Incidence of displacement after nondisplaced distal radial fractures in adults.

BACKGROUND: It is standard practice to closely monitor distal radial fractures treated nonoperatively to ensure that there is no fracture displacement. Patients are often asked to initially return weekly for radiographs. To our knowledge, nondisplaced distal radial fractures in adults have not been specifically evaluated to determine if this level of vigilance is required. If this subset of fractures is unlikely to displace, the cost, radiation exposure, and inconvenience of weekly office visits could be spared. METHODS: Using our billing database, we identified 642 closed distal radial fractures among the patients who presented to our institution during the four-year period from the beginning of 2006 to the end of 2009. Radiographs of the injuries were reviewed to identify fractures for which radiographic measurements were within predefined radiographic norms. Only those fractures that were believed to be nondisplaced by all reviewers were classified as nondisplaced for the purposes of this study. Radiographic measurements were made at the time of injury and at the time of fracture union to evaluate for displacement over time. The total number of clinic visits and radiographs that were received were calculated from the longitudinal medical record for each patient. RESULTS: Eighty-two fractures were identified as nondisplaced. None displaced or required operative intervention. The largest measured difference from injury to fracture union for radial inclination was 3.6° (average 0.8°); for radial height, 2.1 mm (average 0.5 mm); and for palmar tilt, 3.1° (average 1.0°). These numbers are all within the error of measurement. CONCLUSIONS: Nondisplaced distal radial fractures in adults appear to be inherently stable, and it may be appropriate to treat this subset of distal radial fractures with cast immobilization (when swelling allows) and a single follow-up visit with radiographs to document union at the time of cast removal. LEVEL OF EVIDENCE: Prognostic level III. See Instructions for authors for a complete description of levels of evidence.

Incidence of extensor pollicis longus tendon rupture after nondisplaced distal radius fractures.

PURPOSE: The incidence of extensor pollicis longus (EPL) tendon rupture in the setting of nondisplaced distal radius fractures is unknown. Extensor pollicis longus rupture is a known complication after distal radius fractures and is believed to occur more frequently after minimally displaced and nondisplaced distal radius fractures. Our study sought to define the incidence of EPL tendon rupture after nondisplaced distal radius fractures presenting to a level 1 trauma center. METHODS: Using our billing database, we identified distal radius fractures presenting to our institution between 2006 and 2009. We reviewed injury radiographs to identify fractures in which radiographic measurements were within predefined radiographic norms. Two fellowship-trained orthopedic hand surgeons, 1 fellowship-trained musculoskeletal radiologist, and 1 senior orthopedic surgery resident then reviewed these fractures. Only those fractures thought by all 4 reviewers to be nondisplaced were classified as nondisplaced for the purposes of this study. We then reviewed charts of these nondisplaced fractures to identify patients who subsequently sustained an EPL tendon rupture. RESULTS: We identified 3 EPL ruptures out of 61 nondisplaced fractures (5%). These occurred at an average of 6.6 weeks after distal radius fractures. CONCLUSIONS: The incidence of EPL rupture is higher than previously reported in the literature. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Symptomatic osteonecrosis of the hip and knee after cardiac transplantation.

Patients who are treated with steroids for immunosuppression after solid organ transplant are at risk for development of osteonecrosis. The purpose of this study was to determine the prevalence of symptomatic osteonecrosis of the hip and knee in patients who were treated with corticosteroids after cardiac transplantation and to determine if there was a relationship between steroid dose and the development of osteonecrosis. We retrospectively evaluated 204 patients who underwent cardiac transplantation and noted that only 6 (3%) of 204 patients developed symptomatic osteonecrosis of the hip or knee. The osteonecrosis was diagnosed an average of 38.5 months (range, 21-52 months) after transplantation. There was no association noted between steroid dose and the development of symptomatic osteonecrosis. The low prevalence of osteonecrosis supports the hypothesis that the development of osteonecrosis in these patients is an idiosyncratic response to steroids, perhaps related to an underlying hypercoagulable state or hypofibrinolysis.