Range of movement in the wrist as a diagnostic tool in radial-sided wrist pain

Kienböck disease is diagnosed by imaging studies, and is often difficult to diagnose in its early stages. Our clinical impression is that wrist movement is more limited in Kienböck disease than when radial-sided wrist pain is caused by other conditions. The purpose of this study was to determine the use of wrist movement in differentiating between early Kienböck disease and radial-sided sprained wrist. We retrospectively reviewed 62 cases of Kienböck disease and 49 patients with radial-sided wrist sprain. Wrist movement at presentation was recorded. The two groups differed significantly in flexion and extension (p<0.001). The ability of movement of the affected wrist relative to the normal side to distinguish between the groups was excellent (AUC?=?0.96, 0.97, respectively). The ability of wrist movement measurements to differentiate between early Kienböck disease and radial-sided wrist sprain emphasises that wrist movement should be measured prior to invasive or expensive testing.     

Range of movement in the wrist as a diagnostic tool in radial-sided wrist pain.

Kienb?ck disease is diagnosed by imaging studies, and is often difficult to diagnose in its early stages. Our clinical impression is that wrist movement is more limited in Kienb?ck disease than when radial-sided wrist pain is caused by other conditions. The purpose of this study was to determine the use of wrist movement in differentiating between early Kienb?ck disease and radial-sided sprained wrist. We retrospectively reviewed 62 cases of Kienb?ck disease and 49 patients with radial-sided wrist sprain. Wrist movement at presentation was recorded. The two groups differed significantly in flexion and extension (p<0.001). The ability of movement of the affected wrist relative to the normal side to distinguish between the groups was excellent (AUC = 0.96, 0.97, respectively). The ability of wrist movement measurements to differentiate between early Kienb?ck disease and radial-sided wrist sprain emphasises that wrist movement should be measured prior to invasive or expensive testing.     

Epidemiological survey of wrist fractures in children

The incidence of wrist fractures is increasing in children. We undertook an epidemiological survey in western France to determine characteristic features.     

Non-union of carpal scaphoid fractures in children.

Fracture of the carpal scaphoid is uncommon in children, but does occur and may fail to unite. Eight patients with established non-union have been reiewed, with an average follow-up of almost four years. All non-unions were grafted with autogenous bone. Excellent clinical and radiological results have been obtained. It is concluded that non-union in children is best managed by bone grafting through the anterior approach. Possible aetiological factors concerned in non-union of scaphoid fractures in this age group are discussed.     

Sagittal wrist motion of carpal bones following intraarticular fractures of the distal radius

Forty patients (mean age, 37 years) with intraarticular C2 and C3 Colles fractures were treated by open reduction, internal fixation and bone grafting. At a mean follow-up of 8 years radiocarpal and midcarpal motion was evaluated, the depth of the articular surface of the distal radius in the sagittal plane was measured and the presence of arthritis was noted. The fractures healed with a mean palmar tilt of 6 degrees , a mean ulnar tilt of 18 degrees and ulna variance within 1 mm of the contralateral side. The depth of the articular surface of the distal radius was 1.3 mm greater than the uninvolved side. Measurement of carpal bone angles relative to the radius in maximum flexion and extension revealed lunate extension of 23 degrees , lunate flexion of 15 degrees , capitate extension of 62 degrees , capitate flexion of 40 degrees . There was a significant correlation between articular surface depth and radiocarpal motion.     

Two cases of non-union of carpal scaphoid fractures in children

Two cases of non-union of fractures of the carpal scaphoid in children are described, which were successfully treated by cancellous bone grafting with Kirschner wire fixation.     

桡骨远端骨折腕关节MRI和疗效评估的临床研究

目的 探讨桡骨远端骨折疗效欠佳的原因，及其与骨折伴发的软组织损伤的关系。方法 对65例桡骨远端骨折内固定物取出术后，经平均1．8年随访的患者，选择其中20例（评分为良4例，可11例，差5例）进行腕关节MRI检查，观察关节软骨和腕尺侧三角纤维软骨（triangularfibro cartilage，TFC）的损伤情况。结果 MRI检查发现，9例有明显的TFC损伤（占45％，其中评分为良1例，可3例，差5例）。8例有桡骨远端关节软骨的损伤（40％，评分为可3例，差5例）。结论 TFC损伤和创伤性关节炎可能是影响桡骨远端骨折疗效，造成术后腕部慢性疼痛的主要原因。     

Total wrist arthroplasty with Destot prostheses in patients with posttraumatic arthritis

PURPOSE: To analyze the functional and radiologic results after Destot arthroplasty, a wrist prosthesis designed for posttraumatic arthritis, and to define the indications for the use of the implant. METHODS: Using the Meuli point score system, 28 Destot total-wrist arthroplasties in 25 patients with stage 2 or 3 scaphoid nonunion advanced collapse and scapholunate advanced collapse were evaluated for 12 to 96 months after surgery. RESULTS: The overall ratings of the study group were excellent in 17 cases, good in 6, fair in 1, and poor in 4. Eighty-four percent showed improved range of motion and grip strength. Four patients experienced postoperative complications. No imbalance or dislocation was noted after surgery. CONCLUSIONS: The Destot implant seems to be a good solution to restore functional range of motion after posttraumatic wrist arthritis when arthrodesis is required by nonmanual laborers older than 50 years of age.     

Simultaneous distal radial fractures and carpal bones injuries in children: a review article

Accurate diagnosis is crucial in effectively managing and treating both the radial and carpal fractures. Injuries to the carpal bones are not usually associated with fractures of the distal radius; however, the presence of a distal radius fracture does not preclude an associated carpal injury. The purpose of this review article is to compile cases of past reported distal radius fractures and simultaneous carpal injuries to restate its low prevalence within the pediatric population while still serving as a collective reference for management and treatment. After an electronic literature search was performed, we identified 18 published articles and 28 cases dealing with combined distal radial and carpal bones injuries in the pediatric population. As the mechanism of injury is similar for both fractures, despite the low incidence, orthopedic surgeons need to rule out carpal injury with a distal forearm fracture. Failure to treat both injuries appropriately may result in an unsatisfactory clinical result.     

Seasonal variation in the incidence of wrist and forearm fractures,and its consequences

We have used the All Wales Injury Surveillance System (AWISS) in a population-based study of wrist and forearm fractures. We examined seasonal variation in the incidence of these injuries, and looked at resulting pressures on outpatient and inpatient trauma services. AWISS collected data from eight Accident and Emergency (A&E) departments which between them serve a total of 1.2 million people in South Wales. During a single year, we identified all 5013 people who presented with a wrist or forearm fracture. Seasonal variation in wrist/forearm fracture incidence was apparent, but showed a different pattern in different age groups. Overall incidence figures were dominated by an increase in children's fractures in spring and summer. Children under the age of 15 suffered a total of 360 wrist and forearm fractures during the three winter months; an incidence of 5.9/1000 per year that was only about half that observed during the remainder of the year (10.7/1000 per year). In contrast, older people showed a higher incidence in the winter. During the winter months people aged over 75 sustained a total of 160 wrist/forearm fractures; an incidence of 8.2/1000 per year, significantly higher than the incidence observed in other months (5.8/1000 per year). Seasonality of incidence was not apparent in other age groups. Children presenting during the spring and summer months were significantly more likely to need admission to hospital; 22.8% were admitted compared with just 10.3% of those presenting during the winter months (P<0.001, chi(2)-test). Other age groups showed no significant seasonal variation in the likelihood of hospital admission.     

The incidence and pattern of hand fractures in children

The incidence and pattern of hand fractures occurring in children living in Nottingham has been reviewed. The hand is the second commonest site of fracture in children. The incidence is low in infants, but rises steeply after the age of eight, especially in boys. The most common site is the proximal phalanx. The little finger/fifth metacarpal is the most vulnerable area, especially around the metacarpophalangeal joint. Greenstick fractures are more common in metacarpals, while epiphyseal injuries predominate in the phalanges. Over 45% of fractures occurred either at sport or in a fight. Aetiological factors are discussed in relation to the fracture patterns described.     

Universal total wrist implant: Experience with a carpal component fixed with three screws

The Universal Wrist Implant was used to treat 31 patients (37 wrists), who had symptoms indicating pancarpal arthritis of the wrist, diagnosed as total wrist arthroplasty. Their mean age was 58.1 years. Follow-up ranged from 48 to 120 months with a mean of 79.4 months (6.7 years). The carpal component of the Universal Total Wrist is fixed to the carpus by titanium screws. Unlike other total wrist prostheses, the primary fixation of the carpal component is in the capitate and not in the third metacarpal. Intercarpal fusion provides a solid bony support for the carpal plate and results in improved longevity. Articular surface of the radial component is inclined 20°, similar to the articular surface of the radius. Components can be inserted with or without cement. In three patients, the prosthesis had to be removed due to infection and persistent dislocation. Of the remaining 34 wrists, 30 (88%) achieved excellent pain relief. Complications occurred in 12 cases (32%). Of these 12 complications 9 (75%) resolved with appropriate treatment. The most common complication with this nonconstrained prosthesis was dislocation. The Universal Total Wrist Implant provides a predictable option to preserve motion and relieve pain when managing wrist joint arthritis.     

Surgery for posttraumatic wrist deformity: Radial osteotomy and/or ulnar shortening in 16 Colles' fractures

16 patients with pain and impaired function after malunited fracture of the distal radius were treated with opening wedge lengthening osteotomy of the radius with bone grafting (12 cases), shortening osteotomy of the ulna (3 cases), or a combination of these methods (1 case), with or without reattachment of the triangular fibrocartilage complex. 4 patients had to be reoperated because of redisloca-tion, resorption of the graft, fracture of the plate, or persistent non-union. At re-examination after a median of 4 years, all patients but 2 were improved by the procedure.     

Non-union fractures of the scaphoid and carpal bones in children: surgical treatment

Carpal bone fractures in children are rare. This study reports a series of 16 cases: 12 fractures of the scaphoid (11 non-union), two of the trapezium, one (non-union) of the hamatum, and one of the triquetrum. Only three of these fractures (triquetrum, trapezium and hamatum) were seen at an early stage. The non-union cases involving the scaphoid and hamatum were treated by bone graft. The scaphoid fracture seen early and the triquetrum fracture were treated orthopaedically. One trapezium fracture was treated by osteosynthesis with wires, and the other (seen at the defective callus stage) was not treated because of a total absence of symptomatology. All fractures or non-union cases consolidated. After a minimum follow-up of 1 year, all patients except one have regained strength and mobility comparable to that of the contralateral limb, with a near total absence of pain. Only the patient with an articular fracture of the trapezium has lost 30% of strength compared with the uninjured limb.     

The incidence of femoral shaft fractures in children and adolescents

We report the incidence of fractures by sex and age based on 851 femoral shaft fractures from specific types of trauma. The maximum incidence occurred between 2 and 3 years of age, and the total incidence was 2.6 times higher in boys than in girls. In 438 cases the fractures were caused by falls and in 413 cases by traffic accidents. Fractures reported to be caused by falls were most common in children 2 and 3 years of age. Because child abuse has been shown to be involved in the majority of such fractures in early infancy, the data demonstrate the possible magnitude of this problem. Traffic accidents were most common in the oldest age groups, reaching 3.7 cases/10,000 population/year in boys 16 and 17 years of age. Although all fractures were more common during the periods of the fastest skeletal growth, the difference in incidence between different causes indicated that environmental factors are more important than endogenous factors for the risk of fracture.     

Radiographic parameters of increased carpal tunnel pressure with progressive wrist distraction: a cadaveric study

PURPOSE: Increased carpal canal pressure associated with external fixation has been noted as a potential source of complications but no correlated clinical observation has been identified. We hypothesized that there would be a significant change in midcarpal distance and modified carpal height index with increasing distraction across the wrist joint and that these changes would correlate with pressure increases. METHODS: Thirteen cadaveric upper extremities were mounted vertically using 2 half pins in the midradius. Using a previously reported technique, we introduced a balloon-tipped catheter attached to a transducer into the carpal canal for pressure measurement. As weights were hung from the middle finger to create distraction across the carpus, pressure measurements and radiographs of the wrist were taken simultaneously. This sequence was performed for 4.50 kg of distraction in 0.45-kg increments and at 6.80 and 9.07 kg of distraction with the wrist in neutral position. Changes in midcarpal distance and modified carpal height index were calculated and comparisons were made with the Student t test. A 2-tailed Pearson correlation was used to determine whether there was a correlation between carpal canal pressure and radiographic indicators. Significance was set at p相似文献