Simultaneous Bennett's and distal radius fractures treated with external fixation. A case report.

Colles' fracture is rarely associated with a carpal or metacarpal fracture. We report a case of ipsilateral, simultaneous Bennett's and distal radius fracture after moderate trauma. Closed reduction and external fixation led to uneventful healing and no residual symptoms.

Plaster cast versus external fixation for unstable intraarticular Colles' fractures.

This study compares 75 consecutive patients with Frykman Type VIII fractures of the distal forearm treated by primary external fixation with 32 patients who sustained similar injuries and were treated by closed reduction and cast immobilization. The latter group of patients served as an historical control. The two groups were similar with respect to injury and demographic characteristics. All fractures treated with external fixation remained well reduced and aligned, whereas 88% of those treated with casts had unsatisfactory alignment despite the fact that 30% had a second reduction. The external fixator group also had superior results with respect to functional outcome, range of motion, and grip strength.

External fixation versus traditional treatment for comminuted Colles fractures.

The results of conservative treatment of comminuted Colles fractures are discouraging. Due to this several different operative techniques have been presented by different authors for treatment of these injuries. Good results have been reported by external fixation, but this has usually been the "second line of defense" and has been applied only after conservative treatment has failed. The aim of the present study was to compare primary external fixation and conservative treatment for comminuted Colles fractures of type Frykman VIII. The study was designed as a prospective, controlled study.

The congruence of the distal radioulnar joint. A magnetic resonance imaging study.

The functional anatomy of the distal radioulnar joint was studied in 10 healthy volunteers. The joint surface of both the ulnar head and the sigmoid notch of the radius form arcs of circles with small areas of contact because the diameters of the circles are different. The distal radioulnar joint is congruent throughout its range of motion, but the area of contact shifts from dorsal in the sigmoid notch in pronation to volar in supination. The insertion of the distal radioulnar ligaments on the ulnar head explains the congruence of the joint.

Reduction of Colles' fractures without anaesthesia using a new dynamic bone alignment system.

Two techniques for reduction of Colles' fractures were compared in a prospective, randomized study. With use of a newly designed dynamic bone alignment device, reduction manoeuvres were performed on 62 patients with Colles' fractures (group A) without any form of anaesthesia. In a control group of 54 patients (group B) Colles' fractures were reduced manually in the traditional way using local infiltration anaesthesia. In each group the pain experienced by the patients was recorded. Severe pain during the reduction was reported by 8 per cent of the patients in group A and by 35 per cent of those in group B. No complications occurred during or after dynamic reduction without anaesthesia. This method of treatment seems to be a very gentle one for the patients, with the advantage of causing less pain than treatment under local anaesthesia.

Comminuted Colles' fractures treated with external fixation.

In a prospective series of 75 patients the results of early external fixation of comminuted intraarticular Colles' fractures were studied. Comparison was made to a control group of 32 patients treated with plaster cast fixation. The groups were equal with regard to age, sex and fracture type. The treatment consisted of reduction in general anaesthesia or arm block followed by the application of a small external fixation device. The fixation lasted for five weeks after which the patients were allowed free exercises. For evaluation at the one year follow up the following variables were used: Radiographic appearance. Healing in of the styloid process of the ulna. Subjective evaluation according to the Lidström score. Objective evaluation including range of motion and grip strength. In all follow up variables the treatment group was significantly better than the control group. The prognosis of conservatively treated comminuted intraarticular Colles' fractures is poor. The results of after external fixation are, however, very encouraging and the method can be recommended.

Neurological complications of dynamic reduction of Colles' fractures without anesthesia compared with traditional manipulation after local infiltration anesthesia.

To investigate whether or not injection of local anesthetic into the fracture hematoma on reduction of a Colles' fracture increases the risk of neurological complications, a prospective randomized trial was conducted. The outcome in 62 patients whose Colles' fractures were reduced in a new bone-alignment device without anesthesia was compared with that in 54 patients with Colles' fractures that were reduced manually after injection of local anesthetic. At follow-up, any symptoms and signs of nerve damage were recorded. Four cases of such damage were noted in the group treated without local anesthesia, as opposed to 14 in the group in which a local anesthetic was used. The difference is significant (p less than 0.01). The authors have previously shown that injection of local anesthetic into the hematoma of Colles' fractures increases the carpal tunnel pressure. Neurological complications after the use of local anesthesia in reducing Colles' fractures is considered to be secondary to the scarring and fibrosis caused by this increase in pressure.

Carpal tunnel pressure in the acute phase after Colles' fracture.

In order to analyze the pressure on the carpal tunnel in the acute phase after Colles' fractures 13 patients were studied. The initial pressure and the variation after injection of a local anesthetic into the fracture hematoma, as well as the effects of increased volar flexion of the wrist, were measured using a wick catheter technique. Comparisons were made with a control group of ten healthy volunteers. The pressure was significantly higher in the fracture group than in the control group, and it increased significantly after injection of a local anesthetic into the fracture hematoma. A correlation was found between high increases after local anesthetic injection and high initial pressure. The pressure increased linearly with volar flexion of the wrist. There was a correlation between high increases due to volar flexion of the wrist and high initial pressure. The trauma itself causes increased carpal tunnel pressure due to edema and bleeding. Injection of a local anesthetic solution increases the fluid content of the carpal tunnel and raises the pressure. Volar flexion of the wrist decreases the space in the carpal tunnel, which also increases the pressure.