Retrospective study on the modified Uhl technique of closed reduction and percutaneous pin in the treatment of Colles' fracture / 中国骨伤

OBJECTIVE@#To retrospectively assess the advantages of the modified Uhl technique in the treatment of Colles' fracture guided by the principles of Chinese osteosynthesis (CO) concept.@*METHODS@#A retrospective study was conducted on 358 patients with Colles' fracture treated with the modified Uhl technique of closed reduction and percutaneous pin between January 2016 and June 2021. Out of these, 120 eligible cases were selected and categorized into two groups according to different surgical methods:the closed reduction and percutaneous pin group, and the open reduction group. Sixty-eight patients in the closed reduction and percutaneous pin group were treated with the modified Uhl technique, while fifty-two patients in the open reduction group were treated with open reduction and internal fixation using plates. The modified Sarmiento imaging score, Gartland-Werley wrist score, operation time, hospital stay, and treatment costs between the two groups were compared at a 6-month postoperative follow-up.@*RESULTS@#There were no significant differences in terms of gender, age, affected side, injure factors, time of injury to surgery, Sarmiento imaging score, and Gartland-Werley wrist joint score (P>0.05). The closed reduction and percutaneous pin group exhibited an operation time of (35.88±14.11) minutes, hospitalization stay of (9.78±2.48) days, and treatment costs of (16 074.91±1 964.48) yuan, while the open reduction group demonstrated comparatively longer operation time of (65.48±14.26) minutes, hospitalization stay of (15.88±2.00) days, and treatment costs of (20 451.27±1 760.22) yuan (P<0.01).@*CONCLUSION@#The modified Uhl technique presents notable advantages in the management of Colles' fracture, including reliable fixation, less trauma, shorter operation time, less pain, shorter hospital stay, and cost-effectiveness. This technique exhibits promising potential for broader clinical application. However, it is important to note that the pin could potentially damage tendons, and in cases of Colles' fractures with osteoporosis and comminuted fragments, additional techniques may be required for reliable fixation.

Small splint external fixation combined with 3D printing brace for the treatment of Colles fractures / 中国骨伤

OBJECTIVE@#To explore the short-term clinical efficacy of manipulation reduction-combined with small splint and 3D printing wrist brace external fixation of wrist brace for Colles fracture and the advantages of using the brace.@*METHODS@#A total of 60 patients with Colles fractures who were treated in Zhongshan Hospital of Traditional Chinese Medicine from February to December 2017 were selected. Patients were randomly divided into 2 groups according to the order of treatment, with 30 patients in the control group, including 13 males and 17 females, aged from 16 to 66 years, with a mean of (49.46±12.63) years; the time from injury to consultation ranged from 3 to 18 h, averaged (6.86±3.15) h. In the experimental group, there were 30 cases, 12 males and 18 females, ranging in age from 14 to 68 years old, with a mean of (46.73±14.40) years old; the time from injury to consultation ranged from 3 to 19 h, averaged(7.06±3.45)h. All the patients in the experimental group and the control group were treated with the same doctor's manipulation to reduce the fracture. The small splints were applied for external fixation after the satisfactory reduction shown in the X-ray. After 1 week of fracture treatment, the small splints were removed from the patients in the experimental group and the 3D printing braces were replaced to maintain fixation until the fracture healed. In the control group, small splints were maintained until the fracture healed. Wrist joint X-ray films were taken before and after reduction and 4 weeks after reduction to observe the palmar inclination angle, ulnar deviation angle, radius height and compare; VAS score and swelling degree score were recorded before and after reduction for 1 and 2 weeks; Cooney and PRWE score of wrist joint were compared after 6 to 8 weeks of reduction.@*RESULTS@#The VAS score of 2 weeks after reduction was 2.40±0.49 in the experimental group and 2.43±0.50 in the control group. There was no statistical difference in the VAS score between the two groups before and after reduction(=0.364). The swelling degree of 2 weeks after reduction was 0.50±0.50 in the experimental group and 0.53±0.50 in the control group. There was no statistical difference in the swelling degree between the two groups before and after reduction(=0.746). The Cooney and PRWE scores of the experimental group were better than those of the control group 6 to 8 weeks after reduction (<0.05), and the anatomical characteristics of palmar inclination, ulnar deviation and radial shortening of the experimental group were better than those of the control group(<0.05).@*CONCLUSIONS@#3D printing braces are light and breathable, comfortable and beautiful, and convenient for dressing. The combination of small splint sequentially applied to Colles fracture has a definite clinical effect, which enriches the means of external fixation treatment. It is believed that with the deepening of clinical research, the design and materials of 3D printing braces as well as their application in future medical treatment will be further developed.

The Factors Predicting Secondary Displacement after Closed Reduction of Unstable Distal Radius Fracture

PURPOSE: It has been studied prognostic factors about secondary displacement after conservative treatment of the distal radius fracture, but each study showed different results. Authors retrospectively evaluated factors known to be involved secondary displacement of the distal radius fracture to determine its significance. METHODS: One hundred eighteen cases of the radiographically unstable distal radius fractures that closed reduction was adequately performed were retrospectively studied and the radiographic images were taken at 1, 2, 3, 4, 6 weeks after closed reduction. During follow-up, dorsal tilt more than 15°, volar tilt more than 20°, ulnar positive variance more than 4 mm, radial length less than 6 mm, radial inclination less than 10° were thought of the loss of reduction. RESULTS: In 41 cases (34.7%), the loss of reduction occurred. Sex, intra-articular fracture, dorsal and volar comminution, concomitant ulnar fracture and involvement of the distal radio-ulnar joint were statistically not significant. Analysis results of the binomial logistic regression model were as follows: age (p=0.003), radial shortening (p=0.010) and ulnar positive variance (p=0.010) were statistically significant as the predictive prognostic factors. Analysis results of the multinomial logistic regression model showed age (p=0.006) as an only statistically significant factor. CONCLUSION: As the predictive prognostic factors for development of secondary displacement after conservative treatment of the unstable distal radius fracture, age was determined as most significant factor. Also radial shortening and ulnar positive variance were thought of the predictive factors for secondary displacement.

Quantitative evaluation of Colles' fracture by Multislice CT multiplanner reconstruction: a feasibility study / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the feasibility and reliability on the quantitative evaluation of Colles' fracture by multislice CT (MSCT) multiplanner reconstruction (MPR).</p><p><b>METHODS</b>A total of 36 patients with Colles' fracture from July 2011 to July 2014 were investigated in this study. There were 11 males and 25 females with a mean age of (42.5 ± 5.4) years old (ranged 35 to 72 years). All the patients underwent anteroposterior and lateral X-ray films and MSCT scans on wrist joints within 2 days after trauma. Images were sent to the workstation through picture archiving and conserving system (PACS). One associate chief physician independently and respectively measured the dorsal intercalation depth of distal fracture block, palmar angle and dislocation degree of wrist articular surface collapse on anteroposterior and lateral X-ray film and MSCT-MPR. The time interval between the two measurements was 2 weeks. All the data between the first and second measurement on X-ray and MPR and the mean value between the X-ray and MPR was examined with paired t-test. The pearson analyzed their correlation.</p><p><b>RESULTS</b>Among the 35 cases, 35 cases of palmar angle, 21 cases of intercalation depth and 16 cases of dislocation of wrist articular surface collapse could be measured on both X-ray and MPR. For the above parameters, the first measurement results were (12.5 ± 3.6)°, (4.5 ± 2.1) mm, (3.7 ± 1.6) mm and the second measurement results were (4.8 ± 2.2)°, (6.4 ± 3.6) mm, (2.5 ± 1.2) mm on X-ray films respectively. The first measurement results on MPR were (14.5 ± 5.3)°, (4.2 ± 1.2) mm, (5.7 ± 2.3) mm, and the results were (13.2 ± 2.6)°, (4.7 ± 2.2) mm, (4.6 ± 2.1) mm for the second measurement respectively. The three parameters between the first and second measurement on plain film had statistical difference and low correlation (r = 0.681, 0.640, 0.345, P < 0.05). The data between the first and second measurement on MPR showed that the dislocation degree of wrist articular surface collapse had statistical difference (P < 0.05) and no statistical significance was found for the other two parameters (P > 0.05), with the moderate correlation (r = 0.954, 0.854, 0.642). The three parameters had low or moderate correlation with each other on X-ray (r = 0.454, 0.532, 0.378, P < 0.05), compared with the mean value on MPR.</p><p><b>CONCLUSION</b>Using MSCT MPR images may carry on the multiple parameter measurement of Colles fracture, to make quantitative evaluation, and repeated measurement is better reliability.</p>

Treatment of Colles fracture with manipulative closed reduction and U-shaped gypsum functional fixation / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effect of U-shaped gypsum functional fixation after closed manipulative reduction for treatment of Colles' fractures.</p><p><b>METHODS</b>From January 2011 to April 2014,47 cases of Colles fracture were treated by closed reduction and U-shaped gypsum functional fixation including 12 males and 35 females with an average age of 54.8 years old ranging from 8 to 72 years old. The time from injury to treatment was 40 min to 3 d. The patients were closed fractures without neurovascular injury. After manual reduction and U-shaped gypsum functional fixation, the thumb of injury hand were traction by contralateral hand, and other fingers of injury hand were taken flexion to exercise grip function. According to the situation of fracture healing, plaster was removed at 4 to 8 weeks' fixation, the wrist joint functional exercise was strengthened after plaster removed.</p><p><b>RESULTS</b>All patients were followed up from 6 to 12 months with an average of 6.4 months, the fracture healing time was 4 to 8 weeks. According to the Cooney wrist function scoring: the result was excellent in 44 cases, good in 2 cases, 1 case.</p><p><b>CONCLUSION</b>U-shape gypsum functional fixation for treatment of Colles fracture limits the activity of thumb and extensor tendon, can reduce shortening of radial by traction of the injury thumb with the contralateral hand; it is good for blood circulation of hand and wrist, and swelling.</p>

Uso de risedronato na consolidação e formação do calo na fratura de Colles em mulheres na pós-menopausa - estudo solid / Use of risedronate for consolidation and callus formation in Colles fractures in postmenopausal women: solid study

OBJETIVO: Este estudo multicêntrico, randomizado, aberto, grupo paralelo avaliou a eficácia de Actonel(r) 35 mg mais cálcio/vitamina D versus cálcio/vitamina D isoladamente na preservação da densidade mineral óssea (DMO) em mulheres pós-menopausadas com fratura de Colles. MÉTODOS: Pacientes com fratura de Colles em sete dias foram aleatoriamente designadas para receber Actonel(r) 35 mg semanalmente mais cálcio/vitamina D (Grupo AO [GAO]) ou cálcio/vitamina D (grupo O [GO]) isoladamente. As pacientes foram avaliadas após 90 e 180 dias de tratamento. RESULTADOS: Completaram as avaliações 59 pacientes no GAO e 56 no OG. No fim do estudo, a DMO do rádio no local da fratura mostrou variação negativa no GO (32,8%) que foi discretamente menor no GAO (20,8%), assim como uma perda menor na DMO no GAO comparado com o OG. Houve diferença na proporção de paciente com perda da DMO no fim do estudo nos dois grupos de tratamento em favor do GAO, apesar de não estatisticamente significante. Não houve diferença significativa na identificação radiológica da formação do calo entre os grupos de tratamento. Na maioria das pacientes a identificação radiológica do calo ocorreu depois de 90 dias. CONCLUSÃO: Mulheres pós-menopausadas com fratura de Colles que receberam risedronato sódico, além do cálcio/vitamina D, comparado com cálcio/vitamina D não mostraram diferença significativa na perda da DMO na fratura do antebraço, com tendência de efeito protetor do risedronato na perda da DMO devido à imobilização. O tempo até a consolidação da fratura não foi afetado.

OBJECTIVE: This open, randomized and blinded parallel-group multicenter study evaluated the efficacy of Actonel(r) (35 mg) plus calcium/vitamin D versus calcium/vitamin D alone for preserving bone mineral density (BMD) in postmenopausal women with Colles fractures. METHODS: Patients with a Colles fracture for seven days were randomized to receive either Actonel(r) (35 mg) once a week plus calcium/vitamin D (ACD group) or calcium/vitamin D alone (CD group). The patients were evaluated after 90 and 180 days of treatment. RESULTS: 59 ACD patients and 56 CD patients completed all the evaluations. At the end of the study, the BMD of the radius at the fracture location showed a negative change in the CD group (32.8%). The loss of BMD in the ACD group (20.8%) was slightly less than that in the CD group. There was a difference in the proportions of patients with BMD losses at the end of the study period in the two treatment groups, in favor of the ACD group, although this was not statistically significant. There was no significant difference in radiological identification of callus formation between the treatment groups. In the majority of the patients, the callus could be radiologically identified after 90 days. CONCLUSION: Postmenopausal women with Colles fractures who received risedronate sodium plus calcium/vitamin D did not show any significant difference in BMD loss in forearm fractures, in comparison with those who received calcium/vitamin D alone. Risedronate presented a tendency toward a protective effect regarding BMD loss due to immobilization. The time taken for fracture consolidation to be achieved was unaffected.

Tratamiento rehabilitador integral en pacientes con fracturas de Colles consolidadas / Comprehensive rehabilitative treatment in patients with consolidated Colles fractures

Se realizó una intervención terapéutica en 50 pacientes con fracturas de Colles consolidadas, atendidos en el Hospital Clinicoquirúrgico Docente "Dr. Joaquín Castillo Duany" de Santiago de Cuba, en el período 2007-2008, a fin de evaluar el resultado del tratamiento rehabilitador integral. Se conformaron 2 grupos (control y de estudio) de 25 integrantes cada uno -- seleccionados de forma alterna --, quienes recibieron tratamiento convencional e integrador, respectivamente. Luego de aplicadas las escalas funcionales se evidenció mejor resultado terapéutico en los pacientes del segundo grupo, dado por menores complicaciones, mejor estado funcional de la muñeca y mano afectada y menor tiempo de recuperación.

A therapeutic intervention in 50 patients with consolidated Colles fractures; assisted in "Dr. Joaquín Castillo Duany" Teaching Clinical Surgical Hospital in Santiago de Cuba was carried out in the period 2007-2008, in order to evaluate the result of the comprehensive rehabilitative treatment. Two groups were formed (control and study groups) of 25 members each -- selected in an alternating way -- who received conventional and integrative treatment, respectively. After having applied the functional scales, a better therapeutic result was evidenced in the patients of the second group, given by smaller complications, better functional state of the wrist and affected hand and shorter time of recovery.

Evaluation des résultats de l'embrochage intra-focal selon Kapandji des fractures de Pouteau-colles

INTRODUCTION. Le but de ce travail etait d'evaluer les resultats des embrochages intra-focaux selon Kapandji des fractures de Pouteau-Colles realises dans la plupart des cas sous anesthesie locale et sans amplificateur de brillance. MATeRIEL ET MeTHODE. Il s'agissait d'une etude dynamique sur une periode de 12 mois qui a consiste a l'examen clinique complet et a la radiographie du poignet qui nous permettaient de calculer les indices radiologiques de face et de profil. Nos criteres d'inclusion concernaient les patients presentant une fracture de Pouteau-Colles vraie ages de 18 ans au moins; traites par embrochage intra-focal selon la technique de Kapandji effectivement suivis; revus et evalues. L'evaluation des patients se faisait apres un recul moyen de 9 semaines et nous avons utilise les criteres de Castaing.ReSULTATS. Pendant la periode d'etude nous avons enregistre 57 patients pour fracture de Pouteau Colles Parmi eux 35 ont ete operes selon la technique de Kapandji soit 61;4%. L'age moyen des patients etait de 38 ans. Nous avons note une predominance masculine de 16 hommes avec un sex-ratio de 1;2. Par rapport a la comminution posterieure (classification de Grumillier); nous avons note type I 34%; type II 43%; type III 23%. L'operation a ete realisee sans utilisation de l'amplificateur de brillance dans 74;3% des cas. A l'evaluation nous avons obtenu les resultats suivants ont ete obtenus :- Resultats subjectifs; 74;19% de tres bon et bon resultats ; 6;45% de mauvais resultats; - Resultats objectifs; 90;33% de tres bon et bon resultats ; 3;22% de mauvais resultats - resultats radiologiques; 83;88% de tres bon et bon resultats ; 6;45% de mauvais resultats. CONCLUSION.L'embrochage intra-focal selon Kapandji est une methode qui permet de traiter avec succes la plupart des fractures de Pouteau-Colles. L'aspect particulier de notre etude reside sur le fait que; cette technique chirurgicale s'etait executee dans la majeure partie des cas sous anesthesie locale et sans l'utilisation de l'amplificateur de brillance

Guiding role of three-column theory in manipulative reduction, small splint fixation and early rehabilitative exercises for Colles fracture / 中国骨伤

<p><b>OBJECTIVE</b>To explore guiding role of three-column theory in manipulative reduction, small splint fixation and early rehabilitative exercises of Colles fracture.</p><p><b>METHODS</b>From August 2011 to February 2012,47 patients with Colles fractures were treated by manipulative reduction small splinting fixation and early rehabilitative exercises under the guidance of three-column theory, including 21 males and 26 females aged from 40 to 76 years old with an average of (65.5 +/- 2.3). According to AO fracture classification, 27 patients were type A (including 18 cases with type A2 and 9 cases with type A3) and 20 patients were type C (including 10 cases with type C1, 6 cases with type C2 and 4 cases with type C3). Pain and recovery time of swelling, postoperative complications were observed and recorded, Gartland-Werley scoring system were applied for evaluate functional recovery and biomechanical analysis of wrist joint at 12 weeks after operation.</p><p><b>RESULTS</b>All patients were followed up for 3 to 9 months with average of 5 months. Pain relief time ranged from 5 to 15 d with average of (7.6 +/- 2.2) d,recovery time of swelling of opisthenar was for 6 to 13 d with an average of (8.9 +/- 1.9) d. Two patients occurred tension vesicle within 3 days after operation, but no other complications occurred. According to Gartland-Werley scoring system, 25 cases got excellent results, 18 cases good and 4 cases moderate at 12 weeks after operation.</p><p><b>CONCLUSION</b>Under the guidance of three-column theory, treating Colles fracture by manipulative reduction, small splinting fixation and early rehabilitative exercises can reduce pain and swelling time, promote union of fracture, effectively rehabilitate wrist function, improve clinical efficacy, and fit for concept of biomechanics.</p>

Long bone fractures identified in the Joseon Dynasty human skeletons of Korea / 대한해부학회지

Fracture is one of the pathological signs most frequently encountered in archaeologically obtained bones. To expand the paleopathological knowledge on traumatic injuries, it is desirable to secure data on long bone fractures from as wide a geographic and temporal range as possible. We present, for the first time, evidence of long bone fractures in a 16th-18th century Joseon skeletal series (n=96). In this study, we found 3 Colles' fractures of the radius in 2 individual cases. The pattern of fractures was unique. Although previous reports show that the ulna is broken more often than the radius, ulnar fracture associated with fending off a blunt attack was rare in our series (1/7 cases). Transverse fractures, typically caused by intentional violence, were also very rare (1/7 cases) in this study. These results may reflect the relatively tranquil lives of the Joseon people in 16th-18th century Korea. We also found post-fracture complications such as deformations, bone length shortening, and osteomyelitis. The present study would be of interest to medical scientists in related fields because it is one of the few studies conducted on long bone fractures among pre-modern societies in East Asian countries, thus far.

Case-control study on small splint fixation with trapezoid pad and plaster slab fixation for the treatment of comminuted Colles fracture / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical efficacy of trapezoid pad coordinate with small splint fixation treatment with plaster slab fixation treatment for comminuted Colles fracture.</p><p><b>METHODS</b>From October 2010 to March 2012,80 outpatients with comminuted Colles fracture were divided into two groups. There were 40 patients in trapezoid pad splint fixation treatment group and 40 patients in pipe type plaster control group. There were 13 males and 27 females in trapezoid pad splint fixation treatment group,with an average age of (62.1 +/- 19.2) years old. And there were 15 males and 25 females in pipe type plaster control group,with an average age of (60.2 +/- 19.5) years old. After treated with manipulative reduction,the fractures were fixed with pipe plaster in the control group, and were fixed with trapezoid pad joint by small splint in the treatment group. The patients in both groups were regularly taken X-ray recheck and changed dressings to obtain the clinical healing. Patients were guided to do functional exercise after splints were taken off. The therapeutic effects were evaluated according to Gartland-Werlley wrist score when splints taken off and after 2 months.</p><p><b>RESULTS</b>According to wrist score, the average scores in the treatment group were (8.1 +/- 2.8) when splints taken off and (5.3 +/- 4.5) after 2 months. And the average scores in the control group were (10.3 +/- 2.6) when splints taken off and (8.4 +/- 5.8) after 2 months. The score in the treatment group was higher than that of control group. The average shortened lengths of radius were (4.8 + 1.7) mm in the treatment group and (8.2 +/- 2.1) mm in the control group. The shortened length of control group was larger than that of treatment group.</p><p><b>CONCLUSION</b>Trapezoid pad coordinated with small splint fixation is better than traditional pipe type plaster for treating comminuted Colles fracture.</p>

A mobilização articular como acelerador do processode reabilitação: resultados preliminares / Joint mobilization to accelerate rehabilitation process: preliminary results

As fraturas da extremidade distal do rádio são aquelasque ocorrem em uma distância de até 3 cm da articulação rádio--cárpica, estando geralmente associadas à queda sobre a mão, com opunho em extensão, o que causa grande preocupação aos indivíduosdevido ao déficit funcional proporcionado. Objetivo: Realizar estudocomparativo sobre os efeitos de um tratamento baseado apenas emcinesioterapia clássica e um tratamento que a associa às técnicasde mobilização articular. Métodos: Os pacientes foram separadosaleatoriamente em dois grupos, grupo A, que recebeu tratamentocinesioterapêutico associado à mobilização articular, e grupo B,que recebeu o mesmo tratamento, sem aplicação da mobilizaçãoarticular. Após quinze sessões, os pacientes foram reavaliados. Resultados:A análise estatística, através do teste t-Student pareado, nãoapresentou diferença estatisticamente significante (α = 0.05) paraos movimentos de flexão, extensão, desvio ulnar e desvio radial. Nacomparação da evolução do grupo A em relação ao grupo B o testet-Student para amostras independentes também não apresentoudiferença estatisticamente significante (α = 0.05) para todos osmovimentos. Conclusão: Uma hipótese possível para evolução doganho dos ângulos articulares não ter sido significante é o tamanhoda amostra, porém o estudo será continuado para adesão de novospacientes e obtenção de dados mais concisos...

Fractures of the distal radius occur up to 3 cm fromthe radiocarpal joint, and are generally associated with a drop on thehand with the wrist extended, alarming individuals due to functionaldeficit generated. Objective: To conduct a comparative study on theeffects of a treatment based only on classical kinesiotherapy and atreatment that combines the technique of joint mobilization withclassical kinesiotherapy. Methods: Patients were randomly dividedinto two groups, Group A, using kinesiotherapy associated withjoint mobilization, and group B, which received the same treatmentwithout the application of joint mobilization. After fifteen sessions,patients were reassessed. Results: Statistical analysis by paired t-testdid not show statistically significance (α = 0.05) for flexion, extensionand ulnar and radial deviations. To compare the evolution ofgroup A in relation to group B, the t-test for independent samplesalso showed no statistically significant difference (α = 0.05) for allmovements. Conclusion: A possible hypothesis for the no statisticalsignificance of the evolution of the gain of joint angles is the samplesize, but this study will be continued to the accession of new patientsand more concise data collection...

Osteotomias do rádio distal com uso de placa volar de ângulo fixo / Osteotomy of the distal radius using a fixed-angle volar plate

OBJETIVO: A consolidação viciosa do rádio distal, por sequela de fratura, pode causar incapacidade funcional, levando o paciente a apresentar dor, perda de força e diminuição da mobilidade. Baseando-se nos excelentes resultados obtidos com o tratamento cirúrgico das fraturas instáveis do rádio distal com a utilização de abordagem volar e o uso de fixação rígida com a placa volar de ângulo fixo, começamos a utilizar o mesmo método para as osteotomias do rádio distal. MÉTODO: Foi realizada uma revisão retrospectiva e encontrou-se 20 pacientes, no período de fevereiro de 2002 a outubro 2009. O tempo de acompanhamento médio foi de 43,9 meses (variando de 12-96 meses). A indicação cirúrgica foi de dor persistente, deformidade e limitação funcional após fratura de deslocamento dorsal. RESULTADOS: A deformidade média pré-operatória foi de 27º de inclinação dorsal do rádio distal, 87º de angulação ulnar e 7,3 milímetros de encurtamento do rádio. Todas as osteotomias consolidaram e a média final de angulação volar do rádio distal foi de 6,2º, com 69,3º de angulação ulnar e um milímetro de encurtamento. A mobilidade média do punho aumentou em 19,9º na flexão e em 24º na extensão. No antebraço, a supinação média aumentou em 23,5º e em 21,7º na pronação. A força do punho aumentou de 13,4 para 34,5 libras. CONCLUSÃO: O uso da placa volar de ângulo fixo por abordagem volar para as osteotomias do rádio distal permite uma correção satisfatória das deformidades e elimina a necessidade de remoção do material de síntese por complicações nos tendões.

OBJETIVE: 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 27º of dorsal tilt of the distal radius, 87º of ulnar tilt, and 7.3 mm of shortening of the radius. All the osteotomies consolidated and the final mean volar tilt was 6.2º, with ulnar tilt of 69.3º and shortening of 1 mm. The mean mobility of the wrist increased by 19.9º (flexion) and by 24º(extension). Mean forearm supination increased by 23.5º and pronation by 21.7º. 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.

Understanding the treatment of Colles fracture with wrist joint fixation with plaster in flexion-ulnar position / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effects of wrist joint fixation in flexion-ulnar position for the treatment of Colles fracture.</p><p><b>METHODS</b>From January 1998 to June 2008,120 patients with Colles fracture were treated with wrist joint fixation with plaster in flexion-ulnar position. There were 52 males and 68 females with an average age of 57.6 years (ranged, 22 to 90); 41 cases were left, 69 cases were right, and 10 cases were hibateral. All of them were fresh closed fractures. According to fracture displacement to typing, type I of 34 cases, type II of 36 cases, type III of 32 cases, type IV of 18 cases.</p><p><b>RESULTS</b>With dislocated (II-IV type) 86 patients were followed up for 10 months in average. 86 cases with displaced fragments achieved clinical bony union. According to standard of Dienst, 59 cases got excellent results, 12 good, 10 fair, and 5 poor.</p><p><b>CONCLUSION</b>The wrist fixation with plaster in flexion-ulnar position in treating Colles fracture may maintain good fixation after reduction and obtain better functional recovery.</p>

Case-control study on the clinical characteristics of senile-osteoporotic Colles fracture / 中国骨伤

<p><b>OBJECTIVE</b>To analysis and compare the clinical characteristics of Colles fractures between patients with osteoporotic and without osteoporotic.</p><p><b>METHODS</b>From June 2007 to June 2009, 260 patients with Colles fracture were reviewed, including 60 males and 200 females, with a mean age of 66.5 years old. According to Cooney classification: 44 patients were type I, 83 patients were type II, 92 patients were type III and 41 patients were type IV. Among the patients, 96 patients were osteoporotic Colles fractures, and 164 patients without osteoporotic. The general information, invalidiation rate and short-term clinical results were compared between two groups.</p><p><b>RESULTS</b>There were no statistically difference of age, gender and fracture position between the two groups. There were more patients with type III and type IV, and higher invalidiation rate in osteoporotic Colles fracture group compared to those of no osteoporotic Colles fracture group (P<0.01). At the 6 months after treatment, the clinical effects of no osteoporotic Colles fracture group was better than that of osteoporotic Colles fracture group (P<0.01).</p><p><b>CONCLUSION</b>The senile-osteoporotic Colles fracture has different clinical characteristics, which should be given special treatment, frequent review and communication between doctors and patients during the period of treatment.</p>

Manejo terapéutico de pacientes con fractura del extremo distal de radio mayores de 60 años: revisión sistemática / Treatment of distal radius fractures in patients over 60 years old: a systematic review

The distal radius fracture is a fairly common clinical problem in elderly patients, treatment can be either surgical or conservative. We present a synthesis of evidence relating to compare the functional improvement of both treatment modalities, through a Systematic Review of randomized Clinical Trials. Objective: To determine whether there is scientific to endorse that functional improvement in the medium and long-term conservative versus surgical management in patients with fracture of the distal radius over 60 years. Search Strategy: Were included in Search Randomized Clinical Trials (RCTs), meta analysis (MT) and systematic Reviews (RS), the databases used were Medline, CINALH, Central (Cochrane), Lilacs and PEDro. Results: We selected three RCTs that met the eligibility criteria. Conclusions: There is limited evidence that surgical methods studied did not have better functional outcomes and long-term, compares with a closed reduction and cast. The SF-36 at 3-4 months, gives a DM of 3.01 (-1.6- 7.62), difference is not statistically significant (p = 0.54).

La fractura de radio distal es un problema clínico bastante frecuente en adultos mayores, el tratamiento puede ser de tipo quirúrgico o conservador. Realizaremos una síntesis de la evidencia, relativa a comparar la mejoría funcional de ambas modalidades terapéuticas, a través de una revisión sistemática de Ensayos Clínicos Aleatorizados. Objetivo: Determinar si existe evidencia científica que avale la mejoría funcional a mediano y largo plazo del manejo quirúrgico versus el conservador en pacientes con fractura del extremo distal del radio mayores de 60 años. Estrategia de Búsqueda: Se incluyeron en la búsqueda Ensayos Clínicos Aleatorizados (ECAs), Metaanálisis (MT) y Revisiones Sistemáticas (RS), las Bases de datos usadas fueron: Medline, CINALH, Central (Cochrane), Lilacs y PEDro. Resultados: Se seleccionaron 3 ECAs que cumplían con los criterios de elegibilidad. Conclusiones: Existe limitada evidencia que los métodos quirúrgicos estudiados no presentan mejores resultados funcionales a mediano y largo plazo, comparados con una reducción cerrada más yeso. El SF-36 al 3-4 mes, da una DM de 3,01 (-1,6 - 7,62), diferencia que no es estadísticamente significativa(p = 0,54).

Reabilitação das fraturas do rádio distal: [revisão] / Rehabilitation of distal radius fractures: [review]

O objetivo deste estudo foi avaliar a evidência do efeito e eleição da conduta terapêutica nas fraturas do rádio distal. A revisão sistemática utilizou as bases de dados PubMed, Lilacs, Pedro, Cochrane, Scielo, OTseeker, sem restrições de período de publicação, com as seguintes palavras chaves: fraturas do rádio, reabilitação, terapia ocupacional, fisioterapia, incluindo línguas inglesa, espanhola, francesa e portuguesa. Os estudos encontrados foram avaliados independentemente pelos dois autores utilizando critérios da escala PEDro. Estudos não experimentais foram incluídos em busca de esclarecimentos sobre a reabilitação. Foram encontrados 22 estudos, sendo 14 ensaios clínicos controlados randomizados (ECRs). Dentre eles, quatro compararam mobilização precoce com tratamento convencional apresentando evidência moderada a favor da primeira; sete confrontaram tratamento baseado em exercícios domiciliares com tratamento em consultório apontando evidência conflitiva (um deles também comprovou eficácia de mobilização acessória passiva); e três analisaram eficácia de procedimentos terapêuticos: campo eletromagnético pulsado, drenagem linfática, ultra-som, indicando evidências limitadas. Os nove estudos não experimentais encontrados não apresentaram informações suficientes sobre os questionamentos desta pesquisa. Observou-se uma tendência dos autores em utilizar os princípios gerais da reabilitação ao elaborar condutas terapêuticas, mas os procedimentos utilizados não estão bem atestados pela literatura.

The aim of this study was to assess the evidence regarding the adoption and effectiveness of therapeutic procedures employed for rehabilitation of distal radius fractures. This systematic review used the following databases: PubMed, Lilacs, PEDro, Cochrane, Scielo and OTseeker, without time restrictions. The following keywords were searched for: distal radius fracture, rehabilitation, occupational therapy, physiotherapy including reports in English, Spanish, French, and Portuguese. Twenty-two studies were retrieved and analyzed by two independent investigators following the PEDro scale criteria. Other non-experimental studies were included for additional information regarding certain rehabilitation approaches. Of the 14 randomized controlled clinical trials, four compared early mobilization to conventional therapy, showing moderate evidence in favor of earlier mobilization. Seven compared home therapy based on orientations to individual conventional therapy and found conflicting evidences. Three studies also analyzed the efficacy of the following specific therapeutic procedures: Pulsating magnetic field, lymphatic drainage, and ultrasound, which showed limited empirical support. The nine non-experimental studies did not add sufficient information regarding these issues. There was a trend to employ general principles of rehabilitation when elaborating these therapeutic approaches, but these procedures were not adequately supported by literature.

Are distal radius fracture classifications reproducible? Intra and interobserver agreement / As classificações das fraturas do rádio distal são reprodutíveis? Concordância intra e interobservadores

CONTEXT AND OBJECTIVE: Various classification systems have been proposed for fractures of the distal radius, but the reliability of these classifications is seldom addressed. For a fracture classification to be useful, it must provide prognostic significance, interobserver reliability and intraobserver reproducibility. The aim here was to evaluate the intraobserver and interobserver agreement of distal radius fracture classifications. DESIGN AND SETTING: This was a validation study on interobserver and intraobserver reliability. It was developed in the Department of Orthopedics and Traumatology, Universidade Federal de São Paulo - Escola Paulista de Medicina. METHOD: X-rays from 98 cases of displaced distal radius fracture were evaluated by five observers: one third-year orthopedic resident (R3), one sixth-year undergraduate medical student (UG6), one radiologist physician (XRP), one orthopedic trauma specialist (OT) and one orthopedic hand surgery specialist (OHS). The radiographs were classified on three different occasions (times T1, T2 and T3) using the Universal (Cooney), Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF), Frykman and Fernández classifications. The kappa coefficient (κ) was applied to assess the degree of agreement. RESULTS: Among the three occasions, the highest mean intraobserver k was observed in the Universal classification (0.61), followed by Fernández (0.59), Frykman (0.55) and AO/ASIF (0.49). The interobserver agreement was unsatisfactory in all classifications. The Fernández classification showed the best agreement (0.44) and the worst was the Frykman classification (0.26). CONCLUSION: The low agreement levels observed in this study suggest that there is still no classification method with high reproducibility.

CONTEXTO E OBJETIVO: Para que as classificações das fraturas possam ser úteis, elas devem prover o prognóstico, apresentar concordância interobservador e reprodutibilidade intraobservador. O objetivo foi avaliar a concordância intra e interobservadores das classificações das fraturas do rádio distal. TIPO DE ESTUDO E LOCAL: Estudo de validação (concordância intra e interobservadores), desenvolvido no Departamento de Ortopedia e Traumatologia da Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brasil. MÉTODO: Foram avaliadas 90 fraturas do rádio distal com desvio por meio de radiografias por cinco observadores (um médico residente de Ortopedia do terceiro ano, um graduando do sexto ano de medicina, um médico radiologista, um ortopedista especializado em trauma e um ortopedista especializado em cirurgia da mão) em três momentos diferentes, empregando as classificações Universal (Cooney), AO/ASIF (Osteosynthesfragen/Association for the Study of Internal Fixation), Frykman e Fernández. Aplicou-se o coeficiente de concordância kappa (κ) para avaliação das classificações. RESULTADOS: O maior κ intraobservador médio, se considerarmos os três momentos, foi da classificação Universal (κ = 0,61), seguida da Fernández (κ = 0,59), Frykman (κ = 0,55) e AO/ASIF (κ = 0,49). A concordância interobservador foi insatisfatória em todas as classificações. A classificação de Fernández mostrou a melhor concordância (κ = 0,44) e a pior foi a de Frykman (κ = 0,26). CONCLUSÃO: Os baixos níveis de concordância observados neste estudo sugerem que atualmente ainda não há um método de classificação plenamente reprodutível.

Modified Kapandji wiring technique for unstable fractures of distal end of radius

To assess the results of modified Kapandji wiring technique in unstable Colles' fractures. Descriptive study. At Ziauddin Hospital Karachi, From September 2005 to August 2006. A total of one hundred and eighty five adult patients presented in our centre with fractures of lower third of radius during the study period. Of these only twenty eight adult patients were included who had unstable fractures of the distal end of radius. There were nine male and nineteen female patients. Average age was 51 years. Three to four Kirschner-wires were used to stabilize the fracture. According to AO classification system thirteen were type A2, nine were type A3, and six type C1 fractures. X rays revealed good anatomical reconstruction consistent with a good wrist function. There was a much shorter period of rehabilitation as compared with plaster of Paris casts. No major complication occurred with this technique. For unstable fractures of the lower end of radius, intrafocal Kapandji wiring is a safe and successful method for achieving good results. It is easy to learn and perform. The device employed has a low cost

Effect of various external fixation for the treatment of Colles fracture / 中国骨伤

<p><b>OBJECTIVE</b>To observe restoration of the wrist function and complications of Colles fracture treated with different kinds of external fixation.</p><p><b>METHODS</b>Two hundreds and seventy-five patients with Colles fracture during March 1998 to Oct 2006 which were fixed with three kinds of external fixation were analyzed retrospectively. Group A: there were 95 patients, 61 male, 34 female, with an average age of (26.2 +/- 0.4) years, fixed by the small moulding plywood on the wrist in mild dorso-extend or neutral position; Group B:90 patients, 61 male, 29 female, with an average age of (24.0 +/- 1.5) years, fixed by the small moulding plywood on the wrist in mild palmar flexion; Group C: 90 patients, 65 male, 25 female, with an average age of (25.0 +/- 2.1) years, fixed by plaster on the wrist in mild dorso-extend or neutral position. According to the Frykaman typing,number of type I to VIII in group A was 25, 31, 20, 11, 3, 2 ,2, 1 in turn,type I to VIII in group B was 22, 30, 17, 9, 4, 4, 2, 2 in turn; type I to VIII in group C was 24, 30, 18, 9, 4, 3, 1, 1 in turn. Comparing the age, sex and the type of fracture, there were no statistical significant differences among three groups. After 6 to 18 months following-up survey, the restoration of the wrist and complication incidence were statistically analyzed.</p><p><b>RESULTS</b>To compare the restoration of the wrist joint and complication incidence after various fixation, there were significant differences between group A and B and C (P < 0.05) in statistics.</p><p><b>CONCLUSION</b>The treatment of the Colles fracture by the small moulding plywood fixation on the wrist in mild dorso-extend or neutral position is benefit to restore the wrist joint function and has fewer complications..</p>