The impact of shoulder pathology on individuals with distal radius fracture.

BACKGROUND: Shoulder pathology can occur concurrently with a distal radius fracture (DRF) but few studies have examined this population. PURPOSE: The purpose of this study was to expand the understanding of the impact of shoulder pathology on individuals with DRF. STUDY DESIGN: Mixed Methods Design. METHODS: A total of 45 participants with a DRF were categorized into a DRF only (n = 29) and shoulder pathology concurrent with DRF (SPCDRF) (n = 16) groups. Quantitative data gathered included demographics, Quick Disabilities of the Arm, Shoulder, and Hand, Tampa Scale of Kinesiophobia-11, Visual Analog Scale, and Compensatory Mechanism Checklist. Qualitative interviews were performed with 7 participants in the SPCDRF group. Within group correlations were analyzed via the Spearman Rank. The Mann Whitney U test was used to compare the two groups. Qualitative analysis was performed to describe the experience of participants in the SPCDRF group. A mixed methods analysis compared quantitative and qualitative data. RESULTS: Sixteen participants (35.6%) in the sample presented with shoulder pathology; 6 participants (37.5%) presented at initial evaluation due to the fall; 10 participants (62.5%) developed shoulder pathology due to compensation or disuse. Average number of days to develop shoulder pathology after the DRF was 43 days. SPCDRF participants had significantly greater pain levels (p = .02) and more activity avoidance (p = .03) than the DRF only group. Four qualitative themes emerged: It's difficult to perform occupations and changes had to be made; There is fear and uncertainty; The impact of pain; Tried to be normal but could not Mixed methods analysis found that qualitative data further illuminated quantitative findings. CONCLUSIONS: Individuals with shoulder pathology concurrent with a DRF may present with higher pain levels and avoid activity more. In addition, they may describe fearfulness in using their injured upper extremity especially if they have high levels of pain. STUDY DESIGN: Mixed Methods Design.

A biomechanical comparison of volar locked plating of intra-articular distal radius fractures: use of 4 versus 7 screws for distal fixation.

PURPOSE: To determine whether the number of distal locking screws significantly affects stability of a cadaveric simulated distal radius fracture fixed with a volar locking plate. METHODS: We created AO/ASIF type C2 fractures in 10 matched pairs of human fresh-frozen cadaveric wrists and then fixed them using volar locking plates. The number of distal locking screws used was 4 screws or 7 screws in each wrist of the matched pair. We loaded the stabilized fractures cyclically to simulate 6 weeks of postoperative stressing during a therapy protocol and then loaded them to failure. Failure was defined as 2 mm or more of displacement of any fracture fragment as recorded by differential variable reluctance transducers. RESULTS: No wrists failed during the cyclic loading portion for either the 4- or 7-screw construct. The average initial stiffness of the 7-screw construct was 69 N/mm (± 38) versus 48 N/mm (± 14) for the 4-screw construct. The average failure load for the 7-screw construct was 139 N (± 78) versus 108 N (± 18) for the 4-screw construct. Neither of these differences was statistically significant. CONCLUSIONS: Although there was a trend toward increased initial stiffness and higher failure load in fractures fixed distally with 7 locking screws, the results were not statistically significant compared with fractures fixed with only 4 screws. Both constructs can withstand forces likely encountered in early therapy protocols. CLINICAL RELEVANCE: The use of extra distal locking screws when fixing distal radius fractures increases expense and may increase the risk of complications, such as extensor tendon irritation or rupture.

Ulnar artery thrombosis associated with anomalous hypothenar muscle.

Ulnar artery thrombosis should be considered in patients presenting with cold intolerance or ischemia of the small and ring fingers, or a mass in the hypothenar area. Frequently this diagnosis is associated with a history of repetitive blunt trauma to the ulnar hand, thereby traumatizing the ulnar artery in Guyon's canal. This report presents a case of ulnar artery thrombosis associated with an abnormal muscle originating on the palmar antebrachial fascia, traversing volar to the ulnar artery and nerve, and inserting on the ulnar border of the abductor digiti minimi. This muscle is an abductor digiti minimi accessorius.

Biomechanics of external fixation: a review of the literature.

External fixation for the purpose of bony realignment has been in practice since the early 1900s and is widely used today. External fixators are primarily used for trauma but may also be used for deformity correction and arthrodesis, among other applications. The advantages of external fixation over open reduction and internal fixation and intramedullary nailing include simplicity of application, adjustability of the construct, and increased access for wound care and wound monitoring after fixation is achieved. Frame design requires a combination of pins, wires, clamps, rings, and rods to ultimately form a stable construct that can apply compressive, distractive, or neutral forces on bone.