Can external fixation maintain reduction after distal radius fractures?

BACKGROUND: The purpose of this study was to assess the effectiveness of external fixation and percutaneous pinning in maintaining distal radius fracture reduction over a 6-month period and to identify factors that might predict loss of fracture reduction. METHODS: Seventy cases had complete radiographic evaluation before surgery; at surgery; and at 6-week, 3-month, and 6-month follow-up. Radiographic parameters measured included volar tilt, dorsal displacement, radial inclination, radial height, radial shift, and ulnar variance. RESULTS: Dorsal tilt averaged 17.5 degrees from neutral before surgery; this value was corrected to 0.9 degree at surgery, but then progressed to 4.2 degrees by the 6-month follow-up. At 6-month follow-up, 49% of cases had lost more than 5 degrees of initially reduced volar tilt. However, none of these patients went from an acceptable initial reduction to an unacceptable reduction at 6 months. Initial deformity, patient age, use of bone graft, and duration of external fixation were not predictors of loss of reduction. CONCLUSION: Loss of reduction of volar tilt was seen for a period of up to 6 months after fixation, despite the use of pinning to hold the reduction. No specific predictor of loss of reduction was noted, although there was a trend toward loss of reduction in younger patients.     

Hip fracture outcomes in patients with Parkinson's disease

In a prospective, consecutive study conducted at a university teaching hospital, we evaluated the effects of Parkinson's disease (PD) on hip fracture outcomes. We followed 920 community-dwelling patients, aged 65 or older, who sustained a hip fracture that was operatively treated between July 1, 1987, and June 30, 1998. Presence or absence of PD had no bearing on type of surgery performed. Examined outcomes were postoperative complication rates; in-hospital mortality; length of hospital stay; discharge status (to home or to a skilled nursing facility); and mortality rate, place of residence, recovery of prefracture ambulatory ability, and return to prefracture activities of daily living (ADLs) 1 year after surgery Thirty-one patients (3.4%) had a history of PD before hip fracture. Patients with PD were more likely to be male, to live with another person, to have less ambulatory ability, and to be dependent in ADLs before hip fracture. Compared with patients without PD, they were hospitalized significantly longer and were more likely to be discharged to a skilled nursing facility. In addition, they declined more in level of independence in basic ADLs but not as much in instrumental ADLs at 1-year follow-up. Rates of postoperative complications, recovery of ambulatory ability within 1 year, and mortality within 1 year did not differ. These findings may guide orthopedic surgeons in counseling patients with PD and a hip fracture.     

Gunshot wounds to the lower extremities

In this article, we briefly mention the personal, social, and economic costs of gunshot injuries; describe the science of ballistics and how differences in ballistics affect gunshot wounds and their treatment; and review the general principles involved in managing gunshot injuries. We will summarize the strategies for treating adults with gunshot injuries to specific regions of the lower extremities--the hip, the femur, the knee, the tibia, and the foot.     

Early versus late reduction of a physeal fracture in an animal model

This study was designed to determine whether delayed reduction of physeal fractures in an animal model causes growth disturbance, and whether final alignment is better in delayed or malreduced fractures. Salter 1 fractures of the proximal tibia were created in 41 immature rats randomized into five groups. The fractures were reduced as follows: group 1, immediately; group 2, 6 hours; group 3, 24 hours; group 4, 48 hours; and group 5, left malreduced. Both legs were analyzed for leg-length discrepancy, angular deformity, and evidence of radiographic bar. No radiographic physeal bar or leg-length discrepancy was seen among any of the groups. Angular deformity was greatest in group 5 and least in group 1. Immediate reduction resulted in the least angular deformity. Delayed reduction showed no evidence of physeal damage, physeal growth disturbance, or radiographic bar formation. Alignment was not improved in delayed reduction versus malreduced fractures.     

Biomechanical comparison of five external wrist fixators

The relative stiffness of five different external wrist fixators currently in use for distal radius fractures was determined using a uniform fracture model consisting of wood dowels to isolate the effects of the fixators themselves. Each construct was loaded in axial compression, eccentric and cantilever modes of bending, and torsion. The stiffest of the fixators varied by a factor of three in compression, five in bending, and three in torsion. Although the ideal stiffness of a wrist fixator is unknown, there is a large variation in the stiffness of existing devices.     

The association of race, gender, and comorbidity with mortality and function after hip fracture

BACKGROUND: Few studies of hip fracture have large enough samples of men, minorities, and persons with specific comorbidities to examine differences in their mortality and functional outcomes. To address this problem, we combined three cohorts of hip fracture patients to produce a sample of 2692 patients followed for 6 months. Method. Data on mortality, mobility, and other activities of daily living (ADLs) were available from all three cohorts. We used multiple regression to examine the association of race, gender, and comorbidity with 6-month survival and function, controlling for prefracture mobility and ADLs, age, fracture type, cohort, and admission year. RESULTS: The mortality rate at 6 months was 12%: 9% for women and 19% for men. Whites and women were more likely than were nonwhites and men to survive to 6 months, after adjusting for age, comorbidities, and prefracture mobility and function. Whites were more likely than were nonwhites to walk independently or with help at 6 months compared to not walking, after adjusting for age, comorbidities, and prefracture mobility and function. Dementia had a negative impact on survival, mobility, and ADLs at 6 months. The odds of survival to 6 months were significantly lower for people with chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and/or cancer. Parkinson's disease and stroke had negative impacts on mobility and ADLs, respectively, among survivors at 6 months. CONCLUSIONS: The finding of higher mortality and worse mobility for nonwhite patients with hip fractures highlights the need for more research on race/ethnicity disparities in hip fracture care.