Bone density and geometric properties of the distal radius in displaced and undisplaced Colles' fractures: Quantitative CT in 70 women

We examined cortical and trabecular bone density and geometric properties of the unfractured distal radius in 70 women with recent Colles' fractures, using multilayer peripheral quantitative computed tomography (pQCT). We found that cortical volumetric density, cortical area and mean cortical thickness were lower in the displaced than in the undisplaced fractures, suggesting that the cross-sectional volumetric density and geometric properties of cortical bone may be essential in determining the severity of a Colles' fracture. We also compared lumbar spine and femoral neck bone mineral density (BMD) and the occurrence of osteoporosis in the displaced and undisplaced fracture groups and found no significant difference, which suggests that displacement of a Colles' fracture is not associated with general osteoporosis.     

Bone density and geometric properties of the distal radius in displaced and undisplaced Colles' fractures: Quantitative CT in 70 women

We examined cortical and trabecular bone density and geometric properties of the unfractured distal radius in 70 women with recent Colles' fractures, using multilayer peripheral quantitative computed tomography (pQCT). We found that cortical volumetric density, cortical area and mean cortical thickness were lower in the displaced than in the undisplaced fractures, suggesting that the cross-sectional volumetric density and geometric properties of cortical bone may be essential in determining the severity of a Colles' fracture. We also compared lumbar spine and femoral neck bone mineral density (BMD) and the occurrence of osteoporosis in the displaced and undisplaced fracture groups and found no significant difference, which suggests that displacement of a Colles' fracture is not associated with general osteoporosis.     

Lower hip bone mass and proximal femur fractures in elderly patients: more valuable than lumbar vertebrae bone mineral density

A decreased bone mineral density, such as osteoporosis, has been considered a factor closely associated with proximal femur fractures. We studied the relationship between osteoporosis and proximal femur fractures. Dual energy radiograph absorptiometry was used to measure the bone mineral density of 121 patients with a femur neck fracture and 134 patients with an intertrochanteric fracture. The bone density of the femoral neck, Ward's triangle, and the trochanteric region were measured. Two hundred seventeen normal patients who had undergone a bone mineral density test and were found to have no proximal femur fracture were used as the control group. Comparative analysis was performed after the patients were subdivided into different groups depending on sex and fracture type. The bone mineral density of the lumbar vertebra in patients with a proximal femur fracture was not significantly different from that of the control group, but the bone mineral density of the proximal femur in patients with a proximal femur fracture was significantly less than that of the control group. The bone mineral density of the group with an intertrochanteric fracture was lower than that of the femur neck fracture group. However, the difference was statistically insignificant. In bone mineral density comparisons, no significant differences were observed between the displaced and undisplaced femur neck fracture group and between the stable and the unstable intertrochanteric fracture group. The bone mineral density of elderly patients with a proximal femur fracture was significantly less than that of normal individuals. However, femur neck fractures in elderly men were less likely to be associated with a decreased bone mineral density. Little correlation between bone mineral densities of the proximal femur and fracture location (neck vs intertrochanter) and type (nondisplaced vs displaced neck, stable vs unstable intertrochanter) was found.     

Spatial Differences in the Distribution of Bone Between Femoral Neck and Trochanteric Fractures

There is little knowledge about the spatial distribution differences in volumetric bone mineral density and cortical bone structure at the proximal femur between femoral neck fractures and trochanteric fractures. In this case‐control study, a total of 93 women with fragility hip fractures, 72 with femoral neck fractures (mean ± SD age: 70.6 ± 12.7 years) and 21 with trochanteric fractures (75.6 ± 9.3 years), and 50 control subjects (63.7 ± 7.0 years) were included for the comparisons. Differences in the spatial distributions of volumetric bone mineral density, cortical bone thickness, cortical volumetric bone mineral density, and volumetric bone mineral density in a layer adjacent to the endosteal surface were investigated using voxel‐based morphometry (VBM) and surface‐based statistical parametric mapping (SPM). We compared these spatial distributions between controls and both types of fracture, and between the two types of fracture. Using VBM, we found spatially heterogeneous volumetric bone mineral density differences between control subjects and subjects with hip fracture that varied by fracture type. Interestingly, femoral neck fracture subjects, but not subjects with trochanteric fracture, showed significantly lower volumetric bone mineral density in the superior aspect of the femoral neck compared with controls. Using surface‐based SPM, we found that compared with controls, both fracture types showed thinner cortices in regions in agreement with the type of fracture. Most outcomes of cortical and endocortical volumetric bone mineral density comparisons were consistent with VBM results. Our results suggest: 1) that the spatial distribution of trabecular volumetric bone mineral density might play a significant role in hip fracture; 2) that focal cortical bone thinning might be more relevant in femoral neck fractures; and 3) that areas of reduced cortical and endocortical volumetric bone mineral density might be more relevant for trochanteric fractures in Chinese women. © 2017 American Society for Bone and Mineral Research.     

Bone mineral density of the radius in patients with Colles' fracture

To ascertain whether patients with Colles' fracture should be investigated for osteoporosis and the risk of future fractures, we measured the bone mineral density of the distal radius of the other arm in 31 women patients and compared the results with those of a control group of 289 normal women. We divided the patients into two groups, those younger than 66 years and those older. In 25 patients we found values for bone mineral density which were lower than one standard deviation below the mean value for their age. Younger patients had a deficit greater than that expected for their ages. We believe that women with Colles' fracture should be evaluated routinely for osteoporosis, particularly if they are under 66 years of age.     

Management of undisplaced or minimally displaced Colles' fracture: One or three weeks of immobilization

Sixty-two consecutive patients with an undisplaced or minimally displaced Colles' fracture were allocated at random to 1 or 3 weeks of immobilization in a dorsal plaster cast. No significant difference in radiographic results or in functional score, (according to Gartland and Werley 1951, modified by Solgaard 1988) was observed at 12 and 26 weeks. We conclude that patients with an undisplaced or minimally displaced Colles' fracture can be safely treated with only 1 week of immobilization in a dorsal plaster cast. However, the short treatment period does not accelerate return of function.     

Colles' fracture and bone density of the ultradistal radius

To determine whether Colles' fracture, generally considered a manifestation of postmenopausal osteoporosis, is associated with a decrease in bone density at the site of fracture, we measured bone mineral density of the ultradistal radius (UDR-BMD) by single-photon absorptiometry with computer-assisted image processing. In 119 normal women (ages 22-92 years), UDR-BMD decreased by 17% between ages 30 and 75 years. From UDR-BMD measurements in these normal women and in 40 women (ages 53-80 years) with Colles' fracture alone, a population-based analysis was made to estimate fracture risk at different values of UDR-BMD. Colles' fracture was uncommon at UDR-BMD greater than 0.40 g/cm2 (the "fracture threshold"). As bone density decreased below this level, fractures became more frequent (a "gradient of risk").     

Risk Factors for Severity and Type of the Hip Fracture

More severe hip fractures such as displaced femoral neck (FN) fractures and unstable intertrochanteric (IT) fractures lead to poorer outcomes, but risk factors for severe fractures have not been studied. To identify risk factors for severe types of hip fracture, we performed a prospective cohort study and obtained preoperative hip radiographs from women who sustained an incident hip fracture (excluding traumatic fractures). A single radiologist scored the severity of FN fractures by the Garden System: grades I and II, undisplaced; grades III and IV, displaced. The severity of IT hip fractures was rated by the Kyle System: grades I and II, stable; grades III and IV, unstable. A total of 249 women had FN fractures: 75 (30%) were undisplaced. A total of 213 women had IT fractures: 59 (28%) were stable. Both types of hip fracture increased with age, but older age was even more strongly associated with more severe hip fractures. Low BMD was more strongly related to undisplaced FN fractures (p interaction BMD × FN type, p = 0.0008) and stable IT fractures (p interaction BMD × IT type, p = 0.04). Similar findings were observed for estimated volumetric BMD and hip geometric parameters. Corticosteroid use was only associated with displaced FN fractures, and Parkinson's disease was only associated with stable IT fractures. Little difference was reported in the self‐reported circumstances surrounding each type of fracture. In conclusion, the lower the BMD, the greater the likelihood of experiencing a hip fracture that is less displaced and more stable.     

Regional bone mineral density changes after Colles'' and forehand fractures

Patients who sustain a second Colles' fracture only in one of five instances refracture the previously injured wrist. In those who have sustained fractures of the metacarpals or phalanges of the hand (forehand) subsequent fractures of the forehand are twice as likely to be ipsilateral. We investigated whether persisting regional bone mineral changes could be the mechanism underlying these observations. Bilateral bone mineral density measurements were performed on twenty patients who had sustained a Colles' fracture and twenty-nine who had sustained forehand fractures more than one year previously. Among Colles' fracture patients there was an increase in bone mineral density in the distal radius of the fractured side when compared to the uninjured side of thirty-nine percent. The protection of these patients from subsequent ipsilateral Colles' fracture seems to be due to increased bone strength induced by the healing process. Among patients with forehand fractures no significant bone mineral changes could be demonstrated.     

Colles fracture: does the anatomical result affect the final function?

Thirty patients who had sustained a Colles' fracture at least four years previously were examined functionally and radiographically. Seventeen had a good radiological result and 13 were considered to have malunion. Functionally the displaced group performed significantly worse than the undisplaced group. We conclude that malunion of a Colles' fracture results in a weak, deformed, stiff and probably painful wrist.     

Skeletal Structure in Postmenopausal Women With Osteopenia and Fractures Is Characterized by Abnormal Trabecular Plates and Cortical Thinning

The majority of fragility fractures occur in women with osteopenia rather than osteoporosis as determined by dual‐energy X‐ray absorptiometry (DXA). However, it is difficult to identify which women with osteopenia are at greatest risk. We performed this study to determine whether osteopenic women with and without fractures had differences in trabecular morphology and biomechanical properties of bone. We hypothesized that women with fractures would have fewer trabecular plates, less trabecular connectivity, and lower stiffness. We enrolled 117 postmenopausal women with osteopenia by DXA (mean age 66 years; 58 with fragility fractures and 59 nonfractured controls). All had areal bone mineral density (aBMD) measured by DXA. Trabecular and cortical volumetric bone mineral density (vBMD), trabecular microarchitecture, and cortical porosity were measured by high‐resolution peripheral computed tomography (HR‐pQCT) of the distal radius and tibia. HR‐pQCT scans were subjected to finite element analysis to estimate whole bone stiffness and individual trabecula segmentation (ITS) to evaluate trabecular type (as plate or rod), orientation, and connectivity. Groups had similar age, race, body mass index (BMI), and mean T‐scores. Fracture subjects had lower cortical and trabecular vBMD, thinner cortices, and thinner, more widely separated trabeculae. By ITS, fracture subjects had fewer trabecular plates, less axially aligned trabeculae, and less trabecular connectivity. Whole bone stiffness was lower in women with fractures. Cortical porosity did not differ. Differences in cortical bone were found at both sites, whereas trabecular differences were more pronounced at the radius. In summary, postmenopausal women with osteopenia and fractures had lower cortical and trabecular vBMD; thinner, more widely separated and rodlike trabecular structure; less trabecular connectivity; and lower whole bone stiffness compared with controls, despite similar aBMD by DXA. Our results suggest that in addition to trabecular and cortical bone loss, changes in plate and rod structure may be important mechanisms of fracture in postmenopausal women with osteopenia. © 2014 American Society for Bone and Mineral Research.     

Fixation not needed for undisplaced Codes' fracture

A series of 68 undisplaced or minimally displaced Colles' fractures was randomized into two groups undergoing treatment with either a plaster cast or an elastic bandage. Pain, function, grip strength, and range of motion were evaluated 1 year later. There was a difference in the functional outcome in favor of the patients treated with an elastic bandage, who did not have more fracture redislocations than those treated with a plaster cast.     

Imaging Technologies for Assessment of Skeletal Health in Men

Conventional radiography can detect most fractures, evaluate their healing, and visualize characteristic skeletal abnormalities for some metabolic bone diseases. Dual-energy X-ray absorptiometry (DXA) is used to measure areal bone mineral density (BMD) in order to diagnose osteoporosis, estimate fracture risk, and monitor changes in BMD over time. Vertebral fracture assessment by DXA can diagnose vertebral fractures with less ionizing radiation, greater patient convenience, and lower cost than conventional radiography. Quantitative computed tomography (QCT) measures volumetric BMD separately in cortical and trabecular bone compartments. High resolution peripheral QCT and high resolution magnetic resonance imaging are noninvasive research tools that assess the microarchitecture of bone. The use of these technologies and others has been associated with special challenges in men compared with women, provided insights into differences in the pathogenesis of osteoporosis in men and women, and enhanced understanding of the mechanisms of action of osteoporosis treatments.     

Fixation not needed for undisplaced Colles' fracture

A series of 68 undisplaced or minimally displaced Colles' fractures was randomized into two groups undergoing treatment with either a plaster cast or an elastic bandage. Pain, function, grip strength, and range of motion were evaluated 1 year later. There was a difference in the functional outcome in favor of the patients treated with an elastic bandage, who did not have more fracture redislocations than those treated with a plaster cast.     

Osteoporosis and Colles' fractures in the elderly

There is no documentation of the incidence of osteoporosis in patients with Colles' fractures. We have prospectively studied 127 patients over the age of fifty with unilateral Colles' fractures to determine the incidence of osteoporosis and to investigate its influence on the bony deformity. The cortical width of the second metacarpal was used as the indicator of osteoporosis. 74.8% of patients in this group were osteoporotic. The final deformity was significantly greater in patients with osteoporosis.     

Transcondylar fractures of the distal humerus

We classify transcondylar fractures of the distal humerus into four groups: undisplaced; simple displaced; T-type; and fracture dislocations (Posada's fracture). Our treatment of these fractures is based upon this classification. Undisplaced fractures are treated with immobilization. Displaced fractures are reduced and stabilized with internal fixation. Stabilization of these fractures is difficult because the distal fragments are small and a large portion of their surface is covered with articular cartilage. Transposition of the ulnar nerve allows us to use the cubital tunnel as a point for fixation. We found in our series of 11 patients that undisplaced fractures have the best prognosis. However, all of our patients lost elbow motion, particularly extension. Radiographic signs of post-traumatic arthritis were more pronounced in displaced fractures.     

Outcome of undisplaced and moderately displaced femoral neck fractures

Background The optimal treatment for femoral neck fracture is a matter of controversy. We compared the outcome of displaced fractures with good healing potential (moderately displaced fractures) to the outcome of undisplaced fractures treated by internal fixation with 2 parallel screws.

Methods In a consecutive series of hip fracture patients, the rates of reoperation and mortality for 225 undisplaced fractures were compared to those for 241 moderately displaced fractures. The patients were followed for 1-6 years.

Results The total rate of reoperation was 19% (9% because of healing complications) for the undisplaced fractures and 33% (20% because of healing complications) for the moderately displaced fractures. Fracture displacement was the main predictor of reoperation. There was no difference in mortality between the groups, and patient-related background parameters (rather than fracture displacement) were the main predictors of mortality.

Interpretation Undisplaced fractures should be treated by internal fixation. The best treatment for moderately displaced fractures remains to be determined.     

Geometric properties of distal radius and pathogenesis of Colles fracture: a peripheral quantitative computed tomography study.

It is well known among clinicians that Colles fracture patients may have normal projected axial bone mineral density and that bone mass is not synonymous with bone strength. The aim of this work was to investigate whether cross-sectional properties of the distal radius in female patients with recent Colles fracture differ from those of a younger group of normal women without fracture. It was hypothesized that patients with Colles fracture had petite distal radii and that cortical thinning and reduced cortical and trabecular volumetric density are dominant features of this fracture type. We used a multilayer high-precision peripheral quantitative computed tomography (pQCT) device with a long-term precision error of 0.1% for a dedicated phantom during the measurement period (152 d). Clinical measurements were made at an ultradistal site rich in trabecular bone and a less ultradistal site rich in cortical bone. The results show that the following pQCT variables were significantly reduced in the nonfractured radius of the Colles fracture cases: mean ultradistal trabecular volumetric density, mean ultradistal and distal cortical volumetric density, mean ultradistal and distal cortical thickness (p < 0.001 for all differences). The outer cortical diameter, cross-sectional bone area, and cortical bending moment of inertia were not statistically different in the two groups. Thus, it would appear that Colles fracture cases did not have petite distal radii. The results suggest that the deforming force of Colles fracture has a transaxial direction (fall on outstretched arm), resulting in a crush fracture, and that it is not a bending force. We suggest that Colles fracture occurs as a result of the combined effect of a fall on the out-stretched arm, low trabecular and cortical volumetric bone density, and reduced cortical thickness.     

Ipsilateral fractures of the distal radius and scaphoid treated by Herbert screw and external skeletal fixation. A report of two cases.

Two patients with comminuted, displaced fractures of the distal radius associated with ipsilateral, undisplaced scaphoid fractures were treated by internal fixation of the scaphoid fracture with a Herbert screw in association with external fixation of the distal radial fracture. One of the patients had a limited open reduction of the distal radius combined with bone grafting. Both patients had satisfactory results. Internal fixation of the scaphoid is indicated if distraction is applied to the carpus to treat an associated fracture of the distal radius, even if the scaphoid fracture is undisplaced.