Chart and diagram slides for powerpoint beautifully designed chart and diagram s for powerpoint with visually stunning graphics and animation effects. Radiological outcomes of 200 distal radius fractures following surgical treatment were retrospectively assessed to investigate whether malunion was more frequent in older patients. Midcarpal instability caused by malunited fractures of the. Eighty one patients with complex distal radius fractures belonging to type iv a, iv b, iv c of universal classification were treated with an. Out of the total number of cases n412 for fracture distal end radius, 5012% cases were managed with cast, 9122%with percutaneous fixation with kwire, 98 with external fixature, 78. Carpal instability, malunion among complications of distal. In the other hand, unstable fracture easily becomes malunited with inadequate treatment. Fractures of the distal radius linkedin slideshare. Average age of occurrence is between 57 and 66 years. Feb 01, 2012 fractures of the distal radius are extremely common injuries, which are steadily becoming a public health issue. Volar radioscapholunate arthrodesis and distal scaphoidectomy. However, the time course change after surgery for these fractures is unclear. Corrective osteotomy of malunited distal radius fractures. Radiographic outcomes of percutaneous pinning for displaced.
To evaluate rotational deformity in malunited fractures of the distal radius and its effect on forearm rotation. A novel surgical approach for treating distal radial extraarticular. Staged reconstruction for malunited fractures of the distal. Fracture of the distal end of radius represent the most common fracture of the upper extremity comprising approximately 8%17% of fractures seen in the emergency department 2 as per literature.
Radial corrective osteotomy can restore congruity in the distal radioulnar joint druj as well as adequate length of the radius. We describe two possible mechanisms of injury for these rare. Low energy injury usually fall from standing height is the usual cause of distal end radius fracture 66 to 77% of cases. From june 2007 to december 2010, 10 patients 6 females and 4 males presented to the senior author f. For malunited distal radius fracture, a combination of 3d computer simulation and a volar locking plate provides a simple, systematic and accurate corrective surgery. Malunion of the distal radius, archives of orthopaedic and. 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. The objective findings and subjective complaints of a symptomatic malunion. Ulnar shortening osteotomy for malunited distal radius. A prefabricated bone graft substitute corresponding to the patients bone defect was implanted and internal fixation was performed using a plate and screws. Normally stable distal radius fracture is treated nonoperatively with a favorable result. Computerassisted 3d planned corrective osteotomies in. Apr 20, 2012 diepunch fracture a depression fracture of the lunatefossa of the distal radius.
Longterm outcomes of corrective osteotomy for malunited. It also occurs in young men with high velocity, injury. Canale, st, beaty, jh eds campbells operative orthopedics. Pdf background multiple techniques for corrective osteotomy have been developed in recent years with the same aims. Intramedullary fixation is a novel technique for treatment of distal radius fractures. The present work was aimed to study the natural course and. Radial osteotomy and bowers arthroplasty for malunited fractures of the distal end of the radius. Premature physeal closure of an extraphyseal distal radius. For malunited diaphyseal forearm fractures, achievement of axial alignment, and restoration of normal length of both bones are considered to be prerequisites for a clinically. Initially, the left forearm fracture was treated by standard repositioning and cast. Mar 19, 2020 indications for surgical treatment of distal radius fractures drf remain controversial in the literature, especially in elderly patients.
Malunion of the distal radius usually occurs following conservative treatment. The present study aimed to evaluate the functional and radiographic outcomes of intramedullary nailing for correction of posttraumatic deformity in latediagnosed fractures of the. Dr vikas gupta malunited distal radius fractures olwa 2018 duration. May 24, 2002 carpal malalignment following the malunited distal radial fracture is described to develop as an adaptation to realign the hand to the malunion. We present a case of an extraphyseal distal radius fracture treated with closed reduction and percutaneous smooth kirschner wire fixation that went on to premature physeal closure at the site of wire fixation. High potential for functional impairment and frequent complications. Malunited distal radius fractures 272 journal of the american academy of orthopaedic surgeons moid notch and then measuring how much of the ulnar head is distal to that line fig.
Here, we present our experience and early results with arthroscopic resection arthroplasty of the radiocarpal joint. Complication rates after operatively treated drf are low and well documented. Surgical correction of malunited fractures of the distal radius. Patients with a malunited distal radius often have painful and limited forearm rotation, and may progress to arthritis of the distal radioulnar joint druj. Relatively few patients with a malunited distal radius fracture need a corrective osteotomy or salvage procedure. The text is comprehensive, updated and fully revised as per the present day requirements in the subject of orthopedics. Orthopaedic examination made easy download ebook pdf, epub. Chauffeurs fracture hutchinsons an isolated fracture of the radialstyloid process displacement of. In this edition ofbook cases on malunited distal radius fracture, intertrochanteric fracture, cut tendon injuries, carpal tunnel syndrome are included. A less invasive distal osteotomy of the radius for malunited dorsally displaced extraarticular fractures m. Ppt distal radius fractures powerpoint presentation. Distal radius fracture is the most common fracture, approximately 25% of all fractures seen at an emergency department 1 and constitutes 17% of all the fractures and 75% of all forearm fractures. Hernandez rivera journal of hand surgery european volume 2014 40. Do young patients with malunited fractures of the distal.
Thirtyseven patients with a symptomatic malunion of the distal radius 25 with. Distal radius fractures are the most common long bone fracture. Loss of correction in unstable comminuted distal radius. Modality of treatment for the distal end radius fracture dr bhuvnesh chaturvedi, dr sk irfan ali, dr sumit krishna abstract fracture of the distal end of radius is one of the most common fractures. Major complications of distal radius fractures include carpal.
In six cases, a recurrent voluntary midcarpal subluxation was also present during ulnar deviation. In this case, we demonstrate our preoperative lowcost workup for threedimensional 3d planned and assisted corrective osteotomy of a malunited distal radius fracture using an inhospital 3d printer. Management of malunions of the distal radius request pdf. Premature closure of the distal radius physis is rare and is usually associated with a fracture pattern that involves the physis. Distal radius malunion is a major complication of distal radius fractures, reported in 0 to 33% of cases. It worsens gradually after healing of the fracture due to continued loading of the wrist. Corrective osteotomy after a distal radius fracture is a procedure.
Management of posttraumatic malunion of fractures of the. Malunion is a recognized cause of suboptimal function after distal radius fracture. Salvage procedure after malunited distal radius fractures and. Nearly 90 000 older adults in the united states experience distal radius fractures drfs annually.
Keywords distal radius fracture, malunion of distal radius, extraarticular distal. The purpose of this study was to assess range of motion rom, pain, and incidence of radiographic degenerative joint disease djd after volar radioscapholunate rsl arthrodesis and distal scaphoidectomy dse following malunited distal radius fractures drf. Pdf ulnar shortening osteotomy for distal radius malunion. Midcarpal instability caused by malunited fractures of the distal radius thirteen patients with malunited fractures cf the distal radius developed symptoms of pain and instability of the midcarpal joint.
Sep 24, 2017 dr vikas gupta malunited distal radius fractures olwa 2018 duration. Relationship between distal radius fracture malunion and arm. Ulnar shortening osteotomies leave the radius angular deformities unchanged, risking secondary druj osteoarthritis. By applying a 1020 angle in the lateral projection, paralleling the articular surface of the distal radius, visualization of the articular surface is improved as a result of normal radial inclination. Diepunch fracture a depression fracture of the lunatefossa of the distal radius. Malunited fractures were classified into four types. Note the dorsal posture of the lunate and the increases in the scapholunate angle and the capitolunate angle. Distal radius fractures, first described in the 18th century by petit 1 and pouteau 2 commonly account for 10% of all fractures 3 and 72% of all forearm fractures. The goal of the site is to present a comprehensive inventory of distal radius fracture management information and resources, as well as uptodate. Effect of patient age on malunion of operatively treated.
Our new crystalgraphics chart and diagram slides for powerpoint is a collection of over impressively designed datadriven chart and editable diagram s guaranteed to impress any audience. The epidemiology of distal radius fractures hand clin 2012. After a severe trauma, a 16yearold female patient sustained multiple injuries, including a distal radius fracture of the left arm. Case report a 40yearold righthanded woman sustained a distal radius fracture during childhood.
Although not all malunited distal radius fractures are symptomatic, the goal of treatment for displaced extraarticular fractures of the distal radius should be to restore and to maintain the radial geometry until bone healing. Osteotomy for extraarticular malunion of the distal radius. Men who sustain distal radius fractures are usually younger, generally in their 40s vs. Treatment of neglected malunion of the distal radius. The purpose of the study was to find specific radiological features in wrists of patients who had an additional operation in comparison with patients with malunion without secondary surgical intervention. Fractures of the distal radius are extremely common injuries and the outcome differs depending on the type of fracture. Malunion of distal radius fracture often causes discrepancy in the wrist with a long ulna relative to the radius manifesting with ulnar wrist pain, swelling, and limitation of wrist motion. Fractures of the distal radius are extremely common injuries, which are steadily becoming a public health issue. Indications for surgical treatment of distal radius fractures drf remain controversial in the literature, especially in elderly patients.
High energy injuries accounts for 10% of wrist fractures. Distal radius fracture postoperative instructions most wrist fracture surgery is fairly quick, and a majority of patients get back to baseline. Welcome to eradius, the website of the international distal radius fracture study group. Intramedullary nailing for correction of posttraumatic deformity in.
A less invasive distal osteotomy of the radius for malunited dorsally. Ulnar shortening osteotomy for distal radius malunion. Arthroscopic resection arthroplasty for malunited intra. We, therefore, performed a retrospective cohort study. The purpose of this study was to summarize and evaluate results of threedimensional 3d planned corrective osteotomies of malunited distal radius fractures. B,normal radiocarpal and intercarpal alignment in the sagittal plane. We report a case of an anterior dislocation of the elbow with ipsilateral fracture of the distal radius.
Ulnar variance has important prognostic implications. Longterm outcomes of corrective osteotomy for malunited fractures of the distal radius. Patient ages ranged from 17 to 68 years average, 53 y. The purpose of this study was to determine if druj congruency and mechanics were altered in patients with malunited distal radius fractures. The purpose was to investigate the relationship between distal radius fracture malunion and armrelated disability. Assessment of anatomic restoration of distal radius fractures. It occurs in middle aged and elderly women commonly. Resource utilization for patients with distal radius.
Carpal malalignment following the malunited distal radial fracture is described to develop as an adaptation to realign the hand to the malunion. A less invasive distal osteotomy of the radius for malunited. This attempted to eliminate any symptoms present from other. Pdf malunited extraarticular distal radius fractures. With positive ulnar variance, the normal load on the ulnar carpus of approximately 18 % increases up to 65 % 18. This can be altered with fracture of the distal radius 15, 17. Malunion is the most common complication of the distal radial bone fracture and results in pain and reduced hand strength and function 2, 3, 21, 22. In the case of malunited fracture, particularly in younger and more active patients with no arthritic changes, openwedge corrective osteotomy with bone autograft is indicated 1, 10, 16, 17, 19, 20. Using the uso following malunited distal radius fractures, the substantial volar or. Ppt distal radius fractures powerpoint presentation free. Jan, 2011 distal radius fracture is a common injury and may result in substantial dysfunction and pain. Modality of treatment for the distal end radius fracture. Surgical correction of malunited fractures of the distal.
Distal radius fractures of the forearm are the most common fracture type, representing nearly 25% to 30% of all fractures in children. The prospective populationbased cohort study included 143 consecutive patients above 18 years with an acute distal radius fracture treated with closed reduction and either cast 55. Corrective osteotomy using a volar locking plate has recently become an alternative technique. Eight fractures were of the dominant wrist and 2 were of the nondominant wrist. Distal radius fracture is a common injury and may result in substantial dysfunction and pain. Scandinavian journal of plastic and reconstructive surgery and hand surgery. Cartilage damage of the carpals is a contraindication for corrective osteotomy of the malunited intraarticular distal radius fracture and typically is treated in the symptomatic patient with a salvage procedure. Longterm outcomes of corrective osteotomy for malunited fractures. Aro and koivunen4 classified three types of radioulnar relationships at the druj after distal radius. Nov 22, 20 the treatment of ulnarsided wrist pain after malunited distal radius fractures remains controversial. Computerassisted threedimensional corrective osteotomy for. Distal radius fracture problems can arise from complications related to the soft tissues, bony anatomy, joints and hardware. Different modalities of distal end radius fracture treatment.
This site is an academic site devoted to studying distal radius fractures and is open to all surgeons. Jul 15, 2014 malunion of the distal radius usually occurs following conservative treatment. A rare combination of complex elbow dislocation and distal. Corrective osteotomy for malunited extraarticular fractures of the distal radius. Tarallo t, mugnai r, adani r, catani f 2014 malunited extraarticular distal radius fractures. One of the most common complications following distal radius fractures is still malunion of the distal radius. Colles fracture reductioncast with dorsal mold duration. Posttraumatic deformity of the distal radius may lead to multiple sequelae and severe functional impairment. Scandinavian journal of plastic and reconstructive surgery. The malunited distal radius fracture early or late. It is also reported to develop during the immobilization itself rather than after fracture healing.
Ulnar shortening osteotomy after distal radius fracture. The treatment of ulnarsided wrist pain after malunited distal radius fractures remains controversial. These include malunion, degenerative osteoarthritis in the radiocarpal joint and subsequently pain and impaired hand function. There were 8 extraarticular fractures, including 3 with volar angulation, 2 anterior marginal. We have chosen the principle of ligamentotaxis using external fixation and bone grafting in this study to prevent late complications. Distal radius fractures common injury fractures of the distal radius represent approximately 16% of all fractures treated by orthopaedic surgeons three main peaks of fracture distribution. Citeseerx author proof effects of distal radius malunion on. Chauffeurs fracture hutchinsons an isolated fracture of the radialstyloid process displacement of the fragment isuncommon. This distal radius fracture eventually developed into a malunion.
The muscle belly of the flexor pollicis longus is retracted ulnarly to expose the pronator quadratus, which is elevated from its insertion on the radius fig. Surgical technique of corrective osteotomy for malunited. We investigated 19 patients who underwent the computerassisted 3d corrective osteotomy for a malunited fracture of the distal radius after the operation was stimulated with ct data. Corrective osteotomy of the malunited distal radius fracture. 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. The most common deformity following a malunited extraarticular fracture of the distal radius is the loss of the normal palmar tilt of the articular surface in the sagittal plane, and loss of length relative to the ulna. Corrective osteotomy of the distal radius is a well accepted procedure in younger, manual working and active patients with a malunited distal radius fracture. Secondary procedures following a distal radius fracture.