2015-07-01

    Ultrasonic transmitted waves were obtained in an in vitro swine distal ulna specimen, which mimics a human distal radius, that consists of interconnected cortical bone and cancellous bone. The transmitted waveforms appeared similar to the fast waves, slow waves, and overlapping fast and slow waves measured in the specimen after removing the surface cortical bone (only cancellous bone). In addition, the circumferential waves in the cortical bone and water did not affect the fast and slow waves. This suggests that the fast-and-slow-wave phenomenon can be observed in an in vivo human distal radius.

  1. Variable Radius Nacelle Studies

    NASA Technical Reports Server (NTRS)

    McGowan, David M.

    2001-01-01

    An overview of the active shape control for a variable radius nacelle leading edge program is presented. The current technical plan and schedule will be discussed. Results from the structural shape change of curved plates demonstration will be presented, as well as the NASA LaRC concept for a variable radius nacelle leading edge. Results of a Boeing systems integration study of this concept will be discussed briefly. The status of the sensors, actuators, and computational design tools tasks will also be presented.

  2. Fracture of the distal radial physis complicated by compartment syndrome and premature physeal closure.

    PubMed

    Hernandez, J; Peterson, H A

    1986-01-01

    Complications after injury to the epiphyseal growth plate of the distal radius are uncommon. An 11-year-8-month-old boy developed two complications--compartment syndrome of the forearm and premature closure of the physis--after a Salter-Harris Type I injury. Treatment included closed reduction, decompression, skin grafting, excision of the physeal bar, and epiphysiodesis of the distal ulna and the remaining open physis of the distal radius.

  3. Detonation Shock Radius Experiments.

    NASA Astrophysics Data System (ADS)

    Lambert, David; Debes, Joshua; Stewart, Scott; Yoo, Sunhee

    2007-06-01

    A previous passover experiment [1] was designed to create a complex detonation transient used in validating a reduced, asymptotically derived description of detonation shock dynamics (DSD). An underlying question remained on determining the location of the initial detonation shock radius to start the DSD simulation with respect to the dynamical response of the initiation system coupling's to the main charge. This paper concentrates on determining the initial shock radius required of such DSD governed problems. `Cut-back' experiments of PBX-9501 were conducted using an initiation system that sought to optimize the transferred detonation to the desired constant radius, hemispherical shape. Streak camera techniques captured the breakout on three of the prism's surfaces for time-of-arrival data. The paper includes comparisons to simulations using constant volume explosion and high pressure hot spots. The results of the experiments and simulation efforts provide fundamental design considerations for actual explosive systems and verify necessary conditions from which the asymptotic theory of DSD may apply. [1] Lambert, D., Stewart, D. Scott and Yoo, S. and Wescott, B., ``Experimental Validation of Detonation Shock Dynamics in Condensed Explosives. J. of Fluid Mechs., Vol. 546, pp.227-253 (2006).

  4. Bowel perforation presenting with acute abdominal pain and subcutaneous emphysema in a 14-year-old girl with an abandoned distal peritoneal shunt catheter: case report.

    PubMed

    Riccardello, Gerald J; Barr, Luke K; Bassani, Luigi

    2016-09-01

    The authors report the case of 14-year-old girl with a history of myelomeningocele and previously shunt-treated hydrocephalus who presented with right-sided abdominal pain and subcutaneous emphysema that developed over a 1-week period. A CT scan of the patient's abdomen revealed a retained distal ventriculoperitoneal (VP) catheter with air tracking from the catheter to the upper chest wall. Given the high suspicion of the catheter being intraluminal, an exploratory laparotomy was performed and revealed multiple jejunal perforations. The patient required a partial small-bowel resection and reanastomosis for complete removal of the retained catheter. Six other similar cases of bowel perforation occurring in patients with abandoned VP and subdural-peritoneal shunts have been reported. The authors analyzed these cases with regard to age of presentation, symptomatic presentation, management, morbidity, and mortality. While there was 0% mortality associated with bowel perforation secondary to a retained distal VP catheter, the morbidity was significantly high and included peritonitis and small bowel resection.

  5. Antiproton charge radius

    NASA Astrophysics Data System (ADS)

    Crivelli, P.; Cooke, D.; Heiss, M. W.

    2016-09-01

    The upcoming operation of the extra low energy antiprotons ring at CERN, the upgrade of the antiproton decelerator (AD), and the installation in the AD hall of an intense slow positron beam with an expected flux of 1 08 e+ /s will open the possibility for new experiments with antihydrogen (H ¯). Here we propose a scheme to measure the Lamb shift of H ¯. For four months of data taking, we anticipate an uncertainty of 100 ppm. This will provide a test of C P T and the first determination of the antiproton charge radius at the level of 10%.

  6. Arthroscopic Arthrodesis of the Distal Tibiofibular Syndesmosis.

    PubMed

    Lui, Tun Hing

    2015-01-01

    Chronic syndesmosis disruption can occur if an acute lesion is missed or inadequately managed. This can result in significant functional deficit and development of post-traumatic ankle arthritis. Anatomic reduction of the syndesmosis and maintenance of the reduction by syndesmotic screw fixation alone, ligamentous reconstruction, or fusion of the syndesmosis are recommended. A technique of arthroscopic distal tibiofibular syndesmosis arthrodesis is described.

  7. Primary shortening of the forearm and Sauvé-Kapandji for severely comminuted fractures of the distal forearm in elderly patients: a case report.

    PubMed

    Goorens, Chul Ki; Geurts, Ghislain; Goubau, Jean F

    2013-01-01

    We report a case of an elderly female who sustained a severely comminuted distal radial and ulnar fracture, treated by shortening of the forearm, combined with a primary Sauvé-Kapandji procedure and volar plating of the distal radius.

  8. The proportion of distal fibula Salter-Harris type I epiphyseal fracture in the paediatric population with acute ankle injury: a prospective MRI study.

    PubMed

    Hofsli, Mikael; Torfing, Trine; Al-Aubaidi, Zaid

    2016-03-01

    Ankle injuries are common among the paediatric population. There are few prospective studies utilizing MRI to diagnose a clinically suspected Salter-Harris type I of the distal fibula (SH1FDF). The aim of this study was to examine the proportion of clinically suspected SH1FDF in children. All paediatric patients with ankle injury, seen at the emergency room from September 2012 to May 2013 at a single institution, underwent a standardized clinical examination, and their radiographs were obtained if found necessary. All images and data were recorded prospectively and patients suspected of having SH1FDF were referred for MRI of the ankle joint. Out of 391 paediatric patients seen at the emergency room with ankle injury, 38 patients had a clinical suspicion of SH1FDF. A total of 31 patients, 18 male and 13 female, with a mean age of 10 ± 2.86 years, were included in the study. Only seven patients were excluded from the study. MRI was obtained on an average of 6.9 ± 2.87 days. None of the included patients had evidence of SH1FDF on MRI. Our study and review of the literature verifies the high false-positive rate of clinically suspected SH1FDF. Most children had ligamentous lesions, bone contusion or joint effusion, rather than SH1FDF.

  9. Distal Biceps Tendon Rupture

    DTIC Science & Technology

    2010-06-01

    distal tendon. Although these findings overlap with those seen in tendinopathy , the presence of bone marrow edema at the radial tuberosity and fluid in...the bicipitoradial bursa suggests a partial tear rather than tendinopathy .3 When the distal biceps tendon tear is complete, MR imaging shows

  10. Resection Interposition Arthroplasty for Failed Distal Ulna Resections

    PubMed Central

    Papatheodorou, Loukia K.; Rubright, James H.; Kokkalis, Zinon T.; Sotereanos, Dean G.

    2013-01-01

    The major complications of distal ulna resection, the Darrach procedure, are radioulnar impingement and instability. High failure rates have been reported despite published modifications of the Darrach procedure. Several surgical techniques have been developed to treat this difficult problem and to mitigate the symptoms associated with painful convergence and impingement. No technique has demonstrated clinical superiority. Recently, implant arthroplasty of the distal ulna has been endorsed as an option for the management of the symptomatic patient with a failed distal ulna resection. However, there are concerns for implant longevity, especially in young, active adults. Resection interposition arthroplasty relies on interposition of an Achilles tendon allograft between the distal radius and the resected distal ulna. Although this technique does not restore normal mechanics of the distal radioulnar joint, it can prevent painful convergence of the radius on the ulna. Achilles allograft interposition arthroplasty is a safe and highly effective alternative for failed distal ulna resections, especially for young, active patients, in whom an implant or alternative procedure may not be appropriate. PMID:24436784

  11. Replicating a Colles fracture in an excised radius: revisiting testing protocols.

    PubMed

    Wagner, David W; Lindsey, Derek P; Beaupre, Gary S

    2012-04-05

    A distal radius fracture in middle-age and older adults is often considered a sentinel indicator of osteoporosis. Mechanical testing of cadaveric specimens is often used to quantify bone strength and develop insight for relating in-vivo measures to fracture force. Mechanical testing protocols using an intact forearm have been successful at replicating a Colles fracture, however, excised isolated radius protocols based on the intact forearm testing protocol have not been as successful. One protocol originally designed to replicate the physiological condition of a fall on an outstretched hand was reproduced in our laboratory, yet surprisingly the produced distal radius fracture patterns were not consistent among specimens nor was dorsal angulation of the distal fragment that is characteristic of a Colles fracture observed. The purpose of this study was to perform a mechanics-based analysis of the excised radius loading protocol in order to quantify the imposed and internal forces on the radius. An idealized beam model of the excised radius revealed that in the area of the distal radius where Colles fractures occur, 99.99% of the maximum strain on the bone outer surface was the result of pure compressive loading. This loading condition is in direct contrast to the accepted mechanics of a Colles fracture, which is characterized as a metaphyseal bending fracture with the volar cortex failing due to tensile stresses and the dorsal cortex exhibiting compression and comminution. The results suggest that additional research, particularly related to overcoming the difficulties of reliably supporting and applying a force to the distal end of the radius, is necessary for clinical fracture patterns to be reliably reproduced with an excised radius mechanical testing protocol.

  12. Torsion of wandering spleen and distal pancreas

    SciTech Connect

    Sheflin, J.R.; Lee, C.M.; Kretchmar, K.A.

    1984-01-01

    Wandering spleen is the term applied to the condition in which a long pedicle allows the spleen to lie in an abnormal location. Torsion of a wandering spleen is an unusual cause of an acute abdomen and is rarely diagnosed preoperatively. Associated torsion of the distal pancreas is even more uncommon. The authors describe a patient with torsion of a wandering spleen and distal pancreas, who was correctly diagnosed, and define the merits of the imaging methods used. The initial examination should be /sup 99//sup m/Tc-sulfur colloid liner-spleen scanning.

  13. Corrective osteotomies of the radius: Grafting or not?

    PubMed Central

    Mugnai, Raffaele; Tarallo, Luigi; Lancellotti, Enrico; Zambianchi, Francesco; Di Giovine, Ettore; Catani, Fabio; Adani, Roberto

    2016-01-01

    AIM: To review the current literature regarding corrective osteotomies to provide the best evidence of the rule of bone grafting. METHODS: Our MEDLINE literature search included 280 studies using the following key words “Malunited distal radius fracture” and 150 studies using key words “Corrective osteotomy of the distal radius”. Inclusion criteria were: Malunited distal radial, extra articular fracture, volar locking plate, use of iliac bone graft (cancellous or corticocancellous), non-use of bone graft. Twelve studies met the inclusion criteria. RESULTS: Seven of the 12 studies considered, described the use of a graft; the remaining five studies didn’t use any graft. Type of malunion was dorsal in most of the studies. The healing time was comparable using the graft or not (mean 12.5 wk), ranging from 7.5 to 16 wk. The mean disabilities of the arm, shoulder and hand score improvement was 23 points both in the studies that used the graft and in those not using the graft. CONCLUSION: This review demonstrated that corrective osteotomy of extra-articular malunited fractures of the distal radius treated by volar locking plate does not necessarily require bone graft. PMID:26925385

  14. Transphyseal Distal Humerus Fracture.

    PubMed

    Abzug, Joshua; Ho, Christine Ann; Ritzman, Todd F; Brighton, Brian

    2016-01-01

    Transphyseal distal humerus fractures typically occur in children younger than 3 years secondary to birth trauma, nonaccidental trauma, or a fall from a small height. Prompt and accurate diagnosis of a transphyseal distal humerus fracture is crucial for a successful outcome. Recognizing that the forearm is not aligned with the humerus on plain radiographs may aid in the diagnosis of a transphyseal distal humerus fracture. Surgical management is most commonly performed with the aid of an arthrogram. Closed reduction and percutaneous pinning techniques similar to those used for supracondylar humerus fractures are employed. Cubitus varus caused by a malunion, osteonecrosis of the medial condyle, or growth arrest is the most common complication encountered in the treatment of transphyseal distal humerus fractures. A corrective lateral closing wedge osteotomy can be performed to restore a nearly normal carrying angle.

  15. Distal renal tubular acidosis

    MedlinePlus

    ... get better with treatment. When to Contact a Medical Professional Call your health care provider if you have symptoms of distal renal tubular acidosis. Get medical help right away if you develop emergency symptoms ...

  16. A New Distal Radioulnar Joint Prosthesis

    PubMed Central

    Schuurman, Arnold H.

    2013-01-01

    Pain and instability of the distal radioulnar joint (DRUJ) are common sequelae following a fracture of the distal radius. Many soft tissue procedures have been described, not all of which are successful. Ulnar head replacement prostheses are available but do not always provide stability. We designed a two-part, easy to implant, distal radioulnar prosthesis and implanted it in 19 patients. The first prototype was inserted in 2002 and is still in place. During the study, the design was changed twice, resulting in three groups with four patients in group A, five in group B, and ten in group C. Unfortunately all five prostheses in group B had to be removed because of loosening, while only two prostheses in group C had to be removed, for nonprosthetic reasons. For the 12 patients who retained their prosthesis, forearm function increased while grip strength increased significantly. Pain scores decreased and the Disabilities of the Arm, Shoulder, and Hand (DASH) score improved but remained high. We conclude that the prosthesis offers a new treatment option for ulnar instability following distal ulnar resection. PMID:24436843

  17. Differential permeability of the proximal and distal rabbit small bowel

    PubMed Central

    Ross, Allan; Rubin, Allen W.; Deren, Julius J.

    1972-01-01

    The permeability of the proximal and distal rabbit intestine for two to six carbon polyhydric alcohols was compared. Intestinal segments were mounted in chambers that permitted the measurement of the unidirectional flux across the brush border membrane. For both proximal and distal intestine, the permeability for a series of polyhydric alcohols decreased with increasing size. The proximal intestine was more permeable for four, five, and six carbon polyhydric alcohols than distal intestine. This regional permeability difference can be attributed to variations in the permeability characteristics of the brush border specifically. The uptake of alcohols was nonsaturable and was not inhibited by phlorizine or n-ethylmaleimide. The results are compatible with the concept that the brush border membrane has properties similar to artificial porous membranes and that the equivalent radius of the pores of the proximal intestine exceeds that of the distal gut. PMID:4639025

  18. One size does not fit all: distal radioulnar joint dysfunction after volar locking plate fixation.

    PubMed

    Jones, Christopher W; Lawson, Richard D

    2014-02-01

    Background Fractures of the distal radius are among the most common injuries treated by orthopedic surgeons worldwide. Failure to restore distal radius alignment can lead to fracture malunion and poor clinical outcomes, including distal radioulnar joint (DRUJ) instability and limitation of motion. Case Description We present a unique case of DRUJ dysfunction following volar plate fixation of bilateral distal radius fractures and analyze the biomechanical causes of this complication. As a result of a relatively excessive tilt of the precontoured locking plate (in comparison to the patient's particular anatomy), the fracture on one side was "over-reduced," disrupting the biomechanics of the DRUJ, causing a supination block. Clinical Relevance Volar locking plates are not a panacea to all distal radius fractures. Plate selection and fixation technique must include consideration of patient anatomy. Robust plates offer the advantage of providing rigid fixation but can be difficult to contour when reconstructing normal anatomy. Restoration of patient-specific anatomy is crucial to the management of distal radius fractures.

  19. Laparoscopic Distal Pancreatectomy

    PubMed Central

    Melotti, Gianluigi; Butturini, Giovanni; Piccoli, Micaela; Casetti, Luca; Bassi, Claudio; Mullineris, Barbara; Lazzaretti, Maria Grazia; Pederzoli, Paolo

    2007-01-01

    Objective: To describe the clinical characteristics, indications, technical procedures, and outcome of a consecutive series of laparoscopic distal pancreatic resections performed by the same surgical team. Summary Background Data: Laparoscopic distal pancreatic resection has increasingly been described as a feasible and safe procedure, although accompanied by a high rate of conversion and morbidity. Methods: A consecutive series of patients affected by solid and cystic tumors were selected prospectively to undergo laparoscopic distal pancreatectomy performed by the same surgical team. Clinical characteristics as well as diagnostic preoperative assessment and intra- and postoperative data were prospectively recorded. A follow-up of at least 3 months was available for all patients. Results: Fifty-eight patients underwent laparoscopic resection between May 1999 and November 2005. All procedures were successfully performed laparoscopically, and no patient required intraoperative blood transfusion. Splenic vessel preservation was possible in 84.4% of spleen-preserving procedures. There were no mortalities. The overall median hospital stay was 9 days, while it was 10.5 days for patients with postoperative pancreatic fistulae (27.5% of all cases). Follow-up was available for all patients. Conclusions: Our experience in 58 consecutive patients was characterized by the lack of conversions and by acceptable rates of postoperative pancreatic fistulae and morbidity. Laparoscopy proved especially beneficial in patients with postoperative complications as they had a relatively short hospital stay. Solid and cystic tumors of the distal pancreas represent a good indication for laparoscopic resection whenever possible. PMID:17592294

  20. Prediction of Colles' fracture load in human radius using cohesive finite element modeling.

    PubMed

    Ural, Ani

    2009-01-05

    Osteoporotic and age-related fractures are a significant public health problem. One of the most common osteoporotic fracture sites in the aging population is distal radius. There is evidence in the literature that distal radius fractures (Colles' fracture) are an indicative of increased risk of future spine and hip fractures. In this study, a nonlinear fracture mechanics-based finite element method is applied to human radius to assess its fracture load as a function of cortical bone geometry and material properties. Seven three-dimensional finite element models of radius were created and the fracture loads were determined by using cohesive finite element modeling which explicitly represents the crack and the fracture process zone behavior. The fracture loads found in the simulations (731-6793 N) were in the range of experimental values reported in the literature. The fracture loads predicted by the simulations decreased by 4-5% per decade based only on material level changes and by 6-20% per decade when geometrical changes were also included. Cortical polar moment of inertia at 15% distal radius showed the highest correlation to fracture load (r(2)=0.97). These findings demonstrate the strength of fracture mechanics-based finite element modeling and show that combining geometrical and material properties provides a better assessment of fracture risk in human radius.

  1. Traumatic ulnar physeal arrest after distal forearm fractures in children.

    PubMed

    Ray, T D; Tessler, R H; Dell, P C

    1996-01-01

    A review of the orthopaedic literature suggests that traumatic ulnar physeal arrest associated with radial fracture is a rare occurrence. Twenty-three cases of traumatic ulnar physeal arrest have been reported in patients with distal radius fractures, and we report five additional cases. A classification system for the distal ulnar growth deformities is proposed, and the compensatory radial changes are reviewed. Surgical indications for treatment include cosmetic deformity, progressive carpal subluxation, and decreased range of motion. Surgical options for treatment are discussed and include epiphysiodesis, ulnar lengthening, radial osteotomy, and the Suave-Kapandji procedure.

  2. Distal Radioulnar Joint Instability

    PubMed Central

    Mirghasemi, Ali R.; Lee, Daniel J.; Rahimi, Narges; Rashidinia, Shervin

    2015-01-01

    Distal radioulnar joint (DRUJ) instability is a common clinical condition but a frequently missed diagnosis. Both surgical and nonsurgical treatments are possible for chronic cases of DRUJ instability. Nonsurgical treatment can be considered as the primary therapy in less active patients, while surgery should be considered to recover bone and ligament injuries if nonsurgical treatment fails to restore forearm stability and function. The appropriate choice of treatment depends on the individual patient and specific derangement of the DRUJ PMID:26328241

  3. [Loco typico radius fractures--personal experience].

    PubMed

    Darabos, Nikica; Cesarec, Marijan

    2003-01-01

    Fractura radii loco typico (FRLT) is the fracture of the distal radius. That is the one of the most frequent fractures of locomotor system with the widest range of treatment in traumatology. Therapy depends on the stability of the fracture: nonoperative or operative. We analysed the five-year experience of our Department of Traumatology where more than 1500 patients with FRLT have been treated in the urgent surgery clinic and 126 of them were hospitalized. In our study we evaluated the results of the operative treatment and postoperative functional status of a treated wrist. According to the A-O classification, we hospitalized 36 patients with A type, 28 patients with B type, and 62 patients with C type of FRLT. We operated 80 patients. The postoperative functional status of a treated wrist was excellent or good in 64 patients and good in 16 patients. The treatment of FRLT depends on the type and the complications of the fracture and the age of the patients. Operative therapy is indicated in the unstable FRLT or after an inadequate nonoperative treatment.

  4. Prevention of distal embolization and no-reflow in patients with acute myocardial infarction and total occlusion in the infarct-related vessel: a subgroup analysis of the cohort of acute revascularization in myocardial infarction with excimer laser-CARMEL multicenter study.

    PubMed

    Dahm, Johannes B; Ebersole, Douglas; Das, Tony; Madyhoon, Hooman; Vora, Kishor; Baker, John; Hilton, David; Topaz, On

    2005-01-01

    To overcome the adverse complications of percutaneous coronary interventions in thrombus laden lesions (i.e., distal embolization, platelet activation, no-reflow phenomenon), mechanical removal of the thrombus or distal embolization protection devices are frequently required. Pulsed-wave ultraviolet excimer laser light at 308 nm can vaporize thrombus, suppress platelet aggregation, and, unlike other thrombectomy devices, ablate the underlying plaque. The following multicenter registry was instituted to evaluate the safety and efficacy of laser ablation in patients presenting with acute myocardial infarction (AMI) complicated by persistent thrombotic occlusions. Patients with AMI and complete thrombotic occlusion of the infarct-related vessel were included in eight participating centers. Patients with further compromising conditions (i.e., cardiogenic shock, thrombolysis failures) were also included. Primary endpoint was procedural respective laser success; secondary combined endpoints were TIMI flow and % stenosis by quantitative coronary analysis and visual assessment at 1-month follow-up. Eighty-four percent of all patients enrolled (n = 56) had a very large thrombus burden (TIMI thrombus scale > or = 3), and 49% were compromised by complex clinical presentation, i.e., cardiogenic shock (21%), degenerated saphenous vein grafts (26%), or thrombolysis failures (5%). Laser success was achieved in 89%, angiographic success in 93%, and the overall procedural success rate was 86%. The angiographic prelaser total occlusion was reduced angiographically to 58% +/- 25% after laser treatment and to 4% +/- 13% final residual stenosis after adjunctive balloon angioplasty and/or stent placement. TIMI flow increased significantly from grade 0 to 2.7 +/- 0.5 following laser ablation (P < 0.001) and 3.0 +/- 0.2 upon completion of the angioplasty procedure (P > 0.001 vs. baseline). Distal embolizations occurred in 4%, no-reflow was observed in 2%, and perforations in 0.6% of cases

  5. Management of Giant Cell Tumour Radius in a Three Year old Child with an Improvised Technique

    PubMed Central

    Puri, Ajay; Gulia, Ashish; Sharma, Seema; Verma, Amit K

    2014-01-01

    Giant cell tumours of immature skeleton have a very low incidence and epi-metaphyseal location. We are presenting giant cell tumour distal radius in a skeletally immature patient; an uncontained defect with a large soft tissue component which was managed by wide excision and reconstruction with an improvised technique. PMID:25654002

  6. Semiconstrained Distal Radioulnar Joint Prosthesis

    PubMed Central

    Savvidou, Christiana; Murphy, Erin; Mailhot, Emilie; Jacob, Shushan; Scheker, Luis R.

    2013-01-01

    Distal radioulnar joint (DRUJ) problems can occur as a result of joint instability, abutment, or incongruity. The DRUJ is a weight-bearing joint; the ulnar head is frequently excised either totally or partially, and in some cases it is fused, because of degenerative, rheumatoid, or posttraumatic arthritis. Articles about these procedures report the ability to pronate and supinate, but they rarely discuss grip strength, and even less do they address lifting capacity. We report the long term results of the first 35 patients who underwent total DRUJ arthroplasty with the Aptis DRUJ prosthesis after 5 years follow-up. Surgical indications were all causes of dysfunctional DRUJ (degenerative, posttraumatic, autoimmune, congenital). We recorded data for patient demographics, range of motion (ROM), strength, and lifting capacity of the operated and of the nonoperated extremity. Pain and functional assessments were also recorded. The Aptis DRUJ prosthesis, a bipolar self-stabilizing DRUJ endoprosthesis that restores forearm function, consists of a semiconstained and modular implant designed to replace the function of the ulnar head, the sigmoid notch of the radius, and the triangular fibrocartilage ligaments. The surgical technique is presented in detail. The majority of the patients regained adequate ROM and improved their strength and lifting capacity to the operated side. Pain and activities of daily living were improved. Twelve patients experienced complications, most commonly being extensor carpi ulnaris (ECU) tendinitis, ectopic bone formation, bone resorption with stem loosening, low-grade infection, and need for ball replacement. The Aptis total DRUJ replacement prosthesis is an alternative to salvage procedures that enables a full range of motion as well as the ability to grip and lift weights encountered in daily living activities. PMID:24436788

  7. Measurement of solar radius changes

    NASA Technical Reports Server (NTRS)

    Labonte, B. J.; Howard, R.

    1981-01-01

    Results of daily photometric measurements of the solar radius from Mt. Wilson over the past seven years are reported. Reduction of the full disk magnetograms yields a formal error of 0.1 arcsec in the boustrophedonic scans in the 5250.2 A FeI line. 150 scan lines comprise each observation; 1,412 observations were made from 1974-1981. Measurement procedures, determination of the scattered light of the optics and the atmosphere, and error calculations are described, noting that days of poor atmospheric visibility are omitted from the data. The horizontal diameter of the sun remains visually fixed while the vertical component changes due to atmospheric diffraction; error accounting for thermal effects, telescope aberrations, and instrument calibration are discussed, and results, within instrument accuracy, indicate no change in the solar radius over the last seven years.

  8. Distal tibiofibular radiological overlap

    PubMed Central

    Sowman, B.; Radic, R.; Kuster, M.; Yates, P.; Breidiel, B.; Karamfilef, S.

    2012-01-01

    Objectives Overlap between the distal tibia and fibula has always been quoted to be positive. If the value is not positive then an injury to the syndesmosis is thought to exist. Our null hypothesis is that it is a normal variant in the adult population. Methods We looked at axial CT scans of the ankle in 325 patients for the presence of overlap between the distal tibia and fibula. Where we thought this was possible we reconstructed the images to represent a plain film radiograph which we were able to rotate and view in multiple planes to confirm the assessment. Results The scans were taken for reasons other than pathology of the ankle. We found there was no overlap in four patients. These patients were then questioned about previous injury, trauma, surgery or pain, in order to exclude underlying pathology. Conclusion We concluded that no overlap between the tibia and fibula may exist in the population, albeit in a very small proportion. PMID:23610666

  9. Proximal and distal muscle fatigue differentially affect movement coordination

    PubMed Central

    Cowley, Jeffrey C.

    2017-01-01

    Muscle fatigue can cause people to change their movement patterns and these changes could contribute to acute or overuse injuries. However, these effects depend on which muscles are fatigued. The purpose of this study was to determine the differential effects of proximal and distal upper extremity muscle fatigue on repetitive movements. Fourteen subjects completed a repetitive ratcheting task before and after a fatigue protocol on separate days. The fatigue protocol either fatigued the proximal (shoulder flexor) or distal (finger flexor) muscles. Pre/Post changes in trunk, shoulder, elbow, and wrist kinematics were compared to determine how proximal and distal fatigue affected multi-joint movement patterns and variability. Proximal fatigue caused a significant increase (7°, p < 0.005) in trunk lean and velocity, reduced humeral elevation (11°, p < 0.005), and increased elbow flexion (4°, p < 0.01). In contrast, distal fatigue caused small but significant changes in trunk angles (2°, p < 0.05), increased velocity of wrench movement relative to the hand (17°/s, p < 0.001), and earlier wrist extension (4%, p < 0.005). Movement variability increased at proximal joints but not distal joints after both fatigue protocols (p < 0.05). Varying movements at proximal joints may help people adapt to fatigue at either proximal or distal joints. The identified differences between proximal and distal muscle fatigue adaptations could facilitate risk assessment of occupational tasks. PMID:28235005

  10. Distal arthrogryposis syndrome

    PubMed Central

    Kulkarni, K. P.; Panigrahi, I.; Ray, M.; Marwaha, R. K.

    2008-01-01

    A 5-month-old male infant presented with weak cry, decreased body movements, tightness of whole body since birth, and one episode of generalized seizure on day 4 of life. He was born at term by elective caesarian section performed for breech presentation. The child had failure to thrive, contractures at elbow and knee joints, hypertonia, microcephaly, small mouth, retrognathia, and camptodactyly. There was global developmental delay. Abdominal examination revealed umbilical and bilateral inguinal hernia. Visual evoked response and brainstem evoked response audiometry were abnormal. Nerve conduction velocity was normal. Magnetic resonance imaging of brain revealed paucity of white matter in bilateral cerebral hemispheres with cerebellar and brain stem atrophy. The differential diagnoses considered in the index patient were distal arthrogryposis (DA) syndrome, cerebroculofacioskeletal syndrome, and Pena Shokier syndrome. The index patient most likely represents a variant of DA: Sheldon Hall syndrome. PMID:20300297

  11. A Rare Combination of Complex Elbow Dislocation and Distal Radial Fracture in Adults

    PubMed Central

    Vaishya, Raju; Krishnan, Midhun; Agarwal, Amit Kumar

    2016-01-01

    Although it is common for separate elbow joint dislocation and fracture of forearm bones to occur, it is a rare sighting for both elbow dislocation and ipsilateral fracture of the distal radius. We report a case of an anterior dislocation of the elbow with ipsilateral fracture of the distal radius. The case was treated operatively. We describe two possible mechanisms of injury for these rare injury types. The case underlines the importance of assessing the wrist in the case of an elbow fracture and vice versa. PMID:28003939

  12. A Rare Combination of Complex Elbow Dislocation and Distal Radial Fracture in Adults.

    PubMed

    Vaishya, Raju; Krishnan, Midhun; Vijay, Vipul; Agarwal, Amit Kumar

    2016-11-08

    Although it is common for separate elbow joint dislocation and fracture of forearm bones to occur, it is a rare sighting for both elbow dislocation and ipsilateral fracture of the distal radius. We report a case of an anterior dislocation of the elbow with ipsilateral fracture of the distal radius. The case was treated operatively. We describe two possible mechanisms of injury for these rare injury types. The case underlines the importance of assessing the wrist in the case of an elbow fracture and vice versa.

  13. Diagnostic and Therapeutic Advances: Distal Symmetric Polyneuropathy

    PubMed Central

    Callaghan, Brian C.; Price, Raymond S.; Feldman, Eva L.

    2016-01-01

    Importance Peripheral neuropathy is a highly prevalent and morbid condition affecting 2–7% of the population. Patients frequently suffer from pain and are at risk of falls, ulcerations, and amputations. We aimed to review recent diagnostic and therapeutic advances in peripheral neuropathy in distal symmetric polyneuropathy, the most common subtype of peripheral neuropathy. Observations and Advances Current evidence supports limited routine laboratory testing in patients with distal symmetric polyneuropathy. Patients without a known cause should have a complete blood count, comprehensive metabolic panel, B12, serum protein electrophoresis with immunofixation, fasting glucose, and a glucose tolerance test. The presence of atypical features such as asymmetry, non-length-dependence, motor predominance, acute or subacute onset, and/or prominent autonomic involvement should prompt a consultation with a neurologist or neuromuscular specialist. Electrodiagnostic tests and magnetic resonance imaging of the neuroaxis are the main drivers of the cost of the diagnostic evaluation, but evidence supporting their use is lacking. Strong evidence supports the use of tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, and voltage-gated calcium channel ligands in the treatment of neuropathic pain. More intensive glucose control substantially reduces the incidence of distal symmetric polyneuropathy in patients with type 1 diabetes, but does not in type 2 diabetes. Conclusions and Relevance The opportunity exists to improve guideline concordant testing in distal symmetric polyneuropathy patients. Moreover, the role of electrodiagnostic tests needs to be further defined, and interventions to reduce magnetic resonance imaging use in this population are needed. Even though several efficacious medications exist for neuropathic pain treatment, pain is still under-recognized and undertreated. New disease modifying medications are needed to prevent and treat

  14. Radius of curvature controlled mirror

    DOEpatents

    Neil, George R.; Rathke, John Wickham; Schultheiss, Thomas John; Shinn, Michelle D.; Dillon-Townes, Lawrence A.

    2006-01-17

    A controlled radius of curvature mirror assembly comprising: a distortable mirror having a reflective surface and a rear surface; and in descending order from the rear surface; a counter-distortion plate; a flow diverter having a flow diverter aperture at the center thereof; a flow return plate having a flow return aperture at the center thereof; a thermal isolation plate having a thermal isolation plate aperture at the center thereof and a flexible heater having a rear surface and a flexible heater aperture at the center thereof; a double walled tube defining a coolant feed chamber and a coolant return chamber; said coolant feed chamber extending to and through the flow diverter aperture and terminating at the counter-distortion plate and the coolant return chamber extending to and through the thermal isolation backplate and terminating at the flow diverter; and a coolant feed and a coolant return exit at the rear of said flexible heater.

  15. Palmar reconstruction of the triangular fibrocartilage complex for static instability of the distal radioulnar joint.

    PubMed

    Moritomo, Hisao; Kataoka, Toshiyuki

    2014-09-01

    This study describes a new technique that can be used for reconstructing the triangular fibrocartilage complex to correct the static palmar radius instability of the distal radioulnar joint. In the abovementioned condition, the radius is extremely unstable with respect to the ulna and dislocates palmarly in the resting position. Using a palmar approach, a palmaris longus tendon graft was sutured to the remnant of the disrupted palmar radioulnar and ulnocarpal ligaments and then anchored to the bone tunnel that was created at the ulnar fovea. This technique predominantly reinforces the palmar structure of triangular fibrocartilage complex because the palmar radioulnar ligament is the most critical stabilizer of palmar radius instability.

  16. Bone turnover predicts change in volumetric bone density and bone geometry at the radius in men.

    PubMed

    Pye, S R; Ward, K A; Cook, M J; Laurent, M R; Gielen, E; Borghs, H; Adams, J E; Boonen, S; Vanderschueren, D; Wu, F C; O'Neill, T W

    2017-03-01

    Peripheral quantitative computed tomography scans of the distal and midshaft radius were performed in 514 European men aged 40-79 years at baseline and a median of 4.3 years later. Age-related changes in volumetric bone mineral density (vBMD) and bone geometry were greater in men with higher biochemical markers of bone turnover at baseline.

  17. Prediction of endotracheal tube size for pediatric patients from the epiphysis diameter of radius

    PubMed Central

    Cheon, Ji Hyun; Baek, Seung Hoon; Kim, Kyung Hoon

    2017-01-01

    Background Using a too big or a too small size of an endotracheal tube in pediatric patients would result in tracheal injury or insufficient ventilation. Determining the appropriate endotracheal tube size is important because using an inappropriate size can cause complications. This study was performed to predict the appropriate endotracheal tube size by measuring the transverse diameter of the epiphysis of the distal radius under the assumption that the growth rates of cartilages in the entire body are close to each other. Methods Fifty-eight children aged 3 to 10 years who required general anesthesia were intubated with an uncuffed endotracheal tube. The tube size was considered to be appropriate when leaks occurred at inspiratory peak pressures between 10 to 25 mmHg. The transverse diameters of the epiphysis were measured with an ultra-sonogram at the distal radius and the proximal phalanx of the third finger and the fifth finger. Correlations and prediction probabilities of measurements were evaluated. The number needed to harm (NNH), which indicates the number of patients who need to be intubated for one patient who needs tube exchange, was investigated. Results The Spearman's correlation coefficient between the endotracheal tube size and the epiphysis of the distal radius was 0.814, which was the biggest coefficient. For epiphysis of the proximal phalanx of the third finger and the fifth finger, the correlation coefficient was 0.704 and 0.701, respectively. If the Cole's formula was applied for selection of the tube size, the NNH would be 7. Conclusions The appropriate endotracheal tube size could be predicted by means of the epiphyseal transverse diameter of the distal radius rather than the circumference measurements of the phalanx. PMID:28184267

  18. [Fracture of the diaphyseal radius during Cyr wheel practice - an uncommon injury of wheel gymnastics].

    PubMed

    Kauther, M D; Rummel, S; Hussmann, B; Lendemans, S; Nast-Kolb, D; Wedemeyer, C

    2011-12-01

    The cyr wheel is a modified gymnastic wheel with only one ring that can lead to extreme forces on the gymnast. We report on a distal radius shaft fracture (AO 22 A 2.1) and a fracture of the styloid process of the ulna that occurred after holding on to a slipping Cyr wheel and exposition to high pressure on the lower arm. The fracture was fixed by screws and a plate.

  19. Mirror with thermally controlled radius of curvature

    DOEpatents

    Neil, George R.; Shinn, Michelle D.

    2010-06-22

    A radius of curvature controlled mirror for controlling precisely the focal point of a laser beam or other light beam. The radius of curvature controlled mirror provides nearly spherical distortion of the mirror in response to differential expansion between the front and rear surfaces of the mirror. The radius of curvature controlled mirror compensates for changes in other optical components due to heating or other physical changes. The radius of curvature controlled mirror includes an arrangement for adjusting the temperature of the front surface and separately adjusting the temperature of the rear surface to control the radius of curvature. The temperature adjustment arrangements can include cooling channels within the mirror body or convection of a gas upon the surface of the mirror. A control system controls the differential expansion between the front and rear surfaces to achieve the desired radius of curvature.

  20. [Therapy principles of distal fractures of the forearm in childhood].

    PubMed

    Laurer, H; Sander, A; Wutzler, S; Walcher, F; Marzi, I

    2009-11-01

    Fractures of the forearm in children represent one of the most frequent injuries. Most are monotraumatic occurring during sport or leisure activities. Diagnosis can be made by conventional X-ray examination in 2 planes. Distal forearm fractures are classified into epiphyseolysis and epiphyseal fractures, metaphyseal greenstick and buckle fractures, complete distal radius and forearm fractures as well as Galeazzi lesions. The vast majority of cases without relevant dislocation can be treated with immobilization employing a cast. The remaining fractures have to be repositioned and restored depending on age and degree of dislocation.The state of the art in surgical therapy is the Kirschner wire osteosynthesis after closed reduction. Especially meta-diaphyseal fractures can alternatively be stabilized with plate osteosynthesis or external fixation. Following these therapeutic principles, prognosis is excellent and most of the injuries heal without any functional impairment.

  1. Puzzling out the proton radius puzzle

    SciTech Connect

    Mihovilovič, M.; Merkel, H.; Weber, A.

    2016-01-22

    The discrepancy between the proton charge radius extracted from the muonic hydrogen Lamb shift measurement and the best present value obtained from the elastic scattering experiments, remains unexplained and represents a burning problem of today’s nuclear physics: after more than 50 years of research the radius of a basic constituent of matter is still not understood. This paper presents a summary of the best existing proton radius measurements, followed by an overview of the possible explanations for the observed inconsistency between the hydrogen and the muonic-hydrogen data. In the last part the upcoming experiments, dedicated to remeasuring the proton radius, are described.

  2. Puzzling out the proton radius puzzle

    NASA Astrophysics Data System (ADS)

    Mihovilovič, M.; Merkel, H.; Weber, A.

    2016-01-01

    The discrepancy between the proton charge radius extracted from the muonic hydrogen Lamb shift measurement and the best present value obtained from the elastic scattering experiments, remains unexplained and represents a burning problem of today's nuclear physics: after more than 50 years of research the radius of a basic constituent of matter is still not understood. This paper presents a summary of the best existing proton radius measurements, followed by an overview of the possible explanations for the observed inconsistency between the hydrogen and the muonic-hydrogen data. In the last part the upcoming experiments, dedicated to remeasuring the proton radius, are described.

  3. Distal gastrectomy versus total gastrectomy for distal gastric cancer

    PubMed Central

    Liu, Zhen; Feng, Fan; Guo, Man; Liu, Shushang; Zheng, Gaozan; Xu, Guanghui; Lian, Xiao; Fan, Daiming; Zhang, Hongwei

    2017-01-01

    Abstract Even though more than a century later, after the first case of gastrectomy has been successfully performed, the best surgical treatment for distal gastric cancer still remains controversial. Thus, the present study was designed to compare the survival impact of distal (DG) or total gastrectomy (TG) for distal gastric cancer. A total of 1262 distal gastric cancer patients were enrolled in current study including 1157 patients who underwent DG and 157 patients who underwent TG. The postoperative complications and 5-year overall survival were compared between the 2 groups. TG group presented a longer surgical time, a higher volume of intraoperative bleeding, and a larger number of excised lymph nodes (all P < 0.05) compared with the DG group. The postoperative complications were comparable (all P >0.05). The 5-year overall survival rate of DG group was significantly higher than that of TG group (67.6% vs 44.3%, P < 0.001). However, multivariate analysis showed that type of resection was not an independent prognostic factor for distal gastric cancer (P > 0.05). The factor-stratified multivariate analysis showed that only in the subgroup of Tumor-node-metastasis staging system (TNM) stage III (P = 0.049), TG was the independent prognostic factor for poor survival. In conclusion, DG was as feasible as TG; however, TG did not increase the survival rate. DG brought better long-term survival than TG in patients with TNM stage III tumor. We recommended that DG should be the optimal surgical procedure for distal gastric cancer under the premise of negative resection margin. PMID:28151896

  4. Traumatic Distal Ulnar Artery Thrombosis

    PubMed Central

    Karaarslan, Ahmet A.; Karakaşlı, Ahmet; Mayda, Aslan; Karcı, Tolga; Aycan, Hakan; Kobak, Şenol

    2014-01-01

    This paper is about a posttraumatic distal ulnar artery thrombosis case that has occurred after a single blunt trauma. The ulnar artery thrombosis because of chronic trauma is a frequent condition (hypothenar hammer syndrome) but an ulnar artery thrombosis because of a single direct blunt trauma is rare. Our patient who has been affected by a single blunt trauma to his hand and developed ulnar artery thrombosis has been treated by resection of the thrombosed ulnar artery segment. This report shows that a single blunt trauma can cause distal ulnar artery thrombosis in the hand and it can be treated merely by thrombosed segment resection in suitable cases. PMID:25276455

  5. Ulnar buttress arthroplasty after enbloc resection of a giant cell tumor of the distal ulna

    PubMed Central

    Naik, Monappa A; Sujir, Premjit; Rao, Sharath K; Tripathy, Sujit K

    2013-01-01

    Enbloc resection with or without ulnar stump stabilization is the recommended treatment for giant cell tumors (GCT) of the distal ulna. A few sporadic reports are available where authors have described various procedures to prevent ulnar stump instability and ulnar translation of carpal bones. We report a GCT of the distal ulna in a 43-year-old male which was resected enbloc. The distal radioulnar joint was reconstructed by fixing an iliac crest graft to the distal end of the radius (ulnar buttress arthroplasty) and the ulnar stump was stabilized with extensor carpi ulnaris tenodesis. After a followup at three years, there was no evidence of tumor recurrence or graft resorption; the patient had a normal range of movement of the wrist joint and the functional outcome was excellent as per the score of Ferracini et al. PMID:23682187

  6. Salvage of a failed Sauve-Kapandji procedure using a total distal radio-ulnar joint replacement.

    PubMed

    Atwal, N S; Clark, D A; Amirfeyz, R; Bhatia, R

    2010-01-01

    This is the first report in the literature of a patient treated with a DRUJ replacement after Sauvé-Kapandji procedure failed due to pain and instability. The DRUJ replacement is an unconstrained, biomechanically more advantageous implant which can confer stability in cases where soft tissues are inadequate. We describe the treatment and outcome of persistent ulnar instability with a distal radio-ulnar joint replacement following failed salvage procedures for a malunion of a distal radius fracture.

  7. [Results of Kapandji-Sauvé procedure with distal radio-ulnar fusion and segmental resection of the ulna].

    PubMed

    Haferkamp, H; Heidemann, B; Gühne, O; Deventer, B

    2003-05-01

    The Kapandji-Sauvé procedure was performed in 75 patients between 1990 and 2003. The most important indication was painful and restricted forearm rotation after fracture of the distal radius combined with dislocation or destruction of the distal radioulnar joint. 25 patients were followed up using a modified Martini score. We found a significant improvement of forearm rotation, reduction of pain and a good patient satisfaction in a long-term follow-up ranging from three to 12 years.

  8. Clinical and ultrasonographic evidence of a proximal positional fault of the radius. A case report.

    PubMed

    Malo-Urriés, Miguel; Hidalgo-García, César; Bueno-Gracia, Elena; Estébanez-de-Miguel, Elena; Lucha-López, Orosia; Tricás-Moreno, José Miguel

    2014-06-01

    Positional faults are considered a possible underlying mechanism mimicking the symptoms of a joint sprain. Despite numerous clinical studies indicating the presence of positional faults, there is limited evidence of imaging studies confirming positional faults. This case report is a preliminary study that offers clinical and ultrasonographic evidence of a proximal positional fault of the radius, treated successfully with manual therapy techniques. Three weeks after a bike fall on the outstretched hand, the patient in this study presented with right wrist pain and a lack of progress with conventional conservative treatment (NSAIDs, rest and immobilization). Clinical findings indicating a proximal positional fault of the radius included pain during active pronation increased by associating a passive movement of the radius in a proximal direction and it was reduced by associating a passive movement of the radius in a distal direction. Ultrasonographic (US) images showed a reduction of radio-capitellar distance on the right side (11.4 mm) compared to the left side (13.3 mm). A positive response with a distal mobilization of the radius supported the proximal positional fault of the radius. After two manual therapy sessions, the patient had recovered normal asymptomatic function. The outcomes used to assess function and pain were active pronation range of motion, the Spanish version of the DASH questionnaire and a 0-10 numeric pain rating scale. Each measure was conducted prior and after each treatment session and one week post treatment. The patient was re-examined at 6 months follow-up, during which US images, demonstrated a normalization of the right radio-capitellar distance.

  9. A practical guide to the management of distal ulcerative colitis.

    PubMed

    Ardizzone, S; Bianchi Porro, G

    1998-04-01

    This article reviews the role of corticosteroids, sulfasalazine and mesalazine (5-aminosalicylic acid, mesalamine), immunosuppressive agents and alternative novel drugs for the treatment of distal ulcerative colitis. Short cycles of traditional, rectally administered corticosteroids (methylprednisolone, betamethasone, hydrocortisone) are effective for the treatment of mild to moderately active distal ulcerative colitis. In this context, their systemic administration is limited to patients who are refractory to either oral 5-amino-salicylates, topical mesalazine or topical corticosteroids. Of no value in maintaining remission, the long term use of either or topical corticosteroids may be hazardous. A new class of topically acting corticosteroids [budesonide, fluticasone, beclomethasone dipropionate, prednisolone-21-methasulphobenzoate, tixocortol (tixocortol pivalate)] represents a valid alternative for the treatment of active ulcerative colitis, and may be useful in the treatment of refractory distal ulcerative colitis. Although there is controversy concerning dosage or duration of therapy, oral and topical mesalazine is effective in the treatment of mild to moderately active distal ulcerative colitis. Sulfasalazine and mesalazine remain the first-choice drugs for the maintenance therapy of distal ulcerative colitis. Evidence exists showing a trend to a higher remission rate with higher doses of oral mesalazine. Topical mesalazine (suppositories or enemas) also is effective in maintenance treatment. For patients with chronically active or corticosteroid-dependent disease, azathioprine and mercaptopurine are effective in reducing either the need for corticosteroids or clinical relapses. Moreover, they are effective for long term maintenance remission. Cyclosporin may be useful in inducing remission in patients with acutely severe disease who do not achieve remission with an intensive intravenous regimen. Existing data suggest that azathioprine and mercaptopurine may

  10. Hypokalemic quadriparesis and rhabdomyolysis as a rare presentation of distal renal tubular acidosis

    PubMed Central

    Ahmad Bhat, Manzoor; Ahmad Laway, Bashir; Mustafa, Farhat; Shafi Kuchay, Mohammad; Mubarik, Idrees; Ahmad Palla, Nazir

    2014-01-01

    Distal renal tubular acidosis is a syndrome of abnormal urine acidification and is characterized by hyperchloremic metabolic acidosis, hypokalemia, hypercalciurea, nephrocalcinosis and nephrolithiasis. Despite the presence of persistent hypokalemia, acute muscular paralysis is rarely encountered in males. Here, we will report an eighteen year old male patient who presented with flaccid quadriparesis and was subsequently found to have rhabdomyolysis, severe short stature, skeletal deformities and primary distal renal tubular acidosis. PMID:25250276

  11. Mass-radius relationships in icy satellites

    NASA Technical Reports Server (NTRS)

    Lupo, M. J.; Lewis, J. S.

    1979-01-01

    Using published laboratory data for H2O ice, a modeling technique was developed by which the bulk density, density and temperature profile, rotational moment of inertia, central pressure, and location of the rock-ice interface can all be obtained as a function of the radius, the heliocentric distance, and the silicate composition. Models of the interiors of Callisto, Ganymede, Europa, Rhea, and Titan are given, consistent with present mass and radius data. The radius and mass of spheres of ice under self-gravitation for two different temperature classes are given (103 and 77 deg K). Measurements of mass, radius and I/MR2 by spacecraft can be interpreted by this model to yield substantial information about the internal structure and the ice/rock ratio of the icy satellites of Jupiter and Saturn.

  12. Acute laminitis.

    PubMed

    Baxter, G M

    1994-12-01

    Laminitis is an inflammation of the sensitive laminae along the dorsal aspect of the digit and is considered to be a secondary complication of several predisposing or primary factors. Affected horses are usually very lame, have increased digital pulses, are painful to hoof testers along the toe of the foot, and have evidence of downward rotation or distal displacement of the distal phalanx present on radiographs. Treatments for acute laminitis include anti-inflammatory drugs, anti-endotoxin therapy, vasodilators, antithrombotic therapy, corrective trimming and shoeing, and surgical procedures. Treatment regimens are very controversial and the true efficacy of these treatments is unknown. The quality of laminae damage that occurs with laminitis, however, probably has greater influence on the success of treatment and outcome of the horse than the treatment regimen itself.

  13. Perturbed Radius of Geosynchronous-Satellite Orbit

    NASA Astrophysics Data System (ADS)

    Kawase, Sei-Ichiro

    We analyze theoretically how the radius of geosynchronous orbits would vary owing to the perturbations due to the sun/moon gravity, solar radiation pressure, and the oblate earth. The analysis is simple, as it uses a diagrammatic method to solve near-circular orbital motions. Results are obtained in seven terms of corrections to the radius of non-perturbed ideal orbits. Each correction term is derived, with clear physical meaning, from each component of the perturbing forces.

  14. How to resolve the proton radius puzzle?

    NASA Astrophysics Data System (ADS)

    Paz, Gil

    2016-09-01

    In 2010 the first measurement of the proton charge radius from spectroscopy of muonic hydrogen was found to be five standard deviations away from the regular hydrogen value. Six years later, this ``proton radius puzzle'' is still unresolved. One of the most promising avenues to test the muonic hydrogen result is a new muon-proton scattering experiment called MUSE. We describe how effective field theory methods will allow to directly connect muonic hydrogen spectroscopy to muon-proton scattering.

  15. Diminished bone strength is observed in adult women and men who sustained a mild trauma distal forearm fracture during childhood.

    PubMed

    Farr, Joshua N; Khosla, Sundeep; Achenbach, Sara J; Atkinson, Elizabeth J; Kirmani, Salman; McCready, Louise K; Melton, L Joseph; Amin, Shreyasee

    2014-10-01

    Children and adolescents who sustain a distal forearm fracture (DFF) owing to mild, but not moderate, trauma have reduced bone strength and cortical thinning at the distal radius and tibia. Whether these skeletal deficits track into adulthood is unknown. Therefore, we studied 75 women and 75 men (age range, 20 to 40 years) with a childhood (age < 18 years) DFF and 150 sex-matched controls with no history of fracture using high-resolution peripheral quantitative computed tomography (HRpQCT) to examine bone strength (ie, failure load) by micro-finite element (µFE) analysis, as well as cortical and trabecular bone parameters at the distal radius and tibia. Level of trauma (mild versus moderate) was assigned using a validated classification scheme, blind to imaging results. When compared to sex-matched, nonfracture controls, women and men with a mild trauma childhood DFF (eg, fall from standing height) had significant reductions in failure load (p < 0.05) of the distal radius, whereas women and men with a moderate trauma childhood DFF (eg, fall while riding a bicycle) had values similar to controls. Consistent findings were observed at the distal tibia. Furthermore, women and men with a mild trauma childhood DFF had significant deficits in distal radius cortical area (p < 0.05), and significantly lower dual-energy X-ray absorptiometry (DXA)-derived bone density at the radius, hip, and total body regions compared to controls (all p < 0.05). By contrast, women and men with a moderate trauma childhood DFF had bone density, structure, and strength that did not differ significantly from controls. These findings in young adults are consistent with our observations in children/adolescents with DFF, and they suggest that a mild trauma childhood DFF may presage suboptimal peak bone density, structure, and strength in young adulthood. Children and adolescents who suffer mild trauma DFFs may need to be targeted for lifestyle interventions to help achieve improved skeletal health.

  16. Diminished Bone Strength Is Observed in Adult Women and Men Who Sustained a Mild Trauma Distal Forearm Fracture During Childhood

    PubMed Central

    Farr, Joshua N; Khosla, Sundeep; Achenbach, Sara J; Atkinson, Elizabeth J; Kirmani, Salman; McCready, Louise K; Melton, L Joseph; Amin, Shreyasee

    2015-01-01

    Children and adolescents who sustain a distal forearm fracture (DFF) owing to mild, but not moderate, trauma have reduced bone strength and cortical thinning at the distal radius and tibia. Whether these skeletal deficits track into adulthood is unknown. Therefore, we studied 75 women and 75 men (age range, 20 to 40 years) with a childhood (age <18 years) DFF and 150 sex-matched controls with no history of fracture using high-resolution peripheral quantitative computed tomography (HRpQCT) to examine bone strength (ie, failure load) by micro–finite element (µFE) analysis, as well as cortical and trabecular bone parameters at the distal radius and tibia. Level of trauma (mild versus moderate) was assigned using a validated classification scheme, blind to imaging results. When compared to sex-matched, nonfracture controls, women and men with a mild trauma childhood DFF (eg, fall from standing height) had significant reductions in failure load (p < 0.05) of the distal radius, whereas women and men with a moderate trauma childhood DFF (eg, fall while riding a bicycle) had values similar to controls. Consistent findings were observed at the distal tibia. Furthermore, women and men with a mild trauma childhood DFF had significant deficits in distal radius cortical area (p < 0.05), and significantly lower dual-energy X-ray absorptiometry (DXA)-derived bone density at the radius, hip, and total body regions compared to controls (all p < 0.05). By contrast, women and men with a moderate trauma childhood DFF had bone density, structure, and strength that did not differ significantly from controls. These findings in young adults are consistent with our observations in children/adolescents with DFF, and they suggest that a mild trauma childhood DFF may presage suboptimal peak bone density, structure, and strength in young adulthood. Children and adolescents who suffer mild trauma DFFs may need to be targeted for lifestyle interventions to help achieve improved skeletal

  17. Simultaneous bilateral distal biceps tendon repair: case report.

    PubMed

    Storti, Thiago Medeiros; Paniago, Alexandre Firmino; Faria, Rafael Salomon Silva

    2017-01-01

    Simultaneous bilateral rupture of the distal biceps tendon is a rare clinical entity, seldom reported in the literature and with unclear therapeutic setting. The authors report the case of a 39-year-old white man who suffered a simultaneous bilateral rupture while working out. When weightlifting with elbows at 90° of flexion, he suddenly felt pain on the anterior aspect of the arms, coming for evaluation after two days. He presented bulging contour of the biceps muscle belly and ecchymosis in the antecubital fossa, extending distally to the medial aspect of the forearm, as well as a marked decrease of supination strength and pain in active elbow flexion. MRI confirmed the rupture with retraction of the distal biceps bilaterally. The authors opted for performing the tendon repairs simultaneously through the double incision technique and fixation to the bicipital tuberosity with anchors. The patient progressed quite well, with full return to labor and sports activities, being satisfied with the result after two years of surgery. In the literature search, few reports of simultaneous bilateral rupture of the distal biceps were retrieved, with only one treated in the acute phase of injury. Therefore, the authors consider this procedure to be a good option to solve this complex condition.

  18. Distal clavicle fractures in children☆

    PubMed Central

    Labronici, Pedro José; da Silva, Ricardo Rodrigues; Franco, Marcos Vinícius Viana; Labronici, Gustavo José; Pires, Robinson Esteves Santos; Franco, José Sergio

    2015-01-01

    Objective To analyze fractures of the distal clavicle region in pediatric patients. Methods Ten patients between the ages of five to eleven years (mean of 7.3 years) were observed. Nine patients were treated conservatively and one surgically. All the fractures were classified using the Nenopoulos classification system. Results All the fractures consolidated without complications. Conservative treatment was used for nine patients, of whom three were in group IIIB, three IIb, two IIa and one IV. The only patient who was treated surgically was a female patient of eleven years of age with a group IV fracture. Conclusion The treatment indication for distal fractures of the clavicle in children should be based on the patient's age and the displacement of the fragments. PMID:26962489

  19. Distal esophageal spasm: an update.

    PubMed

    Achem, Sami R; Gerson, Lauren B

    2013-09-01

    Distal esophageal spasm (DES) is an esophageal motility disorder that presents clinically with chest pain and/or dysphagia and is defined manometrically as simultaneous contractions in the distal (smooth muscle) esophagus in ≥20% of wet swallows (and amplitude contraction of ≥30 mmHg) alternating with normal peristalsis. With the introduction of high resolution esophageal pressure topography (EPT) in 2000, the definition of DES was modified. The Chicago classification proposed that the defining criteria for DES using EPT should be the presence of at least two premature contractions (distal latency<4.5 s) in a context of normal EGJ relaxation. The etiology of DES remains insufficiently understood, but evidence links nitric oxide (NO) deficiency as a culprit resulting in a disordered neural inhibition. GERD frequently coexists in DES, and its role in the pathogenesis of symptoms needs further evaluation. There is some evidence from small series that DES can progress to achalasia. Treatment remains challenging due in part to lack of randomized placebo-controlled trials. Current treatment agents include nitrates (both short and long acting), calcium-channel blockers, anticholinergic agents, 5-phosphodiesterase inhibitors, visceral analgesics (tricyclic agents or SSRI), and esophageal dilation. Acid suppression therapy is frequently used, but clinical outcome trials to support this approach are not available. Injection of botulinum toxin in the distal esophagus may be effective, but further data regarding the development of post-injection gastroesophageal reflux need to be assessed. Heller myotomy combined with fundoplication remains an alternative for the rare refractory patient. Preliminary studies suggest that the newly developed endoscopic technique of per oral endoscopic myotomy (POEM) may also be an alternative treatment modality.

  20. Endoscopic Distal Tibiofibular Syndesmosis Arthrodesis.

    PubMed

    Lui, Tun Hing

    2016-04-01

    Chronic distal tibiofibular syndesmosis disruption can be managed by endoscopic arthrodesis of the syndesmosis. This is performed through the proximal anterolateral and posterolateral portals. The scar tissue and bone block are resected to facilitate the subsequent reduction of the syndesmosis. The reduction of the syndesmosis can be guided either arthroscopically or endoscopically. The tibial and fibular surfaces of the tibiofibular overlap can be microfractured to facilitate subsequent fusion.

  1. Titanium elastic nailing radius and ulna fractures in adolescents.

    PubMed

    Wall, Lindley; O'Donnell, June C; Schoenecker, Perry L; Keeler, Kathryn A; Dobbs, Matthew B; Luhmann, Scott J; Gordon, J Eric

    2012-09-01

    Over the last 40 years, anatomic reduction with plate stabilization has become the standard in adult patients with diaphyseal fractures of the radius and ulna. When operative fixation has been indicated in skeletally immature patients with these fractures, a variety of techniques have been reported, with intramedullary fixation becoming increasingly accepted. There is currently significant variability in the treatment of adolescents with forearm fractures. The purpose of this study was to investigate the clinical and radiographic outcomes in the adolescent population after intramedullary fixation of both bone forearm fractures. A retrospective review identified 32 patients 12-18 years of age who had undergone intramedullary fixation of both forearm bones in the past 20 years at our institution. Galeazzi, Monteggia, radial head, and distal metaphyseal fractures were excluded. Radiographic evaluation was performed to determine union and postoperative radial bow. Clinical follow-up was carried out for postoperative complications and range of motion of the wrist, forearm, and elbow. The mean age of the patients was 14.1 years. A total of 19 fractures were closed injuries, nine were grade 1, three were grade 2, and one fracture was a grade 3b. Of the patients, 15.6% had limited postoperative range of motion. All patients in the older age group, 15-18 years of age, had a normal range of motion. A decrease in radial bow was not associated with limitation in motion. There was a 98% union rate, and all unions occurred by 7.5 months. Only three major complications occurred, two refractures and one ulnar hardware migration, and subsequent radius nonunion occurred in the one grade 3b injury. Flexible intramedullary nailing of both bone forearm fractures provides reliable bony union and excellent postoperative clinical results in adolescents. Level of evidence, IV.

  2. Dorsal Capsuloplasty for Dorsal Instability of the Distal Ulna

    PubMed Central

    Kouwenhoven, S.T.P.; de Jong, T.; Koch, A.R.

    2013-01-01

    Background Dorsal instability of the distal ulna can lead to chronic wrist pain and loss of function. Structural changes to the dorsal radioulnar ligaments (DRUL) of the triangular fibrocartilage complex (TFCC) and the dorsal capsule around the ulnar head with or without foveal detachment can lead to volar subluxation of the distal radius e.g., dorsal instability of the distal ulna. Purpose Is to evaluate the post-operative results of reinstituting distal radioulnar joint (DRUJ) stability through reefing of the dorsal capsule and dorsal radioulnar ligaments, with and without a foveal reattachment of the TFCC. Methods A total of 37 patients were included in this retrospective study. Diagnosis and treatment was based strictly on dry wrist arthroscopy. In 17 patients isolated reefing of the DRUL and their collateral tissue extension was performed. In 20 patients an additional foveal reinsertion was performed. Postoperative results were evaluated with the DASH questionnaire, VAS scores, grip strength and range of motion. These findings were extrapolated in the Mayo wrist score. The two subgroups were compared. Results Mayo wrist scores of the whole population had a mean of 73. There was no difference between the group that was treated with reefing of the DRUL only and the group that was treated with a combined foveal reinsertion. Conclusion This relatively simple 'dorsal reefing' procedure, with foveal reinsertion when indicated, is a reliable method to restore volar-dorsal DRUJ stability with a significant decrease in pain sensation, good DASH scores and restoration of functional grip strength and ROM. Type of Study/Level of Evidence Therapeutic, Level IV. PMID:24436811

  3. Mass and radius of cosmic balloons

    NASA Technical Reports Server (NTRS)

    Wang, Yun

    1994-01-01

    Cosmic balloons are spherical domain walls with relativistic particles trapped inside. We derive the exact mass and radius relations for a static cosmic balloon using Gauss-Codazzi equations. The cosmic balloon mass as a function of its radius, M(R), is found to have a functional form similar to that of fermion soliton stars, with a fixed point at 2GM(R)/R approximately or equal to 0.486 which corresponds to the limit of infinite central density. We derive a simple analytical approximation for the mass density of a spherically symmetric relativistic gas star. When applied to the computation of the mass and radius of a cosmic balloon, the analytical approximation yields fairly good agreement with the exact numerical solutions.

  4. A Maximum Radius for Habitable Planets.

    PubMed

    Alibert, Yann

    2015-09-01

    We compute the maximum radius a planet can have in order to fulfill two constraints that are likely necessary conditions for habitability: 1- surface temperature and pressure compatible with the existence of liquid water, and 2- no ice layer at the bottom of a putative global ocean, that would prevent the operation of the geologic carbon cycle to operate. We demonstrate that, above a given radius, these two constraints cannot be met: in the Super-Earth mass range (1-12 Mearth), the overall maximum that a planet can have varies between 1.8 and 2.3 Rearth. This radius is reduced when considering planets with higher Fe/Si ratios, and taking into account irradiation effects on the structure of the gas envelope.

  5. Complex radius shaft malunion: osteotomy with computer-assisted planning.

    PubMed

    Schweizer, Andreas; Fürnstahl, Philipp; Harders, Matthias; Székely, Gábor; Nagy, Ladislav

    2010-06-01

    We report about two cases with a combined axial and angular malunion of the radius shaft with functional loss of pro-supination. For the preoperative planning, a computer simulation was developed that allows the quantification of the malunion by comparing the 3-d surface model of the impaired bone with the contralateral anatomy. The proximal parts of the left and right radii are superimposed, while the different positions of the distal parts are used to quantify the malunion. This task is performed fully automatically which reduces the overall planning time. The osteotomies were performed according to the results of the computer-aided planning. The first case showed 1 year postoperatively an increase of pronation from 40° to 70° at expense of supination from 95° to 90°. The patient was practically pain-free and reported functional improvement. The second case showed 6 months postoperatively an improvement of supination from 15° to 40° and of pronation from 50° to 60°. The computer-assisted operation planning facilitated the quantification of combined axial and angular malunions which were difficult to detect on plain radiographs.

  6. Mass and Radius of Neutron Stars Constrained by Photospheric Radius Expansion X-ray Bursts

    NASA Astrophysics Data System (ADS)

    Kwak, Kyujin; Kim, Myungkuk; Kim, Young-Min; Lee, Chang-Hwan

    Simultaneous measurement of mass and radius of a neutron star is important because it provides strong constraint on the equation of state for nuclear matter inside a neutron star. Type I X-ray Bursts (XRBs) that have been observed in low-mass X-ray binaries sometimes show photospheric radius expansion (PRE). By combining observed fluxes, X-ray spectra, and distances of PRE XRBs and using a statistical analysis, it is possible to simultaneously constrain the mass and radius of a neutron star. However, the mass and radius of a neutron star estimated in this method depends on the opacity of accreted material. We investigate the effect of the opacity on the mass and radius estimation by taking into account the cases that the hydrogen mass fraction of accreted material has narrowly-distributed values. We present preliminary results that are investigated with three different values of hydrogen mass fraction and compare our results with previous studies.

  7. Rapid resorption of calcium sulfate and hardware failure following corrective radius osteotomy: 2 case reports.

    PubMed

    Jepegnanam, Thilak S; von Schroeder, Herbert P

    2012-03-01

    Bone substitutes are being increasingly used and may avert the need for autogenous bone graft in orthopedic surgery. Thus it is important to note complications that occur with them to better understand the limitations. We report on early mechanical failure of injectable calcium sulfate leading to implant failure in 2 elderly patients who had corrective osteotomies for malunited distal radius fractures. We hypothesize that these occurred because there was inadequate new bone formation to replace the resorbing bone substitute. We advise caution when using bone substitutes in patients with expected delayed fracture healing.

  8. A Very Rare Presentation of Type 1 Monteggia Equivalent Fracture with Ipsilateral Fracture of Distal Forearm-approach with Outcome: Case Report

    PubMed Central

    Singh, Dhananjay; Awasthi, Bhanu; Padha, Vikas; Thakur, Sanjay

    2016-01-01

    Introduction: We report a case of Type 1 Monteggia equivalent injury with intact radio-capitellar congruity, associated with epiphyseal fracture of distal radius and distal ulna shaft in an 11-year-old boy. There are only a few cases of Monteggia or Monteggia equivalent injury with ipsilateral forearm fractures in children, and injury pattern being reported by us is not only rare but also the only case reported thus far to the best of our knowledge, Sood et al. described Type 1 equivalent with epiphyseal injuries of both radius and ulna Osada et al. also described injury pattern same as Sood et al. with epiphyseal separation in both distal radius and ulna. Our case was slightly different than above two in that distally, there was ulna shaft fracture with Salter Harris Type 2 epiphyseal separation in the radius. Case Report: An 11-year-old, right-hand dominant boy presented in casualty with a history of fall one day back with pain, swelling and deformity in the left forearm with bleeding from left forearm and loss of movement of fingers and thumb of the left hand. On examination, there was a wound of size one centimeter on mid-forearm over the ulnar aspect. Extension of fingers and thumb at metacarpophalangeal joints was lost with intact sensations suggestive of posterior interosseus nerve involvement. No vascular was deficit was present. X-rays were performed which suggested type two epiphyseal separation proximal radius with fracture shaft ulna with lateral angulation in elbow and proximal forearm. Radiocapitellar joint congruity was maintained in the views performed. X-rays of wrist suggested fracture both bones distal forearm epiphysis in distal radius and distal shaft in ulna. The patient was operated with toileting, debridement, and open reduction of proximal ulnar fracture with K-wire. Proximal radius epiphyseal separation was approached by Kocher approach and fixed with two K-wires, while for distal radius epiphyseal separation open reduction and internal

  9. Proton radius from electron scattering data

    NASA Astrophysics Data System (ADS)

    Higinbotham, Douglas W.; Kabir, Al Amin; Lin, Vincent; Meekins, David; Norum, Blaine; Sawatzky, Brad

    2016-05-01

    Background: The proton charge radius extracted from recent muonic hydrogen Lamb shift measurements is significantly smaller than that extracted from atomic hydrogen and electron scattering measurements. The discrepancy has become known as the proton radius puzzle. Purpose: In an attempt to understand the discrepancy, we review high-precision electron scattering results from Mainz, Jefferson Lab, Saskatoon, and Stanford. Methods: We make use of stepwise regression techniques using the F test as well as the Akaike information criterion to systematically determine the predictive variables to use for a given set and range of electron scattering data as well as to provide multivariate error estimates. Results: Starting with the precision, low four-momentum transfer (Q2) data from Mainz (1980) and Saskatoon (1974), we find that a stepwise regression of the Maclaurin series using the F test as well as the Akaike information criterion justify using a linear extrapolation which yields a value for the proton radius that is consistent with the result obtained from muonic hydrogen measurements. Applying the same Maclaurin series and statistical criteria to the 2014 Rosenbluth results on GE from Mainz, we again find that the stepwise regression tends to favor a radius consistent with the muonic hydrogen radius but produces results that are extremely sensitive to the range of data included in the fit. Making use of the high-Q2 data on GE to select functions which extrapolate to high Q2, we find that a Padé (N =M =1 ) statistical model works remarkably well, as does a dipole function with a 0.84 fm radius, GE(Q2) =(1+Q2/0.66 GeV2) -2 . Conclusions: Rigorous applications of stepwise regression techniques and multivariate error estimates result in the extraction of a proton charge radius that is consistent with the muonic hydrogen result of 0.84 fm; either from linear extrapolation of the extremely-low-Q2 data or by use of the Padé approximant for extrapolation using a larger

  10. Proton radius from electron scattering data

    SciTech Connect

    Higinbotham, Douglas W.; Kabir, Al Amin; Lin, Vincent; Meekins, David; Norum, Blaine; Sawatzky, Brad

    2016-05-01

    Background: The proton charge radius extracted from recent muonic hydrogen Lamb shift measurements is significantly smaller than that extracted from atomic hydrogen and electron scattering measurements. The discrepancy has become known as the proton radius puzzle. Purpose: In an attempt to understand the discrepancy, we review high-precision electron scattering results from Mainz, Jefferson Lab, Saskatoon, and Stanford. Methods: We make use of stepwise regression techniques using the F test as well as the Akaike information criterion to systematically determine the predictive variables to use for a given set and range of electron scattering data as well as to provide multivariate error estimates. Results: Starting with the precision, low four-momentum transfer (Q2) data from Mainz (1980) and Saskatoon (1974), we find that a stepwise regression of the Maclaurin series using the F test as well as the Akaike information criterion justify using a linear extrapolation which yields a value for the proton radius that is consistent with the result obtained from muonic hydrogen measurements. Applying the same Maclaurin series and statistical criteria to the 2014 Rosenbluth results on GE from Mainz, we again find that the stepwise regression tends to favor a radius consistent with the muonic hydrogen radius but produces results that are extremely sensitive to the range of data included in the fit. Making use of the high-Q2 data on GE to select functions which extrapolate to high Q2, we find that a Padé (N=M=1) statistical model works remarkably well, as does a dipole function with a 0.84 fm radius, GE(Q2)=(1+Q2/0.66GeV2)−2. Conclusions: Rigorous applications of stepwise regression techniques and multivariate error estimates result in the extraction of a proton charge radius that is consistent with the muonic hydrogen result of 0.84 fm; either from linear extrapolation of the extremely-low-Q2 data or by use of the Padé approximant for extrapolation using a larger range of

  11. Load/Strain Distribution between Ulna and Radius in the Mouse Forearm Compression Loading Model

    PubMed Central

    Lu, Yunkai; Thiagarajan, Ganesh; Nicolella, Daniel P.; Johnson, Mark L.

    2011-01-01

    Finite element analysis (FEA) of the mouse forearm compression loading model is used to relate strain distributions with downstream changes in bone formation and responses of bone cells. The objective of this study was to develop two FEA models – the first one with the traditional ulna only and the second one in which both the ulna and radius are included, in order to examine the effect of the inclusion of the radius on the strain distributions in the ulna. The entire mouse forearm was scanned using microCT and images were converted into FEA tetrahedral meshes using a suite of software programs. The performance of both linear and quadratic tetrahedral elements and coarse and fine meshes were studied. A load of 2 N was applied to the ulna/radius model and a 1.3 N load (based on previous investigations of load sharing between the ulna and radius in rats) was applied to the ulna only model for subsequent simulations. The results showed differences in the cross sectional strain distributions and magnitude within the ulna for the combined ulna/radius model versus the ulna only model. The maximal strain in the combined model occurred about 4 mm towards the distal end from the ulna mid-shaft in both models. Results from the FEA model simulations were also compared to experimentally determined strain values. We conclude that inclusion of the radius in FE models to predict strains during in vivo forearm loading increases the magnitude of the estimated ulna strains compared to those predicted from a model of the ulna alone but the distribution was similar. This has important ramifications for future studies to understand strain thresholds needed to activate bone cell responses to mechanical loading. PMID:21903442

  12. MASS-RADIUS RELATIONSHIPS FOR EXOPLANETS

    SciTech Connect

    Swift, D. C.; Eggert, J. H.; Hicks, D. G.; Hamel, S.; Caspersen, K.; Schwegler, E.; Collins, G. W.; Nettelmann, N.; Ackland, G. J.

    2012-01-01

    For planets other than Earth, particularly exoplanets, interpretation of the composition and structure depends largely on comparing the mass and radius with the composition expected given their distance from the parent star. The composition implies a mass-radius relation which relies heavily on equations of state calculated from electronic structure theory and measured experimentally on Earth. We lay out a method for deriving and testing equations of state, and deduce mass-radius and mass-pressure relations for key, relevant materials whose equation of state (EOS) is reasonably well established, and for differentiated Fe/rock. We find that variations in the EOS, such as may arise when extrapolating from low-pressure data, can have significant effects on predicted mass-radius relations and on planetary pressure profiles. The relations are compared with the observed masses and radii of planets and exoplanets, broadly supporting recent inferences about exoplanet structures. Kepler-10b is apparently 'Earth-like', likely with a proportionately larger core than Earth's, nominally 2/3 of the mass of the planet. CoRoT-7b is consistent with a rocky mantle over an Fe-based core which is likely to be proportionately smaller than Earth's. GJ 1214b lies between the mass-radius curves for H{sub 2}O and CH{sub 4}, suggesting an 'icy' composition with a relatively large core or a relatively large proportion of H{sub 2}O. CoRoT-2b is less dense than the hydrogen relation, which could be explained by an anomalously high degree of heating or by higher than assumed atmospheric opacity. HAT-P-2b is slightly denser than the mass-radius relation for hydrogen, suggesting the presence of a significant amount of matter of higher atomic number. CoRoT-3b lies close to the hydrogen relation. The pressure at the center of Kepler-10b is 1.5{sup +1.2}{sub -1.0} TPa. The central pressure in CoRoT-7b is probably close to 0.8 TPa, though may be up to 2 TPa. These pressures are accessible by planar

  13. Distal realignment (tibial tuberosity transfer).

    PubMed

    Feller, Julian Ashley

    2012-09-01

    Although tibial tuberosity (TT) transfer has for many years been the basis of many protocols for the management of patellar instability, the role of pure medial transfer in particular appears to be declining. In contrast, the greater recognition of the importance of patella alta as a predisposing factor to recurrent patellar dislocation has resulted in a resurgence in the popularity of distal TT transfer. When TT transfer is performed, the direction and amount of transfer is based on the patellar height and the lateralization of the TT relative to the trochlear groove. Patellar height is best assessed on a lateral radiograph with the knee in flexion using a ratio that uses the articular surface of the patella in relation to the height above the tibia. Assessment of lateralization of the TT relative to the trochlear groove can be made using either computed tomography or magnetic resonance imaging scans.

  14. The radius and albedo of Hyperion

    NASA Technical Reports Server (NTRS)

    Cruikshank, D. P.

    1979-01-01

    A measurement of the 20-micron thermal flux from Hyperion is reported, and the radius and surface geometric albedo of this outer satellite of Saturn are computed by the photometric/radiometric method. A corrected and normalized 20-micron thermal flux of 0.033 + or - 0.012 Jy is determined. A radius of 112 + or - 15 km and a surface geometric albedo of 0.47 + or - 0.11 are obtained by assuming values of unity for the phase integral, emissivity, and bolometric/visual geometric-albedo ratio. The sensitivity of the photometric/radiometric method to the assumed values of the parameters involved is discussed, and the results are compared with similar studies of Triton. It is concluded that neither Hyperion nor Triton appears to have a geometric albedo in the lower end of the distribution of small bodies in the solar system.

  15. Solar radius change between 1925 and 1979

    NASA Technical Reports Server (NTRS)

    Sofia, S.; Dunham, D. W.; Dunham, J. B.; Fiala, A. D.

    1983-01-01

    From an analysis of numerous reports from different locations on the duration of totality of the solar eclipses on January 24, 1925, and February 26, 1979, it is found that the solar radius at the earlier date was 0.5 arcsec (or 375 km) larger than at the later date. The correction to the standard solar radius found for each eclipse is different when different subsets of the observations are used (for example, edge of path of totality timings compared with central timings). This is seen as suggesting the existence of systematic inaccuracies in our knowledge of the lunar figure. The differences between the corrections for both eclipses, however, are very similar for all subsets considered, indicating that changes of the solar size may be reliably inferred despite the existence of the lunar figure errors so long as there is proper consideration of the distribution of the observations. These results are regarded as strong evidence in support of the occurrence of solar radius changes on shorter than evolutionary time scales.

  16. Electrode radius predicts lesion radius during radiofrequency energy heating. Validation of a proposed thermodynamic model

    SciTech Connect

    Haines, D.E.; Watson, D.D.; Verow, A.F. )

    1990-07-01

    Myocardial heating by transcatheter delivery of radiofrequency (RF) energy has been proposed as an effective means of arrhythmia ablation. A thermodynamic model describing the radial temperature gradient at steady state during RF-induced heating is proposed. If one assumes that RF power output is adjusted to maintain a constant electrode-tissue interface temperature at all times, then this thermodynamic model predicts that the radius of the RF-induced lesion will be directly proportional to the electrode radius. A total of 76 RF-induced lesions were created in a model of isolated canine right ventricular free wall perfused and superfused with oxygenated Krebs-Henseleit buffer. Electrode radius was varied between 0.75 and 2.25 mm. RF energy (500 kHz) was delivered for 90 seconds, and the power output was adjusted to maintain a constant electrode-tissue interface temperature of 60 degrees C. A strong linear correlation was observed between electrode radius and lesion radius in two dimensions: transverse (p = 0.0001, r = 0.85) and transmural (p = 0.0001, r = 0.89). With these data, the temperature correlation with irreversible myocardial injury in this model was calculated at 46.6-48.8 degrees C. Therefore, the proposed thermodynamic model closely predicts the observed relation between electrode radius and lesion size during RF myocardial heating.

  17. Outcome Assessment after Aptis Distal Radioulnar Joint (DRUJ) Implant Arthroplasty

    PubMed Central

    Kachooei, Amir Reza; Chase, Samantha M; Jupiter, Jesse B

    2014-01-01

    Background: Conventional treatments after complicated injuries of the distal radioulnar joint (DRUJ) such as Darrach and Kapandji-Sauvé procedures have many drawbacks, which may eventually lead to a painful unstable distal ulna. The development of DRUJ prosthesis has significantly evolved over the past years. In this study, we assessed the outcome results of patients after DRUJ implant arthroplasty using the Aptis (Scheker) prosthesis. Methods: We identified 13 patients with 14 prosthesis during the past 10 years. Patients underwent DRUJ arthroplasty due to persistent symptoms of instability, chronic pain, and stiffness. Records and follow-up visits were reviewed to find the final post-operative symptoms, pain, range of motion, and grip strength with a mean follow-up of 12 months (range: 2-25 months). Also, patients were contacted prospectively by phone in order to administer the disabilities of the arm shoulder and hand (DASH), patient rated wrist evaluation (PRWE), and visual analogue scale (VAS), and to interview regarding satisfaction and progress in daily activities. Eleven patients out of 13 could be reached with a median follow-up time of 60 months (range: 2 to 102 months). Results: No patient required removal of the prosthesis. Only two patients underwent secondary surgeries in which both required debridement of the screw tip over the radius. The median DASH score, PRWE score, VAS, and satisfaction were 1.3, 2.5, 0, and 10, respectively. The mean range of flexion, extension, supination, and pronation was 62, 54, 51, and 64, respectively. Conclusions: Distal radioulnar joint injuries are disabling and patients usually undergo one or more salvage surgeries prior to receiving an arthroplasty. The Scheker prosthesis has shown satisfactory results with 100% survival rate in all reports. The constrained design of this prosthesis gives enough stability to prevent painful subluxation. PMID:25386579

  18. Effects of odanacatib on the radius and tibia of postmenopausal women: improvements in bone geometry, microarchitecture, and estimated bone strength.

    PubMed

    Cheung, Angela M; Majumdar, Sharmila; Brixen, Kim; Chapurlat, Roland; Fuerst, Thomas; Engelke, Klaus; Dardzinski, Bernard; Cabal, Antonio; Verbruggen, Nadia; Ather, Shabana; Rosenberg, Elizabeth; de Papp, Anne E

    2014-08-01

    The cathepsin K inhibitor odanacatib (ODN), currently in phase 3 development for postmenopausal osteoporosis, has a novel mechanism of action that reduces bone resorption while maintaining bone formation. In phase 2 studies, odanacatib increased areal bone mineral density (aBMD) at the lumbar spine and total hip progressively over 5 years. To determine the effects of ODN on cortical and trabecular bone and estimate changes in bone strength, we conducted a randomized, double-blind, placebo-controlled trial, using both quantitative computed tomography (QCT) and high-resolution peripheral (HR-p)QCT. In previously published results, odanacatib was superior to placebo with respect to increases in trabecular volumetric BMD (vBMD) and estimated compressive strength at the spine, and integral and trabecular vBMD and estimated strength at the hip. Here, we report the results of HR-pQCT assessment. A total of 214 postmenopausal women (mean age 64.0 ± 6.8 years and baseline lumbar spine T-score -1.81 ± 0.83) were randomized to oral ODN 50 mg or placebo, weekly for 2 years. With ODN, significant increases from baseline in total vBMD occurred at the distal radius and tibia. Treatment differences from placebo were also significant (3.84% and 2.63% for radius and tibia, respectively). At both sites, significant differences from placebo were also found in trabecular vBMD, cortical vBMD, cortical thickness, cortical area, and strength (failure load) estimated using finite element analysis of HR-pQCT scans (treatment differences at radius and tibia = 2.64% and 2.66%). At the distal radius, odanacatib significantly improved trabecular thickness and bone volume/total volume (BV/TV) versus placebo. At a more proximal radial site, odanacatib attenuated the increase in cortical porosity found with placebo (treatment difference = -7.7%, p = 0.066). At the distal tibia, odanacatib significantly improved trabecular number, separation, and BV/TV versus placebo. Safety

  19. Tomographical description of tennis-loaded radius: reciprocal relation between bone size and volumetric BMD.

    PubMed

    Ashizawa, N; Nonaka, K; Michikami, S; Mizuki, T; Amagai, H; Tokuyama, K; Suzuki, M

    1999-04-01

    Effects of long-term tennis loading on volumetric bone mineral density (vBMD) and geometric properties of playing-arm radius were examined. Paired forearms of 16 tennis players (10 women) and 12 healthy controls (7 women), aged 18-24 yr, were scanned at mid and distal site by using peripheral quantitative computerized tomography. Tomographic data at midradius showed that tennis playing led to a slight decrease in cortical vBMD (-0.8% vs. nonplaying arm, P < 0. 05) and increase both in periosteal and endocoritcal bone area (+15. 2% for periosteal bone, P < 0.001; and +18.8% for endocortical bone, P < 0.001). These data suggest that, together with an increase in cortical thickness (+6.4%, P < 0.01), cortical drift toward periosteal direction resulted in improvement of mechanical characteristics of the playing-arm midradius. Enlargement of periosteal bone area was also observed at distal radius (+6.8%, P < 0.01), and the relative side-to-side difference in periosteal bone area was inversely related to that in trabecular vBMD (r = -0.53, P < 0.05). We conclude that an improvement of mechanical properties of young adult bone in response to long-term exercise is related to geometric adaptation but less to changes in vBMD.

  20. Taking Exomoons to the (Radius) Limit

    NASA Astrophysics Data System (ADS)

    Hinkel, Natalie R.; Kane, S. R.

    2014-01-01

    Moons around extrasolar planets are the next up-and-coming objects to be not only observed, but characterized for possible habitability. As with planets orbiting stars, exomoons have a limiting radius at which they are gravitationally bound, or the Hill radius. At a particular distance, they may also become tidally locked and therefore be in a synchronous rotation with the host-planet. We have examined the flux phase profile of a simulated, hypothetical moon orbiting at a distant radius around the confirmed exoplanets μ Ara b, HD 28185 b, BD +14 4559 b, and HD 73534 b. The irradiated flux on an exomoon at it's furthest, stable distance from the planet achieves its largest flux gradient, which places a limit on the flux ranges expected for subsequent (observed) moons closer in distance. We have also analyzed the effect of planetary eccentricity and time spent within the habitable zone on the flux on the moon. From stellar contributions alone, we find moons with host-planets fully within the habitable zone experience thermal equilibrium temperatures above the runaway greenhouse limit, requiring a small heat redistribution efficiency. In contrast, exomoons orbiting planets that only spend a fraction of their time within the habitable zone require a heat redistribution efficiency near 100% in order to achieve temperatures suitable for habitability. In other words, a planet might not need to spend its entire orbit within the habitable zone in order for the exomoon to be potentially habitable. In this way our findings separate exomoons and exoplanets, but it broadens the scope of worlds that may occupy a habitable zone.

  1. Treatment of a Complex Distal Triceps Tendon Rupture With a New Technique: A Case Report

    PubMed Central

    Aunon-Martin, Ismael; Prada-Canizares, Alfonso; Jimenez-Diaz, Veronica; Vidal-Bujanda, Carlos; Leon-Baltasar, Jose Luis

    2016-01-01

    Introduction: The distal triceps tendon rupture is an uncommon injury. The acute treatment is well-defined, but when a delayed diagnosis is made or when a tendon retraction is present the alternatives or reconstruction are limited and sometimes complex. Case Presentation: In this case, we report on a 28-year-old man who presented with a chronic disruption of the distal triceps tendon with a gap of approximately 15 cm. The patient was diagnosed in another center with an inveterate breakage of the distal triceps tendon and was initially treated with an Achilles allograft that was complicated by a wound infection and required more than ten surgeries. Nearly 22 months after the initial trauma, and 12 months after the first surgery, we performed a reconstruction with an Achilles tendon allograft using the new technique of distal attachment. At the 12-month follow-up the patient presented a joint balance from -5º to 110º and presented with no pain. Conclusions: The use of an Achilles tendon allograft provides excellent results in complex distal triceps tendon ruptures. We report the use of a new technique to anchor a distal Achilles allograft. PMID:27148500

  2. Clinical Outcomes and Complications of Cortical Button Distal Biceps Repair: A Systematic Review of the Literature

    PubMed Central

    Pantazis, Konstantinos

    2016-01-01

    Objectives. The purpose of the present study was to investigate the clinical outcomes and complications of the cortical button distal biceps fixation method. Material and Methods. All methods followed the PRISMA guidelines. Included studies had to describe clinical outcomes and complications after acute distal biceps repair with cortical button fixation. Eligibility criteria also included English language, more than 5 cases with minimum follow-up of 6 months, and preferably usage of at least one relevant clinical score (MEPS, ASES, and/or DASH) for final outcome. A loss of at least 30° in motion—flexion, extension, pronation, or supination—and a loss of at least 30% of strength were considered an unsatisfactory result. Results. The review identified 7 articles including 105 patients (mean age 43.6 years) with 106 acute distal biceps ruptures. Mean follow-up was 26.3 months. Functional outcome of ROM regarding flexion/extension and pronation/supination was satisfactory in 94 (89.5%) and 86 (82%) patients in respect. Averaged flexion and supination strength had been reported in 6/7 studies (97 patients) and were satisfactory in 82.4% of them. The most common complication was transient nerve palsy (14.2%). The overall reoperation rate was 4.8% (5/105 cases). Conclusion. Cortical button fixation for acute distal biceps repair is a reproducible operation with good clinical results. Most of the complications can be avoided with appropriate surgical technique. PMID:27525303

  3. An Exoplanet Radius and Transit Timing Survey

    NASA Astrophysics Data System (ADS)

    Deming, Drake; Jennings, Jonald; Sada, Pedro

    2010-02-01

    Many exoplanet systems contain Jupiter-mass planets on close-in orbits. Theories of planetary system formation account for these hot Jupiters as being end states of inward migration. Variants of those theories also predict terrestrial planets to be captured in mean motion resonance with the hot Jupiters. A continuing explosion of discoveries by transit surveys have given us a sample of 45 hot Jupiters transiting planets brighter than V=13. A transit timing survey of these systems could detect hot Earths in resonance, via the large (~ 180 second) perturbations they induce on the giant planet transits. Moreover, the discovery photometry for these systems usually provides only relatively coarse photometric precision, but larger-aperture follow-up can determine the giant planet radius to a precision limited only by knowledge of the stellar mass, and thereby reveal the diversity of giant exoplanet structure, such as the presence of heavy element cores. The relatively large sample now available means that a radius- and transit timing-survey is well matched to classical observing and telescope scheduling. We propose continued observations to perform transit photometry using FLAMINGOS on the 2.1-meter in the J-band, where stellar limb darkening is minimal and transit photometry has excellent sensitivity to planetary radii and shifts in transit time.

  4. An Exoplanet Radius and Transit Timing Survey

    NASA Astrophysics Data System (ADS)

    Deming, Drake; Jennings, Jonald; Sada, Pedro

    2009-08-01

    Many exoplanet systems contain Jupiter-mass planets on close-in orbits. Theories of planetary system formation account for these hot Jupiters as being end states of inward migration. Variants of those theories also predict terrestrial planets to be captured in mean motion resonance with the hot Jupiters. A recent explosion of discoveries by transit surveys have given us a sample of 37 hot Jupiters transiting planets brighter than V=13. A transit timing survey of these systems could detect hot Earths in resonance, via the large (~ 180 second) perturbations they induce on the giant planet transits. Moreover, the discovery photometry for these systems usually provides only relatively coarse photometric precision, but larger-aperture follow-up can determine the giant planet radius to a precision limited only by knowledge of the stellar mass, and thereby reveal the diversity of giant exoplanet structure, such as the presence of heavy element cores. The relatively large sample now available means that a radius- and transit timing-survey is well matched to classical observing and telescope scheduling. We propose continued observations to perform transit photometry using FLAMINGOS on the 2.1-meter in the J-band, where stellar limb darkening is minimal and transit photometry has excellent sensitivity to planetary radii and shifts in transit time.

  5. Premenopausal Women with a Distal Radial Fracture Have Deteriorated Trabecular Bone Density and Morphology Compared with Controls without a Fracture

    PubMed Central

    Rozental, Tamara D.; Deschamps, Laura N.; Taylor, Alexander; Earp, Brandon; Zurakowski, David; Day, Charles S.; Bouxsein, Mary L.

    2013-01-01

    Background: Measurement of bone mineral density by dual x-ray absorptiometry combined with clinical risk factors is currently the gold standard in diagnosing osteoporosis. Advanced imaging has shown that older patients with fragility fractures have poor bone microarchitecture, often independent of low bone mineral density. We hypothesized that premenopausal women with a fracture of the distal end of the radius have similar bone mineral density but altered bone microarchitecture compared with control subjects without a fracture. Methods: Forty premenopausal women with a recent distal radial fracture were prospectively recruited and matched with eighty control subjects without a fracture. Primary outcome variables included trabecular and cortical microarchitecture at the distal end of the radius and tibia by high-resolution peripheral quantitative computed tomography. Bone mineral density at the wrist, hip, and lumbar spine was also measured by dual x-ray absorptiometry. Results: The fracture and control groups did not differ with regard to age, race, or body mass index. Bone mineral density was similar at the femoral neck, lumbar spine, and distal one-third of the radius, but tended to be lower in the fracture group at the hip and ultradistal part of the radius (p = 0.06). Trabecular microarchitecture was deteriorated in the fracture group compared with the control group at both the distal end of the radius and distal end of the tibia. At the distal end of the radius, the fracture group had lower total density and lower trabecular density, number, and thickness compared with the control group (–6% to –14%; p < 0.05 for all). At the distal end of the tibia, total density, trabecular density, trabecular thickness, and cortical thickness were lower in the fracture group than in the control group (–7% to –14%; p < 0.01). Conditional logistic regression showed that trabecular density, thickness, separation, and distribution of trabecular separation remained

  6. Genetics Home Reference: distal hereditary motor neuropathy, type II

    MedlinePlus

    ... distal hereditary motor neuropathy, type II distal hereditary motor neuropathy, type II Enable Javascript to view the ... PDF Open All Close All Description Distal hereditary motor neuropathy, type II is a progressive disorder that ...

  7. Posttraumatic distal ulnar physeal arrest: a case report and review of the literature.

    PubMed

    Chimenti, Peter; Hammert, Warren

    2013-03-01

    We report the case of a 12-year-old male who sustained a Salter-Harris (SH) type IV physeal fracture of the distal ulna and a SH type II fracture of the distal radius. At 34 months later, he presented with activity-related wrist pain and ulnar variance of -17 mm. He successfully underwent ulnar distraction osteogenesis with radial closing wedge osteotomy. At 16-month follow-up, the patient denied wrist pain with activity, and imaging demonstrated ulnar variance of -3 mm. Epiphyseal fracture separations of the distal radius and ulna have the potential to cause early growth arrest and may become symptomatic as a result. High-energy mechanism, open fracture, number of reduction attempts, and age at injury can all increase the risk of premature closure. Therefore, we recommend longitudinal follow-up of patients with these injuries as earlier intervention may improve outcomes. When premature physeal closure is discovered early, treatment may include resection of the physeal bar, osteotomy with or without epiphysiodesis, and distraction osteogenesis.

  8. 21 CFR 886.1450 - Corneal radius measuring device.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Corneal radius measuring device. 886.1450 Section... (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1450 Corneal radius measuring device. (a) Identification. A corneal radius measuring device is an AC-powered device intended to...

  9. The treatment of distal radius articular fractures of C1-C2 type with DVR plate: analysis of 40 cases.

    PubMed

    Tarallo, L; Adani, R; Mugnai, R; Catani, F

    2011-12-01

    The aim of this investigation was to evaluate the efficiency of fixed angle plates DVR in the treatment of C1 and C2 type articular wrist fractures according to the AO classification. From July 2005 to March 2009, 40 wrist fractures were treated: 18 were of C1 type while 22 of C2 type according to AO classification. The age of patients varied from 25 to 79 years old. The average length of follow-up was 17 months (range, 4-37 months). The average articular motility was flexion 59.4° and extension 62.7°. Final radiographic parameters were of 18.7° of average ulnar inclination, 10.3° of average dorsal inclination, and 1.45 mm of negative ulnar variance. All patients were reassessed according to Mayo Modified Wrist Score getting a very good/good result in 82% of cases and a medium/poor one in 18%. The DASH score pulled off 46.3 points in the first group, 5.1 in the second group, and 6 in the third one. The statistical analysis based on Student's t test showed how C1 and C2 classification did not influence the results using the same treatment. DVR plate showed a very good reliability and a sufficient stability with both C1 and C2 fractures.

  10. The comparative risk of developing postoperative complications in patients with distal radius fractures following different treatment modalities

    PubMed Central

    Qiu, Wen-Jun; Li, Yi-Fan; Ji, Yun-Han; Xu, Wei; Zhu, Xiao-Dong; Tang, Xian-Zhong; Zhao, Huan-Li; Wang, Gui-Bin; Jia, Yue-Qing; Zhu, Shi-Cai; Zhang, Feng-Fang; Liu, Hong-Mei

    2015-01-01

    In this study, we performed a network meta-analysis to compare the outcomes of seven most common surgical procedures to fix DRF, including bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating. Published studies were retrieved through PubMed, Embase and Cochrane Library databases. The database search terms used were the following keywords and MeSH terms: DRF, bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating. The network meta-analysis was performed to rank the probabilities of postoperative complication risks for the seven surgical modalities in DRF patients. This network meta-analysis included data obtained from a total of 19 RCTs. Our results revealed that compared to DRF patients treated with bridging external fixation, marked differences in pin-track infection (PTI) rate were found in patients treated with plaster fixation, volar plating, and dorsal and volar plating. Cluster analysis showed that plaster fixation is associated with the lowest probability of postoperative complication in DRF patients. Plaster fixation is associated with the lowest risk for postoperative complications in DRF patients, when compared to six other common DRF surgical methods examined. PMID:26549312

  11. Genetics Home Reference: Laing distal myopathy

    MedlinePlus

    ... Laing distal myopathy is a condition that affects skeletal muscles, which are muscles that the body uses for ... in heart (cardiac) muscle and in type I skeletal muscle fibers. Type I fibers, which are also known ...

  12. Understanding the mass-radius relation for sub-Neptunes: radius as a proxy for composition

    SciTech Connect

    Lopez, Eric D.; Fortney, Jonathan J.

    2014-09-01

    Transiting planet surveys like Kepler have provided a wealth of information on the distribution of planetary radii, particularly for the new populations of super-Earth- and sub-Neptune-sized planets. In order to aid in the physical interpretation of these radii, we compute model radii for low-mass rocky planets with hydrogen-helium envelopes. We provide model radii for planets 1-20 M {sub ⊕}, with envelope fractions 0.01%-20%, levels of irradiation 0.1-1000 times Earth's, and ages from 100 Myr to 10 Gyr. In addition we provide simple analytic fits that summarize how radius depends on each of these parameters. Most importantly, we show that at fixed H/He envelope fraction, radii show little dependence on mass for planets with more than ∼1% of their mass in their envelope. Consequently, planetary radius is to a first order a proxy for planetary composition, i.e., H/He envelope fraction, for Neptune- and sub-Neptune-sized planets. We recast the observed mass-radius relationship as a mass-composition relationship and discuss it in light of traditional core accretion theory. We discuss the transition from rocky super-Earths to sub-Neptune planets with large volatile envelopes. We suggest ∼1.75 R {sub ⊕} as a physically motivated dividing line between these two populations of planets. Finally, we discuss these results in light of the observed radius occurrence distribution found by Kepler.

  13. MASS-RADIUS RELATIONSHIPS FOR VERY LOW MASS GASEOUS PLANETS

    SciTech Connect

    Batygin, Konstantin; Stevenson, David J.

    2013-05-20

    Recently, the Kepler spacecraft has detected a sizable aggregate of objects, characterized by giant-planet-like radii and modest levels of stellar irradiation. With the exception of a handful of objects, the physical nature, and specifically the average densities, of these bodies remain unknown. Here, we propose that the detected giant planet radii may partially belong to planets somewhat less massive than Uranus and Neptune. Accordingly, in this work, we seek to identify a physically sound upper limit to planetary radii at low masses and moderate equilibrium temperatures. As a guiding example, we analyze the interior structure of the Neptune-mass planet Kepler-30d and show that it is acutely deficient in heavy elements, especially compared with its solar system counterparts. Subsequently, we perform numerical simulations of planetary thermal evolution and in agreement with previous studies, show that generally, 10-20 M{sub Circled-Plus }, multi-billion year old planets, composed of high density cores and extended H/He envelopes can have radii that firmly reside in the giant planet range. We subject our results to stability criteria based on extreme ultraviolet radiation, as well as Roche-lobe overflow driven mass-loss and construct mass-radius relationships for the considered objects. We conclude by discussing observational avenues that may be used to confirm or repudiate the existence of putative low mass, gas-dominated planets.

  14. The Sauve-Kapandji procedure for post-traumatic disorders of the distal radio-ulnar joint.

    PubMed

    Carter, P B; Stuart, P R

    2000-09-01

    We present the results of a retrospective series of 41 Sauve-Kapandji procedures carried out for complications of fractures of the distal radius. All the operations were undertaken by one surgeon with a mean follow-up of 32 months. A total of 37 patients was available for clinical review. The indications for surgery were pain on the ulnar side of the wrist and decreased rotation of the forearm. Intraperiosteal and extraperiosteal techniques were used for resection of the ulna, with no difference in outcome. Patients were assessed for pain, rotation of the forearm and complications. A Mayo Modified Wrist Score was used. Pain was improved in 25 of the 37 patients, and unchanged in ten. Rotation of the forearm returned to within 7 degrees of the uninjured side. The results are discussed in relation to the presence of preoperative malunion of the distal radius, age and the functional outcome. Age is not a contraindication for this procedure.

  15. Spontaneous rupture of the distal iliopsoas tendon: clinical and imaging findings, with anatomic correlations.

    PubMed

    Lecouvet, Frederic E; Demondion, Xavier; Leemrijse, Thibaut; Vande Berg, Bruno C; Devogelaer, Jean-Pierre; Malghem, Jacques

    2005-11-01

    We report the clinical and imaging findings in two elderly female patients with spontaneous rupture of the distal iliopsoas tendon from the lesser trochanter of the femur. We emphasize the key contribution of magnetic resonance (MR) imaging to this diagnosis and provide an anatomic correlation. Spontaneous rupture of the distal iliopsoas tendon should be kept in mind in the differential diagnosis of acute groin pain in the elderly. MR imaging enables positive diagnosis, by showing mass effect on the anterior aspect of the hip joint, proximal muscle thickening, and abnormal signal intensity, and by demonstrating interruption of the psoas tendon, whereas the distal insertion of the lateral portion of the iliacus muscle remains muscular and is preserved.

  16. Distal Radial Fractures in the Superelderly: Does Malunion Affect Functional Outcome?

    PubMed Central

    Clement, N. D.; Duckworth, A. D.; Court-Brown, C. M.; McQueen, M. M.

    2014-01-01

    Purpose. The management of unstable distal radial fractures in the superelderly (≥80 years old) remains controversial. The aim of this study was to compare the functional outcome of super-elderly patients with and without malunion after a distal radial fracture. Methods. We identified 51 superelderly patients living independently with displaced fractures from a prospective database of 4024 patients with distal radial fractures. Activities of daily living, presence of wrist pain, whether the wrist had returned to its normal level function, grip strength and ROM were recorded. The dorsal angulation was measured radiographically. Results. There were 17 (33.3%) patients defined to have a malunion. The outcomes of the independent patients with and without malunion were compared at a mean follow-up of 15 months. No difference was observed in activities of daily living (P = 0.28), wrist pain (P = 0.14), whether the wrist had returned to its normal level function (P = 0.25), grip strength (P = 0.31), or ROM (P = 0.41). An increasing degree of dorsal angulation correlated with diminished ROM (P = 0.038), but did not correlate with activities of daily living (P = 0.10). Conclusions. Malunion of the distal radius does not influence the functional outcome of independent superelderly patients. PMID:24967123

  17. Corrective osteotomy of distal radial deformities: a new method of guided locking fixed screw positioning.

    PubMed

    Farshad, M; Hess, F; Nagy, L; Schweizer, A

    2013-01-01

    Corrective osteotomy for distal radial malunion is a valuable but at times technically challenging operation. We have developed a new device to aid in the performance of the operation. We compared clinical use of the new technique with the standard technique. In 11 patients treated with the new technique the volar locking plate needed repositioning only once. With the standard technique in 17 patients the plate was repositioned in nine cases and needed bending in six cases. The new method corrected radial inclination (SD of 3° vs. 9°) and ulnar variance (SD of 0.9 mm vs. 1.4 mm) more predictably than the standard technique but there was no advantage in correction of volar tilt (SD of 6° vs. 4°). In our experience the new device makes corrective osteotomy of the distal radius easier and more reliable.

  18. Closed reduction versus Kapandji-pinning for extra-articular distal radial fractures.

    PubMed

    Stoffelen, D V; Broos, P L

    1999-02-01

    In a randomized prospective trial, treatment of extra-articular distal radial fractures by closed reduction and plaster application was compared with Kapandji-pinning. Closed reduction and plaster cast was used in 50 patients, Kapandji-pinning in 48 patients. According to the Cooney score, good and excellent results were found in the closed reduction and plaster cast group in 74%, compared with 75% in the Kapandji-pinning group. After measuring the maintenance of reduction as well as the functional outcome at 1 year follow-up, no statistically significant differences could be found between the two groups. We conclude that both techniques can be used in treating extra-articular fractures of the distal radius.

  19. Contact mechanics of reverse engineered distal humeral hemiarthroplasty implants.

    PubMed

    Willing, Ryan; King, Graham J W; Johnson, James A

    2015-11-26

    Erosion of articular cartilage is a concern following distal humeral hemiarthroplasty, because native cartilage surfaces are placed in contact with stiff metallic implant components, which causes decreases in contact area and increases in contact stresses. Recently, reverse engineered implants have been proposed which are intended to promote more natural contact mechanics by reproducing the native bone or cartilage shape. In this study, finite element modeling is used in order to calculate changes in cartilage contact areas and stresses following distal humeral hemiarthroplasty with commercially available and reverse engineered implant designs. At the ulna, decreases in contact area were -34±3% (p=0.002), -27±1% (p<0.001) and -14±2% (p=0.008) using commercially available, bone reverse engineered and cartilage reverse engineered designs, respectively. Peak contact stresses increased by 461±57% (p=0.008), 387±127% (p=0.229) and 165±16% (p=0.003). At the radius, decreases in contact area were -21±3% (p=0.013), -13±2% (p<0.006) and -6±1% (p=0.020), and peak contact stresses increased by 75±52% (p>0.999), 241±32% (p=0.010) and 61±10% (p=0.021). Between the three different implant designs, the cartilage reverse engineered design yielded the largest contact areas and lowest contact stresses, but was still unable to reproduce the contact mechanics of the native joint. These findings align with a growing body of evidence indicating that although reverse engineered hemiarthroplasty implants can provide small improvements in contact mechanics when compared with commercially available designs, further optimization of shape and material properties is required in order reproduce native joint contact mechanics.

  20. An X-ray template assessment for distal radial fractures

    PubMed Central

    Lindeboom, R.; Oosterkamp, A. E.; Goslings, J. C.

    2007-01-01

    Background The current method for radiological measurements on plain X-rays of distal radius fractures is unreliable. We examined the reproducibility of a new X-ray assessment technique—where the uninjured side is used as a template for the injured side—compared to the conventional assessment technique. Methods X-rays of 30 patients with a unilateral distal radial fracture were included reflecting the prevalence of AO fracture types in clinical practice. Eight experienced observers assessed these X-rays on two separated occasions (2-month interval) using the traditional measurement technique and the template technique. Reproducibility of the X-ray assessments was quantified by intraclass correlations and weighted kappa coefficients. Results The reproducibility of the radial length measurement did not improve nor did the volar angulation measurement. However, marked improvement in reproducibility was observed for the radial inclination measurement, the kappa increased from 0.36 (95 % CI; 0.30–0.41) to 0.49 (95 % CI; 0.43–0.55) in the template technique. As a result, the classification of the reduction results (Lidström score) greatly improved. The overall kappa for the Lidström score improved from 0.37 (95 % CI; 0.31/0.43) to 0.59 (0.52/0.63). Conclusion The assessment technique using the uninjured side as a template for the injured side resulted only in an improved reproducibility of the radial inclination measurement which in turn resulted in an improved classification reproducibility of the reduction results. PMID:17622544

  1. Fragmentation of a jet with small radius

    NASA Astrophysics Data System (ADS)

    Dai, Lin; Kim, Chul; Leibovich, Adam K.

    2016-12-01

    In this paper, we consider the fragmentation of a parton into a jet with small jet radius R . Perturbatively, logarithms of R can appear, which for narrow jets can lead to large corrections. Using soft-collinear effective theory, we introduce the fragmentation function to a jet (FFJ), which describes the fragmentation of a parton into a jet. We discuss how these objects are related to the standard jet functions. Calculating the FFJ to next-to-leading order, we show that these objects satisfy the standard Dokshitzer-Gribov-Lipatov-Altarelli-Parisi evolution equations, with a natural scale that depends upon R . By using the standard renormalization group evolution, we can therefore resum logarithms of R . We further use the soft-collinear effective theory to prove a factorization theorem where the FFJs naturally appear, for the fragmentation of a hadron within a jet with small R . Finally, we also show how this formalism can be used to resum the ratio of jet radii for a subjet to be emitted from within a fat jet.

  2. On Galaxy Mass-Radius Relationship

    NASA Astrophysics Data System (ADS)

    Bindoni, D.; Secco, L.; Contini, E.; Caimmi, R.

    In the Clausius' virial maximum theory (TCV) [Secco and Bindoni, NewA 14, 567 (2009)] to explain the galaxy Fundamental Plane (FP) a natural explanation follows about the observed relationship between stellar mass and effective radius, M ∗ - r e , for early type galaxies (ETGs). The key of this correlation lies in the deep link which has to exist between cosmology and the existence of the FP. The general strategy consists in using the two-component tensor virial theorem to describe the virial configuration of the baryonic component of mass M B ≃ M ∗ embedded in a dark matter (DM) halo of mass M D at the end of relaxation phase. In a ΛCDM flat cosmology, starting from variance at equivalence epoch, we derive some preliminary theoretical relationships, M ∗ - r e , which are functions of mass ratio m = M D / M B . They appear to be in agreement with the trends extracted from the data of galaxy sample used by [Tortora et al., MNRAS 396, 1132 (2009)].

  3. Experimental study of finite Larmor radius effects

    SciTech Connect

    Struve, K.W.

    1980-08-01

    Linear Z-pinches in Ar, Kr, Xe, N/sub 2/, and He are experimentally studied in regimes where strong finite Larmor radius effects could provide a significant stabilizing effect. Scaling arguments show that for deuterium such a pinch has an electron line density of order 2 x 10/sup 15//cm. For higher Z plasmas a higher line density is allowed, the exact value of which depends on the average ion charge. The pinch is formed by puffing gas axially through the cathode towards the anode of an evacuated pinch chamber. When the gas reaches the anode, the pinch bank is fired. The pinch current rises in 2 to 3 ..mu..sec to a maximum of 100 to 200 kA. The pinch bank capacitance is 900 ..mu..F, and the external inductance is 100 nH. Additionally, the bank is fused to increase dI/dt. The primary diagnostics are a framing camera, a spatially resolved Mach-Zehnder interferometer, and X-ray absorption.

  4. New Physics and the Proton Radius Problem

    SciTech Connect

    Carl E. Carlson, Benjamin C. Rislow

    2012-08-01

    Background: The recent disagreement between the proton charge radius extracted from Lamb shift measurements of muonic and electronic hydrogen invites speculation that new physics may be to blame. Several proposals have been made for new particles that account for both the Lamb shift and the muon anomalous moment discrepancies. Purpose: We explore the possibility that new particles' couplings to the muon can be fine-tuned to account for all experimental constraints. Method: We consider two fine-tuned models, the first involving new particles with scalar and pseudoscalar couplings, and the second involving new particles with vector and axial couplings. The couplings are constrained by the Lamb shift and muon magnetic moments measurements while mass constraints are obtained by kaon decay rate data. Results: For the scalar-pseudoscalar model, masses between 100 to 200 MeV are not allowed. For the vector model, masses below about 200 MeV are not allowed. The strength of the couplings for both models approach that of electrodynamics for particle masses of about 2 GeV. Conclusions: New physics with fine tuned couplings may be entertained as a possible explanation for the Lamb shift discrepancy.

  5. [Correction of posttraumatic disorders of the distal radio-ulnar joint with the Sauvé-Kapandji surgical procedure].

    PubMed

    Voche, P; Van Overstraeten, L; Merle, M

    1993-01-01

    The Sauve-Kapandji procedure was performed on 21 patients with posttraumatic lesions between May of 1985 and May of 1991; average clinical and radiological follow-up was 3.4 years. Causal mechanisms were as follows: 12 cases were sequelae of fractures of the distal extremity of the radius; 5 cases were sequelae of fractures of the diaphyses of the two forearm bones and/or of the head of the radius; 2 cases of instability of the distal radio-ulnar joint; 2 cases of posttraumatic isolated arthritis of the distal radio-ulnar joint. Subjective evaluation by the patients of the results of surgery was as follows: 8 excellent, 6 good, 2 satisfactory and 5 poor. The most consistent improvement was a gain of mobility in pronation and supination which averaged 87 per cent of that of the healthy contralateral side. Nine patients were free of pain, 6 experienced some pain only during effort, and 6 still suffered constant pain. Grip strength was the factor that changed the most: it averaged 55 per cent of that of the healthy contralateral side. Indications for the Sauve-Kapandji procedure and its results in posttraumatic lesions are discussed. This procedure is compared to other techniques used to correct posttraumatic disorders of the distal radio-ulnar joint.

  6. Sextant of Sapphires for Molar Distalization

    PubMed Central

    Palla, Yudistar Venkata; Ganugapanta, Vivek Reddy

    2016-01-01

    Introduction Space analysis quantifies the amount of crowding within the arches estimating the severity of space discrepancy. The space gaining procedures include extraction and non-extraction procedures like expansion, proximal stripping and molar distalization. Aim To identify features seen in molar distalization cases. Materials and Methods The sample size comprised 20 patients in whom molar distalization was decided as the treatment plan. The study models and lateral cephalograms of all the patients were taken. Occlusograms were obtained. Model analysis and cephalometric analysis were performed. Descriptive statistical analysis like mean, standard deviation, standard error and mode were done. Results The parameters in Question gave following results. The Bolton analysis showed anterior mandibular excess with mean value of 1.56mm±1.07. The first order discrepancy between maxillary central and lateral incisors was 5±1.95. The premolar rotation showed mean value of 16.58±5.12. The molar rotation showed the value of 7.66±2.26. The nasolabial angle showed the mean of 101.25±8.7 IMPA of 101.4±5.74. Conclusion The six features studied in molar distalization cases [First order discrepancy between upper central and lateral incisors; Rotation of premolars and molars; Bolton’s discrepancy in anterior dentition; Average to horizontal growth pattern; Proclined lower incisors and Obtuse nasolabial angle] can be taken as patterns seen in molar distalization cases and considered as a valid treatment plan. PMID:27656572

  7. Symptomatic Growth of a Thrombosed Persistent Sciatic Artery Aneurysm after Bypass and Distal Exclusion

    PubMed Central

    Kim, Song-Yi; Cho, Sungsin; Cho, Min-Ji; Min, Sang-il; Ahn, Sanghyun; Ha, Jongwon; Min, Seung-Kee

    2017-01-01

    A 71-year-old woman presented with an enlarging mass in the right buttock, with pain and tingling sensation in sitting position. Five years ago, she was diagnosed with acute limb ischemia due to acute thrombosis of right persistent sciatic artery (PSA), and she underwent successful thromboembolectomy and femoro-tibioperoneal trunk bypass. Computed tomography angiography revealed a huge PSA aneurysm (PSAA). During the previous bypass, the distal popliteal artery was ligated just above the distal anastomosis to exclude the PSAA, whose proximal end was already thrombosed. However, PSAA has grown to cause compression symptoms, and the mechanism of aneurysm growth can be ascribed to type 1a or type 2 endoleak. In order to relieve the compression symptoms, aneurysm excision was performed without any injury to the sciatic nerve. A postoperative tingling sensation due to sciatic-nerve stimulation in the supine position resolved spontaneously one month after surgery. PMID:28377910

  8. Surgical approach for elastic stable intramedullary nail in pediatric radius shaft fracture: a systematic review.

    PubMed

    Nørgaard, Sandra L; Riber, Sara S; Danielsson, Frederik B; Pedersen, Niels W; Viberg, Bjarke

    2017-04-05

    When using elastic stable intramedullary nailing in children's distal radius shaft fractures, the surgical approach can either be lateral or dorsal. The aim of this article was to carry out a systematic review of the literature comparing the two types of approaches in terms of complications. An electronic search of databases was performed. Titles of articles were screened, and abstracts and full text were read. Data were extracted in terms of demographics and complications. The dorsal approach had a 2.6% rate of extensor pollicis longus tendon rupture, whereas the lateral approach had a 2.9% rate of transient superficial radial nerve palsy and 0.3% rate of permanent damage. These complications should be considered when deciding between the two surgical approaches.

  9. Fabrication and Evaluation of a Noncompliant Molar Distalizing Appliance: Bonded Molar Distalizer

    PubMed Central

    Sodagar, A.; Ahmad Akhoundi, M. S.; Rafighii, A.; Arab, S.

    2011-01-01

    Objective Attempts to treat class II malocclusions without extraction in non-compliant patients have led to utilization of intraoral molar distalizing appliances. The purpose of this study was to investigate dental and skeletal effects of Bonded Molar Distalizer (BMD) which is a simple molar distalizing appliance. Materials and Methods Sixteen patients (12 girls, four boys) with bilateral half-cusp class II molar relationship, erupted permanent second molars and normal or vertical growth pattern were selected for bilateral distalization of maxillary molars via BMD. The screws were activated every other day, alternately. Lateral cephalograms and study models were obtained before treatment and after 11 weeks activation of the appliance. Results Significant amounts of molar distalization, molar distal tipping and anchorage loss were observed. The mean maxillary first molar distal movement was 1.22±0.936 mm with a distal tipping of 2.97±3.74 degrees in 11 weeks. The rate of distal movement was 0.48 mm per month. Reciprocal mesial movement of the first premolars was 2.26±1.12 mm with a mesial tipping of 4.25±3.12 degrees. Maxillary incisors moved 3.55±1.46 mm and tipped 9.87±5.03 degrees mesially. Lower anterior face height (LAFH) decreased 1.28±1.36 mm. Conclusion BMD is appropriate for distalizing maxillary molars, especially in patients with critical LAFH, although significant amounts of anchorage loss occur using this appliance. PMID:22457837

  10. Treatment of a fistula at the distal anastomosis after Bentall operation with endoluminal covered stent.

    PubMed

    Roux, Daniel; Brouchet, Laurent; Rousseau, Hervé; Elghobary, Tamer; Glock, Yves; Fournial, Gérard

    2002-12-01

    A 25-year-old Marfan patient was operated on for an acute type A aortic dissection that was complicated twice by false aneurysms at the distal suture line. At the third episode a covered endoprosthesis was inserted in the ascending aorta between the coronary ostia and the inominate artery. The postoperative course was uneventful and a control computed tomographic scan showed complete occlusion of the false aneurysm. This attractive technique should be considered versus an open-heart operation in selected patients.

  11. Osteochondritis of the Distal Tibial Epiphysis

    PubMed Central

    EL Hajj, Firass; Sebaaly, Amer; Kharrat, Khalil; Ghanem, Ismat

    2012-01-01

    Osteochondritis of the distal tibial epiphysis is a very rare entity. 9 cases have been described in 7 articles and 8 other cases have been mentioned in textbooks. This paper describes the 10th case of osteochondritis of the distal tibial epiphysis and summarizes the clinical and radiological presentations of the 9 other cases. The etiology of this entity is well debated in the literature. We believe that it results from a vascular abnormality in the distal tibial epiphysis associated with a mechanical stress (trauma, excessive overload, etc.). Since it is a self-limited disease, the prognosis is good and the younger the patient is the better the prognosis will be. In general, this entity responds well to conservative treatment. PMID:23193412

  12. Tidal radius estimates for three open clusters

    NASA Astrophysics Data System (ADS)

    Danilov, V. M.; Loktin, A. V.

    2015-10-01

    A new method is developed for estimating tidal radii and masses of open star clusters (OCL) based on the sky-plane coordinates and proper motions and/or radial velocities of cluster member stars. To this end, we perform the correlation and spectral analysis of oscillations of absolute values of stellar velocity components relative to the cluster mass center along three coordinate planes and along each coordinate axis in five OCL models. Mutual correlation functions for fluctuations of absolute values of velocity field components are computed. The spatial Fourier transform of the mutual correlation functions in the case of zero time offset is used to compute wavenumber spectra of oscillations of absolute values of stellar velocity components. The oscillation spectra of these quantities contain series of local maxima at equidistant wavenumber k values. The ratio of the tidal radius of the cluster to the wavenumber difference Δ k of adjacent local maxima in the oscillation spectra of absolute values of velocity field components is found to be the same for all five OCL models. This ratio is used to estimate the tidal radii and masses of the Pleiades, Praesepe, and M67 based on the proper motions and sky-plane coordinates of the member stars of these clusters. The radial dependences of the absolute values of the tangential and radial projections of cluster star velocities computed using the proper motions relative to the cluster center are determined, along with the corresponding autocorrelation functions and wavenumber spectra of oscillations of absolute values of velocity field components. The Pleiades virial mass is estimated assuming that the cluster is either isolated or non-isolated. Also derived are the estimates of the Pleiades dynamical mass assuming that it is non-stationary and non-isolated. The inferred Pleiades tidal radii corresponding to these masses are reported.

  13. Contemporary Management of Primary Distal Urethral Cancer.

    PubMed

    Traboulsi, Samer L; Witjes, Johannes Alfred; Kassouf, Wassim

    2016-11-01

    Primary urethral cancer is one of the rare urologic tumors. Distal urethral tumors are usually less advanced at diagnosis compared with proximal tumors and have a good prognosis if treated appropriately. Low-stage distal tumors can be managed successfully with a surgical approach in men or radiation therapy in women. There are no clear-cut indications for the choice of the most appropriate treatment modality. Organ-preserving modalities have shown effective and should be used whenever they do not compromise the oncological safety to decrease the physical and psychological trauma of dismemberment or loss of sexual/urinary function.

  14. Distal Femur Locking Plate: The Answer to All Distal Femoral Fractures

    PubMed Central

    Garg, Sudhir Kumar; Gupta, Parmanand; Jangira, Vivek; Singh, Jagdeep; Rana, Sudhir

    2016-01-01

    Introduction Good results have been published by researchers with distal femur nail, dynamic condylar screw and even addition of a medial plate to a distal femur locking plate for treating distal femur fractures. By this study, we explore the capability of a distal femur locking plate to counter distal femur fractures of extra- articular, partial or intra- articular nature. Positive results have been published by various groups from all over the world. Aim To study the functional and radiological outcome of distal femoral fractures in skeletally mature patients treated by open reduction and internal fixation with distal femur locking plate. Materials and Methods This was a prospective study conducted from January 2012 to March 2014 at the Government Medical College and Hospital (GMCH) with a 2 year follow-up. Twenty five skeletally mature patients with post-traumatic distal femur fractures were included. Patients with open grade 3B and 3C distal femur fractures, according to the Gustilo- Anderson classification and pathological distal femur fractures were excluded from the study. Patients with any fracture other than the distal femur in the ipsilateral limb were excluded from the study. Follow-up at 3 months, 6 months, 1 year and 2 years was carried out and evaluation was done according to the Neer scoring system. The statistical data analysis was carried out using SPSS version 20 (IBM, Chicago, USA). The p-value <0.05 was considered significant. Results Following all principles of fracture reduction, union was achieved in all patients with mean time to radiological union being 19 weeks. The mean Range of Motion (ROM) was 109 degrees with 20 patients having a Neer score graded as excellent to satisfactory. Our study had nine cases which required additional surgeries. Out of these, all nine cases required bone grafting, three also required antibiotic cement bead insertion initially. Three patients developed complications in the form of infection (two cases) and mal

  15. Reconstruction of the Distal Oblique Bundle of the Interosseous Membrane: A Technique to Restore Distal Radioulnar Joint Stability.

    PubMed

    Riggenbach, Michael D; Wright, Thomas W; Dell, Paul C

    2015-11-01

    The distal radioulnar ligament reconstruction is a technique that may be used for distal radioulnar joint instability without arthritis and failed nonsurgical management; clinical results demonstrate resolved or improved stability. Recent literature has focused on the distal oblique bundle of the interosseous membrane and its contributions to stability. This article describes a technically simple surgical technique to reconstruct the distal oblique bundle and restore distal radioulnar joint stability.

  16. Radius of Paranthropus robustus from member 1, Swartkrans formation, South Africa.

    PubMed

    Grine, F E; Susman, R L

    1991-03-01

    Recently recovered hominid postcrania from Member 1, Swartkrans Formation include the proximal and distal ends of a right radius attributed to a single individual of Paranthropus robustus. These fossils are essentially similar to Australopithecus afarensis, A. africanus, and P. boisei homologues. The head manifests an ape-like circumferentia articularis, and the distal end has prominent medial, dorsal, and lateral tubercles and a well developed brachioradialis crest, features also commonly exhibited by extant great apes. The volar set of the P. robustus radiocarpal joint, like that of Australopithecus homologues, more closely resembles the neutral condition exhibited by Homo than the greater flexion evinced by living apes. Compared with fossil and recent specimens of Homo, the configuration of the P. robustus radial head suggests enhanced stability against medial displacement during pronation and supination; the strong crest for the attachment of brachioradialis may attest to enhanced forearm flexor capability. In addition, this crest and the prominent dorsal tubercles may indicate enhanced hand extensor and, therefore, hand flexor capabilities. The differences in radial morphology between Paranthropus and Homo may relate to significant behavioral differences between these two synchronic taxa.

  17. Tilt of the radius from forearm rotational axis reliably predicts rotational improvement after corrective osteotomy for malunited forearm fractures.

    PubMed

    Tatebe, Masahiro; Shinohara, Takaaki; Okui, Nobuyuki; Yamamoto, Michiro; Kurimoto, Shigeru; Hirata, Hitoshi

    2012-02-01

    Forearm rotation occurs around an axis connecting the center of the radial head and the fovea of the distal ulna. The purpose of the present study was to demonstrate the usefulness of the difference between forearm and proximal radial axis in the treatment of malunited forearm fractures. We reviewed the results of eight corrective osteotomies for malunited fractures of the forearm without dislocations of the wrist or elbow. Subjects were 6 men and 2 women (mean age, 15 years; range, 10-21 years). Corrective osteotomy was performed at the fracture site. Preoperatively and at final follow-up, the are of forearm rotation was recorded and anteroposterior and lateral X-rays were taken. Proximal radius tilt was defined as the angle between the rotational axis of the forearm and the axis of the proximal radius. Corrective osteotomy improved proximal radius tilt in all cases. Three patients were considered to have malrotation. Postoperative rotational are correlated with proximal radial tilt (r = -0.83). No significant difference in rotational arc was evident between malunited cases and the remaining cases. To improve forearm rotation, corrective osteotomy should be planned to minimize proximal radius tilt.

  18. Open segmental fracture of both bone forearm and dislocation of ipsilateral elbow with extruded middle segment radius

    PubMed Central

    Kumar, Pawan; Manjhi, Lal Bahadur; Rajak, Ramesh Lal

    2013-01-01

    Extruded middle segment of radius with open segmental fracture both bone forearm and dislocation of ipsilateral elbow is a rare injury. A 12-year-old child presented to us within 4 hours following fall from tree. The child's mother was carrying a 12-cm-long extruded soiled segment of radius. The extruded bone was thoroughly washed. The medullary cavity was properly syringed with antiseptic solution. The bone was autoclaved and put in the muscle plane of the distal forearm after debridement of the wound. After 5 days, a 2.5-mm K-wire was introduced by retrograde method into the proximal radius by passing through the extruded segment. Another 2.5-mm K-wire was passed in ulna. The limb was evaluated clinicoradiologically every 2 weeks. The wound was healed by primary intention. At 4 months, the reposed bone appeared less dense radiologically and K-wire seemed to be out of the bone. In the subsequent months, the roentgenograms show remodeling of the extruded fragment. After 20 weeks, the K-wires were removed (first ulnar and then radial). Complete union was achieved with full range of movement except loss of few degrees of extension of elbow and thumb. This case is reported to show a good outcome following successful incorporation of an extruded segment of radius in an open fracture. PMID:23798764

  19. Open segmental fracture of both bone forearm and dislocation of ipsilateral elbow with extruded middle segment radius.

    PubMed

    Kumar, Pawan; Manjhi, Lal Bahadur; Rajak, Ramesh Lal

    2013-05-01

    Extruded middle segment of radius with open segmental fracture both bone forearm and dislocation of ipsilateral elbow is a rare injury. A 12-year-old child presented to us within 4 hours following fall from tree. The child's mother was carrying a 12-cm-long extruded soiled segment of radius. The extruded bone was thoroughly washed. The medullary cavity was properly syringed with antiseptic solution. The bone was autoclaved and put in the muscle plane of the distal forearm after debridement of the wound. After 5 days, a 2.5-mm K-wire was introduced by retrograde method into the proximal radius by passing through the extruded segment. Another 2.5-mm K-wire was passed in ulna. The limb was evaluated clinicoradiologically every 2 weeks. The wound was healed by primary intention. At 4 months, the reposed bone appeared less dense radiologically and K-wire seemed to be out of the bone. In the subsequent months, the roentgenograms show remodeling of the extruded fragment. After 20 weeks, the K-wires were removed (first ulnar and then radial). Complete union was achieved with full range of movement except loss of few degrees of extension of elbow and thumb. This case is reported to show a good outcome following successful incorporation of an extruded segment of radius in an open fracture.

  20. Subacute dislocation of the elbow following Galeazzi fracture-dislocation of the radius: A case report

    PubMed Central

    2011-01-01

    Introduction The Galeazzi fracture-dislocation was originally described by Sir Astley Cooper in 1822 but was named after Italian surgeon Ricardo Galeazzi in 1934. It is an injury classified as a radial shaft fracture with associated dislocation of the distal radioulnar joint and disruption of the forearm axis joint. The associated distal radioulnar joint injury may be purely ligamentous in nature, tearing the triangular fibrocartilaginous complex, or involve bony tissue (that is, ulnar styloid avulsions) or both. We report this case because of the rare association of posterior dislocation of the elbow along with Galeazzi fracture-dislocation. To the best of our knowledge, this has not been previously reported in the English literature. Case presentation A 26-year-old Caucasian man presented to our department after a fall from a motorbike. He sustained a closed, isolated Galeazzi fracture-dislocation of the right forearm and no associated elbow injuries, and this necessitated open reduction and internal fixation of the radius. Post-operative radiographs films were satisfactory. However, clinical and radiological evidence of ipsilateral elbow dislocation was noted at a five-week follow-up, subsequently requiring open reduction of the joint and collateral ligament repair. Our patient was noted to have full elbow and forearm function at three months. Conclusions Although the Galeazzi fracture-dislocation has been classically described as involving only the distal radioulnar joint, traumatic forces can be transmitted to the elbow via the interosseous membrane of the forearm. This can lead to instability of the elbow joint. Therefore, we recommend that, in every case of forearm fracture, both elbow and wrist joints be assessed clinically as well as radiologically for subluxation or dislocation. PMID:22185342

  1. Force- and moment-generating capacities of muscles in the distal forelimb of the horse.

    PubMed

    Brown, Nicholas A T; Pandy, Marcus G; Kawcak, Christopher E; McIlwraith, C Wayne

    2003-07-01

    A detailed musculoskeletal model of the distal equine forelimb was developed to study the influence of musculoskeletal geometry (i.e. muscle paths) and muscle physiology (i.e. force-length properties) on the force- and moment-generating capacities of muscles crossing the carpal and metacarpophalangeal joints. The distal forelimb skeleton was represented as a five degree-of-freedom kinematic linkage comprised of eight bones (humerus, radius and ulna combined, proximal carpus, distal carpus, metacarpus, proximal phalanx, intermediate phalanx and distal phalanx) and seven joints (elbow, radiocarpal, intercarpal, carpometacarpal, metacarpophalangeal (MCP), proximal interphalangeal (pastern) and distal interphalangeal (coffin)). Bone surfaces were reconstructed from computed tomography scans obtained from the left forelimb of a Thoroughbred horse. The model was actuated by nine muscle-tendon units. Each unit was represented as a three-element Hill-type muscle in series with an elastic tendon. Architectural parameters specifying the force-producing properties of each muscle-tendon unit were found by dissecting seven forelimbs from five Thoroughbred horses. Maximum isometric moments were calculated for a wide range of joint angles by fully activating the extensor and flexor muscles crossing the carpus and MCP joint. Peak isometric moments generated by the flexor muscles were an order of magnitude greater than those generated by the extensor muscles at both the carpus and the MCP joint. For each flexor muscle in the model, the shape of the maximum isometric joint moment-angle curve was dominated by the variation in muscle force. By contrast, the moment-angle curves for the muscles that extend the MCP joint were determined mainly by the variation in muscle moment arms. The suspensory and check ligaments contributed more than half of the total support moment developed about the MCP joint in the model. When combined with appropriate in vivo measurements of joint kinematics

  2. Comparative evaluation of molar distalization therapy using pendulum and distal screw appliances

    PubMed Central

    Cafagna, Alessandra; Fontana, Mattia; Cozzani, Mauro

    2015-01-01

    Objective To compare dentoalveolar and skeletal changes produced by the pendulum appliance (PA) and the distal screw appliance (DS) in Class II patients. Methods Forty-three patients (19 men, 24 women) with Class II malocclusion were retrospectively selected for the study. Twenty-four patients (mean age, 12.2 ± 1.5 years) were treated with the PA, and 19 patients (mean age, 11.3 ± 1.9 years) were treated with the DS. The mean distalization time was 7 months for the PA group and 9 months for the DS group. Lateral cephalograms were obtained at T1, before treatment, and at T2, the end of distalization. A Mann-Whitney U test was used for statistical comparisons of the two groups between T1 and T2. Results PA and DS were equally effective in distalizing maxillary molars (4.7 mm and 4.2 mm, respectively) between T1 and T2; however, the maxillary first molars showed less distal tipping in the DS group than in the PA group (3.2° vs. 9.0°, respectively). Moreover, significant premolar anchorage loss (2.7 mm) and incisor proclination (5.0°) were noted in the PA group, whereas premolar distal movement (1.9 mm) and no significant changes at the incisor (0.1°) were observed in the DS group. No significant sagittal or vertical skeletal changes were detected between the two groups during the distalization phase. Conclusions PA and DS seem to be equally effective in distalizing maxillary molars; however, greater distal molar tipping and premolar anchorage loss can be expected using PA. PMID:26258063

  3. Distally based dorsalis pedis island flap for a distal lateral electric burn of the big toe.

    PubMed

    Governa, M; Barisoni, D

    1996-12-01

    Reconstruction of the small defects in the distal portion of the foot has always represented a difficult problem. A case of a young man with a deep electric burn of the distal lateral side of the big toe successfully treated with a distally based dorsalis pedis island flap based on the first dorsal metatarsal artery (FDMA) is presented. The donor site area of the dorsum of the foot was grafted, and deambulation was reassumed 3 weeks later. Advantages; limits and anatomical consideration regarding the viability of the flap are also discussed.

  4. Anaesthetic management in thoracoscopic distal tracheal resection.

    PubMed

    Acosta Martínez, J; Beato López, J; Domínguez Blanco, A; López Romero, J L; López Villalobos, J L

    2017-03-01

    Surgical resection of tracheal tumours, especially distal tracheal tumours, is a challenge for the anaesthesiologists involved, mainly due to difficulties in ensuring adequate control of the airway and ventilation. We report the case of a patient undergoing tracheal resection and anastomosis by VATS, emphasizing the anaesthetic management.

  5. Combined Isolated Laugier's Fracture and Distal Radial Fracture: Management and Literature Review on the Mechanism of Injury

    PubMed Central

    Osman, Walid; Alaya, Zeineb; Naouar, Nader; Ben Ayeche, Mohamed

    2016-01-01

    Introduction. Isolated fracture of the trochlea is an uncommon condition requiring a particular mechanism of injury. Its association with a distal radial fracture is rare. We aimed through this case report to identify the injury mechanism and to assess surgical outcomes. Case Presentation. We report a 26-year-old female who was admitted to our department for elbow trauma following an accidental fall on her outstretched right hand with her elbow extended and supinated. On examination, the right elbow was swollen with tenderness over the anteromedial aspect of the distal humerus. The elbow range was restricted. Standard radiographs showed an intra-articular half-moon-shaped fragment lying proximal and anterior to the distal humerus. There was a comminuted articular fracture of the distal radius with an anterior displacement. A computed tomography revealed an isolated shear fracture of the trochlea without any associated lesion of the elbow. The patient was surgically managed. Anatomical reduction was achieved and the fracture was fixed with 2 Kirschner wires. The distal radial fracture was treated by open reduction and plate fixation. The postoperative course was uneventful with a good recovery. Conclusion. Knowledge of such entity would be useful to indicate the suitable surgical management and eventually to obtain good functional outcomes. PMID:28070435

  6. The Origin of the Ionic-Radius Ratio Rules

    ERIC Educational Resources Information Center

    Jensen, William B.

    2010-01-01

    In response to a reader query, this article traces the origins of the ionic-radius ratio rules and their incorrect attribution to Linus Pauling in the chemical literature and to Victor Goldschmidt in the geochemical literature. In actual fact, the ionic-radius ratio rules were first proposed within the context of the coordination chemistry…

  7. bamr: Bayesian analysis of mass and radius observations

    NASA Astrophysics Data System (ADS)

    Steiner, Andrew W.

    2014-08-01

    bamr is an MPI implementation of a Bayesian analysis of neutron star mass and radius data that determines the mass versus radius curve and the equation of state of dense matter. Written in C++, bamr provides some EOS models. This code requires O2scl (ascl:1408.019) be installed before compilation.

  8. Modeling the interferometric radius measurement using Gaussian beam propagation

    SciTech Connect

    Medicus, Katherine M.; Snyder, James J.; Davies, Angela

    2006-12-01

    We model the interferometric radius measurement using Gaussian beam propagation to identify biases in the measurement due to using a simple geometric ray-trace model instead of the more complex Gaussian model. The radius measurement is based on using an interferometer to identify the test part's position when it is at two null locations, and the distance between the positions is an estimate of the part's radius. The null condition is observed when there is no difference in curvature between the reflected reference and the test wavefronts, and a Gaussian model will provide a first-order estimate of curvature changes due to wave propagation and therefore changes to the radius measurement. We show that the geometric ray assumption leads to radius biases (errors) that are a strong function of the test part radius and increase as the radius of the part decreases. We tested for a bias for both microscaled(<1 mm) and macroscaled parts. The bias is of the order of parts in 105 for micro-optics with radii a small fraction of a millimeter and much smaller for macroscaled optics. The amount of bias depends on the interferometer configuration (numerical aperture, etc.), the nominal radius of the test part, and the distances in the interferometer.

  9. Calcific periarthritis of the elbow presenting as acute tennis elbow.

    PubMed

    Jawad, F; Jawad, A S M

    2014-01-01

    A 28-year-old woman presented with sudden acute lateral epicondylitis. There was no history of preceding trauma or repetitive use of the arm. Because of the acute onset and signs of acute inflammation, an X-ray was arranged. The X-ray showed a hyperdense calcified elongated globule distal to the lateral epicondyle. A diagnosis of calcific periarthritis (calcium apatite) of the elbow was made. Calcific periarthritis has rarely been reported as a cause of acute elbow pain.

  10. Changes in length of the radioulnar ligament and distal oblique bundle after Colles' fracture.

    PubMed

    Omori, Shinsuke; Moritomo, Hisao; Murase, Tsuyoshi; Miyake, Junichi; Kataoka, Toshiyuki; Kawanishi, Yohei; Sugamoto, Kazuomi; Yoshikawa, Hideki

    2013-10-01

    The purpose of this study was to investigate changes in length of the radioulnar ligament and distal oblique bundle (DOB) within the distal interosseous membrane after Colles' fracture and correlate the magnitude of the changes in length with clinical features. This study investigated 10 patients with malunion of a Colles' fracture. In three-dimensional computed tomography, the paths of the four limbs of the radioulnar ligament (superficial and deep, dorsal, and palmar limbs) and DOB were modelled and each path length was computed. Differences in length between the affected and contralateral unaffected side were calculated and correlated with the radiographic parameters of deformity on plain X-ray, subluxation of the DRUJ on CT, and limited range of forearm rotation in the clinical examination. In the malunited radius, the superficial and deep dorsal limbs of the radioulnar ligament were significantly elongated and DOB was significantly shortened compared with the contralateral side. These length changes correlated with radiographic radial shortening, subluxation of the DRUJ, and inversely correlated with limited range of forearm pronation. This study suggests that the dorsal radioulnar ligament would be overstretched and disrupted in Colles' fracture with severely increased radial shortening, producing laxity of the distal radioulnar joint that could negate limitation of pronation.

  11. INDICATIONS FOR DISTAL RADIOULNAR ARTHROPLASTY: REPORT ON THREE CLINICAL CASES

    PubMed Central

    Santos, Cláudia; Pereira, Alexandre; Sousa, Marco; Trigeuiros, Miguel; Silva, César

    2015-01-01

    Distal radioulnar arthroplasty is an attractive solution for treating various pathological conditions of the distal radioulnar joint because it allows restoration of stability, load transmission and function. The main indications are: radioulnar impingement after partial or complete resection of the distal ulna; and degenerative, inflammatory or post-traumatic arthritis of the distal radioulnar joint. The authors present three clinical cases of distal radioulnar pathological conditions: two patients with post-traumatic sequelae and one case of distal radioulnar impingement after a Sauvé-Kapandji operation. The three cases were treated surgically with a metallic prosthesis to replace the distal ulna (First Choice - Ascension®). The first two were treated with a resurfacing prosthesis and the last one with a modular prosthesis. All of the patients had achieved pain relief and increased movement of the distal radioulnar joint after one year of postoperative follow-up. PMID:27047827

  12. ON THE VARIATION OF SOLAR RADIUS IN ROTATION CYCLES

    SciTech Connect

    Qu, Z. N.; Kong, D. F.; Xiang, N. B.; Feng, W.

    2015-01-10

    The Date Compensated Discrete Fourier Transform and CLEANest algorithm are used to study the temporal variations of the solar radius observed at Rio de Janeiro Observatory from 1998 March 2 to 2009 November 6. The CLEANest spectra show several significant periodicities around 400, 312, 93.5, 86.2, 79.4, 70.9, 53.2, and 26.3 days. Then, combining the data on the daily solar radius measured at Calern Observatory and Rio de Janeiro Observatory and the corresponding daily sunspot areas, we study the short-term periodicity of the solar radius and the role of magnetic field in the variation of the solar radius. The rotation period of the daily solar radius is determined to be statistically significant. Moreover, its temporal evolution is anti-phase with that of sunspot activity, and it is found anti-phase with solar activity. Generally, the stronger solar activity is, the more obvious is the anti-phase relation of radius with solar activity. This indicates that strong magnetic fields have a greater inhibitive effect than weak magnetic fields on the variation of the radius.

  13. Thermoconvective vortices in a cylindrical annulus with varying inner radius.

    PubMed

    Castaño, D; Navarro, M C; Herrero, H

    2014-12-01

    This paper shows the influence of the inner radius on the stability and intensity of vertical vortices, qualitatively similar to dust devils and cyclones, generated in a cylindrical annulus non-homogeneously heated from below. Little relation is found between the intensity of the vortex and the magnitude of the inner radius. Strong stable vortices can be found for both small and large values of the inner radius. The Rankine combined vortex structure, that characterizes the tangential velocity in dust devils, is clearly observed when small values of the inner radius and large values of the ratio between the horizontal and vertical temperature differences are considered. A contraction on the radius of maximum azimuthal velocity is observed when the vortex is intensified by thermal mechanisms. This radius becomes then nearly stationary when frictional force balances the radial inflow generated by the pressure drop in the center, despite the vortex keeps intensifying. These results connect with the behavior of the radius of the maximum tangential wind associated with a hurricane.

  14. Thermoconvective vortices in a cylindrical annulus with varying inner radius

    NASA Astrophysics Data System (ADS)

    Castaño, D.; Navarro, M. C.; Herrero, H.

    2014-12-01

    This paper shows the influence of the inner radius on the stability and intensity of vertical vortices, qualitatively similar to dust devils and cyclones, generated in a cylindrical annulus non-homogeneously heated from below. Little relation is found between the intensity of the vortex and the magnitude of the inner radius. Strong stable vortices can be found for both small and large values of the inner radius. The Rankine combined vortex structure, that characterizes the tangential velocity in dust devils, is clearly observed when small values of the inner radius and large values of the ratio between the horizontal and vertical temperature differences are considered. A contraction on the radius of maximum azimuthal velocity is observed when the vortex is intensified by thermal mechanisms. This radius becomes then nearly stationary when frictional force balances the radial inflow generated by the pressure drop in the center, despite the vortex keeps intensifying. These results connect with the behavior of the radius of the maximum tangential wind associated with a hurricane.

  15. [Laparoscopic distal resection of the pancreas].

    PubMed

    Gürlich, R; Sixta, B; Oliverius, M; Kment, M; Rusina, R; Spicák, J; Sváb, J

    2005-09-01

    During the last two years, reports on laparoscopic procedures of the pancreas have been on increase. Laparoscopic resection of the pancreatic cauda is indicated, primarily, for benign cystic lesions of the cauda of the pancreas and for neuroendocrine tumors of the pancreas (mainly insulinomas). We have not recorded any report on the above procedure in the Czech literature. Therefore, in our case review, we have described laparoscopic distal resection of the pancreas with splenectomy for a pseudopapillary tumor of the pancreas.

  16. Distal renal tubular acidosis with hereditary spherocytosis.

    PubMed

    Sinha, Rajiv; Agarwal, Indira; Bawazir, Waleed M; Bruce, Lesley J

    2013-07-01

    Hereditary spherocytosis (HS) and distal renal tubular acidosis (dRTA), although distinct entities, share the same protein i.e. the anion exchanger1 (AE1) protein. Despite this, their coexistence has been rarely reported. We hereby describe the largest family to date with co-existence of dRTA and HS and discuss the molecular basis for the co-inheritance of these conditions.

  17. Distal biceps tendon injuries: diagnosis and management.

    PubMed

    Ramsey, M L

    1999-01-01

    Rupture of the distal biceps tendon occurs most commonly in the dominant extremity of men between 40 and 60 years of age when an unexpected extension force is applied to the flexed arm. Although previously thought to be an uncommon injury, distal biceps tendon ruptures are being reported with increasing frequency. The rupture typically occurs at the tendon insertion into the radial tuberosity in an area of preexisting tendon degeneration. The diagnosis is made on the basis of a history of a painful, tearing sensation in the antecubital region. Physical examination demonstrates a palpable and visible deformity of the distal biceps muscle belly with weakness in flexion and supination. The ability to palpate the tendon in the antecubital fossa may indicate partial tearing of the biceps tendon. Plain radiographs may show hypertrophic bone formation at the radial tuberosity. Magnetic resonance imaging is generally not required to diagnose a complete rupture but may be useful in the case of a partial rupture. Early surgical reattachment to the radial tuberosity is recommended for optimal results. A modified two-incision technique is the most widely used method of repair, but anterior single-incision techniques may be equally effective provided the radial nerve is protected. The patient with a chronic rupture may benefit from surgical reattachment, but proximal retraction and scarring of the muscle belly can make tendon mobilization difficult, and inadequate length of the distal biceps tendon may necessitate tendon augmentation. Postoperative rehabilitation must emphasize protected return of motion for the first 8 weeks after repair. Formal strengthening may begin as early as 8 weeks, with a return to unrestricted activities, including lifting, by 5 months.

  18. Distal Embolic Protection for Renal Arterial Interventions

    SciTech Connect

    Dubel, Gregory J. Murphy, Timothy P.

    2008-01-15

    Distal or embolic protection has intuitive appeal for its potential to prevent embolization of materials generated during interventional procedures. Distal protection devices (DPDs) have been most widely used in the coronary and carotid vascular beds, where they have demonstrated the ability to trap embolic materials and, in some cases, to reduce complications. Given the frequency of chronic kidney disease in patients with renal artery stenosis undergoing stent placement, it is reasonable to propose that these devices may play an important role in limiting distal embolization in the renal vasculature. Careful review of the literature reveals that atheroembolization does occur during renal arterial interventions, although it often goes undetected. Early experience with DPDs in the renal arteries in patients with suitable anatomy suggests retrieval of embolic materials in approximately 71% of cases and renal functional improvement/stabilization in 98% of cases. The combination of platelet inhibition and a DPD may provide even greater benefit. Given the critical importance of renal functional preservation, it follows that everything that can be done to prevent atheroembolism should be undertaken including the use of DPDs when anatomically feasible. The data available at this time support a beneficial role for these devices.

  19. Novel topical therapies for distal colitis.

    PubMed

    Lawrance, Ian Craig

    2010-10-06

    Distal colitis (DC) can be effectively treated with topical 5ASA agents. Suppositories target the rectum while enemas can reliably reach the splenic flexure. Used in combination with oral 5ASAs, the control of the inflammation is even more effective. Unfortunately, resistant DC does occur and can be extremely challenging to manage. In these patients, the use of steroids, immunosuppressants and the anti-tumor necrosis factor α agents are often required. These, however, can be associated with systemic side effects and are not always effective. The investigation of new topical therapeutic agents is thus required as they are rarely associated with significant blood drug levels and side effects are infrequent. Some of the agents that have been proposed for use in resistant distal colitis include butyrate, cyclosporine and nicotine enemas as well as tacrolimus suppositories and tacrolimus, ecabet sodium, arsenic, lidocaine, rebamipide and Ridogrel(®) enemas. Some of these agents have demonstrated impressive results but the majority of the agents have only been assessed in small open-labelled patient cohorts. Further work is thus required with the investigation of promising agents in the context of randomized double-blinded placebo controlled trials. This review aims to highlight those potentially effective therapies in the management of resistant distal colitis and to promote interest in furthering their investigation.

  20. Distal symmetrical polyneuropathy: definition for clinical research.

    PubMed

    England, J D; Gronseth, G S; Franklin, G; Miller, R G; Asbury, A K; Carter, G T; Cohen, J A; Fisher, M A; Howard, J F; Kinsella, L J; Latov, N; Lewis, R A; Low, P A; Sumner, A J

    2005-01-01

    The objective of this report was to develop a case definition of "distal symmetrical polyneuropathy" to standardize and facilitate clinical research and epidemiological studies. A formalized consensus process was employed to reach agreement after a systematic review and classification of evidence from the literature. The literature indicates that symptoms alone have relatively poor diagnostic accuracy in predicting the presence of polyneuropathy; signs are better predictors of polyneuropathy than symptoms; and single abnormalities on examination are less sensitive than multiple abnormalities in predicting the presence of polyneuropathy. The combination of neuropathic symptoms, signs, and electrodiagnostic findings provides the most accurate diagnosis of distal symmetrical polyneuropathy. A set of case definitions was rank ordered by likelihood of disease. The highest likelihood of polyneuropathy (useful for clinical trials) occurs with a combination of multiple symptoms, multiple signs, and abnormal electrodiagnostic studies. A modest likelihood of polyneuropathy (useful for field or epidemiological studies) occurs with a combination of multiple symptoms and multiple signs when the results of electrodiagnostic studies are not available. A lower likelihood of polyneuropathy occurs when electrodiagnostic studies and signs are discordant. For research purposes, the best approach for defining distal symmetrical polyneuropathy is a set of case definitions rank ordered by estimated likelihood of disease. The inclusion of this formalized case definition in clinical and epidemiological research studies will ensure greater consistency of case selection.

  1. Organophosphates induce distal axonal damage, but not brain oedema, by inactivating neuropathy target esterase

    SciTech Connect

    Read, David J.; Li Yong; Chao, Moses V.; Cavanagh, John B.; Glynn, Paul

    2010-05-15

    Single doses of organophosphorus compounds (OP) which covalently inhibit neuropathy target esterase (NTE) can induce lower-limb paralysis and distal damage in long nerve axons. Clinical signs of neuropathy are evident 3 weeks post-OP dose in humans, cats and chickens. By contrast, clinical neuropathy in mice following acute dosing with OPs or any other toxic compound has never been reported. Moreover, dosing mice with ethyloctylphosphonofluoridate (EOPF) - an extremely potent NTE inhibitor - causes a different (subacute) neurotoxicity with brain oedema. These observations have raised the possibility that mice are intrinsically resistant to neuropathies induced by acute toxic insult, but may incur brain oedema, rather than distal axonal damage, when NTE is inactivated. Here we provide the first report that hind-limb dysfunction and extensive axonal damage can occur in mice 3 weeks after acute dosing with a toxic compound, bromophenylacetylurea. Three weeks after acutely dosing mice with neuropathic OPs no clinical signs were observed, but distal lesions were present in the longest spinal sensory axons. Similar lesions were evident in undosed nestin-cre:NTEfl/fl mice in which NTE had been genetically-deleted from neural tissue. The extent of OP-induced axonal damage in mice was related to the duration of NTE inactivation and, as reported in chickens, was promoted by post-dosing with phenylmethanesulfonylfluoride. However, phenyldipentylphosphinate, another promoting compound in chickens, itself induced in mice lesions different from the neuropathic OP type. Finally, EOPF induced subacute neurotoxicity with brain oedema in both wild-type and nestin-cre:NTEfl/fl mice indicating that the molecular target for this effect is not neural NTE.

  2. Split radius-form blocks for tube benders

    NASA Technical Reports Server (NTRS)

    Lange, D. R.; Seiple, C. W.

    1970-01-01

    Two-piece, radius-form block permits accurate forming and removing of parts with more than a 180 degree bend. Tube bender can shape flexible metal tubing in applications dealing with plumbing, heating, and pressure transmission lines.

  3. Applying Occam's Razor To The Proton Radius Puzzle

    NASA Astrophysics Data System (ADS)

    Higinbotham, Douglas

    2016-09-01

    Over the past five decades, ever more complex mathematical functions have been used to extract the radius of the proton from electron scattering data. For example, in 1963 the proton radius was extracted with linear and quadratic fits of low Q2 data (< 3 fm-2) and by 2014 a non-linear regression of two tenth order power series functions with thirty-one normalization parameters and data out to 25 fm-2 was used. But for electron scattering, the radius of the proton is determined by extracting the slope of the charge form factor at a Q2 of zero. By using higher precision data than was available in 1963 and focusing on the low Q2 data from 1974 to today, we find extrapolating functions consistently produce a proton radius of around 0.84 fm. A result that is in agreement with modern Lamb shift measurements.

  4. Ejecta emplacement: from distal to proximal

    NASA Astrophysics Data System (ADS)

    Artemieva, N.

    2008-09-01

    Introduction Most part of impact ejecta is deposited ballistically at some distance from a crater, defined by ejection velocity V and ejection angle α: d=v2sinα/g. In case of giant impacts, planetary curvature should be taken into account [1]. Combined with ejecta scaling [2], these relations allow to define ejecta thickness as a function of distance. Ejecta from large craters are deposited at velocity high enough to mobilize substrate material and to thicken ejecta deposits [3]. Ballistic approximation is valid for airless bodies (if impact vaporization is not vast) or for proximal ejecta of large impact craters, where ejecta mass per unit area is substantially greater than the mass of involved vapor/atmosphere (M-ratio). Deposition of distal ejecta, in which ejecta mass is negligible compared to the atmosphere, may be also treated in a simplified manner, i.e. as 1) passive motion of ejected particles within an impact plume and 2) later, as sedimentation of particles in undisturbed atmosphere (equilibrium between gravity and drag). In all intermediate M-ratio values, impact ejecta move like a surge, i.e. dilute suspension current in which particles are carried in turbulent flows under the influence of gravity. Surges are well-known for near-surface explosive tests, described in detail for volcanic explosions (Plinian column collapse, phreato-magmatic eruption, lateral blast), and found in ejecta from the Chicxulub [4] and the Ries [5]. Important aspects of surge transport include its ability to deposit ejecta over a larger area than that typical of continuous ballistic ejecta and to create multiple ejecta layers. Numerical model Two-phase hydrodynamics. Surges should be modeled in the frame of two-phase hydrodynamics, i.e. interaction between solid/molten particles and atmospheric gas/impact vapor should be taken into account. There are two techniques of solving equations for dust particle motion in a gas flow. The first one describes solid/molten particles as a

  5. Distal clavicle osteolysis unrelated to trauma, overuse, or metabolic disease.

    PubMed

    Hawkins, B J; Covey, D C; Thiel, B G

    2000-01-01

    Osteolysis of the distal clavicle has been reported to occur from traumatic, atraumatic (overuse), or systemic causes. Three patients with bilateral osteolysis of the distal clavicles whose osteolysis did not fit these etiologic categories were evaluated. Clinical, imaging, and laboratory evaluations were nonspecific, and histologic sections of the distal clavicle showed evidence of chronic inflammation with reactive change of the articular surface. Patients either had complete resolution or marked improvement of their symptoms after bilateral distal clavicle resection at mean followup of 5 years 3 months. These cases of osteolysis of the distal clavicle represent a category of this disorder not previously described.

  6. Radius of Curvature of Off-Axis Paraboloids

    NASA Technical Reports Server (NTRS)

    Robinson, Brian; Reardon, Patrick; Hadaway, James; Geary, Joseph; Russell, Kevin (Technical Monitor)

    2002-01-01

    We present several methods for measuring the vertex radius of curvature of off-axis paraboloidal mirrors. One is based on least-squares fitting of interferometer output, one on comparison of sagittal and tangential radii of curvature, and another on measurement of displacement of the nulled test article from the ideal reference wave. Each method defines radius of curvature differently and, as a consequence, produces its own sort of errors.

  7. Isolated Diaphyseal Fractures of the Radius in Skeletally Immature Patients

    PubMed Central

    Guitton, Thierry G.; Van Dijk, Niek C.; Raaymakers, Ernst L.

    2009-01-01

    Diaphyseal radius fractures without associated ulna fracture or radioulnar dislocation (isolated fracture of the radius) are recognized in adults but are rarely described in skeletally immature patients. A search of our database (1974–2002) identified 17 pediatric patients that had an isolated fracture of the radius. Among the 13 patients with at least 1 year follow-up, ten were treated with manipulative reduction and immobilization in an above elbow cast and three had initial operative treatment with plate and screw fixation. These 13 patients were evaluated for an average of 18 months (range, 12 to 45 months) after injury using the system of Price and colleagues. The incidence of isolated diaphyseal radius fractures in skeletally immature patients was 0.56 per year in our database and represented 27% of the 63 patients with a diaphyseal forearm fracture. All 13 patients, with at least 1 year follow-up, regained full elbow flexion and extension and full forearm rotation. According to the classification system of Price, all 13 patients (100%) had an excellent result. As in adults, isolated radius fractures seem to occur in children more frequently than previously appreciated. Treatment of isolated radius fractures in skeletally immature patients has a low complication rate, and excellent functional outcomes are the rule. PMID:19859772

  8. Relay NBS Graft with the Plus Delivery System to Improve Deployment in Aortic Arch with Small Radius Curve

    SciTech Connect

    Ferro, Carlo; Rossi, Umberto G. Seitun, Sara; Guastavino, Andrea; Scarano, Flavio; Passerone, Gian Carlo

    2011-04-15

    The purpose of this report is to describe deployment of the Relay NBS Thoracic Stent Graft with the Plus Delivery System (Bolton Medical, Sunrise, FL) in a flexible resin arch model with a 15-mm radius curve as well as our preliminary clinical results. The Relay NBS graft with the Plus Delivery System was evaluated by way of bench testing, which was performed with stent grafts with diameters ranging from 24 to 46 mm and lengths ranging from 100 to 250 mm in flexible resin arch models with a 15-mm arch radius of curvature. The deployment sequence was analyzed. The Relay NBS graft with the Plus Delivery System was deployed in two patients, respectively, having a 6.5-cm penetrating aortic ulcer of the proximal third of the descending thoracic aorta and a DeBakey type-I aortic dissection with chronic false lumen dilatation after surgery due to an entry site at the distal thoracic aorta. Bench tests showed proper conformation and apposition of the Relay NBS graft with the Plus Delivery System in the flexible resin model. This stent graft was deployed successfully into the two patients with a correct orientation of the first stent and without early or late complications. The Relay NBS graft with the Plus Delivery System ensures an optimal conformation and apposition of the first stent in the aortic arch with a small radius of curvature.

  9. Relay NBS graft with the plus delivery system to improve deployment in aortic Arch with small radius curve.

    PubMed

    Ferro, Carlo; Rossi, Umberto G; Seitun, Sara; Guastavino, Andrea; Scarano, Flavio; Passerone, Gian Carlo

    2011-04-01

    The purpose of this report is to describe deployment of the Relay NBS Thoracic Stent Graft with the Plus Delivery System (Bolton Medical, Sunrise, FL) in a flexible resin arch model with a 15-mm radius curve as well as our preliminary clinical results. The Relay NBS graft with the Plus Delivery System was evaluated by way of bench testing, which was performed with stent grafts with diameters ranging from 24 to 46 mm and lengths ranging from 100 to 250 mm in flexible resin arch models with a 15-mm arch radius of curvature. The deployment sequence was analyzed. The Relay NBS graft with the Plus Delivery System was deployed in two patients, respectively, having a 6.5-cm penetrating aortic ulcer of the proximal third of the descending thoracic aorta and a DeBakey type-I aortic dissection with chronic false lumen dilatation after surgery due to an entry site at the distal thoracic aorta. Bench tests showed proper conformation and apposition of the Relay NBS graft with the Plus Delivery System in the flexible resin model. This stent graft was deployed successfully into the two patients with a correct orientation of the first stent and without early or late complications. The Relay NBS graft with the Plus Delivery System ensures an optimal conformation and apposition of the first stent in the aortic arch with a small radius of curvature.

  10. Distal tibial physeal fractures in children that may require open reduction.

    PubMed

    Kling, T F; Bright, R W; Hensinger, R N

    1984-06-01

    Fractures of the distal end of the tibia in children often involve the physis. They are of particular importance because partial growth arrest can occur and result in angular deformity, limb-length discrepancy, or incongruity of the joint surface (or a combination of these). We evaluated the cases of thirty-two children who had a fracture leading to established partial growth arrest of the distal end of the tibia. Most of this group had had a Salter-Harris Type-III or Type-IV fracture. Twenty-eight of the fractures had been treated by gentle closed reduction and immobilization in a plaster cast. We also evaluated the cases of thirty-three children who were seen by us for treatment of an acute fracture; most of these were Salter-Harris Type-III or Type-IV fractures of the distal end of the tibia. Nineteen of the twenty acute Type-III or Type-IV fractures that were treated with accurate open reduction of the physis and internal fixation healed without growth disturbance, while five of the nine fractures that were treated by closed means formed a bone bridge, presaging a disturbance in growth. This study suggests that Salter-Harris Type-III and Type-IV, and perhaps Type-II, fractures of the distal end of the tibia commonly cause disturbance of growth in the tibia, and that anatomical reduction of the physis by closed or open means may decrease the incidence of these disturbances of growth, including shortening and varus angulation of the ankle.

  11. Reconstruction and restoration of neglected ruptured patellar tendon using semitendinosus and gracilis tendons with preserved distal insertions: two case reports.

    PubMed

    Chen, Bin; Li, Runguang; Zhang, Sheng

    2012-08-01

    Neglected rupture of the patellar tendon is rare but becomes more difficult to repair the longer it is left untreated. The most common rupture sites are the inferior pole of the patella and distal insertion. Proximal retraction of the patella and extensor mechanism adhesions makes the treatment more difficult than acute tendon rupture. We report two patients with neglected patellar tendon rupture treated by reconstruction and restoration using semitendinosus-gracilis (STG) tendons with preserved distal insertions. Preserved distal insertion provided sufficient blood supply to accelerate healing, while combined fixation with tension-reducing wire, offered the initial stability of the closed-loop sutured tendon. Both patients reacquired near normal strength and stability of the patellar tendon and restoration of function after operation and rehabilitation.

  12. An in vivo microperfusion study of distal tubule bicarbonate reabsorption in normal and ammonium chloride rats.

    PubMed Central

    Levine, D Z

    1985-01-01

    For many years it has been thought that distal nephron hydrogen ion secretion can be importantly modulated by factors such as sodium delivery, sodium avidity, and potassium stores. Free flow micropuncture studies have also indicated that the rate of bicarbonate delivery may also alter the rate of bicarbonate reabsorption. The present studies were undertaken to examine possible luminal influences on total CO2 reabsorption in microperfused distal tubules in the rat in vivo. Tubules from normal and acidotic rats were perfused with five solutions in a manner that induced changes in bicarbonate load, sodium and potassium fluxes (JNa, JK), and luminal sulfate concentration. in each collected perfusate, simultaneous analyses were undertaken to determine water reabsorption, Na, and K concentrations using graphite furnace atomic absorption spectroscopy and total CO2 by microcalorimetry. Using factorial analysis of covariance to account for confounding effects on total CO2 flux (JtCO2) such as water reabsorption, distal tubules of acidotic rats reabsorbed CO2 in the range of 50-112 pmol X min-1 X mm-1 X These JtCO2 values were not significantly correlated with HCO3 load, JNa, or JK despite changes in the latter from net reabsorption to net secretion. Distal tubules of rats with normal acid-base status had JtCO2 values which were neither significantly different from zero nor correlated with changes in JK and JNa. Further, doubling the load from 250-500 pmol/min (by doubling the perfusion rate of 25-mM HCO3 solutions) did not stimulate JtCO2 in these normal animals. Accordingly, these acute in vivo microperfusion studies indicate for the first time that neither load nor potassium or sodium fluxes are important modulators of distal tubule bicarbonate reabsorption. PMID:2982915

  13. Balloon catheter dilatation and thrombectomy for acute aortoiliac occlusion

    PubMed Central

    Archie, Joseph P.

    1981-01-01

    A case of acute distal aortic thrombosis in an elderly high-risk patient was successfully managed with intraoperative thrombectomy and balloon catheter dilatation of the common iliac arteries. Balloon catheter dilatation may be indicated prior to bypass grafting in high-risk patients with acute aortoiliac thrombosis. PMID:15216181

  14. Complications of Distal Biceps Tendon Repair

    PubMed Central

    Amin, Nirav H.; Volpi, Alex; Lynch, T. Sean; Patel, Ronak M.; Cerynik, Douglas L.; Schickendantz, Mark S.; Jones, Morgan H.

    2016-01-01

    Background: Anatomic reinsertion of the distal biceps is critical for restoring flexion and supination strength. Single- and double-incision surgical techniques have been reported, analyzing complications and outcomes measures. Which technique results in superior clinical outcomes and the lowest associated complications remains unclear. Hypothesis: We hypothesized that rerupture rates would be similar between the 2 techniques, while nerve complications would be higher for the single-incision technique and heterotopic ossification would be more frequent with the double-incision technique. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic review was conducted using the PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SPORTSDiscus, and the Cochrane Central Register of Controlled Trials databases to identify articles reporting distal biceps ruptures up to August 2013. We included English-language articles on adult patients with a minimum of 3 cases reporting single- and double-incision techniques. Frequencies of each complication as a percentage of total cases were calculated. Fisher exact tests were used to test the association between frequencies for each repair method, with P < .05 considered statistically significant. Odds ratios with 95% CIs were also computed. Results: A total of 87 articles met the inclusion criteria. Lateral antebrachial cutaneous nerve neurapraxia was the most common complication in the single-incision group, occurring in 77 of 785 cases (9.8%). Heterotopic ossification was the most common complication in the double-incision group, occurring in 36 of 498 cases (7.2%). Conclusion: The overall frequency of reported complications is higher for single-incision distal biceps repair than for double-incision repair. The frequencies of rerupture and nerve complications are both higher for single-incision repairs while the frequency of heterotopic ossification is higher for

  15. Hyperammonaemia with distal renal tubular acidosis.

    PubMed

    Miller, S G; Schwartz, G J

    1997-11-01

    The case is reported of an infant with hyperammonaemia secondary to severe distal renal tubular acidosis. A clinical association between increased concentrations of ammonia in serum and renal tubular acidosis has not previously been described. In response to acidosis the infant's kidneys presumably increased ammonia synthesis but did not excrete ammonia, resulting in hyperammonaemia. The patient showed poor feeding, frequent vomiting, and failure to thrive, but did not have an inborn error of metabolism. This case report should alert doctors to consider renal tubular acidosis in the differential diagnosis of severely ill infants with metabolic acidosis and hyperammonaemia.

  16. Total Elbow Arthroplasty for Distal Humerus Fractures.

    PubMed

    Harmer, Luke S; Sanchez-Sotelo, Joaquin

    2015-11-01

    Total elbow arthroplasty is a good treatment alternative for selected patients with distal humerus fractures. Its attractiveness is related to several factors, including the possibility of performing the procedure; leaving the extensor mechanism intact; faster, easier rehabilitation compared with internal fixation; and overall good outcomes reported in terms of both pain relief and function. Implant failure leading to revision surgery does happen, and patients must comply with certain limitations to extend the longevity of their implant. Development of high-performance implants may allow expanding the indications of elbow arthroplasty for fractures.

  17. Creation of distal canine limb lymphedema

    SciTech Connect

    Chen, H.C.; Pribaz, J.J.; O'Brien, B.M.; Knight, K.R.; Morrison, W.A.

    1989-06-01

    A canine model of distal limb lymphedema was established in order to study the treatment of this condition by lymph node transfer. This model was more difficult to establish than whole-limb lymphedema. Significant edema was achieved by a combination of preoperative irradiation and circumferential removal of skin from the irradiated areas followed by removal of the contents of the popliteal fossa. Despite these measures, it was not possible to produce lymphedema in every case, possibly because of the presence of lymphaticovenous shunts and panvascular compensation mechanisms.

  18. Distal Renal Tubular Acidosis and Calcium Nephrolithiasis

    NASA Astrophysics Data System (ADS)

    Moe, Orson W.; Fuster, Daniel G.; Xie, Xiao-Song

    2008-09-01

    Calcium stones are commonly encountered in patients with congenital distal renal tubular acidosis, a disease of renal acidification caused by mutations in either the vacuolar H+-ATPase (B1 or a4 subunit), anion exchanger-1, or carbonic anhydrase II. Based on the existing database, we present two hypotheses. First, heterozygotes with mutations in B1 subunit of H+-ATPase are not normal but may harbor biochemical abnormalities such as renal acidification defects, hypercalciuria, and hypocitraturia which can predispose them to kidney stone formation. Second, we propose at least two mechanisms by which mutant B1 subunit can impair H+-ATPase: defective pump assembly and defective pump activity.

  19. Distal oblique osteotomy for tailor's bunion.

    PubMed

    Zvijac, J E; Janecki, C J; Freeling, R M

    1991-12-01

    Thirty-six patients with a total of 50 symptomatic tailor's bunions were evaluated clinically, radiographically, and subjectively, both before and after a distal oblique osteotomy procedure was performed. Thirty-four of 36 patients were satisfied with pain relief. Radiographic measurements derived from this study were consistent with those of other studies. Avascular necrosis, nonunions, or neuroma formation were not encountered in this study. The significant advantages of this procedure are its simplicity, safety, and predictability. The procedure does not require internal fixation or postoperative immobilization.

  20. Risk factors affecting metaphyseal irregularities in the radius and ulna of growing Newfoundland dogs.

    PubMed

    Trangerud, C; Meuwissen, T; Ropstad, E; Indrebø, A; Grøndalen, J; Moe, L

    2007-10-01

    The main objective of this study was to study risk factors affecting metaphyseal irregularities (MI) in the distal radius and ulna of growing Newfoundland dogs. Risk factors studied included the genetic effects, effects of litters, BW, circumferences of the distal radius and ulna (CDRU), and total serum alkaline phosphatase (ALP) concentrations. The study included 118 Newfoundland dogs (60 females, 58 males), derived from 32 litters. Body weight, separated on sex and MI, was fitted to the Gompertz function. Occurrence of MI differed significantly between sexes, with 55% of males and 35% of females affected (P = 0.03). Growth curves for the 2 groups of dogs, with and without MI, diverged after 60 to 70 d, and dogs with irregularities were heavier at maturity than dogs of the same sex without irregularities. In univariate analysis, the litter effect was a significant predictor of MI, explaining 32% of total variability of the MI incidence, but the genetic effects were not significant. However, the latter were significant in bivariate analysis of MI and BW. In the bivariate analysis, the effects of litter on MI and BW were significantly correlated at all observational points except at birth, 180 d, and 536 d. Total ALP concentrations decreased with increasing age, and differences between groups diminished with increasing age, indicating a negative effect of total ALP on MI. Correlation between MI and total ALP concentrations of litters was estimated in a bivariate analysis. This correlation was significant and ranged between -0.34 and -0.62. Similarly, the genetic relationship between total ALP and MI from 120 d of age onward varied between -0.31 to -0.60. However, correlations were only significant at 356 d of age (genetic correlation = 0.60; P = 0.01). The mean CDRU increased from 90 d of age toward a peak at 180 d. Thereafter, CDRU declined and stabilized at about 1 yr of age. The mean CDRU between the groups of dogs with and without MI diverged most at 90 d of age

  1. Positioning evaluation of corrective osteotomy for the malunited radius: 3-D CT versus 2-D radiographs.

    PubMed

    Vroemen, Joy C; Dobbe, Johannes G G; Strackee, Simon D; Streekstra, Geert J

    2013-02-01

    The authors retrospectively investigated the postoperative position of the distal radius after a corrective osteotomy using 2-dimensional (2-D) and 3-dimensional (3-D) imaging techniques to determine whether malposition correlates with clinical outcome. Twenty-five patients who underwent a corrective osteotomy were available for follow-up. The residual positioning errors of the distal end were determined retrospectively using standard 2-D radiographs and 3-D computed tomography evaluations based on a scan of both forearms, with the contralateral healthy radius serving as reference. For 3-D analysis, use of an anatomical coordinate system for each reference bone allowed the authors to express the residual malalignment parameters in displacements (Δx, Δy, Δz) and rotations (Δφx, Δφy, Δφz) for aligning the affected bone in a standardized way with the corresponding reference bone. The authors investigated possible correlations between malalignment parameters and clinical outcome using patients' questionnaires. Two-dimensional radiographic evaluation showed a radial inclination of 24.9°±6.8°, a palmar tilt of 4.5°±8.6°, and an ulnar variance of 0.8±1.7 mm. With 3-D analysis, residual displacements were 2.6±3 (Δx), 2.4±3 (Δy), and -2.2±4 (Δz) mm. Residual rotations were -6.2°±10° (Δφx), 0.3°±7° (Δφy), and -5.1°±10° (Δφz). The large standard deviation is indicative of persistent malalignment in individual cases. Statistically significant correlations were found between 3-D rotational deficits and clinical outcome but not between 2-D evaluation parameters. Considerable residual malalignments and statistically significant correlations between malalignment parameters and clinical outcome confirm the need for better positioning techniques.

  2. The Sauve-Kapandji procedure and the Darrach procedure for distal radio-ulnar joint dysfunction after Colles' fracture.

    PubMed

    George, M S; Kiefhaber, T R; Stern, P J

    2004-12-01

    This retrospective study evaluated the results of the Darrach procedure and the Sauve-Kapandji procedure for the treatment of distal radio-ulnar joint derangement following malunion of dorsally displaced, unstable, intraarticular fractures of the distal radius in patients under 50 years of age. Twelve of 18 possible patients in the Sauve-Kapandji group completed the disabilities of the arm, shoulder, and hand survey at a mean of 4 years postoperatively and nine of the 18 returned for a follow-up examination at a mean of 2 years. Twenty-one of 30 possible patients in the Darrach group completed the disabilities of the arm, shoulder, and hand survey at a mean of 6 years postoperatively and 13 of these 30 returned for follow-up examination at a mean of 4 years. The Darrach procedure and the Sauve-Kapandji procedure yielded comparable and unpredictable results with respect to both subjective and objective parameters.

  3. The radius distribution of planets around cool stars

    SciTech Connect

    Morton, Timothy D.; Swift, Jonathan

    2014-08-10

    We calculate an empirical, non-parametric estimate of the shape of the period-marginalized radius distribution of planets with periods less than 150 days using the small yet well-characterized sample of cool (T{sub eff} < 4000 K) dwarf stars in the Kepler catalog. In particular, we present and validate a new procedure, based on weighted kernel density estimation, to reconstruct the shape of the planet radius function down to radii smaller than the completeness limit of the survey at the longest periods. Under the assumption that the period distribution of planets does not change dramatically with planet radius, we show that the occurrence of planets around these stars continues to increase to below 1 R{sub ⊕}, and that there is no strong evidence for a turnover in the planet radius function. In fact, we demonstrate using many iterations of simulated data that a spurious turnover may be inferred from data even when the true distribution continues to rise toward smaller radii. Finally, the sharp rise in the radius distribution below ∼3 R{sub ⊕} implies that a large number of planets await discovery around cool dwarfs as the sensitivities of ground-based transit surveys increase.

  4. Optimal network modification for spectral radius dependent phase transitions

    NASA Astrophysics Data System (ADS)

    Rosen, Yonatan; Kirsch, Lior; Louzoun, Yoram

    2016-09-01

    The dynamics of contact processes on networks is often determined by the spectral radius of the networks adjacency matrices. A decrease of the spectral radius can prevent the outbreak of an epidemic, or impact the synchronization among systems of coupled oscillators. The spectral radius is thus tightly linked to network dynamics and function. As such, finding the minimal change in network structure necessary to reach the intended spectral radius is important theoretically and practically. Given contemporary big data resources such as large scale communication or social networks, this problem should be solved with a low runtime complexity. We introduce a novel method for the minimal decrease in weights of edges required to reach a given spectral radius. The problem is formulated as a convex optimization problem, where a global optimum is guaranteed. The method can be easily adjusted to an efficient discrete removal of edges. We introduce a variant of the method which finds optimal decrease with a focus on weights of vertices. The proposed algorithm is exceptionally scalable, solving the problem for real networks of tens of millions of edges in a short time.

  5. Aqueous outflow: Segmental and distal flow

    PubMed Central

    Swaminathan, Swarup S.; Oh, Dong-Jin; Kang, Min Hyung; Rhee, Douglas J.

    2014-01-01

    A prominent risk factor of primary open-angle glaucoma is ocular hypertension, a pathologic state caused by impaired outflow of aqueous humor through the trabecular meshwork within the iridocorneal angle. The juxtacanalicular region of the trabecular meshwork and the inner wall of Schlemm canal have been identified as the main contributors to aqueous outflow resistance, and both extracellular matrix within the trabecular meshwork and trabecular meshwork cell shape have been shown to affect outflow. Overexpression of multiple ECM proteins in perfused cadaveric human eyes has led to increased outflow resistance and elevated IOP. Pharmacologic agents targeting trabecular meshwork cytoskeletal arrangements have been developed after multiple studies demonstrated the importance of cell shape on outflow. Several groups have shown that aqueous outflow occurs only at certain segments of the trabecular meshwork circumferentially, a concept known as segmental flow. This is based on the theory that aqueous outflow is dependent on the presence of discrete pores within the Schlemm canal. Segmental flow has been described in the eyes of multiple species, including primate, bovine, mouse, and human samples. While the trabecular meshwork appears to be the major source of resistance, trabecular meshwork bypass procedures have been unable to achieve the degree of IOP reduction observed with trabeculectomy, reflecting the potential impact of distal flow, or flow through Schlemm canal and collector channels, on outflow. Multiple studies have demonstrated that outflow occurs preferentially near collector channels, suggesting that these distal structures may be more important to aqueous outflow than previously believed. PMID:25088623

  6. Maxillary molar distalization with first class appliance

    PubMed Central

    Ramesh, Namitha; Palukunnu, Biswas; Ravindran, Nidhi; Nair, Preeti P

    2014-01-01

    Non-extraction treatment has gained popularity for corrections of mild-to-moderate class II malocclusion over the past few decades. The distalization of maxillary molars is of significant value for treatment of cases with minimal arch discrepancy and mild class II molar relation associated with a normal mandibular arch and acceptable profile. This paper describes our experience with a 16-year-old female patient who reported with irregularly placed upper front teeth and unpleasant smile. The patient was diagnosed to have angles class II malocclusion with moderate maxillary anterior crowding, deep bite of 4 mm on a skeletal class II base with an orthognathic maxilla and retrognathic mandible and normal growth pattern. She presented an ideal profile and so molar distalization was planned with the first-class appliance. Molars were distalised by 8 mm on the right and left quadrants and class I molar relation achieved within 4 months. The space gained was utilised effectively to align the arch and establish a class I molar and canine relation. PMID:24577171

  7. Role of dopamine in distal retina.

    PubMed

    Popova, E

    2014-05-01

    Dopamine is the most abundant catecholamine in the vertebrate retina. Despite the description of retinal dopaminergic cells three decades ago, many aspects of their function in the retina remain unclear. There is no consensus among the authors about the stimulus conditions for dopamine release (darkness, steady or flickering light) as well as about its action upon the various types of retinal cells. Many contradictory results exist concerning the dopamine effect on the gross electrical activity of the retina [reflected in electroretinogram (ERG)] and the receptors involved in its action. This review summarized current knowledge about the types of the dopaminergic neurons and receptors in the retina as well as the effects of dopamine receptor agonists and antagonists on the light responses of photoreceptors, horizontal and bipolar cells in both nonmammalian and mammalian retina. Special focus of interest concerns their effects upon the diffuse ERG as a useful tool for assessment of the overall function of the distal retina. An attempt is made to reveal some differences between the dopamine actions upon the activity of the ON versus OFF channel in the distal retina. The author has included her own results demonstrating such differences.

  8. Atypical Miyoshi distal myopathy: A case report

    PubMed Central

    Wang, Meiling; Guo, Yujie; Fu, Yong; Jia, Rui; Chen, Gang

    2016-01-01

    Five distinct predominant distal myopathies have been identified with discrete clinical and genetic patterns. Miyoshi myopathy (MM; early adult-onset, type 2) is a subtype of dysferlinopathy. Furthermore, MM is the most common form of autosomal recessive distal myopathy. MM is typically characterized by muscular weakness, initially affecting the gastrocnemius or soleus muscle from the late teens or early adulthood. The present study reports a case of MM that was confirmed by pathological and immunohistochemical methods, in addition to a review of the relevant literature. A 37-year-old male patient presented with muscular weakness in the left foot. This clinical manifestation was not typical of MM, and the patient was initially diagnosed with inflammatory myopathy. He was treated with dexamethasone at a dose of 10 mg for 5 days followed by gradual tapering, following which the symptoms were alleviated; however, the pathology, immunohistochemistry and electromyography eventually confirmed the diagnosis of MM. The treatment was then terminated and the patient was discharged. The present study further supports the underlying heterogeneity in atypical MM-like phenotypes. Dysferlin protein deficiency can be identified by pathological examination. The pathology of dysferlinopathy is characterized by changes of muscular dystrophy. Inflammatory cellular infiltration is a relatively common finding in the muscle biopsies from numerous patients with dysferlinopathy. Therefore, the detection of dysferlin deficiency or marked reduction on the sarcolemma using immunohistochemical staining is important for the diagnosis of dysferlinopathy. PMID:27882118

  9. Biotin absorption by distal rat intestine

    SciTech Connect

    Bowman, B.B.; Rosenberg, I.H.

    1987-12-01

    We used the in vivo intestinal loop approach, with short (10-min) and long (3-h) incubations, to examine biotin absorption in proximal jejunum, distal ileum, cecum and proximal colon. In short-term studies, luminal biotin disappearance from rat ileum was about half that observed in the jejunum, whereas absorption by proximal colon was about 12% of that in the jejunum. In 3-h closed-loop studies, the absorption of 1.0 microM biotin varied regionally. Biotin absorption was nearly complete in the small intestine after 3 h; however, only about 15% of the dose had been absorbed in the cecum and 27% in the proximal colon after 3 h. Independent of site of administration, the major fraction of absorbed biotin was recovered in the liver; measurable amounts of radioactive biotin were also present in kidney and plasma. The results support the potential nutritional significance for the rat of biotin synthesized by bacteria in the distal intestine, by demonstrating directly an absorptive capability of mammalian large bowel for this vitamin.

  10. Ruptures of the distal biceps tendon.

    PubMed

    Ward, James P; Shreve, Mark C; Youm, Thomas; Strauss, Eric J

    2014-01-01

    Distal biceps ruptures occur most commonly in middle-aged males and result from eccentric contraction of the biceps tendon. The injury typically presents with pain and a tearing sensation in the antecubital fossa with resultant weakness in flexion and supination strength. Physical exam maneuvers and diagnostic imaging aid in determining the diagnosis. Nonoperative management is reserved for elderly, low demand patients, while operative intervention is generally pursued for younger patients and can consist of nonanatomic repair to the brachialis or anatomic repair to the radial tuberosity. Anatomic repair through a one-incision or two-incision approach is commonplace, while the nonanatomic repairs are rarely performed. No clear advantage exists in operative management with a one-incision versus two-incision techniques. Chronic ruptures present a more difficult situation, and allograft augmentation is often necessary. Common complications after repair include transient nerve palsy, which often resolves, and heterotopic ossification. Despite these possible complications, most studies suggest that better patient outcomes are obtained with operative, anatomic reattachment of the distal biceps tendon.

  11. Distal metatarsal coalition: A rare case report

    PubMed Central

    Vun, Shen Hwa; Drampalos, Efstathios; Shareef, Sajan; Sinha, Satyajit; Bramley, Diane

    2015-01-01

    Introduction Metatarsal coalition is an extremely rare condition. We report the second documented case of 4th and 5th distal metatarsal coalition in the literature. Presentation of case An eight-year-old girl was referred to an orthopaedic clinic with a four-month history of forefoot pain and swelling on the plantar aspect of the right little toe. Radiograph and clinical examination confirmed distal metatarsal coalition between the 4th and 5th metatarsals. Following a period of conservative treatment, excision was eventually performed due to worsening symptoms. Patient re-attended two years later with a recurrence of the coalition confirmed by computed tomography (CT) scan. The case was discussed at a tertiary paediatric orthopaedic insititution. Decision was made to manage patient conservatively with insole and physiotherapy until skeletal maturity. A year later, patient’s symptoms did not worsen, and her foot displayed no evidence of change in the arch and shape. Discussion The timing of ossification of coalition varies from one anatomical site to another. Surgery when performed before ossification is complete runs the risk of recurrence. Conclusion Our case report illustrates the importance of restoring normal weight bearing dynamics and pain relief when managing metatarsal coalition, or synostosis in skeletally immature patients. We recommend persevering with conservative treatment, with operative treatment reserved only as a later option, and ideally, until skeletal maturity is achieved. PMID:25670408

  12. Growth disturbances after distal tibial physeal fractures.

    PubMed

    Berson, L; Davidson, R S; Dormans, J P; Drummond, D S; Gregg, J R

    2000-01-01

    Twenty-four patients with distal tibial growth disturbance were reviewed. Disturbances were classified as physeal bar (prior to deformity), angular, linear or combined deformities. Treatment consisted of osteotomy in fourteen, epiphyseodesis in seven, excision of bony bar in two, and observation in one patient. Follow up was an average 36.6 months (range 4-129 months) after treatment of growth disturbance. The age at time of injury was 10.4 years of age average (range 3-15 years). There were 12 SH2, 2 SH3, 7 SH4, and 3 SH5 distal tibial physeal fractures. Thirteen of 15 fractures considered high energy and only 1 of 9 fractures considered low energy resulted in angular deformity. Angular and linear deformities presented an average 46 months (range 12-120 months) and physeal bars at an average 14 months (range 6-25 months) after injury. Patients with a delay in presentation of growth disturbance greater than 24 months had angular deformities in 92% compared with 33% in children presenting less than or at 24 months. Treatment based on type of deformity, age at time of injury, and growth remaining was considered successful in 83%. Patients with angular or linear deformities were more likely to present late, have high energy injuries, be male patients and have Salter-Harris types IV and V. Early diagnosis and treatment of growth disturbance can prevent severe deformity.

  13. Progressive Deconstruction of a Distal Posterior Cerebral Artery Aneurysm Using Competitive Flow Diversion

    PubMed Central

    Johnson, Andrew K.; Lopes, Demetrius K.; Moftakhar, Roham

    2016-01-01

    Progressive deconstruction is an endovascular technique for aneurysm treatment that utilizes flow diverting stents to promote progressive thrombosis by diverting blood flow away from the aneurysm's parent vessel. While the aneurysm thromboses, collateral blood vessels develop over time to avoid infarction that can often accompany acute parent vessel occlusion. We report a 37-year-old woman with a left distal posterior cerebral artery aneurysm that was successfully treated with this strategy. The concept and rationale of progressive deconstruction are discussed in detail. PMID:26958413

  14. Cam radius of curvature modification for improved manufacturability

    SciTech Connect

    Doughty, S.

    1995-12-31

    The design of IC engine cams using the popular polynomial design techniques often results in very high accelerations (and associated high contact forces) as the follower approaches the base circle. In those same parts of the cam action, the cam radius of curvature is likely to change signs, going from convex to concave, and this leads to manufacturing difficulties. When the cam is concave, the radius of the grinding wheel that can be used in manufacture is controlled by the minimum concave radius of curvature of the cam, and this is often much smaller than the wheel size that would result in most economic production. Further, the arc of contact is extended, resulting in loss of coolant flow and rapid loss of wheel dress. A solution is presented, based on substituting a convex circular arc to replace a segment of the cam profile including the concavity. The ramifications of such a modification with regard to the follower motion is also presented.

  15. Correlation between radius and asphericity in surfaces fitted by conics.

    PubMed

    Pérez-Escudero, Alfonso; Dorronsoro, Carlos; Marcos, Susana

    2010-07-01

    The optical surfaces of the eye are often described in terms of their radius and asphericity. The variations caused by experimental noise in repeated measurements of radius and asphericity of the same surface are strongly correlated. We show this correlation in experimental corneal elevation data from videokeratoscopy and Scheimpflug topography, in non-contact profilometry data of artificial lenses, and in simulations. The effect is a characteristic of the fits to conic curves, and not restricted to any experimental device or fitting procedure. A separate analysis of radius and asphericity may estimate incorrectly the statistical significance of the changes in the ocular surfaces. We propose a MANOVA-based statistical analysis that increases sensitivity by a factor of 4.

  16. Attractor radius, a new determination criterion of predictability limit

    NASA Astrophysics Data System (ADS)

    Liu, Deqiang; Ding, Ruiqiang; Li, Jianping; Feng, Jie

    2014-05-01

    Firstly, the definition of the attractor radius was given and then the property of that the attractor radius (AR) in a given n-dimensional attractor A is a constant was proved in theory. Secondly, the SV of the square of the RMS difference was separated into two components - the systematic error and the attractor radius, and it was proved that the observed global climatological RMS (OCR) difference is not equal to 71% of the SV of the RMS difference when the systematic error is existed, however, it is always equal to 71% of the AR. Then the physical understanding of the AR and also the predictability limit determinated by it were discussed. Finally, the spatial distributions of the predictability limit calculated from CFSv2 data by different criterions were compared.

  17. Closed reduction of radius refracture: A case report

    PubMed Central

    Shahid, Mohammad; Yeo, Mildrid; Smibert, John Graham

    2011-01-01

    INTRODUCTION Refractures of the radius and ulna in the paediatric patient with flexible intramedullary nails in situ are known to occur. There are no formal guidelines currently in the literature to guide the management of such fractures. PRESENTATION OF CASE A 10-year-old Caucasian girl, sustained a closed refracture of the radius at the same level, with the flexible intramedullary nails in situ to treat her recent ulna and radius fractures. DISCUSSION We proposed a new non-invasive way of reducing and maintaining such fractures without removal of the bent nail completely. CONCLUSION This method does not significantly reduce the mechanical strength of the nail, as we do not advocate applying an external lateral force, which would compromise nail mechanical strength and eventually lead to breakage of the nail in situ. PMID:22096752

  18. Distal Communication by Chimpanzees (Pan troglodytes): Evidence for Common Ground?

    PubMed Central

    Leavens, David A.; Reamer, Lisa A.; Mareno, Mary Catherine; Russell, Jamie L.; Wilson, Daniel; Schapiro, Steven J.; Hopkins, William D.

    2015-01-01

    van der Goot et al. (2014) proposed that distal, deictic communication indexed the appreciation of the psychological state of a common ground between a signaler and a receiver. In their study, great apes did not signal distally, which they construed as evidence for the human uniqueness of a sense of common ground. This study exposed 166 chimpanzees to food and an experimenter, at an angular displacement, to ask, “Do chimpanzees display distal communication?” Apes were categorized as (a) proximal or (b) distal signalers on each of four trials. The number of chimpanzees who communicated proximally did not statistically differ from the number who signaled distally. Therefore, contrary to the claim by van der Goot et al., apes do communicate distally. PMID:26292996

  19. Proton Charge Radius (PRad) Experiment at Jefferson Lab

    NASA Astrophysics Data System (ADS)

    Peng, C.; Gao, H.

    2016-03-01

    The puzzle of proton charge radius was recently raised by the measurement of muonic hydrogen Lamb shift at Paul Scherrer Institute (PSI), whose results were seven standard deviations smaller than the CODATA recommended value. To investigate this discrepancy, the PRad experiment was proposed and approved at Thomas Jefferson National Accelerator Facility (JLab). The experiment will extract the proton charge radius with a sub-percent accuracy by measuring the cross-sections of unpolarized electronproton elastic scattering in an unprecedented low Q2 region (2×10-4 GeV2/c2).

  20. Radius Constants for Analytic Functions with Fixed Second Coefficient

    PubMed Central

    Nargesi, Mahnaz M.; Ali, Rosihan M.; Ravichandran, V.

    2014-01-01

    Let f(z) = z + ∑n=2∞anzn be analytic in the unit disk with the second coefficient a2 satisfying |a2 | = 2b, 0 ≤ b ≤ 1. Sharp radius of Janowski starlikeness is obtained for functions f whose nth coefficient satisfies |an | ≤ cn + d  (c, d ≥ 0) or |an | ≤ c/n  (c > 0  and  n ≥ 3). Other radius constants are also obtained for these functions, and connections with earlier results are made. PMID:25101327

  1. Pitfalls in the application of distal femur plates for fractures.

    PubMed

    Collinge, Cory A; Gardner, Michael J; Crist, Brett D

    2011-11-01

    Despite design features intended to aid the surgeon in restoring proper alignment, malunion and implant-related problems are relatively common after a distal femur fracture treated with plate fixation. This article presents case examples of these problems followed by a discussion of the relevant distal femoral anatomy, design features of modern locked distal femur plating systems, and technical points necessary to avoid malunion and implant-related problems when using these devices.

  2. [Post-transplant distal limb syndrome].

    PubMed

    Borghi Torzillo, María Florencia; Bavcar, Paula; Lutfi, Rubén; Díaz, Alberto C

    2017-01-01

    The post-transplant distal limb syndrome is a not well known entity, with a prevalence of 5% in patients with renal transplant. Its diagnosis is based on clinical symptoms, bone scintigraphy and MRI, it has a benign course and the patient recovers without sequel. We present the case of a 37-year-old male, with medical history of hypertension, Berger's disease in 1999 that required dialysis three times a week for four years (2009-2013) and renal transplant in 2013. The patient consults on January 2014 referring severe pain in both feet, with sudden onset; he remembers the exact date of the beginning of the pain and denies trauma, pain prevents ambulation. The bone scintigraphy shows pathological uptake in both feet with no difference between the two. Although there is no treatment for this disease, it has a benign course.

  3. Closed-Loop Double Endobutton Technique for Repair of Unstable Distal Clavicle Fractures

    PubMed Central

    Struhl, Steven; Wolfson, Theodore S.

    2016-01-01

    Background: Displaced fractures of the distal clavicle are inherently unstable and lead to nonunion in a high percentage of cases. The optimal surgical management remains controversial. Hypothesis: Indirect osteosynthesis with a closed-loop double endobutton construct would result in reliable fracture union and obviate the need for additional surgery. Study Design: Case series; Level of evidence, 4. Methods: Eight patients with an acute unstable Neer type IIB distal clavicle fracture were treated with a closed-loop double endobutton implant. Mean follow-up averaged 3.4 years (range, 1-9 years). Two patients were lost to follow-up. The remaining 6 patients underwent a detailed functional and radiologic evaluation. Results: Definitive fracture healing was achieved in all patients. There were no complications, and no patients required additional surgery related to the index procedure. The mean Constant score was 97 at final follow-up. Conclusion: The closed-loop double endobutton technique was reliable and effective in achieving fracture union in all patients with unstable Neer type IIB fractures of the distal clavicle. This technique obviates the need for late hardware removal that is often necessary when direct osteosynthesis is used and avoids potential complications associated with coracoclavicular cerclage constructs that require knot fixation. PMID:27504466

  4. Tendinopathies Around the Elbow Part 2: Medial Elbow, Distal Biceps and Triceps Tendinopathies.

    PubMed

    Donaldson, Oliver; Vannet, Nicola; Gosens, Taco; Kulkarni, Rohit

    2014-01-01

    In the second part of this review article the management of medial elbow tendinopathy, distal biceps and distal triceps tendinopathy will be discussed. There is a scarcity of publications concerning any of these tendinopathies. This review will summarise the current best available evidence in their management. Medial elbow tendinopathy, also known as Golfer's elbow, is up to 6 times less common than lateral elbow tendinopathy. The tendinopathy occurs in the insertion of pronator teres and flexor carpi radialis. Diagnosis is usually apparent through a detailed history and examination but care must be made to exclude other conditions affecting the ulnar nerve or less commonly the ulnar collateral ligament complex. If doubt exists then MRI/US and electrophysiology can be used. Treatment follows a similar pattern to that of lateral elbow tendinopathy. Acute management is with activity modification and topical NSAIDs. Injection therapy and surgical excision are utilised for recalcitrant cases. Distal biceps and triceps tendinopathies are very rare and there is limited evidence published. Sequelae of tendinopathy include tendon rupture and so it is vital to manage these tendinopathies appropriately in order to minimise this significant complication. Their management and that of partial tears will be considered.

  5. 21 CFR 886.1450 - Corneal radius measuring device.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Corneal radius measuring device. 886.1450 Section 886.1450 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... chapter, subject to the limitations in § 886.9, only when the device does not include computer software...

  6. 21 CFR 886.1450 - Corneal radius measuring device.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Corneal radius measuring device. 886.1450 Section 886.1450 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... chapter, subject to the limitations in § 886.9, only when the device does not include computer software...

  7. About the horizontal variability of effective radius in stratocumulus clouds

    NASA Astrophysics Data System (ADS)

    Magaritz-Ronen, L.; Khain, A.; Pinsky, M.

    2016-08-01

    The role of turbulent mixing in formation of low horizontal variability of effective radius near the top of nondrizzling stratocumulus clouds is investigated in simulations of clouds observed during the Second Dynamics and Chemistry of Marine Stratocumulus field experiment. The clouds are simulated using a spectral bin microphysics Lagrangian-Eulerian model consisting of ~2000 adjacent parcels moving in a turbulence-like field with observed correlation properties. The parcels interact through drop sedimentation and turbulent mixing. It was found that the effective radius variability in the horizontal direction near cloud top does not exceed ~10% of the averaged value. Three different types of cloud parcels are revealed to be differently influenced by mixing: ascending slightly diluted parcels, cloudy parcels experiencing intense mixing with parcels from inversion, and initially dry parcels. The evolution of droplet size distributions in parcels belonging to these types is investigated. It is shown that in parcels of the first two types the values of effective radii do not change or change only slightly remaining close to the adiabatic value. In initially droplet-free parcels effective radius rapidly reaches a value close to the adiabatic value, while liquid water content remains low. Therefore, turbulent mixing leads to establishing vertical profiles of effective radius, which are close to the adiabatic profile.

  8. Computational Analysis of Dual Radius Circulation Control Airfoils

    NASA Technical Reports Server (NTRS)

    Lee-Rausch, E. M.; Vatsa, V. N.; Rumsey, C. L.

    2006-01-01

    The goal of the work is to use multiple codes and multiple configurations to provide an assessment of the capability of RANS solvers to predict circulation control dual radius airfoil performance and also to identify key issues associated with the computational predictions of these configurations that can result in discrepancies in the predicted solutions. Solutions were obtained for the Georgia Tech Research Institute (GTRI) dual radius circulation control airfoil and the General Aviation Circulation Control (GACC) dual radius airfoil. For the GTRI-DR airfoil, two-dimensional structured and unstructured grid computations predicted the experimental trend in sectional lift variation with blowing coefficient very well. Good code to code comparisons between the chordwise surface pressure coefficients and the solution streamtraces also indicated that the detailed flow characteristics were matched between the computations. For the GACC-DR airfoil, two-dimensional structured and unstructured grid computations predicted the sectional lift and chordwise pressure distributions accurately at the no blowing condition. However at a moderate blowing coefficient, although the code to code variation was small, the differences between the computations and experiment were significant. Computations were made to investigate the sensitivity of the sectional lift and pressure distributions to some of the experimental and computational parameters, but none of these could entirely account for the differences in the experimental and computational results. Thus, CFD may indeed be adequate as a prediction tool for dual radius CC flows, but limited and difficult to obtain two-dimensional experimental data prevents a confident assessment at this time.

  9. Nonlinear buckling analyses of a small-radius carbon nanotube

    NASA Astrophysics Data System (ADS)

    Liu, Ning; Wang, Yong-Gang; Li, Min; Jia, Jiao

    2014-04-01

    Carbon nanotube (CNT) was first discovered by Sumio Iijima. It has aroused extensive attentions of scholars from all over the world. Over the past two decades, we have acquired a lot of methods to synthesize carbon nanotubes and learn their many incredible mechanical properties such as experimental methods, theoretical analyses, and computer simulations. However, the studies of experiments need lots of financial, material, and labor resources. The calculations will become difficult and time-consuming, and the calculations may be even beyond the realm of possibility when the scale of simulations is large, as for computer simulations. Therefore, it is necessary for us to explore a reasonable continuum model, which can be applied into nano-scale. This paper attempts to develop a mathematical model of a small-radius carbon nanotube based on continuum theory. An Isotropic circular cross-section, Timoshenko beam model is used as a simplified mechanical model for the small-radius carbon nanotube. Theoretical part is mainly based on modified couple stress theory to obtain the numerical solutions of buckling deformation. Meanwhile, the buckling behavior of the small radius carbon nanotube is simulated by Molecular Dynamics method. By comparing with the numerical results based on modified couple stress theory, the dependence of the small-radius carbon nanotube mechanical behaviors on its elasticity constants, small-size effect, geometric nonlinearity, and shear effect is further studied, and an estimation of the small-scale parameter of a CNT (5, 5) is obtained.

  10. Finite Larmor radius flute mode theory with end loss

    SciTech Connect

    Kotelnikov, I.A.; Berk, H.L.

    1993-08-01

    The theory of flute mode stability is developed for a two-energy- component plasma partially terminated by a conducting limiter. The formalism is developed as a preliminary study of the effect of end-loss in open-ended mirror machines where large Larmor radius effects are important.

  11. Accuracy of distal limb fracture diagnosis at British racecourses 1999-2005.

    PubMed

    Reardon, R J M; Boden, L; Stirk, A J; Parkin, T D H

    2014-05-10

    Accurate diagnosis of racing injuries can be difficult. The objectives of this study were to describe the postmortem (PM) defined distribution of fatal distal limb fractures (DLF) affecting Thoroughbreds racing in Great Britain between February 1999 and August 2005 and then assess the accuracy of veterinary racecourse diagnoses and examine whether these improved following introduction of a computerised recording system. PM examinations were performed on limbs distal to radius or tibia from all cases of fatal DLF occurring on British racecourses during the study period. Results of these examinations were described and compared with the diagnoses made at the racecourses. Over the study period, fatal DLF prevalence in all race types was 0.63 per 1000 starts (344/545,335), with the lowest frequency (0.34 per 1000 starts) in flat racing on turf and the highest frequency (1.56 per 1000 starts) in national hunt flat races. The prevalence of fatal DLF in steeplechase racing had reduced from that reported previously: from 2.3 to 1 per 1000 starts. Racecourse veterinary identification of fracture presence was good (>93 per cent); however, identification of all fractured bones was poor (<55 per cent). Introduction of a computerised recording system did not significantly improve diagnostic accuracy. The prevalence of fatal DLF has not significantly altered since the 1970s. Techniques such as on course digital radiography to help improve racecourse fracture diagnoses could be introduced.

  12. Clinical and Non-Clinical Aspects of Distal Radioulnar Joint Instability

    PubMed Central

    Wijffels, MME; Brink, PRG; Schipper, IB

    2012-01-01

    Untreated distal radioulnar joint (DRUJ) injuries can give rise to long lasting complaints. Although common, diagnosis and treatment of DRUJ injuries remains a challenge. The articulating anatomy of the distal radius and ulna, among others, enables an extensive range of forearm pronosupination movements. Stabilization of this joint is provided by both intrinsic and extrinsic stabilizers and the joint capsule. These structures transmit the load and prevent the DRUJ from luxation during movement. Several clinical tests have been suggested to determine static or dynamic DRUJ stability, but their predictive value is unclear. Radiologic evaluation of DRUJ instability begins with conventional radiographs in anterioposterior and true lateral view. If not conclusive, CT-scan seems to be the best additional modality to evaluate the osseous structures. MRI has proven to be more sensitive and specific for TFCC tears, potentially causing DRUJ instability. DRUJ instability may remain asymptomatic. Symptomatic DRUJ injuries treatment can be conservative or operative. Operative treatment should consist of restoration of osseous and ligamenteous anatomy. If not successful, salvage procedures can be performed to regain stability. PMID:22675411

  13. OBSERVATIONAL CONSTRAINTS ON THE DEGENERATE MASS-RADIUS RELATION

    SciTech Connect

    Holberg, J. B.; Oswalt, T. D.; Barstow, M. A. E-mail: toswalt@fit.edu

    2012-03-15

    The white dwarf mass-radius relationship is fundamental to modern astrophysics. It is central to routine estimation of DA white dwarf masses derived from spectroscopic temperatures and gravities. It is also the basis for observational determinations of the white dwarf initial-final-mass relation. Nevertheless, definitive and detailed observational confirmations of the mass-radius relation (MRR) remain elusive owing to a lack of sufficiently accurate white dwarf masses and radii. Current best estimates of masses and radii allow only broad conclusions about the expected inverse relation between masses and radii in degenerate stars. In this paper, we examine a restricted set of 12 DA white dwarf binary systems for which accurate (1) trigonometric parallaxes, (2) spectroscopic effective temperatures and gravities, and (3) gravitational redshifts are available. We consider these three independent constraints on mass and radius in comparison with an appropriate evolved MRR for each star. For the best-determined systems it is found that the DA white dwarfs conform to evolve theoretical MRRs at the 1{sigma} to 2{sigma} level. For the white dwarf 40 Eri B (WD 0413-077) we find strong evidence for the existence of a 'thin' hydrogen envelope. For other stars improved parallaxes will be necessary before meaningful comparisons are possible. For several systems current parallaxes approach the precision required for the state-of-the-art mass and radius determinations that will be obtained routinely from the Gaia mission. It is demonstrated here how these anticipated results can be used to firmly constrain details of theoretical mass-radius determinations.

  14. Cystitis - acute

    MedlinePlus

    Uncomplicated urinary tract infection; UTI - acute cystitis; Acute bladder infection; Acute bacterial cystitis ... cause. Menopause also increases the risk for a urinary tract infection. The following also increase your chances of having ...

  15. Incidence of distal femoral and distal tibial deformities in infantile and adolescent blount disease.

    PubMed

    Myers, Thomas G; Fishman, Michael K; McCarthy, James J; Davidson, Richard S; Gaughan, John

    2005-01-01

    The purpose of this study was to assess distal femoral and tibial deformity in patients with infantile and adolescent Blount disease. This was a retrospective review of patients at the authors' institution diagnosed with Blount disease. Thirty-eight patients (21 in the infantile group and 17 in the adolescent group) met the study criteria. Measurements of the anatomic lateral distal femoral angle (aLDFA), anatomic lateral distal tibial angle (aLDTA), and tibiofemoral angle (TFA) were made from long-leg radiographs. The results of the infantile and adolescent measurements were compared with each other and to a normal database. Intraobserver and interobserver error was determined. The adolescent aLDFA measurements were significantly greater (more varus) than for the infantile group and normal database. The aLDTA (ankle) measurements were not statistically different between the two groups, or from the normal database. Analysis of both intraobserver and interobserver error for the aLDFA and aLDTA showed good reliability.

  16. Sauvè-Kapandji operation for disorders of the distal radioulnar joint.

    PubMed

    Mikkelsen, S S; Lindblad, B E; Sommer, J

    1993-02-01

    A series of 13 patients is reported in which a Sauvè-Kapandji procedure consisting of arthrodesis of the articulation between the radius and ulna combined with resection of the collum ulnae was used to treat posttraumatic caput ulnae syndrome. Among the nine female and four male patients whose median age was 42 years (range: 23 to 77 years), nine sustained a distal fracture that had healed with shortening of the radius or with subluxation of the caput ulnae. Median postoperative observation time was 16 months (range: six to 27 months). Preoperatively, all patients had persistent medial wrist pain and restricted pronation-supination. At follow-up, ten patients were without symptoms and three others had improved significantly. No patient suffered from pain from the site of the resection. A significant improvement in pronation-supination of 45 degrees and flexion-extension of 25 degrees were found. Hand grip strength improved significantly during rehabilitation. At follow-up, the average hand grip strength on the operated wrists was 69% compared to the uninjured side.

  17. Variable radius cartography - History and perspectives of a new discipline

    NASA Astrophysics Data System (ADS)

    Scalera, Giancarlo

    2014-05-01

    The map that Toscanelli sent to Columbus was an unconscious application of cartography at a smaller radius than the real. The first really conscious attempts to represent the geography of Earth on globes of radius less than the current one occurred after the formulation of the concept of expanding Earth through geological time. The American chemist and geologist Richard Owen (1810-1890) in his book Key to the geology of the globe (1857) described the principles of what he himself called Anatomical Geology, with the Earth growing as a biological organism. The book contained a global paleogeographic map of the Earth that would have had a radius of about 4000 kilometers. In 1928 J.A.H. Kerkhoff (under the pseudonym Aero-dilettant) published a series of paleogeographic globes on which the modern oceans disappeared. With the same artisan methods of transfer continental outlines from a sphere to a smaller one, in 1933 O.C. Hilgenberg represented three different geological epochs, and, later, for the first time mapped paleopoles with their site-pole segments of meridian. Even today the traditional method of Hilgenberg is followed by senior researchers (Klaus Vogel, 2003) and younger geologists (James Maxlow). In England Hugh Owen applied the methods of traditional cartography to the variable radius one. His Atlas of Continental Displacement was in the 70s and 80s, for this discipline, a real milestone. While in the field of constant radius paleogeography the adherents to plate tectonics created many computer codes of automatic mapping (Bullard et al., 1965; Smith & Hallam, 1970; Scotese et al., 1979; and many others), in the variable radius field few tried to reach the same task. In 1972 in United States a first very simple attempt (but was not further developed) came from a private, R.B. Perry, followed by the still not-computerized Atlas of Owen, and both them constituted inspiration for the construction of a FORTRAN variable radius mapping code at INGV, with which it

  18. An intrinsic timer specifies distal structures of the vertebrate limb.

    PubMed

    Saiz-Lopez, Patricia; Chinnaiya, Kavitha; Campa, Victor M; Delgado, Irene; Ros, Maria A; Towers, Matthew

    2015-09-18

    How the positional values along the proximo-distal axis (stylopod-zeugopod-autopod) of the limb are specified is intensely debated. Early work suggested that cells intrinsically change their proximo-distal positional values by measuring time. Recently, however, it is suggested that instructive extrinsic signals from the trunk and apical ectodermal ridge specify the stylopod and zeugopod/autopod, respectively. Here, we show that the zeugopod and autopod are specified by an intrinsic timing mechanism. By grafting green fluorescent protein-expressing cells from early to late chick wing buds, we demonstrate that distal mesenchyme cells intrinsically time Hoxa13 expression, cell cycle parameters and the duration of the overlying apical ectodermal ridge. In addition, we reveal that cell affinities intrinsically change in the distal mesenchyme, which we suggest results in a gradient of positional values along the proximo-distal axis. We propose a complete model in which a switch from extrinsic signalling to intrinsic timing patterns the vertebrate limb.

  19. Surgical management of pancreatic cancer--distal pancreatectomy.

    PubMed

    Parikh, Purvi Y; Lillemoe, Keith D

    2015-02-01

    Distal pancreatectomy is the standard procedure for tumors located in the body and tail of the pancreas. In the last three decades, significant progress has been made with regard to technical aspects as well as perioperative care so that excellent mortality and morbidity rates can be achieved. Recently, there is growing evidence that distal pancreatectomy may be performed laparoscopically in selected patients, offering the advantages of minimally invasive surgery. Unfortunately, the oncologic outcomes for pancreatic adenocarcinoma remain poor, in part due to the late stage of presentation in most patients. We review the history of distal pancreatectomy, discuss current indications for performing this procedure, compare operative techniques in performing distal pancreatectomy, and review both the early complications seen in patients who have undergone a distal pancreatectomy and the long-term metabolic and oncologic outcomes of these patients.

  20. Link between diurnal stem radius changes and tree water relations.

    PubMed

    Zweifel, R; Item, H; Häsler, R

    2001-08-01

    Internal water reserves are depleted and replenished daily, not only in succulent plants, but also in trees. The significance of these changes in tissue water storage for tree water relations was investigated by monitoring diurnal fluctuations in stem radius. In 6-year-old potted Norway spruce (Picea abies (L.) Karst.) trees, whole-tree transpiration rate (T), sap flow at the stem base and fluctuations in stem radius were measured at 10-min intervals over eight successive weeks. The dynamics of diurnal water storage in relation to the daily course of water movement was simulated and the contribution of stored water to T quantified. The finding that, in P. abies, the course of bark water content is linearly coupled to stem radius fluctuations provided the basis for linking stem radius changes to a functional flow and storage model for tree water relations. This model, which consists of physical functions only and is driven by a single input variable (T), accurately simulates the diurnal course of changes in stem radius and water storage of the tree crown and stem. It was concluded that fluctuations were mainly determined by the course of transpiration. The availability of soil water and the degree to which storage tissues were saturated were also factors affecting the diurnal course of stem radius changes. Internally stored water contributed to daily transpiration even in well-watered trees, indicating that stored water plays an important role not only during periods of drought, but whenever water transport occurs within the tree. Needle and bark water reserves were most heavily depleted during transpiration. Together they supplied approximately 10% of daily T on sunny days, and up to 65% on cloudy days. On a daily basis, the crown (mainly needles) contributed approximately eight times more water to T than the stem (mainly bark). The depletion of the two storage pools and the water movements observed in the trees always occurred in the same sequence. In the morning

  1. Treatment of the distal fracture in radioulna based on the volar wrist dual channel approach and postoperative X-ray diagnosis.

    PubMed

    Li, Zheng; Zhang, Zhenwei; Yu, Shaoxiao; Bai, Yinwei; Lin, Huixin; Zeng, Jinhao; Ye, Xuelang; Xu, Dachuan

    2015-12-01

    The fracture of the distal ulna and radius is a kind of fracture that results in high morbidity and occurrence rate and contributes to about one-sixth of the entire body's fracture. In this study, we implemented the improved palmar wrist surgery by a volar wrist dual channel approach. Between 2011 and 2014, we have treated 67 distal radius fracture patients. We divided them into two parts randomly, and treat them by the Carpometacarpal direct approach solution and dual wrist palmar surgical approach solution respectively. After the surgery, the differences in the incidence of median nerve irritation are significant (P < 0.01). With reference to the exposure time of fracture, the operation time and the pronator quadratus muscle repair rate, we find that the exposure time of fracture and the operation time in the dual wrist palmar surgical approach solution are much less than that as compared to the Carpometacarpal direct approach solution (P < 0.01). The improved dual wrist palmar surgical approach can lead to a successful treatment of the distal radius fractures volar distal radial ulnar by reducing the blind exposure problem. As such, the surgeon can complete treatment of fractures of the region under direct vision during operation. Furthermore, reducing the median nerve in the carpal tunnel and the structure of the stretch can decrease the incidence of postoperative complications. Postoperative X-ray diagnosis is then performed to examine the patients' recovery and assist in clinical follow-up. Our study proves that the volar wrist dual channel approach can be successfully achieved by a surface incision surgical implementation of the dual channel, and gives rise to a minimally invasive operation.

  2. 21 CFR 886.1430 - Ophthalmic contact lens radius measuring device.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ophthalmic contact lens radius measuring device... lens radius measuring device. (a) Identification. An ophthalmic contact lens radius measuring device is an AC-powered device that is a microscope and dial gauge intended to measure the radius of a...

  3. Métastase osseuse isolée du radius métachrone d’un cancer rectal

    PubMed Central

    Eddekkaoui, Houda; Chekrine, Tarik; Sahraoui, Souha; Marouane, Sofia; Alj, Amina; Zamiati, Soumaya; Nechad, Mohamed; Benider, Abdellatif

    2013-01-01

    Les métastases osseuses isolées des cancers colorectaux sont très rares. Le squelette axial est habituellement le plus atteint. La localisation au niveau du radius est exceptionnelle. Nous rapportons l'observation d'une femme âgée de 60 ans avec une métastase du radius distal isolée métachrone d'un cancer du haut rectum opéré un an auparavant. La métastase a été découverte sur les examens d'imagerie et confirmée par biopsie. Une amputation a été réalisée suite à une progression de la maladie après une radiothérapie palliative. L'évolution était marquée par l'apparition de métastases pulmonaires et le décès est survenu dans un tableau de défaillance respiratoire. PMID:23819003

  4. Distal Expression of knotted1 in Maize Leaves Leads to Reestablishment of Proximal/Distal Patterning and Leaf Dissection

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Maize (Zea mays) leaves provide a useful system to study how proximal/distal patterning is established because of the distinct tissues found in the distal blade and the proximal sheath. Several mutants disrupt this pattern, including the dominant knotted1-like homeobox (knox) mutants. knox genes enc...

  5. Theory on the mechanism of distal action of transcription factors: looping of DNA versus tracking along DNA

    NASA Astrophysics Data System (ADS)

    Murugan, R.

    2010-10-01

    In this paper, we develop a theory on the mechanism of distal action of the transcription factors, which are bound at their respective cis-regulatory enhancer modules on the promoter-RNA polymerase II (PR) complexes to initiate the transcription event in eukaryotes. We consider both the looping and tracking modes of their distal communication and calculate the mean first passage time that is required for the distal interactions of the complex of enhancer and transcription factor with the PR via both these modes. We further investigate how this mean first passage time is dependent on the length of the DNA segment (L, base-pairs) that connects the cis-regulatory binding site and the respective promoter. When the radius of curvature of this connecting segment of DNA is R that was induced upon binding of the transcription factor at the cis-acting element and RNAPII at the promoter in cis-positions, our calculations indicate that the looping mode of distal action will dominate when L is such that L > 2πR and the tracking mode of distal action will be favored when L < 2πR. The time required for the distal action will be minimum when L = 2πR where the typical value of R for the binding of histones will be R ~ 16 bps and L ~ 102 bps. It seems that the free energy associated with the binding of the transcription factor with its cis-acting element and the distance of this cis-acting element from the corresponding promoter of the gene of interest is negatively correlated. Our results suggest that the looping and tracking modes of distal action are concurrently operating on the transcription activation and the physics that determines the timescales associated with the looping/tracking in the mechanism of action of these transcription factors on the initiation of the transcription event must put a selection pressure on the distribution of the distances of cis-regulatory modules from their respective promoters of the genes. The computational analysis of the upstream sequences

  6. Review article: problematic proctitis and distal colitis.

    PubMed

    Gionchetti, P; Rizzello, F; Morselli, C; Campieri, M

    2004-10-01

    About two-thirds of patients with ulcerative colitis have an inflammatory involvement distal to the splenic flexure, and therefore may be effectively treated with topical treatment, allowing the delivery of the active drug directly to the site of inflammation and limiting systemic absorption and potential side-effects. Topical aminosalicylate therapy is the most effective approach, and most patients will benefit hugely, provided that the formulation reaches the upper extent of the disease. Therefore, the choice of topical preparation should be based on the proximal extent of the disease and on patient preference. Oral aminosalicylates are less effective than topical therapies; however, a combination of oral and topical aminosalicylates can be successful in refractory patients. Alternatives to aminosalicylates are the new glucocorticoids, budesonide and beclometasone dipropionate, either as enemas or oral formulations (only beclometasone dipropionate). A combination of oral or rectal new glucocorticoids with rectal aminosalicylates should be considered in patients refractory to either approach. When these measures fail, treatment with oral glucocorticoids is necessary. An intensive intravenous steroid regimen is also helpful for patients refractory to oral steroids. Alternative treatments include short-chain fatty acid enemas, nicotine enemas and patches, acetarsol suppositories, ciclosporin enemas and epidermal growth factor enemas. Several factors potentially having a negative impact on therapeutic response include concurrent enteric pathogens, coexistent irritable bowel syndrome, patient nonadherence to therapy, inadequate dosing and duration of therapy, and proximal progression of the disease. Surgical colectomy may be required in those rare patients refractory or intolerant to pharmacotherapy.

  7. Distal interstitial epididymitis in young rats.

    PubMed

    Hoffmann, Guenther; Belote, Duane A; Suttie, Andrew W; Buetow, Bernard S; Muhumuza, Luke

    2015-04-01

    A sporadic, diffuse, interstitial mixed cell epididymitis of unknown etiology was noted in the epididymal cauda and distal corpus of young control Sprague-Dawley (SD) rats. Rats from 2 different suppliers were examined as part of routine toxicology studies. The incidence of this finding was 5/5 (study 1), 2/7 (study 2), and 2/7 (study 3). Although 2 of these studies partially overlapped temporally, none of the affected animals from any study was maintained concurrently with affected animals from any of the other 2 studies, and infectious causes, control article toxicity, or autoimmune processes were considered unlikely etiologies. Inflammation similar to that noted in the epididymides of these young rats was not present in other tissues and was not noted in study cohorts sacrificed at ages older than approximately 11 weeks or in rats of similar age from other concurrent studies. Similar findings were noted sporadically in historical control data, and consequently an age-related finding of unknown etiology and occurring in sporadic clusters is reported in SD rats ≤11 weeks old.

  8. Error analysis for a laser differential confocal radius measurement system.

    PubMed

    Wang, Xu; Qiu, Lirong; Zhao, Weiqian; Xiao, Yang; Wang, Zhongyu

    2015-02-10

    In order to further improve the measurement accuracy of the laser differential confocal radius measurement system (DCRMS) developed previously, a DCRMS error compensation model is established for the error sources, including laser source offset, test sphere position adjustment offset, test sphere figure, and motion error, based on analyzing the influences of these errors on the measurement accuracy of radius of curvature. Theoretical analyses and experiments indicate that the expanded uncertainty of the DCRMS is reduced to U=0.13  μm+0.9  ppm·R (k=2) through the error compensation model. The error analysis and compensation model established in this study can provide the theoretical foundation for improving the measurement accuracy of the DCRMS.

  9. Predicting jet radius in electrospinning by superpositioning exponential functions

    NASA Astrophysics Data System (ADS)

    Widartiningsih, P. M.; Iskandar, F.; Munir, M. M.; Viridi, S.

    2016-08-01

    This paper presents an analytical study of the correlation between viscosity and fiber diameter in electrospinning. Control over fiber diameter in electrospinning process was important since it will determine the performance of resulting nanofiber. Theoretically, fiber diameter was determined by surface tensi