Correlations of calcaneal QUS with pQCT measurements at distal tibia and non-weight-bearing distal radius

Quantitative ultrasound (QUS) is used for prediction for risks of osteoporotic fractures at various skeletal sites, irrespective of weight-bearing or non-weight-bearing skeletons. In the current study, we investigated the correlation between calcaneal QUS measurements (BUA, VOS, and Soundness) and volumetric trabecular, cortical, and its integral bone mineral density (tBMD, cBMD, and iBMD) using peripheral quantitative computed tomography (pQCT) of the weight-bearing distal tibia and non-weight-bearing distal radius in 198 healthy Chinese women between 40 and 62 years of age. Results showed that BUA, VOS, and Soundness measured by calcaneal QUS were significantly correlated with tBMD, cBMD, and iBMD of both distal tibia and distal radius (r = 0.210–0.447; all P < 0.01). The correlation coefficients of all the individual parameters between calcaneus and distal tibia were correspondingly higher (r = 0.214–0.447; all P < 0.01) than that of distal radius (r = 0.210–0.368; all P < 0.01). QUS Soundness showed the highest correlation (r = 0.447; P < 0.01) with tBMD of distal tibia when comparing with all other parameters between these two measurement devices. Stronger within-device correlations (r = 0.640–0.764; all P < 0.01) were found in pQCT measurements between distal tibia and radius. In addition, the largest and significant age-related decline was found in tBMD of the distal radius measured by pQCT and Soundness of the QUS measurement in the postmenopausal group. In conclusion, heel QUS measurement demonstrated slightly better correlation with trabecular bone of the weight-bearing skeleton than that of the non-weight-bearing skeleton measured by pQCT.     

Abnormal microarchitecture and reduced stiffness at the radius and tibia in postmenopausal women with fractures

Measurement of areal bone mineral density (aBMD) by dual‐energy x‐ray absorptiometry (DXA) has been shown to predict fracture risk. High‐resolution peripheral quantitative computed tomography (HR‐pQCT) yields additional information about volumetric BMD (vBMD), microarchitecture, and strength that may increase understanding of fracture susceptibility. Women with (n = 68) and without (n = 101) a history of postmenopausal fragility fracture had aBMD measured by DXA and trabecular and cortical vBMD and trabecular microarchitecture of the radius and tibia measured by HR‐pQCT. Finite‐element analysis (FEA) of HR‐pQCT scans was performed to estimate bone stiffness. DXA T‐scores were similar in women with and without fracture at the spine, hip, and one‐third radius but lower in patients with fracture at the ultradistal radius (p < .01). At the radius fracture, patients had lower total density, cortical thickness, trabecular density, number, thickness, higher trabecular separation and network heterogeneity (p < .0001 to .04). At the tibia, total, cortical, and trabecular density and cortical and trabecular thickness were lower in fracture patients (p < .0001 to .03). The differences between groups were greater at the radius than at the tibia for inner trabecular density, number, trabecular separation, and network heterogeneity (p < .01 to .05). Stiffness was reduced in fracture patients, more markedly at the radius (41% to 44%) than at the tibia (15% to 20%). Women with fractures had reduced vBMD, microarchitectural deterioration, and decreased strength. These differences were more prominent at the radius than at the tibia. HR‐pQCT and FEA measurements of peripheral sites are associated with fracture prevalence and may increase understanding of the role of microarchitectural deterioration in fracture susceptibility. © 2010 American Society for Bone and Mineral Research.     

Characterizing microarchitectural changes at the distal radius and tibia in postmenopausal women using HR-pQCT

Summary

Limited prospective evidence exists regarding bone microarchitectural deterioration. We report annual changes in trabecular and cortical bone microarchitecture at the distal radius and tibia in postmenopausal women. Lost trabeculae with corresponding increase in trabecular thickness at the radius and thinning tibial cortex indicated trabecularization of the cortex at both sites.

Introduction

Osteoporosis is characterized by low bone mass and the deterioration of bone microarchitecture. However, limited prospective evidence exists regarding bone microarchitectural changes in postmenopausal women: a population prone to sustaining osteoporotic fractures. Our primary objective was to characterize the annual change in bone area, density, and microarchitecture at the distal radius and distal tibia in postmenopausal women.

Methods

Distal radius and tibia were measured using high-resolution peripheral quantitative computed tomography (HR-pQCT) at baseline and 1 year later in 51 women (mean age?±?SD, 77?±?7 years) randomly sampled from the Saskatoon cohort of the Canadian Multicentre Osteoporosis Study (CaMos). We used repeated measures analysis of variance (ANOVA) with Bonferroni adjustment for multiple comparisons to characterize the mean annual change in total density, cortical perimeter, trabecular and cortical bone area, density, content, and microarchitecture. Significant changes were accepted at P?<?0.05.

Results

At the distal radius in women without bone-altering drugs, total density (?1.7 %) and trabecular number (?6.4 %) decreased, while trabecular thickness (+6.0 %), separation (+8.6 %), and heterogeneity (+12.1 %) increased. At their distal tibia, cortical area (?4.5 %), density (?1.9 %), content (?6.3 %), and thickness (?4.4 %) decreased, while trabecular area (+0.4 %) increased.

Conclusions

The observed loss of trabeculae with concomitant increase in trabecular size at the distal radius and the declined cortical thickness, density, and content at the distal tibia indicated a site-specific trabecularization of the cortical bone in postmenopausal women.     

Deterioration of trabecular plate-rod and cortical microarchitecture and reduced bone stiffness at distal radius and tibia in postmenopausal women with vertebral fractures

Postmenopausal women with vertebral fractures have abnormal bone microarchitecture at the distal radius and tibia by HR-pQCT, independent of areal BMD. However, whether trabecular plate and rod microarchitecture is altered in women with vertebral fractures is unknown. This study aims to characterize the abnormalities of trabecular plate and rod microarchitecture, cortex, and bone stiffness in postmenopausal women with vertebral fractures. HR-pQCT images of distal radius and tibia were acquired from 45 women with vertebral fractures and 45 control subjects without fractures. Trabecular and cortical compartments were separated by an automatic segmentation algorithm and subjected to individual trabecula segmentation (ITS) analysis for measuring trabecular plate and rod morphology and cortical bone evaluation for measuring cortical thickness and porosity, respectively. Whole bone and trabecular bone stiffness were estimated by finite element analysis. Fracture and control subjects did not differ according to age, race, body mass index, osteoporosis risk factors, or medication use. Women with vertebral fractures had thinner cortices, and larger trabecular area compared to the control group. By ITS analysis, fracture subjects had fewer trabecular plates, less axially aligned trabeculae and less trabecular connectivity at both the radius and the tibia. Fewer trabecular rods were observed at the radius. Whole bone stiffness and trabecular bone stiffness were 18% and 22% lower in women with vertebral fractures at the radius, and 19% and 16% lower at the tibia, compared with controls. The estimated failure load of the radius and tibia were also reduced in the fracture subjects by 13% and 14%, respectively. In summary, postmenopausal women with vertebral fractures had both trabecular and cortical microstructural deterioration at the peripheral skeleton, with a preferential loss of trabecular plates and cortical thinning. These microstructural deficits translated into lower whole bone and trabecular bone stiffness at the radius and tibia. Our results suggest that abnormalities in trabecular plate and rod microstructure may be important mechanisms of vertebral fracture in postmenopausal women.     

Cortical pQCT measures are associated with fractures in dialysis patients.

To determine if pQCT could identify HD patients with fractures, we conducted a cross-sectional study in 52 men and women on HD. We found that cortical, but not trabecular, pQCT measures were associated with fractures. INTRODUCTION: Fractures are common in hemodialysis (HD) patients, yet DXA is inconsistently associated with fractures. One explanation for this lack of association may be that HD patients have a selective decrease in cortical density not identified by standard DXA. MATERIALS AND METHODS: We used pQCT to examine cross-sectional associations between cortical and trabecular measures and fractures in 36 men and 16 women, > or = 50 years of age, on HD for at least 1 year. We confirmed low-trauma nonspine fractures since starting HD. Prevalent vertebral fractures were identified by morphometry of lateral spine X-rays. pQCT measurements of the nondominant radius included trabecular density, cortical density, total area, cortical area, and cortical thickness. We also obtained DXA measurements of the hip and lumbar spine. We used logistic regression models, adjusted for age, weight, and sex, to examine the association between fracture (vertebral and/or self-reported nonspine) and each pQCT measure. Results are reported as ORs per SD decrease in the independent variable. RESULTS: The mean age was 65.8 +/- 9.0 (SD) years, the mean weight was 72.3 +/- 15.6 kg, most (32 of 52) subjects were white, and there were 32 fractures in 27 subjects (prevalent vertebral fracture or low-trauma fracture) since starting dialysis. A decrease in cortical density was associated with fractures (OR = 16.67; 95% CI: 2.94-83.33), as was a decrease in cortical area (OR = 3.04; 95% CI: 1.28-7.25) and a decrease in cortical thickness (OR = 3.26; 95% CI: 1.36-7.87). Fractures were not associated with pQCT trabecular density (OR = 1.18; 95% CI: 0.6-2.33), total area (OR = 1.1; 95% CI: 0.59-1.7), or DXA measurements of the hip and spine. CONCLUSIONS: Cortical parameters of the radius were associated with fractures in HD patients. If confirmed in prospective studies, these findings may explain the lack of association between fracture and standard DXA measurements and raise the possibility that pQCT could be used to identify HD patients at high risk of fracture.     

Scapholunate dissociation associated with distal radius fractures

Objective

The exact prevalence of scapholunate dissociation (SLD) associated with distal radius fracture (DRF) and the effect of persistent SLD on the function of the wrist are not known. So, we examined the association between SLD and DRF and the effects of treatment on clinical outcomes.

Methods

Eight hundred and twenty-nine patients with 839 DRF were included in the study. The radiographs of the patients were examined with special reference to SLD both in pre- and post-reduction period. Persistent SLD cases were evaluated by the scoring system of Green and O’Brien at least 2 years after the fracture.

Results

Of the 839 fractures, 215 had SLD after the injury. When post-reduction radiographs were examined, SLD persisted in 98, but in 14 SLD was detected in the post-reduction period while not apparent in initial radiographs. So, a total of 112 patients (13.4 %) had persistent SLD. Nineteen patients were lost to follow-up and remaining 93 wrists examined clinically. Seventy-nine had pain on the scapholunate joint and 14 had not. When these patients were evaluated by Green and O’Brien system, symptomatic patients had fair or poor results but asymptomatic had good. The association between DRF and SLD is 13.4 %.

Conclusions

Severity of the distal radius fractures is not associated with SLD. Intra-articular fractures were associated with significant increase in the prevalence of SLD. In some cases, SLD may appear after reduction in distal radius. Most cases with SLD are symptomatic, and this may be the reason of poor cases following distal radius fracture.     

Pisiform malalignment associated with distal radius fractures

Background

The association of scaphoid or other carpal bone fractures with distal radius fractures is frequently reported, whereas few studies have described pisiform malalignment associated with distal radius fractures. The purpose of this study was to investigate the frequency and characteristics of pisiform malalignment associated with distal radius fractures.

Postmenopausal women with osteopenia have higher cortical porosity and thinner cortices at the distal radius and tibia than women with normal aBMD: An in vivo HR‐pQCT study

Increases in cortical porosity (Ct.Po) and decreases in cortical thickness (Ct.Th) are associated with increased bone fragility. The purpose of this study was to validate an autosegmentation method for high‐resolution peripheral quantitative computed tomography (HR‐pQCT) scans to measure Ct.Po and Ct.Th and use it to compare Ct.Po and Ct.Th between pre‐ and postmenopausal women with normal, osteopenic, and osteoporotic areal bone mineral density (aBMD). The Ct.Po and Ct.Th measurements were validated using cadaver forearms (n = 10) and micro‐computed tomography (µCT) as the gold standard. The analysis was applied to distal radius and tibia HR‐pQCT scans from a subset of participants from the Calgary, Alberta, cohort of the Canadian Multicentre Osteoporosis Study (n = 280, 18 to 90 years). Analysis of covariance compared Ct.Po and Ct.Th outcomes between 63 normal premenopausal (dual‐energy X‐ray absorptiometry femoral neck T‐score > ?1), 87 normal postmenopausal, 121 osteopenic postmenopausal, and 9 osteoporotic postmenopausal women. Linear regression analysis and Bland‐Altman plots were used to assess the agreement between the HR‐pQCT and µCT measurements, resulting in r² values of 0.80 for Ct.Po and 0.98 for Ct.Th. At both sites, Ct.Po was higher in postmenopausal (all groups) than in premenopausal women (3.2% to 12.9%, p < .001). Ct.Th was not significantly different between normal premenopausal and postmenopausal women at either site; however, both osteopenic and osteoporotic women had thinner (?12.8% to ?30.3%, p < .01), more porous (2.1% to 8.1%, p < .001) cortices than normal postmenopausal women. Our method offers promise as a valuable tool to measure Ct.Po and Ct.Th in vivo and investigate associations among cortical bone structure, age, and disease status. © 2010 American Society for Bone and Mineral Research.     

Intrafocal pin plate fixation of distal ulna fractures associated with distal radius fractures

Subcapital ulnar fractures in association with distal radius fractures in elderly patients increase instability and pose a treatment challenge. Fixation of the ulnar fracture with traditional implants is difficult due to the subcutaneous location, comminution, and osteoporosis. We describe an intrafocal pin plate that provides fixation by a locking plate on the distal ulna and intramedullary fixation within the shaft. The low profile and percutaneous technique make this device a useful alternative for treatment of subcapital ulna fractures in the elderly.     

Bone lead (Pb) content at the tibia is associated with thinner distal tibia cortices and lower volumetric bone density in postmenopausal women

Conflicting evidence suggests that bone lead or blood lead may reduce areal bone mineral density (BMD). Little is known about how lead at either compartment affects bone structure. This study examined postmenopausal women (N = 38, mean age 76 ± 8, body mass index (BMI): 26.74 ± 4.26 kg/m²) within the Hamilton cohort of the Canadian Multicentre Osteoporosis Study (CaMos), measuring bone lead at 66% of the non-dominant leg and at the calcaneus using ¹⁰⁹Cadmium X-ray fluorescence. Volumetric BMD and structural parameters were obtained from peripheral quantitative computed tomography images (200 μm in-plane resolution, 2.3 ± 0.5 mm slice thickness) of the same 66% site and of the distal 4% site of the tibia length. Blood lead was measured using atomic absorption spectrometry and blood-to-bone lead partition coefficients (P_BB, log ratio) were computed. Multivariable linear regression examined each of bone lead at the 66% tibia, calcaneus, blood lead and P_BB as related to each of volumetric BMD and structural parameters, adjusting for age and BMI, diabetes or antiresorptive therapy. Regression coefficients were reported along with 95% confidence intervals. Higher amounts of bone lead at the tibia were associated with thinner distal tibia cortices (− 0.972 (− 1.882, − 0.061) per 100 μg Pb/g of bone mineral) and integral volumetric BMD (− 3.05 (− 6.05, − 0.05) per μg Pb/g of bone mineral). A higher P_BB was associated with larger trabecular separation (0.115 (0.053, 0.178)), lower trabecular volumetric BMD (− 26.83 (− 50.37, − 3.29)) and trabecular number (− 0.08 (− 0.14, − 0.02)), per 100 μg Pb/g of bone mineral after adjusting for age and BMI, and remained significant while accounting for diabetes or use of antiresorptives. Total lead exposure activities related to bone lead at the calcaneus (8.29 (0.11, 16.48)) and remained significant after age and antiresorptives-adjustment. Lead accumulated in bone can have a mild insult on bone structure; but greater partitioning of lead in blood versus bone revealed more dramatic effects on both microstructure and volumetric BMD.     

Multiple vertebral fractures are associated with refractory reflux esophagitis in postmenopausal women

We examined the frequency of multiple vertebral fractures (MVFs) and esophageal hiatal hernia (HH) in 18 Japanese postmenopausal women (74.1 ± 9.9 years, mean ± SD), with refractory reflux esophagitis (RRE) that had needed a proton pump inhibitor for more than 6 months to suppress symptoms such as heartburn and acid regurgitation, as well as in 57 control subjects without RE (71.4 ± 5.9 years). MVFs (two or more VFs), HH, and both features were found in 11 (61%), 16 (89%), and 11 (61%) subjects, respectively, in the RRE group. All 11 patients with MVFs also had HH, suggesting their strong association. On the other hand, MVFs, HH, and both were found in 15 (26%), 23 (40%), and 8 (14%) subjects, respectively, in those without RE. The differences in frequencies of MVFs, HH, and both between the two groups were significant (² = 7.3, 12.9, and 16.0; P = 0.015, 0.0009, and 0.0002, respectively). When univariate logistic regression analysis was performed with the presence of RRE as a dependent variable and the presence of MVFs, HH, and both as independent variables, MVFs, HH, and both were selected as indices affecting the presence of RRE (age-adjusted odds ratios: 4.34, 11.07, and 10.30; 95% confidential intervals: 1.40–13.45, 2.30–53.22, and 2.96–35.86; P = 0.0109, 0.0027, and 0.0002, respectively). These results show that the presence of MVFs is associated with the presence of RRE in Japanese postmenopausal women, and this association becomes more significant when HH is present. Thus, a kyphotic lumbar spine with MVFs may cause HH and RE by raising the intraabdominal pressure. As recent therapeutic agents for osteoporosis, alendronate and risedronate, are known to be very effective for suppressing the occurrence of new VFs, these agents may also prevent gastrointestinal disorders such as HH and RRE in osteoporotic women when administered to subjects without VFs.     

绝经后妇女桡骨远端骨折术后桡骨短缩与骨密度的相关性研究

目的分析绝经后妇女的骨密度与桡骨远端骨折术后出现桡骨短缩的相关性。方法回顾性分析自2012-01—2014-06行手术治疗的252例绝经妇女桡骨远端骨折,术后均达到解剖复位或基本达到解剖复位,获得1年完整随访。将术后3个月桡骨短缩距离4 mm的患者纳入观察组,其余的按年龄、骨折类型及绝经时间进行1∶1个体匹配,纳入与观察组同样数量的病例进入对照组(术后3个月桡骨短缩距离4 mm)。术前、术后3个月及术后6个月用双能X线骨密度仪对2组健侧桡骨进行骨密度测量。结果观察组骨密度值:术前(0.69±0.14)g/cm2,术后3个月(0.67±0.12)g/cm~2,术后6个月(0.62±0.10)g/cm~2。对照组骨密度值:术前(0.79±0.15)g/cm~2,术后3个月(0.76±0.13)g/cm~2,术后6个月(0.71±0.10)g/cm~2。2组骨密度值随时间增加而降低,且观察组术前(F=7.588,P=0.008)、术后3个月(F=8.520,P=0.005)、术后6个月(F=11.203,P=0.001)骨密度值均低于对照组,差异有统计学意义(P0.05)。结论对于桡骨远端骨折患者术后出现桡骨短缩的原因,骨密度降低是一个不容忽略的重要因素,在术后应重视对低骨密度的患者采取相应措施。     

Treatment of bending fractures at the distal radius

This paper deals with problems and therapeutic principles of Smith-fractures. Fractures type II and III by Thomas are treated with T-plate osteosynthesis on principle. Methods are shown and the follow up of 15 surgically treated patients is reported. The good results in comparison with non operative treatment speak in favour of this method.     

Alendronate increases bone density and bone strength at the distal radius in postmenopausal women.

In addition to the alendronate Osteoporosis Intervention Trial (FOSIT) core protocol 901-0A of 1908 enrolled patients, the use of peripheral quantitative computed tomography (pQCT) was explored for the assessment of response to therapy. Bone mineral and strength related parameters at two different sites at the distal radius were explored in a subset of the multicenter core study. One hundred and three patients were entered into the substudy and given either a daily dose of 10 mg of alendronate or placebo for 1 year. Measurements were done at months 0, 3, 6, and 12. Inclusion criteria were bone mineral density (BMD) measurements at the lumbar spine of -2 SD. The response to therapy was assessed by dual-energy X-ray absorptiometry in the lumbar spine and the hip, and by pQCT in the ultradistal and the shaft sites of the radius. In line with the FOSIT core study, alendronate increased BMD at the lumbar spine and the hip, and it decreased the serum biochemical markers of bone turnover. The substudy showed differences between the therapy and placebo group in trabecular bone density (8.4%, p = 0.095), in total density (6.8%, p = 0.009), and in the bone strength index (BSI) (15. 6 mm3, p = 0.037) at the ultradistal site due to treatment and no changes at the radius shaft. A significant correlation was observed between percentage changes from baseline in BMD of the lumbar spine, and in total density and bone strength at the ultradistal radius site in the treatment group, but not in the placebo group. Thus, the ultradistal radius site did respond to alendronate therapy. The increased bone density accompanied a significant gain in the BSI at the ultradistal site, a finding that might help explain the reduced wrist fractures in the alendronate Fracture Intervention Trial.     

Comprehensive management of soft-tissue injuries associated with distal radius fractures

Distal radius fractures can no longer be thought of in isolation. Increasing recognition is being given to the associated soft-tissue injuries that include: median nerve compression, radioulnar ligament injury, fibrocartilage disc substance tear, volar extrinsic ligament injury, dorsal extrinsic ligament injury, and intrinsic ligament injuries. Diagnosis, classification, and management of the associated soft-tissue injuries can be accomplished with a combination of endoscopic and arthroscopic techniques that balance well with current methods of distal radius fixation. The use of these less invasive but stable techniques facilitates an early rehabilitation program with the long-term goal of improved function. Copyright © 2002 by the American Society for Surgery of the Hand     

Finite element analysis performed on radius and tibia HR‐pQCT images and fragility fractures at all sites in men

Few studies have investigated bone microarchitecture and biomechanical properties in men. This study assessed in vivo both aspects in a population of 185 men (aged 71 ± 10 years) with prevalent fragility fractures, compared to 185 controls matched for age, height, and weight, from the Structure of the Aging Men's Bones (STRAMBO) cohort. In this case‐control study, areal BMD (aBMD) was measured by DXA, bone microarchitecture was assessed by high resolution (HR)‐pQCT, and finite element (µFE) analysis was based on HR‐pQCT images of distal radius and tibia. A principal component (PC) analysis (PCA) was used to study the association of synthetic PCs with fracture by computing their odds ratio (OR [95%CI]) per SD change. Specific associations with vertebral fracture (n = 100), and nonvertebral fracture (n = 85) were also computed. At both sites, areal and volumetric BMD, cortical thickness and trabecular number, separation, and distribution were significantly worse in cases than in controls, with differences ranging from ?6% to 15%. µFE‐derived stiffness and failure load were 8% to 9% lower in fractures (p < .01). No difference in load distribution was found between the two groups. After adjustment for aBMD, only differences of µFE‐derived stresses, stiffness, and failure load at the tibia remained significant (p < .05). PCA resulted in defining 4 independent PCs, explaining 83% of the total variability of bone characteristics. Nonvertebral fractures were associated with PC1, reflecting bone quantity and strength at the radius (tibia) with OR = 1.64 [1.27–2.12] (2.21 [1.60–3.04]), and with PC2, defined by trabecular microarchitecture, with OR = 1.27 [1.00–1.61]. Severe vertebral fractures were associated with PC1, with OR = 1.56 [1.16–2.09] (2.21 [1.59–3.07]), and with PC2, with OR = 1.55 [1.17–2.06] (1.45 [1.06–1.98]). In conclusion, microarchitecture and biomechanical properties derived from µFE were associated with all types of fractures in men, showing that radius and tibia mechanical properties were relatively representative of distant bone site properties. © 2011 American Society for Bone and Mineral Research.     

Weight loss and distal forearm fractures in postmenopausal women

Summary  

Weight loss is a risk factor for hip fractures, but few studies have evaluated the effect of weight loss on distal forearm fracture risk. In this longitudinal study including 7,871 postmenopausal women, weight loss of 5% or more was associated with an increased risk of distal forearm fractures.     

Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability

Ulnar-sided injuries of the wrist have received more attention recently for their potential negative impact on the outcome of distal radius fractures. Radiographs and medical records were retrospectively reviewed for 166 distal radius fractures treated during a 1-year interval. Distal radius fractures were classified according to the AO system, and accompanying ulnar styloid fractures were evaluated for both size and displacement. Each distal radius fracture was also evaluated for radiographic and clinical evidence of distal radioulnar joint instability. The distribution of ulnar styloid fractures was not random; greater than one third involved the base. All distal radius fractures complicated by distal radioulnar joint instability were accompanied by an ulnar styloid fracture. A fracture at the ulnar styloid's base and significant displacement of an ulnar styloid fracture were found to increase the risk of distal radioulnar joint instability.     

Surgical correction of deformities of the distal radius due to fractures in pediatric patients

Introduction The indication and treatment of malunited fractures of the distal radius in the growing skeleton differ from those for adults. The literature results are scarce. In this study we examined the results of surgical correction following fractures of the distal radius in infants.Materials and methods Seven infant patients with malaligned fractures of the distal radius that demonstrated significant functional deficit and poor prognosis for spontanous recovery were treated with surgical correction. Two of them were treated because of growth disturbance from post-traumatic closure of the distal radial physis.Results All seven osteotomies healed with acceptable radiologic alignment. After an average follow-up period of 3 years and 1 month (range 10 months to 8 years and 4 months), patients had an average range of wrist motion (ROM) of 131 deg in extension and flexion (93% of the contralateral side, 130% of presurgical situation); 65 deg in ulnar and radial deviation (94% of the contralateral side, 122% of presurgical situation); and 177 deg in pronation and supination of the forearm (97% of the contralateral side, 115% of presurgical situation). The average grip strength of 71.4 kPa was nearly equal to the other side with 72.8 kPa. The average postoperative angulation of the distal radius was 12 (range 10–17) deg, the radial inclination 20 (range 12–30) deg, and the ulnar variance was –0.6 (range –3 to +2) mm. According to the Fernandez point score system as well as the scale of Fernandez, there were five excellent results and two good results. The patients described low disability on the DASH scores, with a median of 4 (range 0–41) points.Conclusions Surgical correction for malunited fractures of the distal radius provides good and excellent radiological and functional results in the growing skeleton. It should be considered immediately if there is poor remodeling capacity and disabling loss of function.     

桡骨远端骨折合并腕关节韧带损伤的关节镜观察

Objective To report te incidence and extent of injuries of the scapholunate interosseous ligament (SLIL), lunotriquetral interosseous ligament (LTIL) and triangular fibrocartilage complex (TFCC)observed under wrist srthroscope during treatment of distal radius fractures.Methods Twenty-seven cases of distal radius fractures were treated with wrist arthroscopic assistance.Distal radius fractures were categorized using AO classification.Injuries of SLIL and LTIL were viewed and graded by Geissler's arthroscopic classification of carpal instability/intercarpal ligament injuries.TFCC lesions were recorded by Palmer's classification.Chi square statistical analysis was used to analyze the relationship between the extent of these ligament injuries and the types of distal radius fractures.Results All 27 cases had SLIL and LTIL injuries of grade Ⅰ to grade Ⅱ.25 cases had type Ⅰa TFCC lesions.There was no significant correlation between ligament injuries and the types of fractures.Conclusion There is a high incidence of ligament injury accompanying distal radius fractures.Wrist arthroscope assisted treatment of distal radius fractures can enhance the accurate detection of these carpal ligament injuries.